Financing Of Services Research Articles

Does financing for private maternity services improve birth experiences in Poland? A mixed-methods study of the Babies Born Better Survey

Does financing for private maternity services improve birth experiences in Poland? A mixed-methods study of the Babies Born Better Survey

“We’re Preventing People From Going Into the Most Expensive Level of Care in Every Way that We Can”: Barriers and Recommendations for Use of Local Funds

Most older Americans do not financially qualify for Medicaid and support provided through the Older Americans Act is quite limited. In response, Ohio has generated funds for services for older adults through the use of local county tax levy programs. Ohio currently leads the nation in the utilization and support of local levy funding, generating more than US$200 million annually. This study conducted qualitative descriptive interviews with 15 locally funded programs across the state. Thematic analysis revealed that local programs encounter an array of implementation barriers, including increased state and federal eligibility requirements, staffing issues, lack of access to services in rural locations, and low reimbursement rates. These barriers are coupled with added pressure from county officials to move individuals onto state-funded programs, rather than locally funded programs. This paper also provides recommendations for how these programs can be better supported to ensure their sustainability for the future.

Effects Of Medicaid Waivers On Use Of Medications For Opioid Use Disorder And Nonfatal Overdoses In 17 States.

A long-standing policy prohibits the use of federal funds for Medicaid services in Institutions for Mental Diseases (facilities with more than sixteen beds that specialize in mental health or substance use disorder treatment). Beginning in 2015, states could apply for Section 1115 Medicaid waivers, which permit federal funding for Institutions for Mental Diseases services and require improvements in opioid use disorder (OUD) treatment. Using 2016-20 Medicaid data, we compared changes in the use of medications for OUD and nonfatal overdoses in seventeen states with waivers approved during 2017-19 to changes in eighteen states without waivers. Waiver implementation was not associated with improvements in overall medication treatment, buprenorphine and naltrexone prescribing, or rates of nonfatal overdoses among Medicaid enrollees with OUD. Waiver implementation was associated with a 2.3-percentage-point increase in the use of methadone with waiver implementation, as a result of coverage changes, and a 3.7-percentage-point increase in any medication treatment among Medicaid enrollees diagnosed with severe OUD who had an inpatient or residential stay. Our findings suggest that such waivers adopted by states during 2017-19 were not associated with significant improvements in medication treatment or reductions in nonfatal opioid-related overdoses among Medicaid enrollees with OUD. However, they may have moderately improved the use of medication treatment for those with severe OUD.

Future Energy Breakthroughs: Implications for the Hydrocarbon Economies of the Arabian Gulf

AbstractCountries in the Arabian Gulf are reliant upon hydrocarbons for revenues, exports, industries and funding services. It is largely assumed that the global energy transition will be gradual, as reflected in planning and strategy documents. However, energy breakthroughs can change the global energy system. This Perspective article seeks to provoke a discussion about potential energy breakthroughs, the plausibility of their rapid expansion at scale, and the implications they may have for the hydrocarbon economies in the Arabian Gulf. Based upon feasibility, scalability, and adoption potential energy breakthroughs are outlined, their probability are assessed, and potential impacts on the hydrocarbon economics of the region are evaluated. The calls to actions are concluded with aim to support the region to be better prepared to track breakthroughs, and be proactively engaged to benefit from them. These include: 1) annual regional research‐policy interface meetings, 2) tailored research and development funding that fosters regional collaboration, 3) investment into breakthrough technologies and energy transition inputs, and 4) seeking synergy in economic diversification regionally to avoid duplication and counterproductive competition.

Health economics and services research in symbiosis: STREAMLINEing mental health services in Austria

Abstract Objectives The cost of mental diseases exceeds 4% of GDP in Europe. In Austria, every 5th person lives with mental ill-health (MIH). Ongoing epidemiological, demographic and societal changes increase the need for easily accessible, better integrated and good value services. In STREAMLINE, we combine, harmonize and implement the latest methods in human service mapping and economic costing to optimize future service provision and financing for MIH in Austria. Methods We comprehensively assess the availability, activity and affordability of human services targeting MIH in Vienna within the health and social care, education, labour and justice sectors based on a conceptual mind map. We identify services through extensive literature, document and web searches plus expert consultations. Services are mapped and costed according to the European PECUNIA methods: classification of the main service types using the international DESDE taxonomy of human services; development of Reference Unit Costs using the PECUNIA RUC templates with primary data; validation of the results with secondary data; compilation of a comprehensive multi-sectoral service catalogue; and synthesis for spatial and policy analyses. Results We identified 756 sources, 75% individual organisations, 5% multi-organisations and 20% existing provider lists. 84% relate to health and social care, 10% labour, and 3% education and justice sectors each. 58% deliver care to adults, 37% to children & adolescents, and 5% support carers. Further service mapping and RUCs will be presented. Discussion STREAMLINE pioneers in coordinated public mental health services and economics research at scale. Assessed levels of fragmentation call for better integration, improved transition, reduced spatial inequity and increased support for carers. Results increase the feasibility of service evaluations from a societal perspective. Planned public service atlas facilitates information and access for service users and carers. Funding: WWTF Key messages • New methods for harmonized health services and economics research allow comprehensive information for optimized future mental health service planning and financing. • Assessed levels of fragmentation highlight the need for better integration, improved transition, reduced spatial inequity and increased support for carers.

The WHO health system performance assessment applied to child healthcare in Luxembourg, 2011-2022

Abstract Background Health System Performance Assessments (HSPAs) evaluate health systems in terms of their objectives and their overall goals, such as access to quality services and health improvement. Beyond the overall health system assessment, HSPA can evaluate performance in providing care to specific populations. We assessed the response of the Luxembourg health system to children’s particular health needs, by populating the WHO HSPA framework for universal healthcare with child-specific indicators. Methods We searched international databases, guidelines, policy documents, and the scientific literature to identify child-specific indicators suitable for assessing the health system objectives as defined by the WHO HSPA framework. To select the most relevant indicators, we conducted expert appraisal regarding feasibility, validity and actionability. Those indicators were calculated based on available national data. To explore inequities within the system, we performed socioeconomic stratifications. Results Twenty-nine indicators were used to populate the framework, sourced from social security databases (n = 15), monitoring and surveillance (n = 11), and surveys (n = 2). For effectiveness assessment, we used 11 indicators and found that preventive services performed best for children under two years. Five indicators showed good accessibility to primary and secondary care. Another five indicators assessed safety indicating a recent increase in the relative use of broad-spectrum antimicrobials and an overuse of caesarean sections. Additional disaggregation of three indicators didn’t expose socioeconomic inequities in service delivery. Data gaps exist to assess children’s user-experience and financing of child health services. Conclusions The WHO HSPA framework proved valuable for evaluating the Luxembourg health system’s performance for children. We identified good performance in accessibility and effectiveness for young children, alongside data gaps to assess user-experience. Key messages • The application of national child-specific indicators to the WHO health system performance assessment, highlighted strengths in accessibility and effectiveness while also pointing to key data gaps. • We used the WHO health system performance assessment (HSPA) to evaluate the health system for children in Luxembourg. This exercise enhances the development of a tailored national HSPA framework.

Large scale system transformation: Ukraine

Abstract In the context of the EU-Ukraine Accession agreement, Ukraine started large scale public health systems reform back in 2015. The COVID-19 pandemic tested the response capacity of the national public health system and led to some improvement during the pandemic such as on laboratory capacity. It also generated lessons for strengthening national and subnational health emergency preparedness and response. Multiple interventions, including a Joint External Evaluation led to the adoption of the Public Health System Law in 2022, laying the foundation to bolster health promotion, disease prevention, and health protection. The Ukrainian Public Health Centre was substantially strengthened, partly oriented on models in other European countries. Corresponding centers for diseases control and prevention at the oblast level were reformed and a subnational network of these centers was created. While the war has a significant impact on the public health system, infrastructure, people and more, decision makers and professionals keep working on sustaining and moving forward the achievements on public health reforms, for example with the adoption of the National Health Strategy 2030 and the adoption of the National Health Security Plan. Further legal and strategic preparations are afoot to strengthen public health services governance capacity, financing, institutional innovation and development, and public health workforce development.

From Policy to Practice: Socio-Ecological Challenges in Implementing the Home and Community Based Settings Rule

The 2014 Centers for Medicare and Medicaid Services “Settings Rule,” which took effect in 2023, restricts Home and Community Based Services funding for adults with intellectual disabilities to small integrated settings and person-centered supports. The Settings Rule responds to the fact that community services, mandated by the Americans with Disabilities Act (ADA) and the Supreme Court Olmstead ruling, while integrated physically, often operate as institutions. The Settings Rule is meant to create integration and individualization. I argue that the regulation cannot, on its own, accomplish these goals. The deinstitutionalization movement has had mixed outcomes—and without change across multiple socio-ecological systems, the Settings Rule will also deliver mixed results.

Using Early Intervening Services Funds to Reduce Racial Disproportionality in Special Education

In this article, we explore how educational leadership, administration, and special education students can effectively use Coordinated Early Intervening Services (34 CFR §300.226) funding. These funds, available under IDEA Part B, aim to address racial disproportionalities in educational opportunities. Through a case study, we examine how a school principal navigates the complexities of using IDEA Part B funds for academic and behavioral support services. It highlights the challenges school leaders face and suggests activities to help educators address the root causes of racial/ethnic disproportionality in student identification, placement, and disciplinary actions.

Constituents over Correlation: Indicators and Arctic Urban Decision-Making

Arctic city mayors influence municipal sustainability outcomes, navigating decisions on waste management, social service funding, and economic development. How do mayors make these decisions and to what extent do they integrate sustainability indicator data? Interviews with the mayors of Fairbanks, Alaska, Yellowknife, Canada, and Luleå, Sweden, revealed indicators are used on a case-by-case basis to track trends but lack systematic integration into decision-making. Constituent concerns drive agendas rather than indicator trends. Based on International Organization for Standardization (ISO) guidelines, 128 indicators grouped into 19 sustainability themes were compiled from 2000 to 2019 for the study cities. Partial Least Squares Structural Equation Modeling (PLS-SEM) was applied to examine the utility of ISO indicators as a guiding factor for sustainability trend tracking, identifying key themes for each city. Results show that indicator trends are too inconsistent and interconnected to be useful as an independent form of guidance for mayors. For Arctic municipalities, sustainability indicator datasets are useful in specific circumstances, but they do not provide the same kind of decision-making heuristic that mayors receive from direct constituent interaction. Findings emphasize the importance of more robust data collection and the development of management frameworks that support sustainability decision-making in Arctic cities.

Research on Equity Policies in Public Education for Learning DisabilitiesTaking China, America and Britain as Examples

With the recovery and development of the global economy, the quality of life worldwide continues to improve, and the demand for public infrastructure such as medical care and education services is becoming more and more vigorous. Medical development and progress have made studying the brain and neurological fields more thorough, and learning disabilities have gradually entered the public eyesight. As a special group, people with learning disabilities are not widely accepted and recognized in the scope of public education. Thus, education must support the development of this virtue cycle through educational fairness policies, as it is a public resource. Based on the existing education policies on learning disabilities in China, the United States, and the United Kingdom, this paper analyzes these policies and puts forward education policy suggestions from four aspects: the education policy formulation system, the education collaborative service system, the education accountability evaluation system, and the education funding service system.Among China, the United Kingdom, and the United States, the first two are based on the improvement of basic policies, focusing on the construction of education collaborative services and education accountability evaluation systems, respectively. The latter focuses on the improvement of education policy.

Confronting our failures: Tensions in remedying systemic discrimination in Canada

This article examines the complexities of providing remedies for systemic discrimination in light of evolving understandings of equality and justice. Despite constitutional and statutory protections affirming the right to live free from discrimination, there remains a significant gap between recognizing systemic discrimination and implementing effective remedies. The 2021 case of Canada (Attorney General) v. First Nations Child and Family Caring Society of Canada serves as a focal point to highlight the shortcomings of the current remedial framework, which often prioritizes corrective over transformative justice, reflecting a formal rather than substantive approach to equality. In this case, the Canadian Human Rights Tribunal found that Canada’s inequitable funding of First Nations child welfare services was discriminatory on the grounds of race and national or ethnic origin. It ordered Canada to compensate every child impacted, while simultaneously imposing systemic remedies such as reforming federal funding policies. By exploring the Tribunal’s decision to uphold both individual and systemic remedies, the paper argues for a more integrated approach that moves beyond the dichotomy of individual versus systemic discrimination. It advocates for co-designed remedies informed by the perspectives of affected communities, calling for a shift in how systemic discrimination is addressed within Canada’s legal framework.

Relationship Between Operational Factors and Cost Efficiency in Defined Contributions Pension Schemes

Pension schemes in Kenya provide income for individuals who attain the retirement age and consequently boost economic growth as well as accelerate domestic savings. The industry is regulated by the Retirement Benefits Authority (RBA). The purpose of the study was to determine the relationship between operational practices on cost efficiency in defined contributions pension schemes in Kenya. The specific objectives were to determine the relationship between service provider costs on cost efficiency in defined contributions pension schemes, to examine the relationship between fund size on cost efficiency in defined contributions pension schemes, to determine the relationship between portfolios mix on cost efficiency in defined contributions pension schemes and to examine the relationship between investment strategy on cost efficiency in defined contributions pension schemes. The study will be significant to the management of defined contributions pension schemes in Kenya and other researchers. The study adopted a descriptive research design. The target population was all the 1,262 pension schemes in Kenya. Stratified random sampling was employed to select small schemes, medium schemes, large schemes and mega pension schemes in Kenya and obtained a total of 304 sample population. The study used secondary data. Descriptive statistics was performed by getting frequencies, means, and standard deviation for the purpose of understanding the results, which was displayed in tables, charts, and graphs. A multiple regression model was fitted to the data and the results revealed that there was a relationship between cost efficiency and service provision expenses, portfolio mix, fund size and investment strategies. Service provision expenses for a pension scheme should be able to cover the cost of administration without unduly compromising the growth of pension savings. Further, while a substantial fund size offered advantages, it should be complemented by strategic acumen and diligent oversight to ensure the scheme delivers on its mandate. A balanced and diversified portfolio is considered a cornerstone providing a buffer against market volatility and therefore enhancing the prospects of sustainable goals and cost efficiency. Finally, the cost associated with portfolio mix and risk management was a necessary investment in securing the long-term sustainability and stability of the pension fund. Recommendation for further studies on cost efficiency of defined benefits schemes should be done as well as further studies on challenges facing pension schemes in Kenya

Exploring the equity of distribution of general medical services funding allocations in Wales: a time-series analysis.

Good access to quality primary care in high-income countries can improve population health. Access to primary care is however often not equal among socioeconomic groups; our analysis sought to explore whether funding, a determinant of service supply, is equitably distributed among GP practices in Wales. We sought to explore the relationship between funding and deprivation among GP practices in Wales, to understand the equity of current funding policies. We obtained funding data for general practices in Wales between 2014 and 2022 and explored the equity of distribution using the percentage of practice patients living in the 20% most deprived small areas in Wales. We generated a linear regression model exploring the relationship between practice funding and deprivation, with an interaction term with time in years. Practice funding rose for all practices between 2014 and 2022. Practice deprivation and time in years were both associated with practice funding, with increases in practice deprivation associated with reduced funding allocations, and time being associated with a small increase in funding over the study period. Over the period of analysis of 2004-2022, for every 10% increase in patients living in the most deprived LSOAs, funding per patient decreases on average by 1%. Primary cares in Wales in more deprived areas receive discernibly less funding per patient than those in less deprived areas. Given the potential and likelihood primary care can affect population health outcomes, this underinvestment may be contributing to existing health inequalities and requires urgent further analysis and action.

Costs and resource distribution of direct services for HIV in Uganda

ObjectiveIn high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of...

The 2024-2025 Commonwealth Budget for Mental Health: Funding unproven initiatives and stings in the tail.

We discuss the ramifications of the Commonwealth of Australia Budget allocations for mental healthcare for 2024-2025. There is funding for population-based mental health initiatives for milder anxiety and depression but no direct funding of services for the most severe and disabling forms of mental illness, other than pre-existing state/territory disbursements from the Commonwealth for state-based health services. There are substantial concerns that the Commonwealth funding has potentially been misallocated to ineffective interventions that are unlikely to reduce the population prevalence of mild anxiety and depression in Australia. Funds may have been better allocated to provide effective care for those with the most severe and disabling illnesses including schizophrenia, bipolar disorder and severe depression.

Experiences of commissioning services for child and adolescent mental health in England (UK): a qualitative framework analysis.

To explore commissioners' experiences of commissioning services for child and adolescent mental health, their perspectives on the needs of their populations, the challenges they face and their needs for support and data. Qualitative study involving semi-structured interviews. All interviews were audio-recorded and transcribed verbatim. Data were analysed using framework analysis. England, UK. 12 integrated care board commissioners, responsible for commissioning NHS England Child and Adolescent Mental Health Services (CAMHS). We identified five themes: 'reflections on role'; 'priorities and tensions: working in a complex and evolving integrated care system'; 'insights and evidence: the role and use of data and informants'; 'children's mental health in the limelight: influences and expectations'; and 'responding to need "CAMHS as the answer to everything"'. Combined, these themes highlight the integral role commissioners play in providing oversight over the local system and challenges to this role including disproportionate funding for services for child and adolescent mental health, different use and value ascribed to 'qualitative' and 'quantitative' data, rises in demand and the limited focus on early intervention and prevention. CAMHS commissioners are currently negotiating a complex and changing political, social and economic environment with competing priorities and pressures. Our research indicates that commissioners require greater support as their roles continue to evolve.

Compounding Institutional Exclusion and Harm: A case study of federally funded Alaskan anti-trafficking service providers

Federal funds for human trafficking victim programmes and services in the United States have increased from approximately USD 10 million in 2002 to more than USD 90 million in 2022. This increase in fund availability, however, has not necessarily translated into meaningful or accessible services for trafficking survivors. This paper examines the distribution of Department of Justice anti-trafficking funds through the Office for Victims of Crime (OVC), particularly looking at OVC recipients in Alaska. It highlights certain trends in OVC funding in the state, including changes in funding distribution, the emphasis on task force creation and collaboration between service providers and law enforcement, and discussions of equity and inclusion. The paper further explores institutional mechanisms of exclusion and harm of some victims, complexities in collaborating with law enforcement, criminalisation of trafficking survivors, and criteria to qualify for services. As the reality faced by trafficking survivors does not always align with OVC narratives, these mechanisms are illustrated through the experiences of a sex trafficking survivor who has been turned away as not qualifying for services by many of the OVC funded providers in Alaska. The paper concludes by exploring the implications of this research for policymakers and service providers.

Factors informing funding of health services for Aboriginal and Torres Strait Islander children: perspectives of decision-makers.

Background The factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children are unclear. This study's objective aimed to describe decision-makers' perspectives on factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children. Methods We conducted semi-structured interviews with 13 participants experienced in making funding decisions at organisational, state, territory and national levels. Decision-makers were from New South Wales, Northern Territory, Queensland, Victoria and Western Australia. Transcripts were analysed thematically following the principles of grounded theory. Results We identified five themes, each with subthemes. First, prioritising engagement for authentic partnerships (opportunities to build relationships and mutual understanding, co-design and co-evaluation for implementation). Second, valuing participant experiences to secure receptiveness (cultivating culturally safe environments to facilitate acceptability, empowering for self-determination and sustainability, strengthening connectedness and collaboration for holistic care, restoring confidence and generational trust through long-term commitments). Third, comprehensive approaches to promote health and wellbeing (linking impacts to developmental milestones, maintaining access to health care, broadening conceptualisations of child health). Fourth, threats to optimal service delivery (fractured and outdated technology systems amplify data access difficulties, failure to 'truly listen' fuelling redundant policy, rigid funding models undermining innovation). Fifth, navigating political and ideological hurdles to advance community priorities (negotiating politicians' willingness to support community-driven objectives, pressure to satisfy economic and policy considerations, countering entrenched hesitancy to community-controlled governance). Conclusion Decision-makers viewed participation, engagement, trust, empowerment and community acceptance as important indicators of service performance. This study highlights factors that influence decisions to fund health services for Aboriginal and Torres Strait Islander children.

Islamic Socialism and Communist Socialism: A Review of Comparative Analytical Studies

The paper reviews studies that compare Communist Socialism and Islamic Socialism to explore how Islamic Socialism is a viable alternative to both Communism and Capitalism. It investigates the shortcomings of Capitalism, which caused the emergence of the idea of socialism. The paper also discusses the strong endorsement of Islamic Socialism by prominent Muslim scholars to inspire confidence in its legitimacy. The analysis reveals that Islamic revival movements that arose during the era of Western political domination emphasized values shared by Islam and the rest of the world and initiated the concept of Islamic Socialism. The principles of Socialism, such as the government’s ownership of productive units and the establishment of social welfare programs, align with Islamic teachings on social justice. In Islam, Zakat serves as a form of funding for welfare programs and social services, reflecting the religion's compassion and concern for the poor.