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2.
Kennedy Inst Ethics J ; 31(1): 77-99, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33716228

RESUMEN

What just societies owe to non-citizen immigrants is a controversial question. This paper considers three accounts of the requirements of distributive justice for non-citizens to determine what they might suggest about the provision of publicly funded health care to pregnant undocumented immigrants. These accounts are compared to locate an overlapping consensus on the duty of the state to provide care to pregnant undocumented immigrants. The aim of this paper is not to take a substantive position on the "right" prenatal policy, but rather to explore the moral space that this issue occupies and suggest that real moral progress can be achieved through the consistent application of shared values.


Asunto(s)
Financiación Gubernamental/ética , Accesibilidad a los Servicios de Salud/economía , Servicios de Salud Materna/economía , Inmigrantes Indocumentados , Consenso , Femenino , Política de Salud , Humanos , Obligaciones Morales , Principios Morales , Embarazo , Justicia Social , Problemas Sociales , Estados Unidos
5.
BMC Public Health ; 21(1): 490, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-33706726

RESUMEN

BACKGROUND: It is now 25 years since the adoption of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the same concerns raised during its negotiations such as high prices of medicines, market exclusivity and delayed market entry for generics remain relevant as highlighted recently by the Ebola and COVID-19 pandemics. The World Health Organization's (WHO) mandate to work on the interface between intellectual property, innovation and access to medicine has been continually reinforced and extended to include providing support to countries on the implementation of TRIPS flexibilities in collaboration with stakeholders. This study analyses the role of intellectual property on access to medicines in the African Region. METHODS: We analyze patent data from the African Regional Intellectual Property Organization (ARIPO) and Organisation Africaine de la Propriété Intellectuelle (OAPI) to provide a situational analysis of patenting activity and trends. We also review legislation to assess how TRIPS flexibilities are implemented in countries. RESULTS: Patenting was low for African countries. Only South Africa and Cameroon appeared in the list of top ten originator countries for ARIPO and OAPI respectively. Main diseases covered by African patents were HIV/AIDS, cardiovascular diseases, cancers and tumors. Majority countries have legislation allowing for compulsory licensing and parallel importation of medicines, while the least legislated flexibilities were explicit exemption of pharmaceutical products from patentable subject matter, new or second use of patented pharmaceutical products, imposition of limits to patent term extension and test data protection. Thirty-nine countries have applied TRIPS flexibilities, with the most common being compulsory licensing and least developed country transition provisions. CONCLUSIONS: Opportunities exist for WHO to work with ARIPO and OAPI to support countries in reviewing their legislation to be more responsive to public health needs.


Asunto(s)
/prevención & control , Comercio/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Propiedad Intelectual , Patentes como Asunto , África , Comercio/historia , Países en Desarrollo , Historia del Siglo XX , Humanos , Derecho Internacional , Salud Pública/legislación & jurisprudencia , Organización Mundial de la Salud
6.
Int J Equity Health ; 20(1): 76, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-33706774

RESUMEN

BACKGROUND: Social support services such as day care centres are important in post-diagnostic dementia care to enable people living with dementia stay at home for longer. Little research has addressed potential inequalities in access, with no research on variations before and since COVID-19. The aim of this study was to explore inequalities in social support service usage before and since the pandemic. METHODS: Unpaid carers and people living with dementia were interviewed over the phone about their experiences of accessing social support services before and since the COVID-19 pandemic. Transcripts were analysed for key themes using inductive and deductive thematic analysis. RESULTS: Fifty participants (42 unpaid carers; eight people living with dementia) were interviewed, and five themes identified: (1) Service issues; (2) Access issues; (3) Relying on own initiative; (4) New inequalities due to COVID-19; and (5) Missing out on the benefits of support services. Participants reported transport, finances, and location as factors reducing their ability to access support service pre-COVID, with inequalities remaining and at times exacerbated since. Carers and people living with dementia also reported struggling with accessing basic necessities during COVID, including food and medicines. CONCLUSIONS: Considering the benefits of accessing support services, resourced procedures and facilities are needed to maintain access to support services with more accessible remote support provision, enabling people from all backgrounds to access the care they need.


Asunto(s)
/epidemiología , Cuidadores/psicología , Demencia/psicología , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/normas , Disparidades en Atención de Salud , Servicio Social , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
7.
J Am Board Fam Med ; 34(Suppl): S210-S216, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622840

RESUMEN

Certain members of society are disproportionately affected by the COVID-19 crisis and the added strain being placed on already overextended health care systems. In this article, we focus on refugee newcomers. We outline vulnerabilities refugee newcomers face in the context of COVID-19, including barriers to accessing health care services, disproportionate rates of mental health concerns, financial constraints, racism, and higher likelihoods of living in relatively higher density and multigenerational dwellings. In addition, we describe the response to COVID-19 by a community-based refugee primary health center in Ontario, Canada. This includes how the clinic has initially responded to the crisis as well as recommendations for providing services to refugee newcomers as the COVID-19 crisis evolves. Recommendations include the following actions: (1) consider social determinants of health in the new context of COVID-19; (2) provide services through a trauma-informed lens; (3) increase focus on continuity of health and mental health care; (4) mobilize International Medical Graduates for triaging patients based on COVID-19 symptoms; and (5) diversify communication efforts to educate refugees about COVID-19.


Asunto(s)
Emigrantes e Inmigrantes , Medicina Familiar y Comunitaria/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Refugiados , /epidemiología , Emigrantes e Inmigrantes/educación , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/economía , Humanos , Masculino , Ontario/epidemiología , Pandemias , Refugiados/educación , Refugiados/psicología , Refugiados/estadística & datos numéricos , Determinantes Sociales de la Salud/economía
8.
Value Health ; 24(2): 188-195, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518025

RESUMEN

OBJECTIVES: To measure access to opioid treatment programs (OTPs) and office-based buprenorphine treatment (OBBTs) at the smallest geographic unit for which the Census Bureau publishes demographic and socioeconomic data (ie, block group) and to explore disparities in access to treatment across the rural-urban and area deprivation continua across the United States. METHODS: Access to OTPs and OBBTs at the block group in 2019 was quantified using an innovative 2-step floating catchment area technique that accounts for the supply of treatment facilities relative to the population size, proximity of facilities relative to the location of population in block groups, and time as a barrier within catchments. Block groups were stratified into tertiles based on the rural-urban continuum codes (metropolitan, micropolitan, small town, or rural) and area deprivation index (least-deprived, middle-deprived, most-deprived). The Integrated Nested Laplace Approximation approach was used for statistical analysis. RESULTS: Across the United States, 3329 block groups corresponding to 2 915 949 adults lacked access to OTPs within a 2-hour drive of their community and 130 block groups corresponding to 86 605 adults did not have access to OBBTs. Disparities in access to treatment were observed across the urban-rural and area deprivation continua including (1) lowest mean access score to OBBTs were found among most-deprived small towns, and (2) lower mean access score to OTPs were found among micropolitan and small towns. CONCLUSIONS: The results of this study revealed disparities in access to medication-assisted treatment. The findings call for creative initiatives and local and regional policies to develop to mitigate access problems.


Asunto(s)
Buprenorfina/uso terapéutico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Antagonistas de Narcóticos/uso terapéutico , Tratamiento de Sustitución de Opiáceos/estadística & datos numéricos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Buprenorfina/administración & dosificación , Estudios Transversales , Accesibilidad a los Servicios de Salud/economía , Humanos , Antagonistas de Narcóticos/administración & dosificación , Trastornos Relacionados con Opioides/epidemiología , Características de la Residencia , Población Rural/estadística & datos numéricos , Análisis de Área Pequeña , Factores Socioeconómicos , Estados Unidos , Población Urbana/estadística & datos numéricos
10.
Lancet Glob Health ; 9(4): e489-e551, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33607016
11.
JAMA Netw Open ; 4(1): e2033424, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33475756

RESUMEN

Importance: The Patient Protection and Affordable Care Act (ACA) temporarily increased primary care practitioners' (PCP) Medicaid fees to that of Medicare for 2013 to 2014 (fee bump) to help accommodate potential increases in demand for care with ACA coverage expansion. This also increased fees for PCPs treating dual-eligible Medicare and Medicaid beneficiaries in many states and eliminated payment differentials for dual-eligible vs non-dual-eligible Medicare beneficiaries that could limit access to care. Objective: To examine the association between the ACA fee bump and primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Design, Setting, and Participants: This cohort study used a difference-in-difference design and Medicare claims data from 2012 to 2016 to compare changes in visit rates for full-subsidy dual-eligible Medicare and Medicaid beneficiaries vs non-dual-eligible Medicare beneficiaries with low income whose fees did not change. Changes were examined overall and separately in states with temporary, extended, or minimal fee increases for dual-eligible vs non-dual-eligible beneficiaries in 2013 to 2014 (mandatory bump) and 2015 to 2016 (postbump or bump extension) vs 2012 (prebump). The study used linear regression models with beneficiary fixed effects, adjusting for time-changing area and beneficiary characteristics. Statistical analysis was performed from February 2018 to November 2019. Exposure: ACA-mandated Medicaid fee bump. Main Outcomes and Measures: Primary care visits per 100 beneficiaries overall and visits billed by physicians vs nurse practitioners and physician assistants. Results: The study included 3 052 044 dual-eligible and non-dual-eligible beneficiaries in 2012; 1 516 534 (49.7%) were aged 65 years or younger, 1 797 556 (58.9%) were women, and 1 754 626 (57.5%) had non-Hispanic White race/ethnicity. Overall primary care visit rates for dual-eligible beneficiaries were unchanged or decreased slightly relative to non-dual-eligible beneficiaries during the fee bump (2013-2014) and the postbump or bump extension period (2015-2016) vs baseline. Compared with non-dual-eligible beneficiaries, visit rates with primary care physicians declined more uniformly for dual-eligible beneficiaries across state groups and time periods (difference-in-difference: -0.37 [95% CI, -0.43 to -0.32] visits per 100 beneficiaries in 2013-2014 vs 2012; P < .001; and difference-in-difference: -0.62 [95% CI, -0.68 to -0.56] visits per 100 beneficiaries in 2015-2016 vs 2012; P < .001), whereas visits with nurse practitioners and physician assistants increased over time (difference-in-difference: 0.11 [95% CI, 0.08 to 0.14] visits per 100 beneficiaries in 2013-2014 vs 2012; P < .001; and difference-in-difference: 0.46 [95% CI, 0.43 to 0.50] visits per 100 beneficiaries in 2015-2016 vs 2012; P < .001). These changes, however, were not associated with the timing of the payment changes. Conclusions and Relevance: The ACA fee bump was not associated with increases in primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Visits for dual-eligible beneficiaries with primary care physicians decreased after the ACA, a decrease that was partially offset by increases in visits with nonphysician clinicians.


Asunto(s)
Accesibilidad a los Servicios de Salud/economía , Medicaid/economía , Medicare/economía , Patient Protection and Affordable Care Act , Atención Primaria de Salud/economía , Anciano , Femenino , Humanos , Masculino , Estados Unidos
12.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431439

RESUMEN

We describe a case of a middle-aged woman who presented with progressive jaundice and was suspected to have rebound choledocholithiasis, which was initially managed with balloon extraction through endoscopic retrograde cholangiopancreatography at her first presentation. Healthcare in Pakistan, like many other developing countries, is divided into public and private sectors. The public sector is not always completely free of cost. Patients seeking specialised care in the public sector may find lengthy waiting times for an urgent procedure due to a struggling system and a lack of specialists and technical expertise. Families of many patients find themselves facing 'catastrophic healthcare expenditure', an economic global health quandary much ignored.


Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/economía , Coledocolitiasis/terapia , Tratamiento Conservador/economía , Accesibilidad a los Servicios de Salud/economía , Ictericia Obstructiva/terapia , Coledocolitiasis/complicaciones , Coledocolitiasis/diagnóstico , Coledocolitiasis/economía , Conducto Colédoco/diagnóstico por imagen , Conducto Colédoco/cirugía , Tratamiento Conservador/métodos , Países en Desarrollo/economía , Progresión de la Enfermedad , Femenino , Fuerza Laboral en Salud/economía , Hospitales Privados/economía , Hospitales Públicos/economía , Humanos , Ictericia Obstructiva/economía , Ictericia Obstructiva/etiología , Persona de Mediana Edad , Pakistán , Cuidados Paliativos , Índice de Severidad de la Enfermedad , Tiempo de Tratamiento/economía , Ultrasonografía
14.
N Z Med J ; 134(1528): 88-95, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33444309

RESUMEN

AIM: This paper offers a grassroots view of the impact of a recent government initiative designed to increase access to contraception and improve health and social outcomes for women in New Zealand. METHOD: District health board and primary health organisation project leads were contacted to request information on how each region had chosen to configure contraception services under the new contract in August 2019, a month after the rollout of the initiative, and again in August 2020. In addition, feedback from individual general practitioners was sought via social media groups. RESULTS: There is significant variation in regional funding and provision of contraception services. Further, complex eligibility criteria can create unnecessary barriers to access for women. CONCLUSION: Variation in funding and access to contraception continues to be a feature of service provision in New Zealand and may have been exacerbated by the recent Ministry of Health funding initiative. This perpetuates inequity, particularly for vulnerable women. Urgent consideration should be given to a whole-of-system approach with contraception being free at the point of access for all women in New Zealand.


Asunto(s)
Anticoncepción/economía , Anticoncepción/estadística & datos numéricos , Anticonceptivos Orales/provisión & distribución , Anticonceptivos Orales/economía , Accesibilidad a los Servicios de Salud/economía , Humanos , Nueva Zelanda
15.
J Neurovirol ; 27(1): 168-170, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33405207

RESUMEN

People living with HIV (PLWH) may be at higher risk for adverse outcomes indirectly associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2). When comparing responses to questionnaires administered when social distancing and quarantine guidelines were first implemented, we found that PLWH were more likely to have restricted access to medical care, increased financial stress, increased symptoms of anxiety and depression, and increased substance use compared to demographically-similar people without HIV.


Asunto(s)
Ansiedad/epidemiología , Depresión/epidemiología , Infecciones por VIH/epidemiología , Pandemias , Estrés Psicológico/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Anciano , Ansiedad/economía , Ansiedad/psicología , Ansiedad/virología , /psicología , Comorbilidad , Depresión/economía , Depresión/psicología , Depresión/virología , Femenino , Infecciones por VIH/economía , Infecciones por VIH/psicología , Infecciones por VIH/virología , VIH-1/patogenicidad , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/ética , Humanos , Masculino , Persona de Mediana Edad , Missouri/epidemiología , Cuarentena/economía , Cuarentena/psicología , Estrés Psicológico/economía , Estrés Psicológico/virología , Trastornos Relacionados con Sustancias/economía , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/virología , Encuestas y Cuestionarios
18.
Epilepsy Behav ; 115: 107491, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33323340

RESUMEN

OBJECTIVE: Epilepsy is a neurologic disease that carries a high disease burden and likely, a huge treatment gap especially in low-to-middle income countries (LMIC) such as the Philippines. This review aimed to examine the treatment gaps and challenges that burden Philippine epilepsy care. MATERIALS & METHODS: Pertinent data on epidemiology, research, health financing and health systems, pharmacologic and surgical treatment options, cost of care, and workforce were obtained through a literature search and review of relevant Philippine government websites. RESULTS: The estimated prevalence of epilepsy in the Philippines is 0.9%. Epilepsy research in the Philippines is low in quantity compared with the rest of Southeast Asia (SEA). Inequities in quality and quantity of healthcare services delivered to local government units (LGUs) have arisen because of devolution. Programs for epilepsy care by both government and nongovernment institutions have been implemented. Healthcare expenditure in the Philippines is still largely out-of-pocket, with only partial coverage from the public sector. There is limited access to antiseizure medications (ASMs), mainly due to cost. Epilepsy surgery is an underutilized treatment option. There are only 20 epileptologists in the Philippines, with one epileptologist for every 45,000 patients with epilepsy. In addition, epilepsy care service delivery has been further impeded by the coronavirus disease of 2019 (COVID-19) pandemic. CONCLUSION: There is a large treatment gap in epilepsy care in the Philippines in terms of high epilepsy disease burden, socioeconomic limitations and inadequate public support, sparse clinico-epidemiologic research on epilepsy, inaccessibility of health care services and essential pharmacotherapy, underutilization of surgical options, and lack of specialists capable of rendering epilepsy care. Acknowledgment of the existence of these treatment gaps and addressing such are expected to improve the overall survival and quality of life of patients with epilepsy in the Philippines.


Asunto(s)
/prevención & control , Costo de Enfermedad , Epilepsia/terapia , Accesibilidad a los Servicios de Salud/tendencias , Programas Nacionales de Salud/tendencias , Anticonvulsivantes/economía , Anticonvulsivantes/uso terapéutico , /epidemiología , Países en Desarrollo/economía , Epilepsia/economía , Epilepsia/epidemiología , Servicios de Salud/economía , Servicios de Salud/tendencias , Accesibilidad a los Servicios de Salud/economía , Humanos , Programas Nacionales de Salud/economía , Filipinas/epidemiología , Calidad de Vida
19.
J Urol ; 205(1): 257-263, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32716676

RESUMEN

PURPOSE: Among some populations access to neonatal circumcision has become increasingly limited despite evidence of its benefits. This study examines national neonatal circumcision trends before and after the 2012 American Academy of Pediatrics recommendation for neonatal circumcision reimbursement. MATERIALS AND METHODS: A retrospective cohort study of boys aged 28 days or less was conducted using data from the Kids' Inpatient Database (2003 to 2016). Boys who underwent neonatal circumcision prior to discharge were compared to boys who did not. Boys with coagulopathies, penile anomalies or a history of prematurity were excluded. RESULTS: An estimated 8,038,289 boys comprised the final cohort. Boys were primarily White (53.7%), privately insured (49.1%) and cared for at large (60.8%) teaching (49.4%) hospitals in metropolitan areas (84.1%). While 55.0% underwent circumcision prior to discharge, neonatal circumcision rates decreased significantly over time (p <0.0001). Black (68.0%) or White (66.0%) boys, boys in the highest income quartile (60.7%) and Midwestern boys (75.0%) were most likely to be circumcised. Neonatal circumcision was significantly more common among privately (64.9%) than publicly (44.6%) insured boys after controlling for demographics, region, hospital characteristics and year (p <0.0001). The odds of circumcision over time were not significantly different in the years before vs after 2012 (p=0.28). CONCLUSIONS: Among approximately 8 million boys sampled over a 13-year period 55.0% underwent neonatal circumcision. The rate of neonatal circumcision varied widely by region, race and socioeconomic status. The finding that boys with public insurance have lower circumcision rates in all years may be related to lack of circumcision access for boys with public insurance.


Asunto(s)
Circuncisión Masculina/tendencias , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Afroamericanos/estadística & datos numéricos , Circuncisión Masculina/economía , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Geografía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/tendencias , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/tendencias , Humanos , Recién Nacido , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Clase Social , Estados Unidos
20.
PLoS One ; 15(12): e0244437, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33378327

RESUMEN

BACKGROUND: Kidney transplantation is the preferred treatment for patients with end stage renal disease. However, it is largely unavailable in many sub-Sahara African countries including Ghana. In Ghana, treatment for end stage renal disease including transplantation, is usually financed out-of-pocket. As efforts continue to be made to expand the kidney transplantation programme in Ghana, it remains unclear whether patients with Chronic Kidney Disease (CKD) would be willing to pay for a kidney transplant. AIM: The aim of the study was to assess CKD patients' willingness to pay for kidney transplantation as a treatment option for end stage renal disease in Ghana. METHODS: A facility based cross-sectional study conducted at the Renal Outpatient clinic and Dialysis Unit of Korle-Bu Teaching Hospital among 342 CKD patients 18 years and above including those receiving haemodialysis. A consecutive sampling approach was used to recruit patients. Structured questionnaires were administered to obtain information on demographic, socio-economic, knowledge about transplant, perception of transplantation and willingness to pay for transplant. In addition, the INSPIRIT questionnaire was used to assess patients' level of religiosity and spirituality. Contingent valuation method (CVM) method was used to assess willingness to pay (WTP) for kidney transplantation. Logistic regression model was used to determine the significant predictors of WTP. RESULTS: The average age of respondents was 50.2 ± 17.1 years with most (56.7% (194/342) being male. Overall, 90 out of the 342 study participants (26.3%, 95%CI: 21.7-31.3%) were willing to pay for a kidney transplant at the current going price (≥ $ 17,550) or more. The median amount participants were willing to pay below the current price was $986 (IQR: $197 -$1972). Among those willing to accept (67.3%, 230/342), 29.1% (67/230) were willing to pay for kidney transplant at the prevailing price. Wealth quintile, social support in terms of number of family friends one could talk to about personal issues and number of family members one can call on for help were the only factors identified to be significantly predictive of willingness to pay (p-value < 0.05). CONCLUSION: The overall willingness to pay for kidney transplant is low among chronic kidney disease patients attending Korle-Bu Teaching Hospital. Patients with higher socio-economic status and those with more family members one can call on for help were more likely to pay for kidney transplantation. The study's findings give policy makers an understanding of CKD patients circumstances regarding affordability of the medical management of CKD including kidney transplantation. This can help develop pricing models to attain an ideal poise between a cost effective but sustainable kidney transplant programme and improve patient access to this ultimate treatment option.


Asunto(s)
Financiación Personal/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Trasplante de Riñón/economía , Insuficiencia Renal Crónica/terapia , Adulto , Anciano , Estudios Transversales , Femenino , Ghana , Humanos , Trasplante de Riñón/psicología , Masculino , Persona de Mediana Edad , Diálisis Renal , Insuficiencia Renal Crónica/economía , Clase Social , Encuestas y Cuestionarios/estadística & datos numéricos
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