The impact of decentralization of health care administration on equity in health and health care in Canada

Zhong, Hai

doi:10.1007/s10754-010-9078-y

Cited by 17 publications

(16 citation statements)

References 25 publications

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“…This finding is consistent with evidence from Spain and Canada (Costa-Font and Rico, 2006;Costa-Font, 2010;Zhong, 2010). The inequality indices are different from zero, but when examining trends in inequalities in outcomes, we find a declining inequality after the consolidation and deepening of decentralization processes.…”

Section: Resultssupporting

confidence: 88%

“…Giannoni and Hitris (2002) find evidence that decentralization has increased the diversity of regional expenditure per capita in Italy. In contrast, Zhong (2010) concludes that regional decentralization in Canada has reduced inter-provincial inequalities while it has increased intra-regional differences in utilization. Similarly, studies examining health care activity (Quadrado et al, 2001) and outputs and outcomes (Costa-Font and Rico, 2006) find a reduction of regional inequalities following the first wave of regional devolution in Spain.…”

Section: Introductionmentioning

confidence: 91%

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Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?

Costa‐Font

Turati

2016

SSRN Journal

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Does regional decentralization threaten the commitment to regional equality in government outcomes? We attempt to shed light on this question by drawing on unique evidence from the largest European unitary states to have engaged in countrywide health system decentralization: Italy and Spain. We estimate, decompose, and run counterfactual analysis of regional inequality in government output (health expenditure per capita) and outcome (health system satisfaction) during expansion of health care decentralization in both countries. We find no evidence of increase in regional inequalities in outcomes and outputs in the examined period. Inequalities are accounted for by differences in health system design. JEL-Codes: H700, I180, I300.

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Section: Resultssupporting

confidence: 88%

Section: Introductionmentioning

confidence: 91%

Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?

Costa‐Font

Turati

2016

SSRN Journal

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“…3 Nevertheless, we have to keep in mind that the bulk of the decentralization process occurred in 2002. 4 See, among many others, the collective work of Saltman et al (2007), the reviews of Jiménez-Rubio (2010) andandKolehmainen-Aitken (2005), the works of Bossert et al (2003) and Arreondo and Orozco (2005) for Latin American countries, the analyses of some African experiences by Jepsson and Okuonzi (2000) and Akin et al (2005), Tang and Bloom (2000) on China, Jiménez-Rubio et al (2008) and Zhong (2010) on Canada, Ferrario and Zanardi (2011) on Italy and Cantarero and Pascual (2006) on European Union countries.…”

Section: Introductionmentioning

confidence: 99%

Effects of health care decentralization in Spain from a citizens’ perspective

et al. 2013

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The aim of this article is to analyze the impact of the decentralization of the public national health system in Spain on citizens' satisfaction with different dimensions of primary and hospital care. Using micro-data from the Health Barometer 1996-2009 and taking advantage of the exogeneity of the different pace of decentralization across Spain, we find that, in general, decentralization has not improved citizens' satisfaction with different features of the health services. In fact, the only significant -though smalleffects found were of the opposite sign, i.e., a reduction in satisfaction as a result of decentralization, regarding the following aspects of medical care: assistance in the primary care centers, waiting time before consultation, ease of getting appointments, confidence transmitted by doctors and the number of persons per hospital room.

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“…In theory, the trend away from federal health care administration could increase disparity in the access to health services between provinces. 31,32 The restrictive policies in some provinces have been cited as a barrier to HCV treatment by patients and providers. 33 Although we found no evidence of provincial effects in our data, our estimates were not precise enough to rule out such effects.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Variation between Canadian centres in the uptake of treatment for hepatitis C by patients coinfected with HIV: a prospective cohort study

et al. 2013

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Background: Uptake of treatment for hepatitis C virus (HCV) is low in Canada despite its publicly funded health care system. We explored the uptake of HCV treatment within the Canadian Co-infection Cohort to determine if some treatment centres have been more successful than others at starting patients with HIV-HCV coinfection on HCV treatment. Methods:We estimated the variation between 16 centres in the uptake of HCV treatment using a Weibull time-to-event model with adjustment for patient characteristics that are thought likely to influence the uptake of treatment. We asked the principal investigator at each centre about access to hepatitis-related specialists and services and the importance of various criteria when determining if a patient with HIV-HCV coinfection should receive treatment for HCV. Results:Among 681 untreated patients in the Canadian Co-infection Cohort, 163 patients with HIV-HCV coinfection started HCV treatment over a period of 1827 patient-years (9 per 100 patient-years). Even after adjustment for case mix, there was still appreciable variation in treatment uptake between centres, with mean hazard ratios of 0.43 (95% credible interval 0.11-1.3) and 3.6 (95% credible interval 1.7-8.4) for the centres least and most likely to start an average patient with HIV-HCV coinfection on HCV treatment. The most important criteria reported by principal investigators for determining eligibility for treatment were severity of fibrosis, current psychiatric comorbidities, current alcohol intake, past HCV treatment and a history of reinfection with HCV. However, the opinions were wide-ranging: 8 of the 15 criteria elicited both the responses "less important" and "very important." Interpretation:The magnitude of the centre effects and diverse opinions about the importance of treatment eligibility criteria suggest that provider-related barriers to HCV treatment uptake are as important as patient-related barriers. AbstractCMAJ OPEN, 1(3) E107 Research CMAJ OPENare infected with HCV. 11,12 In a recent survey, 80% of Canadian physicians who specialize in HCV said that they were not likely to provide HCV treatment to active injection drug users. 13 Injection drug users are often considered ineligible for treatment because of poor adherence to care, psychiatric illness or ongoing use of drugs or alcohol. 14,15 Even if eligible, patients with HCV may be reluctant to start treatment. 16 In the United States, patients are less likely to be offered and to accept HCV treatment if they are older, male, not white, infected with a difficult-to-treat HCV genotype, have psychiatric illness, or if they use drugs or alcohol. [17][18][19] Many studies have evaluated these patient-related barriers to treatment, 20,21 which are difficult to overcome. Provider and institutional barriers are also important; 17,22 these are perhaps more amenable to intervention. Although having access to an experienced provider is clearly important for the uptake of HCV treatment, [17][18][19] it is not clear what other provider and institutional bar...

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The impact of decentralization of health care administration on equity in health and health care in Canada

Cited by 17 publications

References 25 publications

Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?

Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction?

Effects of health care decentralization in Spain from a citizens’ perspective

Variation between Canadian centres in the uptake of treatment for hepatitis C by patients coinfected with HIV: a prospective cohort study

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