Pathways to Colonoscopy in the South: Seeds of Health Disparities
Author(s)Curbow, Barbara A.
Dailey, Amy B.
King-Marshall, Evelyn C.
Barnett, Tracy E.
Schumacher, Jessica R.
George, Thomas J.
KeywordsBioethics and Medical Ethics
Community Health and Preventive Medicine
Other Medicine and Health Sciences
Public Health Education and Promotion
Full recordShow full item record
AbstractObjectives. We aimed to highlight sociodemographic differences in how patients access colonoscopy. Methods. We invited all eligible patients (n = 2500) from 2 academy-affiliated colonoscopy centers in Alachua County, Florida (1 free standing, 1 hospital based), to participate in a precolonoscopy survey (September 2011–October 2013); patients agreeing to participate (n = 1841, response rate = 73.6%) received a $5.00 gift card. Results. We found sociodemographic differences in referral pathway, costs, and reasons associated with obtaining the procedure. Patients with the ideal pathway (referred by their regular doctor for age-appropriate screening) were more likely to be Black (compared with other minorities), male, high income, employed, and older. Having the colonoscopy because of symptoms was associated with being female, younger, and having lower income. We found significant differences for 1 previously underestimated barrier, having a spouse to accompany the patient to the procedure. Conclusions. Patients’ facilitators and barriers to colonoscopy differed by sociodemographics in our study, which implies that interventions based on a single facilitator will not be effective for all subgroups of a population.
Showing items related by title, author, creator and subject.
Good Practices in Health Financing : Lessons from Reforms in Low and Middle-Income CountriesWaters, Hugh R.; Schieber, George J.; Gottret, Pablo (Washington, DC : World Bank, 2012-05-25)This volume focuses on nine countries that have completed, or are well along in the process of carrying out, major health financing reforms. These countries have significantly expanded their people's health care coverage or maintained such coverage after prolonged political or economic shocks. In doing so, this report seeks to expand the evidence base on good performance in health financing reforms in low- and middle-income countries. The countries chosen for the study were Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam. With health at the center of global development policy on humanitarian as well as economic and health security grounds, the international community and developing countries are closely focused on scaling up health systems to meet the Millennium Development Goals (MDGs), improving financial protection, and ensuring long-term financing to sustain these gains. With the scaling up of aid, both donors and countries have come to realize that money alone cannot buy health gains or prevent impoverishment due to catastrophic medical bills. This realization has sent policy makers looking for reliable evidence about what works and what does not, but they have found little to guide their search.
Better Outcomes through Health Reforms in the Russian Federation : The Challenge in 2008 and BeyondMarquez, Patricio V. (World Bank, Washington, DC, 2008-02)The purpose of this discussion paper is
to discuss selected health challenges in the Russian
Federation, focusing on outcomes, expenditures and options
for policy and institutional reforms in the health care
system. The areas covered in the paper draw on recent
studies and reports, and take into account lessons derived
from the implementation of the World Bank-funded Health
Reform Implementation Project (HRIP) at the federal level
and in the Chuvash Republic and the Voronezh Oblast-the
pilot regions of the project, over the 2005-2007 period.
Who pays? Out-of-Pocket Health Spending and Equity Implications in the Middle East and North AfricaElgazzar, Heba; Arfa, Chokri; Salti, Nisreen; Majbouri, Mehdi; Salehi-Isfahani, Djavad; Raad, Firas; Chaaban, Jad; Fesharaki, Sanaz; Mataria, Awad (World Bank, Washington, DC, 2013-05-29)Ensuring affordable, effective health care and financial protection against the adverse effects of household out-of-pocket (OOP) health expenditures represents an important policy objective in most countries, yet relatively little evidence exists regarding patterns and implications of household health expenditures in the Middle East and North Africa (MENA) region. This paper examines the scope of out-of-pocket expenditures and their implications on living standards and policy reforms in six MENA countries including Yemen, the West Bank and Gaza, Egypt, Iran, Tunisia, and Lebanon. Results show that OOP payments represent a relatively high share of total national health care financing at 49 percent on average in the MENA region as of 2006. Households pay an average of 6 percent of their total household expenditure on health. Most of this OOP is spent on medications, doctor visits and diagnostic services. Lower-income and rural households generally face greater financial risk; yet this is reversed where private health services are utilized and paid for more frequently by higher-income groups. 7 to 13 percent of households face particularly high OOP payments, or catastrophic expenditures equal to at least 10 percent of household spending. Poverty rates tend to increase by up to 20 percent after health care spending is accounted for. Results are discussed in light of ongoing policy efforts to strengthen social protection for health care.