SSM - Health Systems最新文献_第3页

The COVID-19 pandemic: A focusing event to promote domestic investment for health systems strengthening in the WHO African Region COVID-19 大流行：促进国内投资以加强世卫组织非洲地区卫生系统的重点活动

SSM - Health Systems

Pub Date : 2024-10-05 DOI: 10.1016/j.ssmhs.2024.100034

Alison T. Mhazo , Arush Lal , Elias Mossialos

Background

The COVID-19 pandemic has been framed as a catalytic occurrence that exposed the chronic underinvestment in health systems strengthening (HSS) in the WHO African Region as well as its potential to galvanize much-needed political attention towards the issue. This expectation aligns with the portrayal of COVID-19 as a ‘focusing event’ for HSS. This study analyzes whether COVID-19 met the criteria of a focusing event for HSS as set forth by John Kingdon, and then, if as a focusing event, it generated political attention towards policy making and implementation for HSS and whether there could be prospects for sustaining such momentum in the post COVID-19 era.

Methods

We carried out a scoping review of available literature using the O’Malley and Arksey method (2005).

Results

The COVID-19 pandemic presented an unprecedented crisis that drew attention to the problem of weak health systems in the WHO African region, a problem that had long been acknowledged but largely ignored. This study has also shown that COVID-19 had a profound personal experience on policy makers since it severely limited their opportunity to seek medical care abroad and forced them to personally witness the weak state of domestic health systems. These attributes suit the criteria of COVID-19 as a focusing event according to Kingdon, which helped to stimulate governmental action on HSS.

Conclusion

The COVID-19 pandemic can indeed be leveraged as a salient focusing event to generate political attention for HSS in the WHO African Region. However, such attention cannot be guaranteed in the long-term, due to the differential dynamics between policy making and implementation in crises and non-crisis situations. By casting light on a plausible but rarely examined mechanism for driving policy change –the personal experience of policy makers, we conclude that lack of financial resources does not sufficiently explain the lack of domestic investments for HSS. This calls for attention towards other reasons of inaction towards HSS, including the insulation of the elite from facing the weak health systems.

背景 COVID-19 大流行被认为是一种催化剂，它暴露了世卫组织非洲地区在加强卫生系统（HSS）方面长期投资不足的问题，并有可能激发对这一问题亟需的政治关注。这一预期与 COVID-19 被描述为卫生系统强化的 "焦点事件 "相吻合。本研究分析了 COVID-19 是否符合 John Kingdon 提出的人文社科焦点事件的标准，以及作为焦点事件，COVID-19 是否引发了对人文社科政策制定和实施的政治关注，以及在 COVID-19 之后是否有可能保持这种势头。方法我们采用 O'Malley 和 Arksey 方法（2005 年）对现有文献进行了范围审查。结果COVID-19 大流行带来了一场前所未有的危机，引起了人们对世界卫生组织非洲地区卫生系统薄弱问题的关注，这一问题长期以来一直被人们所承认，但在很大程度上却被忽视。本研究还表明，COVID-19 给决策者带来了深刻的个人体验，因为它严重限制了他们出国就医的机会，迫使他们亲眼目睹了国内卫生系统的薄弱状况。根据 Kingdon 的观点，这些特征符合 COVID-19 作为焦点事件的标准，它有助于激发政府在人文社科领域采取行动。然而，由于危机和非危机情况下政策制定和实施的动态不同，这种关注不能得到长期保证。通过揭示一个看似合理但却很少被研究的推动政策变化的机制--政策制定者的个人经历，我们得出结论，缺乏财政资源并不能充分解释国内缺乏对人文社科投资的原因。这就需要关注对卫生和社会服务不作为的其他原因，包括精英阶层不愿面对薄弱的卫生系统。

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引用次数: 0

Supply-side factors influencing national health insurance uptake, access and use of primary health care: Evidence from the Upper West Region, Ghana 影响国家医疗保险覆盖率、初级卫生保健的获取和使用的供应方因素：加纳上西部地区的证据

SSM - Health Systems

Pub Date : 2024-09-29 DOI: 10.1016/j.ssmhs.2024.100036

Justine Guguneni Tuolong , Kennedy A. Alatinga , Elijah Yendaw

Supply-side factors, such as the availability of health facilities, equipment, practitioners, and drugs, are crucial for improving global healthcare systems. However, systematic evidence of how these factors affect health insurance clients’ access to primary healthcare (PHC) services in Ghana is lacking. This study addresses this gap by examining the impact of these factors on insured individuals' access to PHC services in Wa Municipality. An explanatory sequential mixed-methods design was employed, involving a quantitative survey of 413 insured individuals randomly selected from 40 communities and 47 healthcare facilities. Purposive sampling was used for qualitative interviews with 17 healthcare providers and 20 key insured informants. Quantitative data were analysed using descriptive statistics, correlation, independent t-tests, and binary logistic regression, while qualitative data were thematically analysed to provide insight into the quantitative findings. Result from quantitative data showed that Community-Based Health Planning and Services (CHPS) were more accessible than hospitals, diagnostic centres, and health centres. Proximity to health facilities influenced access to PHC services and National Health Insurance Scheme (NHIS) uptake. Perceived availability and functionality of healthcare equipment also affected NHIS uptake. Qualitatively, health facilities reported a shortage of human resources, such as midwives and nurses, for PHC service delivery. Triangulating quantitative and qualitative results show that healthcare supplies and skilled professionals are essential for NHIS uptake and access to PHC services. This study recommends that Government of Ghana prioritise expanding healthcare facilities, recruiting and retaining skilled practitioners, procuring medical equipment, and equitably distributing essential medications to improve access to essential healthcare services in underserved areas.

供应方因素，如医疗设施、设备、从业人员和药品的可用性，对于改善全球医疗保健系统至关重要。然而，关于这些因素如何影响加纳医疗保险客户获得初级医疗保健（PHC）服务的系统性证据却很缺乏。本研究通过考察这些因素对瓦市投保人获得初级医疗保健服务的影响，填补了这一空白。本研究采用了解释性顺序混合方法设计，对从 40 个社区和 47 家医疗机构随机抽取的 413 名投保人进行了定量调查。对 17 名医疗服务提供者和 20 名主要投保信息提供者进行了定性访谈。定量数据采用描述性统计、相关性、独立 t 检验和二元逻辑回归等方法进行分析，定性数据则采用主题分析方法，以深入了解定量研究结果。定量数据结果显示，与医院、诊断中心和保健中心相比，社区保健规划和服务（CHPS）更容易获得。与医疗设施的距离影响了初级保健服务的获得和国家医疗保险计划（NHIS）的参加。医疗保健设备的可用性和功能性也影响着国民健康保险计划（NHIS）的采用率。从定性角度看，医疗机构报告称，助产士和护士等提供初级保健服务的人力资源短缺。对定量和定性结果进行三角分析的结果表明，医疗用品和熟练的专业人员对 NHIS 的吸收和 PHC 服务的获取至关重要。本研究建议加纳政府优先扩建医疗保健设施、招聘和留住熟练从业人员、采购医疗设备并公平分配基本药物，以改善服务不足地区获得基本医疗保健服务的机会。

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引用次数: 0

The impact of Ghana’s national health insurance exemption policies on healthcare-seeking behaviour 加纳国家医疗保险豁免政策对就医行为的影响

SSM - Health Systems

Pub Date : 2024-09-26 DOI: 10.1016/j.ssmhs.2024.100035

Yaw Boateng Atakorah , Eric Arthur , Anthony Kofi Osei-Fosu , Jacob Novignon

Countries all over the world are seeking to enhance the general well-being of their populations by instituting a prepayment health system in which people can access healthcare at any time without financial risks. In Ghana, the National Health Insurance Scheme (NHIS) seeks to achieve this objective while leaving no one behind. To accelerate the country’s UHC agenda, the scheme was designed to also provide premium exemptions to the poor and vulnerable. While the exemption policy removes financial barriers to both subscription and healthcare, its impact on health-seeking is unknown. This study, therefore, sought to evaluate the impact of the premium exemption policies on healthcare-seeking behaviours. Data from the most recent round of the Ghana Living Standards Survey (GLSS 7) was used. A total sample of 8297 individuals were included in the analysis comprising 5686 rural and 2611 urban dwellers. We used the Lewbel instrumental variable technique to correct potential endogeneity problems. We found that NHIS exemption policies improved both general and formal healthcare-seeking. For general healthcare-seeking, the impact was driven by individuals exempted through under 18 and aged category. However, focusing on formal care, both exemption through under 18 or aged category as well as through indigents or Free Maternal Services category both improved healthcare-seeking. The magnitude of the impact was also greater for categories that were fully exempted and did not require any form of payment to subscribe. The findings call for a policy review to differentially target individuals living in areas with different economic and health system realities.

世界各国都在寻求通过建立预付费医疗系统来提高人民的总体福祉，在这种系统中，人们可以随时获得医疗保健服务，而无需承担经济风险。在加纳，国家医疗保险计划（NHIS）力求实现这一目标，同时不让任何人掉队。为了加快加纳的全民医保议程，该计划还为穷人和弱势群体提供保费豁免。虽然免缴保费政策消除了参保和就医的经济障碍，但其对就医的影响尚不得而知。因此，本研究试图评估保费豁免政策对就医行为的影响。研究采用了最近一轮加纳生活水平调查（GLSS 7）的数据。参与分析的样本共有 8297 人，其中农村居民 5686 人，城市居民 2611 人。我们使用 Lewbel 工具变量技术来纠正潜在的内生性问题。我们发现，NHIS 豁免政策提高了一般和正规医疗保健的寻求率。对于一般医疗服务而言，影响主要来自于 18 岁以下和高龄人群。然而，就正规医疗而言，通过 18 岁以下或老年人类别以及贫困人口或免费孕产妇服务类别获得的豁免都改善了就医情况。对于完全豁免且不需要支付任何形式费用的类别，其影响程度也更大。研究结果要求对政策进行审查，以便针对生活在不同经济和卫生系统现实地区的个人进行区别对待。

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引用次数: 0

Adjusting for quality of care in primary health care utilization and benefits in Bihar, India: A benefit incidence analysis 调整印度比哈尔邦初级保健利用率和收益中的保健质量：受益发生率分析

SSM - Health Systems

Pub Date : 2024-09-25 DOI: 10.1016/j.ssmhs.2024.100033

Akriti Mehta , Bryan N. Patenaude, Krishna D. Rao

India’s public health policies prioritize the least wealthy and vulnerable. Additionally, for Primary Health Care (PHC) to achieve equitable health outcomes, all must receive high-quality care. This study determined equality of utilization and benefit incidence of PHC services across socioeconomic (SE) groups in Bihar, with and without adjusting for quality of care. It used secondary data from linked PHC facility and household surveys in Bihar that included information on PHC facility utilization, quality of care and household expenditure patterns. Lorenz curves and concentration indices were constructed to examine relative distribution of utilization and benefits from public sector PHC services by SE status, before and after adjusting for quality of care using quality weights. We found that relative distribution of public sector PHC utilization, total and net benefits was statistically no different from perfect equality. With quality weights, utilization and benefits of PHC facilities in Bihar were slightly more pro-rich but statistically no different from perfect equality. The wealthiest do not disproportionately benefit from public sector PHC facilities, but neither do the least wealthy. In conclusion, relative utilization and benefits of public sector PHC facilities were equally distributed across socioeconomic groups in Bihar. Benefits from public sector PHC facilities are not disproportionately concentrated among the least wealthy in the community. As the Ayushman-Bharat Health and Wellness Centers are strengthened to improve public sector PHC services, it would be important to target its benefits towards the least wealthy by ensuring services are accessible and amenable.

印度的公共卫生政策优先考虑最不富裕的弱势群体。此外，要使初级卫生保健（PHC）取得公平的卫生成果，所有人都必须获得高质量的医疗服务。本研究确定了比哈尔邦不同社会经济（SE）群体在使用初级保健服务和受益发生率方面的平等性，并对保健质量进行了调整和未进行调整。研究使用了比哈尔邦相关初级保健设施和家庭调查的二手数据，其中包括初级保健设施利用率、保健质量和家庭支出模式等信息。在使用质量权重对医疗质量进行调整之前和之后，我们构建了洛伦兹曲线和集中指数，以研究公共部门初级保健服务利用率和收益在社会经济地位方面的相对分布情况。我们发现，公共部门初级保健服务的利用率、总收益和净收益的相对分布在统计上与完全平等没有区别。使用质量权重后，比哈尔邦初级保健设施的利用率和收益略微偏向富人，但在统计上与完全平等无异。最富有的人并没有从公共部门的初级保健设施中过多受益，但最不富有的人也没有。总之，比哈尔邦各社会经济群体对公共部门初级保健设施的相对利用率和受益程度相当。公共部门初级保健设施的惠益并没有不成比例地集中于社区中最不富裕的人群。随着 Ayushman-Bharat 保健和健康中心得到加强，公共部门初级保健服务也将得到改善，重要的是通过确保服务的可及性和便利性，使其惠及最不富裕人群。

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引用次数: 0

“We do these audits, but in the end, it’s useless.” How can facility-based maternal death reviews improve the quality of care in Benin? "我们做了这些审核，但最终都是无用功"。以医疗机构为基础的孕产妇死亡评审如何提高贝宁的医疗质量？

SSM - Health Systems

Pub Date : 2024-09-24 DOI: 10.1016/j.ssmhs.2024.100032

Christelle Boyi Hounsou , Jean-Paul Dossou , Thérèse Delvaux , Lenka Benova , Edgard-Marius Ouendo , Sorel Lokossou , Marjolein Zweekhorst , Bruno Marchal

Benin scaled up facility-based Maternal Death Reviewss (MDRs) in 2013 to address its high maternal mortality rate. This study aims to assess the extent to which facilitybased MDR captured the complex causes of maternal deaths in 2022. In this mixedmethod study, we first conducted a quantitative analysis of dysfunctions, root causes,and recommendations extracted from all facility-based MDR reports that occurred in Benin's health facilities in 2022. We calculated frequency distributions based on the systemic maternal care quality assessment framework's components and the iceberg model for system thinking's layers. Second, we conducted in-depth and informal interviews and (non)participant observations and reviewed facility-based MDR policyrelated documents. Content analysis was applied to qualitative data. facility-based MDR teams identified 1295 dysfunctions, 1216 root causes, and 1082 recommendations in facility-based MDR reports of 540 maternal deaths. One-fifth of reports were uninformative, lacking dysfunctions, root causes, or recommendations.Within the health system components, leadership and governance received the least attention regarding dysfunctions (1 %) and root causes (12 %).Most dysfunctions (87 %) and root causes (73 %) focused on the iceberg's tip, leading to reactive recommendations rather than addressing deeper systemic issues. Two main factors emerged: non-compliance with facility-based MDR requirements (time constraints, unreliable data, fear of strained provider relationships) and limitations in facility-based MDR processes (data collection and analysis tool constraints),

贝宁于2013年扩大了基于设施的孕产妇死亡审查（MDRs），以解决孕产妇死亡率高的问题。本研究旨在评估以医疗机构为基础的孕产妇死亡评审在多大程度上反映了 2022 年孕产妇死亡的复杂原因。在这项混合方法研究中，我们首先对 2022 年发生在贝宁医疗机构的所有基于医疗机构的 MDR 报告中提取的功能障碍、根本原因和建议进行了定量分析。我们根据系统性孕产妇护理质量评估框架的组成部分和系统思维冰山模型的层级计算了频率分布。其次，我们进行了深入的非正式访谈和（非）参与者观察，并查阅了基于医疗机构的 MDR 政策相关文件。我们对定性数据进行了内容分析。在针对 540 例孕产妇死亡的医疗机构孕产妇死亡报告中，医疗机构孕产妇死亡报告团队发现了 1295 项功能障碍、1216 项根本原因和 1082 项建议。大多数功能障碍（87%）和根本原因（73%）都集中在冰山一角，导致了被动的建议，而不是解决更深层次的系统性问题。出现了两个主要因素：不遵守基于设施的 MDR 要求（时间限制、数据不可靠、担心提供者关系紧张）和基于设施的 MDR 流程的限制（数据收集和分析工具限制）、

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引用次数: 0

Management outcome of incomplete abortion and its associated factors in Northwest Ethiopia: A health facility based cross-sectional study 埃塞俄比亚西北部不完全流产的管理结果及其相关因素：基于医疗机构的横断面研究

SSM - Health Systems

Pub Date : 2024-09-21 DOI: 10.1016/j.ssmhs.2024.100031

Simegnew Asmer Getie , Getahun Tadele , Habtamu Gebrehana Belay , Natnael Dechasa Gemeda , Fentahun Alemnew Chekole , Wondu Feyisa Balcha

Background

Incomplete abortion can be managed medically or surgically at a health facility by trained healthcare providers. However, women develop unfavorable management outcomes of incomplete abortion following initial management.

Objective

This study aimed to assess the management outcome of incomplete abortion and its associated factors at Injibara General Hospital, Northwest Ethiopia.

Methods

A health facility-based retrospective cross-sectional design was conducted from May 1/2018 to April 30/2020. A medical record review of 260 women who received abortion service was done and 236 cases managed for incomplete abortion were included in the study with a response rate of 90.8 %. Logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95 % and a P-value of less than 0.05 considered statistically significant.

Results

The findings of this study showed that 12.3 % of the women developed unfavorable management outcomes of incomplete abortion. Women who are found in the age group of 15–25 years, gestational age >13 weeks, seek care after 24 hours of the onset of symptoms, and medical management of the incomplete abortion were associated with unfavorable management outcomes of incomplete abortion.

Conclusion

Considering its effect on maternal health, this study showed that the unfavorable management outcome of incomplete abortion was higher. Women's age, gestational age, the timing of seeking care, and method of management were associated with unfavorable management outcomes of incomplete abortion. Therefore, it is necessary to counsel women on the danger signs of early pregnancy and the advantages of early care-seeking.

背景不全流产可在医疗机构由训练有素的医护人员进行药物或手术治疗。本研究旨在评估埃塞俄比亚西北部 Injibara 综合医院不全流产的管理结果及其相关因素。方法在 2018 年 5 月 1 日至 2020 年 4 月 30 日期间进行了一项基于医疗机构的回顾性横断面设计。对接受人工流产服务的 260 名妇女进行了病历审查，236 例因人工流产不全而接受管理的病例被纳入研究，应答率为 90.8%。研究采用逻辑回归分析来估算粗略和调整后的几率，置信区间为 95%，P 值小于 0.05 为具有统计学意义。15-25岁年龄组、孕龄13周、症状出现24小时后就医、不全流产的医学处理与不全流产的不利处理结果有关。结论考虑到对产妇健康的影响，本研究显示不全流产的不利处理结果较高。妇女的年龄、孕龄、就医时间和处理方法与不全流产的不良处理结果有关。因此，有必要向妇女宣传早孕的危险信号和及早就医的好处。

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引用次数: 0

Core components of infectious disease outbreak response 应对传染病爆发的核心内容

SSM - Health Systems

Pub Date : 2024-09-12 DOI: 10.1016/j.ssmhs.2024.100030

Mackenzie Moore , Hailey Robertson , David Rosado , Ellie Graeden , Colin J. Carlson , Rebecca Katz

Outbreak response, as a technical and specialized field of practice, is struggling to keep pace with the evolving landscape of public health emergencies. Here, we analyze 235 different multisectoral activities that comprise outbreak preparedness and response. We explore the conditions under which these activities are applicable, including different phases of response, different operating circumstances, and different disease etiologies, and find that the core activities required for outbreak response largely apply across etiology and scale, but are more substantial during the early phases of response. To validate this framework with real-world examples, we then examine 246 reports from the WHO Disease Outbreak News (DON), a narrative record of outbreak history through time, and examine which of our activities are reported or implied in these narratives. We find that the core components of response are applicable across the vast majority of outbreaks, especially as they relate to basic epidemiology, infection prevention, and governance, and that many different kinds of real-world outbreaks require the same core set of responses. These findings point to a nearly-universal set of outbreak response activities that could be directly incorporated into national and international response plans, significantly reducing the risk and impact of infectious disease outbreaks.

疫情应对作为一个技术性和专业化的实践领域，正努力跟上公共卫生突发事件不断发展的步伐。在此，我们分析了构成疫情防备和应对的 235 项不同的多部门活动。我们探讨了这些活动的适用条件，包括不同的应对阶段、不同的运作环境和不同的疾病病因，并发现应对疫情所需的核心活动在很大程度上适用于不同病因和不同规模，但在应对的早期阶段更为重要。为了用现实世界的例子验证这一框架，我们随后研究了世界卫生组织疾病疫情新闻（DON）中的 246 份报告，这些报告叙述了疫情爆发的历史，并研究了这些叙述中报告或暗示了我们的哪些活动。我们发现，应对措施的核心内容适用于绝大多数疫情，尤其是与基本流行病学、感染预防和治理有关的内容，而且现实世界中许多不同类型的疫情都需要采取相同的核心应对措施。这些研究结果表明，有一套几乎通用的疫情应对活动可直接纳入国家和国际应对计划，从而大大降低传染病爆发的风险和影响。

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引用次数: 0

The role of personal social networks in supporting patients with chronic diseases to access outpatient clinics in Mbeya, Tanzania: A mixed methods study 在坦桑尼亚姆贝亚，个人社交网络在支持慢性病患者前往门诊就医方面的作用：混合方法研究

SSM - Health Systems

Pub Date : 2024-09-06 DOI: 10.1016/j.ssmhs.2024.100029

Brady Hooley , Grace Mhalu , Sally Mtenga , Fabrizio Tediosi

The increasing prevalence of non-communicable diseases (NCDs) in Tanzania and the inequitable provision of NCD care drives patients to seek support from their social networks. We studied a sample of patients with NCDs attending outpatient clinics to understand how informal social support helps patients with NCDs in coping with their illness, and whether it is associated with patients’ engagement in care. We used mixed methods to analyse data from a client exit survey implemented in outpatient clinics in Mbeya, Tanzania in 2022. The quantitative analyses of data on 108 patients was complemented by qualitative analysis of in-depth interviews conducted on a sub-sample of 30 participants. Most patients faced difficulties completing work and household activities, creating a need for financial support. Expectations of reciprocal intergenerational support led patients’ children to be the dominant providers of financial support. Participants’ social ties frequently provided financial support, while emotional and informational support were provided to a lesser extent. Informal social support fills gaps in social health protection schemes and promotes engagement in care by providing patients with the means to finance uninsured costs of care. Expanding old age social security or other resource pooling mechanisms could reduce the susceptibility of patients and their support networks to catastrophic health expenditure, even for those with health insurance.

在坦桑尼亚，非传染性疾病（NCD）的发病率不断上升，非传染性疾病护理服务的不公平促使患者从他们的社交网络中寻求支持。我们对在门诊就诊的非传染性疾病患者进行了抽样调查，以了解非正式社会支持如何帮助非传染性疾病患者应对疾病，以及非正式社会支持是否与患者参与护理有关。我们采用混合方法分析了 2022 年在坦桑尼亚姆贝亚门诊实施的客户退出调查的数据。在对 108 名患者的数据进行定量分析的同时，我们还对 30 名参与者的子样本进行了深入访谈的定性分析。大多数患者在完成工作和家务活动方面面临困难，因此需要经济支持。对代际互惠支持的期望使患者的子女成为经济支持的主要提供者。参与者的社会关系经常提供经济支持，而情感和信息支持则较少。非正式的社会支持弥补了社会健康保护计划的不足，并通过为患者提供支付未投保的医疗费用的手段来促进他们参与医疗服务。扩大老年社会保障或其他资源共享机制可以降低患者及其支持网络对灾难性医疗支出的易感性，即使是对那些有医疗保险的人来说也是如此。

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引用次数: 0

Unmet need and access to family physicians: A national analysis using the Canadian Longitudinal Study on Aging 未满足的需求和获得家庭医生服务的机会：利用加拿大老龄问题纵向研究进行的全国性分析

SSM - Health Systems

Pub Date : 2024-09-02 DOI: 10.1016/j.ssmhs.2024.100028

Feben W. Alemu , Kathryn Nicholson , Piotr Wilk , Jane S. Thornton , Shehzad Ali

Background

The Canadian health care system was founded on the principle of universal access to care. However, recent reports have ranked the country among the lowest performing high-income health systems in terms of access to care and health equity. This study investigates the determinants of access to care in older Canadian adults using a nationally representative survey.

Methods

This cross-sectional study used data from the Canadian Longitudinal Study of Aging (N = 41,135) to examine the determinants of two indicators of healthcare access: self-reported access to a family physician and unmet need of care. Multivariable logistic regression models were used to evaluate the association between these indicators and sociodemographic determinants.

Results

Approximately 1 in 30 of the survey participants (aged ≥ 45 years at baseline) did not have a family physician, and 8 % reported having unmet need for healthcare. The odds of having a family physician were higher among individuals who were older (≥ 55 years), female, had higher income (≥$100,000), poorer perceived mental health, or had ≥1 chronic condition. The odds of reporting unmet need were higher for individuals who were younger (45–54 years), female, non-white, had lower income (<$50,000), poorer perceived health status and had ≥2 chronic conditions.

Conclusions

Despite progress over recent years, access to healthcare remains a challenge for older Canadians, particularly those who are socially disadvantaged. Tailored policy interventions are needed to reduce unmet need in the aging Canadian population.

背景加拿大的医疗保健系统建立在普及医疗保健的原则之上。然而，最近的报告却将加拿大列为在获得医疗服务和健康公平方面表现最差的高收入医疗体系之一。这项横断面研究使用了《加拿大老龄化纵向研究》（Canadian Longitudinal Study of Aging，N=41135）中的数据，研究了获得医疗服务的两个指标的决定因素：自我报告的获得家庭医生服务的情况和未满足的医疗需求。结果大约每 30 名调查参与者（基线年龄≥ 45 岁）中就有 1 人没有家庭医生，8% 的人称其医疗保健需求未得到满足。年龄较大（≥ 55 岁）、女性、收入较高（≥ 100,000 美元）、心理健康状况较差或患有≥一种慢性疾病的人拥有家庭医生的几率更高。年龄较小（45-54 岁）、女性、非白人、收入较低（<50,000 美元）、健康状况较差或患有 ≥ 2 种慢性疾病的人报告需求未得到满足的几率更高。需要采取有针对性的政策干预措施，以减少加拿大老龄人口中未得到满足的需求。

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引用次数: 0

Resilience in interconnected community and formal health (and connected) systems 相互关联的社区和正规卫生（及关联）系统的复原力

SSM - Health Systems

Pub Date : 2024-09-01 DOI: 10.1016/j.ssmhs.2024.100027

Matt Fortnam , Peter Hailey , Sophie Witter , Nancy Balfour

Enhancing the resilience of health systems to expected and unexpected shocks – from COVID-19 to the health impacts of climate change – is becoming a defining challenge of this century worldwide. To date, health system resilience research has focused on formal government health systems, yet emerging evidence points to the importance of families, communities and connected systems (such as disaster management, water, sanitation, social protection and gender disparities) that influence the health status of people, and health system functioning and capacities to respond to shocks. We argue that resilience capacities in both formal and community health systems, and connected systems, be considered in health system resilience conceptual frameworks, and that well-established literature on community resilience capacities from diverse disciplines can help frame research on community health system resilience.

从 COVID-19 到气候变化对健康的影响，提高卫生系统应对预期和意外冲击的复原力正在成为本世纪全球面临的一项决定性挑战。迄今为止，卫生系统抗灾能力的研究主要集中在正规的政府卫生系统，但新出现的证据表明，家庭、社区和相关系统（如灾害管理、水、卫生设施、社会保护和性别差异）对人们的健康状况、卫生系统的运作和应对冲击的能力都有重要影响。我们认为，应在卫生系统复原力概念框架中考虑正规和社区卫生系统以及相关系统的复原力，不同学科中有关社区复原力的成熟文献可帮助确定社区卫生系统复原力研究的框架。

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