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International journal of health services [journal]
- Needs in health care: what beast is that? [Journal Article, Review]
- Int J Health Serv 2013; 43(3):567-85.
Need is a pivotal concept within health systems internationally given its driving force in health care policy, development, and delivery at population and individual levels. Needs assessments are critical activities undertaken to ensure that health services continue to be needed and to identify new target populations that demonstrate unmet need. The concept of need is underpinned by varied theoretical definitions originating from various disciplines. However, when needs are assessed, or health interventions developed based on need, little, if any, detail of the theoretical or conceptual basis of what is being measured is ever articulated. This is potentially problematic and may lead to measurement being invalid and planned health services being ineffective in meeting needs. Seldom are theoretical definitions of need ever compared and contrasted. This critical review is intended to fill this gap in the literature. Interpretations of the concept of need drawing from areas such as psychology, social policy, and health are introduced. The concept and relevance of unmet need for health services are discussed. It is intended that these definitions can be used to operationalize the term "need" in practice, theoretically drive needs assessment, and help guide health care decisions that are based upon need.
- Changes in the health care safety net 1992-2003: disparities in access for uninsured persons in Florida. [Journal Article, Research Support, N.I.H., Extramural]
- Int J Health Serv 2013; 43(3):551-66.
A patchwork of services is available to uninsured in the United States through the health care safety net. During 1996-2003, some safety net hospitals (SNHs) closed or converted their ownership status from public or non-profit to for-profit. Meanwhile, the number of community health centers (CHCs) grew as a result of new federal funding. This article examines the impact of these two countervailing events on access to care for the uninsured. Hospital admissions for ambulatory care sensitive conditions relative to marker conditions were used as our access measure. We examined 35,730 discharges for uninsured adults treated in Florida hospitals in the years 1992 or 2003. A generalized estimating equation model was used to assess differential access effects for racial and ethnic groups. We found that in communities with CHC openings but no SNH contractions, uninsured black and white individuals experienced deteriorations in access over time, but the Hispanic uninsured did not. However, in communities where SNHs closed or converted, access deteriorations occurred for all three racial and ethnic groups. Thus, the potentially beneficial effects of CHC expansions on access to primary care for the uninsured Hispanic population in Florida appeared to be offset if contractions in the hospital safety net were present.
- Egalitarian policies and social determinants of health in Bolivarian Venezuela. [Journal Article, Research Support, Non-U.S. Gov't]
- Int J Health Serv 2013; 43(3):537-49.
In 1999, newly-elected Venezuelan President Hugo Chávez initiated a far-reaching social movement as part of a political project known as the Bolivarian Revolution. Inspired by the democratic ideologies of Simón Bolívar, this movement was committed to reducing intractable inequalities that defined Venezuela's Fourth Republic (1958-1998). Given the ambitious scope of these reforms, Venezuela serves as an instructive example to understand the political context of social inequalities and population health. In this article, we provide a brief overview of the impact of egalitarian policies in Venezuela, stressing: (a) the socialist reforms and social class changes initiated by the Bolivarian Movement; (b) the impact of these reforms and changes on poverty and social determinants of health; (c) the sustainability of economic growth to continue pro-poor policies; and (d) the implications of egalitarian policies for other Latin American countries. The significance and implications of Chávez's achievements are now further underscored given his recent passing, leading one to ask whether political support for Bolivarianism will continue without its revolutionary leader.
- Psychosocial work environment and intention to leave the nursing profession: a cross-national prospective study of eight countries. [Journal Article, Research Support, Non-U.S. Gov't]
- Int J Health Serv 2013; 43(3):519-36.
Many countries throughout the world are facing a serious nursing shortage, and retention of nurses also is a challenge. The aim of this study was to compare the predictive contribution of a broad spectrum of psychosocial work factors, including job strain, effort-reward imbalance, and alternative employment opportunity, to the probability of intention to leave the nursing profession. A total of 7,990 registered female nurses working in hospitals in eight countries (Germany, Italy, France, The Netherlands, Belgium, Poland, Slovakia, and China) were included in the one-year prospective study. A standardized questionnaire on job strain, effort-reward imbalance, employment opportunity, and intention to leave the nursing profession was used in the survey. Multilevel logistic regression modeling was used to analyze the data. Results showed that an imbalance between high effort and low reward (in particular, poor promotion prospects) and good employment opportunity at baseline were independently associated with a new intention to leave the nursing profession at follow-up. However, job strain appeared to have relatively less explanatory power. Findings suggest that interventions to improve the psychosocial work environment, especially the reciprocity experienced between effort and reward, may be effective in improving retention of nurses and tackling the international nursing shortage.
- Social change and women's health. [Journal Article, Research Support, Non-U.S. Gov't]
- Int J Health Serv 2013; 43(3):499-518.
Over the past five decades, the organization of women's lives has changed dramatically. Throughout the industrialized world, paid work and family biographies have been altered as the once-dominant role of homemaker has given way to the role of secondary, dual, or even primary wage-earner. The attendant changes represent a mix of gains and losses for women, in which not all women have benefited (or suffered) equally. But little is known about the health consequences. This article addresses that gap. It develops a "situated biographies" model to conceptualize how life course change may influence women's health. The model stresses the role of time, both as individual aging and as the anchoring of lives in particular historical periods. "Situating" biographies in this way highlights two key features of social change in women's lives: the ambiguous implications for the health of women as a group, and the probable connections to growing social and economic disparities in health among them. This approach lays the groundwork for more integrated and productive population-based research about how historical transformations may affect women's health.
- Health disparities among wage workers driven by employment instability in the Republic of Korea. [Journal Article]
- Int J Health Serv 2013; 43(3):483-98.
Even though labor market flexibility continues to be a source of grave concern in terms of employment instability, as evidenced by temporary employment, only a few longitudinal studies have examined the effects of employment instability on the health status of wage workers. Against this backdrop, this study assesses the manner in which changes in employment type affect the health status of wage workers. The data originate from the Korean Labor and Income Panel Study's health-related surveys for the first through fourth years (n = 1,789; 1998 to 2001). This study estimates potential damage to self-rated health through the application of a generalized estimating equation, according to specific levels of employment instability. While controlling for age, socioeconomic position, marital status, health behavior, and access to health care, the study analysis confirms that changes in employment type exert significant and adverse effects on health status for a given year (OR = 1.47; 95% CII 1.10-1.96), to an extent comparable to the marked effects of smoking on human health (OR = 1.47; 95% CI 1.05-2.04). Given the global prevalence of labor flexibility, policy interventions must be implemented if employment instability triggers broad discrepancies not only in social standing, wage, and welfare benefits, but also in health status.
- Complementarities or contradictions? Scoping the health dimensions of "flexicurity" labor market policies. [Journal Article, Research Support, Non-U.S. Gov't, Review]
- Int J Health Serv 2013; 43(3):473-82.
Flexicurity, or the integration of labor market flexibility with social security and active labor market policies, has figured prominently in economic and social policy discussions in Europe since the mid-1990s. Such policies are designed to transcend traditional labor-capital conflicts and to form a mutually supportive nexus of flexibility and security within a climate of intensified competition and rapid technological change. International bodies have marketed flexicurity as an innovative win-win strategy for employers and workers alike, commonly citing Denmark and The Netherlands as exemplars of best practice. In this article, we apply a social determinants of health framework to conduct a scoping review of the academic and gray literature to: (a) better understand the empirical associations between flexicurity practices and population health in Denmark and (b) assess the relevance and feasibility of implementing such policies to improve health and reduce health inequalities in Ontario, Canada. Based on 39 studies meeting our full inclusion criteria, preliminary findings suggest that flexicurity is limited as a potential health promotion strategy in Ontario, offers more risks to workers' health than benefits, and requires the strengthening of other social protections before it could be realistically implemented within a Canadian context.
- Primary health care, now and forever? A case study of a paradigm change. [Journal Article]
- Int J Health Serv 2013; 43(3):459-71.
The year 2008 marked the 30th anniversary of the Alma Ata Declaration that made Primary Health Care (PHC) the global health policy of member states of the World Health Organization (WHO). Why has PHC remained relevant? In part, this is because of growing evidence that health is a result of social, political, and economic environments, not merely of control of diseases and infirmities through interventions based on biomedical science. Using the conceptual framework developed by Thomas Kuhn, this article traces the emergence of PHC as a new paradigm based on social determinants to address poor health among populations (not individuals), especially those that are low-income. It traces the history of PHC over the last 30 years, focusing on policy developments within WHO. It selects three issues: definitions of PHC; financing and delivery of health services, including lay people's involvement in health care, as examples of the new paradigm; and opposition by those whose concept of health is based on the control of disease and infirmities paradigm. The article concludes by asking whether PHC will continue to be relevant and whether the question mark in the title of this article will be removed in the future.
- Noncommunicable diseases: global health priority or market opportunity? An illustration of the World Health Organization at its worst and at its best. [Journal Article]
- Int J Health Serv 2013; 43(3):437-58.
The promotion of noncommunicable diseases (NCDs) as a global health priority started a decade ago and culminated in a 2011 United Nations high-level meeting. The focus is on four diseases (cardiovascular and chronic respiratory diseases, cancers, and diabetes) and four risk factors (tobacco use, unhealthy diet, physical inactivity, and harmful alcohol use). The message is that disease and death are now globalized, risk factors are overwhelmingly behavioral, and premature NCD deaths, especially in low- and middle-income countries, are the concern. The NCD agenda is promoted by United Nations agencies, foundations, institutes, and organizations in a style that suggests a market opportunity. This "hard sell" of NCDs contrasts with the sober style of the World Health Organization's Global Burden of Disease report, which presents a more nuanced picture of mortality and morbidity and different implications for global health priorities. This report indicates continuing high levels of premature death from infectious disease and from maternal, perinatal, and nutritional conditions in low-income countries and large health inequalities. Comparison of the reports offers an illustration of the World Health Organization at its worst, operating under the influence of the private sector, and at its best, operating according to its constitutional mandate.
- A unifying framework of the demand for transnational medical travel. [Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.]
- Int J Health Serv 2013; 43(3):415-36.
Transnational medical travel has gained attention recently as a strategy for patients to obtain care that is higher quality, costs less, or offers improved access relative to care provided within their home countries. This article examines institutional environments in the European Union and United States that influence transnational medical travel, describes the conceptual model of demand for medical travel, and illustrates individual dimensions in the conceptual model of medical travel using a series of case studies. The conceptual model of medical travel is predicated on Andersen's behavioral model of health services. Transnational medical travel is a heterogeneous phenomenon that is influenced by a number of patient-related factors and by the institutional environment in which the patient resides. While cost, access, and quality are commonly cited factors that influence a patient's decision regarding where to seek care, multiple factors may simultaneously influence the decision about the destination for care, including culture, social factors, and the institutional environment. The conceptual framework addresses the patient-related factors that influence where a patient seeks care. This framework can help researchers and regulatory bodies to evaluate the opportunities and the risks of transnational medical travel and help providers and governments to develop international patient programs.