Universal Access To Health Care Research Articles

TEMPORARY REMOVAL: Drivers of Anemia Reduction among Women of Reproductive Age in the Philippines: A Country Case Study

BackgroundAnemia prevalence among women of reproductive age (WRA) in the Philippines was 25% in 2000, decreasing to 13% in 2018. To date, an in-depth assessment of the determinants associated with this decline has not been conducted. ObjectiveTo conduct a systematic in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in the Philippines between 2008 and 2018. MethodsEmploying standard Exemplars methodology, we conducted quantitative analyses using the Philippines’ National Nutrition Survey, the Expanded National Nutrition Survey, and the Philippines National Demographic and Health Surveys. Qualitative analyses included a comprehnsive literature review, program/policy analysis, and interviews with stakeholders to understand country-level enablers and barriers to WRA anemia decline in the Philippines. A final Oaxaca-Blinder decomposition analysis (OBDA) evaluated the relative contribution of direct and indirect factors. ResultsAmong non-pregnant women (NPW), mean hemoglobin (Hb) increased from 12.7 g/dL in 2008 to 13.1 g/dL in 2018 (p<0.01), corresponding to an 11%-point decline in anemia prevalence (23% to 12%). Inequities by geographical region, household wealth, and women’s educational attainment narrowed considerably during this time. Important direct and indirect nutrition programs were introduced during our study period, including universal healthcare and food fortification. Country experts interviewed credited programs focused on alleviating micronutrient deficiencies and poverty, and improvements in women’s health and well-being, for the country's extraordinary success. OBDA explained ∼50% of the observed change in mean Hb among NPW, with family planning (35%), household socio-demographics (29%), and improvement in women’s nutrition (23%) emerging as critical drivers of anemia decline, corroborating our qualitative and policy analyses. ConclusionsTo protect these gains, WRA anemia prevention efforts in the Philippines should continue to focus on universal healthcare access, women’s empowerment, and poverty alleviation.

Digital Pathology is a Fast and Effective Platform for Providing Head and Neck Pathology Consultations.

Surgical pathology of the head and neck is one of the more challenging areas in all of diagnostic pathology. Its unparalleled diversity and complexity renders it highly vulnerable to diagnostic error compelling unconstrained access to specialized diagnostic expertise. Digital pathology (DP) is a state-of-the-art tool that could facilitate access to specialized expertise, but it is relatively untested in the context of pathology consultations. In a collaboration between Labcorp Dianon and a large academic hospital with subspecialized surgical pathology, DP was implemented to provide the pathology community access to head and neck pathology expertise. From this collaborative experience, glass slides from consecutive consult cases that had been previously diagnosed using DP were reviewed by an expert consultant in a blinded manner following an extended wash-out period. The intraobserver discrepancy rate was recorded. Major discrepancies were defined as those resulting in significant impact on clinical management and/or prognosis, whereas minor discrepancies were those with no impact on care or prognosis. Slides from 57 cases were available for review. The average wash-out period was 19 months. Five discrepancies were recorded (intraobserver concordance rate of 91%). All discrepancies were minor (major discrepancy rate, 0%; minor discrepancy rate, 9%). On appraisal of the discrepant cases, discordant diagnoses were attributed to subjective differences in interpretation rather than objective differences related to the inferiority of DP. DP decreased the median turnaround time by 97% (from 70h 26min to 2h 25min). DP provides efficient and fast access to expert consultants. The speed of case delivery does not compromise diagnostic precision. Discrepancies are uncommon, minor, and reflect subjective interpretative differences inherent to difficult and ambiguous head and neck cases, and not the inferiority of DP as a diagnostic platform. High concordance can be achieved even for those difficult and complex cases that are concentrated in the consultation practice. This observation carries profound implications regarding universal health care access to specialized diagnostic expertise.

Area-based disparities in non-small-cell lung cancer survival.

In the Nordic countries, universal healthcare access has been effective in reducing socioeconomic disparities in non-small-cell lung cancer (NSCLC) management. However, other factors, such as proximity to healthcare facilities, may still affect access to care. This study aimed at investigating the influence of residential area on NSCLC survival. This population-based study utilized hospital records to identify NSCLC patients who underwent their initial treatment at Vaasa Central Hospital between January 1, 2016, and December 31, 2020. Patients were categorized based on their postal codes into urban areas (≤50 km from the hospital) and rural areas (>50 km from the hospital). Survival rates between these two groups were compared using Cox regression analysis. A total of 321 patients were included in the study. Patients residing in rural areas (n = 104) exhibited poorer 12-month survival rates compared to their urban counterparts (n = 217) (unadjusted Hazard Ratio [HR]: 1.38; 95% Confidence Interval [CI]: 1.01-1.89; p = 0.042). After adjusting for factors such as performance status, frailty, and stage at diagnosis in a multivariate Cox regression model, the adjusted HR increased to 1.47 (95% CI: 1.07-2.01; p = 0.017) for patients living in rural areas compared to those in urban areas. The study findings indicate that the distance to the hospital is associated with increased lung cancer mortality. This suggests that geographical proximity may play a crucial role in the disparities observed in NSCLC survival rates. Addressing these disparities should involve strategies aimed at improving healthcare accessibility, particularly for patients residing in rural areas, to enhance NSCLC outcomes and reduce mortality.

Impact of Digitalization on the Healthcare System

Abstract: Digitalization is a pressing necessity with enormous potential to alter economic growth parameters, forging a mutually beneficial relationship with employment generation and long-term sustainability. The domain of healthcare has been moving into the digital world relatively late and only recently has started with digitalizing processes and services on a larger scale. Still, the potential for disruption in the healthcare industry is enormous. Healthcare digitization brings about many benefits to both patients and healthcare professionals throughout different stages in the patient journey. In this paper we review existing impact of digitalization in healthcare system. Digital health indeed needs to be seen as a broad concept whereby the purposes of healthcare are served through technologies that are combined for universal healthcare access, applications across various multi-disciplinary fields and ecosystems in healthcare and the health journey of people, as patients needing (access to) care and as citizens enabled to live healthier and prevent sickness. We conclude by outlining the implications and benefits of digitizing healthcare. There is a potential to improve healthcare by digitalization.

Publicly funded healthcare costs associated with orofacial clefts for children born in Alberta, Canada between 2002 and 2018.

Orofacial clefts (OFCs) include cleft palate (CP), cleft lip (CL), and cleft lip with cleft palate (CLP) and require multidisciplinary healthcare services. Alberta, Canada has a publicly funded, universal access healthcare system. This study determined publicly funded healthcare costs for children with an OFC and compared these costs to children without congenital anomalies. This retrospective population-based cohort analysis used the Alberta Congenital Anomalies Surveillance System to identify children born between 2002 and 2018 with an isolated OFC. They were matched 1:1 to a reference cohort based on sex and year of birth. The study population included 1614 children, from birth to 17 years of age linked to administrative databases to estimate annual inpatient and outpatient costs. Average annual all-cause costs were compared using two-sample independent t tests. The mean total cleft-related costs per patient were highest for children with CLP ($74,138 CAD, standard deviation (SD) $43,447 CAD), followed by CP ($53,062 CAD, SD $74,366 CAD), and CL ($35,288 CAD, SD $49,720 CAD). The mean total all-cause costs per child were statistically significantly higher (p < .001) in children with an OFC ($56,305 CAD, SD $57,744 CAD) compared to children without a congenital anomaly ($18,600 CAD, SD $61,300 CAD). Despite public health strategies to mitigate risk factors, the trend for OFCs has remained stable in Alberta, Canada for over 20 years. The costs reported are useful to other jurisdictions for comparison, and to families, healthcare professionals, service planners, and policy makers.

LGBTQIA+ vs the Brazilian Unified Health System: Basic Health Unit Use and Associated Factors

ABSTRACT The Brazilian Unified Health System provides universal health care access without regard to sexual orientation and gender identity. We conducted a nationwide study with a cross-sectional design and intentional sampling methods to investigate factors associated with Basic Health Unit (BHU) use by the LGBTQIA+ community. Data were collected via a questionnaire available through social networks. Statistical analysis included Poisson regression with robust variance. A total of 603 LGBTQIA+ community members participated in the study, of whom 417 (69.2%) had visited a BHU in the last year. The factors “transgender woman” and “self-rated health status as very good/good/fair” increased the probability of BHU use in the last year by 10% (PR: 1.10; 95% CI: 1.00–1.20) and 9% (PR = 1.09; 95% CI: 1.01–1.18), respectively. “Not suffering sexual orientation-related discrimination at a BHU” and “Not suffering discrimination by a receptionist or waiting room worker” increased the probability of use by 28% (PR = 1.28; 95% CI: 1.22–1.34) and 22% (PR = 1.22; 95% CI: 1.14–1.30), respectively. Our study supports evidence that access to primary health care services in Brazil can be influenced by the social determinants gender identity and sexual discrimination.

Differences in Survival between Black and White Patients with Head and Neck Squamous Cell Carcinoma: Comparison of Data from the DOD Central Cancer Registry and SEER.

Barriers to health care access may contribute to the poorer survival of Black patients with head and neck squamous cell carcinoma (HNSCC) than their White counterparts in the U.S. general population. The Department of Defense's (DOD) Military Health System (MHS) provides universal health care access to all beneficiaries with various racial backgrounds. We compared overall survival of patients with HNSCC by race in the MHS and the general population, respectively, to assess whether there were differences in racial disparity between the two populations. The MHS patients were identified from the DOD's Central Cancer Registry (CCR) and the patients from the U.S. general population were identified from the NCI's Surveillance, Epidemiology and End Results (SEER) program. For each cohort, a retrospective study was conducted comparing survival by race. Black and White patients in the CCR cohort had similar survival in multivariable Cox regression models with a HR of 1.04 and 95% confidence interval (95% CI) of 0.81 to 1.33 after adjustment for the potential confounders. In contrast, Black patients in the SEER cohort exhibited significantly worse survival than White patients with an adjusted HR of 1.47 (95% CI = 1.43-1.51). These results remained similar in the subgroup analyses for oropharyngeal and non-oropharyngeal sites, respectively. There was no racial difference in survival among patients with HNSCC in the MHS system, while Black patients had significantly poorer survival than White patients in the general population. Equal access to health care could reduce racial disparity in overall survival among patients with HNSCC.

Asymmetric Fiscal Federalism and Public Provision of Healthcare: New Insights from India

In this article, we show undesirable consequences of a market-based system and argue for a public provision of healthcare. We examine the healthcare provision from the fiscal federalism perspective. With the asymmetric fiscal federal structure characterised by vertical and horizontal imbalances, states are dependent on transfers from union to provide public goods. Our analysis shows a widespread disparity in the public provision of healthcare in India due to fiscal imbalances. The performance of states in the management of the COVID-19 pandemic reveals that a robust public healthcare system is a prerequisite in managing a health emergency. We identify the withdrawal of governments from healthcare provision and concentration of resources with the union government as critical impediments to achieving universal healthcare access. In light of our analysis, we emphasise the need for resource devolution and cooperative federalism to ensure public provision for a dignified life in a functioning democracy.

Retrospective Study of Blood Transfusion Utilization in Surgical Patients in a Quebec, Canada Health Region: Do We Overestimate the Surgical Risk

Introduction Blood transfusions were initially developed in the 20 th century to support emergency surgery on injured soldiers. Their access and use have since revolutionized our ability to perform elective surgeries. However, there is a misconception that surgical procedures continue to be a primary user of blood transfusions, such that many surgeons have become reliant on blood units being reserved for their patients. A high-risk surgery is currently defined as a 48-hour risk of requiring a transfusion in at least 2-4% of cases ( Blood 2012,120:2954-2963). Patients meeting that risk category must have a blood group determination and cross-match before elective surgeries. While data from the ACS-NSQIP US database reported a decrease from 5.5% to 4% in transfusion rate for general surgery procedures between 2012 and 2018, rates remain elevated, included a risk of 6.6% for hemorrhoid ligation ( Transfusion 2021,61:3119-3128). The present study sought to evaluate the rates of use of transfusions during and immediately following surgery in a Canadian setting. Given improvement in surgical techniques, the regulated training of surgeons, and a universal healthcare access favoring the concentration of more complex surgical cases to regional centers, it was suspected that the need for blood products may be overestimated. Study design We conducted a retrospective study of the use of pRBC transfusions in all surgeries performed during a 24-month period in a single Quebec health region. Region 12 has a mix of urban and rural communities with a total population of almost half a million inhabitants. All types of surgeries are performed, with the exception of cardiac surgery, neurosurgery, and transplantation. The region includes 5 operating theaters, a larger regional center with 8 operating rooms and 4 smaller centers with 2-5 rooms. The current recommendation is for all patients undergoing surgery to have a group determination and cross-match before all major surgeries. Results Between January 2018 to December 2019, a total of 34 934 elective and emergency surgeries were performed. 172 patients received a total of 546 pRBC units (0.49% of surgeries). 395 units were transfused either during surgery or during the first 24 hours post-operatively. During the same period, a total of 10 982 blood units were transfused in the health region for all indications. Only 4.9% were given to surgical patients. Table 1 demonstrates transfusion rates by surgical specialty in Health Region 12. Major surgeries such as thoracic and vascular surgery, and urologic and ENT oncology are centralized to the urban regional center. 9% of vascular surgeries required blood transfusions (half being elective procedures), followed by thoracic surgery with 2.8% of surgeries (half also being elective procedures). All other types of surgeries had a &amp;lt; 1% utilization of blood transfusion, independent of hospital. 34 cases (0.1%) required 3 or more blood units during surgery. Only 3 of 9 patients who received more than 5 blood units during the first 24 hours of surgery survived 30 days post-operatively. Of the 172 patients who were transfused, alloantibodies were found in only 7 patients, of which 4 were significant. All four were already known in the national database, even though two were not detected during the pre-operative cross-match. Conclusions The 48-hour surgical blood transfusion risk in our region is significantly lower than that reported in recent data. Surgical sub-specialization and the concentration of more complex cases in higher volume centers may explain the reduced operative blood transfusion risk. In the present study, only vascular and thoracic surgeries qualified as high-risk, representing only 1.4% of all surgeries performed in the region. Therefore, pre-operative complete cross-matching could be avoided in more than 98% of surgeries, resulting in significant savings in specialized technical time, which is of particular importance at a time of personnel shortages.

Gender gap in life expectancy in Europe and the United Kingdom in 2019

Abstract Background Life expectancy (LE) is an important metric for overall population health and well-being. The gender gap in LE can be used as a population health metric to capture progress and monitor health inequality in a specific setting. Health inequality is an expression of universal health care coverage and unequal access to health care and the quality of health care - otherwise known as ‘amenable’ mortality. Methods The Global Burden of Disease (GBD) Study- a comprehensive global epidemiologic database has developed and validated two population health metrics across 200+ countries- the Universal Health Coverage (UHC) Index (0-100) and the Healthcare Access and Quality (HAQ) Index (0-100) to monitor progress in these two specific domains for each country. We set out to examine the association of gender gap in LE with UHC and HAQ indices across 27 EU countries and the UK combined for year 2019 employing correlation and linear regression analyses. Results Overall, LE ranged from 73.3 years in Bulgaria to 83.1 years in Italy; UHC index was worst in Bulgaria (62.6), while Luxembourg (91.5) was the best performing nation; HAQ index had the highest score in the Netherlands (91.1), while Bulgaria had the lowest score (64.9). Lithuania had the largest gender gap in LE (9.2 years; M:71.5; F: 80.7), while the Netherlands had the narrowest gender gap (3.4 years; M:80.0; F: 83.4). On multivariable linear regression, gender gaps in LE were significantly associated with both HAQ (beta: -0.17; R2=0.66), and UHC (beta: -0.14; R2=0.52) across 27 EU countries and the UK combined. Conclusions Gender gap in LE can be a proxy measure to monitor progress in health inequality in terms of universal health care coverage, as well as health care access and quality of health care for a specific population setting. The findings suggest that gender gap in LE can be significantly reduced through expansion of universal health care and improving both access and quality of health care in the EU. Key messages • Gender gap in life expectancy can be a good proxy to monitor progress in health inequality for EU countries and the UK combined, which has 5.5 years of gender gap in life expectancy on average in 2019. • A 10% increase in both universal health care coverage and health care access and quality, can reduce gender gap in life expectancy by 1.4 and 1.7 years, respectively, across EU and the UK combined.

Cumulative social disadvantage and cardiovascular disease burden and mortality.

To investigate the association between cumulative social disadvantage and cardiovascular burden and mortality in a large cohort of the general population. Cross-sectional (n = 15 010, aged 35 to 74 years, baseline investigation period 2007 to 2012) and longitudinal data (5- and 10-year follow-ups from 2012 to 2022) from the Gutenberg Health Study were used to investigate the association between individual socioeconomic status (SES, measured via a validated questionnaire) and cardiovascular disease (CVD, composite of atrial fibrillation, coronary artery disease, myocardial infarction, stroke, chronic heart failure, peripheral artery disease, and/or venous thromboembolism) risk and mortality. Subjects with prevalent CVD had a lower SES sum score, as well as lower education, occupation, and household net-income scores (all P < 0.0001). Logistic regression analysis showed that a low SES (vs. high, defined by validated cut-offs) was associated with 19% higher odds of prevalent CVD [odds ratio (OR) 1.19, 95% CI 1.01; 1.40] in the fully adjusted model. At 5-year follow-up, low SES was associated with both increased cardiovascular [hazard ratio (HR) 5.36, 2.24; 12.82] and all-cause mortality (HR 2.23, 1.51; 3.31). At 10-year follow-up, low SES was associated with a 68% higher risk of incident CVD (OR 1.68, 1.12; 2.47) as well as 86% higher all-cause mortality (HR 1.86, 1.55; 2.24). In general, the education and occupation scores were stronger related to risk of CVD and death than the household net-income score. Low SES was estimated to account for 451.45 disability-adjusted life years per 1000 people (years lived with disability 373.41/1000 and years of life lost 78.03/1000) and an incidence rate of 11 CVD cases and 3.47 CVD deaths per 1000 people per year. The population attributable fraction for CVD incidence after 5 years was 4% due to low SES. Despite universal healthcare access, cumulative social disadvantage remains associated with higher risk of CVD and mortality. Dimensions of education and occupation, but not household net income, are associated with outcomes of interest.

Barriers and facilitators to healthcare for people without documentation status: A systematic integrative literature review.

To identify the barriers and facilitators to healthcare for people without documentation status. We conducted a systematic integrative literature review following the Whittemore and Knafl methodology. Literature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social-ecological model. Searches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022. The review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti-immigrant rhetoric) and policy-related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety-net clinics and supportive federal policies emerged as key facilitators. These findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population. This paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide. The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. No patient or public contribution was needed. The study protocol was registered with the PROSPERO database (registration number: CRD42022366289).

Assessment the Health Sustainability using Neutrosophic MCDM Methodology: Case Study COVID-19

As a result of the severe difficulties presented by the COVID-19 pandemic, a holistic response is required, one that takes into account both the urgent needs of patients and the long-term viability of healthcare institutions. This study aims to give a complete knowledge of the tactics and techniques necessary to maintain the continuing well-being of people and communities by examining the idea of health sustainability in the context of the COVID-19 pandemic. This study conducts a literature review to investigate the many facets of health sustainability, such as emergency preparedness, mental health care, health workforce support, health education and communication, research and innovation, international cooperation, and resilience in the face of pandemics. This study's results call attention to the necessity for universal healthcare access, mental health services, the upkeep of critical services, and international coordination as part of the COVID-19 response strategy. Societies may construct robust healthcare systems that can deal with the short- and long-term effects of the pandemic if they use a comprehensive strategy that takes into account social, economic, and environmental aspects. So, we used the concept of multi-criteria decision-making (MCDM) to deal with various criteria of health sustainability. The AHP MCDM method is used to deal with various criteria and give the weights of these criteria. The AHP used a comparison between various criteria, so we used the neutrosophic environment to deal with the vague data in the comparison process. The proposed framework is applied in the application of COVID-19.

Military healthcare system mitigates racial disparities for severe maternal morbidity from preeclampsia

In the United States, Black women die at 2.5 times the rate of White women and 3.5 times the rate of Hispanic women. These racial health care disparities have been largely attributed to access to health care and other social determinants of health. We hypothesize that the Military healthcare system models universal health care access seen in other developed countries and should equalize these rates. Delivery data from 41 Military treatment facilities across the Department of Defense (Army, Air Force, and Navy) including over 36,000 deliveries from 2019 to 2020 were compiled in a convenience dataset through the National Perinatal Information Center. After aggregation, the parameters of percent of deliveries complicated by Severe Maternal Morbidity and percent of severe maternal morbidity secondary to pre-eclampsia with and without transfusion were calculated. Risk ratios were calculated by race for the resulting summary data. American Indian/Alaska Native were excluded because of limited total number deliveries preventing statistical analyses. Overall, the risk of severe maternal morbidity was increased among Black women compared to White women. The risk of severe maternal morbidity related to pre-eclampsia showed no significant difference among races with or without transfusion. When other races were set as reference group, there was a significant difference for White women, suggesting a protective effect. Although women of color still experience overall severe maternal morbidity at higher rates than their White counterparts, TRICARE may have equalized the risk of severe maternal morbidity for deliveries complicated by pre-eclampsia.

Racial Differences in Severe Maternal Morbidity Exist for Tricare Beneficiaries [ID: 1377133

INTRODUCTION: Maternal morbidity and mortality rates in the United States have increased in the last two decades with a disproportionate effect on women of color. Military Tricare coverage models universal health care access; however, in studies looking at births in military treatment facilities, disparities still exist for women of color. This study analyzes maternal delivery outcomes for all women with Tricare coverage including deliveries in the civilian sector. METHODS: Data from 6.2 million births in the Centers for Disease Control and Prevention WONDER Linked Birth/Infant Death Records for 2017–2019 were analyzed for all-cause morbidity (transfusions, perineal lacerations, uterine rupture, unplanned hysterectomy, and intensive care unit admissions), severe maternal morbidity (SMM) (excludes lacerations), and SMM excluding transfusion. Risk ratios were calculated comparing overall maternal morbidity rates between Tricare, Medicaid, self-pay, and private insurance. In addition, risk ratios were calculated between insurance types stratified by race. RESULTS: Compared to private insurance, Tricare insurance had significantly reduced risk of all-cause maternal morbidity. Compared to White women, Black women with Tricare and all other insurances had a decreased risk of all-cause morbidity, but a significantly increased risk of SMM and SMM without transfusion. Asian women had significant increased risk of all-cause, SMM and SMM without transfusion. There was no significant difference in the risk of morbidity for women of color with Tricare insurance compared to women of color with Medicaid, private, or self-pay insurance. CONCLUSION: The risk of severe maternal morbidity remains elevated for women of color despite access to Tricare health insurance.

Inequality in Healthcare Access at the Intersection of Caste and Gender

Health equity is of particular concern in the Indian context in the light of widening economic inequality and healthcare reforms which have wider ramifications on healthcare access. Despite various programs and interventions, a wide gap in health condition is observed in society among different castes, groups and income-classes. In this article, the inequality in healthcare access is studied at the cross-section of gender (man and women) and social groups—Schedule Caste and Schedule Tribe (SC-ST), Other backward classes (OBC) and Others—and an attempt has been made to explore how much the women from SC-ST community are deprived of healthcare access in comparison to other gender-group intersections. To proceed with analysis, data on ‘National Sample Survey (NSS), 75th Round (2017–2018) on Health Consumptions’ are taken. Analyses are carried on in SPSS Ver.18 and Stata-16. Regression Analysis shows that women from SC-ST are 1.37 times more likely to non-access to healthcare services than men from the general category. Further, to measure the intensity of inequality in healthcare access, Wagstaff’s Concentration Index (CI) is calculated at –0.195 that shows income-related inequality highly persists among the poor. At last, the decomposition analysis of CI reveals that gender, income and social groups are some of the major contributory factors to CI, that is, health inequality. The results indicate despite the mandate of universal healthcare access, India is lagging in achieving equity in healthcare as the poor and marginalized are deprived of it.

Determinants of utilization of National Health Insurance Fund cover in public health facilities by public health care workers in Makueni County

Background: Robust healthcare funding systems are seen as critical for guaranteeing universal healthcare access. This implies that health services should be adequately accessible to everyone ensuring health situation doesn’t reduce the patient and their family to poverty making analysis of determinants of National Health Insurance Fund (NHIF) cover utilization critical.Methods: Descriptive research design was used to study utilization of NHIF cover among health professionals in public hospitals in Makueni County. Stratified random sampling technique was used to sample the facilities across the different levels. The study sample was 291 from a target population of 1183 health professional. The data was collected using structured questionnaires. Statistical package for social science (SPSS version 25) was used to code and analyze the raw data. Pearson's coefficient of correlation and multiple regressions were used to assess the association between determinants and NHIF utilization.Results: The study found and concluded that at the significance level of 95%, alternative insurance covers, perceived quality of health services and NHIF communication strategy significantly influenced utilization of NHIF cover by public health care workers at α=0.05. On the other hand, NHIF scheme characteristic was an insignificant determinant of utilization of NHIF cover among public health care workers in Makueni County.Conclusions: The study concludes alternative insurance covers, NHIF scheme characteristics, perceived quality of health services influenced utilization of NHIF cover and NHIF communication strategy influenced utilization of NHIF cover among health workers.

Health Equity, History, and a New Presidential Bioethics Commission: Lessons from the "Lost" Reports.

Convening a national bioethics commission has historically been one of the most powerful bioethical legacies a US presidential administration can undertake. The Biden Administration has not yet created such a commission; here we argue that centering health equity and healthcare access would provide a vital framework for a new commission’s legacy. Moreover, we demonstrate two crucial historical episodes when American presidents appointed commissions to examine the practical and ethical implications of these very issues. We turn first to the 1952 President’s Commission report on “Building America’s Health,” a lofty vision of universal healthcare access stymied by both political conflict and unaddressed problems of racism in the era’s legislation. Its rich yet incomplete account of American health inequities serves as a valuable forerunner to questions of justice in bioethics. We then explore the President’s Commission’s 1983 report “Securing Access to Healthcare: A Report on the Ethical Implications of Differences in the Availability of Health Services.” This report took up the mantle of equity in healthcare access, again with mixed results. Only by understanding the checkered history of these overlooked, practically “lost” reports can a new era in American bioethics successfully re-center the goal of equitable health for all.

Challenges and Opportunities With Routinely Collected Data on the Utilization of Cancer Medicines. Perspectives From Health Authority Personnel Across 18 European Countries.

Background: Rising expenditure for new cancer medicines is accelerating concerns that their costs will become unsustainable for universal healthcare access. Moreover, early market access of new oncology medicines lacking appropriate clinical evaluation generates uncertainty over their cost-effectiveness and increases expenditure for unknown health gain. Patient-level data can complement clinical trials and generate better evidence on the effectiveness, safety and outcomes of these new medicines in routine care. This can support policy decisions including funding. Consequently, there is a need for improving datasets for establishing real-world outcomes of newly launched oncology medicines. Aim: To outline the types of available datasets for collecting patient-level data for oncology among different European countries. Additionally, to highlight concerns regarding the use and availability of such data from a health authority perspective as well as possibilities for cross-national collaboration to improve data collection and inform decision-making. Methods: A mixed methods approach was undertaken through a cross-sectional questionnaire followed-up by a focus group discussion. Participants were selected by purposive sampling to represent stakeholders across different European countries and healthcare settings. Descriptive statistics were used to analyze quantifiable questions, whilst content analysis was employed for open-ended questions. Results: 25 respondents across 18 European countries provided their insights on the types of datasets collecting oncology data, including hospital records, cancer, prescription and medicine registers. The most available is expenditure data whilst data concerning effectiveness, safety and outcomes is less available, and there are concerns with data validity. A major constraint to data collection is the lack of comprehensive registries and limited data on effectiveness, safety and outcomes of new medicines. Data ownership limits data accessibility as well as possibilities for linkage, and data collection is time-consuming, necessitating dedicated staff and better systems to facilitate the process. Cross-national collaboration is challenging but the engagement of multiple stakeholders is a key step to reach common goals through research. Conclusion: This study acts as a starting point for future research on patient-level databases for oncology across Europe. Future recommendations will require continued engagement in research, building on current initiatives and involving multiple stakeholders to establish guidelines and commitments for transparency and data sharing.

Association of Socioeconomic Status With Outcomes and Care Quality in Patients Presenting With Undifferentiated Chest Pain in the Setting of Universal Health Care Coverage.

BACKGROUNDThis study aimed to assess whether there are disparities in incidence rates, care, and outcomes for patients with chest pain attended by emergency medical services according to socioeconomic status (SES) in a universal health coverage setting.METHODS AND RESULTSThis was a population‐based cohort study of individually linked ambulance, emergency, hospital admission, and mortality data in the state of Victoria, Australia, from January 2015 to June 2019 that included 183 232 consecutive emergency medical services attendances for adults with nontraumatic chest pain (mean age 62 [SD 18] years; 51% women) and excluded out‐of‐hospital cardiac arrest and ST‐segment–elevation myocardial infarction. Age‐standardized incidence of chest pain was higher for patients residing in lower SES areas (lowest SES quintile 1595 versus highest SES quintile 760 per 100 000 person‐years; P<0.001). Patients of lower SES were less likely to attend metropolitan, private, or revascularization‐capable hospitals and had greater comorbidities. In multivariable models adjusted for clinical characteristics and final diagnosis, lower SES quintiles were associated with increased risks of 30‐day and long‐term mortality, readmission for chest pain and acute coronary syndrome, lower acuity emergency department triage categorization, emergency department length of stay >4 hours, and emergency department or emergency medical services discharge without hospital admission and were inversely associated with use of prehospital ECGs and transfer to a revascularization‐capable hospital for patients presenting to non‐percutaneous coronary intervention centers.CONCLUSIONSIn this study, lower SES was associated with a higher incidence of chest pain presentations to emergency medical services and differences in care and outcomes. These findings suggest that substantial disparities for socioeconomically disadvantaged chest pain cohorts exist, even in the setting of universal health care access.