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Background: The Government of The Gambia introduced a national health insurance scheme (NHIS) in 2021 to promote universal health coverage (UHC). Provider payment systems (PPS) are strategic purchasing arrangements that can enhance provider performance, accountability, and efficiency in the NHIS. This study assessed healthcare workers' (HCWs') preferences for PPS across major service areas in the NHIS. Methods: A facility-based cross-sectional study was conducted using a probability proportionate to size sampling technique to select an appropriate sample size. Health care workers were presented with options for PPS to choose from across major service areas. Descriptive statistics explored HCW socio-demographic and health service characteristics. Multinomial logistic regressions were used to assess the association between these characteristics and choices of PPS. Results: The majority of HCW did not have insurance coverage, but more than 60% of them were willing to join and pay for the NHIS. Gender, professional cadre, facility level, and region influenced HCW's preference for PPS across the major service areas. The preferred PPS varied among HCW depending on the service area, with capitation being the least preferred PPS across all service areas. Conclusion: The National Health Insurance Authority (NHIA) needs to consider HCW's preference for PPS and factors that influence their preferences when choosing various payment systems. Strategic purchasing decisions should consider the incentives these payment systems may create to align incentives to guide provider behaviour towards UHC. The findings of this study can inform policy and decision-makers on the right mix of PPS to spur provider performance and value for money in The Gambia's NHIS. [ABSTRACT FROM AUTHOR]

Background: Expanding fiscal space for health can be defined as providing additional budgetary resources for health, which is highly important during biological crises. This study aimed to provide a model for financing the treatment costs during biological crises using the development of the fiscal space approach. Methods: This study employed a descriptive mixed-method design, consisting of three stages. In the first stage, a systematic review of relevant literature was conducted using multiple databases, including Scopus, PubMed, and Google Scholar. A total of 45 studies that met the inclusion criteria were selected. In the second stage, a panel of 14 experts identified five primary and 32 secondary strategies using an open questionnaire. Any additional strategies not identified during the literature review were added if a consensus was reached by experts. In the final stage, the Best Worst Method (BWM) was used to prioritize the identified strategies and sub-strategies based on their feasibility, effectiveness, quick yield, and fairness. Results: Five strategies and fifty sub-strategies were identified. The most important strategies were the increase in health sector-specific resources (0.3889), increase in efficiency of health expenditures (0.2778), structural reforms (0.1111), health sector-specific grants and foreign aid (0.1667), and conducive macroeconomic conditions (0.05556). The most important sub-strategies were establishing and increasing earmarked taxes for the health sector (0.0140), expanding Universal Health Coverage (UHC) plans (0.0103), attracting the participation of non-governmental organizations (NGOs) and charitable organizations in the health sector (0.0096), integrating basic social insurance funds (0.0934), and tax exemptions for economic activists in the health sector (0.009303) during the crisis. Conclusion: This study identified five main strategies and 50 sub-strategies for financing the treatment costs during biological crises. The most important strategies were increasing health sector-specific resources, improving efficiency of health expenditures, and implementing structural reforms. To finance health expenditures, harmful and luxury goods taxes can be increased and allocated to the health sector during crises. UHC plans should be improved and expanded, and the capacity of NGOs and charitable organizations should be better utilized during crises. [ABSTRACT FROM AUTHOR]

BACKGROUND:The United States is the only high-income nation without universal, government-funded or -mandated health insurance employing a unified payment system. The US multi-payer system leaves residents uninsured or underinsured, despite overall healthcare costs far above other nations. Single-payer (often referred to as Medicare for All), a proposed policy solution since 1990, is receiving renewed press attention and popular support. Our review seeks to assess the projected cost impact of a single-payer approach. METHODS AND FINDINGS:We conducted our literature search between June 1 and December 31, 2018, without start date restriction for included studies. We surveyed an expert panel and searched PubMed, Google, Google Scholar, and preexisting lists for formal economic studies of the projected costs of single-payer plans for the US or for individual states. Reviewer pairs extracted data on methods and findings using a template. We quantified changes in total costs standardized to percentage of contemporaneous healthcare spending. Additionally, we quantified cost changes by subtype, such as costs due to increased healthcare utilization and savings due to simplified payment administration, lower drug costs, and other factors. We further examined how modeling assumptions affected results. Our search yielded economic analyses of the cost of 22 single-payer plans over the past 30 years. Exclusions were due to inadequate technical data or assuming a substantial ongoing role for private insurers. We found that 19 (86%) of the analyses predicted net savings (median net result was a savings of 3.46% of total costs) in the first year of program operation and 20 (91%) predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans. The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administration and drug costs (R2 of 0.035, 0.43, and 0.62, respectively). Only drug cost savings remained significant in multivariate analysis. Included studies were heterogeneous in methods, which precluded us from conducting a formal meta-analysis. CONCLUSIONS:In this systematic review, we found a high degree of analytic consensus for the fiscal feasibility of a single-payer approach in the US. Actual costs will depend on plan features and implementation. Future research should refine estimates of the effects of coverage expansion on utilization, evaluate provider administrative costs in varied existing single-payer systems, analyze implementation options, and evaluate US-based single-payer programs, as available.

Abstract Background Prolonged hospitalization leads to poorer health outcomes and consumes limited hospital resources. This study identified factors associated with prolonged length of stay (PLOS) among internal medicine patients admitted in a tertiary government hospital. Methods We reviewed the medical records of 386 adult patients admitted under the primary service of General Internal Medicine at the Philippine General Hospital from January 1 to December 31, 2019. PLOS was defined as at least 14 days for emergency admissions or 3 days for elective admissions. Sociodemographics, clinical characteristics, admission- and hospital system-related factors, disease-specific factors, outcome on the last day of hospitalization, and hospitalization costs were obtained. We determined the proportion with PLOS and reviewed reasons for discharge delays. We conducted multiple logistic regression analyses to assess associations between various factors and PLOS. Results The prevalence of PLOS is 19.17% (95% CI 15.54, 23.42). Positive predictors include being partially dependent on admission (aOR 2.61, 95% CI 0.99, 6.86), more co-managing services (aOR 1.26, 95% CI 1.06, 1.50), and longer duration of intravenous antibiotics (aOR 1.36, 95% CI 1.22, 1.51). The only negative predictor is the need for intravenous antibiotics (aOR 0.14, 95% CI 0.04, 0.54). The most common reason for discharge delays was prolonged treatment. The median hospitalization cost of patients with PLOS was PHP 77,427.20 (IQR 102,596). Conclusions Almost a fifth of emergency admissions and a quarter of elective admissions had PLOS. Addressing factors related to predictors such as functional status on admission, number of co-managing services, and use of intravenous antibiotics can guide clinical and administrative decisions, including careful attention to vulnerable patients and judicious use of resources.

This cross-sectional study identified characteristics of patients using an online crowdfunding platform for unmet financial obligations associated with cancer care.

Background Diagnosis-related group (DRG)-based hospital payment can potentially be inadequately low (or high) for highly variable, highly specialized, and/or low volume care. DRG-based payment can be combined with other payment mechanisms to avoid unintended consequences of inadequate payment. The aim of this study was to analyze these other payment mechanisms for acute inpatient care across six countries (Germany, Denmark, England, Estonia, France, the United States [Medicare]).Methods Information was collected about elements excluded from DRG-based payment, the rationale for exclusions, and payment mechanisms complementing DRG-based payment. A conceptual framework was developed to systematically describe, visualise and compare payment mechanisms across countries.Results Results show that the complexity of exclusion mechanisms and associated additional payment components differ across countries. England and Germany use many different additional mechanisms, while there are only few exceptions from DRG-based payment in the Medicare program in the United States. Certain areas of care are almost always excluded (eg, certain areas of cancer care or specialized pediatrics). Denmark and England use exclusion mechanisms to steer service provision for highly complex patients to specialized providers.Conclusion Implications for researchers and policy-makers include: (1) certain areas of care might be better excluded from DRG-based payment; (2) exclusions may be used to incentivize the concentration of highly specialized care at specialized institutions (as in Denmark or England); (3) researchers may apply our analytical framework to better understand the specific design features of DRG-based payment systems.

The COVID-19 pandemic caused not only short-term organizational and economic changes in the functioning of occupational health services, but also enforced to include them in the formulation of a strategic systemic approach to this link of the health care system. The aim of the article is to identify and describe the organizational and economic changes in occupational health services during the pandemic. On this basis, the directions of further research on the improvement of the activities of health care entities of working people in response to future health crises have been formulated. The review covered legal acts relating to organizational and economic changes, Polish and foreign expert publications, full-text Polish and English-language scientific articles included in the PubMed database, publications beyond the specified period, consistent and useful in explaining the concepts of organization, management and economics. The changes in occupational health services presented in the literature during the pandemic consisted of: introducing additional organizational forms of providing health care to employees including occupational medicine leaders, strengthening supervision over working conditions, interdisciplinary cooperation for managing the health of working people, participation in pro-vaccination campaigns, activities in the field of rehabilitation after COVID-19 and new-quality cooperation with public and private health stakeholders. As the result of the review, problems were formulated for future research, which included ensuring the security of occupational medicine entities in terms of resource availability, adjusting the allocation of resources to new financial needs during and after a pandemic, evaluation of organizational and economic changes introduced during the pandemic and the legitimacy of their maintenance in subsequent periods, the development of economic and organizational instruments for the time of crisis, the scope and principles of cooperation with health care stakeholders and the introduction of medical technologies based on a medical and economic assessment according to Health Technology Assessment. Med Pr. 2022;73(6):471–83

Background Fiscal decentralisation (FD) is a widely implemented decentralisation policy consisting of the allocation of pooling and spending responsibilities from the central government to lower levels of governance within a country. In 2001, The Italian National Health System (Servizio Sanitario Nazionale, SSN) has introduced a strong element of FD, making regions responsible for their own pooling of resources and for their budgets. Despite the relevance, only few studies exist on health sector-FD in Italy, mostly looking at the effects of FD on infant mortality.Methods This study performs a fixed-effects panel data analysis of Italian Regions and Autonomous provinces between the years 2001 and 2017, to investigate the effects of health sector-FD on availability, accessibility, and utilisation of healthcare services in Italy.Results FD decreases availability of staff and hospital beds, decreases utilisation of care, measured by hospitalisation rates, and increases interregional patients’ mobility for healthcare purposes, a finding suggesting increased disparities in access to healthcare. These effects seem to be stronger for public – rather than private – services, and are more prominent in poorer areas.Conclusion This evidence suggest that FD has created a fragmented and unequal healthcare system, in which levels of availability, utilisation of, and accessibility to resources – as well as the extent of public sector’s retrenchment – coincide with the wealth of the area.

In healthcare the payer, covering the cost of health services, plays the key role. As a result, we do not observe a regular relation seller–buyer, but rather dependency purchaser–payer. In the paper we analyze costs generated by the way of allocation financial resources in healthcare and their distribution by the payer- so called transactional costs. While optimizing healthcare budget costs of intermediaries need to be taken into consideration.

Background: Most publicly-funded health systems purchase healthcare from private providers, but the optimal purchasing arrangements between public purchasers and private healthcare providers are yet to be determined. Objective: This study compares the healthcare purchasing arrangements made with private providers in 2 social health insurance (SHI)-based systems to identify factors that influence the prices paid for private healthcare service provision. Results: France and Japan use different approaches to determine the payment arrangements with public and private providers. The presence of for-profit healthcare providers in the French health system explains the different payment rates for public and private healthcare providers in that country. In both France and Japan, in addition to payment rates, several policy tools are used to assure the provision of public good services and the availability of necessary healthcare for all, which public providers are required to deliver but private providers can choose to deliver. Conclusion: This study highlights the importance of considering the profit-making status of the private healthcare providers operating in the healthcare market, and clarity in the roles and responsibilities of the public, for-profit and not-for-profit providers when determining healthcare purchasing arrangements. Regulatory policy instruments, used alongside payment rates, are essential to influence efficiency, equity, and quality in mixed (public-private) health systems. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Management & Health / Revista Gestão & Saúde is the property of Revista Gestao e Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: to analyze the prevalence and costs of hospitalizations by Primary Care Sensitive Conditions (HPCSC) in Minas Gerais (MG). Method: ecological study analyzing hospital admissions and service structure variables in 2009 and 2014. Based on the Brazilian List (2008), the HPCSC were selected for the study of the infant and elderly populations concerning prevalence and costs. The Pearson's correlation test (p≤0.05) was used for the statistical analysis between the HPCSC and structure variables. Results: lower rates of HPCSC/1000 residents both for the infant and elderly populations and total higher costs only for the elderly. The leading hospitalization causes were heart Failure for the elderly and Bacterial Pneumonias and Gastroenteritis for the children. The coverage by the Family Health Strategy (FHS) was statistically associated with HPCSC in 2009 (p = 0.028) and 2014 (p = 0.006). Conclusion: like in previous studies, a larger FHS coverage associated with a lower HPCSC rate in MG highlights the importance of PHC in coordinating care and organizing care networks, contributing to the user's universal and integral access to services. Learning the prevalence and costs of the HPCSC allows for discussing the financial resources available to the PHC. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has shaken everyday life causing morbidity and mortality across the globe. While each country has been hit by the pandemic, individual countries have had different infection and health trajectories. Of all welfare state institutions, healthcare has faced the most immense pressure due to the pandemic and hence, we take a comparative perspective to study COVID-19 related health system performance. We study the way in which health system characteristics were associated with COVID-19 excess mortality and case fatality rates before Omicron variant. Methods: This study analyses the health system performance during the pandemic in 43 OECD countries and selected non-member economies through three healthcare systems dimensions: (1) healthcare finance, (2) healthcare provision, (3) healthcare performance and health outcomes. Health system characteristics-related data is collected from the Global Health Observatory data repository, the COVID-19 related health outcome indicators from the Our World in Data statistics database, and the country characteristics from the World Bank Open Data and the OECD statistics databases. Results: We find that the COVID-19 excess mortality and case fatality rates were systematically associated with healthcare system financing and organizational structures, as well as performance regarding other health outcomes besides COVID-19 health outcomes. Conclusion: Investments in public health systems in terms of overall financing, health workforce and facilities are instrumental in reducing COVID-19 related mortality. Countries aiming at improving their pandemic preparedness may develop health systems by strengthening their public health systems. [ABSTRACT FROM AUTHOR]

"Comprehensive Healthcare for America" is a largely single-payer reform proposal that, by applying the insights of behavioral economics, may be able to rally patients and clinicians sufficiently to overcome the opposition of politicians and vested interests to providing all Americans with less complicated and less costly access to needed healthcare. [ABSTRACT FROM AUTHOR]

Extending health insurance coverage to informal sector populations remains a major challenge toward achieving universal health coverage. This study aimed to fill the gap in the literature by examining barriers to enrollment in National Health Insurance Scheme (NHIS) among informal sector workers in Nigeria. Data were drawn from the 2018 Nigeria Demographic and Health Survey. The study population comprised of men (n = 10,163) and women (n = 22,216) working in the informal sector. Bivariate and multivariate logistic regression were used to examine barriers to enrollment in NHIS. Results show that the majority of men (98.9%) and women (98.6%) were not enrolled in NHIS. Age, gender of household head, educational level, socioeconomic status, geopolitical zone, distance to a health facility, frequency of reading newspapers or magazines, and watching television were significantly associated with non‐enrollment in NHIS. Findings suggest that enrollment in NHIS in Nigeria is very low. Additionally, there are significant barriers to enrollment. There is a need for governments and policymakers to address these barriers. The use of voluntary prepayments from informal sector workers as a strategy to extend health insurance coverage has not been effective. Key Points: This study examined barriers to enrollment in National Health Insurance Scheme (NHIS) among informal sector workers in Nigeria.Findings indicate that the majority of men (98.9%) and women (98.6%) were not enrolled in NHIS.Authors also found that age, gender of household head, educational level, socioeconomic status, geopolitical zone, distance to a health facility, frequency of reading newspapers or magazines, and watching television were significantly associated with non‐enrollment in NHIS.The use of voluntary prepayments from informal sector workers as a strategy to extend health insurance coverage has not been effective. [ABSTRACT FROM AUTHOR]

This article aims to identify whether the type of healthcare system financing matters in terms of efficiency. The study covered 35 OECD countries, which follow either the Bismarck system or the Beveridge system. The span of analysis covers the year 2015. Data were derived from OECD statistics and Eurostat databases. In purpose to analyse the impact of the financing method on the overall efficiency of the healthcare system, the developed model of Anderson was employed. Thus, the model allowed us to examine both—the components of the healthcare system, resources, population characteristics, benefits and outcomes, and the relationship of individual components to each other, expressed through efficiency, effectiveness and equality. In addition, statistical methods were used such as descriptive analysis, the independent sample t -test and the Pearson correlation coefficient. It was found that countries of the Bismarck system possess more hospital beds and simultaneously more curative care bed days are provided. It could imply the existence of a supply-induced demand problem. In the case of efficiency, the Bismarck states were found to have a more efficient medical doctor as they provide more consultation per inhabitant than their Beveridge counterparts. However, the Beveridge states were found to have more efficient usage of curative care beds as their bed occupancy rate is higher than Bismarck counterparts. [ABSTRACT FROM AUTHOR]

Introduction In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. Methods In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. Results During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. Conclusions The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.

Abstract Background Health insurance is among the healthcare financing reforms proposed to increase the available healthcare resources and to decrease the risk of household financial crisis. Recently, Ethiopia has been implementing community-based health insurance which mainly targets the very large rural agricultural sector and small and informal sector in urban settings. Therefore, this study was aimed to assess the coverage of health insurance and its determinants in Ethiopia. Methods Data were extracted from the 2019 mini Ethiopian Demographic and Health Survey (EDHS) to assess determinants of health insurance coverage in Ethiopia. The analysis included a weighted sample of 8663 respondents. Multivariable logistic regression analysis was conducted and the results were presented as adjusted odds ratio (AOR) at 95% confidence interval (CI), statistical significance was declared at a p-value

Abstract Background High burden of healthcare expenditure precludes the poor from access to quality healthcare services. In Ethiopia, a significant proportion of the population has faced financial catastrophe associated with the costs of healthcare services. The Ethiopian Government aims to achieve universal health coverage (UHC) by 2030; however, the Ethiopian health system is struggling with low healthcare funding and high out-of-pocket (OOP) expenditure despite the implementation of several reforms in health care financing (HCF). This review aims to map the contributions, successes and challenges of HCF initiatives in Ethiopia. Methods We searched literature in three databases: PubMed, Scopus, and Web of science. Search terms were identified in broader three themes: health care financing, UHC and Ethiopia. We synthesised the findings using the health care financing framework: revenue generation, risk pooling and strategic purchasing. Results A total of 52 articles were included in the final review. Generating an additional income for health facilities, promoting cost-sharing, risk-sharing/ social solidarity for the non-predicted illness, providing special assistance mechanisms for those who cannot afford to pay, and purchasing healthcare services were the successes of Ethiopia’s health financing. Ethiopia's HCF initiatives have significant contributions to healthcare infrastructures, medical supplies, diagnostic capacity, drugs, financial-risk protection, and healthcare services. However, poor access to equitable quality healthcare services was associated with low healthcare funding and high OOP payments. Conclusion Ethiopia's health financing initiatives have various successes and contributions to revenue generation, risk pooling, and purchasing healthcare services towards UHC. Standardisation of benefit packages, ensuring beneficiaries equal access to care and introducing an accreditation system to maintain quality of care help to manage service disparities. A unified health insurance system that providing the same benefit packages for all, is the most efficient way to attain equitable access to health care.

The objective of this work is, through a literature review, to promote the debate on personalized medicine and acquire a broad view of the subject and its tools from the perspective of oncology, disseminate the topic, support, and encourage initiatives to implement its technologies in the Brazilian public healthcare system, collaborating for a sustainable ecosystem in the incorporation of technologies, and above all, with the health and quality of life of patients. The implementation of personalized medicine technologies in SUS is feasible and effective. The scenario is optimistic considering the latest updates from the Ministry of Health with the establishment of the Brazilian Genomes Program. With wise management of resources and actions focused on creating an infrastructure that supports it, the entire public healthcare system will be benefited and can take advantage of the improvements. Personalized medicine is the future of healthcare.

Background: Prolonged hospitalization leads to poorer health outcomes and consumes limited hospital resources. This study identified factors associated with prolonged length of stay (PLOS) among internal medicine patients admitted in a tertiary government hospital. Methods: We reviewed the medical records of 386 adult patients admitted under the primary service of General Internal Medicine at the Philippine General Hospital from January 1 to December 31, 2019. PLOS was defined as at least 14 days for emergency admissions or 3 days for elective admissions. Sociodemographics, clinical characteristics, admission- and hospital system-related factors, disease-specific factors, outcome on the last day of hospitalization, and hospitalization costs were obtained. We determined the proportion with PLOS and reviewed reasons for discharge delays. We conducted multiple logistic regression analyses to assess associations between various factors and PLOS. Results: The prevalence of PLOS is 19.17% (95% CI 15.54, 23.42). Positive predictors include being partially dependent on admission (aOR 2.61, 95% CI 0.99, 6.86), more co-managing services (aOR 1.26, 95% CI 1.06, 1.50), and longer duration of intravenous antibiotics (aOR 1.36, 95% CI 1.22, 1.51). The only negative predictor is the need for intravenous antibiotics (aOR 0.14, 95% CI 0.04, 0.54). The most common reason for discharge delays was prolonged treatment. The median hospitalization cost of patients with PLOS was PHP 77,427.20 (IQR 102,596). Conclusions: Almost a fifth of emergency admissions and a quarter of elective admissions had PLOS. Addressing factors related to predictors such as functional status on admission, number of co-managing services, and use of intravenous antibiotics can guide clinical and administrative decisions, including careful attention to vulnerable patients and judicious use of resources. [ABSTRACT FROM AUTHOR]

Objective: to analyze the scope of the performance indicators of the Previne Brasil Program of Primary Health Care. Method: an observational, descriptive study with a quantitative approach was carried out using secondary data, referring to the years 2020 and 2021, in the five Brazilian regions (North, Northeast, South, Southeast and Midwest), available in the Primary Health Care Information System. Descriptive statistics, relative frequencies and measures of central tendency and semiparametric modeling were used considering a 5% confidence interval. Results: there was evidence of evolution in the rates of performance indicators in most Brazilian regions in 2021, compared to 2020, however, the North and Midwest regions had incipient or negative rates, compared to the Southeast region. Despite the evolution in the rates of the indicators, few States managed to reach the goals established by the Ministry of Health for the strategic actions of prenatal care and women's health; and no state achieved the goal in strategic action on chronic diseases. Conclusion: it is considered important to monitor the evolution of current indicators, envisioning their qualification so that they can evaluate primary health care and assistance, as well as guarantee the achievement of goals by ensuring funding for primary care actions. [ABSTRACT FROM AUTHOR]

Copyright of Interface - Comunicação, Saúde, Educação is the property of Fundacao UNI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. [ABSTRACT FROM AUTHOR]

Background: Diagnosis-related group (DRG)-based hospital payment can potentially be inadequately low (or high) for highly variable, highly specialized, and/or low volume care. DRG-based payment can be combined with other payment mechanisms to avoid unintended consequences of inadequate payment. The aim of this study was to analyze these other payment mechanisms for acute inpatient care across six countries (Germany, Denmark, England, Estonia, France, the United States [Medicare]). Methods: Information was collected about elements excluded from DRG-based payment, the rationale for exclusions, and payment mechanisms complementing DRG-based payment. A conceptual framework was developed to systematically describe, visualise and compare payment mechanisms across countries. Results: Results show that the complexity of exclusion mechanisms and associated additional payment components differ across countries. England and Germany use many different additional mechanisms, while there are only few exceptions from DRG-based payment in the Medicare program in the United States. Certain areas of care are almost always excluded (eg, certain areas of cancer care or specialized pediatrics). Denmark and England use exclusion mechanisms to steer service provision for highly complex patients to specialized providers. Conclusion: Implications for researchers and policy-makers include: (1) certain areas of care might be better excluded from DRG-based payment; (2) exclusions may be used to incentivize the concentration of highly specialized care at specialized institutions (as in Denmark or England); (3) researchers may apply our analytical framework to better understand the specific design features of DRG-based payment systems. [ABSTRACT FROM AUTHOR]

AbstractObjective To analyze and compare the effect of a new reimbursement model (based on a modified version of the Swedish free choice reform) on private and public primary care in Iceland during its first year of use.Design Descriptive comparison based on official data from the Ministry of Welfare, Directorate of Health, and the Icelandic Health Insurance on payments in the Icelandic primary care system.Setting Primary care system operating in the Reykjavik capital area. Public primary care has dominated the Icelandic health sector. Both public and private primary care is financed by public taxation.Subjects Fifteen public and four private primary care centers in the capital region.Main outcome measures Different indexes used in the reimbursement model and public vs. private primary care costs.Results No statistically significant cost differences were found between public and private primary care centers regarding total reimbursements, reimbursements per GP, number of registered patients, or per visit. Two indexes covered over 80% of reimbursements in the model.Conclusion The cost for Icelandic taxpayers was equal in numerous indexes between public and private primary care centers. Only public centers got reimbursements for the care need index, which considers a patient's social needs, strengths, and weaknesses.KEY POINTSThe Icelandic primary care system underwent a reform in 2017 to improve availability and quality. A new reimbursement model was introduced, and two new private centers opened following a tender.Two out of 14 indexes cover over 80% of total reimbursements from the new model.Only 5 primary care centers, all publicly driven, got reimbursement for the care need index, which is a social deprivation index.Reimbursement systems should mirror the policies of health authorities and empower the workforce.

Abstract Background Public providers in Jordan are facing increasing health demands due to human crises. This study aimed to benchmark the unit costs of hospital services in public providers in Jordan to provide insights into the outlook for public health care costs. Methods The unit costs of hospital services per admission, inpatient days, outpatient visits, emergency visits and surgical operations were estimated using the standard average costing method (top-down) for the fiscal year 2018–2019. The unit costs per inpatient day were estimated for nine specialities and staff in Jordanian dinars (exchange rate JOD 1 = USD 1.41). Results The average unit cost per admission in Jordan was JOD 782.300 (USD 1101.80), the per inpatient day cost was JOD 236.600 (USD 333.20), the per bed day cost was JOD 172.900 (USD 244.90), the per outpatient visit cost was JOD 58.400 (USD 82.30), the per operation cost was JOD 449.600 (USD 633.20) and the per emergency room visit cost was JOD 31.800 (USD 44.80). The specialities of ICU/CCU and OB/GYN presented the highest unit costs per inpatient day across providers: JOD 377.800 (USD 532.90) and JOD 362.600 (USD 510.70), respectively. The average salaried unit cost of staff depended mainly on year of employment. Nonetheless, the unit costs varied depending on the service utilization, type of service and organizational outlet. Conclusions Knowledge of how unit costs vary across public providers in Jordan is essential to outline cost control strategies and inform future research. Institutionalization of the cost information system and high-level governmental support are necessary to generate a routine practice of collecting and sharing cost information.

Abstract Background The Egyptian healthcare system has multiple stakeholders, including a wide range of public and private healthcare providers and several financing agents. This study sheds light on the healthcare system’s financing mechanisms and the flow of funds in Egypt. It also explores the expected challenges facing the system with the upcoming changes. Methods We conducted a systematic review of relevant papers through the PubMed and Scopus search engines, in addition to searching gray literature through the ISPOR presentations database and the Google search engine. Articles related to Egypt’s healthcare system financing from 2009 to 2019 were chosen for full-text review. Data were aggregated to estimate budgets and financing routes. Results We analyzed the data of 56 out of 454 identified records. Governmental health expenditure represented approximately one-third of the total health expenditure (THE). Total health expenditure as a percent of gross domestic product (GDP) was almost stagnant in the last 12 years, with a median of 5.5%. The primary healthcare financing source is out-of-pocket (OOP) expenditure, representing more than 60% of THE, followed by government spending through the Ministry of Finance, around 37% of THE. The pharmaceutical expenditure as a percent of THE ranged from 26.0 to 37.0%. Conclusions Although THE as an absolute number is increasing, total health expenditure as a percentage of GDP is declining. The Egyptian healthcare market is based mainly on OOP expenditures and the next period anticipates a shift toward more public spending after Universal Health Insurance gets implemented.

Highlights This review presents the current situation of UHC implementation in Argentina, Brazil, Colombia, and Mexico, using different elements from the WHO in their 13th Program of Work to compare service coverage and financial protection. During the 1990s, health systems within several Latin American countries, anticipating to Universal Health Coverage increasing the service coverage, but struggling to fulfill financial protection standards. Still the four countries struggle to find mechanisms that could increase pooling mechanisms capable of increasing service coverage, while reducing financial inequities among people. The decentralization of the primary healthcare system, the development of public-private partnerships, and the implementation of progressive financing mechanisms like conditional cash transfers are potential manners to improve service delivery and financial protection contributing to effective UHC.

Introduction: Severe global shortages in neurosurgery, surgery, and healthcare in general have been documented, especially in low- and middle-income countries (LMICs). Research question: In LMICs, how do we expand both neurosurgery and overall healthcare? Material and methods: Two different approaches to improving neurosurgery are presented. Author EW convinced a private hospital chain that neurosurgical resources were important throughout Indonesia. Author TK established a consortium (Alliance Healthcare) to obtain financial support for healthcare in Peshawar, Pakistan. Results: The expansion over 20 years in neurosurgery (throughout Indonesia) and in healthcare (for Peshawar and Khyber Pakhtunkhwa (KP) province, Pakistan) is impressive. In Indonesia, neurosurgery centers have expanded from one in Jakarta to over 40 throughout the islands of Indonesia. In Pakistan, two general hospitals, schools of medicine, nursing, and allied health professions, and an ambulance service have been established. Recently US$11 million has been awarded to Alliance Healthcare by the International Finance Corporation (the private sector arm of the World Bank Group) to further expand healthcare infrastructure in Peshawar and KP. Discussion and conclusion: The enterprising techniques described here can be implemented in other LMIC settings. Three keys to success both programs utilized: (1) educating the community (population at large) of the need for surgery in particular to improve overall healthcare; (2) being entrepreneurial and persistent in seeking the community support and the professional and financial support needed to advance both neurosurgery and overall healthcare through the private sector; (3) creating sustainable training and support institutions and policies for young neurosurgeons.

The objective of this study is to determine how the Indian health care system is performing relative to health care system of the Kingdom of Saudi Arabia (KSA), given that it is facing sustained financial pressure, increasing population and demand for quality care. This is an observational study using secondary data from major international organizations, ministries of health, other government and non-government agencies in India and KSA. In order to measure the performance of health care systems, four domains such as population and healthcare coverage, healthcare spending, health system capacity and health status were considered. In comparison with KSA, India spends a very low expenditure on healthcare and markedly lower health workforce density. Due to lower healthcare expenditure, India's health services outcomes and health status are low compared to KSA. Although Indian healthcare system has undergone notable progress in the last two decades, it is lagging behind in many healthcare system parameters. If India wants to reach a high performing and a nation with good health outcomes comparable with other G20 member countries, it needs to invest more on primary healthcare, health workforce, strengthening public healthcare system, and prevention and treatment for non-communicable diseases.

The main goal of this policy paper is to provide an overview of the basic problems that have impact on healthcare in Croatia and tend to make it unsustainable. The paper points out that the COVID-19 crisis has deepened and exacerbated the already existing problems of financing the health system. The analysis shows that Croatia swept under the rug systemic problems in financing healthcare and ultimately paid the price through frequent financial bailouts. Thus, in the period from 1994-2021, a total of HRK 23.9 billion was spent on bailing out the health service. On the other hand, the COVID-19 crisis can be seen as a chance to start solving the problem and implement certain reforms, both on the revenue and expenditure side of the health system.

Abstract Bhutan has a free healthcare system that covers almost 90% of the population within 2 h of travel distance. The country has achieved remarkable success in many public health indicators despite the chronic shortage of financial resources and trained manpower. However, there are many aspects of health inequities in the government's health policies, programmes and health services. The Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu in 2020 hosted a policy dialogue on health equity in the context of the Bhutanese health system. With changing demographics and socioeconomic conditions, some of the factors that earlier determined an equitable distribution of services and resources are no longer relevant now. The referral system is easily bypassed not only because the patients have easy access to transportation to tertiary hospitals, but because of frequent interruptions in the service and the non‐availability of doctors in the district and general hospitals. The role of the private sector is restricted to a few diagnostic services while there is an apparent adequate spending capacity of consumers. There is an important component of out‐of‐pocket expenditure and catastrophic health expenditure in patients seeking treatments outside the country. The current health policies and strategic plans for the future lack a measure of health equity. We recommend conscientious assessment of health inequities in the current system and introducing policies and programmes to prevent the worsening of such inequities.

Background: Fiscal decentralisation (FD) is a widely implemented decentralisation policy consisting of the allocation of pooling and spending responsibilities from the central government to lower levels of governance within a country. In 2001, The Italian National Health System (Servizio Sanitario Nazionale, SSN) has introduced a strong element of FD, making regions responsible for their own pooling of resources and for their budgets. Despite the relevance, only few studies exist on health sector-FD in Italy, mostly looking at the effects of FD on infant mortality. Methods: This study performs a fixed-effects panel data analysis of Italian Regions and Autonomous provinces between the years 2001 and 2017, to investigate the effects of health sector-FD on availability, accessibility, and utilisation of healthcare services in Italy. Results: FD decreases availability of staff and hospital beds, decreases utilisation of care, measured by hospitalisation rates, and increases interregional patients' mobility for healthcare purposes, a finding suggesting increased disparities in access to healthcare. These effects seem to be stronger for public - rather than private - services, and are more prominent in poorer areas. Conclusion: This evidence suggest that FD has created a fragmented and unequal healthcare system, in which levels of availability, utilisation of, and accessibility to resources - as well as the extent of public sector's retrenchment - coincide with the wealth of the area. [ABSTRACT FROM AUTHOR]

The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on healthcare services has been reported to be much higher in India than in other countries. This study was conducted to ascertain the extent of this share of medicine expenditure using a novel methodology. OOP expenditure data were collected through exit interviews with 5252 out-patient department patients in three states of India. Follow-up interviews were conducted after Days 1 and 15 of the baseline to identify any additional expenditure incurred. In addition, medicine prescription data were collected from the patients through prescription audits. Self-reported expenditure on medicines was compared with the amount imputed using local market prices based on prescription data. The results were also compared with the mean expenditure on medicines per spell of ailment among non-hospitalized cases from the National Sample Survey (NSS) 75th round for the corresponding states and districts, which is based on household survey methodology. The share of medicines in OOP expenditure did not change significantly for organized private hospitals using the patient-reported vs imputation-based methods (30.74-29.61%). Large reductions were observed for single-doctor clinics, especially in the case of 'Ayurvedic' (64.51-36.51%) and homeopathic (57.53-42.74%) practitioners. After adjustment for socio-demographic factors and types of ailments, we found that household data collection as per NSS methodology leads to an increase of 25% and 26% in the reported share of medicines for public- and private-sector out-patient consultations respectively, as compared with facility-based exit interviews with the imputation of expenditure for medicines as per actual quantity and price data. The nature of healthcare transactions at single-doctor clinics in rural India leads to an over-reporting of expenditure on medicines by patients. While household surveys are valid to provide total expenditure, these are less likely to correctly estimate the share of medicine expenditure. [ABSTRACT FROM AUTHOR]

Background Cancer mortality is high in sub-Saharan Africa (SSA), partly due to inadequate treatment access. We explored access to and affordability of cancer treatment regimens for the top 10 cancers utilizing examples from Kenya, Uganda, and Rwanda. Materials and Methods Population, healthcare financing, minimum wage, and cancer incidence and mortality data were obtained from the WHO, World Bank, public sources, and GLOBOCAN. National Essential Medicines List (NEML) alignment with 2019 WHO EML was assessed as a proportion. Cancer regimen pricing was calculated using public and proprietary sources and methods from prior studies. Affordability through universal healthcare coverage (UHC) was assessed as 1-year cost <3× gross national income per capita; and to patients out-of-pocket (OOP), as 30-day treatment course cost <1 day of minimum wage work. Results A total of 93.4% of the WHO EML cancer medicines were listed on the 2019 Kenya NEML, and 70.5% and 41.1% on Uganda (2016) and Rwanda (2015) NEMLs, respectively. Generic chemotherapies were available and affordable to governments through UHC to treat non-Hodgkin's lymphoma, cervical, breast, prostate, colorectal, ovarian cancers, and select leukemias. Newer targeted agents were not affordable through government UHC purchasing, while some capecitabine-based regimens were not affordable in Uganda and Rwanda. All therapies were not affordable OOP. Conclusion All cancer treatment regimens were not affordable OOP and some were not covered by governments. Newer targeted drugs were not affordable to all 3 governments. UHC of cancer drugs and improving targeted therapy affordability to LMIC governments in SSA are key to improving treatment access and health outcomes. [ABSTRACT FROM AUTHOR]

The objective of this study is to determine how the Indian health care system is performing relative to health care system of the Kingdom of Saudi Arabia (KSA), given that it is facing sustained financial pressure, increasing population and demand for quality care. This is an observational study using secondary data from major international organizations, ministries of health, other government and non-government agencies in India and KSA. In order to measure the performance of health care systems, four domains such as population and healthcare coverage, healthcare spending, health system capacity and health status were considered. In comparison with KSA, India spends a very low expenditure on healthcare and markedly lower health workforce density. Due to lower healthcare expenditure, India's health services outcomes and health status are low compared to KSA. Although Indian healthcare system has undergone notable progress in the last two decades, it is lagging behind in many healthcare system parameters. If India wants to reach a high performing and a nation with good health outcomes comparable with other G20 member countries, it needs to invest more on primary healthcare, health workforce, strengthening public healthcare system, and prevention and treatment for non-communicable diseases. [ABSTRACT FROM AUTHOR]

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Purpose: To determine the cost of surgically treated mandibular fractures, methods of payments, and the relationship between socioeconomic status of subjects and payment methods in a Nigerian tertiary hospital. Methods: A retrospective review of 100 subjects who sustained 148 isolated mandibular fractures was conducted between November 2014 and October 2019. Demographics, socioeconomic status, mechanism of injury, fracture sites, type of treatment, and cost of treatment with methods of payments were obtained from medical records and hospital billing sheets of eligible subjects. The relationship between independent variables (age, sex, payment method, and treatment methods) and dependent variable (income class) was analyzed. Results: The mean age of the subjects was 31.8 ± 10.9 years; age range 17–63 years. The majority (75/100) belonged to the middle-income class. The costs of mandibular fractures repairs were ₦42,900 ($119.17) and ₦132,500 ($386.05) for closed reduction (CRMMF) and open reduction and rigid internal fixation (ORIF) respectively. All subjects in the low-income class (4/100) paid out of pocket for their treatment compared with 93% and 62% of the middle- and high-income classes respectively (p = 0.001). Half of the subjects in the low-income class had ORIF compared with 31% and 62% of the middle- and high-income classes respectively. Conclusions: The treatments costs of mandibular fractures were ₦42,900 ($119.17) and ₦132,500 ($386.05) for CRMMF and ORIF respectively. The treatment costs were mostly out-of-pocket expenditure meaning that the subjects in the low-and middle-income classes bore the financial burden of their injuries. [ABSTRACT FROM AUTHOR]

Abstract: Worldwide, one billion people sustain trauma, and 5 million people will die every year from their injuries. Countries must build trauma systems to effectively address this high-burden disease, but efforts are often challenged by financial constraints. Understanding mechanisms for trauma funding internationally can help to identify opportunities to address the burden of injuries. Trauma leaders from around the world contributed summaries around how trauma is managed across their respective continents. These were aggregated to create a comparison of worldwide trauma systems of care. The burden of injuries is high across the world's inhabited continents, but trauma systems remain underfunded worldwide and, as a result, are overall underdeveloped and do not rise to the levels required given the burden of disease. Some countries in Africa and Asia have invested in financing mechanisms such as road accident funds or trauma-specific funding. In Latin America, active surgeon involvement in accident prevention advocacy has made meaningful impact. All continents show progress in trauma system maturation. This article describes how different regions of the world organize and commit to trauma care financially. Overall, while trauma tends to be underfunded, there is evidence of change in many regions and good examples of what can happen when a country invests in building trauma systems., Level of Evidence: Expert Opinions; Level VII., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Chimeric antigen receptor T-cell therapies (CAR-T therapies) are a type of advanced therapy medicinal product (ATMP) that belong to a new generation of personalised cancer immunotherapies. This paper compares the approval, availability and financing of CAR-T cell therapies in ten countries. It also examines the implementation of this type of ATMP within the health care system, describing the organizational elements of CAR-T therapy delivery and the challenges of ensuring equitable access to all those in need, taking a more systems-oriented view. It finds that the availability of CAR-T therapies varies across countries, reflecting the heterogeneity in the organization and financing of specialised care, particularly oncology care. Countries have been cautious in designing reimbursement models for CAR-T cell therapies, establishing limited managed entry arrangements under public payers, either based on outcomes or as an evidence development scheme to allow for the study of real-world therapeutic efficacy. The delivery model of CAR-T therapies is concentrated around existing experienced cancer centres and highlights the need for high networking and referral capacity. Some countries have transparent and systematic eligibility criteria to help ensure more equitable access to therapies. Overall, as with other pharmaceuticals, there is limited transparency in pricing, eligibility criteria and budgeting decisions in this therapeutic area., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Private Equity (PE) investment in healthcare has grown substantially in recent years, raising alarm about its impact on patient care, healthcare professionals, and the overall integrity of the healthcare system. The influx of PE investments into healthcare has sparked debates regarding profit-driven motives, cost-cutting measures, and potential risks to patient safety and access to essential services. This article examines the extent and possible impacts of private equity in Canadian healthcare using data from a proprietary database. Drawing upon evidence from academic studies in the United States, this article provides evidence on the adverse impacts on the quality of care, the deterioration in working conditions, and degradation of the healthcare system. It provides suggestions to limit the predatory impacts of PE investment., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Historically, the US has been the largest contributor to development assistance for health (DAH), although its allocation has shifted in response to outside forces. This included, for example, the establishment of the Millennium Development Goals (MDGs) in 2000, which emphasised child mortality, maternal health, HIV/AIDS, and malaria. This led to funds being earmarked for disease-specific interventions rather than health system strengthening (HSS). In 2007, the World Health Organization (WHO) published six health system building blocks, representing essential components of strong health systems. In 2015, the MDGs were replaced by the Sustainable Development Goals (SDGs), which emphasised capacity-building as opposed to specific health problems. The Lancet Commission on Global Surgery, meanwhile, highlighted surgical capacity building as essential to achieving Universal Health Coverage (UHC). Given the renewed emphasis on a comprehensive approach rather than disease-specific interventions, one might anticipate the US aligning with this rhetoric in its allocation of DAH. However, we hypothesise that this is not the case., Methods: We queried the Organization for Economic Co-operation and Development (OECD) database for allocation of US DAH to low- and middle-income countries between 1995 and 2019, thereby excluding data after 2019 to avoid the influence of the coronavirus disease 2019 pandemic. OECD entries were assigned to health systems strengthening (HSS) or disease-specific interventions categories. The WHO building blocks were used as a framework for health systems strengthening., Results: From 1995 to 1999, US DAH allocated to HSS decreased from 42% to 34%. The allocation decreased further from 34% in 2000 to 4% in 2007; correspondingly, DAH allocated to disease-specific interventions increased from 67% to 96%. Between 2008 and 2019, the distribution of US DAH remained relatively stable, with funds allocated to HSS versus disease-specific interventions ranging from 3-12% and 88-98% respectively., Conclusions: While total US DAH contributions in the 1990s and early 2000s were significantly lower compared to the decade that followed, the distribution of these funds was more evenly divided between HSS and disease-specific interventions. Despite attempts by the WHO and United Nations to redirect attention to HSS as the path to achieving UHC, the US continues to largely support disease-specific interventions and overlook the importance of HSS, including surgical capacity building., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Introduction: Between 2020 and 2022, there was a rise in employment and entrepreneurial activity, despite some unemployment growth. In the Compulsory Social Health Insurance (CSHI), insured individuals, especially privileged and wage workers, increased. However, certain contributors, like those exempt from contributions and single social taxpayers, decreased, possibly due to legislative changes or the economic climate. The study aimed to evaluate the effectiveness and accessibility of medical services within the frameworks of Compulsory Social Health Insurance and the state Guaranteed volume of free medical care based on data regarding waiting times and the volume of services provided., Methods: This retrospective study analyzed data from 2020 to 2022 on patients receiving care under Kazakhstan's Mandatory Social Medical Insurance System (MSMIS) and Guaranteed Volume of Free Medical Care. Data included insurance status, labor market indicators, and medical service procurement. Descriptive statistics were calculated, and t -tests, with p -values indicating statistical significance ( p  < 0.05)., Results: It has been identified that overall, the execution of the plan for all types of medical care in Kazakhstan, including Almaty, reaches 100.0%, indicating sufficient financial support for the healthcare system. Rehabilitation centers and COVID-19 testing services stand out with shorter waiting times, whereas comprehensive diagnostic and advisory services require significantly longer waiting periods. The Guaranteed Volume of Free Medical Care typically offers a greater number of services with shorter waiting times compared to MSMIS, except for specialized medical care services in diagnosing new formations, where the Guaranteed Volume of Free Medical Care also has shorter waiting times but provides a greater number of services., Conclusion: The study has allowed us to identify differences in the availability and volume of medical services provided between Compulsory Social Health Insurance and the state Guaranteed volume of free medical care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Shurenova, Kurakbayev, Abildaev and Tazhiyeva.)