Universal Coverage Research Articles

Insight into the Epidemiology of the Adult-onset Systemic Autoimmune Rheumatic Diseases in Egypt: A Descriptive Study of 8690 Patients.

Although systemic autoimmune rheumatic diseases (SARDs) seem to be ubiquitous, Africa and the Middle East seem to be a remarkable exception with scarcity of data compared with the developed countries. Furthermore, most of the studies addressed a particular disease. This work aimed to shed light on the relative frequency and epidemiology of the different adult-onset SARDs in Egypt. This is a retrospective hospital-based study including six university hospitals providing free health care services: Cairo, Alexandria, Tanta, Suez Canal, Beni-Suef and Assiut University Hospitals. All available files for patients attending the outpatient clinics or admitted to the inpatient departments between January 2000 and December 2021 were retrospectively reviewed. Data about the patient's diagnosis, gender, age at disease onset, year of disease onset and residence were collected. The study included 8690 patients. Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Behçet's disease (BD) and spondyloarthropathies (SPA) represented the main SARDs in Egypt. They mainly affect young patients below the age of 40 years. RA and SLE mainly affect females; males are mainly affected by axial SPA and BD. There is an increasing incidence of SARDs during the study period. The study revealed the high burden of SARDs in Egypt, helping better allocation of economic resources for the management of diseases of the highest prevalence and those affecting the young reproductive age groups. Increased public and medical staff awareness about SARDs is recommended to help early referral of patients to rheumatologists and, hence, better estimation of their epidemiology.

A 25-Year Retrospective of Health IT Infrastructure Building: The Example of the Catalonia Region

Over the past decades, health care systems have significantly evolved due to aging populations, chronic diseases, and higher-quality care expectations. Concurrently with the added health care needs, information and communications technology advancements have transformed health care delivery. Technologies such as telemedicine, electronic health records, and mobile health apps promise enhanced accessibility, efficiency, and patient outcomes, leading to more personalized, data-driven care. However, organizational, political, and cultural barriers and the fragmented approach to health information management are challenging the integration of these technologies to effectively support health care delivery. This fragmentation collides with the need for integrated care pathways that focus on holistic health and wellness. Catalonia (northeast Spain), a region of 8 million people with universal health care coverage and a single public health insurer but highly heterogeneous health care service providers, has experienced outstanding digitalization and integration of health information over the past 25 years, when the first transition from paper to digital support occurred. This Viewpoint describes the implementation of health ITs at a system level, discusses the hits and misses encountered in this journey, and frames this regional implementation within the global context. We present the architectures and use trends of the health information platforms over time. This provides insightful information that can be used by other systems worldwide in the never-ending transformation of health care structure and services.

Determinants of households' willingness to pay for health insurance in Burkina Faso.

The operationalization of universal health insurance in Burkina Faso represents a significant challenge for health coverage. The willingness of households to pay is a crucial aspect of the process. This highlights the necessity of examining the factors that may explain their willingness to pay. The objective of this study is to analyze the determinants of households' willingness to pay for health insurance in Burkina Faso. The data used in this study were collected between March and September 2017 in the territory of Burkina Faso, covering six administrative regions. A total of 211 households were surveyed, 71 in urban areas and 140 in rural areas. The Tobit model was employed to analyze the determinants of willingness to pay, with the contingent valuation method used to obtain willingness to pay. The results of the descriptive analysis indicate that households are willing to pay approximately 7,600F CFA on average for health insurance. The estimation results demonstrate that income has a positive effect on households' willingness to pay. Additionally, the occupation of the head of household and the insurance reimbursement rate are identified as determinants of willingness to pay. The findings of this study indicate that income, the rate of repayment and the occupation of the head of household are the primary determinants of willingness to pay. In terms of implications, it is essential to ensure that the rate of protection is high, which could encourage households to pay the premium. Furthermore, the results of the evaluation suggest that interventions to increase household income may be beneficial.

Associations Between Hearing Loss and Health-Related Costs: A Retrospective Population-Based Cohort Study

Purpose: Hearing loss (HL) is a leading cause of disability worldwide, but its health-related costs have been incompletely studied. Our objective was to examine the association between HL and direct health care costs and identify subgroups in which costs associated with HL are especially high. Method: This was a retrospective population-based cohort study of adults treated in a universal health care system between April 2008 and March 2019. HL was identified using administrative health data. We estimate health care costs in 2023 Canadian dollars, including costs for hospitalization, provider claims, ambulatory care visits, prescription medications, and long-term care (LTC). Results: Of 4,424,632 participants, 146,644 (3.3%) had HL. Participants with HL were older ( Mdn = 55 years [interquartile range: 43–68] vs. 35 years [24–50]) and had more comorbidities (1 [0–2] vs. 0 [0–1]) at baseline than participants without, whereas the likelihood of female sex, rural residence, and material deprivation were similar between groups with and without HL. Over median follow-up of 11.0 years, total age–sex adjusted annual health costs and each of its component costs were significantly higher in participants with HL compared to those without (annual total costs: $6,871, 95% confidence interval [CI] [$6,778, $6,962] vs. $4,716, 95% CI [$4,729, $4,763]). After full adjustment (a maximum of 29 comorbidities), annual costs remained significantly higher in participants with HL overall and for certain subcomponents (provider claims, ambulatory visits, and medications), whereas adjusted costs of hospitalization and LTC were lower among people with HL. The magnitude of the incremental costs among participants with HL was most pronounced for younger participants, men, or those with less comorbidity. Total projected annual direct health costs for Alberta residents with HL were $1.01 billion in 2023, of which $125 million (95% CI [$116, $135 million]) was attributable to HL specifically. Conclusions: Compared to those without HL, health costs were markedly higher among participants with HL, partially due to a higher burden of comorbidity. The relatively high population attributable costs of HL suggest that better prevention, recognition, and management of this condition could yield substantial economic benefits. Supplemental Material: https://doi.org/10.23641/asha.27353439

Contributory Factors to the Inability of the Poor to Access National Health Protection: A Case Study in Waingapu, Sumba Timur District, Indonesia

Millions of poor Indonesians still need access to Indonesia's National Health Protection (NHP). The study investigated barriers making NHP inaccessible for the poor in Waingapu, Sumba Timur, Indonesia. We used a qualitative approach to identify the contributing factors to why NHP was inaccessible for some populations. A total of 30 residents of Waingapu who attended healthcare in two hospitals and five Community Health Centers were recruited using convenience technic. Twenty residents participated in the semi-structured interview, while ten engaged in casual conversations. We also interviewed three heads of community groups and three health cadres for comparative information. Questions have been developed to guide the interviews and casual conversation. The interviews were audio-taped and transcribed while intensive note-taking was performed during the informal discussion or the conversation was narrated immediately after the talks ended. The information was inductive, analyzed, and coded to produce common information among the participants. The data analysis revealed the factors that contributed to the failure of the resident to enroll in the NHP, such as lack of information about the registration, poor socialization of the program, the ignorance of village officers, unaffordability, and confusion about the parties responsible for the registration. The study concluded that poor people were still vulnerable to access free coverage and healthcare from the NHP. The stakeholders of the NHP, especially the local management of NHP and local government, need to urgently and effectively educate the commoners about the mechanism, benefits, and contribution to the NHP to ensure equity and equality in accessing quality healthcare.

Abstract 4137925: Long-term Outcome of Initial Thoracic Endovascular Repair or Medical Therapy in Acute Uncomplicated Type B Aortic Dissection: Real-world Data from a Nationwide Claims-Database in Japan.

Introduction: Thoracic endovascular aortic repair (TEVAR) has emerged as a promising treatment option for patients with type B aortic dissection (TBAD). However, there is a lack of evidence regarding the long-term morbidity of initial TEVAR compared to optimal medical therapy (OMT) in acute uncomplicated TBAD (uTBAD). Objective: To evaluate real-world data(RWD) on the long-term outcome of Japanese patients with acute uTBAD using a nationwide claims database. Methods: This retrospective cohort study utilizes JMDC, a nationwide claims database under Japan's universal healthcare system. We included patients who were initially hospitalized with a diagnosis of acute TBAD. We defined acute uTBAD by excluding those who died within one month, suffered aortic rupture, traumatic thoracic aortic injury, underwent open-chest surgery, experienced stroke or paralysis, or had less than six months of history in the JMDC. Patients who underwent TEVAR within three months of the index hospitalization (TEVAR group) were compared with those who received optimal medical therapy (OMT group). Propensity score (PS) matching was performed based on age, sex, and year of hospitalization. Using the Kaplan-Meier method, we calculated the cumulative rate of all-cause mortality and aorta-related events. Results: Of 18,445 patients diagnosed with aortic disease between January 2005 and December 2020, 641 were included in the study (OMT group: n=580, TEVAR group: n=61). After PS-matching, demographics of the groups (OMT_PSM: n=183 vs. TEVAR_PSM: n=61) were female (12.6% vs. 13.1%), median age (54 years [IQR, 48-60] vs. 54 years [IQR, 50-61]) and follow-up time (18 months [8-32] vs. 19 months [9-32]), respectively. Kaplan-Meier curves for the aortic-related events (Figure1, 2) are shown as long-term outcomes. Conclusions: This study successfully demonstrated that the estimated 5-year aortic-related event rate in acute uTBAD patients undergoing OMT is approximately 20%, demonstrating the relevance of the RWD source. However, the number of death events in the TEVAR and OMT groups was not sufficient to provide statistical power. Therefore, further studies are warranted to evaluate the long-term prognosis of initial TEVAR for uTBAD.

Trend Analysis of Regulatory Approvals for Generics and Biosimilars in Japan: 15 Years of PMDA During Fiscal Years 2009-2023.

Generics and biosimilars play an important role in sustaining the universal healthcare insurance systems in Japan. The Pharmaceuticals and Medical Devices Agency (PMDA) reviews the quality, efficacy, and safety of generics and biosimilars for marketing authorization in Japan. Trend analyses of generics and biosimilars in terms of regulatory science have rarely been published. The PMDA and National Institute of Health Sciences websites were verified for generics and biosimilars, and information related to guidelines and notifications and the number of newly approved generics and biosimilars for fiscal year (FY) 2009-2023 were compiled. Approximately 1,900 and 200 generic drug products were approved in Japan in FY 2010 and 2023, respectively. The number of approved generic drug products has gradually decreased to one-tenth in the past 15years. Overall, 35 biosimilars were approved in FY 2009-2023. The number of approved biosimilars has increased since FY 2017. This article reported a trend analysis of generics and biosimilars in terms of guidelines, notifications, and the number of applied and approved drug products in FY 2009-2023. Our primary goal is to increase patient access to affordable generics and biosimilars with assurance in appropriate quality.

Global Pathology: A Snapshot of the Problems, the Progress, and the Potential.

For equitable global health care, the United Nations has outlined Sustainable Development Goals for health in low-income and middle-income countries (LMICs) with the goal of reaching universal health care by 2030. Currently, 47% of the global population lacks access to basic diagnostics for many common diseases. The need for diagnostic access has never been more critical owing to the dramatic rise of noncommunicable diseases in LMICS. In a recent analysis, The Lancet Commission on Diagnostics estimated that 1.1 million deaths occurring on an annual basis could be avoided if the diagnostic gap were reduced to 10% for only 6 priority conditions. To provide a nonexhaustive summary of the progress made to overcome the barriers to adequate access and explore the potential solutions needed to achieve global diagnostic equity. Several experts in global pathology were interviewed in addition to pathologists working in low-resource settings outside of the United States. Published literature on the topic of global pathology work was analyzed and summarized to provide a cohesive snapshot of the status of global pathology. Working to increase access to diagnostics in low-resource settings will save millions of lives. The solution to the current inadequate availability of global pathology services will require a global commitment from the entire pathology and laboratory medicine community, government support, and collaboration between the public-private sectors to achieve equitable health care.

Association Between Racial Marginalization with Direct Healthcare Expenditure, Time at Home and Rehabilitation Access Following Moderate to Severe Traumatic Brain Injury.

To determine the association between residence in racialized neighborhoods with direct healthcare expenditure and days at home (DAH) after moderate to severe traumatic brain injury (TBI). Differences in ethno-racial background have been associated with health outcome disparities. Much of this prior research was conducted in settings without universal healthcare coverage. The influence of ethno-racial background on health outcomes after TBI in universal healthcare settings remains unclear. This retrospective multicenter cohort study utilized linked administrative health data to identify adults sustaining moderate to severe TBI between 2009-2021. The primary exposure was an area-level index corresponding to the degree of racialized and immigrant populations within neighborhoods of residence (Q1-least racialized; Q5-most racialized). Co-primary outcomes were direct healthcare expenditure and DAH365days after injury. Secondary outcomes included discharge to rehabilitation and functional independence measure (FIM) scores at rehabilitation discharge. 6,188 patients met inclusion criteria. Patients in the most racialized neighborhoods incurred higher crude and adjusted direct healthcare costs compared to those in the least racialized neighborhoods. This effect was driven predominantly by physician claims and acute care costs. There were no significant differences in crude or adjusted DAH across quintiles. Access to rehabilitation and discharge FIM scores were comparable for patients residing different racialized neighborhood quintiles. Despite differences in healthcare expenditure, this study found similar home time, access to rehab and discharge FIM scores for TBI patients according to racialized neighborhood residence. Recognizing the limitations of area-level indices, our findings suggest equitable care delivery in a publicly funded universal care environment.

A Review on the Approach to Herbal Medicine in Cuban Healthcare System.

Background:Cuban healthcare system, emphasizing a holistic approach with herbal medicine as a key component, has achieved significant advancements in a multitude of health indicators. The aim of this study was to investigate the approach of Cuban healthcare system to Herbal medicine. Methods: The study conducted a review in the year 2024 in accordance with the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Multiple databases, namely PubMed, Scopus, ProQuest, and the Cochrane database of systematic reviews were searched and the quality of the studies was assessed using the AACODS checklist. Finally, a thematic analysis was conducted on the data. Results: 7 studies included within the study. The quality assessment scores presented high level of quality of the final studies with low level of bias. The thematic analysis resulted in six themes including: International collaboration, Universal coverage, Education and encouragement, Utilization, integration, and innovation, Efficiency and sustainability, and Prevention-focused and strategic approach. The Cuban healthcare system incorporates global herbal medicine knowledge, particularly from China, and provides free, regionalized services. It emphasizes the "Green Pharmacy" concept in each neighborhood and integrates herbal medicine into service delivery through a sustainable, prevention-focused policy. Conclusion: The Cuban healthcare system has implemented a multifaceted program on herbal medicine.

Improving equitable healthcare resource use: developing a neighbourhood district nurse needs index for staffing allocation

BackgroundAllocating healthcare resources to local areas in proportion to need is an important element of many universal health care systems, aiming to provide equal access for equal need. The UK National Health Service allocates resources to relatively large areas in proportion to need, using needs-weighted capitation formulae. However, within those planning areas, local providers and commissioners also require robust methods for allocating resources to neighbourhoods in proportion to need to ensure equitable access. We therefore developed a local resource allocation formula for NHS district nursing services for a City in the North West of England, demonstrating a novel application of the national formulae principles for equitable resource allocation to small areas.MethodsUsing linked data from community health services, primary care, secondary care and social care, we used a zero-inflated Poisson regression to model the number of district nursing services contacts for each individual based on predictors of need, while including the supply of district nurses per head to account for historical supply induced patterns. Individual need was estimated based on the predictions from this model, keeping supply fixed at the average. We then compared the distribution of district nurses between neighbourhoods, based on our formula, to the current service staffing distribution.ResultsKey predictors of need for district nursing services were age, deprivation, chronic diseases such as, cardiovascular disease, chronic liver disease, neurological disease, mental ill health, learning disability living in a nursing home, living alone, and receiving palliative care. Need for district nursing services was highly weighted towards older and more deprived populations. The current distribution of staff was, however, more correlated with age than deprivation. Moving to a needs-based staffing distribution would shift staff from less deprived areas to more deprived areas potentially reducing inequalities.ConclusionA neighbourhood-level model for needs for district nursing is a useful tool that can potentially improve the allocation of resources, addressing unmet need and inequalities.

Variation Exists in Service Delivery: Similarities and Differences in the Provision of a Whole Genome Sequencing Service for Paediatric Rare Disease Patients in the English National Health Service.

The English National Health Service (NHS) is the first to offer whole genome sequencing (WGS) as part of standard care. As a high-income country with a universal healthcare system, England contributes a valuable perspective to global developments in WGS. We used an implementation science approach with mixed methods to characterise delivery of WGS for paediatric rare diseases. Observations and field notes of consent appointments in clinical genetics and mainstream settings and follow-up qualitative semi-structured interviews with the clinical team. Process maps were developed for each department to identify similarities and variations between sites, and thematic analysis of interview data to understand barriers and facilitators. Data collection occurred in 12 departments (7 genetic, 3 neurology, 1 cardiology and 1 general paediatric) across 7 NHS Trusts. 26 observations of 21 healthcare professionals were conducted, alongside 19 follow-up interviews. Two master maps were developed - one for clinical genetics and one for the mainstream. We identified 11 steps involved in delivering WGS, including 9 variations and 9 similarities. We identified most variation in the processes related to the 'who', 'when', 'how' and 'where' as these were aspects that could be adapted to fit into the specific set-up of the department. Barriers included reluctance to uptake in the mainstream and difficulties tracking samples. Recommendations include developing SOPs and hiring healthcare professionals responsible for facilitating consent alongside administrative aspects. These would reduce the burden on clinical geneticists and improve turnaround times as well as contribute to streamlining and standardisation of the service.

Global Disparities of Cancer and Its Projected Burden in 2050

Cancer prevention and care efforts have been challenged by the COVID-19 pandemic and armed conflicts, resulting in a decline in the global Human Development Index (HDI), particularly in low- and middle-income countries. These challenges and subsequent shifts in health care priorities underscore the need to continuously monitor cancer outcome disparities and statistics globally to ensure delivery of equitable and optimal cancer prevention and care in uncertain times. To measure the global burden of 36 cancers in 2022 by sex, age, and geographic location and to project future trends by 2050. This cross-sectional study used population-based data from 2022 in 185 countries and territories were obtained from the Global Cancer Observatory database. Data extraction and analysis were carried out in April 2024. Counts, rates, prevalence, mortality to incidence ratios (MIRs), and demography-based projections were used to characterize current and future cancer burden. This population-based study included 36 cancer types from 185 countries and territories. By 2050, 35.3 million cancer cases worldwide are expected, a 76.6% increase from the 2022 estimate of 20 million. Similarly, 18.5 million cancer deaths are projected by 2050, an 89.7% increase from the 2022 estimate of 9.7 million. Cancer cases and deaths are projected to nearly triple in low-HDI countries by 2050, compared to a moderate increase in very high-HDI countries (142.1% vs 41.7% for cancer cases and 146.1% vs 56.8% for cancer deaths). Males had a higher incidence and greater number of deaths in 2022 than females, with this disparity projected to widen by up to 16.0% in 2050. In 2022, the MIR for all cancers was 46.6%, with higher MIRs observed for pancreatic cancer (89.4%), among males (51.7%), among those aged 75 years or older (64.3%), in low-HDI countries (69.9%), and in the African region (67.2%). In this cross-sectional study based on data from 2022, cancer disparities were evident across HDI, geographic regions, age, and sex, with further widening projected by 2050. These findings suggest that strengthening access to and quality of health care, including universal health insurance coverage, is key to providing evidence-based cancer prevention, diagnostics, and care.

A Retrospective Analysis of Universal Health Insurance Policy-Making Process in Iran: A Qualitative Study.

Universal Health Insurance (UHI) coverage began in 2014, after the implementation Health Transformation Plan (HTP) to reduce out-of-pocket payments and improve access to health services in Iran Health Insurance Organization (IHIO). The purpose of this study was to analyze the UHI policy-making process in Iran. This study was performed using Walt and Gilson's (1994) policy triangle framework and Kingdon's multiple streams model. Data were collected through document review, in-depth individual interviews (constituting 17 policymakers and top, middle, and operational level managers), and one round-table discussion (constituting 10 top managers and senior policymakers). The majority of the participants were MD and MPH (47.07%). Document review data were analyzed using thematic content analysis. Interviews and discussions were analyzed using framework analysis. The high-level documents of Iran emphasize the need for insurance coverage. The commitment of the new government to enforce the laws, concurrent implementation of the UHI and the HTP, the new government's approach to enforcing civil rights, and media pressure to speed up the implementation process. UHI was initiated in 2014 and about 11 million people across the country were covered by free health insurance but the budget did not change in proportion to the increase in insured population, and increased IHIO's debt to contracting centers. To achieve continuity and effectiveness of UHI in Iran, all stakeholders should be involved. Political will and commitment and sustainable financing are needed for it.

Trends in All-cause Mortality among U.S. Veterans with Sarcoidosis, 2004–2022

BACKGROUNDSarcoidosis is an idiopathic multiorgan disease with variable clinical outcomes. Comprehensive analysis of sarcoidosis mortality in U.S. Veterans is lacking. RESEARCH QUESTIONSWhat are the trends in all-cause mortality among U.S. Veterans with sarcoidosis, and how are these trends influenced by demographics, Black vs. White racial disparities, and geographic variability in relation to mortality? STUDY DESIGN AND METHODSUsing Veterans Health Administration (VHA) electronic health records (EHR), we conducted a population-based, retrospective cohort study of adjusted all-cause mortality 2004–2022 among Veterans diagnosed with sarcoidosis who received care through the VHA. Demographics, region of residence, service branch, tobacco use, and comorbidities were extracted from EHR. Annual trends in all-cause mortality and patient-level characteristics associated with mortality were examined with multivariable ungrouped Poisson regression. We visualized trends and analyzed state-by-state mortality using the marginal means procedure. In subgroup analysis (2015–2022), we considered the impact of neighborhood-level socioeconomic disparities using the area deprivation index (ADI). RESULTSIn all, 23,745 Veterans were diagnosed with sarcoidosis between 2004 and 2019 and followed through 2022. After adjustment, including age and sex, all-cause mortality increased annually by 4.7% (P<0.0001) and was 6.4% higher in Black than White Veterans (mortality rate ratio=1.064, P=0.02). A subgroup analysis comparing models with and without ADI adjustment showed no meaningful change in mortality trends. Risk factors for increased all-cause mortality included older age, male sex, Black race, and Northeast residence, and lower risk with “Other” service branches. Despite distinct geographical variations in mortality rates, no clear patterns emerged. INTERPRETATIONMortality among Veterans with sarcoidosis is rising. Differences identified by service branch and higher risk among male Veterans raise questions about differences in environmental exposures. The narrower racial disparities and smaller impact of ADI than in other studies may highlight the role of universal healthcare access in achieving equitable outcomes.

Temporal and regional variation in the use of biologic and targeted synthetic DMARDs for rheumatoid arthritis: a nationwide cohort study.

To evaluate temporal and regional variation in biologic and targeted synthetic DMARD (b/tsDMARD) initiation for rheumatoid arthritis (RA) in England and Wales. An observational cohort study was conducted for people with RA enrolled in the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and April 2022 who had 12-month follow-up data. Temporal trends in escalation to b/tsDMARDs within 12 months of initial rheumatology assessment were explored, including comparisons before and after publication (July 2021) of national guidelines that lowered the threshold for b/tsDMARD initiation to include moderate-severity RA. Case-mix-adjusted, mixed-effects regression was used to evaluate regional and hospital-level variation in b/tsDMARD initiation. Of 6,098 RA patients with available follow-up, 508 (8.3%) initiated b/tsDMARDs within 12 months of initial assessment. b/tsDMARD escalation increased marginally towards the end of the study period (9.2% in May 2021/22); however, no significant differences were evident after guidelines were published permitting b/tsDMARDs for moderate-severity RA. The proportion of individuals escalated to b/tsDMARDs varied considerably between regions, ranging from 5.1% in Wales to 10.7% in North-West England. Following case-mix adjustment, the intraclass correlation (ICC) for hospitals within regions was 0.17, compared with a between-region ICC of 0.0, suggesting that the observable regional variation reflected hospital-level differences rather than systematic differences between regions themselves. There is marked variation in escalation to b/tsDMARDs for people newly-diagnosed with RA throughout England and Wales, despite a universal healthcare system. These disparities must be addressed if we are to deliver equitable access to b/tsDMARDs, regardless of geography.

Universal Health Care Coverage for Aging Population

The term Universal Health Coverage (UHC) refers to a situation where “all people (both males and females, boys and girls) have access, without financial hardship, to the full range of type of quality health services when and where they need them, now and at times”. The UHC envisages coverage of the full range of essential health care services: from health promotion to (1) ‘Prevention’, (2) ‘Treatment’, (3) ‘Rehabilitation’, and (4) ‘Palliative care’ [aimed at improving quality of life of people (adults and children) and their families confronted with life-threatening illness]. It is pertinent to note that the UHC aligns with the SDG (Sustainable Development Goal) Target 3.8: achieve universal health coverage. The UHC is, thus, global commitment. However, in to deliver this promise, national governments need and inter-governmental organizations need to have health systems that are rooted in the locations communities they serve. Also, such health systems need to be • Need-based, • Efficient, and • Equitable. The author of this review paper argues that Primary Health Care (PHC) is the most effective and cost-efficient way to reach out to people with the UHC, with consideration of “need-based approach”. Further, it is due to this consideration of need-based theory that every country, with its own socio-economic and demographic profile, adopts a different strategy for the purpose of achieving the UHC. Furthermore, national governments decide what to cover, depending on the needs of their populations, including availability of health infrastructure (resources). Investment in the scientifically designed UHC programs has the potential to ensures that health needs of people are (a) ‘Identified’, (b) ‘Prioritized’, and (c) ‘Addressed’. The conceptual framework of the UHC is of increased relevance for aging population (individuals above the age of 65). The author of this work is of the considered research view that objective of achieving the SDG-3.8 target cannot be fully and adequately realized without transforming health care system that has significant impact on functional ability in older age people (or aging population). Objective of this evidence-based review paper is to investigate into significance and implications of the UHC for aging population. Also, it briefly outlines renewed strategies needed for the UHC for aging population. Secondary data (largely ‘qualitative’ in nature) have been used. The method of data analysis is ‘descriptive’, involving non-statistical (mathematical) techniques. The paper briefly concludes that scientifically-designed mechanism for offering the UHC for older people, without financial burden, is crucial. It is important that health financing systems of the national governments are designed to cater to health needs of older people, while protecting them from to access services when they are needed, but also to protect them from financial catastrophe (by abolishing “out of pocket spending”).

Universal Health Care Coverage for Aging Population

Universal Health Care Coverage for Aging Population

Insights into the historical trajectory and research trends of immune checkpoint blockade in colorectal cancer: visualization and bibliometric analysis.

Colorectal cancer (CRC) is a malignant tumor that poses a significant threat to human health due to rising incidence and mortality rates. In recent years, immune checkpoint blockade (ICB) therapy, represented by Programmed death receptor 1 (PD-1), T-lymphocyte-associated protein 4 (CTLA-4), and others, has been widely applied in CRC and has achieved encouraging results in some patients and has become a hot topic in both clinical and basic research. This study undertakes a comprehensive bibliometric analysis of ICB research in CRC, aiming to evaluate the current status, identify future trends, and provide scientific insights for researchers and decision-makers. Utilizing the Web of Science Core Collection (WoSCC), articles focusing on ICB in CRC from 2000 to 2022 were retrieved. Knowledge mapping and bibliometric analysis were conducted using tools such as CiteSpace, VOSviewer, SCImago Graphicay, and the R package bibliometrix. 6,718 publications were analyzed from 24,846 institutions across 639 regions. Temporally, ICB research in CRC is rapidly advancing, led by the USA and China with extensive global collaborations. Sun Yat-sen University from China stands out as the institution with the highest number of publications. Professor Thierry Andre from Sorbonne University in France is identified as a prolific author in this field, engaging in extensive collaboration for clinical trials on a global scale. Publications related to this research topic were published in 1,142 academic journals, demonstrating a positive co-citation relationship. Key clustering and burst terms analysis indicate that current research on ICB in CRC has shifted from basic experiments to clinical trials and from universal healthcare to precision medicine. ICB therapies have shown substantial progress in CRC, highlighting their therapeutic potential. Research trends emphasize deeper drug mechanisms, treatment efficacy prediction, managing immune-related adverse events, and exploring novel drug delivery methods. Collaboration across borders remains crucial for further advancements.

From legislation to actual health service: evaluation of health provisions in the disability law of Ghana by adolescents with mobility and visual impairments and their families

BackgroundDespite Ghana’s Persons with Disability Act, 2006 (Act 715) making provisions for access to healthcare services for adolescents with disabilities and their families, a corpus of literature has reported that persons with disabilities continue to face challenges in accessing healthcare services. However, the voices of adolescents with disabilities and their families are very scarce in such discourse. This study explored the experiences of adolescents with disabilities and their families in accessing healthcare services as per the provisions described in Ghana’s Act 715.MethodsThis study involved 45 participants, including 25 adolescents with disabilities and 20 family members from a municipality in Ghana. Employing a qualitative descriptive design, semi-structured interviews were conducted which was then analyzed thematically and interpreted using Critical Disability Theory.ResultsThe study identified two major categories of barriers to healthcare access: environmental (socio-economic difficulties, poor built environment, unavailability of rehabilitation services) and systemic (cultural beliefs, poor support at healthcare facilities and inadequate healthcare legislative provisions for families of children with disabilities). Despite legal provisions for free healthcare, participants faced significant financial barriers, with specialist services often not covered by the National Health Insurance Scheme.ConclusionsThe study calls for policy adjustments to fully cover specialist care under Ghana’s National Health Insurance Scheme, establishment of local-level health assessment and resource centers, educational campaigns to change cultural perceptions, and training of healthcare workers to promote quality access to healthcare.