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Virtual health care in the era of COVID-19
Following China's example, on March 30, at the direction of US President Donald Trump, the Centers for Medicare & Medicaid Services (CMS), which oversees the nation's major public health programmes, issued what it termed “an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic”. The risk–benefit ratio for virtual health care has massively shifted and all the red tape has suddenly been cut.” In Italy, although all 20 regions had implemented national telemedicine guidelines as of 2018, hospital managers have been largely caught off guard by the explosion in digital demand, says Elena Sini, information officer for GVM Care & Research, a network of nine private hospitals in northern Italy. With mobile phone use now globally ubiquitous, technological barriers to the adoption of virtual health care are easily surmountable, even in the most resource-scarce settings, notes Alex Jadad, founder of the Centre for Global eHealth Innovation at the University of Toronto, ON, Canada, where he is the director of the Institute for Global Health Equity and Innovation.
Journal Article
Systems-level barriers to treatment in a cervical cancer prevention program in Kenya: Several observational studies
To identify health systems-level barriers to treatment for women who screened positive for high-risk human papillomavirus (hrHPV) in a cervical cancer prevention program in Kenya.
In a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya in 2018-2019, women underwent hrHPV testing offered through community health campaigns, and women who tested positive were referred to government health facilities for cryotherapy. The current analysis draws on treatment data from this trial, as well as two observational studies that were conducted: 1) periodic assessments of the treatment sites to ascertain availability of resources for treatment and 2) surveys with treatment providers to elicit their views on barriers to care. Bivariate analyses were performed for the site assessment data, and the provider survey data were analyzed descriptively.
Seventeen site assessments were performed across three treatment sites. All three sites reported instances of supply stockouts, two sites reported treatment delays due to lack of supplies, and two sites reported treatment delays due to provider factors. Of the 16 providers surveyed, ten (67%) perceived lack of knowledge of HPV and cervical cancer as the main barrier in women's decision to get treated, and seven (47%) perceived financial barriers for transportation and childcare as the main barrier to accessing treatment. Eight (50%) endorsed that providing treatment free of cost was the greatest facilitator of treatment.
Patient education and financial support to reach treatment are potential areas for intervention to increase rates of hrHPV+ women presenting for treatment. It is also essential to eliminate barriers that prevent treatment of women who present, including ensuring adequate supplies and staff for treatment.
Journal Article
Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions
By September 2015, a total of 29 states and Washington, D.C., were participating in the ACA Medicaid expansion. During year 2 after implementation, the expansion was associated with substantial reductions in rates of uninsurance and in reports of inability to afford health care.
The Affordable Care Act (ACA) expanded Medicaid eligibility to persons earning up to 138% of the federal poverty level, as part of the largest expansion of coverage to nonelderly adults since the 1960s. Although the expansion was originally intended to be enacted nationally, a 2012 U.S. Supreme Court decision made it optional for states. A total of 24 states decided not to expand in 2014, which affected 6.7 million uninsured low-income adults who otherwise would have gained eligibility.
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Since 2014, an additional 5 states have implemented expansions, although 19 states still have not adopted the expansion as of January 2017. . . .
Journal Article
Global perspectives on cancer : incidence, care, and experience
\"Two leading oncologists, along with experts spanning several medical disciplines, shed light on the global pandemic of cancer, particularly the difference in diagnosis, treatment, and care between global communities\"--Provided by publisher.
Book
The legal determinants of health: harnessing the power of law for global health and sustainable development
Health risks in the 21st century are beyond the control of any government in any country. In an era of globalisation, promoting public health and equity requires cooperation and coordination both within and among states. Law can be a powerful tool for advancing global health, yet it remains substantially underutilised and poorly understood. Working in partnership, public health lawyers and health professionals can become champions for evidence-based laws to ensure the public’s health and safety. This Lancet Commission articulates the crucial role of law in achieving global health with justice, through legal instruments, legal capacities, and institutional reforms, as well as a firm commitment to the rule of law. The Commission’s aim is to enhance the global health community’s understanding of law, regulation, and the rule of law as effective tools to advance population health and equity.
Journal Article
Risks and challenges in medical tourism : understanding the global market for health services
\"A multidisciplinary international team examines the safety, ethics, and health implications of the emerging global market for health care, and the issues that arise when patients cross borders for medical procedures they cannot afford or access at home, from liposuction to kidney transplants\"--Provided by publisher.
Book
Inequality and the health-care system in the USA
Widening economic inequality in the USA has been accompanied by increasing disparities in health outcomes. The life expectancy of the wealthiest Americans now exceeds that of the poorest by 10–15 years. This report, part of a Series on health and inequality in the USA, focuses on how the health-care system, which could reduce income-based disparities in health, instead often exacerbates them. Other articles in this Series address population health inequalities, and the health effects of racism, mass incarceration, and the Affordable Care Act (ACA). Poor Americans have worse access to care than do wealthy Americans, partly because many remain uninsured despite coverage expansions since 2010 due to the ACA. For individuals with private insurance, rising premiums and cost sharing have undermined wage gains and driven many households into debt and even bankruptcy. Meanwhile, the share of health-care resources devoted to care of the wealthy has risen. Additional reforms that move forward, rather than backward, from the ACA are sorely needed to mitigate health and health-care inequalities and reduce the financial burdens of medical care borne by non-wealthy Americans.
Journal Article