Formulation Of Health Care Policy Research Articles

Empirical Study on the Usage of Telemedicine by Rural and Urban Health Care Consumers in Taiwan: Integrating the Perspectives of Technology Acceptance Model and Theory of Planned Behavior.

Introduction: The outbreak of the novel coronavirus disease-19 posed significant challenges globally, impacting various sectors and health care systems profoundly. In response, telemedicine has emerged as a vital solution to address health care demands and resource shortages. However, there is a lack of comprehensive research on telemedicine usage among health care consumers in urban and rural areas of Taiwan. Methods: This study aimed to investigate the usage, attitudes, and intentions of telemedicine utilization among health care consumers in Taiwan, integrating the Technology Acceptance Model and Theory of Planned Behavior. A cross-sectional study was conducted from April 2023 to May 2024, involving 1,053 participants who utilized telemedicine services. Structured questionnaires were used for data collection, and statistical analyses were performed using SPSS 21.0 software. Results: The results revealed significant disparities in telemedicine utilization between urban and rural areas, with urban residents exhibiting higher levels of perceived ease of use, perceived usefulness, attitude toward use, trust, and intention to use telemedicine. Regression analysis indicated a significant association between urban residence and male gender with telemedicine utilization, contrary to previous research findings. These disparities may stem from differences in health care accessibility and cultural norms prevalent in urban and rural areas. Conclusions: Further investigation into gender differences and interventions to promote telemedicine usage among females, particularly in urban areas, are recommended. This study provides valuable insights for future research and health care policy formulation.

Superior medical resources or geographic proximity? The joint effects of regional medical resource disparity, geographic distance, and cultural differences on online medical consultation

Online medical consultation platforms enable patients to seek health advice from physicians across geographic regions. In this study, we analyze patterns of online consultation between patients and physicians. We examine the joint effects of regional medical resource disparity, geographic distance, and cultural differences between patients and physicians on patients' decisions about which physicians they consult online. Using a unique dataset of city-to-city tuples based on 813,684 online consultation records and combining it with region-level data from multiple external sources, we find that while regional medical resource disparity drives patients from medically disadvantaged regions to seek online consultations with physicians from medically advantaged regions, geographic distance and cultural differences tend to constrain these consultations. We also find that cultural differences can amplify the impact of regional medical resource disparity, whereas geographic distance may lessen this effect. Further, we discover that the constraining effect of geographic distance is partly due to the online-to-offline nature of online medical consultations. Moreover, additional analyses suggest that physicians' online reputation and information about physicians’ participation on the platform can help alleviate the negative effects of geographic distance and cultural differences. These findings hold significant implications for the allocation of medical resources and the formulation of healthcare policies.

Impact of health expenditure on poverty in low- and middle-income countries: An autoregressive distributed lag bounds approach

The high costs of complex and numerous medical services, coupled with various diseases and epidemics, result in a substantial financial burden for individuals. The previous studies have focused on extending health financing and access to health services. However, it is crucial to use resources effectively to avoid impoverishment. This study investigates the relationship between poverty rates and health-care expenditure in low- and middle-income countries from 2000 to 2018 by employing the error correction model and autoregressive distributed lag models to identify the long- and short-run relationships and adjustment speed toward equilibrium. The results demonstrate a significant positive relationship between poverty and healthcare expenditure in both the long and short terms. The significant ECT result implies a relatively slow adjustment speed toward equilibrium, indicating that deviations from the equilibrium level take almost 5 years to rectify. These results emphasize the importance of policymakers judiciously weighing the opportunity costs associated with health-care management goals. While extending health financing and promoting access are crucial objectives, the findings of this study emphasize the need to align these efforts with efficient resource utilization to prevent the inadvertent exacerbation of poverty. In conclusion, this study contributes valuable insights to the discourse on health economics, advocating for a balanced and holistic approach to health-care policy formulation and implementation.

프랑스의 공중보건 위기대응과 위원회의 역할

Needs for effective and prompt actions in public administration of contemporary nations call for almost inevitably diversified and specialized managements in the form of committee system. It is frequently employed by many nations, more prominently in the field of science and technology. Second half of the 20th century saw to it that science drove the flow of the national economy, culminating in intensive developments including international standardization in various fields. Above all, the constitutional basis for this was established finally. and the National Science and Technology Advisory Council Act was enacted in 1991 to provide advice on innovation in science and technology. With the institutional framework on this matter being established, for instance, in the event of infectious diseases such as the coronavirus comes infectious, expert scientific opinion is required mandatory prior to the government's policy formulation and execution. By now the ptactice is solid, and the advices and technical opinions in almost all cases are formed by way of committees. In France, in order to maintain public health in general and respond to crises such as the recent pandemic like Corvid-19, the Ministry of Health is responsible for healthcare policy formulation, execution of it, and let alone research and development. The last part, R&D is shared by an independent administrative agency, the Higher Health Agency, along with various technical institutes and networks of healthcare professionals. In particular in view of the gravity of the Corvid-19 problem the government established a temporary organization on top of the 120-year-old Higher Committee on Public Health and the National Ethics Advisory Committee, which deals with ethical issues and other existing committees. These organizations seek and strive for transparency and fairness in their activities through committee composition, disclosure of committee activities, oaths of professional ethics of members, and ensuring citizen participation.

Cloud based IoT Electronic Healthcare Data Warehouse Integration in emerging 5G Health Grid Ecosystem

The integration of heterogeneous enterprise cloud data warehouses enables the formation of national health grid ecosystem that links public and private health databases to enable supervision of healthcare utilities, costs, quality of care and observance of national healthcare administrative protocols. The development of cloud data warehouse requires information communication technology to condense the costs of patient’s healthcare by supporting care, away from hospitals, where increasingly detailed data can move from patients to centralized cloud server data warehouse, allowing efficiency in diagnosis and treatment options. The global democratization of 5G telecommunication broadband creates entirely new use case scenarios for consumers addressing healthcare sector and industries, intending to improve citizen’s life expectancy. The improved data rate transmission revolutionizes healthcare sector and offers prospects that enable the telecommunication merchants to penetrate the supply chains and initiate partnerships that profit the entire healthcare business ecosystem. This paper analyses the 5G network implementation business potentials, focusing on the 5G business opportunities that originate from industrial healthcare automation, allowing patient data aggregation required for citizens’ healthcare management. The research entrenches the 5G radio frequency access network and distributed cloud IoT server systems in constructing a healthcare grid data warehouse to enable self-optimized service-level agreements. Moreover, this paper observes that the healthcare sector prioritized telecommunication operators when partnership issues were debated above every other service sector addressing healthcare development. The cloud IoT platform offers solution to synchronize-able global device connectivity management for e-healthcare and demonstrates how these improvements enable development of new systems for public healthcare policy formulation and delivery in Nigeria.

Governance in mental healthcare policies during the COVID-19 pandemic in Mexico.

The COVID-19 pandemic has become the greatest burden of disease worldwide and in Mexico, affecting more vulnerable groups in society, such as people with mental disorders (MD). This research aims to analyze the governance processes in the formulation of healthcare policies for people with MD in the face of the COVID-19 pandemic. An analytical qualitative study, based on semi-structured interviews with key informants in the healthcare system was conducted in 2020. The study followed the theoretical-methodological principles of the Governance Analytical Framework (GAF). The software ATLAS.ti-V.9 was used for inductive thematic analysis, classifying themes and their categories. To ensure the proper interpretation of the data, a process of triangulation among the researchers was carried out. The findings revealed that in Mexico, the federal Secretary of Health issued guidelines for mental healthcare, but there is no defined national policy. Decision-making involved multiple actors, with different strategies and scopes, depending on the type of key-actor and their level of influence. Majority of informants described a problem of implementation in which infection control policies in the psychiatric population were the same as in the general populations which decreased the percentage of access to healthcare during the pandemic, without specific measures to address this vulnerable population. The results suggest that there is a lack of specific policies and measures to address the needs of people with mental disorders during the COVID-19 pandemic in Mexico. It also highlights the importance of considering the role of different actors and their level of influence in the decision-making process.

Scholarly Publishing With the American Urological Association—The Expansion of the “Voice of Urology” Into Open Access With the Journal of Urology Open Plus

Scholarly Publishing With the American Urological Association—The Expansion of the “Voice of Urology” Into Open Access With the Journal of Urology Open Plus

Factors influencing injury or death due to traumatic events in Afghanistan’s crisis-affected populations: a cross-sectional nationwide study

ObjectiveAfghanistan, with one of the world’s largest refugee populations, suffers an enormous burden of injury resulting in loss of life. This study aims to identify the epidemiology of injuries or...

Six-Year Incidence and Risk Factors for Primary Angle-Closure Disease: The Singapore Epidemiology of Eye Diseases Study

To determine the incidence and risk factors of primary angle-closure disease (PACD) over 6 years in a multi-ethnic Asian population. Population-based, longitudinal study. The Singapore Epidemiology of Eye Diseases study is a population-based cohort study conducted among adults aged 40 years or more. The baseline examination was conducted between 2004 and 2010, and the 6-year follow-up visit was conducted between 2011 and 2017. Of 6762 participants who attended the follow-up examination, 5298 at risk for primary angle-closure glaucoma (PACG) and 5060 at risk for PACD were included for analyses. Standardized examinations including slit-lamp biomicroscopy, indentation gonioscopy, intraocular pressure (IOP) measurement, and static automated perimetry were performed. In this study, PACD includes primary angle-closure suspect (PACS), primary angle-closure (PAC), and PACG. The 6-year PACD incidence was evaluated among an at-risk population excluding adults with baseline glaucoma, PACS, PAC, pseudophakia at baseline or follow-up, or laser peripheral iridotomy or iridectomy at baseline visit. Logistic regression analysis adjusting for age, gender, and ethnicity was performed to evaluate associations between PACD development and demographic or ocular characteristics. Forward selection based on the Quasi-likelihood Information Criterion was used in multivariable analysis to reduce potential multicollinearity. The 6-year age-adjusted PACD incidence was 3.50% (95% confidence interval [CI], 2.94-4.16). In multivariable analysis, increasing age per decade (odds ratio [OR], 1.35; 95% CI, 1.15-1.59), higher IOP (OR, 1.04; 95% CI, 1.00-1.08), and shallower anterior chamber depth (OR, 1.11; 95% CI, 1.08-1.14) at baseline were associated with higher odds of PACD, whereas late posterior subcapsular cataract (PSC) (OR, 0.60; 95% CI, 0.48-0.76) was associated with lower odds of PACD. The 6-year age-adjusted incidences of PACG, PAC, and PACS were 0.29% (95% CI, 0.14-0.55), 0.46% (95% CI, 0.29-0.75), and 2.54% (95% CI, 2.07-3.12), respectively. Our study showed that the 6-year incidence of PACD was 3.50%. Increasing age, higher IOP, and shallower anterior chamber were associated with a higher risk of incident PACD, whereas late PSC was associated with a lower odds of PACD. These findings can aid in future projections and formulation of health care policies for screening of at-risk individuals for timely intervention.

Examining the reliability of ICD-10 discharge coding in Red Cross War Memorial Children's Hospital administrative database.

Discharge diagnostic data from hospital administrative databases are often used to inform decisions relating to a variety of vital applications. These may include the allocation of resources, quality-of-care assessments, clinical research and formulation of healthcare policy. Accurately coded and reliably captured patient discharge data are of paramount importance for any hospital and health system to function efficiently. To retrospectively examine the reliability of the International Classification of Diseases version 10 (ICD-10) discharge coding in Red Cross War Memorial Children's Hospital (RCWMCH)'s administrative database for primary and secondary discharge diagnoses, and to formulate recommendations for improvement to the current system. This study was a retrospective folder review of 450 patient admissions to the short-stay and general paediatric wards at RCWMCH between 1 August 2013 and 1 September 2014. The principal investigator (PI) completed ICD-10 discharge coding for each admission and compared it with the corresponding admission data captured for each patient in the Clinicom (Siemens Medical Solutions, Germany) health information system. Agreement comparison was done to 4- and 3-character ICD-10 code specificity. Of the initial 450 randomly selected folders, 396 (88%) were analysed during the folder review process. The median number of total diagnoses (primary diagnosis plus secondary diagnoses) coded by the PI folder review was 3, with a distribution of 1 - 10 (interquartile range (IQR) 2 - 4). The median number of total diagnoses coded in Clinicom was 1, with a distribution of 1 - 3 (IQR 1 - 1). Agreement of primary diagnosis coding to 4 characters was 26.3%, with slight improvement to 34.3% when assessed to 3 characters. Agreement of secondary diagnoses to 4 characters was 14.9%, and 27.7% when assessed to 3 characters. Reliability of administrative ICD-10 discharge data from RCWMCH is poor. Inadequacies regarding the employment of dedicated and/or adequately trained coding personnel may significantly contribute to the problem and should be addressed.

Distribution pattern and prevalence of haematological cancers among adults in Abakaliki, South-Eastern Nigeria.

Haematological cancers are clonal diseases of the blood and blood-forming organs, with the distribution pattern not known in our locality. This study aimed to describe the distribution pattern and prevalence of haematological cancers among adults in Abakaliki, Nigeria. This was an 8-year retrospective study in which the hospital records/case notes of adult patients diagnosed and managed for haematological cancers from May 2012 to April 2020 were reviewed. Data obtained were analysed with the SPSS software, version 20. One hundred and thirty-five cases of haematological cancers were included in the study, with 72 (53.4%) males and 63 (46.6%) females and male-to-female ratio of 1.1:1. The age range was 18-82 years, with a mean age of 49 ± 17 years. Lymphoid malignancies predominate more than myeloid (101 [74.8%] vs. 34 [25.2%]). The leukaemias were more predominant than the lymphomas and myeloma accounting for 48.2%, 36.3% and 7.4%, respectively. Chronic leukaemias were more common than the acute leukaemias with chronic lymphocytic leukaemia (CLL) being the most common accounting for 24.4% of haematological cancers. In general, non-Hodgkin's lymphoma (NHL) was the most common haematologic cancer accounting for 35 (25.9%), followed by CLL 33 (24.4%), chronic myeloid leukaemia (CML) 17 (12.6%), Hodgkin's lymphoma (HL) 14 (10.4%) and multiple myeloma (MM) 10 (7.4%). Others include acute lymphoblastic leukaemia (ALL) 9 (6.7%) and acute myeloblastic leukaemia (AML) 6 (4.4%). Myelodysplastic syndrome (MDS) and polycythaemia vera (PV), each contributed 3% while myelofibrosis (MF) and essential thrombocythaemia (ET) contributed 1.5% and 0.7%, respectively. This study has shown that haematological cancers are not uncommon in our locality with NHL being the most common, followed by CLL, CML, HL, MM, ALL, AML, MDS, PV. MF and ET in that order. The burden of haematological cancers in Ebonyi State, Nigeria is therefore significant and should be prioritised in health-care policy formulation and management.

Geographical disparities in the prognosis of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: a large institution-based cohort study from an endemic area

ObjectivesGeographical disparities have been identified as a specific barrier to cancer screening and a cause of worse outcomes for patients with cancer. In the present study, our aim was to...

Incidence and characteristics of cataract surgery in South Korea from 2011 to 2015: A nationwide population-based study.

Detailed incidence data for cataract surgery in the general population are limited, yet important for determining the surgical needs of the community and formulation of healthcare policies. To report incidence rates of cataract surgery in South Korea. Nationwide, retrospective population-based study. This study involved the entire population of South Korea (n = 47 990 761); 2 236 107 eyes of 1 591 176 patients confirmed as having cataract surgery from 1 January 2011 to 31 December 2015 were included. Data for all patients who underwent primary cataract surgery in South Korea were retrieved using Korean Electronic Data Interchange and Korean Standard Classification of Diseases-7 codes. Annual incidence rates were calculated and adjusted to the national population data for the corresponding year. The average incidence of cataract surgery during the 5-year study period was estimated using population data from the 2010 Korean census. The incidence of cataract surgery increased from 8.54/1000 person-years in 2011 to 9.67/1000 person-years in 2015. The probability of second-eye surgery within 12 months after the first-eye surgery increased from 42.98% in 2011 to 48.01% in 2015. In total, 85.72% of surgeries were performed in non-rural areas: 43.18% in individuals with a higher household income and 76.65% in primary healthcare centres. The rate of vitrectomy for posterior capsular rupture was 0.72%. The incidence of cataract surgery in South Korea is increasing over time. Our findings are expected to aid in the formulation of future healthcare policies concerning cataract surgery in South Korea.

Prevalence of female urinary incontinence in the state of Roraima, Brazil

Urinary incontinence (UI) is a significant health problem leading to physical, psychological and social discomfort, especially in elderly women. A study of prevalence and classification of UI in the Roraima state was taken up to aid in formulation of healthcare policy and improvement of patient referral facilities. A retrospective study of 765 female patients who have undergone urodynamic examination between November 2013 and December 2014 has been conducted. Subjects were classified in to diagnostic classes: normal, stress incontinence, mixed incontinence, sensitive emergency, overactive bladder, and others. The overall prevalence of UI was 58.4%. The highest prevalence was observed in the menopausal age group (45- 49 years). Among the etiologies of UI, stress incontinence ranked highest at 30.9%, followed by overactive bladder at 6.9%. In the 25-55 years age group, stress incontinence was predominant (50-63%), while overactive bladder became significant (14-44%) in later years. The prevalence of UI in women in the state of Roraima, was high, in line with its prevalence in Brazil, as well as other western countries.

Llness pattern and the relationship between the prevalence of malaria and other infections in Niger Delta University

The illness pattern and the relationship between malaria and other infections were examined in the present work – a base-line information prior to a meaningful healthcare policy formulation. A period of 5years (2007 – 2011) illness pattern was retrospectively obtained from the University Medical Centre, while questionnaires addressing the various health-related activities were administered to 500 volunteer subjects - students and staff of the institution. Biochemical parameters in the various disease conditions were determined using standard tests, while the means of frequencies of disease occurrence were compared using statistical package for social sciences (SPSS). Results of mean comparison showed that the mean of frequencies of malaria infection was significantly increasing (p 0.05). Malaria infection was the most prevalent illness with the highest frequency occurring around the month of April, accounting for 63.83 – 67.10% of the illnesses compared. This was followed by upper respiratory tract infection (URTI), peptic ulcer, and candidiasis, in that order. The relationship between the illness types showed that a positive correlation existed between malaria and typhoid, and malaria and URTI, (p<0.05). From the results of questionnaire analysis, 70.89% of the male students’ group admitted having a frequency of one to twelve attacks of malaria infection per annum with 43.67% of them who claimed to have suffered previous typhoid infections. As a result, 25.32% were absent from lectures for a period of 1- 30 days per annum. These results showed that malaria infection was on the increase and apart from the likelihood of impacting negatively on students’ performance, could represent a huge source of financial drain on a developing economy.

Prevalence of Autism Spectrum Disorder among Nigerian Children with Intellectual Disability: A Stopgap Assessment

The prevalence of autism spectrum disorder (ASD) among sub-Saharan African children with intellectual disability is about 0.7% more than three decades ago. During this period, the prevalence of ASD has been on the increase worldwide. Studies are not available in recent times addressing epidemiology of ASD among sub-Saharan African children. The present study assessed the prevalence of ASD among Nigerian children with intellectual disability. Forty four children with intellectual disability were assessed for diagnosis of childhood autism based on criteria specified in F84.0 section of International Classification of Diseases, Tenth Edition (ICD-10) Diagnostic Criteria for Research. Five (11.4%) of the children studied met the diagnostic criteria for childhood autism. Male/female ratio was 4:1. There is need for large scale epidemiological studies of ASD among sub-Saharan African children to clearly define the inter-relationship between ASD and intellectual disability in this population and to help in health care policy formulation.

Osteoporosis: burden, health care provision and opportunities in the EU

Osteoporosis, literally "porous bone", is a disease characterized by weak bone. It is a major public health problem, affecting hundreds of millions of people worldwide, predominantly postmenopausal women. The main clinical consequence of the disease is bone fractures. It is estimated that one in three women and one in five men over the age of fifty worldwide will sustain an osteoporotic fracture. Hip and spine fractures are the two most serious fracture types, associated with substantial pain and suffering, disability, and even death. As a result, osteoporosis imposes a significant burden on both the individual and society. During the past two decades, a range of medications has become available for the treatment and prevention of osteoporosis. The primary aim of pharmacological therapy is to reduce the risk of osteoporotic fractures. The objective of this report is to review and describe the current burden of osteoporosis and highlight recent advances and ongoing challenges for treatment and prevention of the disease. The report encompasses both epidemiological and health economic aspects of osteoporosis and osteoporotic fractures with a primary geographic focus on France, Germany, Italy, Spain, Sweden, and the UK. Projections of the future prevalence of osteoporosis and fracture incidence, the total societal burden of the disease, and the consequences of different intervention strategies receive special attention. The report may serve as a basis for the formulation of healthcare policy concerning osteoporosis in general and the treatment and prevention of osteoporosis in particular. It may also provide guidance regarding the overall healthcare priority of the disease. © International Osteoporosis Foundation and National Osteoporosis Foundation 2011.

Comparison Between Pregnant Southeast Asian Immigrant and Taiwanese Women in Terms of Pregnancy Knowledge, Attitude Toward Pregnancy, Medical Service Experiences and Prenatal Care Behaviors

The purpose of this study was to compare pregnant Southeast Asian immigrant and Taiwanese women in terms of their respective pregnancy knowledge, attitudes toward pregnancy, medical service experiences and prenatal care behaviors. Findings should provide a reference for the formulation of healthcare policies. This study used a cross-sectional design. Subjects were recruited from township/ village communities or the outpatient services of local health centers in Kaohsiung County, southern Taiwan. Women between the 28th week of gestation and one year post-delivery were recruited. A total of 132 Southeast Asian immigrants and 127 Taiwanese women were included in this study. Questionnaires were used to collect data. Research instruments included the Demographic Inventory Scale, Knowledge of Pregnancy Scale, Attitude toward Pregnancy Scale, Experience of Medical Services Scale, and Prenatal Care Behavior Scale. Results showed scores of Southeast Asian immigrant women to be lower than those of Taiwanese women in terms pregnancy knowledge, attitude toward pregnancy, and medical service experiences. In terms of prenatal care behaviors, 26 Southeast Asian immigrant women (19.7%) did not receive prenatal care during the first three months, while 54 (40.9%) did not receive periodic prenatal care. These two prenatal care behavior scores for Southeast Asian immigrant women were significantly lower than those for Taiwanese women. Healthcare professionals should provide healthcare education to Southeast Asian immigrant women, assist their families to adopt family planning, and provide appropriate information on prenatal care and local medical services as well as consultation channels so that they can obtain accurate knowledge on the healthcare system and appreciate the purpose and importance of prenatal care.

Putting policy into practice: pre‐ and posttests of implementing standardized languages for nursing documentation

To describe the change in documentation of the nursing process in all inpatient wards in a 900-bed university hospital. Major research question was what are the differences between before and after implementation of documentation policy related to the steps of the nursing process? Implementation of standardized languages has been shown to be difficult to accomplish in clinical practice. Patients are the source of data and their conditions, responses and well-being should be reflected in the nursing record. As such, nursing documentation can create the premises for the development of new knowledge in nursing and the improvement of nursing performance and can provide data and information necessary for nursing researchers to evaluate the quality of interventions and participate in the formulation of healthcare policy. This study is part of longitudinal project to prepare nurses for electronic documentation within the interdisciplinary health record and to improve documentation of nursing using standardized languages. A cross-sectional study design was used: a pretest (n = 355 nursing records) for baseline status of nursing documentation, an intervention and a post-test (n = 349 nursing records) to obtain data on nursing documentation. The year-long intervention comprised planned work in groups, and educational and supporting efforts. A statistically significant improvement was found in the use of Functional Health Patterns for documentation of nursing assessment, NANDA for nursing diagnoses and Nursing Interventions Classification for nursing interventions in documentation of daily nursing care for inpatients. At all organizational levels intervention aimed at putting policy regarding documentation into clinical practice considerably improved daily use of standardized nursing languages. Relevance to clinical practice. Nurses need to use standardized language to document patient care data in the electronic health record and to demonstrate contributions to nursing care.

What Predicts the Quality of Advanced Cancer Care in Latin America? A Look at Five Countries: Argentina, Brazil, Cuba, Mexico, and Peru

Cancer is now a leading cause of death among adults in most Latin American nations. Yet, until recently, there has been limited research on the quality of, and access to, advanced cancer care in developing regions such as Latin America. This landmark, cross-national study assessed the quality of advanced cancer care in five Latin American countries by surveying a convenience sample of 777 physicians and nurses, and identifying the most salient influences on their quality-of-care assessments based on multiple linear regression analyses. Strategies for disseminating this survey included mass mailings, distribution at professional meetings/conferences, collaboration with Latin American institutions, professional organizations, and the Pan American Health Organization, and online posting. Results indicate that the respondents' assessments of the quality of, access to, and affordability of advanced cancer care varied significantly across nations ( P < 0.001). The strongest predictor of providers' national-level assessments of the quality of care was their ratings of access to advanced cancer care (Beta = 0.647). Other predictors included affordability of care, country (Cuba vs. the other four countries), income-gap quintile, and institutional availability of opioid analgesics. Low prioritization of palliative care in both health care policy formulation and provider education also predicted the quality-of-care ratings. Findings from this study suggest that providers from five different nations hold similar equitable notions of quality care that are dependent on the provision of accessible and affordable care. Measures of social equity, such as the income-gap quintile of nations, and measures of policy barriers, such as the scale developed in this study, should be replicated in future studies to enable policy makers to assess and improve advanced cancer care in their countries.