Purchasers Of Health Services Research Articles

Stakeholders’ views of the Baby Friendly Initiative implementation and impact: a mixed methods study

BackgroundThe Baby Friendly Hospital Initiative (BFHI) was launched in 1991 as an intervention to support healthy infant feeding practices, but its global coverage remains around 10%. This study aimed to explore stakeholders’ views of the Baby Friendly Initiative (BFI) programme, the barriers and facilitators to accreditation and its perceived impact.MethodsA mixed methods approach was used. An online survey was distributed through numerous professional networks from September 2020 to November 2020. Quantitative data were analyzed using descriptive statistics, with simple content analysis undertaken on open-ended responses. Individual semi-structured interviews were also undertaken and analyzed using inductive thematic analysis.ResultsA total of 322 respondents completed the survey in part or in full, mainly from the United Kingdom. Fifteen key stakeholders and two maternity service users undertook interviews. Respondents were from various professional backgrounds and currently worked in different roles including direct care of women and their families, public health, education and those responsible for purchasing health services. Survey respondents viewed the BFI to have the greatest impact on breastfeeding initiation, duration, and infant health outcomes. Three overall themes were identified. The first was “BFI as an agent for change”. Most participants perceived the need to implement the whole package, but views were mixed regarding its impact and the accreditation process. Secondly, BFI was regarded as only “one part of a jigsaw”, with no single intervention viewed as adequate to address the complex cultural context and social and health inequities that impact breastfeeding. Finally, “cultural change and education” around breastfeeding were viewed as essential for women, staff and society.ConclusionsThe BFI is not a magic bullet intervention. To create a more supportive breastfeeding environment within society a holistic approach is required. This includes social and cultural changes, increased education ideally starting at school age, and advancing positive messaging around breastfeeding within the media, as well as fully banning breastmilk substitute advertising. Although the BFI comprises a whole package, few survey respondents rated all aspects as equally important. Additional evidence for the effectiveness of each element and the importance of the whole package need to be established and communicated.

A minimum specification dataset for liquid ocular endotamponades: recommendations by a European expert panel

PurposeTo propose a minimum specification dataset to characterize liquid ocular endotamponades (OEs), namely silicone oil (SO), heavy SO (HSO), perfluorodecalin (PFD), and perfluoro-octane (PFO), in terms of physicochemical properties, purity and available evidence of safety, in line with ISO16672:2020.MethodsAn evidence-based consensus using the expert panel technique was conducted. Two facilitators led a committee of 11 European experts. Facilitators prepared a dataset for each compound including the list of specifications relevant for the safety, identified by the group members on the basis of expertise and a comprehensive literature review. Each item was ranked by each member using a 9-point scale from 1 “absolutely to not include” to 9 “absolutely to include” in two rounds followed by discussion. Only items reaching consensus (score ≥ 7 from ≥ 75% of members) were included in the final datasets.ResultsFor all OEs, consensus was reached to include manufacturer, density, refractive index, chemical composition, dynamic viscosity, interfacial and surface tension, endotoxins, in vitro cytotoxicity assessment, and any evidence from ex vivo and/or in vivo tests for safety assessment. Additional specifications were added for SO (molecular weight distribution, content of oligosiloxanes with MW ≤ 1000 g/mol, spectral transmittance) and PFD/PFO (% of pure PFD/PFO in the final product, vapor pressure, chemical analyses performed for safety assessment).ConclusionThe proposed evidence-based minimum specification datasets for SO, HSO, PFD, and PFO have the potential to provide surgeons and health service purchasers with an easily available overview of the most relevant information for the safety assessment of OEs.

AN EVALUATION OF THE TURKISH GENERAL HEALTH INSURANCE WITHIN THE SCOPE OF THE HEALTHCARE REFORM

In line with the recommendations of the World Bank, the Health Transformation Program [Sağlıkta Dönüşüm Programı] was accepted in Türkiye in 2003. Within this scope, reform movements in healthcare delivery were initiated. A universal health insurance model (named general health insurance) was accepted with the Social Insurance and General Health Insurance Act No. 5510 [5510 sayılı Sosyal Sigortalar ve Genel Sağlık Sigortası Kanunu] adopted in 2006. General health insurance, which came into effect gradually since 2008, fundamentally changed the system of benefiting from health services, which had been built as employment-oriented until then. General health insurance aimed to cover not only those included by social insurance but also all citizens or foreigners residing in Türkiye. In the general health insurance system, the principle of purchasing health services from health service providers (providing the financing of health services) has been adopted instead of providing them by the Social Security Institution [Sosyal Güvenlik Kurumu]. This study aims to evaluate the healthcare reform carried out in Türkiye through general health insurance. Therefore, the study first includes the healthcare (and social security) reform in Türkiye and then explains the implementation of general health insurance. Afterward, the study evaluates whether general health insurance meets the healthcare reform targets today and determines the problematic aspects of general health insurance.

The Health Insurance Situation in Iran: A Brief Overview

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

An Analysis of the Social Impacts of a Health System Strengthening Program Based on Purchasing Health Services

Access to universal health coverage is a fundamental right that ensures that even the most disadvantaged receive health services without financial hardship. The Democratic Republic of Congo is among the poorest countries in the world, yet healthcare is primarily made by direct payment which renders care inaccessible for most Congolese. Between 2017 and 2021 a purchasing of health services initiative (Le Programme de Renforcement de l’Offre et Développement de l’accès aux Soins de Santé or PRO DS), was implemented in Kongo Central and Ituri with the assistance of the non-governmental organization Memisa Belgium. The program provided funding for health system strengthening that included health service delivery, workforce development, improved infrastructure, access to medicines and support for leadership and governance. This study assessed the social and health impacts of the PRO DS Memisa program using a health impact assessment focus. A documentary review was performed to ascertain relevant indicators of program effect. Supervision and management of health zones and health centers, use of health and nutritional services, the population’s nutritional health, immunization levels, reproductive and maternal health, and newborn and child health were measured using a controlled longitudinal model. Positive results were found in almost all indicators across both provinces, with a mean proportion of positive effect of 60.8% for Kongo Central, and 70.8% in Ituri. Barriers to the program’s success included the arrival of COVID-19, internal displacement of the population and resistance to change from the community. The measurable positive impacts from the PRO DS Memisa program reveal that an adequately funded multi-faceted health system strengthening program can improve access to healthcare in a low-income country such as the Democratic Republic of Congo.

Philippine Journal of Development

This year’s first issue of the Philippine Journal of Development features articles on healthcare quality in hospitals, health financing, social health insurance benefit payments, and persons with disabilities. The first article measures the capacity of public and private hospitals in the country to provide high-quality health care based on their structural inputs. The second article analyzes the Philippine Health Insurance Corporation’s (PhilHealth) performance as the national strategic purchaser of health services, a role envisioned for it under the Universal Health Care Act. The third article examines the incidence of PhilHealth premium contributions and benefit payments by socioeconomic classes and age groups. The last article discusses the indicators valued by persons with disabilities and their families in Valenzuela City, Philippines, and how these manifest as they participate in the wider community.

Health System Financing: A Comparative Analysis of India and Saudi Arabia

The objective of this study is to provide a comparative analysis of the health financing systems in India and the Kingdom of Saudi Arabia (KSA) across three major domains: resource mobilisation, pooling of resources and purchase of health services. This is an observational study using secondary data collected from international organisations, ministries of health and other government and non-government agencies in India and KSA. The study revealed that India has a very low expenditure on healthcare and markedly lower health outcomes compared to KSA. Although India’s health financing system has undergone notable changes in the last two decades, it is lagging behind in many health financing system parameters. However, the share of government expenditure on current health expenditure has been increasing steadily with higher allocations to primary and secondary care. By expanding health insurance coverage and sustainable public health funding, it is likely that India will make significant progress towards achieving UHC.

The Influence of Socioeconomic Status on the Choice of Patterns and Methods of Health Financing in Jambi Province

Healthcare financing plays role in improving the quality of health services, with an aim to examine the effect of family socioeconomic status on the patterns and methods of ability to purchase health services. A quantitative study with a survey approach used in this research that connects exogenous (family socioeconomic status) and endogenous variables (financing patterns and methods, ability to purchase health services), with total sample of 770 households. The technique used an accidental sampling in western and eastern regions of Jambi, with questionnaire instrument and analysis PLS-SEM’s second order. Based from this research, family socioeconomic status has a direct influence on the ability to purchase health services showing as the first hypothesis. The second hypothesis also proved direct influence on the ability to purchase health services. The third hypothesis was also proved like the first and second hypotheses. Methods of health financing mediated the correlation between family socioeconomic status and ability to purchase health services was accepted of fourth and fifth hypotheses. Therefore, the family’s socioeconomic status, patterns and methods of health financing have a direct influence on the ability to purchase health services. Meanwhile, there was an indirect effect of family socioeconomic status on the ability to purchase health services through health financing patterns and methods.

Government purchasing initiatives involving private providers in the Eastern Mediterranean Region: a systematic review of impact on health service utilisation

ObjectiveThis paper provides a systematic review of evidence of government purchase of health services from private providers through stand-alone contracting-out (CO) initiatives and CO insurance schemes (CO-I) on health service...

Evaluation of the National Health Insurance Program of Nepal: are political promises translated into actions?

BackgroundDespite political promise to reduce out-of-pocket (OOP) expenditure on healthcare through the National Health Insurance Program (NHIP) of Nepal, its implementation is challenging with low enrolment and high drop-out rates. Program performance can often be linked with political economy considerations and interests of stakeholders. This study aimed to develop an in-depth understanding of organizational and systemic challenges in implementing NHIP.MethodsWe conducted a structured narrative review of available literature on the NHIP in Nepal. We analysed data using a political economy analysis for health financing reform framework. The findings were explained under six broad categories: interest groups, bureaucracy, budgets, leadership, beneficiary and external actors. In addition, we triangulated and further presented the literature review findings using expert opinions (views expressed in public forums).ResultsNepal has formulated acts, rules, regulations, and policies to implement NHIP. Under this program, the Health Insurance Board (HIB) is the purchaser of health services, and health facilities under the Ministry of Health and Population (MoHP) are the providers. The NHIP has been rolled out in all 77 districts. Several challenges have hindered the performance of NHIP at the policy and implementation levels. Challenges under interest groups included inadequate or delayed reimbursement and drop-out of hospitals in implementing the programme. Bureaucracy-related challenges were hegemony of provider over the purchaser, and inadequate staff (delay in the approval of organogram of HIB). There was inadequate monitoring of premium collection, and claim reimbursement was higher than collected premium. Challenges under leadership included high political commitments but weak translation into action, consideration of health insurance as poor return on investment, and intention of leaders to privatize the NHIP. Beneficiaries experienced compromised quality of care or lack of services when needed, high drop-out rates and low interest in renewal of premiums. External actors provided technical assistance in policy design but limited support in implementation.ConclusionsDespite enabling a policy environment, the NHIP faced many challenges in implementation. There is an urgent need for institutional arrangements (e.g. digitalization of claims and reimbursement, endorsement of organogram of HIB and recruitment of staff), increased coverage of financial protection and service (increased benefit package and introduction of cost-sharing/co-payment model), legislative reforms (e.g. legal provision for cost-sharing mechanism, integration of fragmented schemes, tripartite agreement to reimburse claims and accreditation of health facilities to ensure quality healthcare), and leveraging technical support from the external actors. High levels of commitment and accountability among political leaders and bureaucrats are required to strengthen financial sustainability and implementation.

Strategic Purchasing of Health Services in Senegal

Strategic Purchasing of Health Services in Senegal

Lessons on Strategic Purchasing of Health Services in Kenya

Lessons on Strategic Purchasing of Health Services in Kenya

Can Strategic Purchasing of Health Services Be Better Coordinated? Experiences of Five Countries in Sub-Saharan Africa

Can Strategic Purchasing of Health Services Be Better Coordinated? Experiences of Five Countries in Sub-Saharan Africa

Strategic Purchasing of Health Services in Sierra Leone

Strategic Purchasing of Health Services in Sierra Leone

Lessons on Key Health Service Purchasing Reforms in Nigeria

Lessons on Key Health Service Purchasing Reforms in Nigeria

The Influence of Message Framing on Elderly Tourists' Purchase Intentions of Health Services: A Case Study of Guangxi Bama.

Traveling has become an increasingly important lifestyle for the elderly to realize active aging. The elderly are more inclined to pay attention to wellbeing-related products whilst on vacations, representing a market opportunity for providers of tourism health services. This study conducted an experiment to explore how message framing affects intentions to purchase health services in elderly tourists over the age of 59 years. A total of 216 elderly tourists from Bama, a famous wellness tourism destination in China, were recruited as participants for a single-factor (message framing: positive versus negative) experiment. Our results indicate the following: (1) message framing has a significant impact on elderly tourists' intentions to purchase health services. Compared with messages that are negatively framed, positive messages are more persuasive. (2) Perceived benefits mediate the above relationship. (3) Perceived susceptibility moderates the impact of message framing around perceived benefits, as well as the indirect effect of perceived benefits on purchase intention. Theoretically, this paper clarifies the mechanism and conditions of message framing in relation to its effects on consumer intentions, enriching knowledge about the intersection between tourism and health consumption. This paper also provides guidance for providers of health tourism who are seeking to capture the market of elderly tourists.

Attributes of funding flows and quality of maternal health services in a mixed provider payment system: A cross‐sectional survey of 108 healthcare providers in Indonesia

AbstractStrategic purchasing of health services requires developing a coherent set of incentives across financing sources. In many countries, including Indonesia, healthcare providers engage with multiple financing sources. It is not well known how multiple funding flows in these mixed provider payment systems may interact at the facility level to influence provider behavior, quality of care, and ultimately health outcomes. Our study explored the association between facility capacity to provide high‐quality maternal and newborn care at delivery and various attributes of facility funding, including funding flexibility, sufficiency of funds to cover direct costs, predictability of funds in timing and amount, and facility autonomy to make management decisions (decision space). We used survey data collected from primary and secondary maternal healthcare providers (n = 108) across eight provinces in Indonesia. We constructed a technical quality index that measures facility capacity to provide high‐quality delivery care and several financing measures that summarize provider perceptions of flexibility, sufficiency, predictability of fund flows, and provider decision space. We found a statistically significant association between the decision space index score and the technical quality index score among hospitals and public primary care providers. One additional point on the decision space index was associated with an additional 0.15 (p = 0.021; 95% confidence interval: 0.024–0.275) on the quality index score after controlling for provider characteristics and geographic location. Our findings suggest that increasing facility autonomy to make management decisions may be one avenue for improving facility capacity to provide high‐quality care in systems where providers deal with multiple fund flows with varying attributes. Design of strategic purchasing reforms must consider the full context in which providers operate to streamline incentives and ensure providers have the capacity to respond to those incentives appropriately.

Supervision for the Public Health Services for Older Adults Under the Background of Government Purchasing: An Evolutionary Game Analysis Framework.

As an important measure to involve services for older adults, the government procurement practices have become a key link for public health services. However, the information asymmetry between public health service purchasers and public health service undertakers triggers a supervision dilemma. Based on this background, this study uses the evolutionary game theory to analyze the symbiotic evolution between local governments and public health service institutions under different reward and punishment mechanisms, explore game evolution, strategy adjustment, and influencing factors of different game subjects, and analyze the necessity and appropriate intensity of dynamic rewards and punishment mechanisms. The results show that: under the static condition, the penalty can change the strategies of local governments to a certain extent, but it is still difficult to achieve complete self-discipline management of public health service institutions. If local governments implement a dynamic reward or penalty mechanism in the supervision process of public health services for older adults, the equilibrium between them tends to be evolutionary stable. For three dynamic mechanisms, a dynamic reward mechanism is more conducive to adopting a self-discipline behavior of public health service institutions, which is helpful to realize the supervision of public health services for older adults. Also, there is a positive correlation between the proportion of public health service institutions who adopt a “self-discipline behavior” strategy and the maximum punishment intensity, and a negative correlation with the reward intensity. This study provides theoretical and decision-making references for governments to explore the promotion and implementation of public health services in older adults.

Examining healthcare purchasing arrangements for strategic purchasing in Nigeria: a case study of the Imo state healthcare system

BackgroundStrategic healthcare purchasing (SHP), as a critical function of health financing, enhances the optimal attainment of health system goals through the efficient use of financial resources. Countries committed to universal health coverage (UHC) have made progress towards strategic purchasing through relevant reforms in their healthcare financing systems. This study examined the purchasing arrangements and practices in the Imo state healthcare system to track progress towards SHP committed to UHC.MethodsA critical review and analysis of healthcare financing schemes in Imo state, south-eastern Nigeria, was undertaken to assess their purchasing practices based on a descriptive qualitative case study approach. Relevant documents were collected and reviewed including in-depth interviews with stakeholders. Information was collected on external factors and governance, purchasing practices and other capacities of the state’s health financing schemes. The analytical framework was guided by comparing purchasing practices of the financing schemes with the ideal strategic purchasing actions (SPAs) developed by RESYST (Resilient and Responsive Health Systems), based on the three pairs of principal–agent relationships.ResultsHealthcare purchasing in the state is dominated by the State Ministry of Health (SMOH) using a general tax-based and public health system, making government revenue a major source of funding and provision of healthcare services. However, purchasing of health services is passive and the stewardship role of government is significantly weak, characterized by substantial insufficient budgetary allocations, inadequate infrastructure and poor accountability. However, the health benefit package significantly reflects the needs of the population. As an integrated system, there is no purchaser–provider split. Provider selection, monitoring and payment processes do not promote quality and efficiency of service delivery. There is very limited institutional and technical capacity for SHP. However, the state recently established the Imo State Health Insurance Agency (IMSHIA), a social agency whose structure and organization support SHP functions, including benefit packages, provider selection processes, appropriate provider payment mechanisms and regulatory controls.ConclusionHealthcare purchasing in Imo state remains mostly passive, with very limited strategic purchasing arrangements. The main challenges stem from the entrenched institutional mechanism of passive purchasing in the government’s health budgets that are derived from general tax revenue, lack of purchaser–provider split, and poor provider payment and performance monitoring mechanisms. The establishment of the social insurance agency represents an opportunity for boosting SHP in the state for enhanced progress towards UHC. Building capacity and awareness of the benefits of SHP among policy-makers and programme managers will improve the efficiency and equity of health purchasing in the state.

Healthcare provider payments: Acceptance and preferences of Myanmar general practitioners

Universal Health Coverage (UHC), or people's access to quality essential health services without financial hardship, is one of the sustainable development goals for UN member countries to achieve by 2030. However, progress towards UHC has been uneven globally due to weaknesses in health financing. Although high-income countries such as New Zealand have been practising UHC for decades, it remains challenging for low-to-middle income countries to meet the goal in time. Myanmar, a Southeast Asian nation now on the verge of becoming a failed state due to the military coup, has struggled to restructure its healthcare financing mechanisms, especially in purchasing health services from private providers. Previous literature is biased to the Global North, with limited reference to Southeast Asia and little research focused on providers' perceptions, attitudes, and beliefs prior to introducing nationwide strategic purchasing payment mechanisms. These research gaps created an opportunity to investigate the relationships between General Practitioners' (GPs) socio-demographic characteristics and clinic services profile and their perceptions on payment methods. This research sought to examine Myanmar GPs' acceptance of, and preferences for, four major healthcare payment methods. A cross-sectional study was used, recruiting 622 participants with a convenience sampling method. A Qualtrics online survey was disseminated to Myanmar GPs through three different channels. The research showed that performance-based payment was the most acceptable and preferred payment method, followed by fee-forservice. Salary payments were reported as the least acceptable and preferred paymenttype, while findings on capitation were inconclusive. Despite the potential for this research to inform strategic purchasing arrangements in Myanmar, the scope for applying these findings, as initially intended, is not realistic in the immediate future because of the current political turmoil. In this context, the study's results provide valuable insights into the possible role of alternative provider payment architectures, particularly during public health emergencies.