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PubMed1997

[Maternity in adolescents in the districts and neighborhoods of Barcelona: its association with the socioeconomic level and the prevalence of low weight at birth. The Working Group of Maternal-Child Health of the Municipal Institute of Health of Barcelona].

OBJECTIVE: To describe the distribution of birth rates and low birth weight among teenagers from the health districts and neighbourhoods of Barcelona and their association with social and economic level. DESIGN: Environmental study. SETTING: City of Barcelona. METHODS: The birth rates for under-20 year olds resident in Barcelona for the periods 1980-1982, 1987-1992 and 1990-1992 were calculated. The index of family economic capacity (IFEC) was used as a social and economic indicator. The coefficient of Spearman was used as a correlative measurement. MEASUREMENTS AND MAIN RESULTS: Between the periods 1980-1982 and 1990-1992, a 65% drop in the adolescent birth rate was observed. The correlation of birth rates with the IFEC for the district fell from -0.91 to -0.69 in the same period. CONCLUSIONS: Adolescent birth rates have very uneven geographical distribution, which correlates with the distribution of income. The percentage of low weight at birth is higher in the poorest districts, but the association with IFEC is much weaker.

Academies and Institutes↗
PubMed1999

[Economics and ethics in public health?].

The topic suggests a conflict between ethics and economy in medical care. It is often argued that today's welfare state in affluent societies with their social insurance systems makes it easier for the doctor to translate ethical demands into reality without being hampered by economic restrictions. Both doctors and patients took advantage of this system of medical care by mingling social guarantees for health with the doctor's income. Hence, medical expenses expanded rapidly, additionally promoted by technical progress in medicine. This entailed a proportionate increase in medical expenses in relation to personal income, especially wage income. Budgets of state authorities were streamlined or deficits became larger. This state of affairs was promoted further by mechanisms of distribution of national income in accordance with the slogan "less state, more market". While national income continued to grow, although at a slower rate, the number of jobless persons grew continually and thus also the social expenses, this was not due, as is usually assumed and pretended, to an economic crisis. Society and economy are facing a crisis of distribution of national income under conditions of technical progress as a job killer, making economic production more productive and efficient. Not taking into account the new challenge of social market economy--the German innovation in market economy creating the economic miracle after World War II--reforms of the system of medical care took place and are still continuing along market principles, particularly the latest German reform law leading to individual contracts between patients and their doctors in respect of cost charging. However, marketing principles promote economy in medicine, but they do not promote medical ethics. Further German guidelines for medical care should take stock of past experiences. There will be more competition in the "growing market of medical care" (private and public) and this will need--as economic experience has shown and economists have affirmed--new organisational devices to ensure better outcomes for the individual patient as a consumer and the doctors as suppliers. More responsibility should be given to the different suppliers of collective security in medical care (private or social systems of insurance). No individual patient as a mere consumer has a genuine chance in handling contracts with doctors carefully who are considered to be "gods in white" according to a popular German saying. These consumers have only a slight chance when arguing in courts of justice for the performance of contracts. Diagnosis and therapy, the system of doctors who treat members of statutory social insurance schemes (National Health general practitioners in the U.K.) and doctors as "free entrepreneurs" in the growing market of medical care should be separated due to the different rules of charging costs and offering medical care. "Classless medical care" does not have a better chance by applying market principles. The same is true for ethics versus economy. Doctors as "free entrepreneurs" must learn that markets will not guarantee reimbursement of costs but react to supply and demand. Hence, regulation of medical care by economic instruments creates better chances even for ethics in medical care against economy.

Cost Control↗
PubMed1975

Dietary survey of low-income, rural families in Iowa and North Carolina. II. Family distribution of dietary adequacy.

Distribution patterns of Iowa and North Carolina families for dietary adequacy at various income levels were compared according to: (a) two family dietary standards, based on the 1968 Recommended Dietary Allowance and the Ten-State Nutrition Survey dietary standards, and (b) two income standards, family income and per capita income. A 24-hr. recall method was used to collect the dietary data. Nutrients studied included: protein, calcium, iron, vitamin A, ascorbic acid, thiamin, and riboflavin. Clear differences emerged in family distribution patterns by the two dietary standards and by the two income standards. Comparison of family distribution patterns for dietary intake by the two standards showed that percentages of families with poor nutrient intakes were lower by Ten-State evaluation than for the recommended allowance evaluation, except for protein and iron. For example, the percentage of families with poor calcium intakes, by Ten-State criteria, was approximately half that measured by the recommended allowances. While, according to the latter, calcium was the most limiting nutrient in many family diets, vitamin A was most limiting by Ten-State evaluation. The proportions of families with poor ascorbic acid, thiamin, and riboflavin intakes were also lower by Ten-State standards. While the iron adequacy remained approximately the same by both dietary standards, the percentage of families with poor protein intakes was higher by the Ten-State criteria. A higher percentage of families at each income level had fair and good diets by Ten-State comparison. Family distribution patterns for intakes of individual nutrients at various family income levels demonstrated a positive relationship between nutritional intake and income. Proportions of families with poor nutrient intakes according to per capita income tended to increase with the income level. For both income standards, the percentages of families with good and fair diets in the total family sample gradually increased with income. Percentages of Iowa families with fair and good diets at various income levels were, in general, higher than those of North Carolina families. The lowest and the highest percentages of families with poor diets of two population groups were higher for per capita income distribution than for family income distribution.

Adolescent↗
PubMed2006

Differences in practice income between solo and group practice physicians.

An examination of the distribution of physician incomes between different types of practices could help policymakers and researchers alike to gain an understanding of the effects of different organizational characteristics of practices on the practice of medicine as a whole. This study uses a national database to explore the relationships that exist between practice incomes and practice types vis-à-vis the overall size of practices. The primary data source for this study, which includes 7757 office-based physicians, was provided by the Taiwan Department of Health (DOH), with the dependent variable of interest to this study being the annual gross income of physician practices, while the independent variables are physician practice types and the number of physicians within a clinic. Multiple regression analyses were used to model the logarithm of annual physician practice incomes as a linear function of a set of independent variables. Kruskal-Wallis test results revealed the existence of significant relationships between practice incomes and practice types (p<0.001) and the number of physicians within a clinic (p<0.001). Multiple regression analysis also showed that after adjusting for socio-demographic and professional characteristics, the annual incomes of physicians in both single-specialty or multi-specialty group practices (p<0.001) were higher than those of their solo practice counterparts. This study concludes that after adjusting for other factors, higher practice incomes are enjoyed by physicians in single-specialty or multi-specialty group practices as compared to their solo practice counterparts. The finding of higher incomes for those physicians organized into groups supports the policy call from the DOH in Taiwan for the widespread formation of group practices.

Adult↗
PubMed2005

Until death do us part: an analysis of the economic well-being of widows in four countries.

OBJECTIVE: Our objective was to show how a woman's economic well-being changes in the United States, Germany, Great Britain, and Canada after her husband's death and the importance of public and private income sources in offsetting the economic consequences of that death. METHODS: With data from the Cross-National Equivalent File, we used event history analysis to track changes in the social security replacement rate and the more comprehensive total income replacement rate for women and to show how these changes vary across age and household income quintiles within and across countries. RESULTS: There were substantial differences across the countries in how income from specific sources changes, especially with respect to the mix of income from government and private sources, but the overall across-country pattern of total income replacement rates was remarkably similar both in size and in distribution across age and the woman's place in the income distribution prior to her husband's death. DISCUSSION: Studies that focus on a social security replacement rate will seriously understate the actual total income replacement rate of women following a husband's death. This will especially be the case in countries like the United States where private sources of income play a more important role in income replacement.

Adult↗
PubMed1994

The impact of health care financing on family budgets.

Although businesses, federal and state governments, and insurance companies are major funding sources for health care, they are just intermediate sources. Ultimately, individuals and families pay all health care costs through out-of-pocket spending, insurance premiums, or federal, state, and local taxes. Using a microsimulation model with data from the 1987 National Medical Expenditure Survey, the Internal Revenue Service's Individual Tax Model, and the Consumer Expenditure Survey, the authors examine the distribution of health care spending, by decile, among families and individuals. They find that the distribution of health expenditures is very regressive, with low-income families paying twice the share of income paid by high-income families. The distribution of out-of-pocket expenditures, which comprise 24 percent of total spending, is the most regressive, with low-income families paying 8.5 times the share of income paid by high-income families. Spending on premiums is also regressive, and the regressivity would increase if everyone had private insurance. Expenditures through the public sector are progressive. Regressivity is greater among the elderly than the nonelderly. Out-of-pocket expenditures account for 41 percent of all health care spending by the elderly. A more equitably financed health care system would increase the share of funding raised through progressive taxes, and decrease reliance on expenditures made out of pocket and on premiums.

Adolescent↗
PubMed2001

Effect of poverty and other socioeconomic variables on renal allograft survival.

BACKGROUND: Socioeconomic variables including low income and noncompliance impact negatively upon long-term renal allograft survival, especially in African Americans. We sought to determine whether other socioeconomic variables contributed to noncompliance and allograft survival. METHODS: A detailed history of socioeconomic variables was made at the time of renal transplant evaluation in 450 consecutive candidates, 128 of whom (89 African American, 39 Caucasian) have thus far undergone transplantation. Variables evaluated included household income, zip code income, insurance coverage, years of education, literacy, marital status, pretransplantation compliance, and history of substance abuse as well as the usual pre- and posttransplantation demographics. RESULTS: Immunologic graft loss occurred primarily in young African Americans with income below the federal poverty level, whereas nonimmunologic graft loss was distributed across racial, income, and other socioeconomic variables. Immunologic graft loss was also associated with a greater number of HLA mismatches, lower levels of education, and noncompliance with transplant medications and follow-up visits. Recipients with gross illiteracy, however, had excellent graft survival. Pretransplantation substance abuse, but not pretransplantation compliance, was predictive of posttransplantation noncompliance. By multivariate analysis, posttransplantation compliance emerged as the single most important factor predictive of graft survival. CONCLUSIONS: Immunologic graft loss in our population is related to noncompliance with transplant medications, which occurred primarily in recipients with a pretransplantation history of substance abuse and is not related to an inability to pay for medications at the time of graft loss. A change in criteria for acceptance of transplant candidates with a prior history of substance abuse might significantly improve graft survival in this patient population.

Adult↗
PubMedDate not supplied

Policy implications of the gradient of health and wealth.

Men in the United States with family incomes in the top 5 percent of the distribution in 1980 had about 25 percent longer to live than did those in the bottom 5 percent. Proportional increases in income are associated with equal proportional decreases in mortality throughout the income distribution. I discuss possible reasons for this gradient and ask whether it calls for the redistribution of income in the interest of public health. I argue that the existence of the gradient strengthens the case for income redistribution in favor of the poor but that targeting health inequalities would not be sound policy.

Adult↗
PubMed1977

The survey of the low-income aged and disabled: an introduction.

As 1974 began, the Social Security Administration started distributing supplemental security income (SSI) payment checks to aged, blind, and disabled poor persons throughout the Nation. Shortly before the first SSI checks were issued, the Bureau of the Census completed personal interviews with 17,551 individuals from which SSI's clientele would be drawn--aged and disabled welfare recipients and the aged and disabled poor persons in the general population. These data, collected for the Social Security Administration is late 1973, and comparable information gathered from the same respondents in late 1974 make up the Survey of the Low-Income Aged and Disabled (SLIAD). Its findings will be used to describe the circumstances of needy aged and disabled persons before SSI, determine the program's success in attracting those who qualified for its benefits during the first year of operations, and assess the effect of participation on the well-being of recipients.

Aged↗
PubMed1997

Health and social cohesion: why care about income inequality?

Throughout the world, wealth and income are becoming more concentrated. Growing evidence suggests that the distribution of income-in addition to the absolute standard of living enjoyed by the poor-is a key determinant of population health. A large gap between rich people and poor people leads to higher mortality through the breakdown of social cohesion. The recent surge in income inequality in many countries has been accompanied by a marked increase in the residential concentration of poverty and affluence. Residential segregation diminishes the opportunities for social cohesion. Income inequality has spillover effects on society at large, including increased rates of crime and violence, impeded productivity and economic growth, and the impaired functioning of representative democracy. The extent of inequality in society is often a consequence of explicit policies and public choice. Reducing income inequality offers the prospect of greater social cohesiveness and better population health.

Global Health↗
PubMed1994

Poverty, income inequality, and health care consumption in Thailand.

The Thai economy has grown rapidly during the past three decades of modern industrialization. The structure of the economy has been changing from an agricultural to manufacturing based. Because industrial development policies has been biased toward Bangkok and surrounding provinces, regional income disparities have been widening. Despite the high growth record, Thailand has failed to distribute the benefits of economic growth equitably. This problem of income distribution could have many important consequences of relevance to the health of population.

Developing Countries↗
PubMed2002

Social capital and health (plus wealth, income inequality and regional health governance).

This article describes an empirical exploration of relationships among aspects of thirty health districts in Saskatchewan, Canada. These aspects include social capital, income inequality, wealth, governance by regional health authorities and population health, the primary dependent variable. The social capital index incorporated associational and civic participation, average and median household incomes served as proxies for wealth, the degree of skew in the distribution of household incomes assessed income inequality while the model for effective governance by District Health Boards (DHBs) focused on reflection of health needs, policy making and implementation, fiscal responsibility and the integration and co-ordination of services. I found no evidence of a relationship between social capital in health districts and the performance of DHBs. Among the determinants of health, wealth appeared unrelated to age-standardised mortality rates while income inequality was positively and social capital was negatively related to mortality. Income inequality was not as strongly related to age-standardised mortality after controlling for social capital. and vice versa, suggesting the two may be comingled somehow when it comes to population health, although they were not significantly related to one another. Of the predictors of social capital the distribution of age in districts appeared to be the most salient; of the predictors of age-standardised mortality rates the gender composition of a district was most salient.

Adolescent↗
PubMed1998

Micro-level analysis of distributional changes in health care financing in Finland.

OBJECTIVES: In the early 1990s the Finnish economy suffered a severe recession at the same time as health care reforms were taking place. This study examines the effects of these changes on the distribution of contributions to health care financing in relation to household income. Explanations for changes in various indicators of health care expenditure and use during that time are offered. METHOD: The analysis is based partly on actual income data and partly on simulated data from the base year (1990). It employs methods that allow the estimation of confidence intervals for inequality indices (the Gini coefficient and Kakwani's progressivity index). RESULTS: In spite of the substantial decrease in real incomes during the recession, the distribution of income remained almost unaltered. The share of total health care funding derived from poorer households increased somewhat, due purely to structural changes. The financial plight of the public sector led to the share of total funding from progressive income taxes to decrease, while regressive indirect taxes and direct payments by households contributed more. CONCLUSIONS: It seems that, aside from an increased financing burden on poorer households, Finland's health care system has withstood the tremendous changes of the early 1990s fairly well. This is largely attributable to the features of the tax-financed health care system, which apportions the effects of financial and functional disturbances equitably.

Cost Sharing↗
PubMed1983

Unearned income of Supplemental Security Income recipients, May 1982.

About 3 out of 5 Supplemental Security Income recipients have some type of unearned income. The major source of this income is Social Security benefits. Other sources are veterans' pensions, pensions from employment, asset income, and support and maintenance in-kind. This article presents for the first time detailed estimates of the distributions of these income sources, based on a 1-percent sample of May 1982 recipients. In two-thirds of the cases, the Social Security benefits were between $100 and $260 a month. Unearned income from sources other than Social Security was usually smaller. Only 5 percent of the SSI population received less tha $100 in Social Security benefits. Differences in distributions for retired-worker and disabled-worker benefits, and for widow's and children's benefits are noted.

Child↗
PubMed1982

Demographic aging in the United States: implications for population and income redistribution to the year 2000.

"The purpose of this paper is to analyze the effects of a prolonged period of sustained low fertility upon shifts in the population distribution of the United States among Department of Energy (DOE) regions." The authors also examine the impact of demographic aging on income distribution up to the year 2000 using the assumptions made in the Series III population projections prepared by the U.S. Bureau of the Census in 1977. It is noted that migration will emerge as the primary agent for internal population redistribution.

Age Distribution↗
PubMed1992

Breast cancer screening among women from 65 to 74 years of age in 1987-88 and 1991. NCI Breast Cancer Screening Consortium.

OBJECTIVE: To compare breast cancer screening rates from the 1991 survey with data from 1987-88 for women aged 65 to 74. DESIGN: Surveys of women from five communities. SETTINGS: Five control communities of the National Cancer Institute's Breast Cancer Screening Consortium. PARTICIPANTS: White, non-Hispanic women, ages 65 to 74; 499 in 1987-88 and 2156 in 1991. Response rates for the first survey wave ranged by area from 65% to 77% and for the second survey wave, from 62% to 85%. MAIN OUTCOME MEASURE: Mammogram and clinical breast examination during the past year and performance of monthly breast self examination, with the screening rates in wave 2 directly standardized to the income and education distribution of wave 1 in each area. RESULTS: Mammography use between waves increased significantly (P < 0.05 after adjusting for education, income, and age) in all but one area (from 19% to 33% in wave 1 to 35% to 59% in wave 2). Among women who had a mammogram, the percent who also had a clinical breast examination decreased between waves from 95% to 85% (P = 0.001). CONCLUSIONS: Mammography in older women increased dramatically over 3 years, although the use of clinical breast examination may be decreasing.

Aged↗
PubMed2005

Decreasing socioeconomic inequalities and increasing health inequalities in Spain: a case study.

OBJECTIVES: We examined the evolution of income inequalities and health inequalities in Spain from the time of the country's entry into the European Union. METHODS: We estimated distributions of provincial income and household income, relations of provincial income with mortality and disability, and relations of household income with disability in 1984-1986 and 1999-2001. RESULTS: Inequalities in average provincial income and household income were lower in 2000 than in 1985. Differences in mortality and disability according to income were greater in 2000 than in 1985, in both absolute and relative terms, except for differences in mortality among individuals aged 25 to 44 years. In most cases, differences in mortality from leading causes of death and differences in major types of disabilities were also greater in 2000. CONCLUSIONS: Our results show that redistribution of income might achieve greater social justice but probably does not lead to reduced health inequalities, despite observed improvements in material circumstances as well as in most health indicators among disadvantaged population groups.

Adult↗
PubMed2005

The status of low-income neighborhoods in the post-welfare reform environment: mapping the relationship between poverty and place.

It has long been recognized that children and adults living in poverty are at risk for a number of negative outcomes. As inequality in the distribution of wealth, income and opportunity has grown in the U.S. during the post-welfare reform era, impoverished children and their families have tended to become increasingly concentrated in urban low-income neighborhoods. Research evidence demonstrates that living in these neighborhoods affects family well-being in several key areas: economic and employment opportunity, health and mental health condition, crime and safety, and children's behavioral and educational outcomes. Using the neighborhood indicator approach, public and nonprofit social service agencies will be better positioned to develop a comprehensive and integrated service delivery model at the neighborhood level by using neighborhood assessment to locate services and utilize neighborhood intervention strategies.

Humans↗