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Article
Publication date: 26 March 2018

Alexandra Edelman, Judy Taylor, Pavel V. Ovseiko and Stephanie M. Topp

Academic health centres (AHCs) are organisations that pursue a “tripartite” mission to deliver high-quality care to patients, undertake clinical and laboratory research…

Abstract

Purpose

Academic health centres (AHCs) are organisations that pursue a “tripartite” mission to deliver high-quality care to patients, undertake clinical and laboratory research, and train future health professionals. The last decade has seen a global spread of AHC models and a growing interest in the role of AHCs in addressing health system equity. The purpose of this paper is to synthesise and critically appraise the evidence on the role of AHCs in improving health equity.

Design/methodology/approach

Peer-reviewed and grey literature published in English between 2000 and 2016 were searched. Articles that identified AHCs as the primary unit of analysis and that also addressed health equity concepts in relation to the AHC’s activity or role were included.

Findings

In total, 103 publications met the inclusion criteria of which 80 per cent were expert opinion. Eight descriptive themes were identified through which health equity concepts in relation to AHCs were characterised, described and operationalised: population health, addressing health disparities, social determinants of health, community engagement, global health, health system reform, value-based and accountable financing models, and role clarification/recalibration. There was consensus that AHCs can and should address health disparities, but there is a lack of empirical evidence to show that AHCs have a capacity to contribute to health equity goals or are demonstrating this contribution.

Originality/value

This review highlights the relevance of health equity concepts in discussions about the role and missions of AHCs. Future research should improve the quality of the evidence base by empirically examining health equity strategies and interventions of AHCs in multiple countries and contexts.

Details

Journal of Health Organization and Management, vol. 32 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 9 April 2021

Melissa Jane Carey and Melissa Taylor

The purpose of this review was to explore the literature for evidence of the impact of interprofessional practice models on health service inequity, particularly within…

Abstract

Purpose

The purpose of this review was to explore the literature for evidence of the impact of interprofessional practice models on health service inequity, particularly within community care settings for diverse ageing populations.

Design/methodology/approach

An integrative systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework combined with the EndNote reference management system. Following the collection and comprehensive screening process completion, a thematic analysis of the included articles occurred utilising within NVivo 12 software.

Findings

The review found that there was a paucity of evidence related to the relationship between interprofessional practice models (IPM) and health service equity for ageing populations. There is a need to improve collaborative practices between social care, public health care and health service providers to more clearly define team member roles. Key aspirations included the need for future innovations in health service delivery to place health service equity as a goal for interprofessional practice. There is a need to find ways to measure and articulate the impact for vulnerable populations and communities.

Research limitations/implications

The review offers insight into the need for health care delivery models to place health service equity at the centre of the model design. In practice settings, this includes setting interprofessional team goals around achieving equitable care outcomes for, and with, vulnerable populations. Implications for practice relate to improving how interprofessional teams work with communities to achieve health care equity.

Originality/value

There is a consensus across the literature that there continues to be health service inequity, yet IPE and interprofessional collaborative practice (IPC) have been growing in momentum for some time. Despite many statements that there is a link between interprofessional practice and improved health service equity and health outcomes, evidence for this is yet to be fully realised. This review highlights the urgent need to review the link between education and practice, and innovative health models of care that enable heath care professionals and social care providers to work together towards achieving health equity for ageing populations. It is clear that more evidence is required to establish evidence for best practice in interprofessional care that has the mitigation of health care inequity as a central objective.

Details

Journal of Health Organization and Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1477-7266

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Book part
Publication date: 11 June 2009

Phusit Prakongsai, Supon Limwattananon and Viroj Tangcharoensathien

Objective – This chapter assesses health equity achievements of the Thai health system before and after the introduction of the universal coverage (UC) policy. It examines…

Abstract

Objective – This chapter assesses health equity achievements of the Thai health system before and after the introduction of the universal coverage (UC) policy. It examines five dimensions of equity: equity in financial contributions, the incidence of catastrophic health expenditure, the degree of impoverishment as a result of household out-of-pocket payments for health, equity in health service use and the incidence of public subsidies for health.

Methodology – The standard methods proposed by O’Donnell, van Doorslaer, and Wagstaff (2008b) were used to measure equity in financial contribution, healthcare utilization and public subsidies, and in assessing the incidence of catastrophic health expenditure and impoverishment. Two major national representative household survey datasets were used: Socio-Economic Surveys and Health and Welfare Surveys.

Findings – General tax was the most progressive source of finance in Thailand. Because this source dominates total financing, the overall outcome was progressive, with the rich contributing a greater share of their income than the poor. The low incidence of catastrophic health expenditure and impoverishment before UC was further reduced after UC. Use of healthcare and the distribution of government subsidies were both pro-poor: in particular, the functioning of primary healthcare (PHC) at the district level serves as a “pro-poor hub” in translating policy into practice and equity outcomes.

Policy implications – The Thai health financing reforms have been accompanied by nationwide extension of PHC coverage, mandatory rural health service by new graduates and systems redesign, especially the introduction of a contracting model and closed-ended provider payment methods. Together, these changes have led to a more equitable and more efficient health system. Institutional capacity to generate evidence and to translate it into policy decisions, effective implementation and comprehensive monitoring and evaluation are essential to successful system-level reforms.

Details

Innovations in Health System Finance in Developing and Transitional Economies
Type: Book
ISBN: 978-1-84855-664-5

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Book part
Publication date: 30 December 2013

John E. Roemer

Equality of opportunity (EOp) for health is defined and advocated as the right conceptualization of equity in the allocation of health care resources. EOp is contrasted…

Abstract

Equality of opportunity (EOp) for health is defined and advocated as the right conceptualization of equity in the allocation of health care resources. EOp is contrasted with the traditional view that equity consists in “horizontal equity,” a state in which all persons in a society with similar health needs receive similar amounts of medical resources. We argue the horizontal equity is neither sufficient nor necessary for distributive justice in this domain. The EOp view holds individuals partially responsible for the quality of lifestyle that they live, in so far as it affects their health, but compensates individuals for the effect on health of circumstances beyond their control, including the effect of circumstances on their lifestyle. EOp generally recommends a distribution of medical resources that is more egalitarian than the utilitarianism recommends, but less egalitarian than the (Rawlsian) maximin view recommends. An example is computed to illustrate the difference between opportunity equalizing and utilitarian health delivery policies.

Details

Health and Inequality
Type: Book
ISBN: 978-1-78190-553-1

Keywords

Content available
Article
Publication date: 23 March 2020

Yara Ahmed, Racha Ramadan and Mohamed Fathi Sakr

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the…

Abstract

Purpose

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the equity of the whole financing system.

Design/methodology/approach

Lorenz dominance analysis and Kakwani progressivity index were applied on data from 2010/2011 Household Income, Expenditure, and Consumption Survey and the National Health Accounts 2011 using Stata to evaluate the progressivity of each source of health-care finance and the financing system overall.

Findings

The data show that Egypt’s health-care system, which is largely financed by out-of-pocket (OOP) payments, is slightly regressive, with an overall Kakwani index of −0.079. The overall regressive effect was the result of three regressive sources (OOP payments, an earmarked cigarette tax and direct taxes), one proportional finance source (social health insurance) and two slightly progressive sources (indirect taxes and private health insurance). This shows that the burden of financing health care falls more on the poor. These results signal the need for reform of health-care financing in Egypt to reduce dependence on OOP payments to achieve more equitable financing.

Originality/value

The paper seeks to augment the literature on health-care financing in Egypt by calculating specific progressivity estimates for all five sources of financing the Egyptian health-care system and analyzing the overall equity of this financing system. It will, therefore, provide a benchmark for monitoring the equity of finance in the Egyptian health-care system in future studies and allow one to assess the impact of implemented financing reforms in the future on the level of progressivity of health system financing.

Details

Journal of Humanities and Applied Social Sciences, vol. 3 no. 1
Type: Research Article
ISSN: 2632-279X

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Article
Publication date: 19 September 2018

Telma Zahirian Moghadam, Pouran Raeissi and Mehdi Jafari-Sirizi

Health Sector Evolution Plan (HSEP) is known as the biggest and most comprehensive reform in Iran’s health system. One of the goals of HSEP is to reduce inequity in the…

Abstract

Purpose

Health Sector Evolution Plan (HSEP) is known as the biggest and most comprehensive reform in Iran’s health system. One of the goals of HSEP is to reduce inequity in the healthcare financing. The purpose of this paper is to demonstrate HSEP agenda setting from the perspective of equity in healthcare financing (EHCF) using the multiple streams model.

Design/methodology/approach

This qualitative study was conducted by 26 documents review and analysis, and 30 semi-structured interview with Iranian key informants in the field of HSEP that were selected based on purposeful and snowball sampling method. Data were collected using a researcher-made checklist based on the goals. All audio-taped interviews were transcribed and analyzed thematically. Data management and analysis were performed using the framework analysis in MAXQDA software.

Findings

The framework analysis identified 12 complementary sub-themes totally. Problem stream included four sub-themes (high share of Out Of Pocket, high index of catastrophic health expenditures, low EHCF index, and inappropriate economic state and sanctions). Focus on EHCF in general policies of the Iran World Health Organization’s report in 2000, the Targeted Subsidies Law and emphasis on equalizing healthcare financing in the Fourth and Fifth Development Plan were considered as policy stream sub-themes. Finally, political stream showed four sub-themes including strong support from the Minister of Health for HSEP, mass media, the pressure of WHO and people’s request to reduce health costs.

Research limitations/implications

The limitations of the present study included paying attention to one package (evolution in the treatment sector) of three health packages to assess EHCF, as well as the lack of similar national and international evidence in implementation framework.

Practical implications

The results of this study can be used to analyze other health sector reforms around the word and can help the formulation and implementation of most practical reforms, especially in field of health system financing.

Social implications

This study gives a holistic view about health system policy setting that can be used for understanding policy-making streams to population.

Originality/value

This is the first study that has examined HSEP (the biggest health sector reform in Iran) from the perspective of agenda setting. In addition, using the popular and well-known Kingdon’s model to explain HSEP agenda setting is one of the strengths of this study. Furthermore, taking advantage of a wide range of related views by including highly informed people increased the strength of the results of the study. In addition, the short interval between the interview and reviewing the results on reforms reduced the recall bias of the participants in the study.

Details

International Journal of Human Rights in Healthcare, vol. 12 no. 2
Type: Research Article
ISSN: 2056-4902

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Article
Publication date: 3 April 2018

Mohsin Altaf, Nageena Tabassum and Sany Sanuri Mohd Mokhtar

The purpose of this paper is to investigate the impact of health-care quality of emergency medical services on brand equity of cardiac institutes by using…

Abstract

Purpose

The purpose of this paper is to investigate the impact of health-care quality of emergency medical services on brand equity of cardiac institutes by using industry-specific measure, 5Qs model of health-care service quality (HCSQ).

Design/methodology/approach

Survey method technique has been used to collect data from the patients availing emergency medical services from 12 cardiac institutes. Effective responses have been received from 393 patients from four localities. Systematic sampling technique has been used to collect data from the respondents. Partial least square structural equation modeling using smartPLS 2.0 has been used to analyze the results.

Findings

Findings of the study reveal that HCSQ has weak relationship with hospital brand loyalty but strong relationship with brand image and brand awareness. Furthermore, brand awareness and brand image have strong relationship with brand loyalty. Furthermore, brand image and brand loyalty have strong relationship with overall hospital brand equity but found nonsignificant relationship of brad awareness with overall hospital brand equity.

Originality/value

The principal contribution of the paper is to provide the insight on the impact of emergency HCSQ on brand equity of the private cardiac hospitals. Second, this study is first in branding literature that has used industry-specific scale 5Qs model to measure the service quality of emergency medical care and its impact on private sector cardiac hospital’s brand equity. Previously researchers used generic scales that were insufficient to measure the service quality of specialized industries (Babakus and Mangold, 1992; Carman, 1990; Caro and Garcia, 2007).

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 12 no. 1
Type: Research Article
ISSN: 1750-6123

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Book part
Publication date: 15 September 2014

Claudia Chaufan and Yi-Chang Li

Over the last few decades, information technology (IT) has significantly altered the nature of work and organizational structures in many industries, including health

Abstract

Purpose

Over the last few decades, information technology (IT) has significantly altered the nature of work and organizational structures in many industries, including health care. The purpose of this analysis is to compare how system-level differences affect IT implementation in health care (HIT) and the implications of these differences for health care equity.

Methodology/approach

We critically analyzed selected claims concerning the capacity of HIT to provide better care to more individuals at lower costs, thus contributing to health care equity, in the context of current health care reform efforts in the United States. We used the case of HIT implementation in Taiwan’s National Health Insurance system as a contrasting case.

Findings

We argue that however much HIT may yield in quality improvements or savings in the context of a universal and publicly financed single payer system, such savings simply cannot be accrued by a system of multiple health plans competing for better customers (i.e., less costly patients) and driven by profit.

Implications

It is important to define the level of analysis in debates about the potential of HIT to produce better health care at lower costs and the equity implications of this potential. In these debates, US policy makers should consider the commitment to health care equity that informed the design of Taiwan’s health care system and of HIT implementation in that country. HIT merely provides enabling tools that are of little value without major systemic changes

Originality/value of the chapter

To our knowledge, the health IT expert literature has overlooked when not ignored the ethical principles informing health care systems, an omission which makes it difficult if not impossible to evaluate the potential of HIT to increase equity in health care.

Details

Technology, Communication, Disparities and Government Options in Health and Health Care Services
Type: Book
ISBN: 978-1-78350-645-3

Keywords

Content available
Book part
Publication date: 6 May 2019

Mitch Blair and Denise Alexander

Equity is an issue that pervades all aspects of primary care provision for children and as such is a recurring theme in the Models of Child Health Appraised project. All…

Abstract

Equity is an issue that pervades all aspects of primary care provision for children and as such is a recurring theme in the Models of Child Health Appraised project. All European Union member states agree to address inequalities in health outcomes and include policies to address the gradient of health across society and target particularly vulnerable population groups. The project sought to understand the contribution of primary care services to reducing inequity in health outcomes for children. We focused on some key features of inequity as they affect children, such as the importance of good health services in early childhood, and the effects of inequity on children, such as the higher health needs of underprivileged groups, but their generally lower access to health services. This indicates that health services have an important role in buffering the effects of social determinants of health by providing effective treatment that can improve the health and quality of life for children with chronic disorders. We identified common risk factors for inequity, such as gender, family situation, socio-economic status (SES), migrant or minority status and regional differences in healthcare provision, and attempted to measure inequity of service provision. We did this by analysing routine data of universal primary care procedures, such as vaccination, age at diagnosis of autism or emergency hospital admission for conditions that can be generally treated in primary care, against variables of inequity, such as indicators of SES, migrant/ethnicity or urban/rural residency. In addition, we focused on the experiences of child population groups particularly at risk of inequity of primary care provision: migrant children and children in the state care system.

Details

Issues and Opportunities in Primary Health Care for Children in Europe
Type: Book
ISBN: 978-1-78973-354-9

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Article
Publication date: 15 August 2011

Akwatu Khenti, Jaime C. Sapag, Consuelo Garcia‐Andrade, Fernando Poblete, Ana Raquel Santiago de Lima, Andres Herrera, Pablo Diaz, Henok Amare, Avra Selick and Sandra Reid

Since 2002, the Centre for Addiction and Mental Health in Ontario, Canada, has been working closely with partners in Latin America and the Caribbean (LAC) to implement…

Abstract

Purpose

Since 2002, the Centre for Addiction and Mental Health in Ontario, Canada, has been working closely with partners in Latin America and the Caribbean (LAC) to implement mental health capacity‐building focused on primary health care. From an equity perspective, this article seeks to critically analyze the process and key results of this capacity‐building effort and to identify various implications for the future.

Design/methodology/approach

This analysis of capacity‐building approaches is based on a critical review of existing documents such as needs assessments and evaluation reports, as well as reflective discussion. Previous health equity literature is used as a framework for analysis.

Findings

More than 1,000 professionals have been engaged in various kinds of training in Chile, Peru, Brazil, Nicaragua, Mexico, and Trinidad and Tobago. These capacity‐building initiatives have had an impact on primary health care from both an equity and systems perspective because participants were engaged at all stages of the process and implementation lessons incorporated into the final efforts. Stigma was also reduced through the collaborations.

Originality/value

Using concrete examples of capacity‐building in mental primary healthcare in LAC, as well as evidence gathered from the literature, this article demonstrates how primary healthcare can play a strong role in addressing health equity and human rights protection for people with mental health and/or substance abuse problems.

Details

Ethnicity and Inequalities in Health and Social Care, vol. 4 no. 3
Type: Research Article
ISSN: 1757-0980

Keywords

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