Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.

In recent years, Florida has acquired a reputation as fertile ground for human trafficking. On the heels of state and federal anti-human trafficking legislation, a host of organizations have risen to provide a range of services. In this thesis, I discuss findings from 26 interviews conducted with law enforcement, service providers, legal representatives and trafficked persons to contextualize the variability in the way anti-trafficking work is conceptualized by stakeholders across the state. Additionally, I explore how conflicting organizational policies on the local, state, and federal levels impact stakeholder collaboration and complicate trafficked persons' attempts to navigate already complex processes of social/health services and documentation. Lastly, I provide policy recommendations that attempt to address the major issues associated with anti-trafficking work identified through the analysis of participant interviews.

To achieve the goal of universal coverage of health insurance for the Americans, in March 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law. The ACA targets at providing help to improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. One of the precedent mandates, implemented in September 2010, is to expand coverage on young adults of age 19 to 26, who may lose insurance coverage due to the remove from their parents’ plan after age 18 and lacking of productivity to bargain with employers in the labor market. This dissertation looks into the impact of the ACA health insurance coverage expansion for young adults on the subsequent health outcomes, health care utilization, and further social impact on traffic fatalities. Difference-in-differences models are used with different treatment groups and corresponding control groups. Chapter I uses survey data (BRFSS) to evaluate health care access, health behavior and self-assessed health status. The results suggest an improvement in health care access and self-assessed health but more risky behavior. Chapter II uses hospital discharge data (NIS) to estimate avoidable hospitalization in order to assess primary care utilization. The result shows that less primary care was consumed, which leads to more avoidable hospitalization but health may have been improved by using more hospital care. The results from both chapters imply potential ex ante moral hazard among young adults in the policy targeting age group. Thus, chapter III uses accident records data (FARS) to examine the impact of the health insurance expansion on traffic fatality for young adults, to see whether young drivers perform ex ante moral hazard through risky behavior like drunk and/or reckless driving after they get covered by the health insurance expansion policy. Primary result shows that there is an increase in traffic accidents and fatalities for those younger adults as a result of the ACA dependent coverage expansion.

L’objet de ce travail de recherche est d’étudier l’accès financier à la complémentaire santé et aux soins des populations modestes en France. Nous nous intéressons plus particulièrement au dispositif d’Aide complémentaire santé (ACS) introduit afin d’inciter les ménages dont les ressources se situent juste au-dessus du plafond d’attribution de la Couverture maladie universelle (CMUC), à acquérir une complémentaire santé. À partir notamment d’une expérimentation sociale et d’un échantillon inédit de ménages éligibles à ces dispositifs, nous sommes en mesure d’éclairer les connaissances sur trois questions : (i) La compréhension et la réduction du non-recours à l’ACS. (ii) Les comportements de recours à la complémentaire santé et aux soins. (iii) L’existence d’un effet de seuil de la CMUC. Les résultats de cette thèse permettent ainsi de nourrir la réflexion afin d’améliorer l’efficacité de ces dispositifs et plus généralement celle des politiques publiques futures visant à améliorer l’équité dans l’accès aux soins. / The purpose of this research is to study the financial access to complementary health insurance (CHI) and to health care of low-income populations in France. We are particularly interested in evaluating a subsidized health insurance program (ACS) introduced to encourage households whose resources are just above the free means-tested complementary health insurance program (CMUC), to purchase a CHI plan. In implementing a randomized experiment and in using a sample of eligible households for these programs, we are able to enhance the knowledge base on three issues: (i) Understanding and reducing the ACS non-take-up. (ii) The take-up of CHI plan and the health care use of low-income populations. (iii) The existence of a CMUC threshold effect. Results of this thesis provide some important tracks to improve the effectiveness of these programs and more generally that of future public policies aiming to improve equity in access to health care.

A ProgramaÃÃo Pactuada Integrada/PPI foi introduzida no Sistema Ãnico de SaÃde, em 1996, como instrumento de planejamento da alocaÃÃo de recursos mediante relaÃÃes intergovernamentais, no sentido da operacionalizaÃÃo do princÃpio da integralidade da atenÃÃo. Para analisar a implantaÃÃo e implementaÃÃo da PPI no CearÃ, entre 2007 e 2009, partindo-se de considerar as necessidades do cidadÃo, realizou-se um estudo quanti-qualitativo, com anÃlise de coerÃncia desta na garantia do acesso e da integralidade das aÃÃes de saÃde. No eixo qualitativo, foi assumido o referencial teÃrico do discurso do sujeito coletivo, de LefÃvre & LefÃvre, para abordar as percepÃÃes dos profissionais das equipes da gestÃo regional na conduÃÃo dos processos de pactuaÃÃo dos recursos financeiros destinados Ãs aÃÃes e serviÃos de saÃde. No eixo quantitativo, foi abordada a relaÃÃo entre a capacidade instalada das unidades de saÃde, as programaÃÃes fÃsico-orÃamentÃrias e as produÃÃes de serviÃos. A coleta de dados foi realizada com entrevistas, mediante aplicaÃÃo de questionÃrio semiestruturado e auto aplicado, alÃm da anÃlise de dados secundÃrios e de documentos. Os resultados evidenciaram a produÃÃo de uma programaÃÃo virtual e incoerente com a capacidade instalada e produÃÃo de serviÃos; assim comprometendo, desde a alocaÃÃo dos recursos, o acesso aos serviÃos e da integralidade das aÃÃes assistenciais. A anÃlise do discurso do sujeito coletivo reforÃou os achados. Ante os limites identificados e as possibilidades de pactuaÃÃo intergestores contribuir no processo de programaÃÃo, discutiu-se a perspectiva de ajustes desta ferramenta da gestÃo, com vistas ao atendimento das necessidades de saÃde da populaÃÃo. / The pactuation integrated programming was introduced in Cearaâs health care system since 1996, as a tool of planning resource allocation/PPI supported by intergovernmental relations, towards the operationalization of the principle of comprehensive care. To analyze the establishment and implementation of the PPI in Cearà between 2007 and 2009, starting to consider the needs of citizens, it was conducted a quantitative and qualitative study, with coherence analysis in ensuring access to comprehensive care. In the qualitative axis it was assumed the theoretical discourse of the collective subject of LefÃvre & LefÃvre, to address the perceptions of the management teams at the regional level in conducting agreements negotiation of financial resources, intended actions and health services. The shaft was quantitatively addressed the relationship between the capacity of health facilities, physical and budgetary schedules and production services. Data collection was carried out with interviews, applying semi-structured self applied questionnaire, as well as analysis of secondary data and documents. The results showed the production of a virtual and inconsistent programming with the installed capacity and services production just committed, since the allocation of resources, access to services and integrated care assistance. The analysis of the collective subject discourse reinforced the findings. Faced with the limitations identified and the possibilities for the managers negotiation contributed to the process of programming it was discussed the prospect of setting this management tool, with a view to meeting the population health needs.

This dissertation examined health care utilization patterns across conventional health care (CHC), complementary and alternative medicine (CAM), and public health care (PHC) systems among Canadians aged fifty and older. I argued that utilization research is currently limited by a primary focus on discrete use of health care services, largely within the CHC system (i.e., medical doctors, specialists, hospitals). However substantial growth in use of CAM and PHC, particularly among late middle-age cohorts, suggests the need to widen the research lens from discretionary service use within health care systems to include medical pluralism or use across health care systems. To address the lack of research on medical pluralism and the need for a comprehensive overview of service use, I used two different strategies to create discrete patterns of service use and non-use. To frame the predictors of these patterns, a medical pluralism paradigm was proposed, which suggests that there are distinct social location and health characteristics that may explain use across health care systems. Five hypotheses were tested using data pooled from two cycles of the Canadian Community Health Survey (Cycles 2.1 [2003] and 3.1 [2005]) to create an overall sample (n=117,824). Results from the deductive (variable oriented) and inductive (person centred) strategies were compared. Differences in both the number and form of patterns are apparent. Across both strategies, the most common pattern is dual use of CHC (medical visits, specialist visits) and PHC (flu shots, sex-specific screening) but not CAM (chiropractors, other CAM providers). Consistent with the literature, women use more types of services overall than do men. The gender effect is significantly mediated by age: older men are less likely to use services across the three health care systems than older women. Strong evidence for a socioeconomic gradient in medical pluralism is also found. Higher levels of income and education increase the likelihood of using services across the three health care systems compared to low and middle levels of both income and education. The relationship between race and health service use was much less significant. Long-term immigrants demonstrate tri-use patterns close to those of Canadian born individuals; however, service differentials remain even after controlling for health needs, in favour of native-born Canadians. Medical pluralism is also associated with health related-need as support was found for both illness and wellness care. Lastly, regional differences point to a greater likelihood of medical pluralism in western Canada, but not always in urban areas. In future, a longitudinal examination of medical pluralism is necessary and would help establish the sequencing of services and how services are used in relation to the disablement process. Health policy would thus benefit from insight into the extent of service duplication for specific conditions and clarify the role of medical doctors in referral processes. / Graduate

No description available.

Background: In South Africa (SA), women with breast cancer (BC) present to the health care system at advanced stages of the disease, resulting in poor prognosis. Limited awareness of the disease, large distances to health care centers, and lack of affordable transportation have all been implicated as factors delaying presentation. In addition, women in SA have limited social and financial independence, which may make it difficult for them to resolve their own health care needs. Despite this, little is known about what South African male partners know about breast cancer and what role they play in their partner’s access to health care. Methods: This interpretive qualitative case study, guided by the theoretical framework of hegemonic masculinity(ies), used semi-structured interviews to investigate perceptions and knowledge of BC and gender norms in regards to health care access in a group of black South African males (n=20) in long-term heterosexual relationships living in a resource-poor setting. Interview data was analyzed using thematic analysis and compared to observational data collected through opportunities with local BC organizations. Results: Participants demonstrated very little knowledge of breast cancer and cancer in general. Some specific misconceptions about cancer are reported, including confusion between cancer and HIV. Participants were positive about receiving health care for cancer but are burdened by barriers to reaching care and a lack of access to information about the disease. The men describe themselves as playing an active, mostly positive role in their partner’s access to health care. They demonstrate perspectives about gender relations that defy hegemonic forms of masculinity. Conclusions: Major public health efforts are required to increase awareness of BC in order to encourage earlier presentation to the healthcare system. These efforts should recognize the importance of the male partner in women’s health issues. / Thesis / Master of Science (MSc) / In South Africa, women with breast cancer often do not reach the conventional healthcare system until the disease has progressed significantly and chances of survival are poor. This occurs because of a lack of knowledge about the disease and large distances to health care centers. Furthermore, in the male-dominated society of South Africa, women have limited independence. Therefore, this study sought to determine what men in South African know about breast cancer and how they are involved in their partner’s access to health care. Interviews were conducted with 20 men living in a resource-poor setting. The men portrayed little knowledge and specific misconceptions about breast cancer and cancer in general. They appear to be playing an active and mostly positive role in their partner’s access to health care. Public health efforts should increase awareness of the disease and recognize the significant role of the male partner in women’s health issues.

There is compelling evidence for the effectiveness of home-based occupational therapy and physiotherapy rehabilitation for community dwelling elderly who may struggle with basic activities and the functions of daily living and mobility. Nonetheless, an estimated 2% of home care’s elderly clients receive these therapies. Ontario’s home care data indicates that 78% of clients that could benefit from these specific therapies are not receiving them. The study examined a subset of elderly clients receiving home care following a hospital discharge during 2009-2010. The aim of this study was to: understand the difference between those home care clients who received occupational therapy or physiotherapy and those who did not; and determine if receiving these therapies impacted the utilization of hospital emergency departments and inpatient admissions. A retrospective cohort design and multivariate and survival analysis of hospital and home care administrative data structured the study. Results suggest that home-based rehabilitation is offered to a minority of the home care population. Distinct client characteristics and process variables significantly associated with the increased likelihood of receiving home-based occupational and physical therapies included: clients who were older, females, admitted to home care from hospital inpatient units, assessed as non-acute for clinical and service needs and required more home making support and assistance with activities of daily living. Almost one quarter of the total sample returned to hospital. Visits to emergency departments accounted for the greater part of hospital utilization and primarily for sub-acute general symptoms and signs, post-procedural complications, infections or acute episodes from chronic obstructive pulmonary disease and renal failure. Slightly over half of the clients returning to hospital did not receive home-based rehabilitation. Clients who received occupational therapy returned to the hospital sooner following their home care admission whereas clients receiving physiotherapy spent the longest time before rehospitalizing. The majority of the clients receiving occupational therapy were admitted to home care having just resolved sub-acute conditions or symptoms, many of which are known to influence functional and physical decline. Moreover, analysis of process variables indicated that the wait time for a referral to occupational therapy was two times longer compared to physiotherapy. These same clients also waited, on average, over one month before an occupational therapist’s first visit. The need to discriminate who receives home-based rehabilitation is essential to understanding how specific therapies contribute to improving systems outcomes. This study is the first examination that focuses specifically on home-based occupational therapy and physiotherapy rehabilitation and the client characteristics and process variables associated with receiving/not receiving these therapies and the impact these factors have on the time-to-rehospitalization. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2013-06-27 12:24:53.085

Using data from the Household Component of the 1996 Medical Expenditure Panel Survey, the study compares (1) the accessibility, and (2) the predictors of health care services utilization among African American and non-Hispanic White males, 18 to 65 years old in the United States. Using ANOVA procedure in comparing the means for use of physicians, hospitals, doctors, and difficulty obtaining care, seven hypotheses were tested in the study. First, it was hypothesized that African American men of working age will have less access to health care services (physicians, hospitals, and dentists), and be more likely to report having experienced delay or difficulty obtaining care, compared to non-Hispanic white males of working age. Second, it was hypothesized that, controlling for health status, African American men of working age will have less access to health care services (physicians, hospitals, and dentists), and will also be more likely to experience delay or difficulty obtaining care, than non-Hispanic white males. This was followed by the third hypothesis which compared utilization of physicians, hospitals, dentists, and difficulty obtaining care among African American and non-Hispanic white males, controlling for health status and insurance coverage (any insurance, private insurance, any public insurance, and Medicaid). Hypotheses four through six compared the utilization of physicians, hospitals, and dentists, as well as difficulty obtaining care among African American and non-Hispanic white males, controlling for the following variables sequentially: health status and poverty status; health status and having a usual source of care; and health status and employment status, in that order. Finally, it was hypothesized that, controlling for health status, any insurance, poverty status, and employment status, African American men of working age will have less access to physicians, hospitals, and dentists, and experience more difficulty and delay obtaining care, compared to non-Hispanic white males of working age. Results from the study indicated that Hypothesis 1 was supported for use of physicians and dentists. Hypotheses 2, 3a and 3c were supported for use of physicians, hospitals, and dentists. Hypotheses 3b, 3d, and 4 received support for use of physicians, hospitals, dentists, and difficulty obtaining care. Additionally, both Hypotheses 5 and 6 were supported for use of physicians, hospitals, and dentists, with the last hypothesis being confirmed for use of physicians, hospitals, dentists, and difficulty obtaining care. The study calls for a closure of the gap in access to health care between African American and non-Hispanic white adult males in the US. A reform-oriented government-sponsored single-payer plan modeled after the Canadian health care system is recommended for the United States. A national health insurance plan is most likely to ensure equity of access, compared to others, in the sense that it is founded on the premise that everyone will be covered in a similar fashion. Considering the role of Community Health Centers in serving Medicaid and Medicare recipients, low-income uninsured and insured, the underinsured, as well as high-risk populations and the elderly, in the interim, they should be extended to every community in the United States.