Determinants Of Access To Health Care Research Articles

Why are they “unreached”? Macro and Meso determinants of health care access in hard to reach areas of Odisha, India

BackgroundReaching hard to reach populations is key to reduce health inequities. Despite targeted interventions, status of crucial public health indicators like neonatal and maternal mortality is still far from optimal. Complex interplay of social determinants can influence both communities and health care workers to effectively access each other. We argue that culturally sensitive and contextually relevant healthcare provision has potential to increase health care utilization by the vulnerable communities living in remote areas.MethodsThe study is an exploratory case study using rapid ethnographic techniques to understand the interplay of social determinants in hard to reach areas of Odisha state, India. We used in-depth interviews, focus group discussion, participatory action research and key informant interviews as tools for data collection. The analysis of data has been guided by thematic analysis approach.ResultsWe found that there are further layers within the designated hard to reach areas and those can be designated as-i) extremely remote ii) remote and iii) reachable areas. Degree of geographic difficulties and cultural dynamics are deciding the ‘perceived’ isolation and interaction with health care providers in hard to reach areas. This ultimately leads to impacting the utilization of the facilities. At extremely remote areas, felt health needs are mainly fulfilled by traditional healers and ethno-medical practices. In reachable areas, people are more prone to seek care from the public health facilities because of easy accessibility and outreach. Being in middle people in remote areas, diversify health care seeking depending upon social (e.g. patient’s gender) economic (e.g. avoid catastrophic expenditure) and health system (timely availability of health human resources, language barriers) factors.ConclusionOur research highlights the need to value and appreciate different worldviews, beliefs and practices, and their understanding of and engagement with the pluralistic health care system around them. Other than pursuing the ‘mainstreaming’ of a standardized health system model across hard to reach areas, strategies need to be adaptive as per local factors. To handle that existing policies need revision with a focus on culturally sensitive and contextual care provision.

Pathway analysis to characterize the relationships between healthcare access and healthcare visits in the United States using the health information national trends survey

Background: Americans had fewer healthcare visits compared to their counterparts in other developed countries. The lack of regular check-ups can contribute to worsening health conditions. Insurance coverage, access to transportation to healthcare services, and having accessed health information via the internet are known to be associated with frequency of healthcare visits. However, there is limited literature detailing the direct and indirect influences of these variables on frequency of patients’ healthcare visits. We aimed to understand the interactive relationship between insurance coverage, access to transportation to healthcare services, and having accessed health information via the internet on frequency of patient healthcare visits.Methods: We used data from the 2018 Health Information National Trends Survey (N=3504), the only survey year providing the source for information on insurance coverage, access to transportation to healthcare services, and having accessed health information via the internet. We used descriptive statistics, random parameter binary logistic regression, and pathway analysis to describe and analyze the associations between these determinants of healthcare access and healthcare visits.Results: Results indicated that access to transportation to healthcare services (18.32%) and having insurance coverage (27.89%) were directly associated with healthcare visit frequency whereas the association between having accessed health information via the internet and reporting a healthcare visit, compare to the former two, was weaken (10.87%). Residential area (rural/urban), health conditions, age, race/ethnicity, employment status were directly associated with visit frequency whereas income status and education level were associated with healthcare visits indirectly through insurance.Conclusions: Better understanding interactive relationships between healthcare access determinants will be key to the development of healthcare access interventions aimed at reducing healthcare disparities.

Healthcare price changes and expenditures in South Africa: Some implications for economic policy

ABSTRACT Healthcare systems around the world are facing great challenges. This has included rising health care prices and its impact on healthcare expenditures and the concomitant effects on access to healthcare, particularly in emerging and developing countries. This study focuses on health care price developments and health expenditures in South Africa. The study identifies four major results. Firstly, South Africa’s healthcare expenditures compare quite favourably with countries at similar levels of development. However, the efficiency of these expenditures lags those in comparable countries. Secondly, it was found that South Africa’s healthcare price rises have exceeded those in advanced countries even though healthcare demand and expenditures in these countries are much higher than is the case in South Africa. Thirdly, healthcare rises exceeds those in other sectors of the South African economy. Finally, healthcare price changes adversely impact healthcare expenditures in South Africa. These results indicate that price considerations are critical to improving healthcare access in South Africa. The paper also highlights some non-price determinants of healthcare access that warrant attention by policymakers in South Africa.

Advancing Oral Health Equity Through School-Based Oral Health Programs: An Ecological Model and Review.

In the United States and elsewhere, children are more likely to have poor oral health if they are homeless, poor, and/or members of racial/ethnic minority and immigrant populations who have suboptimal access to oral health care. As a result, poor oral health serves as the primary marker of social inequality. Here, the authors posit that school-based oral health programs that aim to purposefully address determinants of health care access, health and well-being, and skills-based health education across multiple levels of influence (individual/population, interpersonal, community, and societal/policy) may be more effective in achieving oral health equity than programs that solely target a single outcome (screening, education) or operate only on the individual level. An ecological model is derived from previously published multilevel frameworks and the World Health Organization (WHO) concept of a health-promoting school. The extant literature is then examined for examples of evaluated school-based oral health programs, their locations and outcomes(s)/determinant(s) of interest, the levels of influence they target, and their effectiveness and equity attributes. The authors view school-based oral health programs as vehicles for advancing oral health equity, since vulnerable children often lack access to any preventive or treatment services absent on-site care provision at schools. At the same time, they are incapable of achieving sustainable results without attention to multiple levels of influence. Policy solutions that improve the nutritional quality of children's diets in schools and neighborhoods and engage alternative providers at all levels of influence may be both effective and equitable.

Determinants of Health Care Access After Spinal Cord Injury

This paper presents a review of the literature examining determinants of access to health care among individuals with spinal cord injury (SCI). The literature shows that health insurance, race-ethnicity, income, age, gender, and residential location (rural/urban) are common themes discussed in the literature as factors that influence access to health care of persons with SCI. This review ends with discussion of implications for rehabilitation counseling research and practice.

Air pollution and general practitioner access and utilization: a population based study in Sarnia, 'Chemical Valley,' Ontario

BackgroundHealth impacts of poor environmental quality have been identified in studies around the world and in Canada. While many of the studies have identified associations between air pollution and mortality or morbidity, few have focused on the role of health care as a potential moderator of impacts. This study assessed the determinants of health care access and utilization in the context of ambient air pollution in Sarnia, Ontario, Canada.MethodsResidents of Sarnia participated in a Community Health Study administered by phone, while several ambient air pollutants including nitrogen dioxide (NO2), sulphur dioxide (SO2) and the volatile organic compounds benzene, toluene, ethylbenzene, mp- and o-xylene (BTEX) were monitored across the city. Land Use Regression models were used to estimate individual exposures to the measured pollutants and logistic regression models were utilized to assess the relative influence of environmental, socioeconomic and health related covariates on general practitioner access and utilization outcomes.ResultsThe results show that general practitioner use increased with levels of exposure to nitrogen dioxide (NO2- Odds Ratio [OR]: 1.16, p < 0.05) and sulphur dioxide (SO2- OR: 1.61, p < 0.05). Low household income was a stronger predictor of having no family doctor in areas exposed to high concentrations of NO2 and SO2. Respondents without regular care living in high pollution areas were also more likely to report travelling or waiting for care in excess of 20 minutes (OR: 3.28, p < 0.05) than their low exposure counterparts (OR: 1.11, p > 0.05).ConclusionsThis study provides evidence for inequitable health care access and utilization in Sarnia, with particular relevance to its situation as a sentinel high exposure environment. Levels of exposure to pollution appears to influence utilization of health care services, but poor access to primary health care services additionally burden certain groups in Sarnia, Ontario, Canada.

HEALTH CARE ACCESS AMONG HISPANIC IMMIGRANTS: ¿ALGUIEN ESTÁ ESCUCHANDO?[IS ANYBODY LISTENING?

This systematic review identified 77 studies to examine patterns and determinants of health care access among Hispanic immigrants (HI) living in the U.S. In spite of major mental and physical care needs, HI and their families are at very high risk of not having access to health care compared with non-immigrant Hispanics and non-Hispanic whites. Noncitizenship status is a major barrier for accessing health care due to program ineligibility and fear of stigma and deportation. Low English proficiency is also an important barrier to health care. Culturally appropriate community outreach programs relying heavily on community health workers, also known as promotoras, have improved health care access and quality. Mexico shares the health care cost for HIs living in bordering states, calling for a binational dialogue. Mixed-methods research is needed to better understand: a) the net influence of acculturation on migrant health; b) the role of informal (e.g., family) vs. formal (e.g. promotoras) social support at facilitating health care access; c) issues related to 'single' male migrant farm workers; d) the "Hispanic mortality paradox"; e) traditional healing and medicine among HI. Comprehensive health and immigration reforms are needed to respect the human right that HIs have to gain access to health care.

209: Determinants of Health Care Access on the U.S.-Mexico Border

209: Determinants of Health Care Access on the U.S.-Mexico Border

Socioeconomic and Racial Predictors of Undergoing Laparoscopic Hysterectomy for Selected Benign Diseases: Analysis of 341 487 Hysterectomies

Study Objective Socioeconomic status and race are important determinants of health care access in the United States. The purpose of our study was to evaluate whether these factors influence use of laparoscopic hysterectomy for management of benign gynecologic diseases. Design Retrospective cohort study (Canadian Task Force classification II-3). Setting Data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 1998 to 2002. Patients All records of women with primary discharge diagnosis of uterine leiomyomas or menorrhagia who underwent hysterectomy (laparoscopy or abdominal) were included in the study. Interventions Race (Caucasian, African-American, Hispanic, or other), median household income (<$25 000, $25 000–$34 999, $35 000–$44 999, or ≥$45 000), and insurance status (private, Medicare, Medicaid, or other) were evaluated as determinants of laparoscopic surgical intervention. Unconditional logistic regression was used to estimate likelihood of laparoscopic approach to hysterectomy. Measurements and Main Results Of 341 487 records for hysterectomy, 295 857 were performed by abdominal and 45 630 by laparoscopic approach. In adjusted analyses, African-Americans, Hispanics, and other ethnicities were less likely to undergo laparoscopic hysterectomy; adjusted OR (95% CI): 0.44 (0.42–0.45), 0.58 (0.55–0.61), and 0.68 (0.64–0.72), respectively, as compared with Caucasians. As compared with women with median income of less than $25 000, laparoscopic approach was more commonly performed on women with median household income $25 000 to $34 999, 1.18 (1.10–1.26); $35 000 to $44 999, 1.13 (1.0–1.21); and $45 000 and above, 1.14 (1.06–1.22). As compared with women with Medicaid, laparoscopic approach was more likely to be performed on women with private insurance: 1.45 (1.42–1.62). Conclusion In the United States, median household income, insurance status, and race appear to be important independent determinants of access to laparoscopic hysterectomy for benign diseases.

Clinical Uncertainty and Healthcare Disparities

The Institute of Medicine Report, Unequal Treatment: Confronting Racial and Ethnic Disparities, affirms in its first finding: “Racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable.” The mechanisms that generate racial and ethnic disparities in medical care operate at the levels of the healthcare system and the clinical encounter. Research demonstrates the role of healthcare system factors, including differences in insurance coverage and other determinants of healthcare access, in producing disparities. Research also shows, however, that even when insurance status and other measures of access are controlled for by statistical methods, racial and ethnic disparities persist. These disparities remain when researchers try by various methods to control for patients’ clinical characteristics. Disparities are especially well documented through comparisons between white patients and African Americans and Latinos, but they are believed to affect other minority groups. As a result, many members of minority racial and ethnic groups receive less or inferior care.