1
|
Etemadi M, Hajizadeh M. User fee removal for the poor: a qualitative study to explore policies for social health assistance in Iran. BMC Health Serv Res 2022; 22:250. [PMID: 35209902 PMCID: PMC8867763 DOI: 10.1186/s12913-022-07629-8] [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: 06/27/2021] [Accepted: 02/14/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Removal of user fee for vulnerable people reduces the financial barriers associated with healthcare payments, which, in turn, improves health outcomes and promotes health equity. This study sought to provide policy strategies to reduce user fee at the point of service delivery for the poor in Iran. Methods This is a qualitative study carried out in 2018. The purposive sampling method was applied, and 33 experts with relevant and valuable experiences and maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were used to assure the quality of the results. The data were analyzed based on thematic analysis using the MAXQDA10 software. Results The most important issue regarding financial protection against user fee for the poor in Iran is policy integration and cohesion. Differences in access to financial support for user fee coverage among different groups of the poor have led to inequalities in access and financial protection among the poor. The suggested protection policies against the user fee at the point of service delivery in Iran can be categorized into three main categories: 1) basic health social insurance instruments, 2) free health services to the poor outside of the health insurance system, and 3) complementary insurance mechanisms. Conclusion Implementing a cohesive social assistance policy for all disadvantaged groups is needed to address inequalities in financial protection against user fee payment among the poor in Iran. Reducing user fee through mechanisms such as deductible cap, stop-loss, variable user fee and sliding fee scale can improve financial protection and enhance healthcare utilization among the poor. A user fee exemption is not enough to remove barriers to access to service for the poor, as other costs such as transportation expenditures and informal payments also put financial pressure on them. Therefore, financial support for the poor should be designed in a comprehensive protection package to reduce out-of-pocket payments for healthcare services, and indirect costs associated with healthcare utilization.
Collapse
Affiliation(s)
- Manal Etemadi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| |
Collapse
|
2
|
Demirtas B, Polat G, Özalp Ateş FS, Ka'opua LS. Poverty and health inequalities: Perceptions of social work students and nursing students. Int Nurs Rev 2021; 69:96-105. [PMID: 34547107 DOI: 10.1111/inr.12714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/23/2021] [Indexed: 01/16/2023]
Abstract
AIM This study describes student perceptions on health inequalities and causes of poverty. BACKGROUND As frontline providers, social workers and nurses are expected to engage with patients from socioeconomically diverse backgrounds. METHODS In this cross-sectional study, a socio-demographic questionnaire, a questionnaire on health inequalities and the Perceived Causes of Poverty Scale were administered using a convenience sample of 155 students in social work and 266 students in nursing undergraduate programmes at a state university in Turkey. Mann-Whitney U test and Spearman correlation coefficient were used in the analysis of the data. FINDINGS Social work students were more likely to attribute the cause of poverty to social injustice and a lack of opportunities, whereas nursing students had more fatalistic explanations or beliefs, maintaining that outcomes are pre-determined and therefore cannot be changed. In both groups, those who agreed that there were problems and deficiencies in health service provision and that there was ill-health among poor groups were more likely to associate poverty with social injustice and lack of opportunities. Those without a systemic understanding of poverty and health inequalities showed a tendency to hold more individualistic/fate-related perspectives. CONCLUSION AND IMPLICATIONS FOR NURSING AND EDUCATION POLICY The nursing students, as compared to the social work students, tended to explain poverty more on the basis of individual responsibility and fatalism and were less likely to link poverty with health inequalities and to advocate for policies to end health inequalities. The students' perceptions on the causes of poverty affected their views on health inequalities. These findings suggest the need to develop curricula that equip nursing students with an understanding of poverty as a systemic cause of health inequality. Health inequality and poverty need to be positioned at the centre of training curricula by professional accreditation bodies. Interdisciplinary collaboration is recommended to foster advocacy skills in students. Furthermore, transformative changes are needed in nursing and social work education to prepare students to adequately address the Social Determinants of Health. Curricula should incorporate leadership and political activism within courses to facilitate structural change.
Collapse
Affiliation(s)
- Basak Demirtas
- Faculty of Nursing, Nursing Department, Ankara University, Ankara, Turkey
| | - Gonca Polat
- Faculty of Health Sciences, Department of Social Work, Ankara University, Ankara, Turkey
| | - Funda Seher Özalp Ateş
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Manisa Celal Bayar University, Manisa, Turkey
| | - Lana Sue Ka'opua
- University of Hawai'i, Myron B Thompson School of Social Work, Manoa, Hawaii, USA
| |
Collapse
|
3
|
Medina-Marino A, de Vos L, Bezuidenhout D, Denkinger CM, Schumacher SG, Shin SS, Stevens W, Theron G, van der Walt M, Daniels J. "I got tested at home, the help came to me": acceptability and feasibility of home-based TB testing of household contacts using portable molecular diagnostics in South Africa. Trop Med Int Health 2021; 26:343-354. [PMID: 33289194 DOI: 10.1111/tmi.13533] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The effectiveness of household contact investigations is limited by low referral uptake for clinic-based TB testing by symptomatic household contacts. We qualitatively investigated the acceptability and perceived benefits of home-based TB testing using a portable GeneXpert-I instrument (GX-I) in an urban South African township. METHODS In-depth interviews were conducted with household contacts tested and those that observed testing. Semi-structured interviews explored household contact's understanding of TB, perceptions of the GX-I device and testing procedures, confidentiality, willingness to refer others, and views on home- vs. clinic-based testing. Focus group discussions with home-based TB testing implementing staff assessed operational considerations for scale-up. Data were analysed using a constant comparison approach to qualitatively evaluate the acceptability and feasibility of home-based TB testing. RESULTS Thirty in-depth interviews and two focus group discussions were conducted. Observing one's own sputum being tested resulted in an emergent trust in home-based TB testing, the GX-I device and one's test results. Home-based TB testing was considered convenient, helped to overcome apathy towards testing and mitigated barriers to clinic-based testing. Perceptions that home-based TB testing contributes to improved household and community health resulted in an emergent theme of alleviation of health insecurities. Operational concerns regarding inadvertent disclosure of one's diagnosis to household members and time spent in people's homes were identified. CONCLUSIONS Home-based TB testing was acceptable and feasible. Individuals expressed belief in the machine by being able to witness the testing process. Though most themes mirrored qualitative studies of home-based HIV testing, the alleviation of health insecurities theme is unique to home-based TB testing. Future research must evaluate the impact of home-based TB testing on case finding yield, time-to-treatment initiation and household outcomes.
Collapse
Affiliation(s)
- Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, East London, South Africa.,Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lindsey de Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Dana Bezuidenhout
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Claudia M Denkinger
- Foundation for Innovative New Diagnostics, Geneva, Switzerland.,Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sanghyuk S Shin
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | - Wendy Stevens
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | | | - Joseph Daniels
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| |
Collapse
|
4
|
Schröders J, Dewi FST, Nilsson M, Nichter M, Sebastian MS. Effects of social network diversity in the disablement process: a comparison of causal inference methods and an outcome-wide approach to the Indonesian Family Life Surveys, 2007-2015. Int J Equity Health 2020; 19:128. [PMID: 32736632 PMCID: PMC7393827 DOI: 10.1186/s12939-020-01238-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social networks (SN) have been proven to be instrumental for healthy aging and function as important safety nets, particular for older adults in low and middle-income countries (LMICs). Despite the importance of interpreting health outcomes in terms of SN, in many LMICs - including Indonesia - epidemiological studies and policy responses on the health effects of SN for aging populations are still uncommon. Using outcome-wide multi-method approaches to longitudinal panel data, this study aims to outline more clearly the role of SN diversity in the aging process in Indonesia. We explore whether and to what degree there is an association of SN diversity with adult health outcomes and investigate potential gender differences, heterogeneous treatment effects, and effect gradients along disablement processes. METHODS Data came from the fourth and fifth waves of the Indonesian Family Life Survey fielded in 2007-08 and 2014-15. The analytic sample consisted of 3060 adults aged 50+ years. The primary exposure variable was the diversity of respondents' SN at baseline. This was measured through a social network index (SNI), conjoining information about household size together with a range of social ties with whom respondents had active contact across six different types of role relationships. Guided by the disablement process model, a battery of 19 outcomes (8 pathologies, 5 impairments, 4 functional limitations, 2 disabilities) were included into analyses. Evidence for causal effects of SN diversity on health was evaluated using outcome-wide multivariable regression adjustment (RA), propensity score matching (PSM), and instrumental variable (IV) analyses. RESULTS At baseline, 60% of respondents had a low SNI. Results from the RA and PSM models showed greatest concordance and that among women a diverse SN was positively associated with pulmonary outcomes and upper and lower body functions. Both men and women with a high SNI reported less limitations in performing activities of daily living (ADL) and instrumental ADL (IADL) tasks. A high SNI was negatively associated with C-reactive protein levels in women. The IV analyses yielded positive associations with cognitive functions for both men and women. CONCLUSIONS Diverse SN confer a wide range of strong and heterogeneous long-term health effects, particularly for older women. In settings with limited formal welfare protection, intervening in the SN of older adults and safeguarding their access to diverse networks can be an investment in population health, with manifold implications for health and public policy.
Collapse
Affiliation(s)
- Julia Schröders
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Fatwa Sari Tetra Dewi
- Department of Health Behaviour, Environment and Social Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Maria Nilsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Mark Nichter
- School of Anthropology, University of Arizona, Tucson, AZ, USA
| | | |
Collapse
|
5
|
Qiu M, Jessani N, Bennett S. Identifying health policy and systems research priorities for the sustainable development goals: social protection for health. Int J Equity Health 2018; 17:155. [PMID: 30261882 PMCID: PMC6161373 DOI: 10.1186/s12939-018-0868-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an established body of evidence linking systems of social protection to health systems and health outcomes. The Sustainable Development Goals (SDGs) provide further emphasis on this linkage as necessary to achieving health and non-health goals. Existing literature on social protection and health has focused primarily on cash transfers. We sought to identify potential research priorities concerning social protection and health in low and middle-income countries, from multiple perspectives. METHODS Priority research questions were identified through two sources: 1) research reviews on social protection interventions and health, 2) interviews with 54 policy makers from Ministries of Health, multi-lateral or bilateral organizations, and NGOs. Data was collated and summarized using a framework analysis approach. The final refining and ranking of the questions was completed by researchers from around the globe through an online platform. RESULTS The overview of reviews identified 5 main categories of social protection interventions: cash transfers; financial incentives and other demand side financing interventions; food aid and nutritional interventions; parental leave; and livelihood/social welfare interventions. Policy-makers focused on the implementation and practice of social protection and health, how social protection programs could be integrated with other sectors, and how they should be monitored/evaluated. A collated list resulted in 31 priority research questions. Scale and sustainability of social protection programs ranked highest. The top 10 research questions focused heavily on design, implementation, and context, with a range of interventions that included cash transfers, social insurance, and labor market interventions. CONCLUSIONS There is potentially a rich field of enquiry into the linkages between health systems and social protection programs, but research within this field has focused on a few relatively narrowly defined areas. The SDGs provide an impetus to the expansion of research of this nature, with priority setting exercises such as this helping to align funder investment with researcher effort and policy-maker evidence needs.
Collapse
Affiliation(s)
- Mary Qiu
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA. .,, Washington, 20010, USA.
| | - Nasreen Jessani
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| |
Collapse
|