Disparity In Availability Research Articles

Health Insurance Coverage in Survivors of Childhood Cancer: The Childhood Cancer Survivor Study

To examine the prevalence and predictors of health insurance coverage and the difficulties obtaining coverage in a large cohort of childhood cancer survivors. This study included 12,358 5-year survivors of childhood cancer and 3,553 sibling controls participating in the Childhood Cancer Survivor Study. Data were collected by surveys distributed in 1994 (baseline) and 2000 (follow-up). At baseline, 83.9% of adult survivors, compared with 88.3% of siblings, had health insurance coverage (P < .01); 6 years later, small but significant survivor-sibling differences remained (88% v 91%; P < .01). Twenty-nine percent of survivors reported having had difficulties obtaining coverage, compared with only 3% of siblings (P < .01). In multivariate analysis of survivors 18 years of age or older, factors associated with being uninsured included younger age at diagnosis (diagnosis age of 0 to 4 years; odds ratio [OR] = 1.7; 95% CI, 1.3 to 2.2), male sex (OR = 1.3; 95% CI, 1.2 to 1.5), age at baseline survey (age 22 to 24 years; OR = 1.6; 95% CI, 1.2 to 2.1), lower level of attained education (less than high school, OR = 2.6, 95% CI, 2.1 to 3.3; high school graduate, OR = 2.1, 95% CI, 1.8 to 2.5), income less than 20,000 dollars (OR = 5.6, 95% CI, 4.5 to 7.1), marital status (widowed/divorced/separated; OR = 1.3; 95% CI, 1.1 to 1.6), smoking status (current smoker, OR = 2.0, 95% CI, 1.7 to 2.3; former smoker, OR = 1.4, 95% CI, 1.2 to 1.8), and treatment that included cranial radiation (OR = 1.3, 95% CI, 1.0 to 1.6). Compared with siblings, adult survivors of childhood cancer had significantly lower rates of health insurance coverage and more difficulties obtaining coverage. Since lack of coverage likely has serious health and financial implications for this at-risk population, any disparity in availability and quality of coverage is of great concern.

Resolving taxonmic discrepancies: Role of Electronic Catalogues of Known Organisms

There is a disparity in availability of nomenclature change literature to the taxonomists of the developing world and availability of taxonomic papers published by developing world scientists to their counterparts in developed part of the globe. This has resulted in several discrepancies in the naming of organisms. Development of electronic catalogues of names of known organisms would help in pointing out these issues. We have attempted to highlight a few of such discrepancies found while developing IndFauna, an electronic catalogue of known Indian fauna and comparing it with existing global and regional databases.

Understanding the Disparity in Availability of Prescription Drugs in the United States: Compromise May Be the Answer

Understanding the Disparity in Availability of Prescription Drugs in the United States: Compromise May Be the Answer

Inter-state disparities in health care and financial burden on the poor in India.

Over five decades of independence, India has made rapid strides in various sectors. However, its performance in social sectors and particularly the healthcare sector has not been too rosy. Being the State's responsibility the healthcare has traditionally been influenced by individual State's budgetary allocation. Consequently inter-state disparity in availability and utilization of health services and health manpower are distinctly marked. This has implications for achievement of Health for All for the nation as a whole. Keeping in view the significance of studying inter-state variations in healthcare, this study focuses on the performance of healthcare sector in 15 major States in India. This is attempted through a comparative analysis of various parameters depicting availability of health services, their utilization and health outcomes. Our analysis depicts the prevalence of considerable inequity favoring high income group of States. In terms of healthcare resources, for instance, it indicates that the high income States hold a superior position in terms of: per capita government expenditure on medical and public health, total number of hospitals and dispensaries, per capita availability of beds in hospitals and dispensaries and health manpower in rural and urban areas. These parameters of availability have an impact on utilization levels and health outcomes in these States. A comparative profile of high and low income States as well as middle and low income States, both in rural and urban areas, reaffirms a greater financial burden in availing treatment at OPD and inpatient in low income States. In line with the higher financial burden and low per capita health expenditure, the health outcome indicators also depict a disconcerting situation in regard to low income States. These States are marked by lower life expectancy and higher incidence of diseases as well as high mortality rates. In this regard, demand as well as supply side constraints are observed which restrain the optimum utilization of existing health services. Among the low income States the main constraints on the demand side include illiteracy, malnutrition, and lack of infrastructure in accessing the facilities. Certain state specific supply side factors add significantly to under-utilization in low income States. In some of the States, however, corrective actions have been initiated to overcome the problem of the quality and low utilization of health facilities. In due course of time, it is likely that proper implementation of these measures may result in improved utilization level of existing health services, which may be useful to improve health status indicators. Nonetheless, overcoming the current levels of regional disparities in healthcare across three income groups of States may also require additional resources. The latter could be mobilized through assistance of donor agencies and appropriate mix of social and private insurance. Ultimately mitigating the problem of regional disparities in healthcare and protecting the poor and vulnerable from financial burden may require establishing and maintaining proper linkages between socio-economic development and healthcare planning.

The role of federal policy in stimulating appropriate use of computers in elementary-secondary schools

The conventional wisdom in conceptualizing the role of federal policy in stimulating increased use of computers at the elementary-secondary level is that the federal government should focus on providing funding for the acquisition of large amounts of equipment. In addition, the argument runs that greatly increased use of technology is in the national interest in terms of improving math and science education and that such federal policy would reduce the growing disparity in availability of computers among rich and poor districts. Unfortunately, such a perspective may lead to winning the battle at the expense of losing the war. Dumping large amounts of equipment on school districts at the present time would ensure little more than that the public schools would end up in several years with large amounts of unused, obsolete equipment. The computer is such a relatively new tool in elementary-secondary schools that the culture, norms, and research evidence of the relative effectiveness of computer use have yet to be established.

Primary health care and health education in Japan

In this paper, the substance of the Alma Ata Declaration on Primary Health Care is discussed. Minimum requirements and working goals of Primary Health Care are reviewed. The health status of the Japanese people, and the medical and health delivery systems in Japan are considered, with reference to the Alma Ata Declaration. While the Alma Ata Declaration sets forth the goal of health for all by the year 2000, there is doubt as to whether, even in the developed countries, we will reach this goal. Health indices have improved considerably, but problems of delivery of medical care and health care still remain. Major problems discussed here are the regional disparity in availability of medical manpower and facilities, and the consequent disparity in health indices; sky-rocketing medical costs; the changing needs of Japan's aging population; and socialized medical care, and the lack of integration of insurance schemes. The most significant problem in delivery of Primary Medical Care in Japan is the lack of integration of health and medical services. This is discussed at length. In addition, the importance of health education to community health planning in Primary Health Care is discussed.

Abortion and Medical Ethics

Despite the Supreme Court decision in 1973, Roe v. Wade, making abortion legally available without impedi ment during the first two trimesters of pregnancy, neither the legal nor ethical problems of abortion have been solved. Congressional opposition to federal financial support of abor tion, as well as a wide disparity in availability of abortion, indicates the still unsettled state of public policy on the issue. In medical ethics, a number of problems have surfaced in the past few years, which together form a complex set of both moral and legal issues. Fetal research, on the one hand, and the prospect of in vitro fertilization, on the other, both point to issues which recent Supreme Court decisions have not clarified. The rapid development of amniocentesis as a major tool of prenatal diagnosis highlights some of the new dilem mas. If the Supreme Court decision is read literally, there would appear to be no grounds for a physician to refuse to perform an abortion except for a clear threat to a woman's health from the abortion itself. Yet many, and perhaps most, physicians appear morally opposed to using abortion for sex selection or in those cases where simple postnatal treatment is available to correct a genetic defect. What are the rights of physicians in such cases and what, if any, are the limits on the rights of women to have abortions? Lurking in the back ground is the growing power of medicine to push back the time of viability of an infant earlier and earlier. Both new legal and ethical problems are bound to result. Abortion re mains as deeply complex a moral issue as ever.