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PubMedDate not supplied

Equity in the diagnosis of chest pain: race and gender.

OBJECTIVE: To explore gender and racial equity in emergency room treatment of chest pain. METHODS: Three hundred seventy-nine patient records were analyzed, taking into account effects of age, clinic, comorbid status, and insurance status. RESULTS: Analysis of covariance and logistic regression revealed statistically significant differences between races but not between genders for time to first EKG and percent of patients receiving cardiac catheterization and echocardiography. Blacks waited longer than whites for an EKG and were less likely to receive cardiac catheterizations but more likely to receive echocardiography. CONCLUSION: This study demonstrates a lack of equity by race in treatment of chest pain emergencies.

Adult↗
PubMed2004

Compensation and advancement of women in academic medicine: is there equity?

BACKGROUND: Women have been entering academic medicine in numbers at least equal to their male colleagues for several decades. Most studies have found that women do not advance in academic rank as fast as men and that their salaries are not as great. These studies, however, have typically not had the data to examine equity, that is, do women receive similar rewards for similar achievement? OBJECTIVE: To examine equity in promotion and salary for female versus male medical school faculty nationally. DESIGN: Mailed survey questionnaire. SETTING: 24 randomly selected medical schools in the contiguous United States. PARTICIPANTS: 1814 full-time U.S. medical school faculty in 1995-1996, stratified by sex, specialty, and graduation cohort. MEASUREMENTS: Promotion and compensation of academic medical faculty. RESULTS: Among the 1814 faculty respondents (response rate, 60%), female faculty were less likely to be full professors than were men with similar professional roles and achievement. For example, 66% of men but only 47% of women (P < 0.01) with 15 to 19 years of seniority were full professors. Large deficits in rank for senior faculty women were confirmed in logistic models that accounted for a wide range of other professional characteristics and achievements, including total career publications, years of seniority, hours worked per week, department type, minority status, medical versus nonmedical final degree, and school. Similar multivariable modeling also confirmed gender inequity in compensation. Although base salaries of nonphysician faculty are gender comparable, female physician faculty have a noticeable deficit (-11,691 dollars; P = 0.01). Furthermore, both physician and nonphysician women with greater seniority have larger salary deficits (-485 dollars per year of seniority; P = 0.01). LIMITATIONS: This is a cross-sectional study of a longitudinal phenomenon. No data are available for faculty who are no longer working full-time in academic medicine, and all data are self-reported. CONCLUSIONS: Female medical school faculty neither advance as rapidly nor are compensated as well as professionally similar male colleagues. Deficits for female physicians are greater than those for nonphysician female faculty, and for both physicians and nonphysicians, women's deficits are greater for faculty with more seniority.

Career Mobility↗
PubMedDate not supplied

The equity market for physician practice management companies.

Initial public offerings or selling out to physician practice management (PPM) firms may be an option for raising capital in large physician groups. This article will address whether this is an accurate perception, whether the markets have cooled and if the heat will return, and the various equity-based options by which physicians can raise equity capital and the advantages and disadvantages of each alternative approach.

Capital Financing↗
PubMed1997

Physician equity alliances: attractive alternatives to PHOs.

Physician equity alliances are becoming attractive alternatives to PHOs as integrative models for partnering with physicians, securing managed care contracts and increasing revenue. Unlike many PHOs, these alliances provide mechanisms for asset integration and long-term relationships along with utilization management, sophisticated information systems, access to capital and opportunities for physicians to integrate clinically. There are six major types of physician equity alliances: majority physician-owned, clinic without walls, health system joint venture, publicly held physician practice management company, specialty network, and venture capital. The type of alliance that a physician group practice ultimately develops depends on vision, values, method of capitalization, initial organizer of the alliance, level of involvement of physicians in business issues, corporate structure desired, and characteristics of the managed care market in which the alliance will operate.

Capital Financing↗
PubMed1998

The physician equity option: an alternative to purchasing a practice.

Traditionally, a healthcare organization acquires a physician practice by purchasing the practice's assets and then acting as an employer to the physicians. Another acquisition strategy is for a healthcare organization's medical director to purchase equity in a practice and then direct the physician partners. An alternative to these traditional strategies is the physician equity option, by which a healthcare organization purchases an option to acquire a physician practice at a future date. This strategy enables a healthcare organization to meet its goal of developing relationships with physician groups without the cash outlay involved in purchasing 100 percent of a practice outright.

Health Care Sector↗
PubMed1988

Medicare program; changes to the return on equity capital provisions for outpatient hospital services--HCFA. Final rule.

We are revising the Medicare regulations to eliminate the allowance for a return on equity capital for outpatient services furnished by proprietary hospitals as required by section 4065 of the Omnibus Budget Reconciliation Act of 1987 (enacted on December 22, 1987). Section 4065 prohibits recognition of any return on equity capital with respect to hospital outpatient departments effective January 1, 1988.

Aged↗
PubMed1988

Home equity conversion and the financing of long-term care.

Home equity conversion for the elderly is a means for elderly homeowners to draw down a portion of their accumulated wealth without having to sell their homes and/or move. The instruments to convert equity have substantial promise for matching the expenditure needs associated with long-term care services. There have been no formal attempts to pair these potential revenues and expenditures, but the revenue instruments are evolving to a point where such combinations are realistic and reasonable. This article describes why and how such a match might work.

Aged↗
PubMed2000

Equity MSO (management services organization) benefits hospital and physicians.

Equity MSOs offer an alternative to hospital's employment of physicians and acquisition of their practices. In one example, several primary care physicians, organized into a single professional corporation, entered an agreement with a hospital to establish an equity MSO that was jointly owned by both parties. The partnership enabled the physicians to negotiate managed care contracts more skillfully and improve their bottom line. Under the agreement, the physicians' income is determined by their productivity. The hospital is confident that this new entity will help it sustain relationships with the physicians.

Efficiency↗
PubMed2002

Equity in waiting times for major joint arthroplasty.

OBJECTIVE: To ascertain whether waiting lists are managed in an equitable fashion in a universal health system by examining demographic, socioeconomic and clinical factors, along with 2 health systems variables. DESIGN: A prospective survey by questionnaire. SETTING: The Capital Health Region of Edmonton, Alta. PATIENTS AND METHODS: A cohort of 553 patients, who were waiting for either total hip or total knee replacement surgery, seen between Dec. 18, 1995, and Jan. 24, 1997. INTERVENTIONS: A home visit was made when the patient was first placed on the waiting list and again just before surgery to complete the questionnaires. The Western Ontario and McMaster Universities (WOMAC) instrument and the Medication Quantification Score were administered at the time the patient was placed on the waiting list. MAIN OUTCOME MEASURE: The length of waiting time, defined as the date the patient was put on the waiting list to the date the patient was operated on. RESULTS: There were no biases in waiting time with respect to age, gender, education or work status. Although pain and function were not related to waiting time, multivariate analyses found that marital status, primary language, body mass index, pain medication use and the size of the surgeons' major joint replacement practice determined waiting time for surgery. However, this model explained only 10% of the variance in waiting time. CONCLUSION: Waiting lists were managed unfairly in terms of clinical equity (clinical severity) but managed fairly in terms of social equity.

Aged↗
PubMed2003

Health and equity impacts of a large oil project in Africa.

A system of external reviewers was established by the World Bank Group to promote a thorough environmental and health impact assessment for the 3.5 billion US dollars Chad Oil Export Project, based on a loan request from Chad, Cameroon and a consortium of oil companies. The environmental and health assessment process showed evidence of its ability to minimize the number of deaths from malaria, traffic accidents and construction accidents and the occurrence of minor sexually transmitted diseases, diarrhoeal diseases and respiratory diseases; it also probably limited adverse impacts on wildlife and tropical ecology along the pipeline route. However, the system was unable to deal with the larger issues, which included: the intrinsic unsustainability of this kind of extraction project; its eventual contribution to large amounts of greenhouse gases in the atmosphere; the lack of equity in sharing the risks, negative impacts, benefits and decision-making among the various participants in the project; and the possible acceleration of transmission of the AIDS virus into central Africa. Unfortunately, the international panel of experts appointed by the World Bank Group was largely ignored by the project proponents, and had little success in minimizing the most serious impacts or in improving the social equity of the project.

Cameroon↗
PubMed2003

Conclusion: The Equity Project.

As a result of the work completed during the meeting and summarized at the last session, 4 implementation groups have been established as the organizational framework for the American Academy of Pediatrics (AAP)-Royal College of Paediatrics and Child Health (RCPCH) Equity Project. This project will be the mechanism by which the RCPCH and the AAP will continue the endeavor that was initiated at this meeting. The Equity Project Implementation Groups will focus on Education and Training, Practice and Advocacy, Research and Public Policy, and Children's Rights. The goals and objectives of each group reflect the accomplishments of the conference participants. A call will go out to members of the AAP and the RCPCH to join these groups as the core of the operation of the project. Objectives will be prioritized and joint initiatives developed to focus on these priorities. The project thus will evolve as a broad-based effort to engage as many members of the AAP and the RCPCH as possible in project endeavors.

Child↗
PubMed2004

Improving immunization equity through a public-private partnership in Cambodia.

OBJECTIVE: To examine the effects on immunization equity of the large-scale contracting of primary health-care services in rural areas of Cambodia. METHODS: Data were obtained pre-intervention and post-intervention from a large-scale quasi-experiment in contracting with nongovernmental organizations to provide primary health care in nine rural districts of Cambodia between 1999 and mid-2001. Coverage targets and equity targets for all primary health-care services, including immunization of children, were explicitly included in the contracts awarded in five of nine rural districts which together have a population of over 1.25 million people. The remaining four districts used the traditional government model for providing services and were given identical targets. FINDINGS: After the 2.5 years of the trial, bivariate and multivariate analyses of the results suggested that although there was a substantial increase in the proportion of children who were fully immunized in all districts, children in the poorest 50% of households in the districts served by contractors were more likely to be fully immunized than poor children living in similar circumstances in districts using the government's model, all other things being equal. CONCLUSION: The contracting approach described in this paper suggests a means of moving towards a more equitable distribution of immunization services in developing countries.

Adult↗
PubMed2005

Making equity a reality: oral health promotion in a psychiatric setting.

The aim of the study addresses the inequity in oral health status of long stay psychiatric patients, by promoting an inter-disciplinary team approach to oral health promotion. A cross sectional study using a modified version of the oral health assessment guide (OHAG) (Eilers et al 1988, Sjorgen & Nordstrom 2000) was used by a nurse who received training and calibration at the School of Dentistry, Queen's University, Belfast, to assess the oral health status of long stay psychiatric patients. The paper provides an overview of the literature relating to oral health within the context of holistic health. It highlights the non-random distribution of oral health problems amongst psychiatric patients and the potential contribution of health needs assessment to the realization of equity. The study focused on 65 long stay patients in a psychiatric hospital, mean length of time patients had been in the hospital was 25.6 years; nine patients had been living in the hospital between 40 and 65 years. The study achieved a response rate of 82% and identified that oral health of the psychiatric patients was generally very poor, compared to the general population. Only one patient did not have calculus, decayed or fractured teeth and 12 of the patients were endentate and there was a conspicuous absence of health promoting behaviours amongst the patient group. A case study is used to highlight the lived reality of the patients and the need for a holistic and an inter-disciplinary approach to oral health promotion, for patients residing in a psychiatric setting. This preliminary investigation highlights the benefits of systematic assessment of need: in this instance the use of the OHAG as a tool, for promoting equity based care by making visible the non random distribution of oral health problems amongst the patients.

Adult↗
PubMed2005

Global health and equity: part 2: exploring solutions.

The Millennium Development Goals set an agenda for advancing global health in the 21st century. Nurses have a pivotal role to play in the pursuit of global health and equity, including achieving the goals, but their capacity to contribute has been largely untapped. In this article, the authors examine strategies to mitigate inequities in global health within an international development framework, threats to achieving equity in health and the implications of these issues for nurses and nursing.

Global Health↗
PubMed2006

[The extent and relative changes of equities in utilization of prenatal care among women in some areas of China].

OBJECTIVE: To assess the extent and relative changes of the equities in prenatal care utilization among women with different educational attainment in some areas of China. METHODS: Data were collected in 13 counties/cities covered by Perinatal Health Care Surveillance System established by Institute of Reproductive and Child Health, Peking University. The study population consisted of 103 704 women who delivered single live births in 1994 and 2000. Chi-square and multiple logistic regression were employed to compare the systematic management rates and relative risks. Concentration index was used to assess the relative changes of equities in prenatal care utilization. SPSS 11.5 and Microsoft Excel 2003 were used for analysis. RESULTS: The total systematic management rate was 22.1% in 1994 and 57.4% in 2000. The concentration index was -0.046 in 1994 and 0.066 in 2000. In northern areas, the concentration index increased from 0.015 in 1994 to 0.295 in 2000, while it increased from -0.015 in 1994 to 0.062 in 2000 in southern areas. In rural areas, the concentration index increased from 0.002 in 1994 to 0.026 in 2000, while it decreased from 0.042 in 1994 to 0.019 in 2000 in urban areas. CONCLUSION: Inequities in prenatal care utilization in 2000 become more obvious than in 1994, especially in northern areas. More attention should be paid to solve the inequities.

China↗
PubMedDate not supplied

[Equity and health: research needs for the development of a social policy].

This article presents a general view of the evolution of the conceptual approach to equity in health and its current meaning. The analysis of equity from the standpoint of distribution-accesibility, use and outcome of health services is proposed. Every point of view is addressed to an operational and policy-making position. This paper concludes with a proposal of perspectives for research development in this field.

Health Policy↗
PubMed1984

Returns on equity to not-for-profit hospitals: theory and implementation.

It is argued that not-for-profit hospitals can be assumed to generate a return on equity capital due, in principle, to competition in the final product market for hospital services and in the capital market. Practical difficulties in identifying claimants to the net income of the firm, as well as the incentive problems of cost-based reimbursement, suggest that a competitive pricing approach is likely to be the appropriate means to provide a reasonable return on equity for the not-for-profit and the for-profit hospital. Implications of the analysis for the correct discount rate in investment decisions are outlined.

Capital Financing↗