Percentage Of Total Health Expenditure Research Articles

Cost of Lung Cancer: A Systematic Review

ObjectivesWe performed a systematic review of studies estimating the cost of illness of lung cancer to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices. MethodsA systematic search on studies published in English on cost of illness of lung cancer was performed in MEDLINE (PubMed), Embase, Web of Science, and Scopus. Databases were searched in January 2017, and records were screened based on eligibility criteria. The systematic search was updated on May 7, 2020. The quality of included studies was appraised using a modified Drummond checklist. ResultsOf the 4891 records screened, 19 records were included. Most of the studies were cross-sectional and retrospective and used a prevalence-based approach and a bottom-up approach. Direct medical costs ranged from 4484.13 US dollars purchasing power parity to 45 364.48 US dollars purchasing power parity. Total medical costs as a percentage of total gross domestic product (GDP) ranged from 0.00248 to 0.1326 (median 0.0217), and total medical costs as a percentage of total health expenditure ranged from 0.038 to 0.836 (median 0.209). ConclusionsThere was considerable methodological heterogeneity that made it difficult to compare results between studies. The costs of lung cancer are substantial and impose a substantial economic burden on patients, healthcare systems, and societies. By comparing cancer costs with total health expenditures and GDP per capita, it can be concluded that lung cancer imposes a considerable economic burden on patients and healthcare systems in countries with lower GDP per capita and higher incidence rate.

Assessment of Household Out-of-pocket (OOP) Contributions to Health Expenditure in Niger State North Central Nigeria

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.

Impact of Socio-economic Factors in Reducing Malnutrition among Children: A comparative study of India, Bangladesh and Sri Lanka

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.

Out-of-Pocket Health Expenditure and Poverty: Evidence from a Dynamic Panel Threshold Analysis.

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

BackgroundAn important objective of health systems is financial protection against out-of-pocket health expenditure. In Iran, the Health Sector Evolution Plan (HSEP) has been implemented so as to achieve universal health coverage and decrease out-of-pocket health expenditure as a percentage of total health expenditure. ObjectivesThis study aimed to compare the hospitalization costs of breast cancer before and after the implementation of the HSEP and its impact on patient co-payment in Iran (2017). MethodsThis study was a prevalence-based cost-of-illness study. A total of 151 patients (75 patients 3 years before and 76 patients 3 years after HSEP implementation) were included from a public hospital by the census method. Data were extracted from patients’ records and analyzed using SPSS software (Version 22). ResultsThe total mean hospitalization costs increased significantly after the implementation of HSEP. Before and after the implementation of HSEP the total means (SDs) of hospitalization costs were estimated at 1489.44 (1609.33) PPP (purchasing power parity) and 4343.69 (5389.51) PPP, respectively. The percentage of patient co-payment decreased from 19.61% before the implementation of HSEP to 6.47% after its implementation, whereas the mean (SD) of patient contributions increased from 272.26 (334.50) PPP before the implementation of HSEP to 281.13 (307.22) PPP after its implementation. ConclusionThe cost of breast cancer is substantial. After the implementation of HSEP, the percentage of patient co-payment decreased, but due to the increase in tariffs, hospitalization costs of breast cancer and the amount paid by a patient rose substantially. HSEP certainly requires more attention from health policy-makers.

Evaluation of the performance of national health systems in 2004-2011: An analysis of 173 countries.

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.

The Privatization of Healthcare in selected First-world Countries and its Implications in the Kingdom of Saudi Arabia: A Descriptive-Comparative Study

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.

Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries.

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.

The New and Old Europe: East-West Split in Pharmaceutical Spending.

HIGHLIGHTS Since the geopolitical developments of 1989, former centrally planned economies of Eastern Europe followed distinctively different pathways in national pharmaceutical expenditure evolution as compared to their free market Western European counterparts.Long term spending on pharmaceuticals expressed as percentage of total health expenditure was falling in free market economies as of 1989. Back in early 1990s it was at higher levels in transitional Eastern European countries and actually continued to grow further.Public financing share of total pharmaceutical expenditure was steadily falling in most Central and Eastern European countries over the recent few decades. Opposed scenario were EU-15 countries which successfully increased their public funding of prescription medicines for the sake of their citizens.Pace of annual increase in per capita spending on medicines in PPP terms, was at least 20% faster in Eastern Europe compared to their Western counterparts. During the same years, CEE region was expanding their pharmaceuticals share of health spending in eight fold faster annual rate compared to the EU 15.Private and out-of-pocket expenditure became dominant in former socialist countries. Affordability issues coupled with growing income inequality in transitional economies will present a serious challenge to equitable provision and sustainable financing of pharmaceuticals in the long run.

Medication Insurance Policy - a New Insurance Product in the Polish Health Care System

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

As is the case with many of the Commonwealth of Independent Countries (CIS), since the collapse of the Soviet Union, both Kazakhstan and Uzbekistan have been re-building health care provision, and improving access to medications for their population. This study compares the two separate paths the countries have taken, and aims to establish the outcomes achieved by the two systems as well as the direction of future reforms. Secondary research focused on analysing the systems in place in the two countries, focusing on drug provision. The study assessed the mechanisms in place, drawing comparisons between the two systems, with a particular focus on the outcomes achieved. Uzbekistan provides medications free of cost for certain categories of patients, while in Kazakhstan, the government has approved a list of drugs that are provided for free as part of the guaranteed volume of free medical care. In both the cases these fall under an outpatient setting. Although the procurement of drugs is carried out mostly via tenders, Kazakhstan’s system involves establishing price ceilings. In Uzbekistan, retail and wholesale margins are controlled. Between 2002-2012, public health expenditure as a percentage of total health expenditure rose from 54% to 58% in Kazakhstan and from 45% to 53% in Uzbekistan. Life expectancy however, increased from 65.9 to 69.6 years in Kazakhstan and from 67.1 to 68.1 years in Uzbekistan. With growing government health expenditure, reflecting the expansion of the health care systems, the countries are likely to increasingly look into containing costs. Given that some pricing mechanism is already in place in Kazakhstan, it may consider implementing tighter pricing regulations, moving closer to those seen in Europe. In Uzbekistan, the government may potentially consider expanding the beneficiary categories while ensuring competiveness within the tendering process.

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

Background: HIV/AIDS infection has been the major contributor for mortality and burden of disease among Thais for decades. Studies on burden of diseases in Thailand show the increasing DALY loss from HIV/AIDS from 1999 to 2004, but a decreasing trend in 2009 due to the nationwide implementation of the policy on universal access to anti-retroviral therapy in 2006. Objective: To describe trend in magnitude, proportion of domestic and international financing sources, and financial resources allocated for HIV/AIDS prevention and control in Thailand from 2008 to 2013, and to identify factors contributing to effective financial management and monitoring system. Methods: With the application of Guide to Produce National AIDS Spending Assessment (NASA) 2009, a two dimensional matrix of financing sources and beneficiary population by healthcare function was produced. Comprehensive literature review and compilation of secondary data on actual expenditure on HIV/AIDS where available, from relevant financing agencies and institutes were carried out. The most up-to-date country’s GDP for 2010-2013 were retrieved from the website of the National Economic and Social Development Board (NESDB) of Thailand. Total Health Expenditure for 2008-2011 was retrieved from the National Health Account (NHA) database, and the total health expenditure for 2012-2013 were estimated based on the historical growth of Thailand’s total health expenditure. Results: Total expenditures on HIV/AIDS increased significantly from 230.9 million USD in 2008 to 282.9 and 287.3 million USD in 2012 & 2013, respectively. During this 6-year period, spending on HIV/AIDS was highest in 2011 as 330.7 million USD. The share of expenditures on HIV/AIDS as percentage of total health expenditure (THE) increased from 1.9% in 2008 to 2.4% and 2.2% of THE in 2012 and 2013 respectively. The amount of total AIDS spending per capita ranged from 3.3 to 5.1 USD per capita during the studied period. Domestic funding accounted for the majority of the HIV/AIDS financing in Thailand, but most of the spending was emphasized on care and treatment. During 2009-2013, only 13% to 17% of total AIDS expenditure in Thailand was spent on prevention activities. In 2012 and 2013, it was found that only 11% of total spending on prevention was spent on prevention activities for key population including sex workers, MSM, and people with intravenous drug use (PWID). It is noteworthy that most preventive programs, particularly prevention for key populations including sex workers, MSM, and PWID, were mainly contributed by the Global Fund (GF) and other international resources. Domestic resources were mainly allocated for universal access to ART, and care and treatment activities. Conclusions: Thailand has shown its attempt to be self-reliant in combating HIV/AIDS. Nevertheless, care and treatment expenditures overshadow prevention, and most of the preventive programs, particularly prevention for key populations were mainly financed by international financing sources, especially Global Fund. For better efficiency and future cost savings, more investment in prevention programs is essential, especially due to the declining support from international funds. Thailand should mobilize more domestic resources for financing prevention activities, particularly on key populations.

Abstract 367: Comparison of the Healthcare Systems of the United States and Portugal: Epidemiology and Management of Coronary Heart Disease

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.

Financing Public Health in Europe

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.

Health financing in the African Region: 2000-2009 data analysis.

BackgroundIn order to raise African countries probability of achieving the United Nations Millennium Development Goals by 2015, there is need to increase and more efficiently use domestic and external funding to strengthen health systems infrastructure in order to ensure universal access to quality health care. The objective of this paper is to examine the changes that have occurred in African countries on health financing, taking into account the main sources of funding over the period 2000 to 2009.MethodsOur analysis is based on the National Health Accounts (NHA) data for the 46 countries of the WHO African Region. The data were obtained from the WHO World Health Statistics Report 2012. Data for Zimbabwe was not available. The analysis was done using Excel software.ResultsBetween 2000 and 2009, number of countries spending less than 5% of their GDP on health decreased from 24 to 17; government spending on health as a percentage of total health expenditure increased in 31 countries and decreased in 13 countries; number of countries allocating at least 15% of national budgets on health increased from 2 to 4; number of countries partially financing health through social security increased from 19 to 21; number of countries where private spending was 50% and above of total health expenditure decreased from 29 (64%) to 23 (51%); over 70% of private expenditure on health came from household out-of-pocket payments (OOPS) in 32 (71%) countries and in 27 (60%) countries; number of countries with private prepaid plans increased from 29 to 31; number of countries financing more than 20% of their total health expenditure from external sources increased from 14 to 19; number of countries achieving the Commission for Macroeconomics and Health recommendation of spending at least US$34 per person per year increased from 11 to 29; number of countries achieving the International Taskforce on Innovative Financing recommendation of spending at least US$44 per person per year increased from 11 to 24; average per capita total expenditure on health increased from US$35 to US$82; and average per capita government expenditure on health grew from US$ 15 to US$ 41.ConclusionWhilst the African Region (AFR) average government expenditure on health as a per cent of THE increased by 5.4 per cent, the average private health expenditure decreased by the same percentage between 2000 and 2009. The regional average OOPS as a per cent of private expenditure on health increased by 4.9 per cent. The average external resources for health as a percentage of THE increased by 3.7 per cent. Even though on average the quantity of health funds have increased, we cannot judge from the current study the extent to which financial risk protection, equity and efficiency has progressed or regressed.In 2009 OOPS made up over 20% of total expenditure on health in 34 countries. Evidence shows that where OOPS as a percentage of total health expenditure is less than 20%, the risk of catastrophic expenditure is negligible. Therefore, there is urgent need for countries to develop health policies that address inequities and health financing models that optimize the use of health resources and strengthen health infrastructure. Increased coverage of prepaid health-financing mechanisms would reduce over-reliance on potentially catastrophic and impoverishing out-of-pocket payments.

Public health sector workforce in Serbia and world economic crisis

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.

Health financing in Malawi: Evidence from National Health Accounts

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.

Health care financing and utilization of maternal health services in developing countries

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.

Detecting changes in financial protection: creating evidence for policy in Estonia

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.

Funding of medical research in Australia by the National Health &amp; Medical Research Council

Australia invests a smaller percentage of its GDP, and a smaller percentage of total health expenditure, on medical and health research, than nations with which it often compares itself: some 16% of total national R&D expenditure is in the medical and health area (ASTEC). The National Health and Medical Research Council (NH&MRC) is an independent statutory body, with Principal Committees in medical and health research, health care, public health, and ethics. The Council is widely representative, meets in public, and is formally reviewed triennially. Its Medical Research Committee (MRC) advises on the distribution of $106 M for research projects, programs, units, and major institutes. Features of MRC's allocative procedures are emphasis on investigator-initiated proposals, extensive review, interviews, reporting in full, and “blind” determination of funding cut-offs. An extensive training and career support system is maintained, but no NH&MRC funded posts are tenured. There are extensive guidelines on Conflict of Interest, Good Scientific Practice, and Human and Animal Ethics.