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Background There is substantial interest in leveraging digital health technology to support hypertension management in low- and middle-income countries such as India. The potential for healthcare infrastructure and broader context to support such initiatives in India has not been examined. We evaluated existing healthcare infrastructure to support digital health interventions and examined epidemiologic, socioeconomic, and geographical contextual correlates of healthcare infrastructure in 544 districts covering 29 states and union territories across India. Methods The study was a cross-sectional analysis of India’s Fourth District Level Household and Facility Survey (DLHS-4; 2012–2014), the most up-to-date nationally representative district-level healthcare infrastructure data. Facilities were the unit of analysis, and analyses accounted for clustering within states. The main outcome was healthcare system infrastructural context to implement hypertension management programs. Domains included diagnostics (functional BP instrument), medications (anti-hypertensive medication in stock), essential clinical staff (e.g., staff nurse, medical officer, pharmacist), and IT specific infrastructure (regular power supply, internet connection, computer availability). Descriptive analysis was conducted for infrastructure indicators based on the Indian Public Health Standards, and logistic regression was conducted to estimate the association between epidemiologic and geographical context (exposures) and the composite measure of healthcare system. Results Data from 32,215 government facilities were analyzed. Among lowest-tier subcenters, 30% had some IT infrastructure, while at the highest-tier district hospitals, 92% possessed IT infrastructure. At mid-tier primary health centres and community health centres, IT infrastructure availability was 28 and 51%, respectively. For all but sub-centres, the availability of essential staff was lower than the availability of IT infrastructure. For all but district hospitals, higher levels of blood pressure, body mass index, and urban residents were correlated with more favorable infrastructure. By region, districts in Western India tended towards having the best prepared health facilities. Conclusions IT infrastructure to support digital health interventions is more frequently lacking at lower and mid-tier healthcare facilities compared with apex facilities in India. Gaps were generally larger for staffing than physical infrastructure, suggesting that beyond IT infrastructure, shortages in essential staff impose significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district-level planning.

Background The Israeli National Health Insurance Law provides permanent residents with a basket of healthcare services through non-profit public health insurance plans, independently of the individual’s ability to pay. Since 2015, several reforms and programs have been initiated that were aimed at reinforcing public healthcare and redressing negative aspects of the health system, and specifically the constant rise in private health expenditure. These include the “From Reimbursement-to-Networks Arrangement”, the “Cooling-off Period” program and the program to shorten waiting times. The objectives of this study were to identify, describe, and analyze changes in private hospitals in 1) the volume of publicly and privately funded elective surgical procedures; and 2) private health expenditure on surgical procedures. Methods Data on the volume and funding of surgical procedures during 2013–2018 were obtained from Assuta Medical Center, Hertzelia Medical Center, the Israeli Ministry of Health and the Central Bureau of Statistics. The changes in the volume and financing sources of surgical activities in private hospitals, in the wake of the reforms were analyzed using aggregate descriptive statistics. Results Between 2013 and 2018 the volume of surgical activities in private for-profit hospitals increased by 7%. Between 2013 and 2017, the distribution of financing sources of surgical procedures in private hospitals remained stable, with most surgical procedures (75–77%) financed by the voluntary health insurance programs of the health plans (HP-VHI). In 2018, following the regulatory reforms, a significant change in the distribution of financing sources was observed: there was a sharp decline in the volume of HP-VHI-funded surgical procedures to 26%. Concurrently, the share of publicly-funded surgical procedures performed in private hospitals increased to 56% in 2018.,. During the study period, private spending on elective surgical procedures in private hospitals declined by 53% while public funding for them increased by 51%. Conclusions and policy implications In the wake of the reforms, there was a substantial shift from private to public financing of elective surgical activity in private hospitals. Private for-profit hospitals have become important providers of publicly-funded procedures. It is likely that the reforms affected the public-private mix in the financing of elective surgical procedures in those hospitals, but due to the absence of a control group, causality cannot be proven. It is also unclear whether waiting times were shortened. Health reforms must be accompanied by a clear and comprehensive set of indicators for measuring their success.

Introduction Prostate cancer is the leading cancer type in black South African men. The South African public healthcare sector serves more than 84% of the population, which includes many of these men. Previous evidence suggests that patients’ information needs are influenced by culture. No studies could be found that explored the information needs of black men diagnosed with prostate cancer in a developing country from the patients’ perspectives. Therefore, this study set out to investigate the information needs of black men diagnosed with prostate cancer in a South African public healthcare setting. Methods Nine participants who had completed a radical course of external beam radiation therapy for prostate cancer were interviewed. These participants had gained experience from their cancer journey in this setting and could therefore provide information-rich perspectives about their information needs from the time of diagnosis to end of treatment. Interviews were conducted in the participants’ preferred language, with three interviews conducted in Zulu with an English translator. Results Important themes that emerged included patients' desire to receive more information regarding what was happening in the diagnosis stage, the implications of having prostate cancer and the origin of their symptoms. The participants expressed a need to understand the potential side effects of radiation therapy, the reason for bladder filling and on-treatment set-up imaging verification. Participants also wanted to know how they should care for themselves and adjust their lifestyles, and required more information about follow-up tests and appointments. Conclusion In South Africa, black men with prostate cancer expressed the need for more information about the implications of a prostate cancer diagnosis, the reasons for these treatments and what they were expected to do. They also require information about where to go and what will happen in the different parts of the healthcare system with regard to the diagnosis and treatment of the prostate cancer. Communities should also be educated about cancer to avoid misconceptions. In South Africa, healthcare workers should consider the life-worlds of black men in the public healthcare system when attending to their information needs.

[Objectives] Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain., [Methods] We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends., [Results] The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = −3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC = −0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC = −1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC = −0.2%, p 0.605)., [Conclusions] To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.

Confronted with a global pandemic, public healthcare systems are under pressure, making access to healthcare services difficult for patients. This provides fertile ground for using illegal practices such as informal payments to gain access. This paper aims to evaluate the use of informal payments by patients during the COVID-19 pandemic and the institutions that affect the prevalence of this practice. Various measurements of formal and informal institutions are here investigated, namely the acceptability of corruption, the level of trust, transparency, and performance of the healthcare system. To do so, a logistic regression of 10,859 interviews with patients conducted across 11 Central and Eastern Europe countries in October–December 2020 is employed. The finding is that there are large disparities between countries in the prevalence of informal payments, and that the practice is more likely to occur where there are poorer formal and informal institutions, namely higher acceptability of corruption, lower trust in authorities, lower perceived transparency in handling the COVID-19 pandemic, difficult access to, and poor quality of, healthcare services, and higher mortality rates due to the COVID-19 pandemic. These findings suggest that policy measures for tackling informal payments need to address the current state of the institutional environment.

International audience; In the French diagnosis-related group (DRG)-based payment system, both private and public hospitals are financed by a public single payer. Public hospitals are overcrowded and have no direct financial incentives to choose one procedure over another. If a patient has a strong preference, they can switch to a private hospital. In private hospitals, the preference does come into play, but the patient has to pay for the additional cost, for which they are reimbursed if they have supplementary private health insurance. Do financial incentives from the fees received by physicians for different procedures drive their behavior? Using French exhaustive data on delivery, we find that private hospitals perform significantly more cesarean deliveries than public hospitals. However, for patients without private health insurance, the two sectors differ much less in terms of cesareans rate. We determine the impact of the financial incentive for patients who can afford the additional cost. Affordability is mainly ensured by the reimbursement of costs by private health insurance. These findings can be interpreted as evidence that, in healthcare systems where a public single payer offers universal coverage, the presence of supplementary private insurance can contribute to creating incentives on the supply side and lead to practices and an allocation of resources that are not optimal from a social welfare perspective.

Summarization: This study focused on some of the most important aspects of ethics in the healthcare industry and examined the relevance of the system created to evaluate ethical healthcare practices in the public sector. The research included developing a conceptual model representing variables that influence ethics in public healthcare services in Portugal, using fuzzy cognitive mapping to facilitate the identification of the most significant variables. This method is a well-established decision problem-structuring tool that allows experts to define cause-and-effect relationships between variables and make decisions. The insights obtained were generated in face-to-face group meetings with experts in the public healthcare sector, showing that professional profiles, management, team relationships, external factors, equity principles, and respect are among the most relevant determinants of ethical healthcare. That is, these criteria are the most commonly applied standards in analyses of ethical practices in public healthcare services. The resulting assessment framework and its applicability were validated by both the panel of experts and the chairperson of the board of directors of S. Francisco Xavier Hospital in Lisbon, Portugal. The advantages and limitations of the analysis developed in this study are also discussed. Presented on: Journal of Multi-Criteria Decision Analysis

In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Quebec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job-seekers. Two complementary datasets were used: a self-report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ-5D-5L), the severity of psychiatric symptoms (18-item Brief Symptom Inventory) and self-declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision-making.

There is a lack of scientific evidence on the impact of a biomedical industry on the surrounding economy. The assessment of this issue would allow policy makers to identify the impact on production, local employment and wages in addition to public sector costs. With this aim, the paper evaluates the socio-economic impact of a medical devices firm’s decision to set up its manufacturing plants in Italy, i.e. the effect of industrial activity on employment, earnings and output, using information on production processes to derive the associated interactions with suppliers for the primary industry and secondary industries. Besides being amongst the major contributors of health outcomes, medical technology manufacturers provide additional benefits to public sector and to the economy as a whole. This suggests that a broad perspective needs to be endorsed by policy makers when deciding about the introduction of new technologies in the healthcare sector in order to achieve optimal outcomes for society as a whole.

Objective: To estimate the completeness of malaria notification to the public healthcare system (PHCS) and to describe retrospectively data of malaria cases in Tunisia. Methods: We conducted a retrospective epidemiological survey using a standardized questionnaire for all cases of malaria reported to PHCS and those diagnosed in parasitological laboratory or infectious disease service between January 2002 and December 2007. To estimate the total number of cases, we used a two sources capture-recapture analysis. Results: After record-linkage and cross-validation 317 cases of malaria were identified, of whom 231 were notified, resulting in an observed undernotification of 17%. The estimated number of malaria cases using capture-recapture analysis was 366.3 (95% CI: 335.8-396.8) for the period of study with a completeness of 63.1% which increased from 44.8% for 2002 to 78.7% for 2007. One hundred and sixty two patients (51.1%) had been born in sub-Saharan Africa, 113 (35.6%) in Tunisia, 35 (11.0%) in North Africa and 7 (2.2%) in Europe with predominance of men (87.1% of all cases). The median age was 25.0 years (21-30) for subSaharan Africans, 38.0 years (23.5-45.5) for North Africans, 38.5 years (30.75-38.5) for Tunisian and 39.0 (26-43) for European (P

O objetivo foi analisar a evolução do perfil de utilização de serviços de saúde, entre 2003 e 2008, no Brasil e nas suas macrorregiões. Foram utilizados dados da PNAD. A utilização de serviços de saúde foi medida pela proporção de pessoas que procuraram e foram atendidas nas 2 semanas anteriores e pelos que relataram internação nos últimos 12 meses, segundo SUS e não SUS. Foram analisadas as características socioeconômicas dos usuários, o tipo de atendimento e de serviço e os motivos da procura. A proporção de indivíduos que procuraram serviços de saúde não se alterou, assim como a parcela dos que conseguiram atendimento (96%), entre 2003 e 2008. O SUS respondeu por 56,7% dos atendimentos, realizando a maior parte das internações, vacinação e consultas e somente 1/3 das consultas odontológicas. Em 2008, manteve-se o gradiente de redução de utilização de serviços de saúde SUS conforme o aumento de renda e escolaridade. Houve decréscimo da proporção dos que procuraram serviços de saúde para ações de prevenção e aumento de procura para problemas odontológicos, acidentes e lesões e reabilitação. O padrão de utilização do SUS por região esteve inversamente relacionado à proporção de indivíduos com posse de planos privados de saúde. PNAD data was employed to analyze the utilization profile of health services, and this was measured by the proportion of individuals seeking and reporting use of health services in the prior two weeks and those who reported hospitalization in the preceding 12 months. Private health plans covered 25.9% of the Brazilian population. Comparing data from 2003 and 2008 surveys, there was no change in the proportion of individuals seeking health services, as well as the proportion of those attended by these services (96%). The Unified Health System (SUS) was responsible for 56,7% of all healthcare, providing the bulk of medical visits, vaccine activities and hospital admissions, but accounted for only 1/3 of dental care. There was a reduction in SUS health services utilization with the increase of education and income level, in the two surveys. There was also a decrease in utilization of services due to prevention and an increase in dental problems, accidents, injuries and rehabilitation. The pattern of SUS services utilization per region was inversely related to the proportion of individuals with private health insurance coverage.