International Journal for Equity in Health最新文献

{"title":"Addressing unmet mental health needs of older adults in Turbo, Colombia: a multi-component psychosocial intervention feasibility study.","authors":"Clarissa Giebel, Erika Montoya, Gabriel Saldarriaga, Thais Caprioli, Mark Gabbay, Danicza Martinez, Jessica Rua, Maria Isabel Zuluaga","doi":"10.1186/s12939-025-02381-x","DOIUrl":"10.1186/s12939-025-02381-x","url":null,"abstract":"<p><strong>Background: </strong>Older adults have lived through extreme and stressful live events in Colombia, including during the armed conflict. Without adequate mental health resources in place, the aim of this study was to feasibility test a co-produced community-integrated intervention for older adults to improve their mental health and well-being in Turbo, Colombia.</p><p><strong>Methods: </strong>Based on a systematic review and meta-analysis of community-based mental health interventions for older adults in LMICs, qualitative interviews with older adults and local stakeholders, as well as a mental health needs assessment survey of the local older adult population in Turbo, Colombia, we consulted older adults in the region to co-produce a community-based intervention. The co-produced intervention ran for three months in 2023, with two sessions provided per week in a community centre (26 sessions in total). The multi-component intervention included social engagement, educational interventions, physical activities, and peer support. Older adults were recruited from the local community. Twelve participants were interviewed about their experiences of the intervention and its feasibility.</p><p><strong>Results: </strong>Eighteen older adults participated in the intervention, with 13 completing the 12 weeks. Attendance rate was high, with 10 participants attending between 90 to 100% of all 26 sessions. Qualitative interviews with 12 participants showed that participants valued the intervention and the activities it offered, that the intervention was feasible, and expressed a keen interest for the intervention to be continued.</p><p><strong>Conclusions: </strong>This co-produced and evidence-based intervention for older victims of 'La Violencia' in Colombia has the potential to provide affordable, acceptable and relevant community-based resources supporting mental health and wellbeing within the community; providing care and support with trained facilitation. Normally, this group would not be able to access services to address their social and psychological isolation and distress. In light of limited mental health support across LMICs, this intervention could provide mental health for older adults in other communities in Colombia and elsewhere developed through co-production, cultural adaptation, subject to further evaluation.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"21"},"PeriodicalIF":4.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda.","authors":"Manuela Straneo, Lenka Beňová, Thomas van den Akker, Muzdalifat S Abeid, Elizabeth Ayebare, Jean-Paul Dossou, Greta Handing, Bianca Kandeya, Andrea B Pembe, Claudia Hanson","doi":"10.1186/s12939-025-02379-5","DOIUrl":"10.1186/s12939-025-02379-5","url":null,"abstract":"<p><p>Identification of interacting vulnerabilities is essential to reduce maternal and perinatal mortality in sub-Saharan Africa (SSA). High parity (≥ 5 previous births) is an underemphasized biological vulnerability linked to poverty and affecting a sizeable proportion of SSA births. Despite increased risk, high parity women rarely use hospitals for childbirth. We assessed whether emergency referral during childbirth was associated with adverse events in high parity women in hospitals in Benin, Malawi, Tanzania and Uganda. We used e-registry data collected in 16 hospitals included in the Action Leveraging Evidence to Reduce perinatal morbidity and morTality (ALERT) trial. Main outcomes were severe maternal outcomes and in-facility peripartum death (fresh stillbirth or very early neonatal death). Main exposure was parity; emergency (in-labour) referral was included as effect modifier with potential confounders. We used multivariable logistic regression including parity/referral interaction and post-regression margins analysis. Among 80,663 births, 4,742 (5.9%) were to high parity women. One third reached hospital following emergency referral. Severe maternal outcomes and peripartum mortality were over 2.5-fold higher in high parity women with emergency referral compared to the lowest risk group. To avert these adverse events, emergency referral must be avoided by ensuring high parity women give birth in hospitals. Trial registration Pan African Clinical Trial Registry ( www.pactr.org ): PACTR202006793783148. Registered on 17th June 2020.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"19"},"PeriodicalIF":4.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating diabetes care inequities: an observational study linking chronic care model's structural elements to process and outcomes of type 2 diabetes care in Belgium.","authors":"Philippe Bos, Katrien Danhieux, Edwin Wouters, Josefien van Olmen, Veerle Buffel","doi":"10.1186/s12939-024-02372-4","DOIUrl":"10.1186/s12939-024-02372-4","url":null,"abstract":"<p><strong>Background: </strong>Although the Chronic Care Model (CCM) provides the essential structural components of practice organisation to deliver high-quality type 2 diabetes (T2D) care, little is known about which of its elements are most important, and the extent to which it may reduce social inequities in the quality of T2D care. This study aims to assess the association between the implementation of CCM's structural elements and the quality of T2D care processes and outcomes in Flanders (Belgium), paying specific attention to differences by patients' socioeconomic vulnerability.</p><p><strong>Methods: </strong>We developed a longitudinal database combining information on primary care practices' CCM implementation, with individual-level health insurance and medical lab data. Our sample included 7,593 T2D patients aged 40 years and above from 58 primary care practices in Flanders, followed up from 2017 to 2019. Medical lab data were available for a subsample of 4,549 patients. By estimating a series of hierarchical mixed-effects models, we assessed the association between primary care practices' CCM implementation and two process and two outcome indicators of T2D care. In addition, we explored cross-level interactions with patients' socioeconomic vulnerability.</p><p><strong>Results: </strong>Patients were more likely to have their HbA1c tested twice a year and LDL cholesterol tested yearly in practices with a higher overall CCM implementation. Regarding the different CCM elements, the clinical information system and linkages to the community were significantly associated with higher odds of being up-to-date with HbA1c testing, whereas stronger community linkages was the only dimension significantly associated with yearly LDL cholesterol testing. While socioeconomic vulnerable patients were less likely to have their HbA1c tested twice yearly, this difference disappeared in the highest-scoring practices. Regarding the outcome indicators, only a negligible proportion of variation in HbA1c and LDL cholesterol levels was due to systematic differences between practices, and hence, no clinically relevant associations with the CCM elements were found.</p><p><strong>Conclusion: </strong>Our pioneering findings support the social capital pathway, as CCM implementation is associated with a reduction in the healthcare inequity gap in the T2D care process. This suggests that promoting CCM implementation may improve healthcare equity, particularly in regions with significant socioeconomic disparities or high concentrations of deprived individuals.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"15"},"PeriodicalIF":4.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"After neonatal care, what next? A qualitative study of mothers' post-discharge experiences after premature birth in Kenya.","authors":"Justinah Maluni, Dorothy Oluoch, Sassy Molyneux, Mwanamvua Boga, Caroline Jones, Florence Murila, Mike English, Sue Ziebland, Lisa Hinton","doi":"10.1186/s12939-024-02340-y","DOIUrl":"10.1186/s12939-024-02340-y","url":null,"abstract":"<p><strong>Background: </strong>Approximately 15 million babies are born prematurely every year worldwide. Sub-Saharan Africa (SSA) and Asia account for more than half of the global preterm deliveries. Prominent healthcare structural and socio-economic factors in SSA, for example poverty and weak health systems, amplify vulnerabilities for mothers and premature babies; often leading to poor outcomes. Post-discharge mortality rates are high, and readmission is common. For mothers of premature babies, the transition home from hospital is marked by challenges and uncertainties. This study explored the post-discharge experiences of mothers of premature babies with the aim of identifying their needs and suggests strategies to strengthen and support their discharge preparation to care for their premature baby at home, and to and reduce mortality and readmission rates.</p><p><strong>Methods: </strong>Narrative interviews were conducted face-to-face in English or Swahili with 34 mothers of premature babies recruited from two public hospitals and a social support group in Nairobi, Kenya between August-November 2021. Interviews were audio and video-recorded and transcribed for analysis. After transcription, the interviews were translated, where applicable, and thematic analysis was undertaken.</p><p><strong>Results: </strong>For mothers of premature babies, discharge from neonatal care and the transition home is a complex process marked with mixed emotions; many reported feeling unprepared and facing stigma while in hospital and in their communities. Mothers described the emotional challenges of discharge from the neonatal unit and their information and support needs. Minimal involvement in their baby's care while in the neonatal unit appeared to contribute to the mothers' lack of confidence in caring for their babies independently post-discharge when they no longer had the support of the clinical and nursing staff. Insufficient information provided on discharge hindered a smooth transition to home, highlighting the need for information to support mothers' confidence after discharge. Stigma relating to beliefs around preterm births was experienced by some of the mothers in the community and within some health clinics.</p><p><strong>Conclusions: </strong>To support transitions home, strengthening the timing and adequacy of information provided to mothers at discharge from the neonatal unit in low-income settings in SSA and Asia - such as Kenya-is essential. Introducing strategies to build and assess mothers' competencies with skills such as breastfeeding and identifying signs of deterioration before discharge could support their smooth transition home. Targeted engagement interventions at the community level could demystify and address stigma and knowledge gaps about premature deliveries at the community and social levels more broadly and within the health system.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"17"},"PeriodicalIF":4.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Areas for action to promote positive forms of masculinities in preventing violence against women: a concept mapping study in Spain.","authors":"Ariadna Cerdán-Torregrosa, Belén Sanz-Barbero, Daniel La Parra-Casado, Carmen Vives-Cases","doi":"10.1186/s12939-025-02385-7","DOIUrl":"10.1186/s12939-025-02385-7","url":null,"abstract":"<p><strong>Background: </strong>Violence against women (VAW) perpetrated by men is a public health problem of significant magnitude that negatively affects the whole society. Unequal gender relations produce differentiated positions in the social structure; gender roles that position men and women differently are defined and which are at the root of VAW. Framed within the European PositivMasc project, the aim of this study was to identify the areas for action to promote positive masculinities in preventing VAW in Spain, based on community stakeholders' perceptions on their importance and applicability.</p><p><strong>Methods: </strong>A concept mapping study was carried out, involving a comprehensive and systematic approach that employs both a qualitative and quantitative methodology, between September 2019 and February 2022 in Spain. The research was conducted with a diverse sample of young people, both feminist activists and non-activists, as well as various professionals in the field under study.</p><p><strong>Results: </strong>The results of this study showed that the lines of action in order of importance are: prevention through formal and informal education, general skills for the population, personal work with men, media and social campaigns, governmental and legal measures, activism and support to social organizations. In turn, the order of these lines of action according to applicability in the Spanish context was: media and social campaigns, prevention through formal and informal education, general skills for the population, support to social organizations, activism, personal work with men and governmental and legal measures. Consensus was observed among the participants of different socio-demographic profiles, both at a quantitative level in the scores obtained and at a qualitative level with the interpretations that reinforced the results.</p><p><strong>Conclusions: </strong>There is a need for a comprehensive multisectoral response involving different spaces to strengthen the scale, impact and sustainability of the efforts around anti-VAW masculinities. The evidence produced throughout this concept mapping study can contribute to inform policies to effectively prevent VAW by focusing on positive masculinities, ensuring they align with the perceptions and experiences of key community actors involved in the policy implementation process.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"18"},"PeriodicalIF":4.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular risk profiling among South Asian adults in Hong Kong: a latent class analysis.","authors":"Gary Ka-Ki Chung, Woohyung Lee, Danna Camille Vargas, Bulbul Sharma, Kai Sing Sun, Heidi Hung, Lee Sha Tong, Tsz Lui Tang, Hasiba Munir, Chi Yui Wong, Soniya Pun, Man Hin Chio, Eliza Lai-Yi Wong, Dong Dong, Eng-Kiong Yeoh","doi":"10.1186/s12939-025-02376-8","DOIUrl":"10.1186/s12939-025-02376-8","url":null,"abstract":"<p><strong>Background: </strong>South Asians living in urbanized settings are facing disproportionate cardiovascular burden largely attributable to modifiable risk factors. Given the rapid surge in South Asian population in Hong Kong, this study aims to identify and distinguish clusters of cardiovascular risk profiles among community-dwelling South Asian adults.</p><p><strong>Methods: </strong>Between June 2022 and December 2023, 1181 South Asian adults were recruited through territory-wide outreach health assessments on lifestyle, psychological distress, obesity, clinical cardiovascular conditions, and sociodemographic factors. Latent class analysis was performed to classify the cardiovascular profiles, followed by multinomial logistic regression to identify the sociodemographic characteristics across classes.</p><p><strong>Results: </strong>Five latent classes were identified: low risk (19.6%), lifestyle risk plus distress (8.9%), obesity risk (33.4%), lifestyle risk plus distress with obesity (26.6%), and high clinical risk (11.4%). Apart from the higher clinical risk in older adults, women tended to cluster into classes with obesity, while men and the economically active were more likely in classes with poorer lifestyles and stress. Pakistani and Nepalese consistently exhibited higher risks compared to Indians, whereas the less educated tended to cluster into the high clinical risk class.</p><p><strong>Conclusion: </strong>This study revealed distinct cardiovascular risk patterns and sociodemographic features within the South Asian community in Hong Kong. The heavy burden on obesity especially in women, lifestyle and psychological risks especially in men, and low overall physical activity level may be translated into a tremendous cardiovascular disease burden in the forthcoming decades, in particular among Pakistani and Nepalese as well as the socioeconomically disadvantaged.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"14"},"PeriodicalIF":4.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysing the scientific literature on transgender and gender diverse persons' experiences with sexual and reproductive health care services from an intersectional perspective.","authors":"Susan Heward-Belle, Sarah Ciftci, Renee Lovell","doi":"10.1186/s12939-024-02328-8","DOIUrl":"10.1186/s12939-024-02328-8","url":null,"abstract":"<p><p>Transgender and gender diverse (TGD) persons face considerable challenges accessing sexual and reproductive health care (SRHC), often resulting in poor health outcomes when compared to cisgender persons. Aetiological research predominantly explains these health disparities through a single axis explanation reducing them to factors related to gender identity. Yet, a one-dimensional representation of TGD persons fails to recognize the multiple experiences of systemic oppression that may contribute to poor sexual and reproductive health (SRH) experiences and outcomes. This scoping review was conducted to locate, analyse and synthesise contemporary scientific research exploring TGD persons' experiences with SRHC services, from an intersectional perspective. Searches were conducted in PsycINFO, APA Psychinfo, Ovid MEDLINE®, SCOPUS, and CINAHL. Studies were included if they were in English, conducted in OECD countries, published between 2012 to 2022 in peer-reviewed journals, based upon empirical research, involving human participants and presenting disaggregated data for TGD populations. To be included, studies also had to contain TGD individuals who had accessed SRHC services and data that pertained to forms of oppression, disadvantage, social determinants of health or aspects of identity that intersected with their gender identities. 1290 records were identified and entered into Endnote software X9, with 413 removed before screening. A total of 877 records were screened by the author and a research assistant independently who examined titles and abstracts and selected 27 for in-depth analysis. Included studies were uploaded to NVivo 12 and subjected to in-depth review, coding, and synthesis using descriptive statistics and thematic analysis. The review found that efforts to understand TGD persons' experiences of multiple marginalisation in SRHC settings are hampered by methodological challenges relating to adopted sampling techniques, measures used, the use of small and non-representative samples, and geographic location. The review found multiple intersecting systems of oppression including cissexism, heterosexism, racism, classism, geographical disadvantage and ageism, that challenged TGD persons' access to quality care within SRHC settings. Best practices were identified including affirming, person-centred care, collaboration, trauma-informed care and leveraging informal support networks, which provide hope for improved service provision and design.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"12"},"PeriodicalIF":4.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solidarity and its decoloniality in global health ethics.","authors":"Ademola Kazeem Fayemi, David Gerrard Kirchhoffer, Bridget Pratt","doi":"10.1186/s12939-025-02380-y","DOIUrl":"10.1186/s12939-025-02380-y","url":null,"abstract":"<p><p>Solidarity is one of the emerging values in global health ethics, and a few pieces of bioethics literature link it to decoloniality. However, conceptions of solidarity in global health ethics are influenced primarily by Western perspectives, thus suggesting the decolonial needs to include non-Western perspectives. This article explores a decolonial interpretation of solidarity to enrich our understanding of solidarity. It employs a palaver approach, typical of African (Yorùbá) relational culture, in developing a conception of solidarity grounded in a beehive metaphor. Through a decolonial methodological approach, this article posits that a beehive metaphor allegorically symbolises solidarity. In this decolonial interpretive account, solidarity embeds relational virtues and duties that foster harmony. Solidarity is a positively oriented affective disposition with people with whom one shares similar circumstances for harmonious well-being through concerted efforts. This article addresses five potential objections to this account of solidarity in global health ethics and consequently explores what an African account of solidarity means for global health research funding. This article concludes that the palaver decolonial approach from the Global South has implications for expanding conceptual perspectives on solidarity in global health ethics.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"13"},"PeriodicalIF":4.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a new case-based payment scheme on volume distribution across public hospitals in Zhejiang, China: does 'Same disease, same price' matter.","authors":"Meiteng Yu, Jing Liu, Tao Zhang","doi":"10.1186/s12939-025-02375-9","DOIUrl":"10.1186/s12939-025-02375-9","url":null,"abstract":"<p><strong>Background: </strong>With the implementation of the hierarchical medical system (HMS) in China, Zhejiang Province introduced an innovative payment scheme called \"payment method by disease types with point counting\". This scheme was initially adopted in Jinhua in July 2017, and was later integrated with the \"same disease, same price\" policy in Hangzhou in January 2020. This study aimed to investigate the impact of these reforms on the distribution of health service volume.</p><p><strong>Methods: </strong>Data were obtained from 104 hospitals, including 12 tertiary and 14 secondary hospitals from each of four regions: Jinhua (intervention) vs. Taizhou (control), and Hangzhou (intervention) vs. Ningbo (control). A total of 3848 observation points were examined using two sets of controlled interrupted time series analyses to assess the effects of this new case-based payment, without and with \"same disease, same price\", on the proportion of discharges, total medical revenue and hospitalization revenue. The Herfindahl-Hirschman Index (HHI) were analyzed to evaluate changes in market competition.</p><p><strong>Results: </strong>Following the introduction of the new case-based payment without \"same disease, same price\", secondary hospitals in Jinhua experienced a significant decline in the proportion of discharges (β₆ = -0.1074, p = 0.047), total medical revenue (β₆ = -0.0729, p = 0.026), and hospitalization revenue (β₆ = -0.1062, p = 0.037) compared to those in Taizhou, while tertiary hospitals showed a non-significant increase. After incorporating \"same disease, same price\", the proportion of discharges (β₆ = 0.2015, p = 0.031), total medical revenue (β₆ = 0.1101, p = 0.041) and hospitalization revenue (β₆ = 0.1248, p = 0.032) in Hangzhou's secondary hospitals increased compared with Ningbo's, yet the differences in both the level and trend changes between tertiary hospitals in the two cities were not statistically significant. The HHI in Jinhua (β₇ = 0.0011, p = 0.043) presented an upward trend during the pilot period of the case-based payment, while the HHI in Hangzhou (β₆ = -0.0234, p = 0.021) decreased immediately after the introduction of \"same disease, same price\".</p><p><strong>Conclusion: </strong>This new case-based payment scheme may worsen the disproportionate distribution of service volume across hospitals of different levels. While \"same disease, same price\" shows potential benefits, further evidence is needed to assess its effectiveness in promoting HMS. Policymakers should consider hospital interests in payment design and address unintended strategic behaviors.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"11"},"PeriodicalIF":4.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage.","authors":"Edson Serván-Mori, Sergio Meneses-Navarro, Rocío García-Díaz, Diego Cerecero-García, David Contreras-Loya, Octavio Gómez-Dantés, Arachu Castro","doi":"10.1186/s12939-024-02374-2","DOIUrl":"10.1186/s12939-024-02374-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ethnic and racial discrimination in maternal health care has been overlooked in academic literature and yet it is critical for achieving universal health coverage (UHC). There is a lack of empirical evidence on its impact on the effective coverage of maternal health interventions (ECMH) for Indigenous women in Mexico. Documenting progress in reducing maternal health inequities, particularly given the disproportionate impact of the Covid-19 pandemic on ethnic minorities, is essential to improving equity in health systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a population-based, pooled cross-sectional, and retrospective analysis for 2009-2023, using data from the last three waves (2014, 2018, and 2023) of a nationally representative demographic survey (ENADID). Our study included n = 72,873 (N = 23,245,468) Mexican women aged 12-54 with recent live births. We defined ECMH as adequate antenatal care (ANC), skilled and/or institutional delivery care, timely postpartum care, and complication-free postpartum/puerperium. After describing sociodemographic characteristics and maternal health coverage by Indigenous status, we estimated a pooled fixed-effects multivariable regression model to adjust ECMH for relevant covariates. We used the Blinder-Oaxaca decomposition for nonlinear regression models to quantify inequities in ECMH due to ethnic-racial discrimination, defined as differences in outcomes attributable to differential treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Indigenous women had lower education, labor market participation, and socioeconomic position, higher parity, and more rural, poorer state residence than non-Indigenous women. They faced significant health coverage loss due to the dismantling of Seguro Popular, a public health insurance mechanism in place until the end of 2019, right before the start of the Covid pandemic. Adjusted ECMH was 25.3% for non-Indigenous women and 18.3% for Indigenous women, peaking at 28.8% and 21.2% in 2013-2018, declining to 25.7% and 18.7% pre-Covid (January 2019 to March 2020), and further declining to 24.0% and 17.4% during Covid, with an increase to 26.6% for non-Indigenous women post-Covid, while remaining similar for Indigenous women. Decomposition analyses revealed that during the analyzed period, 30.8% of the gap in ECMH was due to individual characteristics, 51.7% to ethnic-racial discrimination, and 17.5% to their interaction. From 2009 to 2012, 42.2% of the gap stemmed from observable differences, while 40.4% was due to discrimination. In the pre-Covid-19 phase, less than 1% was from observable characteristics, with 75.3% attributed to discrimination, which remained in the post-Covid-19 stage (78.7%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Despite modest health policy successes, the ethnic gap in ECMH remains unchanged, indicating insufficient action against inequity-producing structures. Ethnic and racial discrimination persists, exacerbated during the pandemic","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"10"},"PeriodicalIF":4.5,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}