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    332933

    Proposed areas of investigation for the KN: an initial scoping of the literature. Draft.

    Doherty J; Gilson L

    [Johannesburg, South Africa], University of the Witwatersrand, Centre for Health Policy, Health Systems Knowledge Network, 2006 Feb. [29] p. (Health Systems Knowledge Network (KN) Discussion Document No. 1)

    During July and August 2005 the Health Systems Knowledge Network Hub produced a wide-ranging literature review for discussion at a meeting in India between Hubs and the rest of the Commission on the Social Determinants of Health (Doherty, Gilson and EQUINET 2005). The review was based on literature sourced from within the consortium managing the hub as well as from institutions networked with the consortium members. Some key references from existing materials were also followed up. Given the wide scope of work on health systems, it was not feasible to conduct a general electronic search. Nor was it possible to access substantial quantities of grey literature, given the difficulties associated with identifying and locating copies of this type of literature. Because of time constraints, the review focused on reviews of international experience and articles documenting new lines of investigation. Articles that were, at the time, in press were specifically sought out to ensure as up-todate an evidence base as possible. The review began by presenting data showing that health services tend to be used proportionately more by richer than poorer social groups. It analysed the social factors affecting access to, and uptake of, health services and showed how these interact with inequitable features of the health care system. Overall, the review argued that the interaction between household health-seeking behaviour and experience of the health system generates differential health and economic consequences across social groups. The long-term costs of seeking care often impoverish poorer households, reinforcing preexisting social stratification. The review then examined in some detail the features of the health care system that contribute to inequity (such as certain approaches to priority-setting, resource allocation, financing, organisation, human resources, and management and regulation). (Excerpt)
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