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Xie Z, Chen S, He C, Cao Y, Du Y, Yi L, Wu X, Wang Z, Yang Z, Wang P. Trends and age-period-cohort effect on the incidence of falls from 1990 to 2019 in BRICS. Heliyon 2024; 10:e26771. [PMID: 38434415 PMCID: PMC10907765 DOI: 10.1016/j.heliyon.2024.e26771] [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: 10/05/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Background The increasing burden of falls in BRICS countries warrants a comprehensive investigation to understand the dynamics and trends. This study utilized data from the Global Burden of Disease Study (GBD) 2019 to assess fall incidence rates in Brazil, Russia, India, China, and South Africa (BRICS) to provide valuable insights for the development of targeted prevention and management strategies. Methods Data from the GBD 2019 were employed to estimate fall incidence rates. The study utilized age-period-cohort (APC) model analysis, implemented using R 4.3.0 software and the R package apc, to examine fall incidence trends from 1990 to 2019. Results In 2019, the BRICS nations collectively reported 32.32 million fall cases. The overall fall incidence rate increased from 2681.7 per 100,000 people in 1990-2896.3 per 100,000 people in 2019. China and India exhibited escalating trends, with China experiencing the highest growth rate at 21%, followed by India at 5.8%. South Africa displayed a comparatively lower overall incidence rate increase. Notably, the 90-94 age group in China exhibited the most significant deterioration, with men and women experiencing annual increases of 4.23% and 1.77%, respectively. Age effects indicated a higher susceptibility to falls among preschool children and the elderly. Period effects revealed no improvement in the fall state for India (2005-2019) and China (2015-2019). Cohort effects adversely impacted the incidence rate for individuals born earlier in South Africa. Conclusion The present study highlights a consistent upward trend in fall incidence rates across BRICS countries from 1990 to 2019. With an aging population, the burden of fall-related diseases is on the rise in these nations. Our results underscore the necessity of formulating evidence-based disease prevention and management approaches tailored to the distinctive demographic attributes of each nation. Addressing these trends is crucial for mitigating the growing impact of falls on public health in BRICS countries.
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Affiliation(s)
- Zhiqin Xie
- Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330052, China
| | - Shihan Chen
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Chaozhu He
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Ying Cao
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Yunyu Du
- Department of Thoracic Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330052, China
| | - Linxia Yi
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Xiuqiang Wu
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Zequan Wang
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Zhen Yang
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Pinghong Wang
- Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
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Chen J, Zhu Y, Li Z, Chen X, Chen X, Xie R, Zhang Y, Ye G, Luo R, Shen X, Lin L, Zhuo Y. Temporal trends and projection of blindness and vision loss prevalence in older adults in BRICS countries. J Am Geriatr Soc 2024; 72:544-550. [PMID: 37960928 DOI: 10.1111/jgs.18672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Blindness and vision loss (BVL) is a major global health issue affecting older adults, but its burden in transition countries has received limited attention. Therefore, we aimed to assess the trends in the burden of BVL among older adults between 1990 and 2019 across Brazil, Russia, India, China, and South Africa (BRICS), and predict the burden by 2040. METHODS Data on BVL and its related causes were obtained from the Global Burden of Disease 2019 study. We investigated the temporal trends by calculating the average annual percentage change using joinpoint regression analysis. Subsequently, we performed Bayesian age-period-cohort modeling to estimate the burden of BVL and its related causes by 2040. RESULTS Most BRICS countries experienced a significant decline (p < 0.05) in age-standardized prevalence rates, and the decreasing trends tend to continue. However, by 2040, the number of BVL cases is expected to increase by approximately 50% across BRICS, with an estimated approximately 192, 170, 25, 17, and 7 million cases in China, India, Russia, Brazil, and South Africa, respectively. The related ranks of BVL causes are also estimated to change in the future, particularly in India. CONCLUSIONS The different burdens and trends of BVL across BRICS reflected the different stages of population health transition. Effective eye disease prevention requires appropriate public health interventions. Developing effective health policies and services for older adults is urgently needed in BRICS countries.
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Affiliation(s)
- Jianqi Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xuhao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaohong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Rui Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yuan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Guitong Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Ruiyu Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xinyue Shen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Lifeng Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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Zhang F, Cui Y, Gao X. Time trends in the burden of autoimmune diseases across the BRICS: an age-period-cohort analysis for the GBD 2019. RMD Open 2023; 9:e003650. [PMID: 38056916 DOI: 10.1136/rmdopen-2023-003650] [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: 08/30/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND This study aims to evaluate the long-term trend of prevalence and DALY (disability-adjusted life-year) rate on the age, period and cohort (APC) of the BRICS (Brazil, Russia, India, China and South Africa) country for autoimmune diseases (rheumatoid arthritis (RA), inflammatory bowel disease (IBD), multiple sclerosis (MS) and psoriasis). METHODS The data are sourced from the Global Burden of Disease Study 2019, and it uses the Joinpoint regression model to estimate the time trends of autoimmune diseases from 1990 to 2019. Additionally, it employs the Age-Period-Cohort (APC) model to estimate the age, period, and cohort effects from 1990 to 2019. RESULTS For 1990 to 2019, the ASPR (age-standardised prevalence rate) of IBD increased significantly for China and South Africa, and decreased significantly for Brazil, India, Russian. The Russian ASPR of MS demonstrated a significantly decreasing trend (average annual percent change=-0.5%, 95% CI -0.6 to -0.5), with the most increased occurring in Brazil at 2009-2014. The cohort effect on DALY rates for Psoriasis displayed an ongoing decreasing trend from the 1929-1933 birth cohort to the 1999-2003 birth cohort. Specifically, the five countries relative risk values (RRs) of DALYs due to RA increased significantly by 7.98, 16.07, 5.98, 3.19, 9.13 times, from 20 to 24 age group to 65 to 69 age group. CONCLUSIONS The population of the BRICS countries accounts for more than 40% of the global population. And we found that the age effect of various autoimmune diseases is heavily influenced by population ageing.
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Affiliation(s)
- Fenghao Zhang
- Department of Neonatology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Yiran Cui
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South university, Changsha, China
| | - Xiao Gao
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan, China
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Clarke D, Appleford G, Cocozza A, Thabet A, Bloom G. The governance behaviours: a proposed approach for the alignment of the public and private sectors for better health outcomes. BMJ Glob Health 2023; 8:e012528. [PMID: 38084487 PMCID: PMC10711895 DOI: 10.1136/bmjgh-2023-012528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/29/2023] [Indexed: 12/18/2023] Open
Abstract
Health systems are 'the ensemble of all public and private organisations, institutions and resources mandated to improve, maintain or restore health.' The private sector forms a major part of healthcare practice in many health systems providing a wide range of health goods and services, with significant growth across low-income and middle-income countries. WHO sees building stronger and more effective health systems through the participation and engagement of all health stakeholders as the pathway to further reducing the burden of disease and meeting health targets and the Sustainable Development Goals. However, there are governance and public policy gaps when it comes to interaction or engagement with the private sector, and therefore, some governments have lost contact with a major area of healthcare practice. As a result, market forces rather than public policy shape private sector activities with follow-on effects for system performance. While the problem is well described, proposed normative solutions are difficult to apply at country level to translate policy intentions into action. In 2020, WHO adopted a strategy report which argued for a major shift in approach to engage the private sector based on the performance of six governance behaviours. These are a practice-based approach to governance and draw on earlier work from Travis et al on health system stewardship subfunctions. This paper elaborates on the governance behaviours and explains their application as a practice approach for strengthening the capacity of governments to work with the private sector to achieve public policy goals.
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Affiliation(s)
- David Clarke
- Special Programme on Primary Health Care, World Health Organization, Geneve, Switzerland
| | - Gabrielle Appleford
- Special Programme on Primary Health Care, World Health Organization, Geneve, Switzerland
| | - Anna Cocozza
- Special Programme on Primary Health Care, World Health Organization, Geneve, Switzerland
| | - Aya Thabet
- Special Programme on Primary Health Care, World Health Organization, Geneve, Switzerland
- Health Systems, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Gerald Bloom
- Health and Nutrition Cluster, Institute of Development Study, Brighton, UK
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Liu Z, Wang Z, Xu M, Ma J, Sun Y, Huang Y. The priority areas and possible pathways for health cooperation in BRICS countries. Glob Health Res Policy 2023; 8:36. [PMID: 37641146 PMCID: PMC10464194 DOI: 10.1186/s41256-023-00318-x] [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: 02/20/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
As one of the largest alliances of middle-income countries, the BRICS, known as an acronym for five countries including "Brazil, Russia, India, China, and South Africa", represents half of the global population. The health cooperation among BRICS countries will benefit their populations and other middle- and low-income countries. This study aims to summarize the current status of health cooperation in BRICS countries and identify opportunities to strengthen BRICS participation in global health governance. A literature review was conducted to analyze the status, progress, and challenges of BRICS' health cooperation. Content analysis was used to review the 2011-2021 annual joint declarations of the BRICS Health Ministers Meetings. The priority health areas were identified through segmental frequency analysis. Our research suggested that communicable diseases, access to medicine, and universal health coverage appeared most frequently in the content of declarations, indicating the possible top health priorities among BRICS' health collaboration. These priority areas align with the primary health challenges of each country, including the threats of double burden of diseases, as well as the need for improving health systems and access to medicines. Respective external cooperation, inter-BRICS health cooperation, and unified external cooperation are the main forms of health cooperation among BRICS countries. However, challenges such as the lack of a unified image and precise position, lack of practical impact, and weak discourse power have impeded the impact of BRICS on health governance. This study suggests that the BRICS countries should recognize their positioning, improve their unified image, and establish cooperative entities; at the same time, they should increase their practical strength, promote non-governmental cooperation, and expand the cooperation space through the "BRICS Plus" mechanism with countries with similar interests to join.
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Affiliation(s)
- Zuokun Liu
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Zongbin Wang
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Ming Xu
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Jiyan Ma
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Yinuo Sun
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Yangmu Huang
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
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Sahoo PM, Rout HS, Jakovljevic M. Future health expenditure in the BRICS countries: a forecasting analysis for 2035. Global Health 2023; 19:49. [PMID: 37434257 DOI: 10.1186/s12992-023-00947-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Accelerated globalization especially in the late 1980s has provided opportunities for economic progress in the world of emerging economies. The BRICS nations' economies are distinguishable from other emerging economies due to their rate of expansion and sheer size. As a result of their economic prosperity, health spending in the BRICS countries has been increasing. However, health security is still a distant dream in these countries due to low public health spending, lack of pre-paid health coverage, and heavy out-of-pocket spending. There is a need for changing the health expenditure composition to address the challenge of regressive health spending and ensure equitable access to comprehensive healthcare services. OBJECTIVE Present study examined the health expenditure trend among the BRICS from 2000 to 2019 and made predictions with an emphasis on public, pre-paid, and out-of-pocket expenditures for 2035. METHODS Health expenditure data for 2000-2019 were taken from the OECD iLibrary database. The exponential smoothing model in R software (ets ()) was used for forecasting. RESULTS Except for India and Brazil, all of the BRICS countries show a long-term increase in per capita PPP health expenditure. Only India's health expenditure is expected to decrease as a share of GDP after the completion of the SDG years. China accounts for the steepest rise in per capita expenditure until 2035, while Russia is expected to achieve the highest absolute values. CONCLUSION The BRICS countries have the potential to be important leaders in a variety of social policies such as health. Each BRICS country has set a national pledge to the right to health and is working on health system reforms to achieve universal health coverage (UHC). The estimations of future health expenditures by these emerging market powers should help policymakers decide how to allocate resources to achieve this goal.
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Affiliation(s)
| | - Himanshu Sekhar Rout
- Department of Analytical and Applied Economics & Co-Coordinator, RUSA Centre of Excellence in Public Policy and Governance, Utkal University, Vani Vihar, Odisha, 751 004, 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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M. V. MK, Sastry NKB, Moonesar IA, Rao A. Predicting Universal Healthcare Through Health Financial Management for Sustainable Development in BRICS, GCC, and AUKUS Economic Blocks. Front Artif Intell 2022; 5:887225. [PMID: 35573900 PMCID: PMC9100561 DOI: 10.3389/frai.2022.887225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
The majority of the world's population is still facing difficulties in getting access to primary healthcare facilities. Universal health coverage (UHC) proposes access to high-quality, affordable primary healthcare for all. The 17 UN sustainable development goals (SDGs) are expected to be executed and achieved by all the 193 countries through national sustainable development strategies and multi-stakeholder partnerships. This article addresses SDG 3.8—access to good quality and affordable healthcare and two subindicators related to societal impact (SDG 3.8.1 and 3.8.2) through two objectives. The first objective is to determine whether health expenditure indicators (HEIs) drive UHC, and the second objective is to analyze the importance of key determinants and their interactions with UHC in three economic blocks: emerging Gulf Cooperation Council (GCC); developing Brazil, Russia, India, China, and South Africa (BRICS) vis-à-vis the developed Australia, UK, and USA (AUKUS). We use the WHO Global Health Indicator database and UHC periodical surveys to evaluate the hypotheses. We apply state-of-the-art machine learning (ML) models and ordinary least square (traditional—OLS regression) methods to see the superiority of artificial intelligence (AI) over traditional ones. The ML Random Forest Tree method is found to be superior to the OLS model in terms of lower root mean square error (RMSE). The ML results indicate that domestic private health expenditure (PVT-D), out-of-pocket expenditure (OOPS) per Capita in US dollars, and voluntary health insurance (VHI) as a percentage of current health expenditure (CHE) are the key factors influencing UHC across the three economic blocks. Our findings have implications for drafting health and finance sector public policies, such as providing affordable social health insurance to the weaker sections of the population, making insurance premiums less expensive and affordable for the masses, and designing healthcare financing policies that are beneficial to the masses. UHC is an important determinant of health for all and requires an in-depth analysis of related factors. Policymakers are often faced with the challenge of prioritizing the economic needs of sectors such as education and food safety, making it difficult for healthcare to receive its due share. In this context, this article attempts to identify the key components that may influence the attainment of UHC and enable policy changes to address them more effectively and efficiently.
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Affiliation(s)
- Manoj Kumar M. V.
- Department of Information Science and Engineering, Nitte Meenakshi Institute of Technology, Bangalore, India
- *Correspondence: Manoj Kumar M. V.
| | | | - Immanuel Azaad Moonesar
- Health Administration & Policy, Mohammed Bin Rashid School of Government, Dubai, United Arab Emirates
- Immanuel Azaad Moonesar
| | - Ananth Rao
- Dubai Business School, University of Dubai, Dubai, United Arab Emirates
- Ananth Rao
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Bai J, Zhao Y, Yang D, Ma Y, Yu C. Secular trends in chronic respiratory diseases mortality in Brazil, Russia, China, and South Africa: a comparative study across main BRICS countries from 1990 to 2019. BMC Public Health 2022; 22:91. [PMID: 35027030 PMCID: PMC8759233 DOI: 10.1186/s12889-021-12484-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background As the emerging economies, the BRICS (Brazil, Russia, India, China, and South Africa) shared 61.58% of the global chronic respiratory diseases (CRD) deaths in 2017. This study aimed to assess the secular trends in CRD mortality and explore the effects of age, period, and cohort across main BRICS countries. Methods Data were obtained from the Global Burden of Disease Study (GBD) 2019 and analyzed using the age-period-cohort (APC) model to estimate period and cohort effects between 1990 and 2019. The net drifts, local drifts, longitudinal age curves, period/cohort rate ratios (RRs) were obtained through the APC model. Results In 2019, the CRD deaths across the BRICS were 2.39 (95%UI 1.95 to 2.84) million, accounting for 60.07% of global CRD deaths. Chronic obstructive pulmonary disease (COPD) and asthma remained the leading causes of CRD deaths. The age-standardized mortality rates (ASMR) have declined across the BRICS since 1990, with the most apparent decline in China. Meanwhile, the downward trends in CRD death counts were observed in China and Russia. The overall net drifts per year were obvious in China (-5.89%; -6.06% to -5.71%), and the local drift values were all below zero in all age groups for both sexes. The age effect of CRD presented increase with age, and the period and cohort RRs were following downward trends over time across countries. Similar trends were observed in COPD and asthma. The improvement of CRD mortality was the most obvious in China, especially in period and cohort effects. While South Africa showed the most rapid increase with age across all CRD categories, and the period and cohort effects were flat. Conclusions BRICS accounted for a large proportion of CRD deaths, with China and India alone contributing more than half of the global CRD deaths. However, the declines in ASMR and improvements of period and cohort effects have been observed in both sexes and all age groups across main BRICS countries. China stands out for its remarkable reduction in CRD mortality and its experience may help reduce the burden of CRD in developing countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12484-z.
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Affiliation(s)
- Jianjun Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185# Donghu Road, 430072, Wuhan, China
| | - Yudi Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185# Donghu Road, 430072, Wuhan, China
| | - Donghui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185# Donghu Road, 430072, Wuhan, China
| | - Yudiyang Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185# Donghu Road, 430072, Wuhan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185# Donghu Road, 430072, Wuhan, China. .,Global Health Institute, Wuhan University, 185# Donghu Road, 430072, Wuhan, China.
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Derakhshani N, Doshmangir L, Ahmadi A, Fakhri A, Sadeghi-Bazargani H, Gordeev VS. Monitoring Process Barriers and Enablers Towards Universal Health Coverage Within the Sustainable Development Goals: A Systematic Review and Content Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:459-472. [PMID: 32922051 PMCID: PMC7457838 DOI: 10.2147/ceor.s254946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study builds on previous successes of using tracer indicators in tracking progress towards Universal Health Coverage (UHC) and complements them by offering a more detailed tool that would allow us to identify potential process barriers and enablers towards such progress. PURPOSE This tool was designed accounting for possibly available data in low- and middle-income counties. METHODOLOGY A systematic review of relevant studies was carried out using PubMed, ISI Web of Science, Embase, Scopus, and ProQuest databases with no time restriction. The search was complemented by a scoping review of grey literature, using the World Bank and the World Health Organization (WHO) official reports depositories. Next, an inductive content analysis identified determinants influencing the progress towards UHC and its relevant indicators. The conceptual proximity between indicators and categorized themes was explored through three focus group discussion with 18 experts in UHC. Finally, a comprehensive list of indicators was converted into an assessment tool and refined following three consecutive expert panel discussions and two rounds of email surveys. RESULTS A total of 416 themes (including indicators and determinants factors) were extracted from 166 eligible articles and documents. Based on conceptual proximity, the number of factors was reduced to 119. These were grouped into eight domains: social infrastructure and social sustainability, financial and economic infrastructures, population health status, service delivery, coverage, stewardship/governance, and global movements. The final assessment tool included 20 identified subcategories and 88 relevant indicators. CONCLUSION Identified factors in progress towards UHC are interrelated. The developed tool can be adapted and used in whole or in part in any country. Periodical use of the tool is recommended to understand potential factors that impede or advance progress towards UHC.
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Affiliation(s)
- Naser Derakhshani
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Fakhri
- Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Vladimir Sergeevich Gordeev
- The Institute of Population Health Sciences, Queen Mary University of London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Michel J, Datay MI, Motsohi TJ, Bärnighausen T, Tediosi F, McIntyre D, Tanner M, Evans D. Achieving universal health coverage in sub-Saharan Africa: the role of leadership development. JOURNAL OF GLOBAL HEALTH REPORTS 2020. [DOI: 10.29392/001c.12855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Countries world-wide are striving towards Universal Health Coverage (UHC). Financial resources are extremely limited in developing countries and many developing countries are in the midst of multiple interconnected social, economic, epidemiologic, demographic, technological, institutional, environmental and political transitions. According to the World Health Organization (WHO), accelerating progress towards UHC in Africa will require strong leadership. At the recent Global Conference on Primary Health Care (PHC), the Astana Declaration, the world recommitted to comprehensive Primary Health Care as a keystone of Universal Health Coverage. There is evidence that PHC works. Countries that followed the Alma Ata PHC principles have demonstrated population health outcomes and reduced inequalities at low costs as seen in Chile, Cuba, Ethiopia and Rwanda. What seems to be missing is leadership to apply and uphold these PHC principles. There is consensus that if Astana is to be realized, strong political, economic, education, health, science, institutional, and community leaders are needed to make PHC work this time around. Governments and leaders in Africa have been conveying a constant message, that those leading and managing health systems are not sufficiently prepared to succeed in leadership roles they now occupy. Africa has had different leaders with the same results for decades. Leadership development efforts made to date seem not to be producing desired results. Students taken out of Africa to be trained in leadership at western universities, seem to go back home and carry on as usual. Many students have been taken to the West for education, developed great visions and ideas of how they can transfer knowledge learnt, got home and got swallowed by the system. Pumping more money into a health system with no leadership development will not help us achieve ‘Health for All’ in sub-Saharan Africa. How can accountable leadership with a sense of consciousness for social justice be developed successfully in these contexts? If leadership is key for Universal Health Coverage to be achieved in sub-Saharan Africa, is it not high time attention is paid to leadership development approaches.
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Affiliation(s)
- Janet Michel
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland; University of Basel, Basel, Switzerland
| | - M Ishaaq Datay
- Primary Health Care Directorate, University of Cape Town, Cape Town, South Africa
| | | | - Till Bärnighausen
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Di McIntyre
- Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland; University of Basel, Basel, Switzerland
| | - David Evans
- World Bank Health Economist, Geneva, Switzerland
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Jesus TS, Landry MD, Hoenig H, Zeng Y, Kamalakannan S, Britto RR, Pogosova N, Sokolova O, Grimmer K, Louw QA. Physical Rehabilitation Needs in the BRICS Nations from 1990 to 2017: Cross-National Analyses Using Data from the Global Burden of Disease Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4139. [PMID: 32531949 PMCID: PMC7312462 DOI: 10.3390/ijerph17114139] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/06/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
Abstract
Background: This study analyzes the current and evolving physical rehabilitation needs of BRICS nations (Brazil, Russian Federation, India, China, South Africa), a coalition of large emergent economies increasingly important for global health. Methods: Secondary, cross-national analyses of data on Years Lived with Disability (YLDs) were extracted from the Global Burden of Disease Study 2017. Total physical rehabilitation needs, and those stratified per major condition groups are analyzed for the year 2017 (current needs), and for every year since 1990 (evolution over time). ANOVAs are used to detect significant yearly changes. Results: Total physical rehabilitation needs have increased significantly from 1990 to 2017 in each of the BRICS nations, in every metric analyzed (YLD Counts, YLDs per 100,000 people, and percentage of YLDs relevant to physical rehabilitation; all p < 0.01). Musculoskeletal & pain conditions were leading cause of physical rehabilitation needs across the BRICS nations but to varying degrees: from 36% in South Africa to 60% in Brazil. Country-specific trends include: 25% of South African needs were from HIV-related conditions (no other BRICS nation had more than 1%); India had both absolute and relative growths of pediatric rehabilitation needs (p < 0.01); China had an exponential growth in the per-capita needs from neurological and neoplastic conditions (p < 0.01; r2 = 0.97); Brazil had a both absolute and relative growth of needs coming from musculoskeletal & pain conditions (p < 0.01); and the Russian Federation had the highest neurological rehabilitation needs per capita in 2017 (over than three times those of India, South Africa or Brazil). Conclusions: total physical rehabilitation needs have been increasing in each of the BRICS nations, both in absolute and relative values. Apart from the common growing trend, each of the BRICS nations had own patterns for the amount, typology, and evolution of their physical rehabilitation needs, which must be taken into account while planning for health and physical rehabilitation programs, policies and resources.
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Affiliation(s)
- Tiago S. Jesus
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Michel D. Landry
- School of Medicine, Duke University, Durham, NC 27710, USA;
- Duke Global Health Institute (DGHI), Duke University, Durham, NC 27710, USA
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC 27705, USA;
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Yi Zeng
- Center for Study of Aging and Human Development and Geriatrics Division, School of Medicine, Duke University, Durham, NC 27710, USA;
- National School of Development and Raissun Institute for Advanced Studies, Peking University, Beijing 100871, China
| | - Sureshkumar Kamalakannan
- Public Health Foundation of India (PHFI), South Asia Centre for Disability Inclusive Development and Research (SACDIR), Indian Institute of Public Health, Hyderabad 500 033, (IIPH-H), India;
| | - Raquel R. Britto
- Rehabilitation Science Post Graduation Programs of Universidade Federal de Minas Gerais and Universidade Federal de Juiz de Fora, Juiz de Fora 36036-900, Brazil;
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow 524901, Russian Federation; (N.P.); (O.S.)
| | - Olga Sokolova
- National Medical Research Center of Cardiology, Moscow 524901, Russian Federation; (N.P.); (O.S.)
| | - Karen Grimmer
- Department of Health and Rehabilitation Sciences, Physiotherapy Division, Stellenbosch University, Stellenbosch 7505, South Africa; (K.G.); (Q.A.L.)
| | - Quinette A. Louw
- Department of Health and Rehabilitation Sciences, Physiotherapy Division, Stellenbosch University, Stellenbosch 7505, South Africa; (K.G.); (Q.A.L.)
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Bodhisane S, Pongpanich S. The impact of National Health Insurance upon accessibility of health services and financial protection from catastrophic health expenditure: a case study of Savannakhet province, the Lao People's Democratic Republic. Health Res Policy Syst 2019; 17:99. [PMID: 31842882 PMCID: PMC6915990 DOI: 10.1186/s12961-019-0493-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Many schemes have been implemented by the government of the Lao People's Democratic Republic to provide equity in health service utilisation. Initially, health service utilisations were fully supported by the government and were subsequently followed by the Revolving Drug Fund. In the 2000s, four health financing schemes, namely the Social Security Organization, the State Authority for Social Security, the Health Equity Fund and Community-Based Health Insurance (CBHI), were introduced with various target groups. However, as these voluntary schemes have suffered from a very low enrolment rate, the government decided to pilot the National Health Insurance (NHI) scheme, which offers a flat, co-payment system for health service utilisation. This study aims to assess the effectiveness of the NHI in terms of its accessibility and in providing financial protection from catastrophic health expenditure. METHODS The data collection process was implemented in hospitals of two districts of Savannakhet province. A structured questionnaire was used to retrieve all required information from 342 households; the information comprised of the socioeconomics of the household, accessibility to health services and financial payment for both outpatient and inpatient department services. Binary logistic regression models were used to discover the impact of NHI in terms of accessibility and financial protection. The impact of NHI was then compared with the outcomes of the preceding, voluntary CBHI scheme, which had been the subject of earlier studies. RESULTS Under the NHI, it was found that married respondents, large households and the level of income significantly increased the probability of accessibility to health service utilisation. Most importantly, NHI significantly improved accessibility for the poorest income quantile. In terms of financial protection, households with an existing chronic condition had a significantly higher chance of suffering financial catastrophe when compared to households with healthy members. As probability of catastrophic expenditure was not affected by income level, it was indicated that NHI is able to provide equity in financial protection. CONCLUSION The models found that the NHI significantly enhances accessibility for poor income households, improving health service distribution and accessibility for the various income levels when compared to the CBHI coverage. Additionally, it was also found that NHI had enhanced financial protection since its introduction. However, the NHI policy requires a dramatically high level of government subsidy; therefore, there its long-term sustainability remains to be determined.
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Affiliation(s)
- Somdeth Bodhisane
- College of Public Health Science (CPHS), Chulalongkorn University, Institute building 3 (10th-11th floor), Chulalongkorn soi 62, Phyathai Rd, Bangkok, 10330, Thailand.
| | - Sathirakorn Pongpanich
- College of Public Health Science (CPHS), Chulalongkorn University, Institute building 3 (10th-11th floor), Chulalongkorn soi 62, Phyathai Rd, Bangkok, 10330, Thailand
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Myint CY, Pavlova M, Thein KNN, Groot W. A systematic review of the health-financing mechanisms in the Association of Southeast Asian Nations countries and the People's Republic of China: Lessons for the move towards universal health coverage. PLoS One 2019; 14:e0217278. [PMID: 31199815 PMCID: PMC6568396 DOI: 10.1371/journal.pone.0217278] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/08/2019] [Indexed: 11/19/2022] Open
Abstract
We systematically review the health-financing mechanisms, revenue rising, pooling, purchasing, and benefits, in the Association of Southeast Asian Nations (ASEAN) and the People’s Republic of China, and their impact on universal health coverage (UHC) goals in terms of universal financial protection, utilization/equity and quality. Two kinds of sources are reviewed: 1) academic articles, and 2) countries’ health system reports. We synthesize the findings from ASEAN countries and China reporting on studies that are in the scope of our objective, and studies that focus on the system (macro level) rather than treatment/technology specific studies (micro level).The results of our review suggest that the main sources of revenues are direct/indirect taxes and out of pocket payments in all ASEAN countries and China except for Brunei where natural resource revenues are the main source of revenue collection. Brunei, Indonesia, Philippines, Malaysia, and Viet Nam have a single pool for revenue collection constituting a national health insurance. Cambodia, China, Lao, Singapore, and Thailand have implemented multiple pooling systems while Myanmar has no formal arrangement. Capitation, Fee-for-Service, DRGs, Fee schedules, Salary, and Global budget are the methods of purchasing in the studied countries. Each country has its own definition of the basic benefit package which includes the services that are perceived as essential for the population health. Although many studies provide evidence of an increase in financial protection after reforming the health-financing mechanisms in the studied countries, inequity in financial protection continue to exist. Overall, the utilization of health care among the poor has increased as a consequence of the implementation of government subsidized health insurance schemes which target the poor in most of the studied countries. Inappropriate policies and provider payment mechanisms impact on the quality of health care provision. We conclude that the most important factors to attain UHC are to prioritize and include vulnerable groups into the health insurance scheme. Government subsidization for this kind of groups is found to be an effective method to achieve this goal. The higher the percentage of government expenditure on health, the greater the financial protection is. At the same time, there is a need to weigh the financial stability of the health-financing system. A unified health insurance system providing the same benefit package for all, is the most efficient way to attain equitable access to health care. Capacity building for both administrative and health service providers is crucial for sustainable and good quality health care.
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Affiliation(s)
- Chaw-Yin Myint
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Water, Research and Training Center (WRTC), Yangon, Myanmar
- * E-mail: ,
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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ALIPOURI SAKHA M, BAHMANZIARI N, TAKIAN A. Population Coverage to Reach Universal Health Coverage in Selected Nations: A Synthesis of Global Strategies. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:1155-1160. [PMID: 31341859 PMCID: PMC6635333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to provide tailored transferrable lessons for expanding population coverage through a descriptive lens by reviewing the population coverage policies, reforms and strategies in selected nations. METHODS In this comparative short communication, 14 countries with different status of population coverage and political economy that had successful experiences with coverage expansion were selected and categorized in four groups to study their approaches to reach Universal Health Coverage (UHC). RESULTS Although each country needs to tailor its policies and reforms based on its own contextual factors, the legal right of citizens to social security and health protection are enshrined in most countries' Constitution. Some countries adapted political and economic reforms to evolve their Social Health Insurance schemes. National laws to push governments to adapt UHC as a national strategy for ensuring that every resident is enrolled in health insurance schemes are key policies to reach UHC. CONCLUSION A series of reforms are required to provide total population coverage through various approaches. To create an effective insurance coverage, physical merger of all insurance funds is not necessarily required. Further, the share of GDP for health is not a definite indicator to reach UHC. Finally, strong political commitment and citizens' participation are the key issues in reaching UHC, while considering the poorest, remote and neglected population really matters.
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Affiliation(s)
- Minoo ALIPOURI SAKHA
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh BAHMANZIARI
- Department of Healthcare Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein TAKIAN
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Department of Healthcare Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
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Connolly S, Wren MA. Universal Health Care in Ireland—What Are the Prospects for Reform? Health Syst Reform 2019; 5:94-99. [DOI: 10.1080/23288604.2018.1551700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Sheelah Connolly
- Social Research, Economic and Social Research Institute, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research, Economic and Social Research Institute, Dublin, Ireland
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Jakovljevic M, Camilleri C, Rancic N, Grima S, Jurisevic M, Grech K, Buttigieg SC. Cold War Legacy in Public and Private Health Spending in Europe. Front Public Health 2018; 6:215. [PMID: 30128309 PMCID: PMC6088206 DOI: 10.3389/fpubh.2018.00215] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Abstract
Cold War Era (1946-1991) was marked by the presence of two distinctively different economic systems, namely the free-market (The Western ones) and central-planned (The Eastern ones) economies. The main goal of this study refers to the exploration of development pathways of Public and Private Health Expenditure in all of the countries of the European WHO Region. Based on the availability of fully comparable data from the National Health Accounts system, we adopted the 1995-2014 time horizon. All countries were divided into two groups: those defined in 1989 as free market economies and those defined as centrally-planned economies. We observed six major health expenditures: Total Health Expenditure (% of GDP), Total Health Expenditure (PPP unit), General government expenditure on health (PPP), Private expenditure on health (PPP), Social security funds (PPP) and Out-of-pocket expenditure (PPP). All of the numerical values used refer exclusively to per capita health spending. In a time-window from the middle of the 1990s towards recent years, total health expenditure was rising fast in both groups of countries. Expenditure on health % of GDP in both group of countries increased over time with the increase in the Free-market economies seen to be more rapid. The steeper level of total expenditure on health for the Free-market as of 1989 market economies, is due mainly to a steep increase in both the government and private expenditure on health relative to spending by centrally-planned economies as of the same date, with the out-of-pocket expenditure and the social security funds in the same market economies category following the same steepness. Variety of governments were leading Eastern European countries into their transitional health care reforms. We may confirm clear presence of obvious divergent upward trends in total governmental and private health expenditures between these two groups of countries over the past two decades. The degree of challenge to the fiscal sustainability of these health systems will have to be judged for each single nation, in line with its own local circumstances and perspectives.
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Affiliation(s)
- Mihajlo Jakovljevic
- Department of Global Health, Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Carl Camilleri
- Department of Economics, Faculty of Economics, Management and Accountancy, University of Malta, Msida, Malta
| | - Nemanja Rancic
- Centre for Clinical Pharmacology, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Simon Grima
- Department of Insurance, Faculty of Economics, Management and Accountancy, University of Malta, Msida, Malta
| | - Milena Jurisevic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Kenneth Grech
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Sandra C Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta.,Clinical Performance Unit, Mater Dei Hospital, Msida, Malta
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Social Context and Geographic Space: An Ecological Study about Hospitalizations of Older Persons. Value Health Reg Issues 2018; 17:8-13. [PMID: 29544112 DOI: 10.1016/j.vhri.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 10/28/2017] [Accepted: 12/01/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify the diseases that lead older persons to hospitalizations in the public health system in the state of Rio de Janeiro and, through a study of spatial distribution among hospitalization rates of the municipal districts, discuss the social contexts involved in the hospitalization of the elderly. METHODS An ecological cross-sectional study using secondary data from the Brazilian hospital information system from the period 2009 to 2015 was performed. The hospitalization rates of people 60 years and older, residing in 92 municipalities in the state of Rio de Janeiro, were calculated. The municipal districts were grouped according to the similarity of such rates using K-means nonhierarchical clustering analysis. RESULTS Diseases of the circulatory and respiratory systems, endocrine disorders, illnesses of the genitourinary system or the digestive tract, and certain infectious and parasitic diseases were the most discriminatory diseases for cluster composition. The first cluster, the municipal districts with the lowest hospitalization rates, which were more urbanized and had greater access to social and health services, was named Access and Inclusion. The second group, which had the highest hospitalization rates, was named Isolation and Vulnerability. CONCLUSIONS The primary care-sensitive conditions are the main causes of hospitalization of the elderly in the state, with greater intensity in the municipalities that are geographically rugged and remote. These outcomes reinforce the importance of valuing geographical knowledge, the guidelines of the unified health system concerning equity and regionalization, and the determinants and social determinations involved in the process of health and disease.
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Nghiem S, Graves N, Barnett A, Haden C. Cost-effectiveness of national health insurance programs in high-income countries: A systematic review. PLoS One 2017; 12:e0189173. [PMID: 29244823 PMCID: PMC5731747 DOI: 10.1371/journal.pone.0189173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/18/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES National health insurance is now common in most developed countries. This study reviews the evidence and synthesizes the cost-effectiveness information for national health insurance or disability insurance programs across high-income countries. DATA SOURCES A literature search using health, economics and systematic review electronic databases (PubMed, Embase, Medline, Econlit, RepEc, Cochrane library and Campbell library), was conducted from April to October 2015. STUDY SELECTION Two reviewers independently selected relevant studies by applying screening criteria to the title and keywords fields, followed by a detailed examination of abstracts. DATA EXTRACTION Studies were selected for data extraction using a quality assessment form consisting of five questions. Only studies with positive answers to all five screening questions were selected for data extraction. Data were entered into a data extraction form by one reviewer and verified by another. EVIDENCE SYNTHESIS Data on costs and quality of life in control and treatment groups were used to draw distributions for synthesis. We chose the log-normal distribution for both cost and quality-of-life data to reflect non-negative value and high skew. The results were synthesized using a Monte Carlo simulation, with 10,000 repetitions, to estimate the overall cost-effectiveness of national health insurance programs. RESULTS Four studies from the United States that examined the cost-effectiveness of national health insurance were included in the review. One study examined the effects of medical expenditure, and the remaining studies examined the cost-effectiveness of health insurance reforms. The incremental cost-effectiveness ratio (ICER) ranged from US$23,000 to US$64,000 per QALY. The combined results showed that national health insurance is associated with an average incremental cost-effectiveness ratio of US$51,300 per quality-adjusted life year (QALY). Based on the standard threshold for cost-effectiveness, national insurance programs are cost-effective interventions. CONCLUSIONS Although national health insurance programs have been introduced in most developed countries, only a few studies have examined their cost-effectiveness. All the selected studies revealed strong evidence to support health insurance programs or health reforms in the United States. The average ICER in this study is below the standard threshold for cost-effectiveness used in the US. The small number of relevant studies is the main limitation of this study.
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Affiliation(s)
- Son Nghiem
- Institute of Health and Biomedical Innovation Queensland University of Technology, Brisbane, Queensland, Australia
- * E-mail:
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation Queensland University of Technology, Brisbane, Queensland, Australia
| | - Adrian Barnett
- Institute of Health and Biomedical Innovation Queensland University of Technology, Brisbane, Queensland, Australia
| | - Catherine Haden
- Library Queensland University of Technology, Brisbane, Queensland, Australia
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Ferraz FHRP, Rodrigues CIS, Gatto GC, Sá NMD. Diferenças e desigualdades no acesso a terapia renal substitutiva nos países do BRICS. CIENCIA & SAUDE COLETIVA 2017; 22:2175-2185. [DOI: 10.1590/1413-81232017227.00662017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/28/2016] [Indexed: 02/04/2023] Open
Abstract
Resumo A doença renal terminal (DRT) é um importante problema de saúde pública, sobretudo nos países em desenvolvimento, em vista dos altos recursos econômicos necessários para manutenção dos pacientes nas diversas formas de terapias renais substitutivas (TRS) existentes. O objetivo deste artigo é analisar as diferenças e as desigualdades que envolvem o acesso a TRS nos países que compõem o BRICS (Brasil, Rússia, Índia, China e África do Sul). Estudo aplicado, descritivo, transversal, qualitativo e quantitativo, com análise documental e pesquisa bibliográfica, tendo como fonte de dados censos nacionais e publicações científicas envolvendo o acesso a TRS em tais países. Verificou-se evidências de iniquidade no acesso a TRS em todos os países do BRICS, ausência de censos de diálise e transplante nacionais (Índia), ausência de legislações efetivas que inibam a comercialização de órgãos (Índia e África do Sul) e uso de transplantes de doador falecido de prisioneiros (China). A construção de mecanismos que promovam compartilhamento de benefícios e de solidariedade no campo da cooperação internacional na área da saúde renal passa pelo reconhecimento das questões bioéticas que envolvem o acesso a TRS nos países do BRICS.
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Jakovljevic M, Potapchik E, Popovich L, Barik D, Getzen TE. Evolving Health Expenditure Landscape of the BRICS Nations and Projections to 2025. HEALTH ECONOMICS 2017; 26:844-852. [PMID: 27683202 DOI: 10.1002/hec.3406] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/04/2016] [Accepted: 08/09/2016] [Indexed: 05/17/2023]
Abstract
Global health spending share of low/middle income countries continues its long-term growth. BRICS nations remain to be major drivers of such change since 1990s. Governmental, private and out-of-pocket health expenditures were analyzed based on WHO sources. Medium-term projections of national health spending to 2025 were provided based on macroeconomic budgetary excess growth model. In terms of per capita spending Russia was highest in 2013. India's health expenditure did not match overall economic growth and fell to slightly less than 4% of GDP. Up to 2025 China will achieve highest excess growth rate of 2% and increase its GDP% spent on health care from 5.4% in 2012 to 6.6% in 2025. Russia's spending will remain highest among BRICS in absolute per capita terms reaching net gain from $1523 PPP in 2012 to $2214 PPP in 2025. In spite of BRICS' diversity, all countries were able to significantly increase their investments in health care. The major setback was bold rise in out-of-pocket spending. Most of BRICS' growing share of global medical spending was heavily attributable to the overachievement of People's Republic of China. Such trend is highly likely to continue beyond 2025. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Elena Potapchik
- Institute of Health Economics, Higher School of Economics, National Research University, Moscow, Russian Federation
| | - Larisa Popovich
- Institute of Health Economics, Higher School of Economics, National Research University, Moscow, Russian Federation
| | - Debasis Barik
- National Council for Applied Economic Research, New Delhi, India
| | - Thomas E Getzen
- Risk, Insurance and Healthcare Management Department, Temple University, Philadelphia, PA, USA
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Pescarini JM, Rodrigues LC, Gomes MGM, Waldman EA. Migration to middle-income countries and tuberculosis-global policies for global economies. Global Health 2017; 13:15. [PMID: 28298223 PMCID: PMC5353961 DOI: 10.1186/s12992-017-0236-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background International migration to middle-income countries is increasing and its health consequences, in particular increasing transmission rates of tuberculosis (TB), deserve consideration. Migration and TB are a matter of concern in high-income countries and targeted screening of migrants for active and latent TB infection is a main strategy to manage risk and minimize transmission. In this paper, we discuss some aspects of TB control and migration in the context of middle-income countries, together with the prospect of responding with equitable and comprehensive policies. Main body TB rates in middle-income countries remain disproportionally high among the poorest and most vulnerable groups in large cities where most migrant populations are concentrated. Policies that tackle migrant TB in high-income countries may be inadequate for middle-income countries because of their different socio-economic and cultural scenarios. Strategies to control TB in these settings must take into account the characteristics of middle-income countries and the complexity of TB as a disease of poverty. Intersectoral policies of social protection such as cash-transfer programs help reducing poverty and improving health in vulnerable populations. We address the development of new approaches to improve well-established strategies including contact tracing and active and latent TB screening as an ‘add on’ to the existing health care guidelines of conditional cash transfer programs. In addition, we discuss how it might improve health and welfare among both poor migrants and locally-born populations. Authorities from middle-income countries should recognise that migrants are a vulnerable social group and promote cooperation efforts between sending and receiving countries for mitigation of poverty and prevention of disease in this group. Conclusions Middle-income countries have long sent migrants overseas. However, the influx of large migrant populations into their societies is relatively new and a growing phenomenon and it is time to set comprehensive goals to improve health among these communities. Conditional cash transfer policies with TB screening and strengthening of DOTS are some strategies that deserve attention. Reduction of social and health inequality among migrants should be incorporated into concerted actions to meet TB control targets.
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Affiliation(s)
- Julia Moreira Pescarini
- Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil. .,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - M Gabriela M Gomes
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.,CIBIO-InBIO, Centro de Investigacao em Biodiversidade e Recursos Geneticos, Universidade do Porto, Rua Padre Armando Quintas, n° 7, Vairão, 4485-661, Portugal.,Instituto de Matematica e Estatistica, Universidade de São Paulo, R. do Matão, 1010 - Vila Universitaria, São Paulo, SP, 05508-090, Brazil
| | - Eliseu Alves Waldman
- Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil
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Hallo De Wolf A, Toebes B. Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health. Health Hum Rights 2016; 18:79-92. [PMID: 28559678 PMCID: PMC5394993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The goal of universal health coverage is to "ensure that all people obtain the health services they need without suffering financial hardship when paying for them." There are many connections between this goal and the state's legal obligation to realize the human right to health. In the context of this goal, it is important to assess private actors' involvement in the health sector. For example, private actors may not always have the incentives to deal with externalities that affect the availability, accessibility, acceptability, and quality of health care services; they may not be in a position to provide "public goods"; or they may operate under imperfect information. This paper sets out to answer the question, what legal human rights obligations do states have in terms of regulating private sector involvement in health care?
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Affiliation(s)
- Antenor Hallo De Wolf
- Assistant Professor of International Law and International Human Rights Law at the University of Groningen, the Netherlands
| | - Brigit Toebes
- Professor of Human Rights and Health Law at the University of Groningen, the Netherlands
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Jakovljevic M. Commentary: Implementing Pro-Poor Universal Health Coverage. Front Public Health 2016; 4:186. [PMID: 27618965 PMCID: PMC5003063 DOI: 10.3389/fpubh.2016.00186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/17/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mihajlo Jakovljevic
- The Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; Hosei University Tokyo, Tokyo, Japan
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Mbogo BA, McGill D. "Perspectives on financing population-based health care towards Universal Health Coverage among employed individuals in Ghanzi district, Botswana: A qualitative study". BMC Health Serv Res 2016; 16:413. [PMID: 27543136 PMCID: PMC4992196 DOI: 10.1186/s12913-016-1657-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 08/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, about 150 million people experience catastrophic healthcare expenditure services annually. Among low and middle income countries, out-of-pocket expenditure pushes about 100 million people into poverty annually. In Botswana, 83 % of the general population and 58 % of employed individuals do not have medical aid coverage. Moreover, inequity allocation of financial resources between health services suggests marginalization of population-based health care services (i.e. diseases prevention and health promotion). The purpose of the study is to explore perspectives on employed individuals regarding financing population based health care interventions towards Universal Health Coverage (UHC) in order to make recommendations to the Ministry of Health on health financing options to cover population-based health services. METHODS A qualitative design grounded in interpretivist epistemology through social constructivism lens was critical for exploring perspectives of employed individuals. Through purposive and snowballing sampling techniques, a total of 15 respondents including 8 males and 7 females were recruited and interviewed using a semi-structured format. Their age ranged from 23 to 59 years with a median of 36 years. Data was analyzed using Thematic Content Analysis technique. RESULTS Use of social constructivism lens enabled to classify emerging themes into population coverage, health services coverage and financial protection issues. Despite broad understanding of health coverage schemes among participants, knowledge appears insignificant in increasing enrolment. Participants indicated limited understanding of UHC concepts, however showed willingness to embrace UHC upon brief description. Main thematic issues raised include: exclusion of population-based health services from coverage scheme; disparity in financial protection and health services coverage among enrollees; inability to sustain contracted employees; and systematic exclusion of unemployed individuals and informal sector employees. CONCLUSION Increasing enrolment in health coverage schemes requires targeted campaign for information dissemination through use of myriads mass media including: social networks, TV, Radio and others. Moreover, re-designing health insurance schemes is critical in order to include population-based interventions; expand uptake of unemployed and informal sector employees; flexibility in monthly premiums payment plan and use of technology to increase access to payment points. Further study need to evaluate the content of health financing policy in Botswana measured against the World Health Organization Universal Health Coverage conceptual requirements for Low and Middle Income Countries.
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Affiliation(s)
| | - Deborah McGill
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GL UK
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25
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Poku NK. How should the post-2015 response to AIDS relate to the drive for universal health coverage? Glob Public Health 2016; 13:765-779. [PMID: 27498555 DOI: 10.1080/17441692.2016.1215486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The drive for universal health coverage (UHC) now has a great deal of normative impetus, and in combination with the inauguration of the sustainable development goals, has come to be regarded as a means of ensuring the financial basis for the struggle against HIV and AIDS. The argument of this paper is that such thinking is a case of 'the right thing at the wrong time': it seriously underestimates the scale of the work against HIV and AIDS, and the speed with which we need to undertake it, if we are to consolidate the gains we have made to date, let alone reduce it to manageable proportions. The looming 'fiscal crunch' makes the challenges all the more daunting; even in the best circumstances, the time required to establish UHCs capable of providing both essential health services and a very rapid scale-up of the fight against HIV and AIDS is insufficient when set against the urgency of ensuring that AIDS does not eventuate as a global health catastrophe.
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Affiliation(s)
- Nana K Poku
- a Health Economics and HIV/AIDS Research Division (HEARD) , University of KwaZulu-Natal , Durban , South Africa
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Acharya S, Barber SL, Lopez-Acuna D, Menabde N, Migliorini L, Molina J, Schwartländer B, Zurn P. BRICS and global health. Bull World Health Organ 2016; 92:386-386A. [PMID: 24940006 DOI: 10.2471/blt.14.140889] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shambhu Acharya
- Department of Country Cooperation and Collaboration with the UN System, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Daniel Lopez-Acuna
- Department of Country Cooperation and Collaboration with the UN System, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | | | - Joaquín Molina
- Pan American Health Organization and World Health Organization, Brasília, Brazil
| | | | - Pascal Zurn
- Department of Country Cooperation and Collaboration with the UN System, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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27
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Goeppel C, Frenz P, Grabenhenrich L, Keil T, Tinnemann P. Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries. Bull World Health Organ 2016; 94:276-85C. [PMID: 27034521 PMCID: PMC4794303 DOI: 10.2471/blt.15.163832] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods We obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. Findings The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. Conclusion No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care.
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Affiliation(s)
- Christine Goeppel
- Global Health Science Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Luisenstraße 57, Berlin, 10117, Germany
| | - Patricia Frenz
- Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile
| | - Linus Grabenhenrich
- Global Health Science Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Luisenstraße 57, Berlin, 10117, Germany
| | - Thomas Keil
- Global Health Science Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Luisenstraße 57, Berlin, 10117, Germany
| | - Peter Tinnemann
- Global Health Science Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Luisenstraße 57, Berlin, 10117, Germany
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Abstract
OBJECTIVE The past few decades have been marked by a bold increase in national health spending across the globe. Rather successful health reforms in leading emerging markets such as BRICS reveal a reshaping of their medical care-related expenditures. There is a scarcity of evidence explaining differences in long-term medical spending patterns between top ranked G7 traditional welfare economies and the BRICS nations. METHODS A retrospective observational study was conducted on a longitudinal WHO Global Health Expenditure data-set based on the National Health Accounts (NHA) system. Data were presented in a simple descriptive manner, pointing out health expenditure dynamics and differences between the two country groups (BRICS and G7) and individual nations in a 1995-2013 time horizon. RESULTS Average total per capita health spending still remains substantially higher among G7 (4747 Purchase Power Parity (PPP) $PPP in 2013) compared to the BRICS (1004 $PPP in 2013) nations. The percentage point share of G7 in global health expenditure (million current PPP international $US) has been falling constantly since 1995 (from 65% in 1995 to 53.2% in 2013), while in BRICS nations it grew (from 10.7% in 1995 to 20.2% in 2013). Chinese national level medical spending exceeded significantly that of all G7 members except the US in terms of current $PPP in 2013. CONCLUSIONS Within a limited time horizon of only 19 years it appears that the share of global medical spending by the leading emerging markets has been growing steadily. Simultaneously, the world's richest countries' global share has been falling constantly, although it continues to dominate the landscape. If the contemporary global economic mainstream continues, the BRICS per capita will most likely reach or exceed the OECD average in future decades. Rising out-of-pocket expenses threatening affordability of medical care to poor citizens among the BRICS nations and a too low percentage of GDP in India remain the most notable setbacks of these developments.
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Tediosi F, Finch A, Procacci C, Marten R, Missoni E. BRICS countries and the global movement for universal health coverage. Health Policy Plan 2015; 31:717-28. [PMID: 26704179 DOI: 10.1093/heapol/czv122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2015] [Indexed: 11/12/2022] Open
Abstract
This article explores BRICS' engagement in the global movement for Universal Health Coverage (UHC) and the implications for global health governance. It is based on primary data collected from 43 key informant interviews, complemented by a review of BRICS' global commitments supporting UHC. Interviews were conducted using a semi-structured questionnaire that included both closed- and open-ended questions. Question development was informed by insights from the literature on UHC, Cox's framework for action, and Kingdon's multiple-stream theory of policy formation. The closed questions were analysed with simple descriptive statistics and the open-ended questions using grounded theory approach. The analysis demonstrates that most BRICS countries implicitly supported the global movement for UHC, and that they share an active engagement in promoting UHC. However, only Brazil, China and to some extent South Africa, were recognized as proactively pushing UHC in the global agenda. In addition, despite some concerted actions, BRICS countries seem to act more as individual countries rather that as an allied group. These findings suggest that BRICS are unlikely to be a unified political block that will transform global health governance. Yet the documented involvement of BRICS in the global movement supporting UHC, and their focus on domestic challenges, shows that BRICS individually are increasingly influential players in global health. So if BRICS countries should probably not be portrayed as the centre of future political community that will transform global health governance, their individual involvement in global health, and their documented concerted actions, may give greater voice to low- and middle-income countries supporting the emergence of multiple centres of powers in global health.
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Affiliation(s)
- Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland, University of Basel, Basel, Switzerland, Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, Milan, Italy and
| | - Aureliano Finch
- Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, Milan, Italy and
| | - Christina Procacci
- Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, Milan, Italy and
| | | | - Eduardo Missoni
- Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, Milan, Italy and
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Singh E, Ruff P, Babb C, Sengayi M, Beery M, Khoali L, Kellett P, Underwood JM. Establishment of a cancer surveillance programme: the South African experience. Lancet Oncol 2015; 16:e414-21. [PMID: 26248849 DOI: 10.1016/s1470-2045(15)00162-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/03/2015] [Accepted: 02/05/2015] [Indexed: 12/30/2022]
Abstract
Cancer is projected to become a leading cause of morbidity and mortality in low-income and middle-income countries in the future. However, cancer incidence in South Africa is largely under-reported because of a lack of nationwide cancer surveillance networks. We describe present cancer surveillance activities in South Africa, and use the International Agency for Research on Cancer framework to propose the development of four population-based cancer registries in South Africa. These registries will represent the ethnic and geographical diversity of the country. We also provide an update on a cancer surveillance pilot programme in the Ekurhuleni Metropolitan District, and the successes and challenges in the implementation of the IARC framework in a local context. We examine the development of a comprehensive cancer surveillance system in a middle-income country, which might serve to assist other countries in establishing population-based cancer registries in a resource-constrained environment.
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Affiliation(s)
- Elvira Singh
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; University of Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.
| | - Paul Ruff
- Division of Medical Oncology, Johannesburg, South Africa; University of Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Chantal Babb
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; University of Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Mazvita Sengayi
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Moira Beery
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; South African Field Epidemiology and Laboratory Training Programme, University of Pretoria, School of Public Health, Pretoria, South Africa
| | - Lerato Khoali
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Patricia Kellett
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - J Michael Underwood
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Chukwudozie A. Inequalities in Health: The Role of Health Insurance in Nigeria. J Public Health Afr 2015; 6:512. [PMID: 28299138 PMCID: PMC5349265 DOI: 10.4081/jphia.2015.512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/09/2015] [Indexed: 11/25/2022] Open
Abstract
Health financing is a core necessity for sustainable healthcare delivery. Access inequalities due to financial restrictions in low-middle income countries, and in Africa especially, significantly affect disease rates and health statistics in these regions. This paper focuses on the role of a national health insurance cover as a funding medium in Nigeria, highlighting the theoretical premise of health insurance, its driving forces, key benefits and key limitations particular to the country under scrutiny. Emphasis is laid on its overall effect on the pressing public health issue of health inequality.
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32
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Grover M. Government health expenditure in India. Bull World Health Organ 2015; 93:436. [PMID: 26240468 PMCID: PMC4450706 DOI: 10.2471/blt.14.143362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/29/2014] [Accepted: 12/09/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Manoj Grover
- Health and Family Welfare Division, Planning Commission (NITI Aayog), Government of India, Yojana Bhavan, Sansad Marg, New Delhi, 110001, India
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Jakovljevic MB. BRIC's Growing Share of Global Health Spending and Their Diverging Pathways. Front Public Health 2015; 3:135. [PMID: 26000273 PMCID: PMC4421927 DOI: 10.3389/fpubh.2015.00135] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/20/2015] [Indexed: 11/13/2022] Open
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Vian T, McIntosh N, Grabowski A, Nkabane-Nkholongo EL, Jack BW. Hospital Public-Private Partnerships in Low Resource Settings: Perceptions of How the Lesotho PPP Transformed Management Systems and Performance. Health Syst Reform 2015; 1:155-166. [PMID: 31546306 DOI: 10.1080/23288604.2015.1029060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract-Public-private partnerships (PPPs) seek to expand access to quality health services in ways that best leverage the capacities and resources of both sectors. There are few examples of PPPs in the hospital sector in developing countries, and little is known about how the involvement of the private sector transforms the delivery of health services in this context. In 2006, the government of Lesotho adopted a PPP approach for the health sector, contracting out to design, build, and operate a hospital network in its capital district. This case study examines differences between a government-run hospital and the PPP-run hospital that replaced it, using in-depth interviews with key informants, observation of management systems, and document review. Key informants emphasized changes in infrastructure, communication, human resource management, and organizational culture that improved quality and demand for services. Important drivers of improved performance included better defined policies and procedures, empowerment and training of managers and staff, and increased accountability. Well-functioning support systems kept the hospital clean and equipment functioning, reduced stock-outs, and allowed staff to do the jobs they were trained to do. The Lesotho PPP model provides insight into the mechanisms by which public-private partnerships may increase access and quality of care.
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Affiliation(s)
- Taryn Vian
- Center for Global Health & Development; Boston University School of Public Health; Boston , MA , USA
| | | | - Aria Grabowski
- Center for Global Health & Development; Boston University School of Public Health; Boston , MA , USA
| | | | - Brian W Jack
- Department of Family Medicine; Boston University School of Medicine and Boston Medical Center ; Boston , MA , USA
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Chandra P, Gogate B, Gogate P, Thite N, Mutha A, Walimbe A. Economic burden of diabetes in urban indians. Open Ophthalmol J 2014; 8:91-4. [PMID: 25674186 PMCID: PMC4319201 DOI: 10.2174/1874364101408010091] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022] Open
Abstract
Purpose : To find out the average economic burden of medical care on a patient with diabetes in Pune, India Methods : A semi-open ended questionnaire followed by interview was conducted with patients attending diabetes and ophthalmic out-patient departments. They were asked regarding the duration of diabetes, methods undertaken for blood sugar control and the amount they spend on consultations, laboratory tests, medicines and procedures if any within past year. Expenditure was classified as direct cost (cost of medicines, doctor’s fees, investigations, lasers and surgery) and indirect cost (travel, diet control, health classes and loss of wages). Data was collected regarding the socioeconomic status according to Kuppaswamy classification. Results : 219 patients participated of whom 129 were males (58.9%). Average annual direct cost of diabetes treatment was Rs 8,822 of which 52.1% was spend on medicines, 3.2% was spend on lasers, 12.6% was spend on surgical procedures, 11.6% spent on investigations and 10.4% was spend on clinician fees. Average annual indirect cost was Rs. 3949 of which 3.4% was spend on travelling purpose, 0.4% was spent on health classes, 4.9% was spent on diet control and 91.3% was loss of wages. Average expenditure done by lower middle class was 23.7% of their income. Average percentage of income for direct and indirect cost was 3.6% and 1.4% respectively. The cost of the treatment formed1.3% of the annual income for those in Socio-economic class I, 1.7% in class II, 3.7% in class III and 23.7% in class IV. Conclusion : The cost of managing diabetes was a significant proportion of the patients’ income, especially for those on lower socio-economic scale (class IV).
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Affiliation(s)
- Pablo Chandra
- Bharti Vidyapeeth Medical College, School of Optometry, Pune, India ; Community Eye Care Foundation, Dr. Gogate's Eye Clinic, Pune, India ; West Bengal University Of Technology (Optometry Colleges), Kolkatta, Paschimbaga, India
| | - Bageshri Gogate
- Department of Pathology, Shrimati Kashibai Navale Medical College, Narhe, Pune, India
| | - Parikshit Gogate
- Community Eye Care Foundation, Dr. Gogate's Eye Clinic, Pune, India
| | - Nilesh Thite
- Bharti Vidyapeeth Medical College, School of Optometry, Pune, India
| | - Abhay Mutha
- Diabetes Care and research Foundation, Pune, India
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Ezziane Z. Essential drugs production in Brazil, Russia, India, China and South Africa (BRICS): opportunities and challenges. Int J Health Policy Manag 2014; 3:365-70. [PMID: 25489593 PMCID: PMC4258887 DOI: 10.15171/ijhpm.2014.118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 11/02/2014] [Indexed: 11/09/2022] Open
Abstract
The objective of this work is to elucidate various essential drugs in the Brazil, Russia, India, China and South Africa (BRICS) countries. It discusses the opportunities and challenges of the existing biotech infrastructure and the production of drugs and vaccines in member states of the BRICS. This research is based on a systematic literature review between the years 2000 and 2014 of documents retrieved from the databases Embase, PubMed/Medline, Global Health, and Google Scholar, and the websites of relevant international organizations, research institutions and philanthropic organizations. Findings vary from one member state to another. These include useful comparison between the BRICS countries in terms of pharmaceuticals expenditure versus total health expenditure, local manufacturing of drugs/vaccines using technology and know-how transferred from developed countries, and biotech entrepreneurial collaborations under the umbrella of the BRICS region. This study concludes by providing recommendations to support more of inter collaborations among the BRICS countries as well as between BRICS and many developing countries to shrink drug production costs. In addition, this collaboration would also culminate in reaching out to poor countries that are not able to provide their communities and patients with cost-effective essential medicines.
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Affiliation(s)
- Zoheir Ezziane
- Higher Colleges of Technology, Al Ain, UAE
- The Wharton Entrepreneurship and Family Business Research Centre, University of Pennsylvania, CERT Technology Park, Abu Dhabi, UAE
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