Access to Healthcare

Despite accelerated growth in the field of transgender health, mistrust between trans patients and their providers persists. Insufficient education for providers, research that overlooks patients' foremost concerns, and continued stigma and discrimination in medical settings are among the main barriers leading trans patients to delay or avoid care. Consequently, the transgender community often turns to social media as a self-serve resource for medical knowledge. This article discusses the benefits of directly engaging the trans community using social media to educate professionals, drive relevant research, and inform practice, to ultimately deliver higher quality care.

This document reports the proceedings of a research-to-policy workshop that was organized as part of a multi-country cross-disciplinary research project on the private health care sector in urban poor neighbourhoods in India, Indonesia and Thailand, entitled "Health System Reform and Ethics: Private Practitioners in Poor Urban Neighbourhoods in India, Indonesia and Thailand". The project consisted of a combination of medical anthropological research among private (for-profit) practitioners and among people living in poor urban neighbourhoods; a health economics study among poor urban households and a desk study that assessed existing regulations and ethical guidelines in the three
countries. The project period was April 2004 to December 2007.
A number of other studies in the past have shown that the role of the private sector can be problematic, perhaps even more so in India than in the other participating countries. At the same time, there has been
a push of public-private partnerships. The workshop intended to discuss the rationale, the benefits and limitations and risks of this strategy. Even if there are examples of successful partnerships that serve sound public health purposes, such partnerships may not address the structural problems that establish effective access barriers for the poor. Based on research that provided a critical assessment of the role of the private sector the workshop should develop relevant strategies to address public health problems related to the role of the private-for-profit health sector. The overall purpose of the project was to identify viable strategies for strengthening ethical practice in the private healthcare sector in poor neighbourhoods through feasible and locally acceptable control mechanisms and other possible means.
It was believed that this is only possible through a combined understanding of patients’, private practitioners’ and drug vendors’ perspectives. Health ethics, in this connection, may be broadly
understood as a consensus-based normative regulatory framework that primarily works to protect patients against iatrogenic adverse events when utilizing the health system. The existing scientific literature shows that a framework of this type is not in place, or is not working to the desired effect, in a number of countries in South- and Southeast Asia.
The project consisted of four sub-studies that complemented each other in order to give a detailed and multi-faceted understanding of the local health systems under study:

1) Existing regulatory mechanisms, including ethical codes and legislation with direct implications for general private practitioners: desk study
2) Health systems ethics among private practitioners: ethnographic sub-study
3) Family-level treatment and health-related decision-making: interview sub-study
4) Household survey: health economics sub-study
The project was funded by the Danida Council for Development Research (RUF, after 2006 renamed to FFU) with a budget of four million DKK covering a period of three years (2004-07).

The workshop During 20-22 June 2007, a 3-day workshop was held at Naresuan University, Phitsanulok, Thailand, to disseminate findings of this and related research in the region and develop policy implications.

This paper examines the experiences of people displaced internally by climate-related factors in mainland Bangladesh, one of the world's most climate-vulnerable countries. The data derives from a representative survey of 1,200 households drawn equally from displacement-susceptible areas and areas without climate-related displacement. Comparisons are drawn on the basis of four variables: the displaced versus the non-displaced; before displacement versus after displacement; people displaced suddenly versus those displaced gradually; and the frequency of past displacement. The displaced experience multiple disadvantages, including reduced land ownership and reduced access to electricity, sanitary toilets and healthcare services. The disadvantage is greater following sudden displacement and among those who have been displaced multiple times. The impact on the time and cost of accessing healthcare are greater after displacement. The disadvantage of the displaced, thus, is a function of interactions between exposure to natural disaster, impoverishment and lack of access to health services.

The case-law of the Court of Justice (ECJ) on patient mobility was recently challenged by a ruling that a patient could go to Germany for treatment when facilities in Romanian hospitals were inadequate. Given the reported impact of austerity measures in the field of health care this raises the question; what is the impact of the ECJ's ruling on how Member States can manage expenditure and limit outflows of patients and how should such measures be legally evaluated? The objective of this paper is to analyse potential impact on health systems in the context of increasing pressure on public financing for health. While the ECJ mainly referred to the requirement of treatment in due time, we also analyse possible austerity reductions of the basket of care against the background of EU law (i.e., ECJ case-law, patient mobility directive, Charter of Fundamental rights and social security regulation).

OBJECTIVE: To identify priorities for improving healthcare organization management of patient access to primary care based on prior evidence and a stakeholder panel. BACKGROUND: Studies on healthcare access show its importance for ensuring population health. Few studies show how healthcare organizations can improve access. METHODS: We conducted a modified Delphi stakeholder panel anchored by a systematic review. Panelists (N = 20) represented diverse stakeholder groups including patients , providers, policy makers, purchasers, and payers of healthcare services, predominantly from the Veterans Health Administration. A pre-panel survey addressed over 80 aspects of healthcare organization management of access, including defining access management. Panel-ists discussed survey-based ratings during a 2-day in-person meeting and re-voted afterward. A second panel process focused on each final priority and developed recommendations and suggestions for implementation. RESULTS: The panel achieved consensus on definitions of optimal access and access management on eight urgent and important priorities for guiding access management improvement, and on 1-3 recommendations per priority. Each recommendation is supported by referenced, panel-approved suggestions for implementation. Priorities address two organizational structure targets (interdisciplin-ary primary care site leadership; clearly identified group practice management structure); four process improvements (patient telephone access management; contingency staffing; nurse management of demand through care coordination; proactive demand management by optimizing provider visit schedules), and two outcomes (quality of patients' experiences of access; provider and staff morale). Recommendations and suggestions for implementation, including literature references, are summarized in a panelist-approved, ready-to-use tool. CONCLUSIONS: A stakeholder panel informed by a pre-panel systematic review identified eight action-oriented priorities for improving access and recommendations for implementing each priority. The resulting tool is suitable for guiding the VA and other integrated healthcare delivery organizations in assessing and initiating improvements in access management, and for supporting continued research. KEY WORDS: access to healthcare; access management; expert panel; stakeholder engagement; primary care; modified Delphi panel; quality improvement; implementation research. J Gen Intern Med