Evidence Of Inequalities In Access Research Articles

Geographical distance and reduced access to palliative radiotherapy: systematic review and meta-analysis

BackgroundPalliative radiotherapy (PRT) is an effective way of reducing symptoms caused by advanced incurable cancer. Several studies have investigated factors that contribute to inequalities in access to PRT; distance to...

Citizens' use of digital media to connect with health care: Socio-ethical and regulatory implications.

Digital technologies promise to transform practices of health, medicine and health care and 'power' economies. In expectation of their presumed future benefits, governments in recent years have invested heavily in new technology initiatives and have sought to engender 'digital literacy' among citizens. This article introduces papers and expands on themes arising from a special issue that explores the socio-ethical and regulatory implications of citizens' use of digital media to connect with health care. We set the scene by examining the promissory discourse that attaches to digital technologies as applied to health care, and its role in shaping actions, and then consider the longer term prospects and implications of digitalisation for conceptions of citizenship and established categories and distinctions. As we argue, given the history of new technologies, the longer term implications of digitalisation are likely to differ significantly from those envisaged. Digital technologies promise radical positive disruption. Yet many uncertainties accompany their development and future applications and likely implications. Making reference to papers in the special issue and the wider literature, the article considers the prospects of digitalisation in medicine and health care in light of the colonisation of the Internet by powerful technology companies, the shift in capitalist economies from processes of production to technologies of prediction, evidence of inequalities in access to the Internet and related devices, and the growing number of data breaches involving personal health information. We draw attention to the failure of governments to engage citizens in substantive deliberations about digitalisation and its future potential implications and the ultimate democratic deficit that this represents. We ask, what does it mean to 'regulate' digital media in a context in which data are widely viewed as the 'new oil'? While we have no straightforward answers, we suggest that recent legislative efforts (e.g. General Data Protection Regulation in Europe) and growing calls for 'algorithmic accountability' have the potential to temper the more harmful aspects of digitalisation.

Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

BackgroundInequalities in access to medications among people diagnosed with diabetes in low- and middle-income countries (LMICs) is a public health concern since untreated diabetes can lead to severe complications and premature death.ObjectiveTo assess evidence of inequalities in access to medication for diabetes in adult populations of people with diagnosed diabetes in LMICs.DesignWe conducted a systematic review of the literature using the PRISMA-Equity guidelines. A search of five databases - PubMed, Cochrane, CINAHL, PsycINFO, and EMBASE - was conducted from inception to November 2015. Using deductive content analysis, information extracted from the selected articles was analysed according to the PRISMA-Equity guidelines, based on exposure variables (place of residence, race/ethnicity, occupation, gender, religion, education, socio-economic status, social capital, and others).ResultsFifteen articles (seven quantitative and eight qualitative studies) are included in this review. There were inconsistent findings between studies conducted in different countries and regions although financial and geographic barriers generally contributed to inequalities in access to diabetes medications. The poor, those with relatively low education, and people living in remote areas had less access to diabetes medications. Furthermore, we found that the level of government political commitment through primary health care and in the provision of essential medicines was an important factor in promoting access to medications.ConclusionsThe review indicates that inequalities exist in accessing medication among diabetic populations, although this was not evident in all LMICs. Further research is needed to assess the social determinants of health and medication access for people with diabetes in LMICs.

Socioeconomic differences in waiting times for elective surgery: a population-based retrospective study

BackgroundWidespread literature on inequity in healthcare access and utilization has been published, but research on socioeconomic differences in waiting times is sparse and the evidence is fragmentary and controversial. The objective of the present study is the analysis of the relationship between individual socioeconomic level and waiting times for in-hospital elective surgery.MethodsWe retrospectively studied the waiting times experienced by patients registered on hospital waiting lists for 6 important surgical procedures by using the Hospital Discharge Database (HDD) of the Piedmont Region (4,000,000 inhabitants in the North West of Italy) from 2006 to 2008. The surgical procedures analyzed were: coronary artery by-pass (CABG), angioplasty, coronarography, endarterectomy, hip replacement and cholecystectomy. Cox regression models were estimated to study the relationship between waiting times and educational level taking into account the confounding effect of the following factors: sex, age, comorbidity, registration period, and Local Health Authorities (LHA) as a proxy of supply.ResultsMedian waiting times for low educational level were higher than for high educational level for all the selected procedures. Differences were particularly high for endarterectomy and hip replacement. For all considered procedures, except CABG, an inverse gradient between waiting times and educational level was observed: the conditional probabilities of undergoing surgery were lower among individuals with a low to middle level education than for individuals with a higher level of education after adjustment for sex, age, comorbidities, registration period, and LHAs. For most procedures the effect decreases over the follow up period.ConclusionsThe results of the study show evidence of inequalities in access to elective surgery in Italy. Implementation of policies aimed to promote national information initiatives that guarantee wider access to those with low socio-economic status is strongly recommended.

Health Care for Older Persons in England and the United States: A Contrast of Systems and Values

This article extends previous comparisons of access to health care for older persons in England and the United States by comparing rates of avoidable hospital conditions as a proxy for primary care access and by examining the distribution of care within these older populations. Drawing on hospital data from the two countries, we find that older persons in the United States, particularly those over the age of seventy-five, receive far more revascularizations than do older persons in England. Differences in the use of lower-joint replacement are not as great, but we are unable to assess differences in the need for these procedures. Although older persons have greater access to specialty care in the United States, there appears to be much better access to primary care in England. We are unable to draw comparisons on the extent of inequalities in access to health care, although in the United States there is evidence of inequalities in access by race, and in England we confirm earlier studies that find inequalities by level of deprivation. These findings are discussed in the context of the political debates over access to care and rationing in the two countries.

Location, Location, Location: Residence, Wealth, And The Quality Of Medical Care In Delhi, India

There are seventy medical care providers within walking distance of every household in Delhi. However, inequalities in health outcomes persist among the rich and poor, which might reflect differences in the quality of available care. This paper shows that providers visited by the poor were indeed less knowledgeable than those visited by the rich. There is strong evidence of inequalities in access, with lower competence among private- and public-sector providers in poor neighborhoods, but no evidence of inequalities in choices. Practical policy options include targeted information to patients on provider competence and improving the allocation of public doctors across poor and rich neighborhoods.

The reported views and experiences of cancer service users from minority ethnic groups: a critical review of the literature

There is growing evidence of inequalities in access to high-quality cancer services between minority and majority ethnic groups. However, little research has been carried out from the perspective of users from minority ethnic groups themselves. This paper reports a review of the British literature exploring the views and experiences of cancer service users from minority ethnic groups. We reviewed 25 qualitative studies that reported the experiences of people from minority ethnic groups. The studies highlighted significant issues and challenges, including comprehension and communication barriers, a lack of awareness of the existence of services and a perceived failure by providers to accommodate religious and cultural diversity. This paper critically discusses some of the explanations commonly invoked for ethnic inequalities in access to high-quality care, such as the belief that the lack of use of services reflects a lack of need. Despite positive initiatives to respond better to the needs of minority groups, we suggest the impact of these remains highly variable. Institutional racism within services is still much in evidence.

Ethnicity, equity, and access to genetic services—the UK perspective

The UK is a multi-ethnic, multicultural society with over 300 languages spoken in the capital (London) alone. This short report explores the implications of a diverse population on health and access to genetic services. It considers genetic, cultural and linguistic differences, and provides evidence of inequalities in access. Following recent legislation promoting race equality, the report highlights current activities and shortfalls, and proposes recommendations towards achieving greater equity of access within the context of clinical genetics service provision.

Allocation of Rehabilitation Services: Who Gets a Home Evaluation

The purpose of this study was to (a) identify and describe the subpopulation of rehabilitation inpatients who receive specialized occupational therapy home evaluation services, and (b) examine these data for evidence of inequalities in access to services based on patient gender, race, age, and health insurance status. An archival review was conducted of all inpatient admissions (7,871) to a large urban rehabilitation hospital between January 1, 1994, and December 31, 1998. We had complete data on 7,791 of these patients of whom 6,038 were eligible to receive a home evaluation. Patient demographic data and Functional Independence Measure (FIM) data were obtained in electronic form from the hospital information system. Analysis showed that 12.4% (749/6038) of eligible inpatients received an in-home evaluation, and those who did were significantly more dependent (as measured by the FIM) than those who did not (p < 0.0001). We found no evidence of inequalities in access to this specialized rehabilitation service on the basis of gender, race, age, and type of medical insurance after controlling for level of functional independence. This study found no evidence of inequalities in the allocation of home evaluation services. However, it raises the larger question of how we determine whether inequalities exist. A proper assessment of inequalities in service provision requires that we know the principles by which these services should be allocated and have appropriate measures of the application of these principles. For programmatic and policy reasons, more research is needed to develop well-defined principles of resource allocation, and adequate measures of their impact so we can know whether resources and services are distributed in the way we intend.