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1.
Lima; Perú. Acuerdo Nacional; 20210800. 36 p. ilus.
Monografía en Español | MINSAPERÚ | ID: biblio-1284235

RESUMEN

El Acuerdo Nacional contiene lineamientos prioritarios para el corto y mediano plazo en los temas de Salud, Educación, Lucha contra la Pobreza y Pobreza Extrema, Crecimiento Económico Sostenible con Empleo Digno, Reforma Política y Reforma del Sistema de Administración de Justicia. En tal sentido, son considerados como desarrollos de las políticas de Estado, y apuntan hacia la consecución de la Visión del Perú al 2050 y de los Objetivos de Desarrollo Sostenible que el Perú se ha comprometido a adoptar como Estado miembro de la Organización de las Naciones Unidas.


Asunto(s)
Pobreza , Naciones Unidas , Salud , Estado , Política Nacional de Ciencia, Tecnología e Innovación , Política de Innovación y Desarrollo , Políticas , Desarrollo Sostenible , Crecimiento
2.
BMC Health Serv Res ; 21(1): 600, 2021 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-34167527

RESUMEN

BACKGROUND: In order to solve the problem of "expensive medical treatment and difficult medical treatment" for patients and improve the equity of medical services, China started the health-care reform in 2009, and proposed ambitious goals of providing fair and high-quality basic medical and health services to all citizens and reducing economic burden of diseases. This study was to systematically explore the association between population economic status and incidence of catastrophic health expenditures (CHE) in mainland China in the last decade since 2009 health reform. METHODS: This systematic review was reported according to the standard of preferred reporting items for systematic reviews and meta-analyses (PRISMA). We systematically searched Chinese Electronic literature Database of China Journal Full Text Database, Chinese Biomedical Journal Database, Wan fang Data Resource System, VIP Database, and English literature databases of PubMed, SCI, EMbase and Cochrane Library from January 2000 to June 2020, and references of included studies. Two reviewers independently selected all reports from 2000 to 2020 for empirical studies of CHE in mainland China, extracted data and evaluated the quality of the study. We conducted meta-analysis of the incidence of CHE and subgroup analysis according to the time of the study and the economic characteristics of residents. RESULTS: Four thousand eight hundred seventy-four records were retrieved and eventually 47 studies with 151,911 participants were included. The quality scores of most of studies were beyond 4 points (91.49%). The pooled incidence of CHE of Chinese residents in the last two decades was 23.3% (95% CI: 21.1 to 25.6%). The CHE incidence increased from 2000 to 2017, then decreased over time from 2017 to 2020. From 2000 to 2020, the CHE incidence in rural areas was 25.0% (95% CI: 20.9 to 29.1%) compared to urban 20.9% (95% CI: 18.3 to 23.4%); the CHE incidence in eastern, central and western China was 25.0% (95% CI: 19.2 to 30.8%), 25.4% (95% CI: 18.4 to 32.3%), and 23.1% (95% CI: 17.9 to 28.2%), respectively; the CHE incidence was 30.9% (95% CI: 22.4 to 39.5%), 20.3% (95% CI: 17.0 to 23.6%), 19.9% (95% CI: 15.6 to 24.1%), and 23.7% (95% CI: 18.0 to 29.3%) in poverty group, low-income group, middle-income group, and high-income group, respectively. CONCLUSIONS: In the past two decade, the incidence of CHE in rural areas is higher than that of urban residents; higher in central areas than in eastern, western and other regions; in poverty households than in low-income, middle-income and high-income regions. Further measures should be taken to reduce the incidence of CHE in susceptible people.


Asunto(s)
Reforma de la Atención de Salud , Gastos en Salud , Enfermedad Catastrófica , China/epidemiología , Estatus Económico , Humanos , Factores Socioeconómicos
3.
Soc Sci Med ; 280: 114074, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34051555

RESUMEN

Few studies examine how geographic and non-geographic elements of food access intersect. The purpose of this qualitative study is to explore the relationship between food access, food security, health, and gentrification in the rapidly gentrifying urban centre of Kitchener, Ontario, Canada. Semi-structured interviews were conducted with 20 low-income, longtime residents of Kitchener-Waterloo, and five key informants in the region. This study complicates concepts of food access that focus on density or proximity of (un)healthy food outlets and illustrates the complex decision-making processes of residents in procuring healthy, affordable, and appropriate foods. Race, equity, and food justice-based analysis also illuminate the disproportionate effects of gentrification on racialized residents, who face barriers to obtaining culturally-appropriate foods. These findings expand food access research by showing how individuals creatively cope with and adapt to changes within their food environments. To achieve a multidimensional concept of food access under conditions of gentrification, it is important to build an understanding of individuals' diverse priorities, adaptation strategies, motivations, and behaviours related to food procurement within the context of structural barriers to food security (including urban development practices and social assistance benefit levels). By supporting residents' food agency and food justice in gentrifying cities, it might be possible to develop more effective interventions to support food security and health.


Asunto(s)
Abastecimiento de Alimentos , Remodelación Urbana , Ciudades , Humanos , Ontario , Pobreza
4.
J Glob Health ; 11: 08002, 2021 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-33884194

RESUMEN

Background: To assess the impact of the health care reform on stroke prognoses among low-income Chinese residents. Methods: Stroke events and all-cause deaths were registered during 1992-2018 in Tianjin, China. Trends in stroke management and prognoses were compared during the study periods1992-2008 and 2009-2018. Results: A total of 1462 patients were diagnosed with first-ever stroke during the study periods. For patients aged ≥45 years, the rates of neuroimaging-based diagnoses and hospitalization were greater in 2009-2018 than in 1992-2008, regardless of patient sex or stroke type. Overall, the one-year case fatality rate was significantly lower in 2009-2018 than in the earlier period; the case fatality rate for women aged ≥65 years decreased by 30.0%. Between both periods, the stroke recurrence rate increased 1.9-fold, including a 2.5-fold increase in men (all P < 0.05). During the 2009-2018 period, the one-year case fatality rate was higher among elderly male patients not using medical insurance than among those using it (32.8% vs 20.7%; P = 0.050). After 2009, a significant decline in the recurrence rate (P = 0.001) and a significant increase in the hospitalization rate (P = 0.004) were observed in the interrupted time-series analysis. Conclusions: These findings suggest that the implementation of universal medical insurance for residents in urban and rural China played a major role in improving the prognoses of low-income, rural, first-ever stroke patients, especially for elderly (≥65 years old) residents. However, elderly male patients not using medical insurance benefits had a high case fatality rate. Thus, restructuring of the government medical insurance policy to facilitate its use by low-income, rural residents is crucial for reducing the stroke burden in China.


Asunto(s)
Reforma de la Atención de Salud , Accidente Cerebrovascular , Anciano , China/epidemiología , Femenino , Humanos , Masculino , Pobreza , Pronóstico , Población Rural , Accidente Cerebrovascular/terapia
5.
Int Rev Educ ; : 1-23, 2021 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-33642612

RESUMEN

The COVID-19 pandemic is pushing the world into a devastating economic and social scenario. The consequences of this crisis largely impact children and teenagers, both now and in the future. School closures have particularly affected vulnerable children, deepening the effects of their unequal socio-economic circumstances. In this context, the actions governments are taking to protect their citizens' right to education will be crucial to reducing or exacerbating inequality in the long term. The authors of this article analyse the case of Chile, one of the most successful countries in Latin America regarding educational achievement and enrolment, as well as the most segregated educational system among member countries of the Organisation for Economic Co-operation and Development (OECD). How is the right to education being guaranteed for all during the COVID-19 pandemic? Are the measures taken by the Ministry of Education mitigating or intensifying long-term inequalities? Based on the 4-A scheme described by Katarina Tomasevski, which conceptualises national governments' obligations to guarantee the right to education, the authors examine the normative basis of Chile's market-oriented educational system (1980-2013) as well as the latest educational reform (2014-2017), which aimed to promote the right to quality education, and critically analyse the measures adopted by the Chilean Ministry of Education in response to the pandemic. The authors conclude that Chile is facing a major challenge to ensure the right to education for all. A new social contract is required to reduce structural inequalities, and to avoid a potential setback in human rights.

7.
Int J Equity Health ; 20(1): 30, 2021 01 11.
Artículo en Inglés | MEDLINE | ID: mdl-33430869

RESUMEN

BACKGROUND: Over the years, the Kyrgyz Republic has implemented health reforms that target health financing with the aim of removing financial barriers to healthcare including out-of-pocket health payments (OOPPs). This study examines the trends in OOPPs, and the incidence of catastrophic health expenditure (CHE) post the "Manas Taalimi" and "Den Sooluk" health reforms. METHODS: We used data from the Kyrgyzstan Integrated Household Surveys (2012-2018). Population-weighted descriptive statistics were used to examine the trends in OOPPs and CHE at three thresholds; 10 percent of total household consumption expenditure (Cata10), 25 percent of total household consumption expenditure (Cata25) and 40 percent of total household non-food consumption expenditure (Cata40). Panel and cross-sectional logistic regression with marginal effects were used to examine the predictors of Cata10 and Cata40. FINDINGS: Between 2012 and 2018, OOPPs increased by about US $6 and inpatient costs placed the highest cost burden on users (US $13.6), followed by self-treatment (US $10.7), and outpatient costs (US $9). Medication continues to predominantly drive inpatient, outpatient, and self-treatment OOPPs. About 0.378 to 2.084 million people (6 - 33 percent) of the population incurred catastrophic health expenditure at the three thresholds between 2012 and 2018. Residing in households headed by a widowed or single head, or residing in rural regions, increases the likelihood of incurring catastrophic health expenditure. CONCLUSIONS: The initial gains in the reduction of OOPPs and catastrophic health expenditure appear to gradually erode since costs continue to increase after an initial decline and catastrophic health expenditure continues to rise unabated. This implies that households are increasingly incurring economic hardship from seeking healthcare. Considering that this could result to forgone expenditure on essential items including food and education, efforts should target the sustainability of these health reforms to maintain and grow the reduction of catastrophic health payments and its dire consequences.


Asunto(s)
Enfermedad Catastrófica/economía , Financiación Personal/economía , Gastos en Salud/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Adulto , Enfermedad Catastrófica/psicología , Estudios Transversales , Composición Familiar , Reforma de la Atención de Salud , Financiación de la Atención de la Salud , Humanos , Kirguistán , Modelos Logísticos , Masculino , Población Rural/estadística & datos numéricos , Encuestas y Cuestionarios
8.
Psychiatr Serv ; 72(3): 338-342, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33467868

RESUMEN

OBJECTIVE: The author aimed to assess changes in mental health service use, unmet need for mental health care, and barriers to obtaining care among low-income adults after the implementation of the Affordable Care Act in 2014. METHODS: Data on 15,968 adults with psychological distress and family income <100% of the federal poverty level were drawn from the National Survey on Drug Use and Health, 2009-2018. Health insurance coverage, contact with mental health services, unmet need for mental health care, and self-reported barriers to care were compared between 2009-2013 and 2014-2018. RESULTS: Health insurance coverage increased between 2009-2013 and 2014-2018. However, mental health service use did not change, and unmet need for care modestly decreased. Financial barriers were common and did not change significantly over time. Attitudinal and structural barriers increased. CONCLUSIONS: Further efforts are needed to address the enduring barriers to mental health care among low-income adults.


Asunto(s)
Patient Protection and Affordable Care Act , Distrés Psicológico , Adulto , Reforma de la Atención de Salud , Accesibilidad a los Servicios de Salud , Humanos , Cobertura del Seguro , Seguro de Salud , Medicaid , Salud Mental , Pobreza , Estados Unidos
10.
Fam Med ; 53(1): 48-53, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33471922

RESUMEN

The COVID-19 pandemic, together with its resultant economic downturn, has unmasked serious problems of access, costs, quality of care, inequities, and disparities of US health care. It has exposed a serious primary care shortage, the unreliability of employer-sponsored health insurance, systemic racism, and other dysfunctions of a system turned on its head without a primary care base. Fundamental reform is urgently needed to bring affordable health care that is accessible to all Americans. Over the last 40-plus years, our supposed system has been taken over by corporate stakeholders with the presumption that a competitive unfettered marketplace will achieve the needed goal of affordable, accessible care. That theory has been thoroughly disproven by experience as the ranks of more than 30 million uninsured and 87 million underinsured demonstrates. Three main reform alternatives before us are: (1) to build on the Affordable Care Act; (2) to implement some kind of a public option; and (3) to enact single-payer Medicare for All. It is only the third option that can make affordable, comprehensive health care accessible for our entire population. As the debate goes forward over these alternatives during this election season, the likelihood of major change through a new system of national health insurance is becoming increasingly realistic. Rebuilding primary care and public health is a high priority as we face a new normal in US health care that places the public interest above that of corporate stakeholders and Wall Street investors. Primary care, and especially family medicine, should become the foundation of a reformed health care system.


Asunto(s)
COVID-19 , Medicina Familiar y Comunitaria , Reforma de la Atención de Salud , Sector de Atención de Salud , Disparidades en Atención de Salud/etnología , Atención Primaria de Salud , Calidad de la Atención de Salud , Cobertura Universal del Seguro de Salud , Recesión Económica , Empleo , Tabla de Aranceles , Instituciones Privadas de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Seguro de Salud , Medicare , National Health Insurance, United States , Médicos de Familia/provisión & distribución , Médicos de Atención Primaria/provisión & distribución , SARS-CoV-2 , Desempleo , Estados Unidos
11.
Esc. Anna Nery Rev. Enferm ; 25(4): e20200152, 2021.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1286364

RESUMEN

Resumo Objetivo refletir sobre a figura pública de Florence Nightingale, suas realizações, Reforma Sanitária e a criação da Escola de Enfermeiras, e compreender o nascimento da enfermagem como profissão. Método partiu-se da literatura de um quadro das pressões sociais que agiam sobre o comportamento individual de Florence Nightingale e dos marcos divisórios aparentes, que entendemos como a densidade das relações sócio-históricas, e o seu tempo social. Análise sócio-histórica da história de vida de Florence Nightingale e da literatura social de Charles Dickens. O marco temporal compreendeu da promulgação da New Poor Law (1.834) à revogação (1.601). Resultados Florence Nightingale foi uma mulher adiante do seu tempo que, contrariando as teorias do Darwinismo social de sua época, criou a profissão da enfermeira, e produziu uma clivagem na profissão definindo-a como ciência e arte. Conclusão e implicações para a enfermagem ao criar a figura emblemática da Dama da Lâmpada, Florence Nightingale gravou no cuidado de enfermagem, o zelo, o desvelo e a compaixão, aqui entendida como empatia e piedade com o sofrimento do outro acompanhada do desejo de minorá-lo, uma participação espiritual na dor do outro.


Resumen Objetivo reflexionar sobre la figura pública de Florence Nightingale, sus logros, Reforma Sanitaria y la creación de la Escuela de Enfermeras, y comprender el nacimiento de la enfermería como profesión. Método se partió de la literatura de un cuadro de las presiones sociales sobre el comportamiento individual de Florence Nightingale y de los marcos divisorios aparentes que se entiende como la densidad de las relaciones socio histórico y su tiempo social. Análisis socio histórico de la historia de vida de Florence Nightingale y de la literatura social de Charles Dickens. El marco temporal se comprendió entre la promulgación del New Poor Law en 1834 y su revocación promulgada en 1601. Resultados Florence Nightingale fue una mujer adelante a su tiempo que, contrariando las teorías del Darwinismo social de su época, creó la profesión de enfermera, y produjo una mirada embrionaria en la profesión definiéndola como ciencia y arte. Conclusión e implicaciones para la enfermería al crear la figura emblemática de la Dama de la Lámpara, Florence Nightingale registró en el cuidado de enfermería, el celo, el cuidado y la compasión, entendido aquí como empatía y piedad con el sufrimiento del otro acompañado del deseo de una disminución, una participación espiritual en el dolor del otro.


Abstract Objective to reflect on Florence Nightingale's public figure, her achievements, Health Care Reform and the creation of the School for Nurses, and understand the birth of nursing as a profession. Method a framework of the social pressures acting on Florence Nightingale's individual behavior and the apparent dividing marks, which we understand as the density of socio-historical relations, and her social time, was drawn from the literature. This is a socio-historical analysis of Florence Nightingale's life story and Charles Dickens' social literature. The time frame spanned from the enactment of the New Poor Law (1834) to the repeal (1601). Results Florence Nightingale was a woman ahead of her time who, going against the theories of social Darwinism of her time, created the nurse profession, and produced a divide in the profession by defining it as science and art. Conclusion and implications for nursing by creating the emblematic figure of the Lady of the Lamp, Florence Nightingale engraved in nursing care, zeal, devotion, and compassion, here understood as empathy and pity for the suffering of others accompanied by the desire to alleviate it, a spiritual participation in the pain of others.


Asunto(s)
Humanos , Femenino , Historia del Siglo XIX , Reforma de la Atención de Salud/historia , Descubrimiento del Conocimiento/historia , Historia de la Enfermería , Enfermeras Practicantes/historia , Pobreza/historia , Condiciones Sociales/historia , Identificación Social , Higiene/historia , Agresión , Alcoholismo , Londres
13.
Saúde debate ; 44(spe1): 147-159, Aug. 2020. tab, graf
Artículo en Portugués | LILACS-Express | LILACS, Sec. Est. Saúde SP | ID: biblio-1139587

RESUMEN

RESUMO O relato apresenta a trajetória do movimento Nenhum Serviço de Saúde a Menos (NSSM) no município do Rio de Janeiro, Brasil, em defesa do direito à saúde pública universal. O NSSM é uma frente de ação horizontal envolvendo movimentos sociais em saúde, sindicatos, ativistas em geral, trabalhadores e usuários dos serviços públicos. O movimento utiliza táticas múltiplas como mobilizações territoriais, manifestações, redes sociais, greves, entre outros. Surge como resposta a ataques ao Sistema Único de Saúde (SUS) na cidade em um contexto nacional de crise econômica, política e corte de gastos sociais. Houve diminuição da rede de serviços de Atenção Primária à Saúde, demissões em massa, irregularidades no pagamento de salários e fornecimento de medicamentos e insumos em todos os níveis de atenção. O movimento é analisado à luz dos desafios de mobilização em tempos de precarização do trabalho e dos serviços públicos sob o neoliberalismo. Discute-se as novas formas de organização de movimentos sociais, relacionando-as ao percurso da reforma sanitária brasileira. A principal potência do movimento é a sinergia entre demandas dos trabalhadores da saúde e a defesa de um SUS forte e para todos, ativando vínculos solidários entre os serviços de saúde, profissionais e os diferentes territórios.


ABSTRACT This case study presents the social movement 'Not One Health Service Less' (NSSM) on the defence of the universal right to public health in Rio de Janeiro, Brazil. NSSM is a horizontal front formed by health social movements, unions, activists, workers and users of public health system. The movement uses multiple strategies like local mobilizations, street protests, social networks, strikes, among others. NSSM rises as a response to attacks of the municipal public administration to local health services of the Unified Health System (SUS), in a national context of economic and political crisis. There were budget cuts at Primary Health Care services, dismissals, delays in wages payments, medicines and supplies shortages. The movement was analyzed considering the challenges of social mobilization in times of precarious work conditions and public services precariousness under neoliberalism. We also discuss about new forms of social movement organization, linking it to the trajectory of Brazilian healthcare reform. The ability to create synergies between health workers demands and the defence of a strong and inclusive universal healthcare system is the strongest potentiality of the movement, while activating solidary links between health services, workers and different territories.

14.
Saúde debate ; 44(spe1): 147-159, Aug. 2020. tab, graf
Artículo en Portugués | LILACS-Express | LILACS | ID: biblio-1127478

RESUMEN

RESUMO O relato apresenta a trajetória do movimento Nenhum Serviço de Saúde a Menos (NSSM) no município do Rio de Janeiro, Brasil, em defesa do direito à saúde pública universal. O NSSM é uma frente de ação horizontal envolvendo movimentos sociais em saúde, sindicatos, ativistas em geral, trabalhadores e usuários dos serviços públicos. O movimento utiliza táticas múltiplas como mobilizações territoriais, manifestações, redes sociais, greves, entre outros. Surge como resposta a ataques ao Sistema Único de Saúde (SUS) na cidade em um contexto nacional de crise econômica, política e corte de gastos sociais. Houve diminuição da rede de serviços de Atenção Primária à Saúde, demissões em massa, irregularidades no pagamento de salários e fornecimento de medicamentos e insumos em todos os níveis de atenção. O movimento é analisado à luz dos desafios de mobilização em tempos de precarização do trabalho e dos serviços públicos sob o neoliberalismo. Discute-se as novas formas de organização de movimentos sociais, relacionando-as ao percurso da reforma sanitária brasileira. A principal potência do movimento é a sinergia entre demandas dos trabalhadores da saúde e a defesa de um SUS forte e para todos, ativando vínculos solidários entre os serviços de saúde, profissionais e os diferentes territórios.


ABSTRACT This case study presents the social movement 'Not One Health Service Less' (NSSM) on the defence of the universal right to public health in Rio de Janeiro, Brazil. NSSM is a horizontal front formed by health social movements, unions, activists, workers and users of public health system. The movement uses multiple strategies like local mobilizations, street protests, social networks, strikes, among others. NSSM rises as a response to attacks of the municipal public administration to local health services of the Unified Health System (SUS), in a national context of economic and political crisis. There were budget cuts at Primary Health Care services, dismissals, delays in wages payments, medicines and supplies shortages. The movement was analyzed considering the challenges of social mobilization in times of precarious work conditions and public services precariousness under neoliberalism. We also discuss about new forms of social movement organization, linking it to the trajectory of Brazilian healthcare reform. The ability to create synergies between health workers demands and the defence of a strong and inclusive universal healthcare system is the strongest potentiality of the movement, while activating solidary links between health services, workers and different territories.

15.
Health Hum Rights ; 22(1): 151-161, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32669797

RESUMEN

The social model of disability-which is grounded in the lived realities of disabled people, as well as their activism, research, and theoretical work-has enabled a historic turn in the understanding of disability. This model also facilitates the transition to the rights-based approach that is at the core of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). However, the social model of disability does not straightforwardly translate to the lives of people who end up being detained and forcibly treated in psychiatric facilities. This paper examines the implications of the lack of an equivalent theoretical framework to counteract the hegemony of the biomedical model of "mental illness" and to underpin and guide the implementation of the CRPD for people with psychiatric diagnoses. Critically engaging with some recent attempts to make the CRPD provisions integral to psychiatry, we expose fundamental contradictions inherent in such projects. Our discussion seeks to extend the task of implementation of the CRPD beyond reforming psychiatry, suggesting a much broader agenda for change. We argue for the indispensability of first-person knowledge in developing and owning this agenda and point to the dangers of merely remaking former treatment objects into objects of human rights.


Asunto(s)
Personas con Discapacidad/legislación & jurisprudencia , Derechos Humanos/legislación & jurisprudencia , Trastornos Mentales/terapia , Psiquiatría , Medicina Social , Reforma de la Atención de Salud , Humanos , Inclusión Social , Naciones Unidas
16.
BMC Int Health Hum Rights ; 20(1): 7, 2020 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-32228634

RESUMEN

BACKGROUND: About 5% of the global population, predominantly in low- and middle-income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study assesses the impoverishment resulting from OOP health spending in Ethiopia and the associated factors. METHODS: This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various outpatient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment. RESULTS: Using the Ethiopian national poverty line of Birr 3781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 957,169 individuals) into poverty. At the regional level, impoverishment ranged between 2.35% in Harari and 0.35% in Addis Ababa. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to residing in an urban area. Households headed by males and adults with formal education are less likely to be impoverished by OOP health spending, compared to their counterparts. CONCLUSION: In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lacks financial protection. The estimates of impoverishment from out-of-pocket payments reported in this paper do not consider individuals that are already poor before paying out-of-pocket for health services. It is important to note that this population may either face deepening poverty or forgo healthcare services if a need arises. More is therefore required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.


Asunto(s)
Atención a la Salud , Composición Familiar , Reforma de la Atención de Salud , Gastos en Salud/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Adulto , Etiopía , Femenino , Humanos , Masculino , Población Rural/estadística & datos numéricos , Encuestas y Cuestionarios
17.
J Natl Cancer Inst ; 112(8): 779-791, 2020 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-32277814

RESUMEN

BACKGROUND: Health reform and the merits of Medicaid expansion remain at the top of the legislative agenda, with growing evidence suggesting an impact on cancer care and outcomes. A systematic review was undertaken to assess the association between Medicaid expansion and the goals of the Patient Protection and Affordable Care Act in the context of cancer care. The purpose of this article is to summarize the currently published literature and to determine the effects of Medicaid expansion on outcomes during points along the cancer care continuum. METHODS: A systematic search for relevant studies was performed in the PubMed/MEDLINE, EMBASE, Scopus, and Cochrane databases. Three independent observers used an abstraction form to code outcomes and perform a quality and risk of bias assessment using predefined criteria. RESULTS: A total of 48 studies were identified. The most common outcomes assessed were the impact of Medicaid expansion on insurance coverage (23.4% of studies), followed by evaluation of racial and/or socioeconomic disparities (17.4%) and access to screening (14.5%). Medicaid expansion was associated with increases in coverage for cancer patients and survivors as well as reduced racial- and income-related disparities. CONCLUSIONS: Medicaid expansion has led to improved access to insurance coverage among cancer patients and survivors, particularly among low-income and minority populations. This review highlights important gaps in the existing oncology literature, including a lack of studies evaluating changes in treatment and access to end-of-life care following implementation of expansion.


Asunto(s)
Continuidad de la Atención al Paciente , Accesibilidad a los Servicios de Salud/economía , Medicaid , Neoplasias/terapia , Patient Protection and Affordable Care Act , Continuidad de la Atención al Paciente/economía , Continuidad de la Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/normas , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/métodos , Reforma de la Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en Atención de Salud/economía , Disparidades en Atención de Salud/legislación & jurisprudencia , Disparidades en Atención de Salud/organización & administración , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/legislación & jurisprudencia , Cobertura del Seguro/organización & administración , Medicaid/economía , Medicaid/legislación & jurisprudencia , Medicaid/organización & administración , Grupos Minoritarios/estadística & datos numéricos , Neoplasias/economía , Neoplasias/epidemiología , Patient Protection and Affordable Care Act/economía , Pobreza/economía , Pobreza/estadística & datos numéricos , Medicina Preventiva/economía , Medicina Preventiva/métodos , Medicina Preventiva/organización & administración , Medicina Preventiva/estadística & datos numéricos , Mejoramiento de la Calidad/economía , Mejoramiento de la Calidad/organización & administración , Mejoramiento de la Calidad/normas , Análisis de Supervivencia , Cuidado Terminal/economía , Cuidado Terminal/organización & administración , Cuidado Terminal/normas , Estados Unidos/epidemiología
18.
Int J Soc Psychiatry ; 66(4): 321-330, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32141359

RESUMEN

BACKGROUND AND AIMS: The purpose is to highlight the legal and ethical principles that inspired the reform of mental health care in Italy, the only country to have closed its psychiatric hospitals. The article will also try to verify some macro-indicators of the quality of care and discuss the crisis that the mental health care system in Italy is experiencing. METHODS: Narrative review. RESULTS: The principal changes in the legislation on mental health care in Italy assumed an important role in the evolution of morals and common sense of the civil society of that country. We describe three critical points: first, the differences in implementation in the different Italian regions; second, the progressive lack of resources that cannot be totally attributed to the economic crisis and which has compromised application of the law; and finally, the scarce attention given to measurement of change with scientific methods. CONCLUSION: Italy created a revolutionary approach to mental health care in a historical framework in which it produced impressive cultural expressions in many fields. At that time, people were accustomed to 'believing and doing' rather than questioning results and producing research, and this led to underestimating the importance of a scientific approach. With its economic and cultural crisis, Italy has lost creativity as well as interest in mental health, which has been guiltily neglected. Any future humanitarian approach to mental health must take the Italian experience into account, but must not forget that verification is the basis for any transformation in health care culture.


Asunto(s)
Servicios Comunitarios de Salud Mental/organización & administración , Psiquiatría Comunitaria/organización & administración , Desinstitucionalización/organización & administración , Reforma de la Atención de Salud/organización & administración , Trastornos Mentales/rehabilitación , Servicios Comunitarios de Salud Mental/tendencias , Psiquiatría Comunitaria/tendencias , Desinstitucionalización/tendencias , Recesión Económica , Humanos , Italia , Trastornos Mentales/economía , Calidad de la Atención de Salud/normas
20.
Health Serv Res ; 55(3): 432-444, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-31957022

RESUMEN

OBJECTIVE: To estimate the net effect of living in a gentrified neighborhood on probability of having serious psychological distress. DATA SOURCES: We pooled 5 years of secondary data from the California Health Interview Survey (2011-2015) and focused on southern California residents. STUDY DESIGN: We compared adults (n = 43 815) living in low-income and gentrified, low-income and not gentrified, middle- to high-income and upscaled, and middle- to high-income and not upscaled neighborhoods. We performed a probit regression to test whether living in a gentrified neighborhood increased residents' probabilities of having serious psychological distress in the past year and stratified analyses by neighborhood tenure, homeownership status, and low-income status. Instrumental variables estimation and propensity scores were applied to reduce bias arising from residential selection and simultaneity. An endogenous treatment effects model was also applied in sensitivity analyses. DATA COLLECTION/EXTRACTION METHODS: Adults who completed the survey on their own and lived in urban neighborhoods with 500 or more residents were selected for analyses. Survey respondents who scored 13 and above on the Kessler 6 were categorized as having serious psychological distress in the past year. We used eight neighborhood change measures to classify respondents' neighborhoods. PRINCIPAL FINDINGS: Living in a gentrified and upscaled neighborhood was associated with increased likelihood of serious psychological distress relative to living in a low-income and not gentrified neighborhood. The average treatment effect was 0.0141 (standard error = 0.007), which indicates that the prevalence of serious psychological distress would have been 1.4 percentage points less if none of the respondents lived in gentrified neighborhoods. Gentrification appears to have a negative impact on the mental health of renters, low-income residents, and long-term residents. This effect was not observed among homeowners, higher-income residents, and recent residents. CONCLUSIONS: Gentrification levies mental health costs on financially vulnerable community members and can worsen mental health inequities.


Asunto(s)
Salud Mental/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Estrés Psicológico/epidemiología , Remodelación Urbana/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Adulto Joven
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