Cancer mortality by educational level in the city of Barcelona.
The objective of this study was to examine the relationship between educational level and mortality from cancer in the city of Barcelona. The data were derived from a record linkage between the Barcelona Mortality Registry and the Municipal Census. The relative risks (RR) of death and 95% confidence intervals (CIs) according to level of education were derived from Poisson regression models. For all malignancies, men in the lowest educational level had a RR of death of 1.21 (95% CI 1.13-1.29) compared with men with a university degree, whereas for women a significant decreasing in risk was observed (RR 0.81; 95% CI 0.74-0.90). Among men, significant negative trends of increasing risk according to level of education were present for cancer of the mouth and pharynx (RR 1.70 for lowest vs. highest level of education), oesophagus (RR 2.14), stomach (RR 1.99), larynx (RR 2.56) and lung (RR 1.35). Among women, cervical cancer was negatively related to education (RR 2.62), whereas a positive trend was present for cancers of the colon (RR 0.76), pancreas (RR 0.59), lung (RR 0.55) and breast (RR 0.65). The present study confirms for the first time, at an individual level, the existence of socioeconomic differences in mortality for several cancer sites in Barcelona, Spain. There is a need to implement health programmes and public health policies to reduce these inequities. (+info)
Provider attitudes toward dispensing emergency contraception in Michigan's Title X programs.(2/7828)
Challenges in securing access to care for children.
Congressional approval of Title XXI of the Social Security Act, which created the State Children's Health Insurance Program (CHIP), is a significant public effort to expand health insurance to children. Experience with the Medicaid program suggests that eligibility does not guarantee children's enrollment or their access to needed services. This paper develops an analytic framework and presents potential indicators to evaluate CHIP's performance and its impact on access, defined broadly to include access to health insurance and access to health services. It also presents options for moving beyond minimal monitoring to an evaluation strategy that would help to improve program outcomes. The policy considerations associated with such a strategy are also discussed. (+info)
Mental health/medical care cost offsets: opportunities for managed care.
Health services researchers have long observed that outpatient mental health treatment sometimes leads to a reduction in unnecessary or excessive general medical care expenditures. Such reductions, or cost offsets, have been found following mental health treatment of distressed elderly medical inpatients, some patients as they develop major medical illnesses, primary care outpatients with multiple unexplained somatic complaints, and nonelderly adults with alcoholism. In this paper we argue that managed care has an opportunity to capture these medical care cost savings by training utilization managers to make mental health services more accessible to patients whose excessive use of medical care is related to psychological factors. For financial reasons, such policies are most likely to develop within health care plans that integrate the financing and management of mental health and medical/surgical benefits. (+info)
The health impact of economic sanctions.
Embargoes and sanctions are tools of foreign policy. They can induce a decline in economic activity in addition to reducing imports and untoward health effects can supervene, especially among older persons and those with chronic illnesses. Often, violations of the rights of life, health, social services, and protection of human dignity occur among innocent civilians in embargoed nations. This paper examines the effects of embargoes and sanctions against several nations, and calls for studies to determine ways in which economic warfare might be guided by the rule of humanitarian international law, to reduce the effects on civilians. It suggests that the ability to trade in exempted goods and services should be improved, perhaps by establishing uniform criteria and definitions for exemptions, operational criteria under which sanctions committees might function, and methods for monitoring the impact of sanctions on civilian populations in targeted states, particularly with regard to water purity, food availability, and infectious-disease control. Prospective studies are advocated, to generate the data needed to provide better information and monitoring capacity than presently exists. (+info)
User charges for health care: a review of recent experience.
This paper reviews recent experiences with increases in user charges and their effect on the utilization of health care. Evidence from several countries of differences in utilization between rich and poor is presented, and recent accounts of sharp, and often sustained, drops in utilization following fee increases, are presented and discussed. Fee income, appropriately used, represents a small but significant additional resource for health care. Recent national experiences appear to have concentrated on achieving cost recovery objectives, rather than on improving service quality and health outcomes. Appraisal of financing changes must be linked to probable health outcomes. Successful large-scale experience in linking these two is in short supply. (+info)
Are we ignoring population density in health planning? The issues of availability and accessibility.
Availability of health facilities is commonly expressed in terms of the number of persons dependent on one unit. Whether that unit is actually accessible to those persons depends, however, on the population density. Some examples illustrate the precise relationship. A measure of accessibility is obtained by expressing the availability of facilities as 'one unit within x km distance' (for the average--or, preferably, the median--person). This measure is therefore to be preferred. (+info)
Medical technology and inequity in health care: the case of Korea.
There has been a rapid influx of high cost medical technologies into the Korean hospital market. This has raised concerns about the changes it will bring for the Korean health care sector. Some have questioned whether this diffusion will necessarily have positive effects on the health of the overall population. Some perverse effects of uncontrolled diffusion of technologies have been hinted in recent literature. For example, there is a problem of increasing inequity with the adoption of expensive technologies. Utilization of most of the expensive high technology services is not covered by national health insurance schemes; examples of such technologies are Ultra Sonic, CT Scanner, MRI, Radiotherapy, EKG, and Lithotripter. As a result, the rich can afford expensive high technology services while the poor cannot. This produces a gradual evolution of classes in health service utilization. This study examines how health service utilization among different income groups is affected by the import of high technologies. It discusses changes made within the health care system, and explains the circumstances under which the rapid and excessive diffusion of medical technologies occurred in the hospital sector. (+info)