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The contributors to this latest volume of Research in the Sociology of Health Care investigate macro-level system issues and micro-level issues involving the socially disadvantaged and underserved. Looking specifically at the factors impacting on health and health care differentials, this book is an examination of the health and health care issues of both patients and providers of care in the United States and around the globe. Chapters focus on linkages to policy, population concerns and patients and providers of care as ways to meet health care needs. -- Provided by publisher.

The contributors to this latest volume of Research in the Sociology of Health Care investigate macro-level system issues and micro-level issues involving the socially disadvantaged and underserved. Looking specifically at the factors impacting on health and health care differentials, this book is an examination of the health and health care issues of both patients and providers of care in the United States and around the globe. Chapters focus on linkages to policy, population concerns and patients and providers of care as ways to meet health care needs.

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.

Access to oral health care is essential to promoting and maintaining overall health and well-being, yet only half of the population visits a dentist each year. Poor and minority children are less likely to have access to oral health care than are their nonpoor and nonminority peers. Older adults, people who live in rural areas, and disabled individuals, uniformly confront access barriers, regardless of their financial resources. The consequences of these disparities in access to oral health care can lead to a number of conditions including malnutrition, childhood speech problems, infections, diabetes, heart disease, and premature births. Improving Access to Oral Health Care for Vulnerable and Underserved Populations examines the scope and consequences of inadequate access to oral health services in the United States and recommends ways to combat the economic, structural, geographic, and cultural factors that prevent access to regular, quality care. The report suggests changing funding and reimbursement for dental care; expanding the oral health work force by training doctors, nurses, and other nondental professionals to recognize risk for oral diseases; and revamping regulatory, educational, and administrative practices. It also recommends changes to incorporate oral health care into overall health care. These recommendations support the creation of a diverse workforce that is competent, compensated, and authorized to serve vulnerable and underserved populations across the life cycle. The recommendations provided in Improving Access to Oral Health Care for Vulnerable and Underserved Populations will help direct the efforts of federal, state, and local government agencies; policy makers; health professionals in all fields; private and public health organizations; licensing and accreditation bodies; educational institutions; health care researchers; and philanthropic and advocacy organizations.

Background The Affordable Care Act (ACA) increased funding for Federally Qualified Health Centers (FQHCs). We defined FQHC service areas based on patient use and examined the characteristics of areas that gained FQHC access post-ACA. Methods We defined FQHC service areas using total patient counts by ZIP code from the Uniform Data System (UDS) and compared this approach with existing methods. We then compared the characteristics of ZIP codes included in Medically Underserved Areas/Populations (MUA/Ps) that gained access vs. MUA/P ZIP codes that did not gain access to FQHCs between 2011–15. Results FQHC service areas based on UDS data vs. Primary Care Service Areas or counties included a higher percentage of each FQHC’s patients (86% vs. 49% and 71%) and ZIP codes with greater use of FQHCs among low-income residents (29% vs. 22% and 22%), on average. MUA/Ps that gained FQHC access 2011–2015 included more poor, uninsured, publicly insured, and foreign-born residents than underserved areas that did not gain access, but were less likely to be rural ( p  < .05). Conclusions Measures of actual patient use provide a promising method of assessing FQHC service areas and access. Post-ACA funding, the FQHC program expanded access into areas that were more likely to have higher rates of poverty and uninsurance, which could help address disparities in access to care. Rural areas were less likely to gain access to FQHCs, underscoring the persistent challenges of providing care in these areas.

Background Universal access to quality healthcare remains a fundamental human right; however, underserved populations in rural and remote areas face persistent barriers to timely and appropriate care. Recent advancements in digital technology, especially virtual clinics, present promising opportunities to bridge these healthcare gaps by enhancing access and continuity of care. This review aims to systematically explore the barriers and facilitators influencing the implementation of virtual clinics in underserved regions to guide future policies and strategic development. Methods Employing the Joanna Briggs Institute Manual for Evidence Synthesis and adhering to PRISMA-ScR guidelines, comprehensive searches were conducted in PubMed, Web of Science, Scopus, Google, and Google Scholar databases, supplemented by gray literature from targeted Google searches and snowballing techniques. A three-phase screening process was independently carried out by multiple reviewers based on predetermined inclusion and exclusion criteria. Data extraction and thematic analysis were conducted through a six-stage process using MAXQDA software. Results Sixty-six articles were included from an initial 1590 records screened. The body of research has grown steadily since 2002, predominantly originating from Australia, the USA, and Canada. Major challenges identified include inadequate policy support, high startup costs, resistance from healthcare providers, limited internet infrastructure, privacy and security concerns regarding data, and restrictions in performing physical examinations remotely. Key facilitators encompass strong government policy backing, active stakeholder engagement, sustainable financial models, targeted workforce training (notably indigenous-focused), investment in infrastructure, and the adoption of hybrid care models combining in-person and virtual services. Notably, the nature and severity of these challenges and facilitators vary across countries of different income levels, underscoring the necessity of tailored, context-sensitive strategies. Conclusion Implementing virtual clinics in underserved areas faces multifaceted challenges, but strategic facilitators can significantly advance their adoption and sustainability. Context-specific approaches considering economic capacities, infrastructural strengths, and workforce readiness are essential. Strengthening infrastructure, enhancing digital literacy, supporting human resource development, and formulating enabling policies form the cornerstone for equitable and enduring virtual healthcare access in marginalized regions. Clinical trial Not applicable.

Background Well-functioning primary health care (PHC) systems are needed to meet the challenges of aging populations and increasing care needs. However, “medical deserts”, areas with poor accessibility and availability of PHC services, remain a significant issue throughout Europe, contributing to regional inequalities. Identifying the location of these areas is crucial for effective policymaking and for improving health outcomes. Our aim was to locate underserved areas in Finland by developing a medical desert index. In addition, we examined the impact of telehealth, care needs, and multiple funding sources on the index and analyzed its association with key quality indicators. Methods The index was calculated using routinely collected municipality-level PHC consultation data from 2022 adjusted for population care needs (availability) and the average travel time to the nearest PHC center (accessibility). Telehealth and occupational healthcare consultations were included separately. Standardized index values were mapped and categorized using descriptive analysis, and compared with indicators of healthcare utilization, care accessibility and availability, care satisfaction, and continuity of care using correlation analysis. Results The index displayed clear patterns of medical deserts, primarily in the rural areas of northern and eastern Finland. Approximately 13% of the Finnish population resided in medical deserts, defined as a standard score of -0.5 or lower. The inclusion of telehealth consultations appeared to improve the index values especially in some rural areas. Better accessibility and availability of PHC services, as indicated through the index, was significantly correlated with lower proportion of acute care consultations, fewer hospital care days, and lower continuity of care among clients aged 65 years and older. Conclusions We were able to identify medical deserts in Finland utilizing novel methodology distinct from previous indicators, and thus providing important considerations for future research on regional inequalities in accessibility and availability of PHC services. Our findings demonstrated the potential of telehealth services in mitigating medical deserts, though its appropriateness for some population groups and care needs remains unclear. We call for health policy addressing PHC service provision especially in rural areas.