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Introduction:We examine the characteristics and financial outcomes of online crowdfunding campaigns for patients with major urological cancers in the U.S.Methods:This cross-sectional study ...

The COVID-19 pandemic triggered an economic shock just ten years after the shock of the 2008 global financial crisis. Economic shocks are a challenge for health systems because they reduce government revenue at the same time as they increase the need for publicly financed health care. This article explores the resilience of health financing policy to economic shocks by reviewing policy responses to the financial crisis and COVID-19 in Europe. It finds that some health systems were weakened by responses to the 2008 crisis. Responses to the pandemic show evidence of lessons learnt from the earlier crisis but also reveal weaknesses in health financing policy that limit national preparedness to face economic shocks, particularly in countries with social health insurance schemes. These weaknesses highlight where permanent changes are needed to strengthen resilience in future: countries will have to find ways to reduce cyclicality in coverage policy and revenue-raising; increase the priority given to health in allocating public spending; and ensure that resources are used to meet equity and efficiency goals. Although many health systems are likely to face budgetary pressure in the years ahead, the experience of the 2008 crisis shows that austerity is not an option because it undermines resilience and progress towards universal health coverage.

Since 2017, Population Services International Myanmar (PSI/Myanmar) has been running Strategic Purchasing (SP) clinics in Hlegu and Shwepyithar townships in Yangon, Myanmar. In the project, Population Services International Myanmar simulated the role of a purchaser and contracted SP clinics through a capitation payment scheme. The project aimed to reduce the health-related financial burden of poor populations in the catchment area, by having them registered under respective SP clinics for access to a package of essential health services for a minimal fixed co-payment, as a replacement for usual fee-for-service payments. Four longitudinal surveys of households registered under SP clinics were conducted in 2017, 2018 and 2019. Among 2506 registered households, 867 households sought some health care in all surveys, resulting in 3468 observations. Multivariable linear mixed-effect regression model was used to analyse the changes in out-of-pocket expenditure for health care in relation to household capacity to pay (OOPCTP). The utilization of SP clinics increased over time, and the rates were much higher in Hlegu (20.5% in baseline to 61.9% in round three) compared with those in Shwepyithar (0.2 to 7.9%). Compared with the baseline assessment, household OOPCTP decreased significantly during and after the implementation (0.76 times in round one, 0.80 in round two and 0.82 in round three; P < 0.001). Households in Shwepyithar with less utilization of SP clinics had 1.8 times higher OOPCTP compared with those in Hlegu (1.82, 95% CI 1.58, 2.09; P < 0.001). Household direct expenditures on care-seeking and family planning were up to 50% lower among those who used SP clinics. Our study highlighted that capitation-based health financing schemes could successfully lower out-of-pocket health expenditures among the poor. Optimal utilization of services was paramount in the successful implementation of such programmes. Therefore, for the effective scale-up of new health financing schemes, service utilization rates should be carefully monitored as one of the critical indicators.

Summary Background Childhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making. Methods For this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO–UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates. Findings Between 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5–118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7–61·9) and 79·3% (73·8–81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3–2·8] and $6·4 billion [6·0–7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38–42) in low-income countries and $42 (39–46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6–72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased. Interpretation These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030. Funding Bill & Melinda Gates Foundation.

Health is one of the major determinants of the overall well-being of a society. The World Health Organization has emphasised the right to health for all, and the universal health coverage is a paradigm of this emphasis with an agenda of nobody to be left behind in the provision of health services without any financial burden by 2030.This article tries to analyse the extent of catastrophic expenditure being incurred by the people despite being sheltered under a financial protection (Health Insurance) in the state of Maharashtra. The impact caused by out-of-pocket (OOP) health expenditure on the economic status of the people in the state is assessed using the National Sample Survey Office’s 71st round conducted by the Ministry of Health and Family Welfare, Government of India. It was found that over 4.18% of the population endured the burden caused by OOP expenditure by falling below the poverty line post health payments. A higher proportion of rural population is observed to have experienced a fall in the economic status from above poverty line (APL) to below poverty line (BPL) due to high OOP expenditure than that of the urban population in Maharashtra.

The Social Health Protection Initiative (SHPI) was introduced initially in Pakistan in Khyber Pakhtunkhwa Province. The initiative aimed to provide the lowest socioeconomic group of the population with in-patient healthcare services, which otherwise would be financially hard to obtain. It is one of the flagship projects of the Provincial Government to contribute towards the United Nations Sustainable Development Goals and universal health coverage.To assess consumer choice of health facility and its determinants for public versus private sector health facilities by people enrolled in SHPI.We used secondary data of availed health services from February 2016 to September 2017 under SHPI. A proxy outcome variable, visit to health facility, was used to determine consumer choice between public and private sector health facilities. The treatment group (health services received by beneficiaries) was used as an independent variable controlled for age groups, cost groups, and geographic location of health facilities. All statistical analyses were performed by SPSS version 20.Most beneficiaries chose private over public health facilities (90.25%). The adjusted odds of visiting a public sector health facility for surgical and obstetrics/gynaecological services were 0.12 [95% confidence interval (CI): 0.10-0.16] and 0.11 (95% CI: 0.09-0.14) respectively, when compared to medical services.SHPI beneficiaries have lesser odds of visiting a public hospital over a private one. The choice may be affected by factors such as age of the beneficiary, cost of health services, and geographic location of health facilities.اختيار المستفيدين للمرفق الصحي في أدنى فئة اجتماعية واقتصادية من السكان في المخطط الحديث للتمويل الصحي على جانب الطلب في باكستان.سدرة مالك، نافيد صادق، سعيد أنور، عمير قاضي.بدأت مبادرة الحماية الصحية الاجتماعية في باكستان في مقاطعة خيبر بختونخوا. وكانت المبادرة تهدف إلى تزويد أدنى فئة اجتماعية واقتصادية من السكان بخدمات الرعاية الصحية للمرضى الداخليين، التي لولا ذلك لواجهوا صعوبة مالية في الحصول عليها. وهي أحد المشاريع الرئيسية لحكومة المقاطعة للمساهمة في تحقيق أهداف الأمم المتحدة للتنمية المستدامة والتغطية الصحية الشاملة.هدفت هذه الدراسة الى تقييم اختيار المستفيدين المُسجَّلين في المبادرة للمرفق الصحي ومُدِّدات اختيارهم لمرافق القطاع العام الصحية مقابل مرافق القطاع الخاص.استخدمنا بيانات ثانوية بشأن الخدمات الصحية التي قُدِّمت من فبراير/ شباط 2016، حتى سبتمبر/ أيلول 2017، في إطار المبادرة. واستُخدم متغير مخرجات بديل، هو زيارة المرفق الصحي، لتحديد اختيار المستفيد بين المرافق الصحية للقطاعين العام والخاص. واتُّذت مجموعة العلاج (الخدمات الصحية التي تلقاها المستفيدون) متغيرًا مستقلًّ مُضبطًا للفئات العمرية وفئات التكلفة والموقع الجغرافي للمرافق الصحية. وأُجريت جميع التحليلات الإحصائية بالنسخة 20 من برنامج SPSS.فضَّل معظم المستفيدين المرافق الصحية الخاصة على المرافق الصحية العامة (90.25٪). ومع ذلك، بلغت نسبة الأرجحية المُصحَّحة لزيارة مرفق صحي في القطاع العام من أجل الخدمات الجراحية وخدمات أمراض النساء 0.12 [فاصل الثقة 95٪: 0.10-0.16] و 0.11 [فاصل الثقة 95٪: 0.09-0.14) على التوالي، عند مقارنتها بالخدمات الطبية.احتمالات زيارة المستفيدين من مبادرة الحماية الصحية الاجتماعية لمستشفى عام أقل من احتمالات زيارتهم لمستشفى خاص. وقد يتأثر الاختيار بعوامل مثل عمر المستفيد، وتكلفة الخدمات الصحية، والموقع الجغرافي للمرافق الصحية.Choix des établissements de santé par les usagers appartenant au groupe socio-économique le plus bas dans le cadre d’un nouveau programme de financement de la santé axé sur la demande mis en œuvre au Pakistan.L’initiative de protection sociale de la santé (Social Health Protection initiative, SHPI) a été initialement mise en place au Pakistan dans la province de Khyber Pakhtunkhwa. Son objectif était de fournir au groupe socio-économique le plus bas de la population des services des soins hospitaliers, dont l’accès serait autrement financièrement difficile. Il s’agit de l’un des projets phares du gouvernement provincial visant à contribuer à la réalisation des objectifs de développement durable des Nations Unies et à la mise en place de la couverture sanitaire universelle.Évaluer le choix des établissements de santé par les personnes inscrites à l’initiative de protection sociale de la santé et les facteurs qui déterminent ce choix entre les établissements du secteur public et ceux du secteur privé.Nous avons utilisé les données secondaires des services de santé dispensés de février 2016 à septembre 2017 dans le cadre de l’initiative de protection sociale de la santé. Une variable de résultat de substitution – la fréquentation d’un établissement de santé – a été utilisée pour déterminer le choix des usagers entre les établissements de santé des secteurs public et privé. Le groupe de traitement (services de santé dispensés aux bénéficiaires) a été utilisé comme variable indépendante qui a été contrôlée pour les groupes d’âge, les groupes de coûts et l’emplacement géographique des établissements de santé. Toutes les analyses statistiques ont été réalisées à l’aide du logiciel SPSS version 20.La plupart des bénéficiaires ont préféré les établissements de santé privés aux établissements publics (90,25 %). Cependant, les probabilités ajustées de se rendre dans un établissement de santé du secteur public pour des services chirurgicaux et gynécologiques étaient de 0,12 [intervalle de confiance (IC) à 95 % : 0,10 à 0,16] et de 0,11 (IC à 95 % : 0,09 à 0,14) respectivement, par rapport aux services médicaux.Les bénéficiaires de l’initiative de protection sociale de la santé sont moins susceptibles de se rendre dans un hôpital public que dans un hôpital privé. Le choix peut être influencé par des facteurs tels que l’âge du bénéficiaire, le coût des services de santé et l’emplacement géographique des établissements de santé.

The purpose of this article is to analyze the main causes of corruption in the healthcare sector during the COVID-19 pandemic. The study identified the main problems of national health during the pandemic, such as theft and resale of state-funded medicines, vaccines, and medical supplies (medical equipment), reduced availability and quality of medical services, low wages of medical workers, limited supervision and control (monitoring) in the healthcare sector and etc. As a result of the analysis, it was concluded that there is a need for additional work to identify cases of those types of corruption that are indicated in the article. Also, citizens should be involved in suppressing corruption in the health sector - documenting all cases of corruption that can be detected at the place of service delivery. They will serve as strong evidence to advocate for transparency and accountability mechanisms that guarantee more equitable access to health services. The authors argue that one of the important recommendations for preventing corruption in the health sector is investing in prevention as well as enforcing it: developing health system reforms and new health programs to reduce incentives and opportunities for corruption. The results showed that the method of statistical analysis is quite effective in the field of studying corruption. The study of the statistics of corruption crimes allows us to adequately characterize the level of corruption. The sources are statistical data of the Agency of the Republic of Kazakhstan for Combating Corruption, the Bureau of National Statistics, data from international organizations.

Since Singapore became an independent nation in 1965, the development of its health-care system has been underpinned by an emphasis on personal responsibility for health, and active government intervention to ensure access and affordability through targeted subsidies and to reduce unnecessary costs. Singapore is achieving good health outcomes, with a total health expenditure of 4·47% of gross domestic product in 2016. However, the health-care system is contending with increased stress, as reflected in so-called pain points that have led to public concern, including shortages in acute hospital beds and intermediate and long-term care (ILTC) services, and high out-of-pocket payments. The main drivers of these challenges are the rising prevalence of non-communicable diseases and rapid population ageing, limitations in the delivery and organisation of primary care and ILTC, and financial incentives that might inadvertently impede care integration. To address these challenges, Singapore's Ministry of Health implemented a comprehensive set of reforms in 2012 under its Healthcare 2020 Masterplan. These reforms substantially increased the capacity of public hospital beds and ILTC services in the community, expanded subsidies for primary care and long-term care, and introduced a series of financing health-care reforms to strengthen financial protection and coverage. However, it became clear that these measures alone would not address the underlying drivers of system stress in the long term. Instead, the system requires, and is making, much more fundamental changes to its approach. In 2016, the Ministry of Health encapsulated the required shifts in terms of the so-called Three Beyonds-namely, beyond health care to health, beyond hospital to community, and beyond quality to value.

Private equity (PE) is increasing its role in healthcare financing and may be a source of strategic funding for orthopaedic practice groups. With acquisitions in other medical specialties such as dermatology and ophthalmology, PE works to increase operating efficiency and cut costs. Orthopaedic practices' access to revenue through ancillary services and ambulatory surgery centers, coupled with a growing, aging cohort, make them an attractive candidate for PE acquisition. However, careful consideration is warranted before surgeons enter these partnerships to ensure patient safety, and the quality of care is not compromised because PE works to increase the return on their investment.

This paper aims to investigate the essence and method of building a financial model of healthcare in Russia. The author applies methods such as analysis and synthesis, statistical data processing, systemic and structural approaches. This article is an analysis of the basics of building a budgetary and insurance model: cost allocation (various types of medical care, individual costs) by funding sources; system of inter-budgetary relations; the structure of expenditures of the budgetary system of the Russian Federation on healthcare in 2019. The study presents the financial model of the compulsory medical insurance (СMI) system and defines the role of insurance and private medical organizations in the CMI system. The mechanism of financing state (public) healthcare institutions is shown. The procedure for financing medical organizations according to the territorial program is considered (as illustrated by the example of the Irkutsk region). The article analyzes the methodology for calculating the cost of the territorial program and identifies the problems associated with it. The author pays special attention to organizations that do not carry out activities in the field of compulsory medical insurance, outlining the specifics of financing and legal regulation, and arguing the reasons for excluding a number of diseases from the compulsory medical insurance program. The paper examines the content of the new law on the CHI reform, which provides for direct financing from the budget of the Federal CHI Fund of federal institutions providing specialized medical care. The author highlights the main problems of the building of the budgetary and insurance healthcare funding model such as congestion, inconsistency, cost intensity. The author concluded that it is necessary to revise the organization of the healthcare system and mechanisms for its financial support. The outstripping growth in healthcare costs, on the one hand, and inadequate funding of medical institutions, on the other, lead to a constant search for a compromise between equity and cost-effectiveness. Based on this, the author substantiated the goals and determined the directions for further research, such as reducing transaction costs, changing the motivation of participants, identifying cost growth factors and the possibility of eliminating them.

PurposeThe purpose of this study is to first assess how the US healthcare financing system is influenced by income variation. Then, it examines whether or not the impact of income variation is asymmetric.Design/methodology/approachFor the analyses of this paper, the autoregressive distributed lag (ARDL) model is implemented to a data set covering the period from 1960 to 2018.FindingsThe results provide evidence that major funding sources of aggregate healthcare expenditure (HCE) respond differently to changes in income. The results also imply that the effect of income is not always symmetric.Originality/valueMany studies have attempted to identify the relationship between income and HCE. A common feature of past studies is that they have only focused on aggregate HCE, while one might be interested in knowing how major funders of aggregate HCE would be affected by changes in income. Another common feature of past studies is that they have assumed that the relationship between income and HCE is symmetric.

Background Implementation researchers are increasingly using economic evaluation to explore the benefits produced by implementing evidence-based practices (EBPs) in healthcare settings. However, the findings of typical economic evaluations (e.g., based on clinical trials) are rarely sufficient to inform decisions about how health service organizations and policymakers should finance investments in EBPs. This paper describes how economic evaluations can be translated into policy and practice through complementary research on financing strategies that support EBP implementation and sustainment. Main body We provide an overview of EBP implementation financing, which outlines key financing and health service delivery system stakeholders and their points of decision-making. We then illustrate how economic evaluations have informed decisions about EBP implementation and sustainment with three case examples: (1) use of Pay-for-Success financing to implement multisystemic therapy in underserved areas of Colorado, USA, based in part on the strength of evidence from economic evaluations; (2) an alternative payment model to sustain evidence-based oncology care, developed by the US Centers for Medicare and Medicaid Services through simulations of economic impact; and (3) use of a recently developed fiscal mapping process to collaboratively match financing strategies and needs during a pragmatic clinical trial for a newly adapted family support intervention for opioid use disorder. Conclusions EBP financing strategies can help overcome cost-related barriers to implementing and sustaining EBPs by translating economic evaluation results into policy and practice. We present a research agenda to advance understanding of financing strategies in five key areas raised by our case examples: (1) maximize the relevance of economic evaluations for real-world EBP implementation; (2) study ongoing changes in financing systems as part of economic evaluations; (3) identify the conditions under which a given financing strategy is most beneficial; (4) explore the use and impacts of financing strategies across pre-implementation, active implementation, and sustainment phases; and (5) advance research efforts through strong partnerships with stakeholder groups while attending to issues of power imbalance and transparency. Attention to these research areas will develop a robust body of scholarship around EBP financing strategies and, ultimately, enable greater public health impacts of EBPs.

The increasing chronicity and multimorbidities associated with people living with HIV have posed important challenges to health systems across the world. In this context, payment models hold the potential to improve care across a spectrum of clinical conditions. This study aims to systematically review the evidence of HIV performance-based payments models. Literature searches were conducted in March 2020 using multiple databases and manual searches of relevant papers. Papers were limited to any study design that considers the real-world utilisation of performance-based payment models applied to the HIV domain. A total of 23 full-text papers were included. Due to the heterogeneity of study designs, the multiple types of interventions and its implementation across distinct areas of HIV care, direct comparisons between studies were deemed unsuitable. Most evidence focused on healthcare users (83%), seeking to directly affect patients' behaviour based on principles of behavioural economics. Despite the variability between interventions, the implementation of performance-based payment models led to either a neutral or positive impact throughout the HIV care continuum. Moreover, this improvement was likely to be cost-effective or, at least, did not compromise the healthcare system's financial sustainability. However, more research is needed to assess the durability of incentives and its appropriate relative magnitude.La creciente cronicidad y multimorbilidades asociadas con las personas que viven con el VIH han planteado importantes desafíos para los sistemas de salud en todo el mundo. En este contexto, los modelos de pago tienen el potencial de mejorar la atención en un espectro de condiciones clínicas. Este estudio tiene como objetivo revisar sistemáticamente la evidencia de los modelos de pagos basados ​​en el desempeño aplicados al dominio del VIH. Las búsquedas bibliográficas se realizaron en marzo de 2020 utilizando múltiples bases de datos y búsquedas manuales de artículos relevantes. Los artículos se limitaron a cualquier diseño de estudio que considere la utilización en el mundo real de modelos de pago basados ​​en el desempeño aplicados al dominio del VIH. Se incluyeron un total de 23 artículos de texto completo. Debido a la heterogeneidad de los diseños de los estudios, los múltiples tipos de intervenciones y su implementación en distintas áreas de la atención del VIH, las comparaciones directas entre diferentes estudios se consideraron inadecuadas. La mayoría de la evidencia se centró en los usuarios de la salud (83%), buscando afectar directamente el comportamiento de los pacientes basándose en los principios de la economía del comportamiento. A pesar de la variabilidad entre las intervenciones, la implementación de modelos de pago basados ​​en el desempeño generó un impacto neutral o positivo en todo el proceso de atención del VIH. Además, es probable que esta mejora sea costo-efectiva o, al menos, no comprometa la sostenibilidad financiera del sistema de salud. Sin embargo, se necesita más investigación para evaluar la durabilidad de los incentivos y su magnitud relativa apropiada.

Economist Peter Heller, writing a seminal paper published in Health, Policy and Planning in 2006, identified five opportunities for expanding fiscal space for health: raising revenue, reprioritizing expenditure, borrowing, using seigniorage and mobilizing external grants. The development of the initial framework marked a significant conceptual advancement in health financing, by situating health reforms within a broader macro-fiscal context. Fifteen years later, fiscal space for health is not viewed simply as a question of finding additional revenues but also as a matter of improving public financial management (PFM) in the health sector, specifically for publicly funded health systems. This paper advances the concept of budgetary space for health, which explores available resources generated through greater overall public expenditure, prioritized budget allocations, and improved PFM. The paper adds a critical component, unpacking the ways through which PFM improvements can maximize budgetary space for health. The approach fits the realities of public finances in the era of the Sustainable Development Goals. The key implication is that PFM aspects should be systematically included in assessments of budgetary space to inform more effective country dialogues between the finance and health sectors.

In India, most healthcare expenses are patients' out-of-pocket payments to private sector providers. Catastrophic health expenditures drive millions of families deeper into poverty. To save poorer households, hundreds of government-funded health insurance schemes have been introduced since the 2000s. These "demand side" schemes suggest that treatments in the private sector will be fully reimbursed. Fieldwork in one of India's largest hospitals shows that GFHIs overpromise. GFHIs are designed to turn patients into co-creators of healthcare value, but instead they deepen individuals' lack of market transparency. Poor patients pay the price for the state's lack of trust in them.

Összefoglaló. Bevezetés: A csípőtáji törések jelentősen terhelik az egészségügyi ellátórendszereket. Magyarországon 13 000–15 000 beteg szenved évente csípőtáji törést, jelentős részük műtéten is átesik. A betegek túlélését vizsgálták a EuroHOPE és BRIDGE kutatások, amelyek a Nemzeti Egészségbiztosítási Alapkezelőnek a finanszírozási célból gyűjtött, esetszintű adataira támaszkodtak. Az ilyen jellegű adatok megbízhatóságát több kutatás vizsgálta eltérő eredményekkel, ezért a további vizsgálatok előtt szükségesnek tartottuk a csípőtáji törésekre vonatkozóan is ellenőrizni őket. Célkitűzés: Egy magyarországi kórház reprezentatívan kiválasztott eseteinek vizsgálatán keresztül annak megállapítása, hogy a finanszírozási adatbázis adatai megfelelnek-e a betegdokumentációban rögzített adatoknak. Módszer: Egy magyarországi kórházba 2015-ben csípőtáji töréssel felvett betegek kórlapjainak anonim, reprezentatív mintáját összevetettük a EuroHOPE és BRIDGE kutatások adatbázisával tíz különböző adatelemre vonatkozóan. Az adatbázisokat rekordszinten párosítottuk, az egyezést adatelemre és rekordra vonatkozóan néztük. Eredmények: A reprezentatív minta 259 esetet tartalmazott. Az adatbázisok összevetése során nem találtunk eltérést a beteg neme, életkora, ápolást indokló fődiagnózisa és az osztályról történő távozás dátuma esetén. Egy eltérést találtunk az osztályos felvétel dátumában, a műtét dátumában öt darabot. A beteg további sorsa esetén tíz eltérést találtunk. A műtéttípusok esetén is alacsony mértékű (2–4 eset) eltérést tapasztaltunk. Jelentős mértékű eltérést a társbetegségek és a szövődmények esetén találtunk. Következtetés: Eredményeink alapján további vizsgálatokhoz felhasználhatók az alfanumerikus kódokat, számokat vagy dátumokat tartalmazó mezők (például fődiagnózis, felvételi és távozási dátumok), a társbetegségekre és a szövődményekre vonatkozó adatok azonban nem alkalmazhatók mélyebb elemzések során. Orv Hetil. 2021; 162(18): 712–719. Summary. Introduction: Hip fractures pose a heavy burden on healthcare systems. In Hungary, 13 000–15 000 patients experience hip fractures, most of them undergo surgery. Their survival was examined by the EuroHOPE and BRIDGE studies, using patient level data from the National Health Insurance Fund. Data from healthcare financing reports have been examined worldwide, with contradicting results, so we considered it necessary to observe data validity for hip fractures before further analysis. Objective: The aim of our study was to observe a representative sample of patient records in a Hungarian hospital in order to validate the finance reports. Method: We matched a representative sample of hip fracture patient records in a Hungarian hospital with hip fractures in 2015 with the database of the EuroHOPE and BRIDGE studies. The databases were matched on record level, the analysis included ten data fields and was conducted for data fields and records. Results: The sample included 259 cases. No differences were observed in the patients’ gender, age and main diagnosis, or dates of discharge. One difference was observed in the dates of admission, and 5 in the dates of surgery. Minor differences were found in the types of surgery (2–4 cases), but the differences between the databases in comorbidities and complications were large. Conclusion: Based on our results, we can conclude that data fields containing alphanumeric codes, numbers or dates (e.g., main diagnosis, admission, discharge and surgery dates) can be used for further analysis, but comorbidity and complication data are not recommended for research purposes. Orv Hetil. 2021; 162(18): 712–719.

In the coming years, about a dozen middle-income countries are excepted to transition out of development assistance for health (DAH) based on their economic growth. This anticipated loss of external funds at a time when there is a need for accelerated progress towards universal health coverage (UHC) is a source of concern. Evaluating country readiness for transition towards country ownership of health programmes is a crucial step in making progress towards UHC. We used in-depth interviews to explore: (1) the preparedness of the Nigerian health system to transition out of DAH, (2) transition policies and strategies that are in place in Nigeria, (3) the road map for the implementation of these policies and (4) challenges and recommendations for making progress on such policies. We applied Vogus and Graff’s expanded transition readiness framework within the Nigerian context to synthesize preparedness plans, gaps, challenges and stakeholders’ recommendations for sustaining the gains of donor-funded programmes and reaching UHC. Some steps have been taken to integrate and institutionalize service delivery processes toward sustainable immunization and responsive primary healthcare in line with UHC. There are ongoing discussions on integrating human immunodeficiency virus (HIV) services with other services and the possibility of covering HIV services under the National Health Insurance Scheme (NHIS). We identified more transition preparedness plans within immunization programme compared with HIV programme. However, we identified gaps in all the nine components of the framework that must be filled to be able to sustain gains and make significant progress towards country ownership and UHC. Nigeria needs to focus on building the overall health system by identifying systematic gaps instead of continuing to invest in parallel programmes. Programmes need to be consolidated within the overall health system, health financing priorities and policies. A comprehensive and functional structure will provide continuity even in the event of decreasing external funds or donor exits.

Background Out-of-pocket (OOP) payments for healthcare have been increasing steadily in Bangladesh, which deteriorates the financial risk protection of many households. Methods We aimed to investigate the incidence of catastrophic health expenditure (CHE) and impoverishment from OOP payments and their determinants. We employed nationally representative Household Income and Expenditure Survey 2016 data with a sample of 46 076 households. A household that made OOP payments of >10% of its total or 40% of its non-food expenditure was considered to be facing CHE. We estimated the impoverishment using both national and international poverty lines. Multiple logistic models were employed to identify the determinants of CHE and impoverishment. Results The incidence of CHE was estimated as 24.6% and 10.9% using 10% of the total and 40% of non-food expenditure as thresholds, respectively, and these were concentrated among the poor. About 4.5% of the population (8.61 million) fell into poverty during 2016. Utilization of private facilities, the presence of older people, chronic illness and geographical location were the main determinants of both CHE and impoverishment. Conclusion The financial hardship due to OOP payments was high and it should be reduced by regulating the private health sector and covering the care of older people and chronic illness by prepayment-financing mechanisms.

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin disease that significantly impairs quality of life. There are high direct and indirect financial burdens associated with HS, which may compel patients to turn to online crowdfunding for assistance covering HS-related costs. Crowdfunding is the financing of a specific initiative by pooling many smaller donations from numerous individuals, and has previously been used to fund dermatologic care.

OBJECTIVES To explore contextual factors associated with overall dental service use, and investigate whether these factors influenced choice of the type of service according to the healthcare financing alternatives (public services; out-of-pocket services; and private health insurance), by adults and older individuals, based on the most recent Andersen's behavioural model. METHODS Cross-sectional study with individual data on 17,305 adults from 177 Brazilian municipalities in the National Oral Health Survey (SBBrasil 2010). Municipal-level information was obtained from health information systems and census data. Multilevel multinomial logistic regression was carried out for multivariable analysis. RESULTS In the previous year, 38.2% of the individuals visited the dentist; of which 21.4% used out-of-pocket spending, 11.6% used public services and 5.2% private dental insurance. Municipalities with population coverage of public primary dental care >80% had higher chances of using public services (OR = 1.28, 95%CI:1.00-1.64) than those with ≤60%, but lower chances of using private insurance (OR = 0.56, 95%CI:0.38-0.83). Municipalities with population coverage of private dental insurance > 5% had lower chances of using public services (OR = 0.62, 95%CI:0.47-0.81) than those with

In this paper we adopt a growth accounting projection model to estimate and characterize health-financing needs in Brazil as well as to assess the extent to which financing needs may diverge from spending capacity in the future. We estimate an annual increase of 0.71% in the share of projected financing needs relative to GDP, with excess growth rates being 0.74% and 0.69% for the public and private health sectors, respectively. Institutional reforms and public spending restrictions may leverage public-private segmentation in health financing throughout the next decades, thus potentially leading to losses of equity in the system. Our projections contribute to a scant empirical literature on health financing sustainability in low- and middle-income countries and shed light on the role of spending capacity and institutional constraints over the path towards universal health coverage.

Community health workers play a critical role in providing both essential health services and pandemic response. Community health demonstrates a strong return on investment, but funding for this sector is limited and fragmented. Understanding the underlying costs of a community health system is crucial for both planning and policy; the data demonstrate a strong investment case., Key Messages Community health workers (CHWs) play a critical role in bridging the huge human resources for health gap while providing both essential health services and pandemic response. The case for investment is strong but funding for this sector is limited and fragmented. The current funding gap for at scale CHW program in sub-Saharan Africa has increased from an estimated US$3.1 billion to US$5.4 billion annually but is still cost effective as the cost per capita remains low (US$1.50–US$13.00). To close this funding gap, political prioritization, supportive policies, programs designed to deliver, and reducing fragmentation of existing resources will be critical. Governments can achieve universal health coverage targets by building community health systems that are people centered and quality oriented. Funders should also take a systems approach and focus their investments toward building resilient and sustainable platforms of delivery.

Background and Aims More than 292 million people are living with hepatitis B worldwide and are at risk of death from liver cirrhosis and liver cancer. The World Health Organization (WHO) has set global targets for the elimination of viral hepatitis as a public health threat by 2030. However, current levels of global investment in viral hepatitis elimination programmes are insufficient to achieve these goals. Methods To catalyse political commitment and to encourage domestic- and international-financing, we used published modelling data and key stakeholder interviews to develop an investment framework to demonstrate the return on investment for viral hepatitis elimination. Results The framework utilizes a public health approach to identify evidence-based national activities that reduce viral hepatitis-related morbidity and mortality, as well as international activities and critical enablers that allow countries to achieve maximum impact on health outcomes from investment to achieve WHO 2030 elimination targets. Conclusion Focusing on hepatitis B, this health policy paper employs the investment framework to estimate the substantial economic benefits of investing in the elimination of hepatitis B and demonstrates how such investments could be cost-saving by 2030., Graphical abstract, Highlights • The WHO has set global targets for elimination of hepatitis B by 2030 • To date, global investment in hepatitis B elimination activities has been limited • We have developed a global investment framework for the elimination of hepatitis B to guide domestic and international investment • This Health Policy paper outlines evidence to support the financial returns on investment in hepatitis B elimination, identifies national and international activities to achieve hepatitis B elimination targets and identifies potential funding sources • The goal of this investment framework is to pave the way for countries to build the economic case for investment in national hepatitis B elimination programmes.

The aim:to conduct a comparative analysis of the dynamics of health expenditures from GDP, cash expenditures of families and public expenditures on health in Ukraine, Poland and the countries of the WHO European Region. Materials and methods. The object of the research was the data of the WHO European Office. Historical, analytical-comparative, systemic, logical, graphic, mathematical-statistical and other research methods were used. Research results. It was found that all indicators of the analysis in Ukraine had an unstable character of changes in the years dynamics. Since 1995, Poland and European countries have seen a systematic increase in total health spending (%) of the country's GDP. The indicator of out-of-pocket expenses of families on medical and pharmaceutical support in Ukraine was significantly higher than in Poland and European countries, and its average values in Ukraine were 1.5 times higher than in Poland. In 2014, this indicator reached its maximum (46.2 %) against the background of an increase in government spending (%) of total health spending (from 11.9 % to 12.7 %). In 2014, this indicator exceeded similar values in Poland by 2.0 times and 1.7 times in European countries. In contrast, in Poland, the out-of-pocket expenses of families on medical and pharmaceutical support have been steadily decreasing from 30.0 % to 22.1 %, and since 2010 they have been lower than in European countries. According to government spending as a percentage of total health spending in Europe and Poland, there was a trend towards a gradual increase from 11.0 % to 13.2 % (European countries) and from 8.2 % to 10.7 % (Poland). The corresponding Ukrainian data were higher than in Poland and lower than in European countries (from 10.8 % to 11.4 %). Against the background of the unstable nature of the dynamics of changes in indicators characterizing the participation of the state in financing health care in Ukraine, since 2005, there has been an increase in the cash expenditures of Ukrainian families for relevant needs. As a result of systemic transformations in Poland, on the threshold of its accession to the EU (May 1, 2004), since 2005, there has been a decrease in the out-of-pocket expenditures of families against the background of a slight increase in % of public spending on health care. Conclusions.The unstable nature of the dynamics of changes in domestic indicators, in comparison with similar data that was observed in Poland and the countries of the WHO European Region, suggests the need to introduce more decisive actions, which should lead to a reformatting of the role of the state in financing the health system

Medicare is a publicly funded healthcare system that is a source of national pride in Canada; however, Canadians are increasingly concerned about its performance and sustainability. One proposed solution is private financing (including both private for-profit insurance and private out-of-pocket financing) that would fundamentally change medicare. We investigate international experiences to determine if associations exist between the degree of private spending and two of the core values of medicare – universality and accessibility – as well as the values of equity and quality. We further investigate the impact of private spending on overall health system performance, health outcomes and health expenditure growth rates. Private financing (both private for-profit insurance and private out-of-pocket financing) was found to negatively affect universality, equity, accessibility and quality of care. Increased private financing was not associated with improved health outcomes, nor did it reduce health expenditure growth. Therefore, increased private financing is not the panacea proposed for improving quality or sustainability. The debate over the future of medicare should not be rooted in the source of its funding but rather in the values Canadians deem essential for their healthcare system.

Objective The purpose of this study was to review changes in public health finance since the 2012 Institute of Medicine (IOM) report "For the Public's Health: Investing in a Healthier Future." Design Qualitative study involving key informant interviews. Setting and participants Purposive sample of US public health practitioners, leaders, and academics expected to be knowledgeable about the report recommendations, public health practice, and changes in public health finance since the report. Main outcome measures Qualitative feedback about changes to public health finance since the report. Results Thirty-two interviews were conducted between April and May 2019. The greatest momentum toward the report recommendations has occurred predominantly at the state and local levels, with recommendations requiring federal action making less progress. In addition, much of the progress identified is consensus building and preparation for change rather than clear changes. Overall, progress toward the recommendations has been slow. Conclusions Many of the achievements reported by respondents were characterized as increased dialogue and individual state or local progress rather than widespread, identifiable policy or practice changes. Participants suggested that public health as a field needs to achieve further consensus and a uniform voice in order to advocate for changes at a federal level. Implications for policy and practice Slow progress in achieving 2012 IOM Finance Report recommendations and lack of a cohesive voice pose threats to the public's health, as can be seen in the context of COVID-19 emergency response activities. The pandemic and the nation's inadequate response have highlighted deficiencies in our current system and emphasize the need for coordinated and sustained core public health infrastructure funding at the federal level.

The publication is aimed at defining problems and directions for improving the program-target method in the healthcare during the reform of this industry sector. The article analyzes the program-target method and its use in the planning of expenditures in the field of healthcare, the process of implementation of budget programs in this sphere in the Zhytomyr region. It is determined that the program-target method is important in the formation of healthcare expenditures, but it can potentially further increase the effectiveness of the distribution of budget funds. Despite the actual reduction of healthcare expenditures in the structure of consolidated budget expenditures, the introduction of the target method has inluenced the rational use of budget funds in the field of healthcare. This indicates the feasibility of this method in the budget process. The problems of the program-target method in the formation of healthcare expenditures are substantiated, the main of which are: the lack of medium- and long-term budget planning, a large number of budget programs, the lack of financial indicators in the system of effective indicators, reducing the level of healthcare expenditures. It is proposed: to introduce medium- and long-term budget planning, which will allow to clearly form the targets and results of budget programs in the field of healthcare for several years and consolidate financial resources for the specified targets; to develop a system of financial indicators within the system of effective indicators, which will be based on the expenditures of budget funds for the patient, to form the prerequisites for saving budget funds.

Health prepayment, a key indicator under the Sustainable Development Goals monitoring framework, is strongly associated with household financial protection; however, the impact of government health budget on the level of prepayment has rarely been discussed.To address the following research questions. (1) Does a higher government health budget translate into higher prepayment rates in the healthcare financing system? (2) What are the effects of government health budget on public prepayment and private prepaid plans? (3) What are the heterogeneities between groups of countries with different income levels and public health prepayment systems?Analysis of panel co-integration, impulse response function, and variance decomposition were conducted in 34 Organisation for Economic Co-operation and Development (OECD) members for the period 1995-2016.Government health budget has a long-running equilibrium relationship with the level of public and total prepayment. However, a stable relationship could not be confirmed with private prepaid plans. Moreover, government health budget played a significant positive role in explaining the fluctuations in the total and public prepayments over a long time, that is, 51 and 37 periods, respectively. Considering differences between groups of countries, the impacts are greater for those with higher income levels and more public-dominated health-financing systems.Government health budget has a long-time relationship with the levels of both total prepaid expenditure and public prepayment. By contrast, it does not systematically crowd out private prepaid plans.أثر الميزانية الحكومية على مستويات الدفع المسبق في مجال الصحة: دلائل مستمدة من بلدان منظمة التعاون والتنمية في الميدان الاقتصادي.ينج تشانج، جاك فانيست، وينكينج بان، ليوي تشانج.يرتبط الدفع المسبق للحصول على الخدمات الصحية، وهو مؤشر رئيسي في إطار رصد أهداف التنمية المستدامة، بصورة وثيقة بالحماية المالية للأسر؛ غير أنه من النادر أن تجري مناقشة تأثير الميزانية الحكومية للصحة على مستويات الدفع المسبق.هدفت هذه الدراسة إلى الرد على الأسئلة البحثية التالية: (1) هل يُترجَم ارتفاع مخصصات الميزانية الحكومية للصحة إلى ارتفاع معدلات الدفع المسبق في نظام تمويل الرعاية الصحية؟ (2) ما هي آثار الميزانية الحكومية للصحة على خطط الدفع المسبق العامة وخطط الدفع المسبق الخاصة؟ (3) ما هي أوجه التفاوت بين مجموعات البلدان المختلفة من حيث مستويات الدخل ونُظُم الدفع المسبق في مجال الصحة العامة؟.أجري تحليل تآلف المجموعة، ووظيفة الاستجابة الاندفاعية، وتحليل التفكك التبايني في 34 عضواً في منظمة التعاون والتنمية في الميدان الاقتصادي خلال الفترة من 1995 وحتى 2016.هناك علاقة طويلة الأمد ومتوازنة بين الميزانية الحكومية للصحة ومستوى الدفع المسبق العام وإجمالي الدفع المسبق. ومع ذلك، لم يتسن تأكيد وجود علاقة مستقرة مع خطط الدفع المسبق الخاصة. وعلاوة على ذلك، فقد أدت الميزانية الحكومية للصحة دوراً إيجابياً هاماً في تفسير التقلبات في إجمالي الدفع المسبق والدفع المسبق العام على مدى فترة طويلة بلغت 51 و 37 دورة على التوالي. وبالنظر إلى الاختلافات بين مجموعات البلدان، فإن الآثار المترتبة تكتسي أهمية أكبر بالنسبة للبلدان التي لديها مستويات دخل أعلى ونُظُم تمويل صحي يهيمن عليها القطاع العام أكثر من أي قطاع آخر.هناك علاقة ممتدة بين الميزانية الحكومية للصحة ومستويات إجمالي الإنفاق المدفوع مقدماً والدفع المسبق العام على حد سواء. وعلى العكس من ذلك، فإن الميزانية الحكومية لا تتنافس مع خطط الدفع المسبق الخاصة.Impact du budget de l’État sur les niveaux de prépaiement pour les soins de santé : données probantes des pays membres de l’OCDE.Le prépaiement pour les soins de santé, un indicateur clé du cadre de suivi des objectifs de développement durable, est fortement associé à la protection financière des ménages ; toutefois, l’impact du budget public de la santé sur le niveau de prépaiement a rarement été examiné.Répondre aux questions de recherche suivantes. 1) Une augmentation du budget public de la santé se traduitelle par des taux de prépaiement plus élevés dans le système de financement des soins de santé ? 2) Quels sont les effets du budget public de la santé sur le prépaiement public et les systèmes privés de prépaiement ? 3) Quelles sont les hétérogénéités entre les groupes de pays ayant des niveaux de revenu et des systèmes de prépaiement de santé différents ?Pour la période 1995-2016, 34 membres de l'Organisation de coopération et de développement économiques (OCDE) ont procédé à une analyse de la co-intégration des panels, de la fonction de réponse impulsive et de la décomposition des variances.Le budget public de la santé est depuis longtemps en équilibre avec le niveau des prépaiements publics et totaux. Cependant, une relation stable n'a pas pu être confirmée avec les systèmes privés de prépaiement. En outre, le budget de la santé a joué un rôle positif important en expliquant les fluctuations de l’ensemble des prépaiements et des prépaiements publics sur une longue période, c'est-à-dire 51 et 37 périodes, respectivement. Compte tenu des différences entre groupes de pays, les impacts sont plus importants pour ceux dont les niveaux de revenu sont plus élevés et dont les systèmes de financement de la santé sont plus à dominante publique.Le budget public de la santé est lié depuis longtemps aux niveaux du total des dépenses prépayées et des prépaiements publics. En revanche, il ne permet pas de supplanter systématiquement les systèmes privés de prépaiement.

Background Health insurance is an important mechanism to prevent financial hardship in the process of accessing health care. Since the launch of Nigeria’s National Health Insurance Scheme (NHIS) in 2005, only 5% of Nigerians have health insurance and 70% still finance their healthcare through Out-Of-Pocket (OOP) expenditure. Understanding the contextualized perspectives of stakeholders involved in NHIS is critical to advancing and implementing necessary reforms for expanding health insurance coverage at national and sub-national levels in Nigeria. This study explored the perspectives of sub-national level actors/stakeholders on the design and implementation challenges of Nigeria’s NHIS. Methods A descriptive case study design was used in this research. Data were collected in Ibadan, Oyo State in 2016 from health insurance regulators, healthcare providers, and policymakers. Key informant interviews (KII) were conducted among purposively selected stakeholders to examine their perspectives on the design and implementation challenges of Nigeria’s National Health Insurance Scheme. Data were analysed using inductive and deductive thematic approaches with the aid of NVIVO software package version 11. Results Implementation challenges identified include abject poverty, low level of awareness, low interest (in the scheme), superstitious beliefs, inefficient mode of payment, drug stock-out, weak administrative and supervisory capacity. The scheme is believed to have provided more coverage for the formal sector, its voluntary nature and lack of legal framework at the subnational levels were seen as the overarching policy challenge. Only NHIS staff currently make required financial co-contribution into the scheme, as all other federal employees are been paid for by the (federal) government. Conclusions Sub-national governments should create legal frameworks establishing compulsory health insurance schemes at the subnational levels. Effective and efficient platforms to get the informal sector enrolled in the scheme is desirable. CBHI schemes and the currently approved state supported health insurance programmes may provide a more acceptable platform than NHIS especially among the rural informal sector. These other two should be promoted. Awareness and education should also be raised to enlighten citizens. Stakeholders need to address these gaps as well as poverty.

This article explores longitudinal trends of healthcare financing and mortality levels among the children under 5 (U5) years of age in the BRICS nations between 2000 and 2015. This analysis is based on the relevant secondary data obtained from the WHO data repository and various other publicly available sources. Inferential statistical tools like linear regression analysis was carried out to test the relationship between dependent and independent variables. The results indicate an inverse relationship between current health expenditure and U5 child deaths, revealing a decline of 29,000 U5 child deaths and 19,000 infant deaths for every US$1increase in per capita healthcare expenditure. Further, neonatal deaths declined by 1.74% and infant deaths 2.8%, while U5 child deaths declined by 4.6% per annum. India spends lowest among the BRICS nations—about US$63 per capita, while out-of-pocket expenditure (OOPE) is highest at 69.3%. Countries with higher per capita government health expenditure have better health indicators. This article, therefore, calls for strengthening public investment in healthcare to improve health outcomes.

Singapore's health system generates similar levels of health outcomes as does Sweden's but for only 4.4% rather than 11.0% of gross domestic product, with Singapore's resulting health sector savings being re-directed to help fund both long-term care and retirement pensions for its elderly citizens. This paper contrasts the framework of financial risk-sharing and the configuration and management of health service providers in these two high-income, small-population countries. Two main institutional distinctions emerge from this country case comparison: (1) Key differences exist in the practical configuration of solidarity for payment of health care services, reflecting differing cultural roots and social expectations, which in turn carry substantial implications for financing long-term care and pensions. (2) Differing arrangements exist in the organization of health service institutions, in particular balancing public as against private sector responsibilities for owning, operating and managing these two countries' respective hospitals. These different structural characteristics generate fundamental differences in health sector financial and delivery outcomes in one developed country in Far East Asia as compared with a well-respected tax-funded health system in Western Europe. In the post-COVID era, as Western European policymakers find themselves forced to adjust their publicly funded health systems to (further) reductions in economic growth rates and overall tax receipts, and as the cost of the information revolution continues to rise while efforts to fund better coordinated social and home care services for growing numbers of chronically ill elderly remain inadequate, this two-country case comparison highlights a series of health system design questions that could potentially provide alternative health sector financing and service delivery strategies.

This article examines how alternate-level-of-care (ALC) days are funded through the cancer surgery funding model in Ontario and evaluates policy options to better address ALC days. The contribution of ALC days to hospital funding and the impact of removing or reallocating this funding from cancer surgery is measured. Though costs associated with ALC days in cancer surgery are low, this article highlights the need for policy options that would realign funding across the healthcare system in Ontario to better meet the needs of patients waiting for ALC, reduce pressure on inpatient bed capacity and improve value for money.

Background Research output on global neurosurgery (GNS) has exponentially increased in recent years. As research efforts increase, we must first analyze how the current body of GNS literature fits into the macroscopic schema of systems-based policies. The aim of this study was to identify and categorize GNS research based on health system domains. Methods PubMed, CINAHL, and Embase were searched for GNS literature published from 1999 to 2019. Then, health system domains were defined and itemized based on publicly available documents from the Program in Global Surgery and Social Change. This items chart was subsequently used to categorize the GNS literature into health system domains. Results A total 63 articles were determined to focus on a health system domain. Of these articles, 6 focused on multiple domains, yielding an adjusted total of 70 articles. Overall, the most represented health system domain was service delivery (21 articles), followed by workforce (19), infrastructure (15), financing (12) and information management (3). A total of 30 low- and middle-income countries (LMICs) were represented across all articles. In addition, the first author was affiliated with an institution from a high-income country for 71.4% of the articles. Conclusions This review highlighted the pressing need for more research into information management in the context of GNS. In addition, health system–focused GNS literature represented only 20% of all LMICs (30/143). The trends in authorship should be noted, because many ethical (and practical) issues may arise if there is a disconnect in the objectives of the authors and the neurosurgeons in LMICs.

Purpose: The objective of the paper is to review historical developments and the current setup of healthcare financing models in Central Europe. Methodology: A systematic narrative approach has been taken with the research emphasis on a critical literature review and analyses of healthcare spending statistical data. Findings: A comparison between different models currently in place seems to suggest the existence of patterns leading to improved quality of the healthcare service proposition that is critically impacted by a financing model. Implications: The findings have practical implications since different results have been achieved in countries choosing different models but starting from practically the same point. That realisation should serve as a foundation for further work on this subject, potentially leading to adjustments to financing models chosen by some countries. Value: The paper offers a comparative analysis of the healthcare system financing evolution in four Central European Countries and an overview of their current state.

Limited availability and accessibility of the public health care facilities have resulted in an increased burden of financing healthcare in developing countries. Therefore, we analyse the inpatient-care financing strategies in India using healthcare and morbidity rounds (1994/1995, 2004, and 2014). Although income and saving is the predominant source of financing healthcare expense constituting a major channel in 70% of the inpatient episodes; the poorest 40% of the households rely more on borrowings, which pushes low-income families into debt and poverty trap. The educated, wealthy, and female tend to rely more on income/saving, while a greater number of visits to the hospital, long duration of stay, and chronic illness are positively associated with the borrowing and sales of assets. Hence, the health care policy, guided by the agenda of Universal Health Cover, should aim to extend health insurance for the chronic recurring illnesses that entail distressed financing strategies.

Community health worker (CHW)-led community delivery of HIV antiretroviral therapy (ART) could increase ART coverage and decongest healthcare facilities. It is unknown how much patients would be willing to pay to receive ART at home and, thus, whether ART community delivery could be self-financing. Set in Dar es Salaam, this study aimed to determine patients’ willingness to pay (WTP) for CHW-led ART community delivery. We sampled ART patients living in the neighbourhoods surrounding each of 48 public-sector healthcare facilities in Dar es Salaam. We asked participants (N = 1799) whether they (1) preferred ART community delivery over standard facility-based care, (2) would be willing to pay for ART community delivery and (3) would be willing to pay each of an incrementally increasing range of prices for the service. 45.0% (810/1799; 95% CI: 42.7—47.3) of participants preferred ART community delivery over standard facility-based care and 51.5% (417/810; 95% CI: 48.1—55.0) of these respondents were willing to pay for ART community delivery. Among those willing to pay, the mean and median amount that participants were willing to pay for one ART community delivery that provides a 2-months’ supply of antiretroviral drugs was 3.61 purchasing-power-parity-adjusted dollars (PPP$) (95% CI: 2.96–4.26) and 1.27 PPP$ (IQR: 1.27–2.12), respectively. An important limitation of this study is that participants all resided in neighbourhoods within the catchment area of the healthcare facility at which they were interviewed and, thus, may incur less costs to attend standard facility-based ART care than other ART patients in Dar es Salaam. While there appears to be a substantial WTP, patient payments would only constitute a minority of the costs of implementing ART community delivery. Thus, major co-financing from governments or donors would likely be required.

Background Social media has globalised compassion enabling requests for donations to spread beyond geographical boundaries. The use of social media for medical crowdfunding links people with unmet healthcare needs to charitable donors. There is no doubt that fundraising campaigns using such platforms facilitates access to financial resources to the benefit of patients and their caregivers. Main text This paper reports on a critical review of the published literature and information from other online resources discussing medical crowdfunding and the related ethical questions. The review highlighted the benefits of crowdfunding as well as the under-exploration of the risk of having patients’ desires and human rights undermined during online fundraising campaigns. Majority of these campaigns get initiated on behalf of the patients, especially the very sick and dependant. The ethical questions raised relate to the voluntariness of informed consent and the possibility of patients being used as a means to an end. Vulnerability of patients may expose them to coercion, undue influence, manipulation, and violation of their human rights. The success of these campaigns is influenced by the digital skills, pre-existing social networks and, the emotional potency. Healthcare is a public good, and online market forces should not determine access to essential health services. The benefits of crowdfunding cannot be subverted, but it can perpetuate unintended injustices, especially those arising from socio-economic factors. Conclusions Policymakers ought to monitor the utilisation of crowdfunding sites to identify policy failures and unmet essential health care needs responsible for driving individuals to use these platforms. The upholding of human rights and the fundamental respect of the individual’s wishes is a moral imperative. The need for an ethics framework to guide different stakeholders during medical crowdfunding needs further examination.

Background The world aims to achieve universal health coverage by removing all forms of financial barriers to improve access to healthcare as well as reduce maternal and child deaths by 2030. Although free maternal healthcare has been embraced as a major intervention towards this course in some countries in sub-Saharan Africa (SSA), the perception of the quality of healthcare may influence utilization and maternal health outcomes. We systematically mapped literature and described the evidence on maternal perceptions of the quality of care under the free care financing policies in SSA. Methods We employed the Arskey and O’Malley’s framework to guide this scoping review. We searched without date limitations to 19th May 2019 for relevant published articles in PubMed, Google Scholar, Web of Science, Science Direct, and CINAHL using a combination of keywords, Boolean terms, and medical subject headings. We included primary studies that involved pregnant/post-natal mothers, free maternal care policy, quality of care, and was conduct in an SSA country. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted and organized into themes and a summary of the results reported narratively. The recent version of the mixed methods appraisal tool was used to assess the methodological quality of the included studies. Results Out of 390 studies, 13 were identified to have evidence of free maternal healthcare and client perceived quality of care. All the 13 studies were conducted in 7 different countries. We found three studies each from Ghana and Kenya, two each in Burkina Faso and Nigeria, and a study each from Niger, Sierra Leone, and Tanzania. Of the 13 included studies, eight reported that pregnant women perceived the quality of care under the free maternal healthcare policy to be poor. The following reasons accounted for the poor perception of service quality: long waiting time, ill-attitudes of providers, inadequate supply of essential drugs and lack of potable water, unequal distribution of skilled birth attendants, out-of-pocket payment and weak patient complaint system. Conclusion This study suggests few papers exist that looked at maternal perceptions of the quality of care in the free care policy in SSA. Considering the influence mothers perceptions of the quality of care can have on future health service utilisation, further studies at the household, community, and health facility levels are needed to help unearth and address all hidden quality of care challenges and improve maternal health services towards attaining the sustainable development goals on maternal and child health.

Background How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system. Methods We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no = 20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data. Results Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of funds: Public hospitals relied on user fees, while health centers relied on donor funds as their main sources of funding. Funding flows: Hospitals in four of the five study counties had no financial autonomy. Health centers in all study counties had financial autonomy. Flow of funds to hospitals and health centers in all study counties was characterized by unpredictability of amounts and timing. Health facility expenditure: Staff salaries accounted for over 80% of health facility expenditure. This crowded out other expenditure and led to frequent stock outs of essential health commodities. Conclusion The national and county government should consider improving health facility financing in Kenya by 1) standardizing budgeting and planning processes, 2) transitioning public facility financing away from a reliance on user fees and donor funding 3) reforming public finance management laws and carry out political engagement to facilitate direct facility financing and financial autonomy of public hospitals, and 4) assess health facility resource needs to guide appropriate levels resource allocation.

Background: Performance-based financing (PBF) is promoted to improve the quality and quantity of healthcare services in low-income countries. Despite the complexity of the intervention, little attention has been given to studying its unintended consequences. Our objective is to increase evidence on the unintended consequences of PBF in Burkina Faso. Methods: Using the diffusion of innovations theory, we conducted a multiple case study. The cases were 6 healthcare facilities in two districts. Between April 2015 and 2016, we collected data through 101 semi-structured interviews, discussions, observations, and documents. We conducted thematic analysis using a hybrid deductive-inductive approach. Secondary data was used to illustrate the evolution of reported services. We conducted a cross-case synthesis to identify the results arising independently from more than 1 case. Results: A desirable unintended consequence of PBF was that 3 facilities limited the sale of non-prescribed medication to encourage patients to consult. Undesirable unintended consequences were found in the majority of facilities including fixation on measures rather than on underlying objectives, the pursuit of narrow and less relevant performance indicators, gaming, and teaching trainees improper practices. Providers in all facilities deliberately manipulated medical registers and documents, such that the reported quantity and quality of care differed from what was actually delivered. While most participants indicated that PBF was more advantageous than previous practices, the long payment delays were a source of dissatisfaction and demotivation across all facilities. Dissatisfaction also emerged in relation to the distribution of subsidies and the non-attribution of quality points for services delivered by certain staff considered "unqualified" in guidelines. Results in many facilities revealed suboptimal planning, a perception of the intervention as "budgetivorous," as well as tensions related to the principle of managerial autonomy. Conclusion: PBF led to numerous unintended consequences that could undermine the intervention’s effectiveness. The findings contribute to a more comprehensive picture of the consequences of implementing PBF. Policy-makers can use the results of this study to devise effective strategies before, during and after the implementation of the intervention to minimize undesirable unintended consequences and promote desirable ones.

The aim of this paper is to assess the industry-wide impact of Long-Term Care (LTC) spending on the Spanish economy. LTC spending includes beneficiaries’ copayment and the impact is quantified in terms of output, employment and value added. To this purpose, we use an input–output model of the Spanish economy that allows us to further describe how the value added generated is distributed throughout the economy according to the existing benefit-mix (in kind services, cash benefit for informal care and cash benefit for personal assistance). Additionally, the model provides results on how the return on LTC spending would improve by using only in-kind services instead of the benefit mix currently in place. The 2012 Spanish Input–Output Table at current prices was extracted from the WIOD Database’s 2016 Release. Consumption data for dependent, employed, and unemployed households were collected from the Spanish Household Budget Survey for 2012. The findings reveal that the total annual costs are 7,205.43 million €, with total costs from in-kind services being almost 71% higher than total costs from cash benefits. Each million euros invested in in-kind services and CBPA would create 41.91 jobs (68.41% direct, 9.16% indirect and 22.43% induced). However, each million euros spent on cash benefits would result in 16.88 jobs overall (53.02% direct, 24.53% indirect and 22.45% induced). The total number of jobs is 151,353 at the aggregate level, being 46,840 depending on cash-benefits and 104,513 on in-kind services. Supplementary Information The online version contains supplementary material available at 10.1007/s10754-021-09310-9.

Primary health care offers a cost-effective route to achieving universal health coverage (UHC). However, primary health-care systems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primary health-care systems in 20 low- and middle-income countries using a semi-grounded approach. Options for strengthening primary health-care systems were identified by thematic content analysis. We found that: (i) despite the growing burden of noncommunicable disease, many low- and middle-income countries lacked funds for preventive services; (ii) community health workers were often under-resourced, poorly supported and lacked training; (iii) out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and (iv) health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in primary health care was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of primary health care. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. Policy-making should be supported by adequate resources for primary health-care implementation and government spending on primary health care should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of primary health-care management is also needed. Support from primary health-care systems is critical for progress towards UHC in the decade to 2030.Les soins de santé primaires offrent l'itinéraire le plus économique vers une couverture maladie universelle (CMU). Pourtant, les systèmes dont ils dépendent demeurent fragiles dans de nombreux pays à faible et moyen revenu. La plupart du temps, ils sont incapables de fournir un modèle de soins intégral, intégré et centré sur la personne. Nous avons donc analysé les systèmes de soins de santé primaires dans 20 pays à faible et moyen revenu en adoptant une approche partiellement basée sur la réalité. Les options de renforcement des systèmes de soins de santé primaires ont été identifiées par le biais d'une analyse de contenu thématique. Nous avons constaté que: (i) malgré le fardeau de plus en plus lourd des maladies non transmissibles, nombre de pays à faible et moyen revenu ne possédaient pas les fonds suffisants pour assurer des services de prévention; (ii) les professionnels de santé au sein des communautés manquaient fréquemment de ressources, de soutien et de formation; (iii) les frais non remboursables dépassaient 40% des dépenses de santé dans la moitié des pays étudiés, ce qui entraîne des inégalités; et enfin, (iv) les régimes d'assurance maladie étaient entravés par la fragmentation des systèmes publics et privés, le sous-financement, la corruption et la piètre mobilisation des travailleurs informels. Dans 14 pays, le secteur privé n'était pratiquement soumis à aucune réglementation. Par ailleurs, l'engagement communautaire dans les soins de santé primaires était dérisoire dans les États où les services étaient majoritairement privatisés. Dans certains pays, la décentralisation avait débouché sur une fragmentation des soins de santé primaires. Les performances se révélaient meilleures lorsque des avantages financiers avaient trait à la réglementation et à l'amélioration de la qualité, et l'implication était forte au sein de la communauté. Le processus d'élaboration des politiques devrait être accompagné des ressources nécessaires pour l'instauration d'un système de soins de santé primaires, et les gouvernements devraient accroître leurs dépenses en la matière d'au moins 1% du produit intérieur brut. Il est également impératif de définir des régimes de financement favorisant l'équité et de promouvoir la fiabilité de la gestion des soins de santé primaires. La contribution des systèmes de soins de santé primaires est essentielle à la progression vers une CMU à l'horizon 2030.La atención primaria de salud brinda una vía rentable para lograr la cobertura sanitaria universal (CSU). Sin embargo, los sistemas de atención primaria de salud son deficientes en muchos países de ingresos medios y bajos y con frecuencia no ofrecen una atención integral y centrada en las personas. Se analizaron los sistemas de atención primaria de salud en 20 países de ingresos medios y bajos mediante un enfoque semifundamentado. Se determinaron las alternativas para fortalecer los sistemas de atención primaria de salud por medio de un análisis de contenido temático. Se concluyó que: i) a pesar de la creciente carga de las enfermedades no transmisibles, muchos países de ingresos medios y bajos no disponían de fondos para los servicios preventivos; ii) con frecuencia los profesionales sanitarios de la comunidad carecían de recursos, de apoyo y de capacitación; iii) los gastos directos superaban el 40 % del gasto total en salud en la mitad de los países analizados, lo que afectaba a la equidad; y iv) los planes de seguro médico presentaban dificultades debido a la fragmentación de los sistemas públicos y privados, la falta de financiamiento, la corrupción y la escasa participación de los trabajadores informales. La mayor parte del sector privado de 14 países no estaba regulado. Además, la participación de la comunidad en la atención primaria de salud era muy reducida en los países donde los servicios estaban privatizados en gran medida. Por otra parte, la descentralización de la atención primaria de salud causó la fragmentación de la misma en algunos países. La rentabilidad mejoró cuando los incentivos financieros se vincularon con la regulación y el mejoramiento de la calidad, además de que la participación de la comunidad fue significativa. La formulación de las políticas debería contar con el apoyo de recursos suficientes para prestar los servicios de atención primaria de salud y el gasto público en atención primaria de salud debería aumentar por lo menos en un 1 % del producto interno bruto. Asimismo, es necesario elaborar planes de financiamiento que aumenten la equidad y mejoren la rendición de cuentas de la gestión de la atención primaria de salud. El apoyo de los sistemas de atención primaria de salud es fundamental para avanzar hacia la CSU de aquí a 2030.تقدم الرعاية الصحية الأولية وسيلة فعالة من حيث التكلفة لتحقيق تغطية صحية شاملة (UHC). إلا أن أنظمة الرعاية الصحية الأولية ضعيفة في العديد من البلدان منخفضة الدخل ومتوسطة الدخل، وغالبًا ما تفشل في توفير رعاية شاملة ومتكاملة ومرتكزة على الإنسان. قمنا بتحليل أنظمة الرعاية الصحية الأولية في 20 بلدًا منخفض الدخل ومتوسط الدخل باستخدام أسلوب شبه أساسي. تم تحديد خيارات لتعزيز أنظمة الرعاية الصحية الأولية من خلال تحليل المحتوى المواضيعي. توصلنا إلى ما يلي: (1) على الرغم من العبء المتزايد للأمراض غير المعدية، فإن العديد من البلدان منخفضة الدخل ومتوسطة الدخل افتقرت إلى أموال الخدمات الوقائية؛ و(2) كان العاملون في القطاع الصحي المجتمعي في كثير من الأحيان يعانون من نقص الموارد وضعف الدعم والافتقار إلى التدريب؛ و(3) تجاوز الإنفاق الشخصي 40% من إجمالي الإنفاق الصحي في نصف البلدان التي شملتها الدراسة، وهو ما أثر على العدالة؛ و(4) تعرضت أنظمة التأمين الصحي بسبب تجزئة الأنظمة العامة والخاصة، ونقص التمويل، والفساد، وضعف مشاركة العمال غير الرسميين. كان القطاع الخاص غير منظم بشكل كبير في 14 بلدًا. بالإضافة إلى ذلك، كانت مشاركة المجتمع في الرعاية الصحية الأولية ضعيفة في البلدان التي كانت الخدمات مخصخصة فيها إلى حد كبير. أدت اللامركزية في بعض البلدان إلى تجزئة الرعاية الصحية الأولية. تحسن الأداء عندما تم ربط الحوافز المالية بالتنظيم وتحسين الجودة، وكانت مشاركة المجتمع قوية. يجب دعم وضع السياسات بواسطة الموارد الكافية لتنفيذ الرعاية الصحية الأولية، كما يجب زيادة الإنفاق الحكومي على الرعاية الصحية الأولية بنسبة 1% على الأقل من الناتج المحلي الإجمالي. كما أن هناك حاجة إلى وضع مخططات تمويل لتعزيز العدالة، وتحسين المساءلة بخصوص إدارة الرعاية الصحية الأولية. يعد الدعم الناتج من أنظمة الرعاية الصحية الأولية أمرًا حيويًا لإحراز التقدم نحو تحقيق التغطية الصحية الشاملة (UHC) في العقد الحالي حتى عام 2030.初级卫生保健为实现全民健康覆盖 (UHC) 提供了一种经济有效的途径。然而在许多中低收入国家，初级卫生保健体系非常薄弱，常常无法提供全面的以人为本的综合保健。我们利用半扎根的研究方法分析了 20 个中低收入国家的初级卫生保健体系。通过分析主题内容确定了加强初级保健体系的备选方案。我们发现：(I) 尽管非传染性疾病负担日益沉重，但许多中低收入国家仍缺乏预防服务资金；(ii) 社区卫生工作者通常资源配备不足，无法获得良好的支持，并且缺乏相应培训；(iii) 在所研究的一半国家中，医疗自费超出卫生支出总额的 40％，不利于实现公平；(iv) 公共和私人体系分散、资金不足、腐败以及非正式员工参与不足，阻碍了健康保险计划的实施。14 个国家中，私营部门基本上不受监管。此外，服务基本私有化的国家，社区很少参与初级卫生保健。一些国家权力下放，促使其初级保健分散。当财政激励措施与法规和质量提升相结合，，并且社区参与度增强时，绩效便会有所改善。应该为初级卫生保健的决策制定提供充足的资源，并将政府在初级卫生保健方面的支出至少增加国内生产总值的 1％。还需要制定提升公平的融资方案，加强初级卫生保健管理的问责。初级卫生保健体系的支持对于在截止 2030 年的十年中实现 UHC 至关重要。.Первичная медико-санитарная помощь предлагает экономически эффективный метод обеспечения всеобщего охвата услугами здравоохранения (ВОУЗ). Тем не менее системы первичной медико-санитарной помощи слабо развиты во многих странах с низким и средним уровнем доходов и часто не способны обеспечить комплексное, ориентированное на людей медицинское обслуживание. Авторы проанализировали системы первичной медико-санитарной помощи в 20 странах с низким и средним уровнем доходов, используя метод полуобоснованной теории. Варианты укрепления систем первичной медико-санитарной помощи были определены в ходе анализа тематического содержания. Авторы выяснили следующее: (i) несмотря на растущее бремя неинфекционных заболеваний, многие страны с низким и средним уровнем доходов испытывают недостаток средств для профилактических услуг; (ii) работники здравоохранения на уровне сообществ часто не имеют достаточного количества ресурсов, поддержки и квалификации; (iii) расходы из собственных средств превышают 40% от общих расходов в сфере здравоохранения в половине исследованных стран, что способствует увеличению неравенства; (iv) работе схем медицинского страхования препятствует раздробленность государственных и частных систем, недостаток финансирования, коррупция и низкая степень участия неофициальных работников. В 14 странах частный сектор практически не регулировался. Более того, участие населения в первичной медико-санитарной помощи было низким в странах со значительной степенью приватизации услуг. В некоторых странах децентрализация привела к раздробленности сферы первичной медико-санитарной помощи. Показатели улучшились, когда финансовое стимулирование было связано с регулированием и повышением качества услуг, а также активным участием местного населения. Формирование политики должно подкрепляться соответствующими ресурсами для реализации первичной медико-санитарной помощи, а государственные расходы на первичную медико-санитарную помощь должны быть увеличены как минимум на 1% от валового внутреннего продукта. Также необходимо разработать схемы финансирования, способствующие уменьшению неравенства, и повысить подотчетность в управлении первичной медико-санитарной помощью. Поддержка со стороны систем первичной медико-санитарной помощи имеет решающее значение для достижения ВОУЗ в период до 2030 года.

Context Governments at all levels work to ensure a healthy public, yet financing, organization, and delivery of public health services differ across the United States. A 2012 Institute of Medicine Finance report provided a series of recommendations to ensure a high-performing and adequately funded public health infrastructure. Objectives This review examines the influence of the Finance report's 10 recommendations on public health policy and practice. Design This review utilized peer-reviewed and gray literature published since 2012. Eligibility criteria Documents that address at least one of the Finance report's 10 recommendations and contain information on either official actions taken in response to the Finance report or evidence of the report's influence on the practice community. Results Of 2394 unique documents found, a total of 56 documents met the eligibility criteria. Review of these 56 documents indicated that the most substantial activity related to the recommendations was focused on the "minimum package of public health services" concept and establishment of a uniform chart of accounts. Discussion Progress has been mixed on the Finance report recommendations. Improved tracking and auditing of public health activity appears to be advancing, yet financial benchmarks remain unmet. Challenges remain in determining actual investment in public health and equitable resource allocation approaches. State and local health department use of cost estimation methodology and a uniform chart of accounts tool has contributed to an increase in understanding and improvement in public health spending. Conclusions The Finance report has served as a strong impetus for advocating for an increased investment in governmental public health. Efforts are bolstered by informed public health practitioners and stakeholders but often stymied by policy makers who must balance complex competing issues and priorities. Although many successes have occurred, further work is needed toward improving investment in the nation's public health.

Background The current study examines self-reported professional practices and attitudes of Israeli neuropsychologists, in an attempt to understand how they contribute to funding of neuropsychological assessment (NPA) through the Israeli healthcare system. Methods Two hundred seventy-nine neuropsychologists (176 board-certified experts and 103 interns) participated in an online survey that targeted characteristics of NPA practice in Israel, attitudes toward NPA, and familiarity with healthcare referral procedures. Results Overall, 68% of respondents conducted NPA, with a smaller proportion of experts (56%) doing so than interns (88%). The most common purpose of NPA was to provide treatment recommendations, and respondents listed indications for NPA that matched indications for neuropsychological rehabilitation. Almost two thirds of respondents reported that none of the NPAs that they performed received healthcare funding. While all practitioners believed that the healthcare system should fund NPA, the majority demonstrated lack of familiarity with referral procedures. Conclusions To increase referral rates and create effective neuropsychological services within the Israeli healthcare system, neuropsychologists should work more closely with physicians in integrated care teams. In addition, they should engage in greater advocacy activities that will emphasize the need for publicly funded NPA.

Aims: This study examines the occurrence of various medical cases presented by enrollees that have subscribed to access healthcare from a network of healthcare providers (HCPs) managed by a Health Maintenance Organisation (HMO) under its Private Health Insurance Programme (PHIP). Study Design: A descriptive cross-sectional design was employed. Methodology: Secondary data from collected or submitted medical encounters in form of bills of registered enrollees (principals and their dependants) who have visited and received treatment from their chosen healthcare providers in Kaduna State between the month of January and December 2019 were purposively compiled and analysed. Cases were classified using the National Health Insurance Scheme (NHIS) Operational Guideline. Frequency tables, charts, percentages and Chi-Square analysis were used with the aid of Statistical Package for Social Sciences (SPSS) 22 at P=.05 level of significance. Results: A total of 11,156 medical cases were recorded after attrition, 9,525 (85.38%) primary cases and 1,632 (14.62%) secondary cases. Malaria (41.23%) and Respiratory Tract Infection (11.98%) led the primary case table while Hypertension (3.83%) Urology related cases (2.49%) and Diabetes (0.79%) were among the leading secondary cases. Female enrollees had slightly more cases and therefore higher tendencies to seek medical treatment than their male counterpart even though there was no significant relation between gender and type of case. Conclusion: The study concludes that the awareness and utilization of healthcare services are gradually growing among enrollees under the Private Health Insurance Programme (PHIP). In ensuring that there is an improvement in the health sector of Nigeria and achieving universal health coverage, focus should be on the primary healthcare services with high consideration for research, proper data management and periodic sharing of trends, observations and outcome of researches with the growing health community.

The sequence of systemic measures to combat the COVID-19 pandemic in Russia is described. Some other countries experience of providing the specialized trauma care in a pandemic has been summarized. Almost everywhere, strict measures of infection prevention and treatment were introduced in stages. To date, there are the following generally accepted measures: discontinuation of planned surgeries, screening of emergency patients on COVID-19 with the subsequent separation of patient flows, the maximum reduction of hospital stay length. The special attention should be paid to personal protective equipment. The organizational and medical measures necessary for prevention of such pandemics in the future are described, namely equipping sanitary triage posts, creating a stock of personal protective equipment and disinfectants, developing a plan for transforming general hospitals into hospitals for infectious patients with the allocation of a primary patient reception post and their subsequent distribution into the green or red zones. The importance of pre-operative bed day reduction, telemedicine technologies and the need of healthcare financing increase to solve the tasks are substantiated.

Background Corruption is widespread in Nigeria’s health sector but the reasons why it exists and persists are poorly understood and it is often seen as intractable. We describe a consensus building exercise in which we asked health workers and policy-makers to identify and prioritise feasible responses to corruption in the Nigerian health sector. Methods We employed three sequential activities. First, a narrative literature review identified which types of corruption are reported in the Nigerian health system. Second, we asked 21 frontline health workers to add to what was found in the review (based on their own experiences) and prioritise them, based on their significance and the feasibility of assessing them, by means of a consensus building exercise using a Nominal Group Technique (NGT). Third, we presented their assessments in a meeting of 25 policy-makers to offer their views on the practicality of implementing appropriatemeasures. Results Participants identified 49 corrupt practices from the literature review and their own experience as most important in the Nigerian health system. The NGT prioritised: absenteeism, procurement-related corruption, underthe-counter payments, health financing-related corruption, and employment-related corruption. This largely reflected findings from the literature review, except for the greater emphasis on employment-related corruption from the NGT. Absenteeism, Informal payments and employment-related corruption were seen as most feasible to tackle. Frontline workers and policy-makers agreed that tackling corrupt practices requires a range of approaches. Conclusion Corruption is recognized in Nigeria as widespread but often seems insurmountable. We show how a structured approach can achieve consensus among multiple stakeholders, a crucial first step in mobilizing action to address corruption.