Inequality Index Research Articles

Examining the Influence of ICT Penetration on Gender Disparities: A Data Panel Econometric Analysis of the Seven Southeast Asian Developing Countries

The aim of the study is to analyze to which Information and Communications Technology (ICT) penetration affects gender disparities in seven Southeast Asia’s developing countries. ICT indicators are measured through the individuals using the internet, mobile phone subscriptions, and internet subscriptions. Aside, the seven Southeast Asia’s developing countries include Indonesia, Cambodia, Laos, Malaysia, Thailand, Philippines, and Vietnam. These countries are selected as they have comparable economic development stage from lower to upper-middle income economics on the basis 2022’s World Bank Country Income Classification. The data panel econometrics is carried out to measure the effect of the independent variables towards gender disparity. Gender disparity is represented by the Gender Inequality Index. The time series data is yearly from 2000 to 2022. The econometric assessment shows the individual internet ownership and subscription have a negative and significant effect to gender disparity. It means that more internet penetration can lower the gender disparity in those seven countries. The academic implication is to enhance economic consideration towards more internet penetration and access to reduce gender disparity. In the heart of policymaking, our research indicates more internet accessibility to reduce gender disparity. As in the common knowledge, the internet is a source of information and knowledge to society

Trends in Norwegian adolescents’ substance use between 2014 and 2022: socioeconomic and gender differences

BackgroundSubstance use is a global health concern and early onset among adolescents increases health risks. We explore national overall trends in prevalence and trends in socioeconomic inequalities in past year alcohol intoxication, cannabis use, and use of other illicit drugs among Norwegian adolescents (ages ∼ 15–19 years of age) between 2014 and 2022.MethodThe present study builds on data from a nationwide repeated cross-sectional survey collected in 2014–2016 (T1), 2017–2019 (T2), 2021 (T3) and 2022 (T4). In total 415,560 adolescents (50.3% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).ResultsWhile the prevalence of alcohol intoxication remained fairly stable, the prevalence of cannabis and other illicit drug use increased between 2014 and 2022 among upper secondary school boys (13.3–17.6%, and 2.0–5.2%, respectively) and girls (8.8–12.8%, and 1.1–2.7%, respectively). Similar trends were observed among 10th-grade adolescents. Boys were more likely than girls to use cannabis or other illicit drugs, but the gender gap in cannabis use narrowed during the study period. Among upper secondary girls, use of cannabis and other illicit drugs was higher among those from less affluent backgrounds, with absolute and relative inequalities in cannabis use increasing between 2014 and 2022. Small inequalities in cannabis use and decreasing relative inequalities in the use of other illicit drug were observed among upper secondary boys.ConclusionsThe increasing use of cannabis and other illicit drugs among Norwegian adolescents is concerning. Future studies should explore the underlying causes of this rise and explore the complex factors influencing adolescent substance use behaviours. A comprehensive understanding of these factors is essential for developing targeted and effective interventions.

Inequalities in Ambulatory Care Sensitive Conditions: An International Comparison of High-Income Countries

ObjectiveTo examine the differences in inequalities in Ambulatory Care Sensitive Conditions (ACSC) hospitalizations relative to socioeconomic status across nine countries, namely Australia, Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). ApproachThe International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) research collaborative developed national data sets with hospitalization and sociodemographic data aggregated to small-area levels and pooled across countries using a common data model. Inequalities were assessed using both the slope index of inequality and the relative index of inequality. ResultsThis study developed a common definition and set of codes for ACSC hospitalizations that proved to be comparable across countries and regions. Consistent socioeconomic gradients were observed in all countries with higher ACSC hospitalization rates for individuals in most disadvantaged areas. The greatest difference in hospitalizations between the highest and lowest income quintiles were observed in New Zealand (1603 per 100,000), Finland (1802 per 100,000) and England (1955 per 100,000). ConclusionsThe high-income countries included in this study displayed many commonalities in inequalities in ACSC hospitalizations. As a proxy measure of primary care access and quality, the observed inequalities may implicate disparities in health care quality and access for the lowest socioeconomic status groups. ImplicationsBarriers to health care access in low socioeconomic groups remain a complex and multifaceted issue. Future research should investigate the underlying contributing factors to the observed ACSC hospitalization equity gradients, including primary care delivery model, remuneration approach, and population structure.

Decrease in Socioeconomic Disparities in Self-Rated Oral Health among Brazilian Adults between 2013 and 2019: Results from the National Health Survey.

This cross-sectional study assessed the magnitude of inequalities in self-rated oral health (SROH) among different socioeconomic groups in Brazil. Secondary data from interviews with a sample of adults (≥18 years) from the national health survey 2013 (n = 64,308) and 2019 (n = 88,531) were analyzed. Positive SROH was considered when participants selected the good or very good options. Socioeconomic indicators were monthly household income and years of education. The magnitude of inequalities among socioeconomic groups was estimated using the Slope (SII) and Relative Index of Inequality (RII). Interaction term assessed changes in SII/RII over time. Estimates were adjusted for sex and age. The prevalence of SROH was 67.50% in 2013 and 69.68% in 2019. Individuals with lower socioeconomic indicators had a lower prevalence of positive SROH. Significant reductions in the magnitude of the education-based RII between 2013 (1.58) and 2019 (1.48) in Brazil, as well as in north (1.70; 1.45) and northeast (1.50; 1.41) regions and reduction in the income-based RII in the north (1.71; 1.51) were observed. Socioeconomic inequalities in SROH persist across different Brazilian regions, although there was a reduction in disparities among education groups in 2019 compared with 2013. The findings of this study suggest that equitable Brazilian oral health policies may have contributed to reducing SROH inequality over time.

Demographic and socio-economic inequalities in subjective wellbeing: analysis of repeated cross-sectional health surveys in England 2010-2019.

Good subjective wellbeing (SWB) is a key societal aspiration. The study of SWB determinants is of increasing interest. The present study aimed to examine national inequalities in SWB, and trends in these inequalities, for England across five demographic (sex and age) and socio-economic (educational level, household income and living alone) characteristics. The relative index of inequalities (RII) and slope index of inequalities (SII) were calculated from repeated cross-sectional data from the Health Survey for England from 2010 to 2019 (excluding 2017 and 2018 as our outcome variable was not collected in these years), in a total of 90 236 participants aged 16+. SWB was assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), treated as a dichotomous variable with high and low levels of SWB>40 and≤40, respectively. There were significant inequalities in SWB by income (RII from 1.086 to 1.116), educational level (RII from 0.893 to 0.941) and between people living alone or not (RII from 0.908 to 0.937). The RII and SII trends were not statistically significant. Higher socio-economic status could play a protective role for SWB, and people in the most deprived socio-economic positions may be at higher risk for low SWB. These associations have remained stable over time.

Socioeconomic inequalities in uptake of outreach mammography before and after accessibility improvement of Taiwan’s national universal breast cancer screening policy

BackgroundTaiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparities in outreach screening utilization pre-CAQIP (2005–2009) and post-CAQIP (2010–2014).MethodWe conducted a nationwide population-based observational study in Taiwan, analyzing four population databases to evaluate socioeconomic disparities among women aged 50 to 69 years undergoing their first mammography screening pre-CAQIP. Multivariate logistic regression was used to examine changes in utilization of outreach screening pre- and post-CAQIP implementation, and to estimate the Slope Index of Inequity (SII) and Relative Index of Inequity (RII) values.ResultsUtilization of outreach screening through mobile mammography units (MMUs) increased from 6.12 to 32.87% between the two periods. Following CAQIP, a higher proportion of screened women were older, less educated, and from suburban or rural areas. The SII and RII for age, income, and urbanization levels decreased post-CAQIP. However, regarding education level, SII was − 0.592 and RII was 0.392 in the pre-CAQIP period, increasing to -0.173 and 0.804 post-CAQIP, respectively.ConclusionsOur study observed that utilization of outreach screening through MMUs increased after CAQIP. The MMUs made outreach screening services more accessible in Taiwan. Expanding outreach screening services and educational programs to promote mammography uptake in local communities could help reduce the potential effect of socioeconomic disparities, and thus may enhance early detection of breast cancer. Further study could focus on the accessibility of outreach screening and breast cancer outcomes.

Inequity in the utilization of the home and community integrated healthcare and daily care services in older adults with limited mobility in China

BackgroundThis study aimed to analyze the needs and utilization of the home and community integrated healthcare and daily care services (“home and community care services” for short) among older adults in China and to investigate the inequity in services utilization.MethodsCross-sectional data were obtained from the 2018 China Health and Retirement Longitudinal Study. Needs and utilization rates of the home and community care services in older adults of 60 years old and above were analyzed. Binary logistic regression analysis was performed to explore the factors associated with services utilization among older adults with limited mobility. Concentration index, horizontal inequity index, and Theil index were used to analyze inequity in services utilization. Decomposition analyses of inequity indices were conducted to explain the contribution of different factors to the observed inequity.ResultsAbout 32.6% of older adults aged 60 years old and above had limited mobility in China in 2018, but only 18.5% of them used the home and community care services. Among the single service utilization, the highest using rate (15.5%) was from regular physical examination. Limited mobility, age group, income level, region, self-assessed health, and depression were statistically significant factors associated with utilization of any one type of the services. Concentration indices of any one type service utilization and regular physical examination utilization were both above 0.1, and the contribution of income to inequity were both over 60%. Intraregional factor contributed to about 90% inequity of utilizing any one type service, regular physical examination and onsite visit.ConclusionsThis current study showed that older adults with needs of home and community care services underused the services. Pro-rich inequities in services utilization were identified and income was the largest source of inequity. The difference of the home and community care service utilization was great among provinces but minor across regions. Policies to optimize resources allocation related to the home and community care services are needed to better satisfy the needs of older adults with limited mobility, especially in the low-income group and the central region.

Impact of Globalisation on Unemployment and Inequality in India

The financial system of India has been significantly affected by globalisation, ensuing in a great have an effect on on unemployment and economic inequality. This studies specializes in analysing the impact of India's monetary integration into the global financial system on the U.S.A.'s labour markets and income distribution. Globalisation has propelled financial growth, increased activity opportunities across numerous industries, and facilitated technological improvements. However, the blessings have now not been dispensed fairly, leading to a boom in inequality. A big wide variety of people with constrained capabilities is currently without employment or is operating in roles that don't completely utilise their competencies. This is commonly because of the lack of ability of traditional industries and agriculture to fit the fast enlargement of the provider and information era sectors, which have generated numerous possibilities for people with superior abilties. Moreover, there is currently a more stated disparity among specific areas; urban regions have had extra economic benefits in comparison to rural areas. The effects suggest the need for centered making plans to ensure a greater equitable boom in India, given the intricate interaction between globalisation, employment, and inequality. In order to mitigate the results of globalisation on inequality and unemployment, it's far imperative to address skill deficiencies, beautify social protection nets, and promote equitable nearby increase.

Impact of Globalisation on Unemployment and Inequality in India

Globalization in the Indian economy has severely affected unemployment and income inequality. The study deals with the impact of India’s economic integration on the global economy and income distribution in the country’s labor market. Economic growth, more employment opportunities in industry and all technological developments, have been enhanced by globalization. However, benefits were not distributed equally, and inequality rose as a result. Many low-skilled people are unemployed or underemployed because traditional manufacturing and agriculture have not been able to keep up with the growth of service and IT industries, which despite creating many high-skilled positions, now have wide local differences Urban areas have experienced greater economic gains than rural areas. According to the results, given the strong relationship between globalization, employment and inequality, policymaking should focus on achieving more equitable growth in India To reduce the impact of globalization unevenness and unemployment, it is important to prevent skills gaps, strengthen social security and encourage equitable regional development

Disparities in access to water, sanitation, and hygiene (WASH) services and the status of SDG-6 implementation across districts and states in India

IntroductionAccess to affordable and improved Water, Sanitation, and Hygiene (WASH) facilities is essential for people's daily lives, and it is the primary goal of Sustainable Development Goal 6 (SDG-6). However, achieving this goal is a significant challenge for many countries, including India. The aim of this study is to assess the progress made towards achieving SDG-6 targets in Indian districts, states, and Union Territories (UTs) and to identify clusters by measuring spatial inequality of WASH coverage in India. Aim and objectiveThe primary objective of this study is to measure the progress made towards achieving the SDG-6 targets for WASH facilities in Indian districts, states, and UTs. To fulfill this objective, the study used the household data of the National Family Health Survey-5 (NFHS-5) conducted from 2019 to 21. Data and methodsThe study used the household data of NFHS-5, which is a nationally representative survey that provides information on household and individual-level characteristics related to health and nutrition. The study identified the variables associated with WASH and created a composite index to measure WASH coverage separately and combined. The study used Gini coefficient to show WASH inequality, and Moran's statistics were used to show spatial dependency. ResultThe study found that the inequality of improved water coverage sources in Indian districts was high. Western and northeastern districts need to catch up in terms of achieving the SDG-6 targets. The value of the Gini coefficient (0.29) indicates that inequality in sanitation coverage is also high. All states have reached close to SDG-6 achievement in hygiene indicators. Goa, Sikkim, Andaman & Nicobar Islands, and Lakshadweep are close to the overall WASH coverage achievements of SDG-6. However, Jharkhand, Orissa, Tripura, Assam, and Rajasthan are behind in meeting the goal of SDG-6. ConclusionThe study suggests that more government initiatives and investments are needed to increase the availability, accessibility, and affordability of WASH facilities to improve WASH conditions in western and northeastern Indian districts. The localization or bottom-up approach by giving responsibility to rural and urban local bodies can also help enforce the achievement of SDG-6. The findings of this study can be used to guide policymakers in developing targeted interventions to improve WASH conditions and reduce inequality in India.

Postgrowth welfare systems: a view from the Nordic context

As production and supply chains rely on exploitative extraction of nature and labour, consumption levels (resource use) remain one of the main indicators of inequality, across and within national contexts. In times of ongoing climate crisis and rising levels of inequalities, welfare systems face the dual challenge of transforming economies to reduce their reliance on unsustainable industries as well as maintain and expand equitable distribution of public provision. In this keyword essay, we address three overlapping concerns to consider while envisioning sustainable welfare within the Nordic context: growth and its paradoxical relation with welfare; inequalities and notions of wellbeing; and possible alternatives to arrange provision systems.

Plant size inequality: How to analyse competing spatial dissimilarity indices?

Worldwide biodiversity loss is perceived as a major threat and is likely to be enforced by ongoing climate change. Continued monitoring of biodiversity can assist in compensating for decreasing biodiversity by goal-oriented conservation management. Plant size diversity, also termed size inequality and size hierarchy, has often been neglected in studies of biodiversity, but plays a crucial role in many ecosystems, e.g. in forests. Several competing diversity indices and other characteristics of spatial plant size inequality have been proposed but to date no protocols or guidelines exist for evaluating their relative merits. In our study, we proposed a broad framework for such an analysis. In order to put this framework to a test, we revisited the dissimilarity coefficient, a somewhat ignored but promising spatial size inequality index published at the end of the 1990s, identified its nearest index competitors and analysed their performances in different mathematical-statistical contexts. We learned that the dissimilarity coefficient is more sensitive in statistical significance tests relating to three very different summary characteristics than its closest competitor, the size differentiation index. In addition the dissimilarity coefficient has a more solid foundation than the differentiation index, since it is based on the well-known coefficient of variation. The dissimilarity coefficient can be recommended in a wide range of plant diversity applications. The principle of the dissimilarity coefficient can also be used to define an effective mark correlation function. We recommend our evaluation framework for use in similar analyses of competing diversity characteristics.

Fertility services for gay men: A website content analysis of US fertility clinics and sperm banks.

Fertility preservation and subsequent third-party reproduction represents a principal pathway by which gay and bisexual cisgender men may have biologically related children. Previous studies of a similar design have commented on the availability of fertility services for sexually and gender diverse communities, but none have investigated access to the aforementioned services for this specific population. To assess the availability of fertility preservation and third-party reproduction services for gay and bisexual cisgender men across US fertility clinics and sperm banks. A content analysis was performed on a sample of fertility clinic and sperm bank websites compiled from three online sources. Sample construction and analysis were completed in 2023. Each website was systematically examined by two separate coders with a third coder deciding any discrepancies. Website coding followed a pre-constructed standardized questionnaire. Logistic regression analysis was used to identify statistically significant differences. A total of 675 clinic and sperm bank websites (136 academic and 539 private) were analyzed. Five hundred and two (74.4%) offered third-party reproduction and 326 (48.3%) offered fertility preservation for gay and bisexual cisgender men. Furthermore, 248 websites (36.7%) featured some form of disqualifying language either directly communicating or implying exclusion of gay and bisexual cisgender men from these services. Private facilities were more likely to offer third-party reproduction (odds ratio [OR]=1.88, p<0.01) but less likely to offer fertility preservation (OR=0.68, p<0.05) compared with academic affiliated facilities. Lastly, states in the highest Human Rights Campaign Equality Index tier were significantly more likely to offer third-party reproduction (OR=2.50, p<0.01) than the lowest tier. These findings demonstrate great variability in access to fertility preservation and third-party reproduction services. Geography and ambiguity in facility-specific policies represent persistent barriers to family building for gay and bisexual cisgender men.

Understanding period product use among young women in rural and urban India from a geospatial perspective

Ensuring proper menstrual hygiene management remains a significant challenge for young women in India. The term "exclusive use of hygienic period products during menstruation" refers to relying solely on period products like sanitary pads, tampons, or menstrual cups. Poor menstrual hygiene practices not only increase the risk of reproductive tract infections but also lead to various negative health outcomes, including discomfort and potential complications. This study explores factors associated with the exclusive use of period products during menstruation aged 15–24, investigates geographic disparities, examines rural–urban gaps, and assesses inequality in India. Utilizing data from the fifth National Family Health Survey (NFHS-5), responses from 2,41,180 women aged 15 to 24 were analysed using logistic regression and multivariate decomposition analyses to explore socioeconomic predictors. Moran's I statistics also assessed spatial dependency, while Lorenz curves and Gini coefficients measured inequality. Quintile and LISA maps visualized regional disparities. The study found that 76.15% of women in India reported exclusive use of hygienic period products during menstruation. Rural areas reported a lower percentage of exclusive use of hygienic period products (72.32%) during menstruation compared to urban areas (89.37%). Key factors associated with the exclusive use of hygienic period products among 15–24-year-old women in India include age, education, place of residence, wealth, access to media, and healthcare discussions. Geographically, central districts exhibited the lowest coverage (< 65%), while the Southern region reported the highest (> 85). The GINI coefficient of 0.39 highlighted moderate inequality in distribution. Decomposition analysis revealed that household wealth contributed 49.25% to rural–urban differences, followed by education (13.41%), media access (7.97%), and region (4.97%). This study highlights significant regional disparities and low utilization of hygienic period products among young women in India, particularly in central districts. Policymakers should prioritize interventions targeting these regions, addressing socio-economic disparities. Strategies to promote education, improve media access, and enhance household wealth can facilitate menstrual hygiene adoption. Initiatives to reduce sanitary napkin costs and increase accessibility, particularly in rural areas, are crucial to mitigating geographical disparities nationwide.

Physical activity modification over time according to socioeconomic position: results from the EPIC-Italy cohort study

ObjectivesOur study aimed to investigate how physical activity (PA) changes over an 11-year follow-up among adults from different socioeconomic positions (SEP) near retirement age. Moreover, an analysis of different PA...

Implications of public policies performance on social inequality worldwide

This study probes the linkage between public policy (represented by GDP growth, inflation, CO2 emissions, and unemployment factors) and social inequality indicators, paying attention to economic, environmental, and social elements. The study questions the impact of these policies on overall social inequality as one measure and its separate dimensions, which are gender, income, education, and life expectancy, whereas data was gathered between 2010 and 2021 from the World Bank and the United Nations Development Programme (UNDP) for 139 countries. The linear regression revealed a significant relationship that explained 51% of the variance in overall social inequality, except for unemployment. Regarding separate dimensions of social inequality, the findings point out that GDP growth and inflation both affect life and gender inequality, whereas unemployment only affects income inequality; on the other hand, the CO2 emissions factor has an inverse effect on all dimensions of inequality (income, life expectancy, education, and gender inequalities). Considering the implications, increased CO2 emissions would reduce income inequality by boosting job creation, but they also pose environmental and health hazards, necessitating sustainable development strategies. Rising unemployment exacerbates income distribution, demonstrating the need for policies that enhance job stability and reduce inequality. Additionally, it necessitates investing in healthcare and education, eradicating gender inequality, and implementing sustainable strategies to foster economic growth while considering the consequences of inflation on life and gender justice. Thus, realizing these principles would build a sustainable and equitable society that balances economic enhancement with environmental protection and achieves equal opportunity.

Links between the sustainable development goals: An analysis for Italy

AbstractThe article reviews the links between the Sustainable Development Goals (SDGs), examining how progress in one is related to the others and what factors determine the progress. While most previous work is at the national level, this article focusses at the sub‐national level for one country, namely Italy. After reviewing the evidence from the literature, the paper utilizes an unbalanced panel data collected for Italian provinces, covering the period 2004–2022 and reports descriptive statistics. On the positive side, we see a decline in ambient air pollution, and an increase in indicators of gender equality. There are also big gains in tertiary education and a decline in occupational injuries. These are common to almost all provinces. On the health side, life expectancy has risen across the country. Less positive are the changes in endocrine, metabolic, and nutrition disease rates and in availability of hospital beds. The inter‐province indicator of inequality has also increased. Furthermore, the overall level of inequality has gone up and the difference in inequality between provinces has not fallen. There has been no increase in green spaces or efficiency of courts. There has been progress in poverty reduction but not enough to meet the SDG target by 2030 and regional differences in poverty remain stark. The Italian data are subjected to estimation of causal linkages between indicators using a system of equations. Two‐stage least squares estimation is carried out on the panel data set for provinces in Italy. The empirical modeling finds a positive impact of wealth on life expectancy and of income on poverty. There is an effect of an increase in income on poverty at the sub‐national level. There is also a negative impact of NGOs on land under construction, which is something not observed elsewhere as far as we are aware.

The Mediating Role of Perception of Society Between Income Inequality and Life Satisfaction. Insights from the European Social Survey

The mechanisms between inequality and well-being are not fully known. There is a body of knowledge assuming personal information on the social environment can be important here. In this article, we consider this perception of society (POS) as a mediator between income inequality and life satisfaction. Our research questions are: 1) How are various measures of income inequality associated with life satisfaction, and 2) does the POS mediate the effect of inequality on life satisfaction? The individual-level data come from the European Social Survey 2008 (N = 56,752) and the macro-level data from OECD and World Bank. We use a comprehensive and psychometrically valid measure of the POS to capture individuals' full societal perceptions. The data is analysed with a multilevel linear regression and the mediation effect is tested with a Sobel test. The results reveal significant differences between indicators of income inequality in their ability to predict life satisfaction. Moreover, POS is strongly associated with life satisfaction and mediates the association of income inequality on life satisfaction. In addition, we observed the so-called ‘saturation effect.’ The effect of POS depends on objective conditions—the better the society, the smaller the effect.

Evaluating the impact of the 2010 Swedish choice reform in primary health care on avoidable hospitalization and socioeconomic inequities: an interrupted time series analysis using register data

BackgroundThe Swedish Primary Health Care (PHC) system has, like in other European countries, undergone a gradual transition towards marketization and privatization, most distinctly through a 2010 choice reform. The reform led to an overall but regionally heterogenous expansion of private PHC providers in Sweden, and with evidence also pointing to possible inequities in various aspects of PHC provision. Evidence on the reform’s impact on population-level primary health care performance and equity in performance remains scarce. The present study therefore aimed to examine whether the increase in private provision after the reform impacted on population-average rates of avoidable hospitalizations, as well as on corresponding socioeconomic inequities.MethodsThis register-based study used a multiple-group interrupted time-series design for the study period 2001–2017, with the study population (N = 51 million observations) randomly drawn from the total Swedish population aged 18–85 years. High, medium, and low implementing comparison groups were classified by tertiles of increase in private PHC providers after the reform. PHC performance was measured by avoidable hospitalizations, and socioeconomic position by education and income. Interrupted time series analysis based on individual-level data was used to estimate the reform impact on avoidable hospitalization risk, and on inequities through the Relative Index of Inequality (RII).ResultsAll three comparisons groups displayed decreasing risk of avoidable hospitalizations but increasing socioeconomic inequities across the study period. Compared to regions with little change in provision after the reform, regions with large increase in private provision saw a steeper decrease in avoidable hospitalizations after the reform (relative risk (95%): 1.6% (1.1; 2.1)), but at the same time steeper increase in inequities (by education: 2.0% (0.1%; 4.0); by income: 2.2% (-0.1; 4.3)).ConclusionsThe study suggests that the increase in private health care centers, enabled by the choice reform, contributed to a small improvement when it comes to overall PHC performance, but simultaneously to increased socioeconomic inequities in PHC performance. This duality in the impact of the Swedish reform also reflects the arguments in the European health policy debate on patient choice PHC models, with hopes of improved performance but fears of increased inequities.

An integrated adaptive allocation model for unified optimization of conventional and unconventional water resources based on fairness and efficiency

Unconventional water (UW) use has pros and cons, presenting the challenge of matching water utilization with regional water use characteristics. This study proposed the concept of amount-centered adaptive water allocation and built an integrated adaptive allocation model that includes conventional water (CW) and UW adaptability. The model consists of two modules. The first module introduces the regional composite index and inequality index to match CW and UW allocation amount with the sub-region’s characteristics. The second module defines the efficiency of CW and UW allocation, employs the Zero-Sum Gains Data Envelopment Analysis to find the solution set with the highest efficiency on the Pareto front, and further modifies it to reach the optimal allocation efficiency. Then the proposed model was applied to Jiangsu Province, China. Empirical and comparative analyses of the 54 weighting plans proved the validity and practicability of the model. The results showed: (1) The model tallies with the principles of fairness and efficiency and reduces the spatial heterogeneity of water shortage risk; (2) When available water supply decreases by over 20% due to future water-related emergency incidents, CW allocation would first reach its upper limit, while UW fails to effectively bridge the supply–demand gap; (3) Only by improving the maximum UW consumption by over 40% can the future risk of extreme water shortages be effectively addressed. The model proposed in this study has excellent practicality and application potential, providing a novel perspective for incorporating UW into the unified management of water resources.