Seeking health care: Marshallese migrants in Hawai'i

Objective. The number of Marshallese migrants has dramatically increased in the US and its territories since the 1986 Compact of Free Association agreement. Their poor health status and patterns of untimely care are considered a great public concern in the host society. This paper examines the health care patterns of Marshallese migrants in Hawai‘i and how their specific characteristics and circumstances affect their behaviors when seeking health care services.

Design. In-depth interviews were conducted with Marshallese migrants, key informants in the Marshallese community, and health and social service providers in the local community.

Results. This study reveals three important patterns of health care seeking behavior among Marshallese migrants. First, Marshallese migrants do not seek health care until they perceive a health crisis, usually indicated by pain. This cultural notion of ‘present crisis-oriented health care’ governs overall health care behaviors of Marshallese migrants. Second, Marshallese migrants are highly reliant on parochial networks for health care, given the strong mutual trust and the value assigned to interdependency within their culture. Despite many benefits of these networks, heavy dependence on them results in failure to obtain timely care when network resources become inaccessible or unavailable. Last, Marshallese migrants in Hawai‘i do not rely on traditional health care practices as much as on the allopathic health care system. Their health care depends heavily on curative and tertiary care and health care assistance in the public sector.

Conclusion. Health care seeking behaviors of migrants are shaped by cultural definition of health and health care and macro-social factors such as characteristics of the co-ethnic community and social networks, the health care system, and health policies, in addition to individual's socioeconomic status. These findings have important implications for community health care practices and policies.     

Access to health care resources in the UK: the case of care for arthritis

The paper uses new and detailed data from a population sample of individuals with arthritis to examine the impact of objective measures of need for treatment and individual measures of socio-economic position on the distribution of public and private health care. The quality of the data and the range of explanatory factors are more detailed than previously used to study of the allocation of NHS care. The results indicate that broadly the NHS appears to meet its equity goal of equal care for equal medical need, though there is evidence that education increases the amount of resources received. The results also show the importance of the interaction between the public and private sectors in the UK.     

国内外卫生服务整合评价方法概述

卫生服务整合理念越来越受到国内外学者和政策制定者的关注。在实践的同时进行有效的评价研究可以进一步深入实践的开展。本文概述国内外卫生服务整合的研究内容,详细介绍国内外评价卫生服务整合的方法,分析中国卫生服务整合研究存在的不足,为中国相关研究的深入和实践的开展提供方法学基础。     

Tipping the balance: international collaboration in primary health care reorientation

This paper describes a multicountry initiative aimed at TippingThe Balance towards primary health care (TTB). The Alma Ata declaration was the inspiration for the projectwhich has three branches. This paper describes one of these:community participation and skills development. TTB is a collaboration involving primary health care and otherpublic sector workers, educators, researchers and people inlocal communities. Twelve linked projects in five differentcountries are described. Projects have been grouped into fouraction areas: community participation; protection and promotion;inter-sectoral collaboration; reorientation to primary healthcare. Striking similarities existed in relation to health issues inall countries in the TTB project. All project teams focusedon reduction of inequality in health experiences and expectations,and worked for social justice in health care. It is believed that, by all the efforts documented in this paper,TTB teams can make a significant contribution towards socialjustice in their own countries, and also internationally.     

Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system

ObjectiveTo describe the cost of using evidence‐based implementation strategies for sustained behavioral health integration (BHI) involving population‐based screening, assessment, and identification at 25 primary care sites of Kaiser Permanente Washington (2015‐2018).Data Sources/Study SettingProject records, surveys, Bureau of Labor Statistics compensation data.Study DesignLabor and nonlabor costs incurred by three implementation strategies: practice coaching, electronic health records clinical decision support, and performance feedback.Data Collection/Extraction MethodsPersonnel time spent on these strategies was estimated for five broad roles: (a) project leaders and administrative support, (b) practice coaches, (c) clinical decision support programmers, (d) performance metric programmers, and (e) primary care local implementation team members.Principal FindingImplementation involved 286 persons, 18 131 person‐hours, costing $1 587 139 or $5 per primary care visit with screening or $38 per primary care visit identifying depression, suicidal thoughts and/or alcohol or substance use disorders, in a single year. The majority of person‐hours was devoted to project leadership (35%) and practice coaches (34%), and 36% of costs were for the first three sites.ConclusionsWhen spread across patients screened in a single year, BHI implementation costs were well within the range for commonly used diagnostic assessments in primary care (eg, laboratory tests). This suggests that implementation costs alone should not be a substantial barrier to population‐based BHI.     

Process for improving the integration of care across the primary and acute care settings in rural South Australia: asthma as a case study

OBJECTIVE: To develop a process for improving the integration of care across the rural acute and primary care settings using asthma as a case study. METHODS: Development of the process on the analysis of case note audit, survey, interviews and a workshop. SETTING: A rural region of South Australia. RESULTS: A work plan for improving general practitioner (GP)-hospital integration was developed that resulted from analysis of the defined problem, GPs and stakeholder involvement, communication between all stakeholders, provision of an incentive to bring all the stakeholders together, and identification of evidence-based solutions. CONCLUSIONS: Managing chronic disease in a community requires the integration of care across the primary and acute care setting. To be successful, GP-hospital integration initiatives require stakeholder involvement, locally developed solutions, engagement of GPs, communication and a well-developed plan. This project provides a process for achieving this.     

Assessing perceived quality of primary care under hospital-township health centre integration: A cross-sectional study in China

Since the new round of health care reform in 2009, the vertical integration of hospitals and primary health institutions has become widely implemented in China as an efficient method for improving quality of primary care. This study aimed to answer the following questions: (a) What is the perceived quality of township health centres (THCs) under integration? (B) What differences could be observed among the three typical integration models, namely, private hospital-THC integration, public hospital-THC integration, and loose collaboration? Two rounds of cross-sectional surveys were conducted from November 2016 to June 2018. The Chinese version of the Primary Care Assessment Tool was used to evaluate perceived quality of sample THCs, and 1118 adult patients were interviewed in total. Multiple linear regressions were employed to compare the quality scores between two survey rounds and among different integration models after controlling for potential confounders. The results revealed that the quality of care significantly improved under private hospital-THC integration as observed by comparing two survey rounds, while no change or slight changes were observed in the other two models. The difference observed among the three models was that the perceived quality of THCs integrated with private hospitals was worse than that of THCs integrated with public hospitals and THCs under loose collaboration, while no significant difference was observed between public hospital-THC integration and loose collaboration. Increased attention should be given to highlighting the tight integration between hospitals and THCs and the different roles played by private and public hospitals in the current reform.     

Micro macro integration: Reframing primary healthcare practice and community development in health

The idea of micro macro integration (MMI) provides a useful framework for thinking about primary healthcare (PHC) and community development in health (CD). PHC and CD are important strategies for addressing the structural determinants of health. They are each based on a powerful logic and have a significant body of support. However, while exemplary, even inspiring, instances of practice are common, attempts to replicate models of good practice (or ‘scale up’) often flounder. As frameworks for analysing this paradox, both PHC and CD have limitations, partly because they are overburdened with different and conflicting meanings. This paper explores an alternative framework based on a common aspiration of both PHC and CD: to effect change at both the micro level (meeting the immediate health needs of individuals, families and communities) and also at the macro level (of political, economic and social structures). The MMI framework assumes that health issues can be analysed at different levels of scale and of term (from the micro to the macro); that objectives and strategies can be conceived at these different levels; and that a coherent programme of activities can be conceived and implemented which addresses both the immediate and local problems and the larger scale and longer term phenomena that reproduce those patterns of need. The idea of MMI is less ambitious than either PHC or CD but (partly because of this) has value as a framework for analysing barriers to good practice.     

昆明市流动人口生殖健康知识调查

目的 了解流动人口生殖健康知识现状,为流动人口生殖健康教育提供依据。方法 采用多阶段随机抽样方法,对1 028名流动人口进行问卷调查。结果 被调查对象中,已婚男性133人(12.9%),未婚男性86人(8.4%);已婚女性687人(66.8%),未婚女性122人(11.9%)。年龄以18~35岁为主(74.6%)。教育程度以初中和小学为主(75.4%)。统计学分析发现,男性的计划生育知识得分低于女性(P<0.01),男性的性病/艾滋病知识得分高于女性(P<0.01)。离家务工时间0.5~4年的调查对象生殖健康知识综合得分低于其他组(P<0.01)。已婚者生殖健康知识综合得分高于未婚者。专业人员/行政管理人员的生殖健康知识综合得分高于其他职业人员。随教育程度增高或收入增加,生殖健康知识综合得分也明显增加。结论 未婚、中低学历、从事非技术工作和低收入人群,以及离家务工时间较短的流动人口的生殖健康知识知晓率低。应根据知识实际掌握情况,有针对性地加强教育和引导。     

Willingness to use and satisfaction of primary care services among locals and migrants in Shenzhen,China

The Chinese government has been reforming the health care system by developing a primary care system. The objectives of this study were to compare the willingness to use and satisfaction with community health care centres (CHCs), a component within the Chinese primary care system, between locals and migrants living in Luohu, Shenzhen, China. A 2019 cross-sectional survey data that interviewed 1,205 adult residents living in Luohu district were used for secondary data analysis. Two identifications of migrants were used for analysis, Shenzhen hukou status and urban village status. Linear probability models were used to determine relationship between migrants' status and the outcome variable of willingness to use CHCs and order logistic regression were used to determine the association between migrants' status and the outcome variable of satisfaction with CHCs. Among participants, 37.6% of the participants had Shenzhen hukou. Using the classification of urban village status, 29.1% of participants were urban villagers. Urban villagers were less likely to know the location of nearest CHCs and less likely to select CHCs as their frequently used health care institutions. No statistically significant difference was found on willingness to use CHCs or satisfaction with CHCs between Shenzhen hukou and non-Shenzhen hukou. But urban villagers were more satisfied with attitude and medical skills of health care workers. Our findings indicated that policymakers and social professionals need to adjust the organization and functioning of primary care institutions in the community to increase awareness and utilization of primary care services.     

Insurance + access not equal to health care: typology of barriers to health care access for low-income families

PURPOSE Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers.     

Regional primary health care organisations and migrant and refugee health: the importance of prioritisation,funding, collaboration and engagement

Objective : This paper examines whether Australian regional primary health care organisations – in this case, Medicare Locals (MLs) and Primary Health Networks (PHNs) – have engaged with migrant and refugee health, and what factors encourage work in this area. Methods: The study used mixed methods with surveys of ML (N=210) and PHN staff (N=66), interviews with ML (N=50) and PHN (N=55) staff, national consultations with migrant and refugee organisations (N=8 groups with 62 participants), and analysis of ML and PHN documents. Results : Needs assessment documents identified migrant and refugee health issues in 46% of MLs and 74% of PHNs. However, 48% of MLs and 55% of PHNs did not report any activities on migrant health, and 78% and 62% did not report any activities for refugees, respectively. Key factors identified by participants as associated with whether ML and PHN focus on migrant and refugee health were the determination of local priority areas, policy context and funding, collaboration with migrant and refugee organisations and communities, and mechanisms for engagement. Conclusions : Despite the importance of primary health care for migrants and refugees, there was relatively little attention paid to these population groups in MLs and PHNs, with a small number of notable exceptions. Implications for public health : The paper concludes with a range of recommendations for improving regional primary health care organisation engagement with migrant and refugee health.     

三峡移民健康状况及医疗卫生服务可及性调查

目的调查三峡外迁移民的健康状况及医疗卫生服务可利用性。方法采用自编一般情况调查表对外迁至山东省的320名三峡移民进行问卷调查。结果三峡外迁移民的健康状况明显差于搬迁前,与当地居民比较也有明显偏差,差异均有统计学意义(P<0.05)。与搬迁前相比,移民医疗卫生服务可及性和医疗保障情况均有较大改善。结论与搬迁前相比,移民健康状况有所下降,政府部门应加大对移民健康的关注。     

GP Clinic: promoting access to primary health care for mental health service clients

Objective: To evaluate an innovative rural service offering comprehensive primary health care for mental health service clients. Design: A formative evaluation using mixed methods. Setting: A rural NSW community. Participants: Fifteen health care providers and 120 adult clients. Intervention: A monthly clinic held in a general practice to provide primary health care for clients of the community mental health team. Main outcome measures: Client utilisation and clinic activity data. Provider views of service effectiveness, possible improvements and sustainability. Results: The GP Clinic has operated successfully for 2.5 years without access block. Some 52% of clients had no physical illness and 82% were referred to other health and community services. In total, 40% continued to attend the clinic while 32% went on to consult a GP independently. Client access to care improved as did collaboration between the community mental health team and primary care providers. Conclusion: The GP Clinic is a straightforward and flexible service model that could be used more widely.     

The equity lens in the health care performance evaluation system

The main objective of this paper is to describe how indicators of the equity of access to health care according to socioeconomic conditions may be included in a performance evaluation system (PES) in the regional context level and in the planning and strategic control system of healthcare organisations. In particular, the paper investigates how the PES adopted, in the experience of the Tuscany region in Italy, indicators of vertical equity over time. Studies that testify inequality of access to health services often remain just a research output and are not used as targets and measurements in planning and control systems. After a brief introduction to the concept of horizontal and vertical equity in health care systems and equity measures in PES, the paper describes the ‘equity process’ by which selected health indicators declined by socioeconomic conditions were shared and used in the evaluation of health care institutions and in the CEOs' rewarding system, and subsequently analyses the initial results. Results on the maternal and child path and the chronicity care path not only show improvements in addressing health care inequalities, but also verify whether the health system responds appropriately to different population groups. Copyright © 2013 John Wiley & Sons, Ltd.     

Exploring health care reform in a changing Europe: Lessons from Greece

Abstract

The economic crisis is the major theme in the Eurozone and its impact on public health and outcomes is largely discussed. Under this pressure, concerns of further inequalities exist that may have an impact on the burden of several diseases in certain European countries. In this context, Greece is currently an issue of top interest in any international economic discussion. Although the background of the recession has been largely discussed as a political crisis, its health effects on the population, as well as the key role of primary care and general practice/family medicine in health care reform remain to be explored. Serving both the worldwide trend of orienting health care systems towards strengthened primary care and the inner need for minimizing the demand and lessening the burden from the dysfunctional and costly hospital-care system, the economic crisis sets the perfect timing for prioritizing primary health care. In this article a unique window of opportunity for health care reform in Greece is examined, attempting to establish the axes of an example of how health care system can be reshaped amidst the economic crisis. Equity, quality, value framework, medical professionalism, information technology and decentralization emerge as topics of central interest. There is no doubt that Europe is transitioning under challenging social, economic and public health perspectives. However, taking Greece as an example, the current economic situation sets a good timing for health care reform and the key messages of this paper could be used by other countries facing similar problems.     

流动人口育龄妇女孕产期保健服务利用及其影响因素分析

目的：了解流动人口育龄妇女孕产期保健服务利用状况及其影响因素。方法：采用分层随机抽样的方法,以现场随机拦截访问的形式对江东区669名流动人口育龄妇女进行问卷调查,对建立产检情况、第一次产检时间、产检次数、孕产期保健知识指导和接受产后上门访视分别进行了单因素分析和多因素log istic分析。结果：流动人口育龄妇女的孕产期保健服务利用状况在不同文化程度之间存在显著性差异（P〈0.01）,不同收入水平的育龄妇女产检率虽无显著性差异（P〉0.05）,但在第一次产检时间及产检次数上存在显著差异（P〈0.01）。结论：流动人口妇女的文化程度及收入水平是孕产期保健服务利用的主要影响因素,应重点加强流动人口妇女孕产期保健知识的宣传教育,提高医疗保障水平,降低收费水平,为流动人口孕产妇提供便捷的孕产期保健服务。