Inequalities in health and health service utilisation among reproductive age women in St. Petersburg, Russia: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Russian society has faced dramatic changes in terms of social stratification since the collapse of the Soviet Union. During this time, extensive reforms have taken place in the organisation of health services, including the development of the private sector. Previous studies in Russia have shown a wide gap in mortality between socioeconomic groups. There are just a few studies on health service utilisation in post-Soviet Russia and data on inequality of health service use are limited. The aim of the present study was to analyse health (self-rated health and self-reported chronic diseases) and health care utilisation patterns by socioeconomic status (SES) among reproductive age women in St. Petersburg.</p> <p>Methods</p> <p>The questionnaire survey was conducted in 2004 (n = 1147), with a response rate of 67%. Education and income were used as dimensions of SES. The association between SES and health and use of health services was assessed by logistic regression, adjusting for age.</p> <p>Results</p> <p>As expected low SES was associated with poor self-rated health (education: OR = 1.48; personal income: OR = 1.42: family income: OR = 2.31). University education was associated with use of a wider range of outpatient medical services and increased use of the following examinations: Pap smear (age-adjusted OR = 2.06), gynaecological examinations (age-adjusted OR = 1.62) and mammography among older (more than 40 years) women (age-adjusted OR = 1.98). Personal income had similar correlations, but family income was related only to the use of mammography among older women.</p> <p>Conclusions</p> <p>Our study suggests a considerable inequality in health and utilisation of preventive health service among reproductive age women. Therefore, further studies are needed to identify barriers to health promotion resources.</p

Family doctors' involvement with families in Estonia

BACKGROUND: Family doctors should care for individuals in the context of their family. Family has a powerful influence on health and illness and family interventions have been shown to improve health outcomes for a variety of health problems. The aim of the study was to investigate the Estonian family doctors' (FD) attitudes to the patients' family-related issues in their work: to explore the degree of FDs involvement in family matters, their preparedness for management of family-related issues and their self-assessment of the ability to manage different family-related problems. METHODS: A random sample (n = 236) of all FDs in Estonia was investigated using a postal questionnaire. Altogether 151 FDs responded to the questionnaire (response rate 64%), while five of them were excluded as they did not actually work as FDs. RESULTS: Of the respondents, 90% thought that in managing the health problems of patients FDs should communicate and cooperate with family members. Although most of the family doctors agreed that modifying of the health damaging risk factors (smoking, alcohol and drug abuse) of their patients and families is their task, one third of them felt that dealing with these problems is ineffective, or perceived themselves as poorly prepared or having too little time for such activities. Of the respondents, 58% (n = 83) were of the opinion that they could modify also relationship problems. CONCLUSIONS: Estonian family doctors are favourably disposed to involvement in family-related problems, however, they need some additional training, especially in the field of relationship management

An analysis of trends and determinants of health insurance and healthcare utilisation in the Russian population between 2000 and 2004: the 'inverse care law' in action

BACKGROUND: The break-up of the USSR brought considerable disruption to health services in Russia. The uptake of compulsory health insurance rose rapidly after its introduction in 1993. However, by 2000 coverage was still incomplete, especially amongst the disadvantaged. By this time, however, the state health service had become more stable, and the private sector was growing. This paper describes subsequent trends and determinants of healthcare insurance coverage in Russia, and its relationship with health service utilisation, as well as the role of the private sector. METHODS: Data were from the Russia Longitudinal Monitoring Survey, an annual household panel survey (2000-4) from 38 centres across the Russian Federation. Annual trends in insurance coverage were measured (2000-4). Cross-sectional multivariate analyses of the determinants of health insurance and its relationship with health care utilisation were performed in working-age people (18-59 years) using 2004 data. RESULTS: Between 2000 and 2004, coverage by the compulsory insurance scheme increased from 88% to 94% of adults; however 10% of working-age men remained uninsured. Compulsory health insurance coverage was lower amongst the poor, unemployed, unhealthy and people outside the main cities. The uninsured were less likely to seek medical help for new health problems. 3% of respondents had supplementary (private) insurance, and rising utilisation of private healthcare was greatest amongst the more educated and wealthy. CONCLUSION: Despite high population insurance coverage, a multiply disadvantaged uninsured minority remains, with low utilisation of health services. Universal insurance could therefore increase access, and potentially contribute to reducing avoidable healthcare-related mortality. Meanwhile, the socioeconomically advantaged are turning increasingly to a growing private sector

“A memorable consultation”: Writing reflective accounts articulates students’ learning in general practice

The Meeting between the Patient and the Doctor Experiences among Somali refugees and medical trainees Kristian Svenberg Abstract Background and aim. The overall aim of the thesis is to explore the patient‐doctor encounter based on experiences among Somali refugees and medical interns in Sweden. Though research in this area is scarce, it has demonstrated that the transcultural meeting in health care suffers shortcomings. This applies to treatment and rapport as well as to outcomes of treatment and care. Starting from the experiences of medical students reflecting on a memorable consultation (paper I), the thesis illuminates the experiences of health and illness and of encounters with Swedish health care of one group of patients, Somali refugees (papers II, III). The thesis further explores the experiences among Swedish vocational trainees in general practice of their encounters with patients from Somalia (paper IV). Method. The thesis is based on four qualitative studies. In paper I, data was gathered from written reflective accounts. In paper II and III, data was collected through individual interviews and in paper IV through focus group interviews. Data was analysed using qualitative content analysis (paper I), a hermeneutic‐phenomenological methodology (paper II, III) and phenomenography (paper IV). Findings. Paper I. Involving students in writing reflective accounts stimulated them in articulating practice experiences of the consultation. Main themes of students’ learning experiences were “The person beyond symptoms”, “Facing complexity” and “In search of a professional role”. Paper II. Somali refugees were interviewed as to their experiences in relation to health and illness. One essential theme emerged: “a life in exile”. This was expressed in thematic aspects dealing with longing for the homeland, experience of pain, discrimination and the comforting role of religion. Paper III illuminates the experiences of Somali refugees encountering Swedish health care. Ambiguous feelings of high expectations and disappointment were expressed including sentiments of being rejected and not taken seriously, often resulting in a decision to go abroad for medical care. In paper IV, vocational trainees in Swedish general practice give voice to their experiences of meeting Somali patients. In meeting the patient, they faced high expectations and noticed a certain cultural distance. Perceptions of being both pleased and confused were articulated. Obstacles in the meeting were expressed by a majority of the informants, on a linguistic level as well as of intricacies in understanding the patients’ problem in general. To control this situation, some conformed to an authoritarian strategy, whereas others used approaches coined by curiosity. Conclusion. Somali refugee patients, with problems and complaints frequently caused by a life in exile, often experience rejection in the medical encounter. A major finding of the thesis is the importance of seeing the patient as a person, thus throwing light on the complex web of factors influencing the patients’ symptoms. To promote this, strategies of curiosity and an interest in the patients’ personal history should be encouraged among health care providers. Key words. Medical encounter, experience, medical student, vocational trainee, Somali, refugee, health, illness ISBN 978‐91‐628‐8339‐3 http://hdl.handle.net/2077/2796