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PubMed1992

National mortality rates: the impact of inequality?

Although health is closely associated with income differences within each country there is, at best, only a weak link between national mortality rates and average income among the developed countries. On the other hand, there is evidence of a strong relationship between national mortality rates and the scale of income differences within each society. These three elements are coherent if health is affected less by changes in absolute material standards across affluent populations than it is by relative income or the scale of income differences and the resulting sense of disadvantage within each society. Rather than socioeconomic mortality differentials representing a distribution around given national average mortality rates, it is likely that the degree of income inequality indicates the burden of relative deprivation on national mortality rates.

Humans↗
PubMed1975

The spatial distribution of urban pharmacies.

Pharmacists are thought to play a central role in providing information and advice on health to lower income and other socially disadvantaged groups. However, recent evidence suggests that social biases exist in the spatial distribution of urban pharmacies. Such biases would severely limit the accessibility of the poor and the nonwhite to pharmacy services. To test the general nature of this evidence, we used multiple regression techniques to assess the simultaneous influence of several ecological and socioeconomic variables on the location of pharmacies in Pittsburgh and Omaha. After controlling for the influence of physicians, hospitals, commercial activity, population, and other variables thought to affect pharmacy location, we were unable to detect any evidence of a direct association between pharmacy location and the socioeconomic or demographic (other than total population) characteristics of areas in either city.

Delivery of Health Care↗
PubMed2005

Gender differences in the distribution of cocaine and heroin in Central Harlem.

OBJECTIVE: This article investigates the extent to which users of crack, powder cocaine and heroin in Central Harlem participate in various roles involved in distributing these drugs, examining gender differences among distribution roles. METHODS: Several strategies were combined to acquire a sample of 655 hard drug users and sellers who self-reported demographics, drug use and other factors in a face-to-face interview. Chi-square analyses were used to examine factors associated with having drug distribution roles. RESULTS: More than two-fifths (N = 269) of all respondents self-reported participation in at least one current distribution role. The most common roles were acting as a middleman, steering buyers, holding drugs or money, and transporting drugs. Distributors were more likely to have HIV, previous drug treatments, and less education, employment or housing, but had higher incomes than users. A higher proportion of women reported drug distribution roles, but among distributors, men were twice as likely women to be direct sellers and transporters of drugs, and to perform more distribution roles. CONCLUSIONS: Gender contrasts support previous research indicating male dominance of drug distribution roles. Previous studies may underestimate women's participation in distribution roles. Drug treatment programs are encouraged to augment existing relapse prevention activities with distribution prevention efforts.

Adult↗
PubMed2001

[Surgical procedures of the urinary tract and male genital organs. Rates of surgical intervention: variability and its relationship with distance and income].

OBJECTIVE: To valorate the existence of the variability, in surgical rates on urinary tract and masculine genital organs, between the population of Health Centres (HC) adscribed to the Hospital of Ciudad Real. It so, quantify the influence of the distance (from Health Center to Hospital) or the income have in the variability of these rates. MATERIAL AND METHOD: Surgical activity of the period 1996-98. It has been analyzed for every procedure: residence, sex, age and type (coded by CIE 9th MC). The surgical rates, standardized for age and sex, (TFQ) for every HC has been compared whit the mean (t alpha/2 n-1 alpha = 0.99) of the distribution of rates by HC. The relation between the TFQ and distance or income has been analyzed by lineal regression and ANOVA test for one variable, using the Newman Keuls test to assess the difference of the rates between the HC at different distance or income. It has been considered as significative every p < 0.05. RESULTS: The population studied has a TFQ significatively different (p < 0.01). significant relationship exists between the TFQ and the distance. There were no relations between the TFQ for HC and the income. CONCLUSIONS: 42% of the variance (variability) of the distribution of TFQ for HC is due to the distance.

Adolescent↗
PubMed2003

Public health insurance. Pareto-efficient allocative improvements through differentiated copayment rates.

Moral hazard in an insurance system can be reduced by introducing copayments. Unfortunately, this may exert undesired distribution effects, which are generally regarded to be of specific relevance in the health sector. The article concentrates on an obligatory social health insurance system and tries to show that rightly adjusted and double-differentiated copayment rates can at least partially resolve the dilemma between allocation and distribution. The differentiation considered is with respect to income and to treatment sickness costs. The argument is presented by means of diagrammatic exposition.

Journal Article↗
PubMed2006

The gender shift in veterinary medicine: cause and effect.

The gender shift in veterinary medicine has paralleled other changes in debt and income. Cause and effect are complex and often confused. Popular notions of the priorities of the new generation of men and women are often not supported by research studies. Recent data reveal new insights into questions surrounding the gender issue.

Female↗
PubMed2006

The inequity of informal payments for health care: the case of Hungary.

As in most countries of Central and Eastern Europe, informal payments have been a characteristic feature of the Hungarian health care system both during and since the demise of Soviet type socialist rule. Although informal payments continue to be so characteristic in the region, little empirical evidence exists on their scope or working. As far as equity is concerned, it has sometimes been suggested that physicians play a 'Robin Hood' role and subsidise the poor at the expense of the rich. With the aid of an interview survey of a representative sample of the Hungarian population, we examine the distribution of the burden of informal payments across income groups. Results indicate that informal payments are a highly regressive way of funding health care, with Kakwani progressivity indices of -0.38, -0.39, -0.35 and -0.36 for GP, outpatient specialist, hospital, and total care, respectively. The finding that people with lower income pay proportionally more for public health care through informal payments underlines the emptiness of the 'Robin Hood' claims and the need for reform.

Adult↗
PubMedDate not supplied

Trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain.

OBJECTIVE: To study the trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain between 1987 and 2001. METHODS: We estimated the distribution of educational level and per capita provincial income, and the differences in less-than-good self-perceived health by educational level and per capita provincial income in each period. RESULTS: The percentage of the population that had completed secondary or higher education was larger and inequality in per capita provincial income was smaller in 2001 than in 1987. In general, the differences in less-than-good self-perceived health by educational level and provincial income were greater in 2001 than in 1987, in both absolute and relative terms. However, when the effect of residual correlation within provinces was taken into account, the differences by per capita provincial income were smaller in 1987 than in 2001. CONCLUSIONS: The redistribution of socioeconomic resources achieves greater social justice, but probably does not lead to reduced health inequalities in all cases.

Adult↗
PubMed2000

Distributional impact of higher patient contributions to Australia's Pharmaceutical Benefits Scheme.

This paper uses NATSEM's Pharmaceutical Benefits Model to analyse the effects of a hypothetical 25 per cent rise in patient contributions to prescribed medicines under Australia's Pharmaceutical Benefits Scheme (PBS). The model, based on microsimulation techniques, is able to provide a much broader range of outcomes information, at a much greater level of detail, than is possible with traditional methods. Higher patient contributions are analysed in terms of their impact on the government to patient split in PBS costs, as well as the distribution of such costs across age groups, family incomes, family types and 36 prescribed medicine types. Also considered are changes in the shares of family disposable incomes spent on prescribed drugs arising from the higher patient contributions.

Adolescent↗
PubMed2004

Herpes simplex virus type 1 capsid protein VP26 interacts with dynein light chains RP3 and Tctex1 and plays a role in retrograde cellular transport.

Cytoplasmic dynein is the major molecular motor involved in minus-end-directed cellular transport along microtubules. There is increasing evidence that the retrograde transport of herpes simplex virus type 1 along sensory axons is mediated by cytoplasmic dynein, but the viral and cellular proteins involved are not known. Here we report that the herpes simplex virus outer capsid protein VP26 interacts with dynein light chains RP3 and Tctex1 and is sufficient to mediate retrograde transport of viral capsids in a cellular model. A library of herpes simplex virus capsid and tegument structural genes was constructed and tested for interactions with dynein subunits in a yeast two-hybrid system. A strong interaction was detected between VP26 and the homologous 14-kDa dynein light chains RP3 and Tctex1. In vitro pull-down assays confirmed binding of VP26 to RP3, Tctex1, and intact cytoplasmic dynein complexes. Recombinant herpes simplex virus capsids were constructed either with or without VP26. In pull-down assays VP26+ capsids bound to RP3; VP26-capsids did not. To investigate intracellular transport, the recombinant viral capsids were microinjected into living cells and incubated at 37 degrees C. After 1 h VP26+ capsids were observed to co-localize with RP3, Tctex1, and microtubules. After 2 or 4 h VP26+ capsids had moved closer to the cell nucleus, whereas VP26-capsids remained in a random distribution. We propose that VP26 mediates binding of incoming herpes simplex virus capsids to cytoplasmic dynein during cellular infection, through interactions with dynein light chains.

Biological Transport↗
PubMed2004

Costs associated with combination antiretroviral therapy in HIV-infected patients.

As more effective HIV therapies have become available, resource constraints and cost-effectiveness have increasingly been at the centre of the debate on HIV care. Economic analysis is an important methodological approach to the understanding and establishment of priorities for health interventions designed to combat HIV in both high-income and low-income countries. In this paper, I briefly discuss different types of clinical economic analysis, and then consider the cost, affordability and cost-effectiveness of combination antiretroviral therapy in HIV patients in high-income and low-income countries. In high-income countries, HIV disease has become an expensive treatable chronic disease, with annual expenditures per patient of about US$ 20 000. Cost-effectiveness analyses show that antiretroviral therapeutic regimens offer good value for the resources spent compared to many other accepted health care interventions. In low-income countries, major programmes of combination antiretroviral therapy distribution are being planned and becoming operational as drug prices plummet and resources increase. More refined cost-effectiveness analyses are needed to evaluate available HIV/AIDS prevention, treatment, and care, and to identify the interventions that provide the best value for money.

Animals↗
PubMed2003

Characterization of topological structure on complex networks.

Characterizing the topological structure of complex networks is a significant problem especially from the viewpoint of data mining on the World Wide Web. "Page rank" used in the commercial search engine Google is such a measure of authority to rank all the nodes matching a given query. We have investigated the page-rank distribution of the real Web and a growing network model, both of which have directed links and exhibit a power law distributions of in-degree (the number of incoming links to the node) and out-degree (the number of outgoing links from the node), respectively. We find a concentration of page rank on a small number of nodes and low page rank on high degree regimes in the real Web, which can be explained by topological properties of the network, e.g., network motifs, and connectivities of nearest neighbors.

Journal Article↗
PubMed1990

Changing remuneration systems: effects on activity in general practice.

OBJECTIVE: To investigate the effects on general practitioners' activities of a change in their remuneration from a capitation based system to a mixed fee per item and capitation based system. DESIGN: Follow up study with data collected from contact sheets completed by general practitioners in one period before (March 1987) a change in their remuneration system and two periods after (March 1988, November 1988), with a control group of general practitioners with a mixed fee per item and capitation based system throughout. SETTING: General practices in Copenhagen city (index group) and Copenhagen county (control group). SUBJECTS: 265 General practitioners in Copenhagen city, of whom 100 were selected randomly from the 130 who agreed to participate (10 exclusions) and 326 general practitioners in Copenhagen county. MAIN OUTCOME MEASURES: Number of consultations (face to face and by telephone) and renewals of prescriptions, diagnostic and curative services, and specialist and hospital referrals per 1000 enlisted patients in one week. RESULTS: Of the 75 general practitioners who completed all three sheets, four were excluded for incomplete data. Total contact rates per 1000 patients listed rose significantly compared with the rates before the change index in the city (100.0 before the change v 111.7 (95% confidence interval 106.4 to 117.4 after the change) and over the same time in the control group (100.0 v 106.0), but within a year these rates fell (to 104.2(99.1 to 109.6) and 104.0 respectively). There was an increase in consultations by telephone initially but not thereafter. Rates of examinations and treatments that attracted specific additional remuneration after the change rose significantly compared with those before (diagnostic services, 138.1 (118.7 to 160.5) and 159.5 (137.8 to 184.7) and curative services 194.6 (152.2 to 248.9) and 194.8(152.3 to 249.2) for second and third data collections respectively) and with the control group (diagnostic services 105.3, 107.6 and curative services 106.0, 115.0) whereas referral rates to secondary care fell (specialist referrals 90.1 (80.7 to 100.6) and 77.0 (68.6 to 86.4) and hospital referrals 87.4 (71.1 to 107.5) and 68.4 (54.7 to 85.4] in doctors in the city. CONCLUSIONS: Introducing a partial fee for service system seemed to stimulate the provision of services by general practitioners, resulting in reduced referral rates. The concept of a "target income" which doctors aim at, rather than maximising their income seemed to play a part in adjustment to changing the system of remuneration.

Capitation Fee↗
PubMed1994

Equity in community care.

The implementation of the NHS and Community Care Act 1990 made local authority social services departments responsible for the organisation and funding of support and care in the community. This development took effect at the same time as a blurring of the boundaries between health and social care. One consequence is that the relevance of equity (a guiding principle of the 1946 National Health Service Act, but relatively lacking from the 1948 National Assistance Act, the foundation of many social services) has come to be more keenly appreciated within personal social services. Equity questions arise in community care over the distribution of public resources between different client groups, income groups, generations, and localities. Moreover, no mechanisms exist to monitor the trends that emerge from different ways that people get access to care. Yet there is a risk that substantial divisive consequences may occur, particularly between generations.

Capital Financing↗
PubMed1989

Prescription drug coverage and medical indigence among the elderly.

When Medicare extends catastrophic coverage to outpatient prescription drugs in 1991, the program will benefit an estimated 15% to 25% of the aged population. For some of these individuals Medicare coverage will mean the difference between economic self-sufficiency and impoverishment due to high medical bills. This article provides empirical estimates of the relationship between third-party coverage of outpatient pharmaceuticals and the risk of medical indigence based on the experience in Pennsylvania following enactment of that state's Pharmaceutical Assistance Contract for the Elderly (PACE), a lottery-financed drug benefit program that currently enrolls nearly half a million residents age 65 and older. The study provides data on the distribution of billed charges for outpatient drugs by income class for PACE enrollees and then uses a time series analysis to estimate the impact of PACE implementation (July 1984) on monthly changes in Medicaid enrollments and expenditures by category of elderly Medicaid recipient over the period July 1981 through June 1987. Study findings are discussed in the context of the forthcoming Medicare drug benefit.

Aged↗
PubMedDate not supplied

[Neurology and the reform of the health care system in Colombia].

INTRODUCTION AND OBJECTIVES: Despite the magnitude of the Colombian health system reform, introduced in 1993, changes in specialized medical practice have not been evaluated. This paper is the follow-up of a similar study on the practice of neurology done by the authors before the reform. MATERIAL AND METHODS: Of the 62 members of the Colombian Association of Neurology living in Bogotá, 47 (76%) of them responded an anonymous survey inquiring on the characteristics of their medical practice and registering all the medical encounters during one week in October 1998. RESULTS: Two thirds of the total working time is devoted by neurologists to clinical work. Half of the neurologists in the sample have invested in diagnostic equipment. There was no significant change in the total number of patients attended during the week, as compared with the 1993 study, and the diagnostic profile was similar. The proportion of private patients was significantly lower, while patients from prepaid medical schemes increased. Patients belonging to the Obligatory Health Plan, designed to cover lowest income population, and to prepaid medicine are not distributed homogeneously throughout all ages. The first year of life is particularly uncovered by the Obligatory Health Plan, while prepaid schemes do not address the problems of individuals age 60 or more. CONCLUSIONS: There has been a significant reduction in private practice compensated by an increase in prepaid medicine. There is no evidence of increased coverage for neurological disorders.

Adolescent↗
PubMedDate not supplied

Smoking behaviour among schoolteachers in the north of the Syrian Arab Republic.

Characterizing the smoking habit in specific populations is important for health planners and policy-makers. We studied the smoking patterns of schoolteachers in Saraqeb, Syrian Arab Republic and found that 52.1% of males and 12.3% of females were current smokers. Male daily smokers smoked 20 +/- 1 cigarettes per day, females 10 +/- 4. Males had smoked for, on average, 16 +/- 1 years, females for 9 +/- 4 years. Daily smokers buying foreign brands spent 22.0% of their monthly income on cigarettes, while those smoking local brands spent 12.2%. Most teachers who smoked did so openly at school. Smoking among teachers should receive attention because it is closely related to the attitudes and practices of young people towards smoking.

Adult↗