A Regional Development Index for Portugal

In a report from 2008 the Organization for Economic Cooperation and Development came to the conclusion that Portugal is a country still very much marked by regional asymmetries and in need of better regional governance mechanisms and policies. We propose a regional development index for Portugal at the NUTS III level, based on the methodology of the human development index (HDI) from the United Nations Development Programme, which will be helpful to assess the evolution of the asymmetries between regions and evaluate the need for regional policy. Results show us a country that has most of the highest ranked NUTS III regions positioned along the coastline, although some interior NUTS III regions improved their relative positions in the ranking between 2004 and 2009. In addition to the three traditional dimensions of the HDI—income, education, and health—we include two more, given their increasing importance in the literature that criticizes the HDI and suggests the inclusion of new variables—governance and environment. Results show some considerable differences when we add the environment dimension: the interior regions improve their relative positions in the ranking, but in terms of governance they change little. Results also show that there is still the need for regional policy, although the dispersion in the ranking between the best and worst positioned NUTS III regions has decreased in all dimensions except education.     

Exploring Perceived Discrimination Among LGBT Individuals in Turkey in Education,Employment, and Health Care: Results of an Online Survey

This article explores the discrimination practices encountered by lesbian, gay, bisexual, and transgender (LGBT) individuals in education, income, employment, and health care in Turkey. Limited quantitative data on LGBT individuals are available in Turkey. This study collected data from 2,875 LGBT individuals through a Web-based survey. The findings suggest that LGBT individuals report perceived direct and indirect discrimination in accessing education, employment, and health care. In a country where LGBT rights are not yet recognized and antidiscrimination legislation covering sexual orientation and gender identity is still nonexistent, findings demonstrate perceived discrimination of LGBTs rarely turns into a legal complaint. Even when they do, most LGBTs in our sample report that they did not feel that the justice system addressed their grievances.     

The application of quantitative indices for health planning to regional health service areas in vermont

Health System Agencies (HSAs) are expected to collect and analyze data on the health care delivery systems in their respective geographic areas for the purpose of preventing unnecessary dupplication of health resources and promoting the development of manpower and facilities which meet identified needs and reduce documented inefficiencies. The purpose of this paper is to present the results of a feasibility study of health services in Vermont using a profile system of individual manpower and facility types and summary indices of adequacy and efficiency. The profile system and indices make use of data already available in most health service areas. Profile and the values of summary indices are presented for each of the service areas of Vermont, using state provider/population and facility/population ratios as norms. Profiles and indices based on national norms are also presented for certain types of health professionals. Caveats are given in the interpretation of the results of applying the profile system and indices by health planners.     

Regional Performance Trends in Providing Employment for Persons with Disabilities: Evidence from Italy

The aim of this work is to analyse the situation of persons with disabilities in the Italian labour market, with a view to providing guidelines to promote their inclusion both in the labour market and in society. For this purpose, we propose a two-step analysis focusing on Italian regions for the period 2006–2009. In the first phase, we use the Data Envelopment Analysis method to evaluate regional efficiency in providing employment for persons with disabilities. Cluster analysis is then applied to regional efficiency scores and economic policy variables in order to identify “policy clusters of regions”. Our results show that it is necessary both to focus on the residual work ability of persons with disabilities and to develop a social integration culture on the demand side of the labour market. Moreover, a structural reform of disability benefit systems is required in order to promote a culture of social inclusion.     

政府支出对医疗服务健康公平影响的比较和启示

医疗服务公平和人民的健康是各国卫生系统向其国家居民提供医疗服务所应实现的两个重要目标。但以英美日为例的发达国家根据世界卫生统计年鉴中的医疗服务公平性排名确有明显差距,因此,高收入和高政府医疗卫生支出与医疗卫生服务公平和健康公平性并没有必然关系。本文通过比较分析美日英国的政府间医疗卫生支出责任划分的结构发现高政府医疗卫生支出比例是提高医疗服务筹资公平性的前提,中央承担社会医疗保险责任是实现医疗服务筹资公平性的保证,政府特别是中央政府出资的长期护理有助于提高国民健康水平,地方政府的参与更有助于提高一国医疗系统机构数量特别是医院的数量。     

The Impact of the AIDS Pandemic on Health Services in Africa: Evidence from Demographic and Health Surveys

We document the impact of the AIDS crisis on non-AIDS-related health services in 14 sub-Saharan African countries. Using multiple waves of Demographic and Health Surveys (DHS) for each country, we examine antenatal care, birth deliveries, and rates of immunization for children born between 1988 and 2005. We find deterioration in nearly all these dimensions of health care over this period. The most recent DHS survey for each country collected data on HIV prevalence, which allows us to examine the association between HIV burden and health care. We find that erosion of health services is the largest in regions that have developed the highest rates of HIV. Regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions shouldering the heaviest burdens have seen the largest erosion in non-HIV-related health services for pregnant women and children. Using semiparametric techniques, we can date the beginning of the divergence in the use of antenatal care and in children’s immunizations between high- and low-HIV regions to the mid-1990s.     

Correcting for Scale Perception Bias in Measuring Corruption: an Application to Chile and Spain

Corruption perceptions are commonly utilized as essential information to measure corruption across countries and regions. In this paper we consider the hypothesis that respondents to corruption perception questions utilize different response scales in their answers, i.e. for identical levels of corruption practices, subjects from one country could answer a different level of corruption perception than subjects from another country, based on socioeconomic characteristics. This hypothesis is investigated by utilizing the technique of anchoring vignettes with a sample of citizens in Spain and Chile. The results show that response scales are used differently across individuals in both countries, suggesting that the use of uncorrected measures of corruption perceptions could mislead some conclusions about the comparisons of the corruption levels between countries.     

Differences in Life Expectancy and Disability Free Life Expectancy in Italy. A Challenge to Health Systems

Background Measures of health expectancy such as Disability Free Life Expectancy are used to evaluate and compare regional/national health statuses. These indicators are useful for understanding changes in the health status and defining health policies and decisions on the provision of services because provide useful information on possible areas needing interventions and burden of care to health systems. Methods Two databases have been used for the analysis: the Italian Health Interview Survey and the European Community Household Panel. The data were analyzed by gender and geographic area. DFLE was calculated by the Sullivan method. Results In 2005 in Italy women have a longer life expectancy than men: 84 and 78 years, respectively. But if we consider life without disability in Italy the male disadvantage reduces: men live 85% of their years without disability, women only 75%. Geographic differences do exist because Disability Free Life Expectancy is longer in Northern and in Central regions; shorter in the South. At a European level similar data can be found: on average women live longer but they have a longer time of life with disability. Conclusion In Italy women live longer but have a worse quality of health than men; in the South there is a worse quality of health. Similar findings can be identified at a European level. The Italian situation with the highest percentage of DFLE at 65 out of the total LE at 65 and one of the longest LE witnesses ageing is not necessarily associated to a worsening of health.     

人口因素对公共医疗服务效率的影响——区域差异与动态变化

本文基于2002～2010年我国31个省市的面板数据,在DEA—Tobit两阶段分析框架下研究了人口因素对我国区域公共医疗服务效率的动态影响。首先,通过数据包络分析方法（DEA）测算了各省份医疗卫生体系的综合技术效率、纯技术效率和规模技术效率。在此基础上,利用受限因变量Tobit模型对效率值及人口规模、人口密度、受教育程度、城市化率等人口因素之间的关系进行了检验。研究结果表明：人口规模、人口密度与医疗体系的综合服务效率显著正相关,尽管受教育程度和城市化率与综合效率关系并不明显,但是对医疗体系的规模效率和纯技术效率仍然存在显著影响。     

An Empirical Approach to the Poverty Indicators Based on Revealed Parameters: The Case of Spain

This article investigates the issue of measuring the proportion of the population affected by the phenomenon of poverty in Spain on the basis of the relationship between the severe material deprivation rate and the at-risk-of-poverty rate by regions. The current definitions of equivalence units and equivalent income were analysed and an innovation to allow the introduction of a parametric model, based on the revealed annual consumption of the main different type of households and on the regional purchase power parities, was subsequently proposed. In the case of Spain it was discovered empirically that the equivalence units are not constant, as maintained until now, but that they vary over time. An improvement between the relations of the two rates was obtained by means of the application of these revealed scales. The regional composition was also improved. The results could serve as a base for future studies to provide more detailed information about the breakdown of the relative poverty within each country and, thereby, to meet the relevant information requests, at national and international level, to support the implementation of public policies in this area.     

Does Intergenerational Educational Mobility Shape the Well-Being of Young Europeans? Evidence from the European Social Survey

The level of accessibility to basic services is an important issue because it is closely related to social inclusion and social capital, key aspects of societal well-being. There is a large and growing literature on access to health care in an era of dwindling public resources due to recent economic downturns. Health care is an essential service, but it is not the only basic service. The literature on access to basic services including, but not limited to, health care is relatively small. The paper aims at contributing to the literature by providing a new index to measure and monitor household accessibility to basic services. A study of Italian regions is presented. It is shown that northern regions have more accessible basic services than central, southern and island regions. A longitudinal comparison has been performed. The results are very worrying because show that policy makers have failed in reducing regional (and in particular north–south) disparities in basic service accessibility. Measuring and monitoring the level of accessibility is central for an adequate provision of basic services and for exploring how the delivery of basic services in the most problematic regions can be improved.     

The potential impact of discrimination fears of older gays, lesbians, bisexuals and transgender individuals living in small- to moderate-sized cities on long-term health care

As an exploration of the potential impact of fears of discrimination against GLBTs in long-term health care settings, this study compared perceptions of GLBT persons and heterosexuals. A total of 132 GLBT persons and 187 heterosexuals living in Eastern Washington completed a survey that contained demographic questions and perceptions of discrimination in long-term care settings. Most respondents suspected that staff and residents of care facilities discriminate against GLBTs. GLBT respondents who believed that residents of care facilities are victims of discrimination were more likely to believe that they would have to hide their sexual orientation if admitted to a care facility. GLBT respondents were more likely than heterosexual respondents to believe that GLBTs do not have equal access to health care and social services, that GLBTs residents of care facilities are victims of discrimination, that GLBT sensitivity training programs would benefit staff and residents of care facilities, and that GLBT retirement facilities would be a positive development for older GLBTs. This study is offered as a preliminary investigation of concerns about GLBT discrimination in health care settings, how concerns are expressed, and the implications of those concerns for health care needs.     

The Potential Impact of Discrimination Fears of Older Gays,Lesbians, Bisexuals and Transgender Individuals Living in Small- to Moderate-Sized Cities on Long-Term Health Care

ABSTRACT

As an exploration of the potential impact of fears of discrimination against GLBTs in long-term health care settings, this study compared perceptions of GLBT persons and heterosexuals. A total of 132 GLBT persons and 187 heterosexuals living in Eastern Washington completed a survey that contained demographic questions and perceptions of discrimination in long-term care settings. Most respondents suspected that staff and residents of care facilities discriminate against GLBTs. GLBT respondents who believed that residents of care facilities are victims of discrimination were more likely to believe that they would have to hide their sexual orientation if admitted to a care facility. GLBT respondents were more likely than heterosexual respondents to believe that GLBTs do not have equal access to health care and social services, that GLBTs residents of care facilities are victims of discrimination, that GLBT sensitivity training programs would benefit staff and residents of care facilities, and that GLBT retirement facilities would be a positive development for older GLBTs. This study is offered as a preliminary investigation of concerns about GLBT discrimination in health care settings, how concerns are expressed, and the implications of those concerns for health care needs.     

An Indicator for the Measurement of Political Participation: The Case of Italy

In the modern globalized world, political participation is of paramount importance for balanced socio-economic growth and for human development. The Indagine Multiscopo sulle famiglie, a survey by Italian public institutions (ISTAT and CNEL), provides a wide range of data to evaluate specific aspects of Italian life. This work uses a set of data from the Indagine to analyse political participation in Italy at a regional level, by means of a composite indicator using parametric (Pena’s distance) and non-parametric (Mazziotta–Pareto Index) techniques. We have obtained a ranking that shows the level of political participation in different territorial contexts. The aim is to analyse the relation between Italian regions and the political behaviour of their communities: political discussions, participation in political meetings and marches, voluntary activity or donations to political parties and so on. The ranking is not correlated to voter turnout. We can assume that the politically engaged minority are unable to convince and involve the rest. At the same time, these small groups do not alter the general mistrust in parties and, generally speaking, in politics, which is spreading across Italy and also Europe.     

Gay and lesbian perceptions of discrimination in retirement care facilities

Much research on older gay, lesbian, bisexual and transgender (GLBT) adults has focused on refuting the widely held misconceptions people have about GLBT lifestyles. To date, however, few studies on older GLBTs have examined their social and health care needs. Further, most studies have collected survey samples of older GLBT adults in large metropolitan areas and have not specifically addressed discrimination or bias in retirement care facilities. In the current exploratory study on perceptions of discrimination and bias in retirement care facilities, we surveyed a wide age range GLBT adults in a smaller metropolitan area of fewer than 400,000 people to discover the perceptions of both younger and older GLBTs. We surveyed perceptions of discrimination in retirement care facilities, sources of perceived discrimination, and suggestions for how discrimination might be reduced or eliminated in those settings. Respondents indicated that administration, care staff, and residents of retirement care facilities themselves were all potential sources of discrimination, and that education addressing awareness and acceptance of GLBTs is one potential remedy for discrimination against GLBTs in retirement care facilities. Respondents also indicated a strong desire for the development of GLBT-exclusive or GLBT-friendly retirement care facilities. Chi-square analyses of responses to the discrimination questions and respondents' demographic characteristics revealed significant differences with regard to age, income, gender, community size, and education level of the respondents.     

“You Have to Keep Yourself Hidden”: Perspectives From Malaysian Malay-Muslim Men Who Have Sex With Men on Policy,Network, Community,and Individual Influences on HIV Risk

ABSTRACT

Malay-Muslim men who have sex with men (MSM) are marginalized and hidden in Malaysia, a predominantly Muslim country in southeast Asia. We explored the policy, network, community, and individual factors related to HIV infection among Malay-Muslim MSM through 26 in-depth interviews and one focus group discussion (n = 5) conducted in Kuala Lumpur and Kota Bharu between October 2013 and January 2014. As religion plays an important role in their lives, participants viewed homosexuality as a sin. Low risk perception and misconceptions about HIV/AIDS were common, and most participants expressed reluctance to consult a doctor unless they had symptoms. Additionally, buying condoms was embarrassing and anxiety-producing. Fear of discrimination by health care providers and community hindered participants from disclosing sexual behaviors and accessing health services. Homophobic comments and policies by the government and religious leaders were concerns of participants. A safe and enabling environment is needed to reduce HIV risks among Malay-Muslim MSM.     

Comparability of Health Care Responsiveness in Europe

The aim of this paper is to measure and to correct for the potential incomparability of responses to the SHARE survey on health care responsiveness. A parametric approach based on the use of anchoring vignettes is applied to cross-sectional data (2006–2007) in eleven European countries. More than 7,000 respondents aged 50 years old and over were asked to assess the quality of health care responsiveness in three domains: waiting time for medical treatment, quality of the conditions in visited health facilities, and communication and involvement in decisions about the treatment. Our results suggest that there is reporting heterogeneity across countries and across individuals within countries, and the degree of heterogeneity varies with the health care domain. Although leading countries in terms of health care responsiveness remain among the most successful even after correction for reporting heterogeneity, one may acknowledge many shifts in the ranking of the other countries.     

Economic Disparities and Life Satisfaction in European Regions

This paper investigates the role of economic variables in predicting regional disparities in reported life satisfaction of European Union (EU) citizens. European subnational units (regions) are defined according to the first-level EU nomenclature of territorial units. We use multilevel modeling to explicitly account for the hierarchical nature of our data, respondents within regions and countries, and for understanding patterns of variation within and between regions. Main findings are that personal income matters more in poor regions than in rich regions, a pattern that still holds for regions within the same country. Being unemployed is negatively associated with life satisfaction even after controlled for income variation. Living in high unemployment regions does not alleviate the unhappiness of being out of work. After controlling for individual characteristics and modeling interactions, regional differences in life satisfaction still remain, confirming that regional dimension is relevant for life satisfaction.     

Regional Differences in the Gender Wage Gap in Spain

This study examines regional differences in the gender wage gap in Spain using matched employer–employee microdata, two different econometric decomposition methods and panel data techniques. Our findings suggest that Spain shows a significant regional heterogeneity in the size of the raw gap, roughly comparable to cross-country differences observed in the European context. The results from the decomposition analysis show that although the bulk of the gender wage gap in Spanish regions is due to differences in the endowments of productive characteristics between males and females there is still a substantial part of the gap that remains unexplained. The analysis of the causes behind the variation of both, the raw and the unexplained gender wage gap by region highlights that several economic, institutional and demographic elements identified in previous studies analysing international differences in the gender wage gap are also relevant to explain regional differences in the gender wage gap in Spain.     

Discrimination Against Older Women in Health Care

Growing awareness of apparent gaps in health care received by women and men raises concern over possible discrimination. This literature review examines this issue for elderly women, whose health care is obtained in a system that also may be permeated with age discrimination. Physicians tend to spend more time with women and older patients, suggesting that discrimination may not be an issue in the physician-patient relationship or may work in favor of older women. However, this may simply reflect elderly women's poorer health. Gender and age disparities in medical treatments received provide a more compelling argument that the health care system is a source of discrimination against older women, who are less likely than others to receive available treatments for cardiac, renal, and other conditions. The history of medical treatment of menopause suggests that stereotypes of older women have been advantageous for segments of the health care system. Finally, in addition to discrimination that has its source within the health care system itself, societal-wide inequities, particularly economic, are extremely detrimental to older women's health care. As we respond to the health care crisis, we must be alert to the potential to rectify those structures and tendencies that can lead to discrimination against women and the aged. Health care reform presents a unique opportunity to ensure health care equity.