scholarly journals Measuring inequity in using routinely collected data in an emergency setting: a systematic review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Morisod ◽  
X Luta ◽  
J Marti ◽  
T Brauchli ◽  
J Spycher ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Insurance ◽  
Access To Care ◽  
Health Equity ◽  
Hospital Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Inequity ◽  
Race Ethnicity ◽  
And Gender

Abstract Background The international literature has highlighted many potential challenges in terms of inequitable access to care. In the last few years, health equity is becoming an increasingly important issue for policymakers, particularly in developed countries. The aim of this systematic review was to find how equity is measured and to identify some of its determinants. Methods We conducted a systematic review on all major databases (Medline Ovid SP, PubMed, Embase and Web of Science), following the PRISMA guidelines. We included published observational studies that reported on health equity and using administrative data, with a focus on emergency and unplanned hospital care. Study selection and data extraction were conducted independently and compared by two reviewers. Results In total, 223 records were screened and 39 articles met the inclusion criteria. Studies come from the United States (US) (23), United Kingdom (6), Canada (4), Australia (2) and some European countries (4). To measure health inequity, most of the studies used at least one of these 4 indicators: hospitalisations for chronic ambulatory care sensitive conditions (or preventable hospitalisations), emergency hospitalisation rate, readmissions or mortality. The most relevant health equity determinants concerned race/ethnicity (19), poverty (17), health insurance coverage (17) and gender (16). Race/ethnicity and gender are important determinants of inequities. Concerning poverty, despite the use of heterogeneous indicators, most of studies showed a socio-economic gradient of access to care. Health insurance coverage was often used but with conflicting results. Conclusions The use of indicators linking primary, emergency and hospital care seems to be particularly relevant to measure health inequity. Race/ethinicity, gender and socio-economic status are clear determinants of inequitable access to care. More studies are needed to explain and analyse the determinants of health equity. Key messages Health equity remains a major issue even for high-income countries health care system. Quantitative data about health equity still are needed to support policymaker’s recommendation.

scholarly journals The convergence of racial and income disparities in health insurance coverage in the United States

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

scholarly journals Barriers of effective health insurance coverage for rural-to-urban migrant workers in China: A systematic review and policy gap analysis

2019 ◽  
Author(s):  
Shanquan Chen ◽  
Yingyao Chen ◽  
Zhanchun Feng ◽  
Xi Chen ◽  
Zheng Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Insurance ◽  
Migrant Workers ◽  
Gap Analysis ◽  
Central Government ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Cochrane Library ◽  
Job Stability ◽  
Urban Migrant

Abstract Objective: To review China’s healthcare policies and their applications to rural-to-urban migrant workers (RUMWs) in China, to identify problems faced by RUMWs and the policy gaps that need to be addressed in future, and to facilitate better implementation of the UHC on RUMWs. Methods: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total 71 articles were reviewed. Findings: (1) Chinese RUMWs have a high work mobility and low job stability; (2) Barriers faced by RUMWs to have effective health insurance coverage are mainly due to the reluctancy of employers to provide insurance for all employees and a disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers. Conclusion: It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote the effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW’s characteristics to meet their primary health needs, (4) strengthening supervision over employers, and (5) providing more vocational trainings and other supports to increase RUMW’s job stability.

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