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Wang LY, Hu ZY, Chen HX, Zhou CF, Tang ML, Hu XY. Differences in regional distribution and inequality in health workforce allocation in hospitals and primary health centers in China: A longitudinal study. Int J Nurs Stud 2024; 157:104816. [PMID: 38824719 DOI: 10.1016/j.ijnurstu.2024.104816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND In 2009, China launched a new round of healthcare reform to provide households with secure, efficient, convenient, equitable and affordable healthcare services. Healthcare reform is underpinned by three critical pillars: the health workforce, funding, and infrastructure, with reform of the health workforce being particularly significant. OBJECTIVE This study analyses the disparities in regional distribution and the inequity of healthcare workforce allocation across hospitals and primary health centers in China over twelve years. DESIGN Retrospective longitudinal data from the National Health Statistics Yearbook 2011-2022 and National Statistical Yearbook in China from 2011 to 2022 were collected for analysis. PARTICIPANTS The focus was on hospitals and primary health centers, explicitly examining their health technician and nursing workforce. METHODS The research utilized four key indicators of the healthcare workforce to evaluate the distribution of health resources between hospitals and primary health centers. Furthermore, the Gini coefficient and Theil index were employed to assess the inequality in allocating the health workforce. RESULTS Between 2010 and 2021, there was a nationwide increase in the ratio of health workers per 1000 population in hospitals and primary health centers. It is noted that rural districts had higher ratios than urban districts in terms of the number of health technicians and nurses per 1000 population, whether in hospitals or primary health centers; western districts had higher ratios than eastern and central districts did. In the same year, at different levels of medical institutions, the Theil indices of health technicians and nurses in hospitals were lower than those in primary health centers in terms of both demographic and geographical dimensions. Regarding the allocation of the health workforce by population, the Gini coefficient remained below 0.3, while for geographical allocation, it exceeded 0.4. CONCLUSIONS This study analyzed the temporal trends and inequality of health-resource allocation at the hospital and primary health center levels in China, noting trends of improvements in the quantity and inequality in health workforce allocation from 2010 to 2021, suggesting the success of the government's efforts to advance healthcare reform since 2009. The allocation of health workforce based on population exhibits greater fairness compared to geographical distribution.
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Affiliation(s)
- Ling-Ying Wang
- Critical Care Medicine Department, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China; Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Zi-Yi Hu
- Nursing Department, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Hong-Xiu Chen
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Chun-Fen Zhou
- Mental Health Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Meng-Lin Tang
- Critical Care Medicine Department, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Xiu-Ying Hu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China.
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Conceptualising equity in the impact evaluation of chronic disease management programmes: a capabilities approach. HEALTH ECONOMICS, POLICY, AND LAW 2022; 17:141-156. [PMID: 32327000 DOI: 10.1017/s1744133120000067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic diseases are highly important for the future level and distribution of health and well-being in western societies. Consequently, it seems pertinent to assess not only efficiency of chronic care but also its impact on health equity. However, operationalisation of health equity has proven a challenging task. Challenges include identifying a relevant and measurable evaluative space. Various schools of thought in health economics have identified different outcomes of interest for equity assessment, with capabilities as a proposed alternative to more conventional economic conceptualisations. The aim of this paper is to contribute to the conceptualisation of health equity evaluation in the context of chronic disease management. We do this by firstly introducing an equity enquiry framework incorporating the capabilities approach. Secondly, we demonstrate the application and relevance of this framework through a content analysis of equity-related principles and aims in national chronic disease management guidelines and the national diabetes action plan in Denmark. Finally, we discuss how conceptualisations of equity focused on capabilities may be used in evaluation by scoping relevant operationalisations. A promising way forward in the context of chronic care evaluation may emerge from a combination of concepts of capabilities developed in economics, health sciences and psychology.
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Barry S, Stach M, Thomas S, Burke S. Understanding service reorganisation in the Irish health & social care system from 1998 to 2020: lessons for reform and transformation. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13342.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Given policy drives for integrated care and other reforms requiring service reorganisation this study analyses service reorganisation in the Irish health and social care system from 1998 to 2020 with the aim of identifying lessons for reform implementation and system learning generally. Methods: A mixed-method, co-designed study of three distinct datasets through in a policy document analysis, a thematic analysis of interviews with elite respondents, and a formal review of the international literature, sets the Irish reorganisation story in the context of services and system reorganisation elsewhere. This approach is apt given the complexity involved. Results: We find repeated policy declarations for forms of integrated care from the early 1990s in Ireland. These have not resulted in effective change across the system due to political, organisational and implementation failures. We identify poor clarity and commitment to policy and process, weak change management and resourcing, and reluctance from within the system to change established ways of working, cultures and allegiances. Given its narrative approach and identification of key lessons, this study is of use to policy makers, researchers and practitioners, clinical and managerial. It forms part of a bigger project of evidence building for the implementation of Sláintecare, Ireland’s 10-year health system reform programme. Conclusions: The paper captures important lessons for regionalisation of services delivery and other reorganisations in service-based systems more generally. We find evidence of a negative policy/implementation/practice cycle repeatedly missing opportunities for reform. Learning to break this cycle is essential for implementing Sláintecare and other complex reorganisational health reforms generally.
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O'Connor M, McSherry LA, Dombrowski SU, Francis JJ, Martin CM, O'Leary JJ, Sharp L. Identifying ways to maximise cervical screening uptake: a qualitative study of GPs' and practice nurses' cervical cancer screening-related behaviours. HRB Open Res 2021; 4:44. [PMID: 34458677 PMCID: PMC8370130 DOI: 10.12688/hrbopenres.13246.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Cervical screening uptake is declining in several countries. Primary care practitioners could play a greater role in maximising uptake, but better understanding is needed of practitioners’ cervical screening-related behaviours. Among general practitioners (GPs) and practice nurses, we aimed to identify cervical screening-related clinical behaviours; clarify practitioners’ roles/responsibilities; and determine factors likely to influence clinical behaviours.
Methods: Telephone interviews were conducted with GPs and practice nurses in Ireland. Interview transcripts were analysed using the Theoretical Domains Framework (TDF), a comprehensive psychological framework of factors influencing clinical behaviour. Results: 14 GPs and 19 practice nurses participated. Key clinical behaviours identified were offering smears and encouraging women to attend for smears. Smeartaking responsibility was considered a predominantly female role. Of 12 possible theoretical domains, 11 were identified in relation to these behaviours. Those judged to be the most important were beliefs about capabilities; environmental context and resources; social influences; and behavioural regulation. Difficulties in obtaining smears from certain subgroups of women and inexperience of some GPs in smeartaking arose in relation to beliefs about capabilities. The need for public health education and reluctance of male practitioners to discuss cervical screening with female patients emerged in relation to social influences. Conclusions: We identified - for the first time - primary care practitioners’ cervical-screening related clinical behaviours, their perceived roles and responsibilities, and factors likely to influence behaviours. The results could inform initiatives to enable practitioners to encourage women to have smear tests which in turn, may help increase cervical screening uptake.
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Affiliation(s)
| | - Lisa A McSherry
- National Cancer Registry of Ireland, Kinsale Road, Cork, Ireland, Ireland
| | | | - Jill J Francis
- School of Health Sciences, City University London, London,, UK
| | | | | | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle, UK
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Dong E, Xu J, Sun X, Xu T, Zhang L, Wang T. Differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce: a longitudinal study in China. ACTA ACUST UNITED AC 2021; 79:78. [PMID: 34001268 PMCID: PMC8130126 DOI: 10.1186/s13690-021-00597-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/29/2021] [Indexed: 01/05/2023]
Abstract
Background The distribution of health-care resources is foundational to achieving fairness and having access to health service. China and its local Shanghai’s government have implemented measures to allocate health-care resources with the equity as one of the major goals since 2009-health-care reform. The aim of this study was to analyze differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce in Shanghai over 7 years. Methods The study was conducted using 2010–2016 data to analyze health-resource allocation on institutions, beds, and workforce in Shanghai, China. The annual growth rate (AGR) was used to evaluate the time trends of health-care resource from 2010 to 2016, and Theil index was calculated to measure inequality of five indicators of health-care resource allocation during this study period. Results All quantities of health-care resources per 1000 people increased across Shanghai districts from 2010 to 2016. Compared with suburban districts, the central districts had higher ratios on five health-care resource indicators, and faster average growth in the bed and nurse indicator. The Theil of the indicators, except for doctors in hospitals, all exhibited downward time trends. Conclusions Regional difference between urban and rural areas and inequality between institution and workforce, especially for doctors, still existed. Some targeted measures including but not limited to income raising, facilitation of transportation conditions, investment of more fiscal funds, enhancement of health-care service provision for rural residents should be fully considered to narrow resource distribution gap between urban and rural districts and mitigate the inequality of health-care resource allocation. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00597-1.
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Affiliation(s)
- Enhong Dong
- School of Nursing and Health Management, Shanghai University of Medicine & Health Science, 279 Zhouzhu Road, Pudong New District, Shanghai, 201318, China.,School of Media and Communication, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jie Xu
- Emergency Department, Dezhou People's Hospital, Dezhou, 253003, Shandong Province, China
| | - Xiaoting Sun
- Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, 200072, China
| | - Ting Xu
- School of Nursing and Health Management, Shanghai University of Medicine & Health Science, 279 Zhouzhu Road, Pudong New District, Shanghai, 201318, China
| | - Lufa Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Tao Wang
- Department of Orthopaedics and Traumatology, Shanghai East Hospital Tongji University School of Medicine, Shanghai, 200127, China. .,College of Arts and Media, Tongji University, Shanghai, 200092, China.
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Amri MM, Jessiman-Perreault G, Siddiqi A, O’Campo P, Enright T, Di Ruggiero E. Scoping review of the World Health Organization's underlying equity discourses: apparent ambiguities, inadequacy, and contradictions. Int J Equity Health 2021; 20:70. [PMID: 33658033 PMCID: PMC7931570 DOI: 10.1186/s12939-021-01400-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Given the heightened rhetorical prominence the World Health Organization has afforded to equity in the past half-century, it is important to better understand how equity has been referred to and its conceptual underpinning, which may have broader global implications. ELIGIBILITY CRITERIA Articles were included if they met inclusion criteria - chiefly the explicit discussion of the WHO's concept of health equity, for example in terms of conceptualization and/or definitions. Articles which mentioned health equity in the context of WHO's programs, policies, and so on, but did not discuss its conceptualization or definition were excluded. SOURCES OF EVIDENCE We focused on peer-reviewed literature by scanning Ovid MEDLINE and SCOPUS databases, and supplementing by hand-search. RESULTS Results demonstrate the WHO has held - and continues to hold - ambiguous, inadequate, and contradictory views of equity that are rooted in different theories of social justice. CONCLUSIONS Moving forward, the WHO should revaluate its conceptualization of equity and normative position, and align its work with Amartya Sen's Capabilities Approach, as it best encapsulates the broader views of the organization. Further empirical research is needed to assess the WHO interpretations and approaches to equity.
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Affiliation(s)
- Michelle M. Amri
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, Boston, MA 02115-6021 USA
- School of Public Health and Social Policy, Human and Social Development Building, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2 Canada
| | | | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, USA
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5B 1T8 Canada
| | - Theresa Enright
- Department of Political Science, University of Toronto, 100 St George Street, Toronto, Ontario M5S 3G3 Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
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Dong E, Liu S, Chen M, Wang H, Chen LW, Xu T, Wang T, Zhang L. Differences in regional distribution and inequality in health-resource allocation at hospital and primary health centre levels: a longitudinal study in Shanghai, China. BMJ Open 2020; 10:e035635. [PMID: 32690509 PMCID: PMC7371131 DOI: 10.1136/bmjopen-2019-035635] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To analyse differences in regional distribution and inequality in health-resource allocation at the hospital and primary health centre (PHC) levels in Shanghai over 7 years. DESIGN A longitudinal survey using 2010-2016 data, which were collected for analysis. SETTING The study was conducted at the hospital and PHC levels in Shanghai, China. OUTCOME MEASURES Ten health-resource indicators were used to measure health-resource distribution at the hospital and PHC levels. In addition, the Theil Index was calculated to measure inequality in health-resource allocation. RESULTS All quantities of healthcare resources per 1000 people in hospitals and PHCs increased across Shanghai districts from 2010 to 2016. Relative to suburban districts, the central districts had higher ratios, both in terms of doctors and equipment, and had faster growth in the doctor indicator and slower growth in the equipment indicator in hospitals and PHCs. The Theil Indices of all health-resource allocation in hospitals had higher values compared with those in PHCs every year from 2010 to 2016; furthermore, the Theil Indices of the indicators, except for technicians and doctors in hospitals, all exhibited downward time trends in hospitals and PHCs. CONCLUSIONS Increased healthcare resources and reduced inequality of health-resource allocation in Shanghai during the 7 years indicated that measures taken by the Shanghai government to deepen the new round of healthcare reform in China since 2009 had been successful. Meanwhile there still existed regional difference between urban and rural areas and inequality across different medical institutions. To solve these problems, we prescribe increased wages, improved working conditions, and more open access to career development for doctors and nurses; reduced investments in redundant equipment in hospitals; and other incentives for balancing the health workforce between hospitals and PHCs.
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Affiliation(s)
- Enhong Dong
- School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai, Shanghai, China
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
| | - Shipeng Liu
- Department of Pediatrics, Dezhou People's Hospital, Dezhou, Shandong, China
| | - Minjie Chen
- Outpatient and Emergent Office, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, Shanghai, China
| | - Hongmei Wang
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Li-Wu Chen
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ting Xu
- School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai, Shanghai, China
| | - Tao Wang
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Shanghai, China
| | - Lufa Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
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O'Donnell P, O'Donovan D, Elmusharaf K. Social inclusion in the Irish health context: Policy and stakeholder mapping. Ir J Med Sci 2019; 189:11-26. [PMID: 31302862 DOI: 10.1007/s11845-019-02060-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Social inclusion is a complex concept, and its relationship to health has been widely debated. Across the European Union, there has been a move towards policies promoting social inclusion. Despite this, there has been a limited analysis of how the concept of social inclusion is operationalised in Irish policy. The aim of this research was to document and map the development of social inclusion policies in the Irish context. The objectives were to identify all the relevant stakeholders and policies and to describe the relevance of social inclusion policy in the domain of health. METHODS We utilised a widely recognised policy analysis framework. We conducted a systematic search of relevant government policies, grey literature databases, statutory agencies and stakeholders in the Irish context since 2006. The researchers initially identified a total of 954 results. RESULTS The relevant stakeholders discovered were the research community, service providers, civil society organisations, policy makers and government, philanthropists and socially excluded people. Most policy documents included refer to one of two national policies created to drive social inclusion activities. Social inclusion was being operationalised in the context of health, but the relationship between policymakers and those planning and providing services was unclear. CONCLUSIONS The concept of social inclusion was being operationalised in the Irish policy context. A multitude of stakeholders were involved, reflecting the wide reach of this concept in society. Social inclusion was a particularly important concept in the realm of health, and in the primary care domain in particular.
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Affiliation(s)
- Patrick O'Donnell
- Research Area GEMS 3-026, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Diarmuid O'Donovan
- School of Medicine, Dentistry and Bisomedical Sciences, Queens University, University Road, Belfast, Northern Ireland, BT7 1NN, UK
| | - Khalifa Elmusharaf
- GEMS 3-009A, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Lu L, O'Sullivan E, Sharp L. Cancer-related financial hardship among head and neck cancer survivors: Risk factors and associations with health-related quality of life. Psychooncology 2019; 28:863-871. [PMID: 30779397 DOI: 10.1002/pon.5034] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/24/2019] [Accepted: 02/16/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Cancer survivors are susceptible to financial hardship. In head and neck cancer (HNC) survivors, we investigated (a) predictors for cancer-related financial hardship and (b) associations between financial hardship and health-related quality of life (HRQoL). METHODS We conducted a cross-sectional study in HNC survivors identified from the National Cancer Registry Ireland. HRQoL was based on the Functional Assessment for Cancer Therapy General (FACT-G) plus Head and Neck Module (FACT-HN). Objective cancer-related financial hardship (financial stress) was assessed as household ability to make ends meet due to cancer and subjective financial hardship (financial strain) as feelings about household financial situation due to cancer. Modified Poisson regression was used to identify predictors for financial hardship. Bootstrap linear regression was used to estimate associations between hardship and FACT domain scores. RESULTS Pre-diagnosis retirement (relative risk [RR] 0.50, 95% confidence interval [CI] 0.37-0.67), pre-diagnosis financial stress (RR 1.85, 95% CI 1.58-2.15), and treatment were significantly associated with objective financial hardship. Predictors of subjective financial hardship were similar: aged greater than or equal to 65 years, pre-diagnosis financial stress, and treatment. Participants with objective financial hardship reported significantly lower physical (coefficient -3.45, 95% CI -4.39 to -2.44), emotional (-2.01, 95% CI -2.83 to -1.24), functional (-2.56, 95% CI -3.77 to -1.33) and HN-specific HRQoL (-3.55, 95% CI -5.04 to -2.23). Physical, emotional, and functional HN-specific HRQoL were also significantly lower in participants with subjective financial hardship. CONCLUSION Cancer-related financial hardship is common and associated with worse HRQoL among HNC survivors. This supports the need for services and supports to address financial concerns among HNC survivors.
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Affiliation(s)
- Liya Lu
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne
| | | | - Linda Sharp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne
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Burke SA, Brugha R, Thomas S. It’s the economy, stupid! When economics and politics override health policy goals – the case of tax reliefs to build private hospitals in Ireland in the early 2000s. HRB Open Res 2018. [DOI: 10.12688/hrbopenres.12784.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: To analyse the policy process that led to changes to the Finance Acts in 2001 and 2002 that gave tax-reliefs to build private hospitals in Ireland. Methods: Qualitative research methods of documentary analysis and in-depth semi-structured interviews with elites involved in the policy processes, were used and examined through a conceptual framework devised for this research. Results: This research found a highly politicised and personalised policy making process where policy entrepreneurs, namely private sector interests, had significant impact on the policy process. Effective private sector lobbying encouraged the Minister of Finance to introduce the tax-reliefs for building private hospitals despite advice against this policy measure from his own officials, officials in the Department of Health and the health minister. The Finance Acts in 2001 and 2002 introduced tax-reliefs for building private hospitals, without any public or political scrutiny or consensus. Conclusion: The changes to the Finance Acts to give tax-reliefs to build private hospitals in 2001 and private for-profit hospitals 2002 is an example of a closed, personalised policy making process. It is an example of a politically imposed policy by the finance minister, where economic policy goals overrode health policy goals. The documentary analysis and elite interviews examined through a conceptual framework enabled an in-depth analysis of this specific policy making process. These methods and the framework may be useful to other policy making analyses.
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Financial Impact of Colorectal Cancer and Its Consequences: Associations Between Cancer-Related Financial Stress and Strain and Health-Related Quality of Life. Dis Colon Rectum 2018; 61:27-35. [PMID: 29219919 DOI: 10.1097/dcr.0000000000000923] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The financial impact and consequences of cancer on the lives of survivors remain poorly understood. This is especially true for colorectal cancer. OBJECTIVE We investigated objective cancer-related financial stress, subjective cancer-related financial strain, and their association with health-related quality of life in colorectal cancer survivors. DESIGN This was a cross-sectional postal survey. SETTINGS The study was conducted in Ireland, which has a mixed public-private healthcare system. PATIENTS Colorectal cancer survivors, diagnosed 6 to 37 months prior, were identified from the population-based National Cancer Registry. MAIN OUTCOME MEASURES Cancer-related financial stress was assessed as impact of cancer on household ability to make ends meet and cancer-related financial strain by feelings about household financial situation since cancer diagnosis. Health-related quality of life was based on European Organisation for Research and Treatment of Cancer QLQ-C30 global health status. Logistic regression was used to identify associations between financial stress and strain and low health-related quality of life (lowest quartile, score ≤50). RESULTS A total of 493 survivors participated. Overall, 41% reported cancer-related financial stress and 39% cancer-related financial strain; 32% reported both financial stress and financial strain. After adjustment for sociodemographic and clinical variables, the odds of low health-related quality of life were significantly higher in those who reported cancer-related financial stress postdiagnosis compared with those who reported no change in financial stress postcancer (OR = 2.54 (95% CI, 1.62-3.99)). The odds of low health-related quality of life were also significantly higher in those with worse financial strain postdiagnosis (OR =1.73 (95% CI, 1.09-2.72)). The OR for those with both cancer-related financial stress and financial strain was 2.59 (95% CI, 1.59-4.22). LIMITATIONS Survey responders were younger, on average, than nonresponders. Responders and nonresponders may have differed in cancer-related financial stress and strain or health-related quality of life. CONCLUSIONS Four in 10 colorectal cancer survivors reported an adverse financial impact of cancer. Cancer-related financial stress and strain were significantly associated with low health-related quality of life. To inform support strategies, additional research is needed to better understand how both objective and subjective financial distress influence survivors' health-related quality of life. See Video Abstract http://links.lww.com/DCR/A447.
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A European late starter: lessons from the history of reform in Irish health care. HEALTH ECONOMICS POLICY AND LAW 2017; 14:355-373. [DOI: 10.1017/s1744133117000275] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.
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Ó Céilleachair A, Hanly P, Skally M, O'Leary E, O'Neill C, Fitzpatrick P, Kapur K, Staines A, Sharp L. Counting the cost of cancer: out-of-pocket payments made by colorectal cancer survivors. Support Care Cancer 2017; 25:2733-2741. [PMID: 28341973 DOI: 10.1007/s00520-017-3683-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/20/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Cancer places a significant cost burden on health services. There is increasing recognition that cancer also imposes a financial and economic burden on patients but this has rarely been quantified outside North America. We investigate out-of-pocket costs (OOPCs) incurred by colorectal (CRC) survivors in Ireland. METHODS CRC survivors (ICD10 C18-20) diagnosed 6-30 months previously were identified from the National Cancer Registry Ireland and invited to complete a postal questionnaire. Cancer-related OOPC for tests, procedures, drugs, allied medications and household management in approximately the year following diagnosis were calculated. Robust regression was used to identify predictors of OOPC; this was done for all survivors combined and stratified by age (<70 and ≥70 years) and employment status (working and not working) at diagnosis. RESULTS Four hundred ninety-seven CRC survivors completed questionnaires (response rate = 39%). Almost all (90%) respondents reported some cancer-related OOPC. The average total OOPC was €1589. Stage III at diagnosis was associated with significantly higher OOPCs than other stages in the all-survivor model, in those not working in the employment model and in those under 70 years in the age-stratified model. In all-survivor model, those under 70 also had higher OOPCs, as did those in employment. Having one or more children was associated with significantly lower OOPCs in those under 70 years. CONCLUSIONS Almost all CRC survivors incur cancer-related OOPCs; for some, these are not insignificant. Greater attention should be paid to the development of services to help survivors manage the financial and economic burden of cancer.
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Affiliation(s)
- Alan Ó Céilleachair
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland.
| | - Paul Hanly
- National College of Ireland, IFSC, Dublin 1, Ireland
| | - Máiréad Skally
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland
| | - Eamonn O'Leary
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland
| | | | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin 4, Ireland
| | - Kanika Kapur
- School of Economics and Geary Institute, University College Dublin, Dublin 4, Ireland
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, Newcastle, UK
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Baguma D. Public health safety and environment in inadequate hospital and healthcare settings: a review. Public Health 2017; 144:23-31. [DOI: 10.1016/j.puhe.2016.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/24/2016] [Indexed: 11/30/2022]
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Reflecting on 'Equity in health care: the Irish perspective'. HEALTH ECONOMICS, POLICY, AND LAW 2015; 10:443-7. [PMID: 25858501 DOI: 10.1017/s1744133115000195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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de Camargo Cancela M, Comber H, Sharp L. Which women with breast cancer do, and do not, undergo receptor status testing? A population-based study. Cancer Epidemiol 2015; 39:778-82. [PMID: 26318110 DOI: 10.1016/j.canep.2015.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Receptor status determines of breast cancer treatment and prognosis. In a population-based study, we investigated predictors of receptor test receipt. MATERIALS AND METHODS Invasive breast cancers diagnosed 2006-2008 were abstracted from the National Cancer Registry Ireland. Modified Poisson regression with robust error variance was used to identify socio-demographic, health service and clinical predictors of not undergoing ER, PR or HER2 testing. RESULTS 7619 breast cancers were included. 7% were not tested for any receptor. 92%, 80% and 86% had oestrogen (ER), progesterone (PR) and human epidermal growth factor 2 (HER2) tests, respectively; 73% were tested for all three. For all three tests, unmarried women were significantly less likely to be tested than married women. Current smokers significantly more often had ER and PR tests. Women treated in a high-volume hospital significantly more often had ER and HER2 tests. CONCLUSION After adjusting for clinical factors, socio-demographic and service-related factors significantly predicted receptor test receipt. Some factors deserve further investigation, especially marital status. In the interests of equity, the reasons underlying these associations should be further investigated.
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Affiliation(s)
| | | | - Linda Sharp
- National Cancer Registry Ireland, Cork, Ireland; Institute of Health & Society, Newcastle University, England
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Sharp L, Timmons A. Pre-diagnosis employment status and financial circumstances predict cancer-related financial stress and strain among breast and prostate cancer survivors. Support Care Cancer 2015; 24:699-709. [PMID: 26143038 DOI: 10.1007/s00520-015-2832-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Cancer may have a significant financial impact on patients, but the characteristics that predispose patients to cancer-related financial hardship are poorly understood. We investigated factors associated with cancer-related financial stress and strain in breast and prostate cancer survivors in Ireland, which has a complex mixed public-private healthcare system. METHODS Postal questionnaires were distributed to 1373 people diagnosed with cancer 3-24 months previously identified from the National Cancer Registry Ireland. Outcomes were cancer-related financial stress (impact of cancer diagnosis on household ability to make ends meet) and financial strain (concerns about household financial situation since cancer diagnosis). Modified Poisson regression was used to estimate relative risks (RR) for factors associated with cancer-related financial stress and strain. RESULTS Seven hundred forty survivors participated (response rate = 54 %). Of the respondents, 48 % reported cancer-related financial stress and 32 % cancer-related financial strain. Compared to those employed at diagnosis, risk of cancer-related financial stress was significantly lower in those not working (RR = 0.71, 95 % CI 0.58-0.86) or retired (RR = 0.48, 95 % CI 0.34-0.68). It was significantly higher in those who had dependents; experienced financial stress pre-diagnosis; had a mortgage/personal loans; had higher direct medical out-of-pocket costs; and had increased household bills post-diagnosis. For cancer-related financial strain, significant associations were found with dependents, pre-diagnosis employment status and pre-diagnosis financial stress; risk was lower in those with higher direct medical out-of-pocket costs. CONCLUSIONS Cancer-related financial stress and strain are common. Pre-diagnosis employment status and financial circumstances are important predictors of post-diagnosis financial wellbeing. These findings could inform development of tools to identify patients/survivors most in need of financial advice and support.
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Affiliation(s)
- Linda Sharp
- National Cancer Registry, Building 6800, Kinsale Road, Cork, Ireland. .,Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, England, UK.
| | - Aileen Timmons
- National Cancer Registry, Building 6800, Kinsale Road, Cork, Ireland
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Chen R, Zhao Y, Du J, Wu T, Huang Y, Guo A. Health workforce equity in urban community health service of China. PLoS One 2014; 9:e115988. [PMID: 25551449 PMCID: PMC4281229 DOI: 10.1371/journal.pone.0115988] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/28/2014] [Indexed: 12/02/2022] Open
Abstract
Objectives To reveal the equity of health workforce distribution in urban community health service (CHS), and to provide evidence for further development of community health service in China. Methods A community-based, cross-sectional study was conducted in China from September to December 2011. In the study, 190 CHS centers were selected from 10 provinces of China via stratified multistage cluster sampling. Human resources profiles and basic characteristics of each CHS centers were collected. Lorenz curves and Gini Coefficient were used to measure the inequality in the distribution of health workforce in community health service centers by population size and geographical area. Wilcoxon rank test for paired samples was used to analyze the differences in equity between different health indicators. Results On average, there were 7.37 health workers, including 3.25 doctors and 2.32 nurses per 10,000 population ratio. Significant differences were found in all indicators across the samples, while Beijing, Shandong and Zhejiang ranked the highest among these provinces. The Gini coefficients for health workers, doctors and nurses per 10,000 population ratio were 0.39, 0.44, and 0.48, respectively. The equity of doctors per 10,000 population ratio (G = 0.39) was better than that of doctors per square kilometer (G = 0.44) (P = 0.005). Among the total 6,573 health workers, 1,755(26.7%) had undergraduate degree or above, 2,722(41.4%)had junior college degree and 215(3.3%) had high school education. Significant inequity was found in the distribution of workers with undergraduate degree or above (G = 0.52), which was worse than that of health works per 10000 population (P<0.001). Conclusions Health workforce inequity was found in this study, especially in quality and geographic distribution. These findings suggest a need for more innovative policies to improve health equity in Chinese urban CHS centers.
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Affiliation(s)
- Rui Chen
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China
| | - Yali Zhao
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China
| | - Juan Du
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China
| | - Tao Wu
- Beijing An Zhen Hospital, Capital Medical University, Beijing, P. R. China
| | - Yafang Huang
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China
| | - Aimin Guo
- School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China
- * E-mail:
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Timmons A, Gooberman-Hill R, Sharp L. "It's at a time in your life when you are most vulnerable": a qualitative exploration of the financial impact of a cancer diagnosis and implications for financial protection in health. PLoS One 2013; 8:e77549. [PMID: 24244279 PMCID: PMC3823871 DOI: 10.1371/journal.pone.0077549] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/10/2013] [Indexed: 11/19/2022] Open
Abstract
Although cancer patients may incur a wide range of cancer-related out-of-pocket costs and experience reduced income, the consequences of this financial burden are poorly understood. We investigated: financial adjustments needed to cope with the cancer-related financial burden; financial distress (defined as a reaction to the state of personal finances); and factors that increase risk of financial difficulties. Two sets of semi-structured face-to-face interviews were conducted with 20 patients with breast, lung and prostate cancer and 21 hospital-based oncology social workers (OSWs) in Ireland, which has a mixed public-private healthcare system. Participants were asked about: strategies to cope with the cancer-related financial burden; the impact of the financial burden on the family budget, other aspects of daily life, and wellbeing. OSWs were also asked about patient groups they thought were more likely to experience financial difficulties. The two interview sets were analysed separately using a thematic approach. Financial adjustments included: using savings; borrowing money; relying on family and friends for direct and indirect financial help; and cutting back on household spending. Financial distress was common. Financial difficulties were more likely for patients who were older or younger, working at diagnosis, lacked social support, had dependent children, had low income or had few savings. These issues often interacted with one another. As has been seen in predominantly publically and predominantly privately-funded healthcare settings, a complex mixed public-private healthcare system does not always provide adequate financial protection post-cancer. Our findings highlight the need for a broader set of metrics to measure the financial impact of cancer (and to assess financial protection in health more generally); these should include: out-of-pocket direct medical and non-medical costs; changes in income; financial adjustments (including financial coping strategies and household consumption patterns); and financial distress. In the interim, cancer patients require financial information and advice intermittently post diagnosis.
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Affiliation(s)
| | - Rachael Gooberman-Hill
- Orthopaedic Surgery Research Group, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
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Briggs AD. How changes to Irish healthcare financing are affecting universal health coverage. Health Policy 2013; 113:45-9. [DOI: 10.1016/j.healthpol.2013.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 07/22/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
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Balfe M, Brugha R, Smith D, Sreenan S, Doyle F, Conroy R. Considering quality of care for young adults with diabetes in Ireland. BMC Health Serv Res 2013; 13:448. [PMID: 24168159 PMCID: PMC3883518 DOI: 10.1186/1472-6963-13-448] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 10/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on the quality of diabetes care provided to young adults with Type 1 diabetes is lacking. This study investigates perceptions of quality of care for young adults with Type 1 diabetes (23-30 years old) living in the Republic of Ireland. METHODS Thirty-five young adults with Type 1 diabetes (twenty-nine women, six men) and thirteen healthcare professionals (ten diabetes nurse specialists, three consultant Endocrinologists) were recruited. All study participants completed semi-structured interviews that explored their perspectives on the quality of diabetes services in Ireland. Interviews were analyzed using standard qualitative thematic analysis techniques. RESULTS Most interviewees identified problems with Irish diabetes services for young adults. Healthcare services were often characterised by long waiting times, inadequate continuity of care, overreliance on junior doctors and inadequate professional-patient interaction times. Many rural and non-specialist services lacked funding for diabetes education programmes, diabetes nurse specialists, insulin pumps or for psychological support, though these services are important components of quality Type 1 diabetes healthcare. Allied health services such as psychology, podiatry and dietician services appeared to be underfunded in many parts of the country. While Irish diabetes services lacked funding prior to the recession, the economic decline in Ireland, and the subsequent austerity imposed on the Irish health service as a result of that decline, appears to have additional negative consequences. Despite these difficulties, a number of specialist healthcare services for young adults with diabetes seemed to be providing excellent quality of care. Although young adults and professionals identified many of the same problems with Irish diabetes services, professionals appeared to be more critical of diabetes services than young adults. Young adults generally expressed high levels of satisfaction with services, even where they noted that aspects of those services were sub-optimal. CONCLUSION Good quality care appears to be unequally distributed throughout Ireland. National austerity measures appear to be negatively impacting health services for young adults with diabetes. There is a need for more Endocrinologist and diabetes nurse specialist posts to be funded in Ireland, as well as allied health professional posts.
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Affiliation(s)
- Myles Balfe
- Department of Public Health Medicine and Epidemiology, Royal College of Surgeons in Ireland, St. Stephen’s Green, Dublin, Ireland
- Department of Sociology, University College Cork, Cork, Ireland
| | - Ruairi Brugha
- Department of Public Health Medicine and Epidemiology, Royal College of Surgeons in Ireland, St. Stephen’s Green, Dublin, Ireland
| | - Diarmuid Smith
- Endocrinology Department, Beaumont Hospital, Dublin, Ireland
| | - Seamus Sreenan
- Endocrinology Department, Connolly Hospital, Dublin, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, St. Stephen’s Green, Dublin, Ireland
| | - Ronan Conroy
- Department of Public Health Medicine and Epidemiology, Royal College of Surgeons in Ireland, St. Stephen’s Green, Dublin, Ireland
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