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The Health Care Safety Net in a Post-Reform Worldexamines how national health care reform will impact safety net programs that serve low-income and uninsured patients. The \"safety net\" refers to the collection of hospitals, clinics, and doctors who treat disadvantaged people, including those without insurance, regardless of their ability to pay. Despite comprehensive national health care reform, over twenty million people will remain uninsured. And many of those who obtain insurance from reform will continue to face shortages of providers in their communities willing or able to serve them. As the demand for care grows with expanded insurance, so will the pressure on an overstretched safety net.This book, with contributions from leading health care scholars, is the first comprehensive assessment of the safety net in over a decade. Rather than view health insurance and the health care safety net as alternatives to each other, it examines their potential to be complementary aspects of a broader effort to achieve equity and quality in health care access. It also considers whether the safety net can be improved and strengthened to a level that can provide truly universal access, both through expanded insurance and the creation of a well-integrated and reasonably supported network of direct health care access for the uninsured. Seeing safety net institutions as key components of post-health care reform in the United States-as opposed to stop-gap measures or as part of the problem-is a bold idea. And as presented in this volume, it is an idea whose time has come.

Background The inequity of healthcare utilization in rural China is serious, and the urban-rural segmentation of the medical insurance system intensifies this problem. To guarantee that the rural population enjoys the same medical insurance benefits, China began to establish Urban and Rural Resident Basic Medical Insurance (URRBMI) nationwide in 2016. Against this backdrop, this paper aims to compare the healthcare utilization inequity between URRBMI and New Cooperative Medical Schemes (NCMS) and to analyze whether the inequity is reduced under URRBMI in rural China. Methods Using the data from a national representative survey, the China Health and Retirement Longitudinal Study (CHARLS), which was conducted in 2015, a binary logistic regression model was applied to analyze the influence of income on healthcare utilization, and the decomposition of the concentration index was adopted to compare the Horizontal inequity index (HI index) of healthcare utilization among the individuals insured by URRBMI and NCMS. Results There is no statistically significant difference in healthcare utilization between URRBMI and NCMS, but in outpatient utilization, there are significant differences among different income groups in NCMS; high-income groups utilize more outpatient care. The Horizontal inequity indexes (HI indexes) in outpatient utilization for individuals insured by URRBMI and NCMS are 0.024 and 0.012, respectively, indicating a pro-rich inequity. Meanwhile, the HI indexes in inpatient utilization under the two groups are − 0.043 and − 0.028, respectively, meaning a pro-poor inequity. For both the outpatient and inpatient care, the inequity degree of URRBMI is larger than that of NCMS. Conclusions This paper shows that inequity still exists in rural areas after the integration of urban-rural medical insurance schemes, and there is still a certain gap between the actual and the expected goal of URRBMI. Specifically, compared to NCMS, the pro-rich inequity in outpatient care and the pro-poor inequity in inpatient care are more serious in URRBMI. More chronic diseases should be covered and moral hazard should be avoided in URRBMI. For the vulnerable groups, special policies such as reducing the deductible and covering these groups with catastrophic medical insurance could be considered.

Background Health expenditure efficiency (HEE) is an important research area in health economics. As a large agricultural country, China is faced with the daunting challenge of maintaining equality and efficiency in health resource allocation and health services utilization in the context of rapid economic growth in rural areas. The reasonable allocation of limited rural health resources may be achieved by scientifically measuring the current rural HEE. This subject may help to formulate effective policy or provide incentives for the health sector. Methods The combination of a super-slack-based measure (SBM) model with the Malmquist productivity index (MPI) is proposed to evaluate the static health expenditure efficiency (HEE) and dynamic health expenditure efficiency (DHEE) in rural China from 2007 to 2016. Results The results show that the HEE and DHEE values exhibit unstable trends over time. The HEE does not follow China’s economic development and presents an average of 0.598 (< 1); and the DHEE presents an average value of approximately 0.949 (< 1), indicating that the DHEE of most provinces is not moving in a desirable direction. The level of technological progress and scale optimization are the main factors hindering total factor productivity (TFP) growth. Conclusions The Chinese government could improve the efficiency of rural health resources allocation by improving the rural health service system, optimizing the allocation of material resources and enhancing the level of health of financial resources allocation. The state should continue to moderate policy for different regions. Moreover, scientific and technological advancements should be introduced to improve the scale optimization levels.

Background Interest in the implementation of various innovations (e.g. medical interventions and organizational approaches) has increased rapidly, and management innovations (MIs) are considered particularly complex to implement. In contrast to a traditional view that innovations are implemented , some scholars have promoted the view that innovations are translated into contexts, a view referred to as translation theory. The aim of this paper is to investigate how a translation theory perspective can inform the Consolidated Framework of Implementation Research (CFIR) to increase understanding of the complex process of putting MIs into practice. The empirical base is a two-year implementation of the MI Value-Based Health Care (VBHC) to a psychiatric department in a large Swedish hospital. Methods In this longitudinal case study, a qualitative approach was applied using an insider researcher with unique access to data, who followed the implementation starting in 2015. Data sources includes field notes, documents, and audio recordings of meetings and group reflections which were abridged into an event data file structured by CFIR domains. In a joint analysis, an outsider researcher was added to strengthen the analysis and mitigate potential bias. Results Two themes were identified, for which CFIR did not satisfactorily explain the findings. First, the intervention characteristics (i.e. the content of the MI) were modified along the process and, second, the process did not follow predefined plans. However, the project was still perceived to be successful by internal and external stakeholders. Conclusions The paper proposes three ways in which translation theory can inform CFIR when applied to MIs: 1) strength of evidence is not as important for MIs as for medical and technical innovations; 2) adaptability of the MI can be emphasized more strongly, and 3) it can be more fruitful to view implementation as a dynamic process rather than seeing it as a matter of planning and execution. For managers, this implies encouragement to seize the opportunity to translate MIs to fit their organization, rather than to aim to be true to an original concept.

The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. This study examined scholars' conceptualization and scope of work focused on HL and DHL. Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators' research. A total of 193 (9.5%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7%) were from public health, 83/193 (43%) reported their research focused on HL alone, 46/193 (23.8%) mentioned DHL, and 64/193 (33.2%) mentioned both. The majority (133/153, 86.9%) studied HL/DHL in combination with other SDoH, 106/135 (78.5%) conducted HL/DHL work in a community setting, and 100/156 (64.1%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9%), plain-language materials (82/135, 60.7%), and visual guides (56/135, 41.5%) were the top 3 approaches used. Most worked with adults (131/139, 94.2%) and all races and ethnicities (47/121, 38.8%). HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues.

The importance of optimal well-being and mental health in elite athletes has received increasing attention and debate in both the academic and public discourse. Despite the number of challenges and risk factors for mental health and well-being recognised within the performance lifestyle of elite athletes, the evidence base for intervention is limited by a number of methodological and conceptual issues. Notably, there exists an increasing emphasis on the development of appropriate sport-specific measures of athlete well-being, which are required to underpin strategies targeted at the protection and enhancement of psychosocial functioning. Therefore, the purpose of this article is to review psychometric issues in well-being research and discuss the implications for the measurement of well-being in sport psychology research. Drawing on the broader literature in related disciplines of psychology, the narrative discusses four key areas in the scale development process: conceptual and theoretical issues, item development issues, measurement and scoring issues, and analytical and statistical issues. To conclude, a summary of the key implications for sport psychology researchers seeking to develop a measure of well-being is presented.

Objectives Analyzing the impact of the China’s health care reform policy in 2009 on the intangible service efficiency of PHCI and exploring the way to improve the service efficiency of PHCI. Methods The Malmquist productivity index based on the Data Envelopment Analysis (DEA) was used to measure the variation of TFP and its decomposition of PHCI before and after the implementation of the health care reform policy in 2009. Then, the Tobit model was applied to estimate the key factors affecting the improvement of the intangible service efficiency of PHCI. Results The number of health resources and the intangible service efficiency of PHCI have increased obviously since the implementation of the China’s health care reform. The growth of intangible service efficiency of PHCI was mainly affected by the technical progress, but the management level and scale efficiency change have not yet played an important role. Conclusions The growth of intangible service efficiency in China’s PHCI still belongs to input growth rather than efficiency growth. In the future, the technical progress and improvement in the management level are the key measures to promote the intangible service efficiency of PHCI.

Purpose This study summarizes findings from four cohorts of Oregon Area Health Education Centers Scholars (2018–2022). Area Health Educations Centers (AHECs) aim to expand the healthcare workforce, especially in rural and underserved areas likely to experience workforce shortages. The AHEC Scholars Program, a component of all AHECs nationally, supports health professions learners interested in rural/underserved practice through didactic curricula on core topics about rural/underserved populations and clinical training in these settings. Methods A retrospective pre-post survey was administered assessing changes in self-reported perceptions of knowledge of core topic areas and issues related to health and wellness in specific underserved populations, along with intention to practice in rural or under-resourced settings before and after participation in the AHEC Scholars Program. Descriptive statistics and Wilcoxon signed-rank tests were used to assess pre- and post-participation differences in working knowledge and intent to practice in rural/underserved settings. Results Participants reported higher ratings following the Oregon AHEC Scholars Program compared to their retrospective pre-program ratings. Differences were found in perceptions of working knowledge ratings for all six core topic areas, and for health and wellness for special populations ( p  < 0.001). Lastly, perceptions of intention to practice in rural or underserved settings were also rated more highly post-program compared to pre-program ratings for all of the assessed practice settings. Conclusions The Oregon AHEC Scholars Program appears to be effective in training healthcare professions learners in core topics in rural/underserved healthcare and health and wellness for specific populations and is associated with an increase in learners’ perceptions of their intent to practice in a variety of rural and underserved settings. These findings have implications for addressing workforce maldistribution and the health of patients living in rural or medically under-resourced areas.

Background A recent review of frameworks used in dissemination and implementation (D&I) science described 61 judged to be related either to dissemination, implementation, or both. The current use of these frameworks and their contributions to D&I science more broadly has yet to be reviewed. For these reasons, our objective was to determine the role of these frameworks in the development of D&I science. Methods We used the Web of Science™ Core Collection and Google Scholar™ to conduct a citation network analysis for the key frameworks described in a recent systematic review of D&I frameworks (Am J Prev Med 43(3):337–350, 2012). From January to August 2016, we collected framework data including title, reference, publication year, and citations per year and conducted descriptive and main path network analyses to identify those most important in holding the current citation network for D&I frameworks together. Results The source article contained 119 cited references, with 50 published articles and 11 documents identified as a primary framework reference. The average citations per year for the 61 frameworks reviewed ranged from 0.7 to 103.3 among articles published from 1985 to 2012. Citation rates from all frameworks are reported with citation network analyses for the framework review article and ten highly cited framework seed articles. The main path for the D&I framework citation network is presented. Conclusions We examined citation rates and the main paths through the citation network to delineate the current landscape of D&I framework research, and opportunities for advancing framework development and use. Dissemination and implementation researchers and practitioners may consider frequency of framework citation and our network findings when planning implementation efforts to build upon this foundation and promote systematic advances in D&I science.

This study protocol employs critical race and intersectionality theories to investigate barriers faced by racialized women at various academic career stages within Canadian primary care (PC) and public health (PH). The objectives are to identify faculty characteristics, examine intersectional barriers, and recommend equity-focused, inclusive strategies and policies. The study adopts a sequential mixed-methods approach. A quantitative survey and/or existing datasets will be used to collect demographic data on PC and PH academic position holders in Ontario and British Columbia, Canada. Data will also examine experiences of workplace discrimination; equity, diversity and inclusion (EDI) resource use; and departmental satisfaction. Subsequently, we will conduct interviews with researchers and leaders who are responsible for hiring and involved in or addressing matters related to EDI. Inductive and deductive approaches will be used to analyze the data in accordance with theoretical frameworks to deepen insights into equity and inclusion in academia. The quantitative phase will profile PC and PH academic position holders, highlighting disparities in positions and leadership roles. The qualitative study will explore intersectional challenges faced by racialized women academic position holders during career progression. Preliminary findings will inform effective equity-promoting strategies. This study aims to contribute to the existing body of knowledge on gender and racial inequities in academia by uncovering systemic identity-based disparities in the careers of PC and PH researchers in Canada. The findings will inform the development of targeted interventions to promote equitable hiring, faculty support, and leadership advancement, enhancing diversity and productivity through an inclusive and equitable academic environment. Findings will be shared via publications, policy briefs, workshops, and online platforms to engage academics, advocacy groups, funders and policymakers in promoting equity and driving institutional change in PC and PH research.