Annotated Bibliography Mind Map

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Universal Healthcare Impacting Women's Health

Source 8: WEBSITE Gunja, M. Z., Seervai, S., Zephyrin, L. C., & Williams II, R. D. (2022, April 5). Health and health care for women of reproductive age. Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2022/apr/health-and-health-care-women-reproductive-age

This article shows many visuals of women in the top 11 wealthiest countries and answer questions based on their care. These visuals would be helpful to include in my research paper as it is glaringly obvious in the research that something in the United States Healthcare System must change.

When looking at all women, we found that those in the U.S. have the highest rate of avoidable deaths: nearly 200 in 100,000 deaths could have been prevented or treated with the right care provided at the right time. Swiss women are the least likely to die from a preventable or treatable cause. High rates of avoidable deaths often indicate shortcomings in public health and care delivery systems. Broad use of primary and preventive health care services, including cancer screenings and immunizations, can reduce the number of premature and unnecessary deaths.4

America’s outlier status on this measure likely stems from the large number of women who lack health insurance — 10 million — as well as the high copayments, coinsurance, and deductibles that many U.S. women enrolled in commercial health plans face when seeking care.3

High health care costs are significant burdens for many U.S. households, even those covered by health insurance. Over one-quarter of women of reproductive age in the U.S. and Switzerland spend USD 2,000 or more in out-of-pocket medical costs, as compared with less than 5 percent of women in the U.K., France, and Netherlands. These high costs can discourage women from seeking needed medical care,

This article discusses the results of Commonwealth Fund's 2020 International Health policy Survey and compares outcomes for women of reproductive age in 11 countries. The authors also explore other nation's policies that have been put in place for ensure equitable access and better health outcomes and what would be suggested for the United States.

Source 7: WEBSITE Quick, J., Jay, J., & Langer, A. (2014, January). Improving women’s health through Universal Health Coverage. PLoS medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC3882205/#:~:text=Universal%20health%20coverage%20(UHC)%20is,full%20spectrum%20of%20health%20services.

I plan to use this source as a way to connect with the other sources as further explanation of why women's health is important to assist in funding.

Thailand's 2001 UHC program expanded access to nearly 100% of the population for comprehensive benefit package, which included a wide range of maternal, sexual, and reproductive health services. Equitable public financing reduced out-of-pocket spending and virtually eliminated medical impoverishment. A national study conducted in 2005–2006 found a negligible gap between rich and poor in prenatal care, delivery care, and family planning [21]. In 1999, Rwanda established community-based health insurance (Mutuelles de santé) as part of its strategy for UHC [22].

Women, children, and others most visibly affected by health care inequalities stand to gain the most from well-designed UHC programs. First, UHC removes financial barriers such as user fees at the point of service, reducing burdens on poor people, and especially women, who often have primary responsibility for their families' health care but lesser access to cash.

An extensive WHO analysis of women and health confirms, for example, the extent of deaths from unsafe abortion, the limited progress in reducing unmet need for family planning in sub-Saharan Africa, and the reality that roughly 80% of cervical cancers occur in countries where prevention, screening, and treatment are limited or non-existent [11].

This article on the National Library of Medicine website discusses improving women's health through Universal Health Coverage. This articles gives general examples of embracing women's health as a key priority.

Source 6: Socías, M. E., Shoveller, J., Bean, C., Nguyen, P., Montaner, J., & Shannon, K. (2016). Universal coverage without universal access: Institutional barriers to health care among women sex workers in vancouver, canada. PloS One, 11(5), e0155828-e0155828. https://doi.org/10.1371/journal.pone.0155828

This source is used as a possible argument for the topic that Universal Health Coverage would not be completely beneficial to the overall wellbeing of women's health in the United States as there are still many barriers in this system because of human error. These arguments could be used to find possible solutions for the above issue.

A key and extremely relevant finding of the current study is that sex workers reporting having experienced violent events, either at the partner-, workplace- (i.e., client violence), or community-level (i.e., threatened by community residents or businesses), were at 30% to 50% increased odds of experiencing institutional barriers to health care. This is in line with previous research demonstrating links between partner- and workplace-based violence and reduced access to health services [20, 30–32]. These findings reflect the pervasiveness of violence, as well as ongoing stigma and discrimination against sex workers.

Despite Canada’s universal health system, our results show that women sex workers in Vancouver face high prevalence of institutional barriers to health care. Over a 44-month follow-up period, seven of every ten participants reported institutional barriers to health services, approximately three-times higher than estimates of difficulty accessing care among the general Canadian population

In total, 723 sex workers were included, contributing to 2506 observations. Over the study period, 509 (70.4%) women reported one or more institutional barriers to care. The most commonly reported institutional barriers to care were long wait times (54.6%), limited hours of operation (36.5%), and perceived disrespect by health care providers (26.1%)

This study takes a look at Canada, a country with Universal Health Coverage, and how sex workers are discriminated by lack of access to care. This article explains the stigma and lack of respect in the community, particularly in healthcare settings, and how they are not quite getting adequate care.

Source 5: Kesici, Z., & Yilmaz, V. (2023). Insurance-based disparities in breast cancer treatment pathways in a universal healthcare system: A qualitative study. BMC Health Services Research, 23(1), 112-10. https://doi.org/10.1186/s12913-023-09108-0

This source provides insight on the fact that there is not sufficient knowledge of Universal Healthcare and patients understanding their rights. This also will be used in showing that some hospitals do not comply with the requirements of the public insurance, costing more out of pocket for those with private health insurance, and how the public healthcare should theoretically work.

The lack of adequate information about statutory entitlement was also prevalent among those who relied on SHI, and the impact of this misinformation on this group is more severe. Patients with only SHI are at a distinct disadvantage in that they have to make informal payments to continue their treatment. This happens because private hospitals do not comply with social health insurance regulations.

Although co-insurance is required for most private services, breast cancer treatment is exempt; it is completely free of charge at the point of service [20]. Türkiye has witnessed an upsurge in the number of its citizens who hold private health insurance (PHI) in the last decade, which is an intriguing trend in a universal healthcare system, up from less than a million in 2010 to more than 6.5 million (out of a population of almost 85 million) by the end of 2021

Turkish breast cancer is often diagnosed only when the patient presents to the hospital with symptoms. Importantly, Türkiye is a UMIC with a universal healthcare system where the state’s social health insurance (SHI) pays for all breast cancer treatment, whether it is from a public or private hospital.

This study follows twelve women who are cancer patients in Turkiye, which is a country with Universal Healthcare. This study shows their disparities in spending and the insufficient knowledge of their rights and how they end up paying more out of pocket.

Source 4: Lu, C., Chin, B., Lewandowski, J. L., Basinga, P., Hirschhorn, L. R., Hill, K., Murray, M., & Binagwaho, A. (2012). Towards universal health coverage: An evaluation of rwanda mutuelles in its first eight years. PloS One, 7(6), e39282-e39282. https://doi.org/10.1371/journal.pone.0039282

My plan for this source is to use it as another example of how another country has utilized a public health coverage policy to better the health outcomes of its citizens, especially in the lower income class.

The difference between years was statistically significant. Between 2000 and 2008, under-five child mortality, infant mortality, and maternal mortality also declined drastically and are lower than the average estimates in the sub-Saharan countries

Before 1999, the majority of the population in Rwanda had no health insurance. The uninsured population had to pay for health services out-of-pocket. Facing limited resources, the GoR has been implementing Mutuelles since 1999 to provide affordable basic services, especially child and maternal care, to the uninsured population

The findings show that Mutuelles improved medical care utilization and protected households from catastrophic health spending. Among Mutuelles enrollees, those in the poorest expenditure quintile had a significantly lower rate of utilization and higher rate of catastrophic health spending.

This study, also on the National Library of Medicine website shows a comprehensive study on the effects of public coverage in Rwanda, showing the decline in catastrophic spending, maternal mortality, and shows tables to show the difference between years on how this public coverage has affected the lower income families of this country.

Source 3: Atuhaire, P., Kiracho-Ekirapa, E., & Mutenyo, J. (2023). How equitable is utilization of maternal health services in uganda? implications for achieving universal health coverage. BMC Health Services Research, 23(1), 800-800. https://doi.org/10.1186/s12913-023-09749-1

I plan to use this source as an example of how Universal Health Coverage helps the disparities in Uganda and how they are improving the outcomes using this process.

Declining inequalities in utilisation of maternal healthcare reflect a move towards achieving universal health coverage in Uganda

Women from the richest quintile were 4 times more likely to receive a package of care compared to the poorest women, but were just 1.5 times more likely to receive ANC4 + than those in the poorest quintile.

This article from the National Library of Medicine explains a study in Uganda analyzes the inequalities in maternal healthcare in order to achieve Universal Healthcare.

Source 2: Hieb, L. D. (2004). Universal healthcare is not the solution. Orthopedics (Thorofare, N.J.), 27(4), 363-365. https://doi.org/10.3928/0147-7447-20040401-05

My plan

I plan to use this source as a counterargument to respond to.

If healthcare is a right, then somehow the government must ensure that the right is fulfilled and protected. In short, the government would be empowered to compel physicians to treat people, and if that were insufficient, would be able to compel its citizens to study medicine or to move to under-served areas–whatever it would take to guarantee this right

However, the difference between America’s poor and the poor in most countries is dramatic. In contrast, in truly socialized systems, only a very few at the center of the system obtain high quality care.

The average time for breast cancer treatment in the Canadian medical system a few years ago was noted to be 45 days. Recent studies have suggested that the breast cancer mortality in Britain and Canada is higher than it is in the United States, and this lag to treatment cannot be discounted as a causative factor

This compelling argument by an MD explains, in her opinion, why universal healthcare is not the answer. She explains her reasons by citing sources where patients are not happy with the results they are receiving. Her purpose of writing is that socialism will not work in providing access to care.

Source 1: Basu, S., Andrews, J., Kishore, S., Panjabi, R., & Stuckler, D. (2012). Comparative performance of private and public healthcare systems in low- and middle-income countries: A systematic review. PLoS Medicine, 9(6), e1001244-e1001244. https://doi.org/10.1371/journal.pmed.1001244

My Plan

Use this resource to highlight specifically the women's health portion of this study weighing the pros and cons of private and public health, specifically patient outcomes and the wellbeing of the women in these countries.

3 Quotes

h. In Brazil, privatization of fertility control services led to increased abortions, sterilization, and improper use of oral contraceptives (obtained without medical consultation), ultimately linked to higher mortality rates among young women

g. Dispensation of unnecessary medications and procedures was also reported to be higher among private sector providers according to four reports based on chart reviews

f. Two studies in South Africa found that the majority of private general practitioners were not aware of the recommended medications, doses, or durations for treatment of sexually transmitted infections [54,55]. Reviews in Nigeria and Laos reported similarly widespread use of ineffective therapies for malaria in the private sector [56,57]. Sexually transmitted disease management in private clinics and drugs shops in Uganda revealed that 93% of cases were not properly managed per national guidelines, and the cure rate was 47% [58].

Summary

This study talks about the pros and cons of public versus private health in various countries, explaining complaints and praises of each.