Objective:The scarcity of healthcare resources and inadequate access to medical services in rural and remote areas are pervasive challenges many countries face,particularly in the developing world.Telemedicine,with it...Objective:The scarcity of healthcare resources and inadequate access to medical services in rural and remote areas are pervasive challenges many countries face,particularly in the developing world.Telemedicine,with its capacity to overcome geographical barriers and provide patients with real‐time medical services,has shown considerable potential in addressing these issues,attracting wide-spread attention.Compact medical communities and family doctor systems play important roles in improving healthcare accessibility.However,despite the critical nature of patients'perceptions of healthcare accessibility,research in this domain is sparse.This study aimed to explore the impact of telemedicine on rural residents'perceived healthcare accessibility in China,analyze the mechanisms underpinning this relationship,and elucidate the roles of compact medical communities and the family doctor system.Methods:Survey data from 3311 rural residents were analyzed using a probit model,instrumental variables,and subgroup regression analyses to ascertain causal effects,perform heterogeneity analysis,examine mechanisms,and ascertain the robustness of the findings.Results:Telemedicine significantly enhanced rural residents'perceived healthcare accessibility,with particularly notable benefits for those in sparsely populated areas,regions with high‐speed internet access,within the purview of compact healthcare consortiums,and those with access to family doctor services.Furthermore,telemedicine improved rural residents'perceived healthcare accessibility by encouraging the use of primary care services.Conclusion:Telemedicine in China has played a significant role in improving the perceived healthcare accessibility among rural residents and aiding in the reduction of disparities in accessibility across different demographic groups.This is consistent with the broader objective of achieving universal health coverage.However,the efficacy of telemedicine in enhancing healthcare accessibility is contingent upon certain preconditions.Policymakers must confront local infrastructure challenges,particularly regarding internet connectivity,when expanding telemedicine services to ensure their effective operation.The synergistic interaction observed between telemedicine,the family doctor system,and compact medical communities highlights the importance of integrating telemedicine into existing healthcare systems.Such integration could enhance collaboration with current healthcare frameworks,ensuring the provision of safe,accessible,and affordable healthcare services,and promoting the health and well‐being of local populations.展开更多
Access tohealthcare services using public transportation(PT-based healthcareaccessibility)is a crucial aspect in achieving healthcare equity as it affects individuals’ability to receive healthcare.Previous research h...Access tohealthcare services using public transportation(PT-based healthcareaccessibility)is a crucial aspect in achieving healthcare equity as it affects individuals’ability to receive healthcare.Previous research has focused on the spatial features of healthcare accessibility.However,less attention has been given to its temporal characteristics,which can be influenced by transit schedules,multimodal connectivity,congestion,and other factors.This study proposes a framework to better understand the impacts of temporally varying PT-based healthcare accessibility on healthcare equity.A case study of Shanghai,China is used to illustrate the temporal variation of healthcare accessibility,with a focus on hourly inter-and intra-regional disparities.These disparities are captured using the Gini coefficient and Theil index.Additionally,the study introduces bivariate local Moran’s I to identify healthcare shortage areas and evaluate the spatial autocorrelation between population den sity and healthcare accessibility.The findings of this study reveal that the accessibility to healthcare services experiences significant fluctuations throughout the day,leading to tem poral variations in healthcare equity.Subway service quality contributes more to temporal variations than bus service quality.The lowest point of such equity is reached when PT operates at its full capacity.On a spatial level,individuals residing in newly developed regions,which surround the historical urban core or recently planned city subcenters,tend to experience decreased accessibility to healthcare via public transportation.Consequently,it results in a heightened reliance on motorized transportation inthese areas.These findings provide insights that can inform the design of PT accessibility-based strategies,healthcare improvement plans and inclusive housing policies,to address healthcare equity issues in metropolitan areas.By considering both spatial and temporal factors,we can better understand the complex relationships between transportation and healthcare accessibility to promote equitable access to healthcare services and foster social equity.展开更多
Socioeconomic development,subsidence,and climate change have led to high flood risks in coastal cities,making the vulnerable,especially elderly people,more prone to floods.However,we mostly do not know how the accessi...Socioeconomic development,subsidence,and climate change have led to high flood risks in coastal cities,making the vulnerable,especially elderly people,more prone to floods.However,we mostly do not know how the accessibility of life-saving public resources for the elderly population will change under future scenarios.Using Shanghai as a case,this study introduced a new analytical framework to fill this gap.We integrated for the first time models of coastal flooding,local population growth,and medical resource supply-demand estimation.The results show that under an extreme scenario of coastal flooding in the year 2050,in the absence of adaptation,half of the elderly population may be exposed to floods,the supply of medical resources will be seriously insufficient compared to the demand,and the accessibility of emergency medical services will be impaired by flooding.Our methodology can be applied to gain insights for other vulnerable coastal cities,to assist robust decision making about emergency responses to flood risks for elderly populations in an uncertain future.展开更多
Measuring vulnerability to COVID-19 and healthcare accessibility at the fine-grained level serves as the foundation for spatially explicit health planning and policy making in response to future public health crises.H...Measuring vulnerability to COVID-19 and healthcare accessibility at the fine-grained level serves as the foundation for spatially explicit health planning and policy making in response to future public health crises.However,the evaluation of vulnerability and healthcare accessibility is insufficient in Japan-a nation with high population density and super-aging challenges.Drawing on the 2022 census data,transport network,medical and digital cadastral data,land use maps,and points of interest data,our study extends the concept of vulnerability in the context of COVID-19 and constructs the first fine-grained measure of vulnerability and healthcare accessibility in Tokyo Metropolis,Japan-the most populated metropolitan region in the world.We delineate the vulnerable neighbourhoods with low healthcare access and further evaluate the disparity in healthcare access and built environment of areas at different levels of vulnerability.Our outcome datasets and findings provide nuanced and timely evidence to government and health authorities to have a holistic and latest understanding of social vulnerability to COVID-19 and healthcare access at a fine-grained level.Our analytical framework can be employed in different geographic contexts,guiding through place-based health planning and policy making in the post-COVID era and beyond.展开更多
Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If langua...Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If language is missing for female genitalia or important female sexual functions, could this absence reflect on the position of women in society, reproductive rights, and access to healthcare? Is there a relationship between language and the high rates of the gender-based cervical and breast cancers in some low and middle-income countries? This commentary examines scholarship on the topic of language, the female body, gender-based violence, disparities of healthcare for women, and the consequences of language on sexual attitudes and health.展开更多
The Universal Declaration of Human Rights refers to the human right to health and well-being including medical care, but for the majority of people whom are not covered by health insurance this is better said than don...The Universal Declaration of Human Rights refers to the human right to health and well-being including medical care, but for the majority of people whom are not covered by health insurance this is better said than done. Ensuring the access of all citizens to the needed medical care requires the provision of health insurance coverage to a population pool and gradually expanding the pool to the whole nation. The ethical perspective of pooling resources across various groups of people with different levels of income and different health risks associated with age, genetics, and lifestyle, may raise the issue of individual autonomy versus social solidarity. Governmental, social, private, and community-based healthcare coverage have been used in different countries with varying details in the sources of funding, pooling of contributions, and the purchase of the covered healthcare services; these models have had varying levels of success depending on not only the availability of funds, but also on the political commitment of the state and the social solidarity and cultural attitude of the population towards universal healthcare. Therefore, universal healthcare requires not only a certain level of economic development, but also a strong sense of solidarity among the people as well as a political commitment in their government. I argue that the statement regarding the right to health, well-being, and medical care needs to be rethought, and instead universal access to essential healthcare should be regarded as a basic human right.展开更多
Purpose: Malaria continues to be a public health threat, especially in sub-Saharan Africa, including Uganda. While Batwa Indigenous People (IPs) face a higher burden of malaria, there is limited understanding of their...Purpose: Malaria continues to be a public health threat, especially in sub-Saharan Africa, including Uganda. While Batwa Indigenous People (IPs) face a higher burden of malaria, there is limited understanding of their malaria-lived experiences. We assessed and characterized malaria illness and accessing healthcare lived experiences of the Batwa in Kanungu district to inform contextually and culturally appropriate public health interventions. Methods: An exploratory qualitative study was conducted in 5 Batwa settlements where 5 Focus Group Discussions (n = 36) and 13 Key Informant Interviews (n = 13) were held. Data were collected using printed guides and voice recorders in April 2018. Transcripts from the data that captured the lived experiences of the symptoms, prevention, treatment and barriers to accessing formal healthcare services were applied to Atlas.ti a qualitative data analysis software and condensed into codes, categories, and themes. Results: Many Batwa have experienced malaria in their households, and they know its causes and risk factors, like not sleeping under insecticide-treated mosquito nets (ITNs), living near water bodies, prevention measures like the use of ITNs, and vector management. The lived experiences demonstrate malaria management by an Indigenous population in a rural setting and comprised detecting malaria symptoms, use of herbs as first line of treatment, buying medicines from drug shops, and village health teams (VHTs) treatment. For many Batwa accessing formal healthcare is normally a second option. Barriers for malaria treatment included: long distances to health facilities, geographically difficult terrain, economic constraints, irregular health outreaches, and stockouts of malaria medicines at health facilities. Conclusion: This study characterized Batwa’s malaria illness lived experiences and access to healthcare in rural remote settings. These experiences are essential in appreciating the ways in which Indigenous populations understand and manage common illnesses and how appropriate policies and interventions can be developed.展开更多
Background:Telehealth has emerged as a powerful tool for managing chronic diseases and mental health conditions,offering increased access to care and improved patient outcomes.However,inequities in digital connectivit...Background:Telehealth has emerged as a powerful tool for managing chronic diseases and mental health conditions,offering increased access to care and improved patient outcomes.However,inequities in digital connectivity and technological resources have created significant disparities in access to these potentially life-changing services,disproportionately impacting marginalized and minoritized communities across the globe.Methods:Data on 473,716 telehealth encounters occurring between January 1,2022,and June 30,2023 were retrieved from the electronic health records(EHR)system used by University Hospitals.These encounters were classified into three groups:attended,canceled,and no-show.Relative risk was calculated based on age,sex,and race,and a multivariate linear regression was performed with age,sex,and race as inputs,to determine their effect on the encounter outcome.Results:Our analysis identified significant differences in relative risk between demographic groups.Patients 20-39 years of age had a high relative risk of cancellation and no-show,and Black patients demonstrated the highest relative risk for cancellation and no-show.The regression analysis illustrated a statistically significant link between no-shows and patients with a cellular plan with no other internet subscription(p<0.001),smartphone ownership(p<0.001),and not having a computer(p<0.05).Conclusions:This study highlights the clinical repercussions of the digital divide,as patients relying on a mobile phone and data plan to attend telehealth visits were more likely to no-show.Current disparities in digital connectivity for historically marginalized populations heightens the risk of creating a digital underclass.There is evidence this study may be applicable in multiple countries across the world.Further research on the causes of the observed no-shows is necessary to ensure equitable delivery of digital healthcare services.展开更多
Background:Rural populations in the UK face healthcare inequities despite the NHS’s aim of providing universal healthcare.These disparities include restricted access,transportation challenges,and healthcare workforce...Background:Rural populations in the UK face healthcare inequities despite the NHS’s aim of providing universal healthcare.These disparities include restricted access,transportation challenges,and healthcare workforce shortages,resulting in delayed care and poorer health outcomes.This research aims to investigate the use of telemedicine in rural areas of the United Kingdom to improve access to healthcare facilities.Methods:The research process combines a systematic literature review with a thematic analysis using open coding.The results were presented through thematic representation from an open-coding method,following an established search strategy,inclusion/exclusion criteria,a two-step screening procedure,and data extraction.The PRISMA framework was used to screen the articles for the research.Results:Findings reveal that telemedicine significantly improves access to healthcare in rural areas by reducing travel barriers,enhancing mental health services,and increasing patient engagement.Studies highlight its expanding use during pandemics,cross-border reach,and beneficial effects on mental health services.Digital literacy programs and targeted resource distribution were identified as critical to maximizing the effectiveness of telemedicine.Measures like digital literacy and equitable resource allocation are called for in response to issues like specialized care delivery and equitable access.Together,these projects present a thorough strategy for using telemedicine’s promise of equal access to healthcare in rural areas.Conclusion:Even though studies show that telemedicine was used more frequently during the epidemic,the review underscores the need for enhanced digital literacy and infrastructure to ensure equitable access.Difficulties,including legal complications,a lack of technological literacy,and communication obstacles,still exist.Initiatives to promote digital literacy,fair resource distribution,and regulatory changes for smooth integration are highlighted in the suggested solutions.Overall,telemedicine holds the potential to significantly reduce healthcare disparities in rural areas,provided these challenges are addressed.展开更多
BACKGROUND As a consequence of the economic crisis,the sociopolitical instability and the advent of the coronavirus disease-19 pandemic,nested challenges faced the Lebanese healthcare system.These have resulted in cri...BACKGROUND As a consequence of the economic crisis,the sociopolitical instability and the advent of the coronavirus disease-19 pandemic,nested challenges faced the Lebanese healthcare system.These have resulted in critical shortages of essential resources,including medications vital for oncologic patients.AIM To assess the ramifications of the ongoing economic crisis on oncology patient care focusing on our outpatient oncology department.METHODS A questionnaire was distributed during the month of February 2022 to oncology patients in Hôtel Dieu de France University Hospital in Beirut during their outpatient therapy.The primary objective was to assess the far-reaching impact of the economic crisis on patient care and the resulting psychological implications.RESULTS Among 182 interviewed patients,31.87%experienced treatment interruption mainly due to acute drug shortages.Despite 87.91%of the patients benefiting from third-party coverage,69.60%had to self-pay for their medications leading to 69.78%of patients perceiving that healthcare was more difficult to access after 2020.Psychologically,one-third of the patients exhibited symptoms of anxiety and/or depression,with 7 patients reporting suicidal ideations.Notably,37.93%of patients who interrupted cancer treatment reported a history of comorbidities,and 89.66%who altered their treatment cited financial difficulties.CONCLUSION Lebanese cancer patients face complex challenges spanning economic,healthcare,and psychological realms.Income inequalities exacerbated by the economic crisis hindered healthcare access.展开更多
Background:Hepatitis C (HCV) direct acting antiviral agents (DAAs) are safe,effective,and tolerable.Most contraindications to interferon-based treatment are no long applicable.The aims of this study were to understand...Background:Hepatitis C (HCV) direct acting antiviral agents (DAAs) are safe,effective,and tolerable.Most contraindications to interferon-based treatment are no long applicable.The aims of this study were to understand the predictors of approval to drug accessibility.Methods:We studied all consecutive patients with HCV prescribed DAAs between October 2014 and July 2015.Data on demographic,socioeconomic status,comorbidities,baseline laboratory values,and assessment of liver disease severity,insurance,and specialty pharmacy type were collected.Multivariate analyses were performed to identify predictors of prescription approval.Results:In total,410 patients were prescribed DAAs between October 2014 and July 2015.Of those,332 (81%) patients were insurance approved for therapy.Of the 332 patients accepted,251 were accepted after the first prescription attempt,and 38 were accepted after the second and third attempts.The number of attempts for the other 43 approved patients was unknown.Older age (p =0.001),employment (p =0.001),lack of comorbidities (p =0.02),liver transplantation (p =0.018),and advanced liver disease (p =0.001)were more likely associated with obtaining approval.Household income was not associated with insurance approval.In the multivariate analysis,Medicare insurance (odds ratio [OR]) 2.67,95% confidence interval [CI] 0.96-7.20),lack of nonliver comorbidities (OR 2.72,95% CI 1.35-5.43),and the presence of advanced liver disease (OR 1.82,95% CI 1.04-3.24) independently predicted drug approval.Conclusion:Despite the availability of DAAs for HCV,barriers from insurance carriers continue to impair widespread use.Patients with advanced liver disease,Medicare,and without comorbidities are most likely to be insurance approved for DAAs.展开更多
This article develops a comparative analysis of healthcare provision to migrants in the US and in China.It proceeds in three parts.First,we begin by describing the growth of the unauthorized population and trace the e...This article develops a comparative analysis of healthcare provision to migrants in the US and in China.It proceeds in three parts.First,we begin by describing the growth of the unauthorized population and trace the evolution of social provision of healthcare to immigrants,highlighting the restrictive nature of federal social provisions and greater autonomy of state and local governments in redefining eligibility criteria in the US.Second,we examine the impact of legal status on healthcare access and utilization among Mexicans,using original data from the 2007 Hispanic Healthcare Survey and the Mexican Migration Project.We find that unauthorized immigrants report the lowest level of healthcare access and utilization.Third,we then outline a China-US comparative agenda,pointing to similarities between the two migrant flows.In China,recent developments of healthcare coverage for both rural and urban populations have increased access to healthcare,but rural-to-urban migrants still report many barriers in receiving care and are often left out of this growing safety net.We then close with a discussion of lessons learned from the US experience and remaining questions for future comparative research.展开更多
Background:A major impediment to the treatment of TB is a diagnostic process that requires multiple visits.Descriptions of patient costs associated with diagnosis use different protocols and are not comparable.Methods...Background:A major impediment to the treatment of TB is a diagnostic process that requires multiple visits.Descriptions of patient costs associated with diagnosis use different protocols and are not comparable.Methods:We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis.Surveys of 2225 adults attending smear-microscopy centres in Nigeria,Nepal,Ethiopia and Yemen.Adults>18 years with cough>2 weeks were enrolled prospectively.Direct costs were quantified using structured questionnaires.Patients with costs>75^(th) quartile were considered to have high expenditure(cases)and compared with patients with costs<75^(th) quartile to identify factors associated with high expenditure.Results:The most significant expenses were due to clinic fees and transport.Most participants attended the centres with companions.High expenditure was associated with attending with company,residing in rural areas/other towns and illiteracy.Conclusions:The costs incurred by patients are substantial and share common patterns across countries.Removing user fees,transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs.In locations with limited resources,support could be prioritised for those most at risk of high expenditure;those who are illiterate,attend the service with company and rural residents.展开更多
基金supported by the China National Health Development Rescarch Center Study on Total Health Insurance Package Payment and National Office for Philosophy and Social Sciences,National Social Science Fund of China(17ZDA121)Tsinghua University Dushi Program(2024Z11DSZ001).
文摘Objective:The scarcity of healthcare resources and inadequate access to medical services in rural and remote areas are pervasive challenges many countries face,particularly in the developing world.Telemedicine,with its capacity to overcome geographical barriers and provide patients with real‐time medical services,has shown considerable potential in addressing these issues,attracting wide-spread attention.Compact medical communities and family doctor systems play important roles in improving healthcare accessibility.However,despite the critical nature of patients'perceptions of healthcare accessibility,research in this domain is sparse.This study aimed to explore the impact of telemedicine on rural residents'perceived healthcare accessibility in China,analyze the mechanisms underpinning this relationship,and elucidate the roles of compact medical communities and the family doctor system.Methods:Survey data from 3311 rural residents were analyzed using a probit model,instrumental variables,and subgroup regression analyses to ascertain causal effects,perform heterogeneity analysis,examine mechanisms,and ascertain the robustness of the findings.Results:Telemedicine significantly enhanced rural residents'perceived healthcare accessibility,with particularly notable benefits for those in sparsely populated areas,regions with high‐speed internet access,within the purview of compact healthcare consortiums,and those with access to family doctor services.Furthermore,telemedicine improved rural residents'perceived healthcare accessibility by encouraging the use of primary care services.Conclusion:Telemedicine in China has played a significant role in improving the perceived healthcare accessibility among rural residents and aiding in the reduction of disparities in accessibility across different demographic groups.This is consistent with the broader objective of achieving universal health coverage.However,the efficacy of telemedicine in enhancing healthcare accessibility is contingent upon certain preconditions.Policymakers must confront local infrastructure challenges,particularly regarding internet connectivity,when expanding telemedicine services to ensure their effective operation.The synergistic interaction observed between telemedicine,the family doctor system,and compact medical communities highlights the importance of integrating telemedicine into existing healthcare systems.Such integration could enhance collaboration with current healthcare frameworks,ensuring the provision of safe,accessible,and affordable healthcare services,and promoting the health and well‐being of local populations.
基金This study is supported by the National Natural Science Foundation of China(52272322)the Fundamental Research Funds for the Central Universities(22120220124,2022-5-YB-02,and 2023-4-YB-04).
文摘Access tohealthcare services using public transportation(PT-based healthcareaccessibility)is a crucial aspect in achieving healthcare equity as it affects individuals’ability to receive healthcare.Previous research has focused on the spatial features of healthcare accessibility.However,less attention has been given to its temporal characteristics,which can be influenced by transit schedules,multimodal connectivity,congestion,and other factors.This study proposes a framework to better understand the impacts of temporally varying PT-based healthcare accessibility on healthcare equity.A case study of Shanghai,China is used to illustrate the temporal variation of healthcare accessibility,with a focus on hourly inter-and intra-regional disparities.These disparities are captured using the Gini coefficient and Theil index.Additionally,the study introduces bivariate local Moran’s I to identify healthcare shortage areas and evaluate the spatial autocorrelation between population den sity and healthcare accessibility.The findings of this study reveal that the accessibility to healthcare services experiences significant fluctuations throughout the day,leading to tem poral variations in healthcare equity.Subway service quality contributes more to temporal variations than bus service quality.The lowest point of such equity is reached when PT operates at its full capacity.On a spatial level,individuals residing in newly developed regions,which surround the historical urban core or recently planned city subcenters,tend to experience decreased accessibility to healthcare via public transportation.Consequently,it results in a heightened reliance on motorized transportation inthese areas.These findings provide insights that can inform the design of PT accessibility-based strategies,healthcare improvement plans and inclusive housing policies,to address healthcare equity issues in metropolitan areas.By considering both spatial and temporal factors,we can better understand the complex relationships between transportation and healthcare accessibility to promote equitable access to healthcare services and foster social equity.
基金funded by the National Natural Science Foundation of China(Grant Nos.41971199,42371088,42171080)the National Social Science Foundation of China(Grant No.18ZDA105)+1 种基金the financial support from the program of China Scholarships Council(Grant No.202206140063)the East China Normal University Academic Innovation Promotion Program for Excellent Doctoral Students(Grant No.YBNLTS2023-003)。
文摘Socioeconomic development,subsidence,and climate change have led to high flood risks in coastal cities,making the vulnerable,especially elderly people,more prone to floods.However,we mostly do not know how the accessibility of life-saving public resources for the elderly population will change under future scenarios.Using Shanghai as a case,this study introduced a new analytical framework to fill this gap.We integrated for the first time models of coastal flooding,local population growth,and medical resource supply-demand estimation.The results show that under an extreme scenario of coastal flooding in the year 2050,in the absence of adaptation,half of the elderly population may be exposed to floods,the supply of medical resources will be seriously insufficient compared to the demand,and the accessibility of emergency medical services will be impaired by flooding.Our methodology can be applied to gain insights for other vulnerable coastal cities,to assist robust decision making about emergency responses to flood risks for elderly populations in an uncertain future.
基金funded by the Japan Society for the Promotion of Science KAKENHI research grant(JP22F21725).
文摘Measuring vulnerability to COVID-19 and healthcare accessibility at the fine-grained level serves as the foundation for spatially explicit health planning and policy making in response to future public health crises.However,the evaluation of vulnerability and healthcare accessibility is insufficient in Japan-a nation with high population density and super-aging challenges.Drawing on the 2022 census data,transport network,medical and digital cadastral data,land use maps,and points of interest data,our study extends the concept of vulnerability in the context of COVID-19 and constructs the first fine-grained measure of vulnerability and healthcare accessibility in Tokyo Metropolis,Japan-the most populated metropolitan region in the world.We delineate the vulnerable neighbourhoods with low healthcare access and further evaluate the disparity in healthcare access and built environment of areas at different levels of vulnerability.Our outcome datasets and findings provide nuanced and timely evidence to government and health authorities to have a holistic and latest understanding of social vulnerability to COVID-19 and healthcare access at a fine-grained level.Our analytical framework can be employed in different geographic contexts,guiding through place-based health planning and policy making in the post-COVID era and beyond.
文摘Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If language is missing for female genitalia or important female sexual functions, could this absence reflect on the position of women in society, reproductive rights, and access to healthcare? Is there a relationship between language and the high rates of the gender-based cervical and breast cancers in some low and middle-income countries? This commentary examines scholarship on the topic of language, the female body, gender-based violence, disparities of healthcare for women, and the consequences of language on sexual attitudes and health.
文摘The Universal Declaration of Human Rights refers to the human right to health and well-being including medical care, but for the majority of people whom are not covered by health insurance this is better said than done. Ensuring the access of all citizens to the needed medical care requires the provision of health insurance coverage to a population pool and gradually expanding the pool to the whole nation. The ethical perspective of pooling resources across various groups of people with different levels of income and different health risks associated with age, genetics, and lifestyle, may raise the issue of individual autonomy versus social solidarity. Governmental, social, private, and community-based healthcare coverage have been used in different countries with varying details in the sources of funding, pooling of contributions, and the purchase of the covered healthcare services; these models have had varying levels of success depending on not only the availability of funds, but also on the political commitment of the state and the social solidarity and cultural attitude of the population towards universal healthcare. Therefore, universal healthcare requires not only a certain level of economic development, but also a strong sense of solidarity among the people as well as a political commitment in their government. I argue that the statement regarding the right to health, well-being, and medical care needs to be rethought, and instead universal access to essential healthcare should be regarded as a basic human right.
文摘Purpose: Malaria continues to be a public health threat, especially in sub-Saharan Africa, including Uganda. While Batwa Indigenous People (IPs) face a higher burden of malaria, there is limited understanding of their malaria-lived experiences. We assessed and characterized malaria illness and accessing healthcare lived experiences of the Batwa in Kanungu district to inform contextually and culturally appropriate public health interventions. Methods: An exploratory qualitative study was conducted in 5 Batwa settlements where 5 Focus Group Discussions (n = 36) and 13 Key Informant Interviews (n = 13) were held. Data were collected using printed guides and voice recorders in April 2018. Transcripts from the data that captured the lived experiences of the symptoms, prevention, treatment and barriers to accessing formal healthcare services were applied to Atlas.ti a qualitative data analysis software and condensed into codes, categories, and themes. Results: Many Batwa have experienced malaria in their households, and they know its causes and risk factors, like not sleeping under insecticide-treated mosquito nets (ITNs), living near water bodies, prevention measures like the use of ITNs, and vector management. The lived experiences demonstrate malaria management by an Indigenous population in a rural setting and comprised detecting malaria symptoms, use of herbs as first line of treatment, buying medicines from drug shops, and village health teams (VHTs) treatment. For many Batwa accessing formal healthcare is normally a second option. Barriers for malaria treatment included: long distances to health facilities, geographically difficult terrain, economic constraints, irregular health outreaches, and stockouts of malaria medicines at health facilities. Conclusion: This study characterized Batwa’s malaria illness lived experiences and access to healthcare in rural remote settings. These experiences are essential in appreciating the ways in which Indigenous populations understand and manage common illnesses and how appropriate policies and interventions can be developed.
文摘Background:Telehealth has emerged as a powerful tool for managing chronic diseases and mental health conditions,offering increased access to care and improved patient outcomes.However,inequities in digital connectivity and technological resources have created significant disparities in access to these potentially life-changing services,disproportionately impacting marginalized and minoritized communities across the globe.Methods:Data on 473,716 telehealth encounters occurring between January 1,2022,and June 30,2023 were retrieved from the electronic health records(EHR)system used by University Hospitals.These encounters were classified into three groups:attended,canceled,and no-show.Relative risk was calculated based on age,sex,and race,and a multivariate linear regression was performed with age,sex,and race as inputs,to determine their effect on the encounter outcome.Results:Our analysis identified significant differences in relative risk between demographic groups.Patients 20-39 years of age had a high relative risk of cancellation and no-show,and Black patients demonstrated the highest relative risk for cancellation and no-show.The regression analysis illustrated a statistically significant link between no-shows and patients with a cellular plan with no other internet subscription(p<0.001),smartphone ownership(p<0.001),and not having a computer(p<0.05).Conclusions:This study highlights the clinical repercussions of the digital divide,as patients relying on a mobile phone and data plan to attend telehealth visits were more likely to no-show.Current disparities in digital connectivity for historically marginalized populations heightens the risk of creating a digital underclass.There is evidence this study may be applicable in multiple countries across the world.Further research on the causes of the observed no-shows is necessary to ensure equitable delivery of digital healthcare services.
文摘Background:Rural populations in the UK face healthcare inequities despite the NHS’s aim of providing universal healthcare.These disparities include restricted access,transportation challenges,and healthcare workforce shortages,resulting in delayed care and poorer health outcomes.This research aims to investigate the use of telemedicine in rural areas of the United Kingdom to improve access to healthcare facilities.Methods:The research process combines a systematic literature review with a thematic analysis using open coding.The results were presented through thematic representation from an open-coding method,following an established search strategy,inclusion/exclusion criteria,a two-step screening procedure,and data extraction.The PRISMA framework was used to screen the articles for the research.Results:Findings reveal that telemedicine significantly improves access to healthcare in rural areas by reducing travel barriers,enhancing mental health services,and increasing patient engagement.Studies highlight its expanding use during pandemics,cross-border reach,and beneficial effects on mental health services.Digital literacy programs and targeted resource distribution were identified as critical to maximizing the effectiveness of telemedicine.Measures like digital literacy and equitable resource allocation are called for in response to issues like specialized care delivery and equitable access.Together,these projects present a thorough strategy for using telemedicine’s promise of equal access to healthcare in rural areas.Conclusion:Even though studies show that telemedicine was used more frequently during the epidemic,the review underscores the need for enhanced digital literacy and infrastructure to ensure equitable access.Difficulties,including legal complications,a lack of technological literacy,and communication obstacles,still exist.Initiatives to promote digital literacy,fair resource distribution,and regulatory changes for smooth integration are highlighted in the suggested solutions.Overall,telemedicine holds the potential to significantly reduce healthcare disparities in rural areas,provided these challenges are addressed.
文摘BACKGROUND As a consequence of the economic crisis,the sociopolitical instability and the advent of the coronavirus disease-19 pandemic,nested challenges faced the Lebanese healthcare system.These have resulted in critical shortages of essential resources,including medications vital for oncologic patients.AIM To assess the ramifications of the ongoing economic crisis on oncology patient care focusing on our outpatient oncology department.METHODS A questionnaire was distributed during the month of February 2022 to oncology patients in Hôtel Dieu de France University Hospital in Beirut during their outpatient therapy.The primary objective was to assess the far-reaching impact of the economic crisis on patient care and the resulting psychological implications.RESULTS Among 182 interviewed patients,31.87%experienced treatment interruption mainly due to acute drug shortages.Despite 87.91%of the patients benefiting from third-party coverage,69.60%had to self-pay for their medications leading to 69.78%of patients perceiving that healthcare was more difficult to access after 2020.Psychologically,one-third of the patients exhibited symptoms of anxiety and/or depression,with 7 patients reporting suicidal ideations.Notably,37.93%of patients who interrupted cancer treatment reported a history of comorbidities,and 89.66%who altered their treatment cited financial difficulties.CONCLUSION Lebanese cancer patients face complex challenges spanning economic,healthcare,and psychological realms.Income inequalities exacerbated by the economic crisis hindered healthcare access.
文摘Background:Hepatitis C (HCV) direct acting antiviral agents (DAAs) are safe,effective,and tolerable.Most contraindications to interferon-based treatment are no long applicable.The aims of this study were to understand the predictors of approval to drug accessibility.Methods:We studied all consecutive patients with HCV prescribed DAAs between October 2014 and July 2015.Data on demographic,socioeconomic status,comorbidities,baseline laboratory values,and assessment of liver disease severity,insurance,and specialty pharmacy type were collected.Multivariate analyses were performed to identify predictors of prescription approval.Results:In total,410 patients were prescribed DAAs between October 2014 and July 2015.Of those,332 (81%) patients were insurance approved for therapy.Of the 332 patients accepted,251 were accepted after the first prescription attempt,and 38 were accepted after the second and third attempts.The number of attempts for the other 43 approved patients was unknown.Older age (p =0.001),employment (p =0.001),lack of comorbidities (p =0.02),liver transplantation (p =0.018),and advanced liver disease (p =0.001)were more likely associated with obtaining approval.Household income was not associated with insurance approval.In the multivariate analysis,Medicare insurance (odds ratio [OR]) 2.67,95% confidence interval [CI] 0.96-7.20),lack of nonliver comorbidities (OR 2.72,95% CI 1.35-5.43),and the presence of advanced liver disease (OR 1.82,95% CI 1.04-3.24) independently predicted drug approval.Conclusion:Despite the availability of DAAs for HCV,barriers from insurance carriers continue to impair widespread use.Patients with advanced liver disease,Medicare,and without comorbidities are most likely to be insurance approved for DAAs.
文摘This article develops a comparative analysis of healthcare provision to migrants in the US and in China.It proceeds in three parts.First,we begin by describing the growth of the unauthorized population and trace the evolution of social provision of healthcare to immigrants,highlighting the restrictive nature of federal social provisions and greater autonomy of state and local governments in redefining eligibility criteria in the US.Second,we examine the impact of legal status on healthcare access and utilization among Mexicans,using original data from the 2007 Hispanic Healthcare Survey and the Mexican Migration Project.We find that unauthorized immigrants report the lowest level of healthcare access and utilization.Third,we then outline a China-US comparative agenda,pointing to similarities between the two migrant flows.In China,recent developments of healthcare coverage for both rural and urban populations have increased access to healthcare,but rural-to-urban migrants still report many barriers in receiving care and are often left out of this growing safety net.We then close with a discussion of lessons learned from the US experience and remaining questions for future comparative research.
基金funded by the Bill and Melinda Gates Foundation and the United States Agency for International Development through grants awarded to the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases(Grant Nos.3636/9900727 and AAGG-00-99-00005-31)by a joint research programme of the Economic and Social Research Council(ESRC)the Department for International Development(DfID)(Grant Reference:RES-167-25-0387).
文摘Background:A major impediment to the treatment of TB is a diagnostic process that requires multiple visits.Descriptions of patient costs associated with diagnosis use different protocols and are not comparable.Methods:We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis.Surveys of 2225 adults attending smear-microscopy centres in Nigeria,Nepal,Ethiopia and Yemen.Adults>18 years with cough>2 weeks were enrolled prospectively.Direct costs were quantified using structured questionnaires.Patients with costs>75^(th) quartile were considered to have high expenditure(cases)and compared with patients with costs<75^(th) quartile to identify factors associated with high expenditure.Results:The most significant expenses were due to clinic fees and transport.Most participants attended the centres with companions.High expenditure was associated with attending with company,residing in rural areas/other towns and illiteracy.Conclusions:The costs incurred by patients are substantial and share common patterns across countries.Removing user fees,transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs.In locations with limited resources,support could be prioritised for those most at risk of high expenditure;those who are illiterate,attend the service with company and rural residents.
