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Influence of immigration on prematurity in the context of a free healthcare system with universal coverage.

ABSTRACT: We assessed the risk of preterm birth according to the mother's place of origin in the context of a free and universal healthcare system. We analysed 75,292 newborn infants born between 2008-2011 in Alicante (Spain). The outcomes were: 1) very preterm (gestational age ? 32 weeks) and 2) moderate-to-late preterm (gestational age 33-37 weeks). Other variables: infant's gender, maternal age and origin. We estimated adjusted odds ratios to analyse the relationship between the outcomes and the other variables. The distribution of the gestational age groups in our sample was: very preterm, 812; moderate-to-late preterm, 5,295; full-term, 69,997. There were no statistically significant differences between the mother's place of origin and the outcomes in this free universal healthcare system, which is experiencing the recent phenomenon of immigration. This equality should be maintained throughout the time the immigrants remain in the country.

SUBMITTER: Cortes E

PROVIDER: S-EPMC4441151 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Influence of immigration on prematurity in the context of a free healthcare system with universal coverage.

Cortés Ernesto E Mercedes Rizo-Baeza María M Palazón-Bru Antonio A Aguilar-Cordero María José MJ Francisco Gil-Guillén Vicente V

Scientific reports 20150522

We assessed the risk of preterm birth according to the mother's place of origin in the context of a free and universal healthcare system. We analysed 75,292 newborn infants born between 2008-2011 in Alicante (Spain). The outcomes were: 1) very preterm (gestational age ≤ 32 weeks) and 2) moderate-to-late preterm (gestational age 33-37 weeks). Other variables: infant's gender, maternal age and origin. We estimated adjusted odds ratios to analyse the relationship between the outcomes and the other ...[more]

PMID: 26000871

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Project description:Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of reliable, comprehensive, and timely health facility data. Please see later in the article for the Editors' Summary.

Project description:BackgroundCountries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region.MethodsWe examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts.Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket.ConclusionLeveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations.

Project description:ObjectivesCountries with universal health coverage (UHC) strive for equal access for equal needs without users getting into financial distress. However, differences in healthcare utilisation (HCU) between socioeconomic groups have been reported in countries with UHC. This systematic review provides an overview individual-level, community-level, and system-level factors contributing to socioeconomic status-related differences in HCU (SES differences in HCU).DesignSystematic review following the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The review protocol was published in advance.Data sourcesEmbase, PubMed, Web of Science, Scopus, Econlit, and PsycInfo were searched on 9 March 2021 and 9 November 2022.Eligibility criteriaStudies that quantified the contribution of one or more factors to SES difference in HCU in OECD countries with UHC.Data extraction and synthesisStudies were screened for eligibility by two independent reviewers. Data were extracted using a predeveloped data-extraction form. Risk of bias (ROB) was assessed using a tailored version of Hoy's ROB-tool. Findings were categorised according to level and a framework describing the pathway of HCU.ResultsOf the 7172 articles screened, 314 were included in the review. 64% of the studies adjusted for differences in health needs between socioeconomic groups. The contribution of sex (53%), age (48%), financial situation (25%), and education (22%) to SES differences in HCU were studied most frequently. For most factors, mixed results were found regarding the direction of the contribution to SES differences in HCU.ConclusionsSES differences in HCU extensively correlated to factors besides health needs, suggesting that equal access for equal needs is not consistently accomplished. The contribution of factors seemed highly context dependent as no unequivocal patterns were found of how they contributed to SES differences in HCU. Most studies examined the contribution of individual-level factors to SES differences in HCU, leaving the influence of healthcare system-level characteristics relatively unexplored.

Project description:Policy Points Although immigration policy is recognized as a social determinant of health, less is known about how mechanisms, such as news coverage of policy, influence intermediary and proximal health processes like seeking health care. The extent of news coverage of federal, state, and local exclusionary or integration immigration policies can influence public agendas regarding immigrant inclusion and exclusion. Exclusionary federal immigrant policies have dominated the news across the United States over the past ten years, despite active immigrant integration policymaking at national, state, and local levels.ContextImmigration policymaking at federal, state, and local levels in the United States has proliferated in the past decade. While evidence demonstrates that immigration policy is a determinant of health, there has been limited examination of the mechanisms by which policy influences proximal health processes. News coverage has served as a central platform for debates over restrictive and inclusive immigration policies and may constitute an important health mechanism by shaping public agendas, influencing support for immigrant exclusion or inclusion, and framing policy issues, thereby influencing immigrants' social climates. This study sought to examine the extent of news coverage of exclusionary and inclusive immigration policy at federal and state levels and variations in messages about immigrants during two periods of extensive policymaking.MethodsWe conducted a quantitative content analysis of newspapers' coverage of immigration policy between 2010 and 2013 and between 2017 and 2019. We conducted a systematic NewsBank search of articles covering legislation, lawsuits, and other policies related to immigration (n = 931). Articles were coded for policy type and level, positive or negative framing of immigrants, and other characteristics. Our analysis then compared the patterns of the two periods.ResultsIn both periods, the majority of coverage focused on exclusionary policies at the federal level, despite a significant increase in integration policies between 2017 and 2019. We found significant shifts in both the negative and positive framing of immigrants, from the dominant negative messages of immigrants as an economic drain to immigrants as criminals and the dominant positive messages of immigrants' economic contributions to immigrants as families.ConclusionsSince 2010, coverage of exclusionary federal policy has consistently dominated the news, as messages have increasingly described immigrants as either criminals or part of families. We discuss the health implications and future research directions of news coverages' role in influencing the immigration policy and social contexts that have been linked to health outcomes.

Dataset Information

Influence of immigration on prematurity in the context of a free healthcare system with universal coverage.

Publications

Influence of immigration on prematurity in the context of a free healthcare system with universal coverage.

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