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1.
J Rehabil Med ; 51(10): 770-778, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31501907

RESUMO

OBJECTIVE: To examine associations between funding source, use of rehabilitation and outcomes after total joint replacement and to evaluate variations based on demographic characteristics. DESIGN: Cross-sectional, questionnaire-based national survey. SUBJECTS: Participants aged 45 years or older (n = 522) who received either private or public funding for their surgery, were recruited from the New Zealand Joint Registry 6 months after a total hip, total knee or unicompartmental knee replacement. RESULTS: The cohort was predominantly New Zealand European (90%), aged 68 years, with more men (55%) than women (45%). Privately funded participants were younger, had higher levels of education and employment, and lower rates of comorbidities at the time of surgery. Privately funded participants also reported spending less time on the surgical waiting list, were less likely to participate in pre-surgical rehabilitation, but reported more weeks of post-surgical rehabilitation and better patient-reported outcomes in terms of pain, function and quality of life, compared with their publicly funded counterparts. CONCLUSION: Factors already known to impact on joint replacement outcomes were associated with funding source in this cohort. Socio-economic differences and inequities between private and public systems exist consistent with limited available prior research. In this cross-sectional study, no clinically significant differences in outcomes between the groups were identified. Prospective research will help to clarify whether funding source directly affects joint replacement rehabilitation outcomes.


Assuntos
Artroplastia de Substituição , Adulto , Idoso , Artroplastia de Substituição/economia , Artroplastia de Substituição/reabilitação , Artroplastia de Substituição/estatística & dados numéricos , Estudos Transversais , Feminino , Equidade em Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Qualidade de Vida , Sistema de Registros , Fatores Socioeconômicos , Resultado do Tratamento
2.
BMC Health Serv Res ; 19(1): 610, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470846

RESUMO

BACKGROUND: Even though China launched a series of measures to alleviate several financial burdens (including health insurance scheme, increased government investment, and so on), the economic burden of health expenditure has still not been alleviated. Out-of-pocket payments (OPPs) show not only a time correlation but also some degree of spatial correlation. The aims of the current study were thus to identify the spatial cluster of OPPs, to investigate the main factors affecting variation, and to explore the spatial spillover sources of China's OPP. METHODS: Global and local spatial autocorrelation tests were validated to identify the spatial cluster of OPPs using the panel data of 31 provinces in China from 2005 to 2016. The Spatial Durbin Model, established in this paper, measured the spatial spillover effect of OPPs and analyzed the possible spillover sources (demand, supply, and socio-economic factors. RESULTS: OPPs were found to have a significant and positive spatial correlation. The results of the Spatial Durbin Model showed the direct and indirect effects of demand, supply, and socio- economic factors on China's OPPs. Among the demand factors, the direct and indirect correlation (elasticity) coefficients were positive. Among the supply factors, the direct and indirect effects of the share of primary health beds on residents' OPPs were negative. The ratio of health technicians in hospitals to those in primary health institutions on per capital OPPs had a significant indirect effect. Among the socio-economic factors, the direct effects of GDP, government health expenditure, and urbanization on OPPs were found to be positive. There were no significant indirect effects of socio-economic factors on OPPs. CONCLUSION: This paper finds that China's OPPs are not randomly distributed but, overall, present a positive spatial cluster, even though a series of measures have been launched to promote health equity. Socio-economic factors and those associated with demand were found to be the main influences of variation in OPPs, while demand was seen to be the driver of the positive spatial spillover of OPPs, whereby effective supply could inhibit these positive spillover effects.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , China , Equidade em Saúde/economia , Equidade em Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/economia , Investimentos em Saúde , Análise Espaço-Temporal , Urbanização
4.
Rev Saude Publica ; 53: 50, 2019 May 20.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31116239

RESUMO

OBJECTIVE: To analyze the regional allocation of the resources from the Brazilian Popular Pharmacy Program, taking into account the relative availability of the program and the potential needs of the region. METHODS: Data from the National Health Survey of the Annual Report of Social Information and the administrative database of the program were used to create a non-parametric indicator of coverage using multiple data envelopment analysis technique. This indicator considers the relative availability of the program, taking into account equal access to equal needs (equity based on regional needs). The analysis of this indicator shows if the regions that most need pharmaceutical assistance are those that receive more resources from the Brazilian Popular Pharmacy Program. RESULTS: The states belonging to the richest regions of the country, Southeast and South, present wider relative coverage of the Brazilian Popular Pharmacy Program compared to poorer localities. In addition, the inequalities observed between locations are better explained by inefficiency in the transfer of resources to the basic component of pharmaceutical care than by the Brazilian Popular Pharmacy Program itself. According to the model, a 43.76% increase in the transfer to the basic component of pharmaceutical care would be required in order to improve equity, whereas the increase required by the Brazilian Popular Pharmacy Program is equivalent to 22.71%. CONCLUSIONS: Although the Brazilian Popular Pharmacy Program seeks to reduce the socioeconomic inequalities observed in access to pharmaceutical care, which integrates health care services, regional disparities in access to medicine persist. These regional differences are attributed mostly to allocation failures and problems in managing the conventional pharmaceutical care cycle provided through SUS pharmacies.


Assuntos
Medicamentos Essenciais/provisão & distribução , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Alocação de Recursos/estatística & dados numéricos , Brasil , Orçamentos/estatística & dados numéricos , Estudos Transversais , Medicamentos Essenciais/economia , Alocação de Recursos para a Atenção à Saúde/economia , Equidade em Saúde/economia , Necessidades e Demandas de Serviços de Saúde , Humanos , Programas Nacionais de Saúde/economia , Valores de Referência , Alocação de Recursos/economia , Fatores Socioeconômicos , Análise Espacial
6.
BMC Health Serv Res ; 19(1): 167, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30871510

RESUMO

BACKGROUND: Growing understanding of the influence of social determinants of health (SDH) on healthcare costs and outcomes for low income populations is leading State Medicaid agencies to consider incorporating SDH into their program design. This paper explores states' current approaches to SDH. METHODS: A mixed-methods approach combined a web-based survey sent through the Medicaid Medical Director Network (MMDN) listserv and semi-structured interviews conducted at the MMDN Annual Meeting in November 2017. RESULTS: Seventeen MMDs responded to the survey and 14 participated in an interview. More than half reported current collection of SDH data and all had intentions for future collection. Most commonly reported SDH screening topics were housing instability and food insecurity. In-depth interviews underscored barriers to optimal SDH approaches. CONCLUSION: These results demonstrate that Medicaid leaders recognize the importance of SDH in improving health, health equity, and healthcare costs for the Medicaid population but challenges for sustainable implementation remain.


Assuntos
Medicaid/organização & administração , Determinantes Sociais da Saúde , Abastecimento de Alimentos , Equidade em Saúde/economia , Equidade em Saúde/organização & administração , Prioridades em Saúde/economia , Prioridades em Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Habitação/estatística & dados numéricos , Humanos , Medicaid/economia , Pobreza/economia , Pobreza/estatística & dados numéricos , Governo Estadual , Estados Unidos
7.
CA Cancer J Clin ; 69(3): 166-183, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30786025

RESUMO

Between 1991 and 2015, the cancer mortality rate declined dramatically in the United States, reflecting improvements in cancer prevention, screening, treatment, and survivorship care. However, cancer outcomes in the United States vary substantially between populations defined by race/ethnicity, socioeconomic status, health insurance coverage, and geographic area of residence. Many potentially preventable cancer deaths occur in individuals who did not receive effective cancer prevention, screening, treatment, or survivorship care. At the same time, cancer care spending is large and growing, straining national, state, health insurance plans, and family budgets. Indeed, one of the most pressing issues in American medicine is how to ensure that all populations, in every community, derive the benefit from scientific research that has already been completed. Addressing these questions from the perspective of health care delivery is necessary to accelerate the decline in cancer mortality that began in the early 1990s. This article, part of the Cancer Control Blueprint series, describes challenges with the provision of care across the cancer control continuum in the United States. It also identifies goals for a high-performing health system that could reduce disparities and the burden of cancer by promoting the adoption of healthy lifestyles; access to a regular source of primary care; timely access to evidence-based care; patient-centeredness, including effective patient-provider communication; enhanced coordination and communication between providers, including primary care and specialty care providers; and affordability for patients, payers, and society.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Metas , Equidade em Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Neoplasias/economia , Neoplasias/prevenção & controle , Continuidade da Assistência ao Paciente/economia , Equidade em Saúde/economia , Acesso aos Serviços de Saúde/economia , Humanos , Seguro Saúde/economia , Seguro Saúde/organização & administração , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Neoplasias/epidemiologia , Estados Unidos/epidemiologia
8.
BMJ Open ; 9(1): e025184, 2019 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-30782750

RESUMO

OBJECTIVES: 'Horizontal inequity' in healthcare finance occurs when people with equal income contribute unequally to healthcare payments. Prior research is lacking on horizontal inequity in China. Accordingly, this study set out to examine horizontal inequity in the Chinese healthcare financing system in 2002 and 2007 through two rounds of national household health surveys. DESIGN: Two rounds of cross-sectional study. SETTING: Heilongjiang Province, China. PARTICIPANTS: Adopting a multistage stratified random sampling, 3841 households with 11 572 individuals in 2003 and 5530 households with 15 817 individuals in 2008 were selected. METHODS: The decomposition method of Aronson et al was used in the present study to measure the redistributive effects and horizontal inequity in healthcare finance. FINDINGS: Over the period 2002-2007, the absolute value of horizontal inequity in total healthcare payments decreased from 93.85 percentage points to 35.50 percentage points in urban areas, and from 113.19 percentage points to 37.12 percentage points in rural areas. For public health insurance, it increased from 17.84 percentage points to 28.02 percentage points in urban areas, and decreased from 127.93 percentage points to 0.36 percentage points in rural areas. Horizontal inequity in out-of-pocket payments decreased from 79.92 percentage points to 24.83 percentage points in urban areas, and from 127.71 percentage points to 53.10 percentage points in rural areas. CONCLUSIONS: Our results show that horizontal inequity in total healthcare financing decreased over the period 2002-2007 in China. In addition, out-of-pocket payments contributed most to the extent of horizontal inequity, which were reduced both in urban and rural areas over the period 2002-2007.


Assuntos
Assistência à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Equidade em Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Cobertura do Seguro/economia , Adolescente , Adulto , Criança , Pré-Escolar , China , Estudos Transversais , Características da Família , Feminino , Custos de Cuidados de Saúde/tendências , Gastos em Saúde/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , População Rural , Fatores Socioeconômicos , População Urbana , Adulto Jovem
9.
Value Health ; 22(2): 247-253, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30711071

RESUMO

BACKGROUND: There is an implicit equity approach in cost-effectiveness analysis that values health gains of socioeconomic position groups equally. An alternative approach is to integrate equity by weighting quality-adjusted life-years according to the socioeconomic position group. OBJECTIVES: To use two approaches to derive equity weights for use in cost-effectiveness analysis in Australia, in contexts in which the use of the traditional nonweighted quality-adjusted life-years could increase health inequalities between already disadvantaged groups. METHODS: Equity weights derived using epidemiological data used burden of disease and mortality data by Socio-Economic Indexes for Areas quintiles from the Australian Institute of Health and Welfare. Two ratios were calculated comparing quintile 1 (lowest) to the total Australian population, and comparing quintile 1 to quintile 5 (highest). Preference-based weights were derived using a discrete choice experiment survey (n = 710). Respondents chose between two programs, with varying gains in life expectancy going to a low- or a high-income group. A probit model incorporating nominal values of the difference in life expectancy was estimated to calculate the equity weights. RESULTS: The epidemiological weights ranged from 1.2 to 1.5, with larger weights when quintile 5 was the denominator. The preference-based weights ranged from 1.3 (95% confidence interval 1.2-1.4) to 1.8 (95% confidence interval 1.6-2.0), with a tendency for increasing weights as the gains to the low-income group increased. CONCLUSIONS: Both methods derived plausible and consistent weights. Using weights of different magnitudes in sensitivity analysis would allow the appropriate weight to be considered by decision makers and stakeholders to reflect policy objectives.


Assuntos
Efeitos Psicossociais da Doença , Análise de Dados , Equidade em Saúde/economia , Anos de Vida Ajustados por Qualidade de Vida , Fatores Socioeconômicos , Inquéritos e Questionários , Adolescente , Adulto , Austrália/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Adulto Jovem
10.
Can J Public Health ; 110(1): 114-117, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30232717

RESUMO

This commentary is in response to the May 2018 announcement by the Canadian Institutes of Health Research (CIHR) of a new procedure to ensure fairer access to health research funding for participants. As such, all applicants to CIHR's funding programs will now be required to complete a five-question questionnaire covering the dimensions of gender, age, Indigenous origin, visible minorities, and disability. On this basis, CIHR intends to gain a better understanding of the performance of its funding programs in terms of equity. In this commentary, we wish to question the theoretical and conceptual assumptions of a vision of equity framed principally in terms of diversity upstream from the research process as a founding principle of more equitable health research in Canada. We draw attention to the fact that diversity policies do not necessarily challenge inequity in research funding or in research projects. Having established the urgent need for action on equity to improve the health of populations, we recall the ethical responsibility of research and researchers to better take the various facets of equity in research into account. We recommend expanding efforts to understand and reflexively address both equity and diversity when considering the performance of population health research programs.


Assuntos
Custos e Análise de Custo , Equidade em Saúde/economia , Apoio à Pesquisa como Assunto/economia , Canadá , Humanos
12.
Rev. panam. salud pública ; 43: e12, 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-985760

RESUMO

RESUMEN La equidad en salud es un principio rector de la acción en salud pública -cuyo noble propósito es construir sociedades más saludables y sostenibles y, al mismo tiempo, más justas e inclusivas. Ello se refleja en el compromiso mundial por 'no dejar a nadie atrás' que preside la Agenda 2030 para el desarrollo sostenible, aunque en ninguna de sus 169 metas se establezca ni conceptual ni cuantitativamente la reducción de desigualdades en salud. Reconociendo la urgencia de trascender la retórica y avanzar consecuentemente en la formulación y puesta en marcha de políticas sociales y de salud pro-equitativas -de lo local a lo global-, en este informe especial se revisan las bases conceptuales y metodológicas para el abordaje de la equidad en salud, se vinculan explícitamente en una propuesta instrumental y práctica que promueve el uso analítico de los datos administrativos disponibles desagregados subnacionalmente para informar la toma de decisiones en esa dirección, y se concluye planteando la necesidad de institucionalizar la medición, análisis y monitoreo de las desigualdades sociales en salud para crear efectivamente capacidades nacionales para actuar sobre los determinantes sociales y ambientales de la salud y rendir cuentas sobre el compromiso de no dejar a nadie atrás en el camino hacia el desarrollo sostenible, la salud universal y la justicia social.


ABSTRACT Health equity is a guiding principle for public health action. Its noble purpose is to build healthier, sustainable societies that are also more just and inclusive. This is reflected in the global commitment to "leave no one behind", expressed in the 2030 Agenda for Sustainable Development, although none of the Agenda's 169 targets focuses on reducing health inequalities, either conceptually or quantitatively. Recognizing the urgency to go beyond words and move forward decidedly in the design and implementation of pro-equity social and health policies at both the local and global levels, this special report reviews the conceptual and methodological framework for tackling health equity. Concepts and methodology are explicitly linked in a practical proposal that promotes the analytical use of subnationally disaggregated administrative data to inform decision-making in that area. This report concludes by proposing the need to institutionalize the measurement, analysis, and monitoring of social disparities in health to create effective national capacity to act on the social and environmental determinants of health and ensure accountability in the commitment to "leave no one behind" on the road to sustainable development, universal health, and social justice.


RESUMO A equidade em saúde é um princípio norteador da ação em saúde pública cujo propósito nobre é edificar sociedades mais saudáveis e sustentáveis e, ao mesmo tempo, mais justas e inclusivas. Isso está refletido no compromisso mundial de "não deixar ninguém atrás" que guia a Agenda 2030 para o Desenvolvimento Sustentável, apesar de nenhuma das 169 metas estabelecer de forma conceitual ou quantitativa a redução das desigualdades em saúde. Reconhecendo a urgência de transcender a retórica e avançar na formulação e implementação de políticas sociais e de saúde pró-equitativas do nível local ao global, são revistas as bases conceituais e metodológicas para a abordagem da equidade em saúde, vinculadas explicitamente em uma proposta instrumental e prática que promove o uso analítico dos dados administrativos disponíveis desagregados ao nível subnacional para subsidiar a tomada de decisão. Em conclusão, faz-se necessário institucionalizar a mensuração, análise e monitoramento das desigualdades sociais em saúde para efetivamente estabelecer capacidades nacionais para atuar nos determinantes sociais e ambientais da saúde e prestar contas quanto ao compromisso de não deixar ninguém atrás no rumo ao desenvolvimento sustentável, saúde universal e justiça social.


Assuntos
Fatores Socioeconômicos , Equidade em Saúde/economia , Equidade em Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração
13.
J Ment Health Policy Econ ; 21(3): 91-103, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30530870

RESUMO

BACKGROUND: For decades, insurance plans in the United States have applied more restrictive treatment limits and higher cost-sharing burdens for mental health and substance use treatments compared to physical health treatments. The Mental Health Parity and Addiction Equity Act (MHPAEA) required health plans that offer mental health and substance use benefits to offer them at parity with physical health benefits starting in January 2010. AIMS OF THE STUDY: To determine the effect of MHPAEA on out-of-pocket spending and utilization of outpatient specialty behavioral health services. METHODS: The proportion of individuals with at least one outpatient specialty behavioral health visit, the average number of visits among those with any behavioral health visit, and the proportion of behavioral health spending paid out-of-pocket were obtained from the nationally-representative Medical Expenditure Panel Survey (MEPS) for the years 2006 to 2013. Difference-in-differences models were estimated comparing individuals with employer-sponsored insurance to those with Medicaid, Medicare, or who were uninsured. RESULTS: Out-of-pocket share of spending was lowest among Medicaid (2.0%) and highest among the uninsured (22%), followed by the employer group (13%). Individuals in Medicaid had the highest proportion of any behavioral health visit (11%) and the uninsured had the lowest (2.4%). Among those with any behavioral health visits, the average number of visits was similar across groups. Our primary and sensitivity analyses suggest MHPAEA did not lead to changes in utilization or spending on specialty outpatient behavioral visits for individuals with employer-sponsored insurance compared to other groups. DISCUSSION: Potential reasons for MHPAEA's apparent lack of effect are that health plans were already at parity before the law's passage, that many health plans continue to be out of compliance with the law, that concurrent changes in plans' cost-sharing blunted the law's effects, and that other barriers to behavioral health service use continue to limit utilization. While our study cannot provide direct evidence of these mechanisms, we review existing evidence in support of each of them. Our study had several limitations. We cannot test definitively whether the difference-in-differences assumption was violated or fully control for time-varying differences between groups. We attempt to address this by using multiple control groups and presenting evidence of parallel trends before MHPAEA implementation. Second, because our data do not have state identifiers, we cannot control for which states had existing mental health parity laws. Third, a nationally representative analysis may mask substantial heterogeneity for affected subgroups. IMPLICATIONS FOR HEALTH POLICIES: We find no evidence MHPAEA substantially affected behavioral health utilization or out-of-pocket spending. Federal parity legislation alone is likely insufficient to address barriers to behavioral health affordability and access.


Assuntos
Assistência Ambulatorial/economia , Equidade em Saúde/economia , Equidade em Saúde/legislação & jurisprudência , Gastos em Saúde/estatística & dados numéricos , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Recuperação da Saúde Mental/economia , Planos de Assistência de Saúde para Empregados/economia , Humanos , Medicaid/economia , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Estados Unidos , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos
14.
R I Med J (2013) ; 101(9): 27-31, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30384516

RESUMO

Poor management of chronic diseases, such as hypertension and diabetes, particularly among the uninsured, places medical and financial burdens on the healthcare system. Clínica Esperanza/Hope Clinic initiated a chronic disease management program for uninsured residents of Rhode Island (RI) called Bridging the [Health Equity] Gap (BTG), which offers continuity of care, quarterly goal-setting appointments, and healthy lifestyle interventions. Outcomes for 549 participants from the initial evaluation period are presented here. Over the first 12 months of enrollment, mean hemoglobin A1c decreased from 10.2% to 8.3% (p<0.001), and mean blood glucose of individuals with diabetes decreased by 51 mg/dL (p<0.01). BTG participants used the local emergency department (ED) 60% less than Medicaid-insured RI residents and had 61% fewer "potentially preventable" ED visits. The positive impact of BTG on chronic disease outcomes and ED usage by uninsured patients suggests that programs like BTG may reduce overall healthcare costs in the state.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Equidade em Saúde/organização & administração , Pessoas sem Cobertura de Seguro de Saúde , Instituições de Assistência Ambulatorial/economia , Doença Crônica , Redução de Custos , Diabetes Mellitus/terapia , Serviço Hospitalar de Emergência/economia , Feminino , Hemoglobina A Glicada/análise , Equidade em Saúde/economia , Indicadores Básicos de Saúde , Humanos , Masculino , Medicaid/estatística & dados numéricos , Rhode Island , Estados Unidos
15.
Lancet ; 392(10156): 1473-1481, 2018 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-30343861

RESUMO

Weakness of primary health-care (PHC) systems has represented a challenge to the achievement of the targets of disease control programmes (DCPs) despite the availability of substantial development assistance for health, in resource-poor settings. Since 2005, Ethiopia has embraced a diagonal investment approach to strengthen its PHC systems and concurrently scale up DCPs. This approach has led to a substantial improvement in PHC-system capacity that has contributed to increased coverage of DCPs and improved health status, although gaps in equity and quality in health services remain to be addressed. Since 2013, Ethiopia has had a decline in development assistance for health. Nevertheless, the Ethiopian Government has been able to compensate for this decline by increasing domestic resources. We argue that the diagonal investment approach can effectively strengthen PHC systems, achieve DCP targets, and sustain the gains. These goals can be achieved if a visionary and committed leadership coordinates its development partners and mobilises the local community, to ensure financial support to health services and improve population health. The lessons learnt from Ethiopia's efforts to improve its health services indicate that global-health initiatives should have a proactive and balanced investment approach to concurrently strengthen PHC systems, achieve programme targets, and sustain the gains, in resource-poor settings.


Assuntos
Reforma dos Serviços de Saúde/economia , Equidade em Saúde/economia , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/normas , Países em Desenvolvimento/economia , Etiópia , Reforma dos Serviços de Saúde/normas , Equidade em Saúde/normas , Humanos , Pobreza , Atenção Primária à Saúde/legislação & jurisprudência , Cobertura Universal do Seguro de Saúde
16.
Breastfeed Med ; 13(8): 520-523, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30335487

RESUMO

Breast milk (human milk) is the recommended standard for nutrition for infants. There are strategies to increase breastfeeding for people of color due in part to health disparities experienced in underrepresented populations.


Assuntos
Aleitamento Materno/etnologia , Equidade em Saúde/economia , Disparidades nos Níveis de Saúde , Leite Humano , Análise Custo-Benefício , Equidade em Saúde/legislação & jurisprudência , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Unidades de Terapia Intensiva Neonatal , Bancos de Leite , Educação de Pacientes como Assunto , Patient Protection and Affordable Care Act/economia , Estados Unidos
17.
BMC Health Serv Res ; 18(1): 726, 2018 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-30231874

RESUMO

BACKGROUND: Equity is an important goal for countries in formulating relevant health policies, and research on the equity of health services is more important for China, where the gap between the rich and poor is widening. The aims of this study are to explore to what extent the benefit equity of New Rural Cooperative Medical System enrollees has been achieved and to determine the geographical disparities in Shaanxi province and thus provide suggestions for future policy formulations. METHODS: Data were obtained from the fifth Health Service Survey of Shaanxi province in 2013. A two-step mode was used to analyse the influencing factors of the inpatient benefit rate and inpatient compensation fee. Concentration indexes and concentration curves were applied to measure the inequity of the inpatient benefit rate and inpatient compensation fee. The decomposition method was employed to explore the source of inequity and horizontal inequity. RESULTS: Based on a sample of 38,032 enrollees, our results showed that there were pro-rich inequities in the inpatient benefit rate and compensation fee. The concentration index of the inpatient benefit rate and compensation fee in 2013 were 0.064 and 0.174, respectively. The economic level (224.62%), self-evaluated health status (- 25.89%) and occupation status (- 12.32%) were the primary three contributors to the inequity of the inpatient benefit rate, and the economic level (106.16%) and age (- 2.88%) were the first two contributors to the inequity of the compensation fee. There were regional differences in the sources of inequities. Moreover, pro-rich horizontal inequity remained after standardizing health care needs. CONCLUSIONS: Our results indicated that there were pro-rich inequities in the inpatient benefit rate and compensation fee in the New Rural Cooperative Medical System. The economic levels of enrollees accounted for most of the existing inequity, followed by self-evaluated health scores and age. Efforts should be made to strengthen policies and programmes in the New Rural Cooperative Medical System to achieve basic health services equity, such as implementing hierarchical medical treatments and reducing extra inpatient benefits for the rich.


Assuntos
Pacientes Internados , Cobertura do Seguro , Seguro Saúde , População Rural , Adolescente , Adulto , China , Feminino , Pesquisas sobre Serviços de Saúde , Equidade em Saúde/economia , Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Adulto Jovem
18.
Int J Equity Health ; 17(1): 138, 2018 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-30208921

RESUMO

BACKGROUND: Many low and middle income countries are implementing reforms to support Universal Health Coverage (UHC). Perhaps one of the most ambitious examples of this is Indonesia's national health scheme known as the JKN which is designed to make health care available to its entire population of 255 million by end of 2019. If successful, the JKN will be the biggest single payer system in the world. While Indonesia has made steady progress, around a third of its population remains without cover and out of pocket payments for health are widespread even among JKN members. To help close these gaps, especially among the poor, the Indonesian government is currently implementing a set of UHC policy reforms that include the integration of remaining government insurance schemes into the JKN, expansion of provider networks, restructuring of provider payments systems, accreditation of all contracted health facilities and a range of demand side initiatives to increase insurance uptake, especially in the informal sector. This study evaluates the equity impact of this latest set of UHC reforms. METHODS: Using a before and after design, we will evaluate the combined effects of the national UHC reforms at baseline (early 2018) and target of JKN full implementation (end 2019) on: progressivity of the health care financing system; pro-poorness of the health care delivery system; levels of catastrophic and impoverishing health expenditure; and self-reported health outcomes. In-depth interviews with stakeholders to document the context and the process of implementing these reforms, will also be undertaken. DISCUSSION: As countries like Indonesia focus on increasing coverage, it is critically important to ensure that the poor and vulnerable - who are often the most difficult to reach - are not excluded. The results of this study will not only help track Indonesia's progress to universalism but also reveal what the UHC-reforms mean to the poor.


Assuntos
Equidade em Saúde/tendências , Cobertura Universal do Seguro de Saúde/tendências , Equidade em Saúde/economia , Gastos em Saúde/tendências , Política de Saúde , Financiamento da Assistência à Saúde , Humanos , Indonésia , Cobertura Universal do Seguro de Saúde/economia
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