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All for Universal Coverage
... Universal health coverage (UHC) as devoted to by the United Nations affiliate in the SDGs, can contribute to health equity if it is appropriately premeditated and realized [28,29]. To achieve the overarching goal of good health and wellbeing for all people as well as other important healthcare targets in the SDGs, such as mortality reduction and the prevention of premature mortality from noncommunicable diseases. ...
... WHO Report of 2019 called for all health systems to move toward universal coverage, defined as "access to adequate healthcare for all at an affordable price" [28]. Everyone wants access to high-quality, reasonable healthcare. ...
Health insurance is one of the instruments to achieve universal health coverage, which is not only the major goal for health reform in many countries but also the priority objective of World Health Organization. It provides financial security against healthcare costs and lessens the risk of incurring medical debt. There is an increasing understanding that poverty is exacerbated by ill health. Developing nations have recently increased the usage of various health insurance schemes to improve access to healthcare for low-income households to stop the negative downward circle of poverty and illness. These models help all countries regardless of income level can set out on the path to universal health coverage through a mix of different prepayment and risk-pooling mechanisms, tax-funding, and social health insurance. Right policies are necessary to achieve UHC. Concentrating on providing strong coverage for a clearly defined basket of services is well preferable to shallow coverage for every service with a high patient cost-sharing ratio. Health insurance system must be designed from the outset to be financially sustainable, which includes looking into ways to increase revenue sources and giving priority to the efficient use of resources.
... It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care [1,2]. The progress towards this aspiration seems poor [3] particularly for countries whose fiscal capacity is low and whose social health insurance for the employed sector is absent or very small, thus limiting the mobilization of additional resources from payroll contributions. ...
... This is one of the obstacles to accessing healthcare in Ethiopia too [10]. Thus this made reasonable to advocate community-based health insurance program (CBHI) to be able financing healthcare [3]. However, low household enrolment rate challenged the accessibility of healthcare [7,8]. ...
Background
Community Based Health Insurance (CBHI) is a type of health insurance program that provides financial protection against the cost of illness and improving access to health care services for communities engaged in the informal sector. In Ethiopia, the coverage of CBHI enrolment varies across regions and decision of household enrolment is affected by different factors. There are pocket studies on CBHI scheme with different coverage in Ethiopia and there is no pooled study on CBHI enrolment coverage in Ethiopia for better understanding the scheme and decision making. The aim of this systematic review and meta-analysis was to identify the pooled coverage of CBHI enrolment in Ethiopia to understand its policy implications.
Methods
The systematic review and meta-analysis was done by adhering the PRISMA guideline with exhaustive search in PubMed/Medline, HINARI, SCOPUS and Google scholar complemented by manual search. Two authors independently selected studies, extracted data, and assessed quality of studies. The I ² test statistic was used to test heterogeneity among studies. The overall coverage of CBHI scheme was estimated by using random-effects model.
Result
Among 269 identified, 17 studies were included in this meta-analysis and the overall coverage of CBHI scheme was 45% (95% CI 35%, 55%) in Ethiopia. The sub-group analysis shows higher enrolment rate 55.97 (95%CI: 41.68, 69.77) in earlier (2016–2017) studies than recent 37.33 (95%CI: 24.82, 50.77) studies (2018–2020).
Conclusion
The pooled coverage of CBHI enrolment is low in Ethiopia compared the national target of 80% set for 2020. It is also concentrated in only major regions of the country. The finding of the study helps national decision making for CBHI scheme service improvement. Due attention to be given to improving geographic expansion of CBHI and to the declining coverages with in the CBHI implementing regions by addressing the main bottlenecks restraining coverages.
Trial registration
The protocol of this systematic review and meta-analysis was published in PROSPERO with registration number: CRD42021252762 .
... In the past two decades, along with some High-Income Countries (HICs) that have achieved UHC, there was a substantial increase in the number of Low and Middle-Income countries (LMICs) showing great endeavors to reach the state of the sample countries [12,13]. As, in the coming decades, most Asian and African countries will be able to implement basic and effective plans to achieve UHC by acquiring sufficient abilities to provide their essential resources in the health system for their country [14,15]. ...
... The protection against financial risks in the UHC, an issue that is also mentioned in the framework of control knobs, is highly influenced by the financing of the country's health system. In such a way, that choosing any of the financing methods by countries can have direct and indirect effects on the implementation of UHC [8,10,13,31,84,85]. However, focusing on increasing economic growth [86,87] and GDP, while allocating a proportional percentage of this GDP to the health sector are other leading elements in this case [83,88]. ...
Background
The initial purpose of healthcare systems around the world is to promote and maintain the health of the population. Universal Health Coverage (UHC) is a new approach by which a healthcare system can reach its goals. World Health Organization (WHO) emphasized maximum population coverage, health service coverage, and financial protection, as three dimensions of UHC. In progress for achieving UHC, recognizing the influential factors allows us to accelerate such progress. Therefore, this study aimed to identify the influential factors to achieve UHC in Iran.
Methods
This is a multi-method study was conducted in four phases: First, a systematic review of the literature was conducted to identify the factors in PubMed, Web of Science, Embase, Scopus, ProQuest, Cochrane library, and Science Direct databases, and hand searching google scholar search engine. For recognizing the unmentioned factors, a qualitative study consisting of one session of Focus Group Discussion (FGD) and five semi-structured interviews with experts was designed. The extracted factors were merged and categorized by round table discussion. Finally, the pre-categorized factors were refined and re-categorized under the health system’s control knobs framework during three expert panel sessions.
Results
Finally, 33 studies were included. Eight hundred two factors were extracted through systematic review and 96 factors through FGD and interviews (totally, 898). After refining them by the experts’ panel, 105 factors were categorized within the control knob framework (financing 19, payment system7, Organization 23, regulation and supervision 33, Behavior 11, and Others 12). The majority of the identified factors were related to the “regulation and supervision” dimension, whilst the “payment system” entailed the fewest. The political commitment during political turmoil, excessive attention to the treatment, referral system, paying out of pocket(OOP) and protection against high costs, economic growth, sanctions, conflict of interests, weakness of the information system, prioritization of services, health system fragmented, lack of managerial support and lack of standard benefits packages were identified as the leading factors on the way to UHC.
Conclusion
Considering the distinctive role of the context in policymaking, the identification of the factors affecting UHC accompanying by the countries’ experiences about UHC, can boost our speed toward it. Moreover, adopting a long-term plan toward UHC based on these factors and the robust implementation of it pave the way for Iran to achieve better outcomes comparing to their efforts.
... The outermost tier of the SEM, policy, accounts for the local, state, and national laws and policies that impact health practices [11]. Policies play a fundamental role in access to healthcare services, utilization of healthcare services, and the adoption of healthy behaviors [27]. For example, there is ample evidence that universal healthcare coverage increases access to healthcare services, including immunization [27][28][29]. ...
... Policies play a fundamental role in access to healthcare services, utilization of healthcare services, and the adoption of healthy behaviors [27]. For example, there is ample evidence that universal healthcare coverage increases access to healthcare services, including immunization [27][28][29]. ...
Background
Nigeria is one of the ten countries globally that account for 62% of under- and unvaccinated children worldwide. Despite several governmental and non-governmental agencies’ interventions, Nigeria has yet to achieve significant gains in childhood immunization coverage. This study identifies intrapersonal, interpersonal, organizational, community, and policy-level factors that influence childhood immunization uptake from various stakeholders’ perspectives using the Socioecological Model (SEM).
Methods
Using the Socioecological Model as a guiding framework, we conducted ten focus group sessions with mothers/caregivers and community leaders residing in Lagos state and nine semi-structured interviews with healthcare workers who provide routine immunization services in Lagos state primary healthcare facilities. We performed a qualitative analysis of focus groups and semi-structured interviews using deductive coding methods.
Results
The study sample included 44 mothers/caregivers and 24 community leaders residing in Lagos State, Nigeria, and 19 healthcare workers (routine immunization focal persons) working in the primary healthcare setting in Lagos state. Study participants discussed factors at each level of the SEM that influence childhood immunization uptake, including intrapersonal (caregivers’ immunization knowledge, caregivers’ welfare and love of child/ren), interpersonal (role of individual relationships and social networks), organizational (geographical and financial access to health facilities, health facilities attributes, staff coverage, and healthcare worker attributes), community (community outreaches and community resources), and policy-level (free immunization services and provision of child immunization cards). Several factors were intertwined, such as healthcare workers’ education of caregivers on immunization and caregivers’ knowledge of vaccination.
Conclusions
The reciprocity of the findings across the Socioecological Model levels emphasizes the importance of developing multi-pronged interventions that operate at multiple levels of the SEM. Our results can inform the design of culturally appropriate and effective interventions to address Nigeria’s suboptimal immunization coverage.
... The outermost tier of the SEM, policy, accounts for the local, state, and national laws and policies that impact health practices (11). Policies play a fundamental role in access to healthcare services, utilization of healthcare services, and the adoption of healthy behaviors (41). For example, there is ample evidence that universal healthcare coverage increases access to healthcare services, including immunization (41)(42)(43). ...
... Policies play a fundamental role in access to healthcare services, utilization of healthcare services, and the adoption of healthy behaviors (41). For example, there is ample evidence that universal healthcare coverage increases access to healthcare services, including immunization (41)(42)(43). Similarly, the presence of public or organizational policies providing women with paid maternity leave has been found to increase breastfeeding initiation and duration (44)(45)(46). ...
Background
Nigeria is one of the ten countries globally that accounts for 62% of under- and unvaccinated children worldwide. Despite several governmental and non-governmental agencies' interventions, Nigeria has yet to achieve significant gains in childhood immunization coverage. This study identifies intrapersonal, interpersonal, organizational, community, and policy-level factors that influence childhood immunization uptake from various stakeholders' perspectives using the Socioecological Model (SEM).
Methods
Using the Socioecological Model as a guiding framework, we conducted ten focus group sessions with mothers/caregivers and community leaders residing in Lagos state and nine semi-structured interviews with healthcare workers who provide routine immunization services in Lagos state primary healthcare facilities. We performed a qualitative analysis of focus groups and semi-structured interviews using deductive coding methods.
Results
The study sample included 44 mothers/caregivers and 24 community leaders residing in Lagos State, Nigeria, and 18 healthcare workers (routine immunization focal persons) working in the primary healthcare setting in Lagos state. Study participants discussed factors at the each level of the SEM that influence childhood immunization uptake, including intrapersonal (caregivers’ immunization knowledge, caregivers’ welfare and love of child/ren), interpersonal (role of individual relationships and social networks), organizational (geographical and financial access to health facilities, health facilities attributes, staff coverage, and healthcare worker attributes), community (community outreaches and community resources), and policy-level (free immunization services and provision of child immunization cards) that influence childhood immunization uptake. Several factors were intertwined, such as healthcare workers’ education of caregivers on immunization and caregivers' knowledge of vaccination.
Conclusions
The reciprocity of the findings from the different Socioecological Model levels emphasizes the importance of developing multi-pronged interventions that operate at multiple levels of the SEM. Our results can inform the design of culturally appropriate and effective interventions to address Nigeria's suboptimal immunization coverage.
... Because there is not yet a standard, internationally agreed quantitative framework to measure progress towards UHC, in this analysis we review national data and present a qualitative analysis of eff orts to reach UHC in each of the BRICS countries. 5 Defi ned as access to needed health services and fi nancial risk protection, 6 UHC is a shared health policy goal for all the BRICS countries, and is increasingly regarded as an overarching goal for health in the post-2015 development agenda. 7 Although there are notable diff erences within and across these countries in terms of wealth, health indicators, and systems (table 1), in this paper we use a simple framework to assess health systems and reforms towards UHC (as defi ned in the 2010 World Health Report), and consider these eff orts and remaining challenges. ...
... 28 Expenditure on medicines accounts for 72% of out-of-pocket spending. 5 In 2004, fi nancial barriers led to roughly a quarter of the population unable to access health services; 35% of patients admitted to hospital were pushed into poverty. 29 Paying for health pushed 60 million Indians below the poverty line in 2010. ...
Short-term experiences in global health (STEGHs) are common ways trainees engage in global health activities, which can be viewed by students as either altruistic or opportunistic. This article explores how STEGHs express the social contract medicine has with society, emphasizes areas of breakdown in this social contract, and calls for medical schools, licensure boards, STEGH-sponsoring organizations, and professional societies to take active roles in addressing these ethical challenges.
... 11 In response to this growing challenge, UHC is becoming the organizing principle for health systems everywhere. 39,40 UHC means 3 things: (1) access for all to (2) appropriate health services (at a minimum, health promotion and primary care, with additional services depending on local epidemiology and economics), and (3) without financial hardship (financial hardship is defined as 25% or more of total household expenditures spent on out-of-pocket health expenditures). 37 UHC is not about donors buying health insurance but about national governments organizing health financing in equitable, prepaid risk pools. ...
... Universal Health Coverage a : The New Frontier for Global Health a The graph assesses the proportion of the population affiliated with national health insurance or social, private, or micro-insurance schemes.Source: This graph was first published inGarret (2009) 39 and later updated in the International Labour Organization (2017 ...
Unprecedented economic progress and demands for social protection have engendered an economic transition in health in many low- and middle-income countries, characterized by major increases in domestic health spending and growing national autonomy. At the global level, development assistance is refocusing on fragile states, the poorest communities, and cooperation on global public goods like health security, technical norms, and innovation. Intergovernmental organizations like WHO need the wherewithal and support to provide leadership and to properly advance this new world health era.
... Predictions are that the loss of healthy life years due to global environmental change (including climate change) is 500 times greater in Africa than in Europe and, yet, health is widely recognised globally as a fundamental human right (McMichael et al., 2008). A vital step towards achieving health for all, even in Africa, requires nations to ensure the provision of access to universal health coverage (Garrett et al., 2009). In addition, the World Health Organisation's (WHO) Commission on Social Determinants of Health has emphasized that actions to promote health must go well beyond health care and must focus on people's daily living conditions, including the conditions in which they are born, grow, live, work and age, and on the structural drivers of those conditions such as inequities in access to power, money and other resources (WHO, 2008). ...
Climate change is a global phenomenon that significantly disturbs urban life through occurrences such as urban flooding, resulting from extensive rainfall in the cities that are built up and consist mainly of concrete surfaces. The effects of climate change have been exacerbated by the urbanisation process in Africa’s major cities and towns. It has dominated contemporary debates in urban planning and development practice. As towns and cities continue to grow and climatic conditions endure change, the urban landscape continues experiencing negative effects of climate stress. The effects of climate change are felt by the natural and built environment, but they are mostly felt by people who inhabit these environments and reap benefits from it. Effects of climate change impact and are costly on service delivery, provision of infrastructure, housing, health and livelihood of the urban citizens. On the other hand, major African cities contribute significantly to climate change due to urban emissions. Built-up areas that include buildings, surfaced roads and concrete driveways prevent precipitation and storm-water to percolate into the ground. Climate change has direct and indirect effects on urban temperatures, rainfall intensity, built infrastructure, energy or power, hydrology and flooding, habitats and biodiversity. Open spaces, parks and places, gardens and streets provide critical services to the urban ecosystem, biodiversity and quality of life for urban citizens. The deliberate and conscious investment in policy and programmes that deal with climate change has been lagging in urban areas in Africa. The idea of developing urban infrastructure that adapts to climate change has not been fully exploited in African cities and towns. In most populated parts of major cities in Africa, the infrastructure is dilapidated and cannot adapt to climate change. Rapid urbanisation in Africa has reduced the capacities of major cities and towns to provide the required infrastructure and services that adapt to climate change. There has been a mismatch between existing urban infrastructure and population levels in major cities in Africa.
... There are still some people with catastrophic diseases who are not covered by medical insurance (40). China has reached a milestone success in achieving the goal of universal health coverage. ...
Background
Catastrophic disease sufferers face a heavy financial burden and are more likely to fall victim to the “illness-poverty-illness” cycle. Deeper reform of the medical insurance system is urgently required to alleviate the financial burden of individuals with catastrophic diseases.
Methods
Data were obtained from a cross-sectional questionnaire survey conducted in Heilongjiang in 2021, and logistic regression and restricted cubic spline model was used to predict the core factors related to medical insurance that alleviate the financial burden of people with catastrophic diseases.
Results
Overall, 997 (50.92%) medical insurance-related professionals negatively viewed financial burden relief for people with catastrophic diseases. Factors influencing its effectiveness in relieving the financial burden were: whether or not effective control of omissions from medical insurance coverage (OR = 4.04), fund supervision (OR = 2.47) and degree of participation of stakeholders (OR = 1.91). Besides, the reimbursement standards and the regional and population benefit package gap also played a role. The likelihood of financial burden relief increased by 21 percentage points for each unit increase in the level of stakeholder discourse power in reform.
Conclusion
China’s current medical insurance policies have not yet fully addressed the needs of vulnerable populations, especially the need to reduce their financial burden continuously. Future reform should focus on addressing core issues by reducing the uninsured, enhancing the width and depth of medical insurance coverage, improving the level and capacity of medical insurance governance that provides more discourse power for the vulnerable population, and building a more responsive and participatory medical insurance governance system.
... Tis theory has been adopted in a few studies, including public health related studies such as a study on factors related to immunization uptake [13][14][15]. With regard to health perspective, fve multilevel factors from intrapersonal (individual characteristic and behaviour) [16], interpersonal (relationship between family and it social networks) [14], institutional (for example, health institution and its workers), community (for example, risk perception on vaccination uptake from community) [17], and policy (for example, providing role in delivering the healthcare access and services utilisation) [18] infuence the population healthcare practice. Trough reviewing polio SIA challenges by each of these levels interdependently, it enables to provide fundamental results that are useful for polio prevention plans that address the identifed gaps from each level. ...
Background:
Polio supplementary immunization activities (SIAs) are one of the polio eradication pillars in the Global Polio Eradication Initiative (GPEI) that increased the immunization coverage and made progress towards polio eradication. However, socioecological challenges faced during SIAs contribute to suboptimal campaign quality. The aim of this review is to identify the reported challenges during polio supplementary immunization activities (SIAs) and associated improvement strategies based on the socioecological model (SEM).
Methods:
Articles were searched from three databases which were WOS, Scopus, and PubMed. The systemic review identified the primary articles related to SIA that focused on the impact of immunization coverage, challenges, and improvement strategies. The inclusion criteria were open access English articles that were published between 2012 and 2021 and conducted in the Asia region.
Results:
There are nine articles described and explained regarding some form of supplementary immunization activities (SIAs) in their findings across Asia region. The majority of studies selected reported on post vaccination coverage and revealed a multifaceted challenge faced during SIAs which are widely diverse range from the microlevel of interpersonal aspects up to the macrolevel of government policy. Upon further analysis, the intervention at community level was the most dominant strategies reported during the SIA program.
Conclusions:
An effective SIAs program provides the opportunity to increase the national capacity of the polio immunization program, reducing inequities in service delivery and offering additional public health benefits in controlling polio outbreaks in both endemic and nonendemic countries. Strengthening routine immunization (RI) programmes is also important for the sustainability of SIA's programs. Despite the challenges and hurdles, many Asian countries exhibited great political willingness to boost polio immunization coverage through SIA efforts.
... The e-healthcare system may give general support on a larger scale, such as management assistance, healthcare service delivery, and so on, as well as specialized help, such as citizen health data [135]. The provision of health care via the internet and technology is carried out by combining existing tools and assuring the quality of the services supplied [136]. The spread of the contagious coronavirus is an issue that needs immediate attention. ...
Federated Learning (FL), Artificial Intelligence (AI), and Explainable Artificial Intelligence (XAI) are the most trending and exciting technology in the intelligent healthcare field. Traditionally, the healthcare system works based on centralized agents sharing their raw data. Therefore, huge vulnerabilities and challenges are still existing in this system. However, integrating with AI, the system would be multiple agent collaborators who are capable of communicating with their desired host efficiently. Again, FL is another interesting feature, which works decentralized manner; it maintains the communication based on a model in the preferred system without transferring the raw data. The combination of FL, AI, and XAI techniques can be capable of minimizing several limitations and challenges in the healthcare system. This paper presents a complete analysis of FL using AI for smart healthcare applications. Initially, we discuss contemporary concepts of emerging technologies such as FL, AI, XAI, and the health-care system. We integrate and classify the FL-AI with healthcare technologies in different domains. Further, we address the existing problems, including security, privacy, stability, and reliability in the healthcare field. In addition, we guide the readers to solving strategies of healthcare using FL and AI. Finally, we address extensive research areas as well as future potential prospects regarding FL-based AI research in the healthcare management system.
... The e-healthcare system may give general support on a larger scale, such as management assistance, healthcare service delivery, and so on, as well as specialized help, such as citizen health data [135]. The provision of health care via the internet and technology is carried out by combining existing tools and assuring the quality of the services supplied [136]. The spread of the contagious coronavirus is an issue that needs immediate attention. ...
Federated Learning (FL), Artificial Intelligence (AI), and Explainable Artificial Intelligence (XAI) are the most trending and exciting technology in the intelligent healthcare field. Traditionally, the healthcare system works based on centralized agents sharing their raw data. Therefore, huge vulnerabilities and challenges are still existing in this system. However, integrating with AI, the system would be multiple agent collaborators who are capable of communicating with their desired host efficiently. Again, FL is another interesting feature, which works decentralized manner; it maintains the communication based on a model in the preferred system without transferring the raw data. The combination of FL, AI, and XAI techniques can be capable of minimizing several limitations and challenges in the healthcare system. This paper presents a complete analysis of FL using AI for smart healthcare applications. Initially, we discuss contemporary concepts of emerging technologies such as FL, AI, XAI, and the healthcare system. We integrate and classify the FL-AI with healthcare technologies in different domains. Further, we address the existing problems, including security, privacy, stability, and reliability in the healthcare field. In addition, we guide the readers to solving strategies of healthcare using FL and AI. Finally, we address extensive research areas as well as future potential prospects regarding FL-based AI research in the healthcare management system.
... Despite this difficulty with measurability, the concept of effective coverage is useful for orienting health policy. When combined with financial protection, it enables a more precise specification of UHC: it is system-wide effective coverage combined with universal financial protection [5,6]. Although the objectives embedded in UHC are distinct, UHC is a unified concept. ...
Global attention has recently converged on the need for countries to achieve universal health coverage (UHC), which aims to guarantee that all
persons are able to access needed and effective healthcare without facing financial ruin by using services. In the attempt to move towards UHC,
several low- and middle-income countries are developing more sustainable revenue sources, expanding pooling arrangements and employing more
efficient and sustainable purchasing strategies. Their experiences represent a growing evidence of the application of mandatory (social), private and
community-based health insurance in low- and middle-income countries and their potential contribution to UHC. UHC reforms are an inherently
political process, and public health advocates will need to do more to promote not only the health benefits of public health interventions but also
the economic and political benefits too. Crucially, as UHC continues to be championed and rolled out globally, all people working in global health
need to reinforce the importance of including the full scope of public health in health system reforms; only then can the full potential of UHC be
realized—a true reduction in health inequities. However, implementation of a UHC is not an easy phenomenon, rather it needs proper design of a
good health insurance system by integrating both the public and private health care providers. The influence of good governance and a sustainable
health financing system is fundamental to establish UHC in the developing countries. This review Paper encompasses recent developments and future
challenges in the implementation of Universal Health Coverage Policy framework in some countries.
... It includes all the processes involved to formulate and administrate public policy usually by the interaction between social groups and governmental institutions or between political leadership and public opinion based on the politics of the concerned society [6]. The path to achieve UHC, coupled with highly-ranked health outcomes, has been an explicitly political process [7], [8]. Different types of political processes are having an outsized influence on health. ...
Recently the global community is starting to recognize the political nature of Universal Health Coverage (UHC). UHC is not only about services that are covered, but also how they are funded, managed, and delivered. Universal financial protection and equitable access to healthcare are the backbones of the concept of UHC. The current article was motivated by a lack of understanding of how political processes affect the drive for UHC in resource-restricted settings. The political process (PP) is the means of public policy formulation and administration, usually by the interaction between political leadership and public opinion. This article investigates the following question: how political processes impact UHC in African countries—using a conceptual framework derived from the Political Process Theory. The framework structure views UHC as a new social movement that embraces three key dimensions (organizations, political opportunities, and interest's opinion) that can work together to affect the drive for UHC by providing effective policies and legislations. Additionally, three African countries (Ethiopia, Rwanda, and Kenya) were selected as a case study. The cross-national analysis of the relationship between PP and UHC confirmed that reforms required to deliver UHC are inherently political processes that required the creation of new political opportunities with strong political support and democratic organization that allow active public participation in policy formation and governance to achieve sustainable UHC.
... This finding is at odds with a previous study which demonstrated that people greater or equal to 40 years old were more likely to have uterine fibroids [1]. In addition, this study demonstrated that health insurance coverage in Haiti was extremely low and was about 6 to 7 times lower than the health insurance coverage in U.S. and Europe [33]. The high out-of-pocket expenditures may be explained by the lack of public health insurance in Haiti or persistent gaps in universal health coverage. ...
Background:
Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women's lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women's quality of life.
Methods:
A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH's (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results.
Results:
Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication- 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1-10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6-12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6-13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1-0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1-0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women's lives. The poverty cycle of uterine fibroids emerged.
Conclusions:
A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.
... The goal of achieving universal health coverage (UHC) has for several years been a global priority (WHO, 2005(WHO, , 2010Garrett et al., 2009). In 2005, the World Health Assembly defined UHC as: 'access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access'. ...
Patient navigation interventions, which are designed to enable patients excluded from health systems to overcome the barriers they face in accessing care, have multiplied in high-income countries since the 1990s. However, in low-income countries (LICs), indigents are generally excluded from health policies despite the international paradigm of universal health coverage (UHC). Fee exemption interventions have demonstrated their limits and it is now necessary to act on other dimensions of access to healthcare. However, there is a lack of knowledge about the interventions implemented in LICs to support the indigents throughout their care pathway. The aim of this paper is to synthesize what is known about patient navigation interventions to facilitate access to modern health systems for vulnerable populations in LICs. We therefore conducted a scoping review to identify all patient navigation interventions in LICs. We found 60 articles employing a total of 48 interventions. Most of these interventions targeted traditional beneficiaries such as people living with HIV, pregnant women and children. We utilized the framework developed by Levesque et al. (Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12:18) to analyse the interventions. All acted on the ability to perceive, 34 interventions on the ability to reach, 30 on the ability to engage, 8 on the ability to pay and 6 on the ability to seek. Evaluations of these interventions were encouraging, as they often appeared to lead to improved health indicators and service utilization rates and reduced attrition in care. However, no intervention specifically targeted indigents and very few evaluations differentiated the impact of the intervention on the poorest populations. It is therefore necessary to test navigation interventions to enable those who are worst off to overcome the barriers they face. It is a major ethical issue that health policies leave no one behind and that UHC does not benefit everyone except the poorest.
... Lack of health insurance is viewed as one of the main reasons for health inequalities around the world. 1,2 Consequently, the World Health Organization (WHO) has supported the introduction of universal health coverage (UHC) across the globe 3 to provide equal accessibility and affordability of health care to eliminate or narrow health inequality. Based on different countries' experiences, some studies have shown that the implementation of UHC could reduce health inequality, 4,5 while others indicate that such a policy could not narrow the gap of health inequality. ...
Purpose:
Regarding the universal health coverage (UHC) goal of eliminating health disparity, this study seeks to examine whether this objective has actually been achieved and whether residence affects health and well-being inequality.
Methods:
Based on Taiwan's experience with its UHC system, this research quantifies health and well-being indicators, including quality-adjusted life expectancy (QALE), consumption, and utility-adjusted life expectancy (UALE), and uses the geographic information system (GIS) to map regional well-being throughout Taiwan. Using spatial lag regressions, this study estimates how residence and socio-economic factors affect population's well-being.
Results:
Estimation results indicate a 1‰ increase in the mortality rate reduces the population's UALE by 0.4131 utility-adjusted life-years (UALYs). The differences in health and well-being indicators between urban and rural residents were 6.49 quality-adjusted life-years (QALYs) and 3.84 UALYs. Residents living in Taipei City had the highest level of QALE, consumption, and well-being, and those in Taitung County had the lowest level of QALE and well-being. The regional spatial autocorrelation results show that a population's health status and well-being are connected to residence.
Conclusion:
Our estimation results show that risk of higher mortality rates in disadvantaged areas appears to be associated with well-being inequality, even with universal healthcare coverage. We suspect that related health intervention efforts, such as preventive and curative medical devotion, in Taiwan might not have effectively reached more rural residents, and thus recommend more work be undertaken to reduce mortality rates in these communities.
... The main limitation of this strand of literature-at least in recent years-is that it has focused almost exclusively on lower and middle-income countries (LMICs). 8,[10][11][12]15,16 High-income countries have, instead, been largely neglected, probably due to the assumption that they have already provided health insurance coverage for the total population, apart from some well-known exceptions such as the United States. But, this is not the case. ...
Purpose
The aim of this article is to address the following questions: (1) Which OECD (The Organization for Economic Co‐operation and Development) and EU countries guarantee health insurance coverage to the entire population and which, conversely, leave part of the resident population without coverage?, (2) How many people do not have health coverage, and what are their characteristics? and (3) Within the OECD and the EU, is there actually a trend toward universal population coverage?
Findings
Approximately one third of OECD and European Union countries do not ensure health insurance coverage to the entire population. At present, the uninsured in European Union countries totals more than seven million people. Considering all 36 OECD countries, the uninsured reach almost 48 million.
Conclusion
The diachronic analysis shows that, from the 1970s to present day, the percentage of the uninsured in OECD member countries has gradually decreased. Conversely, in EU countries, the tendency toward universalism shows a fluctuating trend. Until the mid‐90s, the number of uninsured decreased. However, a trend reversal took place and the number of uninsured started to rise again from the second half of the 1990s. The number of individuals without insurance coverage is currently 2‐fold higher than the figure recorded before the outbreak of the great financial crisis.
... Yet, no matter the robustness of a health system, reform is inevitable due to the need to respond to never-ending changing nature of societal health demands and policy dynamism [2,3]. Despite its complex nature [4], countries worldwide constantly embark on health reforms to facilitate the achievement of universal health coverage (UHC)by ensuring that all people (especially the vulnerable) can have access to the health services they need without risk of financial ruin or impoverishment [5,6]. ...
Background:
Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. Today, the Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). This study aimed to analyze the HTP at the PHC level in Iran.
Methods:
Qualitative data were collected through document analysis, round-table discussion, and semi-structured interviews with stakeholders at the micro, meso and macro levels of the health system. A tailored version of Walt & Gilson's policy triangle model incorporating the stages heuristic model was used to guide data analysis.
Results:
The HTP emerged through a political process. Although the initiative aimed to facilitate the achievements of UHC by improving the entire health system of Iran, little attention was given to PHC especially during the first phases of policy development - a gap that occurred because politicians were in a great haste to fulfil a campaign promise.
Conclusions:
Health reforms targeting UHC and the health-related Sustainable Development Goals require the political will to improve PHC through engagements of all stakeholders of the health system, plus improved fiscal capacity of the country and financial commitments to implement evidence-informed initiatives.
... . It is often advocated as a way of improving health equity. The new paradigms of universal coverage or access embrace a wide range of health-related areas such as HIV/AIDS [4], reproductive health [5], health insurance [6], and free health services, particularly for women and children [3]. ...
... Over the past decade, there has been increased impetus in the development of inclusive and equitable health outcomes at the international level. This has led to surging support for UHC and its development within concepts including 'Health for All' and 'Health in All Policies' (WHO, 2005;2014b;Garrett et al., 2009). Belesova et al. (2016) also examine synergies and tensions between the climate change and economic progress goals, and the opportunity of intersectoral governance mechanisms, such as health-sensitive macroeconomic progress indicators, or long-term and non-monetary values that could address climate change through accounting for health. ...
... Since the mid20th century, most nations have signed many accords establishing that the pro vision of health is a fundamental human right. Health for all should be not only an aspirational target but also an essential framework for the United Nations system (Garrett et al, 2009). We are potentially at the cusp of a new era in mental health. ...
This paper provides a six-point definition of what parity of esteem for mental health means in practice. It highlights examples of the current disparity between mental and physical health and the importance of redressing this. The significance of securing a legislative basis for parity in England is discussed. The authors make a call for action, and pose six questions for international readers to consider and respond to.
... Una tarea esencial a la hora de las definiciones es la evaluación de la carga o riesgo individual de la enfermedad para poder definir si el acceso a las vacunas es un punto relevante para lograr la igualdad de acceso sanitario de la población. En este sentido la disponibilidad de las mismas en forma gratuita es una definición que apunta a respetar dicho principio (26) . ...
This review provides a critical analysis of the different cervical cancer prevention strategies, with an emphasis on immunization, implementation modalities, health strategies and national regulations. Rather than favoring or opposing the obligation to observe health policies, the study aims to offer a critical discussion on the strategy. It is often said that arguments in favor of the obligatory nature of a policy or recommendation are defined by two main axes: the first one refers to defining whether the population is facing a health risk in the population and the second one, whether informed decisions need to be promoted to achieve a larger impact. Thus, defining if addressing HPV infection within a comprehensive prevention strategy, as a sexually transmitted disease, is of paramount importance. To that end, the obligatory nature for all individuals involved in the epidemiological chain should be extensively discussed. HPV vaccination is recommended in the framework of comprehensive educational programs, as in secondary, tertiary and quaternary prevention. Equality in terms of population protection against cervical cancer needs to be achieved, and in this respect the government needs to take responsibility for these actions and universal access to all strategies. In other words, equal access to vaccination is essential, as well as to other recommended prevention measures. However, the need to refer to compulsory measures to stop avoidable deaths with measures we already know may be arguable, as this is a way to make up for failure to achieve other preventive measures, which have been demonstrated to reduce cervical cancer incidence and mortality.
... A critical mass of financing work placed attention on the equity dimensions of "universal coverage" Tangcharoensathien et al. 2011). Key financing actors in leadership positions at global organizations, such as WHO and the Rockefeller Foundation, further developed and promoted this concept (Garrett et al. 2009;WHO 2010;Brearley et al. 2013;Kutzin 2013). This global frame has been somewhat clarified and augmented over the course of the study with efforts to link UHC to previous global health campaigns such as the Health for All movement and the Alma-Ata Declaration of 1978 O'Connell et al. 2013;Kutzin & Sparkes 2016). ...
Universal Health Coverage (UHC), comprehensive access to affordable and quality health services, is a key component of the newly adopted 2015 Sustainable Development Goals (SDGs). Prior to formally adopting the goals at the United Nations in September 2015, several countries began incorporating elements of UHC into the domestic policy arena. Little research has been conducted on the process through which UHC financing policies have been contested in the political realm. In 2013, President Uhuru Kenyatta of Kenya announced initiatives aimed at moving the country towards UHC, which have proven controversial. This study drew on recent theoretical innovations in the field of critical policy studies to examine the ways in which actors understood and engaged with three highly contested health financing polices introduced as part of the movement towards UHC in Kenya: user fee removal, raising contributions to the mandatory health insurer, and the failed 2004 Bill on Social Health Insurance. In addition to document review, this study involved interpretive analysis of transcripts from 50 semi-structured interviews with leading actors involved in the health financing policy process in Kenya. The frame-critical analysis focused on how actors 1) make sense of the policy environment and create meaning through circulating finance ideas; 2) name various elements of the policy design through a process of selecting and categorizing; 3) tell stories and create narratives in ways that illustrate salient features of the process and generate shared understandings. Furthermore, this analysis also focused on what is subject to framing in this dynamic process, including 1) the substantive issues of the policies in question; 2) actor identities and relationships; and 3) the policy process itself. This study found that user fee removal was framed by finance experts as an achievable shortterm target for the Jubilee Coalition’s party manifesto. The rate increase for the mandatory insurer, the National Hospital Insurance Fund (NHIF), was consistently obscured by framing the debate around the shortcomings of NHIF and its damaged legacy. Lastly, the failed 2004 Bill on National Social Health Insurance has since fragmented into several incremental policy proposals that remain the subject of divisive framing contests. This study provides timely insight into the political dynamics surrounding the UHC movement, the policy process for health financing in Kenya, as well as theoretical and methodological considerations for frame-critical policy analysis and the field of critical policy studies more widely.
... One of the targets to accomplish the goal is "the attainment of universal health coverage which includes financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". 4 According to WHO, universal coverage is defined as "access to key promotive, preventive, curative, and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access." The principle of financial-risk protection ensures that the cost of care does not put people at risk of financial catastrophe. ...
p> Background: Studying the formation of postgraduate training in primary care within countries which has attained Universal Health Coverage (UHC) is important to support the development of similar training in low-and middle-income countries aiming to achieve UHC by 2030. This review aims to describe the state of postgraduate training for primary care physicians in UHC-attaining countries.
Methods: A literature review of published literature and official documents from the websites of regional and global health/primary care organizations or societies such as World Health Organization (WHO), World Organization of Family Doctors (WONCA), European Forum for Primary Care, European Union of General Practitioners (GP)/Family Physicians (FP), European Academy of Teachers in GP/Family Medicine (FM), as well as the websites of GP/FP organizations in each of the respective countries. The list of UHC attained countries were identified through WHO and International Labor Organization databases.
Results: A total number of 72 UHC-attained countries were identified. Postgraduate education for primary care physicians exists in 62 countries (86%). Explicit statements that establish primary care postgraduate training were corresponded with the policy on UHC is found in 11 countries (18%). The naming of the program varies, general practice and family medicine were the commonest. In 33 countries (53%), physicians are required to undertake training to practice in primary level. The program duration ranged from 2–6 years with 3 years for the majority.
Conclusion: Although UHC is not the principal driving force for the establishment of postgraduate training for primary care physicians in many countries, most UHC-attaining countries make substantial endeavor to ensure its formation as a part of their health care reform to improve national health.</p
... As proposed in the Alma Ata Declaration, participation of people as a group or individually in planning and implementing their health care is a human right and duty. 1 A concerted effort is needed to improve health service coverage to achieve the health-related Millennium Development Goals. 2 Among some feasible approaches, insurance schemes are part of a strategic approach that is gaining favour. 3 The World Health Organization (WHO) report of 2015 showed that 400 million people do not have access to essential health services and 6% of people in low-and middle-income countries are tipped into extreme poverty because of medical expenditures. 4 Schoen C et al conducted a survey in 2010 in 11 different industrialized countries with different health systems and found significant differences in access, cost burdens, and problems with health insurance that are associated with the insurance design. ...
Basic Medical Insurance (BMI) has changed remarkably over time in China because of health reforms that aim to achieve universal coverage and better health care with adequate efforts by increasing subsidies, reimbursement, and benefits. In this paper, we present the development of BMI, including financing and operation, with a systematic review. Meanwhile, Pudong New Area in Shanghai was chosen as a typical BMI sample for its coverage and management; a stratified cluster sampling survey together with an ordinary logistic regression model was used for the analysis. Enrolee satisfaction and the factors associated with enrolee satisfaction with BMI were analysed. We found that the reenrolling rate superficially improved the BMI coverage and nearly achieved universal coverage. However, BMI funds still faced dual contradictions of fund deficit and insured under compensation, and a long-term strategy is needed to realize the integration of BMI schemes with more homogeneous coverage and benefits. Moreover, Urban Resident Basic Medical Insurance participants reported a higher rate of dissatisfaction than other participants. The key predictors of the enrolees' satisfaction were awareness of the premium and compensation, affordability of out-of-pocket costs, and the proportion of reimbursement. These results highlight the importance that the Chinese government takes measures, such as strengthening BMI fund management, exploring mixed payment methods, and regulating sequential medical orders, to develop an integrated medical insurance system of universal coverage and vertical equity while simultaneously improving enrolee satisfaction.
... Improving the quality of care and efficiency of service delivery while reducing costs has become increasingly important because of the pressures on budgetary in recent years. Healthcare expenditure accounts for a significant share of the national budget in most countries [11]. Jordan, as a developing country, has no significant oil resources with limited slow progress in energy sector, and natural gas reserve which is not able to support a substantial production increase. ...
... However, majority of developing countries are still in the designing and planning phase to achieve it. For ensuring UHC in a country, Ministry of Health (MoH) need to create rational health financing which should include risk pools under the contribution of public or private funding sources [1]. People without the UHC, need to buy essential health services in exchange of out-of-pocket expenditures. ...
The term of universal health coverage (UHC)c are getting popularity among the countries who have not yet attained it. Majority of the developing countries are planning to implement the UHC to protect the vulnerable citizen who cannot afford to buy the health services. Poor people living in developing countries, where there is no UHC, are bereft of getting equal health care. They have to bear a significant amount of health cost in buying different services which often causes catastrophic expenditures for an individual and a family. If a country can provide UHC, it will be possible to bring all citizens under the provision of equal and quality care. However, implementation of a UHC is not an easy phenomenon; rather it needs proper design of a good health insurance system by integrating both the public and private health care providers. The influence of good governance and a sustainable health financing system is fundamental to establish UHC in the developing countries.
... [1][2][3] The disadvantages of vertical approaches have sparked a greater interest in the concept of the 'horizontal' or integrated multi-disease focus-as expressed in concepts of 'health systems', 'health systems strengthening' (HSS), and more recently 'universal health coverage', as a counterbalance in global health policy. [4][5][6] Responding to this, a variety of funding agencies, including those with a predominantly vertical approach, have articulated, promoted, and implemented policies that consider health systems, even as they continue to retain their disease-specific foci. 7 A substantial body of literature has emerged examining various aspects of the role of GHIs in strengthening health systems. ...
Background:
This study aims to understand the determinants of the Global Fund to Fight AIDS, Tuberculosis, and Malaria's dedicated channel for health systems strengthening (HSS) funding across countries and to analyze their health system priorities expressed in budgets and performance indicators.
Methods:
We obtained publicly available data for disease-specific and HSS grants from the Global Fund over 2004-2013 prior to the new funding model. Regression analysis was employed to assess the determinants of dedicated HSS funding across 111 countries. Documents for 27 dedicated HSS grants including budgets and performance indicators were collected, and activities were analyzed by health system functions.
Results:
HSS funding per capita is significantly associated with TB and HIV funding per capita, but not per capita income and health worker density. Of 27 dedicated HSS grants, 11 had line-item budgets publicly available, in which health workforce and medical products form the majority (89% or US$132 million of US$148 million) of funds. Yet these areas accounted for 41.7% (215) of total 516 performance indicators.
Conclusions:
Health worker densities were not correlated with HSS funding, despite the emphasis on health workforce in budgets and performance indicators. Priorities in health systems in line-item budgets differ from the numbers of indicators used.
... Predictions are that the loss of healthy life years due to global environmental change (including climate change) is 500 times greater in Africa than in Europe, and yet health is widely recognized globally as a fundamental human right (McMichael et al., 2008). A vital step towards achieving health for all even in Africa requires nations to ensure the provision of access to universal health coverage (Garrett et al., 2009). ...
This chapter explores the impacts of climate change on global development outcomes such as health, economic growth, and poverty, and evaluates options for adaptation, mitigation and resilience. With the possible future scenario of an increase of 4 degrees in global temperatures over the coming period, this paper will attempt synthesis efforts to demonstrate a causal link between climate change and four affected categories of development, by proposing a set of transposable indicators for each: economics and agriculture; water; ecosystem and biodiversity; and, coast region degradation. The chapter concludes by offering several policy recommendations and avenues for future research focus.
... This risks increased inequality, with the poorest and most aff ected people having potentially reduced access to preventive and treatment services, especially in areas in which social protection mechanisms are weak or non-existent. 124 Within existing constraints, NTPs try to provide services that are free of charge or highly subsidised, with mixed success. Although NTPs in most high-burden countries provide free sputum-smear microscopy for all patients with suspected pulmonary tuberculosis, only nine of 22 also provide other diagnostic tests free of charge (table 2). ...
... Basic healthcare services have been considered human rights. The World Health Organization (WHO) has supported the concept of universal health coverage (UHC) across the globe [1][2][3]. This initiative aims to meet basic health needs of the public, assuming achieving UHC would result in better health. ...
Aims: Even though basic healthcare services have been considered human rights, studies on optimal level of healthcare utilization have produced mixed results. A growing body of literatures has been using unmet healthcare needs, a subjective survey measure, to find inequity in healthcare. But no studies so far have tried to reveal the association of unmet needs with health outcomes so it was hard to get the public’s attention. To answer it, this study tries to reveal the associations between unmet healthcare needs and health outcomes.
Methods: A 4-year Korean panel dataset of 7,717 persons (31,668 person-years) were analyzed. Unmet healthcare needs were asked (if yes, its reason was also surveyed) if the respondent ever felt healthcare services were needed but could not receive it in the past 12 months. A health-related quality of life instrument (EQ-5D) and self-rated health were used as dependent variables. To avoid simultaneity, 1-year lagged outcome variables were used. And to control for unobserved individual heterogeneity, fixed effects estimation was also run based on Grossman’s human capital model.
Findings: Since 2009, more than 14.5% of the study population had reported unmet healthcare needs. When 1-year lagged health outcome variables were regressed on unmet needs, compared to the means, unmet needs were found to associate with 1% decline in EQ-5D and 4.5% decline in self-rated health. Unmet needs due to mild symptoms were not related with outcomes in fixed effects estimation among the elderly.
Conclusions: Even though causal inference were not found, the association between unmet needs and health outcomes were established. Recognizing demand side determinants of healthcare was a strength of this study.
Healthcare has an impact on everyone, and healthcare funding decisions shape how and what healthcare is provided. In this book, Stephen Duckett outlines a Christian, biblically grounded, ethical basis for how decisions about healthcare funding and priority-setting ought to be made. Taking a cue from the parable of the Good Samaritan (Luke 10:25-37), Duckett articulates three ethical principles drawn from the story: compassion as a motivator; inclusivity, or social justice as to benefits; and responsible stewardship of the resources required to achieve the goals of treatment and prevention. These are principles, he argues, that should underpin a Christian ethic of healthcare funding. Duckett's book is a must for healthcare professionals and theologians struggling with moral questions about rationing in healthcare. It is also relevant to economists interested in the strengths and weaknesses of the application of their discipline to health policy.
Background: The Universal Health Coverage (UHC) is a very important and effective policy in the health system of countries worldwide. Using the experiences and learning from the best practices of successful countries in the UHC can be very helpful. Therefore, the aim of the present study is to provide a scoping review of successful global interventions and practices in achieving UHC.
Methods: This is a scoping review study that has been conducted using the Arkesy and O'Malley framework. To gather information, Embase, PubMed, The Cochrane Library, Scopus, Scientific Information Database, and MagIran were searched using relevant keywords from 2000 to 2019. Studies about different reforms in health systems and case studies, which have examined successful interventions and reforms on the path to UHC, were included. Articles and abstracts presented at conferences and congresses were excluded. Framework Analysis was also used to analyze the data.
Results: Out of 4257 articles, 57 finally included in the study. The results showed that of the 40 countries that had successful interventions, most were Asian. The interventions were financial protection (40 interventions that were categorized into 14 items), service coverage (31 interventions categorized into 7 items), population coverage (36 interventions categorized into 9 items), and quality (18 interventions categorized into 7 items), respectively. Also, the positive results of interventions on the way to achieving UHC were financial protection (14 interventions), service coverage (7 interventions), population coverage (9 interventions), and quality (7 interventions), respectively.
Conclusion: This study provides a comprehensive and clear view of successful interventions in achieving the UHC. Therefore, with consideration to lessons learned from successful interventions, policymakers can design appropriate interventions for their country.
Background
Ethiopia launched community-based health insurance scheme in 2011 as part of the revised health care financing strategy to ensure universal health coverage and implementation has started in most part of the country since the launching of the scheme. However, the roll out of the scheme started in Somali Region in 2020—much later the rest of the country. The aim of this study was to assess determinants of enrollment of community-based health insurance among households in Awbarre Woreda, Somali Region, EthiopiaMethods
Community based unmatched case control study using a mixed approach of quantitative and qualitative methods was conducted between March and April 2021 and the study participants were selected using multi-stage sampling technique. The quantitative method used interviewer administered structured questionnaire among 216 participants (54 enrolled and 162 non-enrolled), while the qualitative method used key informant interview and focus group discussions in two rural and two urban kebeles of the woreda. The quantitative data was analyzed using SPSS version 20 and thematic analysis was used for the qualitative data. Multivariable logistic regression was used to determine the determinants of enrollment for the community-based health insurance and statistical significance was set at p value of <5%. Result Awareness about CBHI scheme AOR = 9.41(1.16,76.19), households income AOR = 2.73(0.77, 9.57); and being a member of community-based solidarity groups AOR = 2.88(1.17, 7.12) were the determinants for CBHI enrollment and reaffirmed by the qualitative findings. Conclusions
The enrollment for community-based insurance was determined by being well informed about the scheme, household income, and being a member of solidarity groups at community level. Given the early stage of implementation, enhancing sensitization of the community about the scheme using various community platforms, promotion of the existing community based solidarity groups/associations, diligent targeting of the poor households/indigents and ensuring linkage with any existing social protection program would help to increase enrolment for the scheme.
O capítulo de saúde desta edição de Políticas Sociais: Acompanhamento e Análise n. 27 apresenta o compromisso assumido na área de saúde na Agenda 2030. A seção 3 mostra como as metas de saúde constantes nos Objetivos de Desenvolvimento do Milênio (ODM) foram incorporadas à agenda, traz um resumo da proposta de ajuste para as circunstâncias brasileiras das metas do Objetivo de Desenvolvimento Sustentável 3 (ODS 3) e um diagnóstico da situação inicial brasileira em relação às metas estabelecidas. Contudo, antes de se entrar na Agenda 2030, abordar-se-á, na seção 2, um importante tema a ela relacionado: o debate em torno do conceito de cobertura universal de saúde. Esse debate se torna relevante no contexto de análise do ODS 3 devido à existência de uma meta específica para o alcance da cobertura universal de saúde e proteção financeira contra gastos elevados com saúde, a meta 3.8, sendo que o entendimento que se tenha deste conceito poderá ter repercussões sobre o sistema de saúde brasileiro e sobre o alcance das metas estabelecidas. Ademais, como argumentaremos a seguir, o Brasil avançou em direção a um sistema público de acesso universal, tendo por princípios a igualdade e a integralidade. Esse sistema foi central para o alcance das metas propostas para o ODM e será o que garantirá, junto com outras políticas sociais e econômicas, que o país avance em direção ao alcance das metas proposta pelos ODS.
Health is a fundamental condition for human development in a country. In Bangladesh, the share of government expenditure on healthcare has been declining for several consecutive years, resulting in several burdensome problems. The purpose of the paper is to analyze the trend of budget allocation in the health sector of Bangladesh. In the last six years, Bangladesh's health sector has received approximately 5% of the total budget. The study found that financial scarcity in healthcare had a negative influence on society. As a result, out-of-pocket spending in the health sector increased to 71% in 2015, up from 60% in 2008. The higher OOP is enough to deter poor people from utilizing health care services that have a negative impact on their health as a result of neglect. It also found that budget cuts in health sectors are also causing problems such as increased burdens on the poor, inadequate health infrastructure facilities of low quality, and an increase in non-communicable diseases. The study recommended that policymakers should advocate raising per-capita health spending to ensure adequate health facilities for the citizens, particularly for the rural people of Bangladesh.
According to its Constitution, the mission of the World Health Organization (WHO) was nothing less than the 'attainment by all peoples of the highest possible level of health' without distinction of race, religion, political belief, economic status, or social condition. But how consistently and how well has the WHO pursued this mission since 1946? This comprehensive and engaging new history explores these questions by looking at its origins and its institutional antecedents, while also considering its contemporary and future roles. It examines how the WHO was shaped by the particular environments of the postwar period and the Cold War, the relative influence of the US and other approaches to healthcare, and its place alongside sometimes competing international bodies such as UNICEF, the World Bank, and the Gates Foundation. The authors re-evaluate the relative success and failure of critical WHO campaigns, from early malaria and smallpox eradication programs to struggles with Ebola today.
‘This long-awaited volume by three distinguished historians of public health, does not disappoint. Though the general lines of this history are familiar, this extensively researched, clearly written volume greatly enriches this history, providing new details on nearly every page, and situating the WHO within the wider history of global political change.'
Randall Packard - The Johns Hopkins University
Health care globally has made great strides; for example, there are lower rates of infant and maternal mortality. Increased incomes have led to lower rates of diseases accompanying poverty and hunger. There has been a shift away from the infectious diseases so deadly in developing nations toward first-world conditions. This article presents health care statistics across age groups and geographic areas to help the primary care physician understand these changes. There is a special focus on underserved populations. New technologies in health and health care spending internationally are addressed, emphasizing universal health care. The article concludes with recommendations for the future.
Background: Micro health insurance (MHI) has proved to be a potential health-financing tool for many developing countries. Bangladesh also included MHI in its current health-financing strategy which aims to achieve universal health coverage. However, low uptake, low renewal and high dropouts have historically challenged financial sustainability of these schemes.
Objective: This study aims to identify factors influencing people from low-resource settings, particularly those from Bangladesh, to enrol in MHI schemes.
Methods: The study analyses the ‘Amader Shasthya’ MHI scheme operating in Chakaria, a sub-district under Cox’s Bazar district, Bangladesh. A household survey was carried out during May–June 2016 among 2,000 households from the scheme coverage area. The Outreville’s insurance-demand framework was used to identify enrolment influencing factors. Multivariate logistic regression analysis was carried out to identify significant influencing factors of enrolment.
Results: Enrolment influencing factors were identified in four dimensions: economic, socio-cultural, demographic and structural. Households with the main income earner having 10+ years of schooling (odds 1.9 [CI 1.2–2.9] compared to illiterate), having financial literacy (odds 1.5 [CI 1.2–1.8] compared to financially illiterate) and being a public/private service holder (odds 1.6 [CI 1.1–2.4] compared to menial labour) were more likely to enrol. Membership in development programmes of NGOs also influenced enrolment decision significantly (odds 1.3 [CI 1.0–1.5]). The presence of chronic illness in household encouraged enrolment (odds 1.5 [CI 1.2–1.8]). Households living closer to health centres were more likely to enrol (odds 2.1 [CI 1.6–2.7]) compared to those living further away.
Conclusion: The findings are expected to have significant implications in terms of designing similar health insurance schemes, particularly in terms of designing demand-driven and context adapted schemes that have greater potential to attract a larger client pool, ensure effective risk pooling and eventually expedite the achievement of universal health coverage in low-resource settings.
In September 2015, the United Nations General Assembly’s adoption of the Sustainable Development Goals (SDGs), in place of the Millennium Development Goals (MDGs), constituted a historical landmark. Previously, developed nations provided developing nations with substantial aid for the implementation of the MDGs that entailed measurable and limited targets. Among these targets, health was prioritized, accounting for 28.6% of the total targets. The new SDGs, by contrast, entail 17 goals and 169 targets that apply not just to developing nations, but also to developed nations. The proportion of health targets (7.7%) in the SDGs, being a quarter of that in the MDGs, appears to indicate lower prioritization of health. However, health remains central for the achievement of the SDGs, given a total of 23 health-related targets associated with other goals such as no poverty, nutrition, and sanitation. Additionally, a “Health in all Policies” approach can be likely adopted for the SDGs to facilitate the implementation of effective interventions for improving social, environmental, and economical determinants of health. Decision makers may find it difficult to comprehend the objectives of the SDGs because of their ‘universality’ and obscure focus in relation to sustainable development targets. This paper presents concepts and approaches aimed at fostering ‘convergence’ to overcome these deficiencies. Health-related examples of convergence include ‘universal health coverage (UHC)’ and ‘gland convergence (GC)’. A myriad of stakeholders, with contrasting opinions and ideas, participated in the SDG formulation process. This has resulted in the inclusion of diverse contemporary health issues that are socially significant such as non-communicable diseases, mental health, substance abuse, and road traffic accidents. Competing specialists’ claims that prioritize particular diseases, saying “my disease is more important than your disease”, have probably contributed to the diversity of SDG targets. UHC and GC will play crucial roles in the future realization of the SDGs.
With the arrival of all-oral directly acting antiviral (DAA) therapy with high cure rates, the promise of hepatitis C virus (HCV) eradication is within closer reach. The availability of generic DAAs has improved access to countries with constrained resources. However, therapy is only one component of the HCV care continuum, which is the framework for HCV management from identifying patients to cure. The large number of undiagnosed HCV cases is the biggest concern, and strategies to address this are needed, as risk factor screening is suboptimal, detecting <20% of known cases. Improvements in HCV confirmation through either reflex HCV RNA screening or ideally a sensitive point of care test are needed. HCV notification (e.g., Australia) may improve diagnosis (proportion of HCV diagnosed is 75%) and may lead to benefits by increasing linkage to care, therapy and cure. Evaluations for cirrhosis using non-invasive markers are best done with a biological panel, but they are only moderately accurate. In resource-constrained settings, only generic HCV medications are available, and a combination of sofosbuvir, ribavirin, ledipasvir or daclatasvir provides sufficient efficacy for all genotypes, but this is likely to be replaced with pangenetypic regimens such as sofosbuvir/velpatasvir and glecaprevir/pibrentaasvir. In conclusion, HCV management in resource-constrained settings is challenging on multiple fronts because of the lack of infrastructure, facilities, trained manpower and equipment. However, it is still possible to make a significant impact towards HCV eradication through a concerted effort by individuals and national organisations with domain expertise in this area.
Health care globally has made great strides; for example, there are lower rates of infant and maternal mortality. Increased incomes have led to lower rates of diseases accompanying poverty and hunger. There has been a shift away from the infectious diseases so deadly in developing nations toward first-world conditions. This article presents health care statistics across age groups and geographic areas to help the primary care physician understand these changes. There is a special focus on underserved populations. New technologies in health and health care spending internationally are addressed, emphasizing universal health care. The article concludes with recommendations for the future.
Options for health financing reform are often portrayed as a choice between general taxation (known as the Beveridge model) and social health insurance (known as the Bismarck model). Ten years of health financing reform in Kyrgyzstan, since the introduction of its compulsory health insurance fund in 1997, provide an excellent example of why it is wrong to reduce health financing policy to a choice between the Beveridge and Bismarck models. Rather than fragment the system according to the insurance status of the population, as many other low- and middle-income countries have done, the Kyrgyz reforms were guided by the objective of having a single system for the entire population. Key features include the role and gradual development of the compulsory health insurance fund as the single purchaser of health-care services for the entire population using output-based payment methods, the complete restructuring of pooling arrangements from the former decentralized budgetary structure to a single national pool, and the establishment of an explicit benefit package. Central to the process was the transformation of the role of general budget revenues – the main source of public funding for health – from directly subsidizing the supply of services to subsidizing the purchase of services on behalf of the entire population by redirecting them into the health insurance fund. Through their approach to health financing policy, and pooling in particular, the Kyrgyz health reformers demonstrated that different sources of funds can be used in an explicitly complementary manner to enable the creation of a unified, universal system.
Options for health financing reform are often portrayed as a choice between general taxation (known as the Beveridge model) and social health insurance (known as the Bismarck model). Ten years of health financing reform in Kyrgyzstan, since the introduction of its compulsory health insurance fund in 1997, provide an excellent example of why it is wrong to reduce health financing policy to a choice between the Beveridge and Bismarck models. Rather than fragment the system according to the insurance status of the population, as many other low- and middle-income countries have done, the Kyrgyz reforms were guided by the objective of having a single system for the entire population. Key features include the role and gradual development of the compulsory health insurance fund as the single purchaser of health-care services for the entire population using output-based payment methods, the complete restructuring of pooling arrangements from the former decentralized budgetary structure to a single national pool, and the establishment of an explicit benefit package. Central to the process was the transformation of the role of general budget revenues - the main source of public funding for health - from directly subsidizing the supply of services to subsidizing the purchase of services on behalf of the entire population by redirecting them into the health insurance fund. Through their approach to health financing policy, and pooling in particular, the Kyrgyz health reformers demonstrated that different sources of funds can be used in an explicitly complementary manner to enable the creation of a unified, universal system.
In 2003, the Mexican Congress approved a reform establishing the Sistema de Protección Social en Salud [System of Social Protection in Health], whereby public funding for health is being increased by one percent of the 2003 gross domestic product over seven years to guarantee universal health insurance. Poor families that had been excluded from traditional social security can now enrol in a new public insurance scheme known as Seguro Popular [People's Insurance], which assures legislated access to a comprehensive set of health-care entitlements. This paper describes the financial innovations behind the expansion of health-care coverage in Mexico to everyone and their effects. Evidence shows improvements in mobilization of additional public resources; availability of health infrastructure and drugs; service utilization; effective coverage; and financial protection. Future challenges are discussed, among them the need for additional public funding to extend access to costly interventions for non-communicable diseases not yet covered by the new insurance scheme, and to improve the technical quality of care and the responsiveness of the health system. Eventually, the progress achieved so far will have to be reflected in health outcomes, which will continue to be evaluated so that Mexico can meet the ultimate criterion of reform success: better health through equity, quality and fair financing.
60 years ago, the Universal Declaration of Human Rights laid the foundations for the right to the highest attainable standard of health. This right is central to the creation of equitable health systems. We identify some of the right-to health features of health systems, such as a comprehensive national health plan, and propose 72 indicators that reflect some of these features. We collect globally processed data on these indicators for 194 countries and national data for Ecuador, Mozambique, Peru, Romania, and Sweden. Globally processed data were not available for 18 indicators for any country, suggesting that organisations that obtain such data give insufficient attention to the right-to-health features of health systems. Where they are available, the indicators show where health systems need to be improved to better realise the right to health. We provide recommendations for governments, international bodies, civil-society organisations, and other institutions and suggest that these indicators and data, although not perfect, provide a basis for the monitoring of health systems and the progressive realisation of the right to health. Right-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.
Health care is neither "a necessity" or "a luxury"; it is "both" since the income elasticity varies with the level of analysis. With insurance, individual income elasticities are typically near zero, while national health expenditure elasticities are commonly greater than 1.0. The debate over whether health care is or is not a luxury good arises primarily from the failure to specify levels of analysis clearly so as to distinguish variation within groups from variation between groups. Apparently, contradictory empirical results are shown to be consistent with a simple nested multilevel model of health care spending.
In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9-2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged dollar 11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick.
Policymakers as well as physicians need to understand how rapidly rising health care costs are affecting specific groups of patients.
To estimate the number and characteristics of individuals in the United States faced with very high financial burdens for health care.
Data from a nationally representative sample of civilian, noninstitutionalized US individuals younger than 65 years from the Medical Expenditure Panel Surveys were used to calculate 2 measures of financial burden as a function of tax-adjusted family income. Total burden included all out-of-pocket expenditures for health care services, including premiums. Health care services burden excluded premiums and, when applied to the insured population, was used to identify the underinsured. We defined the underinsured as insured persons with health care service burdens in excess of 10% of tax-adjusted family income.
Total and health care services burdens exceeding 10% and 20% of family income in 1996 and 2003.
In 2003, there were 48.8 million individuals (19.2%) living in families spending more than 10% of family income on health care, an increase of 11.7 million persons since 1996. Of these individuals, about 18.7 million (7.3%) were spending more than 20% of family income. In 2003, individuals with higher-than-average risk of incurring high total burdens included poor and low-income persons and those with nongroup coverage, aged 55 to 64 years, living in a non-metropolitan statistical area, in fair or poor health, having any type of limitation, or having a chronic medical condition. Applying our definition of underinsured to the insured population, an estimated 17.1 million persons younger than 65 years were underinsured in 2003, including 9.3 million persons with private employment-related insurance, 1.3 million persons with private nongroup policies, and 6.6 million persons with public coverage.
Our analysis identifies patients at greatest risk of health-related financial burdens that may adversely affect their access and adherence to recommended treatments. Our study also highlights the high costs associated with nongroup health insurance policies.
With health insurance moving toward greater patient cost sharing, this study finds a sharp increase in the number of underinsured people. Based on indicators of cost exposure relative to income, as of 2007 an estimated twenty-five million insured people ages 19-64 were underinsured-a 60 percent increase since 2003. The rate of increase was steepest among those with incomes above 200 percent of poverty, where underinsurance rates nearly tripled. In total, 42 percent of U.S. adults were underinsured or uninsured. The underinsured report high levels of access problems and financial stress. The findings underscore the need for policy attention to benefit design, to assure care and affordability.
In 2003, the Mexican Congress approved a reform establishing the Sistema de Protección Social en Salud [System of Social Protection in Health], whereby public funding for health is being increased by one percent of the 2003 gross domestic product over seven years to guarantee universal health insurance. Poor families that had been excluded from traditional social security can now enrol in a new public insurance scheme known as Seguro Popular [People's Insurance], which assures legislated access to a comprehensive set of health-care entitlements. This paper describes the financial innovations behind the expansion of health-care coverage in Mexico to everyone and their effects. Evidence shows improvements in mobilization of additional public resources; availability of health infrastructure and drugs; service utilization; effective coverage; and financial protection. Future challenges are discussed, among them the need for additional public funding to extend access to costly interventions for non-communicable diseases not yet covered by the new insurance scheme, and to improve the technical quality of care and the responsiveness of the health system. Eventually, the progress achieved so far will have to be reflected in health outcomes, which will continue to be evaluated so that Mexico can meet the ultimate criterion of reform success: better health through equity, quality and fair financing.
World Development Indicators, the World Bank's respected statistical publication presents the most current and accurate information on global development on both a national level and aggregated globally. This information allows readers to monitor the progress made toward meeting the goals endorsed by the United Nations and its member countries, the World Bank, and a host of partner organizations in September 2001 in their Millennium Development Goals. The print edition of World Development Indicators 2005 allows you to consult over 80 tables and over 800 indicators for 152 economies and 14 country groups, as well as basic indicators for a further 55 economies. There are key indicators for the latest year available, important regional data, and income group analysis. The report contains six thematic presentations of analytical commentary covering: World View, People, Environment, Economy, States and Markets, and Global Links.
Previously published as an Appendix to the World development report. Incl. users guide, list of acronyms, bibl., index. The Little data book is a pocket edition of WDI
The need for timely and reliable information about global health resource flows to low-income and middle-income countries is widely recognised. We aimed to provide a comprehensive assessment of development assistance for health (DAH) from 1990 to 2007.
We defined DAH as all flows for health from public and private institutions whose primary purpose is to provide development assistance to low-income and middle-income countries. We used several data sources to measure the yearly volume of DAH in 2007 US$, and created an integrated project database to examine the composition of this assistance by recipient country.
DAH grew from $5.6 billion in 1990 to $21.8 billion in 2007. The proportion of DAH channelled via UN agencies and development banks decreased from 1990 to 2007, whereas the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Alliance for Vaccines and Immunization (GAVI), and non-governmental organisations became the conduit for an increasing share of DAH. DAH has risen sharply since 2002 because of increases in public funding, especially from the USA, and on the private side, from increased philanthropic donations and in-kind contributions from corporate donors. Of the $13.8 [corrected] billion DAH in 2007 for which project-level information was available, $4.9 [corrected] billion was for HIV/AIDS, compared with $0.6 [corrected] billion for tuberculosis, $0.7 [corrected] billion for malaria, and $0.9 billion for health-sector support. Total DAH received by low-income and middle-income countries was positively correlated with burden of disease, whereas per head DAH was negatively correlated with per head gross domestic product.
This study documents the substantial rise of resources for global health in recent years. Although the rise in DAH has resulted in increased funds for HIV/AIDS, other areas of global health have also expanded. The influx of funds has been accompanied by major changes in the institutional landscape of global health, with global health initiatives such as the Global Fund and GAVI having a central role in mobilising and channelling global health funds.
Bill & Melinda Gates Foundation.
Our 2001 study in 5 states found that medical problems contributed to at least 46.2% of all bankruptcies. Since then, health costs and the numbers of un- and underinsured have increased, and bankruptcy laws have tightened.
We surveyed a random national sample of 2314 bankruptcy filers in 2007, abstracted their court records, and interviewed 1032 of them. We designated bankruptcies as "medical" based on debtors' stated reasons for filing, income loss due to illness, and the magnitude of their medical debts.
Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.
Illness and medical bills contribute to a large and increasing share of US bankruptcies.
In earlier work we demonstrated that increases in the cost of health care accounted for the decline in insurance coverage from 1979 to 2002. Here we examine whether our model adequately accounts for observed changes in coverage though 2007, and we provide an estimate of the effects of the recession on the number of uninsured Americans through 2010. We project that the number will increase by at least 6.9 million. The estimate does not directly take into account the additional effects of job losses, which are likely to add millions more to the number of uninsured Americans.
In recent years, there has been national alarm about the rising rate of home foreclosures, which now strike one in every 92 households in America and which contribute to even broader macroeconomic effects. The "standard account" of home foreclosure attributes this spike to loose lending practices, irresponsible borrowers, a flat real estate market, and rising interest rates. Based on our study of homeowners going through foreclosures in four states, we find that the standard account fails to represent the facts and thus makes a poor guide for policy. In contrast, we find that half of all foreclosures have medical causes, and we estimate that medical crises put 1.5 million Americans in jeopardy of losing their homes last year.Half of all respondents (49%) indicated that their foreclosure was caused in part by a medical problem, including illness or injuries (32%), unmanageable medical bills (23%), lost work due to a medical problem (27%), or caring for sick family members (14%). We also examined objective indicia of medical disruptions in the previous two years, including those respondents paying more than $2,000 of medical bills out of pocket (37%), those losing two or more weeks of work because of injury or illness (30%), those currently disabled and unable to work (8%), and those who used their home equity to pay medical bills (13%). Altogether, seven in ten respondents (69%) reported at least one of these factors.If these findings can be replicated in more comprehensive studies, they will suggest critical policy reforms. We lay out one approach, focusing on an insurance-model, which would help homeowners bridge temporary gaps caused by medical crises. We also present a legal proposal for staying foreclosure proceedings during verifiable medical crises, as a way to protect homeowners and to minimize the negative externalities of foreclosure.
The 2008 G8 summit in Toyako, Japan, produced a strong commitment for collective action to strengthen health systems in developing countries, indicating Japan's leadership on, and the G8's increasing engagement with, global health policy. This paper describes the context for the G8's role in global health architecture and analyses three key components-financing, information, and the health workforce-that affect the performance of health systems. We propose recommendations for actions by G8 leaders to strengthen health systems by making the most effective use of existing resources and increasing available resources. We recommend increased attention by G8 leaders to country capacity and country ownership in policy making and implementation. The G8 should also implement a yearly review for actions in this area, so that changes in health-system performance can be monitored and better understood.
In 2005, the Member States of WHO adopted a resolution encouraging countries to develop health financing systems capable of achieving and/or maintaining universal coverage of health services - where all people have access to needed health services without the risk of severe financial consequences. In doing this, a major challenge for many countries will be to move away from out-of-pocket payments, which are often used as an important source of fund collection. Prepayment methods will need to be developed or expanded but, in addition to questions of revenue collection, specific attention will also have to be paid to pooling funds to spread risks and to enable their efficient and equitable use. Developing prepayment mechanisms may take time, depending on countries' economic, social and political contexts. Specific rules for health financing policy will need to be developed and implementing organizations will need to be tailored to the level that countries can support and sustain. In this paper we propose a comprehensive framework focusing on health financing rules and organizations that can be used to support countries in developing their health financing systems in the search for universal coverage.
To explore factors associated with household coping behaviours in the face of health expenditures in 15 African countries and provide evidence for policy-makers in designing financial health protection mechanisms.
A series of logit regressions were performed to explore factors correlating with a greater likelihood of selling assets, borrowing or both to finance health care. The average partial effects for different levels of spending on inpatient care were derived by computing the partial effects for each observation and taking the average across the sample. Data used in the analysis were from the 2002-2003 World Health Survey, which asked how households had financed out-of-pocket payments over the previous year. Households selling assets or borrowing money were compared to those that financed health care from income or savings. Those that used insurance were excluded. For the analysis, a value of 1 was assigned to selling assets or borrowing money and a value of 0 to other coping mechanisms.
Coping through borrowing and selling assets ranged from 23% of households in Zambia to 68% in Burkina Faso. In general, the highest income groups were less likely to borrow and sell assets, but coping mechanisms did not differ strongly among lower income quintiles. Households with higher inpatient expenses were significantly more likely to borrow and deplete assets compared to those financing outpatient care or routine medical expenses, except in Burkina Faso, Namibia and Swaziland. In eight countries, the coefficient on the highest quintile of inpatient spending had a P-value below 0.01.
In most African countries, the health financing system is too weak to protect households from health shocks. Borrowing and selling assets to finance health care are common. Formal prepayment schemes could benefit many households, and an overall social protection network could help to mitigate the long-term effects of ill health on household well-being and support poverty reduction.
Mandatory participation in mutual health insurance schemes and public subsidies for the poor have led to considerable improvement in public health and health care in Rwanda, but even at US$ 2 a year, the price for some members of the population remains prohibitively high. Aimable Twahirwa reports from Kigali. [ILLUSTRATION OMITTED] Rwanda's Ministry of Health plans, to boost community participation in the financing of health-care services in the 1980s and 1990s, were hampered in the immediate aftermath of the war and genocide of 1994. But since those dark days, Rwandan authorities have engaged in an effort to strengthen communities' role in managing and co-financing health-care provision. One of the ways it has done this is through mutual health insurance schemes, known in Rwanda as mutuelles de sante or mutuelles. Mutuelles were reinitiated as pilot projects in Rwanda in 1999 and uptake accelerated sharply in 2004-2005 with the adoption of a national policy on mutuelles and a roll-out of the schemes with the financial and technical support of development partners. As of April this year, every Rwandan is obliged by law to have some form of health insurance. There are currently several health insurance programmes in Rwanda targeting specific groups of the population. However, the biggest in terms of membership is the mutuelles scheme, participation in which is organized on a per household basis, with an annual payment of 1000 Rwandan francs (US$ 2) per family member. [ILLUSTRATION OMITTED] For WHO's Laurent Musango, former director of the School of Public Health at the National University of Rwanda, the growth of the mutual health insurance system has been a great success from the point of view of the affordability of the programme, and the fact that all comers are covered: "Rwanda is the only country in sub-Saharan Africa in which 85% of the population participates in mutual insurance programmes for their health coverage," he says, adding that coverage is afforded to, "the rich as well as the poor, the young as well the old, the urban as well as the rural population". Musango argues that mutualization has also led to a reduction in health-care costs, and the increased use of healthcare services. Taken together with other reforms such as the decentralization of health-care services, performance-based financing, quality insurance and improvements in quality control through supervision, Musango believes mutualization has made a significant contribution to the well-being of the population. But there have been suggestions that people are being pressured into participating in a scheme they can ill-afford. "In the poorest regions of Rwanda there are people who are finding it difficult to pay for the mutuelle, but the government is doing a lot to help," says Didi Bertrand Farmer, director of community health and social development with Partners in Health, a nongovernmental organization that is working in eastern Rwanda. …
In this paper, we examine the 'catch-up' hypothesis, that is, whether or not per capita health expenditures of the UK, Canada, Japan, Switzerland, and Spain converge to the per capita health expenditures of the USA over the period 1960-2000. We propose a framework to examine convergence of health expenditures and use recent developments in unit root testing, namely the Lagrange multiplier univariate and panel approaches that allow for at most two structural breaks. Our main finding is that while univariate and panel tests that do not incorporate structural breaks fail to find evidence of convergence, univariate and panel LM tests that allow for structural breaks find strong evidence of convergence of per capita health expenditures of the UK, Canada, Japan, Switzerland, and Spain to that of the USA.
Growth in national health spending is projected to slow slightly from 6.9 percent in 2005 to 6.8 percent in 2006, marking the fourth consecutive year of a slowing trend. The health share of gross domestic product (GDP) is expected to hold steady in 2006 before resuming its historical upward trend, reaching 19.6 percent of GDP by 2016. Prescription drug spending growth is expected to accelerate to 6.5 percent in 2006. Medicare prescription drug coverage has dramatically changed the distribution of drug spending among payers, but the net effect on aggregate spending is anticipated to be small.
The outlook for national health spending calls for continued steady growth. Spending growth is projected to be 6.7 percent in 2007, similar to its rate in 2006. Average annual growth over the projection period is expected to be 6.7 percent. Slower growth in private spending toward the end of the period is expected to be offset by stronger growth in public spending. The health share of gross domestic product (GDP) is expected to increase to 16.3 percent in 2007 and then rise throughout the projection period, reaching 19.5 percent of GDP by 2017.
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