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PubMed1985

Equity financing for long-term care companies.

Going public is not for every long-term health care company. However, the equity marketplace provides an exciting, fascinating arena for soliciting capital which might otherwise prove too costly or difficult. The popularity of going public is evidenced by investor demand and the amount of capital raised can be phenomenal. In 1983 Russell (1985) noted that 889 companies raised $12.95 billion by going public. In 1984 equity raised dropped back to $3.5 billion. It is more true today than ever before that long-term health care companies possess an important financial weapon within their arsenal if they so choose to utilize it. By going public and raising equity financing the private entity can become a meaner, leaner long-term health care company. A company which now possesses greater leverage and bargaining power to create and to direct its own corporate destiny.

Capital Financing↗

PubMed1999

[Modified cost-benefit analysis takes equity into consideration. Treatment of brain tumors is more cost-effective than hip replacement].

As health care resources are held to be insufficient to permit free choice of available treatment options, prioritizing is necessary. A precondition of careful prioritizing is comprehensive knowledge of the consequences, both for the patient and the community, of adopting each of the available options in a given case. A tool used in setting priorities is cost-benefit analysis, based on the utilitarian principle of health maximisation. However, it is evident from findings in recent studies that equity is widely considered a factor which ought to be included in the analysis. The article presents a method for correcting the variable, quality-adjusted life years (QALY), by introducing an equity factor, yielding a new variable, equity-adjusted QALY (EQALY). Use of the method is illustrated by comparison of the cost-effectiveness of two procedures, hip replacement and the treatment of malignant glioma, and showing how priority ranking of the two procedures is reversed if the EQALY variable is used instead of QALY.

Adult↗

PubMed1999

Willingness to pay for the maintenance of equity in a local ivermectin distribution scheme in Toro, Northern Nigeria.

The willingness to pay (WTP) for the maintenance of equity in a local ivermectin distribution scheme in the context of a community financing framework was determined in Toro, Northern Nigeria, using 214 randomly selected heads of households, or their representatives. Though WTP of the respondents for their own households was elicited, the focus of this paper is on WTP to maintain equity in a community financing scheme. Contingent valuation was used for the exercise, and WTP was elicited using an open-ended question. 97.2% of the respondents were in favour of allowing those that lack the ability to pay, to benefit from the scheme and the maximum WTP amounts they were willing to contribute annually so that those who lack the ability to pay could benefit from the scheme ranged from 5 Naira ($0. 06) to 100 Naira ($1.25). The mean WTP to maintain equity was 29.00 Naira ($0.36) while the median was 20.00 Naira ($0.25). This study shows that a community financing scheme for local ivermectin distribution will not be inequitable, since enough funds will be realised from well-to-do community members to cover the costs for those who are unable to pay.

Adult↗

PubMed1999

A framework for assessing the effectiveness, efficiency, and equity of behavioral healthcare.

OBJECTIVE: To evaluate the effectiveness, efficiency, and equity of behavioral healthcare and to guide an assessment of the current state of the art of behavioral health-oriented health services research. STUDY DESIGN: The framework is grounded in previous conceptual work by the authors in defining a prevention- and outcomes-oriented continuum of healthcare and in identifying and integrating the concepts and methods of health services research and policy analysis for assessing healthcare system performance. PATIENTS AND METHODS: The defining assumptions are that (1) the denominator for behavioral healthcare services must encompass a look at the population, not just the patients, who manifest behavioral health risks; and (2) the delivery system to address these needs must extend beyond acute, treatment-oriented services to include both primary prevention and aftercare services for chronic relapsing conditions. RESULTS: Current policy and practice in behavioral healthcare reveal the absence of a comprehensive, coordinated continuum of care; substantial variation in policy and financial incentives to encourage such development; and poorly defined or articulated outcome goals and objectives. The current state of the art of research in this area reflects considerable imprecision in conceptualizing and measuring the effectiveness, efficiency, and equity criteria. Further, these 3 criteria have not been examined together in evaluating system performance. CONCLUSIONS: The first era of behavioral healthcare focused on cost savings in managed care alternatives; the second is focusing on quality and outcomes; a third must consider the issues of equity and access to behavioral healthcare, especially for the most seriously ill and vulnerable, in an increasingly managed care-dominated public and private policy environment.

Behavioral Medicine↗

PubMed2000

Equity as a goal for health care: an operational inquiry.

Difference in health status, allocation of resources, provision of services and development of basic health infrastructure, both within and between countries raise questions of fairness. The means for assessing this differential, developing strategies to overcome them and documenting changes become crucial. This paper will explore the concepts of equity and justice from an operational perspective, present a number of scenarios in dealing with the health of populations and assess the impact of using equity as a goal for health care in those cases. The objective is to present an analysis of how the same goal in health care may result in different actions with variable results. An evaluation of the potential conflict between equity and utility is presented. Implications for further work on the means of assessing inequities, use of indicators and measuring the result of interventions is discussed.

Community Health Planning↗

PubMed2003

[Equity and health sector reform in Latin America: a necessary debate].

Reform and equity are terms that have frequented political discourse, technical documents, and conceptual discussions in recent decades in different proposals with different ideological references. To understand the importance and centrality of these themes in the contemporary debate in Latin America implies a more in-depth reflection on health policy in the sphere of social policies and to define which reforms were are discussing and the place equity occupies in this discussion. The first part of this essay discusses the concepts of reform and equity, followed by a review of health policy as a social policy. The article ends by discussing the central elements on the health systems reform agenda in Latin America. The conclusion is that the situation is dramatic and that recent reforms have exacerbated inequalities and created new problems by replacing the values of solidarity and equal opportunity with those of "radical utilitarian individualism"; meanwhile, the principle of "health needs" has been replaced by that of "risk", "monetarized" and defined according to the individual's social and economic position. It becomes necessary to resume the discussion of social and health policies as the matrix of principles justifying the order ascribed to any other policies.

Health Care Reform↗

PubMed2003

[Equity and health policy: some reflections on the Family Health Program in Brazil].

This article focuses on key elements contributing to the public social policy debate, specifically from the perspective of promoting distributive justice. The reference is the Family Health Program in Brazil and its relation to recent changes in national health policy and the literature on the issues of equity and social justice. This concern is due to recent changes in social interventions by the Brazilian state, where targeting assumes a central place in the reform process. Specifically concerning health policy, the issue of equity has gained visibility, linked to the discussion on the profile of health expenditures. One of the central aspects in this context lies in the debate between notions such as the regressive and inequitable nature of targeted measures and programs, on the one hand, and the expanded perspective of access by what have traditionally been socially excluded sectors, on the other. The debate between such perspectives highlights the controversies concerning the effectiveness of health measures, equity, and the distributive concept of social justice, with the latter as the central discussion in this study.

Brazil↗

PubMed2005

Global health and equity. Part 1: setting the context.

Equity is considered one of the prerequisites and conditions for health. The pursuit of global health and equity is a relevant goal for nursing, based on the belief that health is a core phenomenon of interest to the discipline. In this article, the first in a two-part series, global health, equity and globalization are analysed. In addition, factors that contribute to global health inequity, including their relevance for nurses and nursing, are examined.

Altruism↗

PubMed2005

Health sector reform and equity: a study at a family health center affiliated to health insurance organization in Alexandria.

The 1990's witnessed a wave of reform in health systems of many countries. Health sector reform (HSR) initiatives aimed at improving health status, utilizers' satisfaction, as well as equity and accessibility of care. This study aims at exploring the question of whether there is a socioeconomically- based differential access to services provided by a family health center applying HSR. A total of 248 utilizers were randomly selected and interviewed. An access index comprised of eight elements was developed to measure access and its corollary equity. Results demonstrated that the majority belonged to the low middle socio-economic class and one- quarter belonged to the low class. Approximately 9/10 of utilizers had high access to the services offered. Mean access index score for all utilizers was above the 90% mark. ANOVA analysis of mean access index according to socio-economic class revealed that there is no statistically significant disparity among various socio-economic classes regarding their access to care. However, it was demonstrated that higher classes had a higher opinion concerning the completeness of physical examination during the initial visit than lower classes. It was recommended to establish an appropriate policy framework to assure optimal standards of equity, preferably a 100% of high access as measured through the access index devised in this study.

Adolescent↗

PubMed1982

Equity of access to health care: some conceptual and ethical issues.

Problems of defining equity and equality of access are not trivial; there are fundamental disagreements about the nature of health care as a social good and about other principles of distributive justice. Presuppositions about equity underlying several current proposals for reform of health care "markets" are considered. Issues of equity--and theories of justice--arise also in contexts other than disputes about access.

Economic Competition↗

PubMed1991

Generational equity and public health policy: a critique of "age/race war" thinking.

A potent new tool in the politics of fiscal retrenchment lies in the creation of a framework for policy analysis which implicitly or explicitly "blames" the old for poverty and economic hardships in the young. This paper examines the recent efforts to promulgate this generational equity or "age/race wars" perspective and demonstrates that opinion poll data fail to support the rhetoric of growing age/race group antagonisms over entitlement programs for the old. The assumptions underlying the generational equity framework are critiqued, and the race and ethnic issues embedded within this framework are examined. In particular, we explore spurious assumptions concerning the relative financial wellbeing of the elderly, escalating Social Security and Medicare costs as a primary cause of poverty in the young, and growing resentment of programs for the old among minorities and youth. Attempts to deligitimate the claims of the elderly through the advancement of the ideology of age/race wars are seen to have significant implications for public health policy, with the country's recent experience with the Medicare Catastrophic Coverage Act serving as an important case in point. The need for an alternative policy framework stressing the interdependence of generations is suggested, and some guiding principles put forward toward the development of such an alternative framework.

Age Factors↗

PubMed1980

Equity and changing patient characteristics--1950 to 1975.

The treatment patterns for psychiatric patients in a northeastern industrial community in 1975 are compared with treatment patterns in 1950. This survey is a follow-up of Hollingshead and Redlich's Social Class and Mental Illness. Special emphasis is placed on current treatment settings for the patient groups that in 1950 were either totally excluded from psychiatric care or using the state hospital exclusively. In spite of an enormous proliferation in the range and number of psychiatric services available to inpatients in the community in 1975, these patients were still receiving much of their inpatient care at the state hospital. In addition, they were found in public inpatient and outpatient units characterized by low-intervention treatment and staffed by semiprofessional and nonprofessional clinicians. These survey findings raise equity issues for such "low-status" patients. The concept of equity is applied to the survey results to generate relevant social policy questions.

Adult↗

PubMedDate not supplied

Intergenerational equity: an exploration of the 'fair innings' argument.

Many different equity principles may need to be traded off against efficiency when prioritizing health care. This paper explores one of them: the concept of a 'fair innings'. It reflects the feeling that everyone is entitled to some 'normal' span of health (usually expressed in life years, e.g. 'three score years and ten') and anyone failing to achieve this has been cheated, whilst anyone getting more than this is 'living on borrowed time'. Four important characteristics of the 'fair innings' notion are worth noting: firstly, it is outcome based, not process-based or resource-based; secondly, it is about a person's whole life-time experience, not about their state at any particular point in time; thirdly, it reflects an aversion to inequality; and fourthly, it is quantifiable. Even in common parlance it is usually expressed in numerical terms: death at 25 is viewed very differently from death at 85. But age at death should be no more than a first approximation, because the quality of a person's life is important as well as its length. The analysis suggests that this notion of intergenerational equity requires greater discrimination against the elderly than would be dictated simply by efficiency objectives.

Adolescent↗

PubMed1998

On the measurement of the nation's equity adjusted health.

The aim of this article is to show a method for measuring the nation's equity-adjusted health. In order to estimate what the 'nation's health function' looks like, data from a survey sent to a sample of Swedish politicians were used. The results from the survey can be interpreted as a measure of inequity aversion, and this was applied to data on healthy years (HY) for males in different social groups for the period 1975-1990. The mean of healthy years increased during the period 1986-1990 by 1.09% while equity adjusted healthy years (HY(EDE)) dropped by -1.78%. The nation's health has decreased in spite of the fact that the individual's health has increased.

Adult↗

PubMed2000

Equity in the allocation of health care resources.

This paper examines some of the issues that arise when seeking to tackle health inequalities in a context of limited health care resources. Increasingly, central agencies are using devolved budgets for health care providers as a central instrument of expenditure control. Equity objectives play an important role in the resource allocation methods used to determine such budgets. Yet, unless integrated into a proper system of risk management, the use of budgets can lead to serious inequity. The paper discusses the potential contributions of different disciplines to promoting equity within a health care budgetary regime.

Budgets↗

PubMed2006

Some indicators of socio-economic status may not be reliable and use of indices with these data could worsen equity.

Socio-economic status (SES) indices are increasingly being used to characterise (in)equity, with the assumption that SES indices are reliable. However, the accuracy of such SES indices is questionable if they are unreliable. We examined the inter-rater and test-retest reliability of a range of indicators commonly used to generate SES indices as well as the composite SES indices. Results from research in southeast Nigeria showed considerable variation, with some indicators having only low to moderate reliability (reliability coefficients 0.25-0.77). Inter-rater and test-retest reliability of SES indices was 0.63 in both cases. Many households were misclassified because of the unreliable SES indices. Analyses of the distribution of resources based on such indicators could lead to inaccuracies in benefit incidence estimates and policy decisions based on low to moderately reliable SES indicators could worsen equity in access to and use of resources. Greater rigour is needed in conceptualising as well as undertaking SES measurements.

Humans↗

PubMed1996

Transforming objectivity to promote equity in transplant candidate selection.

It is necessary to recognize the variety of levels at which values and norms may inappropriately affect the equity of the transplantation process, including candidate selection. Using a revised, richer concept of objectivity, adopted from Longino's work in the philosophy of science and empirical studies of candidate selection, this paper examines what sort of objectivity can be obtained in the transplant candidate selection process, and the closely related question of how selection can occur in an equitable manner. This concept of objectivity requires that transformative criticism occur so that (1) the conceptual and normative commitments underlying selection may be articulated and perhaps challenged, and (2) the relationship between those commitments and criteria for candidate selection may be examined and justified, or revised. Through such transformative criticism, a greater degree of objectivity may be attained, which in turn will increase the likelihood of equity.

Adult↗

PubMed1997

FORUM: Dynamics and Causation of Environmental Equity, Locally Unwanted Land Uses, and Neighborhood Changes

/ Why are some environmental risks distributed disproportionately in the neighborhoods of the minorities and the poor? A hypothesis was proposed in a recent study that market dynamics contributed to the current environmental inequity. That is, locally unwanted land uses (LULUs) make the host communities home to more poor people and people of color. This hypothesis was allegedly supported by a Houston case study, whereby its author analyzed the postsiting changes of the socioeconomic characteristics of the neighborhoods surrounding solid waste facilities. I argue that such an analysis of postsiting changes alone is insufficient to test the causation hypothesis. Instead, I propose a conceptual framework for analysis of environmental equity dynamics and causation. I suggest that the presiting neighborhood dynamics and the characteristics of control neighborhoods be analyzed as the first test for the causation hypothesis. Furthermore, I present theories of neighborhood change and then examine alternative hypotheses that these theories offer for explaining neighborhood changes and for the roles of LULUs in neighborhood changes. These alternative hypotheses should be examined when analyzing the relationship between LULUs and neighborhood changes in a metropolitan area. Using this framework of analysis, I revisited the Houston case. First, I found no evidence that provided support for the hypothesis that the presence of LULUs made the neighborhoods home to more blacks and poor people, contrary to the conclusion made by the previous study. Second, I examined alternative hypotheses for explaining neighborhood changes-invasion-succession, other push forces, and neighborhood life-cycle; the former two might offer better explanation.KEY WORDS: Environmental equity and justice; Locally unwanted lane uses; Siting; Market dynamics; Invasion-succession; Neighborhood changes

Journal Article↗