Article

Informal politics and inequity of access to health care in Lebanon.

Program in Health Care Financing, Harvard School of Public Health, 124 Mount Auburn Street, Suite 410, Cambridge, MA 02138, USA.
International Journal for Equity in Health (impact factor: 1.71). 05/2012; 11:23. DOI:10.1186/1475-9276-11-23
Source: PubMed

ABSTRACT Despite the importance of political institutions in shaping the social environment, the causal impact of politics on health care access and inequalities has been understudied. Even when considered, research tends to focus on the effects of formal macro-political institutions such as the welfare state. We investigate how micro-politics and informal institutions affect access to care.
This study uses a mixed-methods approach, combining findings from a household survey (n = 1789) and qualitative interviews (n = 310) in Lebanon. Multivariate logistic regression was employed in the analysis of the survey to examine the effect of political activism on access to health care while controlling for age, sex, socioeconomic status, religious commitment and piety.
We note a significantly positive association between political activism and the probability of receiving health aid (p < .001), with an OR of 4.0 when comparing individuals with the highest political activity to those least active in our sample. Interviews with key informants also reveal that, although a form of "universal coverage" exists in Lebanon whereby any citizen is eligible for coverage of hospitalization fees and treatments, in practice, access to health services is used by political parties and politicians as a deliberate strategy to gain and reward political support from individuals and their families.
Individuals with higher political activism have better access to health services than others. Informal, micro-level political institutions can have an important impact on health care access and utilization, with potentially detrimental effects on the least politically connected. A truly universal health care system that provides access based on medical need rather than political affiliation is needed to help to alleviate growing health disparities in the Lebanese population.

0 0
 · 
0 Bookmarks
 · 
54 Views
  • Article: Social differentials in the decline of infant mortality in Sweden in the twentieth century: the impact of politics and policy.
    Bo Burström
    [show abstract] [hide abstract]
    ABSTRACT: This article describes some of the policies behind the decline of infant mortality in Sweden during the 20th century, from very high levels and large social differentials at the turn of the 19th century to one of the lowest levels in the world by 1950. Political commitment to reducing infant mortality and disparities between groups, a more equitable distribution of economic resources, and a successful combination of universal social and health policies most benefiting the least advantaged families and their children contributed to this favorable development.
    International Journal of Health Services 02/2003; 33(4):723-41; discussion 743-9. · 1.21 Impact Factor
  • Article: Do welfare regimes mediate the effect of socioeconomic position on health in adolescence? A Cross-national comparison in Europe, North America, and Israel.
    Alessio Zambon, Will Boyce, Ester Cois, Candace Currie, Patrizia Lemma, Paola Dalmasso, Alberto Borraccino, Franco Cavallo
    [show abstract] [hide abstract]
    ABSTRACT: This article examines whether different types of welfare states mediate the effect of socioeconomic position on adolescents' health. The authors' main hypothesis is that countries with stronger redistributive policies will be more effective in weakening the association between socioeconomic position and health, thus reducing health inequalities. Analyses were carried out for Israel and 32 countries of Europe and North America. Data in the 2001-2002 Health Behavior in School-aged Children survey were collected through self-administered questionnaires distributed in schools to boys and girls 11, 13, and 15 years old. Socioeconomic position was measured with the Family Affluence Scale, based on reported consumption in the family. Health indicators were perceived health, general well-being, symptom load, and health behaviors. Social welfare regimes were classified using an expanded Esping-Andersen classification. The analysis supports the authors' hypothesis, at least partially. Social democratic and conservative welfare regimes rank lowest in the strength of association between low socioeconomic position and poor health, followed by liberal and other regime types, but it is more difficult to interpret data from Mediterranean and post-communist countries.
    International Journal of Health Services 02/2006; 36(2):309-29. · 1.21 Impact Factor
  • Article: Differences in self reported morbidity by educational level: a comparison of 11 western European countries.
    A E Cavelaars, A E Kunst, J J Geurts, R Crialesi, L Grötvedt, U Helmert, E Lahelma, O Lundberg, J Matheson, A Mielck, A Mizrahi, N K Rasmussen, E Regidor, T Spuhler, J P Mackenbach
    [show abstract] [hide abstract]
    ABSTRACT: To assess whether there are variations between 11 Western European countries with respect to the size of differences in self reported morbidity between people with high and low educational levels. National representative data on morbidity by educational level were obtained from health interview surveys, level of living surveys or other similar surveys carried out between 1985 and 1993. Four morbidity indicators were included and a considerable effort was made to maximise the comparability of these indicators. A standardised scheme of educational levels was applied to each survey. The study included men and women aged 25 to 69 years. The size of morbidity differences was measured by means of the regression based Relative Index of Inequality. The size of inequalities in health was found to vary between countries. In general, there was a tendency for inequalities to be relatively large in Sweden, Norway, and Denmark and to be relatively small in Spain, Switzerland, and West Germany. Intermediate positions were observed for Finland, Great Britain, France, and Italy. The position of the Netherlands strongly varied according to sex: relatively large inequalities were found for men whereas relatively small inequalities were found for women. The relative position of some countries, for example, West Germany, varied according to the morbidity indicator. Because of a number of unresolved problems with the precision and the international comparability of the data, the margins of uncertainty for the inequality estimates are somewhat wide. However, these problems are unlikely to explain the overall pattern. It is remarkable that health inequalities are not necessarily smaller in countries with more egalitarian policies such as the Netherlands and the Scandinavian countries. Possible explanations are discussed.
    Journal of Epidemiology &amp Community Health 05/1998; 52(4):219-27. · 3.19 Impact Factor

Show more

Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

causal impact
 
detrimental effects
 
formal macro-political institutions
 
health aid
 
health care
 
health care access
 
health disparities
 
health services
 
higher political activism
 
highest political activity
 
micro-level political institutions
 
political activism
 
political parties
 
provides access
 
qualitative interviews
 
religious commitment
 
reward political support
 
socioeconomic status
 
universal health care system
 
welfare state
 

Bradley Chen