Financing Of Health Care Services Research Articles

Changes in opinions on health insurance benefits deservingness in the Netherlands between 2013-2023

Abstract Background In many European countries, including the Netherlands, the healthcare system is financed according to the principles of solidarity. Although people are generally highly supportive of collectively financed healthcare services, some groups are considered more deserving of health insurance benefits than others. Increasing knowledge of the health risks of certain lifestyle choices and pressure on healthcare systems may result in changing opinions on the allocation of resources. Our study looks into changes in citizen’s opinions on the deservingness of different groups between 2013 and 2023. Methods Questionnaires were sent out to samples of 1.500 members of the Dutch Health Care Consumer Panel in 2013, 2015, 2017, 2019, 2021, and 2023. Response rates varied between 42% (2015) and 56% (2021). Deservingness was studied by asking respondents about their opinions on the amount of health insurance premium for different, opposing groups, for example older and younger people and those with a healthy and unhealthy lifestyle (group A should pay more, both groups should pay the same amount, or group B should pay more). Multinominal logistic regression models were used to examine changes in deservingness opinions over time. Results Our study showed year-to-year fluctuations in opinions on the premium amount for health insurance for different, opposing groups. However, no distinct increases or decreases were observed over the whole time period. This applies to both the general population and to people who do and do not belong to the different groups. Conclusions Although there are differences in the degree to which groups are considered deserving of health insurance benefits, deservingness opinions were found to be fairly stable in the Netherlands between 2013 and 2023. Our results do not point to increasing support for premium differentiation based on personal characteristics. This suggests that support for solidarity in healthcare financing is not in decline. Key messages • Opinions on the deservingness of health insurance benefits of different groups were found to be fairly stable in the Netherlands between 2013 and 2023. • No evidence of increasing support for premium differentiation based on personal characteristics was found.

The Factors Affecting Productivity in Healthcare Sector

Purpose: Due to increasing cost pressures, and the necessity to ensure high quality patient care while maintaining a safe environment for patients and staff, interest in the capacity for HRM practices to make a difference has piqued the attention of healthcare professionals. The purpose of this papers is to present and test a model whereby engagement mediates the relationship between four HRM practices and quality of care and safety in two different occupational groups in healthcare, namely, nurses and administrative support workers.Design/methodology/approach: Structural equation modeling was used to analyze questionnaire data collected by the National Health Service as part of their Staff Survey .The authors tested the hypotheses for nurses and administrative support workers separately.Findings: Training, participation in decision making, opportunities for development, and communication were positively related to quality of care and safety via work engagement. The strength of the relationships was conditional on whether an employee was a nurse or administrative support worker.Originality/value: This is the first paper to examine the mediating role of engagement on the relationship between four relevant HRM practices in the healthcare context, and outcomes important to healthcare practitioners. The authors also add value to the HRM literature by being among the first to use the job demands resources model to explain the impact of HRM practices on performance outcomes. Moreover, the authors provide insight into how HRM practices affect outcomes in the world’s largest publicly funded healthcare service

Preconditions for efficiency and affordability in mixed health systems: are they fulfilled in the Australian public-private mix?

The Australian health system is characterised by high quality care by international standards, produced by a mix of public and private provision and funding of healthcare services. Despite good overall results, three issues are of concern. The first issue relates to the public procurement of healthcare, whose flaws have impacted individuals' access to care, and the high out-of-pocket spending. The second issue concerns the sustainability of the private health insurance market, given the government's goal of relieving cost and capacity from the public scheme, incentivising participation. Third, there are existing inefficiencies and inequities related to the duplication resulting from the interaction between public and private schemes. To ensure a sustainable, efficient and equitable health system, structural reforms are necessary to achieve long-term performance improvements. Using a framework for mixed public-private health systems, we assess the extent to which the Australian healthcare system achieves preconditions for efficiency and affordability in competitive healthcare markets.

ОТНОШЕНИЕ РОССИЯН К РОЛИ ГОСУДАРСТВА В СФЕРЕ ЗДРАВООХРАНЕНИЯ

The aim of the study was: 1) to consider the views of Russians on the state’s role in providing and financing health care services and the success of the government in this area; 2) to identify changes in these views over time; 3) to explore the relationship between the Russians’ opinions and their individual characteristics. The analysis of International Social Survey Programme (ISSP) data collected in 2006 and in 2016 shows that support for the government’s role in providing and financing health care has slightly declined over a ten-year period and a significant part of the respondents are dissatisfied with the government’s success in ensuring treatment to those in need of medical attention. However, despite this, most Russians still support government involvement in health care. Individual characteristics associated with the attitude to the role of the state in healthcare have also been identified.

Cancer care and economic burden-A narrative review.

Cancer care poses a significant economic burden in India, where noncommunicable diseases contribute to a large number of deaths and disability-adjusted life-years. Despite economic growth, equitable wealth distribution remains a challenge, leading to inequalities in healthcare access. India's healthcare system is primarily privatized, financed through out-of-pocket expenditure (OOPE), and lacks coverage for a majority of the population. As a result, individuals without financial means face catastrophic health consequences when seeking necessary healthcare. OOPE in India's healthcare system is a major concern, with medicines accounting for a significant portion of expenses, followed by diagnostic tests and consultation fees. Nonmedical expenses also contribute to the financial burden. Cancer care specifically faces substantial financial challenges, with high treatment costs, reduced workforce participation, and the need for distress financing. Cancer-related OOPE is predominantly borne by patients and their families, leading to significant financial strain. The lack of comprehensive health insurance coverage and limited access to publicly funded healthcare services exacerbate the problem. Catastrophic health expenditure (CHE) in cancer care is prevalent, pushing households into financial distress and potentially impoverishment. Efforts have been made to address this issue, such as increasing public spending on healthcare and implementing health insurance schemes. However, challenges remain in ensuring their effectiveness and reach. The role of family care physicians is crucial in supporting patients and their families during catastrophic health expenditures related to cancer-related palliative care. They coordinate care, provide advocacy, emotional support, symptom management, and facilitate end-of-life discussions. Comprehensive measures are needed to strengthen healthcare infrastructure, improve access to affordable cancer care, enhance health insurance coverage, and implement supportive measures for cancer patients. Additionally, promoting preventive measures and early detection can help reduce the need for expensive treatments and decrease the risk of catastrophic health expenditures.

National Health Policy 2017 - Review in the context of Nursing Services and Practice

The Union Cabinet approved the new National Health Policy On March 15, 2017 with an aim to inform, clarify, strengthen and prioritize the role of the Government role in shaping health systems in all its dimensions, investment in health, organization and financing of healthcare services, prevention of diseases and promotion of good health through cross sectoral action, access to technologies, developing human resources, encouraging medical pluralism, building the knowledge base required for better health, financial protection strategies and regulation and progressive assurance for health. The target is to achieve “Health for All”, which is the basic objective of NHP 2017. National Health Policy impacting Nursing Profession at educational and service levels in view of overall well - being aspects of society.

The Health Insurance Situation in Iran: A Brief Overview

The financing process of the health system includes the collection, accumulation, and management of financial resources to purchase health services. Sustainable financing of the health system is a core function, which can enable progress towards universal health coverage (UHC). There are multiple funding sources to finance health care services in Iran, including out-of-pocket payment, government funds, general taxation, health insurance, and individual donations. Inefficiency in health insurance systems has led to an increase in out-of-pocket payments, and ultimately catastrophic expenditures. According to the results of the household income-expenditure survey in 2017, about 17% of the population faced catastrophic expenditures by spending more than 10% of their total consumption expenditure on health, and 75% of exposure to catastrophic expenditures (equivalent to 13% of population) was only due to paying out of pocket to receive medical services. (1) According to the health insurance coverage in 2010, about 84% of the total population in Iran was covered by various insurance plans and supplementary health insurance included 20% of the total population. (2) After the recent reforms entitled as the "Health Transformation Plan" launched in 2014, more than 90% of the population was covered by health insurance. However, the services were not fully covered by insurance benefits and only included inpatient health services. In addition, the insurance share was free for patients, which increased moral hazard from patients and induced demand from providers. Finally, this reform plan was stopped due to the instability of resources. Among the disadvantages of this type of insurance, the following can be mentioned: 1. All people could register in this insurance without any limitation. 2. The insurance premium was very small and negligible. So, it was not considered as an insurance because there was not the accumulation of risk, which is one of the main characteristics of any insurance industry. 3. Considering that many people were covered in this type of insurance, the depth and level of service coverage were reduced due to limited resources. In this insurance type, financing was from the government and there was no assessment for individuals; and it was a kind of support fund or support package. So, it was stopped at some point after the health transformation plan. Although Article 10 of the General Insurance Law in Iran refers to determining the scope and medical services and drugs, (3) there are no criteria to evaluate the covered packages. Despite the UHC's goal of increasing the number and variety of services for patients, many services for specific diseases, palliative care, etc. are not covered by the basic insurance. Also, some services such as dental and optometric services are considered a luxury service and are not covered by basic insurance. The lack of resources to provide proper services to the insured people and the impossibility of receiving the services from the private sector using health insurance benefits are other challenges of this type of insurance. Finally, Iran has not been able to achieve UHC due to the lack of proper management capacity in the insurance sector. To realize universal health coverage and improve outcomes, policymakers must consider several demand and supply factors. In this regard, expansion of infrastructure, human resources, and health services can be effective from the supply perspective. Meanwhile, increasing health insurance coverage, expanding health benefits package, and reducing the contribution of people in paying expenses using payment methods with a certain ceiling such as per capita and quality-based payment can be effective from the demand perspective. Also, the existence of comprehensive and transparent information systems, especially the system for identifying vulnerable and low-income groups, can greatly contribute to the successful implementation of UHC. Finally, designing suitable financial and non-financial incentives can also lead to increasing the satisfaction of professionals and health sector employees.

Level of community contribution toward the financing of health care services in Jigawa state

Community involvement in health related activities is generally acknowledged by international and national health planners to be the key to the successful organization of primary health care, comparatively little is known about its potential and limitations. Drawing on the experiences of Jigawa State, this paper reports on research undertaken to compare and contrast the scope and Extent of community participation in the delivery of primary health care in a community run and financed health post and a state run and financed health post. Unlike many other health posts in Jigawa these facilities do provide effective curative services, and neither of them suffers from chronic shortage of drugs. However, community-financing did not appear to widen the scope and the extent of participation. Villagers in both communities relied on the health post for the treatment of less than one-third of symptoms, and despite the planners' intentions, community involvement outside participation in benefits was found to be very limited. Aim: This study assess the level of community contribution toward the financing of health care services in Jigawa state, Nigeria Methodology: A cross-sectional descriptive research was conducted on the respondents. The study population comprised the entire eligible respondent in a case study of government hospitals in Jigawa state Nigeria within the study area, who were selected and agreed to participate in the study. Sample sizes of One Hundred (100), respondents were recruited using a multistage sampling technique. Data was collected using Questionnaire Data collected was coded, entered, and analyzed using the Statistical Package for the Social Sciences (SPSS) version 24. Result: The cooperation within department and with other departments in cooperation with equals was very good were 65(68.4%), good were 17(17.9%), Ok were 10(10.5%), not so good were 3(3.2%) and bad were 0(0.0%) respectively. The cooperation within department and with other departments in cooperation with PWD was Very good were 50(52.6%), good were 25(26.3%), Ok were 12(12.6%), not so good were 5(5.3%) and bad were 3(3.2%) respectively. In this studied many of the respondents has Diploma with 38.9% as their highest education qualification working with the Jigawa State Healthcare. Therefore, there is need for the continuous education programme of the health workers in the facility for proper and effective conduct of operations. Conclusions: The findings from this study will help to develop programs that can improve knowledge of community Health Financing and services provided by the health-care system and can reduce burden on government by providing other alternative.

Post-COVID-19 Pandemic Era and Sustainable Healthcare: Organization and Delivery of Health Economics Research (Principles and Clinical Practice)

Health services research aims to improve population health by studying the organization, delivery, and financing of healthcare services. While the field has made progress in defining its boundaries and core research topics, our literature survey revealed a lack of attention given to the management, cost, and policy aspects of healthcare systems (SCs). Moreover, the readiness of the system to handle supply policy and device deficiencies, especially during the pandemic, was rarely mentioned. Unplanned urban growth, characterized by reduced open spaces, deteriorating infrastructure, and changes in biological morphology, has led to an uneven distribution of urban amenities, facilities, and healthcare services. This research proposes two reliable models for site selection in a major hospital in Hong Kong, considering uncertainty levels, infeasibility tolerance, and reliability. We examine two categories of uncertainty—symmetric and bounded—and provide a solution with a nominal objective function value of 121.37. By considering 23 uncertain parameters with specific tolerance levels, we extend the processing time of uncertain tasks to ensure feasibility. However, the objective function value decreases due to violations of intermediate due-dates and decreased overall production. A comparative analysis is presented to evaluate the solution and address scheduling challenges under uncertainty using a specified probability distribution function. The study concludes by introducing justice and health problems, outlining four typical strategies, and emphasizing the importance of the effective management of systems, components, and procedures for the production, distribution, and administration of medications and healthcare supplies. This research contributes to fairness in health systems and population health at local, national, and global levels, addressing health inequity and promoting public dialogues on the subject.

Survival inequalities in head and neck cancers: A hospital-based cohort study.

We investigated whether the socioeconomic status (SES) influenced survival rates in oropharynx cancers (OPC), oral cavity cancers (OCC), and larynx cancers (LC) in Brazilian patients. This hospital-based cohort study assessed the age-standardized 5-year relative survival (RS) using the Pohar Perme estimator. Overall, we identified 37 191 cases, and 5-year RS were 24.4%, 34.1%, and 44.9% in OPC, OCC, and LC, respectively. In multiple Cox regression, the highest risk of death occurred in the most vulnerable social strata for all subsites-that is, illiterates or patients relying on publicly funded healthcare services. Disparities increased over time by 34.9% in OPC due to the rising of survival rates in the highest SES, whereas they reduced by 10.2% and 29.6% in OCC and LC. The potential inequities were more significant for OPC than for OCC and LC. It is urgent to tackle social disparities to improve prognoses in highly unequal countries.

Microfinance Intervention and Health Outcomes of Marginalized People: A Systematic Literature Review

INTRODUCTION: People from developing countries may have poor health due to economic constraints. Microfinance institutions provide collateral-free microcredit to the unbanked people for their livelihood improvement. This study aims to assess the impact of microfinance services on the health outcomes of marginalized people. MATERIALS AND METHODS: The research is based on a review of empirical studies, reports, and data. The PubMed search engine was used to locate research publications on microfinance and health. The PubMed Open Database was applied to find the publications using the keywords "microfinance" and "health." All papers that were published from January 1, 2010, to April 15, 2023, were checked for the study. 71 research papers were discovered during the initial inquiry; nine duplicate articles were eliminated, and 13 were irrelevant to the study. Finally, 50 research papers and reports were selected for evaluation. RESULTS: Health outcomes and microfinance intervention are related. Microfinance services are useful to improve access to healthcare, health initiatives/awareness, and funding for healthcare services. When financial services are integrated with health care services, the poor and marginalized people benefit from the microfinance intervention in the diverse areas of health care services such as communicable and non-communicable diseases, food security and nutrition, contraceptives, and mental health risks of intimate partner violence, as well as health awareness, quality of life, social integration, and economic wellbeing. CONCLUSIONS: Financial accessibility is important for promoting the health of the underprivileged. The poor and marginalized individuals gain from the microfinance intervention in the broad spectrum of health care services when financial services are linked with health care services.

Estimated reimbursement impact of COVID-19 on emergency physicians.

The delivery and financing of health care services were altered in unprecedented ways by COVID-19 and subsequent policy responses. We estimated reimbursement losses to emergency physicians in 2020 compared to 2019 related to shifting acute care utilization during COVID-19. This was an observational analysis of the Clinical Emergency Department Registry (CEDR) and the Nationwide Emergency Department Sample (NEDS). Study sample included all ED visits from a sample of 214 emergency department (ED) sites in the CEDR in 2019 and 2020 as well as all ED visits in the NEDS in 2019. We identified level of service billing code for evaluation and management (E&M) services, insurance payer, and geographic location of ED visits across sites in the CEDR and linked these to fee schedules to estimate total professional reimbursement across sites. Our primary analysis was to estimate reimbursement in 2020 compared to 2019 across the CEDR sites. In our secondary analysis, we linked sites in the CEDR to those in NEDS to estimate nationwide reimbursement. Total E&M reimbursement for emergency physicians in the CEDR was $1.6 billion in 2019 and $1.3 billion in 2020, reflecting a 19.7% decline year over year ($308 million loss). In our secondary analysis, we estimate nationwide losses of $6.6 billion, a -19.4% decline year over year. If emergency physicians had received maximum allowable federal relief funds via CARES Act Phases 1 to 3 (2% of 2019 revenue) this would sum to $680 million (2% of the $34 billion) or 10.3% of the estimated $6.6 billion pandemic-related losses. Our analyses provide an estimate of the scale of economic impacts of the COVID-19 pandemic. These findings warrant consideration for policymaker relief and future redesign of emergency care financing. Ultimately, the COVID-19 pandemic likely expanded known cracks in the financing of health care into steep fault lines.

Determinants of trust in healthcare facilities among community-based health insurance members in the Manna district of Ethiopia

BackgroundLow-income countries, including Ethiopia, face substantial challenges in financing healthcare services to achieve universal health coverage. Consequently, millions of people suffer and die from health-related conditions. These can be efficiently managed in areas where community-based health insurance (CBHI) is properly implemented and communities have strong trust in healthcare facilities. However, the determinants of community trust in healthcare facilities have been under-researched in Ethiopia.ObjectiveTo assess the determinants of trust in healthcare facilities among community-based health insurance members in the Manna District of Ethiopia.MethodsA community-based cross-sectional study was conducted from March 01 to 30, 2020 among 634 household heads. A multistage sampling technique was used to recruit the study participants. A structured interviewer-administered questionnaire was used to collect the data. Descriptive statistics were computed as necessary. Multivariable linear regression analyses were performed, and variables with a p-value < 0.05 were considered to have a significant association with households’ trust in healthcare facilities.ResultsIn total, 617 households were included in the study, with a response rate of 97.0%. Household age (ß=0.01, 95% CI:0.001, 0.0013), satisfaction with past health services (ß=0.13, 95% CI:0.05, 0.22), perceived quality of services (ß= -0.47, 95% CI: -0.64, -0.29), perceived provider’s attitude towards CBHI members (ß = -0.68, 95% CI: -0.88, -0.49), and waiting time (ß= -0.002, 95% CI:- 0.003, -0.001) were determinants of trust in healthcare facilities.ConclusionThis study showed that respondents’ satisfaction with past experiences, older household age, long waiting time, perceived poor quality of services, and perceived unfavorable attitudes of providers towards CBHI members were found to be determinants of trust in healthcare facilities. Thus, there is a need to improve the quality of health services, care providers’ attitudes, and clients’ satisfaction by reducing waiting time in order to increase clients’ trust in healthcare facilities.

A Review Article on Impact of Coronavirus Disease on Patients in the Health Care Setting: A Tale or Reality

Background: Coronavirus disease had a devastating effect on the World, with significant disruption in healthcare, the burgeoning impact is still unfolding. The inequities and fragilities amongst nations particularly low and medium economic countries whose patients are dependent on out of pocket expenditure to access healthcare, has occasioned varied consequence of the pandemic on patients in the health care setting and it has reshaped how health care is practiced. Aims: The aim of this review article was to assess the impact of Coronavirus disease on health care utilization by non -COVID patient during the pandemic. Methods: The review article was carried out with a search engine focused on articles related to impact of Coronavirus disease published between December 2019 till date, which were identified and reviewed. Conclusion: The review article gave an insight to the significant disruptions in health care services amongst patients witnessed across countries of the world, the disparities in the disruptions were due to heterogeneity amongst nations, national policies and health policies during the pandemic and the socioeconomic realities that ensued. Outpatient services witnessed varying reduction across the globe ranging between 30-50%. Sub-Saharan Africa witnessed disruption as much as 50% depending on load of COVID-19 infection amongst populace. The reason for the interruptions across the world was the fear of contracting the disease, access to health care setting due to lock down and shortage of health care personnel, in addition in sub-Saharan Africa, the economic down turn occasioned by the pandemic reduced household income which in turn reduced expenditure on health since most countries were dependent on out of pocket expenditure to fund health care services. In-patient care was also not spared of the disruptions witnessed even though emergency care was prioritized. Overall, there was a reported reduction in admissions for respiratory diseases due to non- pharmacological measures aimed at stemming COVID-19 infection which was equally effective for other respiratory diseases. In some countries like United States the reduction in hospital admissions was paralleled by increasing mortality particularly amongst Hispanic blacks as more acute and severe cases were deemed to have presented for admissions. Surgical priority was maintaining emergency services and prioritization of cancer care, there was a measurable reduction in surgical procedures as elective surgeries were postponed or cancelled. Most laparoscopic and endoscopic procedures were cancelled because of the perceived notion that they are aerosol generating and could increase transmission of COVID-19 infection from asymptomatic carriers, however US jettisoned cancellation of its surgical procedures after 35 days considering that it could not cope. The psychosocial impact of the pandemic and health care access spiraled into increasing anxiety and depression for both health care workers and patients, while the fear of stigmatization was rife from contracting the disease. The consensus therefore was to strengthen adaptive measures and reconfigure health care to mitigate this impact in future pandemic, while allowing telehealth to take center stage.

Dr Hammond's COVID-19 inquiry

Dr Hammond's COVID-19 inquiry

Awareness and perception of public/civil servants toward the National Health Insurance Scheme in Minna, Niger State, Nigeria

Background: Nigeria’s healthcare system has been characterized by a decline in healthcare service providers due to the inability of governments to adequately fund healthcare services over the years. Thus, this study aims to assess the knowledge and perception among public/civil servants toward the National Health Insurance Scheme (NHIS) in Minna, Niger State, Nigeria. Materials and Methods: The study was conducted using mixed qualitative and quantitative research methods. The study employed a descriptive research design that is also comparative. Data were collected using questionnaires and presented and analyzed using IBM-SPSS version 25.0 for Windows with the help of tables and graphs. Results: Most respondents were aware of the National Health Insurance Scheme (NHIS), but there was an overall unimpressive perception of NHIS funding, cost, and coverage. Age, gender, marital status, education, and grade level were not considerably associated with knowledge of NHIS (P &gt; 0.05), but those spending more than 5000.00 Nigerian Naira (NGN) monthly on medical bills were more aware of NHIS than those paying ≤2000 (P &lt; 0.05). The perception of NHIS was not significantly associated with gender, marital status, grade level, education attainment, and monthly expenses on healthcare services (P &gt; 0.05) but was significantly associated with age. Conclusion: The study concluded that there is a high awareness of NHIS among the study respondents, although not all had in-depth knowledge of the operations of the health insurance scheme. More efforts are required to increase awareness of NHIS and its benefits among public/civil servants in Minna, Niger State, Nigeria, to improve participation in the scheme.

How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state.

BackgroundImprovements in the financing of healthcare services are important for developing countries like India to make progress towards universal health coverage. Inpatient-care contributes to a big share of total health expenditure in India. India has a mixed health-system with a sizeable presence of private hospitals. Existing studies show that out-of-pocket expenditure (OOPE) incurred per hospitalisation in private hospitals was greater than public facilities. But, such comparisons have not taken into account the healthcare spending by government.MethodsFor a valid comparison between public and for-profit private providers, this study in Indian state of Chhattisgarh assessed the combined spending by government and households per episode of hospitalisation. The supply-side and demand-side spending from public and private sources was taken into account. The study used two datasets: a) household survey for data on hospital utilisation, OOPE, cash incentives received by patients and claims raised under publicly funded health insurance (PFHI) schemes (n = 903 hospitalisation episodes) b) survey of public facilities to find supply-side government spending per hospitalisation (n = 64 facilities).ResultsTaking into account all relevant demand and supply side expenditures, the average total spending per day of hospitalisation was INR 2833 for public hospitals and INR 6788 for private hospitals. Adjusted model for logarithmic transformation of OOPE while controlling for variables including case-mix showed that a hospitalisation in private hospitals was significantly more expensive than public hospitals (coefficient = 2.9, p < 0.001). Hospitalisations in private hospitals were more likely to result in a PFHI claim (adjusted-odds-ratio = 1.45, p = 0.02) and involve a greater amount than public hospitals (coefficient = 0.27, p < 0.001). Propensity-score matching models confirmed the above results.Overall, supply-side public spending contributed to 16% of total spending, demand-side spending through PFHI to 16%, cash incentives to 1% and OOPE to 67%. OOPE constituted 31% of total spending per episode in public and 86% in private hospitals.ConclusionsGovernment and households put together spent substantially more per hospitalisation in private hospitals than public hospitals in Chhattisgarh. This has important implications for the allocative efficiency and the desired public-private provider-mix. Using public resources for purchasing inpatient care services from private providers may not be a suitable strategy for such contexts.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13561-022-00372-0.

Out-of-Pocket Expenditure on Medical Services Among Older Adults: A Longitudinal Analysis.

The upturn in life expectancy and its consequence, population aging, are challenging labor, pension, and social-security systems throughout the developed world. The focal aim of this study is to measure the extent of out-of-pocket funding of healthcare services by the older adult population. The study has three objectives: to profile the healthcare services for which older adults pay out of pocket, profile the older adults who pay out of pocket for medical services and detect changes over the years, and identify predictors of out-of-pocket healthcare services funding by older adults. The study is predicated on the SHARE-Israel database (SHARE—Survey of Health, Ageing and Retirement in Europe). Relating to information yielded by the last two waves of SHARE-Israel (Wave 7 and Wave 8), it sheds light on the characteristics of those who reported having paid out-of-pocket for medical services. A large majority of the older-adult population in Israel that consumes healthcare services is asked to pay for services out of pocket. Having supplemental health insurance, personal state of health and changes in it, and economic resources are found to have the strongest effect on the probability of out-of-pocket funding. The motive of financial and/or social support that older adults receive from and/or give to their immediate surroundings makes it more likely that they will pay out of pocket for healthcare services. The probability of such funding varies between nationalities and immigration statuses. It is found with emphasis that the share of out-of-pocket funding of healthcare in older adult households' total annual income is trending upward. Furthermore, economic motives are central in determining whether such expenditure will stabilize over time. The findings stress the need to enhance the healthcare system's awareness of the profile of older adults who find it necessary to pay out of pocket for healthcare services.

Hospitalization &amp; health expenditure in Odisha: Evidence from National Sample Survey (1995-2014)

Financing healthcare services through out-of-pocket payments is common in India. Household impoverishments due to health expenditure can be daunting, especially among the economically vulnerable households. This study investigated hospitalization and patient's health expenditure in Odisha State in India. The national sample survey data were used to assess hospitalization and patient's health expenditure over two time periods (1995 and 2014). Disease classification was made following International Classification of Diseases 10th revision (ICD-10). The hospitalization rate and health expenditure were estimated for infectious, cardiovascular, non-communicable, disability and other diseases. Andersen model was used to examine the determinants of healthcare expenditure. Findings of the study revealed that hospitalization in Odisha increased nearly three folds and health expenditure by more than two times between 1995 to 2014. While the hospitalization for other diseases remained consistently higher, health expenditure for disability was the highest and it increased three times within the last two decades. The socio-economic and demographic divides in the hospitalization rate and health expenditure were evident. Our analysis indicated that predisposing factors such as age and marital status played an important role in hospitalization whereas, enabling factors likely determined the health expenditure. There is a need to recognize the unique vulnerabilities of older population, widowed and health financial mechanism for disability-related illness.

Cash Transfer Programmes For Reducing Poverty And Vulnerabilities: Effects On Children’s Health In Sub-Saharan Africa And Latin America

This paper summarizes the arguments and counterarguments within the scientific discussion on cash transfers and child health. The main purpose of the research is to assess the effects of cash transfers on children’s health and development outcomes in sub-Saharan Africa and Latin America. Systematization of the literary sources indicates that studies have justified cash transfer as social-income support that addresses a vital social determinant of health (income) for children in low-and-middle-income countries. The methodological basis of this study is a systematic review that searched a wide range of electronic databases such as PubMed, ResearchGate and ScienceDirect. Studies included in this review included randomized controlled trials (RCTs), cluster-RCTs, quasi-experimental and mixed methods studies of cash transfer interventions in children 0-18 years. Inclusion criteria were met by eight studies, four from Africa and four from Latin America. The systematic review presents the results of data synthesis of the included studies that mainly reported the effects of cash transfer programmes on child anthropometry outcomes, cognitive development, morbidity, and healthcare utilization. The review found cash transfer programmes to improve these variables among children in households receiving cash transfers. This systematic review has added to the debate on cash transfers and children’s health outcomes. In general, the systematic review indicates that cash transfer programmes intended for children are effective at improving anthropometric, health, and cognitive outcomes, as well as access to healthcare. However, there is a need for more research to clarify the multiple pathways by which cash transfers can improve children’s health and nutritional outcomes. It is also necessary to clarify what factors explain the variety of effects of cash transfer programs on child health and nutritional status. Finally, cash transfer interventions are not permanent mechanisms for promoting access to healthcare. Policymakers in developing countries should borrow ideas on how to finance healthcare services for improving the socio-economic wellbeing of citizens.