Health Care Service Access and Utilization

Every Woman Matters

by Charmaine C. Williams

A community reporr from a participatory community-based pronect with the Women's Health in Women's Hands community health centre in Toronto, Canada. the study presents exoeriences of Black Women and Women of Colour accessing primary health care with attention to intersecting vectors of racism, sexism, heterosexism and homophobia, poverty, homelessness and Hiv phobia and stigma.

Increasing access and building equity into mental health services: An examination of the potential for change

by Charmaine C. Williams

Access to healthcare for" undocumented citizens" in the Rio Grande Valley

by Milena Melo

Psychosocial stress as an indicator for disease severity, mental health and health care utilization in IBD patients. Evaluation of a short scale of perceived stress in chronic diseases

by Juliane Hardt

Health care usage among immigrants and native-born elderly populations in eleven European countries: Results from SHARE

by Aïda Solé-Auró

Co-authored with Montserrat Guillén and Eileen M. Crimmins

Differences in health care utilization (HCU) of immigrants 50 years of age and older relative to the... more
Differences in health care utilization (HCU) of immigrants 50 years of age and older relative to the native-born populations in eleven European countries are investigated. Negative Binomial and zero-inflated Poisson regression are used to examine differences between immigrants and native-borns in number of doctor visits, visits to general practitioners (GPs), and hospital stays using the SHARE database. In some countries older immigrants use more health services than native-borns with the same characteristics. After controlling for differences in the need for health care, immigrants have between 6% and 21% more visits to the doctor, GP or hospital stays than native-born persons. So, the difference in the use of medical care between immigrants and native-born individuals is greater in physician visits, but immigrants also have more visits to the GP and hospital. We also find that country level gross domestic product (GDP), methods of paying physicians, physician density and health system characteristics affect HCU differentially for immigrants and natives. The results of this study add to our understanding of the behaviour of elderly citizens’ across Europe. Among older individuals, the greater HCU for elderly immigrants could be caused by differences in health, cultural differences, or informational differences. If the main reason immigrants use medical care more often than the native-born is due to cultural reasons or lack of information, then health campaigns should be designed to explain and promote efficient use of medical care units.  If the cause of the differential demand is the lack of social integration or the fragility of social networks, then efforts must be made to integrate elderly immigrants into European society. If no directed efforts are made in this direction, then a growing immigrant elderly population will exert more pressure on health care systems in subsequent years. A major innovation of this paper is that it uses a comparable dataset and two models of the demand for medical care services for a group of European countries to examine health care usage differences between immigrants and natives.  This contributes to the HCU literature by providing a unique statistical, demographic and economic approach to clarify how older immigrant populations use medical services.



Keywords: count data, physician services, elderly, immigration, Europe

Health care utilization among immigrants and native-born populations in 11 European countries. Results from the Survey of Health, Ageing and Retirement in Europe

by Aïda Solé-Auró

Claiming ‘cultural competence’: The promotion of multi-ethnic Malaysia as a medical tourism destination

by Meghann Ormond

Ormond, Meghann. (2012, forthcoming) Claiming ‘cultural competence’: The promotion of multi-ethnic Malaysia as a medical tourism destination. In Hall, C.M. (ed.), Medical Tourism: The Ethics, Regulation, and Marketing of Health Mobility, London: Routledge. Available at: http://www.routledge.com/books/details/9780415665759/

‘Culturally-competent’ patient-centred care plays an increasingly expedient role in medical tourism destinations’... more ‘Culturally-competent’ patient-centred care plays an increasingly expedient role in medical tourism destinations’ ability to capture international patient-consumer markets. While Malaysia’s ethnic, linguistic and religious pluralism had been framed as threatening to nation-building efforts in the early period following independence, recent decades have witnessed growing state awareness of the value of its culturally diverse population for plugging Malaysia into lucrative transnational networks. Engagement with global capital has helped to revalue and identify cultural diversity as central to Malaysian identity. This chapter argues that Malaysia’s burgeoning medical tourism industry is profoundly entrenched in this task and explores how claims to ‘cultural’ expertise get enacted, mobilised and reified in the promotion of the country as a destination.

Exploring the option of a multi-level monitoring and evaluation standard in health care systems

by Jan Goossenaerts

Shifting subjects of healthcare: Placing ‘medical tourism’ in the context of Malaysian domestic healthcare reform

by Meghann Ormond

Ormond, M. (2011) Shifting subjects of healthcare: Placing ‘medical tourism’ in the context of Malaysian domestic healthcare reform, Asia Pacific Viewpoint, 52(3), 247-259.

‘Medical tourism’ frequently has been held to unsettle naturalised relationships between the state and its citizenry.... more ‘Medical tourism’ frequently has been held to unsettle naturalised relationships between the state and its citizenry. Yet, in casting ‘medical tourism’ as either an outside ‘innovation’ or ‘invasion’, scholars have too often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic healthcare systems of the ‘developing’ countries increasingly recognised as international medical travel destinations. While there is little doubt that ‘medical tourism’ impacts destinations’ healthcare systems, it remains essential to contextualise them. This paper offers a reading of the emergence of ‘medical tourism’ from within the context of on-going healthcare privatisation reform in one of today’s most prominent destinations: Malaysia. It argues that ‘medical tourism’ to Malaysia has been mobilised politically both to advance domestic healthcare reform and to cast off the country’s ‘under-developed’ image not only among foreign patient-consumers but also among its very own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective healthcare consumers.

How Is Health-Related “Deservingness” Reckoned? Perspectives from Unauthorized Im/migrants in Tel Aviv

by Sarah Willen

Willen, Sarah S. 2012. “How Is Health-Related ‘Deservingness’ Reckoned? Perspectives from Unauthorized Im/migrants in Tel Aviv.” Special Issue: “Migration, ‘Illegality,’ and Health: Mapping Embodied Vulnerability and Debating Health-Related Deservingness.” S. Willen, guest ed. Social Science and Medicine. 74(6): 812-821.

Do unauthorized im/migrants have a right to health? Do they deserve health care, or health protection, or access to... more Do unauthorized im/migrants have a right to health? Do they deserve health care, or health protection, or access to the social determinants of good health? Are they party to prevailing social contracts, or does their exclusion from mainstream systems of health promotion, prevention, and care “make sense”? Questions like these, which generate considerable attention in multiple spheres of scholarship, policy, and public debate, revolve around an issue that merits substantially greater consideration among social scientists of health: health-related “deservingness.” In addition to putting the issue of health-related deservingness squarely on the map as an object of analysis, the paper further argues that we cannot focus solely on those with power, influence, and public voice. Rather, we also must investigate how deservingness is reckoned in relation to – and, furthermore, from the perspectives of – unauthorized im/migrants and members of other groups commonly constructed in public and policy discourse as undeserving. Additionally, we must also examine the complicated relationship between universalizing juridical arguments about formal entitlement to health rights, on one hand, and situationally specific, vernacular moral arguments about deservingness, on the other.

KEYWORDS: Israel – unauthorized im/migration – im/migrant health – “illegality” – deservingness – health care access – idioms of social justice mobilization – renegade moralities

Predictors of exposure to sexual health education among teens who are newcomers to Canada

by Roxana Salehi

Roxana Salehi¹, Sarah Flicker¹, and the Toronto Teen Survey Team

The aim of this component of the Toronto Teen Survey was to explore predictors of access to sexual health education... more The aim of this component of the Toronto Teen Survey was to explore predictors of access to sexual health education among urban youth with a focus on newcomers to Canada. A total of 1216 teens were surveyed through community-based agencies. The sample was diverse in terms of age, gender, race, language, religion, length of residency in Canada, and sexual behaviour. Most participants (65%) were born in Canada with 33% born elsewhere. The one third of those born elsewhere (11% of the total sample) who reported living in Canada for three years or less were identified as “newcomers” for the purposes of this analysis. Overall, 92% of the total sample indicated that they had received some sexual health education through classes or workshops and 8% said they had received no such education. Controlling for gender, age, religion, socioeconomic status, and sexual experience, all youth not born in Canada were significantly less likely to report having received sexual health education than those born in Canada. Within this group, 81.2% of those identified as newcomer youth had received some sexual health education compared to 91.8% for youth who had been in Canada longer and 93.7% for Canadian born youth (The Canadian Journal of Human Sexuality, 2010, 19: 157-168).

Young but older than 20”: better practices in enhancing newcomer youth’ access to services

by Roxana Salehi

Young but older than 20”: better practices in enhancing newcomer youth’ access to services. 12 (1). Canadian Journal of Social Work

Medical tourism, medical exile: Responding to the cross-border pursuit of healthcare in Malaysia

by Meghann Ormond

Ormond, M. (2011) 'Medical tourism, medical exile: Responding to the cross-border pursuit of healthcare in Malaysia', in Minca, C. and Oakes, T. (eds), Real Tourism: Practice, Care and Politics in Contemporary Travel, London: Routledge, pp. 143-161. Available at: http://www.routledge.com/books/details/9780415582247/

Considering the growing relevance of healthcare-motivated travel across borders, this chapter draws attention to... more Considering the growing relevance of healthcare-motivated travel across borders, this chapter draws attention to tensions derived from destinations’ focus on satisfying the needs of the desired western ‘medical tourist’ while the more everyday intraregional flows of medical travellers, though constituting the bulk of international medical travel today, pass largely under the radar. The chapter situates the development of Malaysia’s principal medical travel destinations as a response to the growth of patient-consumers from Indonesia for the treatment of ailments ranging from the mundane to the acute. It then identifies the disjuncture with Malaysia’s burgeoning national ‘medical tourism’ agenda, disproportionately orientated towards catering to an ideal tourism still largely devoid of tourists by directing investment towards adapting to the ‘everyday’ standards deemed requisite to attract the high-spending, long-haul ‘medical tourist’ archetype, eclipsing the response to the needs of a significant proportion of medical travellers. In offering a grounded reading of the management of Indonesian medical travel to Malaysia, this chapter points to the active role of destinations at a range of scales in recognising and catering to different categories of medical travellers, laying out the complex ethical, economic and political contours shaping the recognition of medical travellers’ corporeal vulnerabilities and the correlate extension of hospitality.

Harnessing 'diasporic' medical mobilities

by Meghann Ormond

Ormond, M. (2012, forthcoming) ‘Harnessing “diasporic” medical mobilities’, in F. Thomas & J. Gideon (eds) Migration, Health and Inequality, London: Zed Books.

Migrant diasporas are increasingly pegged as the ‘natural’ markets for and ‘ambassadors’ to the world-class private... more Migrant diasporas are increasingly pegged as the ‘natural’ markets for and ‘ambassadors’ to the world-class private health care increasingly available in their countries of origin. This chapter explores the pursuit and provision of health care by migrant populations ‘back home’, and examines the potential of healthcare to deepen their diasporic linkages with the countries of origin.

Pattern and consequences of first visits to obstetrician/gynecologists by adolescents in Taiwan: A nationwide study.

by Yu Chun Chen

J Chin Med Assoc. 2010 Mar;73(3):144-9.
Yeh HY, Chen YC, Su I, Chou LF, Chao HT, Chen TJ, Hwang SJ.

Comment in:
J Chin Med Assoc. 2010 Apr;73(4):186-7.

BACKGROUND: Some adolescents have special... more Comment in:
J Chin Med Assoc. 2010 Apr;73(4):186-7.

BACKGROUND: Some adolescents have special health care needs. Privacy concerns,
unawareness or ethnical/cultural factors are barriers to women visiting
obstetricians/gynecologists (OB/GYNs). The utilization of OB/GYN services by
adolescent girls is seldom reported. The aim of this study was to investigate the
pattern and consequences of first visits to OB/GYNs by adolescent girls within
the National Health Insurance in Taiwan.
METHODS: From the 1-million cohort dataset of the National Health Insurance
Research Database spanning from 1996 to 2007, adolescent girls visiting OB/GYNs
for the first time were identified. The characteristics of first visits were
analyzed. Their follow-up visits and admissions within 1 year after their first
visits to OB/GYNs were traced.
RESULTS: In 2006, only 5.8% (n = 2,682) of 46,582 adolescent girls in our study
cohort had their first visits to OB/GYNs: 46.7% with diagnoses of menstrual
disorders and 14.8% with diagnoses related to inflammatory or infectious diseases
of the genital organs. The examination most frequently ordered was pregnancy test
(for 19.9% of these first visits). Very few (0.4%) first visits were for
preventive services. Among the infrequent admissions (85 admissions of 75 girls)
to obstetric/gynecology wards within 1 year after first visits, the majority (74
of 85 admissions) were pregnancy-related.
CONCLUSION: The leading motivating factor for first visits to OB/GYNs by
adolescent girls was menstrual disorders. The majority of subsequent admissions
were pregnancy-related, indicating that adolescent pregnancy deserves further
attention.

Potentially inappropriate medication for emergency department visits by elderly patients in Taiwan.

by Yu Chun Chen

Pharmacoepidemiol Drug Saf. 2009 Jan;18(1):53-61.
Chen YC, Hwang SJ, Lai HY, Chen TJ, Lin MH, Chen LK, Lee CH.

PURPOSE: The potential for adverse drug events caused by potentially
inappropriate medication (PIM) use in... more PURPOSE: The potential for adverse drug events caused by potentially
inappropriate medication (PIM) use in elderly patients at emergency department
(ED) visits is a growing concern. The objects of this study were to determine the
prevalence, characteristics and risk factors of PIM use among elderly ED visits
in Taiwan.
METHODS: The nationwide computerized claims database of elderly ED visits under
the National Health Insurance (NHI) in Taiwan during 2001-2004 was accessed. PIM,
independent of diseases diagnoses or conditions and should be generally be
avoided in elderly people, was evaluated using the updated 2003 Beers criteria.
RESULTS: Between 2001 and 2004, 14.7% of total 1 429 463 elderly ED visits with
prescriptions had PIM, and 19.3% of elderly people who visited ED received at
least one PIM annually. Odds ratio for PIM prescriptions to ED elderly was higher
for visits at which more drugs were prescribed, visits at local community
hospital, female and older physicians, patients aged 65-69 years and female
patients. Common PIM categories were short acting nifedipine, muscle relaxants
and anti-spasmodics, antihistamines and ketorolac. When health care resource
utilization was compared in 2004, subjects receiving PIM at ED visit had
significantly more mean ambulatory care visits, ED visits and hospital admissions
than subjects who did not receive PIM.
CONCLUSIONS: About one fifth of elderly people who visited ED received PIM
annually in Taiwan. The public and physicians should be educated, and a
computerized drug surveillance system might be needed to avoid PIM prescriptions
to the ED elderly patients.

High prevalence of potentially inappropriate medication for ambulatory care visits by elderly patients within the national health insurance system in Taiwan.

by Yu Chun Chen

Patterns of traditional Chinese medicine use in patients with inflammatory bowel disease: A population study in Taiwan.

by Yu Chun Chen

Hepatogastroenterology. 2008 Mar-Apr;55(82-83):467-70.
Chen YC, Chen FP, Chen TJ, Chou LF, Hwang SJ.

BACKGROUND/AIMS: Many researchers have reported on the utilization of
complementary and alternative medicine by... more BACKGROUND/AIMS: Many researchers have reported on the utilization of
complementary and alternative medicine by patients with inflammatory bowel
disease (IBD). The aim of this study was to investigate the use of traditional
Chinese medicine (TCM) by all IBD patients within the National Health Insurance
in Taiwan.
METHODOLOGY: The complete ambulatory visits records of TCM in 2004 were obtained
from the National Health Insurance Research Database. For all IBD patients
identified from the registry for catastrophic illness patients, patterns of TCM
visits were analyzed.
RESULTS: The prevalence of IBD in Taiwan was 5.6 per 100,000 persons at the end
of 2004. Of 1,206 IBD patients, 440 (37%) patients have in total 3,169 TCM visits
in 2004. Women were more likely to use TCM than men (40.5% vs. 34.3%). Among the
TCM users of the IBD patients, 200 (45.5%) patients had gastroenterological
diagnoses at their TCM visits. Most of their TCM visits contained herbal remedies
(90%), followed by manual therapy (11.7%) and acupuncture (9.8%).
CONCLUSIONS: The high utilization rate of TCM among the IBD patients in Taiwan
implied that their needs of medical care were not satisfied by the mainstream
Western medicine. The TCM herbal regimens deserve further studies.

Intra-articular hyaluronic acid for treatment of osteoarthritis: A nationwide study among the older population in Taiwan

by Yu Chun Chen

BMC Health Serv Res. 2008 Jan 28;8:24.
Lai HY, Chen YC, Chen TJ, Chou LF, Chen LK, Hwang SJ.

BACKGROUND: Although intra-articular treatment with hyaluronic acid (HA) for
symptomatic osteoarthritis has... more BACKGROUND: Although intra-articular treatment with hyaluronic acid (HA) for
symptomatic osteoarthritis has become widely accepted in recent decades, the
pattern of its use has seldom been reported. We have explored the epidemiology of
intra-articular HA treatment in Taiwan by using the rich data source from
nationwide insurance claims.
METHODS: Taiwan's National Health Insurance (NHI), which covers 97% of
inhabitants, offers extensive hospitalisation and ambulatory care. We identified
the beneficiaries aged 60 years and older who received intra-articular HA within
the NHI during 2004. The number of visits in which HA was administered were
analysed by patient's age and gender and by the physician's specialty and
practice site.
RESULTS: Among the 73,410,777 ambulatory visits by 2,909,219 beneficiaries aged
60 years and older in 2004, 35,782 (1.2%) patients received intra-articular HA
treatment in 205,012 (0.3%) visits. The highest prevalence of HA use was in the
70-79 year age group in both sexes. Women received intra-articular HA treatment
more frequently than men in all age groups, especially in the 60-69 and 70-79
year groups (1.6% vs. 0.5%, 2.2% vs. 1.0%, respectively). Most intra-articular HA
procedures were performed by orthopaedic surgeons (75.1%) and physical medicine
and rehabilitation physicians (15.2%), and at metropolitan hospitals (34.5%) and
local community hospitals (38.2%).
CONCLUSION: One out of 100 older patients in Taiwan received intra-articular HA
treatment for osteoarthritis of the knee during the course of the year. There
were age-gender differences in use of HA treatment. The completion rate of this
treatment in our study was high, and thus intra-articular HA might be a good
alternative for patients for whom conventional treatment fails. Further research
is needed to examine the age-gender differences in use of intra-articular HA in
Taiwan.

Utilization of psychotropic drugs in Taiwan: An overview of outpatient sector in 2000.

by Yu Chun Chen

Zhonghua Yi Xue Za Zhi (Taipei). 2002 Aug;65(8):378-91.
Su TP, Chen TJ, Hwang SJ, Chou LF, Fan AP, Chen YC.

BACKGROUND: Development of pharmacological treatment in mental disorders has
risen drastically over the past... more BACKGROUND: Development of pharmacological treatment in mental disorders has
risen drastically over the past decade in Taiwan. We performed a survey of the
National Health Insurance claims for outpatient psychiatric services to study the
utilization of psychotropic drugs. The analysis followed the drug classification
and standardized measurements proposed by the World Health Organization.
METHODS: The sampling datasets from the National Health Insurance Research
Database served as data sources. They represented 0.2% of the entire claims for
outpatient medical services in 2000. The measurement units used for psychotropic
drugs were either prescription volumes (drug items) or the number of defined
daily doses (DDDs). To estimate the proportion of the population treated daily
with psychotropic drugs, numbers of DDDs per 1000 inhabitants per day were also
calculated. Beside overall description, the data of psychotropic substance
prescriptions were analyzed by stratifying patient's age, physician's specialty,
accreditation status of hospital, and chemical subgroup of psychotropic drugs.
RESULTS: Prescription of psychotropic drug items (n = 63,539) was 3.24% of the
total drug items (n = 1,958,820) claimed. The psychotropic drugs were prescribed
to 9.2% of the total patients and in 9% of the total visits. Major consumers of
psychotropic drugs were between 35-74 years of age and there were more women than
men. The psychiatrist was the largest group of physicians who had prescribed
psychotropic drugs and contributed 18.5% of all drug items and 38.3% of total
DDDs of psychotropic drugs. The number of DDDs per 1000 inhabitants per day for
all kinds of psychotropic drugs was estimated to be 32.94 in Taiwan, where
anxiolytics accounted 14.30, hypnotics and sedatives 10.64, antipsychotics 3.41,
antidepressants 3.06 and mood stabilizers 1.43. Ordered by total DDDs, the top 10
most frequently used chemical substances were flunitrazepam, alprazolam,
fludiazepam, oxazolam, lorazepam, diazepam, zolpidem, estazolam, zopiclone, and
haloperidol.
CONCLUSIONS: The usage level of psychotropic drugs in Taiwan was lower than in
most industrialized countries, especially for antidepressants. The future goals
are to focus on the longitudinal analysis of general trend for each psychotropic
substance and to associate the pharmacoepidemiological data in parallel with the
upcoming epidemiological study of mental disorders in Taiwan.