Gender and health outcomes: The impact of healthcare systems and their financing on life expectancies of women and men

The paper considers the impact of healthcare systems and how they are financed on the life expectancies (LEs) of women and men in 19 OECD countries during the period 1990–2005 using OECD Health Data 2009. There is a gap in life expectancy (LE) between men and women, with women living longer than men, and most studies point to socio-economic variables and lifestyle and health-related behaviors. The role of healthcare systems and access to medical services is still disputed. This article proposes a number of adjustments to previous studies. First, it uses several variables broken down according to gender. Second, it considers healthcare systems by measuring their national expenditure as well as their public and private sources of funding. Third, it includes factors indirectly affecting health as expenditures on other realms of social policy. Fourth, it examines the factors impacting LEs of women and men at birth and at 65. Using a hierarchical model of panel-data regressions, the study finds: (1) there is a marginal impact on LEs at birth for both genders and greater impact on LEs at 65 for both genders; (2) a public mode of funding has greater effect than private; (3) the findings that men benefit more from access to medical services might be the result of the variables controlled in the analysis.     

The impact of public employment on health and health inequalities: evidence from China

Because the public and private sectors often operate with different goals, individuals employed by the two sectors may receive different levels of welfare. This can potentially lead to different health status. As such, employment sector offers an important perspective for understanding labor market outcomes. Using micro-level data from a recent Chinese household survey, this study empirically evaluated the impact of employment sector on health and within-sector health inequalities. It found that public sector employment generated better health outcomes than private sector employment, controlling for individual characteristics. The provision of more job security explained an important part of the association between public sector employment and better health. The study also found less health inequality by social class within the public sector. These findings suggest that policymakers should think critically about the "conventional wisdom" that private ownership is almost always superior, and should adjust their labor market policies accordingly.     

The impact of financing and quality changes on health care demand in Niger

This paper assesses the demand effects of a cost recovery and quality improvement pilot study conducted in Niger in 1993. Direct user charges and indirect insurance payments were implemented in government health care facilities in different parts of the country, and were preceded or accompanied by quality changes in these facilities. Decision-making by patients is modelled as a three-stage process of reporting an illness, seeking treatment and choice of provider; and multinomial nested logit techniques are used to estimate the parameters of the decision-tree. Overall, the results give a reasonably favourable impression of the policy changes. In neither case is there evidence of serious reductions in access or increases in cost. Particularly notable is that despite an increase in formal user charges, the observed decline in rates of visits is statistically insignificant, suggesting the success of measures to improve quality of health care in public facilities. The observed increase in the probability of formal visits in the district with indirect payments is also striking. Both contrast with the control region of Illela, where neither user charges were introduced nor were any efforts made to improve quality. The data suggest that higher utilization of formal care, probably due to improvements in quality, outweighed the decrease in utilization that may have come about due to introduction of cost recovery, so that the net effect of the policy changes was an increase in utilization. Quality considerations appear to be important in ensuring the long-term success of cost sharing.     

论卫生服务筹资的公平性对我国药品可及性的影响

目的:提高我国民众的药品可及性。方法:文章建立在对卫生筹资公平性了解的基础上,探讨其对药品可及性的影响。结果:不同人群支付比例不一致、卫生筹资中的融资不公平以及卫生费用地域不公平等均对我国药品可及性产生一定的影响。结论:重视卫生服务筹资中的公平性问题,提高我国药品可及性,以促进民众健康状况的改善。     

New forms of management and their impact on health inequalities

In recent years in Spain the system of health foundations has been favoured among the so-called new ways of management, as a mechanism to increase the efficiency of public health centers. The purpose of our research is to compare the running of health foundations with hospitals managed in the traditional way who attend a population with similar characteristics. From the comparison between the two types of centers it has been deduced that foundations have less staff in all the categories (doctors, nurses, etc.), and offer fewer beds and operating theatres/1000 inhabitants. The numbers of admissions, surgical operations, emergencies services, and medical consultations/1000 inhabitants are all lower in the foundations, although only the latter case has statistical significance. Also, waiting lists for surgery are longer, and expenditure/1000 inhabitants per year is lower, in both cases statistically significant. From all this it has been deduced that the foundations spend less per inhabitant because they offer fewer health services to the reference population, something which creates access problems and is a source of inequality. The foundations exhibit a notable lack of transparency, which has limited the variables available for study and has made it difficult to carry out an investigation of quality between the two models.     

Effectiveness of influenza vaccination and its impact on health inequalities

BACKGROUND: Since 1998, annual publicly funded campaigns for mass vaccination against influenza of the population aged 65 years or older have been performed in the city of S?o Paulo, Brazil. The effectiveness of the intervention was not assessed for its contribution to the reduction of influenza-attributable mortality. This study sought to compare the age-specific mortality (65 years or older) before and after the onset of yearly vaccination, and to assess the impact of the intervention on health inequalities in relation to inner-city areas. METHODS: Official information on deaths and population allowed assessment of overall pneumonia and influenza mortality. Monitoring of outbreaks and the estimation of mortality attributable to influenza peaks used Serfling and ARIMA models. Rates were compared between 1998 and 2002, when vaccination coverage ranked higher than 60% among individuals aged 65 years or older, and 1993-97 (prior to vaccination). RESULTS: Overall mortality due to pneumonia and influenza fell by 26.3% after vaccination. An even higher reduction was observed for mortality specifically attributable to influenza epidemics; the number of peaks of influenza mortality also decreased. Deprived areas of the city had a higher decrease of mortality by pneumonia and influenza during the vaccination period. CONCLUSIONS: Influenza vaccination contributed to reduce influenza-attributable mortality in this age group, and was associated with the reduction of inequalities in the burden of the disease among social groups. The concurrent promotion of health and social justice is feasible when there is political will and commitment to implement public health interventions with prompt and effective universal access.     

卫生筹资公平性分析方法研究

综合国内外文献介绍在卫生领域内卫生筹资公平性分析的原理、指标、步骤和评价方法,探讨如何进行数据开发并利用公平性评价方法进行相关的政策分析,以及如何通过累进性分析更好地理解和评价卫生筹资系统的公平性。     

Health impact assessment and the consideration of health inequalities

Equity and the consideration of the differential impacts of public policy within populations are core values of health impact assessment. A recent paper setting out the results of the government's consultation exercise on tackling health inequalities argues for health impact assessment to be used as a mechanism to bring about reductions in health inequalities. However, we would contend that most, if not all, published health impact assessments have not considered the effects of public policies on health inequalities in a robust or reliable manner. In this paper we set out and explore some of the issues that require consideration if health impact assessment is fulfil the government's expectations.     

The interactive atlas on health inequalities

In order to translate specialized scientific information into available, relevant and useful knowledge for decision-makers in public health, the PRIMUS group has developed the on-line Interactive Atlas on Health Inequalities (IAHI), based on user's needs assessments and data availability. Built on multidimensional tables, the IAHI is an health information system which has the power to allow users, especially those concerned by health inequalities, to query rapidly and interactively large volumes of health data (in aggregated format) at different spatial and population levels and to produce meaningful results displayed as tables, graphs or maps almost instantly. Designed explicitly to reveal inequalities in health, the IAHI offers relevant information for understanding social and geographical health inequalities observed for myocardial infarction, osteoporotic fractures, diabetes, chronic pain, schizophrenia, and mood disorders. The IAHI is a powerful support tool for decision-makers, serving the long term goal of closing the gaps across sub-populations, in terms of prevalence of diseases, access to health care, treatments and health outcomes.     

国家财税制度改革对政府卫生投入的影响

系统回顾了改革开放以来我国财税制度的改革历程,分析了财税制度改革对政府卫生筹资的影响,建议建立制度并形成政府投入的科学增长机制、提高对中部及农村地区的转移支付力度、进一步明确各级政府的责任,深化财税制度改革.     

The impact of competition among health care financing authorities on market yields and issuer interest expenses

The main source of capital for non-for-profit health care organizations is tax-exempt municipal bonds. The tax-exempt nature of this debt requires that they be issued through financing authorities, which are run by, or affiliated with, state or local government agencies. In some states, all tax-exempt health care bonds must be issued through a single financing authority, but in other states the issuing health care organization has a choice of multiple authorities. Using a Herfindahl index of issuer concentration, prior research has found that greater competition among authorities results in lower interest costs to the issuing health care organization. We pick up where this earlier study left off, examining the links between authority competition, the interest expenses to the issuer, and the yield to the market investor. Although our analysis of all hospital bonds issued between 1994 and 2002 corroborates earlier findings with regard to interest expenses to the issuing health care organization, we also find market yield is lower for statewide authorities where issuer concentration is lower. Thus, authority competition is good from the issuers' point of view, but holds no favor in the investors' eyes. On the other hand, the lower market yield associated with statewide authorities does not make its way down to the issuer in the form of lower interest costs. To help sort through this paradox, we explore our findings through interviews of executives in state issuing authorities.     

Aversion to health inequalities in healthcare prioritisation: A multicriteria optimisation perspective

In this paper we discuss the prioritisation of healthcare projects where there is a concern about health inequalities, but the decision maker is reluctant to make explicit quantitative value judgements and the data systems only allow the measurement of health at an aggregate level. Our analysis begins with a standard welfare economic model of healthcare resource allocation. We show how – under the assumption that the healthcare projects under consideration have a small impact on individual health – the problem can be reformulated as one of finding a particular subset of the class of efficient solutions to an implied multicriteria optimisation problem. Algorithms for finding such solutions are readily available, and we demonstrate our approach through a worked example of treatment for clinical depression.     

Area effects on health inequalities: the impact of neighbouring deprivation on mortality

The exact nature of the association between the context of the local area and local health outcomes is unknown. We investigated whether areas geographically close but divergent in terms of deprivation have greater inequality in health than those where deprivation is similar across neighbouring localities. In order to disaggregate the strong correlation between the deprivation of a target area and that of its surrounding areas, we used principal component analysis to create a measure of relative deprivation. Both deprivation (ß=0.183, p<0.001) and relative deprivation were positively associated with mortality (ß=0.099, p<0.001), and the effect of relative deprivation was shown to be most pronounced in more affluent segments of the population.