Health System Coverage Research Articles

Disparities in healthcare-seeking behaviors and associated costs between Venezuelan migrants and Colombians residing in Colombia

BackgroundColombia, which hosts over 3 million of the Venezuelan diaspora, is lauded for its progressive approach to social integration, including providing migrants access to its universal health coverage system. However, barriers to healthcare persist for both migrant and host populations, with poorly understood disparities in healthcare-seeking behaviors and associated costs. This is the first study to link healthcare-seeking behaviors with costs for Venezuelan migrants in Colombia, encompassing costs of missing work or usual activities due to healthcare events.MethodsWe use self-reported survey data from Venezuelan migrants and Colombians living in Colombia (September-November 2020) to compare healthcare-seeking behaviors and cost variables by nationality using two-sampled t-tests or Chi-square tests (X2). The International Classification of Diseases was used to compare reported household illnesses for both populations. Average health service direct costs were estimated using the Colombian Government’s Suficiencia database and self-reported out-of-pocket (OOP) payments for laboratory and pharmacy services. Indirect costs were calculated by multiplying self-reported days of missed work or usual activities with estimated income levels, derived by matching characteristics using the Gran Enquesta Integrada de Hogares database. We calculate economic burdens for both populations, combining self-reported healthcare-seeking behaviors and estimated healthcare service unit costs across six healthcare-seeking behavior categories.ResultsDespite similar disease profiles, Venezuelan migrants are 21.3% more likely to forego formal care than Colombians, with 746.3% more Venezuelans reporting lack of health insurance as their primary reason. Venezuelan women and uninsured report the greatest difficulties in accessing health services, with accessing medications becoming more difficult for Venezuelan women during the COVID-19 pandemic. Colombians cost the health system more per treated illness event (US$40) than Venezuelans (US$26) in our sample, over a thirty-day period. Venezuelans incur higher costs for emergency department visits (123.5% more) and laboratory/ pharmacy OOP payments (24.7% more).ConclusionsWhile Colombians and Venezuelans share similar disease burdens, significant differences exist in access, cost, and health-seeking behaviors. Increasing Venezuelan health insurance enrollment and tackling accessibility barriers are crucial for ensuring healthcare equity and effectively integrating the migrant population. Findings suggest that improving migrant access to primary healthcare would produce savings in Colombian healthcare expenditures.

Hospital Admission for Diabetic Ketoacidosis in Thai Children and Adolescents with Type 1 Diabetes: A National Study during 2015-2019.

To study the national incidence of admission for diabetic ketoacidosis (DKA) in Thai children and adolescents with type 1 diabetes (T1D) and characterize risk factors for DKA admission. Admission records of children and adolescents with T1D during the years 2015-2019 were retrieved from the Thai health coverage system of all schemes. Hospitalization was categorized according to patients' age groups (<1, 1-5, 6-12 and 13-17 years), sex and geographical regions (Bangkok, Central, Northeast, North and South). DKA admission incidence and rate were calculated and compared among subgroups. The annual incidences of T1D and DKA admissions progressively increased over the study period (T1D: 12.0 to 15.0, p<0.001 and DKA: 4.8 to 7.3 per 100,000 child-years, p<0.001). About half of DKA admissions (52%) were recurrent episodes. DKA admission rate was 1.49 admissions/patient. The incidence of DKA admission was greatest in individuals aged 13-17 years (13-17 years: 10.3; 6-12 years: 6.3; 1-5 years: 1.7; and <1 year: 0.6 per 100,000 child-years, p<0.001). DKA admission incidence was greater in females than males (7.6 vs. 4.3 per 100,000 child-years, p<0.001). Among 5 geographical regions, greatest percentage of recurrent DKA (57%), rate of increased annual incidence of DKA admission (3.8 to 7.8 per 100,000 child-years), and DKA admission rate (1.64 admissions/patient) were found in the Northeast region. During the years 2015-2019, rising annual incidences of T1D and DKA admissions among Thai youth were observed. Individuals older than 6 years, being females, and resided in the Northeast region had higher risk for DKA hospitalization.

Work and health habits of Thai physicians.

Physicians usually have a high responsibility in caring for people. Many times, they encounter work-life imbalances that can impact both their personal health and the quality of medical services they provide. To evaluate the works and health habits of Thai physicians. Thai physicians who participated in the hospital's Corporate Social Responsibility "Save Doctors' Heart" project, conducted between February 14, 2022 and October 31, 2022, were invited to participate in the study. Data collected was personal data, work habits, including workplace, work hours, and health habits, including fiber in the diet, exercise, sense of well-being, history of health surveillance, and health coverage system. The characteristic features associated with their work and health habits were studied. The responses to each question varied among the 1,244 physicians who agreed to join the study. The median age was 45.0 years (IQR 39,56 years). Almost all (98.6%) were still active in medical practice, with >1 workplace in 14.7%. Nearly half (44.5%) worked >40 hours per week. Most reported a moderate to high fiber diet (80.8%), but only 29.7% exercised >3 days per week. Some degree of stress was revealed in 82.1%, being moderate to severe in 25.8%. The younger physicians with less exercise were significantly associated with moderate/severe stress. Only slightly more than half (53.0%) had a good sense of well-being. Nearly 30% had irregular health surveillance. The two most common reasons were unavailability/no time and having no symptoms. Thai participating physicians were still active professionally and had mixed health habits. Most consumed a moderate to high fiber diet and had regular health surveillance; however, with less exercise and some degree of stress. More than half were self-assessed to have a good sense of well-being.

The paradox of growing technical capacities with low global governance: a review of Voluntary National Reviews’ SDG health-related indicators

BackgroundThis study delves into the States’ accountability for health-related Sustainable Development Goal (SDG) indicators from 2016 to 2020. An analysis of Voluntary National Reviews (VNR) is employed as an instrument to scrutinize the alignment of States’ indicators with the global indicator framework, shedding light on global health governance within the context of the 2030 Agenda and States’ strategic prioritization. A curation of 60 health-related indicators from 195 VNRs, produced during the aforementioned period, is organized into thematic groups.ResultsOur results highlight a concerning discrepancy in the reporting frequency of various health-related themes. The findings reveal a paradoxical coexistence characterized by the concurrent strengthening and diminution of the global health governance articulated in the Agenda’s global health governance. This manifests in the increased utilization and consistency of health-related indicators over the study years, coupled with an emphasis on infectious diseases and child and maternal health indicators. Conversely, a discernible governance decline is evidenced by the inadequate representation of health-related indicators in VNRs, notably within the domains of universal health coverage and health system indicators. Furthermore, High-Income States exhibit diminished accountability.ConclusionsThe VNRs unveil a paradox wherein burgeoning technical capacity coexists with governance deficits, a phenomenon attributable to both statistical capabilities and political preferences. The prevalent use of proxy indicators in VNRs oversimplifies the presentation of official indicators, thereby compromising the aspirational goal of pioneering statistical innovations for measuring intricate issues in the SDGs. In light of our conceptualization of the 2030 Agenda’s global health as a regime complex governance, we advocate for comprehensive investigations into each health regime cluster. This approach aims to unravel disputes, discern patterns, and elucidate States’ preferences concerning specific thematic areas. Functioning as an accountability mechanism for the Agenda’s governance, VNRs underscore States’ adaptability and short-term learning capabilities, offering valuable insights for identifying harmful goal prioritization. The discretionary nature of indicator selection by States in the VNRs, enabled by the Agenda’s proposition of a contextual adaptation of the SDGs and a blind eye to the guideline’s request to review all SDG indicators, highlights a critical flaw in the VNR as an accountability mechanism.

Epidemiology of hip fractures in Thailand.

To examine the annual incidence of hip fractures over 10years (2013-2022), hip fracture trends, and the annual hospitalization costs for hip fractures in a population aged 50years and older within the Universal Health Coverage System. A retrospective study was conducted. Hip fracture hospitalizations were identified using ICD-10. Data on the number of hip fracture hospitalizations, population aged ≥ 50years, and hospitalization costs were obtained. The primary outcome was the annual incidence of hip fractures. The secondary outcomes were hip fracture incidence by 5-year age group, the annual hospitalization costs for hip fractures, and the number of hip fractures in 6 regions of Thailand. The hip fracture incidence increased annually from 2013-2019 and then plateaued from 2019-2022, with the crude incidence (per 100,000 population) increasing from 112.7 in 2013 to 146.7 in 2019 and 146.9 in 2022. The age-standardized incidence (per 100,000 population) increased from 116.3 in 2013 to 145.1 in 2019 and remained at 140.7 in 2022. Increases in the crude incidence were observed in both sexes (34% in females and 21% in males; p < 0.05). The annual hospitalization costs for hip fractures increased 2.5-fold, from 17.3 million USD in 2013 to 42.8 million USD in 2022 (p < 0.001). The number of hip fractures increased in all six regions of Thailand across the 10-year study period. Osteoporotic hip fractures are a significant health concern in Thailand. The incidence and the annual hospitalization costs for hip fractures increased significantly from 2013 to 2022.

ԱՌՈՂՋՈՒԹՅԱՆ ՀԱՄԱՊԱՐՓԱԿ ԱՊԱՀՈՎԱԳՐՈՒԹՅԱՆ ՀԱՄԱԿԱՐԳԻ ԱԶԴԵՑՈՒԹՅՈՒՆՆԵՐԸ ՀՀ ԲՆԱԿՉՈՒԹՅԱՆ ԵԿԱՄՈՒՏՆԵՐԻ ՆԵՐԱՌԱԿԱՆ ԲԱՇԽՄԱՆ ՈՒ ԱՆՀԱՎԱՍԱՐՈՒԹՅԱՆ ՀԱՂԹԱՀԱՐՄԱՆ ՀԱՄԱՏԵՔՍՏՈՒՄ / THE EFFECTS OF THE UNIVERSAL HEALTH INSURANCE SYSTEM IN THE CONTEXT OF INCLUSIVE DISTRIBUTION OF INCOME OF THE RA POPULATION AND OVERCOMING INEQUALITY

The purpose of the article is to discuss the possible social consequences of the implementation of the universal health coverage (UHC) system in the Republic of Armenia from the point of view of ensuring inclusiveness and to evaluate their possible effects on the incomes of different strata of the population. The problems of the research are related to the study of the issues of both quantitative and qualitative assessment of the effects caused by the introduction of UHC and the development of relevant recommendations for reforms in that context. During the research, statistical, inductive and deductive, analytical, simulation analysis methods were used. According to the results of the research, the introduction of UHC in the form proposed by the draft law will significantly increase the tax burden of taxpayers included in the lowest income groups of the population, in some cases even reaching up to the entire income. Within the framework of the research, it was substantiated that the Gini coefficient of income inequality before taxation in the Republic of Armenia is 0.5724, after taxation, taking into account only income tax, 0.5722, with the effects of other regressive components of labor taxation: social and stamp fees, 0.5911. And here, if we take into account the impact of the introduction of the Universal health coverage rate, the Gini coefficient after taxation will be 0.6088, which means that the inequality from the viewpoint of income distribution will be deepened even more with the introduction of this framework of the system. In order to solve the problems, identified within the framework of the research, it is proposed to introduce a progressive scale of mandatory medical insurance premiums, as well as to provide somewhat different mechanisms of state copayments (subsidies) for socially vulnerable and low-income groups of the population.

Social Vulnerability and Access to Health Services Ethical Dimension

The problem of social vulnerability emerges with greater presence in everyday life given the depth of the threats that increasingly slow down the conditions of stability of human life. The most recent and complete expression of this issue is the devastating short, medium and long-term effects of COVID-19, which made visible the gaps in the coverage of health systems globally. This work reveals the relationship between social vulnerability, understood as the specific level of exposure and fragility suffered by people in the face of a threat of various natures, with access to health services based on the ethical content of said relationship. The issue is topical because analysts and decision makers have not found effective solutions to inequalities, while actions are sterile in the face of the deep and widespread vulnerabilities that extend to the broadest sectors of the world's population.

Health Inequities in Cancer Incidence According to Economic Status and Regions Are Still Existed Even under Universal Health Coverage System in Korea: A Nationwide Population Based Study Using the National Health Insurance Database.

The purpose of this study is to determine the level of health equity in relation to cancer incidence. We used the National Health Insurance claims data of the National Health Insurance Service between 2005 and 2022 and annual health insurance and medical aid beneficiaries between 2011 and 2021 to investigate the disparities of cancer incidence. We calculated age-sex standardized cancer incidence rates by cancer and year according to the type of insurance and the trend over time using the annual percentage change. We also compared the hospital type of the first diagnosis by cancer type and year and cancer incidence rates by cancer type and region in 2021 according to the type of insurance. The total cancer incidence increased from 255,971 in 2011 to 325,772 cases in 2021. The absolute difference of total cancer incidence rate between the NHI beneficiaries and the medical aid (MA) recipients increased from 510.1 cases per 100,000 population to 536.9 cases per 100,000 population. The odds ratio of total cancer incidence for the MA recipients increased from 1.79 (95% confidence interval [CI], 1.77 to 1.82) to 1.90 (95% CI, 1.88 to 1.93). Disparities in access to hospitals and regional cancer incidence were profound. This study examined health inequities in relation to cancer incidence over the last decade. Cancer incidence was higher in the MA recipients, and the gap was widening. We also found that regional differences in cancer incidence still exist and are getting worse. Investigating these disparities between the NHI beneficiaries and the MA recipients is crucial for implementing of public health policies to reduce health inequities.

How to Implement Universal Healthcare Coverage in the United States: Two Novel Pathways

Universal Health Coverage does not exist in the United States for two reasons: (1) there is a general unwillingness to dismantle the historically grown framework of the world’s most complex mix of public and private sector health coverage, and (2) mere cost considerations. The first concern can be alleviated by establishing a Universal Health Coverage system that retains much of the existing U.S. health infrastructure. The two proposed pathways presented herein comprise either (1) a leveled solution through Medicare expansion for the uninsured only, or (2) a more complex solution through a national, 2-tier healthcare system for all Americans. Both pathways are based on solid financing without major tax increases, utilizing existing and/or yet untapped funding sources. For the sake of forming a more perfect union, as stated in the Constitution, Universal Health Coverage in the United States must no longer be an illusion that continues to haunt our society in the 21st century.

Willingness to Pay for Universal Health Coverage among the General Population in Armenia

Abstract Background In Armenia, as in many low and middle-income countries, a large segment of the population is still required to make high out-of-pocket payments to obtain essential services at the secondary or tertiary levels of healthcare. Countries are showing growing interest to provide financial protection to their citizens via a universal health coverage system. We assessed the willingness to pay for universal health coverage (UHC) among the general population of Armenia, and the factors that influence their willingness to pay. Methods We administered a national telephone survey (random digit dialing), among the adult population (18-65 years old) of Armenia. Multivariable logistic regression was applied to analyze the data. Results The total number of survey participants was 787 with a 67% response rate. The mean age of the study participants was 41, and 55% of them were women. The majority of participants (60%) were employed. Around 45% of participants had an average monthly expenditure below AMD 200,000 (about USD 510) and more than one-third (36%) of participants had an average monthly income below AMD 200,000. The majority (72%) of participants were willing to pay 2%−6% of their monthly income to obtain UHC. Multivariable logistic regression analysis showed that one year increase in participants’ age was associated with a small decrease in willingness to pay (OR = 0.97, CI = 0.96; 0.99). Participants with an average monthly expenditure of more than AMD 200,000 (about USD 510) were about 3.4 times more likely to pay 2%−6% of their monthly income than those with an average monthly expenditure of less than AMD 200,000 (OR = 3.44, CI = 1.63; 7.30). Conclusions UHC could be a viable solution for improved healthcare access; however, socioeconomic factors influence public readiness to pay for it. To successfully implement a UHC system, governments need to design progressive premium contributions providing more subsidies to lower socioeconomic groups of their populations. Key messages • Socioeconomic factors of a population can impact their willingness to pay for a universal health coverage system. • Governments must tailor premium contribution to UHC systems to the socioeconomic composition of their populations and implement progressive contribution approaches.

Perceptions and use of Universal Health Coverage (Plan Sésame) among the elderly in Dakar (Senegal), impacts on health expenditure related to diabetes and hypertension

In 2006, the Senegalese government set up a health coverage programme for people aged 60 and over - the Plan Sésame - to provide free medical care in all the country's public health facilities. This scheme has been integrated into the Universal Health Coverage (CMU) promoted from 2013. The objective of the study was to describe and analyse the knowledge and representations of professionals and users about health coverage and the Plan Sésame, the use of the scheme by the elderly, to evaluate the amount of medical expenses incurred during a routine medical consultation for the monitoring of their illness (hypertension and diabetes), and to calculate the out-of-pocket expenses related to the consultation. Study conducted between July 2020 and October 2021 in two public health facilities in Dakar. Mixed approach: 1/ qualitative study by semi-directive interviews, informal interviews, observations and field diary with 35 people selected according to a reasoned choice procedure with the aim of diversifying gender, age, social status, therapeutic itineraries for 23 people (including 12 women, ages between 60 and 85 years), and professional activities for 12 health actors; 2/ quantitative cross-sectional study by questionnaire of 225 people (including 141 women) aged 60 and over; we calculated the total cost of the consultation and associated prescriptions (complementary examinations and medicines) as well as the remaining medical expenses (out-of-pocket) and the cost of transporting patients. This is a descriptive exploratory study of a non-representative sample of the elderly population in Senegal. The health professionals interviewed supported the principle of health coverage, but most of them had limited and sometimes imprecise knowledge of the existing schemes and the methods of access or the services covered. Their point of view about the consequences of the Plan Sésame on their practice reveals some contradictions: some complain about the increase in workload, the criticism is extended to all the free schemes which would have a negative impact on daily practice because of the increase in the number of consultations which would be linked to abuse by patients.The interviews highlight the heterogeneity of the knowledge of elderly people about the health coverage intended for them, even though the Plan Sésame has been in place for over ten years. The interviews clearly show that the use of the health coverage system by the elderly depends closely on the information they have and their ability to use it, both for women and men. There is a close link between the level of social integration of people and their use of health coverage: the most socially integrated people are those who know how to use CMU services best. The use of health coverage by the elderly appears to vary according to the individual.Although Plan Sésame is defined as part of a national strategy, its implementation varies according to the health structures and the periods; in the two study sites, the range of services covered by Plan Sésame is very limited, so the coverage provided by Plan Sésame is only partial: between 30 and 50% of the medical costs; the remaining cost of a consultation for elderly patients with hypertension and/or diabetes varies between 24,000 and 28,000 CFA francs.These amounts must be put into perspective with the resources available to people. Statistical studies published in 2021 report that in Senegal the average daily expenditure is 1,390 CFA francs/person/day; and that almost 38% of the population lives on 913 CFA francs/person/ day, which is the poverty line calculated in 2019. Thus, the average out-of-pocket expenses for a follow-up consultation for hypertension, diabetes or a combination of the two diseases represent 15 to 30 days of daily expenditure. While the vast majority of elderly people in Senegal do not have a retirement pension, health expenses are therefore borne by their relatives. Within households, medical expenditure for the elderly competes with basic needs, particularly food, which usually take up more than half of household resources. This indispensable family support places the elderly in a situation of total dependence. In 2021, Plan Sésame does not yet allow for completely free care for the elderly. However, its application, even partial, has resulted in a real reduction in health care costs for the elderly. Its use remains limited due to inconsistent application by most health structures. Its impact is insufficient in view of the amounts that users have to pay in a context of social and economic vulnerability. These observations reinforce the need to work on reducing the price of medical services and strengthening the UHC, in order to improve the equity and performance of the system, and to make it fully functional in all health structures.

Health insurance coverage and maternal health services in Rwanda: a policy paradox

PurposeResearch has found a strong correlation between maternal healthcare and health insurance coverage. But, despite having one of the best health coverage systems in the developing world, Rwanda still faces formidable challenges in provision certain key maternal health services, leading to higher levels of maternal morbidity and mortality. To understand this paradox, this study will examine the association between maternal health services and insurance coverage, utilizing the latest data from the Rwanda Demographic Health Survey.Design/methodology/approachUsing a sample of 6,167 childbearing women aged 15–49 years, a bivariate and multivariate analysis was conducted to examine the paradoxical relationship between health insurance and maternal health services, such as antenatal care, in Rwanda.FindingsThe results reveal significant differences in ANC4+ and the timing of the first ANC, which remain low in Rwanda. Despite significant improvements in delivery factors and skilled ANC providers, ANC4+ rates in the country remain the lowest. However, this study found a positive and significant association between ANC4+ and insurance coverage (AOR = 1.64, p < 0.001).Originality/valueRwanda has implemented an effective health insurance policy, but there has been minimal progress in the utilization of maternal health services. Therefore, there is a strong need for policy interventions to reduce barriers to healthcare utilization. Additionally, supply-side factors such as transportation, socio-cultural factors and other logistic barriers should be examined in greater detail. These factors may overshadow the impact of health insurance on the utilization of healthcare services in Rwanda.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2023-0059

Population health outcomes in South Korea 1990–2019, and projections up to 2040: a systematic analysis for the Global Burden of Disease Study 2019

South Korea has one of the longest operating universal health coverage (UHC) systems. A comprehensive analysis of long-term trajectories of morbidity and mortality in the South Korean population after the inception of UHC is needed to inform health-care policy and practice. We used data from the Global Burden of Disease Study (GBD) 2019 to present estimates of cause-specific mortality, incidence, prevalence, years of life lost (YLLs), years of life lived with disability, and disability-adjusted life-years (DALYs) in South Korea from 1990 to 2019. We also examined forecasted estimates of YLLs up to 2040 to investigate likely future changes in disease burden. Finally, we evaluated GBD estimates from seven comparator countries to place disease burden in South Korea within a broader context. Age-standardised DALYs related to non-communicable diseases (NCDs) decreased by 43·6% (95% uncertainty interval [UI] 39·4-47·9) and mortality by 58·8% (55·9-60·5) from 1990 to 2019. In 2019, the ratio of male to female age-standardised rates of YLLs in South Korea was higher than the global average for 75·9% (22 of 29 diseases) of leading causes, indicating a disproportional disease burden on males in South Korea. Among risk factors, tobacco use accounted for the highest number of 2019 deaths (44 470 [95% UI 37 432-53 989]) in males and high systolic blood pressure for the highest number (21 014 [15 553-26 723]) in females. Among the top ten leading causes of YLLs forecast in South Korea in 2040, nine were NCDs, for both males and females. Our report shows a positive landscape of population health outcomes in South Korea following the establishment of UHC. However, due in part to the effects of population ageing driving up medical expenditures for NCDs, financial pressures and sustainability challenges associated with UHC are pressing concerns. Policy makers should work to tackle population ageing and allocate resources efficiently by prioritising interventions that address the leading causes of death and disability identified in this study. Bill & Melinda Gates Foundation.

Epidemiology of Angioid Streaks and Pseudoxanthoma Elasticum (2011–2020): A Nationwide Population-based Cohort Study

We aimed to describe the epidemiology of angioid streaks (AS) and pseudoxanthoma elasticum (PXE), which are rare diseases, using a national claims database. This was a population-based longitudinal cohort study. A total of 126 million individuals were covered by the universal health coverage system in Japan. With permission from the Ministry of Health, Labor and Welfare, we accessed all data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, which contains the nationwide health insurance claims data for 126 million Japanese. We identified individuals with AS and PXE between January 2011 and December 2020. The incidence rates, prevalence, overlap of AS and PXE, and mean age at death were calculated. The incidence rates and prevalence of AS and PXE. A total of 6598 cases of AS and 1020 cases of PXE were identified during the 10-year study period. The incidence rates of AS and PXE were 0.52 (95% confidence interval, 0.48-0.56) and 0.08 (95% confidence interval, 0.07-0.10) per 100 000 person-years, respectively. On October 1, 2020, the prevalence of AS and PXE was 6.5 (95% confidence interval, 6.38-6.66) and 0.83 (95% confidence interval, 0.78-0.89) per 100 000 persons, respectively. The overlap of AS and PXE was 363 patients. The mean age at death of individuals with AS and PXE was 79.3±0.51 and 77.1±2.68 years, respectively. This is the first population-based study to elucidate the epidemiology of AS and PXE. The mean age of death of both AS and PXE patients was younger than the mean life expectancy of the general Japanese population, thus, appropriate diagnosis and management are important to avoid preventable death. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Delivery of essential pediatric congenital surgical care within Brazil’s universal health coverage system: a national survey of pediatric surgeons

ObjectiveIn this study, we assess the delivery of congenital pediatric surgical care under Brazil’s system of universal health coverage and evaluate differences in delivery between public and private sectors.MethodsA cross-sectional...

Application of an interrupted time series analysis (ITS) to evaluate the effect of universal dialysis policy from 2006 to 2016 in a province of northeastern Thailand

Background: An interrupted time series (ITS) analysis is a powerful tool for policy evaluation. In Thailand, chronic kidney disease (CKD) is a public health problem that requires a long recovery time and has a high treatment cost. The universal coverage policy for renal replacement therapy (universal dialysis policy), is used to treat this disease but policy evaluation using ITS analysis has rarely been conducted. This study applied ITS analysis to test the effect of such a policy between 2006 and 2016. Methods: Data were retrieved from the electronic database of the health data center in Roi Et Province for the period between January 1, 2006 and December 31, 2016. 15,681 CKD stage 5 patients were included. The intervention under assessment was the universal health coverage system, which has been implemented since 2008. Results: Results showed that before implementation of the universal dialysis policy, the overall trend of access to renal replacement therapy (RRT) slightly increased (0.74; 95% confidence interval (CI): 0.58, 0.90). After implementation of the policy, access sharply increased (6.10; 95%CI: 3.67, 8.54), while the linear trend after policy implementation also slightly increased (0.29; 95%CI: 0.05, 0.14). The stratified analysis showed the same linear directional trend before and immediately after implementing the universal dialysis policy. Conclusions: Implementation of the universal dialysis policy positively impacted the rate of renal replacement therapy in CKD stage 5 patients, while access to health care services also increased.

Mental Health Insurance in India and Other Countries: A Comparative Perspective

Improved health and health coverage are of vital concern to the welfare of Indian society. The nascent health insurance system of a country is experiencing an explosive expansion and various models of schemes but lacking mental health coverage. This article discusses the effect of different systems of health coverage and insurance and develops a system of health coverage in India.

Health and Environment

Bangladesh is passing through the dividend phase of demographic transition, with 45 million (over a quarter of the total population) in the age group of 15-29 years and 52.8 million (about a third) in the 15-36 age group. Young scientists belong to the upper segments of the later age group (some may be somewhat older than 36), who will in the fullness of time, take up leadership positions in their respective fields. Whatever be the field of human endeavour, the capability of the protagonists, is certainly a pivotal key to success. Indeed, human capability depends on education, skill training and health services. The better the availability of these services, the better is expected to be the ability acquired by the people concerned. One of these key services, health, is included in the theme of this conference. This paper has proposed that a universal health coverage (UHC) system be developed in Bangladesh so that people from all walks of life can access at least primary health services. The UHC can be developed centering around the 14,000 or so Community Clinics in place all around rural Bangladesh. Bangladesh is pursuing the goal of sustainable development within the UN adopted 2030 Agenda for Sustainable Development framework. This agenda is anchored on three pillars-economic, social and environmental. Sustainable development can be succinctly defined as socially acceptable, environmentally sound economic growth. Also, a basic tenet characterising sustainable development is that nobody can be left behind, i.e., everybody has to be included. The theme of this conference consist of the environmental pillar of sustainable development. In fact, the environment is the ultimate resource base of all development. Climate change, a major sub-set of environmental issues, is fast deteriorating and becoming an existential threat to humanity. This paper has discussed what has been happening in relation to climate change and what is being done to combat the menace globally and in Bangladesh. The efforts of Bangladesh in policy, programming, funding, and action in the context of responding to the increasingly adverse impacts on the country caused by the worsening climate change have been reviewed. Also, since this problem is global and cannot be adequately combatted by any one country, much less by a resource-poor country like Bangladesh, what role the international community is playing in this regard has been examined. The final section relates the lessons from the above discussions and reviews the future roles that young scientists need to play. J. Bangladesh Acad. Sci. 46(2); 129-134: December 2022

Resilient Regions in Brazil: Unfolding the Effects of COVID-19 From a Socioeconomic Perspective

At the beginning of 2020, the world was left in an unprecedented state of shock by the COVID-19 pandemic. Brazil quickly became the epicenter of new cases of contamination, where the propagation of the virus was unrestrained, despite boasting one of the strongest Universal health coverage systems in Latin America. This paper has at least three empirical contributions to the literature about economic resilience and the COVID-19 pandemic. Firstly it is a critical issue regarding the “economics versus life” trade-off, which is an essential question for developing countries, given that policymakers must decide between policies to reduce the number of COVID-19 infections without damaging the economy. Secondly, our findings suggest that the early adoption of isolation measures applied in 2020, such as the financial aid and the vaccination have been effective in controlling the effects of the pandemic, especially in vulnerable microregions. Furthermore, it was verified that the Emergency financial aid was a fundamental policy in minimizing the economic impacts of the pandemic and allowing people to practice social distancing, contributing positively to the Employment Resilience Index and negatively related to the growth rate of deaths due to COVID-19. The contribution of our study is to measure an inverted U-shaped curve to demonstrate that policymakers must achieve a minimum of families to decrease the COVID-19 deaths. These contributions are essential and straightforward findings to lead policymakers' decisions in developing countries facing financial constraints in the public budget and population reticence about physical distancing, self-quarantine and vaccination.

Digital health systems strengthening in Africa for rapid response to COVID-19.

The COVID-19 pandemic has painfully exposed the constraints of fragile health systems in low- and middle-income countries, where global containment measures largely set by high-income countries resulted in disproportionate collateral damage. In Africa, a shift is urgently needed from emergency response to structural health systems strengthening efforts, which requires coordinated interventions to increase access, efficiency, quality, transparency, equity, and flexibility of health services. We postulate that rapid digitalization of health interventions is a key way forward to increase resilience of African health systems to epidemic challenges. In this paper we describe how PharmAccess' ongoing digital health system interventions in Africa were rapidly customized to respond to COVID-19. We describe how we developed: a COVID-19 App for healthcare providers used by more than 1,000 healthcare facilities in 15 African countries from May-November 2020; digital loans to support private healthcare providers with USD 20 million disbursed to healthcare facilities impacted by COVID-19 in Kenya; a customized Dutch mobile COVID-19 triage App with 4,500 users in Ghana; digital diaries to track COVID-19 impacts on household expenditures and healthcare utilization; a public-private partnership for real-time assessment of COVID-19 diagnostics in West-Kenya; and an expanded mobile phone-based maternal and child-care bundle to include COVID-19 adapted services. We also discuss the challenges we faced, the lessons learned, the impact of these interventions on the local healthcare system, and the implications of our findings for policy-making. Digital interventions bring efficiency due to their flexibility and timeliness, allowing co-creation, targeting, and rapid policy decisions through bottom-up approaches. COVID-19 digital innovations allowed for cross-pollinating the interests of patients, providers, payers, and policy-makers in challenging times, showing how such approaches can pave the way to universal health coverage and resilient healthcare systems in Africa.