scholarly journals Editorial: Access, affordability and equity

2004 ◽  
Vol 10 (1) ◽  
pp. 7
Author(s):  
Hal Swerissen
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Practice Patterns ◽  
Metropolitan Areas ◽  
Access To Services ◽  
Major Focus ◽  
Health Politics ◽  
Consumer Expectations ◽  
Access And Affordability ◽  
Out Of Pocket Costs

Access and affordability of primary care is currently a major focus of health politics. Bulk-billing rates for GPs have now fallen to around 65%, from a high of about 80% in 1997. A range of factors, including the supply of GPs, changing consumer expectations, shifts in practice patterns, increasing costs and declining relative incomes have probably contributed to the fall in bulk billing. As bulk-billing rates fall, out-of-pocket costs for patients go up and affordability and access to services is reduced, at least for people on lower incomes. Access and affordability are particular problems for people in rural areas where bulk-billing rates are generally 10% to 20% below those in metropolitan areas.

Albania

2021 ◽  
pp. 857-878
Author(s):  
Mirza Balaj
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Medical Practice ◽  
Rural Areas ◽  
Public System ◽  
Health Politics ◽  
The Public ◽  
Democratic System ◽  
Compulsory Health Insurance ◽  
Gradual Expansion

This chapter offers an in-depth look at health politics and the compulsory health insurance system in Albania. It traces the development of the Albanian healthcare system, characterized by the introduction of a universal and state-run health system during communism, which since the 1970s suffered underfinancing and outdated technology. Since the early 1990s, when Albania experienced a tumultuous transition from a communist to a democratic system, Albanian health politics focused on the legalization of private medical practice, the establishment and gradual expansion of compulsory health insurance, and, recently, the introduction of free primary care—reforms which were facilitated by the support of international organizations. Notably, the contracting of private services in the public system was not allowed until 2011. The main healthcare issues have been insufficient financing and extremely high out-of-pocket costs, people refraining from paying insurance contributions, and shortages of medical staff especially in rural areas.

International Telesupervision: The Clinical Fellowship Experience

2017 ◽  
Vol 2 (11) ◽  
pp. 73-78
Author(s):  
David W. Rule ◽  
Lisa N. Kelchner
Keyword(s):  
Graduate Students ◽  
Clinical Supervision ◽  
Rural Areas ◽  
The United States ◽  
Speech Language Pathology ◽  
Access To Services ◽  
East African ◽  
The World ◽  
Language Pathology ◽  
National Certification

Telepractice technology allows greater access to speech-language pathology services around the world. These technologies extend beyond evaluation and treatment and are shown to be used effectively in clinical supervision including graduate students and clinical fellows. In fact, a clinical fellow from the United States completed the entire supervised clinical fellowship (CF) year internationally at a rural East African hospital, meeting all requirements for state and national certification by employing telesupervision technology. Thus, telesupervision has the potential to be successfully implemented to address a range of needs including supervisory shortages, health disparities worldwide, and access to services in rural areas where speech-language pathology services are not readily available. The telesupervision experience, potential advantages, implications, and possible limitations are discussed. A brief guide for clinical fellows pursuing telesupervision is also provided.

scholarly journals The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ingmar Schäfer ◽  
Heike Hansen ◽  
Agata Menzel ◽  
Marion Eisele ◽  
Daniel Tajdar ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Rural Areas ◽  
Longitudinal Observational Study ◽  
Multivariable Analyses ◽  
Gastrointestinal Complaints ◽  
Urban And Rural Areas ◽  
Quota Sampling ◽  
Primary Care Practices

Abstract Objectives The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP. Methods We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices. Results One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001). Conclusions We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.

The Rural-Urban Continuum of Polarization: Understanding the Geography of the 2018 Midterms

The Forum ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kenneth M. Johnson ◽  
Dante J. Scala
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Metropolitan Areas ◽  
Political Attitudes ◽  
The United States ◽  
Rural America ◽  
Rural Regions ◽  
Urban America ◽  
Urban And Rural Areas ◽  
The Continuum

Abstract This study of the 2018 congressional midterms demonstrates how voting patterns and political attitudes vary across a spectrum of urban and rural areas in the United States. Rural America is no more a monolith than is urban America. The rural-urban gradient is better represented by a continuum than a dichotomy. This is evident in the voting results in 2018, just as it was in 2016. We found that the political tipping point lies beyond major metropolitan areas, in the suburban counties of smaller metropolitan areas. Democrats enjoyed even greater success in densely populated urban areas in 2018 than in 2016. Residents of these urban areas display distinctive and consistent social and political attitudes across a range of scales. At the other end of the continuum in remote rural areas, Republican candidates continued to command voter support despite the challenging national political environment. Voters in these rural regions expressed social and political attitudes diametrically opposed to their counterparts in large urban cores.

scholarly journals How long does it take patients to find a new primary care physician when theirs retires: a population-based, longitudinal study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lindsay Hedden ◽  
Megan A. Ahuja ◽  
M. Ruth Lavergne ◽  
Kimberlyn M. McGrail ◽  
Michael R. Law ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Rural Areas ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Care Physician ◽  
Potential Threat ◽  
Patient Age ◽  
Patient Âgé

Abstract Background The retirement of a family physician can represent a challenge in accessibility and continuity of care for patients. In this population-based, longitudinal cohort study, we assess whether and how long it takes for patients to find a new majority source of primary care (MSOC) when theirs retires, and we investigate the effect of demographic and clinical characteristics on this process. Methods We used provincial health insurance records to identify the complete cohort of patients whose majority source of care left clinical practice in either 2007/2008 or 2008/2009 and then calculated the number of days between their last visit with their original MSOC and their first visit with their new one. We compared the clinical and sociodemographic characteristics of patients who did and did not find a new MSOC in the three years following their original physician’s retirement using Chi-square and Fisher’s exact test. We also used Cox proportional hazards models to determine the adjusted association between patient age, sex, socioeconomic status, location and morbidity level (measured using Johns Hopkins’ Aggregated Diagnostic Groupings), and time to finding a new primary care physician. We produce survival curves stratified by patient age, sex, income and morbidity. Results Fifty-four percent of patients found a new MSOC within the first 12 months following their physician’s retirement. Six percent of patients still had not found a new physician after 36 months. Patients who were older and had higher levels of morbidity were more likely to find a new MSOC and found one faster than younger, healthier patients. Patients located in more urban regional health authorities also took longer to find a new MSOC compared to those in rural areas. Conclusions Primary care physician retirements represent a potential threat to accessibility; patients followed in this study took more than a year on average to find a new MSOC after their physician retired. Providing programmatic support to retiring physicians and their patients, as well as addressing shortages of longitudinal primary care more broadly could help to ensure smoother retirement transitions.

Primary Care: The Future for Pediatric Education

PEDIATRICS ◽  
1990 ◽  
Vol 86 (5) ◽  
pp. 653-659
Author(s):  
Joel J. Alpert
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Geographic Location ◽  
Pediatric Care ◽  
Past Century ◽  
Inner Cities ◽  
Critical Issues ◽  
Definition Of ◽  
Care Problems

There is a continuing crisis in primary care, characterized by inadequate numbers of appropriately trained primary care physicians and the failure to mount an effective and consistent graduate educational program for primary care. This paper reviews the history of the primary care crisis; revisits the definition of primary care; and, through identification of critical issues, presents a primary care educational agenda for the 1990s. Pediatrics is at a crossroads regarding primary care, as powerful social and economic forces are impacting on today's major pediatric care problems. Before the second World War there were more than 300 primary care physicians available for each 100 000 of our population. Today the ratio is 75 for 100 000. This is despite the fact that a shortage of 50 000 physicians 10 years ago no longer exists. The majority view is that a physician surplus of 70 000 will be present by the early 1990s.1 Whether there is a surplus is subject to interpretation and the surplus may end up as nonexistent. Moreover, the availability of primary care physicians varies with geographic location, and even a single figure for this nation provides a distorted picture. The shortage is especially serious in inner cities and in many rural areas. In addition, the use of overall numbers assumes that all primary care physicians are appropriately trained in the general disciplines. For the past century, physicians have cared for patients usually as family physicians. Today, however, the generalist has been replaced by the specialist. Is this a function of financial rewards and society's needs and values or the educational experience?

COMMON HEALTH PROBLEMS AND UTILIZATION OF PRIMARY HEALTH CARE SERVICES IN THE RURAL AREAS OF THUA THIEN HUE PROVINCE

2020 ◽  
pp. 62-71
Author(s):  
Tuan Duong Quang ◽  
Anh Le Ho Thi Quynh ◽  
Hung Nguyen Nam ◽  
Tam Nguyen Minh
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Status ◽  
Rural Areas ◽  
Health Problems ◽  
Care Utilization ◽  
Mountainous Area ◽  
Geography Information System ◽  
Care Services ◽  
Geography Information

Although health status in Vietnam has been much improved, people living in rural areas have faced several challenges, including a rapid increase of the aging population, inadequate capacity of health system, and problems of inequities in access to the healthcare system. Objectives: This study aimed to explore the common health problems and health care utilization of people living in the rural areas of Thua Thien Hue province. Methods: A cross-sectional study and geography information system application were carried out. A total of 2.631 individuals in 599 households of a lowland area and a mountainous area was interviewed with a structured questionnaire regarding to health status and health care utilization during the last 6 months. Geography information system software was used to visualize these data of household. Results: 32.8% of participants reported at least an episode of illness within 6 months prior to the interviews. Most of illness people lived in mountainous area. Fever, uncomplicated hypertension, cough, and headache were reported as the most common health problems among participants. Most of participants preferred to visit commune health centers and district hospitals. People in different areas have a significant difference trend from another in choosing health facilities. Conclusion: Residents in difficult-to-reach areas had high prevalence of health problems and experienced social and structural barriers of healthcare services access. It is necessary to improve the availability and quality of primary care services to improve the health status and accessibility of disadvantaged people. Keywords: primary care, utilization, rural areas, health care acessibility

scholarly journals Changing boundaries: Overcoming modifiable areal unit problems related to unemployment data in South Africa

2016 ◽  
Vol Volume 112 (Number 3/4) ◽  
Author(s):  
Gina Weir-Smith ◽  
◽  
Keyword(s):  
South Africa ◽  
Rural Areas ◽  
Census Data ◽  
Metropolitan Areas ◽  
Geographic Area ◽  
Areal Unit ◽  
Areal Interpolation ◽  
Unemployment Data ◽  
Municipal Boundaries ◽  
Longitudinal Comparison

Abstract The longitudinal comparison of census data in spatial format is often problematic because of changes in administrative boundaries. Such shifting boundaries are referred to as the modifiable areal unit problem (MAUP). This article utilises unemployment data between 1991 and 2007 in South Africa to illustrate the challenge and proposes ways to overcome it. Various censuses in South Africa use different reporting geographies. Unemployment data for magisterial districts of census 1991 and 1996 were re-modelled to the 2005 municipal boundaries. This article showed that areal interpolation to a common administrative boundary could overcome these reporting obstacles. The results confirmed more accurate interpolations in rural areas with standard errors below 3300. Conversely, the largest errors were recorded in the metropolitan areas. Huge increases in unemployment between 1996 and 2001 statistics were also evident, especially in the metropolitan areas. Although such areas are more complex in nature, making it more difficult to accurately calculate census data, the increase in unemployment could also be the result of census taking methods. The article concludes that socio-economic data should be available at the smallest possible geographic area to ensure more accurate results in interpolation. It also recommends that new output areas be conceptualised to create a seamless database of census data from 1991 to 2011 in South Africa.

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