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Mayhew SH, Doyle K, Babawo LS, Mokuwa E, Rohan H, Martinez-Alverez M, Borghi J, Pitt C. Did aid to the Ebola crisis divert aid for reproductive, maternal, and newborn health? An analysis of donor-reported data in Sierra Leone. Confl Health 2024; 18:38. [PMID: 38678265 PMCID: PMC11055248 DOI: 10.1186/s13031-024-00589-2] [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: 09/29/2023] [Accepted: 03/27/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Infectious disease outbreaks like Ebola and Covid-19 are increasing in frequency. They may harm reproductive, maternal and newborn health (RMNH) directly and indirectly. Sierra Leone experienced a sharp deterioration of RMNH during the 2014-16 Ebola epidemic. One possible explanation is that donor funding may have been diverted away from RMNH to the Ebola response. METHODS We analysed donor-reported data from the Organisation for Economic Cooperation and Development (OECD)'s Creditor Reported System (CRS) data for Sierra Leone before, during and after the 2014-16 Ebola epidemic to understand whether aid flows for Ebola displaced aid for RMNH. We estimated aid for Ebola using key term searches and manual review of CRS records. We estimated aid for RMNH by applying the Muskoka-2 algorithm to the CRS and analysing CRS purpose codes. RESULTS We find substantial increases in aid to Sierra Leone (from $484 million in 2013 to $1 billion at the height of the epidemic in 2015), most of which was earmarked for the Ebola response. Overall, Ebola aid was additional to RMNH funding. RMNH aid was sustained during the epidemic (at $42 m per year) and peaked immediately after (at $77 m in 2016). There is some evidence of a small displacement of RMNH aid from the UK during the period when its Ebola funding increased. CONCLUSIONS Modest changes to RMNH donor aid patterns are insufficient to explain the severe decline in RMNH indicators recorded during the outbreak. Our findings therefore suggest the need for substantial increases in routine aid to ensure that basic RMNH services and infrastructure are strong before an epidemic occurs, as well as increased aid for RMNH during epidemics like Ebola and Covid-19, if reproductive, maternal and newborn healthcare is to be maintained at pre-epidemic levels.
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Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
- Adjunct Professor, Njala University, Bo, Sierra Leone.
| | | | - Lawrence S Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo, Sierra Leone
- Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone
- Mattru School of Nursing, Bonthe District, Mattru, Sierra Leone
| | - Esther Mokuwa
- Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone
- University of Wageningen, Wageningen, The Netherlands
| | - Hana Rohan
- Non-resident affiliate of the Center for Global Health Science and Security at Georgetown University, Washington DC, USA
| | | | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine Pitt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Neill R, Kautsar H, Trujillo A. Is economic growth enough to propel rehabilitation expenditures? An empirical analysis of country panel data and policy implications. BMC Public Health 2024; 24:1154. [PMID: 38658878 PMCID: PMC11044423 DOI: 10.1186/s12889-024-18601-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE Rehabilitation is a set of services designed to increase functioning and improve wellbeing across the life course. Despite being a core part of Universal Health Coverage, rehabilitation services often receive limited public expenditure, especially in lower income countries. This leads to limited service availability and high out of pocket payments for populations in need of care. The purpose of this research was to assess the association between macroeconomic conditions and rehabilitation expenditures across low-, middle-, and high-income countries and to understand its implications for overall rehabilitation expenditure trajectory across countries. MATERIALS AND METHODS We utilized a panel data set from the World Health Organization's Global Health Expenditure Database comprising the total rehabilitation expenditure for 88 countries from 2016 to 2018. Basic macroeconomic and population data served as control variables. Multiple regression models were implemented to measure the relationship between macroeconomic conditions and rehabilitation expenditures. We used four different model specifications to check the robustness of our estimates: pooled data models (or naïve model) without control, pooled data models with controls (or expanded naïve model), fixed effect models with all controls, and lag models with all controls. Log-log specifications using fixed effects and lag-dependent variable models were deemed the most appropriate and controlled for time-invariant differences. RESULTS Our regression models indicate that, with a 1% increase in economic growth, rehabilitation expenditure would be associated with a 0.9% and 1.3% increase in expenditure. Given low baseline levels of existing rehabilitation expenditure, we anticipate that predicted increases in rehabilitation expenditure due to economic growth may be insufficient to meet the growing demand for rehabilitation services. Existing expenditures may also be vulnerable during periods of economic recession. CONCLUSION This is the first known estimation of the association between rehabilitation expenditure and macroeconomic conditions. Our findings demonstrate that rehabilitation is sensitive to macroeconomic fluctuations and the path dependency of past expenditures. This would suggest the importance of increased financial prioritization of rehabilitation services and improved institutional strengthening to expand access to rehabilitation services for populations.
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Affiliation(s)
- Rachel Neill
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, 21205, Baltimore, MD, USA.
| | - Hunied Kautsar
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, 21205, Baltimore, MD, USA
| | - Antonio Trujillo
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, 21205, Baltimore, MD, USA
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Berquist VL. Private equity investment in health care delivery, Australia, 2008-2022. Med J Aust 2024; 220:368-371. [PMID: 38566454 DOI: 10.5694/mja2.52270] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 10/30/2023] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To examine the scale of private equity investment in Australian health care delivery assets (clinics, hospitals, imaging facilities, other doctor-led health care services). STUDY DESIGN, SETTING Extraction of information about private equity acquisitions of hospitals, clinics, imaging centres and in vitro fertilisation facilities in Australia, 2008-2022, from a commercial database (PitchBook), supplemented by information from publicly available online media sources. MAIN OUTCOME MEASURES Number and value of private equity acquisitions of health care assets, 2008-2022; numbers of clinic parent company and clinic acquisitions, 2017-2022. RESULTS A total of 75 private equity acquisitions of health care delivery assets in Australia during 2008-2022 were identified; the annual number rose from three acquisitions in 2008 to eighteen in 2022. During 2008-2010, five of seven acquisitions were of in vitro fertilisation providers; during 2020-2022, 22 of 39 acquisitions were of clinics or clinic groups, including eleven of eighteen in 2022. The total value of the 39 acquisitions for which purchase price could be ascertained (52%) was $24.1 billion. During 2017-2022, the clinic specialty with the greatest number of private equity acquisitions was general practice (256 of 446 clinics purchased within acquisitions). Seven companies owning ophthalmology clinics (24 clinics) were acquired by private equity. Four private equity acquisitions during 2017-2022 included 60 oncology clinics, all related to a single clinic group. CONCLUSIONS The number of private equity acquisitions of Australian health care delivery assets increased during 2008-2022. Doctors should be aware of the motivations and dynamics of private equity companies, as they are increasingly likely to interact with these firms and assets owned by these firms.
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Affiliation(s)
- Victoria L Berquist
- Harvard Kennedy School, Harvard University, Cambridge, MA, United States of America
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Akhnif EH, Belmadani A, Mataria A, Bigdeli M. UHC in Morocco: a bottom-up estimation of public hospitals' financing size based on a costing database. Health Econ Rev 2024; 14:25. [PMID: 38557700 PMCID: PMC10983621 DOI: 10.1186/s13561-024-00501-x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Morocco is engaged in a health system reform aimed at generalizing health insurance across the whole population by 2025. This study aims to build a national database of costs at all levels of public hospitals in Morocco and craft this database as a resource for further use in a strategic purchasing system. It also aims at estimating the funding gap and the budget that should be secured for public hospitals in Morocco to fully play their roles in the current ambitious reform. METHOD A costing study was implemented in 39 hospitals in 12 regions of Morocco (10 provincial hospitals, 11 regional hospitals, and 18 teaching hospitals). Using the hospital costing approach, we adapted and validated nationally our methodology to generate a database of unit costs based on data from 2019. All perspectives on cost were considered. Data collection was performed by cadres from MoH and facilitated by the WHO country office in Morocco. The production of the cost database allowed the development of a bottom-up estimation of the financing size for public health hospitals. RESULTS The study showed the feasibility of large-scale costing in the context of Morocco. The ownership of MoH and adherence to the process ensured the high quality of the collected data. There are many differences in unit costs for the same services moving from one hospital to another, which indicates existing inefficiencies. The database will contribute to shaping the strategic purchasing mechanism within the generalized health insurance schemes. The studied hospitals could be used as references to systematically update the billing system for health insurance.
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Affiliation(s)
- El Houcine Akhnif
- World health organization/country office of Morocco, 3 Avenue S.A.R. Sidi Mohamed, Rabat, Morocco.
| | - Abdelouahab Belmadani
- Ministry of health, Directorate of planning of financial resources, 335, Avenue Mohamed V, Rabat, Morocco
| | - Awad Mataria
- World Health Organization Regional Office for the Eastern Mediterranean, Nasr City, PO Box 7608, Cairo, 11371, Egypt
| | - Maryam Bigdeli
- World health organization/country office of Morocco, 3 Avenue S.A.R. Sidi Mohamed, Rabat, Morocco
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Beggs PJ, Trueck S, Linnenluecke MK, Bambrick H, Capon AG, Hanigan IC, Arriagada NB, Cross TJ, Friel S, Green D, Heenan M, Jay O, Kennard H, Malik A, McMichael C, Stevenson M, Vardoulakis S, Dang TN, Garvey G, Lovett R, Matthews V, Phung D, Woodward AJ, Romanello MB, Zhang Y. The 2023 report of the MJA-Lancet Countdown on health and climate change: sustainability needed in Australia's health care sector. Med J Aust 2024; 220:282-303. [PMID: 38522009 DOI: 10.5694/mja2.52245] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/06/2023] [Indexed: 03/25/2024]
Abstract
The MJA-Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020, 2021 and 2022. It examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In this, the sixth report of the MJA-Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. Our results highlight the health and economic costs of inaction on health and climate change. A series of major flood events across the four eastern states of Australia in 2022 was the main contributor to insured losses from climate-related catastrophes of $7.168 billion - the highest amount on record. The floods also directly caused 23 deaths and resulted in the displacement of tens of thousands of people. High red meat and processed meat consumption and insufficient consumption of fruit and vegetables accounted for about half of the 87 166 diet-related deaths in Australia in 2021. Correction of this imbalance would both save lives and reduce the heavy carbon footprint associated with meat production. We find signs of progress on health and climate change. Importantly, the Australian Government released Australia's first National Health and Climate Strategy, and the Government of Western Australia is preparing a Health Sector Adaptation Plan. We also find increasing action on, and engagement with, health and climate change at a community level, with the number of electric vehicle sales almost doubling in 2022 compared with 2021, and with a 65% increase in coverage of health and climate change in the media in 2022 compared with 2021. Overall, the urgency of substantial enhancements in Australia's mitigation and adaptation responses to the enormous health and climate change challenge cannot be overstated. Australia's energy system, and its health care sector, currently emit an unreasonable and unjust proportion of greenhouse gases into the atmosphere. As the Lancet Countdown enters its second and most critical phase in the leadup to 2030, the depth and breadth of our assessment of health and climate change will be augmented to increasingly examine Australia in its regional context, and to better measure and track key issues in Australia such as mental health and Aboriginal and Torres Strait Islander health and wellbeing.
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Affiliation(s)
| | | | | | - Hilary Bambrick
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Anthony G Capon
- Monash Sustainable Development Institute, Monash University, Melbourne, VIC
| | | | | | | | | | - Donna Green
- Climate Change Research Centre and ARC Centre of Excellence for Climate Extremes, UNSW, Sydney, NSW
| | - Maddie Heenan
- Australian Prevention Partnership Centre, Sax Institute, Sydney, NSW
- The George Institute for Global Health, Sydney, NSW
| | - Ollie Jay
- Thermal Ergonomics Laboratory, University of Sydney, Sydney, NSW
| | - Harry Kennard
- Center on Global Energy Policy, Columbia University, New York, NY, USA
| | | | | | - Mark Stevenson
- Transport, Health and Urban Design (THUD) Research Lab, University of Melbourne, Melbourne, VIC
| | - Sotiris Vardoulakis
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Tran N Dang
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Raymond Lovett
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
- Australian Institute of Aboriginal and Torres Strait Islander Studies, Canberra, ACT
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Sydney, NSW
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Castaño-Doste G, Callau-Calvo A, Castaño-Doste MB, Royo-Crespo I, Callau-Calvo A, Castaño-Lasaosa JI. [Incremental impact of population dispersion on health personnel resources in Primary Care]. Semergen 2024; 50:102221. [PMID: 38555755 DOI: 10.1016/j.semerg.2024.102221] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To quantify the incremental impact that population dispersion has on the number of health personnel in Primary Care in Alto Aragón, using a reproducible method. METHOD Descriptive observational study that compares health the number of health personnel (family medicine, pediatrics and nursing) in EAP and PA emergencies in 2019 in an unpopulated and dispersed territory such as Huesca, with the number that would correspond to it by applying population ratios per professional of hypothetical constructs with different population densities. RESULTS Huesca, with respect to the national average, has 39% more PA health personnel. There are 239 additional professionals (112 in family medicine, 2 in pediatrics and 115 in nursing), 130 in emergencies and 109 in EAP. With the average of the five most densely populated provinces, it would reduce this staff by 49%, and with the average of the five least densely populated provinces, it would increase it by 12%. CONCLUSIONS There is a relationship between low population density and a greater number of family medicine and PC nurses, but not with pediatrics. The powerful incremental effect that dispersion has on health care spending gives it a relevant role in the regional financing system. Comparing PC health personnel in scenarios with different population density is a useful method for quantifying the impact of dispersion.
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Affiliation(s)
- G Castaño-Doste
- Grupo de investigación en Gestión Sanitaria y Economía de la Salud", Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, España; Medicina Familiar y Comunitaria, Centro de Salud Berbegal, Sector Sanitario Barbastro, Servicio Aragonés de Salud, Huesca, España
| | - A Callau-Calvo
- Grupo de investigación en Gestión Sanitaria y Economía de la Salud", Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, España; Servicio de Anestesia y Reanimación, Hospital Universitario San Jorge, Servicio Aragonés de Salud, Huesca, España
| | | | - I Royo-Crespo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Lozano Blesa, Servicio Aragonés de Salud, Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, España
| | - A Callau-Calvo
- Odontología, Universidad Católica de Valencia San Vicente Mártir, Valencia, España
| | - J I Castaño-Lasaosa
- Grupo de investigación en Gestión Sanitaria y Economía de la Salud", Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, España; Servicio Provincial de Sanidad de Huesca, Huesca, España; Departamento de Sanidad, Gobierno de Aragón, Zaragoza, España.
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Ryan JB. Who should get the last TAVI valve? Public versus private access to disruptive technologies in the Australian health care system. Med J Aust 2024; 220:231-233. [PMID: 38327243 DOI: 10.5694/mja2.52226] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Jonathon B Ryan
- University of New South Wales, Sydney, NSW
- Prince of Wales Hospital and Community Health Services, Sydney, NSW
- Prince of Wales Private Hospital, Sydney, NSW
- Eastern Heart Clinic, Sydney, NSW
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Koller TS, Janeva JK, Ognenovska E, Vasilevska A, Atanasova S, Brown C, Dedeu A, Johansen A. Towards leaving no one behind in North Macedonia: a mixed methods assessment of barriers to effective coverage with health services. Int J Equity Health 2024; 23:58. [PMID: 38491541 PMCID: PMC10943884 DOI: 10.1186/s12939-023-02082-3] [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: 11/01/2023] [Accepted: 12/15/2023] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The Government of North Macedonia's Primary Health Care reform is committed to leaving no one behind on the path to Universal health Coverage (UHC). During mid-2022 to March 2023, the World Health Organization (WHO) collaborated with the Government and other national stakeholders for an assessment of barriers to effective coverage with health services experienced by adult citizens, with a specific focus on rural areas and subpopulations in situations of vulnerability. METHODS This study constituted the piloting of a draft forthcoming WHO handbook on assessing barriers for health services, grounded in the Tanahashi framework for effective coverage with health services. In North Macedonia, the convergent parallel mixed methods study involved four sources. These were: a nationally representative Computer Assisted Telephone Interview Survey (1,139 respondents); 24 key informant interviews with representatives from government, professional associations, non-governmental and civil society organizations, and development partners; 12 focus groups in four regions with adults from vulnerable/high risk groups in rural areas and small urban settlements and an additional focus group with persons with disabilities; and a literature review. Instrument design was underpinned by the Tanahashi framework, which also orientated data triangulation and deductive analysis. The research team synergistically incorporated emerging themes in an inductive way. A key component of the assessment was participatory design of the study protocol with inputs from national stakeholders as well as participatory deliberation of the results and the ways forward. RESULTS Despite considerable progress towards UHC in North Macedonia, the assessment elucidated remaining challenges. These included: insufficient numbers of health workers, in general and particularly in the more disadvantaged regions of the country; inadequate number of outpatient medicines covered by health insurance; distance and transportation obstacles, including indirect travel costs, particularly in rural areas; adverse gender norms and relations for both women and men inhibiting timely treatment seeking; perceived discrimination by providers on multiple grounds; bottlenecks including waiting times to get appointments for specialist referrals; and lack of patient adherence, due several factors including costs of medicines and health products. CONCLUSIONS The outputs from this study of barriers to effective coverage with health services for adult citizens of North Macedonia are feeding into the ongoing Primary Health Care reform, and provide evidence for equity-related actions in the forthcoming National Development Strategy.
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Affiliation(s)
- Theadora Swift Koller
- Department for Gender Equality, Human Rights and Health Equity, WHO Headquarters, Geneva, Switzerland.
| | | | | | | | - Simona Atanasova
- World Health Organization Country Office in North Macedonia, Skopje, North Macedonia
| | - Chris Brown
- WHO European Office for Investment for Health and Development, Venice, Italy
| | - Antoni Dedeu
- WHO European Centre for Primary Health Care, Almaty, Kazakhstan
| | - Anne Johansen
- World Health Organization Country Office in North Macedonia, Skopje, North Macedonia
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Kim E, Park YL, Lo YR, Keoprasith B, Panyakeo S. Sustaining essential health services in Lao PDR in the context of donor transition and COVID-19. Health Policy Plan 2024; 39:i131-i136. [PMID: 38253449 DOI: 10.1093/heapol/czad090] [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: 01/24/2023] [Revised: 08/08/2023] [Indexed: 01/24/2024] Open
Abstract
Lao People's Democratic Republic (Lao PDR) aims at graduating from least developed country status by 2026 and must increase the level of domestic financing for health. This paper examines how the government has prepared for the decline of external assistance and how donors have applied their transition approaches. Adapting a World Health Organization (WHO) framework, reflections and lessons were generated based on literature review, informal and formal consultations and focus group discussions with the Lao PDR government and development partners including budget impact discussion. The government has taken three approaches to transition from external to domestic funding: mobilizing domestic resources, increasing efficiency across programs and prioritization with a focus on strengthening primary health care (PHC). The government has increased gradually domestic government health expenditures as a share of the government expenditure from 2.6% in 2013 to 4.9% in 2019. The Ministry of Health has made efforts to design and roll out integrated service delivery of maternal, newborn, child, and adolescent health services, immunization and nutrition; integrated 13 information systems of key health programs into one single District Health Information Software 2; and prioritized PHC, which has led to shifting donors towards supporting PHC. Donors have revisited their aid policies designed to improve sustainability and ownership of the government. However, the government faces challenges in improving cross-programmatic efficiency at the operational level and in further increasing the health budget due to the economic crisis aggravated during Coronavirus disease 2019 (COVID-19). Working to implement donor transition strategies under the current economic situation and country challenges, calls into question the criteria used to evaluate transition. This criterion needs to include more appropriate indicators other than gross national income per capita, which does not reflect a country's readiness and capacity of the health system. There should be a more country-tailored strategy and support for considering the context and system-wide readiness during donor transition.
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Affiliation(s)
- Eunkyoung Kim
- Health System Development team, World Health Organization Country Office for the Lao People's Democratic Republic, 125 Saphanthong Road, Unit 5, Ban Saphanthongtai, Sisattanak District, Vientiane Capital 0103, Lao People's Democratic Republic
| | - Yu Lee Park
- Health System Development team, World Health Organization Country Office for the Lao People's Democratic Republic, 125 Saphanthong Road, Unit 5, Ban Saphanthongtai, Sisattanak District, Vientiane Capital 0103, Lao People's Democratic Republic
| | - Ying-Ru Lo
- WHO Representative to Lao People's Democratic Republic, World Health Organization Country Office for the Lao People's Democratic Republic, 125 Saphanthong Road, Unit 5, Ban Saphanthongtai, Sisattanak District, Vientiane Capital 0103, Lao People's Democratic Republic
| | - Bounserth Keoprasith
- Department of Planning and Finance, Ministry of Health, Ban Thatkhao, Sisattanack District, Rue Simeuang, Vientiane Capital 0103, Lao People's Democratic Republic
| | - Suphab Panyakeo
- Department of Planning and Finance, Ministry of Health, Ban Thatkhao, Sisattanack District, Rue Simeuang, Vientiane Capital 0103, Lao People's Democratic Republic
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Nonvignon J, Soucat A, Ofori-Adu P, Adeyi O. Making development assistance work for Africa: from aid-dependent disease control to the new public health order. Health Policy Plan 2024; 39:i79-i92. [PMID: 38253444 PMCID: PMC10803194 DOI: 10.1093/heapol/czad092] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/05/2023] [Accepted: 10/23/2023] [Indexed: 01/24/2024] Open
Abstract
The Coronavirus disease (COVID-19) pandemic has revealed the fragility of pre-crisis African health systems, in which too little was invested over the past decades. Yet, development assistance for health (DAH) more than doubled between 2000 and 2020, raising questions about the role and effectiveness of DAH in triggering and sustaining health systems investments. This paper analyses the inter-regional variations and trends of DAH in Africa in relation to some key indicators of health system financing and service delivery performance, examining (1) the trends of DAH in the five regional economic communities of Africa since 2000; (2) the relationship between DAH spending and health system performance indicators and (3) the quantitative and qualitative dimensions of aid substitution for domestic financing, policy-making and accountability. Africa is diverse and the health financing picture has evolved differently in its subregions. DAH represents 10% of total spending in Africa in 2020, but DAH benefitted Southern Africa significantly more than other regions over the past two decades. Results in terms of progress towards universal health coverage (UHC) are slightly associated with DAH. Overall, DAH may also have substituted for public domestic funding and undermined the formation of sustainable UHC financing models. As the COVID-19 crisis hit, DAH did not increase at the country level. We conclude that the current architecture of official development assistance (ODA) is no longer fit for purpose. It requires urgent transformation to place countries at the centre of its use. Domestic financing of public health institutions should be at the core of African social contracts. We call for a deliberate reassessment of ODA modalities, repurposing DAH on what it could sustainably finance. Finally, we call for a new transparent framework to monitor DAH that captures its contribution to building institutions and systems.
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Affiliation(s)
- Justice Nonvignon
- Africa Centre for Disease Control and Prevention, Addis Ababa, Ethiopia
- School of Public Health, University of Ghana, Accra, Ghana
| | - Agnès Soucat
- Agence Francaise de Developpement, Paris, France
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Paulina Ofori-Adu
- Policy Planning Monitoring and Evaluation Division, Ghana Health Service, Ghana
| | - Olusoji Adeyi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Resilient Health Systems, Washington, DC, United States
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Nabanoba C, Zakumumpa H. Experiences of membership in munno mubulwadde (your friend indeed) - a novel community-based health insurance scheme in Luwero district in rural central Uganda. BMC Health Serv Res 2024; 24:89. [PMID: 38233909 PMCID: PMC10792776 DOI: 10.1186/s12913-023-10517-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Community-Based Health Insurance (CBHI) schemes are recognized as an important health financing pathway to achieving universal health coverage (UHC). Although previous studies have documented CBHIs in low-income countries, the majority of these have been provider-based. Non-provider based schemes have received comparatively less empirical attention. We sought to describe a novel non-provider based CBHI munno mubulwadde (your friend indeed) comprising informal sector members in rural central Uganda to understand the structure of the scheme, the experiences of scheme members in terms of the perceived benefits and barriers to retention in the scheme. METHODS We report qualitative findings from a larger mixed-methods study. We conducted in-depth interviews with insured members (n = 18) and scheme administrators (n = 12). Four focus groups were conducted with insured members (38 participants). Data were inductively analyzed by thematic approach. RESULTS Munno mubulwadde is a union of ten CBHI schemes coordinated by one administrative structure. Members were predominantly low-income rural informal sector households who pay annual premiums ranging from $17 and $50 annually and received medical care at 13 scheme-contracted private health facilities in Luwero District in Central Uganda. Insured members reported that scheme membership protected them from catastrophic health expenditure during episodes of sickness among household members, and especially so among households with children under-five who were reported to fall sick frequently, the scheme enabled members to receive perceived better quality health care at private providers in the study district relative to the nearest public facilities. The identified barriers to retention in the scheme include inconvenient dates for premium payment that are misaligned with harvest periods for cash crops (e.g. maize corn) on which members depended for their agrarian livelihoods, long distances to insurance-contracted private providers, falling prices of cash crops which diminished real incomes and affordability of insurance premiums in successive years after initial enrolment. CONCLUSION Munno mubulwadde was perceived by as a valuable financial cushion during episodes of illness by rural informal sector households. Policy interventions for promoting price stability of cash crops in central Uganda could enhance retention of members in this non-provider CBHI which is worthy of further research as an additional funding pathway for realizing UHC in Uganda and other low-income settings.
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Affiliation(s)
- Christine Nabanoba
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Henry Zakumumpa
- School of Public Health, Makerere University, Kampala, Uganda.
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Ojiako CP. Innovative health financing mechanisms: the case of Africa's unified approach to vaccine acquisition. Health Policy Plan 2024; 39:84-86. [PMID: 37971713 PMCID: PMC10775217 DOI: 10.1093/heapol/czad109] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/21/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Chiamaka P Ojiako
- The Robert F. Wagner Graduate School of Public Service, New York University, 295 Lafayette St, New York, NY 10012, USA
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Jha A, Kolesar RJ, Comas S, Gribble J, Ugaz J, Gonzalez-Pier E. Getting ready for reduced donor dependency: the co-financing of family planning commodities. Health Policy Plan 2024; 39:87-93. [PMID: 37987720 PMCID: PMC10775212 DOI: 10.1093/heapol/czad106] [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: 02/06/2023] [Revised: 06/04/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
Family planning (FP) programmes in low and lower-middle income countries are confronting the dual impact of reduced external donor commitments and stagnant or reduced domestic financing, worsened by economic consequences of the COVID-19 pandemic. Co-financing-a donor-government agreement to jointly fund aspects of a programme, with transition towards the government assuming increasing responsibility for total cost-can be a powerful tool to help build national ownership, fiscal sustainability and programme visibility. Using Gavi's successful co-financing model as reference, the current paper draws out a set of key considerations for developing policies on co-financing of FP commodities in resource-poor settings. Macroeconomic and contextual sensitivities must be incorporated while classifying countries and determining co-financing obligations-using the actual GNI per capita on a scale or sovereign credit ratings, in conjunction with programmatic indicators, may be preferred. It is also important for policies to allow sufficiently long time for countries to transition-dependent on the country context, may be up to 10 years as allowed under the US Agency for International Development FP graduation policy and flexibility to revisit the terms following externalities that can influence the fiscal space for health. Incentivizing new domestic financing to pay for co-financing dues is critical, so as not to displace government funding from related health or social sector programs. Pragmatic ways to ensure country compliance can include engaging both the ministries of health and finance as co-signatories to identify and address known administrative and fiscal challenges; establishing dedicated co-financing account with the finance ministry; and instituting a mutual monitoring mechanism. Lastly, the overall process of policymaking can benefit from an alignment of goals and interests of the key development partners.
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Affiliation(s)
- Ayan Jha
- Palladium Group, 1331 Pennsylvania Avenue NW, Suite 600, Washington, DC 20004, USA
| | - Robert John Kolesar
- Palladium Group, 1331 Pennsylvania Avenue NW, Suite 600, Washington, DC 20004, USA
| | - Sophia Comas
- Palladium Group, 1331 Pennsylvania Avenue NW, Suite 600, Washington, DC 20004, USA
| | - Jay Gribble
- Palladium Group, 1331 Pennsylvania Avenue NW, Suite 600, Washington, DC 20004, USA
| | - Jorge Ugaz
- Palladium Group, 1331 Pennsylvania Avenue NW, Suite 600, Washington, DC 20004, USA
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Wu W, Long S, Cerda AA, Garcia LY, Jakovljevic M. Population ageing and sustainability of healthcare financing in China. Cost Eff Resour Alloc 2023; 21:97. [PMID: 38115117 PMCID: PMC10729482 DOI: 10.1186/s12962-023-00505-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND In China, the healthcare financing structure involves multiple parties, including the government, society and individuals. Medicare Fund is an important way for the Government and society to reduce the burden of individual medical costs. However, with the aging of the population, the demand of Medicare Fund is increasing. Therefore, it is necessary to explore the sustainability of the healthcare financing structure in the context of population ageing. OBJECTIVE The purpose of this paper is to organize the characteristics of population ageing as well as healthcare financing in China. On this basis, it analyzes the impact mechanism of population ageing on healthcare financing and the sustainability of existing healthcare financing. METHODS This paper mainly adopts the method of literature research and inductive summarization. Extracting data from Health Statistics Yearbook of China and Labor and Social Security Statistics Yearbook of China. Collected about 60 pieces of relevant literature at home and abroad. RESULTS China has already entered a deeply ageing society. Unlike developed countries in the world, China's population ageing has distinctive feature of ageing before being rich. A healthcare financing scheme established by China, composing of the government, society, and individuals, is reasonable. However, under the pressure of population ageing, China's current healthcare financing scheme will face enormous challenges. Scholars are generally pessimistic about the sustainability of China's healthcare financing scheme. CONCLUSIONS Population ageing will increase the expenditure and reduce the income of the Medicare Fund. This will further affect the sustainability of the healthcare financing structure. As a consequence, the state should pay particular attention to this issue and take action to ensure that the Fund continues to operate steadily.
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Affiliation(s)
- Wenqing Wu
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Shujie Long
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Arcadio A Cerda
- Faculty of Economics and Business, University of Talca, Talca, Chile
| | - Leidy Y Garcia
- Faculty of Economics and Business, University of Talca, Talca, Chile
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia.
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan.
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia.
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Hawkins L, Kasekamp K, van Ginneken E, Habicht T. Governing health service purchasing agencies: Comparative study of national purchasing agencies in 10 countries in eastern Europe and central Asia. Health Policy Open 2023; 5:100111. [PMID: 38144041 PMCID: PMC10746362 DOI: 10.1016/j.hpopen.2023.100111] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
This study discusses findings from comparative case studies of the governance of health services purchasing agencies in 10 eastern European and central Asian countries established over the past 30 years, and the relationship between governance attributes, institutional development, and the progress made in strategic purchasing. The feasibility and effectiveness of implementing international recommendations from the health sector and wider public sector governance literature and practice are also discussed. The study finds that only those countries that have transitioned from middle to high-income status during the study period have been successful in comprehensively and consistently implementing internationally recommended practices. Moreover, these countries have made varying progress in developing capable purchasers with technical and operational independence, as well as advancing strategic purchasing. However, the current middle-income countries (MICs) in the study have implemented only certain elements of recommended governance practices, often superficially. Notably, the study reveals that some international recommendations, particularly those related to higher degrees of purchaser autonomy and the associated governance structures observed in western European social health insurance funds, have proven challenging to implement effectively or sustain in the MICs. None of the MICs succeeded in strategic purchasing beyond a limited agenda or scale, and even then, only implementing and sustaining them during favorable conditions. Difficulties in maintaining these achievements can be attributed, in part, to governance deficiencies. However, setbacks are commonly linked to periods of political and economic instability, which in turn lead to fluctuations in policy priorities, institutional instability, and inadequacies in health budgets. The study findings point to some actions related to civil society and stakeholder engagement, accountability frameworks, and digitalization in MICs that can facilitate continuity in health reforms and the functioning of purchasing institutions despite these challenges. The findings of the study provide important lessons for countries designing or newly implementing health purchasing agencies and for countries reviewing the performance and governance of their health purchasing agencies with a view to developing or strengthening strategic purchasing.
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Affiliation(s)
- Loraine Hawkins
- WHO Barcelona Office for Health Systems Financing, Spain
- The Health Foundation, United Kingdom
| | - Kaija Kasekamp
- WHO Barcelona Office for Health Systems Financing, Spain
- Institute of Family Medicine and Public Health, University of Tartu, Estonia
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Technische Universität Berlin, Germany
| | - Triin Habicht
- WHO Barcelona Office for Health Systems Financing, Spain
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Callander EJ, Enticott JC, Eklom B, Gamble J, Teede HJ. The value of maternity care in Queensland, 2012-18, based on an analysis of administrative data: a retrospective observational study. Med J Aust 2023; 219:535-541. [PMID: 37940105 PMCID: PMC10952409 DOI: 10.5694/mja2.52156] [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: 07/26/2022] [Accepted: 08/18/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To quantify the value of maternity health care - the relationship of outcomes to costs - in Queensland during 2012-18. STUDY DESIGN Retrospective observational study; analysis of Queensland Perinatal Data Collection data linked with the Queensland Health Admitted Patient, Non-Admitted Patient, and Emergency Data Collections, and with the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) databases. SETTING, PARTICIPANTS All births in Queensland during 1 July 2012 - 30 June 2018. MAIN OUTCOME MEASURES Maternity care costs per birth (reported in 2021-22 Australian dollars), both overall and by funder type (public hospital funders, MBS, PBS, private health insurers, out-of-pocket costs); value of care, defined as total cost per positive birth outcome (composite measure). RESULTS The mean cost per birth (all funders) increased from $20 471 (standard deviation [SD], $17 513) during the second half of 2012 to $30 000 (SD, $22 323) during the first half of 2018; the annual total costs for all births increased from $1.31 billion to $1.84 billion, despite a slight decline in the total number of births. In a mixed effects linear analysis adjusted for demographic, clinical, and birth characteristics, the mean total cost per birth in the second half of 2018 was $9493 higher (99.9% confidence interval, $8930-10 056) than during the first half of 2012. The proportion of births that did not satisfy our criteria for a positive birth outcome increased from 27.1% (8404 births) during the second half of 2012 to 30.5% (9041 births) during the first half of 2018. CONCLUSION The costs of maternity care have increased in Queensland, and many adverse birth outcomes have become more frequent. Broad clinical collaboration, effective prevention and treatment strategies, as well as maternal health services focused on all dimensions of value, are needed to ensure the quality and viability of maternity care in Australia.
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Affiliation(s)
| | - Joanne C Enticott
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
| | | | | | - Helena J Teede
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
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17
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Beggs PJ, Zhang Y. The Lancet Countdown on health and climate change: Australia a world leader in neglecting its responsibilities. Med J Aust 2023; 219:528-529. [PMID: 37982350 DOI: 10.5694/mja2.52152] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/01/2023] [Indexed: 11/21/2023]
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Kurowski C, Evans DB, Ottersen T, Gopinathan U, Dale E, Norheim OF. New strides towards fair processes for financing universal health coverage. Health Policy Plan 2023; 38:i5-i8. [PMID: 37963075 PMCID: PMC10645048 DOI: 10.1093/heapol/czad065] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/19/2023] [Accepted: 08/02/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Christoph Kurowski
- Health, Nutrition and Population, World Bank Group, 1818 H Street, NW, Washington, DC 20433, United States
| | - David B Evans
- Health, Nutrition and Population, World Bank Group, 1818 H Street, NW, Washington, DC 20433, United States
| | - Trygve Ottersen
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Unni Gopinathan
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Elina Dale
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Ole Frithjof Norheim
- Bergen Centre for Ethics and Priority Setting, University of Bergen (BCEPS), University of Bergen, Årstadveien 21, Bergen 5018, Norway
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Dzhygyr Y, Dale E, Voorhoeve A, Gopinathan U, Maynzyuk K. Procedural fairness and the resilience of health financing reforms in Ukraine. Health Policy Plan 2023; 38:i59-i72. [PMID: 37963081 PMCID: PMC10645049 DOI: 10.1093/heapol/czad062] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/28/2023] [Accepted: 07/26/2023] [Indexed: 11/16/2023] Open
Abstract
In 2017, Ukraine's Parliament passed legislation establishing a single health benefit package for the entire population called the Programme of Medical Guarantees, financed through general taxes and administered by a single national purchasing agency. This legislation was in line with key principles for financing universal health coverage. However, health professionals and some policymakers have been critical of elements of the reform, including its reliance on general taxes as the source of funding. Using qualitative methods and drawing on deliberative democratic theory and criteria for procedural fairness, this study argues that the acceptance and sustainability of these reforms could have been strengthened by making the decision-making process fairer. It suggests that three factors limited the extent of stakeholders' participation in this process: first, a perception among reformers that fast-paced decision-making was required because there was only a short political window for much needed reforms; second, a lack of trust among reformers in the motives, representativeness, and knowledge of some stakeholders; and third, an under-appreciation of the importance of dialogic engagement with the public. These findings highlight a profound challenge for policymakers. In retrospect, some of those involved in the reform's design and implementation believe that a more meaningful engagement with the public and stakeholders who opposed the reform might have strengthened its legitimacy and durability. At the same time, the study shows how difficult it is to have an inclusive process in settings where some actors may be driven by unconstrained self-interest or lack the capacity to be representative or knowledgeable interlocutors. It suggests that investments in deliberative capital (the attitudes and behaviours that facilitate good deliberation) and in civil society capacity may help overcome this difficulty.
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Affiliation(s)
- Yuriy Dzhygyr
- Independent Expert, 54a Pivnichna Str, Kyiv 04213, Ukraine
| | - Elina Dale
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Alex Voorhoeve
- Department of Philosophy, Logic and Scientific Method, London School of Economics and Political Science (LSE), Houghton Street, London WC2A 2AE, United Kingdom
| | - Unni Gopinathan
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
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Gopinathan U, Dale E, Evans DB. Procedural fairness in health financing for universal health coverage: why, what and how. Health Policy Plan 2023; 38:i1-i4. [PMID: 37963077 PMCID: PMC10645044 DOI: 10.1093/heapol/czad069] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Unni Gopinathan
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Elina Dale
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - David B Evans
- Health, Nutrition and Population, World Bank Group, 1818 H Street NW, Washington, DC 20433, USA
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21
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Dale E, Peacocke EF, Movik E, Voorhoeve A, Ottersen T, Kurowski C, Evans DB, Norheim OF, Gopinathan U. Criteria for the procedural fairness of health financing decisions: a scoping review. Health Policy Plan 2023; 38:i13-i35. [PMID: 37963078 PMCID: PMC10645052 DOI: 10.1093/heapol/czad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/13/2022] [Revised: 06/19/2023] [Accepted: 08/02/2023] [Indexed: 11/16/2023] Open
Abstract
Due to constraints on institutional capacity and financial resources, the road to universal health coverage (UHC) involves difficult policy choices. To assist with these choices, scholars and policy makers have done extensive work on criteria to assess the substantive fairness of health financing policies: their impact on the distribution of rights, duties, benefits and burdens on the path towards UHC. However, less attention has been paid to the procedural fairness of health financing decisions. The Accountability for Reasonableness Framework (A4R), which is widely applied to assess procedural fairness, has primarily been used in priority-setting for purchasing decisions, with revenue mobilization and pooling receiving limited attention. Furthermore, the sufficiency of the A4R framework's four criteria (publicity, relevance, revisions and appeals, and enforcement) has been questioned. Moreover, research in political theory and public administration (including deliberative democracy), public finance, environmental management, psychology, and health financing has examined the key features of procedural fairness, but these insights have not been synthesized into a comprehensive set of criteria for fair decision-making processes in health financing. A systematic study of how these criteria have been applied in decision-making situations related to health financing and in other areas is also lacking. This paper addresses these gaps through a scoping review. It argues that the literature across many disciplines can be synthesized into 10 core criteria with common philosophical foundations. These go beyond A4R and encompass equality, impartiality, consistency over time, reason-giving, transparency, accuracy of information, participation, inclusiveness, revisability and enforcement. These criteria can be used to evaluate and guide decision-making processes for financing UHC across different country income levels and health financing arrangements. The review also presents examples of how these criteria have been applied to decisions in health financing and other sectors.
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Affiliation(s)
- Elina Dale
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | | | - Espen Movik
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Alex Voorhoeve
- Philosophy, Logic and Scientific Method, London School of Economics and Political Science (LSE), Houghton Street, London WC2A 2AE, UK
| | - Trygve Ottersen
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Christoph Kurowski
- Health, Nutrition and Population, World Bank Group, 1818 H Street, NW, Washington, DC 20433, USA
| | - David B Evans
- Health, Nutrition and Population, World Bank Group, 1818 H Street, NW, Washington, DC 20433, USA
| | - Ole Frithjof Norheim
- Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Årstadveien 21, Bergen 5018, Norway
| | - Unni Gopinathan
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
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González-Pier E, Bryne IC, Cárdenas Gamboa DI, Dsane-Selby L, Kapologwe N, Radutskyi M, Sadanandan R. Policymakers' perspective on the importance of procedural fairness to implement and sustain health financing reforms. Health Policy Plan 2023; 38:i9-i12. [PMID: 37963074 PMCID: PMC10645043 DOI: 10.1093/heapol/czad064] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/20/2023] [Accepted: 07/27/2023] [Indexed: 11/16/2023] Open
Abstract
Fair process is instrumental to implementing and sustaining health financing reforms. Ensuring a fair process during the design and adoption phases can garner political capital and secure a sense of citizens' ownership. This will prove useful when reforms are contested before benefits are yet to be fully materialized. Since many well devised health financing reforms are vulnerable to being dismantled after a few years of being launched, fair process should play a more strategic role in the implementation and evaluation phases when policies get challenged and reformulated to reflect the changing political and socioeconomic landscapes and to better manage early evidence on performance.
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Affiliation(s)
| | | | | | | | - Ntuli Kapologwe
- Director of Health Services, President’s Office Regional Administration and Local Government, Tanzania
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Abugu JO, Chukwu AM, Onyeso OK, Alumona CJ, Adandom II, Chukwu OAD, Awosoga OA. Determinants of the managerial staff's disposition towards e-payment platforms in public tertiary hospitals in Enugu, Nigeria: a cross-sectional study. BMC Health Serv Res 2023; 23:1240. [PMID: 37951924 PMCID: PMC10638801 DOI: 10.1186/s12913-023-10302-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Many Nigerians pay out-of-pocket for their health care, and some hospitals have started utilising e-payment systems to increase transactional efficiency. The study investigated the type and usage of e-payment platforms in public hospitals and the factors that may influence the managerial staff's disposition towards using the e-payment system. METHODS We conducted a cross-sectional survey of 300 managerial staff within the four public tertiary hospitals in Enugu, Nigeria, through proportionate quota sampling. The survey obtained participants' demographic characteristics, types of e-payment platforms, managerial staff's technophobia, perception of credibility, and disposition towards e-payment. Data were analysed using descriptive statistics, Spearman correlation, and hierarchical linear regression. RESULTS The majority of the respondents (n = 278, 92.7% completion rate) aged 43.4 ± 7.6 years were females (59.0%) with a bachelor's degree (54.7%). Their disposition (80.0%±17.9%), perceptions of the usefulness (85.7 ± 13.9%), and user-friendliness (80.5 ± 18.1%) of e-payment in the hospital were positive, credibility (72.6 ± 20.1%) and technophobia (68.0 ± 20.7%) were moderate. There was a negative correlation between technophobia and disposition toward the use of e-payment (ρ = -0.50, P < 0.001). Significant multivariate predictors of managerial disposition towards e-payment were; being a woman (β = 0.12, P = 0.033), married (β = 0.18, P = 0.003), positive perception of usefulness (β = 0.14, P = 0.025), and credibility (β = 0.15, P = 0.032). CONCLUSION Most participants had a positive disposition towards e-payment in public hospitals. However, managers with technophobia, a negative perception of e-payment usefulness, and credibility had a lesser disposition to its use. To ensure the universal implementation of e-payment in Nigerian hospitals, the service providers should make the e-payment platforms more secure and user-friendly to health services consumers and providers.
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Affiliation(s)
- James Okechukwu Abugu
- Department of Marketing, Faculty of Business Administration, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Amaechi Marcellus Chukwu
- Department of Marketing, Faculty of Business Administration, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ogochukwu Kelechi Onyeso
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Chiedozie James Alumona
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria.
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada.
| | | | - Ogo-Amaechi D Chukwu
- Department of Computer Science, Faculty of Physical Sciences, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
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Ramezani M, Takian A, Bakhtiari A, Rabiee HR, Fazaeli AA, Sazgarnejad S. The application of artificial intelligence in health financing: a scoping review. Cost Eff Resour Alloc 2023; 21:83. [PMID: 37932778 PMCID: PMC10626800 DOI: 10.1186/s12962-023-00492-2] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Artificial Intelligence (AI) represents a significant advancement in technology, and it is crucial for policymakers to incorporate AI thinking into policies and to fully explore, analyze and utilize massive data and conduct AI-related policies. AI has the potential to optimize healthcare financing systems. This study provides an overview of the AI application domains in healthcare financing. METHOD We conducted a scoping review in six steps: formulating research questions, identifying relevant studies by conducting a comprehensive literature search using appropriate keywords, screening titles and abstracts for relevance, reviewing full texts of relevant articles, charting extracted data, and compiling and summarizing findings. Specifically, the research question sought to identify the applications of artificial intelligence in health financing supported by the published literature and explore potential future applications. PubMed, Scopus, and Web of Science databases were searched between 2000 and 2023. RESULTS We discovered that AI has a significant impact on various aspects of health financing, such as governance, revenue raising, pooling, and strategic purchasing. We provide evidence-based recommendations for establishing and improving the health financing system based on AI. CONCLUSIONS To ensure that vulnerable groups face minimum challenges and benefit from improved health financing, we urge national and international institutions worldwide to use and adopt AI tools and applications.
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Affiliation(s)
- Maryam Ramezani
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran.
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ahad Bakhtiari
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid R Rabiee
- Department of Computer Engineering, Sharif University of Technology, Tehran, Iran
| | - Ali Akbar Fazaeli
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Sazgarnejad
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Tapsoba Y, Ndokabilya E, Wema JC, Engels T, Paul É. Mapping and analysis of health financing in South Kivu province (DRC). Sante Publique 2023; 35:315-328. [PMID: 37848378 DOI: 10.3917/spub.233.0315] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Introduction In South-Kivu, the health system is underfunded due to numerous constraints. Several initiatives have been tested but are insufficient for increasing and sustaining health financing. Purpose of research Analyze the health financing system in South-Kivu, through a mapping as well as quantitative and qualitative analysis of health financing mechanisms. Results The provincial health financing system is fragmented, with poorly coordinated mechanisms and interventions, leading to duplication of health system strengthening activities in addition to the absence of a mechanism for pooling external funding flows. Costs recovery (i.e. user fees) and external supports are the most widely used schemes while the government hardly contributes to the financing of the provincial health system. Mutual health insurance is supposed to improve access to health care, but its coverage is still extremely low. Results-Based Financing and free health care programs, fully financed by external donors, are irregular and insufficiently sustainable. Conclusions It would be critical to implement a strategic purchasing model that is anchored in local institutions, owned by all stakeholders, and integrating all existing financing mechanisms, which could be supported by a common fund supporting the provincial health system. The “Single Contract” initiative developed to harmonize, pool, and sustain external programs, could be a good basis in this respect. This would involve strengthening policy dialogue, developing an investment case to support resource mobilization and implementing a joint monitoring and evaluation platform for disbursements led by the provincial health authorities.
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Affiliation(s)
| | - Eustache Ndokabilya
- Coopération suisse – Direction du Développement et de la Coopération – Bukavu – RDC
| | | | | | - Élisabeth Paul
- Université Libre de Bruxelles – École de santé publique – Bruxelles – Belgique
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26
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Segal L, Hiscock H. Child abuse and premature mortality: disrupting the harm cascade. Med J Aust 2023; 219:301-302. [PMID: 37622210 DOI: 10.5694/mja2.52092] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
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Joram F, Hiliza J, Nathanael S, Anaeli A. Implementation of direct health facility financing in the rural District of Kigoma in Western Tanzania. Pan Afr Med J 2023; 46:19. [PMID: 38035157 PMCID: PMC10683170 DOI: 10.11604/pamj.2023.46.19.41052] [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: 07/12/2023] [Accepted: 08/23/2023] [Indexed: 12/02/2023] Open
Abstract
The adoption of decentralization by devolution in Tanzania has enabled the implementation of a Direct Health Facility Financing (DHFF) program in the facilities. While copious gains have been reported under DHFF, there are also notable failures to improve health service provision. This study aims to explore the experience of implementing the DHFF program in the rural areas of the Kigoma District Council. An exploratory qualitative study was conducted in Primary Health Care (PHC) facilities of the Kigoma District Council. A purposive sampling technique was used to draw 21 key informants including leaders of health facilities and members of the Health Facility Governing Committees (HFGC). Key Informant Interviews (KII) were used to solicit information from the study participants. Content analysis technique was used to analyze data collected from study participants. Our findings present enablers and barriers in the implementation of DHFF. Successful implementation of DHFF was enabled by the availability of formal training and supportive supervision, adherence to DHFF guidelines, availability of planning guidelines at the health facility, functionality of the HFGC, and adherence to the procurement process. A low sense of ownership of the program, delays and insufficient fund disbursement, shortage of health workers, and inadequate knowledge of DHFF program implementation emerged as the barriers that impeded successful program implementation. Evaluating the implementation experience of the DHFF program requires policymakers at the national level to devise a mechanism for the timely disbursement of funds, reinforcing capacity building to increase the autonomy of health facilities in their daily operations. Furthermore, structural and operational barriers warrant further operational and implementation research.
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Affiliation(s)
- Flora Joram
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Jairos Hiliza
- World Health Organization, Kigoma Field Office, Kigoma, Tanzania
| | - Sirili Nathanael
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Amani Anaeli
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
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Nguyen HA, Ahmed S, Turner HC. Overview of the main methods used for estimating catastrophic health expenditure. Cost Eff Resour Alloc 2023; 21:50. [PMID: 37553675 PMCID: PMC10408045 DOI: 10.1186/s12962-023-00457-5] [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: 03/06/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
Out-of-pocket payments are expenditures borne directly by an individual/household for health services that are not reimbursed by any third-party. Households can experience financial hardship when the burden of such out-of-pocket payments is significant. This financial hardship is commonly measured using the "catastrophic health expenditure" (CHE) metric. CHE has been applied as an indicator in several health sectors and health policies. However, despite its importance, the methods used to measure the incidence of CHE vary across different studies and the terminology used can be inconsistent. In this paper, we introduce and raise awareness of the main approaches used to calculate CHE and discuss critical areas of methodological variation in a global health context. We outline the key features, foundation and differences between the two main methods used for estimating CHE: the budget share and the capacity-to-pay approach. We discuss key sources of variation within CHE calculation and using data from Ethiopia as a case study, illustrate how different approaches can lead to notably different CHE estimates. This variation could lead to challenges when decisionmakers and policymakers need to compare different studies' CHE estimates. This overview is intended to better understand how to interpret and compare CHE estimates and the potential variation across different studies.
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Affiliation(s)
- Huyen Anh Nguyen
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Vietnam.
| | - Sayem Ahmed
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Vietnam
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, Norfolk Place, London, UK
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29
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Bollinger LA, Corlis J, Ombam R, Forsythe S, Resch SC. Unit cost repositories for health program planning and evaluation: a report on research in practice with lessons learned. BMC Public Health 2023; 23:1055. [PMID: 37264335 DOI: 10.1186/s12889-023-15964-6] [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: 09/30/2022] [Accepted: 05/22/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Most low- and middle-income countries have limited access to cost data that meets the needs of health policy-makers and researchers in health intervention areas including HIV, tuberculosis, and immunization. Unit cost repositories (UCRs)-searchable databases that systematically codify evidence from costing studies-have been developed to reduce the effort required to access and use existing costing information. These repositories serve as public resources and standard references, which can improve the consistency and quality of resource needs projections used for strategic planning and resource mobilization. UCRs also enable analysis of cost determinants and more informed imputation of missing cost data. This report examines our experiences developing and using seven UCRs (two global, five country-level) for cost projection and research purposes. DISCUSSION We identify advances, challenges, enablers, and lessons learned that might inform future work related to UCRs. Our lessons learned include: (1) UCRs do not replace the need for costing expertise; (2) tradeoffs are required between the degree of data complexity and the useability of the UCR; (3) streamlining data extraction makes populating the UCR with new data easier; (4) immediate reporting and planning needs often drive stakeholder interest in cost data; (5) developing and maintaining UCRs requires dedicated staff time; (6) matching decision-maker needs with appropriate cost data can be challenging; (7) UCRs must have data quality control systems; (8) data in UCRs can become obsolete; and (9) there is often a time lag between the identification of a cost and its inclusion in UCRs. CONCLUSIONS UCRs have the potential to be a valuable public good if kept up-to-date with active quality control and adequate support available to end-users. Global UCR collaboration networks and greater control by local stakeholders over global UCRs may increase active, sustained use of global repositories and yield higher quality results for strategic planning and resource mobilization.
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Affiliation(s)
- Lori A Bollinger
- Avenir Health, Glastonbury, P.O. Box 1337, CT, 06033-6337, Glastonbury, USA.
| | - Joseph Corlis
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, MA, Boston, USA
| | - Regina Ombam
- USAID/KEA Mission Support for Journey to Self-Reliance, Nairobi, Kenya
| | - Steven Forsythe
- Avenir Health, Glastonbury, P.O. Box 1337, CT, 06033-6337, Glastonbury, USA
| | - Stephen C Resch
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, MA, Boston, USA
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30
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Garg CC, Goyanka R. A comparison of the cost of outpatient care delivered by Aam Aadmi Mohalla Clinics compared to other public and private facilities in Delhi, India. Health Policy Plan 2023:7156522. [PMID: 37148326 DOI: 10.1093/heapol/czad033] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/11/2023] [Accepted: 05/04/2023] [Indexed: 05/08/2023] Open
Abstract
Aam Admi Mohalla Clinics (AAMC) were introduced in Delhi in 2015 as neighborhood clinics to strengthen the delivery of primary care. To inform the policies on government investments for outpatient care, this study estimated the cost of outpatient care per visit in Delhi for 2019-20 for AAMC and compared with urban primary health center (UPHC), public hospitals, private clinics, and private hospitals. Facility cost for AAMC and UPHC were also estimated. Using the data from national health survey, government annual budgets and reports, a modified top-down methodology was adopted to measure true cost of public facilities, taking in account both the government expenditure and out-of-pocket expenditures (OOPE). Inflation adjusted OOPE was used to measure cost of private facilities. The cost per visit at a private clinic at ₹1146 (US$16) was more than three times higher than that at a UPHC (₹325/US$5) and eight times higher than that at AAMC (₹143/US$2.0). These costs were ₹1099 (US$15) and ₹1818 (US$25) at public and private hospitals respectively. The annual economic cost per facility of a UPHC at ₹ 92,80,000/$130,000 is approximately four times that at AAMC (₹24,74,000/$35,000). Unit costs are found to be lower at AAMCs. Utilization for outpatient care has shifted in favor of public primary care facilities. Higher investments in public primary care facilities with expanded services for prevention and promotion, upscaled infrastructure and a gate-keeping mechanism can strengthen the delivery of primary care and promote universal health care at a lower cost.
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Affiliation(s)
- Charu C Garg
- Independent Consultant, USA and Director, OJAS consulting, GenevaInstitute for Human Development, New Delhi
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31
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Callander EJ. Out-of-pocket fees for health care in Australia: implications for equity. Med J Aust 2023; 218:294-297. [PMID: 37062007 PMCID: PMC10953298 DOI: 10.5694/mja2.51895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 04/04/2023]
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32
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Leus S, Bollen J. Access to voluntary assisted dying in Australia requires fair remuneration for medical practitioners. Med J Aust 2023; 218:432. [PMID: 37037670 DOI: 10.5694/mja2.51923] [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: 01/12/2023] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Stefan Leus
- Maastricht University, Maastricht, the Netherlands
| | - Jan Bollen
- Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
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33
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Habicht T, Kasekamp K, Webb E. 30 years of primary health care reforms in Estonia: The role of financial incentives to achieve a multidisciplinary primary health care system. Health Policy 2023; 130:104710. [PMID: 36764032 PMCID: PMC10695763 DOI: 10.1016/j.healthpol.2023.104710] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 11/15/2022] [Accepted: 01/16/2023] [Indexed: 01/23/2023]
Abstract
Estonia has a legacy of hospital-focused service provision, but since the 1990s, has introduced a series of reforms to strengthen primary health care (PHC). The recent PHC reforms have placed an increasing focus on multidisciplinary care, involving home nurses, midwives, and physiotherapists, and emphasize PHC centres over single physician practices. These incremental reforms, without a supporting legal basis nor explicitly defined timelines and targets, nonetheless demonstrated the ability of financial incentives to drive change. EU structural funds in particular provided essential funding for infrastructure investments in PHC. Yet not all stakeholders supported these initiatives, largely due to the uncertain sustainability of funding. The EHIF also adjusted contract and payment terms to support PHC reforms, with some concessions to PHC providers operating as single practitioners. Despite substantial progress over the last three decades to shift the focus to PHC, there are some important bottlenecks that hinder the progress. These include PHC providers' hesitance to give up their freedom as single practitioners, low interest from specialists to start working at the PHC level, and a lack of financial incentives and adequate funding for a broader scope of PHC services. This looks to become more challenging in the future, as nearly half of family physicians are 60 years old or older. The development of the new PHC strategy in 2023 is very timely to comprehensively address these bottlenecks and to set the vision for the future of PHC in Estonia.
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Affiliation(s)
- Triin Habicht
- WHO Barcelona Office for Health Systems Financing, Spain
| | - Kaija Kasekamp
- Institute of Family Medicine and Public Health, University of Tartu, Estonia
| | - Erin Webb
- Department of Healthcare Management, Berlin University of Technology, Germany; European Observatory on Health Systems and Policies, Department of Healthcare Management, Berlin University of Technology, Germany.
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34
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Rogers B, Legaspi JP, Bastiampillai T. Hospital congestion: a market solution to address delayed transfers of care from hospital beds. Med J Aust 2023; 218:298-300. [PMID: 36966447 DOI: 10.5694/mja2.51876] [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: 08/28/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 03/27/2023]
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Kitole FA, Lihawa RM, Mkuna E. Equity in the public social healthcare protection in Tanzania: does it matter on household healthcare financing? Int J Equity Health 2023; 22:50. [PMID: 36941603 PMCID: PMC10026448 DOI: 10.1186/s12939-023-01855-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023] Open
Abstract
Efforts to promote equity in healthcare involve implementing policies and programs that address the root causes of healthcare disparities and promote equal access to care. One such program is the public social healthcare protection schemes. However, like many other developing countries, Tanzania has low health insurance coverage, hindering its efforts to achieve universal health coverage. This study examines the role of equity in public social healthcare protection and its effects on household healthcare financing in Tanzania. The study used secondary data collected from the National Bureau of Statistics' National Panel Survey 2020/21 and stratified households based on their place of residence (rural vs. urban). Moreover, the logit regression model, ordered logit, and the endogenous switching regression model were used to provide counterfactual estimates without selection bias and endogeneity problems. The results showed greater variations in social health protection across rural and urban households, increasing disparities in health outcomes between these areas. Rural residents are the most vulnerable groups. Furthermore, education, income, and direct healthcare costs significantly influence equity in healthcare financing and the ability of households to benefit from public social healthcare protection schemes. To achieve equity in healthcare in rural and urban areas, developing countries need to increase investment in health sector by reducing the cost of healthcare, which will significantly reduce household healthcare financing. Furthermore, the study recommends that social health protection is an essential strategy for improving fair access to quality healthcare by removing differences across households and promoting equality in utilizing healthcare services.
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Affiliation(s)
| | | | - Eliaza Mkuna
- Department of Economics, Mzumbe University, P.O Box 5, Mzumbe, Tanzania
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Kaiser AH, Okorafor O, Ekman B, Chhim S, Yem S, Sundewall J. Assessing progress towards universal health coverage in Cambodia: Evidence using survey data from 2009 to 2019. Soc Sci Med 2023; 321:115792. [PMID: 36842307 DOI: 10.1016/j.socscimed.2023.115792] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/27/2022] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Over the past decades, many low- and middle-income countries have implemented health financing and system reforms to progress towards universal health coverage (UHC). In the case of Cambodia, out-of-pocket expenditure (OOPE) remains the main source of current health expenditure after several decades of reform, exposing households to financial risks when accessing healthcare and violating UHC's key tenet of financial protection. We use pre-pandemic data from the nationally representative Cambodia Socio-Economic Surveys of 2009 to 2019 to assess progress in financial protection to evaluate the reforms and obtain internationally comparable estimates. We find that following strong improvements in financial protection between 2009 and 2017, there was a reversal in the trend thereafter. The OOPE budget share rose, and the incidence of catastrophic spending and impoverishment increased in nearly all geographical and socioeconomic strata. For example, 17.7% of households experienced catastrophic health expenditure in 2019 at the threshold of 10% of total household consumption expenditure, and 3.9% of households were pushed into poverty by OOPE. The distribution of all financial protection indicators varied strongly across socioeconomic and geographical strata in all years. Fundamentally, the demonstrated trend reversal may jeopardize Cambodia's ability to progress towards UHC. To improve financial protection in the short term, there is a need to address the burden created by OOPE through targeted interventions to household groups that are most affected. In the medium term, our findings emphasize the importance of expanding health pre-payment schemes to currently uncovered vulnerable groups, specifically the near-poor. The government also needs to consider extending the scope of services covered and the range of providers to include the private sector under these schemes to reduce reliance on OOPE.
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Affiliation(s)
- Andrea Hannah Kaiser
- Lund University, Department of Clinical Sciences, Malmö (IKVM), Division of Social Medicine and Global Health (SMGH), CRC, Jan Waldenströms Gata 35, Malmö, Sweden; Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Cambodia, Improving Social Protection and Health Project, Sayon Building, Samdach Pan Ave No. 41, 12211, Phnom Penh, Cambodia.
| | - Okore Okorafor
- Forte Metrix Consulting, 58 Sara Circle, Langeberg Heights, Durbanville, 7550, Western Cape, South Africa.
| | - Björn Ekman
- Lund University, Department of Clinical Sciences, Malmö (IKVM), Division of Social Medicine and Global Health (SMGH), CRC, Jan Waldenströms Gata 35, Malmö, Sweden.
| | - Srean Chhim
- National Institute of Public Health Cambodia, Lot 80, Street 566 & Corner with Street 289, Boeung Kak 2, Toul Kork, Phnom Penh, Cambodia.
| | - Sokunthea Yem
- National Institute of Public Health Cambodia, Lot 80, Street 566 & Corner with Street 289, Boeung Kak 2, Toul Kork, Phnom Penh, Cambodia.
| | - Jesper Sundewall
- Lund University, Department of Clinical Sciences, Malmö (IKVM), Division of Social Medicine and Global Health (SMGH), CRC, Jan Waldenströms Gata 35, Malmö, Sweden; HEARD, University of KwaZulu-Natal, South Africa.
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Yazbeck AS, Soucat AL, Tandon A, Cashin C, Kutzin J, Watson J, Thomson S, Nguyen SN, Evetovits T. Addiction to a bad idea, especially in low- and middle-income countries: Contributory health insurance. Soc Sci Med 2023; 320:115168. [PMID: 36822716 DOI: 10.1016/j.socscimed.2022.115168] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 05/10/2022] [Accepted: 06/21/2022] [Indexed: 02/23/2023]
Abstract
Despite limited evidence of successful development and implementation of contributory health insurance and low and middle income countries, many countries are in the process implementing such schemes. This commentary summarizes all available evidence on the limitations of contributory health insurance including the lack of good theoretical underpinning and the considerable evidence of inequity and fragmentation created by such schemes. Moreover, the initiation of a contributory health insurance scheme has not been found to increase revenues to the health sector or help health countries achieve universal health coverage. Low and middle income countries can improve equity and efficiency of the health sector by replacing out-of-pocket spending with pre-paid pooling mechanisms, but that is best done through budget transfers and not by contributory insurance that links payment to sub-population entitlements.
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Affiliation(s)
- Abdo S Yazbeck
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | | | | | | | - Joseph Kutzin
- Health Financing Policy at the World Health Organization, Geneva, Switzerland
| | | | - Sarah Thomson
- WHO Barcelona Office for Health Systems Strengthening, Barcelona, Spain
| | | | - Tamas Evetovits
- WHO Barcelona Office for Health Systems Strengthening, Barcelona, Spain
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Woods L, Eden R, Canfell OJ, Nguyen KH, Comans T, Sullivan C. Show me the money: how do we justify spending health care dollars on digital health? Med J Aust 2023; 218:53-57. [PMID: 36502453 PMCID: PMC10107451 DOI: 10.5694/mja2.51799] [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: 04/11/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Digital Health Cooperative Research Centre, Sydney, NSW
| | - Rebekah Eden
- Queensland University of Technology, Brisbane, QLD
| | - Oliver J Canfell
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Digital Health Cooperative Research Centre, Sydney, NSW.,University of Queensland, Brisbane, QLD
| | - Kim-Huong Nguyen
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Global Brain Health Institute, Trinity College Dublin and University California, San Francisco, Dublin, Ireland
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Clair Sullivan
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD
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Angeles MR, Crosland P, Hensher M. Challenges for Medicare and universal health care in Australia since 2000. Med J Aust 2023; 218:322-329. [PMID: 36739106 DOI: 10.5694/mja2.51844] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 08/24/2022] [Revised: 11/14/2022] [Accepted: 12/05/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To identify the financing and policy challenges for Medicare and universal health care in Australia, as well as opportunities for whole-of-system strengthening. STUDY DESIGN Review of publications on Medicare, the Pharmaceutical Benefits Scheme, and the universal health care system in Australia published 1 January 2000 - 14 August 2021 that reported quantitative or qualitative research or data analyses, and of opinion articles, debates, commentaries, editorials, perspectives, and news reports on the Australian health care system published 1 January 2015 - 14 August 2021. Program-, intervention- or provider-specific articles, and publications regarding groups not fully covered by Medicare (eg, asylum seekers, prisoners) were excluded. DATA SOURCES MEDLINE Complete, the Health Policy Reference Centre, and Global Health databases (all via EBSCO); the Analysis & Policy Observatory, the Australian Indigenous HealthInfoNet, the Australian Public Affairs Information Service, Google, Google Scholar, and the Organisation for Economic Co-operation and Development (OECD) websites. RESULTS The problems covered by the 76 articles included in our review could be grouped under seven major themes: fragmentation of health care and lack of integrated health financing, access of Aboriginal and Torres Strait Islander people to health services and essential medications, reform proposals for the Pharmaceutical Benefits Scheme, the burden of out-of-pocket costs, inequity, public subsidies for private health insurance, and other challenges for the Australian universal health care system. CONCLUSIONS A number of challenges threaten the sustainability and equity of the universal health care system in Australia. As the piecemeal reforms of the past twenty years have been inadequate for meeting these challenges, more effective, coordinated approaches are needed to improve and secure the universality of public health care in Australia.
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Affiliation(s)
| | - Paul Crosland
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | - Martin Hensher
- Menzies Institute for Medical Research, the University of Tasmania, Hobart, TAS
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Bärnreuther S. Disrupting healthcare? Entrepreneurship as an "innovative" financing mechanism in India's primary care sector. Soc Sci Med 2023; 319:115314. [PMID: 36127193 DOI: 10.1016/j.socscimed.2022.115314] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
"Innovation" - whether in the form of digital technologies or business models - dominates imaginaries of global health futures and is often promoted as a "solution" through which the goal of universal health coverage can be achieved. Seemingly disrupting the status quo, it offers the promise of novel and simple answers to longstanding and complex social problems. In this article, I analyze a public-private partnership between the Indian state of West Bengal and an Indian-owned social enterprise. One of its defining features is an "innovative" financing mechanism based on loans and entrepreneurship. The project employs young people from marginalized communities as health entrepreneurs, who market digital healthcare in rural areas in order to provide access to affordable and high-quality biomedical care. Although the model promises sustainable modes of financing healthcare, it shifts financial risk to low-income groups. As health workers resisted attempts to be turned into self-reliant entrepreneurs and continued to make demands on the developmental state, frictions emerged during project implementation. The question of how healthcare should be made accessible and affordable, in what manner the state should be involved in financing it, and what role innovation should play in this regard was all contested. Although an entrepreneurial business model to deliver primary care is seen as an innovative solution at a time when government expenditure in the social sector remains low and levels of un- and underemployment are high, this paper complicates prevailing claims about its disruptive powers in India and argues that its effective role for equitable social change has to be critically examined.
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Affiliation(s)
- Sandra Bärnreuther
- Department of Social Anthropology, University of Lucerne, Lucerne, Switzerland.
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Alemayehu YK, Dessie E, Medhin G, Birhanu N, Hotchkiss DR, Teklu AM, Kiros M. The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia. BMC Health Serv Res 2023; 23:67. [PMID: 36683041 PMCID: PMC9869550 DOI: 10.1186/s12913-022-09019-6] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Evidence on the effectiveness of community-based health insurance (CBHI) in low-income countries is inconclusive. This study assessed the impact of CBHI on health service utilization and financial risk protection in Ethiopia. METHODS We conducted a comparative cross-sectional study nested within a larger national household survey in 2020. Data was collected from three groups of households-CBHI member households (n = 1586), non-member households from CBHI implementing woredas (n = 1863), and non-member households from non-CBHI implementing woredas (n = 789). Indicators of health service utilization, out-of-pocket health spending, catastrophic health expenditure, and impoverishment due to health spending among CBHI members were compared with non-members from CBHI implementing woredas and households from non-CBHI implementing woredas. Propensity score matching (PSM) was used to account for possible selection bias. RESULTS The annual number of OPD visits per capita among CBHI member households was 2.09, compared to 1.53 among non-member households from CBHI woredas and 1.75 among households from non-CBHI woredas. PSM estimates indicated that CBHI members had 0.36 (95% CI: 0.25, 0.44) and 0.17 (95% CI: -0.04, 0.19) more outpatient department (OPD) visits per capita per year than their matched non-member households from CBHI-implementing and non-CBHI implementing woredas, respectively. CBHI membership resulted in a 28-43% reduction in annual OOP payments as compared to non-member households. CBHI member households were significantly less likely to incur catastrophic health expenditures (measured as annual OOP payments of more than 10% of the household's total expenditure) compared to non-members (p < 0.01). CONCLUSION CBHI membership increases health service utilization and financial protection. CBHI proves to be an important strategy for promoting universal health coverage. Implementing CBHI in all woredas and increasing membership among households in woredas that are already implementing CBHI will further expand its benefits.
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Affiliation(s)
| | - Ermias Dessie
- World Health Organization – Ethiopia, Addis Ababa, Ethiopia
| | | | - Negalign Birhanu
- grid.411903.e0000 0001 2034 9160Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - David R. Hotchkiss
- grid.265219.b0000 0001 2217 8588School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | | | - Mizan Kiros
- grid.414835.f0000 0004 0439 6364Ministry of Health, Addis Ababa, Ethiopia
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Law HD, Marasinghe D, Butler D, Welsh J, Lancsar E, Banks E, Biddle N, Korda R. Progressivity of out-of-pocket costs under Australia's universal health care system: A national linked data study. Health Policy 2023; 127:44-50. [PMID: 36456400 DOI: 10.1016/j.healthpol.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND In line with affordability and equity principles, Medicare-Australia's universal health care program-has measures to contain out-of-pocket (OOP) costs, particularly for lower income households. This study examined the distribution of OOP costs for Medicare-subsidised out-of-hospital services and prescription medicines in Australian households, according to their ability to pay. METHODS OOP costs for out-of-hospital services and medicines in 2017-18 were estimated for each household, using 2016 Australian Census data linked to Medicare Benefits Schedule (MBS) and Pharmaceutical Benefit Scheme (PBS) claims. We derived household disposable income by combining income information from the Census linked to income tax and social security data. We quantified OOP costs as a proportion of equivalised household disposable income and calculated Kakwani progressivity indices (K). RESULTS Using data from 82% (n = 6,830,365) of all Census private households, OOP costs as a percentage of equivalised household disposable income decreased from 1.16% in the poorest decile to 0.63% in the richest decile for MBS services, and from 1.35% to 0.35% for PBS medicines. The regressive trend was less pronounced for MBS services (K = -0.06), with percentage OOP cost relatively stable between the 2nd and 9th income deciles; while percentage OOP cost decreased with increasing income for PBS medicines (K = -0.24). CONCLUSION OOP costs for out-of-hospital Medicare services were mildly regressive while those for prescription medicines were distinctly regressive. Actions to reduce inequity in OOP costs, particularly for medicines, should be considered.
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Lohman D, Callaway M, Pardy S, Mwangi-Powell F, Foley KM. Six Key Approaches in Open Society Foundations' Support for Global Palliative Care Development. J Pain Symptom Manage 2023; 65:47-57. [PMID: 36064160 DOI: 10.1016/j.jpainsymman.2022.08.020] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Between 1998 and 2021, the Open Society Foundations (OSF) network invested around US$50 million in supporting the emerging field of palliative care worldwide, funding different approaches and interventions to advance its objective of putting palliative care on the global public health agenda. OBJECTIVE To describe six approaches that were instrumental to the successes of Open Society Foundations' support in building the global field of palliative care. A robust discussion of lessons learnt is unfortunately not possible because Open Society Foundations did not commission a rigorous evaluation of the impacts of its investments. METHODS This article describes these six approaches: Investing in versatile palliative care leaders at national and regional level; investing in palliative care champions within the OSF network; proactively engaging the World Health Organization (WHO) in efforts to promote palliative care; developing tools and skills to improve palliative care financing; using a human rights-based approach; and supporting self-advocacy by people with palliative care needs. RESULTS Deep, long-term investments in national and regional champions from the palliative care community and OSF's own network built palliative care leaders with well-rounded skills, knowledge and opportunities to develop their own networks. The active engagement and involvement of the WHO in efforts to advance palliative care enhanced the credibility of palliative care as a discipline as well its champions, whereas the human rights approach resulted in more diverse strategies to overcome barriers to palliative care. The focus on palliative care financing and self-advocacy showed significant promise for impact. DISCUSSION The approaches and strategies described helped a nascent palliative care field develop into a health service that is increasingly integrated into public health systems. Other funders and national governments can build on OSF's long term support for the palliative care field and support further integration of palliative care within public health to increase access.
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Affiliation(s)
- Diederik Lohman
- Former Senior Advisor to Open Society Foundations' Public Health Program (D.L.), New York, USA.
| | - Mary Callaway
- Former director of the International Palliative Care Initiative (M.C.), New York, USA
| | - Sara Pardy
- Former Senior Administrative Specialist to Open Society Foundations' Public Health Program (S.P.), New York, USA
| | - Faith Mwangi-Powell
- Former Senior Program Officer Advocacy and Financing in the International Palliative Care Initiative; current CEO Girls Not Brides (F.M.P.), London, UK
| | - Kathleen M Foley
- Former medical director of the International Palliative Care Initiative (K.M.F.), New York, USA
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Boachie MK, Agyemang J, Immurana M. Health sector funding in Ghana: The effect of IMF conditionalities. Dialogues Health 2022; 1:100045. [PMID: 38515887 PMCID: PMC10953935 DOI: 10.1016/j.dialog.2022.100045] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 03/23/2024]
Abstract
Purpose This paper examines the factors influencing government health spending in Ghana with a particular focus on IMF conditionalities. Design/methodology/approach We estimate four simultaneous equations using three-stage least squares (3SLS) estimator. The data used cover the period 1980-2014. Findings After controlling for some other factors affecting government health spending, the results show that democracy and foreign aid significantly increase public sector health funding. IMF programs with its associated conditionalities insignificantly reduce public health spending Ghana. Originality/value This study provides important evidence on the impact of IMF conditionalities on health sector funding in Ghana. The results will serve as guide to policymakers when negotiating for IMF credit so that such arrangements do not obstruct health sector funding.
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Affiliation(s)
- Micheal Kofi Boachie
- SAMRC/Wits Centre for Health Economics and Decision – PRICELESS SA, School of Public Health, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - John Agyemang
- School of Public Health/Internal Audit Department, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mustapha Immurana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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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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Haemmerli M, Asante A, Susilo D, Satrya A, Fattah RA, Cheng Q, Kosen S, Novitasari D, Puteri GC, Adawiyah E, Hayen A, Gilson L, Mills A, Tangcharoensathien V, Jan S, Thabrany H, Wiseman V. Using measures of quality of care to assess equity in health care funding for primary care: analysis of Indonesian household data. BMC Health Serv Res 2022; 22:1349. [PMID: 36376946 PMCID: PMC9664775 DOI: 10.1186/s12913-022-08739-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many countries implementing pro-poor reforms to expand subsidized health care, especially for the poor, recognize that high-quality healthcare, and not just access alone, is necessary to meet the Sustainable Development Goals. As the poor are more likely to use low quality health services, measures to improve access to health care need to emphasise quality as the cornerstone to achieving equity goals. Current methods to evaluate health systems financing equity fail to take into account measures of quality. This paper aims to provide a worked example of how to adapt a popular quantitative approach, Benefit Incidence Analysis (BIA), to incorporate a quality weighting into the computation of public subsidies for health care. METHODS We used a dataset consisting of a sample of households surveyed in 10 provinces of Indonesia in early-2018. In parallel, a survey of public health facilities was conducted in the same geographical areas, and information about health facility infrastructure and basic equipment was collected. In each facility, an index of service readiness was computed as a measure of quality. Individuals who reported visiting a primary health care facility in the month before the interview were matched to their chosen facility. Standard BIA and an extended BIA that adjusts for service quality were conducted. RESULTS Quality scores were relatively high across all facilities, with an average of 82%. Scores for basic equipment were highest, with an average score of 99% compared to essential medicines with an average score of 60%. Our findings from the quality-weighted BIA show that the distribution of subsidies for public primary health care facilities became less 'pro-poor' while private clinics became more 'pro-rich' after accounting for quality of care. Overall the distribution of subsidies became significantly pro-rich (CI = 0.037). CONCLUSIONS Routine collection of quality indicators that can be linked to individuals is needed to enable a comprehensive understanding of individuals' pathways of care. From a policy perspective, accounting for quality of care in health financing assessment is crucial in a context where quality of care is a nationwide issue. In such a context, any health financing performance assessment is likely to be biased if quality is not accounted for.
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Affiliation(s)
- Manon Haemmerli
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Dwidjo Susilo
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Aryana Satrya
- Department of Management, Faculty of Economics, University of Indonesia, Depok, Indonesia
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Rifqi Abdul Fattah
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Danty Novitasari
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Gemala Chairunnisa Puteri
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
- Centre for Health Economics and Policy Studies, University of Indonesia, Jakarta, Indonesia
| | - Eviati Adawiyah
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Health Policy and Systems Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Anne Mills
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Kirby Institute, University of New South Wales, Sydney, Australia
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Dragos SL, Mare C, Dragos CM, Muresan GM, Purcel AA. Does voluntary health insurance improve health and longevity? Evidence from European OECD countries. Eur J Health Econ 2022; 23:1397-1411. [PMID: 35124741 DOI: 10.1007/s10198-022-01439-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
The financing structure of the healthcare system and, particularly, the voluntary health insurance (VHI) constituent, has been a vital pillar in improving the overall quality of life. Consequently, this study aims to shed light on the effect of VHI on the population's health and longevity in a sample of 26 European OECD countries. The methodology employed covers both hierarchical clustering and the novel dynamic panel threshold technique. First, the descriptive cluster analysis unveils a delimitation of the countries into four main groups with respect to a broad set of health status indicators. Second, the estimates show that VHI is a significant determinant of health and longevity. More specifically, we find that the relationship between variables is characterized by a threshold effect, whose estimated value is roughly 6.3% of the total healthcare financing. Also, the heterogeneity analysis unveils consistent differences regarding the impact of VHI on health and longevity for the supplementary and complementary types of VHI. Overall, results are strongly robust, the signs and the significance of the coefficients being preserved in the presence of several additional control factors. From a policy perspective, the study's findings can be used nationwide to stimulate regulatory policies to encourage the achievement of a satisfactory level of private health insurance.
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Affiliation(s)
- Simona Laura Dragos
- Department of Finance, Faculty of Economics and Business Administration, Babeș-Bolyai University, 58-60, Teodor Mihali str., 400591, Cluj-Napoca, Romania
| | - Codruta Mare
- Department of Statistics-Forecasts-Mathematics, Faculty of Economics and Business Administration, Babeș-Bolyai University, 58-60, Teodor Mihali str., 400591, Cluj-Napoca, Romania.
- Interdisciplinary Centre for Data Science, Babeș-Bolyai University, 68, Avram Iancu str., 4th floor, 400083, Cluj-Napoca, Romania.
| | - Cristian Mihai Dragos
- Department of Statistics-Forecasts-Mathematics, Faculty of Economics and Business Administration, Babeș-Bolyai University, 58-60, Teodor Mihali str., 400591, Cluj-Napoca, Romania
| | - Gabriela Mihaela Muresan
- Department of Finance, Faculty of Economics and Business Administration, Babeș-Bolyai University, 58-60, Teodor Mihali str., 400591, Cluj-Napoca, Romania
| | - Alexandra-Anca Purcel
- Department of Statistics-Forecasts-Mathematics, Faculty of Economics and Business Administration, Babeș-Bolyai University, 58-60, Teodor Mihali str., 400591, Cluj-Napoca, Romania
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Furtado KM, Raza A, Mathur D, Vaz N, Agrawal R, Shroff ZC. The trust and insurance models of healthcare purchasing in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in India: early findings from case studies of two states. BMC Health Serv Res 2022; 22:1056. [PMID: 35982425 PMCID: PMC9389741 DOI: 10.1186/s12913-022-08407-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Pradhan Mantri Jan Arogya Yojana (PMJAY), a publicly funded health insurance scheme for the poor in India, was launched in 2018. Early experiences of states with various purchasing arrangements can provide valuable insights for its future performance. We sought to understand the institutional agencies and performance of the trust and insurance models of purchasing with respect to; a) Provider contracting b) Claim management c) Implementation costs. METHODS A mixed methods case study design was adopted. Two states, Uttar Pradesh (representing a trust model) and Jharkhand (representing the insurance model) were purposively selected. Data sources included document reviews, key informant interviews, quantitative scheme data from the provider empanelment and claims database, and primary data on costs. Descriptive statistics were reported for quantitative data, content analysis was used for thematic reporting of qualitative data. RESULTS In both models, the state was the final authority on empanelment decisions, with no significant influence of the insurance company. Private hospitals constituted the majority of empanelled providers, with wide variations in district-wise distribution of bed capacities in both states. The urgency of completing empanelment in the early days of the scheme created the need for both states to re-review hospitals and de-empanel those not meeting requirements. Very few quality- accredited private hospitals were empaneled. The trust displayed more oversight of support agencies for claim management, longer processing times, a higher claim rejection rate and numbers of queries raised, as compared to the insurance model. Support agencies in both states faced challenges in assessing the clinical decisions of hospitals. Cost-effectiveness showed mixed results; the trust cost less than the insurance model per beneficiary enrolled, but more per claim generated. CONCLUSIONS Efforts are required to enable a better distribution and ensure quality of care in empanelled hospitals. The adoption of standard treatment guidelines is needed to support hospitals and implementing agencies in better claim management. The oversight of agencies through enforcement of contracts remains vital in both models. Assessing the comparative performance of trusts and insurance companies in more states at later stages of scheme implementation, would be further useful to determine their cost-effectiveness as purchasers.
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Affiliation(s)
| | - Arif Raza
- Goa Institute of Management, Poriem, Sattari, Goa, India, 403505
| | | | - Nafisa Vaz
- Goa Institute of Management, Poriem, Sattari, Goa, India, 403505
| | - Ruchira Agrawal
- National Health Authority, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Rudasingwa M, De Allegri M, Mphuka C, Chansa C, Yeboah E, Bonnet E, Ridde V, Chitah BM. Universal health coverage and the poor: to what extent are health financing policies making a difference? Evidence from a benefit incidence analysis in Zambia. BMC Public Health 2022; 22:1546. [PMID: 35964020 PMCID: PMC9375934 DOI: 10.1186/s12889-022-13923-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Zambia has invested in several healthcare financing reforms aimed at achieving universal access to health services. Several evaluations have investigated the effects of these reforms on the utilization of health services. However, only one study has assessed the distributional incidence of health spending across different socioeconomic groups, but without differentiating between public and overall health spending and between curative and maternal health services. Our study aims to fill this gap by undertaking a quasi-longitudinal benefit incidence analysis of public and overall health spending between 2006 and 2014. Methods We conducted a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies at three time points. We combined data from household surveys and National Health Accounts. Results Results showed that public (concentration index of − 0.003; SE 0.027 in 2006 and − 0.207; SE 0.011 in 2014) and overall (0.050; SE 0.033 in 2006 and − 0.169; SE 0.011 in 2014) health spending on curative services tended to benefit the poorer segments of the population while public (0.241; SE 0.018 in 2007 and 0.120; SE 0.007 in 2014) and overall health spending (0.051; SE 0.022 in 2007 and 0.116; SE 0.007 in 2014) on institutional delivery tended to benefit the least-poor. Higher inequalities were observed at higher care levels for both curative and institutional delivery services. Conclusion Our findings suggest that the implementation of UHC policies in Zambia led to a reduction in socioeconomic inequality in health spending, particularly at health centres and for curative care. Further action is needed to address existing barriers for the poor to benefit from health spending on curative services and at higher levels of care.
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Affiliation(s)
- Martin Rudasingwa
- Heidelberg Institute of Global Health, University Hospital & Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital & Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Chrispin Mphuka
- Department of Economics, University of Zambia, Lusaka, Zambia
| | - Collins Chansa
- Heidelberg Institute of Global Health, University Hospital & Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Edmund Yeboah
- Heidelberg Institute of Global Health, University Hospital & Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Emmanuel Bonnet
- IRD, UMR 215 Prodig, CNRS, Université Paris 1 Panthéon-Sorbonne, AgroParisTech, 5, Cours des Humanités, F-93 322 Aubervilliers Cedex, Paris, France
| | - Valéry Ridde
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
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Kumar R, Suharlim C, Amaris Caruso A, Gilmartin C, Mehra M, Castro HE. Assessing progression of health technology assessment implementation in Asia: a balanced scorecard for cross comparison of selected countries in Asia. Int J Technol Assess Health Care 2022; 38:e60. [PMID: 35858879 DOI: 10.1017/S0266462322000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To provide an update on the use of health technology assessment (HTA) in Asia and lessons for countries seeking to advance HTA. METHODS Build upon the research by Chootipongchaivat and the World Health Organization identifying eighteen "factors conducive to the development of HTA in Asia." These factors were used to create a balanced scorecard to assess the progress of HTA, measuring progress against each factor in China, India, Indonesia, Malaysia, Philippines, South Korea, Taiwan, Thailand, and Vietnam. A scoring system was used wherein: 1, No progress; 2, milestone at early stages, ad hoc HTA use; 3, progress on milestone but limited impact; 4, significant progress but limited remit; and 5, significant progress on milestone, routine HTA informs decisions. Total scores indicated progress of HTA while milestone scores provided contextual insights within countries. Literature reviews and expert interviews were used to complete scorecards. RESULTS South Korea and Thailand scored highest with seventy-three and seventy-one points, respectively, while Vietnam scored lowest at 28.5. Advanced HTA programs have independent HTA agencies with a broad remit, explicit process and methods, network of researchers, and routine use of HTA. Taiwan and Malaysia fall in a middle tier, with established HTA programs with limited remit. The final tier with China, India, Indonesia, Philippines, and Vietnam, emerging HTA processes. CONCLUSIONS Universal Health Coverage goals have catalyzed expansion of HTA. Political will, technical expertise, and sustained financing remain challenges for sustainable HTA programs. Legislation supporting HTA is helpful but political will is key. Recommendations for regional collaboration are provided.
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