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Inequalities in Health Care
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Inequalities in Health Care

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 24890

Special Issue Editors

Prof. Dr. Milena Pavlova

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Chief Guest Editor
Department of Health Services Research; CAPHRI; Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
Interests: health economics; health systems; health policy; out-of-pocket payments; access; affordability; consumer preferences; equity
Special Issues, Collections and Topics in MDPI journals
Dr. Tetiana Stepurko

E-Mail Website1 Website2
Guest Editor
School of Public Health, National University of Kyiv-Mohyla Academy, Kyiv 04655, Ukraine
Interests: informal patient payments; informality; integrity in medical education; mother and child health; healthcare governance; corruption in healthcare; medical education; social science and healthcare
Special Issues, Collections and Topics in MDPI journals
Dr. Marzena Tambor

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Guest Editor
Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Kraków, Poland
Interests: health economics; health and social policy; health care financing; financial protection; equity; out-of-pocket payments
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Poverty, deprived living conditions, low literacy, and unhealthy lifestyles commonly go hand in hand and jointly worsen one’s health status, which makes recovery from an illness prolonged and sometimes incomplete or even impossible. In low-resource settings, access to care is also challenging. Healthcare facilities might be difficult to reach because of a lack of transportation, inadequate communication, and poor road conditions. Those who can reach the facilities might be confronted with unaffordable out-of-pocket payments, a lack of skilled care providers, as well as a lack of equipment or inability to use the equipment available at the facilities due to staff shortage or technical problems. Limited facility capacity might even prevent the necessary basic isolation of patients with a contagious disease, resulting in further spread of the disease, and some patients might not even have the chance to receive adequate care or even any care at all, which can increase morbidity and mortality outcomes.

All these factors threaten the achievement of the universal health coverage goal, i.e., equal access to health services of sufficient quality to be effective, without suffering financial hardship. Strengthening the resilience and flexibility of the health system is an important future strategy. Thus, politicians, medical practitioners, public health experts, scientists, and industry should come together to establish effective mechanisms for continuous monitoring of health systems to promptly detect acute system gaps.

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) focuses on the inequalities in the distribution of health resources and barriers to access to adequate healthcare services. We welcome research papers, reviews, case reports, and commentaries, especially those dealing with new approaches and insights. We will accept manuscripts from different disciplines, including but not limited to public health, health economics, health systems research, and healthcare management.


Prof. Dr. Milena Pavlova
Dr. Marzena Tambor
Dr. Tetiana Stepurko
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • equity
  • health resources
  • healthcare services
  • out-of-pocket payments
  • access
  • affordability
  • vulnerable groups
  • financial protection

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Published Papers (6 papers)

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Research

19 pages, 1642 KiB  
Article
Socio-Economic Inequalities in Access to Drinking Water among Inhabitants of Informal Settlements in South Africa
by Marieke J. Oskam, Milena Pavlova, Charles Hongoro and Wim Groot
Int. J. Environ. Res. Public Health 2021, 18(19), 10528; https://doi.org/10.3390/ijerph181910528 - 7 Oct 2021
Cited by 13 | Viewed by 5441
Abstract
While evidence from several developing countries suggests the existence of socio-economic inequalities in the access to safe drinking water, a limited number of studies have been conducted on this topic in informal settlements. This study assessed socio-economic inequalities in the use of drinking [...] Read more.
While evidence from several developing countries suggests the existence of socio-economic inequalities in the access to safe drinking water, a limited number of studies have been conducted on this topic in informal settlements. This study assessed socio-economic inequalities in the use of drinking water among inhabitants of informal settlements in South Africa. The study used data from “The baseline study for future impact evaluation for informal settlements targeted for upgrading in South Africa.” Households eligible for participation were living in informal settlements targeted for upgrading in all nine provinces of South Africa. Socio-economic inequalities were assessed by means of multinomial logistic regression analyses, concentration indices, and concentration curves. The results showed that the use of a piped tap on the property was disproportionately concentrated among households with higher socio-economic status (concentration index: +0.17), while households with lower socio-economic status were often limited to the use of other inferior (less safe or distant) sources of drinking water (concentration index for nearby public tap: −0.21; distant public tap: −0.17; no-tap water: −0.33). The use of inferior types of drinking water was significantly associated with the age, the marital status, the education status, and the employment status of the household head. Our results demonstrate that reducing these inequalities requires installing new tap water points in informal settlements to assure a more equitable distribution of water points among households. Besides, it is recommended to invest in educational interventions aimed at creating awareness about the potential health risks associated with using unsafe drinking water. Full article
(This article belongs to the Special Issue Inequalities in Health Care)
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16 pages, 3894 KiB  
Article
Spatial Accessibility of Primary Health Care in Rural Areas in Poland
by Łukasz Lechowski and Angelika Jasion
Int. J. Environ. Res. Public Health 2021, 18(17), 9282; https://doi.org/10.3390/ijerph18179282 - 2 Sep 2021
Cited by 19 | Viewed by 3646
Abstract
The aim of the study was to assess the spatial accessibility of basic and universal healthcare (understood as primary healthcare (PHC) facilities) in rural statistical localities in Poland. Data from the National Health Fund, Central Statistical Office, National Register of Geographic Names and [...] Read more.
The aim of the study was to assess the spatial accessibility of basic and universal healthcare (understood as primary healthcare (PHC) facilities) in rural statistical localities in Poland. Data from the National Health Fund, Central Statistical Office, National Register of Geographic Names and OpenStreetMap were used in the research. The research was carried out on the basis of modelled distance from the rural statistical localities to the nearest PHC facility. The methods used included network analysis, characteristics of normal point distribution, Theil index, and spatial autocorrelation. Areas where the greatest shortages of access to PHC facilities occurred were indicated on the basis of the analysis of their clustering density. The average distance from rural statistical localities in Poland to PHC facilities is about 5 km. Slightly more than 70% of the distance values are within one standard deviation of the mean. Better access to the examined healthcare facilities is available in the southern and central parts of Poland, while northern and eastern Poland, as well as the border areas, suffer from lower accessibility. Poor access to PHC occurs first of all at the border of Greater Poland Voivodeship with the Kuyavian–Pomeranian Voivodeship, on the border of the Lodz Voivodeship, in Masovian and Swietokrzyskie Voivodeship, and in the ring surrounding Warsaw, as well as in the Pomeranian Voivodeship. The research findings can be used to develop strategies to improve the accessibility of primary care facilities in rural areas. Full article
(This article belongs to the Special Issue Inequalities in Health Care)
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13 pages, 343 KiB  
Article
Socioeconomic Inequalities and Obesity in South Africa—A Decomposition Analysis
by Eva Goetjes, Milena Pavlova, Charles Hongoro and Wim Groot
Int. J. Environ. Res. Public Health 2021, 18(17), 9181; https://doi.org/10.3390/ijerph18179181 - 31 Aug 2021
Cited by 15 | Viewed by 3533
Abstract
Background: Prior evidence shows that inequalities are related to overweight and obesity in South Africa. Using data from a recent national study, we examine the socioeconomic inequalities associated with obesity in South Africa and the factors associated with it. Methods: We use quantitative [...] Read more.
Background: Prior evidence shows that inequalities are related to overweight and obesity in South Africa. Using data from a recent national study, we examine the socioeconomic inequalities associated with obesity in South Africa and the factors associated with it. Methods: We use quantitative data from the South African National Health and Nutrition Examination Survey (SANHANES-1) carried out in 2012. We estimate the concentration index (CI) to identify inequalities and decompose the CI to explore the determinants of these inequalities. Results: We confirm the existence of pro-rich inequalities associated with obesity in South Africa. The inequalities among males are larger (CI of 0.16) than among women (CI of 0.09), though more women are obese than men. Marriage increases the risk of obesity for women and men, while smoking decreases the risk of obesity among men significantly. Higher education is associated with lower inequalities among females. Conclusions: We recommend policies to focus on promoting a healthy lifestyle, including the individual’s perception of a healthy body size and image, especially among women. Full article
(This article belongs to the Special Issue Inequalities in Health Care)
18 pages, 420 KiB  
Article
A Step towards Understanding and Tackling Health Inequalities: The Use of Secondary Prevention Services and the Need for Health Promotion in a Rural Setting
by Monika Karasiewicz, Ewelina Chawłowska, Agnieszka Lipiak and Barbara Więckowska
Int. J. Environ. Res. Public Health 2021, 18(16), 8492; https://doi.org/10.3390/ijerph18168492 - 11 Aug 2021
Cited by 5 | Viewed by 2680
Abstract
Poland has recently intensified its health promotion in an effort to extend healthy life expectancy and reduce health inequalities. Our aim was to reach a deprived rural population, increase its health literacy, and explore its use of and barriers to cancer screening and [...] Read more.
Poland has recently intensified its health promotion in an effort to extend healthy life expectancy and reduce health inequalities. Our aim was to reach a deprived rural population, increase its health literacy, and explore its use of and barriers to cancer screening and public health care. A CBPR study was conducted in one of the poorest districts in Wielkopolska region, Poland, among 122 beneficiaries of health education workshops. A self-developed questionnaire was used. The reported barriers to participation in cancer screening included: lack of time, lack of need, or feeling healthy (32.8%); long waiting times (17.2%); fear of costs (9%). Physicians seldom recommended screening to their patients. Only 7.4% of respondents had ever received dermatoscopy. Among women, 18.2% did not perform any breast exams and 25% had never had smear tests. Diagnostics was often financed out of pocket (thyroid ultrasound = 58.1%; smear test = 48.5%; breast ultrasound = 36.8%). The health system needs mentioned by participants included better access to physicians (65.6%), promotion of free screening tests (54.9%), and access to public health programmes (22.1%). There is an urgent need to translate national strategies into action. Health promotion and better access to care must become priorities in deprived areas, while primary care providers should become key figures in delivering these services. Full article
(This article belongs to the Special Issue Inequalities in Health Care)
14 pages, 363 KiB  
Article
Self-Reported Waiting Times for Outpatient Health Care Services in Hungary: Results of a Cross-Sectional Survey on a National Representative Sample
by Óscar Brito Fernandes, Armin Lucevic, Márta Péntek, Dionne Kringos, Niek Klazinga, László Gulácsi, Zsombor Zrubka and Petra Baji
Int. J. Environ. Res. Public Health 2021, 18(5), 2213; https://doi.org/10.3390/ijerph18052213 - 24 Feb 2021
Cited by 4 | Viewed by 2831
Abstract
(1) Background: System-level data on waiting time in the outpatient setting in Hungary is scarce. The objective of the study was to explore self-reported waiting time for an appointment and at a doctor’s office. (2) Methods: An online, cross-sectional, self-administered survey [...] Read more.
(1) Background: System-level data on waiting time in the outpatient setting in Hungary is scarce. The objective of the study was to explore self-reported waiting time for an appointment and at a doctor’s office. (2) Methods: An online, cross-sectional, self-administered survey was carried out in 2019 in Hungary among a representative sample (n = 1000) of the general adult population. Chi-squared test and logistic regression analysis were carried out to explore if socioeconomic characteristics, health status, or residence were associated with waiting times and the perception of waiting time as a problem. (3) Results: Proportions of 90%, 41%, and 64% of respondents were seen within a week by family doctor, public specialist, and private specialist, respectively. One-third of respondents waited more than a month to get an appointment with a public specialist. Respondents in better health status reported shorter waiting times; those respondents were less likely to perceive a problem with: (1) waiting time to get an appointment (OR = 0.400) and (2) waiting time at a doctor’s office (OR = 0.519). (4) Conclusions: Longest waiting times were reported for public specialist visits, but waiting times were favorable for family doctors and private specialists. Further investigation is needed to better understand potential inequities affecting people in worse health status. Full article
(This article belongs to the Special Issue Inequalities in Health Care)
26 pages, 809 KiB  
Article
Financing Healthcare in Central and Eastern European Countries: How Far Are We from Universal Health Coverage?
by Marzena Tambor, Jacek Klich and Alicja Domagała
Int. J. Environ. Res. Public Health 2021, 18(4), 1382; https://doi.org/10.3390/ijerph18041382 - 3 Feb 2021
Cited by 21 | Viewed by 5484
Abstract
After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the [...] Read more.
After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the role of government and households in financing healthcare in eight countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied to collect quantitative data on healthcare expenditures and qualitative data on gaps in universal health coverage. A linear regression analysis was used to analyze a trend in health expenditure over the years 2000–2018. Our results indicate that a high reliance on out-of-pocket payments persists in many EU-8 countries, and only a few countries have shown a significant downward trend over time. The gaps in universal coverage in the EU-8 countries are due to explicit rationing (a limited benefit package, patient cost sharing) and implicit mechanisms (wait times). There is need to increase the role of public financing in CEE countries through budget prioritization, reducing patient co-payments for medical products and medicines, and extending the benefit package for these goods, as well as improving the quality of care. Full article
(This article belongs to the Special Issue Inequalities in Health Care)
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