Health Care Financing System Research Articles

Social Networks and Dying at Home: Analysis of Outcomes From 13 Countries Using SHARE

Social networks are critical for end-of-life decision-making and hands on support and may also impact end-of-life outcomes including location of death. Yet we fail to consider these factors in the context of cultural values and variation in healthcare system financing and resources, e.g., availability of palliative care. Using SHARE, we examined the following factors for 6,391 decedents across 13 countries interviewed in the last year of life: family size, living alone, and size and characteristics of social networks. We compared these characteristics cross-nationally for persons dying at home as opposed to in hospital and other formal settings. While individuals with larger social networks are more likely to die at home, we find a cross-national gradient of higher unmet healthcare needs resulting in overall more home-based deaths. Our findings suggest that individual factors such as family availability must be considered in the context of country-level factors when examining quality end-of-life indicators.

СУЧАСНІ ТА МАЙБУТНІ ВИКЛИКИ ДЛЯ ПУБЛІЧНОГО УПРАВЛІННЯ У СФЕРІ ОХОРОНИ ЗДОРОВ’Я

The general articulation of the issue and its connection with the important research and practice tasks. Demographic processes and epidemiological characteristics, social norms changes and standards of development of public expectations, evolution of organizational and legal bases of the health care system, improvement of medical technologies will have a significant impact on characteristic of public health administration in the future.The analysis of the recent publications regarding the issues this article deals with; identification of parts of the general problem that have not been previously addressed. Publications of Ukrainian and foreign scientists, analytical and statistical data of the World Health Organization, the World Bank, the Ministry of Health of Ukraine were researched. There is a need to substantiate competencies of public health administration taking into account the characteristics of social development and public expectations.The purpose (the objective) of this article is to substantiate of the main directions of improvement of public health administration, organization and financing of health care system in Ukraine according to the development of social norms, standards and public expectations.The key results and the background. In the future, the health care needs of the population in Ukraine will be primarily affected by the characteristics of demographic and epidemiological processes. They are population aging, lifestyle, individual risk factors, socially communicable diseases, in particular COVID-19.It will be important not only the result of health care institutions, but also the process (the concept of evidencebased public health, comprehensive quality management, horizontal integration of health care institutions and social assistance, assessment of impacts on public health, etc.).Conclusions and the prospects of the further research. Significant civilizational changes in the development of society, related to science, technology and management, will increase changes in the field of health care. Public administration and training programs for health care managers need to be improved in line with updated social expectations.

A single-centre, prospective cohort study of COVID-19 patients admitted to ICU for mechanical ventilatory support.

BackgroundMortality rates in COVID‐19 patients in need of mechanical ventilation are high, with wide variations between countries. Most studies were retrospective, and results may not be generalizable due to differences in demographics, healthcare organization and surge capacity. We present a cohort of mechanically ventilated COVID‐19 patients from a resource‐rich, publicly financed healthcare system.MethodsProspective study from a tertiary hospital. Consecutive SARS‐CoV‐2 positive adult patients admitted to the ICU for mechanical ventilation from 10 March 2020 to 04 May 2020 were included. Triage and treatment were protocolized. High‐dose dalteparin was adjusted by D‐dimer. Demographics, treatments and high‐resolution physiological variables were collected. Outcomes were 30‐day and hospital mortality. Data are medians (quartiles).ResultsOf the 1484 persons in the hospital catchment area testing positive for SARS‐CoV‐2, 201 (13.5%) were hospitalized. Thirty‐eight (19%) patients were mechanically ventilated, of whom five (13%) died. Of the 163 patients treated with supplemental oxygen, eight (5%) died.In ventilated patients (75% males, age 61 (53‐70) years), severe, moderate and mild ARDS was present in 25%, 70% and 5%. Tidal volume ≤8 mL/kg ideal bodyweight was achieved in 34 (94%) patients. Proning and neuromuscular blockers were used in 19 (54%) and 20 (61%) patients. Duration of ventilation was 12 days (8‐23). D‐dimer peaked at 3.8 mg/L (2.1‐5.3), and maximum dalteparin dose was 15 000 IU/24 h (10 000‐15 000). Despite organizational changes, a high degree of adherence to treatment protocols was achieved.ConclusionIn a prospective cohort study of mechanically ventilated COVID‐19 patients treated in a resource‐rich, publicly financed healthcare system, mortality was considerably lower than previously reported in retrospective studies.

Ten years of progress towards universal health coverage: has China achieved equitable healthcare financing?

IntroductionThis study aims to systematically evaluate vertical and horizontal equity in the Chinese healthcare financing system over the period 2008–2018 during the progress towards Universal Health Coverage (UHC), and to...

Effective factors and drivers of Iran's health care financing system

Background: Different factors affect Iran's health care financing system, and regardless of this impact, the future of this system will face fundamental challenges. In this environment, a health system is successful if it is able to anticipate the effects of these factors in the future of health care financing and preplan appropriate interventions towards health care financing system. The present study aims to identify these factors and trends. Methods: This study compiled a round view of the experts on the subject, with a future studies approach through a qualitative method. To collect data, a deep and semi-structured interview was performed. The results of the interviews were analyzed using content analysis method, and the primary and secondary themes were extracted using the Micmac software. Results: A total of 71 variables were identified in the form of 12 groups with titles of stewardship, service provision, resource gathering, purchasing and resource allocation, sociocultural, technological, environmental, economic, political, and managerial, and laws and values. Four variables, including distant-service provision, administrative bureaucracy, administrative focus and corruption, low-support decision-making, economic blockade, and sales of oil were among the influential factors and drivers. Conclusion: The findings showed Iran's financing system is relatively stable but fragile and 3 areas of technology, politics, and economics have the most impact on structuring Iran's financing system.

Flu Vaccinations in Pharmacies-A Review of Pharmacists Fighting Pandemics and Infectious Diseases.

The phenomenon of population ageing observed over recent years involves growing healthcare needs and the limited staffing and financing of healthcare systems, and as such demands some functional changes in the healthcare model in many countries. This situation is particularly significant in the face of a pandemic, e.g., flu, and currently COVID-19.As well as social education, preventive vaccinations are the most effective method of fighting the infectious diseases posing a special threat to seniors. Despite this, the vaccination coverage level in most European countries is relatively low. This is largely due to patients having limited access to vaccinations. In some countries, implementing vaccinations in pharmacies and by authorized pharmacists has significantly improved vaccination coverage rates and herd immunity, while lowering the cost of treating infections and the resulting complications, as well as minimizing the phenomenon of inappropriate antibiotic therapies. This article presents the role of pharmacists in the prevention of infectious diseases, pointing out the measurable effects of engaging pharmacists in conducting preventive vaccinations, as well as analyzing the models of implementing and conducting vaccinations in pharmacies in selected countries, and depicting recommendations regarding vaccinations developed by international organizations. The presented data is used to suggest requirements for the implementation of preventive vaccinations in community pharmacies.

Пандемія COVID-19 та фіскальна стійкість

The article deals with the impact of the COVID-19 pandemic on the financing of the health care system, and the main challenges to the stability of the financial mechanisms of post-pandemic health care development have been identified. The author substantiates the peculiarities of the crisis of health care financing in the conditions of the current pandemic, further economic recession and decreased fiscal sustainability. The global practice of fiscal response to the manifestations of the COVID-19 pandemic has been systematized and the volumes of the corresponding financing in the countries with insurance and budgetary systems of health care financing have been estimated. The article identifies mechanisms for the transformation and expansion of the fiscal space in the context of expanded financing of the growing need for medical care in the face of new epidemic risks in different countries. Most often, the expansion of a country's fiscal space is carried out by: redistributing the existing amount of government expenditure for health care and redirecting funding flows from financing certain types of medical care to financing programs to overcome and combat COVID-19; changes in the priority of government health expenditure to combat COVID-19 compared to other budget expenditures on the social sphere and economic development; and using national reserve funds and emergency funds. It has been found that in the field of health care, the vast majority of countries have reduced the economic and territorial deprivation of all population groups in access to the diagnosis and treatment of COVID-19. The author emphasizes the weaknesses of insurance based and decentralized health financing mechanisms to respond to the growing need for health care and financial stability during the pandemic. Substantiated the necessity to expand the fiscal space needed to cover the fiscal gap in Ukraine caused by the requirement to increase health care financing in response

Improving risk-equalization in Switzerland: Effects of alternative reform proposals on reallocating public subsidies for hospitals

The Swiss healthcare financing system is on the verge of one of its largest reforms. The Swiss parliament is currently debating how to reallocate about 20 % of total health expenditures. Swiss cantons make substantial tax-funded contributions to health expenditures by paying 55 % of hospital inpatient costs. As health insurers are fully responsible for all outpatient costs, the present system may provide unintended incentives to treat patients in inpatient settings. This paper presents and evaluates three alternative reform proposals for the reallocation of the cantonal contribution. Two proposals are currently under consideration in the Swiss parliament, suggesting either partial cost-sharing (20 %) of all healthcare costs or inclusion of cantonal contributions into the risk-equalization fund. A third option is developed in this paper, which proposes using the cantonal funds to pay a share of insurer’s expenses above a high-cost threshold. The high-cost risk-sharing alternative is clearly superior: it mitigates the incentive to discriminate against sicker individuals, improves incentives for cost control, and reduces risk of loss for insurers. The paper adds results from Switzerland to an international literature on the properties of adding high-cost risk sharing to a risk equalization model.

Hungary

Abstract Background The impact of Populist Radical Right (PRR) parties on health policy has so far been neglected by health policy and welfare state literature. The case of the Alliance of Young Democrats (Fidesz) in Hungary, a large PPR party which secured three consecutive supermajorities since 2010, is illustrative of the priorities PPR parties. Methods We conducted a review of available primary sources (legal and policy documents) and secondary literature (academic, press, and think-tank publications). Resulting data was analyzed thematically. Results Under Viktor Orban, Fidesz nominally stopped marketization reforms of the previous governments by re-nationalizing hospitals in its first term. However, voluntary and employer-sponsored private insurance has grown rapidly, resulting in a parallel system of health care financing and provision, likely due to continued underfunding and understaffing of the public sector. The government has not stopped the exodus of health professionals. In public health, Fidesz sought to reduce smoking rates by imposing a wide-reaching smoking ban and by nationalizing the sale of tobacco in its first mandate. Conclusions Fidesz' election in 2010 was brought in part due to protests against health privatization. Health care continued to be a prominent theme of the 2018 elections, this time mobilized by the far-right opposition as a grievance against the government. Fidesz's electoral success is less attributable to health policy than to nationalist and populist rhetoric.

COVID-19 pandemic in Finland – Preliminary analysis on health system response and economic consequences

ObjectivesThe objective of this study was to describe and analyze the impact of the coronavirus disease COVID-19 on health policy, social- and health system, and economic and financing system to prevent, treat, contain and monitor the virus in Finland. MethodsThis study provides early outcomes of health policy measures, social- and health system capacity as well as economic challenges in COVID-19 pandemic in Finland. This paper is based available documents and reports of different ministries and social, health and economic authorities collected online. This was complemented by other relevant pandemic data from Finland. ResultsThe impact of COVID-19 pandemic on the Finnish society has been unpredictable although it has not been as extensive and massive than in many other countries. As the situation evolved the Government took strict measures to stop the spread of the virus (e.g. Emergency Powers Act). Available information shows that the economic consequences will be drastic also in Finland, albeit perhaps less dramatic than in large industrial economies. ConclusionsFinland has transferred gradually to a “hybrid strategy”, referring to a move from extensive restrictive measures to enhanced management of the epidemic. However, health system must be prepared for prospective setback. It is possible, that COVID-19 pandemic has accelerated the development of digital health services and telemedicine in Finnish healthcare system.

Effective factors and drivers of Iran's health care financing system

Background: Different factors affect Iran's health care financing system, and regardless of this impact, the future of this system will face fundamental challenges. In this environment, a health system is successful if it is able to anticipate the effects of these factors in the future of health care financing and preplan appropriate interventions towards health care financing system. The present study aims to identify these factors and trends. Methods: This study compiled a round view of the experts on the subject, with a future studies approach through a qualitative method. To collect data, a deep and semi-structured interview was performed. The results of the interviews were analyzed using content analysis method, and the primary and secondary themes were extracted using the Micmac software. Results: A total of 71 variables were identified in the form of 12 groups with titles of stewardship, service provision, resource gathering, purchasing and resource allocation, sociocultural, technological, environmental, economic, political, and managerial, and laws and values. Four variables, including distant-service provision, administrative bureaucracy, administrative focus and corruption, low-support decision-making, economic blockade, and sales of oil were among the influential factors and drivers. Conclusion: The findings showed Iran's financing system is relatively stable but fragile and 3 areas of technology, politics, and economics have the most impact on structuring Iran’s financing system.

Exclusion of Migrant Workers from National UHC Systems-Perspectives from HealthServe, a Non-profit Organisation in Singapore.

Low-wage migrant workers in Singapore are legally entitled to healthcare provided by their employers and supported by private insurance, separate from the national UHC (universal health coverage) system. In practice, they face multiple barriers to access. In this article, we describe this policy-practice gap from the perspective of HealthServe, a non-profit organisation that assists low-wage migrant workers. We outline the healthcare financing system for migrant workers, describe commonly encountered barriers, and comment on their implications for the global UHC movement’s key ethical concepts of fairness, equity, and solidarity.

Assessment of Health Budgetary Allocation and Expenditure Toward Achieving Universal Health Coverage in Nigeria

Context: The implementation of the Universal Health Coverage (UHC) promotes access to quality health care delivery through cost-effective initiatives to ensure good health and wellbeing without discrimination. This study examines government finance, budgetary allocation, and expenditure as key health development indicators towards achieving the UHC in Nigeria. Evidence Acquisition: Data analyzed in the study were gotten from journal articles, reports and other secondary sources. Searches were conducted in PubMed, Google Scholar, and WHO Library Database with pre-determined search terms. Further publications were identified through snowballing of citations and references. We reviewed only papers written in English with no date restrictions placed on searches. Results: Within the period of analysis, the annual national health budgetary allocation in Nigeria has been below the 2001 Abuja declaration of allocating 15% of the national budget to health. Our analysis also revealed that if the Abuja declaration was implemented, additional allocations of NGN 4.99 trillion should have been injected into the health sector between 2014 and 2020. In addition, Nigeria also lags behind relative to some other low-and middle-income countries in terms of government expenditure to the health sector in achieving the UHC. Conclusions: The inadequate budgetary allocation in Nigeria to healthcare has significantly influenced recurrent and capital health expenditure. It is worthy to note that the insufficient allocation will continue to significantly affect capital expenditure which is a large determinant of the development of any health system. With the current state of healthcare budget allocation in Nigeria, efforts need to be intensified to ensure the achievement of UHC. In the face of achieving UHC, reviewing the system of healthcare financing and ensuring prudent allocation of resources while shifting the focus from out-of-pocket payments for health is essential. We also recommend increase in political commitment towards improving the health of the populace so as to ensure health systems goals of efficiency, equity, quality of care, sustainability, financial risk protection for all citizens are achievable.

Exploration of Influence of Socioeconomic Determinants on Mortality in the European Union.

Economic performance measured through the gross domestic product indicator and the poverty rate varies across the whole European Union, together with the considerable income inequalities in the long-term. Economic growth may not bring a reduction in the health inequalities in the individual countries themselves. In order to eliminate health inequalities, the different types of policies implemented in the health, social and economic systems need to be explored in more detail. Mortality is explored through an indicator of the standardised mortality rate for both sexes explained by the several socioeconomic determinants, among which variables such as the variations of the gross domestic product per capita, the healthcare expenditures, the unemployment rate, and the healthcare system financing. Almost in all the described cases, these dimensions have negative impact. All the influences are expressed in a relative way in order to be suitably interpretable. The analysis is not comprehensive; nevertheless, it contains 18 regression models to cover as many aspects as it is possible. The Discussion section offers an evaluation of the obtained results according to the outcome of the other studies.

Curbing Financial Corruption in Lebanese Healthcare Sector

Up to 2016, Lebanon was ranked the first among the Arab countries in the high level of corruption in its administration and public institutions. This corruption has penetrated the Lebanese healthcare sector deeply and has spread at different levels including hospitalization, medicine, and most notably within the healthcare financing system. The objective of this paper is to highlight the major global corruption practices in health sector while focusing on the current state of Lebanon. Secondary data and statistics are obtained from published reports, statements and interviews. Mainly, there is an irrational high expenditure and relative surplus in the healthcare market especially for medical equipment’s. In addition, there is a gap in health policies in terms of laws, regulations, and governance practices such as lack of accountability; transparency and access to information. Key implications are presented for healthcare practitioners to adapt anti-corruption interventions and coordinate with the guarantors in curbing the financial corruption and raising the social awareness. Future studies can expand this issue empirically and put the discussion into a comparison approach. This paper highlights some of the announced corrupt practices in the Lebanese healthcare sector and proposes proactive anti-corruption interventions for much more hidden violations.

Indicators of the effectiveness of the health care financing system in the Western Balkan countries-critical analyze

Background/Aim. The main objective of the health system is to preserve and improve the general level of health of the population. Every country is making considerable efforts to ensure a sustainable healthcare financing system that would enable the qualitative realization of basic social security rights, rights to healthcare. The aim of the study was to determine the difference between the health system and the concepts of financing through the critical analysis of the system/model and indicators of financing health care in the Western Balkan countries. Methods. An overview of the current state of the health care system in the Western Balkan countries was based on data collected from sources such as the World Bank, World Health Organization, United Nations Development Programme (UNDP) reports, health ministries, finance ministries and statistical institutes of all countries in the analysis. Following the classification of the data, some categories were created to identify differences and similarities between the funding methods used in the Western Balkan countries. The analysis was performed by measuring the effect of healthcare funding on variables by measuring performance. Because it is impossible to measure the relationship between variables in a single regression analysis model, several regression functions were used for accurately determining the relationship results. Results. The two indicators: a total expenditure on health services and institutions as a percent of gross domestic product (GDP), and health expenditure per capita shows weak positive correlation (p = 0.3) indicating that a higher amount of GDP per capita does not have a positive impact on the percentage of health expenditure in the Western Balkan countries observed. Despite differences in expenditures, all countries had a relatively similar funding method with different regulation that has impact on effectiveness of health system and resources used. Conclusion. The health sector in the Western Balkans is characterized by a lack of adequate administrative resources, legislation and regulations, as well as significant constraints in securing the necessary budget. Considering the resources devoted to the health sector in the Balkan countries, it can be said that the authorities in these countries do not see the health system as an important pillar of the country''s development, as they do not devote sufficient financial resources to ensure the functioning of the health system.

Socioeconomic differences in use of public, occupational and private health care: A register-linkage study of a working-age population in Finland.

There is little knowledge on socioeconomic differences in use of health care organized by different care schemes and on exclusive and concurrent use of health care at different schemes in different socioeconomic groups. In Finland, public, occupational and private schemes offer parallel outpatient primary health care services. Each scheme mainly reaches different population groups because of differences in availability, costs and gatekeeping. This study aimed to analyse how the probability of using health care organized by the three schemes differed by socioeconomic status in a working-age population. Individual-level register-based data on use of public, occupational and private outpatient primary health care during 2013 as well as data on sociodemographic covariates were linked for the total population aged 25–64 of the city of Oulu, Finland. Data were analysed with descriptive methods and multinomial logistic regression models. Those in the study population most often used only occupational care or only public care, or did not use any of the studied health care schemes at all. The lower the socioeconomic status, the higher was the probability of not using care or using only public care. The higher the socioeconomic status, the higher was the probability of using occupational care–either only occupational care or occupational care in combination with private care. Education, occupational class and income were all associated with care use also when adjusted for sociodemographic covariates and chronic disease, but income proved to be the strongest predictor of the three. The results reflect the design of the Finnish health care system, with a strong occupational health care scheme for the employed population contributing to inequality in use of health care and potentially to health inequality between socioeconomic groups.

Reverse decoupling: Ukrainian case of healthcare financing system reform

PurposeThe purpose of this paper is to explore inter-organizational interactions that might result in prolonged decoupling between central governments' ideas and local governments' practices during the reform of an institutional field (i.e. healthcare).Design/methodology/approachThe paper is based on a qualitative study of the centrally directed reform of the healthcare financing system in Ukraine and focusses on practices and reform ideas from 1991 to 2016.FindingsThe findings show that, for more than 25 years, local governments, as providers of healthcare services, faced two major problems associated with drawbacks of the healthcare financial system: line-item budgeting and fragmentation of healthcare funds. Over 25 years, central government's attempts to reform the healthcare financing system did not comprehensively or systematically address the stated problems. The reformers' ideas seemed to focus on creating reform agendas and issuing new laws, instead of paying attention to challenges in local practices.Practical implicationsThis article has two main points that are relevant for practitioners. First, it calls for greater involvement from local actors during all stages of public sector reforms, in order to ensure the relevance of developed reform strategies. Second, it points to potential challenges that central governments may face when conducting healthcare financing system reforms in transitional economies.Originality/valueThe paper's contribution is twofold: it outlines reasons for problematic implementation of healthcare financing system reform in Ukraine and explains them through a “reverse decoupling” concept.

A Scoping Review of Populist Radical Right Parties' Influence on Welfare Policy and its Implications for Population Health in Europe.

Background: In light of worrying public health developments such as declining life expectancy gains and increasing health inequalities, there is a heightened interest in the relationship between politics and health. This scoping review explores the possible welfare policy consequences of populist radical right (PRR) parties in Europe and the implications for population health. The aim is to map the available empirical evidence regarding the influence of PRR parties on welfare policy reforms and to understand how this relationship is mediated by political system characteristics in different countries. Methods and Analysis: A scoping review of peer-reviewed empirical literature addressing the relationship between PRR parties, political systems and welfare policy in Europe was performed using the methodology by the Joanna Briggs Institute. Data was charted on main study characteristics, concepts and relevant results, after which a qualitative content analysis was performed. The data was categorised according to the political system characteristics: constitution, political economy, interest representation and partisanship. Five expert interviews were conducted for validation purposes. Early evidence from 15 peer-reviewed articles suggests that exclusionary welfare chauvinistic positions of PRR parties are likely to have negative effects on the access to welfare provisions and health of vulnerable population groups. Differences in implementation of welfare chauvinistic policy reforms are partly explained by mediation of the constitutional order (judicial institutions at national and European Union [EU] level), political economy (healthcare system funding and European single market) and partisanship (vote-seeking strategies by PRR and mainstream parties). No clear evidence was found regarding the influence of interest representation on welfare chauvinistic policies. Discussion: While early evidence suggests that the welfare chauvinistic ideology of PRR parties is harmful for public health, the possible mediating role of political system characteristics on PRR welfare policy influence offers risk and protective factors explaining why the PRR ideology plays out differently across Europe.

OBJECTIVES OF USING OF PUBLIC-PRIVATE PARTNERSHIP MECHANISMS TO IMPROVE THE QUALITY OF MEDICAL SERVICES

Since the 1990s, developed countries have begun to introduce a new mechanism of public-private partnership to attract representatives of the private sector and their funds to carry out their functions.The projects of the public-private partnership mechanism are determined by the government on the basis of the established priorities of the country's development. The volume of investments in the economies of developed countries through the use of public-private partnerships is growing from year to year. Public-private partnership serves to ensure the quality and speedy implementation of certain functions of the goverment. Therefore, based on the experience of developed countries, developing countries pay great attention to the use of public-private partnership mechanisms to provide social services, including medical services, to improve their quality and increase the level of healthcare.An analysis of the practice of approaches of developed and developing countries to public-private partnerships shows that the directions of the public-private partnership projects are different. While the share of projects in the field of healthcare and education in the UK is high and main projects in the United States are implemented in the field of road construction. The authors have analyzed the public-private partnership, its stages and forms of development on the basis of the experience of developed countries. As a result of the analysis, recommendations were made to develop the use of this mechanism in financing of healthcare system in Uzbekistan.