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Health care inequality

Yongjian Xu, Jie Ma, Na Wu, Xiaojing Fan, Tao Zhang, Zhongliang Zhou, Jianmin Gao, Jianping Ren, Gang Chen
INTRODUCTION: In 2009, China officially launched the New Health Care Reform (NHCR). One important purpose of the reform was to reduce financial burden of health care through health insurance expansion and health care provider regulations. This study aimed to provide evidence on the effect of the NHCR reform on catastrophic health expenditure (CHE) by comparing the occurrence and inequality of CHE among households with chronic diseases patients before and after the reform. METHODS: This study used the subset of data from the 2008 and 2013 National Health Services Survey conducted in Shaanxi Province...
2018: PloS One
Ignacio Aznar-Lou, Anton Pottegård, Ana Fernández, María Teresa Peñarrubia-María, Antoni Serrano-Blanco, Ramón Sabés-Figuera, Montserrat Gil-Girbau, Marta Fajó-Pascual, Patricia Moreno-Peral, Maria Rubio-Valera
OBJECTIVE: Copayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level. DESIGN: A population-based study was conducted using real-world evidence. SETTING: Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013...
March 15, 2018: BMJ Quality & Safety
Louis M Katz, John J Donnelly, Christopher J Gresens, Jerry A Holmberg, James MacPherson, Peter J K Zacharias, Jean Stanley, Christine Bales
On March 24, 2017, more than 90 experts in blood safety and international development from blood centers, industry, government, and international and nongovernmental organizations gathered in Arlington, Virginia, for the Third International Blood Safety Forum, cosponsored by America's Blood Centers and Global Healing. This report summarizes presentations and major conclusions. The meeting explored ways to increase access to affordable, safe blood for low- and lower-middle-income countries (LMICs) in an era when funding from the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund has been redirected from preventing the spread of human immunodeficiency virus (HIV) to diagnosing and treating the 25 million-plus people living with HIV in LMICs...
March 14, 2018: Transfusion
Ricardo Araya, Pedro Zitko, Niina Markkula
Universal health care programmes have the potential to reduce treatment gaps. We explored the potential impact of an equity-oriented universal health care programme on access to care for depression, hypertension and diabetes using data from two nationally representative health surveys in Chile. The likelihood a depressed individual had accessed health care appears to have increased significantly after the programme was introduced whereas those for hypertension and diabetes remained unchanged. Depressed women seem to have benefited mostly from the programme...
March 14, 2018: Administration and Policy in Mental Health
Natasha Slater, Simon White, Rebecca Venables, Martin Frisher
OBJECTIVES: While older age and ill health are known to be associated with polypharmacy, this paper aims to identify whether wealth, body mass index (BMI), smoking and alcohol consumption are also associated with polypharmacy (5-9 prescribed medications) and hyperpolypharmacy prevalence (≥10 prescribed medications), among older people living in England. DESIGN: Cross-sectional study. SETTING: The English Longitudinal Study of Ageing Wave 6 (2012-2013)...
March 14, 2018: BMJ Open
Natalie Colaneri, Mark Sheldon, Andrew Adesman
PURPOSE OF REVIEW: Given the pervasiveness of psychotropic medication in the youth population and an increasingly competitive culture regarding educational performance, children, teenagers, and/or their parents may increasingly seek psychotropic substances in an effort to enhance a student's cognitive abilities and/or academic performance. Physicians must become aware of this very important and clinically relevant issue and work to ensure that medications remain in the hands of patients seeking wellness and not enhancement...
March 13, 2018: Current Opinion in Pediatrics
Ebony Rempel, Lorie Donelle, Jodi Hall, Susan Rodger
Violence against women (VAW) is a global social issue affecting health, social, and legal systems. VAW contributes to the inequities with respect to the social determinants of health that many women face today. The onus on self-care in the face of violence remains almost singularly with the victims. Access to information and services in support of women's health and safety is fundamental. However, research gaps exist regarding how women access health information across all stages of an abusive intimate relationship...
March 14, 2018: Informatics for Health & Social Care
Brian Park, Anastasia J Coutinho, Noemi Doohan, Jonathan Jimenez, Sara Martin, Max Romano, Diana Wohler, Jennifer DeVoe
The second Starfield Summit was held in Portland, Oregon, in April 2017. The Summit addressed the role of primary care in advancing health equity by focusing on 4 key domains: social determinants of health in primary care, vulnerable populations, economics and policy, and social accountability. Invited participants represented an interdisciplinary group of primary care clinicians, researchers, educators, policymakers, community leaders, and trainees. The Pisacano Leadership Foundation was one of the Summit sponsors and held its annual leadership symposium in conjunction with the Summit, enabling several Pisacano Scholars to attend the Summit...
March 2018: Journal of the American Board of Family Medicine: JABFM
Laura Coll-Planas, Sergi Blancafort, Xavier Rojano, Marta Roqué, Rosa Monteserín
BACKGROUND: Older people living in socio-economic deprived urban areas especially suffer the effects of health inequalities but have been insufficiently targeted. Strategies promoted by local primary health care agents might influence health and social behaviours as intermediate social determinants that are modifiable and thus can potentially mitigate health inequalities. Therefore, we aim to develop and assess the effectiveness of a complex intervention based on a community programme that promotes self-management, health literacy and social capital targeting older people from urban socioeconomically disadvantaged areas in order to improve their self-perceived health as an indicator of health inequality reduction...
March 13, 2018: BMC Public Health
Karina Araujo Pinto, Rosane Harter Griep, Lucia Rotenberg, Maria da Conceição Chagas Almeida, Rosane Sousa Barreto, Estela M L Aquino
Perceived time constraints have been highlighted in sociological studies as representing a core issue in determining quality of life. The objective of this study was to test the hypothesis that gender inequalities regarding insufficiency of time play a role in the development of overweight and obesity in adults. The study used baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), which monitors a cohort of 15,105 civil servants of 35 to 74 years of age. Insufficient time for personal care and leisure due to professional and domestic duties, as detailed in a structured questionnaire, comprised the main exposure variable...
2018: PloS One
Easter Joury, Eduardo Bernabe, Jennifer E Gallagher, Wagner Marcenes
Little is known about the burden and impact of orofacial pain in deprived areas, and whether it mediates the relationship between socio-economic position (SEP) and impacts on daily life. We analysed data from a representative sample of 2,168 adults, aged 16-65 years, from the East London Oral Health Inequality study. Participants completed a validated questionnaire on demographics, SEP (area deprivation), orofacial pain (by anatomical site) in the past month and impacts related to oral conditions on daily life...
March 12, 2018: Pain
Stewart W Mercer, Yuefang Zhou, Gerry M Humphris, Alex McConnachie, Andisheh Bakhshi, Annemieke Bikker, Maria Higgins, Paul Little, Bridie Fitzpatrick, Graham C M Watt
PURPOSE: The influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation. METHODS: We conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland...
March 2018: Annals of Family Medicine
Sekar Ayu Paramita, Chiho Yamazaki, Elsa Pudji Setiawati, Hiroshi Koyama
Indonesia has been decentralized since 2001, and we evaluated the distribution trends of physicians, puskesmas (community health centers), hospitals, and hospital beds in 34 provinces in Indonesia for 2000 to 2014. Inequality index of Gini showed improvement of the distribution of physicians and decreased from 0.38 to 0.29. The indices in distributions of hospitals and hospital beds also decreased from 0.26 to 0.17 and from 0.25 to 0.18, respectively. However, the index in the distribution of puskesmas increased from 0...
March 11, 2018: International Journal of Health Planning and Management
Rebecca Burch, Paul Rizzoli, Elizabeth Loder
BACKGROUND AND OBJECTIVES: In this targeted systematic review, we aimed to identify up-to-date prevalence estimates of migraine and severe headache in adults from population-based US government surveys. Our goal was to assess the stability of prevalence estimates over time, and to identify additional information pertinent to the burden and treatment of migraine and other severe headache conditions. METHODS: We searched for the most current publicly available summary statistics from the National Health Interview Survey (NHIS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the National Ambulatory Medical Care Survey (NAMCS)...
March 12, 2018: Headache
Nele van der Wielen, Andrew Amos Channon, Jane Falkingham
Introduction: This paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare...
2018: BMJ Global Health
Ricardo Araya, Pedro Zitko, Niina Markkula, Dheeraj Rai, Kelvyn Jones
BACKGROUND: The relative importance of individual and country-level factors influencing access to diagnosis and treatment for depression across the world is fairly unknown. METHODS: We analysed cross-national data from the WHO World Health Surveys. Depression diagnosis and access to health care were ascertained using a structured interview. Logistic Bayesian Multilevel analyses were performed to establish individual and country level factors associated with: (1) receiving a diagnosis and (2) accessing treatment for depression if a diagnosis was ascertained...
February 27, 2018: Journal of Affective Disorders
Geetanjali D Datta, Alexandra Blair, Marie-Pierre Sylvestre, Lise Gauvin, Mylene Drouin, Marie-Helene Mayrand
In Canada, over 40% of invasive cervical cancers occur among women who have never been screened. Although 12% of Canadian women have never been screened, this number can be as high as 43% among certain social groups. Little is published on factors associated with screening uptake and inequalities among women residing in Quebec. Four waves of the Canadian Community Health Survey (2003, 2005, 2008, 2012, N = 6393) were utilized to assess lifetime screening and screening in the previous 3 years among women residing in Montreal...
March 7, 2018: Preventive Medicine
Marek Gróf, Tatiana Vagašová, Marián Oltman, Ľubomír Skladaný, Lenka Maličká
AIM: The economy of each state provides a significant amount of money into the health care system with the aim of knowing the health status of its population in the context of socioeconomic characteristics for effective resource allocation. In recent years, there is a growing number of cancer deaths in Slovakia. Therefore, the structure of cancer deaths according to its primary determinants, such as age, sex and education with the aim of effective implementation of prevention programs in Slovakia was examined...
December 2017: Central European Journal of Public Health
Nada El Osta, Lana El Osta, Lydia Rabbaa Khabbaz, Robert Saad, Carole Abi-Ghosn, Martine Hennequin, Stephanie Tubert-Jeannin, Jihad Fakhouri
BACKGROUND AND OBJECTIVE: The percentage of Lebanese older people has increased considerably. Given that Lebanese seniors are marginalized in the health policy-making process, we suggest a high social inequality in oral health that has not been studied so far. The purpose of our study was to describe and compare oral health status in a group of Lebanese older people according to their socioeconomic status (SES) MATERIALS AND METHODS: Participants were recruited from three different primary health care clinics in Beirut, Lebanon...
March 8, 2018: Aging Clinical and Experimental Research
Inácio Crochemore Mohnsam da Silva, Maria Clara Restrepo-Mendez, Janaína Calu Costa, Fernanda Ewerling, Franciele Hellwig, Leonardo Zanini Ferreira, Luis Paulo Vidaletti Ruas, Gary Joseph, Aluísio J D Barros
This study aims to describe methodological approaches to measure and monitor health inequalities and to illustrate their applicability. The measures most frequently used in the literature were reviewed. Data on coverage and quality of pre-natal care in Brazil, from the Demographic and Maternal and Child Health Survey (PNDS-2006) and the National Health Survey (PNS-2013) were used to illustrate their applicability. Absolute and relative measures of inequalities were presented, highlighting their complementary character...
March 5, 2018: Epidemiologia e Servicos de Saude: Revista do Sistema Unico de Saude do Brasil
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