International journal of social determinants of health and health services最新文献

Little is known about nursing home (NH) financial status in the United States even though most NH care is publicly funded. To address this gap, this descriptive study used 2019 Medicare cost reports to examine NH revenues, expenditures, net income, related-party expenses, expense categories, and capital structure. After a cleaning process for all free-standing NHs, a study population of 11,752 NHs was examined. NHs had total net revenues of US$126 billion and a profit of US$730 million (0.58%) in 2019. When US$6.4 billion in disallowed costs and US$3.9 billion in non-cash depreciation expenses were excluded, the profit margin was 8.84 percent. About 77 percent of NHs reported US$11 billion in payments to related-party organizations (9.54% of net revenues). Overall spending for direct care was 66 percent of net revenues, including 27 percent on nursing, in contrast to 34 percent spent on administration, capital, other, and profits. Finally, NHs had long-term debts that outweighed their total available financing. The study shows the value of analyzing cost reports. It indicates the need to ensure greater accuracy and completeness of cost reports, financial transparency, and accountability for government funding, with implications for policy changes to improve rate setting and spending limits.

To understand the mechanism of health inequities and their influence on maternal health, the Commission on Social Determinants of Health (CSDH) provides a framework to identify structural and intermediate causes of health inequity. This review maps and describes the current socioeconomic determinants of maternal health in Morocco according to the CSDH framework. A scoping study was carried out from six databases (Springer, Web of Science, Pubmed, Science Direct, Jstor, and Cochrane library) based on quantitative and qualitative research done since 1990. Structural factors such as women's employment and economic status, education level, culture, and gender equity were influenced by intermediary factors such as place of residence, age at marriage, maternal age at childbirth, and parity (either alone or in conjunction with other variables). Together these factors worked to influence maternal health service usage or affected maternal health outcomes. Power dynamics were identified in a variety of social situations that impacted access to health care for women across socioeconomic categories. Studies reveal how social determinants impact maternal health in Morocco. Addressing these determinants is required for sustainably improving maternal and infant health in Morocco.

This study examined different barriers to the access and utilization of primary health care services by the elderly in the occupied Palestinians territories. We collected quantitative data from a larger convenience sample of a national survey of 1299 persons in the occupied Palestinian territories (oPt) that examined the effects of Israel's colonization and its effects on health care delivery between October 2021 and February 2022. The research tool was based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questionnaire. The data was obtained from 76 elderly participants with a mean age of 68.33 years standard deviation (SD = 7.09 years). The majority (75%) reported having at least one chronic health issue and having limited access to health care. They had all finished at least six years of education. The participants claimed having health insurance, while 47.4 percent reported paying for out-of-pocket expenses and medical care was a burden. Access and affordability of health care was a problem for 70 percent of participants. Older persons and their families face access to care issues created by political, geographic, and economic barriers. Poor incomes, war-like conditions, a weak health care system, and a lack of comprehensive care delivery all impact their health.

Many researchers, consumer groups, activists and civil society organizations agree that the pharmaceutical sector has been left too much to the private sector, which is solely driven by a profit motive. Therefore, it is imperative to take a bold initiative to turn the idea of medicine, pharmaceutical products, and health technology as a common good into a reality. We propose to establish a European institute that can oversee an ambitious research portfolio. This institute can provide research grants or do in-house research but, in any case, any intellectual property rights emanating from the research will have to be shared in the interest of the public good. A collective knowledge pool, where all results and technological knowledge are gathered and shared, will likewise be part of the institute. Any final product developed within the Institute will be subject to an open license. We ensure that all necessary data and information remain public and that know-how about the production of a medicine can be passed on to those who need it. Finally, this institute should have a focus on production and distribution. Price, quality, availability and even working conditions of the staff will be criteria in any bidding process.

Despite overwhelming international evidence of elevated rates of poor mental health in LGBTQ+ youth compared to their cis-heterosexual peers, we know relatively little about effective mental health services for this population group. This study aims to produce the first early intervention model of "what works" to support LGBTQ+ youth with emerging mental health problems. Utilizing a mixed method case study, we collected data across 12 UK mental health service case study sites that involved: (a) interviews with young people, parents, and mental health practitioners (n = 93); (b) documentary analysis; (c) nonparticipant observation. The data analysis strategy was theoretical using the "explanation-building" analytical technique. Our analysis suggests an intersectional youth rights approach with 13 principles that must be enacted to provide good mental health services as advocated by the United Nations Convention on the Rights of the Child and World Health Organization. This approach should address the multiple forms of marginalization and stigmatization that LGBTQ+ youth may experience, enable informed independent decision-making, and uphold the right to freedom of safe self-expression. A rights-based approach to mental health services for LGBTQ+ young people is not prominent. This needs to change if we are to tackle this mental health inequality and improve the mental well-being of LGBTQ+ youth worldwide.

Health services research is underpinned by partnerships between researchers and health services. Partnership-based research is increasingly needed to deal with the uncertainty of global pandemics, climate change induced severe weather events, and other disruptions. To date there is very little data on what has happened to health services research during the COVID-19 pandemic. This paper describes the establishment of an Australian multistate Decolonising Practice research project and charts its adaptation in the face of disruptions. The project used cooperative inquiry method, where partner health services contribute as coresearchers. When the COVID-19 pandemic hit, data collection needed to be immediately paused, and when restrictions started to lift, all research plans had to be renegotiated with services. Adapting the research surfaced health service, university, and staffing considerations. Our experience suggests that cooperative inquiry was invaluable in successfully navigating this uncertainty and negotiating the continuance of the research. Flexible, participatory methods such as cooperative inquiry will continue to be vital for successful health services research predicated on partnerships between researchers and health services into the future. They are also crucial for understanding local context and health services priorities and ways of working, and for decolonising Indigenous health research.

Over the past two decades, depression has become a prominent global public health concern, especially in low- and middle-income countries (LMICs). The World Health Organization (WHO) and the Movement for Global Mental Health have developed international guidelines to improve mental health services globally, prioritizing LMICs. These efforts hold promise for advancing care and treatment for depression and other mental, neurological, and substance abuse disorders in LMICs. The intervention guides, such as the WHO's mhGAP-Intervention Guides, are evidence-based tools and guidelines to help detect, diagnose, and manage the most common mental disorders. Using the Global South as an empirical site, this article draws on Foucauldian critical discourse and document analysis methods to explore how these international intervention guides operate as part of knowledge-power processes that inscribe and materialize in the world in some forms rather than others. It is proposed that these international guidelines shape the global discourse about depression through their (re)production of biopolitical assumptions and impacts, governmentality, and "conditions of possibility." The article uses empirical data to show nuance, complexity, and multi-dimensionality where binary thinking sometimes dominates, and to make links across arguments for and against global mental health. The article concludes by identifying several resistive discourses and suggesting reconceptualizing the treatment gap for common mental disorders.

We sought to determine whether a country's social policy configuration-its welfare state regime-is associated with food insecurity risk. We conducted a cross-sectional study of 2017 U.N. Food and Agriculture Organization individual-level food insecurity survey data from 19 countries (the most recent data available prior to COVID-19). Countries were categorized into three welfare state regimes: liberal (e.g., the United States), corporatist (e.g., Germany), or social democratic (e.g., Norway). Food insecurity probability, calibrated to an international reference standard, was calculated using a Rasch model. We used linear regression to compare food insecurity probability across regime types, adjusting for per-capita gross domestic product, age, gender, education, and household composition. There were 19,008 participants. The mean food insecurity probability was 0.067 (SD: 0.217). In adjusted analyses and compared with liberal regimes, food insecurity probability was lower in corporatist (risk difference: -0.039, 95% CI -0.066 to -0.011, p  =  .006) and social democratic regimes (risk difference: -0.037, 95% CI -0.062 to -0.012, p  =  .004). Social policy configuration is strongly associated with food insecurity risk. Social policy changes may help lower food insecurity risk in countries with high risk.

As in other countries, the growth of precarious work arrangements in Australia from the late 1970s has had significant adverse effects on occupational health and safety (OHS). While there is now a large body of global research on this issue and its connection to the rise of neoliberalism, there has been less investigation of efforts to address these problems. This article reviews regulatory interventions in Australia over the past two decades. It particularly focuses on industrial relations regulation, which can play a critical role in addressing at least some of the underlying reasons why precarious work undermines OHS. The most significant of these changes were passed by the Australian Parliament in February 2024, including a highly controversial but world-leading creation of minimum standards for platform workers.