The impact of reimbursement systems on equity in access and quality of primary care: A systematic literature review

BACKGROUND: Reimbursement systems provide incentives to health care providers and may drive physician behaviour. This review assesses the impact of reimbursement system on socioeconomic and racial inequalities in access, utilization and quality of primary care. METHODS: A systematic search was performed in Web of Science and PubMed for English language studies published between 1980 and 2013, supplemented by reference tracking. Articles were selected based on inclusion criteria, and data extraction and critical appraisal were performed by two authors independently. Data were synthesized in a narrative manner and categorized according to study outcome and reimbursement system. RESULTS: Twenty seven articles, mostly from the United States and United Kingdom, were included in the data synthesis. Reimbursement systems seem to have limited effect on socioeconomic and racial inequity in access, utilization and quality of primary care. Capitation might have a more beneficial impact on inequity in access to primary care and number of ambulatory care sensitive admissions than fee-for-service, but did worse in patient satisfaction. Pay-for-performance had little or no impact on socioeconomic and racial inequity in the management of diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, and preventive services. CONCLUSION: We found little scientific evidence supporting an association between reimbursement system and socioeconomic or racial inequity in access, utilization and quality of primary care. Overall, few studies addressed this research question, and heterogeneity in context and outcomes complicates comparisons across studies. Further empirical studies are warranted. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-016-1805-8) contains supplementary material, which is available to authorized users

A Biobank of Colorectal Cancer Patient-Derived Xenografts

Colorectal cancer (CRC) is a challenging disease, with a high mortality rate and limited effective treatment options, particularly for late-stage disease. Patient-derived xenografts (PDXs) have emerged as an informative, renewable experimental resource to model CRC architecture and biology. Here, we describe the generation of a biobank of CRC PDXs from stage I to stage IV patients. We demonstrate that PDXs within our biobank recapitulate the histopathological and mutation features of the original patient tumor. In addition, we demonstrate the utility of this resource in pre-clinical chemotherapy and targeted treatment studies, highlighting the translational potential of PDX models in the identification of new therapies that will improve the overall survival of CRC patients

Do welfare regimes mediate the effect of SES on health in adolescence? A cross-national comparison in Europe, North America, and Israel

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.<br/