scholarly journals Inequities in access to mammographic screening in Brazil

2019 ◽  
Vol 35 (6) ◽  
Author(s):  
Mário Círio Nogueira ◽  
Vívian Assis Fayer ◽  
Camila Soares Lima Corrêa ◽  
Maximiliano Ribeiro Guerra ◽  
Bianca De Stavola ◽  
...  

Abstract: Our objectives with this study were to describe the spatial distribution of mammographic screening coverage across small geographical areas (micro-regions) in Brazil, and to analyze whether the observed differences were associated with spatial inequities in socioeconomic conditions, provision of health care, and healthcare services utilization. We performed an area-based ecological study on mammographic screening coverage in the period of 2010-2011 regarding socioeconomic and healthcare variables. The units of analysis were the 438 health micro-regions in Brazil. Spatial regression models were used to study these relationships. There was marked variability in mammographic coverage across micro-regions (median = 21.6%; interquartile range: 8.1%-37.9%). Multivariable analyses identified high household income inequality, low number of radiologists/100,000 inhabitants, low number of mammography machines/10,000 inhabitants, and low number of mammograms performed by each machine as independent correlates of poor mammographic coverage at the micro-region level. There was evidence of strong spatial dependence of these associations, with changes in one micro-region affecting neighboring micro-regions, and also of geographical heterogeneities. There were substantial inequities in access to mammographic screening across micro-regions in Brazil, in 2010-2011, with coverage being higher in those with smaller wealth inequities and better access to health care.

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sakthivel Selvaraj ◽  
Anup K. Karan ◽  
Wenhui Mao ◽  
Habib Hasan ◽  
Ipchita Bharali ◽  
...  

Abstract Background Health policy interventions were expected to improve access to health care delivery, provide financial risk protection, besides reducing inequities that underlie geographic and socio-economic variation in population access to health care. This article examines whether health policy interventions and accelerated health investments in India during 2004–2018 could close the gap in inequity in health care utilization and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context. Methods Employing Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilization, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used 2 waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus north eastern states and non-focus states. Such categorization facilitates quantification of reform impact of policy level interventions across the three groups. Results Utilisation of healthcare services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had significantly declined during the same period. As far as concentration of healthcare is concerned, the Concentrate Index (CI) underlying inpatient care in public sector fell from 0.07 in 2004 to 0.05 in 2018, implying less pro-rich distribution. The CI in relation to pre-natal, institutional delivery and postnatal services in government facilities were pro-poor both in 2004 and 2018 in all 3 groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, measured by CIs which declined sharply across all groups of states for both outpatient (from 0.21 in 2004 to 0.16 in 2018) and inpatient (from 0.24 in 2004 to 0.14 in 2018) respectively. The CI for subsidy on prenatal services declined from approximately 0.01 in 2004 to 0.12 in 2018. In respect to post-natal care, similar results were observed, implying the subsidy on prenatal and post-natal services was overwhelmingly received by poor. The CI underscoring subsidy for institutional delivery although remained positive both in 2018 and 2004, but slightly increased from 0.17 in 2004 to 0.28 in 2018. Conclusions Improvement in infrastructure and service provisioning through NHM route in the public facilities appears to have relatively benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results.


Author(s):  
Davit Meparishvili ◽  
◽  
Manana Maridashvili ◽  
Ekaterine Sanikidze ◽  
◽  
...  

Assessing the effectiveness of the Georgian healthcare system in the modern period and conditions, takes into account the results achieved, as well as the main problems that hinder the effective functioning of this important field; At the same time, it is important to develop the main directions of their solution, where we consider the improvement of the state policy-making process during the implementation of reforms in the healthcare sector, which should take into account the state of health of the population, quality of healthcare services, results, health care; furthermore disease prevention, equality, financial provision, access to health care, efficiency, rational allocation of health care system resources and other key features of the health care system.


2020 ◽  
Vol 6 (1) ◽  
pp. 103-122
Author(s):  
Kelly Jauding ◽  
Colonius Atang

Penyelidikan Geografi Kesihatan sebagai subdisiplin dalam Geografi Manusia mula berkembang seiring dengan penggunaan kaedah kualitatif  yang semakin popular menjelang tahun 1990-an.  Pengkajian Geografi Kesihatan adalah berfokuskan kepada pemberian makna tempat dan pengaruh persekitaran kepada kesihatan. Pendekatan ini berkontradiksi dengan pendekatan Geografi Perubatan yang melihat tempat hanyalah sebagai ‘kanvas’ dimana peristiwa berlaku. Pemberian makna tempat dalam kajian Geografi Kesihatan menunjukkan bahawa tempat bukan hanya dicirikan oleh sifat fizikal malah juga dicirikan oleh sifat sosiobudaya. Justeru, dalam memahami tentang hasil kesihatan disesebuah tempat, ciri budaya turut perlu diambil kira. Oleh itu, dalam artikel ini elemen sosiobudaya yang mempengaruhi tingkah laku orang asal dalam penjagaan kesihatan akan diulas dengan lebih lanjut. Kepercayaan kesihatan dalam kalangan orang asal didapati adalah bersifat kolektif yang meliputi kesihatan fizikal dan mental, hubungan dengan nenek moyang, komuniti dan alam semula jadi. Manakala elemen sosiobudaya yang mempengaruhi tingkah laku penjagaan kesihatan dalam kalangan orang asal adalah pelbagai seperti batasan bahasa, pendidikan, jaringan keselamatan sosial, pengaruh gender dan sebagainya. Elemen sosiobudaya tersebut didapati menyebabkan halangan akses penjagaan kesihatan dalam kalangan orang asal. Maka itu, intervensi yang berkesan dalam mengatasi halangan tersebut perlulah bersifat holistik dan melibatkan pendekatan transdisiplin bagi meningkatkan keyakinan dan penggunaan orang asal terhadap perkhidmatan penjagaan kesihatan. Health Geography research as a subdiscipline in Human Geography began to grow in line with qualitative methods that became increasingly popular by the 1990s. The study of Health Geography is focused on giving meaning to places and the influence of the environment on health. This approach contradicts the Medical Geography approach, which sees the place only as a 'canvas' where events occur. The definition of place in the study of Health Geography shows that place is not only characterized by physical properties but also characterized by socio-cultural properties. Therefore, in understanding the health outcomes of a place, a place's cultural characteristics should be taken into account. Thus, in this paper, the socio-cultural elements influencing indigenous behavior in health care will be reviewed further. Health beliefs among indigenous peoples were collective in nature, covering physical and mental health, ancestral relationships, community, and nature. At the same time, the socio-cultural elements that influence health care behavior among indigenous people are various such as language limitations, education, social security networks, gender influences, and so on. These socio-cultural elements were found to cause barriers to access to health care among indigenous peoples. Therefore, effective interventions in overcoming these barriers must be holistic and involve a transdisciplinary approach to increase indigenous people's confidence and use in healthcare services.  


2020 ◽  
Author(s):  
Gorgeous Sarah Chinkonono ◽  
Vivian Namuli ◽  
Catherine Atuhaire ◽  
Hamida Massaquoi ◽  
Sourav Mukhopadhyay ◽  
...  

Abstract Background: Individuals who are Deaf or hard of hearing (DHH) face a lot of challenges when accessing health care services. The main barrier that they face is communication. Despite this, not much research had been carried out in Africa to understand how individuals who are DHH access healthcare services. This study sought to explore experiences of individuals who are DHH in Botswana when accessing healthcare services to propose recommendations towards improving their situation.Methods: This is a qualitative research study using phenomenological approach. Participants were observed at one point in time. Face-to-face in-depth interviews were conducted with 22 DHH individuals living in Francistown and Tati, using a semi-structured interview guide and an interpreter. Participants age range was between 18years to 40years. Purposive sampling and snowballing sampling techniques were used to select the participants.Results: The main challenge that individuals who are DHH in Botswana face is communication barrier which has culminated in their reception of poor healthcare services as the healthcare professionals fail to effectively attain to their health needs. This is evident through wrong prescriptions and treatment; poor counselling services, lack of confidentiality; poor maternal health services especially during child delivery; and limited health information. However, individuals who are DHH in Botswana continues to utilise healthcare services.Conclusion: Poor communication between healthcare professionals and individuals who are DHH act as an impediment to acquiring proper healthcare services by individuals who are DHH. This can lead to poor health outcomes for the DHH population as they are not well informed about health issues that they are at risk of and at times do not know where to seek specific healthcare services pertaining to the health problems they are experiencing. Therefore, there is a need to provide sign language interpreters in the healthcare centres to reduce the impact of this problem.


2020 ◽  
Vol 15 (1) ◽  
pp. 35-48 ◽  
Author(s):  
Sasan Rasi

Background: Research has demonstrated lower access to healthcare services by immigrant patients in comparison to native people. Cultural and linguistic differences have been considered as main factors that impede this access and as barriers to creating an effective relationship between immigrant patients and health professionals.  Objective: The aim of this study was to better understand and synthesize the available evidence regarding the impact of immigrant patients’ language proficiency on access to health care. Methods: A systematic literature search was performed to identify studies published between January 2000 and January 2019 that examined the impact of language proficiency on access to and use of health services by immigrant patients. Only articles in English were included. Cross-referencing of the identified articles was also performed.  Results: A total of 140 publications was identified through online databases. In all 24 studies were reviewed, and the results were reported using four interrelated themes identified from the articles. These reports consistently showed a clear association between inadequate language ability and underuse of health care services, ineffective communication, and increased use of emergency care by immigrant patients. Identifying factors that can influence access to care, applying immigrant-friendly solutions such as provision of professional interpreters, and encouraging culturally and linguistically sensitive education may improve the quality of care and increase access to care. One study recommended utilisation of communication technologies such as telemedicine to bridge the communication gap and increase accessibility of healthcare services by immigrant patients.  Conclusions: All included studies indicated that language barriers hindered access to healthcare services. The data resulting from this study can update policy and practical solutions for language barriers on access to care by immigrant patients and provide an agenda for further investigations. 


Author(s):  
André Hajek ◽  
Freia De Bock ◽  
Lothar H. Wieler ◽  
Philipp Sprengholz ◽  
Benedikt Kretzler ◽  
...  

This paper examined the determinants of perceived access to health care use during the COVID-19 pandemic in Germany using data from two waves (8 and 16) of the COVID-19 Snapshot Monitoring (COSMO). Descriptive and regression analysis were used. In wave 8, we found that about 60% of the individuals rather disagreed about having had problems accessing medical care. Furthermore, 73% of the individuals rather disagreed to having experienced health deteriorations due to restrictions on the availability of medical care. Moreover, 85% of the individuals were rather optimistic about future access to healthcare services. Overall, slightly better past and future access to healthcare services has been reported in wave 16. Several determinants were identified in regression analysis. In conclusion, data suggest that perceived past and future access to healthcare services during the COVID-19 pandemic is reasonably good.


2020 ◽  
Vol 46 (2) ◽  
pp. e154
Author(s):  
Alethia Alvarez-Cano ◽  
Dorian Yarih Garcia-Ortega ◽  
Hector Hugo Romero-Garza ◽  
Edson Rene Marcos-Ramirez ◽  
Edelmiro Perez-Rodriguez ◽  
...  

2021 ◽  
Vol 16 (1) ◽  
pp. 86-94
Author(s):  
Sachin Pokharel ◽  
Shiva Raj Acharya ◽  
Sandip Pahari ◽  
Deog Hwan Moon ◽  
Yong Chul Shin

Background: Healthcare financing as a lever to move closer to universal health coverage. Financing health care has been identified as a barrier to access to health care and increases the likelihood of impoverishment of households. There is still limited study and information on healthcare service utilization in the rural community of Nepal. Our study aims to assess utilization of healthcare services & patterns of healthcare expenditure in the rural households of Nepal. Methods: A community-based research study was conducted among 341 rural households of Tanahun District, Nepal. A Chi-square test was used for assessing the associated factors with healthcare utilization. Results: The utilization of in-patient and out-patient health services was 89.9 % and 10.1 % respectively. The majority of households (88%) had in USD less than $410 annual household healthcare expenditure. The mean annual healthcare expenditure was found to be $279. Nearly three-fourths (71.4%) of households had annual expenditure on medicine more than $40 with mostly on allopathic medicine (93.4%). The majority of participants (70%) mentioned that the healthcare expenditure was a burden to their household. Conclusion: Despite the higher knowledge of health insurance, the involvement was found to be very low & poor. Educational status, knowledge about insurance, privileged ethnicity, religion, income source were the major factors associated with the utilization of healthcare services. Awareness & promotion programs focusing on rural communities should be implemented with affordable health services.


2021 ◽  
Vol 9 (01) ◽  
pp. 1039-1055
Author(s):  
Kaoutar Chiheb ◽  
◽  
Mohamed Sbihi ◽  

For equal access to health care and to allow citizens greater access to the health system, Law 65-00 relating to Basic Health Insurance (BHI) was created in Morocco in 2005. The development of this law marks the starting point for all optimized actions with measurable objectives in the health sector. Even if this law has evolved gradually to try to generalize medical coverage, but it currently remains obsolete, because fifteen years after its implementation, it has not allowed the universalization of medical coverage to all citizens. However, further reform is called for. Government, institutions and society are under increasing pressure to ensure further reform. The constraints of implementing solid governance, financing, equal access to healthcare services are challenges to be taken up in order to reform the regulations relating to medical coverage in Morocco.


2021 ◽  
Author(s):  
Tehmina Naseem

This research paper seeks to understand the relationship between an individual’s legal status and their access to Canada’s healthcare system. The level of access of non-citizens to health care in Canada is determined by an individual’s immigration status. Refugees, asylum seekers, temporary foreign workers, and permanent residents are four classes of immigrants that have access to specific health care policies depending on their legal status. Refugees and asylum seekers are eligible under the federal government’s Interim Federal Health Care Program (IFHP) which provides them with access – although limited – to healthcare services in Canada. Conversely, there is not a federal or provincial health care policy that legally provides undocumented migrants with a right to access healthcare without any repercussions. The analysis of policies will reveal the current discourse surrounding citizenship status, legality, and human rights, in addition to the role of the state in exercising power over certain bodies.


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