Financing and Resource Constraints Hindering the Optimal Implementation of the Universal Health Care Act in the Philippines

Purpose: Private sector is the major providers of Primary health care for the poor in many low- and middle-income countries. In the public healthcare providers, the health facilities are built by the government and the healthcare workers, draw their salaries from government treasuries. In the private providers, the health facilities are owned by individual or a group of people and the salaries of the workers are paid from the resources generated in the facilities. They are either for profit or non-profit making. Enrollees are given freehand to choose either of the providers, but the information available to them is not enough to make decision on which of the providers to choose. This study aimed at determining the enrollee’s choice of private and public healthcare providers of community-based health insurance scheme in Edu LGA Kwara state.
 Methodology: The design was descriptive cross-sectional study. Sample size of 400 was used in each of the provider. The respondents were recruited by systematic sampling method among private healthcare provider while multistage sampling method was adopted in public healthcare providers. Data was collected using semi structured questionnaire. Focus Group Discussion was also carried out. Data collected were analyzed using SPSS version 23.0. Results were tabulated and logistic regression was adopted to determine level of significance. Level of Significance was set at P<0.05
 Findings: Nine- point-five (9.5%) of the respondents of the private healthcare provider and 5.7% of the respondents of the public healthcare providers had good knowledge score of community based health insurance scheme. The difference in knowledge score was statistically significant as the p=0.035. Mode of premium collection had Odd ratio 2.99 (CI =1.934- 4.622), P<0.001; Trust of the system Odd ratio 2.987 (CI = 1.884-4.733); Quality of health care Odd ratio 2.673 (CI = 1.757-4.065) P<0.001; Proximity to health facility Odd ratio 2.225 (CI = 1.412-3.506) P=0.001. Mode of joining the scheme Odd ratio 0.400 (CI = 0.290-0.552) P<0.001 and cost of accessing care Odd ratio 0.577 (CI = 0.42-0.779) P<0.001.
 Recommendation: It was recommended that private health facilities should be maintained which will improve access to health care for the enrollees. The government should also improve the quality of health care in the public healthcare providers.

In Vietnam, as in many other countries, tuberculosis (TB) control has long been organized exclusively within the public health-care system. However, recently the private health-care sector has become more important and private health-care providers currently have a role in TB care delivery in Vietnam. Through a retrospective survey of patients at District Tuberculosis Units (DTUs) of the National Tuberculosis Programme in Ho Chi Minh City, we investigated utilization of private and public health-care providers among people with symptoms of TB. Eight hundred and one patients in eight DTUs were interviewed. For the current illness episode, about half of the patients had initially opted for a private health-care provider. Twenty-seven percent had been to a private physician and 31% to a private pharmacy at some time during their current illness. We found no significant association between socioeconomic status and use of private health-care providers. Utilization of private health-care providers among people with TB or symptoms of TB in Ho Chi Minh City seems to be similar to the general utilization of private providers in Vietnam, at least before TB is diagnosed. Since a large proportion of people with TB in Ho Chi Minh City across all economic and social strata consult private providers at some time during their illness, planners of TB control strategies need to consider both the health-care seeking behaviour of people with TB and the clinical behaviour of private providers, in order to secure early detection of TB, early initiation of appropriate treatment, and maintenance of appropriate treatment.

BackgroundGlobally, extending financial protection and equitable access to health services to those outside the formal sector employment is a major challenge for achieving universal coverage. While some favour contributory schemes, others have embraced tax-funded health service cover for those outside the formal sector. This paper critically examines the issue of how to cover those outside the formal sector through the lens of stakeholder views on the proposed one-time premium payment (OTPP) policy in Ghana.DiscussionGhana in 2004 implemented a National Health Insurance Scheme, based on a contributory model where service benefits are restricted to those who contribute (with some groups exempted from contributing), as the policy direction for moving towards universal coverage. In 2008, the OTPP system was proposed as an alternative way of ensuring coverage for those outside formal sector employment. There are divergent stakeholder views with regard to the meaning of the one-time premium and how it will be financed and sustained. Our stakeholder interviews indicate that the underlying issue being debated is whether the current contributory NHIS model for those outside the formal employment sector should be maintained or whether services for this group should be tax funded. However, the advantages and disadvantages of these alternatives are not being explored in an explicit or systematic way and are obscured by the considerable confusion about the likely design of the OTPP policy. We attempt to contribute to the broader debate about how best to fund coverage for those outside the formal sector by unpacking some of these issues and pointing to the empirical evidence needed to shed even further light on appropriate funding mechanisms for universal health systems.SummaryThe Ghanaian debate on OTPP is related to one of the most important challenges facing low- and middle-income countries seeking to achieve a universal health care system. It is critical that there is more extensive debate on the advantages and disadvantages of alternative funding mechanisms, supported by a solid evidence base, and with the policy objective of universal coverage providing the guiding light.

A lack of access to evidence-based, unbiased, and youth-friendly family planning and reproductive health (FP/RH) information and care limit young people's ability to prevent unplanned pregnancies and HIV and sexually transmitted infections. This threat-ens their health and is a significant cause of school drop-out, limiting young peoples' well-being, future potential, and employment opportunities. To address these challenges facing youth, YLabs used an end-to-end human-centered design (HCD) approach to create CyberRwanda, a digital platform aiming to improve the health and livelihoods of adolescents (aged 12-19 years) in Rwanda. From 2016 to 2020, CyberRwanda was designed and piloted using an HCD approach in partnership with more than 1,000 youth, parents, teachers, and public and private health care providers. During the problem recognition phase, HCD revealed participants' beliefs, behavioral preferences, and experiences as they relate to FP/RH specifically and their broader life experiences, motivations, and challenges. Several phases of analog, digital, and live prototyping with youth and key stakeholders were used to codesign, test, and refine the intervention for implementation. CyberRwanda is a direct-to-consumer platform where adolescents can learn integrated, age-appropriate health, and skills-building information through edutainment behavior change stories and a robust frequently asked questions library, order health products online, and be linked to CyberRwanda's network of private and public health care providers who have been trained to provide adolescent-friendly care. The HCD process resulted in significant pivots to the design of the digital platform and the implementation model. Using HCD provided a structured methodology to combine technical FP/RH expertise and visual and product design expertise to codesign and iteratively develop a digital health intervention with and for Rwandan youth.

Indonesia has a high incidence of tuberculosis (TB), despite the successful introduction of the directly observed treatment short-course strategy (DOTS strategy). DOTS depends on passive case finding. It is therefore important to identify determinants of patient delay and reasons for visiting a DOTS healthcare provider when seeking care. The aim of this study was to assess these determinants in TB suspects (coughing for at least 2 weeks). Cross-sectional data were gathered with a structured questionnaire in which psychosocial determinants were based on an extended version of the theory of planned behaviour (TPB). The study was conducted in five governmental lung clinics of Yogyakarta province. In total, 194 TB suspects that registered at the lung clinics were interviewed. The median patient delay was 14 days (range 0-145). Ordinal regression analyses showed that visiting a private healthcare provider when first seeking health care, reporting travel distance/travel time as reason for choosing a certain healthcare provider when first seeking health care, discussing the symptoms with family and a reported short travel time, but no factors of TPB, were significantly associated with a shorter patient delay. An important factor negatively associated with visiting a DOTS clinic was the reported travel time. Accessibility of the healthcare provider was the main determinant of patient delay, but the role of psychosocial factors cannot be fully excluded. Urban and suburban areas have relatively good access to (private) health care, hence the short delay. Thus, future studies should be focussed on extending the DOTS strategy to the private sector.

This chapter explores the governance issues in the implementation of insurance coverage for the informal labour sector in the context of universal health coverage (UHC). The COVID-19 pandemic highlights the vulnerabilities of the informal sector that remain overlooked by employer health insurance and are not targeted by the government’s cash transfer programmes for the poor. While universal health coverage may, on paper, assure every one of the basic minimum health care packages, issues of capturing subsidies for and availing of similar no user charges for the poor may be a Gordian knot before universal coverage is achieved. The chapter interrogates this issue as follows—firstly, we present key health financing features of the Philippine efforts to cover the informal sector in the national health insurance programme; and secondly, based on a concept approach, we analyse the elements of a social contract that may enhance or break down relationships in informal sector health insurance—with the market, bureaucratic and networks in health systems. Implications are drawn on the design of institutional arrangements to capture subsidies, contributions, and provider payments as part of a post-pandemic new normal of greater health security through the financing of health in the context of a social contract.

Supplement: Vision for U.S. Health Care21 January 2020Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of PhysiciansFREERobert Doherty, BA, Thomas G. Cooney, MD, Ryan D. Mire, MD, Lee S. Engel, MD, and Jason M. Goldman, MD, for the Health and Public Policy Committee and Medical Practice and Quality Committee of the American College of Physicians*Robert Doherty, BAAmerican College of Physicians, Washington, DC (R.D.), Thomas G. Cooney, MDOregon Health & Science University and Portland Veterans Affairs Medical Center, Portland, Oregon (T.G.C.), Ryan D. Mire, MDHeritage Medical Associates, Nashville, Tennessee (R.D.M.), Lee S. Engel, MDLouisiana State University Health Sciences Center, New Orleans, Louisiana (L.S.E.), and Jason M. Goldman, MDPrivate Practice, Coral Springs, Florida (J.M.G.), for the Health and Public Policy Committee and Medical Practice and Quality Committee of the American College of Physicians*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2411 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Visual Abstract. Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians Download figure Download PowerPoint What would a better health care system for all Americans be like?This is the question that the American College of Physicians (ACP) has been asking of its members since July 2018, when the ACP Board of Regents asked ACP's Health and Public Policy Committee and Medical Practice and Quality Committee to "develop a new vision for the future of health care policy," to examine ways to achieve universal coverage with improved access to care, reduce per capita health care costs and the rate of growth in spending, reform clinician compensation, and reduce the complexity of our health care system.To develop this vision and recommend ways to realize it, ACP considered evidence on the effectiveness of health care in the United States and other countries; solicited input from U.S-based members and ACP's policy committees; adopted draft recommendations for review by ACP's regents, governors, committees, and council members; finalized recommendations in response to this feedback; and submitted the recommendations for approval by the ACP Board of Regents. On 2 November 2019, the Board of Regents approved this call to action and 3 companion papers on coverage and cost of care (1), health care delivery and payment system reforms (2), and reducing barriers to care and addressing social determinants of health (3).Why Does the United States Need a Better Health Care System?In developing its new vision for health care, ACP focused on 4 questions:1. Why do so many Americans lack coverage for the care they need?2. Why is U.S. health care so expensive and therefore unaffordable for many?3. What barriers to health care, in addition to coverage and cost, do patients face?4. How do delivery and physician payment systems affect costs, access, quality, and equity?As detailed in the accompanying position papers, there is a clear case that the U.S. health care system requires systematic reform. Too many Americans lack health care coverage. Despite historic gains in coverage with the Affordable Care Act, the United States is the only high-income industrialized nation without universal health coverage (4). Affordability is among the most commonly cited reasons for remaining uninsured (5, 6). The United States spends far more per capita on health care than other wealthy countries do, with nearly 17% of the nation's gross domestic product in 2016 directed to health care (7). Drivers of higher spending include higher prices for health care services, devices, and medications in the United States than in other wealthy countries (8). In addition, administrative costs account for 25% of total U.S. hospital spending (9). Complex medical billing, documentation, and performance reporting requirements for value-based payment initiatives have made the U.S. health care system one of the most administratively burdensome in the world. This burden takes time away from direct patient care, generates billions of dollars of unnecessary administrative costs, and contributes to unprecedented levels of burnout among physicians and other clinicians.Despite high health expenditure, U.S. spending and prices generally do not correlate with better health outcomes. The United States consistently ranks last or near-last in access, administrative efficiency, equity, and health care outcomes (10). Mortality rates are higher in the United States than in comparable countries for most leading causes of death, although the United States does better than its peer countries on deaths from cancer (11). Life expectancy has been decreasing in the United States since 2014 (12). Environmental health hazards, poor nutrition, tobacco use, substance use disorders, prescription drug misuse, suicide, injuries and deaths from firearms, and maternal mortality are reversing progress made over generations of increasing life expectancy. Contributing to suboptimal health outcomes are the many systematic barriers to care that Americans face, including discrimination because of personal characteristics, such as race, ethnicity, religion, language, sex and sexual orientation, gender and gender identity, and country of origin.Underinvestment in primary care in the United States also contributes to suboptimal outcomes. Evidence shows that greater use of primary care is associated with decreased health expenditures, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality. A Primary Care Collaborative review found that primary care investment is associated with a decrease in ambulatory-sensitive hospitalization and emergency department visits, yet the national average for primary care investment is approximately 5% to 10% of total health care spending, depending on how primary care is defined; it also varies substantially across states. The United States spends much less on primary care than other peer countries. Organisation for Economic Co-operation and Development countries spend an average of 14% on primary care (13). Despite the value that internal medicine specialists and other primary care physicians bring to the health system, the current U.S health care system undervalues primary care and cognitive services (14, 15).Much of the high spending and uneven health outcomes in the United States have been attributed to a fee-for-service payment system (16). Policymakers have sought to move toward value-based payment, but there is little agreement on how best to measure value across health care settings and patients with diverse medical and socioeconomic conditions and preferences. The clinical accuracy, ability of clinicians to act on measures of their performance, and usefulness of quality criteria across programs and payers have come under scrutiny.Finally, health information technology (IT) holds promise to facilitate improvements in care, reduce administrative burdens of practice, and help both physicians and patients communicate and navigate the complexities of the health care system. However, ample evidence shows that health IT is not reaching these goals, but rather adding administrative burden to clinical practice (17, 18).In summary, U.S. health care costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients' interests; undervalues primary care and public health; spends too much on administration at the expense of patient care; fails to invest and support public health approaches to reduce preventable injuries, deaths, diseases, and suffering; and fosters barriers to care for and discrimination against vulnerable individuals.The ACP's Vision of a Better Health Care System for AllThe ACP believes the United States can, and must, do better and offers the following 10 vision statements for a better health care system for all.1. The American College of Physicians envisions a health care system where everyone has coverage for and access to the care they need, at a cost they and the country can afford.2. The American College of Physicians envisions a health system that ameliorates social factors that contribute to poor and inequitable health (social determinants); overcomes barriers to care for vulnerable and underserved populations; and ensures that no person is discriminated against based on characteristics of personal identity, including but not limited to race, ethnicity, religion, gender or gender identity, sex or sexual orientation, or national origin.3. The American College of Physicians envisions a health care system where payment and delivery systems put the interests of patients first, by supporting physicians and their care teams in delivering high-value and patient-centered care.4. The American College of Physicians envisions a health care system where spending is redirected from unnecessary administrative costs to funding health care coverage and research, public health, and interventions to address social determinants of health.5. The American College of Physicians envisions a health care system where clinicians and hospitals deliver high-value and evidence-based care within available resources, as determined through a process that prioritizes and allocates funding and resources with the engagement of the public and physicians.6. The American College of Physicians envisions a health care system where primary care is supported with a greater investment of resources; where payment levels between complex cognitive care and procedural care are equitable; and where payment systems support the value that internal medicine specialists offer to patients in the diagnosis, treatment, and management of team-based care, from preventive health to complex illness.7. The American College of Physicians envisions a health care system where financial incentives are aligned to achieve better patient outcomes, lower costs, and reduce inequities in health care.8. The American College of Physicians envisions a health care system where patients and physicians are freed of inefficient administrative and billing tasks, documentation requirements are simplified, payments and charges are more transparent and predictable, and delivery systems are redesigned to make it easier for patients to navigate and receive needed care conveniently and effectively.9. The American College of Physicians envisions a health care system where value-based payment programs incentivize collaboration among clinical care team–based members and use only appropriately attributed, evidence-based, and patient-centered measures.10. The American College of Physicians envisions a health care system where health information technologies enhance the patient–physician relationship, facilitate communication across the care continuum, and support improvements in patient care.The accompanying policy papers (1–3) offer specific recommendations, supporting rationales, and evidence on ways the United States can move to achieve ACP's vision.In "Envisioning a Better Health Care System for All: Coverage and Cost of Care" (1), ACP recommends transitioning to a system of universal coverage through either a single payer system, or a public choice to be offered along with regulated private insurance. Although each approach has advantages and disadvantages, either can achieve ACP's vision of a health care system where everyone has coverage for and access to the care they need, at a cost they and the country can afford. The evidence suggests that publicly financed and administered plans have the potential to reduce administrative spending and associated burdens on patients and clinicians compared with private insurers. Other approaches were considered by ACP, including market-based approaches, yet ACP found they would fall short of achieving our vision of affordable coverage and access to care for all. The ACP asserts that under a single payer or public option model, payments to physicians and other health professionals, hospitals, and others delivering health care services must be sufficient to ensure access and not perpetuate existing inequities, including the undervaluation of primary and cognitive care.The ACP proposes that costs be controlled by lowering excessive prices, increasing adoption of global budgets and all-payer rate setting, prioritizing spending and resources, increasing investment in primary care, reducing administrative costs, promoting high-value care, and incorporating comparative effectiveness and cost into clinical guidelines and coverage decisions.In "Envisioning a Better Health Care System for All: Health Care Delivery and Payment Systems" (2), ACP calls for increasing payments for primary and cognitive care services, redefining the role of performance measures to focus on value to patients, eliminating "check-the-box" reporting of measures, and aligning payment incentives with better outcomes and lower costs. The position paper calls for eliminating unnecessary or inefficient administrative requirements, and redesigning health information technology to better meet the needs of clinicians and patients. The ACP concludes there is no one-size-fits-all approach to reforming delivery and payment systems, and a variety of innovative payment and delivery models should be considered, evaluated, and expanded.In "Envisioning a Better Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health" (3), ACP calls for ending discrimination and disparities in access and care based on personal characteristics; correcting workforce shortages, including the undersupply of primary care physicians; and understanding and ameliorating social determinants of health. This position paper calls for increased efforts to address urgent public health threats, including injuries and deaths from firearms; environmental hazards; climate change; maternal mortality; substance use disorders; and the health risks associated with nicotine, tobacco use, and electronic nicotine delivery systems.These are just a partial summary of the recommendations in the 3 position papers; considered together, they offer a comprehensive and interconnected set of policies to guide the way to a better a health care system for all. We urge readers of this call to action to review the 3 papers for a complete understanding of ACP's recommendations and the evidence in support of them.Where Do We Go From Here?The ACP believes that our recommendations, if adopted, would address many shortcomings in U.S. health care, but acknowledges that the recommendations do not address every area of needed improvement. In some cases, more research is needed for effective policy development. Because both are needed, the recommendations aim to balance the imperative for transformational changes with improvements in the current system.The ACP is committed to ensuring that the patient's voice is paramount in creating a health care system that better meets their needs. The ACP also believes that physicians are uniquely trusted and qualified to offer solutions to the problems in U.S. health care.We hope that those who challenge ACP's recommendations will offer their own thoughtful alternative solutions rather than just opposing ours.The ACP rejects the view that the status quo is acceptable, or that it is too politically difficult to achieve needed change. Dr. Atul Gawande wrote, "Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try" (19). By articulating a new vision for health care, ACP is showing a willingness to try to achieve a better U.S. health care system for all. We urge others to join us.

Few modelling studies have been carried out to investigate patients’ involvement in the decision-making process in a healthcare system. Here we perform theoretical and simulation analysis of a healthcare business model involving three populations: Public Healthcare Providers, Private Healthcare Providers and Patients. The analysis contributes to healthcare economic modelling by analyzing the dynamics and emergence of cooperative behavior of agents within the three populations. Resorting to agent-based simulations, we examine the effect of increasing behavioural mutation and providers’ capacity on patients’ cooperative behaviour. We show that the former introduces more randomness in agents’ behaviors enabling cooperation to emerge in more difficult conditions. Moreover, when the providers’ capacity to meet patients’ demand is limited, patients exhibit low levels of cooperation, implying a more difficult cooperation dilemma in a healthcare system that needs addressing.

Our health care system is plagued by four overriding deficiencies: lack of universal coverage, high costs, inadequate chronic illness prevention and management, and deficient public health preparedness. An inadequate information technology infrastructure and suboptimal quality of care are aspects of one or more of these four challenges. As a result of these shortcomings, the American people are actually less healthy than our counterparts in developed nations around the world. This travesty saps our potential as individuals and as a country. Lost productivity associated with having 47 million uninsured people costs up to $205 billion per year. Accordingly, I have proposed a comprehensive plan for health care reform marked by its inclusiveness and balance. PUTTING UNIVERSAL COVERAGE FIRST Universal coverage forms the predicate of solving many of our health system problems. Without the continuity of access universal coverage promotes, effective chronic disease management that improves health outcomes and generates savings will be much harder to attain. Certainly, disaster preparedness becomes dramatically more difficult while large pockets of uncompensated care and reliance on hospital emergency rooms remain significant characteristics of American health care. My health care plan provides for unequivocal universal health care coverage through universal responsibility. Americans will be able to get their private insurance through a health insurance marketplace called Universal HealthMart. Modeled after the Federal Employees Health Benefits Plan, Universal HealthMart will provide Americans with the same benefits as every Member of Congress. Insurance company discrimination based on condition will be ended. Every employer and individual will be given the chance to go to Universal HealthMart to purchase high-quality, affordable health care or, if they wish, keep their existing insurance arrangements. If a person is unable to pay for insurance or cover the entire cost, their costs will be subsidized on a sliding scale based on income. Business contributions will also be based on ability to pay. Every American with an income below 100 percent of the Federal Poverty Level will become eligible for Medicaid while changes in the federal match will assure that states are held harmless for this expansion. My plan is the only plan to provide for automatic enrollment and a defined timeline to implement universal coverage. Coverage will occur through direct enrollment as people choose their plans or automatically when people file their tax returns, complete W-4's, or show up for health care with a provider. Through the process of automatic coverage and enrollment, universal coverage is guaranteed. Within 2 years of enactment, all children, young adults to age 29, and adults age 55-64 will be covered. Over the next two years, all remaining adults between 30-54 will be enrolled. MAKING HEALTH CARE MORE AFFORDABLE My plan will make healthcare more affordable because health insurance premiums will be based on ability to pay. In addition, my health care plan will reduce costs throughout the system, especially administrative costs. First, as more and more Americans participate in the marketplace, the agency contracting with health plans on their behalf gains increasing leverage to require sensible efficiencies and price accountability. Second, according to McKinsey Global Institute, medical underwriting and marketing costs alone account for $64 billion in excess insurance company expenses. My plan eliminates insurance company discrimination based on condition, while marketing will be consolidated and streamlined. It explicitly redirects premium dollars to prevention and management of chronic illness, the effects of which are discussed more fully below. IMPROVING CHRONIC ILLNESS MANAGEMENT Chronic illness accounts for 74 percent of private health insurance medical spending and 96 percent of Medicare spending. …

The future of health markets

Microfinance: an alternative means of healthcare financing for the poor

Ensuring the availability of quality and affordable health care for all citizens is a primary goal of every government. However, how they do it differs from country to country, but the bottom line is that many countries especially developing ones have challenges in providing accessible quality health care to all their citizens. Among the numerous approaches to providing health care to all, universal health care is the newest ‘kid in the block’ approach. Kenya has made numerous attempts to provide free or affordable health care to citizens but has encountered numerous challenges in the process. The approach has been mainly through health care reforms such as universal or categorical free health care or the introduction of health insurance and the expansion of its coverage. In Kenya, health care had been free since independence. Achieving quality health care requires concerted efforts aimed at diversifying and strengthening financing mechanisms and schemes as well as eliminating inefficiencies in health care. Moreover, there is a need to boost economic growth so as to raise GDP and income per capita which will go a long in improving the affordability of health care. This review article has looked at various mechanisms and challenges of financing health care in developing countries, with a particular focus on Kenya, in order to achieve universal health care. Nonetheless, there is a need for further research and comparative analysis on the cost-effectiveness of various financing mechanisms for health care in different countries. This is vital considering that health care is a right to all people.

A country’s payment and settlement system refers to payment means or instruments, procedures, supportive and technical services of clearance, fund transfer, and final settlement. To study the various dimensions of the payment and settlement system, an online survey was administered and 240 responses were collected from Saudi and non-Saudi nationals, while secondary data were obtained from the SAMA (Saudi Arabian Monetary Authority) website. Index numbers, percentages, ranks, Average Trend Growth Rate, and payment weights means are applied to get the mutual growth trend, average growth, and contribution of specific means in payment and settlement in Saudi Arabia. There are negative trends in the traditional payment and settlement system in Saudi Arabia. Based on the value (amount) of transactions, Mada (Debit card) and E-payment (SADAD – a payment system, and SARIE – Saudi Arabian Riyal Interbank Express) are the most significant contributors to online payment (51.63%), while POS (point of sale) is the fastest-growing (158%) means of payment and settlement in Saudi Arabia. The means of traditional payment and settlement negligibly (< 1%) contribute to the payment and settlement system in Saudi Arabia. The analysis of responses reveals that payment and settlement users were unsatisfied with the various dimensions of security (39%) and traceability (35%) of the payment and settlement systems in Saudi Arabia. All dimensions of security and traceability must be considered to increase the degree of satisfaction with payments and, in particular, settlements in Saudi Arabia. Acknowledgment The authors are grateful to the Deanship of Scientific Research, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia, for providing funding to complete this project (Project No. 2021/02/18709).

PurposeThe purpose of this paper is to investigate patients’ views toward the perceived service quality of public and private healthcare service providers. Determinants of healthcare service quality were compared by carrying out a GAP analysis to equate perceived and expected services and examined differences in the service quality.Design/methodology/approachThe study sample comprises 310 inpatients of public and private healthcare service providers. Self-administered questionnaires were used along a five-point Likert scale and analyzed through the Statistical Package for Social Sciences. GAP analysis was used to observe the difference between expectations and perceived service quality.FindingsA cross-sectional study revealed significant quality gaps between the expected and perceived services of public and private healthcare service providers; conversely patients’ expectations are not fully met in both types of hospitals. Private hospitals surpassed in terms of overall perceived service quality from their counterparts. Perceived services were found better in terms of physician medical services in public sector hospitals, while rooms and housekeeping services were found better in terms of private sector hospitals.Practical implicationsThe result can be used by both public and private healthcare service providers to restructure their quality management practices which could only be possible through effective management commitment, regular patients’ feedback and translucent complaint procedures.Originality/valueThe study conceptualizes the expected and perceived hospital service quality dimensions as an eight-dimensional framework. A comparison between public and private sector hospitals is made to get a better understanding about the differences in the perceived healthcare services among two sectors. Consequences of the study will aid hospital managers and policy makers to get a fuller picture of healthcare services in order to contrive enhancement practices.

Universal antiretroviral treatment: the challenge of human resources