Social science & medicine
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Social science & medicine · Nov 2012
Revenue, relationships and routines: the social organization of acute myocardial infarction patient transfers in the United States.
Heart attack, or acute myocardial infarction (AMI), is a leading cause of death in the United States (U. S.). The most effective therapy for AMI is rapid revascularization: the mechanical opening of the clogged artery in the heart. ⋯ Transfer destination selection was primarily driven at an institutional level by organizational concerns and bed supply, rather than physician choice or patient preference. Transfer routinization emerged as a form of social order that invoked tradeoffs between process speed and efficiency and patient-centered, quality-driven decision making. We consider the implications of routinization and institutional imperatives for health policy, quality improvement and health informatics interventions.
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Social science & medicine · Nov 2012
Impact of gender-based career obstacles on the working status of women physicians in Japan.
Research has shown that women physicians work fewer hours and are more likely to become inactive professionally and to switch to part-time labor, compared with their male counterparts. The published literature suggests that a gender disparity still exists in medicine which may decrease work motivation among women physicians. The authors investigated whether the experience and the perception of gender-based career obstacles among women physicians in Japan are associated with their working status (i.e., full-time vs. part-time). ⋯ The scores for perception of gender-based career obstacles were statistically higher among part-time workers compared with full-time workers (mean difference = 1.20, 95% CI: 0.39-2.00). Adjusting for age, marital status, the presence of children, workplace, board certification, holding a PhD degree, overall satisfaction of being a physician, and household income, stepwise logistic regression models revealed that physicians with the strongest perception of gender-based career obstacles were more likely to work part-time rather than full-time (OR, 0.59; 95% CI: 0.40-0.88). Although the experience of gender-based obstacles was not associated with working status among women physicians, the results demonstrated that a strong perception of gender-based obstacles was associated with part-time practice rather than full-time practice.
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Social science & medicine · Nov 2012
Hidden costs: the direct and indirect impact of user fees on access to malaria treatment and primary care in Mali.
About 20 years after initial calls for the introduction of user fees in health systems in sub-Saharan Africa, a growing coalition is advocating for their removal. Several African countries have abolished user fees for health care for some or all of their citizens. However, fee-for-service health care delivery remains a primary health care funding model in many countries in sub-Saharan Africa. ⋯ The effects of user fees were amplified by conditions of poverty, as well as gender and health inequality; user fees in turn reinforced the inequalities created by those very conditions. The qualitative data reveal multi-faceted health and socioeconomic effects of user fees, and illustrate that user fees for health care may impact quality of care, health outcomes, food insecurity, and gender inequality, in addition to impacting health care utilization and household finances. As many countries consider user fee abolition policies, these findings indicate the need to create a broader evaluation framework-one that can measure the health and socioeconomic impacts of user fee polices and of their removal.