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Are There Differences Between Healthcare "Needs" and "Wants" in Low Socioeconomic Populations?

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From a Public Health point of view, health economics is just one of many disciplines that may be used to analyse issues of health and health care, specifically as one of the set of analytical methods labelled Health Services Research. But from an economics point of view, health economics is simply one of many topics to which economic principles and methods can be applied. So, in describing the principles of health economics, we are really setting out the principles of economics and how they might be interpreted in the context of health and health care. Health economics is the application of economic theory, models and empirical techniques to the analysis of decision-making by individuals, health care providers and governments with respect to health and health care.

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The standard theory of how markets work is the model of supply and demand, in which buyers and sellers are guided by prices to an efficient allocation of resources. Yet, as we will see, the market for healthcare deviates from this model in many ways. These deviations often call for government policies to ensure that healthcare resources are allocated efficiently and equitably. And, indeed, in most nations, governments are deeply involved in healthcare markets. After discussing the forces at work in healthcare markets, we look at some key facts that describe the healthcare system in the United States. The healthcare system today is very different from what it was fifty years ago, and it is also different from the healthcare systems in other nations. Recognizing these differences is important for understanding the healthcare system we have as well as for imagining systems we could have. The proper scope of government intervention in the healthcare system is a topic of continuing political debate. We won’t go into the details of that debate here. But this basic introduction to the economics of healthcare should help you become a more informed participant in what will surely be an ongoing national discussion for many years to come.Healthcare is not the only good or service in the economy that departs from the standard model of supply, demand, and the invisible hand. But healthcare may be the most important good or service that departs so radically from this benchmark. Examining the special features of this market is a good starting point for understanding why the government plays a large role in the provision of healthcare and why health policy is often complex and vexing.

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Ensuring access to timely and appropriate primary healthcare for deprived patients is an issue facing all countries, even those with universal healthcare systems. There is a paucity of information on how patients living in a context of material and social deprivation perceive barriers in the healthcare system. This study combines the perspectives of persons living in poverty and of healthcare providers to explore barriers to responsive care for underserved persons with a view to developing equity-focused primary care. Healthcare systems can increase health inequalities if they do not take into account the needs and socioeconomic living conditions of underserved populations [1,2]. The most recent Marmot report [3] draws attention to the alarmingly low consideration given to the causes of social inequalities in the English healthcare system (Loignon C, Bedos C, Sevigny R, 2007). In Canada and Quebec, barriers to universal healthcare represent a heavy burden for certain populations, particularly people living on a low income or social assistance, people with disabilities, Aboriginal peoples, and recent immigrants and refugees in precarious situations. Persons living in poverty (PLPs) are at greater risk for deterioration in health status, chronic illnesses, and premature death than are affluent persons. Yet there is a growing body of evidence indicating that PLPs receive the least amount of healthcare (known as the inverse care law). PLPs are less likely to have a family physician and to obtain preventive and secondary care, and more likely to report negative experiences of care. Compared to moderate and high-income populations, PLPs experience greater need for support to access preventive care and improved care experiences. Yet adequately responding to these needs is often challenging for front-line healthcare providers (HCPs), specifically family physicians and primary care teams (Reid C., 2007).

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In sum, you may be violating Title VI of the Civil Rights Act if you ask questions regarding the citizenship status, immigration status, or SSN of non-applicants and thus deter, delay, or deny eligible consumers from getting health coverage. People not lawfully present can still purchase coverage outside of the FFMs and may be eligible for emergency medical assistance from Medicaid. Unlawfully present people are eligible for an exemption from the PPACA's individual shared responsibility provision. In addition, they aren't subject to a fee (even for tax years prior to 2019) if they don't have coverage. The immigration eligibility rules that apply in the individual market FFMs don't apply in an FF-SHOP Marketplace.

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Loignon C, Bedos C, Sevigny R, Leduc N. Understanding the self-care strategies of patients with asthma. Patient Educ Couns. 2009

Reid C. The wounds of exclusion. Poverty, women’s health and social justice. Oxford: Berg Publishers; 2007.

Mercer SW, Cawston PG, Bikker AP. Quality in general practice consultations; a qualitative study of the views of patients living in an area of high socio-economic deprivation in Scotland. BMC Fam Pract. 2007

Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol. 2006

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Are There Differences Between Healthcare "Needs" and "Wants" in Low Socioeconomic Populations?
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