Health Care Service Access and Utilization

Health care sector grows tremendously in last few decades. The health care sector has generated huge amounts of data that has huge volume, enormous velocity and vast variety. Also it comes from a variety of new sources as hospitals are now tend to implemented electronic health record (EHR) systems. These sources have strained the existing capabilities of existing conventional relational database management systems. In such scenario, Big data solutions offer to harness these massive, heterogeneous and complex data sets to obtain more meaningful and knowledgeable information. This paper basically studies the impact of implementing the big data solutions on the healthcare sector, the potential opportunities, challenges and available platform and tools to implement Big data analytics in health care sector.

In today’s world, people move more, move further, and move for increasingly varied reasons such as work, studies or leisure. Seeking health care away from one’s home is a part of this trend and many patients do not hesitate to cross national borders to consult a physician or get a surgical intervention. This article examines this form of mobility towards Thailand from both global and regional perspectives. This situation involves long-distance patients travelling from highly industrialized countries and closeby neighbors, such as Laotians, who may just cross the border to get treated a few kilometers away from home. Constrasting these senarios complicates the findings by studies on “medical travel” as it brings in heterogeneity and variability. There are significant differences in patients’ motives, in the social implications of their cross-border health-seeking behaviours, and in the responses by health infrastructures and authorities in both the host country (marketing, regulation or even quality of care) and the patients’ lands of origin (policies, intermediaries, and emerging specialized agencies). This paper takes this situation as a case study to describe and explain the rise of a new transnational healthcare paradigm.

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.

Objectives The objective was to explore progress of
equity in the utilization of maternal health care services in
developing countries since maternal care is a crucial factor
in reducing maternal mortality, which is targeted by the
Millennium Development Goal 5.
Methods A systematic review of quantitative studies was
done. PubMed Central, Web of Science, and Science Direct
databases were searched for peer-reviewed and Englishlanguage
articles published between 2005 and 2015.
Results Thirty-six articles were included in the review.
The results reveal the lack of equity in the utilization of
maternal health care in developing countries. Thirty-three
out of 36 studies found evidence supporting severe
inequities while three studies found evidence of equity or at
least improvement in terms of equity.
Conclusions Most of the literature devoted to utilization
of maternal health care generally provides information on
the level of maternal care used and ignore the equity
problem. Research in this area should focus not only on the
level of maternal care used but also on the most disadvantaged
segments of the population in terms of utilization
of maternal care in order to reach the set targets.

Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism and health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems; the status of a medical traveller's ailment or therapy; and the existence of organised support for recognition and management of these in the home context.

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.

Restrictive U.S. immigration policies and enforcement have led to concerns among providers about how these changes affect service utilization among Latinx and immigrant communities. This study outlines perceptions from twenty service providers in health care, mental health, legal affairs, and immigrant advocacy in El Paso, Texas. Nearly all respondents stated that their work has been negatively affected by immigration enforcement policies under the current federal administration. Most reported changes in utilization among undocumented immigrants and families of mixed immigration status, as well as legal permanent and temporary residents, refugees or asylum seekers, and U.S. citizens. Negative effects were related to immigration-related fear and uncertainty in the community, a need for public education about policies and individu-als' rights, and changes in immigration policy enforcement. Further research about the impacts of immigration enforcement policies on service utilization is needed. To protect the well-being of immigrant communities, policy makers should be aware of the human rights implications of immigration enforcement policies with regard to service utilization. In a global environment of increasing nationalism and xenophobia, nations must carefully consider the implications of harsh anti-immigrant narratives and strict immigration enforcement on the well-being of minority and immigrant populations.

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).

The argument this research paper attempts to establish is that undocumented citizens have very little access to healthcare free from barriers that the United States government and healthcare facilities impose on them. The purpose of this thesis was to discover barriers that undocumented citizens encounter when accessing healthcare. Structured interviews were conducted with healthcare providers, administrators, and undocumented citizens in the Rio Grande Valley. Finances were determined by all interviewees to be the largest barrier to accessing healthcare. This issue requires further research and quantitative studies into a topic in healthcare that is scarcely studied and that needs immediate attention because of this group"s great impact on the country in order to understand the dilemma at hand. Policy makers, hospitals, governments, and the general public need to be challenged to advocate for the right to healthcare access for undocumented citizens living in the United States and the RGV. iii DEDICATION The completion of my Master"s degree and thesis would not have been possible without the love and support of my family and friends. My father, David Ruben Melo, my mother, Mireya Melo, my brother, David Melo, my sister, Melinda Melo, and my best friend, Jasmine Esmaeili, pushed and encouraged me to persevere in my endeavors and gave me the confidence to know and believe it could be accomplished. I dedicate this thesis to them especially as a tribute of my appreciation for their encouragement in my studies and life. I also dedicate this to the millions of undocumented citizens living in the Rio Grande Valley and the rest of the world. I hope that through this thesis and future research their plight will be known and that they may receive the basic human rights they deserve. iv ACKNOWLEDGEMENTS My gratitude will always be indebted to Dr. Margaret Graham, chair of my thesis committee, for all of her guidance and mentoring to make this thesis possible. Her encouraging words, patience, and input under tough time constraints helped me push on to the end. I am also indebted to my thesis committee members: Dr. Dejun Su and Dr. Margaret Dorsey. Their suggestions and critique helped to ensure the quality of this thesis to be the best possible.

‘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.

Post-Traumatic Stress Disorder (PTSD) is reported to affect 6.8% of the population of the United States, but often goes undiagnosed due to perceived stigma. Left untreated, PTSD has deleterious effects on quality of life, harming families, employers, and taxpayers with loss of life, loss of productivity, and elevated risk for criminality and addiction. Health care providers and employers play a vital role in reducing stigma, which derives, in part, from the nature of the trauma. Expanded routine screening, psychoeducation of stakeholders, and computer-mediated therapy may diminish stigma-related costs and improve access to care. The implications of stigma as a barrier to treatment should be considered in further research on the public health outcomes of PTSD.

The human right to the highest possible standard of mental and physical health applies to everyone, regardless of immigration status. This right imposes obligations on states to provide access to good quality healthcare, as well as other areas that affect health, including good housing. Refugees and asylum seekers are considered to be members of a population who are particularly vulnerable and in need of special protection. However, many of those who live in the UK, often find it difficult to exercise their right (EHRC, 2018a; EHRC, 2018b; EHRC, 2018c). This report explores the health experiences of refugees and asylum seekers in the Greater Nottingham area, whilst aiming to identify examples of best practice and areas for improvement.

Background
A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.

Methods
Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.

Findings
In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.

Interpretation
GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.

A Deliberation on Health Care Access, outlined herein, is a design for synthesizing the voice of regional stakeholders in health care. The outcome of this work addresses the question of what ought to be done to improve access to health care in the region. The first engagement of this deliberation is with Leadership South Coast and area leaders in the health care community of the region.

The project wiki is http://deliberateaccess.wikispaces.com/

‘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.

Under the Compacts of Free Association (COFA), people from
the Freely Associated States — the Republic of Palau (ROP), the
Republic of the Marshall Islands (RMI), and the Federated States
of Micronesia (FSM) — have been migrating to the United States
in increasing numbers. In 1996, Congress passed broad welfare
reform (Personal Responsibility and Work Opportunity Reconciliation
Act) which limited certain federal benefi ts previously available
to COFA migrants, including Medicaid benefi ts. Prior to July 2010,
the State of Hawai‘i had continued to include COFA migrants
under its state-funded Medicaid program. In the face of budget
constraints, the State removed these people from its Medicaid rolls.
A challenge on the legal basis of the denial of equal protection of
the laws, ie, the Fourteenth Amendment to the US Constitution,
was successful in reinstating health care to the COFA migrants in
December 2010. From the health worker’s perspective, regardless
of various social justice arguments that may have been marshaled
in favor of delivering health care to the people, it was an appeal to
the judicial system that succeeded. From the attorney’s perspective,
the legal victories are potentially limited to the four walls of the
courtroom without community involvement and related social justice
movements. Together, the authors propose that in order to better
address the issue of health care access for Micronesian peoples,
we must work together, as health and legal advocates, to defi ne a
more robust vision of both systems that includes reconciliation and
community engagement.

The Canadian government's recent cuts to healthcare coverage for refugee claimants has rekindled the debate in Canada about what medical services should be provided to individuals with precarious immigration status, and who should pay for these services. This article further explores this debate, focussing on the perceptions of healthcare workers in Montreal, a large multiethnic Canadian city. In April–June 2010, an online survey was conducted to assess how clinicians, administrators, and support staff in Montreal contend with the ethical and professional dilemmas raised by the issue of access to healthcare services for pregnant women and children who are partially or completely uninsured. Drawing on qualitative analysis of answers (n = 237) to three open-ended survey questions, we identify the discursive frameworks that our respondents mobilized when arguing for, or against, universal access to healthcare for uninsured patients. In doing so, we highlight how their positions relate to their self-evaluations of Canada's socioeconomic situation, as well as their ideological representations of, and sense of social connection to, precarious status immigrants. Interestingly, while abstract values lead some healthcare workers to perceive uninsured immigrants as “deserving” of universal access to healthcare, negative perceptions of these migrants, coupled with pragmatic considerations, pushed most workers to view the uninsured as “underserving” of free care. For a majority of our respondents, the right to healthcare of precarious status immigrants has become a “privilege”, that as taxpayers, they are increasingly less willing to contribute to. We conclude by arguing for a reconsideration of access to healthcare as a right, and offer recommendations to move in this direction.

Geographers play important roles in public health research, particularly in understanding healthcare accessibility, utilisation, and individual healthcare experiences. Most accessibility studies have benefited from the increased sophistication of geographic information systems (GIS). Some studies have been enhanced with semi-structured in-depth interviews to understand individual experiences of people as they access healthcare. However, few accessibility studies have explicitly utilised individual in-depth interview data in the construction of new GIS accessibility measures. Using mixed methods including GIS analysis and individual data from semi-structured in-depth interviews, we offer satisfaction-adjusted distance as a new way of conceptualising accessibility in GIS. Based on fieldwork in a predominantly lower-income community in Columbus, Ohio (USA), we find many residents felt neighbourhood healthcare facilities offered low-quality care, which suggested an added perceived distance as they attempt to access high-quality healthcare facilities. The
satisfaction-adjusted distance measure accounts for the perceived distance some residents feel as they search for high-quality healthcare in lower-income urban neighbourhoods. In moving beyond conventional GIS and re-conceptualising accessibility in this way, we offer a more realistic portrayal of the issues lower-income urban residents face as they attempt to access high-quality healthcare
facilities. The work has theoretical implications for conceptualising healthcare accessibility, advances the mixed-methodologies literature, and argues for a more equitable distribution of high-quality healthcare in urban neighbourhoods.

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

Grid computing has emerged from category of distributed and parallel computing where the heterogeneous resources from different network are used simultaneously to solve a particular problem that need huge amount of resources. Potential of Grid computing depends on my issues such as security of resources, heterogeneity of resources, fault tolerance & resource discovery and job scheduling. Scheduling is one of the core steps to efficiently exploit the capabilities of heterogeneous distributed computing resources and is an NP-complete problem. To achieve the promising potential of grid computing, an effective and efficient job scheduling algorithm is proposed, which will optimized two important criteria to improve the performance of resources i.e. makespan time & resource utilization. With this, we have classified various tasks scheduling heuristic in grid on the basis of their characteristics.

Asian Indians are one of the fastest growing immigrant groups in the USA and are at high risk for preventable chronic diseases, such as diabetes and cardiovascular disease. We describe the cultural practices of Asian Indians living in the USA to build a theory of health seeking behaviour for preventive healthcare services. We conducted in-depth qualitative, semi-structured interviews with 21 Asian Indians seen at two outpatient clinics in the San Francisco Bay Area. Using the Constructionist Grounded Theory, we show that How does culture influence preventive service utilisation? 233 participants typically use primary healthcare services for urgent health problems and had been unfamiliar with routine care for disease prevention when immigrating to the USA. Participants deviated from this pattern during culturally significant life course events, such as marriage or childbirth and in response to the concerns of family members, local social network members, and primary care service providers during medical visits for urgent illnesses.

Providing timely and appropriate primary health care after-hours is a major policy issue confronting many Western governments. Increasingly, consumers are seeking care from emergency departments, for health problems that would be better serviced by a primary care professional. Mindful of this issue both State and Federal government in Australia have established and funded General Practice Super Clinics to provide after-hours care in low socioeconomic areas for vulnerable populations. A key policy requirement of funding is the provision of after-hours care. This paper takes a case study of parents seeking after-hours, non-emergency care for their sick child. This study illustrates the way in which GP Super Clinics provide an appropriate response to this issue, but the analysis questions whether or not this can be achieved under the current arrangements.

Better health depends on the level of access to the health care facilities. Since good health is part and parcel for better human resources, there should be proper access to the health care system. The indigenous peoples of any country are usually deprived of their due share. They remain at a vulnerable stage and this is equally true for indigenous peoples of Chittagong Hill Tracts. They have less access to all types of services due to different circumstances. But it is the right of any citizen of the country to have equal access to all facilities and opportunities provided by the state. In order to explore the accessibility of different indigenous peoples to the health care facilities, the study is conducted on the basis of secondary data which were collected from different sources, reports, journals, and published literature. Though the study explored some Government and NGOs initiatives on health, the access of indigenous peoples to this facility is not at the satisfactory level.

Economic improvement in Palu City has an impact on changes in the structure and general view of transportation facilities, by technological advances, as well as engineering in the field of transportation, so that the public's need for transportation can provide maximum service. This study aims to analyze the degree of saturation and identify the use of land use, as well as to analyze the influence of land use development along the National Road Corridor Jalan Jenderal Sudirman – Pelabuhan Pantoloan? The results of the study show that the development of land use will cause attraction and generation from an area, increasing accessibility and intensity of traffic flow using this road corridor with the largest degree of saturation in Segment 3 - Jl. Yos Sudarso is 0.65 and Segment 5 - Kebonsari – Tawaeli is 0.63. It is found that the generation of movement, residential areas, gives a figure of 1737 smp/hour. As for the pull of movement, it is strongly influenced by the trade and service area with 2041 smp/hour. In the Office Area for attraction of movement of 838 junior high school/hour, Education Area of 22 junior high school/hour and Health Area of 26 junior high school/hour. Almost all of these interactions are carried out with trips that will result in traffic flow, thus causing a problem with increasing traffic volume along the road which causes the performance of the road segment to decrease.

A territory-wide two-stage stratified random sample of 2,282 community-dwelling Hong Kong adults were surveyed between 2014 and 2015 to investigate the association between poverty and regular source of primary care utilization. Poverty was operationalized by income-poverty and deprivation. About 94% of our sample reported having regular source of primary care (Western and/or Chinese medical practitioner) and about 69% among them were in private sector. Multivariable logistic regression showed that people who were income-poor and deprived were less likely to have regular source of primary care (income-poor: OR = 0.523, p = .027; deprived: OR = 0.488, p = .007) and visit private primary care doctors (income-poor: OR = 0.445, deprived: OR = 0.222, both p < .0001). Those who had chronic diseases were more likely to have regular source of primary care (multimorbid: OR = 10.709, p < .0001), but less likely to access care in the private sector (one chronic disease: OR = 0.690, p = .019; multimorbid: OR = 0.374, p < .0001) than those without. Further, being older and less skilled were significantly associated with less likelihood of visiting a private doctor. Path analysis showed that the number of chronic diseases had significant indirect effect on having regular source of primary care with being income-poor and deprived as the mediators (β = −.0183, p = .0016). Therefore, despite a public health-care system that aims to deny no one from adequate health care for lack

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]). 
Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.
Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 visits were reviewed. The PMHNP was more likely to care for younger patients while the MD cared for more older patients (p<.001). The PMHNPs cared for a more diverse gender spectrum than the MD (p = .031). The MD was more likely to care for Caucasian patients; whereas, the PHMNPs cared for a more diverse racial or ethnic population (p <.001). The MD was more likely to care for the self-pay patient than the PMHNP who cared for those with a larger range of payor types (p< .001). The rate of emergency department (ED) visits and hospitalizations between providers was essentially the same (p=0.40) and (p=0.31) respectively.
Implications: No determination could be made in the key outcome measures of ED visits or hospitalizations between the PMHNPs and MD due to lack of documentation in the record. However, 450 more patients per month were treated for mental healthcare needs when PMHNPs were utilized.

In this paper the authors present a research committed by a local authority to explore the relationship between not self-sufficient elders, their family members and the community based assistance services they uses. The exploratory data analysis, conducted with the Emotional Text Analysis (ETA) (Carli, Paniccia, 2002), was used to identify emotional and cultural factors related to the experience of assisting and being assisted at home and within the community based services. The ETA has been realized on an assembled text corpus produced transcribing 45 audio recorded interviews to not self-sufficient elders and their family members, patients of general practitioners and/or users of the community based services (home-based and half-residential). The
interviews has been processed with T-Lab statistic software (Lancia, 2004) and ETA has been applied to produce a clusters analysis. Four clusters of dense words related to each others on 3 factorial axes emerged. From the factorial axes emerges a emotional representation of elderlness as a continuos allert related to the risk of dyng
and as a depressive prescription to survive related to the pretension to be assisted within their own family in virtue of “blood ties”. The reciprocal control and contentiousness, and the desirers to transgress the obligation of care giving and being cared are some relevant emotions emerging by the ETA. The research's results shows also a demand of a new assistance model emerges, founded on the possibility to talk, to play and to have fun with others. Finally it emerges a demand of services not only dealing with medical problems but also providing psychological support and training to the families to develop relational competences and to build reliable relationship out of the family. In the conclusions of the paper some considerations regarding the relationships between the clusters on the factorial axes and between clusters and illustrative variables are highlithed.

Ongoing national debates about the right to affordable health care and proposals to either contract or expand health access to those without citizenship status in localities will have profound impacts to those most vulnerable – unaccompanied migrant youth (UMY). UMYs are constituted by two subgroups: Unaccompanied Alien Children (UACs) and newcomers. UAC is a juridical-legal category used to identify those who are apprehended by immigration enforcement agents. Newcomers include youth who evaded apprehension (new arrivals). Their growing demographic presence – 200,00-500,000 UACs came in the past two decades – make UMYs a major part of the US child population. Using the case of California’s 2016 Medi-Cal – the state’s Medicaid program – health coverage expansion for undocumented immigrants in California, this article will discuss how this policy may reduce fiscal costs, help diminish the human vulnerabilities of UMYs and their families, and improve overall public health. This article is divided into four sections. The first explores the structural reasons that fuel the migration of UMYs. The second section introduces the concept of structural vulnerability to comprehend how various structures interact to create distress among UMYs. The third section features a discussion of the near universal health coverage in California, where since 2016, includes unauthorized immigrants. The fourth section identifies the policy relevance of broadening affordable health care to the unauthorized, the potential impact of possible reforms that aim to scale back health coverage, and areas for future research.

When it comes to health care in Mexico, “universal” has never meant equal, particularly when it came to the access to adequate care for the country’s 52 million uninsured. Civil society organization Fundar — a research organization with a background in budgetary analysis — developed a successful advocacy strategy on health policy to change this.

The full version and short summary of this case study are available in English.

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.

Space and time are the basic notions which provide basis for all modes of thoughts and beliefs. Spatial dimension of health care encompasses this relationship while addressing the questions of what, where, why, and why there? These concerns became significant especially when the scarcity of resources present a critical situation and access of these resources poses a challenge. In developmental domain, cities have always become challenge with their nature of expansion with shift in demand of different services as well as spatial difference in their demands.
This paper focuses on spatial expansion of the National Capital Territory of Delhi over recent times and evolution of health care services in the region. Paper further analyzes spatial coverage of health care institutions and their access by the different socioeconomic groups. Geographical information system (GIS) and remote sensing tools and techniques have been used to analyze the phenomenon.

Background: Health systems are faced with different needs, conditions and expectations concerning health and healthcare delivery. The most vulnerable groups risk receiving poorer care due to barriers and inequities in health service provision and utilisation. However health care organisations are often not sufficiently equipped to effectively recognise and respond to the diverse needs of the population served. To this end, the Task Force Migration, Equity and Diversity (TF MED) developed a set of standards that allow health care organisations to evaluate equity in service provision and implement improvements. A test was conducted in 52 pilot organisations from sixteen countries to assess compliance with the standards, as well as to explore challenges and opportunities for the effective uptake of equity measures.

Las redes de atención en salud constituyen un conjunto de servicios
asistenciales organizados por niveles de complejidad tecnológica, que
configuran unidades locales con determinada población bajo cobertura

en un espacio geográfico específico. En este artículo se presenta el pro-
yecto general de trabajo y algunos de sus resultados preliminares, en el

cual se analiza el modelo de gestión en Red indagando en la estructura
sanitaria de referencia-contrarreferencia de pacientes pediátricos entre

los efectores de salud públicos de la Red del Sudeste Bonaerense (sub-
área de la Región Sanitaria VI de la Prov. de Buenos Aires). El abordaje

de esta problemática articula tres líneas interdisciplinarias: a) el análisis
de los sistemas y servicios de salud en red; b) el análisis espacial entre
los centros de salud y la población en el territorio de referencia; c) el análisis de redes sociales que identifica estructuras y dinámicas de flujo
de pacientes entre los centros. La muestra bajo análisis se compone de
1793 casos de atención pediátrica durante un semestre de 2018 en los
municipios de Quilmes, Alte. Brown, F. Varela y Berazategui...

Rationing health care by ordeals is likely to have different effects on women and men, and on distinct groups of women. I show how such putative effects of ordeals are relevant to achieving gender justice. I explain why some ordeals may disproportionately set back women’s interest in discretionary time, health and access to health care, and may undermine equality of opportunity for positions of advantage. Some ordeals protect the interests of the worse-off women yet set back the interests of better-off women in equal opportunities. I suggest how we can use ordeal design to advance particular aims of gender justice.