Comprehensive Health Care Coverage Research Articles

Strengthening the Healthcare Workforce for Universal Health Coverage in Nigeria: Lessons and Strategies

Background: Achieving Universal Health Coverage (UHC) is a global imperative to ensure equitable access to quality healthcare services for all individuals. A pivotal factor in this endeavor is the strength and capacity of the healthcare workforce. This paper examines the intersection of a robust healthcare workforce and the goals of UHC, with a specific focus on the Nigerian context.
 Methods: The paper delves into the strengths and weaknesses of the Nigerian healthcare workforce, analyzing factors such as diversity, distribution, skill utilization, and the prevailing challenges. Insights from global approaches in the paper highlight innovative strategies, including workforce training, collaborative delivery models, and workforce motivation to enhance healthcare accessibility and quality.
 Results: The paper addresses contextual nuances such as cultural diversity, geographic challenges, and socioeconomic disparities that shape the Nigerian healthcare landscape. The relevance of tailored solutions that accommodate these nuances is emphasized. The paper underscores the potential impact of a strengthened healthcare workforce on achieving UHC, reducing health disparities, and improving overall health outcomes.
 Conclusion: The paper offers policy recommendations tailored to Nigeria's unique circumstances. The conclusion highlights the significance of continual monitoring, research, and evaluation of workforce-centric interventions for sustained progress towards UHC. The findings contribute to the broader discourse on health equity, offering insights into how a capable healthcare workforce can drive transformative change and pave the way for comprehensive healthcare coverage in Nigeria.

Healthcare coverage affects survival of EGFR-mutant Thai lung cancer patients.

Despite significant benefits of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) treatment in patients with EGFR-mutated NSCLC, access remains limited in Thailand and elsewhere. Retrospective analysis of patients with locally advanced/recurrent NSCLC and known EGFR mutation (EGFRm) status treated at Ramathibodi Hospital (2012-2017). Prognostic factors for overall survival (OS), including treatment type and healthcare coverage, were analyzed using Cox regression. Of 750 patients, 56.3% were EGFRm-positive. After first-line therapy (n=646), 29.4% received no subsequent (second-line) treatment. EGFR-TKI-treated EGFRm-positive patients survived significantly longer than EGFRm-negative patients without EGFR-TKIs (median OS [mOS] 36.4 vs. 11.9 months; hazard ratio HR=0.38 [95%CI 0.32-0.46], P<0.001). Cox regression indicated significantly longer OS in patients with comprehensive healthcare coverage that included reimbursement of EGFR-TKIs, versus basic coverage (mOS 27.2 vs. 18.3 months; adjusted HR=0.73 [95%CI 0.59-0.90]). Compared with best supportive care (BSC; reference), EGFR-TKI-treated patients survived significantly longer (mOS 36.5 months; adjusted HR (aHR)=0.26 [95%CI 0.19-0.34]), and versus chemotherapy alone (14.5 months; aHR=0.60 [95%CI 0.47-0.78]). In EGFRm-positive patients (n=422), relative survival benefit of EGFR-TKI treatment remained highly significant (aHR[EGFR-TKI]=0.19 [95%CI 0.12-0.29]; aHR(chemotherapy only)=0.50 [95%CI 0.30-0.85]; reference:BSC), indicating that healthcare coverage (reimbursement) affected treatment choice and survival. Our analysis describes EGFRm prevalence and survival benefit of EGFR-TKI therapy for EGFRm-positive NSCLC patients treated from 2012-2017, one of the largest such Thai datasets. Together with research by others, these findings contributed evidence supporting the decision to broaden erlotinib access on healthcare schemes in Thailand from 2021, demonstrating the value of local real-world outcome data for healthcare policy decision-making.

Distribution Pattern of Community Pharmacies in Port Harcourt Metropolis, Niger Delta, Nigeria

Background: The primary importance to every society is tied to her citizen’s ability to access good healthcare services at a reasonable reach. Community pharmacies often serve as the first point of contact for persons in need of health services and therefore are the most accessible suitable platforms for accessing of healthcare services. Aim: The study aimed at examining the distribution pattern and accessibility of community pharmacies in Port Harcourt metropolis to the populace. Materials and methods: High resolution Google Earth Image, Geographic Information System as well as the Global Positioning System were employed in data collection. The overlaying and buffering analysis were employed to examine the Geo-location and the compliance of pharmacies to stipulated regulation respectively. The nearest neighbour analysis tools in the spatial analysis extension of the ArcGIS 10.4 version were used to determine the spatial pattern of pharmacies across the study area. Results: Finding revealed that, pharmacies were clustered in the heart of the metropolis (urban centers) with focus on areas of higher financial or monetary/purchasing capacity (population) and an average opening corridor of 12hours between the hours of 8am and 11 pm maximum. Conclusion: To ensure better distribution of pharmacies and ensure comprehensive healthcare coverage, emphasis should be paid on Geo-location in the approval of operating licenses, accommodating attributes such as financial strength, age and other vulnerability of residents.

Diabetes is associated with a higher risk of mortality among women in a middle-income country: Results form the Mexican Teacher's cohort study

AimsIn Mexico City, the mortality rate among patients with diabetes appears to be four times that of people without diabetes. Our study aimed to refine analyses of the impact of diabetes on mortality in a large cohort of women from different areas in Mexico with healthcare insurance. MethodsOur study followed 111,299 women with comprehensive healthcare coverage from the Mexican Teachers’ Cohort. After a median follow-up of 7.8years, 5514 (5%) prevalent self-reported diabetes cases and 4023 incident cases were identified, while deaths were identified through employers’ databases and next-of-kin reports, with dates and causes of death for 1121 women obtained from mortality databases. Hazard ratios (HRs) for total and cause-specific mortality were estimated by Cox regression models, using follow-up time as the time scale and allowing for time-variable diabetes status after adjusting for age, socioeconomic status, use of health services, and anthropometric and lifestyle variables. ResultsIn multivariable-adjusted models, the HR for all-cause mortality was 3.28 (95% CI: 2.86–3.75) in women with vs. without diabetes. The impact of diabetes on mortality was higher in rural vs. urban areas (HR: 4.72 vs. 2.98, respectively). HRs were 1.57 and 23.44 for cancer and renal disease mortality, respectively. ConclusionIn women with healthcare coverage in Mexico, the magnitude of the association between diabetes and all-cause mortality was higher than that observed in high-income countries, but less than what has previously been reported for Mexico. Such elevated mortality suggests a lack of adequate access to quality diabetes care in the population despite comprehensive healthcare coverage.

Egypt towards Better Health and Well-being

Good health and well-being are essential for a stronger society and a fundamental human right. Ill health is evidently associated with poverty. Egypt targets improving health services, despite the scarcity of financial resources, a growing population, and the need for better governance. The Ministry of Health has identified strategic objectives to be achieved by 2030, which primarily targets improving the health of citizens by providing and enhancing primary healthcare via awareness and preventive measures; and achieving comprehensive healthcare coverage for all citizens. Recently, Egypt has a new success story in managing hepatitis C virus (HCV). Egypt was among the top countries with a highly prevalent HCV. Eliminating HCV faced several obstacles including shortage in global funding for treatment, late diagnosis, insufficient data, and poor screening. Treating HCV in Egypt has been nationally prioritized with the rise of the highly effective direct-acting antivirals. Egypt implemented a pattern of care, which could aid other similar countries in combating HCV. Moreover, In December 2017 followed by May 2018, the universal health insurance law and its executive regulations were issued successively in Egypt. Under the new law, health care will be accessible for all citizens and expanded to the estimated 30% of the Egyptians who cannot afford it. Enrollment in the scheme will be mandatory, with fees rated according to income with supplementary funding resources including taxes on polluting industries. The system will be initially adopted in five governorates and will be gradually implemented between 2018 and 2032.

Delivering a “New Deal” of Kidney Health Opportunities to Improve Outcomes Within the Veterans Health Administration

Just as the "New Deal" aimed to elevate the "forgotten man" of the Great Depression through governmental relief and reform, so does the Department of Veterans Affairs (VA) health care system aim to improve the health of veterans with the invisible illness of chronic kidney disease through a concerted series of health care delivery reforms. Augmenting its primary care platform with advances in informatics and health service delivery initiatives targeting kidney disease, the VA is changing how nephrology care is provided to veterans with the goal of optimized population kidney health. As the largest provider of kidney health services in the country, the VA offers an instructive case study of the value of comprehensive health care coverage for people with chronic kidney disease. Recent reports of kidney health outcomes among veterans support the benefit of the VA's integrated health care delivery system. Suggestions to optimize veterans' kidney health further may be equally applicable to other health systems caring for people afflicted with kidney disease.

Clinical and Epidemiological Profile of Breast Cancer in Mexico: Results of the Seguro Popular.

PurposeOne half of the Mexican population lacks comprehensive health care coverage. In 2003, a reform to the General Health Law was approved that led to the creation of the System of Social Protection in Health and made universal health coverage mandatory. The main innovation of this reform was Seguro Popular, which provided coverage for breast cancer. Here we report the outcomes of women with breast cancer treated at a cancer center in Mexico under Seguro Popular.Materials and MethodsThis was a retrospective cohort study that included all patients with breast cancer treated in the Instituto Nacional de Cancerología in Mexico City between January 2007 and December 2013 with Seguro Popular coverage. Demographic and clinical information were collected and survival outcomes were analyzed.ResultsA total of 4,300 women with breast cancer were included in this analysis. Most patients had locally advanced disease at diagnosis (53%, n = 2,293), and 13% (n = 558) presented with stage IV disease. Neoadjuvant chemotherapy was administered to 1,834 patients (52%), with a pathologic complete response in 25.1% (n = 460). Median follow-up was 40.5 months. Five-year survival for the entire cohort was 82% (95% CI, 81% to 84%). Five-year survival was 97% for early-stage disease (95% CI, 95% to 98%), 82% for locally advanced disease (95% CI, 80% to 84%), and 36% for metastatic disease (95% CI, 30% to 42%).ConclusionThis represents the first description of a cohort of patients with breast cancer treated in Mexico under Seguro Popular. Seguro Popular has allowed our institution, and other Mexican centers, to establish efficient standardized mechanisms to treat patients with breast cancer.

Refugee healthcare in Canada: responses to the 2012 changes to the interim federal health program

From its inception in 1957, Canada's Interim Federal Health Program (IFHP) offered comprehensive healthcare coverage to refugees regardless of their status. In 2012, Canada's federal government introduced changes to the IFHP that differentiated between basic and expanded or supplemental levels of care, and coverage depending upon status. These changes were broadly opposed by many Canadians who feared that Canada was no longer meeting its healthcare obligations for refugees, and through a successful legal challenge in the Federal Court of Canada. The analysis presented here interrogates these changes against the international obligations assumed by the Government of Canada through ratification of international instruments since 1948 and national commitments contained in the 1982 Canadian Charter of Rights and Freedoms.

Increasing Avenues to Care: Department of Veterans Affairs Makes Move to Grant APRNs Full Practice Authority

Tracing back to the 1600s, the United States has passed legislation and created systems to support veterans returning to civilian life after service. Beginning with offering services for disabled veterans returning from war with the Pequot Indians in 1636, support expanded rapidly to include comprehensive health care coverage for all injuries and diseases, regardless of their connection to time in service ( U.S. Department of Veterans Affairs, n.d U.S. Department of Veterans Affairs History: Department of Veterans Affairs. http://www.va.gov/about_va/vahistory.asp Google Scholar ) The Veterans Health Administration (VHA), operating under the VA is now the largest health care system in the nation, composed of 152 hospitals, 800 community-based outpatient clinics, 126 nursing home care units, and 35 domicillaries. The system oversees the delivery of care for more than 9 million veterans and does so with the employment of over 300,000 health care professionals (VA, n.d.)

Exploring Different Interpretations of the Capability Approach in a Health Care Context: Where Next?

In comparing the first applications of the capability approach (CA) to health and health care by Ruger with three subsequent interpretations of the CA, this paper identifies two distinct motivations: (i) the adoption of capability as an alternative to utilitarian health maximization, in the context of resource allocation and (ii) facilitating agreement on a core concept of health (incorporating mortality, morbidity and health agency) with which to drive policy reform. Where there is already comprehensive healthcare coverage, research is evolving to consider the broader impact of health on well-being and facilitate the joint evaluation of health and social care services. Although measures developed within this “expansionist” framework are becoming increasingly well used, their inclusion of health itself requires greater consideration. The health capability paradigm adopts health capability as a holistic object of health policy broadly conceived. Whilst instruments exist for assessing health functioning, qualitative studies are beginning to illuminate which indicators should be used to assess health agency. Shortfall sufficiency, a current pillar of the health capability paradigm, is considered as a potentially useful decision-rule when allocating health and social care resources. Setting a shortfall threshold will represent a value judgement and this should be informed through public deliberation and debate. The implications of adopting shortfall sufficiency also need to be explored and alternatives considered.

Door to Health Care Coverage Opens a Little Wider

New rates, eligibility standards, and incentives introduced by HHS help ensure that a greater number of people with preexisting conditions are eligible for immediate, comprehensive health care coverage.

Utilization and Costs of Antipsychotic Agents: A Canadian Population-Based Study, 1996–2006

This study evaluated the prescribing patterns and costs for antipsychotic agents in the population of the Canadian province of Manitoba over the past decade. A population-based study of antipsychotic utilization and costs was conducted on data collected from the administrative databases of the Manitoba Population Health Data Repository and the Statistics Canada census between index years 1996 and 2006 (April 1, 1995, through March 31, 2006). The total annual number of antipsychotic prescriptions dispensed in Manitoba increased by 227% between 1996 and 2006, and the prevalence of antipsychotic users increased by 62% over the same time interval. The fastest-growing segment of antipsychotic users in Manitoba appears to be young males, who increased from .16% in 1996 to .88% in 2006. The highest numbers of prescriptions were reported for schizophrenia, dementia, and conduct disorder. Annual expenditures for antipsychotics increased from $1.7 million in 1996 to $22.0 million in 2006 (expenditures are in Canadian dollars). The cost of second-generation agents reached 80% of total antipsychotic expenditures in 2006; risperidone was the most prescribed agent in all age groups of patients. The per-patient annual cost of antipsychotic pharmacotherapy increased by approximately 680% between 1996 and 2006 in Manitoba. The number of antipsychotic prescriptions and the prevalence of users of antipsychotic medications increased significantly in Manitoba over the study period, despite a steady-state population of approximately 1.2 million. Incremental costs relative to the use of antipsychotic medications can be explained by the market penetration of the second-generation agents and their expanded use in the treatment of various diagnoses.

A pricing policy towards the sourcing of cheaper drugs in Cyprus

In contrast to other EU countries, Cyprus lacks comprehensive health care coverage for its population, thus a significant portion of the population lacks insurance for medicines. Due to the small size of the country and small indigenous pharmaceutical industry, pharmaceuticals are mainly imported. Prices in the private sector are determined based on the ex-factory price from the country of origin. Distribution margins are calculated as a percentage of the import price, which creates perverse incentives for wholesalers to import products from high price countries, or import very expensive products, to maximize their income. In this article, we compare pharmaceutical prices in Cyprus to other EU counties with higher or similar GDP per capita and found Cyprus to be a high price country. We then propose a new pricing system to change wholesaler incentives, which would encourage them to shop around for the best buy in Europe. Prices can be set based on average prices from a basket of European countries, and adjusted to reflect the GDP per capita level in Cyprus. This will establish the wholesale price that the government will accept, and wholesalers can procure products from any country at a lower rate. Thus, wholesalers would be encouraged to go for the lowest prices and the authorities would be indifferent to the actual price they obtain, so long as the necessary criteria (good manufacturing practice, safety, effectiveness and efficacy) are met. Our proposal has implications for low and middle income countries where this system of pharmaceutical pricing and wholesaler incentives can be used.

Over the Rainbow: Advancing Child Health in the New Millennium

Research studies presented at the annual Pediatric Academic Societies meeting provide continued evidence of the impact of the environment on child health, the prevalence of mental health problems in children and adolescents, and the benefits of comprehensive health care coverage. Other studies report on the efficacy of new formats for delivering pediatric health care and the content of health supervision visits, and identify potential solutions for existing deficits and disparities in health care delivery. Despite this abundance of positive studies, the United States continues to lag behind many developed countries in its broader adoption of effective strategies such as universal health coverage. Child health care professionals must continue to speak out on behalf of the needs of infants, children, and adolescents and work for systemic change in health care delivery.

Using Health Savings Accounts to Provide Low-Cost Health Care

The recent Medicare Modernization Act made health savings accounts (HSAs) available to all non-Medicare individuals in the United States. HSAs can be combined with high-deductible health insurance plans to provide organizations with an economical approach for providing comprehensive health care coverage to their employees. Because unused funds accumulate over time, consumers are more likely to economize on their use of medical care. Proponents of HSAs argue that HSAs will slow the growth of health care costs in the United States Alternatively, critics suggest that HSAs will cause consumers to avoid necessary preventive care and will penalize the chronically ill. This article addresses these issues and includes examples of how HSAs affect both employers and employees.

Poverty and medical treatment: when public policy compromises accessibility.

To explore poor Edmontonians' access to medical treatment services. Data were collected during interviews with 130 poor Edmontonians. 38% of study participants had failed to obtain physician services when they were sick or bothered by a health problem, and 40% who had been prescribed a medication had not filled the prescription. Participants experienced three main barriers to access: lack of money, lack of comprehensive health care coverage, and lack of affordable transportation. Findings suggest that a variety of health care and social assistance policies limit access to treatment services for people living in poor families. Despite the principles of the Canada Health Act, access to medical treatment is not based solely on need, but is tied, in part, to income. There is a need for health care, social, and economic policies that aim to reduce the barriers that limit access to physician services and prescription medications by people living in poverty.

Poverty and Medical Treatment: When Public Policy Compromises Accessibility

To explore poor Edmontonians' access to medical treatment services.Data were collected during interviews with 130 poor Edmontonians.38% of study participants had failed to obtain physician services when they were sick or bothered by a health problem, and 40% who had been prescribed a medication had not filled the prescription. Participants experienced three main barriers to access: lack of money, lack of comprehensive health care coverage, and lack of affordable transportation. Findings suggest that a variety of health care and social assistance policies limit access to treatment services for people living in poor families.Despite the principles of the Canada Health Act, access to medical treatment is not based solely on need, but is tied, in part, to income. There is a need for health care, social, and economic policies that aim to reduce the barriers that limit access to physician services and prescription medications by people living in poverty.

Health care finance in the US: Past, present, and future

Presently the US is the only major industrialized nation that does not insure universal access to health care for all of its citizens. Although the US spends one out of every eight dollars on health care, over one-eighth of all Americans lack basic health insurance coverage. Another concern is health care cost inflation. The quest for comprehensive health care coverage for all Americans began shortly after the turn of the century and has received varying degrees of support since then. Since the historical course of health policy in the US has followed an evolutionary rather than revolutionary course, unless consistent policies are developed to rationalize the incentives facing consumers, providers, and insurers, alike, the future path of American health policy will continue to be characterized by disjointed incrementalism. National health insurance can provide decision makers with a tool to structure and focus the American health care system. In order for cost control measures to be effective they must be coordinated with measures to promote universal access, and vice versa. NHI can be a catalyst to focus attention on the dual goals of access to care and cost containment.

Forming and reforming the market for third-party purchasing of health care: a German perspective.

Germany is known for its comprehensive health care coverage by sickness funds and private health insurers and its successful cost containment policy. The stabilization of health care expenditures as a percentage of GNP was enforced by five cost containment laws since 1977. The last one became effective in 1993 and the next ones are planned for 1996 and 2000. The 1993 law has initiated drastic changes of the system. Office based physicians will be paid by a mixture of capitation, fee-for-service and fees for combined service packages. The hospital financing will be transformed from the current per diem remuneration to a payment system where per diems are combined with payments based on diagnostic related groups and patient management categories. Up till now many restrictions exist for insurees to switch sickness funds. These limitations were removed by the 1993 law. To allow unbiased competition between sickness funds, a risk compensation pool, some kind of statutory reinsurance, will transfer financial resources from sickness funds with good risk structure to those with many bad risks. In many respects health policy has imposed what health economists have recommended for a long time. However, there is some doubt whether increased competition will really increase efficiency of providing medical care because it takes place in a highly regulated market.

INSURABILITY ISSUES FACING THE ADOLESCENT AND ADULT WITH CONGENITAL HEART DISEASE

Access to comprehensive health care coverage for congenital heart disease patients is often limited because of their "preexisting condition." Life insurance may be difficult to obtain if the congenital lesion carries a higher than standard mortality rating. Various insurance program options are available to many of these patients. Knowledgeable health care professionals can assist these individuals to obtain the needed coverage, enabling better medical and financial security for this growing patient population.