Public Health Funding Research Articles

Voluntary Health Insurance in India:Trend Analysis of Public and Private Insurance Companies

Financing healthcare is a major concern for every nation. In developed countries tax revenue and social insurance are important sources of health financing. Unfortunately, in developing economies like India, the public funding for health is low, so the economic burden of medical expenditures falls on households. In such a situation it is argued that health insurance can play an invaluable role in improving access to healthcare facilities. India's tryst with voluntary health insurance was very limited until the passing of the IRDA Act in 2000. The 21st century, witnessed a mushroom growth of private health insurance companies. The demand for these market-based health insurance policies was derived from the rising expectation of middle class for good quality healthcare. An attempt has been made in this study to examine the pattern and growth trend of premiums of companies offering health insurance in India. The CAGRs of premiums underwritten by public and private health insurance companies were calculated for the time period 2002–03 to 2015–16 and testing of trend was done. The CAGR trend was found to be highly statistically significant for most of the companies.

Prevalence of cochlear implants in Europe: trend between 2010 and 2016

Objective: To collect figures on the numbers of children and adults receiving cochlear implants across Europe, compare the figures for 2016 with those for 2010, and identify any trends. Materials and methods: In 2018 EURO-CIU invited their 23 member countries to conduct a survey collecting data on the number of CI recipients in 2016 and 2017. Data were received from 15 countries, representing more than 100 000 CI recipients in Europe. Results: For paediatric CI, there was an increase in nearly all European countries (except Denmark, the UK and Luxembourg) between 2010 and 2016. We found an annual figure of one CI per 1000 newborns common in most countries where reimbursement of paediatric CI’s is available. Conversely the adult data reveals no increase between 2010 and 2016 and the data is less homogeneous than the paediatric data with huge differences across countries. Conclusion: There is little agreement on data on numbers of CI across Europe, which makes it difficult to plan public health policy, funding or services. In all European countries included in this study (except Germany) there needs to be work on raising more awareness of adult hearing loss and adult cochlear implantation to improve access.

Public Health Is Essential: COVID-19's Learnable Moment for Medical Education.

The COVID-19 pandemic, an unprecedented challenge for this generation of physicians and for the health care system, has reawakened calls to strengthen the United States’ public health systems. This global event is also a “learnable moment” for medical education—an opportunity to decisively incorporate public health, including public health systems, through the continuum of medical education. Although medical educators have made progress in integrating public health content into medical curricula, “public health” is not a phrase that is consistently used in curricular standards, and public health colleagues are not identified as unique and essential partners to improve and protect health. The COVID-19 crisis has demonstrated how a strong public health system is necessary to support the health of patients and populations, as well as the practice of medicine. Partnerships between medical and public health communities, through individual- and population-based interventions, can also more effectively combat more common threats to health, such as chronic diseases, health inequities, and substance abuse.To achieve a more effective medicine–public health relationship in practice, curricula across the continuum of medical education must include explanations of public health systems, the responsibilities of physicians to their local and state governmental public health agencies, and opportunities for collaboration. Medical education should also prepare physicians to advocate for public health policies, programs, and funding in order to improve and protect the health of their patients and communities. Pandemic COVID-19 demonstrates with laser focus that all physicians are part of public health systems and that public health content has a distinct and critical place across the continuum of medical education to prepare physicians to participate in, collaborate with, and advocate for public health systems.

Fourth COVID-19 Spending Bill Includes Funding for Hospitals, Testing

Back to table of contents Previous article Next article Government & LegalFull AccessFourth COVID-19 Spending Bill Includes Funding for Hospitals, TestingMark MoranMark MoranSearch for more papers by this authorPublished Online:8 May 2020https://doi.org/10.1176/appi.pn.2020.5b22AbstractAlthough primarily focused on replenishing the Small Business Administration’s Paycheck Protection Program, the bill also adds to a provider relief fund originally created by the CARES Act. iStock/PgiamPresident Donald Trump last month signed the fourth emergency COVID-19 spending bill, a $484 billion package.Approved by Congress and signed into law in the last week of April, the spending package was mainly intended to prop up the Small Business Administration’s Paycheck Protection Program, which ran out of money earlier in the month following a run on claims for assistance.But the Paycheck Protection Plan and Healthcare Enhancement Act (HR 266) also provides $100 billion in supplemental appropriations to the Department of Health and Human Services (HHS) for the Public Health and Social Services Emergency Fund. This includes $75 billion to reimburse health care providers for health care–related expenses or lost revenues that are attributable to the coronavirus outbreak in addition to the $100 billion approved in late March under the Coronavirus Aid, Relief, and Economic Security (CARES) Act; and $25 billion for expenses to research, develop, manufacture, administer, and expand capacity for COVID-19 tests to effectively monitor and suppress COVID-19.In the run up to the bill’s passage, APA and 11 other mental health and substance use treatment organizations sent a statement alerting Congressional leadership to the urgent need for direct funding to behavioral health and substance use treatment programs from the provider relief fund enacted under the CARES Act. While the spending bill approved last month did not specifically include funding for behavioral health, some mental health and substance use treatment programs may benefit from the funding.HHS posted a fact sheet about the provider relief fund. APA has also posted guidance to practitioners regarding provider relief and other practice issues related to COVID-19 on the APA website (see end of article for links).Meanwhile, APA and other medical and mental health specialty groups continue to work with Congress and the Trump administration to maintain and increase support for community behavioral health programs.“Before the pandemic broke out, there was bipartisan consensus that addressing mental health, substance use, and suicide were urgent national priorities. Congress took preliminary steps to increase funding for mental health and addiction services, but these investments may soon be lost because of the financial strain COVID-19 has taken on our mental health and addiction system,” the coalition said in a statement sent to Congressional leaders last month.Citing a survey conducted by the National Council for Behavioral Health (see story), the coalition noted that many behavioral health organizations “don’t have the funds they need to ride out this crisis.” The survey of 880 behavioral health organizations across the country revealed that 62% believe they can survive financially for only three months or less under current conditions. “Organizations have canceled, rescheduled, or turned away 31% of patients, and 92% have reduced their operations,” they wrote.The statement noted that the CARES Act included funding to health care professionals, with a priority on paying hospitals through Medicare. However, community behavioral health organizations rely primarily on Medicaid and have largely been left out of critical emergency funding. “We urge Congress to dedicate significant resources specifically to supporting community behavioral health programs during the crisis,” the coalition stated. ■The text of the Paycheck Protection and Healthcare Enhancement Act is posted here.Guidance from APA regarding the provider relief fund and other COVID-related practice issues is posted here.The HHS fact sheet about the provider relief fund established by the CARES Act is posted here. ISSUES NewArchived

Beyond Disclosure: Developing Law and Policy to Tackle Corporate Influence.

Corporate influence is one of the most pressing issues in public health. It cuts across many of our most intractable problems-from obesity to the opioid epidemic. Companies develop close relationships with public health agencies, research universities, academic medical centers, professional societies, and patient advocacy organizations-often funding medical research and public health interventions intended to address the very challenges these corporations are creating or exacerbating. How we view relationships with industry, including how these relationships are framed in ethical discourse, shapes our legal and policy responses to them. In recent years, fueled in part by the opioid epidemic, the ethical framing of industry relationships has begun to evolve in significant ways. But legal and policy responses have not yet caught up. In this article, I develop a temporal account of corporate influence, and legal and policy responses to corporate influence. This account clarifies the limitations and adverse effects of conflicts of interest disclosure, especially when implemented as the sole legal or policy response. Disclosure can illuminate corporate influence-but policymakers cannot and should not rely on disclosure to eliminate corporate influence or its effects. Nor should we allow disclosure to crowd out structural and systemic responses to corporate influence-including sequestration of and separation from private-sector entities.

Coronavirus Disease 2019 (COVID-19) and Your Radiology Practice: Case Triage, Staffing Strategies, and Addressing Revenue Concerns.

Coronavirus Disease 2019 (COVID-19) and Your Radiology Practice: Case Triage, Staffing Strategies, and Addressing Revenue Concerns.

APA, Partner Groups Call for Action on COVID-19

Back to table of contents Previous article Next article Government & LegalFull AccessAPA, Partner Groups Call for Action on COVID-19Katie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:10 Apr 2020https://doi.org/10.1176/appi.pn.2020.4b13AbstractAPA and its coalition partners gave specific recommendations on how state and federal governments can help patients and physicians on the front lines during the COVID-19 outbreak and urged swift action to help mitigate the spread of the disease.Throughout the COVID-19 pandemic, APA has worked with its coalition partners to give specific recommendations on how federal and state governments can help patients and physicians on the front lines during the outbreak, urging swift action to help mitigate the spread of the disease.Earlier in March when Congress was debating phases I, II, and III of COVID-19 legislation, APA and five other medical organizations representing more than 600,000 physicians and medical students sent a joint statement outlining numerous specific actions that state and federal governments should take to address the pandemic.“During this unprecedented national emergency, our organizations are committed to doing everything possible to prevent and slow the spread of the virus while ensuring that patients get the care they need,” the statement reads. “However, they can’t do it alone; there are specific actions that federal and state governments can take now to support access to and coverage for COVID-19 treatment and prevention.”Collectively known as the Group of Six, the organizations in addition to APA are the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, and American Osteopathic Association.“The repercussions of the COVID-19 pandemic on the physical and mental health of Americans will be long lasting and far reaching,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “With strong, immediate support from federal and state governments using science and medical experts to guide the response, we can slow the spread of this highly contagious virus and ensure patients receive the care they need.”In the statement, the organizations praised some of the steps that Congress and President Donald Trump’s administration have taken so far, including the president’s declaration that COVID-19 is a national emergency under the Stafford Act and the passage of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (HR 6074) and the Families First Coronavirus Response Act (HR 6201).Yet they urged further action, as well. The organizations outlined several key policy actions that state and federal governments should implement to help ensure widespread coverage of and access to COVID-19 testing and treatment. The recommendations also highlight ways in which governments can support health care system capacity and availability of personal protection equipment (PPE).Recommendations include the following:Congress, the administration, and state governments should continue to assess, fund, and increase the immediate and long-term availability of COVID-19 tests, as well as masks, PPE, and other pharmaceutical and medical supplies. Congress partially addressed this issue in each of the emergency supplemental funding in phases I, II, and III of the COVID-19 legislation, requiring health insurers to cover COVID-19 tests at no cost to patients and increasing funding for PPE and other medical equipment.Congress should appropriate at least $200 million to the Hospital Preparedness Program to bolster health care system emergency readiness. The CARES Act, phase III of COVID-19 legislation, included an additional $100 billion for hospitals and other health care facilities responding to COVID-19 through the Public Health and Social Services Emergency Fund. This funding could be used for hospital readiness, but it is unclear how these funds will be allocated given that this is new funding, not specifically designated for the Hospital Preparedness Program.Congress should additionally authorize funding for community health centers, community mental health centers, and the Teaching Health Center Graduate Medical Education Program. The CARES Act reauthorized and funded these programs through November 30, 2020.The administration should use national disaster relief funding to reimburse physicians at 110% of the Medicare rates for COVID-19–related care for people who are uninsured.“People all over the country are struggling with the stress and anxiety this pandemic is causing,” said APA President Bruce Schwartz, M.D. “Congress, the administration, and the states must act decisively so the physicians on the front lines of the crisis can protect their patients’ and their own physical and mental health.” ■ “Frontline Physicians Recommend Further Actions to Address COVID-19” is posted here. ISSUES NewArchived

Assessment of Equity in Access to Percutaneous Coronary Intervention (PCI) Centres in Poland.

The purpose of this study is to analyse the disparities in the distribution of percutaneous coronary intervention (PCI) centres in Poland and the impact of eventual inequities on access to the invasive treatment of acute myocardial infarctions (AMI). To examine the distribution of PCI centres against population size and geographic size in Poland, the Gini coefficient calculated based on the Lorenz Curve was engaged. In addition, the regression function was employed to estimate the impact of distribution of PCI centres on access to invasive procedures (coronarographies and primary percutaneous coronary intervention). Data were collected from the public statistical system and Polish National Health Fund database for the year 2018. The relation and the level of equity was measured based on the aggregated data at a district (voivodeship) level. The results of the Gini coefficient analysis show that the distribution of invasive cardiology units measured against population size is more equitable than when measured against geographic size. In addition, the regression analysis shows the moderate size of the positive correlation between number of PCI centres per 100,000 population and the number of all categories of the invasive treatment of AMI per 100,000 population, and the lack of similar correlation in case of the number of PCI centres expressed per 1000 km2, which could be evidence of an insufficiency of PCI centres in areas where the concentration of PCI centres per 100,000 population is lower. The main implication for policy makers that results from this research is the need for a correction of PCI centres distribution per 100,000 inhabitants to ensure better access to invasive procedures.

US allocates $8.3 billion for coronavirus

On March 5, the US Congress passed $8.3 billion in funding to help the government “prevent, prepare for, and respond to” the outbreak of the novel coronavirus, called SARS-CoV-2. President Donald J. Trump signed the bill on March 6. The amount of funding is far greater than the $2.5 billion that the Trump administration had originally requested. The largest chunk will go into a fund set up in 1983 for emergency response. “We are heartened that the agencies are given flexibility to put these resources to their best use and that the public health and social services emergency fund was bolstered to support federal, state, and local response efforts,” says Ellie Dehoney, vice president of policy and advocacy at Research!America. The spread of COVID-19, the respiratory disease caused by the virus, “should be a wake-up call—our nation lacks a well-resourced standing fund that can be tapped without delay in the

Public health financing, environmental quality, and the quality of life in Nigeria

This study explores the relationship between health financing, environmental quality, and the quality of life in Nigeria. The Bayer and Hanck cointegration test affirms cointegration. Findings further reveal that CO2 emissions have no meaningful impact on life expectancy in the short run. In the long run, urbanization significantly deteriorates the quality of life. Also, public health expenditure has not contributed meaningfully to the quality of life. The study discovers no evidence of a feedback causality, but a one‐way causality flowing from urbanization to CO2 emissions. Policies that can enhance a sustainable environment and improve the quality of life are discussed.

Poverty effects of public health reforms in Turkey: A focus on out-of-pocket payments.

Expanded financial coverage is critical to fight against poverty through public health reforms in developing countries. This study explores inequity in public health financing reforms in Turkey between 2003 and 2015. This paper has two parts. The first part examines inequity in health care financing in Turkey between 2003 and 2015. Gini, entropy (Theil and mean logarithmic deviation), and Atkinson indexes were calculated. In the second part of the paper, we investigated the degree of progressivity by using Kakwani index and Lorenz and concentration curves. We found a decreasing trend in terms of inequity. After major public health reforms and unification of the health financing system, it is seen that the distribution of out-of-pocket expenditure on health stands on the shoulders of vulnerable groups. Study results provide a deep understanding of the effects of poverty on public health financing reforms on households in Turkey. To reduce out-of-pocket health spending inequities and to protect vulnerable groups from increasing the level of health expenditures, we suggest that the government enlarges health insurance coverage for the poor.

Braiding and Layering Funding: Doing More With What We Have

Braiding and Layering Funding: Doing More With What We Have

Predicting Hospital Closure Using Popular Financial Indicators: An Exploratory Study of Muhlenberg Hospital

The role of government in the U.S. healthcare system is critical and hospitals play fundamental roles in our communities, among them critical healthcare provider and major employer. The federal funding program Medicare, and the federal-state funding source, Medicaid, are the two public health financing mechanisms that comprise significant funding to hospitals. Further, Medicare and Medicaid account for approximately 37 percent of all health expenditures in the U.S. (United States Centers for Medicare and Medicaid Services, 2018), and more than 60 percent of all hospital care (American Hospital Association, 2016). The public administration roles in the $3.4 trillion U.S. healthcare industry span that of provider, purchaser of services, initiatives and research funder, regulator, and policy implementer. In today's precarious political climate, amidst layers of government bureaucracies and an increased focus on better and fairer healthcare outcomes, the integration of public policy, administration, and healthcare has become increasingly important to practitioners and researchers. Indeed, the American Hospital Association tallies 5,564 hospitals in the United States, with 16 million employees and accounting for about one-sixth of the U.S. economy. Recently, of particular importance is the rise in U.S. hospital closures that impact healthcare and the economy in our local communities. This study contributes to the literature by identifying indicators for detecting warning trends in hospital financial condition before closures occur using a parsimonious system that can be replicated by both practitioners and policymakers with minimal data gathering efforts. The findings discussed here suggest that in the case of Muhlenberg Hospital, a clear trend of worsening financial condition could be detected at least four years prior to its closure. Current ratio, total margin, and debt to net asset ratio for Muhlenberg Hospital evidenced very clear indicators of financial instability. Consequently, the question emerges as to why neither the hospital nor the community was able to adequately negotiate these treacherous financial challenges to retain this valuable community asset.

The potential global gains in health and revenue from increased taxation of tobacco, alcohol and sugar-sweetened beverages: a modelling analysis

IntroductionGlobally, a growing burden of morbidity and mortality is attributable to lifestyle behaviours, and in particular to the consumption of tobacco, alcohol and sugar-sweetened beverages (SSB). In low-income and middle-income...

Mechanisms and pathways to impact in public health research: a preliminary analysis of research funded by the National Institute for Health Research (NIHR)

BackgroundThe mechanisms and pathways to impacts from public health research in the UK have not been widely studied. Through the lens of one funder (NIHR), our aims are to map the diversity of public health research, in terms of funding mechanisms, disciplinary contributions, and public health impacts, identify examples of impacts, and pathways to impact that existing reporting mechanisms may not otherwise have captured, and provide illustrations of how public health researchers perceive the generation of non-academic impact from their work.MethodsA total of 1386 projects were identified as ‘public health research’ by the NIHR and listed in the NIHR Public Health Overview database (2000–2016). From these, a subset of 857 projects were matched as potentially having begun reporting impacts via an external data-gathering platform (Researchfish). Data on the 857 projects were analyzed quantitatively, and nine projects were selected to investigate further through semi-structured interviews with principal investigators. Two workshops took place to validate emerging and final findings and facilitate analysis.ResultsIn addition to the NIHR School for Public Health Research and the NIHR Public Health Research Programme, 89% of projects contained in the NIHR Public Health Overview portfolio as ‘public health research’ are funded via other NIHR research programmes, suggesting significant diversity in disciplines contributing to public health research and outcomes. The pathways to impact observed in our in-depth case studies include contributing to debates on what constitutes appropriate evidence for national policy change, acknowledging local ‘unintended’ impacts, building trusted relationships with stakeholders across health and non-health sectors and actors, collaborating with local authorities, and using non-academic dissemination channels.ConclusionsPublic health as a discipline contributes substantially to impact beyond academia. To support the diversity of these impacts, we need to recognise localized smaller-scale impacts, and the difference in types of evidence required for community and local authority-based impacts. This will also require building capacity and resources to enable impact to take place from public health research. Finally, support is required for engagement with local authorities and working with non-health sectors that contribute to health outcomes.

A Novel Approach to Local Level Food Policy Case Studies: Application of the Advocacy Coalition Framework

This case study-based research was influenced by the growing movement of UK municipalities joining the Sustainable Food Cities (SFC) Network and developing food policies. This comes at a time of “growing tensions between global and local dynamics of food”. The national devolution of power to UK municipalities has resulted in Local Authorities (LAs) joining forces with Civil Society (CS) groups out of mutual need at a time of over £700 million in cuts to local public health funding and social services over the last decade [1,2]. Recognition of diverse skillsets, networks, access to funding as well as formal power for policy change highlight these mutually beneficial partnership arrangement at a time where cities are being seen as drivers of change for social policy [3]. As an examination of local food policy development, this work examined five cases from within the SFC network (Bath and Northeast Somerset (BNES), the cities of Bristol, Belfast, and the counties of Durham and Devon). These cases represent three different coalition structures, ranging from council/public authority-led to civil society-led and a hybrid partnership. This research examined how the concept of sustainability and local food production were understood and linked to one another by Civil Society (CS) and Local Authority (LA) actors to achieve local objectives. Based on the idea that policies and programs reflect the “translated beliefs” of those actors involved in the policy development process [4], this research compared interview material and the content of the local food strategy as a process output. Acknowledging the role of power as one that is central to policy research [5], the cases were examined according to their governance structures, to illustrate how power was concentrated and exercised within these partnerships. Ultimately, this had significant bearing on how sustainability and local food production content were presented in the documents and framed for the audience.

Limited alignment of publicly competitive disease funding with disease burden in Japan.

ObjectiveThe need to align investments in health research and development (R&D) with public health needs is one of the most important public health challenges in Japan. We examined the alignment of disease-specific publicly competitive R&D funding to the disease burden in the country.MethodsWe analyzed publicly available data on competitive public funding for health in 2015 and 2016 and compared it to disability-adjusted life year (DALYs) in 2016, which were obtained from the Global Burden of Disease (GBD) 2017 study. Their alignment was assessed as a percentage distribution among 22 GBD disease groups. Funding was allocated to the 22 disease groups based on natural language processing, using textual information such as project title and abstract for each research project, while considering for the frequency of information.ResultsTotal publicly competitive funding in health R&D in 2015 and 2016 reached 344.1 billion JPY (about 3.0 billion USD) for 32,204 awarded projects. About 49.5% of the funding was classifiable for disease-specific projects. Five GDB disease groups were significantly and relatively well-funded compared to their contributions to Japan’s DALY, including neglected tropical diseases and malaria (funding vs DALY = 1.7% vs 0.0%, p<0.01) and neoplasms (28.5% vs 19.2%, p<0.001). In contrast, four GDB disease groups were significantly under-funded, including cardiovascular diseases (8.0% vs 14.8%, p<0.001) and musculoskeletal disorders (1.0% vs 11.9%, p<0.001). These percentages do not include unclassifiable funding.ConclusionsWhile caution is necessary as this study was not able to consider public in-house funding and the methodological uncertainties could not be ruled out, the analysis may provide a snapshot of the limited alignment between publicly competitive disease-specific funding and the disease burden in the country. The results call for greater management over the allocation of scarce resources on health R&D. DALYs will serve as a crucial, but not the only, consideration in aligning Japan's research priorities with the public health needs. In addition, the algorithms for natural language processing used in this study require continued efforts to improve accuracy.

E-Coaching: the DianaWeb study to prevent breast cancer recurrences.

Breast cancer is the most common cancer in women worldwide, for which the survival rate is increasing over time. Growing evidence are showing that the effect of lifestyle could have the same weight of the effect of the usual clinical-pathological risk factors on survival rate. The DianaWeb study responds to the pressing request of patients diagnosed with breast cancer to know the most advanced point of scientific research on the prevention of recurrences, to have a virtual space to meet, where to receive advice and practical information for the daily management the lifestyle change. DianaWeb is a community-based participatory research, dedicated to breast cancer patients, aimed to monitor lifestyle, provide them tips to encourage sustainable lifestyle changes, and to analyze clinical outcomes. In order to achieve these aims, DianaWeb uses a specific interactive website (http://www.dianaweb.org/). The web architecture has been designed essential and light, with a rigorous implantation that brings the figure of the woman to the center. In order to humanized the project the acronym used to identify the study was Diana (Diet and Androgens), a classical female name, who was illustrated as a female avatar, aimed to symbolize all women. The graphical interface was developed using seven pastel tones colors, which become a fundamental elements of the layout, such as frame, navigation menu, and separation interspaces. The project started in 2015, and in 4 days the web site was visited by more than 1000 people. A total of 2823 persons enrolled in the study, but 2182 did not send the full documentations, 61 persons abandoned the study, 641 timely answered to the questionnaires. The high number of participants' interaction within the web page, confirmed the high usability of the web page and the great interest of patients. Prevention of breast cancer recurrences with low cost technologies, easily available to everybody, is a priority for both public health and public finances.

Comparing Public and Provider Preferences for Setting Healthcare Priorities: Evidence From Kuwait

As attempts are made to allocate health resources more efficiently, understanding the acceptability of these changes is essential. This study aims to compare the priorities of the public with those of health service providers in Kuwait. It also aims to compare the perceptions of both groups regarding key health policies in the country. Members of the general public and a sample of health service providers, including physicians, dentists, nurses, and technicians, were randomly selected to complete a structured, self-administered questionnaire. They were asked to rank health services by their perceived importance, rank preferred sources of additional health funding, and share their perceptions of the current allocation of health resources, including current healthcare spending choices and the adequacy of total resources allocated to healthcare. They were also asked for their perception of the current local policies on sending patients abroad for certain types of treatments and the policy of providing private health insurance for retirees. The response rate was above 75% for both groups. A higher tax on cigarettes was preferred by 73% of service providers as a source of additional funding for healthcare services, while 59% of the general public group chose the same option. When asked about the sufficiency of public sector health funding, 26.5% of the general public thought that resources were sufficient to meet all healthcare needs, compared with 40% of service providers. The belief that the public should be offered more opportunities to influence health resource allocation was held by 56% of the general public and 75% of service providers. More than half of the respondents from both groups believed that the policy on sending patients abroad was expensive, misused, and politically driven. Almost 64% of the general public stated that the provision of private health insurance for retirees was a ‘good’ policy, while only 34% of service providers agreed with this statement. This study showed similarities and differences between the general public and health service providers’ preferences. Both groups showed a preference for treating the young rather than the old. The general public preferred more expensive health services that had immediate effects rather than health promotion activities with delayed benefits and health services for the elderly. These findings suggest that the general public may not accept common allocative efficiency improvements in public health spending unless the challenges in this sector and the gains from reallocation are clearly communicated.

Community-Based Responses to Negative Health Impacts of Sexual Humanitarian Anti-Trafficking Policies and the Criminalization of Sex Work and Migration in the US

System-involvement resulting from anti-trafficking interventions and the criminalization of sex work and migration results in negative health impacts on sex workers, migrants, and people with trafficking experiences. Due to their stigmatized status, sex workers and people with trafficking experiences often struggle to access affordable, unbiased, and supportive health care. This paper will use thematic analysis of qualitative data from in-depth interviews and ethnographic fieldwork with 50 migrant sex workers and trafficked persons, as well as 20 key informants from legal and social services, in New York and Los Angeles. It will highlight the work of trans-specific and sex worker–led initiatives that are internally addressing gaps in health care and the negative health consequences that result from sexual humanitarian anti-trafficking interventions that include policing, arrest, court-involvement, court-mandated social services, incarceration, and immigration detention. Our analysis focuses on the impact of criminalization on sex workers and their experiences with sexual humanitarian efforts intended to protect and control them. We argue that these grassroots community-based efforts are a survival-oriented reaction to the harms of criminalization and a response to vulnerabilities left unattended by mainstream sexual humanitarian approaches to protection and service provision that frame sex work itself as the problem. Peer-to-peer interventions such as these create solidarity and resiliency within marginalized communities, which act as protective buffers against institutionalized systemic violence and the resulting negative health outcomes. Our results suggest that broader public health support and funding for community-led health initiatives are needed to reduce barriers to health care resulting from stigma, criminalization, and ineffective anti-trafficking and humanitarian efforts. We conclude that the decriminalization of sex work and the reform of institutional practices in the US are urgently needed to reduce the overall negative health outcomes of system-involvement.