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1.
Int J Equity Health ; 18(1): 156, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615530

RESUMO

BACKGROUND: With the adoption of the Sustainable Development Goals (SDGs), there is a renewed commitment of tackling the varied challenges of undernutrition, particularly stunting (SDG 2.2). Health equity is also a priority in the SDG agenda and there is an urgent need for disaggregated analyses to identify disadvantaged subgroups. We compared time trends in socioeconomic inequalities obtained through stratification by wealth quintiles and deciles for stunting prevalence. METHODS: We used 37 representative Demographic and Health Surveys and Multiple Indicator Cluster surveys from nine Latin American and Caribbean (LAC) countries conducted between 1996 and 2016. Stunting in children under-5 years was assessed according to the 2006 WHO Child Growth Standards and stratified by wealth quintiles and deciles. Within-country socioeconomic inequalities were measured through concentration index (CIX) and slope index of inequality (SII). We used variance-weighted least squares regression to estimate annual changes. RESULTS: Eight out of nine countries showed a statistical evidence of reduction in stunting prevalence over time. Differences between extreme deciles were larger than between quintiles in most of countries and at every point in time. However, when using summary measures of inequality, there were no differences in the estimates of SII with the use of deciles and quintiles. In absolute terms, there was a reduction in socioeconomic inequalities in Peru, Honduras, Dominican Republic, Belize, Suriname and Colombia. In relative terms, there was an increase in socioeconomic inequalities in Peru, Bolivia, Haiti, Honduras and Guatemala. CONCLUSIONS: LAC countries have made substantial progress in terms of reducing stunting,. Nevertheless, renewed actions are needed to improve equity. Particularly in those countries were absolute and relative inequalities did not change over time such Bolivia and Guatemala. Finer breakdowns in wealth distribution are expected to elucidate more differences between subgroups; however, this approach is relevant to cast light on those subgroups that are still lagging behind within populations and inform equity-oriented health programs and practices.


Assuntos
Transtornos do Crescimento/epidemiologia , Equidade em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Criança , Pré-Escolar , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , América Latina/epidemiologia , Prevalência , América do Sul
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
3.
Infect Dis Poverty ; 8(1): 73, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31474228

RESUMO

BACKGROUND: Directly observed treatment, short-course (DOTS) is the current mainstay to control tuberculosis (TB) worldwide. Context-specific adaptations of DOTS have impending implications in the fight against TB. In Ethiopia, there is a national TB control programme with the goal to eliminate TB, but uneven distribution across lifestyle gradients remains a challenge. Notably, the mobile pastoralist communities in the country are disproportionately left uncovered. The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia. MAIN TEXT: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and systematically reviewed articles in seven electronic databases: Excerptra Medical Database, African Journal Online, PubMed, Google Scholar, Centre for Agriculture and Bioscience International Direct, Cochrane Library and Web of Science. The databases were searched from inception to December 31, 2018, with no language restriction. We screened 692 items of which 19 met our inclusion criteria. Using a meta-ethnographic method, we identified six themes: (i) pastoralism in Ethiopia; (ii) pastoralists' livelihood profile; (iii) pastoralists' service utilisation; (iv) pastoralists' knowledge and awareness on TB control services; (v) challenges of TB control in pastoral settings; and (vi) equity disparities affecting pastoralists. Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country. CONCLUSIONS: This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle. Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision. Targeting these two parameters holds promise to enhance effectiveness of an intervention.


Assuntos
Controle de Doenças Transmissíveis/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Estilo de Vida , População Rural/estatística & dados numéricos , Tuberculose/prevenção & controle , Etiópia , Equidade em Saúde/estatística & dados numéricos , Humanos
4.
Public Health ; 175: 68-78, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31404717

RESUMO

OBJECTIVES: Progress on health equity will require a robust metric. The aim of this article is to propose a new health equity metric that is distinct from existing measures and that allows meaningful comparisons across time and place, is calculable using health data typically available, and measures health equity across all major forms of social exclusion. STUDY DESIGN: A cross-sectional study. METHODS: The new health equity measure was calculated using data included from all 50 states and the District of Columbia in the 2017 Behavioral Risk Factor Surveillance Survey, collected by the US Centers for Disease Control and Prevention. The total sample size was 287,602. State-specific sample sizes ranged from 2269 (Alaska) to 14,685 (Kansas) with a median of 4452. A Healthy Days measure was calculated as the mean number of days that the respondents reported being physically healthy and mentally healthy out of the previous 30 days. The proposed measure defines individual health disutility as the distastefulness associated with one's health falling short of optimal achievable health, instrumentalized as the median health of the most socially privileged category, that of upper-income white men. The value of the health equity metric in a population is the mean value of this distastefulness over the entire population and has a theoretical range of -∞ to 1. RESULTS: There is substantial variation across states (mean: 0.13; standard deviation: 0.15), with the District of Columbia (0.48), Minnesota (0.37), and Connecticut (0.30) showing the greatest health equity, and West Virginia (-0.26), Arkansas (-0.18), and Kentucky (-0.13) exhibiting the least. Across states, the value of the health equity metric is not correlated with the size of black-white health disparities. CONCLUSIONS: It is feasible to use a single health equity metric for consistent and objective measurement of health equity. Doing so may facilitate more rapid progress toward health equity.


Assuntos
Equidade em Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Indicadores de Qualidade em Assistência à Saúde , Adolescente , Adulto , Estudos Transversais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estados Unidos , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-31373297

RESUMO

Health care equity reflects an equal opportunity to utilize public health and health care resources in order to maximize one's health potential. Achieving health care equity necessitates the consideration of both quantity and quality of care, as well as vertical (greater health care use by those with greater needs) and horizontal (equal health care use by those with equal needs) equity. In this paper, we summarize the approaches introduced by authors contributing to this Special Issue and how their work is captured by the National Institute of Minority Health and Health Disparities (NIMHD) framework. The paper concludes by pointing out intervention and public policy opportunities for future investigation in order to achieve health care equity.


Assuntos
Equidade em Saúde/estatística & dados numéricos , Política de Saúde/legislação & jurisprudência , Saúde Pública/estatística & dados numéricos , Humanos
6.
Int J Equity Health ; 18(1): 101, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262310

RESUMO

BACKGROUND: People experiencing homelessness are often marginalized and are known to face barriers to accessing acceptable and respectful healthcare services. This study examines the experience of accessing hospital-based services of persons experiencing homelessness or vulnerable housing in southeastern Ontario and considers the potential of Equity-Oriented Health Care (EOHC) as an approach to improving care. METHODS: Focus groups and in-depth interviews with people with lived experience of homelessness (n=31), as well as in-depth interviews of health and social service provider key informants (n=10) were combined with qualitative data from a survey of health and social service providers (n=136). Interview transcripts and written survey responses were analyzed using directed content analysis to examine experiences of people with lived experience of homelessness within the healthcare system. RESULTS: Healthcare services were experienced as stigmatizing and shaming particularly for patients with concurrent substance use. These negative experiences could lead to avoidance or abandonment of care. Despite supposed universality, participants felt that the healthcare system was not accountable to them or to other equity-seeking populations. Participants identified a system that was inflexible, designed for a perceived middle-class population, and that failed to take into account the needs and realities of equity-seeking groups. Finally, participants did identify positive healthcare interactions, highlighting the importance of care delivered with dignity, trust, and compassion. CONCLUSIONS: The experiences of healthcare services among the homeless and vulnerably housed do not meet the standards of universally accessible patient-centered care. EOHC could provide a framework for changes to the healthcare system, creating a system that is more trauma-informed, equity-enhancing, and accessible to people experiencing homelessness, thus limiting identified barriers and negative experiences of care.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Problemas Sociais/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Grupos Focais , Humanos , Ontário , Inquéritos e Questionários
7.
Int J Equity Health ; 18(1): 97, 2019 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-31227001

RESUMO

BACKGROUND: Many organizations have prioritized health equity and the social determinants of health (SDoH). These organizations need information to inform their planning, but, relatively few quantifiable measures exist. This study was conducted as an environmental scan to inform the American Academy of Family Physician's (AAFP's) health equity strategy. The objectives of the study were to identify and prioritize a comprehensive list of strategies in four focus areas: health equity leadership, policy, research, and diversity. METHODS: A Delphi study was used to identify and prioritize the most important strategies for reducing health inequities among the four aforementioned focus areas. Health equity experts were purposefully sampled. Data were collected in three rounds for each focus area separately. A comprehensive list of strategy statements was identified for each focus area in round one. The strategy statements were prioritized in round two and reprioritized in a final third round. Quantitative and qualitative data were integrated for the final analysis. RESULTS: Fifty strategies were identified across the four focus areas. Commitment to health equity, knowledge of health inequities, and knowledge of effective strategies to address the drivers of health inequities were ranked the highest for leadership. Universal access to health care and health in all policies were ranked highest for policy. Multi-level interventions, the effect of policy, governance, and politics, and translating and disseminating health equity interventions into practice were ranked the highest for research. Providing financial support to students from minority or low-socioeconomic backgrounds, commitment from undergraduate and medical school leadership for educational equity, providing opportunities for students from minority or low-socioeconomic backgrounds to prepare for standardized tests, and equitable primary and secondary school funding were ranked highest for diversity. CONCLUSIONS: The AAFP and other medical specialty societies have an important opportunity to advance health equity. They should develop a health equity policy agenda, equip physicians and other stakeholders, use their connections with practice-based research networks to identify and translate practical solutions to address the SDoH, and advocate for a more diverse medical workforce. TRIAL REGISTRATION: Not applicable.


Assuntos
Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Equidade em Saúde/organização & administração , Equidade em Saúde/estatística & dados numéricos , Planejamento em Saúde/métodos , Política de Saúde , Grupos Minoritários/estatística & dados numéricos , Adulto , Técnica Delfos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos de Família , Determinantes Sociais da Saúde , Estados Unidos
8.
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
9.
BMC Public Health ; 19(1): 247, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819146

RESUMO

BACKGROUND: Mortality is a robust indicator of health and offers valuable insight into the health of immigrants. However, mortality estimates can vary significantly depending on the manner in which immigrant status is defined. Here, we assess the impact of nationality, country of origin, and length of stay in the host country on mortality estimates in an immigrant population in Aragón, Spain. METHODS: Cross-sectional retrospective study of all adult subjects from the EpiChron Cohort in 2011 (n = 1,102,544), of whom 146,100 were foreign-born (i.e., according to place of birth) and 127,213 were non-nationals (i.e., according to nationality). Directly standardized death proportions between years 2012-2015 were calculated, taking into account the age distribution of the European population in 2013. Binary logistic regression was used to compare the four-year probability of death. RESULTS: The age- and sex-standardized number of deaths per 1000 subjects were 45.1 (95%CI 44.7-45.2) for the Spanish-born population, 29.3 (95%CI 26.7-32.1) for the foreign-born population, and 18.4 (95%CI 15.6-21.6) for non-Spanish nationals. Compared with the Spanish-born population, the age- and sex-adjusted likelihood of dying was equally reduced in the foreign-born and non-national populations (OR 0.6; 95%CI 0.5-0.7) when the length of stay was less than 10 years. No significant differences in mortality estimates were detected when the length of stay was over 10 years. CONCLUSIONS: Mortality estimates in immigrant populations were lower than those of the native Spanish population, regardless of the criteria applied. However, the proportion of deaths was lower when immigrant status was defined using nationality instead of country of birth. Age- and sex-standardized death proportions tended to increase with increased length of stay in the host country.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Mortalidade , Adolescente , Adulto , África , Idoso , Idoso de 80 Anos ou mais , Ásia , Estudos de Coortes , Estudos Transversais , Europa Oriental , Feminino , Humanos , América Latina , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Adulto Jovem
10.
Rev. Hosp. Ital. B. Aires (2004) ; 39(1): 4-11, mar. 2019. ilus., tab., graf.
Artigo em Espanhol | LILACS | ID: biblio-1021445

RESUMO

El sedentarismo está aumentando en la Ciudad Autónoma de Buenos Aires (CABA). Es importante estudiar el ambiente construido que promueve la realización de actividad física (AF). Nuestro objetivo fue analizar la distribución del espacio verde (EV) apto para realizar AF, así como la oferta estatal de actividades deportivas gratuitas en la ciudad. Se realizó un estudio ecológico analizando y mapeando datos según fuentes e informes oficiales de CABA para 2015. Hicimos un análisis por número absoluto, superficie, densidad poblacional y valor promedio del metro cuadrado construido por comuna. Además, realizamos un análisis cualitativo según imágenes satelitales de la ciudad. La mediana de espacio verde apto para AF era de 2,6 m2/habitante (rango intercuartílico de 1,0 a 4,6). La menor cantidad estuvo en las comunas céntricas, más densamente pobladas, así como en la mayoría de las de menor valor del terreno (una de estas tenía buena cantidad de EV, pero con un ambiente construido que podría limitar la realización de AF). En cambio, en cuanto a las actividades deportivas gratuitas, a menor valor del terreno había mayor oferta. Estos resultados deben analizarse junto con condiciones ambientales y de seguridad para la planificación integral de la ciudad. (AU)


Sedentary lifestyle is increasing in Buenos Aires City (CABA). It is important to study the built environment that promotes physical activity (PA). Our objective was to analyze the distribution of the green spaces or urban open spaces (GS) suitable for PA, as well as the state offer of free sports activities in the city. We did an ecological study, analyzing and mapping data according to sources and official reports of CABA for 2015. We performed analyses by absolute number, area, population density and average value of the built squared meter for each district (comuna). In addition, we did a qualitative analysis according to satellite images of the city. The median of green space suitable for PA was 2.6 m2 / inhabitant (interquartile range 1.0 to 4.6). The smallest amount was in the central districts, more densely populated, as well as in most of the lower landvalue ones (one of these had a good amount of GS, but with a built environment that could limit the practice of PA). In contrast, regarding free sports activities, the lower the value of the land, the greater the state offer. These results must be analyzed along with environmental and safety conditions for an integral planning of the city. (AU)


Assuntos
Humanos , Regionalização/organização & administração , Esportes/tendências , Equidade em Saúde/estatística & dados numéricos , Áreas Verdes/estatística & dados numéricos , Doenças não Transmissíveis/prevenção & controle , /estatística & dados numéricos , Argentina , Qualidade de Vida , Regionalização/tendências , Classe Social , Esportes/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Equidade em Saúde/organização & administração , Estudos Ecológicos , Comportamento Sedentário , Senso de Coerência , Estilo de Vida Saudável , /provisão & distribução , /tendências , Promoção da Saúde/organização & administração
11.
Int J Equity Health ; 18(1): 36, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782161

RESUMO

BACKGROUND: Despite the wealth of frameworks on social determinants of health (SDOH), two current limitations include the relative superficial description of factors affecting health and a lack of focus on measuring health equity. The Health Equity Measurement Framework (HEMF) addresses these gaps by providing a more encompassing view of the multitude of SDOH and drivers of health service utilisation and by guiding quantitative analysis for public health surveillance and policy development. The objective of this paper is to present the HEMF, which was specifically designed to measure the direct and indirect effects of SDOH to support improved statistical modelling and measurement of health equity. METHODS: Based on a framework synthesis, the HEMF development involved initially integrating theoretical components from existing SDOH and health system utilisation frameworks. To further develop the framework, relevant publications on SDOH and health equity were identified through a literature review in major electronic databases. White and grey literatures were critically reviewed to identify strengths and gaps in the existing frameworks in order to inform the development of a unique health equity measurement framework. Finally, over a two-year period of consultation, scholars, health practitioners, and local policy influencers from municipal and provincial governments provided critical feedback on the framework regarding its components and causal relationships. RESULTS: This unified framework includes the socioeconomic, cultural, and political context, health policy context, social stratification, social location, material and social circumstances, environment, biological factors, health-related behaviours and beliefs, stress, quality of care, and healthcare utilisation. Alongside the HEMF's self-exploratory diagram showing the causal pathways in-depth, a number of examples are provided to illustrate the framework's usefulness in measuring and monitoring health equity as well as informing policy-making. CONCLUSIONS: The HEMF highlights intervention areas to be influenced by strategic public policy for any organisation whose purview has an effect on health, including helping non-health sectors (such as education and labour) to better understand how their policies influence population health and perceive their role in health equity promotion. The HEMF recognises the complexity surrounding the SDOH and provides a clear, overarching direction for empirical work on health equity.


Assuntos
Equidade em Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Modelos Estatísticos , Determinantes Sociais da Saúde , Saúde Global , Política de Saúde , Humanos , Formulação de Políticas , Literatura de Revisão como Assunto , Fatores Socioeconômicos
12.
J Med Econ ; 22(5): 455-463, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30744446

RESUMO

BACKGROUND: Critical illness insurance (CII) is one kind of health insurance that is gradually gaining attention worldwide. China implemented CII in 2012 to decrease patients' out-of-pocket (OOP) medical payments. The aims of this study were to determine if the project had positive impacts on relieving financial burden and improving health equity. METHODS: A series of questionnaire surveys were undertaken in two counties before and after the intervention in rural China. OOP expenditure, catastrophic Health Expenditure (CHE) incidence, and associated average gap (AG) were assessed across different income groups and project durations, measuring short-term direct medical cost. Medical debt rate and amount were used to measure long-term financial burden; concentration index (CI) was calculated for equity. All data were evaluated by descriptive statistics and multi-variate variance analysis. The linear regression and logit regression with random effect analysis upon area was used to evaluate the effect of CII. RESULTS: Six hundred and thirteen and 834 patients were surveyed at baseline and final evaluation. After the program, the OOP payments of hospitalizations sharply decreased from RMB 39,363.2 to RMB 28,426.1 (p < 0.001), with the largest decrease for lowest income patients (from RMB 44,507.6 to RMB 29,214.2). With longer duration of CII, more OOP medical payments decreased. The amount of medical debt was decreased by RMB 7,209.4 among all the patients, and the decrease was highest in the highest income group (RMB 8,119.9). The CI of AG changed a lot (from -0.858 to -0.670). CONCLUSION: The CII has effectively reduced the financial burden of patients with high medical cost, whether in the short-term or a longer length of time. It also improved health equity in health service utilization and expenditure. However, rich householders still receive more benefits from the policy, government health insurance financing is increased, and the policy needs to further benefit the poor.


Assuntos
Estado Terminal/economia , Equidade em Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , China , Estudos Transversais , Feminino , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto Jovem
13.
Cultur Divers Ethnic Minor Psychol ; 25(1): 1-5, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30714761

RESUMO

Research on health disparities emerged in the 1990s and has rapidly grown in scope and content. This introduction provides an overall frame for the articles presented in this special issue. The frame includes an overview of how health disparities and health equities have been defined and examined in previous research, challenges in conducting health disparities research, and the progress that has been made. The articles in this special issue address the challenges of health disparity research through new conceptual models, the expansion of diseases and health behaviors wherein disparities occur, intersectionality theory, innovative research designs, and workforce training. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Equidade em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Melhoria de Qualidade , Pesquisa sobre Serviços de Saúde , Humanos , Grupos Minoritários/estatística & dados numéricos , Estados Unidos
14.
Int J Equity Health ; 18(1): 8, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642332

RESUMO

BACKGROUND: There are many factors across different sectors that contribute to inequities in obesity levels. This implies the need for action across different government departments and policy domains (hereafter referred to as whole of government multisectoral action). In this study we explored the public policy attention given to inequities in obesity using an Australian case study. METHODS: Interviews were conducted with 33 stakeholders involved in the development and implementation of the whole of government Healthy Weight Initiative (HWI). A thematic analysis was undertaken to identify ways in which government policy makers and implementers explicitly or implicitly described how actions delivered through the HWI addressed inequities in obesity within the population. RESULTS: The analysis revealed that the focus of the HWI was predominantly aimed at the general population, with minimal attention given to addressing the social distribution of obesity. The reasons for this were explained in terms of five themes: (1) rationale for a population wide approach; (2) when to apply an equity lens, (3) issues of government responsibility, (4) philosophically opposing concepts of equity, and (5) tensions across departments as a result of competing concepts of equity. CONCLUSIONS: It is important to create a shared understanding plus a concern for addressing inequities in public policy, regardless of whether or not a universal population-wide or a targeted approach is being applied. It is also important that policies and programs address the social distribution of obesity while understanding local contexts and needs. In striving to develop policy that brings an explicit focus on health equity, policymakers must consider the sociological, political, economic, and philosophical tensions at play between different policy actors and government departments, and identify how to navigate these without reverting to siloed working.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Programas Governamentais/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Política de Saúde , Obesidade/terapia , Programas de Redução de Peso/organização & administração , Programas de Redução de Peso/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Int J Gynaecol Obstet ; 144(1): 80-84, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30240532

RESUMO

OBJECTIVE: To investigate health-system challenges responsible for the poor performance of a cervical cancer prevention program in the Kurdistan Region of Iraq. METHOD: A qualitative study was conducted among a purposive sample of healthcare providers and female volunteers in Erbil, Kurdistan Region of Iraq, between December 10, 2014, and July 23, 2016. Data were collected from participants using in-depth semi-structured interviews. The interviews were then transcribed and analyzed with an inductive content analysis approach. RESULTS: In total, 23 individuals completed the interviews. The participants included 8 (35%) female volunteers; 5 (22%) nurses; 4 (17%) managers; 3 (13%) doctors; and 3 (13%) gynecologists. The health-system challenges were classified into three main categories: existence of an official reminder system, public information delivery programs, and infrastructures of facilities, which included three subcategories-cervical cancer screening center, material resources, and human resources. CONCLUSIONS: The Kurdistan Region of Iraq health system faced several challenges in delivering a cervical cancer prevention program. These challenges must be addressed to improve the coverage of cervical cancer screening, diagnosis, and treatment.


Assuntos
Equidade em Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Atitude do Pessoal de Saúde , Detecção Precoce de Câncer/métodos , Feminino , Acesso aos Serviços de Saúde , Humanos , Iraque , Pessoa de Meia-Idade , Pesquisa Qualitativa , Neoplasias do Colo do Útero/diagnóstico
16.
BMC Med Res Methodol ; 18(1): 106, 2018 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-30314471

RESUMO

BACKGROUND: Health inequalities, worse health associated with social and economic disadvantage, are reported by a minority of research articles. Locating these studies when conducting an equity-focused systematic review is challenging due to a deficit in standardised terminology, indexing, and lack of validated search filters. Current reporting guidelines recommend not applying filters, meaning that increased resources are needed at the screening stage. METHODS: We aimed to design and test search filters to locate studies that reported outcomes by a social determinant of health. We developed and expanded a 'specific terms strategy' using keywords and subject headings compiled from recent systematic reviews that applied an equity filter. A 'non-specific strategy' was compiled from phrases used to describe equity analyses that were reported in titles and abstracts, and related subject headings. Gold standard evaluation and validation sets were compiled. The filters were developed in MEDLINE, adapted for Embase and tested in both. We set a target of 0.90 sensitivity (95% CI; 0.84, 0.94) in retrieving 150 gold standard validation papers. We noted the reduction in the number needed to screen in a proposed equity-focused systematic review and the proportion of equity-focused reviews we assessed in the project that applied an equity filter to their search strategy. RESULTS: The specific terms strategy filtered out 93-95% of all records, and retrieved a validation set of articles with a sensitivity of 0.84 in MEDLINE (0.77, 0.89), and 0.87 (0.81, 0.92) in Embase. When combined (Boolean 'OR') with the non-specific strategy sensitivity was 0.92 (0.86, 0.96) in MEDLINE (Embase 0.94; 0.89, 0.97). The number needed to screen was reduced by 77% by applying the specific terms strategy, and by 59.7% (MEDLINE) and 63.5% (Embase) by applying the combined strategy. Eighty-one per cent of systematic reviews filtered studies by equity. CONCLUSIONS: A combined approach of using specific and non-specific terms is recommended if systematic reviewers wish to filter studies for reporting outcomes by social determinants. Future research should concentrate on the indexing standardisation for equity studies and further development and testing of both specific and non-specific terms for accurate study retrieval.


Assuntos
Bases de Dados Bibliográficas/normas , Equidade em Saúde/normas , Disparidades em Assistência à Saúde/normas , MEDLINE/normas , Ferramenta de Busca/normas , Bases de Dados Bibliográficas/estatística & dados numéricos , Guias como Assunto/normas , Equidade em Saúde/estatística & dados numéricos , Recursos em Saúde/normas , Recursos em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , MEDLINE/estatística & dados numéricos , Registros/normas , Registros/estatística & dados numéricos , Padrões de Referência , Ferramenta de Busca/métodos , Ferramenta de Busca/estatística & dados numéricos , Revisão Sistemática como Assunto
19.
Int J Equity Health ; 17(1): 154, 2018 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30261924

RESUMO

BACKGROUND: The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care. METHODS: The theoretically-informed and evidence-based intervention known as 'EQUIP' included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics' organizational processes and priorities, and on staff. RESULTS: Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact. CONCLUSIONS: This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens.


Assuntos
Equidade em Saúde/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Racismo/estatística & dados numéricos , Canadá , Feminino , Equidade em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Violência/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos
20.
Glob Health Action ; 11(sup1): 1496972, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30067161

RESUMO

BACKGROUND: Universal and equitable access to safe and affordable drinking water and adequate sanitation and hygiene in Indonesia are vital to ensure healthy lives and promote well-being for all at all ages. OBJECTIVES: To quantify subnational regional inequality in access to improved drinking water and sanitation in Indonesia. METHODS: Data about access to improved drinking water and sanitation were derived from the 2015 Indonesian National Socioeconomic Survey (SUSENAS) and disaggregated by 510 districts across the 34 provinces of Indonesia. Two summary measures of inequality, mean difference from mean and weighted index of disparity, were calculated to quantify within-province absolute and relative inequality, respectively. RESULTS: While the majority of Indonesian households had access to improved drinking water (71.0%) and sanitation (62.1%), there were large variations between and within provinces. Access to improved drinking water ranged from 93.4% in DKI Jakarta to 41.1% in Bengkulu, and access to improved sanitation ranged from 89.3% in Jakarta to 23.9% in East Nusa Tenggara. Provinces with similar numbers of districts and similar overall averages showed variable levels of absolute and/or relative inequality. Certain districts reported very low levels of access to improved drinking water and/or sanitation. CONCLUSIONS: There are inequalities in access to improved drinking water and sanitation by subnational region in Indonesia. Monitoring within-country inequality in these indicators serves to identify underserved areas, and is useful for developing approaches to improve inequalities in access that can help Indonesia make progress towards the 2030 Agenda for Sustainable Development.


Assuntos
Água Potável , Equidade em Saúde/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Geografia , Humanos , Indonésia , Fatores Socioeconômicos , Inquéritos e Questionários
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