International journal of health services [journal]
- Gender Policies and Gender Inequalities in Health in Europe: Results of the Sophie Project. [JOURNAL ARTICLE]
- Int J Health Serv 2016 Aug 15.
The aim of this article is to explain the results of the SOPHIE project regarding the effect of gender policies on gender inequalities in health in Europe. We start with the results of a systematic review on how gender regimes and gender equality policies at the country level impact women's health and gender inequalities in health. Then, we report on three empirical analyses on the relationship between different family policy models existing in Europe and gender inequalities in health. Finally we present four case studies on specific examples of gender policies or determinants of gender inequalities in health. The results show that policies that support women's participation in the labor force and decrease their burden of care, such as public services and support for families and entitlements for fathers, are related to lower levels of gender inequality in terms of health. In addition, public services and benefits for disabled and dependent people can reduce the burden placed on family caregivers and hence improve their health. In the context of the current economic crisis, gender equality policies should be maintained or improved.
- Reflections on Participation and Knowledge-Making as Part of India's National Urban Health Mission Technical Resource Group Recommendation Exercise. [JOURNAL ARTICLE]
- Int J Health Serv 2016 Aug 15.
India's urbanization, though precipitous, is undirected, random, and opportunistic, shaped more by pressures than by policies. This has resulted in inequitable access to health services and adverse health outcomes for the urban poor. Late 2013 saw the launch of India's National Urban Health Mission, a broad scheme aimed at prioritizing urban health in the country with an emphasis on the poor. Acknowledging both the diversity and complexity of urban poverty across India's cities, a Technical Resource Group was convened by the Ministry of Health and Family Welfare to support the process. We describe the context surrounding this effort and the procedure followed, which entailed in-depth interactions with the urban poor themselves and with officials, health system actors, civil society, and other stakeholders. Even as recommendations were accepted, given the meager allocation for health in the country, only piecemeal implementation is underway. Thus, policy processes are often a dialectic involving shifts that a range of stakeholders may variably resist or embrace. The most important lesson, however, is that it is both feasible and desirable to engage directly with the community, implementers, and researchers and to negotiate and connect their knowledge in the crafting of public policy.
- Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study. [JOURNAL ARTICLE]
- Int J Health Serv 2016 Aug 12.
Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children's and young adults' receipt of mental health and substance abuse care using nationally representative data from the 2006-2012 Medical Expenditure Panel Surveys. Blacks' and Hispanics' visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services. Disparities were generally larger for young adults than for children. Black and white children had similar psychiatric inpatient and emergency department utilization rates, while Hispanic children had lower hospitalization rates. Multivariate control for mental health impairment, demographics, and insurance status did not attenuate racial/ethnic disparities in outpatient care. We conclude that psychiatric and behavioral problems among minority youth often result in school punishment or incarceration, but rarely mental health care.
- The Trans Pacific Partnership Agreement and Pharmaceutical Regulation in Canada and Australia. [JOURNAL ARTICLE]
- Int J Health Serv 2016 Aug 11.
The Trans Pacific Partnership Agreement (TPP) is a large regional trade agreement involving 12 countries. It was signed in principle in February 2016 but has not yet been ratified in any of the participating countries. The TPP provisions place a range of constraints on how governments regulate the pharmaceutical sector and set prices for medicines. This article presents a prospective policy analysis of the possible effects of the TPP on these two points in Canada and Australia. Five chapters of relevance to pharmaceutical policy are analyzed: chapters on Technical Barriers to Trade (Chapter 8), Intellectual Property (Chapter 18), Investment (Chapter 9), Dispute Resolution (Chapter 28), and an annex of the chapter on Transparency and Anti-Corruption (Chapter 26, Annex 26-A). The article concludes that the TPP could have profound effects on the criteria these countries use to decide on drug safety and effectiveness, how new drugs are approved (or not) for marketing, post-market surveillance and inspection, the listing of drugs on public formularies, and how individual drugs are priced in the future. Furthermore, the TPP, if ratified and enforced, will reduce future policy flexibility to address the increasing challenge of rising drug prices.
- Experiencing Unmet Medical Needs or Delayed Care Because of Cost: Foreign-Born Adults in the U.S. by Region of Birth. [JOURNAL ARTICLE]
- Int J Health Serv 2016 Aug 5.
Healthy People 2020 in the United States highlights timely access to necessary health care as a major factor that can reduce health-related disparities. This study examined the prevalence of delaying/missing necessary health care because of cost among foreign-born adults (26+ years old) in the United States by their region of origin, after controlling for geographic clustering at the county and state levels.Using the pooled 2007-2011 National Health Interview Survey and linked state/county-level data, this study analyzed data on 61,732 foreign-born adults from nine regions of birth. Three-level multilevel modeling (state > county > individual) was conducted. The age-adjusted percentages of foreign-born adults who delayed/missed necessary health care because of cost varied by region of birth, ranging from 7.0% (Southeast Asia) and 11.9% (Europe) to 15.5% (Mexico/Central America/Caribbean) and 16.7% (the Middle East). However, after controlling for geographic clustering and other individual-level covariates (e.g., insurance), adults from Mexico/Central America/Caribbean were less likely to delay or not receive necessary care compared to their counterparts from all other parts of the world except for those from Asian regions. This study implies that disparities can be reduced if some known risk factors (e.g., insurance) are improved among foreign-born adults.
- Cultural Disparities in the Use of Prescription and Nonprescription Medications Among Midlife Women in Israel. [JOURNAL ARTICLE]
- Int J Health Serv 2016 Aug 5.
The study aimed to examine differences in medication use among midlife women from different cultural origins and to identify socio-demographic, health, and lifestyle characteristics associated with prescribed and non-prescribed medication use. Face-to-face interviews with women aged 45-64 years were conducted during 2004-2006 within three population groups: long-term Jewish residents (LTJR), immigrants from the former Soviet Union after 1989, and Arab women. The survey instrument included current use of medications and way of purchasing (with/without prescription). The level of prescribed and non-prescribed medication use was categorized as taking none, taking 1-2, and taking 3 or more medications. The rates of medication use were 59.5% for prescribed medication and 47% for non-prescribed medications. Differences between the minority groups and LTJR were observed mainly for cardiovascular, vitamins, supplements, and hormonal medications. The analyses showed significantly lower use of prescribed medications among immigrants and of non-prescribed medications among Arab women after taking into account health and socioeconomic indicators. Increased use of prescribed and non-prescribed medications was associated with worse health status and older age. Education was associated with increased use of non-prescribed medications. The disparities in pharmaceutical care may be linked to barriers in access to health care and to cultural preferences among minorities.
- An Assessment of the Results of European Parliament Elections in Greece and European Union Under the Shadow of Economic Crisis. [JOURNAL ARTICLE]
- Int J Health Serv 2016 Aug 4.
On January 1, 1981, Greece became the tenth member of the European Economic Community and, 20 years later, on January 1, 2001, joined the euro area. In May of 2010 and February of 2012, Greece signed the first and the second economic adjustment programs and adopted austerity policies throughout the public sector in order to avoid the economic collapse, affecting residents' income and health status. We studied the questionnaires of polls conducted in Greece before the elections of the European Parliament (May 25, 2014) and the "Europeans 2014" Eurobarometer's survey in March of 2014. The responses of Greek voters from the Greek polls were alarming, pointing out their declining personal economic situation and Greece's national economic situation, with a sense that the country was heading in the wrong direction, declaring themselves unsatisfied and insecure. The responses of Greek voters from the "Europeans 2014" survey were even more alarming. Health was the first priority for the voters. As the Greek polls and the Eurobarometer's survey forecasted, but more significantly as the results of the Euro-elections showed, Greek voters preferred to put their hopes in something new.
- Health Promotion and Education: A Study of the Effectiveness of Programs Focusing on the Aging Process. [JOURNAL ARTICLE]
- Int J Health Serv 2016 Aug 2.
Considering the population aging and the failure of biologistic and hospital-based treatment model, health promotion programs based on scientific evidence are necessary. A comprehensive review of literature was performed, aiming to identify and analyze health promotion and education experiments focused on the aging process. Papers published in eight databases, together with the database of the Pan-American Health Organization, were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. A total of 22 studies were included, the majority of which adopted a quantitative approach, with a sample larger than 100 elderly or pre-retirement individuals. The majority of studies reported positive results in terms of health promotion and education. One study obtained minimum improvement and one reported that no statistically significant improvement had occurred. The positive effects most indicated by authors were: general or self-perceived improvement in physical health, improvement in psychosocial aspects and in relation to the aging process, improvement in adherence to preventative actions and in healthy conduct and lifestyle, increase in level of physical activity, improvement in quality of life and/or physical well-being, and improvement in activities of daily living or reduction of the risk of developing disabilities.
- The History and Future of Neoliberal Health Reform: Obamacare and Its Predecessors. [JOURNAL ARTICLE]
- Int J Health Serv 2016 Aug 2.
The Colombian reform of 1994, through a strange historical sequence, became a model for health reform in Latin America, Europe, and the United States. Officially, the reform aimed to improve access for the uninsured and underinsured, in collaboration with the private, for-profit insurance industry. After several historical attempts at health reform adhering to the neoliberal pattern, favored by international financial institutions and multinational insurance corporations, the Affordable Care Act (ACA) similarly enhanced access by corporations to public-sector trust funds. An ideology favoring for-profit corporations in the marketplace justified these reforms through unproven claims about the efficiency of the private sector and enhanced quality of care under principles of competition and business management. The ACA maintains this historical continuity by dealing with health care as a commodity bought and sold in a marketplace, rather than a fundamental human right to be guaranteed according to principles of social solidarity. As the ACA heads toward probable failure, a space finally will open for a U.S. national health program that does not follow same historical patterns of the neoliberal model.
- The Changing Political Undercurrents in Health Services Delivery in Sub-Saharan Africa. [JOURNAL ARTICLE]
- Int J Health Serv 2016 Aug 3.
This article reviews the changing political undercurrent in health service delivery in Sub-Saharan Africa, chronicling the ideological shift in orientation toward neoliberalism in the health sector, an ideology crafted and introduced into Sub-Saharan Africa by the International Monetary Fund and the World Bank. The article examines the implication of this neoliberal reform on the efficiency in health care provision and on the quality and accessibility of health services by the poor and vulnerable. Drawing inference from countries like Nigeria, the authors argue that the ascendency of neoliberalism in the health systems of Sub-Saharan Africa has engendered unethical practices and introduced elements of moral hazard in the health sector, reducing the incentive for governments to develop effective service delivery over the long term. The authors therefore advocate for a rejection of neoliberal ideology in favor of a universal coverage principle if an inclusive health system is to be developed.