31 March 2010

Healthcare corner #12 - Equity, mental health, and current events

almost done being a faux student.

if these first topics bore you, definitely skip to the end "current events" at least.

first, we had a lecture on equity. so, basically there is equality and then there is equity. equality, at least as used in this context, is literally when everyone has the same amount of something, ie. same amount of resources, same utilization of health care, same access to health care, etc. for our purpose, there is no judgment as to whether this is good or bad, its simply a measure of sameness. for equity, there is a moral or value judgment attached. with health care utilization, for example, we probably want to see older people using the system more since we recognize they tend to have more health problems. if they are using the system the same amount as the healthy 25 year olds, we might be concerned that the older person is not getting the best treatment possible.

there are lots of ways to study this and, of course, its a very hot and controversial field. typically everyone has a favorite population they want to label as being inequitably served. in canada, there have been a number of studies in this area. a few notable findings:
- data from 2000/2001 found that people with low income tended to visit their general practitioners (GPs) less frequently than higher income people. but, those who did visit their GP where then more likely to come back for frequent visits (perhaps showing that they delayed seeing the dr until their condition became more serious...thus requiring more dr visits). this same study also found that people with lower income had less contact with specialists than higher income people.

- studies published between 2004-2006 noted that people of lower socioeconomic status (SES) were more likely to say that they had an "unmet health care need" when surveyed than higher SES people. however, there was no association found with "unmet needs" and immigration status in canada.

- a 1998 study surveyed a sample of cardiac physicians and administrative health care staff about their practices related to preferential access to patients. 80% of doctors and 53% of administrators said that they were aware of preferential access being given to certain patients.
then we had a lecture/discussion on canadian mental health:
1. apparently the world health organization says that at least 5% of a countrys total health care expenditure should be on mental health. in 2003/2004, canada spent this bare minimum (a total of $6.6 billion was spent on mental health with $5.5 billion coming from the public funds).

2. a 2005 paper showed that about 12% of canadians have a self-perceived need for mental health treatment, while almost 20% of canadians are said to have some kind of mental health condition.

3. a 1998 study found that toronto had a total of 1% homelessness in its population. two-thirds of these homeless people had a lifetime mental disorder and two-thirds had a lifetime substance abuse problem. 75% of those people with mental disorders, also had substance abuse problems. the majority suffered from depression.

4. there are some good canadian websites dealing with mental health: one-in-five deals with the mental health of all canadians, and there is another, more local site, focused on teen mental health.
lastly, there have been some current event type articles mentioned by students and my boss in recent days:

1. a news article with updated numbers on canadian wait times.

2. a news article talking about quebecs new provincial budget and the controversial new health care "user fees" they are wanting/needing to impose on people (remember, previously no canadian has had to pay ANYthing when they visit the hospital or their doctor for a necessary health service).

3. there is a neat website about canadian health care with brief "mythbusters." basically short evidence-based summaries are provided to debunk canadian health care system myths. they are well researched and presented in a style to be read by lay-people. they have pertinent topics like "Myth: Canada's system of healthcare financing is unsustainable."

4. shortly after health care reform passed in the u.s., the canadian "globe and mail" did an article about our bill and summarized what was in it. seems like an important piece of reading for people who may still be confused about what is, and what is not, in that legislation...

5. my boss mentioned to the students (since many of them seem to be following the u.s. health care stuff) that she was recently turned on to this blog called "the health care blog," which attempts to keep up on all the u.s. health care goings-on.

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