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Health Care Equity

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (31 December 2018) | Viewed by 118175

Special Issue Editors

Dr. Shelley White-Means

E-Mail Website
Guest Editor
College of Graduate Health Sciences, The University of Tennessee Health Science Center Memphis, TN 38163, USA
Interests: health disparities; health care disparities; health economics, breast cancer disparities; family caregiving; minority health; implicit bias; long term care for ethnic elderly
Special Issues, Collections and Topics in MDPI journals
Dr. Darrell J. Gaskin

E-Mail Website
Guest Editor
Department of Health Policy and Management, Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins University, 624 N. Broadway, Hampton House 441, Baltimore, Maryland 21205, USA

Special Issue Information

Dear Colleagues,

Health care equity reflects an equal opportunity to utilize health care resources in order to maximize one’s health potential. This potential requires equitable access to and use of preventive, diagnostic, and therapeutic services. Achieving health care equity necessitates the consideration of both quantity and quality of care, as well as vertical (greater health care use by those with greater needs) and horizontal (equal health care use by those with equal needs) equity. Health care inequities may occur due to preferences, constraints, and perceptions of patients, providers, and institutions. Researchers, providers, community leaders, and patients have been working on policies, interventions, and strategies to address health care inequity.

This special issue of the International Journal of Environmental Research and Public Health will document how recent or proposed policy changes and interventions affect health care equity, with emphasis on the roles of biological, behavioral, physical/built environment, sociocultural environment, and healthcare system influences at the individual, interpersonal, community, and societal levels.  Lessons learned across health care settings, geographic regions, and underserved populations will be provided. The National Institute of Minority Health and Health Disparities provides a research framework for understanding the multifaceted domains of influence and levels of influence within domains that facilitate changes in health care equity. Researchers interested in submitting papers for this Special Issue should refer to this framework (https://www.nimhd.nih.gov/about/overview/research-framework.html). Examples of strategies that may influence health care equity include: expansion of Medicaid programs, implementation of the health insurance benefit exchanges, implementation of other provisions of the ACA, efforts to address environmental justice, neighborhood revitalization, community health coalitions, and implementation of precision medicine.

Dr. Shelley White-Means
Dr. Darrell J. Gaskin
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Equity
  • Disparities
  • Health care equity
  • Interventions
  • Policy
  • Health Care system influences

Published Papers (19 papers)

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Editorial

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11 pages, 721 KiB  
Editorial
Intervention and Public Policy Pathways to Achieve Health Care Equity
by Shelley White-Means, Darrell J. Gaskin and Ahmad Reshad Osmani
Int. J. Environ. Res. Public Health 2019, 16(14), 2465; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16142465 - 11 Jul 2019
Cited by 7 | Viewed by 3296
Abstract
Health care equity reflects an equal opportunity to utilize public health and health care resources in order to maximize one’s health potential. Achieving health care equity necessitates the consideration of both quantity and quality of care, as well as vertical (greater health care [...] Read more.
Health care equity reflects an equal opportunity to utilize public health and health care resources in order to maximize one’s health potential. Achieving health care equity necessitates the consideration of both quantity and quality of care, as well as vertical (greater health care use by those with greater needs) and horizontal (equal health care use by those with equal needs) equity. In this paper, we summarize the approaches introduced by authors contributing to this Special Issue and how their work is captured by the National Institute of Minority Health and Health Disparities (NIMHD) framework. The paper concludes by pointing out intervention and public policy opportunities for future investigation in order to achieve health care equity. Full article
(This article belongs to the Special Issue Health Care Equity)

Research

Jump to: Editorial, Review, Other

18 pages, 509 KiB  
Article
No Man is an Island: The Impact of Neighborhood Disadvantage on Mortality
by Darrell J. Gaskin, Eric T. Roberts, Kitty S. Chan, Rachael McCleary, Christine Buttorff and Benjo A. Delarmente
Int. J. Environ. Res. Public Health 2019, 16(7), 1265; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16071265 - 09 Apr 2019
Cited by 20 | Viewed by 2996
Abstract
This study’s purpose is to determine if neighborhood disadvantage, air quality, economic distress, and violent crime are associated with mortality among term life insurance policyholders, after adjusting for individual demographics, health, and socioeconomic characteristics. We used a sample of approximately 38,000 term life [...] Read more.
This study’s purpose is to determine if neighborhood disadvantage, air quality, economic distress, and violent crime are associated with mortality among term life insurance policyholders, after adjusting for individual demographics, health, and socioeconomic characteristics. We used a sample of approximately 38,000 term life policyholders, from a large national life insurance company, who purchased a policy from 2002 to 2010. We linked this data to area-level data on neighborhood disadvantage, economic distress, violent crime, and air pollution. The hazard of dying for policyholders increased by 9.8% (CI: 6.0–13.7%) as neighborhood disadvantage increased by one standard deviation. Area-level poverty and mortgage delinquency were important predictors of mortality, even after controlling for individual personal income and occupational status. County level pollution and violent crime rates were positively, but not statistically significantly, associated with the hazard of dying. Our study provides evidence that neighborhood disadvantage and economic stress impact individual mortality independently from individual socioeconomic characteristics. Future studies should investigate pathways by which these area-level factors influence mortality. Public policies that reduce poverty rates and address economic distress can benefit everyone’s health. Full article
(This article belongs to the Special Issue Health Care Equity)
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12 pages, 298 KiB  
Article
Disentangling Race, Poverty, and Place in Disparities in Physical Activity
by Armani M. Hawes, Genee S. Smith, Emma McGinty, Caryn Bell, Kelly Bower, Thomas A. LaVeist, Darrell J. Gaskin and Roland J. Thorpe, Jr.
Int. J. Environ. Res. Public Health 2019, 16(7), 1193; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16071193 - 03 Apr 2019
Cited by 46 | Viewed by 5403
Abstract
Significant racial disparities in physical activity—a key protective health factor against obesity and cardiovascular disease—exist in the United States. Using data from the 1999–2004 National Health and Nutrition Examination Survey and the 2000 United States (US) Census, we estimated the impact of race, [...] Read more.
Significant racial disparities in physical activity—a key protective health factor against obesity and cardiovascular disease—exist in the United States. Using data from the 1999–2004 National Health and Nutrition Examination Survey and the 2000 United States (US) Census, we estimated the impact of race, individual-level poverty, neighborhood-level poverty, and neighborhood racial composition on the odds of being physically active for 19,678 adults. Compared to whites, blacks had lower odds of being physically active. Individual poverty and neighborhood poverty were associated with decreased odds of being physically active among both whites and blacks. These findings underscore the importance of social context in understanding racial disparities in physical activity and suggest the need for future research to determine specific elements of the social context that drive disparities. Full article
(This article belongs to the Special Issue Health Care Equity)
13 pages, 766 KiB  
Article
The Economic Benefits of Reducing Racial Disparities in Health: The Case of Minnesota
by Marilyn S. Nanney, Samuel L. Myers, Jr., Man Xu, Kateryna Kent, Thomas Durfee and Michele L. Allen
Int. J. Environ. Res. Public Health 2019, 16(5), 742; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16050742 - 01 Mar 2019
Cited by 23 | Viewed by 5280
Abstract
This paper estimates the benefits of eliminating racial disparities in mortality rates and work weeks lost due to illness. Using data from the American Community Survey (2005–2007) and Minnesota vital statistics (2011–2015), we explore economic methodologies for estimating the costs of health disparities. [...] Read more.
This paper estimates the benefits of eliminating racial disparities in mortality rates and work weeks lost due to illness. Using data from the American Community Survey (2005–2007) and Minnesota vital statistics (2011–2015), we explore economic methodologies for estimating the costs of health disparities. The data reveal large racial disparities in both mortality and labor market non-participation arising from preventable diseases and illnesses. Estimates show that if racial disparities in preventable deaths were eliminated, the annualized number of lives saved ranges from 475 to 812, which translates into $1.2 billion to $2.9 billion per year in economic savings (in 2017 medical care inflation-adjusted dollars). After eliminating the unexplained racial disparities in labor market participation, an additional 4,217 to 9185 Minnesota residents would have worked each year, which equals $247.43 million to $538.85 million in yearly net benefits to Minnesota. Full article
(This article belongs to the Special Issue Health Care Equity)
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12 pages, 313 KiB  
Article
Determinants of Overall Satisfaction with Public Clinics in Rural China: Interpersonal Care Quality and Treatment Outcome
by Wenhua Wang, Elizabeth Maitland, Stephen Nicholas and Jeannie Haggerty
Int. J. Environ. Res. Public Health 2019, 16(5), 697; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16050697 - 27 Feb 2019
Cited by 13 | Viewed by 3041
Abstract
The primary health care quality factors determining patient satisfaction will shape patient-centered health reform in China. While rural public clinics performed better than hospitals and private clinics in terms of patient perceived quality of primary care in China, there is little information about [...] Read more.
The primary health care quality factors determining patient satisfaction will shape patient-centered health reform in China. While rural public clinics performed better than hospitals and private clinics in terms of patient perceived quality of primary care in China, there is little information about which quality care aspects drove patients’ satisfaction. Using a World Health Organization database on 1014 rural public clinic users from eight provinces in China, our multiple linear regression model estimated the association between patient perceived quality aspects, one treatment outcome, and overall primary health care satisfaction. Our results show that treatment outcome was the strongest predictor of overall satisfaction (β = 0.338 (95% CI: 0.284 to 0.392); p < 0.001), followed by two interpersonal care quality aspects, Dignity (being treated respectfully) (β = 0.219 (95% CI: 0.117 to 0.320); p < 0.001) and Communication (clear explanation by the physician) (β = 0.103 (95% CI: 0.003 to 0.203); p = 0.043). Prompt attention (waiting time before seeing the doctor) and Confidentiality (talking privately to the provider) were not correlated with overall satisfaction. The treatment outcome focus, and weak interpersonal primary care aspects, in overall patient satisfaction, pose barriers towards a patient-centered transformation of China’s primary care rural clinics, but support the focus of improving the clinical competency of rural primary care workers. Full article
(This article belongs to the Special Issue Health Care Equity)
12 pages, 644 KiB  
Article
Perceived Impact of Taiwan’s National Health Insurance Allocation Strategy: Health Professionals’ Perspective
by Patrick Opiyo Owili, Miriam Adoyo Muga, Ya-Ting Yang and Yi-Hsin Elsa Hsu
Int. J. Environ. Res. Public Health 2019, 16(3), 467; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16030467 - 05 Feb 2019
Cited by 2 | Viewed by 4396
Abstract
Studies on health care demand have indicated high levels of public satisfaction with Taiwan’s National Health Insurance (NHI). However, the global budget allocation mechanism (GBAM) used by NHI has led to various adjustments in the providers’ way of practice, quality of care, utilization [...] Read more.
Studies on health care demand have indicated high levels of public satisfaction with Taiwan’s National Health Insurance (NHI). However, the global budget allocation mechanism (GBAM) used by NHI has led to various adjustments in the providers’ way of practice, quality of care, utilization of care, and health expenditure. Studies focusing on the satisfaction of providers with health care supply, however, remain limited. We therefore explored the provider’s perceived impact of the NHI allocation plan. A cross-sectional data of 299 health professionals was collected at Taipei Medical University Hospitals in April 2012. Perceptions and attitudes were assessed using a validated 5-point Likert-type questionnaire before using a structural equation modeling technique to explore the complex interrelationships of the NHI’s perceived impact. The causal path relationships between the latent variables ‘characteristics of NHI’s allocation plan’ and ‘perceived positive effect’ (β = 0.39), ‘perceived positive effect’ and ‘satisfaction of health professionals’ (β = 0.53), and between ‘characteristics of NHI’s allocation plan’ and ‘satisfaction of health professionals’ (β = 0.30) were positively associated; while the path relationships between the latent variables ‘perceived negative effect’ and ‘satisfaction of health professionals’ (β = −0.27) and ‘characteristics of NHI’s allocation plan’ and ‘attitude toward allocation criteria’ (β = −0.22) were negatively associated. These results indicate that providers perceived a positive impact of the NHI allocation strategy. The NHI allocation plan is an important decision-making tool among policy makers since it helps optimize outcomes. Research based on its impact at both horizontal and vertical levels on the supply side may be useful towards understanding Taiwan’s GBAM. Policy-makers should therefore consider understanding the impact of GBAM at both the demand and supply side in adjusting allocation criteria. Full article
(This article belongs to the Special Issue Health Care Equity)
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12 pages, 306 KiB  
Article
Public Hospitals in China: Is There a Variation in Patient Experience with Inpatient Care
by Wenhua Wang, Ekaterina (Katya) Loban and Emilie Dionne
Int. J. Environ. Res. Public Health 2019, 16(2), 193; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16020193 - 11 Jan 2019
Cited by 7 | Viewed by 3558
Abstract
In China, public hospitals are the main provider of inpatient service. The Chinese public hospital reform has recently shifted towards health care organizations and delivery to improve health care quality. This study analyzes the variation of one of the dimensions of health care [...] Read more.
In China, public hospitals are the main provider of inpatient service. The Chinese public hospital reform has recently shifted towards health care organizations and delivery to improve health care quality. This study analyzes the variation of one of the dimensions of health care quality, patient-centeredness, among inpatients with different socioeconomic status and geographical residency in China. 1471 respondents who received inpatient care in public hospitals were included in our analysis. Patient-centeredness performance was assessed on the dimensions of Communication, Autonomy, Dignity, and Confidentiality. Variations of inpatient experience were estimated using binary logistic regression models according to: residency, region, age, gender, education, income quintile, self-rated health, and number of hospital admissions. Our results indicate that older patients, and patients living in rural areas and Eastern China are more likely to report positive experience of their public hospital stay according to the care aspects of Dignity, Communication, Confidentiality and Autonomy. However, there remains a gap between China and other countries in relation to inpatient experience. Noticeable disparities in inpatient experience also persist between different geographical regions in China. These variations of patient experience pose a challenge that China’s health policy makers would need to consider in their future reform efforts. Full article
(This article belongs to the Special Issue Health Care Equity)
12 pages, 293 KiB  
Article
Is Patient-Provider Racial Concordance Associated with Hispanics’ Satisfaction with Health Care?
by Tunay Oguz
Int. J. Environ. Res. Public Health 2019, 16(1), 31; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16010031 - 24 Dec 2018
Cited by 18 | Viewed by 4545
Abstract
This study adds a gender approach to determine how patient provider racial concordance and acculturation affect Hispanics’ satisfaction with care and inform more nuanced approaches to improving the quality of care for this population. Using the Medical Expenditure Panel Surveys (MEPS) from 2009–2011, [...] Read more.
This study adds a gender approach to determine how patient provider racial concordance and acculturation affect Hispanics’ satisfaction with care and inform more nuanced approaches to improving the quality of care for this population. Using the Medical Expenditure Panel Surveys (MEPS) from 2009–2011, four binary satisfaction outcome measures were created from the MEPS: “doctor showed respect”, “spent enough time”, “explained things in a way you could understand”, and “listened carefully”. Next, a Probit model was employed to estimate the impact of racial concordance and acculturation on the probability of being satisfied with provider care for both male and female Hispanics. For Hispanic women, no significant association was found for the relationship between patient-provider concordance and the overall satisfaction with their care. Hispanic men were found to be less likely to be satisfied with some aspects of their medical care when they were racially concordant with their provider. Overcoming assumptions about shared identity is a crucial step in providing culturally competent care for all patients. There is a need for additional considerations in medical training to help physicians connect with patients, regardless of any type of observable concordance. Full article
(This article belongs to the Special Issue Health Care Equity)
12 pages, 636 KiB  
Article
Sistas Taking a Stand for Breast Cancer Research (STAR) Study: A Community-Based Participatory Genetic Research Study to Enhance Participation and Breast Cancer Equity among African American Women in Memphis, TN
by Alana Smith, Gregory A. Vidal, Elizabeth Pritchard, Ryan Blue, Michelle Y. Martin, LaShanta J. Rice, Gwendolynn Brown and Athena Starlard-Davenport
Int. J. Environ. Res. Public Health 2018, 15(12), 2899; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15122899 - 18 Dec 2018
Cited by 8 | Viewed by 4990
Abstract
African American women are substantially underrepresented in breast cancer genetic research studies and clinical trials, yet they are more likely to die from breast cancer. Lack of trust in the medical community is a major barrier preventing the successful recruitment of African Americans [...] Read more.
African American women are substantially underrepresented in breast cancer genetic research studies and clinical trials, yet they are more likely to die from breast cancer. Lack of trust in the medical community is a major barrier preventing the successful recruitment of African Americans into research studies. When considering the city of Memphis, TN, where the percentage of African Americans is significantly higher than the national average and it has a high rate of breast cancer mortality inequities among African American women, we evaluated the feasibility of utilizing a community-based participatory (CBPR) approach for recruiting African American women into a breast cancer genetic study, called the Sistas Taking A Stand for Breast Cancer Research (STAR) study. From June 2016 and December 2017, African American women age 18 and above were recruited to provide a 2 mL saliva specimen and complete a health questionnaire. A total of 364 African American women provided a saliva sample and completed the health questionnaire. Greater than 85% agreed to be contacted for future studies. Educational workshops on the importance of participating in cancer genetic research studies, followed by question and answer sessions, were most successful in recruitment. Overall, the participants expressed a strong interest and a willingness to participate in the STAR study. Our findings highlight the importance of implementing a CBPR approach that provides an educational component detailing the importance of participating in cancer genetic research studies and that includes prominent community advocates to build trust within the community. Full article
(This article belongs to the Special Issue Health Care Equity)
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11 pages, 301 KiB  
Article
Wealth Inequality as a Predictor of Subjective Health, Happiness and Life Satisfaction among Nepalese Women
by Zhifei He, Zhaohui Cheng, Ghose Bishwajit and Dongsheng Zou
Int. J. Environ. Res. Public Health 2018, 15(12), 2836; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15122836 - 12 Dec 2018
Cited by 24 | Viewed by 4509
Abstract
Socioeconomic status has shown to be associated with subjective health, well-being, satisfaction with overall life and estimation of happiness. The body of research concerning the question of whether higher economic status leads to better health and well-being are mostly from developed countries. The [...] Read more.
Socioeconomic status has shown to be associated with subjective health, well-being, satisfaction with overall life and estimation of happiness. The body of research concerning the question of whether higher economic status leads to better health and well-being are mostly from developed countries. The present study was therefore conducted among women in Nepal with an aim to investigate whether household wealth status is associated with satisfaction about (1) self-reported health, (2) happiness, and (3) life overall. Methods: Subjects were 5226 Nepalese women aged between 15 and 24 years. Cross-sectional data were extracted from round 5 of the Nepal Multiple Indicator Cluster Survey (NMICS), conducted in 2014, and analyzed using chi-square tests of association, bivariate and multivariable regression methods. Results: Wealth status was significantly associated with satisfaction about health, estimation of happiness and satisfaction. Compared with women in the poorest households, the odds of positive estimation about overall happiness were respectively 30% higher for poorer (p < 0.0001; 95% CI = 1.653–3.190), 80% higher for middle (p = 0.001; 95% CI = 1.294–2.522), 64% higher for richer (p = 0.006; 95% CI = 1.155–2.326), and 40% higher for richest households. The odds of reporting satisfaction about life were respectively 97% higher for poorer (p < 0.0001; 95% CI = 1.680–2.317), 41% higher for middle (p < 0.0001; 95% CI = 1.165–1.715), 62% higher for richer (p < 0.0001; 95% CI = 1.313–2.003), and 31% higher for richest households (p = 0.043; 95% CI = 1.008–1.700). Conclusion: Our results conclude that women in households with lower wealth status report poorer subjective health, quality of life and happiness. However, the findings need to be interpreted in light of the existing sociocultural conditions mediating the role of household wealth status on women’s lives. Full article
(This article belongs to the Special Issue Health Care Equity)
13 pages, 765 KiB  
Article
HIV Infection-Related Care Outcomes among U.S.-Born and Non-U.S.-Born Blacks with Diagnosed HIV in 40 U.S. Areas: The National HIV Surveillance System, 2016
by Hanna B. Demeke, Anna S. Johnson, Hong Zhu, Zanetta Gant, Wayne A. Duffus and Hazel D. Dean
Int. J. Environ. Res. Public Health 2018, 15(11), 2404; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15112404 - 30 Oct 2018
Cited by 16 | Viewed by 3481
Abstract
HIV care outcomes must be improved to reduce new human immunodeficiency virus (HIV) infections and health disparities. HIV infection-related care outcome measures were examined for U.S.-born and non-U.S.-born black persons aged ≥13 years by using National HIV Surveillance System data from 40 U.S. [...] Read more.
HIV care outcomes must be improved to reduce new human immunodeficiency virus (HIV) infections and health disparities. HIV infection-related care outcome measures were examined for U.S.-born and non-U.S.-born black persons aged ≥13 years by using National HIV Surveillance System data from 40 U.S. areas. These measures include late-stage HIV diagnosis, timing of linkage to medical care after HIV diagnosis, retention in care, and viral suppression. Ninety-five percent of non-U.S.-born blacks had been born in Africa or the Caribbean. Compared with U.S.-born blacks, higher percentages of non-U.S.-born blacks with HIV infection diagnosed during 2016 received a late-stage diagnoses (28.3% versus 19.1%) and were linked to care in ≤1 month after HIV infection diagnosis (76.8% versus 71.3%). Among persons with HIV diagnosed in 2014 and who were alive at year-end 2015, a higher percentage of non-U.S.-born blacks were retained in care (67.8% versus 61.1%) and achieved viral suppression (68.7% versus 57.8%). Care outcomes varied between African- and Caribbean-born blacks. Non-U.S.-born blacks achieved higher care outcomes than U.S.-born blacks, despite delayed entry to care. Possible explanations include a late-stage presentation that requires immediate linkage and optimal treatment and care provided through government-funded programs. Full article
(This article belongs to the Special Issue Health Care Equity)
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12 pages, 342 KiB  
Article
Economic Crisis and Amenable Mortality in Spain
by Andreu Nolasco, Pamela Pereyra-Zamora, Elvira Sanchis-Matea, Nayara Tamayo-Fonseca, Pablo Caballero, Inmaculada Melchor and Joaquín Moncho
Int. J. Environ. Res. Public Health 2018, 15(10), 2298; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15102298 - 19 Oct 2018
Cited by 13 | Viewed by 3490
Abstract
Background: Both overall mortality and avoidable mortality have decreased in recent years in most European countries. It has become clear that less privileged socioeconomic groups have an increased risk of death. In 2008, most countries went into a severe economic recession, whose effects [...] Read more.
Background: Both overall mortality and avoidable mortality have decreased in recent years in most European countries. It has become clear that less privileged socioeconomic groups have an increased risk of death. In 2008, most countries went into a severe economic recession, whose effects on the health of the population are still ongoing. While on the one hand, some evidence associates the economic crisis with positive health outcomes (pro-cyclical effect), on the other hand, some other evidence suggests that the economic crisis may pose serious public health problems (counter-cyclical effect), which has given rise to controversy. Objectives: To describe the evolution of overall mortality and amenable mortality in Spain between 2002–2007 (before the economic crisis) and 2008–2013 (during the economic crisis), nationally and by province, as well as to analyse trends in the risks of death and their association with indicators of the impact of the crisis. Methods: Ecological study of overall mortality and amenable mortality describing the evolution of the risks of death between 2002–2007 and 2008–2013. Age Standardised Rates were calculated, as well as their percentage change between periods. The association between percentage changes and provincial indicators of the impact of the crisis was analysed. Amenable mortality was studied both overall and categorised into five groups. Results: Amenable mortality represented 8.25% of overall mortality in 2002–2007, and 6.93% in 2008–2013. Age Standardised Rates for overall mortality and global amenable mortality generally declined, with the sharpest decline in amenable mortality. Decreases in overall mortality and amenable mortality were directly related to vulnerability indicators. The most significant decreases were registered in ischaemic heart disease, cerebrovascular disease, and other amenable causes. The relationship with vulnerability indices varied from direct (cancer) to inverse (hypertensive disease). Conclusions: Amenable mortality shows a more significant decrease than overall mortality between both study periods, albeit unevenly between provinces causes of death. Higher vulnerability indicators entail greater declines, although this trend varied for different causes. Mortality trends and their relationship with socioeconomic indicators in a situation of crisis must be conducted cautiously, taking into consideration a possible pro-cyclical effect. Full article
(This article belongs to the Special Issue Health Care Equity)
26 pages, 4543 KiB  
Article
Affordable Care Act and Disparities in Health Services Utilization among Ethnic Minority Breast Cancer Survivors: Evidence from Longitudinal Medical Expenditure Panel Surveys 2008–2015
by Shelley I. White-Means and Ahmad Reshad Osmani
Int. J. Environ. Res. Public Health 2018, 15(9), 1860; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15091860 - 28 Aug 2018
Cited by 20 | Viewed by 4871
Abstract
Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for white and black women but mortality rates are higher for black women. This study draws on rich, nationally representative data, the 2008–2015 Medical Expenditure Panel Surveys, to [...] Read more.
Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for white and black women but mortality rates are higher for black women. This study draws on rich, nationally representative data, the 2008–2015 Medical Expenditure Panel Surveys, to estimate effects of the Affordable Care Act (ACA) on reducing disparities in and access to use of diagnostic and medical services for black and Hispanic breast cancer survivors. Random effects multinomial logit, flexible hurdle and Box-Cox estimation techniques are used. The robust estimates indicate that the ACA narrowed the racial/ethnic disparity in health insurance coverage, health care utilization and out-of-pocket prescription drug expenditures among breast cancer survivors. Gaps in uninsurance significantly declined for black and Hispanic survivors. Hispanic women generally and black breast cancer survivors specifically increased use of mammography services post-ACA. The ACA did not significantly impact disparities in physician utilization or out-of-pocket prescription drug expenditures for Hispanic survivors, while there were substantive improvements for black breast cancer survivors. The paper concludes with a discussion of the strengths and limitations of the ACA for reducing disparities and improving health outcomes for a growing population of breast cancer survivors in the US. Full article
(This article belongs to the Special Issue Health Care Equity)
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12 pages, 311 KiB  
Article
Can Urban-Rural Patterns of Hospital Selection Be Changed Using a Report Card Program? A Nationwide Observational Study
by Tsung-Hsien Yu, Nikolas Matthes and Chung-Jen Wei
Int. J. Environ. Res. Public Health 2018, 15(9), 1827; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15091827 - 24 Aug 2018
Cited by 5 | Viewed by 3199
Abstract
Background: Guiding patients to choose high-quality healthcare providers helps ensure that patients receive excellent care and helps reduce health disparities among patients of different socioeconomic backgrounds. The purpose of this study was to examine and compare the effect of implementing a report-card program [...] Read more.
Background: Guiding patients to choose high-quality healthcare providers helps ensure that patients receive excellent care and helps reduce health disparities among patients of different socioeconomic backgrounds. The purpose of this study was to examine and compare the effect of implementing a report-card program on the patterns of hospital selection in patients from different socioeconomic subgroups. Patients undergoing total knee replacement (TKR) surgery were used as the sample population. Methods: A patient-level, retrospective, observational and cross-sectional study design was conducted. Taiwan National Health Insurance claims data were used and all patients in this database who had received TKR between April 2007–March 2008 (prior to report-card program implementation) and between April 2009–March 2010 (after program implementation) were included. Those patients who were under 18 years of age or who lacked area-of-residence or National Health Insurance premium information were excluded. Travelling distance to the hospital and level of hospital performance were used to evaluate the effect of the report-card program. Results: A total of 32,821 patients were included in this study. The results showed that patterns of hospital selection varied based on the socioeconomic characteristics of patients. In terms of travelling distance and hospital selection, the performance of urban and higher income patients was shorter and better, respectively, than their rural and lower-income peers both before and after report-card-program implementation. Moreover, although the results of multivariate analysis showed that the urban-rural difference in travelling distance enlarged (by 4.75 km) after implementation of the report-card program, this increase was shown to not be significantly related to this program. Furthermore, the results revealed that implementation of the report-card program did not significantly affect the urban-rural difference in terms of level of hospital performance. Conclusions: A successful report-card program should ensure that patients in all socioeconomic groups obtain comprehensive information. However, the results of this study indicate that those in higher socioeconomic subgroups attained more benefits from the program than their lower-subgroup peers. Ensuring that all have equal opportunity to access high-quality healthcare providers may therefore be the next issue that needs to be addressed and resolved. Full article
(This article belongs to the Special Issue Health Care Equity)
12 pages, 718 KiB  
Article
Association between the General Practitioner Workforce Crisis and Premature Mortality in Hungary: Cross-Sectional Evaluation of Health Insurance Data from 2006 to 2014
by János Sándor, Anita Pálinkás, Ferenc Vincze, Valéria Sipos, Nóra Kovács, Tibor Jenei, Zsófia Falusi, László Pál, László Kőrösi, Magor Papp and Róza Ádány
Int. J. Environ. Res. Public Health 2018, 15(7), 1388; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15071388 - 02 Jul 2018
Cited by 11 | Viewed by 3662
Abstract
The workforce crisis of primary care is reflected in the increasing number of general medical practices (GMP) with vacant general practitioner (GP) positions, and the GPs’ ageing. Our study aimed to describe the association between this crisis and premature mortality. Age-sex-standardized mortality for [...] Read more.
The workforce crisis of primary care is reflected in the increasing number of general medical practices (GMP) with vacant general practitioner (GP) positions, and the GPs’ ageing. Our study aimed to describe the association between this crisis and premature mortality. Age-sex-standardized mortality for 18–64 years old adults was calculated for all Hungarian GMPs annually in the period from 2006 to 2014. The relationship of premature mortality with GPs’ age and vacant GP positions was evaluated by standardized linear regression controlled for list size, urbanization, geographical location, clients’ education, and type of the GMP. The clients’ education was the strongest protective factor (beta = −0175; p < 0.001), followed by urban residence (beta = −0.149; p < 0.001), and bigger list size (beta1601–2000 = −0.054; p < 0.001; beta2001−X = −0.096; p < 0.001). The geographical localization also significantly influenced the risk. Although GMPs with a GP aged older than 65 years (beta = 0; p = 0.995) did not affect the risk, GP vacancy was associated with higher risk (beta = 0.010; p = 0.033), although the corresponding number of attributable cases was 23.54 over 9 years. The vacant GP position is associated with a significant but hardly detectable increased risk of premature mortality without considerable public health importance. Nevertheless, employment of GPs aged more than 65 does not impose premature mortality risk elevation. Full article
(This article belongs to the Special Issue Health Care Equity)
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18 pages, 1421 KiB  
Article
Evaluating Disparities in Elderly Community Care Resources: Using a Geographic Accessibility and Inequality Index
by Hui-Ching Wu and Ming-Hseng Tseng
Int. J. Environ. Res. Public Health 2018, 15(7), 1353; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15071353 - 27 Jun 2018
Cited by 41 | Viewed by 5127
Abstract
This study evaluated geographic accessibility and utilized assessment indices to investigate disparities in elderly community care resource distribution. The data were derived from Taiwanese governmental data in 2017, including 3,148,283 elderly individuals (age 65+), 7681 villages, and 1941 community care centers. To identify [...] Read more.
This study evaluated geographic accessibility and utilized assessment indices to investigate disparities in elderly community care resource distribution. The data were derived from Taiwanese governmental data in 2017, including 3,148,283 elderly individuals (age 65+), 7681 villages, and 1941 community care centers. To identify disparities in geographic accessibility, we compared the efficacy of six measurements and proposed a composite index to identify levels of resource inequality from the Gini coefficient and “median-mean” skewness. Low village-level correlation (0.038) indicated inconsistencies between the demand populations and community care center distribution. Method M6 (calculated accessibility of nearest distance-decay accounting for population of villages, supplier loading, and elderly walkability) was identified as the most comprehensive disparity measurement. Community care policy assessment requires a comprehensive and weighted calculation process, including the elderly walkability distance-decay factor, demand population, and supplier loading. Three steps were suggested for elderly policy planning and improvement in future. Full article
(This article belongs to the Special Issue Health Care Equity)
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15 pages, 2039 KiB  
Article
Incorporating Spatial Statistics into Examining Equity in Health Workforce Distribution: An Empirical Analysis in the Chinese Context
by Bin Zhu, Chih-Wei Hsieh and Yue Zhang
Int. J. Environ. Res. Public Health 2018, 15(7), 1309; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15071309 - 22 Jun 2018
Cited by 22 | Viewed by 4547
Abstract
Existing measures of health equity bear limitations due to the shortcomings of traditional economic methods (i.e., the spatial location information is overlooked). To fill the void, this study investigates the equity in health workforce distribution in China by incorporating spatial statistics (spatial autocorrelation [...] Read more.
Existing measures of health equity bear limitations due to the shortcomings of traditional economic methods (i.e., the spatial location information is overlooked). To fill the void, this study investigates the equity in health workforce distribution in China by incorporating spatial statistics (spatial autocorrelation analysis) and traditional economic methods (Theil index). The results reveal that the total health workforce in China experienced rapid growth from 2004 to 2014. Meanwhile, the Theil indexes for China and its three regions (Western, Central and Eastern China) decreased continually during this period. The spatial autocorrelation analysis shows that the overall agglomeration level (measured by Global Moran’s I) of doctors and nurses dropped rapidly before and after the New Medical Reform, with the value for nurses turning negative. Additionally, the spatial clustering analysis (measured by Local Moran’s I) shows that the low–low cluster areas of doctors and nurses gradually reduced, with the former disappearing from north to south and the latter from east to west. On the basis of these analyses, this study suggests that strategies to promote an equitable distribution of the health workforce should focus on certain geographical areas (low–low and low–high cluster areas). Full article
(This article belongs to the Special Issue Health Care Equity)
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Review

Jump to: Editorial, Research, Other

17 pages, 1021 KiB  
Review
STI Health Disparities: A Systematic Review and Meta-Analysis of the Effectiveness of Preventive Interventions in Educational Settings
by Nway Mon Kyaw Soe, Yelena Bird, Michael Schwandt and John Moraros
Int. J. Environ. Res. Public Health 2018, 15(12), 2819; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15122819 - 11 Dec 2018
Cited by 19 | Viewed by 9470
Abstract
The purpose of this systematic review and meta-analysis was to address disparities related to sexual health among students by examining the effectiveness of sexually transmitted infection (STI) preventive interventions in educational settings. PubMed, Medline, Cochrane Library, Public Health Database, and EMBASE databases were [...] Read more.
The purpose of this systematic review and meta-analysis was to address disparities related to sexual health among students by examining the effectiveness of sexually transmitted infection (STI) preventive interventions in educational settings. PubMed, Medline, Cochrane Library, Public Health Database, and EMBASE databases were used to conduct searches. Information relating to studies, programs, participants, and quantitative outcome variables were extracted. Risk of bias was assessed and meta-analysis was conducted. This systematic review included 16 articles. The outcomes were classified into behavioral and psychosocial categories. The behavioral category included sexual partners, sexual activity, condom use, STI/HIV testing, and alcohol/drug use before sex. The psychosocial category consisted of knowledge, motivational factors, and skills. Interventions had a significantly positive impact on both behavioral (OR, 1.28; 95% CI, 1.17–1.39) and psychosocial (OR, 1.92; 95% CI, 1.36–2.72) outcomes. Among the psychosocial outcomes, the interventions were most effective at promoting knowledge (OR, 3.17; 95% CI, 2.13–4.72), followed by enhancing motivational factors (OR, 1.69; 95% CI, 1.04–2.75) and increasing behavioral skills (OR, 1.43; 95% CI, 1.13–1.81). The results of this systematic review provide empirical evidence for public health professionals and policy makers regarding planning, implementation, evaluation, and modification of STI preventive intervention programs in educational settings. Full article
(This article belongs to the Special Issue Health Care Equity)
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Other

26 pages, 363 KiB  
Commentary
Reducing Racial Inequities in Health: Using What We Already Know to Take Action
by David R. Williams and Lisa A. Cooper
Int. J. Environ. Res. Public Health 2019, 16(4), 606; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16040606 - 19 Feb 2019
Cited by 249 | Viewed by 32786
Abstract
This paper provides an overview of the scientific evidence pointing to critically needed steps to reduce racial inequities in health. First, it argues that communities of opportunity should be developed to minimize some of the adverse impacts of systemic racism. These are communities [...] Read more.
This paper provides an overview of the scientific evidence pointing to critically needed steps to reduce racial inequities in health. First, it argues that communities of opportunity should be developed to minimize some of the adverse impacts of systemic racism. These are communities that provide early childhood development resources, implement policies to reduce childhood poverty, provide work and income support opportunities for adults, and ensure healthy housing and neighborhood conditions. Second, the healthcare system needs new emphases on ensuring access to high quality care for all, strengthening preventive health care approaches, addressing patients’ social needs as part of healthcare delivery, and diversifying the healthcare work force to more closely reflect the demographic composition of the patient population. Finally, new research is needed to identify the optimal strategies to build political will and support to address social inequities in health. This will include initiatives to raise awareness levels of the pervasiveness of inequities in health, build empathy and support for addressing inequities, enhance the capacity of individuals and communities to actively participate in intervention efforts and implement large scale efforts to reduce racial prejudice, ideologies, and stereotypes in the larger culture that undergird policy preferences that initiate and sustain inequities. Full article
(This article belongs to the Special Issue Health Care Equity)
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