International Journal of Health Services最新文献

The use of sanctions as a policy tool to affect change in the political behavior of target states has increased over the past 30 years, along with a concern about their impact on civilian health. Some researchers have proposed that targeting sanctions can avoid their moral costs, yet others have challenged this claim. This systematic mixed-studies review explored the debate about targeted sanctions by appraising their health effects as reported in the medical and public health literature, with a global focus and through the COVID-19 era.We searched three electronic databases without temporal or geographical restrictions and identified 50 studies spanning three decades (1992-2021) meeting our inclusion criteria. Using a piloted form, we extracted quotations addressing our research questions and identified themes that we grouped according to the effects of sanctions on health or its determinants, generating frequency distributions to assess the strength of support for each theme. While no study posited a causal relationship between sanctions and health, or engaged the morality of sanctions, most implied that when sanctions were present, health was inevitably impacted, even for sanctions ostensibly targeted to minimize civilian harm. Our findings suggest that given the integrated nature of the global economy, it is all but impossible to design sanctions that will achieve their stated goals without inflicting significant harm on civilians. We conclude that the use of sanctions as a policy tool threatens global health and human rights, especially in times of crises.

This qualitative study explores lived experiences of Palestinians in the West Bank during the COVID-19 pandemic intersecting with life under Israeli military occupation, structural violence, and racism. Insight is provided into the pandemic's effect on daily life and health and into coping and support mechanisms employed under apartheid conditions. Forty-three semi-structured interviews were conducted among a stratified sample of Palestinian adults. Interviews were digitally recorded, transcribed, and analyzed using thematic analysis. During the pandemic, Palestinian social lives were interrupted, jobs were lost, and incomes declined. Families fell into social and financial crises, with strife, insecurity, uncertainty, and fear negatively affecting physical and mental health. Pandemic effects were compounded by the Palestinian Authority's shortcomings and policies not taking into account citizens' rights and social protection and by Israel's continued colonization of Palestinian land and violation of Palestinian human rights. Social solidarity was instrumental for coping during the pandemic just as it was during intensified political violence. One key feature that helped Palestinians survive promoting their cause for freedom, sovereignty, and self-determination is their social solidarity in times of strife. This has proven to be a crucial component in overcoming threats to the survival of a people during the twentieth century and into the twenty-first century.

When it comes to climate change, gun control, and abortion rights, the U.S. Supreme Court is on a minority rule roll, with grave consequences for the health of people and life on Earth. Its June 2022 decisions to limit the ability of the U.S. Environmental Protection Agency to regulate climate-heating emissions, to overturn gun control legislation, and to overturn Roe v. Wade not only will harm health and increase health inequities, but also flout public opinion. The U.S. Supreme Court, however, is not alone in being out of step with majority views: so too are state and federal elected officials. For effective action, it is imperative for health professionals not only to marshal evidence of harms posed by actions such as the Supreme Court decisions, but also to contribute to efforts to understand and address how changing the "rules of the game"-for example, through gerrymandering and voter suppression-is enabling branches of the U.S. government to undermine not only use of scientific evidence but also majority rule.

Private equity investments in U.S. health care have become very common across more parts of our health care system than most physicians and other health professionals realize. The motivation in every case is to reap short-term profits for investors regardless of the consequences on patient care. These investments range from hospitals, emergency room services, and outpatient facilities to nursing homes and home care. Physician practices have been bought and sold in a number of specialties, including anesthesiology, dermatology, emergency medicine, gastroenterology, obstetrics-gynecology, ophthalmology, orthopedic surgery, and radiology. After leveraged buyouts using borrowed money, the typical modus operandi of private equity is to load the acquired asset with debt, cut costs as a way to increase revenues, press for unnecessary procedures, then sell the asset typically in three to five years. This article describes that process, including the harmful impacts of private equity on health care, and summarizes what is being done to rein in the exploitive practices of private equity ownership.

Many of the simple and low-cost child diarrhea morbidities interventions, such as adequate home care, access to health care services, and improved sanitation and hygiene practices, are far beyond the reach of many households in developing countries, and Namibia is not an exception to this. In this study, a quantitative cross-sectional study design using a multivariable log-binomial model was used to examine the effect of household demographic characteristics on diarrhea morbidity in children aged zero to 48 months using data collected from the 2013 Namibia Demographic and Health Survey. Household demographic characteristics such as household's wealth index and main language spoken at home had lower risks on child diarrhea morbidity, while characteristics such as age of household head, toilet facilities shared with other households, current age of child, residency of the child, and child vaccination status had higher risks. The Namibian government, together with nongovernmental organizations, should make necessary vaccines interventions compulsory to prevent diarrheal diseases during the first few years of the child's life and continuously enhance initiatives that invest in good sanitation and hygiene infrastructure within Rukwangali- and Lozi-speaking communities in the country.

Hailed as a major reform, the No Surprises Act (NSA) is a profoundly conservative law that aims neither to reform design of insurance, to regulate fees, nor to limit health care spending. The NSA mitigates a perverse but narrow problem: unpredictable and uncontrollable high out-of-pocket bills for individuals who are unable to receive care within their insurance network. However, the NSA neglects to address the broader high medical costs, limited choice of caregivers, and the resulting insecurity and unfairness that characterize American health care. It allows caregivers to extract high payments and insurers to restrict choice of caregivers. Insurers can continue to employ ineffective cost controls that generate unpredictable high out-of-pocket costs for patients-and high levels of denial of payments to doctors and hospitals. The law amputated the most politically and visibly gangrenous consequences of unregulated private insurance in the United States in ways that enable business as usual in private health insurance to persist, subject to unnecessarily complex arbitration rules that magnify administrative waste.

Health care is central to sustainable development, but it is underfunded in many developing countries such as Nigeria. This study empirically examined gender variations and inequity in health care financing in Southeast Nigeria. To decompose the Gini coefficient and analyze inequity by gender and differences in health care financing among states in the region, Dagum's approach for decomposition of the Gini coefficient is used. Empirical results showed that gender inequity exists in health care financing in Southeast Nigeria. In addition, variations in health care financing inequity among states in the Southeast region were found. Based on the foregoing, the study recommends that when implementing health care financing reforms, different population groups be covered in order to achieve the broader equity and effectiveness goals. Furthermore, governments in various states should step up efforts to assist disadvantaged and oppressed communities, such as poor indigenous people, in terms of health care utilization, which could reduce the health care financing burden.

The factors impacting life expectancy (LE) are important to a country as LE reflects the essential quality of its population. Previous studies showed that other than economic factors, health status and resources (HSR) and sociodemographic (SD) also affect LE. This area has not been previously studied in Bahrain, especially in the past five decades. Hence, this study aims to develop an explanatory model for HSR, macroeconomic (ME), and SD factors on LE in Bahrain. The research was a retrospective, time-series design that collected the annual published data on SD, ME, HSR, and LE in Bahrain's population from 1971 to 2020. The data were analyzed using the partial least squares-structural equation modeling (PLS-SEM) method. The result shows that ME (0.463, P < .001) and HSR (0.595, P < .001) have significant direct effects on LE. ME has an indirect effect (0.488, P < .001) on LE via SD and HSR, and SD has an indirect effect (0.496, P < .001) on LE through HSR. During the socioeconomic downturn, the health resources provision should not be reduced as it directly affects LE. An integrated policy addressing socioeconomic and health-related factors could protect the future of Bahrain's population health outcomes.

The objective of this article is to assess the dominant global economic system and the resulting power relations from the perspective of the strategies used worldwide against the SARS-CoV-2 pandemic. The predominantly biomedical approach has not sufficiently taken into account the actual dimension of COVID-19 as a syndemic. While the much longer-term pandemic caused by the neoliberalism virus has not been systematically considered by public and global health scholars in the context of COVID-19, it exhibits essential characteristics of an infectious pathogen, and the symptoms can be described and detected according to biomedical criteria. Even more, the severity of leading symptoms of neoliberalism such as growing inequities calls for immunization campaigns and ultimately herd immunity from viral neoliberalism. However, achieving worldwide immunity would require an anti-neoliberal vaccine, which is extremely challenging to develop vis-à-vis the power relations in global health.

In this article, we examine the effects of high temperatures on hospital visits and mortality in Finland. This provides new information of the topic in a context of predominantly cool temperatures. Unique, individual-level data are used to examine the relationship at the municipality-month level over a span of 20 years. Linear regression methods alongside high-dimensional fixed effects are used to minimize confounding variation. Analysis is conducted with special emphasis on the elderly population, as well as on specific elderly risk groups identified in previous literature. We show that for an additional day per month above 25°C, monthly all-cause mortality increases by 1.5 percent (95% CI: 0.4%-2.6%) and acute hospital visits increase by 1.1 percent (95% CI: 0.7%-1.6%). We also find some evidence that these effects are elevated in selected population subgroups, the low-income elderly, and people with dementia. Hospital visits also increase among younger age groups, illustrating the importance of using multiple health indicators. Such detailed evidence is important for identifying vulnerable groups as extreme heat waves are expected to become more frequent and intense in northern countries.