International Journal of Health Services最新文献

The coronavirus disease 2019 (COVID-19) pandemic has affected almost all countries and territories. As of December 6, 2020, the United States of America and India have the highest prevalence. Each country has implemented different strategies to control and reduce the spread of disease. Here, the association between prevalence number and health policies is evaluated by comparing 2 groups of countries: (1) Italy, the United States of America, Germany, Spain, and India with a higher prevalence than a linear trend line; and (2) Singapore and China with a lower or equal prevalence than linear forecasts. A rapid overview revealed that many countries have similar strategies for controlling COVID-19, including the suspension of air travel, the lockdown on the cities with the most cases detected, active case findings, monitoring of close contacts, and raising public awareness. Also, they used a gradual and phased plan to reopen activities. So, the difference between countries in the burden of COVID-19 can be attributable to the strict mode and nonstrict mode of implementation of strategies. Limitations at the national levels call for systemic rather than regional strategies.

Privatized Medicare Advantage has grown rapidly among seniors in the United States in recent years. It is now being promoted actively by corporate stakeholders and even by the Centers for Medicare and Medicaid Services itself as a new proposal to extend this approach to cover all Americans. There is little public awareness, however, of the current costs and adverse impacts of Medicare Advantage on enrollees' access, costs, and outcomes of care while deceptive marketing and disinformation prevails. This article traces the history of Medicare Advantage, outlines false assertions being made by proponents of Medicare Advantage for All, and refutes them based on evidence and their track record. If ever enacted, it would end up lining the pockets of corporate stakeholders and Wall Street investors while limiting access to care, increasing costs, and reducing quality and outcomes of care. The United States already ranks last for access, equity, and outcomes of care in periodic studies by the Commonwealth Fund. This proposal would worsen that situation while costing patients, families, and taxpayers more as their health suffers.

Despite South Asia's promising social inclusion processes, staggering social and health inequalities leave indigenous populations largely excluded. Marginalization in the South Asian polity, unequal power relations, and poor policy responses deter Adivasi populations' rights and opportunities for health gains and dignity. The ongoing COVID-19 pandemic is likely to result in a disproportionate share of infections and deaths among the Adivasis, given poor social conditions and exclusions. Poor health of indigenous people, inequalities between indigenous and non-indigenous groups, and failures in enforcing constitutional and legal provisions to reclaim indigenous land and cultural identity herald deeper structural and political fractures. This article unravels health inequalities between the Adivasis and non-Adivasi populations in their social context based on a critical review of secondary sources. We call for intersectoral policies and integrated health care services to address systemic inequalities, discrimination, power asymmetries, and consequent poor health outcomes. The current COVID-19 pandemic should be viewed as a window to pursue real change.

What can national governments do to improve their capacity for well-being? While increasing public medical care expenditures can facilitate increased well-being in developing nations, cross-national research often finds that public medical care expenditures have no effect on indicators of well-being, such as child mortality. This ineffective public spending could be due to a lack of governance; however, this relationship is understudied in the cross-national literature. Using 2-way fixed and generalized least squares random effects models for a sample of 74 low- and middle-income nations from 1996 to 2012, I examine how the interaction among 5 measures of national governance and public medical care expenditures impact child mortality. The findings reveal the importance of governance in determining the effectiveness of public medical care expenditures. Both public medical care expenditures and governance improvements are essential to reduce child mortality.

The recent events in Palestine-Israel once again have brought anger and frustration to people inside and outside the medical community. Especially for the pediatric community, the recent wars' toll of at least 67 children in the Gaza Strip and two children in Israel killed warrants attention. Armed conflicts have both direct effects on children's physical health and indirect harms through toxic stress and deprivation. During these troubling times, when civilians, including children, are dying and being mutilated because of conflict, it is crucial to understand the role of structural violence in perpetuating immediate violence. This article will shed light on the historical context of the recurrent wars and military aggressions in Palestine-Israel and contextualize them from a broader public health perspective.

The objective of this research was to systematically review and synthesize quantitative studies that assessed the association between socioeconomic inequalities and primary health care (PHC) utilization among older people living in low- and middle- income countries (LMICs). Six databases were searched, including Embase, Medline, Psych Info, Global Health, Latin American and Caribbean Health Sciences Literature (LILACS), and China National Knowledge Infrastructure, CNKI, to identify eligible studies. A narrative synthesis approach was used for evidence synthesis. A total of 20 eligible cross-sectional studies were included in this systematic review. The indicators of socioeconomic status (SES) identified included income level, education, employment/occupation, and health insurance. Most studies reported that higher income, higher educational levels and enrollment in health insurance plans were associated with increased PHC utilization. Several studies suggested that people who were unemployed and economically inactive in older age or who had worked in formal sectors were more likely to use PHC. Our findings suggest a pro-rich phenomenon of PHC utilization in older people living in LMICs, with results varying by indicators of SES and study settings.

The commercial determinants of health (CDoH) describe the adverse health effects associated with for-profit actors and their actions. Despite efforts to advance the definition, conceptualization, and empirical analyses of CDoH, the term's practical application to mitigate these effects requires the capacity to measure the influences of specific components of CDoH and the cumulative impacts of CDoH on the health and well-being of specific populations. Building on the Global Burden of Disease Study, we begin by conceptualizing CDoH as risk factor exposures that span agency and structural influences. We identify 6 components of these influences and propose an initial set of indicators and datasets to rank exposures as high, medium, or low. These are combined into a commercial determinants of health index (CDoHi) and illustrated by 3 countries. Although now a proof of concept, comparative analysis of CDoH exposures by population, over time and space, and their associated health outcomes will become possible with further development of indicators and datasets. Expansion of the CDoHi and application to varied populations groups will enable finer targeting of interventions to reduce health harms. The measurement of improvements to health and wellness from such interventions will, in turn, inform overall efforts to address the CDoH.

This article focuses on Canada's liberal welfare state and the COVID-19 pandemic, offering an overview of some of the unequal health and social effects of the crisis. It argues that the policy response to the pandemic should be situated within a broader pattern of welfare restructuring and organization that serves to instrumentalize economic insecurity and extend labor discipline. Without making firm predictions about the future, we argue that this is likely to reproduce increasingly unequal patterns of welfare access, providing benefits to some constituents while disciplining vulnerable groups to facilitate competitive gains.

Sweden has since the start of the pandemic a COVID-19 mortality rate that is 4 to 10 times higher than in the other Nordic countries. Also, measured as age-standardized all-cause excess mortality in the first half of 2020 compared to previous years Sweden failed in comparison with the other Nordic countries, but only among the elderly. Sweden has large socioeconomic and ethnic inequalities in COVID-19 mortality. Geographical, ethnic, and socioeconomic inequalities in mortality can be due to differential exposure to the virus, differential immunity, and differential survival. Most of the country differences are due to differential exposure, but the socioeconomic disparities are mainly driven by differential survival due to an unequal burden of comorbidity. Sweden suffered from an unfortunate timing of tourists returning from virus hotspots in the Alps and Sweden's government response came later and was much more limited than elsewhere. The government had an explicit priority to protect the elderly in nursing and care homes but failed to do so. The staff in elderly care are less qualified and have harder working conditions in Sweden, and they lacked adequate care for the clients. Sweden has in recent years diverged from the Scandinavian welfare model by strong commercialization of primary care and elderly care.

This rapid scoping review has informed the development of the UN Research Roadmap for the COVID-19 Recovery on the topic of "Ensuring Social Protection and Basic Services." The aim was to provide a robust synthesis of key concepts and existing evidence drawn from a wide range of disciplines to support the identification and appraisal of research priorities. An emergent theme has been the notion that measures implemented in response to COVID-19 merely ameliorate symptoms of entrenched, systemic gender-, age-, and race-based inequity, inequality, and exclusion. Key findings include the critical role of contextual and community-based knowledge for informing the design, development, and delivery of programs, as well as the urgent need for implementation science to move existing knowledge into action. This review also describes how the disruption associated with "shock events" such as the COVID-19 pandemic is often associated with unusually high levels of interest and willingness to invest in programs and policies to strengthen strained systems. As such, an unprecedented window of opportunity exists to leverage measures implemented in response to the COVID-19 pandemic to effect large-scale, sustainable change and thereby increase the resiliency of our interconnected systems for the future.