Suchergebnisse

Although Portugal has been deeply affected by the global financial crisis, the impact of the recession and subsequent austerity on health and to health care has attracted relatively little attention. We used several sources of data including the European Union Statistics for Income and Living Conditions (EU-SILC) which tracks unmet medical need during the recession and before and after the Troika's austerity package. Our results show that the odds of respondents reporting having an unmet medical need more than doubled between 2010 and 2012 (OR = 2.41, 95% CI 2.01–2.89), with the greatest impact on those in employment, followed by the unemployed, retired, and other economically inactive groups. The reasons for not seeking care involved a combination of factors, with a 68% higher odds of citing financial barriers (OR = 1.68, 95% CI 1.32–2.12), more than twice the odds of citing waiting times and inability to take time off work or family responsibilities (OR 2.18, 95% CI 1.20–3.98), and a large increase of reporting delaying care in the hope that the problem would resolve on its own (OR = 13.98, 95% CI 6.51–30.02). Individual-level studies from Portugal also suggest that co-payments at primary and hospital level are having a negative effect on the most vulnerable living in disadvantaged areas, and that health care professionals have concerns about the impact of recession and subsequent austerity measures on the quality of care provided. The Portuguese government no longer needs external assistance, but these findings suggest that measures are now needed to mitigate the damage incurred by the crisis and austerity.

This study hypothesizes that differences in health care access and utilization exist across Latino adults (>18 years), with U.S. Latino adults of Mexican ancestry demonstrating the worst patterns of access and utilization. The analyses use the National Health Interview Survey (NHIS) data from 1999 to 2007 ( N = 33,908). The authors first estimate the disparities in health care access and utilization among different categories of Latinos. They also implement Blinder—Oaxaca techniques to decompose disparities into observed and unobserved components, comparing Latinos of Mexican ancestry with non-Mexican Latinos. Latinos of Mexican ancestry consistently demonstrate lower health care access and utilization patterns than non-Mexican Latinos. Health insurance and region of residence were the most important factors that explained observable differences. In contrast, language and citizenship status were relatively unimportant. Although a significant share of these disparities may be explained by observed characteristics, disparities because of unobserved heterogeneity among the different Latino cohorts are also considerable.

Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs.

IMPORTANCE: Cancer survivors face ongoing health issues and need access to affordable health care, yet studies examining health care access and affordability in this population are lacking. OBJECTIVES: To evaluate health care access and affordability in a national sample of cancer survivors compared with adults without cancer and to evaluate temporal trends during implementation of the Affordable Care Act. DESIGN, SETTING, AND PARTICIPANTS: We used data from the National Health Interview Survey from 2010 through 2016 to conduct a population-based study of 30 364 participants aged 18 years or older. We grouped participants as cancer survivors (n = 15 182) and those with no reported history of cancer, whom we refer to as control respondents (n = 15 182), matched on age. We excluded individuals reporting a cancer diagnosis prior to age 18 years and those with nonmelanoma skin cancers. MAIN OUTCOMES AND MEASURES: We compared issues with health care access (eg, delayed or forgone care) and affordability (eg, unable to afford medications or health care services) between cancer survivors and control respondents. We also explored trends over time in the proportion of cancer survivors reporting these difficulties. RESULTS: Of the 30 364 participants, 18 356 (57.4%) were women. The mean (SD) age was 63.5 (23.5) years. Cancer survivors were more likely to be insured (14 412 [94.8%] vs 13 978 [92.2%], P < .001) and to have government-sponsored insurance (7266 [44.3%] vs 6513 [38.8%], P < .001) compared with control respondents. In multivariable models, cancer survivors were more likely than control respondents to report delayed care (odds ratio [OR], 1.38; 95% CI, 1.16-1.63), forgone medical care (OR, 1.76; 95% CI, 1.45-2.12), and/or inability to afford medications (OR, 1.77; 95% CI, 1.46-2.14) and health care services (OR, 1.46; 95% CI, 1.27-1.68) (P < .001 for all). From 2010 to 2016, the proportion of survivors reporting delayed medical care decreased each year (B = 0.47; P = .047), and the proportion of those ...

There are approximately 2.3 million mixed-status families in the United States, containing varied combinations of citizens, permanent legal residents, undocumented immigrants, and individuals in legal limbo. These families offer an opportunity to examine the functioning of the contemporary state and its penetration at the household level. For many Latino youth, experiences are framed not only by their own but other family members' legal status. This article reports on health care seeking experiences of mixed-status families in the Lower Rio Grande Valley of South Texas and the impact of the recent health care reform (Affordable Care Act). We utilized qualitative ethnographic methods including 55 semistructured interviews with mixed-status families and 43 interviews with health care providers, caseworkers, and public health officials. Results indicate that changes accompanying the reform directly and indirectly affect mixed-status households' ability to access care. We describe strategies in times of illness, including those unique to border communities. We conclude that, for successful implementation of policies associated with health care reform, broader issues related to immigration status must be addressed, especially anxieties regarding future chances of regularization. These uniquely affect mixed-status families, create a ripple effect on all household members, and result in unintended consequences for U.S. citizen children. Implications point to the need for a pathway to citizenship for parents as a basic step in improving well-being of children.

Although Portugal has been deeply affected by the global financial crisis, the impact of the recession and subsequent austerity on health and to health care has attracted relatively little attention. We used several sources of data including the European Union Statistics for Income and Living Conditions (EU-SILC) which tracks unmet medical need during the recession and before and after the Troika's austerity package. Our results show that the odds of respondents reporting having an unmet medical need more than doubled between 2010 and 2012 (OR=2.41, 95% CI 2.01-2.89), with the greatest impact on those in employment, followed by the unemployed, retired, and other economically inactive groups. The reasons for not seeking care involved a combination of factors, with a 68% higher odds of citing financial barriers (OR=1.68, 95% CI 1.32-2.12), more than twice the odds of citing waiting times and inability to take time off work or family responsibilities (OR 2.18, 95% CI 1.20-3.98), and a large increase of reporting delaying care in the hope that the problem would resolve on its own (OR=13.98, 95% CI 6.51-30.02). Individual-level studies from Portugal also suggest that co-payments at primary and hospital level are having a negative effect on the most vulnerable living in disadvantaged areas, and that health care professionals have concerns about the impact of recession and subsequent austerity measures on the quality of care provided. The Portuguese government no longer needs external assistance, but these findings suggest that measures are now needed to mitigate the damage incurred by the crisis and austerity. ; info:eu-repo/semantics/acceptedVersion

Migration flux is being transformed by globalization, and the number of people with either undocumented or with a precarious status is growing in Canada. There are no epidemiological data on the health and social consequences of this situation, but clinicians working in primary care with migrants and refugees are increasingly worried about the associated morbidity. This commentary summarizes findings from a pilot study with health professionals in the Montreal area and suggests that the uninsured population predicament is a national problem. Although ethical and legal issues associated with data collection by clinicians, institutions and governments need to be examined, estimating the public health consequences and long-term cost associated with problems in access to health care due to migratory status should be a priority. Current regulations and administrative policies appear to be at odds with the principles of equal rights set out by the Canadian Charter of Rights and Freedoms and the UN Convention on the Rights of the Child. Beyond the commitment of individual clinicians, Canadian medical associations should take an advocacy role and scrutinize the ethical and medical implications of the present system.

A contested issue is the extent to which refugee claimants should have access to health care in Western host countries with publicly subsidized health-care systems. In Canada, for a period of over fifty years, the federal government provided relatively comprehensive health coverage to refugees and refugee claimants through the Interim Federal Health Plan (IFHP). Significant cuts to the IFHP were implemented in June 2012 by the Conservative federal government (2006–15), who justified these cuts through public statements portraying refugee claimants as bringing bogus claims that inundate the refugee determination system. A markedly different narrative was articulated by a pan-Canadian coalition of health providers who characterized refugee claimants as innocent victims done further harm by inhumane health-care cuts. This article presents an analysis of these two positions in terms of frame theory, with a greater emphasis on the health-provider position. This debate can be meaningfully analyzed as a contest between competing frames: bogus and victim. Frame theory suggests that frames by nature simplify and condense, in this case packaging complex realities about refugee claimants into singular images (bogus and victim), aiming to inspire suspicion and compassion respectively. It will be argued that the acceptance of current frames impoverishes the conversation by reinforcing problematic notions about refugee claimants while also obscuring a rights-based argument for why claimants should have substantial access to health care. ; L'étendue de l'accès aux services de santé pour les demandeurs du statut de réfugié dans le contexte des pays d'accueil occidentaux munis de régimes de santé financés publique- ment constitue un enjeu controversé. Au Canada, pendant plus de 50 ans, c'était le gouvernement fédéral qui fournissait une couverture relativement intégrale de services de santé aux réfugiés ainsi qu'aux demandeurs du statut de réfugié par l'entremise du Programme fédéral de santé intérimaire (PFSI). Des réductions ...