Health Care Financing System Research Articles

Business cycle sensitivity of Statutory Health Insurance: evidence from the Czech Republic

BackgroundThe Statutory Health Insurance scheme is one of two main schemes of health care system financing in Europe. This scheme mainly relies on wage-based contributions from employers and employees and is thus prone to business cycle fluctuations. This turned out to be a problem especially after the 2008 crisis. We estimate the magnitude of the effect of the business cycle on health insurance funds’ revenues in the Czech Republic where the health care system financing is based on the Statutory Health Insurance scheme. The relationship between the business cycle and healthcare system’s revenues has not been quantified to this date.MethodsWe use static and lagged regression models to estimate the impact of business cycle on health care system’s revenues. The business cycle is proxied by eight different indicators (nominal GDP, unemployment, industrial production, recession index, business cycle index, GDP gap, consumer price index and consumer expenditure). Using quarterly data from 2000–2017, we examine the effect of business cycle on total revenues and its two main components: the employer-employee contributions and state contributions.ResultsHealth insurance funds’ revenues display significant pro-cyclicality, which is mainly driven by employer-employee contributions. Out of all eight business cycle indicators, nominal GDP has the largest effect. In particular, the model estimates that if quarter-over-quarter GDP increases by 1%, then quarter-over-quarter healthcare system’s revenues increase by 0.7% and quarter-over-quarter employer-employee contributions increase by 1.1%. The lagged effect of business cycle on healthcare system’s revenues is smaller in magnitude. State contributions on behalf of economically inactive people do not display a significant relationship with business cycle in the static nor lagged model. The effect is consistent across different business cycle indicators, although the magnitudes of the effect vary.ConclusionThe results show large pro-cyclicality in healthcare system’s revenues in Statutory Health Insurance schemes. Counter-cyclical mechanisms are needed to offset this loss of revenues during economic downturns to ensure sufficient resources in healthcare.

Healthcare Financing in Saudi Arabia: A Comprehensive Review.

Saudi Vision 2030 is a game-changer for all aspects of the economy, including healthcare. This article provides a comprehensive overview of healthcare financing in the Kingdom of Saudi Arabia (KSA). It identifies key healthcare financing challenges that must be addressed to achieve the initiative's envisioned health system goals. The review also examines and demonstrates how healthcare funds in the KSA are allocated among different healthcare services, to offer a perspective on resource use efficiency at various healthcare levels. This research used a mixed-method design which includes a literature review and secondary data analysis. A literature review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. The secondary data were gathered from the reports and websites of government agencies, international organizations, and non-governmental organizations. Despite implementing significant reforms in its healthcare system, the share of private healthcare expenditure in total healthcare spending has seen only marginal growth. The current healthcare financing system appears insufficient to adequately support the chronically ill and the poor. There is a significant imbalance in the allocation of government budgets between hospitals and primary care, with four-fifths of financial resources directed towards hospital services. The Ministry of Health's budget allocation prioritizes personnel compensation, potentially reducing the available budget for medicines and other essential healthcare supplies. Ongoing reforms in the health sector, including privatization, public-private partnership initiatives, and the government's commitment to developing a robust primary healthcare network, are expected to play a significant role in controlling rapidly increasing public healthcare expenditures in Saudi Arabia.

Discourses of (Dis)trust and Hegemonic Masculinity: Service Providers’ Perspectives on the Disclosure Process of Men Who Have Experienced Sexual Violence in Childhood

ABSTRACT In this article, we explore the discourses of service providers that influence the disclosure process for men who have experienced childhood sexual violence (CHSV). Previous research has shown that it is typical for men to take over a decade to disclose their experiences of CHSV. Disclosing to a service provider can lead to receiving necessary help, yet men who have experienced CHSV often face gendered challenges within the Finnish healthcare system. Several support organizations for sexual violence were contacted using a non-probability sampling technique to recruit participants. The data for this qualitative study were collected through semi-structured interviews with eight service providers who work with male clients. The data were analyzed using critical discourse analysis. Our findings reveal that men typically do not seek help specifically for CHSV; rather, the issue often emerges while discussing other problems. We identified two distinct discourses that affect help-seeking and disclosure of CHSV by male survivors: a) the discourse of (dis)trust, which is closely connected to whether men discuss their traumatic experiences, and b) the discourse of hegemonic masculinities, in which normative masculinities inhibit men from disclosing. We recommend increasing general awareness of CHSV through various campaigns and incorporating sexual violence education into the curricula for healthcare students.

The Effects of Health Insurance on Demand for Healthcare Services in Tanzania

ABSTRACT: Consistent healthcare financing systems within a particular nation or community have been regarded as vital for making universal healthcare access. This study intended to examine the influence of health insurance on the demand for healthcare services and the influence of socio-economic, demographic and hospital-related factors on demand for health care services in Tanzania context. The study employed secondary data, which were analysed by descriptive statistics and the results were presented in tables and percentages. Econometric analysis was also done using binary probit regression model to determine the factors influencing demand for health care services in Tanzania. The instrumental variable was applied to address the problem of endogeneity of health insurance. The regression results revealed that gender, education level, household size, income, treatment cost, perceived health quality and health insurance type were significant and positively linked with demand for health care services. However, marital status was also significant but negatively associated with the demand for healthcare services. The study concluded that, despite of the efforts made by the government and other stakeholders on emphasis over having health insurance, the enrolment to health insurance schemes is still low although it has been noted to significantly influence the demand for health care services. Lastly, the paper recommends that the government and other stakeholders are required to formulate or strengthen the formulated policy in practice, purposively to improve access, affordability and the quality of health care services. Governmental and non-governmental organizations (NGO`s) and other stakeholders should put more effective strategies to improve coverage but also reduce the financial burden caused by illness. Also, the government needs to subsidize the healthcare sector, especially to the poor and provide subsidies to private healthcare facilities, improvement of insurance type, specifically, the NHIF which needs to increase coverage. Furthermore, health care managers should educate other people and make a clear observation on factors that make individuals demand for health care because they have a great role in the health care sector as well as strategies to improve household`s income to meet the health needs in Tanzania.

Organization and financing of the health care system in Kazakhstan

Despite the challenges posed by the consequences of the global pandemic, achieving the country's national development goals remains a strategic direction of public health policy. The article aims to study the dynamics of healthcare financing in Kazakhstan, provide forecasts of upcoming development, and compare it with healthcare systems of developed countries. Based on the analysis of the current state and potential problems, recommendations were developed to improve the healthcare financing system in Kazakhstan. This article also analyzes the main parameters of health financing in the Republic of Kazakhstan for the period 2012–2022 and, in comparison with developed countries, provides the main reasons for maintaining low parameters of public health financing, which becomes a real obstacle to the implementation of measures aimed at achieving universal health coverage. During the research, a wide range of methodological approaches was applied, including system analysis (the study of an object as an integral system, interrelated elements), comparative analysis (comparison of the studied object with others in a number of characteristics), functional analysis (identification of the functions of the elements of the object and their interrelations), economic and statistical analysis and synthesis (collection, processing, interpretation of economic and statistical data), mathematical methods (modeling of studied processes and phenomena using mathematical models), dialectical methods (the study of an object in its development, change and contradictions), analysis of the burden of the disease (assessment of the economic and social consequences of the disease).

Environmental Quality, Extreme Heat, and Healthcare Expenditures

Although the effects of the environment on human health are well-established, the literature on the relationship between the quality of the environment and expenditures on healthcare is relatively sparse and disjointed. In this study, the Environmental Quality Index developed by the Environmental Protection Agency and heatwave days were compared against per capita Medicare spending at the county level. A general additive model with a Markov Random Field smoothing term was used for the analysis to ensure that spatial dependence did not undermine model results. The Environmental Quality Index was found to hold a statistically significant (p < 0.05), multifaceted nonlinear association with spending, as was the average seasonal maximum heat index. The same was not true of heatwave days, however. In a secondary analysis on the individual domains of the index, the social and built environment components were significantly related to spending, but the air, water, and land domains were not. These results provide initial support for the simultaneous benefits of healthcare financing systems to mitigate some dimensions of poor environmental quality and consistently high air temperatures.

Statistical Analysis of the Prevalence and Predictors of Asthma and Allergic Rhinitis in Nigeria

The incidence and prevalence of asthma and allergic rhinitis have increased worldwide over the past ten years and it places a burden on already poorly financed healthcare systems. This article explores the prevalence of asthma and allergic rhinitis in Nigeria, utilizing statistical analyses to investigate the prevalence, demographic predictors, and familial associations. Objectives include determining average ages of diagnosis, identifying significant predictors, examining the relationship between asthma and allergic rhinitis, and investigating familial associations. The study employed the use of statistical tools like logistics regression, chi-square test of independence, cross-tabulation, and descriptive statistics. The analysis reveals an average age of 22 for asthma and 28 for allergic rhinitis. Significant predictors influencing asthma include age, body mass index, years of smoking, level of education, and the number of cigarettes smoked per day. The study establishes a positive correlation between asthma and allergic rhinitis, emphasizing their interconnected nature. Importantly, a highly significant relationship is identified between a family history of asthma and individual diagnoses. The prevalence of asthma and allergic rhinitis in Nigeria is influenced by various demographic factors that should be looked into, emphasizing the importance of considering demographic factors and age in developing effective approaches to address and manage asthma in the Nigerian population.

Assessing the maturity of integration of health and social care in Finland – findings from a pilot study

PurposeIntegrated care is the leading approach to developing health and social care services in Finland. After the national health and social care reform, the importance of assessing integration has been emphasized. The aim of this study was to pilot the SCIROCCO tool, which assesses integration maturity, in Finland. The SCIROCCO tool was translated and adapted to the Finnish health and social care context. The feasibility and utility of this tool for assessing the maturity for integration across health and social care in Finland were evaluated using empirical pilot data collected among employees of selected well-being service counties. The study also provided baseline information on the maturity of integration after the national health and social care reform.Design/methodology/approachEmployees (n = 111) of different personnel groups in health and social care services in four well-being service counties assessed the maturity of integration using a web-based survey. A pilot study design was used.FindingsThe SCIROCCO tool was found to be useful for assessing the maturity of integration in health and social care within the well-being service counties. However, the tool requires further development to be fully adapted to the Finnish health and social care system and to assess integration across sectors. The results emphasize the need to understand the perspectives of different personnel groups on integration and to consider them in the development work.Originality/valueThis was the first study conducted in Finland that provided valuable insights into the assessment of integration across the health and social care sectors. This study establishes the foundation for future research and development in the field of integration assessment.

Examining the Effect of Depicting a Patient Affected by a Negative Reimbursement Decision in Healthcare on Public Disagreement with the Decision.

The availability of increasingly advanced and expensive new health technologies puts considerable pressure on publicly financed healthcare systems. Decisions to not-or no longer-reimburse a health technology from public funding may become inevitable. Nonetheless, policymakers are often pressured to amend or revoke negative reimbursement decisions due to the public disagreement that typically follows such decisions. Public disagreement may be reinforced by the publication of pictures of individual patients in the media. Our aim was to assess the effect of depicting a patient affected by a negative reimbursement decision on public disagreement with the decision. We conducted a discrete choice experiment in a representative sample of the public (n = 1008) in the Netherlands and assessed the likelihood of respondents' disagreement with policymakers' decision to not reimburse a new pharmaceutical for one of two patient groups. We presented a picture of one of the patients affected by the decision for one patient group and "no picture available" for the other group. The groups were described on the basis of patients' age, health-related quality of life (HRQOL) and life expectancy (LE) before treatment, and HRQOL and LE gains from treatment. We applied random-intercept logit regression models to analyze the data. Our results indicate that respondents were more likely to disagree with the negative reimbursement decision when a picture of an affected patient was presented. Consistent with findings from other empirical studies, respondents were also more likely to disagree with the decision when patients were relatively young, had high levels of HRQOL and LE before treatment, and large LE gains from treatment. This study provides evidence for the effect of depicting individual, affected patients on public disagreement with negative reimbursement decisions in healthcare. Policymakers would do well to be aware of this effect so that they can anticipate it and implement policies to mitigate associated risks.

Political electoral cycles and evolution of Italian health care system financing. A long run perspective

A notable feature of the Italian healthcare system – where funding is centralized and regions manage services locally – is the mismatch between expenditure and funding dynamics, leading to a structural deficit and frequent bailouts on the part the regions. To explain the actions of central and regional governments, we propose a strategic game. The nature of the game varies depending on whether we are in an electoral period for the renewal of the regional government. During elections, regional incumbents use their information advantages, and it is rational for them to increase the deficit, whereas for the central government, it is rational to reduce transfers.That result is confirmed by the empirical analysis run on the 15 Italian Regions with ordinary statutes between 1982 and 2020. We have used Italy as a case study to demonstrate the relevance of our hypothesis, but we believe that the theoretical framework proposed in our paper can be applied to explain the significance of political cycles in determining the interaction between different levels of government in other federal contexts.

Willingness to join community-based health insurance and its associated factors among households in Nekemte City, Ethiopia. A community-based cross-sectional study

IntroductionEthiopia has been implementing community-based health insurance programs since 2011 to improve health care financing system. However, the prevalence of household willingness to join the community-based health insurance (CBHI) program and its associated factors are less explored in urban area. Therefore, this study was aimed to assess the prevalence of willingness to join community-based health insurance program and its associated factors among households in Nekemte City, Ethiopia.MethodsA community-based cross-sectional study was conducted on 422 randomly selected households in Nekemte City, Ethiopia. Bivariate and multivariable analyses were performed to see the association between the independent and outcome variables using binary logistic regression model. Association was described using an adjusted odd ratio (AOR) and a 95% confidence interval (CI). Finally, p-value < 0.05 was considered the cut-off point for declaring a significant.ResultsAmong 422 study participants, 320 (75.83%) [95% CI = 71.5-79.8%)] of the households were willing to join community-based health insurance program. The willingness to join for community-based health insurance was 3.11 times more likely among households who were in the richest quintile (AOR = 3.11; 95% CI = 1.08–8.93), 3.4 times more likely among those who were merchants (AOR = 3.40;1.33, 8.69), 2.52 times more likely among those who had history of chronic illness in the household (AOR = 2.52; 95% CI = 1.43–4.45), 4.09 times more likely among those who had the awareness about the scheme (AOR = 4.09; 95% CI = 1.97–8.47) and 3.29 times more likely among those who had the experience of borrow for medical care (AOR = 3.29; 95% CI = 1.48–7.30).ConclusionNearly three fourth of the households were willing to join community-based health insurance program, however, about one fourth of households were not willing, which is a significant public health problem. Being merchant, having awareness about the scheme, being in the richest wealth quintile, having experience of borrowing for medical care, and having history of chronic illness in the household were factors found to be significantly associated with willingness to join community based health insurance in the study area. Therefore, strengthening awareness creation at community level about the benefit package and principle of the program would increase their demand for the community-based health insurance scheme.

Inequalities in Out-of-Pocket Health Expenditure Measured Using Financing Incidence Analysis (FIA): A Systematic Review.

Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure inequalities measured by the FIA across different territories, in the context of achieving UHC by 2030. A comprehensive systematic search was conducted in the PubMed, Scopus, and Web of Science databases to identify original quantitative and mixed-method studies published in the English language between 2016 and 2022. A total of 336 articles were initially identified, and after the screening process, 15 articles were included in the systematic review, following the removal of duplicates and articles not meeting the inclusion criteria. Despite the overall regressivity, insurance systems have generally improved population coverage and reduced inequality in out-of-pocket health expenditures among the employed population, but regional studies highlight the importance of examining the situation at a micro level. The results of the study provide further evidence supporting the notion that healthcare financing systems relying less on public funding and direct tax financing and more on private payments are associated with a higher prevalence of catastrophic health expenditures and demonstrate a more regressive pattern in terms of healthcare financing, highlighting the need for policy interventions to address these inequities. Governments face significant challenges in achieving universal health coverage due to inequalities experienced by financially vulnerable populations, including high out-of-pocket payments for pharmaceutical goods, informal charges, and regional disparities in healthcare financing administration.

Addressing Financial and Administrative Challenges in Public Sector Health Programs: A Review of Pakistan’s Health care System

This study examines the financial and administrative obstacles that public sector health programs encounter, with Pakistan as the focal point. It explores the challenges associated with overseeing and financing public health projects. The study adds to the address on enhancing healthcare systems in developing nations such as Pakistan by analyzing key obstacles and possible remedies. Pakistan's healthcare system encounters various obstacles, such as restricted service accessibility, inadequate infrastructure, insufficient financial resources, disparities in healthcare quality, prevalent public health concerns, fragmented financing approaches, and governance inefficiencies. A comprehensive number of solutions and interventions are suggested to tackle these issues. These actions involve enhancing healthcare infrastructure, procuring cutting-edge medical equipment and technologies, increasing healthcare funding through creative approaches, enhancing healthcare worker training and education, launching extensive public health campaigns, revamping healthcare financing systems, and improving governance and management frameworks. Implementing these measures may assist Pakistan in developing a more robust, equitable, and effective healthcare system that guarantees equitable access to healthcare services for all.

Financial protection and equity in the healthcare financing system in Iran: a cross-sectional study among slum dwellers with type 2 diabetes

ObjectivesThis study was conducted to assess financial protection and equity in the healthcare financing system among slum dwellers with type 2 diabetes (T2D) in Iran in 2022.DesignCross-sectional study.SettingPrimary care centres...

Финансирование национальной системы здравоохранения с учетом тенденций развития медицинской помощи и социально-экономических реалий

The effectiveness of the functioning of the health care system consists in achieving high indicators of the quality of life of the population, which is achieved through the use of various regulatory and self-regulation tools in the health care system, which are always based on the need for financial support, which is the cornerstone of solving problems related to the need to increase the effectiveness of the health protection system. The financing of the healthcare system is considered from the point of view of its compliance with modern socio-economic realities. The optimal model of financing the domestic healthcare system is being investigated in terms of the relationship between the life expectancy of the population, the amount of financing for the health protection system, the number of medical institutions and the availability of medical personnel. The priority directions of the development of the national health financing system are substantiated. It is concluded that the national model for financing the health protection system should be a model based on the allocation of funds from the federal budget, which are directed to ensuring the financing of programs for the development of the national health system, as well as based on the creation of institutional, legislative and mental conditions for attracting public funds to the insurance industry medicine. It is confirmed that there is a close relationship between the effective indicator of life expectancy and public spending on health, which corresponds to WHO statistics. Other factors do not have such a strong impact on the national health system. It is recommended to further develop the healthcare financing system based on foreign experience, on the development of insurance and paid medicine.

Abstract P153: Disruptions to Diabetes and Hypertension Care During the COVID-19 Pandemic and Recovery Approaches in the Latin America and Caribbean Region

Background: The COVID-19 pandemic disrupted healthcare services in Latin America and the Caribbean (LAC). However, few studies provided comprehensive and quantitative data on the magnitude of this disruption. Objectives: To synthesize evidence on the extent of disruptions to diabetes and hypertension care in LAC during the COVID-19 pandemic and interventions to recover. Methods: We conducted a scoping review of published papers in English, Spanish, and Portuguese. We adopted the Primary Health Care Performance Initiative (PHCPI) Framework to identify healthcare services susceptible to disruptions during the COVID-19 pandemic, specific to diabetes and hypertension, including recovery approaches. We synthesized study findings narratively to represent the diversity of findings geographically and health system. Results: Our search yielded 33,510 abstracts after de-duplication; following title/abstract screening and full-text review, 330 articles (218 on disruptions; 112 on interventions) were included in the synthesis. Although there was high heterogeneity, similarities in landscape of disruptions to primary care services across LAC exist. Of the PHCPI Framework domains, disruptions to workforce, medications and supplies, and patient-related outcomes were most recurrent. Intervention studies focused telehealth using digital strategies for diverse care areas and counseling support for health behaviors and mental health. There were data gaps within LAC regarding health system readiness and digital health effectiveness, adoption, efficiency, reach, and sustainability ( Figure ). Conclusions: This scoping review identified priorities for action within LAC: 1) establish and fund high-quality research and surveillance systems for hypertension and diabetes; 2) Optimally integrate digital health into hypertension and diabetes care; 3) implement mental health promotion strategies among healthcare workers; 4) establish optimal governance, leadership, and financing of healthcare systems.

Effectiveness of the Coordinated Return to Work model after orthopaedic surgery for lumbar discectomy and hip and knee arthroplasty: a register-based study

ObjectivesThis study examined the effectiveness of an individualised Coordinated Return to Work (CRtW) model on the length of the return to work (RTW) period compared with a standard prescription of...

Effect of supplementary private health insurance on out-of-pocket inpatient medical expenditure: evidence from Malaysia.

The vital role of healthcare financing in achieving universal health coverage is indisputable. However, most countries, including Malaysia, face challenges in establishing an equitable and sustainable healthcare financing system due to escalating healthcare costs, an ageing population and a growing disease burden. With desirable pre-payment and risk pooling features, private health insurance (PHI) is considered an alternative financing option to reduce out-of-pocket (OOP) medical expenditure. However, ongoing theoretical and empirical debates persist regarding the adequacy of financial risk protection provided by PHI largely because it depends on its role, the benefit design and the regulations in place. Our study aimed to investigate the effect of supplementary PHI on OOP inpatient medical expenditure in Malaysia. Secondary data analysis was conducted using the Malaysian National Health and Morbidity Survey 2019 dataset. A total of 983 respondents with a history of inpatient hospitalization in the past 12 months were included in the study. Instrumental variable analysis using a two-stage residual inclusion was performed to address endogeneity bias, with wealth status and education level as the instrumental variables. Tobit regression model was used in the second stage considering the censored distribution of the outcome variable. Missing data were handled using multiple imputation. About one-fifth of the respondents had PHI. In this study, we found that having PHI significantly increased OOP inpatient medical expenditure in all three marginal effects. Additionally, age, residential location, ethnicity (citizenship), being covered by government guarantee letter, government funding and employer-sponsored health insurance were other significant factors associated with OOP inpatient medical expenditure. Our findings undermine a key justification to advocate PHI uptake among the population, with a need for the Malaysian government to reassess the role of PHI in healthcare financing and reconsider PHI subsidization policy. Regulations should also be strengthened to enhance the financial risk protection provided by PHI.

Association of Frailty with Healthcare Utilization for Patients over One Year Following Surgical Evaluation.

Characterize the distribution of healthcare utilization associated with pre-operative frailty in the year following evaluation by a surgeon. Frailty is associated with increased morbidity, mortality, and costs for surgical patients. However, the total financial burden for frail patients beyond the index surgery and inpatient stay remains unknown. Prospective cohort assembled from February 2016 to December 2020 within a multi-hospital integrated healthcare delivery and finance system (IDFS), from patients evaluated with the Risk Analysis Index (RAI) of frailty. Inclusion criteria: age greater than 18, valid RAI, membership in the IDFS Health Plan. Data were stratified by frailty and surgical status. The mean (SD) age was 54.7 (16.1) and 58.2% female of the cohort (n=86,572). For all patients with reimbursement for surgery (n=53,856), frail and very frail patients incurred respective increases of 8% ( P =0.027) and 29% ( P <0.001) on utilization relative to the normal group. Robust patients saw a 52% ( P <0.001) decrease. This pattern was more pronounced in the cohort without surgery (n=32,716). The increase over normal utilization for frail and very frail patients increased to 23% ( P =0.004) and 68% ( P <0.001), respectively. Utilization among robust patients decreased 62% ( P <0.001). Increases among the frail were primarily due to increased inpatient medical and post-acute care services (all P <0.001). Patient frailty is associated with increased total healthcare utilization, primarily via increased inpatient medical and post-acute care following surgery. Quantifying these frailty-related financial burdens may inform clinical decision making as well as the design of value-based reimbursement strategies.

System's Crisis Resilience as a Societal Crisis: Knowledge Structure and Gaze of the Finnish Health Care System.

The crisis resilience of vital social systems is currently the target of constant development efforts in Finland, as their drifting into crisis would weaken societies' functional abilities, safety, and security. This is also the case regarding the Finnish health care system. In an attempt to move beyond existing frameworks of crisis imagination, this article takes an unconventional stance by elucidating endogenous crisis dynamics present in the Finnish health care system. Delphi process was conducted for top experts in Finnish health care and crisis management. With a dissensus-seeking orientation, our aim was to fertilize disagreements among panelists to reveal key vulnerabilities in the health system. Despite our efforts to evoke dissensus, the panelists ended up generating a consensus that aims to protect the underlying assumptions of the health system's knowledge structure. Through inductive analysis of expert discourses, the data was analyzed through our research question "what constitutes a crisis-proof health system and a crisis-prone health system". What is framed as a strength of the system by our panelists, namely the ability to maintain legitimacy, improve efficiency, and guarantee continuity, can still have questionable implications that are left ungrasped. A system's theory approach illustrates how such effects can develop and escalate beyond the reach of social interventions, and thus be predisposed to cause objectionable yet concealed social crises. The discussion illustrates how these endogenous crisis dynamics could be seen to materialize in real-life cases.