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This article analyses how the World Bank formulates healthcare financing recommendations by examining the cases of Argentina and Croatia, two representative cases of socio-political transformations in Latin America and Central and Eastern Europe during the Washington (1987–1997) and post-Washington Consensus (1997–2007) periods. It argues that when formulating recommendations, the World Bank is involved in the process of policy bricolage, defined as a process in which policy actors draw on multiple sources of knowledge and information to piece together contextualised policy solutions instead of relying on textbook blueprints or predefined solutions. By conducting a document analysis of World Bank publications, our findings suggest that, in formulating healthcare financing recommendations, the organisation does not dogmatically follow a particular policy paradigm. Instead, it contextualises and recombines existing ideas to tailor recommendations to country-specific conditions, namely economic and political circumstances, as well as healthcare system performance. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) adopted Universal health coverage (UHC) as a target of the Sustainable Development Goal (SDG) 3. In 2018, Egypt issued the Universal Health Insurance Law (UHI), which aimed to achieve the UHC for its population and provide them with the needed health services without financial hardship. The Universal Health Insurance System (UHIS), applied in six governorates as Phase I, has achieved multiple successes covering all levels of medical care (primary, secondary, and tertiary). There are a group of implementation challenges; including the problems of overpopulation besides thousands of refugees and asylum-seekers, the dual burden of diseases, brain-drain of physicians, and the pricing of healthcare services, that have recently put the successful completion of subsequent UHC phases in great danger. This review article aims to provide recommendations to ensure the sustainability of the UHIS and gain its targeted benefits. Conclusion: A group of challenges threatens the successful completion and sustainability of the subsequent UHC phases, so it is important to address them using well-tailored targeted strategies and interventions. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic in Australia resulted in significant additional infection control precautions for consumers and the health workforce. Prior to widespread vaccine availability, substantial changes were made to the operating theatre management of patients presenting for surgery with suspected or diagnosed COVID-19. This study aimed to calculate the actual costs of operating theatre care for patients with confirmed or suspected COVID-19. Data were prospectively collected for all patients presenting for surgery with confirmed or suspected COVID-19 at the Royal Brisbane and Women's Hospital. Information collected included patient characteristics, surgical and anaesthesia details, equipment, theatre utilisation, staffing and cleaning. The associated variable costs and usual costs of care were calculated according to the Australian National Efficient Price. We compared estimated usual costs with those estimated for patients with confirmed or suspected COVID-19. Twenty-four patients with suspected COVID-19 infection underwent surgery between May 2020 and February 2021. Cost analysis revealed a mean (standard deviation (SD), range) increase in costs of providing perioperative care for COVID-19 suspect patients of A$2252 (A$2570, A$315.85–10,398); that is, a mean of 207.5% more than usual care costs. This was primarily due to the increased number of staff and time required to complete these cases with appropriate infection control. [ABSTRACT FROM AUTHOR]

Venture capital (VC) plays a vital role in advancing spinal surgery technologies, driven by the growing burden of spinal disorders and high healthcare costs. Despite increasing interest, trends in VC funding for spinal surgery remain understudied. This study aimed to examine temporal and thematic trends in VC investments in spinal surgery companies from 2000 to 2023. A retrospective cross-sectional study analyzing VC investment trends in privately held US-based spinal surgery companies. Using the PitchBook database, we analyzed 1001 VC investments in 227 spinal surgery companies between 2000 and 2023. Investments were categorized into surgical devices, noninvasive devices, biotechnology, surgical software, and clinical services. Total and annual investments were quantified in USD. From 2000 to 2023, $5.37 billion was invested in spine surgery, with nonsurgical devices receiving the largest share (42.6%), followed by surgical devices (26.3%) and biotechnology (22.2%). Annual investment increased by 1782%, with a decline in 2023 likely due to macroeconomic factors. VC funding in spinal surgery has grown significantly, especially in noninvasive technologies. Further research is needed to assess the long-term impact of these investments and explore alternative financing models. [ABSTRACT FROM AUTHOR]

Background: Healthcare and pension expenditures represent significant budgetary commitments in OECD countries, with considerable variation in spending levels influenced by factors such as demographic structures, healthcare system models, and the role of private insurance. Germany, Austria, and Czechia exemplify diverse approaches to universal healthcare, reflecting unique socio-economic and policy contexts. Objective: This study aims to compare the financial flows and spending efficiencies of healthcare systems in Germany, Austria and Czechia to identify opportunities for savings and policy innovations. Methods: A comparative analysis of secondary data from OECD reports and academic literature was conducted, examining key metrics such as public and private expenditure, health insurance contributions, and administrative costs. Results: The analysis reveals that while Germany’s dual public-private insurance system ensures comprehensive coverage, it faces challenges in integrating care services. Austria’s regionally managed system benefits from robust public funding but struggles with administrative complexity. Czechia’s centralised financing model supports equitable access but requires improved resource allocation and efficiency. Across all systems, health insurance contributions exhibit tax-like characteristics, with significant implications for public policy and perception. Recommendations: Policymakers should consider measures such as integrating care services in Germany, streamlining administrative processes in Austria, and refining fund redistribution mechanisms in Czechia. Leveraging digital health technologies and fostering transparency in healthcare financing are critical for achieving systemic savings and equity. Practical relevance/social implications: This study highlights the importance of tailored financial reforms to address demographic shifts and rising healthcare costs. Its findings provide actionable insights for policymakers aiming to balance equity and efficiency in healthcare financing while ensuring public trust and sustainability. Originality/value: By dissecting the healthcare financial flows in Germany, Austria, and Czechia, this study offers a nuanced understanding of their systems' dynamics and identifies opportunities for cross-border learning to inform global healthcare policy reform.

Domestic resource mobilisation (DRM) is vital for achieving sustainable healthcare financing in Nigeria, where dependence on external funding and oil revenues has long hindered health sector progress. The Nigerian healthcare system faces persistent challenges, including inadequate funding, inefficiencies and limited access to essential services, particularly in rural areas. This paper explores the challenges and prospects of DRM as a means of financing healthcare in Nigeria. A Medline search and a search of other internet search engines were carried out for published studies on healthcare financing in Nigeria, Africa and worldwide, we also examined policy documents and healthcare financing data to analyse the potential of DRM in Nigeria. A total of 38 publications were reviewed revealing that mechanisms such as general tax revenue, social insurance systems and community-based health insurance are central to DRM efforts. However, challenges such as inadequate budgetary allocations, corruption, poor database management and the emigration of health workers persist. Despite these obstacles, there are promising prospects, including increased tax revenue, development of the domestic capital market and the potential for sustainable and equitable healthcare financing through public–private partnerships. To harness these opportunities, the Nigerian government must implement effective policies, strengthen governance structures and promote transparency and accountability. DRM offers a promising path towards reducing dependency on external aid and achieving a more resilient and equitable healthcare system in Nigeria.

The promise of contributory health insurance to generate additional, self-sustaining funding for the health sector has not been achieved in many low- and lower-middle-income countries. Instead, contributory health insurance has been found to exacerbate inequities in access to health care because entitlements are linked to contributions. For these countries with contributory health insurance schemes, with separate institutional arrangements for revenue collection and purchasing, that operate alongside budget-funded and other health financing schemes, it is usually not politically or technically feasible to reverse or eliminate these arrangements even when they fragment the health system. We propose three complementary policy options for countries in this difficult position to enable progress towards UHC: (1) Merge existing schemes into a single scheme (or fewer schemes) to consolidate pooling and purchasing functions. (2) Build on what they have by: reducing reliance on contributions by increasing budget transfers; using existing revenue collection mechanisms to allow the insurance agency to focus on the purchasing function; and strengthening insurance agencies' operational capacity for purchasing. (3) Reframe the insurance agency's role within the overall health system, rather than treating it as a distinct system by: unifying data collection and analysis for all patient visits irrespective of scheme membership, and universalizing core benefits across the population. We urge countries to review the patchwork of schemes and avoid worsening fragmentation that compromises health system performance. Countries can then create a strategy to expand coverage more equitably in a sequential manner, while consolidating institutional capacity for purchasing and unifying data systems. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) stands as a paramount public health issue within Nigeria, deeply compounded by escalating costs of insulin and other antihyperglycaemic medications. The price surge, influenced by factors such as inflation and reliance on imports, significantly impedes access to vital drugs for numerous individuals managing diabetes in Nigeria. The resultant financial strain on patients’ insufficient healthcare infrastructure and subpar insurance coverage collectively precipitates deteriorated health outcomes and inflated healthcare expenditures. Non-adherence to prescribed medications due to prohibitive costs further amplifies complications and hospital admissions, thereby imposing significant pressure on both patients and the broader healthcare system. There is an imperative need for efficacious strategies encompassing drug price regulation, implementation of subsidies, encouragement of generic drug use, and enhancement of healthcare financing to address and alleviate these pervasive issues, ultimately fostering better diabetes management in Nigeria. [ABSTRACT FROM AUTHOR]

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

Copyright of Cuadernos Médico Sociales is the property of Colegio Medico de Chile (A.G.) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Domestic resource mobilisation (DRM) is vital for achieving sustainable healthcare financing in Nigeria, where dependence on external funding and oil revenues has long hindered health sector progress. The Nigerian healthcare system faces persistent challenges, including inadequate funding, inefficiencies and limited access to essential services, particularly in rural areas. This paper explores the challenges and prospects of DRM as a means of financing healthcare in Nigeria. A Medline search and a search of other internet search engines were carried out for published studies on healthcare financing in Nigeria, Africa and worldwide, we also examined policy documents and healthcare financing data to analyse the potential of DRM in Nigeria. A total of 38 publications were reviewed revealing that mechanisms such as general tax revenue, social insurance systems and community-based health insurance are central to DRM efforts. However, challenges such as inadequate budgetary allocations, corruption, poor database management and the emigration of health workers persist. Despite these obstacles, there are promising prospects, including increased tax revenue, development of the domestic capital market and the potential for sustainable and equitable healthcare financing through public–private partnerships. To harness these opportunities, the Nigerian government must implement effective policies, strengthen governance structures and promote transparency and accountability. DRM offers a promising path towards reducing dependency on external aid and achieving a more resilient and equitable healthcare system in Nigeria. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the one-year sum of direct costs related to open lower limb fracture treatment in an academic setting in the Netherlands. The secondary objective was to estimate the impact of deep infection and nonunion on one-year total direct costs. Methods: A multi-center, retrospective cost analysis of open lower limb fractures treated in an academic setting in the Netherlands, between 1 January 2017 and 31 December 2018, was conducted. The costing methodology was based on patient level aggregation using a bottom-up approach. A multiple linear regression model was used to predict the total costs based on Fracture-related-infections, multitrauma, intensive care unit (ICU) admission, Gustilo-Anderson grade and nonunion. Results: Overall, 70 fractures were included for analysis, the majority Gustilo-Anderson grade III fractures (57%). Median (IQR) one-year hospital costs were €31,258 (20,812–58,217). Costs were primarily attributed to the length of hospital stay (58%) and surgical procedures (30%). The median length of stay was 16 days, with an increase to 50 days in Fracture-related infections. Subsequent costs (46,075 [25,891–74,938] vs. 15,244 [8970–30,173]; p = 0.002), and total hospital costs (90,862 [52,868–125,004] vs. 29,297 [21,784–40,677]; p < 0.001) were significantly higher for infected cases. It was found that Fracture-related infection, multitrauma, and Gustilo-Anderson grade IIIA-C fractures were significant predictors of increased costs. Conclusion: In treatment of open lower limb fractures, deep infection, higher Gustilo-Anderson classification, and multitrauma significantly increase direct hospital costs. Considering the impact of infection on morbidity and total healthcare costs, future research should focus on preventing Fracture-related infections. [ABSTRACT FROM AUTHOR]

From 2005 to 2019, the Mexican government financed cervical cancer treatment for individuals without social security insurance through Seguro Popular's Fund for Protection against Catastrophic Health Expenses. To better understand the impact of this program on access to treatment, we estimated the cervical cancer treatment gap (the proportion of patients with cervical cancer in this population who did not receive treatment). To calculate the expected number of incident cervical cancer cases we used national surveys with information on insurance affiliation and incidence estimates from the Global Burden of Disease study. We used a national claims database to determine the number of cases whose treatment was financed by Seguro Popular. From 2006 to 2016, the national cervical cancer treatment gap changed from 0.61 (95% CI 0.59 to 0.62) to 0.45 (95% CI 0.43 to 0.48), with an average yearly reduction of -0.012 (95% CI -0.024 to -0.001). The gap was greater in states with higher levels of marginalization and in the youngest and oldest age groups. Although the cervical cancer treatment gap among individuals eligible for Seguro Popular decreased after the introduction of public financing for treatment, it remained high. Seguro Popular was eliminated in 2019; however, individuals without social security have continued to receive cancer care financed by the government in the same healthcare facilities. These results suggest that barriers to care persisted after the introduction of public financing for treatment. These barriers must be reduced to improve cervical cancer care in Mexico, particularly in states with high levels of marginalization.

IntroductionIn India, large inequities in health exist by geography, gender, socio-economic class, religion and caste. Universal health coverage (UHC) is envisioned to address these gaps. The deficiencies in our healthcare system cannot be solely bridged by additional investment, increasing manpower, adoption of technology or establishing regulatory Institutes. While UHC offers promise, its nation-wide implementation must be carefully planned and monitored.Objectives(1) To review published literature appraising the concepts of UHC such as coverage of health services and financial protection in the Indian healthcare system, (2) To review the deficiencies of the healthcare system in India and explore solutions within the framework of UHC.MethodsThe relevant articles for review were retrieved from PubMed and Google scholar databases using pertinent text terms. This scoping review includes 12 citations and 3 other published reports which address the determinants of UHC and its impact on the healthcare system in India.ResultsUHC aims to address the concept of health in all its dimensions and not merely as a response to illness. This Program’s objectives include reducing the gap between the need and utilization of healthcare, improving its quality and providing financial protection. In India, the public health sector suffers from shortfalls in management, manpower issues and poor accountability, whereas the private health sector is unregulated and contributes to the increasing health expenditure. UHC will improve access to health care and prevent financial impoverishment, which will be advantageous to the rural people and urban poor including workers of the unorganized sector.ConclusionUHC enables health systems to efficiently deliver a wide range of healthcare services to the population, as well as adopt sustainable financing mechanisms. Given the current Covid-19 pandemic and the need to address future pandemics, we need to build resilient health systems as well as hasten the implementation of UHC.

Abstract Introduction Healthcare financing systems, dependent on out-of-pocket expenditure(OOPE), impose a heavy burden on those who use the services regularly, such as patients suffering from chronic diseases. High OOPE for health services leads to decreased utilization of the services and/or catastrophic health expenditure, which would significantly impede the achievement of Universal Health coverage. Objective We aimed to determine variations in OOPE and factors associated with Catastrophic Health Expenditure (CHE) of households with patients suffering from non-communicable diseases(NCDs) in four districts. Methods A survey was conducted among 2344 adult patients having selected NCD/s. Multi-stage stratified cluster sampling selected respondents from 4 districts representing urban, rural, semi-urban, and estate. Data was collected using a validated interviewer-administered questionnaire. Logistic regression identified the predictors of CHE(> 40%). Significance was considered as 0.05. Results Common NCDs were hypertension(29.1%), diabetes(26.8.0%), hyperlipidaemia(9.8%) and asthma(8.2%). Only 13% reported complications associated with NCDs. Fifty-six percent(N = 1304) were on regular clinic follow-up, and majority utilized western-medical government hospitals(N = 916,70.2%). There were 252 hospital admissions for chronic-disease management in the past 12 months. Majority(86%) were admitted to government sector hospitals. Most patients incurred nearly SLR 3000 per clinic visit and SLR 3300 per hospital admission. CHE was beyond 40% for 13.5% of the hospital admissions and 6.1% of the regular clinic follow-up. Patients admitted to private sector hospitals had 2.61 times higher CHE than those admitted to government sector hospitals. Conclusions Patients with NCDs incurred high OOPE and faced CHE during healthcare seeking in Sri Lanka. The prevalence of NCDs and complications were high among the participants. Patients with chronic conditions incur high OOPE for a single clinic visit and a hospital admission. Patients incur high OOPE on direct medical costs, and district-wise variations were observed. The proportion with more than 40% CHE on monthly clinic care was high. Patients being followed up in the government sector are more likely to have CHE when obtaining healthcare and are more likely to face barriers in obtaining needed health services. The services rendered to patients with chronic conditions warrant a more integrative approach to reduce the burden of costs and related complications.

Abstract Background Type 1 diabetes (T1D) management exerts a considerable financial burden on patients, caregivers, and developing nations at large. In Ghana, a key governments effort to attenuate the financial burden of T1D on patients was to fashion safety-net mechanisms through financial risk pooling/sharing known as the National Health Insurance Scheme (NHIS). However, there is limited research on patients and caregivers’ experiences with the cost of managing T1D within the NHIS in Ghana. Objective This study explored the cost of T1D management, and the impact of the NHIS policy on mitigating costs of care. Methods A semi-structured interview guide was developed to collect qualitative data from 28 young people living with T1D (PLWD), 12 caregivers, 6 healthcare providers, and other stakeholders in Western, Central and the Greater Accra regions. Multiple data collection techniques including mystery client and in-depth interviews were used to collect data. Thematic content analysis was performed with QSR NVivo 14. Results Five key domains/themes which are: cost of T1D management supplies; cost of clinical care; cost of transportation; cost of diet; and NHIS were identified. The daily cost of blood glucose testing and insulin injection per day was between GHC 5–7 (US$ 0.6 to 1.0). The NHIS did not cover supplies such as strips, glucometers, HbA1c tests, and periodic medical tests. Even for those cost which were covered by the NHIS (mainly pre-mixed insulin), marked government delays in funds reimbursement to accredited NHIS facilities compelled providers to push the financial obligation onto patients and caregivers. Such cost obligations were fulfilled through out-of-pocket top-up or full payment of insulin of about GHC 15–25 (US$ 2–4), and GHC 25–50 (US$4–8) depending on the region and place of residence. Conclusion The cost of managing T1D was a burden for patients and their caregivers. There was a commodification of life-saving insulin on the Ghanaian market, and the NHIS did not function well to ease the cost-burden of T1D management on patients and caregivers. The findings call for the need to scale up NHIS services to include simple supplies, particularly test strips, and always ensure the availability of life-saving insulin in healthcare facilities.

Background: Type 1 diabetes (T1D) management exerts a considerable financial burden on patients, caregivers, and developing nations at large. In Ghana, a key governments effort to attenuate the financial burden of T1D on patients was to fashion safety-net mechanisms through financial risk pooling/sharing known as the National Health Insurance Scheme (NHIS). However, there is limited research on patients and caregivers' experiences with the cost of managing T1D within the NHIS in Ghana. Objective: This study explored the cost of T1D management, and the impact of the NHIS policy on mitigating costs of care. Methods: A semi-structured interview guide was developed to collect qualitative data from 28 young people living with T1D (PLWD), 12 caregivers, 6 healthcare providers, and other stakeholders in Western, Central and the Greater Accra regions. Multiple data collection techniques including mystery client and in-depth interviews were used to collect data. Thematic content analysis was performed with QSR NVivo 14. Results: Five key domains/themes which are: cost of T1D management supplies; cost of clinical care; cost of transportation; cost of diet; and NHIS were identified. The daily cost of blood glucose testing and insulin injection per day was between GHC 5–7 (US$ 0.6 to 1.0). The NHIS did not cover supplies such as strips, glucometers, HbA1c tests, and periodic medical tests. Even for those cost which were covered by the NHIS (mainly pre-mixed insulin), marked government delays in funds reimbursement to accredited NHIS facilities compelled providers to push the financial obligation onto patients and caregivers. Such cost obligations were fulfilled through out-of-pocket top-up or full payment of insulin of about GHC 15–25 (US$ 2–4), and GHC 25–50 (US$4–8) depending on the region and place of residence. Conclusion: The cost of managing T1D was a burden for patients and their caregivers. There was a commodification of life-saving insulin on the Ghanaian market, and the NHIS did not function well to ease the cost-burden of T1D management on patients and caregivers. The findings call for the need to scale up NHIS services to include simple supplies, particularly test strips, and always ensure the availability of life-saving insulin in healthcare facilities. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare financing systems, dependent on out-of-pocket expenditure(OOPE), impose a heavy burden on those who use the services regularly, such as patients suffering from chronic diseases. High OOPE for health services leads to decreased utilization of the services and/or catastrophic health expenditure, which would significantly impede the achievement of Universal Health coverage. Objective: We aimed to determine variations in OOPE and factors associated with Catastrophic Health Expenditure (CHE) of households with patients suffering from non-communicable diseases(NCDs) in four districts. Methods : A survey was conducted among 2344 adult patients having selected NCD/s. Multi-stage stratified cluster sampling selected respondents from 4 districts representing urban, rural, semi-urban, and estate. Data was collected using a validated interviewer-administered questionnaire. Logistic regression identified the predictors of CHE(> 40%). Significance was considered as 0.05. Results: Common NCDs were hypertension(29.1%), diabetes(26.8.0%), hyperlipidaemia(9.8%) and asthma(8.2%). Only 13% reported complications associated with NCDs. Fifty-six percent(N = 1304) were on regular clinic follow-up, and majority utilized western-medical government hospitals(N = 916,70.2%). There were 252 hospital admissions for chronic-disease management in the past 12 months. Majority(86%) were admitted to government sector hospitals. Most patients incurred nearly SLR 3000 per clinic visit and SLR 3300 per hospital admission. CHE was beyond 40% for 13.5% of the hospital admissions and 6.1% of the regular clinic follow-up. Patients admitted to private sector hospitals had 2.61 times higher CHE than those admitted to government sector hospitals. Conclusions: Patients with NCDs incurred high OOPE and faced CHE during healthcare seeking in Sri Lanka. The prevalence of NCDs and complications were high among the participants. Patients with chronic conditions incur high OOPE for a single clinic visit and a hospital admission. Patients incur high OOPE on direct medical costs, and district-wise variations were observed. The proportion with more than 40% CHE on monthly clinic care was high. Patients being followed up in the government sector are more likely to have CHE when obtaining healthcare and are more likely to face barriers in obtaining needed health services. The services rendered to patients with chronic conditions warrant a more integrative approach to reduce the burden of costs and related complications. [ABSTRACT FROM AUTHOR]

Objective. To present a proposal to estimate healthcare resource requirements for the population with no social security in Mexico City and the domestic projection, including access and coverage. Materials and methods. The gross domestic product percentage for healthcare is calculated using the Medical-Technical Baseline Cost (MTBC) or the Medical Economic Card (MEC) standard according to diagnosis and care treatment for the population with no social security, thus projecting the prospective resource requirements. Results. There is a shortfall of resources for 2024; the prospective per capita for the first level of healthcare is $3 813 and the historical one is $1 933; and the corresponding values for the second level are $4 430 and $3 861. The %GDP-healthcare for Mexico City in 2024 exhibits a 42% difference between the historical and prospective categories. The shortfall of resources for the three levels of healthcare in the entire country is 19%. Conclusions. The prospective budget makes it possible to calculate healthcare resource requirements with a higher degree of certainty and graduality. [ABSTRACT FROM AUTHOR]

Global turbulence and uncertainty force civil servants and executors to optimise public finance distribution. The COVID-19 pandemic aligned with the necessity of assessing the efficiency of healthcare financing due to its capability in overcoming the negative consequences. The paper analyses the peculiarities of healthcare financing in 34 European countries and points out trends and changes in its structure and dynamics. It also realises cluster analysis to reveal models of healthcare financing and their specific features. Panel data regression analysis was used to assess the efficiency of healthcare financing within each cluster by clarifying the relationship between healthcare expenditures and public health outcome—life expectancy. The distributed lag model was also used to test for time lags between financial inflows in healthcare and its outcome. Empirical results highlight key tips for optimising healthcare financing and creating the benchmark model. [ABSTRACT FROM AUTHOR]

Over the past decade, the gig/platform economy has experienced substantial expansion due to the adoption of technology and its ability to cater to various everyday needs. Consequently, informal work arrangements have proliferated and are characterized by diverse employment structures distinct from traditional contracts. Projections indicate that the global gig economy will reach a value of $50 billion by the decade's end, engaging over 500 million individuals. However, gig workers face vulnerability to health and economic crises without the safety net of contractual social benefits. Mutual insurance, with its longstanding history of providing crucial financial coverage and risk management solutions, offers a potential avenue for addressing these challenges. This paper examines how the mutual care model can capitalize on the platform economy's growth worldwide, proposing solutions to urgent issues concerning the health and economic welfare of a significant population lacking access to formal social security benefits within an informal work setting. [ABSTRACT FROM AUTHOR]

AbstractThe OPEC governments mainly financed their budgets by relying on oil production, similar to many other governments globally. However, the world’s ongoing economic development, changes in countries’ political relationships, and exchange of sanctions could have adverse consequences for government financing, including healthcare. This study investigates whether economic sanctions have shifted governments’ healthcare financing from oil dependence. Quantitative data covering 2000 to 2020 were extracted from the WHO and assessed using a comparison of means Welch’s t-test. The results showed the independence of government healthcare financing from oil in Libya, Iraq, and Iran, evident in the absence of a response to changes in their sanctions programs, attributed to their long experience with sanctions. This is in contrast to Venezuela, where governmental healthcare financing was adversely affected after sanctions were imposed. With global economic uncertainty, continuous political changes, and the global transformation to green energy, this study suggests that countries worldwide maintain financing strategies other than dependence on oil, with constant revisions to global developments.

IntroductionBetween 2020 and 2022, there was a rise in employment and entrepreneurial activity, despite some unemployment growth. In the Compulsory Social Health Insurance (CSHI), insured individuals, especially privileged and wage workers, increased. However, certain contributors, like those exempt from contributions and single social taxpayers, decreased, possibly due to legislative changes or the economic climate. The study aimed to evaluate the effectiveness and accessibility of medical services within the frameworks of Compulsory Social Health Insurance and the state Guaranteed volume of free medical care based on data regarding waiting times and the volume of services provided.MethodsThis retrospective study analyzed data from 2020 to 2022 on patients receiving care under Kazakhstan’s Mandatory Social Medical Insurance System (MSMIS) and Guaranteed Volume of Free Medical Care. Data included insurance status, labor market indicators, and medical service procurement. Descriptive statistics were calculated, and t-tests, with p-values indicating statistical significance (p

Background Students of medical universities, future employees, will have an impact on the shaping healthcare system. It is important to know and understand their opinions on the factors affecting working conditions and, consequently, changes necessary to improve effectiveness of health care. Students’ expectations can contribute to the changing working conditions for graduates and bring added value to health system redefinition. Material and Methods The study used factor analysis to check whether its use was justified. Reliability analysis was performed and structure indicators were determined for each question. The anonymous survey was conducted from September 2017 until March 2018; 1205 students were randomly selected for the sample. Results Eighty percent of the students declared interest in healthcare changes, >50% reported that the main factors influencing the work were competencies, financing, medical equipment and organization. Over 90% of the respondents indicated too long wait times for an appointment with a specialist and admission to hospital as the reason for the low efficiency of healthcare, whereas >80% of the survey participants considered insufficient funding to be a barrier. The need for changing the financing scheme was underlined by >90% of the students, and of health priorities by about 80%. Approximately 71% of the respondents were in favour of limiting the role of government in decision-making processes and introducing changes into the education system. Conclusions Students’ views on organizational and financial factors of working conditions can contribute to improvement in systemic solutions at both micro and macro levels. Limiting the role of politicians in planning and implementing reforms can motivate employees to be more creative and decisive. Analysis of opinions can bring added value to health policy and systemic changes and should be extended by further research results after the COVID-19 pandemic. Students’ interest in healthcare reform encourages reflection on enriching education with managerial skills. Med Pr Work Health Saf. 2024;75(4):321–332

Background: Strengthening primary health care services for the elderly is vital. In this regard, adequate and sustainable financing is necessary for primary health care. Therefore, the present study aimed to investigate the methods of financing primary health care for the elderly in Iran in 2021.Methods: This is a mixed method cross-sectional study carried out in 2021 with a combination of quantitative and qualitative data. The sample size was estimated to be 254 subjects. Sampling was done in a stratified manner. The studied variables were the result of a comparative study and interview. In this study, to measure the construct validity, exploratory and confirmatory factor analysis method was used. Data were analyzed using SPSS-21 and AMOS-24 software.Results: The results of exploratory factor analysis showed that all variables had factor loadings above 0.3. The results of the second-order confirmatory factor analysis showed that all the items of primary health care financing for the elderly were approved. These items include the allocation of GDP to cover part of the costs of old age care, tax collection, social insurance coverage for the disabled and retired, allocation of subsidies to vulnerable groups, private and supplementary insurances, transfer of employee insurance premiums to medical funds to cover the health and medical expenses in old age, the use of municipal and governorate budgets, and incentive policies. The results showed that the use of municipal and governorate budgets and incentive policies had the highest (0.726) and the lowest (0.531) standard coefficients, respectively.Conclusion: The findings of the study show that the construct validity of the designed model has a good level. Using this model by managers, policymakers, and health planners can improve the financing of primary health care services for the elderly and thus meet their health needs.

Over the last decade, Singapore has grappled with substantial healthcare challenges, chiefly a bourgeoning aging population and a mounting burden of chronic diseases. The oral health landscape has also changed, with the Ministry of Health placing a greater focus on a life‐course approach supported by policies that facilitate Singaporeans to receive dental care appropriately and affordably. A pivotal oral health policy is the National Dental Strategy, a comprehensive framework governing dental services in the public sector. This strategy encompasses aspects such as financing, workforce management, and capacity considerations. To facilitate affordability and accessibility to dental services in the public sector, the government extends subsidies to reduce out‐of‐pocket costs. Those attending private dental clinics also benefit from the Community Health Assist Scheme, introduced in 2012, which alleviates treatment costs for enrolled Singaporeans. Furthermore, additional age‐banded subsidies have been introduced for older Singaporeans born before 1960, enhancing financial support when accessing dental services in both private and public sectors. In 2019, a national adult oral health survey was commissioned to gauge the oral health status of Singaporeans aged 21 and above. The findings reported 34.8% having untreated dental caries, and 15.7% and 41.2% experiencing moderate and severe periodontitis, respectively. While over half (53.9%) of respondents visited the dentist at least annually, about 60% of eligible individuals did not utilize their government dental subsidies. In response, the Ministry of Health is committed to strengthening oral disease prevention, integrating oral health into general healthcare services, expanding dental financing schemes to enhance service utilization, improving the quality and transparency of dental care, and leveraging advancements in tele‐dentistry and other modes of dental services. It is imperative to adapt Singapore's oral health policies and service delivery models to meet the evolving needs of the population and ensure a sustainable, equitable and resilient oral healthcare system. [ABSTRACT FROM AUTHOR]

A survey conducted among neurologists and clinical geneticists in Singapore found that the majority of respondents supported treatment for spinal muscular atrophy (SMA) patients under 2 years old with 2 or 3 SMN2 gene copies, with a preference for onasemnogene abeparvovec (OAV) over SMN2 gene modifiers. Treatment was also supported for patients older than 2 years with 2 to 3 SMN2 copies if they were not ventilated. The survey also revealed support for presymptomatic treatment and newborn screening, but the lack of a funding framework in Singapore hinders the implementation of these treatments. The text emphasizes the importance of considering factors such as disease severity, timing of therapy, and individual patient preferences in treatment decisions, and highlights the need for a structured funding framework to ensure equitable access to treatment for all patients. [Extracted from the article]

This comprehensive rapid review meticulously evaluates the transformative influence of Vision 2030 on the healthcare sector in Saudi Arabia. Vision 2030, with its broad scope, targets an extensive overhaul of healthcare through infrastructure enhancement, digital health adoption, workforce empowerment, innovative public health initiatives, and advancements in quality of care and patient safety. By employing a rigorous analytical approach, this review synthesizes a broad spectrum of data highlighting Saudi Arabia's significant progress toward establishing an accessible, efficient, and superior healthcare system. It delves into the kingdom's alignment with global healthcare trends and its distinctive contributions, notably in digital health and public health, illustrating a proactive stance on future healthcare challenges. The analysis rigorously explores Vision 2030's ambitious objectives and the concrete outcomes achieved, providing deep insights into the evolving healthcare landscape in Saudi Arabia. Furthermore, it assesses the global ramifications of these reformative efforts, emphasizing the pivotal themes of innovation, equity, and excellence as the foundation for future healthcare advancements. This review not only sheds light on Vision 2030's extensive impact on Saudi healthcare but also positions the kingdom as an exemplar of healthcare innovation and reform on the global stage, offering valuable lessons for healthcare policy and practice around the world. [ABSTRACT FROM AUTHOR]

Introduction Whether men find it easier to quit smoking than women is still controversial. Different studies have reported that the efficacy of pharmacological treatments could be different between men and women. This study conducted a secondary analysis of ‘Subsidized pharmacological treatment for smoking cessation by the Spanish public health system’ (FTFT-AP study) to evaluate the effectiveness of a drug-funded intervention for smoking cessation by gender. Methods A pragmatic randomized clinical trial by clusters was used. The population included smokers aged ≥18 years, smoking >10 cigarettes per day, randomly assigned to an intervention group receiving regular practice and financed pharmacological treatment, or to a control group receiving only regular practice. The main outcome was continued abstinence at 12 months, self-reported and validated with CO-oximetry. The percentage, with 95% confidence intervals, of continued abstinence was compared between both groups at 12 months postintervention, by gender and the pharmacological treatment used. Multilevel logistic regression analysis was performed. Results A total of 1154 patients from 29 healthcare centers were included. The average age was 46 years (SD=11.78) and 51.7% were men. Overall, the selfreported abstinence at 12 months was 11.1% (62) in women and 15.7% (93) in men (AOR=1.4; 95% CI: 1.0–2.0), and abstinence validated by CO-oximetry was 4.6% (26) and 5.9% (35) in women and men, respectively (OR=1.3; 95% CI: 0.7–2.2). In the group of smokers receiving nicotine replacement treatment, self-reported abstinence was higher in men compared to women (29.5% vs 13.5%, OR=2.7; 95% CI: 1.3–5.8). Conclusions The effectiveness of a drug-financed intervention for smoking cessation was greater in men, who also showed better results in self-reported abstinence with nicotine replacement treatment.

Abstract Background The World Health Organisation (WHO) estimates a 10 million health worker shortage by 2030. Despite this shortage, some low-income African countries paradoxically struggle with health worker surpluses. Technically, these health workers are needed to meet the minimum health worker-population ratio, but insufficient job opportunities in the public and private sector leaves available health workers unemployed. This results in emigration and un- or underemployment, as few countries have policies or plans in place to absorb this excess capacity. Sierra Leone, Liberia and Guinea have taken a different approach; health authorities and/or public hospitals ‘recruit’ medical and nursing graduates on an unsalaried basis, promising eventual paid public employment. 50% Sierra Leone’s health workforce is currently unsalaried. This scoping review examines the existing evidence on Sierra Leone’s unsalaried health workers (UHWs) to establish what impact they have on the equitable delivery of care. Methods A scoping review was conducted using Joanna Briggs Institute guidance. Medline, PubMed, Scopus, Web of Science were searched to identify relevant literature. Grey literature (reports) and Ministry of Health and Sanitation policy documents were also included. Results 36 texts, containing UHW related data, met the inclusion criteria. The findings divide into two categories and nine sub-categories: Charging for care and medicines that should be free; Trust and mistrust; Accountability; Informal provision of care, Private practice and lack of regulation. Over-production of health workers; UHW issues within policy and strategy; Lack of personnel data undermines MoHS planning; Health sector finance. Conclusion Sierra Leone’s example demonstrates that UHWs undermine equitable access to healthcare, if they resort to employing a range of coping strategies to survive financially, which some do. Their impact is wide ranging and will undermine Sierra Leone’s efforts to achieve Universal Health Coverage if unaddressed. These findings are relevant to other LICs with similar health worker surpluses.

The post-COVID era has posed unprecedented challenges to healthcare systems worldwide, urging a reevaluation of healthcare financing mechanisms. This study investigates the evolving landscape of private health insurance markets in the aftermath of the pandemic while considering the influence of international sanctions. Employing a spatial lag model (SLM), data from Albania, Russia, and Malaysia were analyzed to uncover the intricate interplay of factors shaping private health insurance coverage rates. The findings reveal nuanced patterns and disparities across these countries. The significance of variables varies: while private insurance share and government health expenditure consistently exhibit positive and substantial impacts on coverage rates, the unemployment rate presents differential effects. COVID-19 deaths influence coverage in Russia, emphasizing the pandemic's specific impact. Moreover, hospital beds’ significance in Malaysia underscores healthcare infrastructure's varying importance. Importantly, the spatial lag effect is consistently significant, emphasizing regional interdependence. Collectively, our study highlights the multifaceted determinants of private health insurance coverage, revealing insights crucial for policymakers navigating post-pandemic healthcare financing challenges among international sanctions. Doi: 10.28991/ESJ-2023-07-06-013 Full Text: PDF

Background Efforts to move towards universal health coverage (UHC) aim to rebalance health financing in ways that increase efficiency, equity, and quality. Resource constraints require a shift from passive to strategic purchasing (SP). In this paper, we report on the experiences of SP in public sector health insurance schemes in nine middle-income countries to understand what extent SP has been established, the challenges and facilitators, and how it is helping countries achieve their UHC goals.Methods We conducted a systematic search to identify papers on SP. Nine countries were selected for case study analysis. We extracted data from 129 articles. We used a common framework to compare the purchasing arrangements and key features in the different schemes. The evidence was synthesised qualitatively.Results Five countries had health technology assessment (HTA) units to research what services to buy. Most schemes had reimbursement mechanisms that enabled some degree of cost control. However, we found evidenced-based changes to the reimbursement mechanisms only in Thailand and China. All countries have some form of mechanism for accreditation of health facilities, although there was considerable variation in what is done. All countries had some strategy for monitoring claims, but they vary in complexity and the extent of implementation; three countries have implemented e-claim processing enabling a greater level of monitoring. Only four countries had independent governance structures to provide oversight. We found delayed reimbursement (six countries), failure to provide services in the benefits package (four countries), and high out-of-pocket (OOP) payments in all countries except Thailand and Indonesia, suggesting the schemes were failing their members.Conclusion We recommend investment in purchaser and research capacity and a focus on strong governance, including regular engagement between the purchaser, provider and citizens, to build trusting relationships to leverage the potential of SP more fully, and expand financial protection and progress towards UHC.

Abstract Historically, the NHS did not routinely collect cost data, unlike many countries with private insurance markets. In 1998, for the first time the government mandated NHS trusts to submit estimates of their costs of service, known as reference costs. These have informed a wide range of health economic evaluations and important functions in the health service, such as setting prices. Reference costs are collected by progressively disaggregating budgets top-down into disease and treatment groups. Despite ongoing improvements to methods and guidance, these submissions continued to suffer a lack of accuracy and comparability, fundamentally undermining their credibility for critical functions. To overcome these issues, there was a long-held ambition to collect “patient-level” cost data. Patient-level costs are estimated with a combination of disaggregating budgets but also capturing the patient-level “causality of costs” bottom-up in the allocation of resources to patient episodes. These not only aim to capture more of the drivers of costs, but also improve consistency of reporting between providers. The change in methods may confer improvements to data quality, though judgement is still required and achieving consistency between trusts will take further work. Estimated costs may also change in important ways that may take many years to fully understand. We end on a cautionary note that patient-level cost methods may unlock potential, they alone contribute little to our understanding of the complexities involved with service quality or need, while that potential will require substantial investment to realise. Many healthcare resources cannot be attributed to individual patients so the very notion of “patient-level” costs may be misplaced. High hopes have been put in these new data, though much more work is now necessary to understand their quality, what they show and how their use will impact the system.

Abstract Laos has introduced various SHI schemes for multiple groups of the population, such as government officials and other population groups under the NHI schemes. There is no specific health insurance policy for this group of people who need special health services and may have a higher possibility of entering financial catastrophe. This study aims to assess the impact of SHI schemes on accessibility and financial catastrophe against catastrophic health expenditures for older people in Laos. A structured questionnaire has been used to retrieve information from 400 older people across 39 villages in Kaysone Phomvihane District, Savannakhet province, the largest province in Laos. In the analytical process, this study used a cross-sectional study design and binary logistic regression models to predict the likelihood of accessing health facilities and experiencing financial catastrophe. The study outcome shows that the increase in age, occupation, number of older people within a household, and presence of chronic conditions increase the likelihood of using health services. Despite the existence of various SHI schemes, this study found that 74 out of 165 households reported using health services experienced catastrophic health expenditure. Several characteristics are associated with catastrophic health expenditure: age, income level, and gender are prone to suffer from catastrophic health expenditure. The difficult problems stem from the absence of comprehensive legislation regarding the older population. Recommendations for policymakers in various timeframes have been made, which cover short- and long-term policy proposals, including providing a specialized lane or fast-track for an older population, building health facilities exclusively for older people, and providing transportation services for older individuals living alone.

Abstract Background People experiencing long-term homelessness face significant difficulties accessing appropriate healthcare at the right time and place. This study explores how and why healthcare performance management and funding arrangements contribute to healthcare accessibility or the lack thereof using long-term homeless adults as an example of a population experiencing social exclusion. Methods A realist evaluation was undertaken. Thirteen realist interviews were conducted after which data were transcribed, coded, and analysed. Results Fourteen CMOCs were created based on analysis of the data collected. These were then consolidated into four higher-level CMOCs. They show that health systems characterised by fragmentation are designed to meet their own needs above the needs of patients, and they rely on practitioners with a special interest and specialised services to fill the gaps in the system. Key contexts identified in the study include: health system fragmentation; health service fragmentation; bio-medical, one problem at a time model; responsive specialised services; unresponsive mainstream services; national strategy; short health system funding cycles; and short-term goals. Conclusion When health services are fragmented and complex, the needs of socially excluded populations such as those experiencing homelessness are not met. Health systems focus on their own metrics and rely on separate actors such as independent NGOs to fill gaps when certain people are not accommodated in the mainstream health system. As a result, health systems lack a comprehensive understanding of the needs of all population groups and fail to plan adequately, which maintains fragmentation. Policy makers must set policy and plan health services based on a full understanding of needs of all population groups.

Introduction Research on psychiatric deinstitutionalization has neglected that reforms in this field are nested in a health system that has undergone financial reforms. This subordination could introduce incentives that are misaligned with new mental health policies. According to Chile’s National Mental Health Plan, this would be the case in the Community Mental Health Centers (CMHC). The goal is to understand how the CMHCpayment mechanism is a potential incentive for community mental health. Methods A mixed quantitative-qualitative convergent study using grounded theory. We collected administrative production data between 2010 and 2020. Following the payment mechanism theory, we interviewed 25 payers, providers, and user experts. We integrated the results through selective coding. This article presents the relevant results of mixed selective integration. Results Seven payment mechanisms implemented heterogeneously in the country’s CMHC are recognized. They respond to three schemes subject to rate limits and prospective public budget. They differ in the payment unit. They are associated with implementing the community mental health model negatively affecting users, the services provided, the human resources available, and the governance adopted. Governance, management, and payment unit conditions favoring the community mental health model are identified. Conclusions A disjointed set of heterogeneously implemented payment schemes negatively affects the community mental health model. Formulating an explicit financing policy for mental health that is complementary to existing policies is necessary and possible.

Health systems are complex entities. The Mexican health system includes the private and public sectors, and subsystems that target different populations based on corporatist criteria. Lack of unity and its consequences can be better understood using two concepts, segmentation and fragmentation. These reveal mechanisms and strategies that impede progress toward universality and equity in Mexico and other low- and middle-income countries. Segmentation refers to separation of the population by position in the labour market. Fragmentation refers to institutions, and to financial aspects, health care levels, states' systems of care, and organizational models. These elements explain inequitable allocation of resources and packages of health services offered by each institution to its population. Overcoming segmentation will require a shift from employment to citizenship as the basis for eligibility for public health care. Shortcomings of fragmentation can be avoided by establishing a common package of guaranteed benefits. Mexico illustrates how these two concepts characterize a common reality in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

INTRODUCTION Whether men find it easier to quit smoking than women is still controversial. Different studies have reported that the efficacy of pharmacological treatments could be different between men and women. This study conducted a secondary analysis of 'Subsidized pharmacological treatment for smoking cessation by the Spanish public health system' (FTFT-AP study) to evaluate the effectiveness of a drug-funded intervention for smoking cessation by gender. METHODS A pragmatic randomized clinical trial by clusters was used. The population included smokers aged ≥18 years, smoking >10 cigarettes per day, randomly assigned to an intervention group receiving regular practice and financed pharmacological treatment, or to a control group receiving only regular practice. The main outcome was continued abstinence at 12 months, self-reported and validated with CO-oximetry. The percentage, with 95% confidence intervals, of continued abstinence was compared between both groups at 12 months postintervention, by gender and the pharmacological treatment used. Multilevel logistic regression analysis was performed. RESULTS A total of 1154 patients from 29 healthcare centers were included. The average age was 46 years (SD=11.78) and 51.7% were men. Overall, the selfreported abstinence at 12 months was 11.1% (62) in women and 15.7% (93) in men (AOR=1.4; 95% CI: 1.0--2.0), and abstinence validated by CO-oximetry was 4.6% (26) and 5.9% (35) in women and men, respectively (OR=1.3; 95% CI: 0.7-2.2). In the group of smokers receiving nicotine replacement treatment, self-reported abstinence was higher in men compared to women (29.5% vs 13.5%, OR=2.7; 95% CI: 1.3-5.8). CONCLUSIONS The effectiveness of a drug-financed intervention for smoking cessation was greater in men, who also showed better results in self-reported abstinence with nicotine replacement treatment. [ABSTRACT FROM AUTHOR]

The theme of this research is the analysis of the sustainability of healthcare system financing in the Federation of Bosnia and Herzegovina (in continuation of the work of BiH), with a particular focus on achieving more rational costs compared to European countries. The research aims to identify opportunities for implementing reforms on the expenditure side, with a focus on increasing system efficiency. The main source of funding for healthcare rights from mandatory health insurance comes from contributions paid by employed individuals, with significantly lower contributions for other insured groups. Considering challenges such as the aging population, growing healthcare needs, and low employment rates and average wages, the research will use a comparative and historical method for the period from 2019 to 2022. Special attention will be given to the analysis of revenue and expenditures within the healthcare system. In conclusion, the paper will offer potential solutions with the potential to enhance the financial model of the healthcare system throughout the Federation of BiH. In the first chapter, global trends in healthcare are analyzed, along with an overview of fundamental healthcare system models worldwide. The second chapter examines the legal framework and the financing model of the healthcare system in the Federation of BiH for the period 2019-2022, specifically focusing on the mandatory health insurance system and healthcare institution perspectives. The analysis will cover healthcare system spending, expenditure structure by purpose, and the trends of individual revenues and their sources. The third chapter presents potential solutions to ensure the sustainability of healthcare system financing. The paper concludes with summarizing the research results. [ABSTRACT FROM AUTHOR]

Objective. Analyze the implementation of diagnosis-related groups (DRGs) in Chile with a view to optimizing the distribution of public resources. Methods. A chronological narrative analysis of the main milestones was complemented by simulated application of DRGs through emulated competition and cluster analysis for evaluative purposes. Results. In 2001, DRGs were introduced in Chile in an academic context. The National Health Fund (FONASA) began using DRGs in the private sector. A public sector pilot was launched in 2015. After nearly two decades of progress, in 2020 FONASA established the DRG program as a payment mechanism for public hospitals. However, the COVID-19 pandemic slowed its development. In 2022, implementation was resumed. After evaluating the program, it was evident that the hospital clusters that had been predefined for differentiated payment did not successfully differentiate homogeneous groups. In 2023, the program was reformed, financing was increased, a single cluster and base rate were defined, and greater hospital complexity was recognized, compared to previous years. Three hospitals were added to the program, for a total of 68. Conclusions. This experience shows that it is possible to sustain a public health financing policy that achieves greater efficiency and equity in the health system, based on the existence of robust institutions that continuously develop and improve. [ABSTRACT FROM AUTHOR]

The Mobile Emergency Care Service is the pre-hospital mobile component of the Emergency Care Network. It works as a privileged network observatory that allows articulation and integration with the different health services. This study aims to evaluate the financing governance of a Regional Mobile Emergency Care Service. This evaluative study was developed through documentary analysis and interviews with seven informants from the Mobile Emergency Care Service in the northern macroregion of the State of Paraná, from June 2017 to August 2018. The results show that the financial contribution was carried out according to ministerial ordinances, but insufficient to maintain the service, with municipalities bearing more than 50% of total expenses during the study period. It was possible to infer that the governance of financing of this Mobile Emergency Care Service is incipient, because the information about the financing they were disparate, little publicized, and little appropriated by the actors involved in the governance process. It is concluded that the poor financing governance contributes to the difficulty of Mobile Emergency Care Service in fulfilling the function of ordering and articulating the integration of the components of the Urgency and Emergency Network. [ABSTRACT FROM AUTHOR]

Background and Aims: The impact of health financing on the performance of the entire health system, including access, quality, and efficiency of healthcare, has been emphasized in the Astana Declaration, and the need to strengthen primary healthcare (PHC) and policy integration has been emphasized. After about two decades, the family medicine (FM) program in Iran is still facing great challenges. The aim of this study is to explore strategies for strengthening financing of the FM program in Iran, a vital component of PHC. Methods: A qualitative study was conducted in 2021. Purposeful sampling was used to select 34 policymakers, managers, and experts from various levels of the Ministry of Health, Iran universities of medical sciences, plan and budget organization of Iran, and health insurance organization in Iran. Thirty‐four semistructured interviews were conducted to collect data, which were analyzed by content analysis. Results: Through the analysis of interviews, our study has identified five strategies (identification and management of sustainable resources, pooling of sustainable resources, modeling of service provision, payment system model and its implementation process, and FM management structure), and 13 actions for strengthening financing of the FM program in Iran. Conclusion: Our study has identified five strategies and 13 actions for strengthening the financing of the FM program in Iran. These strategies and actions should be considered by policymakers during the review of the FM program in Iran. Without implementation of the suggested strategies and action, allocated resources may be wasted. [ABSTRACT FROM AUTHOR]

In order to guarantee equal access to healthcare, it must be funded in an equitable manner to ensure that people are not forced to forgo healthcare and to prevent healthcare from becoming too large a financial burden for patients. This is achieved by ensuring that health‑ care received by the poorest people is subsidised by wealthier people, while also ensuring that patients suffering poor health are not burdened with excessive costs for a given income. In prac‑ tice, patients are required to cover some of their healthcare costs across all European healthcare systems. Since out‑of‑pockets are only paid by healthcare consumers, their existence may com‑ promise equity in healthcare financing. In this article, we evaluate how out‑of‑pockets contribute to vertical and horizontal equity in healthcare financing for people aged 50 and over in Europe. Using concentration indices, we demonstrate that equity in financing is not respected, particu‑ larly in healthcare systems where out-of-pockets are the least regulated. [ABSTRACT FROM AUTHOR]

Abstract Introduction Iran is host to one of the world’s largest and longest-standing refugee populations. Although Iran has initiated a basic health insurance scheme for refugees throughout the country since September 2015, the population coverage of this scheme is very low, and various factors have caused a significant percentage of refugees to still lack insurance coverage and often face financial hardships when receiving health services. In response, this study aimed to understand barriers to insurance coverage among refugees in Iran and propose effective policies that can address persistent gaps in financial protection. Methods This qualitative study was conducted in two phases. First, a review of policy documents and interviews with participants were conducted to investigate the common barriers and facilitators of effective insurance coverage for refugees in Iran. Then, a systems thinking approach was applied to visualize the common variables and interactions on the path to achieving financial protection for refugees. Results Findings showed that various factors, such as (1) household-based premium for refugees, (2) considering a waiting time to be eligible for insurance benefits, (3) determining high premiums for non-vulnerable groups and (4) a deep difference between the health services tariffs of the public and private service delivery sectors in Iran, have caused the coverage of health insurance for non-vulnerable refugees to be challenging. Furthermore, some policy solutions were found to improve the health insurance coverage of refugees in Iran. These included removing household size from premium calculations, lowering current premium rates and getting monthly premiums from non-vulnerable refugees. Conclusions A number of factors have caused health insurance coverage to be inaccessible for refugees, especially non-vulnerable refugees in Iran. Therefore, it is necessary to adopt effective policies to improve the health financing for the refugee with the aim of ensuring financial protection, taking into account the different actors and the interactions between them.

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