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Belrhiti Z, Bigdeli M, Lakhal A, Kaoutar D, Zbiri S, Belabbes S. Unravelling collaborative governance dynamics within healthcare networks: a scoping review. Health Policy Plan 2024; 39:412-428. [PMID: 38300250 PMCID: PMC11005841 DOI: 10.1093/heapol/czae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/02/2024] Open
Abstract
In many countries, healthcare systems suffer from fragmentation between hospitals and primary care. In response, many governments institutionalized healthcare networks (HN) to facilitate integration and efficient healthcare delivery. Despite potential benefits, the implementation of HN is often challenged by inefficient collaborative dynamics that result in delayed decision-making, lack of strategic alignment and lack of reciprocal trust between network members. Yet, limited attention has been paid to the collective dynamics, challenges and enablers for effective inter-organizational collaborations. To consider these issues, we carried out a scoping review to identify the underlying processes for effective inter-organizational collaboration and the contextual conditions within which these processes are triggered. Following appropriate methodological guidance for scoping reviews, we searched four databases [PubMed (n = 114), Web of Science (n = 171), Google Scholar (n = 153) and Scopus (n = 52)] and used snowballing (n = 22). A total of 37 papers addressing HN including hospitals were included. We used a framework synthesis informed by the collaborative governance framework to guide data extraction and analysis, while being sensitive to emergent themes. Our review showed the prominence of balancing between top-down and bottom-up decision-making (e.g. strategic vs steering committees), formal procedural arrangements and strategic governing bodies in stimulating participative decision-making, collaboration and sense of ownership. In a highly institutionalized context, the inter-organizational partnership is facilitated by pre-existing legal frameworks. HN are suitable for tackling wicked healthcare issues by mutualizing resources, staff pooling and improved coordination. Overall performance depends on the capacity of partners for joint action, principled engagement and a closeness culture, trust relationships, shared commitment, distributed leadership, power sharing and interoperability of information systems To promote the effectiveness of HN, more bottom-up participative decision-making, formalization of governance arrangement and building trust relationships are needed. Yet, there is still inconsistent evidence on the effectiveness of HN in improving health outcomes and quality of care.
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Affiliation(s)
- Zakaria Belrhiti
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
| | - Maryam Bigdeli
- World Health Organization, 3 Av. S.A.R. Sidi Mohamed, Rabat, Geneva 10170, Morocco
| | - Aniss Lakhal
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Directorate of Hospitals and Ambulatory Care, Ministry of Health and Social Protection, Route d’El Jadida, Agdal, Rabat 10100, Morocco
| | - Dib Kaoutar
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Directorate of Hospitals and Ambulatory Care, Ministry of Health and Social Protection, Route d’El Jadida, Agdal, Rabat 10100, Morocco
| | - Saad Zbiri
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
| | - Sanaa Belabbes
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
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Boukhalfa C, Ouakhzan B, Masbah H, Acharai L, Zbiri S. Investing in midwifery for sustainable development goals in low- and middle-income countries: a cost-benefit analysis. Cost Eff Resour Alloc 2024; 22:1. [PMID: 38178078 PMCID: PMC10768217 DOI: 10.1186/s12962-023-00507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/23/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Maternal and neonatal mortality in low- and middle-income countries is frequently caused by inadequate management of obstetric and neonatal complications and a shortage of skilled health workers. The availability of these workers is essential for effective and high-quality healthcare. To meet the needs of sexual, reproductive, maternal, new-born, child, and adolescent health by 2030, more than one million health workers, including 900 000 midwives, are required globally. Despite this, uncertainty persists regarding the return on investment in the health workforce. METHODS The objective of this research was to determine the cost-benefit ratio of increasing investment in midwifery in Morocco from 2021 to 2030. A comparative analysis was conducted between scenarios "with" and "without" the additional investment. The costs and benefits were estimated using relevant data from national and international sources. RESULTS Following the International Confederation of Midwives' recommendations, it is advised that Morocco recruit 760 midwives annually to achieve 95% of universal health coverage. This increase in midwifery could result in saving 120 593 lives by 2030, including reducing maternal deaths by 3 201, stillbirths by 48 399, and neonatal deaths by 68 993. The estimated economic benefit of investing in midwives was US$ 10 152 287 749, while the total cost was US$ 638 288 820. Consequently, the cost-benefit ratio was calculated as 15.91, indicating that investing in midwifery would provide 16 times more benefits than costs. CONCLUSION Increasing investment in midwifery appears to be an efficient strategy for achieving comprehensive maternal and child health coverage in low- and middle-income countries.
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Affiliation(s)
- Chakib Boukhalfa
- National School of Public Health, Rue Lamfadel Cherkaoui, Madinat Al Irfane, Rabat, BP 6329, Morocco.
| | - Brahim Ouakhzan
- Human Resources Direction, Ministry of Health and Social Protection, Rabat, Morocco
| | - Hanane Masbah
- Human Resources Direction, Ministry of Health and Social Protection, Rabat, Morocco
| | | | - Saad Zbiri
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco.
- Laboratory of Public Health, Health Economics, and Health Management, Mohammed VI Center for Research and Innovation, Rabat, Morocco.
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Zbiri S, Rozenberg P, Milcent C. Overuse of caesareans: Potential healthcare and financial benefits of prenatal education. BJOG 2024; 131:233-234. [PMID: 37387241 DOI: 10.1111/1471-0528.17584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Saad Zbiri
- Research Unit 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health" (RISCQ), UVSQ, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, American Hospital of Paris, Neuilly-sur-Seine, France
- Paris Saclay University, UVSQ, Inserm, Team U1018, Clinical Epidemiology, CESP, Montigny-le-Bretonneux, France
| | - Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Centre for Scientific Research (CNRS), Paris, France
- Paris School of Economics (PSE), Paris, France
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Abstract
Background The COVID-19 pandemic has spread rapidly to all countries with significant health, socioeconomic, and political consequences. Several safe and effective vaccines have been developed. However, it is not certain that all African countries have successfully vaccinated their populations. Objective To study the distribution and determinants of COVID-19 vaccination in Africa from March 2021 to June 2022. Methods Using reliable open-access data, we used the proportion of fully vaccinated people with a complete schedule as a reference variable. To analyze the level of inequality in COVID-19 vaccination, we computed common inequality indicators including two percentile ratios, the Generalized Entropy index, the Gini coefficient, and the Atkinson index. We also estimated the Lorenz curve. To identify drivers of COVID-19 vaccination, we estimated univariate and multivariate regression models as a function of COVID-19-related variables, demographic, epidemiologic, socioeconomic, and health system-related variables. To overcome a potential endogeneity bias, we checked our results using simultaneous equation models. Results 53 African countries with available data were included in the study. The proportion of fully vaccinated people increased during the study period. However, this increase remained unequal across African countries. Based on the inequality indicators and the Lorenz curve, inequalities in COVID-19 vaccination across African countries were high, although they have decreased in recent months. Total COVID-19 cases and human development index were identified as significant determinant factors that were independently associated with COVID-19 vaccination. Conclusions Inequality in COVID-19 vaccination in Africa was high. Promoting adequate information to the general population and providing financial and logistical support to low-income countries can help expand COVID-19 vaccination in Africa.
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Affiliation(s)
- Saad Zbiri
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca
- Laboratory of Public Health, Health Economics and Health Management, Mohammed VI Center for Research and Innovation, Rabat
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Bouaddi O, Zbiri S, Belrhiti Z. Interventions to improve migrants' access to sexual and reproductive health services: a scoping review. BMJ Glob Health 2023; 8:e011981. [PMID: 37311580 DOI: 10.1136/bmjgh-2023-011981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Migrants' access to sexual and reproductive health (SRH) services is constrained by several individual, organisational and structural barriers. To address these barriers, many interventions have been developed and implemented worldwide to facilitate the access and utilisation of SRH services for migrant populations. The aim of this scoping review was to identify the characteristics and scope of interventions, their underlying theory of change, reported outcomes and key enablers and challenges to improve access to SRH services for migrants. METHODS A scoping review was conducted according to the Arksey and O'Malley (2005) guidelines. We searched three electronic databases (MEDLINE, Scopus and Google Scholar) and carried out additional searches using manual searching and citations tracking of empirical studies addressing interventions aimed at improving access and utilisation of SRH services for migrant populations published in Arabic, French or English between 4 September 1997 and 31 December 2022. RESULTS We screened a total of 4267 papers, and 47 papers met our inclusion criteria. We identified different forms of interventions: comprehensive (multiple individual, organisational and structural components) and focused interventions addressing specific individual attributes (knowledge, attitude, perceptions and behaviours). Comprehensive interventions also address structural and organisational barriers (ie, the ability to pay). The results suggest that coconstruction of interventions enables the building of contextual sensitive educational contents and improved communication and self-empowerment as well as self-efficacy of migrant populations, and thus improved access to SRH. CONCLUSION More attention needs to be placed on participative approaches in developing interventions for migrants to improve access to SRH services.
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Affiliation(s)
- Oumnia Bouaddi
- International School of Public Health, Mohammed VI University of Health and Sciences (UM6SS), Casablanca, Morocco
- Knowledge for Health Policies Center, University Mohammed VI of Health and Sciences, (UM6SS), Casablanca, Morocco
- Mohammed VI Center for Research and Innovation, (CM6), Rabat, Morocco
| | - Saad Zbiri
- International School of Public Health, Mohammed VI University of Health and Sciences (UM6SS), Casablanca, Morocco
- Knowledge for Health Policies Center, University Mohammed VI of Health and Sciences, (UM6SS), Casablanca, Morocco
- Mohammed VI Center for Research and Innovation, (CM6), Rabat, Morocco
| | - Zakaria Belrhiti
- International School of Public Health, Mohammed VI University of Health and Sciences (UM6SS), Casablanca, Morocco
- Knowledge for Health Policies Center, University Mohammed VI of Health and Sciences, (UM6SS), Casablanca, Morocco
- Mohammed VI Center for Research and Innovation, (CM6), Rabat, Morocco
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Zbiri S, Fauconnier A, Milcent C. Delayed treatment for uterine fibroids during the COVID-19 pandemic. BJOG 2023. [PMID: 37016483 DOI: 10.1111/1471-0528.17466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Saad Zbiri
- Research Unit 7285 'Risk and Safety in Clinical Medicine for Women and Perinatal Health' (RISCQ), UVSQ, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Arnaud Fauconnier
- Research Unit 7285 'Risk and Safety in Clinical Medicine for Women and Perinatal Health' (RISCQ), UVSQ, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Obstetrics and Gynaecology, Poissy Saint-Germain Hospital, Poissy, France
| | - Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Center for Scientific Research (CNRS), Paris, France
- Paris School of Economics (PSE), Paris, France
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Zbiri S, Fauconnier A, Milcent C. Care for uterine fibroids: another casualty of the COVID pandemic. BJOG 2023; 130:321-322. [PMID: 36151919 DOI: 10.1111/1471-0528.17293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/04/2022] [Accepted: 09/12/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Saad Zbiri
- Research Unit 7285 'Risk and Safety in Clinical Medicine for Women and Perinatal Health' (RISCQ), UVSQ, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Arnaud Fauconnier
- Research Unit 7285 'Risk and Safety in Clinical Medicine for Women and Perinatal Health' (RISCQ), UVSQ, Paris-Saclay University, Montigny-le-Bretonneux, France.,Department of Gynaecology and Obstetrics, Poissy Saint-Germain Hospital, Poissy, France
| | - Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Center for Scientific Research (CNRS), Paris, France.,Paris School of Economics (PSE), Paris, France
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Conde KK, Camara AM, Jallal M, Khalis M, Zbiri S, De Brouwere V. Factors determining membership in community-based health insurance in West Africa: a scoping review. Glob Health Res Policy 2022; 7:46. [PMID: 36443890 PMCID: PMC9703663 DOI: 10.1186/s41256-022-00278-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In many low-income countries, households bear most of the health care costs. Community-based health insurance (CBHI) schemes have multiplied since the 1990s in West Africa. They have significantly improved their members' access to health care. However, a large proportion of users are reluctant to subscribe to a local CBHI. Identifying the major factors affecting membership will be useful for improving CBHI coverage. The objective of this research is to obtain a general overview of existing evidence on the determinants of CBHI membership in West Africa. METHODS A review of studies reporting on the factors determining membership in CBHI schemes in West Africa was conducted using guidelines developed by the Joanna Briggs Institute. Several databases were searched (PubMed, ScienceDirect, Global Health database, Embase, EconLit, Cairn.info, BDPS, Cochrane database and Google Scholar) for relevant articles available by August 15, 2022, with no methodological or linguistic restrictions in electronic databases and grey literature. RESULTS The initial literature search resulted in 1611 studies, and 10 studies were identified by other sources. After eliminating duplicates, we reviewed the titles of the remaining 1275 studies and excluded 1080 irrelevant studies based on title and 124 studies based on abstracts. Of the 71 full texts assessed for eligibility, 32 additional papers were excluded (not relevant, outside West Africa, poorly described results) and finally 39 studies were included in the synthesis. Factors that negatively affect CBHI membership include advanced age, low education, low household income, poor quality of care, lack of trust in providers and remoteness, rules considered too strict or inappropriate, low trust in administrators and inadequate information campaign. CONCLUSIONS This study shows many lessons to be learned from a variety of countries and initiatives that could make CBHI an effective tool for increasing access to quality health care in order to achieve universal health coverage. Coverage through CBHI schemes could be improved through communication, improved education and targeted financial support.
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Affiliation(s)
- Kaba Kanko Conde
- grid.501379.90000 0004 6022 6378International School of Public Health, Mohammed VI University of Health Sciences, Bld Mohammed Taïeb Naciri, Commune Hay Hassani, 82 403 Casablanca, Morocco
| | - Aboubacar Mariama Camara
- grid.501379.90000 0004 6022 6378International School of Public Health, Mohammed VI University of Health Sciences, Bld Mohammed Taïeb Naciri, Commune Hay Hassani, 82 403 Casablanca, Morocco
| | - Manar Jallal
- grid.501379.90000 0004 6022 6378International School of Public Health, Mohammed VI University of Health Sciences, Bld Mohammed Taïeb Naciri, Commune Hay Hassani, 82 403 Casablanca, Morocco ,grid.501379.90000 0004 6022 6378Laboratory of Public Health, Health Economics and Health Management, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Mohamed Khalis
- grid.501379.90000 0004 6022 6378International School of Public Health, Mohammed VI University of Health Sciences, Bld Mohammed Taïeb Naciri, Commune Hay Hassani, 82 403 Casablanca, Morocco ,grid.501379.90000 0004 6022 6378Laboratory of Public Health, Health Economics and Health Management, Mohammed VI University of Health Sciences, Casablanca, Morocco ,Knowledge for Health Policies Centre, Casablanca, Morocco
| | - Saad Zbiri
- grid.501379.90000 0004 6022 6378International School of Public Health, Mohammed VI University of Health Sciences, Bld Mohammed Taïeb Naciri, Commune Hay Hassani, 82 403 Casablanca, Morocco ,grid.501379.90000 0004 6022 6378Laboratory of Public Health, Health Economics and Health Management, Mohammed VI University of Health Sciences, Casablanca, Morocco ,Knowledge for Health Policies Centre, Casablanca, Morocco
| | - Vincent De Brouwere
- grid.501379.90000 0004 6022 6378International School of Public Health, Mohammed VI University of Health Sciences, Bld Mohammed Taïeb Naciri, Commune Hay Hassani, 82 403 Casablanca, Morocco ,grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium ,grid.444715.70000 0000 8673 4005School of Tropical Medicine and Global Health, University of Nagasaki, Nagasaki, Japan
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Abstract
Prior to the COVID-19 pandemic, French healthcare practitioners seldom used teleconsultations in France. COVID-19 has brought with it a great need for the use of teleconsultation and other interventions using digital technology. The study’s objective was to identify how French healthcare practitioners used teleconsultation for obstetrics and gynecology care services before and during COVID-19. Our study used a survey of French healthcare practitioners specializing in obstetrics and gynecology from 1 March 2020, to 31 April 2020. We first described the global picture of the teleconsultation context prior to COVID-19 and then during the first lockdown measures. For both contexts, we set up three aspects: 1- teleconsultation regarding providers’ ability; 2- teleconsultation with regards to its technological features; and 3- teleconsultation for which type of healthcare. Second, we mobilized logit models to study the determinant factors of teleconsultation use as well as what drives provider satisfaction with teleconsultation practice. We show the central role of training, and the importance of some main digital technology benefits, namely improving public health, responding to patients’ requests, and facilitating healthcare access. We also exhibit the importance of the limitations specifically related to the lack of convenience in digital technology use and the lack of trust in the digital service provided. Our results guide policy makers on suppliers’ motivation and needs for teleconsultation adoption. These results highlight the conditions for efficient use of teleconsultation.
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Affiliation(s)
- Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Center for Scientific Research (CNRS), Paris, France; Paris School of Economics (PSE), Paris, France
| | - Saad Zbiri
- Research Unit 7285 (RISCQ), UVSQ, Paris-Saclay University, Montigny-le-Bretonneux, France
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Milcent C, Zbiri S. Supplementary private health insurance: The impact of physician financial incentives on medical practice. Health Econ 2022; 31:57-72. [PMID: 34636088 DOI: 10.1002/hec.4443] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/17/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
In the French diagnosis-related group (DRG)-based payment system, both private and public hospitals are financed by a public single payer. Public hospitals are overcrowded and have no direct financial incentives to choose one procedure over another. If a patient has a strong preference, they can switch to a private hospital. In private hospitals, the preference does come into play, but the patient has to pay for the additional cost, for which they are reimbursed if they have supplementary private health insurance. Do financial incentives from the fees received by physicians for different procedures drive their behavior? Using French exhaustive data on delivery, we find that private hospitals perform significantly more cesarean deliveries than public hospitals. However, for patients without private health insurance, the two sectors differ much less in terms of cesareans rate. We determine the impact of the financial incentive for patients who can afford the additional cost. Affordability is mainly ensured by the reimbursement of costs by private health insurance. These findings can be interpreted as evidence that, in healthcare systems where a public single payer offers universal coverage, the presence of supplementary private insurance can contribute to creating incentives on the supply side and lead to practices and an allocation of resources that are not optimal from a social welfare perspective.
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Affiliation(s)
- Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Center for Scientific Research, Paris, France
| | - Saad Zbiri
- EA 7285, Versailles Saint Quentin University, Montigny-le-Bretonneux, France
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Zbiri S, Rozenberg P, Milcent C. Access-to-care: evidence from home-based postnatal coordinated care after hospital discharge. BMC Health Serv Res 2021; 21:1137. [PMID: 34674698 PMCID: PMC8532282 DOI: 10.1186/s12913-021-07151-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Home-based postnatal care after hospital discharge has become an integral part of postnatal care. This study aimed to determine the factors relating either to individuals or the healthcare system that affect enrollment and full participation (adherence) in the French home-based postnatal coordinated care program (PRADO). METHODS All admitted women for delivery in a French district over one year and eligible for this home-based midwifery support after hospital discharge were included (N = 4189). Both a simple probit model and a probit Heckman selection model were used. The control variables were the characteristics of the women, the municipalities, and the hospitals. RESULTS Approximately 68% of the eligible women chose to enroll in the PRADO program, of who nearly 60% fully participated in this program. Enrollment in the program was influenced mostly by the family context, such as the woman's age at the time of her pregnancy and the number of children in the household, the woman's level of prenatal education and information about postnatal care, as well as some hospital variables such as the characteristics and organization of the maternity units. Full participation in the program was influenced by the accessibility to health professionals, particularly midwives. Furthermore, the women's level of prenatal education and information about postnatal care, as well as their accessibility to health professionals, correlated with the socioeconomic environment. CONCLUSION While individual factors impacted enrollment in the PRADO program, only healthcare system-related factors influenced full participation in the program. A public health policy promoting home-based postnatal care could increase the women's participation by improving their level of prenatal education and information about postnatal care. In addition, reducing regional inequality is likely to have a positive impact, as the availability of health professionals is a key factor for participation in home-based postnatal coordinated care.
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Affiliation(s)
- Saad Zbiri
- EA 7285, Versailles Saint-Quentin University, Montigny-le-Bretonneux, France.
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco.
| | - Patrick Rozenberg
- EA 7285, Versailles Saint-Quentin University, Montigny-le-Bretonneux, France
- Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France
| | - Carine Milcent
- French National Center for Scientific Research (CNRS), Paris, France.
- Paris School of Economics (PSE), Paris, France.
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Motaib I, Zbiri S, Elamari S, Haoudar A, Chadli A, El Kettani C. Cardiovascular Risk Factors and the Severity of COVID-19 Disease. Cureus 2021; 13:e15486. [PMID: 34262822 PMCID: PMC8261192 DOI: 10.7759/cureus.15486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background and objective Several cardiovascular risk factors have emerged as important determinants of severe illness and death among coronavirus disease 2019 (COVID-19) patients. However, the full impact of these cardiovascular risk factors is still under investigation. This study aimed to investigate the association between patients' level of cardiovascular risk and the severity of COVID-19. Materials and methods This observational study included all adult patients with COVID-19 hospitalized at Sheikh Khalifa Ibn Zaid International University Hospital from March 20 to May 10, 2020. The cardiovascular risk level was assessed by the doctor responsible for each patient based on the 2019 European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS), and the European Association for the Study of Diabetes (EASD) guidelines. We examined the association between the patients' level of cardiovascular risk and their severity of COVID-19 disease by using a logistic regression model. Results Among 133 patients with confirmed COVID-19, 46.6% had a low cardiovascular risk level, 19.5% had a moderate risk level, 15.8% had a high risk level, and 18.1% was found to have a very high risk level. Patients with different cardiovascular risk levels had significantly different rates of complications including secondary infection (p-value: <0.001), acute respiratory distress syndrome (ARDS) (p-value = 0.017), intensive care unit (ICU) admission (p-value: <0.001), and death (p-value: <0.001). A patient's very high cardiovascular risk level versus low, moderate, or high cardiovascular risk level was independently associated with ICU admission [OR = 6.42, 95% CI: (1.45-28.30)]. Conclusion Based on our findings, an increased level of cardiovascular risk among patients was strongly associated with the severity of COVID-19. This study also highlights the need for assessing cardiovascular risk factors in all patients with COVID-19.
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Affiliation(s)
- Imane Motaib
- Endocrinology, Diabetes, and Metabolism, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Saad Zbiri
- Epidemiology and Public Health, Laboratory of Public Health, Health Economics, and Health Management, International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Saloua Elamari
- Endocrinology, Diabetology, Metabolic Disease, and Nutrition, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Amal Haoudar
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Asma Chadli
- Endocrinology, Diabetology, Metabolic Disease, and Nutrition, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Chafik El Kettani
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
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Abstract
Background Obesity can be associated with one or more co-morbidities that worsen the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies demonstrated that severe forms of coronavirus disease (COVID-19) have occurred in elderly patients and patients with co-morbidities such as diabetes, hypertension, and cardiovascular diseases. Objective This study investigated the impact of obesity on COVID-19 severity, irrespective of other individual factors. Methods This retrospective observational study included all adult patients with confirmed COVID-19 infection, who were admitted to Sheikh Khalifa Ibn Zaid International University Hospital between March 20 and May 10, 2020. First, we compared patients with and those without obesity in terms of demographic characteristics, co-morbidities, clinical symptoms, and outcomes. Further, using logistic regression models, we analyzed the association between obesity and intensive care unit (ICU) admission. Also, we examined whether the association between obesity and ICU admission was also consistent among overweight patients. Results The study population included 107 patients with confirmed COVID-19 infection. Obese patients have been admitted in ICU more than patients without obesity (P-value = 0.035). While adjusting for other risk factors for ICU admission, we found that obesity was an independent risk factor for ICU admission (OR = 5.04, 95% CI (1.14-22.37)). When we examined the association of both obesity and overweight with ICU admission, we found that only obesity was significantly associated with ICU admission (OR = 9.11, 95% CI (1.49-55.84)). Conclusion Our study found that obesity was strongly associated with severity of COVID-19. The risk of ICU admission is greater in the presence of obesity. Physicians should be awarded to the need of specific and early management of obese patients with COVID-19 disease.
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Affiliation(s)
- Imane Motaib
- Department of Endocrinology, Diabetology, Metabolic Disease, and Nutrition, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Saad Zbiri
- Laboratory of Public Health, Health Economics and Health Management, International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Saloua Elamari
- Department of Endocrinology, Diabetology, Metabolic Disease, and Nutrition, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Nezha Dini
- Department of Paediatrics, The International University Hospital Cheikh Khalifa Ibn Zaid, Casablanca, MAR.,Department of Paediatrics, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Asma Chadli
- Department of Endocrinology, Diabetology, Metabolic Disease, and Nutrition, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Chafik El Kettani
- Department of Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
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Elamari S, Motaib I, Zbiri S, Elaidaoui K, Chadli A, Elkettani C. Characteristics and outcomes of diabetic patients infected by the SARS-CoV-2. Pan Afr Med J 2020; 37:32. [PMID: 33209159 PMCID: PMC7648481 DOI: 10.11604/pamj.2020.37.32.25192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 01/13/2023] Open
Abstract
Diabetes is considered a risk factor for complications due to COVID-19. In order to clarify this association, we are exploring the characteristics, the clinical signs, the outcomes and death in diabetic patients with COVID-19. In this retrospective observational study we are evaluating the demographic characteristics, the comorbidities of the patients, the clinical signs of the infection, the signs of clinical severity, the biological assessment at admission, the treatment, the outcomes and the deaths of 133 patients with COVID-19, of which 25 (19,4%) had diabetes. In the compared COVID-19 patients, with and without diabetes, the patients with diabetes were older, had higher blood pressure and more cardio-vascular diseases. Severe forms were more present in diabetic patients (56% versus 27.1%). Weight loss was higher in diabetic patients (6kg versus 3kg). Biologically, diabetic patients had higher levels of C-reactive protein (28 versus 5.8mg/l), procalcitonin (0.28 versus 0,13ng/l), ferritin (501 versus 140ng/ml), lactic dehydrogenase (268 versus 226IU/l) and of D. dimer (665 versus 444μg/l). Diabetic patients required more oxygen therapy (60% versus 26.9%), more mechanical ventilation (20% versus 8.3%) and more frequent admission to the intensive care unit (60% versus 27.8%). They presented more thromboembolic complications (12% versus 9%) but there were not significant differences in the other outcomes and in death rates. The excess of morbidity and mortality due to diabetes was still not fully clarified; the role of demographic factors, the interaction of mediations with ACE-2 receptors and the role of co-morbidities will all need to be studied in order to identify the patient at risk profile, i.e. who can develop severe forms of the diseases and more outcomes. The early identification of a possible hyper inflammation could be very valuable. More attention should be paid to patients with COVID-19 with diabetes because they are at a high risk of complications.
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Affiliation(s)
- Saloua Elamari
- Department of Endocrinology, Diabetology, Metabolic Disease and Nutrition, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Imane Motaib
- Department of Endocrinology, Diabetology, Metabolic Disease and Nutrition, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Saad Zbiri
- Laboratory of Medical Evaluation and Health Economics, International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Karim Elaidaoui
- Department of Anesthesiology, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Asmaa Chadli
- Department of Endocrinology, Diabetology, Metabolic Disease and Nutrition, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Chafik Elkettani
- Department of Anesthesiology, Mohammed VI University of Health Sciences, Casablanca, Morocco
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15
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Ahnach M, Zbiri S, Nejjari S, Ousti F, Elkettani C. C-reactive protein as an early predictor of COVID-19 severity. J Med Biochem 2020; 39:500-507. [PMID: 33312067 DOI: 10.5937/jomb0-27554] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023] Open
Abstract
Background Data for predicting severity of patients with COVID-19 infection are sparse and still under investigation. We retrospectively studied whether the admission serum C-reactive protein level (CRP) can serve as nearly predictor of disease severity during COVID-19 infection in comparison with other hematologic and inflammatory markers. Methods We included all consecutive patients who were admitted in Cheikh Khalifa International University Hospital, Casablanca, Morocco, between February to April 2020, with a confirmed diagnosis of COVID-19 infection using SARS-CoV-2 viral nucleic acid via RT-PCR. The complete blood count and serum CRP level were routinely measured on admission. All clinical and laboratory data of patients were collected and analyzed. The classification of the disease severity was in accordance with the clinical classification of the WHO interim guidance, and the management of patients were adapted to the national management guideline. We estimated receiver operating characteristic (ROC) curves of blood routine parameters as well as their association with COVID-19 disease severity. Results 145 COVID-19 patients were included in the study. The median age (range) was 50 (32-63) years, and 75 (51.7%) were men. 101 patients were classified in the non-severe group and 44 patients in the severe group. Based on disease severity, significant differences were observed in the age, gender, comorbidities, and respiratory symptom. Similarly, the biological analysis found significant differences for the neutrophil count, lymphocyte count, eosinophil count, and CRP level. However, according to ROC curves of these laboratory biomarkers, the AUC of CRP at 0.872 was significantly higher than all other parameters. Further, CRP was independently associated with severity of COVID-19 disease (OR = 1.11, 95% IC (1.01-1.22) and or = 1.13, 95% IC (1.04-1.23)). Conclusions This study found that the CRP level at admission represent a simple and independent factor that can be useful for early detection of severity during COVID-19 and the easy guidance of primary care.
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Affiliation(s)
- Maryame Ahnach
- Mohammed VI University of Health Sciences (UM6SS), Cheikh Khalifa International University Hospital, Department of Hematology, Casablanca, Morocco
| | - Saad Zbiri
- Mohammed VI University of Health Sciences (UM6SS), International School of Public Health, Laboratory of Medical Evaluation and Health Economics, Casablanca, Morocco
| | - Sara Nejjari
- Mohammed VI University of Health Sciences (UM6SS), Cheikh Khalifa International University Hospital, Department of Hematology, Casablanca, Morocco
| | - Fadwa Ousti
- Mohammed VI University of Health Sciences (UM6SS), National Reference Laboratory, Casablanca, Morocco
| | - Chafik Elkettani
- Mohammed VI University of Health Sciences (UM6SS), Cheikh Khalifa International University Hospital, Department of Anesthesiology and Reanimation, Casablanca, Morocco
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Milcent C, Zbiri S. Prenatal care and socioeconomic status: effect on cesarean delivery. Health Econ Rev 2018; 8:7. [PMID: 29525909 PMCID: PMC5845483 DOI: 10.1186/s13561-018-0190-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/02/2018] [Indexed: 05/23/2023]
Abstract
Cesarean deliveries are widely used in many high- and middle-income countries. This overuse both increases costs and lowers quality of care and is thus a major concern in the healthcare industry. The study first examines the impact of prenatal care utilization on cesarean delivery rates. It then determines whether socioeconomic status affects the use of prenatal care and thereby influences the cesarean delivery decision. Using exclusive French delivery data over the 2008-2014 period, with multilevel logit models, and controlling for relevant patient and hospital characteristics, we show that women who do not participate in prenatal education have an increased probability of a cesarean delivery compared to those who do. The study further indicates that attendance at prenatal education varies according to socioeconomic status. Low socioeconomic women are more likely to have cesarean deliveries and less likely to participate in prenatal education. This result emphasizes the importance of focusing on pregnancy health education, particularly for low-income women, as a potential way to limit unnecessary cesarean deliveries. Future studies would ideally investigate the effect of interventions promoting such as care participation on cesarean delivery rates.
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Affiliation(s)
- Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Center for Scientific Research, Paris, France
| | - Saad Zbiri
- EA 7285, Versailles Saint Quentin University, Montigny-le-Bretonneux, France
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