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Adamu AA, Jalo RI, Muhammad ID, Essoh TA, Ndwandwe D, Wiysonge CS. Sustainable financing for vaccination towards advancing universal health coverage in the WHO African region: The strategic role of national health insurance. Hum Vaccin Immunother 2024; 20:2320505. [PMID: 38414114 PMCID: PMC10903629 DOI: 10.1080/21645515.2024.2320505] [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: 01/02/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
There is a growing political interest in health reforms in Africa, and many countries are choosing national health insurance as their main financing mechanism for universal health coverage. Although vaccination is an essential health service that can influence progress toward universal health coverage, it is not often prioritized by these national health insurance systems. This paper highlights the potential gains of integrating vaccination into the package of health services that is provided through national health insurance and recommends practical policy actions that can enable countries to harness these benefits at population level.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ibrahim D. Muhammad
- Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Téné-Alima Essoh
- Agence de Médecine Préventive, Regional Office for Africa, Abidjan, Cote d’Ivoire
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Waitzberg R, Allin S, Grignon M, Ljungvall Å, Habimana K, Kantaris M, Thomas S, Rice T. Mitigating the regressivity of private mechanisms of financing healthcare: An Assessment of 29 countries. Health Policy 2024; 143:105058. [PMID: 38569330 DOI: 10.1016/j.healthpol.2024.105058] [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: 12/29/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
Progressive financing of health care can help advance the equity and financial protection goals of health systems. All countries' health systems are financed in part through private mechanisms, including out-of-pocket payments and voluntary health insurance. Yet little is known about how these financing schemes are structured, and the extent to which policies in place mitigate regressivity. This study identifies the potential policies to mitigate regressivity in private financing, builds two qualitative tools to comparatively assess regressivity of these two sources of revenue, and applies this tool to a selection of 29 high-income countries. It provides new evidence on the variations in policy approaches taken, and resultant regressivity, of private mechanisms of financing health care. These results inform a comprehensive assessment of progressivity of health systems financing, considering all revenue streams, that appears in this special section of the journal.
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Affiliation(s)
- Ruth Waitzberg
- Department of Health Care Management, Faculty of Economics & Management, Technische Universität Berlin, Germany. Straße des 17. Juni 135 10623 Berlin, Germany; Myers-JDC-Brookdale Institute, Jerusalem, Israel.
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada. 155 College Street, Toronto M5T 3M6, Ontario, Canada
| | - Michel Grignon
- Department of Economics, McMaster University, Canada. 1280 Main Street West, Hamilton L8S 4M4, Ontario, Canada
| | - Åsa Ljungvall
- Swedish Agency for Health and Care Services Analysis, Stockholm, Sweden. Drottninggatan 89 113 16 Stockholm, Sweden
| | - Katharina Habimana
- International Consultant and Health Expert at Austrian National Health Institute, Austria
| | | | - Steve Thomas
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, College Green. Dublin 2 Ireland
| | - Thomas Rice
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Ulinski KGB, Carvalho BG, Vieira FS, Rodrigues R, Lima LDD. [Effects of parliamentary amendments on municipal financing of primary health care in the Brazilian Unified National Health System]. CAD SAUDE PUBLICA 2024; 40:e00007323. [PMID: 38656068 DOI: 10.1590/0102-311xpt007323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 10/19/2023] [Indexed: 04/26/2024] Open
Abstract
This study aims to analyze the effects of the expansion of the federal transfer of parliamentary amendments for municipal financing of primary health care (PHC) in the Brazilian Unified National Health System (SUS), from 2015 to 2020. A longitudinal study was conducted using secondary data on transfers of parliamentary amendments from the Brazilian Ministry of Health and expenditure of municipalities' own resources on public health actions and services and PHC. The effect of the transfer of parliamentary amendments on municipal financing was verified in a stratified way by population size of the municipalities, using generalized estimating equation models. The transfer of parliamentary amendments for PHC showed a large discrepancy in per capita values among municipalities of different population sizes. No correlation with municipal spending on public health actions and services was observed in municipalities with more than 10,000 inhabitants, and the association with spending on PHC (p < 0.050) was inverse in all municipalities. Therefore, the increase in the transfer of parliamentary amendments by the Brazilian Ministry of Health favored a reduction in the allocation of municipal revenues to PHC, which may have been directed to other spending purposes in the SUS. These changes seem to represent priorities established for municipal budget expenditure, which have repercussions on local conditions for guaranteeing stable funding for PHC in Brazil.
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Affiliation(s)
| | | | | | | | - Luciana Dias de Lima
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Brikci N. Innovative domestic financing mechanisms for health in Africa: An evidence review. J Health Serv Res Policy 2024; 29:132-140. [PMID: 37328259 PMCID: PMC10910821 DOI: 10.1177/13558196231181081] [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] [Indexed: 06/18/2023]
Abstract
OBJECTIVES This article synthesizes the evidence on what have been called innovative domestic financing mechanisms for health (i.e. any domestic revenue-raising mechanism allowing governments to diversify away from traditional approaches such as general taxation, value-added tax, user fees or any type of health insurance) aimed at increasing fiscal space for health in African countries. The article seeks to answer the following questions: What types of domestic innovative financial mechanisms have been used to finance health care across Africa? How much additional revenue have these innovative financing mechanisms raised? Has the revenue raised through these mechanisms been, or was it meant to be, earmarked for health? What is known about the policy process associated with their design and implementation? METHODS A systematic review of the published and grey literature was conducted. The review focused on identifying articles providing quantitative information about the additional financial resources generated through innovative domestic financing mechanisms for health care in Africa, and/or qualitative information about the policy process associated with the design or effective implementation of these financing mechanisms. RESULTS The search led to an initial list of 4035 articles. Ultimately, 15 studies were selected for narrative analysis. A wide range of study methods were identified, from literature reviews to qualitative and quantitative analysis and case studies. The financing mechanisms implemented or planned for were varied, the most common being taxes on mobile phones, alcohol and money transfers. Few articles documented the revenue that could be raised through these mechanisms. For those that did, the revenue projected to be raised was relatively low, ranging from 0.01% of GDP for alcohol tax alone to 0.49% of GDP if multiple levies were applied. In any case, virtually none of the mechanisms have apparently been implemented. The articles revealed that, prior to implementation, the political acceptability, the readiness of institutions to adapt to the proposed reform and the potential distortionary impact these reforms may have on the targeted industry all require careful consideration. From a design perspective, the fundamental question of earmarking proved complex both politically and administratively, with very few mechanisms actually earmarked, thus questioning whether they could effectively fill part of the health-financing gap. Finally, ensuring that these mechanisms supported the underlying equity objectives of universal health coverage was recognized as important. CONCLUSIONS Additional research is needed to understand better the potential of innovative domestic revenue generating mechanisms to fill the financing gap for health in Africa and diversify away from more traditional financing approaches. Whilst their revenue potential in absolute terms seems limited, they could represent an avenue for broader tax reforms in support of health. This will require sustained dialogue between Ministries of Health and Ministries of Finance.
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Affiliation(s)
- Nouria Brikci
- Research Fellow in health economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Dasgupta T, De Allegri M, Brenner S, Kaminjolo-Kambala C, Lohmann J. Good while it lasted? Estimating the long-term and withdrawal effects of results-based financing in Malawi on maternal care utilisation using routine data. BMJ Open 2024; 14:e066115. [PMID: 38458806 DOI: 10.1136/bmjopen-2022-066115] [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] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the effect of introduction and subsequent withdrawal of the Results-based Financing for Maternal and Newborn Health Initiative (RBF4MNH) in Malawi on utilisation of facility-based childbirths, antenatal care (ANC) and postnatal care (PNC). DESIGN A controlled interrupted time series design was used with secondary data from the Malawian Health Management Information System. SETTING Healthcare facilities at all levels identified as providing maternity services in four intervention districts and 20 non-intervention districts in Malawi. PARTICIPANTS Routinely collected, secondary data of total monthly service utilisation of facility-based childbirths, ANC and PNC services. INTERVENTIONS The intervention is the RBF4MNH initiative, introduced by the Malawian government in 2013 to improve maternal and infant health outcomes and withdrawn in 2018 after ceasing of donor funding. OUTCOME MEASURES Differences in total volume and trends of utilisation of facility-based childbirths, ANC and PNC services, compared between intervention versus non-intervention districts, for the study period of 90 consecutive months. RESULTS No significant effect was observed, on utilisation trends for any of the three services during the first 2.5 years of intervention. In the following 2.5 years after full implementation, we observed a small positive increase for facility-based childbirths (+0.62 childbirths/month/facility) and decrease for PNC (-0.55 consultations/month/facility) trends of utilisation respectively. After withdrawal, facility-based childbirths and ANC consultations dropped both in immediate volume after removal (-10.84 childbirths/facility and -20.66 consultations/facility, respectively), and in trends of utilisation over time (-0.27 childbirths/month/facility and -1.38 consultations/month/facility, respectively). PNC utilisation levels seemed unaffected in intervention districts against a decline in the rest of the country. CONCLUSIONS Concurrent with wider literature, our results suggest that effects of complex health financing interventions, such as RBF4MNH, can take a long time to be seen. They might not be sustained beyond the implementation period if measures are not adopted to reform existing health financing structures.
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Affiliation(s)
- Tisha Dasgupta
- Department of Women & Children's Health, King's College London, London, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Stephan Brenner
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | | | - Julia Lohmann
- London School of Hygiene & Tropical Medicine, London, UK
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Mladovsky P, Prince R, Hane F, Ridde V. The primacy of politics in neoliberal universal health coverage policy reform. A commentary on 'financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution?" by William C Hsiao and Winnie Yip. Soc Sci Med 2024; 345:115742. [PMID: 36775703 DOI: 10.1016/j.socscimed.2023.115742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Mathauer I, Oranje M. Machine learning in health financing: benefits, risks and regulatory needs. Bull World Health Organ 2024; 102:216-224. [PMID: 38420574 PMCID: PMC10898280 DOI: 10.2471/blt.23.290333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/12/2023] [Accepted: 10/29/2023] [Indexed: 03/02/2024] Open
Abstract
There is increasing use of machine learning for the health financing functions (revenue raising, pooling and purchasing), yet evidence lacks for its effects on the universal health coverage (UHC) objectives. This paper provides a synopsis of the use cases of machine learning and their potential benefits and risks. The assessment reveals that the various use cases of machine learning for health financing have the potential to affect all the UHC intermediate objectives - the equitable distribution of resources (both positively and negatively); efficiency (primarily positively); and transparency (both positively and negatively). There are also both positive and negative effects on all three UHC final goals, that is, utilization of health services in line with need, financial protection and quality care. When the use of machine learning facilitates or simplifies health financing tasks that are counterproductive to UHC objectives, there are various risks - for instance risk selection, cost reductions at the expense of quality care, reduced financial protection or over-surveillance. Whether the effects of using machine learning are positive or negative depends on how and for which purpose the technology is applied. Therefore, specific health financing guidance and regulations, particularly for (voluntary) health insurance, are needed. To inform the development of specific health financing guidance and regulation, we propose several key policy and research questions. To gain a better understanding of how machine learning affects health financing for UHC objectives, more systematic and rigorous research should accompany the application of machine learning.
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Affiliation(s)
- Inke Mathauer
- Department of Health Financing, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
| | - Maarten Oranje
- Department of Health Financing, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
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Tandon A, Hoang-Vu Eozenou P, Neelsen S. Compulsion and redistribution remain key tenets for financing universal health coverage. Soc Sci Med 2024; 345:115744. [PMID: 36725438 DOI: 10.1016/j.socscimed.2023.115744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Ajay Tandon
- World Bank, 1818, H Street, NW, Washington, DC, 20433, United States.
| | | | - Sven Neelsen
- World Bank, 1818, H Street, NW, Washington, DC, 20433, United States.
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Hsiao WC, Yip W. Financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution? Soc Sci Med 2024; 345:115730. [PMID: 36803450 DOI: 10.1016/j.socscimed.2023.115730] [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: 11/08/2021] [Revised: 03/20/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
The international consensus in support of universal health coverage (UHC), though commendable, thus far lacks a clear mechanism to finance and deliver accessible and effective basic healthcare to the two billion rural residents and informal workers of low- and lower-middle-income countries (LLMICs). Importantly, the two preferred financing modes for UHC, general tax revenue and social health insurance, are often infeasible for LLMICs. We identify from historical examples a community-based model that we argue shows promise as a solution to this problem. This model, which we call Cooperative Healthcare (CH), is characterized by community-based risk-pooling and governance and prioritizes primary care. CH leverages communities' existing social capital, such that even those for whom the private benefit of enrolling in a CH scheme is outweighed by the cost may choose to enroll (given sufficient social capital). For CH to be scalable, it needs to demonstrate that it can organize delivery of accessible and reasonable-quality primary healthcare that people value, with management accountable to the communities themselves through structures that people trust, combined with government legitimacy. Once LLMICs with CH programs have industrialized sufficiently to make universal social health insurance feasible, CH schemes can be rolled into such universal programs. We defend cooperative healthcare's suitability for this bridging role and urge LLMIC governments to launch experiments testing it out, with careful adaptation to local conditions.
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Affiliation(s)
- William C Hsiao
- Emeritus, Global Health and Population, 104 Mount Auburn St., 303, Cambridge, MA, 02138, USA.
| | - Winnie Yip
- Health Policy and Economics, Harvard University T H Chan School of Public Health, Boston, MA, USA
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Waters AR, Easterly CW, Turner C, Ghazal L, Tovar I, Mulvaney M, Poquadeck M, Rains SA, Cloyes KG, Kirchhoff AC, Kent EE, Warner EL. LGBTQ+ inequity in crowdfunding cancer costs: The influence of online reach and LGBTQ+ state policy. Cancer Med 2024; 13:e6926. [PMID: 38275010 PMCID: PMC10905337 DOI: 10.1002/cam4.6926] [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: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Emerging literature suggests that LGBTQ+ cancer survivors are more likely to experience financial burden than non-LGBTQ+ survivors. However, LGBTQ+ cancer survivors experience with cost-coping behaviors such as crowdfunding is understudied. METHODS We aimed to assess LGBTQ+ inequity in cancer crowdfunding by combining community-engaged and technology-based methods. Crowdfunding campaigns were web-scraped from GoFundMe and classified as cancer-related and LGBTQ+ or non-LGBTQ+ using term dictionaries. Bivariate analyses and generalized linear models were used to assess differential effects in total goal amount raised by LGBTQ+ status. Stratified models were run by online reach and LGBTQ+ inclusivity of state policy. RESULTS A total of N = 188,342 active cancer-related crowdfunding campaigns were web-scraped from GoFundMe in November 2022, of which N = 535 were LGBTQ+ and ranged from 2014 to 2022. In multivariable models of recent campaigns (2019-2022), LGBTQ+ campaigns raised $1608 (95% CI: -2139, -1077) less than non-LGBTQ+ campaigns. LGBTQ+ campaigns with low (26-45 donors), moderate (46-87 donors), and high (88-240 donors) online reach raised on average $1152 (95% CI: -$1589, -$716), $1050 (95% CI: -$1737, -$364), and $2655 (95% CI: -$4312, -$998) less than non-LGBTQ+ campaigns respectively. When stratified by LGBTQ+ inclusivity of state level policy states with anti-LGBTQ+ policy/lacking equitable policy raised on average $1910 (95% CI: -2640, -1182) less than non-LGBTQ+ campaigns from the same states. CONCLUSIONS AND RELEVANCE Our findings revealed LGBTQ+ inequity in cancer-related crowdfunding, suggesting that LGBTQ+ cancer survivors may be less able to address financial burden via crowdfunding in comparison to non-LGBTQ+ cancer survivors-potentially widening existing economic inequities.
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Affiliation(s)
- Austin R. Waters
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
- Cancer Control and Population SciencesHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
| | - Caleb W. Easterly
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Cindy Turner
- College of NursingUniversity of UtahSalt Lake CityUtahUSA
| | - Lauren Ghazal
- Crowdfunding Cancer Costs (C3) LGBTQ+ Study Advisory BoardHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
- School of NursingUniversity of RochesterRochesterNew YorkUSA
| | - Ida Tovar
- College of NursingUniversity of UtahSalt Lake CityUtahUSA
| | - Megan Mulvaney
- Crowdfunding Cancer Costs (C3) LGBTQ+ Study Advisory BoardHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
- School of Public HealthIndiana University BloomingtonBloomingtonIndianaUSA
| | - Matt Poquadeck
- Crowdfunding Cancer Costs (C3) LGBTQ+ Study Advisory BoardHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
- Wilmot Cancer InstituteUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Stephen A. Rains
- Department of CommunicationUniversity of ArizonaTucsonArizonaUSA
| | - Kristin G. Cloyes
- School of NursingOregon Health and Science UniversityPortlandOregonUSA
| | - Anne C. Kirchhoff
- Cancer Control and Population SciencesHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
- Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Erin E. Kent
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Echo L. Warner
- Cancer Control and Population SciencesHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
- College of NursingUniversity of UtahSalt Lake CityUtahUSA
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Shroff ZC, Sparkes SP, Paina L, Skarphedinsdottir M, Gotsadze G, Zakumumpa H, Tang K, Perera PN, Yuan M, Hanson K. Managing transitions from external assistance: cross-national learning about sustaining effective coverage. Health Policy Plan 2024; 39:i50-i64. [PMID: 38253447 DOI: 10.1093/heapol/czad101] [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: 04/26/2023] [Revised: 08/29/2023] [Indexed: 01/24/2024] Open
Abstract
The often-prominent role of external assistance in health financing in low- and middle-income countries raises the question of how such resources can enable the sustained or even expanded coverage of key health services and initiatives even after donor funding is no longer available. In response to this question, this paper analyses the process and outcomes of donor transitions in health-where countries or regions within countries are no longer eligible to receive grants or concessional loans from external sources based on eligibility criteria or change in donor policy. The comparative analysis of multiple donor transitions in four countries-China, Georgia, Sri Lanka and Uganda-identifies 16 factors related to policy actors, policy process, the content of donor-funded initiatives and the broader political-economic context that were associated with sustained coverage of previously donor supported interventions. From a contextual standpoint, these factors relate to favourable economic and political environments for domestic systems to prioritize coverage for donor-supported interventions. Clear and transparent transition processes also enabled a smoother transition. How the donor-supported initiatives and services were organized within the context of the overall health system was found to be critically important, both before and during the transition process. This includes a targeted approach to integrate, strengthen and align key elements of the governance, financing, input management and service delivery arrangements with domestic systems. The findings of this analysis have important implications for how both donors and country policy makers can better structure external assistance that enables sustained coverage regardless of the source of funding. In particular, donors can better support sustained coverage through supporting long-term structural and institutional reform, clear co-financing policies, ensuring alignment with local salary scales and engaging with communities to ensure a continued focus on equitable access post-transition.
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Affiliation(s)
| | - Susan P Sparkes
- World Health Organization, Department of Health Financing and Economics, World Health Organization, Avenue Appia 20, Geneva 1211, Switzerland
- World Health Organization, Alliance for Health Policy and Systems Research, Avenue Appia 20, Geneva 1211, Switzerland
| | - Ligia Paina
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore 21205, USA
| | | | - George Gotsadze
- Curatio International Foundation, Georgia and Ilia State University, 0179 Kavsadze str. 3, Office 5, Tbilisi, Georgia
| | - Henry Zakumumpa
- Department of Health Policy, Planning and Management, Makerere University, School of Public Health, 7062 University Rd, Kampala, Uganda
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Rd, Haidian District, Beijing 100190, China
| | - Prasadini N Perera
- Institute for Health Policy, 72, Park Street, Colombo 2, Sri Lanka
- University of Peradeniya, Galaha Rd 20400, Peradeniya, Sri Lanka
| | - MyMai Yuan
- World Health Organization, Department of Health Financing and Economics, World Health Organization, Avenue Appia 20, Geneva 1211, Switzerland
| | - Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
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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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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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15
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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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Ridde V, Caffin JH, Hane F. External influences over Senegalese health financing policy: delaying universal health coverage? Health Policy Plan 2024; 39:80-83. [PMID: 38011666 PMCID: PMC10775215 DOI: 10.1093/heapol/czad108] [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: 01/30/2023] [Revised: 07/20/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
Senegal has long sought solutions to achieve universal health coverage (UHC). However, in a context dependent on international aid, the country faces multiple external pressures to choose policy instruments. In this commentary, we propose an analysis of this influence. The empirical material comes from our involvement in analysing health reforms for 20 years and from many interviews and observations. While studies have shown that community-based health insurance (CBHI) was not an appropriate solution for UHC, some international actors have influenced their continued application. Another global partner proposed an alternative (professional and departmental CBHI), which was counteracted and delayed. These issues of powers and influences of international and national consultants, established in a neo-liberal approach to health, have lost at least a decade from UHC in Senegal. The alternative now appears to be acquired and is scaling up at the country level, witnessing a change in the current policy paradigm.
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Affiliation(s)
- Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, 45, Rue des Saints Pères, Paris F-75006, France
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Senegal
| | - Jean-Hugues Caffin
- CIRAD (Agricultural Research for Development), UMR ASTRE, Dakar, Senegal
| | - Fatoumata Hane
- IRL 3189 Environnement, Santé et Société UCAD, Université de Assane Seck de Ziguinchor, Ziguinchor, Sénégal
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17
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Binyaruka P, Martinez-Alvarez M, Pitt C, Borghi J. Assessing equity and efficiency of health financing towards universal health coverage between regions in Tanzania. Soc Sci Med 2024; 340:116457. [PMID: 38086221 DOI: 10.1016/j.socscimed.2023.116457] [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: 04/12/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024]
Abstract
Equity and efficiency in health financing are intermediate universal health coverage (UHC) objectives. While there is growing attention to monitoring these goals at the national level, subnational assessment is also needed to uncover potential divergences across subnational units. We assessed whether health funds were allocated or contributed equitably and spent efficiently across 26 regions in Tanzania in 2017/18 for four sources of funding. Government and donor health basket fund (HBF) expenditure data were obtained from government authorities. Household contributions to health insurance and out-of-pocket payments were obtained from the national household budget survey. We used the Kakwani index (KI) to measure regional funding equity, whereby regional GDP per capita measured regional economic status. Efficiency analysis included four financing inputs and two UHC outputs (maternal health service coverage and financial protection indices). Data envelopment analysis estimated efficiency scores. There was substantial variation in per capita regional funding, especially in insurance contributions (TZS 473-13,520), and service coverage performance (49-86.3%). There was less variation in per capita HBF spending (TZS 1294-2394) and financial protection (93.5-99.4%). Government spending (KI: -0.047, p = 0.348) was proportional to regional economic status; but HBF spending (KI: -0.195, p < 0.001) was significantly progressive (equitably distributed), being targeted to regions with high economic need (poor). The burden of contributing to social health insurance (NHIF) was proportional (KI: 0.058, p = 0.613), while the burden of paying for community-based insurance (CHF, KI: -0.152, p=0.012) and out-of-pocket payments (KI: -0.187, p=0.005) was higher among the poor (regressive). The average efficiency score across regions was 90%, indicating that 90% of financial resources were used optimally, while 10% were wasted or underutilised. Tanzania should continue mobilising domestic resources for health towards UHC, and reduce reliance on inequitable out-of-pocket payments and community-based health insurance. Policymakers must enhance resource allocation formulas, public financial management, and sub-national resource tracking to improve equity and efficiency in resource use.
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Affiliation(s)
- Peter Binyaruka
- Department of Health System, Impact Evaluation, and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
| | - Melisa Martinez-Alvarez
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia; Université Cheikh Anta Diop, Dakar-Fann, Senegal.
| | - Catherine Pitt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
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18
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Zhang X, Wang J, Lane JM, Xu X, Sörensen S. Investigating Racial Disparities in Cancer Crowdfunding: A Comprehensive Study of Medical GoFundMe Campaigns. J Med Internet Res 2023; 25:e51089. [PMID: 38085562 PMCID: PMC10751626 DOI: 10.2196/51089] [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: 07/20/2023] [Revised: 08/29/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In recent years, there has been growing concern about prejudice in crowdfunding; however, empirical research remains limited, particularly in the context of medical crowdfunding. This study addresses the pressing issue of racial disparities in medical crowdfunding, with a specific focus on cancer crowdfunding on the GoFundMe platform. OBJECTIVE This study aims to investigate racial disparities in cancer crowdfunding using average donation amount, number of donations, and success of the fundraising campaign as outcomes. METHODS Drawing from a substantial data set of 104,809 campaigns in the United States, we used DeepFace facial recognition technology to determine racial identities and used regression models to examine racial factors in crowdfunding performance. We also examined the moderating effect of the proportion of White residents on crowdfunding bias and used 2-tailed t tests to measure the influence of racial anonymity on crowdfunding success. Owing to the large sample size, we set the cutoff for significance at P<.001. RESULTS In the regression and supplementary analyses, the racial identity of the fundraiser significantly predicted average donations (P<.001), indicating that implicit bias may play a role in donor behavior. Gender (P=.04) and campaign description length (P=.62) did not significantly predict the average donation amounts. The race of the fundraiser was not significantly associated with the number of donations (P=.42). The success rate of cancer crowdfunding campaigns, although generally low (11.77%), showed a significant association with the race of the fundraiser (P<.001). After controlling for the covariates of the fundraiser gender, fundraiser age, local White proportion, length of campaign description, and fundraising goal, the average donation amount to White individuals was 17.68% higher than for Black individuals. Moreover, campaigns that did not disclose racial information demonstrated a marginally higher average donation amount (3.92%) than those identified as persons of color. Furthermore, the racial composition of the fundraiser's county of residence was found to exert influence (P<.001); counties with a higher proportion of White residents exhibited reduced racial disparities in crowdfunding outcomes. CONCLUSIONS This study contributes to a deeper understanding of racial disparities in cancer crowdfunding. It highlights the impact of racial identity, geographic context, and the potential for implicit bias in donor behavior. As web-based platforms evolve, addressing racial inequality and promoting fairness in health care financing remain critical goals. Insights from this research suggest strategies such as maintaining racial anonymity and ensuring that campaigns provide strong evidence of deservingness. Moreover, broader societal changes are necessary to eliminate the financial distress that drives individuals to seek crowdfunding support.
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Affiliation(s)
- Xupin Zhang
- School of Economics and Management, East China Normal University, Shanghai, China
| | - Jingjing Wang
- School of Economics and Management, East China Normal University, Shanghai, China
| | - Jamil M Lane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xin Xu
- School of Economics and Management, East China Normal University, Shanghai, China
| | - Silvia Sörensen
- Warner School for Education and Human Development, University of Rochester, Rochester, NY, United States
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19
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Brown GW, Rhodes N, Tacheva B, Loewenson R, Shahid M, Poitier F. Challenges in international health financing and implications for the new pandemic fund. Global Health 2023; 19:97. [PMID: 38053177 DOI: 10.1186/s12992-023-00999-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The failures of the international COVID-19 response highlighted key gaps in pandemic preparedness and response (PPR). The G20 and WHO have called for additional funding of $10.5 billion per year to adequately strengthen the global PPR architecture. In response to these calls, in 2022 the World Bank announced the launch of a new Financial Intermediary Fund (The Pandemic Fund) to catalyse this additional funding. However, there is considerable unclarity regarding the governance makeup and financial modalities of the Pandemic Fund, and divergence of opinion about whether the Fund has been successfully designed to respond to key challenges in global health financing. METHODS/RESULTS The article outlines eight challenges associated with global health financing instruments and development aid for health within the global health literature. These include misaligned aid allocation; accountability; multistakeholder representation and participation; country ownership; donor coherency and fragmentation; transparency; power dynamics, and; anti-corruption. Using available information about the Pandemic Fund, the article positions the Pandemic Fund against these challenges to determine in what ways the financing instrument recognizes, addresses, partially addresses, or ignores them. The assessment argues that although the Pandemic Fund has adopted a few measures to recognise and address some of the challenges, overall, the Pandemic Fund has unclear policies in response to most of the challenges while leaving many unaddressed. CONCLUSION It remains unclear how the Pandemic Fund is explicitly addressing challenges widely recognized in the global health financing literature. Moreover, there is evidence that the Pandemic Fund might be exacerbating these global financing challenges, thus raising questions about its potential efficacy, suitability, and chances of success. In response, this article offers four sets of policy recommendations for how the Pandemic Fund and the PPR financing architecture might respond more effectively to the identified challenges.
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Affiliation(s)
- Garrett Wallace Brown
- School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT, UK.
| | - Natalie Rhodes
- School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT, UK
| | - Blagovesta Tacheva
- School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT, UK
| | | | - Minahil Shahid
- Centre for Policy and Impact in Global Health, Duke University, Durham, USA
- Global Health Institute, Duke University, Durham, USA
| | - Francis Poitier
- Nuffield Centre for International Development and Health, University of Leeds, Leeds, UK
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Doshmangir L, Majdzadeh R. The imperative of good governance and enhanced learning systems for resilient health financing. Lancet Glob Health 2023; 11:e1842-e1843. [PMID: 37973330 DOI: 10.1016/s2214-109x(23)00464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Leila Doshmangir
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, and Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz 5166614711, Iran.
| | - Reza Majdzadeh
- School of Health and Social Care, University of Essex, Colchester, UK
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21
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De Foo C, Verma M, Tan SY, Hamer J, van der Mark N, Pholpark A, Hanvoravongchai P, Cheh PLJ, Marthias T, Mahendradhata Y, Putri LP, Hafidz F, Giang KB, Khuc THH, Van Minh H, Wu S, Caamal-Olvera CG, Orive G, Wang H, Nachuk S, Lim J, de Oliveira Cruz V, Yates R, Legido-Quigley H. Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries. Lancet Glob Health 2023; 11:e1964-e1977. [PMID: 37973344 PMCID: PMC10664823 DOI: 10.1016/s2214-109x(23)00448-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develop a framework for resilient health financing, and use this pandemic to argue a case to move towards universal health coverage (UHC). METHODS In this case study, we examined the national health financing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing. FINDINGS Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. We observed that five key financing policies were implemented across the countries-namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. INTERPRETATION Our findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Duke NUS Graduate Medical School, Singapore.
| | - Monica Verma
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Si Ying Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jess Hamer
- Centre for Universal Health, Chatham House, London, UK
| | | | - Aungsumalee Pholpark
- Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Piya Hanvoravongchai
- National Health Foundation, Bangkok, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Tiara Marthias
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Yodi Mahendradhata
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Likke Prawidya Putri
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Firdaus Hafidz
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Kim Bao Giang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
| | - Thi Hong Hanh Khuc
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
| | | | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - Jeremy Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Rob Yates
- Centre for Universal Health, Chatham House, London, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Imperial College and the George Institute for Global Health, London, UK
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22
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Collins TE, Akselrod S, Atun R, Bennett S, Ogbuoji O, Hanson M, Dubois G, Shakarishvili A, Kalnina I, Requejo J, Mosneaga A, Watabe A, Berlina D, Allen LN. Converging global health agendas and universal health coverage: financing whole-of-government action through UHC. Lancet Glob Health 2023; 11:e1978-e1985. [PMID: 37973345 PMCID: PMC10664822 DOI: 10.1016/s2214-109x(23)00489-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
UN member states have committed to universal health coverage (UHC) to ensure all individuals and communities receive the health services they need without suffering financial hardship. Although the pursuit of UHC should unify disparate global health challenges, it is too commonly seen as another standalone initiative with a singular focus on the health sector. Despite constituting the cornerstone of the health-related Sustainable Development Goals, UHC-related commitments, actions, and metrics do not engage with the major drivers and determinants of health, such as poverty, gender inequality, discriminatory laws and policies, environment, housing, education, sanitation, and employment. Given that all countries already face multiple competing health priorities, the global UHC agenda should be used to reconcile, rationalise, prioritise, and integrate investments and multisectoral actions that influence health. In this paper, we call for greater coordination and coherence using a UHC+ lens to suggest new approaches to funding that can extend beyond biomedical health services to include the cross-cutting determinants of health. The proposed intersectoral co-financing mechanisms aim to support the advancement of health for all, regardless of countries' income.
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Affiliation(s)
| | | | - Rifat Atun
- Department of Global Health and Population, T H Chan School of Public Health, Boston, MA, USA
| | - Sara Bennett
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Osondu Ogbuoji
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Mark Hanson
- Institute of Development Sciences, University of Southampton, Southampton, UK
| | | | | | - Ilze Kalnina
- Partnership for Maternal, Newborn, and Child Health, Geneva, Switzerland
| | - Jennifer Requejo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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23
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Nonvignon J, Aryeetey GC, Adjagba A, Asman J, Sharkey A, Hasman A, Pallas SW, Griffiths UK. The political economy of financing traditional vaccines and vitamin A supplements in six African countries. Health Policy Plan 2023; 38:1154-1165. [PMID: 37667813 DOI: 10.1093/heapol/czad079] [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: 10/14/2022] [Revised: 07/18/2023] [Accepted: 09/04/2023] [Indexed: 09/06/2023] Open
Abstract
Vaccines and vitamin A supplementation (VAS) are financed by donors in several countries, indicating that challenges remain with achieving sustainable government financing of these critical health commodities. This qualitative study aimed to explore political economy variables of actors' interests, roles, power and commitment to ensure government financing of vaccines and VAS. A total of 77 interviews were conducted in Burundi, Comoros, Ethiopia, Madagascar, Malawi and Zimbabwe. Governments and development partners had similar interests. Donor commitment to vaccines and VAS was sometimes dependent on the priorities and political situation of the donor country. Governments' commitment to financing vaccines was demonstrated through policy measures, such as enactment of immunization laws. Explicit government financial commitment to VAS was absent in all six countries. Some development partners were able to influence governments directly via allocation of health funding while others influenced indirectly through coordination, consolidation and networks. Government power was exercised through multiple systemic and individual processes, including hierarchy, bureaucracy in governance and budgetary process, proactiveness of Ministry of Health officials in engaging with Ministry of Finance, and control over resources. Enablers that were likely to increase government commitment to financing vaccines and VAS included emerging reforms, attention to the voice of citizens and improvements in the domestic economy that in turn increased government revenues. Barriers identified were political instability, health sector inefficiencies, overly complicated bureaucracy, frequent changes of health sector leadership and non-health competing needs. Country governments were aware of their role in financing vaccines, but only a few had made tangible efforts to increase government financing. Discussions on government financing of VAS were absent. Development partners continue to influence government health commodity financing decisions. The political economy environment and contextual factors work together to facilitate or impede domestic financing.
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Affiliation(s)
- Justice Nonvignon
- School of Public Health, University of Ghana, P.O. Box LG13, Legon, Ghana
| | | | - Alex Adjagba
- UNICEF, Health Programme, Belgravia, Harare, Zimbabwe
| | - Jennifer Asman
- Social Policy and Social Protection, Programme Group, UNICEF, New York, NY 10017, USA
| | - Alyssa Sharkey
- School of Public and International Affairs, Princeton University, Princeton, NJ 08540, USA
| | | | - Sarah W Pallas
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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24
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Nabyonga-Orem J, Christmals CD, Addai KF, Mwinga K, Karenzi-Muhongerwa D, Namuli S, Asamani JA. The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review. J Glob Health 2023; 13:04153. [PMID: 37962340 PMCID: PMC10644850 DOI: 10.7189/jogh.13.04153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Background Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries (LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nature of innovative health financing instruments, mechanisms and policies implemented in Africa. We further reviewed the factors that hinder or facilitate implementation, the lessons learnt on the structure, the development process and the implementation. Methods We conducted a systematic scoping review of the literature to analyze the nature, type, and factors impacting the implementation of innovative health financing mechanisms in the World Health Organization (WHO) African region. Results Innovative health financing mechanisms are increasing in the WHO African region as a result of international policy, the need to improve healthy eating and social life of the populace, advocacy and the availability of international mechanisms to which countries can subscribe. The 41 documents included in this review reported ten innovative financing mechanisms in 43 out of the 47 WHO Africa region member states. The most common mechanisms include an excise tax on tobacco products (43 countries) and alcoholic beverages and spirits (41 countries), airline ticket levy (18 countries), sugar-based beverages tax (seven countries), and levy on oil, gas and mineral tax (four countries). Other mechanisms include the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) trust fund, the social impact bond, the financial transaction tax, mobile phone tax and equity funds. Funds generated from many mechanisms are not allocated to health, although some portions are allocated to health-related activities. In some countries where mechanisms implemented are public health-related, emphasis is placed on positive health behavior beyond raising funds. Persistent resistance from industries due to conflicting economic policies is a major challenge. Conclusions Leveraging international policies and setting up intersectoral committees to develop and implement innovative mechanisms that involve excise taxes are recommended as possible solutions to the conflicts of interest.
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Affiliation(s)
- Juliet Nabyonga-Orem
- World Health Organization Regional office for Africa, Office of the Regional Director, Brazzaville, Congo
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
| | - Christmal D Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
| | - Kingsley F Addai
- World Health Organization Ghana country office, Universal Health Coverage Life Course Cluster, Accra, Ghana
| | - Kasonde Mwinga
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - Diane Karenzi-Muhongerwa
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - Sylvia Namuli
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
| | - James A Asamani
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
- World Health Organization, Africa regional office, Universal Health Coverage Life Course Cluster, Brazzaville Congo
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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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Njie H, Dale E, Gopinathan U. Procedural fairness in decision-making for financing a National Health Insurance Scheme: a case study from The Gambia. Health Policy Plan 2023; 38:i73-i82. [PMID: 37963076 PMCID: PMC10645046 DOI: 10.1093/heapol/czad063] [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: 10/11/2022] [Revised: 03/29/2023] [Accepted: 07/27/2023] [Indexed: 11/16/2023] Open
Abstract
Achieving universal health coverage (UHC) involves difficult policy choices, and fair processes are critical for building legitimacy and trust. In 2021, The Gambia passed its National Health Insurance (NHI) Act. We explored decision-making processes shaping the financing of the NHI scheme (NHIS) with respect to procedural fairness criteria. We reviewed policy and strategic documents on The Gambia's UHC reforms to identify key policy choices and interviewed policymakers, technocrats, lawmakers, hospital chief executive officers, private sector representatives and civil society organizations (CSOs) including key CSOs left out of the NHIS discussions. Ministerial budget discussions and virtual proceedings of the National Assembly's debate on the NHI Bill were observed. To enhance public scrutiny, Gambians were encouraged to submit views to the National Assembly's committee; however, the procedures for doing so were unclear, and it was not possible to ascertain how these inputs were used. Despite available funds to undertake countrywide public engagement, the public consultations were mostly limited to government institutions, few trade unions and a handful of urban-based CSOs. While this represented an improved approach to public policy-making, several CSOs representing key constituents and advocating for the expansion of exemption criteria for insurance premiums to include more vulnerable groups felt excluded from the process. Overload of the National Assembly's legislative schedule and lack of National Assembly committee quorum were cited as reasons for not engaging in countrywide consultations. In conclusion, although there was an intent from the Executive and National Assembly to ensure transparent, participatory and inclusive decision-making, the process fell short in these aspects. These observations should be seen in the context of The Gambia's ongoing democratic transition where institutions for procedural fairness are expected to progressively improve. Learning from this experience to enhance the procedural fairness of decision-making can promote inclusiveness, ownership and sustainability of the NHIS in The Gambia.
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Affiliation(s)
- Hassan Njie
- Department of Community Medicine and Global Health, University of Oslo, Postboks 1130 Blindern, Oslo 0318, Norway
| | - Elina Dale
- Cluster for Global Health, Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Unni Gopinathan
- Cluster for Global Health, Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
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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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Sumankuuro J, Griffiths F, Koon AD, Mapanga W, Maritim B, Mosam A, Goudge J. The Experiences of Strategic Purchasing of Healthcare in Nine Middle-Income Countries: A Systematic Qualitative Review. Int J Health Policy Manag 2023; 12:7352. [PMID: 38618795 PMCID: PMC10699827 DOI: 10.34172/ijhpm.2023.7352] [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: 04/26/2022] [Accepted: 10/18/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Efforts to move towards universal health coverage (UHC) aim to rebalance health financing in ways that increase efficiency, equity, and quality. Resource constraints require a shift from passive to strategic purchasing (SP). In this paper, we report on the experiences of SP in public sector health insurance schemes in nine middle-income countries to understand what extent SP has been established, the challenges and facilitators, and how it is helping countries achieve their UHC goals. METHODS We conducted a systematic search to identify papers on SP. Nine countries were selected for case study analysis. We extracted data from 129 articles. We used a common framework to compare the purchasing arrangements and key features in the different schemes. The evidence was synthesised qualitatively. RESULTS Five countries had health technology assessment (HTA) units to research what services to buy. Most schemes had reimbursement mechanisms that enabled some degree of cost control. However, we found evidenced-based changes to the reimbursement mechanisms only in Thailand and China. All countries have some form of mechanism for accreditation of health facilities, although there was considerable variation in what is done. All countries had some strategy for monitoring claims, but they vary in complexity and the extent of implementation; three countries have implemented e-claim processing enabling a greater level of monitoring. Only four countries had independent governance structures to provide oversight. We found delayed reimbursement (six countries), failure to provide services in the benefits package (four countries), and high out-of-pocket (OOP) payments in all countries except Thailand and Indonesia, suggesting the schemes were failing their members. CONCLUSION We recommend investment in purchaser and research capacity and a focus on strong governance, including regular engagement between the purchaser, provider and citizens, to build trusting relationships to leverage the potential of SP more fully, and expand financial protection and progress towards UHC.
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Affiliation(s)
- Joshua Sumankuuro
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Policy and Management, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana
- School of Community Health, Charles Sturt University, Orange, NSW, Australia
| | - Frances Griffiths
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Adam D. Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Witness Mapanga
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Beryl Maritim
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Atiya Mosam
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Villalobos Dintrans P, Roder-DeWan S, Wang H. Financing networks of care: a cross-case analysis from six countries. BMJ Open 2023; 13:e072304. [PMID: 37923350 PMCID: PMC10626858 DOI: 10.1136/bmjopen-2023-072304] [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: 01/30/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES Describe experiences of countries with networks of care's (NOCs') financial arrangements, identifying elements, strategies and patterns. DESIGN Descriptive using a modified cross-case analysis, focusing on each network's financing functions (collecting resources, pooling and purchasing). SETTING Health systems in six countries: Argentina, Australia, Canada, Singapore, the United Kingdom and the USA. PARTICIPANTS Large-scale NOCs. RESULTS Countries differ in their strategies to implement and finance NOCs. Two broad models were identified in the six cases: top-down (funding centrally designed networks) and bottom-up (financing individual projects) networks. Despite their differences, NOCs share the goal of improving health outcomes, mainly through the coordination of providers in the system; these results are achieved by devoting extra resources to the system, including incentives for network formation and sustainability, providing extra services and setting incentive systems for improving the providers' performance. CONCLUSIONS Results highlight the need to better understand the financial implications and alternatives for designing and implementing NOCs, particularly as a strategy to promote better health in low- and middle-income settings.
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Affiliation(s)
| | - Sanam Roder-DeWan
- World Bank, Washington, DC, USA
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
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Zeng M, Niu L. Spatiotemporal patterns of healthy life expectancy and the effects of health financing in West African countries, 1995-2019: A Spatial Panel Modelling Study. J Glob Health 2023; 13:04123. [PMID: 37861131 PMCID: PMC10588290 DOI: 10.7189/jogh.13.04123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Background Health financing produce a broad range of healthy life expectancy (HLE) disparities. In West Africa, limited research exists on the association between health financing and HLE at ecological level during a consecutive period of time from the spatial perspectives. This study aimed to determine the existence, quantify the magnitude, and interpret the association between health financing and HLE. Methods A Dynamic Spatial Durbin model was used to explain the association between HLE and health financing level and structure during 1995-2019 in West Africa. Spatial spillover effects were introduced to interpret the direct and indirect effects caused by health financing level and structure on HLE during the long and short terms. Results Spatial dependence and clustering on HLE were observed in West Africa. Although the overall level of total health spending, government health spending, out-of-pocket health spending, and development assistance for health (DAH) increased from 1995 to 2019, government health spending per person experienced a declining trend. Out-of-pocket health spending per total health spending was the highest among other sources of health financing, decreasing from 57% during 1995-1999 to 42% during 2015-2019. Total health spending and out-of-pocket health spending affected HLE positively and negatively in the long term, respectively. Government health spending and prepaid private health spending per person had positive effects on local and adjacent country HLE in the short-term, while DAH had negative effects on the same. The short-term spatial spillover effects of government health spending, DAH, and prepaid private health spending per person were more pronounced than the long-term effects. Conclusions Spatial variations of HLE existed at country-level in West Africa. Health financing regarding government, non-government, as well as external assistance not only affected HLE disparities at local scale but also among nearby countries. Policymakers should optimise supportive health financing transition policies and narrow the national gap to reduce health disparities and increase HLE. Externalities of policy of those health financing proxies should be took into consideration to promote health equity to improve global health governance.
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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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Jamal MH, Abdul Aziz AF, Aizuddin AN, Aljunid SM. Gatekeepers in the health financing scheme: Assessment of knowledge, attitude, practices, and participation of Malaysian private general practitioners in the PeKa B40 scheme. PLoS One 2023; 18:e0292516. [PMID: 37847678 PMCID: PMC10581488 DOI: 10.1371/journal.pone.0292516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/27/2023] [Indexed: 10/19/2023] Open
Abstract
This is cross-sectional research done to assess the readiness of the private Malaysian general practitioners (GPs) for the implementation of the national health financing scheme. The study focused on their levels of knowledge and attitudes towards the types of health financing scheme, gatekeeper roles in the health financing scheme, and their participation in the PeKa B40 scheme. Their acceptance and level of participation in the national health financing scheme (NHFS) were also assessed. A set of self-designed and pre-tested questionnaires focusing on the aforementioned objectives were mailed to the respondents. The selection of respondents was done by stratified random sampling of the GPs in all 14 Malaysian states at both urban and rural levels. Out of a calculated number of 362 GPs targeted, 296 responses were received which represented a response rate of 81.7%. The respondents had a mean age of 50.7 years 165 (55.75%) were males and 131 (44.3%) were females. The rural respondents totalled 158 (53.4%) as compared to those from urban 138 (46.6%) areas. The outcomes observed were that GPs with PeKa B40 provider status, positive attitude towards health financing schemes, gatekeeper roles, and PeKa B40, were strongly associated with their acceptance and level of participation in the NHFS. The GPs possessed a positive attitude and were generally ready to participate in the NHFS, but the lower scores in knowledge levels would require definite education and training plans to further enhance their readiness. More incentives should be given to GPs to enrol as PeKa B40 providers. The results of this study should be strongly considered by the government in the efforts to engage the Malaysian private GPs in the forthcoming NHFS. Most importantly, the role of GPs as gatekeepers needed to be implemented, and the PeKa B40 scheme be greatly improved.
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Affiliation(s)
- Mohammad Husni Jamal
- University of Cyberjaya, Cyberjaya, Malaysia
- Academy of Family Physicians of Malaysia, Kuala Lumpur, Malaysia
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Azimatun Noor Aizuddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Malaysia
- International Centre for Casemix and Clinical Coding, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid
- International Centre for Casemix and Clinical Coding, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
- International Medical University, Kuala Lumpur, Malaysia
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Lassa S, Saddiq M, Owen J, Burton C, Balen J. Evolving Power Dynamics in Global Health: From Biomedical Hegemony to Market Dynamics in Global Health Financing; A Response to the Recent Commentaries. Int J Health Policy Manag 2023; 12:8264. [PMID: 38618797 PMCID: PMC10590226 DOI: 10.34172/ijhpm.2023.8264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/02/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Samuel Lassa
- School of Health and Health Related Research, University of Sheffield, Sheffield, UK
- Division of Population Health, University of Sheffield, Sheffield, UK
- The Department of Community Medicine, University of Jos, Jos, Nigeria
| | - Muhammed Saddiq
- School of Health and Health Related Research, University of Sheffield, Sheffield, UK
| | - Jenny Owen
- School of Health and Health Related Research, University of Sheffield, Sheffield, UK
| | | | - Julie Balen
- School of Health and Health Related Research, University of Sheffield, Sheffield, UK
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Faraja, The Gambia
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
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Madu AC, Osborne K. Healthcare Financing in Nigeria: A Policy Review. Int J Soc Determinants Health Health Serv 2023; 53:434-443. [PMID: 37186783 DOI: 10.1177/27551938231173611] [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: 05/17/2023]
Abstract
A good health financing system is crucial for the effective performance of a country's health system. Many health systems around the world, especially in lower- and middle-income countries such as Nigeria, grapple with perennial challenges such as chronic underfunding, wastefulness, and lack of accountability rendering these systems inefficient. Nigeria's health system faces additional extraneous challenges such as a huge and rapidly growing population, a stagnant economy, and worsening insecurity of lives and property. Furthermore, recent disease outbreaks such as the Ebola epidemic and the COVID-19 pandemic and an evolving disease demography evidenced by an increasing prevalence of chronic, noncommunicable diseases asphyxiate an already floundering health system. To address these challenges and to bolster its efforts in attaining universal health coverage (UHC) and meeting the targets of the Sustainable Development Goals, the Nigerian government launched a new health policy in 2017. A review of the health financing section of this policy shows a focus on improving funding for health care by all levels of government and guaranteeing affordable and equitable access to health services by all Nigerians, albeit with insufficient clarity on how these will be achieved. A more critical review of the country's health financing system also reveals deep-seated systemic issues. Its out-of-pocket payments for funding health care are among the highest in the world, with abysmally low government contributions to health. Successive governments seem to lack the political will to address these shortfalls. Critical gaps exist in the country's health laws, making it difficult to implement the strategies proposed in the new policy. Nigeria must strengthen its health laws to, among other things, mandate health insurance and provide adequate funding for the health system by the government. It should also formulate a dedicated, more precise health financing policy with specific, measurable aims targeting identified problems to enable it to attain universal health coverage.
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Affiliation(s)
| | - Katy Osborne
- Flinders University, Bedford Park, South Australia, Australia
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Loewenson R, Mukumba C. Recovering lost tax to meet the health financing gap for universal public sector health systems in East and Southern Africa. BMJ Glob Health 2023; 8:e011820. [PMID: 37813446 PMCID: PMC10565176 DOI: 10.1136/bmjgh-2023-011820] [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: 01/20/2023] [Accepted: 04/21/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Universal healthcare services funded through taxation and free at point-of-access are the most equitable ways of funding healthcare rights. This paper examines key public sector health financing measures in 17 East and Southern African (ESA) countries, estimates the funding gap for basic and comprehensive services and relates this to sources of lost tax revenue. METHODS Health financing and tax data for 2018 (the most recent year available) were extracted from international databases for each ESA country, and analysed collectively for the region, comparing against intergovernmental estimates of optimal funding and tax capacity. Despite limitations noted, the scale of the health financing gap and tax losses informed policy recommendations. RESULTS The annual average per capita financing gap ranged from $28 to $84 for basic to comprehensive services, respectively, applying estimates of funding needs. Many innovative financing measures being explored do not meet this scale of deficit. Annual ESA per capita tax losses were estimated as: US$34.20 from shortfalls in domestic tax capacity and US$13.80 from illicit financial flows largely due to commercial practices. A proposed 25% minimum effective tax rate on multinationals in a fairer global tax system would yield an additional annual collection US$26.20 in the region. CONCLUSIONS Addressing a total annual tax loss of US$34 billion from these three sources alone would almost completely finance the region's US$36 billion financing gap for a comprehensive public sector health system. The COVID-19 pandemic's exposure of the need for investment in public sector services suggests an opportunity for an alliance between health and finance sectors to ensure progressive taxation as the core funding for an equitable, universal health system. This implies costing the health funding demands and gap in ESA countries; strengthening domestic tax capacity, expanding wealth taxes, curbing illicit outflows and providing health evidence to ongoing African diplomacy for a fairer global tax system.
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Affiliation(s)
| | - Chenai Mukumba
- Policy Research and Advocacy, Tax Justice Network Africa, Nairobi, Kenya
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Meijer MA, Brabers AEM, de Jong JD. Social context matters: The role of social support and social norms in support for solidarity in healthcare financing. PLoS One 2023; 18:e0291530. [PMID: 37708164 PMCID: PMC10501638 DOI: 10.1371/journal.pone.0291530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
In many European countries, including the Netherlands, the healthcare system is financed according to the principles of solidarity. It is important, therefore, that public support for solidarity in healthcare financing is sufficient in order to ensure that people remain willing to contribute towards solidarity-based systems. The high willingness to contribute to the healthcare costs of others in the Netherlands suggests that support is generally high. However, there are differences between groups. Previous research has focused on mechanisms at the individual and institutional level to explain these differences. However, people's social context may also play a role. Little research has been conducted into this. To fill this gap, we examined the role of perceived social support and social norms in order to explain differences in the willingness to contribute to other people's healthcare costs. In November 2021, we conducted a survey study in which a questionnaire was sent to a representative sample of 1,500 members of the Dutch Healthcare Consumer Panel. This was returned by 837 panel members (56% response rate). Using logistic regression analysis, we showed that people who perceive higher levels of social support are more willing to contribute to the healthcare costs of others. We also found that the willingness to contribute is higher when someone's social context is more supportive of healthcare systems that are financed according to the principles of solidarity. This effect does not differ between people who perceive low and high levels of social support. Our results suggest that, next to the individual and institutional level, the social context of people has to be taken into consideration in policy and research addressing support for solidarity in healthcare financing.
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Affiliation(s)
- Marloes A. Meijer
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Anne E. M. Brabers
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Judith D. de Jong
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Owens JA, Mattingly TJ, Foote JD, Okoye GE, Nguyen VAT, Pribil SL, Lilly FRW. Donations wanted: Assessing online medical crowdfunding campaigns created for dementia care. J Am Geriatr Soc 2023; 71:2979-2983. [PMID: 37079450 DOI: 10.1111/jgs.18391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Jennifer A Owens
- University of Maryland Graduate School, University of Maryland, Baltimore, Maryland, USA
| | - T Joseph Mattingly
- University of Maryland School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - Jourdan D Foote
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Godwin E Okoye
- University of Maryland School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - Van Anh T Nguyen
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Sarah L Pribil
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Flavius R W Lilly
- University of Maryland Graduate School, University of Maryland, Baltimore, Maryland, USA
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Galbraith AA, Price J, Abraham C, Giardino AP. Principles of Child Health Care Financing. Pediatrics 2023; 152:e2023063283. [PMID: 37635688 DOI: 10.1542/peds.2023-063283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
The American Academy of Pediatrics believes that the United States can and should ensure that all children, adolescents, and young adults from birth through the age of 26 years who reside within its borders have affordable access to high-quality comprehensive health care. Comprehensive, high-quality care addresses issues, challenges, and opportunities unique to children and young adults and addresses the effects of historic and present inequities. All families should have equitable access to professionals and facilities with expertise in the care of children within a reasonable distance of their residence. Payment methodologies should be structured to guarantee the economic viability of the pediatric medical home and of pediatric specialty and subspecialty practices. The recent increase in child uninsurance over the last several years is a threat to the well-being of children and families in the short- and long-term. Deficiencies in plans currently covering insured children pose similar threats. The AAP believes that the United States must not sacrifice recent hard-won gains for our children and that child health care financing should be based on the following guiding principles: (1) coverage with quality, affordable health insurance should be universal; (2) comprehensive pediatric services should be covered; (3) cost sharing should be affordable and should not negatively affect care; (4) payment should be adequate to strengthen family- and patient-centered medical homes; (5) child health financing policy should promote equity and address longstanding health and health care disparities; and (6) the unique characteristics and needs of children should be reflected.
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Affiliation(s)
- Alison A Galbraith
- Department of Pediatrics, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Jonathan Price
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Claire Abraham
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Angelo P Giardino
- Department of Pediatrics, University of Utah School of Medicine, Intermountain Primary Children's Hospital, Salt Lake City, Utah
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Ramkissoon B, Deonanan R. How do remittances impact child mortality and are there preconditions? Soc Sci Med 2023; 333:116178. [PMID: 37595420 DOI: 10.1016/j.socscimed.2023.116178] [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: 03/23/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
While recent research suggests that remittances affect child mortality, little is known about how remittances influence this outcome and what conditions may moderate its effectiveness. This article investigates whether and how remittances affect child mortality in developing countries. We examine the impact of remittances on the three leading causes of child mortality, explore potential channels through which this may occur and examine whether socioeconomic or political factors affect the remittances-mortality relationship. Using data for 122 developing countries over the period 2003-2018 and a dynamic panel estimator, with both internal instruments and a shift-share external instrument, we find that remittances reduce child mortality from diarrheal diseases. Our findings suggest that sanitation usage is a possible channel through which remittances affect diarrheal mortality. We also find that the mortality-reducing effect of remittances does not appear to be contingent on the level of governance or health infrastructure. However, it remains unclear whether the effect is influenced by other forms of health funding. These findings suggest that remittances serve an important role in improving child health, and the effectiveness of these inflows is not reliant on onerous preconditions being met. Thus, remittances may be important to public health dialogue, especially in developing countries where diarrheal diseases are prevalent.
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Affiliation(s)
- Benjamin Ramkissoon
- Department of Economics, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Regan Deonanan
- Department of Economics, The University of the West Indies, St. Augustine, Trinidad and Tobago.
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Moysidou K, Cohen Chen S. Inducing collective action intentions for healthcare reform through medical crowdfunding framing. Soc Sci Med 2023; 333:116090. [PMID: 37562245 DOI: 10.1016/j.socscimed.2023.116090] [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: 03/01/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023]
Abstract
As a response to the shortcomings of the U.S. healthcare system, Americans are increasingly turning to crowdfunding platforms to bankroll their health-related costs. However, although medical crowdfunding has rapidly become institutionalized as part of the U.S. healthcare financing landscape, empirical evidence on how Americans perceive its role in healthcare and the impact it might have on public attitudes is scarce. To shed more light on the above, we analyze data from one correlational and one experimental study conducted over September-November 2021. Our correlational study reveals that political orientation is associated with Americans' views on medical crowdfunding. Specifically, we find that those who self-identified as conservative perceived medical crowdfunding as a valid part of the system, and more positively than a universal healthcare system. In contrast, medical crowdfunding is perceived less positively, as hindering a system of universal and affordable healthcare by those more liberally-oriented. In our experimental study, we explore how medical crowdfunding narratives can induce social attitudes conducive to change. Specifically, we test the effect of politicized narratives (vs. control) on group efficacy and subsequently on collective action intentions for healthcare reform, as a function of political orientation. Our results show that politicized narratives might induce collective action intentions through higher group efficacy, but only among those who self-identified as conservative. Liberally-oriented individuals held high collective action intentions for healthcare reform and were not affected by the manipulation. Our work is the first to establish empirically that medical crowdfunding, when employing politicized narratives, can induce collective action intentions, but this effect is moderated by political ideology.
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Gopalan SS. Health Financing Options for Sri Lanka: What, and Why? Ceylon Med J 2023; 68:58-61. [PMID: 37610975 DOI: 10.4038/cmj.v68isi 1.9737] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
The purpose of this paper is to renew and stimulate the national discourse on how to further Sri Lanka's aspirational goal of achieving Universal Health Coverage (UHC [1]) in line with the global sustainable development goals (SDG) to which Sri Lanka is a signatory. After a brief status update about UHC in Sri Lanka, the paper focuses on the financing function, justified on the basis of its central role in addressing the problems confronting the health system, in terms of its inherent inefficiencies as well as the specific context of the economic crisis which the country is currently facing. The paper argues for a well-managed prepaid, pooled health financing mechanism (such as the current tax-based system or social health insurance schemes), incorporating strategic purchasing approaches, leveraging the private sector (both for-profit and non-profit), in order to increase efficiency, equity and accountability by separating the financing and purchasing functions from service delivery.
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Yang S, Ke X, Cheng C, Bian Y. A matter of life and death: The power of personal networks for medical crowdfunding performance. Soc Sci Med 2023; 329:115968. [PMID: 37329720 DOI: 10.1016/j.socscimed.2023.115968] [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: 10/15/2022] [Revised: 03/31/2023] [Accepted: 05/13/2023] [Indexed: 06/19/2023]
Abstract
Medical crowdfunding is an accessible alternative for individuals to meet their unaffordable health needs. This study explores the role of personal networks in medical crowdfunding performance from the perspective of tie strength and whether gender inequality persists in the returns of personal networks in this survival context, using bilateral data of both the ego and the alters collected from a large representative medical crowdfunding platform in China. It is found that kin ties play a fundamental and predominant role while pseudo-kin ties, being less strong than kin ties in terms of mutual sentiment and reciprocal obligations to help each other, play an accumulative role and are more influential in increasing crowdfunding performance, and neighbour and other role relations have the weakest effect and contribution. Importantly, women are not discriminated against when mobilizing personal networks for medical crowdfunding as they enjoy the same returns of most personal ties as men do.
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Affiliation(s)
- Shen Yang
- Department of Sociology, Xi'an Jiaotong University, 710049, PR China; Center for Medical Language and Culture Studies, Xi'an Medical University, 710021, PR China.
| | - Xiwang Ke
- Department of Sociology, Xi'an Jiaotong University, 710049, PR China
| | - Cheng Cheng
- Department of Sociology, Southeast University, 211189, PR China.
| | - Yanjie Bian
- Department of Sociology, Xi'an Jiaotong University, 710049, PR China
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Puteh SEW, Abdullah YR, Aizuddin AN. Catastrophic Health Expenditure (CHE) among Cancer Population in a Middle Income Country with Universal Healthcare Financing. Asian Pac J Cancer Prev 2023; 24:1897-1904. [PMID: 37378917 PMCID: PMC10505870 DOI: 10.31557/apjcp.2023.24.6.1897] [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: 12/01/2022] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The study investigated healthcare expenditure from the perspective of cancer patients, to determine the level of Catastrophic Health Expenditure (CHE) and its associated factors. METHODS This cross-sectional study was conducted in three Malaysian public hospitals namely Hospital Kuala Lumpur, Hospital Canselor Tuanku Muhriz and the National Cancer Institute using a multi-level sampling technique to recruit 630 respondents from February 2020 to February 2021. CHE was defined as incurring a monthly health expenditure of more than 10% of the total monthly household expenditure. A validated questionnaire was used to collect the relevant data. RESULTS The CHE level was 54.4%. CHE was higher among patients of Indian ethnicity (P = 0.015), lower level education (P = 0.001), those unemployed (P < 0.001), lower income (P < 0.001), those in poverty (P < 0.001), those staying far from the hospital (P < 0.001), living in rural areas (P = 0.003), small household size (P = 0.029), moderate cancer duration (P = 0.030), received radiotherapy treatment (P < 0.001), had very frequent treatment (P < 0.001), and without a Guarantee Letter (GL) (P < 0.001). The regression analysis identified significant predictors of CHE as lower income aOR 18.63 (CI 5.71-60.78), middle income aOR 4.67 (CI 1.52-14.41), poverty income aOR 4.66 (CI 2.60-8.33), staying far from hospital aOR 2.62 (CI 1.58-4.34), chemotherapy aOR 3.70 (CI 2.01-6.82), radiotherapy aOR 2.99 (CI 1.37-6.57), combination chemo-radiotherapy aOR 4.99 (CI 1.48-16.87), health insurance aOR 3.99 (CI 2.31-6.90), without GL aOR 3.38 (CI 2.06-5.40), and without health financial aids aOR 2.94 (CI 1.24-6.96). CONCLUSIONS CHE is related to various sociodemographic, economic, disease, treatment and presence of health insurance, GL and health financial aids variables in Malaysia.
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Affiliation(s)
| | - Yang Rashidi Abdullah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia.
| | - Azimatun Noor Aizuddin
- Department of Community Health, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Jalan Yaakob Latif Bandar Tun Razak, Malaysia.
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Brown GW, Rhodes N. The Dynamics of Power Flow From the Global Health Financing Comment on "Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process". Int J Health Policy Manag 2023; 12:7806. [PMID: 37579388 PMCID: PMC10425677 DOI: 10.34172/ijhpm.2023.7806] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/03/2023] [Indexed: 08/16/2023] Open
Abstract
This article agrees with Lassa et al that biomedical paradigms and medical professionals are a dominating force within the policy dynamics of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and that there needs to be greater community involvement in how global health initiatives (GHIs) are adopted, designed, implemented and evaluated. However, we argue that many of the conditions identified are entrenched and perpetuated by how GHIs are financed and the financing modalities employed in Development Aid for Health (DAH), particularly in low resource settings. As a result, the dynamics of power not only flow from traditionally entrenched epistemic authorities but are disproportionally sustained by global health financing modalities that favour particular GHIs over others. As we argue, these DAH modalities can exert forms of power with problematic effects on policy-making.
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Affiliation(s)
| | - Natalie Rhodes
- School of Politics and International Studies (POLIS), University of Leeds, Leeds, UK
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Davis AR, Elbers SK, Kenworthy N. Racial and gender disparities among highly successful medical crowdfunding campaigns. Soc Sci Med 2023; 324:115852. [PMID: 36989837 PMCID: PMC10916987 DOI: 10.1016/j.socscimed.2023.115852] [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: 12/02/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
There has been growing recognition of the popularity of medical crowdfunding and research documenting how crowdfunding arises from, and contributes to, social and health inequities. While many researchers have surmised that racism could well play a role in medical crowdfunding campaign outcomes, research on these dynamics has been limited. No research to date has examined these dynamics among the most successful medical crowdfunding campaigns, focusing instead on average users' experiences or specific patient subpopulations. This paper analyzes key characteristics and demographics of the 827 most successful medical crowdfunding campaigns captured at a point in time in 2020 on the popular site GoFundMe, creating the first demographic archetype of "viral" or highly successful campaigns. We hypothesized that this sample would skew towards whiter, younger populations, more heavily represent men, and reflect critical illnesses and accidents affecting these populations, in addition to having visually appealing, well-crafted storytelling. Analysis supported these hypotheses, showing significant levels of racial and gender disparities among campaigners. While white men had the greatest representation, Black and Asian users, and black women in particular, were highly underrepresented. Like other studies, we find evidence that racial and gender disparities persist in terms of campaign outcomes as well. Alongside this quantitative analysis, a targeted discourse analysis revealed campaign narratives and comments reinforced racist and sexist tropes of selective deservingness. These findings add to growing calls for more health research into the ways that social media technologies shape health inequities for historically marginalized and disenfranchised populations. In particular, we underscore how successful crowdfunding campaigns, as a both a means of raising funds for health and a broader site of public engagement, may deepen and normalize gendered and racialized inequities. In this way, crowdfunding can be seen as a significant technological amplifier of the fundamental social causes of health disparities.
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Affiliation(s)
- Aaron Renee Davis
- Department of Epidemiology, UW Box # 351619, Seattle, WA, 98195, School of Public Health, University of Washington, USA.
| | - Shauna K Elbers
- School of Interdisciplinary Arts and Sciences, 17927 113rd Ave NBox 358530, Bothell, WA, 98011-7909, University of Washington Bothell, USA
| | - Nora Kenworthy
- School of Nursing and Health Studies, Box #358532, 17927 113rd Ave NE, Bothell, WA, 98011-7909, University of Washington Bothell, USA
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Pandey AR. Health financing reforms in the quest for universal health coverage: Challenges and opportunities in the context of Nepal. J Glob Health 2023; 13:03021. [PMID: 37114984 PMCID: PMC10143109 DOI: 10.7189/jogh.13.03021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
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Livingstone A, Servais L, Wilkinson DJC. The ethics of crowdfunding in paediatric neurology. Dev Med Child Neurol 2023; 65:450-455. [PMID: 36271489 PMCID: PMC10952454 DOI: 10.1111/dmcn.15442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022]
Abstract
In the last decade, there has been a dramatic increase in the number of families resorting to internet-based public appeals to fund access to novel, highly expensive, or experimental therapies for rare disorders. Medical crowdfunding may provide a means to fund treatments or interventions, but it raises individual and societal ethical questions. In this review, we consider the ethical challenges crowdfunding poses in paediatric neurology, drawing on the example of gene therapy for spinal muscular atrophy. We discuss physician responsibilities, and how neurologists should respond to crowdfunding that they encounter in clinical practice. We also briefly consider actions that can be taken by clinicians, charities, and crowdfunding websites to reduce harms. The best way to mitigate these harms may be to target the high costs and restrictive criteria that limit access to many novel treatments, and to optimize treatment utility, for instance by newborn screening. WHAT THIS PAPER ADDS: Crowdfunding is a social phenomenon arising from families' inability to access desired treatment. Treatments sought by crowdfunding range from those that are clearly beneficial (but unaffordable) to those that would be ineffective and potentially harmful. Crowdfunding carries a range of harms and risks to families and children and has wider social impact.
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Affiliation(s)
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre, Department of PaediatricsUniversity of OxfordOxfordUK
- Neuromuscular Reference CenterUniversity Hospital and University of LiègeLiègeBelgium
| | - Dominic J. C. Wilkinson
- John Radcliffe HospitalOxfordUK
- Oxford Uehiro Centre for Practical Ethics, Faculty of PhilosophyUniversity of OxfordOxfordUK
- Murdoch Children's Research InstituteMelbourneAustralia
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