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Batbold O, Banzragch T, Davaajargal D, Pu C. Crowding-Out Effect of Out-of-Pocket Health Expenditures on Consumption Among Households in Mongolia. Int J Health Policy Manag 2022; 11:1874-1882. [PMID: 34634880 PMCID: PMC9808239 DOI: 10.34172/ijhpm.2021.91] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/19/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND High out-of-pocket (OOP) health expenditures are a common problem in developing countries. Studies rarely investigate the crowding-out effect of OOP health expenditures on other areas of household consumption. OOP health costs are a colossal burden on families and can lead to adjustments in other areas of consumption to cope with these costs. METHODS This cross-sectional study used self-reported household consumption data from the nationally representative Household Socioeconomic Survey (HSES), collected in 2018 by the National Statistical Office of Mongolia. We estimated a quadratic conditional Engel curves system to determine intrahousehold resource allocation among 12 consumption variables. The 3-stage least squared method was used to deal with heteroscedasticity and endogeneity problems to estimate the causal crowding-out effect of OOP. RESULTS The mean monthly OOP health expenditure per household was ₮64 673 (standard deviation [SD]=259 604), representing approximately 6.9% of total household expenditures. OOP health expenditures were associated with crowding out durables, communication, transportation, and rent, and with crowding in education and heating for all households. The crowding-out effect of ₮10 000 in OOP health expenditures was the largest for food (₮5149, 95% CI=-8582; -1695) and crowding-in effect was largest in heating (₮2691, 95% CI=737; 4649) in the lowest-income households. The effect of heating was more than 10 times greater than that in highest-income households (₮261, 95% CI=66; 454); in the highest-income households, food had a crowding-in effect (₮179, 95% CI=-445; 802) in absolute amounts. In terms of absolute amount, the crowding-out effect for food was up to 5 times greater in households without social health insurance (SHI) than in those with SHI. CONCLUSION Our findings suggest that Mongolia's OOP health expenses are associated with reduced essential expenditure on items such as durables, communication, transportation, rent, and food. The effect varies by household income level and SHI status, and the lowest-income families were most vulnerable. SHI in Mongolia may not protect households from large OOP health expenditures.
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Affiliation(s)
- Ochirbat Batbold
- Ach Medical University, Ulaanbaatar, Mongolia
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, Etugen University, Ulaanbaatar, Mongolia
| | - Tuvshin Banzragch
- Mongolian Institute of Certified Public Accountants, Ulaanbaatar, Mongolia
| | | | - Christy Pu
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Li M, Li Z, Yip CMW. Informal payments and patients' perceptions of the physician agency problem: Evidence from rural China. Soc Sci Med 2022; 298:114853. [PMID: 35231782 DOI: 10.1016/j.socscimed.2022.114853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
Informal payment for medical services is a common phenomenon in China. Patients make informal payments, in cash or in kind, to physicians in addition to official charges billed for medical services. This paper assesses the associations between patients' perceptions of the physician as an agent for the patient's interests (physician agency problem) and informal payment behavior. Using data of 24,000 and 6700 rural households respectively from the Health Development of Rural China Program database (collected in 2008) and Ningxia data source (collected in 2015), we find that patients' concern about physician agency problems is significantly associated with informal payments. The data shows that patients are more likely to make informal payments when they show low trust towards their physicians. For example, in the surgical cases, among patients who strongly distrusted the physicians, 17.9% (95% confidence interval [CI]:]: 13.5, 22.3) initiated informal payments, compared to 8.0% (95% CI: 5.1, 10.9) who expressed "strong trust" in their physicians. Poor communication was also significantly associated with an increase in the informal payment rate. For example, in the non-surgical setting, among the patients who rated the physicians' explaining skills as "poor," 5.9% (95% CI: 5.0, 6.9) of them made informal payments, significantly higher than the patients who rated "excellent" (of whom 1.8% made informal payments 95% CI, 0.9, 2.7). In this study, we provide an explanation for this finding: patients may initiate informal payments to physicians in order to mitigate the physician agency problem. It suggests that to mitigate informal payments, improving alignment between doctors' incentives and patients' interests would be essential.
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Affiliation(s)
- Mingqiang Li
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China.
| | - Chi-Man Winnie Yip
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Matovu F, Gatome-Munyua A, Sebaggala R. Has Strategic Purchasing Led to Improvements in Health Systems? A Narrative Review of Literature on Strategic Purchasing. Health Syst Reform 2022; 8:2151698. [PMID: 36562734 DOI: 10.1080/23288604.2022.2151698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Strategic purchasing is noted in the literature as an approach that can improve the efficiency of health spending, increase equity in access to health care services, improve the quality of health care delivery, and advance progress toward universal health coverage. However, the evidence on how strategic purchasing can achieve these improvements is sparse. This narrative review sought to address this evidence gap and provide decision makers with lessons and policy recommendations. The authors conducted a systematic review based on two research questions: 1) What is the evidence on how purchasing functions affect purchasers' leverage to improve: resource allocation, incentives, and accountability; intermediate results (allocative and technical efficiency); and health system outcomes (improvements in equity, access, quality, and financial protection)? and 2) What conditions are needed for a country to make progress on strategic purchasing and achieve health system outcomes? We used database searches to identify published literature relevant to these research questions, and we coded the themes that emerged, in line with the purchasing functions-benefits specification, contracting arrangements, provider payment, and performance monitoring-and the outcomes of interest. The extent to which strategic purchasing affects the outcomes of interest in different settings is partly influenced by how the purchasing functions are designed and implemented, the enabling environment (both economic and political), and the level of development of the country's health system and infrastructure. For strategic purchasing to provide more value, sufficient public funding and pooling to reduce fragmentation of schemes is important.
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Affiliation(s)
- Fred Matovu
- Department of Policy and Development Economics, Makerere University School of Economics, Kampala, Uganda
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Alvis-Zakzuk NJ, Díaz-Jiménez D, Chaparro-Narváez P, Gutiérrez-Clavijo JC, Castillo-Rodríguez L, Edna-Estrada F, Castañeda-Orjuela C, De La Hoz-Restrepo F. Substantial Out-of-Pocket Health Expenditure on Prenatal Check-Ups: Estimates from a Sample of Pregnant Women in Cartagena, Colombia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:51-60. [PMID: 35140484 PMCID: PMC8818551 DOI: 10.2147/ceor.s274379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We aimed to estimate out-of-pocket (OOP) health expenditures and the indirect costs related to prenatal check-ups in pregnant women seen in a maternity hospital in the Colombian Caribbean region. METHODS We described the economic costs of pregnant women, with no age limits, who attended prenatal check-ups in a maternity hospital. To estimate OOP and indirect costs owing to prenatal check-ups in pregnant women, a survey was constructed, where the woman was asked about some sociodemographic variables, to characterize those attending the prenatal check-ups. Absolute and relative frequencies, averages and confidence intervals were used to characterize the population and estimate OOP and indirect costs in pregnant women. The latter were estimated from the percentile method. A bootstrapping was performed to reduce the bias within the analysis. RESULTS In total, 56 pregnant women were surveyed, with an average age of 25.9 years (±6.2). All women surveyed had OOP associated to the prenatal check-up in at least one cost-item, and the OOP ranged between $0.3 and $108.7. Transportation was the item with the highest frequency of expenses, followed by food, other expenses, and drugs. The mean of OOP expenditures was $24.3 (CI 95% $18.1-31.4) for women who attended their prenatal check-up. DISCUSSION Considering the estimated OOP health expenditures caused by prenatal check-ups by household income, women living with <1 minimum wage spend 7% of their income in a prenatal check-up. In women with 1-2 and >2-3 minimum wages, these proportions were 5%, 3%, respectively. Unfortunately, this makes prenatal care a significant source of economic burden, impacting poor households in Cartagena.
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Affiliation(s)
- Nelson J Alvis-Zakzuk
- Observatorio Nacional de Salud, Instituto Nacional de Salud, Bogotá, D.C., Colombia
- Departamento de Ciencias de la Salud, Universidad de la Costa-CUC, Barranquilla, Colombia
| | - Diana Díaz-Jiménez
- Observatorio Nacional de Salud, Instituto Nacional de Salud, Bogotá, D.C., Colombia
| | | | | | | | | | | | - Fernando De La Hoz-Restrepo
- Grupo de Evaluación en Epidemiología y Salud Pública, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
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Busse CE, Onyango D, Tumlinson K. Informal payments for modern family planning methods at public facilities in Tanzania: room for improvement. HUMAN RESOURCES FOR HEALTH 2022; 20:13. [PMID: 35093091 PMCID: PMC8800329 DOI: 10.1186/s12960-022-00712-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Financial access to family planning (FP) is essential to the health and well-being of women in Tanzania. Tanzanian policy dictates that FP methods and services obtained at public facilities are provided for free. However, public sector FP is no longer free when providers solicit informal payments. In this analysis, we investigate the prevalence and amount of informal payments for FP in Tanzania. METHODS We used data from the 2015-2016 Tanzania Demographic and Health Survey to investigate whether informal payments for FP had been effectively eliminated by this policy. RESULTS We found that, at public sector facilities, the majority (84.6%) of women received their current FP method for free (95% confidence interval (CI): 81.9, 87.3), but this proportion varied meaningfully by facility and method type. Injectable contraception was the most commonly used method by women in the lowest wealth quintiles and was most frequently sought by these women from a government dispensary. One in four women (25.8%) seeking injectable contraception from government dispensaries reported paying a fee (95% CI: 19.5, 32.1). Among injectable users who reported payment for their current method, the mean cost at public sector facilities was 1420 Tanzanian Shillings (TSh) and the mean cost at private sector facilities was TSh 1930 (approximately 0.61 United States Dollars (USD) and 0.83 USD, respectively). Among implant users who reported payment for their current method, the mean cost at public sector facilities was TSh 4127 and the mean cost at private sector facilities was TSh 6194 (approximately 1.78 USD and 2.68 USD, respectively). CONCLUSION These findings suggest that the majority of women visiting public facilities in Tanzania did not pay informal payments for FP methods or services; however, informal payments at public facilities did occur, varying by facility and method type. Adherence to existing policies mandating free FP methods and services at public facilities, especially government dispensaries, is critical for ensuring contraceptive access among the most economically vulnerable women.
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Affiliation(s)
- Clara E Busse
- Carolina Population Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, United States of America
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, Chapel Hill, United States of America
| | - Dickens Onyango
- Kisumu County Department of Health, P.O. BOX 3670, Kisumu, 40100, Kenya.
- Utrecht University, Utrecht, The Netherlands.
- Institute of Tropical Medicine, Antwerp, Belgium.
| | - Katherine Tumlinson
- Carolina Population Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, United States of America
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, Chapel Hill, United States of America
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Lekhan VN, Zaiarskyi MI, Vudvud VV, Kovalevych DA. NATIONAL HEALTH EXPENDITURE TRENDS, 2000 TO 2019. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1140-1146. [PMID: 35758492 DOI: 10.36740/wlek202205116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To assess the long-term dynamics of health spending in Ukraine from the standpoint of readiness to make progress in the universal health coverage (UHC). PATIENTS AND METHODS Materials and methods: Data from the Global Health Expenditure Database, European Health for All database, World Bank Open Data, collected during 2000-2019 were used. The research was conducted using bibliosemantic, historical methods and benchmarking. RESULTS Results: All indicators of health spending in Ukraine showed some growth: total and government health spending of % Gross Domestic Product (GDP) by 34% (95% CI 13-55) and 28% (95% CI 8-48), total and government health spending per capita in US $ by 7.1 and 6.5 times and in Purchasing power parity (PPP) - by 4 and 3.8 times. Growth was interrupted during the global (2008) and national (2017-2019) financial crises. Out-of-pocket spending in Ukraine grew and amounted to 51.1% in 2019, which is by 2.1 times more than in the European region - 24.0% (15.5; 36.6). In 2019 Ukraine ranked among 10% of the countries with the worst combination of government health spending per share of GDP and share of OOPS in total health spending. CONCLUSION Conclusions: The study found an unsustainable upward dynamic in health spending. In the last decade, there has been a clear trend towards an increase % OOPS in total health spending against low, aimed at reducing government health spending as % of GDP, which could negatively affect UHC.
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Affiliation(s)
| | | | - Viktoriia V Vudvud
- CHERNIVTSI INSTITUTE OF TRADE AND ECONOMICS OF THE KYIV NATOINAL UNIVERSITY OF TRADE AND ECONOMICS, CHERNIVTSI, UKRAINE
| | - Daria A Kovalevych
- CHERNIVTSI INSTITUTE OF TRADE AND ECONOMICS OF THE KYIV NATOINAL UNIVERSITY OF TRADE AND ECONOMICS, CHERNIVTSI, UKRAINE
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Tumlinson K, Britton LE, Williams CR, Wambua DM, Otieno Onyango D. Informal payments for family planning: prevalence and perspectives of women, providers, and health sector key informants in western Kenya. Sex Reprod Health Matters 2021; 29:1-17. [PMID: 34590988 PMCID: PMC8494287 DOI: 10.1080/26410397.2021.1970958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Informal payments are off-the-record financial transactions made by patients to their healthcare providers. Providers in low- and middle-income countries solicit informal payments from patients to purchase additional supplies, supplement wages, or for other reasons. Informal payments reduce equitable access to healthcare services and undermine efforts to ensure universal health coverage. This study used multiple data collection methods to estimate the prevalence of informal payments, describe the impact, and explore feasible solutions for curbing this practice in western Kenya. Facility-level data were collected in 60 public sector facilities (contributing 142 mystery client visits and, in a subsample of 10 facilities, 253 client-provider observations). We conducted 8 focus groups with current and prior contraceptive users, 19 key informant interviews, and 2 journey mapping workshops. Providers solicited informal payments in 25% of mystery client visits and 13% of client-provider observations; the median amount of money requested from mystery clients was 1 USD. Focus group and journey mapping participants reported informal payments are a financial barrier and contribute to unintended pregnancy; key informants suggested greater community monitoring of facilities is key for reducing this behaviour.
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Affiliation(s)
- Katherine Tumlinson
- Assistant Professor, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Faculty Fellow, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura E Britton
- Postdoctoral Fellow, Columbia University School of Nursing, New York City, NY, USA
| | - Caitlin R Williams
- Doctoral Student, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS-Argentina), Buenos Aires, Argentina
| | | | - Dickens Otieno Onyango
- Director, Kisumu County Department of Health, Kisumu, Kenya; Doctoral Student, Institute of Tropical Medicine, Antwerp, Belgium
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Vian T. Anti-corruption, transparency and accountability in health: concepts, frameworks, and approaches. Glob Health Action 2020; 13:1694744. [PMID: 32194010 PMCID: PMC7170369 DOI: 10.1080/16549716.2019.1694744] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: As called for by the Sustainable Development Goals, governments, development partners and civil society are working on anti-corruption, transparency and accountability approaches to control corruption and advance Universal Health Coverage. Objectives: The objective of this review is to summarize concepts, frameworks, and approaches used to identify corruption risks and consequences of corruption on health systems and outcomes. We also inventory interventions to fight corruption and increase transparency and accountability. Methods: We performed a critical review based on a systematic search of literature in PubMed and Web of Science and reviewed background papers and presentations from two international technical meetings on the topic of anti-corruption and health. We identified concepts, frameworks and approaches and summarized updated evidence of types and causes corruption in the health sector. Results: Corruption, or the abuse of power for private gain, in health systems includes bribes and kickbacks, embezzlement, fraud, political influence/nepotism and informal payments, among other behaviors. Drivers of corruption include individual and systems level factors such as financial pressures, poorly managed conflicts of interest, and weak regulatory and enforcement systems. We identify six typologies and frameworks that model relationships influencing the scope and seriousness of corruption, and show how anti-corruption strategies such as transparency, accountability, and civic participation can affect corruption risk. Little research exists on the effectiveness of anti-corruption measures; however, interventions such as community monitoring and insurance fraud control programs show promise. Conclusions: Corruption undermines the capacity of health systems to contribute to better health, economic growth and development. Interventions and resources on prevention and control of corruption are essential components of health system strengthening for Universal Health Coverage.
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Affiliation(s)
- Taryn Vian
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
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Faruqui N, Bernays S, Martiniuk A, Abimbola S, Arora R, Lowe J, Denburg A, Joshi R. Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage. BMC Public Health 2020; 20:1641. [PMID: 33143668 PMCID: PMC7607709 DOI: 10.1186/s12889-020-09758-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are multiple barriers impeding access to childhood cancer care in the Indian health system. Understanding what the barriers are, how various stakeholders perceive these barriers and what influences their perceptions are essential in improving access to care, thereby contributing towards achieving Universal Health Coverage (UHC). This study aims to explore the challenges for accessing childhood cancer care through health care provider perspectives in India. METHODS This study was conducted in 7 tertiary cancer hospitals (3 public, 3 private and 1 charitable trust hospital) across Delhi and Hyderabad. We recruited 27 healthcare providers involved in childhood cancer care. Semi-structured interviews were audio recorded after obtaining informed consent. A thematic and inductive approach to content analysis was conducted and organised using NVivo 11 software. RESULTS Participants described a constellation of interconnected barriers to accessing care such as insufficient infrastructure and supportive care, patient knowledge and awareness, sociocultural beliefs, and weak referral pathways. However, these barriers were reflected upon differently based on participant perception through three key influences: 1) the type of hospital setting: public hospitals constituted more barriers such as patient navigation issues and inadequate health workforce, whereas charitable trust and private hospitals were better equipped to provide services. 2) the participant's cadre: the nature of the participant's role meant a different degree of exposure to the challenges families faced, where for example, social workers provided more in-depth accounts of barriers from their day-to-day interactions with families, compared to oncologists. 3) individual perceptions within cadres: regardless of the hospital setting or cadre, participants expressed individual varied opinions of barriers such as acceptance of delay and recognition of stakeholder accountabilities, where governance was a major issue. These influences alluded to not only tangible and structural barriers but also intangible barriers which are part of service provision and stakeholder relationships. CONCLUSION Although participants acknowledged that accessing childhood cancer care in India is limited by several barriers, perceptions of these barriers varied. Our findings illustrate that health care provider perceptions are shaped by their experiences, interests and standpoints, which are useful towards informing policy for childhood cancers within UHC.
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Affiliation(s)
- Neha Faruqui
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Alexandra Martiniuk
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Seye Abimbola
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia
| | - Ramandeep Arora
- Cankids … Kidscan, New Delhi, India.,Max Super Speciality Hospital, New Delhi, India
| | | | - Avram Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rohina Joshi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,George Institute for Global Health, New Delhi, India
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Sakha MA, Zahirian Moghadam T, Ghobadi H, Zandian H. Exploring the changes of physicians' behaviour toward informal payment based on Health Transformation Plan in Iran: A qualitative study. Int J Health Plann Manage 2020; 35:1127-1139. [PMID: 32666608 DOI: 10.1002/hpm.3020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/01/2020] [Accepted: 06/05/2020] [Indexed: 11/09/2022] Open
Abstract
By implementation of the Health Transformation Plan (HTP), a revised tariff system for healthcare services was executed in Iran. This study explores the changes in physicians' behaviour in facing informal payment (IP) based on HTP implementation in Iran. We conducted in-depth semi-structured interviews with 15 purposefully selected physicians and policy makers to explore the changes (positive, negative and no) in physicians' behaviours with and without the implementation of HTP. The interviews were conducted individually and face to face. The conventional content analysis for data analysis by MAXQDA ver.10 was used. Based on the results, regardless of the HTP implemented, market competitiveness could control physicians' demand for IP. However, unreal tariffs, irregular payments, inflation, expensive healthcare and comparing income with other occupations increase physicians' demand for IP as negative behaviour. This study explored three patterns of physicians' behavioural change because of HTP implementation: 1-positive behavioural change with four factors; 2-negative behavioural changes with two factors; and 3-no behavioural change with four factors. Various factors influenced physicians' behaviour towards IP with and without the HTP. To combat IP more efficiently, we recommend strengthening the HTP's positive interventions, compensation of physicians' target income, enhancing supervision, reducing the gap among various medical specialities and taking a systematic approach with law offenders.
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Affiliation(s)
| | - Telma Zahirian Moghadam
- Health Policy, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hassan Ghobadi
- Pulmonary Diseases, Digestive Diseases Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamed Zandian
- Health Policy, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
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Sécula F, Erismann S, Cerniciuc C, Chater A, Shabab L, Glen F, Curteanu A, Serbulenco A, Silitrari N, Demiscan D, Prytherch H. Evidence-based policy making for health promotion to reduce the burden of non-communicable diseases in Moldova. BMC Proc 2020; 14:1. [PMID: 32165921 PMCID: PMC7059653 DOI: 10.1186/s12919-020-0183-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The Republic of Moldova faces several concurrent health challenges most notably an increase in chronic non-communicable diseases, spiralling health care costs and widening health inequalities. To accelerate progress in their resolution there is a need for new and innovative health promotion and behaviour change communication interventions. The Ministry of Health, Labour and Social Protection in collaboration with the newly created National Agency for Public Health held a conference on the occasion of the Moldovan National Day of Health Promotion on 14th March 2018 in which national and invited international experts exchanged their views on (1) best practice examples of behaviour change interventions, health promotion activities and lessons learned from the UK and elsewhere; and (2) possible ways forward for Moldova to implement cost-effective and evidence-based intersectoral health promotion programmes. The experts provided recommendations on implementing behaviour change interventions to reduce and prevent obesity; on the creation of a favourable tobacco control environment to reduce smoking prevalence; and on how physical activity programme design can benefit from health psychology research. All these strategies could foster health promotion activities and ultimately contribute to improving the health outcomes of the Moldovan population.
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Affiliation(s)
- Florence Sécula
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Séverine Erismann
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Carolina Cerniciuc
- Swiss Development Cooperation’s Healthy Life Project, Chisinau, Republic of Moldova
| | - Angel Chater
- Department of Psychology and Sport Sciences, University of Hertfordshire, Hatfield, AL10 9AB UK
- School of Sport Science and Physical Activity, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, MK41 9EA UK
- UCL School of Pharmacy, Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London, BMA House, London, WC1H 9JP UK
| | - Lion Shabab
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Fiona Glen
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU UK
| | - Ala Curteanu
- Swiss Development Cooperation’s Healthy Life Project, Chisinau, Republic of Moldova
| | - Aliona Serbulenco
- Ministry of Health, Labor and Social Protection of the Republic of Moldova, Subsequently Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | | | - Daniela Demiscan
- Ministry of Health, Labor and Social Protection of the Republic of Moldova, Subsequently Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
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Ekenze SO, Jac-Okereke CA, Nwankwo EP. Funding paediatric surgery procedures in sub-Saharan Africa. Malawi Med J 2020; 31:233-240. [PMID: 31839896 PMCID: PMC6895386 DOI: 10.4314/mmj.v31i3.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background In sub-Saharan Africa, there is a growing awareness of the burden of paediatric surgical diseases. This has highlighted the large discrepancy between the capacity to treat and the ability to afford treatment, and the effect of this problem on access to care. This review focuses on the sources and challenges of funding paediatric surgical procedures in sub-Saharan Africa. Methods We undertook a search for studies published between January 2007 and November 2016 that reported the specific funding of paediatric surgical procedures and were conducted in sub-Saharan Africa. Abstract screening, full-text review and data abstraction were completed and resulting data were analysed using Statistical Package for Social Sciences (SPSS) software. Results Thirty-five studies met our inclusion criteria and were reviewed. The countries that were predominantly emphasized in the publications reviewed were Nigeria, South Africa, Kenya, Ghana and Uganda. The paediatric surgical procedures involved general paediatric surgery/urology, cardiac surgery, neurosurgery, oncology, plastics, ophthalmology, orthopaedics and otorhinolaryngology. The mean cost of these procedures ranged from 60 to 21,140 United States Dollars (USD). The source of funding for these procedures was mostly out-of-pocket payments (OOPs) by the patient's family in 32 studies, (91.4%) and medical mission/non-governmental organizations (NGOs) in 21 (60%) studies. This pattern did not differ appreciably between the articles published in the initial and latter 5 years of the study period, although there was a trend towards a reduction in OOP funding. Improvements in healthcare funding by individual countries supported by international organizations and charities were the predominant suggested solutions to challenges in funding. Conclusion While considering the potential limitations created by diversity in study design, the reviewed publications indicate that funding for paediatric surgical procedures in sub-Saharan Africa is mostly by OOPs made by families of the patients. This may result in limited access to some procedures. Coordinated efforts, and collaboration between individual countries and international agencies, may help to reduce OOP funding and thus improve access to critical procedures.
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Affiliation(s)
- Sebastian O Ekenze
- Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria, Enugu Campus, Enugu 400001, Nigeria
| | - Chukwunonso A Jac-Okereke
- Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria, Enugu Campus, Enugu 400001, Nigeria
| | - Elochukwu P Nwankwo
- Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria, Enugu Campus, Enugu 400001, Nigeria
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13
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Pourtaleb A, Jafari M, Seyedin H, Akhavan Behbahani A. New insight into the informal patients' payments on the evidence of literature: a systematic review study. BMC Health Serv Res 2020; 20:14. [PMID: 31902368 PMCID: PMC6943960 DOI: 10.1186/s12913-019-4647-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/16/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Nowadays, a growing literature reveals how patients use informal payments to seek either better treatment or additional services, but little systematic review has been accomplished for synthesizing the main factors. The purpose of this study was to analyze the content of literatures to demonstrate the factors for informal patient payments. METHODS In this systematic review study, PubMed, Web of Science, Wiley Online Library, Science Direct, Ovid, Scopus, and Iranian databases were investigated without time limitation for eligible English and Persian studies. Achieved data were analyzed using content analysis approach and MAXQDA 10 software. RESULTS Themes related to informal payments in external context of health system were demographic features of health service consumers, patient's personality features and social & cultural backgrounds of the community. Health system challenges' themes were about stewardship weakness, and sustainable financing and social protection weakness. These were followed by human resources' organizational behavior challenges, drugs, medical products, and services delivery provision process challenges and finally change management weakness for reducing and dealing with IPs. CONCLUSION It appears that improving the quality of health care services and accurate monitoring of delivery processes, along with performing some strategies for regulating payroll and medical tariffs, strict rules and regulations and improving health staff motivation, would be effective ways against informal payments. Improving the health insurance contribution, promoting transparency & accountability in health system especially in financing, identify precise control mechanism, using empower patient/public related approach, modifying community perception, reinforcing social resistance to unofficial payments and rebuilt lost social capital in health care are some of the other recommendations in this field. To practice these strategies, a comprehensive and systemic vision and approach is needed, however, the key point is that before applying any strategy the impact of this strategy on access, efficiency, equity, and other health systems' goals and policies should be investigated due to the consideration.
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Affiliation(s)
- Arefeh Pourtaleb
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehdi Jafari
- Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Seyedin
- Department of Health in Disaster and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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14
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Schaaf M, Topp SM. A critical interpretive synthesis of informal payments in maternal health care. Health Policy Plan 2019; 34:216-229. [PMID: 30903167 PMCID: PMC6528746 DOI: 10.1093/heapol/czz003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 01/01/2023] Open
Abstract
Informal payments for healthcare are widely acknowledged as undercutting health care access, but empirical research is somewhat limited. This article is a critical interpretive synthesis that summarizes the evidence base on the drivers and impact of informal payments in maternal health care and critically interrogates the paradigms that are used to describe informal payments. Studies and conceptual articles identified both proximate and systems drivers of informal payments. These include norms of gift giving, health workforce scarcity, inadequate health systems financing, the extent of formal user fees, structural adjustment and the marketization of health care, and patient willingness to pay for better care. Similarly, there are proximal and distal impacts, including on household finances, patient satisfaction and provider morale. Informal payments have been studied and addressed from a variety of different perspectives, including anti-corruption, ethnographic and other in-depth qualitative approaches and econometric modelling. Summarizing and discussing the advantages and disadvantages of these and other paradigms illustrates the value of an inter-disciplinary approach. The same tacit, hidden attributes that make informal payments hard to measure also make them hard to discuss and address. A multidisciplinary health systems approach that leverages and integrates positivist, interpretivist and constructivist tools of social science research can lead to better insight. With this, we can challenge ‘master narratives’ and meet universalistic, equity-oriented global health objectives.
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Affiliation(s)
- Marta Schaaf
- Program on Global Health Justice and Governance, Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, B3, New York, NY, USA
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, James Cook Drive, Townsville, Australia
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15
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Kohler JC. I Know It When I See It: The Challenges of Addressing Corruption in Health Systems Comment on "We Need to Talk About Corruption in Health Systems". Int J Health Policy Manag 2019; 8:563-566. [PMID: 31657180 PMCID: PMC6815984 DOI: 10.15171/ijhpm.2019.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/08/2019] [Indexed: 11/09/2022] Open
Abstract
In this commentary, I argue that corruption in health systems is a critical and legitimate area for research in order to strengthen health policy goals. This rationale is based partly on citizen demand for more accountable and transparent health systems, along with the fact that the poor and vulnerable suffer the most from the presence of corruption in health systems. What is more, there is a growing body of literature on the impact of corruption in the health system and best practices in terms of anti-corruption, transparency and accountability (ACTA) strategies and tactics within the health system. Still, we need to support ACTA integration into the health system by having a common definition of corruption that is meaningful for health systems and ensure that ACTA strategies and tactics are transparent themselves. The 2019 Consultation on a proposed Global Network on ACTA in Health Systems is promising for these efforts.
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Affiliation(s)
- Jillian Clare Kohler
- WHO Collaborating Center for Governance, Accountability and Transparency in the Pharmaceutical Sector and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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16
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Trumbo SP, Silver D, Domenti O, Gasoyan H, Paatashvili E, Gellin BG, Gordon JL. Strengthening legal frameworks for vaccination: The experiences of Armenia, Georgia, and Moldova. Vaccine 2019; 37:4840-4847. [DOI: 10.1016/j.vaccine.2018.10.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/24/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
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17
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Blake C, Bohle LF, Rotaru C, Zarbailov N, Sava V, Sécula F, Prytherch H, Curteanu A. Quality of care for non-communicable diseases in the Republic of Moldova: a survey across primary health care facilities and pharmacies. BMC Health Serv Res 2019; 19:353. [PMID: 31164125 PMCID: PMC6547568 DOI: 10.1186/s12913-019-4180-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background The Republic of Moldova is faced with a high prevalence of non-communicable diseases (NCDs) related to lifestyle and health behavioural factors. Within the frame of the decentralisation reform, the primary health care system has been tasked to play an important role in the provision of preventative and curative NCD health services. There is however limited evidence available on the actual coverage and quality of care provided. Our paper aims to provide an updated overview of the coverage and quality of service provision in rural and urban regions of Moldova. Methods We designed a facility-based survey to measure aspects of coverage and quality of care of NCD services across 20 districts of the Republic of Moldova. This study presents descriptive data on the structural, procedural and clinical aspects of primary healthcare delivery at health centre and family doctor office level. Adjacent private pharmacies were also assessed for the availability of essential NCD medicine. Results Organised under the WHO Health Systems Framework, our findings highlight that service provision and information were generally the strongest among the six health systems building blocks, with more weaknesses found in the area of the health workforce, medical products, financing, and leadership/governance. Urban facilities generally fared better across all indicators. Conclusions The gaps in service provision identified by this study require broad health system improvements to ensure NCD related policies and strategies are embedded in primary health care service provision. This likely calls for stronger coordination and collaboration between the public and private sectors and the different levels of government working towards ensuring universal health coverage in Moldova. Electronic supplementary material The online version of this article (10.1186/s12913-019-4180-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolyn Blake
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Leah F Bohle
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Cristina Rotaru
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chisinau, Moldova
| | - Natalia Zarbailov
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chisinau, Moldova.,State University of Medicine and Pharmacy "Nicolae Testemiţanu", Chișinău, Moldova
| | - Valeriu Sava
- Swiss Agency for Development and Cooperation (SDC), Chisinau, Moldova
| | - Florence Sécula
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Helen Prytherch
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Ala Curteanu
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chisinau, Moldova.,Mother and Child Institute, Chisinau, Moldova
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18
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Meskarpour Amiri M, Bahadori M, Motaghed Z, Ravangard R. Factors affecting informal patient payments: a systematic literature review. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2019. [DOI: 10.1108/ijhg-01-2019-0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Informal payments (IPs) for healthcare are a serious obstacle to equitable access and universal health coverage in developing countries. Policy makers need to know more about the hidden nature of informal patient payments (IPPs) before any policy adoption and implementation. The purpose of this paper is to systematically review the main factors affecting IPPs.
Design/methodology/approach
This systematic review was conducted in 2018 using the standard guideline of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses. All English original articles on the determinants of IPPs published in the scientific journals, whose full text was available through Scopus, PubMed and Web of Science databases, which were given consideration for review.
Findings
The results showed that IPPs were greatly dependent on the characteristics of healthcare consumers, providers, healthcare system and services. Among healthcare consumers’ characteristics affecting IPPs, the income, age, education, gender, employment and health status were more cited factors, respectively. Among healthcare providers’ characteristics affecting IPPs, the providers’ experience, reputation, and salary satisfaction were better known, respectively. Among healthcare services features, the hospitalization, service specialty and the level of treatment urgency were more noted, respectively.
Originality/value
Policy making against IPs in the health sector requires precise attention to all components of healthcare market, including healthcare consumers, providers, healthcare system and services characteristics.
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19
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Meskarpour Amiri M, Teymourzadeh E, Ravangard R, Bahadori M. Health informal payments and their main determinants: The case of Iran. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105818822594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Ehsan Teymourzadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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20
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Meskarpour Amiri M, Assari A, Bahadori M, Ravangard R, Hosseini-Shokouh SM. Informal payments for health care in Iran. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2018. [DOI: 10.1108/ijhg-02-2018-0007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Reducing informal payments (IPs) for health services has always been a top priority for health policymakers all over the world. As the newest attempts to reduce IPs, Iran’s Government applied a set of reforms in the health care system in 2014 called “Health Sector Evolution Plan” (HSEP). The purpose of this paper is to investigate the prevalence and nature of IPs one year after implementing this plan.
Design/methodology/approach
This descriptive and cross-sectional study was a nationwide survey on Iran's health sector informal payments carried out in 2016. To do this, a sample of 1,112 Iranain households was selected from all over the country using a multistage cluster-stratified sampling method. The prevalence and nature of IPs were determined through conducting face-to-face interviews using a standard questionnaire.
Findings
One year after implementing the HSEP, about 27.7 percent of sampled Iranians had at least one experience of IPs for health services. The prevalences of compulsory and voluntary IPs were 21.4 and 11.5 percent, respectively. IPs were reported by 26.1 and 12.5 percent in the inpatient and outpatient services, respectively.
Originality/value
According to the results, compulsory IPs are still prevalent in both the outpatient and inpatient services of Iran’s health system and it seems that the HSEP has not been completely successful in achieving the goal of eradicating IPs. It can be said that the HSEP has been the first step toward eradicating IPs in Iran and should not be the last one. The study provides useful results of the prevalence and nature of IPs after implementing the HSEP, which should be considered in designing the next steps.
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21
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Utilization and out of pocket (OOP) payment for physiotherapy services in public hospitals of Shahid Beheshti University of Medical Sciences. Med J Islam Repub Iran 2018; 32:19. [PMID: 30159270 PMCID: PMC6108256 DOI: 10.14196/mjiri.32.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Physiotherapy services constitute a principle part of health care systems, and interest in their use has increased in the recent decades. This study was conducted to investigate the utilization and OOP payment for physiotherapy services in public hospitals of Shahid Beheshti University of Medical Sciences in Tehran, Iran.
Methods: This cross-sectional study was conducted using the data of physiotherapy department of three public hospitals. The study sample included 6528 patients who had received 7257 episodes of care. Data were extracted through hospital information systems and analyzed using multivariate regression analysis by SPSS17.
Results: The average episode per patient was 1.11 and 12.6 session per episode. The average cost of each episode and treatment session was 1 784 660 IRR (USD 59) and 142 023 IRR (USD 4.7), respectively. The OOP payment share for physiotherapy was 31%. Age, OOP amount, having insurance coverage, insurance type, and service type significantly affected physiotherapy utilization. Number of treatment sessions, having insurance coverage, type of insurance coverage, and gender were related to OOP payment.
Conclusion: There is a large variety in utilization and OOP payment in the insurance funds, which could restrict the accessibility and utilization of services by patients, leading to inequalities in utilization. Therefore, policymakers should conduct an overall review on the tariffs and service packages of insurer organizations to provide better conditions for the elderly, unhealthy, and vulnerable population to mitigate inequality in service utilization and decrease OOP payment.
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22
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Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran. HEALTH SCOPE 2018. [DOI: 10.5812/jhealthscope.62319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Gupta A, Reddy BV, Semwal V, Singh AK. Financial Burden of Out-of-Pocket Expenditures for Primary Health Care in Hilly Areas of Garhwal Region, Uttarakhand, North India. J Clin Diagn Res 2017; 11:LC08-LC11. [PMID: 28571170 DOI: 10.7860/jcdr/2017/24761.9646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/14/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION High total health expenditures via Out-of-Pocket (OOP) as formal user fees and informal payments put India in challenging situation to achieve towards universal health coverage. AIM To assess the (OOP) expenditure and its determinants among outpatient in primary care settings of Uttarakhand, North India. MATERIALS AND METHODS A hospital based cross-sectional study was conducted in a Outpatient Department of Urban Health Training Centre, Srinagar, Uttarakhand, India and Rural Health Training Centre, Kritinagar, Uttarakhand in 2015. A total of 200 patients were enrolled in the study using random sampling. Questionnaire covering costs like: travel cost, drug cost, investigation cost, and others was used for measuring OOP expenditure incurred toward health care by patients. RESULTS Of the total 200 patients, 43.5% were males and 56.5% were females with mean age 40.36 (SD 19.45) in years. Average annual family income was 11718.5 INR±13457.3 INR. Of the total study subjects, 42.5% were unskilled or had no occupation (unemployed, student, and homemaker). The majority (68.5%) had travelled less than or equal to 10 km to reach the health facility. About 50% of the study subjects presented with communicable diseases and 20% with non-communicable diseases. The health expenditure of the outpatient revealed that major part of the expenditure is the direct cost of the treatment, including registration fee, drugs, and investigation. Mean OOP expenditure for drugs and investigations was 509 INR and 673.1 INR, respectively. Mean total out-of-patient expenditure was 303.1 INR. The proportion of monthly family income spent on out-of-patient expenditure was 2.58%. CONCLUSION The implementation of primary health care needs to be further strengthened in order to improve access of public sector hospitals for curative care.
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Affiliation(s)
- Arti Gupta
- Assistant Professor, Department of Community Medicine, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute, Garhwal, Uttrakhand, India
| | - B Venkatashiva Reddy
- Assistant Professor, Department of Community Medicine, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute, Garhwal, Uttarahand, India
| | - Vandana Semwal
- Assistant Professor, Department of Community Medicine, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute, Garhwal, Uttarakhand, India
| | - Amit Kumar Singh
- Professor and Head, Department of Community Medicine, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute, Garhwal, Uttarahand, India
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Hone T, Habicht J, Domente S, Atun R. Expansion of health insurance in Moldova and associated improvements in access and reductions in direct payments. J Glob Health 2016; 6:020702. [PMID: 27909581 PMCID: PMC5112006 DOI: 10.7189/jogh.06.020702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Moldova is the poorest country in Europe. Economic constraints mean that Moldova faces challenges in protecting individuals from excessive costs, improving population health and securing health system sustainability. The Moldovan government has introduced a state benefit package and expanded health insurance coverage to reduce the burden of health care costs for citizens. This study examines the effects of expanded health insurance by examining factors associated with health insurance coverage, likelihood of incurring out-of-pocket (OOP) payments for medicines or services, and the likelihood of forgoing health care when unwell. METHODS Using publically available databases and the annual Moldova Household Budgetary Survey, we examine trends in health system financing, health care utilization, health insurance coverage, and costs incurred by individuals for the years 2006-2012. We perform logistic regression to assess the likelihood of having health insurance, incurring a cost for health care, and forgoing health care when ill, controlling for socio-economic and demographic covariates. FINDINGS Private expenditure accounted for 55.5% of total health expenditures in 2012. 83.2% of private health expenditures is OOP payments-especially for medicines. Healthcare utilization is in line with EU averages of 6.93 outpatient visits per person. Being uninsured is associated with groups of those aged 25-49 years, the self-employed, unpaid family workers, and the unemployed, although we find lower likelihood of being uninsured for some of these groups over time. Over time, the likelihood of OOP for medicines increased (odds ratio OR = 1.422 in 2012 compared to 2006), but fell for health care services (OR = 0.873 in 2012 compared to 2006). No insurance and being older and male, was associated with increased likelihood of forgoing health care when sick, but we found the likelihood of forgoing health care to be increasing over time (OR = 1.295 in 2012 compared to 2009). CONCLUSIONS Moldova has achieved improvements in health insurance coverage with reductions in OOP for services, which are modest but are eroded by increasing likelihood of OOP for medicines. Insurance coverage was an important determinant for health care costs incurred by patients and patients forgoing health care. Improvements notwithstanding, there is an unfinished agenda of attaining universal health coverage in Moldova to protect individuals from health care costs.
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Affiliation(s)
- Thomas Hone
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Jarno Habicht
- WHO Country Office in Kyrgyzstan, World Health Organization
| | | | - Rifat Atun
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
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25
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Democratic transitions, health institutions, and financial protection in the emerging economies: insights from Asia. HEALTH ECONOMICS POLICY AND LAW 2016; 12:309-323. [PMID: 27839519 DOI: 10.1017/s1744133116000293] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In recent years, several emerging economies have introduced national health insurance programs ensuring access to health care while offering financial protection from out-of-pocket and catastrophic expenses. Nevertheless, in several nations these expenses continue to increase. While recent research has emphasized the lack of funding, poor policy design and corruption as the main culprits, little is known about the politics of establishing federal regulatory agencies ensuring that state governments adhere to national insurance reimbursement and coverage procedures. This article fills in this lacuna by providing an alternative perspective, one that accounts for differences between nations in the creation of regulatory institutions, with an emphasis instead on governing elite strategies to campaign on access to health care during transitions to democracy, civil societal mobilization, constitutional constraints and the national electoral incentives to overcome ineffective decentralization processes. The cases of Indonesia and China are introduced as examples of how and why their differences in this political process accounted for Indonesia's success and China's failure to ensure financial protection.
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26
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Mackey TK, Kohler JC, Savedoff WD, Vogl F, Lewis M, Sale J, Michaud J, Vian T. The disease of corruption: views on how to fight corruption to advance 21 st century global health goals. BMC Med 2016; 14:149. [PMID: 27680102 PMCID: PMC5041569 DOI: 10.1186/s12916-016-0696-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 11/10/2022] Open
Abstract
Corruption has been described as a disease. When corruption infiltrates global health, it can be particularly devastating, threatening hard gained improvements in human and economic development, international security, and population health. Yet, the multifaceted and complex nature of global health corruption makes it extremely difficult to tackle, despite its enormous costs, which have been estimated in the billions of dollars. In this forum article, we asked anti-corruption experts to identify key priority areas that urgently need global attention in order to advance the fight against global health corruption. The views shared by this multidisciplinary group of contributors reveal several fundamental challenges and allow us to explore potential solutions to address the unique risks posed by health-related corruption. Collectively, these perspectives also provide a roadmap that can be used in support of global health anti-corruption efforts in the post-2015 development agenda.
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Affiliation(s)
- Tim K Mackey
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA. .,Division of Global Public Health, University of California, San Diego School of Medicine, Department of Medicine, San Diego, CA, USA. .,Global Health Policy Institute, 6256 Greenwich Drive, Mail Code: 0172X, San Diego, CA, 92122, USA. .,WHO Collaborating Centre for Governance, Transparency and Accountability in the Pharmaceutical Sector, University of Toronto, Toronto, Ontario, Canada.
| | - Jillian Clare Kohler
- WHO Collaborating Centre for Governance, Transparency and Accountability in the Pharmaceutical Sector, University of Toronto, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, Munk School of Global Affairs, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Frank Vogl
- Transparency International, Secretariat, Berlin, Germany.,The Partnership for Transparency Fund, Washington, DC, USA
| | - Maureen Lewis
- Georgetown University, Washington, DC, USA.,Aceso Global, Washington, DC, USA
| | - James Sale
- Transparency International UK, London, UK
| | - Joshua Michaud
- Kaiser Family Foundation, Washington, DC, USA.,Johns Hopkins University School of Advanced International Studies, Washington, DC, USA
| | - Taryn Vian
- Boston University School of Public Health, Boston, MA, USA
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27
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Mathauer I, Theisling M, Mathivet B, Vilcu I. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European Region. Int J Equity Health 2016; 15:57. [PMID: 27038787 PMCID: PMC4818884 DOI: 10.1186/s12939-016-0321-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many low-and middle-income countries (LMIC) of the World Health Organization (WHO) European Region have introduced social health insurance payroll taxes after the political transition in the late 1980s, combined with budget transfers to allow for exempting specific population groups from paying contributions, such as those outside formal sector work and in particular vulnerable groups. This paper assesses the institutional design aspects of such financing arrangements and their performance with respect to universal health coverage progress in LMIC of the European region. METHODS The study is based on a literature review and review of secondary databases for the performance assessment. RESULTS Such financing arrangements currently exist in 13 LMIC of that region, with strong commonalities in institutional design: This includes a wide range of different eligible population groups, mostly mandatory membership, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. Performance is more varied. Enrolment rates range from about 65 % to above 95 %, and access to care and financial protection has improved in several countries. Yet, inequities between income quintiles persist. CONCLUSIONS Budget transfers to health insurance arrangements have helped to deepen UHC or maintain achievements with respect to UHC in these European LMICs by covering those outside formal sector work, and in particular vulnerable population groups. However, challenges remain: a comprehensive benefit package on paper is not enough as long as supply side constraints and quality gaps as well as informal payments prevail. A key policy question is how to reach those so far uncovered.
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Affiliation(s)
- Inke Mathauer
- />Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 1211 Geneva, Switzerland
| | - Mareike Theisling
- />Health, Population Policy, Social Security Division, Federal Ministry for Economic Cooperation and Development, Bonn, Germany
| | - Benoit Mathivet
- />Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 1211 Geneva, Switzerland
| | - Ileana Vilcu
- />Consultant with the World Health Organization at the time of writing from October 2014 to December 2015, Avenue Appia, 1211 Geneva, Switzerland
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