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Akhnif EH, Hachri H, Belmadani A, Mataria A, Bigdeli M. Policy dialogue and participation: a new way of crafting a national health financing strategy in Morocco. Health Res Policy Syst 2020; 18:114. [PMID: 32993697 PMCID: PMC7523367 DOI: 10.1186/s12961-020-00629-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Policy dialogue for health policies has started to gain importance in recent years, especially for complex issues such as health financing. Moroccan health financing has faced several challenges during the last years. This study aims to document the Moroccan experience in developing a consolidated health financing strategy according to the policy dialogue approach. It especially considers the importance of conceptualising this process in the Moroccan context. METHOD We documented the process of developing a health financing strategy in Morocco. It concerned four steps, as follows: (1) summarising health financing evidence in preparation of the policy dialogue; (2) organising the health policy dialogue process with 250 participants (government, private sector, NGOs, civil society, parliamentarians, technical and financial partners); (3) a technical workshop to formulate the strategy actions; and (4) an ultimate workshop for validation with decision-makers. The process lasted 1 year from March 2019 to February 2020. We have reviewed all documents related to the four steps of the process through our active participation in the policy debate and the documentation of two technical workshops to produce the strategy document. RESULTS The policy dialogue approach showed its usefulness in creating convergence among all health actors to define a national shared vision on health financing in Morocco. There was a high political commitment in the process and all actors officially adopted recommendations on health financing actions. A strategy document produced within a collaborative approach was the final output. This experience also marked a shift from previous top-down approaches in designing health policies for more participation and inclusion. The evidence synthesis played a crucial role in facilitating the debate. The collaborative approach seems to work in favouring national consensus on practical health financing actions. CONCLUSION The policy dialogue process adopted for health financing in Morocco helped to create collective ownership of health financing actions. Despite the positive results in terms of national mobilisation around the health financing vision in Morocco, there is a need to institutionalise the policy dialogue with a more decentralised approach to consider subnational specificities.
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Affiliation(s)
- El Houcine Akhnif
- World Health Organization Country Office of Morocco, 3 Avenue S.A.R. Sidi Mohamed, Rabat, Morocco
| | - Hafid Hachri
- World Health Organization Country Office of Morocco, 3 Avenue S.A.R. Sidi Mohamed, Rabat, Morocco
| | - Abdelouahab Belmadani
- Ministry of Health, Directorate of Planning of Financial Resources, 335, Avenue Mohamed V, Rabat, Morocco
| | - Awad Mataria
- World Health Organization Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371 Egypt
| | - Maryam Bigdeli
- World Health Organization Country Office of Morocco, 3 Avenue S.A.R. Sidi Mohamed, Rabat, Morocco
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152
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Affiliation(s)
| | - Ryan Koski-Vacirca
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Joshua Sharfstein
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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153
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Himmler S, van Exel J, Perry-Duxbury M, Brouwer W. Willingness to pay for an early warning system for infectious diseases. Eur J Health Econ 2020; 21:763-773. [PMID: 32180067 PMCID: PMC7364296 DOI: 10.1007/s10198-020-01171-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/25/2020] [Indexed: 06/01/2023]
Abstract
Early warning systems for infectious diseases and foodborne outbreaks are designed with the aim of increasing the health safety of citizens. As a first step to determine whether investing in such a system offers value for money, this study used contingent valuation to estimate people's willingness to pay for such an early warning system in six European countries. The contingent valuation experiment was conducted through online questionnaires administered in February to March 2018 to cross-sectional, representative samples in the UK, Denmark, Germany, Hungary, Italy, and The Netherlands, yielding a total sample size of 3140. Mean willingness to pay for an early warning system was €21.80 (median €10.00) per household per month. Pooled regression results indicate that willingness to pay increased with household income and risk aversion, while they decreased with age. Overall, our results indicate that approximately 80-90% of people would be willing to pay for an increase in health safety in the form of an early warning system for infectious diseases and food-borne outbreaks. However, our results have to be interpreted in light of the usual drawbacks of willingness to pay experiments.
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Affiliation(s)
- Sebastian Himmler
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Meg Perry-Duxbury
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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154
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Affiliation(s)
- Vageesh Jain
- University College London, UK
- Public Health England, UK
| | - Peter Baker
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK
- Center for Global Development, UK
| | - Kalipso Chalkidou
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK
- Center for Global Development, UK
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155
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Zhao X, Liu Y. Empirical prediction of patent pledge financing of pharmaceutical enterprises-A case study in Jiangsu China. PLoS One 2020; 15:e0233601. [PMID: 32497063 PMCID: PMC7271991 DOI: 10.1371/journal.pone.0233601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/28/2020] [Indexed: 11/18/2022] Open
Abstract
Financing by patent pledge is an important way for small- and medium-sized pharmaceutical enterprises to address financing problems. In this study, eight indexes are analyzed considering both the pledge patent value and pledger credit value. And a prediction model for the patent pledge financing amount for pharmaceutical enterprises is constructed for the first time using the analytic hierarchy process and the fuzzy comprehensive evaluation method. Three levels of financing amount are concluded through the prediction model and prediction results corresponding with the financing amount are displayed. This model was designed to help small- and medium-sized pharmaceutical enterprises get access to financing through patent pledge to relieve their financial stress. At the same time, it provides guides for pledgees and policymakers to improve the efficiency and quality of patent pledge. This work is reliable and valid in that it constructs this prediction model based on systematical data from official data sources.
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Affiliation(s)
- Xiaojuan Zhao
- School of Intellectual Property, Nanjing University of Science and Technology, Nanjing, Jiangsu, China
| | - Yunhua Liu
- School of Intellectual Property, Nanjing University of Science and Technology, Nanjing, Jiangsu, China
- University of Copenhagen, Copenhagen, Danmark
- * E-mail:
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156
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Abstract
BACKGROUND China's health financing system has changed from the government-led mode under the planned economy to the diversified mode under the market economy. Equity in health financing has been a national health priority. This study aimed to predict changes in total health expenditure (THE), government health expenditure (GHE), social health expenditure (SHE) and out-of-pocket health expenditure (OOP) in China from 2018 to 2022, and to provide a theoretical basis for health policy adjustment. METHODS Based on health expenditure date of time series from 1978-2017, R3.5.1 software was used to construct the Autoregressive Integrated Moving Average (ARIMA) model. RESULTS The model of THE, GHE, SHE and OOP are ARIMA (3.3.0), ARIMA (1.3.1), ARIMA (2.4.0), ARIMA (2.2.2). According to the simulation results, in 2022, China's THE is expected to reach 8473.00 billion Yuan, and the constituent ratios in GHE, SHE and OOP will be 25.49%, 51.25% and 23.26%, respectively. The proportion of THE to GDP will continuously increase from 2018-2022 at a reasonable pace, while THE itself will increase rapidly. CONCLUSIONS China should take effective measures to control the excessive growth of THE, keep decreasing the OOP percentage, and improve the efficiency and fairness of the use of health funds.
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Affiliation(s)
- Ang Zheng
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Quan Fang
- College of the Humanities and Social Sciences, China Medical University, Shenyang, Liaoning Province, China
| | - Yalan Zhu
- College of the Humanities and Social Sciences, China Medical University, Shenyang, Liaoning Province, China
| | - Chunling Jiang
- College of Basic Medical Science, China Medical University, Shenyang, Liaoning Province, China
| | - Feng Jin
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xin Wang
- College of the Humanities and Social Sciences, China Medical University, Shenyang, Liaoning Province, China
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157
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Global Burden of Disease Health Financing Collaborator Network. Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3. Lancet 2020; 396:693-724. [PMID: 32334655 DOI: 10.1016/S0140-6736(20)30608-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sustainable Development Goal (SDG) 3 aims to "ensure healthy lives and promote well-being for all at all ages". While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. METHODS We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. FINDINGS Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching $7·9 trillion (95% uncertainty interval 7·8-8·0) in 2017 and is expected to increase to $11·0 trillion (10·7-11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was $20·2 billion (17·0-25·0) and on tuberculosis it was $10·9 billion (10·3-11·8), and in malaria-endemic countries spending on malaria was $5·1 billion (4·9-5·4). Development assistance for health was $40·6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019, $374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6-81·7) in 2015 to 83·1% (82·8-83·3) in 2030. INTERPRETATION Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. FUNDING The Bill & Melinda Gates Foundation.
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Binagwaho A, Scott KW, Dushime T, Uwaliraye P, Kamuhangire E, Akishuri D, Wanyana D, Eagan A, Kakana L, Atwine J. Creating a pathway for public hospital accreditation in Rwanda: progress, challenges and lessons learned. Int J Qual Health Care 2020; 32:76-79. [PMID: 31322671 PMCID: PMC7172019 DOI: 10.1093/intqhc/mzz063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/28/2019] [Accepted: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
QUALITY PROBLEM Weaknesses in the quality of care delivered at hospitals translates into patient safety challenges and causes unnecessary harm. Low-and-middle-income countries disproportionately shoulder the burden of poor quality of hospital care. INITIAL ASSESSMENT In the early 2000s, Rwanda implemented a performance-based financing (PBF) system to improve quality and increase the quantity of care delivered at its public hospitals. PBF evaluations identified quality gaps that prompted a movement to pursue an accreditation process for public hospitals. CHOICE OF SOLUTION Since it was prohibitively costly to implement an accreditation program overseen by an external entity to all of Rwanda's public hospitals, the Ministry of Health developed a set of standards for a national 3-Level accreditation program. IMPLEMENTATION In 2012, Rwanda launched the first phase of the national accreditation system at five public hospitals. The program was then expected to expand across the remainder of the public hospitals throughout the country. EVALUATION Out of Rwanda's 43 public hospitals, a total of 24 hospitals have achieved Level 1 status of the accreditation process and 4 have achieved Level 2 status of the accreditation process. LESSONS LEARNED Linking the program to the country's existing PBF program increased compliance and motivation for participation, especially for those who were unfamiliar with accreditation principles. Furthermore, identifying dedicated quality improvement officers at each hospital has been important for improving engagement in the program. Lastly, to improve upon this process, there are ongoing efforts to develop a non-governmental accreditation entity to oversee this process for Rwanda's health system moving forward.
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Affiliation(s)
- Agnes Binagwaho
- University of Global Health Equity, Kigali, Rwanda
- Harvard Medical School, Boston, MA, USA
- Geisel School of Medicine, Dartmouth, Hanover, NH, USA
| | | | | | | | | | - Dennis Akishuri
- Management Sciences for Health, Rwanda Health System Strengthening Project, Kigali, Rwanda
| | | | | | - Laetitia Kakana
- Management Sciences for Health, Rwanda Health System Strengthening Project, Kigali, Rwanda
| | - Joy Atwine
- Management Sciences for Health, Rwanda Health System Strengthening Project, Kigali, Rwanda
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160
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Novytskyi V, Novytskyi A, Lysenko O, Taran Y, Ryzhuk O. ECONOMIC AND LEGAL FORECAST ANALYSIS OF THE HEALTHCARE FINANCING SOURCES MATURITY IN UKRAINE. Georgian Med News 2020:183-188. [PMID: 32535586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this article is to analyze the current situation of the development of the financial support sources in healthcare. In theoretical part we used generalized scientific methods of research such as analysis and synthesis to determine all the financial support sources in healthcare. In practical part we used the bulk of raw and processed statistical data and forecasting engine from Excel 2019 to understand the development trends of the healthcare financing sources and to define the level of their maturity based on their development lines. Public expenses on healthcare cant cover all expenses of healthcare institutions, low level of insurance medicine in Ukraine, high corruption risks in healthcare sector and others. So, healthcare institutions have to search for additional funding. In our article, we analyzed both parts of the financial source maturity problem - theoretical and practical. In theoretical part we defined the term financial source maturity, underlined its levels and described the lines of indicators for each level. In practical part we proposed the mechanism of financing source maturity testing and tested the level of maturity of all available healthcare financing sources. As potential result, we tested that it is possible to use a forecasting engine based on AAA version of exponential smoothing that is provided by Excel 2016, 365 and 2019 versions for this research. Other versions contains the AAA version of exponential smoothing that doesn't have needed instructions and indicators.
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Affiliation(s)
- V Novytskyi
- 1University of State Fiscal Service of Ukraine, Irpin, Ukraine
| | - A Novytskyi
- 1University of State Fiscal Service of Ukraine, Irpin, Ukraine
| | - O Lysenko
- 2East European University of Economics and Management, Cherkasy, Ukraine
| | - Ye Taran
- 3National Academy for Public Administration under the President of Ukraine, Kyiv, Ukraine
| | - O Ryzhuk
- 4Open International University for Human Development «Ukraina», Kyiv, Ukraine
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Nunes AB, Oliveira AP, Jamanca A, Brito DV, Silva NM, Duarte S, Coelho A. [Asthma Management and Control in Portuguese Speaking Countries]. ACTA MEDICA PORT 2020; 33:269-274. [PMID: 32238241 DOI: 10.20344/amp.11927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Asthma affects more than 339 million people worldwide. In the Community of Portuguese Speaking Countries, in 2016, its prevalence ranged from 9.5% (Portugal) to 3.91% (Brazil). Chronic disease management programs aim to improve the health status of patients with chronic disease and reduce associated costs. The objective of this study is to identify models of asthma asthma 'management and control' that are that are implemented in the Community of Portuguese Speaking Countries (CPLP), and analyse them through the integrated disease management model. MATERIAL AND METHODS A rapid review of the PubMed indexed scientific literature and grey literature on 'management and control of asthma' in the countries of the Community of Portuguese-Speaking Countries was carried out. RESULTS Portugal, Brazil and Mozambique presented publications on 'management and control of asthma', at different stages of implementation. Clinical management and organization and service delivery are the dimensions of integrated disease management most addressed in publications. DISCUSSION The implementation of asthma management and control programs is influenced by health systems, care delivery structures, and the surrounding political and social environment. The dimensions of funding and information systems are the most difficult to implement given the degree of economic, social and technological development of most countries under study. CONCLUSION Only Portugal, Brazil and Mozambique adopted asthma integrated disease management as the main form of asthma management and control. The programs developed by these countries can constitute a model for asthma integrated disease management in the other countries under study.
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Affiliation(s)
- Ana Beatriz Nunes
- Unidade de Saúde Pública. Agrupamento de Centros de Saúde do Alentejo Central. Évora. Portugal
| | - Ana Pinto Oliveira
- Unidade de Saúde Pública. Agrupamento de Centros de Saúde do Arco Ribeirinho. Barreiro. Portugal
| | - Aua Jamanca
- Serviço de Ginecologia. Hospital Nacional Simão Mendes. Bissau. Guiné-Bissau. Guinea-Bissau
| | - Duarte Vital Brito
- Unidade de Saúde Pública. Agrupamento de Centros de Saúde de Lisboa Central. Lisboa. Global Health and Tropical Medicine. Instituto de Higiene e Medicina Tropical. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Nádia Mendes Silva
- Serviço de Pediatria. Hospital Nacional Simão Mendes. Bissau. Guinea-Bissau
| | - Sara Duarte
- Global Health and Tropical Medicine. Instituto de Higiene e Medicina Tropical. Universidade Nova de Lisboa. Lisboa. Unidade de Saúde Pública. Unidade Local de Saúde do Alto Minho. Viana do Castelo. Portugal
| | - Anabela Coelho
- Departamento da Qualidade na Saúde. Direção-Geral da Saúde. Lisboa. Portugal
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Zouari A. What are the economic implications of COVID-19. Tunis Med 2020; 98:312-313. [PMID: 32395795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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González Block MÁ, Reyes Morales H, Hurtado LC, Balandrán A, Méndez E. Mexico: Health System Review. Health Syst Transit 2020; 22:1-222. [PMID: 33527902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This analysis of the Mexican health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Mexican health system consists of three main components operating in parallel: 1) employment-based social insurance schemes, 2) public assistance services for the uninsured supported by a financial protection scheme, and 3) a private sector composed of service providers, insurers, and pharmaceutical and medical device manufacturers and distributors. The social insurance schemes are managed by highly centralized national institutions while coverage for the uninsured is operated by both state and federal authorities and providers. The largest social insurance institution - the Mexican Social Insurance Institute (IMSS) - is governed by a corporatist arrangement, which reflects the political realities of the 1940s rather than the needs of the 21st century. National health spending has grown in recent years but is lower than the Latin America and Caribbean average and considerably lower than the OECD average in 2015. Public spending accounts for 58% of total financing, with private contributions being mostly comprised of out-of-pocket spending. The private sector, while regulated by the government, mostly operates independently. Mexico's health system delivers a wide range of health care services; however, nearly 14% of the population lacks financial protection, while the insured are mostly enrolled in diverse public schemes which provide varying benefits packages. Private sector services are in high demand given insufficient resources among most public institutions and the lack of voice by the insured to ensure the fulfilment of entitlements. Furthermore, the system faces challenges with obesity, diabetes, violence, as well as with health inequity. Recognizing the inequities in access created by its segmented structure, both civil society and government are calling for greater integration of service delivery across public institutions, although no consensus yet exists as to how to bring this about.
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Peters AW, Roa L, Rwamasirabo E, Ameh E, Ulisubisya MM, Samad L, Makasa EM, Meara JG. National Surgical, Obstetric, and Anesthesia Plans Supporting the Vision of Universal Health Coverage. Glob Health Sci Pract 2020; 8:1-9. [PMID: 32234839 PMCID: PMC7108944 DOI: 10.9745/ghsp-d-19-00314] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
Developing a national surgical, obstetric, and anesthesia plan is an important first step for countries to strengthen their surgical systems and improve surgical care. Barriers to successful implementation of these plans include data collection, scalability, and financing, yet surgical system strengthening efforts are gaining momentum in achieving universal access to emergency and essential surgical care.
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Affiliation(s)
- Alexander W Peters
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA.
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Emmanuel Ameh
- Department of Surgery, National Hospital, Abuja, Nigeria
| | - Mpoki M Ulisubisya
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - Lubna Samad
- Center for Essential Surgical and Acute Care, Indus Health Network, Karachi, Pakistan
| | - Emmanuel M Makasa
- Public Service Management Division Cabinet Office, Office of the President, Lusaka, Zambia
- Wits Centre of Surgical Care for Primary Health & Sustainable Development, School of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
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Ayandipo O, Wone I, Kenu E, Fasehun LK, Ayandipo O, Gaye F, Ojo A, Ayoola Y, Omogi J, Lakew D, Thiam S. Cancer ecosystem assessment in West Africa: health systems gaps to prevent and control cancers in three countries: Ghana, Nigeria and Senegal. Pan Afr Med J 2020; 35:90. [PMID: 32636988 PMCID: PMC7320762 DOI: 10.11604/pamj.2020.35.90.18516] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 11/05/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Sub-Saharan Africa is experiencing a rapid epidemiological transition with the increasing incidence of Non-Communicable Diseases (NCD). Among these, cancer is one of the main causes of death in adults. This is a public health problem whose burden is unknown due to lack of statistical data. In addition, the already overburdened health systems are experiencing enormous constraints to address the problem with the double challenge of communicable and NCDs. METHODS The purpose of this evaluation was to assess the capacity and needs of health systems to prevent and control cancer. A cross-sectional study, using both quantitative and qualitative methods, was conducted between April 2017 and February 2018 in target countries, through in-depth interviews with key actors, direct observations and documents review. The WHO framework for health system strengthening with the 6 pillars was used for the gaps analysis. RESULTS Little priority is given to the fight against cancer because of low political commitment. Programs´ resources are very limited and there is a poor coordination of the actions. Human resources are insufficient, and most of them are concentrated in the capital city. This limits access to care with a late consultation of patients. Diagnosis and treatment services are expensive and generally paid by households. Finally, the unavailability of reliable data at national level hinders the decision-based evidence. CONCLUSION There is an urgent need to create strong partnerships at national and regional levels to (i) Advocate for a strong political commitment; (ii) Strengthen the coordination of actions and create more synergy among stakeholders; (iii) Improve the quality and quantity of human resources; (iv) Extend universal health coverage to cancer and improve program funding; and (v) Set up cancer registries at national level.
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Affiliation(s)
- Omobolaji Ayandipo
- Department of Surgery, College of Medicine University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Issa Wone
- Health Sciences Department, University Assane Seck of Ziguinchor, Ziguinchor, Senegal
| | - Ernest Kenu
- University of Ghana, School of Public Health, Department of Epidemiology and Disease Control, Accra, Ghana
| | | | | | - Fatou Gaye
- Amref Health Africa, West Africa hub, 105 Sacre Coeur 3 Dakar, Senegal
| | - Adedoyin Ojo
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | | | - Jarim Omogi
- Amref International University P.O. Box. 27691- 00506; Nairobi, Kenya
| | - Desta Lakew
- Amref Health Africa, Headquarters Langata Road PO Box 27691-0506 Nairobi, Kenya
| | - Sylla Thiam
- Amref Health Africa, West Africa hub, 105 Sacre Coeur 3 Dakar, Senegal
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Dong H, Li Z, Failler P. The Impact of Business Cycle on Health Financing: Subsidized, Voluntary and Out-of-Pocket Health Spending. Int J Environ Res Public Health 2020; 17:ijerph17061928. [PMID: 32188003 PMCID: PMC7143791 DOI: 10.3390/ijerph17061928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 11/23/2022]
Abstract
Diverse types of healthcare systems in countries offer opportunities to explore the heterogeneous sources of health financing. This paper widely explores the effect of the business cycle on subsidized, voluntary and out-of-pocket health spending in 34 countries with different types of healthcare systems, by the methodology of hierarchical linear modeling (HLM). We use a panel of annual data during the years from 2000 to 2016. It further examines the business cycle-health financing mechanism by inquiring into the mediating effect of external conditions and innovative health financing, based on the structural equation modeling (SEM). The empirical results reveal that the business cycle harms subsidized spending, whereas its effect on voluntary and protective health spending is positive. Results related to the SEM indicate that the mediating effect of external conditions on the relationship between the business cycle and health financing is negative. However, we find that the business cycle plays a positive effect on health financing through innovative health financing channels. Thus, designing and implementing efforts to shift innovative health financing have substantial effects on the sustainability of healthcare systems.
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Affiliation(s)
- Hao Dong
- School of Economics and Statistics, Guangzhou University, Guangzhou 510006, China;
| | - Zhenghui Li
- Guangzhou International Institute of Finance and Guangzhou University, Guangzhou 510006, China
- Correspondence: ; Tel.: 86-1335-285-7358
| | - Pierre Failler
- Economics and Finance Group, Portsmouth Business School, University of Portsmouth, Portsmouth PO1 3DE, UK;
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167
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Legido-Quigley H, Asgari N, Teo YY, Leung GM, Oshitani H, Fukuda K, Cook AR, Hsu LY, Shibuya K, Heymann D. Are high-performing health systems resilient against the COVID-19 epidemic? Lancet 2020; 395:848-850. [PMID: 32151326 PMCID: PMC7124523 DOI: 10.1016/s0140-6736(20)30551-1] [Citation(s) in RCA: 258] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| | - Nima Asgari
- Asia Pacific Observatory on Health Systems and Policies, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Yik Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Keiji Fukuda
- School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kenji Shibuya
- Institute for Population Health, King's College London, London, UK
| | - David Heymann
- London School of Hygiene & Tropical Medicine, London, UK
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168
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Witter S, Chirwa Y, Chandiwana P, Munyati S, Pepukai M, Bertone MP, Banda S. Results-based financing as a strategic purchasing intervention: some progress but much further to go in Zimbabwe? BMC Health Serv Res 2020; 20:180. [PMID: 32143626 PMCID: PMC7059677 DOI: 10.1186/s12913-020-5037-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/25/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Results-Based Financing (RBF) has proliferated in the health sectors of low and middle income countries, especially those which are fragile or conflict-affected, and has been presented by some as a way of reforming and strengthening strategic purchasing. However, few if any studies have empirically and systematically examined how RBF impacts on health care purchasing. This article examines this question in the context of Zimbabwe's national RBF programme. METHODS The article is based on a documentary review, including 60 documents from 2008 to 2018, and 40 key informant (KI) interviews conducted with international, national and district level stakeholders in early 2018 in Zimbabwe. Interviews and analysis of both datasets followed an existing framework for strategic purchasing, adapted to reflect changes over. RESULTS We find that some functions, such as assessing service infrastructure gaps, are unaffected by RBF, while others, such as mobilising resources, are partially affected, as RBF has focused on one package of care (maternal and child health services) within the wider essential health care, and has contributed important but marginal costs. Overall purchasing arrangements remain fragmented. Limited improvements have been made to community engagement. The clearest changes to purchasing arrangements relate to providers, at least in relation to the RBF services. Its achievements included enabling flexible resources to reach primary providers, funding supervision and emphasising the importance of reporting. CONCLUSIONS Our analysis suggests that RBF in Zimbabwe, at least at this early stage, is mainly functioning as an additional source of funding and as a provider payment mechanism, focussed on the primary care level for MCH services. RBF in this case brought focus to specific outputs but remained one provider payment mechanism amongst many, with limited traction over the main service delivery inputs and programmes. Zimbabwe's economic and political crisis provided an important entry point for RBF, but Zimbabwe did not present a 'blank slate' for RBF to reform: it was a functional health system pre-crisis, which enabled relatively swift scale-up of RBF but also meant that the potential for restructuring of institutional purchasing relationships was limited. This highlights the need for realistic and contextually tailored expectations of RBF.
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Affiliation(s)
- Sophie Witter
- ReBUILD programme, Queen Margaret University, Edinburgh, EH21 6UU Scotland
| | - Yotamu Chirwa
- ReBUILD and Biomedical Research and Training Institute, P O Box CY, 1753 Harare, Zimbabwe
| | - Pamela Chandiwana
- Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare Zimbabwe
| | - Shungu Munyati
- Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare Zimbabwe
| | - Mildred Pepukai
- Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare Zimbabwe
| | | | - Steve Banda
- Policy and Planning, Ministry of Health and Child Care, Harare, Zimbabwe
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169
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Oraro-Lawrence T, Wyss K. Policy levers and priority-setting in universal health coverage: a qualitative analysis of healthcare financing agenda setting in Kenya. BMC Health Serv Res 2020; 20:182. [PMID: 32143629 PMCID: PMC7059333 DOI: 10.1186/s12913-020-5041-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 02/26/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Competing priorities in health systems necessitate difficult choices on which health actions and investments to fund: decisions that are complex, value-based, and highly political. In light of the centrality of universal health coverage (UHC) in driving current health policy, we sought to examine the value interests that influence agenda setting in the country's health financing space. Given the plurality of Kenya's health policy levers, we aimed to examine how the perspectives of stakeholders involved in policy decision-making and implementation shape discussions on health financing within the UHC framework. METHODS A series of in-depth key informant interviews were conducted at national and county level (n = 13) between April and May 2018. Final thematic analysis using the Framework Method was conducted to identify similarities and differences amongst stakeholders on the challenges hindering Kenya's achievement of UHC in terms of its the optimisation of health service coverage; expansion of the population that benefits from essential healthcare services; and the minimisation of out-of-pocket costs associated with health-seeking behaviour. RESULTS Our findings indicate that the perceived lack of strategic leadership from Kenya's national government has led to a lack of agreement on stakeholders' interpretation of what is to be understood by UHC, its contextual values and priorities. We observe material differences between and within policy networks on the country's priorities for population coverage, healthcare service provision, and cost-sharing under the UHC dispensation. In spite of this, we note that progressive universalism is considered as the preferred approach towards UHC in Kenya, with most interviewees prioritising an equity-based approach that prioritises better access to healthcare services and financial risk protection. However, the conflicting priorities of key stakeholders risk derailing progress towards the expansion of access to health services and financial risk protection. CONCLUSIONS This study adds to existing knowledge of UHC in Kenya by contextualising the competing and evolving priorities that should be taken into consideration as the country strategises over its UHC process. We suggest that clear policy action is required from national government and county governments in order to develop a logical and consistent approach towards UHC in Kenya.
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Affiliation(s)
- Tessa Oraro-Lawrence
- Swiss Center for International Health, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Center for International Health, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
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170
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Kenworthy N, Dong Z, Montgomery A, Fuller E, Berliner L. A cross-sectional study of social inequities in medical crowdfunding campaigns in the United States. PLoS One 2020; 15:e0229760. [PMID: 32134984 PMCID: PMC7058302 DOI: 10.1371/journal.pone.0229760] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/11/2020] [Indexed: 01/10/2023] Open
Abstract
Americans are increasingly relying on crowdfunding to pay for the costs of healthcare. In medical crowdfunding (MCF), online platforms allow individuals to appeal to social networks to request donations for health and medical needs. Users are often told that success depends on how they organize and share their campaigns to increase social network engagement. However, experts have cautioned that MCF could exacerbate health and social disparities by amplifying the choices (and biases) of the crowd and leveraging these to determine who has access to financial support for healthcare. To date, research on potential axes of disparity in MCF, and their impacts on fundraising outcomes, has been limited. To answer these questions, this paper presents an exploratory cross-sectional study of a randomized sample of 637 MCF campaigns on the popular platform GoFundMe, for which the race, gender, age, and relationships of campaigners and campaign recipients were categorized alongside campaign characteristics and outcomes. Using both descriptive and inferential statistics, the analysis examines race, gender, and age disparities in MCF use, and tests how these are associated with differential campaign outcomes. The results show systemic disparities in MCF use and outcomes: people of color (and black women in particular) are under-represented; there is significant evidence of an additional digital care labor burden on women organizers of campaigns; and marginalized race and gender groups are associated with poorer fundraising outcomes. Outcomes are only minimally associated with campaign characteristics under users' control, such as photos, videos, and updates. These results corroborate widespread concerns with how technology fuels health inequities, and how crowdfunding may be creating an unequal and biased marketplace for those seeking financial support to access healthcare. Further research and better data access are needed to explore these dynamics more deeply and inform policy for this largely unregulated industry.
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Affiliation(s)
- Nora Kenworthy
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, United States of America
| | - Zhihang Dong
- Department of Statistics; Department of Sociology, University of Washington, Seattle, WA, United States of America
| | - Anne Montgomery
- Health Studies, Haverford College, Haverford, PA, United States of America
| | - Emily Fuller
- Department of Philosophy, University of Washington, Seattle, WA, United States of America
| | - Lauren Berliner
- School of Interdisciplinary Arts and Sciences, University of Washington Bothell, Bothell, WA, United States of America
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171
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Abstract
Background The report from the World Health Organization (WHO) reveals that health spending worldwide remains highly unequal as more than 80% of the world's population live in low and middle-income countries but only account for about 20% of global health expenditure. Another report by the WHO on the state of health financing in Africa published in 2013 intimates that countries that are part of their member states are still on the average level in meeting set goals in financing key health projects. Objective The study set out to investigate the association between public and private spending and health status for eight selected African countries, namely Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Sudan, Tanzania and Uganda. Health status indicators include the incidence of tuberculosis, mortality rates, maternal deaths and prevalence of HIV. Methods Descriptive statistics and pairwise correlation are used to assess the relationship between healthcare spending and health status. Random and fixed effect models are further employed to provide insights into the association between descriptive statistics and pairwise correlation. We used annual data from the year 2000 to 2014 obtained from world development indicators. Results The relationship between healthcare spending (public and private) and health status is statistically significant. Public healthcare expenditure has a higher association than private expenditure in reducing the mortality rate, tuberculosis and HIV for the average country in our sample. For example, an increase in public healthcare spending is negatively associated and statistically significant at 5% or better in reducing female mortality, male mortality, tuberculosis and HIV. Private healthcare spending is more impactful in the area of maternal deaths, where it is associated negatively and statistically significant at 1%. An increase in private healthcare spending is linked to a reduction in maternal deaths. We also compared the association between an increase in healthcare spending on males versus females and observed that public health expenditure impacts the health status of both sexes equally, however, private health expenditure provides a greater positive benefit to males. It is worth remembering that two goals of the United Nations agenda on sustainable development are gender equality and ensuring healthcare for all. Conclusion The findings of this research call for the selected African countries to pay more attention to public healthcare expenditure in order to improve health status, especially since private healthcare which provides access to healthcare facilities for some poor people leads to costs that are a burden. So, future research should focus on analyzing components of private healthcare spending such as direct household out-of-pocket spending, private insurance and direct service payments by private corporations as dependent variables to understand what form of private investment should be encouraged.
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Affiliation(s)
- Murad Bein
- Department of Accounting and Finance, Faculty of Economics and Administrative Sciences, Cyprus International University
| | - Elizabeth Y Coker-Farrell
- Department of Business Administration, Faculty of Economics and Administrative Sciences, Cyprus International University
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172
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Mbau R, Kabia E, Honda A, Hanson K, Barasa E. Examining purchasing reforms towards universal health coverage by the National Hospital Insurance Fund in Kenya. Int J Equity Health 2020; 19:19. [PMID: 32013955 PMCID: PMC6998279 DOI: 10.1186/s12939-019-1116-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kenya has prioritized the attainment of universal health coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF). In 2015, the NHIF introduced reforms in premium contribution rates, benefit packages, and provider payment methods. We examined the influence of these reforms on NHIF's purchasing practices and their implications for strategic purchasing and health system goals of equity, efficiency and quality. METHODS We conducted an embedded case study with the NHIF as the case and the reforms as embedded units of analysis. We collected data at the national level and in two purposively selected counties through 41 in-depth interviews with health financing stakeholders, facility managers and frontline providers; 4 focus group discussions with 51 NHIF members; and, document reviews. We analysed the data using a Framework approach. RESULTS The new NHIF reforms were characterized by weak purchasing actions. Firstly, the new premium contribution rates were inadequately communicated and unaffordable for certain citizen groups. Secondly, while the new benefit packages were reported to be based on service needs, preferences and values of the population, they were inadequately communicated and unequally distributed across different citizen groups. In addition, the presence of service delivery infrastructure gaps in public healthcare facilities and the pro-urban and pro-private distribution of contracted health facilities compromised delivery of, and access to, these new services. Lastly, the new provider payment methods and rates were considered inadequate, with delayed payments and weak links to financial accountability mechanisms which compromised their ability to incentivize equity, efficiency and quality of healthcare delivery. CONCLUSION While NHIF sought to expand population and service coverage and reduce out-of-pocket payments with the new reforms, weaknesses in the reforms' design and implementation limited NHIF's purchasing actions with negative implications for the health system goals of equity, efficiency and quality. For the reforms to accelerate the country's progress towards UHC, policy makers at the NHIF and, national and county government should make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that are aimed at improving health system goals.
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Affiliation(s)
- Rahab Mbau
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O. BOX 43640-00100, Nairobi, Kenya
| | - Evelyn Kabia
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O. BOX 43640-00100, Nairobi, Kenya
| | | | - Kara Hanson
- London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O. BOX 43640-00100, Nairobi, Kenya
- Nuffield department of medicine, Oxford University, Oxford, UK
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173
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Ha TV, Hoang MV, Vu MQ, Hoang NAT, Khuong LQ, Vu AN, Pham PC, Vu CV, Duong LH. Willingness to pay for a quality-adjusted life year among advanced non-small cell lung cancer patients in Viet Nam, 2018. Medicine (Baltimore) 2020; 99:e19379. [PMID: 32118784 PMCID: PMC7478749 DOI: 10.1097/md.0000000000019379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To examine the willingness to pay (WTP) for a quality-adjusted life year (QALY) gained among advanced non-small cell lung cancer (NSCLC) patients in Viet Nam and to analyze the factors affecting an individual's WTP.A cross-sectional, contingent valuation study was conducted among 400 NSCLC patients across 6 national hospitals in Viet Nam. Self-reported information was recorded from patients regarding their socio-demographic status, EQ-5D (EuroQol-5 dimensions) utility, EQ-5D vas, and WTP for 1 QALY gained. To explore the factors related to the WTP, Gamma Generalized Linear Model and multiple logistic regression tools were applied to analyze data.The overall mean and median of WTP/QALY among the NSCLC patients were USD $11,301 and USD $8002, respectively. Strong association was recorded between WTP/QALY amount and the patient's education, economic status, comorbidity status, and health utility.Government and policymakers should consider providing financial supports to disadvantaged groups to improve their access to life saving cancer treatment.
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Affiliation(s)
- Thuy Van Ha
- Viet Nam Department of Health Insurance, Ministry of Health
| | | | | | | | | | - Anh Nu Vu
- Viet Nam Department of Health Insurance, Ministry of Health
| | | | - Chinh Van Vu
- Viet Nam Health Economics Association, Hanoi, Viet Nam
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Kaddas HK, Pannier ST, Mann K, Waters AR, Salmon S, Tsukamoto T, Warner EL, Fowler B, Lewis MA, Fair DB, Kirchhoff AC. Age-Related Differences in Financial Toxicity and Unmet Resource Needs Among Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2020; 9:105-110. [PMID: 31524556 PMCID: PMC7047093 DOI: 10.1089/jayao.2019.0051] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Financial toxicity may differ by age at diagnosis between adolescents and young adults (AYAs) with cancer. We surveyed 52 AYA cancer patients about unmet needs and financial toxicity using the COmprehensive Score for financial Toxicity (COST). We compared outcomes by age at diagnosis (15-25-year olds [n = 25, 48%] vs. 26-39-year olds [n = 27, 52%]). AYAs diagnosed ages 26-39 reported that cancer negatively affected their finances more than 15-25-year olds (77.8% vs. 37.5%, p = 0.0005). Lower mean COST scores among those diagnosed ages 26-39 indicated greater financial toxicity compared to those 15-25 years (18.22 vs. 24.84, p = 0.02). Financial burden appears to be greater for older AYAs with cancer.
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Affiliation(s)
- Heydon K. Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Samantha T. Pannier
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Karely Mann
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Austin R. Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Sara Salmon
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Echo L. Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Brynn Fowler
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Douglas B. Fair
- Intermountain Healthcare, Salt Lake City, Utah
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
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175
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Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform. Bull World Health Organ 2020; 98:132-139. [PMID: 32015584 PMCID: PMC6986215 DOI: 10.2471/blt.19.234153] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 11/27/2022] Open
Abstract
Universal health coverage (UHC) means that all people can access health services of good quality without experiencing financial hardship. Three health financing functions - revenue raising, pooling of funds and purchasing health services - are vital for UHC. This article focuses on pooling: the accumulation and management of prepaid financial resources. Pooling creates opportunities for redistribution of resources to support equitable access to needed services and greater financial protection even if additional revenues for UHC cannot be raised. However, in many countries pooling arrangements are very fragmented, which create barriers to redistribution. The purpose of this article is to provide an overview of pooling reform options to support countries who are exploring ways to enhance redistribution of funds. We outline four broad types of pooling reforms and discuss their potential and challenges in addressing fragmentation of health financing: (i) shifting to compulsory or automatic coverage for everybody; (ii) merging different pools to increase the number of pool members and the diversity of pool members' health needs and risks; (iii) cross-subsidization of pools that have members with lower revenues and higher health risks; and (iv) harmonization across pools, such as benefits, payment methods and rates. Countries can combine several reform elements. Whether the potential for redistribution is actually realized through a pooling reform also depends on the alignment of the pooling structure with revenue raising and purchasing arrangements. Finally, the scope for reform is constrained by institutional and political feasibility, and the political economy around pooling reforms needs to be anticipated and managed.
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Affiliation(s)
- Inke Mathauer
- Department of Health Systems Governance and Financing, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Joseph Kutzin
- Department of Health Systems Governance and Financing, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Melitta Jakab
- World Health Organization Barcelona Office for Health Systems Strengthening, Barcelona, Spain
| | - Kara Hanson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England
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176
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Zarocostas J. Humanitarian crises: needs grow as health funding falls. Lancet 2020; 395:259-260. [PMID: 31982057 DOI: 10.1016/s0140-6736(20)30153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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177
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Nimpagaritse M, Korachais C, Meessen B. Effects in spite of tough constraints - A theory of change based investigation of contextual and implementation factors affecting the results of a performance based financing scheme extended to malnutrition in Burundi. PLoS One 2020; 15:e0226376. [PMID: 31929554 PMCID: PMC6957191 DOI: 10.1371/journal.pone.0226376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/25/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND From January 2015 to December 2016, the health authorities in Burundi piloted the inclusion of child nutrition services into the pre-existing performance-based financing free health care policy (PBF-FHC). An impact evaluation, focused on health centres, found positive effects both in terms of volume of services and quality of care. To some extent, this result is puzzling given the harshness of the contextual constraints related to the fragile setting. METHODS With a multi-methods approach, we explored how contextual and implementation constraints interacted with the pre-identified tracks of effect transmission embodied in the intervention. For our analysis, we used a hypothetical Theory of Change (ToC) that mapped a set of seven tracks through which the intervention might develop positive effects for children suffering from malnutrition. We built our analysis on (1) findings from the facility surveys and (2) extra qualitative data (logbooks, interviews and operational document reviews). FINDINGS Our results suggest that six constraints have weighted upon the intervention: (1) initial low skills of health workers; (2) unavailability of resources (including nutritional dietary inputs and equipment); (3) payment delays; (4) suboptimal information; (5) restrictions on autonomy; and (6) low intensity of supervision. Together, they have affected the intensity of the intervention, especially during its first year. From our analysis of the ToC, we noted that the positive effects largely occurred as a result of the incentive and information tracks. Qualitative data suggests that health centres have circumvented the many constraints by relying on a community-based recruitment strategy and a better management of inputs at the level of the facility and the patient himself. CONCLUSION Frontline actors have agency: when incentives are right, they take the initiative and find solutions. However, they cannot perform miracles: Burundi needs a holistic societal strategy to resolve the structural problem of child malnutrition. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT02721160; March 2016 (retrospectively registered).
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Affiliation(s)
- Manassé Nimpagaritse
- Institut National de Santé Publique, Bujumbura, Burundi
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Institut de Recherche Santé et Société, Université Catholique de Louvain, Clos Chapelle-aux-Champs, Bruxelles, Belgique
| | - Catherine Korachais
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Meessen
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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178
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Cai C, Runte J, Ostrer I, Berry K, Ponce N, Rodriguez M, Bertozzi S, White JS, Kahn JG. Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLoS Med 2020; 17:e1003013. [PMID: 31940342 PMCID: PMC6961869 DOI: 10.1371/journal.pmed.1003013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The United States is the only high-income nation without universal, government-funded or -mandated health insurance employing a unified payment system. The US multi-payer system leaves residents uninsured or underinsured, despite overall healthcare costs far above other nations. Single-payer (often referred to as Medicare for All), a proposed policy solution since 1990, is receiving renewed press attention and popular support. Our review seeks to assess the projected cost impact of a single-payer approach. METHODS AND FINDINGS We conducted our literature search between June 1 and December 31, 2018, without start date restriction for included studies. We surveyed an expert panel and searched PubMed, Google, Google Scholar, and preexisting lists for formal economic studies of the projected costs of single-payer plans for the US or for individual states. Reviewer pairs extracted data on methods and findings using a template. We quantified changes in total costs standardized to percentage of contemporaneous healthcare spending. Additionally, we quantified cost changes by subtype, such as costs due to increased healthcare utilization and savings due to simplified payment administration, lower drug costs, and other factors. We further examined how modeling assumptions affected results. Our search yielded economic analyses of the cost of 22 single-payer plans over the past 30 years. Exclusions were due to inadequate technical data or assuming a substantial ongoing role for private insurers. We found that 19 (86%) of the analyses predicted net savings (median net result was a savings of 3.46% of total costs) in the first year of program operation and 20 (91%) predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans. The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administration and drug costs (R2 of 0.035, 0.43, and 0.62, respectively). Only drug cost savings remained significant in multivariate analysis. Included studies were heterogeneous in methods, which precluded us from conducting a formal meta-analysis. CONCLUSIONS In this systematic review, we found a high degree of analytic consensus for the fiscal feasibility of a single-payer approach in the US. Actual costs will depend on plan features and implementation. Future research should refine estimates of the effects of coverage expansion on utilization, evaluate provider administrative costs in varied existing single-payer systems, analyze implementation options, and evaluate US-based single-payer programs, as available.
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Affiliation(s)
- Christopher Cai
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Jackson Runte
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Isabel Ostrer
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Kacey Berry
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Ninez Ponce
- UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Michael Rodriguez
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Stefano Bertozzi
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Justin S. White
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - James G. Kahn
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Saunes IS, Karanikolos M, Sagan A. Norway: Health System Review. Health Syst Transit 2020; 22:1-163. [PMID: 32863241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This analysis of the Norwegian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Norway is among the wealthiest nations in the world, with low levels of income inequality. Norwegians enjoy long and healthy lives, with substantial improvement made due to effective and high-quality medical care and the impact of broader public health policies. However, this comes at a high cost, as the Norwegian health system is among the most expensive in Europe, with most financing coming from public funds. Yet there are several areas requiring substantial co-payments, such as adult dental care, outpatient pharmaceuticals, and institutional care for older or disabled people. Recent and ongoing reforms have focused on aligning provision of care to changing population health needs, including adapting medical education, strengthening primary care and improving coordination between primary and specialist care sectors. There has been an increasing use of e-health solutions, and information and communication technologies. Improvements in measuring performance and a more effective use of indicators is expected to play a larger role in informing policy and planning of health services.
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Affiliation(s)
| | | | - Anna Sagan
- European Observatory on Health systems and policies
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180
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Fridell M, Edwin S, von Schreeb J, Saulnier DD. Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords. Int J Health Policy Manag 2020; 9:6-16. [PMID: 31902190 PMCID: PMC6943300 DOI: 10.15171/ijhpm.2019.71] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 09/02/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept. Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords "health system" and "resilience" for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience. DISCUSSION No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.
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Affiliation(s)
- My Fridell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Abstract
Online crowdfunding platforms such as GoFundMe are used to raise funds for health-related expenses associated with medical conditions such as organ transplantation. By investigating crowdfunding in Canadian organ transplantation, this study aimed to increase understanding of the motivations and outcomes of organ transplantation crowdfunding. Canadian liver and kidney transplantation campaigns posted to GoFundMe between May 30 & 31 2018 were identified and after exclusion, 258 kidney and 171 liver campaigns were included in study. These campaigns were coded for: worthiness of the campaign recipient, requested financial and non-monetary contributions, how monetary donations would be spent, and comments on the Canadian health system, among others. Results suggest Canadian organ donors, transplant candidates, recipients, and their families and caregivers experience significant financial difficulties not addressed by the public health system. Living and medication costs, transportation and relocation expenses, and income loss were the expenses most commonly highlighted by campaigners. Liver campaigns raised nearly half their goal while kidney campaigns received 11.5% of their requested amount. Findings highlight disease burden and the use of crowdfunding as a response to the extraordinary costs associated with organ transplantation. Although crowdfunding reduces some financial burden, it does not do so equitably and raises ethical concerns.
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Affiliation(s)
- Sarah J. Pol
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Samantha J. Anthony
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
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Abstract
OBJECTIVES The function of pooling and the ways that countries organize this is critical for countries' progress towards universal health coverage, but its potential as a policy instrument has not received much attention. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. METHODS The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. FINDINGS We propose eight broad types of pooling arrangements: (1.) a single pool; (2.) territorially distinct pools; (3.) territorially overlapping pools in terms of service and population coverage; (4.) different pools for different socio-economic groups with population segmentation; (5.) different pools for different population groups, with explicit coverage for all; (6.) multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6.), (7.) fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) complementary or supplementary voluntary health insurance. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. CONCLUSION Pooling arrangements set the potential for redistributive health spending. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover.
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Affiliation(s)
- Inke Mathauer
- Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 1211, Geneva, Switzerland.
| | | | - Joe Kutzin
- Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 1211, Geneva, Switzerland
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McGuire F, Vijayasingham L, Vassall A, Small R, Webb D, Guthrie T, Remme M. Financing intersectoral action for health: a systematic review of co-financing models. Global Health 2019; 15:86. [PMID: 31849335 PMCID: PMC6918645 DOI: 10.1186/s12992-019-0513-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing the social and other non-biological determinants of health largely depends on policies and programmes implemented outside the health sector. While there is growing evidence on the effectiveness of interventions that tackle these upstream determinants, the health sector does not typically prioritise them. From a health perspective, they may not be cost-effective because their non-health outcomes tend to be ignored. Non-health sectors may, in turn, undervalue interventions with important co-benefits for population health, given their focus on their own sectoral objectives. The societal value of win-win interventions with impacts on multiple development goals may, therefore, be under-valued and under-resourced, as a result of siloed resource allocation mechanisms. Pooling budgets across sectors could ensure the total multi-sectoral value of these interventions is captured, and sectors' shared goals are achieved more efficiently. Under such a co-financing approach, the cost of interventions with multi-sectoral outcomes would be shared by benefiting sectors, stimulating mutually beneficial cross-sectoral investments. Leveraging funding in other sectors could off-set flat-lining global development assistance for health and optimise public spending. Although there have been experiments with such cross-sectoral co-financing in several settings, there has been limited analysis to examine these models, their performance and their institutional feasibility. AIM This study aimed to identify and characterise cross-sectoral co-financing models, their operational modalities, effectiveness, and institutional enablers and barriers. METHODS We conducted a systematic review of peer-reviewed and grey literature, following PRISMA guidelines. Studies were included if data was provided on interventions funded across two or more sectors, or multiple budgets. Extracted data were categorised and qualitatively coded. RESULTS Of 2751 publications screened, 81 cases of co-financing were identified. Most were from high-income countries (93%), but six innovative models were found in Uganda, Brazil, El Salvador, Mozambique, Zambia, and Kenya that also included non-public and international payers. The highest number of cases involved the health (93%), social care (64%) and education (22%) sectors. Co-financing models were most often implemented with the intention of integrating services across sectors for defined target populations, although models were also found aimed at health promotion activities outside the health sector and cross-sectoral financial rewards. Interventions were either implemented and governed by a single sector or delivered in an integrated manner with cross-sectoral accountability. Resource constraints and political relevance emerged as key enablers of co-financing, while lack of clarity around the roles of different sectoral players and the objectives of the pooling were found to be barriers to success. Although rigorous impact or economic evaluations were scarce, positive process measures were frequently reported with some evidence suggesting co-financing contributed to improved outcomes. CONCLUSION Co-financing remains in an exploratory phase, with diverse models having been implemented across sectors and settings. By incentivising intersectoral action on structural inequities and barriers to health interventions, such a novel financing mechanism could contribute to more effective engagement of non-health sectors; to efficiency gains in the financing of universal health coverage; and to simultaneously achieving health and other well-being related sustainable development goals.
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Affiliation(s)
- Finn McGuire
- University of York (Centre for Health Economics), York, UK
| | - Lavanya Vijayasingham
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia.
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, (Centre for Health Economics in London (CHIL)), London, UK
| | - Roy Small
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
| | - Douglas Webb
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
| | - Teresa Guthrie
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
- Independent consultant, Cape Town, South Africa
| | - Michelle Remme
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
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Abstract
A major challenge to achieve health coverage in Nigeria is expansion of health access to the poor, vulnerable and informal sectors, which constitute over 70% of the population of more than 186 million. Evidence from other countries suggests that it is difficult for contributory insurance schemes to achieve universal health coverage in such conditions, especially with such a large informal sector. In fact, Nigeria's national social health insurance program has provided coverage to less than 5% of the population since its implementation in 2005, private voluntary health insurance has shown poor potential to extend coverage, and community-based health insurance has failed to expand access to poor, vulnerable and informal sector populations as well. Decentralization of health insurance to the states has limited potential to expand health insurance coverage for the poor, vulnerable and those in the informal sector. Furthermore, social health insurance in many developed countries has taken many years to achieve universal health coverage. This paper suggests that policy makers should consider adopting a tax-based, noncontributory, universal health-financing system as the primary funding mechanism to accelerate progress toward universal health coverage. Social health insurance and its decentralization to states for formal sector workers should serve as a supplement, while private voluntary health insurance should cover better-off groups. Simultaneously, it is critical to tackle issues of poor governance structures, mismanagement of funds, corruption, and lack of transparency and accountability within regulatory and implementing agencies, to ensure that monies allocated for expanded health insurance coverage are well managed. Although the proposed universal health coverage reform may take some years to achieve, it is more feasible to collect taxes, improve tax administration and expand the tax base than to enforce payment of contributions from nonsalaried workers and those who cannot afford to pay for health insurance or for services out of pocket.
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Behmane D, Dudele A, Villerusa A, Misins J, Klavina K, Mozgis D, Scarpetti G. Latvia: Health System Review. Health Syst Transit 2019; 21:1-165. [PMID: 32863240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This analysis of the Latvian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. After regaining independence in 1991, Latvia experimented with a social health insurance type system. However, to overcome decentralization and fragmentation of the system, the National Health Service (NHS) was established in 2011 with universal population coverage. More recently, reforms in 2017 proposed the introduction of a Compulsory Health Insurance System, with the objective of increasing revenues for health, which links access to different health care services to the payment of social health insurance contributions. In June 2019 the implementation of this proposal was postponed to 2021. Latvia has recovered from the severe economic recession of 2008, which resulted in the adoption of austerity measures that significantly affected the health care system. The recovery has created fiscal space to focus on policy challenges neglected in the past, especially regarding health. Despite recent increases in spending, the health system remains underfunded and resources have to be allocated wisely. Latvia's health outcomes should be considered within this context of limited health system resources. While life expectancy at birth in Latvia has increased since 2000, reaching 74.9 years in 2017, it remains among the lowest in the EU. Recent reforms have focused on improving access to services in rural/remote areas, increasing funding for health care services, and tougher regulation of tobacco and alcohol. However, a number of longstanding unresolved problems still need to be addressed, including financial sustainability and low public funding, high levels of unmet need, high rates of preventable and treatable mortality, and challenges in both communicable and noncommunicable diseases.
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Affiliation(s)
| | | | | | | | | | | | - Giada Scarpetti
- Berlin University of Technology and European Observatory on Health Systems and Policies
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188
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Beggs PJ, Zhang Y, Bambrick H, Berry HL, Linnenluecke MK, Trueck S, Bi P, Boylan SM, Green D, Guo Y, Hanigan IC, Johnston FH, Madden DL, Malik A, Morgan GG, Perkins-Kirkpatrick S, Rychetnik L, Stevenson M, Watts N, Capon AG. The 2019 report of the MJA-Lancet Countdown on health and climate change: a turbulent year with mixed progress. Med J Aust 2019; 211:490-491.e21. [PMID: 31722443 DOI: 10.5694/mja2.50405] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The MJA-Lancet Countdown on health and climate change was established in 2017 and produced its first Australian national assessment in 2018. It examined 41 indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. It found that, overall, Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In this report we present the 2019 update. We track progress on health and climate change in Australia across the same five broad domains and many of the same indicators as in 2018. A number of new indicators are introduced this year, including one focused on wildfire exposure, and another on engagement in health and climate change in the corporate sector. Several of the previously reported indicators are not included this year, either due to their discontinuation by the parent project, the Lancet Countdown, or because insufficient new data were available for us to meaningfully provide an update to the indicator. In a year marked by an Australian federal election in which climate change featured prominently, we find mixed progress on health and climate change in this country. There has been progress in renewable energy generation, including substantial employment increases in this sector. There has also been some progress at state and local government level. However, there continues to be no engagement on health and climate change in the Australian federal Parliament, and Australia performs poorly across many of the indicators in comparison to other developed countries; for example, it is one of the world's largest net exporters of coal and its electricity generation from low carbon sources is low. We also find significantly increasing exposure of Australians to heatwaves and, in most states and territories, continuing elevated suicide rates at higher temperatures. We conclude that Australia remains at significant risk of declines in health due to climate change, and that substantial and sustained national action is urgently required in order to prevent this.
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Affiliation(s)
| | | | | | | | | | | | - Peng Bi
- University of Adelaide, Adelaide, SA
| | | | - Donna Green
- Climate Change Research Centre, UNSW, Sydney, NSW
| | | | | | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
| | | | | | - Geoffrey G Morgan
- University Centre for Rural Health, University of Sydney, Lismore, NSW
| | | | - Lucie Rychetnik
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
| | | | - Nick Watts
- Institute of Global Health, University College London, London, UK
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Humphry J, Kiernan J. Insights in Public Health: Community Health Workers Are the Future of Health Care: How Can We Fund These Positions? Hawaii J Health Soc Welf 2019; 78:371-374. [PMID: 31886469 PMCID: PMC6911776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Jasmin Kiernan
- West Hawai'i Community Health Center, Kailua-Kona, HI (JK)
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190
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Sieleunou I, Turcotte-Tremblay AM, De Allegri M, Taptué Fotso JC, Azinyui Yumo H, Magne Tamga D, Ridde V. How does performance-based financing affect the availability of essential medicines in Cameroon? A qualitative study. Health Policy Plan 2019; 34:iii4-iii19. [PMID: 31816071 PMCID: PMC6901074 DOI: 10.1093/heapol/czz084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2019] [Indexed: 11/13/2022] Open
Abstract
Performance-based financing (PBF) is being implemented across low- and middle-income countries to improve the availability and quality of health services, including medicines. Although a few studies have examined the effects of PBF on the availability of essential medicines (EMs) in low- and middle-income countries, there is limited knowledge of the mechanisms underlying these effects. Our research aimed to explore how PBF in Cameroon influenced the availability of EMs, and to understand the pathways leading to the experiential dimension related with the observed changes. The design was an exploratory qualitative study. Data were collected through in-depth interviews, using semi-structured questionnaires. Key informants were selected using purposive sampling. The respondents (n = 55) included health services managers, healthcare providers, health authorities, regional drugs store managers and community members. All interviews were recorded, transcribed and analysed using qualitative data analysis software. Thematic analysis was performed. Our findings suggest that the PBF programme improved the perceived availability of EMs in three regions in Cameroon. The change in availability of EMs experienced by stakeholders resulted from several pathways, including the greater autonomy of facilities, the enforced regulation from the district medical team, the greater accountability of the pharmacy attendant and supply system liberalization. However, a sequence of challenges, including delays in PBF payments, limited autonomy, lack of leadership and contextual factors such as remoteness or difficulty in access, was perceived to hinder the capacity to yield optimal changes, resulting in heterogeneity in performance between health facilities. The participants raised concerns regarding the quality control of drugs, the inequalities between facilities and the fragmentation of the drug management system. The study highlights that some specific dimensions of PBF, such as pharmacy autonomy and the liberalization of drugs supply systems, need to be supported by equity interventions, reinforced regulation and measures to ensure the quality of drugs at all levels.
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Affiliation(s)
- Isidore Sieleunou
- Research for Development International, Opposite Fokou Mendong, Yaoundé 30 883, Cameroon
- University of Montreal Public Health Research Institute, 7101 Avenue du Parc, Room 3060, Montreal, QC H3N 1X9, Canada
- Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada
| | - Anne-Marie Turcotte-Tremblay
- University of Montreal Public Health Research Institute, 7101 Avenue du Parc, Room 3060, Montreal, QC H3N 1X9, Canada
- Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada
| | - Manuela De Allegri
- Medical Faculty and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, INF 130.3, Heidelberg 69120, Germany
| | | | - Habakkuk Azinyui Yumo
- Research for Development International, Opposite Fokou Mendong, Yaoundé 30 883, Cameroon
| | | | - Valéry Ridde
- University of Montreal Public Health Research Institute, 7101 Avenue du Parc, Room 3060, Montreal, QC H3N 1X9, Canada
- IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, 45 rue des Saints Pères, Paris 75006, France
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Banke-Thomas A, Nieuwenhuis S, Ologun A, Mortimore G, Mpakateni M. Embedding value-for-money in practice: A case study of a health pooled fund programme implemented in conflict-affected South Sudan. Eval Program Plann 2019; 77:101725. [PMID: 31629248 DOI: 10.1016/j.evalprogplan.2019.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/19/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
In recent times, there has been an increasing drive to demonstrate value for money (VfM) for investments made in public health globally. However, there is paucity of information on practical insights and best practices that have helped implementing organisations to successfully embed VfM in practice for programming and evaluation. In this article, we discuss strengths and weaknesses of approaches that been used and insights on best practices to manage for, demonstrate, and compare VfM, using a health pooled fund programme implemented in conflict-affected South Sudan as case study supported by evidence reported in the literature while critiquing adequacy of the available approaches in this setting. An expanded and iterative process framework to guide VfM embedding for health programming and evaluation is then proposed. In doing so, this article provides a very relevant one-stop source for critical insight into how to embed VfM in practice. Uptake and scale-up of the proposed framework can be essential in improving VfM and aid effectiveness which will ultimately contribute to progress towards achieving the Sustainable Development Goals by 2030.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Department of Health Policy, London School of Economics and Political Science, London, WC2 2AE, UK; Health Pooled Fund, Juba, South Sudan.
| | | | - Adesoji Ologun
- LAMP Development, 3 Melville Crescent, Edinburgh, EH3 7HW, UK
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Fox H, Topp SM, Callander E, Lindsay D. A review of the impact of financing mechanisms on maternal health care in Australia. BMC Public Health 2019; 19:1540. [PMID: 31752792 PMCID: PMC6873587 DOI: 10.1186/s12889-019-7850-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The World Health Organization states there are three interrelated domains that are fundamental to achieving and maintaining universal access to care - raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out-of-pocket costs, and allocating funds in a way that promotes quality, efficiency and equity. In Australia, a comprehensive account of the mechanisms for financing the health system have not been synthesised elsewhere. Therefore, to understand how the maternal health system is financed, this review aims to examine the mechanisms for funding, pooling and purchasing maternal health care and the influence these financing mechanisms have on the delivery of maternal health services in Australia. METHODS We conducted a scoping review and interpretative synthesis of the financing mechanisms and their impact on Australia's maternal health system. Due to the nature of the study question, the review had a major focus on grey literature. The search was undertaken in three stages including; searching (1) Google search engine (2) targeted websites and (3) academic databases. Executive summaries and table of contents were screened for grey literature documents and Titles and Abstracts were screened for journal articles. Screening of publications' full-text followed. Data relating to either funding, pooling, or purchasing of maternal health care were extracted for synthesis. RESULTS A total of 69 manuscripts were included in the synthesis, with 52 of those from the Google search engine and targeted website (grey literature) search. A total of 17 articles we included in the synthesis from the database search. CONCLUSION Our study provides a critical review of the mechanisms by which revenues are raised, funds are pooled and their impact on the way health care services are purchased for mothers and babies in Australia. Australia's maternal health system is financed via both public and private sources, which consequentially creates a two-tiered system. Mothers who can afford private health insurance - typically wealthier, urban and non-First Nations women - therefore receive additional benefits of private care, which further exacerbates inequity between these groups of mothers and babies. The increasing out of pocket costs associated with obstetric care may create a financial burden for women to access necessary care or it may cause them to skip care altogether if the costs are too great.
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Affiliation(s)
- Haylee Fox
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4814 Australia
| | - Stephanie M. Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4814 Australia
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, VIC 3010 Australia
| | - Emily Callander
- School of Medicine, Griffith University, Southport, QLD 4215 Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4814 Australia
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194
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Abstract
Expenditure on cancer therapies is rising rapidly in many countries, particularly for cancer drugs. In recent years, this has stimulated a global debate among the public, patients, clinicians, decision-makers, and the pharmaceutical industry on value, affordability, and sustainability propositions relating to cancer therapies. In this article, we discuss some recent developments in evidence-based approaches to priority setting and resource allocation in Canadian cancer systems. These developments include new methods for deliberative public engagement, generating and using real-world evidence, multi-criteria decision analysis, and handling uncertainty with evidence for gene therapies.
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Affiliation(s)
- Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam J N Raymakers
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Kelvin K W Chan
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Care Ontario, Toronto, Ontario, Canada
- Sunnybrook Hospital Research Institute, Toronto, Ontario, Canada
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195
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Abstract
When health systems aim to improve, two key considerations tend to be front and centre: cost and quality. On the cost side, health spending in Canada continues to rise. On the quality side, improvement is needed across the country. As the primary funder of healthcare, governments' historical role has focused on managing costs through their powers to set budgets, decide who gets paid, and how. Increasingly, governments are recognizing that the ways in which they choose to pay providers and organizations can also have an impact on the quality of care provided. Using Ontario as an example, we present a Canadian vision for modernizing how healthcare is organized and reimbursed and for using evidence and evaluation as the backbone for iterating new models. Realizing this vision will move Canada closer to international leadership in delivering high-quality, affordable care.
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Affiliation(s)
| | - Irfan Dhalla
- Health Quality Ontario, Toronto, Ontario, Canada
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196
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Juzwishin D. A Message from the Editor-in-Chief. Healthc Manage Forum 2019; 32:278-279. [PMID: 31470749 DOI: 10.1177/0840470419871724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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197
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McCabe C, Round J. Hard choices: Reflections from the tomb of the unknown patient. Healthc Manage Forum 2019; 32:288-292. [PMID: 31505957 DOI: 10.1177/0840470419871319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Health Technology Assessment (HTA) has always sought to incorporate the evidence of all patients affected in the decision-making process. While health system budgets could increase to cover costs of new technologies, the relevant patients are those benefitting from access to the technology being appraised. More recently, with health system budgets effectively fixed, costs of new technologies are covered by displacing other, currently funded care. This reallocation means the patients affected by the decision include those whose healthcare is displaced. These patients are typically unidentified, however, and so HTA in this instance involves choosing between identified and unidentified patients. We argue that HTA should take account of identifiability bias in this decision-making, to avoid promoting inequitable and inefficient access to healthcare.
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Affiliation(s)
- Christopher McCabe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta, Canada
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198
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Gadbois EA, Durfey S, Meyers DJ, Brazier JF, O'Connor B, McCreedy E, Wetle TF, Thomas KS. Medicare Advantage plan representatives' perspectives on Pay for Success. Am J Manag Care 2019; 25:561-568. [PMID: 31747235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To understand how Medicare Advantage (MA) plan representatives perceive the alternative financing model Pay for Success (PFS) and its potential to address members' social risk factors. STUDY DESIGN Semistructured qualitative interviews designed to understand plan representatives' priorities regarding addressing nonmedical needs of their members, awareness of and experiences with PFS, and thoughts about implementing PFS as a method to address members' nonmedical needs. METHODS Interviews with 38 upper-management representatives from 17 MA plans, which represent 65% of MA beneficiaries nationally, were conducted from July to November 2018. Plans varied in geographic coverage, star rating, and enrollment. Transcripts were qualitatively analyzed to understand overarching themes and patterns of responses. RESULTS MA plan representatives were largely unfamiliar with PFS and were interested in learning more about how it could address members' social needs. When probed about specific requirements of PFS, responses varied: Some reported willingness to share data with project partners and be reviewed by independent evaluators; others expressed their preference to keep data and performance analysis internal to the organization. Although most representatives prioritized innovation, some were more risk averse and preferred to use traditional methods to deliver new services. CONCLUSIONS MA plan representatives were unfamiliar with PFS, but most expressed interest in it as an alternative model for funding initiatives to address members' social needs. Education of MA representatives about PFS as an alternative payment model for innovative programming is warranted. However, further guidance from CMS is needed to assuage the concerns raised by these representatives.
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Affiliation(s)
- Emily A Gadbois
- Brown University School of Public Health, 121 S Main St, Providence, RI 02912.
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199
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Dieleman JL, Micah AE. Development Assistance for Health in Low-Income Countries-Reply. JAMA 2019; 322:1518. [PMID: 31613343 DOI: 10.1001/jama.2019.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Angela E Micah
- Institute for Health Metrics and Evaluation, Seattle, Washington
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200
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Affiliation(s)
- Desmond T Jumbam
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Dominique Vervoort
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
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