Wilm Quentin

University of Bayreuth · Chair of Planetary & Public Health

Background: Since the Ghanaian National Health Insurance Scheme (NHIS) was introduced in 2004, coverage rates have remained low, despite affordable premiums and payment exemptions for minor, senior, poor and pregnant individuals. While 82% of the population have registered with the NHIS, many fail to complete the annual renewal and thus lose their...

Background Despite comparatively low rates of COVID-19 admissions and recorded deaths in sub-Saharan Africa (SSA), the pandemic still had significant impact on health service utilization (HSU). The aim of this scoping review is to synthesize the available evidence of HSU in SSA during the pandemic, focusing on types of studies, changes in HSU compa...

Background Understanding and comparing health systems is key for cross-country learning and health system strengthening. Templates help to develop standardised and coherent descriptions and assessments of health systems, which then allow meaningful analyses and comparisons. Our scoping review aims to provide an overview of existing templates, their...

Background Achieving universal health coverage in the African region requires health systems strengthening. Assessing and comparing health systems contributes to this process, but requires internationally comparable data. The European Observatory on Health Systems and Policies has produced Health Systems in Transition (HiT) reviews in Europe, Asia,...

Background Although the COVID-19 pandemic claimed a great deal of lives, it is still unclear how it affected mortality in low- and lower-middle-income countries (LLMICs). This review summarized the available literature on excess mortality during the COVID-19 pandemic in LLMICs, including methods, sources of data, and potential contributing factors...

Introduction Universal health coverage (UHC) is a global priority, ensuring equitable access to quality healthcare services without financial hardship. Many countries face challenges in progressing towards UHC. Health financing is pivotal for advancing UHC by raising revenues, enabling risk-sharing through pooling of funds and allocating resources....

Background: The Mobile Renewal System (MRS) has increased insurance renewal rates among Ghana's National Health Insurance Scheme (NHIS) subscribers. However, population coverage with active NHIS membership remains insufficient for Universal Health Coverage (UHC) ambitions, especially among informal workers. This qualitative study aimed to understan...

Background: The COVID-19 pandemic caused a massive death toll, but its effect on mortality remains uncertain in low- and lower-middle-income countries (LLMICs). This review summarized the available literature on excess mortality in LLMICs, including methods, data sources, and factors that might have influenced excess mortality. Methods: The protoco...

Background Prehabilitation aims to improve patients' functional capacity before surgery to reduce perioperative complications, promote recovery and decrease probability of disability. The planned economic evaluation is performed alongside a large German multi-centre pragmatic, two-arm parallel-group, randomized controlled trial on prehabilitation f...

Introduction The COVID-19 pandemic has been marked by a massive death toll. However, the overall effect of the pandemic, including potential unintended negative impacts of some control measures, on mortality remains poorly understood in low-income and lower middle-income countries (LLMICs). This review aims to summarise the available literature on...

Introduction Countries in the WHO’s African region have found community-based surveillance useful in ensuring the effectiveness of the Integrated Disease Surveillance and Response strategy. This approach encourages community participation in the surveillance system, in addition to early detection of outbreaks and other health threats. Thus, advance...

Ghana confirmed its first cases of COVID-19 on March 12, 2020. As in other countries, a number of control measures were initiated, including contact tracing and enforcement of lockdowns. Despite the rollout of these measures, the country cumulatively had the 3rd highest number of COVID-19 related deaths in West Africa by February 2022. Understandin...

Introduction The Coronavirus Disease 2019(COVID-19) pandemic has undoubtedly exposed weaknesses in health systems, especially in sub-Saharan Africa (SSA). Despite comparatively low rates of COVID-19 admissions and recorded deaths in SSA, the pandemic still had a significant impact on health service utilization (HSU). The aim of this scoping review...

Background Peer support has been proposed as a promising policy intervention for addressing adverse maternal and child healthcare (MCH) outcomes in sub-Saharan Africa (SSA). Existing reviews on peer support largely draw on evidence from high-income countries or focus on single services like breastfeeding, nutrition or postnatal care. In contrast, t...

Background Community-based surveillance may encourage early detection of outbreaks and other health threats. Mobile digital tools for health (mHealth) can potentially support the role of community health workers (CHW) in disease surveillance. However, limited information is available on mhealth use by CHW for infectious disease surveillance in Afri...

Background The COVID-19 pandemic caused a massive death toll, but its effect on mortality remains uncertain in low- and lower-middle-income countries (LLMICs). This review summarized the available literature on excess mortality in LLMICs, including methods, data sources, and drivers of excess mortality. Methods A protocol was registered in PROSPER...

Background The COVID-19 pandemic has had a massive impact on mortality and health service utilisation globally. However, its impact in low- and lower middle-income countries (LLMIC), in particular in sub-Saharan Africa, remains poorly understood. The German West-African Centre (G-WAC) for Global Health and Pandemic Prevention aims to contribute to...

Background The COVID-19 pandemic has affected health systems and impacted health service utilization (HSU) globally. The aim of this scoping review is to synthesize the available evidence on HSU in sub-Saharan Africa during the COVID-19 pandemic focusing on (1) changes in HSU compared to the pre-pandemic period, (2) changes in HSU amongst particula...

Background Elderly patients frequently develop a frailty syndrome. Frailty is characterized by reduced physical reserves which increases the risk of perioperative complications and, thus, of patients needing long-term care. Prehabilitation before elective surgery can reduce risk factors and is currently evaluated as a new and sustainable care pathw...

Introduction The COVID-19 pandemic has exposed weaknesses in health systems of many countries, including those in sub-Saharan Africa. Despite comparatively low rates of COVID-19 admissions and deaths in sub-Saharan Africa, the pandemic still had a significant impact by disrupting health service utilisation (HSU). The aim of this scoping review is t...

Background Prehabilitation aims at enhancing patients’ functional capacity and overall health status to enable them to withstand a forthcoming stressor like surgery. Our aim was to synthesise the evidence on the cost-effectiveness of prehabilitation for patients awaiting elective surgery compared with usual preoperative care. Methods We searched P...

Background Prehabilitation aims to improve patients' functional capacity before surgery to reduce perioperative complications, promote recovery and decrease probability of disability. The planned economic evaluation is performed alongside a large German multi-centre pragmatic, two-arm parallel-group, randomized controlled trial on prehabilitation f...

Background Peer support has been proposed as a promising policy intervention for addressing adverse maternal and child healthcare (MCH) outcomes in sub-Saharan Africa (SSA). Existing reviews on peer support largely draw on evidence from high-income countries or focus on single services like breastfeeding, nutrition or postnatal care. In contrast, t...

Background Prehabilitation aims at enhancing patients’ functional capacity and overall health status to enable them to withstand a forthcoming stressor like surgery. Our aim was to synthesise the evidence on the cost-effectiveness of prehabilitation for patients awaiting elective surgery compared with usual preoperative care. Methods We searched P...

Background Sub-Saharan Africa suffers from the highest maternal mortality ratio (MMR) in the world, with 542 deaths per 100,000 live births in 2017, relative to a global ratio of 211. Reducing gender inequities, increasing awareness regarding gender-based discrimination (GBD), and increasing the empowerment of women and girls have recently been rec...

Introduction Gender-based discrimination (GBD) is generally defined as unequal or disadvantageous treatment based on one’s gender. Emerging evidence suggests that exposure to GBD in its various forms can yield negative consequences for women’s health, including delaying access to healthcare services and lowering the quality of nutrition. Although c...

Background In 2013–2014, Israel accelerated adoption of activity-based payments to hospitals. While the effects of such payments on patient length of stay (LoS) have been examined in several countries, there have been few analyses of incentive effects in the Israeli context of capped reimbursements and stretched resources. Methods We examined admi...

Objective As part of the Dose Reduction Immunobridging and Safety Study of Two HPV Vaccines in Tanzanian Girls (DoRIS; NCT02834637), the current study is one of the first to evaluate the financial and economic costs of the national rollout of an HPV vaccination program in school-aged girls in sub-Saharan Africa and the potential costs associated wi...

Since 2018, the Health System and Policy Monitor (HSPM) network of the European Observatory on Health Systems and Policies has tracked health reform activity in its countries. Top three reforms are identified by national experts yearly and classified across 11 policy clusters. Efforts inform a standardized overview of healthcare development. 337 re...

Background Universal Health Coverage (UHC) is key for reaching Sustainable Development Goal 3. Digital technologies for health financing (DTHF) may help countries in sub-Saharan Africa (SSA) make progress towards achieving UHC. DTHF are increasingly used to strengthen health financing systems across their three key functions, (1) raising revenues,...

Background Cervical cancer caused by human papillomavirus (HPV) is the most frequent cancer in women in many low-income countries.Tanzania implemented a national HPV vaccination program in 2018 using a two-dose quadrivalent HPV vaccine. This study aimed to (1) estimate financial and economic costs of a two-dose vaccination program based on experien...

Background Payment methods are known to influence maternal care delivery in health systems. Ghana suspended a piloted capitation provider payment system after nearly five years of implementation. This study aimed to examine the effects of Ghana’s capitation policy on maternal health care provision as part of lesson learning and bridging this critic...

Background European countries are still searching to eliminate or contain the Covid-19 pandemic. A variety of approaches have achieved different levels of success in limiting the spread of the disease early and preventing avoidable deaths. Governmental policy responses may explain these differences and this study aims to describe evidence about the...

Background: Improving the quality of hospital care is an important policy objective. Hospitals operate under pressure to contain costs and might face challenges related to financial deficits. The objective of this paper was to identify and map the available evidence on the association between hospital financial performance (FP) and quality of car...

Background Frailty is expressed by a reduction in physical capacity, mobility, muscle strength, and endurance. (Pre-)frailty is present in up to 42% of the older surgical population, with an increased risk for peri- and postoperative complications. Consequently, these patients often suffer from a delayed or limited recovery, loss of autonomy and qu...

Introduction Cholera remains a significant contributor to diarrhoeal illness, especially in sub-Saharan Africa. Few studies have estimated the cost of illness (COI) of cholera in Malawi, a cholera-endemic country. The present study estimated the COI of cholera in Nsanje, southern Malawi, as part of the Cholera Surveillance in Malawi (CSIMA) program...

Background: Diagnosis-related group (DRG)-based hospital payment can potentially be inadequately low (or high) for highly variable, highly specialized, and/or low volume care. DRG-based payment can be combined with other payment mechanisms to avoid unintended consequences of inadequate payment. The aim of this study was to analyze these other paym...

Background Frailty is accompanied with a reduced physical capacity, mobility, muscle strength and endurance. (Pre-)Frailty is present in an older surgical population in up to 50% with an increased risk for peri- and post-surgical complications. Consequently, these patients often suffer from a delayed or diminished recovery, loss of autonomy and qua...

Patient registration with a primary care providers supports continuity in the patient-provider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of countries; and identifies challenges and ongoing reform efforts. Twelve jurisdictions (Denma...

Background Hospitals operate under constant pressure to contain costs and improve the quality of care (Q). The potential association between hospital financial performance (FP) and Q can have two directions: (1) providers with better FP might have a greater capacity to maintain and/or improve Q; (2) a better Q might lead to better FP, i.e. increase...

Background Imbalances in the distribution of health as well as global interconnectedness led to the consideration of health as a global public good. Health is placed therefor at the center of the goal-based movement for sustainability led by the United Nations (UN). Health System Strengthening (HSS) is an approach to align and harmonize all stakeho...

Climate change and its impact on the environment will have negative effects on health worldwide. National health strategies and plans (NHSPs) play an essential role in defining the future of a country's health system. It remains unknown whether and how NHSPs take climate change and related health risks into account and if this is done by countries...

Background Stroke is a major cause of death and disability in Europe. European guidelines for patients with ischemic stroke (about 85% of all strokes) recommend rapid access to hospital care and rehabilitation after discharge from hospital. Information on access to stroke care in Europe is limited. Methods A stroke vignette was developed reflectin...

Background Describing and assessing health systems is a challenging but essential task for researchers and policy makers striving to perform cross-country comparisons and to ensure evidence-based global health policy. The European Observatory on Health Systems and Policies has developed a template for country health system reviews (HiT) to systemat...

A health system review provides a detailed description of a health care system and of reform and policy initiatives in progress or under development. The health system review of Ghana serves as an effort to also assess the system's performance towards the attainment of universal health coverage (UHC). A workshop was organized in 2018 to develop a t...

COVID-19 has affected health providers economically in two main ways. First, some providers lost income due to postponed services or patients refraining from seeking care. Second, other providers took on new tasks by treating (high volumes of) COVID-19 patients. All providers faced higher costs due to new hygiene and distance requirements. We revie...

Introduction Comparing health systems allows policymakers to benchmark against other countries, and improve processes and performance. A template to guide authors on how to present systems' features and performance in a meaningful manner is the basis for understanding and assessing a country's health system. This study presents an overview of appro...

Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs rela...

Purpose The purpose is to assess the impact of clinical costing approaches on the quality of cost information in seven countries (Denmark, England, France, Germany, Ireland, the Netherlands and Portugal). Design/methodology/approach Costing practices in seven countries were analysed via questionnaires, interviews and relevant published material. Fi...

Countries with social health insurance (SHI) systems display some common defining characteristics - pluralism of actors and strong medical associations - that, in dealing with crisis times, may allow for common learnings. This paper analyses health system responses during the COVID-19 pandemic in eight countries representative of SHI systems in Eur...

Background: Hospital professionals are "dual agents" who may face dilemmas between their commitment to patients' clinical needs and hospitals' financial sustainability. This study examines whether and how hospital professionals balance or reconcile clinical and economic considerations in their decision-making in two countries with activity-based p...

Background Hospitals operate under constant pressure to contain costs and improve the quality of care. The literature suggests that there is an association between health care providers’ financial performance and the quality of care. On the one hand, providers that are financially more stable might have better capacity to maintain reliable systems...

Background: High-income countries continuously reform their healthcare systems. Often, similar reforms are introduced concomitantly across countries. Although national policymakers would benefit from con- sidering reform experiences abroad, exchange is limited. This paper provides an overview of health re- form trends in 31 high-income countries in...

Policy Points • We compared the structure of health care systems and the financial effects of the COVID-19 pandemic on health care providers in the United States, England, Germany, and Israel: systems incorporating both public and private insurers and providers. • The negative financial effects on health care providers have been more severe in the...

Background : High-income countries continuously reform their healthcare systems. Often, similar reforms are introduced concomitantly across countries. Although national policymakers would benefit from considering reform experiences abroad, exchange is limited. This paper provides an overview of health reform trends in 31 high-income countries in 20...

Introduction: Preoperative functional capacity is an important predictor of postoperative outcomes. Prehabilitation aims to optimise patients’ functional capacity before surgery to improve postoperative outcomes. As prolonged hospital stay and postoperative complications present an avoidable use of healthcare resources, prehabilitation might also s...

Background Effective primary care requires continuity in the patient-provider relationship so that the primary care provider can act as the central coordinator of services. For this reason, some high-income countries have insisted on patient registration with a primary care team as part of different reform efforts. This paper develops a framework f...

Background Countries in Europe are continuously reforming their health care systems. Often similar reforms are happening simultaneously in different countries, and policymakers would benefit from considering reform experiences made abroad. However, no systematic information is available about reforms happening simultaneously across countries. This...

Background Hospital managers and physicians may face dilemmas due to their role as dual agents, committed both to their hospitals and their patients. We aim to pinpoint situations where economic and clinical considerations are aligned or conflicting; and to explore how managers and physicians reconcile different considerations in their decision-mak...

Achieving Person-Centred Health Systems - edited by Ellen Nolte August 2020

Background: Health policy and systems research (HPSR) is an inherently cross-disciplinary field of investigation. However, conflicting conceptualisations about inter-, multi- and transdisciplinary research have contributed to confusion about the characteristics of cross-disciplinary approaches in HPSR. This review was conducted to (1) define the c...

PROSPERO record: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=182813

Problem: In Latvia, the move towards community-based mental health-care services has been slow. Approach: The hospital managers of the only psychiatric hospital in Riga decided to establish two community-based clinics that were financially and administratively integrated with the hospital. The clinics were established using a step-wise approach...

Background: Since 2010, Israel has expanded the adoption of procedure-related group (PRG) based payments for hospitals. While there is a rich quantitative literature that assesses the effects of payment reforms on efficiency or quality of care, very few qualitative studies have focused on the impacts of diagnosis-related group (DRG)-like payments...

This paper aims to: (1) provide a brief overview of hospital sector characteristics in 11 Central and Eastern European countries (Bulgaria, Czech Republic, Estonia, Croatia, Latvia, Lithuania, Hungary, Poland, Romania, Slovakia, Slovenia); (2) compare recent (2008 – 2019) hospital reforms in these countries; and (3) identify common trends, success...

All countries in Europe will have to find solutions to protect hospitals from revenue shortfalls and to adequately reimburse for COVID-19-related costs of care. This article reports on changes to hospital payment systems in Belgium, the United Kingdom (England). Hospitals in these countries are paid for treating COVID-19 patients using the usual sy...

[This corrects the article DOI: 10.1371/journal.pone.0220583.].

Assessing and improving quality of care presupposes an understanding of what it does and does not entail. Different definitions often specify relatively long lists of various attributes that they recognize as part of quality. Effectiveness, patient safety, and responsiveness/patient-centeredness seem to have become universally accepted as core dime...

Background Israel has expanded procedure-related group (PRG) payments instead of per-diem payments for hospitals. There is scarce literature that documents the process of adoption of DRGs and its entailed economic incentives according to hospital workers’ perspectives. Important issues remain underexplored such as how managers transmit the incentiv...

Background In 2013-14, Israel stepped up the replacement of per-diem payments by Procedure-Related Group (PRG) based hospital payments, a local version of Diagnosis-Related groups (DRGs). PRGs were created for selected procedures in urology, general surgery, gynecology and ophthalmology. We analyzed how did this change affect inpatient activities,...

P4Q can be implemented in various health care settings, targeting a range of health care providers or professionals. P4Q schemes can reward high quality measured in terms of structures, processes