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Brindley C, Lomas J, Siciliani L. The effect of hospital spending on waiting times. HEALTH ECONOMICS 2023; 32:2427-2445. [PMID: 37424194 DOI: 10.1002/hec.4735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/03/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
Long waiting times have been a persistent policy issue in the United Kingdom that the COVID-19 pandemic has exacerbated. This study analyses the causal effect of hospital spending on waiting times in England using a first-differences panel approach and an instrumental variable strategy to deal with residual concerns for endogeneity. We use data from 2014 to 2019 on waiting times from general practitioner referral to treatment (RTT) measured at the level of local purchasers (known as Clinical Commissioning Groups). We find that increases in hospital spending by local purchasers of 1% reduce median RTT waiting time for patients whose pathway ends with a hospital admission (admitted pathway) by 0.6 days but the effect is not statistically significant at 5% level (only at the 10% level). We also find that higher hospital spending does not affect the RTT waiting time for patients whose pathway ends with a specialist consultation (non-admitted pathway). Nor does higher spending have a statistically significant effect on the volume of elective activity for either pathway. Our findings suggest that higher spending is no guarantee of higher volumes and lower waiting times, and that additional mechanisms need to be put in place to ensure that increased spending benefits elective patients.
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - James Lomas
- Centre for Health Economics, University of York, York, UK
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK
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Bosque-Mercader L, Carrilero N, García-Altés A, López-Casasnovas G, Siciliani L. Socioeconomic inequalities in waiting times for planned and cancer surgery: Evidence from Spain. HEALTH ECONOMICS 2023; 32:1181-1201. [PMID: 36772982 DOI: 10.1002/hec.4661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/20/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Waiting times act as a non-price rationing mechanism to bring together the demand for and the supply of public healthcare services and ensure equal access independently of ability to pay. This study tests for the presence of socioeconomic inequalities in waiting times for ten publicly-funded planned and cancer surgeries in Catalonia (Spain) in 2015-2019. Socioeconomic status (SES), measured by four categories (very low, low, middle, high), is based on co-payment levels for medicines which depend on patient's income. Using administrative data, we estimate the association between SES and waiting times controlling for patient characteristics and hospital fixed effects. Compared to patients with low SES, patients with middle SES wait 2-6 fewer days for hip replacement, cataract surgery, and hysterectomy, and less than a day for breast cancer surgery. These inequalities arise within hospitals and are not explained by patient nor hospital characteristics. For some surgeries, the results also show that patients with higher SES are more likely to voluntarily exit the waiting list and have a lower probability of having a surgery canceled for medical reasons and dying while waiting.
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Affiliation(s)
- Laia Bosque-Mercader
- Nuffield Department of Primary Care Health Sciences, Centre for Health Service Economics and Organisation, University of Oxford, Oxford, UK
- Department of Economics and Related Studies, University of York, York, UK
| | - Neus Carrilero
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | | | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK
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McIntyre D, Marschner S, Thiagalingam A, Pryce D, Chow CK. Impact of Socio-demographic Characteristics on Time in Outpatient Cardiology Clinics: A Retrospective Analysis. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231159491. [PMID: 36922913 PMCID: PMC10021097 DOI: 10.1177/00469580231159491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Inequitable access to health services influences health outcomes. Some studies have found patients of lower socio-economic status (SES) wait longer for surgery, but little data exist on access to outpatient services. This study analyzed patient-level data from outpatient public cardiology clinics and assessed whether low SES patients spend longer accessing ambulatory services. Retrospective analysis of cardiology clinic encounters across 3 public hospitals between 2014 and 2019 was undertaken. Data were linked to age, gender, Indigenous status, country of birth, language spoken at home, number of comorbidities, and postcode. A cox proportional hazards model was applied adjusting for visit type (new/follow up), clinic, and referral source. Higher hazard ratio (HR) indicates shorter clinic time. Overall, 22 367 patients were included (mean [SD] age 61.4 [15.2], 14 925 (66.7%) male). Only 7823 (35.0%) were born in Australia and 8452 (37.8%) were in the lowest SES quintile. Median total clinic time was 84 min (IQR 58-130). Visit type, clinic, and referral source were associated with clinic time (R2 = 0.23, 0.35, 0.20). After adjusting for these variables, older patients spent longer in clinic (HR 0.94 [0.90-0.97]), though there was no difference according to SES (HR 1.02 [0.99-1.06]) or other variables of interest. Time spent attending an outpatient clinic is substantial, amplifying an already significant time burden faced by patients with chronic health conditions. SES was not associated with longer clinic time in our analysis. Time spent in clinics could be used more productively to optimize care, improve health outcomes and patient experience.
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Affiliation(s)
- Daniel McIntyre
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia.,Westmead Hospital, Sydney, Australia
| | | | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia.,Westmead Hospital, Sydney, Australia
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García-Corchero JD, Jiménez-Rubio D. Waiting times in healthcare: equal treatment for equal need? Int J Equity Health 2022; 21:184. [PMID: 36539735 PMCID: PMC9763792 DOI: 10.1186/s12939-022-01799-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In many universal health systems, waiting times act as a non-monetary rationing mechanism, one that should be based on clinical need rather than the ability to pay. However, there is growing evidence that among patients with similar levels of need, waiting times often differ according to socioeconomic status. The mechanisms underlying inequality in access remain unclear. METHODS Using data for Spain, we study whether waiting times for primary and specialist care depend on patients' socioeconomic status (SES). Additionally, we make use of the continuous nature of our data to explore whether the SES-related differences in waiting times found for specialist consultations vary among different points of the waiting time distribution. RESULTS Our results reveal the presence of a SES gradient in waiting times for specialist services explained on the basis of education, employment status and income. In addition, for primary care, we found evidence of a slightly more moderate SES gradient mostly based on employment status. Furthermore, although quantile regression estimates indicated the presence of a SES gradient within the distribution of waiting times for specialist visits, the SES differences attenuated in the context of longer waiting times in the public sector but did not disappear. CONCLUSION Our findings suggest the principle of equal treatment for equal need, assumed to be inherent to national health systems such as the Spanish system, is not applied in practice. Determining the mechanism(s) underlying this selective barrier to healthcare is of crucial importance for policymakers, especially in the current COVID-19 health and economic crises, which could exacerbate these inequalities as increasing numbers of treatments are having to be postponed.
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Affiliation(s)
| | - Dolores Jiménez-Rubio
- grid.4489.10000000121678994Department of Applied Economics, University of Granada, Granada, Spain
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Pandolfini C, Clavenna A, Cartabia M, Campi R, Bonati M. National, longitudinal NASCITA birth cohort study to investigate the health of Italian children and potential influencing factors. BMJ Open 2022; 12:e063394. [PMID: 36379649 PMCID: PMC9668025 DOI: 10.1136/bmjopen-2022-063394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The NASCITA Study, a national-level, population-based, prospective cohort study, was set up to better understand the early health status of Italian children, comprising their physical, cognitive and psychological development, and how it is affected by social and health determinants, including nurturing care. NASCITA will also assess geographical differences and disparities in healthcare. PARTICIPANTS Participating family paediatricians from throughout Italy enrolled infants born during the enrolment period (April 2019-July 2020). The 5054 newborns seen by the 139 paediatricians for at least two visits, including the first well-child visit, and for whom parental consent was given, make up the baseline population. FINDINGS TO DATE Mothers had a mean age at delivery of 33.0 years and tended to have a high or medium level of education (42.5% university and 41.7% high school degrees) and to be employed (69.7%). One-third (36.1%) took folic acid supplementation appropriately, and 6.5% smoked or consumed alcohol (10.0%) during pregnancy. One-third (31.7%) of deliveries were caesarean deliveries. Concerning the newborns, 5.8% had a low birth weight and 6.2% were born prematurely. The majority (87.7%) slept in the supine position, and 63.6% were exclusively breast fed at 1 month, with a decreasing north to south prevalence (χ2 t 52; p<0.001). Significant north-south differences were found in all areas, including parental education, behaviours in pregnancy and hospital practices. When compared with national level data, the cohort population's distribution, maternal sociodemographic characteristics and newborn physical characteristics reflect those of the Italian population. FUTURE PLANS Data will continue to be collected during the well-child visits until the children are 6 years old, and multiple health outcomes will be studied, spanning child development and illness, as well as potentially related factors including caregiving routines. The findings will be used to develop specific interventions to improve children's health. TRIAL REGISTRATION NUMBER NCT03894566.
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Affiliation(s)
- Chiara Pandolfini
- Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Antonio Clavenna
- Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Massimo Cartabia
- Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Rita Campi
- Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Maurizio Bonati
- Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Di Filippo A, Perna S, Pierantozzi A, Milozzi F, Fortinguerra F, Caranci N, Moro L, Agabiti N, Belleudi V, Cesaroni G, Nardi A, Spadea T, Gnavi R, Trotta F. Socio-economic inequalities in the use of drugs for the treatment of chronic diseases in Italy. Int J Equity Health 2022; 21:157. [DOI: 10.1186/s12939-022-01772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Since the use of medicines is strongly correlated to population health needs, higher drug consumption is expected in socio-economical deprived areas. However, no systematic study investigated the relationship between medications use in the treatment of chronic diseases and the socioeconomic position of patients. The purpose of the study is to provide a description, both at national level and with geographical detail, of the use of medicines, in terms of consumption, adherence and persistence, for the treatment of major chronic diseases in groups of population with different level of socioeconomic position.
Methods
A cross-sectional study design was used to define the “prevalent” users during 2018. A longitudinal cohort study design was performed for each chronic disease in new drug users, in 2018 and the following year. A retrospective population-based study, considering all adult Italian residents (i.e. around 50.7 million people aged ≥ 18 years). Different medications were used as a proxy for underlying chronic diseases: hypertension, dyslipidemia, osteoporosis, diabetes and chronic obstructive pulmonary disease. Only “chronic” patients who had at least 2 prescriptions within the same subgroup of drugs or specific medications during the year were selected for the analysis. A multidimensional measures of socio-economic position, declined in a national deprivation index at the municipality level, was used to identify and estimate the relationship with drug use indicators. The medicine consumption rate for each pharmacological category was estimated for prevalent users while adherence and persistence to pharmacologic therapy at 12 months were evaluated for new users.
Results
The results highlighted how the socioeconomic deprivation is strongly correlated with the use of medicines: after adjustment by deprivation index, the drug consumption rates decreased, mainly in the most disadvantaged areas, where consumption levels are on average higher than in other areas. On the other hand, the adherence and persistence indicators did not show the same trend.
Conclusions
This study showed that drug consumption is influenced by the level of deprivation consistently with the distribution of diseases. For this reason, the main levers on which it is necessary to act to reduce disparities in health status are mainly related to prevention. Moreover, it is worth pointing out that the use of a municipal deprivation indicator necessarily generates an ecological bias, however, the experience of the present study, which for the first-time deals with the complex and delicate issue of equity in Italian pharmaceutical assistance, sets the stage for new insights that could overcome the limits.
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Kulkarni K, Shah R, Mangwani J, Dias J. The impact of deprivation on patients awaiting planned care. Bone Jt Open 2022; 3:777-785. [PMID: 36210732 PMCID: PMC9626867 DOI: 10.1302/2633-1462.310.bjo-2022-0037.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims Deprivation underpins many societal and health inequalities. COVID-19 has exacerbated these disparities, with access to planned care falling greatest in the most deprived areas of the UK during 2020. This study aimed to identify the impact of deprivation on patients on growing waiting lists for planned care. Methods Questionnaires were sent to orthopaedic waiting list patients at the start of the UK’s first COVID-19 lockdown to capture key quantitative and qualitative aspects of patients’ health. A total of 888 respondents were divided into quintiles, with sampling stratified based on the Index of Multiple Deprivation (IMD); level 1 represented the ‘most deprived’ cohort and level 5 the ‘least deprived’. Results The least deprived cohort were older (mean 65.95 years (SD 13.33)) than the most deprived (mean 59.48 years (SD 13.85)). Mean symptom duration was lower in the least deprived areas (68.59 months (SD 112.26)) compared to the most deprived (85.85 months (SD 122.50)). Mean pain visual analogue scores (VAS) were poorer in the most compared to the least deprived cohort (7.11 (SD 2.01) vs 5.99 (SD 2.57)), with mean mood scores also poorer (6.06 (SD 2.65) vs 4.71 (SD 2.78)). The most deprived areas exhibited lower mean quality of life (QoL) scores than the least (0.37 (SD 0.30) vs 0.53 (SD 0.31)). QoL findings correlated with health VAS and Generalized Anxiety Disorder 2-item (GAD2) scores, with the most deprived areas experiencing poorer health (health VAS 50.82 (SD 26.42) vs 57.29 (SD 24.19); GAD2: 2.94 (SD 2.35) vs 1.88 (SD 2.07)). Least-deprived patients had the highest self-reported activity levels and lowest sedentary cohort, with the converse true for patients from the most deprived areas. Conclusion The most deprived patients experience poorer physical and mental health, with this most adversely impacted by lengthy waiting list delays. Interventions to address inequalities should focus on prioritizing the most deprived. Cite this article: Bone Jt Open 2022;3(10):777–785.
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Affiliation(s)
- Kunal Kulkarni
- Pulvertaft Hand Centre, University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | - Rohi Shah
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Jitendra Mangwani
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Joseph Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
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Turner AJ, Francetic I, Watkinson R, Gillibrand S, Sutton M. Socioeconomic inequality in access to timely and appropriate care in emergency departments. JOURNAL OF HEALTH ECONOMICS 2022; 85:102668. [PMID: 35964420 DOI: 10.1016/j.jhealeco.2022.102668] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
In publicly-funded healthcare systems, waiting times for care should be based on need rather than ability to pay. Studies have shown that individuals with lower socioeconomic status face longer waits for planned inpatient care, but there is little evidence on inequalities in waiting times for emergency care. We study waiting times in emergency departments (EDs) following arrival by ambulance, where health consequences of extended waits may be severe. Using data from all major EDs in England during the 2016/17 financial year, we find patients from more deprived areas face longer waits during some parts of the ED care pathway. Inequalities in waits are small, but more deprived individuals also receive less complex ED care, are less likely to be admitted for inpatient care, and are more likely to re-attend ED or die shortly after attendance. Patient-physician interactions and unconscious bias towards more deprived patients may be important sources of inequalities.
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Affiliation(s)
- Alex J Turner
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, United Kingdom, M13 9PL; PHMR Ltd, London, NW1 8XY, England.
| | - Igor Francetic
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, United Kingdom, M13 9PL
| | - Ruth Watkinson
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, United Kingdom, M13 9PL
| | - Stephanie Gillibrand
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, United Kingdom, M13 9PL
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, United Kingdom, M13 9PL
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Binyaruka P, Borghi J. An equity analysis on the household costs of accessing and utilising maternal and child health care services in Tanzania. HEALTH ECONOMICS REVIEW 2022; 12:36. [PMID: 35802268 PMCID: PMC9264712 DOI: 10.1186/s13561-022-00387-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/30/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Direct and time costs of accessing and using health care may limit health care access, affect welfare loss, and lead to catastrophic spending especially among poorest households. To date, limited attention has been given to time and transport costs and how these costs are distributed across patients, facility and service types especially in poor settings. We aimed to fill this knowledge gap. METHODS We used data from 1407 patients in 150 facilities in Tanzania. Data were collected in January 2012 through patient exit-interviews. All costs were disaggregated across patients, facility and service types. Data were analysed descriptively by using means, medians and equity measures like equity gap, ratio and concentration index. RESULTS 71% of patients, especially the poorest and rural patients, accessed care on foot. The average travel time and cost were 30 minutes and 0.41USD respectively. The average waiting time and consultation time were 47 min and 13 min respectively. The average medical cost was 0.23 USD but only18% of patients paid for health care. The poorest and rural patients faced substantial time burden to access health care (travel and waiting) but incurred less transport and medical costs compared to their counterparts. The consultation time was similar across patients. Patients spent more time travelling to public facilities and dispensaries while incurring less transport cost than accessing other facility types, but waiting and consultation time was similar across facility types. Patients paid less amount in public than in private facilities. Postnatal care and vaccination clients spent less waiting and consultation time and paid less medical cost than antenatal care clients. CONCLUSIONS Our findings reinforce the need for a greater investment in primary health care to reduce access barriers and cost burdens especially among the worse-offs. Facility's construction and renovation and increased supply of healthcare workers and medical commodities are potential initiatives to consider. Other initiatives may need a multi-sectoral collaboration.
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Affiliation(s)
- Peter Binyaruka
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Cima J, Almeida Á. The impact of cancellations in waiting times analysis: evidence from scheduled surgeries in the Portuguese NHS. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:95-104. [PMID: 34304324 PMCID: PMC8310557 DOI: 10.1007/s10198-021-01354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Equity in access to scheduled surgery has been a topic of attention of researchers and decision-makers on healthcare. Most studies analyse the number of days that patients wait before undergoing surgery, and ignore patients that have been on the waiting list but have not benefited from surgery. This study contributes to the existing literature on waiting lists by analysing cancellations along with surgery episodes. METHODS We use a database comprising all patients that entered the waiting list for scheduled surgeries in the Portuguese National Health Service from 2011 to 2015 (around 3 million observations) and estimate survival models to explain waiting times, where cancellations are introduced as censored data. RESULTS The cancellation rate is significant (around 14%), and has a considerable impact on results: ignoring cancellations biases estimates, in particular for gender differences (that are overestimated without cancelations), and for the age effect (that is underestimated). CONCLUSION Thus, our approach provides a more accurate understanding of the impact that several factors have on overall access to scheduled surgery.
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Affiliation(s)
- Joana Cima
- Faculdade de Economia, Universidade Do Porto, 4200-464 Porto, Portugal
| | - Álvaro Almeida
- CEF.UP and Faculdade de Economia, Universidade Do Porto, Porto, Portugal
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Zanetti M, Clavenna A, Pandolfini C, Pansieri C, Calati MG, Cartabia M, Miglio D, Bonati M. Informatics Methodology Used in the Web-Based Portal of the NASCITA Cohort Study: Development and Implementation Study. J Med Internet Res 2021; 23:e23087. [PMID: 33709930 PMCID: PMC7998320 DOI: 10.2196/23087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/12/2020] [Accepted: 01/18/2021] [Indexed: 01/12/2023] Open
Abstract
Background Many diseases occurring in adults can be pinned down to early childhood and birth cohorts are the optimal means to study this connection. Birth cohorts have contributed to the understanding of many diseases and their risk factors. Objective To improve the knowledge of the health status of Italian children early on and how it is affected by social and health determinants, we set up a longitudinal, prospective, national-level, population-based birth cohort, the NASCITA study (NAscere e creSCere in ITAlia). The main aim of this cohort is to evaluate physical, cognitive, and psychological development; health status; and health resource use in the first 6 years of life in newborns, and potential associated factors. A web-based system was set up with the aim to host the cohort; provide ongoing information to pediatricians and to families; and facilitate accurate data input, monitoring, and analysis. This article describes the informatics methodology used to set up and maintain the NASCITA cohort with its web-based platform, and provides a general description of the data on children aged over 7 months. Methods Family pediatricians were contacted for participation in the cohort and enrolled newborns from April 2019 to July 2020 at their first well-child visit. Information collected included basic data that are part of those routinely collected by the family pediatricians, but also parental data, such as medical history, characteristics and lifestyle, and indoor and outdoor environment. A specific web portal for the NASCITA cohort study was developed and an electronic case report form for data input was created and tested. Interactive data charts, including growth curves, are being made available to pediatricians with their patients’ data. Newsletters covering the current biomedical literature on child cohorts are periodically being put up for pediatricians, and, for parents, evidence-based information on common illnesses and problems in children. Results The entire cohort population consists of 5166 children, with 139 participating pediatricians, distributed throughout Italy. The number of children enrolled per pediatrician ranged from 1 to 100. The 5166 enrolled children represent 66.55% (5166/7763) of the children born in all of 2018 covered by the same pediatricians participating in the cohort. The number of children aged over 7 months at the time of these analyses, and for whom the most complete data were available upon initial analyses, was 4386 (2226/4381 males [50.81%] and 142/4370 twins [3.25%]). The age of the mothers at birth of the 4386 children ranged from 16 to 54 years. Most newborns’ mothers (3758/4367, 86.05%) were born in Italy, followed by mothers born in Romania (101/4367, 2.31%), Albania (75/4367, 1.72%), and Morocco (60/4367, 1.37%). Concerning the newborns, 138/4386 (3.15%) were born with malformations and 352/4386 (8.03%) had a disease, most commonly neonatal respiratory distress syndrome (n=52), neonatal jaundice (n=46), and neonatal hypoglycemia (n=45). Conclusions The NASCITA cohort is well underway and the population size will permit significant conclusions to be drawn. The key role of pediatricians in obtaining clinical data directly, along with the national-level representativity, will make the findings even more solid. In addition to promoting accurate data input, the multiple functions of the web portal, with its interactive platform, help maintain a solid relationship with the pediatricians and keep parents informed and interested in participating. Trial Registration ClinicalTrials.gov NCT03894566; https://clinicaltrials.gov/ct2/show/NCT03894566
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Affiliation(s)
- Michele Zanetti
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Pandolfini
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Claudia Pansieri
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria Grazia Calati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Massimo Cartabia
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Daniela Miglio
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Self-Reported Waiting Times for Outpatient Health Care Services in Hungary: Results of a Cross-Sectional Survey on a National Representative Sample. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052213. [PMID: 33668115 PMCID: PMC7956329 DOI: 10.3390/ijerph18052213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: System-level data on waiting time in the outpatient setting in Hungary is scarce. The objective of the study was to explore self-reported waiting time for an appointment and at a doctor’s office. (2) Methods: An online, cross-sectional, self-administered survey was carried out in 2019 in Hungary among a representative sample (n = 1000) of the general adult population. Chi-squared test and logistic regression analysis were carried out to explore if socioeconomic characteristics, health status, or residence were associated with waiting times and the perception of waiting time as a problem. (3) Results: Proportions of 90%, 41%, and 64% of respondents were seen within a week by family doctor, public specialist, and private specialist, respectively. One-third of respondents waited more than a month to get an appointment with a public specialist. Respondents in better health status reported shorter waiting times; those respondents were less likely to perceive a problem with: (1) waiting time to get an appointment (OR = 0.400) and (2) waiting time at a doctor’s office (OR = 0.519). (4) Conclusions: Longest waiting times were reported for public specialist visits, but waiting times were favorable for family doctors and private specialists. Further investigation is needed to better understand potential inequities affecting people in worse health status.
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Cima J, Guimarães P, Almeida Á. Explaining the Gender Gap in Waiting Times for Scheduled Surgery in the Portuguese National Health Service. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000514798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objective:</i></b> This paper evaluates the gender gap in waiting times for scheduled surgery, using information on 2.6 million surgical episodes in Portuguese National Health Service hospitals covering the period from 2011 to 2015. <b><i>Methodology:</i></b> We estimated the gross gender gap, i.e., the differential between the waiting times of men and women, and then add several explanatory variables that can account for this difference to estimate an adjusted gender gap. The variables are added in a way that permits the most flexible parametric specification. Next, we used Gelbach’s decomposition to understand the contribution of each variable to the difference between the gross and the adjusted gender gaps. <b><i>Results:</i></b> The gross gender gap of 10% is reduced to a 3% adjusted gender gap after accounting for observable explanatory factors. Gelbach’s decomposition shows that patient priority and hospital-fixed effects are the variables that contribute the most to the explained component of the gap. The analysis suggests that men tend to be ranked with more severe priorities, and that there are hospital specificities that cause men to have shorter waiting times. <b><i>Conclusions:</i></b> Overall, we identified a gender bias against women in surgery waiting times, but the size of the bias is smaller than was previously suggested in the literature.
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Sabry N, ElHadidi S, Kamel A, Abbassi M, Farid S. Awareness of the Egyptian public about COVID-19: what we do and do not know. Inform Health Soc Care 2021; 46:244-255. [PMID: 33622157 DOI: 10.1080/17538157.2021.1883029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To survey the health-seeking behaviors and perspectives of the Egyptian population toward the COVID-19 pandemic. A descriptive survey was designed and disseminated via social media platforms. The survey consisted of 32 questions addressing respondent's demographics, knowledge, practice, and attitude toward the COVID-19 pandemic. A total of 25,994 Egyptians participated in the survey from the 29 Egyptian governorates. More than 99% of the respondents were aware of the COVID-19 pandemic. Responses showed split opinions regarding whether people should wear gloves or masks to prevent COVID-19 infection (47.7% and 49.5% replied with "False", respectively). Almost one-quarter (23.1%) of the respondents went to crowded places during the last 14 days. Calling the emergency hotline and self-isolation at home were the most frequent practices to deal with COVID-19 symptoms (34.1% and 44.5%, respectively). A total of 85% of respondents reported their confidence in the Egyptian healthcare system to win the battle against COVID-19 despite the challenges. A vast majority of this large population sample reported reasonable knowledge levels and potentially appropriate practices toward COVID-19.
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Affiliation(s)
| | - Seif ElHadidi
- Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, New Cairo, Egypt
| | - Ahmed Kamel
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | | | - Samar Farid
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Mathiarasan S, Hüls A. Impact of Environmental Injustice on Children's Health-Interaction between Air Pollution and Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020795. [PMID: 33477762 PMCID: PMC7832299 DOI: 10.3390/ijerph18020795] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 02/07/2023]
Abstract
Air pollution disproportionately affects marginalized populations of lower socioeconomic status. There is little literature on how socioeconomic status affects the risk of exposure to air pollution and associated health outcomes, particularly for children’s health. The objective of this article was to review the existing literature on air pollution and children’s health and discern how socioeconomic status affects this association. The concept of environmental injustice recognizes how underserved communities often suffer from higher air pollution concentrations in addition to other underlying risk factors for impaired health. This exposure then exerts larger effects on their health than it does in the average population, affecting the whole body, including the lungs and the brain. Children, whose organs and mind are still developing and who do not have the means of protecting themselves or creating change, are the most vulnerable to the detrimental effects of air pollution and environmental injustice. The adverse health effects of air pollution and environmental injustice can harm children well into adulthood and may even have transgenerational effects. There is an urgent need for action in order to ensure the health and safety of future generations, as social disparities are continuously increasing, due to social discrimination and climate change.
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Affiliation(s)
- Sahana Mathiarasan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Correspondence:
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Packness A, Wehberg S, Hastrup LH, Simonsen E, Søndergaard J, Waldorff FB. Socioeconomic position and mental health care use before and after first redeemed antidepressant and time until subsequent contact to psychologist or psychiatrists: a nationwide Danish follow-up study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:449-462. [PMID: 32642803 PMCID: PMC7904708 DOI: 10.1007/s00127-020-01908-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/30/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose was to investigate inequalities in access to care among people with possible depression. METHOD In this nationwide register-based cohort study of 30,593 persons, we observed the association between socioeconomic position (SEP, education/income) and mental health care use (MHCU) four months before the date of first redeemed antidepressant (Index Date/ID) and 12 months afterwards-and time to contact to psychologist/psychiatrist (PP). Logistic, Poisson, and Cox regression models were used, adjusted for sex, age, cohabitation, and psychiatric comorbidity. RESULTS Before ID, high SEP was associated with less GP contact (general practitioner), higher odds ratios for GP-Mental Health Counseling (GP-MHC), psychologist contact, and admissions to hospital. This disparity decreased the following 12 months for GP-MHC but increased for contact to psychologist; same pattern was seen for rate of visits. However, the low-income group had more contact to private psychiatrist. For the 25,217 individuals with no MHCU before ID, higher educational level was associated with almost twice the rate of contact to PP the following 12 months; for the high-income group, the rate was 40% higher. 10% had contact to PP within 40 days after ID in the group with higher education; whereas, 10% of those with a short education would reach PP by day 120. High-income group had faster access as well. CONCLUSION Being in high SEP was positively associated with MHCU, before and after ID, and more rapid PP contact, most explicit when measured by education. Co-payment for psychologist may divert care towards private psychiatrist for low-income groups.
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Affiliation(s)
- Aake Packness
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark. .,Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4200, Slagelse, Denmark.
| | - Sonja Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lene Halling Hastrup
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark ,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Frans Boch Waldorff
- Section of General Practice and The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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17
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Simonsen NF, Oxholm AS, Kristensen SR, Siciliani L. What explains differences in waiting times for health care across socioeconomic status? HEALTH ECONOMICS 2020; 29:1764-1785. [PMID: 32996212 DOI: 10.1002/hec.4163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 07/02/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
In publicly funded health systems, waiting times act as a rationing mechanism that should be based on need rather than socioeconomic status. However, several studies suggest that individuals with higher socioeconomic status wait less. Using individual-level data from administrative registers, we estimate and explain socioeconomic inequalities in access to publicly funded care for seven planned hospital procedures in Denmark. For each procedure, we first estimate the association between patients' waiting time for health care and their socioeconomic status as measured by income and education, controlling for patient severity. Then, we investigate how much of the association remains after controlling for (i) other individual characteristics (patients' family status, labor market status, and country of origin) that may be correlated with income and education, (ii) possible selection due to patients' use of a waiting time guarantee, and (iii) hospital factors which allow us to disentangle whether inequalities in waiting times arise across hospitals or within the hospital. Only for a few procedures, we find inequalities in waiting times related to income and education. These inequalities can be explained mostly by geographical and institutional factors across hospitals. But we also find inequalities for some procedures in relation to non-Western immigrants within hospitals.
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Affiliation(s)
- Nicolai Fink Simonsen
- Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Anne Sophie Oxholm
- Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Søren Rud Kristensen
- Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK
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18
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Park SW, Park SS, Kim EJ, Sung WS, Ha IH, Jung B. Sex differences in the association between self-rated health and high-sensitivity C-reactive protein levels in Koreans: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey. Health Qual Life Outcomes 2020; 18:341. [PMID: 33054839 PMCID: PMC7556930 DOI: 10.1186/s12955-020-01597-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/07/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND No studies have investigated the association between self-rated health (SRH) and high-sensitivity C-reactive protein (hs-CRP) levels in South Koreans. We explored this association and analyzed differences between sexes. METHODS Using cross-sectional data from the 2015-2017 Korea National Health and Nutrition Examination Survey, we analyzed the association between SRH and high hs-CRP levels (> 1.0 mg/L) in 14,544 Koreans aged ≥ 19 years who responded to the SRH survey and had available hs-CRP test results. Differences in sociodemographic factors were analyzed using the Pearson's chi-square test for categorical variables or the Mann-Whitney U test for continuous variables. Multiple logistic regression analysis was used to measure the association between hs-CRP levels and SRH according to sex while adjusting for other possible confounders. RESULTS The percentage of very poor to poor SRH was higher in the high hs-CRP group (22.4%) than in the low hs-CRP group (17.66%). Among men, the risk of a high hs-CRP level increased with worse SRH (adjusted for confounders; P for trend < 0.001). After adjusting for all confounders, including chronic diseases, men with very poor SRH showed a higher odds ratio (OR) for high hs-CRP levels than those with very good SRH (fully adjusted OR, 1.74; 95% CI, 1.04-2.90). Significant correlations were absent among women. CONCLUSIONS Poor SRH was correlated with low-grade inflammation (high hs-CRP levels) among Korean male adults. These findings could be useful for developing health improvement programs and in goal setting at a national scale.
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Affiliation(s)
- Se-Won Park
- Department of Sasang Constitutional Medicine, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seong-Sik Park
- Department of Acupuncture and Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eun-Jung Kim
- Department of Acupuncture and Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Won-Suk Sung
- Department of Acupuncture and Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Boyoung Jung
- Department of Health Administration, Hanyang Women's University, 200, Salgoji-gil, Seongdong-gu, Seoul, 04763, Republic of Korea.
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19
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Martin S, Siciliani L, Smith P. Socioeconomic inequalities in waiting times for primary care across ten OECD countries. Soc Sci Med 2020; 263:113230. [PMID: 32823046 DOI: 10.1016/j.socscimed.2020.113230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/09/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Waiting times for health care are a major policy concern across OECD countries. Waiting times are generally tolerated in publicly-funded health systems and perceived as equitable if access to care is not based on socioeconomic status. Although a growing literature has documented that socioeconomic status is negatively associated with waiting times for secondary care in several countries, less is known about waiting time inequalities in primary care, which is the focus of this study. We exploit the Commonwealth Fund's International Health Policy Survey of Adults in 2010, 2013 and 2016 and include ten OECD countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom). Waiting time for primary care is measured by the time reported to get an appointment to see a doctor or a nurse. We employ interval regression models to investigate for each country whether socioeconomic status (household income and education) are associated with the waiting time for a primary care appointment. We control for age, gender, chronic conditions, and whether the individual holds private health insurance. We find a negative association between household income and waiting times in Canada, Germany, Norway and Sweden.
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Affiliation(s)
- Steve Martin
- Department of Economics and Related Studies, University of York, York, UK
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK.
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20
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Landi S, Ivaldi E, Testi A. The role of regional health systems on the waiting time inequalities in health care services: Evidences from Italy. Health Serv Manage Res 2020; 34:136-147. [PMID: 32475173 DOI: 10.1177/0951484820928302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inequalities in effective access to healthcare are present among countries and within the same country. Despite in Italy exist the principle of equity in access to health system, there are evidence of different access rates in the form of unequal waiting time within the country. Waiting times are an instruments to ration healthcare services dealing with resource scarsity. Theoretically, it is a fair tool because waiting times should depend only on health needs and not on the ability to pay. However, a growing literature has pointed out that belonging to a particular socioeconomic status leads to waiting times inequalities for healthcare services. Many countries have socioeconomic disparities among regions, and healthcare organizations need to take into account these differences. The increasing power of Regional Health Authorities in decentralized health systems, as in the case of Italy, has generated different organizational ways to provide health care, possibly leading to different access rates in the form of unequal waiting time within the country. This paper aims to understand if the administrative area (Regional Health Authorities) in charge of health services affects waiting times lowering or strengthening health care access inequalities. Using a series of logistic regression models, this work suggests the presence of two vectors: socioeconomic inequalities and regional inequalities. Health organizations need to implement different kinds of answers for each vectors of inequalities.
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Affiliation(s)
- Stefano Landi
- Department of Management, Università Ca' Foscari, Venezia, Italy
| | - Enrico Ivaldi
- Department of Statistics, University of Genoa Faculty of Political Science, Genova, Italy
| | - Angela Testi
- Department of Economics, University of Genoa Faculty of Economics, Genova, Italy
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21
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Corrao G, Rea F, Carle F, Di Martino M, De Palma R, Francesconi P, Lepore V, Merlino L, Scondotto S, Garau D, Spazzafumo L, Montagano G, Clagnan E, Martini N, Bucci A, Carle F, Dajko M, Arcà S, Bellentani D, Bruno V, Carbone S, Ceccolini C, De Feo A, Lispi L, Mariniello R, Masullo M, Medici F, Pisanti P, Visca M, Zanini R, Di Fiandra T, Magliocchetti N, Romano G, Cantarutti A, Corrao G, Pugni P, Rea F, Davoli M, Fusco D, Di Martino M, Lallo A, Marinacci C, Maggioni A, Vittori P, Belotti L, De Palma R, Di Felice E, Chiandetti R, Clagnan E, Del Zotto S, Di Lenarda A, Mariotto A, Zanier L, Agnello M, Lora A, Merlino L, Scirè CA, Sechi G, Spazzafumo L, Massaro G, Simiele M, Cosentino M, Marvulli MG, Attolini E, Bisceglia L, Lepore V, Petrarolo V, Dondi L, Martini N, Pedrini A, Piccinni C, Fantaci G, Addario SP, Scondotto S, Bellomo F, Braga M, Di Fabrizio V, Forni S, Francesconi P, Profili F, Avossa F, Corradin M, Bucci A, Carle F, Dajko M, Arcà S, Bellentani D, Bruno V, Carbone S, Ceccolini C, De Feo A, Lispi L, Mariniello R, Masullo M, Medici F, Pisanti P, Visca M, Zanini R, Di Fiandra T, Magliocchetti N, Romano G, Cantarutti A, Corrao G, Pugni P, Rea F, Davoli M, Fusco D, Di Martino M, Lallo A, Marinacci C, Maggioni A, Vittori P, Belotti L, De Palma R, Di Felice E, Chiandetti R, Clagnan E, Del Zotto S, Di Lenarda A, Mariotto A, Zanier L, Agnello M, Lora A, Merlino L, Scirè CA, Sechi G, Spazzafumo L, Massaro G, Simiele M, Cosentino M, Marvulli MG, Attolini E, Bisceglia L, Lepore V, Petrarolo V, Dondi L, Martini N, Pedrini A, Piccinni C, Fantaci G, Addario SP, Scondotto S, Bellomo F, Braga M, Di Fabrizio V, Forni S, Francesconi P, Profili F, Avossa F, Corradin M. Measuring multimorbidity inequality across Italy through the multisource comorbidity score: a nationwide study. Eur J Public Health 2020; 30:916-921. [DOI: 10.1093/eurpub/ckaa063] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. A simple multisource comorbidity score (MCS) has been recently developed and validated. A very large real-world investigation was conducted with the aim of measuring inequalities in the MCS distribution across Italy.
Methods
Beneficiaries of the Italian National Health Service aged 50–85 years who in 2018 were resident in one of the 10 participant regions formed the study population (15.7 million of the 24.9 million overall resident in Italy). MCS was assigned to each beneficiary by categorizing the individual sum of the comorbid values (i.e. the weights corresponding to the comorbid conditions of which the individual suffered) into one of the six categories denoting a progressive worsening comorbidity status. MCS distributions in women and men across geographic partitions were compared.
Results
Compared with beneficiaries from northern Italy, those from centre and south showed worse comorbidity profile for both women and men. MCS median age (i.e. the age above which half of the beneficiaries suffered at least one comorbidity) ranged from 60 (centre and south) to 68 years (north) in women and from 63 (centre and south) to 68 years (north) in men. The percentage of comorbid population was lower than 50% for northern population, whereas it was around 60% for central and southern ones.
Conclusion
MCS allowed of capturing geographic variability of multimorbidity prevalence, thus showing up its value for addressing health policy in order to guide national health planning.
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Affiliation(s)
- Giovanni Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Flavia Carle
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rossana De Palma
- Authority for Healthcare and Welfare, Emilia Romagna Regional Health Service, Bologna, Italy
| | - Paolo Francesconi
- Regional Health Agency of Tuscany (Agenzia regionale di sanità), Florence, Italy
| | - Vito Lepore
- Regional Health Agency of Puglia (Agenzia regionale socio-sanitaria), Bari, Italy
| | - Luca Merlino
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | | | - Donatella Garau
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Regional Councillorship of Health ‘Regione Autonoma della Sardegna’, Cagliari, Italy
| | - Liana Spazzafumo
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Biostatistics Centre, INRCA-IRCCS National Institute, Ancona, Italy
| | | | - Elena Clagnan
- Regional Health Agency of Friuli-Venezia-Giulia (Azienda Regionale di Coordinamento per la Salute), Udine, Italy
| | - Nello Martini
- Research and Health Foundation (Fondazione ReS-Ricerca e Salute), Bologna, Italy
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Bruzzi C, Ivaldi E, Landi S. Non-compensatory aggregation method to measure social and material deprivation in an urban area: relationship with premature mortality. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:381-396. [PMID: 31811513 DOI: 10.1007/s10198-019-01139-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/14/2019] [Indexed: 05/27/2023]
Abstract
Health inequalities exist between nations, regions, and even smaller units. In societies where social and economic structures change rapidly and continuously, analysis of health socioeconomic determinants plays a fundamental role to provide proper policy answers. This study aims to measure accurately two different conceptions of deprivation by developing two different indexes using non-compensatory among sub-indicators aggregation methods. The proposed indicators are compared with premature mortality to verify deprivation's effect on health status. The results show that materially deprived areas are not necessarily socially deprived and vice versa. Material deprivation has a positive statistical co-graduation with premature mortality, while social deprivation has no association with premature mortality.
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Affiliation(s)
| | - Enrico Ivaldi
- University of Genoa, Department of Political Sciences and Centro de Investigaciones en Econometría - CIE University of Buenos Aires, Genoa, Italy
| | - Stefano Landi
- Department of Management, Ca' Foscari University of Venice, Venice, Italy.
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Yee CA, Legler A, Davies M, Prentice J, Pizer S. Priority access to health care: Evidence from an exogenous policy shock. HEALTH ECONOMICS 2020; 29:306-323. [PMID: 31999884 PMCID: PMC8284942 DOI: 10.1002/hec.3982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 10/11/2019] [Accepted: 10/27/2019] [Indexed: 06/10/2023]
Abstract
Access to care is an important issue in public health care systems. Unlike private systems, in which price equilibrates supply and demand, public systems often ration medical services through wait times. Access that is given on a first come, first served basis might not yield an allocation of resources that maximizes the health of a population, potentially creating suboptimal heterogeneity in wait times. In this study, we examine an access disparity between two groups of patients-established patients and new patients. We exploit an exogenous policy change-implemented by the U.S. Veterans Health Administration-that removed the disparity and homogenized the wait time. We find strong evidence that without such a policy, established patients have priority access over new patients. We discuss whether this is a suboptimal allocation of resources. We additionally find that established patient priority access is an important determinant of access for new patients; accounting for it increased the explanatory power of our statistical model of new patient wait times by a factor of five. The findings imply that policy and management decisions may be more effective in achieving the optimal distribution of access if access heterogeneity is recognized and accounted for explicitly.
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Affiliation(s)
- Christine A. Yee
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Economics, University of Maryland Baltimore County, Baltimore, Maryland
| | - Aaron Legler
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts
- School of Public Health, Boston University, Boston, Massachusetts
| | - Michael Davies
- Office of Veterans Access to Care, U.S. Department of Veterans Affairs, Washington, D.C
| | - Julia Prentice
- Center for Access Policy, Evaluation and Research, VA Boston Healthcare System, Boston, Massachusetts
- School of Medicine, Boston University, Boston, Massachusetts
| | - Steven Pizer
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts
- School of Public Health, Boston University, Boston, Massachusetts
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Pansieri C, Clavenna A, Pandolfini C, Zanetti M, Calati MG, Miglio D, Cartabia M, Zanetto F, Bonati M. NASCITA Italian birth cohort study: a study protocol. BMC Pediatr 2020; 20:80. [PMID: 32075601 PMCID: PMC7029570 DOI: 10.1186/s12887-020-1961-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 02/06/2020] [Indexed: 01/15/2023] Open
Abstract
Background Young children’s healthy development depends on nurturing care, which ensures health, nutrition, responsive caregiving, safety and security, and early learning. Infancy and childhood are characterized by rapid growth and development, and these two factors contribute largely to determining health status and well-being across the lifespan. Identification of modifiable risk factors and prognostic factors during the critical periods of life will contribute to the development of effective prevention and intervention strategies. The NASCITA (NAscere e creSCere in ITAlia) study was created to evaluate physical, cognitive, and psychological development, health status and health resource utilization during the first six years of life in a cohort of newborns, and to evaluate potential associated factors. Methods NASCITA is an ongoing, dynamic, prospective, population-based birth cohort study of an expected number of more than 5000 newborns who will be recruited in 22 national geographic clusters starting in 2019. It was designed to follow children from birth to school entry age for a wide range of determinants, disorders, and diseases. Recruitment of the newborns (and their parents) will take place during the first routine well-child visit, which takes place at the office of the pediatrician assigned to them by the local health unit of residence, and which is scheduled for all newborns born in Italy within the first 45 days of their life. Data will be web-based and collected by the family pediatricians during each of the 7 standard well-child visits scheduled for all children during their first 6 years of life. Information on every contact with the enrolled children in addition to these prescheduled visits will be also recorded. Discussion The NASCITA cohort study provides a framework in which children are followed from birth to six-years of age. NASCITA will broaden our understanding of the contribution of early-life factors to infant and child health and development. NASCITA provides opportunities to initiate new studies, also experimental ones, in parts of the cohort, and will contribute relevant information on determinants and health outcomes to policy and decision makers. Cohort details can be found on https://coortenascita.marionegri.it. Trial registration Clinicaltrials.gov: NCT03894566. Ethics committee approval: 6 February 2019, Verbale N 59.
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Affiliation(s)
- Claudia Pansieri
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Pandolfini
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Michele Zanetti
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria Grazia Calati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Daniela Miglio
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Massimo Cartabia
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Federica Zanetto
- President Associazione Culturale Pediatri (ACP), Narbolia, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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McIntyre D, Chow CK. Waiting Time as an Indicator for Health Services Under Strain: A Narrative Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2020; 57:46958020910305. [PMID: 32349581 PMCID: PMC7235968 DOI: 10.1177/0046958020910305] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/08/2019] [Accepted: 01/13/2020] [Indexed: 11/18/2022]
Abstract
As pressure increases on public health systems globally, a potential consequence is that this is transferred to patients in the form of longer waiting times to receive care. In this review, we overview what waiting for health care encompasses, its measurement, and the data available in terms of trends and comparability. We also discuss whether waiting time is equally distributed according to socioeconomic status. Finally, we discuss the policy implications and potential approaches to addressing the burden of waiting time. Waiting time for elective surgery and emergency department care is the best described type of waiting time, and it either increases or remains unchanged across multiple developed countries. There are many challenges in drawing direct comparisons internationally, as definitions for these types of waiting times vary. There are less data on waiting time from other settings, but existing data suggest waiting time presents a significant barrier to health care access for a range of health services. There is also evidence that waiting time is unequally distributed to those of lower socioeconomic status, although this may be improving in some countries. Further work to better clarify definitions, identify driving factors, and understand hidden waiting times and identify opportunities for reducing waiting time or better using waiting time could improve health outcomes of our health services.
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Affiliation(s)
| | - Clara K. Chow
- The University of Sydney, Westmead, NSW,
Australia
- Westmead Hospital, Westmead, NSW,
Australia
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Landi S, Ivaldi E, Testi A. Socioeconomic Status and Waiting Times for Health Services: Current Evidences and Next Area of Research. Health Serv Insights 2019; 12:1178632919871295. [PMID: 31516311 PMCID: PMC6724484 DOI: 10.1177/1178632919871295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 11/15/2022] Open
Abstract
Waiting times are an issue in many countries, excessive waiting for treatments may deteriorate patient's health status and reduce treatment effectiveness potentially, becoming a barrier in the access to health care services. Waiting time to be equitable should be related only to the health need, people with the same health need have to wait the same time, without any difference due to socioeconomic status. In the commentary, the results of the extensive literature review and policy implications are discussed.
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Affiliation(s)
- Stefano Landi
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
| | - Enrico Ivaldi
- Department of Political Science, University of Genoa, Genoa, Italy
| | - Angela Testi
- Department of Economics and Business Studies, University of Genoa, Genoa, Italy
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Sutherland JM, Kurzawa Z, Karimuddin A, Duncan K, Liu G, Crump T. Wait lists and adult general surgery: is there a socioeconomic dimension in Canada? BMC Health Serv Res 2019; 19:161. [PMID: 30866903 PMCID: PMC6416854 DOI: 10.1186/s12913-019-3981-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 03/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about whether patients' socioeconomic status influences their access to elective general surgery in Canada. The purpose of this study was to assess the association between socioeconomic status and wait times for elective general surgery. METHODS Analysis of prospectively recruited participants' data. The setting was six hospitals in the Vancouver Coastal Health Authority, a geographically defined region that includes Vancouver, British Columbia, Canada. Participants had elective general surgery between October 2013 and April 2017, community dwelling, aged 19 years or older and could complete survey forms. The outcome measure was wait time, defined as the number of weeks between being registered for elective general surgery and surgery date. RESULTS One thousand three hundred twenty elective general surgery participants were included in the study. The response rate among eligible patients was 53%. Regression analyses found no statistically significant association between patients' wait time with SES, adjusting for health status, cancer status, surgical priority level, comorbidity burden and demographic characteristics. Participants with proven or suspected cancer status had shorter waits relative to participants waiting for surgery for benign conditions. Participants with at least one comorbidity tended to experience shorter waits of approximately 5 weeks (p < 0.01). Pre-operative pain or depression/anxiety were not associated with shorter wait times. CONCLUSIONS Although this study found no relationship between SES and surgical wait time for elective general surgeries in the study hospitals, patients in lower SES categories reported worse health when assigned to the surgical queue.
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Affiliation(s)
- Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201-2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
| | - Zuzanna Kurzawa
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201-2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Ahmer Karimuddin
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Katrina Duncan
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201-2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Trafford Crump
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
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