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Since 2013, Permitted Development Rights (PDR) in England have allowed commercial-to-residential conversions in locations once deemed suitable only for non-residential land-use. This deregulation of planning control has been justified as a way of encouraging more home-building in areas experiencing 'housing crisis', but its overall consequences remain unclear. This paper hence compiles quantitative evidence on a city-wide scale on the price, size, build and location of these conversions in London 2013–2021. It finds that homes produced through this route are generally smaller than the London average and are over-concentrated in neighbourhoods with fewer accessible green spaces and higher-than-average levels of air pollution. Here, larger conversion schemes (of more than 10 units) appear particularly problematic, potentially subjecting residents to forms of 'slow violence' that could have long-term consequences for their physical and mental health. The paper also finds that, on average, PDR conversions are marginally more affordable than other new developments in the capital, but are also more expensive per square metre, suggesting deregulation is allowing developers to 'extract' maximum value from these schemes rather than providing affordable homes per se. The implications of this are discussed in relation to the politics of housing in London and the wider forms of planning deregulation allowing developers to accrue increased profits from housing in an era of intense financialisation. [ABSTRACT FROM AUTHOR]

AbstractSince around 2008 there has been a sharp decline in homeownership rates in many OECD countries, particularly among young adults. This may reflect changing preferences for more flexible housing options or a decline in affordability due to a combination of house price increases and more difficult access to finance (mortgage loans, deteriorating labour market conditions, insufficient income, etc.). We first examine how these trends affect Austria as a whole and then focus on two regions with long-term policy strategies to promote homeownership through tailored housing subsidy programmes (Lower Austria, Vorarlberg). We use survey data from three sources (Microcensi, EU-SILC, HFCS) and regional administrative data. Our results show that young adults (up to 35) are less likely to become homeowners in 2020 than in 2010, although this is more pronounced for the middle-aged (35–49) than for younger people. We show that the analysis at national level is insufficient, as there are large differences between regions and between types of dwelling. Focusing on the regional level reveals that price dynamics in urban areas, which exceed income developments, appear to be the main drivers. As young households participate less in homeownership than previous generations, this points to a latent and deepening problem of intergenerational equity. Current regional policies to promote homeownership do not reach the necessary scale to counteract the dominant market trends. We discuss regional policy options that make use of the Austrian housing policy framework and focus on increasing the overall supply of housing rather than exclusively on demand-side measures. [ABSTRACT FROM AUTHOR]

Food insecurity affects an estimated 691–783 million people globally and is disproportionately high in Africa and Asia. It arises from poverty, armed conflict, and climate change, among other demographic and globalization forces. This review summarizes evidence for policies and practices across five elements of the agrifood system framework and identifies gaps that inform an agenda for future research. Under availability, imbalanced agriculture policies protect primarily staple food producers, and there is limited evidence on food security impacts for smallholder and women food producers. Evidence supports the use of cash transfers and food aid for affordability and school feeding for multiple benefits. Food-based dietary guidelines can improve the nutritional quality of dietary patterns, yet they may not reflect the latest evidence or food supplies. Evidence from the newer food environment elements, promotion and sustainability, while relatively minimal, provides insight into achieving long-term impacts. To eliminate hunger, our global community should embrace integrated approaches and bring evidence-based policies and practices to scale. [ABSTRACT FROM AUTHOR]

Background: China has implemented policies to make rare diseases more affordable. While previous studies evaluated overall affordability, few have examined affordability differences across regions and disease types. Given the vastness of China and varying medical policies across cities, this study assesses the affordability of rare diseases based on China's First List of Rare Diseases (CFLRD), National Reimbursement Drug List (NRDL), and outpatient chronic and special disease policies in each prefecture. Method: Six rare diseases were selected and the average annual treatment cost of all relevant drugs in NRDL was calculated for each disease. Based on the WHO/HAI standardized approach, the study analyzed 289 cities with outpatient chronic and special disease policies, measured the security levels by the actual reimbursement ratio of Basic Medical Insurance (BMI) and affordability by the ratio of individual expenses after reimbursement to the annual disposable income of urban residents in the province. The security levels and affordability differences across disease types and provinces were analyzed using the Mann-Whitney U test and the K-W test. Result: The affordability of rare diseases varied significantly on the disease types and annual treatment cost. Diseases with an annual treatment cost below 100 000 yuan are affordable to all prefectures even with low reimbursement rates, while those with a higher treatment cost were not affordable in at least 80% of prefectures even though the reimbursement ratio is high. The affordability of the same disease varies significantly across provinces and municipalities. Outpatient chronic and special diseases insurance and critical illness insurance, and the inconsistencies between them, result in regional differences. Conclusion: Although China has made progress in improving the affordability of rare diseases, significant differences persist between cities and diseases. The study suggests the optimization of the BMI system and explores independent funds and innovative insurance models to enhance the affordability of rare diseases, particularly those with extremely high treatment costs. [ABSTRACT FROM AUTHOR]

In this cross-sectional descriptive study conducted in the Ratnapura district, Sri Lanka, we assessed the affordability of oral pediatric anti-infective medicines (OPAIMs). Using a modified WHO/HAI medicinal price methodology, we examined the availability, median price ratios (MPRs), mean percentage difference, and affordability of the standard treatment of the originator brand (OB) and lowest-priced generic (LPG) OPAIMs in 30 private and 2 state-owned pharmacies. The study revealed disparities in availability, with only 50% of private pharmacies offering all 11 medicinal drugs in their generic form. The MPRs of OPAIMs for OB and LPG varied, with three drugs exceeding the financially acceptable MPR of 2 (albendazole, amoxicillin, and erythromycin). The standard treatment with LPGs costs between 0.17 and 0.85 and between 0.06 and 0.28 days' wages for the lowest daily salary of the private sector and unskilled public employees, respectively. We identified erythromycin and albendazole as having less than 50% availability in their generic form in private pharmacies. To address these findings, we recommend frequent pricing revisions based on exchange rates and associated costs, coupled with the establishment of a transparent scientific criterion to subsidize essential medicines deemed "unaffordable." Failure to implement such measures amidst economic crises may adversely impact financial access to essential medications. [ABSTRACT FROM AUTHOR]

Definition: Research on sustainable, affordable housing is evolving. Yet, its conceptual efficacy in light of the changing needs of today's cities and targeted low-to-middle-income households remains unknown. In today's rapidly urbanizing world, understanding the conceptual relevance and importance of land use planning tools such as vertical subdivision to the delivery of sustainable housing is tenable. In response to this knowledge gap, this entry inquires, how can the delivery of affordable housing be configured in a manner that leverages the potential of a redefined vertical subdivision development to optimize densities and ensure that housing affordability is sustainable? Here, this entry re-defines vertical subdivision development as a housing planning and design tool that allows for the segregation of air spaces into individual volumetric land parcels that mimic the environmental features of the land-on-ground, such that housing construction within such volumetric spaces is a function of the contextually relevant needs of occupants. This entry demonstrates a paradigm shift from existing housing infrastructure planning models and narratives to one that responds to and addresses all three dimensions of sustainability: economic (sustainable affordability), environmental (sustainable densities), and social (occupant wellness) in the housing infrastructure planning and delivery process. [ABSTRACT FROM AUTHOR]

Proponents of demand-side rental subsidy programmes have argued that they enhance consumer choice while costing less than supply-side interventions. However, unanswered questions remain on the effectiveness of demand-side rental subsidies in reducing affordability stress among low-income renters. This paper analyses Australia's Commonwealth Rent Assistance (CRA) as a case study for evaluating the effectiveness of housing allowance interventions. Our evaluation exemplifies some important policy principles. First, we demonstrate that a multi-pronged package can simultaneously improve adequacy and targeting on those in greatest housing stress, while maintaining revenue neutrality. Second, whether CRA is designed as an income-oriented or housing-oriented subsidy can affect its effectiveness in improving rental affordability. Third, country-specific institutional contexts cannot be ignored. In Australia, constitutional amendments may be required if CRA is to be paid as a stand-alone housing payment rather than as a supplement to other social security payments. Furthermore, given the role of CRA in the esoteric funding structure of social housing, reforms to payment structure must incorporate meaningful measures to avoid unintended damaging consequences in this arena. Finally, any implementation of reforms should be embedded within a strong housing logic that aims to reduce affordability stress rather than as part of a fiscal cost reduction exercise. [ABSTRACT FROM AUTHOR]

Highlights: Recent progress in Zn–air batteries is critically reviewed. Current challenges of rechargeable Zn–air batteries are highlighted. Strategies for the advancement of the anode, electrolyte, and oxygen catalyst are discussed. Future research directions are provided to design commercial Zn–air batteries. Zinc–air batteries (ZABs) are gaining attention as an ideal option for various applications requiring high-capacity batteries, such as portable electronics, electric vehicles, and renewable energy storage. ZABs offer advantages such as low environmental impact, enhanced safety compared to Li-ion batteries, and cost-effectiveness due to the abundance of zinc. However, early research faced challenges due to parasitic reactions at the zinc anode and slow oxygen redox kinetics. Recent advancements in restructuring the anode, utilizing alternative electrolytes, and developing bifunctional oxygen catalysts have significantly improved ZABs. Scientists have achieved battery reversibility over thousands of cycles, introduced new electrolytes, and achieved energy efficiency records surpassing 70%. Despite these achievements, there are challenges related to lower power density, shorter lifespan, and air electrode corrosion leading to performance degradation. This review paper discusses different battery configurations, and reaction mechanisms for electrically and mechanically rechargeable ZABs, and proposes remedies to enhance overall battery performance. The paper also explores recent advancements, applications, and the future prospects of electrically/mechanically rechargeable ZABs. [ABSTRACT FROM AUTHOR]

The study explored the link between Energy Security (ES) and the productivity of SMEs in the Greater Accra Region of Ghana. The study assessed the perceptions of 246 respondents from 500 SMEs. Means, Relative Importance Index (RII) and P-values were calculated for availability, affordability, efficiency, and environmental stewardship indicators and used to assess the association between ES and the productivity of SMEs. ES at the SMEs is highest for affordability, followed by environmental stewardship, efficiency, and availability. ES has a significant positive correlation with sales revenue, output per unit cost of production, labour utilization, and capital utilization of SMEs. [ABSTRACT FROM AUTHOR]

Background: Food insecurity is a public health issue for many regions globally, and especially Indigenous communities. We propose food budget ratio (FBR)—the ratio of food spending to after-tax income—as an affordability metric that better aligns with health equity over traditional price-focused metrics. Existing census and inflation monitoring programs render FBR an accessible tool for future affordability research. Methods: Public census and food pricing datasets from 2011 to 2021 were analyzed to evaluate food affordability for a cohort of 121 remote Indigenous communities in Canada (n = 80,354 persons as of March 2021). Trends in population-weighted versus community-weighted averages, inflation-adjusted mean price of the Revised Northern Food Basket (RNFB), and distributions of FBR, per-capita price of food, and per-capita after-tax income were calculated and compared to Canada at large. Results: Population-weighted versus community-weighted mean price of the RNFB differed by < 5% for most points in time, peaking at 17%. Mean raw price of the RNFB was relatively stable, while mean inflation-adjusted price of the RNFB decreased 19%. Mean and standard deviation in FBR trended downwards from (0.40; 0.21) in 2011 to (0.25; 0.10) in 2021, while the mean for Canada held stable at 0.10 ± 0.01. Mean and standard deviation in inflation-adjusted per-capita price of food fell from ($5,621; $493) to ($4,510; $243), while the Canada-wide mean rose from $2,189 to $2,567; values for per-capita after-tax income increased from ($17,384; $7,816) to ($21,661; $9,707), while the Canada-wide mean remained between $24,443 and $26,006. Current Nutrition North Canada (NNC) subsidy rates correlate closely with distance to nearest transportation hub (σXY = 0.68 to 0.70) whereas food pricing, after-tax income, and FBR correlate poorly with distance (σXY = -0.22 to 0.03). Conclusions: The FBR approach yields greater insights on food affordability compared to price-based results, while using readily available public datasets. Whereas 19% reductions in RNFB per-capita food price were observed, FBR decreased 63% yet remained 2.5 times the Canada-wide FBR. The reduction in FBR was driven both by the reduced price of food and a 25% increase in after-tax income. It is recommended that NNC consider FBR for performance measurement and setting subsidy rates. [ABSTRACT FROM AUTHOR]

Background: The most recent World Medicines Situation Report published in 2011 found substantial medicine availability and affordability challenges across WHO regions, including Africa. Since publication of the 2011 report, medicine availability and affordability has risen on the international agenda and was included in the Sustainable Development Goals as Target 3.8. While numerous medicine availability and affordability studies have been conducted in Africa since the last World Medicines Situation Report, there has not been a systematic analysis of the methods used in these studies, measures of medicine availability and affordability, categories of medicines studied, or geographic distribution. Filling this knowledge gap can help inform future medicine availability and affordability studies, design systems to monitor progress toward Sustainable Development Goal Target 3.8 in Africa and beyond, and inform policy and program decisions to improve medicine availability and affordability. Methods: We conducted a systematic scoping review of studies assessing medicine availability or affordability conducted in the WHO Africa region published from 2009–2021. Results: Two hundred forty one articles met our eligibility criteria. 88% of the articles (213/241) reported descriptive studies, while 12% (28/241) reported interventional studies. Of the 198 studies measuring medicine availability, the most commonly used measure of medicine availability was whether a medicine was in stock on the date of a survey (124/198, 63%). We also identified multiple other availability methods and measures, including retrospective stock record reviews and self-reported medicine availability surveys. Of the 59 articles that included affordability measures, 32 (54%) compared the price of the medicine to the daily wage of the lowest paid government worker. Other affordability measures were patient self-reported affordability, capacity to pay measures, and comparing medicines prices with a population-level income standard (such as minimum wage, poverty line, or per capita income). The most commonly studied medicines were antiparasitic and anti-bacterial medicines. We did not identify studies in 22 out of 48 (46%) countries in the WHO Africa Region and more than half of the studies identified were conducted in Ethiopia, Kenya, Tanzania, and/or Uganda. Conclusion: Our results revealed a wide range of medicine availability and affordability assessment methodologies and measures, including cross-sectional facility surveys, population surveys, and retrospective data analyses. Our review also indicated a need for greater focus on medicines for certain non-communicable diseases, greater geographic diversity of studies, and the need for more intervention studies to identify approaches to improve access to medicines in the region. [ABSTRACT FROM AUTHOR]

Background: Affordability of healthy food is a key determinant of the diet-related health of First Nations Peoples. This systematic scoping review was commissioned by the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council (NPYWC) in Central Australia to identify interventions to improve economic access to healthy food in First Nations communities in selected high-income, colonised countries. Methods: Eight databases and 22 websites were searched to identify studies of interventions and policies to improve economic access to healthy food in First Nations communities in Australia, Canada, the United States or New Zealand from 1996 to May 2022. Data from full text of articles meeting inclusion criteria were extracted to a spreadsheet. Results were collated by descriptive synthesis. Findings were examined with members of the NPYWC Anangu research team at a co-design workshop. Results: Thirty-five publications met criteria for inclusion, mostly set in Australia (37%) or the US (31%). Interventions (n = 21) were broadly categorised as price discounts on healthy food sold in communities (n = 7); direct subsidies to retail stores, suppliers and producers (n = 2); free healthy food and/or food vouchers provided to community members (n = 7); increased financial support to community members (n = 1); and other government strategies (n = 4). Promising initiatives were: providing a box of food and vouchers for fresh produce; prescriptions for fresh produce; provision/promotion of subsidised healthy meals and snacks in community stores; direct funds transfer for food for children; offering discounted healthy foods from a mobile van; and programs increasing access to traditional foods. Providing subsidies directly to retail stores, suppliers and producers was least effective. Identified enablers of effective programs included community co-design and empowerment; optimal promotion of the program; and targeting a wide range of healthy foods, particularly traditional foods where possible. Common barriers in the least successful programs included inadequate study duration; inadequate subsidies; lack of supporting resources and infrastructure for cooking, food preparation and storage; and imposition of the program on communities. Conclusions: The review identified 21 initiatives aimed at increasing affordability of healthy foods in First Nations communities, of which six were deemed promising. Five reflected the voices and experiences of members of the NPYWC Anangu research team and will be considered by communities for trial in Central Australia. Findings also highlight potential approaches to improve economic access to healthy foods in First Nations communities in other high-income colonised countries. Trial registration: PROSPERO CRD42022328326. [ABSTRACT FROM AUTHOR]

In Kenya 26% of children under age 5 experience stunted growth, 4% are wasted and 11% are underweight. In pregnant women, the prevalence of iron deficiency is 36% and iron‐deficiency anaemia prevalence is 26%. Previous studies have identified affordability as a key barrier to the intake of nutrients, particularly from animal‐source foods (ASFs). Thus, this study analyzes to what extent the affordability of ASF in Kenya can be improved. It focuses on four ASFs: eggs, milk, chicken and beef. Using a computable general equilibrium model, three policy simulations were undertaken to establish the impact of potential changes on nutritious ASF availability and affordability: a 20% increase in total factor productivity (TFP) for the four products; a 20% TFP increase plus a 25% reduction in trade and transportation margins; and a 20% TFP increase for ASF and maize (a key input in animal feed). Simulations suggest increasing the productivity of the four ASF products would increase their availability and lower consumer prices (up to 17% lower). Household consumption of the four commodities would increase, resulting in improved household dietary diversity. Rural households would gain more compared with urban households. Poor households (the lowest 40%) would register larger welfare (Equivalent Variation) gains than other households in both urban and rural areas. The richest 20% of the population would neither lose nor gain following the policy changes. Reducing transportation costs and trade margins and increasing maize productivity could further reduce the price of ASFs through lower production costs and increased consumption. [ABSTRACT FROM AUTHOR]

Complementary feeding among children aged 6–23 months is a key determinant of micronutrient deficiencies and childhood stunting, the burdens of which remain high in Kenya. This study examines the affordability of complementary foods to increase young children's nutrient consumption across eight provinces in Kenya. We combined data from household surveys, food composition tables and published sources to estimate the cost of portion sizes that could meet half of the children's daily iron, vitamin A, calcium, zinc, folate, vitamin B12 and protein requirements from complementary feeding. These costs were compared to current household food expenditures. The selection of foods and price and expenditure data were stratified by province. Our analysis indicates that vitamin A, vitamin B12 and folate are affordable to most households in Kenya via liver, beans and in some provinces, orange‐fleshed fruits and vegetables, avocado and small dried fish. Calcium, animal‐ source protein, zinc and iron were less affordable and there was more provincial variation. In some provinces, small dried fish were an affordable source of calcium, protein and zinc. In others (North Eastern, Central, Eastern, parts of Rift Valley and Coast), small dried fish were not commonly consumed and other foods were less affordable. Future research should consider interventions aimed at reducing prices, increasing availability and changing behaviours related to these foods. Solutions such as supplementation and fortification may be needed for iron and zinc in some locations. Food affordability presented the greatest barriers in North Eastern province, which had lower dietary diversity and may require additional targeted interventions. [ABSTRACT FROM AUTHOR]

In Kenya 26% of children under age 5 experience stunted growth, 4% are wasted and 11% are underweight. In pregnant women, the prevalence of iron deficiency is 36% and iron‐deficiency anaemia prevalence is 26%. Previous studies have identified affordability as a key barrier to the intake of nutrients, particularly from animal‐source foods (ASFs). Thus, this study analyzes to what extent the affordability of ASF in Kenya can be improved. It focuses on four ASFs: eggs, milk, chicken and beef. Using a computable general equilibrium model, three policy simulations were undertaken to establish the impact of potential changes on nutritious ASF availability and affordability: a 20% increase in total factor productivity (TFP) for the four products; a 20% TFP increase plus a 25% reduction in trade and transportation margins; and a 20% TFP increase for ASF and maize (a key input in animal feed). Simulations suggest increasing the productivity of the four ASF products would increase their availability and lower consumer prices (up to 17% lower). Household consumption of the four commodities would increase, resulting in improved household dietary diversity. Rural households would gain more compared with urban households. Poor households (the lowest 40%) would register larger welfare (Equivalent Variation) gains than other households in both urban and rural areas. The richest 20% of the population would neither lose nor gain following the policy changes. Reducing transportation costs and trade margins and increasing maize productivity could further reduce the price of ASFs through lower production costs and increased consumption.Key messages: Affordability is a key barrier to the consumption of nutritious animal‐source foods (ASFs) in Kenya.We undertook simulations to understand how policy changes would impact ASF affordability and availability.Increasing the supply of ASFs could yield lower prices for these foods.The impact on prices could be magnified if supply increases were accompanied by reduced trade and transportation margins.Intake of ASFs and dietary diversity could increase if prices were lowered. [ABSTRACT FROM AUTHOR]

Cancer medicines have become one of the most dominant global medical technologies. They generate huge profits for the biopharmaceutical industry as well as fuel the research and advocacy activities of public funders, patient organisations, clinical and scientific communities and entire federal political ecosystems. The mismatch between the price, affordability and value of many cancer medicines and global need has generated significant policy debate, yet we see little change in behaviours from any of the major actors from public research funders through to regulatory authorities. In this policy analysis we examine whether, considering the money and power inherent in this system, any rationale global consensus and policy can be achieved to deliver affordable and equitable cancer medicines that consistently deliver clinically meaningful benefit. [ABSTRACT FROM AUTHOR]

Background: Low fruit and vegetable (FV) intake in low- and middle-income countries, which is associated with noncommunicable diseases and micronutrient deficiencies, requires food system interventions addressing FV accessibility, affordability, and acceptability. Periodic FV intake monitoring during interventions informs progress toward achieving increased intakes and contributes to understanding the effectiveness of these interventions. Objectives: This study evaluates the trend in FV intake before, during, and after implementation of a set of nutrition-sensitive food system interventions addressing accessibility, affordability, and acceptability to increase FV consumption over a 1-y period in Vietnamese and Nigerian low-income urban and periurban females. Methods: We used the Diet Quality Questionnaire to assess FV food group consumption among 600 Vietnamese (Hanoi) and 610 Nigerian (Ibadan) females before, during, and after the interventions (Vietnam: July 2020-September 2021; Nigeria: November 2020-December 2021). A FV score was compared between exposure groups with (mixed) count modeling. The trend in consumption of individual FV groups was analyzed with mixed logistic regression. Results: The FV score was stable over time, and a small increase was observed after the intervention period especially in Nigeria and in urban Vietnam. A decrease in the total score was observed in periurban Vietnam. Fluctuations were detected in the probability of consumption of individual FV groups over time especially within the fruit groups, probably due to seasonal availability. The degree of exposure could not explain differences in FV intake. Conclusions: We found a marginal increase in the proportion of females consuming FV during the interventions in both countries. The FV score appeared to be a simple, quick, and easy-to-use indicator for monitoring diversity, variety, and consumption. [ABSTRACT FROM AUTHOR]

Background: Access to safe, effective, affordable, and high-quality medications has been included in the Sustainable Development Goals (SDGs) of the United Nations as a crucial step towards attaining universal health coverage. Access to medicines is a fundamental human right. If medicines are accessible and affordable, they save lives by reducing mortality and morbidity associated with acute and chronic diseases. WHO recommends that all countries voluntarily reach the minimum target of 80% availability of medicines by 2025. The primary purpose of this research is to assess access to essential medicines in Juba County, South Sudan. Methods: This study was undertaken using the standard World Health Organization/Health Action International Organization (WHO/HAI) approach for surveying the prices, availability, and affordability of medicines. A survey was conducted in six payams of Juba County, South Sudan, and 55 health facilities were assessed. Results: Prices for generic medicines were better in faith-based health facilities with a median price ratio of 1.95. Private pharmacies and private clinics had MPRs of 4.64 and 4.32, respectively. Local prices were high compared to International referent prices. Availability of medicines was highest in the faith-based health facilities (65.5%) and slightly lower in private pharmacies (55.4%), private clinics (57.7%) and public (50.4%) sectors. Most of the surveyed medicines were unaffordable. The medicines needed to treat non-communicable diseases cost up to 33.7-day wages for one full course of treatment. Conclusions: In South Sudan, medicines are poorly available in all sectors. Medicines are affordable in the public sector but Most medicines are unaffordable in private pharmacies, private clinics and faith-based health facilities. Poor medicines availability in the public sector contributes to the overall unaffordability of medicines in all the other sectors. [ABSTRACT FROM AUTHOR]

Background: Tunafasi is a community-based rehabilitation (CBR) programme for persons with disability, implemented by a local non-governmental organisation in Uvira, Democratic Republic of Congo, in partnership with government. To assess affordability and support discussions with the government about continued financing and implementation, Tunafasi representatives commissioned a cost-effectiveness study of the programme's health component. Objectives: This study aimed to estimate the programme's impacts, costs, cost per disability-adjusted life year (DALY) averted and affordability of the health component implemented from February 2019 to December 2021. Method: Health-related improvements were assessed for a sample of 511 persons with disability and converted to DALYs averted. Total expenditure during the period February 2019 to December 2021 was estimated from audited financial statements. The cost per DALY averted was estimated by dividing total programme expenditure by the sum of DALYs averted and compared against newly generated, country-specific thresholds to assess affordability. Results: The programme cost $55 729.00 to implement from February 2019 to December 2021 and averted 234 DALYs in 511 persons, at a cost per DALY averted of $224.00. This falls above the affordability threshold of $54.00 – $199.00. Conclusion: While the cost per DALY averted is higher than what thresholds consider affordable for Democratic Republic of Congo, improved engagement from CBR facilitators and greater possibilities for treatment in the post-pandemic era should improve results. Contribution: This new CBR implementation modality offers a possibly affordable solution to African governments struggling to operationalise disability commitments such as United Nations Convention on the Rights of Persons with Disabilities. [ABSTRACT FROM AUTHOR]

Background: Poor diets lead to negative health outcomes, including increased risk of noncommunicable diseases. Food systems, most notably agriculture, contribute to greenhouse gas emissions (GHGE) that lead to climate change. Meat consumption plays a role in both health and environmental burden. Consumption of meat alternatives may reduce these harms. The aim was to compare meat products and their plant‐based alternatives on nutritional parameters, GHGE and price to examine if it is feasible and beneficial for policymakers and health professionals to recommend meat alternatives. Methods: Data on nutritional information and cost for 99 selected products were collected from five UK supermarkets. Estimates for GHGEs for 97 of these products were found through secondary articles. Median values for nutritional value, GHGE (kgCO2e) and price per 100 g were calculated to allow comparisons between meat products and their alternatives. Mann–Whitney U tests were used to look for significant differences for each nutrient, emissions and price. Results: Meat alternatives contained significantly more fibre and sugar and were significantly higher in price compared to the equivalent meat products. Meat alternatives had a significantly lower number of calories, saturated fat, protein and kgCO2e than meat products. There was no significant difference in the amount of salt between meat and meat alternatives. Conclusions: Overall, this paper found that meat alternatives are likely to be better for health according to most parameters, while also being more environmentally friendly, with lower GHGEs. However, the higher price of these products may be a barrier to switching to meat alternatives for the poorest in society. Key points: Plant‐based meat alternatives (PBMA) were compared with meat products on nutrition, environmental impact, and affordability. PBMA contained less saturated fat, protein and calories, more fibre and sugar, and similar salt content. They were more expensive but had less emissions. All plant‐based meat alternatives and most meat products were classed as ultra‐processed. [ABSTRACT FROM AUTHOR]

Background: Since the introduction of BCR::ABL1 tyrosine kinase inhibitors (TKIs) in 2000, the treatment of Philadelphia chromosome (Ph)‐positive chronic myeloid leukemia (CML) has improved significantly. Methods: This study aimed to evaluate Ph‐positive CML outcomes in the TKI therapy era, considering factors like age, ethnicity, and income. Using the Surveillance, Epidemiology, and End Results (SEER) database, 2857 patients with Ph‐positive CML diagnosed from 2000 to 2019 were analyzed. Results: The overall 5‐year survival rates in Ph‐positive CML increased to above 80%, compared with pre‐TKIs historical data reporting 5‐year overall survival (OS) rates of less than 50%. The 5‐year OS rate was 73% for patients diagnosed in 2000–2004, 82% in 2005–2009, and 78% in 2010–2014; the 4‐year OS rate was 83% in 2015–2019. The 5‐year OS rate for younger patients (<60 years old) was 88% in 2000–2009 and 90% in 2010–2019 (p value.426). In older patients (60+ years old), the 5‐year OS rates were 64% and 65%, respectively (p value,.303). Lower household income was associated with inferior survival across the 2000–2019. These results are inferior to European studies where TKIs are universally available and affordable, and relative OS in CML is similar to age‐matched normal populations. Conclusions: Although the outcome of Ph‐positive CML has improved significantly since 2000, the SEER data still shows differences in outcomes among patient subsets, some anticipated (worse OS in older patients accounted by the relative OS), but others that suggest less than universal access and affordability of this therapy (among poorer patients) in the United States. Although the outcome of Ph‐positive chronic myeloid leukemia has improved significantly since 2000, the Surveillance, Epidemiology, and End Results data still shows differences in outcomes among patient subsets, some anticipated (worse survival in older patients accounted by the relative survival), but others that suggest less than universal access and affordability of this therapy (among poorer patients) in the United States. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the general public's perception of services provided by community pharmacies, their willingness to utilize these services, their satisfaction with and understanding of community pharmacists, and their views on dispensing separation and pharmacy medicines (P medicines). Methods: An online cross-sectional study was conducted, in which questionnaires were distributed among the general public. A novel questionnaire was designed and validated specifically for this study. It was composed of six sections: demographics, pharmacy usage and service preferences, understanding and satisfaction with pharmacists, views on dispensing separation, private community pharmacies, and knowledge of P medicines. Statistical analyses such as one-way ANOVA, independent t test, and binary logistic regression were employed, with a p value of < 0.05 considered statistically significant. Results: The study received 222 responses. The majority of the respondents were females within the 20–29-year-old age group (62.2%). Most respondents preferred to consult doctors for medical treatment, with their primary reason for visiting community pharmacies being to collect prescribed medicines. About 52.7% of respondents expressed their willingness to avail of screening services and treatment for minor illnesses at community pharmacies. A statistically significant difference was found among different age groups regarding their views on the dispensing separation system, with those aged 41–50 years demonstrating higher scores. However, the binary logistic regression analysis did not reveal any statistical significance when comparing the understanding of P medicines among respondents. Conclusions: In general, the public prefers to consult doctors for medical treatment and visit community pharmacies predominantly to collect prescriptions or purchase over-the-counter medications. Nonetheless, they are also open to utilizing services provided by community pharmacists, particularly screening services and treatment for minor illnesses. [ABSTRACT FROM AUTHOR]

Background: China initiated a health system reform in 2009 to achieve Universal Health Coverage (UHC) by 2020. While the effectiveness of health-system reforms has been studied, equity in health-service utilization and financial burden remains underexplored. This study evaluated whether the health system reform has improved the equity in utilization and financial burden of health services among patients with hypertension in China. Methods: We obtained data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted between 2011 and 2018. The main outcome variables were outpatient and inpatient service utilization rates and catastrophic health expenditure (CHE) for patients with hypertension. The Standardized Concentration Index (CI) was used to measure the changing equity in health service utilization and affordability. Results: Outpatient service utilization was relatively equal among patients with varying socioeconomic statuses (SESs) (CI: 0.041 in 2011 and 0.064 in 2018). Inpatient service utilization inequity improved from CI 0.144 in 2011 to CI 0.066 in 2018. CHE incidence increased from 15.6% in 2011 to 24.2% in 2018. CI for CHE declined from -0.069 in 2011 to -0.012 in 2015 but increased to -0.063 in 2018. Conclusions: Health insurance expansion and poverty alleviation policies promoted equity in inpatient service utilization for hypertensive patients. However, the financial burden for the poor requires further attention through reimbursement policy adjustments for outpatient services in primary care settings. [ABSTRACT FROM AUTHOR]

Abstract Rural infrastructure is fundamental to rural development in developing countries. Yet, rural governments endure heavier fiscal constraints than their urban counterparts. Thus, the capacity of rural residents to subsidize infrastructure supply is critical to facilitating provision. While this capability has increased, the willingness of rural inhabitants to absorb cost burdens remains low. However, the factors impacting willingness remains unexamined. This study addresses this deficiency by identifying influencing factors through the lens of “public goods theory.” A field survey of 266 rural Chinese residents is conducted. Results reveal that opinions on affordability are shaped by government policy, perceptions of equitable burden-sharing, and group behavior. Situational cognition plays an important intermediary role in affecting rural residents’ willingness. The “free-rider effect” is also confirmed as a factor. The findings of this study offer strategies for increasing the affordability of rural infrastructure investment in developing countries by raising the pay-for-use willingness of beneficiaries. [ABSTRACT FROM AUTHOR]

Background: Access to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn't well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients' perceived affordability of essential medicines, and accommodation and acceptability of the public facility. Methods: A cross-sectional study was carried out at 30 primary healthcare facilities' drug dispensaries across three districts in Khartoum state. Within each Centre's dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan's national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26. Results: Participants' ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets. Conclusion: Patients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients' access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients' satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan. [ABSTRACT FROM AUTHOR]

Introduction: Availability of essential medicines that meet the expected quality standards, in appropriate dosage forms at affordable prices is a fundamental prerequisite to fulfill healthcare needs of given a population. This study assessed available products, prices and affordability of essential medicines (EM) in community pharmacies in Sri Lanka with comparison of registration status from the National Medicines Regulatory Authority(NMRA). Methods: A cross-sectional island-wide survey of 80 pharmacies was conducted according to World Health Organization and Health Action International Manual (WHO/HAI). Hundred medicines were selected from the global core list(n = 14), regional core list(n = 16) and the Sri Lanka Essential Medicine List (SL-EML) (n = 70) based on healthcare needs. Number of registered products in 2015 and 2021 were compared. Findings: Average availability was 85.4%(± 12.31) and availability was lowest in the Northern province (69.38 ± 21.18%)(p = 0.008). Availability between the state owned, franchise and privately owned pharmacies was not significantly different (p > 0.05). 89.4% medicines were affordable except for amiodarone, hydroxychloroquine, sitagliptin, soluble insulin, isophane insulin, losartan, levodopa carbidopa combination, clonazepam and ceftriaxone. The median price ratio (MPR) of 33.7% of medicines was less than 1 and MPR of 37.1% originator brands (OB) was over 3. Median number of generic brands in the market was 8(range 2–44), 9% of medicines had 20 or more products in the market and 72.7% medicines had more products available than the number registered in 2015. The average number of registered products were similar in 2015 (8.27) and 2021(7.59) (p = 0.15). Conclusion: The overall availability of EMs in Sri Lanka was high in all categories of community pharmacies. Medicines were largely affordable and reasonably priced in 2015, although OBs were generally more expensive. Majority of medicines had more products in the market than the number of registered products. [ABSTRACT FROM AUTHOR]

The present study examined predictors of attitude toward professional psychological help-seeking in Hong Kong. A cross-sectional approach was adopted and a total of 166 participants (120 female) ranging in age from 20 to 60 years were recruited online. The relationship between attitudes toward professional help-seeking, self-stigma, and perceived accessibility and affordability of services were examined, gender differences were also examined. Findings revealed that self-stigma was significantly negatively associated with attitude toward professional psychological help-seeking, while perceived affordability was positively associated with attitudes. The current study demonstrates that stigma is still an ever-present obstacle, which could contribute to low utilization of services in Hong Kong. [ABSTRACT FROM AUTHOR]

Background: Cost-effectiveness analysis (CEA) is a standard tool for evaluating health programs and informing decisions about resource allocation and prioritization. Most CEAs evaluating health interventions in low- and middle-income countries adopt a health sector perspective, accounting for resources funded by international donors and country governments, while often excluding out-of-pocket expenditures and time costs borne by program beneficiaries. Even when patients' costs are included, a companion analysis focused on the patient perspective is rarely performed. We view this as a missed opportunity. Methods: We developed methods for assessing intervention affordability and evaluating whether optimal interventions from the health sector perspective also represent efficient and affordable options for patients. We mapped the five different patterns that a comparison of the perspective results can yield into a practical framework, and we provided guidance for researchers and decision-makers on how to use results from multiple perspectives. To illustrate the methodology, we conducted a CEA of six HIV treatment delivery models in Mozambique. We conducted a Monte Carlo microsimulation with probabilistic sensitivity analysis from both patient and health sector perspectives, generating incremental cost-effectiveness ratios for the treatment approaches. We also calculated annualized patient costs for the treatment approaches, comparing the costs with an affordability threshold. We then compared the cost-effectiveness and affordability results from the two perspectives using the framework we developed. Results: In this case, the two perspectives did not produce a shared optimal approach for HIV treatment at the willingness-to-pay threshold of 0.3 × Mozambique's annual GDP per capita per DALY averted. However, the clinical 6-month antiretroviral drug distribution strategy, which is optimal from the health sector perspective, is efficient and affordable from the patient perspective. All treatment approaches, except clinical 1-month distributions of antiretroviral drugs which were standard before Covid-19, had an annual cost to patients less than the country's annual average for out-of-pocket health expenditures. Conclusion: Including a patient perspective in CEAs and explicitly considering affordability offers decision-makers additional insights either by confirming that the optimal strategy from the health sector perspective is also efficient and affordable from the patient perspective or by identifying incongruencies in value or affordability that could affect patient participation. [ABSTRACT FROM AUTHOR]

In recent years there has been a surge of interest in the relation between transport and equity. While transport expenditure plays a pivotal role in promoting equity within public transport systems, out-of-pocket user costs are often overlooked. Making transport affordable is one of the foremost challenges, especially in the Global South, where inequality levels are high. The primary objective of this research was to determine who was most affected by high public transport fares and to assess the resulting implications for equity in Rio de Janeiro. This study uses survey data collected from public transport users in 2023 to assess real transport expenditures and incomes to provide a complex description of fare affordability in the city. By considering both perceived affordability and a calculated affordability metric, we use statistical analysis to identify which groups were most likely to be adversely impacted by the existing fare policies. We then evaluated these groups' accompanying perceptions of public transport. Finally, a Pseudo Palma ratio was used to measure the equity of fare costs across those who could and could not afford their transport. Our findings revealed that income, gender, transport expenditure, trip time and trip purpose were the main factors that distinguish those who could or could not afford their daily transport needs. We find that the relation between fare policies and transport equity depends on a complex interaction between fare costs, sociodemographic characteristics, perceptions, and spatial organization. [ABSTRACT FROM AUTHOR]

Introduction: Access to primary healthcare (PHC) services is a significant concern, especially for those living in remote areas. Mobile health clinics (MHCs) are a model widely used to enhance access to healthcare in rural areas. In Saudi Arabia, the Ministry of Health has launched mobile clinics to facilitate access to PHC and increase access to healthcare. This study aims to assess the accessibility of MHCs in rural areas of Saudi Arabia measuring four dimensions of access from the patient's perspective: physical accessibility, availability, financial affordability, and acceptability. Methods: A quantitative cross-sectional survey in the form of an interviewer-administered questionnaire was performed on patients who attended mobile clinics between August and October 2020. All these people have been targeted to be interviewed as a nonprobability sample. Data was collected through a survey filled out by the interviewer. Results: Five hundred participants were interviewed in nine mobile clinics in the nine cities of the Kingdom. The majority were men (82.4%) and from Makkah city (13.6%) and 94.2% of the participants were Saudi nationals. In total, 98.3% of the respondents were satisfied with the overall mobile clinic services and 11.4% of the participants had difficulties with the mobile clinics' work schedules. There was a positive correlation between access to mobile clinics and satisfaction. Conclusions: The mobile clinics in rural and remote areas in Saudi Arabia during the study period were accessible to the respondents and met patient satisfaction. Most participants accept the work schedule for mobile clinics. However, it requires further improvements to meet all access dimensions of the study. [ABSTRACT FROM AUTHOR]

This paper examines the ways an inter-municipality bus system for passengers improved its accessibility and affordability for end-users at regional level. Using archetype theory, we conducted a case-study in FÖLI, a not-for-profit organization tasked with collective transport of passengers by bus in Southwest Finland. We find that FÖLI implemented a radical revolutionary change by introducing a new framework for the carriage of passengers by bus at a regional level, in which a zone free and flat fare policy applies. The sequence of change became central; with a continuous reorientation linearity aiming to improve the accessibility and affordability of collective transport by bus for commuters. The paper contributes to archetype theory by examining the relevance of accessibility and affordability in the configuration process of designing and implementing change, and extending knowledge in this area. Specifically, for the first time, our research shows the way in which FÖLI used the accessibility and affordability policy as an interpretative scheme to design and implement the change process successfully. The practical implication is that municipalities understood the relevance of improving collective transport infrastructures (roads, systems and technologies) to attract commuters as a way of saving total costs to fund underperforming buslines. [ABSTRACT FROM AUTHOR]

Objective: One of the objectives of the Intersectoral Global Action Plan on epilepsy and other neurological disorders for 2022 to 2031 is to ensure at least 80% of people with epilepsy (PWE) will have access to appropriate, affordable, and safe antiseizure medications (ASMs) by 2031. However, ASM affordability is a significant issue in low‐ and middle‐income countries, preventing PWE from accessing optimal treatment. This study aimed to determine the affordability of the newer (second and third generation) ASMs in resource‐limited countries in Asia. Methods: We conducted a cross‐sectional survey by contacting country representatives in lower‐middle‐income countries (LMICs) in Asia, including Indonesia, Lao People's Democratic Republic (PDR), Myanmar, Philippines, Vietnam, India, Bangladesh, and Pakistan, and the upper‐middle‐income country Malaysia, from March 2022 to April 2022. The affordability of each ASM was calculated by dividing the 30‐day ASM cost by the daily wage of the lowest paid unskilled laborers. Treatment costing 1 day's wage or less for a 30‐day supply of chronic disease is considered affordable. Results: Eight LMICs and one upper‐middle‐income country were included in this study. Lao PDR had no newer ASM, and Vietnam had only three newer ASMs. The most frequently available ASMs were levetiracetam, topiramate, and lamotrigine, and the least frequently available was lacosamide. The majority of the newer ASMs were unaffordable, with the median number of days' wages for a 30‐day supply ranging from 5.6 to 14.8 days. Significance: All new generation ASMs, whether original or generic brands, were unaffordable in most Asian LMICs. [ABSTRACT FROM AUTHOR]

This study of 643 students covering 1286 individual undergraduate business classes explored the factors impacting student acquisition of assigned textbooks and instructional materials. The findings indicated that counterintuitively, lower textbook prices did not increase acquisition rates, and that the utility of assigned materials was the primary determinant of acquisition. When students do not acquire their textbooks and materials, it appears to be tied to the belief that course success is not linked to acquiring those materials. Results suggest that materials not needed to obtain a good grade will not be acquired by many students, even at lower prices. Recommendations for practice and policy are offered. [ABSTRACT FROM AUTHOR]

Simple Summary: This research study aims to understand whether the Medicare Advantage program, which provides healthcare to a significant portion of Medicare beneficiaries, including cancer survivors, is effectively improving access to care, healthcare outcomes, and affordability. The study highlights the need for the ongoing evaluation and re-evaluation of the role of Medicare Advantage in promoting equity among beneficiaries with cancer. It provides valuable insights for policymakers and healthcare professionals involved in decision-making processes related to Medicare Advantage and its impact on healthcare access, affordability, and financial well-being for cancer survivors. This research informs discussions on potential improvements in the Medicare program to ensure that the needs of cancer survivors are adequately addressed. Background: The Medicare Advantage program provides care to nearly half of Medicare beneficiaries, including a rapidly growing population of cancer survivors. Despite its increased adoption, it is still unknown whether or not the program improves healthcare access, outcomes, and affordability for cancer survivors. Methods: We performed a cross-sectional study of Medicare beneficiaries aged ≥ 65 years with a self-reported history of cancer from the 2019 National Health Interview Survey. We used multivariable logistic regression to evaluate the association between Medicare program type (Medicare Advantage vs. traditional Medicare) and measures of healthcare access, acute care utilization, and affordability. Results: We identified 4451 beneficiaries with a history of cancer, corresponding to 26.6 million weighted cancer survivors in 2019. Of the beneficiaries, 35.8% were enrolled in Medicare Advantage, whereas 64.2% were enrolled in traditional Medicare. The age, sex, racial and ethnic composition, household income, primary site of cancer, and comorbidity burden of Medicare Advantage and traditional Medicare beneficiaries were similar. In the adjusted analysis, there were no differences in healthcare access or acute care utilization between traditional Medicare and Medicare Advantage beneficiaries. However, cancer survivors enrolled in Medicare Advantage were more likely to worry about (34.3% vs. 29.4%; aOR, 1.3 (95% CI, 1.1–1.5)) or have problems paying (13.6% vs. 11.1%; aOR, 1.4 (95% CI, 1.1–1.8)) medical bills. Conclusions: We found no evidence that Medicare Advantage beneficiaries with cancer had better healthcare access, affordability, or acute care utilization than traditional Medicare beneficiaries did. Furthermore, Medicare Advantage beneficiaries were more likely to report financial strain and have difficulty paying for their medical bills than were those with traditional Medicare. Despite the generous benefits and attractive incentives, Medicare Advantage plans may not be more cost-effective than traditional Medicare is for cancer survivors. Our study informs ongoing congressional deliberations to re-evaluate the role of Medicare Advantage in promoting equity among beneficiaries with cancer. [ABSTRACT FROM AUTHOR]

The year 2020 will always be remembered in the world as the year of the COVID lockdown. In Spain, as in many other countries around the world, population confinement measures were implemented. This fact, together with other socio-economic consequences of the pandemic, was reflected in the reality of energy poverty in the country. This study presents an analysis of this phenomenon in the light of the available data, i.e., using the 2020 Spanish HBS and SILC. This assessment is carried out by applying different metrics, namely, the four main indicators proposed by the EU Energy Poverty Observatory (EPOV), and two additional metrics of disproportionate expenditure and underspending, respectively. The results show that while the disproportionate and underspending indicators, in general, did not change significantly as a result of the policies prohibiting supply cut-offs, the subjective indicators, i.e., arrears in utility bills and inadequate temperature, worsened significantly. On the other hand, the additional metric of underspending reveals a very relevant incidence (21%) of hidden energy poverty in the country. The study also highlights an uneven geographical distribution of energy poverty. [ABSTRACT FROM AUTHOR]

Abstract Background Methods Results Conclusions This paper considers the extent to which people drinking at harmful levels responded to minimum unit pricing (MUP) in Scotland in the way they, family members and those providing services anticipated they would. It examines data taken from a larger evaluation of the impact of MUP on people who are drinking at harmful levels.Qualitative interview data, (utilizing interviews and focus groups, with individuals, treatment services, and family members) was generated prior to the implementation of MUP in Scotland to provide insights into anticipated responses and comparable data generated across an extended 19-month period post-implementation and provided insights into actual responses.Overall, the data showed consistency between anticipated and actual responses, with fewer differences observed. In line with anticipated responses, many drinkers switched from cheap, strong ciders to other alcohol products, notably vodka. They consistently responded to the decrease in alcohol affordability by utilizing existing behavior such as managing finances and prioritizing spends on alcohol, including borrowing money, foregoing essentials, and using savings. There was less evidence of anticipated harmful consequences of MUP occurring, such as increased crime, switching to other drugs, or examples of acute withdrawal.Drinkers and those living and working with them, have a good command of how alcohol affordability is maintained or impacts on expenditure and other choices, and how they respond to any decrease in affordability including the introduction of minimum price policies. [ABSTRACT FROM AUTHOR]

Background: Patient and health system costs for treating multidrug-resistant tuberculosis (MDR-TB) remain high even after treatment duration was shortened. Many patients do not finish treatment, contributing to increased transmission and antimicrobial resistance. A restructure of health services, that is more patient-centred has the potential to reduce costs and increase trust and patient satisfaction. The aim of the study is to investigate how costs would change in the delivery of MDR-TB care in Ethiopia under patient-centred and hybrid approaches compared to the current standard-of-care. Methods: We used published data, collected from 2017 to 2020 as part of the Standard Treatment Regimen of Anti-Tuberculosis Drugs for Patients with MDR-TB (STREAM) trial, to populate a discrete event simulation (DES) model. The model was developed to represent the key characteristics of patients' clinical pathways following each of the three treatment delivery strategies. To the pathways of 1000 patients generated by the DES model we applied relevant patient cost data derived from the STREAM trial. Costs are calculated for treating patients using a 9-month MDR-TB treatment and are presented in 2021 United States dollars (USD). Results: The patient-centred and hybrid strategies are less costly than the standard-of-care, from both a health system (by USD 219 for patient-centred and USD 276 for the hybrid strategy) and patient perspective when patients do not have a guardian (by USD 389 for patient-centred and USD 152 for the hybrid strategy). Changes in indirect costs, staff costs, transport costs, inpatient stay costs or changes in directly-observed-treatment frequency or hospitalisation duration for standard-of-care did not change our results. Conclusion: Our findings show that patient-centred and hybrid strategies for delivering MDR-TB treatment cost less than standard-of-care and provide critical evidence that there is scope for such strategies to be implemented in routine care. These results should be used inform country-level decisions on how MDR-TB is delivered and also the design of future implementation trials. [ABSTRACT FROM AUTHOR]

Purpose: Housing policies in India (last modified in 2017) define "affordable housing" on three main parameters – income of the target group, dwelling unit size and house price to income ratio. The Covid-19 pandemic has questioned the robustness of the defining parameters of affordable housing. This paper aims to study the impact of Covid-19 pandemic on housing affordability and adequacy for the urban poor and highlights how one pandemic has directly challenged the practicality of the affordable housing criteria in urban India. Design/methodology/approach: The study is based on a pilot test conducted through interviews with the consumer group. Furthermore, the affordable housing policies of urban India were studied in conjunction with the pandemic guidelines laid down by the World Health Organization. The consumer responses were analyzed in relation to the policies and guidelines to arrive at the inferences. The secondary case examples of the Dharavi slums in Mumbai and the Savda Ghevra slum resettlement colony in Delhi, along with the findings of the primary survey in the economically weaker section category, are used to formulate the conclusions. Findings: The pilot test conducted for the target consumer group clearly indicates that (i) the pandemic has severely affected the housing purchase capacity of the target consumer, thereby questioning the "affordability" of housing; (ii) proposed housing solutions are inadequate to enable livability, thereby questioning the "adequacy" of housing; and (iii) proposed housing solutions are inept to accommodate pandemic protocols. The Covid-19 pandemic and the conditions it imposed on the built environment clearly highlight the inadequacy of affordable housing parameters being followed in urban India. Research limitations/implications: Further research may be conducted on global best practices in housing, which may advise the housing policies in India. Practical implications: The study suggests key areas that need intervention and modification to make the housing policies more robust and effective. Social implications: The study explores the social sustainability aspects of housing, which are often considered secondary in policies. Originality/value: Because housing has a direct bearing on the physical, social and mental well-being of society, it is imperative to find housing solutions that are safe and resilient for a sustainable future. This paper is an original attempt by the author to question and highlight how the current affordable housing solutions adopted in urban India will continue to fail under any external adverse conditions unless modifications are considered in the existing housing parameters. [ABSTRACT FROM AUTHOR]

Indonesia has established a Self-Help Stimulant Assistance (SHSA) to help develop affordable housing in Low-Income Communities (LIC). SHSA funding is provided to selected LIC to independently build new housing and renovate uninhabitable residential houses to bring them up to habitable standards and social workers have been key to the implementation of this program. This study uses two theoretical frameworks for effective housing policy (Schill & Wachter 2001, Hannigan & Wagner 2003) to explore the extent to which the SHSA was perceived by social workers to exhibit these qualities. To explore the role of social workers in the implementation of the SHSA, 25 qualitative interviews were completed with social workers working in LICs in Indonesia. Six themes from the theoretical framework were found to be important to the effective implementation of SHSA, including: 1. links to other social policies; 2. using production subsidies to overcome obstacles, 3. not adopting a one-size-fits-all model, 4. provides permanent affordability housing, 5. is comfortable, and 6. accessible and flexible service provision. The findings also highlight the importance of providing social workers in the housing assistance sector with greater authority, especially with strategic decision-making to overcome various problems and obstacles to implementing the SHSA. These obstacles included a lack of supply of building materials for housing construction, the high cost of production, the lack of commitment and awareness of the recipients of the program of appropriate building materials and practices and a lack of attention to the development schedule. Overall, these findings point to greater opportunities and bargaining positions for social workers in the social housing assistance sector through granting authority to social workers in the social housing assistance sector, especially in making decisions as strengthening the capacity and potential of individuals and groups of social workers. In addition, a more systematic mechanism and approach for social workers to adhere to a set of ideal housing policy principles including target achievement, scale, and focus on low-income people's efficiency in obtaining home ownership, access to clean water, sanitation, and electricity, and increase in family economic income...(provide a broader perspective here as to why the findings are important). [ABSTRACT FROM AUTHOR]

Introduction: Emerging long-acting (LA) prevention and treatment medicines, technologies and regimens could be gamechanging for the HIV response, helping reach the ambitious goal of halting the epidemic by 2030. To attain this goal, the rapid expansion of at-scale, sustainable, quality-assured, and affordable supplies of LA HIV prevention and treatment products through accelerated and stronger competition, involving both originator and generic companies, will be essential. To do this, global health stakeholders should take advantage of voluntary licensing of intellectual property (IP) rights, such as through the United Nations-backed, not-for-profit Medicines Patent Pool, as a proven mechanism to support broad access to existing HIV medicines across low- and middle-income countries (LMICs). Discussion: While voluntary licensing may unlock the possibility for generic competition to take place ahead of patent expiry, there are additional elements--of amplified importance for more complex LA HIV medicines--that need to be taken into consideration. This paper discusses 10 enablers of voluntary licensing of IP rights as a model to rapidly expand at-scale, sustainable, quality-assured, and affordable supplies of LA HIV prevention and treatment regimens in LMICs: 1. Identifying promising LA technology platforms and drug formulations at an early developmental stage and engaging with patent holders 2. Consolidating a multidisciplinary network and strengthening early-stage coordination and collaboration to foster innovation 3. Embedding public health considerations in product design and delivery 4. Building innovative partnerships for product development and commercialization 5. Raising awareness of and creating demand for emerging LA products 6. Estimating the market size, ensuring sufficient competition and protecting sustainability 7. Using technology transfer and hands-on technical support to reduce product development timelines and costs 8. Exploring de-risking mechanisms and financial incentives to support generic manufacturers 9. Optimizing strategies for generic product development and regulatory filings 10. Aligning and coordinating efforts of stakeholders across the value chain. Conclusions: Rapid access to emerging LA prevention and treatment regimens and technologies can be facilitated by voluntary licensing--catalyzed and supplemented by enabling collaborative and non-duplicative efforts of various other stakeholders. This can effectively lead to improved--accelerated and cheaper--access to quality-assured medicines for populations in LMICs. [ABSTRACT FROM AUTHOR]

Introduction: Emerging long‐acting (LA) prevention and treatment medicines, technologies and regimens could be game‐changing for the HIV response, helping reach the ambitious goal of halting the epidemic by 2030. To attain this goal, the rapid expansion of at‐scale, sustainable, quality‐assured, and affordable supplies of LA HIV prevention and treatment products through accelerated and stronger competition, involving both originator and generic companies, will be essential. To do this, global health stakeholders should take advantage of voluntary licensing of intellectual property (IP) rights, such as through the United Nations‐backed, not‐for‐profit Medicines Patent Pool, as a proven mechanism to support broad access to existing HIV medicines across low‐ and middle‐income countries (LMICs). Discussion: While voluntary licensing may unlock the possibility for generic competition to take place ahead of patent expiry, there are additional elements—of amplified importance for more complex LA HIV medicines—that need to be taken into consideration. This paper discusses 10 enablers of voluntary licensing of IP rights as a model to rapidly expand at‐scale, sustainable, quality‐assured, and affordable supplies of LA HIV prevention and treatment regimens in LMICs: Identifying promising LA technology platforms and drug formulations at an early developmental stage and engaging with patent holdersConsolidating a multidisciplinary network and strengthening early‐stage coordination and collaboration to foster innovationEmbedding public health considerations in product design and deliveryBuilding innovative partnerships for product development and commercializationRaising awareness of and creating demand for emerging LA productsEstimating the market size, ensuring sufficient competition and protecting sustainabilityUsing technology transfer and hands‐on technical support to reduce product development timelines and costsExploring de‐risking mechanisms and financial incentives to support generic manufacturersOptimizing strategies for generic product development and regulatory filingsAligning and coordinating efforts of stakeholders across the value chain. Conclusions: Rapid access to emerging LA prevention and treatment regimens and technologies can be facilitated by voluntary licensing—catalyzed and supplemented by enabling collaborative and non‐duplicative efforts of various other stakeholders. This can effectively lead to improved—accelerated and cheaper—access to quality‐assured medicines for populations in LMICs. [ABSTRACT FROM AUTHOR]

The healthcare expenditure for managing diabetes with glucose-lowering medications has been substantial in the United States. We simulated a novel, value-based formulary (VBF) design for a commercial health plan and modeled possible changes in spending and utilization of antidiabetic agents. We designed a 4-tier VBF with exclusions in consultation with health plan stakeholders. The formulary information included covered drugs, tiers, thresholds, and cost sharing amounts. The value of 22 diabetes mellitus drugs was determined primarily in terms of incremental cost-effectiveness ratios. Using pharmacy claims database (2019-2020), we identified 40 150 beneficiaries who were on the included diabetes mellitus medicines. We simulated future health plan spending and out-of-pocket costs with 3 VBF designs, using published own price elasticity estimates. The average age of the cohort is 55 years (51% female). Compared with the current formulary, the proposed VBF design with exclusions is estimated to reduce total annual health plan spending by 33.2% (current: $33 956 211; VBF: $22 682 576), saving $281 in annual spending per member (current: $846; VBF: $565) and $100 in annual out-of-pocket spending per member (current: $119; VBF: $19). Implementing the full VBF with new cost shares, along with exclusions, has the potential to achieve the greatest savings, compared with the 2 intermediate VBF designs (ie, VBF with prior cost sharing and VBF without exclusions). Sensitivity analyses using various price elasticity values showed declines in all spending outcomes. Designing a VBF with exclusions in a US employer–based health plan has the potential to reduce health plan and patient spending. • A value-based formulary (VBF) typically assesses value primarily using cost-effectiveness analysis, assigning pharmaceuticals with a high assessed value (low incremental cost-effectiveness ratio) to lower copayments, and pharmaceuticals with a low assessed value (high incremental cost-effectiveness ratio) to higher copayments. • This study illustrates the process of designing a novel VBF involving consultation with multiple health plan stakeholders, which can be used to inform future VBF designs. • Using own price elasticities concepts and pharmacy claims data from a commercial health plan, we demonstrate that a VBF with exclusions for antidiabetic agents can generate savings for both patients and the health plan. [ABSTRACT FROM AUTHOR]

Background: Unmet need for medical care is common among Medicare beneficiaries, but less is known whether unmet need differs between those with high and low levels of need. Objective: To examine unmet need for medical care among fee-for-service (FFS) Medicare beneficiaries by level of care need. Design, Setting, and Participants: We included 29,123 FFS Medicare beneficiaries from the 2010–2016 Medicare Current Beneficiary Survey. Main Measures: Our outcomes included three measures of unmet need for medical care. We also examined the reasons for not obtaining needed medical care. Our primary independent variable was a categorization of groups by levels of care need: those with low need (the relatively healthy and those with simple chronic conditions) and those with high need (those with minor complex chronic conditions, those with major complex chronic conditions, the frail, and the non-elderly disabled). Results: The rates of reporting unmet need for medical care were highest among the non-elderly disabled (23.5% [95% CI: 19.8–27.3] for not seeing a doctor despite medical need, 23.8% [95% CI: 20.0–27.6] for experiencing delayed care, and 12.9% [95% CI: 10.2–15.6] for experiencing trouble in getting needed care). However, the rates of reporting unmet need were relatively low among the other groups (ranging from 3.1 to 9.9% for not seeing a doctor despite medical need, from 3.4 to 5.9% for experiencing delayed care, and from 1.9 to 2.9% for experiencing trouble in getting needed care). The most common reason for not seeing a doctor despite medical need was concerns about high costs for the non-elderly disabled (24%), but perception that the issue was not too serious was the most common reason for the other groups. Conclusions and Relevance: Our findings suggest the need for targeted policy interventions to address unmet need for non-elderly disabled FFS Medicare beneficiaries, especially for improving affordability of care. [ABSTRACT FROM AUTHOR]

Background: Availability and accessibility of anti-cancer medicines is the pillar of cancer management, and it is one of the main concerns in low-income countries including Rwanda. The objective of this study was to assess the availability and affordability of anticancer medicines at cancer-treating hospitals in Rwanda. Methodology: A descriptive cross-sectional study was conducted at 5 cancer-treating hospitals in Rwanda. Quantitative data were collected from stock cards and software that manage medicines and included the availability of anti-cancer medicines at the time of data collection, their stock status within the last two years, and the selling price. Results: The study found the availability of anti-cancer medicines at 41% in public hospitals at the time of data collection, and 45% within the last two years. We found the availability of anti-cancer medicines at 45% in private hospitals at the time of data collection, and 61% within the last two years. 80% of anti-cancer medicines in private hospitals were unaffordable while 20% were affordable. The public hospital that had most of the anti-cancer medicines in the public sector provided free services to the patients, and no cost was applied to the anti-cancer medicines. Conclusion: The availability of anti-cancer medicines in cancer-treating hospitals is low in Rwanda, and most of them are unaffordable. There is a need to design strategies that can increase the availability and affordability of anti-cancer medicines, for the patients to get recommended cancer treatment options. [ABSTRACT FROM AUTHOR]

Objective. A significant proportion of Australians defer or do not fill prescriptions they require due to cost. This article explores whether, and under what circumstances, physicians have a duty to assist these patients by disclosing how they can access more affordable medicines via personal importation. Methods. This study involved a critical examination of Australian statutory and case law pertaining to physicians’ duty to disclose material information to identify key principles applicable to the context of cost-motivated personal importation. Results. There are several legal principles that suggest that physicians have a duty to advise patients of options for accessing more affordable medicines, including via personal importation. These include a duty to warn of inherent and non-inherent risks, a duty to disclose treatments that offer clear advantages, and a duty to facilitate access to the means for achieving patients’ health goals. However, it is unclear whether, and on what grounds, responsibility for harm arising from a patient's inability to afford prescribed medicines should be attributed to the prescribing physician. Arguments supporting attribution of such a responsibility are proposed to motivate further legal, policy and ethical debate. Conclusions. Physicians have a duty to take reasonable steps to mitigate foreseeable harm to their patients, however the law is silent on whether this duty extends to taking steps to help patients access medicines that they can afford. This investigation provides a framework to guide the development of sound policy and law on informed financial consent and economically motivated prescribing. [ABSTRACT FROM AUTHOR]

Housing affordability is one of the most pervasive social determinants of physical and mental health in many parts of the world. To date, some housing scholars have looked at public housing interventions as a mechanism for increased affordability. However, their findings have not been synthesised and it is still unclear as to whether these interventions improve mental and physical health. The present study is a systematic review of quantitative studies conducted over the past 25 years that assess the impact of publicly subsidised housing on mental health. In total, 1886 studies were identified from a structured search of four databases. Included articles were peer-reviewed sources that quantitatively measured the relationship between mental health and publicly subsidised housing interventions. In total, 6 studies met the inclusion criteria for this review. Evidence on mental health benefits from publicly subsidised housing was inconsistent, and depended on the specific housing subsidy programme, type of housing assistance, housing stability, and neighbourhood quality. This review identified a need for more rigorous studies to gain a better understanding of the conditions needed for housing affordability policies and programmes to positively contribute to mental health. [ABSTRACT FROM AUTHOR]

Background: Sustainable Development Goal (SDG) indicator 3.b.3 monitors progress in medicines' accessibility for adults and has significant limitations when applying to medicines for children. An adapted indicator methodology was developed to fill this gap, but no proof of its robustness exists. We provide this evidence through sensitivity analyses. Methods: Data on availability and prices of child medicines from ten historical datasets were combined to create datasets for analysis: Dataset 1 (medicines selected at random) and Dataset 2 (preference given to available medicines, to better capture affordability of medicines). A base case scenario and univariate sensitivity analyses were performed to test critical components of the methodology, including the new variable of number of units needed for treatment (NUNT), disease burden (DB) weighting, and the National Poverty Line (NPL) limits. Additional analyses were run on a continuously smaller basket of medicines to explore the minimum number of medicines required. Mean facility scores for access were calculated and compared. Results: The mean facility score for Dataset 1 and Dataset 2 within the base case scenario was 35.5% (range 8.0–58.8%) and 76.3% (range 57.2–90.6%). Different NUNT scenarios led to limited variations in mean facility scores of + 0.1% and -0.2%, or differences of + 4.4% and -2.1% at the more critical NPL of $5.50 (Dataset 1). For Dataset 2, variations to the NUNT generated differences of + 0.0% and -0.6%, at an NPL of $5.50 the differences were + 5.0 and -2.0%. Different approaches for weighting for DB induced considerable fluctuations of 9.0% and 11.2% respectively. Stable outcomes with less than 5% change in mean facility score were observed for a medicine basket down to 12 medicines. For smaller baskets, scores increased more rapidly with a widening range. Conclusion: This study has confirmed that the proposed adaptations to make SDG indicator 3.b.3 appropriate for children are robust, indicating that they could be an important addition to the official Global Indicator Framework. At least 12 child-appropriate medicines should be surveyed to obtain meaningful outcomes. General concerns that remain about the weighting of medicines for DB and the NPL should be considered at the 2025 planned review of this framework. [ABSTRACT FROM AUTHOR]

In the present study, we aimed to investigate the availability and affordability of osteoporosis (OP) treatment drugs in Wuhan and provide references for policymakers. We used the WHO/HAI standardization method to investigate the OP drug in Wuhan and collected drug information for statistical analysis to evaluate the availability and affordability. The results showed that the availability of bisphosphonates, active vitamin D, and their analogs was relatively high; the availability of denosumab, salmon calcitonin, and teriparatide was general; and the availability of calcitonin, raloxifene, and strontium ranelate was l ow. In terms of affordability, alendronate generic drugs had good affordability, while the other 10 OP treatment drugs had poor affordability. Generally, the overall availability of OP treatment drugs in Wuhan was average, and the affordability was poor. As China's aging problem intensified, relevant government departments might consider including more OP treatment drugs in the medical insurance catalog and concentrating their quantities in the procurement process to further improve the availability and affordability of OP treatment drugs. [ABSTRACT FROM AUTHOR]

The objective of this study was to analyze the accessibility of psychotropic medicine in developing countries based on the availability, price, and affordability indicators to create international evidence to guide the development of policies on the accessibility of medicines. This study included 5 types of psychotropic medicines listed in the 22nd edition of the World Health Organization Model List of Essential Medicines published by the World Health Organization in 2021. Derived from 84 surveys in 59 countries, this study summarizes the availability, price, and affordability of originator branded drugs (OBs) and lowest-price generic drugs (LPGs) in the public and private sectors and compares them based on income levels in different countries. The average availability of psychotropic medicine was 45% in low- and lower-middle-income countries (LLMICs) compared with 49% in high- and upper-middle-income countries (HUMICs) whereas the availability of LPGs was higher than that of OBs in all country groups. The average patient price for OBs and LPGs was 94.0 and 23.2, respectively, and the overall patient price of psychotropic medicine in LLMICs was higher than that in HUMICs. The affordability of psychotropic medicine in LLMICs was lower than that in HUMICs. Psychotropic medicines in lower-middle-income countries have lower availability, a higher average patient price, and lower average affordability than in HUMICs, which requires lower-middle-income countries to take effective and various measures to improve the accessibility of psychotropic medicine. • The low level of accessibility of psychotropic medicine in developing countries, especially in low-income countries, seriously hinders patients' long-term access to psychotropic medicine. • In developing countries, even though the accessibility of generic medicine is higher than that of branded medicine, the procurement and patient prices of generic medicines remain much higher than international reference prices, and the availability and affordability of generic medicine remain at the nonideal level. • To further improve accessibility of psychotropic medicine, developing countries, especially low-income countries, can encourage patients to substitute generic medicine for branded medicines while adopting efficient procurement mechanisms. [ABSTRACT FROM AUTHOR]

Substantial out-of-pocket costs for hearing aids constitute a barrier to hearing health care accessibility for older adults among whom prevalence of hearing loss is high. This study is the first to estimate the proportion of Americans with functional hearing loss for which out-of-pocket expenditures for hearing aids would be unaffordable at current average costs and determine how affordability varies by sociodemographic factors. We utilized data from the 2016 American Community Survey to determine the proportion of adults with functional hearing loss for whom hearing aids would constitute ≥3% of annual income or have post-purchase income below a poverty standard. Chi-square tests were used to identify differences in affordability outcomes by sociodemographic characteristics. Results indicated that an average bundled cost of $2500 would constitute a catastrophic expense for 77% of Americans with functional hearing loss (N = 7,872,292) and would add an additional 4% of the population into poverty for the year (N = 423,548). Affordability outcomes varied significantly by age, race, sex, educational attainment and geographic location. Hearing aids were unaffordable for three-fourths of Americans with functional hearing loss, and their purchase would result in impoverishment for hundreds of thousands of individuals. Reductions in out-of-pocket hearing aid costs to $500 or $1000 would alleviate affordability issues for many Americans with hearing loss. Future federal and state policy should address poor rates of insurance coverage for hearing care, specifically among Medicare and Medicaid, to reduce out-of-pocket costs for hearing care particularly for older adults. An average out-of-pocket hearing care cost of $2500 was unaffordable for over three quarters of Americans with functional hearing loss. Hearing care affordability varied significantly by demographic characteristics such as age, sex, gender, educational attainment and geographic region. Affordability constitutes a significant barrier to hearing care accessibility in the United States, where most costs of hearing aids and rehabilitation are statutorily excluded from insurance coverage, including the largest insurer of Americans, Medicare. [ABSTRACT FROM AUTHOR]