Health Care Service Access and Utilization

Asian Indians are one of the fastest growing immigrant groups in the USA and are at high risk for preventable chronic diseases, such as diabetes and cardiovascular disease. We describe the cultural practices of Asian Indians living in the USA to build a theory of health seeking behaviour for preventive healthcare services. We conducted in-depth qualitative, semi-structured interviews with 21 Asian Indians seen at two outpatient clinics in the San Francisco Bay Area. Using the Constructionist Grounded Theory, we show that How does culture influence preventive service utilisation? 233 participants typically use primary healthcare services for urgent health problems and had been unfamiliar with routine care for disease prevention when immigrating to the USA. Participants deviated from this pattern during culturally significant life course events, such as marriage or childbirth and in response to the concerns of family members, local social network members, and primary care service providers during medical visits for urgent illnesses.

Background
A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.

Methods
Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.

Findings
In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.

Interpretation
GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.

Better health depends on the level of access to the health care facilities. Since good health is part and parcel for better human resources, there should be proper access to the health care system. The indigenous peoples of any country are usually deprived of their due share. They remain at a vulnerable stage and this is equally true for indigenous peoples of Chittagong Hill Tracts. They have less access to all types of services due to different circumstances. But it is the right of any citizen of the country to have equal access to all facilities and opportunities provided by the state. In order to explore the accessibility of different indigenous peoples to the health care facilities, the study is conducted on the basis of secondary data which were collected from different sources, reports, journals, and published literature. Though the study explored some Government and NGOs initiatives on health, the access of indigenous peoples to this facility is not at the satisfactory level.

‘Medical tourism’ frequently has been held to unsettle naturalised relationships between the state and its citizenry. Yet, in casting ‘medical tourism’ as either an outside ‘innovation’ or ‘invasion’, scholars have too often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic healthcare systems of the ‘developing’ countries increasingly recognised as international medical travel destinations. While there is little doubt that ‘medical tourism’ impacts destinations’ healthcare systems, it remains essential to contextualise them. This paper offers a reading of the emergence of ‘medical tourism’ from within the context of on-going healthcare privatisation reform in one of today’s most prominent destinations: Malaysia. It argues that ‘medical tourism’ to Malaysia has been mobilised politically both to advance domestic healthcare reform and to cast off the country’s ‘under-developed’ image not only among foreign patient-consumers but also among its very own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective healthcare consumers.

Do unauthorized im/migrants have a right to health? Do they deserve health care, or health protection, or access to the social determinants of good health? Are they party to prevailing social contracts, or does their exclusion from mainstream systems of health promotion, prevention, and care “make sense”? Questions like these, which generate considerable attention in multiple spheres of scholarship, policy, and public debate, revolve around an issue that merits substantially greater consideration among social scientists of health: health-related “deservingness.” In addition to putting the issue of health-related deservingness squarely on the map as an object of analysis, the paper further argues that we cannot focus solely on those with power, influence, and public voice. Rather, we also must investigate how deservingness is reckoned in relation to – and, furthermore, from the perspectives of – unauthorized im/migrants and members of other groups commonly constructed in public and policy discourse as undeserving. Additionally, we must also examine the complicated relationship between universalizing juridical arguments about formal entitlement to health rights, on one hand, and situationally specific, vernacular moral arguments about deservingness, on the other.

KEYWORDS: Israel – unauthorized im/migration – im/migrant health – “illegality” – deservingness – health care access – idioms of social justice mobilization – renegade moralities

In today’s world, people move more, move further, and move for increasingly varied reasons such as work, studies or leisure. Seeking health care away from one’s home is a part of this trend and many patients do not hesitate to cross national borders to consult a physician or get a surgical intervention. This article examines this form of mobility towards Thailand from both global and regional perspectives. This situation involves long-distance patients travelling from highly industrialized countries and closeby neighbors, such as Laotians, who may just cross the border to get treated a few kilometers away from home. Constrasting these senarios complicates the findings by studies on “medical travel” as it brings in heterogeneity and variability. There are significant differences in patients’ motives, in the social implications of their cross-border health-seeking behaviours, and in the responses by health infrastructures and authorities in both the host country (marketing, regulation or even quality of care) and the patients’ lands of origin (policies, intermediaries, and emerging specialized agencies). This paper takes this situation as a case study to describe and explain the rise of a new transnational healthcare paradigm.

Economic improvement in Palu City has an impact on changes in the structure and general view of transportation facilities, by technological advances, as well as engineering in the field of transportation, so that the public's need for transportation can provide maximum service. This study aims to analyze the degree of saturation and identify the use of land use, as well as to analyze the influence of land use development along the National Road Corridor Jalan Jenderal Sudirman – Pelabuhan Pantoloan? The results of the study show that the development of land use will cause attraction and generation from an area, increasing accessibility and intensity of traffic flow using this road corridor with the largest degree of saturation in Segment 3 - Jl. Yos Sudarso is 0.65 and Segment 5 - Kebonsari – Tawaeli is 0.63. It is found that the generation of movement, residential areas, gives a figure of 1737 smp/hour. As for the pull of movement, it is strongly influenced by the trade and service area with 2041 smp/hour. In the Office Area for attraction of movement of 838 junior high school/hour, Education Area of 22 junior high school/hour and Health Area of 26 junior high school/hour. Almost all of these interactions are carried out with trips that will result in traffic flow, thus causing a problem with increasing traffic volume along the road which causes the performance of the road segment to decrease.

Background: Access to health care is considered a basic right and integral to human life. However, this still remains a challenge especially in developing countries where the majority of the poor reside and suffer from a disproportionate amount of disease. The study determined the six key components of health care access: approachability, availability, accessibility, affordability, acceptability, and accommodation, as perceived by a rural community in Taytay, Rizal, Philippines.
Methods: This descriptive-cross sectional study included a convenience sample of 62 participants. The Perceived Access to Health Care Instrument was utilized. Frequency, percentage, mean, standard deviation, and univariate linear regression were used to analyze the data.
Results: The study revealed that health care access in terms of approachability was rated as good, whereas availability was rated as good, and accessibility was rated as fair. On the other hand, the affordability of health care services was rated as good, the acceptability was rated as good while the accommodation was rated as fair. It was also revealed that none of the demographic profiles significantly predicted the perceived access to health care
Conclusion: Assessment of health care access is an important measure of health care equity and despite several factors previously shown to affect health care access, the results of this study showed that the participants have good access to health care in their community.

Health care sector grows tremendously in last few decades. The health care sector has generated huge amounts of data that has huge volume, enormous velocity and vast variety. Also it comes from a variety of new sources as hospitals are now tend to implemented electronic health record (EHR) systems. These sources have strained the existing capabilities of existing conventional relational database management systems. In such scenario, Big data solutions offer to harness these massive, heterogeneous and complex data sets to obtain more meaningful and knowledgeable information. This paper basically studies the impact of implementing the big data solutions on the healthcare sector, the potential opportunities, challenges and available platform and tools to implement Big data analytics in health care sector.

Considering the growing relevance of healthcare-motivated travel across borders, this chapter draws attention to tensions derived from destinations’ focus on satisfying the needs of the desired western ‘medical tourist’ while the more everyday intraregional flows of medical travellers, though constituting the bulk of international medical travel today, pass largely under the radar. The chapter situates the development of Malaysia’s principal medical travel destinations as a response to the growth of patient-consumers from Indonesia for the treatment of ailments ranging from the mundane to the acute. It then identifies the disjuncture with Malaysia’s burgeoning national ‘medical tourism’ agenda, disproportionately orientated towards catering to an ideal tourism still largely devoid of tourists by directing investment towards adapting to the ‘everyday’ standards deemed requisite to attract the high-spending, long-haul ‘medical tourist’ archetype, eclipsing the response to the needs of a significant proportion of medical travellers. In offering a grounded reading of the management of Indonesian medical travel to Malaysia, this chapter points to the active role of destinations at a range of scales in recognising and catering to different categories of medical travellers, laying out the complex ethical, economic and political contours shaping the recognition of medical travellers’ corporeal vulnerabilities and the correlate extension of hospitality.

Background: Health systems are faced with different needs, conditions and expectations concerning health and healthcare delivery. The most vulnerable groups risk receiving poorer care due to barriers and inequities in health service provision and utilisation. However health care organisations are often not sufficiently equipped to effectively recognise and respond to the diverse needs of the population served. To this end, the Task Force Migration, Equity and Diversity (TF MED) developed a set of standards that allow health care organisations to evaluate equity in service provision and implement improvements. A test was conducted in 52 pilot organisations from sixteen countries to assess compliance with the standards, as well as to explore challenges and opportunities for the effective uptake of equity measures.

Grid computing has emerged from category of distributed and parallel computing where the heterogeneous resources from different network are used simultaneously to solve a particular problem that need huge amount of resources. Potential of Grid computing depends on my issues such as security of resources, heterogeneity of resources, fault tolerance & resource discovery and job scheduling. Scheduling is one of the core steps to efficiently exploit the capabilities of heterogeneous distributed computing resources and is an NP-complete problem. To achieve the promising potential of grid computing, an effective and efficient job scheduling algorithm is proposed, which will optimized two important criteria to improve the performance of resources i.e. makespan time & resource utilization. With this, we have classified various tasks scheduling heuristic in grid on the basis of their characteristics.

The argument this research paper attempts to establish is that undocumented citizens have very little access to healthcare free from barriers that the United States government and healthcare facilities impose on them. The purpose of this thesis was to discover barriers that undocumented citizens encounter when accessing healthcare. Structured interviews were conducted with healthcare providers, administrators, and undocumented citizens in the Rio Grande Valley. Finances were determined by all interviewees to be the largest barrier to accessing healthcare. This issue requires further research and quantitative studies into a topic in healthcare that is scarcely studied and that needs immediate attention because of this group"s great impact on the country in order to understand the dilemma at hand. Policy makers, hospitals, governments, and the general public need to be challenged to advocate for the right to healthcare access for undocumented citizens living in the United States and the RGV. iii DEDICATION The completion of my Master"s degree and thesis would not have been possible without the love and support of my family and friends. My father, David Ruben Melo, my mother, Mireya Melo, my brother, David Melo, my sister, Melinda Melo, and my best friend, Jasmine Esmaeili, pushed and encouraged me to persevere in my endeavors and gave me the confidence to know and believe it could be accomplished. I dedicate this thesis to them especially as a tribute of my appreciation for their encouragement in my studies and life. I also dedicate this to the millions of undocumented citizens living in the Rio Grande Valley and the rest of the world. I hope that through this thesis and future research their plight will be known and that they may receive the basic human rights they deserve. iv ACKNOWLEDGEMENTS My gratitude will always be indebted to Dr. Margaret Graham, chair of my thesis committee, for all of her guidance and mentoring to make this thesis possible. Her encouraging words, patience, and input under tough time constraints helped me push on to the end. I am also indebted to my thesis committee members: Dr. Dejun Su and Dr. Margaret Dorsey. Their suggestions and critique helped to ensure the quality of this thesis to be the best possible.

Network on chip (NOC) is used to connect Multiple Cores in a tiled multicore Processor. Here each core is connected to L1 cache where LLC (L2) is shared by the entire core. The data in the Last Level Cache slices can be accessed by multiple cores simultaneously and results in congestion at the LLC and increases the access time .So in order to find a solution to this problem, Propose a congestion management Technique in the LLC that contains NOC Router with small storage (Router Buffer Cache) to keep a copy of heavily shared cache blocks. The simulation of the Multicore system can be done by Gem5 tool and evaluate its effectiveness by running a set of parallel benchmarks , Thereby Reducing the LLC access Time "

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]). 
Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.
Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 visits were reviewed. The PMHNP was more likely to care for younger patients while the MD cared for more older patients (p<.001). The PMHNPs cared for a more diverse gender spectrum than the MD (p = .031). The MD was more likely to care for Caucasian patients; whereas, the PHMNPs cared for a more diverse racial or ethnic population (p <.001). The MD was more likely to care for the self-pay patient than the PMHNP who cared for those with a larger range of payor types (p< .001). The rate of emergency department (ED) visits and hospitalizations between providers was essentially the same (p=0.40) and (p=0.31) respectively.
Implications: No determination could be made in the key outcome measures of ED visits or hospitalizations between the PMHNPs and MD due to lack of documentation in the record. However, 450 more patients per month were treated for mental healthcare needs when PMHNPs were utilized.

Background: Although, there are several programs in place in Nigeria to ensure maternal and child health, maternal and neonatal mortality rates remain high with maternal mortality rates being 576/100,000 and neonatal mortality rates at 37/1000 live births (NDHS, 2013). While there are many studies on the utilization of maternal health services such as antenatal care and skilled delivery at birth, studies on postnatal care are limited. Therefore, the aim of this study is to examine the factors associated with the non-utilization of postnatal care among mothers in Nigeria using the Nigeria Demographic and Health Survey (NDHS) 2013. Methods: For analysis, the postnatal care uptake for 19,418 children born in the 5 years preceding the survey was considered. The dependent variable was a composite variable derived from a list of questions on postnatal care. A multinomial logistic regression model was applied to examine the adjusted and unadjusted determinants of non-utilization of postnatal care. Results: Results from this study showed that 63 % of the mothers of the 19,418 children did not utilize postnatal care services in the period examined. About 42 % of the study population between 25 and 34 years did not utilize postna-tal care and 61 % of the women who did not utilize postnatal care had no education. Results from multinomial logistic regression show that antenatal care use, distance, education, place of delivery, region and wealth status are significantly associated with the non-utilization of postnatal care services. Conclusions: This study revealed the low uptake of postnatal care service in Nigeria. To increase mothers' utilization of postnatal care services and improve maternal and child health in Nigeria, interventions should be targeted at women in remote areas who don't have access to services and developing mobile clinics. In addition, it is crucial that steps should be taken on educating women. This would have a significant influence on their perceptions about the use of postnatal care services in Nigeria.

‘Culturally-competent’ patient-centred care plays an increasingly expedient role in medical tourism destinations’ ability to capture international patient-consumer markets. While Malaysia’s ethnic, linguistic and religious pluralism had been framed as threatening to nation-building efforts in the early period following independence, recent decades have witnessed growing state awareness of the value of its culturally diverse population for plugging Malaysia into lucrative transnational networks. Engagement with global capital has helped to revalue and identify cultural diversity as central to Malaysian identity. This chapter argues that Malaysia’s burgeoning medical tourism industry is profoundly entrenched in this task and explores how claims to ‘cultural’ expertise get enacted, mobilised and reified in the promotion of the country as a destination.

Restrictive U.S. immigration policies and enforcement have led to concerns among providers about how these changes affect service utilization among Latinx and immigrant communities. This study outlines perceptions from twenty service providers in health care, mental health, legal affairs, and immigrant advocacy in El Paso, Texas. Nearly all respondents stated that their work has been negatively affected by immigration enforcement policies under the current federal administration. Most reported changes in utilization among undocumented immigrants and families of mixed immigration status, as well as legal permanent and temporary residents, refugees or asylum seekers, and U.S. citizens. Negative effects were related to immigration-related fear and uncertainty in the community, a need for public education about policies and individu-als' rights, and changes in immigration policy enforcement. Further research about the impacts of immigration enforcement policies on service utilization is needed. To protect the well-being of immigrant communities, policy makers should be aware of the human rights implications of immigration enforcement policies with regard to service utilization. In a global environment of increasing nationalism and xenophobia, nations must carefully consider the implications of harsh anti-immigrant narratives and strict immigration enforcement on the well-being of minority and immigrant populations.

ID: 329 Fachbereich: Prävention sozial und nachhaltig gestalten Themenbereich: Sozialepidemiologie/ Psychosoziale Einflüsse auf Gesundheit Beitragsart: Beitrag zu organisierter Veranstaltung Psychosocial stress as an indicator for disease severity, mental health and health care utilization in IBD patients. Evaluation of a short scale of perceived stress in chronic diseases J Hardt, S Conrad, C Muche-Borowski, H Raspe

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths ...

Under the Compacts of Free Association (COFA), people from
the Freely Associated States — the Republic of Palau (ROP), the
Republic of the Marshall Islands (RMI), and the Federated States
of Micronesia (FSM) — have been migrating to the United States
in increasing numbers. In 1996, Congress passed broad welfare
reform (Personal Responsibility and Work Opportunity Reconciliation
Act) which limited certain federal benefi ts previously available
to COFA migrants, including Medicaid benefi ts. Prior to July 2010,
the State of Hawai‘i had continued to include COFA migrants
under its state-funded Medicaid program. In the face of budget
constraints, the State removed these people from its Medicaid rolls.
A challenge on the legal basis of the denial of equal protection of
the laws, ie, the Fourteenth Amendment to the US Constitution,
was successful in reinstating health care to the COFA migrants in
December 2010. From the health worker’s perspective, regardless
of various social justice arguments that may have been marshaled
in favor of delivering health care to the people, it was an appeal to
the judicial system that succeeded. From the attorney’s perspective,
the legal victories are potentially limited to the four walls of the
courtroom without community involvement and related social justice
movements. Together, the authors propose that in order to better
address the issue of health care access for Micronesian peoples,
we must work together, as health and legal advocates, to defi ne a
more robust vision of both systems that includes reconciliation and
community engagement.

Space and time are the basic notions which provide basis for all modes of thoughts and beliefs. Spatial dimension of health care encompasses this relationship while addressing the questions of what, where, why, and why there? These concerns became significant especially when the scarcity of resources present a critical situation and access of these resources poses a challenge. In developmental domain, cities have always become challenge with their nature of expansion with shift in demand of different services as well as spatial difference in their demands.
This paper focuses on spatial expansion of the National Capital Territory of Delhi over recent times and evolution of health care services in the region. Paper further analyzes spatial coverage of health care institutions and their access by the different socioeconomic groups. Geographical information system (GIS) and remote sensing tools and techniques have been used to analyze the phenomenon.

Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism and health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems; the status of a medical traveller's ailment or therapy; and the existence of organised support for recognition and management of these in the home context.

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths ...

Rationing health care by ordeals is likely to have different effects on women and men, and on distinct groups of women. I show how such putative effects of ordeals are relevant to achieving gender justice. I explain why some ordeals may disproportionately set back women’s interest in discretionary time, health and access to health care, and may undermine equality of opportunity for positions of advantage. Some ordeals protect the interests of the worse-off women yet set back the interests of better-off women in equal opportunities. I suggest how we can use ordeal design to advance particular aims of gender justice.

A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers ...

Background Social diversity can affect healthcare outcomes in situations when access to healthcare is limited for specific groups. Although the principle of equality is one of the central topics on the agenda of the European Union (EU), its scope in the field of healthcare, however, is relatively unexplored. The aim of this study is to identify and systematically analyze primary and secondary legislation of the EU Institutions that concern the issue of access to healthcare for various minority groups. In our research, we have concentrated on three features of diversity: a) gender identity and sexual orientation, b) race and ethnicity, and c) religion or belief. Method and materials For the purpose of this analysis, we conducted a search of database Eur-Lex, the official website of European Union law and other public documents of the European Union, based on specific keywords accompanied by review of secondary literature. Relevant documents were examined with regard to the research t...

When we began our project, we used the concept of 'best practice' but this was changed later on. The existing literature uses both concepts, 'best' and 'good', although there is not an in depth discussion about the actual utilization of one or the other. In the process of building up this report, and having discussed the issue with the authors and/or practitioners involved, we opted to use the term 'good' rather than 'best'. Several reasons made us believe that good is a more adequate adjective for what we are referring. In the first place, 'best' tacitly implies that there are other ways and that the selected one is better that the others. 'Best' also suggests the existence of a hierarchy, and we did not have a complete set of practices to rank. Secondly, 'best' would imply that all the criteria presented above are met by all the selected practices. However, this was not the case for most of the examples found: for most of the selected practices, at least one of the criteria was not completely met. Thirdly, 'best' would also imply that a given practice is a better way to do things compared to other approaches. This is not necessarily true either, as practices respond to specific needs in given situations, and it was not possible for us to compare and evaluate. Thus, due to the multiplicity of situations that indicated that the cases or practices selected could not or should not be thought as 'best', we opted for the word 'good'. Using this definition we could include practices that may be a solution to some issues or problems but that do not necessarily meet the four criteria listed above. As the practices are a product of their environment, reality and circumstances, they are relative, and could be more or less creative, more or less sustainable or more or less replicable. On the other hand, in most cases, good practices make a difference for the populations involved, at least compared with what was available before the practice was in place. A more exhaustive commentary and analysis on the process and on the good practices will be presented in latter sections of this report. Methodology This report results from a long process that started when Portugal submitted a project to the European Commission for the organisation of some key events during its Presidency of the EU Council. The project included the organisation of a conference on Health and Migration (Lisbon, 27-28 September 2007) which would generate preparatory work, namely, the commission of two reports. The first of the reports focuses on demographic, and epidemiological issues as well as policies regarding health and migration. The second one, this present volume, is a study of Good Practices on Health and Migration in the EU. Table 1-Best Practices Models UNESCO Model US Department of Health and Humana Services Model Composition of the practice Approach Purpose/objective Main Partner Other partners (community, NGO, etc.) Stakeholders Cost Time-frame Geographical scope Administrative data about the organization Contacts (organization and people) Culture sensitivity/specificity Strengths Weakness Lessons learned Brief Description of how it works As a consequence of the fruitful discussions that the editors had with the majority of the authors in Brussels, some changes were introduced to this initial matrix. These changes supported the shift from 'best' to 'good' practices and also gave alternative ways to provide information for some of the fields that were problematic or more complex in some cases, such as giving the opportunity to offer testimonies and pictures as a different way to illustrate results and success. In this sense, the new fields incorporated were 'lessons learned' and an 'annex' section that would provide information to the editors for a better comprehension of the practice, mainly to be used when writing the conclusions, but that would not be published. It follows the matrix adopted for Good Practices. Matrix for Good Practices (Model adopted) Introduction: background information about the specific public health problem, its significance and impact, population(s) affected, and trends Goals and Objectives: state what you seek to achieve as a result of your efforts to solve the public health problem Model: describe the approach being taken or framework of procedures being used to address the public health problem Field or determinant: indicate the field(s) or determinant(s) involved in the practice (i.e. prevention, promotion, maternal health, etc.) Scope: explain the scope of the model, that is, level of centralization, decentralization, etc. that is appropriate (i.e. national, regional, local, etc.) Provider: indicate whether the provider is a public, private or non-governmental institution, or if it is a partnership of several Resources: describe the main financial aspects of the practice (i.e. sources of funding, etc.) Management: indicate how decisions are made, and how they are implemented. Are interested stakeholders taken into account somehow? Indicators: indicate if there is a way to measure or control the effect of the practice (if possible, state the before and after). Results: Discuss the basis for determining the success of your model in terms of measurable outcomes. Use no more than one graphic, preferably in JPEG or GIF format, and not more than 400x400 pixels in size. Conclusions: briefly summarize the meaning of your results and potential implications for public health practice and policy. Future: outline steps that you may take to extend or further improve the model. References (optional): provide no more than five citations. Lessons learned: provide advice from experience, identify weaknesses and strengths thinking in replication/application. Testimony / Picture: attach a testimony of a migrant who has taken advantage of the good practice. If you wish, you may also attach a picture.

Americans and Missourians are sick with limited access to care. Missouri spends approximately $6,967 per person (about 41.6 billion per year) and ranks in the bottom third of states for quality and health outcomes despite paying more than the U.S. average (Missouri Foundation for Health, 2013; The Commonwealth Fund, 2017; United Health Foundation, 2017). According to the U.S. News rankings, Missouri ranks 35th for healthcare access (U.S. News, 2017). Thirty-seven percent of Missouri’s population is rural and made up of approximately 2.22 million people (Missouri Department of Health and Senior Services, n.d.). Missouri currently has 526 health provider shortage areas (HPSAs) for primary care and mental health defined by the Health Resources & Services Administration (Health Resources & Services Administration, 2018). HPSAs are shortages in primary care, dental, or mental health services that may be geographic, population, or facility-based (Health Resources & Services Administration, 2016). All states bordering Missouri have less HPSAs for combined primary care and mental health compared to Missouri (Health Resources & Services Administration, 2016). So, in addition to poor outcomes, Missouri has reduced access to healthcare. The following paper addresses measures Missouri politicians can take to improve access to health care services to Missourians.

Differences in health care utilization (HCU) of immigrants 50 years of age and older relative to the native-born populations in eleven European countries are investigated. Negative Binomial and zero-inflated Poisson regression are used to examine differences between immigrants and native-borns in number of doctor visits, visits to general practitioners (GPs), and hospital stays using the SHARE database. In some countries older immigrants use more health services than native-borns with the same characteristics. After controlling for differences in the need for health care, immigrants have between 6% and 21% more visits to the doctor, GP or hospital stays than native-born persons. So, the difference in the use of medical care between immigrants and native-born individuals is greater in physician visits, but immigrants also have more visits to the GP and hospital. We also find that country level gross domestic product (GDP), methods of paying physicians, physician density and health system characteristics affect HCU differentially for immigrants and natives. The results of this study add to our understanding of the behaviour of elderly citizens’ across Europe. Among older individuals, the greater HCU for elderly immigrants could be caused by differences in health, cultural differences, or informational differences. If the main reason immigrants use medical care more often than the native-born is due to cultural reasons or lack of information, then health campaigns should be designed to explain and promote efficient use of medical care units.  If the cause of the differential demand is the lack of social integration or the fragility of social networks, then efforts must be made to integrate elderly immigrants into European society. If no directed efforts are made in this direction, then a growing immigrant elderly population will exert more pressure on health care systems in subsequent years. A major innovation of this paper is that it uses a comparable dataset and two models of the demand for medical care services for a group of European countries to examine health care usage differences between immigrants and natives.  This contributes to the HCU literature by providing a unique statistical, demographic and economic approach to clarify how older immigrant populations use medical services.



Keywords: count data, physician services, elderly, immigration, Europe