Implementation Of Universal Health Coverage Research Articles

Catastrophic cost and coping strategies of tuberculosis patients in a block of Purba Bardhaman District, West Bengal: A crossectional study

BackgroundThe elevated expenses associated with tuberculosis (TB), can hinder access to treatment and adherence. ObjectivesThis study was done to find out catastrophic cost (defined as 20% of the total annual income) resulting from treatment and diagnosis of TB, factors associated with it and delineated the coping mechanisms employed by the affected individuals and their families. Materials and methodsA cross sectional study was conducted for a period of 6 months, September 2023 to February 2024, among 146 patients registered in the Tuberculosis Unit (TU) of Bhatar block, Purba Bardhaman District,West Bengal. A pre validated questionnaire was used for interviewing the patients. Data was analysed using the principles of descriptive statistics, organised and presented in the form of tables. ResultsOut of 146 tuberculosis (TB) patients, the study revealed mean total cost incurred for TB-related services amounted to Rs 30,046 ± Rs 9406 with direct cost of Rs 2964.26 ± Rs 990.3 and indirect cost of Rs 27,406 ± Rs 9,351.54(36.9%) of the study population reported that their families faced catastrophic costs. Coping strategies like taking loan emerged as the most prevalent means, with 45(30.8%) patients reporting it followed by selling livestock which was prevalent among 14(9.6%) of them. ConclusionsIn spite of the implementation of Universal Health Coverage, TB-affected households still faces the risk of catastrophic total costs. A cost-mitigation policy and financial protection should be provided additionally along with better health care facility to all patients.

"For a man to go to hospital, then that would be his last option": A qualitative study exploring men's experiences, perceptions and healthcare needs in the implementation of Universal Health Coverage in Kenya.

The achievement of Universal Health Coverage (UHC) requires equitable access and utilization of healthcare services across all population groups, including men. However, men often face unique barriers that impede their engagement with health systems which are influenced by a myriad of socio-cultural, economic, and systemic factors. Therefore, understanding men's perspectives and experiences is crucial to identifying barriers and facilitators to their healthcare-seeking behaviour under UHC initiatives. This qualitative study sought to explore men's perceptions, experiences, healthcare needs and potential strategies to inform an impartial implementation of Universal Health Coverage (UHC) in Kenya. The study employed a qualitative research design to investigate men's healthcare experiences in 12 counties across Kenya. Thirty focus group discussions involving 296 male participants were conducted. Men were purposively selected and mobilized through the support of health facility-in-charges, public health officers, and community health extension workers. Data was coded according to emergent views and further categorized thematically into three main domains (1) Perspectives and experiences of healthcare access (2) Socio-cultural beliefs and societal expectations (3) Desires and expectations of health systems. Findings revealed complex sociocultural, economic, and health system factors that influenced men's healthcare experiences and needs which included: masculinity norms and gender roles, financial constraints and perceived unaffordability of services, lack of male-friendly and gender-responsive healthcare services, confidentiality concerns, and limited health literacy and awareness about available UHC services. Our study has revealed a disconnect between men's needs and the current healthcare system. The expectations concerning masculinity further exacerbate the problem and exclude men further hindering men's ability to receive appropriate care. This data provides important considerations for the development of comprehensive and gender-transformative approaches challenging harmful masculine norms, pushing for financial risk protection mechanisms and gender-responsive healthcare delivery attuned to the unique needs and preferences of men.

Scopes of practice for advanced practice nursing and advanced practice midwifery in Kenya: A gap analysis.

There is increasing global evidence on the impact of advanced nursing and midwifery practitioners, and Kenya's healthcare system has an excellent opportunity to develop scopes of practice and other regulatory frameworks for the integration of these roles. The primary purpose of this gap analysis was to explore the existing evidence on opportunities and threats toward the integration of the advanced practice nursing (APN) and advanced practice midwifery (APM) roles in Kenya's healthcare system. The study team conducted a structured electronic database search of PubMed, CINAHL, Scopus, EBSCOhost Academic Search Complete, and PsycINFO to retrieve articles and credible websites for reports highlighting the opportunities and threats toward the integration of the APN and APM roles in Kenya's healthcare systems. The retrieved articles were screened for relevance and synthesized for reporting using the traditional literature review approach. The Kenya Health Policy Framework 2014-2030, growing population needs, and implementation of universal health coverage provide an opportunity to harness and leverage advanced practice roles in nursing and midwifery. There is also momentum to develop advanced practice because of strategic alliances and global evidence showing the contributions and quality of services offered by advanced practice nurses and advanced practice midwives. However, lack of financial support, structural challenges, and lack of national policies, regulations, and legislation continue to obstruct progress. Developing scopes of practice for APN and APM in Kenya will benefit the professions, the country's healthcare delivery system, and the population. Achieving universal health coverage depends on a health workforce trained and practicing at optimal levels in tandem with education and training to deliver quality care.

The Readiness of Implementation of Universal Health Coverage Program in Soppeng Regency: A Qualitative Study

Objective: This study aims to determine the readiness to implement the Universal Health Coverage program in Soppeng Regency in 2023. Theoritical Framework : This research was chosen based on theoretical views (George C. Edwards III, 1980) where the supporting variables in policy implementation that influence the success or failure of policy implementation are divided into four parts that mutually support each other, including communication, resources, attitudes and structure bureaucracy. Method: The type of research used in this research is descriptive qualitative research with in-depth interviews using questionnaires and documentation. The research was conducted in July-August 2023 in Soppeng Regency. The number of samples used were 10 informants who were taken using a purposive sampling technique. Results and Conclusion: The results of this study indicate that communication, the implementation of the Universal Health Coverage program in Soppeng Regency has been going well, the delivery of information from BPJS Kesehatan to the Regional Government has been conveyed clearly and consistently. Resources, the implementation of the Universal Health Coverage program in Soppeng Regency, in terms of the quantity of human resources, both policy makers and program implementer, are considered good and competent, accompanied by supporting facilities. The attitude/disposition, commitment and support of BPJS Kesehatan, Regional Government, related OPD to village government in implementing the Universal Health Coverage program in Soppeng Regency are considered quite good. The bureaucratic structure, the implementation of the Universal Health Coverage program has been going quite well where the mechanism for implementing the JKN-KIS program, in this case BPJS Kesehatan, with the coordination of the Health Office, has made every effort to provide the best service to the community and provide financial protection. Implications of the Research: The implementation of Universal Health Coverage (UHC) in Soppeng Regency aims to ensure that everyone, everywhere can get quality health services without causing financial problems due to the disease they suffer from.

Health systems' capacity in availability of human resource for health towards implementation of Universal Health Coverage in Kenya.

Kenya faces significant challenges related to health worker shortages, low retention rates, and the equitable distribution of Human Resource for Health (HRH). The Ministry of Health (MOH) in Kenya has established HRH norms and standards that define the minimum requirements for healthcare providers and infrastructure at various levels of the health system. The study assessed on the progress of Universal Health Coverage (UHC) piloting on Human Resource for Health in the country. The study utilized a Convergent-Parallel-Mixed-Methods design, incorporating both quantitative and qualitative approaches. The study sampled diverse population groups and randomly selected health facilities. Four UHC pilot counties are paired with two non-UHC pilot counties, one neighboring county and the second county with a geographically distant and does not share a border with any UHC pilot counties. Stratification based on ownership and level was performed, and the required number of facilities per stratum was determined using the square root allocation method. Data on the availability of human resources for health was collected using a customized Kenya Service Availability and Readiness Assessment Mapping (SARAM) tool facilitated by KoBo ToolKitTM open-source software. Data quality checks and validation were conducted, and the HRH general service availability index was measured on availability of Nurses, Clinician, Nutritionist, Laboratory technologist and Pharmacist which is a minimum requirement across all levels of health facilities. Statistical analyses were performed using IBM SPSS version 27 and comparisons between UHC pilot counties and non-UHC counties where significance threshold was established at p < 0.05. Qualitative data collected using focus group discussions and in-depth interview guides. Ethical approval and research permits were obtained, and written informed consent was obtained from all participants. The study assessed 746 health facilities with a response rate of 94.3%. Public health facilities accounted for 75% of the sample. The overall healthcare professional availability index score was 17.2%. There was no significant difference in health workers' availability between UHC pilot counties and non-UHC pilot counties at P = 0.834. Public health facilities had a lower index score of 14.7% compared to non-public facilities at 27.0%. Rural areas had the highest staffing shortages, with only 11.1% meeting staffing norms, compared to 31.8% in urban areas and 30.4% in peri-urban areas. Availability of health workers increased with the advancement of The Kenya Essential Package for Health (KEPH Level), with all Level 2 facilities across counties failing to meet MOH staffing norms (0.0%) except Taita Taveta at 8.3%. Among specific cadres, nursing had the highest availability index at 93.2%, followed by clinical officers at 52.3% and laboratory professionals at 55.2%. The least available professions were nutritionists at 21.6% and pharmacist personnel at 33.0%. This result is corroborated by qualitative verbatim. The study findings highlight crucial challenges in healthcare professional availability and distribution in Kenya. The UHC pilot program has not effectively enhanced healthcare facilities to meet the standards for staffing, calling for additional interventions. Rural areas face a pronounced shortage of healthcare workers, necessitating efforts to attract and retain professionals in these regions. Public facilities have lower availability compared to private facilities, raising concerns about accessibility and quality of care provided. Primary healthcare facilities have lower availability than secondary facilities, emphasizing the need to address shortages at the community level. Disparities in the availability of different healthcare cadres must be addressed to meet diverse healthcare needs. Overall, comprehensive interventions are urgently needed to improve access to quality healthcare services and address workforce challenges.

Validating the implementation of an indicator reporting policies and laws on free public maternal health-related services in the era of universal health coverage: A multi-country cross-sectional study.

The concept of universal health coverage (UHC) encompasses both access to essential health services and freedom from financial harm. The World Health Organization's Maternal Newborn Child and Adolescent Health (MNCAH) Policy Survey collects data on policies that have the potential to reduce maternal morbidity and mortality. The indicator, "Are the following health services provided free of charge at point-of-use in the public sector for women of reproductive age?", captures the free provision of 13 key categories of maternal health-related services, to measure the success of UHC implementation with respect to maternal health. However, it is unknown whether it provides a valid measure of the provision of free care. Therefore, this study compared free maternal healthcare laws and policies against actual practice in three countries. We conducted a cross-sectional study in four districts/provinces in Argentina, Ghana, and India. We performed desk reviews to identify free care laws and policies at the country level and compared those with reports at the global level. We conducted exit interviews with women aged 15-49 years who used a component service or their accompanying persons, as well as with facility chief financial officers or billing administrators, to determine if women had out-of-pocket expenditures associated with accessing services. For designated free services, prevalence of expenditures at the service level for women and reports by financial officers of women ever having expenditures associated with services designated as free were computed. These three sources of data (desk review, surveys of women and administrators) were triangulated, and chi-square analysis was conducted to determine if charges were levied differentially by standard equity stratifiers. Designation of services as free matched what was reported in the MNCAH Policy Survey for Argentina and Ghana. In India, insecticide-treated bed nets and testing and treatment for syphilis were only designated as free for selected populations, differing from the WHO MNCAH Policy Survey. Among 1046, 923, and 1102 women and accompanying persons who were interviewed in Argentina, Ghana, and India, respectively, the highest prevalence of associated expenditures among women who received a component service in each setting was for cesarean section in Argentina (26%, 24/92); family planning in Ghana (78.4%, 69/88); and postnatal maternal care in India (94.4%, 85/90). The highest prevalence of women ever having out of pocket expenditures associated with accessing any free service reported by financial officers was 9.1% (2/22) in Argentina, 64.1% (93/145) in Ghana, and 29.7% (47/158) in India. Across the three countries, self-reports of out of pocket expenditures were significantly associated with district/province and educational status of women. Additionally, wealth quintile in Argentina and age in India were significantly associated with women reporting out of pocket expenditures. Free care laws were largely accurately reported in the global MNCAH policy database. Notably, we found that women absorbed both direct and indirect costs and made both formal and informal payments for services designated as free. Therefore, the policy indicator does not provide a valid reflection of UHC in the three settings.

Social determinants of the non-use of the explicit health guarantees plan (the GES plan)

IntroductionThe public policy called Explicit health guarantees (GES) could serve as a basis for the future implementation of universal health coverage in Chile. An improvement in the quality of health of the Chilean population has been observed since the launching of the GES, which has a high adherence (84% of the beneficiary population uses this health program). This work seeks the social determinants related to a portion of the remaining 16% of people who do not use the GES.MethodsThis secondary analysis study used a sample of GES recipients (n = 164,786) from the National Socioeconomic Characterization Survey (CASEN) 2020. The GES recipients included in the study responded that they had been under medical treatment for 20 of the 85 pathologies included in the GES, and they had not had access to such policy due to “trust in physician/facility,“ “decided not to wait,“ or “lack of information.” The CASEN survey chose the 20 pathologies. The Average Marginal Effects of social determinants of the non-use of the GES health plan were predicted using multivariable and panel multinomial probit regression analyses, where the outcome variable assumed three possible values (the three reasons for not accessing) while taking those variables reported in previous studies as independent variables.ResultsA higher probability of non-access due to distrust in the physician/facility among adults with higher economic income was found. Among those who prefer not to wait are vulnerable groups of people: women, people with a lower-middle income, those who belong to groups with longer waiting times, and ethnic groups. The people who least access the GES due to lack of information correspond to part of the migrant population and those belonging to the lowest income group.ConclusionsThe GES policy must necessarily improve the timeliness and quality of the services to make them attractive to groups that currently do not have access to them, managing waiting times rather than referrals and using patient-centered evaluations, especially in those most vulnerable groups that do not access GES because they choose not to wait or lack the necessary information, thereby improving their health literacy.

Demographic and economic correlates of health security in West Sumatra province - Indonesia

Objectives: Access to health insurances could indicate the degree of health security among communities. Indonesia made a commitment to attain universal health insurance coverage by the end of 2019. However, until today it has not reached the goal of 100% coverage. Therefore, there is a need to portray the demographic and economic correlates of health insurance coverage in an area to improve health security achievement. Methods: This secondary analysis was based on the 2017 Indonesian national socio-economic survey conducted in the West Sumatra province. Multivariable models using logistic regression were used to estimate the odds ratios (OR) for being uninsured. Results: The results showed that health security, in terms of insurance coverage, was influenced by demographic and economic factors. Young and middle-aged individuals were more likely to be uninsured than older ones (OR = 1.49 and OR = 1.21, respectively). People from a lower educated family, or with lower consumption per capita have higher risk of being uninsured (OR = 3.00 and OR = 1.26, respectively). Conclusion: Insurance coverage was influenced by demographic and economic factors. Policymakers should consider demographic and economic factors related to the implementation of universal health coverage. Campaign about the importance of universal health coverage should reach all citizens.

The Health Insurance Situation in Iran: A Brief Overview

The financing process of the health system includes the collection, accumulation, and management of financial resources to purchase health services. Sustainable financing of the health system is a core function, which can enable progress towards universal health coverage (UHC). There are multiple funding sources to finance health care services in Iran, including out-of-pocket payment, government funds, general taxation, health insurance, and individual donations. Inefficiency in health insurance systems has led to an increase in out-of-pocket payments, and ultimately catastrophic expenditures. According to the results of the household income-expenditure survey in 2017, about 17% of the population faced catastrophic expenditures by spending more than 10% of their total consumption expenditure on health, and 75% of exposure to catastrophic expenditures (equivalent to 13% of population) was only due to paying out of pocket to receive medical services. (1) According to the health insurance coverage in 2010, about 84% of the total population in Iran was covered by various insurance plans and supplementary health insurance included 20% of the total population. (2) After the recent reforms entitled as the "Health Transformation Plan" launched in 2014, more than 90% of the population was covered by health insurance. However, the services were not fully covered by insurance benefits and only included inpatient health services. In addition, the insurance share was free for patients, which increased moral hazard from patients and induced demand from providers. Finally, this reform plan was stopped due to the instability of resources. Among the disadvantages of this type of insurance, the following can be mentioned: 1. All people could register in this insurance without any limitation. 2. The insurance premium was very small and negligible. So, it was not considered as an insurance because there was not the accumulation of risk, which is one of the main characteristics of any insurance industry. 3. Considering that many people were covered in this type of insurance, the depth and level of service coverage were reduced due to limited resources. In this insurance type, financing was from the government and there was no assessment for individuals; and it was a kind of support fund or support package. So, it was stopped at some point after the health transformation plan. Although Article 10 of the General Insurance Law in Iran refers to determining the scope and medical services and drugs, (3) there are no criteria to evaluate the covered packages. Despite the UHC's goal of increasing the number and variety of services for patients, many services for specific diseases, palliative care, etc. are not covered by the basic insurance. Also, some services such as dental and optometric services are considered a luxury service and are not covered by basic insurance. The lack of resources to provide proper services to the insured people and the impossibility of receiving the services from the private sector using health insurance benefits are other challenges of this type of insurance. Finally, Iran has not been able to achieve UHC due to the lack of proper management capacity in the insurance sector. To realize universal health coverage and improve outcomes, policymakers must consider several demand and supply factors. In this regard, expansion of infrastructure, human resources, and health services can be effective from the supply perspective. Meanwhile, increasing health insurance coverage, expanding health benefits package, and reducing the contribution of people in paying expenses using payment methods with a certain ceiling such as per capita and quality-based payment can be effective from the demand perspective. Also, the existence of comprehensive and transparent information systems, especially the system for identifying vulnerable and low-income groups, can greatly contribute to the successful implementation of UHC. Finally, designing suitable financial and non-financial incentives can also lead to increasing the satisfaction of professionals and health sector employees.

Socioeconomic inequalities in health outcomes among Thai older population in the era of Universal Health Coverage: trends and decomposition analysis

BackgroundThailand’s Universal Health Coverage (UHC) has been achieved since 2002 when the entire population are covered by three main public health security schemes: (1) Civil Servant Medical Benefit Scheme (CSMBS); (2) Social Security Scheme (SSS); and (3) Universal Coverage Scheme (UCS). Citizens have access to healthcare services at all life stages and are protected from catastrophic expenditure and medical impoverishment. However, there are health inequalities in both health outcomes and access to healthcare among older Thais. This study aims to: (1) assess the degrees of socioeconomic inequalities in health outcomes among the older Thai population during the period of Thailand’s UHC implementation (2003–2019), and (2) explain socioeconomic inequalities in health outcomes through decomposition of the contributions made by Thailand’s UHC policy and other health determinants.MethodsData sets come from a four-year series of the National Health and Welfare Survey (HWS) between 2003 and 2019. The health outcome of interest was obtained from the Thai EQ-5D index. The Erreygers’ concentration index (CI) was used to calculate the socioeconomic inequality in health outcomes. Multivariate methods were employed to decompose inequalities.ResultsFindings indicated Thai older adults (aged 50 and older) are healthier during the UHC implementation. Better health outcomes remain concentrated among the wealthier groups (pro-rich inequality). However, the degree of socioeconomic inequalities in health outcomes significantly declined by almost a factor-of-three (from CI = 0.061 in 2003 to CI = 0.024 in 2019) after the roll-out of the UHC. Decomposed results reported that Thailand’s UHC, urban residence, and household wealth were major contributors in explaining pro-rich inequalities in health outcomes among Thai older adults.ConclusionsOlder persons in Thailand have better health while health inequalities between the rich and the poor have substantially decreased. However, there is inequalities in health outcomes within all three national health security schemes in Thailand. Minimizing differences between schemes continues to be a crucial cornerstone to tackling health inequalities among the older population. At the same time, making Thailand’s UHC sustainable is necessary through preparing financial sustainability and developing health resources to better serve an ageing society.

Importance and Limitations of Healthcare Verification for Accelerating Implementation of Universal Health Coverage in Burundi

Introduction: As one of the avenues for implementing universal health coverage, healthcare verification for financing health facilities is receiving increased attention. Verification is the process of ensuring that healthcare services provided to users meet the predetermined criteria for billing and payment. The objective of this article was to examine the Burundi health system practices in healthcare verification for financing health facilities in order to identify strengths, limitations, and potential solutions for more advancement in universal health coverage implementation. Methods: A critical case study was used as the overall methodological approach and a narrative review design to draw conclusions about the case. Results: The results show that verification helps visualise the country’s level of progression in implementation of universal health coverage. While it promotes efficiency in healthcare service reimbursement by allowing payment for quality care services, verification has proven to be a resilient function to fraud, abuse, and waste in the demand for, and supply of, healthcare services. However, verification has some limitations in terms of services and population targeting, and technical effectiveness of the verification team. The most important way identified for alleviating these limitations is to separate the demand for, and supply of, healthcare services. Conclusions: More investments in research are required to recognise verification as an essential sub-function of health financing for universal health coverage implementation.

New Medicine Service by Community Pharmacists: An Opportunity to Enhance Universal Health Coverage at a Primary Health Level in South Africa.

The implementation of universal health coverage (UHC) in South Africa has focused on promoting equitable health care services to all citizens. In this regard, pharmacists are expected to expand their professional capabilities to promote primary healthcare system functionality. The new medicine service (NMS) has proven to be beneficial in medicine optimization and adherence. The aim of the NMS is to assist and advise patients on their newly diagnosed conditions and to promote the safe and rational use of medicines. This study explores the provision of NMS within the UHC primary healthcare service package and the opportunity for enhancing pharmacist practice. This pilot reports on the implementation of NMS in a low-middle income country. Data was obtained using convenience sampling and an interview-based approach. Findings were evaluated, analyzed, and reported using qualitative techniques. This study was conducted at an independent community pharmacy in Durban, South Africa. Fifty-four patients were successfully enrolled into the program based on the eligibility criteria; 19 patients exited the program before completion. From those that completed the program, 65.71% had no problems detected; rather the program served as a platform to provide information and ensure proper adherence practices, 34.29% of patients experienced problems and were referred back to the prescriber, or pharmacist. After the completion of the program, 54.29% where found to be adherent to their medication, however, 45.71% were found to be non-adherent and were counseled accordingly or referred back to the medical practitioner. This paper highlighted that the implementation of a pharmacist's full scope of practice and services such as the NMS is essential in improving therapeutic outcomes, recognize medicine related problems, and avert unnecessary use of medicines.

Universal health coverage: a very ambitious role, many challenges

Universal Health Coverage (UHC) has now become an essential element of international strategies aimed at improving the health of populations. Multiple objectives are associated with UHC, which must enable the protection of the human right to health, facilitate the achievement of the Sustainable Development Goals by 2030 and, finally, contribute to the preparation of all states for future pandemics. The analysis of these objectives but also of the obstacles to the implementation of UHC makes it possible to better understand this concept and is essential for the development and improvement of the strategies to be implemented.

Cancer survival in Thailand from 1997 to 2012: Assessing the impact of universal health coverage

BackgroundIn recent decades, many countries worldwide have implemented some form of Universal Health Coverage (UHC). We sought to evaluate incidence and survival trends of breast, cervical, and colorectal cancer before and after the implementation of UHC in Thailand. MethodsThe age-standardized incidence rate and 1- and 5-year net survival (NS) were calculated for five Thai provinces, namely Bangkok, Chiang Mai, Khon Kaen, Lampang, and Songkhla for breast, cervix, and colorectal cancer in three study periods (1997–2012): before, during, and after the implementation of UHC. ResultsThe incidence of breast and colorectal cancer has increased over time, while the incidence of cervical cancer has decreased (17.9–29.9, 9.0–13.6, and 19.6–12.3 per 100,000, respectively). Larger proportion of breast cancer were diagnosed with localized stage after UHC implementation compared to the period prior to UHC (31.5 % vs 19.0 %). Overall, The improvement in survival by cancer site varied in magnitude with a 5-year NS increase from 61.3 % to 75.1 % for breast, 55.4–59.5 % for cervical, and 39.9–47.6 % for colorectal cancer. The amount of increase slightly differed across provinces. ConclusionRising incidence for breast and colorectal, and declining cervical cancer may partly be attributable to improved awareness and early detection programs. Additionally, improvement in survival may partly be attributable to increased access to healthcare, availability of treatment, and increased access to cancer screening after UHC was implemented. Thus, continued expansion of UHC package on cancer could potentially contribute to further improvement of cancer control in Thailand. Policy summaryThis study provides important evidence on the impact of UHC in cancer burden and survival for breast, cervical, and colorectal cancer in Thailand. This study serves as an example for other countries where UHC has been recently implemented and guide policymakers in allocating resources towards UHC and cancer control programs.

CALCULATION AND ANALYSIS OF THE COSTS OF BIOCHEMISTRY EXAMINATIONS BY THE ACTIVITY-BASED COSTING METHOD -ABC-CASE OF THE LABORATORY AT THE PREFECTURAL HOSPITAL OF SALE- MOROCCO

Objectives: The implementation of Universal Health Coverage, as a necessary step towards achieving the Sustainable Development Target, in particular MDT3, brings into play the question of good management, the efficiency of hospitals with a view to reduce costs, which seems to be an international issue. It is in this context that the present study fits. It aims to analyze and calculate the cost of biochemistry examinations. Methods: This is a retrospective accounting study in the year 2019 which focuses on the calculation of the average cost by the accounting method based on the activity of 32 biochemical examinations at the Prefectural Hospital of SALE. Data analysis was performed by SPSS 20.0. Results: The costs of biochemistry examinations are around 15,335,689.58MAD, which is three times higher than the income envisaged by the application of the national pricing system, which is of the order of 5,081,280.00 MAD. The most significant expenses are attributed to laboratory consumables and personnel they represent respectively 45.20% and 40.05% of the overall expenses. The activities that consume the largest share of resources with 74.03% and 9.12% are respectively the processing of examinations and the management of the laboratory. Among the costs examinations, we quote Uric acid (114.78MAD)-Albuminemia117.12MAD)- Ferritin (250.96MAD)-PSA (253.22MAD). Conclusions: The results could be essential for both efficient resource allocation, hospital reimbursement and health policy decision-making. Also, the introduction of ABC in our Moroccan hospitals could help the transition from a flat-rate pricing system to fee-for-service (T2A).

Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia

BackgroundThe health insurance system in Indonesia was transformed in 2014 to achieve universal health coverage (UHC). The effective implementation of essential primary health services through UHC has resulted in efficient healthcare utilisation, which is reflected in the health-seeking behaviour of the community. Our study aimed to examine the changes in health-seeking behaviour before and after the implementation of UHC in Indonesia and to identify what factors determine these changes.MethodsWe conducted a retrospective cohort study using the recall method and data collected through questionnaire-based interviews in Bandung, Indonesia. We used a two-step sampling technique—randomised sampling and purposive sampling, and a total of 579 respondents with acute or chronic episodes were recruited. {chi }^{2} tests were used to identify the association between factors. Difference in difference model and a logistic regression model for binary outcomes were used to estimate the effect of the implementation of UHC on the health-seeking behaviour.ResultsUtilisation of public health facilities increased significantly after implementation of UHC, from 34.9% to 65.4% among the respondents with acute episodes and 33.7% to 65.8% among those with chronic episodes. The odds of respondents going to health facilities when they developed an acute episode increased after the implementation of UHC (OR = 1.22, p = 0.05; AOR = 1.42, p < 0.001). For respondents experiencing chronic episodes, the implementation of UHC increased the odds ratio (OR = 1.74, p < 0.001; AOR = 1.64, p < 0.001) that they would use health facilities. Five years after the implementation of UHC, we still found respondents who did not have health insurance (26 and 19 respondents among those with acute episode and chronic episode, respectively).ConclusionsThe effect of the implementation of UHC seemed greater for those experiencing chronic episodes than for those with an acute episode. Although the implementation of UHC has improved utilisation of public health facilities, the presence of people who are not covered by health insurance is a potential problem that could threaten future improvements in healthcare access and utilisation.

A comparison of attitudes and knowledge of pre-exposure prophylaxis (PrEP) between hospital and Key Population Led Health Service providers: Lessons for Thailand's Universal Health Coverage implementation.

HIV Pre-exposure prophylaxis (PrEP) has demonstrated efficacy and effectiveness among high-risk populations. In Thailand, PrEP has been included in the National Guidelines on HIV/AIDS Treatment and Prevention since 2014. As a part of the national monitoring and evaluation framework for Thailand's universal coverage inclusion, this cross-sectional survey was conducted to assess knowledge of, attitudes to and practice (KAP) of PrEP service providers in Thailand. We conducted a cross-sectional survey to explore knowledge of, and attitudes towards PrEP among providers from hospital and Key Population Led Health Services (KPLHS) settings. The questionnaire was distributed online in July 2020. Descriptive and univariate analysis using an independent-sample t-test were applied in the analyses. Attitudes were ranked from the most negative (score of 1) to the most positive (score of 5). Overall, there were 196 respondents (158 from hospitals and 38 from KPLHS) in which most hospital providers are female nurse practitioners while half of those from KPLHS report current gender as gay. Most respondents report a high level of PrEP knowledge and support provision in all high-risk groups with residual concern regarding anti-retroviral drugs resistance. Over two-fifths of providers from both settings perceive that PrEP would result in risk compensation and half of KPLHS providers are concerned regarding risk of sexual transmitted infections. Limited PrEP counselling time is a challenge for hospital providers. Service integration between both settings, more involvement and distribution of KPLHS in reaching key populations would be essential in optimizing PrEP uptake and retention. Continuing support particularly in raising awareness about PrEP among healthcare providers and key populations, facilities and manpower, unlimited quota of patient recruitment and PrEP training to strengthen providers' confidence and knowledge would be essential for successful PrEP implementation.

The Possibility of Universal Health Coverage in the United States

This research paper intends to examine the ways in which universal healthcare coverage can potentially benefit the United States population, as well as investigate the challenges of implementing it. This paper found that there are many problems within the current U.S. healthcare system that can be improved by the implementation of Universal Health Coverage (UHC). Additionally, this paper includes evidence that UHC could have many economic and public health benefits in the United States. The paper then mentions the clear plans for implementing UHC in the U.S. and that there are other countries which have successfully implemented it. Finally, the paper ends by highlighting the certain difficulties that come with implementation as well as underscoring their possible solutions.Keywords: universal healthcare coverage, United States healthcare, health insurance

Towards Universal Health Coverage

This paper explores the universal health coverage (UHC) in Kenya through the lens of its potential to progressively realize the constitutional promise of the right to the highest attainable standard of health. The health sector in Kenya has experienced tremendous changes since the government piloted the UHC program in four counties that led to the abolition of all fees, more than 200 community health units launched, 7700 community health volunteers with over 700 health workers recruited (MOH, 2020). Still, the government is in the process of scaling up UHC, reforming the national hospital insurance fund (NHIF) to establish a mandatory universal health coverage scheme. This paper sought to examine the framing of UHC; assess the healthcare system between 2017 -2020; investigate the challenges faced in the implementation of UHC in Kenya. The researcher utilized documents analysis to collect the relevant data using a coding schedule. A purposive search was undertaken to identify key policy documents and relevant documents. 18 documents were sampled. The findings reveal that Kenya’s healthcare facilities index stands at 59%, with a density of 2.2 per 10,000 population, the workforce density is at 15.6/10,000. Four counties including Tharaka Nithi (33.8), Nyeri (31.0), Uasin Gishu (28.2), and Nairobi (26.3) have achieved well above the WHO target. Several strategies and programs such as Afya Care, abolished maternity fees for mothers delivering at public facilities, and expansion of the National Health Insurance Fund, has been initiated to drive the UHC agenda. The Ministry of Health’s (MoH) budget also continues to rise, in 2018/19 the MoH received its largest allocation. Kenya, now more than ever, has an opportunity to accelerate progress towards equitable access to healthcare.

Does the implementation of UHC reforms foster greater equality in health spending? Evidence from a benefit incidence analysis in Burkina Faso

IntroductionBurkina Faso is one among many countries in sub-Saharan Africa having invested in Universal Health Coverage (UHC) policies, with a number of studies have evaluated their impacts and equity impacts....