Equity analysis of health system accessibility from perspective of people with disability

2019 ◽  
Vol 24 (4) ◽  
pp. 298-309
Author(s):  
Hussain Zandam ◽  
Muhamad Hanafiah Juni
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Delivery ◽  
Access To Health Care ◽  
Care Delivery ◽  
Physical Disabilities ◽  
People With Disabilities ◽  
Cross Sectional Survey ◽  
Content Type ◽  
Access To Health

Purpose Self-evaluated access and accessibility has been found to be associated with healthcare seeking and quality of life. Studies have shown that, however, a vast majority of individuals with disability living in poor countries have limited access to healthcare influenced by several barriers. The purpose of this paper is to compare the perception of general accessibility of health care services and its association with access barriers and other contextual factors between people with physical disabilities and counterparts without disability. Design/methodology/approach This study is a cross sectional survey involving 213 individuals with physical disabilities and 213 counterparts without disability sampled using a multi-stage method. Data were collected using a structured questionnaire with sections on socioeconomic and living conditions, education, health, employment and access to health care. Data analysis involved using χ2 for proportions and T-test and multiple regressions (stepwise) method to determine significant factors that influence perception on accessibility. Findings The study finds that people with disabilities fared worse in various socioeconomic factors such as education, employment, income and assets possession. People with disabilities also experience more dimensional barriers and reported poor health system accessibility. The difference in accessibility continued after adjusting for other variables, implying that there are more inherent factors that explain the perception of access for people with disabilities. Practical implications Governments should ensure equitable access to health care delivery for people with disabilities through equitable health policies and services that are responsive to the needs of people with disabilities and promote the creation of enabling environment to enhance participation in health care delivery. Originality/value The authors confirm that the paper has neither been submitted to peer review, nor is in the process of peer reviewing or accepted for publishing in another journal. The author(s) confirms that the research in this work is original, and that all the data given in the paper are real and authentic. If necessary, the paper can be recalled, and errors corrected. The undersigned authors transfer the copyright for this work to the International Journal of Health Governance. The authors are free of any personal or business association that could represent a conflict of interest regarding the paper submitted, and the authors have respected the research ethics principles.

Access to health care and Informal Patient Payments for health care in Serbia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Buch Mejsner ◽  
S Lavasani Kjær ◽  
L Eklund Karlsson
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Health Care Services ◽  
Local Population ◽  
Civil Servants ◽  
Care Providers ◽  
Care Services ◽  
Access To Health

Abstract Background Evidence often shows that migrants in the European region have poor access to quality health care. Having a large number of migrants seeking towards Europe, crossing through i.e. Serbia, it is crucial to improve migrants' access to health care and ensure equality in service provision Aim To investigate what are the barriers and facilitators of access to health care in Serbia, perceived by migrants, policy makers, health care providers, civil servants and experts working with migrants. Methods six migrants in an asylum center and eight civil servants in the field of migration were conducted. A complementary questionnaire to key civil servants working with migrants (N = 19) is being distributed to complement the data. The qualitative and quantitative data will be analysed through Grounded Theory and Logistic Regression respectively. Results According to preliminary findings, migrants reported that they were able to access the health care services quite easily. Migrants were mostly fully aware of their rights to access these health care services. However, the interviewed civil servants experienced that, despite the majority of migrants in camps were treated fairly, some migrants were treated inappropriately by health care professionals (being addressed inappropriately, poor or lacking treatment). The civil servants believed that local Serbs, from their own experiences, were treated poorer than migrants (I.e. paying Informal Patient Payments, poor quality of and access to health care services). The interviewed migrants were trusting towards the health system, because they felt protected by the official system that guaranteed them services. The final results will be presented at the conference. Conclusions There was a difference in quality of and access to health care services of local Serbs and migrants in the region. Migrants may be protected by the official health care system and thus have access to and do not pay additional fees for health care services. Key messages Despite comprehensive evidence on Informal Patient Payments (IPP) in Serbia, further research is needed to highlight how health system governance and prevailing policies affect IPP in migrants. There may be clear differences in quality of and access to health care services between the local population and migrants in Serbia.

scholarly journals Incorporating digital self-services into integrated mental health care: a physician’s perspective

2018 ◽  
Vol 52 (11) ◽  
pp. 2234-2250 ◽  
Author(s):  
Heini Sisko Maarit Taiminen ◽  
Saila Saraniemi ◽  
Joy Parkinson
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Delivery ◽  
Value Creation ◽  
Care Delivery ◽  
Service Marketing ◽  
Content Type ◽  
Integrated Mental Health ◽  
Physician’S Perspective

Purpose This paper aims to enhance the current understanding of digital self-services (computerized cognitive behavioral therapy [cCBT]) and how they could be better incorporated into integrated mental health care from the physician’s perspective. Service marketing and information systems literature are combined in the context of mental health-care delivery. Design/methodology/approach An online survey of 412 Finnish physicians was undertaken to understand physicians’ acceptance of cCBT. The study applies thematic analysis and structural equation modeling to answer its research questions. Findings Adopting a service marketing perspective helps understand how digital self-services can be incorporated in health-care delivery. The findings suggest that value creation within this context should be seen as an intertwined process where value co-creation and self-creation should occur seamlessly at different stages. Furthermore, the usefulness of having a value self-creation supervisor was identified. These value creation logic changes should be understood and enabled to incorporate digital self-services into integrated mental health-care delivery. Research limitations/implications Because health-care systems vary across countries, strengthening understanding through exploring different contexts is crucial. Practical implications Assistance should be provided to physicians to enable better understanding of the application and suitability of digital self-service as a treatment option (such as cCBT) within their profession. Additionally, supportive facilitating conditions should be created to incorporate them as part of integrated care chain. Social implications Digital self-services have the potential to serve goals beyond routine activities in a health-care setting. Originality/value This study demonstrates the relevance of service theories within the health-care context and improves understanding of value creation in digital self-services. It also offers a profound depiction of the barriers to acceptance.

scholarly journals A COMPARATIVE STUDY OF THE PERCEPTIONS OF RURAL DWELLERS TOWARDS HEALTH CARE DELIVERY

2021 ◽  
Vol 9 (04) ◽  
pp. 451-454
Author(s):  
Felix a ◽  
◽  
J. Ugwu ◽  
Clara Okenyi ◽  
◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Significant Relationship ◽  
Survey Design ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Test Analysis ◽  
Rural Dwellers

The present study aimed to comparatively analyze healthcare delivery perception among rural dwellers based on education (formal/informal) and gender. The study adopted a cross-sectional survey design. A total of two hundred rural dwellers comprising males and females participated in the study. Perception towards health care delivery was measured with a self-developed instrument with demographic information. An independent t-test analysis found no statistically significant relationship between education and perception towards health care delivery. However, the result revealed a significant relationship between gender and perception towards health care delivery. Females were found to show a more positive attitude towards health care delivery than their male counterparts. The findings and conclusions are discussed.

Managed care Medicaid

2017 ◽  
Vol 11 (2) ◽  
pp. 198-210 ◽  
Author(s):  
William Trombetta
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Care Quality ◽  
Market Segment ◽  
Economic Aspects ◽  
Content Type ◽  
The Poor

Purpose Providing health care to the poor is evolving in the new US marketplace. The Affordable Care Act has set goals enhancing access to health care, lowering costs and improving patient outcomes. A key segment in this evolution is the most vulnerable health-care population of all: Medicaid. This paper aims to provide a general review of how providing health care to Medicaid patients is changing including how socio-economic aspects of this vulnerable population affects the quality of the health care provided. Design/methodology/approach The paper is entirely secondary research; no primary research has been conducted. Findings Managed care Medicaid provides a risk-based model to treating a vulnerable health-care market segment. The jury is still out on whether managed care Medicaid (MCM) is improving health-care quality and saving cost, but the provision of health care to the Medicaid segment is definitely shifting from a fee-for-service model to value based payment. Very recent developments of new health-care delivery approaches present a positive outlook for improving quality and containing costs going forward. Research limitations/implications At this stage, whether or not MCM saves money or provides better health-care quality to this vulnerable population is a work in progress. Health-care marketing can impact socio-economic aspects of health care for the poor. There is a need to follow up on the positive results being documented in demonstration health-care delivery models. Practical implications At this point, there has been no long-term study of whether managed care Medicaid offers better quality of health care and cost savings. The research to date suggest that the quality of health-care delivery to the poor is improving at a lower cost to payers. Social implications Medicaid patients are an underserved market segment. Managed care Medicaid offers a new model that has the potential to provide quality care at acceptable cost. Critical to this vulnerable market segment is the need to integrate socio-economic aspects of the population with the delivery of health care. Originality/value There has been very little discussion of Medicaid overall in the marketing literature, much less any discussion of managed care Medicaid.

Projection of pediatric manpower requirements

PEDIATRICS ◽  
1977 ◽  
Vol 59 (3) ◽  
pp. 323-324
Author(s):  
Robert D. Burnett ◽  
Mary Kaye Willian ◽  
Richard W. Olmsted
Keyword(s):  
United States ◽  
Health Care ◽  
Medical School ◽  
Health Care Delivery ◽  
Care Delivery ◽  
The United States ◽  
Physician Shortage ◽  
Access To Health Services ◽  
Access To Health ◽  
The 1960S

In the 1960s, predictions were made that the United States faced a "physician shortage."1,2 On the basis of these predictions, federal legislation subsidized the establishment of new medical schools and the expansion of those in existence. From 1968 to 1974, the number of medical school graduates rose from 7,973 to 11,613.3 Nevertheless, problems of availability of, and access to, health services remain. Mere increase in number of physicians is not the solution to the problem of health care delivery in the United States; in fact, there is concern that we now face an oversupply of physicians.4 The recently published Carnegie report recommends that only "one" new medical school be established.5

scholarly journals Health mediator model as a way to access to care and health information for Syrian refugees in Turkey

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
I Kayi ◽  
Z Şimşek2 ◽  
G Yıldırımkaya
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Health Care Services ◽  
Legal Status ◽  
Healthcare Access ◽  
Syrian Refugees ◽  
Care Services ◽  
Access To Health ◽  
The City

Abstract The number of Syrian refugees residing in Turkey has increased over 200 times since 2012 reaching to 3,621,330 (April 2019). Turkey has granted temporary protection status, including access healthcare in the city of registration. Ministry of Health provides on-site health service in temporary shelters, however more than 90% of the Syrian refugees choose to stay in community settings, which along with language barriers limits their ability to access health care and information. With UNFPA we have designed a health mediator model to improve access to health care and awareness on priority concerns such as mental health, reproductive health, child health, health system in Turkey and legal status provided to Syrian refugees. This study is a participatory operational research to test the health mediator model. Operationalization took place in 3 phases: (1) selection and training of Syrian health mediators and provincial coordinators; (2) household visits and data collection; (3) evaluation and supervision. So far, we have trained 174 health mediators from 24 different Turkish cities. Training took 5 days with up to 30 participants each. UNFPA collaborated with NGOs that work with Syrian refugees for coordination purposes. Health mediators made household visits to reach out to Syrian families, gave health education and where necessary support for access to health care services, and conducted a needs assessment. Data collected has been the subject to weekly supervision meetings by local NGOs, health mediators and coordinators to set priorities for the upcoming week. Health mediator model was effective in reaching out to hard-to-reach groups among Syrian refugees, increased health system and legal awareness, contribute to improved healthcare access and prevention of negative health outcomes such as teenage marriages and pregnancies. Inclusion of refugees in decision-making and guidance during the implementation of the project was key for project success.

The case for integrated oral and primary medical health care delivery: Marshfield Clinic Health System

2020 ◽  
Vol 84 (8) ◽  
pp. 924-931
Author(s):  
R. Lamont (Monty) MacNeil ◽  
Helena Hilario ◽  
Megan M. Ryan ◽  
Ingrid Glurich ◽  
Greg R. Nycz ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Medical Health Care ◽  
Medical Health ◽  
Marshfield Clinic

scholarly journals Does the ehealth card facilitate access to healthcare from the point of view of refugees in Germany?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Rolke ◽  
J Wenner ◽  
O Razum
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Chronic Illnesses ◽  
Point Of View ◽  
Informal Support ◽  
Federal State ◽  
Health Card ◽  
Delayed Treatment ◽  
Access To Health

Abstract Background The municipalities in the federal state of North Rhine-Westphalia (NRW) decide autonomously how to organize access to health care for refugees: either with electronic health card (eHC model) or with health care voucher (HcV model). The eHC model is often expected to facilitate access to health care and to reduce bureaucratic barriers. However, there are only few analyses of how refugees perceive the two models and their corresponding access to health care. Methods A total of 28 problem-centered interviews with refugees were conducted in three municipalities in NRW (two with HcV and one with eHC model). Sampling was purposive, aiming to achieve a maximum variation of interview partners with regard to age, gender, chronic illnesses, pregnancy and parenthood. The interviews were conducted with the support of translators in the language of the respondents’ choice. Interviews transcripts were evaluated by content analysis using the software atlas.ti. Results Refugees using both the eHC and HcV models report mostly positive experiences when seeking care - both in terms of treatment and interaction with physicians or non-medical staff. The first contact with the health care system was rarely organized by refugees themselves in both models, but mostly with the support of social workers, friends, or family members. The main perceived difference between the models was that in the HcV model, urgent treatment required additional waiting time. Conclusions Access to care is assessed similarly well by refugees in all municipalities. The additional approval process for treatment by the social welfare office in HcV municipalities may lead to a delayed treatment. Formal and informal support is particularly important for newly arriving refugees to help them navigate the complex German health system. Key messages The implementation of one access model alone does not facilitate access to health care for refugees. Formal and informal support is necessary for refugees to gain access to the health system.

The ACA's Choice Problem

2020 ◽  
Vol 45 (4) ◽  
pp. 501-515
Author(s):  
Allison K. Hoffman
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Affordable Care Act ◽  
Access To Health Care ◽  
Care Delivery ◽  
Health Plans ◽  
Vicious Cycle ◽  
Love Affair ◽  
Policy Theory ◽  
Access To Health

Abstract The Affordable Care Act (ACA) is in many ways a success. Millions more Americans now have access to health care, and the ACA catalyzed advances in health care delivery reform. Simultaneously, it has reinforced and bolstered a problem at the heart of American health policy and regulation: a love affair with choice. The ACA's insurance reforms doubled down on the particularly American obsession with choice. This article describes three ways in which that doubling down is problematic for the future of US health policy. First, pragmatically, health policy theory predicts that choice among health plans will produce tangible benefits that it does not actually produce. Most people do not like choosing among health plan options, and many people—even if well educated and knowledgeable—do not make good choices. Second, creating the regulatory structures to support these choices built and reinforced a massive market bureaucracy. Finally, and most important, philosophically and sociologically the ACA reinforces the idea that the goal of health regulation should be to preserve choice, even when that choice is empty. This vicious cycle seems likely to persist based on the lead up to the 2020 presidential election.

Five focus strategies to organize health care delivery

2016 ◽  
Vol 29 (2) ◽  
pp. 177-191 ◽  
Author(s):  
Antti Peltokorpi ◽  
Miika Linna ◽  
Tomi Malmström ◽  
Paulus Torkki ◽  
Paul Martin Lillrank
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Management Practices ◽  
Care Delivery ◽  
System Level ◽  
Content Type ◽  
Requisite Variety ◽  
Care Outcomes ◽  
Definition Of ◽  
Focus Strategies

Purpose – The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations. Design/methodology/approach – First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies. Findings – The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes. Research limitations/implications – Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination. Practical implications – Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization’s strategy and key performance indicators. Originality/value – Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care.

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