Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system?

OBJECTIVES: To assess an association of Socio-economic status with utilization of health care services between years 2002 and 2008 in Israel. METHODS: We retrospectively analyzed the utilization of health care services in a cohort of 100,000 members, 21 years and older, of a Clalit Health Services. The research compared utilization according to the neighborhood SES status; and clinic’s location as another SES proxy. Data included: Charlson Score morbidity factor, utilization of health care services (visits to primary physicians and specialists, purchase of pharmaceuticals, number of hospitalization days, visits to ED, utilization of laboratory tests and imaging). The analysis was performed using Generalized Linear Model (GLM) technique. RESULTS: People with lower SES visited more the ED and primary physicians and were hospitalized for longer periods. People with higher SES visited more specialists, bought more prescription drugs and used more medical imaging. The associations between SES and most of the services we analyzed did not change between 2002 and 2008. However, the gap between lower and higher SES levels in ED visits and the use of prescription drugs slightly increased over time, while the gap in visits to specialists decreased. CONCLUSIONS: The research shows that even in a universal health care system SES is associated with utilization of health care services. In order to improve equity in utilization of services the Israeli public health should reduce economic barriers and in parallel invest in making information accessible to improve “navigation skills” for all

The Presidency and the Executive Branch in Latin America: What We Know and What We Need to Know

The presidential politics literature depicts presidents either as all- powerful actors or figureheads and seeks to explain outcomes accordingly. Th e president and the executive branch are nonetheless usually treated as black boxes, particularly i n developing countries, even though the presidency has evolved into an extremely complex branch of government. While these developments have been studied in the U nited States, far less i s known in other countries, particularly in Latin America, where presi dential systems have been considered the source of all goods and evils. To help close the knowledge gap and explore differences in policymaking characteristics not only between Latin America and the US but also across Latin American countries, this paper s ummarizes the vast literature on the organization and resources of the Executive Branch in the Americas and sets a research agenda for the study of Latin American presidencies.Fil: Bonvecchi, Alejandro. Universidad Torcuato Di Tella. Departamento de Ciencia Política y Estudios Internacionales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Scartascini, Juan Carlos. Banco Interamericano de Desarrollo; Estados Unido

The Political Economy of Fiscal Reform in Latin America: The Case of Argentina

This paper investigates the political economy of fiscal reform activism in Argentina since the late 1980s. Between 1988 and 2008, tax legislation was changed 83 times, fiscal federal rules 14 times, and budgetary institutions sixteen times. Tax and budgetary reforms moved from centralizing revenue sources and spending authority in the federal government to mild decentralization lately. Fiscal federal rules combined centralization of revenues and management in the federal government with short-term compensations for the provinces. This paper contends that reform activism can be explained by the recurrence of economic and policy shocks while reform patterns may be accounted for as consequences of the decreasing political integration of national parties in a polity whose decisionmaking rules encourage the formation of oversized coalitions. The decrease in political integration weakened the national party leaderships ability to coordinate intergovernmental bargaining, and strengthened the local bosses and factions needed to form oversized coalitions

The medical text: between biomedicine and hegemony

The unequal distribution of power in contemporary society is reflected and reproduced in medical ideology. The present article analyses some articles from Israeli medical journals in order to show the ways in which biomedicine--the dominant medical ideology--is reinforced through hegemonic discourse. The central ways by which this is achieved are medicalization--which includes the desocialization of disease and the explanation of social phenomena in medical terms--and the affirmation by the Israeli medical literature of national, ethnic, class and gender relationships of domination. Analysis of the Israeli example provides useful insights about biomedicine's desocializing role, as the disregard for the social dimension of disease is particularly telling in a society characterized by several cleavages which determine a clearly unequal distribution of power and resources.Hegemony Biomedicine Medical ideology Israel Palestinians The occupied territories

Is Latin America on the Right Track? An Analysis of Medium-Term Frameworks and the Budget Process

Medium Term Fiscal Frameworks (MTFs) have become one of the most popular reforms to the budgetary process in Latin America during the last decade, and introducing MTFs seemed to be the magic solution for most fiscal ailments. Nonetheless, there has been no comprehensive evaluation of their impact. This document discusses the normative merits of using MTFs, provides a characterization of the different types of MTF, and describes their development in the Latin American region based on extensive field work. As a first approximation for understanding how they are working, this document explores in detail the cases of Argentina, Colombia and Peru. While an unambiguous diagnosis is not possible, this document lays the groundwork for progress toward comprehensive impact evaluations and, eventually, to the consolidation of MTFs in the region