Disparities in access to health care in three French regions
Health Policy, DOI 10.1016/j.healthpol.
Michael K. Gusmano, Daniel Weisz, Victor G. Rodwin, Jonas Lang, Meng Quian, Aurelie Bocquier, Veronique Moysan, Pierre Verger
Objectives: This paper compares access to primary and specialty care in three metropolitan regions of France: Ile de France (IDF), Nord-Pas-de-Calais (NPC) and Provence-Alpes-Côte d’Azur (PACA); and identifies the factors that contribute to disparities in access to care within and among these regions.
Methods: To assess access to primary care, we compare variation among residence-based, age-adjusted hospital discharge rates for ambulatory care sensitive conditions (ASC). To assess access on one dimension of specialty care, we compare residence-based, age- adjusted hospital discharge rates for revascularization – bypass surgery and angioplasty – among patients diagnosed with ischemic heart disease (IHD). In addition, for each region we rely on a multilevel generalized linear mixed effect model to identify a range of individual and area-level factors that affect the discharge rates for ASC and revascularization. Results: In comparison with other large metropolitan regions, in France, access to primary care is greater in Paris and its surrounding region (IDF) than in NPC but worse than in PACA. With regard to revascularization, after controlling for the burden of IHD, use of services is highest in PACA followed by IDF and NPC. In all three regions, disparities in access are much greater for revascularization than for ASC. Residents of low-income areas and those who are treated in public hospitals have poorer access to primary care and revascularizations. In addition, the odds of hospitalization for ASC and revascularization are higher for men. Finally, people who are treated in public hospitals, have poorer access to primary care and revascularization services than those who are admitted for ASC and revascularization services in private hospitals.
Conclusions: Within each region, we find significant income disparities among geographic areas in access to primary care as well as revascularization. Even within a national health insurance system that minimizes the financial barriers to health care and has one of the highest rates of spending on health care in Europe, the challenge of minimizing these disparities remains.
Disparities in Service Quality Among Insured Adult Patients Seen in Physicians’ Offices
Journal of General Internal Medicine, 2010. Volume 25 / Issue 04 / April 2010, pp 357-362, Published online
Dan Ly, Sherry Glied
To examine racial disparities in health care service quality.
Secondary data analyses of visits by primary care service users in the Community Tracking Study household sample.
Sixty communities across the United States.
A total of 41,537 insured adult patients making sick visits to primary care physicians in 1996–1997, 1998–1999, 2000–2001, and 2003.
Lag between appointment and physician visit, waiting time in physician office, and satisfaction with care were analyzed.
Blacks but not other minorities were more likely to have an appointment lag of more than 1 week (13% white vs. 21% black, p < 0.001). Blacks, Hispanics, and other minorities were more likely to wait more than 30 min before being seen by the physician (16% white vs. 26% black, p < 0.001; vs. 27% Hispanic and 22% other minority, p < 0.001 and p = 0.02, respectively) and were less likely to report that they were very satisfied with their care (65% white vs. 60% black, p = 0.02; vs. 57% Hispanic and 48% other minority, p = 0.004 and p < 0.001, respectively). The differences in appointment lag and wait time remain large and statistically significant after the inclusion of multiple covariates, including geographic controls for CTS site. For all groups, satisfaction with care was affected by objective measures of service quality. Differences in objective measures of service quality explained much of the black-white difference in satisfaction, though not differences for other minority groups.
There are substantial racial/ethnic disparities in satisfaction with care, and these are related to objective quality measures that can be improved.
Reducing Racial and Ethnic Disparities: The Action Plan from the Department of Health and Human Services
Health Affairs, 2011. Volume 30 / Issue 10 / October 2011, pp 1822-1829, Published online
Howard K. Koh, Garth Graham and Sherry Glied
The Department of Health and Human Services (HHS) recently unveiled the most comprehensive federal commitment yet to reducing racial and ethnic health disparities. The 2011 HHS Action Plan to Reduce Racial and Ethnic Health Disparities not only responds to advice previously offered by stakeholders around the nation, but it also capitalizes on new and unprecedented opportunities in the Affordable Care Act of 2010 to benefit diverse communities. The Action Plan advances five major goals: transforming health care; strengthening the infrastructure and workforce of the nation’s health and human services; advancing Americans’ health and well-being; promoting scientific knowledge and innovation; and upholding the accountability of HHS for making demonstrable progress. By mobilizing HHS around these goals, the Action Plan moves the country closer to realizing the vision of a nation free of disparities in health and health care.
Vietnam Inequality Report 2005
Department for International Development (UK) – published report commissioned for the Vietnam National Assembly
Fritzen, Scott, Brassard C.
This paper explores the tensions and opportunities surrounding Vietnam’s attempt to reach the goals of rapid economic growth while also being a Socialist “fair society.” It does so by looking at the phenomenon of inequality in the process of economic transition and development.
The ultimate goal of this paper is to inform government policy choices – to examine how the actions of the government can have an impact, in a market economy context, on the achievement of equitable, balanced development.
Donors, local development groups and institutional reform over Vietnam's development decade
in Kerkvliet, B.J., Heng, R.H.K. and Hock, D.K.W. (eds.), Getting organized in Vietnam: Moving in and around the socialist state, Singapore: Institute of Southeast Asian Studies, pp. 234-270.
International donors have attempted to contribute to, and indeed influence, the overall tenor of socioeconomic and governance-related reforms in Vietnam. They have done so in a number of ways: directly supporting policy research, stablishing forums for debate of developmental issues with government counterparts, funding projects on administrative and judiciary reform and central level capacity building, and providing direct financial and sometimes indirect support for ‘indigenous’ NGOs, primarily development service organizations working as contractors for particular development projects. This paper examines another modality through which donors sought to influence administrative reform over the heady ‘development decade’ of the 1990s – donor support for rural development projects conceived as ‘policy experiments’ (Rondinelli 1983). Though diverse in sectoral focus, these projects commonly attempted to introduce local institutional arrangements promoting greater responsiveness and accountability of local governments to rural communities as a whole, or to particular sub-groups such as smallholder farmers. To do so, local organizations or grassroots groups were typically established as new ways of organizing the rural populace to demand, plan for, access or provide services underpinning rural development and poverty alleviation. “Local development groups” (LDGs) is the name I give to groups comprised of farmers and other end-users of project services (or representatives they choose) that were formed in the process of implementing particular development projects. This paper probes the experience of these development projects and LDGs over approximately the last ten years. It depicts how projects funded by a wide range of donors became an important part of the institutional landscape in many areas of Vietnam, leaving a significant mark on many sectors related to rural development. Five sections follow this introduction. The first examines how changing donor roles interacted with institutional developments to produce an opportunity for projects to influence policy. Section two presents a theoretical framework with which to assess LDGs and the policy experiments in which they were embedded, which section three applies the framework to a sample of 15 donor projects operational over the 1990s in Vietnam. Section four presents more qualitative detail on a few of the higher-impact projects. The final section concludes with implications for donors and the study of local institutional change in Vietnam.
The ‘misery’ of implementation: Governance, institutions and anti-corruption in Vietnam
in Tarling, N. (ed) Corruption and good governance in Asia, New York: Routledge, pp. 98-120.
Implementation of anti-corruption programs is plagued by a paradox: the very actors posited to be the source of the problem are those most critical to implementation success. This paper presents a framework for understanding the large gaps that exist between policy intentions and outcomes in anti-corruption programs. It applies this to ‘grassroots democratization’ as an anti-corruption initiative in Vietnam, a high-profile policy mandating greater transparency in local budget use and participation in decisionmaking. Local leaders in this case face weak incentives for implementation that stem from both poor policy design and local institutional environments. But as with many anti-corruption programs in adverse environments, potential exists for the initiative to
provide tools with which reform-minded leaders and social groups can challenge local governance practices in unanticipated ways.
Bat Binh Dang va Nhung Lua Chon Chinh Sach [Inequality: A Policy Assessment]
Hoat Dong Khoa Hoc [Science Activities Review], 47(2): 57-60. [Vietnamese journal published by Ministry of Science and Technology]
Fritzen, Scott, Brassard .
Elsewhere, U.S.A: How We Got from the Company Man, Family Dinners, and the Affluent Society to the Home Office, BlackBerry Moms,and Economic Anxiety
One Thing I Know: Falling Upward
Contexts, 10(3): 84
The Consequences of the ‘Missing Girls’ of China
World Bank Economic Review 23(3):399-425.
Ebenstein, Avraham and Ethan Jennings
In the wake of the one-child policy of 1979, China experienced an unprecedented rise in the sex ratio at birth (ratio of male to female births). In cohorts born between 1980 and 2000, there were 22 million more men than women. Some 10.4 percent of these additional men will fail to marry, based on simulations presented here that assess how different scenarios for the sex ratio at birth affect the probability of failure to marry in 21st century China. Three consequences of the high sex ratio and large numbers of unmarried men are discussed: the prevalence of prostitution and sexually transmitted infections, the economic and physical well-being of men who fail to marry, and China's ability to care for its elderly, with a particular focus on elderly males who fail to marry. Several policy options are suggested that could mitigate the negative consequences of the demographic squeeze.
Demographics, clinical characteristics and outcomes of neonates diagnosed with fetomaternal haemorrhage.
Arch Dis Child Fetal Neonatal Ed. 2012 Feb 28. [Epub ahead of print] PMID: 22375020
Stroustrup, Annemarie and Leonardo Trasande
Objective:To determine clinical characteristics, demographics and short-term outcomes of neonates diagnosed with fetomaternal haemorrhage (FMH).
Design:The authors analysed the Nationwide Inpatient Sample, 1993 to 2008. Singleton births diagnosed with FMH were identified by International Classification of Diseases (ICD-9) code 762.3. Descriptive, univariate and multivariable regression analyses were performed to determine the national annual incidence of FMH over time as well as demographics and clinical characteristics of neonates with FMH.ResultsFMH was identified in 12 116 singleton births. Newborns with FMH required high intensity of care: 26.3% received mechanical ventilation, 22.4% received blood product transfusion and 27.8% underwent central line placement. Preterm birth (OR 3.7), placental abruption (OR 9.8) and umbilical cord anomaly (OR 11.4) were risk factors for FMH. Higher patient income was associated with increased likelihood of FMH diagnosis (OR 1.2), and Whites were more likely to be diagnosed than ethnic minorities (OR 1.9). There was reduced frequency of diagnosis in the Southern USA (OR 0.8 vs the Northeastern USA).
Conclusions: Diagnosis of FMH is associated with significant morbidity as well as regional, socioeconomic and racial disparity. Further study is needed to distinguish between diagnostic coding bias and true epidemiology of the disease. This is the first report of socioeconomic and racial/ethnic disparities in FMH, which may represent disparities in detection that require national attention.
The 2013 Federal Budget's Impact on Communities of Color and Low-Income Families
Women of Color Policy Network
The Obama administration's budget proposal for fiscal year 2013 (FY 2013) strengthens the national economy by investing in schools, communities and safety net programs. The FY 2013 budget also includes a number of important investments in infrastructure that will spur much needed job growth in a time of economic uncertainty for many working and low-income families. It is critical that such investments take into account the persistently high unemployment in communities of color, and target spending to increase the economic security of the communities most impacted by the "Great Recession." Additionally, the budget includes important changes to the tax code that will lay the foundation for a fairer and more equitable economy.
Above Board: Raising the Standards for Passenger Service Workers at the Nation's Busiest Airports
Mason, C. Nicole & Garcia, Lisette
I n the fall of 2011, the Women of Color Policy Network at New York University's Robert F. Wagner Graduate School of Public Service conducted a survey of over 300 passenger service workers at the region's three major airports: LaGuardia, Kennedy International and Newark Liberty International.
Only workers contracted by the airlines were surveyed. This report focuses on the impact of the low-bid
contracting system on passenger service workers at the airports. It also proposes ways forward and concrete recommendations to raise job quality and performance standards for companies contracted directly with airlines.
2011 Federal Policy Review
Published by the Women of Color Policy Network, August 2011.
Women of Color Policy Network
This summary of legislative action pertinent to the Network's federal policy priorities assesses how noteworthy acts and trends in Congress affect the lives of women of color, their families, and communities. Covering the areas of economic security, social equity, and immigration, the brief provides updates on the status of reproductive rights, job creation, safety net programs, and the DREAM Act, among other topics. The Network's assessment of the policy implications indicates that although the federal legislative landscape offers some progressive opportunities for women of color, obstacles to their advancement loom large amongst ongoing budget and deficit reduction negotiations.
Resetting our priorities in environmental health: An example from the south-north partnership in Lake Chapala, Mexico
Environ Res. 2011 Aug;111(6):877-80.
Cifuentes E, Lozano Kasten F, Trasande L, Goldman RH.
Lake Chapala is a major source of water for crop irrigation and subsistence fishing for a population of 300,000 people in central Mexico. Economic activities have created increasing pollution and pressure on the whole watershed resources. Previous reports of mercury concentrations detected in fish caught in Lake Chapala have raised concerns about health risks to local families who rely on fish for both their livelihood and traditional diet. Our own data has indicated that 27% of women of childbearing age have elevated hair mercury levels, and multivariable analysis indicated that frequent consumption of carp (i.e., once a week or more) was associated with significantly higher hair mercury concentrations. In this paper we describe a range of environmental health research projects. Our main priorities are to build the necessary capacities to identify sources of water pollution, enhance early detection of environmental hazardous exposures, and deliver feasible health protection measures targeting children and pregnant women. Our projects are led by the Children's Environmental Health Specialty Unit nested in the University of Guadalajara, in collaboration with the Department of Environmental Health of Harvard School of Public Health and Department of Pediatrics of the New York School of Medicine. Our partnership focuses on translation of knowledge, building capacity, advocacy and accountability. Communication will be enhanced among women's advocacy coalitions and the Ministries of Environment and Health. We see this initiative as an important pilot program with potential to be strengthened and replicated regionally and internationally.
A qualitative analysis of environmental policy and children's health in Mexico
Environ Health. 2010 Mar 23;9:14
Cifuentes E, Trasande L, Ramirez M, Landrigan PJ.
Since Mexico's joining the North American Free Trade Agreement (NAFTA) and the Organization for Economic Cooperation and Development (OECD) in 1994, it has witnessed rapid industrialization. A byproduct of this industrialization is increasing population exposure to environmental pollutants, of which some have been associated with childhood disease. We therefore identified and assessed the adequacy of existing international and Mexican governance instruments and policy tools to protect children from environmental hazards.
We first systematically reviewed PubMed, the Mexican legal code and the websites of the United Nations, World Health Organization, NAFTA and OECD as of July 2007 to identify the relevant governance instruments, and analyzed the approach these instruments took to preventing childhood diseases of environmental origin. Secondly, we interviewed a purposive sample of high-level government officials, researchers and non-governmental organization representatives, to identify their opinions and attitudes towards children's environmental health and potential barriers to child-specific protective legislation and implementation.
We identified only one policy tool describing specific measures to reduce developmental neurotoxicity and other children's health effects from lead. Other governance instruments mention children's unique vulnerability to ozone, particulate matter and carbon monoxide, but do not provide further details. Most interviewees were aware of Mexican environmental policy tools addressing children's health needs, but agreed that, with few exceptions, environmental policies do not address the specific health needs of children and pregnant women. Interviewees also cited state centralization of power, communication barriers and political resistance as reasons for the absence of a strong regulatory platform.
The Mexican government has not sufficiently accounted for children's unique vulnerability to environmental contaminants. If regulation and legislation are not updated and implemented to protect children, increases in preventable exposures to toxic chemicals in the environment may ensue.
Federal Policy Agenda for the 112th Congress
Women of Color Policy Network
This Federal Policy Agenda describes the priorities of the Women of Color Policy Network for the 112th Congress. Areas include: Economic Security, Social Equity and Immigration.
Wage Disparities and Women of Color
Women of Color Policy Network
More women are becoming the primary wage earners in households across the country, yet men continue earn higher wages than women. Occupational segmentation and unequal access to wealth lead to exponentially growing career income gaps for women. This brief explores the policy implications of recent Census data revealing that women earn 77 cents for every dollar earned by men. With Black women and Hispanic women earning even less, targeted policy solutions must incorporate opportunities for women in low-income and marginalized communities. Policies will contribute to greater wage equity if they incorporate: pay check fairness; the extension of paid sick leave benefits to caregivers; and increased access to labor market, child care, and educational opportunities for low-income women.
Second Annual Status of Women of Color Report: Women of Color in New York City: Still Invisible in Policy
Women of Color Policy Network Roundtable of Institutions of People of Color
Stafford, Walter & Salas, Diana
Demography is not destiny. While groups of color - Asians, Blacks, Latinos, and Native Americans - have emerged as New York City's new majority, large segments of the groups remain burdened by many of the historical problems associated with disadvantaged minorities. This report highlights the problems faced by lower-income women of color, especially single mothers. Often bypassed during the economic boom of the 1990s, these women have found that employment opportunities have all but evaporated in the current economic malaise. The elimination of federal welfare entitlements have only served to exacerbate these problems. To read more click on the link below.
Understanding Client and Occupation Barriers in New York City
Women of Color Policy Network
In 2006, the Network was commissioned by United Way of New York to access the viability of New York City's first workforce development program. Using a mix method approach of surveys, individual interviews with program participants and extensive secondary data, the Network helped identify labor and workforce trends as well as barriers and challenges to sustained employment within low-income communities. A three-part series of our findings and recommendations for future programs in workforce development was released. An Assessment of Client Barriers: A Sample of NYC Works Program Participants Industry and Occupational Assessment of NYC Works NYCWorks program staff perceptions of Client Barriers