Intersecting Positions of Social Disadvantage and Self-Reported Health Status Disparities

Health disparities along the gender, race and class are particularly important to monitor and study given the predicted differential distribution of health along these social identities. Intersectionality is a theoretical framework that allows public health and health disparities researchers to account for the simultaneous, mutually constitutive, reinforcing and multidimensional effects of gender, class, and race with the aim to better understand health disparities. Disparities along gender, race and class have been noted in self-reported health status (SRHS) which has been shown to be a strong predictive factor of mortality, morbidity and mental health independent of other physiologic, behavioral and psychosocial risk factors. To assess SRHS disparities through an intersectional lens, a quantitative application of the framework was applied to a secondary data analysis of the 2010 Medical Expenditure Panel Survey (MEPS) Household Component. Two models were constructed to assess the relationship between the probability of reporting a poor/fair health status and two versions of a variable denoting socially disadvantaged populations. The first model explored the relationship between poor/fair health status and a variable of interest that denoted low-income females of any minority racial group where the referent comprised of those individuals who did not meet the socially disadvantaged criteria for the model. The second model explored the relationship between poor/fair health status and a variable of interest that identified low-income females of five different racial groups (White, Black, Asian, Native [NativeAmerican/Alaskan Native & Native Hawaiian & other Pacific Islander], and Multiracial) compared to the referent (which was composed of those who did not meet the criteria to be in any of the social disadvantaged groups pertaining to the model). The models were estimated using survey-weighed logit regression with average marginal effects at varying levels of age (25, 45, and 65) and years of education (12 or 16 years). Results show that for the two models the social disadvantage variables had a positive relationship with the probability of reporting a poor/fair health status. For both models, the magnitude of the social disadvantage effect on the probability of reporting a poor/fair health status increased with age and was moderated by education levels, with higher levels of education reducing the magnitude of the social disadvantage effect. The second model results show that Black low-income females had an almost ten percentage point increase in the probability of reporting a poor or fair health status compared to the referent, the largest magnitude noticed in the results. It is important to study the joint effects of the social positions occupied by those bearing the burden of health disparities; applying the intersectional framework may elucidate on new ways to present, address and target health disparities. Keywords: Health Disparities, Health Inequities, Intersectionality, Social Disadvantage, Self-Reported Health Statu

Equity in out-of-pocket payment in Chile

OBJECTIVE To assess the distribution of financial burden in Chile, with a focus on the burden and progressivity of out-of-pocket payment. METHODS Based on the principle of ability to pay, we explore factors that contribute to inequities in the health system finance and issues about the burden of out-of-pocket payment, as well as the progressivity and redistributive effect of out-of-pocket payment in Chile. Our analysis is based on data from the 2006 National Survey on Satisfaction and Out-of-Pocket Payments. RESULTS Results from this study indicate evidence of inequity, in spite of the progressivity of the healthcare system. Our analysis also identifies relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. CONCLUSIONS In order to reduce the detected disparities among income groups, healthcare priorities should target low-income groups. Furthermore, policies should explore changes in the access to education and its impact on equity

Equity in health care utilization in Chile

One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly.Keywords: Country, Model, Medical care, Inequalities, Acces

How household healthcare expenditures redistribute disposable income? An analysis using Bangladesh household income and expenditure survey, 2010.

Essential healthcare is a civil right. Payments toward healthcare is a moral compulsion, and no less strong than legal compulsion like income tax. Healthcare payments can redistribute disposable income. Redistribution may be vertical (from rich to poor or opposite) and horizontal (from men to women or from households without children to households with children). Health planners are interested in degrees to which redistribution occurs. In this paper, we aim to analyze how well different forms of healthcare payments in Bangladesh redistribute disposable income. Our data comes from Bangladesh Household Income and Expenditure Survey, 2010. Using the methods developed by Aronson et al. (1994), we assessed average rate effect, progressivity, horizontal equity and re-ranking. The results suggest that Bangladesh health systems finance has a pro-rich redistribution of disposable income. Post-payment disposable income decreases for the poor and increases for the rich. As a result, the poor are in a shortfall in disposable income, which ultimately get them to impoverishment, and or push them to deeper poverty. On the contrary, the rich become richer due to increase in post-payment disposable income. This leads to an increase in inequality

Consideraciones para la transformación del sistema de salud del Ecuador desde una perspectiva de equidad

Objectivo: El propósito del presente estudio es analizar las inequidades socioeconómicas en la utilización de servicios de salud en el Ecuador, las inequidades en la distribución geográfica de recursos humanos en salud, y reflexionar sobre los retos de equidad que el sistema de salud ecuatoriano enfrenta en la actualidad. Métodos: Se utilizó la Encuesta Demográfica y de Salud Materno-Infantil (ENDEMAIN 2004) como la principal fuente de datos, cuya muestra es representativa de la población ecuatoriana. Para estimar los efectos en utilización de servicios de salud utilizamos análisis multivariado multinivel (usando el paquete estadístico MLWiN 2.02) y análisis espacial de recursos en salud (usando GeoDa 1.0.1 ). Resultados: Nuestro análisis encontró que inequidades sociales, económicas y geográficas limitan el acceso a servicios de salud en el Ecuador. Hogares de bajos recursos, indígenas y aquellos que viven enáreas rurales (muchos con las tres características a la vez) tienen menos posibilidades de utilizar servicios de salud. A pesar de la marcada concentración de proveedores de salud en zonas urbanas, encontramos que la presencia de personal de salud (excluyendo a médicos) en entidades públicas rurales incrementa la posibilidad de utilización de servicios preventivos y curativos. Conclusiones: Los esfuerzos para transformar el sistema de salud deben reducir barreras sociales, culturales, financieras; y las desigualdades en la distribución de recursos humanos en salud, particularmente en elárea rural. Consideramos que la orientación comunitaria y familiar de los servicios, y el incremento de espacios de participación ciudadana son necesarios para reducir dichas inequidades.OBJECTIVE: The present study was aimed at analysing socioeconomic inequity regarding the use of health services in Ecuador, inequity regarding the geographic distribution of healthcare-related human resources and reflecting on the challenges concerning equity which the Ecuadorian health system is currently facing. METHODS: The Ecuadorian Demographic, Maternal and Infant Health Survey (2004) was used as the main data source, as its sample was representative of the Ecuadorian population. Multilevel multivariate analysis (MLWiN 2.02 statistical software) and spatial data analysis regarding health resources (GeoDa 1.0.1) were used for estimating the effects of using health services. RESULTS: It was found that social, economic and geographic inequity limited access to health services in Ecuador. People living in low economic resource households or indigenous housing and people living in rural areas (many of them having all three characteristics at the same time) had less possibility of using health services. In spite of a marked concentration of health-service providers in urban areas, it was found that the presence of healthcare personnel (excluding doctors) in rural public entities increased the possibility of using preventative and curative services. CONCLUSIONS: Efforts at transforming the Ecuadorian health system must be aimed at reducing social, cultural and financial barriers and inequality regarding the distribution of healthcare-related human resources, particularly in rural areas. Community and family orientation of the services and increasing spaces for citizen participation are necessary for reducing such inequity.This is the publisher’s final pdf. The published article is copyrighted by the Universidad Nacional de Colombia and can be found at: http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0124-0064&lng=en&nrm=iso.Keywords: Healthcare-based resources, Health service accessibility, Health service, Health equity, Servicios de salud, Accesibilidad a los servicios de salud, Recursos en salud, Equidad en salu

Assessing the context of health care utilization in Ecuador: A spatial and multilevel analysis

<p>Abstract</p> <p>Background</p> <p>There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services.</p> <p>Methods</p> <p>This study is cross-sectional and analyzes data from the 2004 National Demographic and Maternal & Child Health dataset. Provider variables come from the Ecuadorian System of Social Indicators (SIISE). Global Moran's I statistic is used to assess spatial autocorrelation of the provider variables. Multilevel modeling is used for the simultaneous analysis of provision of services at the province-level with use of services at the individual level.</p> <p>Results</p> <p>Spatial analysis indicates no significant differences in the density of health care providers among Ecuadorian provinces. After adjusting for various predisposing, enabling, need factors and interaction terms, density of public practice health personnel was positively associated with use of preventive care, particularly among rural households. On the other hand, density of private practice physicians was positively associated with use of curative care, particularly among urban households.</p> <p>Conclusions</p> <p>There are significant public/private, urban/rural gaps in provision of services in Ecuador; which in turn affect people's use of services. It is necessary to strengthen the public health care delivery system (which includes addressing distribution of health workers) and national health information systems. These efforts could improve access to health care, and inform the civil society and policymakers on the advances of health care reform.</p

Integrating traditional medicine into modern health care systems: Examining the role of Chinese medicine in Taiwan

Since the World Health Organization officially promoted traditional medicine in developing countries in 1978, there have been increasing interests among developing countries in integrating traditional medicine into a national health care system. Most of these policies, however, tend to be the policy of coexistence instead of integration. This paper focuses on the rationale, strategies, and process of integrating traditional medicine into a modern health care system by using the experience of Chinese medicine in Taiwan as an example. After briefly describing the changing roles of Chinese medicine in Taiwan, the author critically reviews the government policies and regulations on Chinese medicine. Research findings and government statistics on the demand and supply of Chinese medicine are also described to provide some insights for developing recommendations for an appropriate integration policy. To effectively integrate traditional medicine into a modern health care system, this paper suggests that such integration should begin at the grass roots level, that is with the training of physicians and practitioners. A successful, integrated health care system would facilitate more efficient use of domestic medical resources, and enhance self-sufficiency in health development for resource poor countries. Integrating traditional medicine into a modern health care system, moreover, can benefit industrialized nations as well. After recommending several strategies for integration, the author proposes a further development of a unified medical system as the final stage of full integration. This unified medical system should be an inclusive medical system, which could help countries to expand the available medical resources.traditional medicine Chinese medicine integration of traditional medicine Taiwan

Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing

Abstract Background The relationship between payments towards healthcare and ability to pay is a measure of financial fairness. Analysis of progressivity is important from an equity perspective as well as for macroeconomic and political analysis of healthcare systems. Bangladesh health systems financing is characterized by high out-of-pocket payments (63.3%), which is increasing. Hence, we aimed to see who pays what part of this high out-of-pocket expenditure. To our knowledge, this was the first progressivity analysis of health systems financing in Bangladesh. Methods We used data from Bangladesh Household Income and Expenditure Survey, 2010. This was a cross sectional and nationally representative sample of 12,240 households consisting of 55,580 individuals. For quantification of progressivity, we adopted the ‘ability-to-pay’ principle developed by O’Donnell, van Doorslaer, Wagstaff, and Lindelow (2008). We used the Kakwani index to measure the magnitude of progressivity. Results Health systems financing in Bangladesh is regressive. Inequality increases due to healthcare payments. The differences between the Gini coefficient and the Kakwani index for all sources of finance are negative, which indicates regressivity, and that financing is more concentrated among the poor. Income inequality increases due to high out-of-pocket payments. The increase in income inequality caused by out-of-pocket payments is 89% due to negative vertical effect and 11% due to horizontal inequity. Conclusions Our findings add substantial evidence of health systems financing impact on inequitable financial burden of healthcare and income. The heavy reliance on out-of-pocket payments may affect household living standards. If the government and people of Bangladesh are concerned about equitable financing burden, our study suggests that Bangladesh needs to reform the health systems financing scheme