Health Care Financing Research Articles

The role of big data in transforming financial management in U.S. healthcare: A conceptual framework

This paper explores the transformative role of big data in financial management within the U.S. healthcare sector, highlighting its capacity to address long-standing financial inefficiencies, enhance decision-making, and improve regulatory compliance. Big data technologies, such as predictive analytics and real-time financial reporting, provide healthcare institutions with the tools to forecast financial trends, optimize budgeting, and mitigate risks. Despite the significant benefits, the adoption of big data in healthcare finance faces challenges, including data privacy concerns, regulatory complexities, and technological limitations. The paper examines these barriers and enablers, offering strategic recommendations for healthcare institutions and policymakers to optimize the use of big data. By improving data governance, upgrading infrastructure, and fostering collaboration across departments, healthcare organizations can maximize the impact of big data on their financial operations. The review concludes with a call for continued policy support and financial incentives to encourage the broader adoption of big data in healthcare finance, ultimately promoting cost efficiency and operational resilience in the sector. Keywords: Big Data, Healthcare Financial Management, Predictive Analytics, Data Governance, Regulatory Compliance, Financial Decision-Making.

Perceptions of healthcare finance and system quality among Nigerian healthcare workers

Perceptions of healthcare finance and system quality among Nigerian healthcare workers

From strategic autonomy to strategic partnership: EU–India relations in health diplomacy

AbstractThe study examines the potential of the European Union (EU)–India cooperation in health diplomacy and the exchange of lessons learned by both actors. Particularly, the growing discourse on achieving strategic autonomy in health has not been adequately analysed in the existing literature, which is surprising given that both actors share this interest. This paper begins by contextualising the discourse of strategic autonomy in the European and Indian political discourse with a specific focus on achieving autonomy in health and subsequently argues for a transition from strategic autonomy to a strategic partnership by recognising the strategic interdependencies. A qualitative content analysis was used to analyse all 16 EU–India summits to locate health diplomacy in their relations and present recommendations for future cooperation. The shift from strategic autonomy to strategic partnership also necessitates a strategic vision towards shaping the EU–India cooperation. With the upcoming EU–India Summit in 2025, research and development, strengthening supply chains, harmonisation of regulations, and financing of healthcare are key areas that can be deliberated on to enhance the cooperation between the two global actors in healthcare.

Respiratory Diagnoses Year-Round: Unraveling the Multifaceted Pediatric Infection Cycles.

The aim of the study is to analyze the annual cycle of pediatric medically attended respiratory illnesses. Data on 141 million pediatric respiratory visits from the years 2010-2019 were obtained from the Polish National Healthcare Fund. To identify underlying patterns and trends within the aggregated data, techniques like seasonal-trend decomposition using LOESS (STL) and principal component analysis (PCA) were applied. A strongly recurring pattern was observed. Following the annual minimum in late summer, there was a sudden surge in upper respiratory infections in early September. Subsequently, overall visits declined gradually, while the share of lower respiratory infections increased, particularly during the influenza peaks from January to March. Afterwards, visits declined steadily, with an additional peak of tonsillopharyngitis noted in midsummer. Dimensionality reduction of diagnoses implied the existence of two major groups of co-occurring diagnoses, the proportions of which change over the year: one smaller but more severe, peaking during the influenza season, and the second dominating with lower severity. Age differences in diagnoses were observed, with babies showing upper respiratory infections likely diagnosed with the common cold rather than a more specific upper respiratory infection. While enhancing surveillance strategies is indeed a desirable long-term goal, it is worth noting that despite the variability observed in the onset of the influenza season, the infection cycles generally follow a relatively fixed pattern. This consistency provides a foundation for effective planning and underscores the potential for proactive measures to mitigate the impact of seasonal outbreaks.

ANALYSIS OF MODERN APPROACHES TO FINANCIAL SUPPORT OF HEALTHCARE FACILITIES IN UKRAINE

The purpose of the study is to analyze modern effective approaches to the financial support of healthcare institutions, which have been successfully implemented in the leading countries of the world, in order to form a unique model of their financing in Ukraine. The uniqueness of the model is ensured by taking into account the institutional features of modern Ukrainian reality. The article analyzes the financial instruments for providing healthcare under various models of financing the healthcare system, which are used in global practice. The process of reforming the healthcare system in Ukraine was studied, which made it possible to establish changes in the financing of healthcare. The components of the healthcare institution's budget are given. The main advantages and disadvantages of approaches to financing healthcare in Ukraine are determined. The volume and structure of expenditures of the Consolidated Budget of Ukraine on healthcare, as well as the main results of the activities of medical care providers covering all regions of Ukraine, were analyzed. The problems of financing healthcare facilities at the local level in Ukraine, which negatively affect the availability and quality of medical services, have been identified. The need to develop a mixed model of healthcare financing in Ukraine through a rational partnership between state medical institutions and the private sector is substantiated. Taking into account the identified problems and needs, a comprehensive approach to improving the financing of healthcare facilities through the introduction of mandatory health insurance and the development of public-private partnerships in the form of facility management, including resource optimization and technological innovations, is proposed.

Assessment of the influence of healthcare financing strategies on universal health coverage: a case of Garissa County, Kenya

Background: Universal health coverage aims to ensure that all people can use the promotive, preventive, and curative health services they need, while also ensuring that the use of these services does not expose the user to financial hardship. This study aimed to assess the influence of healthcare financing strategies on universal health coverage in Garissa County, Kenya. Methods: The research design for this study was an analytical cross-section study. The study used a mixed research methodology approach where both qualitative and quantitative data were obtained for triangulation purposes. Purposive, systematic, and simple random sampling techniques were employed to recruit study participants in this study. Results: The findings indicated that UHC coverage in Garissa County had been achieved only to a moderate extent. The results indicated that public healthcare financing had a positive and significant influence on UHC coverage in Garissa County (β=0.459; p<0.05). The results indicated that healthcare financing through aid had a positive and significant influence on UHC coverage in Garissa County (β=0.249; p<0.05). The results indicated that private healthcare financing had a negative and not significant influence on UHC coverage in Garissa County (β=-0.092; p>0.05). Conclusions: The results led to the conclusion that public and healthcare aid financing were the most appropriate financing approaches to achieve a notable improvement in UHC coverage in the county. The study also concluded that private health financing had a negative impact on the attainment of UHC.

Changes in opinions on health insurance benefits deservingness in the Netherlands between 2013-2023

Abstract Background In many European countries, including the Netherlands, the healthcare system is financed according to the principles of solidarity. Although people are generally highly supportive of collectively financed healthcare services, some groups are considered more deserving of health insurance benefits than others. Increasing knowledge of the health risks of certain lifestyle choices and pressure on healthcare systems may result in changing opinions on the allocation of resources. Our study looks into changes in citizen’s opinions on the deservingness of different groups between 2013 and 2023. Methods Questionnaires were sent out to samples of 1.500 members of the Dutch Health Care Consumer Panel in 2013, 2015, 2017, 2019, 2021, and 2023. Response rates varied between 42% (2015) and 56% (2021). Deservingness was studied by asking respondents about their opinions on the amount of health insurance premium for different, opposing groups, for example older and younger people and those with a healthy and unhealthy lifestyle (group A should pay more, both groups should pay the same amount, or group B should pay more). Multinominal logistic regression models were used to examine changes in deservingness opinions over time. Results Our study showed year-to-year fluctuations in opinions on the premium amount for health insurance for different, opposing groups. However, no distinct increases or decreases were observed over the whole time period. This applies to both the general population and to people who do and do not belong to the different groups. Conclusions Although there are differences in the degree to which groups are considered deserving of health insurance benefits, deservingness opinions were found to be fairly stable in the Netherlands between 2013 and 2023. Our results do not point to increasing support for premium differentiation based on personal characteristics. This suggests that support for solidarity in healthcare financing is not in decline. Key messages • Opinions on the deservingness of health insurance benefits of different groups were found to be fairly stable in the Netherlands between 2013 and 2023. • No evidence of increasing support for premium differentiation based on personal characteristics was found.

An Innovative Public Health Solution with European Features for an American Problem

Abstract Problem The Eastern Shore of Maryland is a beautiful region that boasts a multicultural community of 455,000 year-round residents. Despite its rural location, the coastal lifestyle attracts retirees, making it the state’s oldest population. Unfortunately, the region also has the highest socioeconomic disparities in the state, which creates difficulties in accessing healthcare. This is a significant public health issue that results in costly barriers to preventive care and timely, accounting for $320 billion in unnecessary healthcare spending. Description of the problem Maryland’s healthcare funding formulas favor larger health systems in urban areas, leading to health inequities. To address this, we propose an innovative scenario analysis model partially based on European public health approaches. This model will adjust funding formulas based on each region’s specific needs and challenges, promoting fairness and equity in healthcare funding. Results Adopting this population health management approach would have built-in efficiencies: In the United States, healthcare spending tends to be higher among underserved populations due to delayed care, access challenges, missed diagnoses, and limited access to the latest scientific advances as well as proper preventive services. Lessons The proposed scenario-based public health funding approach targeting the needs of the underserved population on the Eastern Shore of Maryland could yield significant positive health outcomes and health savings generating a ripple effect across the state, and perhaps even the country. The lessons learned in how other countries handle public health funding could lead to global collaboration. Key messages • Our approach aims to provide a practical solution to unnecessary healthcare spending. • We must adapt to the changing tides to stay on course.

Productivity and consultation times in Portuguese primary care: trends and payment model variations

Abstract Background Portugal faces a shortage of primary care workforce resulting in an increase in patients without Family Physician (FP). While expanding the patient list per FP may help, it could also result in excessive workloads, compromising Consultation Times (CT) and quality of care. Furthermore, it is important to study the role of the primary healthcare (PHC) financing model in incentivizing their productivity. This study aims to analyse the productivity and CT in PHC units in Portugal, variation over time, and differences across PHC unit payment models. Methods 6,563 PHC units with different payment models (salary at UCSP, salary and group pay-for-performance at USF-A, and salary, capitation, and individual pay-for-performance at USF-B) from 2015 to 2022 were analysed, including the annual numbers of medical and nursing consultations and full-time equivalents (FTE) of physicians and nurses. Weekly productivity (WP) was calculated using the consultations per FTE physician and nurse. CT were determined by dividing each FTE’s weekly workload by WP. Multivariate analysis explored differences in CT between PHC units, temporal variations, and the influence of the patient population characteristics. Results FTE physicians had a mean WP of 117 consultations (SD 39) lasting 22.4 minutes (SD 7.0). FTE nurses had a mean WP of 56 consultations (SD 18) lasting 41.0 minutes (SD 14.3). Compared to UCSPs, USF-A and USF-B had shorter CT (p < 0.05) by 2.48 to 4.05 minutes for medical consultations and by 5.51 to 8.04 minutes for nursing consultations. CT increased over time, decreased with higher PHC age and favorable socio-demographic context, and increased with higher population density and elderly patients’ proportion (p < 0.05). Conclusions USF-B professionals showed higher productivity and shorter CT, suggesting that financial incentives are effective in enhancing productivity but that gains may be obtained with losses in visit duration. Key messages • Effective workforce management is crucial given the current primary care professionals shortages. • Physicians and nurses in PHC units pay-for-performance exhibit higher productivity and shorter consultation time.

Cultures of Activity, Cultivating Resistance.

The problem of antimicrobial resistance (AMR) is often viewed through biomedical and/or behavioral lenses, with the underlying economic principles and "headwinds" shaping resistance less visible. In this paper, we focus on how healthcare funding models structure the ways AMR is perceived and addressed as an institutional priority. Specifically, we explore how activity-based funding reflects and operationalizes ingrained assumptions about what is valuable and/or worthwhile within the organizational ecology of the hospital. Drawing on interviews with 36 executives from several hospital clinical care settings across two Australian states, we illuminate the ways the activity-based funding paradigm works against efforts to combat AMR. Concerningly, we further observe how activity-based funding models can inadvertently position rising rates of resistance as a benefit-at least in the short term-as the new and intensified interventions required to address resistant infections require more "activity" and thus deliver higher reimbursement at the level of annualized budgets. In failing to recognize the (social and economic) value of reduced activity, activity-based funding risks contributing to AMR, rather than working to resolve it.

Determinants of Healthcare Expenditure: A Cross-Sectional Analysis at the Country Level

This study examines the determinants of healthcare expenditure through a cross-sectional analysis of 153 countries using 2018 data. The research employs a classical linear regression model to identify key socioeconomic and demographic factors influencing healthcare spending per capita, expressed in PPP (Purchasing Power Parity). The results show that GDP per capita, public health expenditure as a percentage of GDP, physician availability, and out-of-pocket healthcare costs are statistically significant determinants of healthcare spending. Specifically, the analysis highlights the non-linear relationship between GDP and healthcare expenditure, where wealthier nations tend to spend disproportionately more on healthcare. Public investment in healthcare and the availability of medical professionals also play crucial roles in shaping national healthcare expenditures. Out-of-pocket expenses by households further increase overall healthcare costs, especially in countries with lower public funding. The proposed model explains 96.5% of the variation in healthcare expenditure, suggesting that the selected variables are strong predictors of healthcare spending. These findings provide valuable insights for policymakers, particularly in the context of balancing public healthcare financing and improving access to medical services while managing overall costs.

The origins of social protection in healthcare: classifying healthcare systems at introduction in 165 countries

ABSTRACT While the emergence of welfare states, and the origins of social protection in healthcare, have been examined extensively for Global North countries, there is much less research with a global perspective. Addressing this gap, this study provides a descriptive and analytical account of the characteristics of healthcare systems as they were introduced worldwide. Using original and unpublished data, the study classifies healthcare systems according to the main actor type in regulation, financing, and service provision. We find two worlds of healthcare regulation – a state-regulated and a societally-regulated. Adding the financing dimension yields six clusters of healthcare regulation and financing. Based on regulation, financing, and service provision the classification reveals the existence of 12 healthcare system types. While systems that rely on societal actors mainly emerged prior to the mid-twentieth century, state-based systems have characterized system introductions since then. The classification of healthcare systems in 165 countries shows that only a limited number of actor combinations can be found empirically. However, it still presents greater variety than previous studies focusing on the Global North. The notable historical and regional patterns in the choice of healthcare system types can serve as a starting point for further research on healthcare system development.

Five Years of National Health Policy in India: Critical Analysis of the Public Health Expenditure from 2017 to 2022 and Way Forward

This retrospective study assesses the impact of India’s National Health Policy (NHP) 2017 on public health expenditure and its implications for achieving Universal Health Coverage (UHC) and Sustainable Development Goal 3 (SDG-3). Using secondary data analysis from government sources, we observed health budget trends relative to GDP from 2017 to 2022. The study found a marginal increase in public health expenditure from 0.9% to 1.6% of GDP, which is below the NHP’s target of 2.5%. The results underscore the challenge of high out-of-pocket expenses, which remain a barrier to UHC. The COVID-19 pandemic has further highlighted the inadequacies of the current funding levels. We conclude that a substantial increase in health budget allocations is crucial for India to make significant strides toward UHC and meet SDG-3 targets. The study also calls for strategic enhancements in healthcare infrastructure and services to address the persistent gaps in healthcare delivery and financing. The findings advocate for a more aggressive approach to public health investment to ensure that quality healthcare services are accessible, affordable, and equitable for all citizens, thereby advancing India’s progress toward comprehensive health coverage.

Rural health care access and financing among cooperative members in rural Nigeria

Rural areas in developing countries have limited access to inclusive healthcare delivery and financing. Membership in cooperatives has been suggested as a pathway to rural health inclusiveness. However, whether cooperative membership supports rural health access and financing remains unclear. This study appraises rural healthcare access and financing, and whether membership in cooperative societies offers healthcare advantages to rural households in Nigeria. Primary data were collected in 45 rural communities consisting of 900 households as respondents. Healthcare access is limited among rural households with only 1.1% of pregnant women having access to maternity healthcare. Traditional healthcare access and self-medication exist (27%), in addition to the use of medicine stores (23.2%) and poorly equipped private medical facilities (13.8%) in rural areas. Cooperative organisations provide limited support to healthcare access (74%) for the members. Similarly, rural health financing support from the cooperative is almost non-existent (73.6%). There is a near absence of health insurance (90.8%) in rural areas. However, rural healthcare financing support for the employed exists (31.7%). Rural households find support for healthcare access from family (1.3%), personal savings, and sales of assets (16.2%) while the majority (82.5%) use herbs at no quantifiable cost to meet healthcare needs. Cooperative societies must be educated on the need to incorporate healthcare packages into their products for members. Rural healthcare policies should pay significant attention to how long it takes rural inhabitants to reach existing healthcare facilities.

The Effects of Health Insurance on Demand for Healthcare Services in Tanzania

ABSTRACT: Consistent healthcare financing systems within a particular nation or community have been regarded as vital for making universal healthcare access. This study intended to examine the influence of health insurance on the demand for healthcare services and the influence of socio-economic, demographic and hospital-related factors on demand for health care services in Tanzania context. The study employed secondary data, which were analysed by descriptive statistics and the results were presented in tables and percentages. Econometric analysis was also done using binary probit regression model to determine the factors influencing demand for health care services in Tanzania. The instrumental variable was applied to address the problem of endogeneity of health insurance. The regression results revealed that gender, education level, household size, income, treatment cost, perceived health quality and health insurance type were significant and positively linked with demand for health care services. However, marital status was also significant but negatively associated with the demand for healthcare services. The study concluded that, despite of the efforts made by the government and other stakeholders on emphasis over having health insurance, the enrolment to health insurance schemes is still low although it has been noted to significantly influence the demand for health care services. Lastly, the paper recommends that the government and other stakeholders are required to formulate or strengthen the formulated policy in practice, purposively to improve access, affordability and the quality of health care services. Governmental and non-governmental organizations (NGO`s) and other stakeholders should put more effective strategies to improve coverage but also reduce the financial burden caused by illness. Also, the government needs to subsidize the healthcare sector, especially to the poor and provide subsidies to private healthcare facilities, improvement of insurance type, specifically, the NHIF which needs to increase coverage. Furthermore, health care managers should educate other people and make a clear observation on factors that make individuals demand for health care because they have a great role in the health care sector as well as strategies to improve household`s income to meet the health needs in Tanzania.

Organization and financing of the health care system in Kazakhstan

Despite the challenges posed by the consequences of the global pandemic, achieving the country's national development goals remains a strategic direction of public health policy. The article aims to study the dynamics of healthcare financing in Kazakhstan, provide forecasts of upcoming development, and compare it with healthcare systems of developed countries. Based on the analysis of the current state and potential problems, recommendations were developed to improve the healthcare financing system in Kazakhstan. This article also analyzes the main parameters of health financing in the Republic of Kazakhstan for the period 2012–2022 and, in comparison with developed countries, provides the main reasons for maintaining low parameters of public health financing, which becomes a real obstacle to the implementation of measures aimed at achieving universal health coverage. During the research, a wide range of methodological approaches was applied, including system analysis (the study of an object as an integral system, interrelated elements), comparative analysis (comparison of the studied object with others in a number of characteristics), functional analysis (identification of the functions of the elements of the object and their interrelations), economic and statistical analysis and synthesis (collection, processing, interpretation of economic and statistical data), mathematical methods (modeling of studied processes and phenomena using mathematical models), dialectical methods (the study of an object in its development, change and contradictions), analysis of the burden of the disease (assessment of the economic and social consequences of the disease).

Environmental Quality, Extreme Heat, and Healthcare Expenditures

Although the effects of the environment on human health are well-established, the literature on the relationship between the quality of the environment and expenditures on healthcare is relatively sparse and disjointed. In this study, the Environmental Quality Index developed by the Environmental Protection Agency and heatwave days were compared against per capita Medicare spending at the county level. A general additive model with a Markov Random Field smoothing term was used for the analysis to ensure that spatial dependence did not undermine model results. The Environmental Quality Index was found to hold a statistically significant (p < 0.05), multifaceted nonlinear association with spending, as was the average seasonal maximum heat index. The same was not true of heatwave days, however. In a secondary analysis on the individual domains of the index, the social and built environment components were significantly related to spending, but the air, water, and land domains were not. These results provide initial support for the simultaneous benefits of healthcare financing systems to mitigate some dimensions of poor environmental quality and consistently high air temperatures.

Effects of pay for performance in primary care in an under-registration scenario.

To propose a method for detecting and analyzing under-registration and highlight its potential financial effect in view of the implementation of the Previne Brasil Program. An ecological study was carried out to analyze cytopathological exams in programmatic area 3.1 in the municipality of Rio de Janeiro. The data was collected from the Departamento de Informática do Sistema Único de Saúde (DATASUS - Department of Informatics of the Unified Health System) database, including information on reports from outsourced cytopathology laboratories and those available in the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Care) and the Sistema de Informação do Câncer do Colo do Útero (SISCOLO - Cervical Cancer Information System) of DATASUS/Ministry of Health. The estimated under-registrations per health unit totaled 108,511 exams in the last two years in the programmatic area 3.1 area, which corresponds to an estimated total of R$ 435,129.00 that would have been foregone if the Previne Brasil Program had been in place during the period studied. The article's main contribution lies in the presentation of empirical evidence of the potential effects of under-registration on Primary Health Care financing. In addition, there are two other significant findings - firstly, it highlights weaknesses in the process of recording health information inherent to vulnerable regions; secondly, it indicates a vicious circle potentially fueled by sudden changes in Primary Health Care funding conditions, in addition to potential consequences for other levels of care.

Austerity Measures and the Resilience of Zimbabwe's Healthcare System: Challenges and Solutions.

Austerity measures have become a contentious topic, shaping the landscape of health care systems around the world. As governments grapple with economic challenges, the impact of austerity on health care has emerged as a critical concern. This study focuses on the consequences of austerity actions adopted by the Zimbabwean government under the Transitional Stabilization Program (TSP) from August 2018 to December 2025. This research examines the impact of austerity measures on Zimbabwe's health care sector, exploring its connections with health infrastructure and resources, accessibility and affordability of health care, health funding, health care inequalities, and the health care workforce. Using a quantitative approach and data from 970 participants, including the general populace, health care providers, and government officials, significant positive correlations between austerity measures and these health care variables were identified. The findings indicated a noteworthy positive correlation between the independent variable "austerity measures" and five dependent variables: health care accessibility and affordability, health care inequalities, infrastructure and resources, health care funding, and health care workforce. The t-statistics values exceeded the threshold of 1.96, with values of 5.085, 3.120, 6.459, 8.517, and 3.830, respectively. These findings highlight the importance of considering the effects of austerity on health care access, health funding, health care inequalities, health workforce, health infrastructure and resources development. Policymakers should prioritize equitable resource allocation and targeted investments to strengthen the resilience of the health care system during economic challenges. Understanding these associations is crucial for evidence-based policy decisions and fostering a more equitable and resilient health care system in Zimbabwe.

Between Public Guidelines for User Involvement and Ideals About Free Research: Using Collaborative Autoethnography to Explore Researcher Experiences From a User Involvement Process.

User participation is a prerequisite for receiving research funding in healthcare in Norway. Despite many positive benefits, studies report challenges from users' and researchers' perspectives. Limited knowledge exists concerning researchers' experiences in scenarios where the users are professionals within healthcare and research. The aim of this retrospective study was to explore and reflect on personal experiences as researchers from a process of planning and developing research questions for a PhD project, following the James Lind Alliance guidelines, which were a requirement for funding. We focused on how the process of collaboration with a specific group of users influenced the researchers' sense of selves. We used a qualitative design based on collaborative autoethnography, exploring personal experiences from a sociocultural point of view. Two of the three researchers in the team recollected their experiences from the user involvement process while applying the James Lind Alliance guidelines. We used different data sources to develop two autoethnographic narratives. The narratives were analysed using thematic analysis. The autoethnographic narratives demonstrate the complexity of user involvement from the researchers' perspectives. We identified four themes in the analysis: intrinsic and extrinsic motivation, competing paradigms, hierarchy and dual roles. The accounts illustrated the researchers' ambivalence within the process, indicating that they feared a loss of control over the direction of the research project. The narratives visualised a struggle to appear as credible researchers, illustrating how the involvement of a specific group of users and adherence to a specific guideline for user involvement influenced the researchers' experiences of their roles and identities in the collaboration. The results point to the relevance of the sociocultural backdrop; researchers might become frontline providers of policy implementation in research, balancing tensions between regulatory constraints, user involvement and researchers' professional identity and research ideals, when a specific, detailed procedure for user involvement is required. Two user panels comprising participants from clinical practice, education and research, along with a service user, collaborated in the planning and development of research questions for a PhD project. This autoethnographic study elaborates this process.