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Article
Publication date: 13 April 2010

Rati Ram

The purpose of this paper is to study the cross‐country relation between initial levels of infant‐, child‐ and maternal‐mortality and their rates of decline so as to see…

Abstract

Purpose

The purpose of this paper is to study the cross‐country relation between initial levels of infant‐, child‐ and maternal‐mortality and their rates of decline so as to see whether the so‐called Matthew effect or the inverse‐care principle operates relative to these three important health indicators.

Design/methodology/approach

Data on the three variables for a large number of countries covering several periods between 1950 and 2007 are considered. Signs and significance of correlations between initial levels and the rates of decline over the period, and of coefficients of initial levels in regressions of rates of decline on the initial level, are studied.

Findings

First, in a broad global context, higher initial levels of mortality are associated with significantly lower rates of decline in each of the three indicators for every period, thus providing strong support to the operation of the inverse‐care principle and the Matthew effect. Second, the high‐income countries (and transition economies) deviate from the global pattern. Third, following Hart's suggestion, the parametric contrast between the high income and the developing groups may be interpreted as indicative of stronger government intervention in the healthcare sector in high‐income countries. Fourth, the contrast may thus indicate the desirability of greater government intervention in provision of healthcare in developing countries. Fifth, operation of the inverse‐care principle and the Matthew effect is observed even in the absence of high‐HIV prevalence. Sixth, the observed negative covariation between initial mortality and its rate of decline implies cross‐country divergence in these core indicators of health.

Originality/value

First, this is the only study to investigate the operation of the inverse‐care principle relative to infant mortality for such a large number of countries and such a long period. Second, it is also the only study to extend the investigation to child‐mortality and maternal‐mortality, which are heavily emphasized in the millennium development goals. Third, the patterns are studied not only merely for the entire set of countries, but also for several subgroups. Fourth, the observed parametric contrasts are interpreted as possibly reflecting the importance of government intervention in the healthcare sector in mitigating the operation of the inverse‐care phenomenon. Fifth, an effort is made to factor out the role of HIV so as to show that the pattern is not significantly altered by high prevalence of HIV in poor countries. Sixth, the implied cross‐country divergence in these important health variables is suggestive of the need for caution in interpreting the conclusions stated by some scholars about convergence in several quality‐of‐life indicators. Last, contrary to what some scholars have suggested, not merely does it not seem to be the case that the inverse‐care proposition relative to infant mortality is observed only in exceptional cases, but the reported evidence suggests that the proposition holds globally over long periods even for child‐ and maternal‐mortality.

Details

International Journal of Social Economics, vol. 37 no. 5
Type: Research Article
ISSN: 0306-8293

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Article
Publication date: 18 October 2011

Rati Ram

In the context of a much higher infant mortality rate (IMR) among Blacks than among Whites in the USA, the purpose of this paper is to compare changes in IMR in the two…

Abstract

Purpose

In the context of a much higher infant mortality rate (IMR) among Blacks than among Whites in the USA, the purpose of this paper is to compare changes in IMR in the two groups to judge whether the rates of decline are indicative of the so‐called Matthew‐effect or the inverse‐care principle, which, in contrast with the usual expectation of “diminishing marginal product,” suggests that higher level of IMR would be associated with a slower rate of IMR decline.

Design/methodology/approach

Changes in the IMR for each group over the period 1980‐2007 are studied. Levels and rates of decline in the two groups are compared for 1980‐1990, 1990‐2000, and 1980‐2007 for the USA. In addition, the levels and rates of decline in the two groups over these periods are also compared for each state.

Findings

Despite the much higher level of IMR among Blacks, the rates of decline in IMR over 1980‐1990, 1990‐2000, and 1980‐2007 are considerably lower for Blacks than for Whites when data for the entire USA are considered. Moreover, the same pattern is observed for a vast majority of the states in each period.

Originality/value

This is perhaps the only study that considers the possible operation of the inverse‐care principle relative to Black and White IMR in the USA over a fairly long period. The findings suggest several useful points. First, the pattern is consistent with the Matthew‐effect or the inverse‐care principle, and is not supportive of the usual expectation of “diminishing marginal product” in healthcare improvements. Second, the observed pattern seems to reflect poorer access of Blacks to prenatal, maternal, and infant healthcare. Third, it appears likely that, as suggested by Hart and indicated by recent research on increasing Black‐White IMR disparity, the pattern reflects a high degree of reliance on the market forces in healthcare provision and innovation, particularly relative to infant mortality. Fourth, in that context, greater role of the public sector in healthcare, particularly relative to IMR, might be given serious consideration. Fifth, given the observed pattern, the goal of eliminating racial disparities in IMR is unlikely to be met for a long time. Sixth, the relatively low‐international ranking of the USA in IMR, which has been declining, might not improve for quite some time.

Details

International Journal of Social Economics, vol. 38 no. 12
Type: Research Article
ISSN: 0306-8293

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Book part
Publication date: 13 October 2008

Kevin Fiscella

The second national goal for Healthy People 2010 is the elimination of health disparities related to social disadvantage in the United States. Unfortunately, progress to…

Abstract

The second national goal for Healthy People 2010 is the elimination of health disparities related to social disadvantage in the United States. Unfortunately, progress to date has been limited. Our national strategy to achieve this goal has been too narrowly focused on public health. Success will require a broader strategy including alignment of existing national policies in non-health areas that affect the health of the socially disadvantaged such as education, health care, labor, welfare, housing, criminal justice, the environment, and taxation if it is to succeed. Key criteria are needed to begin to prioritize areas for federal investment to achieve this goal. These include the impact of the targeted condition on disparities, evidence base for the intervention, potential impact of the policy on disparities, economic impact, and federal politics. Two “big ideas” offer promise including federal investment in early child education and enhanced primary care within federally qualified community health centers. The proposed criteria are applied to each proposed policy.

Details

Beyond Health Insurance: Public Policy to Improve Health
Type: Book
ISBN: 978-1-84855-181-7

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Article
Publication date: 1 September 2008

Erik Bulten, Annelies Vissers and Karel Oei

Mental health care in prisons involves many stakeholders. As a consequence, the goals involved are divergent but there is no sound theoretical framework that accounts for…

Abstract

Mental health care in prisons involves many stakeholders. As a consequence, the goals involved are divergent but there is no sound theoretical framework that accounts for the complexity of care in prison. This paper considers a broad theory and its conceptual framework that differentiates between prisoners with emotional suffering and those without, the need for care from an objective point of view as opposed to a subjective one, and the need for care related to mental health problems versus care related to limiting recidivism.

Details

Mental Health Review Journal, vol. 13 no. 3
Type: Research Article
ISSN: 1361-9322

Keywords

Content available
Article
Publication date: 13 May 2014

Ian Hamilton

Abstract

Details

Advances in Dual Diagnosis, vol. 7 no. 2
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 6 April 2010

Nana Owusu‐Frimpong, Sonny Nwankwo and Baba Dason

This paper aims to explore patients' satisfaction with access to treatment in both the public and private healthcare sectors in London.

Abstract

Purpose

This paper aims to explore patients' satisfaction with access to treatment in both the public and private healthcare sectors in London.

Design/methodology/approach

Qualitative and quantitative methods were employed to determine patients' levels of satisfaction. A semi‐structured face ‐to‐face non‐probability quota sampling and a probability sample drawn from multistage cluster sampling methods were employed.

Findings

The results revealed varying access experiences among public and private care users. Public, as opposed to private, healthcare users experience unsatisfactory outcomes in relation to service climate factors (e.g. getting attention from doctors, time taken to get appointments, access to core treatment and opening hours). Overall, while women are more disadvantaged by spatial accessibility to treatment than men, both public and private healthcare users indicate major problems in accessing healthcare despite the myriad intervention strategies aimed at ameliorating the situation in both sectors. Therefore, access‐to‐care problems are significant and need to be addressed by managers and healthcare providers in order to improve the quality of service delivery and patient satisfaction. Private care users fare better than public users in obtaining medical care at short notice, having more agreeable opening hours for treatment and getting appointments for treatment with less difficulty.

Research limitations/implications

Whereas the limitation of the study was due to its small sample size, it nevertheless will stimulate insight into further academic endeavours.

Practical implications

Academics and practitioners will find the results very useful when making decisions about healthcare provisions and how they can best meet user/patient satisfaction.

Originality/value

This study is significant in drawing on the current literature on satisfaction which is usefully applied to evaluate patients' response to the quality management initiatives in the healthcare sector.

Details

International Journal of Public Sector Management, vol. 23 no. 3
Type: Research Article
ISSN: 0951-3558

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: 17 September 2019

Hussain Zandam and Muhamad Hanafiah Juni

Self-evaluated access and accessibility has been found to be associated with healthcare seeking and quality of life. Studies have shown that, however, a vast majority of…

Abstract

Purpose

Self-evaluated access and accessibility has been found to be associated with healthcare seeking and quality of life. Studies have shown that, however, a vast majority of individuals with disability living in poor countries have limited access to healthcare influenced by several barriers. The purpose of this paper is to compare the perception of general accessibility of health care services and its association with access barriers and other contextual factors between people with physical disabilities and counterparts without disability.

Design/methodology/approach

This study is a cross sectional survey involving 213 individuals with physical disabilities and 213 counterparts without disability sampled using a multi-stage method. Data were collected using a structured questionnaire with sections on socioeconomic and living conditions, education, health, employment and access to health care. Data analysis involved using χ2 for proportions and T-test and multiple regressions (stepwise) method to determine significant factors that influence perception on accessibility.

Findings

The study finds that people with disabilities fared worse in various socioeconomic factors such as education, employment, income and assets possession. People with disabilities also experience more dimensional barriers and reported poor health system accessibility. The difference in accessibility continued after adjusting for other variables, implying that there are more inherent factors that explain the perception of access for people with disabilities.

Practical implications

Governments should ensure equitable access to health care delivery for people with disabilities through equitable health policies and services that are responsive to the needs of people with disabilities and promote the creation of enabling environment to enhance participation in health care delivery.

Originality/value

The authors confirm that the paper has neither been submitted to peer review, nor is in the process of peer reviewing or accepted for publishing in another journal. The author(s) confirms that the research in this work is original, and that all the data given in the paper are real and authentic. If necessary, the paper can be recalled, and errors corrected. The undersigned authors transfer the copyright for this work to the International Journal of Health Governance. The authors are free of any personal or business association that could represent a conflict of interest regarding the paper submitted, and the authors have respected the research ethics principles.

Details

International Journal of Health Governance, vol. 24 no. 4
Type: Research Article
ISSN: 2059-4631

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Article
Publication date: 1 May 1999

D.A. Reisman

Thailand, like a number of other less‐developed countries, has experienced a rapid rise in the share of its national product that is being devoted to health. This paper…

Abstract

Thailand, like a number of other less‐developed countries, has experienced a rapid rise in the share of its national product that is being devoted to health. This paper examines the ways in which the country is paying for its preventive and curative care. Section 1 provides the context by discussing age‐structure and geographical distribution of the population, together with the rates of mortality and morbidity. Section 2 explores the delivery of medical attention, private and State. Section 3 evaluates seven ways in which medical care is financed in Thailand. It also makes recommendations for the future of social insurance which are of relevance both to Thailand and to other countries at a similar stage of economic development.

Details

International Journal of Social Economics, vol. 26 no. 5
Type: Research Article
ISSN: 0306-8293

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Article
Publication date: 27 July 2018

Nimruji Jammulamadaka and Kamalika Chakraborty

This paper aims to examine the geographic distribution of social enterprises at the local sub-district level in one Indian state.

Abstract

Purpose

This paper aims to examine the geographic distribution of social enterprises at the local sub-district level in one Indian state.

Design/methodology/approach

This paper adopts a multimethod approach. The exploratory phase involved interviews and analysis of social enterprise distribution at the national level. Phase 2 involved mapping the distribution of social enterprises at the sub-district level in one state. Distribution around established social enterprises was plotted using latitude–longitude positions. Grounded theory approach to analysing qualitative data was adopted to identify the mechanism for agglomeration.

Findings

Social entrepreneurship sees the entrepreneurial problems as solving universalized social problems abstracting them out of the geo-historical and political economic context of the social problem. This study shows that solving a social problem is itself implicated in a social–historical organizational context of aid giving within developing countries. Networks of resources that early enterprises enable draw newer organizations toward them and lead to the formation of clusters. While such clusters might improve chances of enterprise survival, the phenomenon inadvertently leads to a new kind of inequity, as areas with fewer social enterprises lack the organizational infrastructure necessary for delivery of welfare.

Research limitations/implications

Research in social enterprises needs to pay more attention to the context of the enterprises or society in addition to its current focus on universal social problems. Social enterprises themselves could be new sources of inequity in terms of the organizational infrastructure they represent.

Originality/value

Policymakers need to make directed efforts that respond not only to social problems but also to the socio-historic-organizational contexts where the problems are being solved and seeding the entrepreneurial effort in those spaces.

Details

Social Enterprise Journal, vol. 14 no. 3
Type: Research Article
ISSN: 1750-8614

Keywords

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