Utilization-based approaches have predominated the measurement of socioeconomic-related inequity in health care. This approach, however, can be misleading when preferences over health and health care are correlated with socioeconomic status, especially when the underlying focus is on equity of access. We examine the potential usefulness of an alternative approach to assessing inequity of access using a direct measure of possible barriers to access-self-reported unmet need (SUN)-which is documented to vary with socioeconomic status and is commonly asked in health surveys. Specifically, as part of an assessment of its external validity, we use Canadian longitudinal health data to test whether self-reported unmet need in one period is associated with a subsequent deterioration in health status in a future period, and find that it is. This suggests that SUN does reflect in part reduced access to needed health care, and therefore may have a role in assessing health system equity as a complement to utilization-based approaches.
We examine the roles of subnational and national governments in Canada and the USA vis-à-vis protective public health response in the onset phase of the global COVID-19 pandemic. This period was characterized in both countries by incomplete and incorrect information as well as the uncertainty regarding which level of government should be responsible for which policies. The crisis represents an opportunity to study how national and subnational governments respond to such policy challenges. In this paper, we present a unique dataset which catalogues the policy responses of US states and Canadian provinces as well as those of the respective federal governments: the Protective Policy Index (PPI). We then compare the US and Canada along several dimensions including: the absolute values of subnational levels of the index relative to the total protections enjoyed by citizens, the relationship between "early threat" (as measured by the mortality rate near the start of the public health crisis) and the evolution of the PPI, and finally, the institutional/legislative origins of the protective health policies. We find that the subnational contribution to policy is more important for both the US and Canada as compared to their national-level policies, and is unrelated in scope to our "early threat" measure. We also show that the institutional origin of the policies as evidenced by COVID-19 response differs greatly between the two countries and has implications for the evolution of federalism in each.
INTRODUCTIONThis study aimed to identify Canadian access-limited data sources and evaluate a subset of restricted health sciences data sources to determine how well they make their data discoverable and accessible.MATERIALS AND METHODSA search was conducted across Canadian sectors and national experts were consulted to identify access-limited data sources. A subset of restricted health sciences data sources (n=48) was evaluated using a rubric to assess how well they make their data discoverable and accessible. The rubric assigned data sources a grade of A through C denoting how well they met certain discoverability and access criteria. The degree to which data sources demonstrated consistency between their discovery and access grades was assessed using Kendall’s rank correlation coefficient.RESULTS137 Canadian data sources were identified. Restricted health sciences sources received poor data discovery grades due to a lack of metadata (38/48, 79%), an inability to search/browse datasets (32/46, 70%), and lack of data documentation to support interpretability and reuse (27/48, 56%). Low data accessibility grades were assigned for the lack of transparent pricing information (31/48, 65%) and opaque data restriction criteria (25/48, 52%). Data sources with higher discovery scores had higher access scores on average (tau-b=0.31, p=0.0059).DISCUSSIONThis study highlights areas for improvement with respect to the discovery of and access to Canadian restricted data. Developing metadata standards to accommodate restricted data access procedures, improving data infrastructure to support restricted data, and expanding data documentation training for restricted data custodians are necessary to ensure that restricted data is discoverable, accessible, and reusable in the future.
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