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PubMed2003

How did Finland's economic recession in the early 1990s affect socio-economic equity in the use of hospital care?

The study evaluates the changes in socio-economic equity in the use of general hospital care in Finland from the late 1980s to the mid 1990s. In the early 1990s the Finnish economy plunged into a deep recession which slashed over 10% of GDP and resulted in a 12% decrease in national health expenditure. At the same time, the administration and financing of specialised health services were reformed. The impact on general hospital care was controversial: budgets were reduced but better productivity increased the supply of many services. According to the study, data, based on individual linkage of nationwide hospital registers to disposable family income data in population censuses, overall acute general hospital admission rates among Finns aged 25-74 increased by over 10% from 1988 to 1996. For some surgical procedures, such as cataract, coronary revascularisation and some orthopaedic operations, rates more than doubled. In both years, lower-income groups generally used hospital care more than the better-off. However, there was a slight shift towards a pro-rich distribution, mainly due to a larger increase in surgical care among the high-income groups. In 1988 the lowest income quintile used 8% and in 1996 15% fewer operations than the highest. For individual procedures and surgical diagnostic categories, the general trends of increasing disparities were similar. Despite cuts in expenditures in the early 1990s, the Finnish general hospital system based on public funding and provision managed to increase the supply of services. However, this increase coincided with widening socio-economic discrepancies in the use of surgical services. The paper proposes that these increasing inequities were due to certain features of the Finnish health care system which create social discrepancies in access to hospital care. These include the high profile of the private sector in specialised ambulatory care and in the supply of some elective procedures, and semi-private public hospital services requiring supplementary payments from patients.

Adult↗
PubMed2004

Risk segmentation and equity in the Chilean mandatory health insurance system.

For decades, the Chilean health system has included a requirement for dependent workers to spend a certain percentage of their wages on health insurance. Since 1981, workers have been able to choose between public insurance and several private insurance providers. The reforms introduced more choice, moving away from reliance on an exclusive public provider. By 1999, about half of the country's active dependent workers had opted out of the public and into the private insurance system. The development of the private insurance system has been accompanied by controversy, however, regarding possible inequities in the utilization of medical services, the degree of risk segmentation, inefficiencies in the system's operation, and other factors. This paper discusses the issues of risk segmentation and equity. It starts by reviewing the system's design on a theoretical level, then deriving hypothesis and finally providing empirical evidence regarding these hypothesis. Particular attention is given to the issues of how individuals choose between the public and private system (to determine the reasons behind risk segmentation) and the differences in utilization among the various income groups (to clarify the issue of possible inequities).

Actuarial Analysis↗
PubMed2004

Inequality of water fluoridation in Southern Brazil--the inverse equity hypothesis revisited.

The purpose of this ecological study was to investigate the association between social and economic indicators at the municipal level and the presence of water fluoridation and time when water fluoridation was implemented in the 293 municipalities of Santa Catarina State in Southern Brazil. Several social and economic indicators were obtained from official Brazilian agencies as well as from UNICEF. Questionnaires were sent to local authorities and to the local government water supply Company to obtain information about the presence or not of a fluoridated water supply and the year when fluoridation was implemented. Differences in social and economic indicators between municipalities with and without fluoridated water and between those that have had this service for different lengths of time were compared by the Mann-Whitney U test. In addition, multiple logistic regression analyses was performed to identify associations between social and economic indicators at the municipal level and presence and time of implementation of water fluoridation. Results indicated that larger populations are associated with municipalities with fluoridated water. Larger populations, higher child development indexes and low illiteracy rates are associated with a longer time since the implementation of water fluoridation. The finding that less developed municipalities delayed the provision of water fluoridation corroborates the inverse equity hypothesis.

Brazil↗
PubMed1997

[Judicial liability and blood transfusion--equity, opportunity?].

Blood transfusion centres are regularly sentenced to compensate for damages caused to individuals contaminated following a transfusion. Some blood transfusion centre directors and certain senior civil servants of the Health Ministry were sentenced by the repressive courts. This article explains how these solutions are not innovative and only result from the application of the rules of common law to transfusion activity. The author tries to assess the opportunity and equity of this.

Blood Banks↗
PubMed1998

Reflective practice in nurse education: a step towards equity in education and health care.

In the past, the Australian health care system, whose mainstream services are essentially monocultural, has not always successfully met the needs of clients from a variety of cultural groups. Entry of more young immigrant people into the essential health services is one strategy which may assist in bringing positive benefits to health care consumers from non-English speaking backgrounds (NESB). For NESB students, however, the tertiary education experience frequently produces inequities similar to those encountered by NESB consumers of health care, and failure rates of these students are often disproportionately high. This paper describes the process of reflective practice used to investigate the needs of NESB students enrolled in the first year of an undergraduate nursing degree, and the strategies subsequently initiated to improve educational outcomes for these students. In terms of academic success, outcomes for NESB students involved in the investigation were markedly improved in comparison to the previous year. More importantly, the project fostered reflection on teaching practices, and led to modifications which, although small, represented a positive step towards equity.

Australia↗
PubMed1983

Equity and efficiency in the allocation of the personal social services.

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.

Aged↗
PubMed1989

Outcome-based equity in the treatment of colon cancer patients in Finland.

The differences in survival rates of colon cancer patients between hospital districts were used as an indicator of equity in cancer treatment in Finland. The merits of two different assessment methods were evaluated. The large variation was mainly due to confounding by age and the extent of the disease and to random variation.

Aged↗
PubMed2001

Consumer preferences and brand equity measurement of Spanish national daily newspapers: a conjoint analysis approach.

Brand is a product attribute that, for many types of goods or services, makes a major contribution to consumer preferences. Conjoint analysis is a useful technique for the assessment of brand values for a given consumer or group of consumers. In this paper, an application of conjoint analysis to the estimation of brand values in the Spanish daily newspaper market is reported. Four newspaper attributes were considered: brand (i.e., newspaper name), price (0.60, 1.05, or 1.50 euros), Sunday supplement (yes/no), and daily pullout (yes/no). A total of 510 regular readers of the national press, stratified by age and sex, were asked to rank 16 profiles representing an orthogonal fraction of the possible attribute-level combinations. Brand was by far the most important attribute, whereas price had negligible effect. More generally, the results confirm the utility of conjoint analysis for assessing brand equity in the newspaper market and for estimating the relative importance of the various attributes to different subgroups of consumers.

Adolescent↗
PubMed2002

5.2 Ethics, equity and global responsibilities in oral health and disease.

The charge of this Section is ethics and global responsibilities in oral health and disease. Oral health is determined by the same factors as those for general health. To a limited extent, the level of oral health care and dental education. The philosophy and organization of the health care system and dental education, therefore, are key determinants of oral health. Dental education has expanded in many countries where there has been an increase in wealth. Unfortunately, there has been no concomitant increase in the number of dental educators. This is a problem throughout the world. This present situation raises certain ethical issues with regard to professional responsibilities. It also raises some important questions for dental education. This Section has chosen to focus its efforts on examining two issues: * What can be done within dental schools? * What can be done external to dental schools - either individually or collectively? The best practices identified are more akin to goals, as it is recognized that, in a world in which there are enormous variations in economic, environmental, social, and cultural features, a single uniform set of practices is impracticable. The central core value identified is the realization by students, and faculty/teaching staff of the quest of life-long learning against a background of the social and ethical responsibilities of health professionals. The conclusion of the group is that biology is not the sole determinant of health. Understanding the role of social, economic, environmental and other factors in determining health status is critical if greater equity in dental education and care are to be achieved.

Developing Countries↗
PubMed2002

The relationship between early recruitment-related activities and the application decisions of new labor-market entrants: a brand equity approach to recruitment.

Theory and research from the marketing literature on customer-based brand equity were used to predict how positive exposure to 4 early recruitment-related activities-publicity, sponsorships, word-of-mouth endorsements, and advertising-may affect the application decisions of engineering students. Similar to prior marketing findings, the results suggested that early recruitment-related activities were indirectly related to intentions and decisions through 2 dimensions of employer brand image: general attitudes toward the company and perceived job attributes. The relationships between word-of-mouth endorsements and the 2 dimensions of brand image were particularly strong. In addition, it was found that early recruitment-related activities interacted with one another such that employer brand image was stronger when firms used publicity in conjunction with other early recruitment-related activities.

Decision Making↗
PubMed2006

Does marriage protect older people from distress? The role of equity and recency of bereavement.

The association between marital status and distress was examined in a largely neglected group, namely older people (65 and older; N = 1,649). In this 2-wave study, married persons were less distressed than single persons, but perceived equity within the marriage and recency of bereavement qualified these findings. Married persons who felt inequitably treated were more distressed than persons who had always been single. Married persons reported less distress than recently (= 2 years ago) widowed persons, but only equitably treated married persons reported less distress than persons widowed for more than 2 years. Increased distress between the 2 waves occurred in recently widowed persons, and there was a decrease in distress in persons who were widowed shortly before the 1st wave. No gender effects were found.

Adaptation, Psychological↗
PubMedDate not supplied

GIS-based measures of environmental equity: exploring their sensitivity and significance.

In order to determine whether principles of environmental justice have been violated, a large number of empirical studies have been carried out to ascertain whether minority and low-income populations are disproportionately exposed to industrial pollution. This study provides a comparative evaluation of two commonly employed proximity measures in GIS-based environmental equity assessment, examining their influence on the results of the analysis, and proposes a methodology for evaluating the significance of these results. 1990 census data on population characteristics and data from the 1995 EPA's toxic release inventory (TRI) for the City of Minneapolis, MN are used. These results also allow a preliminary assessment of environmental equity/inequity in potential exposure to airborne toxic chemicals for racial minorities, poor people and children in Minneapolis. In the third part of the paper we develop and employ a geographic randomization methodology for assessing the significance of these results.

Adult↗
PubMed2001

Developing a UK health equity network.

The UK Health Equity Network (HEN) was established in 1999 to encourage and facilitate multidisciplinary and multi-stakeholder collaboration in health inequalities research. This paper briefly details the history, objectives and location of HEN.

Cooperative Behavior↗
PubMed1989

A case at last for age-phased reduction in equity.

Maximizing expected utility over a lifetime leads one who has constant relative risk aversion and faces random-walk securities returns to be "myopic" and hold the same fraction of portfolio in equities early and late in life--a defiance of folk wisdom and casual introspection. By assuming one needs to assure at retirement a minimum ("subsistence") level of wealth, the present analysis deduces a pattern of greater risk-taking when young than when old. When a subsistence minimum is needed at every period of life, the rentier paradoxically is least risk tolerant in youth--the Robert C. Merton paradox that traces to the decline with age of the present discounted value of the subsistence-consumption requirements. Conversely, the decline with age of capitalized human capital reverses the Merton effect.

Aging↗
PubMed2001

Equity in access to public dental services: the experience from Norway.

The aim of this study was to identify possible factors associated with the marked geographical variation in supply of public dental services in Norway. We identified three sources for this uneven distribution: differences in dental care needs, differences in revenue levels between counties, and differences in the party composition of the county councils. Analyses were undertaken to ascertain whether these factors were related to the variation in the number of man-labor years of public dental officers. The analyses were performed on a set of data from Norwegian counties for the period 1985-92. There was an association between the number of man-labor years of public dental officers and our indicators of dental care needs, county revenue, and party composition of the county councils. Our findings are encouraging, as they indicate that the county councils seemed to respond to the dental care needs of the local population. On the other hand, there were inequalities in supply of public dental services that were due to differences in revenue between counties. From an equity point of view, this inequality is undesirable. The inequality could most likely be reduced by decreasing the variation in revenue between counties. Differences in party composition of the county councils had only a small effect on the geographical variation in the number of man-labor years of public dental officers.

Adolescent↗
PubMedDate not supplied

Ethnicity, equity, and access to genetic services--the UK perspective.

The UK is a multi-ethnic, multicultural society with over 300 languages spoken in the capital (London) alone. This short report explores the implications of a diverse population on health and access to genetic services. It considers genetic, cultural and linguistic differences, and provides evidence of inequalities in access. Following recent legislation promoting race equality, the report highlights current activities and shortfalls, and proposes recommendations towards achieving greater equity of access within the context of clinical genetics service provision.

Cultural Diversity↗
PubMed2004

Equity in the use of IVF in Finland in the late 1990s.

AIMS: The purpose of this study was to describe equity in the use of in vitro fertilization (IVF; including micro-injections and frozen-embryo transfers), and compare its use with that of other assisted reproduction technologies (other ARTs; including ovulation inductions with or without inseminations). METHODS: The women who received IVF (n=9, 175) and other ARTs (n=10,254) between 1996 and 1998 were identified from the reimbursement records of the Social Insurance Institution (SII) covering all Finns. Population controls, matched by age and municipality, were selected for IVF women (n=9,175). Information concerning background characteristics came from the Central Population Register and the SII's reimbursement files. The sector (public vs. private) was defined using prescribing physicians' codes. IVF use was studied by the proportions of women treated and the frequency of treatment. RESULTS: The age-standardized IVF incidence per thousand 20-to-49-year-old women was 8.8 in urban and 7.3 in rural areas, but the use of other ARTs did not vary correspondingly (9.2, 9.3). The regional incidence of IVF and other ARTs varied considerably. In the private sector, women in the highest socioeconomic position were over-represented (29% private, 18% public, 16% controls). During the mean 1.5 years of the study period, the IVF women had somewhat more treatment cycles in the private than in the public sector (mean 3.3, 2.7), and those in the highest socioeconomic position had more cycles than others (3.5, 3.2); the frequency was not age-dependent. In the public sector the number of cycles did not differ by socioeconomic group (mean 2.7-2.8 per woman), and women aged 25 to 39 had more cycles than others. CONCLUSION: There were socioeconomic differences in use of IVF services, but they were small because of the equitable use of public services.

Adult↗