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Background People prefer to age in place and not move into a nursing home as long as possible. The prevention of cognitive and functional impairments is feasible to support this goal. Health services play a key role in providing support for underlying medical conditions. We examined differentials in nursing home admissions between patient sharing networks in Germany and whether potential variations can be attributed to indicators of health care provision. Methods We conducted an ecological study using data of patients of 65 years and above from all 11 AOK statutory health insurance companies in Germany. Nursing home admissions were observed in a cohort of persons becoming initially care-dependent in 2006 (n = 118,213) with a follow-up of up to 10 years. A patient sharing network was constructed and indicators for quality of health care were calculated based on data of up to 6.6 million patients per year. Community detection was applied to gain distinct patient populations. Analyses were conducted descriptively and through regression analyses to identify the variation explained by included quality indicators. Results The difference in the proportion of nursing home admissions between identified clusters shows an interquartile range (IQR) of 12.6% and the average time between onset of care-dependency and admission to a nursing home an IQR of 10,4 quarters. Included quality indicators attributed for 40% of these variations for the proportion of nursing home admissions and 49% for the time until nursing home admission, respectively. Indicators of process quality showed the single highest contribution. Effects of single indicators were inconclusive. Conclusions Health services can support persons in their preference to age in place. Research and discussion on adequate health care for care-dependent persons and on conditions, where nursing home admission may be beneficial, is necessary.

[ES] El cribado neonatal es una actuación sanitaria regulada específicamente en nuestra legislación. El ordenamiento jurídico establece que el cribado sanitario es una actuación de salud pública, enfocada a la prevención de la salud de la sociedad en general y, a la vez, una prestación sanitaria, es decir, un derecho de los individuos, cuyo interés constituye el eje de la regulación. En su diseño e implantación están involucradas las autoridades sanitarias estatales y autonómicas. La eficacia, eficiencia y calidad son los criterios para valorar su idoneidad, y la adopción de medidas que garanticen los derechos de los participantes, la trasparencia y la voluntariedad, son imprescindibles para su aprobación. Estas exigencias generales se refuerzan cuando el cribado se dirige a la población pediátrica y cuando se trata de cribados genéticos, caso en que está prevista la revisión por parte de un comité de ética como requisito previo a su autorización. [EN] Neonatal screening is a health action specifically regulated in our legislation. The legal system establishes that health screening is a public health action, focused on the prevention of health of the community in general and, at the same time, a health service, that is, a right of individuals, whose interest is the focus of the regulation. In its design and implementation are involved the State and Regional Health Authorities. The effectiveness, efficiency and quality, are the criteria for assessing its suitability, and the adoption of measures to ensure the rights of participants, transparency and voluntariness, are essential for approval. These general requirements are reinforced when the screening is aimed at the paediatric population and when it comes to genetic screening, in which case a review by an ethics committee is foreseen as a prerequisite for authorization. Grupo de Investigación Cátedra de Derecho y Genoma Humano. Financiado por el Departamento de Educación del Gobierno Vasco (Grupos de Investigación del Sistema Universitario Vasco. Referencia número IT1066-16). No

Neonatal screening is a health action specifically regulated in our legislation. The legal system establishes that health screening is a public health action, focused on the prevention of health of the community in general and, at the same time, a health service, that is, a right of individuals, whose interest is the focus of the regulation. In its design and implementation are involved the State and Regional Health Authorities. The effectiveness, efficiency and quality. are the criteria for assessing its suitability, and the adoption of measures to ensure the rights of participants. transparency and voluntariness, are essential for approval. These general requirements are reinforced when the screening is aimed at the paediatric population and when it comes to genetic screening, in which case a review by an ethics committee is foreseen as a prerequisite for authorization.

Faith-inspired institutions (FIIs) play an important role in improving health care in many African countries through the delivery of facility-based care, training of the health workforce, involvement in community-based activities, and participation in health promotion campaigns. FIIs represent a wide array of faiths and diverse motivations and goals. While a number of factors shape the approaches taken by FIIs in planning their activities, an often expressed priority is to serve the poor for whom care often remains unaffordable. Many faith-based providers also aim to provide preventive and/or curative care to those who are at a disadvantage or marginalized. In the case of Burkina Faso, significant progress has been achieved to facilitate access to care—examples include, among others, the construction of new facilities, vaccination campaigns, and the reduction or elimination of selected fees. As a result, many health statistics such as the rate of assisted childbirth, the use of health services, vaccination, and infant mortality have improved. Nevertheless, available household survey data suggest that apart from cases when an individual does not seek care because there is no need for it, or self-medicates when ill or sick, the main reason for not seeking care is cost.

The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a ‘mashup’ index that captures both aspects of UHC: that everyone—irrespective of their ability-to-pay—gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. Service coverage is broken down into prevention and treatment, and financial protection into impoverishment and catastrophic spending; nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off; nonlinear tradeoffs are allowed between and within the two dimensions of the UHC index; and all indicators are expressed such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which there are detailed information on UHC-inspired reforms, a cluster of high-performing countries emerges with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico and South Africa) and a cluster of low-performing countries emerges with UHC scores in the range 35–57 (Ethiopia, Guatemala, India, Indonesia and Vietnam). Countries have mostly improved their UHC scores between the earliest and latest years for which there are data—by about 5 points on average; however, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare.

This Public Expenditure Review (PER) for health in Zimbabwe is an analytical report developed by the World Bank Health, Nutrition and Population Task Team working with the World Bank’s Macroeconomics and Fiscal Management Global Practice team, Zimbabwe’s Ministry of Finance and Economic Development (MOFED) and Ministry of Health and Child Care (MOHCC), with input from development partners. The aims of the PER are to provide objective evidence to inform the allocation of resources to enable equitable, efficient, and sustainable health care provision and to highlight questions about health sector performance for policy makers and key stakeholders. The findings also aim to present Zimbabwe’s health sector spending in an international and regional perspective, highlighting key issues for improving health outcomes. The PER is based on analysis of primary and secondary data as well as an extensive review of existing literature. The research was complemented by interviews with key stakeholders, and data collection from major development partners and domestic health funders, including private companies. Micro-level data from household and health facility surveys in May–August 2014 (primarily for the impact evaluation of the Results-Based Financing (RBF) program supported by the World Bank) complemented these scarce data.

Despite their strong contribution to the overall world economic growth, gender gaps are wide in many countries in sub Saharan Africa and low representation of women in the private health sector is wider than in other sectors. While women and youth use the majority of health services both private and public, women are underrepresented as private health care providers and have limited access to financing to open their own private practices. This landscape has prompted the HNP Global Practice to take a critical look at the factors which hamper the growth of female and young private health practitioners vis a vis their male counterparts (usually older and more experienced in their profession). This assessment provides information on ways to close the gap which exists between male private service providers and female providers as well as recommends ways in which the existing gaps can be addressed. The assessment also provides the basis for further developing a strong public- private dialogue in health while providing avenues for building capacities for women to fully contribute to the development of the private health sector through the development of training module to be administered in private training schools as a pilot in Burkina Faso and Mali.

This paper broadly examines the development process of Korea’s health care system toward the achievement of Universal Health Coverage. Korea implemented a series of health care reforms after a rapid expansion of population coverage to improve efficiency and equity in financing and delivery of health care. The authors also investigate changes in the governance structure of Korea’s national health Insurance, which is now represented by two agencies: National Health Insurance Service (NHIS) and Health Insurance Review and Assessment Service (HIRA). Health insurance agencies have improved the accountability and transparency of the health insurance system, thanks to the ICT-based centralized claim review and assessment. Lessons and challenges from Korea’s experiences and achievements on the road to UHC could provide valuable policy implications to low- and middle-income countries.

The World Bank supported the community nutrition project (CNP) in the Lao People’s Democratic Republic (PDR) from 2009 to 2013, ostensibly to respond to the global food crisis of 2007-08. The evaluation finds an attributable effect on only one of the six formal project indicators: children in intervention areas were more likely to receive full diphtheria, pertussis, and tetanus (DPT) vaccines. This impact evaluation seeks to address whether the CNP can make causal claims to improving indicators related to its six stated project development objective measurements for mothers and children under two years old: antenatal care visits, institutional delivery, well-child checkups, breastfeeding, immunization, and diarrhea oral rehydration solutions. The results of quasi-experimental impact evaluation methods indicate that although general effects for these outcomes are mixed, the project shows improvements for the poorest 40 percent of the population.

In 2008, India launched Rashtriya Swasthya Bima Yojana (RSBY), a government subsidized health insurance scheme for the poor that covers secondary hospital care for Below Poverty Line (BPL) households. Designed to improve access to healthcare and reduce the financial burden of healthcare expenses, RSBY currently covers 32 million households. The authors exploit the phased rollout of RSBY to estimate the impact of the scheme in its early days on hospitalization rates and out-of-pocket health expenditure using a difference-in-differences approach with matching. We use secondary data from the National Sample Survey Organization conducted in 2009-10. We find that the scheme has led to a small decrease in out-of-pocket household outpatient expenditure and consequently total medical expenditure. The authors also find limited evidence of increase in the number of households that have had a hospitalization case though there are regional variations in the nature of impact. It is unclear whether the improved access to inpatient care is reducing outpatient expenses through decreased need for outpatient care or because some people or hospitals are colluding to convert outpatient treatment to inpatient to avail of the scheme. The authors suggest that additional evidence with a more recent data set allowing for more time for RSBY to display effects is needed to strengthen these early findings.

Background In 2002, the World Health Organization published a health system performance ranking for 191 member countries. The ranking was based on five indicators, with fixed weights common to all countries. Methods We investigate the feasibility and desirability of using mathematical programming techniques that allow weights to vary across countries to reflect their varying circumstances and objectives. Results By global distributional measures, scores and ranks are found to be not very sensitive to changes in weights, although differences can be large for individual countries. Conclusions Building the flexibility of variable weights into calculation of the performance index is a useful way to respond to the debates and criticisms appearing since publication of the ranking.

Usage of health facilities in Ethiopia is among the lowest in the world; raising usage rates is probably critical for improving health outcomes. The government has diagnosed the principal problem as the lack of primary health facilities and is devoting a large share of the health budget to building more facilities. But household data suggest that usage of health facilities is sensitive not just to the distance to the nearest facility but also to the quality of health care provided. If the quality of weak facilities were raised to that currently provided by the majority of facilities in Ethiopia, usage would rise significantly. National data suggest that given the current density and quality of service provision, additional expenditure on improving the quality of service delivery will be more cost-effective than increasing the density of service provision. The budget allocation rule presented in the article can help local policymakers make decisions about how to allocate funds between improving the quality of care and decreasing the distance to the nearest health care facility.