The increasing prevalence of chronic conditions is a significant challenge for healthcare systems worldwide, not only from a public health perspective but also for the aggregate cost that these represent. This paper estimates the additional use of healthcare services due to chronic health conditions and their associated costs in nine European countries. We analyzed inpatient and outpatient healthcare utilization using longitudinal data (Survey of Health, Ageing and Retirement in Europe [SHARE]). We implemented a difference-in-differences approach across multiple time periods. Monetary estimates were derived using WHO-CHOICE healthcare service costs. To compare countries, we calculated the healthcare cost burden of chronic conditions as a percentage of total health expenditure. People with chronic conditions require significantly more healthcare services than those without such conditions, averaging three additional outpatient visits and one extra overnight inpatient stay annually. These patterns vary across countries. In Germany, outpatient care usage is particularly high, with an average of four additional visits, while Switzerland leads in inpatient care with two extra overnight stays. The associated costs also differ widely, influenced by variations in healthcare demand, service pricing, and the prevalence of chronic conditions in each country. Chronic conditions significantly increase healthcare utilization, and demographic trends suggest this demand will continue to grow steadily. This rising pressure poses serious challenges for healthcare systems, necessitating a shift toward more efficient service delivery models.

This paper explores how the poor and vulnerable can afford free health services as the government intends to enhance universal health coverage attainment in Cameroon by 2035. The Autoregressive Distributed Lag (ARDL) approach is employed time series data spanning 28 years. Focusing on Out of Pocket Health Expenditure (OOPHE), Household per capita income (HpCY), Household per capita Health Expenditure (HCHExp), Income tax (Ytax) and Private Health Insurance (PrivHIns) as explanatory variables, the paper explains how long life (proxy to Universal Health Coverage(UHC) emanates from national health expenditures. With adjusted R-squared value of 0.86, it indicates that about 86% variations in universal health coverage in Cameroon are jointly accounted for by variations in the variables included in the regression model. Other results show that the mean of OOPHE as a percentage of total health expenditure stands at 72.7%, which could be very prohibitive to financial access on UHC given the huge rate of unemployment and the burden of poverty in Cameroon. As a result, it is recommended that health policy reforms should focus on optimizing financial risk protection on the poor and vulnerable and increasing national health expenditure as a proportion of the national budget of Cameroon to 15 percent as per the Abuja Declaration. Finally, the reduction of poverty as an appropriate stepping stone towards the attainment of universal health coverage in Cameroon is both a strategy and pathway policy recommendation.

Cost of Lung Cancer: A Systematic Review

In Nigeria, revenue for financing the health sector is collected from pooled and un‐pooled sources. The un‐pooled sources contribute over 70% of total health expenditure, and this can be Out-of-Pockets (OOPs) in the form of fees to healthcare providers at the time of service. The aim of the study was to estimate the out-of-pocket health expenditure of the households in Niger State. A cross-sectional quantitative study was carried out among 1,235 households made up of 6,482 individuals using a multi-stage stratified probability sampling technique. Data was collected using a well-structured survey instrument and analyzed using descriptive statistics and SPSS statistical software version 23. Findings shows that the annual per capita out-of-pocket expenditure on health services was approximately ₦19,463 ($46.9), and 64% of the total OOP expenditure is spent on public facilities. 32% of the OOP was incurred mainly from accessing maternal health services, with 56% likely to incur catastrophic expenditure. 75% of the sampled population expressed willingness to enroll into a form of health insurance, and an average household is willing to pay a monthly premium of ₦798 ($1.9) for health insurance. The study shows the urgency with which policy makers need to increase public healthcare funding and provide social health protection plans against informal OOP health payments. Furthermore, for Niger State to achieve the recommended benchmark of 30% OOP as a percentage of total health expenditure, it is critical that the newly signed into law contributory health insurance scheme is well designed, successfully implemented, and financially sustainable.

Objective: To assess the impact of economic and gender factors on malnutrition among children below 5 years age by making a comparative study between India, Bangladesh and Sri Lanka Design and setting: The study uses data and information on economic and gender status parameters taken from the secondary sources for three South Asian Countries between the years 2000 to 2018. The study uses ANOVA, Post Hoc test and Fixed Effects Panel Regression analysis to arrive at the conclusions. Results: Comparative analysis between the three countries shows that the extent of malnutrition among children is lowest in Sri Lanka and highest in India. The study finds that economic factors such as domestic government’s expenditure of healthcare as percentage of total health expenditure and gender factors measured in terms of female labour force participation, and school enrolment of girls at secondary level significantly impact the level of malnutrition among children. Conclusion: Malnutrition among children is a complex challenge which cannot be solved by emphasizing on only economic growth. Policies emphasising on gender parity and empowerment integrated in healthcare policies will positively impact nutritional level of children.

The current study investigated the association between out-of-pocket health expenditure and poverty using macroeconomic data from a sample of 145 countries from 2000 to 2017. In particular, it was examined whether the relationship between out-of-pocket health expenditure and poverty was contingent on a certain threshold level of out-of-pocket health spending. The dynamic panel threshold method, which allows for the endogeneity of the threshold regressor (out-of-pocket health expenditure), was used. Three indicators were adopted as poverty measures, namely the poverty headcount ratio, the poverty gap index, and the poverty gap squared index. At the same time, out-of-pocket health expenditure was measured as a percentage of total health expenditure. The results showed the validity of the estimated threshold models, indicating that only beyond the turning point, which was about 29 percent, that out-of-pocket health spending led to increased poverty. When heterogeneity was controlled for in the sample, using the World Bank income classification, the findings showed variations in the estimated threshold, with higher values for the low- and lower-middle-income groups, as compared to the high-income group. For the lower-income groups, below the threshold for out-of-pocket health expenditure, it had a positive or insignificant effect on poverty reduction, while it led to higher poverty above the threshold. Further, the sampled countries were divided into regions, according to the World Health Organization. Generally, improving health care systems through tolerable levels of out-of-pocket health expenditure is an inevitable step toward better health coverage and poverty reduction in many developing countries.

Hospitalization costs of breast cancer before and after the implementation of the Health Sector Evolution Plan (HSEP), Iran, 2017: a retrospective single-centre study

This study examined the differences in health spending within the World Health Organization (WHO) Europe region by comparing the EU15, the EU post-2004, CIS, EU Candidate and CARINFONET countries. The WHO European Region (53 countries) has been divided into the following sub-groups: EU15, EU post-2004, CIS, EU Candidate countries and CARINFONET countries. The study period, based on the availability of WHO Global Health expenditure data, was 1995 to 2014. EU15 countries have exhibited the strongest growth in total health spending both in nominal and purchasing power parity terms. The dynamics of CIS members’ private sector expenditure growth as a percentage of GDP change has exceeded that of other groups. Private sector expenditure on health as a percentage of total government expenditure, has steadily the highest percentage point share among CARINFONET countries. Furthermore, private households’ out-of-pocket payments on health as a percentage of total health expenditure, has been dominated by Central Asian republics for most of the period, although, for the period 2010 to 2014, the latter have tended to converge with those of CIS countries. Western EU15 nations have shown a serious growth of health expenditure far exceeding their pace of real economic growth in the long run. There is concerning growth of private health spending among the CIS and CARINFONET nations. It reflects growing citizen vulnerability in terms of questionable affordability of healthcare. Health care investment capability has grown most substantially in the Russian Federation, Turkey and Poland being the classical examples of emerging markets.

In an effort to improve health service delivery and achieve better health outcomes, the World Health Organization (WHO) has called for improved efficiency of health care systems to better use the available funding. This study aims to examine the efficiency of national health systems using longitudinal country-level data. Data on health spending per capita, infant mortality rate (IMR), under 5 mortality rate (U5MR), and life expectancy (LE) were collected from or imputed for 173 countries from 2004 through 2011. Data envelopment analyses were used to evaluate the efficiency and regression models were constructed to examine the determinants of efficiency. The average efficiency of the national health system, when examined yearly, was 78.9%, indicating a potential saving of 21.1% of health spending per capita to achieve the same level of health status for children and the entire population, if all countries performed as well as their peers. Additionally, the efficiency of the national health system varied widely among countries. On average, Africa had the lowest efficiency of 67%, while West Pacific countries had the highest efficiency of 86%. National economic status, HIV/AIDS prevalence, health financing mechanisms and governance were found to be statistically associated with the efficiency of national health systems. Taking health financing as an example, a 1% point increase of social security expenses as a percentage of total health expenditure correlated to a 1.9% increase in national health system efficiency. The study underscores the need to enhance efficiency of national health systems to meet population health needs, and highlights the importance of health financing and governance in improving the efficiency of health systems, to ultimately improve health outcomes.

Background: A long-term debate persists in global health concerns about the proper balance in the delivery of healthcare services between the private and public sector to the people of the low and middle income countries. The private sector allies claim that private companies may be more efficient and receptive in fulfilling patient needs, while the public sector allies have stressed the incapacity of the poor people to pay that causes imbalances in access to health care. Aim: This study aims to compare the health-care privatization models of the United Kingdom, Germany, and Canada through health expenditure statistics. The findings will serve as a source of benefits from the privatization of health sectors in Kingdom of Saudi Arabia to strengthen its implementation. Method: This is a descriptive-comparative research where the healthcare privatization model among the chosen first-world countries will be compared through the available health expenditure statistics. Results: The United States of America (USA) has the highest Total Health Expenditure as a percentage of the Gross Domestic Product with 15-17% since 2006, and lasted until 2014. Saudi Arabia has only 3-5% as compared to the selected first-world countries. The United Kingdom (UK), Germany, Canada, and Saudi Arabia have significantly higher General Government Health Expenditure as a percentage of Total Health Expenditure. On the contrary, the Private Health Expenditure (PvtHE) of USA is higher with 52-55% than the GGHE with only 45-48%. Also, the private insurance as a percentage of PvTHE of the USA is the highest with 63-65% as compared to UK, Germany, Canada and Saudi Arabia. Conclusion: The healthcare system of Saudi Arabia is a mainly public-funded and public-owned similar to the UK, Germany, and Canada. Despite of the effectiveness of the public-contract model, the private insurance or provider model and the privatization of hospitals could notably change the healthcare system in Saudi Arabia. Thus, the resources and the quality of healthcare services in Saudi Arabia must be enhanced through these mechanisms.

IntroductionIt is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries.MethodsThe SHARE dataset for individuals aged 50+ and their households, collected in 2010–2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model.ResultsWe found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure.DiscussionOur study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio-economic contexts, but also due to the specific characteristics of the different health systems. In view of the ageing of European populations, it will be crucial to strengthen the mechanisms for financial protection for older people with chronic diseases.

In the Polish healthcare system, medications (including compounded preparations) are wholly or partially paid for from public funds. Subsidising medications which are either central or incidental to treatment (e.g., when patients are unable to work because of an illness) means that medication costs make up a large percentage of total health expenditure and are a drain on the patients' purse. Medication insurance (or drug coverage) policies are a relatively new product and are featured in business insurance portfolios of only a handful of insurance companies offering coverage for medication costs. This article sets out to discuss and analyze available medication coverage policies.

PIH93 - Kazakhstan Verse Uzbekistan: A Review of the Drug Provision Systems

Trends in National Spending on HIV/AIDS Prevention and Control in Thailand from 2008 to 2013

Objectives: Adoption of health technologies may yield significant individual and societal benefits. Because different healthcare systems vary in their adoption speeds, an understanding of the underlying healthcare system is critical. We compared the United States (US) and Portugal (PT) healthcare systems focusing on coronary heart disease (CHD). CHD remains one of the main causes of death in high-income countries with significant economic costs. Methods: We conducted a comprehensive literature review based on publications from national governmental bodies, international institutional organizations, professional associations, and scientific journals. We abstracted information regarding risk factors, incidence, access to health technologies, and hospital mortality rates in CHD observed between 2000 and 2011. Findings: The prevalence of obesity and high cholesterol levels is higher in the US while higher rates of hypertension and tobacco consumption prevail in PT. The 2009 incidence of cardiovascular disease per 100000 population in the US is 1944.5 versus 1320.4 in PT. The percentage of total health expenditure financed through public funds is 48.2% in the US versus 65.8% in PT. Public hospitals represent 26% (1526 of 5754) of US hospitals and 55% (129 of 231) of hospitals in PT. Between 2000 and 2011, the average high-risk device approval time was 43 months quicker in the European Union (EU) compared to the US. Drug-eluting stents were approved in 2002 in the EU and in PT versus 2003 in the US. Speeds of approval for pharmaceuticals vary – prasugrel, and ticagrelor were approved 5 and 8 months faster in PT compared to the US but PT approval of glycoprotein IIb/IIIa inhibitors was slower (18 months slower on average). However, US CHD standardized mortality is more than twice that of PT (126.5 vs 59.4 per 100000). Conclusions: Procedure and new technology use differ dramatically between the two healthcare systems for CHD care. Portugal offers an interesting contrast to the US for studies focusing on health technologies adoption, diffusion, cost-effectiveness and determinants of outcomes in the realm of CHD. How these factors directly impact patient outcomes remains unknown and deserves further investigation.

The aim of this study was to ascertain the levels and mechanisms of funding public health in Europe. A review of published and unpublished documents and expenditure data was undertaken. Expenditure on public health in Europe is difficult to determine, but data from national health accounts suggest that it differs greatly across countries, both as a percentage of total health expenditure and per capita. Better data are urgently needed, given that a lack of sustainable, long-term funding may be the most significant barrier to public health programmes and interventions in Europe. In view of the current economic crisis, it will be essential to safeguard financing for public health and to put it on a more sustainable basis.

Introduction. Health care, as one of the most important and sensitive fields of human endeavour, has a significant social impact; therefore changes in this area have wide implications on society in general. The latest economic crisis resulted in slow growth of gross domestic product (GDP), high unemployment rates, low living standards, and increased poverty across the globe. This includes decreased capacity of health system, and reduced quality and supply of health services. The aim of the study was to explore possible impact of the current world economic crisis on the public health sector workforce in Serbia. Materials and Methods. The study was conducted as retrospective analyses of the Public Health Institute (PHI) human resource data, the Republic Statistical Office publications and database, the Republic Development Bureau report, as well as the analysis of healthcare expenditures obtained from the Chamber of Health Institutions reports. The comparative analytical method was used for the assessment of socio-economic and human resource indicators over the period of five years, 2006 to 2010. Results. Results showed that the world economic crisis discontinued steady economic growth in Serbia. Between 2006 and 2008, the real GDP growth rate has been fluctuating between 3.6% and 5.4 %, while in 2009 it had negative growth rate of -3.1 % and slight increase in 2010 of 1.0%. In 2006, the GDP per capita was US$ 3,943, and by 2008 it almost doubled reaching US$ 6,498, while in 2009 it fell down to US$ 5,499, and continued decrease in 2010 to US$ 5,006. In 2007, the overall inflation rate was 6.5%, and after fluctuaion between 11.7% in 2008 and 8.4% in 2009 it droped again to 6.5% in 2010. According to the PHI, from 2006 to 2008 there was steady increase of full-time employees in the public health care sector; from 108,975 in 2006 to 114,317 in 2008. In 2009, the number of full-time employees slightly declined to 114,175 and 114,432 in 2010. There was constant increase in total number of employees in the public health care sector, from 125,081 in 2006 to 129,357 in 2008. In 2009, the total number of employees decreased to 128,694 and in 2010 to 122,695. At the same time, the total expenditure of human resources in the health sector as the percentage of total health expenditure declined from 37.7% in 2006 to 34.7% in 2010. The public health sector salaries after steady increase from 59.9% of total health expenditure in 2006 to 61.2% in 2007 and 2008, decreased to 56.2% in 2010. The unemployment rate for medical doctors almost doubled in 2010 as compared to 2006. Conclusion. Preliminary study results showed that the world economic crisis had negative impact not only on GDP growth rate, the inflation and unemployment rate, but on the public health sector workforce, their salaries and unemployment rate in Serbia.

BackgroundNational health accounts provide useful information to understand the functioning of a health financing system. This article attempts to present a profile of the health system financing in Malawi using data from NHA. It specifically attempts to document the health financing situation in the country and proposes recommendations relevant for developing a comprehensive health financing policy and strategic plan.MethodsData from three rounds of national health accounts covering the Financial Years 1998/1999 to 2005/2006 was used to describe the flow of funds and their uses in the health system. Analysis was performed in line with the various NHA entities and health system financing functions.ResultsThe total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. The country had not met the Abuja of allocating at least 15% of national budget on health. The percentage of total health expenditure from households' direct out-of-pocket payments decreased from 26% in 1998/99 to 12.1% in 2005/2006.ConclusionThere is a need to increase government contribution to the total health expenditure to at least the levels of the Abuja Declaration of 15% of the national budget. In addition, the country urgently needs to develop and implement a prepaid health financing system within a comprehensive health financing policy and strategy with a view to assuring universal access to essential health services for all citizens.

The Millennium Development Goals call for a 75% reduction in maternal mortality between 1990 and 2015. Skilled birth attendance and emergency obstetric care, including Caesarean section, are two of the most important interventions to reduce maternal mortality. Although international pressure is rising to increase donor assistance for essential health services in developing countries, we know less about whether government or the private sector is more effective at financing these essential services in developing countries. We conducted a cross-national analysis to determine the association between government versus private financing of health services and utilization of antenatal care, skilled birth attendants and Caesarean section in 42 low-income and lower-middle-income countries. We controlled for possible confounding effects of total per capita health spending and female literacy. In multivariable analysis, adjusting for confounders, government health expenditure as a percentage of total health expenditure is significantly associated with utilization of skilled birth attendants (P = 0.05) and Caesarean section (P = 0.01) but not antenatal care. Total health expenditure is also significantly associated with utilization of skilled birth attendants (P < 0.01) and Caesarean section (P < 0.01). Greater government participation in health financing and higher levels of health spending are associated with increased utilization of two maternal health services: skilled birth attendants and Caesarean section. While government financing is associated with better access to some essential maternal health services, greater absolute levels of health spending will be required if developing countries are to achieve the Millennium Development Goal on maternal mortality.

Ninety-four per cent of the Estonian population is covered by public health insurance, but private expenditure has been increasing quickly both in real terms and as a percentage of total health expenditure. To date, little attention has been given to the impact this could have on the population's financial protection. Out-of-pocket payments, which account for the bulk of the private expenditure in many low- and middle-income countries, can push people into poverty and more generally represent too high a burden for some households. It is therefore very important that governments monitor the impact of out-of-pocket payments on health. Using an example from Estonia, this paper aims to illustrate that, if household budget survey data are available, monitoring a population's financial protection is not a complex undertaking. Further, by combining simple statistical analyses of these data with a good knowledge of a country's health system, it is possible to give a fairly detailed diagnostic of the nature of the population's coverage limitation. This allows for the presentation of easily interpretable results that can raise awareness among policy-makers and help to target adequate policy responses. Using Estonian household budget surveys from 1995, 2001 and 2002, we show that the proportion of households who spend more than 20% of their capacity to pay on health increased from 3.4% in 1995 to 7.4% in 2002 and that in 2002, 1.3% of the population fell into poverty because of health payments. Logistic regression helps in identifying the population most at risk: elderly patients who belong to poor households and spend high amounts on medicines. This study, which can be replicated, did raise awareness among policy-makers about the changes in financial protection over the years in Estonia.