SSM - Health Systems最新文献

Background

Objective

Methods

Results

Conclusion

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.

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.

In the Netherlands, many parents of children with profound intellectual and multiple disabilities care for their children at home. Little is known about how parents and involved healthcare professionals share and align medical care for these children. This study aims to contribute to a better understanding of the dimensions that affect how medical care is shared and how healthcare professionals can align care with family needs. The study design was inspired by grounded theory. We analyzed in-depth interviews with 25 Dutch parents. The analysis identified five dimensions affecting how parents and professionals shared and aligned medical care: fragility, planned care, irregularities, interactions with providers, and parents’ choices. We recognized three distinctive ways these dimensions interplayed, characterizing scenarios of sharing care: dependent care, dialogical care, and autonomous care. The findings illuminated that parental distress decreased when parents could communicate about what they considered important for their child and family and its implications for sharing care. Parents developed their capacity to manage medical care and often evolved in their thinking about the quality of care and life. Sometimes this evolution was due to struggles with the care provided by professionals. Therefore, healthcare professionals may need to broaden the relational work of shared decision-making to include the sharing of medical care. Arrangements need to be continually reassessed as changes in the child’s and family’s situation trigger changes in preferred patterns of sharing care. Commitment to parents’ autonomy implies that healthcare professionals should be attentive to the parents’ emotional and relational needs.

The Government of Kerala in 2017 launched the Aardram Mission aimed at a complete overhaul of the State’s health system. A crucial component of the Mission was the Family Health Centre (FHC) initiative using Comprehensive Primary Health Care. A core strategy of the FHC initiative was its emphasis on strengthening community participation through decentralization and creating newer ways of engagement. The study aimed to examine the meanings attributed to community participation within policy and functionaries of the health system using qualitative content analysis of the FHC policy and narratives of health functionaries. The policy analysis suggested a genuine commitment to community participation by locating FHCs under the leadership of local self-governments and through newer mechanisms like ‘Arogyasena’ volunteers constituted by community cross-sections. However, the narratives of health functionaries’ points to a reductionist view of community participation that excluded communities from priority setting and decisionmaking. Communities were seen as incapable of planning health activities and, therefore, their participation equated with the idea of expressing their needs. Participation was also seen from the perspective of communities as ‘resources’ for implementing activities and as ‘responsible beneficiaries’ who maintain positive health behaviours. Findings from the study suggest the prevailing conflicts between health functionaries’ reductionist views on communities as compared to policies’ aspirations in achieving a transformative idea of community participation. This demands urgent attention and resolution to enable the successful implementation of the FHC initiative as well as achieve the larger goals of social justice and equity.

Objective

Worsening economic and social conditions in Venezuela have forced many to migrate. Women and girls are particularly at risk of health vulnerability in this context. This study examines healthcare expenditure and financial risk protection inequalities among Venezuelan migrant women in Brazil.

Methods

We conducted a survey of 2012 Venezuelan women aged 15–49 who migrated to Brazil between 2018 and 2021. We estimated and decomposed concentration indices to analyse inequalities in out-of-pocket healthcare expenditures (OOPHE) and catastrophic health expenditures (CHE) across the entire socioeconomic distribution. We applied Blinder-Oaxaca decompositions to explain differences in healthcare spending between migrant and Brazilian women.

Results

Venezuelan migrant women displayed noticeable disparities in OOPHE and incidence of CHE. Approximately half of our sample of migrants reported no income, no expenditures, and hence no CHE. OOPHE and CHE incidence were concentrated among less poor migrant women, whilst for Brazilian women, CHE was concentrated among the poorer. Location, time since arrival to Brazil, higher education, and income were key contributors to socioeconomic inequality in OOPHE and CHE for migrants. The main explanatory factor for differences in OOPHE between migrants and non-migrants was differences in income profiles.

Conclusions

Addressing financial risk protection in health is crucial for displaced populations, especially women and girls. While the public health system in Brazil offers universal healthcare coverage in principle, our results suggest that there is still a significant risk of lack of access to healthcare for Venezuelan migrant women, which may be driven by insufficient financial means.