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Henriquez J, van de Ven W, Melia A, Paolucci F. The roads to managed competition for mixed public-private health systems: a conceptual framework. HEPL 2024:1-16. [PMID: 38562087 DOI: 10.1017/s1744133123000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Health systems' insurance/funding can be organised in several ways. Some countries have adopted systems with a mixture of public-private involvement (e.g. Australia, Chile, Ireland, South Africa, New Zealand) which creates two-tier health systems, allowing consumers (groups) to have preferential access to the basic standard of care (e.g. skipping waiting times). The degree to which efficiency and equity are achieved in these types of systems is questioned. In this paper, we consider integration of the two tiers by means of a managed competition model, which underpins Social Health Insurance (SHI) systems. We elaborate a two-part conceptual framework, where, first, we review and update the existing pre-requisites for the model of managed competition to fit a broader definition of health systems, and second, we typologise possible roadmaps to achieve that model in terms of the insurance function, and focus on the consequences on providers and governance/stewardship.
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Affiliation(s)
- Josefa Henriquez
- College of Human and Social Futures, Newcastle Business School, University of Newcastle, Callaghan, NSW, Australia
| | - Wynand van de Ven
- Erasmus School of Health Policy & Management, Health Systems and Insurance (HSI), Erasmus University, Rotterdam, The Netherlands
| | - Adrian Melia
- College of Human and Social Futures, Newcastle Business School, University of Newcastle, Callaghan, NSW, Australia
| | - Francesco Paolucci
- College of Human and Social Futures, Newcastle Business School, University of Newcastle, Callaghan, NSW, Australia
- Department of Sociology and Business Law, School of Economics and Statistics, University of Bologna, Bologna, Italy
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Eastin EF, Nelson DA, Shaw JG, Shaw KA, Kurina LM. Postpartum long-acting reversible contraceptive use among active-duty, female US Army soldiers. Am J Obstet Gynecol 2023; 229:432.e1-432.e12. [PMID: 37460035 DOI: 10.1016/j.ajog.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/02/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Postpartum use of long-acting reversible contraception has been found to be effective at increasing interpregnancy intervals, reducing unintended pregnancies, and optimizing health outcomes for mothers and babies. Among female active-duty military service members, reproductive planning may be particularly important, yet little is known about postpartum long-acting reversible contraceptive use among active-duty soldiers. OBJECTIVE This study aimed to (1) quantify postpartum uptake of long-acting reversible contraception among active-duty female US Army soldiers and (2) identify demographic and military-specific characteristics associated with use. STUDY DESIGN This retrospective cohort study used longitudinal data of all digitally recorded health encounters for active-duty US Army soldiers from 2014 to 2017. The servicewomen included in our analysis were aged 18 to 44 years with at least one delivery and a minimum of 4 months of total observed time postdelivery within the study period. We defined postpartum long-acting reversible contraception use as initiation of use within the delivery month or in the 3 calendar months following delivery and identified likely immediate postpartum initiation via the proxy of placement recorded during the same month as delivery. We then evaluated predictors of postpartum long-acting reversible contraception use with multivariable logistic regression. RESULTS The inclusion criteria were met by 15,843 soldiers. Of those, 3162 (19.96%) initiated the use of long-acting reversible contraception in the month of or within the 3 months following delivery. Fewer than 5% of these women used immediate postpartum long-acting reversible contraception. Among women who initiated postpartum long-acting reversible contraceptive use, 1803 (57.0%) received an intrauterine device, 1328 (42.0%) received an etonogestrel implant, and 31 received both (0.98%). Soldiers of younger age, self-reported White race, and those who were married or previously married were more likely to initiate long-acting reversible contraception in the postpartum period. Race-stratified analyses showed that self-reported White women had the highest use rates overall. When compared with these women, the adjusted odds of postpartum use among self-reported Black and Asian or Pacific Islander women were 18% and 30% lower, respectively (both P<.001). There was also a trend of decreasing postpartum use with increasing age within each race group. Differences observed between age groups and race identities could partially be attributed to differential use of permanent contraception (sterilization), which was found to be significantly more prevalent among both women aged 30 years or older and among women who identified as Black. CONCLUSION Among active-duty US Army servicewomen, 1 in 5 used postpartum long-acting reversible contraception, and fewer than 5% of these women used an immediate postpartum method. Within this population with universal healthcare coverage, we observed relatively low rates of use and significant differences in the uptake of effective postpartum long-acting contraceptive methods across self-reported race categories.
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Affiliation(s)
- Ella F Eastin
- Stanford University School of Medicine, Stanford, CA
| | - D Alan Nelson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Kate A Shaw
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Lianne M Kurina
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
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Parker S, Mac Conghail L, Siersbaek R, Burke S. How to not revert to type: Complexity-informed learnings from the pandemic response for health system reform and universal access to integrated care. Front Public Health 2023; 11:1088728. [PMID: 36908402 PMCID: PMC9996344 DOI: 10.3389/fpubh.2023.1088728] [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: 11/03/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Background COVID-19 has highlighted existing health inequalities and health system deficiencies both in Ireland and internationally; however, understanding of the critical opportunities for health system change that have arisen during the pandemic is still emerging and largely descriptive. This research is situated in the Irish health reform context of Sláintecare, the reform programme which aims to deliver universal healthcare by strengthening public health, primary and community healthcare functions as well as tackling system and societal health inequities. Aims and objectives This study set out to advance understanding of how and to what extent COVID-19 has highlighted opportunities for change that enabled better access to universal, integrated care in Ireland, with a view to informing universal health system reform and implementation. Methods The study, which is qualitative, was underpinned by a co-production approach with Irish health system leadership. Semi-structured interviews were conducted with sixteen health system professionals (including managers and frontline workers) from a range of responses to explore their experiences and interpretations of social processes of change that enabled (or hindered) better access to universal integrated care during the pandemic. A complexity-informed approach was mobilized to theorize the processes that impacted on access to universal, integrated care in Ireland in the COVID-19 context. Findings A range of circumstances, strategies and mechanisms that created favorable system conditions in which new integrated care trajectories emerged during the crisis. Three key learnings from the pandemic response are presented: (1) nurturing whole-system thinking through a clear, common goal and shared information base; (2) harnessing, sharing and supporting innovation; and (3) prioritizing trust and relationship-building in a social, human-centered health system. Policy and practice implications for health reform are discussed.
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Affiliation(s)
- Sarah Parker
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Saunders SL, Sutcliffe KL, McOrist NS, Levett KM. The associations between women who are immigrants, refugees, or asylum seekers, access to universal healthcare, and the timely uptake of antenatal care: A systematic review. Aust N Z J Obstet Gynaecol 2022; 63:134-145. [PMID: 36480342 DOI: 10.1111/ajo.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends that antenatal care (ANC) commence before 12 weeks' gestation to reduce the risk of obstetric and perinatal complications. Immigrants, refugees, and asylum seekers are at higher risk for late or non-initiation of ANC, and exclusion from universal healthcare (UHC) may be a contributing factor. AIMS The aims were to synthesise evidence regarding uptake of ANC and to examine if this is associated with inadequate access to UHC and to evaluate the link between ANC and the risk of pregnancy outcomes in the immigrant, refugee and asylum seeker population. METHODS The review was performed according to meta-analysis of observational studies in epidemiology (MOOSE) guidelines. Five databases were systematically searched. Abstracts were screened against inclusion criteria, and eligible papers underwent data extraction by two independent reviewers per paper. The ROBINS-I tool was used to assess risk of bias. RESULTS Twelve studies were included in the final review. All studies reported that ANC was delayed for women who were classified as immigrants, refugees, and asylum seekers as per the WHO recommendations, and this was statistically significant compared to controls in 11 of 12 studies (P < 0.05). Findings regarding ANC uptake and pregnancy complications were too heterogeneous to conclusively report an association. CONCLUSION Immigrants, refugees and asylum seekers who are excluded from UHC present significantly later to ANC than receiving-country-born women with full access to UHC. The link between delayed ANC due to inadequate UHC access and pregnancy complications remains unclear due to the heterogeneous nature of the studies.
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Affiliation(s)
- Samantha L Saunders
- The University of Notre Dame, Sydney, Auburn Clinical School, Faculty of Medicine, Auburn, New South Wales, Australia
- Gosford Hospital, Gosford, NSW, Australia
| | - Kerry L Sutcliffe
- The University of Notre Dame, Sydney, Auburn Clinical School, Faculty of Medicine, Auburn, New South Wales, Australia
| | - Nathan S McOrist
- The University of Notre Dame, Sydney, Auburn Clinical School, Faculty of Medicine, Auburn, New South Wales, Australia
- Gosford Hospital, Gosford, NSW, Australia
| | - Kate M Levett
- The University of Notre Dame, Sydney, Auburn Clinical School, Faculty of Medicine, Auburn, New South Wales, Australia
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
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Grosso AA, Di Maida F, Tellini R, Viola L, Lambertini L, Valastro F, Mari A, Masieri L, Carini M, Minervini A. Assessing the impact of socio-economic determinants on access to care, surgical treatment options and outcomes among patients with renal mass: Insight from the universal healthcare system. Eur J Cancer Care (Engl) 2022; 31:e13666. [PMID: 35869594 PMCID: PMC9787702 DOI: 10.1111/ecc.13666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/07/2022] [Accepted: 07/05/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess whether socio-economic disparities exist on access to care, treatment options and outcomes among patients with renal mass amenable of surgical treatment within the universal healthcare system. METHODS Data of consecutive patients submitted to partial nephrectomy (PN) or radical nephrectomy (RN) at our Institution between 2017 and 2020 were retrospectively evaluated. Patients were grouped according to their income level (low, intermediate, and high) based on the Indicator of Equivalent Economic Situation national criterion. Survival analysis was performed. Cox regression models were employed to analyse the impact of socio-economic variables on survival outcomes. RESULTS One thousand forty-two patients were included (841 PN and 201 RN). Patients at the lowest income level were found more likely symptomatic and with a higher pathological tumour stage in the RN cohort (p > 0.05). The guidelines adherence on surgical indication rate as well as the access to minimally invasive surgery did not differ according to patient's income level in both cohorts (p > 0.05). Survival curves were comparable among the groups. Cox regression analysis showed that none of the included socio-economic variables was associated with survival outcomes in our series. CONCLUSIONS Universal healthcare system may increase the possibility to ensure egalitarian treatment modalities for patients with renal cancer.
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Affiliation(s)
- Antonio Andrea Grosso
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Fabrizio Di Maida
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Riccardo Tellini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Lorenzo Viola
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Luca Lambertini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Francesca Valastro
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Andrea Mari
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Lorenzo Masieri
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Marco Carini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Andrea Minervini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
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Cheung DC, Bremner KE, Tsui TCO, Croxford R, Lapointe-Shaw L, Giudice LD, Mendlowitz A, Perlis N, Pataky RE, Teckle P, Zeitouny S, Wong WWL, Sander B, Peacock S, Krahn MD, Kulkarni GS, Mulder C. "Bring the Hoses to Where the Fire Is!": Differential Impacts of Marginalization and Socioeconomic Status on COVID-19 Case Counts and Healthcare Costs. Value Health 2022; 25:1307-1316. [PMID: 35527165 PMCID: PMC9072854 DOI: 10.1016/j.jval.2022.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/01/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Local health leaders and the Director General of the World Health Organization alike have observed that COVID-19 "does not discriminate." Nevertheless, the disproportionate representation of people of low socioeconomic status among those infected resembles discrimination. This population-based retrospective cohort study examined COVID-19 case counts and publicly funded healthcare costs in Ontario, Canada, with a focus on marginalization. METHODS Individuals with their first positive severe acute respiratory syndrome coronavirus 2 test from January 1, 2020 to June 30, 2020, were linked to administrative databases and matched to negative/untested controls. Mean net (COVID-19-attributable) costs were estimated for 30 days before and after diagnosis, and differences among strata of age, sex, comorbidity, and measures of marginalization were assessed using analysis of variance tests. RESULTS We included 28 893 COVID-19 cases (mean age 54 years, 56% female). Most cases remained in the community (20 545, 71.1%) or in long-term care facilities (4478, 15.5%), whereas 944 (3.3%) and 2926 (10.1%) were hospitalized, with and without intensive care unit, respectively. Case counts were skewed across marginalization strata with 2 to 7 times more cases in neighborhoods with low income, high material deprivation, and highest ethnic concentration. Mean net costs after diagnosis were higher for males ($4752 vs $2520 for females) and for cases with higher comorbidity ($1394-$7751) (both P < .001) but were similar across levels of most marginalization dimensions (range $3232-$3737, all P ≥ .19). CONCLUSIONS This study suggests that allocating resources unequally to marginalized individuals may improve equality in outcomes. It highlights the importance of reducing risk of COVID-19 infection among marginalized individuals to reduce overall costs and increase system capacity.
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Affiliation(s)
- Douglas C Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Teresa C O Tsui
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | | - Lauren Lapointe-Shaw
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lisa Del Giudice
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Reka E Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paulos Teckle
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Seraphine Zeitouny
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - William W L Wong
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carol Mulder
- Chiefs of Ontario, Toronto, Ontario, Canada; Queen's University, Kingston, Ontario, Canada.
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Galvani AP, Parpia AS, Pandey A, Sah P, Colón K, Friedman G, Campbell T, Kahn JG, Singer BH, Fitzpatrick MC. Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic. Proc Natl Acad Sci U S A 2022; 119:e2200536119. [PMID: 35696578 PMCID: PMC9231482 DOI: 10.1073/pnas.2200536119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. During a pandemic, the lives saved and economic benefits of a single-payer universal healthcare system relative to the status quo would be even greater. For Americans who are uninsured and underinsured, financial barriers to COVID-19 care delayed diagnosis and exacerbated transmission. Concurrently, deaths beyond COVID-19 accrued from the background rate of uninsurance. Universal healthcare would alleviate the mortality caused by the confluence of these factors. To evaluate the repercussions of incomplete insurance coverage in 2020, we calculated the elevated mortality attributable to the loss of employer-sponsored insurance and to background rates of uninsurance, summing with the increased COVID-19 mortality due to low insurance coverage. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved about 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a single-payer universal healthcare system over the course of the pandemic. These economic benefits are in addition to US$438 billion expected to be saved by single-payer universal healthcare during a nonpandemic year.
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Affiliation(s)
- Alison P. Galvani
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- 1To whom correspondence may be addressed. or
| | - Alyssa S. Parpia
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Abhishek Pandey
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Pratha Sah
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Kenneth Colón
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- bMaxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY 13244
| | - Gerald Friedman
- cDepartment of Economics, College of Social and Behavioral Sciences, University of Massachusetts Amherst, Amherst, MA 01002
| | - Travis Campbell
- cDepartment of Economics, College of Social and Behavioral Sciences, University of Massachusetts Amherst, Amherst, MA 01002
| | - James G. Kahn
- dInstitute for Health Policy Studies, School of Medicine, University of California, San Francisco, CA 94118
| | - Burton H. Singer
- eEmerging Pathogens Institute, University of Florida, Gainesville, FL 32610
- 1To whom correspondence may be addressed. or
| | - Meagan C. Fitzpatrick
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- fCenter for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
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Barreto JVP, Lorenzetti E, Pertile SFN, Bertasso NP, dos Santos RM, Jardim ADM, Kemper DAG, Zundt M, Rego FCDA. The COVID-19 pandemic's impact on the practices and biosecurity measures of veterinary medicine professionals in Brazil. Braz J Vet Med 2022; 44:e005221. [PMID: 35749093 PMCID: PMC9183226 DOI: 10.29374/2527-2179.bjvm005221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/20/2022] [Indexed: 12/04/2022] Open
Abstract
Veterinarians, among other health professionals, are considered health professionals at high risk of exposure to and contraction of COVID-19. The main objective of this study is to assess changes in the clinical practices of veterinarians during the COVID-19 pandemic around prophylactic and biosafety measures, as well as to evaluate changes in workload and cost-benefit ratio. An online questionnaire was sent to veterinary professionals from July 2020 to July 2021 using Google Forms. A total of 1134 veterinarians answered the questionnaire on clinical experiences and biosafety practices during the COVID-19 pandemic. Veterinarians changed their routine clinical practices, as there was a reduction in working hours, and applied new patient approaches and advice to their owners, as well as restricting the number of people allowed inside. Biosafety measures were added in their workplaces, with an increase in the use of personal protective equipment. COVID-19 tests were administered at least once in 19.0%, and more than once in 9.5% of the respondents. Flu symptoms were present in 23.8% of the respondents, and 31.0% of the veterinarians attended to COVID-19 positive pet owners. Therefore, most veterinarians altered their routine practices, and some were exposed to sources of COVID-19 infection.
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Affiliation(s)
- José Victor Pronievicz Barreto
- Veterinarian, MSc, Programa de Pós-Graduação Stricto Sensu em Saúde e Produção Animal (PPGSSSPA), Universidade Pitágoras Unopar (UNOPAR), Arapongas, PR, Brazil.
- Correspondence José Victor Pronievicz Barreto Centro de Ciências Agrárias, Universidade Pitágoras Unopar – UNOPAR. Rodovia Pr 218, Km 01, S/N CEP 86702-670 - Arapongas (PR), Brazil E-mail:
| | | | | | - Nicolas Peralta Bertasso
- Veterinarian, MSc, Programa de Pós-Graduação Stricto Sensu em Saúde e Produção Animal (PPGSSSPA), Universidade Pitágoras Unopar (UNOPAR), Arapongas, PR, Brazil.
| | | | - Andressa de Melo Jardim
- Veterinarian, MSc, Programa de Pós-Graduação Stricto Sensu em Saúde e Produção Animal (PPGSSSPA), Universidade Pitágoras Unopar (UNOPAR), Arapongas, PR, Brazil.
| | | | - Marilice Zundt
- Zootechnist, Dsc, PPGSSSPA, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil.
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Hey CY. It's time to 'Build Back Fairer': what can we do to reduce health inequalities in cardiology? Br J Cardiol 2022; 29:27. [PMID: 36873718 PMCID: PMC9982665 DOI: 10.5837/bjc.2022.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Disparities in cardiovascular morbidity and mortality are among the leading health and social care concerns in the UK. The disruption of the COVID-19 pandemic to health services has further placed cardiovascular care and the respective patient communities at the sharp end, not least in exacerbating existing health inequalities across service interfaces and patients' health outcomes. While the pandemic engenders unprecedented constraints within established cardiology services, it conduces to a unique opportunity to embrace novel transformative approaches within the way we deliver patient care in maintaining best practices during and beyond the crisis. As the first step in navigating toward the 'new norm', a clear recognition of the challenges inherent in cardiovascular health inequalities is critical, primarily in preventing the widening of extant inequalities as cardiology workforces continue to build back fairer. We may consider the challenges through the lens of health services' diverse facets, including the aspects of universality, interconnectivity, adaptability, sustainability, and preventability. This article explores the pertinent challenges and provides a focused narration concerning potential measures to foster equitable and resilient cardiology services that are patient centred in the post-pandemic landscape.
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Affiliation(s)
- Cong Ying Hey
- Internal Medical Trainee Department of Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge, CB2 0AY
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Hirota T, Bishop S, Adachi M, Shui A, Takahashi M, Mori H, Nakamura K. Utilization of the Maternal and Child Health Handbook in Early Identification of Autism Spectrum Disorder and Other Neurodevelopmental Disorders. Autism Res 2020; 14:551-559. [PMID: 33251760 DOI: 10.1002/aur.2442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 10/13/2020] [Accepted: 11/10/2020] [Indexed: 11/07/2022]
Abstract
There is relatively little information about prospectively reported developmental milestones from caregivers of children who go on to be diagnosed with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD). The current study examined rates of early skill attainment in 5-year-old children who participated in a comprehensive in-person assessment for NDDs in Hirosaki in Japan. Developmental milestone data were extracted from their Maternal and Child Health Handbook (MCHH), a booklet distributed to all pregnant women as part of universal health care. Seven hundred and twenty children underwent the assessment, among whom 455 received one or more NDD diagnoses (ASD: n = 124, non-ASD NDD: n = 331). Developmental skills were organized into four domains (motor, social interaction, communication, self-help), and the cumulative number of potential delays in each domain was calculated for each participant within three different age ranges (by 12 months, by 24 months, and by 36 months). Even by age 12 months, children with ASD/NDDs showed more potential delays across domains compared to those who received no NDD diagnosis. However, differences between those with ASD and those with non-ASD NDDs were not apparent until 24 months for social interaction and communication, and 36 months for self-help. These findings provide insights into specific behaviors that could be used to screen for ASD and other NDDs. In addition, the present study indicates the potential utility of the MCHH as a broadband screening tool to educate parents about what to look for in charting their child's early development. LAY SUMMARY: The present study examined prospectively charted developmental milestones from home-based records used as part of universal health care in 720 5-year-old children from Hirosaki, Japan. All children participated in a comprehensive evaluation to determine if they met criteria for a neurodevelopmental disorder (NDD), including autism spectrum disorder (ASD). Compared to those who received no NDD diagnosis, children with NDDs exhibited higher rates of potential delays across developmental domains, including social interaction, communication, and self-help. For some children, these delays were apparent before the age of 12 months. Differences between diagnostic groups became even more pronounced by 24 and 36 months, well before the average age of diagnosis. This suggests that home-based records can be useful tools to educate caregivers about what to look for in charting their child's early development and could assist with early screening efforts.
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Affiliation(s)
- Tomoya Hirota
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA.,Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Aomori, Japan
| | - Somer Bishop
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Masaki Adachi
- Graduate School of Health Sciences, Hirosaki University, Aomori, Japan.,Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Aomori, Japan
| | - Amy Shui
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Michio Takahashi
- Graduate School of Health Sciences, Hirosaki University, Aomori, Japan.,Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Aomori, Japan
| | - Hiroyuki Mori
- Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Aomori, Japan
| | - Kazuhiko Nakamura
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Aomori, Japan.,Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Aomori, Japan
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11
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Lakha F, Suriyawongpaisul P, Sangrajrang S, Leerapan B, Coker R. Breast cancer in Thailand: policy and health system challenges to universal healthcare. Health Policy Plan 2020; 35:1159-1167. [PMID: 33212481 DOI: 10.1093/heapol/czaa063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/14/2022] Open
Abstract
Thailand has successfully implemented Universal Health Coverage (UHC) and embedded the 2030 Agenda for Sustainable Development into its Thailand 4.0 policy. Breast cancer is a growing challenge in Thailand, as it is globally. It serves as a perfect medium through which to interrogate UHC and demonstrate areas of the health system which require further strengthening if UHC is to be sustainable in the longer term. We conducted a situation analysis and used a Systemic Rapid Assessment (SYSRA) framework to examine the challenges posed to UHC through the lens of breast cancer. We identified a number of challenges facing UHC including (1) continued political commitment; (2) the need for coordinated scale-up of strategic investments involving increased financing and fine-tuning of the allocation of resources according to health needs; (3) reducing inequities between health insurance schemes; (4) investing in innovation of technologies, and more critically, in technology transfer and capacity building; (5) increasing capacity, quality and confidence in the whole primary healthcare team but especially family medicine doctors. This would subsequently increase both efficiency and effectiveness of the patient pathway, as well as allow patients wherever possible to be treated close to their homes, work and family; (6) developing and connecting information systems to facilitate understanding of what is working, where needs are and track trends to monitor improvements in patient care. Our findings add to an existing body of evidence which suggest, in light of changing disease burden and increasing costs of care, a need for broader health system reforms to create a more enabling platform for integrated healthcare as opposed to addressing individual challenging elements one vertical system at a time. As low- and middle-income countries look to realize the 2015 Sustainable Development Goals and sustainable UHC this analysis may provide input for policy discussion at national, regional and community levels and have applicability beyond breast cancer services alone and beyond Thailand.
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Affiliation(s)
- Fatim Lakha
- Department of Global Health and Development, Communicable Disease Policy Research Group, London School Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | - Suleeporn Sangrajrang
- Cluster of Health System Development, National Cancer Institute, Bangkok 10400, Thailand
| | | | - Richard Coker
- Department of Global Health and Development, Communicable Disease Policy Research Group, London School Hygiene and Tropical Medicine, London WC1E 7HT, UK
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12
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Zieff G, Kerr ZY, Moore JB, Stoner L. Universal Healthcare in the United States of America: A Healthy Debate. Medicina (Kaunas) 2020; 56:E580. [PMID: 33143030 DOI: 10.3390/medicina56110580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/11/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022]
Abstract
This commentary offers discussion on the pros and cons of universal healthcare in the United States. Disadvantages of universal healthcare include significant upfront costs and logistical challenges. On the other hand, universal healthcare may lead to a healthier populace, and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation. In particular, substantial health disparities exist in the United States, with low socio–economic status segments of the population subject to decreased access to quality healthcare and increased risk of non-communicable chronic conditions such as obesity and type II diabetes, among other determinants of poor health. While the implementation of universal healthcare would be complicated and challenging, we argue that shifting from a market-based system to a universal healthcare system is necessary. Universal healthcare will better facilitate and encourage sustainable, preventive health practices and be more advantageous for the long-term public health and economy of the United States.
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13
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Sohn M, Che X, Park HJ. Unmet Healthcare Needs, Catastrophic Health Expenditure, and Health in South Korea's Universal Healthcare System: Progression Towards Improving Equity by NHI Type and Income Level. Healthcare (Basel) 2020; 8:healthcare8040408. [PMID: 33081357 PMCID: PMC7711549 DOI: 10.3390/healthcare8040408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 01/29/2023] Open
Abstract
This study examined the effects of healthcare inequality on personal health. It aimed to determine how health insurance type and income level influence catastrophic health expenditure and unmet healthcare needs among South Koreans. Unbalanced Korean Health Panel data from 2011 to 2015, including 33,374 adults, were used. A time-trend and panel regression analysis were performed. The first to identify changes in the main variables and, the second, mediating effects of unmet healthcare needs and catastrophic health expenditure on the relationship between health insurance type, income level, and health status. The independent variables were: high-, middle-, low-income employee insured, high-, middle-, low-income self-employed insured, and medical aid. The dependent variable was health status, and the mediators were unmet needs and catastrophic health expenditure. The medical aid beneficiaries and low-income self-employed insured groups demonstrated a higher probability of reporting poor health status than the high-income, insured group (15.6%, 2.2%, and 2.3%, respectively). Participants who experienced unmet healthcare needs or catastrophic health expenditure were 10.7% and 5.6% higher probability of reporting poor health, respectively (Sobel test: p < 0.001). National policy reforms could improve healthcare equality by integrating insurance premiums based on income among private-sector employees and self-employed individuals within the health insurance network.
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Affiliation(s)
- Minsung Sohn
- Department of Health and Care Administration, The Cyber University of Korea, Seoul 03051, Korea;
| | - Xianhua Che
- Department of Health Policy Research, Daejeon Public Health Policy Institute, Daejeon 35015, Korea;
| | - Hee-Jung Park
- Department of Dental Hygiene, College of Health Science, Kangwon National University, Gangwon-do 25945, Korea
- Correspondence: ; Tel.: +82-33-540-3395
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14
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Li HOY, Bailey AJM, Grose E, McDonald JT, Quimby A, Johnson-Obaseki S, Nessim C. Socioeconomic Status and Melanoma in Canada: A Systematic Review. J Cutan Med Surg 2020; 25:87-94. [PMID: 32955341 DOI: 10.1177/1203475420960426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
As melanoma is one of the leading cancers in average years of life lost per death from disease, screening and early diagnosis are imperative to decrease morbidity and mortality. Socioeconomic status (SES) has been shown to be associated with melanoma incidence. However, it is unclear if this association holds true in universal healthcare systems where screening, diagnostic, and treatment services are available to all patients. The objective of this systematic review was to evaluate the evidence on the association of SES and melanoma incidence in Canada. A comprehensive search of PubMed and EMBASE yielded 7 studies reporting on melanoma incidence or outcomes with respect to SES in Canada. High SES was associated with increased melanoma incidence across all studies, which encompassed all Canadian provinces, and time periods spanning from 1979 to 2012. Studies also reported an increasing incidence of melanoma over time. There were substantial discrepancies in melanoma incidence across Canadian provinces, after controlling for SES and demographic characteristics. Populations of lower SES and living within certain healthcare regions had increased risks of advanced melanoma at diagnosis. This review highlights the potential for inequities in access to care even within a universal healthcare system. Future research is needed to characterize specific risk factors within different patient groups and within the universal health system context in order to implement targeted strategies to lower melanoma incidence, morbidity, and mortality.
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Affiliation(s)
| | | | - Elysia Grose
- 12365 Faculty of Medicine, University of Ottawa, ON, Canada
| | | | - Alexandra Quimby
- 27337 Department of Otolaryngology, The Ottawa Hospital, ON, Canada
| | | | - Carolyn Nessim
- 27337 Division of Surgical Oncology, Department of Surgery, The Ottawa Hospital, ON, Canada
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15
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Holtkamp MD. Does race matter in universal healthcare? Stroke cost and outcomes in US military health care. Ethn Health 2020; 25:888-896. [PMID: 29724114 DOI: 10.1080/13557858.2018.1455810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
Introduction: It is well documented in the US civilian healthcare system that race is correlated with different outcomes for ischemic stroke patients. That healthcare system has wide variations in access to and quality of care. In contrast, the US military healthcare system (MHS) a universal healthcare system where every member has access to the same healthcare benefits. Do racial disparities evident in the civilian healthcare system transfer to the MHS? Methods: Data was collected from the MHS Military Mart (M2) database from calendar years 2010 through 2015. All adult patients with a primary diagnosis of ischemic stroke upon discharge were reviewed. Race was compared across primary outcomes of: (1) IV tPA administration and (2) Disposition destination 'poor disposition destination or in-hospital mortality'. And secondary outcomes of: (1) Total cost of hospitalization and (2) Length of hospital stay. Relevant demographic and co-morbidities were adjusted with regression analysis. Results: A total of 3623 patients met this study's parameters. Race was identified in 2661 (73.5%) admissions. Racial composition of this patient sample was: White 1767 (48.8%), African Americans 619 (17.1%), Asian 275 (7.6%), Other or Unknown 962 (26.5%). There was no correlation between race and administration of IV tPA, poor disposition destination or in-hospital mortality. There was a correlation between African Americans and increased cost of hospitalization. This finding was correlated with costs for radiological studies but was not correlated with any increase in the length of stay. Conclusion: Racial disparities evident in the civilian healthcare system do not appear to transfer the universal healthcare system represented by the MHS. Universal healthcare mitigates racial disparities in ischemic stroke admissions.
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Affiliation(s)
- Matthew D Holtkamp
- Department of Medicine, Intrepid Spirit, Traumatic Brain Injury Clinic, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
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16
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Levin-Zamir D, Baron-Epel O. Health Literacy in Israel - From Measurement to Intervention: Two Case Studies. Stud Health Technol Inform 2020; 269:220-228. [PMID: 32593996 DOI: 10.3233/shti200035] [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: 06/11/2023]
Abstract
This report focuses on opportunities, challenges and outcomes of health literacy related interventions in Israel, based on health literacy measurement. The importance of a system's and community approaches are discussed, as is cultural appropriateness. Two case studies are highlighted - the first on childhood immunization and the second on self-management of chronic health situations. In the second example, a combination of community, media, digital, and face-to-face interventions comprise a broad approach to intervention. The impact and some findings are presented, including conclusions derived from each initiative.
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Affiliation(s)
- Diane Levin-Zamir
- School of Public Health, University of Haifa, Israel
- Department of Health Education and Promotion, Clalit Health Services, Israel
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17
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Kuo RN, Chen W, Lin Y. Do informed consumers in Taiwan favour larger hospitals? A 10-year population-based study on differences in the selection of healthcare providers among medical professionals, their relatives and the general population. BMJ Open 2019; 9:e025202. [PMID: 31101695 PMCID: PMC6530349 DOI: 10.1136/bmjopen-2018-025202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Exploring whether medical professionals, who are considered to be 'informed consumers' in the healthcare system, favour large providers for elective treatments. In this study, we compare the inclination of medical professionals and their relatives undergoing treatment for childbirth and cataract surgery at medical centres, against those of the general population. DESIGN Retrospective study using a population-based matched cohort data. PARTICIPANTS Patients who underwent childbirth or cataract surgery between 1 January 2004 and 31 December 2013. PRIMARY AND SECONDARY OUTCOMES MEASURES We used multiple logistic regression to compare the ORs of medical professionals and their relatives undergoing treatment at medical centres, against those of the general population. We also compared the rate of 14-day re-admission (childbirth) and 14-day reoperation (cataract surgery) after discharge between these groups. RESULTS Multivariate analysis showed that physicians were more likely than patients with no familial connection to the medical profession to undergo childbirth at medical centres (OR 5.26, 95% CI 3.96 to 6.97, p<0.001), followed by physicians' relatives (OR 2.68, 95% CI 2.20 to 3.25, p<0.001). Similarly, physicians (OR 1.63, 95% CI 1.21 to 2.19, p<0.01) and their relatives (OR 1.43, 95% CI 1.13 to 1.81, p<0.01) were also more likely to undergo cataract surgery at medical centres. Physicians also tended to select healthcare providers who were at the same level or above the institution at which they worked. We observed no significant difference in 14-day re-admission rates after childbirth and no significant difference in 14-day reoperation rates after cataract surgery across patient groups. CONCLUSIONS Medical professionals and their relatives are more likely than the general population to opt for service at medical centres. Understanding the reasons that medical professionals and general populations both have a preferential bias for larger medical institutions could help improve the efficiency of healthcare delivery.
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Affiliation(s)
- Raymond N Kuo
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
- Innovation and Policy Centre for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Wanchi Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
| | - Yuting Lin
- National Health Insurance Administration, Taipei Division, Taipei City, Taiwan
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Stempler I. Giving Women the Power of the Purse P@CCT: Incentivizing Patient-Centered Quality Care. Breastfeed Med 2018; 13:537-538. [PMID: 30335495 DOI: 10.1089/bfm.2018.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ilyse Stempler
- COO, Open Development , Washington, District of Columbia
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19
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Gendler R. An American physician's foray into Scandinavian healthcare. Scand J Public Health 2016; 44:225-7. [PMID: 26879080 DOI: 10.1177/1403494815627385] [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] [Accepted: 12/23/2015] [Indexed: 11/15/2022]
Abstract
The article describes the experience of the author, an American Physician, seeking care for an uncommon orthopedic condition. Unable to find adequate treatment in the United States, the author traveled to Finland for surgical treatment.
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20
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Nsanzimana S, Prabhu K, McDermott H, Karita E, Forrest JI, Drobac P, Farmer P, Mills EJ, Binagwaho A. Improving health outcomes through concurrent HIV program scale-up and health system development in Rwanda: 20 years of experience. BMC Med 2015; 13:216. [PMID: 26354601 PMCID: PMC4564958 DOI: 10.1186/s12916-015-0443-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/07/2015] [Indexed: 11/26/2022] Open
Abstract
The 1994 genocide against the Tutsi destroyed the health system in Rwanda. It is impressive that a small country like Rwanda has advanced its health system to the point of now offering near universal health insurance coverage. Through a series of strategic structural changes to its health system, catalyzed through international assistance, Rwanda has demonstrated a commitment towards improving patient and population health indicators. In particular, the rapid scale up of antiretroviral therapy (ART) has become a great success story for Rwanda. The country achieved universal coverage of ART at a CD4 cell count of 200 cells/mm(3) in 2007 and increased the threshold for initiation of ART to ≤350 cells/mm(3) in 2008. Further, 2013 guidelines raised the threshold for initiation to ≤500 cells/mm(3) and suggest immediate therapy for key affected populations. In 2015, guidelines recommend offering immediate treatment to all patients. By reviewing the history of HIV and the scale-up of treatment delivery in Rwanda since the genocide, this paper highlights some of the key innovations of the Government of Rwanda and demonstrates the ways in which the national response to the HIV epidemic has catalyzed the implementation of interventions that have helped strengthen the overall health system.
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Affiliation(s)
- Sabin Nsanzimana
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda. .,Basel Institute for Clinical Epidemiology & Biostatistics and Swiss Tropical and Public Health institute, University of Basel, Basel, Switzerland.
| | | | | | | | - Jamie I Forrest
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Global Evaluative Sciences, Vancouver, Canada
| | | | - Paul Farmer
- Harvard University Medical School, Boston, USA.,Partners in Health, Boston, USA
| | | | - Agnes Binagwaho
- Harvard University Medical School, Boston, USA.,Ministry of Health of Rwanda, Kigali, Rwanda.,Geisel School of Medicine, Dartmouth College, Hanover, USA
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Abstract
INTRODUCTION The role of community health workers in healthcare delivery system is considered inevitable to meet the goal of universal healthcare provision. The study was planned to assess the knowledge and practices for maternal health care delivery among Accredited Social Health Activist (ASHA) workers in North-East district of Delhi, India. MATERIALS AND METHODS A descriptive cross-sectional study was conducted in North-East district of Delhi among 55 ASHA workers after taking written informed consent. Data were collected using a pretested semi-structured questionnaire consisted of items on sociodemographic profile of ASHA workers, knowledge, and practices about maternal health. The data was analyzed by using SPSS software version 17. Qualitative data were expressed in percentages and quantitative data were expressed in mean ± standard deviation (SD). RESULTS Mean age (±SD) of ASHAs was 31.84 ± 7.2 years. Most of the ASHAs workers were aware of their role in provision of maternal health services. Most of the ASHAs workers were aware of their work of bringing mothers for antenatal check-up (94.5%), counseling for family planning (96.4%), and accompanying them for hospital for delivery (89.1%). 87% of ASHAs knew that iron tablets have to be taken for minimum 100 days during pregnancy. 51 (92.7%) ASHAs reported that they used to maintain antenatal register. Some problems reported by ASHAs while working in community were shortage of staff at health center (16.4%), no transportation facility available (14.5%), no money for emergency, and opposition from local dais (12.7% each). CONCLUSION Present study showed that ASHAs knowledge is good but their practices are poor due to number of problems faced by them which need to be addressed through skill based training in terms of good communication and problem solving. Monitoring should be made an integral part of ASHA working in the field to ensure that knowledge is converted into practices as well.
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Affiliation(s)
- Charu Kohli
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Jugal Kishore
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Shantanu Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Harsavsardhan Nayak
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
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Prinja S, Kaur M, Kumar R. Universal health insurance in India: ensuring equity, efficiency, and quality. Indian J Community Med 2012; 37:142-9. [PMID: 23112438 PMCID: PMC3483505 DOI: 10.4103/0970-0218.99907] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 02/03/2012] [Indexed: 12/04/2022] Open
Abstract
Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India's workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete.
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Affiliation(s)
- Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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