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Adolescence is a time when a young person develops his or her identity, acquires greater autonomy and independence, experiments and takes risks and grows mentally and physically. To successfully navigate these changes, an accessible and health system when needed is essential.

We assessed the structure and content of national primary care services against these standards in the field of adolescent health services. The main criteria identified by adolescents as important for primary care are as follows: accessibility, staff attitude, communication in all its forms, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community.

We found that although half of the Models of Child Health Appraised countries have adopted adolescent-specific policies or guidelines, many countries do not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care or respond to life-threatening behaviour is limited. Many countries provide good access to contraception, but specialised care for a pregnant adolescent may be hard to find.

Access needs to be improved for vulnerable adolescents; greater advocacy should be given to adolescent health and the promotion of good health habits. Adolescent health services should be well publicised, and adolescents need to feel empowered to access them.

Micro hospitals are a new form of for-profit health-care facility with rapid expansion in some parts of the country. They continue to grow in Texas without in-depth public understanding or explicit policy guidance on their role in the health-care system. Our project aims to define socioeconomic and demographic characteristics of areas served by micro and regular hospitals, and by doing so help assess micro hospitals' impact in expanding health-care access for disadvantaged populations in Texas.

We (1) estimated hospital service areas (catchment areas) with a spatial model based on advanced Geographic Information System (GIS) methods using a proprietary ESRI traffic network; (2) assigned population socioeconomic measures to the catchment areas from the 2014–2018 American Community Survey 5-Year Estimates, weighted with an empirically tested Gaussian distribution; (3) used two-tailed t-tests to compare means of population characteristics between micro and regular hospital catchment areas; and (4) conducted logistic regressions to examine relationships between selected population variables and the associated odds of micro hospital presence.

We found micro hospitals in Texas tend to serve a population less stressed in health-care access compared to those who are more in need as measured by various dimensions of disadvantages.

Our analysis takes a cross sectional look at the population characteristics of micro hospital service areas. Even though the initial geographic choices of micro hospitals may not reflect the long-term population changes in specific neighborhoods, our analysis can provide policy makers a tool to examine health-care access for disadvantaged populations at given point in time. As the population socioeconomic characteristics have long been associated with health-care inequality, we hope our analysis will help foster structural policy considerations that balance growing health-care delivery innovations and their social accountability.

We used GIS based spatial modeling to dynamically capture the potential patient basis by travel time calculated with a street network dataset, rather than using the traditional static census tract to define hospital service areas. By integrating both spatial and nonspatial dimensions of healthcare access, we demonstrated that the policy considerations on the implications of equal opportunity for health-care access need to take into account the social realities and lived experiences of those experiencing the most vulnerability in our society, rather than a conceptual “equality” existing in the spatial and market abstraction.

This study aims to provide a better understanding of Native American women veterans’ experiences with Veteran Administration and Indian Health Services. Eighteen interviews were conducted with special attention to the quality and quantity of health and mental health care services veterans accessed, the barriers and local contextual factors in accessing and utilizing services, and potential solutions to service gaps for women veterans from two Montana reservations, the Northern Cheyenne Reservation and the Confederated Salish and Kootenai Tribes of the Flathead Reservation.

We examine the barriers and needs of Native American veterans in both reservations using qualitative methods. The research analyzed 18 interviews with women veterans from the Northern Cheyenne and Flathead reservations.

Native American women veterans identified a number of barriers to accessing care, some of which include lack of information regarding eligibility and the types of services available. Women often found the application process to be confusing and difficult. Other barriers included distance, cost of travel, and conflicts with their work schedule.

This exploratory case study served to clarify the challenges and obstacles Native American women veterans experience with accessing health and mental health services. This research revealed several patterns and themes in the experience of Native American women veterans in both reservation communities when attempting to access and seek care at Veterans Administration (VA) facilities and Indian Health Services (IHS). This research calls for policy changes and research to clarify how resources can be more efficiently and effectively distributed to rural veterans.

Little research has addressed the needs of Native American veterans. American Indians and Alaska Natives serve at a higher rate in the U.S. military than any other population. This research provides important information about Native American veterans who are often underrepresented in survey research, yet a rapidly growing segment of the United States military and veteran population.

A common observation is that both single- and multi-payer health care systems will achieve lower overall costs if they use primary care gatekeeping. Questioning this common wisdom, we focus on the health care access system, that is, the way in which patients gain access to health care. Gatekeeping, the use of primary care providers to control access to more specialized physician and hospital services, has come under intense scrutiny in the United States and in Europe. The few international comparative studies that have focused on the issues of quality of care, cost containment, and patient satisfaction find weak or no support for common assumptions about gatekeeping. Hence, we examine the institutional environments in seven countries in order to: (a) define and categorize health care access systems; (b) identify the components of a health care access system; (c) explore the notion of a strategic fit between health care financing systems and access system configurations; and (d) propose that the health care access system is a key determinant of process-level cost efficiency. Drawing upon institutional and governance theories, we posit that the structure and organization of an access system is determined by how it addresses six essential questions: Who is covered? Which services are included? What are the points of access? How much time elapses before access? What are the ways of selecting among points of access? and Are services and their quality the same for everyone? This analytical framework reveals that national health care access systems vary the most in their points of access, access times, and selection mechanisms. These findings and our explanations imply that access systems are one of the only tools for demand management, that any lasting change to an access system typically is implemented over an extended time period, and that managers of health care organizations often have limited freedom to define governance structures and shape health care service production systems.

Purpose: We respond to a call for studies of “embodied experiences of stigma in context” by investigating how transgender embodiment shapes perceived needs for access to and experiences of “sex-specific” cancer screenings (SSCS) (e.g., breast and prostate exams, Pap smears) in the North American healthcare system.

Design/Methodology/Approach: We analyze data from semistructured interviews with a diverse sample of 35 transgender-identified adults. Based on thematic narrative analysis, we explore four themes in relation to embodiment: discrimination; discomfort and hyperawareness of genitalia; strategic reframing and active management; and SSCS health care encounters as positive and gender affirming.

Findings: In relation to SSCS, transgender individuals experience discrimination, do emotion work, and actively manage situations to obtain needed health care, and sometimes forego care because barriers are insurmountable. Health care providers' responses to transgender embodiment can disrupt health care encounters, but they can also facilitate access and create opportunities for affirmation, agency, advocacy, and new forms of interaction. Embodiment- and gender-affirming interactions with health care providers, which varied by gender, emerged as key influences on participants' experiences of SSCS.

Research Limitations/Implications: Our sample primarily includes binary gender-identified individuals, and while our interview guide covered many topics, the SSCS question did not explicitly reference testicular exams.

Practical Implications: Cancer prevention and detection Cancer prevention and detection require health care professionals who are prepared for differently embodied persons. Preventive cancer screenings are not “sex-specific”; they are relevant to individuals with medically necessary needs regardless of gender identity or embodiment.

Social Implications

Originality/Value: Few medical sociologists have focused on transgender embodiment. Findings enhance our understanding of how transgender embodiment and minority stress processes influence access to needed SSCS.

A developing body of research has demonstrated the impact of racial residential segregation on a variety of negative health outcomes. However, little is known about the effect of residential segregation on access to health care.

This study utilizes multilevel binary logit models based on individual-level health data from the 2008 Behavioral Risk Factor Surveillance System linked to metropolitan-area level data to examine the association between Black-White segregation in 136 metropolitan statistical areas in the United States and health-care coverage.

Overall, an increase in Black-White segregation is related to a decrease in the likelihood of having health insurance for Black residents and an increase in the Black-White gap in health-care coverage. These effects are substantial even when controlling for the effects of educational, social, and economic factors.

This study is the first to examine the impact of segregation on an individual's ability to access health-care coverage, which is an essential starting point for accessing health care in the United States.

This chapter examines the relationship between health service restructuring and the health care experiences of women from rural and remote areas of Canada. Data were collected from 34 focus groups (237 women), 15 telephone interviews and 346 responses from an online survey. Access to services, care quality and satisfaction are salient themes in these data. Problems include: travel, shortage of providers, turnover in personnel, delays associated in accessing care, lack of knowledge of women's health issues and patronizing attitudes of some health care providers. Health care service restructuring has led to deterioration in service availability and quality. Key areas for policy development need to address health care access and quality improvement issues, including increasing access to more (particularly female) providers who are sensitive to women's health issues.

To examine associations by gender between cancer history and major health insurance transitions (gains and losses), and relationships between insurance transitions and access to care.

Longitudinal 2008–2013 Medical Expenditure Panel Survey data were pooled yielding 2,223 cancer survivors and 50,692 individuals with no cancer history ages 18–63 years upon survey entry, with gender-specific sub-analyses. Access-to-care implications of insurance loss or gain were compared by cancer history and gender.

Initially uninsured cancer survivors were significantly more likely to gain insurance coverage than individuals with no cancer history (RR: 1.25; 95% CI: 1.08–1.44). Females in particular were significantly more likely to gain insurance (unmarried RR: 1.16; 95% CI: 1.06–1.28; married RR: 1.09; 95% CI: 1.02–1.16). Significantly higher rates of difficulty accessing needed medical care and prescription medications were reported by those remaining uninsured, those who lost insurance, and women in general. Remaining uninsured, losing insurance, and male gender were associated with lack of a usual source of care.

Additional outreach to disadvantaged populations is needed to improve access to affordable insurance and medical care. Future longitudinal studies should assess whether major Affordable Care Act (ACA) provisions enacted after the 2008–2013 study period (or those of ACA’s replacement) are addressing these important issues.

Loss of health insurance coverage can reduce health care access resulting in poor health outcomes. Cancer survivors may be particularly at risk of insurance coverage gaps due to the long-term chronic disease trajectory. This study is novel in exploring associations between cancer history by gender and health insurance transitions, both gains and losses, in a national non-elderly adult sample.

This chapter seeks to quantify the effects of geographic access to community health centers on the likelihood of an individual having a regular source of health care.

Utilizing survey and center location data, the analysis employs bivariate cross-tabulation with chi-square and multinominal logistic regression to quantify the relationship between variables.

While individuals living in close spatial proximity to community health centers were more likely to identify a community health center as a regular source of care as compared with those without proximal access, the effect of community health center access on the identification of any source of regular health care was generally insignificant or negative, except for populations with a chronic medical condition.

While these findings support current literature suggesting that spatial proximity to care is insufficient to transform at-risk populations into regular primary care users, it is important to note that it is possible that individuals prefer to access primary care services outside of their immediate neighborhoods, potentially mediating the observed effect of proximity to care on the likelihood of having a regular source of care. Also, because this analysis is based on cross-sectional survey data, it is impossible to make a causal argument about the relationship between variables. Only the observed association can be asserted and used to inform future studies.

Existing research supports a positive association between community health center utilization and measures of health for social groups traditionally facing barriers to care, but few studies isolate the effect of center availability and health, particularly when considering those living in the catchment area but are not regular users. Due to the complexity and prevalence of barriers to health care for vulnerable and at-risk populations, these findings suggest that improving geographic access to primary health care does not guarantee positive outcomes for target groups. The magnitude of social disadvantage on vulnerable and at-risk populations can have a devastating effect on health care outcomes that is not easily overcome by social programs.

In this chapter organizational theory is used to clarify and synthesize the large and diverse literature on the relationship between managed care (MC) and ethnic differences in access to health services. MC practices are classified by whether they are used by health care organizations to define their boundaries or to coordinate care. MC practices used to coordinate care are further categorized as one of five types: rules and programs, authority, goal setting, culture, or client coordination. This review also presents hypotheses derived from this literature that specify the predicted effects of MC practices on ethnic differences in access to health services. It was found that few of these hypotheses had been empirically investigated and although some evidence was found that MC boundary-setting practices disadvantage minorities, there were not consistent findings with respect to those practices used to coordinate care.