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Results for “equity”

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PubMed1981

Equity in the distribution of quality of care.

This article examines whether the quality of health care services in the United States is equitably distributed across all groups in the population, especially groups defined by age, race, sex, and income characteristics. The framework within which the question is answered draws distinctions among structural, process, and outcome inequities. The available evidence suggests that all three types of inequity are present, at least to some extent. However, there are too many gaps and weaknesses in what is known about this issue to reveal systematic patterns or to support broad generalizations. The need for additional research on this issue is discussed, as are the policy implications of what is already known about equity in the distribution of quality of care.

Age Factors↗

PubMed1995

Can a public health care system achieve equity? The Norwegian experience.

Equity in health care provision is an important policy goal in Norway. This article addresses equality in the services provided by primary care physicians. These services are the responsibility of local government financed mainly through public funding. Patient fees are low. The local government system results in geographical variation in the number of physicians relative to local health demands. The authors present the hypothesis that this generates inequalities in health care utilization. The system of government finance is based on the assumption that utilization of health services is independent of patient income. Therefore, variation in income is expected to have only a small impact on utilization. The authors estimate a demand model by combining extensive micro data with aggregate data on municipal supply. There is very little relationship between indicators of access and health care utilization. The estimated income elasticities approximate zero, supporting the argument that equality in utilization has been achieved. However, the authors results also raise the question of whether equality has been achieved at the cost of limiting supply of services for people who could afford to consume more, or to pay for services of higher quality.

Adolescent↗

PubMed2000

Duties to future generations, proxy consent, intra- and intergenerational equity: the case of nuclear waste.

How does one deal with problems of risk transfer if it is the case that increasing risks to future generations decreases the risks to present generations, and increasing the risks to present generations decreases the risks to future generations? In the case of high-level nuclear waste and spent fuel, for example, should billions of dollars be spent to secure the wastes and protect future generations, or should the same monies be spent on present-day needs, under the assumption that future generations will be better able to deal with the waste than we are at present? Although these questions may appear insoluble, they become less so when one recognizes several common ethical and logical errors that beset many discussions of technological risk and duties to future generations. After briefly explaining the grounds for inter- and intragenerational equity, this analysis argues for three propositions about many treatments of inter- and intragenerational ethics: (1) these discussions often err because they frame policy arguments in terms that ignore rights and focus on maximizing welfare or utility, (2) they err because they frequently frame policy arguments in ways that set inter- and intragenerational welfare at odds, when they are not, because they ignore ameliorating practices and the conditions for proxy consent, and (3) they also err because they engage in risk practices that do not match their risk rhetoric.

Journal Article↗

PubMed2000

Equity, efficiency, uncertainty, and the mitigation of global climate change.

Policies to mitigate potential damages from global climate change impose costs on the current generation to provide benefits to future generations. This article examines how comparisons among three stylized policies-business-as-usual, mitigation of climate change, and compensation for climate damages-depend on social preferences with respect to risk and intertemporal equity. Also examined is the opportunity-cost criterion, which asserts that mitigation should not be chosen if its net present value is smaller than that of business-as-usual. Analysis reveals that the discount factor used to evaluate whether mitigation satisfies this criterion depends on preferences regarding risk and intertemporal inequality of consumption, and on the risk of the compensation policy. Risk aversion favors mitigation over business-as-usual. If society is neutral to inequality, risk aversion disfavors compensation, but if society is inequality averse, the effect of risk aversion on preferences between compensation and business-as-usual is ambiguous. Inequality aversion tends to favor business-as-usual over both alternative policies provided that, roughly speaking, the anticipated future improvements in welfare exceed the anticipated climate damages.

Journal Article↗

PubMed2001

Acute exposure to extremely hazardous substances: an analysis of environmental equity.

Although environmental equity research has focused primarily on chronic pollution sources, recent advances in environmental modeling and geographic information systems (GIS) provide a foundation for developing measures that can be used to evaluate differential exposure to acute pollution events. This article describes a methodology that uses facility-specific information to develop a risk surface representing the spatial distribution of accidental exposure to hazardous substances in a study area. Environmental pollution models recommended by the U.S. Environmental Protection Agency were used in conjunction with GIS software to achieve this objective. The methodology was implemented in a large metropolitan region (Hillsborough County, Florida) to examine disproportionate exposure to worst-case releases of extremely hazardous substances. The environmental inequity hypothesis was investigated by directly comparing the distribution of potential exposures within each racial (non-White versus White) and income (below poverty versus above poverty) subgroup. The results indicate that a significantly large proportion of both non-White and impoverished individuals resided in areas potentially exposed to multiple accidental releases.

Environmental Exposure↗

PubMed2006

Accessibility and equity of health and social care services: exploring the views and experiences of Bangladeshi carers in South Wales, UK.

There is a paucity of information regarding the extent and nature of caring provided by minority ethnic communities. The proportion of older people from these communities will dramatically increase in the next 20 years, which will be accompanied by increasing health and social care needs and an increased demand for carers. A qualitative, exploratory study was conducted to identify the health and social care needs of informal carers, who were caring for a dependent adult from a Bangladeshi community in South Wales, UK. This paper focuses on Bangladeshi carers' access to formal support services provided by the statutory, private and voluntary sectors to assist them with their caring responsibilities. The findings are based on data collected using face-to-face, focused interviews with 20 Bangladeshi carers. Purposive and snowball sampling were used to recruit the sample. The data were analysed using thematic content analysis. The dimensions of accessibility and equity of quality of care were drawn upon to aid understanding of the findings. Bangladeshi carers faced a number of barriers in accessing health and social service provision, which impeded uptake of these services. Additionally, there was evidence of inequity in service provision. Recommendations for improving the accessibility of health and social care services are proposed, which may assist in promoting more equitable services for carers from the Bangladeshi community.

Adolescent↗

PubMed1999

The horizontal equity of health care in New Zealand.

OBJECTIVE: Given that 'equal access for equal need' is a clearly articulated goal of the New Zealand public health system, this study is an attempt to determine if access to public health care services in New Zealand is, for people of equal health need, independent of income. METHOD: Information on health status, income and health service utilisation for just over 6,000 New Zealanders was obtained from the national Household Health Survey 1992-93. Using standardised expenditure concentration curves and a concentration index, the distribution of health service use by individuals in different income groups, as a proxy for access, was illustrated and quantified. RESULTS: The results suggest either appropriate or slightly excess use of services by the poor given their estimated health need. Due to analytical problems caused by data deficiencies, these results must be regarded as tentative. CONCLUSION: For the period under study, no evidence was found to indicate significant access barriers to publicly funded health care for people on different incomes. This study has served to demonstrate one approach to measuring inequality and analysing the relationship between inequality and inequity. Given the reforms to the health sector since 1993, ongoing monitoring of equity of access to health care services is essential. IMPLICATIONS: Given the income-related disparities in health that do exist, the public health community should endeavour to develop techniques to monitor the delivery of publicly funded health care to ensure that further inequity is not borne by the poor.

Adolescent↗

PubMed2000

Access and equity in the provision of general practitioner services for women in Australia.

OBJECTIVE: To assess geographical equity in the availability, accessibility and out-of-pocket costs of general practitioner (GP) services for women in Australia. METHOD: Data on general practice consultations during 1995 and 1996 for women aged 18-23 years (n = 5,260), 45-50 years (n = 7,898) and 70-75 years (n = 6,542) in the Australian Longitudinal Study on Women's Health were obtained from the Health Insurance Commission. A sub-study of 4,577 participants provided data on access to health services. RESULTS: Older women were more likely to have no out-of-pocket costs for their GP consultations, but in all age groups, the proportion was lower in rural areas than in urban areas (older age: 60% rural areas, 76% capital cities; mid-age: 24% rural areas, 40% capital cities; young age: 35% rural areas, 52% capital cities). Among mid-aged women, the median out-of-pocket cost per consultation ranged from $2.11 in capital cities to $6.48 in remote areas. Women living in rural and remote areas gave lower ratings for the availability, accessibility and affordability of health services than women living in urban areas. CONCLUSIONS: This study has shown a striking gradient in financial and nonfinancial barriers to health care associated with area of residence. IMPLICATIONS: The geographical imbalance in the supply and distribution of GP services in Australia has long been recognised but inequities in the affordability of services must also be addressed. Longitudinal survey data and Health Insurance Commission data provide a means to evaluate policies designed to improve access to health services in rural and remote areas.

Adolescent↗

PubMed2004

Promoting equity in health through research and understanding.

Developing strategies to reduce inequities in health requires an understanding of how inequities occur, determining the salient factors in their production, and deciding which ones are most amenable to change. The recognition of several principles regarding the manifestations and genesis of inequities can help to decide on strategies. In making decisions, it is important to consider whether the aim is to reduce disparities in the occurrence of ill health or to reduce disparities in the severity (including co-morbidity, disability, dysfunction and fatality) of ill health. Evidence shows that the major impact on equity of health services, particularly regarding their potential to reduce severity, is attributable to the strength of primary care resources and services in communities and countries. Virtually every influence on the genesis of inequities is determined by the political context in which policy is made. The issue of health services is not different in this regard from other types of strategies. There is no longer any doubt about the pervasive influence of social factors on health. Almost two centuries of descriptive research provides convincing evidence of associations between social structures and relationships and health status in all countries and in all societies; if there is anything new from more recent research, it is that the association is not limited to differences between the lowest social strata and other social strata. Rather, the association is noted throughout the social spectrum. That is, there is a social gradient in health such that, for many if not most manifestations of ill health, the lower the social stratum, the worse the health. The challenge for the future is to understand why this is the case, to create a consensus that these inequalities are unnecessary and unacceptable, and to devise strategies that are both effective and possible. This paper will focus on the first of these aims, in a context that facilitates attention to the second and third aims.

Health Services Accessibility↗

PubMed1976

Dental insurance and equity of access to dental services.

The first-year consequences of national dental insurance, introduced in Sweden in 1974, are examined here from the point of view of social justice. The concept of equity of access in medical care is discussed. In a local survey, a comparison is made between use of dental services in 1972, 1973, and 1974. The results indicate that the fewer people visited the dentist after the implementation of the insurance than before. Other evidence supports this conclusion. People traditionally considered to be underprivileged as to dental care were compared with other people. One underprivileged group, edentulous persons, received more treatment after the insurance was instituted than before.

Adolescent↗

PubMed2002

Achieving equity in Medicare disproportionate share payments to rural hospitals: an assessment of the financial impact of recent and proposed changes to the disproportionate share hospital payment formula.

Historically, the Medicare Disproportionate Share Hospital (DSH) payment program has been less favorable to rural hospitals: eligibility thresholds were higher and the payment adjustment was smaller for rural than for urban hospitals. Although the Medicare, Medicaid, and SCHIP Benefit Improvement and Protection Act (BIPA) of 2000 established a uniform low-income threshold and increased the magnitude of the adjustment for certain small and rural hospitals as a means to promote payment equity, the DSH distribution formula continues to vary by location. This study examines how the DSH revisions mandated under BIPA are likely to affect rural hospitals' financial performance and simulates the financial impact of implementing a uniform DSH payment adjustment. Using data from the 1998 Medicare cost report and impact files, this study found that two-thirds of both rural and urban hospitals would have qualified for DSH payments following BIPA compared with only one-fifth of rural hospitals and one-half of urban hospitals prior to BIPA. Although the impact of BIPA revisions on rural hospitals' total margins were found to be modest, the financial impact of a uniform payment adjustment would be somewhat greater: rural hospitals' average total margins would have increased by 1.6 percentage points. Importantly, 20% of rural hospitals with negative total margins would have been "in the black" if rural and urban hospitals were reimbursed using the same DSH formula. These findings suggest that elimination of rural and urban disparities in DSH payment could strengthen the rural health care safety net.

Fee-for-Service Plans↗

PubMed1998

Perceived equity and intimacy in marriage.

The extent to which perceived inequity is related to perceived marital intimacy was examined. Sixty-six couples married five years or less were randomly selected from marriage license records in a western rural community. Equity/inequity was assessed using the Walster global measure of equity. Levels of overall intimacy, conflict resolution, affection, cohesion, sexuality, identity, compatibility, autonomy, and expressiveness were measured using the Waring Intimacy Questionnaire (WIQ). Inequity was associated with lower levels of overall intimacy, compatibility, identity, and expressiveness among the wives. Among the husbands, inequity was not associated with any types of intimacy. When comparing husbands in inequitable relationships to wives in inequitable relationships, the wives reported lower scores for only one kind of intimacy--identity. Explanations and implications for marriage therapy are discussed.

Adult↗

PubMed1989

Justice and discrimination between minimal groups: the limits of equity.

Intergroup discrimination in the minimal group paradigm (MGP), which is usually invoked in support of social identity theory (SIT), seems to contradict every principle of social justice. A contradiction to equity theory (ET), however, exists only if one is committed to the transferability of ET from intragroup to intergroup relations. But even in that case one could explain intergroup discrimination in the MGP as a reaction to anticipated discrimination by out-group members and as therefore being in accordance with ET. Two experiments were devised to test SIT against ET as an explanation of intergroup discrimination in the MGP. In the first experiment the introduction of 'interindividual mutuality' into the experimental condition was found to significantly reduce intergroup discrimination almost down to equality as compared with a control condition which resembles the usual MGP procedure. In a second experiment first assumed distribution behaviour of out-group members as well as subjects' own intended distribution behaviour were assessed and second anticipation of fairness and discrimination was manipulated. Although most of the subjects assumed that they would be treated fairly by out-group members and likewise intended to be fair themselves, manipulation of anticipated out-group behaviour was found to lead to significant intergroup discrimination regardless of whether discrimination or fairness was anticipated. Implications of these findings for SIT and ET are discussed.

Adolescent↗

PubMed1980

Equity and the NHS: self-reported morbidity, access, and primary care.

The patterns of access to primary health care for 27 154 people were examined, using the raw data of the 1974 General Household Survey about self-reported morbidity and use of services. Access rates were calculated for four categories of health: the not ill, the acutely sick, the chronically sick without restricted activity, and the chronically sick with restricted activity. Contrary to the conclusions of existing publications, the analysis shows that the NHS has achieved equity in terms of access to primary health care: there is no consistent bias against the lower socioeconomic groups and, in the case of some health care categories, these have proportionately higher rates of access than their rates of self-reported morbidity would indicate. The findings also show large variations in patterns of access both between and within these categories of health.

Acute Disease↗

PubMed2005

Assisted reproductive technologies and equity of access issues.

In Australia and other countries, certain groups of women have traditionally been denied access to assisted reproductive technologies (ARTs). These typically are single heterosexual women, lesbians, poor women, and those whose ability to rear children is questioned, particularly women with certain disabilities or who are older. The arguments used to justify selection of women for ARTs are most often based on issues such as scarcity of resources, and absence of infertility (in lesbians and single women), or on social concerns: that it "goes against nature"; particular women might not make good mothers; unconventional families are not socially acceptable; or that children of older mothers might be orphaned at an early age. The social, medical, legal, and ethical reasoning that has traditionally promoted this lack of equity in access to ARTs, and whether the criteria used for client deselection are ethically appropriate in any particular case, are explored by this review. In addition, the issues of distribution and just "gatekeeping" practices associated with these sensitive medical services are examined.

Attitude of Health Personnel↗

PubMed1992

Determinants of equality and equity for special populations served by public mental health systems.

Within the publicly funded mental health service delivery system, debate continues over what constitutes a fair and just system for special populations. To determine a system's fairness, the author proposes a conceptual framework in which two standards of fairness--equality and equity--are applied to three dimensions of a mental health system: utilization of services, funding for services, and access to services. An equal system assumes that rates of mental illness and needs for treatment are the same for all subgroups of the general population; funds are allocated and services are offered accordingly. An equitable system assumes that special populations have different rates of mental illness and different treatment needs; funds are allocated and programs are designed based on the recognition of these differences. The author argues that the publicly funded mental health service system must establish equitable, rather than equal, services for special populations.

Community Mental Health Services↗

PubMed2003

Daily supportive equity in close relationships.

Receiving support in committed relationships has frequently been associated with negative psychological outcomes in the recipient, such as increased distress. The authors hypothesized that these negative effects could be offset by support recipients' reciprocation of support, that is, by creating a sense of supportive equity. To investigate this hypothesis, the authors obtained daily reports of mood and of received and given emotional support from both partners in 85 couples throughout a 4-week period. Reciprocity in support transactions was associated with higher levels of positive mood and lower levels of negative mood. In line with previous research, receiving support without reciprocation was associated with increases in negative mood. Giving support, regardless of receipt, was associated with a decrease in negative mood.

Adult↗

PubMedDate not supplied

Equity in environmental health: data collection and interpretation issues.

In order to assess the issue of inequity in exposure to environmental hazards, researchers must identify subgroups whose exposure is disproportionately greater than the average exposure experienced by the remainder of the population. The general population is a complex mixture of subgroups, each consisting of individuals who experience a wide range of exposures and whose ability to cope with the consequences of those exposures is equally varied. Therefore, large efforts are needed to collect data that will enable researchers to determine comprehensively which subgroups are highly exposed and which subgroups have disproportionately greater health effects as a result of exposures to environmental hazards. The interpretation of findings is more of an art than a science, especially when two population subgroups are being contrasted. Addressing environmental equity requires explicit comparisons between groups, and racial and ethnic contrasts will be prominent. It is often difficult to identify the underlying mechanisms that produce particular patterns of results. However, researchers and policy makers must understand the dynamics that may have produced a particular pattern of results so they can separate those factors that are amenable to change from those that are not.

Data Collection↗