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Forum: equity in access to health care. Introduction
Travassos, Claudia;
Cadernos de Saúde Pública , 2008, DOI: 10.1590/S0102-311X2008000500023
Abstract: the introduction outlines this issue's special forum on equity in access to health care, including three articles and a postscript. the forum represents a continuation of the debates raised during a seminar organized by the oswaldo cruz foundation in the city of rio de janeiro, brazil, in 2006, in collaboration with unicef, undp, world bank, the who special program for research and training in tropical diseases, and the united nations research institute for social development. the authors approach health care access and equity from a comprehensive and contemporaneous perspective, introducing a new conceptual framework for access, in which information plays a central role. trust is proposed as an important value for an equitable health care system. unethical practices by health administrators and health care professionals are highlighted as hidden critical aspects of inequities in health care. as a whole, the articles represent a renewed contribution for understating inequalities in access, and for building socially just health care systems.
Access and Equity in Basic Education  [cached]
Saqib Shahzad,Riasat Ali,Dr. Hukamdad,Safdar Rehman Ghazi
Asian Social Science , 2010, DOI: 10.5539/ass.v6n8p138
Abstract: Education is the key to development in any society. It is also true to say that the condition of the educational institution in any given society reflects the standard of living and the attitudes towards life of that society. The major purpose of this study was to investigate the access and equity in basic education in Northern. The main objectives of the study were: To assess the extent of availability of primary level schools in West Frontier Province. To compare the reasons of repetition and dropout rates among children at primary level. To understand the views of teachers and parents regarding access and equity in basic education. To recommend some measures for the improvement of basic education in West Frontier Province. Two questionnaires, one for teacher and for parents were administered to collect data. The collected data were tabulated, analyzed and interpreted in the light of objectives of the studies. In the light of conclusions it is recommended that more primary schools should be established for reducing distance from home to school for small children particularly in rural area. Moreover, maximum physical facilities may be provided. Measures should be taken to reduce gender disparity in West Frontier Province. Syllabus may be revised and developed according to the mental level and requirements of the students. Education may be made cheap/free and trained/qualified teachers may be appointed wherever needed.
Equity in access to ARV drugs in Malawi
P R Ntata
SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) , 2007,
Abstract: This paper discusses the issue of equity in the distribution of ARV drugs in the Malawi health system. Malawi is one of the countries most severely affected by HIV/AIDS in southern Africa. It is also one of the poorest countries in the world.ARV drugs are expensive.The Malawi government, with assistance from the Global Fund on Tuberculosis, Malaria and HIV/AIDS, started providing free ARV drugs to eligible HIV-infected people in September 2004.The provision of free drugs brought the hope that everyone who was eligible would access them. Based on data collected through a qualitative research methodology, it was found that achieving equity in provision would face several challenges including policy, operational and socio-economic considerations. Specifically, the existing policy framework, shortage of medical personnel, access to information and inadequacy of effective community support groups are some of the key issues affecting equity. SAHARA J Vol. 4 (1) 2007: pp. 564-574
Gender, sexuality and the discursive representation of access and equity in health services literature: implications for LGBT communities
Andrea E Daley, Judith A MacDonnell
International Journal for Equity in Health , 2011, DOI: 10.1186/1475-9276-10-40
Abstract: A critical discourse analysis of selected health services access and equity documents, using a gender-based diversity framework, was conducted to offer insight into dominant and counter discourses underlying health services access and equity initiatives.A continuum of five discourses that characterize the health services access and equity literature were identified including two dominant discourses: 1) multicultural discourse, and 2) diversity discourse; and three counter discourses: 3) social determinants of health (SDOH) discourse; 4) anti-oppression (AOP) discourse; and 5) citizen/social rights discourse.The analysis offers a continuum of dominant and counter discourses on health services access and equity as determined from a gender-based diversity perspective. The continuum of discourses offers a framework to identify and redress organizational assumptions about, and ideological commitments to, sexual and gender diversity and health services access and equity. Thus, the continuum of discourses may serve as an important element of a health care organization's access and equity framework for the evaluation of access to good quality care for diverse LGBT populations. More specfically, the analysis offers four important points of consideration in relation to the development of a health services access and equity framework.Public health and clinical researchers across a number of countries agree that there is now strong evidence to show that as a population, LGBT people (The acronym LGBT is used in some areas of the paper as a means of including the broad spectrum of sexual and gender identities and communities. During other areas of the paper other acronyms are used, e.g., LG, when referencing research that focuses on the health care experiences of members of some sexual and gender identities and communities and not others) experience significant health inequities with well-documented negative health impacts that include increased risks for chronic disease and ment
Prevalence and Predictors of Polypharmacy among Korean Elderly  [PDF]
Hong-Ah Kim, Ju-Young Shin, Mi-Hee Kim, Byung-Joo Park
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0098043
Abstract: Objective Polypharmacy is widespread in the elderly because of their multiple chronic health problems. The objective of this study was to investigate the prevalence and predictors associated with polypharmacy in a nationally representative sample of Korean elderly individuals. Methods We used the Korea Health Insurance Review and Assessment Service – National Patient Sample (HIRA-NPS) data from 2010 and 2011. We used information on 319,185 elderly patients (aged 65 years or older) between January 1, 2010 and December 31, 2011 from the HIRA-NPS database. We defined ‘polypharmacy’ as the concurrent use of 6 medications or more per person, ‘major polypharmacy’ as 11 medications or more, and ‘excessive polypharmacy’ as 21 medications or more. The frequency and proportion (%) and their 95% confidence intervals were presented according to the polypharmacy definition. Polypharmacy was visualized by the Quantum Geographic Information Systems (QGIS) program to describe regional differences in patterns of drug use. Multivariate ordinal logistic regression was performed to estimate odds ratios (ORs) and their 95% confidence intervals (CI) to investigate the risk factors for polypharmacy. Results Of the Korean elderly studied, 86.4% had polypharmacy, 44.9% had major polypharmacy and 3.0% had excessive polypharmacy. Polypharmacy was found to be primarily concentrated in the Southwest region of the country. Significant associations between polypharmacy and the lower-income Medical Aid population (OR = 1.52, 95% CI 1.47, 1.56) compared with National Health Insurance patients was observed. Conclusions Nationwide efforts are needed for managing polypharmacy among Korean elderly patients. In particular, a national campaign and education to promote appropriate use of medicines for the Medical Aid population is needed.
Barriers to access and the purchasing function of health equity funds: lessons from Cambodia
Bigdeli,Maryam; Annear,Peter Leslie;
Bulletin of the World Health Organization , 2009, DOI: 10.1590/S0042-96862009000700019
Abstract: problem: high out-of-pocket payments and user fees with unfunded exemptions limit access to health services for the poor. health equity funds (hef) emerged in cambodia as a strategic purchasing mechanism used to fund exemptions and reduce the burden of health-care costs on people on very low incomes. their impact on access to health services must be carefully examined. approach: evidence from the field is examined to define barriers to access, analyse the role played by hef and identify how hef address these barriers. local setting: two-thirds of total health expenditure consists of patients' out-of-pocket spending at the time of care, mainly for self-medication and private services. while the private sector attracts most out-of-pocket spending, user fees remain a barrier to access to public services for people on very low incomes. relevant changes: hef brought new patients to public facilities, satisfying some unmet health-care needs. there was no perceived stigma for hef patients but many of them still had to borrow money to access health care. lessons learned: hef are a purchasing mechanism in the cambodian health-care system. they exercise four essential roles: financing, community support, quality assurance and policy dialogue. these roles respond to the main barriers to access to health services. the impact is greatest where a third-party arrangement is in place. a strong and supportive policy environment is needed for the hef to exercise their active purchasing role fully.
THE PRESENT AND THE IMPORTANCE OF SOCIAL ECONOMY IN ENSURING THE EQUITY OF THE ACCESS TO HEALTH SERVICES  [PDF]
Adina Rebeleanu
Revista de Economie Sociala , 2013,
Abstract: It is recognized and accepted that social economy has a significant contribution within the area of social inclusion policies. The intervention areas regarded are extremely diverse: professional education and training, employment policies, social and socio‐medical services, social insurances, the banking and cultural environment,leisure activities, proximity services designed for the population with social exclusion risk etc. This study focuses on some of the ways where social economy mechanisms could be introduced in the field of health protection from Romania.Accepting and recognizing the utility of the mutual insurance type structures is desirable for the increase of the preconditions of a real equity within the access tothe health care services, including the vulnerable groups, without endangering social solidarity, focusing on the service needs and guaranteeing the active participation to the formation and management of the funds thus created.
Equity of access to health care for older adults in four major Latin American cities
Wallace,Steven P.; Gutiérrez,Verónica F.;
Revista Panamericana de Salud Pública , 2005, DOI: 10.1590/S1020-49892005000500012
Abstract: objectives: to identify if older adults have equitable access to health services in four major latin american cities and to determine if the inequities that are found follow the patterns of economic inequality in each of the four nations studied. methods: data from persons age 60 and over in the cities of s?o paulo, brazil (n = 2 143); santiago, chile (n = 1 301); mexico city, mexico (n = 1 247); and montevideo, uruguay (n = 1 450) were collected through a collaboration led by the pan american health organization. for our study, three process indicators of access (availability, accessibility, and acceptability) and one indicator of actual health services use (visit to a medical doctor in the past 12 months) were analyzed by wealth quintiles, health insurance type, education, health status, and demographic characteristics. results: each of the four cities had a different level of access to care, and those levels of access were only weakly related to per capita national wealth. given the relatively high level of wealth inequality in brazil and the lower level in uruguay, older persons in s?o paulo had better-than-expected equity in access to care, while older persons in montevideo had less equity than expected. inequity in mexico city was driven primarily by low levels of health insurance coverage. in santiago, inequity followed socioeconomic status more than it did health insurance. conclusions: in the four cities studied, health insurance and the operation of health systems mediate the link between economic inequality and inequitable access to health care. therefore, special attention needs to be paid to equity of access in health services, independent of differences in economic inequality and national wealth.
ACCESS AND EQUITY: Challenges for Open and Distance Learning
TOJDE
The Turkish Online Journal of Distance Education , 2008,
Abstract: "The emergence of the system of open and distance education is an inevitable and phenomenal evolution in the history of educational developments internationally. While the formal system of education continues to be the mainstream of educational transaction, it has its inherent limitations with regard to expansion, provision of access and equity and cost-effectiveness. On the other hand, the growth of information and communication technologies has facilitated the expansion of distance mode of education. It is now possible to adopt flexible, constructivist, learner-friendly and multi-perspective approaches to teaching-learning, so essential for nurturing creativity, leadership, scholarship and integrated development of human personality.
Spatial analysis of elderly access to primary care services
Lee R Mobley, Elisabeth Root, Luc Anselin, Nancy Lozano-Gracia, Julia Koschinsky
International Journal of Health Geographics , 2006, DOI: 10.1186/1476-072x-5-19
Abstract: We examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas.The relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across the landscape may not be optimal. The finding that elderly who reside in sprawling urban areas have access impediments about equal to residents of poor rural communities is new, and demonstrates the value of conceptualizing and modelling impedance based on place and local context.This section is provided for readers with no background understanding of U.S. health insurance markets. The U.S. has many forms of private and public health insurance, with different levels of regulatory control and oversight. Persons over age 64 who have contributed to the Social Security (retirement income) System during their working years are entitled to Medicare health insurance; when they enroll they become Medic
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