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PubMed2004

Field based evidence of enhanced healthcare utilization among persons insured by micro health insurance units in Philippines.

Underutilization of healthcare is common among rural and low-income population segments in countries with lower income or inequitable income distribution. Micro health insurance units (MIUs) are created by informal sector groups because people cannot access health insurance or are dissatisfied with the programmes they can access. The policy choice to support MIUs relies on evidence that affiliation with these schemes increases healthcare utilization. This article examines new evidence of the association between affiliation with MIUs and healthcare utilization. We analyzed field data collected in 6 MIUs in the Philippines in 2002 (through a household survey encompassing 890 insured- and 1063 uninsured households). The two cohorts did not differ in demographic parameters, and differed only marginally in income and education levels, both higher amongst the insured. Insured persons reported higher hospitalization rates, higher rates of professionally-attended deliveries, lower rates of delivery at home, a higher frequency of primary-care physician encounters, a higher rate of diagnosed chronic diseases, and better drug compliance among chronically ill. Increased utilization by the insured is not due to adverse selection, judging by two facts: morbidity of the two cohorts, as assessed by a proxy indicator (the reported number of episodes of illness) did not differ; and rates of deliveries were even slightly higher among the uninsured. We conclude that MIUs in the Philippines can alleviate underutilization of heath care.

Adolescent↗
PubMed2003

The use of quantitative medical sociology.

The present article reviews, in relation to quantitative work on the social structure, papers published in Sociology of Health and Illness during its first 25 years. Each issue published during the years 1979-2002 has been examined; and quantitative papers, relating to various aspects of the social structure, have been identified. Such papers are found to have formed a minor but substantively significant theme within the Journal. These contributions situate the journal between sociology and social epidemiology. Articles in the Journal, for example, have been part of sociological debates about the measurement of social class, and of social epidemiological debates about the relationship between income distribution and population health. The contribution of Sociology of Health and Illness to a number of such debates is reviewed. The article concludes that the present situation, in particular the intellectual crisis in social epidemiology and social science investment in large data sets, gives the Journal the chance to build on this distinguished tradition by encouraging, through its publication policy, the further development of quantitative medical sociology.

Bibliometrics↗
PubMed2006

Dental service use and its correlates in a dentate population: an analysis of the Saskatchewan population health and dynamics survey, 1999-2000.

OBJECTIVES: To document the frequency of self-reported use of dental services within a 2-year period by a sample of dentate Saskatchewan residents aged 18 years and older; explore the correlates associated with dental service use for men and women separately; and examine the age, gender and income distribution of dental insurance coverage. METHODS: The 1999-2000 Saskatchewan Population Health and Dynamics Survey provided a representative sample of 5,003 dentate respondents (mean age 45.5 years; 52.3% women), 18 years and older, randomly selected and interviewed by telephone. RESULTS: Of those interviewed, 77% of the women and 67% of the men reported a dental visit within the previous 2 years. For women, logistic regression analysis indicated that when all other factors were held constant, the odds of dental service use within the last 2 years were higher among those who were aged 18-19 years, had post-secondary education or technical certification, were in the highest household income adequacy category, held dental insurance and engaged in such preventive behaviours as regular general checkups, eye checkups, skin self-examination and not smoking daily. For men, the odds of dental service use within the last 2 years were greater if they had education at or beyond the secondary level, were students, were in the upper or highest income adequacy levels, held dental insurance and engaged in preventive health behaviours such as general checkups, eye checkups and not smoking daily. Dental insurance coverage was strongly associated with household income adequacy and peaked among men and women aged 30-49 years. CONCLUSIONS: This study indicates that the roles of gender, income, education, age, health-related behaviours and resources such as dental insurance should be considered in future public oral health strategies. We propose a conceptual model to aid in understanding the social structural and individual pathways to oral health.

Adolescent↗
PubMed1982

Political constraints to nutritional improvement: the case of Guyana.

The processes generating malnutrition are examined with particular reference to Guyana. The theoretical framework includes the concept of limiting factors, which in this case means that the failure to alter a critical variable will prevent nutritional improvement, despite intervention in other variables. Among important factors found to cause malnutrition age low national production, inequitable income distribution, and maladaptive cultural practices. These are located in the economy of the country and in the institutions and ideas which support that economy. Power and politics therefore fundamentally affect nutritional outcome; and imperialist control of underdeveloped economies makes international relations an indispensible consideration. It is concluded that for Guyana the political process is the limiting factor which must be altered before significant nutritional improvement can occur.

Child, Preschool↗
PubMed1986

Health care usage by Hispanic outpatients as function of primary language.

Three groups of Hispanic patients at five outpatient clinics in San Diego County, California, participated in a survey questionnaire concerning health care usage according to whether they were Spanish-speaking only, bilingual with Spanish as a primary language or primarily English speaking. Although the three groups were similar in age and income distribution, the use of health services (regular source of health care, health insurance, admission to hospital and frequency of general physical, eye and dental examinations) was positively correlated with increased use of English. Likewise, respondents whose primary language was English were more likely to describe their health care as more than adequate and their own health as excellent than were those whose primary language was Spanish.

California↗
PubMed2005

Differential improvement among countries in child stunting is associated with long-term development and specific interventions.

Stunting represents growth failure resulting from poor nutrition and health during the pre- and postnatal periods. Initiatives since 1980 have steadily reduced malnutrition and consequent retardation of child growth, but 1 of 3 preschool children worldwide remains stunted. Countries have varied substantially in progress achieved in reducing stunting. This study aimed to understand which underlying (i.e., proximal) and basic (i.e., distal) national factors have been most important in explaining this variation among countries, and the relation between the 2 sets of factors. Eighty-five developing countries with at least 2 surveys for stunting >4 y apart were included from the WHO Global Database on Child Growth. The analytic data set with independent variables from several sources was constructed to match closely by year for each country to initial and final stunting data. Full-information maximum likelihood estimated multiple linear regression models while accounting for missing data in independent variables. The final model explained 65.5% of the variance of change in stunting, and included both underlying and basic variables: initial and change in immunization rate, initial and change in safe water rate, initial female literacy rate, initial government consumption, initial income distribution, and the initial proportion of the economy devoted to agriculture. Although factors that were important for reducing stunting in the past may not necessarily be the ones that are important in the future, these results suggest that it possible for substantial progress to be made in reducing the current high prevalence of stunting by investing in both long-term development and in specific interventions.

Agriculture↗
PubMed1997

Measuring spatial focusing in a migration system.

Equality indexes used in other geographical contexts may be used to gauge the degree of spatial focusing in an entire migration system or within the gross in- and out-migration fields of specific regions. They provide useful indicators of overall shifts in the patterns of interregional migration and can help give insight into the population redistributive roles played by specific regions. Perhaps the most common equality index used to measure income distribution is the Gini coefficient, yet it appears almost never to have been applied in migration research. In this paper we set forth a variety of Gini indexes to be used for different migration analyses and illustrate their application with recent data on U.S. interstate movements. We argue that the Gini index provides some singularly useful insights that differ from those afforded by other measures more commonly found to date in the migration analyst's tool kit.

Censuses↗
PubMed1983

Structural characteristics of the macroeconomy and mental health: implications for primary prevention research.

Recent research on the impact of economics on mental and physical health has raised fundamental questions about structural elements in the macro-economy. Specifically, five characteristics of our current economic system: instability in the business cycle, unemployment, inequality in income distribution, capital mobility, and fragmentation of the work process, appear to play some pathogenic role in the incidence of behavioral and physical disorders. These macroeconomic elements require intervention at the social policy level since they seem to be more powerful than the individual coping mechanisms of some demographic subgroups. Psychologists can play an important role in policy decisions by providing data on the relative impact of structural economic variables on human functioning. Examples of structural research are presented and the implications for primary prevention are discussed.

Community Mental Health Services↗
PubMed1985

The impact of cost sharing on emergency department use.

We studied the effect of insurance coverage on the use of emergency department services, using data from a national trial of cost sharing in health insurance. A total of 3973 persons below the age of 62 years were randomly assigned to fee-for-service health insurance plans with coinsurance rates of 0, 25, 50, or 95 per cent, subject to an income-related upper limit on out-of-pocket expenses. Persons with no cost sharing had emergency department expenses that were 42 per cent higher than those for persons on the 95 per cent plan (P less than 0.01) and about 16 per cent higher than those for persons with smaller amounts of cost sharing. Without cost sharing, emergency department visits for less serious diagnoses (e.g., abrasions) increased three times as much as did visits for more serious diagnoses (e.g., lacerations). After control for insurance, persons in the lower third of the income distribution had emergency department expenses that were 64 per cent higher than those in the upper third (P less than 0.001) and received a greater proportion of their ambulatory care in the emergency department. We conclude that the absence of cost sharing results in significantly greater emergency department use than does insurance with cost sharing. A disproportionate amount of the increased use involves less serious conditions.

Ambulatory Care↗
PubMed2002

Poverty, social exclusion and health in Portugal.

People in Portugal have never been so healthy. Nevertheless, there are great differences in health status between social groups and regions. In 1994, Portugal was the country with the second worst level of inequality in terms of income distribution and with the highest level of poverty in the European Union (EU). Poverty in Portugal affects mainly the elderly and women (especially in single parent families). Beyond these groups, there are the children, the ethnic minorities and the homeless. Substance abusers, the unemployed, and ex-prisoners are also strongly affected by situations of social exclusion and poverty. Although poverty has been an important issue on the political agenda in Portugal, it shows a worrying tendency to resist traditional Social Security interventions. In the late 1990s, however, welfare coverage rates appear to have risen. To what extent can poverty cause a worsening of health status? Is there any sustainable positive association between welfare and improved health status? How, to whom and when should actions to improve the health status of the disadvantaged be addressed, without subverting the health status of the rest of the population. It is also necessary to reveal the consequences of poor health to individuals, families and communities in terms of income, social empowerment and the ability to fulfil other needs. Finally, reflection on the role and effectiveness of traditional social security models is necessary, in order to improve the impact and adequacy of its interventions. The goal of this paper is to contribute to the knowledge about disadvantage, the current health situation of the most vulnerable groups in Portuguese society-those affected by poverty, deprivation and social exclusion-and to detect the constraints on access to health and health care.

Adolescent↗
PubMed1999

Have family income mobility patterns changed?

We examine the mobility of individuals in the United States based on equivalent family income--that is, total income of all family members adjusted for family size according to the equivalence scale implicit in the U.S. poverty line. Our analysis, which tracks movements across quintiles, centers on four questions: How much movement is there across the family income distribution? How has this mobility changed over time? To what extent are the movements attributable to factors related to changes in family composition versus events in the labor markets? In light of major socioeconomic changes occurring in the quarter-century under study, have the determinants of mobility changed over time? Our findings indicate that mobility rates in the 1980s differed little from those in the 1970s. However, individuals in families headed by a young person or a person without a college education were less likely to experience upward mobility in the 1980s than in the 1970s.

Adolescent↗
PubMed1991

Social policy and economic change in Chile, 1974-1985: the case of children.

Taking the case of Chile in the period 1974-85, this article examines the impact of economic conditions and social policies on poor households, and especially on children. The study starts with an analysis of the nature of the economic policies implemented in Chile during 1974-85 and their effects on income distribution and on the material living conditions of poor households. It then looks into the social policies, government expenditure, and the main programs directed toward poor households and children, as well as at the changes in child welfare that followed. From this macrosocial level the study diverts to the household level and describes, based on several in-depth studies of small samples of households in the Santiago metropolitan area during the years 1982-85, the daily experiences of poor households--their deteriorating economic conditions and the behaviors adopted to stretch scarce resources to satisfy basic needs. The final part draws some lessons from the Chilean case.

Child↗
PubMed1980

[Environmental and sociocultural parameters affecting nutrition in Third World countries].

The thrust of this paper is an analysis of the environmental and sociocultural parameters affecting dietary patterns in Third World countries. The author utilizes data from several studies to emphasize her thesis that malnutrition in developing societies is not an entity caused simply by income constraints, or food availability, but rather that malnutrition constitutes a critical entity resulting from a constellation of problems, ranging from environmental stresses, to social inequities to cultural factors. Special discussion is given to the variables of income distribution, social stratification and food beliefs as major contributing influences of malnutrition in Third World countries. The problems facing newly migrating urban squatters--or what is known as "societies in transition" in the context of high unemployment and new demands for food--are also dealt with in the Latin American setting. The author discusses the importance to recognize that since the etiology of malnutrition is ecologically-based; therefore, the approaches to solve this problem should--also by definition--be of an ecological nature. The need to further develop meaningful conceptual models--in contrast to utilizing "imported" ones--in order to study and understand the nature and magnitude of malnutrition problems in Third World countries is also stressed.

Developing Countries↗
PubMed1998

Poverty and ill health: physicians can, and should, make a difference.

A growing body of research confirms the existence of a powerful connection between socioeconomic status and health. This research has implications for both clinical practice and public policy and deserves to be more widely understood by physicians. Absolute poverty, which implies a lack of resources deemed necessary for survival, is self-evidently associated with poor health, particularly in less developed countries. Over the past two decades, economic decline or stagnation has reduced the incomes of 1.6 billion people. Strong evidence now indicates that relative poverty, which is defined in relation to the average resources available in a society, is also a major determinant of health in industrialized countries. For example, persons in U.S. states with income distributions that are more equitable have longer life expectancies than persons in less egalitarian states. There are numerous possible approaches to improving the health of poor populations. The most essential task is to ensure the satisfaction of basic human needs: shelter, clean air, safe drinking water, and adequate nutrition. Other approaches include reducing barriers to the adoption of healthier modes of living and improving access to appropriate and effective health and social services. Physicians as clinicians, educators, research scientists, and advocates for policy change can contribute to all of these approaches. Physicians and other health professionals should understand poverty and its effects on health and should endeavor to influence policymakers nationally and internationally to reduce the burden of ill health that is a consequence of poverty.

Health Policy↗
PubMed2004

[ENDEF and PNSN: trends in physical growth of Brazilian children].

This paper compares the results of two nationally representative nutritional surveys carried out in Brazil: the "Estudo Nacional de Despesa Familiar (ENDEF)" (National Survey on Household Expenses), conducted in 1974-77, and the "Pesquisa Nacional de Saúde e Nutrição (PNSN)" (National Survey on Health and Nutrition), conducted in 1989. The findings point to a reduction of more than 60% in the prevalence of undernutrition, as evaluated by anthropometric parameters. The results from regional surveys and the trends in infant mortality throughout the 1970s and 1980s are consistent with the improvements in nutritional status. Less striking reductions in undernutrition rates were observed in certain regions of the country (e.g., the North and Northeast), where prevalences were higher in the 1970s, resulting in a widening of regional differences. The improvements in child nutrition are attributed to moderate increases in family income, particularly in the 1970s, and to the expansion of sanitation, public health, and educational services, as well as food supplementation programs, which were also favored by a fall in fertility levels. The authors call attention to the fact that the lack of clear-cut indications of economic recovery in Brazil recently, coupled wih cuts in government budgets for social services and the persistence of inequality in income distribution, among other factors, make it unlikely that improvements in nutritional status, as observed in the 1970, will take place in the upcoming years.

English Abstract↗
PubMed2004

The role of public and private transfers in the cost-benefit analysis of mental health programs.

This paper revisits the issue of whether to include maintenance costs in an economic evaluation in mental health. The source of these maintenance costs may be public or private transfers. The issue is discussed in terms of a formal cost-benefit criterion. It is shown that, when transfers have productivity effects, income distribution is important, and one recognizes that public transfers have tax implications, transfers can have real resource effects and cannot be ignored. The criterion is then applied to an evaluation of three case management programs in California that sought to reduce the intensive hospitalization of the severely mentally ill.

Aftercare↗
PubMed1988

Diet, mortality and life expectancy: a cross national analysis.

"There are numerous reasons why mortality and life expectancy vary between countries. Epidemiological studies seem to indicate that dietary variations may be among them. A sample of 51 countries studied with data from the International Comparisons Project and other sources, shows that after controlling for nutrient intake, consumption of medical goods and services, income distribution, weather, and literacy, countries with more meat and poultry in their diet have lower life expectancies after age five. The results for infant mortality and child death between one and five indicate that a more animal-intensive diet may be actually beneficial, especially if fish consumption is increased and meat and poultry consumption reduced."

Demography↗