SEARCH · PubMed Health

Results for “Equity”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources

PubMed2002

The Asian Voice in building equity in health for development - from the Asian Forum for Health Research, Manila, February 2000.

The Asian Forum for Health Research convened in Manila, the Philippines, in February 2000 to determine how best to create a new paradigm for health research in Asia. The forum was organized as an 'open university of research for equity in health development' to define the new paradigm and to identify methods for building a dynamic and collaborative architecture to more effectively link the nations and region of Asia with global stakeholders in health research. It was also to: determine Asian actions required to enhance leadership functions for innovative health research management; develop and disseminate tools and methodologies needed to accomplish essential tasks; establish collaborative networks within developing countries/regions to ensure efforts are not duplicated and international inputs are not monopolized; and use new information and communication technologies to integrate the process and contents of health research with equity in health development. Results of the forum's review of issues were presented and discussed at the International Conference on Health Research for Development, held in October 2000 in Bangkok, Thailand.

Asia↗

PubMed2002

Ministry of Health user fees, equity and decentralization: lessons from Honduras.

Decentralization is commonly championed as a means for achieving equity. To date, however, there has been little discussion of the mechanisms underlying this relationship, and several of the few empirical investigations that have addressed the topic have found the converse; that decentralization has exacerbated inequalities. This article examines the performance and equity in financing of the Honduras Ministry of Health's (MOH) decentralized user fee system. The MOH of Honduras established a national user fee policy in 1989. It provided a framework of rules and regulations and decentralized administration of the system to the regional offices. A survey conducted under the auspices of this study provided detailed information about the structures and operations of MOH user fee systems. The survey revealed that the systems vary markedly by region, creating horizontal inequities, and that they have numerous other shortcomings. The average price of a consultation is low, US dollars 0.16, and revenues have consistently equalled just 2% of MOH expenditures. The systems' administrative costs are equal to 67% of their revenues. Eliminating the user fee systems in all but the national and regional hospitals would actually save money and/or enable the MOH to provide more care. Average consultation prices are highest in health posts, intermediate in centres and lowest in the national hospitals, thereby encouraging the inappropriate use of the MOH's pyramidal referral system and fostering MOH inefficiency. Fee levels and exemption practices are horizontally and vertically inequitable. The likelihood of paying for an ambulatory visit is highest at a health post, 89%, and lowest at a hospital, 49%. Individuals from the poorest one-fifth of households are the most likely to have to pay for care. Honduras' experience demonstrates that a decentralized user fee system is not necessarily equitable, and that, more generally, the gains that can be realized from decentralizing user fee systems are not automatic. They must be anticipated, planned for and cultivated by a well-designed and well-implemented initiative that is not a single, one-time event, but rather a dynamic, on-going enterprise.

Ambulatory Care Facilities↗

PubMed2002

Quality and equity of private sector care for sexually transmitted diseases in South Africa.

The private sector plays a major role in the delivery of health care in South Africa. Over the past two decades, the quality and equity of such provision has been questioned internationally. A study was conducted in Gauteng Province to explore these issues, using care for sexually transmitted disease (STD) as a case study. Private general practitioners (GPs) were interviewed by telephone. Each was presented with a set of STD syndromes and requested to describe how s/he would manage the patient, first if the patient was insured, then secondly if the patient was paying cash (uninsured). Reported prescriptions were costed and assessed for effectiveness against main causative pathogens using local standard clinical guidelines. Knowledge of recent developments in STD syndromic management and effectiveness of prescribed drugs was poor, especially for genital ulcer and pelvic inflammatory disease, and less than half the prescriptions overall were judged as effective. Although the effectiveness of prescriptions for insured and uninsured patients were similar, for most syndromes uninsured patients were offered significantly cheaper and less convenient antibiotic regimens. Effective regimens were also significantly more expensive than ineffective regimens. The results suggest that GPs' perceptions of patients' willingness or ability to pay for drugs have a bearing on quality of care. The paper concludes that STD patients who present to GPs are often offered poor quality of care, and the choice of inconvenient antibiotics impacts disproportionately on the poor. Improvements in the quality and equity of GP care will require interventions that address the factors that determine their behaviour.

Anti-Bacterial Agents↗

PubMed1996

The economics of independent living: efficiency, equity and ethics.

People with disabilities are routinely denied the exercise of choice in their daily lives. There are strong efficiency arguments for the promotion of greater choice and autonomy for disabled people. There are equally strong moral arguments for an investment in the capabilities of disabled people to allow them to participate in both the educational system and the labour market. This investment will not come cheaply nor will the pay-off always be of such magnitude to justify the expenditure on narrow cost-benefit criteria. Those who value efficiency above everything else must, however, set out the system of justice implied by such a choice. The conclusions of a narrow efficiency argument may turn out to be unacceptable to the majority of citizens. Likewise, however, those who value equity at all costs must consider the implications of their approach for individual freedom, economic growth and technical efficiency. This paper is an attempt to explore the meaning of efficiency and equity in the context of independent-living programmes for people with disabilities.

Activities of Daily Living↗

PubMed1980

Optimism on attaining health care equity.

In spite of persistent problems, progress of the last 40 years gives grounds for optimism about trends toward equity in health care. In the United States, substantial improvements have been achieved in the coverage of insurance providing economic access to medical care, in the extent of group medical practice, in health manpower resources, in the supply and distribution of hospital beds, in the scope of preventive public health services, in medical care of the poor, in the surveillance of medical care quality, in the availability of sound patterns of health care delivery, in comprehensive planning of health resources and services, and in the health status of the population. All these gains have made against the bitter opposition of conservative interests. With continued and determined efforts, one may be optimistic about achieving further progress toward health care equity.

Delivery of Health Care↗

PubMed2003

Subjective and quantitative assessment of patient fitness for cadaveric kidney transplantation: the "equity penalty".

BACKGROUND: Patient fitness at the time of organ allocation has an impact on graft survival equivalent to the effect of human leukocyte antigen (HLA) matching. The variation between institutions in assessment of fitness is not known, nor is the potential impact on mean graft survival of incorporating patient fitness into local adult cadaveric-kidney transplant-allocation algorithms. METHODS: Data from the Collaborative Transplant Study (CTS, 1985-2000) were reviewed. Quantitative criteria (QC) of patient fitness based on national transplant society guidelines were compared with subjective categorization (SC) of each patient on the current local transplant waiting list (n=109) determined by their supervising nephrologist. RESULTS: Five-year cadaveric graft survival was 70%, 61%, and 53% for good-, moderate-, and poor-risk patients in the CTS data set (n=102, 612), equivalent to half lives of 12.7, 9.8, and 8.7 years, respectively, with similar results from the local program. The distribution of local waiting-list patients into fitness categories A (good), B (moderate), C (poor), and D (unacceptable) was 51%:31%:13%:5% by SC and 25%:40%:27%:8% by QC. At one hospital, 61% (n=51) of patients were classified category A by SC, and falling to 16% by QC (P<.0001). Compared with preferential category A recipient allocation, an unrestricted allocation policy was estimated to sacrifice 1.5 years of overall program-mean graft survival. CONCLUSIONS: Use of QC may reduce the variation in subjective patient assessment seen between institutions. Any proposed changes in organ allocation methods should address the "equity versus efficiency" balance in an open fashion and predict the impact on the overall graft survival for the program by quantifying the "equity penalty."

Adolescent↗

PubMed2001

Safe and sorry: risk, environmental equity, and hazardous waste management facilities.

Many empirical environmental equity analyses have attempted to determine if hazardous waste treatment, storage, or disposal facilities (TSDFs) are in disproportionately minority or low-income areas. These prior analyses did not explain the extent of the risks posed by TSDFs, nor did they weight the distribution of those risks by the individual characteristics of the TSDFs. This study evaluated the risks posed by TSDFs in general and then examined whether any such risks were distributed inequitably when each TSDF was weighted by the amount of hazardous waste that it managed. Based on an assessment of the nature of the hazardous wastes that TSDFs manage, the possible exposure paths to risk from TSDFs, the laws designed to minimize the risks that TSDFs pose, and TSDFs' safety records, the attention devoted to TSDFs by environmental equity researchers is greatly exaggerated. Furthermore, based on this study's analyses, there was no pattern of the TSDFs or the risks that they posed being inequitably concentrated in disproportionately minority or low-income areas. Most of the TSDFs and the hazardous waste that they manage are in areas that are either unpopulated or have fewer minority or low-income people than the national average. There are, however, some TSDFs that are in highly populated, heavily minority or low-income areas, which results in such people being more likely overall to be in close proximity to these facilities.

Censuses↗

PubMed2000

The Power Equity Guide: attending to gender in family therapy.

In the past two decades, feminist scholars have challenged the field of family therapy to incorporate the organizing principle of gender in its theory, practice, and training. In this paper, we introduce a training, research, and therapeutic tool that provides guidance for addressing or observing gender and power differentials in the practice of family therapy. As a training tool, the Power Equity Guide helps trainees to translate their theoretical understanding of feminist principles into specific behaviors in therapy. Researchers and supervisors can use the Power Equity Guide to evaluate the practice of gender-informed family therapy. We also provide specific suggestions for its use by trainers, supervisors, therapists, and researchers.

Family Therapy↗

PubMed2001

Harnessing genomics and biotechnology to improve global health equity.

With decisive and timely action, genome-related biotechnology can be harnessed to improve global health equity. In June 2002 in Kananaskis, Canada, leaders of the G8 industrial nations will develop an action plan to support implementation of the New African Initiative. By extending their discussion of health issues raised in the New African Initiative to include genomics, G8 leaders could signal their intention to increase global health equity by preventing a health genomics divide from developing. There are already some early and growing examples of genome-related biotechnology being applied successfully to health problems in developing countries. But how can genomics be systematically harnessed to benefit health in developing countries? We propose a five-point strategy, including research, capacity strengthening, consensus building, public engagement, and an investment fund.

Biotechnology↗

PubMed2004

Gender equity and trichiasis surgery in the Vietnam and Tanzania national trachoma control programmes.

AIMS: To calculate the gender distribution of trichiasis cases in trachoma communities in Vietnam and Tanzania, and the gender distribution of surgical cases, to determine if women are using surgical services proportional to their needs. METHODS: Population based data from surveys done in Tanzania and Vietnam as part of the national trachoma control programmes were used to determine the rate of trichiasis by gender in the population. Surgical records provided data on the gender ratio of surgical cases. RESULTS: The rates of trichiasis in both countries are from 1.4-fold to sixfold higher in females compared to males. In both countries, the female to male rate of surgery was the same or even higher than the female to male rate of trichiasis in the population. CONCLUSIONS: These data provide assurance of gender equity in the provision and use of trichiasis surgery services in the national programmes of these two countries. Such simple analyses should be used by other programmes to assure gender equity in provision and use of trichiasis surgery services.

Eyelashes↗

PubMed1994

Equity in community care.

The implementation of the NHS and Community Care Act 1990 made local authority social services departments responsible for the organisation and funding of support and care in the community. This development took effect at the same time as a blurring of the boundaries between health and social care. One consequence is that the relevance of equity (a guiding principle of the 1946 National Health Service Act, but relatively lacking from the 1948 National Assistance Act, the foundation of many social services) has come to be more keenly appreciated within personal social services. Equity questions arise in community care over the distribution of public resources between different client groups, income groups, generations, and localities. Moreover, no mechanisms exist to monitor the trends that emerge from different ways that people get access to care. Yet there is a risk that substantial divisive consequences may occur, particularly between generations.

Capital Financing↗

PubMed2004

Equity of access to health care: outlining the foundations for action.

The Ministers of Health from Chile, Germany, Greece, New Zealand, Slovenia, Sweden, and the United Kingdom recently established The International Forum on Common Access to Health Care Services, based on a common belief that their citizens should enjoy universal and equitable access to good quality health care. The ministers intend to form a network to share thinking and evidence on health care improvements, with the specific aim of sustaining and promoting equitable access to health care. Despite a vast literature on the notion of equity of access, little agreement has been reached in the literature on exactly what this notion ought to mean. This article provides a brief description of the relevance of the access principle of equity, and summarises the research programme that is necessary for turning the principle into a useful, operational policy objective.

Ethnicity↗

PubMed1992

Equity and medical practice variation: relationships between standardised discharge ratios in total and for selected conditions in English districts.

STUDY OBJECTIVE: The aim was to investigate relationships for residents of English district health authorities between rates of discharges from acute hospitals for all conditions and variations in discharge rates for eight common conditions (five surgical, three medical). DESIGN: Hospital Inpatient Enquiry data on discharges for 1984 were analysed. Standardised discharge ratios (ratios of actual to expected numbers of discharges x 100) were derived for selected conditions and all conditions; and correlation coefficients for these statistics were calculated. Districts were grouped into quintiles according to the value of the standardised discharge ratio, and systematic variation within each quintile was calculated for the selected conditions. SETTING: The study involved all 192 English district health authorities, but 57 were excluded because the proportion of unspecified diagnoses exceeded 5%. PATIENTS: The analyses were based on 336,799 cases from 135 districts. MEASUREMENTS AND MAIN RESULTS: Discharge ratios for the medical conditions and one surgical condition were significantly correlated with the levels of total discharge rates (p less than 0.01). The medical conditions showed greater systematic variation in discharge ratios than the surgical conditions. There was no consistent pattern in the values of systematic variation for the selected conditions across the different levels of discharge ratios for all conditions. CONCLUSIONS: It is argued that the changes in the NHS introduced in April 1991 are intended to introduce greater equity in the standardised discharge ratios and increase the total numbers of discharges. The results of this analysis suggest that, even if these objectives were achieved, they may not result in increased levels of elective care, nor result in greater equity in terms of rates of discharge for individual conditions.

Acute Disease↗

PubMed1996

Cost effectiveness and equity of a community based cardiovascular disease prevention programme in Norsjö, Sweden.

STUDY OBJECTIVE: To evaluate the cost effectiveness and equity of a community based cardiovascular disease prevention programme. DESIGN: A prospective cross sectional design. SETTING: A community based intervention to reduce cardiovascular disease in the district of Norsjö (n = 5500), Sweden. The intervention was aimed at both the general population and at individuals thought to be at special risk, the emphasis being on changing dietary habits and reducing cholesterol concentrations. PARTICIPANTS: The participants were men and women aged 30-60 years. MAIN RESULTS: The mean serum cholesterol concentration in the Norsjö population was reduced by nearly 20% during the first six years of intervention. It was estimated that the programme's overall total societal costs were 363,000 pounds and estimates of the cost per year of life saved ranged from 14,900 pounds to net savings, according to different assumptions. Taking only health care costs and savings into account, the cost per year of life saved ranged from 1100 pounds to 4050 pounds. The results varied between different sex and age groups, but not between social classes. Even if a causal relationship exists between low cholesterol concentrations and excess mortality, the estimated side effects of lowering cholesterol values in Norsjö were negligible in comparison with the expected benefits. CONCLUSIONS: The community based intervention in Norsjö seems to be cost effective even under conservative assumptions. The approach used seems to have benefited all social classes. Cost effectiveness analyses that take consequences for equity into account are valuable tools in decision making.

Adult↗

PubMed2001

Equity - some theory and its policy implications.

This essay seeks to characterise the essential features of an equitable health care system in terms of the classical Aristotelian concepts of horizontal and vertical equity, the common (but ill-defined) language of "need" and the economic notion of cost-effectiveness as a prelude to identifying some of the more important issues of value that policy-makers will have to decide for themselves; the characteristics of health (and what determines it) that can cause policy to be ineffective (or have undesired consequences); the information base that is required to support a policy directed at securing greater equity, and the kinds of research (theoretical and empirical) that are needed to underpin such a policy.

Cost-Benefit Analysis↗

PubMed2004

Equity of access to adult hospice inpatient care within north-west England.

There is a growing debate about the question of equity of access to hospice and palliative care services. Even countries with relatively well developed palliative care systems are considered to have problems of access and inequity of provision. Despite these concerns, we still lack a relevant evidence base to serve as a guide to action. We present an analysis of access to adult hospice inpatient provision in the north-west region of England that employs Geographical Information Systems (GIS). Measures of the possible demand for, and supply of, hospice inpatient services are used to determine the potential accessibility of cancer patients, assessed at the level of small areas (electoral wards). Further, the use of deprivation scores permits an analysis of the equity of access to adult inpatient hospice care, leading to the identification of areas where additional service provision may be warranted. Our research is subject to a number of caveats--it is limited to inpatient hospice provision and does not include other kinds of inpatient and community-based palliative care services. Likewise, we recognise that not everyone with cancer will require palliative care and also that palliative care needs exist among those with nonmalignant conditions. Nevertheless, our methodology is one that can also be applied more generally.

Adult↗

PubMed2006

Beyond the sound of one hand clapping: experiences in six countries using health equity research in policy.

In an attempt to better understand the complex and sometimes tenuous relationship between health equity research and health policy, we undertook a collaborative comparison of six case studies with researchers from the United States, the United Kingdom, the Netherlands, China, South Africa, and Chile. Patterns in factors contributing to governments' interest in research included the role of domestic advocacy, interest in their international standing, and the existence of internal government champions. Strategies used by researchers to promote their findings included carefully crafting messages and selecting messengers in accordance with their audience's concerns, delaying publication until interactions with policy makers had occurred, monitoring public opinion, and a host of ideas relating to the style and content of government-sponsored commission reports. Most of the similarities crossed the developing/developed country divide, although it did appear that in the three case studies from the north, greater attention was paid to the professional legitimacy of institutions, individuals, and journals, while in the three developing countries the existence of trusted personal messengers appeared essential. While there are no prescriptions for ensuring the use of health equity research in policy, the comparison across such different international settings stimulated participants to question their assumptions about what works, when, and why.

Chile↗

PubMed1993

The generational equity debate: a progressive framing of a conservative issue.

This article discusses the generational equity debate in the United States--including its origins and the functions it serves. This debate has emerged in the context of concerns over the aging of the population, budgetary crises, growing health care costs, increased poverty among children, growing economic inequality, and declining faith in institutions. By potentially fragmenting support for Social Security and other social programs, the generational equity approach to framing public policy issues may serve the interests of those conservatives wishing to shrink and restructure the American approach to social welfare. However, the possibility exists that this debate could serve also as a forum to advance progressive ideas about universal access for persons of all ages to income and health benefits and employment opportunities.

Adult↗