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Were BN, Mwangi EM, Muiruri LW. Barriers of access to primary healthcare services by National Health Insurance Fund capitated members in Uasin Gishu county, Kenya. BMC Health Serv Res 2024; 24:1025. [PMID: 39232753 PMCID: PMC11375832 DOI: 10.1186/s12913-024-11282-8] [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: 02/11/2024] [Accepted: 07/04/2024] [Indexed: 09/06/2024] Open
Abstract
PURPOSE The study identifies provision of primary healthcare services using the capitated health model as a prerequisite for promoting positive healthcare outcomes for a country's population. However, capitated members have continued to face challenges in accessing primary healthcare services despite enrolment in the National Health Insurance Fund (NHIF). This study sought to determine if variables such as patient knowledge of the NHIF benefit package, NHIF Premium Payment processes, selecting NHIF capitated health facilities, and NHIF Communication to citizens' influences access to primary healthcare services. METHOD A cross-sectional analytical research design was adopted. Data was collected from patients who were using NHIF cards, who were drawn from health facilities. Data was collected using a structured questionnaire where some of the questions were rated using the Likert scale to enable the generation of descriptive statistics. Data was analysed using descriptive and inferential statistics. Logistic regression was conducted to determine the relationship between the independent and the dependent variables. RESULTS The study found that four independent variables (Patient knowledge of NHIF Benefit Package, NHIF Premium Payment processes, Selecting NHIF capitated Health Facility, and NHIF Communication to citizens) were significant predictors of access to capitated healthcare services with significance values of .001, .001, .001 and .001 respectively at 95% significance level. CONCLUSIONS The study found that familiarity with the NHIF benefit package significantly influenced NHIF capitated members' access to primary healthcare services in Uasin Gishu County. While most members were aware of their healthcare entitlements, there's a need for increased awareness regarding access to surgical services and dependents' inclusion. Facility selection also played a crucial role, influenced by factors like freedom of choice, NHIF facility selection rules, facility appearance, and proximity to members' homes. NHIF communication positively impacted access, with effective communication channels aiding service accessibility. Premium payment processes also significantly linked with service access, influenced by factors such as payment procedures, premium awareness, payment schedules, registration waiting periods, and penalties for defaults. Overall, patient knowledge, NHIF communication, premium payment processes, and facility selection all contributed positively to NHIF capitated members' access to primary healthcare services in Uasin Gishu County.
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Affiliation(s)
- Barbara Nawire Were
- Department of Health Systems Management, Kenya Methodist University-Nairobi, Nairobi, Kenya.
| | - Eunice Muthoni Mwangi
- Department of Population Health - Medical College, Aga Khan University-Nairobi, Nairobi, Kenya
| | - Lillian Wambui Muiruri
- Department of Health Systems Management, Kenya Methodist University-Nairobi, Nairobi, Kenya
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Mead ES, Teeling SP, McNamara M. A Realist Review Protocol into the Contexts and Mechanisms That Enable the Inclusion of Environmental Sustainability Outcomes in the Design of Lean Healthcare Improvement Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:868. [PMID: 39063445 PMCID: PMC11276605 DOI: 10.3390/ijerph21070868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024]
Abstract
Healthcare makes a significant contribution to the social, economic and environmental benefits of communities. It is correspondingly a significant employer and consumer of both energy and consumables, often at high costs. Lean, a quality improvement methodology focuses on the elimination of non-value add (NVA) activities (steps that do not add value from the perspective of the customer) to improve the flow of people, information or goods. Increasingly, Lean thinking is evolving from its initial focus on eliminating NVA to a more holistic approach that encompasses sustainability. However, little work has been undertaken intentionally, including environmental sustainability outcomes in Lean healthcare interventions. Realist review methodology facilitates an understanding of the extent to which an intervention works, for whom, in what context, why and how, and has proven useful in research relating to Lean interventions in healthcare settings. This protocol provides details for a realist review that will enable an understanding of the specific contexts in which certain mechanisms are activated that enable the inclusion of environmental sustainability outcomes in the design of Lean healthcare improvement interventions.
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Affiliation(s)
- Elaine Shelford Mead
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
| | - Seán Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
- Centre for Person-Centered Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
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Barbosa PM, Szrek H, Ferreira LN, Cruz VT, Firmino-Machado J. Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals. Ann Phys Rehabil Med 2024; 67:101824. [PMID: 38518399 DOI: 10.1016/j.rehab.2024.101824] [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: 07/03/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Stroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. OBJECTIVE To determine the most cost-effective rehabilitation pathway during the first 12 months after a first-ever stroke. METHODS A cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values. RESULTS From the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual's perspective and between €10992 and €31319 from the healthcare service perspective. CONCLUSION Assuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.
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Affiliation(s)
- Pedro Maciel Barbosa
- Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal; Centro de Investigação em Reabilitação, Escola Superior de Saúde, Instituto Politécnico do Porto, R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| | - Helena Szrek
- Centre for Economics and Finance, University of Porto, R. Dr. Roberto Frias, 4200-464 Porto, Portugal
| | - Lara Noronha Ferreira
- ESGHT, Universidade do Algarve, Estr. da Penha 139, 8005-246 Faro, Portugal; Centre for Health Studies and Research of the University of Coimbra, Avenida Dias da Silva 165, 3004-512 Coimbra, Portugal; Research Centre for Tourism, Sustainability and Well-Being (CinTurs), Portugal.
| | - Vitor Tedim Cruz
- Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - João Firmino-Machado
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; Centro Académico Clínico Egas Moniz, 810-193 Aveiro, Portugal; Centro Hospitalar Vila Nova de Gaia/Espinho, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
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Yeh MJ, Lee PH. The Ethics of Population Policy for the Two Worlds of Population Conditions. HEALTH CARE ANALYSIS 2024; 32:1-14. [PMID: 37477837 DOI: 10.1007/s10728-023-00462-y] [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] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
Population policy has taken two divergent trajectories. In the developing part of the world, controlling population growth has been a major tune of the debate more than a half-century ago. In the more developed part of the world, an inverse pattern results in the discussion over the facilitation of population growth. The ethical debates on population policy have primarily focused on the former and ignored the latter. This paper proposes a more comprehensive account that justifies states' population policy interventions. We first consider the reasons that support pro-natalist policies to enhance fertility rates and argue that these policies are ethically problematic. We then establish an ethics of population policy grounded on account of self-sustaining the body politic, which consists of four criteria: survival, replacement, accountability, and solidarity. We discuss the implications of this account regarding birth-control and pro-natalist policies, as well as non-procreative policies such as immigration, adoption, and unintended baby-saving strategies.
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Affiliation(s)
- Ming-Jui Yeh
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, 17 Xuzhou Rd, Taipei City, 100, Taiwan.
| | - Po-Han Lee
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, 17 Xuzhou Rd, Taipei City, 100, Taiwan
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Psarras A, Karakolias S. A Groundbreaking Insight Into Primary Care Physiotherapists' Remuneration. Cureus 2024; 16:e54732. [PMID: 38523929 PMCID: PMC10961143 DOI: 10.7759/cureus.54732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Physiotherapy in Greece, as part of primary health care (PHC), faces sound imbalances: reduced quality, productivity, and efficiency, along with rather inflexible remuneration schemes. This study is aimed at reporting the attitude and perceptions of Greek PHC physiotherapists toward their current remuneration and also at identifying any other preferable remuneration schemes. Methods A stratified proportional sampling study was undertaken, using an anonymous, electronic survey. The participants were 250 self-employed physiotherapists running their business in Central and Eastern Macedonia and Thrace, being also contracted with the National Organisation for Healthcare Provision (EOPYY). The sample size stands for 34% of the population with a circa 5% margin of error. Results Nearly 9/10 physiotherapists (84%) underline that remuneration falls short of their productivity, leading to reduced job satisfaction. Moreover, their remuneration does not motivate them to provide services of higher quality (46%), while 58% of them stated that they are forced to claim informal fees. There is no clear desire regarding the remuneration scheme, but nearly ¼ of physiotherapists revealed their preference for the cost-per-case philosophy combined with co-payments. Conclusion The majority of physiotherapists believe that their current remuneration does not reflect their productivity nor the quality of their services and, therefore, informal payments arise. The preference of physiotherapists lies between cost-per-case fees and patient co-payments, which, however, favors supplier-induced demand and access inequalities, respectively. Hence, policymakers should revise the current remuneration scheme and overcome its deficiencies without creating new ones.
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Affiliation(s)
| | - Stefanos Karakolias
- Department of Organisation Management, Marketing and Tourism, International Hellenic University, Thessaloniki, GRC
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Odipo E, Jarhyan P, Nzinga J, Prabhakaran D, Aryal A, Clarke-Deelder E, Mohan S, Mosa M, Eshetu MK, Lewis TP, Kapoor NR, Kruk ME, Fink G, Okiro EA. The path to universal health coverage in five African and Asian countries: examining the association between insurance status and health-care use. Lancet Glob Health 2024; 12:e123-e133. [PMID: 38096884 PMCID: PMC10716621 DOI: 10.1016/s2214-109x(23)00510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 12/17/2023]
Abstract
Despite major efforts to achieve universal health coverage (UHC), progress has lagged in many African and Asian countries. A key strategy pursued by many countries is the use of health insurance to increase access and affordability. However, evidence on insurance coverage and on the association between insurance and UHC is mixed. We analysed nationally representative cross-sectional data collected between 2022 and 2023 in Ethiopia, Kenya, South Africa, India, and Laos. We described public and private insurance coverage by sociodemographic factors and used logistic regression to examine the associations between insurance status and seven health-care use outcomes. Health insurance coverage ranged from 25% in India to 100% in Laos. The share of private insurance ranged from 1% in Ethiopia to 13% in South Africa. Relative to the population with private insurance, the uninsured population had reduced odds of health-care use (adjusted odds ratio 0·68, 95% CI 0·50-0·94), cardiovascular examinations (0·63, 0·47-0·85), eye and dental examinations (0·54, 0·42-0·70), and ability to get or afford care (0·64, 0·48-0·86); private insurance was not associated with unmet need, mental health care, and cancer screening. Relative to private insurance, public insurance was associated with reduced odds of health-care use (0·60, 0·43-0·82), mental health care (0·50, 0·31-0·80), cardiovascular examinations (0·62, 0·46-0·84), and eye and dental examinations (0·50, 0·38-0·65). Results were highly heterogeneous across countries. Public health insurance appears to be only weakly associated with access to health services in the countries studied. Further research is needed to improve understanding of these associations and to identify the most effective financing strategies to achieve UHC.
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Affiliation(s)
- Emily Odipo
- Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Jacinta Nzinga
- Health Economics Research Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Amit Aryal
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Emma Clarke-Deelder
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | | | | | | | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Emelda A Okiro
- Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Nabyonga-Orem J, Christmals CD, Addai KF, Mwinga K, Karenzi-Muhongerwa D, Namuli S, Asamani JA. The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review. J Glob Health 2023; 13:04153. [PMID: 37962340 PMCID: PMC10644850 DOI: 10.7189/jogh.13.04153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Background Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries (LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nature of innovative health financing instruments, mechanisms and policies implemented in Africa. We further reviewed the factors that hinder or facilitate implementation, the lessons learnt on the structure, the development process and the implementation. Methods We conducted a systematic scoping review of the literature to analyze the nature, type, and factors impacting the implementation of innovative health financing mechanisms in the World Health Organization (WHO) African region. Results Innovative health financing mechanisms are increasing in the WHO African region as a result of international policy, the need to improve healthy eating and social life of the populace, advocacy and the availability of international mechanisms to which countries can subscribe. The 41 documents included in this review reported ten innovative financing mechanisms in 43 out of the 47 WHO Africa region member states. The most common mechanisms include an excise tax on tobacco products (43 countries) and alcoholic beverages and spirits (41 countries), airline ticket levy (18 countries), sugar-based beverages tax (seven countries), and levy on oil, gas and mineral tax (four countries). Other mechanisms include the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) trust fund, the social impact bond, the financial transaction tax, mobile phone tax and equity funds. Funds generated from many mechanisms are not allocated to health, although some portions are allocated to health-related activities. In some countries where mechanisms implemented are public health-related, emphasis is placed on positive health behavior beyond raising funds. Persistent resistance from industries due to conflicting economic policies is a major challenge. Conclusions Leveraging international policies and setting up intersectoral committees to develop and implement innovative mechanisms that involve excise taxes are recommended as possible solutions to the conflicts of interest.
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Affiliation(s)
- Juliet Nabyonga-Orem
- World Health Organization Regional office for Africa, Office of the Regional Director, Brazzaville, Congo
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
| | - Christmal D Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
| | - Kingsley F Addai
- World Health Organization Ghana country office, Universal Health Coverage Life Course Cluster, Accra, Ghana
| | - Kasonde Mwinga
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - Diane Karenzi-Muhongerwa
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - Sylvia Namuli
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - James A Asamani
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
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Almodhen F, Moneir WM. Toward a Financially Sustainable Healthcare System in Saudi Arabia. Cureus 2023; 15:e46781. [PMID: 37954697 PMCID: PMC10632744 DOI: 10.7759/cureus.46781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND This study aimed to find out the application of a sustainability model framework to test the financial sustainability of the healthcare system in Saudi Arabia and to suggest some reforms required to maintain a sustainable healthcare system in the country. METHODS To test the financial sustainability of the publicly funded healthcare system in Saudi Arabia, we applied analytical techniques using a sustainability model framework based on the framework indicators proposed previously by the Office of Sustainable Development, Bureau for Africa, U.S. Agency for International Development. An empirical time-trend analysis was also used to judge the financial sustainability of the healthcare system of Saudi Arabia in the future. RESULTS The results showed significant threats to the financial sustainability of the healthcare system. Saudi Arabia's revenues, gross domestic product (GDP), government budget, and Ministry of Health (MOH) budget were all directly influenced by the oil prices. CONCLUSION The healthcare system in Saudi Arabia seems to be financially unsustainable, and the need for change is inevitable. Saudi's ambitious program of development "Vision 2030" will surmount the challenges faced by the country and will lead to substantial enhancements in the health sector in Saudi Arabia, and other opportunities for improvement do exist.
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Affiliation(s)
- Fayez Almodhen
- Pediatric Urology, Surgery Department, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Wael M Moneir
- Pediatric Urology, King Abdulaziz Medical City, Riyadh, SAU
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Lim MY, Kamaruzaman HF, Wu O, Geue C. Health financing challenges in Southeast Asian countries for universal health coverage: a systematic review. Arch Public Health 2023; 81:148. [PMID: 37592326 PMCID: PMC10433621 DOI: 10.1186/s13690-023-01159-3] [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: 02/14/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) has received much attention and many countries are striving to achieve it. The Southeast Asian region, in particular, comprises many developing countries with limited resources, exacerbating challenges around attaining UHC. This paper aims to specifically explore the health financing challenges these countries face in achieving UHC via a systematic review approach and formulate recommendations that will be useful for policymakers. METHODS The systematic review followed the guidelines as recommended by PRISMA. The narrative synthesis approach was used for data synthesis, followed by identifying common themes. RESULTS The initial search returned 160 articles, and 32 articles were included after the screening process. The identified challenges in health financing towards achieving UHC in the Southeast Asian region are categorised into six main themes, namely (1) Unsustainability of revenue-raising methods, (2) Fragmented health insurance schemes, (3) Incongruity between insurance benefits and people's needs, (4) Political and legislative indifference, (5) Intractable and rapidly rising healthcare cost, (6) Morally reprehensible behaviours. CONCLUSIONS The challenges identified are diverse and therefore require a multifaceted approach. Regional collaborative efforts between countries will play an essential role in the progress towards UHC and in narrowing the inequity gap. At the national level, individual countries must work towards sustainable health financing strategies by leveraging innovative digital technologies and constantly adapting to dynamic health trends. REGISTRATION This study is registered with PROSPERO, under registration number CRD42022336624.
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Affiliation(s)
- Ming Yao Lim
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK.
| | - Hanin Farhana Kamaruzaman
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
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Yu ZQ, Chen LP, Qu JQ, Wu WZ, Zeng Y. A study on the sustainability assessment of China's basic medical insurance fund under the background of population aging-evidence from Shanghai. Front Public Health 2023; 11:1170782. [PMID: 37333524 PMCID: PMC10273205 DOI: 10.3389/fpubh.2023.1170782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Objective As China's population aging process accelerates, the expenditure of China's basic medical insurance fund for employees may increase significantly, which may threaten the sustainability of China's basic medical insurance fund for employees. This paper aims to forecast the future development of China's basic medical insurance fund for employees in the context of the increasingly severe aging of the population. Methods This paper taking an empirical study from Shanghai as an example, constructs an actuarial model to analyze the impact of changes in the growth rate of per capita medical expenses due to non-demographic factors and in the population structure on the sustainability of the basic medical insurance fund for employees. Results Shanghai basic medical insurance fund for employees can achieve the goal of sustainable operation in 2021-2035, with a cumulative balance of 402.150-817.751 billion yuan in 2035. The lower the growth rate of per capita medical expenses brought about by non-demographic factors, the better the sustainable operation of the fund. Conclusion Shanghai basic medical insurance fund for employees can operate sustainably in the next 15 years, which can further reduce the contribution burden of enterprises, which lays the foundation for improving the basic medical insurance treatment for employees.
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Affiliation(s)
- Zhi-Qing Yu
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Li-Peng Chen
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Jun-Qiao Qu
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Wan-Zong Wu
- Business School, Yangzhou University, Yangzhou, China
| | - Yi Zeng
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
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Matthew A, Guirguis S, Incze T, Stragapede E, Peltz S, Yang G, Jamnicky L, Elterman D. The Anatomy of a Hybrid In-Person and Virtual Sexual Health Clinic in Oncology. Curr Oncol 2023; 30:2417-2428. [PMID: 36826145 PMCID: PMC9955462 DOI: 10.3390/curroncol30020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Sexual health is compromised by the diagnosis and treatment of virtually all cancer types. Despite the prevalence and negative impact of sexual dysfunction, sexual health clinics are the exception in cancer centers. Consequently, there is a need for effective, efficient, and inclusive sexual health programming in oncology. This paper describes the development of the innovative Sexual Health Clinic (SHC) utilizing a hybrid model of integrated in-person and virtual care. The SHC evolved from a fusion of the in-person and virtual prostate cancer clinics at Princess Margaret. This hybrid care model was adapted to include six additional cancer sites (cervical, ovarian, testicular, bladder, kidney, and head and neck). The SHC is theoretically founded in a biopsychosocial framework and emphasizes interdisciplinary intervention teams, participation by the partner, and a medical, psychological, and interpersonal approach. Virtual visits are tailored to patients based on biological sex, cancer type, and treatment type. Highly trained sexual health counselors facilitate the virtual clinic and provide an additional layer of personalization and a "human touch". The in-person visits complement virtual care by providing comprehensive sexual health assessment and sexual medicine prescription. The SHC is an innovative care model which has the potential to close the gap in sexual healthcare. The SHC is designed as a transferable, stand-alone clinic which can be shared with cancer centers.
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Affiliation(s)
- Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Toronto, ON M5G 1Z6, Canada
- Correspondence: ; Tel.: +1-416-946-2332
| | - Steven Guirguis
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Toronto, ON M5G 1Z6, Canada
| | - Taylor Incze
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Toronto, ON M5G 1Z6, Canada
| | - Elisa Stragapede
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Toronto, ON M5G 1Z6, Canada
| | - Sarah Peltz
- Division of Urology, Department of Surgery, Mackenzie Health, Richmond Hill, ON L4C 4Z3, Canada
| | - Gideon Yang
- NexJ Health, Inc., Toronto, ON M4N 3N1, Canada
| | - Leah Jamnicky
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Toronto, ON M5G 1Z6, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON M5T 2SB, Canada
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Moes RGJ, Huisman EL, Malkin SJP, Hunt B. Evaluating the Clinical and Economic Outcomes Associated with Poor Glycemic Control in People with Type 1 Diabetes in the Netherlands. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:87-96. [PMID: 36778040 PMCID: PMC9910197 DOI: 10.2147/ceor.s391626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Achieving and maintaining glycemic control is the cornerstone of type 1 diabetes management, with the aim of reducing the incidence of diabetes-related complications over the long term. However, many individuals fail to reach glycemic targets. The present study evaluated the clinical and economic burden associated with poor glycemic control in people with type 1 diabetes in the Netherlands, and the improvements in outcomes that can be achieved by improving treatment. Methods Immediate glycemic control, defined as achieving a glycated hemoglobin (HbA1c) target of 7.0% at the start of the analysis, was compared with delays in achieving control of 1, 3 and 7 years, with outcomes projected using the IQVIA CORE Diabetes Model. Projections of life expectancy, quality-adjusted life expectancy, and direct and indirect costs (expressed in 2021 euros [EUR]) were made at a patient level and extrapolated to the population level. Results Improving HbA1c from 8.0% to 7.0% and 9.0% to 7.0% resulted in gains of up to 0.66 and 1.37 quality-adjusted life years (QALYs) per patient over a lifetime, respectively. At a population level, achieving immediate glycemic control was associated with gains of 9438, 27,171 and 72,717 QALYs and cost savings of up to EUR 224 million, EUR 556 million and EUR 1.3 billion compared with remaining in poor control for 1, 3 and 7 years, respectively. Conclusion The clinical and economic burden of poor glycemic control in people with type 1 diabetes in the Netherlands was projected to be substantial, but considerable gains in quality-adjusted life expectancy and cost savings could be achieved through early and effective treatment.
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Affiliation(s)
| | | | | | - Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
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Abstract
OBJECTIVES To conduct a comprehensive literature review on the state of population aging, healthcare financing, and provision in India. METHODS To obtain relevant records in the Indian context, multiple publications were searched from databases, such as Scopus, ScienceDirect, Web of Science, Medline/PubMed, JSTOR, and Google Scholar using the following keywords: "Population Ageing," "Population Aging," "Health System," "Demographic Dividend," "Non-communicable Diseases," "Double Burden of Diseases," "Health Spending," "Sustainable Health Financing," and "Health Coverage." Data on different health indices were collected from different websites of the government of India and international organizations (e.g. World Bank, UN, WHO, and Statista). RESULTS As people live longer, India faces a double burden of disease, with the rising incidence of non-communicable diseases (NCDs) amidst the presence of widespread communicable diseases. The combined problem of the double burden of diseases and population aging poses a severe sustainability challenge for its healthcare financing and the entire health system. Healthcare financing based on progressive taxation and large-scale prepayment coverage is an effective solution for sustaining the health system. However, due to the prevalence of indirect taxes, India's tax system is regressive. Hence, community-based health insurance (CBHI) schemes can be a feasible solution to cover the large mass of poor working in the informal sector. CONCLUSIONS India needs to address the alterations in its healthcare needs and demands brought on by the advancing demographic shift. To achieve so, the country's healthcare system must be reformed to accommodate strong national policies focusing on universal access to critical care especially geriatric and palliative care.
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Affiliation(s)
| | - Himanshu Sekhar Rout
- Department of Analytical & Applied Economics, Utkal University, Bhubaneswar, India
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
- Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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Kariuki-Barasa I, Adam MB. Living on the Edge of Possibility. Crit Care Clin 2022; 38:853-863. [DOI: 10.1016/j.ccc.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Yigezu A, Zewdie SA, Mirkuzie AH, Abera A, Hailu A, Agachew M, Memirie ST. Cost-analysis of COVID-19 sample collection, diagnosis, and contact tracing in low resource setting: The case of Addis Ababa, Ethiopia. PLoS One 2022; 17:e0269458. [PMID: 35679290 PMCID: PMC9182302 DOI: 10.1371/journal.pone.0269458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Ethiopia has been responding to the COVID-19 pandemic through a combination of interventions, including non-pharmaceutical interventions, quarantine, testing, isolation, contact tracing, and clinical management. Estimating the resources consumed for COVID-19 prevention and control could inform efficient decision-making for epidemic/pandemic-prone diseases in the future. This study aims to estimate the unit cost of COVID-19 sample collection, laboratory diagnosis, and contact tracing in Addis Ababa, Ethiopia. Methods Primary and secondary data were collected to estimate the costs of COVID-19 sample collection, diagnosis, and contact tracing. A healthcare system perspective was used. We used a combination of micro-costing (bottom-up) and top-down approaches to estimate resources consumed and the unit costs of the interventions. We used available cost and outcome data between May and December 2020. The costs were classified into capital and recurrent inputs to estimate unit and total costs. We identified the cost drivers of the interventions. We reported the cost for the following outcome measures: (1) cost per sample collected, (2) cost per laboratory diagnosis, (3) cost per sample collected and laboratory diagnosis, (4) cost per contact traced, and (5) cost per COVID-19 positive test identified. We conducted one-way sensitivity analysis by varying the input parameters. All costs were reported in US dollars (USD). Results The unit cost per sample collected was USD 1.33. The unit cost of tracing a contact of an index case was USD 0.66. The unit cost of COVID-19 diagnosis, excluding the cost for sample collection was USD 3.91. The unit cost of sample collection per COVID-19 positive individual was USD 11.63. The unit cost for COVID-19 positive test through contact tracing was USD 54.00. The unit cost COVID-19 DNA PCR diagnosis for identifying COVID-19 positive individuals, excluding the sample collection and transport cost, was USD 37.70. The cost per COVID-19 positive case identified was USD 49.33 including both sample collection and laboratory diagnosis costs. Among the cost drivers, personnel cost (salary and food cost) takes the highest share for all interventions, ranging from 51–76% of the total cost. Conclusion The costs of sample collection, diagnosis, and contact tracing for COVID-19 were high given the low per capita health expenditure in Ethiopia and other low-income settings. Since the personnel cost accounts for the highest cost, decision-makers should focus on minimizing this cost when faced with pandemic-prone diseases by strengthening the health system and using digital platforms. The findings of this study can help decision-makers prioritize and allocate resources for effective public health emergency response.
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Affiliation(s)
- Amanuel Yigezu
- National Data Management Center for Health, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
- * E-mail:
| | - Samuel Abera Zewdie
- Partnership and Cooperation Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Alemnesh H. Mirkuzie
- National Data Management Center for Health, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Adugna Abera
- Parasitology Department, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Alemayehu Hailu
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care Medicine, University of Bergen, Bergen, Norway
| | - Mesfin Agachew
- National Data Management Center for Health, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Solomon Tessema Memirie
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Cancer Control Funding in Nigeria: A Case for Universal Health Coverage. J Cancer Policy 2022; 32:100335. [DOI: 10.1016/j.jcpo.2022.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/02/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022]
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Xu Y, Tao R, Mahmood CK, Altuntaş M. Re-Examining the Financial Structure and Health Nexus in Asian Economies. Front Public Health 2022; 10:860325. [PMID: 35309196 PMCID: PMC8931330 DOI: 10.3389/fpubh.2022.860325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/02/2022] [Indexed: 11/21/2022] Open
Abstract
The study's main purpose is to estimate the impact of the financial structure of Asian economies on the healthcare sector from 2000 to 2019. For empirical estimation, we relied on two-stage least square (2SLS) and generalized method of moment (GMM) estimation techniques. Two different proxies, infant mortality and life expectancy, were used in the analysis to represent the health status of the people. The findings of both 2SLS and GMM models confirm that improved financial structure causes life expectancy to rise and infant mortality to fall. Moreover, the increased usage of the internet also exerts a positive impact on the health status of Asians. Further, the rise in gross domestic product (GDP) and health expenditures also improve the health status of Asians by increasing their life expectancy and reducing their infant mortality rate. Improvement in financial structure causes the health status of the people to rise. Therefore, to achieve superior health status, the development of financial structure should be part and parcel of health policies and strategies in Asian economies.
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Affiliation(s)
- Yanling Xu
- School of Business, Wuchang University of Technology, Wuhan, China
| | - Ran Tao
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
- *Correspondence: Ran Tao
| | - Chaudhry Kashif Mahmood
- College of Business Administration, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mehmet Altuntaş
- Department of Economics, Faculty of Economics, Administrative and Social Sciences, Nisantasi University, Istanbul, Turkey
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Geurten RJ, Struijs JN, Elissen AMJ, Bilo HJG, van Tilburg C, Ruwaard D. Delineating the Type 2 Diabetes Population in the Netherlands Using an All-Payer Claims Database: Specialist Care, Medication Utilization and Expenditures 2016-2018. PHARMACOECONOMICS - OPEN 2022; 6:219-229. [PMID: 34862962 PMCID: PMC8864033 DOI: 10.1007/s41669-021-00308-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of this study was to describe the healthcare utilization and expenditures related to medical specialist care and medication of the entire type 2 diabetes population in the Netherlands in detail. METHODS For this retrospective, observational study, we used an all-payer claims database. Comprehensive data on specialist care and medication utilization and expenditures of the type 2 diabetes population (n = 900,522 in 2018) were obtained and analyzed descriptively. Data were analyzed across medical specialties and for various types of diabetes medication (or glucose-lowering drugs [GLDs]) and other medication. RESULTS Specialist care utilization was diverse: different medical specialties were visited by a considerable fraction of the type 2 diabetes population. Total expenditures on specialist care were €2498 million in 2018 (i.e., 10.6% of the national specialist care expenditures). In total, 97.8% of patients used other medication (not GLDs) and 81.8% used GLDs; 25.6% of medication expenditures were for GLDs. For both specialist care and medication, mean expenditures per treated patient were higher than median expenditures, indicating a skewed distribution of spending. CONCLUSION Use of and expenditures on specialist care and medication of the type 2 diabetes population is diverse. These heterogeneous healthcare use patterns are likely caused by the presence of comorbidities. Additionally, we found that a small fraction of the population is responsible for a large share of the expenditures. A shift towards more patient-centered care could lead to health improvements and a reduction in overall costs, subsequently promoting the sustainability of healthcare systems.
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Affiliation(s)
- Rose J Geurten
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Campus The Hague, The Hague, The Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Akokuwebe ME, Idemudia ES. A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031766. [PMID: 35162789 PMCID: PMC8835528 DOI: 10.3390/ijerph19031766] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023]
Abstract
Background: The core Universal Health Coverage (UHC) objectives are to ensure universal access to healthcare services by reducing all forms of inequalities. However, financial constraints are major barriers to accessing healthcare, especially in countries such as Nigeria and South Africa. The findings of this study may aid in informing and communicating health policy to increase financial access to healthcare and its utilization in South Africa and Nigeria. Nigeria-South Africa bilateral relations in terms of politics, economics and trade are demonstrated in the justification of the study setting selection. The objectives were to estimate the prevalence of health insurance coverage, and to explore the socio-demographic factors associated with health insurance in South Africa and Nigeria. Methods: This was a cross-sectional study using the 2018 Nigeria Demographic Health Survey and the 2016 South Africa Demographic Health Survey. The 2018 Nigeria Demographic Health Survey data on 55,132 individuals and the 2016 South Africa Demographic Health Survey on 12,142 individuals were used to investigate the prevalence of health insurance associated with socio-demographic factors. Percentages, frequencies, Chi-square and multivariate logistic regression were e mployed, with a significance level of p < 0.05. Results: About 2.8% of the Nigerian population and 13.3% of the South African population were insured (Nigeria: males-3.4%, females-2.7% vs. South Africa: males-13.9%, females-12.8%). The multivariate logistic regression analyses showed that higher education was significantly more likely to be associated with health insurance, independent of other socio-demographic factors in Nigeria (Model I: OR: 1.43; 95% CI: 0.34-1.54, p < 0.05; Model II: OR: 1.34; 95% CI: 0.28-1.42, p < 0.05) and in South Africa (Model I: OR: 1.33; 95% CI: 0.16-1.66, p < 0.05; Model II: OR: 1.76; 95% CI: 0.34-1.82, p < 0.05). Respondents with a higher wealth index and who were employed were independently associated with health insurance uptake in Nigeria and South Africa (p < 0.001). Females were more likely to be insured (p < 0.001) than males in both countries, and education had a significant impact on the likelihood of health insurance uptake in high wealth index households among both male and females in Nigeria and South Africa. Conclusion: Health insurance coverage was low in both countries and independently associated with socio-demographic factors such as education, wealth and employment. There is a need for continuous sensitization, educational health interventions and employment opportunities for citizens of both countries to participate in the uptake of wide health insurance coverage.
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Hope DL, Campbell C. Sustainability via PebblePad digitization of pharmacy practice resources. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:173-181. [PMID: 35190159 DOI: 10.1016/j.cptl.2021.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 11/05/2021] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Digitization of learning and teaching resources allows for paper-free, digitally-enabled approaches to learning. While PebblePad is well recognized as an electronic portfolio platform, this study aimed to evaluate PebblePad for delivery of foundational workshop materials to provide sustainable and ongoing student access. METHODS From 2017, all workshops in a foundational pharmacy practice course were transferred from a paper-based manual to a modular digitized format hosted in PebblePad. An electronic survey tool assessed students' experiences with the platform. The voluntary and anonymous survey sought participant opinions on use, usability, ways of using, and reflection on using PebblePad on a five-point Likert-type scale (strongly disagree to strongly agree). Participants were asked to identify techniques they used to become familiar with PebblePad and the ways in which they used the platform. RESULTS From 2017 to 2019, 81 (45.3%) of 179 second-year pharmacy students participated in the research. Students most strongly agreed with statements related to comfort with online technologies for learning (n = 46/80, 57.5%), ease of use of PebblePad (n = 41/80, 51.3%), and having sufficient support from teaching staff (n = 39/78, 50%). The primary technique for becoming familiar with PebblePad was individual guidance from the teacher. The main use was to complete required workbook templates. Free-text comments demonstrated overwhelming support for PebblePad used in this teaching context. CONCLUSIONS PebblePad provided a valuable and sustainable platform for hosting digitized foundational pharmacy practice workshop resources.
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Affiliation(s)
- Denise L Hope
- School of Pharmacy and Medical Sciences, Griffith University, Clinical Sciences 2 G16_3.26, Gold Coast Campus, QLD 4222, Australia.
| | - Chris Campbell
- Learning Futures/Griffith Online, Griffith University, Nathan Campus, QLD, Australia
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21
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Factors Associated with Out-of-Pocket Health Expenditure in Polish Regions. Healthcare (Basel) 2021; 9:healthcare9121750. [PMID: 34946475 PMCID: PMC8701368 DOI: 10.3390/healthcare9121750] [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] [Received: 11/03/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022] Open
Abstract
Out-of-pocket (OOP) payments are perceived as the most regressive means of health financing. Using the panel-data approach and region-aggregated data from Statistics Poland, this research investigated associations between socio-economic factors and OOP health spending in 16 Polish regions for the period 1999–2019. The dependent variable was real (inflation-adjusted) monthly OOP health expenditure per person in Polish households. Potential independent variables included economic, labour, demographic, educational, health, environmental, and lifestyle measures based on previous research. A set of panel-data estimators was used in regression models. The factors that were positively associated with OOP health spending were disposable income, the proportions of children (aged 0–9) and elderly (70+ years) in the population, healthcare supply (proxied by physicians’ density), air pollution, and tobacco and alcohol expenditure. On the other hand, the increased unemployment rate, life expectancy at age 65, mortality rate, and higher sports participation were all related to lower OOP health spending. The results may guide national strategies to improve health-care allocations and offer additional financial protection for vulnerable groups, such as households with children and elderly members.
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Geurten RJ, Elissen AMJ, Bilo HJG, Struijs JN, van Tilburg C, Ruwaard D. Identifying and delineating the type 2 diabetes population in the Netherlands using an all-payer claims database: characteristics, healthcare utilisation and expenditures. BMJ Open 2021; 11:e049487. [PMID: 34876422 PMCID: PMC8655569 DOI: 10.1136/bmjopen-2021-049487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to identify and delineate the Dutch type 2 diabetes population and the distribution of healthcare utilisation and expenditures across the health system from 2016 to 2018 using an all-payer claims database. DESIGN Retrospective observational cohort study based on an all-payer claims database of the Dutch population. SETTING The Netherlands. PARTICIPANTS The whole Dutch type 2 diabetes population (n=900 522 in 2018), determined based on bundled payment codes for integrated diabetes care and medication use indicating type 2 diabetes. OUTCOME MEASURES Annual prevalence of type 2 diabetes, comorbidities and characteristics of the type 2 diabetes population, as well as the distribution of healthcare utilisation and expenditures were analysed descriptively. RESULTS In 2018, 900 522 people (6.5% of adults) were identified as having type 2 diabetes. The most common comorbidity in the population was heart disease (12.1%). Additionally, 16.2% and 5.6% of patients received specialised care for microvascular and macrovascular diabetes-related complications, respectively. Most patients with type 2 diabetes received pharmaceutical care (99.1%), medical specialist care (97.0%) and general practitioner consultations (90.5%). In total, €8173 million, 9.4% of total healthcare expenditures, was reimbursed for the type 2 diabetes population. Medical specialist care accounted for the largest share of spending (38.1%), followed by district nursing (12.4%), and pharmaceutical care (11.5%). CONCLUSIONS All-payer claims databases can be used to delineate healthcare use: this insight can inform health policy and practice and, thereby, support better decisions to promote long-term sustainability of healthcare systems. The healthcare utilisation of the Dutch type 2 diabetes population is distributed across the health system and utilisation of medical specialist care is high. This is likely to be due to presence of concurrent morbidities and complications. Therefore, a shift from a disease-specific approach to a person-centred and integrated care approach could be beneficial in the treatment of type 2 diabetes.
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Affiliation(s)
- Rose J Geurten
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department Public Health and Primary Care, Leiden University Medical Center Campus The Hague, The Hague, The Netherlands
| | - Chantal van Tilburg
- Department Intelligence, Vektis Healthcare Information Center, Zeist, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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BEHZADIFAR MASOUD, SHAHABI SAEED, ZEINALI MOHAMMAD, GHANBARI MAHBOUBEHKHATON, MARTINI MARIANO, BRAGAZZI NICOLALUIGI. A policy analysis of agenda-setting of Brucellosis in Iran using a multiple-stream framework: health policy and historical implications. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E544-E551. [PMID: 34604598 PMCID: PMC8451350 DOI: 10.15167/2421-4248/jpmh2021.62.2.2041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
Background Brucellosis, a major zoonotic disease, is highly present in Iran, especially in Lorestan province. The aim of this study was to understand the issues related to Brucellosis utilizing the multiple streams framework. Methods A two-step method was adopted: 1) assessment of brucellosis-related documents and 2) interviews with stakeholders. As a first step, all documents related to Brucellosis were reviewed at provincial and national levels. Policy documentation on health issues included the consultation of guidelines, rules and regulations, websites, reports, books, guides, and conferences. These documents were collected by referring to specialized centers, institutions, and organizations. In the second step, semi-structured interviews were conducted to determine the burden of disease with actors and stakeholders involved with the brucellosis program in the Lorestan province. More in detail, physicians, healthcare workers, managers, policy- and decision-makers were selected for interviews. Results The problem stream was characterized by: 1) high prevalence of the disease, 2) traditional livestock production, 3) unsafe animal slaughtering, 4) centers for the sale and distribution of non-authorized dairy products, 5) raw milk and 6) traditional unsafe dairy products consumption, 7) incomplete livestock vaccination, 8) lack of knowledge of Brucellosis, 9) neighboring countries with high prevalence of Brucellosis, 10) lack of livestock quarantine, and 10) nomadic immigration. The policy stream was characterized by 1) primary healthcare networks, 2) guidelines, 3) medicines, insurance, and 4) diagnostic services. Finally, the political stream was characterized by: 1) support of the University of Medical Sciences, 2) sponsorship by the Ministry of Health and Medical Education, 3) Health transformation plan, and 4) Working Group on Health and Food Security in Lorestan. Conclusion This study examined the brucellosis-related agenda setting: if different issues are taken into consideration, it can be perceived as a health priority.
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Affiliation(s)
- MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
- Correspondence: Masoud Behzadifar, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran - E-mail: /
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - MOHAMMAD ZEINALI
- Zoonoses Control Unit, Center of Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - MAHBOUBEH KHATON GHANBARI
- Zoonoses Control Unit, Center of Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, Section of Medical History and Ethics, University of Genoa, Italy
| | - NICOLA LUIGI BRAGAZZI
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Aikins M, Tabong PTN, Salari P, Tediosi F, Asenso-Boadi FM, Akweongo P. Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders. PLoS One 2021; 16:e0253109. [PMID: 34129630 PMCID: PMC8205146 DOI: 10.1371/journal.pone.0253109] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The National Health Insurance Scheme (NHIS) was introduced in 2003 to reduce "out-of-pocket" payments for health care in Ghana. Over a decade of its implementation, issues about the financial sustainability of this pro-poor policy remains a crippling fact despite its critical role to go towards Universal Health Coverage. We therefore conducted this study to elicit stakeholders' views on ways to improve the financial sustainability of the operations of NHIS. METHODS Twenty (20) stakeholders were identified from Ministry of Health, Ghana Health Services, health workers groups, private medical practitioners, civil society organizations and developmental partners. They were interviewed using an interview guide developed from a NHIS policy review and analysis. All interviews were recorded and transcribed verbatim. The data were analysed thematically with the aid of NVivo 12 software. RESULTS Stakeholders admitted that the NHIS is currently unable to meet its financial obligations. The stakeholders suggested first the adoption of capitation as a provider payment mechanism to minimize the risk of providers' fraud and protection from political interference. Secondly, they indicated that rapid releases of specific statutory deductions and taxes for NHIS providers could reduce delays in claims' reimbursement which is one of the main challenges faced by healthcare providers. Aligning the NHIS with the Community-based Health Planning and Services and including preventive and promotive health is necessary to position the Scheme for Universal Health Coverage. CONCLUSION The Scheme will potentially achieve UHC if protected from political interference to improve the governance and transparency that affects the finances of the scheme and the expansion of services to include preventive and promotive services and cancers.
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Affiliation(s)
- Moses Aikins
- Department of Health Policy Planning and Management, School of Public Health, University of Ghana, Legon, Accra
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Legon, Accra
| | - Paola Salari
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Patricia Akweongo
- Department of Health Policy Planning and Management, School of Public Health, University of Ghana, Legon, Accra
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Müller L, El Oakley R, Saad M, Mokdad AH, Etolhi GA, Flahault A. A multidimensional framework for rating health system performance and sustainability: A nine plus one ranking system. J Glob Health 2021; 11:04025. [PMID: 34026052 PMCID: PMC8109277 DOI: 10.7189/jogh.11.04025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Health Care provision in terms of prevention, detection and treatment is primarily dependent on the quality of the hosting Health System. In its health report 2000, the WHO's attempt to assess and rank health systems’ quality Worldwide was heavily criticized. We propose a novel framework for health system performance and ranking using three indicators for three domains; general health system performance, clinical outcome of treatment applied to the main causes of death and health system sustainability domains. Methods Each domain was rated as “A – high”, “B – intermediate” or “C – poor” according to the aggregate score values of its three indicators. Hence the highest rank a health system can achieve is “AAA” and the lowest is “CCC”. If there is a need to define a “numerical rank” to further differentiate health systems with similar rating from one another, the total health expenditure per capita per year was used as an additional “number 10” indicator to achieve that level of differentiation. The framework was applied to Health Systems serving most of the World population including China, India, Brazil, USA, Russia, Germany, Japan, UK, France, Singapore and Switzerland. Data pertinent to each indicator was captured from published reports in peer-reviewed journals and/or from official websites. A Delphi survey was conducted for data not available online. Results Among the 11 health systems tested, no one scored AAA, Switzerland, France, Germany and Japan scored AAB, Singapore scored ABB, UK scored BBB, USA, Russia and China scored BBC, Brazil scored BCC while India scored CCC. Total health expenditure per capita per year lead to ranking Switzerland first followed by France, Germany, and Japan. Conclusion This novel ranking system is a practical and an applicable tool that test health system performance and sustainability. It can be utilized to guide all organizations, people and actions whose primary intent is to promote, restore or maintain health to achieve their targets. An International Health System Ranking database that will be hosted by the Institute of Global, Health, Faculty of Medicine, University of Geneva, Switzerland.
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Affiliation(s)
- Laura Müller
- Institute of Global, Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Reida El Oakley
- Cardiac Centre, King Abdel Aziz Specialist Hospital, Taif, Saudi Arabia
| | - Mohammed Saad
- The Libyan International Medical University, Benghazi, Libya
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle,Washington, USA
| | - Giamal A Etolhi
- The Libyan International Medical University, Benghazi, Libya
| | - Antoine Flahault
- Institute of Global, Health, Faculty of Medicine, University of Geneva, Switzerland
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Kierkegaard P, Owen-Smith J. Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians. BMJ Open 2021; 11:e042334. [PMID: 33402408 PMCID: PMC7786804 DOI: 10.1136/bmjopen-2020-042334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Most scholarly attention to studying collaborative ties in physician networks has been devoted to quantitatively analysing large, complex datasets. While valuable, such studies can reduce the dynamic and contextual complexities of physician collaborations to numerical values. Qualitative research strategies can contribute to our understanding by addressing the gaps left by more quantitative approaches. This study seeks to contribute to the literature that applies network science approaches to the context of healthcare delivery. We use qualitative, observational and interview, methods to pursue an in-depth, micro-level approach to the deeply social and discursive processes that influence patterns of collaboration and referral decision-making in physician networks. DESIGN Qualitative methodologies that paired ethnographic field observations, semistructured interviews and document analysis were used. An inductive thematic analysis approach was used to analyse, identify and describe patterns in those data. SETTING This study took place in a high-volume cardiovascular department at a major academic medical centre (AMC) located in the Midwest region of the USA. PARTICIPANTS Purposive and snowballing sampling were used to recruit study participants for both the observational and face-to-face in-depth interview portions of the study. In total, 25 clinicians and 43 patients participated in this study. RESULTS Two primary thematic categories were identified: (1) circumstances for external engagement; and (2) clinical conditions for engagement. Thematic subcategories included community engagement, scientific engagement, reputational value, experiential information, professional identity, self-awareness of competence, multidisciplinary programmes and situational factors. CONCLUSION This study adds new contextual knowledge about the mechanisms that characterise referral decision-making processes and how these impact the meaning of physician relationships, organisation of healthcare delivery and the knowledge and beliefs that physicians have about their colleagues. This study highlights the nuances that influence how new collaborative networks are formed and maintained by detailing how relationships among physicians develop and evolve over time.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London, UK
- CRUK Convergence Science Centre, Institute of Cancer Research & Imperial College London, London, UK
| | - Jason Owen-Smith
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Department of Sociology, University of Michigan, Ann Arbor, Michigan, USA
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[Constructing a new institutional hegemony in the health field]. Salud Colect 2020; 16:e3360. [PMID: 33374088 DOI: 10.18294/sc.2020.3360] [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: 12/19/2020] [Accepted: 12/19/2020] [Indexed: 11/24/2022] Open
Abstract
This article argues for the construction of a new institutional hegemony with a rhizomatic design based on health centers with direct relations to a network of hospitals with increasing levels of complexity, which are put at the service of these health centers and not the other way around. The proposal for these centers includes community-based teams of workers carrying out humanized practice centered on the shift from health services to care within the community, respecting the particularities and idiosyncrasies of its residents and their cultures. First, a brief historical revision of the genesis of health centers and of hospitals is presented. Second, technical recommendations to restructure models of care and institutional organization in the health field are put forth, and technical-political proposals for this new institutional hegemony are outlined, which are developed along three dimensions: organization, policy, and service and care processes. Lastly, some barriers to the construction of this new hegemony are identified.
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Mathonnat J, Audibert M, Belem S. Analyzing the Financial Sustainability of User Fee Removal Policies: A Rapid First Assessment Methodology with a Practical Application for Burkina Faso. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:767-780. [PMID: 31432456 PMCID: PMC7716817 DOI: 10.1007/s40258-019-00506-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The purpose of this paper is to briefly present a methodological framework that does not require cumbersome investigations for a first assessment of the financial sustainability of policies aiming to remove or reduce healthcare user fees (the so-called free healthcare policy [FHCP]). This paper is organized in two main sections. The first analyzes the various possibilities available to finance an FHCP. Using several scenarios, it includes a special focus devoted to the calculus of what to consider when assessing the sustainability of expanding fiscal space for financing the FHCP. The second section relies on the current FHCP being implemented in Burkina Faso to illustrate a selection of specific issues raised in the methodological framework. The results suggest that sustainable FHCP financing is not outside the range of the government but does represent a significant challenge, as it will require, both currently and in the future, complex and delicate budget trade-offs at the highest governmental levels, regardless of other policy options to be considered.
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Affiliation(s)
- Jacky Mathonnat
- University Clermont Auvergne and FERDI (Fondation pour les Etudes et Recherches sur le Développement International), 63 Bd François Mitterrand, 63000, Clermont-Ferrand, France.
| | - Martine Audibert
- University Clermont Auvergne, CERDI (Centre d'Etudes et de Recherches sur le Développement International), 26, Avenue Léon Blum, 63000, Clermont-Ferrand, France
| | - Salam Belem
- Sahel Demographic Dividend (SWEDD), Health Development Support Program, Ministry of Health, Ouagadougou, Burkina Faso
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Vijayasingham L, Govender V, Witter S, Remme M. Employment based health financing does not support gender equity in universal health coverage. BMJ 2020; 371:m3384. [PMID: 33109510 PMCID: PMC7587231 DOI: 10.1136/bmj.m3384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health financing and entitlement systems linked to employment can disadvantage women, argue Lavanya Vijayasingham and colleagues
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Affiliation(s)
- Lavanya Vijayasingham
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | | | - Sophie Witter
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Michelle Remme
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
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Behzadifar M, Saran M, Behzadifar M, Martini M, Bragazzi NL. The 'Health Transformation Plan' in Iran: A policy to achieve universal health coverage in slums and informal settlement areas. Int J Health Plann Manage 2020; 36:267-272. [PMID: 32996231 DOI: 10.1002/hpm.3082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 01/23/2023] Open
Abstract
Universal health coverage (UHC) is one of the strategies that health decision- and policy-makers worldwide are implementing to guarantee a good health status to everyone. Living in slums is characterized by several issues, including homelessness and malnutrition, environmental challenges, lack of sanitation and access to safe, healthy drinking water, waste disposal problems, widespread social disruptions, job insecurity, feelings of dissatisfaction and inadequacy. In Iran, the 'Health Transformation Plan' (HTP), despite its weaknesses, has had good effects on the health level of people living in slums, ensuring insurance coverage and reducing many economic, social and cultural problems, with a dramatic decline in out-of-pocket expenditures. Good governmental financial support and an adequate revision of the initial packages of health services and provisions have resulted in a higher access rate to healthcare. The HTP has been, indeed, a major step towards reaching UHC in Iran. If policy- and decision-makers can further improve the present situation and provide more and better-quality services to these people, it can be expected that health indicators in suburbs will be significantly improved. Researchers should monitor the impact of HTP and examine its effects on health indicators, specifically among particularly vulnerable groups such as children, women and the elderly.
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Affiliation(s)
- Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Saran
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mariano Martini
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
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Oñatibia-Astibia A, Malet-Larrea A, Mendizabal A, Valverde E, Larrañaga B, Gastelurrutia MÁ, Ezcurra M, Arbillaga L, Calvo B, Goyenechea E. The medication discrepancy detection service: A cost-effective multidisciplinary clinical approach. Aten Primaria 2020; 53:43-50. [PMID: 32994060 PMCID: PMC7752972 DOI: 10.1016/j.aprim.2020.04.008] [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: 10/10/2019] [Revised: 02/14/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To estimate the effectiveness of a Medication Discrepancy Detection Service (MDDS), a collaborative service between the community pharmacy and Primary Care. DESIGN Non-controlled before-and-after study. SETTING Bidasoa Integrated Healthcare Organisation, Gipuzkoa, Spain. PARTICIPANTS The service was provided by a multidisciplinary group of community pharmacists (CPs), general practitioners (GPs), and primary care pharmacists, to patients with discrepancies between their active medical charts and medicines that they were actually taking. OUTCOMES The primary outcomes were the number of medicines, the type of discrepancy, and GPs' decisions. Secondary outcomes were time spent by CPs, emergency department (ED) visits, hospital admissions, and costs. RESULTS The MDDS was provided to 143 patients, and GPs resolved discrepancies for 126 patients. CPs identified 259 discrepancies, among which the main one was patients not taking medicines listed on their active medical charts (66.7%, n=152). The main GPs' decision was to withdraw the treatment (54.8%, n=125), which meant that the number of medicines per patient was reduced by 0.92 (9.12±3.82 vs. 8.20±3.81; p<.0001). The number of ED visits and hospital admissions per patient were reduced by 0.10 (0.61±.13 vs 0.52±0.91; p=.405 and 0.17 (0.33±0.66 vs. 0.16±0.42; p=.007), respectively. The cost per patient was reduced by €444.9 (€1003.3±2165.3 vs. €558.4±1273.0; p=.018). CONCLUSION The MDDS resulted in a reduction in the number of medicines per patients and number of hospital admissions, and the service was associated with affordable, cost-effective ratios.
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Affiliation(s)
- Ainhoa Oñatibia-Astibia
- Official Pharmacist Association of Gipuzkoa, Prim 2, 20006 Donostia/San Sebastian, Spain; Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, P. Universidad 7, 01006 Vitoria, Spain.
| | - Amaia Malet-Larrea
- Official Pharmacist Association of Gipuzkoa, Prim 2, 20006 Donostia/San Sebastian, Spain
| | - Amaia Mendizabal
- Primary Care Pharmacy, Bidasoa Integrated Healthcare Organisation (Osakidetza), Spain
| | - Elena Valverde
- Primary Care Pharmacy, Bidasoa Integrated Healthcare Organisation (Osakidetza), Spain
| | - Belen Larrañaga
- Official Pharmacist Association of Gipuzkoa, Prim 2, 20006 Donostia/San Sebastian, Spain
| | - Miguel Ángel Gastelurrutia
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071 Granada, Spain
| | - Martín Ezcurra
- Martin Ezcurra Fernandez Pharmacy, Harmugarrieta 2, 20305 Irun, Spain
| | - Leire Arbillaga
- Official Pharmacist Association of Gipuzkoa, Prim 2, 20006 Donostia/San Sebastian, Spain
| | - Begoña Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, P. Universidad 7, 01006 Vitoria, Spain
| | - Estibaliz Goyenechea
- Official Pharmacist Association of Gipuzkoa, Prim 2, 20006 Donostia/San Sebastian, Spain
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Karsan Y, Anderson C, Boyd MJ, Thornley T. Exploring barriers to the sustainability of an electronic administration system in long-term care facilities: A case study approach. Res Social Adm Pharm 2020; 17:1066-1071. [PMID: 32878714 DOI: 10.1016/j.sapharm.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The safe provision of medicines administration is a fundamental challenge faced in long-term care facilities (LTCFs). Many residents of LTCFs are frail older persons with multiple morbidities, and in addition to polypharmacy, are particularly at risk of harm due to concomitant disease and disability. One potential method to optimise medication safety and facilitate medicines administration within LTCFs is the introduction of technology. OBJECTIVE This paper explores the barriers to long-term sustainability concerning the use of an electronic administration system (eMAR) in LTCFs. METHODS Fifteen in depth, semi-structured interviews were conducted with LTCF staff (9), eMAR service commissioners (2), members of the implementation team (2) and care home strategy managers (2) across three LTCF sites. The study participants were purposefully sampled and each interview audio-recorded, transcribed verbatim and analysed using Nvivo 11. In addition to interviews, observational notes were taken by the lead researcher from visits to the LCTFs as a form of data collection. The analysis process consisted of a two-stage process of thematic analysis then theoretical mapping. RESULTS Barriers identified were split into four main overarching areas: structural, implementation team, system user and operational barriers. The adoption of eMAR within this setting was welcomed by top-level stakeholders, however, LTCF staff displayed concerns over its usability. The lack of co-development and on-going training need highlighted barriers to its sustainability, in addition to risks associated with current legislation. The themes identified throughout the framework highlight challenges faced when exploring the sustainability of eMAR in LTCF. CONCLUSIONS The use of technology in health care is evolving. Awareness of actors relating to its introduction can have significant impact on success and service sustainability.
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Affiliation(s)
- Yasmin Karsan
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, East Drive, University Park, Nottingham, NG7 2RD, UK.
| | - Claire Anderson
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, East Drive, University Park, Nottingham, NG7 2RD, UK
| | - Matthew J Boyd
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, East Drive, University Park, Nottingham, NG7 2RD, UK
| | - Tracey Thornley
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, East Drive, University Park, Nottingham, NG7 2RD, UK; Boots UK, Nottingham, NG90 1BS, UK
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Behzadifar M, Martini M, Behzadifar M, Bakhtiari A, Bragazzi NL. The barriers to the full implementation of strategic purchasing and the role of health policy and decision-makers: past, current status, ethical aspects and future challenges. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E119-E124. [PMID: 32490277 PMCID: PMC7225644 DOI: 10.15167/2421-4248/jpmh2020.61.1.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022]
Abstract
Healthcare systems are complex, multi-level, highly integrated organizations, comprising of different professional figures, institutions, and resources. Such breadth and complexity reflect the multi-dimensionality of the concept of health, which implies the adoption of a holistic approach. Health, rather than merely being the absence of disorders or infirmity, is a highly dynamic state, which represents the abilities of an individual to cope with adverse social, physical and emotional/psychological events and conditions, continuously adapting to them. Ensuring an adequate health state is one of the most important concerns, and the healthcare systems are called to renew themselves in order to meet with the new challenges and health needs. Throughout the last decades, due to demographic shifts and transitions, epidemiological and societal changes, technological achievements and scientific advancements, healthcare systems have undergone an extensive series of reform plans. Therefore, health policy- and decision-makers have made efforts to develop and implement initiatives for preserving the quality of the healthcare provisions. Strategic purchasing is an approach of purchasing that takes into account several health-related issues such as a proper, comprehensive planning of service delivery, the design and selection of the best packages of services and provisions, the appropriate selection of providers and the allocation of economical and financial incentives to provide better services and to motivate managers to adopt appropriate policies to implement strategic purchasing. Here, we intend to consider the various dimensions and aspects that can be effective in strategic purchasing, as well as the main barriers and obstacles that hinder its full implementation.
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Affiliation(s)
- M Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - M Martini
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- UNESCO Chair, "Health Anthropology Biosphere and Healing Systems," University of Genoa, Italy
| | - M Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - A Bakhtiari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - N L Bragazzi
- UNESCO Chair, "Health Anthropology Biosphere and Healing Systems," University of Genoa, Italy
- Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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Yeh MJ. Discourse on the idea of sustainability: with policy implications for health and welfare reform. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:155-163. [PMID: 31858388 DOI: 10.1007/s11019-019-09937-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sustainability has become a major goal of domestic and international development. This essay analyzes the transitions of normative ideas embedded in the notion of sustainability by reviewing the discourses in the representative reports and literature from different periods. Three sets of ideas are proposed: inter- and intra-generational equity, stability of public systems, and a sense of solidarity, which confirms the scope of community and functions as a precondition for the previous two ideas. This essay uses the case of a health system in a hypothetical country to illustrate that, besides securing financial sustainability, a genuinely sustainable public system must also meet the three normative ideas of sustainability. This essay also finds that these three ideas may create intrinsic tensions within the prevalent policy-making model-democracy. The pursuit of sustainability is not only the responsibility of a democratic government, but also a shared moral obligation of the body politic.
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Affiliation(s)
- Ming-Jui Yeh
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
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Lloyd HM, Ekman I, Rogers HL, Raposo V, Melo P, Marinkovic VD, Buttigieg SC, Srulovici E, Lewandowski RA, Britten N. Supporting Innovative Person-Centred Care in Financially Constrained Environments: The WE CARE Exploratory Health Laboratory Evaluation Strategy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3050. [PMID: 32353939 PMCID: PMC7246834 DOI: 10.3390/ijerph17093050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 12/24/2022]
Abstract
The COST CARES project aims to support healthcare cost containment and improve healthcare quality across Europe by developing the research and development necessary for person-centred care (PCC) and health promotion. This paper presents an overview evaluation strategy for testing 'Exploratory Health Laboratories' to deliver these aims. Our strategy is theory driven and evidence based, and developed through a multi-disciplinary and European-wide team. Specifically, we define the key approach and essential criteria necessary to evaluate initial testing, and on-going large-scale implementation with a core set of accompanying methods (metrics, models, and measurements). This paper also outlines the enabling mechanisms that support the development of the "Health Labs" towards innovative models of ethically grounded and evidenced-based PCC.
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Affiliation(s)
- Helen M. Lloyd
- School of Psychology, University of Plymouth, Plymouth PL6 8BX, UK
| | - Inger Ekman
- Institute of Health and Care Sciences, Gothenburg University Centre for Person-Centred Care (GPCC), 405 30 Gothenburg, Sweden;
| | - Heather L. Rogers
- Biocruces Bizkaia Health Research Institute, Barakaldo, 48903 Bizkaia, Spain;
- IKERBASQUE, Basque Foundation for Science, Bilbao, 48013 Bizkaia, Spain
| | - Vítor Raposo
- Centre for Business and Economics Research (CeBER), Centre of Health Studies and Research of the University of Coimbra, Faculty of Economics, University of Coimbra, Av. Dr. Dias da Silva 165, 3004-512 Coimbra, Portugal;
| | - Paulo Melo
- Centre for Business and Economics Research, Faculty of Economics, INESC Coimbra, University of Coimbra, Av. Dr. Dias da Silva 165, 3004-512 Coimbra, Portugal;
| | - Valentina D. Marinkovic
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmaceutical Legislation, University of Belgrade, Vojvode Stepe 450, 11000 Belgrade, Serbia;
| | - Sandra C. Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, MSD2080 Msida, Malta;
| | - Einav Srulovici
- Department of Nursing, University of Haifa, Haifa 3498838, Israel;
| | | | - Nicky Britten
- Institute of Health Research, University of Exeter Medical School, St Luke’s Campus, Exeter EX1 2LU, UK;
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Dong H, Li Z, Failler P. The Impact of Business Cycle on Health Financing: Subsidized, Voluntary and Out-of-Pocket Health Spending. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061928. [PMID: 32188003 PMCID: PMC7143791 DOI: 10.3390/ijerph17061928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 11/23/2022]
Abstract
Diverse types of healthcare systems in countries offer opportunities to explore the heterogeneous sources of health financing. This paper widely explores the effect of the business cycle on subsidized, voluntary and out-of-pocket health spending in 34 countries with different types of healthcare systems, by the methodology of hierarchical linear modeling (HLM). We use a panel of annual data during the years from 2000 to 2016. It further examines the business cycle-health financing mechanism by inquiring into the mediating effect of external conditions and innovative health financing, based on the structural equation modeling (SEM). The empirical results reveal that the business cycle harms subsidized spending, whereas its effect on voluntary and protective health spending is positive. Results related to the SEM indicate that the mediating effect of external conditions on the relationship between the business cycle and health financing is negative. However, we find that the business cycle plays a positive effect on health financing through innovative health financing channels. Thus, designing and implementing efforts to shift innovative health financing have substantial effects on the sustainability of healthcare systems.
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Affiliation(s)
- Hao Dong
- School of Economics and Statistics, Guangzhou University, Guangzhou 510006, China;
| | - Zhenghui Li
- Guangzhou International Institute of Finance and Guangzhou University, Guangzhou 510006, China
- Correspondence: ; Tel.: 86-1335-285-7358
| | - Pierre Failler
- Economics and Finance Group, Portsmouth Business School, University of Portsmouth, Portsmouth PO1 3DE, UK;
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Were LPO, Were E, Wamai R, Hogan J, Galarraga O. Effects of social health insurance on access and utilization of obstetric health services: results from HIV+ pregnant women in Kenya. BMC Public Health 2020; 20:87. [PMID: 31959153 PMCID: PMC6971983 DOI: 10.1186/s12889-020-8186-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing maternal morbidity and mortality remains a top global health agenda especially in high HIV/AIDS endemic locations where there is increased likelihood of mother to child transmission (MTCT) of HIV. Social health insurance (SHI) has emerged as a viable option to improve population access to health services, while improving outcomes for disenfranchised populations, particularly HIV+ women. However, the effect of SHI on healthcare access for HIV+ persons in limited resource settings is yet to undergo rigorous empirical evaluation. This study analyzes the effect of health insurance on obstetric healthcare access including institutional delivery and skilled birth attendants for HIV+ pregnant women in Kenya. METHODS We analyzed cross-sectional data from HIV+ pregnant women (ages 15-49 years) who had a delivery (full term, preterm, miscarriage) between 2008 and 2013 with their insurance enrollment status available in the electronic medical records database of a HIV healthcare system in Kenya. We estimated linear and logistic regression models and implemented matching and inverse probability weighting (IPW) to improve balance on observable individual characteristics. Additionally, we estimated heterogeneous effects stratified by HIV disease severity (CD4 < 350 as "Severe HIV disease", and CD4 > 350 otherwise). FINDINGS Health Insurance enrollment is associated with improved obstetric health services utilization among HIV+ pregnant women in Kenya. Specifically, HIV+ pregnant women covered by NHIF have greater access to institutional delivery (12.5-percentage points difference) and skilled birth attendants (19-percentage points difference) compared to uninsured. Notably, the effect of NHIF on obstetric health service use is much greater for those who are sicker (CD4 < 350) - 20 percentage points difference. CONCLUSION This study confirms conceptual and practical considerations around health insurance and healthcare access for HIV+ persons. Further, it helps to inform relevant policy development for health insurance and HIV financing and delivery in Kenya and in similar countries in sub-Saharan Africa in the universal health coverage (UHC) era.
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Affiliation(s)
- Lawrence P O Were
- Department of Health Sciences, Boston University's College of Health and Rehabilitation Sciences: Sargent College, Boston, USA.
- School of Public Health, Brown University, Providence, RI, USA.
| | - Edwin Were
- Department of Reproductive Health, Moi University & AMPATH-Kenya, Eldoret, Kenya
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Northeastern University, Boston, MA, USA
| | - Joseph Hogan
- School of Public Health, Brown University, Providence, RI, USA
| | - Omar Galarraga
- School of Public Health, Brown University, Providence, RI, USA
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Foresight Based on MADM-Based Scenarios’ Approach: A Case about Comprehensive Sustainable Health Financing Models. Symmetry (Basel) 2019. [DOI: 10.3390/sym12010061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As indicated by a worldwide common perspective about health and sustainable health systems, the health structure as a part of public health is a key theme of many societies. The future is shaped by probable future scenarios, for which dealing practically has many complications. This study is focused on the future scenarios for a comprehensive sustainable health financing model to support a superior structure for a decision and policy-making pilot for the society. This aim is followed based on multiple attribute decision making (MADM)-based scenarios using two MADM methods, step-wise weight assessment ratio analysis (SWARA) and weighted aggregated sum product assessment (WASPAS), as a hybrid model which is the first real case study of the approach. Four main probable future scenarios are identified and selected based on experts’ viewpoints about sustainable health financing models. These scenarios include membership in the World Trade Organization (WTO), dynamic basic insurance, international cooperation, and effective resources management. The process of evaluating based on the approach works as a wider picture, including all criteria and alternatives together. Sustainable medical services, empowering the private sector in both production and technology, and employing international managers took place as the top priority for considering the most applicable alternatives in the future. This structure is designed and developed in Iran’s context, and the Institute for Futures Studies in Health is the pilot of the research.
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Lippi G, Plebani M. Integrated diagnostics: the future of laboratory medicine? Biochem Med (Zagreb) 2019; 30:010501. [PMID: 31839719 PMCID: PMC6904966 DOI: 10.11613/bm.2020.010501] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/12/2019] [Indexed: 01/01/2023] Open
Abstract
The current scenario of in vitro and in vivo diagnostics can be summarized using the “silo metaphor”, where laboratory medicine, pathology and radiology are three conceptually separated diagnostic disciplines, which will increasingly share many comparable features. The substantial progresses in our understanding of biochemical-biological interplays that characterize many human diseases, coupled with extraordinary technical advances, are now generating important multidisciplinary convergences, leading the way to a new frontier, called integrated diagnostics. This new discipline, which is currently defined as convergence of imaging, pathology and laboratory tests with advanced information technology, has an enormous potential for revolutionizing diagnosis and therapeutic management of human diseases, including those causing the largest number of worldwide deaths (i.e. cardiovascular disease, cancer and infectious diseases). However, some important drawbacks should be overcome, mostly represented by insufficient information technology infrastructures, costs and enormous volume of different information that will be integrated and delivered. To overcome these hurdles, some specific strategies should be defined and implemented, such as planning major integration of exiting information systems or developing innovative ones, combining bioinformatics and imaging informatics, using health technology assessment for assessing cost and benefits, providing interpretative comments in integrated reports, developing and using expert systems and neural networks, overcoming cultural and political boundaries for generating multidisciplinary teams and integrated diagnostic algorithms.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
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Gourab G, Khan MNM, Hasan AMR, Sarwar G, Irfan SD, Reza MM, Saha TK, Rahman L, Rana AKMM, Khan SI. The willingness to receive sexually transmitted infection services from public healthcare facilities among key populations at risk for human immunodeficiency virus infection in Bangladesh: A qualitative study. PLoS One 2019; 14:e0221637. [PMID: 31483809 PMCID: PMC6726367 DOI: 10.1371/journal.pone.0221637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 08/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background In Bangladesh, community-based and peer-led prevention interventions for human immunodeficiency virus infection are provided to key populations (KPs) by drop-in centers (DICs), which are primarily supported by external donors. This intervention approach was adopted because public healthcare facilities were reportedly insensitive to the needs and culture of KPs, particularly with regard to the provision of sexually transmitted infection (STI) services. Nonetheless, in the absence of external funding, STI services need to be integrated into public healthcare systems. Methods A qualitative study was conducted in 2017 to understand the willingness of KPs to uptake the STI services of public healthcare facilities. Data were collected based on 34 in-depth interviews, 11 focus group discussions, and 9 key informant interviews. The social-ecological theoretical framework was used to analyze the data thematically and contextually. Results Most participants were either resistant or reluctant to uptake STI services from public healthcare facilities because of their previous firsthand experiences (e.g., disrespectful and judgmental attitudes and behaviors), perceived discrimination, anticipatory fear, and a lack of privacy. Very few participants who had visited these facilities to receive STI services were motivated to revisit them. Nevertheless, they emphasized their comfort in DICs over public healthcare facilities. Thus, it appears that KPs can be situated along a care-seeking continuum (i.e., resistance to complete willingness). Unless policymakers understand the context and reasons that underlie their movement along this continuum, it would be difficult to encourage KPs to access STI services from public healthcare facilities. Conclusion KPs’ willingness to uptake the STI services of public healthcare facilities depends not only on individual and community experiences but also on the nexus between socio-structural factors and health inequalities. Community mobilization and training about the needs and culture of KPs for healthcare professionals are essential. Therefore, addressal of a wide range of structural factors is required to motivate KPs into seeking STI services from public healthcare facilities.
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Affiliation(s)
- Gorkey Gourab
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
- * E-mail:
| | | | - A. M. Rumayan Hasan
- Universal Health Coverage, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Golam Sarwar
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Md. Masud Reza
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Lima Rahman
- HIV/AIDS Program, Health, Nutrition and HIV/AIDS Sector, Save the Children, Dhaka, Bangladesh
| | - A. K. M. Masud Rana
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
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Less is more: ten reasons for considering to discontinue unproven interventions. Intensive Care Med 2019; 45:1626-1628. [PMID: 31435683 DOI: 10.1007/s00134-019-05740-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
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42
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Greaves RF, Bernardini S, Ferrari M, Fortina P, Gouget B, Gruson D, Lang T, Loh TP, Morris HA, Park JY, Roessler M, Yin P, Kricka LJ. Key questions about the future of laboratory medicine in the next decade of the 21st century: A report from the IFCC-Emerging Technologies Division. Clin Chim Acta 2019; 495:570-589. [DOI: 10.1016/j.cca.2019.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/21/2022]
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Jansen T, Verheij RA, Schellevis FG, Kunst AE. Use of out-of-hours primary care in affluent and deprived neighbourhoods during reforms in long-term care: an observational study from 2013 to 2016. BMJ Open 2019; 9:e026426. [PMID: 30872553 PMCID: PMC6429913 DOI: 10.1136/bmjopen-2018-026426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/11/2018] [Accepted: 01/21/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Major long-term care (LTC) reforms in the Netherlands in 2015 may specifically have disadvantaged socioeconomically deprived groups to acquire LTC, possibly impacting the use of acute care. We aimed to demonstrate whether LTC reforms coincided with changes in the use of out-of-hours (OOH) primary care services (PCSs), and to compare changes between deprived versus affluent neighbourhoods. DESIGN Ecological observational retrospective study using routinely recorded electronic health records data from 2013 to 2016 and population registry data. SETTING Data from 15 OOH PCSs participating in the Nivel Primary Care Database (covering approximately 6.5 million inhabitants) in the Netherlands. PCS utilisation data on neighbourhood level were matched with sociodemographic characteristics, including neighbourhood socioeconomic status (SES). PARTICIPANTS Electronic health records from 6 120 384 OOH PCS contacts in 2013-2016, aggregated to neighbourhood level. OUTCOME MEASURES AND ANALYSES Number of contacts per 1000 inhabitants/year (total, high/low-urgency, night/evening-weekend-holidays, telephone consultations/consultations/home visits).Multilevel linear regression models included neighbourhood (first level), nested within PCS catchment area (second level), to account for between-PCS variation, adjusted for neighbourhood characteristics (for instance: % men/women). Difference-in-difference in time-trends according to neighbourhood SES was assessed with addition of an interaction term to the analysis (year×neighbourhood SES). RESULTS Between 2013 and 2016, overall OOH PCS use increased by 6%. Significant increases were observed for high-urgency contacts and contacts during the night. The largest change was observed for the most deprived neighbourhoods (10% compared with 4%-6% in the other neighbourhoods; difference not statistically significant). The increasing trend in OOH PCS use developed practically similar for deprived and affluent neighbourhoods. A a stable gradient reflected more OOH PCS use for each lower stratum of SES. CONCLUSIONS LTC reforms coincided with an overall increase in OOH PCS use, with nearly similar trends for deprived and affluent neighbourhoods. The results suggest a generalised spill over to OOH PCS following LTC reforms.
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Affiliation(s)
- Tessa Jansen
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Robert A Verheij
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Francois G Schellevis
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute Amsterdam University Medical Centers | Location VUmc, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
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Behzadifar M, Bragazzi NL, Arab-Zozani M, Bakhtiari A, Behzadifar M, Beyranvand T, Yousefzadeh N, Azari S, Sajadi HS, Saki M, Saran M, Gorji HA. The challenges of implementation of clinical governance in Iran: a meta-synthesis of qualitative studies. Health Res Policy Syst 2019; 17:3. [PMID: 30626377 PMCID: PMC6327528 DOI: 10.1186/s12961-018-0399-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background Policy- and decision-makers seek to improve the quality of care in the health sector and therefore aim to improve quality through appropriate policies. Higher quality of care will satisfy service providers and the public, reduce costs, increase productivity, and lead to better organisational performance. Clinical governance is a method through which management can be improved and made more accountable, and leads to the provision of better quality of care. In November 2009, the Iranian Ministry of Health and Medical Education implemented new clinical guidelines to standardise and improve clinical services as well as to increase efficiency and reduce costs. The purpose of this study was to assess the challenges of implementing clinical governance through a meta-synthesis of qualitative studies published in Iran. Methods Ten databases, including ISI/Web of Sciences, PubMed/MEDLINE, Embase, PsycINFO, the Cochrane Library, CINAHL, Scopus, Barakatns, MagIran and the Scientific Information Database, were searched between January 2009 and May 2018. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. Thematic synthesis was used to analyse the data. Results Ten studies were selected and included based on the inclusion/exclusion criteria. In the first stage, 75 items emerged and were coded, and, following comparison and combination of the codes, 32 codes and 8 themes were finally extracted. These themes included health system structure, management, person-power, cultural factors, information and data, resources, education and evaluation. Conclusion The findings of the study showed that there exist a variety of challenges for the implementation of clinical governance in Iran. To successfully implement a health policy, its infrastructure needs to be created. Using the views and support of stakeholders can ensure that a policy is well implemented. Trial registration CRD42017079077. Dated October 10, 2017. Electronic supplementary material The online version of this article (10.1186/s12961-018-0399-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - Morteza Arab-Zozani
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahad Bakhtiari
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Behzadifar
- Department of Epidemiology, Faculty of Health & Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Tina Beyranvand
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Negar Yousefzadeh
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Samad Azari
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Haniye Sadat Sajadi
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mandana Saki
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Saran
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hasan Abolghasem Gorji
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Maranta F, Cianfanelli L, Regoni M, Cianflone D. Cardiologist and Diabetologist crosstalk in the era of cardiovascular outcome trials of novel glucose-lowering drugs. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2018; 21:80-86. [PMID: 30402533 PMCID: PMC6205052 DOI: 10.1016/j.ijcha.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/25/2018] [Accepted: 10/03/2018] [Indexed: 12/11/2022]
Abstract
The prevalence of type 2 diabetes continues to increase and cardiovascular (CV) diseases remain the leading cause of death in diabetic patients. Diabetologists and Cardiologists have to work together in order to provide the best management to these patients. After years of disappointing studies showing no reduction of CV events with strict glycaemic control, some of the novel glucose-lowering drugs (GLDs) seem to offer a new approach to tackle the problem, since the CV outcome trials (CVOTs-D) of liraglutide, semaglutide, empagliflozin and canagliflozin have demonstrated not only their CV safety but also their efficacy in the reduction of CV morbidity and mortality. Along with the initial enthusiasm, concerns have been raised about the economical sustainability of long-term therapies considering higher costs of new molecules relative to the traditional ones. As expenses in the medical field are on the rise, healthcare systems need to balance the positive impact of an intervention and its overall cost. This review is meant to offer the Cardiologists a different point of view on the positive influence of GLDs, in the light of the main trials in the CV fields they are familiar with. The purpose of this article is to critically review the magnitude of the CVOTs-D results by the analysis of their statistical determinants, to establish the extent of the GLDs positive impact on patients with both diabetes and CV disease. The analysis has been performed taking into account models and statistical determinants used in the main landmark cardiology trials. It is fundamental to translate the result of CVOTs-D in clinical practice: the interdisciplinary crosstalk between the Cardiologist and Diabetologist is of paramount importance in order to fully exploit the power of the new available pharmacological strategies.
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Affiliation(s)
- Francesco Maranta
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Via Olgettina 48/60, 20132 Milan, Italy
| | - Lorenzo Cianfanelli
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Via Olgettina 48/60, 20132 Milan, Italy
| | - Maria Regoni
- Neuropsychopharmacology Unit, Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 48/60, 20132 Milan, Italy
| | - Domenico Cianflone
- San Raffaele Vita-Salute University, Via Olgettina 58, 20132 Milan, Italy
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The Prevention of Corruption as an Unavoidable Way to Ensure Healthcare System Sustainability. SUSTAINABILITY 2018. [DOI: 10.3390/su10093071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Corruption has found very fertile ground in the health sector. Many studies demonstrate the negative relationship between sustainability and corruption. However, relatively little is known at this time about how to prevent corruption in healthcare organizations (HCOs), and thus to recover the important sustainability of the entire healthcare system. After noticing this gap in the literature, the authors’ aim in undertaking this study was twofold: first, to analyze the current state of knowledge about how Italian HCOs adopt corruption prevention plans in compliance with the National Plan issued by the National Anti-Corruption Authority; second, to identify some clusters of HCOs which represent different adoption patterns of corruption prevention interventions and to classify these HCOs. For these purposes, the authors studied 68 HCOs along 13 dimensions that characterized the corruption prevention plans. The empirical results showed that the HCOs were not fully compliant with the anti-corruption legislation. At the same time, the authors identified three clusters of HCOs with different patterns of anti-corruption prevention interventions. The clusters that adopted some specific interventions seemed to be more sustainable than others.
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Golinelli D, Bucci A, Toscano F, Filicori F, Fantini MP. Real and predicted mortality under health spending constraints in Italy: a time trend analysis through artificial neural networks. BMC Health Serv Res 2018; 18:671. [PMID: 30157828 PMCID: PMC6116437 DOI: 10.1186/s12913-018-3473-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/16/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND After 2008 global economic crisis, Italian governments progressively reduced public healthcare financing. Describing the time trend of health outcomes and health expenditure may be helpful for policy makers during the resources' allocation decision making process. The aim of this paper is to analyze the trend of mortality and health spending in Italy and to investigate their correlation in consideration of the funding constraints experienced by the Italian national health system (SSN). METHODS We conducted a 20-year time-series study. Secondary data has been extracted from a national, institution based and publicly accessible retrospective database periodically released by the Italian Institute of Statistics. Age standardized all-cause mortality rate (MR) and health spending (Directly Provided Services - DPS, Agreed-Upon Services - TAUS, and private expenditure) were reviewed. Time trend analysis (1995-2014) through OLS and Multilayer Feed-forward Neural Networks (MFNN) models to forecast mortality and spending trend was performed. The association between healthcare expenditure and MR was analyzed through a fixed effect regression model. We then repeated MFNN time trend forecasting analyses on mortality by adding the spending item resulted significantly related with MR in the fixed effect analyses. RESULTS DPS and TAUS decreased since 2011. There was a mismatch in mortality rates between real and predicted values. DPS resulted significantly associated to mortality (p < 0.05). In repeated mortality forecasting analysis, predicted MR was found to be lower when considering the pre-constraints health spending trend. CONCLUSIONS Between 2011 and 2014, Italian public health spending items showed a reduction when compared to prior years. Spending on services directly provided free of charge appears to be the financial driving force of the Italian public health system. The overall mortality was found to be higher than the predicted trend and this scenario may be partially attributable to the healthcare funding constraints experienced by the SSN.
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Affiliation(s)
- Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Bucci
- Department of Economics and Social Sciences, Marche Polytechnic University, Ancona, Italy
| | - Fabrizio Toscano
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, USA
| | - Filippo Filicori
- The Oregon Clinic, Division of Minimally Invasive Gastrointestinal Surgery, Portland, OR USA
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Golinelli D, Toscano F, Bucci A, Lenzi J, Fantini MP, Nante N, Messina G. Health Expenditure and All-Cause Mortality in the 'Galaxy' of Italian Regional Healthcare Systems: A 15-Year Panel Data Analysis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:773-783. [PMID: 28828741 DOI: 10.1007/s40258-017-0342-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The sustainability of healthcare systems is a topic of major interest. During periods of economic instability, policy makers typically reallocate resources and execute linear cuts in different areas of public spending, including healthcare. OBJECTIVES The aim of this paper was to examine whether and how per capita public healthcare expenditure (PHE) in the Italian regions was related to the all-cause mortality rate (MR) between 1999 and 2013 and to determine which expenditure item most affected mortality in the short and very short term. METHODS We conducted a pooled cross-sectional time series study. Secondary data were extracted from 'Health for All', a database released periodically by the Italian National Institute of Statistics. PHE is subdivided into directly provided services (DPS), pharmaceutical care, general practitioner care, specialist medical care, privately delivered hospital care, other privately delivered medical services, and psychiatric support and rehabilitation. We used a fixed-effects regression to assess the effects of PHE items on the MR after controlling for a number of socioeconomic and supply variables. RESULTS Higher spending on DPS was associated with a lower MR. Other expenditure variables were not significantly associated with the MR. CONCLUSIONS The results highlight the importance of medical services and goods provided directly by public services (i.e. hospital-based general and specialized wards and offices, emergency departments, etc.). DPS represents the driving force of the system and should be considered a determinant of the health of the Italian population. Our results suggest that the context and financing methods of a healthcare system should be carefully analysed before linear cuts are made or resources are reallocated.
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Affiliation(s)
- Davide Golinelli
- Post-Graduate School of Public Health, Department of Molecular and Developmental Medicine, University of Siena, Via A. Moro 2, 53100, Siena, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Fabrizio Toscano
- Post-Graduate School of Public Health, Department of Molecular and Developmental Medicine, University of Siena, Via A. Moro 2, 53100, Siena, Italy.
| | - Andrea Bucci
- Department of Economics and Social Sciences, Marche Polytechnic University, Ancona, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Nicola Nante
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Gabriele Messina
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Smigorowsky MJ, Norris CM, McMurtry MS, Tsuyuki RT. Measuring the effect of nurse practitioner (NP)-led care on health-related quality of life in adult patients with atrial fibrillation: study protocol for a randomized controlled trial. Trials 2017; 18:364. [PMID: 28774317 PMCID: PMC5543536 DOI: 10.1186/s13063-017-2111-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia associated with significant morbidity, mortality, and healthcare resource use. The prevalence of AF is increasing with a growing and aging population, and timely access to care for these patients is a concern. Nontraditional models of care delivery, such as nurse practitioner (NP)-led clinics, may improve access to care and quality of care, but they require formal assessment. The objective of this study is to assess the effect of NP-led care on the health-related quality of life (HRQoL) of adult patients with AF. METHODS/DESIGN We plan a randomized controlled trial comparing NP-led care vs. standard care. Inclusion criteria are ≥18 years of age, documented nonvalvular AF, willingness to give informed consent, and capacity to complete questionnaires. Patients referred for electrophysiological intervention who are clinically unstable or unable to attend follow-up visits will not be eligible to participate. Patients will be asked for verbal consent during the initial triage phone call from the nurse. Randomization will occur via a secure website. The intervention includes an NP consult, including medical history, physical examination, patient teaching, treatment plan, and follow-up at 3 and 6 months. The control arm involves usual cardiologist consultation with follow-up determined by the cardiologist's practice pattern. The primary outcome will be the difference in change in Atrial Fibrillation Effect on Quality of Life Survey scores at 6 months between groups. Secondary outcomes will include difference in change of EQ-5D scores at 6 months between groups, difference in composite outcomes of death resulting from cardiovascular cause, hospitalizations and emergency department visits between groups, and satisfaction with NP-led care measured by the Consultant Satisfaction Questionnaire. A sample size of 70 per group will ensure adequate power despite a potential 10% loss to follow-up. DISCUSSION Our study will determine the effect of NP-led AF care on HRQoL in patients with AF, as well as measure its impact on relevant outcomes such as death, hospitalization, and emergency department visits. Our findings may have implications for delivery of care to patients with AF. TRIAL REGISTRATION ClincalTrials.gov, NCT02745236 . Registered on 16 April 2016.
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Affiliation(s)
- Marcie J Smigorowsky
- Mazankowski Alberta Heart Institute, 2C2, WMC, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, 4-127, Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Micheal Sean McMurtry
- Division of Cardiology, University of Alberta, 2C2, WMC, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Ross T Tsuyuki
- Faculty of Medicine and Dentistry, EPICORE Centre, University of Alberta, 362 Heritage Medical Research Centre, Edmonton, AB, T6G 2S2, Canada.
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