Disparities In Access To Services Research Articles

HEALTH FINANCING ANALYSIS OF MINIMUM SERVICE STANDARDS IN THE HEALTH SECTOR

Background: This research focuses on health financing Minimum Service Standards (MSS) in the health sector in Lumajang Regency, Indonesia, spanning 2019 to 2022. Despite the government's emphasis on Health MSS, disparities in service access and health conditions persist across different regions. Aims: The research aims to provide insights into the effectiveness of health financing, serving as a foundation for policy recommendations to enhance the efficiency and effectiveness of health fund allocation in Lumajang Regency. Methods: The research employs a quantitative descriptive approach, utilizing DHA and CBA. The study also investigates the budget allocation for MSS Health services. Results: The findings of the research reveal that the realization of Local Original Revenue (LOR) in the Health sector tends to fall below targets. Non-Physical DAK dominate the funding sources in Community Health Centers (Puskesmas). Maternal health services receive the highest MSS Health budget allocation, but the spending proportion relative to total health expenditure is decreasing. Conclusion: The research underscores the importance of addressing disparities in health financing and service access in Lumajang Regency. Recommendations include the diversification of funding sources, optimization of financing at the Puskesmas level, and a reevaluation of the budget allocation for maternal health services. Keywords: CBA, DHA, health financing analysis, minimum service standards

Health financing analysis in the implementation of minimum service standards in Lumajang Regency

Background: Health financing in Lumajang is still far from the target. Therefore, a study focused on the implementation of minimum service standards (MSS) in the health sector is needed. Despite the government emphasis on MSS health, disparities in service access and health conditions persist.Objective: To provide insights into the effectiveness of health financing, serving as a foundation for policy recommendations to enhance the efficiency and effectiveness of health fund allocation in Lumajang Regency.Methods: The study employed a quantitative approach, utilising district health accounts (DHA) and cost and benefit analysis (CBA). The budget allocation for different MSS health services was also investigated. The analysis involved examining the spending proportion relative to total health expenditure. The study design used a qualitative descriptive method. The data source was obtained from the budget realisation report for the MSS health sub-activities at the Community Health Center (CHC) and the Lumajang Health Office. Data analysis was performed by an integration of DHA and CBA approaches. We performed mapping costs and benefits analysis and calculated the sensitivity of financing to whether it is economically profitable and provides leverage for achieving MSS performance indicator targets. Results: The realisation of local original revenue in the health sector tended to fall below targets. Central transfer funds dominated the funding sources in CHC. The highest health budget allocation of MSS was received by maternal health services, while other services only received a proportion relative to a decrease in total health expenditure.Conclusion: In Lumajang Regency, analysis of the costs and benefits of regional health financing to fulfil MSS health showed that the benefit-cost ratio (BCR) value was > 1, meaning that health financing for MSS in the District Health Sector was profitable, so it should be used as a regional priority program in overcoming regional health problems.

Invited Symposium 4: Innovations in Infant, Toddler, and Young Child Neuropsychological Models of Care

Abstract & Learning Objectives:The neuropsychology of babies, toddlers, and young children is a rapidly evolving frontier within our discipline. While there is an inaccurate perception among referral sources that neuropsychological services are not useful before school-age, pediatric neuropsychologists are especially well-suited to identify delay or dysfunction in the years before school entry (Baron and Anderson, 2012). Patterns of neurodevelopmental strengths and weaknesses can be detected very early on in development and used to make inferences about brain-behavior relationships integral for guiding treatment across a number of medical and neurodevelopmental diagnoses. As such, there is a need to foster ongoing clinical interest and expertise and promote the utility of neuropsychological services within this age range. The INS BabIes, ToddlerS, and Young children (BITSY) SIG was recently developed to bring together scientists and clinicians from across the world who conduct research and provide neuropsychological services within this age range to foster collaboration and learning. A priority of the BITSY SIG is not only to promote awareness of the novel needs of this age range, but to consider historical and ongoing disparities in service access, representation in research, and neuropsychological practice. For this inaugural BITSY SIG symposium, four members of the SIG will discuss innovations in infant, toddler, and young child neuropsychological models of care. This topic was developed in direct response to survey results from the first BITSY SIG meeting held during INS 2022, indicating the need for the development and refinement of clinical approaches that incorporate diverse perspectives as well as training opportunities in models of care for very young children. As such, speakers will cover innovations in neuropsychological service models from the prenatal period to formative early years that are inclusive of diverse neurological and neurodevelopmental populations commonly served by neuropsychologists including spina bifida, prematurity, hypoxic-ischemic encephalopathy (HIE), congenital heart disease (CHD), autism (ASD) and attention-deficit/hyperactivity disorder (ADHD). The first talk will highlight the unique role of the neuropsychologist in prenatal and infant consultation, whereas the second talk will focus on the state of the field with regard to the utility of neuroimaging in neonatal populations and the integration of this tool in neuropsychological care. The third talk will discuss early screening and assessment models in a diverse range of conditions within an interdisciplinary setting. The final talk will illustrate a novel neuropsychological intervention designed with and for the empowerment of caregivers for young children impacted by neurological and neurodevelopmental conditions. The unifying theme across the talks is how unplanned discoveries and acute observations of children and families during the critical early years have led to these inclusive care models that prioritize family preferences, values, and culture. Upon conclusion of this course, learners will be able to: 1.Summarize several novel models of neuropsychological care for infants, toddlers, and young children.2.Recognize ways in which neuropsychologists work within interdisciplinary teams to serve infants, toddlers, and young children and their families.3.Apply these models of care to your conceptualization of the scope of neuropsychological services available for infants, toddlers, and young children.

Feasibility and Acceptability of Spanish-Language Parenting Interventions for Young Children With Developmental Delays.

Hispanic/Latinx parents of children with developmental delays/disabilities (DD) face disparities in service access and research participation. In the present study, 60 Spanish-speaking caregivers of young children with DD participated in randomly assigned stress reduction interventions (psychoeducation/support groups or Mindfulness-Based Stress Reduction [MBSR]), followed by behavioral parent training (BPT). Caregiver attendance and satisfaction ratings were measured, and focus groups gathered additional information on caregivers' takeaways from the interventions. Caregivers demonstrated high satisfaction across interventions, with slightly greater preference for psychoeducation/support groups, and qualitative data indicated that the relevance of the information and style of delivery may be responsible. Researchers and clinicians may attain greater engagement with this population by focusing on intervention services that include psychoeducation and peer support elements.

Use of public sector diabetes eye services in New Zealand 2006-2019: Analysis of national routinely collected datasets.

To assess diabetes eye service use in New Zealand among people aged ≥15 years by estimating service attendance, biennial screening rate, and disparities in the use of screening and treatment services. We obtained Ministry of Health data from the National Non-Admitted Patient Collection on diabetes eye service events between 1 July 2006 and 31 December 2019 and sociodemographic and mortality data from the Virtual Diabetes Register and linked these using a unique patient identifier (encrypted National Health Index). We 1) summarized attendance at retinal screening and ophthalmology services, 2) calculated biennial and triennial screening rate, 3) summarized treatment with laser and anti-VEGF and used log-binomial regression to examine associations of all of these with age group, ethnicity, and area-level deprivation. In total, 245,844 people aged ≥15 years had at least one diabetes eye service appointment attended or scheduled; half of these (n = 125,821, 51.2%) attended only retinal screening, one-sixth attended only ophthalmology (n = 35,883, 14.6%) and one-third attended both (n = 78,300, 31.8%). The biennial retinal screening rate was 62.1%, with large regional variation (73.9% in Southern District to 29.2% in West Coast). Compared with NZ Europeans, Māori were approximately twice as likely to never receive diabetes eye care or to access ophthalmology when referred from retinal screening, 9% relatively less likely to receive biennial screening and received the fewest anti-VEGF injections when treatment was commenced. Disparities in service access were also present for Pacific Peoples compared to NZ Europeans, younger and older age groups compared to those aged 50-59 years and those living in areas with higher deprivation. Access to diabetes eye care is suboptimal, with substantial disparity between age groups, ethnicity groups, area level deprivation quintile and across districts. Efforts to improve access to and quality of diabetes eye care services must include strengthening data collection and monitoring.

Hukou-based rural\u2013urban disparities in maternal health service utilization and delivery modes in two Chinese cities in Guangdong Province

BackgroundMost existing research on rural–urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural–urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China.MethodsUtilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015–2019) and 25,849 live births in City B (2018–2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable.ResultsWhile there is no statistically significant difference in rural and urban mothers’ probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively.ConclusionsRural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services.

Culturally Responsive Trauma-Informed Services: A Multilevel Perspective from Practitioners Serving Latinx Children and Families.

Using a multilevel ecological framework, we take a qualitative approach to examining important cultural considerations that support successful implementation of trauma-informed services within the Latinx community. We conducted key informant interviews with community practitioners recruited primarily in the Phoenix, AZ metro area. Themes that emerged from interviews captured societal, community, and individual barriers to effective implementation of a culturally responsive trauma-informed approach. Specifically, multilevel barriers included socioeconomic circumstances, normalization of trauma exposure, and the transgenerational impact of trauma. Practitioners also reported approaching their work using relationship-focused and family-centered frameworks as facilitators to service engagement. We highlight the critical need for a culturally responsive trauma-informed approach that stresses the importance of context, recognizes transgenerational vulnerabilities, and promotes equity and the utilization of cultural humility in order to lessen the multilayered disparities in service accessibility experienced by minoritized communities.

Socioeconomic variations and disparity in space–time accessibility in suburban China: A case study of Guangzhou

The concept of conventional place-based accessibility, despite being well researched, tends to ignore people’s space–time constraints arising from mandatory activities (e.g. work and household duties), which confine people’s potential movement and delimit the accessible opportunities. As people with different socioeconomic statuses may have different space–time constraints even while living in similar locations, using the place-based measures could lead to an underestimation of accessibility inequality. This study applies a space–time measure to unravel the disparities in service accessibility in suburban China. Since the late 1970s, suburbanisation in Chinese cities has fostered income inequality and has elevated other dimensions (e.g. institutional status and gender) of disparity within each income class. Within this context, we conduct a case study of suburban neighbourhoods in Guangzhou, based on the activity diary data derived from a home-based questionnaire survey. Findings indicate that the use of a space–time measure effectively captures the disparities in service accessibility among residents in suburban Guangzhou. On the basis of structural equation modelling, we further identify that certain socioeconomic groups (e.g. high-income residents, public sector workers, local hukou holders, male household heads and welfare housing residents) tend to experience fewer space–time constraints from rigid activities, such as work, commuting and household duties, and are thus more advantaged in accessing service facilities. These findings imply that urban planning should address the space–time perspective to promote equal service access for the highly heterogeneous social groups in suburban China and to incorporate time-sensitive policies (e.g. flexitime policies).

An Effectiveness Open Trial of Internet-Delivered Parent Training for Young Children With Conduct Problems Living in Regional and Rural Australia

There is accumulating evidence for the efficacy of online parent management training (PMT) programs to improve conduct problems in young children, and findings have been used to support the potential of online programs to close the research-to-practice gap in underserved rural settings. However, to date, no study has evaluated the effectiveness of online PMT under real-world conditions; that is, delivered by community practitioners as part of services-as-usual to families residing in rural communities. This has resulted in a critical lack of evidence supporting the capacity of online PMT to ameliorate actual geographical disparities in service accessibility. Accordingly, the current study evaluated effectiveness and engagement outcomes of Internet-delivered Parent-Child Interaction Therapy (I-PCIT) delivered from a community-based early childhood clinic to rural consumers. Participants were 27 mothers and their 1.5- to 4-year-old child with conduct problems (M age = 3.02, SD = 0.73) living in regional and rural New South Wales, Australia. Parent-rated and observed child conduct problems and observed parenting behaviors were assessed pre and post I-PCIT, and treatment attrition, parental satisfaction with treatment, and homework compliance provided indicators of treatment engagement. Results of linear mixed and marginal models indicated that I-PCIT produced significant improvements in parent-reported and observed child conduct problems and observed parenting behaviors, with “small” to “very large” effect sizes (ds = 0.3-1.4). Treatment retention was adequate (63%), and treatment-completing parents reported high treatment satisfaction and good homework compliance. Findings provide preliminary evidence for the real world effectiveness of I-PCIT, supporting its capacity to narrow the research-to-practice gap. Findings suggest a role for I-PCIT in a stepped care model of remote treatment for childhood conduct problems in Australia.

CREATING NEW MODELS FOR AGING IN PLACE: DIVERSE COMMUNITIES AND THE NAVIGATION OF LONG-TERM SERVICES AND SUPPORTS

There is a growing interest among aging services providers to better understand the pathways through which older adults and their caregivers navigate LTSS. Although there have been attempts at modeling this process they are often dependent on the quality of existing data, which can result in models which are incomplete and study samples that homogenize diverse older adult populations. These models face two challenges – 1) the data may not include information about important elements of the LTSS navigation process, and 2) the actions of ethnic/cultural sub-groups may not be captured. This study uses a conceptual method called Social Interaction Modeling (SIM) to examine how older adults in two limited English-speaking communities (Spanish / Mandarin Chinese) navigate the use of LTSS and to evaluate disparities in service access. The findings will help to build a more comprehensive model which looks at service navigation among all older adults in Philadelphia.

Brief Report: A Pilot Online Pivotal Response Treatment Training Program for Parents of Toddlers with Autism Spectrum Disorder.

Despite advances in evidence-based treatment for autism spectrum disorder (ASD), disparities in service access remain a serious concern. Current treatment models may not be feasible for families who live in remote geographical regions or have limited resources. To address this, studies have begun to explore parent-implemented interventions via an online format. The current study examined a new online course designed to help parents implement Pivotal Response Treatment (PRT) for their toddler with ASD. Parents submitted videos of parent-child interactions which were coded for fidelity of implementation (FOI) and social communicative behaviors. The data indicate that PRT fidelity and child behaviors significantly improved following course participation. This suggests that an online intervention may be a feasible approach to disseminating PRT strategies.

African-American Caregivers’ Perceptions of Care Needs Affecting Access to Services for Their Children With Autism

Abstract Date Presented 4/21/2018 Racial and ethnic disparities in service access for children with autism disproportionately impact African-American families. This qualitative study identified caregiver beliefs, knowledge, and expectations that influenced their help seeking and the specific help-seeking steps they used to obtain care. Primary Author and Speaker: Teal Benevides Additional Authors and Speakers: Beth DeGrace, Pam Kearney Contributing Authors: Mallory Lanier, Sharon Cosper

Improperly-zoned, spatially-marginalized, and poorly-served? An analysis of mobile home parks in Los Angeles County

More than 6% of Americans live in mobile homes, and yet there has been limited scholarly attention to mobile home location or quality of life compared to conditions in other housing types. There has not been a single comprehensive study to date that assesses where mobile home parks (MHPs) are located within metropolitan areas, that explores why some neighborhoods have a greater concentration of MHPs than others, or examines what environmental or basic service conditions are like in those neighborhoods. In California, more than 1 million residents live in mobile homes, with the vast majority (75%) of these living in MHPs rather than standalone units. We answer two questions in this study. First, are MHPs in “worse” neighborhoods in terms of socioeconomic status, zoning, local land uses, accessibility to jobs, and environmental quality? Second, which neighborhood factors are most strongly correlated with MHP locations and concentrations? We answer these questions using data for all mobile home parks in Los Angeles County, California. We find that MHPs are more likely to be located in lower density neighborhoods and at the urban fringe. More than 41% of MHPs are in areas zoned for commercial or industrial purposes rather than residential uses. Not surprisingly then, we find that MHPs are located in areas with more environmental hazards. A multivariate analysis of neighborhood factors confirms our hypotheses. Moreover, we find that MHPs’ access to public services is worse than the average neighborhood in the county. We recommend that policymakers engage in targeted efforts to address disparities in service access and mitigate environmental hazards.

The Grand Challenge of Reducing Gender and Racial/Ethnic Disparities in Service Access and Needs Among Adults with Alcohol Misuse

This study examined the impact of the Affordable Care Act (ACA) on gender and racial and ethnic disparities in accessing and using behavioral health services among a national sample of adults who reported heavy or binge alcohol use (n = 52,496) and those with alcohol use disorder (AUD; n = 22,966). Difference-in-differences models estimated service-related disparities before (2008–2009) and after (2011–2014) health care reform. A subanalysis was conducted before (2011–2013) and after (2014) full implementation of the ACA. Asian subgroups among respondents with heavy or binge drinking were excluded from substance use disorder (SUD) treatment and unmet need outcome models due to insufficient cell size. Among heavy or binge drinkers, unmet SUD treatment need decreased among Black women and increased among Black men. Mental health (MH) treatment decreased among Asian men, whereas unmet MH treatment need decreased among Hispanic men. MH treatment increased among Hispanic women with AUD. Although there were improvements in service use and access among Black and Hispanic women and Hispanic men, there were setbacks among Black and Asian men. Implications for social workers are discussed.

Patterns and Predictors of Mental Healthcare Utilization in Schools and Other Service Sectors Among Adolescents at Risk for Depression

This study examined racial/ethnic and socioeconomic differences in service utilization across sectors (specialty mental health, school, primary care) for youth at risk of depression. Our sample included 362 adolescents who were enrolled in a larger project examining the effects of an indicated school-based depression prevention program. Service use across sectors mirrored national trends and previous research findings in which the education sector was most frequently utilized for mental health services. Race/ethnicity was significantly associated with parent-reported specialty mental health service utilization, even when controlling for other predictors of use. The study also suggests that racial disparities in service access generally appear to be reduced through the availability of education sector mental health services. Socioeconomic status was not associated with service use in any sector when controlling for other predictors. Parent-child agreement was moderate for report of specialty mental health service use and low for report of use of services within the education and primary care sectors.

Homeless and Housed Inpatients with Schizophrenia: Disparities in Service Access upon Discharge from Hospital

This study examines differences in services available at the time of discharge for homeless and housed psychiatric inpatients. Participants diagnosed with schizophrenia or schizoaffective disorder were recruited from a general hospital psychiatric inpatient unit. Thirty homeless individuals and 21 housed controls (matched for diagnosis, gender, and age) completed a questionnaire and clinical interview. Data on discharge services were extracted from the electronic health record. Factors associated with access to services were examined using logistic regression models. Despite a similar duration of hospitalization to housed participants, homeless participants were significantly less likely to have outpatient follow-up with a family physician, intensive case management, assertive community treatment, income support or prescription drug coverage at the time of discharge from hospital. Although inpatient hospitalization presents an opportunity to reduce homeless people’s barriers to accessing health and social services, our results show inequities for homeless people persist at the time of discharge.

Legacies of primary health care in an age of health sector reform: Vietnam's commune clinics in transition

Developing countries that were early, enthusiastic adopters of primary health care often developed an extensive—but eventually dilapidated and under utilized—network of public clinics at the grassroots. As paradigms and investment patterns of health sector reform have shifted, the question of what role these public clinics can meaningfully play, and how best to revitalize them, has become important in a number of countries. This paper evaluates the strategy taken by, and outcomes of, a major attempt in Vietnam to revitalize the grassroots infrastructure of primary health care against the backdrop of the country's economic transition. The project's substantial supply-side investments in infrastructure led to marginal increases in utilization and the quality of preventive health services provided by the centers. But because the project failed to take adequate stock of broader, public sector-wide trends and reforms over the transition, the investments had little impact on the incentives, accountability patterns and capacities of clinic staff and the local authorities. Such institutional factors are heavily implicated, in Vietnam as elsewhere, in the substantial and often increasing disparities in service access and quality that continue to afflict transitional health sectors.