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In the present time, what has been called the "medical–industrial insurance complex" in the United States needs reform. As health insurance in the United States remains inaccessible to millions of people, and as prices continue to rise, questions arise about the most moral ways to ensure delivery of health care especially to the most vulnerable populations. In this essay, I offer a virtue analysis of the moral implications of health insurance mandated by the US Government in contrast to an increasingly popular alternative to insurance, namely, healthcare sharing ministries. In part 1, I list some of the moral problems entangled with US Government-mandated health insurance, including injustice, disrespect for patient autonomy, limitations on patient freedom, exploitation of patients for profit, undermining of conscience rights, cooperation with evil, and scandal. In part 2, I discuss the issue of risk and then list some potential moral advantages to healthcare ministries, including respect for patient autonomy, conscience, and the religious freedom to witness to the Catholic faith in charity and solidarity. Summary: Mandated health insurance the United States presents some moral challenges for conscientious Catholics, whereas healthcare sharing ministries appear to ameliorate some of these issues. Ultimately, the individual should have freedom to choose either insurance or healthcare sharing, given the different benefits and risks entailed by both. [ABSTRACT FROM AUTHOR]

Western medicine developed as an expression of Christian charity and played a large role in the growth of the early church. Despite its original foundation in Christian moral principles, modern medicine has deviated from its origins. The principles of human dignity, solidarity, and subsidiarity have been subjugated to a materialist and transactional construct that forms the basis of the contemporary medical delivery and financing systems. The dehumanization of both healthcare practitioners and patients by the partnership of governmental and corporate entities, and the use of health care as a political instrument, has debased the original mission of the medical profession and represents an affront to the principles of Catholic social teaching (CST). This essay explores the ways in which the US medical delivery and financing systems violate the principles of CST by means seldom recognized due to the inurement of the public and medical professionals. By examining the prevailing healthcare model through the lens of CST, the author illustrates the ways in which CST principles are systematically violated. This analysis serves as the foundation of a Catholic response to the question of how faithful Christians might live out their calls to holiness through the exercise of their professional vocations. A vision of an invigorated model of medicine as vocation, along with illustrative examples, is presented. By exemplifying the principles of human dignity, solidarity and subsidiarity in health care, Christians can seize a golden opportunity for evangelization by rearticulating the historical spiritual mission of Western medicine. [ABSTRACT FROM AUTHOR]

This article examines the structure of pricing within health care. The price mechanism within health care does not function as it does in other sectors of the economy. The author examines the price theories of capitalism, socialism, and solidarism to illuminate the purpose of prices relevant to health care. Drawing points from each system, the author argues in favor of a solidarist approach to prices relying on principles set forth in Catholic social teaching, with the caveat that the capitalist natural price must first be determined. The unique features of healthcare pricing and prioritization indicate that moral principles must guide the economics of health care, not merely supply and demand. Summary: This article discusses the problems with creating useful prices in health care. It examines the price theories of capitalism, socialism, and solidarism to see which would be most useful for health care price formation. [ABSTRACT FROM AUTHOR]

Objective. To analyze sources of fiscal space for the health sector in Honduras, in the context of sectoral reform, with a commitment to achieving the target of public expenditure on health equivalent to 6% of gross domestic product (GDP). Methods. An analysis of baseline conditions and sources of fiscal space was conducted on the basis of a literature review and secondary data. The size of each source was estimated from official data, international statistics, and previous studies. In parallel to this study, political feasibility was analyzed and an online survey was administered to key actors. Results. Estimates of baseline conditions for economic growth show that other sources must be identified in order to generate new resources. The recent tax reform limits the political feasibility of creating new taxes, except for "sin taxes", that could be used exclusively to fund health. Social protection reform paves the way to explore measures that could make resources available by improving efficiency in the sector. One limitation on public expenditure based on social security contributions is the ceiling on taxable income, notwithstanding acceleration in the formalization of the labor market. Conclusions. Honduras can advance towards achieving the target of public expenditure on health equivalent to 6% of GDP with the support of plans for sectoral reform, but its options are limited by the recent tax reform. The reform of social protection in health should consider additional available resources so as not to jeopardize implementation of the reform. [ABSTRACT FROM AUTHOR]

Objective. To assess from a technical and political point of view the capacity of Bolivia to generate fiscal space for health that allows it to sustain progress and fulfill the commitment of a public health expenditure of 6% of gross domestic product. Methods. A review of the international evidence on fiscal space and its measurements was conducted. The technical analysis was developed through statistics and official reports from multiple national and international secondary sources. The political and social analysis was carried out through 20 interviews with representatives of organizations and institutions. Results. There is capacity to create fiscal space in health for Bolivia. There are three sources with the greatest technical and political feasibility: economic growth linked to the commitment to reprioritize public spending on health; improvements in the internal sources of revenue through the reduction of informal work; and reduction of tax expenditures. External financing and an increase of Social Security contributions are less feasible. Conclusions. Bolivia is able to achieve a public health spending of 6% of gross domestic product. The timing to achieve this goal depends on maintaining the prioritization of spending in the sector, with social and political consensus and within a framework of economic growth and stability. [ABSTRACT FROM AUTHOR]

Objective. In 2014, the Pan American Health Organization member countries signed the Strategy for Universal Access to Health and Universal Health Coverage. In it, they committed to increasing public health expenditure until reaching the benchmark of 6% of gross domestic product (GDP). The objective of this paper is to determine, for each country in the Region, if they can reach this goal by economic growth alone and, if so, how long it would take. Methods. Using World Bank and World Health Organization data, elasticity of public health expenditure with regard to GDP was estimated for each country. Real economic growth and International Monetary Fund projections for 2016-2021 were used to project the expenditure series and determine the year each country would reach 6% of GDP. Results. Six countries have already reached the 6% goal. The Latin American and Caribbean countries that have achieved it are those that have single health systems, based on universal access and coverage. If current prioritization of public health expenditure is maintained, three countries could reach the goal in the next decade. Four more countries would reach it before mid-century, ten in the second half of the century, and one would have to wait until the next century. Finally, 13 countries would never reach the proposed goal. Conclusions. This analysis demonstrates the limitations of economic growth as a source of fiscal space. Other sources will need to be tapped, such as increased tax collection, specific health taxes, and greater efficiency in public spending, which will require social and political dialogue in the countries regarding their commitment to universal health principles. [ABSTRACT FROM AUTHOR]

Objective. To characterize the process of health sector reform (HSR) in Peru (launched publicly in 2013), identifying the principal advances in its implementation and the pending challenges from the perspective of the participating actors. Methods. This study systematizes experiences through semi-structured interviews conducted with 21 key informants, including three ex-ministers of health, using the decade 2005-2015 as the time frame. Official databases were analyzed to verify variations in health indicators. Results. The proposed reform was based on expanding insurance coverage (predominantly public health insurance), following the structured pluralism model, with clear separation between the functions of delivery, financing, regulation, and governance. The main progress in HSR identified by this study involves: having transcended the poverty criterion for public insurance, strengthening investments in infrastructure and human resources, strengthening the National Health Authority with a focus on the rights of users, and reinforcing the public health role of the Ministry of Health. The main challenges involve providing non-poverty- related insurance coverage for the population, having sufficient specialized human resources, and reducing out-of-pocket expenditure. Conclusions. In the 10 years under analysis, HSR is a process that builds on the progress made in prior years; a process that consolidates an insurance model aimed at universal coverage based on public health insurance and that has led to a demonstrable increase in public spending and population coverage. However, progress has been limited mainly due to insufficient provision of specialized human resources and out-of-pocket expenditure, which remains very high. [ABSTRACT FROM AUTHOR]

Objective. To assess the fiscal space for public health in Peru so as to attain the goal of raising health spending to 6% of gross domestic product, as agreed upon by member countries of the Pan American Health Organization in 2014. Methods. The main sources of fiscal space were identified by means of a thorough literature review. Technical feasibility was determined from statistics and national and international surveys and by reviewing various documents and official reports. Political feasibility was ascertained by studying policy guidelines. Results. The sources showing the greatest technical and political feasibility are economic growth, a broadening of the personal income tax base, and an increase in tobacco-specific taxes. Decreasing informality in the job market and increasing contributory coverage are considered to be less politically feasible, but there is ample technical space for these measures. Conclusions. There is enough fiscal space to allow for an increase in public health spending. Nevertheless, the 6% target will be reached only if the timeline is extended, tax revenues are increased, and informality in the job market is reduced. [ABSTRACT FROM AUTHOR]

Objective. Evaluate the effect of the relationship among public health expenditures, income inequality, and the marginalization index on maternal and child mortality in Mexico, to determine the effect of these factors on health system performance from a technical efficiency perspective. Methods. An ecological study of 32 Mexican states. Correlations were estimated between maternal and infant mortality and public health expenditures in total per capita, federal per capita, and state per capita for the years 2000, 2005, and 2010 (Gini coefficient and marginalization index). Linear regressions were used to explore the association of these variables with health indicators in the state systems. Results. Negative correlations were observed for the marginalization index and Gini coefficient with regard to life expectancy at birth (-0.62 and -0.28 respectively). Furthermore, there was a positive correlation of 0.59 between the marginalization index and infant mortality (P <0.05). Multiple linear regression models revealed a negative effect of the marginalization index and Gini coefficient on health outcomes. Federal funding had a positive effect on system performance in terms of health indicators. Conclusions. Health system reform in Mexico has had a positive impact on the country's health indicators; federal financial investment seems to be effective in this regard. Social determinants have an important effect on health system performance, and analysis using multisectoral and multidisciplinary approaches are needed in addressing them. [ABSTRACT FROM AUTHOR]

Objective. Identify priorities for health policy and systems research related to human resources in Latin America and Caribbean countries. Methods. An online survey was designed based on a search in PubMed, Cochrane Library, and LILACS that contributed previously prioritized research questions. Respondents, mainly researchers and decision makers, were identified through various sources. The first round, directed at researchers, aimed at refining and adding research questions and prioritizing questions that researchers regarded as relevant or very relevant. The second round was directed at researchers and decision makers. A question was considered a priority when 50% (or more) of respondents described it as “relevant” or “very relevant.” Results. The first round included 20 questions on human resources and 33/66 re searchers responded. Questions suggested by the researchers were added, resulting in 26 questions for the second round, which were sent to 121 researchers and decision makers. Respondent representation by country was uniform in both rounds. In the second round, 14/26 (54%) questions were described as very relevant. Priority issues related to regulation of the market, integration of education and health care needs, and distribution of human resources. The response rate was 50% in the first round (33/66), and 34% in the second round (41/121). Conclusions. The results of this exercise provide a starting point for mobilization of resources for health policy and systems research. Identification of health systems re search priorities is an effective and efficient strategy for reorienting political, financial, management, and social organization efforts for attaining universal health coverage. [ABSTRACT FROM AUTHOR]

The European Union has criticized the legal nature of the payments in concept of Taxes on Retail Sales of Certain Hydrocarbons (IVMDH) that the road transport sector has been doing in recent years, particularly since 2005. This paper investigates the legal characteristics of IVMDH, the collection that the Regional Governments have done in this concept and the cost it has brought to the professional sector of road transport, and also the amount that could be returned to these companies depending on its fleet and the region where they operate. [ABSTRACT FROM AUTHOR]

The unachievable cost of dementia care is revealed in a new report that also highlights the loneliness of carers.

Health funding, as a proportion of gross domestic product, has been shrinking for several years. The impact of that shrinkage is taking a severe tolL on those working in the health system.

Over the following pages, nurses, midwives and health care assistants describe how an underfunded health service undermines their ability to provide good care.

Funding for children's hospices and palliative care charities in England is in crisis with seriously ill children facing a postcode lottery for their care, a new report has revealed.

The RCN has called for protected funding for health visitors as latest workforce figures showed hundreds fewer posts in recent months.

Children who require palliative care are being 'short changed or ignored', according to a survey of services in England by the charity Together for Short Lives.

'SERIOUS' STAFFING and funding shortages must be addressed urgently if the numbers of stillbirths and neonatal deaths in the UK are to be reduced, charities have urged.