Potential access to healthcare facilities is one of the main determinants of health. This study investigates the extent of spatial inequalities in potential access to care, and the relationship ...between potential access and patients' behaviour. Taking Piedmont, an Italian Alpine region, as a case study, the analysis emphasizes that potential access is not uniform within the region and lower potential access is associated with other important indicators of socioeconomic deprivation. Moreover, people living in places characterized by poor access tend to use healthcare services less often than other citizens, and to be less mobile than the rest of the population.
ObjectivesTo investigate whether there is an association between differences in travel time/travel distance to healthcare services and patients' health outcomes and assimilate the methodologies used ...to measure this.DesignSystematic Review. We searched MEDLINE, Embase, Web of Science, Transport database, HMIC and EBM Reviews for studies up to 7 September 2016. Studies were excluded that included children (including maternity), emergency medical travel or countries classed as being in the global south.SettingsA wide range of settings within primary and secondary care (these were not restricted in the search).Results108 studies met the inclusion criteria. The results were mixed. 77% of the included studies identified evidence of a distance decay association, whereby patients living further away from healthcare facilities they needed to attend had worse health outcomes (eg, survival rates, length of stay in hospital and non-attendance at follow-up) than those who lived closer. 6 of the studies identified the reverse (a distance bias effect) whereby patients living at a greater distance had better health outcomes. The remaining 19 studies found no relationship. There was a large variation in the data available to the studies on the patients' geographical locations and the healthcare facilities attended, and the methods used to calculate travel times and distances were not consistent across studies.ConclusionsThe review observed that a relationship between travelling further and having worse health outcomes cannot be ruled out and should be considered within the healthcare services location debate.
Access is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept ...across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services.
A synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework.
Here, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage.
This paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels.
Access to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for ...health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa.
A systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards.
Forty-four studies on mHealth projects in Africa were included and classified as: "patient follow-up and medication adherence" (n = 19), "staff training, support and motivation" (n = 2), "staff evaluation, monitoring and guidelines compliance" (n = 4), "drug supply-chain and stock management" (n = 2), "patient education and awareness" (n = 1), "disease surveillance and intervention monitoring" (n = 4), "data collection/transfer and reporting" (n = 10) and "overview of mHealth projects" (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or lack of resources.
mHealth in Africa is an innovative approach to delivering health services. In this fast-growing technological field, research opportunities include assessing implications of scaling-up mHealth projects, evaluating cost-effectiveness and impacts on the overall health system.
Many parts of the world are experiencing extreme weather events, energy poverty, food insecurity, and lack of access to basic healthcare. Moreover, concerns over socioeconomic, gender, and racial ...inequalities are growing. These socially relevant issues are ripe for analysis and improvement using an operations management lens. In this paper, we review some of the relevant research advancements made in the last decade, and identify future research directions on these important topics. In particular, we focus on papers related to sustainable planet (renewable energy, environmentally and socially responsible operations, regulation‐driven operations), agriculture, and public health. For future research directions, we discuss the role of innovative business models and disruptive technologies, such as artificial intelligence (AI) and blockchain, in addressing these pressing issues.
This study sought to systematically review the existing literature on self-reported unmet healthcare needs in Southeastern Europe.
A systematic literature review of quantitative evidence in English ...and Bulgarian was performed in July 2023 using the following databases: Medline, Embase and EconLit. Publications were only included if they used self-reported unmet healthcare needs as an indicator of access to healthcare, concerned people living in Albania, Bosnia and Herzegovina, Bulgaria, Greece, Kosovo, Montenegro, Serbia, North Macedonia or Romania and if they were published after 2003. Quality assessment of the included publications was performed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool.
Twenty-three publications of varying quality were included in the review. Significantly more evidence was available for Greece, Bulgaria and Romania than for the rest of the region. Data collected through Pan-European surveys were commonly used, but almost half of the studies were only descriptive. Generally, the prevalence of unmet healthcare needs has decreased over the years. Unmet healthcare needs were higher among people of lower socioeconomic and educational status, ethnic minorities and migrants and high cost was consistently identified as the primary barrier to accessing healthcare.
Unmet healthcare needs are more prevalent among already disadvantaged societal groups. A trend of a declining prevalence of unmet needs has been observed, but it is more notable in the more socioeconomically developed countries. Improving financial protection should be a priority for the healthcare systems.
Tuberculosis (TB) is both preventable and curable, yet it is the top killer disease in South Africa. In 2018, about 300,000 people in South Africa fell ill with TB and about 63,000 people died of TB. ...This demonstrates that the incidence of TB in South Africa is far greater than in other continents. This calls for a paradigm shift in the response to fighting the TB epidemic. Specifically, this necessitates promoting access to progressive treatment methods to fight the age-old disease that is still affecting a greater fraction of the South African population. Treating TB with monotherapy has, in most instances, proven to be ineffective. The burden of the TB epidemic as witnessed in South Africa is a compelling reason for alternative treatment options such as human genome editing. The main purpose of this paper is to examine to what extent the legal and policy framework in South Africa enables the government to provide TB treatment to patients using human genome editing. The paper concludes that the right approach to accessing this technology is important because it provides a solid ground to demand access.
PDF
