Stratification and “Universality”

2017 ◽  
Author(s):  
Tiffany D. Joseph
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Low Income ◽  
Health Care Professionals ◽  
State Level ◽  
Universal Health Care System ◽  
Documentation Status ◽  
Health Organization ◽  
Universal Health ◽  
Care System

Tiffany D. Joseph’s chapter examines how stratification of access by immigration status effectively undermined a “universal” health policy. While the ACA only extended coverage to U.S. citizens and eligible documented immigrants, Massachusetts pursued a universal health care system at the state level and offered coverage to all residents, regardless of documentation status. Despite this policy that aimed for inclusion, immigrants in Massachusetts were still more likely than non-immigrants to remain uninsured. Joseph interviewed Brazilian and Dominican immigrants, health care professionals, and immigrant/health organization employees to find out why immigrants remained uninsured. She identified immigration-related, health care system, and bureaucratic barriers that prevented individuals from effectively accessing care. Massachusetts serves as both a model and a cautionary tale for ACA implementation, with barriers exacerbated for immigrant, low-income, and minority populations.

scholarly journals Childbirth-Related Hospital Burden by Socioeconomic Status in a Universal Health Care Setting

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Sarah Meghan Mah ◽  
Claudia Sanmartin ◽  
Sam Harper ◽  
Nancy A Ross
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Health Care System ◽  
Low Income ◽  
Teenage Pregnancy ◽  
Universal Health Care ◽  
Discharge Abstract Database ◽  
Universal Health Care System ◽  
Universal Health ◽  
Care System

IntroductionHospital utilization varies across socioeconomic and demographic strata in Canada, which has a universal health care system that grants essential services to everyone. Rates of adverse birth outcomes are known to differ among high and low SES women, but less is known of the excess burden attached to those outcomes across Canadian provinces. ObjectiveTo examine length of stay for childbirth relative to women’s socio-demographic characteristics, in the context of the Canadian universal health care system. MethodsA population-based record linkage between the Canadian Community Health Survey (CCHS) cycles 3.1 (2005) and 4.1 (2007/8), and the Discharge Abstract Database (DAD) allowed the tracking of hospital utilization for linked survey respondents between 2005 and 2009. Hourly length of stay for delivery was modeled by socio-demographic factors, controlling for other clinical and individual-level characteristics. ResultsThere were 7,166 complete delivery records from 5,570 female CCHS respondents who agreed to link and share their information. Women with the lowest income had on average, four-hour longer stays for vaginal delivery as compared to high-income women (IRR 1.07, 95% CI 1.02-1.13, p=0.01), and eight-hour longer stays for Caesarian delivery (IRR 1.08, 95% CI 0.95-1.22, p=0.23). A greater proportion of teenage pregnancy was seen for Aboriginal girls. Aboriginal status and rural area of residence were co-determinants of elevated length of stay. ConclusionThe absence of egregious socio-demographic differences regarding childbirth is reassuring for the Canadian health care system. However, the persistence of marginally longer, and in turn, costlier visits for low-income and rural Aboriginal women is suggestive that policies of cash transfers during the prenatal period might be highly cost-effective if they achieve population-wide reductions in length of stay.

scholarly journals The effect of centralization on short term outcomes of pancreatoduodenectomy in a universal health care system

HPB ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 319-327 ◽  
Author(s):  
Linn S. Nymo ◽  
Kjetil Søreide ◽  
Dyre Kleive ◽  
Frank Olsen ◽  
Kristoffer Lassen
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Universal Health Care ◽  
Short Term ◽  
Universal Health Care System ◽  
Universal Health ◽  
Care System

Material deprivation and access to cancer care in a universal health care system

Cancer ◽  
2020 ◽  
Vol 126 (20) ◽  
pp. 4545-4552
Author(s):  
Laura E. Davis ◽  
Natalie G. Coburn ◽  
Julie Hallet ◽  
Craig C. Earle ◽  
Ying Liu ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Cancer Care ◽  
Material Deprivation ◽  
Universal Health Care ◽  
Universal Health Care System ◽  
Universal Health ◽  
Care System

Does Socioeconomic Status Affect Stage at Presentation for Larynx Cancer in Canada’s Universal Health Care System?

2018 ◽  
Vol 160 (3) ◽  
pp. 488-493 ◽  
Author(s):  
Diana Khalil ◽  
Martin J. Corsten ◽  
Margaret Holland ◽  
Adele Balram ◽  
James Ted McDonald ◽  
...  
Keyword(s):  
Health Care ◽  
Socioeconomic Status ◽  
Health Care System ◽  
Laryngeal Cancer ◽  
Income Quintile ◽  
Universal Health Care ◽  
Urban Residence ◽  
Universal Health Care System ◽  
Universal Health ◽  
Care System

Objective Diagnosis of laryngeal cancer is dependent on awareness that persistent hoarseness needs to be investigated as well as access to an otolaryngologist. This study aimed to better classify and understand 3 factors that may lead to variability in stage at presentation of laryngeal cancer: (1) socioeconomic status (SES), (2) differences in access to health care by location of residence (rural vs urban or by province), and (3) access to an otolaryngologist (by otolaryngologists per capita). Study Design Registry-based multicenter cohort analysis. Setting This was a national study across Canada, a country with a single-payer, universal health care system. Subjects All persons 18 years or older who were diagnosed with laryngeal cancer from 2005 to 2013 inclusive were extracted from the Canadian Cancer Registry (CCR). Methods Ordered logistic regression was used to determine the effect of income, age, sex, province of residence, and rural vs urban residence on stage at presentation. Results A total of 1550 cases were included (1280 males and 265 females). The stage at presentation was earlier in the highest income quintile (quintile 5) compared to the lower income quintiles (quintiles 1-4) (odds ratio [OR], 0.68; P < .05). There was a statistically significant difference in stage at presentation based on rural or urban residence within the highest income quintile (OR, 1.73; P < .005). Conclusion There is a relationship between SES and stage at presentation for laryngeal cancer even in the Canadian universal health care system.

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