جستجوی مقالات مرتبط با کلیدواژه "health equity" در نشریات گروه "پزشکی"

As embedded researchers in Northern Ontario, Canada, we offer our reflections on Kasaai and colleagues’ 2023 “Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program.” In our commentary, we draw on our experiences and what is known about embedded research training to examine how to build and strengthen the workforce for equity-centered learning health systems. Does our narrow understanding of outcomes and impacts of embedded research training in Canada affect who benefits and which systems can realize the potential of learning health systems? We identify three areas for deeper analysis: outcomes and impacts at the individual, partnership, and system level, knowledge on the social identities and needs of individuals in embedded research partnerships, and research generalism as a complement to embedded research. Our recommendations suggest tailored approaches to strengthen the workforce capacity for equity-centered learning health systems in Canada.

Context: 

Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran.

Evidence Acquisition: 

This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022.

The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers.

The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda.

Over the past three decades, healthcare organizations have prioritized enhancing patient care quality (1). The Institute of Medicine (IoM) has highlighted that most medical errors stem from flawed systems and processes rather than individual actions (2). Consequently, initiatives to improve processes and safety in healthcare have explored various quality improvement (QI) methodologies, including healthcare accreditation programs (1). Accreditation is a systematic process that evaluates a healthcare organization’s compliance against pre-defined peer review standards, which are structural, procedural, and outcomeoriented (3). Assessments are undertaken by various governmental or non-governmental entities, using different modalities in voluntary or mandatory approaches. The scope of accreditation may encompass the entire health organization, individual hospitals, health facilities, only a specialty, or even a sub-specialty (4). Accreditation standards cover diverse domains including clinical governance and patient-centeredness, with the consequences of failing to meet these standards variable across different health system contexts (5). First proposed and implemented by the American College of Surgeons in 1917, accreditation has since undergone numerous transformations and adaptations.

The healthcare industry is constantly evolving to bridge the inequality gap and provide precision care to its diverse population. One of these approaches is the integration of digital health tools into healthcare delivery. Significant milestones such as reduced maternal mortality, rising and rapidly proliferating health tech start-ups, and the use of drones and smart devices for remote health service delivery, among others, have been reported. However, limited access to family planning, migration of health professionals, climate change, gender inequity, increased urbanization, and poor integration of private health firms into healthcare delivery rubrics continue to impair the attainment of universal health coverage and health equity. Health policy development for an integrated health system without stigma, addressing inequalities of all forms, should be implemented. Telehealth promotion, increased access to infrastructure, international collaborations, and investment in health interventions should be continuously advocated to upscale the current health landscape and achieve health equity.

Monitoring households' exposure to catastrophic health expenditure (CHE) based on out-of-pocket (OOP) health payments is a critical tool for evaluating the equitable financial protection status within the health system. The COVID-19 pandemic has brought unprecedented global change and potentially affected the mentioned protection indicators. This study aimed to assess the prevalence of CHE among households in Iran during the COVID-19 period.  

The present study employed a retrospective-descriptive design utilizing data derived from two consecutive cross-sectional Annual Household Income and Expenditure Surveys (HIES) undertaken by the Statistical Centre of Iran (SCI) in 2020 and 2021. The average annual OOP health payments and the prevalence of households facing CHE were estimated separately for rural and urban areas, as well as at the national level. Based on the standard method recommended by the World Health Organization (WHO), CHE was identified as situations in which OOP health payments surpass 40% of a household's capacity to pay (CTP). The intensity of CHE was also calculated using the overshoot measure. All statistical analyses were carried out using Excel-2016 and Stata-14 software.  

The average OOP health payments increased in 2021, compared to 2020, across rural and urban areas as well as at the national level. Urban residents consistently experienced higher OOP health payments than rural residents and the national level in both years. At the national level, the prevalence of CHE was 2.92% in 2020 and increased to 3.18% in 2021. In addition, rural residents faced a higher prevalence of CHE based on total health services OOP, outpatient services OOP, and inpatient services OOP compared to urban residents and the national level. Regarding the intensity of CHE using overshoot, the results for 2020 and 2021 revealed that the overshoot ranged between 0.60% and 0.65% in rural areas, between 0.30% and 0.33% in urban areas, and between 0.38% and 0.41% at the national level.  

A considerable percentage of households in Iran still incur CHE. This trend has increased in the second year of COVID-19 compared to the first year, as households received more healthcare services. The situation is even more severe for rural residents. There is an urgent need for targeted interventions in the health system, such as strengthening prepayment mechanisms, to reduce OOP and ensure equitable protection for healthcare recipients.

human right with a long history of appreciation, indicating that governments should guarantee the highest possible level of access to health and provide health-care serivces with no discrimination based on nationality, race, gender, language or religion. The present study explored this topic using an analytic-descriptive approach. We reviewed related laws, policies and other available documents with the aim to investigate the ethico-legal aspects of Afghan refugees' and immigrants' access to health care and the challenges in in this regard within the Iranian health law system. According to the results of this study, the Iranian health law could be interpreted to include all Afghan immigrants in the country’s public health system as a legal commitment. In addition, while basic and primary health coverage is available for all Afghan immigrants in Iran, provision of other medical and rehabilitative health services to documented and undocumented immigrants follow different methods. In order to alleviate the current situation, we recommend strategies such as supporting policy changes intended to register undocumented immigrants, which naturally results in an increase in their access to health care.

Analysis of policy implementation for chronic disease in Belgium highlights the difficulties of launching experiments for integrated care in a health system with fragmented governance. It also entreats us to consider the inherent challenges of piloting integrated care for chronic disease. Sociomedical characteristics of chronic disease –political, social, and economic aspects of improving outcomes – pose distinct problems for pilot projects, particularly because addressing health inequity requires collaboration across health and social sectors and a long-term, life-course perspective on health. Drawing on recent US experience with demonstration projects for health service delivery reform and on chronic disease research, I discuss constraints of and lessons from pilot projects. The policy learning from pilots lies beyond their technical evaluative yield. Pilot projects can evince political and social challenges to achieving integrated chronic disease care, and can illuminate overlooked perspectives, such as those of community-based organizations (CBOs), thereby potentially extending the terms of policy debate.

This article aims to compare the foundations of the post-pandemic economy and its impact on health equity, according to Labonté with the economics theory. The methodology developed is based on bibliometrics analysis, the documents, and specifications for a cluster of concepts, allowing deepened exposure of Labonté, complementing with the latest publications on the post-pandemic economy. Finally, the results agreed with Labonté about to economic development for achieving an economy that allows health equity considering sustainable development and the possibility of achieving the livelihood of Green New Deal as a basis.

The authors wholeheartedly agree with Labonté: global health equity needs radical changes in economic thinking and policies, including degrowth and reducing consumption in parts of the world. But to mobilize sufficient people for radical change, reducing overconsumption and for degrowth, we may need to stop calling it that. Language is important and using the same frames and words as our opponents do can be counterproductive. Global health advocates need to be strategic about framing, use hope-based communication and develop attractive and convincing narratives. By doing so, hopefully we can bring these messages across to larger groups of people and increase the push for social change.

The high reliance on out-of-pocket (OOP) payments for health financing in Iran have been led to different inequity problems such as catastrophic health expenditure (CHE) and impoverishment. This scoping review has been conducted to understand the variations in CHE and impoverishment, the underlying determinants of CHE, and its inequality in the past 20 years.  

This scoping review is guided by Arksey and O’Malley’s scoping review framework. systematically PubMed, Scopus, Web of Science, ProQuest, Scientific Information Database, IranMedex, IranDoc, Magiran Science, Google Scholar, and grey literature were searched systematically from 1 January 2000 to August 2021. We included studies that reported the rate of CHE, impoverishment, inequality, and its influencing factors. Simple descriptive statistics and narrative synthesis were used to present the review findings.  

From 112 included articles, the average incidence of CHE was 3.19% at the 40% threshold, and about 3.21% of the households had impoverished. We found an unfavorable status of health inequality indices, including the average of fair financial contribution (0.833), concentration (-0.01), Gini coefficient (0.42), and Kakwani (-0.149). The most widely applied key drivers influencing the rate of CHE in these studies were household economic status, place of residence, health insurance status, household size, head of the household’s gender, education level and employment status, having a household member under 5/ above 60 years old, with chronic diseases (in particular cancer and dialysis), disability, using inpatient and outpatient and dentistry services, medicines and equipment, and low insurance coverage.  

The result of this review calls for intensifying health policies and financing structures in Iran to provide more equitable access to all populations, especially the poorest and vulnerable. Moreover, the government is expected to adopt effective measures in inpatient and outpatient care, dental services, medicines, and equipment.

Health and economy has substantially been influenced by the coronavirus disease 2019 (COVID-19) pandemic. Because of these impacts, household financial contribution to health system is likely to be changed. This study aimed to compare the distribution of household financial contributions before and during the COVID-19 epidemic.  

This is a cross-sectional study. The data were obtained from Iran's Households Income and Expenditure Survey as a national representative survey and included 38,328 households in 2019 (before COVID-19) and 37,577 households in 2020 (during COVID-19 pandemic). The household expenditures deflated according to the Consumer Price Index. The indices of households’ out-of-pocket Payments (OPP), catastrophic health expenditures (CHE), and impoverishment were calculated based on a standard methodology. Data analysis was done using an Excel-based software.  

The households' total expenditures declined for both urban and rural areas during the COVID-19 outbreak. Meanwhile, health expenditure experienced a negative growth rate for urban and rural households at –25.75% and –15.47%, respectively. The average per capita of OOP annually was 1,220,416 ($41.086 PPP) Rials for urban households and 1,017,760 Rials ($34.263 PPP) for rural households in 2020 (the era of COVID-19), which had dropped –30% and –16%, respectively, relative to 2019 (before COVID-19). The proportional share of health service types from the total health expenditure did not change importantly after the onset of COVID-19. The incidence of CHE and impoverishment due to health payments reduced after the onset of COVID-19.  

The households' health expenditures changed considerably during the COVID-19 pandemic and these changes were the same for the urban and rural areas. Despite COVID-19 multi-faceted shocks, the findings of this study showed a slight decline in the incidence of CHE and impoverishment caused by health expenditures. It might be due to forgone health services during the COVID-19 pandemic. Data from these household surveys have some limits to depicting the real effects of this crisis.

The World Health Organisation (WHO) emphasizes that equitable access to safe and affordable medicines is vital to attaining the highest possible standard of health by all. Ensuring equitable access to medicines (ATM) is also a key narrative of the Sustainable Development Goals (SDGs), as SDG 3.8 specifies “access to safe, effective, quality and affordable essential medicines and vaccines for all” as a central component of universal health coverage (UHC). The SDG 3.b emphasizes the need to develop medicines to address persistent treatment gaps. However, around 2 billion people globally have no access to essential medicines, particularly in lower- and middle-income countries. The states’ recognition of health as a human right obligates them to ensure access to timely, acceptable, affordable health care. While ATM is inherent in minimizing the treatment gaps, global health diplomacy (GHD) contributes to addressing these gaps and fulfilling the state’s embracement of health as a human right.

Coronavirus (COVID-19) pandemic has caused great shocks across all sectors of society. The pandemic highlighted three crucial policy issues (i.e., healthcare spending, social determinants of health, and health equity). It is also projected that recurrent wintertime outbreaks of COVID-19 will likely occur after this initial wave in the next few years.

Descriptive review was conducted to provide information on the critical lessons learned from the first wave of COVID-19 to improve the well-being of society in light of predicted future waves. We searched articles from PubMed/Medline, Scopus, Embase, and Google Scholar with systematic search inquiry.

We included 96 articles in this descriptive review. Health is the ultimate goal of the healthcare sector and an essential prerequisite for achieving other societal goals. The first wave of the COVID-19 pandemic showed that countries that have given less attention to social determinants of health (SDH), health equity, and marginalized, vulnerable populations faced the tremendous burden of disease morbidity and mortality. Spending on healthcare or other developmental sectors should be based country’s health production function status (i.e., understanding the marginal return of healthcare). Health and well-being are indivisible from other societal goals. It should be addressed with due consideration of their interconnectedness. A comprehensive multi-disciplinary approach involving health in all policies, which integrates SDH and health equity into modeling with the principle of leaving no one behind, will have a critical impact on improving economic and health outcomes during future anticipated COVID-19 Waves.

In general, improving and adopting novel strategies, confronting the multiple facets of the public health mitigation measures, and facilitating and stimulating interdisciplinary public health interventions are essential to reduce the health and economic impacts of anticipated future COVID-19 waves. Developing countries could benefit from increasing public expenditure on health with due consideration of SDH. For developed countries like the United States, it is imperative to shift health policy focus from illness-oriented healthcare towards policies that affect the social determinants of health.