WorldWideScience

Sample records for healthcare inequities access

  1. Decentralization, healthcare access, and inequality in Mpumalanga, South Africa.

    Science.gov (United States)

    Winchester, Margaret S; King, Brian

    2018-04-27

    Healthcare access and utilization remain key challenges in the Global South. South Africa represents this given that more than twenty years after the advent of democratic elections, the national government continues to confront historical systems of spatial manipulation that generated inequities in healthcare access. While the country has made significant advancements, governmental agencies have mirrored international strategies of healthcare decentralization and focused on local provision of primary care to increase healthcare access. In this paper, we show the significance of place in shaping access and health experiences for rural populations. Using data from a structured household survey, focus group discussions, qualitative interviews, and clinic data conducted in northeast South Africa from 2013 to 2016, we argue that decentralization fails to resolve the uneven landscapes of healthcare in the contemporary period. This is evidenced by the continued variability across the study area in terms of government-sponsored healthcare, and constraints in the clinics in terms of staffing, privacy, and patient loads, all of which challenge the access-related assumptions of healthcare decentralization. Copyright © 2018 Elsevier Ltd. All rights reserved.

  2. Inequalities versus Utilization: Factors Predicting Access to Healthcare in Ghana

    Directory of Open Access Journals (Sweden)

    Dominic Buer Boyetey

    2016-08-01

    Full Text Available Universal access to health care remains a significant source of inequality especially among vulnerable groups. Challenges such as lack of insurance coverage, absence of certain types of care, as well as high individual financial care cost can be blamed for the growing inequality in the healthcare sector. The concern is worrying especially when people are denied care. It is in this light that the study set to find out what factors are likely to impact the chances of access to health care, so far as the Ghana Demographic and Health Survey Data 2014 data are concerned, particularly to examine the differences in access to healthcare in connection with varying income groups, educational levels and residential locations. The study relied on the logistic regression analysis to establish that people with some level of education have greater chances of accessing health care compared with those without education. Also chances of access to health care in the sample were high for people in the lower quartile and upper quartile of the household wealth index and a local minimum for those in the middle class. It became evident also that increased number of people with NHIS or PHIS or combination of cash with NHIS or PHIS will give rise to a corresponding increment in the probability of gaining access to health care.

  3. Healthcare for Men and Women with Learning Disabilities: Understanding Inequalities in Access

    Science.gov (United States)

    Redley, Marcus; Banks, Carys; Foody, Karen; Holland, Anthony

    2012-01-01

    Healthcare for men and women with learning disabilities (known internationally as intellectual disabilities) has risen up the political agenda in the United Kingdom, propelled by a report from the charity Mencap. This report has resulted in renewed efforts, set out in "Valuing People Now", to ensure that people with learning disabilities…

  4. How Can Information and Communication Technology Improve Healthcare Inequalities and Healthcare Inequity? The Concept of Context Driven Care.

    Science.gov (United States)

    Yee, Kwang Chien; Bettiol, Silvana; Nash, Rosie; Macintyrne, Kate; Wong, Ming Chao; Nøhr, Christian

    2018-01-01

    Advances in medicine have improved health and healthcare for many around the world. The challenge is achieving the best outcomes of health via healthcare delivery to every individual. Healthcare inequalities exist within a country and between countries. Health information technology (HIT) has provided a mean to deliver equal access to healthcare services regardless of social context and physical location. In order to achieve better health outcomes for every individual, socio-cultural factors, such as literacy and social context need to consider. This paper argues that HIT while improves healthcare inequalities by providing access, might worsen healthcare inequity. In order to improve healthcare inequity using HIT, this paper argues that we need to consider patients and context, and hence the concept of context driven care. To improve healthcare inequity, we need to conceptually consider the patient's view and methodologically consider design methods that achieve participatory outcomes.

  5. Migrants' access to healthcare

    DEFF Research Database (Denmark)

    Norredam, Marie

    2011-01-01

    There are strong pragmatic and moral reasons for receiving societies to address access to healthcare for migrants. Receiving societies have a pragmatic interest in sustaining migrants' health to facilitate integration; they also have a moral obligation to ensure migrants' access to healthcare...... according to international human rights principles. The intention of this thesis is to increase the understanding of migrants' access to healthcare by exploring two study aims: 1) Are there differences in migrants' access to healthcare compared to that of non-migrants? (substudy I and II); and 2) Why...... are there possible differences in migrants' access to healthcare compared to that of non-migrants? (substudy III and IV). The thesis builds on different methodological approaches using both register-based retrospective cohort design, cross-sectional design and survey methods. Two different measures of access were...

  6. Healthcare investment and income inequality.

    Science.gov (United States)

    Bhattacharjee, Ayona; Shin, Jong Kook; Subramanian, Chetan; Swaminathan, Shailender

    2017-12-01

    This paper examines how the relative shares of public and private health expenditures impact income inequality. We study a two period overlapping generation's growth model in which longevity is determined by both private and public health expenditure and human capital is the engine of growth. Increased investment in health, reduces mortality, raises return to education and affects income inequality. In such a framework we show that the cross-section earnings inequality is non-decreasing in the private share of health expenditure. We test this prediction empirically using a variable that proxies for the relative intensity of investments (private versus public) using vaccination data from the National Sample Survey Organization for 76 regions in India in the year 1986-87. We link this with region-specific expenditure inequality data for the period 1987-2012. Our empirical findings, though focused on a specific health investment (vaccines), suggest that an increase in the share of the privately provided health care results in higher inequality. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Inequalities in healthcare provision for individuals with substance use disorders : Perspectives from healthcare professionals and clients

    NARCIS (Netherlands)

    van Boekel, L.C.; Brouwers, E.P.M.; van Weeghel, J.; Garretsen, H.F.L.

    2016-01-01

    Background: Little is known about inequalities in healthcare provision for individuals with substance use disorders. The main objective of this study was to assess expectations and perceptions of inequalities in healthcare provision among healthcare professionals (HCPs) and clients in treatment for

  8. Access inequalities addressed by audit.

    Science.gov (United States)

    Singh, Rajiv; Pentland, Brian

    2005-08-01

    The Disability Discrimination Act (1995) protects disabled people from discrimination in access to services, facilities and goods as well as in education and employment. All hospitals have an inherent duty to enable access to services but this will now be enshrined in law. As the health sector has most contact with disability, it may be expected that most hospitals would already be in a good position to comply with the Act, especially one treating many patients with disability. However we identified many problems in a rehabilitation hospital setting by means of a simple access audit in March 2004. Recommendations were set out and by March 2005 considerable improvements had been made costing Pound 100,000. Although many necessary changes will be expensive, not all problems identified require costly correction. Many simply involve a change in staff attitudes and practices. We recommend that all hospitals start to identify the changes needed under the Act by means of a simple access audit that can be carried out by hospital staff with no specialist equipment.

  9. Socio-economic inequality in oral healthcare coverage

    DEFF Research Database (Denmark)

    Hosseinpoor, A R; Itani, L; Petersen, P E

    2012-01-01

    wealth quintiles in each country, a wealth-based relative index of inequality was used to measure socio-economic inequality. The index was adjusted for sex, age, marital status, education, employment, overall health status, and urban/rural residence. Pro-rich inequality in oral healthcare coverage......The objective of this study was to assess socio-economic inequality in oral healthcare coverage among adults with expressed need living in 52 countries. Data on 60,332 adults aged 18 years or older were analyzed from 52 countries participating in the 2002-2004 World Health Survey. Oral healthcare...... coverage was defined as the proportion of individuals who received any medical care from a dentist or other oral health specialist during a period of 12 months prior to the survey, among those who expressed any mouth and/or teeth problems during that period. In addition to assessment of the coverage across...

  10. Interpreting ethnic inequalities in healthcare consumption: a conceptual framework for research

    NARCIS (Netherlands)

    Essink-Bot, Marie-Louise; Lamkaddem, Majda; Jellema, Petra; Nielsen, Signe Smith; Stronks, Karien

    2013-01-01

    The increasing diversity of the Western-European population demands identification of potential ethnic healthcare inequities. We developed a framework that helps researchers in interpreting ethnic inequalities in healthcare consumption in equity terms. From this framework, we develop recommendations

  11. Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany

    Directory of Open Access Journals (Sweden)

    Jens Hoebel

    2017-09-01

    Full Text Available Research into health inequalities in the elderly population of Germany is relatively scarce. This study examines socioeconomic inequalities in health and perceived unmet needs for healthcare and explores the dynamics of health inequalities with age among elderly people in Germany. Data were derived from the Robert Koch Institute’s cross-sectional German Health Update study. The sample was restricted to participants aged 50–85 years (n = 11,811. Socioeconomic status (SES was measured based on education, (former occupation, and income. Odds ratios and prevalence differences were estimated using logistic regression and linear probability models, respectively. Our results show that self-reported health problems were more prevalent among men and women with lower SES. The extent of SES-related health inequalities decreased at older ages, predominantly among men. Although the prevalence of perceived unmet needs for healthcare was low overall, low SES was associated with higher perceptions of unmet needs in both sexes and for several kinds of health services. In conclusion, socioeconomic inequalities in health exist in a late working age and early retirement but may narrow at older ages, particularly among men. Socially disadvantaged elderly people perceive greater barriers to accessing healthcare services than those who are better off.

  12. Socio-economic Inequalities and Healthcare Utilization in Ghana

    Directory of Open Access Journals (Sweden)

    Bashiru I.I. Saeed

    2013-07-01

    Full Text Available A socio-economic inequality in the use of healthcare services in Ghana is investigated in this paper. The data employed in the study were drawn from Global Ageing and Adult Health survey conducted in Ghana by SAGE and was based on the design for the World Health Survey (WHS, 2003. The survey was conducted in 2007 and collected data on socio-economic characteristics and other variables of the individuals interviewed. Using generalized logit model, the study found that health status is a very strong determinant of the type of healthcare services Ghanaians look for. In Ghana, there are still important socio-economic gradients in the use of some healthcare services. These differences may be due to socio-economic inequities but could also indicate that the existing health facilities are not always used in an optimal way. Patient factors may be more important than supply factors in explaining the differential use of health services.

  13. Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need.

    Directory of Open Access Journals (Sweden)

    Jens Detollenaere

    Full Text Available Access to healthcare is inequitably distributed across different socioeconomic groups. Several vulnerable groups experience barriers in accessing healthcare, compared to their more wealthier counterparts. In response to this, many countries use resources to strengthen their primary care (PC system, because in many European countries PC is the first entry-point to the healthcare system and plays a central role in the coordination of patients through the healthcare system. However it is unclear whether this strengthening of PC leads to less inequity in access to the whole healthcare system. This study investigates the association between strength indicators of PC and inequity in unmet need by merging data from the European Union Statistics on Income and Living Conditions database (2013 and the Primary Healthcare Activity Monitor for Europe (2010. The analyses reveal a significant association between the Gini coefficient for income inequality and inequity in unmet need. When the Gini coefficient of a country is one SD higher, the social inequity in unmet need in that particular country will be 4.960 higher. Furthermore, the accessibility and the workforce development of a country's PC system is inverse associated with the social inequity of unmet need. More specifically, when the access- and workforce development indicator of a country PC system are one standard deviation higher, the inequity in unmet healthcare needs are respectively 2.200 and 4.951 lower. Therefore, policymakers should focus on reducing income inequality to tackle inequity in access, and strengthen PC (by increasing accessibility and better-developing its workforce as this can influence inequity in unmet need.

  14. Inequality in healthcare costs between residing and non-residing patients: evidence from Vietnam.

    Science.gov (United States)

    Nguyen, Hieu M

    2017-05-12

    Place of residence has been shown to impact health. To date, however, previous studies have only focused on the variability in health outcomes and healthcare costs between urban and rural patients. This study takes a different approach and investigates cost inequality facing non-residing patients - patients who do not reside in the regions in which the hospitals are located. Understanding the sources for this inequality is important, as they are directly related to healthcare accessibility in developing countries. The causal impact of residency status on individual healthcare spending is documented with a quasi-experimental design. The propensity score matching method is applied to a unique patient-level dataset (n = 900) collected at public general and specialist hospitals across North Vietnam. Propensity score matching shows that Vietnamese patients who do not reside in the regions in which the hospitals are located are expected to pay about 15 million Vietnamese dongs (approximately 750 USD) more than those who do, a sizable gap, given the distribution of total healthcare costs for the overall sample. This estimate is robust to alternative matching specifications. The obtained discrepancy is empirically attributable to the differences in three potential contributors, namely spending on accompanying relatives, "courtesy funds," and days of hospitalization. The present study finds that there is significant inequality in healthcare spending between residing and non-residing patients at Vietnamese hospitals and that this discrepancy can be partially explained by both institutional and non-institutional factors. These factors signal practical channels through which policymakers can improve healthcare accessibility.

  15. Income inequality and access to housing in Europe

    NARCIS (Netherlands)

    Dewilde, C.; Lancee, B.

    2012-01-01

    This paper analyses the relation between income inequality and access to housing for low- income households. Three arguments are developed, explaining how inequality might affect housing affordability, quality and quantity. First, it is the absolute level of resources, not their relative

  16. Income inequality and access to housing in Europe

    NARCIS (Netherlands)

    Dewilde, C.L.; Lancee, B.

    2013-01-01

    This article analyzes the relationship between income inequality and access to housing for low-income homeowners and renters ‘at market rent’ across Europe. We develop three arguments that explain how inequality affects housing affordability, quality, and quantity—together these dimensions indicate

  17. Return Migrants’ Experience of Access to Care in Corrupt Healthcare Systems

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Olwig, Karen Fog; Bygbjerg, Ib Christian

    2016-01-01

    unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia......Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by corruption is largely......, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than...

  18. Public health, healthcare, health and inequality in health in the Nordic countries

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Lauridsen, Jørgen Trankjær; Kifmann, Mathias

    2018-01-01

    -economic equality in health. Each of the five countries has established extensive public health programmes, although with somewhat different measures to increase health of the populations. We compare these countries to the UK and Germany by using data from the European Social Survey for 2002 and 2012 in addition......All five Nordic countries emphasize equal and easy access to healthcare, assuming that increased access to healthcare leads to increased health. It is the purpose of the present study to explore to which extent the populations of these countries have reached good health and a high degree of socio...... to OECD statistics for the same years. Health is measured by self-assessed health in five categories, which is transformed to a cardinal scale using Swedish time trade-off (TTO) weights. As socio-economic measures we use household income and length of education. Socio-economic inequality in health...

  19. [Inequalities in access to care in Africa].

    Science.gov (United States)

    Livinec, Bertrand; Milleliri, Jean-Marie; Rey, Jean-Loup; Saliou, Pierre

    2013-05-01

    Social inequalities in health are increasingly in the news in Africa. While appeals, international declarations and new strategies for health in Africa have succeeded one another over the years, we must admit that the health inequalities are increasing. It is perhaps time to take health out of its compartment and understand that it is one of the components of overall development and that we cannot act effectively against these health inequalities unless we also act on the pressing need to see all States (in the North and South) finally meet their financial commitments, demand of African leaders that they provide good government and fight against corruption, the leaders of African good government and a fight against corruption, and finally ensure that the strategies proposed in Africa focus on the health priorities of each country. If we mention the Scandinavian example, we must admit that the Nordic countries have demonstrated their capacity to obtain excellent results in health, to narrow social inequalities, and provide public transparency and aid to development. They constitute today an excellent example for most Western countries and for African countries - and also for African and western civil societies, which can be inspired by the concrete measures of transparency and strong public activity, which promote improvement in the overall statistics of their societies, in particular, in health. Accordingly we propose a new approach that looks at health statistics in the light of inequalities (especially via the Gini coefficient) and public transparency (especially via the benchmarks of perceived corruption). A New Deal for health in Africa is needed, and all the organization involved should be asked to act together for a holistic public health vision that will benefit the populations of Africa. Health cannot be separated from a political, ethical and equitable vision of society.

  20. Corruption, inequality and population perception of healthcare quality in Europe.

    Science.gov (United States)

    Nikoloski, Zlatko; Mossialos, Elias

    2013-11-11

    Evaluating the quality of healthcare and patient safety using general population questionnaires is important from research and policy perspective. Using a special wave of the Eurobarometer survey, we analysed the general population's perception of health care quality and patient safety in a cross-country setting. We used ordered probit, ordinary least squares and probit analysis to estimate the determinants of health care quality, and ordered logit analysis to analyse the likelihood of being harmed by a specific medical procedure. The models used population weights as well as country-clustered standard errors. We found robust evidence for the impact of socio-demographic variables on the perception of quality of health care. More specifically, we found a non-linear impact of age on the perception of quality of health care and patient safety, as well as a negative impact of poverty on both perception of quality and patient safety. We also found robust evidence that countries with higher corruption levels were associated with worse perceptions of quality of health care. Finally, we found evidence that income inequality affects patients' perception vis-à-vis safety, thus feeding into the poverty/health care quality nexus. Socio-demographic factors and two macro variables (corruption and income inequality) explain the perception of quality of health care and likelihood of being harmed by adverse events. The results carry significant policy weight and could explain why targeting only the health care sector (without an overall reform of the public sector) could potentially be challenging.

  1. Assessing maternal healthcare inequities among migrants: a qualitative study

    Directory of Open Access Journals (Sweden)

    Ligia Moreira Almeida

    2014-02-01

    Full Text Available Considering pregnancy and motherhood as periods of increased vulnerability in migrant women, to characterize the healthcare provided to this collective, we sought to identify and understand patterns of satisfaction and demand of maternal and child healthcare, assessing women’s perceptions about its quality. The study followed a qualitative methodology (semi-structured interviews for collecting and analysing data (content analysis and was conducted in Porto, the second largest city of Portugal. Participants were 25 recent immigrant mothers from Eastern European countries, Brazil, Portuguese-speaking African countries and six native Portuguese recent mothers (for comparison, contacted through social associations and institutions. Data suggests that healthcare depends not only on accessibility but especially on social opportunities. Equitable public health action must provide individuals and groups the equal opportunity to meet their needs, which may not be achieved by providing the same standard if care to all.

  2. Private health insurance and access to healthcare.

    Science.gov (United States)

    Duggal, Ravi

    2011-01-01

    The health insurance business in India has seen a growth of over 25% per annum in the last few years with the expansion of the private health insurance sector. The premium incomes of health insurance have crossed the Rs 8,000 crore mark with the share of private companies increasing to over 41%. This is despite the fact that from the perspective of patients, health insurance is not a good deal, especially when they need it most. This raises a number of ethical issues regarding how the health insurance business runs and how medical practice adjusts to it for profiteering. This article uses the personal experience of the author to argue that health insurance in an unregulated environment can only lead to unethical practices, further victimising the patient. Further, publicly financed healthcare which operates in an environment regulating both public and private healthcare provisioning is the only way to assure access to ethical and equitable healthcare to people.

  3. Solidarity, justice and unconditional access to healthcare.

    Science.gov (United States)

    Gheaus, Anca

    2017-03-01

    Luck egalitarianism provides a reason to object to conditionality in health incentive programmes in some cases when conditionality undermines political values such as solidarity or inclusiveness. This is the case with incentive programmes that aim to restrict access to essential healthcare services. Such programmes undermine solidarity. Yet, most people's lives are objectively worse, in one respect, in non-solidary societies, because solidarity contributes both instrumentally and directly to individuals' well-being. Because solidarity is non-excludable, undermining it will deprive both the prudent and the imprudent citizens of its goods. Thereby, undermining solidarity can make prudent citizens worse off than they would have otherwise been, out of no fault or choice of their own, but rather as a result of somebody else's imprudent choice. This goes against the spirit of luck egalitarianism. Therefore (luck egalitarian) justice can require us to save the imprudent and avoid conditionality in access to essential healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Access and Inequities in Radiotherapy. Chapter 5

    International Nuclear Information System (INIS)

    Camacho Rodríguez, R.; De Sousa Neves, D.

    2017-01-01

    Cancer is the result of very complex interactions between environmental factors (e.g. inhalation of tobacco smoke, infectious diseases, unhealthy diets) and genetic susceptibility. The vast majority of cancers in adults are not genetically inherited, but rather are related to associated co-morbidities and exposure to carcinogenic substances. Historically, the incidence of cancer has been higher in developed countries than in developing countries. The recent demographic growth observed in the developing world as a consequence of the successful management of communicable diseases, which had caused substantial premature death, is inevitably making these populations more susceptible to cancer. In fact, of the estimated 14 million new cancer cases every year, 8 million are predicted to occur in the developing world. Although early detection and optimal treatment have already proved to have a demonstrable effect on the decline of the cancer mortality rate in most developed countries, diagnosis of cancer in developing countries is too frequently made during the advanced stages. In countries with limited resources, cancer care can suffer from extreme limitations of human resources, physical capacity and equipment, leading to a mortality to incidence ratio about 19% higher than that in industrialized countries. This difference is associated above all with elements of access, quality and efficiency of cancer care. The burden of the disease is shifting rapidly; thus, significant planning is required to prevent, detect earlier, treat and palliate cancer in developing countries. In order to address the complex issue of cancer control, the World Health Organization (WHO) has provided a framework for the development of national cancer control programmes (NCCPs). NCCPs constitute health approaches designed to tackle cancer through optimization, coordination and integration of the available resources in a systematic and comprehensive manner into evidence based strategies for

  5. Reducing inequalities in access to health care: developing a toolkit through action research.

    Science.gov (United States)

    Goyder, E C; Blank, L; Ellis, E; Furber, A; Peters, J; Sartain, K; Massey, C

    2005-10-01

    Healthcare organisations are expected both to monitor inequalities in access to health services and also to act to improve access and increase equity in service provision. Locally developed action research projects with an explicit objective of reducing inequalities in access. Eight different health care services in the Yorkshire and Humber region, including community based palliative care, general practice asthma care, hospital based cardiology clinics, and termination of pregnancy services. Changes in service provision, increasing attendance rates in targeted groups. Local teams identified the population concerned and appropriate interventions using both published and grey literature. Where change to service provision was achieved, local data were collected to monitor the impact of service change. A number of evidence based changes to service provision were proposed and implemented with variable success. Service uptake increased in some of the targeted populations. Interventions to improve access must be sensitive to local settings and need both practical and managerial support to succeed. It is particularly difficult to improve access effectively if services are already struggling to meet current demand. Key elements for successful interventions included effective local leadership, identification of an intervention which is both evidence based and locally practicable, and identification of additional resources to support increased activity. A "toolkit" has been developed to support the identification and implementation of appropriate changes.

  6. [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.

  7. An Attribute Based Access Control Framework for Healthcare System

    Science.gov (United States)

    Afshar, Majid; Samet, Saeed; Hu, Ting

    2018-01-01

    Nowadays, access control is an indispensable part of the Personal Health Record and supplies for its confidentiality by enforcing policies and rules to ensure that only authorized users gain access to requested resources in the system. In other words, the access control means protecting patient privacy in healthcare systems. Attribute-Based Access Control (ABAC) is a new access control model that can be used instead of other traditional types of access control such as Discretionary Access Control, Mandatory Access Control, and Role-Based Access Control. During last five years ABAC has shown some applications in both recent academic fields and industry purposes. ABAC by using user’s attributes and resources, makes a decision according to an access request. In this paper, we propose an ABAC framework for healthcare system. We use the engine of ABAC for rendering and enforcing healthcare policies. Moreover, we handle emergency situations in this framework.

  8. Return Migrants’ Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example

    Directory of Open Access Journals (Sweden)

    Line Neerup Handlos

    2016-09-01

    Full Text Available Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by corruption is largely unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than was the case for those who had not left the country, as doctors considered them to be better endowed financially and therefore demanded larger bribes from them than they did from those who had remained in Bosnia. Moreover, during their stay abroad the returnees had lost the connections that could have helped them sidestep the corruption. Returned refugees are thus particularly vulnerable to the effects of corruption.

  9. Return Migrants’ Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example

    Science.gov (United States)

    Neerup Handlos, Line; Fog Olwig, Karen; Bygbjerg, Ib Christian; Norredam, Marie

    2016-01-01

    Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by corruption is largely unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than was the case for those who had not left the country, as doctors considered them to be better endowed financially and therefore demanded larger bribes from them than they did from those who had remained in Bosnia. Moreover, during their stay abroad the returnees had lost the connections that could have helped them sidestep the corruption. Returned refugees are thus particularly vulnerable to the effects of corruption. PMID:27657096

  10. Return Migrants' Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example.

    Science.gov (United States)

    Neerup Handlos, Line; Fog Olwig, Karen; Bygbjerg, Ib Christian; Norredam, Marie

    2016-09-19

    Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants' access to healthcare is affected by corruption is largely unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than was the case for those who had not left the country, as doctors considered them to be better endowed financially and therefore demanded larger bribes from them than they did from those who had remained in Bosnia. Moreover, during their stay abroad the returnees had lost the connections that could have helped them sidestep the corruption. Returned refugees are thus particularly vulnerable to the effects of corruption.

  11. Age-related inequalities in health and healthcare: the life stages approach.

    Science.gov (United States)

    Jecker, Nancy S

    2017-05-16

    How should healthcare systems prepare to care for growing numbers and proportions of older people? Older people generally suffer worse health than younger people do. Should societies take steps to reduce age-related health inequalities? Some express concern that doing so would increase age-related inequalities in healthcare. This paper addresses this debate by (1) presenting an argument in support of three principles for distributing scarce resources between age groups; (2) framing these principles of age group justice in terms of life stages; and (3) indicating policy implications that merit further attention in light of rapidly aging societies. © 2017 John Wiley & Sons Ltd.

  12. [Social inequalities in health, missions of a regional healthcare agency].

    Science.gov (United States)

    Ginot, Luc

    The presence of social inequalities in health requires a multi-faceted intervention, focusing on the social determinants as well as the provision of care and prevention strategies. Regional health agencies have important levers at their disposal, as illustrated by the example of the Île-de-France region. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study.

    Science.gov (United States)

    Ganle, John K; Parker, Michael; Fitzpatrick, Raymond; Otupiri, Easmon

    2014-11-01

    Inequities in accessibility to, and utilisation of maternal healthcare services impede progress towards attainment of the maternal health-related Millennium Development Goals. The objective of this study is to examine the extent to which maternal health services are utilised in Ghana, and whether inequities in accessibility to and utilization of services have been eliminated following the implementation of a user-fee exemption policy, that aims to reduce financial barriers to access, reduce inequities in access, and improve access to and use of birthing services. We analyzed data from the 2007 Ghana Maternal Health Survey for inequities in access to and utilization of maternal health services. In measuring the inequities, frequency tables and cross-tabulations were used to compare rates of service utilization by region, residence and selected socio-demographic variables. Findings show marginal increases in accessibility to and utilisation of skilled antenatal, delivery and postnatal care services following the policy implementation (2003-2007). However, large gradients of inequities exist between geographic regions, urban and rural areas, and different socio-demographic, religious and ethnic groupings. More urban women (40%) than rural, 53% more women in the highest wealth quintile than women in the lowest, 38% more women in the best performing region (Central Region) than the worst (Upper East Region), and 48% more women with at least secondary education than those with no formal education, accessed and used all components of skilled maternal health services in the five years preceding the survey. Our findings raise questions about the potential equity and distributional benefits of Ghana's user-fee exemption policy, and the role of non-financial barriers or considerations. Exempting user-fees for maternal health services is a promising policy option for improving access to maternal health care, but might be insufficient on its own to secure equitable access to

  14. Geographic and Individual Differences in Healthcare Access for U.S. Transgender Adults: A Multilevel Analysis.

    Science.gov (United States)

    White Hughto, Jaclyn M; Murchison, Gabriel R; Clark, Kirsty; Pachankis, John E; Reisner, Sari L

    2016-12-01

    To identify geographic and individual-level factors associated with healthcare access among transgender people in the United States. Multilevel analyses were conducted to investigate lifetime healthcare refusal using national data from 5831 U.S. transgender adults. Hierarchical generalized linear models examined associations between individual (age, gender, race, income, insurance, and healthcare avoidance) and state-level factors (percent voting Republican, percent same-sex couple households, income inequality, and transgender protective laws) and lifetime refusal of care. Results show that individual-level factors (being older; trans feminine; Native American, multiracial, or other racial/ethnic minority; having low income; and avoiding care due to discrimination) are positively associated with care refusal (all P-values transgender residents at increased odds of experiencing care refusal, relative to other regions of the United States. When adjusting for state-level factors, the percentage of the state population voting Republican was positively associated with care refusal among the transgender adults sampled (P Transgender adults surveyed reported differential access to healthcare by geographic region. Identifying geographic and individual-level factors associated with healthcare barriers allows for the development of targeted educational and policy interventions to improve healthcare access for transgender people most in need of services.

  15. Geographic and Individual Differences in Healthcare Access for U.S. Transgender Adults: A Multilevel Analysis

    Science.gov (United States)

    Murchison, Gabriel R.; Clark, Kirsty; Pachankis, John E.; Reisner, Sari L.

    2016-01-01

    Abstract Purpose: To identify geographic and individual-level factors associated with healthcare access among transgender people in the United States. Methods: Multilevel analyses were conducted to investigate lifetime healthcare refusal using national data from 5831 U.S. transgender adults. Hierarchical generalized linear models examined associations between individual (age, gender, race, income, insurance, and healthcare avoidance) and state-level factors (percent voting Republican, percent same-sex couple households, income inequality, and transgender protective laws) and lifetime refusal of care. Results: Results show that individual-level factors (being older; trans feminine; Native American, multiracial, or other racial/ethnic minority; having low income; and avoiding care due to discrimination) are positively associated with care refusal (all P-values care refusal, relative to other regions of the United States. When adjusting for state-level factors, the percentage of the state population voting Republican was positively associated with care refusal among the transgender adults sampled (P < 0.01). Conclusion: Transgender adults surveyed reported differential access to healthcare by geographic region. Identifying geographic and individual-level factors associated with healthcare barriers allows for the development of targeted educational and policy interventions to improve healthcare access for transgender people most in need of services. PMID:27636030

  16. Measurements of Inequalities in Access to Higher Education: Case of the Russian Federation

    Science.gov (United States)

    Osipian, Ararat L.

    2005-01-01

    This paper focuses on the systematic investigation of the influence of the quasi-experimental projects on possible changes in inequality in access to higher education in Russia. While intuition points toward a positive effect of introduction of the standardized tests and educational vouchers on the decrease in inequality in access to higher…

  17. Can ethnicity data collected at an organizational level be useful in addressing health and healthcare inequities?

    Science.gov (United States)

    Browne, Annette J; Varcoe, Colleen M; Wong, Sabrina T; Smye, Victoria L; Khan, Koushambhi B

    2014-01-01

    Following arguments made in the USA, the UK and New Zealand regarding the importance of population-level ethnicity data in understanding health and healthcare inequities, health authorities in several Canadian provinces are considering plans to collect ethnicity data from patients at the point of care within selected healthcare organizations. The purpose of this paper is to examine the potential quality, utility and relevance of ethnicity data collected at an organizational level as a means of addressing health and healthcare inequities. We draw on findings from a recent Canadian study that examined the implications of collecting ethnicity data in healthcare contexts. Using a qualitative design, data were collected in a large city, and included interviews with 104 patients, community and healthcare leaders, and healthcare workers within diverse clinical contexts. Data were analyzed using interpretive thematic analysis. Our results are discussed in relation to discourses reflected in the current literature that require consideration in relation to the potential utility and relevancy of ethnicity data collected at the point of care within healthcare organizations. These discourses frame excerpts from the ethnographic data that are used as illustrative examples. Three key challenges to the potential relevance and utility of ethnicity data collected at the level of local healthcare organizations are identified: (a) issues pertaining to quality of the data, (b) the fact that data quality is most problematic for those with the greatest vulnerability to the negative effects of health inequities, and (c) the lack of data reflecting structural disadvantages or discrimination. The quality of ethnicity data collected within healthcare organizations is often unreliable, particularly for people from racialized or visible minority groups, who are most at risk, seriously limiting the usefulness of the data. Quality measures for collecting data reflecting ethnocultural identity in

  18. Social workers' role in tempering inequality in healthcare in hospitals and clinics: a study in Israel.

    Science.gov (United States)

    Baum, Nehami; Shalit, Hani; Kum, Yishay; Tal, Malka

    2016-09-01

    The paper presents an empirical examination of the role social workers play in tempering inequality in medical care. Data were collected in 2011 through face-to-face, semi-structured, in-depth interviews with 60 social workers employed in hospitals and clinics in Israel and selected through purposive sampling. The interviews probed the social workers' perceptions of the scope, causes and manifestations of inequality in health and healthcare and the actions they took to ameliorate it. The interviews were analysed using grounded theory. The findings show that all the social workers were acutely aware of the inequalities in their places of work, regarded reducing the inequalities as a major part of their role and made efforts to do so. They facilitated communication between doctors and patients of low socioeconomic status and advocated for such patients with medical staff and administration, as well as with the country's medical and social welfare bureaucracies. The paper details the means they used and the challenges they faced. The study highlights the important role that social workers play in reducing inequality in healthcare. © 2015 John Wiley & Sons Ltd.

  19. Does the edge effect impact on the measure of spatial accessibility to healthcare providers?

    Science.gov (United States)

    Gao, Fei; Kihal, Wahida; Le Meur, Nolwenn; Souris, Marc; Deguen, Séverine

    2017-12-11

    Spatial accessibility indices are increasingly applied when investigating inequalities in health. Although most studies are making mentions of potential errors caused by the edge effect, many acknowledge having neglected to consider this concern by establishing spatial analyses within a finite region, settling for hypothesizing that accessibility to facilities will be under-reported. Our study seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application. This study was carried out in the department of Nord, France. The statistical unit we use is the French census block known as 'IRIS' (Ilot Regroupé pour l'Information Statistique), defined by the National Institute of Statistics and Economic Studies. The geographical accessibility indicator used is the "Index of Spatial Accessibility" (ISA), based on the E2SFCA algorithm. We calculated ISA for the pregnant women population by selecting three types of healthcare providers: general practitioners, gynecologists and midwives. We compared ISA variation when accounting or not edge effect in urban and rural zones. The GIS method was then employed to determine global and local autocorrelation. Lastly, we compared the relationship between socioeconomic distress index and ISA, when accounting or not for the edge effect, to fully evaluate its impact. The results revealed that on average ISA when offer and demand beyond the boundary were included is slightly below ISA when not accounting for the edge effect, and we found that the IRIS value was more likely to deteriorate than improve. Moreover, edge effect impact can vary widely by health provider type. There is greater variability within the rural IRIS group than within the urban IRIS group. We found a positive correlation between socioeconomic distress variables and composite ISA. Spatial analysis results (such as Moran's spatial

  20. Human rights and access to healthcare services for indigenous peoples in Africa.

    Science.gov (United States)

    Durojaye, Ebenezer

    2017-09-20

    In September 2015, the United Nations adopted the sustainable development goals (SDGs) to address among others poverty and inequality within and among countries of the world. In particular, the SDGs aim at ameliorating the position of disadvantaged and vulnerable groups in societies. One of the over-arching goals of the SDGs is to ensure that no one is left behind in the realisation of their access to health care. African governments are obligated under international and regional human rights law to ensure access to healthcare services for everyone, including indigenous populations, on a non-discriminatory basis. This requires the governments to adopt appropriate measures that will remove barriers to healthcare services for disadvantaged and marginalised groups such as indigenous peoples.

  1. Electronic information sources access and use for healthcare ...

    African Journals Online (AJOL)

    Background: Access to and use of electronic information sources for clinical decision is the key to the attainment of health related sustainable goals. Therefore, this study was to assess Electronic Information Sources (EIS) access and use for healthcare service among hospitals of Western Oromia, Ethiopia, 2013. Materials ...

  2. Inequity in Hospitalization Care: A Study on Utilization of Healthcare Services in West Bengal, India

    Directory of Open Access Journals (Sweden)

    Montu Bose

    2015-01-01

    Full Text Available Background Out of eight commonly agreed Millennium Development Goals (MDG, six are related to the attainment of Universal Health Coverage (UHC throughout the globe. This universalization of health status suggests policies to narrow the gap in access and benefit sharing between different socially and economically underprivileged classes with that of the better placed ones and a consequent expansion of subsidized healthcare appears to be a common feature for most of the developing nations. The National Health Policy in India (2002 suggests expansion of market-based care for the affording class and subsidized care for the deserving class of the society. So, the benefit distribution of this limited public support in health sector is important to examine to study the welfare consequences of the policy. This paper examines the nature of utilizationto inpatient care by different socio-economic groups across regions and gender in West Bengal (WB, India. The benefit incidence of public subsidies across these socio-economic groups has also been verified for different types of services like medicines, diagnostics and professional care etc. Methods National Sample Survey Organization (NSSO has collected information on all hospitalized cases (60th round, 2004 with a recall period of 365 days from the sampled households through stratified random sampling technique. The data has been used to assess utilization of healthcare services during hospitalization and the distribution of public subsidies among the patients of different socio-economic background; a Benefit Incidence Analysis (BIA has also been carried out. Results Analysis shows that though the rate of utilization of public hospitals is quite high, other complementary services like medicine, doctor and diagnostic tests are mostly purchased from private market. This leads to high Out-of-Pocket (OOP expenditure. Moreover, BIA reveals that the public subsidies are mostly enjoyed by the relatively better

  3. Inequity in hospitalization care: a study on utilization of healthcare services in West Bengal, India.

    Science.gov (United States)

    Bose, Montu; Dutta, Arijita

    2015-01-01

    Out of eight commonly agreed Millennium Development Goals (MDG), six are related to the attainment of Universal Health Coverage (UHC) throughout the globe. This universalization of health status suggests policies to narrow the gap in access and benefit sharing between different socially and economically underprivileged classes with that of the better placed ones and a consequent expansion of subsidized healthcare appears to be a common feature for most of the developing nations. The National Health Policy in India (2002) suggests expansion of market-based care for the affording class and subsidized care for the deserving class of the society. So, the benefit distribution of this limited public support in health sector is important to examine to study the welfare consequences of the policy. This paper examines the nature of utilization to inpatient care by different socio-economic groups across regions and gender in West Bengal (WB), India. The benefit incidence of public subsidies across these socio-economic groups has also been verified for different types of services like medicines, diagnostics and professional care etc. National Sample Survey Organization (NSSO) has collected information on all hospitalized cases (60(th) round, 2004) with a recall period of 365 days from the sampled households through stratified random sampling technique. The data has been used to assess utilization of healthcare services during hospitalization and the distribution of public subsidies among the patients of different socio-economic background; a Benefit Incidence Analysis (BIA) has also been carried out. Analysis shows that though the rate of utilization of public hospitals is quite high, other complementary services like medicine, doctor and diagnostic tests are mostly purchased from private market. This leads to high Out-of-Pocket (OOP) expenditure. Moreover, BIA reveals that the public subsidies are mostly enjoyed by the relatively better placed patients, both socially and

  4. Inequities in health and healthcare viewed through the ethical lens of critical social justice: contextual knowledge for the global priorities ahead.

    Science.gov (United States)

    Anderson, Joan M; Rodney, Patricia; Reimer-Kirkham, Sheryl; Browne, Annette J; Khan, Koushambhi Basu; Lynam, M Judith

    2009-01-01

    The authors use the backdrop of the Healthy People 2010 initiative to contribute to a discussion encompassing social justice from local to national to global contexts. Drawing on findings from their programs of research, they explore the concept of critical social justice as a powerful ethical lens through which to view inequities in health and in healthcare access. They examine the kind of knowledge needed to move toward the ideal of social justice and point to strategies for engaging in dialogue about knowledge and actions to promote more equitable health and healthcare from local to global levels.

  5. Deaf women: experiences and perceptions of healthcare system access.

    Science.gov (United States)

    Steinberg, Annie G; Wiggins, Erin A; Barmada, Carlin Henry; Sullivan, Vicki Joy

    2002-10-01

    The authors investigated the knowledge, attitudes, and healthcare experiences of Deaf women. Interviews with 45 deaf women who participated in focus groups in American Sign Language were translated, transcribed, and analyzed. Deaf women's understanding of women's health issues, knowledge of health vocabulary in both English and American Sign Language, common health concerns among Deaf women, and issues of access to information, including pathways and barriers, were examined. As a qualitative study, the results of this investigation are limited and should be viewed as exploratory. A lack of health knowledge was evident, including little understanding of the meaning or value of cancer screening, mammography, or Pap smears; purposes of prescribed medications, such as hormone replacement therapy (HRT); or necessity for other medical or surgical interventions. Negative experiences and avoidance or nonuse of health services were reported, largely due to the lack of a common language with healthcare providers. Insensitive behaviors were also described. Positive experiences and increased access to health information were reported with practitioners who used qualified interpreters. Providers who demonstrated minimal signing skills, a willingness to use paper and pen, and sensitivity to improving communication were appreciated. Deaf women have unique cultural and linguistic issues that affect healthcare experiences. Improved access to health information may be achieved with specialized resource materials, improved prevention and targeted intervention strategies, and self-advocacy skills development. Healthcare providers must be trained to become more effective communicators with Deaf patients and to use qualified interpreters to assure access to healthcare for Deaf women.

  6. Water safety and inequality in access to drinking-water between rich and poor households.

    Science.gov (United States)

    Yang, Hong; Bain, Robert; Bartram, Jamie; Gundry, Stephen; Pedley, Steve; Wright, James

    2013-02-05

    While water and sanitation are now recognized as a human right by the United Nations, monitoring inequality in safe water access poses challenges. This study uses survey data to calculate household socio-economic-status (SES) indices in seven countries where national drinking-water quality surveys are available. These are used to assess inequalities in access as indicated by type of improved water source, use of safe water, and a combination of these. In Bangladesh, arsenic exposure through drinking-water is not significantly related to SES (p = 0.06) among households using tubewells, whereas in Peru, chlorine residual in piped systems varies significantly with SES (p access nonpiped improved sources, which may provide unsafe water, resulting in greater inequality of access to "safe" water compared to "improved" water sources. Concentration indices increased from 0.08 to 0.15, 0.10 to 0.14, and 0.24 to 0.26, respectively, in these countries. There was minimal difference in Jordan and Tajikistan. Although the results are likely to be underestimates as they exclude individual-level inequalities, they show that use of a binary "improved"/"unimproved" categorization masks substantial inequalities. Future international monitoring programmes should take account of inequality in access and safety.

  7. Auditing Medical Records Accesses via Healthcare Interaction Networks

    Science.gov (United States)

    Chen, You; Nyemba, Steve; Malin, Bradley

    2012-01-01

    Healthcare organizations are deploying increasingly complex clinical information systems to support patient care. Traditional information security practices (e.g., role-based access control) are embedded in enterprise-level systems, but are insufficient to ensure patient privacy. This is due, in part, to the dynamic nature of healthcare, which makes it difficult to predict which care providers need access to what and when. In this paper, we show that modeling operations at a higher level of granularity (e.g., the departmental level) are stable in the context of a relational network, which may enable more effective auditing strategies. We study three months of access logs from a large academic medical center to illustrate that departmental interaction networks exhibit certain invariants, such as the number, strength, and reciprocity of relationships. We further show that the relations extracted from the network can be leveraged to assess the extent to which a patient’s care satisfies expected organizational behavior. PMID:23304277

  8. Decomposing Educational Inequalities in Child Mortality: A Temporal Trend Analysis of Access to Water and Sanitation in Peru

    OpenAIRE

    Bohra, Tasneem; Benmarhnia, Tarik; McKinnon, Britt; Kaufman, Jay S.

    2017-01-01

    Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortalit...

  9. Deaf New Zealand Sign Language users' access to healthcare.

    Science.gov (United States)

    Witko, Joanne; Boyles, Pauline; Smiler, Kirsten; McKee, Rachel

    2017-12-01

    The research described was undertaken as part of a Sub-Regional Disability Strategy 2017-2022 across the Wairarapa, Hutt Valley and Capital and Coast District Health Boards (DHBs). The aim was to investigate deaf New Zealand Sign Language (NZSL) users' quality of access to health services. Findings have formed the basis for developing a 'NZSL plan' for DHBs in the Wellington sub-region. Qualitative data was collected from 56 deaf participants and family members about their experiences of healthcare services via focus group, individual interviews and online survey, which were thematically analysed. Contextual perspective was gained from 57 healthcare professionals at five meetings. Two professionals were interviewed, and 65 staff responded to an online survey. A deaf steering group co-designed the framework and methods, and validated findings. Key issues reported across the health system include: inconsistent interpreter provision; lack of informed consent for treatment via communication in NZSL; limited access to general health information in NZSL and the reduced ability of deaf patients to understand and comply with treatment options. This problematic communication with NZSL users echoes international evidence and other documented local evidence for patients with limited English proficiency. Deaf NZSL users face multiple barriers to equitable healthcare, stemming from linguistic and educational factors and inaccessible service delivery. These need to be addressed through policy and training for healthcare personnel that enable effective systemic responses to NZSL users. Deaf participants emphasise that recognition of their identity as members of a language community is central to improving their healthcare experiences.

  10. Inequity in access to childhood immunization in Enugu urban ...

    African Journals Online (AJOL)

    Principal components analysis in STATA software was used to characterize socioeconomic inequity. Results: Immunization coverage was as follows: Diphtheria, pertussis, tetanus third dose(DPT3), 3, 65.3%; oral polio vaccine 3, 78.0%; hepatitis B3, 65.2%; and measles, 55.8%. The full immunization rates for children 1–5 ...

  11. Geographical heterogeneity and inequality of access to improved drinking water supply and sanitation in Nepal.

    Science.gov (United States)

    He, Wen-Jun; Lai, Ying-Si; Karmacharya, Biraj M; Dai, Bo-Feng; Hao, Yuan-Tao; Xu, Dong Roman

    2018-04-02

    Per United Nations' Sustainable Development Goals, Nepal is aspiring to achieve universal and equitable access to safe and affordable drinking water and provide access to adequate and equitable sanitation for all by 2030. For these goals to be accomplished, it is important to understand the country's geographical heterogeneity and inequality of access to its drinking-water supply and sanitation (WSS) so that resource allocation and disease control can be optimized. We aimed 1) to estimate spatial heterogeneity of access to improved WSS among the overall Nepalese population at a high resolution; 2) to explore inequality within and between relevant Nepalese administrative levels; and 3) to identify the specific administrative areas in greatest need of policy attention. We extracted cluster-sample data on the use of the water supply and sanitation that included 10,826 surveyed households from the 2011 Nepal Demographic and Health Survey, then used a Gaussian kernel density estimation with adaptive bandwidths to estimate the distribution of access to improved WSS conditions over a grid at 1 × 1 km. The Gini coefficient was calculated for the measurement of inequality in the distribution of improved WSS; the Theil L measure and Theil T index were applied to account for the decomposition of inequality. 57% of Nepalese had access to improved sanitation (range: 18.1% in Mahottari to 100% in Kathmandu) and 92% to drinking-water (range: 41.7% in Doti to 100% in Bara). The most unequal districts in Gini coefficient among improved sanitation were Saptari, Sindhuli, Banke, Bajura and Achham (range: 0.276 to 0.316); and Sankhuwasabha, Arghakhanchi, Gulmi, Bhojpur, Kathmandu (range: 0.110 to 0.137) among improved drinking-water. Both the Theil L and Theil T showed that within-province inequality was substantially greater than between-province inequality; while within-district inequality was less than between-district inequality. The inequality of several districts was

  12. Inequality

    DEFF Research Database (Denmark)

    Addison, Tony; Pirttilä, Jukka; Tarp, Finn

    2017-01-01

    Many low‐ and middle‐income countries are achieving good rates of economic growth, while high inequality remains a priority concern. Some countries meanwhile have low growth, high inequality, and pervasive poverty—often linked to their fragility. There is now active debate on how countries should...... set themselves goals for achieving both absolute poverty reduction and lower inequality. But policy action needs to be better served by analysis and data....

  13. Building partnership to improve migrants’ access to healthcare in Mumbai

    Directory of Open Access Journals (Sweden)

    Nilesh Chandrakant Gawde

    2015-11-01

    Full Text Available Objectives: An intervention to improve migrants’ access to healthcare was piloted in Mumbai with purpose of informing health policy and planning. This paper aims to describe the process of building partnership for improving migrants’ access to healthcare of the pilot intervention including the role played by different stakeholders and the contextual factors affecting the intervention. Methods: The process evaluation was based upon Baranowski and Stables’ framework. their Observations in community and conversations with stakeholders as recorded in daily diaries, minutes of pre-intervention workshops and stakeholder meetings served as data sources. Data were coded using the framework and descriptive summaries of evaluation components were prepared.Results: Recruitment of stakeholders was easier than sustaining their interest. Community representatives led the intervention assisted by government officials. They planned community level interventions to improve access to healthcare which involved predominantly information, education and communication activities for which pre-existing formal and informal social networks and community events were used. Although the intervention reached migrants living with families, single male migrants neither participated nor did the intervention reach them consistently. Contextual factors such as culture differences between migrants and native population and illegality in the nature of the settlement resulting in the exclusion from services were the barriers. Conclusion: Inclusive multi-stakeholder partnership including migrants themselves and using both formal and informal networks in community is a feasible strategy for health education and has potential to improve the migrants’ access to healthcare. However, there are challenges to the partnership process and new strategies to overcome these challenges need to be tested such as peer-led models for involvement of single male migrants. For sustaining such

  14. Building Partnership to Improve Migrants' Access to Healthcare in Mumbai.

    Science.gov (United States)

    Gawde, Nilesh Chandrakant; Sivakami, Muthusamy; Babu, Bontha V

    2015-01-01

    An intervention to improve migrants' access to healthcare was piloted in Mumbai with purpose of informing health policy and planning. This paper aims to describe the process of building partnership for improving migrants' access to healthcare of the pilot intervention, including the role played by different stakeholders and the contextual factors affecting the intervention. The process evaluation was based on Baranowski and Stables' framework. Observations in community and conversations with stakeholders as recorded in daily diaries, minutes of pre-intervention workshops, and stakeholder meetings served as data sources. Data were coded using the framework and descriptive summaries of evaluation components were prepared. Recruitment of stakeholders was easier than sustaining their interest. Community representatives led the intervention assisted by government officials. They planned community-level interventions to improve access to healthcare that involved predominantly information, education, and communication activities for which pre-existing formal and informal social networks and community events were used. Although the intervention reached migrants living with families, single male migrants neither participated nor did the intervention reach them consistently. Contextual factors such as culture differences between migrants and native population and illegality in the nature of the settlement, resulting in the exclusion from services, were the barriers. Inclusive multi-stakeholder partnership, including migrants themselves and using both formal and informal networks in community is a feasible strategy for health education and has potential to improve the migrants' access to healthcare. However, there are challenges to the partnership process and new strategies to overcome these challenges need to be tested such as peer-led models for involvement of single male migrants. For sustaining such efforts and mainstreaming migrants, addressing contextual factors and

  15. Rural women and violence situation: access and accessibility limits to the healthcare network.

    Science.gov (United States)

    Costa, Marta Cocco da; Silva, Ethel Bastos da; Soares, Joannie Dos Santos Fachinelli; Borth, Luana Cristina; Honnef, Fernanda

    2017-07-13

    To analyze the access and accessibility to the healthcare network of women dwelling in rural contexts undergoing violence situation, as seen from the professionals' speeches. A qualitative, exploratory, descriptive study with professionals from the healthcare network services about coping with violence in four municipalities in the northern region of Rio Grande do Sul. The information derived from interviews, which have been analyzed by thematic modality. (Lack of) information of women, distance, restricted access to transportation, dependence on the partner and (lack of) attention by professionals to welcome women undergoing violence situation and (non)-articulation of the network are factors that limit the access and, as a consequence, they result in the lack of confrontation of this problem. To bring closer the services which integrate the confrontation network of violence against women and to qualify professionals to welcome these situations are factors that can facilitate the access and adhesion of rural women to the services.

  16. Task-role-based Access Control Model in Smart Health-care System

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

    As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for...

  17. Accessing VA Healthcare During Large-Scale Natural Disasters.

    Science.gov (United States)

    Der-Martirosian, Claudia; Pinnock, Laura; Dobalian, Aram

    2017-01-01

    Natural disasters can lead to the closure of medical facilities including the Veterans Affairs (VA), thus impacting access to healthcare for U.S. military veteran VA users. We examined the characteristics of VA patients who reported having difficulty accessing care if their usual source of VA care was closed because of natural disasters. A total of 2,264 veteran VA users living in the U.S. northeast region participated in a 2015 cross-sectional representative survey. The study used VA administrative data in a complex stratified survey design with a multimode approach. A total of 36% of veteran VA users reported having difficulty accessing care elsewhere, negatively impacting the functionally impaired and lower income VA patients.

  18. Accessibility Inequality to Basic Education in Amhara Region, Ethiopia

    African Journals Online (AJOL)

    owner

    educational services in Amhara region of Ethiopia in terms of availability and accessibility ... Dept. of Geography Bahir Dar University Bahir Dar, Ethiopia ... and very high students / teacher ratio. .... facilities to train their children (Hanmer et ...

  19. An Unequal Information Society: How Information Access Initiatives Contribute to the Construction of Inequality

    Science.gov (United States)

    Sanfilippo, Madelyn Rose

    2016-01-01

    Unequal access to information has significant social and political consequences, and is itself a consequence of sociotechnical systems born of social, cultural, economic, and institutional context. Information is unequally distributed both within and between communities. While many factors that shape information inequality shift subtly over time,…

  20. Dynamics of Inequalities in Access to Higher Education: Bulgaria in a Comparative Perspective

    Science.gov (United States)

    Ilieva-Trichkova, Petya; Boyadjieva, Pepka

    2014-01-01

    This paper aims at studying the dynamics of inequalities in access to higher education (HE) both in a historical and a comparative perspective. It uses Bulgaria as a case study and places it among five other countries such as Estonia, Hungary, Poland, Slovakia and Slovenia. The adopted approach differentiates between equity in HE and inequalities…

  1. [Use of indicators of geographical accessibility to primary health care centers in addressing inequities].

    Science.gov (United States)

    De Pietri, Diana; Dietrich, Patricia; Mayo, Patricia; Carcagno, Alejandro; de Titto, Ernesto

    2013-12-01

    Characterize geographical indicators in relation to their usefulness in measuring regional inequities, identify and describe areas according to their degree of geographical accessibility to primary health care centers (PHCCs), and detect populations at risk from the perspective of access to primary care. Analysis of spatial accessibility using geographic information systems (GIS) involved three aspects: population without medical coverage, distribution of PHCCs, and the public transportation network connecting them. The development of indicators of demand (real, potential, and differential) and analysis of territorial factors affecting population mobility enabled the characterization of PHCCs with regard to their environment, thereby contributing to local and regional analysis and to the detection of different zones according to regional connectivity levels. Indicators developed in a GIS environment were very useful in analyzing accessibility to PHCCs by vulnerable populations. Zoning the region helped identify inequities by differentiating areas of unmet demand and fragmentation of spatial connectivity between PHCCs and public transportation.

  2. An authentication scheme for secure access to healthcare services.

    Science.gov (United States)

    Khan, Muhammad Khurram; Kumari, Saru

    2013-08-01

    Last few decades have witnessed boom in the development of information and communication technologies. Health-sector has also been benefitted with this advancement. To ensure secure access to healthcare services some user authentication mechanisms have been proposed. In 2012, Wei et al. proposed a user authentication scheme for telecare medical information system (TMIS). Recently, Zhu pointed out offline password guessing attack on Wei et al.'s scheme and proposed an improved scheme. In this article, we analyze both of these schemes for their effectiveness in TMIS. We show that Wei et al.'s scheme and its improvement proposed by Zhu fail to achieve some important characteristics necessary for secure user authentication. We find that security problems of Wei et al.'s scheme stick with Zhu's scheme; like undetectable online password guessing attack, inefficacy of password change phase, traceability of user's stolen/lost smart card and denial-of-service threat. We also identify that Wei et al.'s scheme lacks forward secrecy and Zhu's scheme lacks session key between user and healthcare server. We therefore propose an authentication scheme for TMIS with forward secrecy which preserves the confidentiality of air messages even if master secret key of healthcare server is compromised. Our scheme retains advantages of Wei et al.'s scheme and Zhu's scheme, and offers additional security. The security analysis and comparison results show the enhanced suitability of our scheme for TMIS.

  3. Socioeconomic inequalities in the access to and quality of health care services

    OpenAIRE

    Nunes, Bruno Pereira; Thumé, Elaine; Tomasi, Elaine; Duro, Suele Manjourany Silva; Facchini, Luiz Augusto

    2014-01-01

    OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in...

  4. Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach.

    Science.gov (United States)

    Topp, Stephanie M; Moonga, Clement N; Luo, Nkandu; Kaingu, Michael; Chileshe, Chisela; Magwende, George; Heymann, S Jody; Henostroza, German

    2016-11-01

    Prison populations in sub-Saharan Africa (SSA) experience a high burden of disease and poor access to health care. Although it is generally understood that environmental conditions are dire and contribute to disease spread, evidence of how environmental conditions interact with facility-level social and institutional factors is lacking. This study aimed to unpack the nature of interactions and their influence on health and healthcare access in the Zambian prison setting. We conducted in-depth interviews of a clustered random sample of 79 male prisoners across four prisons, as well as 32 prison officers, policy makers and health care workers. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems. A majority of inmates, as well as facility-based officers reported anxiety linked to overcrowding, sanitation, infectious disease transmission, nutrition and coercion. Due in part to differential wealth of inmates and their support networks on entering prison, and in part to the accumulation of authority and material wealth within prison, we found enormous inequity in the standard of living among prisoners at each site. In the context of such inequities, failure of the Zambian prison system to provide basic necessities (including adequate and appropriate forms of nutrition, or access to quality health care) contributed to high rates of inmate-led and officer-led coercion with direct implications for health and access to healthcare. This systems-oriented analysis provides a more comprehensive picture of the way resource shortages and human interactions within Zambian prisons interact and affect inmate and officer health. While not a panacea, our findings highlight some strategic entry-points for important upstream and downstream reforms including urgent improvement in the availability of human resources for health; strengthening of facility-based health services systems

  5. Paralympics 2012 Legacy: Accessible Housing and Disability Equality or Inequality?

    Science.gov (United States)

    Ahmed, Nadia

    2013-01-01

    The golden summer of sport is now over, but what is the legacy of London 2012 for disabled people? Nadia Ahmed, a disabled student, discusses the difficulties she has faced in finding accessible accommodation in London. She argues that while the Games are over, the United Kingdom still has lots of hurdles to leap when it comes to disability. The…

  6. Inequities in access to inpatient rehabilitation after stroke: an international scoping review.

    Science.gov (United States)

    Lynch, Elizabeth A; Cadilhac, Dominique A; Luker, Julie A; Hillier, Susan L

    2017-12-01

    Background Inequities in accessing inpatient rehabilitation after stroke have been reported in many countries and impact on patient outcomes. Objective To explore variation in international recommendations regarding which patients should receive inpatient rehabilitation after stroke and to describe reported access to rehabilitation. Methods A scoping review was conducted to identify clinical guidelines with recommendations regarding which patients should access inpatient rehabilitation after stroke, and data regarding the proportion of patients accessing stroke rehabilitation. Four bibliographic databases and grey literature were searched. Results Twenty-eight documents were included. Selection criteria for post-acute inpatient rehabilitation were identified for 14 countries or regions and summary data on the proportion of patients receiving inpatient rehabilitation were identified for 14 countries. In Australia, New Zealand, and the United Kingdom, it is recommended that all patients with stroke symptoms should access rehabilitation, whereas guidelines from the United States, Canada, and Europe did not consistently recommend rehabilitation for people with severe stroke. Access to inpatient rehabilitation ranged from 13% in Sweden to 57% in Israel. Differences in availability of early supported discharge/home rehabilitation programs and variations in reporting methods may influence the ability to reliably compare access to rehabilitation between regions. Conclusion Recommendations regarding which patients with moderate and severe strokes should access ongoing rehabilitation are inconsistent. Clinical practice guidelines from different countries regarding post-stroke rehabilitation do not always reflect the evidence regarding the likely benefits to people with stroke. Inequity in access to rehabilitation after stroke is an international issue.

  7. Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective

    Directory of Open Access Journals (Sweden)

    Maria Wiklund

    2016-08-01

    Full Text Available Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain. Objective: This study explores patient accounts and perceptions about important (social factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic. Design: Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients’ perceptions of important factors for accessing rehabilitation. Results: One main theme was formulated as Access to rehab – not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight. The character of diagnosis received (medical versus psychiatric or social was also noted. Conclusions: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.

  8. A cross-sectional ecological study of spatial scale and geographic inequality in access to drinking-water and sanitation.

    Science.gov (United States)

    Yu, Weiyu; Bain, Robert E S; Mansour, Shawky; Wright, Jim A

    2014-11-26

    Measuring inequality in access to safe drinking-water and sanitation is proposed as a component of international monitoring following the expiry of the Millennium Development Goals. This study aims to evaluate the utility of census data in measuring geographic inequality in access to drinking-water and sanitation. Spatially referenced census data were acquired for Colombia, South Africa, Egypt, and Uganda, whilst non-spatially referenced census data were acquired for Kenya. Four variants of the dissimilarity index were used to estimate geographic inequality in access to both services using large and small area units in each country through a cross-sectional, ecological study. Inequality was greatest for piped water in South Africa in 2001 (based on 53 areas (N) with a median population (MP) of 657,015; D = 0.5599) and lowest for access to an improved water source in Uganda in 2008 (N = 56; MP = 419,399; D = 0.2801). For sanitation, inequality was greatest for those lacking any facility in Kenya in 2009 (N = 158; MP = 216,992; D = 0.6981), and lowest for access to an improved facility in Uganda in 2002 (N = 56; MP = 341,954; D = 0.3403). Although dissimilarity index values were greater for smaller areal units, when study countries were ranked in terms of inequality, these ranks remained unaffected by the choice of large or small areal units. International comparability was limited due to definitional and temporal differences between censuses. This five-country study suggests that patterns of inequality for broad regional units do often reflect inequality in service access at a more local scale. This implies household surveys designed to estimate province-level service coverage can provide valuable insights into geographic inequality at lower levels. In comparison with household surveys, censuses facilitate inequality assessment at different spatial scales, but pose challenges in harmonising water and sanitation typologies across countries.

  9. Who Decided College Access in Chinese Secondary Education? Rural-Urban Inequality of Basic Education in Contemporary China

    Science.gov (United States)

    Li, Jian

    2016-01-01

    This paper investigates the rural-urban inequalities in basic education of contemporary China. The China Education Panel Survey (2013-2014) (CEPS) was utilized to analyze the gaps between rural and urban inequality in junior high schools in terms of three domains, which include the equalities of access, inputs, and outcomes. From the sociocultural…

  10. Gender inequality and the use of maternal healthcare services in rural sub-Saharan Africa.

    Science.gov (United States)

    Adjiwanou, Vissého; LeGrand, Thomas

    2014-09-01

    In this study, we measure gender inequality both at individual level by women׳s household decision-making and at contextual level by permissive gender norms associated with tolerance of violence against women and assess their impact on maternal healthcare services utilisation in rural Africa. We apply multilevel structural equation modelling to Demographic and Health Survey (DHS) data from Ghana, Kenya, Tanzania and Uganda to gain better measure and effect of the gender norms construct. The results show that women in Ghana and Uganda, who live in areas where gender norms are relatively tolerant of violence against women, are less likely to use skilled birth attendants and timely antenatal care. In Tanzania, women who live in this type of environment are less likely to attend four or more antenatal visits. In contrast, the effects of a woman׳s decision-making authority on maternal health service use are less pronounced in the same countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Socioeconomic inequalities in the access to and quality of health care services

    Directory of Open Access Journals (Sweden)

    Bruno Pereira Nunes

    2014-12-01

    Full Text Available OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days for assistance, and waiting time (in hours in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.

  12. A cross-sectional ecological study of spatial scale and geographic inequality in access to drinking-water and sanitation

    OpenAIRE

    Yu, Weiyu; Bain, Robert ES; Mansour, Shawky; Wright, Jim A

    2014-01-01

    IntroductionMeasuring inequality in access to safe drinking-water and sanitation is proposed as a component of international monitoring following the expiry of the Millennium Development Goals. This study aims to evaluate the utility of census data in measuring geographic inequality in access to drinking-water and sanitation.MethodsSpatially referenced census data were acquired for Colombia, South Africa, Egypt, and Uganda, whilst non-spatially referenced census data were acquired for Kenya. ...

  13. Health, healthcare access, and use of traditional versus modern medicine in remote Peruvian Amazon communities: a descriptive study of knowledge, attitudes, and practices.

    Science.gov (United States)

    Williamson, Jonathan; Ramirez, Ronald; Wingfield, Tom

    2015-04-01

    There is an urgent need for healthcare research, funding, and infrastructure in the Peruvian Amazon. We performed a descriptive study of health, health knowledge and practice, and healthcare access of 13 remote communities of the Manatí and Amazon Rivers in northeastern Peru. Eighty-five adults attending a medical boat service were interviewed to collect data on socioeconomic position, health, diagnosed illnesses, pain, healthcare access, and traditional versus modern medicine use. In this setting, poverty and gender inequality were prevalent, and healthcare access was limited by long distances to the health post and long waiting times. There was a high burden of reported pain (mainly head and musculoskeletal) and chronic non-communicable diseases, such as hypertension (19%). Nearly all participants felt that they did not completely understand their diagnosed illnesses and wanted to know more. Participants preferred modern over traditional medicine, predominantly because of mistrust or lack of belief in traditional medicine. Our findings provide novel evidence concerning transitional health beliefs, hidden pain, and chronic non-communicable disease prevalence in marginalized communities of the Peruvian Amazon. Healthcare provision was limited by a breach between health education, knowledge, and access. Additional participatory research with similar rural populations is required to inform regional healthcare policy and decision-making. © The American Society of Tropical Medicine and Hygiene.

  14. Geographical accessibility to healthcare and malnutrition in Rwanda.

    Science.gov (United States)

    Aoun, Nael; Matsuda, Hirotaka; Sekiyama, Makiko

    2015-04-01

    The prevalence of stunting in children less than five years of age is elevated in Rwanda. It is one of the main health challenges upon which the government is struggling to achieve progress. Health centers and district hospitals in Rwanda are expected to provide a package of health services including nutrition related activities, nutritional rehabilitation, education, and growth monitoring. They can hence play a potent role in alleviating malnutrition and stunting in Rwanda. This study tested whether travel time from household clusters to the nearest health center was significantly and negatively associated with the distribution of height-for-age z-scores of younger than five year old children in the eastern province of Rwanda. Data for 974 children was extracted from the Rwanda Demographic and Health Survey (DHS) database. However, since DHS does not contain any information on travel time to health centers, the latter was simulated using AccessMod 4.0, an extension to ArcGIS 9.3.1 that simulates health facilities' catchment areas and travel times to health facilities. Travel time was found to be negatively associated with height-for-age z-scores at the 5% level in a stepwise regression analysis that controlled for wealth index, mother's primary and secondary education, sex of the child, preceding birth interval, and birth order of the child. Field measurements are needed to validate travel time. If validated, results point to the importance of improved access to healthcare facilities as a potential pathway in reducing stunting in Rwanda. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Educational expansion and its consequences for vertical and horizontal inequalities in access to higher education in West Germany

    DEFF Research Database (Denmark)

    Reimer, David; Pollak, Reinhard

    2010-01-01

    education has become increasingly relevant for labour market prospects and life course opportunities. Our article studies the access to tertiary education of students with different social origins in light of educational expansion in Germany. First, we examine inequalities in access to four vertical...... strategies irrespective of the ongoing expansion of secondary and tertiary education.......For scholars of social stratification one of the key questions regarding educational expansion is whether it diminishes or magnifies existing inequalities in educational attainment. The effect of expansion on educational inequality in tertiary education is of particular importance, as tertiary...

  16. Geographic and Perceived Healthcare Access Equity among Patients with Acute Cardiovascular Event in China

    OpenAIRE

    Ma, Xiaoguang; Tang, Wenxi; Gan, Da; Lin, Jie; Zhang, Lichao; Guo, Huilan

    2017-01-01

    Introduction: In acute cardiovascular event (ACE) such as stroke and myocardial infarction, access to comprehensive, timely, and quality healthcare services was critical for receiving appropriate treatment and improving prognosis. However, due to significant disparities on distribution of healthcare resources, allocating the limited resources to regions and population in needs was a key challenge for China. This study aimed to evaluate both geographic and perceived healthcare access of ACE pa...

  17. Exploring the Association of Homicides in Northern Mexico and Healthcare Access for US Residents.

    Science.gov (United States)

    Geissler, Kimberley H; Becker, Charles; Stearns, Sally C; Thirumurthy, Harsha; Holmes, George M

    2015-08-01

    Many legal residents in the United States (US)-Mexico border region cross from the US into Mexico for medical treatment and pharmaceuticals. We analyzed whether recent increases in homicides in Mexico are associated with reduced healthcare access for US border residents. We used data on healthcare access, legal entries to the US from Mexico, and Mexican homicide rates (2002-2010). Poisson regression models estimated associations between homicide rates and total legal US entries. Multivariate difference-in-difference linear probability models evaluated associations between Mexican homicide rates and self-reported measures of healthcare access for US residents. Increased homicide rates were associated with decreased legal entries to the US from Mexico. Contrary to expectations, homicides did not have significant associations with healthcare access measures for legal residents in US border counties. Despite a decrease in border crossings, increased violence in Mexico did not appear to negatively affect healthcare access for US border residents.

  18. Architecture and implementation for a system enabling smartphones to access smart card based healthcare records.

    Science.gov (United States)

    Karampelas, Vasilios; Pallikarakis, Nicholas; Mantas, John

    2013-01-01

    The healthcare researchers', academics' and practitioners' interest concerning the development of Healthcare Information Systems has been on a steady rise for the last decades. Fueling this steady rise has been the healthcare professional need of quality information, in every healthcare provision incident, whenever and wherever this incident may take place. In order to address this need a truly mobile health care system is required, one that will be able to provide a healthcare provider with accurate patient-related information regardless of the time and place that healthcare is provided. In order to fulfill this role the present study proposes the architecture for a Healthcare Smartcard system, which provides authenticated healthcare professionals with remote mobile access to a Patient's Healthcare Record, through their Smartphone. Furthermore the research proceeds to develop a working prototype system.

  19. The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá – Colombia: an ecological analysis

    Directory of Open Access Journals (Sweden)

    Mosquera Paola A

    2012-11-01

    Full Text Available Abstract Background Colombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá. Methods An ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI. Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR, under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation. The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007. Results In both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%, IMR (19% and acute

  20. The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá-Colombia: an ecological analysis.

    Science.gov (United States)

    Mosquera, Paola A; Hernández, Jinneth; Vega, Román; Martínez, Jorge; Labonte, Ronald; Sanders, David; San Sebastián, Miguel

    2012-11-13

    Colombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá. An ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007. In both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also contributed approximately 20

  1. Task-role-based Access Control Model in Smart Health-care System

    Directory of Open Access Journals (Sweden)

    Wang Peng

    2015-01-01

    Full Text Available As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for the medical health-care environment, task-role-based access control model, which overcomes the disadvantages of traditional access control models. The task-role-based access control (T-RBAC model introduces a task concept, dividing tasks into four categories. It also supports supervision role hierarchy. T-RBAC is a proper access control model for Smart Health-care System, and it improves the management of access rights. This paper also proposes an implementation of T-RBAC, a binary two-key-lock pair access control scheme using prime factorization.

  2. Understanding access to healthcare among Indigenous peoples: A comparative analysis of biomedical and postcolonial perspectives.

    Science.gov (United States)

    Horrill, Tara; McMillan, Diana E; Schultz, Annette S H; Thompson, Genevieve

    2018-03-25

    As nursing professionals, we believe access to healthcare is fundamental to health and that it is a determinant of health. Therefore, evidence suggesting access to healthcare is problematic for many Indigenous peoples is concerning. While biomedical perspectives underlie our current understanding of access, considering alternate perspectives could expand our awareness of and ability to address this issue. In this paper, we critique how access to healthcare is understood through a biomedical lens, how a postcolonial theoretical lens can extend that understanding, and the subsequent implications this alternative view raises for the nursing profession. Drawing on peer-reviewed published and gray literature concerning healthcare access and Indigenous peoples to inform this critique, we focus on the underlying theoretical lens shaping our current understanding of access. A postcolonial analysis provides a way of understanding healthcare as a social space and social relationship, presenting a unique perspective on access to healthcare. The novelty of this finding is of particular importance for the profession of nursing, as we are well situated to influence these social aspects, improving access to healthcare services broadly, and among Indigenous peoples specifically. © 2018 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.

  3. Cultural Health Capital on the margins: Cultural resources for navigating healthcare in communities with limited access.

    Science.gov (United States)

    Madden, Erin Fanning

    2015-05-01

    Communities struggling with access to healthcare in the U.S. are often considered to be disadvantaged and lacking in resources. Yet, these communities develop and nurture valuable strategies for healthcare access that are underrecognized by health scholars. Combining medical sociology and critical race theory perspectives on cultural capital, this paper examines the health-relevant cultural resources, or Cultural Health Capital, in South Texas Mexican American border communities. Ethnographic data collected during 2011-2013 in Cameron and Hidalgo counties on the U.S.-Mexico border provide empirical evidence for expanding existing notions of health-relevant cultural capital. These Mexican American communities use a range of cultural resources to manage healthcare exclusion and negotiate care in alternative healthcare spaces like community clinics, flea markets and Mexican pharmacies. Navigational, social, familial, and linguistic skills and knowledge are used to access doctors and prescription drugs in these spaces despite social barriers to mainstream healthcare (e.g. cost, English language skills, etc.). Cultural capital used in marginalized communities to navigate limited healthcare options may not always fully counteract healthcare exclusion. Nevertheless, recognizing the cultural resources used in Mexican American communities to facilitate healthcare challenges deficit views and yields important findings for policymakers, healthcare providers, and advocates seeking to capitalize on community resources to improve healthcare access. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Migrants' access to healthcare services within the European Union: a content analysis of policy documents in Ireland, Portugal and Spain.

    Science.gov (United States)

    Ledoux, Céline; Pilot, Eva; Diaz, Esperanza; Krafft, Thomas

    2018-06-15

    The current migration flow into Europe is leading to a growing ethnically diverse population in many European countries. Now more than ever, those populations have different healthcare needs, languages, traditions, and previous level of care. This higher level of diversity is likely to increase health inequalities that might challenge healthcare systems if not addressed. In this context, this study aims at reviewing the policy framework for migrants' access to healthcare in Spain, Portugal and Ireland, countries with a long history of immigration, to identify lessons to be learned for policies on migrants' health. A content analysis of official policy documents was undertaken and the conceptual framework developed by Mladowsky was adapted to classify the actions indicated in the policies. The content analysis revealed that the policy aim for all three analysed countries is the improvement of the health status of the immigrant population based on equity and equality principles. The main strategies are the adaptation of services through actions targeting patients and providers, such as the implementation of cultural mediators and trainings for health professionals. The three countries propose a great range of policies aiming at improving access to healthcare services for immigrants that can inspire other European countries currently welcoming refugees. Developing inclusive policies, however does not necessarily mean they will be implemented or felt on the ground. Inclusive policies are indeed under threat due to the economic and social crises and due to the respective nationalistic attitudes towards integration. The European Union is challenged to take a more proactive leadership and ensure that countries effectively implement inclusive actions to improve migrant's access to health services.

  5. Public-private partnerships and new models of healthcare access

    NARCIS (Netherlands)

    Lange, Joep M. A.; Schellekens, Onno P.; Lindner, Marianne; van der Gaag, Jacques

    2008-01-01

    PURPOSE OF REVIEW: The aim of this article is to lay the ground for the engagement and support of a well managed and effectively regulated private sector in the delivery of healthcare in sub-Saharan Africa. RECENT FINDINGS: About 60% of healthcare financing in sub-Saharan Africa comes from private

  6. "Socioeconomic inequalities in children's accessibility to food retailing: Examining the roles of mobility and time".

    Science.gov (United States)

    Ravensbergen, Léa; Buliung, Ron; Wilson, Kathi; Faulkner, Guy

    2016-03-01

    Childhood overweight and obesity rates in Canada are at concerning levels, more apparently so for individuals of lower socioeconomic status (SES). Accessibility to food establishments likely influences patterns of food consumption, a contributor to body weight. Previous work has found that households living in lower income neighbourhoods tend to have greater geographical accessibility to unhealthy food establishments and lower accessibility to healthy food stores. This study contributes to the literature on neighbourhood inequalities in accessibility to healthy foods by explicitly focusing on children, an understudied population, and by incorporating mobility and time into metrics of accessibility. Accessibility to both healthy and unhealthy food retailing is measured within children's activity spaces using Road Network and Activity Location Buffering methods. Weekday vs. weekend accessibility to food establishments is then compared. The results suggest that children attending lower SES schools had almost two times the density of fast food establishments and marginally higher supermarket densities in their activity spaces. Children attending higher SES schools also had much larger activity spaces. All children had higher supermarket densities during weekdays than on weekend days. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Health inequalities by gradients of access to water and sanitation between countries in the Americas, 1990 and 2010.

    Science.gov (United States)

    Mújica, Oscar J; Haeberer, Mariana; Teague, Jordan; Santos-Burgoa, Carlos; Galvão, Luiz Augusto Cassanha

    2015-11-01

    To explore distributional inequality of key health outcomes as determined by access coverage to water and sanitation (WS) between countries in the Region of the Americas. An ecological study was designed to explore the magnitude and change-over-time of standard gap and gradient metrics of environmental inequalities in health at the country level in 1990 and 2010 among the 35 countries of the Americas. Access to drinking water and access to improved sanitation facilities were selected as equity stratifiers. Five dependent variables were: total and healthy life expectancies at birth, and infant, under-5, and maternal mortality. Access to WS correlated with survival and mortality, and strong gradients were seen in both 1990 and 2010. Higher WS access corresponded to higher life expectancy and healthy life expectancy and lower infant, under-5, and maternal mortality risks. Burden of life lost was unequally distributed, steadily concentrated among the most environmentally disadvantaged, who carried up to twice the burden than they would if WS were fairly distributed. Population averages in life expectancy and specific mortality improved, but whereas absolute inequalities decreased, relative inequalities remained mostly invariant. Even with the Region on track to meet MDG 7 on water and sanitation, large environmental gradients and health inequities among countries remain hidden by Regional averages. As the post-2015 development agenda unfolds, policies and actions focused on health equity-mainly on the most socially and environmentally deprived-will be needed in order to secure the right for universal access to water and sanitation.

  8. Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study

    Science.gov (United States)

    Lindahl, Bertil; Hanning, Marianne; Westerling, Ragnar

    2016-01-01

    Background Several international studies suggest inequity in access to evidence-based heart failure (HF) care. Specifically, studies of ACE inhibitors (ACEIs) point to reduced ACEI access related to female sex, old age and socioeconomic position. Thus far, most studies have either been rather small, lacking diagnostic data, or lacking the possibility to account for several individual-based sociodemographic factors. Our aim was to investigate differences, which could reflect inequity in access to ACEIs based on sex, age, socioeconomic status or immigration status in Swedish patients with HF. Methods Individually linked register data for all Swedish adults hospitalised for HF in 2005–2010 (n=93 258) were analysed by multivariate regression models to assess the independent risk of female sex, high age, low employment status, low income level, low educational level or foreign country of birth, associated with lack of an ACEI dispensation within 1 year of hospitalisation. Adjustment for possible confounding was made for age, comorbidity, Angiotensin receptor blocker therapy, period and follow-up time. Results Analysis revealed an adjusted OR for no ACEI dispensation for women of 1.31 (95% CI 1.27 to 1.35); for the oldest patients of 2.71 (95% CI 2.53 to 2.91); and for unemployed patients of 1.59 (95% CI 1.46 to 1.73). Conclusions Access to ACEI treatment was reduced in women, older patients and unemployed patients. We conclude that access to ACEIs is inequitable among Swedish patients with HF. Future studies should include clinical data, as well as mortality outcomes in different groups. PMID:26261264

  9. Is there equity in use of healthcare services among immigrants, their descendents, and ethnic Danes?

    DEFF Research Database (Denmark)

    Nielsen, Signe S; Hempler, Nana F; Waldorff, Frans B

    2012-01-01

    Legislation in Denmark explicitly states the right to equal access to healthcare. Nevertheless, inequities may exist; accordingly evidence is needed. Our objective was to investigate whether differences in healthcare utilisation in immigrants, their descendents, and ethnic Danes could be explaine...

  10. Access to Parks for Youth as an Environmental Justice Issue: Access Inequalities and Possible Solutions

    Directory of Open Access Journals (Sweden)

    Alessandro Rigolon

    2014-04-01

    Full Text Available Although repeated contact with nature helps foster mental and physical health among young people, their contact with nature has been diminishing over the last few decades. Also, low-income and ethnic minority children have even less contact with nature than white middle-income children. In this study, we compared accessibility to play in parks for young people from different income and racial backgrounds in Denver, Colorado. Park access for children and youth was measured using a geographic information system (GIS. Each neighborhood was classified according to income level, residential density, and distance from downtown; and then each park was classified based on formal and informal play, and level of intimacy. Comparisons between neighborhoods show that that low-income neighborhoods have the lowest access and high-income neighborhoods have the highest access to parks, and that differences are even higher for parks with play amenities and high levels of intimacy. To overcome this issue, the paper proposes a framework for action to improve access to parks for low-income children and youth and to help planners, decision makers and advocacy groups prioritize park investments.

  11. Decomposing Educational Inequalities in Child Mortality: A Temporal Trend Analysis of Access to Water and Sanitation in Peru.

    Science.gov (United States)

    Bohra, Tasneem; Benmarhnia, Tarik; McKinnon, Britt; Kaufman, Jay S

    2017-01-11

    Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population. © The American Society of Tropical Medicine and Hygiene.

  12. Income-Related Inequalities in Access to Dental Care Services in Japan.

    Science.gov (United States)

    Nishide, Akemi; Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira

    2017-05-12

    Background : This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods : The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results : Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions : There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system.

  13. Healthcare access and health beliefs of the indigenous peoples in remote Amazonian Peru.

    Science.gov (United States)

    Brierley, Charlotte K; Suarez, Nicolas; Arora, Gitanjli; Graham, Devon

    2014-01-01

    Little is published about the health issues of traditional communities in the remote Peruvian Amazon. This study assessed healthcare access, health perceptions, and beliefs of the indigenous population along the Ampiyacu and Yaguasyacu rivers in north-eastern Peru. One hundred and seventy-nine adult inhabitants of 10 remote settlements attending health clinics were interviewed during a medical services trip in April 2012. Demographics, health status, access to healthcare, health education, sanitation, alcohol use, and smoke exposure were recorded. Our findings indicate that poverty, household overcrowding, and poor sanitation remain commonplace in this group. Furthermore, there are poor levels of health education and on-going barriers to accessing healthcare. Healthcare access and health education remain poor in the remote Peruvian Amazon. This combined with poverty and its sequelae render this population vulnerable to disease.

  14. Healthcare Access and Health Beliefs of the Indigenous Peoples in Remote Amazonian Peru

    Science.gov (United States)

    Brierley, Charlotte K.; Suarez, Nicolas; Arora, Gitanjli; Graham, Devon

    2014-01-01

    Little is published about the health issues of traditional communities in the remote Peruvian Amazon. This study assessed healthcare access, health perceptions, and beliefs of the indigenous population along the Ampiyacu and Yaguasyacu rivers in north-eastern Peru. One hundred and seventy-nine adult inhabitants of 10 remote settlements attending health clinics were interviewed during a medical services trip in April 2012. Demographics, health status, access to healthcare, health education, sanitation, alcohol use, and smoke exposure were recorded. Our findings indicate that poverty, household overcrowding, and poor sanitation remain commonplace in this group. Furthermore, there are poor levels of health education and on-going barriers to accessing healthcare. Healthcare access and health education remain poor in the remote Peruvian Amazon. This combined with poverty and its sequelae render this population vulnerable to disease. PMID:24277789

  15. Tackling inequalities in political socialisation: A systematic analysis of access to and mitigation effects of learning citizenship at school.

    Science.gov (United States)

    Hoskins, Bryony; Janmaat, Jan Germen; Melis, Gabriella

    2017-11-01

    This article tackles the issue of social inequalities in voting and identifies how and when differences in learning political engagement are influenced by social background in the school environment between the ages of 11-16 in England. Using Latent Growth Curve Modelling and Regression Analysis on the Citizenship Education Longitudinal (CELS) data this research identifies two elements that influence the political socialisation process: access to political learning and effectiveness in the form of learning in reducing inequalities in political engagement. The results show that there is unequal access by social background to learning political engagement through political activities in school and through an open classroom climate for discussion. However, there is equal access by social background to Citizenship Education in schools and this method of learning political engagement is effective at the age of 15-16 in reducing inequalities in political engagement. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  16. Contextualising healthcare access for men who have sex with men

    African Journals Online (AJOL)

    2018-01-19

    Jan 19, 2018 ... with HIV, and HIV prevalence amongst adults aged 15–49 years was estimated to be 16.6%.6. In 2015 ..... to stereotyping and assumptions of criminal and violent behaviour. ... illustrates a healthcare worker's self-reflection on their own .... very old. So she was busy writing and asking questions and.

  17. Factors affecting access to healthcare services by intermarried Filipino women in rural Tasmania: a qualitative study.

    Science.gov (United States)

    Hannah, Chona T; Lê, Quynh

    2012-10-01

    Access to health care services is vital for every migrant's health and wellbeing. However, migrants' cultural health beliefs and views can hinder their ability to access available services. This study examined factors affecting access to healthcare services for intermarried Filipino women in rural Tasmania, Australia. A qualitative approach using semi-structured interviews was employed to investigate the factors affecting access to healthcare services for 30 intermarried Filipino women in rural Tasmania. The study used grounded theory and thematic analysis for its data analysis. Nvivo v8 (www.qsrinternational.com) was also used to assist the data coding process and analysis. Five influencing factors were identified: (1) language or communication barriers; (2) area of origin in the Philippines; (3) cultural barriers; (4) length of stay in Tasmania; and (5) expectations of healthcare services before and after migration. Factors affecting intermarried Filipino women in accessing healthcare services are shaped by their socio-demographic and cultural background. The insights gained from this study are useful to health policy-makers, healthcare professionals and to intermarried female migrants. The factors identified can serve as a guide to improve healthcare access for Filipino women and other migrants.

  18. Informal politics and inequity of access to health care in Lebanon

    Directory of Open Access Journals (Sweden)

    Chen Bradley

    2012-05-01

    Full Text Available Abstract Introduction Despite the importance of political institutions in shaping the social environment, the causal impact of politics on health care access and inequalities has been understudied. Even when considered, research tends to focus on the effects of formal macro-political institutions such as the welfare state. We investigate how micro-politics and informal institutions affect access to care. Methods This study uses a mixed-methods approach, combining findings from a household survey (n = 1789 and qualitative interviews (n = 310 in Lebanon. Multivariate logistic regression was employed in the analysis of the survey to examine the effect of political activism on access to health care while controlling for age, sex, socioeconomic status, religious commitment and piety. Results We note a significantly positive association between political activism and the probability of receiving health aid (p , with an OR of 4.0 when comparing individuals with the highest political activity to those least active in our sample. Interviews with key informants also reveal that, although a form of “universal coverage” exists in Lebanon whereby any citizen is eligible for coverage of hospitalization fees and treatments, in practice, access to health services is used by political parties and politicians as a deliberate strategy to gain and reward political support from individuals and their families. Conclusions Individuals with higher political activism have better access to health services than others. Informal, micro-level political institutions can have an important impact on health care access and utilization, with potentially detrimental effects on the least politically connected. A truly universal health care system that provides access based on medical need rather than political affiliation is needed to help to alleviate growing health disparities in the Lebanese population.

  19. Informal politics and inequity of access to health care in Lebanon.

    Science.gov (United States)

    Chen, Bradley; Cammett, Melani

    2012-05-09

    Despite the importance of political institutions in shaping the social environment, the causal impact of politics on health care access and inequalities has been understudied. Even when considered, research tends to focus on the effects of formal macro-political institutions such as the welfare state. We investigate how micro-politics and informal institutions affect access to care. This study uses a mixed-methods approach, combining findings from a household survey (n = 1789) and qualitative interviews (n = 310) in Lebanon. Multivariate logistic regression was employed in the analysis of the survey to examine the effect of political activism on access to health care while controlling for age, sex, socioeconomic status, religious commitment and piety. We note a significantly positive association between political activism and the probability of receiving health aid (p political activity to those least active in our sample. Interviews with key informants also reveal that, although a form of "universal coverage" exists in Lebanon whereby any citizen is eligible for coverage of hospitalization fees and treatments, in practice, access to health services is used by political parties and politicians as a deliberate strategy to gain and reward political support from individuals and their families. Individuals with higher political activism have better access to health services than others. Informal, micro-level political institutions can have an important impact on health care access and utilization, with potentially detrimental effects on the least politically connected. A truly universal health care system that provides access based on medical need rather than political affiliation is needed to help to alleviate growing health disparities in the Lebanese population.

  20. Informal politics and inequity of access to health care in Lebanon

    Science.gov (United States)

    2012-01-01

    Introduction Despite the importance of political institutions in shaping the social environment, the causal impact of politics on health care access and inequalities has been understudied. Even when considered, research tends to focus on the effects of formal macro-political institutions such as the welfare state. We investigate how micro-politics and informal institutions affect access to care. Methods This study uses a mixed-methods approach, combining findings from a household survey (n = 1789) and qualitative interviews (n = 310) in Lebanon. Multivariate logistic regression was employed in the analysis of the survey to examine the effect of political activism on access to health care while controlling for age, sex, socioeconomic status, religious commitment and piety. Results We note a significantly positive association between political activism and the probability of receiving health aid (p political activity to those least active in our sample. Interviews with key informants also reveal that, although a form of “universal coverage” exists in Lebanon whereby any citizen is eligible for coverage of hospitalization fees and treatments, in practice, access to health services is used by political parties and politicians as a deliberate strategy to gain and reward political support from individuals and their families. Conclusions Individuals with higher political activism have better access to health services than others. Informal, micro-level political institutions can have an important impact on health care access and utilization, with potentially detrimental effects on the least politically connected. A truly universal health care system that provides access based on medical need rather than political affiliation is needed to help to alleviate growing health disparities in the Lebanese population. PMID:22571591

  1. Socioeconomic Inequalities in Green Space Quality and Accessibility-Evidence from a Southern European City.

    Science.gov (United States)

    Hoffimann, Elaine; Barros, Henrique; Ribeiro, Ana Isabel

    2017-08-15

    Background : The provision of green spaces is an important health promotion strategy to encourage physical activity and to improve population health. Green space provision has to be based on the principle of equity. This study investigated the presence of socioeconomic inequalities in geographic accessibility and quality of green spaces across Porto neighbourhoods (Portugal). Methods : Accessibility was evaluated using a Geographic Information System and all the green spaces were audited using the Public Open Space Tool. Kendall's tau-b correlation coefficients and ordinal regression were used to test whether socioeconomic differences in green space quality and accessibility were statistically significant. Results : Although the majority of the neighbourhoods had an accessible green space, mean distance to green space increased with neighbourhood deprivation. Additionally, green spaces in the more deprived neighbourhoods presented significantly more safety concerns, signs of damage, lack of equipment to engage in active leisure activities, and had significantly less amenities such as seating, toilets, cafés, etc. Conclusions : Residents from low socioeconomic positions seem to suffer from a double jeopardy; they lack both individual and community resources. Our results have important planning implications and might contribute to understanding why deprived communities have lower physical activity levels and poorer health.

  2. Differences and inequalities in relation to access to renal replacement therapy in the BRICS countries.

    Science.gov (United States)

    Ferraz, Fábio Humberto Ribeiro Paes; Rodrigues, Cibele Isaac Saad; Gatto, Giuseppe Cesare; Sá, Natan Monsores de

    2017-07-01

    End-stage renal disease (ESRD) is an important public health problem, especially in developing countries due to the high level of economic resources needed to maintain patients in the different programs that make up renal replacement therapy (RRT). To analyze the differences and inequalities involved in access to RRT in the BRICS countries (Brazil, Russian Federation, India, China and South Africa). This is an applied, descriptive, cross-sectional, quantitative and qualitative study, with documentary analysis and a literature review. The sources of data were from national censuses and scientific publications regarding access to RRT in the BRICS countries. There is unequal access to RRT in all the BRICS countries, as well as the absence of information regarding dialysis and transplants (India), the absence of effective legislation to inhibit the trafficking of organs (India and South Africa) and the use of deceased prisoners as donors for renal transplants (China). The construction of mechanisms to promote the sharing of benefits and solidarity in the field of international cooperation in the area of renal health involves the recognition of bioethical issues related to access to RRT in the BRICS countries.

  3. An Intersectional Perspective on Access to HIV-Related Healthcare for Transgender Women

    Science.gov (United States)

    Lacombe-Duncan, Ashley

    2016-01-01

    Abstract Transgender women experience decreased access to HIV-related healthcare relative to cisgender people, in part due to pervasive transphobia in healthcare. This perspective describes intersectionality as a salient theoretical approach to understanding this disparity, moving beyond transphobia to explore how intersecting systems of oppression, including cisnormativity, sexism/transmisogyny, classism, racism, and HIV-related, gender nonconformity, substance use, and sex work stigma influence HIV-related healthcare access for transgender women living with HIV. This perspective concludes with a discussion of how intersectionality-informed studies can be enhanced through studying underexplored intersections and bringing attention to women's resiliency and empowerment. PMID:29159304

  4. A Population-based Study of Age Inequalities in Access to Palliative Care Among Cancer Patients

    Science.gov (United States)

    Burge, Frederick I.; Lawson, Beverley J.; Johnston, Grace M.; Grunfeld, Eva

    2013-01-01

    Background Inequalities in access to palliative care programs (PCP) by age have been shown to exist in Canada and elsewhere. Few studies have been able to provide greater insight by simultaneously adjusting for multiple demographic, health service, and socio-cultural indicators. Objective To re-examine the relationship between age and registration to specialized community-based PCP programs among cancer patients and identify the multiple indicators contributing to these inequalities. Methods This retrospective, population-based study was a secondary data analysis of linked individual level information extracted from 6 administrative health databases and contextual (neighborhood level) data from provincial and census information. Subjects included all adults who died due to cancer between 1998 and 2003 living within 2 District Health Authorities in the province of Nova Scotia, Canada. The relationship between registration in a PCP and age was examined using hierarchical nonlinear regression modeling techniques. Identification of potential patient and ecologic contributing indicators was guided by Andersen’s conceptual model of health service utilization. Results Overall, 66% of 7511 subjects were registered with a PCP. Older subjects were significantly less likely than those center had a major impact on registration. Conclusions Age continues to be a significant predictor of PCP registration in Nova Scotia even after controlling for the confounding effects of many new demographic, health service, and ecologic indicators. PMID:19300309

  5. Anaemia and malaria in Yanomami communities with differing access to healthcare.

    Science.gov (United States)

    Grenfell, P; Fanello, C I; Magris, M; Goncalves, J; Metzger, W G; Vivas-Martínez, S; Curtis, C; Vivas, L

    2008-07-01

    Inequitable access to healthcare has a profound impact on the health of marginalised groups that typically suffer an excess burden of infectious disease morbidity and mortality. The Yanomami are traditionally semi-nomadic people living in widely dispersed communities in Amazonian Venezuela and Brazil. Only communities living in the vicinity of a health post have relatively constant access to healthcare. To monitor the improvement in the development of Yanomami healthcare a cross-sectional survey of 183 individuals was conducted to investigate malaria and anaemia prevalence in communities with constant and intermittent access to healthcare. Demographic and clinical data were collected. Malaria was diagnosed by microscopy and haemoglobin concentration by HemoCue. Prevalence of malaria, anaemia, splenomegaly, fever and diarrhoea were all significantly higher in communities with intermittent access to healthcare (anaemia 80.8% vs. 53.6%, P<0.001; malaria 18.2% vs. 6.0%, P=0.013; splenomegaly 85.4% vs.12.5%, P<0.001; fever 50.5% vs. 28.6%, P=0.003; diarrhoea 30.3% vs.10.7% P=0.001). Haemoglobin level (10.0 g/dl vs. 11.5 g/dl) was significantly associated with access to healthcare when controlling for age, sex, malaria and splenomegaly (P=0.01). These findings indicate a heavy burden of anaemia in both areas and the need for interventions against anaemia and malaria, along with more frequent medical visits to remote areas.

  6. Are there good reasons for inequalities in access to renal transplantation in children?

    Science.gov (United States)

    Hogan, Julien; Audry, Benoit; Harambat, Jérôme; Dunand, Olivier; Garnier, Arnaud; Salomon, Rémi; Ulinski, Tim; Macher, Marie-Alice; Couchoud, Cécile

    2015-12-01

    Studies in the USA and Europe have demonstrated inequalities in adult access to renal transplants. We previously demonstrate that the centre of treatment was impacting the time to be registered on the renal waiting list. In this study, we sought to ascertain the influence of patient and centre characteristics on the probability of transplantation within 1 year after registration on the waiting list for children. We included patients <18 years awaiting transplantation from the French ESRD National Registry. The effects of patient and centre characteristics were studied by hierarchical logistic regression. Centre effects were assessed by centre-level residual variance. A descriptive survey was performed to investigate differences in the centres' practices, and linear regression was used to confirm findings of different HLA compatibility requirements between centres. The study included 556 patients treated at 54 centres; 450 (80.9%) received transplants in the year after their listing. HLA group scarcity, time of inactive status during the year, pre-emptive listing and listing after age 18 were associated with lower probabilities of transplantation. Patient characteristics explained most of the variability among centres, but patients treated in paediatric centres had a lower probability of transplantation within 1 year because of higher HLA compatibility requirements for transplants. Although patient characteristics explained most of the inter-centre variability, harmonization of some practices might enable us to reduce some inequalities in access to renal transplantation while maintaining optimal transplant survival and chances to get a second transplant when needed. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  7. Strategic purchasing reform in Estonia: Reducing inequalities in access while improving care concentration and quality.

    Science.gov (United States)

    Habicht, Triin; Habicht, Jarno; van Ginneken, Ewout

    2015-08-01

    As of 2014, the Estonian Health Insurance Fund has adopted new purchasing procedures and criteria, which it now has started to implement in specialist care. Main changes include (1) redefined access criteria based on population need rather than historical supply, which aim to achieve more equal access of providers and specialties; (2) stricter definition and use of optimal workload criteria to increase the concentration of specialist care (3) better consideration of patient movement; and (4) an increased emphasis on quality to foster quality improvement. The new criteria were first used in the contract cycle that started in 2014 and resulted in fewer contracted providers for a similar volume of care compared to the previous contract cycle. This implies that provision of specialized care has become concentrated at fewer providers. It is too early to draw firm conclusions on the impact on care quality or on actors, but the process has sparked debate on the role of selective contracting and the role of public and private providers in Estonian health care. Lastly, the Estonian experience may hold important lessons for other countries looking to overcome inequalities in access while concentrating care and improving care quality. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  8. Faith community nursing scope of practice: extending access to healthcare.

    Science.gov (United States)

    Balint, Katherine A; George, Nancy M

    2015-01-01

    The role of the Faith Community Nurse (FCN) is a multifaceted wholistic practice focused on individuals, families, and the faith and broader communities. The FCN is skilled in professional nursing and spiritual care, supporting health through attention to spiritual, physical, mental, and social health. FCNs can help meet the growing need for healthcare, especially for the uninsured, poor, and homeless. The contribution of FCNs on, primary prevention, health maintenance, and management of chronic disease deserves attention to help broaden understanding of the scope of FCN practice.

  9. Health inequalities by gradients of access to water and sanitation between countries in the Americas, 1990 and 2010

    Directory of Open Access Journals (Sweden)

    Oscar J. Mújica

    Full Text Available OBJECTIVE: To explore distributional inequality of key health outcomes as determined by access coverage to water and sanitation (WS between countries in the Region of the Americas. METHODS: An ecological study was designed to explore the magnitude and change-over-time of standard gap and gradient metrics of environmental inequalities in health at the country level in 1990 and 2010 among the 35 countries of the Americas. Access to drinking water and access to improved sanitation facilities were selected as equity stratifiers. Five dependent variables were: total and healthy life expectancies at birth, and infant, under-5, and maternal mortality. RESULTS: Access to WS correlated with survival and mortality, and strong gradients were seen in both 1990 and 2010. Higher WS access corresponded to higher life expectancy and healthy life expectancy and lower infant, under-5, and maternal mortality risks. Burden of life lost was unequally distributed, steadily concentrated among the most environmentally disadvantaged, who carried up to twice the burden than they would if WS were fairly distributed. Population averages in life expectancy and specific mortality improved, but whereas absolute inequalities decreased, relative inequalities remained mostly invariant. CONCLUSIONS: Even with the Region on track to meet MDG 7 on water and sanitation, large environmental gradients and health inequities among countries remain hidden by Regional averages. As the post-2015 development agenda unfolds, policies and actions focused on health equity-mainly on the most socially and environmentally deprived-will be needed in order to secure the right for universal access to water and sanitation.

  10. Scrambling for access: availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa.

    Science.gov (United States)

    Müller, Alex

    2017-05-30

    Sexual orientation and gender identity are social determinants of health for people identifying as lesbian, gay, bisexual and transgender (LGBT), and health disparities among sexual and gender minority populations are increasingly well understood. Although the South African constitution guarantees sexual and gender minority people the right to non-discrimination and the right to access to healthcare, homo- and transphobia in society abound. Little is known about LGBT people's healthcare experiences in South Africa, but anecdotal evidence suggests significant barriers to accessing care. Using the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, this study analyses the experiences of LGBT health service users using South African public sector healthcare, including access to HIV counselling, testing and treatment. A qualitative study comprised of 16 semi-structured interviews and two focus group discussions with LGBT health service users, and 14 individual interviews with representatives of LGBT organisations. Data were thematically analysed within the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, focusing on availability, accessibility, acceptability and quality of care. All interviewees reported experiences of discrimination by healthcare providers based on their sexual orientation and/or gender identity. Participants recounted violations of all four elements of the UN General Comment 14: 1) Availability: Lack of public health facilities and services, both for general and LGBT-specific concerns; 2) Accessibility: Healthcare providers' refusal to provide care to LGBT patients; 3) Acceptability: Articulation of moral judgment and disapproval of LGBT patients' identity, and forced subjection of patients to religious practices; 4) Quality: Lack of knowledge about LGBT identities and health needs, leading to poor-quality care. Participants had delayed or

  11. Understanding differences in access and use of healthcare between international immigrants to Chile and the Chilean-born: a repeated cross-sectional population-based study in Chile.

    Science.gov (United States)

    Cabieses, Baltica; Tunstall, Helena; Pickett, Kate E; Gideon, Jasmine

    2012-11-16

    International evidence indicates consistently lower rates of access and use of healthcare by international immigrants. Factors associated with this phenomenon vary significantly depending on the context. Some research into the health of immigrants has been conducted in Latin America, mostly from a qualitative perspective. This population-based study is the first quantitative study to explore healthcare provision entitlement and use of healthcare services by immigrants in Chile and compare them to the Chilean-born. Data come from the nationally representative CASEN (Socioeconomic characterization of the population in Chile) surveys, conducted in 2006 and 2009. Self-reported immigrants were compared to the Chilean-born, by demographic characteristics (age, sex, urban/rural, household composition, ethnicity), socioeconomic status (SES: education, household income, contractual status), healthcare provision entitlement (public, private, other, none), and use of primary services. Weighted descriptive, stratified and adjusted regression models were used to analyse factors associated with access to and use of healthcare. There was an increase in self-reported immigrant status and in household income inequality among immigrants between 2006 and 2009. Over time there was a decrease in the rate of immigrants reporting no healthcare provision and an increase in reporting of private healthcare provision entitlement. Compared to the Chilean-born, immigrants reported higher rates of use of antenatal and gynaecological care, lower use of well-baby care, and no difference in the use of Pap smears or the number of attentions received in the last three months. Immigrants in the bottom income quintile were four times more likely to report no healthcare provision than their equivalent Chilean-born group (with different health needs, i.e. vertical inequity). Disabled immigrants were more likely to have no healthcare provision compared to the disabled Chilean-born (with similar health

  12. Apartheid and healthcare access for paediatric systemic lupus ...

    African Journals Online (AJOL)

    and children with SLE in Africa are potentially at high risk for poor outcomes based on race ... coloured people.*[6,9] Through a ... areas are least likely to have access to a private car, yet may not have emergency .... High tra c accident mortality.

  13. THE AFTERMATH OF THE ECONOMIC CRISIS: HEALTHCARE SYSTEMS’ INEQUALITIES IN EUROPE

    Directory of Open Access Journals (Sweden)

    Silvia PALASCA

    2014-12-01

    Full Text Available During an economic downturn the non-productive sectors (education, health, and social services are the most exposed to sudden policy changes, as a result of austerity measures. This article aims to assess the impact of the late 2000’s crisis on some European countries’ healthcare systems in order to highlight the link between the breakdown of the economic context and the negative outcomes on a social level. In this regard, a panel data analysis was employed, focusing on out-of-pocket health expenses as an estimation of a nation’s wellbeing and healthcare development level. The cross-time results indicated a clear collapse of all national healthcare systems in 2009 while the cross-section effects implied that the twenty three countries could be divided in three groups according to their healthcare policy, especially regarding health insurance. Thus, countries should pay more attention to the private insurances component of the healthcare systems as the others are defenseless against business cycle fluctuations.

  14. Accessibility and availability of the Female Condom2: Healthcare provider’s perspective

    Directory of Open Access Journals (Sweden)

    Seepaneng S. Phiri

    2015-11-01

    Full Text Available Background: Despite the acceptability of the Female Condom2 (FC2 as a contraceptive method by some women, it remains inaccessible and unavailable to the majority of women because of affordability, training, distribution and marketing strategies. The FC2 affords women dual protection and the option to negotiate safe sex. Objective: This paper explores and describes the perspective of the healthcare providers regarding accessibility and availability of the FC2 as a contraceptive method in the Tshwane district. Method: The study used an explorative, descriptive, and qualitative design. Data were collected from 26 healthcare providers who were purposively selected. In-depth face-to-face interviews were conducted with these healthcare providers in the Tshwane district. Tesch’s method of open coding was used for data analysis. Results: Two main themes emerged, namely, the availability of the FC2 and the knowledge o fthe healthcare providers. The findings of this study indicated that the availability of the FC2 remains a challenge because of factors such as lack of affordability, inefficient procurement and lack of distribution measures. The condoms are also not available at strategic points so as to ensure accessibility. Insufficient knowledge amongst healthcare providers was described as a barrier which affects the quality of training of the service users. Conclusions: It is evident that the FC2 is not yet available in all healthcare settings, therefore strategies to safeguard accessibility and availability of the FC2 as a contraceptive method are recommended.

  15. [Continuous access to healthcare, a bond of trust with the patient].

    Science.gov (United States)

    Mechali, Denis; Dehaudt, Sylvie; Pintir, Marie-Laure

    2015-10-01

    Working with vulnerable patients who are in precarious situations or sometimes do not speak French raises questions about the caregiver's role. A "Permanence d'Accès aux Soins de Santé" (Pass--Continuous Access to Healthcare) requires patient involvement in their healthcare, communicating honestly and taking into account the various difficulties they are faced with every day, using a holistic approach. A physician and two nurses share their points of view and their way of doing things to ensure that their patients find their unique place as the subject of their healthcare. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Accession strategy to hand hygiene by healthcare professionals

    Directory of Open Access Journals (Sweden)

    Danielle Galdino de Paula

    2017-05-01

    Full Text Available Background and Objective: Healthcare-associated infections are serious health threat to hospitalized patients and contribute to increased mortality and morbidity. Hand hygiene is the simplest individual measure and lower cost in order to prevent the spread of infections in health care services. The study seeks to analyze the publications related to the strategies used to improve adherence of health professionals to hand hygiene in hospital. Contents: Integrative literature review. The descriptors were used in isolation and the associated descriptor AND;OR, by the following inclusion criteria: work full text of Article kind, published in the period 2008-2015, in Portuguese and English and used the electronic databases MEDLINE , LILACS and SCIELO. The analysis determined eleven strategies most used to improve adherence to hand hygiene in hospital. Conclusion: The availability of better resources and the use of a single strategy sometimes was not enough to increase membership, and often necessary to apply various strategies together with health professionals. KEYWORDS: Cross infection. Hand hygiene. Health personnel.

  17. Social Networks and Health: Understanding the Nuances of Healthcare Access between Urban and Rural Populations.

    Science.gov (United States)

    Amoah, Padmore Adusei; Edusei, Joseph; Amuzu, David

    2018-05-13

    Communities and individuals in many sub-Saharan African countries often face limited access to healthcare. Hence, many rely on social networks to enhance their chances for adequate health care. While this knowledge is well-established, little is known about the nuances of how different population groups activate these networks to improve access to healthcare. This paper examines how rural and urban dwellers in the Ashanti Region in Ghana distinctively and systematically activate their social networks to enhance access to healthcare. It uses a qualitative cross-sectional design, with in-depth interviews of 79 primary participants (28 urban and 51 rural residents) in addition to the views of eight community leaders and eight health personnel. It was discovered that both intimate and distanced social networks for healthcare are activated at different periods by rural and urban residents. Four main stages of social networks activation, comprising different individuals and groups were observed among rural and urban dwellers. Among both groups, physical proximity, privacy, trust and sense of fairness, socio-cultural meaning attached to health problems, and perceived knowledge and other resources (mainly money) held in specific networks inherently influenced social network activation. The paper posits that a critical analysis of social networks may help to tailor policy contents to individuals and groups with limited access to healthcare.

  18. Access and utilisation of healthcare services in rural Tanzania

    DEFF Research Database (Denmark)

    Shayo, Elizabeth H.; Senkoro, Kesheni P.; Momburi, Romanus

    2016-01-01

    was also found in the provider–client relationship satisfaction level between non-public (89.1%) and public facilities (74.7%) (OR = 2.8, CI: 1.5–5.0), indicating a level of lower trust in the later. Revised strategies are needed to ensure availability of medicines in public facilities, which are used......This study compared the access and utilisation of health services in public and non-public health facilities in terms of quality, equity and trust in the Mbarali district, Tanzania. Interviews, focus group discussions, and informal discussions were used to generate data. Of the 1836 respondents...

  19. Removing user fees for health services: A multi-epistemological perspective on access inequities in Senegal.

    Science.gov (United States)

    Mladovsky, Philipa; Ba, Maymouna

    2017-09-01

    Plan Sésame (PS) is a user fee exemption policy launched in 2006 to provide free access to health services to Senegalese citizens aged 60 and over. Analysis of a large household survey evaluating PS echoes findings of other studies showing that user fee removal can be highly inequitable. 34 semi-structured interviews and 19 focus group discussions with people aged 60 and over were conducted in four regions in Senegal (Dakar, Diourbel, Matam and Tambacounda) over a period of six months during 2012. They were analysed to identify underlying causes of exclusion from/inclusion in PS and triangulated with the household survey. The results point to three steps at which exclusion occurs: (i) not being informed about PS; (ii) not perceiving a need to use health services under PS; and (iii) inability to access health services under PS, despite having the information and perceived need. We identify lay explanations for exclusion at these different steps. Some lay explanations point to social exclusion, defined as unequal power relations. For example, poor access to PS was seen to be caused by corruption, patronage, poverty, lack of social support, internalised discrimination and adverse incorporation. Other lay explanations do not point to social exclusion, for example: poor implementation; inadequate funding; high population demand; incompetent bureaucracy; and PS as a favour or moral obligation to friends or family. Within a critical realist paradigm, we interpret these lay explanations as empirical evidence for the presence of the following hidden underlying causal mechanisms: lacking capabilities; mobilisation of institutional bias; and social closure. However, social constructionist perspectives lead us to critique this paradigm by drawing attention to contested health, wellbeing and corruption discourses. These differences in interpretation lead to subsequent differential policy recommendations. This demonstrates the need for the adoption of a "multi

  20. The significance of socially-assigned ethnicity for self-identified Māori accessing and engaging with primary healthcare in New Zealand.

    Science.gov (United States)

    Reid, Jennifer; Cormack, Donna; Crowe, Marie

    2016-03-01

    Despite increased focus in New Zealand on reducing health inequities between Māori and New Zealand European ethnic groups, research on barriers and facilitators to primary healthcare access for Māori remains limited. In particular, there has been little interrogation of the significance of social-assignment of ethnicity for Māori in relation to engagement with predominantly non-Māori primary healthcare services and providers. A qualitative study was undertaken with a subsample (n = 40) of the broader Hauora Manawa Study to examine experiences of accessing and engaging with primary healthcare among adult urban Māori. Thematic analysis of in-depth interviews identified that participants perceived social-assignment as New Zealand European as an efficacious form of capital when interacting with predominantly non-Māori health professionals. Skin colour that was 'white' or was perceived to identify Māori as belonging to the 'dominant' New Zealand European ethnic group was reported as broadly advantageous and protective. In contrast, social-assignment as Māori was seen to be associated with risk of exposure to differential and discriminatory healthcare. Reducing the negative impacts of racialisation in a (neo)colonial society where 'White' cultural capital dominates requires increased recognition of the health-protective advantages of 'White' privilege and concomitant risks associated with socially-assigned categorisation of ethnicity as non-'White'. © The Author(s) 2015.

  1. Healthcare access as a right, not a privilege: a construct of Western thought

    Directory of Open Access Journals (Sweden)

    Papadimos Thomas J

    2007-03-01

    Full Text Available Abstract Over 45 million Americans are uninsured or underinsured. Those living in poverty exhibit the worst health status. Employment, education, income, and race are important factors in a person's ability to acquire healthcare access. Having established that there are people lacking healthcare access due to multi-factorial etiologies, the question arises as to whether the intervention necessary to assist them in obtaining such access should be considered a privilege, or a right. The right to healthcare access is examined from the perspective of Western thought. Specifically through the works of Aristotle, Immanuel Kant, Thomas Hobbes, Thomas Paine, Hannah Arendt, James Rawls, and Norman Daniels, which are accompanied by a contemporary example of intervention on behalf of the medically needy by the The Johns Hopkins Urban Health Institute. As human beings we are all valuable social entities whereby, through the force of morality, through implicitly forged covenants among us as individuals and between us and our governments, and through the natural rights we maintain as individuals and those we collectively surrender to the common good, it has been determined by nature, natural laws, and natural rights that human beings have the right, not the privilege, to healthcare access.

  2. Healthcare access as a right, not a privilege: a construct of Western thought.

    Science.gov (United States)

    Papadimos, Thomas J

    2007-03-28

    Over 45 million Americans are uninsured or underinsured. Those living in poverty exhibit the worst health status. Employment, education, income, and race are important factors in a person's ability to acquire healthcare access. Having established that there are people lacking healthcare access due to multi-factorial etiologies, the question arises as to whether the intervention necessary to assist them in obtaining such access should be considered a privilege, or a right. The right to healthcare access is examined from the perspective of Western thought. Specifically through the works of Aristotle, Immanuel Kant, Thomas Hobbes, Thomas Paine, Hannah Arendt, James Rawls, and Norman Daniels, which are accompanied by a contemporary example of intervention on behalf of the medically needy by the The Johns Hopkins Urban Health Institute. As human beings we are all valuable social entities whereby, through the force of morality, through implicitly forged covenants among us as individuals and between us and our governments, and through the natural rights we maintain as individuals and those we collectively surrender to the common good, it has been determined by nature, natural laws, and natural rights that human beings have the right, not the privilege, to healthcare access.

  3. Inequities in access to and use of drinking water services in Latin America and the Caribbean.

    Science.gov (United States)

    Soares, Luiz Carlos Rangel; Griesinger, Marilena O; Dachs, J Norberto W; Bittner, Marta A; Tavares, Sonia

    2002-01-01

    To identify and evaluate inequities in access to drinking water services as reflected in household per capita expenditure on water, and to determine what proportion of household expenditures is spent on water in 11 countries of Latin America and the Caribbean. Using data from multi-purpose household surveys (such as the Living Standards Measurement Survey Study) conducted in 11 countries from 1995 to 1999, the availability of drinking water as well as total and per capita household expenditures on drinking water were analyzed in light of socioeconomic parameters, such as urban vs. rural setting, household income, type and regularity of water supply service, time spent obtaining water in homes not served by running water, and type of water-purifying treatment, if any. Access to drinking water as well as total and per capita household expenditures on drinking water show an association with household income, economic conditions of the household, and location. The access of the rural population to drinking water services is much more restricted than that of the urban population for groups having similar income. The proportion of families having a household water supply system is comparable in the higher-income rural population and the lower-income urban population. Families without a household water supply system spend a considerable amount of time getting water. For poorer families, this implies additional costs. Low-income families that lack a household water supply spend as much money on water as do families with better income. Access to household water disinfection methods is very limited among poor families due to its relatively high cost, which results in poorer drinking water quality in the lower-income population. Multi-purpose household surveys conducted from the consumer's point of view are important tools for research on equity and health, especially when studying unequal access to, use of, and expenditures on drinking water. It is recommended that countries

  4. Inequities in access to and use of drinking water services in Latin America and the Caribbean

    Directory of Open Access Journals (Sweden)

    Soares Luiz Carlos Rangel

    2002-01-01

    Full Text Available Objective. To identify and evaluate inequities in access to drinking water services as reflected in household per capita expenditure on water, and to determine what proportion of household expenditures is spent on water in 11 countries of Latin America and the Caribbean. Methods. Using data from multi-purpose household surveys (such as the Living Standards Measurement Survey Study conducted in 11 countries from 1995 to 1999, the availability of drinking water as well as total and per capita household expenditures on drinking water were analyzed in light of socioeconomic parameters, such as urban vs. rural setting, household income, type and regularity of water supply service, time spent obtaining water in homes not served by running water, and type of water-purifying treatment, if any. Results. Access to drinking water as well as total and per capita household expenditures on drinking water show an association with household income, economic conditions of the household, and location. The access of the rural population to drinking water services is much more restricted than that of the urban population for groups having similar income. The proportion of families having a household water supply system is comparable in the higher-income rural population and the lower-income urban population. Families without a household water supply system spend a considerable amount of time getting water. For poorer families, this implies additional costs. Low-income families that lack a household water supply spend as much money on water as do families with better income. Access to household water disinfection methods is very limited among poor families due to its relatively high cost, which results in poorer drinking water quality in the lower-income population. Conclusions. Multi-purpose household surveys conducted from the consumer's point of view are important tools for research on equity and health, especially when studying unequal access to, use of, and

  5. Informal workers and access to healthcare: a qualitative study of facilitators and barriers to accessing healthcare for beer promoters in the Lao People's Democratic Republic.

    Science.gov (United States)

    Sychareun, Vanphanom; Vongxay, Viengnakhone; Thammavongsa, Vassana; Thongmyxay, Souksamone; Phummavongsa, Phouthong; Durham, Jo

    2016-04-18

    Informal workers often face considerable risks and vulnerabilities as a consequence of their work and employment conditions. The purpose of this study was to examine the interplay between the experience of informal work and access to health, using as an example, female beer promoters employed in the informal economy, in the Lao People's Democratic Republic. In-depth interviews were undertaken with 24 female beer promoters working in beer shops, restaurants and entertainment venues in Vientiane City. The recruitment strategy of snowball sampling was used. Interviews explored the beer promoter's experience of the organization of work, perceived healthcare needs, access to healthcare and insurance, and health seeking practices. The data was analysed thematically and subsequently using Bourdieu's concepts of habitus, capital and field. Most of the beer promoters included in the study were 18 years of age, single, had worked as beer promoters for more than one year and just over half were working to support their higher education. The beer promoters demonstrated a holistic view of health, also viewing good health as contributing to being beautiful - an important attribute in their work. Many reported that their work conditions, including the noisy environment, exposure to second-hand tobacco smoke, long hours on their feet and sexual harassment negatively affected their physical and mental health. Only four participants had any form of health insurance with access to healthcare constrained by individual characteristics, health system factors and the conditions of their informal employment. Drawing on the work of Bourdieu, the study shows how both employment and illness are linked to habitus embodied in everyday practices, access to capital and the position the female beer promoters hold in the social hierarchy in the field of employment.

  6. Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis.

    Science.gov (United States)

    Cabieses, Baltica; Cookson, Richard; Espinoza, Manuel; Santorelli, Gillian; Delgado, Iris

    2015-01-01

    Chile, a South American country recently defined as a high-income nation, carried out a major healthcare system reform from 2005 onwards that aimed at reducing socioeconomic inequality in health. This study aimed to estimate income-related inequality in self-reported health status (SRHS) in 2000 and 2013, before and after the reform, for the entire adult Chilean population. Using data on equivalized household income and adult SRHS from the 2000 and 2013 CASEN surveys (independent samples of 101 046 and 172 330 adult participants, respectively) we estimated Erreygers concentration indices (CIs) for above average SRHS for both years. We also decomposed the contribution of both "legitimate" standardizing variables (age and sex) and "illegitimate" variables (income, education, occupation, ethnicity, urban/rural, marital status, number of people living in the household, and healthcare entitlement). There was a significant concentration of above average SRHS favoring richer people in Chile in both years, which was less pronounced in 2013 than 2000 (Erreygers corrected CI 0.165 [Standard Error, SE 0.007] in 2000 and 0.047 [SE 0.008] in 2013). To help interpret the magnitude of this decline, adults in the richest fifth of households were 33% more likely than those in the poorest fifth to report above-average health in 2000, falling to 11% in 2013. In 2013, the contribution of illegitimate factors to income-related inequality in SRHS remained higher than the contribution of legitimate factors. Income-related inequality in SRHS in Chile has fallen after the equity-based healthcare reform. Further research is needed to ascertain how far this fall in health inequality can be attributed to the 2005 healthcare reform as opposed to economic growth and other determinants of health that changed during the period.

  7. Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis.

    Directory of Open Access Journals (Sweden)

    Baltica Cabieses

    Full Text Available Chile, a South American country recently defined as a high-income nation, carried out a major healthcare system reform from 2005 onwards that aimed at reducing socioeconomic inequality in health. This study aimed to estimate income-related inequality in self-reported health status (SRHS in 2000 and 2013, before and after the reform, for the entire adult Chilean population.Using data on equivalized household income and adult SRHS from the 2000 and 2013 CASEN surveys (independent samples of 101 046 and 172 330 adult participants, respectively we estimated Erreygers concentration indices (CIs for above average SRHS for both years. We also decomposed the contribution of both "legitimate" standardizing variables (age and sex and "illegitimate" variables (income, education, occupation, ethnicity, urban/rural, marital status, number of people living in the household, and healthcare entitlement.There was a significant concentration of above average SRHS favoring richer people in Chile in both years, which was less pronounced in 2013 than 2000 (Erreygers corrected CI 0.165 [Standard Error, SE 0.007] in 2000 and 0.047 [SE 0.008] in 2013. To help interpret the magnitude of this decline, adults in the richest fifth of households were 33% more likely than those in the poorest fifth to report above-average health in 2000, falling to 11% in 2013. In 2013, the contribution of illegitimate factors to income-related inequality in SRHS remained higher than the contribution of legitimate factors.Income-related inequality in SRHS in Chile has fallen after the equity-based healthcare reform. Further research is needed to ascertain how far this fall in health inequality can be attributed to the 2005 healthcare reform as opposed to economic growth and other determinants of health that changed during the period.

  8. Memorandum "Open Metadata". Open Access to Documentation Forms and Item Catalogs in Healthcare.

    Science.gov (United States)

    Dugas, M; Jöckel, K-H; Friede, T; Gefeller, O; Kieser, M; Marschollek, M; Ammenwerth, E; Röhrig, R; Knaup-Gregori, P; Prokosch, H-U

    2015-01-01

    At present, most documentation forms and item catalogs in healthcare are not accessible to the public. This applies to assessment forms of routine patient care as well as case report forms (CRFs) of clinical and epidemiological studies. On behalf of the German chairs for Medical Informatics, Biometry and Epidemiology six recommendations to developers and users of documentation forms in healthcare were developed. Open access to medical documentation forms could substantially improve information systems in healthcare and medical research networks. Therefore these forms should be made available to the scientific community, their use should not be unduly restricted, they should be published in a sustainable way using international standards and sources of documentation forms should be referenced in scientific publications.

  9. Stock-outs, uncertainty and improvisation in access to healthcare in war-torn Northern Uganda.

    Science.gov (United States)

    Muyinda, Herbert; Mugisha, James

    2015-12-01

    Stock-outs, also known as shortages or complete absence of a particular inventory, in public health facilities have become a hallmark in Uganda's health system making the notions of persistent doubt in access to healthcare - uncertainty, and doing more with less - 'improvisation', very pronounced. The situation becomes more critical in post-conflict areas with an over whelming burden of preexisting and conflict-related ailments amidst weak health systems. Particularly in the war-torn Northern Uganda, the intersection between the effects of violent conflict and shortage of medications is striking. There are problems getting the right type of medications to the right people at the right time, causing persistent shortages and uncertainty in access to healthcare. With reference to patients on Antiretroviral Therapy (ART), we present temporal trends in access to healthcare in the context of medication shortages in conflict-affected areas. We examine uncertainties in access to care, and how patients, medical practitioners, and the state - the key actors in the domain of supplying and utilizing medicines, respond. Our observation is that, while improvisation is a feature of biomedicine and facilitates problem solving in daily life, it is largely contextual. Given the rapidly evolving contexts and social and professional sensitivities that characterize war affected areas, there is a need for deliberate healthcare programs tailored to the unique needs of people and to the shaping of appropriate policies in post-conflict settings, which call for more North-South collaboration on equal terms. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Exploring the unequal landscapes of healthcare accessibility in lower-income urban neighborhoods through qualitative inquiry

    NARCIS (Netherlands)

    Hawthorne, T.; Kwan, M.-P.

    2013-01-01

    Geographers and public health researchers recognize that healthcare accessibility is a multi-dimensional concept contingent upon the interplay of a variety of spatial and non-spatial factors, including geographic distance, cost, availability, and quality of services. Understanding such complex

  11. Policies of access to healthcare services for accompanied asylum-seeking children in the Nordic countries.

    Science.gov (United States)

    Sandahl, Hinuga; Norredam, Marie; Hjern, Anders; Asher, Henry; Nielsen, Signe Smith

    2013-08-01

    Asylum-seeking children constitute a vulnerable group with high prevalence and risk for mental health problems. The aim of this study was to compare policies of access to healthcare services, including physical examination and screening for mental health problems on arrival, for accompanied asylum-seeking children in the Nordic countries. This study was based on the national reports "Reception of refugee children in the Nordic countries" written by independent national experts for the Nordic Network for Research on Refugee Children, supplemented by information from relevant authorities. In Sweden, Norway and Iceland, asylum-seeking children had access to healthcare services equal to children in the general population. On a policy level, Denmark imposed restrictions on non-acute hospitalisations and prolonged specialist treatments. Regarding health examinations, Sweden deviated from the Nordic pattern by not performing these systematically. In Denmark, Iceland, and some counties in Sweden, but not in Norway, screening for mental health problems was offered to asylum-seeking children. Access to healthcare services for asylum-seeking children differs in the Nordic countries; the consequences of these systematic differences for the individual asylum-seeking child are unknown. For asylum-seeking children, access to healthcare has to be considered in a wider context that includes the core conditions of being an asylum-seeker. A comparative study at policy level needs to be supplemented with empirical follow-up studies of the well-being of the study population to document potential consequences of policies in practice.

  12. Impact of Socioeconomic Inequality on Access, Adherence, and Outcomes of Antiretroviral Treatment Services for People Living with HIV/AIDS in Vietnam.

    Science.gov (United States)

    Tran, Bach Xuan; Hwang, Jongnam; Nguyen, Long Hoang; Nguyen, Anh Tuan; Latkin, Noah Reed Knowlton; Tran, Ngoc Kim; Minh Thuc, Vu Thi; Nguyen, Huong Lan Thi; Phan, Huong Thu Thi; Le, Huong Thi; Tran, Tho Dinh; Latkin, Carl A

    2016-01-01

    Ensuring an equal benefit across different patient groups is necessary while scaling up free-of-charge antiretroviral treatment (ART) services. This study aimed to measure the disparity in access, adherence, and outcomes of ART in Vietnam and the effects of socioeconomic status (SES) characteristics on the levels of inequality. A cross-sectional study was conducted in 1133 PLWH in Vietnam. ART access, adherence, and treatment outcomes were self-reported using a structured questionnaire. Wealth-related inequality was calculated using a concentration index, and a decomposition analysis was used to determine the contribution of each SES variable to inequality in access, adherence, and outcomes of ART. Based on SES, minor inequality was found in ART access and adherence while there was considerable inequality in ART outcomes. Poor people were more likely to start treatment early, while rich people had better adherence and overall treatment outcomes. Decomposition revealed that occupation and education played important roles in inequality in ART access, adherence, and treatment outcomes. The findings suggested that health services should be integrated into the ART regimen. Furthermore, occupational orientation and training courses should be provided to reduce inequality in ART access, adherence, and treatment outcomes.

  13. Healthcare Needs of and Access Barriers for Brazilian Transgender and Gender Diverse People.

    Science.gov (United States)

    Costa, Angelo Brandelli; da Rosa Filho, Heitor Tome; Pase, Paola Fagundes; Fontanari, Anna Martha Vaitses; Catelan, Ramiro Figueiredo; Mueller, Andressa; Cardoso, Dhiordan; Soll, Bianca; Schwarz, Karine; Schneider, Maiko Abel; Gagliotti, Daniel Augusto Mori; Saadeh, Alexandre; Lobato, Maria Inês Rodrigues; Nardi, Henrique Caetano; Koller, Silvia Helena

    2018-02-01

    Transgender and gender diverse people (TGD) have specific healthcare needs and struggles with access barriers that should be addressed by public health systems. Our study aimed to address this topic in the Brazilian context. A hospital and web-based cross-sectional survey built with input from the medical and transgender communities was developed to assess TGD healthcare needs of and access barriers in two Brazilian states. Although services that assist this population have existed in Brazil since the 1990s, TGD have difficulty accessing these services due to discrimination, lack of information and a policy design that does not meet the needs of TGD. A history of discrimination was associated with a 6.72-fold increase in the frequency of health service avoidance [95% CI (4.5, 10.1)]. This article discusses the urgent necessity for adequate health policies and for the training of professionals regarding the needs of Brazilian TGD.

  14. The impact of a hybrid social marketing intervention on inequities in access, ownership and use of insecticide-treated nets

    Directory of Open Access Journals (Sweden)

    Stallworthy Guy

    2007-01-01

    Full Text Available Abstract Background An ITN intervention was initiated in three predominantly rural districts of Eastern Province, Zambia, that lacked commercial distribution and communication infrastructures. Social marketing techniques were used for product and message development. Public sector clinics and village-based volunteers promoted and distributed subsidized ITNs priced at $2.5 per net. A study was conducted to assess the effects of the intervention on inequities in knowledge, access, ownership and use of ITNs. Methods A post-test only quasi-experimental study design was used to compare intervention and comparison districts. A total of 2,986 respondents were interviewed. Survey respondents were grouped into four socio-economic (SES categories: low, medium-low, medium and high. Knowledge, access, ownership and use indicators are compared. Concentration index scores are calculated. Interactions between intervention status and SES help determine how different SES groups benefited from the intervention. Results Although overall use of nets remained relatively low, post-test data show that knowledge, access, ownership and use of mosquito nets was higher in intervention districts. A decline in SES inequity in access to nets occurred in intervention districts, resulting from a disproportionately greater increase in access among the low SES group. Declines in SES inequities in net ownership and use of nets were associated with the intervention. The largest increases in net ownership and use occurred among medium and high SES categories. Conclusion Increasing access to nets among the poorest respondents in rural areas may not lead to increases in net use unless the price of nets is no longer a barrier to their purchase.

  15. The impact of a hybrid social marketing intervention on inequities in access, ownership and use of insecticide-treated nets.

    Science.gov (United States)

    Agha, Sohail; Van Rossem, Ronan; Stallworthy, Guy; Kusanthan, Thankian

    2007-01-29

    An ITN intervention was initiated in three predominantly rural districts of Eastern Province, Zambia, that lacked commercial distribution and communication infrastructures. Social marketing techniques were used for product and message development. Public sector clinics and village-based volunteers promoted and distributed subsidized ITNs priced at 2.5 dollars per net. A study was conducted to assess the effects of the intervention on inequities in knowledge, access, ownership and use of ITNs. A post-test only quasi-experimental study design was used to compare intervention and comparison districts. A total of 2,986 respondents were interviewed. Survey respondents were grouped into four socio-economic (SES) categories: low, medium-low, medium and high. Knowledge, access, ownership and use indicators are compared. Concentration index scores are calculated. Interactions between intervention status and SES help determine how different SES groups benefited from the intervention. Although overall use of nets remained relatively low, post-test data show that knowledge, access, ownership and use of mosquito nets was higher in intervention districts. A decline in SES inequity in access to nets occurred in intervention districts, resulting from a disproportionately greater increase in access among the low SES group. Declines in SES inequities in net ownership and use of nets were associated with the intervention. The largest increases in net ownership and use occurred among medium and high SES categories. Increasing access to nets among the poorest respondents in rural areas may not lead to increases in net use unless the price of nets is no longer a barrier to their purchase.

  16. Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China.

    Science.gov (United States)

    Zhang, Xufan; Dupre, Matthew E; Qiu, Li; Zhou, Wei; Zhao, Yuan; Gu, Danan

    2017-07-19

    Studies have shown that inadequate access to healthcare is associated with lower levels of health and well-being in older adults. Studies have also shown significant urban-rural differences in access to healthcare in developing countries such as China. However, there is limited evidence of whether the association between access to healthcare and health outcomes differs by urban-rural residence at older ages in China. Four waves of data (2005, 2008/2009, 2011/2012, and 2014) from the largest national longitudinal survey of adults aged 65 and older in mainland China (n = 26,604) were used for analysis. The association between inadequate access to healthcare (y/n) and multiple health outcomes were examined-including instrumental activities of daily living (IADL) disability, ADL disability, cognitive impairment, and all-cause mortality. A series of multivariate models were used to obtain robust estimates and to account for various covariates associated with access to healthcare and/or health outcomes. All models were stratified by urban-rural residence. Inadequate access to healthcare was significantly higher among older adults in rural areas than in urban areas (9.1% vs. 5.4%; p China. The associations between access to healthcare and health outcomes were generally stronger among older adults in rural areas than in urban areas. Our findings underscore the importance of providing adequate access to healthcare for older adults-particularly for those living in rural areas in developing countries such as China.

  17. The relation between household income and surgical outcome in the Dutch setting of equal access to and provision of healthcare.

    Science.gov (United States)

    Ultee, Klaas H J; Tjeertes, Elke K M; Bastos Gonçalves, Frederico; Rouwet, Ellen V; Hoofwijk, Anton G M; Stolker, Robert Jan; Verhagen, Hence J M; Hoeks, Sanne E

    2018-01-01

    The impact of socioeconomic disparities on surgical outcome in the absence of healthcare inequality remains unclear. Therefore, we set out to determine the association between socioeconomic status (SES), reflected by household income, and overall survival after surgery in the Dutch setting of equal access and provision of care. Additionally, we aim to assess whether SES is associated with cause-specific survival and major 30-day complications. Patients undergoing surgery between March 2005 and December 2006 in a general teaching hospital in the Netherlands were prospectively included. Adjusted logistic and cox regression analyses were used to assess the independent association of SES-quantified by gross household income-with major 30-day complications and long-term postoperative survival. A total of 3929 patients were included, with a median follow-up of 6.3 years. Low household income was associated with worse survival in continuous analysis (HR: 1.05 per 10.000 euro decrease in income, 95% CI: 1.01-1.10) and in income quartile analysis (HR: 1.58, 95% CI: 1.08-2.31, first [i.e. lowest] quartile relative to the fourth quartile). Similarly, low income patients were at higher risk of cardiovascular death (HR: 1.26 per 10.000 decrease in income, 95% CI: 1.07-1.48, first income quartile: HR: 3.10, 95% CI: 1.04-9.22). Household income was not independently associated with cancer-related mortality and major 30-day complications. Low SES, quantified by gross household income, is associated with increased overall and cardiovascular mortality risks among surgical patients. Considering the equality of care provided by this study setting, the associated survival hazards can be attributed to patient and provider factors, rather than disparities in healthcare. Increased physician awareness of SES as a risk factor in preoperative decision-making and focus on improving established SES-related risk factors may improve surgical outcome of low SES patients.

  18. A re-conceptualization of access for 21st century healthcare.

    Science.gov (United States)

    Fortney, John C; Burgess, James F; Bosworth, Hayden B; Booth, Brenda M; Kaboli, Peter J

    2011-11-01

    Many e-health technologies are available to promote virtual patient-provider communication outside the context of face-to-face clinical encounters. Current digital communication modalities include cell phones, smartphones, interactive voice response, text messages, e-mails, clinic-based interactive video, home-based web-cams, mobile smartphone two-way cameras, personal monitoring devices, kiosks, dashboards, personal health records, web-based portals, social networking sites, secure chat rooms, and on-line forums. Improvements in digital access could drastically diminish the geographical, temporal, and cultural access problems faced by many patients. Conversely, a growing digital divide could create greater access disparities for some populations. As the paradigm of healthcare delivery evolves towards greater reliance on non-encounter-based digital communications between patients and their care teams, it is critical that our theoretical conceptualization of access undergoes a concurrent paradigm shift to make it more relevant for the digital age. The traditional conceptualizations and indicators of access are not well adapted to measure access to health services that are delivered digitally outside the context of face-to-face encounters with providers. This paper provides an overview of digital "encounterless" utilization, discusses the weaknesses of traditional conceptual frameworks of access, presents a new access framework, provides recommendations for how to measure access in the new framework, and discusses future directions for research on access.

  19. Inequality in access to health care in Cambodia: socioeconomically disadvantaged women giving birth at home assisted by unskilled birth attendants.

    Science.gov (United States)

    Hong, Rathavuth; Them, Rathnita

    2015-03-01

    Cambodia faces major challenges in its effort to provide access to health care for all. Although there is a sharp improvement in health and health care in Cambodia, 6 in 10 women still deliver at home assisted by unskilled birth attendants. This practice is associated with higher maternal and infant deaths. This article analyzes the 2005 Cambodia Demographic and Health Survey data to examine the relationship between socioeconomic inequality and deliveries at home assisted by unskilled birth attendants. It is evident that babies in poorer households are significantly more likely to be delivered at home by an unskilled birth attendant than those in wealthier households. Moreover, delivery at home by an unskilled attendant is associated with mothers who have no education, live in a rural residence, and are farmers, and with higher birth order children. Results from this analysis demonstrate that socioeconomic inequality is still a major factor contributing to ill health in Cambodia. © 2011 APJPH.

  20. Healthcare Barriers and Utilization Among Adolescents and Young Adults Accessing Services for Homeless and Runaway Youth.

    Science.gov (United States)

    Chelvakumar, Gayathri; Ford, Nancy; Kapa, Hillary M; Lange, Hannah L H; McRee, Annie-Laurie; Bonny, Andrea E

    2017-06-01

    Homeless and runaway youth are at disproportionate risk for adverse health outcomes. Many barriers to accessing healthcare have been documented; however, the relative impact of discrete barriers on homeless youth healthcare utilization behavior is not firmly established. We administered a survey examining reported barriers and healthcare utilization among adolescents and young adults accessing services at three community centers for homeless and runaway youth. Of 180 respondents, 57 % were male, 80 % non-White, and 21 % identified as a sexual minority. Stepwise logistic regression models, controlling for age and study site, explored associations between barriers and 3 healthcare utilization outcomes (doctor visit in past 12 months; regular care provider; frequent emergency department (ED) visits). The most commonly reported barriers were "don't have a ride" (27.2 %), "no insurance" (23.3 %), and "costs too much" (22.8 %). All fear-based barriers (e.g., "I don't trust the doctors") were reported by runaway youth as the impact of discrete barriers varies depending on outcome of focus.

  1. Communication Access for Deaf People in Healthcare Settings: Understanding the Work of American Sign Language Interpreters.

    Science.gov (United States)

    Olson, Andrea M; Swabey, Laurie

    Despite federal laws that mandate equal access and communication in all healthcare settings for deaf people, consistent provision of quality interpreting in healthcare settings is still not a reality, as recognized by deaf people and American Sign Language (ASL)-English interpreters. The purpose of this study was to better understand the work of ASL interpreters employed in healthcare settings, which can then inform on training and credentialing of interpreters, with the ultimate aim of improving the quality of healthcare and communication access for deaf people. Based on job analysis, researchers designed an online survey with 167 task statements representing 44 categories. American Sign Language interpreters (N = 339) rated the importance of, and frequency with which they performed, each of the 167 tasks. Categories with the highest average importance ratings included language and interpreting, situation assessment, ethical and professional decision making, manage the discourse, monitor, manage and/or coordinate appointments. Categories with the highest average frequency ratings included the following: dress appropriately, adapt to a variety of physical settings and locations, adapt to working with variety of providers in variety of roles, deal with uncertain and unpredictable work situations, and demonstrate cultural adaptability. To achieve health equity for the deaf community, the training and credentialing of interpreters needs to be systematically addressed.

  2. Understanding health-care access and utilization disparities among Latino children in the United States.

    Science.gov (United States)

    Langellier, Brent A; Chen, Jie; Vargas-Bustamante, Arturo; Inkelas, Moira; Ortega, Alexander N

    2016-06-01

    It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006-2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., income) and (2) those attributable to differences in group-specific regression coefficients that measure the health-care 'return' Latino, White, and Black children receive on these characteristics. In the United States, Latino children are less likely than Whites to have a usual source of care, receive at least one preventive care visit, and visit a doctor, and are more likely to have delayed care. The return on sociodemographic characteristics explains 20-30% of the disparity between Latino and White children in the usual source of care, delayed care, and doctor visits and 40-50% of the disparity between Latinos and Blacks in emergency department use and preventive care. Much of the health-care disadvantage experienced by Latino children would persist if Latinos had the sociodemographic characteristics as Whites and Blacks. © The Author(s) 2014.

  3. Healthcare Access for Iraqi Refugee Children in Texas: Persistent Barriers, Potential Solutions, and Policy Implications.

    Science.gov (United States)

    Vermette, David; Shetgiri, Rashmi; Al Zuheiri, Haidar; Flores, Glenn

    2015-10-01

    To identify access barriers to healthcare and potential interventions to improve access for Iraqi refugee children. Four focus groups were conducted using consecutive sampling of Iraqi refugee parents residing in the US for 8 months to 5 years. Eight key-informant interviews also were conducted with employees of organizations serving Iraqi refugee families, recruited using snowball sampling. Focus groups and interviews were audiotaped, transcribed, and analyzed using margin coding and grounded theory. Iraqi refugees identified provider availability, Medicaid maintenance and renewal, language issues, and inadequate recognition of post-traumatic stress disorder as barriers to care for their children. Interviewees cited loss of case-management services and difficulties in understanding the Medicaid renewal process as barriers. Potential interventions to improve access include community-oriented efforts to educate parents on Medicaid renewal, obtaining services, and accessing specialists. Given the enduring nature of language and Medicaid renewal barriers, policies addressing eligibility alone are insufficient.

  4. Accessibility and use of primary healthcare for immigrants living in the Niagara Region.

    Science.gov (United States)

    Lum, Irene D; Swartz, Rebecca H; Kwan, Matthew Y W

    2016-05-01

    Although the challenges of accessing and using primary healthcare for new immigrants to Canada have been fairly well documented, the focus has primarily been on large cities with significant immigrant populations. The experiences of immigrants living in smaller, less diverse urban centres remain largely unknown. The purpose of this study was to examine the lived experiences of immigrants living in a small urban centre with regards to the primary healthcare system. A total of 13 immigrants living in the Greater Niagara Region participated in semi-structured interviews. All interviews were recorded, transcribed, and then coded and analyzed for emergent themes using NVivo. Five factors were found to impact primary care access and use: lack of social contacts, lack of universal healthcare coverage during their initial arrival, language as a barrier, treatment preferences, and geographic distance to primary care. Overall findings suggest that immigrants moving to smaller areas such as the Niagara Region face similar barriers to primary care as those moving into large cities. Some barriers, however, appear to be specific to the context of smaller urban centres, further exacerbated by living in a small city due to a smaller immigrant population, fewer services for immigrants, and less diversity in practicing physicians. More research is required to understand the contextual factors inhibiting primary care access and use among immigrants moving to smaller urban centres, and determine effective strategies to overcome these barriers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Health-Care Access during the Ebola Virus Epidemic in Liberia.

    Science.gov (United States)

    McQuilkin, Patricia A; Udhayashankar, Kanagasabai; Niescierenko, Michelle; Maranda, Louise

    2017-09-01

    The Ebola virus disease (EVD) epidemic, which began in West Africa in December 2013, claimed more than 11,000 lives, with more than 4,800 of these deaths occurring in Liberia. The epidemic had an additional effect of paralyzing the health-care systems in affected countries, which led to even greater mortality and morbidity. Little is known about the impact that the epidemic had on the provision of basic health care. During the period from March to May 2015, we undertook a nationwide, community-based survey to learn more about health-care access during the EVD epidemic in Liberia. A cluster sampling strategy was used to administer a structured in-person survey to heads of households located within the catchment areas surrounding all 21 government hospitals in Liberia. A total of 543 heads of household from all 15 counties in Liberia participated in the study; more than half (67%) of urban respondents and 46% of rural respondents stated that it was very difficult or impossible to access health care during the epidemic. In urban areas, only 20-30% of patients seeking care during the epidemic received care, and in rural areas, only 70-80% of those seeking care were able to access it. Patients requiring prenatal and obstetric care and emergency services had the most difficulty accessing care. The results of this survey support the observation that basic health care was extremely difficult to access during the EVD epidemic in Liberia. Our results underscore the critical need to support essential health-care services during humanitarian crises to minimize preventable morbidity and mortality.

  6. Disparities in the access to primary healthcare in rural areas from the county of Iasi - Romania.

    Science.gov (United States)

    Duma, Olga-Odetta; Roşu, Solange Tamara; Manole, M; Petrariu, F D; Constantin, Brânduşa

    2014-01-01

    To identify the factors that may conduct to various forms of social exclusion of the population from the primary healthcare and to analyze health disparities as population-specific differences in the access to primary healthcare in rural compared to urban residence areas from Iasi, the second biggest county, situated in the North--East region of Romania. This research is a type of inquiry-based opinion survey of the access to primary healthcare in rural compared to urban areas of the county of Iasi. Data were collected by face-to-face interviews. There were taken into account the socioeconomic status (education level in the adult population, employment status, family income, household size) and two temporal variables (the interval of time spent to arrive at the primary healthcare office as a marker for the geographical access and the waiting time for a consultation). The study group consisted of two samples, from rural and urban area, each of 150 patients, all ages, randomly selected, who were waiting at the family doctor's practice. The study has identified disparities related to a poor economic status assessed through the employed status ("not working" 15% in urban and of 20% in rural).The income calculated per member of family and divided in terciles has recorded significant differences for "high" (36.7% urban and 14.7% rural) and "low", respectively (14.6% urban and 56.6% rural). High household size with more than five members represented 22.6% of the total subjects in rural and 15.3% in urban areas. The assessment of the education level in the adult population (> 18 years) revealed that in the rural areas more than a half (56%) of the sample is placed in the category primary and secondary incomplete, whereas the value for secondary complete and postsecondary was 37.3%. The proportion of respondents in the urban areas who have post-secondary education is five times higher than those in rural areas (15.4% vs. 2.7%). The reduced geographical access assessed as

  7. Inequalities in Educational Access in Mexico: A Study with Graduates Students of a High Performance Technical High School

    Directory of Open Access Journals (Sweden)

    Fernando Pérez-Santiago

    2016-09-01

    Full Text Available Access to the higher education system in Mexico has been characterized by educational inequalities explained by social and reproductionist currents. The phenomenon occurs in graduate students with a high school diploma and coming from different contexts (social, cultural, economic, institutional and academic ones that create a process of transition far away from equal opportunities. Therefore, the differences due to cultural diversity do not generate equitable access to higher education institutions. The aim of this study was to identify the social, cultural and academic factors affecting the access to or the abandonment of the academic education of students with expectations of entering the higher education system. The research was based on the results obtained from forty technicians who studied at a vocational high school with high academic performance in Mexico, and were supposed to enter the higher level. It was an exploratory descriptive investigation with qualitative approach, using two multiple-choice item questionnaires whose results were analyzed interpretively. The sampling was non-probability, with the technique of “snowball” and “convenience”. The results showed that the level of parents’ schooling, social relations, and academic career of graduates were decisive to enter the higher education; so it can be concluded that the students’ origin generate inequality in educational achievement.

  8. Lesbian womens' access to healthcare, experiences with and expectations towards GPs in German primary care.

    Science.gov (United States)

    Hirsch, Oliver; Löltgen, Karina; Becker, Annette

    2016-11-21

    Lesbian women have higher rates of physical and psychiatric disorders associated with experiences of discrimination, homophobia and difficulties with coming out. Therefore, easy access to specialized healthcare in an open atmosphere is needed. We aimed to describe women's access to and experiences with healthcare in Germany, and to assess the responsibility of the general practitioner (GP) compared to other specialities providing primary health care. A questionnaire study was conducted via internet and paper-based sampling. Using current literature, we designed a questionnaire consisting of sociodemographic data, sexual orientation, access to care and reasons for encounter, disclosure of sexual orientation, experience with the German health system (discrimination, homophobia), and psychological burden. Depression was assessed using the depression screening from the Patient Health Questionnaire (PHQ-2). We obtained responses from 766 lesbian women. Although 89% had a primary care physician, only 40% had revealed their sexual orientation to their doctor. The main medical contacts were GPs (66%), gynaecologists (10%) or psychiatrists (6%). Twenty-three percent claimed they were unable to find a primary care physician. Another 12.4% had experienced discrimination. Younger lesbian women with higher education levels and who were less likely to be out to other physicians were more likely to disclose their sexual orientation to their primary care physician. GPs play an important role in healthcare for lesbian women, even in a non-gatekeeping healthcare system like Germany. Study participants suggested improvements regarding gender neutral language, flyers on homosexuality in waiting areas, involvement of partners, training of physicians, directories of homosexual physicians and labelling as a lesbian-friendly practice. GPs should create an open atmosphere and acquire the respective knowledge to provide adequate treatment. Caring for marginal groups should be incorporated

  9. Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients - a systematic review

    Directory of Open Access Journals (Sweden)

    Corrieri Sandro

    2010-08-01

    Full Text Available Abstract Background In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP associated with income, education or gender in the Elderly aged 65+. Methods Based on an online search (PubMed, 29 studies providing information on OOPP of 65+ beneficiaries in relation to income, education and gender were reviewed. Results Low-income individuals pay the highest OOPP in relation to their earnings. Prescription drugs account for the biggest share. A lower educational level is associated with higher OOPP for prescription drugs and a higher probability of insufficient insurance protection. Generally, women face higher OOPP due to their lower income and lower labour participation rate, as well as less employer-sponsored health-care. Conclusions While most studies found educational and gender inequalities to be associated with income, there might also be effects induced solely by education; for example, an unhealthy lifestyle leading to higher payments for lower-educated people, or exclusively gender-induced effects, like sex-specific illnesses. Based on the considered studies, an explanation for inequalities in OOPP by these factors remains ambiguous.

  10. Access to healthcare for disabled persons. How are blind people reached by HIV services?

    Science.gov (United States)

    Saulo, Bryson; Walakira, Eddy; Darj, Elisabeth

    2012-03-01

    Disabled people are overlooked and marginalised globally. There is a lack of information on blind people and HIV-related services and it is unclear how HIV-services target blind people in a sub-Saharan urban setting. To explore how blind people are reached by HIV-services in Kampala, Uganda. A purposeful sample of blind people and seeing healthcare workers were interviewed, and data on their opinions and experiences were collected. The data were analysed by qualitative content analysis, with a focus on manifest content. Three categories emerged from the study, reaching for HIV information and knowledge, lack of services, and experiences of discrimination. General knowledge on HIV prevention/transmission methods was good; however, there was scepticism about condom use. Blind people mainly relied on others for accessing HIV information, and a lack of special services for blind people to be able to test for HIV was expressed. The health service for blind people was considered inadequate, unequal and discriminatory, and harassment by healthcare staff was expressed, but not sexual abuse. Concerns about disclosure of personal medical information were revealed. Access to HIV services and other healthcare related services for blind people is limited and the objectives of the National Strategic Plan for HIV/AIDS 2007-2012 have not been achieved. There is a need for alternative methods for sensitisation and voluntary counselling and testing (VCT) for blind people. Copyright © 2011 Elsevier B.V. All rights reserved.

  11. Gender identity, healthcare access, and risk reduction among Malaysia’s mak nyah community

    Science.gov (United States)

    Gibson, Britton A.; Brown, Shan-Estelle; Rutledge, Ronnye; Wickersham, Jeffrey A.; Kamarulzaman, Adeeba; Altice, Frederick L.

    2016-01-01

    Transgender women (TGW) face compounded levels of stigma and discrimination, resulting in multiple health risks and poor health outcomes. TGW identities are erased by forcing them into binary sex categories in society or treating them as men who have sex with men (MSM). In Malaysia, where both civil and religious law criminalize them for their identities, many TGW turn to sex work with inconsistent prevention methods, which increases their health risks. This qualitative study aims to understand how the identities of TGW sex workers shapes their healthcare utilization patterns and harm reduction behaviours. In-depth, semi-structured interviews were conducted with 21 male-to-female transgender (mak nyah) sex workers in Malaysia. Interviews were transcribed, translated into English, and analysed using thematic coding. Results suggest that TGW identity is shaped at an early age followed by incorporation into the mak nyah community where TGW were assisted in gender transition and introduced to sex work. While healthcare was accessible, it failed to address the multiple healthcare needs of TGW. Pressure for gender-affirming health procedures and fear of HIV and sexually transmitted infection screening led to potentially hazardous health behaviours. These findings have implications for developing holistic, culturally-sensitive prevention and healthcare services for TGW. PMID:26824463

  12. Gender identity, healthcare access, and risk reduction among Malaysia's mak nyah community.

    Science.gov (United States)

    Gibson, Britton A; Brown, Shan-Estelle; Rutledge, Ronnye; Wickersham, Jeffrey A; Kamarulzaman, Adeeba; Altice, Frederick L

    2016-01-01

    Transgender women (TGW) face compounded levels of stigma and discrimination, resulting in multiple health risks and poor health outcomes. TGW identities are erased by forcing them into binary sex categories in society or treating them as men who have sex with men (MSM). In Malaysia, where both civil and religious law criminalise them for their identities, many TGW turn to sex work with inconsistent prevention methods, which increases their health risks. This qualitative study aims to understand how the identities of TGW sex workers shapes their healthcare utilisation patterns and harm reduction behaviours. In-depth, semi-structured interviews were conducted with 21 male-to-female transgender (mak nyah) sex workers in Malaysia. Interviews were transcribed, translated into English, and analysed using thematic coding. Results suggest that TGW identity is shaped at an early age followed by incorporation into the mak nyah community where TGW were assisted in gender transition and introduced to sex work. While healthcare was accessible, it failed to address the multiple healthcare needs of TGW. Pressure for gender-affirming health procedures and fear of HIV and sexually transmitted infection screening led to potentially hazardous health behaviours. These findings have implications for developing holistic, culturally sensitive prevention and healthcare services for TGW.

  13. Healthcare

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  14. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups

    Directory of Open Access Journals (Sweden)

    Smith Lucy

    2006-07-01

    Full Text Available Abstract Background Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK Methods This project involved the development and use of the method of Critical Interpretive Synthesis (CIS. This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis. Results Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually. A more useful means of understanding access is offered by the synthetic construct of candidacy. Candidacy describes how people's eligibility for healthcare is determined between themselves and health services. It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services. Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention. Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes. By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research. Discussion By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical

  15. : health is my capital: a qualitative study of access to healthcare by Chinese migrants in Singapore.

    Science.gov (United States)

    Tam, Wai Jia; Goh, Wei Leong; Chua, Jeffrey; Legido-Quigley, Helena

    2017-06-15

    Since the 1970s, Singapore has turned into one of the major receiving countries of foreign workers in Southeast Asia. Over the years, challenges surrounding access to healthcare by Chinese migrant workers have surfaced globally. This study aims to explore the experiences of Chinese migrants accessing primary and secondary/tertiary healthcare in Singapore, and the opportunities for overcoming these barriers. We conducted 25 in-depth interviews of 20 Chinese migrants and five staff from HealthServe, a non-governmental organization serving Chinese migrants in Singapore from October 2015 to January 2016. Interviews were transcribed and analysed inductively adopting thematic analysis. Chinese migrants in Singapore who were interviewed are mainly middle-aged breadwinners with multiple dependents. Their concept of health is encapsulated in a Chinese proverb ", meaning "health is my capital". Health is defined by them as a personal asset, needed to provide for their families. From their health-seeking behaviors, six pathways were identified, highlighting different routes chosen and resulting outcomes depending on whether their illness was perceived as major or minor, and if they sought help from the private or public sector private or public sector. Key barriers were identified relating to vulnerabilities during the migration process, during their illness, when consulting with healthcare providers, and during repatriation. A transactional doctor-patient culture in China contrasts with the trust migrants place in Singaporean's public health system, perceived as equitable and personable. However, challenges remain for injured migrants who sought help from the private sector and those with chronic diseases. Policy recommendations to increase patient autonomy enabling choice of healthcare provider and provide for non-work related illnesses are suggested. Partnerships between migrant advocacy organizations and various stakeholders such as hospitals, government agencies and

  16. Food Insecurity and Chronic Disease: Addressing Food Access as a Healthcare Issue.

    Science.gov (United States)

    Decker, Dominic; Flynn, Mary

    2018-05-01

    Food insecurity, or lack of access to nutritionally adequate food, affects millions of US households every year. Food insecure individuals face disproportionately higher rates of chronic diseases, like diabetes mellitus and HIV/AIDS, and therefore accrue more healthcare costs. This puts into motion a cycle of disease and expense that furthers disparities between food secure and insecure patients. Our aim is to provide an overview of food insecurity, define its link to chronic disease and offer practical solutions for addressing this growing problem. [Full article available at http://rimed.org/rimedicaljournal-2018-05.asp].

  17. Estimation and Evaluation of Future Demand and Supply of Healthcare Services Based on a Patient Access Area Model

    Directory of Open Access Journals (Sweden)

    Shunsuke Doi

    2017-11-01

    Full Text Available Accessibility to healthcare service providers, the quantity, and the quality of them are important for national health. In this study, we focused on geographic accessibility to estimate and evaluate future demand and supply of healthcare services. We constructed a simulation model called the patient access area model (PAAM, which simulates patients’ access time to healthcare service institutions using a geographic information system (GIS. Using this model, to evaluate the balance of future healthcare services demand and supply in small areas, we estimated the number of inpatients every five years in each area and compared it with the number of hospital beds within a one-hour drive from each area. In an experiment with the Tokyo metropolitan area as a target area, when we assumed hospital bed availability to be 80%, it was predicted that over 78,000 inpatients would not receive inpatient care in 2030. However, this number would decrease if we lowered the rate of inpatient care by 10% and the average length of the hospital stay. Using this model, recommendations can be made regarding what action should be undertaken and by when to prevent a dramatic increase in healthcare demand. This method can help plan the geographical resource allocation in healthcare services for healthcare policy.

  18. Inequality in Preschool Quality? Community-Level Disparities in Access to High-Quality Learning Environments

    Science.gov (United States)

    Bassok, Daphna; Galdo, Eva

    2016-01-01

    In recent years, unequal access to high-quality preschool has emerged as a growing public policy concern. Because of data limitations, it is notoriously difficult to measure disparities in access to early learning opportunities across communities and particularly challenging to quantify gaps in access to "high-quality" programs. Research…

  19. Telemedicine and its potential impacts on reducing inequalities in access to health manpower.

    Science.gov (United States)

    Nouhi, Mojtaba; Fayaz-Bakhsh, Ahmad; Mohamadi, Efat; Shafii, Milad

    2012-10-01

    Human resources for health have many diverse aspects that sometimes bring about conflicts in the healthcare market. In recent decades issues such as attrition, migration, and different types of imbalances in health workers were not only considered as international problems, but also took on new particular dimensions and complications. Rapid growth in establishing infrastructure of communications and many diseases such as human immunodeficiency virus/AIDS and malaria, as well as shortages in skilled healthcare providers in developing countries, interested many health economists and health professionals to consider telemedicine as an approach to deliver some healthcare and to pursue its effects on human resources management in healthcare. The objective of this communication is to offer a better understanding of the value of telemedicine in human resources management in healthcare. This article briefly reviews related literature on potential contributions of telemedicine in mitigating four different types of imbalances in health workers and points out some of its capabilities. Although there is a great need for systematic, scientific, and analytical studies in effects of telemedicine on health workers, expansion of communication infrastructure throughout and especially in remote areas, political commitment, and provision of useful information and education to reduce problems of human resources for health are beneficial.

  20. Association between parental access to paid sick leave and children's access to and use of healthcare services.

    Science.gov (United States)

    Asfaw, Abay; Colopy, Maria

    2017-03-01

    We examined the association between parental access to paid sick leave (PPSL) and children's use of preventive care and reduced likelihood of delayed medical care and emergency room (ER) visits. We used the child sample of the National Health Interview Survey data (linked to the adult and family samples) from 2011 through 2015 and logistic and negative binomial regression models. Controlling for covariates, the odds of children with PPSL receiving flu vaccination were 12.5% [95%CI: 1.06-1.19] higher and receiving annual medical checkups were 13.2% [95%CI: 1.04-1.23] higher than those of children without PPSL. With PPSL, the odds of children receiving delayed medical care because of time mismatch were 13.3% [95%CI: 0.76-0.98] lower, and being taken to ER were 53.6% [95%CI: 0.27-0.81] lower than those of children without PPSL. PPSL was associated with 11% [95%CI: 0.82-0.97] fewer ER visits per year. PPSL may improve children's access and use of healthcare services and reduce the number of ER visits. Am. J. Ind. Med. 60:276-284, 2017. © 2017 Wiley Periodicals, Inc. © Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  1. Hub and spoke model: making rural healthcare in India affordable, available and accessible.

    Science.gov (United States)

    Devarakonda, Srichand

    2016-01-01

    Quality health care should be within everyone's reach, especially in a developing country. While India has the largest private health sector in the world, only one-fifth of healthcare expenditure is publically financed; it is mostly an out-of-pocket expense. About 70% of Indians live in rural areas making about $3 per day, and a major portion of that goes towards food and shelter and, thus, not towards health care. Transportation facilities in rural India are poor, making access to medical facilities difficult, and infrastructure facilities are minimal, making the available medical care insufficient. The challenge presented to India was to provide health care that was accessible, available and affordable to people in rural areas and the low-income bracket. The intent of this article is to determine whether the hub and spoke model (HSM), when implemented in the healthcare industry, can expand the market reach and increase profits while reducing costs of operations for organizations and, thereby, cost to customers. This article also discusses the importance of information and communications technologies (ICT) in the HSM approach, which the handful of published articles in this topic have failed to discuss. This article opts for an exploratory study, including review of published literature, web articles, viewpoints of industry experts, published journals, and in-depth interviews. This article will discuss how and why the HSM works in India's healthcare industry while isolating its strengths and weaknesses, and analyzing the impact of India's success. India's HSM implementation has become a paramount example of an acceptable model that, while exceeding the needs and expectations of its patients, is cost-effective and has obtained operational and health-driven results. Despite being an emerging nation, India takes the top spot in terms of affordability of ICT as well as for having the highest number of computer-literate graduates and healthcare workers in the world

  2. A review of accessibility of administrative healthcare databases in the Asia-Pacific region.

    Science.gov (United States)

    Milea, Dominique; Azmi, Soraya; Reginald, Praveen; Verpillat, Patrice; Francois, Clement

    2015-01-01

    We describe and compare the availability and accessibility of administrative healthcare databases (AHDB) in several Asia-Pacific countries: Australia, Japan, South Korea, Taiwan, Singapore, China, Thailand, and Malaysia. The study included hospital records, reimbursement databases, prescription databases, and data linkages. Databases were first identified through PubMed, Google Scholar, and the ISPOR database register. Database custodians were contacted. Six criteria were used to assess the databases and provided the basis for a tool to categorise databases into seven levels ranging from least accessible (Level 1) to most accessible (Level 7). We also categorised overall data accessibility for each country as high, medium, or low based on accessibility of databases as well as the number of academic articles published using the databases. Fifty-four administrative databases were identified. Only a limited number of databases allowed access to raw data and were at Level 7 [Medical Data Vision EBM Provider, Japan Medical Data Centre (JMDC) Claims database and Nihon-Chouzai Pharmacy Claims database in Japan, and Medicare, Pharmaceutical Benefits Scheme (PBS), Centre for Health Record Linkage (CHeReL), HealthLinQ, Victorian Data Linkages (VDL), SA-NT DataLink in Australia]. At Levels 3-6 were several databases from Japan [Hamamatsu Medical University Database, Medi-Trend, Nihon University School of Medicine Clinical Data Warehouse (NUSM)], Australia [Western Australia Data Linkage (WADL)], Taiwan [National Health Insurance Research Database (NHIRD)], South Korea [Health Insurance Review and Assessment Service (HIRA)], and Malaysia [United Nations University (UNU)-Casemix]. Countries were categorised as having a high level of data accessibility (Australia, Taiwan, and Japan), medium level of accessibility (South Korea), or a low level of accessibility (Thailand, China, Malaysia, and Singapore). In some countries, data may be available but accessibility was restricted

  3. A review of accessibility of administrative healthcare databases in the Asia-Pacific region

    Science.gov (United States)

    Milea, Dominique; Azmi, Soraya; Reginald, Praveen; Verpillat, Patrice; Francois, Clement

    2015-01-01

    Objective We describe and compare the availability and accessibility of administrative healthcare databases (AHDB) in several Asia-Pacific countries: Australia, Japan, South Korea, Taiwan, Singapore, China, Thailand, and Malaysia. Methods The study included hospital records, reimbursement databases, prescription databases, and data linkages. Databases were first identified through PubMed, Google Scholar, and the ISPOR database register. Database custodians were contacted. Six criteria were used to assess the databases and provided the basis for a tool to categorise databases into seven levels ranging from least accessible (Level 1) to most accessible (Level 7). We also categorised overall data accessibility for each country as high, medium, or low based on accessibility of databases as well as the number of academic articles published using the databases. Results Fifty-four administrative databases were identified. Only a limited number of databases allowed access to raw data and were at Level 7 [Medical Data Vision EBM Provider, Japan Medical Data Centre (JMDC) Claims database and Nihon-Chouzai Pharmacy Claims database in Japan, and Medicare, Pharmaceutical Benefits Scheme (PBS), Centre for Health Record Linkage (CHeReL), HealthLinQ, Victorian Data Linkages (VDL), SA-NT DataLink in Australia]. At Levels 3–6 were several databases from Japan [Hamamatsu Medical University Database, Medi-Trend, Nihon University School of Medicine Clinical Data Warehouse (NUSM)], Australia [Western Australia Data Linkage (WADL)], Taiwan [National Health Insurance Research Database (NHIRD)], South Korea [Health Insurance Review and Assessment Service (HIRA)], and Malaysia [United Nations University (UNU)-Casemix]. Countries were categorised as having a high level of data accessibility (Australia, Taiwan, and Japan), medium level of accessibility (South Korea), or a low level of accessibility (Thailand, China, Malaysia, and Singapore). In some countries, data may be available but

  4. Inequalities in Access to Treatment and Care for Patients with Dementia and Immigrant Background

    DEFF Research Database (Denmark)

    Stevnsborg, Lea; Jensen-Dahm, Christina; Nielsen, Thomas R

    2016-01-01

    BACKGROUND: Previous studies demonstrated lower quality diagnostic assessment of dementia in immigrant populations, but knowledge about the quality of treatment and care for dementia is still lacking. OBJECTIVE: To conduct a nationwide registry-based study to determine whether inequality exists...... in a nursing home were compared among Danish-born and Western and non-Western immigrants with dementia. Logistic regression analysis was done with adjustment for age, sex, comorbidity, marital status, basis of inclusion, and time since dementia diagnosis. RESULTS: Immigrant background was associated...

  5. Workarounds to computer access in healthcare organizations: you want my password or a dead patient?

    Science.gov (United States)

    Koppel, Ross; Smith, Sean; Blythe, Jim; Kothari, Vijay

    2015-01-01

    Workarounds to computer access in healthcare are sufficiently common that they often go unnoticed. Clinicians focus on patient care, not cybersecurity. We argue and demonstrate that understanding workarounds to healthcare workers' computer access requires not only analyses of computer rules, but also interviews and observations with clinicians. In addition, we illustrate the value of shadowing clinicians and conducing focus groups to understand their motivations and tradeoffs for circumvention. Ethnographic investigation of the medical workplace emerges as a critical method of research because in the inevitable conflict between even well-intended people versus the machines, it's the people who are the more creative, flexible, and motivated. We conducted interviews and observations with hundreds of medical workers and with 19 cybersecurity experts, CIOs, CMIOs, CTO, and IT workers to obtain their perceptions of computer security. We also shadowed clinicians as they worked. We present dozens of ways workers ingeniously circumvent security rules. The clinicians we studied were not "black hat" hackers, but just professionals seeking to accomplish their work despite the security technologies and regulations.

  6. A dialogue-based web application enhances personalized access to healthcare professionals – an intervention study

    Directory of Open Access Journals (Sweden)

    Bjoernes Charlotte D

    2012-09-01

    Full Text Available Abstract Background In today’s short stay hospital settings the contact time for patients is reduced. However, it seems to be more important for the patients that the healthcare professionals are easy to get in contact with during the whole course of treatment, and to have the opportunity to exchange information, as a basis for obtaining individualized information and support. Therefore, the aim was to explore the ability of a dialogue-based application to contribute to accessibility of the healthcare professionals and exchangeability of information. Method An application for online written and asynchronous contacts was developed, implemented in clinical practice, and evaluated. The qualitative effect of the online contact was explored using a Web-based survey comprised of open-ended questions. Results Patients valued the online contacts and experienced feelings of partnership in dialogue, in a flexible and calm environment, which supported their ability to be active partners and feelings of freedom and security. Conclusion The online asynchronous written environment can contribute to accessibility and exchangeability, and add new possibilities for dialogues from which the patients can benefit. The individualized information obtained via online contact empowers the patients. The Internet-based contacts are a way to differentiate and expand the possibilities for contacts outside the few scheduled face-to-face hospital contacts.

  7. Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study

    Science.gov (United States)

    Ganle, John Kuumuori; Otupiri, Easmon; Obeng, Bernard; Edusie, Anthony Kwaku; Ankomah, Augustine; Adanu, Richard

    2016-01-01

    Background While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. Methods and Findings A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Conclusions Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and

  8. The role of gender inequities in women's access to reproductive health care: a population-level study of Namibia, Kenya, Nepal, and India

    Directory of Open Access Journals (Sweden)

    Namasivayam A

    2012-07-01

    Full Text Available Amrita Namasivayam,1 Donatus C Osuorah,2 Rahman Syed,3 Diddy Antai3,41Department of Public Health, Division of Global Health (IHCAR, Karolinska Institute, Stockholm, Sweden; 2Department of Pediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria; 3Department of Public Health, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden; 4Division of Global Health and Inequalities, The Angels Trust, Abuja, NigeriaBackground: The role of gender inequities in explaining women's access to reproductive health care was examined in four countries (two sub-Saharan African and two South Asian countries. The extent of gender inequities varies across and within countries, and is rooted in the different cultural practices and gender norms within these different countries, and differences in the status and autonomy of women.Methods: Demographic and Health Survey data from women aged 15–49 years within these countries were analyzed with multivariate logistic regression analysis to examine the role of multidimensional characteristics of gender inequities, operationalized as access to skilled antenatal care, tetanus toxoid injection during pregnancy, and access to skilled antenatal care.Results: Significant associations were found between several dimensions of gender inequities (with the exception of decision-making autonomy and reported use of maternal reproductive health care services. Several pathways of influence between the outcome and exposure variables were also identified.Conclusion: Dimensions of gender inequities (with the exception of decision-making autonomy differentially influenced woman's use of reproductive health care services, thus highlighting the urgent need for concerted and sustained efforts to change these harmful traditional values if several of these countries are to meet Millennium Development Goal-5.Keywords: women, gender inequities, reproductive health care, Namibia, Kenya, Nepal, India

  9. Equal and universal access?: water at mealtimes, inequalities, and the challenge for schools in poor and rural communities.

    Science.gov (United States)

    Ramirez, Sarah M; Stafford, Randall

    2013-05-01

    As a result of the rising national obesity rates, public health researchers and advocates have initiated a number of obesity prevention interventions to reduce the rates of overweight and obesity along with their related medical conditions and costs. Policymakers have also initiated a wide range of environmental and policies to support healthy eating and physical activity. Policies such as California's SB1413, which requires that free drinking water be served in school cafeterias during mealtimes, and subsequently the Healthy Hunger-Free Kids Act of 2010, assume an equal access to safe and healthy drinking water. As a result, these policies and their application may unintentionally, exacerbate the inequities already present. Unless we take reasonable steps to address the needs of high-need communities, these one-size-fits-all policy efforts may result in an unequal patchwork of disparities and may have a greater negative impact in high-need poor and rural areas.

  10. Improving Maternal Healthcare Access and Neonatal Survival through a Birthing Home Model in Rural Haiti

    Directory of Open Access Journals (Sweden)

    Elizabeth Wickstrom

    2007-10-01

    Full Text Available High neonatal mortality in Haiti is sustained by limited access to essential maternity services, particularly for Haiti’s rural population. We investigated the feasibility of a rural birthing home model to provide basic prenatal, delivery, and neonatal services for women with uncomplicated pregnancies while simultaneously providing triage and transport of women with pregnancy related complications. The model included consideration of the local context, including women’s perceptions of barriers to healthcare access and available resources to implement change. Evaluation methods included the performance of a baseline community census and collection of pregnancy histories from 791 women living in a defined area of rural Haiti. These retrospective data were compared with pregnancy outcome for 668 women subsequently receiving services at the birthing home. Of 764 reported most recent pregnancies in the baseline survey, 663(87% occurred at home with no assistance from skilled health staff. Of 668 women followed after opening of the birthing home, 514 (77% subsequently gave birth at the birthing home, 94 (14% were referred to a regional hospital for delivery, and only 60 (9% delivered at home or on the way to the birthing home. Other measures of clinical volume and patient satisfaction also indicated positive changes in health care seeking. After introduction of the birthing home, fewer neonates died than predicted by historical information or national statistics. The present experience points out the feasibility of a rural birthing home model to increase access to essential maternity services.

  11. Hybrid Solution for Privacy-Preserving Access Control for Healthcare Data

    Directory of Open Access Journals (Sweden)

    SMITHAMOL, M. B.

    2017-05-01

    Full Text Available The booming in cloud and IoT technologies has accelerated the growth of healthcare system. The IoT devices monitor the patient's health, and upload collected data as Electronic Medical Records (EMRs to the cloud for storage and sharing. Outsourcing EMRs to the cloud introduce new security and privacy challenges. In this paper, we proposed a novel architecture ensuring security and privacy for the outsourced health records. The proposed model uses partially ordered set (POSET for constructing the group based access structure and Ciphertext-Policy Attribute-Based Encryption (CP-ABE to provide fine-grained EMR access control. The modified group based CP-ABE (G-CP-ABE minimizes the computational overhead by reducing the number of leaf nodes in the access tree. Also, the proposed G-CP-ABE framework merges symmetric encryption and CP-ABE scheme to minimize the overall encryption time. As a result, G-CP-ABE can be used to monitor health conditions even from a resource constrained IoT device. The performance analysis shows the efficiency of the proposed model, making it suitable for practical use.

  12. Creating community-based access to primary healthcare for the uninsured through strategic alliances and restructuring local health department programs.

    Science.gov (United States)

    Scotten, E Shirin L; Absher, Ann C

    2006-01-01

    In 2003, the Wilkes County Health Department joined with county healthcare providers to develop the HealthCare Connection, a coordinated and continuous system of low-cost quality care for uninsured and low-income working poor. Through this program, local providers of primary and specialty care donate specialty care or ancillary services not provided by the Health Department, which provides case management for the program. Basing their methods on business models learned through the UNC Management Academy for Public Health, planners investigated the best practices for extending healthcare coverage to the underinsured and uninsured, analyzed operational costs, discovered underutilized local resources, and built capacity within the organization. The HealthCare Connection is an example of how a rural community can join together in a common business practice to improve healthcare access for uninsured and/or low-income adults.

  13. Infrastructure Gap in South Asia: Inequality of Access to Infrastructure Services

    OpenAIRE

    Biller, Dan; Andrés, Luis; Herrera Dappe, Matías

    2014-01-01

    The South Asia region is home to the largest pool of individuals living under the poverty line, coupled with a fast-growing population. The importance of access to basic infrastructure services on welfare and the quality of life is clear. Yet the South Asia region's rates of access to infrastructure (sanitation, electricity, telecom, and transport) are closer to those of Sub-Saharan Africa...

  14. Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria.

    Science.gov (United States)

    Crowell, Trevor A; Keshinro, Babajide; Baral, Stefan D; Schwartz, Sheree R; Stahlman, Shauna; Nowak, Rebecca G; Adebajo, Sylvia; Blattner, William A; Charurat, Manhattan E; Ake, Julie A

    2017-04-20

    Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour-related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria. Respondent-driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self-report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex-selling on the risk of HIV. From 12 initial seed participants, 1552 men were recruited from March 2013-March 2016. Of these, 735 (47.4%) reported sex-selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p harassment (39.2% vs. 26.8%, p sexual behaviour-related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria.

  15. Modeling Social Capital as Dynamic Networks to Promote Access to Oral Healthcare.

    Science.gov (United States)

    Wang, Hua; Northridge, Mary E; Kunzel, Carol; Zhang, Qiuyi; Kum, Susan S; Gilbert, Jessica L; Jin, Zhu; Metcalf, Sara S

    2016-01-01

    Social capital, as comprised of human connections in social networks and their associated benefits, is closely related to the health of individuals, communities, and societies at large. For disadvantaged population groups such as older adults and racial/ethnic minorities, social capital may play a particularly critical role in mitigating the negative effects and reinforcing the positive effects on health. In this project, we model social capital as both cause and effect by simulating dynamic networks. Informed in part by a community-based health promotion program, an agent-based model is contextualized in a GIS environment to explore the complexity of social disparities in oral and general health as experienced at the individual, interpersonal, and community scales. This study provides the foundation for future work investigating how health and healthcare accessibility may be influenced by social networks.

  16. Design and development of a customizable telemedicine platform for improving access to healthcare for underserved populations.

    Science.gov (United States)

    Goel, Neha A; Alam, Amal A; Eggert, Emily M R; Acharya, Soumyadipta

    2017-07-01

    Telemedicine offers a method to bridge the healthcare access gap in low and middle income countries (LMICs) by connecting providers with patients using appropriate technology. Here we describe the design and development of a novel modular telemedicine platform, Intelehealth, that would enable health systems to connect remote doctors with patients in rural clinics using a customizable Android-based platform and a cloud-based electronic health record system at the backend (OpenMRS). This open source platform enables task shifting of medically relevant information gathering by a local health worker, transmission of this information to a remote doctor, and a telephonic conversation between the doctor and the patient that subsequently allows for delivery of an appropriate therapeutic plan. Intelehealth is designed to operate on a low bandwidth internet environment, and will be tested and validated in rural health clinics in India.

  17. A global map of travel time to cities to assess inequalities in accessibility in 2015

    Science.gov (United States)

    Weiss, D. J.; Nelson, A.; Gibson, H. S.; Temperley, W.; Peedell, S.; Lieber, A.; Hancher, M.; Poyart, E.; Belchior, S.; Fullman, N.; Mappin, B.; Dalrymple, U.; Rozier, J.; Lucas, T. C. D.; Howes, R. E.; Tusting, L. S.; Kang, S. Y.; Cameron, E.; Bisanzio, D.; Battle, K. E.; Bhatt, S.; Gething, P. W.

    2018-01-01

    The economic and man-made resources that sustain human wellbeing are not distributed evenly across the world, but are instead heavily concentrated in cities. Poor access to opportunities and services offered by urban centres (a function of distance, transport infrastructure, and the spatial distribution of cities) is a major barrier to improved livelihoods and overall development. Advancing accessibility worldwide underpins the equity agenda of ‘leaving no one behind’ established by the Sustainable Development Goals of the United Nations. This has renewed international efforts to accurately measure accessibility and generate a metric that can inform the design and implementation of development policies. The only previous attempt to reliably map accessibility worldwide, which was published nearly a decade ago, predated the baseline for the Sustainable Development Goals and excluded the recent expansion in infrastructure networks, particularly in lower-resource settings. In parallel, new data sources provided by Open Street Map and Google now capture transportation networks with unprecedented detail and precision. Here we develop and validate a map that quantifies travel time to cities for 2015 at a spatial resolution of approximately one by one kilometre by integrating ten global-scale surfaces that characterize factors affecting human movement rates and 13,840 high-density urban centres within an established geospatial-modelling framework. Our results highlight disparities in accessibility relative to wealth as 50.9% of individuals living in low-income settings (concentrated in sub-Saharan Africa) reside within an hour of a city compared to 90.7% of individuals in high-income settings. By further triangulating this map against socioeconomic datasets, we demonstrate how access to urban centres stratifies the economic, educational, and health status of humanity.

  18. A global map of travel time to cities to assess inequalities in accessibility in 2015.

    Science.gov (United States)

    Weiss, D J; Nelson, A; Gibson, H S; Temperley, W; Peedell, S; Lieber, A; Hancher, M; Poyart, E; Belchior, S; Fullman, N; Mappin, B; Dalrymple, U; Rozier, J; Lucas, T C D; Howes, R E; Tusting, L S; Kang, S Y; Cameron, E; Bisanzio, D; Battle, K E; Bhatt, S; Gething, P W

    2018-01-18

    The economic and man-made resources that sustain human wellbeing are not distributed evenly across the world, but are instead heavily concentrated in cities. Poor access to opportunities and services offered by urban centres (a function of distance, transport infrastructure, and the spatial distribution of cities) is a major barrier to improved livelihoods and overall development. Advancing accessibility worldwide underpins the equity agenda of 'leaving no one behind' established by the Sustainable Development Goals of the United Nations. This has renewed international efforts to accurately measure accessibility and generate a metric that can inform the design and implementation of development policies. The only previous attempt to reliably map accessibility worldwide, which was published nearly a decade ago, predated the baseline for the Sustainable Development Goals and excluded the recent expansion in infrastructure networks, particularly in lower-resource settings. In parallel, new data sources provided by Open Street Map and Google now capture transportation networks with unprecedented detail and precision. Here we develop and validate a map that quantifies travel time to cities for 2015 at a spatial resolution of approximately one by one kilometre by integrating ten global-scale surfaces that characterize factors affecting human movement rates and 13,840 high-density urban centres within an established geospatial-modelling framework. Our results highlight disparities in accessibility relative to wealth as 50.9% of individuals living in low-income settings (concentrated in sub-Saharan Africa) reside within an hour of a city compared to 90.7% of individuals in high-income settings. By further triangulating this map against socioeconomic datasets, we demonstrate how access to urban centres stratifies the economic, educational, and health status of humanity.

  19. Challenges with access to healthcare from the perspective of patients living with HIV: a scoping review & framework synthesis.

    Science.gov (United States)

    Asghari, Shabnam; Hurd, Jillian; Marshall, Zack; Maybank, Allison; Hesselbarth, Lydia; Hurley, Oliver; Farrell, Alison; Kendall, Claire E; Rourke, Sean B; Becker, Marissa; Johnston, Sharon; Lundrigan, Phil; Rosenes, Ron; Bibeau, Christine; Liddy, Clare

    2018-08-01

    Accessing healthcare can be difficult but the barriers multiply for people living with HIV (PLHIV). To improve access and the health of PLHIV, we must consider their perspectives and use them to inform standard practice. A better understanding of the current literature related to healthcare access from the perspective of PLHIV, can help to identify evidence gaps and highlight research priorities and opportunities. To identify relevant peer-reviewed publications, search strategies were employed. Electronic and grey literature databases were explored. Articles were screened based on their title and abstract and those that met the screening criteria, were reviewed in full. Data analysis was conducted using a collaborative approach that included knowledge user consultation. Initial concepts were extracted, summarized and through framework synthesis, developed into emerging and final themes. From 20,678 articles, 326 articles met the initial screening criteria and 64 were reviewed in full. The final themes identified, in order of most to least frequent were: Acceptability, Availability, Accessibility, Affordability, Other Barriers, Communication, Satisfaction, Accommodation, Preferences and Equity in Access. The most frequently discussed concepts related to negative interactions with staff, followed by long wait times, limited household resources or inability to pay fees, and fear of one's serostatus being disclosed. Knowledge users were in agreement with the categorization of initial concepts and final themes; however, some gaps in the literature were identified. Specific changes are critical to improving access to healthcare for PLHIV. These include improving availability by ensuring staff and healthcare professionals have proper training, cultivating acceptability and reducing stigma through improving HIV awareness, increasing accessibility through increased HIV information for PLHIV and improved dissemination of this information to increase patient knowledge and

  20. Access to healthcare for undocumented migrants in France: a critical examination of State Medical Assistance.

    Science.gov (United States)

    André, Jean-Marie; Azzedine, Fabienne

    2016-01-01

    In France in 2012, of the total population of 65.2 million, 8.7 % were migrants. After being the third principal host country, France is now the 6th highest host country in the OECD. Since the 1980's numerous Acts have been passed by parliament on immigration issues. In 2000 the Universal Health Cover (Couverture Maladie Universelle) was created as health coverage for all residents of France. At the same time the State Medical Assistance (Aide Médicale de l'Etat) was created as health protection for undocumented migrants. Since the creation of this scheme, it has been the object of many political debates which call it into question, on account of its cost, perceived fraud, and the legitimacy of a social protection for undocumented migrants. Recently, access to State Medical Assistance has been made difficult by introducing conditions of residence and financial contributions. After a reports' analysis on institutional, associative, research studies and European recommendations, we note that all reports converge on the necessity of health protection for undocumented migrants. The major reasons are humanitarian, respect of European and International conventions, for public health, and financial. Moreover, fraud allegations have proved to be unfounded. Finally, State Medical Assistance is underused: in 2014 data from Médecins du Monde shows that only 10.2 % of undocumented migrant patients in their health facilities have access to this scheme. We conclude that the political debate concerning the State Medical Assistance should be about its under-utilisation, its improvement, its merger with the Universal Health Cover, and not its elimination. Moreover, the current debates regarding this scheme stigmatize this population, which is already precarious, making it more difficult for migrants to access healthcare, and generally, weaken national social cohesion.

  1. Access to health-care in Canadian immigrants: a longitudinal study of the National Population Health Survey.

    Science.gov (United States)

    Setia, Maninder Singh; Quesnel-Vallee, Amelie; Abrahamowicz, Michal; Tousignant, Pierre; Lynch, John

    2011-01-01

    Immigrants often lose their health advantage as they start adapting to the ways of the new society. Having access to care when it is needed is one way that individuals can maintain their health. We assessed the healthcare access in Canadian immigrants and the socioeconomic factors associated with access over a 12-year period. We compared two measures of healthcare access (having a regular doctor and reporting an unmet healthcare need in the past 12 months) among immigrants and Canadian-born men and women, aged more than 18 years. We applied a logistic random effects model to evaluate these outcomes separately, in 3081 males and 4187 females from the National Population Health Survey (1994-2006). Adjusting for all covariates, immigrant men and women (white and non-white) had similar odds of having a regular doctor than the Canadian-born individuals (white immigrants: males OR: 1.32, 95% C.I.: 0.89-1.94, females OR: 1.14, 95% C.I.: 0.78-1.66; non-white immigrants: males OR: 1.28, 95% C.I.: 0.73-2.23, females OR: 1.23, 95% C.I.: 0.64-2.36). Interestingly, non-white immigrant women had significantly fewer unmet health needs (OR: 0.32, 95% C.I.: 0.17-0.59). Among immigrants, time since immigration was associated with having access to a regular doctor (OR per year: 1.02, 95% C.I.: 1.00-1.04). Visible minority female immigrants were least likely to report an unmet healthcare need. In general, there is little evidence that immigrants have worse access to health-care than the Canadian-born population. © 2010 Blackwell Publishing Ltd.

  2. Exploring inequalities in access to and use of maternal health services in South Africa

    Directory of Open Access Journals (Sweden)

    Silal Sheetal P

    2012-05-01

    Full Text Available Abstract Background South Africa’s maternal mortality rate (625 deaths/100,000 live births is high for a middle-income country, although over 90% of pregnant women utilize maternal health services. Alongside HIV/AIDS, barriers to Comprehensive Emergency Obstetric Care currently impede the country’s Millenium Development Goals (MDGs of reducing child mortality and improving maternal health. While health system barriers to obstetric care have been well documented, “patient-oriented” barriers have been neglected. This article explores affordability, availability and acceptability barriers to obstetric care in South Africa from the perspectives of women who had recently used, or attempted to use, these services. Methods A mixed-method study design combined 1,231 quantitative exit interviews with sixteen qualitative in-depth interviews with women (over 18 in two urban and two rural health sub-districts in South Africa. Between June 2008 and September 2009, information was collected on use of, and access to, obstetric services, and socioeconomic and demographic details. Regression analysis was used to test associations between descriptors of the affordability, availability and acceptability of services, and demographic and socioeconomic predictor variables. Qualitative interviews were coded deductively and inductively using ATLAS ti.6. Quantitative and qualitative data were integrated into an analysis of access to obstetric services and related barriers. Results Access to obstetric services was impeded by affordability, availability and acceptability barriers. These were unequally distributed, with differences between socioeconomic groups and geographic areas being most important. Rural women faced the greatest barriers, including longest travel times, highest costs associated with delivery, and lowest levels of service acceptability, relative to urban residents. Negative provider-patient interactions, including staff inattentiveness, turning

  3. The educational impact of the Specialty Care Access Network-Extension of Community Healthcare Outcomes program.

    Science.gov (United States)

    Salgia, Reena J; Mullan, Patricia B; McCurdy, Heather; Sales, Anne; Moseley, Richard H; Su, Grace L

    2014-11-01

    With the aging hepatitis C cohort and increasing prevalence of fatty liver disease, the burden on primary care providers (PCPs) to care for patients with liver disease is growing. In response, the Veterans Administration implemented initiatives for primary care-specialty referral to increase PCP competency in complex disease management. The Specialty Care Access Network-Extension of Community Healthcare Outcomes (SCAN-ECHO) program initiative was designed to transfer subspecialty knowledge to PCPs through case-based distance learning combined with real-time consultation. There is limited information regarding the initiative's ability to engage PCPs to learn and influence their practice. We surveyed PCPs to determine the factors that led to their participation in this program and the educational impact of participation. Of 51 potential participants, 24 responded to an anonymous survey. More than 75% of respondents participated more than one time in a SCAN-ECHO clinic. Providers were motivated to participate by a desire to learn more about liver disease, to apply the knowledge gained to future patients, and to save their patients time traveling to another center for specialty consultation. Seventy-one percent responded that the didactic component and case-based discussion were equally important. It is important that participation changed clinical practice: 75% of providers indicated they had personally discussed the information they learned from the case presentations with their colleague(s), and 42% indicated they helped a colleague care for their patient with the knowledge learned during discussions of other participants' cases. This study shows that the SCAN-ECHO videoconferencing program between PCPs and specialists can educate providers in the delivery of specialty care from a distance and potentially improve healthcare delivery.

  4. A comparison of usability factors of four mobile devices for accessing healthcare information by adolescents.

    Science.gov (United States)

    Sheehan, B; Lee, Y; Rodriguez, M; Tiase, V; Schnall, R

    2012-01-01

    Mobile health (mHealth) is a growing field aimed at developing mobile information and communication technologies for healthcare. Adolescents are known for their ubiquitous use of mobile technologies in everyday life. However, the use of mHealth tools among adolescents is not well described. We examined the usability of four commonly used mobile devices (an iPhone, an Android with touchscreen keyboard, an Android with built-in keyboard, and an iPad) for accessing healthcare information among a group of urban-dwelling adolescents. Guided by the FITT (Fit between Individuals, Task, and Technology) framework, a thinkaloud protocol was combined with a questionnaire to describe usability on three dimensions: 1) task-technology fit; 2) individual-technology fit; and 3) individual-task fit. For task-technology fit, we compared the efficiency, and effectiveness of each of the devices tested and found that the iPhone was the most usable had the fewest errors and prompts and had the lowest mean overall task time For individual-task fit, we compared efficiency and learnability measures by website tasks and found no statistically significant effect on tasks steps, task time and number of errors. Following our comparison of success rates by website tasks, we compared the difference between two mobile applications which were used for diet tracking and found statistically significant effect on tasks steps, task time and number of errors. For individual-technology fit, interface quality was significantly different across devices indicating that this is an important factor to be considered in developing future mobile devices. All of our users were able to complete all of the tasks, however the time needed to complete the tasks was significantly different by mobile device and mHealth application. Future design of mobile technology and mHealth applications should place particular importance on interface quality.

  5. Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Misuzu Fujita

    Full Text Available The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0-74 years who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40-59-year-old men and 60-69-year-old women, and in duration of hospitalization among 40-59 and 60-69-year-olds of both sexes and 70-74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts.

  6. Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study

    Science.gov (United States)

    Fujita, Misuzu; Hata, Akira

    2016-01-01

    The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0–74 years) who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40–59-year-old men and 60–69-year-old women, and in duration of hospitalization among 40–59 and 60–69-year-olds of both sexes and 70–74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts. PMID:26978270

  7. Disability in post-earthquake Haiti: prevalence and inequality in access to services.

    Science.gov (United States)

    Danquah, Lisa; Polack, Sarah; Brus, Aude; Mactaggart, Islay; Houdon, Claire Perrin; Senia, Patrick; Gallien, Pierre; Kuper, Hannah

    2015-01-01

    To assess the prevalence of disability and service needs in post-earthquake Haiti, and to compare the inclusion and living conditions of people with disabilities to those without disabilities. A population-based prevalence survey of disability was undertaken in 2012 in Port-au-Prince region, which was at the centre of the earthquake in 2010. Sixty clusters of 50 people aged 5 + years were selected with probability proportionate to size sampling and screened for disability (Washington Group short set questionnaire). A case-control study was undertaken, nested within the survey, matching cases to controls by age, gender and cluster. There was additional case finding to identify further children with disabilities. Information was collected on: socioeconomic status, education, livelihood, health, activities, participation and barriers. The prevalence of disability was 4.1% (3.4-4.7%) across 3132 eligible individuals. The earthquake was the second leading cause of disability. Disability was more common with increasing age, but unrelated to poverty. Large gaps existed in access of services for people with disabilities. Adults with disabilities were less likely to be literate or work and more likely to visit health services than adults without disabilities. Children with disabilities were less likely to be currently enrolled at school compared to controls. Children and adults with disabilities reported more activity limitations and participation restriction. Further focus is needed to improve inclusion of people with disabilities in post-earthquake Haiti to ensure that their rights are fulfilled. Almost one in six households in this region of Haiti included a person with a disability, and the earthquake was the second leading cause of disability. Fewer than half of people who reported needing medical rehabilitation had received this service. The leading reported barriers to the uptake of health services included financial constraints (50%) and difficulties with

  8. Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion.

    Science.gov (United States)

    Mumtaz, Zubia; O'Brien, Beverley; Bhatti, Afshan; Jhangri, Gian S

    2012-09-19

    Pakistan is one of the six countries estimated to contribute to over half of all maternal deaths worldwide. To address its high maternal mortality rate, in particular the inequities in access to maternal health care services, the government of Pakistan created a new cadre of community-based midwives (CMW). A key expectation is that the CMWs will improve access to skilled antenatal and intra-partum care for the poor and disadvantaged women. A critical gap in our knowledge is whether this cadre of workers, operating in the private health care context, will meet the expectation to provide care to the poorest and most marginalized women. There is an inherent paradox between the notions of fee-for-service and increasing access to health care for the poorest who, by definition, are unable to pay. Data will be collected in three interlinked modules. Module 1 will consist of a population-based survey in the catchment areas of the CMW's in districts Jhelum and Layyah in Punjab. Proportions of socially excluded women who are served by CMWs and their satisfaction levels with their maternity care provider will be assessed. Module 2 will explore, using an institutional ethnographic approach, the challenges (organizational, social, financial) that CMWs face in providing care to the poor and socially marginalized women. Module 3 will identify the social, financial, geographical and other barriers to uncover the hidden forces and power relations that shape the choices and opportunities of poor and marginalized women in accessing CMW services. An extensive knowledge dissemination plan will facilitate uptake of research findings to inform positive developments in maternal health policy, service design and care delivery in Pakistan. The findings of this study will enhance understanding of the power dynamics of gender and class that may underlie poor women's marginalization from health care systems, including community midwifery care. One key outcome will be an increased sensitization

  9. Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion

    Directory of Open Access Journals (Sweden)

    Mumtaz Zubia

    2012-09-01

    Full Text Available Abstract Background Pakistan is one of the six countries estimated to contribute to over half of all maternal deaths worldwide. To address its high maternal mortality rate, in particular the inequities in access to maternal health care services, the government of Pakistan created a new cadre of community-based midwives (CMW. A key expectation is that the CMWs will improve access to skilled antenatal and intra-partum care for the poor and disadvantaged women. A critical gap in our knowledge is whether this cadre of workers, operating in the private health care context, will meet the expectation to provide care to the poorest and most marginalized women. There is an inherent paradox between the notions of fee-for-service and increasing access to health care for the poorest who, by definition, are unable to pay. Methods/Design Data will be collected in three interlinked modules. Module 1 will consist of a population-based survey in the catchment areas of the CMW’s in districts Jhelum and Layyah in Punjab. Proportions of socially excluded women who are served by CMWs and their satisfaction levels with their maternity care provider will be assessed. Module 2 will explore, using an institutional ethnographic approach, the challenges (organizational, social, financial that CMWs face in providing care to the poor and socially marginalized women. Module 3 will identify the social, financial, geographical and other barriers to uncover the hidden forces and power relations that shape the choices and opportunities of poor and marginalized women in accessing CMW services. An extensive knowledge dissemination plan will facilitate uptake of research findings to inform positive developments in maternal health policy, service design and care delivery in Pakistan. Discussion The findings of this study will enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems, including

  10. Social Responsibility and Healthcare in Finland.

    Science.gov (United States)

    Ahola-Launonen, Johanna

    2016-07-01

    This article examines current trends and prospects in Finnish healthcare literature and discussion. The Finnish healthcare system was long considered to manifest an equal, universal, and solidaristic welfare scheme. However, recent data reveals structural inequalities in access to healthcare that result in health differences among socioeconomic groups. The political will aims at tackling these inequalities, but the ideological trend toward responsibilization of the individual taking place across political spheres elsewhere in Europe creates potential challenges to this goal. The applications of this trend have a theoretical background in the responsibility-sensitive egalitarian-or luck egalitarian-tradition. The theory, which is unfit for real-life policy applications, has explicit appeal in considerations aiming at the responsibilization of the individual within the healthcare sector. It remains to be seen in which direction the Finnish welfare schemes will continue to develop.

  11. Quantifying the impact of accessibility on preventive healthcare in sub-Saharan Africa using mobile phone data.

    Science.gov (United States)

    Wesolowski, Amy; O'Meara, Wendy Prudhomme; Tatem, Andrew J; Ndege, Samson; Eagle, Nathan; Buckee, Caroline O

    2015-03-01

    Poor physical access to health facilities has been identified as an important contributor to reduced uptake of preventive health services and is likely to be most critical in low-income settings. However, the relation among physical access, travel behavior, and the uptake of healthcare is difficult to quantify. Using anonymized mobile phone data from 2008 to 2009, we analyze individual and spatially aggregated travel patterns of 14,816,521 subscribers across Kenya and compare these measures to (1) estimated travel times to health facilities and (2) data on the uptake of 2 preventive healthcare interventions in an area of western Kenya: childhood immunizations and antenatal care. We document that long travel times to health facilities are strongly correlated with increased mobility in geographically isolated areas. Furthermore, we found that in areas with equal physical access to healthcare, mobile phone-derived measures of mobility predict which regions are lacking preventive care. Routinely collected mobile phone data provide a simple and low-cost approach to mapping the uptake of preventive healthcare in low-income settings.

  12. Health, Healthcare Access, and Use of Traditional Versus Modern Medicine in Remote Peruvian Amazon Communities: A Descriptive Study of Knowledge, Attitudes, and Practices

    OpenAIRE

    Williamson, Jonathan; Ramirez, Ronald; Wingfield, Tom

    2015-01-01

    There is an urgent need for healthcare research, funding, and infrastructure in the Peruvian Amazon. We performed a descriptive study of health, health knowledge and practice, and healthcare access of 13 remote communities of the Manat? and Amazon Rivers in northeastern Peru. Eighty-five adults attending a medical boat service were interviewed to collect data on socioeconomic position, health, diagnosed illnesses, pain, healthcare access, and traditional versus modern medicine use. In this se...

  13. El impacto de la financiación de la asistencia sanitaria en las desigualdades The impact of healthcare financing on health inequalities

    Directory of Open Access Journals (Sweden)

    Rosa M. Urbanos

    2004-05-01

    Full Text Available El presente trabajo examina el impacto de la financiación de la asistencia sanitaria sobre las desigualdades en la oferta, el acceso y la utilización de los servicios de salud. El nuevo modelo de financiación autonómica y sanitaria, pese a las iniciales ganancias de equidad y suficiencia en el momento de su puesta en funcionamiento, introduce incertidumbre con respecto al volumen de recursos que en el futuro podrán dedicar las comunidades autónomas a la financiación de la sanidad, lo que puede originar desigualdades en la oferta de servicios y en el acceso a la asistencia sanitaria. El Fondo de Cohesión Sanitaria, diseñado para financiar la atención a los desplazados, no parece el instrumento adecuado para garantizar la igualdad de acceso a las prestaciones en el conjunto del Sistema Nacional de Salud. Por otra parte, el cambio en la composición de las fuentes de financiación de la sanidad, en la medida en que otorgue más peso a los impuestos indirectos, puede acarrear pérdidas de equidad o progresividad. Finalmente, este trabajo discute el posible impacto de la actual asignación funcional del presupuesto sanitario, excesivamente sesgada hacia el ámbito de la atención especializada, en las desigualdades en su utilización.This article summarizes the impact of health care financing instruments on inequalities of supply, access and use of health care services. Firstly, the new scheme of regional and health care financing, apart from the initial gains in terms of equity and sufficiency, introduces uncertainty about the volume of resources that will be devoted to health care facilities by the regions. This fact may cause some inter-territorial inequalities in the health care supply and the access to public services. The Health Care Cohesion Fund, which was designed to guarantee equality of access to the National Health Service, is not the optimal instrument to achieve such an ambitious goal. Secondly, the change in composition of

  14. Access to healthcare and financial risk protection for older adults in Mexico: secondary data analysis of a national survey.

    Science.gov (United States)

    Doubova, Svetlana V; Pérez-Cuevas, Ricardo; Canning, David; Reich, Michael R

    2015-07-21

    While the benefits of Seguro Popular health insurance in Mexico relative to no insurance have been widely documented, little has been reported on its effects relative to the pre-existing Social Security health insurance. We analyse the effects of Social Security and Seguro Popular health insurances in Mexico on access to healthcare of older adults, and on financial risk protection to their households, compared with older adults without health insurance. Secondary data analysis was performed using the 2012 Mexican Survey of Health and Nutrition (ENSANUT). The study population comprised 18,847 older adults and 13,180 households that have an elderly member. The dependent variables were access to healthcare given the reported need, the financial burden imposed by health expenditures measured through catastrophic health-related expenditures, and using savings for health-related expenditures. Separate propensity score matching analyses were conducted for each comparison. The analysis for access was performed at the individual level, and the analysis for financial burden at the household level. In each case, matching on a wide set of relevant characteristics was achieved. Seguro Popular showed a protective effect against lack of access to healthcare for older adults compared with those with no insurance. The average treatment effect on the treated (ATET) was ascertained through using the nearest-neighbour matching (-8.1%, t-stat -2.305) analysis. However, Seguro Popular did not show a protective effect against catastrophic expenditures in a household where an older adult lived. Social Security showed increased access to healthcare (ATET -11.3%, t-stat -3.138), and protective effect against catastrophic expenditures for households with an elderly member (ATET -1.9%, t-stat -2.178). Seguro Popular increased access to healthcare for Mexican older adults. Social Security showed a significant protective effect against lack of access and catastrophic expenditures compared with

  15. Impact of health-care accessibility and social deprivation on diabetes related foot disease.

    Science.gov (United States)

    Leese, G P; Feng, Z; Leese, R M; Dibben, C; Emslie-Smith, A

    2013-04-01

    To determine whether geography and/or social deprivation influences the occurrence of foot ulcers or amputations in patients with diabetes. A population-based cohort of people with diabetes (n = 15 983) were identified between 2004 and 2006. Community and hospital data on diabetes care, podiatry care and onset of ulceration and amputation was linked using a unique patient identifier, which is used for all patient contacts with health-care professionals. Postcode was used to calculate social deprivation and distances to general practice and hospital care. Over 3 years' follow-up 670 patients with diabetes developed new foot ulcers (42 per 1000) and 99 proceeded to amputation (6 per 1000). The most deprived quintile had a 1.7-fold (95% CI 1.2-2.3) increased risk of developing a foot ulcer. Distance from general practitioner or hospital clinic and lack of attendance at community retinal screening did not predict foot ulceration or amputation. Previous ulcer (OR 15.1, 95% CI 11.6-19.6), insulin use (OR 2.7, 95% CI 2.1-3.5), absent foot pulses (5.9: 4.7-7.5) and impaired monofilament sensation (OR 6.5, 95% CI 5.0-8.4) all predicted foot ulceration. Previous foot ulcer, absent pulses and impaired monofilaments also predicted amputation. Social deprivation is an important factor, especially for the development of foot ulcers. Geographical aspects such as accessibility to the general practitioner or hospital clinic are not associated with foot ulceration or amputation in this large UK cohort study. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.

  16. Chronic kidney disease in Nigeria: an evaluation of the spatial accessibility to healthcare for diagnosed cases in Edo State

    Directory of Open Access Journals (Sweden)

    Osaretin Oviasu

    2016-05-01

    Full Text Available Chronic kidney disease (CKD is a growing problem in Nigeria, presenting challenges to the nation’s health and economy. This study evaluates the accessibility to healthcare in Edo State of CKD patients diagnosed between 2006 and 2009. Using cost analysis techniques within a geographical information system, an estimated travel time to the hospital was used to examine the spatial accessibility of diagnosed patients to available CKD healthcare in the state. The results from the study indicated that although there was an annual rise in the number of diagnosed cases, there were no significant changes in the proportion of patients that were diagnosed at the last stage of CKD. However, there were indications that the travel time to the hospital for CKD treatment might be a contributing factor to the number of diagnosed CKD cases. This implies that the current structure for CKD management within the state might not be adequate.

  17. Assessing Accessibility and Transport Infrastructure Inequities in Administrative Units in Serbia’s Danube Corridor Based on Multi-Criteria Analysis and Gis Mapping Tools

    Directory of Open Access Journals (Sweden)

    Ana VULEVIC

    2018-02-01

    Full Text Available The Danube Regions, especially the sub-national units of governance, must be ready to play an active role in spatial development policies. A precondition for this is good accessibility and the coordinated development of all transport systems in the Danube corridor. The main contribution of this paper is to provide a multi-criteria model for potential decision making related to the evaluation of transportation accessibility in Serbia’s Danube Corridor. Geographic Information Systems (GIS, based on maps, indicate the existing counties’ transport infrastructures inequities (between well-connected and isolated counties in terms of accessibility to central places. Through the research, relevant indicators have been identifi ed. This provides an outline of transportation perspectives regarding the development achieved and also fosters the increase of transportation accessibility in some peripheral Serbian Danube administrative units – counties (Nomenclature of Territorial Units for Statistics level 3 – NUTS 3.

  18. Perceived efficacy of herbal remedies by users accessing primary healthcare in Trinidad

    Directory of Open Access Journals (Sweden)

    Gomes Natalie

    2007-02-01

    Full Text Available Abstract Background The increasing global popularity of herbal remedies requires further investigation to determine the probable factors driving this burgeoning phenomenon. We propose that the users' perception of efficacy is an important factor and assessed the perceived efficacy of herbal remedies by users accessing primary health facilities throughout Trinidad. Additionally, we determined how these users rated herbal remedies compared to conventional allopathic medicines as being less, equally or more efficacious. Methods A descriptive cross-sectional study was undertaken at 16 randomly selected primary healthcare facilities throughout Trinidad during June-August 2005. A de novo, pilot-tested questionnaire was interviewer-administered to confirmed herbal users (previous or current. Stepwise multiple regression analysis was done to determine the influence of predictor variables on perceived efficacy and comparative efficacy with conventional medicines. Results 265 herbal users entered the study and cited over 100 herbs for the promotion of health/wellness and the management of specific health concerns. Garlic was the most popular herb (in 48.3% of the sample and was used for the common cold, cough, fever, as 'blood cleansers' and carminatives. It was also used in 20% of hypertension patients. 230 users (86.8% indicated that herbs were efficacious and perceived that they had equal or greater efficacy than conventional allopathic medicines. Gender, ethnicity, income and years of formal education did not influence patients' perception of herb efficacy; however, age did (p = 0.036. Concomitant use of herbs and allopathic medicines was relatively high at 30%; and most users did not inform their attending physician. Conclusion Most users perceived that herbs were efficacious, and in some instances, more efficacious than conventional medicines. We suggest that this perception may be a major contributing factor influencing the sustained and increasing

  19. Identifying and intervening on barriers to healthcare access among members of a small Korean community in the southern USA.

    Science.gov (United States)

    Rhodes, Scott D; Song, Eunyoung; Nam, Sang; Choi, Sarah J; Choi, Seungyong

    2015-04-01

    We used community-based participatory research (CBPR) to explore barriers to healthcare access and utilization and identify potentially effective intervention strategies to increase access among members of the Korean community in North Carolina (NC). Our CBPR partnership conducted 8 focus groups with 63 adult Korean immigrants in northwest NC and 15 individual in-depth interviews and conducted an empowerment-based community forum. We identified 20 themes that we organized into four domains, including practical barriers to health care, negative perceptions about care, contingencies for care, and provider misconceptions about local needs. Forum attendees identified four strategies to improve Korean community health. Despite the implementation of the Patient Protection and Affordable Care Act (ACA), many Korean community members will continue to remain uninsured, and among those who obtain insurance, many barriers will remain. It is imperative to ensure the health of this highly neglected and vulnerable community. Potential strategies include the development of (1) low-literacy materials to educate members of the Korean community about how to access healthcare services, (2) lay health advisor programs to support navigation of service access and utilization, (3) church-based programming, and (4) provider education to reduce misconceptions about Korean community needs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Inequity of healthcare utilization on mammography examination and Pap smear screening in Thailand: Analysis of a population-based household survey.

    Directory of Open Access Journals (Sweden)

    Sukanya Chongthawonsatid

    Full Text Available Healthcare in Thailand is not equally distributed, and not all people can equally access healthcare resources even if they are covered by health insurance. To examine factors associated with the utilization of mammography examination for breast cancer and Pap smear screening for cervical cancer, data from the national reproductive health survey conducted by the National Statistical Office of Thailand in 2009 was examined. The survey was carried out on 15,074,126 women aged 30-59 years. The results showed that the wealthier respondents had more mammograms than did the lower-income groups. The concentration index was 0.144. The data on Pap smears for cervical cancer also showed that the wealthier respondents were more likely to have had a Pap smear than their lower-income counterparts. The concentration index was 0.054. Determinants of mammography examination were education, followed by health welfare and wealth index, whereas the determinants of Pap smear screening were wealth index, followed by health welfare and education. The government should support greater education for women because education was associated with socioeconomic status and wealth. There should be an increase in the number of screening campaigns, mobile clinics, and low-cost mammograms and continued support for accessibility to mammograms, especially in rural areas and low-income communities.

  1. Retrospective chart review for obesity and associated interventions among rural Mexican-American adolescents accessing healthcare services.

    Science.gov (United States)

    Champion, Jane Dimmitt; Collins, Jennifer L

    2013-11-01

    To report a retrospective analysis of data routinely collected in the course of healthcare services at a rural health clinic and to assess obesity incidence and associated interventions among rural Mexican-American adolescents. Two hundred and twelve charts reviewed; 98 (46.2%) males and 114 (53.8%) females. Data extracted included Medicaid exams conducted at the clinic within 5 years. Equal overweight or obese (n = 105, 49.5%), versus normal BMI categorizations (n = 107, 50.5%) documented overall and by gender. Female obesity higher (25.4%) than national norms (17.4%); male rates (25.5%) were within national norm. Interventions provided by nurse practitioners (94%) for 34.8%-80% of overweight/obese had limited follow-up (4%). Obesity incidence markedly increased between 13 and 18 years of age without associated interventions; 51.4%-75.6% without interventions. Obesity is a healthcare problem among rural Mexican-American adolescents accessing care at the rural health clinic. Obesity intervention and follow-up was suboptimal within this setting. Rural and ethnic minority adolescents experience health disparities concerning obesity prevalence and remote healthcare access. Obesity prevention and treatment during adolescence is a national health priority given physiologic and psychological tolls on health and potential for obesity into adulthood. Obesity assessment and translation of evidence-based interventions for rural Mexican-American adolescents at rural health clinics is implicated. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  2. Impact of residential displacement on healthcare access and mental health among original residents of gentrifying neighborhoods in New York City.

    Science.gov (United States)

    Lim, Sungwoo; Chan, Pui Ying; Walters, Sarah; Culp, Gretchen; Huynh, Mary; Gould, L Hannah

    2017-01-01

    As gentrification continues in New York City as well as other urban areas, residents of lower socioeconomic status maybe at higher risk for residential displacement. Yet, there have been few quantitative assessments of the health impacts of displacement. The objective of this paper is to assess the association between displacement and healthcare access and mental health among the original residents of gentrifying neighborhoods in New York City. We used 2 data sources: 1) 2005-2014 American Community Surveys to identify gentrifying neighborhoods in New York City, and 2) 2006-2014 Statewide Planning and Research Cooperative System. Our cohort included 12,882 residents of gentrifying neighborhoods in 2006 who had records of emergency department visits or hospitalization at least once every 2 years in 2006-2014. Rates of emergency department visits and hospitalizations post-baseline were compared between residents who were displaced and those who remained. During 2006-2014, 23% were displaced. Compared with those who remained, displaced residents were more likely to make emergency department visits and experience hospitalizations, mainly due to mental health (Rate Ratio = 1.8, 95% confidence interval = 1.5, 2.2), after controlling for baseline demographics, health status, healthcare utilization, residential movement, and the neighborhood of residence in 2006. These findings suggest negative impacts of displacement on healthcare access and mental health, particularly among adults living in urban areas and with a history of frequent emergency department visits or hospitalizations.

  3. Impact of residential displacement on healthcare access and mental health among original residents of gentrifying neighborhoods in New York City.

    Directory of Open Access Journals (Sweden)

    Sungwoo Lim

    Full Text Available As gentrification continues in New York City as well as other urban areas, residents of lower socioeconomic status maybe at higher risk for residential displacement. Yet, there have been few quantitative assessments of the health impacts of displacement. The objective of this paper is to assess the association between displacement and healthcare access and mental health among the original residents of gentrifying neighborhoods in New York City.We used 2 data sources: 1 2005-2014 American Community Surveys to identify gentrifying neighborhoods in New York City, and 2 2006-2014 Statewide Planning and Research Cooperative System. Our cohort included 12,882 residents of gentrifying neighborhoods in 2006 who had records of emergency department visits or hospitalization at least once every 2 years in 2006-2014. Rates of emergency department visits and hospitalizations post-baseline were compared between residents who were displaced and those who remained.During 2006-2014, 23% were displaced. Compared with those who remained, displaced residents were more likely to make emergency department visits and experience hospitalizations, mainly due to mental health (Rate Ratio = 1.8, 95% confidence interval = 1.5, 2.2, after controlling for baseline demographics, health status, healthcare utilization, residential movement, and the neighborhood of residence in 2006.These findings suggest negative impacts of displacement on healthcare access and mental health, particularly among adults living in urban areas and with a history of frequent emergency department visits or hospitalizations.

  4. Access to and utilisation of healthcare services by sex workers at truck-stop clinics in South Africa: A case study

    NARCIS (Netherlands)

    Fobosi, S. C.; Lalla-Edward, S. T.; Ncube, S.; Buthelezi, F.; Matthew, P.; Kadyakapita, A.; Slabbert, M.; Hankins, C. A.; Venter, W. D. F.; Gomez, G. B.

    2017-01-01

    Background. Sex worker-specific health services aim to respond to the challenges that this key population faces in accessing healthcare. These services aim to integrate primary healthcare (PHC) interventions, yet most services tend to focus on prevention of HIV and sexually transmitted infections

  5. Inequalities in health: the role of health insurance in Nigeria

    Directory of Open Access Journals (Sweden)

    Amanda Chukwudozie

    2016-08-01

    Full Text Available Health financing is a core necessity for sustainable healthcare delivery. Access inequalities due to financial restrictions in low-middle income countries, and in Africa especially, significantly affect disease rates and health statistics in these regions. This paper focuses on the role of a national health insurance cover as a funding medium in Nigeria, highlighting the theoretical premise of health insurance, its driving forces, key benefits and key limitations particular to the country under scrutiny. Emphasis is laid on its overall effect on the pressing public health issue of health inequality.

  6. Flexible and Lightweight Access Control for Online Healthcare Social Networks in the Context of the Internet of Things

    Directory of Open Access Journals (Sweden)

    Zhen Qin

    2017-01-01

    Full Text Available Online healthcare social networks (OHSNs play an essential role in sharing information among medical experts and patients who are equipped with similar experiences. To access other patients’ data or experts’ diagnosis anywhere and anytime, it is necessary to integrate the OHSN into the Internet as part of the Internet of Things (IoT. Therefore, it is crucial to design an efficient and versatile access control scheme that can grant and revoke a user to access the OHSN. In this paper, we propose novel attribute-based encryption (ABE features with user revocation and verifiable decryption outsourcing to control the access privilege of the users. The security of the proposed ABE scheme is given in the well-studied random oracle model. With the proposed ABE scheme, the malicious users can be excluded from the system and the user can offload most of the overhead in the decryption to an untrusted cloud server in a verifiable manner. An access control scheme for the OHSN has been given in the context of the IoT based on the proposed ABE scheme. The simulation demonstrates that our access control mechanism is practical.

  7. Rationing access to care to the medically uninsured: the role of bureaucratic front-line discretion at large healthcare institutions.

    Science.gov (United States)

    Weiner, Saul J; Laporte, Margaret; Abrams, Richard I; Moswin, Arthur; Warnecke, Richard

    2004-04-01

    Medically uninsured patients seeking nonemergency care are not guaranteed access to services at most healthcare institutions. They must first register with a clerk who could require a deposit and/or payment on an outstanding debt. This study examines the factors that influence whether nonmedical bureaucratic staff sign in or turn away uninsured patients who cannot meet prepayment requirements. The study was conducted at a for-profit, a not-for-profit, and a public healthcare institution in a metropolitan area. The authors explored the relevant policy environment through interviews with senior administrators and a review of documents pertaining to the management of self-pay patients. Then they examined how policies affecting access were implemented through in-depth, semistructured, audiotaped interviews with 55 front-line clerical personnel. At all 3 institutions, policies were ambiguous about what to do when uninsured patients cannot afford required prepayments. Seventy-one percent of staff reported they do not turn patients away; the remainder stated that on occasion they do. A variety of rationales were provided for how decisions are made. Those with the lowest-level positions were significantly more likely to be sympathetic to indigent patients and less likely to report turning patients away. Consistent with other studies of front-line bureaucracies indicating that low-level personnel who interface with clients make discretionary decisions, particularly when organizations pursue potentially conflicting priorities, this preliminary investigation found that nonmedical personnel play a significant role in decisions affecting access to care for medically indigent patients.

  8. Structural barriers to HIV prevention among men who have sex with men (MSM) in Vietnam: Diversity, stigma, and healthcare access.

    Science.gov (United States)

    Philbin, Morgan M; Hirsch, Jennifer S; Wilson, Patrick A; Ly, An Thanh; Giang, Le Minh; Parker, Richard G

    2018-01-01

    Men who have sex with men (MSM) in Vietnam experience disproportionate rates of HIV infection. To advance understanding of how structural barriers may shape their engagement with HIV prevention services, we draw on 32 in-depth interviews and four focus groups (n = 31) conducted with MSM in Hanoi between October 2015- March 2016. Three primary factors emerged: (1) Diversity, both in relation to identity and income; Vietnamese MSM described themselves as segregated into Bóng kín (hidden, often heterosexually-identified MSM) and Bóng lộ ('out,' transgender, or effeminate MSM). Lower-income, 'hidden' MSM from rural areas were reluctant to access MSM-targeted services; (2) Stigma: MSM reported being stigmatized by the healthcare system, family, and other MSM; and (3) Healthcare access: this was limited due to economic barriers and lack of MSM-friendly services. Our research suggests the need for multiple strategies to reach diverse types of MSM as well as to address barriers in access to health services such as stigma and costs. While a great deal has been written about the diversity of MSM in relation to gender performance and sexual identities, our research points to the substantial structural-level barriers that must be addressed in order to achieve meaningful and effective HIV prevention for MSM worldwide.

  9. Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: A national longitudinal analysis.

    Directory of Open Access Journals (Sweden)

    Thomas Hone

    2017-05-01

    Full Text Available Universal health coverage (UHC can play an important role in achieving Sustainable Development Goal (SDG 10, which addresses reducing inequalities, but little supporting evidence is available from low- and middle-income countries. Brazil's Estratégia de Saúde da Família (ESF (family health strategy is a community-based primary healthcare (PHC programme that has been expanding since the 1990s and is the main platform for delivering UHC in the country. We evaluated whether expansion of the ESF was associated with differential reductions in mortality amenable to PHC between racial groups.Municipality-level longitudinal fixed-effects panel regressions were used to examine associations between ESF coverage and mortality from ambulatory-care-sensitive conditions (ACSCs in black/pardo (mixed race and white individuals over the period 2000-2013. Models were adjusted for socio-economic development and wider health system variables. Over the period 2000-2013, there were 281,877 and 318,030 ACSC deaths (after age standardisation in the black/pardo and white groups, respectively, in the 1,622 municipalities studied. Age-standardised ACSC mortality fell from 93.3 to 57.9 per 100,000 population in the black/pardo group and from 75.7 to 49.2 per 100,000 population in the white group. ESF expansion (from 0% to 100% was associated with a 15.4% (rate ratio [RR]: 0.846; 95% CI: 0.796-0.899 reduction in ACSC mortality in the black/pardo group compared with a 6.8% (RR: 0.932; 95% CI: 0.892-0.974 reduction in the white group (coefficients significantly different, p = 0.012. These differential benefits were driven by greater reductions in mortality from infectious diseases, nutritional deficiencies and anaemia, diabetes, and cardiovascular disease in the black/pardo group. Although the analysis is ecological, sensitivity analyses suggest that over 30% of black/pardo deaths would have to be incorrectly coded for the results to be invalid. This study is limited by

  10. Access to and utilisation of healthcare services by sex workers at ...

    African Journals Online (AJOL)

    North Star Alliance (North Star) is a public-private partnership providing a healthcare service package in roadside wellness clinics (RWCs) to at-risk populations along transport corridors in sub-Saharan Africa. Objectives. To inform future service development for sex workers and describe North Star's contribution to ...

  11. Understanding differences in access and use of healthcare between international immigrants to Chile and the Chilean-born: a repeated cross-sectional population-based study in Chile

    Science.gov (United States)

    2012-01-01

    Introduction International evidence indicates consistently lower rates of access and use of healthcare by international immigrants. Factors associated with this phenomenon vary significantly depending on the context. Some research into the health of immigrants has been conducted in Latin America, mostly from a qualitative perspective. This population-based study is the first quantitative study to explore healthcare provision entitlement and use of healthcare services by immigrants in Chile and compare them to the Chilean-born. Methods Data come from the nationally representative CASEN (Socioeconomic characterization of the population in Chile) surveys, conducted in 2006 and 2009. Self-reported immigrants were compared to the Chilean-born, by demographic characteristics (age, sex, urban/rural, household composition, ethnicity), socioeconomic status (SES: education, household income, contractual status), healthcare provision entitlement (public, private, other, none), and use of primary services. Weighted descriptive, stratified and adjusted regression models were used to analyse factors associated with access to and use of healthcare. Results There was an increase in self-reported immigrant status and in household income inequality among immigrants between 2006 and 2009. Over time there was a decrease in the rate of immigrants reporting no healthcare provision and an increase in reporting of private healthcare provision entitlement. Compared to the Chilean-born, immigrants reported higher rates of use of antenatal and gynaecological care, lower use of well-baby care, and no difference in the use of Pap smears or the number of attentions received in the last three months. Immigrants in the bottom income quintile were four times more likely to report no healthcare provision than their equivalent Chilean-born group (with different health needs, i.e. vertical inequity). Disabled immigrants were more likely to have no healthcare provision compared to the disabled Chilean

  12. Understanding differences in access and use of healthcare between international immigrants to Chile and the Chilean-born: a repeated cross-sectional population-based study in Chile

    Directory of Open Access Journals (Sweden)

    Cabieses Baltica

    2012-11-01

    Full Text Available Abstract Introduction International evidence indicates consistently lower rates of access and use of healthcare by international immigrants. Factors associated with this phenomenon vary significantly depending on the context. Some research into the health of immigrants has been conducted in Latin America, mostly from a qualitative perspective. This population-based study is the first quantitative study to explore healthcare provision entitlement and use of healthcare services by immigrants in Chile and compare them to the Chilean-born. Methods Data come from the nationally representative CASEN (Socioeconomic characterization of the population in Chile surveys, conducted in 2006 and 2009. Self-reported immigrants were compared to the Chilean-born, by demographic characteristics (age, sex, urban/rural, household composition, ethnicity, socioeconomic status (SES: education, household income, contractual status, healthcare provision entitlement (public, private, other, none, and use of primary services. Weighted descriptive, stratified and adjusted regression models were used to analyse factors associated with access to and use of healthcare. Results There was an increase in self-reported immigrant status and in household income inequality among immigrants between 2006 and 2009. Over time there was a decrease in the rate of immigrants reporting no healthcare provision and an increase in reporting of private healthcare provision entitlement. Compared to the Chilean-born, immigrants reported higher rates of use of antenatal and gynaecological care, lower use of well-baby care, and no difference in the use of Pap smears or the number of attentions received in the last three months. Immigrants in the bottom income quintile were four times more likely to report no healthcare provision than their equivalent Chilean-born group (with different health needs, i.e. vertical inequity. Disabled immigrants were more likely to have no healthcare provision compared

  13. Requirements and Challenges of Location-Based Access Control in Healthcare Emergency Response

    DEFF Research Database (Denmark)

    Vicente, Carmen Ruiz; Kirkpatrick, Michael; Ghinita, Gabriel

    2009-01-01

    Recent advances in positioning and tracking technologies have led to the emergence of novel location-based applications that allow participants to access information relevant to their spatio-temporal context. Traditional access control models, such as role-based access control (RBAC), are not suf...... to such settings. We overview the main technical issues to be addressed, and we describe the architecture for policy decision and enforcement points....

  14. Inequities in access to HIV prevention services for transgender men: results of a global survey of men who have sex with men.

    Science.gov (United States)

    Scheim, Ayden I; Santos, Glenn-Milo; Arreola, Sonya; Makofane, Keletso; Do, Tri D; Hebert, Patrick; Thomann, Matthew; Ayala, George

    2016-01-01

    Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM). In the global context of stigma and poor healthcare access, transgender (trans) MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-transgender) MSM. The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM) from any country and available in seven languages. Baseline data (n=3857) were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4:1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status. About 3.4% of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5%); lived in western Europe, North America, or Oceania (75.4%); and reported being HIV-negative (98.6%). HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1% of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR=0.57, 95% CI=0.33, 0.98) and condom-compatible lubricants (OR=0.54, 95% CI=0.30, 0.98). This first look at access to HIV prevention services for trans MSM

  15. Neoliberalism and the recommodification of health inequalities: A case study of the Swedish welfare state 1980 to 2011.

    Science.gov (United States)

    Farrants, Kristin; Bambra, Clare

    2018-02-01

    This paper examines the effects of neoliberalism on health inequalities through an empirical examination of the recommodification of the social determinants of health. It uses a detailed case study of changes to three specific welfare policy domains in Sweden: unemployment, healthcare, and pensions. Using time series data from the repeat cross-sectional Swedish Living Conditions Survey for 1980-2011, it examines: (1) the effects of reductions in the replacement rate value of unemployment benefit on inequalities in self-reported general health between the employed and the unemployed; (2) the effects of reductions in the replacement rate value of pensions on educational inequalities in self-reported general health among pensioners; and (3) the effects of the increase in user charges on inequalities in having visited a doctor in the past 3 months by educational level. The results suggest mixed effects of welfare state recommodification on health inequalities: inequalities increased between the Swedish employed and unemployed, yet they did not increase in the retired population, and inequalities in access to healthcare also remained steady during the study period. The paper concludes that the association between recommodification and health inequalities in Sweden is stronger regarding unemployment benefits than pensions or healthcare, and that this may relate to the stigmatisation of the unemployed.

  16. Gender Based Within-Household Inequality in Childhood Immunization in India: Changes over Time and across Regions

    OpenAIRE

    Singh, Ashish

    2012-01-01

    Background and Objectives Despite India's substantial economic growth in the past two decades, girls in India are discriminated against in access to preventive healthcare including immunizations. Surprisingly, no study has assessed the contribution of gender based within-household discrimination to the overall inequality in immunization status of Indian children. This study therefore has two objectives: to estimate the gender based within-household inequality (GWHI) in immunization status of ...

  17. Healthcare Information Technology (HIT) in an Anti-Access (A2) and Area Denial (AD) Environment

    Science.gov (United States)

    2014-03-01

    point for multiple sites to connect to each other so radiologists can read diagnostic images by managing firewall connections. The idea of multiple...learn from them.41 Although IBM’s Watson isn’t living up to the hype just yet, the artificial intelligent ( AI ) computer system is a precursor for a...on the ground can control a UAV with two passengers in it; one technician and one AI healthcare machine (Medical IBM Watson). Once the UAV lands

  18. 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

  19. 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

  20. Use of internet for accessing healthcare information among patients in an outpatient department of a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Lakshmi Renganathan

    2017-01-01

    Full Text Available Background: Health information is one of the most accessed topics online. Worldwide, about 4.5% of all Internet searches are for health-related informationand more than 70, 000 websites disseminate health information. However, critics question the quality and credibility of online health information as contents are mostly a result of limited research or are commercialised. There is a need to train people to locate relevant websites where they can efficiently retrieve evidence based information and evaluate the same. The study was conducted with the objectives of determining the prevalence of use of internet for accessing healthcare information amongst literate adult population in an urban area and to assess the association between the demography and the reasons of internet use. Methodology: We used an anonymous, cross sectional survey completed by a sample of out patients of 408 individuals who came to a tertiary care centre at Pune during the year 2015. The survey consisted of 17 questions related to behavioural, attitudinal and demographic items. Results: Out of the total of 408 individuals, 256 (63.2% individuals used internet for health information though 332 (82.4% of them were aware of authorised websites for health information and 69 (16.9% thought information available in the internet can be harmful. Also, 63 out of 256 (24.6% agreed to the fact that they ask questions to their doctors based on the information that they acquired from internet while surfing about that particular disease/ ailment. More individuals (p<0.05 who were working and who were educated, graduates and above, were using internet for health information. Conclusion: Our results suggest the great potential for using the internet to disseminate the information and awareness to the public about health and healthcare facilities. However, it is important to disseminate credible information from reliable and authorised websites assigned for health since online healthcare

  1. A qualitative study into the perceived barriers of accessing healthcare among a vulnerable population involved with a community centre in Romania.

    Science.gov (United States)

    George, Siân; Daniels, Katy; Fioratou, Evridiki

    2018-04-03

    Minority vulnerable communities, such as the European Roma, often face numerous barriers to accessing healthcare services, resulting in negative health outcomes. Both these barriers and outcomes have been reported extensively in the literature. However, reports on barriers faced by European non-Roma native communities are limited. The "Health Care Access Barriers" (HCAB) model identifies pertinent financial, structural and cognitive barriers that can be measured and potentially modified. The present study thus aims to explore the barriers to accessing healthcare for a vulnerable population of mixed ethnicity from a charity community centre in Romania, as perceived by the centre's family users and staff members, and assess whether these reflect the barriers identified from the HCAB model. Eleven community members whose children attend the centre and seven staff members working at the centre participated in face-to-face semi-structured interviews, exploring personal experiences and views on accessing healthcare. The interviews were transcribed and analysed using an initial deductive and secondary inductive approach to identify HCAB themes and other emerging themes and subthemes. Identified themes from both groups aligned with HCAB's themes of financial, structural and cognitive barriers and emergent subthemes important to the specific population were identified. Specifically, financial barriers related mostly to health insurance and bribery issues, structural barriers related mostly to service availability and accessibility, and cognitive barriers related mostly to healthcare professionals' attitudes and discrimination and the vulnerable population's lack of education and health literacy. A unique theme of psychological barriers emerged from both groups with associated subthemes of mistrust, hopelessness, fear and anxiety of this vulnerable population. The current study highlights healthcare access barriers to a vulnerable non-Roma native population involved with a

  2. Why reduce health inequalities?

    Science.gov (United States)

    Woodward, A; Kawachi, I

    2000-12-01

    It is well known that social, cultural and economic factors cause substantial inequalities in health. Should we strive to achieve a more even share of good health, beyond improving the average health status of the population? We examine four arguments for the reduction of health inequalities.1 Inequalities are unfair. Inequalities in health are undesirable to the extent that they are unfair, or unjust. Distinguishing between health inequalities and health inequities can be contentious. Our view is that inequalities become "unfair" when poor health is itself the consequence of an unjust distribution of the underlying social determinants of health (for example, unequal opportunities in education or employment).2 Inequalities affect everyone. Conditions that lead to marked health disparities are detrimental to all members of society. Some types of health inequalities have obvious spillover effects on the rest of society, for example, the spread of infectious diseases, the consequences of alcohol and drug misuse, or the occurrence of violence and crime.3 Inequalities are avoidable. Disparities in health are avoidable to the extent that they stem from identifiable policy options exercised by governments, such as tax policy, regulation of business and labour, welfare benefits and health care funding. It follows that health inequalities are, in principle, amenable to policy interventions. A government that cares about improving the health of the population ought therefore to incorporate considerations of the health impact of alternative options in its policy setting process.3 Interventions to reduce health inequalities are cost effective. Public health programmes that reduce health inequalities can also be cost effective. The case can be made to give priority to such programmes (for example, improving access to cervical cancer screening in low income women) on efficiency grounds. On the other hand, few programmes designed to reduce health inequalities have been formally

  3. Hepatitis B: report of prevalence and access to healthcare among Chinese residents in Sheffield UK.

    Science.gov (United States)

    Vedio, Alicia B; Ellam, Helena; Rayner, Frances; Stone, Benjamin; Kudesia, Goura; McKendrick, Michael W; Green, Stephen T

    2013-12-01

    Overall prevalence of hepatitis B (HBV) in the UK is low. However, among migrants from endemic areas, prevalence has been shown to be high. Furthermore, timely diagnosis and/or referral are required prevent serious health consequences through early institution of treatment. We identified locations that would be familiar to Chinese members of the community with the objective of facilitating testing. Dried blood spot samples were collected from 229 Chinese subjects and tested for HBV and also for hepatitis C virus (HCV) infection--offering complete chronic viral hepatitis screening. HBsAg was positive in 20/229 (8.7%) participants, (10 F, 10 M). Five women and one man were aware of their condition, but only one man and none of the women were under specialist care. The average length of residence in the UK for positive patients was 15 years (range 2-40). Evidence of HBV past infection, HBcAb(+)/HBsAg(-), was seen in 28/229 participants (12.2%). HCV antibody testing produced negative results in all participants. The methodology of testing was well accepted, 139/144 (95%) responded to a feedback questionnaire declaring no discomfort and 100% finding the information session useful. This model of outreach testing is helpful for addressing health inequalities afflicting the UK's Chinese community. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  4. Free versus subsidised healthcare: options for fee exemptions, access to care for vulnerable groups and effects on the health system in Burkina Faso.

    Science.gov (United States)

    Yaogo, Maurice

    2017-07-12

    The many forms of healthcare fee exemptions implemented in Burkina Faso since the 2000s have varied between total exemption (free) and cost subsidisation. This article examines both options, their contextual variations and the ways in which they affect access to healthcare for vulnerable people as well as the operation of the health system. This research is part of an interdisciplinary regional program on the elimination of user fees for health services in West Africa (Burkina Faso, Mali and Niger). A conceptual framework and a chronological review of policy interventions are used as references to summarise the results of the three qualitative studies presented. Historical reference points are used to describe the emergence of healthcare fee exemption policies in Burkina Faso and the events that influenced their adoption. The joint analysis of opinions on options for fee exemption focuses on the different types of repercussions on access to healthcare and the operation of the health system. In conjunction with the twists and turns of the gradual development of a national health policy and in response to international recommendations, healthcare fee exemptions have evolved since colonisation. The limitations of the changes introduced with cost recovery and the barriers to healthcare access for the poorest people led to the adoption of the current sectorial fee exemptions. The results provide information on the reasons for the changes that have occurred over time. The nuanced perspectives of different categories of people surveyed about fee exemption options show that, beyond the perceived effects on healthcare access and the health system, the issue is one of more equitable governance. In principle, the fee exemption measures are intended to provide improved healthcare access for vulnerable groups. In practice, the negative effects on the operation of the health system advocate for reforms to harmonise the changes to multifaceted fee exemptions and the actual needs

  5. How Marginalized Young People Access, Engage With, and Navigate Health-Care Systems in the Digital Age: Systematic Review.

    Science.gov (United States)

    Robards, Fiona; Kang, Melissa; Usherwood, Tim; Sanci, Lena

    2018-04-01

    This systematic review examines how marginalized young people access and engage with health services and navigate health-care systems in high-income countries. Medline, CINAHL, PsychInfo, The University of Sydney Library database, and Google Scholar were searched to identify qualitative and quantitative original research, published from 2006 to 2017, that focused on selected definitions of marginalized young people (12 to 24 years), their parents/carers, and/or health professionals working with these populations. A thematic synthesis was undertaken identifying themes across and between groups on barriers and/or facilitators to access, engagement, and/or navigation of health-care systems. Of 1,796 articles identified, 68 studies in the final selection focused on marginalized young people who were homeless (n = 20), living in rural areas (n = 14), of refugee background (n = 11), gender and/or sexuality diverse (n = 11), indigenous (n = 4), low income (n = 4), young offenders (n = 2), or living with a disability (n = 2). Studies were from the United States, Australia, Canada, United Kingdom, New Zealand, and Portugal, including 44 qualitative, 16 quantitative, and 8 mixed-method study types. Sample sizes ranged from 3 to 1,388. Eight themes were identified relating to ability to recognize and understand health issues; service knowledge and attitudes toward help seeking; structural barriers; professionals' knowledge, skills, attitudes; service environments and structures; ability to navigate the health system; youth participation; and technology opportunities. Marginalized young people experience barriers in addition to those common to all young people. Future studies should consider the role of technology in access, engagement, and health system navigation, and the impact of intersectionality between marginalized groups. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  6. Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study.

    Science.gov (United States)

    Lee, Andrew Chee Keng; Vedio, Alicia; Liu, Eva Zhi Hong; Horsley, Jason; Jesurasa, Amrita; Salway, Sarah

    2017-09-26

    Global migration from hepatitis B endemic countries poses a significant public health challenge in receiving low-prevalence countries. In the UK, Chinese migrants are a high risk group for hepatitis B. However, they are an underserved population that infrequently accesses healthcare. This study sought to increase understanding of the determinants of hepatitis B testing and healthcare access among migrants of Chinese ethnicity living in England. We sought to obtain and integrate insights from different key stakeholders in the system. We conducted six focus group discussions and 20 in-depth interviews with community members and patients identifying themselves as 'Chinese', and interviewed 21 clinicians and nine health service commissioners. Data were thematically analysed and findings were corroborated through two validation workshops. Three thematic categories emerged: knowledge and awareness, visibility of the disease, and health service issues. Low disease knowledge and awareness levels among community members contributed to erroneous personal risk perception and suboptimal engagement with services. Limited clinician knowledge led to missed opportunities to test and inaccurate assessments of infection risks in Chinese patients. There was little social discourse and considerable stigma linked to the disease among some sub-sections of the Chinese population. A lack of visibility of the issue and the population within the health system meant that these health needs were not prioritised by clinicians or commissioners. Service accessibility was also affected by the lack of language support. Greater use of community outreach, consultation aids, 'cultural competency' training, and locally adapted testing protocols may help. Hepatitis B among migrants of Chinese ethnicity in England can be characterised as an invisible disease in an invisible population. Multi-modal solutions are needed to tackle barriers within this population and the health system.

  7. Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study

    Directory of Open Access Journals (Sweden)

    Andrew Chee Keng Lee

    2017-09-01

    Full Text Available Abstract Background Global migration from hepatitis B endemic countries poses a significant public health challenge in receiving low-prevalence countries. In the UK, Chinese migrants are a high risk group for hepatitis B. However, they are an underserved population that infrequently accesses healthcare. This study sought to increase understanding of the determinants of hepatitis B testing and healthcare access among migrants of Chinese ethnicity living in England. Methods We sought to obtain and integrate insights from different key stakeholders in the system. We conducted six focus group discussions and 20 in-depth interviews with community members and patients identifying themselves as ‘Chinese’, and interviewed 21 clinicians and nine health service commissioners. Data were thematically analysed and findings were corroborated through two validation workshops. Results Three thematic categories emerged: knowledge and awareness, visibility of the disease, and health service issues. Low disease knowledge and awareness levels among community members contributed to erroneous personal risk perception and suboptimal engagement with services. Limited clinician knowledge led to missed opportunities to test and inaccurate assessments of infection risks in Chinese patients. There was little social discourse and considerable stigma linked to the disease among some sub-sections of the Chinese population. A lack of visibility of the issue and the population within the health system meant that these health needs were not prioritised by clinicians or commissioners. Service accessibility was also affected by the lack of language support. Greater use of community outreach, consultation aids, ‘cultural competency’ training, and locally adapted testing protocols may help. Conclusions Hepatitis B among migrants of Chinese ethnicity in England can be characterised as an invisible disease in an invisible population. Multi-modal solutions are needed to tackle

  8. Improving access to healthcare with eHealth in sub-Saharan Africa ...

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

    23 août 2013 ... Health systems across Africa are hindered by inadequate resources and growing disease burdens. Access to timely and affordable health services is needed to manage diseases and improve health and well-being. The growing field of electronic health (eHealth) is helping fill gaps in decision-making and ...

  9. Special Issue Journal of Healthcare Engineering Accessibility, Inclusion and Rehabilitation Using Information Technologies

    DEFF Research Database (Denmark)

    Brooks, Anthony Lewis; González-Cid, Yolanda

    2018-01-01

    limitation to perform tasks that they were formerly unable to accomplish, in inclusion for people with different abilities and preferences, and in rehabilitation. Potential topics include but are not limited to the following: ● Design, evaluation and use of IT to benefit people with disabilities (sensory......, motor and cognitive impairments / multiple disabilities) and elderly people ● Information technologies to accessibility to enable people with functional limitation to perform tasks that they were formerly unable to accomplish ● IT for the inclusion for people with different abilities and preferences......Accessibility, Inclusion and Rehabilitation Using Information Technologies Social exclusion occurs when individuals or even entire communities of people are blocked from rights, opportunities and resources preventing them from full participation in the activities of the society in which they live...

  10. Changing the navigator's course: How the increasing rationalization of healthcare influences access for undocumented immigrants under the Affordable Care Act.

    Science.gov (United States)

    López-Sanders, Laura

    2017-04-01

    A number of researchers have shown that brokers (e.g., navigators and street-level bureaucrats) bridge access to healthcare services and information for immigrant patients through rich personal relationships and a mission of ethical care. An open question remains concerning how the increasing rationalization of healthcare over the past few decades influences brokerage for undocumented immigrant patients. Drawing from fieldwork and interviews conducted in California, as the Affordable Care Act (ACA) was implemented, I develop the concept of the "double-embedded-liaison." While other studies treat brokers as acting either as gatekeepers or patient representatives, this study explains how brokers simultaneously operate on multiple planes when new roles are added. I argue that with more formalization and scrutiny at health centers, the impact of brokerage is destabilized and, subsequently, diminished. Two consequences of the double-embedded-liaison brokerage form are: (1) some brokers become disillusioned and exit -resulting in the loss of valuable resources at the health centers, and (2) immigrants move away from the health centers that historically served them. In looking at brokers' simultaneous performance as gatekeepers and representatives, this research extends brokerage typologies and street-level bureaucracy arguments that largely treat brokerage in a mono-planar rather than in a bi-planar mode. Furthermore, in examining the risks and opportunities brokerage brings to addressing health disparities, the study provides insights into the effects of replacing the ACA or repealing it all together in the Post-Obama era. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Health survey of U.S. long-haul truck drivers: work environment, physical health, and healthcare access.

    Science.gov (United States)

    Apostolopoulos, Yorghos; Sönmez, Sevil; Shattell, Mona M; Gonzales, Clifford; Fehrenbacher, Caitlin

    2013-01-01

    While trucking in industrialized nations is linked with driver health afflictions, the role of trucking in U.S. truckers' health remains largely unknown. This paper sheds light on links between the trucking work environment and drivers' physical health. Using a cross-sectional design, 316 truckers were enrolled in the Healthy Trucker Survey. Questions included work history, physical and mental health, and healthcare access. PASW 18 was used to examine patterns among factors. 316 truckers participated. Respondents were mainly full-time, long-haul drivers with over 5 years of experience, and who spent over 17 days on the road per month. While almost 75% described their health as good, 83.4% were overweight/obese, 57.9% had sleeping disturbances, 56.3% fatigue, 42.3% musculoskeletal disorders, and about 40% cardiovascular disease concerns. About 33% had no health insurance, 70% had no regular healthcare visits, 24.4% could not afford insurance, and 42.1% took over-the-counter drugs when sick, while 20.1% waited to reach home for medical care. Exercise facilities were unavailable in over 70% of trucking worksites and 70% of drivers did not exercise regularly. The trucking occupation places drivers at high risk for poor health outcomes. Prospective studies are needed to delve into how continued exposure to trucking influences the progression of disease burden.

  12. [Exploration of the design of media access control layer of wireless body area network for medical healthcare].

    Science.gov (United States)

    Liu, Xuemei; Ge, Baofeng

    2012-04-01

    This paper proposes a media access control (MAC) layer design for wireless body area network (WBAN) systems. WBAN is a technology that targets for wireless networking of wearable and implantable body sensors which monitor vital body signs, such as heart-rate, body temperature, blood pressure, etc. It has been receiving attentions from international organizations, e. g. the Institute of Electrical and Electronics Engineers (IEEE), due to its capability of providing efficient healthcare services and clinical management. This paper reviews the standardization procedure of WBAN and summarizes the challenge of the MAC layer design. It also discusses the methods of improving power consumption performance, which is one of the major issues of WBAN systems.

  13. MEDNET: Telemedicine via Satellite Combining Improved Access to Health-Care Services with Enhanced Social Cohesion in Rural Peru

    Science.gov (United States)

    Panopoulos, Dimitrios; Sachpazidis, Ilias; Rizou, Despoina; Menary, Wayne; Cardenas, Jose; Psarras, John

    Peru, officially classified as a middle-income country, has benefited from sustained economic growth in recent years. However, the benefits have not been seen by the vast majority of the population, particularly Peru's rural population. Virtually all of the nation's rural health-care centres are cut off from the rest of the country, so access to care for most people is not only difficult but also costly. MEDNET attempts to redress this issue by developing a medical health network with the help of the collaboration medical application based on TeleConsult & @HOME medical database for vital signs. The expected benefits include improved support for medics in the field, reduction of patient referrals, reduction in number of emergency interventions and improved times for medical diagnosis. An important caveat is the emphasis on exploiting the proposed infrastructure for education and social enterprise initiatives. The project has the full support of regional political and health authorities and, importantly, full local community support.

  14. Racial inequalities in access to women's health care in southern Brazil Desigualdades raciais no acesso à saúde da mulher no Sul do Brasil

    Directory of Open Access Journals (Sweden)

    Fernanda Souza de Bairros

    2011-12-01

    Full Text Available The aim of this population-based cross-sectional study was to investigate access by 20 to 60 year-old women - both black and white - to early detection (pap-smear exams for breast and cervical cancer in two towns - São Leopoldo and Pelotas - in Rio Grande do Sul State, southern Brazil. Estimates of the association between race/color and access to pap-smear and breast exams were adjusted for income, education, economic class and age. Of the 2,030 women interviewed, 16.1% were black and 83.9%, white. Black women were significantly less likely to have had a pap-smear and/or breast exam than white women. Racial inequalities in access to cancer early detection exams persisted after controlling for age and other socioeconomic factors. Racial differentials in access to early detection (pap-smear exams for breast and cervical cancers might result from racial and socioeconomic inequalities experienced by black women in access to reproductive health care services and programs.O objetivo da pesquisa foi investigar o acesso de mulheres negras e brancas aos exames de detecção precoce de câncer de mama e colo de útero (citopatológico, em duas cidades no Sul do Brasil. Foi realizado um estudo transversal de base populacional realizado com mulheres de 20-60 anos, residentes em São Leopoldo e Pelotas, Rio Grande do Sul, Brasil. As análises foram ajustadas por renda, escolaridade, classe econômica e idade para verificar a associação entre raça/cor e acesso aos exames. Foram entrevistadas 2.030 mulheres, sendo que 16,1% eram negras e 83,9% brancas. A probabilidade das mulheres não realizarem os exames citopatológico e de mama foi significantemente maior nas negras. A desigualdade racial no acesso aos exames de detecção precoce de câncer persistiu após controle para idade e variáveis socioeconômicas. O diferencial na realização dos exames de detecção precoce pode ser um reflexo das desigualdades raciais e socioeconômicas vividas por

  15. On measuring and decomposing inequality of opportunity in access to health services among Tunisian children: a new approach for public policy.

    Science.gov (United States)

    Saidi, Anis; Hamdaoui, Mekki

    2017-10-25

    The early years in children's life are the key to physical, cognitive-language, and, socio-emotional skills development. So, it is of paramount importance in this period to be interested in different indicators that would influence the child's health. This paper measures inequality of opportunities among Tunisian children concerning access to nutritional and healthy services using Human Opportunity-Index and Shapely decomposition methods. Many disparities between regions have been detected since 1982 until 2012. Tunisian children face unequal opportunities to develop in terms of health, nutrition, cognitive, social, and emotional development. Likewise, we found that, parents' education, wealth, age of household head and geographic factors as key factors determining child development outcomes. Our findings suggested that childhood unequal opportunities in Tunisia are explained by pension funds deficiency and structural problem in the labor market. The results of a health care intervention on human participants "retrospectively registered".

  16. A remote data access architecture for home-monitoring health-care applications.

    Science.gov (United States)

    Lin, Chao-Hung; Young, Shuenn-Tsong; Kuo, Te-Son

    2007-03-01

    With the aging of the population and the increasing patient preference for receiving care in their own homes, remote home care is one of the fastest growing areas of health care in Taiwan and many other countries. Many remote home-monitoring applications have been developed and implemented to enable both formal and informal caregivers to have remote access to patient data so that they can respond instantly to any abnormalities of in-home patients. The aim of this technology is to give both patients and relatives better control of the health care, reduce the burden on informal caregivers and reduce visits to hospitals and thus result in a better quality of life for both the patient and his/her family. To facilitate their widespread adoption, remote home-monitoring systems take advantage of the low-cost features and popularity of the Internet and PCs, but are inherently exposed to several security risks, such as virus and denial-of-service (DoS) attacks. These security threats exist as long as the in-home PC is directly accessible by remote-monitoring users over the Internet. The purpose of the study reported in this paper was to improve the security of such systems, with the proposed architecture aimed at increasing the system availability and confidentiality of patient information. A broker server is introduced between the remote-monitoring devices and the in-home PCs. This topology removes direct access to the in-home PC, and a firewall can be configured to deny all inbound connections while the remote home-monitoring application is operating. This architecture helps to transfer the security risks from the in-home PC to the managed broker server, on which more advanced security measures can be implemented. The pros and cons of this novel architecture design are also discussed and summarized.

  17. Ethnic minority inequalities in access to treatments for schizophrenia and schizoaffective disorders: findings from a nationally representative cross-sectional study.

    Science.gov (United States)

    Das-Munshi, Jayati; Bhugra, Dinesh; Crawford, Mike J

    2018-04-18

    Ethnic minority service users with schizophrenia and schizoaffective disorders may experience inequalities in care. There have been no recent studies assessing access to evidence-based treatments for psychosis amongst the main ethnic minority groups in the UK. Data from nationally representative surveys from England and Wales, for 10,512 people with a clinical diagnosis of schizophrenia or schizoaffective disorders, were used for analyses. Multi-level multivariable logistic regression analyses were used to assess ethnic minority inequalities in access to pharmacological treatments, psychological interventions, shared decision making and care planning, taking into account a range of potential confounders. Compared with white service users, black service users were more likely prescribed depot/injectable antipsychotics (odds ratio 1.56 (95% confidence interval 1.33-1.84)). Black service users with treatment resistance were less likely to be prescribed clozapine (odds ratio 0.56 (95% confidence interval 0.39-0.79)). All ethnic minority service users, except those of mixed ethnicity, were less likely to be offered cognitive behavioural therapy, compared to white service users. Black service users were less likely to have been offered family therapy, and Asian service users were less likely to have received copies of care plans (odds ratio 0.50 (95% confidence interval 0.33-0.76)), compared to white service users. There were no clinician-reported differences in shared decision making across each of the ethnic minority groups. Relative to white service users, ethnic minority service users with psychosis were generally less likely to be offered a range of evidence-based treatments for psychosis, which included pharmacological and psychological interventions as well as involvement in care planning.

  18. Does the distribution of healthcare utilization match needs in Africa?

    Science.gov (United States)

    Bonfrer, Igna; van de Poel, Ellen; Grimm, Michael; Van Doorslaer, Eddy

    2014-10-01

    An equitable distribution of healthcare use, distributed according to people's needs instead of ability to pay, is an important goal featuring on many health policy agendas worldwide. However, relatively little is known about the extent to which this principle is violated across socio-economic groups in Sub-Saharan Africa (SSA). We examine cross-country comparative micro-data from 18 SSA countries and find that considerable inequalities in healthcare use exist and vary across countries. For almost all countries studied, healthcare utilization is considerably higher among the rich. When decomposing these inequalities we find that wealth is the single most important driver. In 12 of the 18 countries wealth is responsible for more than half of total inequality in the use of care, and in 8 countries wealth even explains more of the inequality than need, education, employment, marital status and urbanicity together. For the richer countries, notably Mauritius, Namibia, South Africa and Swaziland, the contribution of wealth is typically less important. As the bulk of inequality is not related to need for care and poor people use less care because they do not have the ability to pay, healthcare utilization in these countries is to a large extent unfairly distributed. The weak average relationship between need for and use of health care and the potential reporting heterogeneity in self-reported health across socio-economic groups imply that our findings are likely to even underestimate actual inequities in health care. At a macro level, we find that a better match of needs and use is realized in those countries with better governance and more physicians. Given the absence of social health insurance in most of these countries, policies that aim to reduce inequities in access to and use of health care must include an enhanced capacity of the poor to generate income. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine

  19. Variation in prescribing for anxiety and depression: a reflection of health inequalities, cultural differences or variations in access to care?

    OpenAIRE

    Peters Jean; Grimsley Michael; Dibben Chris; Goyder Elizabeth; Blank Lindsay; Ellis Elizabeth

    2006-01-01

    Abstract Background There are large variations in mental health prescribing in UK populations. However the underlying reasons for these differences, which may be related to differences in prevalence, cultural expectations or practical difficulties in access to treatment, remain uncertain. Methods Linear modelling was used to investigate whether population characteristics or access to primary care account for variations in mental health prescribing across 39 deprived neighbourhoods. Results Th...

  20. Vertical equity of healthcare in Taiwan: health services were distributed according to need

    OpenAIRE

    Wang, Shiow-Ing; Yaung, Chih-Liang

    2013-01-01

    Abstract Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health ne...

  1. How social policies can improve financial accessibility of healthcare: a multi-level analysis of unmet medical need in European countries.

    Science.gov (United States)

    Israel, Sabine

    2016-03-05

    The article explores in how far financial accessibility of healthcare (FAH) is restricted for low-income groups and identifies social protection policies that can supplement health policies in guaranteeing universal access to healthcare. The article is aimed to advance the literature on comparative European social epidemiology by focussing on income-related barriers of healthcare take-up. The research is carried out on the basis of multi-level cross-sectional analyses using 2012 EU-SILC data for 30 European countries. The social policy data stems from EU-SILC beneficiary information. It is argued that unmet medical needs are a reality for many individuals within Europe - not only due to direct user fees but also due to indirect costs such as waiting time, travel costs, time not spent working. Moreover, low FAH affects not only the lowest income quintile but also the lower middle income class. The study observes that social allowance increases the purchasing power of both household types, thereby helping them to overcome financial barriers to healthcare uptake. Alongside healthcare system reform aimed at improving the pro-poor availability of healthcare facilities and financing, policies directed at improving FAH should aim at providing a minimum income base to the low-income quintile. Moreover, categorical policies should address households exposed to debt which form the key vulnerable group within the low-income classes.

  2. Global Inequality

    DEFF Research Database (Denmark)

    Niño-Zarazúa, Miguel; Roope, Laurence; Tarp, Finn

    2017-01-01

    This paper measures trends in global interpersonal inequality during 1975–2010 using data from the most recent version of the World Income Inequality Database (WIID). The picture that emerges using ‘absolute,’ and even ‘centrist’ measures of inequality, is very different from the results obtained...... using standard ‘relative’ inequality measures such as the Gini coefficient or Coefficient of Variation. Relative global inequality has declined substantially over the decades. In contrast, ‘absolute’ inequality, as captured by the Standard Deviation and Absolute Gini, has increased considerably...... and unabated. Like these ‘absolute’ measures, our ‘centrist’ inequality indicators, the Krtscha measure and an intermediate Gini, also register a pronounced increase in global inequality, albeit, in the case of the latter, with a decline during 2005 to 2010. A critical question posed by our findings is whether...

  3. The impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa

    Directory of Open Access Journals (Sweden)

    Elsje Scheffler

    2015-06-01

    Full Text Available Background: Health care access is complex and multi-faceted and, as a basic right, equitable access and services should be available to all user groups. Objectives: The aim of this article is to explore how service delivery impacts on access to healthcare for vulnerable groups in an urban primary health care setting in South Africa. Methods: A descriptive qualitative study design was used. Data were collected through semi-structured interviews with purposively sampled participants and analysed through thematic content analysis. Results: Service delivery factors are presented against five dimensions of access according to the ACCESS Framework. From a supplier perspective, the organisation of care in the study setting resulted in available, accessible, affordable and adequate services as measured against the DistrictHealth System policies and guidelines. However, service providers experienced significant barriers in provision of services, which impacted on the quality of care, resulting in poor client and provider satisfaction and ultimately compromising acceptability of service delivery. Although users found services to be accessible, the organisation of services presented them with challenges in the domains of availability, affordability and adequacy, resulting in unmet needs, low levels of satisfaction and loss of trust. These challenges fuelled perceptions of unacceptable services. Conclusion: Well developed systems and organisation of services can create accessible, affordable and available primary healthcare services, but do not automatically translate into adequate and acceptable services. Focussing attention on how services are delivered might restore the balance between supply (services and demand (user needs and promote universal and equitable access.

  4. Rural and remote speech-language pathology service inequities: An Australian human rights dilemma.

    Science.gov (United States)

    Jones, Debra M; McAllister, Lindy; Lyle, David M

    2018-02-01

    Access to healthcare is a fundamental human right for all Australians. Article 19 of the Universal Declaration of Human Rights acknowledges the right to freedom of opinion and to seek, receive and impart information and ideas. Capacities for self-expression and effective communication underpin the realisation of these fundamental human rights. For rural and remote Australian children this realisation is compromised by complex disadvantages and inequities that contribute to communication delays, inequity of access to essential speech-language pathology services and poorer later life outcomes. Localised solutions to the provision of civically engaged, accessible, acceptable and sustainable speech-language pathology services within rural and remote Australian contexts are required if we are to make substantive human rights gains. However, civically engaged and sustained healthcare can significantly challenge traditional professionalised perspectives on how best to design and implement speech-language pathology services that seek to address rural and remote communication needs and access inequities. A failure to engage these communities in the identification of childhood communication delays and solutions to address these delays, ultimately denies children, families and communities of their human rights for healthcare access, self-expression, self-dignity and meaningful inclusion within Australian society.

  5. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015

    DEFF Research Database (Denmark)

    2017-01-01

    Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high......-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care...... the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks...

  6. Association of Socioeconomic Position and Demographic Characteristics with Cardiovascular Disease Risk Factors and Healthcare Access among Adults Living in Pohnpei, Federated States of Micronesia

    Directory of Open Access Journals (Sweden)

    G. M. Hosey

    2014-01-01

    Full Text Available Background. The burden of cardiovascular disease (CVD is increasing in low-to-middle income countries. We examined how socioeconomic and demographic characteristics may be associated with CVD risk factors and healthcare access in such countries. Methods. We extracted data from the World Health Organization’s STEPwise approach to surveillance 2002 cross-sectional dataset from Pohnpei, Federated States of Micronesia (FSM. We used these data to estimate associations for socioeconomic position (education, income, and employment and demographics (age, sex, and urban/rural with CVD risk factors and with healthcare access, among a sample of 1638 adults (25–64 years. Results. In general, we found significantly higher proportions of daily tobacco use among men than women and respondents reporting primary-level education (12 years. Results also revealed significant positive associations between paid employment and waist circumference and systolic blood pressure. Healthcare access did not differ significantly by socioeconomic position. Women reported significantly higher mean waist circumference than men. Conclusion. Our results suggest that socioeconomic position and demographic characteristics impact CVD risk factors and healthcare access in FSM. This understanding may help decision-makers tailor population-level policies and programs. The 2002 Pohnpei data provides a baseline; subsequent population health surveillance data might define trends.

  7. [Right of access to healthcare in the context of the Royal Decree-Law 16/2012: the perspective of civil society organizations and professional associations].

    Science.gov (United States)

    Suess, Amets; Ruiz Pérez, Isabel; Ruiz Azarola, Ainhoa; March Cerdà, Joan Carles

    2014-01-01

    The recent publication of the Royal Decree-Law 16/2012 (RDL 16/2012), which introduces structural changes in the Spanish Public Healthcare System, can be placed in the broader context of budgetary adjustments in response to the current economic crisis. An analysis of the interrelationships among economic crisis, healthcare policies, and health reveals that citizen participation is one of several potential strategies for reducing the impact of this situation on the population. This observation raises the interest to know the citizens' perspectives on the modifications introduced by the RDL 16/2012. Narrative review of documents related to the RDL 16/2012 published by civil society organizations and professional associations in the Spanish context. A broad citizen response can be observed to the introduction of RDL 16/2012. The documents reviewed include an analysis of changes in the healthcare model inherent to the RDL 16/2012, as well as predictions on its impact on access to healthcare, healthcare quality, and health. The civil society organizations and professional associations offer recommendations and proposals, as well as collaboration in elaborating alternative strategies to reduce costs. The response of civil society organizations and professional associations underscores the importance of strengthening citizen participation in the development of healthcare policies aimed at maintaining the universal character and sustainability of the Spanish Public Healthcare System in the current moment of economic and systemic crisis. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  8. The relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan.

    Science.gov (United States)

    Yang, Ya-Ting; Iqbal, Usman; Ko, Hua-Lin; Wu, Chia-Rong; Chiu, Hsien-Tsai; Lin, Yi-Chieh; Lin, Wender; Elsa Hsu, Yi-Hsin

    2015-06-01

    The purpose of this study was to explore the relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan. Cross-sectional study from 2007 Taiwan Longitudinal Study on Ageing (TLSA) survey. Community-based study. A total of 4249 middle-aged and elderly subjects were recruited. None. Outpatient visits within 1 month, and hospitalization, emergency visits as well as to shop in pharmacy stores within 1 year, respectively. Adjusting for important confounding variables, the middle-aged and elderly with National Health Insurance (NHI) and commercial insurance compared with those with NHI alone tended to have outpatient visits. The middle-aged and elderly with longer time to access healthcare facilities were less likely to shop in pharmacy stores compared with those with shop in pharmacy stores compared with those with perceived convenience. Our study of Taiwan's experience could provide a valuable lesson for countries that are planning to launch universal health insurance system, locate budgets in health care and transportation. The middle-aged and elderly who were facing more challenges in accessing health care, no matter in perceived accessibility or real time to access health care, had less outpatient visits and more drug stores shopping. Strategic policies are needed to improve accessibility in increasing patients' perception on access and escalating convenience of transportation system for improving accessibility. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  9. Soffer's inequality

    International Nuclear Information System (INIS)

    Goldstein, G.R.; Jaffe, R.L.; Ji, X.

    1995-01-01

    Various issues surrounding a recently proposed inequality among twist-two quark distributions in the nucleon are discussed. We provide a rigorous derivation of the inequality in QCD, including radiative corrections and scale dependence. We also give a more heuristic, but more physical derivation, from which we show that a similar inequality does not exist among twist-three quark distributions. We demonstrate that the inequality does not constrain the nucleon's tensor charge. Finally we explore physical mechanisms for saturating the inequality, arguing it is unlikely to occur in nature

  10. Global Inequality

    DEFF Research Database (Denmark)

    Niño-Zarazúa, Miguel; Roope, Laurence; Tarp, Finn

    2017-01-01

    This paper measures trends in global interpersonal inequality during 1975–2010 using data from the most recent version of the World Income Inequality Database (WIID). The picture that emerges using ‘absolute,’ and even ‘centrist’ measures of inequality, is very different from the results obtained...... by centrist measures such as the Krtscha, could return to 1975 levels, at today's domestic and global per capita income levels, but this would require quite dramatic structural reforms to reduce domestic inequality levels in most countries....... using standard ‘relative’ inequality measures such as the Gini coefficient or Coefficient of Variation. Relative global inequality has declined substantially over the decades. In contrast, ‘absolute’ inequality, as captured by the Standard Deviation and Absolute Gini, has increased considerably...

  11. Use of geographic indicators of healthcare, environment and socioeconomic factors to characterize environmental health disparities.

    Science.gov (United States)

    Padilla, Cindy M; Kihal-Talantikit, Wahida; Perez, Sandra; Deguen, Severine

    2016-07-22

    An environmental health inequality is a major public health concern in Europe. However just few studies take into account a large set of characteristics to analyze this problematic. The aim of this study was to identify and describe how socioeconomic, health accessibility and exposure factors accumulate and interact in small areas in a French urban context, to assess environmental health inequalities related to infant and neonatal mortality. Environmental indicators on deprivation index, proximity to high-traffic roads, green space, and healthcare accessibility were created using the Geographical Information System. Cases were collected from death certificates in the city hall of each municipality in the Nice metropolitan area. Using the parental addresses, cases were geocoded to their census block of residence. A classification using a Multiple Component Analysis following by a Hierarchical Clustering allow us to characterize the census blocks in terms of level of socioeconomic, environmental and accessibility to healthcare, which are very diverse definition by nature. Relation between infant and neonatal mortality rate and the three environmental patterns which categorize the census blocks after the classification was performed using a standard Poisson regression model for count data after checking the assumption of dispersion. Based on geographic indicators, three environmental patterns were identified. We found environmental inequalities and social health inequalities in Nice metropolitan area. Moreover these inequalities are counterbalance by the close proximity of deprived census blocks to healthcare facilities related to mother and newborn. So therefore we demonstrate no environmental health inequalities related to infant and neonatal mortality. Examination of patterns of social, environmental and in relation with healthcare access is useful to identify census blocks with needs and their effects on health. Similar analyzes could be implemented and considered

  12. (Mis)perceptions of inequality.

    Science.gov (United States)

    Hauser, Oliver P; Norton, Michael I

    2017-12-01

    Laypeople's beliefs about the current distribution of outcomes such as income and wealth in their country influence their attitudes toward issues ranging from taxation to healthcare - but how accurate are these beliefs? We review the burgeoning literature on (mis)perceptions of inequality. First, we show that people on average misperceive current levels of inequality, typically underestimating the extent of inequality in their country. Second, we delineate potential causes of these misperceptions, including people's overreliance on cues from their local environment, leading to their erroneous beliefs about both the overall distributions of wealth and income and their place in those distributions. Third, we document that these (mis)perceptions of inequality - but not actual levels of inequality - drive behavior and preferences for redistribution. More promisingly, we review research suggesting that correcting misperceptions influences preferences and policy outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Timing of access to secondary healthcare services for diabetes management and lower extremity amputation in people with diabetes: a protocol of a case-control study.

    LENUS (Irish Health Repository)

    Buckley, Claire M

    2013-09-03

    Lower extremity amputation (LEA) is a complication of diabetes and a marker of the quality of diabetes care. Clinical and sociodemographic determinants of LEA in people with diabetes are well known. However, the role of service-related factors has been less well explored. Early referral to secondary healthcare is assumed to prevent the occurrence of LEA. The objective of this study is to investigate a possible association between the timing of patient access to secondary healthcare services for diabetes management, as a key marker of service-related factors, and LEA in patients with diabetes.

  14. Highly active antiretroviral therapy in Brazil: the challenge of universal access in a context of social inequality.

    Science.gov (United States)

    Hacker, Mariana A; Petersen, Maya L; Enriquez, Melissa; Bastos, Francisco I

    2004-08-01

    To investigate trends in AIDS mortality and incidence in Brazil over the period of 1984 to 2000 and to assess the impact of the introduction of universal access to highly active antiretroviral therapy (HAART) in the country in 1996. Data from the Brazilian disease notification system and the national mortality information system were used to calculate annual region-specific and sex-specific AIDS incidence and mortality rates. We also calculated sex- and region-specific ratios of the number of AIDS deaths in one year to the number of AIDS cases notified two years earlier. AIDS mortality rates for both men and women and in all five of the geographic regions of Brazil declined following introduction of HAART, despite continued growth in AIDS incidence. The ratio of the number of AIDS deaths in one year to the number of AIDS cases notified two years earlier for men equalized rapidly with the ratio for women following introduction of HAART. More recently, AIDS incidence declined for both sexes and in most of the regions of Brazil. Despite Brazil's resource limitations and disparities in wealth between men and women and among the country's regions, the introduction of universal access to HAART in Brazil has helped achieve impressive declines in AIDS mortality, and it may also be contributing to declines in AIDS incidence.

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

    Science.gov (United States)

    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.

  16. Obstacles to "race equality" in the English National Health Service: Insights from the healthcare commissioning arena.

    Science.gov (United States)

    Salway, Sarah; Mir, Ghazala; Turner, Daniel; Ellison, George T H; Carter, Lynne; Gerrish, Kate

    2016-03-01

    Inequitable healthcare access, experiences and outcomes across ethnic groups are of concern across many countries. Progress on this agenda appears limited in England given the apparently strong legal and policy framework. This disjuncture raises questions about how central government policy is translated into local services. Healthcare commissioning organisations are a potentially powerful influence on services, but have rarely been examined from an equity perspective. We undertook a mixed method exploration of English Primary Care Trust (PCT) commissioning in 2010-12, to identify barriers and enablers to commissioning that addresses ethnic healthcare inequities, employing:- in-depth interviews with 19 national Key Informants; documentation of 10 good practice examples; detailed case studies of three PCTs (70+ interviews; extensive observational work and documentary analysis); three national stakeholder workshops. We found limited and patchy attention to ethnic diversity and inequity within English healthcare commissioning. Marginalization of this agenda, along with ambivalence, a lack of clarity and limited confidence, perpetuated a reinforcing inter-play between individual managers, their organisational setting and the wider policy context. Despite the apparent contrary indications, ethnic equity was a peripheral concern within national healthcare policy; poorly aligned with other more dominant agendas. Locally, consideration of ethnicity was often treated as a matter of legal compliance rather than integral to understanding and meeting healthcare needs. Many managers and teams did not consider tackling ethnic healthcare inequities to be part-and-parcel of their job, lacked confidence and skills to do so, and questioned the legitimacy of such work. Our findings indicate the need to enhance the skills, confidence and competence of individual managers and commissioning teams and to improve organizational structures and processes that support attention to ethnic

  17. Health facility management and access: a qualitative analysis of challenges to seeking healthcare for children under five in Uganda.

    Science.gov (United States)

    Allen, Elizabeth Palchik; Muhwezi, Wilson Winstons; Henriksson, Dorcus Kiwanuka; Mbonye, Anthony Kabanza

    2017-09-01

    While several studies have documented the various barriers that caretakers of children under five routinely confront when seeking healthcare in Uganda, few have sought to capture the ways in which caretakers themselves prioritize their own barriers to seeking services. To that end, we asked focus groups of caretakers to list their five greatest challenges to seeking care on behalf of children under five. Using qualitative content analysis, we grouped responses according to four categories: (1) geographical access barriers; (2) facility supplies, staffing, and infrastructural barriers; (3) facility management and administration barriers (e.g. health worker professionalism, absenteeism and customer care); and (4) household barriers related to financial circumstances, domestic conflicts with male partners and a stated lack of knowledge about health-related issues. Among all focus groups, caretakers mentioned supplies, staffing and infrastructure barriers most often and facility management and administration barriers the least. Caretakers living furthest from public facilities (8-10 km) more commonly mentioned geographical barriers to care and barriers related to financial and other personal circumstances. Caretakers who lived closest to health facilities mentioned facility management and administration barriers twice as often as those who lived further away. While targeting managerial barriers is vitally important-and increasingly popular among national planners and donors-it should be done while recognizing that alleviating such barriers may have a more muted effect on caretakers who are geographically harder to reach - and by extension, those whose children have an increased risk of mortality. In light of calls for greater equity in child survival programming - and given the limited resource envelopes that policymakers often have at their disposal - attention to the barriers considered most vital among caretakers in different settings should be weighed. © The

  18. Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil.

    Science.gov (United States)

    Garcia-Subirats, Irene; Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; da Silva, Maria Rejane Ferreira; Unger, Jean Pierre; Vázquez, María Luisa

    2014-04-01

    There are few comprehensive studies available on barriers encountered from the initial seeking of healthcare through to the resolution of the health problem; in other words, on access in its broad domain. For Colombia and Brazil, countries with different healthcare systems but common stated principles, there have been no such analyses to date. This paper compares factors that influence access in its broad domain in two municipalities of each country, by means of a cross-sectional study based on a survey of a multistage probability sample of people who had had at least one health problem within the last three months (2163 in Colombia and 2155 in Brazil). The results reveal important barriers to healthcare access in both samples, with notable differences between and within countries, once differences in sociodemographic characteristics and health needs are accounted for. In the Colombian study areas, the greatest barriers were encountered in initial access to healthcare and in resolving the problem, and similarly when entering the health service in the Brazilian study areas. Differences can also be detected in the use of services: in Colombia greater geographical and economic barriers and the need for authorization from insurers are more relevant, whereas in Brazil, it is the limited availability of health centres, doctors and drugs that leads to longer waiting times. There are also differences according to enrolment status and insurance scheme in Colombia, and between areas in Brazil. The barriers appear to be related to the Colombian system's segmented, non-universal nature, and to the involvement of insurance companies, and to chronic underfunding of the public system in Brazil. Further research is required, but the results obtained reveal critical points to be tackled by health policies in both countries. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  19. Universal or Commodified Healthcare? Linking Out-of-Pocket Payments to Income-Related Inequalities in Unmet Health Needs in Europe

    DEFF Research Database (Denmark)

    Kaminska, Monika Ewa; Wulfgramm, Melike

    2018-01-01

    This study investigates the outcomes out-of-pocket payments (OOPP) produce in terms of income-related disparities in unmet health needs (UHN) due to inability to pay and highlights the commodifying effect of OOPP in European healthcare systems. It merges micro data from the European Union...

  20. Functional inequalities

    CERN Document Server

    Ghoussoub, Nassif

    2013-01-01

    The book describes how functional inequalities are often manifestations of natural mathematical structures and physical phenomena, and how a few general principles validate large classes of analytic/geometric inequalities, old and new. This point of view leads to "systematic" approaches for proving the most basic inequalities, but also for improving them, and for devising new ones--sometimes at will and often on demand. These general principles also offer novel ways for estimating best constants and for deciding whether these are attained in appropriate function spaces. As such, improvements of Hardy and Hardy-Rellich type inequalities involving radially symmetric weights are variational manifestations of Sturm's theory on the oscillatory behavior of certain ordinary differential equations. On the other hand, most geometric inequalities, including those of Sobolev and Log-Sobolev type, are simply expressions of the convexity of certain free energy functionals along the geodesics on the Wasserstein manifold of...

  1. Inequalities in the dental health needs and access to dental services among looked after children in Scotland: a population data linkage study.

    Science.gov (United States)

    McMahon, Alex D; Elliott, Lawrie; Macpherson, Lorna Md; Sharpe, Katharine H; Connelly, Graham; Milligan, Ian; Wilson, Philip; Clark, David; King, Albert; Wood, Rachael; Conway, David I

    2018-01-01

    There is limited evidence on the health needs and service access among children and young people who are looked after by the state. The aim of this study was to compare dental treatment needs and access to dental services (as an exemplar of wider health and well-being concerns) among children and young people who are looked after with the general child population. Population data linkage study utilising national datasets of social work referrals for 'looked after' placements, the Scottish census of children in local authority schools, and national health service's dental health and service datasets. 633 204 children in publicly funded schools in Scotland during the academic year 2011/2012, of whom 10 927 (1.7%) were known to be looked after during that or a previous year (from 2007-2008). The children in the looked after children (LAC) group were more likely to have urgent dental treatment need at 5 years of age: 23%vs10% (n=209/16533), adjusted (for age, sex and area socioeconomic deprivation) OR 2.65 (95% CI 2.30 to 3.05); were less likely to attend a dentist regularly: 51%vs63% (n=5519/388934), 0.55 (0.53 to 0.58) and more likely to have teeth extracted under general anaesthesia: 9%vs5% (n=967/30253), 1.91 (1.78 to 2.04). LAC are more likely to have dental treatment needs and less likely to access dental services even when accounting for sociodemographic factors. Greater efforts are required to integrate child social and healthcare for LAC and to develop preventive care pathways on entering and throughout their time in the care system. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Inequalities in health--future threats to equity.

    Science.gov (United States)

    Gunning-Schepers, L J; Stronks, K

    1999-01-01

    In discussions about equity there is a tendency to focus on the inequalities in health status that appear to be the result of the material and immaterial consequences of a lower income, professional or social status in society. If we look at publications such as the Black Report in the UK or Ongelijke gezondheid in The Netherlands, we have to accept that despite our universal access to healthcare and the existence in many Western countries of social security measures that preclude 'real' poverty, considerable differences in health continue to exist between socioeconomic groups. This is corroborated for many other European countries in the research carried out by a concerted action led by Mackenbach. These inequalities in health have been referred to in many countries as inequities, meaning that society finds them unjust and expects them to be 'avoidable' or amenable to policy interventions. However, the research on the causal networks underlying the occurrence and the avoidability of inequalities in health remains sparse and intervention studies seem to focus on policy measures that can be evaluated, but which will most likely have a limited impact on the inequalities measured at the population level. Thus the research community leaves policymakers with very little evidence on which to build policy initiatives that are nevertheless requested by many governments. The third element, which needs to be addressed in this context, is the ominous inequality in access to healthcare. Since the debate on equity in health has rightly been initiated in the context of a broader, more intersectoral approach to health policy, very little attention has been paid, so far, to the issue of universal access to quality healthcare services. This is because in the second half of this century most Western (European) countries have created a healthcare system with universal access, financed either through taxation or through social insurance schemes. It is these financing systems that will

  3. The value of grounded theory for disentangling inequalities in maternal-child healthcare in contexts of diversity : a psycho-sociopolitical approach

    OpenAIRE

    Hernández Plaza, Sonia; Padilla, Beatriz; Ortiz, Alejandra; Rodrigues, Elsa

    2014-01-01

    Adopting a psycho-sociopolitical approach, the present paper describes the results of a community-based participatory needs assessment focusing on the perceived needs of women of reproductive age as users of primary healthcare in contexts of migration-driven diversity and socioeconomic vulnerability in the Metropolitan Area of Lisbon. The investigation comprised 64 in-depth interviews with women, including natives and immigrants to Portugal from the main origin countries in the co...

  4. The value of grounded theory for disentangling inequalities in maternal-child healthcare in contexts of diversity: a psycho-sociopolitical approach

    OpenAIRE

    Hernández Plaza, Sonia; Padilla, Beatriz; Ortiz, Alejandra; Rodrigues, Elsa

    2014-01-01

    Adopting a psycho-sociopolitical approach, the present paper describes the results of a community-based participatory needs assessment focusing on the perceived needs of women of reproductive age as users of primary healthcare in contexts of migration-driven diversity and socioeconomic vulnerability in the Metropolitan Area of Lisbon. The investigation comprised 64 in-depth interviews with women, including natives and immigrants to Portugal from the main origin countries in the context under ...

  5. Experiences of Healthcare Professionals to the Introduction in Sweden of a Public eHealth Service: Patients' Online Access to their Electronic Health Records.

    Science.gov (United States)

    Ålander, Ture; Scandurra, Isabella

    2015-01-01

    Patients' increasing demands for medical information, the digitization of health records and the fast spread of Internet access form a basis of introducing new eHealth services. An international trend is to provide access for patients to health information of various kind. In Sweden, access by patients to their proper electronic health record (EHR) has been provided in a pilot county since November 2012. This eHealth service is controversial and criticism has arised from the clinical professions, mainly physicians. Two web surveys were conducted to discover whether the opinions of healthcare professionals differ; between staff that have had experience with patients accessing their own EHR and those who have no such expericence. Experienced nurses found the EHR more important for the patients and a better reform, compared to unexperienced nurses in the rest of the country. Similarly, physicians with their own experience had a more positive attitude compared to non-experienced physicians. The conclusion of this study is that healthcare professionals must be involved in the implementation of public eHealth services such as EHRs and that real experiences of the professionals should be better disseminated to their inexperienced peers.

  6. The effect of herd formation among healthcare investors on health sector growth in China.

    Science.gov (United States)

    Lulin, Zhou; Antwi, Henry Asante; Wang, Wenxin; Yiranbon, Ethel; Marfo, Emmanuel Opoku; Acheampong, Patrick

    2016-07-19

    China has become the world's second largest healthcare market based on a recent report by the World Health Organization. Eventhough China achieved universal health insurance coverage in 2011, representing the largest expansion of insurance coverage in human history achieved; health inequality remains endemic in China. Lessons from the effect of market crisis on health equity in Europe and other places has reignited interest in exploring the potential healthcare market aberrations that can trigger distributive injustice in healthcare resource allocation among China's provinces. Recently, many healthcare investors in China have become more concerned about capital preservation, and are responding by abandoning long term investments strategies in healthcare. This investment withdrawal en mass is perceived to be influenced by herding tendencies and can trigger or consolidate endemic health inequality. Our study simultaneously employs four testing models (two state spaced models and two return dispersion models) to establish the existence of procyclical (herding) behavior among the stocks and its health equity implications. These are applied to a large set of data to compare and contrast results of herd formation among investors in fourteen healthcare sectors in China. The study reveals that apart from the cross sectional standard deviation (CSSD) model, the remaining two models and our augmented state space model yields significant evidence of herding in all subsectors of the healthcare market. We also find that the herding effect is more prominent during down movements of the market. Herding behavior may lead to contemporaneous loss of investor confidence and capital withdrawal and thereby deprive the healthcare sector of the much needed capital for expansion. Thus there may be obvious delay in efforts to bridge the gap in access to healthcare facilities, medical support services, medical supplies, pharmaceuticals, biotechnology, diagnostic substances, medical

  7. Tackling Health Inequalities Locally

    DEFF Research Database (Denmark)

    Diderichsen, Finn; Scheele, Christian Elling; Little, Ingvild Gundersen

    of this study. It is based on three sources: 1. Interviews with policymakers (administrators and politicians) within healthcare administrations, childhood/education, and labour market administrations from September 2014 to March 2015*. 2. Textual analysis of available policy documents from regions...... of translating small inequalities in wealth into small inequalities in health. Denmark, Norway and Sweden all have legislation that indifferent ways offers local governments key roles in public health. This is partly due to local governments’ responsibility for many policy areas of great relevance to health...... state model, including its health policy, as an area of Nordic collaboration (104). However, realising the principle of health (equity) in all policiesis no simple matter. The national authorities and local government federations in Denmark, Norway and Sweden have therefore initiated various activities...

  8. Matrix inequalities

    CERN Document Server

    Zhan, Xingzhi

    2002-01-01

    The main purpose of this monograph is to report on recent developments in the field of matrix inequalities, with emphasis on useful techniques and ingenious ideas. Among other results this book contains the affirmative solutions of eight conjectures. Many theorems unify or sharpen previous inequalities. The author's aim is to streamline the ideas in the literature. The book can be read by research workers, graduate students and advanced undergraduates.

  9. How Mobility Systems Produce Inequality

    DEFF Research Database (Denmark)

    Richardson, Tim; Jensen, Ole B.

    2008-01-01

    This paper explores a crucial aspect of sustainable mobility: the production of social inequality in mobility systems. The approach taken is to focus on how, as new transit infrastructures create alternative ways of traveling in and accessing the city, they create changed conditions for the forma......This paper explores a crucial aspect of sustainable mobility: the production of social inequality in mobility systems. The approach taken is to focus on how, as new transit infrastructures create alternative ways of traveling in and accessing the city, they create changed conditions...... for the formation of subject identities. New types of travellers are realised in the newly engineered spaces of mobility. The paper argues that this focus on these emergent mobile subject types can be useful in investigating the social inequalities that can result from the introduction of new infrastructures...... are constructed and how social inequality is materially produced....

  10. Accessibility

    DEFF Research Database (Denmark)

    Brooks, Anthony Lewis

    2017-01-01

    This contribution is timely as it addresses accessibility in regards system hardware and software aligned with introduction of the Twenty-First Century Communications and Video Accessibility Act (CVAA) and adjoined game industry waiver that comes into force January 2017. This is an act created...... by the USA Federal Communications Commission (FCC) to increase the access of persons with disabilities to modern communications, and for other purposes. The act impacts advanced communications services and products including text messaging; e-mail; instant messaging; video communications; browsers; game...... platforms; and games software. However, the CVAA has no legal status in the EU. This text succinctly introduces and questions implications, impact, and wider adoption. By presenting the full CVAA and game industry waiver the text targets to motivate discussions and further publications on the subject...

  11. Measuring Physical Accessibility with Space-Time Prisms in a GIS: A Case Study of Access to Health-Care Facilities

    OpenAIRE

    Lee, Ming S.; McNally, Michael G.

    2002-01-01

    Physical accessibility is a measurement of opportunities available to people in a geographical region. The purpose of such a measurement is for the redirection of regional and transportation policies toward the provision of quality of life. Public policies should provide individuals with more options to choose from, and these options should be more equally distributed among the population. A physical accessibility measure can reflect the efficiency of policies in addressing these issues. This...

  12. Assessing spatial access to public and private hospitals in Sichuan, China: The influence of the private sector on the healthcare geography in China.

    Science.gov (United States)

    Pan, Jay; Zhao, Hanqing; Wang, Xiuli; Shi, Xun

    2016-12-01

    In 2009, the Chinese government launched a new round of healthcare reform, which encourages development of private hospitals. Meanwhile, many public hospitals in China also became increasingly profit-oriented. These trends have led to concerns about social justice and regional disparity. However, there is a lack of empirical scientific analysis to support the debate. We started to fill this gap by conducting a regional-level analysis of spatial variation in spatial access to hospitals in the Sichuan Province. Such variation is an important indication of (in) equity in healthcare resource allocation. Using data of 2012, we intended to provide a snapshot of the situation that was a few years later since the new policies had set out. We employed two methods to quantify the spatial access: the nearest-neighbor method and the enhanced two-step floating catchment area (E2SFCA) method. We recognized two sub-regions of Sichuan: the rural West Sichuan and the well-developed East Sichuan. We classified the hospitals using both ownership and level. We applied the analysis to the resulting groups of hospitals and their combinations in the two sub-regions. The two sub-regions have a high contrast in the spatial access to hospitals, in terms of both quantity and spatial pattern. Public hospitals still dominated the service in the province, especially in the West Sichuan, which had been solely relying on public hospitals. Private hospitals only occurred in the East Sichuan, and at the primary level, they had surpassed public hospitals in terms of spatial accessibility. However, the governmental health expenditures seemed to be disconnected with the actual situation of the spatial access to hospitals. The government should continue carrying on its responsibility in allocating healthcare resources, be cautious about marketizing public hospitals, and encourage private hospitals to expand into rural areas. Methodologically, the results from the two methods are concurring but not

  13. Free Access to Point of Care Resource Results in Increased Use and Satisfaction by Rural Healthcare Providers

    Directory of Open Access Journals (Sweden)

    Lindsay Alcock

    2016-12-01

    Full Text Available A Review of: Eldredge, J. D., Hall, L. J., McElfresh, K. R., Warner, T. D., Stromberg, T. L., Trost, J. T., & Jelinek, D. A. (2016. Rural providers’ access to online resources: A randomized controlled trial. Journal of the Medical Library Association, 104(1, 33-41. http://dx.doi.org/10.3163/1536-5050.104.1.005 Objective – To determine whether free access to the point of care (PoC resource Dynamed or the electronic book collection AccessMedicine was more useful to rural health care providers in answering clinical questions in terms of usage and satisfaction. Design – Randomized controlled trial. Setting – Rural New Mexico. Subjects – Twenty-eight health care providers (physicians, nurses, physician assistants, and pharmacists with no reported access to PoC resources, (specifically Dynamed and AccessMedicine or electronic textbook collections prior to enrollment.

  14. Right and access to healthcare for undocumented children: addressing the gap between international conventions and disparate implementations in North America and Europe.

    Science.gov (United States)

    Ruiz-Casares, Mónica; Rousseau, Cécile; Derluyn, Ilse; Watters, Charles; Crépeau, François

    2010-01-01

    Limited access to healthcare for vulnerable immigrant children in Europe and North America is increasingly worrisome as immigration policies harden. This paper analyzes the gap between States' obligations under international human rights law and the disparate local implementations in diverse countries. Studies that are both multidisciplinary and incorporate micro and macro level indicators are needed to reveal discrepancies between entitlements and access. It is argued that the lack of available data on the magnitude of the problem and on its individual and public health consequences stems from the conflicting situation faced by health institutions required to simultaneously protect the best interest of each child and allocate limited resources. Collaboration in research is urgently needed to assist policy-makers and institutions make informed decisions. Copyright 2009 Elsevier Ltd. All rights reserved.

  15. There Are Many Purposes for Conditional Incentives to Accessing Healthcare; Comment on “Denial of Treatment to Obese Patients—the Wrong Policy on Personal Responsibility for Health”

    Directory of Open Access Journals (Sweden)

    Sridhar Venkatapuram

    2013-01-01

    Full Text Available This commentary is a brief response to Nir Eyal’s argument that health policies should not make healthy behaviour a condition or prerequisite in order to access healthcare as it could result in the people who need healthcare the most not being able to access healthcare. While in general agreement due to the shared concern for equity, I argue that making health behaviour a condition to accessing healthcare can serve to develop commitment to lifestyle changes, make the health intervention more successful, help appreciate the value of the resources being spent, and help reflect on the possible risks of the intervention. I also argue that exporting or importing the carrot and stick policies to other countries without a solid understanding of the fiscal and political context of the rise of such policies in the US can lead to perverse consequences.

  16. Impact of the healthcare payment system on patient access to oral anticancer drugs: an illustration from the French and United States contexts

    Science.gov (United States)

    2014-01-01

    Background Oral anticancer drugs (OADs) allow treating a growing range of cancers. Despite their convenience, their acceptance by healthcare professionals and patients may be affected by medical, economical and organizational factors. The way the healthcare payment system (HPS) reimburses OADs or finances hospital activities may impact patients’ access to such drugs. We discuss how the HPS in France and USA may generate disincentives to the use of OADs in certain circumstances. Discussion French public and private hospitals are financed by National Health Insurance (NHI) according to the nature and volume of medical services provided annually. Patients receiving intravenous anticancer drugs (IADs) in a hospital setting generate services, while those receiving OADs shift a part of service provision from the hospital to the community. In 2013, two million outpatient IADs sessions were performed, representing a cost of €815 million to the NHI, but positive contribution margin of €86 million to hospitals. Substitution of IADs by OADs mechanically induces a shortfall in hospital income related to hospitalizations. Such economic constraints may partially contribute to making physicians reluctant to prescribe OADs. In the US healthcare system, coverage for OADs is less favorable than coverage for injectable anticancer drugs. In 2006, a Cancer Drug Coverage Parity Act was adopted by several states in order to provide patients with better coverage for OADs. Nonetheless, the complexity of reimbursement systems and multiple reimbursement channels from private insurance represent real economic barriers which may prevent patients with low income being treated with OADs. From an organizational perspective, in both countries the use of OADs generates additional activities related to physician consultations, therapeutic education and healthcare coordination between hospitals and community settings, which are not considered in the funding of hospitals activities so far

  17. Health inequalities

    DEFF Research Database (Denmark)

    Diderichsen, Finn

    2016-01-01

    Social investment policy has become a central response to the demographic and economic challenges facing European welfare states. This focus on investment in human capabilities and their efficient use is, however, challenged by health inequalities where education, health and employment...... are increasingly linked. This paper outlines the main principles of social investment policies (learning, activation and protection) and links them to a conceptual model of health inequalities and the policy entry-points tackling them by addressing the processes of social stratification, differential exposure...... investments in health so as to enable social investments to tackle the health divide....

  18. The less healthy urban population: income-related health inequality in China.

    Science.gov (United States)

    Yang, Wei; Kanavos, Panos

    2012-09-18

    Health inequality has been recognized as a problem all over the world. In China, the poor usually have less access to healthcare than the better-off, despite having higher levels of need. Since the proportion of the Chinese population living in urban areas increased tremendously with the urbanization movements, attention has been paid to the association between urban/rural residence and population health. It is important to understand the variation in health across income groups, and in particular to take into account the effects of urban/rural residence on the degree of income-related health inequalities. This paper empirically assesses the magnitude of rural/urban disparities in income-related adult health status, i.e., self-assessed health (SAH) and physical activity limitation, using Concentration Indices. It then uses decomposition methods to unravel the causes of inequalities and their variations across urban and rural populations. Data from the China Health and Nutrition Survey (CHNS) 2006 are used. The study finds that the poor are less likely to report their health status as "excellent or good" and are more likely to have physical activity limitation. Such inequality is more pronounced for the urban population than for the rural population. Results from the decomposition analysis suggest that, for the urban population, 76.47 per cent to 79.07 per cent of inequalities are driven by non-demographic/socioeconomic-related factors, among which income, job status and educational level are the most important factors. For the rural population, 48.19 per cent to 77.78 per cent of inequalities are driven by non-demographic factors. Income and educational attainment appear to have a prominent influence on inequality. The findings suggest that policy targeting the poor, especially the urban poor, is needed in order to reduce health inequality.

  19. The less healthy urban population: income-related health inequality in China

    Science.gov (United States)

    2012-01-01

    Background Health inequality has been recognized as a problem all over the world. In China, the poor usually have less access to healthcare than the better-off, despite having higher levels of need. Since the proportion of the Chinese population living in urban areas increased tremendously with the urbanization movements, attention has been paid to the association between urban/rural residence and population health. It is important to understand the variation in health across income groups, and in particular to take into account the effects of urban/rural residence on the degree of income-related health inequalities. Methods This paper empirically assesses the magnitude of rural/urban disparities in income-related adult health status, i.e., self-assessed health (SAH) and physical activity limitation, using Concentration Indices. It then uses decomposition methods to unravel the causes of inequalities and their variations across urban and rural populations. Data from the China Health and Nutrition Survey (CHNS) 2006 are used. Results The study finds that the poor are less likely to report their health status as “excellent or good” and are more likely to have physical activity limitation. Such inequality is more pronounced for the urban population than for the rural population. Results from the decomposition analysis suggest that, for the urban population, 76.47 per cent to 79.07 per cent of inequalities are driven by non-demographic/socioeconomic-related factors, among which income, job status and educational level are the most important factors. For the rural population, 48.19 per cent to 77.78 per cent of inequalities are driven by non-demographic factors. Income and educational attainment appear to have a prominent influence on inequality. Conclusion The findings suggest that policy targeting the poor, especially the urban poor, is needed in order to reduce health inequality. PMID:22989200

  20. The less healthy urban population: income-related health inequality in China

    Directory of Open Access Journals (Sweden)

    Yang Wei

    2012-09-01

    Full Text Available Abstract Background Health inequality has been recognized as a problem all over the world. In China, the poor usually have less access to healthcare than the better-off, despite having higher levels of need. Since the proportion of the Chinese population living in urban areas increased tremendously with the urbanization movements, attention has been paid to the association between urban/rural residence and population health. It is important to understand the variation in health across income groups, and in particular to take into account the effects of urban/rural residence on the degree of income-related health inequalities. Methods This paper empirically assesses the magnitude of rural/urban disparities in income-related adult health status, i.e., self-assessed health (SAH and physical activity limitation, using Concentration Indices. It then uses decomposition methods to unravel the causes of inequalities and their variations across urban and rural populations. Data from the China Health and Nutrition Survey (CHNS 2006 are used. Results The study finds that the poor are less likely to report their health status as “excellent or good” and are more likely to have physical activity limitation. Such inequality is more pronounced for the urban population than for the rural population. Results from the decomposition analysis suggest that, for the urban population, 76.47 per cent to 79.07 per cent of inequalities are driven by non-demographic/socioeconomic-related factors, among which income, job status and educational level are the most important factors. For the rural population, 48.19 per cent to 77.78 per cent of inequalities are driven by non-demographic factors. Income and educational attainment appear to have a prominent influence on inequality. Conclusion The findings suggest that policy targeting the poor, especially the urban poor, is needed in order to reduce health inequality.

  1. Healthcare needs and access in a sample of Chinese young adults in Vancouver, British Columbia: A qualitative analysis

    Directory of Open Access Journals (Sweden)

    Christine H.K. Ou, RN, BN, MSN

    2017-04-01

    Conclusion: Chinese young adults share similar issues with other young adults in relation to not having a primary care provider and accessing preventive care but their health beliefs and practices make their needs for care unique from other young adults.

  2. Gender Inequality in University Administration and Services

    OpenAIRE

    Estelles Miguel, Sofia; NAVARRO GARCÍA, ANTONIO; Palmer Gato, Marta Elena; Albarracín Guillem, José Miguel

    2014-01-01

    This work is licensed under a Creative Commons Attribution 3.0 License. This article addresses inequalities between men and women at work. Inequalities in job access and career progression are addressed. The article reviews literature on equal opportunities at work. A case study of administrative and services staff at a public university in Valencia (Spain) is then presented. The case study assesses the current reality of gender inequality in Spanish public institutions. Spanish public uni...

  3. Healthcare provider perspectives on barriers to HIV-care access and utilisation among Latinos living with HIV in the US-Mexico border.

    Science.gov (United States)

    Servin, Argentina E; Muñoz, Fátima A; Zúñiga, María Luisa

    2014-01-01

    Latinos living with HIV residing in the US-Mexico border region frequently seek care on both sides of the border. Given this fact, a border health perspective to understanding barriers to care is imperative to improve patient health outcomes. This qualitative study describes and compares experiences and perceptions of Mexican and US HIV care providers regarding barriers to HIV care access for Latino patients living in the US-Mexico border region. In 2010, we conducted in-depth qualitative interviews with HIV care providers in Tijuana (n = 10) and San Diego (n = 9). We identified important similarities and differences between Mexican and US healthcare provider perspectives on HIV care access and barriers to service utilisation. Similarities included the fact that HIV-positive Latino patients struggle with access to ART medication, mental health illness, substance abuse and HIV-related stigma. Differences included Mexican provider perceptions of medication shortages and US providers feeling that insurance gaps influenced medication access. Differences and similarities have important implications for cross-border efforts to coordinate health services for patients who seek care in both countries.

  4. Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare

    Directory of Open Access Journals (Sweden)

    Griffiths Frances

    2011-01-01

    Full Text Available Abstract Background Research has investigated whether communication technologies (e.g. mobile telephony, forums, email can be used to transfer digital information between healthcare professionals and young people who live with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on communication. Methods Nine electronic databases were searched. Technologies were described and a narrative synthesis of all studies was undertaken. Results Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five categories of communication technologies were identified: video-and tele-conferencing (n = 2; mobile telephony (n = 3; telephone support (n = 3; novel electronic communication devices for transferring clinical information (n = 10; and web-based discussion boards (n = 1. Ten studies showed a positive improvement in HbA1c following the intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication technologies increased the frequency of contact between patient and healthcare professional. Findings were inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was available concerning behavioural and care coordination outcomes, although improvement in quality of life, patient-caregiver interaction, self-care and metabolic transmission were reported for some communication technologies. Conclusions The breadth of study design and types of technologies reported make the magnitude of benefit and their effects on health difficult to determine. While communication technologies may increase the frequency of contact between patient and health care professional, it remains unclear whether this results in improved outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness and cost effectiveness of increasing the use of communication

  5. Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare.

    Science.gov (United States)

    Sutcliffe, Paul; Martin, Steven; Sturt, Jackie; Powell, John; Griffiths, Frances; Adams, Ann; Dale, Jeremy

    2011-01-06

    Research has investigated whether communication technologies (e.g. mobile telephony, forums, email) can be used to transfer digital information between healthcare professionals and young people who live with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on communication. Nine electronic databases were searched. Technologies were described and a narrative synthesis of all studies was undertaken. Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five categories of communication technologies were identified: video-and tele-conferencing (n = 2); mobile telephony (n = 3); telephone support (n = 3); novel electronic communication devices for transferring clinical information (n = 10); and web-based discussion boards (n = 1). Ten studies showed a positive improvement in HbA1c following the intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication technologies increased the frequency of contact between patient and healthcare professional. Findings were inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was available concerning behavioural and care coordination outcomes, although improvement in quality of life, patient-caregiver interaction, self-care and metabolic transmission were reported for some communication technologies. The breadth of study design and types of technologies reported make the magnitude of benefit and their effects on health difficult to determine. While communication technologies may increase the frequency of contact between patient and health care professional, it remains unclear whether this results in improved outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness and cost effectiveness of increasing the use of communication technologies between young people and healthcare professionals.

  6. Inequity in childhood immunization in India: a systematic review.

    Science.gov (United States)

    Mathew, Joseph L

    2012-03-01

    Despite a reduction in disease burden of vaccine preventable diseases through childhood immunization, considerable progress needs to be made in terms of ensuring efficiency and equity of vaccination coverage. To conduct a systematic review to identify and explore factors associated with inequities in routine vaccination of children in India. Publications reporting vaccination inequity were retrieved through a systematic search of Medline and websites of the WHO, UNICEF and demographic health surveys in India. No restrictions were applied in terms of study designs. The primary outcome measure was complete vaccination or immunization defined as per the standard WHO definition. There were three nationwide data sets viz. the three National Family Health Surveys (NFHS), a research study conducted by the Indian Council of Medical Research (ICMR) and a UNICEF coverage evaluation survey. In addition, several publications representing different population groups or geographic regions were available. A small number of publications were reanalyses of data from the NFHS series. There is considerable inequity in vaccination coverage in different states. Within states, traditionally poor performing states have greater inequities, although there are significant inequities even within better performing states. There are significant inequities in childhood vaccination based on various factors related to individual (gender, birth order), family (area of residence, wealth, parental education), demography (religion, caste), and the society (access to health-care, community literacy level) characteristics. Girls fare uniformly worse than boys and higher birth order infants have lower vaccination coverage. Urban infants have higher coverage than rural infants and those living in urban slums. There is an almost direct relationship between household wealth and vaccination rates. The vaccination rates are lower among infants with mothers having no or low literacy, and families with

  7. Protocole of a controlled before-after evaluation of a national health information technology-based program to improve healthcare coordination and access to information.

    Science.gov (United States)

    Saillour-Glénisson, Florence; Duhamel, Sylvie; Fourneyron, Emmanuelle; Huiart, Laetitia; Joseph, Jean Philippe; Langlois, Emmanuel; Pincemail, Stephane; Ramel, Viviane; Renaud, Thomas; Roberts, Tamara; Sibé, Matthieu; Thiessard, Frantz; Wittwer, Jerome; Salmi, Louis Rachid

    2017-04-21

    Improvement of coordination of all health and social care actors in the patient pathways is an important issue in many countries. Health Information (HI) technology has been considered as a potentially effective answer to this issue. The French Health Ministry first funded the development of five TSN ("Territoire de Soins Numérique"/Digital health territories) projects, aiming at improving healthcare coordination and access to information for healthcare providers, patients and the population, and at improving healthcare professionals work organization. The French Health Ministry then launched a call for grant to fund one research project consisting in evaluating the TSN projects implementation and impact and in developing a model for HI technology evaluation. EvaTSN is mainly based on a controlled before-after study design. Data collection covers three periods: before TSN program implementation, during early TSN program implementation and at late TSN program implementation, in the five TSN projects' territories and in five comparison territories. Three populations will be considered: "TSN-targeted people" (healthcare system users and people having characteristics targeted by the TSN projects), "TSN patient users" (people included in TSN experimentations or using particular services) and "TSN professional users" (healthcare professionals involved in TSN projects). Several samples will be made in each population depending on the objective, axis and stage of the study. Four types of data sources are considered: 1) extractions from the French National Heath Insurance Database (SNIIRAM) and the French Autonomy Personalized Allowance database, 2) Ad hoc surveys collecting information on knowledge of TSN projects, TSN program use, ease of use, satisfaction and understanding, TSN pathway experience and appropriateness of hospital admissions, 3) qualitative analyses using semi-directive interviews and focus groups and document analyses and 4) extractions of TSN

  8. Healthcare Strategic Planning as Part of National and Regional Development in the Israeli Galilee: A Case Study of the Planning Process.

    Science.gov (United States)

    Peled, Ronit; Schenirer, Jerry

    2009-10-01

    This article describes a systematic process of geographic and strategic planning for healthcare services as a part of a regional development plan in the Israeli Galilee. The planning process consisted of three stages: (a) assessment of needs, demand and existing resources; (b) prioritisation of initiatives; and (c) scheduling of theoretical priorities. For many years the region has suffered from inequities and inequalities regarding the availability and accessibility of a regional healthcare system, resulting in high mortality and morbidity rates and low quality of life. The aim of the healthcare strategic plan was to suggest initiatives and actions to be taken in order to improve healthcare provision and the health and wellbeing of local residents.

  9. Utilization and Accessibility of Healthcare on Pemba Island, Tanzania: Implications for Health Outcomes and Disease Surveillance for Typhoid Fever

    Science.gov (United States)

    Kaljee, Linda M.; Pach, Alfred; Thriemer, Kamala; Ley, Benedikt; Ali, Said M.; Jiddawi, Mohamed; Puri, Mahesh; von Seidlein, Lorenz; Deen, Jacqueline; Ochiai, Leon; Wierzba, Thomas; Clemens, John

    2013-01-01

    Salmonella enterica serotype Typhi (S. Typhi) was estimated to cause over 200,000 deaths and more than 21 million illnesses worldwide, including over 400,000 illnesses in Africa. The current study was conducted in four villages on Pemba Island, Zanzibar, in 2010. We present data on policy makers', health administrators', and village residents' and leaders' perceptions of typhoid fever, and hypothetical and actual health care use among village residents for typhoid fever. Qualitative data provided descriptions of home-based treatment practices and use of western pharmaceuticals, and actual healthcare use for culture-confirmed typhoid fever. Survey data indicate health facility use was associated with gender, education, residency, and perceptions of severity for symptoms associated with typhoid fever. Data have implications for education of policy makers and health administrators, design and implementation of surveillance studies, and community-based interventions to prevent disease outbreaks, decrease risks of complications, and provide information about disease recognition, diagnosis, and treatment. PMID:23208887

  10. Protocol for determining primary healthcare practice characteristics, models of practice and patient accessibility using an exploratory census survey with linkage to administrative data in Nova Scotia, Canada.

    Science.gov (United States)

    Marshall, Emily Gard; Gibson, Richard J; Lawson, Beverley; Burge, Frederick

    2017-03-16

    There is little evidence on how primary care providers (PCPs) model their practices in Nova Scotia (NS), Canada, what services they offer or what accessibility is like for the average patient. This study will create a database of all family physicians and primary healthcare nurse practitioners in NS, including information about accessibility and the model of care in which they practice, and will link the survey data to administrative health databases. 3 census surveys of all family physicians, primary care nurse practitioners (ie, PCPs) and their practices in NS will be conducted. The first will be a telephone survey conducted during typical daytime business hours. At each practice, the person answering the telephone will be asked questions about the practice's accessibility and model of care. The second will be a telephone survey conducted after typical daytime business hours to determine what out-of-office services PCP practices offer their patients. The final will be a tailored fax survey that will collect information that could not be obtained in the first 2 surveys plus new information on scope of practice, practice model and willingness to participate in research. Survey data will be linked with billing data from administrative health databases. Multivariate regression analysis will be employed to assess whether access and availability outcome variables are associated with PCP and model of practice characteristics. Negative binomial regression analysis will be employed to assess the association between independent variables from the survey data and health system use outcomes from administrative data. This study has received ethical approval from the Nova Scotia Health Authority and the Health Data Nova Scotia Data Access Committee. Dissemination approached will include stakeholder engagement at local and national levels, conference presentations, peer-reviewed publications and a public website. Published by the BMJ Publishing Group Limited. For permission to

  11. Widening access to cardiovascular healthcare: community screening among ethnic minorities in inner-city Britain – the Healthy Hearts Project

    Directory of Open Access Journals (Sweden)

    Tracey Inessa

    2007-11-01

    Full Text Available Abstract Background The burden of cardiovascular disease (CVD in Britain is concentrated in inner-city areas such as Sandwell, which is home to a diverse multi-ethnic population. Current guidance for CVD risk screening is not established, nor are there specific details for ethnic minorities. Given the disparity in equitable healthcare for these groups, we developed a 'tailored' and systematic approach to CVD risk screening within communities of the Sandwell locality. The key anticipated outcomes were the numbers of participants from various ethnic backgrounds attending the health screening events and the prevalence of known and undiagnosed CVD risk within ethnic groups. Methods Data was collected during 10 health screening events (September 2005 and July 2006, which included an assessment of raised blood pressure, overweight, hyperlipidaemia, impaired fasting glucose, smoking habit and the 10 year CVD risk score. Specific features of our approach included (i community involvement, (ii a clinician who could deliver immediate attention to adverse findings, and (iii the use of an interpreter. Results A total of 824 people from the Sandwell were included in this study (47% men, mean age 47.7 years from community groups such as the Gujarati Indian, Punjabi Indian, European Caucasian, Yemeni, Pakistani and Bangladeshi. A total of 470 (57% individuals were referred to their General Practitioner with a report of an increased CVD score – undetected high blood pressure in 120 (15%, undetected abnormal blood glucose in 70 (8%, undetected raised total cholesterol in 149 (18%, and CVD risk management review in 131 (16%. Conclusion Using this systematic and targeted approach, there was a clear demand for this service from people of various ethnic backgrounds, of whom, one in two needed review from primary or secondary healthcare. Further work is required to assess the accuracy and clinical benefits of this community health screening approach.

  12. Access to healthcare, HIV/STI testing, and preferred pre-exposure prophylaxis providers among men who have sex with men and men who engage in street-based sex work in the US.

    Directory of Open Access Journals (Sweden)

    Kristen Underhill

    Full Text Available Pre-exposure prophylaxis (PrEP is a promising strategy for HIV prevention among men who have sex with men (MSM and men who engage in sex work. But access will require routine HIV testing and contacts with healthcare providers. This study investigated men's healthcare and HIV testing experiences to inform PrEP implementation.We conducted 8 focus groups (n = 38 in 2012 and 56 in-depth qualitative interviews in 2013-14 with male sex workers (MSWs (n = 31 and other MSM (n = 25 in Providence, RI. MSWs primarily met clients in street-based sex work venues. Facilitators asked participants about access to healthcare and HIV/STI testing, healthcare needs, and preferred PrEP providers.MSWs primarily accessed care in emergency rooms (ERs, substance use clinics, correctional institutions, and walk-in clinics. Rates of HIV testing were high, but MSWs reported low access to other STI testing, low insurance coverage, and unmet healthcare needs including primary care, substance use treatment, and mental health services. MSM not engaging in sex work were more likely to report access to primary and specialist care. Rates of HIV testing among these MSM were slightly lower, but they reported more STI testing, more insurance coverage, and fewer unmet needs. Preferred PrEP providers for both groups included primary care physicians, infectious disease specialists, and psychiatrists. MSWs were also willing to access PrEP in substance use treatment and ER settings.PrEP outreach efforts for MSWs and other MSM should engage diverse providers in many settings, including mental health and substance use treatment, ERs, needle exchanges, correctional institutions, and HIV testing centers. Access to PrEP will require financial assistance, but can build on existing healthcare contacts for both populations.

  13. Access to healthcare, HIV/STI testing, and preferred pre-exposure prophylaxis providers among men who have sex with men and men who engage in street-based sex work in the US.

    Science.gov (United States)

    Underhill, Kristen; Morrow, Kathleen M; Colleran, Christopher M; Holcomb, Richard; Operario, Don; Calabrese, Sarah K; Galárraga, Omar; Mayer, Kenneth H

    2014-01-01

    Pre-exposure prophylaxis (PrEP) is a promising strategy for HIV prevention among men who have sex with men (MSM) and men who engage in sex work. But access will require routine HIV testing and contacts with healthcare providers. This study investigated men's healthcare and HIV testing experiences to inform PrEP implementation. We conducted 8 focus groups (n = 38) in 2012 and 56 in-depth qualitative interviews in 2013-14 with male sex workers (MSWs) (n = 31) and other MSM (n = 25) in Providence, RI. MSWs primarily met clients in street-based sex work venues. Facilitators asked participants about access to healthcare and HIV/STI testing, healthcare needs, and preferred PrEP providers. MSWs primarily accessed care in emergency rooms (ERs), substance use clinics, correctional institutions, and walk-in clinics. Rates of HIV testing were high, but MSWs reported low access to other STI testing, low insurance coverage, and unmet healthcare needs including primary care, substance use treatment, and mental health services. MSM not engaging in sex work were more likely to report access to primary and specialist care. Rates of HIV testing among these MSM were slightly lower, but they reported more STI testing, more insurance coverage, and fewer unmet needs. Preferred PrEP providers for both groups included primary care physicians, infectious disease specialists, and psychiatrists. MSWs were also willing to access PrEP in substance use treatment and ER settings. PrEP outreach efforts for MSWs and other MSM should engage diverse providers in many settings, including mental health and substance use treatment, ERs, needle exchanges, correctional institutions, and HIV testing centers. Access to PrEP will require financial assistance, but can build on existing healthcare contacts for both populations.

  14. A randomized trial comparing two intraosseous access devices in intrahospital healthcare providers with a focus on retention of knowledge, skill, and self-efficacy.

    Science.gov (United States)

    Derikx, H J G M; Gerritse, B M; Gans, R; van der Meer, N J M

    2014-10-01

    Intraosseous access is recommended in vitally compromised patients if an intravenous access cannot be easily obtained. Intraosseous infusion can be initiated by various healthcare providers. Currently, there are two mechanical intraosseous devices approved by the U.S. Food and Drug Administration (FDA) for use in adults and children. A comparison is made in this study of the theoretical and practical performance by anesthesiologists and registered nurses of anesthesia (RNAs) in the use of the battery-powered device (device A) versus the spring-loaded needle device (device B). This study entailed a 12-month follow-up of knowledge, skill retention, and self-efficacy measured by standardized testing. A prospective randomized trial was performed, initially comparing 15 anesthesiologists and 15 RNAs, both on using the two types of intraosseous devices. A structured lecture and skill station was given with the educational aids provided by the respective manufacturers. Individual knowledge and practical skills were tested at 0, 3, and 12 months after the initial course. There was no statistical significant difference in the retention of theoretical knowledge between RNAs and anesthesiologists on all testing occasions. However, the self-efficacy of the anesthesiologists is significantly higher (p intraosseous access has been disproven, as anesthesiologists were as successful as RNAs. However, the low self-efficacy of RNAs in the use of intraosseous devices could diminish the chance of them actually using one.

  15. Gender inequality: Bad for men's health

    African Journals Online (AJOL)

    2013-03-02

    Mar 2, 2013 ... have attributed this risk to men's poorer health-seeking behaviour, which may prevent them from accessing ART, being ... Gender inequality: Bad for men's health ..... New York: United Nations Development Programme, 2005.

  16. Out-of-pocket costs and other determinants of access to healthcare for children with febrile illnesses: a case-control study in rural Tanzania.

    Directory of Open Access Journals (Sweden)

    Joëlle Castellani

    Full Text Available To study private costs and other determinants of access to healthcare for childhood fevers in rural Tanzania.A case-control study was conducted in Tanzania to establish factors that determine access to a health facility in acute febrile illnesses in children less than 5 years of age. Carers of eligible children were interviewed in the community; cases were represented by patients who went to a facility and controls by those who did not. A Household Wealth Index was estimated using principal components analysis. A multivariable logistic regression analysis was performed to understand the factors which influenced attendance of healthcare facility including severity of the illness and household wealth/socio-demographic indicators. To complement the data on costs from community interviews, a hospital-based study obtained details of private expenditures for hospitalised children under the age of 5.Severe febrile illness is strongly associated with health facility attendance (OR: 35.76, 95%CI: 3.68-347.43, p = 0.002 compared with less severe febrile illness. Overall, the private costs of an illness for patients who went to a hospital were six times larger than private costs of controls ($5.68 vs. $0.90, p<0.0001. Household wealth was not significantly correlated with total costs incurred. The separate hospital based cost study indicated that private costs were three times greater for admissions at the mission versus public hospital: $13.68 mission vs. $4.47 public hospital (difference $ 9.21 (95% CI: 7.89 -10.52, p<0.0001. In both locations, approximately 50% of the cost was determined by the duration of admission, with each day in hospital increasing private costs by about 12% (95% CI: 5% - 21%.The more severely ill a child, the higher the probability of attending hospital. We did not find association between household wealth and attending a health facility; nor was there an association between household wealth and private cost.

  17. Is Provision of Healthcare Sufficient to Ensure Better Access? An Exploration of the Scope for Public-Private Partnership in India

    Directory of Open Access Journals (Sweden)

    Sabitri Dutta

    2015-07-01

    Full Text Available Background India’s economic growth rate in recent years has been fairly impressive. But, it has been consistently failing to make considerable progress in achieving health related Millennium Development Goal (MDG targets. Lack of coherence between provisions and utilization becomes the face of the problem. Inadequacies in outreach, access and affordability coupled with escalating healthcare costs have aggravated the problem. Here the application of PublicPrivate Partnership (PPP model seems to have enormous potential to ease the impasse. Methods This paper tries to find the gap between the provisions and access in healthcare. The paper attempts to construct a Health Infrastructure Index (HII and Health Attainment Index (HAI for different states of India. Considering the presence of regional variations found in health infrastructure and attainment among the states, two states, viz. Maharashtra (MAH and West Bengal (WB have been chosen. Then contributions of health programs like Rashtriya Swasthya Bima Yojana (RSBY, National Rural Telemedicine Network (NRTN and Fair Price Shops (FPS, all PPP initiatives, have been assessed for both the states by carrying out comprehensive benefit-cost analysis. Results The health infrastructure for population per unit area captures the outreach/delivery issue and the health attainment reveals the true scenario about how far the infrastructure has been accessed by the people; and the gap between the two, as the paper finds, is the root of the problem. The combined effect of RSBY and NRTN will leave both MAH and WB higher benefits in terms of health attainment. The contributions of RSBY and NRTN have been assessed for both the states by carrying out comprehensive benefit-cost analysis. FPS comes up with immense benefits for WB. It is yet to be implemented in MAH. Conclusion The outreach and access problems arising from deficiencies in infrastructure, human resources and financial ability are expected to be well

  18. H1N1, globalization and the epidemiology of inequality.

    Science.gov (United States)

    Sparke, Matthew; Anguelov, Dimitar

    2012-07-01

    This paper examines the lessons learned from the 2009 H1N1 pandemic in relation to wider work on globalization and the epidemiology of inequality. The media attention and economic resources diverted to the threats posed by H1N1 were significant inequalities themselves when contrasted with weaker responses to more lethal threats posed by other diseases associated with global inequality. However, the multiple inequalities revealed by H1N1 itself in 2009 still provide important insights into the future of global health in the context of market-led globalization. These lessons relate to at least four main forms of inequality: (1) inequalities in blame for the outbreak in the media; (2) inequalities in risk management; (3) inequalities in access to medicines; and (4) inequalities encoded in the actual emergence of new flu viruses. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Global oral inequalities in HIV infection.

    Science.gov (United States)

    Challacombe, S J

    2016-04-01

    Analysis of the prevalence and incidence of HIV infection globally reveal striking variances with regard to continent, country, region and gender. Of the global total of 33 million people infected with HIV, approximately 65% are in sub-Saharan African countries and 15% in South and South-East Asia with the remaining 20% spread over the rest of the world. As a percentage of the population, the Caribbean at 1.1% is second only to sub-Saharan Africa (5.5%). The majority of the world's HIV is in women. Deaths from HIV are twenty-fold greater in Africa than in Europe or the USA. Individual countries in sub-Saharan Africa show huge variances in the HIV+ prevalence with most West African countries having a rate of less than 2% whilst southern African countries including Swaziland and Botswana have rates of around 25%. Environment, education and social habits all contribute to the HIV infection rates. Similar variations between countries are seen in SE Asia with Cambodia and Papua New Guinea having rates three times greater than Pakistan. One of the most striking examples of inequality is in life years added to HIV populations as a result of antiretroviral therapy. UN AIDS figures over 1996-2008 suggest an average of 2.88 added years in the USA and Europe, but only 0.1 in sub-Saharan Africa, a thirty-fold difference largely due to accessibility to ART. ART leads to a reduction in oral lesions but it is estimated that some 10 million HIV+ subjects do not have access to oral care. Thus, inequalities exist both for HIV infection and for the associated oral lesions, mainly related to ART access. HIV infection and oral mucosal lesions both appear to be related to general social determinants of health. Oral HCW must be part of mainstream healthcare teams to address these inequalities. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Geographic analysis of the variation in the incidence of ADHD in a country with free access to healthcare

    DEFF Research Database (Denmark)

    Madsen, Kathrine Bang; Ersbøll, Annette Kjær; Olsen, Jørn

    2015-01-01

    and individual tracking based on unique personal identification may in particular contribute to our understanding of the reasons for this increase. Based on Danish registers we aimed to examine the geographical patterns of the distribution of ADHD diagnosis and medication use and explore the association...... between neighbouring municipalities, no significant associations were found between ADHD and access to diagnostic services, different diagnostic culture, socioeconomic status at municipality level or the municipal spending on health care for children. CONCLUSIONS: A large geographical variation of ADHD...

  1. [Inequalities in access to and utilization of dental care in Brazil: an analysis of the Telephone Survey Surveillance System for Risk and Protective Factors for Chronic Diseases (VIGITEL 2009)].

    Science.gov (United States)

    Peres, Marco A; Iser, Betine Pinto Moehlecke; Boing, Antonio Fernando; Yokota, Renata Tiene de Carvalho; Malta, Deborah Carvalho; Peres, Karen Glazer

    2012-01-01

    This study aimed to evaluate access to and utilization of various types of dental services by individuals 18 years or older in Brazil's State capitals. We gathered data from the Telephone Survey Surveillance System for Risk and Protective Factors for Chronic Diseases (VIGITEL) in 2009 (n = 54,367). More than half of the target population reported the need for dental treatment in the previous year; of these, 15.2% lacked access to dental services when needed. The private sector provided 61.1% of all dental appointments. The share of services provided by the Unified National Health System (SUS) ranged from 6.2% in the Federal District to 35.2% in Boa Vista, in the North. Multivariate Poisson regression models showed higher prevalence of dental treatment needs among women, middle-aged adults, and individuals with more schooling. Lack of access to dental care was more frequent among women, young adults, less educated individuals, and among lightener-skinned blacks. Our findings highlight sharp inequalities in the use of and access to dental services in the Brazilian State capitals.

  2. Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience.

    Science.gov (United States)

    Anwar, Jasim; Mpofu, Elias; Matthews, Lynda R; Shadoul, Ahmed Farah; Brock, Kaye E

    2011-06-30

    The reproductive and mental health of women contributes significantly to their overall well-being. Three of the eight Millennium Development Goals are directly related to reproductive and sexual health while mental disorders make up three of the ten leading causes of disease burden in low and middle-income countries. Among mental disorders, depression and anxiety are two of the most prevalent. In the context of slower progress in achieving Millennium Development Goals in developing countries and the ever-increasing man-made and natural disasters in these areas, it is important to understand the association between reproductive health and mental health among women with post-disaster experiences. This was a cross-sectional study with a sample of 387 women of reproductive age (15-49 years) randomly selected from the October 2005 earthquake affected areas of Pakistan. Data on reproductive health was collected using the Centers for Disease Control reproductive health assessment toolkit. Depression and anxiety were measured using the Hopkins Symptom Checklist-25, while earthquake experiences were captured using the Harvard Trauma Questionnaire. The association of either depression or anxiety with socio-demographic variables, earthquake experiences, reproductive health and access to health facilities was estimated using multivariate logistic regression. Post-earthquake reproductive health events together with economic deprivation, lower family support and poorer access to health care facilities explained a significant proportion of differences in the experiencing of clinical levels of depression and anxiety. For instance, women losing resources for subsistence, separation from family and experiencing reproductive health events such as having a stillbirth, having had an abortion, having had abnormal vaginal discharge or having had genital ulcers, were at significant risk of depression and anxiety. The relationship between women's post-earthquake mental health and

  3. Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis.

    Science.gov (United States)

    Leone, Tiziana; Cetorelli, Valeria; Neal, Sarah; Matthews, Zoë

    2016-01-28

    Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Women's experience of user fees in 5 African countries. Using quasi-experimental regression analysis we tested the impact of user fee reforms on facilities' births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries' choice. We analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria). User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana. Findings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Inequality in rehabilitation

    DEFF Research Database (Denmark)

    Guldager, Rikke; Poulsen, Ingrid

    OBJECTIVES: The overall Ph.d.-study aims to investigate rehabilitation trajectories in adult patients with traumatic brain injury (TBI) and stroke, and to describe mechanisms behind the institutionalized (health care) part of inequality in health with emphasis on interfaces and critical transitions...... from time of accident to twelve month follow-up. The case study aims to explore the process of rehabilitation in a high status patient, related to professions in healthcare. The focus is on how a high status patient is perceived and handled in organizations and among professions, and strategies applied...... by the patient and relatives. METHODS: Observation and qualitative interview has been conducted of one patient following the patients’ trajectories though different phases of the rehabilitation process during admission at Traumatic Brain Unit. Interdisciplinary meetings are regarded as key elements...

  5. Expansion, Differentiation, and the Persistence of Social Class Inequalities in British Higher Education

    Science.gov (United States)

    Boliver, Vikki

    2011-01-01

    Conventional political wisdom has it that educational expansion helps to reduce socioeconomic inequalities of access to education by increasing equality of educational opportunity. The counterarguments of Maximally Maintained Inequality (MMI) and Effectively Maintained Inequality (EMI), in contrast, contend that educational inequalities tend to…

  6. Socioeconomic Inequalities in the Kidney Transplantation Process: A Registry-Based Study in Sweden

    Directory of Open Access Journals (Sweden)

    Ye Zhang, MSc

    2018-02-01

    Conclusions. Socioeconomic status-related inequalities exist with regard to both access to the waitlist, and kidney transplantation conditional on listing. However, the former inequality is substantially larger and is therefore expected to contribute more to societal inequalities. Further studies are needed to explore the potential mechanisms and strategies to reduce these inequalities.

  7. Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis

    Directory of Open Access Journals (Sweden)

    Karine Legrand

    2017-09-01

    Full Text Available Background: Despite social inequalities in overweight/obesity prevalence, evidence-based public health interventions to reduce them are scarce. The PRALIMAP-INÈS trial aimed to investigate whether a strengthened-care management for adolescents with low socioeconomic status has an equivalent effect in preventing and reducing overweight as a standard-care management for high socioeconomic status adolescents. Methods: PRALIMAP-INÈS was a mixed, prospective and multicenter trial including 35 state-run schools. It admitted overweight or obese adolescents, age 13–18 years old, for 3 consecutive academic years. One-year interventions were implemented. Data were collected before (T0, after (T1 and post (T2 intervention. Among 2113 eligible adolescents who completed questionnaires, 1639 were proposed for inclusion and 1419 were included (220 parental refusals. Two groups were constituted according to the Family Affluence Scale (FAS score: the less advantaged (FAS≤5 were randomly assigned to 2 groups in a 2/1 ratio. The 3 intervention groups were: advantaged with standard-care management (A.S, n = 808, less advantaged with standard-care management (LA.S, n = 196, and less advantaged with standard and strengthened-care management (LA.S.S, n = 415. The standard-care management was based on the patient education principle and consisted of 5 collective sessions. The strengthened-care management was based on the proportionate universalism principle and consisted of activities adapted to needs. Inclusion results: The written parental refusal was less frequent among less advantaged and more overweight adolescents. A dramatic linear social gradient in overweight was evidenced. Discussion: The PRALIMAP-INÈS outcomes should inform how effectively a socially adapted public health program can avoid worsening social inequalities in overweight adolescents attending school. Trial registration: ClinicalTrials.gov (NCT01688453. Keywords: Adolescents

  8. Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis.

    Science.gov (United States)

    Legrand, Karine; Lecomte, Edith; Langlois, Johanne; Muller, Laurent; Saez, Laura; Quinet, Marie-Hélène; Böhme, Philip; Spitz, Elisabeth; Omorou, Abdou Y; Briançon, Serge

    2017-09-01

    Despite social inequalities in overweight/obesity prevalence, evidence-based public health interventions to reduce them are scarce. The PRALIMAP-INÈS trial aimed to investigate whether a strengthened-care management for adolescents with low socioeconomic status has an equivalent effect in preventing and reducing overweight as a standard-care management for high socioeconomic status adolescents. PRALIMAP-INÈS was a mixed, prospective and multicenter trial including 35 state-run schools. It admitted overweight or obese adolescents, age 13-18 years old, for 3 consecutive academic years. One-year interventions were implemented. Data were collected before (T0), after (T1) and post (T2) intervention. Among 2113 eligible adolescents who completed questionnaires, 1639 were proposed for inclusion and 1419 were included (220 parental refusals). Two groups were constituted according to the Family Affluence Scale (FAS) score: the less advantaged (FAS≤5) were randomly assigned to 2 groups in a 2/1 ratio. The 3 intervention groups were: advantaged with standard-care management (A.S, n = 808), less advantaged with standard-care management (LA.S, n = 196), and less advantaged with standard and strengthened-care management (LA.S.S, n = 415). The standard-care management was based on the patient education principle and consisted of 5 collective sessions. The strengthened-care management was based on the proportionate universalism principle and consisted of activities adapted to needs. The written parental refusal was less frequent among less advantaged and more overweight adolescents. A dramatic linear social gradient in overweight was evidenced. The PRALIMAP-INÈS outcomes should inform how effectively a socially adapted public health program can avoid worsening social inequalities in overweight adolescents attending school. ClinicalTrials.gov (NCT01688453).

  9. Reconciling consumption inequality with income inequality

    NARCIS (Netherlands)

    Lepetyuk, V.; Stoltenberg, C.A.

    2012-01-01

    The rise in consumption inequality in response to the increase in income inequality over the last three decades in the U.S. is puzzling to expected-utility-based incomplete market models. The two-sided lack of commitment models exhibit too little consumption inequality while the standard incomplete

  10. Reconciling consumption inequality with income inequality

    NARCIS (Netherlands)

    Lepetyuk, V.; Stoltenberg, C.A.

    2013-01-01

    The rise in within-group consumption inequality in response to the increase in within-group income inequality over the last three decades in the U.S. is puzzling to expected-utility-based incomplete market models. The two-sided lack of commitment models exhibit too little consumption inequality

  11. The current situation of human resources for health in the province of Cabinda in Angola: is it a limitation to provide universal access to healthcare?

    Science.gov (United States)

    Macaia, Damas; Lapão, Luís Velez

    2017-12-28

    significant HRH management efforts contributing to this result. Whereas HRH are financed by the State General Budget, the majority of health facilities are still dependent on the Provincial Health Secretariat budget. The study provides a broader view of the current HRH situation in Cabinda Province. Geographical imbalances and other issues with impact in delivering universal access to healthcare are highlighted.

  12. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015 : a novel analysis from the Global Burden of Disease Study 2015

    NARCIS (Netherlands)

    Barber, Ryan M.; Fullman, Nancy; Sorensen, Reed JD; Bollyky, Thomas; McKee, Martin; Nolte, Ellen; van Boven, Job; Murray, Christopher J L

    2017-01-01

    Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on

  13. Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance.

    Directory of Open Access Journals (Sweden)

    Victoria Pattison de Menil

    Full Text Available The gap in Kenya between need and treatment for mental disorders is wide, and private providers are increasingly offering services, funded in part by private health insurance (PHI. Chiromo, a 30-bed psychiatric hospital in Nairobi, forms part of one of the largest private psychiatric providers in East Africa. The study evaluated the effects of insurance on service use and charge, questioning implications on access to care. Data derive from invoices for 455 sequential patients, including 12-month follow-up. Multi-linear and binary logistic regressions explored the effect of PHI on readmission, cumulative length of stay, and treatment charge. Patients were 66.4% male with a mean age of 36.8 years. Half were employed in the formal sector. 70% were admitted involuntarily. Diagnoses were: substance use disorder 31.6%; serious mental disorder 49.5%; common mental disorder 7%; comorbid 7%; other 4.9%. In addition to daily psychiatric consultations, two-thirds received individual counselling or group therapy; half received lab tests or scans; and 16.2% received ECT. Most took a psychiatric medicine. Half of those on antipsychotics were given only brands. Insurance paid in full for 28.8% of patients. Mean length of stay was 11.8 days and, in 12 months, 16.7 days (median 10.6. 22.2% were readmitted within 12 months. Patients with PHI stayed 36% longer than those paying out-of-pocket and had 2.5 times higher odds of readmission. Mean annual charge per patient was Int$ 4,262 (median Int$ 2,821. Insurers were charged 71% more than those paying out-of-pocket--driven by higher fees and longer stays. Chiromo delivers acute psychiatric care each year to approximately 450 people, to quality and human rights standards higher than its public counterpart, but at considerably higher cost. With more efficient delivery and wider insurance coverage, Chiromo might expand from its occupancy of 56.6% to reach a larger population in need.

  14. Health inequity

    DEFF Research Database (Denmark)

    Frausing, Kristian Park; Smærup, Michael; Maibom, Kirsten

    living alone. Social and psychological needs were of primary concern whereas practical needs were of lesser concern. The second study showed older men living alone with no/short education to rate their health significantly worse on almost all items compared to men of higher education. The third study......Background: Being male, living alone and being of low socioeconomic status (SES) are all risk factors for health inequities, including a shorter lifespan. Not much is known, however, about older low-SES men living alone. This study maps their health. Methods: Three studies were conducted. First......, an electronic survey with municipal preventive home visitors nationwide inquiring into their perception of the health and needs of old men living alone. The second study compared older men's self-rated health according to their living arrangements and educational level using data from 29.791 older men from...

  15. Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector.

    Science.gov (United States)

    Gordeev, Vladimir S; Pavlova, Milena; Groot, Wim

    2011-10-01

    This paper reviews the empirical evidence on the outcomes of the financial reforms in the Russian public healthcare sector. A systematic literature review identified 37 relevant publications that presented empirical evidence on changes in quality, equity, efficiency and sustainability in public healthcare provision due to the Russian public healthcare financial reforms. Evidence suggests that there are substantial inter-regional inequalities across income groups both in terms of financing and access to public healthcare services. There are large efficiency differences between regions, along with inter-regional variations in payment and reimbursement mechanisms. Informal and quasi-formal payments deteriorate access to public healthcare services and undermine the overall financing sustainability. The public healthcare sector is still underfinanced, although the implementation of health insurance gave some premises for future increases of efficiency. Overall, the available empirical data are not sufficient for an evidence-based evaluation of the reforms. More studies on the quality, equity, efficiency and sustainability impact of the reforms are needed. Future reforms should focus on the implementation of cost-efficiency and cost-control mechanisms; provide incentives for better allocation and distribution of resources; tackle problems in equity in access and financing; implement a system of quality controls; and stimulate healthy competition between insurance companies. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  16. Fighting status inequalities

    DEFF Research Database (Denmark)

    Nielsen, Morten Ebbe Juul; Landes, Xavier

    2016-01-01

    Status inequalities seem to play a fairly big role in creating inequalities in health. This article assumes that there can be good reasons to fight status inequalities in order to reduce inequalities in health. It examines whether the neorepublican ideal of non-dominance does a better job as a th...

  17. Income-related inequality and inequity in the use of dental services in Finland after a major subsidization reform.

    Science.gov (United States)

    Raittio, Eero; Kiiskinen, Urpo; Helminen, Sari; Aromaa, Arpo; Suominen, Anna Liisa

    2015-06-01

    In Finland, a major oral healthcare reform (OHCR), implemented during 2001-2002, opened the public dental services (PDS) and extended subsidies for private dental services to entire adult population. Before the reform, adults born earlier than 1956 were not entitled to use PDS nor did they receive any reimbursements for their private dental costs. We aimed to examine changes in the income-related inequality and inequity in the use of dental services among the adult Finns after the reform. Representative data from Finnish adults born in 1970 or earlier were gathered from three identical postal surveys concerning the use of dental services and subjective perceptions of oral health. Those surveys were conducted before the OHCR in 2001 (n = 1907) and after the OHCR in 2004 (n = 1629) and 2007 (n = 1509). We used concentration index and its decomposition to analyse income-related inequality and inequity in the use of dental services and factors associated with them. Results showed that pro-rich inequality and inequity in the overall use of dental services narrowed from 2001 to 2004. However, between 2004 and 2007, pro-rich inequality and inequity widened, so it returned to a rather similar level in 2007 as it had been in 2001. Most of the pro-rich inequality and inequity were related to regular dental visiting habit and income level. While there was pro-poor inequality and inequity in the use of PDS, there was pro-rich inequality and inequity in the use of private dental services throughout the study years. It seems that income-related inequality and inequity in the use of dental services narrowed only temporarily after the reform. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Interoperative fundus image and report sharing in compliance with integrating the healthcare enterprise conformance and web access todigital imaging and communication in medicinepersistent object protocol

    Directory of Open Access Journals (Sweden)

    Hui-Qun Wu

    2013-12-01

    Full Text Available AIM:To address issues in interoperability between different fundus image systems, we proposed a web eye-picture archiving and communication system (PACS framework in conformance with digital imaging and communication in medicine (DICOM and health level 7 (HL7 protocol to realize fundus images and reports sharing and communication through internet.METHODS: Firstly, a telemedicine-based eye care work flow was established based on integrating the healthcare enterprise (IHE Eye Care technical framework. Then, a browser/server architecture eye-PACS system was established in conformance with the web access to DICOM persistent object (WADO protocol, which contains three tiers.RESULTS:In any client system installed with web browser, clinicians could log in the eye-PACS to observe fundus images and reports. Multipurpose internet mail extensions (MIME type of a structured report is saved as pdf/html with reference link to relevant fundus image using the WADO syntax could provide enough information for clinicians. Some functions provided by open-source Oviyam could be used to query, zoom, move, measure, view DICOM fundus images.CONCLUSION:Such web eye-PACS in compliance to WADO protocol could be used to store and communicate fundus images and reports, therefore is of great significance for teleophthalmology.

  19. Interoperative fundus image and report sharing in compliance with integrating the healthcare enterprise conformance and web access to digital imaging and communication in medicine persistent object protocol.

    Science.gov (United States)

    Wu, Hui-Qun; Lv, Zheng-Min; Geng, Xing-Yun; Jiang, Kui; Tang, Le-Min; Zhou, Guo-Min; Dong, Jian-Cheng

    2013-01-01

    To address issues in interoperability between different fundus image systems, we proposed a web eye-picture archiving and communication system (PACS) framework in conformance with digital imaging and communication in medicine (DICOM) and health level 7 (HL7) protocol to realize fundus images and reports sharing and communication through internet. Firstly, a telemedicine-based eye care work flow was established based on integrating the healthcare enterprise (IHE) Eye Care technical framework. Then, a browser/server architecture eye-PACS system was established in conformance with the web access to DICOM persistent object (WADO) protocol, which contains three tiers. In any client system installed with web browser, clinicians could log in the eye-PACS to observe fundus images and reports. Multipurpose internet mail extensions (MIME) type of a structured report is saved as pdf/html with reference link to relevant fundus image using the WADO syntax could provide enough information for clinicians. Some functions provided by open-source Oviyam could be used to query, zoom, move, measure, view DICOM fundus images. Such web eye-PACS in compliance to WADO protocol could be used to store and communicate fundus images and reports, therefore is of great significance for teleophthalmology.

  20. Inequalities in Human Well-Being in the Urban Ganges Brahmaputra Meghna Delta

    Directory of Open Access Journals (Sweden)

    Sylvia Szabo

    2016-06-01

    Full Text Available The recently endorsed Sustainable Development Goals (SDGs agenda unanimously agrees on the need to focus on inclusive development, the importance of eradicating extreme poverty and managing often complex human well-being impacts of rapid urban growth. Sustainable and inclusive urbanisation will accelerate progress towards the SDGs and contribute to eradicating extreme poverty. In tropical delta regions, such as the Ganges Brahmaputra Meghna delta region, urban growth and resulting intra-urban inequalities are accelerated by the impact of environmental and climate change. In this context, the present study uses the 2010 Household Income and Expenditure Survey to analyse the extent of wealth-based inequalities in human well-being in the urban delta region and the determinants of selected welfare measures. The results suggest that the extent of intra-urban inequalities is greatest in educational attainment and access to postnatal healthcare and relatively low in the occurrence of gastric disease. The paper concludes by providing policy recommendations to reduce increasing wealth inequalities in urban areas, thus contributing to sustainable development of the region.

  1. Inpatient care of the elderly in Brazil and India: Assessing social inequalities

    Science.gov (United States)

    Channon, Andrew Amos; Andrade, Monica Viegas; Noronha, Kenya; Leone, Tiziana; Dilip, T.R.

    2012-01-01

    The rapidly growing older adult populations in Brazil and India present major challenges for health systems in these countries, especially with regard to the equitable provision of inpatient care. The objective of this study was to contrast inequalities in both the receipt of inpatient care and the length of time that care was received among adults aged over 60 in two large countries with different modes of health service delivery. Using the Brazilian National Household Survey from 2003 and the Indian National Sample Survey Organisation survey from 2004 inequalities by wealth (measured by income in Brazil and consumption in India) were assessed using concentration curves and indices. Inequalities were also examined through the use of zero-truncated negative binomial models, studying differences in receipt of care and length of stay by region, health insurance, education and reported health status. Results indicated that there was no evidence of inequality in Brazil for both receipt and length of stay by income per capita. However, in India there was a pro-rich bias in the receipt of care, although once care was received there was no difference by consumption per capita for the length of stay. In both countries the higher educated and those with health insurance were more likely to receive care, while the higher educated had longer stays in hospital in Brazil. The health system reforms that have been undertaken in Brazil could be credited as a driver for reducing healthcare inequalities amongst the elderly, while the significant differences by wealth in India shows that reform is still needed to ensure the poor have access to inpatient care. Health reforms that move towards a more public funding model of service delivery in India may reduce inequality in elderly inpatient care in the country. PMID:23041128

  2. Measuring Recent Changes in South African Inequality and Poverty using 1996 and 2001 Census Data

    OpenAIRE

    Murray Leibbrandt; Laura Poswell; Pranushka Naidoo; Matthew Welch; Ingrid Woolard

    2005-01-01

    The paper analyses poverty and inequality changes in South Africa for the period 1996 to 2001 using Census data. To gain a broader picture of well-being in South Africa, both income-based and access-based measurement approaches are employed. At the national level, findings from the income-based approach show that inequality has unambiguously increased from 1996 to 2001. As regards population group inequality, within-group inequality has increased; while between-group inequality has decreased ...

  3. Socio-economic inequalities in health and health service use among older adults in India: results from the WHO Study on Global AGEing and adult health survey.

    Science.gov (United States)

    Brinda, E M; Attermann, J; Gerdtham, U G; Enemark, U

    2016-12-01

    The objectives of this study were to measure socio-economic inequalities in self-reported health (SRH) and healthcare visits and to identify factors contributing to health inequalities among older people aged 50-plus years. This study is based on a population-based, cross-sectional survey. We accessed data of 7150 older adults from the World Health Organization's Study on Global AGEing and adult health Indian survey. We used multivariate logistic regression to assess the correlates of poor SRH. We estimated the concentration index to measure socio-economic inequalities in SRH and healthcare visits. Regression-based decomposition analysis was employed to explore the correlates contributing to poor SRH inequality. About 19% (95% CI: 18%, 20%) reported poor health (n = 1368) and these individuals were significantly less wealthy. In total, 5134 (71.8%) participants made at least one health service visit. Increasing age, female gender, low social caste, rural residence, multimorbidity, absence of pension support, and health insurance were significant correlates of poor SRH. The standardized concentration index of poor SRH -0.122 (95% CI: -0.102; -0.141) and healthcare visits 0.364 (95% CI: 0.324, 0.403) indicated pro-poor and pro-rich inequality, respectively. Economic status (62.3%), pension support (11.5%), health insurance coverage (11.5%), social caste (10.7%) and place of residence (4.1%) were important contributors to inequalities in poor health. Socio-economic disparities in health and health care are major concerns in India. Achievement of health equity demand strategies beyond health policies, to include pro-poor, social welfare policies among older Indians. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  4. Urbanization and Access Inequality to Collective Consumption Goods & Services related to Sanitation & Solid Waste in the cities of Sao Paulo State, Brazil

    Science.gov (United States)

    Roig, C. D. A.; Feitosa, F. D. F.; Monteiro, A. M. V.

    2016-12-01

    Cities are mainly a product of collective consumption and there is a pressing need to expand and deepen the discussion about the quality of access to collective goods and services in the urban world: the availability of electricity and potable water and its interrelation with the lack of solid waste management and wastewater treatment leading to pollution of water sources.This study attempts to measure urban stratification through access conditions to collective goods in the metropolitan regions of Sao Paulo State (SPS) by contributing with a research method that incorporates collective consumption as a core component of the population-environment relationship. The use of spatial analysis allows the examination of the structure and distribution of accessibility to sanitation services and basic urban infrastructure.The water stress situation in SPS is dramatic. The average water loss within these distribution systems is 34,3% and a 39% average sewage treatment rate of all wastewater generated. The SPS also imports 60,6% of electricity from other states that use mostly hydroelectric power which imposes greater pressure on the country's water resources. The energy and water crisis has harmed a number of essential rights related mostly to resource access and service continuity as suburban residents of poor municipalities are the ones most affected by disruptions.SPS is the most populous state of Brazil and this region of study is responsible for 75% of total State population with 83% of State GDP. There has been a major increase in water use conflicts such as power generation, urban water supply (including the Rio de Janeiro water demand) and the dilution of urban sewage and solid waste disposal. These collective consumption access problems demonstrate the urgent need for better integrated metropolitan management of natural resources and the urban commons.

  5. Health equity monitoring for healthcare quality assurance.

    Science.gov (United States)

    Cookson, R; Asaria, M; Ali, S; Shaw, R; Doran, T; Goldblatt, P

    2018-02-01

    Population-wide health equity monitoring remains isolated from mainstream healthcare quality assurance. As a result, healthcare organizations remain ill-informed about the health equity impacts of their decisions - despite becoming increasingly well-informed about quality of care for the average patient. We present a new and improved analytical approach to integrating health equity into mainstream healthcare quality assurance, illustrate how this approach has been applied in the English National Health Service, and discuss how it could be applied in other countries. We illustrate the approach using a key quality indicator that is widely used to assess how well healthcare is co-ordinated between primary, community and acute settings: emergency inpatient hospital admissions for ambulatory care sensitive chronic conditions ("potentially avoidable emergency admissions", for short). Whole-population data for 2015 on potentially avoidable emergency admissions in England were linked with neighborhood deprivation indices. Inequality within the populations served by 209 clinical commissioning groups (CCGs: care purchasing organizations with mean population 272,000) was compared against two benchmarks - national inequality and inequality within ten similar populations - using neighborhood-level models to simulate the gap in indirectly standardized admissions between most and least deprived neighborhoods. The modelled inequality gap for England was 927 potentially avoidable emergency admissions per 100,000 people, implying 263,894 excess hospitalizations associated with inequality. Against this national benchmark, 17% of CCGs had significantly worse-than-benchmark equity, and 23% significantly better. The corresponding figures were 11% and 12% respectively against the similar populations benchmark. Deprivation-related inequality in potentially avoidable emergency admissions varies substantially between English CCGs serving similar populations, beyond expected statistical

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

    Science.gov (United States)

    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.

  7. The Great Recession and inequalities in access to health care: a study of unemployment and unmet medical need in Europe in the economic crisis.

    Science.gov (United States)

    Madureira-Lima, Joana; Reeves, Aaron; Clair, Amy; Stuckler, David

    2018-02-01

    Unmet medical need (UMN) had been declining steadily across Europe until the 2008 Recession, a period characterized by rising unemployment. We examined whether becoming unemployed increased the risk of UMN during the Great Recession and whether the extent of out-of-pocket payments (OOP) for health care and income replacement for the unemployed (IRU) moderated this relationship. We used the European Survey on Income and Living Conditions (EU-SILC) to construct a pseudo-panel (n = 135 529) across 25 countries to estimate the relationship between unemployment and UMN. We estimated linear probability models, using a baseline of employed people with no UMN, to test whether this relationship is mediated by financial hardship and moderated by levels of OOP and IRU. Job loss increased the risk of UMN [β = 0.027, 95% confidence interval (CI) 0.022-0.033] and financial hardship exacerbated this effect. Fewer people experiencing job loss lost access to health care in countries where OOPs were low or in countries where IRU is high. The results are robust to different model specifications. Unemployment does not necessarily compromise access to health care. Rather, access is jeopardized by diminishing financial resources that accompany job loss. Lower OOPs or higher IRU protect against loss of access, but they cannot guarantee it. Policy solutions should secure financial protection for the unemployed so that resources do not have to be diverted from health. © The Author 2017. Published by Oxford University Press on behalf of the International Epidemiological Association

  8. Healthcare financing in Croatia

    Directory of Open Access Journals (Sweden)

    Nevenka Kovač

    2013-12-01

    Full Text Available Healthcare financing system is of crucial importance for the functioning of any healthcare system, especially because there is no country in the world that is able to provide all its residents with access to all the benefits afforded by modern medicine. Lack of resources in general and rising healthcare expenditures are considered a difficult issue to solve in Croatia as well. Since Croatia gained its independence, its healthcare system has undergone a number of reforms, the primary objective of which was to optimize healthcare services to the actual monetary capacity of the Croatian economy. The objectives of the mentioned re - forms were partially achieved. The solutions that have been offered until now, i.e. consolidation measures undertaken in the last 10 years were necessary; however, they have not improved the operating conditions. There is still the issue of the deficit from the previous years, i.e. outstanding payments, the largest in the last decade. Analysis of the performance of healthcare institutions in 2011 shows that the decision makers will have to take up a major challenge of finding a solution to the difficulties the Croatian healthcare system has been struggling with for decades, causing a debt of 7 billion kuna. At the same time, they will need to uphold the basic principles of the Healthcare Act, i.e. to provide access to healthcare and ensure its continuity, comprehensiveness and solidarity, keeping in mind that the National Budget Act and Fiscal Responsibility Act have been adopted.

  9. Navigating Troubled Waters. An analysis of how urban water regimes in the global South reproduce inequality

    OpenAIRE

    Nastar, Maryam

    2014-01-01

    This research is an attempt to conceptualize the underlying forces behind persistent and ubiquitous problems of inequality in access to water in cities of the global south. Inequality in water access is hypothesized to result from urban water regimes that tend to prioritize the right to water access or to provide preferential terms of access for some groups in society, while marginalizing others. By employing a critical realist approach, different theories in relation to inequality are app...

  10. Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh.

    Science.gov (United States)

    Haider, Mohammad Rifat; Rahman, Mohammad Masudur; Moinuddin, Md; Rahman, Ahmed Ehsanur; Ahmed, Shakil; Khan, M Mahmud

    2017-01-01

    Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups

  11. A Generalized Affine Isoperimetric Inequality

    OpenAIRE

    Chen, Wenxiong; Howard, Ralph; Lutwak, Erwin; Yang, Deane; Zhang, Gaoyong

    2004-01-01

    A purely analytic proof is given for an inequality that has as a direct consequence the two most important affine isoperimetric inequalities of plane convex geometry: The Blaschke-Santalo inequality and the affine isoperimetric inequality of affine differential geometry.

  12. Evaluating Inequality or Injustice in Water Use for Food

    Science.gov (United States)

    D'Odorico, P.; Carr, J. A.; Seekell, D. A.

    2014-12-01

    Water availability and population density distributions are uneven and therefore inequality exists in human access to freshwater resources; but is this inequality unjust or only regrettable? To examine this question we formulated and evaluated elementary principles of water ethics relative to human rights for water and explored the need for global trade to improve societal access to water by transferring plant and animal commodities and the "virtual water" embedded in them. We defined human welfare benchmarks and evaluated country specific patterns of water use for food with, and without trade, over a 25-year period in order to elucidate the influence of trade and inequality on equability of water use. We found that trade improves mean water use and wellbeing, when related to human welfare benchmarks, suggesting that inequality is regrettable but not necessarily unjust. However, trade has not significantly contributed to redressing inequality. Hence, directed trade decisions can improve future conditions of water and food scarcity through reduced inequality.

  13. Inequality or injustice in water use for food?

    Science.gov (United States)

    Carr, J. A.; Seekell, D. A.; D'Odorico, P.

    2015-02-01

    The global distributions of water availability and population density are uneven and therefore inequality exists in human access to freshwater resources. Is this inequality unjust or only regrettable? To examine this question we formulated and evaluated elementary principles of water ethics relative to human rights for water, and the need for global trade to improve societal access to water by transferring ‘virtual water’ embedded in plant and animal commodities. We defined human welfare benchmarks and evaluated patterns of water use with and without trade over a 25-year period to identify the influence of trade and inequality on equitability of water use. We found that trade improves mean water use and wellbeing, relative to human welfare benchmarks, suggesting that inequality is regrettable but not necessarily unjust. However, trade has not significantly contributed to redressing inequality. Hence, directed trade decisions can improve future conditions of water and food scarcity through reduced inequality.

  14. Inequality or injustice in water use for food?

    International Nuclear Information System (INIS)

    Carr, J A; Seekell, D A; D’Odorico, P

    2015-01-01

    The global distributions of water availability and population density are uneven and therefore inequality exists in human access to freshwater resources. Is this inequality unjust or only regrettable? To examine this question we formulated and evaluated elementary principles of water ethics relative to human rights for water, and the need for global trade to improve societal access to water by transferring ‘virtual water’ embedded in plant and animal commodities. We defined human welfare benchmarks and evaluated patterns of water use with and without trade over a 25-year period to identify the influence of trade and inequality on equitability of water use. We found that trade improves mean water use and wellbeing, relative to human welfare benchmarks, suggesting that inequality is regrettable but not necessarily unjust. However, trade has not significantly contributed to redressing inequality. Hence, directed trade decisions can improve future conditions of water and food scarcity through reduced inequality. (letter)

  15. Globalization and inequality

    NARCIS (Netherlands)

    Mills, Melinda

    Globalization is increasingly linked to inequality, but with often divergent and polarized findings. Some researchers show that globalization accentuates inequality both within and between countries. Others maintain that these claims are patently incorrect, arguing that globalization has

  16. Immigration and income inequality

    DEFF Research Database (Denmark)

    Deding, Mette; Hussain, Azhar; Jakobsen, Vibeke

    2010-01-01

    During the last two decades most Western countries have experienced increased net immigration as well as increased income inequality. This article analyzes the effects on income inequality of an increased number of immigrants in Denmark and Germany for the 20- year period 1984-2003 and how...... the impact of the increased number of immigrants differs between the two countries. We find higher inequality for immigrants than natives in Denmark but vice versa for Germany. Over the period 1984-2003, this particular inequality gap has narrowed in both countries. At the same time, the contribution...... of immigrants to overall inequality has increased, primarily caused by increased between-group inequality. The share of immigrants in the population is more important for the change in overall inequality in Denmark than in Germany, while the opposite is the case for inequality among immigrants....

  17. Is there Equity in Use of Healthcare Services among immigrants, their descendents, and ethnic Danes?

    DEFF Research Database (Denmark)

    Nielsen, Signe Smith; Hempler, Nana Folmann; Waldorff, Frans Boch

    2012-01-01

    Background: Legislation in Denmark explicitly states the right to equal access to healthcare. Nevertheless, inequities may exist; accordingly evidence is needed. Our objective was to investigate whether differences in healthcare utilization in immigrants, their descendents, and ethnic Danes could...... were linked to registries on healthcare utilization. Using Poisson regression models, contacts to hospital, emergency room (ER), general practitioner (GP), specialist in private practice, and dentist were estimated. Analyses were adjusted for health symptoms, sociodemographic factors, and proxies...... of integration. Results: In adjusted analyses, immigrants and their descendents had increased use of ER (multiplicative effect=1.19–5.02 dependent on immigrant and descendent group) and less frequent contact to dentist (multiplicative effect=0.04–0.80 dependent on the group). For hospitalization, GP...

  18. Determinants of income inequality

    OpenAIRE

    Afandi, Akhsyim; Rantung, Vebryna Permatasari; Marashdeh, Hazem

    2017-01-01

    This study examines whether changing economic structure, social conditions, and financialization are responsible for increased income inequality in Indonesia. By employing panel data of 32 provinces in Indonesia that spans from 2007 to 2013, it finds that structural change affects income inequality, increased share of finance reduces inequality, which is against the financialization hypothesis, and social conditions have expected effects on income inequality. While an increased share of both ...

  19. Graphing Inequalities, Connecting Meaning

    Science.gov (United States)

    Switzer, J. Matt

    2014-01-01

    Students often have difficulty with graphing inequalities (see Filloy, Rojano, and Rubio 2002; Drijvers 2002), and J. Matt Switzer's students were no exception. Although students can produce graphs for simple inequalities, they often struggle when the format of the inequality is unfamiliar. Even when producing a correct graph of an…

  20. Access to generic antiretrovirals: inequality, intellectual property law, and international trade agreements Acceso a antirretrovirales genéricos: desigualdad, derecho de propiedad intelectual y acuerdos comerciales internacionales

    Directory of Open Access Journals (Sweden)

    Arachu Castro

    2007-01-01

    Full Text Available The governments of numerous low- and middle-income countries are currently instituting rules that strengthen changes in domestic intellectual property legislation, often made to conform to the mandates of "free" trade agreements signed with the United States. These measures frequently include intellectual property provisions that extend beyond the patent law standards agreed upon in recent World Trade Organization negotiations, which promised to balance the exigencies of public health and patent holders. In this paper, we analyze the concern that this augmentation of patent law standards will curtail access to essential medicines, particularly as they relate to the AIDS pandemic. We critically examine the potential threats posed by trade agreements vis-à-vis efforts to provide universal access to antiretroviral medications and contend that the conditioning of economic development upon the strengthening of intellectual property law demands careful attention when public health is at stake. Finally, we examine advocacy successes in challenging patent law and conclude that greater advocacy and policy strategies are needed to ensure the protection of global health in trade negotiations.Actualmente diversos países de renta media y baja están creando leyes de propiedad intelectual más rígidas, muchas veces para adaptarse a las exigencias de los tratados de "libre" comercio con los Estados Unidos. Tales medidas suelen incluir dispositivos que transcienden las normas sobre patentes negociadas recientemente en la Organización Mundial del Comercio, que prometían equilibrar las exigencias de la salud pública y las de patentes. Este artículo analiza la preocupación de que este endurecimiento restrinja el acceso a medicamentos esenciales, en particular en el contexto de la pandemia de SIDA. El artículo examina las amenazas potenciales creadas por los tratados comerciales contra los esfuerzos dirigidos para el acceso universal a los

  1. Strengthening the decentralised healthcare system in rural South Africa through improved service delivery: testing mobility, information and communication technology intervention options

    CSIR Research Space (South Africa)

    Chakwizira, J

    2010-09-01

    Full Text Available their own human resources in providing healthcare services that ultimately counteract these inequalities. Presently, what could be considered the last level of decentralised healthcare is mostly represented by home and community-based healthcare...

  2. Inequality, Tolerance, and Growth

    DEFF Research Database (Denmark)

    Bjørnskov, Christian

    This paper argues for the importance of individuals' tolerance of inequality for economic growth. By using the political ideology of governments as a measure of revealed tolerance of inequality, the paper shows that controlling for ideology improves the accuracy with which the effects of inequality...... are measured. Results show that inequality reduces growth but more so in societies where people perceive it as being relatively unfair. Further results indicate that legal quality and social trust are likely transmission channels for the effects of inequality....

  3. Inequality, Tolerance, and Growth

    DEFF Research Database (Denmark)

    Bjørnskov, Christian

    2004-01-01

    This paper argues for the importance of individuals' tolerance of inequality for economic growth. By using the political ideology of governments as a measure of revealed tolerance of inequality, the paper shows that controlling for ideology improves the accuracy with which the effects of inequality...... are measured. Results show that inequality reduces growth but more so in societies where people perceive it as being relatively unfair. Further results indicate that legal quality and social trust are likely transmission channels for the effects of inequality....

  4. Does inequality in health impede economic growth?

    Science.gov (United States)

    Grimm, Michael

    2011-01-01

    This paper investigates the effects of inequality in health on economic growth in low and middle income countries. The empirical part of the paper uses an original cross-national panel data set covering 62 low and middle income countries over the period 1985 to 2007. I find a substantial and relatively robust negative effect of health inequality on income levels and income growth controlling for life expectancy, country and time fixed-effects and a large number of other effects that have been shown to matter for growth. The effect also holds if health inequality is instrumented to circumvent a potential problem of reverse causality. Hence, reducing inequality in the access to health care and to health-related information can make a substantial contribution to economic growth.

  5. Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

    Directory of Open Access Journals (Sweden)

    Mala Rao

    Full Text Available Equity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for 'catastrophic' health expenditure (CHE, in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education.We used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design.Between 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups.During the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the synergistic potential

  6. Migration and regional inequality

    DEFF Research Database (Denmark)

    Peng, Lianqing; Swider, Sarah

    2017-01-01

    Scholars studying economic inequality in China have maintained that regional inequality and economic divergence across provinces have steadily increased over the past 30 years. New studies have shown that this trend is a statistical aberration; calculations show that instead of quickly and sharply...... rising, regional inequality has actually decreased, and most recently, remained stable. Our study suggests that China’s unique migratory regime is crucial to understanding these findings. We conduct a counterfactual simulation to demonstrate how migration and remittances have mitigated income inequality...... across provinces in order to show that without these processes, we would have seen more of a rise in interprovincial income inequality. We conclude by arguing that inequality in China is still increasing, but it is changing and becoming less place-based. As regional inequality decreases, there are signs...

  7. A tour of inequality

    Science.gov (United States)

    Eliazar, Iddo

    2018-02-01

    This paper presents a concise and up-to-date tour to the realm of inequality indices. Originally devised for socioeconomic applications, inequality indices gauge the divergence of wealth distributions in human societies from the socioeconomic 'ground state' of perfect equality, i.e. pure communism. Inequality indices are quantitative scores that take values in the unit interval, with the zero score characterizing perfect equality. In effect, inequality indices are applicable in the context of general distributions of sizes - non-negative quantities such as count, length, area, volume, mass, energy, and duration. For general size distributions, which are omnipresent in science and engineering, inequality indices provide multi-dimensional and infinite-dimensional quantifications of the inherent inequality - i.e., the statistical heterogeneity, the non-determinism, the randomness. This paper compactly describes the insights and the practical implementation of inequality indices.

  8. A Method of Measuring Inequality within a Selection Process

    Science.gov (United States)

    Bulle, Nathalie

    2016-01-01

    To explain the inequalities in access to a discrete good G across two populations, or across time in a single national context, it is necessary to distinguish, for each population or period of time, the effect of the diffusion of G from that of unequal outcomes of underlying micro-social processes. The inequality of outcomes of these micro-social…

  9. Individual responsibility, solidarity and differentiation in healthcare

    NARCIS (Netherlands)

    Stegeman, I.; Willems, D. L.; Dekker, E.; Bossuyt, P. M.

    2014-01-01

    Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. A vignette study was

  10. Dynamic inequalities on time scales

    CERN Document Server

    Agarwal, Ravi; Saker, Samir

    2014-01-01

    This is a monograph devoted to recent research and results on dynamic inequalities on time scales. The study of dynamic inequalities on time scales has been covered extensively in the literature in recent years and has now become a major sub-field in pure and applied mathematics. In particular, this book will cover recent results on integral inequalities, including Young's inequality, Jensen's inequality, Holder's inequality, Minkowski's inequality, Steffensen's inequality, Hermite-Hadamard inequality and Čebyšv's inequality. Opial type inequalities on time scales and their extensions with weighted functions, Lyapunov type inequalities, Halanay type inequalities for dynamic equations on time scales, and Wirtinger type inequalities on time scales and their extensions will also be discussed here in detail.

  11. Bell inequalities and waiting times

    Energy Technology Data Exchange (ETDEWEB)

    Poeltl, Christina; Governale, Michele [School of Chemical and Physical Sciences and MacDiarmid Institute for Advanced Materials and Nanotechnology, Victoria University of Wellington, PO Box 600, Wellington 6140 (New Zealand)

    2015-07-01

    We propose a Bell test based on waiting time distributions for spin entangled electron pairs, which are generated and split in mesoscopic Coulomb blockade structures, denoted as entanglers. These systems have the advantage that quantum point contacts enable a time resolved observation of the electrons occupying the system, which gives access to quantities such as full counting statistics and waiting time distributions. We use the partial waiting times to define a CHSH-Bell test, which is a purely electronic analogue of the test used in quantum optics. After the introduction of the Bell inequality we discuss the findings on the two examples of a double quantum dot and a triple quantum dot. This Bell test allows the exclusion of irrelevant tunnel processes from the statistics normally used for the Bell correlations. This can improve the parameter range for which a violation of the Bell inequality can be measured significantly.

  12. Inequality dynamics in the workplace among microbiologists and infectious disease specialists: a qualitative study in five European countries.

    Science.gov (United States)

    Huttner, A; Cacace, M; d'Andrea, L; Skevaki, C; Otelea, D; Pugliese, F; Tacconelli, E

    2017-05-01

    To explore the social, cultural, psychological and organizational factors associated with inequality in the workplace among clinical microbiologists (CM) and infectious disease (ID) specialists in European hospitals. We analysed data from 52 interviews and five focus groups involving 82 CM/ID specialists selected from university, research or community hospitals in five countries, one each in Northern, Western, Eastern, Southeastern and Southwestern Europe. The 80 hours of recordings were transcribed, and the anonymous database coding process was cross-checked iteratively by six researchers. Inequality affects all the institutions in all the countries we looked at, denying or reducing access to professional assets with intensity and form that vary largely according to the cultural and organizational context. Discrimination is generally not explicit and uses disrespectful microbehaviours that are hard to respond to when they occur. Inequality affected also loans, distribution of research funds and gender and country representation in boards and conference faculty. Parenthood has a major impact on women's careers, as women are still mainly responsible for family care. Responses to discrimination range from reactive to surrender strategies. Our study offers an effective model for diagnosing discriminatory behaviours in a medical professional setting. Knowledge of inequality's drivers could help national ID/CM societies in collaboration with major European stakeholders to further reduce such discrimination. The effect of discrimination on the quality of healthcare in Europe needs further exploration. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  13. Educational Inequality and Income Inequality: An Empirical Study on China

    Science.gov (United States)

    Yang, Jun; Huang, Xiao; Li, Xiaoyu

    2009-01-01

    Based on the endogenous growth theory, this paper uses the Gini coefficient to measure educational inequality and studies the empirical relationship between educational inequality and income inequality through a simultaneous equation model. The results show that: (1) Income inequality leads to educational inequality while the reduction of…

  14. Charting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999-2014).

    Science.gov (United States)

    Gandhi, Gian

    2015-11-30

    GAVI's focus on reducing inequities in access to vaccines, immunization, and GAVI funds, - both between and within countries - has changed over time. This paper charts that evolution. A systematic qualitative review was conducted by searching PubMed, Google Scholar and direct review of available GAVI Board papers, policies, and program guidelines. Documents were included if they described or evaluated GAVI policies, strategies, or programs and discussed equity of access to vaccines, utilization of immunization services, or GAVI funds in countries currently or previously eligible for GAVI support. Findings were grouped thematically, categorized into time periods covering GAVI's phases of operations, and assessed depending on whether the approaches mediated equity of opportunity or equity of outcomes between or within countries. Serches yielded 2816 documents for assessment. After pre-screening and removal of duplicates, 552 documents underwent detailed evaluation and pertinent information was extracted from 188 unique documents. As a global funding mechanism, GAVI responded rationally to a semi-fixed funding constraint by focusing on between-country equity in allocation of resources. GAVI's predominant focus and documented successes have been in addressing between-country inequities in access to vaccines comparing lower income (GAVI-eligible) countries with higher income (ineligible) countries. GAVI has had mixed results at addressing between-country inequities in utilization of immunization services, and has only more recently put greater emphasis and resources towards addressing within-country inequities in utilization to immunization services. Over time, GAVI has progressively added vaccines to its portfolio. This expansion should have addressed inter-country, inter-regional, inter-generational and gender inequities in disease burden, however, evidence is scant with respect to final outcomes. In its next phase of operations, the Alliance can continue to

  15. Guidance for the national healthcare disparities report

    National Research Council Canada - National Science Library

    Swift, Elaine K

    2002-01-01

    The Agency for Healthcare Research Quality commissioned the Institute of Medicine establish a committee to provide guidance on the National Healthcare Disparities Report is of access to health care...

  16. Bell's inequalities for quantum mechanics

    International Nuclear Information System (INIS)

    Andaas, H.E.

    1991-10-01

    Inequalities corresponding to the generalized Bell's inequalities of local realism are derived for the quantum case. The extremal values permitted by these inequalities exceed those allowed by the generalized Bell's inequalities. Quantum predictions for systems of two spin-1/2 particles prepared as mixtures do not violate Bell's inequalities. 15 refs

  17. THE DAMASCUS INEQUALITY

    Directory of Open Access Journals (Sweden)

    F. M. Dannan

    2016-12-01

    Full Text Available In 2016 Prof. Fozi M. Dannan from Damascus, Syria, proposed an interesting inequality for three positive numbers with unit product. It became widely known but was not proved yet in spite of elementary formulation. In this paper we prove this inequality together with similar ones, its proof occurred to be rather complicated. We propose some proofs based on different ideas: Lagrange multipliers method, geometrical considerations, Klamkin–type inequalities for symmetric functions, usage of symmetric reduction functions of computer packages. Also some corollaries and generalizations are considered, they include cycle inequalities, triangle geometric inequalities, inequalities for arbitrary number of values and special forms of restrictions on numbers, applications to cubic equations and symmetric functions.

  18. Educational inequalities in tuberculosis mortality in sixteen European populations

    Science.gov (United States)

    Álvarez, J. L.; Kunst, A. E.; Leinsalu, M.; Bopp, M.; Strand, B. H.; Menvielle, Gwenn; Lundberg, O.; Martikainen, P.; Deboosere, P.; Kalediene, R.; Artnik, B.; Mackenbach, J. P.; Richardus, J. H.

    2011-01-01

    Objective We aim to describe the magnitude of socioeconomic inequalities in tuberculosis (TB) mortality by level of education in male, female, urban, and rural populations in several European countries. Design Data were obtained from the Eurothine project covering 16 populations between 1990 and 2003. Age- and sex-standardized mortality rates, the Relative Index of Inequality, and the slope index of inequality were used to assess educational inequalities. Results The number of TB deaths reported was 8530, with a death rate of 3 per 100 000 per year, of which 73% were males. Educational inequalities in TB mortality were present in all European populations. Inequalities in TB mortality were larger than in total mortality. Relative and absolute inequalities were large in Eastern Europe, and Baltic countries but relatively small in Southern countries and in Norway, Finland, and Sweden. Mortality inequalities were observed among both men and women, and in both rural and urban populations. Conclusions Socioeconomic inequalities in TB mortality exist in all European countries. Firm political commitment is required to reduce inequalities in the social determinants of TB incidence. Targeted public health measures are called for to improve vulnerable groups’ access to treatment and thereby reduce TB mortality. PMID:22008757

  19. Vertical equity of healthcare in Taiwan: health services were distributed according to need

    Directory of Open Access Journals (Sweden)

    Wang Shiow-Ing

    2013-01-01

    Full Text Available Abstract Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform.

  20. Improving Outcomes in the Nigeria Healthcare Sector through Public ...

    African Journals Online (AJOL)

    Nigeria's healthcare sector over the years has continued to degenerate with health indicators ... in service delivery as well as increases access to quality healthcare. ... Key words: Nigeria, Healthcare Sector, Health Outcomes, Health Indicators, ...

  1. Gender Inequality and Trade

    OpenAIRE

    Busse, Matthias; Spielmann, Christian

    2004-01-01

    The paper empirically explores the international linkages between gender inequality and trade flows of a sample of 92 developed and developing countries. The focus is on comparative advantage in labour-intensive manufactured goods. The results indicate that gender wage inequality is positively associated with comparative advantage in labour-intensive goods, that is, countries with a larger gender wage gap have higher exports of these goods. Also, gender inequality in labour force activity rat...

  2. Inequality in OECD countries.

    Science.gov (United States)

    Thévenot, Celine

    2017-08-01

    This article recalls the state of play of inequality levels and trends in OECD countries, with a special focus on Nordic countries. It sheds light on explaining the drivers of the rise in inequality and its economic consequences. It addresses in particular the issue of redistribution through taxes and transfers. It concludes with an overview of policy packages that should be considered to address the issue of rising inequalities.

  3. Globalisation, Inequality and Populism

    OpenAIRE

    Nolan, Brian

    2017-01-01

    read before the Society, 20 April 2017; Symposium 2016-2017: Globalisation, Inequality and the Rise of Populism Inequality in the distribution of income and wealth among individuals has now come to the fore as a core concern across the industrialised world. In 2013 then President of the United States Barack Obama identified rising income inequality as ?the defining challenge of our times?. The Managing Director of the International Monetary Fund Christine Lagarde has stated that ?reducing ...

  4. Inequalities in Science

    OpenAIRE

    Xie, Y.

    2014-01-01

    Inequalities in scientists’ contributions to science and their rewards have always been very high. There are good reasons to propose that inequalities in science across research institutions and across individual scientists have increased in recent years. In the meantime, however, globalization and internet technology have narrowed inequalities in science across nations and facilitated the expansion of science and rapid production of scientific discoveries through international collaborative ...

  5. Inequalities in Science

    Science.gov (United States)

    Xie, Y.

    2014-01-01

    Inequalities in scientists’ contributions to science and their rewards have always been very high. There are good reasons to propose that inequalities in science across research institutions and across individual scientists have increased in recent years. In the meantime, however, globalization and internet technology have narrowed inequalities in science across nations and facilitated the expansion of science and rapid production of scientific discoveries through international collaborative networks. PMID:24855244

  6. Ethnicity, Inequality, and Higher Education in Malaysia.

    Science.gov (United States)

    Selvaratnam, Viswanathan

    1988-01-01

    Traces the development since 1957 of Malaysian education policies aimed at providing equitable access to higher education. Suggests that these policies have increased representation of the Malay underclass in tertiary institutions and the professions, but have had little effect on intraethnic class inequalities. 46 references. (SV)

  7. Inequality and Child Well­Being: the Case of Indonesia

    OpenAIRE

    Arianto Patunru; Santi Kusumaningrum

    2013-01-01

    We discuss the issue of inequality in Indonesia with an emphasis on the wellbeing of the children. Inequality is surveyed in two dimensions: vertical, in the form of income and wealth inequality; and horizontal (which includes inequality in access to education, health and nutrition, sanitation, clean water, care and protection) that is presented in snapshots that apply across different age groups, gender, geographical areas and other horizontal settings. This study...

  8. A Turning Point? Recent Developments on Inequality in Latin America and the Caribbean

    OpenAIRE

    Gasparini, Leonardo; Cruces, Guillermo; Tornarolli, Leopoldo; Marchionni, Mariana

    2009-01-01

    This paper documents patterns and recent developments on different dimensions of inequality in Latin America and the Caribbean (LAC). New comparative international evidence confirms that LAC is a region of high inequality, although maybe not the highest in the world. Income inequality has fallen in the 2000s, suggesting a turning point from the significant increases of the 1980s and 1990s. There have been some significant improvements toward the reduction in inequalities in the access to prim...

  9. Inequality or injustice in water use for food?

    OpenAIRE

    Carr, J. A.; Seekell, David A.; D'Odorico, P.

    2015-01-01

    The global distributions of water availability and population density are uneven and therefore inequality exists in human access to freshwater resources. Is this inequality unjust or only regrettable? To examine this question we formulated and evaluated elementary principles of water ethics relative to human rights for water, and the need for global trade to improve societal access to water by transferring 'virtual water' embedded in plant and animal commodities. We defined human welfare benc...

  10. Data scan. With access to a newly available trove of private insurers' claims data, new institute aims to study what's driving spiraling healthcare costs.

    Science.gov (United States)

    Evans, Melanie

    2011-09-26

    A new research initiative aims to delve into private-insurer claims data to study utilization and what's driving healthcare costs. The Health Care Cost Institute will help researchers, who have been limited to Medicare data or limited private claims. "We're optimistic. We have nothing to hide here," says Michael Richards, left, of Gundersen Lutheran Medical Center.

  11. Immigration and income inequality

    DEFF Research Database (Denmark)

    Deding, Mette; Jakobsen, Vibeke; Azhar, Hussain

    Four income inequality measures (Gini-coefficient, 90/10-decile ratio, and two generalized entropy indices) are applied to analyse immigrants’ income position relative to natives in a comparative perspective. Administrative data is used for Denmark, while survey data is used for Germany. We find...... higher inequality among immigrants than natives in Denmark, but vice versa for Germany. Over the period 1984-2003, this inequality gap has narrowed in both countries. At the same time, the contribution of immigrants to overall inequality has increased systematically, primarily caused by the increased...... share of immigrants in the population....

  12. Inequality and development

    Directory of Open Access Journals (Sweden)

    Jovanović-Gavrilović Biljana D.

    2003-01-01

    Full Text Available Inequality can be analyzed from various aspects. In this paper our attention is drawn to economic inequality, most frequently manifested through income and wealth. The measurement of economic inequality is a complex task. The Lorenz curve and a number of numerical indices are applied, and let us mention the following ones: the Gini coefficient, the coefficient of variation, the Theil index and the Atkinson measure. These indices do satisfy the criteria (principles presenting, according to general consent an appropriate measure of economic inequality: anonymity (symmetry principle, population principle, relative income principle and the Dalton principle of transfer. In recent times, the problem of inequality has been attracting a lot of attention. The explanation should be sought in the widening of income differences (within individual countries and between them and also in new knowledge about the relationship between inequality and development. The attitude to inequality being determined mainly by the economic development level (as presented in the Kuznets hypothesis is gradually being replaced by the attitude to inequality being the determinant of income and its growth. Contrary to previous beliefs about the stronger income inequalities being favorable to the economic growth, more recent research has pointed to the fact that a more equal distribution of income through various channels, can possibly act as an efficient stimulus of growth.

  13. Lean healthcare.

    Science.gov (United States)

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  14. Social Inequalities in Youth Volunteerism

    DEFF Research Database (Denmark)

    Bonnesen, Lærke

    2017-01-01

    Civic participation among today’s youth is a topic of widespread concern for policy-makers, academics, and the publics of Western countries at large. Though scholars have increasingly become aware of deep-rooted social inequalities in access to volunteering in the adult population, differences...... with multiple waves enriched with national register data. The study sheds light on the changing importance of longstanding dividing lines—gender, social class, and education—in volunteering trends among the young. While young people are seemingly more gender-equal in their volunteering behavior than older...

  15. Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh.

    Science.gov (United States)

    Hong, Rathavuth; Banta, James E; Betancourt, Jose A

    2006-12-05

    Household food insecurity and under-nutrition remain critically important in developing countries struggling to emerge from the scourge of poverty, where historically, improvements in economic conditions have benefited only certain privileged groups, causing growing inequality in health and healthcare among the population. Utilizing information from 5,977 children aged 0-59 months included in the 2004 Bangladesh Demographic and Health Survey , this study examined the relationship between household wealth inequality and chronic childhood under-nutrition. A child is defined as being chronically undernourished or whose growth rate is adversely stunted, if his or her z-score of height-for-age is more than two standard deviations below the median of international reference. Household wealth status is measured by an established index based on household ownership of durable assets. This study utilized multivariate logistic regressions to estimate the effect of household wealth status on adverse childhood growth rate. The results indicate that children in the poorest 20% of households are more than three time as likely to suffer from adverse growth rate stunting as children from the wealthiest 20% of households (OR=3.6; 95% CI: 3.0, 4.3). The effect of household wealth status remain significantly large when the analysis was adjusted for a child's multiple birth status, age, gender, antenatal care, delivery assistance, birth order, and duration that the child was breastfed; mother's age at childbirth, nutritional status, education; household access to safe drinking water, arsenic in drinking water, access to a hygienic toilet facility, cooking fuel cleanliness, residence, and geographic location (OR=2.4; 95% CI: 1.8, 3.2). This study concludes that household wealth inequality is strongly associated with childhood adverse growth rate stunting. Reducing poverty and making services more available and accessible to the poor are essential to improving overall childhood health

  16. Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh

    Directory of Open Access Journals (Sweden)

    Betancourt Jose A

    2006-12-01

    Full Text Available Abstract Background Household food insecurity and under-nutrition remain critically important in developing countries struggling to emerge from the scourge of poverty, where historically, improvements in economic conditions have benefited only certain privileged groups, causing growing inequality in health and healthcare among the population. Methods Utilizing information from 5,977 children aged 0-59 months included in the 2004 Bangladesh Demographic and Health Survey , this study examined the relationship between household wealth inequality and chronic childhood under-nutrition. A child is defined as being chronically undernourished or whose growth rate is adversely stunted, if his or her z-score of height-for-age is more than two standard deviations below the median of international reference. Household wealth status is measured by an established index based on household ownership of durable assets. This study utilized multivariate logistic regressions to estimate the effect of household wealth status on adverse childhood growth rate. Results The results indicate that children in the poorest 20% of households are more than three time as likely to suffer from adverse growth rate stunting as children from the wealthiest 20% of households (OR=3.6; 95% CI: 3.0, 4.3. The effect of household wealth status remain significantly large when the analysis was adjusted for a child's multiple birth status, age, gender, antenatal care, delivery assistance, birth order, and duration that the child was breastfed; mother's age at childbirth, nutritional status, education; household access to safe drinking water, arsenic in drinking water, access to a hygienic toilet facility, cooking fuel cleanliness, residence, and geographic location (OR=2.4; 95% CI: 1.8, 3.2. Conclusion This study concludes that household wealth inequality is strongly associated with childhood adverse growth rate stunting. Reducing poverty and making services more available and accessible

  17. [Health-care utilization in elderly (Spain 2006-2012): Influence of health status and social class].

    Science.gov (United States)

    Aguilar-Palacio, Isabel; Carrera-Lasfuentes, Patricia; Solsona, Sofía; Sartolo, M Teresa; Rabanaque, M José

    2016-04-01

    to explore health-care utilization (primary and specialized health-care, hospitalizations, day hospital and emergency services) and overuse in elderly in Spain, considering the influence of health status, sex, social class and its temporal trend. cross sectional study in two phases. Spain. people surveyed in the National Health Surveys 2006 and 2011-12. Health status was measured using self-rated and diagnosed health (number and diagnoses). Social class was obtained from the last occupation of the main supporter (manual and non-manual workers). Logistic regression analyses were conducted adjusting by sex, age, health status, social class and year, obtaining its predictive capacity. the percentage of elderly population with health-care utilization decreased during the period analyzed. Women who belonged to the manual workers category presented the highest prevalence of low health (low self-rated health in 2006: 70.6%). Low health status was associated with a higher utilization of health-care services. Self-rated health was a better predictor of health-care utilization and overuse than diagnosed health, getting the highest predictive capacity for specialized health-care (C = 0.676). Old people from low social class used with higher frequency primary health-care and emergency services. On the other hand, specialized health-care and day hospital were more used by high social classes. inequalities in health and health-care utilization have been observed in elderly according social class. It is necessary to consider self-rated health as a health-care utilization predictor and to review our health-care services accessibility and equity. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  18. Testing the race inequality

    DEFF Research Database (Denmark)

    Gondan, Matthias; Heckel, A.

    2008-01-01

    In speeded response tasks with redundant signals, parallel processing of the redundant signals is generally tested using the so-called race inequality. The race inequality states that the distribution of fast responses for a redundant stimulus never exceeds the summed distributions of fast...

  19. The Ginibre inequality

    International Nuclear Information System (INIS)

    Sylvester, G.S.

    1980-01-01

    In the Ising-type models of statistical mechanics and the related quantum field theories, an inequality of Ginibre implies useful positivity and monotonicity properties: the Griffiths correlation inequalities. Essentially, the Ginibre inequality states that certain functions on the cycle group of a graph are positive definite. This has been proved for arbitrary graphs when the spin dimensions is 1 or 2 (classical Ising or plane rotator models). We give a counterexample to show that these spin dimensions are the only ones for which the Ginibre inequality is generally true: there are graphs for which it never holds when the spin dimension is at least 3. On the other hand, we show that for any graph the inequality holds for the apparent leading term in the large-spin-dimension limit. (The leading term vanishes in the graph of the counterexample.) Based on these results, one expects the Ginibre inequality to be true in most instances, with infrequent exceptions. A numerical survey supports this. The surprising failure of the Ginibre inequality in higher dimensions need not necessarily mean the Griffiths inequalities fail as well, but a different approach to them is required. (orig.)

  20. Health Inequality and Careers

    Science.gov (United States)

    Robertson, Peter J.

    2014-01-01

    Structural explanations of career choice and development are well established. Socioeconomic inequality represents a powerful factor shaping career trajectories and economic outcomes achieved by individuals. However, a robust and growing body of evidence demonstrates a strong link between socioeconomic inequality and health outcomes. Work is a key…

  1. Dual affine isoperimetric inequalities

    Directory of Open Access Journals (Sweden)

    Bin Xiong

    2006-01-01

    Full Text Available We establish some inequalities for the dual -centroid bodies which are the dual forms of the results by Lutwak, Yang, and Zhang. Further, we establish a Brunn-Minkowski-type inequality for the polar of dual -centroid bodies.

  2. Inequalities for Differential Forms

    CERN Document Server

    Agarwal, Ravi P

    2009-01-01

    Presents a series of local and global estimates and inequalities for differential forms, in particular the ones that satisfy the A-harmonic equations. This work focuses on the Hardy-Littlewood, Poincare, Cacciooli, imbedded and reverse Holder inequalities. It is for researchers, instructors and graduate students

  3. Global Inequality: An Introduction

    Directory of Open Access Journals (Sweden)

    Michelle Bata

    2015-08-01

    Full Text Available Global inequality has been little analyzed by sociologists despite their claim to be the scienti?c experts most in charge of the study of human inequalities and social strati?cation. Most undergraduate courses on social inequalities study race, class and gender without ever acknowledging that the greatest inequalities are between those individuals and households that live in developed versus less developed societies. The amount of international inequality has vastly outweighed within country inequalities since at least the 1870s when a wave of economic globalization under the Pax Britannica increased average wages in the core while leaving most of the periphery and the semiperiphery at subsistence levels. Increasing inequality was one of the most important consequences of nineteenth century globalization, and this fact is pregnant with importance for those who seek to understand what the consequences of twentieth century globalization may be. Resistance to global capitalism and attacks on symbols of power are likely to increase, just as they did in the decades following the great expansion of trade and investment in the last decades of the nineteenth century. Research into the causes of increasing inequalities is thus extremely important for social scientists, policy makers and global citizens who need to understand how the world-system works in order to change it.

  4. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015.

    Science.gov (United States)

    2017-07-15

    National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This

  5. The State of Gender Inequality in India

    Directory of Open Access Journals (Sweden)

    Sumanjeet Singh

    2016-12-01

    Full Text Available Despite a high growth rate and plentiful Government measures to encourage gender equality, the gender gap still exists in India. Lack of gender equality not only limits women’s access to resources and opportunities, but also imperils the life prospects of the future generation. In the present article an attempt has been made to examine the problem of gender inequality in India. In this process, the article not only discusses the extent, causes and consequences of the problem, but also suggests policy measures to reduce gender inequality in India.

  6. Ethical issues in healthcare financing.

    Science.gov (United States)

    Maharaj, S R; Paul, T J

    2011-07-01

    The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

  7. Testing Psychometrics of Healthcare Empowerment Questionnaires ...

    African Journals Online (AJOL)

    Testing Psychometrics of Healthcare Empowerment Questionnaires (HCEQ) among Iranian ... PROMOTING ACCESS TO AFRICAN RESEARCH ... translation and backtranslation procedures, pilot testing, and getting views of expert panel.

  8. Inequalities with applications to engineering

    CERN Document Server

    Cloud, Michael J; Lebedev, Leonid P

    2014-01-01

    This book offers a concise introduction to mathematical inequalities for graduate students and researchers in the fields of engineering and applied mathematics. It begins by reviewing essential facts from algebra and calculus and proceeds with a presentation of the central inequalities of applied analysis, illustrating a wide variety of practical applications. The text provides a gentle introduction to abstract spaces, such as metric, normed, and inner product spaces. It also provides full coverage of the central inequalities of applied analysis, such as Young's inequality, the inequality of the means, Hölder's inequality, Minkowski's inequality, the Cauchy–Schwarz inequality, Chebyshev's inequality, Jensen's inequality, and the triangle inequality. The second edition features extended coverage of applications, including continuum mechanics and interval analysis. It also includes many additional examples and exercises with hints and full solutions that may appeal to upper-level undergraduate and graduate...

  9. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016

    DEFF Research Database (Denmark)

    Moesgaard Iburg, Kim

    2018-01-01

    used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods...... and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used......·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America...

  10. Gender based within-household inequality in childhood immunization in India: changes over time and across regions.

    Directory of Open Access Journals (Sweden)

    Ashish Singh

    Full Text Available Despite India's substantial economic growth in the past two decades, girls in India are discriminated against in access to preventive healthcare including immunizations. Surprisingly, no study has assessed the contribution of gender based within-household discrimination to the overall inequality in immunization status of Indian children. This study therefore has two objectives: to estimate the gender based within-household inequality (GWHI in immunization status of Indian children and to examine the inter-regional and inter-temporal variations in the GWHI.The present study used households with a pair of male-female siblings (aged 1-5 years from two rounds of National Family Health Survey (NFHS, 1992-93 and 2005-06. The overall inequality in the immunization status (after controlling for age and birth order of children was decomposed into within-households and between-households components using Mean log deviation to obtain the GWHI component. The analysis was conducted at the all-India level as well as for six specified geographical regions and at two time points (1992-93 and 2005-06. Household fixed-effects models for immunization status of children were also estimated.Findings from household fixed effects analysis indicated that the immunization scores of girls were significantly lower than that of boys. The inequality decompositions revealed that, at the all-India level, the absolute level of GWHI in immunization status decreased from 0.035 in 1992-93 to 0.023 in 2005-06. However, as a percentage of total inequality, it increased marginally (15.5% to 16.5%. In absolute terms, GWHI decreased in all the regions except in the North-East. But, as a percentage of total inequality it increased in the North-Eastern, Western and Southern regions. The main conclusions are the following: GWHI contributes substantially to the overall inequality in immunization status of Indian children; and though the overall inequality in immunization status declined

  11. Gender based within-household inequality in childhood immunization in India: changes over time and across regions.

    Science.gov (United States)

    Singh, Ashish

    2012-01-01

    Despite India's substantial economic growth in the past two decades, girls in India are discriminated against in access to preventive healthcare including immunizations. Surprisingly, no study has assessed the contribution of gender based within-household discrimination to the overall inequality in immunization status of Indian children. This study therefore has two objectives: to estimate the gender based within-household inequality (GWHI) in immunization status of Indian children and to examine the inter-regional and inter-temporal variations in the GWHI. The present study used households with a pair of male-female siblings (aged 1-5 years) from two rounds of National Family Health Survey (NFHS, 1992-93 and 2005-06). The overall inequality in the immunization status (after controlling for age and birth order) of children was decomposed into within-households and between-households components using Mean log deviation to obtain the GWHI component. The analysis was conducted at the all-India level as well as for six specified geographical regions and at two time points (1992-93 and 2005-06). Household fixed-effects models for immunization status of children were also estimated. Findings from household fixed effects analysis indicated that the immunization scores of girls were significantly lower than that of boys. The inequality decompositions revealed that, at the all-India level, the absolute level of GWHI in immunization status decreased from 0.035 in 1992-93 to 0.023 in 2005-06. However, as a percentage of total inequality, it increased marginally (15.5% to 16.5%). In absolute terms, GWHI decreased in all the regions except in the North-East. But, as a percentage of total inequality it increased in the North-Eastern, Western and Southern regions. The main conclusions are the following: GWHI contributes substantially to the overall inequality in immunization status of Indian children; and though the overall inequality in immunization status declined in all the

  12. Gender Based Within-Household Inequality in Childhood Immunization in India: Changes over Time and across Regions

    Science.gov (United States)

    Singh, Ashish

    2012-01-01

    Background and Objectives Despite India's substantial economic growth in the past two decades, girls in India are discriminated against in access to preventive healthcare including immunizations. Surprisingly, no study has assessed the contribution of gender based within-household discrimination to the overall inequality in immunization status of Indian children. This study therefore has two objectives: to estimate the gender based within-household inequality (GWHI) in immunization status of Indian children and to examine the inter-regional and inter-temporal variations in the GWHI. Data and Methods The present study used households with a pair of male-female siblings (aged 1–5 years) from two rounds of National Family Health Survey (NFHS, 1992–93 and 2005–06). The overall inequality in the immunization status (after controlling for age and birth order) of children was decomposed into within-households and between-households components using Mean log deviation to obtain the GWHI component. The analysis was conducted at the all-India level as well as for six specified geographical regions and at two time points (1992–93 and 2005–06). Household fixed-effects models for immunization status of children were also estimated. Results and Conclusions Findings from household fixed effects analysis indicated that the immunization scores of girls were significantly lower than that of boys. The inequality decompositions revealed that, at the all-India level, the absolute level of GWHI in immunization status decreased from 0.035 in 1992–93 to 0.023 in 2005–06. However, as a percentage of total inequality, it increased marginally (15.5% to 16.5%). In absolute terms, GWHI decreased in all the regions except in the North-East. But, as a percentage of total inequality it increased in the North-Eastern, Western and Southern regions. The main conclusions are the following: GWHI contributes substantially to the overall inequality in immunization status of Indian children

  13. Healthcare Robotics

    OpenAIRE

    Riek, Laurel D.

    2017-01-01

    Robots have the potential to be a game changer in healthcare: improving health and well-being, filling care gaps, supporting care givers, and aiding health care workers. However, before robots are able to be widely deployed, it is crucial that both the research and industrial communities work together to establish a strong evidence-base for healthcare robotics, and surmount likely adoption barriers. This article presents a broad contextualization of robots in healthcare by identifying key sta...

  14. Leggett–Garg inequalities

    International Nuclear Information System (INIS)

    Emary, Clive; Lambert, Neill; Nori, Franco

    2014-01-01

    In contrast to the spatial Bell's inequalities which probe entanglement between spatially separated systems, the Leggett–Garg inequalities test the correlations of a single system measured at different times. Violation of a genuine Leggett–Garg test implies either the absence of a realistic description of the system or the impossibility of measuring the system without disturbing it. Quantum mechanics violates the inequalities on both accounts and the original motivation for these inequalities was as a test for quantum coherence in macroscopic systems. The last few years has seen a number of experimental tests and violations of these inequalities in a variety of microscopic systems such as superconducting qubits, nuclear spins, and photons. In this article, we provide an introduction to the Leggett–Garg inequalities and review these latest experimental developments. We discuss important topics such as the significance of the non-invasive measurability assumption, the clumsiness loophole, and the role of weak measurements. Also covered are some recent theoretical proposals for the application of Leggett–Garg inequalities in quantum transport, quantum biology and nano-mechanical systems. (review article)

  15. Income Inequality and Education

    Directory of Open Access Journals (Sweden)

    Richard Breen

    2015-08-01

    Full Text Available Many commentators have seen the growing gap in earnings and income between those with a college education and those without as a major cause of increasing inequality in the United States and elsewhere. In this article we investigate the extent to which increasing the educational attainment of the US population might ameliorate inequality. We use data from NLSY79 and carry out a three-level decomposition of total inequality into within-person, between-person and between-education parts. We find that the between-education contribution to inequality is small, even when we consider only adjusted inequality that omits the within-person component. We carry out a number of simulations to gauge the likely impact on inequality of changes in the distribution of education and of a narrowing of the differences in average incomes between those with different levels of education. We find that any feasible educational policy is likely to have only a minor impact on income inequality.

  16. Has India's national rural health mission reduced inequities in maternal health services? A pre-post repeated cross-sectional study.

    Science.gov (United States)

    Vellakkal, Sukumar; Gupta, Adyya; Khan, Zaky; Stuckler, David; Reeves, Aaron; Ebrahim, Shah; Bowling, Ann; Doyle, Pat

    2017-02-01

    In 2005, India launched the National Rural Health Mission (NRHM) to strengthen the primary healthcare system. NRHM also aims to encourage pregnant women, particularly of low socioeconomic backgrounds, to use institutional maternal healthcare. We evaluated the impacts of NRHM on socioeconomic inequities in the uptake of institutional delivery and antenatal care (ANC) across high-focus (deprived) Indian states. Data from District Level Household and Facility Surveys (DLHS) Rounds 1 (1995-99) and 2 (2000-04) from the pre-NRHM period, and Round 3 (2007-08), Round 4 and Annual Health Survey (2011-12) from post-NRHM period were used. Wealth-related and education-related relative indexes of inequality, and pre-post difference-in-differences models for wealth and education tertiles, adjusted for maternal age, rural-urban, caste, parity and state-level fixed effects, were estimated. Inequities in institutional delivery declined between pre-NRHM Period 1 (1995-99) and pre-NRHM Period 2 (2000-04), but thereafter demonstrated steeper decline in post-NRHM periods. Uptake of institutional delivery increased among all socioeconomic groups, with (1) greater effects among the lowest and middle wealth and education tertiles than highest tertile, and (2) larger equity impacts in the late post-NRHM period 2011-12 than in the early post-NRHM period 2007-08. No positive impact on the uptake of ANC was found in the early post-NRHM period 2007-08; however, there was considerable increase in the uptake of, and decline in inequity, in uptake of ANC in most states in the late post-NRHM period 2011-12. In high-focus states, NRHM resulted in increased uptake of maternal healthcare, and decline in its socioeconomic inequity. Our study suggests that public health programs in developing country settings will have larger equity impacts after its almost full implementation and widest outreach. Targeting deprived populations and designing public health programs by linking maternal and child

  17. Legal Quality, Inequality, and Tolerance

    DEFF Research Database (Denmark)

    Bjørnskov, Christian

    Previous findings suggest that income inequality leads to lower legal quality. This paper argues that voters' tolerance of inequality exerts an additional influence. Empirical findings suggest that inequality leads to lower legal quality due to its effect on trust while the tolerance of inequality...

  18. Legal Quality, Inequality, and Tolerance

    DEFF Research Database (Denmark)

    Bjørnskov, Christian

    2004-01-01

    Previous findings suggest that income inequality leads to lower legal quality. This paper argues that voters' tolerance of inequality exerts an additional influence. Empirical findings suggest that inequality leads to lower legal quality due to its effect on trust while the tolerance of inequality...

  19. Volume Inequalities for Isotropic Measures

    OpenAIRE

    Lutwak, Erwin; Yang, Deane; Zhang, Gaoyong

    2006-01-01

    A direct approach to Ball's simplex inequality is presented. This approach, which does not use the Brascamp-Lieb inequality, also gives Barthe's characterization of the simplex for Ball's inequality and extends it from discrete to arbitrary measures. It also yields the dual inequality, along with equality conditions, and it does both for arbitrary measures.

  20. Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio-economically disadvantaged migrants in Delhi, India.

    Science.gov (United States)

    Kusuma, Yadlapalli S; Kumari, Rita; Kaushal, Sonia

    2013-10-01

    To identify the determinants of adequate antenatal care (ANC) utilisation and institutional deliveries among socio-economically disadvantaged migrants living in Delhi, India. In a cross-sectional survey, 809 rural-urban migrant mothers with a child aged below 2 years were interviewed with a pretested questionnaire. Data on receiving antenatal, delivery and post-natal services, migration history and other social, demographic and income were collected. Recent migrants used the services significantly less than settled migrants. ANC was adequate only among 37% (35% of recent migrant women and 39% of settled migrants). Multinomial regression revealed that being a recent migrant, multiparous, illiterate and married to an unskilled worker were significant risk factors for receiving inadequate ANC. Around 53% of deliveries took place at home. ANC seeking has a strong influence on place of delivery: 70% of births to women who received inadequate ANC were at home. Women who are educated, had their first delivery after the age of 20 years and received adequate ANC were more likely to deliver their child in hospital. Post-natal care is grossly neglected among these groups. Migrant women, particularly recent migrants, are at the risk of not receiving adequate maternal healthcare. Because migration is a continuing phenomenon, measures to mitigate disadvantage due to migration need to be taken in the healthcare system. © 2013 John Wiley & Sons Ltd.

  1. Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area.

    Science.gov (United States)

    Wan, Shaowei; Teichman, Peter G; Latif, David; Boyd, Jennifer; Gupta, Rahul

    2018-03-01

    To meet the needs of an aging population who often have multiple chronic conditions, interprofessional care is increasingly adopted by patient-centred medical homes and Accountable Care Organisations to improve patient care coordination and decrease costs in the United States, especially in underserved areas with primary care workforce shortages. In this cross-sectional survey across multiple clinical settings in an underserved area, healthcare providers perceived overall outcomes associated with interprofessional care teams as positive. This included healthcare providers' beliefs that interprofessional care teams improved patient outcomes, increased clinic efficiency, and enhanced care coordination and patient follow-up. Teams with primary care physician available each day were perceived as better able to coordinate care and follow up with patients (p = .031), while teams that included clinical pharmacists were perceived as preventing medication-associated problems (p care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.

  2. Investigating the role of healthcare centre accessibility on the decision to attend for screening for gestational diabetes mellitus in Ireland [presentation

    LENUS (Irish Health Repository)

    Cullinan, John

    2011-01-01

    Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy and is associated with several serious maternal and neonatal complications and conditions. Screening practices for GDM vary within and across European countries, with some offering universal screening to all pregnant women and others only to selective high risk groups. In Ireland, no single policy with respect to GDM screening is implemented nationally and a debate exists as to what form such a policy should take. Within this context, the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network was established in 2005 to provide robust information on pregnancy outcomes for women with diabetes. The network includes five healthcare centres along the Atlantic seaboard and provides testing for all pregnant women at 24-28 weeks using a 75g Oral Glucose Tolerance Test. The centres are linked using a clinical information system which allows for data to be captured within a central database, containing a comprehensive range of data on screening uptake rates, maternal characteristics, outcomes for mothers and infants, healthcare resource usage over the course of pregnancy, as well as the postal address of each individual. At present it contains observations on 9,043 pregnant women offered the screening, 5,218 (58%) of whom participated in testing.\\r\

  3. Firming Up Inequality

    OpenAIRE

    Jae Song; David J. Price; Fatih Guvenen; Nicholas Bloom; Till von Wachter

    2015-01-01

    Earnings inequality in the United States has increased rapidly over the last three decades, but little is known about the role of firms in this trend. For example, how much of the rise in earnings inequality can be attributed to rising dispersion between firms in the average wages they pay, and how much is due to rising wage dispersion among workers within firms? Similarly, how did rising inequality affect the wage earnings of different types of workers working for the same employer—men vs. w...

  4. Corruption in healthcare and medicine: why should physicians and bioethicists care and what should they do?

    Science.gov (United States)

    Chattopadhyay, Subrata

    2013-01-01

    Corruption, an undeniable reality in the health sector, is arguably the most serious ethical crisis in medicine today. However, it remains poorly addressed in scholarly journals and by professional associations of physicians and bioethicists. This article provides an overview of the forms and dynamics of corruption in healthcare as well as its implications in health and medicine. Corruption traps millions of people in poverty, perpetuates the existing inequalities in income and health, drains the available resources undermines people's access to healthcare, increases the costs of patient care and, by setting up a vicious cycle, contributes to ill health and suffering. No public health programme can succeed in a setting in which scarce resources are siphoned off, depriving the disadvantaged and poor of essential healthcare. Quality care cannot be provided by a healthcare delivery system in which kickbacks and bribery are a part of life. The medical profession, historically considered a noble one, and the bioethics community cannot evade their moral responsibility in the face of this sordid reality. There is a need to engage in public discussions and take a stand - against unethical and corrupt practices in healthcare and medicine - for the sake of the individual's well-being as well as for social good.

  5. Healthcare leadership's diversity paradox.

    Science.gov (United States)

    Silver, Reginald

    2017-02-06

    Purpose The purpose of this research study was to obtain healthcare executives' perspectives on diversity in executive healthcare leadership. The study focused on identifying perspectives about diversity and its potential impact on the access of healthcare services by people of color. The study also identified perspectives about factors that influence the attainment of executive healthcare roles by people of color. Design/methodology/approach A convenience sample of healthcare executives was obtained. The executives identified themselves as belonging to one of two subgroups, White healthcare executives or executives of color. Participants were interviewed telephonically in a semi-structured format. The interviews were transcribed and entered into a qualitative software application. The data were codified and important themes were identified. Findings The majority of the study participants perceive that diversity of the executive healthcare leadership team is important. There were differences in perspective among the subgroups as it relates to solutions to improve access to healthcare by people of color. There were also differences in perspective among the subgroups, as it relates to explaining the underrepresentation of people of color in executive healthcare leadership roles. Research limitations/implications This research effort benefited from the subject matter expertise of 24 healthcare executives from two states. Expansion of the number of survey participants and broadening the geographical spread of where participants were located may have yielded more convergence and/or more divergence in perspectives about key topics. Practical implications The findings from this research study serve to add to the existing body of literature on diversity in executive healthcare leadership. The findings expand on the importance of key elements in contemporary literature such as diversity, cultural competency and perspectives about the need for representation of people of

  6. A qualitative study of the impact of the implementation of advanced access in primary healthcare on the working lives of general practice staff

    Directory of Open Access Journals (Sweden)

    Offredy Maxine

    2005-09-01

    Full Text Available Abstract Background The North American model of 'advanced access' has been emulated by the National Primary Care Collaborative in the UK as a way of improving patients' access in primary care. The aim of this study was to explore the impact of the implementation of advanced access on the working lives of general practice staff. Methods A qualitative study design, using semi-structured interviews, was conducted with 18 general practice staff: 6 GPs, 6 practice managers and 6 receptionists. Two neighbouring boroughs in southeast England were used as the study sites. NUD*IST computer software assisted in data management to identify concepts, categories and themes of the data. A framework approach was used to analyse the data. Results Whilst practice managers and receptionists saw advanced access as having a positive effect on their working lives, the responses of general practitioners (GPs were more ambivalent. Receptionists reported improvements in their working lives with a change in their role from gatekeepers for appointments to providing access to appointments, fewer confrontations with patients, and greater job satisfaction. Practice managers perceived reductions in work stress from fewer patient complaints, better use of time, and greater flexibility for contingency planning. GPs recognised benefits in terms of improved consultations, but had concerns about the impact on workload and continuity of care. Conclusion AA has improved working conditions for receptionists, converting their perceived role from gatekeeper to access facilitator, and for practice managers as patients were more satisfied. GP responses were more ambivalent, as they experienced both positive and negative effects.

  7. Inequalities an approach through problems

    CERN Document Server

    Venkatachala, B J

    2018-01-01

    This book discusses about the basic topics on inequalities and their applications. These include the arithmetic mean–geometric mean inequality, Cauchy–Schwarz inequality, Chebyshev inequality, rearrangement inequality, convex and concave functions and Muirhead's theorem. The book contains over 400 problems with their solutions. A chapter on geometric inequalities is a special feature of this book. Most of these problems are from International Mathematical Olympiads and from many national mathematical Olympiads. The book is intended to help students who are preparing for various mathematical competitions. It is also a good source book for graduate students who are consolidating their knowledge of inequalities and their applications. .

  8. Governance mechanisms for healthcare apps

    DEFF Research Database (Denmark)

    Manikas, Konstantinos; Hansen, Klaus Marius; Kyng, Morten

    2014-01-01

    The introduction of the `app store' concept has challenged the way software is distributed and marketed: developers have easier access to customers, while customers have easy access to innovative applications. Apps today are increasingly focusing on more "mission-critical" areas like healthcare...... with the Apple AppStore counting more than 40,000 apps under the category "health & fitness". This rapid development of healthcare apps increases the necessity of governance as, currently, healthcare apps are not thoroughly governed. The U.S. Food and Drug Administration and the European Commission only have...... policies for apps that are medical devices.In this paper, we approach the problem of how to govern healthcare and medical apps by addressing the risks the use of these apps pose, while at the same time inviting for development of new apps. To do so we (i) analyze four cases of healthcare app governance...

  9. Healthcare Providers' Responses to Narrative Communication About Racial Healthcare Disparities.

    Science.gov (United States)

    Burgess, Diana J; Bokhour, Barbara G; Cunningham, Brooke A; Do, Tam; Gordon, Howard S; Jones, Dina M; Pope, Charlene; Saha, Somnath; Gollust, Sarah E

    2017-10-25

    We used qualitative methods (semi-structured interviews with healthcare providers) to explore: 1) the role of narratives as a vehicle for raising awareness and engaging providers about the issue of healthcare disparities and 2) the extent to which different ways of framing issues of race within narratives might lead to message acceptance for providers' whose preexisting beliefs about causal attributions might predispose them to resist communication about racial healthcare disparities. Individual interviews were conducted with 53 providers who had completed a prior survey assessing beliefs about disparities. Participants were stratified by the degree to which they believed providers contributed to healthcare inequality: low provider attribution (LPA) versus high provider attribution (HPA). Each participant read and discussed two differently framed narratives about race in healthcare. All participants accepted the "Provider Success" narratives, in which interpersonal barriers involving a patient of color were successfully resolved by the provider narrator, through patient-centered communication. By contrast, "Persistent Racism" narratives, in which problems faced by the patient of color were more explicitly linked to racism and remained unresolved, were very polarizing, eliciting acceptance from HPA participants and resistance from LPA participants. This study provides a foundation for and raises questions about how to develop effective narrative communication strategies to engage providers in efforts to reduce healthcare disparities.

  10. Looking for symmetric Bell inequalities

    OpenAIRE

    Bancal, Jean-Daniel; Gisin, Nicolas; Pironio, Stefano

    2010-01-01

    Finding all Bell inequalities for a given number of parties, measurement settings and measurement outcomes is in general a computationally hard task. We show that all Bell inequalities which are symmetric under the exchange of parties can be found by examining a symmetrized polytope which is simpler than the full Bell polytope. As an illustration of our method, we generate 238 885 new Bell inequalities and 1085 new Svetlichny inequalities. We find, in particular, facet inequalities for Bell e...

  11. Inequality of Opportunity in Egypt

    OpenAIRE

    Hassine, Nadia Belhaj

    2012-01-01

    The article evaluates the contribution of inequality of opportunity to earnings inequality in Egypt and analyzes its evolution across three time periods and different population groups. It provides parametric and nonparametric estimates of a lower bound for the degree of inequality of opportunity for wage and salary workers. On average, the contribution of opportunity-shaping circumstances to earnings inequality declined from 22 percent in 1988 to 15 percent in 2006. Levels of inequality of o...

  12. Several applications of Cartwright-Field's inequality

    OpenAIRE

    Minculete, Nicuşor; Furuichi, Shigeru

    2011-01-01

    In this paper we present several applications of Cartwright-Field's inequality. Among these we found Young's inequality, Bernoulli's inequality, the inequality between the weighted power means, H\\"{o}lder's inequality and Cauchy's inequality. We give also two applications related to arithmetic functions and to operator inequalities.

  13. Covariance Bell inequalities

    Science.gov (United States)

    Pozsgay, Victor; Hirsch, Flavien; Branciard, Cyril; Brunner, Nicolas

    2017-12-01

    We introduce Bell inequalities based on covariance, one of the most common measures of correlation. Explicit examples are discussed, and violations in quantum theory are demonstrated. A crucial feature of these covariance Bell inequalities is their nonlinearity; this has nontrivial consequences for the derivation of their local bound, which is not reached by deterministic local correlations. For our simplest inequality, we derive analytically tight bounds for both local and quantum correlations. An interesting application of covariance Bell inequalities is that they can act as "shared randomness witnesses": specifically, the value of the Bell expression gives device-independent lower bounds on both the dimension and the entropy of the shared random variable in a local model.

  14. Social inequalities in 'sickness'

    DEFF Research Database (Denmark)

    Wel, Kjetil A. van der; Dahl, Espen; Thielen, Karsten

    2011-01-01

    The aim of this paper is to examine educational inequalities in the risk of non-employment among people with illnesses and how they vary between European countries with different welfare state characteristics. In doing so, the paper adds to the growing literature on welfare states and social...... from Eurostat and OECD that include spending on active labour market policies, benefit generosity, income inequality, and employment protection. Using multilevel techniques we find that comprehensive welfare states have lower absolute and relative social inequalities in sickness, as well as more...... inequalities in health by studying the often overlooked ‘sickness’-dimension of health, namely employment behaviour among people with illnesses. We use European Union Statistics on Income and Living Conditions (EU-SILC) data from 2005 covering 26 European countries linked to country characteristics derived...

  15. Inequity in Cancer Care: A Global Perspective

    International Nuclear Information System (INIS)

    2011-01-01

    The strategies of United Nations system organizations such as the International Atomic Energy Agency (IAEA) and the World Health Organization (WHO) are based on guiding principles, the attainment of health equality being an important one. Therefore, their strategies focus on the needs of low and middle income countries and of vulnerable and marginalized populations. The IAEA is committed to gender equality. In keeping with the United Nations policies and agreements on both gender equality and gender mainstreaming, the IAEA has the responsibility of integrating gender equality into its programmes, as well as for contributing to worldwide gender equality. In addition, the IAEA strongly emphasizes the attainment of the United Nations Millennium Development Goals, of which gender equality is a central tenet. This publication focuses on the issue of inequality (disparity) as it applies to cancer care in general, and access to prevention, screening, palliative and treatment services in particular. The problem of inequality in access to radiation oncology services is addressed in detail. Access to cancer care and radiotherapy services for women and children is specifically considered, reflecting the currently published literature. The report is aimed at radiotherapy professionals, health programme managers and decision makers in the area of cancer control. It was developed to create awareness of the role of socioeconomic inequality in access to cancer care, and to eventually mobilize resources to be equitably allocated to public health programmes in general, and to cancer control and radiotherapy programmes in particular

  16. Medications for sexual health available from non-medical sources: a need for increased access to healthcare and education among immigrant Latinos in the rural southeastern USA.

    Science.gov (United States)

    Rhodes, Scott D; Fernández, Facundo M; Leichliter, Jami S; Vissman, Aaron T; Duck, Stacy; O'Brien, Mary Claire; Miller, Cindy; Wilkin, Aimee M; Harris, Glenn A; Hostetler, Dana M; Bloom, Fred R

    2011-12-01

    This study documented the types and quality of sexual health medications obtained by immigrant Latinos from non-medical sources. Samples of the medications were purchased from non-medical sources in the rural Southeast by trained native Spanish-speaking "buyers". Medications were screened the presence of active pharmaceutical ingredients using mass spectrometry. Eleven medications were purchased from tiendas and community members. Six were suggested to treat sexually transmitted diseases, one was to treat sexual dysfunction, one was to prevent pregnancy, and two were to assist in male-to-female transgender transition or maintenance. All medications contained the stated active ingredients. Findings suggest that medications are available from non-medical sources and may not be used as indicated. Interventions that target immigrant Latinos within their communities and rely on existing structures may be effective in reducing barriers to medical and healthcare services and increasing the proper use of medications to reduce potential harm.

  17. Regional inequalities in mortality.

    OpenAIRE

    Illsley, R; Le Grand, J

    1993-01-01

    STUDY OBJECTIVE--To examine the hypothesis of sustained and persistent inequalities in health between British regions and to ask how far they are a consequence of using standardised mortality ratios as the tool of measurement. DESIGN, SETTING AND PARTICIPANTS--Data are regional, age specific death rates at seven points in time from 1931 to 1987-89 for the British regions, reconstructed to make them comparable with the 1981 regional definitions. Log variance is used to measure inequality; regi...

  18. Increasing income inequality

    DEFF Research Database (Denmark)

    Frederiksen, Anders; Poulsen, Odile

    In recent decades most developed countries have experienced an increase in income inequality. In this paper, we use an equilibrium search framework to shed additional light on what is causing an income distribution to change. The major benefit of the model is that it can accommodate shocks...... that shocks to the employees' relative productivity, i.e., skill-biased technological change, are unlikely to have caused the increase in income inequality....

  19. Child Labour and Inequality

    OpenAIRE

    D'Alessandro, Simone; Fioroni, Tamara

    2011-01-01

    This paper focuses on the evolution of child labour, fertility and human capital in an economy characterized by two type of individuals, low and high skilled workers. This heterogeneity allows for an endogenous analysis of inequality generated by child labour. More specifically, according to empirical evidence, we oer an explanation for the emergence of a vicious cycle between child labour and inequality. The basic intuition behind this result is the interdependence between child labour and f...

  20. Corruption and inequality

    OpenAIRE

    Uslaner, Eric M.

    2006-01-01

    Economic inequality provides a fertile breeding ground for corruption and, in turn, leads to further inequalities. Most corruption models focus on the institutional determinants of government dishonesty. However, such accounts are problematic. Corruption is remarkably sticky over time. There is a very powerful correlation between crossnational measures corruption in 1980 and in 2004. In contrast, measures of democracy such as the Freedom House scores are not so strongly correlated over time, ...

  1. Gender Inequality since 1820

    OpenAIRE

    Carmichael, Sarah; Dilli, Selin; Rijpma, Auke

    2014-01-01

    Historically, gender inequalities in health status, socio-economic standing and political rights have been large. This chapter documents gender differences in life expectancy and birth rates (to cover health status); in average years of schooling, labour force participation, inheritance rights and marriage age (to cover socioeconomic status); and in parliamentary seats and suffrage (to cover political rights). A composite indicator shows strong progress in reducing gender inequality in the pa...

  2. Inequalities for Humbert functions

    Directory of Open Access Journals (Sweden)

    Ayman Shehata

    2014-04-01

    Full Text Available This paper is motivated by an open problem of Luke’s theorem. We consider the problem of developing a unified point of view on the theory of inequalities of Humbert functions and of their general ratios are obtained. Some particular cases and refinements are given. Finally, we obtain some important results involving inequalities of Bessel and Whittaker’s functions as applications.

  3. Boole and Bell inequality

    International Nuclear Information System (INIS)

    Michielsen, K.; De Raedt, H.; Hess, K.

    2011-01-01

    We discuss the relation between Bell's and Boole's inequality. We apply both to the analysis of measurement results in idealized Einstein-Podolsky-Rosen-Bohm experiments. We present a local realist model that violates Bell's and Boole's inequality due to the absence of Boole's one-to-one correspondence between the two-valued variables of the mathematical description and the two-valued measurement results.

  4. Generalized quasi variational inequalities

    Energy Technology Data Exchange (ETDEWEB)

    Noor, M.A. [King Saud Univ., Riyadh (Saudi Arabia)

    1996-12-31

    In this paper, we establish the equivalence between the generalized quasi variational inequalities and the generalized implicit Wiener-Hopf equations using essentially the projection technique. This equivalence is used to suggest and analyze a number of new iterative algorithms for solving generalized quasi variational inequalities and the related complementarity problems. The convergence criteria is also considered. The results proved in this paper represent a significant improvement and refinement of the previously known results.

  5. Global Oral Health Inequalities

    Science.gov (United States)

    Garcia, I.; Tabak, L.A.

    2011-01-01

    Despite impressive worldwide improvements in oral health, inequalities in oral health status among and within countries remain a daunting public health challenge. Oral health inequalities arise from a complex web of health determinants, including social, behavioral, economic, genetic, environmental, and health system factors. Eliminating these inequalities cannot be accomplished in isolation of oral health from overall health, or without recognizing that oral health is influenced at multiple individual, family, community, and health systems levels. For several reasons, this is an opportune time for global efforts targeted at reducing oral health inequalities. Global health is increasingly viewed not just as a humanitarian obligation, but also as a vehicle for health diplomacy and part of the broader mission to reduce poverty, build stronger economies, and strengthen global security. Despite the global economic recession, there are trends that portend well for support of global health efforts: increased globalization of research and development, growing investment from private philanthropy, an absolute growth of spending in research and innovation, and an enhanced interest in global health among young people. More systematic and far-reaching efforts will be required to address oral health inequalities through the engagement of oral health funders and sponsors of research, with partners from multiple public and private sectors. The oral health community must be “at the table” with other health disciplines and create opportunities for eliminating inequalities through collaborations that can harness both the intellectual and financial resources of multiple sectors and institutions. PMID:21490232

  6. Gender inequalities and demographic behavior.

    Science.gov (United States)

    1995-01-01

    A summary was provided of the central findings about gender inequalities in Egypt, India, Ghana, and Kenya published by the Population Council in 1994. These countries exhibited gender inequalities in different ways: the legal, economic, and educational systems; family planning and reproductive health services; and the health care system. All countries had in common a high incidence of widowhood. Widowhood was linked with high levels of insecurity, which were linked with high fertility. Children thus became insurance in old age. In Ghana, women's insecurity was threatened through high levels of marital instability and polygyny. In Egypt, insecurity was translated into economic vulnerability because of legal discrimination against women when family systems were disrupted. In India and all four countries, insecurity was reflective of limited access to education, an impediment to economic autonomy. In all four countries, women's status was inferior due to limited control over reproductive decision making about childbearing limits and contraception. In India, the cultural devaluation of girls contributed to higher fertility to satisfy the desire for sons. In India and Egypt, family planning programs were dominated by male-run organizations that were more concerned about demographic objectives than reproductive health. The universal inequality was the burden women carry for contraception. Family planning programs have ignored the local realities of reproductive behavior, family structures, and gender relations. The assumption that husbands and wives have similar fertility goals or that fathers fully share the costs of children is mistaken in countries such as Ghana. Consequently, fertility has declined less than 13% in Ghana, but fertility has declined by over 30% in Kenya. Family planning programs must be aware of gender issues.

  7. A Way Forward for Healthcare in Madagascar?

    Science.gov (United States)

    Marks, Florian; Rabehanta, Nathalie; Baker, Stephen; Panzner, Ursula; Park, Se Eun; Fobil, Julius N; Meyer, Christian G; Rakotozandrindrainy, Raphaël

    2016-03-15

    A healthcare utilization survey was conducted as a component of the Typhoid Fever Surveillance in Africa Program (TSAP). The findings of this survey in Madagascar contrasted with those in other sites of the program; namely, only 30% of the population sought healthcare at the government-provided healthcare facilities for fever. These findings promoted us to determine the drivers and barriers in accessing and utilizing healthcare in Madagascar. Here we review the results of the TSAP healthcare utilization initiative and place them in the context of the current organization of the Madagascan healthcare system. Our work highlights the demands of the population for access to appropriate healthcare and the need for novel solutions that can quickly provide an affordable and sustainable basic healthcare infrastructure until a government-funded scheme is in place. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  8. Healthcare in Equatorial Guinea, West Africa: obstacles and barriers to care.

    Science.gov (United States)

    Reuter, Kim Eleanor; Geysimonyan, Aurora; Molina, Gabriela; Reuter, Peter Robert

    2014-01-01

    The provision of healthcare services in developing countries has received increasing attention, but inequalities persist. One nation with potential inequalities in healthcare services is Equatorial Guinea (Central-West Africa). Mitigating these inequalities is difficult, as the Equatoguinean healthcare system remains relatively understudied. In this study, we interviewed members of the healthcare community in order to: 1) learn which diseases are most common and the most common cause of death from the perspective of healthcare workers; and 2) gain an understanding of the healthcare community in Equatorial Guinea by describing how: a) healthcare workers gain their professional knowledge; b) summarizing ongoing healthcare programs aimed at the general public; c) discussing conflicts within the healthcare community and between the public and healthcare providers; d) and addressing opportunities to improve healthcare delivery. We found that some causes of death, such as serious injuries, may not be currently treatable in country, potentially due to a lack of resources and trauma care facilities. In addition, training and informational programs for both healthcare workers and the general public may not be effectively transmitting information to the intended recipients. This presents hurdles to the healthcare community, both in terms of having professional competence in healthcare delivery and in having a community that is receptive to medical care. Our data also highlight government-facility communication as an opportunity for improvement. Our research is an important first step in understanding the context of healthcare delivery in Equatorial Guinea, a country that is relatively data poor.

  9. Socioeconomic inequalities and mortality trends in BRICS, 1990-2010.

    Science.gov (United States)

    Mújica, Oscar J; Vázquez, Enrique; Duarte, Elisabeth C; Cortez-Escalante, Juan J; Molina, Joaquin; Barbosa da Silva Junior, Jarbas

    2014-06-01

    To explore the presence and magnitude of--and change in--socioeconomic and health inequalities between and within Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--between 1990 and 2010. Comparable data on socioeconomic and health indicators, at both country and primary subnational levels, were obtained from publicly available sources. Health inequalities between and within countries were identified and summarized by using standard gap and gradient metrics. Four of the BRICS countries showed increases in both income level and income inequality between 1990 and 2010. The exception was Brazil, where income inequality decreased over the same period. Between-country inequalities in level of education and access to sanitation remained mostly unchanged but the largest between-country difference in mean life expectancy increased, from 9 years in 1990 to 20 years in 2010. Throughout the study period, there was disproportionality in the burden of disease between BRICS. However, the national infant mortality rate fell substantially over the study period in all five countries. In Brazil and China, the magnitude of subnational income-related inequalities in infant mortality, both absolute and relative, also decreased substantially. Despite the economic prosperity and general improvements in health seen since 1990, profound inequalities in health persist both within and between BRICS. However, the substantial reductions observed--within Brazil and China--in the inequalities in income-related levels of infant mortality are encouraging.

  10. Socioeconomic inequalities and mortality trends in BRICS, 1990–2010

    Science.gov (United States)

    Mújica, Oscar J; Vázquez, Enrique; Duarte, Elisabeth C; Cortez-Escalante, Juan J; Molina, Joaquin

    2014-01-01

    Abstract Objective To explore the presence and magnitude of – and change in – socioeconomic and health inequalities between and within Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – between 1990 and 2010. Methods Comparable data on socioeconomic and health indicators, at both country and primary subnational levels, were obtained from publicly available sources. Health inequalities between and within countries were identified and summarized by using standard gap and gradient metrics. Findings Four of the BRICS countries showed increases in both income level and income inequality between 1990 and 2010. The exception was Brazil, where income inequality decreased over the same period. Between-country inequalities in level of education and access to sanitation remained mostly unchanged but the largest between-country difference in mean life expectancy increased, from 9 years in 1990 to 20 years in 2010. Throughout the study period, there was disproportionality in the burden of disease between BRICS. However, the national infant mortality rate fell substantially over the study period in all five countries. In Brazil and China, the magnitude of subnational income-related inequalities in infant mortality, both absolute and relative, also decreased substantially. Conclusion Despite the economic prosperity and general improvements in health seen since 1990, profound inequalities in health persist both within and between BRICS. However, the substantial reductions observed – within Brazil and China – in the inequalities in income-related levels of infant mortality are encouraging. PMID:24940014

  11. Queueing for healthcare.

    Science.gov (United States)

    Palvannan, R Kannapiran; Teow, Kiok Liang

    2012-04-01

    Patient queues are prevalent in healthcare and wait time is one measure of access to care. We illustrate Queueing Theory-an analytical tool that has provided many insights to service providers when designing new service systems and managing existing ones. This established theory helps us to quantify the appropriate service capacity to meet the patient demand, balancing system utilization and the patient's wait time. It considers four key factors that affect the patient's wait time: average patient demand, average service rate and the variation in both. We illustrate four basic insights that will be useful for managers and doctors who manage healthcare delivery systems, at hospital or department level. Two examples from local hospitals are shown where we have used queueing models to estimate the service capacity and analyze the impact of capacity configurations, while considering the inherent variation in healthcare.

  12. Socioeconomic inequalities in health in 22 European countries

    DEFF Research Database (Denmark)

    Mackenbach, Johan P; Stirbu, Irina; Roskam, Albert-Jan R

    2008-01-01

    , such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality...... by improving educational opportunities, income distribution, health-related behavior, or access to health care.......BACKGROUND: Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe. METHODS: We obtained data on mortality according...

  13. [Inequalities in health in Italy].

    Science.gov (United States)

    Caiazzo, Antonio; Cardano, Mario; Cois, Ester; Costa, Giuseppe; Marinacci, Chiara; Spadea, Teresa; Vannoni, Francesca; Venturini, Lorenzo

    2004-01-01

    Socioeconomic inequality and its impact on health is a growing concern in the European public health debate. In many countries, the issue is moving away from description towards the identification of the determinants of inequalities and the development of policies explicitly aimed at reducing inequalities in health. In Italy, ten years after the publication of the first report on inequalities in health, this topic is seldom present on the agenda of public policy makers. The purpose of this report is to update the Italian profile of social variation in health and health care in order to stimulate the debate on ways to tackle inequalities in health that are preventable. In the first section of this book, the threefold objective is to describe the principal mechanisms involved in the generation of social inequalities in health (Introduction); to report Italian data on the distribution and magnitude of this phenomenon in the last decade; and to evaluate policies and interventions in both the social (chapter 1.9, Section I) and the health sector (chapter 2.3, Section I), which are potentially useful to reduce health inequalities. It is intended for anyone who is in a position to contribute t o decision-making that will benefit the health of communities. For this reason, chapters are organized by specific determinants of inequalities on which interentions may have an impact. The methodological approach in the second section focuses on the best methods to monitor social inequalities including recommendations on social indicators, sources of information and study models, based on European guidelines revised for the Italian situation. According to data from national and local studies, mortality increases linearly with social disadvantage for a wide range of indicators at both the individual (education, social class, income, quality of housing) and the geographical level (deprivation indexes computed at different levels of aggregation). This positive correlation is evident

  14. Hardy type inequalities on time scales

    CERN Document Server

    Agarwal, Ravi P; Saker, Samir H

    2016-01-01

    The book is devoted to dynamic inequalities of Hardy type and extensions and generalizations via convexity on a time scale T. In particular, the book contains the time scale versions of classical Hardy type inequalities, Hardy and Littlewood type inequalities, Hardy-Knopp type inequalities via convexity, Copson type inequalities, Copson-Beesack type inequalities, Liendeler type inequalities, Levinson type inequalities and Pachpatte type inequalities, Bennett type inequalities, Chan type inequalities, and Hardy type inequalities with two different weight functions. These dynamic inequalities contain the classical continuous and discrete inequalities as special cases when T = R and T = N and can be extended to different types of inequalities on different time scales such as T = hN, h > 0, T = qN for q > 1, etc.In this book the authors followed the history and development of these inequalities. Each section in self-contained and one can see the relationship between the time scale versions of the inequalities and...

  15. Gender inequality in the field of science and research

    Directory of Open Access Journals (Sweden)

    Blanka Poczatková

    2017-05-01

    Full Text Available The article focuses on gender inequality in the field of science and research in the Czech Republic. The authors of this article present an unbiased view on women in science and research and they also point out that gender inequality still exists in Russia and the USA. Based on accessible statistical and information data (see references that have been elaborated by synthetic-analytical methods, this article authors state their opinion to this topic.

  16. Gender inequality in the field of science and research

    OpenAIRE

    Blanka Poczatková; Pavlína Křibíková

    2017-01-01

    The article focuses on gender inequality in the field of science and research in the Czech Republic. The authors of this article present an unbiased view on women in science and research and they also point out that gender inequality still exists in Russia and the USA. Based on accessible statistical and information data (see references) that have been elaborated by synthetic-analytical methods, this article authors state their opinion to this topic.

  17. Digital inequalities and different experiences of ageing

    DEFF Research Database (Denmark)

    Givskov, Cecilie

    of such - actually means to different people. My research is based on the assumption that people’s access to (and use of) media is integral to the power relations of current social and cultural transformations. In order to contribute to user-centered and practice-based understandings of why and how media matters......The complexity of the emerging digital media environment inevitably raises questions about digital literacy and social inequality. However, a major shortcoming of the existing research on digital inequality in later life is that it tells us little to nothing about how and why media actually matters...... to different older people and how this intersects with dis- or empowerment in later life and social segmentation. The way people use (digital) media in everyday life therefore constitutes a critical access-point to the study of differences in ageing as well as to the study of what literacy - or the lack...

  18. Mobile phone-based interactive voice response as a tool for improving access to healthcare in remote areas in Ghana - an evaluation of user experiences.

    Science.gov (United States)

    Brinkel, J; May, J; Krumkamp, R; Lamshöft, M; Kreuels, B; Owusu-Dabo, E; Mohammed, A; Bonacic Marinovic, A; Dako-Gyeke, P; Krämer, A; Fobil, J N

    2017-05-01

    To investigate and determine the factors that enhanced or constituted barriers to the acceptance of an mHealth system which was piloted in Asante-Akim North District of Ghana to support healthcare of children. Four semi-structured focus group discussions were conducted with a total of 37 mothers. Participants were selected from a study population of mothers who subscribed to a pilot mHealth system which used an interactive voice response (IVR) for its operations. Data were evaluated using qualitative content analysis methods. In addition, a short quantitative questionnaire assessed system's usability (SUS). Results revealed 10 categories of factors that facilitated user acceptance of the IVR system including quality-of-care experience, health education and empowerment of women. The eight categories of factors identified as barriers to user acceptance included the lack of human interaction, lack of update and training on the electronic advices provided and lack of social integration of the system into the community. The usability (SUS median: 79.3; range: 65-97.5) of the system was rated acceptable. The principles of the tested mHealth system could be of interest during infectious disease outbreaks, such as Ebola or Lassa fever, when there might be a special need for disease-specific health information within populations. © 2017 John Wiley & Sons Ltd.

  19. The State of Gender Inequality in India

    OpenAIRE

    Sumanjeet Singh

    2016-01-01

    Despite a high growth rate and plentiful Government measures to encourage gender equality, the gender gap still exists in India. Lack of gender equality not only limits women’s access to resources and opportunities, but also imperils the life prospects of the future generation. In the present article an attempt has been made to examine the problem of gender inequality in India. In this process, the article not only discusses the extent, causes and consequences of the problem, but also suggest...

  20. Does Corruption Affect Income Inequality and Poverty?

    OpenAIRE

    Sanjeev Gupta

    1998-01-01

    This paper demonstrates that high and rising corruption increases income inequality and poverty by reducing economic growth, the progressivity of the tax system, the level and effectiveness of social spending, and the formation of human capital, and by perpetuating an unequal distribution of asset ownership and unequal access to education. These findings hold for countries with different growth experiences, at different stages of development, and using various indices of corruption. An import...

  1. Product spaces and Nelson's inequality

    International Nuclear Information System (INIS)

    Faris, W.G.

    1976-01-01

    Certain inequalities for unbounded linear operators in L 2 extend to product spaces. This product space property is used to give a new proof that Gross's inequality for matrices implies Nelson's inequality for ordinary differential operators, and that this in turn implies Nelson's inequality for partial differential operators in infinitely many dimensions. A new proof of Gross's inequality is given. There is also a discussion of the physical meaning of Nelson's inequality in quantum field theory. The article may serve as an introduction for non-specialists to some of the recent mathematical work in this subject. (Auth.)

  2. Critical Access Hospitals (CAH)

    Science.gov (United States)

    ... for Success Am I Rural? Evidence-based Toolkits Economic Impact Analysis Tool Community Health Gateway Sustainability Planning ... hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, ...

  3. Disparities in Healthcare Access and Utilization among Children with Autism Spectrum Disorder from Immigrant Non-English Primary Language Households in the United States

    Directory of Open Access Journals (Sweden)

    Sue C. Lin, MS

    2015-09-01

    Full Text Available Background: The prevalence of autism spectrum disorder (ASD in United State (US has surged from 1 in 150 children in 2007 to 1 in 88 children in 2012 with substantial increase in immigrant minority groups including Hispanic and Somali children. Our study objective is to examine the associations between household language among children with ASD and national health quality indicators attainment. Methods: We conducted bivariate and multivariate logistic regression analyses using cross-sectional data from the publicly-available 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN to investigate the association between household language use and quality indicators of medical home, adequate insurance, and early and continuous screening. Results: Approximately, 28% of parents of children with ASD from non-English primary language (NEPL households reported their child having severe ASD as compared with 13% of parents from English primary language (EPL households. Older children were more likely to have care that met the early and continuous screening quality indicator, while lower income children and uninsured children were less likely to have met this indicator. Conclusions and Global Health Implications: Despite the lack of differences in the attainment of quality indicators by household language, the higher severity found in children in NEPL households suggests that they are exceptionally vulnerable. Enhanced early screening and identification for these children and supporting their parents in navigating the complex US health care delivery system would increase their participation in early intervention services. Immigration of children with special health care needs from around the world to the US has been increasing from countries with diverse healthcare systems. Our findings will help to inform policies and interventions to reduce health disparities for children with ASD from immigrant populations. As the prevalence of

  4. Equity for open-access journal publishing.

    Directory of Open Access Journals (Sweden)

    Stuart M Shieber

    2009-08-01

    Full Text Available Open-access journals, which provide access to their scholarly articles freely and without limitations, are at a systematic disadvantage relative to traditional closed-access journal publishing and its subscription-based business model. A simple, cost-effective remedy to this inequity could put open-access publishing on a path to become a sustainable, efficient system.

  5. Global income related health inequalities

    Directory of Open Access Journals (Sweden)

    Jalil Safaei

    2007-01-01

    Full Text Available Income related health inequalities have been estimated for various groups of individuals at local, state, or national levels. Almost all of theses estimates are based on individual data from sample surveys. Lack of consistent individual data worldwide has prevented estimates of international income related health inequalities. This paper uses the (population weighted aggregate data available from many countries around the world to estimate worldwide income related health inequalities. Since the intra-country inequalities are subdued by the aggregate nature of the data, the estimates would be those of the inter-country or international health inequalities. As well, the study estimates the contribution of major socioeconomic variables to the overall health inequalities. The findings of the study strongly support the existence of worldwide income related health inequalities that favor the higher income countries. Decompositions of health inequalities identify inequalities in both the level and distribution of income as the main source of health inequality along with inequalities in education and degree of urbanization as other contributing determinants. Since income related health inequalities are preventable, policies to reduce the income gaps between the poor and rich nations could greatly improve the health of hundreds of millions of people and promote global justice. Keywords: global, income, health inequality, socioeconomic determinants of health

  6. The Relationship between Income Inequality and Inequality in Schooling

    Science.gov (United States)

    Mayer, Susan E.

    2010-01-01

    Children of affluent parents get more schooling than children of poor parents, which seems to imply that reducing income inequality would reduce inequality in schooling. Similarly, one of the best predictors of an individual's income is his educational attainment, which seems to imply that reducing inequality in schooling will reduce income…

  7. Social inequalities in "sickness"

    DEFF Research Database (Denmark)

    van der Wel, Kjetil A; Dahl, Espen; Thielen, Karsten

    2012-01-01

    In comparative studies of health inequalities, public health researchers have usually studied only disease and illness. Recent studies have also examined the sickness dimension of health, that is, the extent to which ill health is accompanied by joblessness, and how this association varies...... consistent results. They analyze data from the European Union Statistics on Income and Living Conditions (EU-SILC); health was measured by limiting longstanding illness (LLSI). Results show that for both men and women reporting LLSI in combination with low educational level, the probabilities of non......-employment were particularly high in the Anglo-Saxon and Eastern welfare regimes, and lowest in the Scandinavian regime. For men, absolute and relative social inequalities in sickness were lowest in the Southern regime; for women, inequalities were lowest in the Scandinavian regime. The authors conclude...

  8. Inequality and Corruption

    DEFF Research Database (Denmark)

    Alt, James E.; Lassen, David Dreyer

    High-quality data on state-level inequality and incomes, panel data on corruption convictions, and careful attention to the consequences of including or excluding fixed effects in the panel specification allow us to estimate the impact of income considerations on the decision to undertake corrupt...... acts. Following efficiency wage arguments, for a given institutional environment the corruptible employee's or official's decision to engage in corruption is affected by relative wages and expected tenure in the public sector, the probability of detection, the cost of fines and jail terms......, and the degree of inequality, which indicate diminished prospects facing those convicted of corruption. In US states over 25 years we show that inequality and higher government relative wages significantly and robustly produce less corruption. This reverses other findings of a positive association between...

  9. Spatially Embedded Inequality

    DEFF Research Database (Denmark)

    Holck, Lotte

    2016-01-01

    /methodology/approach: – The (re)production of inequality is explored by linking research on organizational space with HRM diversity management. Data from an ethnographic study undertaken in a Danish municipal center illustrates how a substructure of inequality is spatially upheld alongside a formal diversity policy. Archer...... and ethnification of job categories. However, the same spatial structures allows for a variety of opposition and conciliation strategies among minority employees, even though the latter tend to prevail in a reproduction rather than a transformation of the organizational opportunity structures. Research limitations...... the more subtle, spatially embedded forms of inequality. Originality/value: – Theoretical and empirical connections between research on organizational space and HRM diversity management have thus far not been systematically studied. This combination might advance knowledge on the persistence of micro...

  10. Economic inequality increases risk taking.

    Science.gov (United States)

    Payne, B Keith; Brown-Iannuzzi, Jazmin L; Hannay, Jason W

    2017-05-02

    Rising income inequality is a global trend. Increased income inequality has been associated with higher rates of crime, greater consumer debt, and poorer health outcomes. The mechanisms linking inequality to poor outcomes among individuals are poorly understood. This research tested a behavioral account linking inequality to individual decision making. In three experiments ( n = 811), we found that higher inequality in the outcomes of an economic game led participants to take greater risks to try to achieve higher outcomes. This effect of unequal distributions on risk taking was driven by upward social comparisons. Next, we estimated economic risk taking in daily life using large-scale data from internet searches. Risk taking was higher in states with greater income inequality, an effect driven by inequality at the upper end of the income distribution. Results suggest that inequality may promote poor outcomes, in part, by increasing risky behavior.

  11. Industrialization and inequality revisited

    DEFF Research Database (Denmark)

    Molitoris, Joseph; Dribe, Martin

    2016-01-01

    This work combines economic and demographic data to examine inequality of living standards in Stockholm at the turn of the twentieth century. Using a longitudinal population register with occupational information, we utilize event-history models to show that despite absolute decreases in mortality......, relative differences between socioeconomic groups remained virtually constant. The results also show that child mortality continued to be sensitive to short-term fluctuations in wages and that there were no socioeconomic differences in this response. We argue that the persistent inequality in living...

  12. Ordinal bivariate inequality

    DEFF Research Database (Denmark)

    Sonne-Schmidt, Christoffer Scavenius; Tarp, Finn; Østerdal, Lars Peter Raahave

    This paper introduces a concept of inequality comparisons with ordinal bivariate categorical data. In our model, one population is more unequal than another when they have common arithmetic median outcomes and the first can be obtained from the second by correlationincreasing switches and/or median......-preserving spreads. For the canonical 2x2 case (with two binary indicators), we derive a simple operational procedure for checking ordinal inequality relations in practice. As an illustration, we apply the model to childhood deprivation in Mozambique....

  13. Type Inference with Inequalities

    DEFF Research Database (Denmark)

    Schwartzbach, Michael Ignatieff

    1991-01-01

    of (monotonic) inequalities on the types of variables and expressions. A general result about systems of inequalities over semilattices yields a solvable form. We distinguish between deciding typability (the existence of solutions) and type inference (the computation of a minimal solution). In our case, both......Type inference can be phrased as constraint-solving over types. We consider an implicitly typed language equipped with recursive types, multiple inheritance, 1st order parametric polymorphism, and assignments. Type correctness is expressed as satisfiability of a possibly infinite collection...

  14. Ordinal Bivariate Inequality

    DEFF Research Database (Denmark)

    Sonne-Schmidt, Christoffer Scavenius; Tarp, Finn; Østerdal, Lars Peter Raahave

    2016-01-01

    This paper introduces a concept of inequality comparisons with ordinal bivariate categorical data. In our model, one population is more unequal than another when they have common arithmetic median outcomes and the first can be obtained from the second by correlation-increasing switches and....../or median-preserving spreads. For the canonical 2 × 2 case (with two binary indicators), we derive a simple operational procedure for checking ordinal inequality relations in practice. As an illustration, we apply the model to childhood deprivation in Mozambique....

  15. Schooling, Child Labor, and the Returns to Healthcare in Tanzania

    Science.gov (United States)

    Adhvaryu, Achyuta R.; Nyshadham, Anant

    2012-01-01

    We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal-sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children's allocation of time to school and work.…

  16. Wringing out better Bell inequalities

    International Nuclear Information System (INIS)

    Braunstein, S.L.; Caves, C.M.

    1989-01-01

    Local realism implies constraints on the statistics of two physically separated systems. These constraints, known collectively as Bell inequalities, can be violated by quantum mechanics. We generalize the standard Bell inequalities in two ways: first, by 'chaining' the Clauser-Horne-Shimony-Holt Bell inequality for two-state systems and, second, by formulating information-theoretic Bell inequalities that apply to any pair of systems. (orig.)

  17. Quantum mechanics and Bell's inequalities

    International Nuclear Information System (INIS)

    Jones, R.T.; Adelberger, E.G.

    1994-01-01

    Santos argues that, if one interprets probabilities as ratios of detected events to copies of the physical system initially prepared, the quantum mechanical predictions for the classic tests of Bell's inequalities do not violate the inequalities. Furthermore, he suggests that quantum mechanical states which do violate the inequalities are not physically realizable. We discuss a physically realizable experiment, meeting his requirements, where quantum mechanics does violate the inequalities

  18. Leveraging Digital Innovation in Healthcare

    DEFF Research Database (Denmark)

    Brown, Carol V.; Jensen, Tina Blegind; Aanestad, Margun

    2014-01-01

    Harnessing digital innovations for healthcare delivery has raised high expectations as well as major concerns. Several countries across the globe have made progress in achieving three common goals of lower costs, higher quality, and increased patient access to healthcare services through...... investments in digital infrastructures. New technologies are leveraged to achieve widespread 24x7 disease management, patients’ wellbeing, home-based healthcare and other patient-centric service innovations. Yet, digital innovations in healthcare face barriers in terms of standardization, data privacy...... landscapes in selected countries. Then panelists with expertise in digital data streams, cloud, and mobile computing will present concrete examples of healthcare service innovations that have the potential to address one or more of the global goals. ECIS attendees are invited to join a debate about...

  19. Gender Inequality Index Appropriateness for Measuring Inequality.

    Science.gov (United States)

    Amin, Elham; Sabermahani, Asma

    2017-01-01

    Gender inequality means unequal distribution of wealth, power, and benefits among women and men. The gender inequality index (GII) measures the lost human development in three important dimensions: reproductive health, political empowerment, and economic status. The first purpose of this study was to calculate the index for provinces of Iran, and the second purpose was to survey the appropriateness of that, for comparing different regions, through regression estimations. In this study, GII has been calculated for Iran between the years 2006-2011 and provinces have been ranked based on it. Then, a panel composed of 30 sections was estimated for five years to determine the most important factor affecting level of index. Some changes have been made to analyze values of the index and the ranking of provinces. Based on panel model, share of parliamentary seats was the most effective factor for determination of the index. After applying adjustments, some differences were seen in the ranking of provinces and general level of index. Weighing of dimensions of the index and considering an overall variable, such as life expectancy in the field of health, will give a more accurate comparison of the GII among different regions though concurrent attention to non-discriminatory cultural dimensions of political participation of women; therefore, making more analyses possible for a more correct comparison of the extensive geographical regions, such as countries.

  20. Lorentz-invariant Bell's inequality

    International Nuclear Information System (INIS)

    Kim, Won Tae; Son, Edwin J.

    2005-01-01

    We study Bell's inequality in relation to the Einstein-Podolsky-Rosen paradox in the relativistic regime. For this purpose, a relativistically covariant analysis is used in the calculation of the Bell's inequality, which results in the maximally violated Bell's inequality in any reference frame

  1. Trends in Global Gender Inequality

    Science.gov (United States)

    Dorius, Shawn F.; Firebaugh, Glenn

    2010-01-01

    This study investigates trends in gender inequality throughout the world. Using data encompassing a large majority of the world's population, we examine trends in recent decades for key indicators of gender inequality in education, mortality, political representation and economic activity. We find that gender inequality is declining in virtually…

  2. Isoperimetric inequalities for minimal graphs

    International Nuclear Information System (INIS)

    Pacelli Bessa, G.; Montenegro, J.F.

    2007-09-01

    Based on Markvorsen and Palmer's work on mean time exit and isoperimetric inequalities we establish slightly better isoperimetric inequalities and mean time exit estimates for minimal graphs in N x R. We also prove isoperimetric inequalities for submanifolds of Hadamard spaces with tamed second fundamental form. (author)

  3. The Growth-Inequality Association:

    DEFF Research Database (Denmark)

    Bjørnskov, Christian

    2008-01-01

    This note suggests that the association between income inequality and economic growth rates might arguably depend on the political ideology of incumbent governments. Estimates indicate that under leftwing governments, inequality is negatively associated with growth while the association is positive...... under rightwing governments. This may provide a qualification to recent studies of inequality....

  4. On weighted dyadic Carleson's inequalities

    Directory of Open Access Journals (Sweden)

    Tachizawa K

    2001-01-01

    Full Text Available We give an alternate proof of weighted dyadic Carleson's inequalities which are essentially proved by Sawyer and Wheeden. We use the Bellman function approach of Nazarov and Treil. As an application we give an alternate proof of weighted inequalities for dyadic fractional maximal operators. A result on weighted inequalities for fractional integral operators is given.

  5. Population distribution, settlement patterns and accessibility across Africa in 2010.

    Directory of Open Access Journals (Sweden)

    Catherine Linard

    Full Text Available The spatial distribution of populations and settlements across a country and their interconnectivity and accessibility from urban areas are important for delivering healthcare, distributing resources and economic development. However, existing spatially explicit population data across Africa are generally based on outdated, low resolution input demographic data, and provide insufficient detail to quantify rural settlement patterns and, thus, accurately measure population concentration and accessibility. Here we outline approaches to developing a new high resolution population distribution dataset for Africa and analyse rural accessibility to population centers. Contemporary population count data were combined with detailed satellite-derived settlement extents to map population distributions across Africa at a finer spatial resolution than ever before. Substantial heterogeneity in settlement patterns, population concentration and spatial accessibility to major population centres is exhibited across the continent. In Africa, 90% of the population is concentrated in less than 21% of the land surface and the average per-person travel time to settlements of more than 50,000 inhabitants is around 3.5 hours, with Central and East Africa displaying the longest average travel times. The analyses highlight large inequities in access, the isolation of many rural populations and the challenges that exist between countries and regions in providing access to services. The datasets presented are freely available as part of the AfriPop project, providing an evidence base for guiding strategic decisions.

  6. Who Defines Culturally Acceptable Health Access? Universal rights, healthcare politics and the problems of two Mbya-Guarani communities in the Misiones Province, Argentina

    Directory of Open Access Journals (Sweden)

    A. Sy

    2013-05-01

    Full Text Available This paper seeks to analyze the problems and barriers encountered when public policy health programs are implemented within indigenous communities. The initial stumbling block for such programs is precisely the idea of health as a universal right, around which emerges a characterization and stereotype of the indigenous population who are consequently addressed as a homogenized unit subsisting below the poverty line, and marginalized. A result of this is that the  particular ethno-cultural register of such populations fails to be acknowledged and form part of a systematic public health policy. Consequently, health policies become generalized in character, unable to variate and differentiate according to the culturally specific contexts within which health outreach and access is needed. In this sense, based on the results of an ethnographic study carried out in two Mbya-Guaraní indigenous communities of Argentina, our study highlights as to how public policies of indigenous health are perceived, their impact value measured, and the meanings which emerge locally about the policy practices implemented.Lastly, our study identifies problems that can be avoided in fulfilling the goals of universal policies and certain questions to consider at the time of policy design and implementation.

  7. Democracy and growth in divided societies: A health-inequality trap?

    Science.gov (United States)

    Powell-Jackson, Timothy; Basu, Sanjay; Balabanova, Dina; McKee, Martin; Stuckler, David

    2011-07-01

    Despite a tremendous increase in financial resources, many countries are not on track to achieve the child and maternal mortality targets set out in the Millennium Development Goals 4 and 5. It is commonly argued that two main social factors - improved democratic governance and aggregate income - will ultimately lead to progress in reducing child and maternal mortality. However, these two factors alone may be insufficient to achieve progress in settings where there is a high level of social division. To test the effects of growth and democratisation, and their interaction with social inequalities, we regressed data on child and maternal mortality rates for 192 countries against internationally used indexes of income, democracy, and population inequality (including income, ethnic, linguistic, and religious divisions) covering the period 1970-2007. We found that a higher degree of social division, especially ethnic and linguistic fractionalisation, was significantly associated with greater child and maternal mortality rates. We further found that, even in democratic states, greater social division was associated with lower overall population access to healthcare and lesser expansion of health system infrastructure. Perversely, while greater democratisation and aggregate income were associated with reduced maternal and child mortality overall, in regions with high levels of ethnic fragmentation the health benefits of democratisation and rising income were undermined and, at high levels of inequality reversed, so that democracy and growth were adversely related to child and maternal mortality. These findings are consistent with literature suggesting that high degrees of social division in the context of democratisation can strengthen the power of dominant elite and ethnic groups in political decision-making, resulting in health and welfare policies that deprive minority groups (a health-inequality trap). Thus, we show that improving economic growth and democratic

  8. PUBLIC FINANCING OF HEALTHCARE SERVICES

    Directory of Open Access Journals (Sweden)

    Agnieszka Bem

    2013-10-01

    Full Text Available Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ, state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions.

  9. Better reproductive healthcare for women with disabilities: a role for nursing leadership.

    Science.gov (United States)

    Phillips, Lorraine J; Phillips, Win

    2006-01-01

    This paper examines the reproductive healthcare experiences of women with disabilities in the light of commonly accepted principles of biomedical ethics. Recommendations are made for nursing to assume a leadership role in reducing gender and disability inequity in health care.

  10. Inequality in health versus inequality in lifestyle choices

    Directory of Open Access Journals (Sweden)

    Arnstein Øvrum

    2015-10-01

    Full Text Available Repeated Norwegian cross-sectional data for the period 2005 to 2011 are used to compare sources of inequality in health, as represented by self-assessed health and obesity, with sources of inequality in lifestyles that are central to the production of health, as represented by physical activity, cigarette smoking and dietary behavior. Sources of overall inequality and socioeconomic inequality in these lifestyle and health indicators are compared by estimating probit models, and by decomposing the explained part of the associated Gini and concentration indices with respect to education and income. As potential sources of inequality, we consider education, income, occupation, age, gender, marital status, psychological traits and childhood circumstances. Our results suggest that sources of inequality in health are not necessarily representative of sources of inequality in underlying lifestyles. While education is generally an important source of overall inequality in both lifestyles and health, income is unimportant in all lifestyle indicators except physical activity. In several cases, education and income are clearly outranked by other factors in terms of explaining overall inequality, such as gender in eating fruits and vegetables and age in fish consumption. These results suggest that it is important to decompose both overall inequality and socioeconomic inequality in different lifestyle and health indicators. In indicators where other factors than education and income are clearly most important, policy makers should consider to target these factors to efficiently improve overall population health.

  11. Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers.

    Science.gov (United States)

    Yu, Catherine H; Bahniwal, Robinder; Laupacis, Andreas; Leung, Eman; Orr, Michael S; Straus, Sharon E

    2012-01-01

    To identify and evaluate the effectiveness, clinical usefulness, sustainability, and usability of web-compatible diabetes-related tools. Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, world wide web. Studies were included if they described an electronic audiovisual tool used as a means to educate patients, care givers, or clinicians about diabetes management and assessed a psychological, behavioral, or clinical outcome. Study abstraction and evaluation for clinical usefulness, sustainability, and usability were performed by two independent reviewers. Of 12,616 citations and 1541 full-text articles reviewed, 57 studies met inclusion criteria. Forty studies used experimental designs (25 randomized controlled trials, one controlled clinical trial, 14 before-after studies), and 17 used observational designs. Methodological quality and ratings for clinical usefulness and sustainability were variable, and there was a high prevalence of usability errors. Tools showed moderate but inconsistent effects on a variety of psychological and clinical outcomes including HbA1c and weight. Meta-regression of adequately reported studies (12 studies, 2731 participants) demonstrated that, although the interventions studied resulted in positive outcomes, this was not moderated by clinical usefulness nor usability. This review is limited by the number of accessible tools, exclusion of tools for mobile devices, study quality, and the use of non-validated scales. Few tools were identified that met our criteria for effectiveness, usefulness, sustainability, and usability. Priority areas include identifying strategies to minimize website attrition and enabling patients and clinicians to make informed decisions about website choice by encouraging reporting of website quality indicators.

  12. Inequality in Health

    DEFF Research Database (Denmark)

    Dybbroe, Betina; Kappel, Nanna

    The overall purpose of the research we want to present, is to discuss how social inequality in health can both be maintained and strengthened- and changed through the health system and health efforts. Our contribution provides a view of a special point of intersection in which the health system...

  13. Higher Education and Inequality

    Science.gov (United States)

    Brown, Roger

    2018-01-01

    After climate change, rising economic inequality is the greatest challenge facing the advanced Western societies. Higher education has traditionally been seen as a means to greater equality through its role in promoting social mobility. But with increased marketisation higher education now not only reflects the forces making for greater inequality…

  14. Gender Inequality since 1820

    NARCIS (Netherlands)

    Carmichael, Sarah; Dilli, Selin; Rijpma, Auke

    2014-01-01

    Historically, gender inequalities in health status, socio-economic standing and political rights have been large. This chapter documents gender differences in life expectancy and birth rates (to cover health status); in average years of schooling, labour force participation, inheritance rights and

  15. Inequity aversion revisted

    NARCIS (Netherlands)

    Yang, Y.; Onderstal, S.; Schram, A.

    2012-01-01

    We provide the first systematic study of the robustness of parameter estimates for the Fehr-Schmidt (1999) model of inequity aversion with respect to (i) the occurrence of efficiency concerns; (ii) the scale of payoffs; and (iii) the game used (i.e., cross-game consistency). Moreover, we provide

  16. Roots of inequity

    DEFF Research Database (Denmark)

    Chomba, Susan Wangui; Kariuki, Juliet; Lund, Jens Friis

    2016-01-01

    policy of the project maps onto the existing unequal land distribution, it reinforces inequality. By illustrating how current, well-intended, REDD+ efforts inadvertently come to entrench a long process of dispossession of marginalized people, we call attention to the pivotal importance that historical...

  17. Gender Inequality at Work.

    Science.gov (United States)

    Jacobs, Jerry A., Ed.

    These 14 papers address many dimensions of gender inequality at work. The empirical studies include examinations of original surveys, secondary analyses of large data sets, and historical reports assaying the significance of personal, family, and structural factors with regard to gender in the workplace. An introduction (Jacobs) sketches how sex…

  18. Inequality and Happiness

    DEFF Research Database (Denmark)

    Bjørnskov, Christian; Dreher, Axel; Fischer, Justina A.V.

    2013-01-01

    We argue that perceived fairness of the income generation process affects the association between income inequality and subjective well-being, and that there are systematic differences in this regard between countries that are characterized by a high or, respectively, low level of actual fairness...

  19. Analysis of income inequalities

    Czech Academy of Sciences Publication Activity Database

    Federičová, Miroslava

    2011-01-01

    Roč. 9, 7-8 (2011), s. 13-15 ISSN 1214-1720 R&D Projects: GA ČR GA403/08/0109 Institutional research plan: CEZ:AV0Z70280505 Keywords : inequalities * Europe * labour market Subject RIV: AO - Sociology, Demography http://www.socioweb.cz/index.php?disp=teorie&shw=478&lst=117

  20. Access to health care as a human right in international policy: critical reflections and contemporary challenges.

    Science.gov (United States)

    Castillo, Camilo Hernán Manchola; Garrafa, Volnei; Cunha, Thiago; Hellmann, Fernando

    2017-07-01

    Using the United Nations (UN) and its subordinate body, the World Health Organization (WHO), as a frame of reference, this article explores access to healthcare as a human right in international intergovernmental policies. First, we look at how the theme of health is treated within the UN, focusing on the concept of global health. We then discuss the concept of global health from a human rights perspective and go on to outline the debate surrounding universal coverage versus universal access as a human right, addressing some important ethical questions. Thereafter, we discuss universal coverage versus universal access using the critical and constructivist theories of international relations as a frame of reference. Finally, it is concluded that, faced with the persistence of huge global health inequalities, the WHO began to reshape itself, leaving behind the notion of health as a human right and imposing the challenge of reducing the wide gap that separates international intergovernmental laws from reality.

  1. The value of education in special care dentistry as a means of reducing inequalities in oral health.

    LENUS (Irish Health Repository)

    Faulks, D

    2012-11-01

    People with disability are subject to inequality in oral health both in terms of prevalence of disease and unmet healthcare needs. Over 18% of the global population is living with moderate to severe functional problems related to disability, and a large proportion of these persons will require Special Care Dentistry at some point in their lifetime. It is estimated that 90% of people requiring Special Care Dentistry should be able to access treatment in a local, primary care setting. Provision of such primary care is only possible through the education and training of dentists. The literature suggests that it is vital for the dental team to develop the necessary skills and gain experience treating people with special needs in order to ensure access to the provision of oral health care. Education in Special Care Dentistry worldwide might be improved by the development of a recognised academic and clinical discipline and by providing international curricula guidelines based on the International Classification of Functioning, Disability and Health (ICF, WHO). This article aims to discuss the role and value of promoting and harmonising education in Special Care Dentistry as a means of reducing inequalities in oral health.

  2. The intersection of disability and healthcare disparities: a conceptual framework.

    Science.gov (United States)

    Meade, Michelle A; Mahmoudi, Elham; Lee, Shoou-Yih

    2015-01-01

    This article provides a conceptual framework for understanding healthcare disparities experienced by individuals with disabilities. While health disparities are the result of factors deeply rooted in culture, life style, socioeconomic status, and accessibility of resources, healthcare disparities are a subset of health disparities that reflect differences in access to and quality of healthcare and can be viewed as the inability of the healthcare system to adequately address the needs of specific population groups. This article uses a narrative method to identify and critique the main conceptual frameworks that have been used in analyzing disparities in healthcare access and quality, and evaluating those frameworks in the context of healthcare for individuals with disabilities. Specific models that are examined include the Aday and Anderson Model, the Grossman Utility Model, the Institute of Medicine (IOM)'s models of Access to Healthcare Services and Healthcare Disparities, and the Cultural Competency model. While existing frameworks advance understandings of disparities in healthcare access and quality, they fall short when applied to individuals with disabilities. Specific deficits include a lack of attention to cultural and contextual factors (Aday and Andersen framework), unrealistic assumptions regarding equal access to resources (Grossman's utility model), lack of recognition or inclusion of concepts of structural accessibility (IOM model of Healthcare Disparities) and exclusive emphasis on supply side of the healthcare equation to improve healthcare disparities (Cultural Competency model). In response to identified gaps in the literature and short-comings of current conceptualizations, an integrated model of disability and healthcare disparities is put forth. We analyzed models of access to care and disparities in healthcare to be able to have an integrated and cohesive conceptual framework that could potentially address issues related to access to

  3. Spatial Distribution and Accessibility of Health Facilities in Akwa ...

    African Journals Online (AJOL)

    This paper therefore analyzed the spatial patterns of healthcare facilities in Akwa ... Data on six health indicator variables were obtained and analyzed to assess ... of healthcare facilities and thus hinders good access to high quality healthcare ...

  4. Looking for symmetric Bell inequalities

    International Nuclear Information System (INIS)

    Bancal, Jean-Daniel; Gisin, Nicolas; Pironio, Stefano

    2010-01-01

    Finding all Bell inequalities for a given number of parties, measurement settings and measurement outcomes is in general a computationally hard task. We show that all Bell inequalities which are symmetric under the exchange of parties can be found by examining a symmetrized polytope which is simpler than the full Bell polytope. As an illustration of our method, we generate 238 885 new Bell inequalities and 1085 new Svetlichny inequalities. We find, in particular, facet inequalities for Bell experiments involving two parties and two measurement settings that are not of the Collins-Gisin-Linden-Massar-Popescu type.

  5. Looking for symmetric Bell inequalities

    Energy Technology Data Exchange (ETDEWEB)

    Bancal, Jean-Daniel; Gisin, Nicolas [Group of Applied Physics, University of Geneva, 20 rue de l' Ecole-de Medecine, CH-1211 Geneva 4 (Switzerland); Pironio, Stefano, E-mail: jean-daniel.bancal@unige.c [Laboratoire d' Information Quantique, Universite Libre de Bruxelles (Belgium)

    2010-09-24

    Finding all Bell inequalities for a given number of parties, measurement settings and measurement outcomes is in general a computationally hard task. We show that all Bell inequalities which are symmetric under the exchange of parties can be found by examining a symmetrized polytope which is simpler than the full Bell polytope. As an illustration of our method, we generate 238 885 new Bell inequalities and 1085 new Svetlichny inequalities. We find, in particular, facet inequalities for Bell experiments involving two parties and two measurement settings that are not of the Collins-Gisin-Linden-Massar-Popescu type.

  6. Health inequality - determinants and policies

    DEFF Research Database (Denmark)

    Diderichsen, Finn; Andersen, Ingelise; Manual, Celie

    2012-01-01

    The review ”Health inequality – determinants and policies” identifies key-areas to be addressed with the aim to reduce the social inequality in health. The general life expectancy has steadily been increasing, but the data reveals marked social inequalities in health as well as life expectancy....... The review seeks to identify the causes of this social inequality. The analysis finds 12 areas of great importance for the inequality in health. This is i.e. early child development, schooling and education, the health behavior of the population, and the role of the health system. Within each of the 12 areas...

  7. Healthcare Lean.

    Science.gov (United States)

    Long, John C

    2003-01-01

    Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

  8. Social inequality in health, responsibility and egalitarian justice

    DEFF Research Database (Denmark)

    Andersen, Martin Marchman; Dalton, Susanne Oksbjerg; Johansen, Christoffer

    2013-01-01

    Are social inequalities in health unjust when brought about by differences in lifestyle? A widespread idea, luck egalitarianism, is that inequality stemming from individuals’ free choices is not to be considered unjust, since individuals, presumably, are themselves responsible for such choices....... Thus, to the extent that lifestyles are in fact results of free choices, social inequality in health brought about by these choices is not in tension with egalitarian justice. If this is so, then it may put in question the justification of free and equal access to health care and existing medical...... not fully establish - that at the most fundamental level people are never responsible in such a way that appeals to individuals’ own responsibility can justify inequalities in health....

  9. Tobacco Control Measures to Reduce Socioeconomic Inequality in Smoking: The Necessity, Time-Course Perspective, and Future Implications.

    Science.gov (United States)

    Tabuchi, Takahiro; Iso, Hiroyasu; Brunner, Eric

    2018-04-05

    Previous systematic reviews of population-level tobacco control interventions and their effects on smoking inequality by socioeconomic factors concluded that tobacco taxation reduce smoking inequality by income (although this is not consistent for other socioeconomic factors, such as education). Inconsistent results have been reported for socioeconomic differences, especially for other tobacco control measures, such as smoke-free policies and anti-tobacco media campaigns. To understand smoking inequality itself and to develop strategies to reduce smoking inequality, knowledge of the underlying principles or mechanisms of the inequality over a long time-course may be important. For example, the inverse equity hypothesis recognizes that inequality may evolve in stages. New population-based interventions are initially primarily accessed by the affluent and well-educated, so there is an initial increase in socioeconomic inequality (early stage). These inequalities narrow when the deprived population can access the intervention after the affluent have gained maximum benefit (late stage). Following this hypothesis, all tobacco control measures may have the potential to reduce smoking inequality, if they continue for a long term, covering and reaching all socioeconomic subgroups. Re-evaluation of the impact of the interventions on smoking inequality using a long time-course perspective may lead to a favorable next step in equity effectiveness. Tackling socioeconomic inequality in smoking may be a key public health target for the reduction of inequality in health.

  10. Socioeconomic inequalities in very preterm birth rates.

    Science.gov (United States)

    Smith, L K; Draper, E S; Manktelow, B N; Dorling, J S; Field, D J

    2007-01-01

    To investigate the extent of socioeconomic inequalities in the incidence of very preterm birth over the past decade. Ecological study of all 549 618 births in the former Trent health region, UK, from 1 January 1994 to 31 December 2003. All singleton births of 22(+0) to 32(+6) weeks gestation (7 185 births) were identified from population surveys of neonatal services and stillbirths. Poisson regression was used to calculate incidence of very preterm birth (22-32 weeks) and extremely preterm birth (22-28 weeks) by year of birth and decile of deprivation (child poverty section of the Index of Multiple Deprivation). Incidence of very preterm singleton birth rose from 11.9 per 1000 births in 1994 to 13.7 per 1000 births in 2003. Those from the most deprived decile were at nearly twice the risk of very preterm birth compared with those from the least deprived decile, with 16.4 per 1000 births in the most deprived decile compared with 8.5 per 1000 births in the least deprived decile (incidence rate ratio 1.94; 95% CI (1.73 to 2.17)). This deprivation gap remained unchanged throughout the 10-year period. The magnitude of socio-economic inequalities was the same for extremely preterm births (22-28 weeks incidence rate ratio 1.94; 95% CI (1.62 to 2.32)). This large, unique dataset of very preterm births shows wide socio-economic inequalities that persist over time. These findings are likely to have consequences on the burden of long-term morbidity. Our research can assist future healthcare planning, the monitoring of socio-economic inequalities and the targeting of interventions in order to reduce this persistent deprivation gap.

  11. Disparities in Healthcare for Racial, Ethnic, and Sexual Minorities

    Science.gov (United States)

    Collins, Joshua C.; Rocco, Tonette S.

    2014-01-01

    This chapter situates healthcare as a concern for the field of adult education through a critique of disparities in access to healthcare, quality of care received, and caregiver services for racial, ethnic, and sexual minorities.

  12. Globalization, Inequality & International Economic Law

    Directory of Open Access Journals (Sweden)

    Frank J. Garcia

    2017-04-01

    Full Text Available International law in general, and international economic law in particular, to the extent that either has focused on the issue of inequality, has done so in terms of inequality between states. Largely overlooked has been the topic of inequality within states and how international law has influenced that reality. From the perspective of international economic law, the inequality issue is closely entwined with the topics of colonialism and post-colonialism, the proper meaning of development, and globalization. While international economic law has undoubtedly contributed to the rise of inequality, it is now vital that the subject of international economic law be examined for how it may contribute to the lessening of inequality. To do so will require a shift in the way that we think, in order to address inequality as a problem of an emerging global market society, and how best to regulate that society and its institutions.

  13. Accessibility, affordability and use of health services in an urban area in South Africa

    Directory of Open Access Journals (Sweden)

    Ethelwynn L. Stellenberg

    2015-03-01

    Full Text Available Background: Inequalities in healthcare between population groups of South Africa existed during the apartheid era and continue to exist both between and within many population groups. Accessibility and affordability of healthcare is a human right. Objectives: The aim of the study was to explore and describe accessibility, affordability and the use of health services by the mixed race (coloured population in the Western Cape, South Africa. Method: A cross-sectional descriptive, non-experimental study with a quantitative approach was applied. A purposive convenient sample of 353 participants (0.6% was drawn from a population of 63 004 economically-active people who lived in the residential areas as defined for the purpose of the study. All social classes were represented. The hypothesis set was that there is a positive relationship between accessibility, affordability and the use of health services. A pilot study was conducted which also supported the reliability and validity of the study. Ethics approval was obtained from the University of Stellenbosch and informed consent from respondents. A questionnaire was used to collect the data. Results: The hypothesis was accepted. The statistical association between affordability (p = < 0.01, accessibility (p = < 0.01 and the use of health services was found to be significant using the Chi-square (χ² test. Conclusion: The study has shown how affordability and accessibility may influence the use of healthcare services. Accessibility is not only the distance an individual must travel to reach the health service point but more so the utilisation of these services. Continuous Quality Management should be a priority in healthcare services, which should be user-friendly.

  14. Accessibility, affordability and use of health services in an urban area in South Africa.

    Science.gov (United States)

    Stellenberg, Ethelwynn L

    2015-03-10

    Inequalities in healthcare between population groups of South Africa existed during the apartheid era and continue to exist both between and within many population groups. Accessibility and affordability of healthcare is a human right. The aim of the study was to explore and describe accessibility, affordability and the use of health services by the mixed race (coloured) population in the Western Cape, South Africa. A cross-sectional descriptive, non-experimental study with a quantitative approach was applied. A purposive convenient sample of 353 participants (0.6%) was drawn from a population of 63 004 economically-active people who lived in the residential areas as defined for the purpose of the study. All social classes were represented. The hypothesis set was that there is a positive relationship between accessibility, affordability and the use of health services. A pilot study was conducted which also supported the reliability and validity of the study. Ethics approval was obtained from the University of Stellenbosch and informed consent from respondents. A questionnaire was used to collect the data. The hypothesis was accepted. The statistical association between affordability (p = < 0.01), accessibility (p = < 0.01) and the use of health services was found to be significant using the Chi-square (χ²) test. The study has shown how affordability and accessibility may influence the use of healthcare services. Accessibility is not only the distance an individual must travel to reach the health service point but more so the utilisation of these services. Continuous Quality Management should be a priority in healthcare services, which should be user-friendly.

  15. Orthopedic surgeons’ and neurologists’ attitudes towards second opinions in the Israeli healthcare system: a qualitative study

    Directory of Open Access Journals (Sweden)

    Greenfield Geva

    2012-07-01

    Full Text Available Abstract Background Second opinion is a treatment ratification tool that may critically influence diagnosis, treatment, and prognosis. Second opinions constitute one of the largest expenditures of the supplementary health insurance programs provided by the Israeli health funds. The scarcity of data on physicians’ attitudes toward second opinion motivated this study to explore those attitudes within the Israeli healthcare system. Methods We interviewed 35 orthopedic surgeons and neurologists in Israel and qualitatively analyzed the data using the Grounded Theory approach. Results As a common tool, second opinion reflects the broader context of the Israeli healthcare system, specifically tensions associated with health inequalities. We identified four issues: (1 inequalities between central and peripheral regions of Israel; (2 inequalities between private and public settings; (3 implementation gap between the right to a second opinion and whether it is covered by the National Health Insurance Law; and (4 tension between the authorities of physicians and religious leaders. The physicians mentioned that better mechanisms should be implemented for guiding patients to an appropriate consultant for a second opinion and for making an informed choice between the two opinions. Conclusions While all the physicians agreed on the importance of the second opinion as a tool, they raised concerns about the way it is provided and utilized. To be optimally implemented, second opinion should be institutionalized and regulated. The National Health Insurance Law should strive to provide the mechanisms to access second opinion as stipulated in the Patient’s Rights Law. Further studies are needed to assess the patients' perspectives.

  16. Poor access to basic services | IDRC - International Development ...

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

    2015-10-28

    Oct 28, 2015 ... Poor access to basic services can foster competition and fuel conflict between groups. ... Make clean water, sanitation, electricity, and other services accessible ... Poverty, inequality, and violence in urban India: Towards more ...

  17. [The system of informal caregiving as inequality].

    Science.gov (United States)

    García-Calvente, María del Mar; Mateo-Rodríguez, Inmaculada; Eguiguren, Ana P

    2004-05-01

    In our setting, it is families, not the health and social services, who play the greatest role in providing continuous care to persons in need of such services. Informal health care poses two key questions with regard to the issue of equity: differences in the burdens borne by men and women, which contribute to gender inequality and, depending on their educational and socio-economic level, inequities in their ability to choose and gain access to needed resources and support services, thus contributing to social class inequalities. Distributing the burden of caregiving between men and women, and between the family and the state, constitutes a crucial debate in public health. This study analyzes the concept and characteristics of informal care, provides data on its dimensions in our setting, and analyzes the profile of caregivers, as well as the work they do and the impact it has on their lives. Finally, it presents currently existing models and support strategies for informal caregivers. It is largely women who assume the principal role of providing informal care, undertaking the most difficult and demanding tasks and dedicating the largest share of their time to them. As a result, women bear an elevated cost in their lives in terms of health, quality of life, access to employment and professional development, social relations, availability of time for themselves, and economic repercussions. Unemployed, under-educated women from the least privileged social classes constitute the largest group of informal caregivers in our country. Any policies aimed at supporting those who provide such care should keep in mind the unequal point from which they start and be evaluated in terms of their impact on gender and social class inequality.

  18. Implanting inequality: empirical evidence of social and ethical risks of implantable radio-frequency identification (RFID) devices.

    Science.gov (United States)

    Monahan, Torin; Fisher, Jill A

    2010-10-01

    The aim of this study was to assess empirically the social and ethical risks associated with implantable radio-frequency identification (RFID) devices. Qualitative research included observational studies in twenty-three U.S. hospitals that have implemented new patient identification systems and eighty semi-structured interviews about the social and ethical implications of new patient identification systems, including RFID implants. The study identified three primary social and ethical risks associated with RFID implants: (i) unfair prioritization of patients based on their participation in the system, (ii) diminished trust of patients by care providers, and (iii) endangerment of patients who misunderstand the capabilities of the systems. RFID implants may aggravate inequalities in access to care without any clear health benefits. This research underscores the importance of critically evaluating new healthcare technologies from the perspective of both normative ethics and empirical ethics.

  19. '1Care' and the Politics of Healthcare in Malaysia

    OpenAIRE

    Por Heong Hong

    2014-01-01

    In this article, we assess the current state of healthcare financing and the contestation surrounding it in Malaysia. The stakes are high because the system of healthcare financing in a country influences to a large extent issues of healthcare accessibility, equity and universal coverage. The taxation-based public healthcare system is a primary welfare source for the people of this country. Nevertheless, privatization of the healthcare sector, expansion of private hospitals, and increase in u...

  20. Inequalities in health

    DEFF Research Database (Denmark)

    Blank, N; Diderichsen, Finn

    1996-01-01

    would have been expected on the assumption of additivity of the singular effects of these variables. It is suggested that it is necessary to highlight in further research the complex interactions and pathways between factors associated with health outcomes to improve our understanding of the causal...... of the study is to analyse the interaction between socio-economic and personal circumstances in explaining inequalities in health. It is based on a theoretical framework which presupposes that inequalities in health are likely to be explained by a complicated process involving a multitude of factors....... At the same time, differential exposures and differential responses to risk factors between socio-economic classes for certain health outcomes are determined. The joint effect on general health status, seven years later, of being a manual worker and having reported psychosomatic symptoms is 113% greater than...