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Bayked EM, Assfaw AK, Toleha HN, Zewdie S, Biset G, Ibirongbe DO, Kahissay MH. Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis. Front Public Health 2024; 12:1390937. [PMID: 38706546 PMCID: PMC11066245 DOI: 10.3389/fpubh.2024.1390937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/20/2024] [Indexed: 05/07/2024] Open
Abstract
Background Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia. Methods Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI. Results Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it. Conclusion The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.
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Affiliation(s)
- Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Abebe Kibret Assfaw
- Department of Psychology, Institute of Teachers’ Education and Behavioral Science, Wollo University, Dessie, Ethiopia
| | - Husien Nurahmed Toleha
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Segenet Zewdie
- Department of Pharmacy, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia
| | - Gebeyaw Biset
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | | | - Mesfin Haile Kahissay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Quang DT, Luong Thi T, Nguyen Di K, Vu Thi Quynh C, Nguyen Thi Hoa H, Phan Ngoc Q. Illuminating the breast cancer survival rates among Southeast Asian women: A systematic review and meta-analysis spanning four decades. Curr Probl Cancer 2024; 48:101062. [PMID: 38309146 DOI: 10.1016/j.currproblcancer.2024.101062] [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: 12/03/2023] [Revised: 12/27/2023] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
In Southeast Asia, breast cancer is the most prevalent cancer among women and ranks as the second leading cause of cancer-related deaths. This systematic review and meta-analysis, encompassing 27 observational cohort studies with a minimum one-year follow-up period, aimed to examine temporal trends in breast cancer survival rates. Among the subset of five out of eleven Southeast Asian nations with available data, our analysis revealed pooled survival rates of 88.8 % at 1 year, 73.8 % at 3 years, 70.8 % at 5 years, and 49.3 % at 10 years for breast cancer patients. The mean age at diagnosis was 50.77±10.07 years, with 52.81 % of patients presenting with positive lymph nodes. Notably, stages I and II remained predominant even five years post-diagnosis. Although an overall amelioration in survival rates transpired over the preceding four decades, a noticeable exception pertained to the 3-year rate, demonstrating limited improvement. These findings underscore the pressing need for enhanced research efforts, particularly in countries within the region that lack survival data, to enable accurate estimations. Furthermore, our review also emphasizes the crucial need for future comprehensive, well-designed studies to delve into the factors behind survival rate disparities in Southeast Asia and the younger age at diagnosis compared to other regions.
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Affiliation(s)
- Duc Tran Quang
- Faculty of Health Sciences, Dong Nai Technology University, Nguyen Khuyen Street, Trang Dai Ward, Bien Hoa City, Vietnam.
| | - Thanh Luong Thi
- Faculty of Health Sciences, Dong Nai Technology University, Nguyen Khuyen Street, Trang Dai Ward, Bien Hoa City, Vietnam
| | - Khanh Nguyen Di
- Faculty of Health Sciences, Dong Nai Technology University, Nguyen Khuyen Street, Trang Dai Ward, Bien Hoa City, Vietnam
| | - Chi Vu Thi Quynh
- The University of Danang, School of Medicine and Pharmacy, 41 Le Duan, Hai Chau, Danang 550000, Vietnam
| | - Huyen Nguyen Thi Hoa
- College of Health Sciences, VinUniveristy, Vinhomes Ocean Park, Gia Lam District, Hanoi, Vietnam
| | - Quang Phan Ngoc
- The Center Service For Technology Science Of Medi-Phar. Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street Thai Binh city, Vietnam
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Atobatele S, Sampson S, Jimoh AU, Isiaka SD, Ayodeji O, David JC, Daniel V, Dehinbo O. Integrating health intervention into existing program structure of the neglected tropical diseases: lessons learned from Yobe and Ebonyi states. Front Public Health 2024; 11:1281091. [PMID: 38298261 PMCID: PMC10827911 DOI: 10.3389/fpubh.2023.1281091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024] Open
Abstract
Background Nigeria has a national policy on neglected tropical diseases (NTD) which is coordinated by the Federal Ministry of Health and integrated into the health system at all government levels. A network of grassroots mobilizers, named community drug distributors (CDDs), deliver NTD drugs and commodities to rural and hard-to-reach communities throughout Nigeria. Methods Interviews with state and local government coordinators of Nigerian NTD programs and focus group discussions with CDDs in Yobe and Ebonyi states were conducted to understand the working modalities of NTD programs in Nigeria to identify the potential of leveraging the NTD structure for additional health interventions such as COVID-19 vaccine rollouts. Collected data was coded and managed on NVivo version 12 using content analysis. Results and discussion The study found that the NTD committee had the following: a structured planning and coordination process, a community mobilization approach for the effective delivery of routine Mass Administration of Medication (MAM) activities. Challenges encountered included little or no incentives for the CDDs, insecurity, transportation and logistics, and lack of equipment and drug commodities. Nigerian NTD health structures have a wide reach, with a presence in all states and local government areas (LGAs), and this has previously been leveraged to deliver commodities and interventions to rural and hard-to-reach communities for non-NTD health programs and could thus be used similarly for COVID-19 vaccination programs. The enablers of integrating health interventions into the NTD structure are increased availability of finances and manpower, while lack of financial incentives and partners' buy-in were identified as possible. challenges. Conclusion The study suggests that integrating COVID-19 interventions into the NTD program in Nigeria would be a significant accomplishment, as the existing structure can support future interventions. The study also highlights the efficiency of the NTD program's modalities and processes, indicating that an organized structural system for public health interventions can. increase the services of existing interventions while allowing for the integration of future interventions.
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Affiliation(s)
- Sunday Atobatele
- Sydani Group, FCT, Abuja, Nigeria
- Sydani Institute for Research and Innovation, Abuja, Nigeria
| | | | | | - Saheed D. Isiaka
- Sydani Group, FCT, Abuja, Nigeria
- Sydani Institute for Research and Innovation, Abuja, Nigeria
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Van Haute M, Agagon A, Gumapac FF, Anticuando MA, Coronel DN, David MC, Davocol DA, Din EJ, Grey CA, Lee YH, Muyot MB, Ragasa CL, Shao G, Tamaña CA, Uy TS, De Silos J. Determinants of differences in RT-PCR testing rates among Southeast Asian countries during the first six months of the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002593. [PMID: 37934719 PMCID: PMC10629619 DOI: 10.1371/journal.pgph.0002593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
A positive correlation has been demonstrated between gross domestic product (GDP) per capita and COVID-19 tests per 1000 people. Although frequently used as an indicator of economic performance, GDP per capita does not directly reflect income distribution inequalities and imposed health costs. In this longitudinal ecological study, we aimed to determine if, besides GDP per capita, indicators relating to governance, public health measures enforcement, and health and research investment explain differences in RT-PCR testing rates among countries in Southeast Asia (SEA) during the first six months of the COVID-19 pandemic. Using open-access COVID-19 panel data, we estimated the effect of various indicators (GDP per capita, health expenditure per capita, number of researchers per one million population, corruption perceptions index, stringency index, regional authority index) on daily COVID-19 testing by performing fixed-effects negative binomial regression. After accounting for all indicators, the number of daily confirmed COVID-19 cases, and population density, the model provided a 2019 GDP per capita coefficient of 0.0046330 (95% CI: 0.0040171, 0.0052488; p <0.001), indicating that a rise in 2019 GDP per capita by 100 international dollars is associated with a 46.33% increase in the number of daily tests performed. Additionally, all indicators were significantly associated with the daily number of RT-PCR testing on multivariable analysis. In conclusion, we identified different country-level indicators significantly associated with differences in COVID-19 testing rates among SEA countries. Due to the study's ecological design, we caution on applying our results to the individual level given potential for systematic differences between the included countries. Additional investigation is likewise needed to understand how government expenditure on healthcare may have impacted COVID-19 testing capacity during the initial stages of the pandemic.
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Affiliation(s)
- Michael Van Haute
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Alexandra Agagon
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Franz Froilan Gumapac
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Marie Abigail Anticuando
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Dianne Nicole Coronel
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Mary Coleen David
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Dan Ardie Davocol
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Eunice Jairah Din
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Carlos Alfonso Grey
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Young Hee Lee
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Marvin Bryan Muyot
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Charissma Leiah Ragasa
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Genesis Shao
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Cailin Adrienne Tamaña
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Trixia Scholastica Uy
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
| | - Jeriel De Silos
- College of Medicine, De La Salle Medical and Health Sciences Institute, City of Dasmariñas, Cavite, Philippines
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Lim MY, Kamaruzaman HF, Wu O, Geue C. Health financing challenges in Southeast Asian countries for universal health coverage: a systematic review. Arch Public Health 2023; 81:148. [PMID: 37592326 PMCID: PMC10433621 DOI: 10.1186/s13690-023-01159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) has received much attention and many countries are striving to achieve it. The Southeast Asian region, in particular, comprises many developing countries with limited resources, exacerbating challenges around attaining UHC. This paper aims to specifically explore the health financing challenges these countries face in achieving UHC via a systematic review approach and formulate recommendations that will be useful for policymakers. METHODS The systematic review followed the guidelines as recommended by PRISMA. The narrative synthesis approach was used for data synthesis, followed by identifying common themes. RESULTS The initial search returned 160 articles, and 32 articles were included after the screening process. The identified challenges in health financing towards achieving UHC in the Southeast Asian region are categorised into six main themes, namely (1) Unsustainability of revenue-raising methods, (2) Fragmented health insurance schemes, (3) Incongruity between insurance benefits and people's needs, (4) Political and legislative indifference, (5) Intractable and rapidly rising healthcare cost, (6) Morally reprehensible behaviours. CONCLUSIONS The challenges identified are diverse and therefore require a multifaceted approach. Regional collaborative efforts between countries will play an essential role in the progress towards UHC and in narrowing the inequity gap. At the national level, individual countries must work towards sustainable health financing strategies by leveraging innovative digital technologies and constantly adapting to dynamic health trends. REGISTRATION This study is registered with PROSPERO, under registration number CRD42022336624.
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Affiliation(s)
- Ming Yao Lim
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK.
| | - Hanin Farhana Kamaruzaman
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
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Feng Y, Maimaitiming M, Shi J, Wang M, Li N, Jin Y, Zheng ZJ. Inequity of maternal-child health services in ASEAN member states from 1993 to 2021. Int J Equity Health 2023; 22:149. [PMID: 37550702 PMCID: PMC10408145 DOI: 10.1186/s12939-023-01974-8] [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: 05/18/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Inequity in maternal-child health services is a challenge to global health as it hinders the achievement of Sustainable Development Goals (SDGs) and Universal Health Coverage. Though the Association of Southeast Asian Nations (ASEAN) has made remarkable achievements in maternal-child health, there remain gaps in reaching global goals. This study aimed to compare and investigate the inequity in maternal-child health (MCH) services in ASEAN member states to help guide policy decisions to improve equitable health services in the SDG era and beyond. METHODS Using the WHO Health Inequality Monitor, we identified inequity summary measures for five MCH services in ASEAN member states from 1993 to 2021: antenatal care, births attended by skilled health personnel, diphtheria, tetanus and pertussis (DTP3) immunization, measles immunization, and polio immunization. We divided the analysis dimension of inequity into urban-rural inequity, economic status inequity, and sub-regional inequity. Trends of absolute and relative inequity in every dimension of MCH services in ASEAN member states were examined with the principal component analysis (PCA). RESULTS The mean coverages of MCH services are 98.80% (Thailand), 86.72% (Cambodia), 84.54% (Viet Nam), 78.52 (Indonesia), 76.94% (Timor-Leste), 72.40% (Lao PDR), 68.10% (Philippines) and 48.52% (Myanmar) in 2021. Thailand have the lowest MCH services absolute inequity indexes of -1.945, followed by Vietnam (-1.449). Lao PDR and Myanmar have relatively higher MCH services absolute inequity indexes of 0.852 and 0.054 respectively. The service in Cambodia, Indonesia, and the Philippines is pro-specific regions (with subnational region absolute inequity indexes of -0.02, 0.01, and 1.01 respectively). The service in Myanmar is pro-rich (with economic status absolute inequity index of 0.43). The service in Lao PDR and Timor-Leste is pro-urban areas, pro-rich, and pro-specific regions. CONCLUSION The inequity of MCH services in ASEAN persists but is in a declining trend. Thailand and Vietnam have performed well in ensuring MCH services equity, while Laos and Myanmar are still facing serious inequity dilemmas. The progress of MCH service equity in Myanmar, Cambodia, the Philippines, and Indonesia is uneven. It is acceptable to learn from the successful experiences of Thailand and Vietnam to improve the equities in other ASEAN countries. Policies should be developed according to the specific types of MCH inequity in member states to improve equity levels.
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Affiliation(s)
- Yikai Feng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Mailikezhati Maimaitiming
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Junyi Shi
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Minmin Wang
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Na Li
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
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Kaiser AH, Rotigliano N, Flessa S, Ekman B, Sundewall J. Extending universal health coverage to informal workers: A systematic review of health financing schemes in low- and middle-income countries in Southeast Asia. PLoS One 2023; 18:e0288269. [PMID: 37432943 DOI: 10.1371/journal.pone.0288269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/23/2023] [Indexed: 07/13/2023] Open
Abstract
Achieving universal health coverage (UHC) is a priority of most low- and middle-income countries, reflecting governments' commitments to improved population health. However, high levels of informal employment in many countries create challenges to progress toward UHC, with governments struggling to extend access and financial protection to informal workers. One region characterized by a high prevalence of informal employment is Southeast Asia. Focusing on this region, we systematically reviewed and synthesized published evidence of health financing schemes implemented to extend UHC to informal workers. Following PRISMA guidelines, we systematically searched for both peer-reviewed articles and reports in the grey literature. We appraised study quality using the Joanna Briggs Institute checklists for systematic reviews. We synthesized extracted data using thematic analysis based on a common conceptual framework for analyzing health financing schemes, and we categorized the effect of these schemes on progress towards UHC along the dimensions of financial protection, population coverage, and service access. Findings suggest that countries have taken a variety of approaches to extend UHC to informal workers and implemented schemes with different revenue raising, pooling, and purchasing provisions. Population coverage rates differed across health financing schemes; those with explicit political commitments toward UHC that adopted universalist approaches reached the highest coverage of informal workers. Results for financial protection indicators were mixed, though indicated overall downward trends in out-of-pocket expenditures, catastrophic health expenditure, and impoverishment. Publications generally reported increased utilization rates through the introduced health financing schemes. Overall, this review supports the existing evidence base that predominant reliance on general revenues with full subsidies for and mandatory coverage of informal workers are promising directions for reform. Importantly, the paper extends existing research by offering countries committed to progressively realizing UHC around the world a relevant updated resource, mapping evidence-informed approaches toward accelerated progress on the UHC goals.
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Affiliation(s)
- Andrea Hannah Kaiser
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Improving Social Protection and Health Project, Phnom Penh, Cambodia
| | - Niccolò Rotigliano
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Improving Social Protection and Health Project, Phnom Penh, Cambodia
| | - Steffen Flessa
- Department of Health Care Management, University of Greifswald, Greifswald, Germany
| | - Björn Ekman
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
| | - Jesper Sundewall
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
- HEARD, University of KwaZulu-Natal, Durban, South Africa
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Alberto NRI, Alberto IRI, Puyat CVM, Antonio MAR, Ho FDV, Dee EC, Mahal BA, Eala MAB. Disparities in access to cancer diagnostics in ASEAN member countries. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 32:100667. [PMID: 36785859 PMCID: PMC9918780 DOI: 10.1016/j.lanwpc.2022.100667] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 01/09/2023]
Abstract
Diagnostics, including laboratory tests, medical and nuclear imaging, and molecular testing, are essential in the diagnosis and management of cancer to optimize clinical outcomes. With the continuous rise in cancer mortality and morbidity in the Association of Southeast Asian Nations (ASEAN), there exists a critical need to evaluate the accessibility of cancer diagnostics in the region so as to direct multifaceted interventions that will address regional inequities and inadequacies in cancer care. This paper identifies existing gaps in service delivery, health workforce, health information systems, leadership and governance, and financing and how these contribute to disparities in access to cancer diagnostics in ASEAN member countries. Intersectoral health policies that will strengthen coordinated laboratory services, upscale infrastructure development, encourage health workforce production, and enable proper appropriation of funding are necessary to effectively reduce the regional cancer burden.
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Affiliation(s)
| | | | | | | | | | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brandon A. Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Michelle Ann B. Eala
- College of Medicine, University of the Philippines, Manila, Philippines,Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA,Corresponding author.
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Laksono AD, Megatsari H, Senewe FP, Latifah L, Ashar H. Policy to expand hospital utilization in disadvantaged areas in Indonesia: who should be the target? BMC Public Health 2023; 23:12. [PMID: 36597082 PMCID: PMC9808954 DOI: 10.1186/s12889-022-14656-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/17/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The disadvantaged areas are one of the government's focuses in accelerating development in Indonesia, including the health sector. The study aims to determine the target for expanding hospital utilization in disadvantaged areas in Indonesia. METHODS The study employed the 2018 Indonesian Basic Health Survey data. This cross-sectional study analyzed 42,644 respondents. The study used nine independent variables: residence, age, gender, marital, education, employment, wealth, insurance, and travel time, in addition to hospital utilization, as a dependent variable. The study employed binary logistic regression to evaluate the data. RESULTS The results found that average hospital utilization in disadvantaged areas in Indonesia in 2018 was 3.7%. Urban areas are 1.045 times more likely than rural areas to utilize the hospital (95% CI 1.032-1.058). The study also found age has a relationship with hospital utilization. Females are 1.656 times more likely than males to use the hospital (95% CI 1.639-1.673). Moreover, the study found marital status has a relationship with hospital utilization. The higher the education level, the higher the hospital utilization. Employed individuals have a 0.748 possibility to use the hospital compared with those unemployed (95% CI 0.740-0.757). Wealthy individuals have more chances of using the hospital than poor individuals. Individuals with all insurance types are more likely to utilize the hospital than those uninsured. Individuals with travel times of ≤ 1 h are 2.510 more likely to use the hospital than those with > 1 h (95% CI 2.483-2.537). CONCLUSION The specific targets to accelerate the increase in hospital utilization in disadvantaged areas in Indonesia are living in a rural area, being male, never in a union, having no education, being employed, being the poorest, uninsured, and having a travel time of > 1 h. The government should make a policy addressing the problem based on the research findings.
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Affiliation(s)
- Agung Dwi Laksono
- National Research and Innovation Agency, Republic of Indonesia, Jakarta, Indonesia
| | - Hario Megatsari
- grid.440745.60000 0001 0152 762XFaculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | | | - Leny Latifah
- National Research and Innovation Agency, Republic of Indonesia, Jakarta, Indonesia
| | - Hadi Ashar
- National Research and Innovation Agency, Republic of Indonesia, Jakarta, Indonesia
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Downey LE, Gadsden T, Vilas VDR, Peiris D, Jan S. The impact of COVID-19 on essential health service provision for endemic infectious diseases in the South-East Asia region: A systematic review. THE LANCET REGIONAL HEALTH - SOUTHEAST ASIA 2022; 1:100011. [PMID: 35769109 PMCID: PMC9069250 DOI: 10.1016/j.lansea.2022.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background There is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services. The South East Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, and continues to bear a significant proportion of communicable disease burden worldwide. Methods We conducted a systematic literature review of quantitative evidence to estimate the impact of COVID-19 on the provision of essential prevention, detection, treatment, and management services for five high-burden infectious diseases across the SEAR. Findings A total of 2338 studies were reviewed, and 12 studies were included in our analysis, covering six countries across the SEAR (Bhutan, Sri Lanka, Nepal, Myanmar, Thailand, and India) for three conditions of interest (HIV, TB, dengue fever). We identified significant disruption to TB testing (range=25% to 77.9%) and diagnoses (range=50% to 58%) in India, Nepal, and Indonesia; and similar disruptions were observed for screening, new diagnoses and commencing HIV treatment in India and Thailand. There was also drastically reduced case detection for dengue fever (range=75% to 90% disrupted) in Bhutan and Sri Lanka. No studies were identified for malaria nor hepatitis in any country, and nor for any service in the remaining six SEAR countries. Interpretation We identified evidence of significant disruption to the prevention, diagnoses, treatment, and management of TB, HIV, and dengue fever due to the COVID-19 pandemic across multiple SEAR country settings. This has the potential to set back hard-fought gains in infectious disease control across the region. The lack of evidence for the impact of the pandemic on malaria and hepatitis services, and in the remaining six SEAR countries, is an important evidence gap that should be addressed in order to inform future policy for service protection and pandemic preparedness. Funding This work was supported by the WHO Sri Lanka Country office.
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Effects of Changes in Multiple Chronic Conditions on Medical Costs among Older Adults in South Korea. Healthcare (Basel) 2022; 10:healthcare10040742. [PMID: 35455919 PMCID: PMC9029782 DOI: 10.3390/healthcare10040742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 11/17/2022] Open
Abstract
This study aims to analyze the relationship between cognitive function and out-of-pocket cost of the state change of multiple chronic conditions in individuals aged 60 or older. Data from the 2014 to 2018 Korean Longitudinal Study of Aging were used for 2202 older adults who were cognitively “normal” at the start of the survey. Four status change groups were established (“Good → Good,” “Good → Bad,” “Bad → Good,” and “Bad → Bad”) according to the change in the number of chronic diseases. Generalized estimating equation modeling analyzed the association between these changes and out-of-pocket medical cost. Out-of-pocket cost was significantly higher among older adults with multiple chronic conditions (p < 0.0001). Total out-of-pocket medical cost and out-of-pocket cost for outpatient care and prescription drugs were significantly higher for Bad→ Bad or Good → Bad changes. Older adults with cognitive decline had significantly higher total out-of-pocket medical cost and out-of-pocket cost for prescription drugs. This study demonstrates the need to improve the multiple chronic conditions management construction model to enhance the health of older adults in Korea and secure national health care finances long-term. It provides a foundation for related medical and medical expenses-related systems.
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Bhatia D, Mishra S, Kirubarajan A, Yanful B, Allin S, Di Ruggiero E. Identifying priorities for research on financial risk protection to achieve universal health coverage: a scoping overview of reviews. BMJ Open 2022; 12:e052041. [PMID: 35264342 PMCID: PMC8915291 DOI: 10.1136/bmjopen-2021-052041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Financial risk protection (FRP) is an indicator of the Sustainable Development Goal 3 universal health coverage (UHC) target. We sought to characterise what is known about FRP in the UHC context and to identify evidence gaps to prioritise in future research. DESIGN Scoping overview of reviews using the Arksey & O'Malley and Levac & Colquhoun framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. DATA SOURCES MEDLINE, PsycINFO, CINAHL-Plus and PAIS Index were systematically searched for studies published between 1 January 1995 and 20 July 2021. ELIGIBILITY CRITERIA Records were screened by two independent reviewers in duplicate using the following criteria: (1) literature review; (2) focus on UHC achievement through FRP; (3) English or French language; (4) published after 1995 and (5) peer-reviewed. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data using a standard form and descriptive content analysis was performed to synthesise findings. RESULTS 50 studies were included. Most studies were systematic reviews focusing on low-income and middle-income countries. Study periods spanned 1990 and 2020. While FRP was recognised as a dimension of UHC, it was rarely defined as a concept. Out-of-pocket, catastrophic and impoverishing health expenditures were most commonly used to measure FRP. Pooling arrangements, expansion of insurance coverage and financial incentives were the main interventions for achieving FRP. Evidence gaps pertained to the effectiveness, cost-effectiveness and equity implications of efforts aimed at increasing FRP. Methodological gaps related to trade-offs between single-country and multicountry analyses; lack of process evaluations; inadequate mixed-methods evidence, disaggregated by relevant characteristics; lack of comparable and standardised measurement and short follow-up periods. CONCLUSIONS This scoping overview of reviews characterised what is known about FRP as a UHC dimension and found evidence gaps related to the effectiveness, cost-effectiveness and equity implications of FRP interventions. Theory-informed mixed-methods research using high-quality, longitudinal and disaggregated data is needed to address these objectives.
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Affiliation(s)
- Dominika Bhatia
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sujata Mishra
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abirami Kirubarajan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Bernice Yanful
- Public Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Erica Di Ruggiero
- Public Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Darrudi A, Ketabchi Khoonsari MH, Tajvar M. Challenges to Achieving Universal Health Coverage Tthroughout the World: A Systematic Review. J Prev Med Public Health 2022; 55:125-133. [PMID: 35391524 PMCID: PMC8995934 DOI: 10.3961/jpmph.21.542] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives No systematic review has explored the challenges related to worldwide universal health coverage (UHC). This study reviewed challenges on the road to UHC. Methods A systematic electronic search of all studies that identified the challenges of worldwide UHC was conducted, without any restrictions related to the publication date or language. A hand search and a bibliographic search were also conducted to identify which texts to include in this study. These sources and citations yielded a total of 2500 articles, only 26 of which met the inclusion criteria. Relevant data from these papers were extracted, summarized, grouped, and reported in tables. Results Of the 26 included studies, 7 (27%) were reviews, 6 (23%) were reports, and 13 (50%) had another type of study design. The publication dates of the included studies ranged from 2011 to 2020. Nine studies (35%) were published in 2019. Using the World Health Organization conceptual model, data on all of the challenges related to UHC in terms of the 4 functions of health systems (stewardship, creating resource, financing, and delivering services) were extracted from the included studies and reported. Conclusions This study provides a straightforward summary of previous studies that explored the challenges related to UHC and conducted an in-depth analysis of viable solutions.
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Affiliation(s)
- Alireza Darrudi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Tajvar
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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14
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Jakovljevic M, Lamnisos D, Westerman R, Chattu VK, Cerda A. Future health spending forecast in leading emerging BRICS markets in 2030: health policy implications. Health Res Policy Syst 2022; 20:23. [PMID: 35183217 PMCID: PMC8857747 DOI: 10.1186/s12961-022-00822-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/27/2022] [Indexed: 01/07/2023] Open
Abstract
Background The leading emerging markets of Brazil, Russia, India, China and South Africa (BRICS) are increasingly shaping the landscape of the global health sector demand and supply for medical goods and services. BRICS’ share of global health spending and future projections will play a prominent role during the 2020s. The purpose of the current research was to examine the decades-long underlying historical trends in BRICS countries’ health spending and explore these data as the grounds for reliable forecasting of their health expenditures up to 2030. Methods BRICS’ health spending data spanning 1995–2017 were extracted from the Institute for Health Metrics and Evaluation (IHME) Financing Global Health 2019 database. Total health expenditure, government, prepaid private and out-of-pocket spending per capita and gross domestic product (GDP) share of total health spending were forecasted for 2018–2030. Autoregressive integrated moving average (ARIMA) models were used to obtain future projections based on time series analysis. Results Per capita health spending in 2030 is projected to be as follows: Brazil, $1767 (95% prediction interval [PI] 1615, 1977); Russia, $1933 (95% PI 1549, 2317); India, $468 (95% PI 400.4, 535); China, $1707 (95% PI 1079, 2334); South Africa, $1379 (95% PI 755, 2004). Health spending as a percentage of GDP in 2030 is projected as follows: Brazil, 8.4% (95% PI 7.5, 9.4); Russia, 5.2% (95% PI 4.5, 5.9); India, 3.5% (95% PI 2.9%, 4.1%); China, 5.9% (95% PI 4.9, 7.0); South Africa, 10.4% (95% PI 5.5, 15.3). Conclusions All BRICS countries show a long-term trend towards increasing their per capita spending in terms of purchasing power parity (PPP). India and Russia are highly likely to maintain stable total health spending as a percentage of GDP until 2030. China, as a major driver of global economic growth, will be able to significantly expand its investment in the health sector across an array of indicators. Brazil is the only large nation whose health expenditure as a percentage of GDP is about to contract substantially during the third decade of the twenty-first century. The steepest curve of increased per capita spending until 2030 seems to be attributable to India, while Russia should achieve the highest values in absolute terms. Health policy implications of long-term trends in health spending indicate the need for health technology assessment dissemination among the BRICS ministries of health and national health insurance funds. Matters of cost-effective allocation of limited resources will remain a core challenge in 2030 as well.
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15
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Takura T, Miura H. Socioeconomic Determinants of Universal Health Coverage in the Asian Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042376. [PMID: 35206562 PMCID: PMC8872323 DOI: 10.3390/ijerph19042376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/02/2022] [Accepted: 02/16/2022] [Indexed: 02/04/2023]
Abstract
The World Health Organization (WHO) states that examining medical financial systems is the most important process in evaluating universal health coverage (UHC). This study used the service coverage index (SCI) as a proxy of the progress toward UHC in eleven Asian countries. We employed a fixed-effects regression model to analyze panel data from 2015 to 2017, to explain the interrelationship between the SCI and major socioeconomic indicators. We also conducted a performance analysis (ratio of achieved SCI level to gross domestic product (GDP) or health expenditure displacement) to examine the balance between the degree of achievements related to UHC and a country’s economic level. The results showed that GDP and health expenditure were significantly positively correlated with the SCI (p < 0.01). The panel data analysis results showed that GDP per capita was a factor that greatly influenced the SCI as well as poverty (partial regression coefficient: 0.0017, 95% CI: 0.0013–0.0021). The results of the performance analysis showed that the Philippines had the highest scores (GDP: 1.84 SCI score/USD per capita, health expenditure: 1.04 SCI score/USD per capita) and South Korea the lowest. We conclude that socioeconomic factors, such as GDP, health expenditure, unemployment, poverty, and population influence the progress of UHC, regardless of system maturity or geographic characteristics.
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Affiliation(s)
- Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
- Correspondence: ; Tel.: +81-3-5800-9523; Fax: +81-3-5800-8948
| | - Hiroko Miura
- Division of Disease Control and Epidemiology, School of Dentistry, Health Sciences University of Hokkaido, Ishikari 061-0293, Japan;
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16
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Opportunities and Barriers for FinTech in SAARC and ASEAN Countries. JOURNAL OF RISK AND FINANCIAL MANAGEMENT 2022. [DOI: 10.3390/jrfm15020077] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article assesses the opportunities and challenges for different categories of FinTechs in the SAARC and ASEAN regions. We consider the global financial inclusion data released by the World Bank and map the responses to gain insights into the opportunities and challenges for FinTechs in the respective regions. We develop a new index, termed the FinTech Opportunity Index (FOI), to conceptualise the opportunities and barriers based on individual savings, borrowings, purchasing behaviour, and payment preferences. We note that FinTech services have potential opportunities for expansion in the ASEAN regions but less so in the SAARC regions. The need for different types of FinTech services varies between regions. Services such as crowdfunding, neobanks, and InsurTech have potential in the ASEAN regions, especially with the positive attitude towards entrepreneurship and asset investments. In the SAARC regions, InsurTechs linked to health care has potential along with LendTechs and neobanks. We further note that males, and the young are more likely adopters of FinTechs in both regions. The analysis suggests the need for innovative promotions and education to motivate the more sceptical, especially women and the elderly population, to adopt FinTech services.
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17
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Lucero-Prisno DE, Olayemi AH, Ekpenyong I, Okereke P, Aldirdiri O, Buban JMA, Ndikumana S, Yelarge K, Sesay N, Turay FU, Huang J, Kouwenhoven MBN. Prospects for financial technology for health in Africa. Digit Health 2022; 8:20552076221119548. [PMID: 35968028 PMCID: PMC9373123 DOI: 10.1177/20552076221119548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
Over the years, technology has revolutionized the operations of many industries, ranging from manufacturing and agriculture to financial institutions which are usually the first users of innovations. Owing to the recent technological trends in the financial sector, such as mobile money, artificial intelligence, and medical robotics, as well as the rapidly increasing human population and the emergence of new patterns of disease, it is necessary for the healthcare sector to adopt new strategies to deliver efficient and effective healthcare services. Financial technology (FinTech), a combination of financial services and technology, entails the incorporation of modern, innovative technologies by industries into their financial services. FinTech is an endless array of applications, products, and services which includes mobile banking, cryptocurrency, insurance, and investment apps among many others. Any enterprise that employs technology to enhance or automate financial services and processes is referred to as FinTech. This fast-growing industry serves the interests of both the business sector and the consuming public. There have been many applications and uses of FinTech, however, its employment in the field of health remains to be explored further and maximized, particularly in the developing world like Africa. This paper aims to explore the prospects of FinTech for healthcare in Africa.
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Affiliation(s)
- Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Management and Development Studies, University of the Philippines Open University, Los Baños, Laguna, Philippines
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | | | | | - Precious Okereke
- Faculty of Management Sciences, Department of Accounting, University of Port Harcourt, Port Harcourt, Nigeria
| | - Osman Aldirdiri
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Julian MA Buban
- College of Medicine, University of the Philippines Manila, Manila, Philippines
- Global Health Focus Asia, Manila, Philippines
| | - Sudi Ndikumana
- Health Maintenance Organization in Africa, Goma, Democratic Republic of Congo
| | - Kwasi Yelarge
- Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Noah Sesay
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Foday Umaro Turay
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Junjie Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - MBN Kouwenhoven
- Department of Physics, Xi’an Jiaotong-Liverpool University, Suzhou, PR China
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18
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Macariola AD, Santarin TMC, Villaflor FJM, Villaluna LMG, Yonzon RSL, Fermin JL, Kee SL, AlDahoul N, Karim HA, Tan MJT. Breaking Barriers Amid the Pandemic: The Status of Telehealth in Southeast Asia and its Potential as a Mode of Healthcare Delivery in the Philippines. Front Pharmacol 2021; 12:754011. [PMID: 34819860 PMCID: PMC8606793 DOI: 10.3389/fphar.2021.754011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Aitana Dy Macariola
- Department of Natural Sciences, University of St. La Salle, Bacolod, Philippines
| | | | | | | | | | - Jamie Ledesma Fermin
- Yo-Vivo Corporation, Bacolod City, Philippines.,Department of Electronics Engineering, University of St. La Salle, Bacolod, Philippines
| | - Shaira Limson Kee
- Department of Natural Sciences, University of St. La Salle, Bacolod, Philippines.,Yo-Vivo Corporation, Bacolod City, Philippines
| | - Nouar AlDahoul
- Yo-Vivo Corporation, Bacolod City, Philippines.,Faculty of Engineering, Multimedia University, Cyberjaya, Malaysia
| | | | - Myles Joshua Toledo Tan
- Department of Natural Sciences, University of St. La Salle, Bacolod, Philippines.,Yo-Vivo Corporation, Bacolod City, Philippines.,Department of Chemical Engineering, University of St. La Salle, Bacolod, Philippines
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19
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Duangchan C, Steffen A, Matthews AK. Perspectives and practices regarding colorectal cancer survivorship care: Online survey results from oncology nurses in Thailand. Eur J Oncol Nurs 2021; 55:102048. [PMID: 34634574 DOI: 10.1016/j.ejon.2021.102048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Limited research has highlighted disparities in survivorship care in low- and middle-income countries. However, such care for colorectal cancer (CRC) survivors remains unexplored, especially in Thailand. This study examined Thai oncology nurses' perceptions of responsibility, confidence levels, and frequency of survivorship care practice for CRC survivors and identified factors impeding such care. METHODS A cross-sectional study utilizing an online survey approach was conducted between October and November 2020. Thai oncology nurses (N = 155) completed the survey's demographic questionnaire, 29-item survivorship care scale, and 16-item impeding factor scale. RESULTS Oncology nurses had high levels of perceived responsibility (mean = 73.37, SD = 12.12) and confidence (mean = 65.09, SD = 14.89) for providing CRC survivorship care. However, they reported less frequency of practice (mean = 47.60, SD = 21.03), especially concerning sexual, fertility, employment, and financial issues. Nurses with higher education had significantly higher responsibility perceptions, confidence levels, and frequency of practice (all p < .05). Also, nurses with specialty training in cancer care reported higher frequency of practice (p = .013). Common factors impeding survivorship care were lack of physical facilities (60.4%), knowledge/skills (57.4%), and educational resources for family members (52.3%) and survivors (51.6%). CONCLUSIONS This study revealed inconsistencies between oncology nurses' responsibility perceptions, confidence levels, and frequency of survivorship care practice. The results can guide nurse researchers, educators, leaders, and policymakers in enhancing the quality of CRC survivorship care in low- and middle-income countries such as Thailand. Future efforts should focus on developing educational resources and training programs for survivorship care for oncology nurses and addressing factors impeding such care during healthcare service planning.
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Affiliation(s)
- Cherdsak Duangchan
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA; Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
| | - Alana Steffen
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Alicia K Matthews
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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20
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Nguyen PT, Rahman MS, Le PM, Nguyen HV, Vu KD, Nguyen HL, Dao ATM, Khuong LQ, Hoang MV, Gilmour S. Trends in, projections of, and inequalities in reproductive, maternal, newborn and child health service coverage in Vietnam 2000-2030: A Bayesian analysis at national and sub-national levels. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100230. [PMID: 34528011 PMCID: PMC8342952 DOI: 10.1016/j.lanwpc.2021.100230] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Background To assess the reproductive, maternal, newborn and child health (RMNCH) service coverage in Vietnam with trends in 2000−2014, projections and probability of achieving targets in 2030 at national and sub-national levels; and to analyze the socioeconomic, regional and urban-rural inequalities in RMNCH service indicators. Methods We used national population-based datasets of 44,624 households in Vietnam from 2000 to 2014. We applied Bayesian regression models to estimate the trends in and projections of RMNCH indicators and the probabilities of achieving the 2030 targets. Using the relative index, slope index, and concentration index of inequality, we examined the patterns and trends in RMNCH coverage inequality. Findings We projected that 9 out of 17 health service indicators (53%) would likely achieve the 2030 targets at the national level, including at least one and four ANC visits, BCG immunization, access to improved water and adequate sanitation, institutional delivery, skilled birth attendance, care-seeking for pneumonia, and ARI treatment. We observed very low coverages and zero chance of achieving the 2030 targets at national and sub-national levels in early initiation and exclusive breastfeeding, family planning needs satisfied, and oral rehydration therapy. The most deprived households living in rural areas and the Northwest, Northeast, North Central, Central Highlands, and Mekong River Delta regions would not reach the 80% immunization coverage of DPT3, Polio3, Measles and full immunization. We found socioeconomic, regional, and urban-rural inequalities in all RMNCH indicators in 2014 and no change in inequalities over 15 years in the lowest-coverage indicators. Interpretation Vietnam has made substantial progress toward UHC. By improving the government's health system reform efforts, re-allocating resources focusing on people in the most impoverished rural regions, and restructuring and enhancing current health programs, Vietnam can achieve the UHC targets and other health-related SDGs. Funding The authors did not receive any funds for conducting this study.
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Affiliation(s)
- Phuong T Nguyen
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.,Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Md Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Phuong Mai Le
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Huy Van Nguyen
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.,Innovation Health and Transformation Centre, Federation University, Australia.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Massachusetts, USA
| | - Kien Duy Vu
- OnCare Medical Technology Company Limited, Hanoi, Vietnam
| | - Hoa L Nguyen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Massachusetts, USA
| | - An Thi Minh Dao
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Massachusetts, USA.,School of Public Health, The University of Queensland, Queensland, Australia.,Institution for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
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21
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Li ZZ, Liu G, Tao R, Lobont OR. Do Health Expenditures Converge Among ASEAN Countries? Front Public Health 2021; 9:699821. [PMID: 34568255 PMCID: PMC8460855 DOI: 10.3389/fpubh.2021.699821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
This paper aims to determine the existence of convergence in health expenditures among Association for South East Asian Nations (ASEAN) countries. Based on the SPSM procedure and panel KSS unit root test results, the public health expenditures (PUHE) in Indonesia, Lao PDR, Cambodia, the Philippines, and Myanmar are converging, while that of Brunei Darussalam, Malaysia, Vietnam, Singapore, and Thailand are diverging. In addition, the sequences of private health expenditures (PRHE) in ASEAN member states are stationary, which implies convergence. This finding is in accordance with Wagner's law, that is, as nations develop, they are forced to expand public expenditure. Specifically, countries with low levels of PUHE tend to catch up with the high health spending countries. This research has policy implications with regard to the convergence of health expenditure across countries. The government in low- and lower-middle income countries should raise PUHE to provide access to health services for those who are unaffordable individuals.
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Affiliation(s)
- Zheng-Zheng Li
- Department of Economics, School of Economics, Qingdao University, Qingdao, China
| | - Guangzhe Liu
- Department of Graduate School, Graduate School, St. Paul University Philippines, Tuguegarao, Philippines
| | - Ran Tao
- Qingdao Municipal Center for Disease Control and Preventation, Qingdao, China
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22
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Derakhshani N, Maleki M, Pourasghari H, Azami-Aghdash S. The influential factors for achieving universal health coverage in Iran: a multimethod study. BMC Health Serv Res 2021; 21:724. [PMID: 34294100 PMCID: PMC8299681 DOI: 10.1186/s12913-021-06673-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/23/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The initial purpose of healthcare systems around the world is to promote and maintain the health of the population. Universal Health Coverage (UHC) is a new approach by which a healthcare system can reach its goals. World Health Organization (WHO) emphasized maximum population coverage, health service coverage, and financial protection, as three dimensions of UHC. In progress for achieving UHC, recognizing the influential factors allows us to accelerate such progress. Therefore, this study aimed to identify the influential factors to achieve UHC in Iran. METHODS This is a multi-method study was conducted in four phases: First, a systematic review of the literature was conducted to identify the factors in PubMed, Web of Science, Embase, Scopus, ProQuest, Cochrane library, and Science Direct databases, and hand searching google scholar search engine. For recognizing the unmentioned factors, a qualitative study consisting of one session of Focus Group Discussion (FGD) and five semi-structured interviews with experts was designed. The extracted factors were merged and categorized by round table discussion. Finally, the pre-categorized factors were refined and re-categorized under the health system's control knobs framework during three expert panel sessions. RESULTS Finally, 33 studies were included. Eight hundred two factors were extracted through systematic review and 96 factors through FGD and interviews (totally, 898). After refining them by the experts' panel, 105 factors were categorized within the control knob framework (financing 19, payment system7, Organization 23, regulation and supervision 33, Behavior 11, and Others 12). The majority of the identified factors were related to the "regulation and supervision" dimension, whilst the "payment system" entailed the fewest. The political commitment during political turmoil, excessive attention to the treatment, referral system, paying out of pocket(OOP) and protection against high costs, economic growth, sanctions, conflict of interests, weakness of the information system, prioritization of services, health system fragmented, lack of managerial support and lack of standard benefits packages were identified as the leading factors on the way to UHC. CONCLUSION Considering the distinctive role of the context in policymaking, the identification of the factors affecting UHC accompanying by the countries' experiences about UHC, can boost our speed toward it. Moreover, adopting a long-term plan toward UHC based on these factors and the robust implementation of it pave the way for Iran to achieve better outcomes comparing to their efforts.
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Affiliation(s)
- Naser Derakhshani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Sy MCC, Espiritu AI, Sy MSC, Jamora RDG, Anlacan VMM. Dementia Research Productivity and Associations with Socioeconomic Factors and Burden of Disease in Southeast Asia. J Alzheimers Dis 2021; 76:1151-1160. [PMID: 32597811 DOI: 10.3233/jad-200355] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Scientific output in Southeast Asia (SEA) on the topic of dementia is postulated to be low in quality and quantity. It is also speculated that certain socioeconomic variables and measures of disease burden for dementia may play a significant role in driving the research output of a particular country. OBJECTIVE This study aimed to determine the research impact of published journal articles on dementia in SEA and its association with country-level socioeconomic factors and measures of disease burden for dementia. METHODS A systematic search was conducted using electronic healthcare databases. We included articles published on dementia until August 2019 with at least 1 author affiliated with any SEA institution. We obtained bibliometric indices, relevant socioeconomic factors, and measures of disease burden for dementia from published sources. RESULTS One thousand six articles fulfilled the inclusion criteria. The majority of publications were related to Alzheimer's disease (n = 775, 77.0%). Singapore contributed the highest number of publications (n = 457, 45.4%). Gross domestic product (GDP) per capita, % GDP for research and development, and total neurologists significantly correlated with several bibliometric indices. On the other hand, the measures of disease burden for dementia in SEA countries were not significantly associated with research productivity. CONCLUSION Research productivity in SEA on dementia has substantially increased in recent years. Augmenting GDP per capita and expanding the apportionment of resources to research and development (R&D) may have a significant role in the advancement of dementia research in SEA.
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Affiliation(s)
- Marie Charmaine C Sy
- Department of Neurosciences, Division of Adult Neurology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Adrian I Espiritu
- Department of Neurosciences, Division of Adult Neurology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | | | - Roland Dominic G Jamora
- Department of Neurosciences, Division of Adult Neurology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Veeda Michelle M Anlacan
- Department of Neurosciences, Division of Adult Neurology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Neurosciences, Center for Memory and Cognition, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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A landscape analysis of health technology assessment capacity in the Association of South-East Asian Nations region. Health Res Policy Syst 2021; 19:19. [PMID: 33573676 PMCID: PMC7879649 DOI: 10.1186/s12961-020-00647-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Progress towards achieving Universal Health Coverage and institutionalizing healthcare priority setting through health technology assessment (HTA) in the Association of South-East Asian Nations (ASEAN) region varies considerably across countries because of differences in healthcare expenditure, political support, access to health information and technology infrastructure. To explore the status and capacity of HTA in the region, the ASEAN Secretariat requested for member countries to be surveyed to identify existing gaps and to propose solutions to help countries develop and streamline their priority-setting processes for improved healthcare decision-making. Methods A mixed survey questionnaire with open- and closed-ended questions relating to HTA governance, HTA infrastructure, supply and demand of HTA and global HTA networking opportunities in each country was administered electronically to representatives of HTA nodal agencies of all ASEAN members. In-person meetings or email correspondence were used to clarify or validate any unclear responses. Results were collated and presented quantitatively. Results Responses from eight out of ten member countries were analysed. The results illustrate that countries in the ASEAN region are at different stages of HTA institutionalization. While Malaysia, Singapore and Thailand have well-established processes and methods for priority setting through HTA, other countries, such as Cambodia, Indonesia, Lao PDR, Myanmar, the Philippines and Vietnam, have begun to develop HTA systems in their countries by establishing nodal agencies or conducting ad-hoc activities. Discussion and conclusion The study provides a general overview of the HTA landscape in ASEAN countries. Systematic efforts to mitigate the gaps between the demand and supply of HTA in each country are required while ensuring adequate participation from stakeholders so that decisions for resource allocation are made in a fair, legitimate and transparent manner and are relevant to each local context.
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Rizvi SS, Douglas R, Williams OD, Hill PS. The political economy of universal health coverage: a systematic narrative review. Health Policy Plan 2020; 35:364-372. [PMID: 31904858 DOI: 10.1093/heapol/czz171] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2019] [Indexed: 11/14/2022] Open
Abstract
The uptake and implementation of universal health coverage (UHC) is primarily a political, rather than a technical, exercise, with contested ideas and diverse stakeholders capable of facilitation or resistance-even veto-of the policy uptake. This narrative systematic review, undertaken in 2018, sought to identify all peer-reviewed publications dealing with concepts relating to UHC through a political economy framing. Of the 627 papers originally identified, 55 papers were directly relevant, with an additional eight papers added manually on referral from colleagues. The thematic analysis adapted Fox and Reich's framework of ideas and ideologies, interests and institutions to organize the analysis. The results identified a literature strong in its exploration of the ideologies and ideas that underpin UHC, but with an apparent bias in authorship towards more rights-based, left-leaning perspectives. Despite this, political economy analyses of country case studies suggested a more diverse political framing for UHC, with the interests and institutions engaged in implementation drawing on pragmatic and market-based mechanisms to achieve outcomes. Case studies offered limited detail on the role played by specific interests, though the influence of global development trends was evident, as was the role of donor organizations. Most country case studies, however, framed the development of UHC within a narrative of national ownership, with steps in implementation often critical political milestones. The development of institutions for UHC implementation was predicated largely on available infrastructure, with elements of that infrastructure-federal systems, user fees, pre-existing insurance schemes-needing to be accommodated in the incremental progress towards UHC. The need for technical competence to deliver ideological promises was underlined. The review concludes that, despite the disparate sources for the analyses, there is an emerging shared narrative in the growing literature around the political economy of UHC that offers an increasing awareness of the political dimensions to UHC uptake and implementation.
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Affiliation(s)
- Syed Shahiq Rizvi
- Faculty of Medicine, The University of Queensland, Herston Road, Herston, QLD 4006, Australia
| | - Rundell Douglas
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052, USA
| | - Owain D Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Road, Herston, QLD 4006, Australia
| | - Peter S Hill
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Road, Herston, QLD 4006, Australia
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Asante A, Man N, Wiseman V. Evaluating Equity in Health Financing Using Benefit Incidence Analysis: A Framework for Accounting for Quality of Care. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:759-766. [PMID: 32567036 PMCID: PMC7716894 DOI: 10.1007/s40258-020-00597-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Equity in health care financing has gained increased attention in low- and middle-income countries (LMICs) following the renewed global interest in universal health coverage (UHC), a key component of the sustainable development goals (SDGs). UHC requires that people have access to the health services they need without risking financial hardship. Health financing is central to UHC and many LMICs have initiated reforms to align their health financing systems with the goals of UHC. Evaluation of the equity impact of these reforms has become a growing area of research, especially in countries with large health inequalities where the pressure to move towards UHC is most intense and the need for evidence to inform policy most critical. However, current analytical tools for evaluating equity in health financing conspicuously exclude indicators of quality, an important dimension of UHC. The aim of this paper was to address this critical methodological gap by introducing quality scores into benefit incidence analysis (BIA), one of the key techniques for assessing equity in health financing. BIA measures the extent to which different socioeconomic groups benefit from public spending on health care through their use of health services. The benefit (public subsidy) is captured in monetary terms by multiplying the quantity of a particular health service consumed by the unit cost of that service and subtracting any out-of-pocket costs incurred while using the service. It does not account for variations in the quality of health services in the computation of the public subsidy.
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Affiliation(s)
- Augustine Asante
- School of Public Health and Community Medicine, University of New South Wales (UNSW) Sydney, Room 238, Level 2 Samuels Building, Sydney, NSW, 2052, Australia.
| | - Nicola Man
- National Drug and Alcohol Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia
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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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Xu TL, Ao MY, Zhou X, Zhu WF, Nie HY, Fang JH, Sun X, Zheng B, Chen XF. China's practice to prevent and control COVID-19 in the context of large population movement. Infect Dis Poverty 2020; 9:115. [PMID: 32814591 PMCID: PMC7435224 DOI: 10.1186/s40249-020-00716-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/07/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The emerging infectious disease, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), poses a serious threat in China and worldwide. Challenged by this serious situation, China has taken many measures to contain its transmission. This study aims to systematically review and record these special and effective practices, in hope of benefiting for fighting against the ongoing worldwide pandemic. METHODS The measures taken by the governments was tracked and sorted on a daily basis from the websites of governmental authorities (e.g. National Health Commission of the People's Republic of China). And the measures were reviewed and summarized by categorizations, figures and tables, showing an ever-changing process of combating with an emerging infectious disease. The population shift levels, daily local new diagnosed cases, daily mortality and daily local new cured cases were used for measuring the effect of the measures. RESULTS The practices could be categorized into active case surveillance, rapid case diagnosis and management, strict follow-up and quarantine of persons with close contacts, and issuance of guidance to help the public understand and adhere to control measures, plus prompt and effective high-level policy decision, complete activation of the public health system, and full involvement of the society. Along with the measures, the population shift levels, daily local new diagnosed cases, and mortality were decreased, and the daily local new cured cases were increased in China. CONCLUSIONS China's practices are effective in controlling transmission of SARS-CoV-2. Considering newly occurred situations (e.g. imported cases, work resumption), the control measures may be adjusted.
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Affiliation(s)
- Tie-Long Xu
- Evidence-based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, P. R. China
| | - Mei-Ying Ao
- Evidence-based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, P. R. China
| | - Xu Zhou
- Evidence-based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, P. R. China
| | - Wei-Feng Zhu
- Evidence-based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, P. R. China
| | - He-Yun Nie
- Evidence-based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, P. R. China
| | - Jian-He Fang
- Evidence-based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, P. R. China
| | - Xin Sun
- Evidence-based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, P. R. China. .,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, P. R. China.
| | - Bin Zheng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, and National Center for Tropical Diseases Research, Shanghai, People's Republic of China.
| | - Xiao-Fan Chen
- Evidence-based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang City, Jiangxi Province, P. R. China.
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Ganju A, Goulart AC, Ray A, Majumdar A, Jeffers BW, Llamosa G, Cañizares H, Ramos-Cañizares IJ, Fadhil I, Subramaniam K, Lim LL, El Bizri L, Ramesh M, Guilford M, Ali R, Devi RD, Malik RA, Potkar S, Wang YP. Systemic Solutions for Addressing Non-Communicable Diseases in Low- and Middle-Income Countries. J Multidiscip Healthc 2020; 13:693-707. [PMID: 32801732 PMCID: PMC7394587 DOI: 10.2147/jmdh.s252300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022] Open
Abstract
Non-communicable diseases (NCDs) have been on the rise in low- and middle-income countries (LMICs) over the last few decades and represent a significant healthcare concern. Over 85% of "premature" deaths worldwide due to NCDs occur in the LMICs. NCDs are an economic burden on these countries, increasing their healthcare expenditure. However, targeting NCDs in LMICs is challenging due to evolving health systems and an emphasis on acute illness. The major issues include limitations with universal health coverage, regulations, funding, distribution and availability of the healthcare workforce, and availability of health data. Experts from across the health sector in LMICs formed a Think Tank to understand and examine the issues, and to offer potential opportunities that may address the rising burden of NCDs in these countries. This review presents the evidence and posits pragmatic solutions to combat NCDs.
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Affiliation(s)
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Amrit Ray
- Research, Development and Medical, Upjohn - a Pfizer Division, New York, NY, USA
| | - Anurita Majumdar
- Research, Development and Medical, Emerging Markets, Upjohn - a Pfizer Division, Singapore
| | - Barrett W Jeffers
- Research, Development and Medical, Upjohn - a Pfizer Division, New York, NY, USA
| | - Gloria Llamosa
- Mexican Neurology and Psychiatry Society, Mexico City, Mexico
| | - Henry Cañizares
- Vicente Sotto Memorial Medical Center, Cebu City, Philippines
| | | | | | - Kannan Subramaniam
- Research, Development and Medical, Upjohn - a Pfizer Division, Sydney, Australia
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Luna El Bizri
- School of Pharmacy, Lebanese University, Hadath, Lebanon
| | - M Ramesh
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | | | - Raghib Ali
- Public Health Research Center, New York University, Abu Dhabi, United Arab Emirates
| | - Ratna Duddi Devi
- Executive Office, DakshamA Health and Education, Gurgaon, India.,Board of Directors, International Alliance of Patient Organizations, London, England
| | | | - Shekhar Potkar
- Research, Development and Medical, Upjohn - a Pfizer Division, Dubai, United Arab Emirates
| | - Yuan-Pang Wang
- Instituto de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Castillo-Carandang NT, Buenaventura RD, Chia YC, Do Van D, Lee C, Duong NL, Ng CH, Robles YR, Santoso A, Sigua HS, Sukonthasarn A, Tan R, Viora E, Zakaria H, Brizuela GE, Ratnasingham P, Thomas M, Majumdar A. Moving Towards Optimized Noncommunicable Disease Management in the ASEAN Region: Recommendations from a Review and Multidisciplinary Expert Panel. Risk Manag Healthc Policy 2020; 13:803-819. [PMID: 32765135 PMCID: PMC7371561 DOI: 10.2147/rmhp.s256165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality in the Association of Southeast Asian Nations (ASEAN) member states. Progress has been slow despite the World Health Organization action plan for the prevention and control of NCDs in the region. This paper presents recommendations focused on practical strategies for optimizing NCD management in the ASEAN region. Methods A multidisciplinary group of experts from six ASEAN member states convened for two face-to-face meetings to discuss barriers and possible recommendations for optimizing NCD management, focused on cardiovascular diseases and mental disorders, in the region. Multiple approaches, ie, analysis of insights from the meetings and a review of existing literature on NCD programs in the ASEAN region were followed. The proposed recommendations were also based on selected successful interventions in ASEAN member states, thus providing actionable strategies. Results The gaps identified in NCD management for cardiovascular diseases and mental disorders in the ASEAN region were classified into gaps relating to policies and to clinical and public health practice. The proposed solutions addressing policy gaps include fostering multisectoral public–private partnerships, employing “whole-of-government” and “whole-of-society” approaches and promoting “health-in-all policies approach” to manage issues with financing, accessibility, efficiency and quality of health services. Whereas proposed solutions to bridge clinical and public health practice gaps entail strengthening primary care services, building the capacity of trained healthcare workers and employing collaborative care for holistic management of patients. Conclusion The scale of premature and preventable deaths from NCDs in the ASEAN region remains a serious public health concern and requires a “whole-of-system approach”. The interventions proposed in this paper build on regional collaborations and knowledge sharing to help develop a concerted and targeted response to NCDs.
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Affiliation(s)
- Nina T Castillo-Carandang
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; and Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Robert D Buenaventura
- Department of Psychiatry, Manila Theological College - College of Medicine, Manila, Philippines
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Dung Do Van
- The University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore
| | - Ngoc Long Duong
- Department of Research, Education and Technology, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yolanda R Robles
- College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology, Vascular Medicine, National Cardiovascular Centre - Harapan Kita Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Helen S Sigua
- University of the Philippines Open University, Laguna, Philippines
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Roger Tan
- Roger Kidney Clinic, Gleneagles Hospital, Singapore
| | - Eka Viora
- Indonesia Psychiatrist Association, Jakarta, Indonesia
| | - Hazli Zakaria
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Grace E Brizuela
- Research, Development and Medical, Pfizer Upjohn, Manila, Philippines
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Yeoh EK, Johnston C, Chau PYK, Kiang N, Tin P, Tang J. Governance Functions to Accelerate Progress toward Universal Health Coverage (UHC) in the Asia-Pacific Region. Health Syst Reform 2020; 5:48-58. [PMID: 30924745 DOI: 10.1080/23288604.2018.1543521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Many countries in the Asia-Pacific region have committed to universal health coverage (UHC), which is reflected in both their political commitment and the governance actions they have taken in steering their health systems toward the goals of universal access to care and protection from financial hardship. Countries throughout the region are at different stages of development and have different political and governance contexts, which in turn shape how they pursue governance for UHC. This article reviews the governance functions deployed in the Asia-Pacific and finds that, in many, governance reforms adapting their health systems toward greater regulation, accountability, oversight, and stewardship of the health system have been part of their wider move toward UHC. Countries have not followed a set pattern, but shared aspects include establishing UHC as a goal in national policy making and priority setting; the creation of new roles and/or new institutions within the health system; establishing systems of monitoring and evaluation; and putting in place mechanisms to facilitate collaboration and ensure greater accountability. The relationship between governance and UHC in the Asia-Pacific region is found to be complex, negotiated, and shaped by a number of factors in both the internal and external environment, including broader governance arrangements in the public sector (institutional changes and decentralization are particularly prominent factors) and the ability of governments to implement policies and steer the health system.
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Affiliation(s)
- Eng-Kiong Yeoh
- a Jockey Club School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong , China
| | - Cathryn Johnston
- a Jockey Club School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong , China
| | - Patsy Yuen Kwan Chau
- a Jockey Club School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong , China
| | - Nicole Kiang
- a Jockey Club School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong , China
| | - Pamela Tin
- a Jockey Club School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong , China.,b Our Hong Kong Foundation , Hong Kong , China
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Sajo MEJV, Teves JMY, Corachea AJM, Diaz LA, Chan AFO, Valparaiso AP, Dy Echo AVV, Macalindong SS, Uy GLB, Dofitas RB, Habana MAE, Gerona RR, Irwin JC, Giudice LC, Velarde MC. A Pilot Cancer-Phenome Biobanking System in a Low-Resource Southeast Asian Setting: The Philippine General Hospital Biobank Experience. Biopreserv Biobank 2020; 18:180-188. [PMID: 32202927 DOI: 10.1089/bio.2019.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Biobanking has become an indispensable tool for translational research and health innovations. While the field of biobanking has progressed and evolved globally, biobanking in developing Association of Southeast Asian Nations (ASEAN) countries such as the Philippines remains underrepresented because of several challenges often encountered in these low- and middle-income countries. Recently, the Philippine government has undertaken enormous efforts to advancing research and development in the country, and one of the current research pursuits is the establishment of biobanks, with the hope of attaining more discoveries and innovations in the future. Given that cancer remains a leading cause of death in the Philippines, the Philippine government supported the establishment of a cancer biobank at the Philippine General Hospital (PGH). In this study, we present a specific use case of biobanking activity at the PGH Biobank, to build a cohort of biospecimens from Filipino patients with breast, endometrial, and ovarian cancer. This initiative is part of a biomonitoring study (1) to assess environmental exposures and possible risk factors in the Philippine population and (2) to develop a system of culturing human cells from Filipino patients for subsequent in vitro studies. We discuss issues faced and the solutions developed during the implementation of the biobank. Strong research collaboration, a funding source, basic infrastructure, and appropriate technology helped initiate this pilot biobank in the Philippines. Overall, the experiences of establishing the PGH Biobank may help other institutions in low-resource countries to set up cancer biobanks.
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Affiliation(s)
- Ma Easter Joy V Sajo
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Joji Marie Y Teves
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Allen Joy M Corachea
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Leomir A Diaz
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Alison Faye O Chan
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Apple P Valparaiso
- Department of General Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Ana Victoria V Dy Echo
- Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Shiela S Macalindong
- Department of General Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Gemma Leonora B Uy
- Department of General Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Rodney B Dofitas
- Department of General Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Ma Antonia E Habana
- Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Roy R Gerona
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Juan C Irwin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Michael C Velarde
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
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Ng JYS, Ramadani RV, Hendrawan D, Duc DT, Kiet PHT. National Health Insurance Databases in Indonesia, Vietnam and the Philippines. PHARMACOECONOMICS - OPEN 2019; 3:517-526. [PMID: 30859490 PMCID: PMC6861401 DOI: 10.1007/s41669-019-0127-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Social health insurance administrative databases were established in Indonesia, Vietnam and the Philippines in 2014, 2017 and 2012, respectively; however, these databases have been scarcely used for research, if at all. This study explored the feasibility and accessibility of using these databases for scientific research, highlighting challenges and barriers in their use. METHODOLOGY The databases included in this evaluation comprised the Jaminan Kesehatan Nasional (JKN) from Indonesia, Vietnam Health Insurance Scheme (VHIS) from Vietnam and PhilHealth from the Philippines. These databases were qualitatively assessed based on the data capture, potential linkage to other databases or registries, data access and extraction, privacy and security, and quality and validation procedures. RESULTS All databases contain population-based cohort data on the medical costs of reimbursed medical conditions, identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Linkage to other national databases, ensuring protection of patient privacy data, would improve their usability. Duration to database access and data extraction varies from country to country. The main limitations of all databases include the short span of data records, and the unknown degree of internal validity. Both JKN and PhilHealth databases capture bundled claims, inherently excluding information on prescriptions and out-of-pocket expenditure. Due to the recent establishment of the VHIS database, it may not be suitable for studies that intend to explore trends. CONCLUSION The JKN, VHIS and PhilHealth databases offer population-based, financial, utilization, and demographic data, which could provide valuable epidemiological and pharmacoeconomic insights if the findings are interpreted within the limitations of each database.
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Affiliation(s)
- Junice Yi Siu Ng
- Real-World Insights, IQVIA Asia-Pacific, 79 Anson Road, #19-01, Singapore, 079906, Singapore.
| | - Royasia Viki Ramadani
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Beji, Kota Depok, Jawa Barat, Indonesia
| | - Donni Hendrawan
- Primary Health Care Financing, Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | - Duong Tuan Duc
- North Center for Medical Review and Tertiary Care Payment, Vietnam Social Security, Hanoi, Vietnam
| | - Pham Huy Tuan Kiet
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
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Barua P, Bangpan M, Narattharaksa K, Suphanchaimat R, Chaiyakunapruk N. Healthcare Policies for Stateless Populations in ASEAN Countries: A Scoping Review. J Immigr Minor Health 2019; 22:597-620. [PMID: 31741181 DOI: 10.1007/s10903-019-00945-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed at summarizing the existing health policies for stateless populations living in the 10 ASEAN countries: Brunei, Cambodia, Lao PDR, Indonesia, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam. We followed scoping review method recommended by Arksey and O'Malley. Our inclusion criteria were based on three concepts: populations (stateless and undocumented people), issues (healthcare policies and regulations), and settings (10 ASEAN countries). Our findings suggest that none of the ASEAN countries have explicit healthcare policies for stateless people except Thailand. We also observed that ratification of international human rights treaties relating to the right to health does not necessarily translate into the provision of healthcare policies for stateless population. Although Thailand seems like the only country among 10 ASIAN countries having health policies for stateless populations in the country, the question remains whether having a policy would lead to a proper implementation by ensuring right to health.
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Affiliation(s)
- Proloy Barua
- Health Systems Management, Graduate School, Naresuan University, Phitsanulok, 65000, Thailand
- Independent Evaluation and Research Cell (IERC), BRAC International, 75 Mohakhali, Dhaka, 1212, Bangladesh
| | - Mukdarut Bangpan
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Department of Social Science, UCL Institute of Education, 20 Bedford Way, London, WC1H 0AL, UK
| | - Kanida Narattharaksa
- Health Systems Management, Graduate School, Naresuan University, Phitsanulok, 65000, Thailand
- Faculty of Medical Science, Naresuan University, Phitsanulok, 65000, Thailand
| | - Rapeepong Suphanchaimat
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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Bakar NSA, Manual A, Hamid JA. Socioeconomic Status Affecting Inequity of Healthcare Utilisation in Malaysia. Malays J Med Sci 2019; 26:79-85. [PMID: 31496896 PMCID: PMC6719882 DOI: 10.21315/mjms2019.26.4.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/02/2019] [Indexed: 12/29/2022] Open
Abstract
Background Equity is one of the important aspects of universal health coverage. Variation in socioeconomic status (SES) has been proved to contribute discrepancies in the use of healthcare services. This study aimed to assess equity for inpatient, outpatient and dental care utilisation by household SES over time. Methods This study used five series of National Health and Morbidity Survey data from 1986 to 2015. Healthcare utilisation for inpatient, outpatient and dental care were analysed. SES was grouped based on household expenditure variables accounting for total number of adults and children in the household using consumption per adult equivalents approach. The determination of healthcare utilisation across the SES segments was measured using concentration index. Results The overall distribution of inpatient utilisation tended towards the pro-poor, although only data from 1996 (P-value = 0.017) and 2006 (P-value = 0.021) were statistically significant (P < 0.05). Out-patient care showed changing trends from initially being pro-rich in 1986 (P < 0.05), then gradually switching to pro-poor in 2015 (P < 0.05). Dental care utilisation was significantly pro-rich throughout the survey period (P < 0.05). Public providers mostly showed significantly pro-poor trends for both in- and out-patient care (P < 0.05). Private providers, meanwhile, constantly showed a significantly pro-rich (P < 0.05) trend of utilisation. Conclusion Total health utilisation was close to being equal across SES throughout the years. However, this overall effect exhibited inequities as the effect of pro-rich utilisation in the private sector negated the pro-poor utilisation in the public sector. Strategies to improve equity should be consistent by increasing accessibility to the private sectors, which has been primarily dominated by the richest population.
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Affiliation(s)
- Nurul Salwana Abu Bakar
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Adilius Manual
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Jabrullah Ab Hamid
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
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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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Cuadrado C, Crispi F, Libuy M, Marchildon G, Cid C. National Health Insurance: A conceptual framework from conflicting typologies. Health Policy 2019; 123:621-629. [PMID: 31151828 DOI: 10.1016/j.healthpol.2019.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/17/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Abstract
In the path to universal health coverage, policymakers discuss different alternative health system's financing schemes. Classical typologies have been posited, including models such as National Health Service, Social Health Insurance and Private Health Insurance. More recently, National Health Insurance (NHI) has been suggested as a separate model. Nevertheless, there are discrepancies regarding what defines an NHI model. The purpose of this article is to propose a comprehensive definition of an NHI model, aimed to disentangle the current discrepancies in the conceptualization and the scope of this type of arrangement. Based on the previous literature we identified some common characteristics across NHI definitions, namely universal coverage, pooling in a single fund and a purchasing function based on a single-payer financing mechanism. Areas of controversy were also identified. While some authors emphasized the importance of an effective separation between the purchaser and provider functions, others highlighted the relative importance of privately-owned provision to define a system like NHI-type. Based on empirical data, we suggest that the ownership is not a critical variable to distinguish an NHI from other models, and instead, suggest that a pivotal characteristic of the NHI is the single payer mechanism that is not integrated with the health providers.
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Affiliation(s)
- Cristóbal Cuadrado
- Programa de Políticas, Sistemas y Gestión en Salud, School of Public Health, University of Chile, Chile.
| | - Francisca Crispi
- Programa de Políticas, Sistemas y Gestión en Salud, School of Public Health, University of Chile, Chile
| | - Matías Libuy
- Programa de Políticas, Sistemas y Gestión en Salud, School of Public Health, University of Chile, Chile
| | - Gregory Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Camilo Cid
- Health Services and Access Unit (HSS/HS), Pan American Health Organization, United States
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Myint CY, Pavlova M, Groot W. Patterns of health care use and out-of-pocket payments among general population and social security beneficiaries in Myanmar. BMC Health Serv Res 2019; 19:258. [PMID: 31029112 PMCID: PMC6486983 DOI: 10.1186/s12913-019-4071-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/08/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND As a consequence of the low government expenditure and limited access to health insurance offered by the Social Security Scheme (SSS), out-of-pocket payments (OOPPs) have become the main source of payment for health care in Myanmar. This study aims to provide evidence on the patterns of health care use and OOPPs by the general population and SSS beneficiaries in Myanmar. METHOD Face-to-face interviews were conducted among two samples drawn independently of each other. The first sample, the general population sample of persons not insured by SSS, was drawn from the general population in the Yangon Region. The second sample, the SSS sample, was drawn from those possessing SSS insurance. The data were analyzed per sample. Mann-Whitney U tests were applied to compare ordinal variables and independent sample t-tests were applied to compare continuous variables between the two samples. Two-step cluster analysis was applied to identify clusters of respondents with similar patterns of health care use and OOPPs. After the clustering procedure, we used regression analysis to examine the association between socio-demographic characteristics and cluster membership (patterns of health care use and OOPPs) for the two samples separately. RESULTS Only 23% of those who belonged to the SSS sample and sought health care during the past 12 months, report receiving health care from a SSS clinic during the last episode of illness. Close distance is the main reason for choosing a specific health facility in both samples. OOPPs for health care and pharmaceuticals, used during the last episode of illness are significantly higher in the general population sample. The regression analysis shows that the pattern of health care use is significantly associated with household income. In addition, respondents in the general population sample with a higher income pay higher amounts for their last health care used and were significantly more likely to have to borrow money or sell assets as a coping strategy to cover the payments. CONCLUSION Significantly higher OOPPs in the general population sample highlight the need of financial protection among this group. Myanmar needs to extend social protection for both coverage breadths and coverage depth.
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Affiliation(s)
- Chaw-Yin Myint
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Water, Research and Training Center (WRTC), Yangon, Myanmar
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Wim Groot
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Kunaviktikul W, Guptarak M. Networking for local and global change: The Southeast and East Asian Nursing Education and Research Network. Nurs Health Sci 2019; 21:1-3. [PMID: 30821417 DOI: 10.1111/nhs.12592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Marisa Guptarak
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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Lee Y, Kim S, Kim SY, Kim G. Ethical Consideration of National Health Insurance Reform for Universal Health Coverage in the Republic of Korea. Asian Bioeth Rev 2019; 11:41-56. [PMID: 33717299 PMCID: PMC7747280 DOI: 10.1007/s41649-019-00079-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 10/26/2022] Open
Abstract
In the current era of the Sustainable Development Goals (SDGs), many countries are attempting to strengthen their health system and achieving Universal Health Coverage (UHC). The Korean National Health Insurance (NHI) system functions as a core element of health financing, contributing to achieving UHC by promoting public health and social security through insurance benefits for prevention, diagnosis, treatment, rehabilitation, childbirth, and health promotion. The Republic of Korea achieved 100% NHI coverage of the target population in 1989, 12 years after the introduction of the social insurance system. However, poor coverage of health services and lack of financial protection are major obstacles to achieving UHC. Therefore, the Korean government announced and implemented 'Moon Jae-in Care' in August 2017 to enhance the coverage rate of NHI by 70%. First, this study reviews the existing health insurance system in Korea from the perspective of health financing and UHC. Second, it analyses 'Moon Jae-in Care', based on the main framework of UHC. Third, it considers the ethical implications of these developments, with focus on the principles of equity, fairness, autonomy, and solidarity. Although the NHI reform is expected to propel Korean health care closer to UHC, many ethical, social, and political issues remain.
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Affiliation(s)
- Yuri Lee
- Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, Republic of Korea
- Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Siwoo Kim
- Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, Republic of Korea
| | - So Yoon Kim
- Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, Republic of Korea
- Department of Medical Law and Ethics, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Ganglip Kim
- Office for Planning and Coordination, Ministry of Health and Welfare, Sejong, Republic of Korea
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Te V, Griffiths R, Law K, Hill PS, Annear PL. The impact of ASEAN economic integration on health worker mobility: a scoping review of the literature. Health Policy Plan 2018; 33:957-965. [PMID: 30289511 DOI: 10.1093/heapol/czy071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2018] [Indexed: 12/14/2022] Open
Abstract
The Association of Southeast Asian Nations (ASEAN) Economic Community (AEC) was inaugurated in December 2015 with the primary aim of achieving a strong and prosperous community through accelerating economic integration. The notion of a single market, underpinned by the free flow of trade in services and skilled labour, is integral to the spirit of the AEC. To facilitate the intra-regional mobility of health professionals, Mutual Recognition Arrangements (MRAs) were signed, for nursing in 2006 and for medicine and dentistry in 2009, and now sit within the AEC objectives. This study examines the observed and potential impact of the health-related MRAs on health worker mobility within the region, particularly with regard to qualified doctors and nurses. To explore the available evidence, the authors undertook a narrative literature and document review, consistent with the RAMESES guidelines for qualitative research in international development and policy making in the area of health. Peer-reviewed articles and the grey literature from the period beginning in 2005 were reviewed. We find that the implementation of health-related MRAs has been slow and complex due to a number of barriers and challenges, such as resistance to the inflow of health professionals by the local workforce, shortcomings in the implementing mechanisms and an individual preference among health professionals for seeking better opportunities outside the region. Despite increasing worker mobility generally within ASEAN through formal and informal mechanisms, the MRAs themselves do not appear yet to have facilitated the freer movement of health workers. To strengthen health worker mobility, the full implementation of the health-related MRAs is essential, requiring support from broader trade and immigration policies and a stronger political commitment. Policy makers in ASEAN Member States will need to manage competing national interests in order to harness support for effective implementation.
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Affiliation(s)
- Vannarath Te
- School of Public Health, The University of Queensland, Level 2, Public Health Building (887) Corner of Herston Road and Wyndham Street, Herston, Brisbane, QLD, Australia.,National Institute of Public Health, Ministry of Health, Cambodia
| | - Rachel Griffiths
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Kristy Law
- School of Public Health, The University of Queensland, Level 2, Public Health Building (887) Corner of Herston Road and Wyndham Street, Herston, Brisbane, QLD, Australia
| | - Peter S Hill
- School of Public Health, The University of Queensland, Level 2, Public Health Building (887) Corner of Herston Road and Wyndham Street, Herston, Brisbane, QLD, Australia
| | - Peter Leslie Annear
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Chong HY, Allotey PA, Chaiyakunapruk N. Current landscape of personalized medicine adoption and implementation in Southeast Asia. BMC Med Genomics 2018; 11:94. [PMID: 30367635 PMCID: PMC6203971 DOI: 10.1186/s12920-018-0420-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/11/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The emergence of personalized medicine (PM) has raised some tensions in healthcare systems. PM is expensive and health budgets are constrained - efficient healthcare delivery is therefore critical. Notwithstanding the cost, many countries have started to adopt this novel technology, including resource-limited Southeast Asia (SEA) countries. This study aimed to describe the status of PM adoption in SEA, highlight the challenges and to propose strategies for future development. METHODS The study included scoping review and key stakeholder interviews in four focus countries - Indonesia, Malaysia, Singapore, and Thailand. The current landscape of PM adoption was evaluated based on an assessment framework of six key themes - healthcare system, governance, access, awareness, implementation, and data. Six PM programs were evaluated for their financing and implementation mechanisms. RESULTS The findings revealed SEA has progressed in adopting PM especially Singapore and Thailand. A regional pharmacogenomics research network has been established. However, PM policies and programs vary significantly. As most PM programs are champion-driven and the available funding is limited, the current PM distribution has the potential to widen existing health disparities. Low PM awareness in the society and the absence of political support with financial investment are fundamental barriers. There is a clear need to broaden opportunities for critical discourse about PM especially for policymakers. Multi-stakeholder, multi-country strategies need to be prioritized in order to leverage resources and expertise. CONCLUSIONS Adopting PM remains in its infancy in SEA. To achieve an effective PM adoption, it is imperative to balance equity issues across diverse populations while improving efficiency in healthcare.
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Affiliation(s)
- Huey Yi Chong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor Malaysia
| | - Pascale A. Allotey
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor Malaysia
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, University of Wisconsin, Madison, USA
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Malaysia
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Madyaningrum E, Chuang YC, Chuang KY. Factors associated with the use of outpatient services among the elderly in Indonesia. BMC Health Serv Res 2018; 18:707. [PMID: 30200949 PMCID: PMC6131867 DOI: 10.1186/s12913-018-3512-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 08/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background Elderly people tend to have greater healthcare utilization because of their health status. However, with the 4th largest population in the world, little is known concerning the use of services among the Indonesian elderly. Hence, this study aimed to identify factors related to the use of outpatient services among the Indonesian elderly. Methods This is cross sectional study using data from the Indonesian Family Life Survey 5 (IFLS 5), conducted in 2014 and 2015. Only those who were 60 years or older were included in the analyses. We used a logistic regression analysis to determine factors associated with use of outpatient services. Results Among 2912 participants, only 22.7% of respondents had visited health workers or doctors within the previous 4 weeks before the survey. After controlling for other variables, factors associated with the use of outpatient services were socioeconomic status, insurance status, regions of residence, self-rated health, and the number of chronic conditions. Conclusion Inequality in outpatient services was observed among the elderly in Indonesia. More effort is need to expand insurance coverage for the elderly, particularly for those in the lower economic status, and to improve access to outpatient services in rural regions by allocating the needed resources.
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Affiliation(s)
- Ema Madyaningrum
- School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11014, Taiwan.,School of Nursing, Faculty of Medicine, Universitas Gadjah Mada, Farmako Street, Sekip Utara, Yogyakarta, 55281, Indonesia
| | - Ying-Chih Chuang
- School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11014, Taiwan
| | - Kun-Yang Chuang
- School of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11014, Taiwan.
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Venkatason P, Zaharan NL, Ismail MD, Wan Ahmad WA, Mahmood Zuhdi AS. Trends and variations in the prescribing of secondary preventative cardiovascular therapies for non-ST elevation myocardial infarction (NSTEMI) in Malaysia. Eur J Clin Pharmacol 2018; 74:953-960. [PMID: 29582106 PMCID: PMC5999133 DOI: 10.1007/s00228-018-2451-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Information is lacking on prescribing of preventative cardiovascular pharmacotherapies for patients with non-ST elevation myocardial infarction (NSTEMI) in the Asian region. This study examined the prescribing rate of these pharmacotherapies, comparing NSTEMI to STEMI, and variations across demographics and clinical factors within the NSTEMI group in the multi-ethnic Malaysian population. METHODS This is a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome registry from year 2006 to 2013 (n = 30,873). On-discharge pharmacotherapies examined were aspirin, ADP-antagonists, statins, ACE-inhibitors, angiotensin-II-receptor blockers, and beta-blockers. Multivariate logistic regression was used to calculate adjusted odds ratio of receiving individual pharmacotherapies according to patients' characteristics in NSTEMI patients (n = 11,390). RESULTS Prescribing rates for cardiovascular pharmacotherapies had significantly increased especially for ADP-antagonists (76%) in NSTEMI patients. More than 85% were prescribed statins and antiplatelets but rates remained significantly lower compared to STEMI. Women and those over 65 years old were less likely to be prescribed these pharmacotherapies compared to men and younger NSTEMI patients. Chinese and Indians were more likely to receive selected pharmacotherapies compared to Malays (main ethnicity). Geographical variations were observed; East Malaysian (Malaysian Borneo) patients were less likely to receive these compared to Western region of Malaysian Peninsular. Underprescribing in patients with risk factors such as diabetes were observed with other co-morbidities influencing prescribing selectively. CONCLUSION This study uncovers demographic and clinical variations in cardiovascular pharmacotherapies prescribing for NSTEMI. Concerted efforts by policy makers, specialty societies, and physicians are required focusing on elderly, women, Malays, East Malaysians, and high-risk patients.
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Affiliation(s)
- Padmaa Venkatason
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nur Lisa Zaharan
- Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Muhammad Dzafir Ismail
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Fadlallah R, El-Jardali F, Hemadi N, Morsi RZ, Abou Samra CA, Ahmad A, Arif K, Hishi L, Honein-AbouHaidar G, Akl EA. Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review. Int J Equity Health 2018; 17:13. [PMID: 29378585 PMCID: PMC5789675 DOI: 10.1186/s12939-018-0721-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Community-based health insurance (CBHI) has evolved as an alternative health financing mechanism to out of pocket payments in low- and middle-income countries (LMICs), particularly in areas where government or employer-based health insurance is minimal. This systematic review aimed to assess the barriers and facilitators to implementation, uptake and sustainability of CHBI schemes in LMICs. METHODS We searched six electronic databases and grey literature. We included both quantitative and qualitative studies written in English language and published after year 1992. Two reviewers worked in duplicate and independently to complete study selection, data abstraction, and assessment of methodological features. We synthesized the findings based on thematic analysis and categorized according to the ecological model into individual, interpersonal, community and systems levels. RESULTS Of 15,510 citations, 51 met the eligibility criteria. Individual factors included awareness and understanding of the concept of CBHI, trust in scheme and scheme managers, perceived service quality, and demographic characteristics, which influenced enrollment and sustainability. Interpersonal factors such as household dynamics, other family members enrolled in the scheme, and social solidarity influenced enrollment and renewal of membership. Community-level factors such as culture and community involvement in scheme development influenced enrollment and sustainability of scheme. Systems-level factors encompassed governance, financial and delivery arrangement. Government involvement, accountability of scheme management, and strong policymaker-implementer relation facilitated implementation and sustainability of scheme. Packages that covered outpatient and inpatient care and those tailored to community needs contributed to increased enrollment. Amount and timing of premium collection was reported to negatively influence enrollment while factors reported as threats to sustainability included facility bankruptcy, operating on small budgets, rising healthcare costs, small risk pool, irregular contributions, and overutilization of services. At the delivery level, accessibility of facilities, facility environment, and health personnel influenced enrollment, service utilization and dropout rates. CONCLUSION There are a multitude of interrelated factors at the individual, interpersonal, community and systems levels that drive the implementation, uptake and sustainability of CBHI schemes. We discuss the implications of the findings at the policy and research level. TRIAL REGISTRATION The review protocol is registered in PROSPERO International prospective register of systematic reviews (ID = CRD42015019812 ).
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Affiliation(s)
- Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Review in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Review in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Nour Hemadi
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Review in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Rami Z. Morsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Clara Abou Abou Samra
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ali Ahmad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khurram Arif
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lama Hishi
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Elie A. Akl
- Center for Systematic Review in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Ability to Pay for Future National Health Financing Scheme among
Malaysian Households. Ann Glob Health 2017; 83:654-660. [DOI: 10.1016/j.aogh.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/17/2017] [Indexed: 11/20/2022] Open
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Suphanchaimat R, Pudpong N, Tangcharoensathien V. Extreme exploitation in Southeast Asia waters: Challenges in progressing towards universal health coverage for migrant workers. PLoS Med 2017; 14:e1002441. [PMID: 29166397 PMCID: PMC5699792 DOI: 10.1371/journal.pmed.1002441] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Rapeepong Suphanchaimat and colleagues present the plight of migrant workers in the fishing industry in Southeast Asia and discuss challenges in providing for their health and safety.
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Affiliation(s)
- Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
- Banphai Hospital, Khon Kaen, Thailand
- * E-mail:
| | - Nareerut Pudpong
- Healthcare Accreditation Institute (Public Organization), Ministry of Public Health, Nonthaburi, Thailand
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Virani S, Bilheem S, Chansaard W, Chitapanarux I, Daoprasert K, Khuanchana S, Leklob A, Pongnikorn D, Rozek LS, Siriarechakul S, Suwanrungruang K, Tassanasunthornwong S, Vatanasapt P, Sriplung H. National and Subnational Population-Based Incidence of Cancer in Thailand: Assessing Cancers with the Highest Burdens. Cancers (Basel) 2017; 9:E108. [PMID: 28817104 PMCID: PMC5575611 DOI: 10.3390/cancers9080108] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 12/20/2022] Open
Abstract
In Thailand, five cancer types-breast, cervical, colorectal, liver and lung cancer-contribute to over half of the cancer burden. The magnitude of these cancers must be quantified over time to assess previous health policies and highlight future trajectories for targeted prevention efforts. We provide a comprehensive assessment of these five cancers nationally and subnationally, with trend analysis, projections, and number of cases expected for the year 2025 using cancer registry data. We found that breast (average annual percent change (AAPC): 3.1%) and colorectal cancer (female AAPC: 3.3%, male AAPC: 4.1%) are increasing while cervical cancer (AAPC: -4.4%) is decreasing nationwide. However, liver and lung cancers exhibit disproportionately higher burdens in the northeast and north regions, respectively. Lung cancer increased significantly in northeastern and southern women, despite low smoking rates. Liver cancers are expected to increase in the northern males and females. Liver cancer increased in the south, despite the absence of the liver fluke, a known factor, in this region. Our findings are presented in the context of health policy, population dynamics and serve to provide evidence for future prevention strategies. Our subnational estimates provide a basis for understanding variations in region-specific risk factor profiles that contribute to incidence trends over time.
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Affiliation(s)
- Shama Virani
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand.
- Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Surichai Bilheem
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand.
| | - Wasan Chansaard
- Cancer Registry Unit, Surat Thani Cancer Hospital, Surath Thani 84100, Thailand.
| | - Imjai Chitapanarux
- Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
| | | | | | - Atit Leklob
- Cancer Unit, Lopburi Cancer Center, Lopburi 15000, Thailand.
| | - Donsuk Pongnikorn
- Cancer Registry Unit, Lampang Cancer Hospital, Lampang 52000, Thailand.
| | - Laura S Rozek
- Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | | | - Krittika Suwanrungruang
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
| | | | - Patravoot Vatanasapt
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand.
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Allotey PA, Allotey-Reidpath CD, Reidpath DD. Health systems implications of rare genetic conditions in low- and middle-income countries: a case study approach. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1344772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Pascale A. Allotey
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | | | - Daniel D. Reidpath
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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Kaplan WA, Ashigbie PG, Brooks MI, Wirtz VJ. Comparison of medicines management strategies in insurance schemes in middle-income countries: four case studies. J Pharm Policy Pract 2017; 10:17. [PMID: 28523128 PMCID: PMC5434642 DOI: 10.1186/s40545-017-0105-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 04/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many middle-income countries are scaling up health insurance schemes to provide financial protection and access to affordable medicines to poor and uninsured populations. Although there is a wealth of evidence on how high income countries with mature insurance schemes manage cost-effective use of medicines, there is limited evidence on the strategies used in middle-income countries. This paper compares the medicines management strategies that four insurance schemes in middle-income countries use to improve access and cost-effective use of medicines among beneficiaries. METHODS We compare key strategies promoting cost-effective medicines use in the New Rural Cooperative Medical Scheme (NCMS) in China, National Health Insurance Scheme in Ghana, Jamkesmas in Indonesia and Seguro Popular in Mexico. Through the peer-reviewed and grey literature as of late 2013, we identified strategies that met our inclusion criteria as well as any evidence showing if, and/or how, these strategies affected medicines management. Stakeholders involved and affected by medicines coverage policies in these insurance schemes were asked to provide relevant documents describing the medicines related aspects of these insurance programs. We also asked them specifically to identify publications discussing the unintended consequences of the strategies implemented. RESULTS Use of formularies, bulk procurement, standard treatment guidelines and separation of prescribing and dispensing were present in all four schemes. Also, increased transparency through publication of tender agreements and procurement prices was introduced in all four. Common strategies shared by three out of four schemes were medicine price negotiation or rebates, generic reference pricing, fixed salaries for prescribers, accredited preferred provider network, disease management programs, and monitoring of medicines purchases. Cost-sharing and payment for performance was rarely used. There was a lack of performance monitoring strategies in all schemes. CONCLUSIONS Most of the strategies used in the insurance schemes focus on containing expenditure growth, including budget caps on pharmaceutical expenditures (Mexico) and ceiling prices on medicines (all four countries). There were few strategies targeting quality improvement as healthcare providers are mostly paid through fixed salaries, irrespective of the quality of their prescribing or the health outcomes actually achieved. Monitoring healthcare system performance has received little attention.
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Affiliation(s)
- Warren A. Kaplan
- Department of Global Health, Boston University School of Public Health, Crosstown Center, Room CT-363, 801 Massachusetts Avenue, Boston, Massachusetts 02118 USA
| | - Paul G. Ashigbie
- Department of Global Health, Boston University School of Public Health, Crosstown Center, Room CT-363, 801 Massachusetts Avenue, Boston, Massachusetts 02118 USA
| | - Mohamad I. Brooks
- Department of Global Health, Boston University School of Public Health, Crosstown Center, Room CT-363, 801 Massachusetts Avenue, Boston, Massachusetts 02118 USA
- Pathfinder International, 9 Galen Street, Suite 217, Watertown, 02472 Massachusetts USA
| | - Veronika J. Wirtz
- Department of Global Health, Boston University School of Public Health, Crosstown Center, Room CT-363, 801 Massachusetts Avenue, Boston, Massachusetts 02118 USA
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