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Levi Z, Abu-Frecha N, Comanesther D, Backenstein T, Cohen AD, Eizenstein S, Flugelman A, Weinstein O. Racial/ethnic and socioeconomic disparities in colorectal cancer screening in a large organization with universal insurance before and during the coronavirus disease 2019 pandemic. J Med Screen 2024; 31:85-90. [PMID: 37964557 DOI: 10.1177/09691413231214186] [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: 11/16/2023]
Abstract
OBJECTIVES Israel is regarded as a country with a developed economy and a moderate income inequality index. In this population-based study, we aimed to measure the inequalities in colorectal cancer screening within Clalit Health, an organization with universal insurance, before and during the coronavirus disease 2019 pandemic. SETTING Retrospective analysis within Clalit Health Services, Israel. METHODS We evaluated the rate of being up to date with screening (having a colonoscopy within 10 years or a fecal occult blood test within 1 year) and the colonoscopy completion rate (having a colonoscopy within 6 months of a positive fecal occult blood test) among subjects aged 50-75 in 2019-2021. RESULTS In 2019, out of 918,135 subjects, 61.3% were up to date with screening; high socioeconomic status: 65.9% (referent), medium-socioeconomic status: 60.1% (odds ratio 0.81, 95% confidence interval 0.80-0.82), low-socioeconomic status: 59.0% (odds ratio 0.75, 95% confidence interval 0.74-0.75); Jews: 61.9% (referent), Arabs: 59.7% (odds ratio 0.91, 95% confidence interval 0.90-0.92), Ultraorthodox-Jews: 51.7% (odds ratio 0.77, 95% confidence interval 0.75-0.78). Out of 21,308 with a positive fecal occult blood test, the colonoscopy completion rate was 51.8%; high-socioeconomic status: 59.8% (referent), medium-socioeconomic status: 54.1% (odds ratio 0.79, 95% confidence interval 0.73-0.86), low-socioeconomic status: 45.5% (odds ratio 0.60, 95% confidence interval 0.56-0.65); Jews: 54.7% (referent), Ultraorthodox-Jews: 51.4% (odds ratio 0.91, 95% confidence interval 0.90-0.92), Arabs: 44.7% (odds ratio 0.77, 95% confidence interval 0.75-0.78). In 2020-2021, there was a slight drop in the rate of being up to date with screening, while most of the discrepancies were kept or slightly increased with time. CONCLUSIONS We report significant inequalities in colorectal cancer screening before and during the coronavirus disease 2019 pandemic in Israel, despite a declared policy of equality and universal insurance.
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Affiliation(s)
- Zohar Levi
- Division of Gastroenterology, Rabin Medical Center, Clalit Health Services, Israel
- Tel Aviv University, Israel
| | - Naim Abu-Frecha
- Department of Gastroenterology, Soroka Medical Center, Clalit Health Services, Israel
- Ben-Gurion University, Beer Sheva, Israel
| | - Doron Comanesther
- Division of Health Policy, Department of Quality Measures, Clalit Health Services, Israel
| | - Tania Backenstein
- Division of Health Policy, Department of Quality Measures, Clalit Health Services, Israel
| | - Arnon D Cohen
- Ben-Gurion University, Beer Sheva, Israel
- Division of Health Policy, Department of Quality Measures, Clalit Health Services, Israel
| | | | - Anath Flugelman
- Technion Israel Institute of Technology The Ruth and Bruce Rappaport Faculty of Medicine Haifa, Haifa, IL, USA
| | - Orly Weinstein
- The Clalit Health Services Headquarters, Tel Aviv, Israel
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Tiruneh MG, Fenta ET, Endeshaw D, Delie AM, Adal O, Tareke AA, Bogale EK, Anagaw TF. Health extension service utilization in Ethiopia: systematic review and meta-analysis. BMC Health Serv Res 2024; 24:537. [PMID: 38671447 PMCID: PMC11046976 DOI: 10.1186/s12913-024-11038-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/24/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Ethiopia strives to achieve Universal Health Coverage (UHC) through Primary Health Care (PHC) by expanding access to services and improving the quality and equitable comprehensive health services at all levels. The Health Extension Program (HEP) is an innovative strategy to deliver primary healthcare services in Ethiopia and is designed to provide basic healthcare to approximately 5000 people through a health post (HP) at the grassroots level. Thus, this review aimed to assess the magnitude of health extension service utilization in Ethiopia. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guideline was used for this review and meta-analysis. The electronic databases (PubMed, Cochrane Library, and African Journals Online) and search engines (Google Scholar and Grey literature) were searched to retrieve articles by using keywords. The Joanna Briggs Institute (JBI) meta-analysis of statistics assessment and review instrument was used to assess the quality of the studies. Heterogeneity was assessed using the I2 statistic. The meta-analysis with a 95% confidence interval using STATA 17 software was computed to present the pooled utilization of health extension services. Publication bias was assessed by visually inspecting the funnel plot and statistical tests using Egger's and Begg's tests. RESULT 22 studies were included in the systematic review with a total of 28,171 participants, and 8 studies were included in the meta-analysis. The overall pooled magnitude of health extension service utilization was 58.5% (95% CI: 40.53, 76.48%). In the sub-group analysis, the highest pooled proportion of health extension service utilization was 60.42% (28.07, 92.77%) in the mixed study design, and in studies published after 2018, 59.38% (36.42, 82.33%). All studies were found to be within the confidence interval of the pooled proportion of health extension service utilization in leave-out sensitivity analysis. CONCLUSIONS The utilization of health extension services was found to be low compared to the national recommendation. Therefore, policymakers and health planners should come up with a wide variety of health extension service utilization strategies to achieve universal health coverage through the primary health care.
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Affiliation(s)
- Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Destaw Endeshaw
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Mebrat Delie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Ousman Adal
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abiyu Abadi Tareke
- Amref Health Africa in Ethiopia, SLL project COVID-19/EPI technical assistant at West Gondar Zonal Health Department, Gondar, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Sciences, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, PO. Box.079, Bahir Dar, Ethiopia
| | - Tadele Fentabel Anagaw
- Department of Health Promotion and Behavioral Sciences, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, PO. Box.079, Bahir Dar, Ethiopia
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Bayked EM, Assfaw AK, Toleha HN, Zewdie S, Biset G, Ibirongbe DO, Kahissay MH. Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis. Front Public Health 2024; 12:1390937. [PMID: 38706546 PMCID: PMC11066245 DOI: 10.3389/fpubh.2024.1390937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/20/2024] [Indexed: 05/07/2024] Open
Abstract
Background Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia. Methods Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI. Results Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it. Conclusion The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.
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Affiliation(s)
- Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Abebe Kibret Assfaw
- Department of Psychology, Institute of Teachers’ Education and Behavioral Science, Wollo University, Dessie, Ethiopia
| | - Husien Nurahmed Toleha
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Segenet Zewdie
- Department of Pharmacy, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia
| | - Gebeyaw Biset
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | | | - Mesfin Haile Kahissay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Naidoo V, Suleman F, Bangalee V. Roles and reimbursement of pharmacists as South Africa transitions towards Universal Health Coverage (UHC): An online survey-based study. PLoS One 2021; 16:e0257348. [PMID: 34555058 PMCID: PMC8459985 DOI: 10.1371/journal.pone.0257348] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The implementation of Universal Health Coverage in SA has sought to focus on promoting affordable health care services that are accessible to all citizens. In this regard, pharmacists are expected to play a pivotal function in the revitalization of primary health care (PHC) during this transition by the expansion of their practice roles. OBJECTIVES To assess the readiness and perceptions of pharmacists to expand their roles in an integrated health care system. To determine the availability and pricing of primary health care services currently provided within a community pharmacy environment and to evaluate suitable reimbursement for the provision of such services by a community pharmacist. METHODS Community pharmacists' across SA were invited to participate in an online survey-based study. The survey consisted of both open- and closed-ended questions. Descriptive statistics for closed-ended questions were generated and analysed using Microsoft Excel® and Survey Monkey®. Responses for the open-ended questions were transcribed, analysed, and reported as emerging themes. RESULTS Six hundred and sixty-four pharmacists' responded to the online survey. Seventy-five percent of pharmacists' reported that with appropriate training, a transition into a more patient-centered role might be beneficial in the re-engineering of the PHC system. However, in order to adopt these new roles, appropriate reimbursement structures are required. The current fee levied by pharmacists in community pharmacies that offered these PHC services was found to be lower to that recommended by the South African Pharmacy Council; this disparity is primarily due to a lack of information and policy standardisation. Therefore, in order to ensure that fees levied are fair, comprehensive service package guidelines are required. CONCLUSIONS This study provides baseline data for policy makers on pharmacists' readiness to transition into expanded roles. Furthermore, it can be used as a foundation to establish appropriate reimbursement frameworks for pharmacists providing PHC services.
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Affiliation(s)
- Vivian Naidoo
- Discipline of Pharmaceutical Sciences, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
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Keel S, Müller A, Block S, Bourne R, Burton MJ, Chatterji S, He M, Lansingh VC, Mathenge W, Mariotti S, Muirhead D, Rabiu MM, Ravilla TD, Resnikoff S, Silva JC, Tapply I, Vos T, Wang N, Cieza A. Keeping an eye on eye care: monitoring progress towards effective coverage. Lancet Glob Health 2021; 9:e1460-e1464. [PMID: 34237266 PMCID: PMC8440222 DOI: 10.1016/s2214-109x(21)00212-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 12/02/2022]
Abstract
The eye care sector is well positioned to contribute to the advancement of universal health coverage within countries. Given the large unmet need for care associated with cataract and refractive error, coupled with the fact that highly cost-effective interventions exist, we propose that effective cataract surgery coverage (eCSC) and effective refractive error coverage (eREC) serve as ideal indicators to track progress in the uptake and quality of eye care services at the global level, and to monitor progress towards universal health coverage in general. Global targets for 2030 for these two indicators were endorsed by WHO Member States at the 74th World Health Assembly in May, 2021. To develop consensus on the data requirements and methods of calculating eCSC and eREC, WHO convened a series of expert consultations to make recommendations for standardising the definitions and measurement approaches for eCSC and eREC and to identify areas in which future work is required.
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Affiliation(s)
- Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
| | - Andreas Müller
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Rupert Bourne
- Cambridge University Hospitals, Cambridge, UK; Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Moorfields Eye Hospital, London, UK
| | - Somnath Chatterji
- Data and Analytics Department, World Health Organization, Geneva, Switzerland
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China; Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia
| | - Van C Lansingh
- Retina Department, Instituto Mexicano de Oftalmología IAP, Santiago De Querétaro, Querétaro, Mexico; HelpMeSee, New York, NY, USA
| | | | - Silvio Mariotti
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Debbie Muirhead
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; The Fred Hollows Foundation, Melbourne, VIC, Australia
| | - M Mansur Rabiu
- Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia; Brien Holden Vision Institute, Sydney, NSW, Australia; Organisation pour la Prévention de la Cécité, Paris, France
| | - Juan Carlos Silva
- Division of Blindness Prevention, Pan American Health Organization, Bogota, Colombia
| | - Ian Tapply
- Cambridge University Hospitals, Cambridge, UK
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Alarcos Cieza
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Laowahutanon T, Nakamura H, Tachimori H, Nomura S, Liabsuetrakul T, Lim A, Rawdaree P, Suchonwanich N, Yamamoto H, Ishizuka A, Shibuya K, Miyata H, Chongsuvivatwong V. Hospital admission for type 2 diabetes mellitus under the Universal Coverage Scheme in Thailand: A time- and geographical-trend analysis, 2009-2016. PLoS One 2021; 16:e0253434. [PMID: 34197492 PMCID: PMC8248737 DOI: 10.1371/journal.pone.0253434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 06/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Descriptive analyses of 2009-2016 were performed using the data of the Universal Coverage Scheme (UCS) which covers nearly 70 percent of the Thai population. The analyses described the time and geographical trends of nationwide admission rates of type 2 diabetes mellitus (T2DM) and its complications, including chronic kidney disease (CKD), myocardial infarction, cerebrovascular diseases, retinopathy, cataract, and diabetic foot amputation. METHODS AND FINDINGS The database of T2DM patients aged 15-100 years who were admitted between 2009 and 2016 under the UCS and that of the UCS population were retrieved for the analyses. The admitted cases of T2DM were extracted from the database using disease codes of principal and secondary diagnoses defined by the International Classification of Diseases 9th and 10th Revisions. The T2DM admission rates in 2009-2016 were the number of admissions divided by the number of the UCS population. The standardized admission rates (SARs)were further estimated in contrast to the expected number of admissions considering age and sex composition of the UCS population in each region. A linearly increased trend was found in T2DM admission rates from 2009 to 2016. Female admission rates were persistently higher than that of males. In 2016, an increase in the T2DM admission rates was observed among the older ages relative to that in 2009. Although the SARs of T2DM were generally higher in Bangkok and central regions in 2009, except that with CKD and foot amputation which had higher trends in northeastern regions, the geographical inequalities were fairly reduced by 2016. CONCLUSION Admission rates of T2DM and its major complications increased in Thailand from 2009 to 2016. Although the overall geographical inequalities in the SARs of T2DM were reduced in the country, further efforts are required to improve the health system and policies focusing on risk factors and regions to manage the increasing T2DM.
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Affiliation(s)
| | - Haruyo Nakamura
- International Development Center of Japan Inc., Tokyo, Japan
| | - Hisateru Tachimori
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation National Center for Global Health and Medicine, Shinjuku City, Japan
- Endowed Course for Health System Innovation, Keio University School of Medicine, Minato City, Japan
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, Keio University School of Medicine, Minato City, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Apiradee Lim
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University Pattani Campus, Pattani, Thailand
| | - Petch Rawdaree
- Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Netnapis Suchonwanich
- The Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
| | - Hiroyuki Yamamoto
- Department of Health Policy and Management, Keio University School of Medicine, Minato City, Japan
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Japan
| | - Aya Ishizuka
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation National Center for Global Health and Medicine, Shinjuku City, Japan
- Department of Health Policy and Management, Keio University School of Medicine, Minato City, Japan
| | - Kenji Shibuya
- Soma COVID Vaccination Medical Center, Fukushima, Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management, Keio University School of Medicine, Minato City, Japan
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Weaver MR, Nandakumar V, Joffe J, Barber RM, Fullman N, Singh A, Sparks GW, Yearwood J, Lozano R, Murray CJL, Ngo D. Variation in Health Care Access and Quality Among US States and High-Income Countries With Universal Health Insurance Coverage. JAMA Netw Open 2021; 4:e2114730. [PMID: 34181011 PMCID: PMC9434824 DOI: 10.1001/jamanetworkopen.2021.14730] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Based on mortality estimates for 32 causes of death that are amenable to health care, the US health care system did not perform as well as other high-income countries, scoring 88.7 out of 100 on the 2016 age-standardized Healthcare Access and Quality (HAQ) index. OBJECTIVE To compare US age-specific HAQ scores with those of high-income countries with universal health insurance coverage and compare scores among US states with varying insurance coverage. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used 2016 Global Burden of Diseases, Injuries, and Risk Factor study results for cause-specific mortality with adjustments for behavioral and environmental risks to estimate the age-specific HAQ indices. The US national age-specific HAQ scores were compared with high-income peers (Canada, western Europe, high-income Asia Pacific countries, and Australasia) in 1990, 2000, 2010, and 2016, and the 2016 scores among US states were also analyzed. The Public Use Microdata Sample of the American Community Survey was used to estimate insurance coverage and the median income per person by age and state. Age-specific HAQ scores for each state in 2010 and 2016 were regressed based on models with age fixed effects and age interaction with insurance coverage, median income, and year. Data were analyzed from April to July 2018 and July to September 2020. MAIN OUTCOMES AND MEASURES The age-specific HAQ indices were the outcome measures. RESULTS In 1990, US age-specific HAQ scores were similar to peers but increased less from 1990 to 2016 than peer locations for ages 15 years or older. For example, for ages 50 to 54 years, US scores increased from 77.1 to 82.1 while high-income Asia Pacific scores increased from 71.6 to 88.2. In 2016, several states had scores comparable with peers, with large differences in performance across states. For ages 15 years or older, the age-specific HAQ scores were 85 or greater for all ages in 3 states (Connecticut, Massachusetts, and Minnesota) and 75 or less for at least 1 age category in 6 states. In regression analysis estimates with state-fixed effects, insurance coverage coefficients for ages 20 to 24 years were 0.059 (99% CI, 0.006-0.111); 45 to 49 years, 0.088 (99% CI, 0.009-0.167); and 50 to 54 years, 0.101 (99% CI, 0.013-0.189). A 10% increase in insurance coverage was associated with point increases in HAQ scores among the ages of 20 to 24 years (0.59 [99% CI, 0.06-1.11]), 45 to 49 years (0.88 [99% CI, 0.09-1.67]), and 50 to 54 years (1.01 [99% CI, 0.13-1.89]). CONCLUSIONS AND RELEVANCE In this cross-sectional study, the US age-specific HAQ scores for ages 15 to 64 years were low relative to high-income peer locations with universal health insurance coverage. Among US states, insurance coverage was associated with higher HAQ scores for some ages. Further research with causal models and additional explanations is warranted.
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Affiliation(s)
- Marcia R. Weaver
- Departments of Health Metrics Sciences and
Global Health, Institute for Health Metrics and Evaluation, University of
Washington, Seattle
| | - Vishnu Nandakumar
- Institute for Health Metrics and Evaluation,
University of Washington, Seattle
| | - Jonah Joffe
- Institute for Health Metrics and Evaluation,
University of Washington, Seattle
| | - Ryan M. Barber
- Institute for Health Metrics and Evaluation,
University of Washington, Seattle
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation,
University of Washington, Seattle
| | - Arjun Singh
- Institute for Health Metrics and Evaluation,
University of Washington, Seattle
| | - Gianna W. Sparks
- Institute for Health Metrics and Evaluation,
University of Washington, Seattle
| | - Jamal Yearwood
- Institute for Health Metrics and Evaluation,
University of Washington, Seattle
| | - Rafael Lozano
- Departments of Health Metrics Sciences and
Global Health, Institute for Health Metrics and Evaluation, University of
Washington, Seattle
| | - Christopher J. L. Murray
- Departments of Health Metrics Sciences and
Global Health, Institute for Health Metrics and Evaluation, University of
Washington, Seattle
| | - Diana Ngo
- Institute for Health Metrics and Evaluation,
University of Washington, Seattle
- Department of Economics, Occidental College, Los
Angeles, California
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Fan H, Yan Q, Liu S, Cai J, Coyte PC. Childhood Nutrition in Rural China: What Impact Does Public Health Insurance Have? Value Health 2021; 24:317-324. [PMID: 33641764 DOI: 10.1016/j.jval.2020.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/28/2020] [Accepted: 06/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the impact of public health insurance coverage, specifically the New Cooperative Medical Scheme (NCMS), on childhood nutrition in poor rural households in China, and to identify the mechanisms through which health insurance coverage affects nutritional intake. METHODS Longitudinal data on 3291 children were taken from four time periods (2004, 2006, 2009, and 2011) from the China Health and Nutrition Survey (CHNS). Panel data analysis was performed with the fixed-effect model and the propensity score matching with difference-in-differences (PSM-DID) approach. RESULTS The introduction of the NCMS was associated with a decline in calories, fat, and protein intake, and an increase in the intake of carbohydrates. The NCMS had the greatest negative effect on children aged 0 to 5 years, particularly girls. Out-of-pocket medical expenses were identified as the main channel through which the NCMS affected the nutritional intake of children. CONCLUSIONS The study showed that the NCMS neither significantly improved the nutritional status of children nor enhanced intake of high-quality nutrients among rural poor households. These findings were attributed to the way in which health-seeking behavior was modified in the light of NCMS coverage. Specifically, NCMS coverage tended to increase healthcare utilization, which in turn increased out-of-pocket medical expenditures. This encouraged savings to aid financial risk protection and resulted in less disposable income for food consumption.
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Affiliation(s)
- Hongli Fan
- School of Insurance, Shandong University of Finance and Economics, Jinan, Shandong, China
| | - Qingyue Yan
- School of Insurance, Shandong University of Finance and Economics, Jinan, Shandong, China
| | - Suchun Liu
- School of Insurance, Shandong University of Finance and Economics, Jinan, Shandong, China
| | - Jiaoli Cai
- School of Economics and Management, Beijing Jiaotong University, Beijing, China.
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Ifeagwu SC, Yang JC, Parkes-Ratanshi R, Brayne C. Health financing for universal health coverage in Sub-Saharan Africa: a systematic review. Glob Health Res Policy 2021; 6:8. [PMID: 33641673 PMCID: PMC7916997 DOI: 10.1186/s41256-021-00190-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/02/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Universal health coverage (UHC) embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals having access to required health services, of sufficient quality, without suffering financial hardship. Effective strategies for financing healthcare are critical in achieving this goal yet remain a challenge in Sub-Saharan Africa (SSA). This systematic review aims to determine reported health financing mechanisms in SSA within the published literature and summarize potential learnings. METHODS A systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. On 19 to 30 July 2019, MEDLINE, EMBASE, Web of Science, Global Health Database, the Cochrane Library, Scopus and JSTOR were searched for literature published from 2005. Studies describing health financing approaches for UHC in SSA were included. Evidence was synthesised in form of a table and thematic analysis. RESULTS Of all records, 39 papers were selected for inclusion. Among the included studies, most studies were conducted in Kenya (n = 7), followed by SSA as a whole (n = 6) and Nigeria (n = 5). More than two thirds of the selected studies reported the importance of equitable national health insurance schemes for UHC. The results indicate that a majority of health care revenue in SSA is from direct out-of-pocket payments. Another common financing mechanism was donor funding, which was reported by most of the studies. The average quality score of all studies was 81.6%, indicating a high appraisal score. The interrater reliability Cohen's kappa score, κ=0.43 (p = 0.002), which showed a moderate level of agreement. CONCLUSIONS Appropriate health financing strategies that safeguard financial risk protection underpin sustainable health services and the attainment of UHC. It is evident from the review that innovative health financing strategies in SSA are needed. Some limitations of this review include potentially skewed interpretations due to publication bias and a higher frequency of publications included from two countries in SSA. Establishing evidence-based and multi-sectoral strategies tailored to country contexts remains imperative.
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Affiliation(s)
- Susan C. Ifeagwu
- Department of Public Health and Primary Care, Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Justin C. Yang
- Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Rosalind Parkes-Ratanshi
- Department of Public Health and Primary Care, Cambridge Public Health, University of Cambridge, Cambridge, UK
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Public Health, University of Cambridge, Cambridge, UK
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Zhou S, Huang T, Li A, Wang Z. Does universal health insurance coverage reduce unmet healthcare needs in China? Evidence from the National Health Service Survey. Int J Equity Health 2021; 20:43. [PMID: 33478484 PMCID: PMC7819183 DOI: 10.1186/s12939-021-01385-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Received: 09/23/2020] [Accepted: 01/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND China has nearly achieved universal health insurance coverage, but considerable unmet healthcare needs still exist. Although this topic has attracted great attention, there have been few studies examining the relationship between universal health insurance coverage and unmet healthcare needs. This study aimed to clarify the impact of universal health insurance coverage and other associated factors on Chinese residents' unmet healthcare needs. METHODS Data was derived from the fourth, fifth, and sixth National Health Service Survey of Jiangsu Province, which were conducted in 2008, 2013, and 2018, respectively. Descriptive statistics were used to analyze the prevalence of unmet healthcare needs. Binary multivariate logistic regression was used to estimate the association between unmet healthcare needs and universal health insurance coverage, along with other socioeconomic factors. RESULTS 8.99%, 1.37%, 53.37%, and 13.16% of the respondents in Jiangsu Province reported non-use of outpatient services, inpatient services, physical examinations, and early discharge from hospital, respectively. The trend in the prevalence of unmet healthcare needs showed a decline from 2008 to 2018. Health insurance had a significant reducing effect on non-use of outpatient services, inpatient services, or early discharge from hospital. People having health insurance in 2013 and 2018 were significantly less likely to report unmet healthcare needs compared to those in 2008. The effect of health insurance and its universal coverage on reducing unmet healthcare needs was greater in rural than in urban areas. Other socioeconomic factors, such as age, marital status, educational level, income level, or health status, also significantly affected unmet healthcare needs. CONCLUSIONS Universal health insurance coverage has significantly reduced Chinese residents' unmet healthcare needs. Policy efforts should pay more attention to the benefits of health insurances in rural areas and optimize urban-rural health resources to promote effective utilization of healthcare.
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Affiliation(s)
- Shenping Zhou
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166 P.R. China
| | - Tianyu Huang
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166 P.R. China
| | - Anqi Li
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166 P.R. China
| | - Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166 P.R. China
- Creative Health Policy Research Group, Nanjing Medical University, Nanjing, 211166 China
- Center for Global Health, Nanjing Medical University, Nanjing, 211166 China
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Mansour A, Sirichotiratana N, Viwatwongkasem C, Khan M, Srithamrongsawat S. District division administrative disaggregation data framework for monitoring leaving no one behind in the National Health Insurance Fund of Sudan: achieving sustainable development goals in 2030. Int J Equity Health 2021; 20:5. [PMID: 33407542 PMCID: PMC7789368 DOI: 10.1186/s12939-020-01338-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 11/30/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim of this study is to monitor the concept of 'leaving no one behind' in the Sustainable Development Goals (SDGs) to track the implications of the mobilization of health care resources by the National Health Insurance Fund (NHIF) of Sudan. METHODS A cross-sectional study was used to monitor 'leaving no one behind' in NHIF by analyzing the secondary data of the information system for the year 2016. The study categorized the catchment areas of health care centers (HCCS) according to district administrative divisions, which are neighborhood, subdistrict, district, and zero. The District Division Administrative Disaggregation Data (DDADD) framework was developed and investigated with the use of descriptive statistics, maps of Sudan, the Mann-Whitney test, the Kruskal-Wallis test and health equity catchment indicators. SPSS ver. 18 and EndNote X8 were also used. RESULTS The findings show that the NHIF has mobilized HCCs according to coverage of the insured population. This mobilization protected the insured poor in high-coverage insured population districts and left those living in very low-coverage districts behind. The Mann-Whitney test presented a significant median difference in the utilization rate between catchment areas (P value < 0.001). The results showed that the utilization rate of the insured poor who accessed health care centers by neighborhood was higher than that of the insured poor who accessed by more than neighborhood in each state. The Kruskal-Wallis test of the cost of health care services per capita in each catchment area showed a difference (P value < 0.001) in the median between neighborhoods. The cost of health care services in low-coverage insured population districts was higher than that in high-coverage insured population districts. CONCLUSION The DDADD framework identified the inequitable distribution of health care services in low-density population districts leaves insured poor behind. Policymakers should restructure the equation of health insurance schemes based on equity and probability of illness, to distribute health care services according to needs and equity, and to remobilize resources towards districts left behind.
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Affiliation(s)
- Ashraf Mansour
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
| | - Nithat Sirichotiratana
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
| | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Mahmud Khan
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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Assefa Y, Hill PS, Gilks CF, Damme WV, van de Pas R, Woldeyohannes S, Reid S. Global health security and universal health coverage: Understanding convergences and divergences for a synergistic response. PLoS One 2020; 15:e0244555. [PMID: 33378383 PMCID: PMC7773202 DOI: 10.1371/journal.pone.0244555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 12/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Global health security (GHS) and universal health coverage (UHC) are key global health agendas which aspire for a healthier and safer world. However, there are tensions between GHS and UHC strategy and implementation. The objective of this study was to assess the relationship between GHS and UHC using two recent quantitative indices. METHODS We conducted a macro-analysis to determine the presence of relationship between GHS index (GHSI) and UHC index (UHCI). We calculated Pearson's correlation coefficient and the coefficient of determination. Analyses were performed using IBM SPSS Statistics Version 25 with a 95% level of confidence. FINDINGS There is a moderate and significant relationship between GHSI and UHCI (r = 0.662, p<0.001) and individual indices of UHCI (maternal and child health and infectious diseases: r = 0.623 (p<0.001) and 0.594 (p<0.001), respectively). However, there is no relationship between GHSI and the non-communicable diseases (NCDs) index (r = 0.063, p>0.05). The risk of GHS threats a significant and negative correlation with the capacity for GHS (r = -0.604, p<0.001) and the capacity for UHC (r = -0.792, p<0.001). CONCLUSION The aspiration for GHS will not be realized without UHC; hence, the tension between these two global health agendas should be transformed into a synergistic solution. We argue that strengthening the health systems, in tandem with the principles of primary health care, and implementing a "One Health" approach will progressively enable countries to achieve both UHC and GHS towards a healthier and safer world that everyone aspires to live in.
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Affiliation(s)
- Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
| | - Peter S. Hill
- School of Public Health, the University of Queensland, Brisbane, Australia
| | - Charles F. Gilks
- School of Public Health, the University of Queensland, Brisbane, Australia
| | | | | | | | - Simon Reid
- School of Public Health, the University of Queensland, Brisbane, Australia
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Marchildon GP. Social Democratic Solidarity and the Welfare State: Health Care and Single-Tier Universality in Sweden and Canada. Can Bull Med Hist 2020; 38:177-196. [PMID: 32822550 DOI: 10.3138/cbmh.443-052020] [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: 06/11/2023]
Abstract
Although it is not generally done, it is useful to compare the history of the evolution of universal health coverage (UHC) in Canada and Sweden. The majority of citizens in both countries have shared, and continue to share, a commitment to a strong form of single-tier universality in the design of their respective UHC systems. In the postwar era, they also share a remarkably similar timeline in the emergence and entrenchment of single-tier UHC, despite the political and social differences between the two countries. At the same time, UHC was initially designed, implemented, and managed by social democratic governments that held power for long periods of time, creating a path dependency for single-tier Medicare that was difficult for future governments of different ideological persuasions to alter.
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Affiliation(s)
- Gregory P Marchildon
- Gregory P. Marchildon - Dalla Lana School of Public Health/Munk School of Global Affairs and Public Policy, University of Toronto
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Nambiar D, Sankar D. H, Negi J, Nair A, Sadanandan R. Monitoring Universal Health Coverage reforms in primary health care facilities: Creating a framework, selecting and field-testing indicators in Kerala, India. PLoS One 2020; 15:e0236169. [PMID: 32745081 PMCID: PMC7398520 DOI: 10.1371/journal.pone.0236169] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022] Open
Abstract
In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with "no-one left behind" are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram's monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.
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Affiliation(s)
- Devaki Nambiar
- The George Institute for Global Health India, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Karnataka, India
| | - Hari Sankar D.
- The George Institute for Global Health India, New Delhi, India
| | - Jyotsna Negi
- Independent Consultant, Baltimore, MD, United States of America
| | - Arun Nair
- ACCESS Health International Inc, New Delhi, India
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Chaleunvong K, Phoummalaysith B, Phonvixay B, Vonglokham M, Sychareun V, Durham J, Essink D. Factors associated with patient payments exceeding National Health Insurance fees and out-of-pocket payments in Lao PDR. Glob Health Action 2020; 13:1791411. [PMID: 32741345 PMCID: PMC7480633 DOI: 10.1080/16549716.2020.1791411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/09/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Attaining universal health coverage is a target in the Sustainable Development Goals. In Lao PDR, to achieve universal health coverage, the government is implementing a national insurance scheme, initially targeting the informal sector. OBJECTIVE The purpose was to assess: i) the percentage of NHI patients who paid above the scheduled amount, based on individual billing payment; and ii) the factors related to overpayment. METHODS Descriptive cross-sectional study based on a structured questionnaire administered at health facilities in face-to-face interviews with 1,850 patients in six provinces. RESULTS All 1,850 participants worked in the informal sector. Of these, 78.8% of respondents (77.9% of in-patients; 79.5% of out-patients) made co-payments or were exempted from. Factors associated with in-patients paying above the scheduled fee were living in the province and district (OR = 2.8; 95%CI 1.2 to 6.3); not having documents with them (OR = 21.2; 95%CI 5.6 to 80.3); or not having documents (OR: 7.8; 95% CI 2.1 to 28.6). Significant factors associated with additional costs for out-patients were level of facility used at the provincial hospital (OR:1.4; 95% CI 1.1 to 1.9); older age (OR = 2.2; 95%CI 1.5 to 3.1); living in the province and district (OR = 2.3; 95%CI 1.5 to 3.7); living more than 5 km from the facility (OR = 1.4; 95%CI 1.1 to 1.9); buying medicine or supplies outside of the health facility (OR: 5.6; 95% CI 3.1 to 10.2); not bringing documents (OR:9.1; 95% CI 6.1 to 13.5), not having the right documents (OR: 8.9; 95% CI 5.4 to 14.8). CONCLUSIONS A number of patients paid above scheduled fee rates, which may deter people from utilising services when needing them. There is a need for increased understanding of the benefits of the national insurance scheme among patients and healthcare staff.
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Affiliation(s)
- Kongmany Chaleunvong
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | - Bounfeng Phoummalaysith
- Director General of the Lao National Health Insurance, Ministry of Health, Vientiane, Lao PDR
| | - Bouaphat Phonvixay
- Vice Director General of the Lao National Health Insurance, Ministry of Health, Vientiane, Lao PDR
| | | | | | - Jo Durham
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove QLD, Australia
| | - Dirk Essink
- Athena Institute, Faculty Science, VU University Amsterdam, Amsterdam, Netherlands
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Suchman L, Hashim CV, Adu J, Mwachandi R. Seeking care in the context of social health insurance in Kenya and Ghana. BMC Public Health 2020; 20:614. [PMID: 32366310 PMCID: PMC7197151 DOI: 10.1186/s12889-020-08742-1] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/20/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Social Health Insurance (SHI) is widely used by countries attempting to move toward Universal Health Coverage (UHC). While evidence suggests that SHI is a promising strategy for achieving UHC, low-income countries often struggle to implement and sustain SHI systems. It is therefore important to understand how SHI enrollees use health insurance and how it affects their health-seeking behavior. This paper examines how SHI affects patient decision-making regarding when and where to seek care in Kenya and Ghana, two countries with established SHI systems in sub-Saharan Africa. METHODS This paper draws from two datasets collected under the African Health Markets for Equity (AHME) program. One dataset, collected in 2013 and 2017 as part of the AHME qualitative evaluation, consists of 106 semi-structured clinic exit interviews conducted with patients in Ghana and Kenya. This data was analyzed using an inductive, thematic approach. The second dataset was collected internally by the AHME partner organizations. It derives from a cross-sectional survey of social franchise clients at three social franchise networks supported by AHME. Data collection took place from February - May 2018 and in December 2018. RESULTS Many clients appreciated that insurance coverage made healthcare more affordable, reported seeking care more frequently when covered with SHI. Clients also noted that the coverage gave them access to a wider variety of providers, but rarely sought out SHI-accredited providers specifically. However, clients sometimes were charged for services that should have been covered by insurance. Due to a lack of understanding of SHI benefits, clients rarely knew they had been charged inappropriately. CONCLUSIONS Clients and providers would benefit from education on what is included in the SHI package. Providers should be monitored and held accountable for charging clients inappropriately; in Ghana this should be accompanied by reforms to make government financing for SHI sustainable. Since clients valued provider proximity and both Kenya and Ghana have a dearth of providers in rural areas, both countries should incentivize providers to work in these areas and prioritize accrediting rural facilities into SHI schemes to increase accessibility and reach.
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Affiliation(s)
- Lauren Suchman
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
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Abstract
AIMS To examine whether income-related disparities in glycaemic control decline after the age of 65 years, when publicly funded universal drug insurance is acquired in Ontario, Canada. METHODS We conducted a population-based cross-sectional study using linked administrative healthcare databases. Adults with diabetes, aged 40-89 years, with available HbA1c data were included (N = 716 297). Income was based on median neighbourhood household income. Multiple linear regression was used to test for effect modification of age ≥65 years on the relationship between income and HbA1c . RESULTS There was a significant inverse association between income and HbA1c level. After adjusting for baseline factors, the effect of income on HbA1c level was significantly greater for individuals aged <65 years (mean difference HbA1c for lowest vs highest income group +2.5 mmol/mol, 95% CI +2.3 to +2.7 [+0.23%, 95% CI 0.21 to 0.24]) than for those aged ≥65 years (+1.2 mmol/mol, 95% CI +1.0 to +1.3 [+0.11%, 95% CI 0.10 to 0.12]; P < 0.0001 for interaction). CONCLUSIONS Despite universal access to healthcare, people with diabetes with lower incomes had significantly worse glycaemic control compared with their counterparts on higher incomes. However, income gradients in glycaemic control were markedly reduced after the age of 65 years, possibly as a result of access to prescription drug coverage.
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Affiliation(s)
- L Branfield Day
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - P C Austin
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Toronto, ON, Canada
| | - B R Shah
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Marsh AD, Muzigaba M, Diaz T, Requejo J, Jackson D, Chou D, Cresswell JA, Guthold R, Moran AC, Strong KL, Banerjee A, Soucat A. Effective coverage measurement in maternal, newborn, child, and adolescent health and nutrition: progress, future prospects, and implications for quality health systems. Lancet Glob Health 2020; 8:e730-e736. [PMID: 32353320 PMCID: PMC7196884 DOI: 10.1016/s2214-109x(20)30104-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 10/23/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 12/25/2022]
Abstract
Intervention coverage-the proportion of the population with a health-care need who receive care-does not account for intervention quality and potentially overestimates health benefits of services provided to populations. Effective coverage introduces the dimension of quality of care to the measurement of intervention coverage. Many definitions and methodological approaches to measuring effective coverage have been developed, resulting in confusion over definition, calculation, interpretation, and monitoring of these measures. To develop a consensus on the definition and measurement of effective coverage for maternal, newborn, child, and adolescent health and nutrition (MNCAHN), WHO and UNICEF convened a group of experts, the Effective Coverage Think Tank Group, to make recommendations for standardising the definition of effective coverage, measurement approaches for effective coverage, indicators of effective coverage in MNCAHN, and to develop future effective coverage research priorities. Via a series of consultations, the group recommended that effective coverage be defined as the proportion of a population in need of a service that resulted in a positive health outcome from the service. The proposed effective coverage measures and care cascade steps can be applied to further develop effective coverage measures across a broad range of MNCAHN services. Furthermore, advances in measurement of effective coverage could improve monitoring efforts towards the achievement of universal health coverage.
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Affiliation(s)
| | - Moise Muzigaba
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, United Nations Children's Fund, Headquarters, New York, NY, USA
| | - Debra Jackson
- Health Division, United Nations Children's Fund, Headquarters, New York, NY, USA; School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Doris Chou
- Department of Sexual and Reproductive Health and Research including the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Jenny A Cresswell
- Department of Sexual and Reproductive Health and Research including the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Regina Guthold
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Kathleen L Strong
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Agnès Soucat
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
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Assefa Y, Hill PS, Van Damme W, Dean J, Gilks CF. Leaving no one behind: lessons from implementation of policies for universal HIV treatment to universal health coverage. Global Health 2020; 16:17. [PMID: 32093771 PMCID: PMC7038514 DOI: 10.1186/s12992-020-00549-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The third Sustainable Development Goal (SDG - 3) aims to ensure healthy lives and promote well-being for all at all ages. SDG-3 has a specific target on universal health coverage (UHC), which emphasizes the importance of all people and communities having access to quality health services without risking financial hardship. The objective of this study is to review progress towards UHC using antiretroviral treatment (ART) as a case study. METHODS We used a mixed-methods design including qualitative and quantitative approaches. We reviewed and synthesised the evidence on the evolution of the WHO HIV treatment guidelines between 2002 and 2019. We calculated ART coverage over time by gender, age group, and location. We also estimated ART coverage differences and ratios. FINDINGS ART guidelines have evolved from "treating the sickest" to "treating all". ART coverage increased globally from under 7% in 2005 to 62% in 2018. There have been successes in increasing ART coverage in all populations and locations. However, progress varies by population and location in many regions. There is inequity in ART coverage: women (68%) versus men (55%), and adults (62%) versus children (54%). This inequity has widened over time, and with expanded ART eligibility criteria. On the other hand, data from at least one high-burden country (Ethiopia) shows that inequity among regions has narrowed over time due to the improvements in the primary health care systems and implementation of the public health approach in the country. CONCLUSION ART coverage has increased at global, regional and national levels to all population groups. However, the gains have not been equitable among locations and populations. Policies towards universality may widen the inequity in resource-limited settings unless countries take precautions and "put the last first". We argue that primary health care and public health approaches, with multi-sectoral actions and community engagement, are vital to minimize inequity, achieve UHC and leave no one behind.
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Affiliation(s)
- Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
| | - Peter S. Hill
- School of Public Health, the University of Queensland, Brisbane, Australia
| | | | - Judith Dean
- School of Public Health, the University of Queensland, Brisbane, Australia
| | - Charles F. Gilks
- School of Public Health, the University of Queensland, Brisbane, Australia
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Tangcharoensathien V, Mills A, Patcharanarumol W, Witthayapipopsakul W. Universal health coverage: time to deliver on political promises. Bull World Health Organ 2020; 98:78-78A. [PMID: 32015572 PMCID: PMC6986228 DOI: 10.2471/blt.20.250597] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Anne Mills
- London School of Hygiene and Tropical Medicine, University of London, London, England
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Dartanto T, Halimatussadiah A, Rezki JF, Nurhasana R, Siregar CH, Bintara H, Pramono W, Sholihah NK, Yuan EZW, Soeharno R. Why Do Informal Sector Workers Not Pay the Premium Regularly? Evidence from the National Health Insurance System in Indonesia. Appl Health Econ Health Policy 2020; 18:81-96. [PMID: 31535352 DOI: 10.1007/s40258-019-00518-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The challenges of universal health coverage (UHC) in developing countries with a significant proportion of the labor force that works in the informal sector include administrative difficulties in recruiting, registering and collecting regular contributions in a cost-effective way. As most developing countries have a limited fiscal space to support the program in the long run, the fiscal sustainability of UHC, such as that in Indonesia, relies heavily on the contributions of its members. The failure of a large proportion of voluntary enrollees/self-enrolled members/informal sector workers (Peserta Mandiri/Pekerja Bukan Penerima Upah [PBPU] members) to pay their premiums may lead to the National Health Insurance System (NHIS) in Indonesia being unable to effectively deliver its services. OBJECTIVE This study aims at exploring the important factors that affect the compliance behavior of informal sector workers (PBPU members) in regularly paying their insurance premium. This analysis may be a basis for designing effective measures to encourage payment sustainability in informal sector workers in the NHIS. METHOD This study utilizes the survey data collected from three regional offices of the Indonesian Social Security Agency for Health (SSAH), which cover approximately 1210 PBPU members, to understand the relationship between members' characteristics and their compliance behavior regarding the premium payment. We applied an econometric analysis of a logit regression to statistically estimate which factors most affect their compliance behavior in paying the insurance premium. RESULTS This study reveals that almost 28% of PBPU members do not pay their insurance premiums in a sustainable way. Our logistic regression statistically confirms that the number of household members, financial hardship, membership in other social protection arrangements, and the utilization of health services are negatively correlated with the compliance rate of informal sector workers in paying their insurance premium. For instance, people who experience financial hardship tend to have a 7.7 percentage point lower probability of routinely paying the premium. In contrast, households that work in agricultural sectors and have income stability, the cost of inpatient care incurred before joining the NHIS, a comprehensive knowledge of the SSAH's services, and the availability of health professionals are all positively correlated with regular premium payment. CONCLUSION Although there is no single policy that can ensure that informal sector workers (PBPU members) regularly pay their premiums, this study recommends some policy interventions, including (1) flexibility in applying for a government subsidy for premiums (Penerima Bantuan Iuran [PBI]), especially for people who have financial hardship; (2) an intensive promotion of insurance literacy; (3) expanding the quantity and quality of healthcare services; and (4) tailor-made policies for ensuring the sustainability of premium payments for each regional division.
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Affiliation(s)
- Teguh Dartanto
- Department of Economics, Faculty of Economics and Business, Universitas Indonesia, West Java, Indonesia.
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Jakarta, Indonesia.
| | - Alin Halimatussadiah
- Department of Economics, Faculty of Economics and Business, Universitas Indonesia, West Java, Indonesia
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Jakarta, Indonesia
| | - Jahen Fachrul Rezki
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Jakarta, Indonesia
- Department of Economics, University of York, York, UK
| | - Renny Nurhasana
- Urban Studies Program, School of Strategic and Global Studies, Universitas Indonesia, Jakarta, Indonesia
| | - Chairina Hanum Siregar
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Jakarta, Indonesia
| | - Hamdan Bintara
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Jakarta, Indonesia
| | - Wahyu Pramono
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Jakarta, Indonesia
| | - Nia Kurnia Sholihah
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Jakarta, Indonesia
| | - Edith Zheng Wen Yuan
- Department of Economics, Faculty of Economics and Business, Universitas Indonesia, West Java, Indonesia
| | - Rooswanti Soeharno
- Former Staff of ADB Indonesia Resident Mission, and Health Specialist at UNICEF Indonesia, Jakarta, Indonesia
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Yan LD, Hanvoravongchai P, Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Neelapaichit N, Stokes AC. Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand. PLoS One 2020; 15:e0226286. [PMID: 31940366 PMCID: PMC6961827 DOI: 10.1371/journal.pone.0226286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/22/2019] [Indexed: 12/31/2022] Open
Abstract
Background Diabetes is a growing challenge in Thailand. Data to assess health system response to diabetes is scarce. We assessed what factors influence diabetes care cascade retention, under universal health coverage. Methods We conducted a cross-sectional analysis of the 2014 Thai National Health Examination Survey. Diabetes was defined as fasting plasma glucose ≥126mg/dL or on treatment. National and regional care cascades were constructed across screening, diagnosis, treatment, and control. Unmet need was defined as the total loss across cascade levels. Logistic regression was used to examine the demographic and healthcare factors associated with cascade attrition. Findings We included 15,663 individuals. Among Thai adults aged 20+ with diabetes, 67.0% (95% CI 60.9% to 73.1%) were screened, 34.0% (95% CI 30.6% to 37.2%) were diagnosed, 33.3% (95% CI 29.9% to 36.7%) were treated, and 26.0% (95% CI 22.9% to 29.1%) were controlled. Total unmet need was 74.0% (95% CI 70.9% to 77.1%), with regional variation ranging from 58.4% (95% CI 45.0% to 71.8%) in South to 78.0% (95% CI 73.0% to 83.0%) in Northeast. Multivariable models indicated older age (OR 1.76), males (OR 0.65), and a higher density of medical staff (OR 2.40) and health centers (OR 1.58) were significantly associated with being diagnosed among people with diabetes. Older age (OR 1.80) and higher geographical density of medical staff (OR 1.82) and health centers (OR 1.56) were significantly associated with being controlled. Conclusions Substantial attrition in the diabetes care continuum was observed at diabetes screening and diagnosis, related to both individual and health system factors. Even with universal health insurance, Thailand still needs effective behavioral and structural interventions, especially in primary health care settings, to address unmet need in diabetes care for its population.
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Affiliation(s)
- Lily D. Yan
- Internal Medicine, Boston Medical Center, Boston, MA, United States of America
| | | | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwat Chariyalertsak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Nareemarn Neelapaichit
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Thailand Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Andrew C. Stokes
- Global Health, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
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Paudel DR. Factors Affecting Enrollment in Government Health Insurance Program in Kailali District. J Nepal Health Res Counc 2019; 17:388-393. [PMID: 31735937 DOI: 10.33314/jnhrc.v17i3.2026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/03/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Health care financial burden on households is high in Nepal. High health care expenditure is a major obstacle in achieving universal health coverage. The health insurance is expected to reduce healthcare expenditure. However, only small segments of the population are covered by health insurance in Nepal.This study assessed the factors affecting enrollment in government health insurance program in the first piloted district, Kailali, Nepal. METHODS A cross-sectional survey was conducted among 1048 households located in 26 wards of Kailali district after 21 months of the implementation of social health insurance program, Nepal. The sample was selected in two stages, first stage being the selection of wards and second, being the households. RESULTS The higher level of household economic status was associated with increased odds of enrollment in health insurance program (ORs=4.99, 5.04, 5.13, 8.05, for second, third, fourth, and the highest quintile of households, respectively). A higher level of head's education was associated with increased odds of health insurance enrollment (ORs = 1.58, 1.78, 2.36, for primary, secondary, tertiary education, respectively). Presence of chronic illness in the household was positively associated with increased odds of health insurance enrollment (OR= 1.29). CONCLUSIONS The poor and low educated groups were less benefited by social health insurance program in Kailali district, Nepal. Hence, policymakers should focus to implement income-based premium scheme for ensuring equal access to healthcare.Since household with chronic illness leads to high odds of being enrolled, a compulsory health insurance scheme can make the program financially sustainable.
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Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PLoS One 2019; 14:e0219731. [PMID: 31461458 PMCID: PMC6713352 DOI: 10.1371/journal.pone.0219731] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Expanding public health insurance seeks to attain several desirable objectives, including increasing access to healthcare services, reducing the risk of catastrophic healthcare expenditures, and improving health outcomes. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years. METHODS We reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. No language restrictions were applied. Our focus was on both randomised and observational studies, particularly those including explicitly attempts to tackle selection bias in estimating the treatment effect of health insurance. The main outcomes are: (1) utilisation of health services, (2) financial protection for the target population, and (3) changes in health status. FINDINGS 8755 abstracts and 118 full-text articles were assessed. Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. Overall, health insurance schemes in low- and middle-income countries (LMICs) have been found to improve access to health care as measured by increased utilisation of health care facilities (32 out of 40 studies). There also appeared to be a favourable effect on financial protection (26 out of 46 studies), although several studies indicated otherwise. There is moderate evidence that health insurance schemes improve the health of the insured (9 out of 12 studies). INTERPRETATION Increased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage.
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Affiliation(s)
- Darius Erlangga
- Department of Health Sciences, University of York, York, England, United Kingdom
| | - Marc Suhrcke
- Centre of Health Economics, University of York, York, England, United Kingdom
- Luxembourg Institute of Socio-economic Research (LISER), Luxembourg
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, England, United Kingdom
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Karen Bloor
- Department of Health Sciences, University of York, York, England, United Kingdom
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Tsai TH, Huang N, Lin IF, Chou YJ. Variation in the 11-year trajectories of medical care seeking behaviors in diabetes patients under a single payer system: persisting gaps to be filled. BMC Health Serv Res 2019; 19:580. [PMID: 31426781 PMCID: PMC6699076 DOI: 10.1186/s12913-019-4399-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care-seeking behavior is widely acknowledged to have strong influences on health outcomes among individuals with chronic conditions including diabetes. Despite its dynamic nature, care seeking behavior are often considered as time invariant in most studies. The likelihood of patients changing their regularity and source of chronic care over time is often neglected. This study aimed to determine the long-term trajectories of care-seeking patterns of both care-seeking regularity and health provider choices; and their associated factors among patients with type 2 diabetes under the National Health Insurance (NHI) program in Taiwan. METHODS We utilized population-based data from the National Health Insurance Research Database (NHIRD) in Taiwan. Three thousand, nine hundred and eighty-seven adult patients with newly diagnosed type 2 diabetes in 1999 were enrolled in the cohort. We assessed their trajectories of regular care visits and sources of diabetes care from 2000 to 2010. A group-based trajectory model was applied. RESULTS Seven distinct groups of long-term care-seeking patterns were identified. Only 51.44% of patients with newly diagnosed diabetes had regularly visited their providers over time. Among them, 56.41 and 16.09% had persistently sought care from generalized and specialized providers, respectively. 27.50% had sought care from different levels of providers. Patients who were male, elderly, low-income, and had a higher baseline diabetes severity were significantly more likely to either continue with their irregular care-seeking behavior or fail to maintain their regular care seeking behavior over time. Those who were younger, had a higher socioeconomic status, and lived in an urban area were significantly more likely to persistently seek care from specialized care settings. CONCLUSIONS This study is the first population-based assessment of long-term care-seeking behaviors of type 2 diabetes patients under a single-payer system with a comprehensive benefit coverage. The most alarming finding was that, despite the existence of the comprehensive universal health insurance coverage in Taiwan, almost 50% of patients did not seek or maintain regular visits to providers over time as recommended. Understanding variations in the long-term trajectories of care adherence and sources of care may help to identify gaps in diabetes care management.
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Affiliation(s)
- Tzu-Ho Tsai
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
- Department of Intensive Care, Cheng-Hsin Hospital, No. 45, Cheng Hsin Street, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
| | - I-Feng Lin
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
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Phimha S, Promthet S, Suwanrungruang K, Chindaprasirt J, Bouphan P, Santong C, Vatanasapt P. Health Insurance and Colorectal Cancer Survival in Khon Kaen, Thailand. Asian Pac J Cancer Prev 2019; 20:1797-1802. [PMID: 31244302 PMCID: PMC7021590 DOI: 10.31557/apjcp.2019.20.6.1797] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/04/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Evidence from healthcare studies demonstrates that patients’ health insurance affects service accessibility and the outcome of treatment. However, assessment on how colorectal cancer survival relates to health insurance is limited. Objective: The study examined the association between health insurance and colorectal cancer survival in Khon Kaen, Thailand. Methods: The retrospective cohort study was conducted with 1,931 colorectal cancer patients from Khon Kaen cancer registry between January 1, 2003 and December 31, 2012, and was followed-up until December 31, 2015. Relative survival was used to estimate the survival rate. Cox proportional hazard regression was used to estimate the relationship between health insurance and colorectal cancer survival, represented with the hazard ratio. Result: Most of the participants were males, and the median age was 62 years. The median survival time was 2.25 years (95% CI: 2.00-2.51). The five-year observed survival rate and relative survival rate were 36.87 (95% CI: 34.66-39.08) and, 42.28 (95% CI: 39.75-44.81), respectively. The factors that showed significant associations with poorer survival after adjustment for gender and age were non-surgical treatments (HRadj=1.88;95%CI=1.45-2.45), advanced stage (III+IV) (HRadj=2.50; 95%CI=2.00-3.12), histological grading in poorly differentiated (HRadj=1.84; 95%CI=1.32-2.56), and Universal Coverage Scheme (HRadj=1.37;95%CI=1.09-1.72). Conclusion: The survival of colorectal cancer patients in the Universal Coverage Scheme was likely to be poorer than in the Civil Servant Medical Benefit Scheme. This indicates an urgent need for a national program for colorectal cancer screening in the general population and access to health insurance.
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Affiliation(s)
- Surachai Phimha
- Doctor of Philosophy Program in Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
- ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Supannee Promthet
- ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Krittika Suwanrungruang
- ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Khon Kaen, Thailand.
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Jarin Chindaprasirt
- Division of Oncology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Prachak Bouphan
- Department of Public Health Administration Health Promotion Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Chalongpon Santong
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Patravoot Vatanasapt
- ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Khon Kaen, Thailand.
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Khan JAM, Ahmed S, Chen T, Tomeny EM, Niessen LW. A Transparent Universal Health Coverage Index with Decomposition by Socioeconomic Groups: Application in Asian and African Settings. Appl Health Econ Health Policy 2019; 17:399-410. [PMID: 30880358 DOI: 10.1007/s40258-019-00464-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Health and wellbeing as one of the Sustainable Development Goals requires all countries to achieve Universal Health Coverage (UHC). That is, all people must have access to healthcare when needed at an affordable price. While several indices were developed recently to assess UHC status, these indices appeared to be difficult for practitioners to apply without statistical knowledge. OBJECTIVE This paper presents a transparent and step-by-step practical calculation method of such an index using Excel spreadsheets, applied to some Asian and African countries. We also decompose the contribution of socioeconomic groups to UHC index values. METHODS We utilized the well known UHC illustration (three-dimensional box, showing population coverage, service coverage and financial protection) to calculate the UHC index. We also broke down the index into socioeconomic groups. For validation, correlation coefficients between our index and other UHC indices were calculated and the relationship of our index with out-of-pocket (OOP) payments was estimated. RESULTS World Bank data from six Asian and 15 African countries on health-service coverage of people in five socioeconomic quintiles with financial protection were used to calculate our UHC index. Among the Asian countries, indices ranged between 26.0% (Nepal) and 58.7% (Kazakhstan), while in African countries indices ranged between 8.9% (Chad) and 55.3% (Namibia). Decomposition of the UHC index showed a higher contribution to the index by richer socioeconomic groups. The correlation coefficients between our estimated UHC index values and those of others ranged between 0.774 and 0.900. Our index reduced by 1.4% in response to a 1% increase in OOP payments. CONCLUSIONS This spreadsheet approach for calculating the UHC index appeared to be useful, where the interrelation of UHC dimensions was easily observed. Decomposition of the index could be useful for policy-makers to identify the subpopulations and health services with need for further interventions towards UHC achievement.
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Affiliation(s)
- Jahangir A M Khan
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna Campus, 171 77, Stockholm, Sweden.
- James P Grant School of Public Health, Brac University, 68, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Sayem Ahmed
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna Campus, 171 77, Stockholm, Sweden
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tao Chen
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Ewan M Tomeny
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Louis W Niessen
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Department of International Health, Johns Hopkins SPH, Baltimore, MD, USA
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Abstract
The USA is home to more immigrants than any other country-about 46 million, just less than a fifth of the world's immigrants. Immigrant health and access to health care in the USA varies widely by ethnicity, citizenship, and legal status. In recent decades, several policy and regulatory changes have worsened health-care quality and access for immigrant populations. These changes include restrictions on access to public health insurance programmes, rhetoric discouraging the use of social services, aggressive immigration enforcement activities, intimidation within health-care settings, decreased caps on the number of admitted refugees, and rescission of protections from deportation. A receding of ethical norms has created an environment favourable for moral and public health crises, as evident in the separation of children from their parents at the southern US border. Given the polarising immigration rhetoric at the national level, individual states rather than the country as a whole might be better positioned to address the barriers to improved health and health care for immigrants in the USA.
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Affiliation(s)
- Dhruv Khullar
- Department of Healthcare Policy and Research and Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Dave A Chokshi
- New York City Health and Hospitals Corporation, New York, NY, USA; Departments of Population Health and Medicine, New York University Langone Health, New York, NY, USA
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Zhang C, Rahman MS, Rahman MM, Yawson AE, Shibuya K. Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study. PLoS One 2019; 14:e0209126. [PMID: 31116754 PMCID: PMC6530887 DOI: 10.1371/journal.pone.0209126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/30/2019] [Indexed: 11/18/2022] Open
Abstract
Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators in Ghana from 1995 to 2015 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analyses estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, we calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for the prevention services, the same cannot be applied to the treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9-3.5) and 0.4% (95%CrI: 0.2-0.8), respectively. These are projected to reduce to 0.4% (95% CrI: 0.1-1.3) and 0.2% (0.0-0.5) respectively by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection over the years. However, inequalities across wealth quintiles and regions continue to be cause of concerns. Further efforts are needed to narrow these gaps.
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Affiliation(s)
- Cherri Zhang
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Md. Shafiur Rahman
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Md. Mizanur Rahman
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Alfred E. Yawson
- Department of Community Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Kenji Shibuya
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- University Institute for Population Health, King’s College London, London, United Kingdom
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Bourgeois S, Mulkay JP, Lasser L, Robaeys G, Bastens B, Delwaide J, Pollet S, Van den Enden M. A multicentre, observational study on demographic and disease characteristics of patients seeking care for chronic hepatitis C in Belgium in 2016. Acta Gastroenterol Belg 2019; 82:43-52. [PMID: 30888753] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND STUDY AIMS Direct-acting antivirals provide interferon-free treatments for chronic hepatitis C (CHC) virus infection. In Belgium, in 2016, access to these agents was limited to patients with advanced liver fibrosis stages F3 and F4. This study is the first to describe Belgium's patient population ineligible for interferon-free treatment. PATIENTS AND METHODS This was an observational, cross-sectional, multicentre study that enrolled adult patients with CHC ineligible for interferon-free treatment. Patient data recorded at a single visit included demographic data, disease characteristics, comorbidities, co-medications, treatment status, and laboratory data. RESULTS Three hundred and three patients from 16 centres in Belgium were included in the statistical analysis. On average, patients were aged 53.5 years and 50.2% were women ; 94.1% had health insurance and 99.0% resided in Belgium. The current hepatitis C virus (HCV) infection was the first infection for 96.0% of patients and the mean time since infection was 20.0 years. Liver fibrosis stage was F0 for 23.7%, F0/F1 or F1 for 38.3%, F1/F2 or F2 for 25.8%, F3 for 7.1%, and F4 for 5.1% of patients ; 28.4% of patients were CHC treatment-experienced. The main reason for ineligibility for interferon-free treatment was lack of reimbursement (84.8%). Other reasons included no treatment urgency or medical decision to wait (27.1%), waiting for future treatment option (8.3%), and no social insurance coverage (3.6%). CONCLUSIONS This study provides recent data on the CHC patient population and disease characteristics in Belgium that could help medical communities and government agencies manage CHC disease burden.
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Affiliation(s)
| | | | | | - G Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
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Kuper H, Mactaggart I, Dionicio C, Cañas R, Naber J, Polack S. Can we achieve universal health coverage without a focus on disability? Results from a national case-control study in Guatemala. PLoS One 2018; 13:e0209774. [PMID: 30589885 PMCID: PMC6307777 DOI: 10.1371/journal.pone.0209774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/11/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To compare access to healthcare services for people with disabilities to those without disabilities, within a national case-control study in Guatemala. METHODS We undertook a population-based case-control study, nested within a national survey in Guatemala. Cases with disabilities were people with self-reported difficulties in functioning. One control without disabilities was selected per case, matched by age, gender and cluster. Information was collected on: health status, access to health services and rehabilitation, and socioeconomic status. RESULTS The study included 707 people with disabilities, and 465 controls. People with disabilities were more likely to report a serious health problem (aOR 2.8, 2.2-3.7) or doctor-diagnosis of one of 17 general health conditions (aOR 2.9, 2.2-3.8) as compared to controls without disabilities. People with disabilities were twice as likely as controls to have received treatment for a diagnosed condition (aOR 2.2, 1.7-2.8). Coverage of treatment for impairment-related health conditions was low, as was awareness and access to rehabilitation services. People with disabilities were more likely than controls to report being disrespected (aOR 1.9, 1.0-3.7) or finding it difficult to understand information given (aOR 1.6, 1.1-1.4). CONCLUSION Efforts are needed to raise awareness about rehabilitation services and improve quality of health services for people with disabilities in Guatemala, to ensure that their rights are fulfilled and to assist in the achievement of Universal Health Coverage. Better tools are needed to measure healthcare access, including consideration of geographic access, quality and affordability, to allow the generation of comparable data on access to healthcare among people with disabilities.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Rafael Cañas
- National Council on Disability, Guatemala City, Guatemala
| | - Jonathan Naber
- National Council on Disability, Guatemala City, Guatemala
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Kruk ME, Gage AD, Joseph NT, Danaei G, García-Saisó S, Salomon JA. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet 2018; 392:2203-2212. [PMID: 30195398 PMCID: PMC6238021 DOI: 10.1016/s0140-6736(18)31668-4] [Citation(s) in RCA: 435] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/28/2018] [Accepted: 07/17/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Universal health coverage has been proposed as a strategy to improve health in low-income and middle-income countries (LMICs). However, this is contingent on the provision of good-quality health care. We estimate the excess mortality for conditions targeted in the Sustainable Development Goals (SDG) that are amenable to health care and the portion of this excess mortality due to poor-quality care in 137 LMICs, in which excess mortality refers to deaths that could have been averted in settings with strong health systems. METHODS Using data from the 2016 Global Burden of Disease study, we calculated mortality amenable to personal health care for 61 SDG conditions by comparing case fatality between each LMIC with corresponding numbers from 23 high-income reference countries with strong health systems. We used data on health-care utilisation from population surveys to separately estimate the portion of amenable mortality attributable to non-utilisation of health care versus that attributable to receipt of poor-quality care. FINDINGS 15·6 million excess deaths from 61 conditions occurred in LMICs in 2016. After excluding deaths that could be prevented through public health measures, 8·6 million excess deaths were amenable to health care of which 5·0 million were estimated to be due to receipt of poor-quality care and 3·6 million were due to non-utilisation of health care. Poor quality of health care was a major driver of excess mortality across conditions, from cardiovascular disease and injuries to neonatal and communicable disorders. INTERPRETATION Universal health coverage for SDG conditions could avert 8·6 million deaths per year but only if expansion of service coverage is accompanied by investments into high-quality health systems. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Anna D Gage
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Naima T Joseph
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Joshua A Salomon
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
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Kuo FC, Chang CJ, Bell KL, Lee MS, Wang JW. No Difference in Morbidity and Mortality After Total Joint Arthroplasty in Liver Transplant Recipients: A Propensity Score-Matched Analysis of a Nationwide, Population-Based Study Using Universal Healthcare Data. J Arthroplasty 2018; 33:3147-3152.e1. [PMID: 29941381 DOI: 10.1016/j.arth.2018.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/25/2018] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Controversy remains regarding the outcomes after total joint arthroplasty (TJA) among patients with or without liver transplantation (LT). This study aimed at investigating the prevalence of TJA in patients after LT and comparing the morbidity and mortality with the non-LT group. METHODS We conducted a nationwide, population-based study, with data extracted from a universal health insurance database, based on the International Classification of Disease, Ninth Revision, Clinical Modification. Patients who underwent TJAs between January 2001 and December 2014 were included. Patients who had bilateral TJAs or a TJA before LT were excluded. A total of 43 patients with LT and 350,337 patients without LT were included. The analysis was implemented using data from all patients and those matched by 1-to-10 propensity score matching. Multivariable logistic regression was used to control confounding variables. RESULTS The prevalence of patients undergoing TJA after LT was 1.3% (43/3276). After propensity score matching, patients with LT were not associated with 30-day complications (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.93-1.03; P = .35), 30-day readmission rates (aOR, 0.93; 95% CI, 0.92-1.08; P = .87), 90-day complication rates (aOR, 0.95; 95% CI, 0.88-1.02; P = .16), 1-year infection rates (aOR, 1.04; 95% CI, 0.96-1.12; P = .35), reoperation rates (aOR, 1.06; 95% CI, 0.92-1.23; P = .41), or mortality (aOR, 0.91; 95% CI, 0.80-1.04; P = .18). CONCLUSION The morbidity and mortality seem to be comparable whether TJA is performed in patients with or without LT. Methods for risk assessment would be feasible in liver transplant recipients.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Comorbidity
- Databases, Factual
- Female
- Humans
- Liver Diseases/epidemiology
- Liver Diseases/surgery
- Liver Transplantation/statistics & numerical data
- Male
- Middle Aged
- Morbidity
- Prevalence
- Propensity Score
- Risk Assessment
- Taiwan/epidemiology
- Universal Health Insurance/statistics & numerical data
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Affiliation(s)
- Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan; Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kerri L Bell
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Jun-Wen Wang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
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Andrade MV, Coelho AQ, Xavier Neto M, de Carvalho LR, Atun R, Castro MC. Transition to universal primary health care coverage in Brazil: Analysis of uptake and expansion patterns of Brazil's Family Health Strategy (1998-2012). PLoS One 2018; 13:e0201723. [PMID: 30096201 PMCID: PMC6086633 DOI: 10.1371/journal.pone.0201723] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 07/20/2018] [Indexed: 11/19/2022] Open
Abstract
Family Health Strategy, the primary health care program in Brazil, has been scaled up throughout the country, but its expansion has been heterogeneous across municipalities. We investigate if there are unique municipal characteristics that can explain the timing of uptake and the pattern of expansion of the Family Health Strategy from years 1998 to 2012. We categorized municipalities in six groups based on the relative speed of the Family Health Strategy uptake and the pattern of Family Health Strategy coverage expansion. We assembled data for 11 indicators for years 2000 and 2010, for 5,507 municipalities, and assessed differences in indicators across the six groups, which we mapped to examine spatial heterogeneities. Important factors differentiating early and late adopters of the Family Health Strategy were supply of doctors and population density. Sustained coverage expansion was related mainly to population size, marginal benefits of the program and doctors’ supply. The uptake was widespread nationwide with no distinct patterns among regions, but highly heterogeneous at the state and municipal level. The Brazilian experience of expanding primary health care offers three lessons in relation to factors influencing diffusion of primary health care. First, the funding mechanism is critical for program implementation, and must be accompanied by ways to support the supply of primary care physicians in low density areas. Second, in more developed and bigger areas the main challenge is lack of incentives to pursue universal coverage, especially due to the availability of private insurance. Third, population size is a crucial element to guarantee coverage sustainability over time.
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Affiliation(s)
- Monica Viegas Andrade
- Center for Development and Regional Planning, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Augusto Quaresma Coelho
- Faculty of Medical Sciences, University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mauro Xavier Neto
- Faculty of Medical Sciences, University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lucas Resende de Carvalho
- Center for Development and Regional Planning, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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Chandoevwit W, Phatchana P. Inpatient care expenditure of the elderly with chronic diseases who use public health insurance: Disparity in their last year of life. Soc Sci Med 2018; 207:64-70. [PMID: 29730551 DOI: 10.1016/j.socscimed.2018.04.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/14/2016] [Revised: 04/09/2018] [Accepted: 04/24/2018] [Indexed: 11/18/2022]
Abstract
The Thai elderly are eligible for the Civil Servant Medical Benefit Scheme (CS) or Universal Coverage Scheme (UCS) depending on their pre-retirement or their children work status. This study aimed to investigate the disparity in inpatient care expenditures in the last year of life among Thai elderly individuals who used the two public health insurance schemes. Using death registration and inpatient administrative data from 2007 to 2011, our subpopulation group included the elderly with four chronic disease groups: diabetes mellitus, hypertension and cardiovascular disease, heart disease, and cancer. Among 1,242,150 elderly decedents, about 40% of them had at least one of the four chronic disease conditions and were hospitalized in their last year of life. The results showed that the means of inpatient care expenditures in the last year of life paid by CS and UCS per decedent were 99,672 Thai Baht and 52,472 Thai Baht, respectively. On average, UCS used higher healthcare resources by diagnosis-related group relative weight measure per decedent compared with CS. In all cases, the rates of payment for inpatient treatment per diagnosis-related group adjusted relative weight were higher for CS than UCS. This study found that the disparities in inpatient care expenditures in the last year of life stemmed mainly from the difference in payment rates. To mitigate this disparity, unified payment rates for various types of treatment that reflect costs of hospital care across insurance schemes were recommended.
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Affiliation(s)
- Worawan Chandoevwit
- Faculty of Economics, Khon Kaen University, 123 Mitraphab Rd., Muang, Khon Kaen, 40002, Thailand.
| | - Phasith Phatchana
- Thailand Development Research Institute, 565 Ramkhamhaeng Rd. Soi 39, Bangkok, 10310, Thailand.
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Ahmed S, Szabo S, Nilsen K. Catastrophic healthcare expenditure and impoverishment in tropical deltas: evidence from the Mekong Delta region. Int J Equity Health 2018; 17:53. [PMID: 29703209 PMCID: PMC5924496 DOI: 10.1186/s12939-018-0757-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Received: 06/06/2017] [Accepted: 04/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Universal health coverage implies that people obtain the health services they need without experiencing financial hardship. While the factors contributing to catastrophic health expenditure (CHE) among households are well understood, few studies have examined this relationship in the context of environmentally vulnerable regions, such as tropical deltas. This study aims to examine the disparities in the prevalence of CHE and impoverishment due to out-of-pocket (OOP) healthcare payments in the Mekong Delta in comparison with rest of Vietnam. It also intends to investigate the associations between economic and environmental shocks, CHE and the impoverishment from healthcare payments. METHODS Using data from the Vietnam Household Living Standards Survey 2012, the prevalence of CHE was estimated from the fraction of healthcare costs in relation to household consumption expenditure. The poverty headcount was estimated using the total household consumption expenditure considering both with and without OOP expenditure for healthcare in comparison with the national poverty-line. Simple and multiple logistic regression models were used to examine the associations between geography, health systems, environmental and demographic variables and OOP healthcare expenditure related CHE, and impoverishment respectively. RESULTS Both the level of OOP household healthcare expenditure and the proportion of households suffering from impoverishment as the result of such payments were higher in the Mekong Delta region compared to rest of Vietnam. Although the results from the multiple regression analysis showed that households in the Mekong Delta region were significantly less likely to suffer from CHE, they were significantly more likely to be impoverished due to OOP healthcare expenditure. While health insurance membership did not have a significant effect on either outcomes, households that faced an economic or an environmental shock in past 5 years were considerably more likely to suffer from CHE and impoverishment from OOP healthcare payments. CONCLUSIONS The findings suggest that the financial protection capacity of health insurance schemes in Vietnam should be improved and expanded to reduce impoverishment as the result of OOP healthcare payments, particularly in the Mekong Delta region. Additional investments in disaster preparedness strategies can further help to reduce the financial burden of households in this environmentally vulnerable region.
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Affiliation(s)
- Sayem Ahmed
- Health Economics and Financing Research Group, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Sylvia Szabo
- Department of Development and Sustainability, Asian Institute of Technology, Bangkok, Thailand
- Centre for Population Change, University of Southampton, Southampton, UK
| | - Kristine Nilsen
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
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Countdown to 2030 Collaboration. Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health. Lancet 2018; 391:1538-48. [PMID: 29395268 DOI: 10.1016/S0140-6736(18)30104-1] [Citation(s) in RCA: 259] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 01/04/2023]
Abstract
Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH.
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Goudge J, Alaba OA, Govender V, Harris B, Nxumalo N, Chersich MF. Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme. Int J Equity Health 2018; 17:1. [PMID: 29301537 PMCID: PMC5755208 DOI: 10.1186/s12939-017-0710-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 12/14/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for government employees in 2005 with the aim of improving access to care and extending health coverage. In this paper we ask whether the new scheme has assisted in efforts to move towards UHC. METHODS Using a cross-sectional survey across four of South Africa's nine provinces, we interviewed 1329 government employees, from the education and health sectors. Data were collected on socio-demographics, insurance coverage, health status and utilisation of health care. Multivariate logistic regression was used to determine if service utilisation was associated with insurance status. RESULTS A quarter of respondents remained uninsured, even higher among 20-29 year olds (46%) and lower-skilled employees (58%). In multivariate analysis, the odds of an outpatient visit and hospital admission for the uninsured was 0.3 fold that of the insured. Cross-subsidisation within the scheme has provided lower-paid civil servants with improved access to outpatient care at private facilities and chronic medication, where their outpatient (0.54 visits/month) and inpatient utilisation (10.1%/year) approximates that of the overall population (29.4/month and 12.2% respectively). The scheme, however, generated inequities in utilisation among its members due to its differential benefit packages, with, for example, those with the most benefits having 1.0 outpatient visits/month compared to 0.6/month with lowest benefits. CONCLUSIONS By introducing the scheme, the government chose to prioritise access to private sector care for government employees, over improving the availability and quality of public sector services available to all. Government has recently regained its focus on achieving UHC through the public system, but is unlikely to discontinue GEMS, which is now firmly established. The inequities generated by the scheme have thus been institutionalised within the country's financing system, and warrant attention. Raising scheme uptake and reducing differentials between benefit packages will ameliorate inequities within civil servants, but not across the country as a whole.
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Affiliation(s)
- Jane Goudge
- Centre for Health Policy/MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Olufunke A. Alaba
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Veloshnee Govender
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Harris
- Centre for Health Policy/MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nonhlanhla Nxumalo
- Centre for Health Policy/MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew F. Chersich
- Centre for Health Policy/MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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He AJ, Wu S. Towards Universal Health Coverage via Social Health Insurance in China: Systemic Fragmentation, Reform Imperatives, and Policy Alternatives. Appl Health Econ Health Policy 2017; 15:707-716. [PMID: 27333794 DOI: 10.1007/s40258-016-0254-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
China's remarkable progress in building a comprehensive social health insurance (SHI) system was swift and impressive. Yet the country's decentralized and incremental approach towards universal coverage has created a fragmented SHI system under which a series of structural deficiencies have emerged with negative impacts. First, contingent on local conditions and financing capacity, benefit packages vary considerably across schemes, leading to systematic inequity. Second, the existence of multiple schemes, complicated by massive migration, has resulted in weak portability of SHI, creating further barriers to access. Third, many individuals are enrolled on multiple schemes, which causes inefficient use of government subsidies. Moral hazard and adverse selection are not effectively managed. The Chinese government announced its blueprint for integrating the urban and rural resident schemes in early 2016, paving the way for the ultimate consolidation of all SHI schemes and equal benefits for all. This article proposes three policy alternatives to inform the consolidation: (1) a single-pool system at the prefectural level with significant government subsidies, (2) a dual-pool system at the prefectural level with risk-equalization mechanisms, and (3) a household approach without merging existing pools. Vertical integration to the provincial level is unlikely to happen in the near future. Two caveats are raised to inform this transition towards universal health coverage.
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Affiliation(s)
- Alex Jingwei He
- Department of Asian and Policy Studies, the Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong.
| | - Shaolong Wu
- School of Public Health, Zhongshan Er Road, Guangzhou, Guangdong Province, China
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Abstract
Rapeepong Suphanchaimat and colleagues present the plight of migrant workers in the fishing industry in Southeast Asia and discuss challenges in providing for their health and safety.
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Affiliation(s)
- Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
- Banphai Hospital, Khon Kaen, Thailand
- * E-mail:
| | - Nareerut Pudpong
- Healthcare Accreditation Institute (Public Organization), Ministry of Public Health, Nonthaburi, Thailand
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Barber RM, Fullman N, Sorensen RJD, Bollyky T, McKee M, Nolte E, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abdurahman AA, Abera SF, Abraham B, Abreha GF, Adane K, Adelekan AL, Adetifa IMO, Afshin A, Agarwal A, Agarwal SK, Agarwal S, Agrawal A, Kiadaliri AA, Ahmadi A, Ahmed KY, Ahmed MB, Akinyemi RO, Akinyemiju TF, Akseer N, Al-Aly Z, Alam K, Alam N, Alam SS, Alemu ZA, Alene KA, Alexander L, Ali R, Ali SD, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amo-Adjei J, Amoako YA, Anderson BO, Androudi S, Ansari H, Ansha MG, Antonio CAT, Ärnlöv J, Artaman A, Asayesh H, Assadi R, Astatkie A, Atey TM, Atique S, Atnafu NT, Atre SR, Avila-Burgos L, Avokpaho EFGA, Quintanilla BPA, Awasthi A, Ayele NN, Azzopardi P, Saleem HOB, Bärnighausen T, Bacha U, Badawi A, Banerjee A, Barac A, Barboza MA, Barker-Collo SL, Barrero LH, Basu S, Baune BT, Baye K, Bayou YT, Bazargan-Hejazi S, Bedi N, Beghi E, Béjot Y, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Bernal OA, Beyene AS, Beyene TJ, Bhutta ZA, Biadgilign S, Bikbov B, Birlik SM, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Bose D, Brainin M, Brauer M, Brazinova A, Breitborde NJK, Brenner H, Butt ZA, Cárdenas R, Cahuana-Hurtado L, Campos-Nonato IR, Car J, Carrero JJ, Casey D, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cecilio P, Cercy K, Charlson FJ, Chen AZ, Chew A, Chibalabala M, Chibueze CE, Chisumpa VH, Chitheer AA, Chowdhury R, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Coggeshall MS, Cooper LT, Cortinovis M, Crump JA, Dalal K, Danawi H, Dandona L, Dandona R, Dargan PI, das Neves J, Davey G, Davitoiu DV, Davletov K, De Leo D, Del Gobbo LC, del Pozo-Cruz B, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dey S, Dharmaratne SD, Dicker D, Ding EL, Dokova K, Dorsey ER, Doyle KE, Dubey M, Ehrenkranz R, Ellingsen CL, Elyazar I, Enayati A, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Fürst T, Faghmous IDA, Fanuel FBB, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Feigl AB, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Feyissa TR, Fischer F, Fitzmaurice C, Fleming TD, Foigt N, Foreman KJ, Forouzanfar MH, Franklin RC, Frostad J, G/hiwot TT, Gakidou E, Gambashidze K, Gamkrelidze A, Gao W, Garcia-Basteiro AL, Gebre T, Gebremedhin AT, Gebremichael MW, Gebru AA, Gelaye AA, Geleijnse JM, Genova-Maleras R, Gibney KB, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gold A, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goto A, Graetz N, Greaves F, Griswold M, Guban PI, Gugnani HC, Gupta PC, Gupta R, Gupta R, Gupta T, Gupta V, Habtewold TD, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Hakuzimana A, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hankey GJ, Hao Y, Harb HL, Hareri HA, Haro JM, Hassanvand MS, Havmoeller R, Hay RJ, Hay SI, Hendrie D, Heredia-Pi IB, Hoek HW, Horino M, Horita N, Hosgood HD, Htet AS, Hu G, Huang H, Huang JJ, Huntley BM, Huynh C, Iburg KM, Ileanu BV, Innos K, Irenso AA, Jahanmehr N, Jakovljevic MB, James P, James SL, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jeemon P, Jha V, John D, Johnson C, Johnson SC, Jonas JB, Juel K, Kabir Z, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimi SM, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kazanjan K, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Kerbo AA, Kereselidze M, Kesavachandran CN, Khader YS, Khalil I, Khan AR, Khan EA, Khan G, Khang YH, Khoja ATA, Khonelidze I, Khubchandani J, Kibret GD, Kim D, Kim P, Kim YJ, Kimokoti RW, Kinfu Y, Kissoon N, Kivipelto M, Kokubo Y, Kolk A, Kolte D, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishnaswami S, Krohn KJ, Defo BK, Bicer BK, Kuipers EJ, Kulkarni VS, Kumar GA, Kumsa FA, Kutz M, Kyu HH, Lager ACJ, Lal A, Lal DK, Lalloo R, Lallukka T, Lan Q, Langan SM, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Latif AA, Lawrynowicz AEB, Leasher JL, Leigh J, Leinsalu M, Leshargie CT, Leung J, Leung R, Levi M, Liang X, Lim SS, Lind M, Linn S, Lipshultz SE, Liu P, Liu Y, Lo LT, Logroscino G, Lopez AD, Lorch SA, Lotufo PA, Lozano R, Lunevicius R, Lyons RA, Macarayan ERK, Mackay MT, El Razek HMA, El Razek MMA, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mantovani LG, Manyazewal T, Mapoma CC, Marcenes W, Marks GB, Marquez N, Martinez-Raga J, Marzan MB, Massano J, Mathur MR, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McNellan C, Meaney PA, Mehari A, Mehndiratta MM, Meier T, Mekonnen AB, Meles KG, Memish ZA, Mengesha MM, Mengiste DT, Mengistie MA, Menota BG, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mezgebe HB, Micha R, Millear A, Mills EJ, Minnig S, Mirarefin M, Mirrakhimov EM, Mock CN, Mohammad KA, Mohammed S, Mohanty SK, Mokdad AH, Mola GLD, Molokhia M, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Mori R, Moses M, Mueller UO, Murthy S, Musa KI, Nachega JB, Nagata C, Nagel G, Naghavi M, Naheed A, Naldi L, Nangia V, Nascimento BR, Negoi I, Neupane SP, Newton CR, Ng M, Ngalesoni FN, Ngunjiri JW, Nguyen G, Ningrum DNA, Nolte S, Nomura M, Norheim OF, Norrving B, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Osborne RH, Osman M, Owolabi MO, PA M, Pain AW, Pakhale S, Castillo EP, Pana A, Papachristou C, Parsaeian M, Patel T, Patton GC, Paudel D, Paul VK, Pearce N, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pesudovs K, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Polinder S, Pond CD, Prakash V, Purwar M, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rai RK, Ram U, Rana SM, Rankin Z, Rao PV, Rao PC, Rawaf S, Rego MAS, Reitsma M, Remuzzi G, Renzaho AMNN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Roba HS, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy NK, Sachdev PS, Sackey BB, Saeedi MY, Safiri S, Sagar R, Sahraian MA, Saleh MM, Salomon JA, Samy AM, Sanabria JR, Sanchez-Niño MD, Sandar L, Santos IS, Santos JV, Milicevic MMS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Saylan MI, Schöttker B, Schutte AE, Schwebel DC, Seedat S, Seid AM, Seifu CN, Sepanlou SG, Serdar B, Servan-Mori EE, Setegn T, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shakh-Nazarova M, Shamsipour M, Islam SMS, Sharma J, Sharma R, She J, Sheikhbahaei S, Shen J, Shi P, Shigematsu M, Shin MJ, Shiri R, Shoman H, Shrime MG, Sibamo ELS, Sigfusdottir ID, Silva DAS, Silveira DGA, Sindi S, Singh A, Singh JA, Singh OP, Singh PK, Singh V, Sinke AH, Sinshaw AE, Skirbekk V, Sliwa K, Smith A, Sobngwi E, Soneji S, Soriano JB, Sousa TCM, Sposato LA, Sreeramareddy CT, Stathopoulou V, Steel N, Steiner C, Steinke S, Stokes MA, Stranges S, Strong M, Stroumpoulis K, Sturua L, Sufiyan MB, Suliankatchi RA, Sun J, Sur P, Swaminathan S, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Taffere GR, Talongwa RT, Tarajia M, Tavakkoli M, Taveira N, Teeple S, Tegegne TK, Tehrani-Banihashemi A, Tekelab T, Tekle DY, Shifa GT, Terkawi AS, Tesema AG, Thakur JS, Thomson AJ, Tillmann T, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Tortajada M, Troeger C, Truelsen T, Tura AK, Uchendu US, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Boven JFM, Van Dingenen R, Varughese S, Vasankari T, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wagner JA, Wakayo T, Waller SG, Walson JL, Wang H, Wang YP, Watkins DA, Weiderpass E, Weintraub RG, Wen CP, Werdecker A, Wesana J, Westerman R, Whiteford HA, Wilkinson JD, Wiysonge CS, Woldeyes BG, Wolfe CDA, Won S, Workicho A, Workie SB, Wubshet M, Xavier D, Xu G, Yadav AK, Yaghoubi M, Yakob B, Yan LL, Yano Y, Yaseri M, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Zambrana-Torrelio C, Zapata T, Zenebe ZM, Zodpey S, Zoeckler L, Zuhlke LJ, Murray CJL. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet 2017; 390:231-266. [PMID: 28528753 PMCID: PMC5528124 DOI: 10.1016/s0140-6736(17)30818-8] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. METHODS We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. FINDINGS Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. INTERPRETATION This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. FUNDING Bill & Melinda Gates Foundation.
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Clarfield AM, Manor O, Nun GB, Shvarts S, Azzam ZS, Afek A, Basis F, Israeli A. Health and health care in Israel: an introduction. Lancet 2017; 389:2503-2513. [PMID: 28495109 DOI: 10.1016/s0140-6736(17)30636-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/21/2022]
Abstract
Starting well before Independence in 1948, and over the ensuing six decades, Israel has built a robust, relatively efficient public system of health care, resulting in good health statistics throughout the life course. Because of the initiative of people living under the British Mandate for Palestine (1922-48), the development of many of today's health services predated the state's establishment by several decades. An extensive array of high-quality services and technologies is available to all residents, largely free at point of service, via the promulgation of the 1994 National Health Insurance Law. In addition to a strong medical academic culture, well equipped (albeit crowded) hospitals, and a robust primary-care infrastructure, the country has also developed some model national projects such as a programme for community quality indicators, an annual update of the national basket of services, and a strong system of research and education. Challenges include increasing privatisation of what was once largely a public system, and the underfunding in various sectors resulting in, among other challenges, relatively few acute hospital beds. Despite substantial organisational and financial investment, disparities persist based on ethnic origin or religion, other socioeconomic factors, and, regardless of the country's small size, a geographic maldistribution of resources. The Ministry of Health continues to be involved in the ownership and administration of many general hospitals and the direct payment for some health services (eg, geriatric institutional care), activities that distract it from its main task of planning for and supervising the whole health structure. Although the health-care system itself is very well integrated in relation to the country's two main ethnic groups (Israeli Arabs and Israeli Jews), we think that health in its widest sense might help provide a bridge to peace and reconciliation between the country and its neighbours.
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Affiliation(s)
- A Mark Clarfield
- Medical School for International Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Gabi Bin Nun
- Department of Health Systems Management, Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shifra Shvarts
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zaher S Azzam
- Rambam Health Care Campus, Rapaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Arnon Afek
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fuad Basis
- Rambam Health Care Campus, Rapaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Avi Israeli
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
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Brooks MI, Thabrany H, Fox MP, Wirtz VJ, Feeley FG, Sabin LL. Health facility and skilled birth deliveries among poor women with Jamkesmas health insurance in Indonesia: a mixed-methods study. BMC Health Serv Res 2017; 17:105. [PMID: 28148258 PMCID: PMC5288898 DOI: 10.1186/s12913-017-2028-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/17/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The growing momentum for quality and affordable health care for all has given rise to the recent global universal health coverage (UHC) movement. As part of Indonesia's strategy to achieve the goal of UHC, large investments have been made to increase health access for the poor, resulting in the implementation of various health insurance schemes targeted towards the poor and near-poor, including the Jamkesmas program. In the backdrop of Indonesia's aspiration to reach UHC is the high rate of maternal mortality that disproportionally affects poor women. The objective of this study was to evaluate the association of health facility and skilled birth deliveries among poor women with and without Jamkesmas and explore perceived barriers to health insurance membership and maternal health service utilization. METHODS We used a mixed-methods design. Utilizing data from the 2012 Indonesian Demographic and Health Survey (n = 45,607), secondary analysis using propensity score matching was performed on key outcomes of interest: health facility delivery (HFD) and skilled birth delivery (SBD). In-depth interviews (n = 51) were conducted in the provinces of Jakarta and Banten among poor women, midwives, and government representatives. Thematic framework analysis was performed on qualitative data to explore perceived barriers. RESULTS In 2012, 63.0% of women did not have health insurance; 19.1% had Jamkesmas. Poor women with Jamkesmas were 19% (OR = 1.19 [1.03-1.37]) more likely to have HFD and 17% (OR = 1.17 [1.01-1.35]) more likely to have SBD compared to poor women without insurance. Qualitative interviews highlighted key issues, including: lack of proper documentation for health insurance registration; the preference of pregnant women to deliver in their parents' village; the use of traditional birth attendants; distance to health facilities; shortage of qualified health providers; overcrowded health facilities; and lack of health facility accreditation. CONCLUSIONS Poor women with Jamkesmas membership had a modest increase in HFD and SBD. These findings are consistent with economic theory that health insurance coverage can reduce financial barriers to care and increase service uptake. However, factors such as socio-cultural beliefs, accessibility, and quality of care are important elements that need to be addressed as part of the national UHC agenda to improve maternal health services in Indonesia.
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Affiliation(s)
- Mohamad I. Brooks
- Pathfinder International, 9 Galen St, Suite 217, Watertown, 02472 MA USA
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118 MA USA
| | - Hasbullah Thabrany
- Center for Health Economics and Policy Studies, University of Indonesia School of Public Health, Building G Room 311, Depok, 16424 West Java Indonesia
| | - Matthew P. Fox
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot T2C, Boston, 02118 MA USA
- Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118 MA USA
| | - Veronika J. Wirtz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118 MA USA
- Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118 MA USA
| | - Frank G. Feeley
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118 MA USA
- Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118 MA USA
| | - Lora L. Sabin
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118 MA USA
- Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118 MA USA
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Abstract
OBJECTIVES To assess the effects of costs on access to medicines in 11 developed countries offering different levels of prescription drug coverage for their populations. DESIGN Cross-sectional study of data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults. SETTING Telephone survey conducted in 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA. PARTICIPANTS 22 532 adults aged 55 and older and living in the community in studied countries. PRIMARY OUTCOME MEASURE Self-reported cost-related non-adherence (CRNA) in the form of either not filling a prescription or skipping doses within the last 12 months because of out-of-pocket costs. RESULTS Estimated prevalence of CRNA among all older adults varied from <3% in the France, Norway, Sweden, Switzerland and the UK to 16.8% in the USA. Canada had the second highest national prevalence of CRNA (8.3%), followed by Australia (6.8%). Older adults in the USA were approximately six times more likely to report CRNA than older adults in the UK (adjusted OR=6.09; 95% CI 3.60 to 10.20). Older adults in Australia and Canada were also statistically significantly more likely to report CRNA than older adults in the UK. Across most countries, the prevalence of CRNA was higher among lower income residents and lower among residents over age 65. CONCLUSIONS Observed differences in national prevalence of CRNA appear to follow lines of availability of prescription drug coverage and the extent of direct patient charges for prescriptions under available drug plans.
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Affiliation(s)
- Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Augustine Lee
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
BACKGROUND Migrant health is receiving increasing international attention, reflecting recognition of the health inequities experienced among many migrant populations and the need for health systems to adapt to diverse migrant populations. In the Greater Mekong Subregion (GMS) there is increasing migration associated with uneven economic integration and growth, socio-economic vulnerabilities, and disparities between countries. There has been limited progress, however, in improving migrant access to health services in the Subregion. This paper examines the health needs, access barriers, and policy responses to cross-border migrants in five GMS countries. METHODS A review of published literature and research was conducted on migrant health and health service access in Cambodia, Lao People's Democratic Republic, Myanmar, Thailand, and Viet Nam, as well as analysis of current migration trends and universal health coverage (UHC) indicators in the Subregion. The review included different migrant types: i.e. migrant workers, irregular migrants, victims of trafficking, refugees and asylum seekers, and casual cross-border migrants. RESULTS There is substantial diversity in the capacity of GMS health systems to address migrant populations. Thailand has sought to enhance migrant health coverage, including development of migrant health policies/programs, bilateral migrant worker agreements, and migrant health insurance schemes; Viet Nam provides health protection for emigrant workers. Overall, however, access to good quality health care remains weak for many citizens in GMS countries let alone migrants. Migrant workers - and irregular migrants in particular - face elevated health risks yet are not adequately covered and incur high out-of-pocket (OOP) payments for health services. CONCLUSIONS UHC implies equity: UHC is only achieved when everyone has the opportunity to access and use good-quality health care. Efforts to achieve UHC in the GMS require deliberate policy decisions to include migrants. The emergence of the UHC agenda, and the focus on migrant health among policy makers and partners, present an opportunity to tackle barriers to health service access, extend coverage, and strengthen partnerships in order to improve migrant health. This is an opportune time for GMS countries to develop migrant-inclusive health systems.
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Affiliation(s)
- Celia McMichael
- The University of Melbourne, School of Geography, Carlton, Australia
| | - Judith Healy
- Australian National University, School of Regulation and Global Governance (RegNet), Canberra, Australia
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Wehrmeister FC, Restrepo-Mendez MC, Franca GVA, Victora CG, Barros AJD. Summary indices for monitoring universal coverage in maternal and child health care. Bull World Health Organ 2016; 94:903-912. [PMID: 27994283 PMCID: PMC5153929 DOI: 10.2471/blt.16.173138] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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: 03/17/2016] [Revised: 07/27/2016] [Accepted: 08/15/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare two summary indicators for monitoring universal coverage of reproductive, maternal, newborn and child health care. METHODS Using our experience of the Countdown to 2015 initiative, we describe the characteristics of the composite coverage index (a weighted average of eight preventive and curative interventions along the continuum of care) and co-coverage index (a cumulative count of eight preventive interventions that should be received by all mothers and children). For in-depth analysis and comparisons, we extracted data from 49 demographic and health surveys. We calculated percentage coverage for the two summary indices, and correlated these with each other and with outcome indicators of mortality and undernutrition. We also stratified the summary indicators by wealth quintiles for a subset of nine countries. FINDINGS Data on the component indicators in the required age range were less often available for co-coverage than for the composite coverage index. The composite coverage index and co-coverage with 6+ indicators were strongly correlated (Pearson r = 0.73, P < 0.001). The composite coverage index was more strongly correlated with under-five mortality, neonatal mortality and prevalence of stunting (r = -0.57, -0.68 and -0.46 respectively) than was co-coverage (r = -0.49, -0.43 and -0.33 respectively). Both summary indices provided useful summaries of the degrees of inequality in the countries' coverage. Adding more indicators did not substantially affect the composite coverage index. CONCLUSION The composite coverage index, based on the average value of separate coverage indicators, is easy to calculate and could be useful for monitoring progress and inequalities in universal health coverage.
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Affiliation(s)
- Fernando C Wehrmeister
- Federal University of Pelotas, Rua Marechal Deodoro 1160, 3 piso. Pelotas, 96020-220, Rio Grande do Sul, Brazil
| | | | - Giovanny VA Franca
- Federal University of Pelotas, Rua Marechal Deodoro 1160, 3 piso. Pelotas, 96020-220, Rio Grande do Sul, Brazil
| | - Cesar G Victora
- Federal University of Pelotas, Rua Marechal Deodoro 1160, 3 piso. Pelotas, 96020-220, Rio Grande do Sul, Brazil
| | - Aluisio JD Barros
- Federal University of Pelotas, Rua Marechal Deodoro 1160, 3 piso. Pelotas, 96020-220, Rio Grande do Sul, Brazil
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Abstract
After leaving Chile during the Pinochet era, Dr Morales studied economics, health administration and international health at the University of Montreal. But his baptism in the field came in Haiti, where he was first PAHO advisor to the health ministry, and then for five years was responsible for human resources and health economics in the PAHO offices in the capital of Port-au-Prince. He was at his post during the flooding in Gonaïves, five hurricanes, the 2010 earthquake and the ensuing cholera epidemic-doubtless the most dramatic and complex times for the country's health in recent history. Before becoming the PAHO/WHO Representative in Cuba in 2015, he was Regional Advisor in Financing and Health Economics based in Washington, DC. In that role, he plunged into the often thorny debates about just how far governments of the Americas were willing to go towards achieving universal health-universal coverage plus universal access. The result was a historic resolution passed in late 2014 by PAHO's Directing Council (CD53.R14 Strategy for Universal Access to Health and Universal Health Coverage). Dr Morales talks about the process, the outcomes… and the road ahead.
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Promprasert W, Upakdee N, Pannarunothai S. Hospitalizations of Diabetes Ambulatory Care Sensitive Condition - Universal Coverage Scheme at a Referral Hospital in Bangkok, Thailand: Five-Year Cross-Sectional Study. J Med Assoc Thai 2016; 99:949-955. [PMID: 29949314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Universal coverage (UC) scheme covers most of the population in Thailand (76.3%) and diabetes (DM) was the most prevalent ambulatory disease in most health care centers. Rajavithi Hospital is designated as one of the top referral hospital in Bangkok. OBJECTIVE To examine the trend of avoidable hospitalization related to diabetes in the UC patients who registered at Rajavithi Hospital. RESULTS This cross-sectional study collected data from electronic medical record from Rajavithi Hospital and the National Health Security Office (NHSO). DM and related diseases based on a list of diagnosis codes (ICD-10) were selected as an ambulatory care sensitive condition (ACSC) to reflect the avoidable hospitalization. Outpatient and inpatient data between 2007 and 2011 were studied. The ACSC rate was calculated by number of hospitalizations on DM and related conditions divided by number of the DM patients visited as ambulatory care. CONCLUSION The avoidable hospitalization for DM patients registered at Rajavithi Hospital was stable during the five years of the study. Future study on avoidable hospitalization should cover admissions to other hospitals and DM related conditions. Further studies should investigate the reasons of avoidable hospitalization.
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Flatø H, Zhang H. Inequity in level of healthcare utilization before and after universal health coverage reforms in China: evidence from household surveys in Sichuan Province. Int J Equity Health 2016; 15:96. [PMID: 27334384 PMCID: PMC4917991 DOI: 10.1186/s12939-016-0385-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 06/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has since the beginning of this millennium engaged in substantial Universal Health Coverage (UHC) reforms. This paper adds evidence on how equity in level of health service utilization changed after UHC reforms. METHODS Our study was based on household survey data from 30 counties in Sichuan province in 2004 and 2011. We introduce an unusual outcome variable, namely level of healthcare utilization. Concentration index (CI) was used to measure income based inequality in level of healthcare utilization. Horizontal index (HI) was used to assess whether inequalities are inequitable. We decomposed the concentration index to measure the factors contributing to inequality in level of utilization. Oaxaca type decomposition was applied to control whether identified changes were attributable to changed inequality or to other factors. RESULTS Pro-rich inequity in level of healthcare utilization increased after UHC reforms. Overall, a higher proportion of users sought services at county hospitals or higher in 2011 compared with 2004. Richer users were considerably more likely than the poor to seek care at hospitals rather than at clinics or health centers, and the pro-rich inequality in level of healthcare utilization was highly inequitable. Insurance enrollment became the main driver of pro-rich inequity in level of healthcare utilization after reforms, while health needs became less important for determining level of care, all disfavoring low income groups. CONCLUSIONS Assessments of equity should pay attention to inequalities in level of healthcare utilization. Our results indicate that in China, wide insurance coverage is insufficient to ensure equity in level of healthcare utilization. On the contrary, type of insurance enrollment has become a main driver of inequity in level of utilization. Hence, equalizing health insurance schemes would be of crucial importance in order to improve health equity in China. Moreover, UHC reforms should strengthen the primary sector and limit non-needs based use of high-level hospitals in order to promote equitable use of healthcare services.
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Affiliation(s)
- Hedda Flatø
- Fafo Research Foundation, PO Box 2947, Tøyen, NO-0608 Oslo Norway
| | - Huafeng Zhang
- Fafo Research Foundation, PO Box 2947, Tøyen, NO-0608 Oslo Norway
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O'Donnell O, Jones AM. Symposium: Efforts to Extend Effective Coverage in Asia. Health Econ 2016; 25:647-649. [PMID: 27061754 DOI: 10.1002/hec.3344] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Owen O'Donnell
- Erasmus University Rotterdam, Rotterdam, The Netherlands
- Tinbergen Institute, Amsterdam, The Netherlands
- University of Macedonia, Thessaloniki, Greece
| | - Andrew M Jones
- University of York, York, UK
- Monash University, Melbourne, VIC, Australia
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