Health Care System Reform Research Articles

The personnel maintenance of primary health care physicians in condition of challenges from menaces to population health

In condition of challenges from menaces to health due to COVID-19 the role of primary health care physicians increases that requires development of management decisions at the regional level. The purpose of the study. On the basis of analysis of medical demographic indicators and data concerning provision of primary health care personnel in the Russian Federation, proposals were made related to reforming of primary health care system in conditions of implementation of general medical practice with purpose to counteract menaces to population health. The analytical and statistical methods were applied. The official statistics data from the Minzdrav of the Russian Federation and Rosstat, results of original researches with content analysis and interpretation were used. The COVID-19 pandemic negatively impacted population health. The indicator of newly detected morbidity in the Russian Federation in 2020 decreased as compared to 2019 from 78024.3 to 75989.7‰oo (by 2.6%). This is the result of decreasing of dispensary and preventive activities among population. In next COVID-19 year (2021), as compared to 2020, indicator of primary morbidity increased to 85531.6‰oo that 12.6% higher than in 2020. The increase occurred in all classes of diseases that caused necessity of rehabilitation of these patients. The COVID-19 morbidity increased up to 2.4 times i.e. from 3391.1 in 2020 to 8085.7‰oo in 2021. The provision of physicians in the Russian Federation was 37.7‰o in 2021. Across the Federal Okrugs differences in indicators made up to 1.3 times and in subjects of the Russian Federation - up to 2.7 times. In conditions of COVID-19 significance of menaces to population health worsened. The situation requires both enhancement of primary health care and implementation of physicians of new formation - general practitioners responsible for patient health. The general practice (GP) widely developed in Russia in the 1990s during last ten years loses its significance in most subjects of the Russian Federation. In 2021, provision of general practitioners in the Russian Federation made up to 0.67‰o. In the Federal Okrugs, difference between indicators made up to 5.6 times. In the subjects of the Russian Federation the difference is enormous - 141.5 times. The article presents and scientifically substantiates prospective functional organizational models of general practice. The established situation with COVID-19 infection requires development of management decisions and measures at the regional level concerning improvement of organization of primary health care and implementation of general practice in conditions of counteracting risks of menaces to population health and health preservation.

Understanding Mental Health Challenges in Cardiovascular Care.

There is a profound link between cardiovascular health and mental well-being. This narrative review shows that heart and mental health are not isolated domains but deeply interconnected, influencing each other. It describes how cardiovascular diseases (CVDs) can cause mental health issues such as stress, anxiety, and depression. It also explains how these mental conditions can, in turn, worsen or raise the risk of CVDs. In addition, it emphasizes the necessity of a holistic approach to healthcare that integrates the treatment of physical symptoms of CVDs with interventions aimed at addressing mental health issues. This approach advocates for comprehensive care strategies that include psychotherapy, pharmacological treatments, lifestyle modifications, and digital health technologies. It also highlights the significant role of family and social support in recovery and discusses barriers to integrating mental health care in cardiovascular treatment. The article argues for a paradigm shift in healthcare towards more inclusive and integrated care models. The authors hope to foster a healthcare environment that prioritizes holistic care by increasing awareness about the connection between heart and mind. The call to action includes policy changes and healthcare system reforms aimed at facilitating the integration of mental health services into cardiovascular care, ultimately leading to improved outcomes for patients with CVDs and associated mental health issues.

Primary health reforms in China since the New Healthcare Reform: Policy, Practice, and Progress

In 2009, China launched a new round of radical healthcare system reforms, with primary health as a key area. Great progress and good outcomes have been made in promoting primary health which have helped to form the typical model and experience of primary health in China in its current development stage. Based on literature analysis and case study, this paper reviewed the history of primary health care in China since the latest round of healthcare system reforms, summarized the practices and outcomes of initiating institutional reforms, enhancing health capacity, improving care delivery, and building the system, so as to provide some experiences for the international comparison. In the face of the new situation of population aging and changes in the spectrum of diseases, China's primary health care is still facing problems and challenges such as unbalanced development, weak service capacity, weak talent team, and the lack of a hierarchical diagnosis and treatment system. Considering the actual situation of primary health in China and looking ahead, next step five areas need be reinforced.

PROVISION OF HEALTH SERVICES TO THE POPULATION AND DEMOGRAPHIC DEVELOPMENT: THE CASE OF AZERBAIJAN

The purpose of the research – the study aims to evaluate the progress made in Azerbaijan's healthcare system, considering recent developments. This includes assessing their impact on life expectancy at birth, a crucial indicator of population reproduction. Additionally, the research seeks to identify potential avenues for future development in light of existing challenges. The methodology of the research – descriptive analysis and comparative analysis methods were used in the research. The practical importance of the research - deeply understanding the current state of the healthcare sector is crucial for successfully implementing the activities outlined in the demographic development concept, which aims to improve the population's quality of life. This research lays the groundwork for future analyses that will utilize econometric models to explore the intricate relationship between health and demographic indicators. The results of the research - recent reforms in Azerbaijan's healthcare system have broadened access to medical services for the population, leading to a notable increase in life expectancy. Notably, the establishment of the Institute of Family Physicians and the enhanced collaboration between public and private medical institutions have played a crucial role in tackling key challenges. These include addressing regional disparities in healthcare deve­lopment indicators and increasing the share of healthcare expenditures within the national GDP. The originality and scientific novelty of the research - the processes in the healthcare system were analyzed comprehensively, linking them to demographic indicators. This descriptive analysis revealed positive trends in the field of medicine, accompanied by an increase in life expectancy.

Innovating Health Governance in Australian Integrated Care

Background: Australia is one of many countries implementing integrated care initiatives to facilitate the Quadruple Aim (the improvement of health outcomes, patient experience, provider experience and health system sustainability). These initiatives can be complex while working within a fragmented and siloed health system. NSW Health has created the Patient Centred Collaborative Commissioning Groups (PCCGs) program facilitating Local Health Districts (LHDs) and Primary Health Networks (PHNs) to co-commission health initiatives targeting local populations and their specific health needs. These PCCGs are unique as they are comprised of stakeholders involved at all levels of government in addition those from the community and private sectors. The LHDs and PNHs collaborate with additional relevant and local stakeholders to co-design new service pathways and ensure collaboration within one local health system.
 The literature evaluating integrated care aims at advancing knowledge of patient and provider experiences. Both areas are vital to understanding the successes and failures of integrated care but are insufficient to understand the ‘how’ and ‘why’ of successful system integration. This study therefore focuses on the under-researched question of ‘is it possible to govern integrated care?’
 In the Australian context, the governance of integrated care needs significant attention. In the context of this research, health system governance is defined as “the norms, structures, actors, institutions, and formal and informal relationships that shape authority and action in a health system”.
 Methods: This qualitative study involves semi-structured interviews with key stakeholders involved in the PCCGs and reviewing the governance documents of each local program. Data collected is thematically analysed and compared to existing governance models to draw out aspects of the individual PCCG governance mechanisms. This is part of a larger study that aims to understand the stakeholders, partnerships, and governance in integrated care in Australia.
 Implications for the future: This study will provide an in-depth understanding of the decision-making processes involved in the development (and subsequent use) of the governance models, as well as determining which actors have what roles and accountabilities within the PCCG. It is vital to determine what contributes to and facilitates each domain of health system governance (as defined above) to truly understand how we can achieve sustainable health care system reform. Traditional governance models are not sufficient to regulate the dynamic nature of integrated care initiatives, so they cannot facilitate the sustainability of these initiatives. As such, the overarching aim of this research is to create an ideal governance framework that can be replicated and applied across various integrated care initiatives.

Challenges to China's Healthcare System Reform in the Context of Aging and Future Reform Direction

China's healthcare system faces challenges due to economic development and aging. This study focuses on adapting to aging and improving healthcare accessibility for the middle-aged and elderly, crucial for hospital competitiveness and meeting societal needs. The paper proposes measures based on a literature review. As healthcare reform progresses, high hospital costs and imbalanced pricing emerge. To address this, the government should optimize policies to allocate medical resources reasonably and reduce burdens on the middle-aged and elderly by targeting common diseases. Moreover, China lacks geriatric medical institutions and suffers from discipline imbalances. Strengthening geriatric disciplines, training professionals, and investing in grassroots facilities like specialized hospitals and community centers are necessary. Considering external shocks like COVID-19 and an aging population is vital for reform. Optimizing resource allocation, increasing transparency, promoting digitization, and enhancing efficiency and equity of healthcare utilization are essential. These steps will boost hospital competitiveness, foster long-term system development, adapt to aging challenges, and meet national healthcare demands.

INVESTIGATION AND THE ANALYSIS OF MEDICAL BIG DATA AND THE EMPLOYMENT OF ARTIFICIAL INTELLIGENCE FOR DISEASE PREDICTION

The development of technologies like big data, cloud services, Internet+, and artificial intelligence has greatly improved data communication services in the traditional pharmaceutical industry, driving the progress of the healthcare sector in our country. These advancements have facilitated healthcare system reforms, enhanced the quality and efficiency of medical services, and fostered technological innovation. In this context, our research focuses on the following areas and draws the following conclusions: In recent years, the pharmaceutical industry has leveraged technologies such as big data, cloud computing, Internet+, and artificial intelligence to enhance data transmission services. These advancements are considered crucial strategic resources for the pharmaceutical industry and ongoing healthcare system reforms in our country. Their goal is to improve the efficiency and quality of medical services, establish new models of healthcare delivery, and drive economic growth. Given this, our research aims to further explore these advancements. There is an increasing demand for an in-depth exploration of the utilization of logic in the fields of artificial intelligence and computer science. To address this need, the Manual of Logic in Artificial Intelligence and Logic Programming, along with its companion, the Manual of Logic in Computer Science, were developed. These resources combine comprehensive investigations and fundamental research to delve into various underlying topics across multiple disciplines. A foundational understanding of mathematical complexity is assumed as background knowledge, making the material of interest to logicians and mathematicians [1]. However, existing works primarily focus on core concepts and technologies, leaving out extensions, applications, and languages. The handbook aims to provide a comprehensive coverage of constraint programming, offering readers an accurate overview of the entire field and its potential. While each topic is presented in a survey-like manner, some details may be omitted in favor of broader coverage [2].Among various types of uncertainties, randomness and ambiguity are considered crucial and fundamental. The relationship between randomness and ambiguity is discussed, exploring uncertain states and their changes through measures like entropy and hyperentropy. The study investigates uncertainties in chaotic, fractal, and complex networks' evolutions and differentiations. A simple and effective method for simulating uncertainty through knowledge representation is proposed, providing a foundation for automating logical and visual thinking in the presence of uncertainty [4]. The appropriate timing for monitoring implementation remains unclear. Although there is room for improvement, if a data processing algorithm functions correctly, it can be employed separately from the original algorithm. However, there are limitations to its usage [5] Keywords: Big Data, biomedicine, cluster, electronic health cards, healthcare.

COVID-19 Disruption To Routine Health Care Services: How 8 Latin American And Caribbean Countries Responded.

Latin America and the Caribbean was one of the regions hardest hit globally by SARS-CoV-2. This qualitative exploratory study examined how the COVID-19 pandemic disrupted the delivery of routine health services from the perspective of health care system decision makers and managers. Between May and December 2022, we conducted forty-two semistructured interviews with decision makers from ministries of health and health care managers with responsibilities during the COVID-19 pandemic in eight countries in Latin America and the Caribbean. On the basis of these interviews, we identified themes in three domains: impacts on the provision of routine health services, including postponed and forgone primary care and hospital services; barriers to maintaining routine health services due to preexisting structural health care system weaknesses and difficulties attributed to the pandemic; and innovative strategies to sustain and recover services such as public-private financing and coordination, telemedicine, and new roles for primary care. In the short term, policy efforts should focus on recovering postponed services, including those for noncommunicable diseases. Medium- and long-term health care system reforms should strengthen primary care and address structural issues, such as fragmentation, to promote more resilient health care systems.

The clinicians’ perspective on the National Health Insurance implementation in Indonesia: A study in a government hospital

ABSTRACT Effective healthcare system reforms in hospital settings depend on clinicians’ supportive responses, given their crucial role in decision-making and resource allocation. This qualitative research, conducted in a government hospital in Indonesia, explores clinicians’ reactions to challenges arising from National Health Insurance (NHI) implementation and their responses to hospital initiatives addressing NHI-related issues. Under NHI, cost control measures have constrained clinicians’ clinical autonomy, resource utilization, and, in many cases, their income. However, clinicians’ perspectives on NHI have evolved from initial scepticism and resistance to eventual adaptation and acceptance, influenced by the alignment of NHI with their professional values and goals. The responsiveness and adeptness of hospital management in balancing NHI standards with professional values have been pivotal in facilitating this transformation. The management’s effectiveness in applying mutually advantageous initiatives, harmonizing with the values and objectives of healthcare reform, healthcare professionals, and healthcare organizations, has been instrumental in the successful reform implementation. This study underscores the importance of a collaborative approach between clinicians and hospital management in navigating the complexities of healthcare reform. This research contributes valuable insights to the ongoing discourse on healthcare reform, emphasizing the interconnectedness of actors, their values, and organizational responses in shaping the outcomes of reform efforts.

Impact of Humble Leadership Behaviours of Hospital Leaders on The Innovation Performance and Work Engagement of Employees

Currently, the medical environment of hospitals is in a constant state of change, with the advancement of medical and healthcare system reforms. The organizational environment of hospitals is also becoming more and more dynamic, uncertain, and unpredictable. Relying only on the experience and knowledge of hospital administrators is no longer sufficient, necessitating employee participation. Vital to this is the provision of opportunities enabling employees to boost their motivation levels and encourage innovative practices. Four scales - leadership humility, innovation performance, psychological capital and job involvement - organize and design a questionnaire in this paper. Statistical methods are utilized to scrutinize and validate questionnaire data for quantitative research. This paper examines the factors that influence employees' innovative performance and work engagement. The aim is to identify ways in which the humble behaviour of hospital leaders can contribute concretely to enhance employees' work initiative and performance, thereby providing a substantive basis for better functioning of hospital departments.

Healthcare provision of transcatheter aortic valve implantation in Germany.

Transcatheter aortic valve implantation (TAVI) for aortic stenosis in older patients is the standard of care with awell-established supply density in Germany. In the near future, healthcare reform is planned that may affect TAVI capacities. Therefore, it is important to know how political regulations may interfere with access to services and what the need for TAVI will be in the future, based on demographic trends. The number of TAVI procedures (DRG F98A +F98) and the in-hospital main diagnoses of aortic stenosis (ICD I35) in 2021 were analyzed at the level of county or federal state based on anonymized data from hospital reports, according to §21 of the German hospital reimbursement law. The number of TAVI and aortic stenosis cases was projected for 2035 based on data from the German Federal Statistical Office on demographic developments. With quality assurance data from hospitals in 2019 and aroute planner, the travel time to the next hospital performing TAVI (OPS 5‑35a.0) was calculated, and the consequence of apolitically suggested minimum volume cut-off was analyzed. In 2021, atotal of 26,506 TAVI procedures were reported with amean number of TAVI per 100,000 inhabitants of32 (range between federal states from25 to42). Among the 66,045 diagnoses of aortic stenosis, there was avariation per 100,000 inhabitants from64 to 108 (mean79) between federal states. Compared to 2021, an additional 8748 (+13%) diagnoses of aortic stenosis and an increase of 4673 (+18%) TAVI procedures is to be expected in 2035. In 2019, 57% of German citizens could reach aTAVI hospital within 30 min and 91% within 60 min of driving time by car (mean time to hospital 31 min). Applying aminimum number of 150 TAVI/hospital per year would increase the driving time to hospital from 33to 52 min in Saxony-Anhalt and instantly remove six out of eight hospitals from service in Hesse. Regulation of TAVI services by minimum volume numbers would arbitrarily interfere with access to services, in contradiction to the medical service assurance tasks of federal state governments. These issues should be considered in the upcoming healthcare system reform.

Fragilising clients: A positioning analysis of identity construction during clinical psychology trainees' supervision.

Western mental healthcare system reforms prioritise person-centred care and require clinicians to adjust their professional positions. Realising these reforms will necessitate clinicians-including clinical psychologists-acquiring professional identities that align with them. Learners develop professional identities through socialisation activities: within interactional spaces such as supervision learners come to understand the self (clinician) and, by extension, the other (client). A clinician's understanding of who I am is intertwined with an understanding of who they are. Our study offers a moment-by-moment examination of supervision interactions of clinical psychology trainees to illuminate processes through which the identities of therapists and clients are constructed. We examined how clinical psychology trainees and supervisors construct identities for themselves and clients in supervision. We used positioning analysis to explore identity construction during interactions between supervisors (n= 4) and trainees (n= 12) in a clinical psychology training clinic. Positioning analysis focuses on the linguistic choices participants make as they position themselves (and others) in certain social spaces during everyday interactions. Twelve supervision sessions were audio recorded and transcribed. We found that clients were frequently positioned as fragile and subsequently analysed these sequences (n= 12). Clients' identities were constructed as fragile, which co-occurred with clinical psychologists' claiming positions as responsible for managing their distress. Supervisors played an active role in linguistically positioning clients and trainees in this way. Trainees rarely contested the identities made available to them by supervisors. We suggest that linguistically positioning clients as fragile perpetuates paternalistic clinical discourses that do not align with mental healthcare reform priorities. We make visible how this is achieved interactionally through language and influenced by organisational power relations. Intentional efforts are required to support the professional identity construction of clinical psychologists in ways that do not perpetuate paternalism. We offer recommendations for education and clinical practice to support these efforts.

Colorectal Cancer Survival in German-Danish Border Regions-A Registry-Based Cohort Study.

The aim of this study was (i) to update the reporting of colorectal cancer survival differences over time in the German-Danish border region (Schleswig-Holstein, Southern Denmark, and Zealand) and (ii) to assess the extent to which it can be explained by stage and primary treatment. Incident invasive colorectal cancer cases diagnosed from 2004 to 2016 with a follow-up of vital status through 31 December 2017 were extracted from cancer registries. Analyses were conducted by anatomical subsite and for four consecutive periods. Kaplan-Meier curves and log-rank tests were computed. Cox regression models using data from Schleswig-Holstein from 2004 to 2007 as the reference category were run while controlling for age, sex, stage, and treatment. The cox regression models showed decreasing hazard ratios of death for all three regions over time for both anatomical subsites. The improvement was stronger in the Danish regions, and adjustment for age, sex, stage, and treatment attenuated the results only slightly. In 2014-2016, colon cancer survival was similar across regions, while rectal cancer survival was significantly superior in the Danish regions. Regional survival differences can only partially be explained by differing stage distribution and treatment and may be linked additionally to healthcare system reforms and screening efforts.

Challenges for Developing Palliative Care Services in Resource- Limited Settings of Kazakhstan.

Background: Approximately 40 million people in need of palliative care worldwide, while 80% of them live in low- and middle-income countries. Kazakhstan, a low-to middle-income country with a reforming healthcare system, is committed to improving quality and accessibility of care for its 100,000 terminal patients in need of palliative care. Policy Options and Recommendations: To join the group of countries where palliative care is available, accessible, and affordable, Kazakhstan must integrate palliative services into the mainstream healthcare system at all levels, from primary healthcare to hospices, and from major cities to remote villages. Based on the evidence thoroughly collected directly from the Ministry of Health, authors propose a feasible set of recommendations regarding palliative policy, pain relief, infrastructure, workforce, and education, which could be implemented in LMICs beyond Kazakhstan. Conclusion: This study presents an analysis of challenges, recent developments, and needs of palliative care in Kazakhstan, including funding, policy, workforce, education, and infrastructure, providing an evidence base and recommendations for future development of palliative care in Kazakhstan and in other LMICs.

Mental health policy and implementation from 2009 to 2020 in China

Mental health is a major component of overall health. Before 2009, the inequity between supply and demand of mental health services in China was extremely prominent, and the mental health service system faced significant challenges. In 2009, China embarked on its new healthcare system reform. The government attributed much more importance to mental health services and introduced a series of policies and measures to improve the mental health service system, as well as personnel service capability and service models. For example, the Mental Health Law was issued, community mental health services were expanded to the whole country, more psychiatric hospitals and clinics were built, the number of psychiatrists was increased through academic education, and a comprehensive mechanism of interdepartmental cooperation in mental health was established to improve service delivery. Furthermore, the mental health of key groups such as children, adolescents and older people was emphasized, and more attention was gradually paid to patients with common mental disorders to realize the stepwise transformation from an individual-focused mental health approach to a public-focused one. Most of the implementations began with pilot projects that developed practical experience and then expanded all over the country. This article summarizes and analyses the important mental health policies and implementations in China from 2009 to 2020 and prioritizes the next steps.

P44 Moral Hazard Effects of Payment Methods Reform in China

With the development of economy, the intensification of healthy aging and the gradual expansion of health insurance coverage, the rapidly increasing medical expenses have become one of the main challenges facing the reform of China's medical and health care system. The key to effectively controlling the excessive rise of medical expenditures and ensuring the sustainability of medical insurance funds lies in whether the reform of medical insurance payment methods can be effectively promoted. China started a pilot project to modify the DRG payment reform in 2017, and intends to implement a multifaceted and complex medical insurance payment method based on payment by diagnosis-related groups or disease type in 2024. Diagnosis-related group payment system is frequently seen as helpful in containing the development of healthcare costs. However, it also causes moral hazard issues on the supply side, including higher rates of readmission to hospitals and cost shifting. This research aims to explore the impact of diagnosis-related group payment reform on supply-side moral hazard in China.

Horizontal inequity trends of health care utilization in rural China after the medicine and healthcare system reform: based on longitudinal data from 2010 to 2018

BackgroundTo assess the effectiveness of China's medicine and health care reform in promoting equity in health care utilization among rural residents, it is necessary to analyze temporal trends in equity in health care utilization among rural residents in China. This study is the first to assess horizontal inequity trends in health care utilization among rural Chinese residents from 2010 to 2018 and provides evidence for improving government health policies.MethodsLongitudinal data obtained from China Family Panel Studies from 2010 to 2018 were used to determine trends in outpatient and inpatient utilization. Concentration index, concentration curve, and horizontal inequity index were calculated to measure inequalities. Decomposition analysis was applied to measure the contribution of need and non-need factors to the unfairness.ResultsFrom 2010 to 2018, outpatient utilization among rural residents increased by 35.10%, while inpatient utilization increased by 80.68%. Concentration indices for health care utilization were negative in all years. In 2012, there was an increase in the concentration index for outpatient utilization (CI = -0.0219). The concentration index for inpatient utilization decreased from -0.0478 in 2010 to -0.0888 in 2018. Except for outpatient utilization in 2012 (HI = 0.0214), horizontal inequity indices for outpatient utilization were negative in all years. The horizontal inequity index for inpatient utilization was highest in 2010 (HI = -0.0068) and lowest in 2018 (HI = -0.0303). The contribution of need factors to the inequity exceeded 50% in all years.ConclusionsBetween 2010 and 2018, low-income groups in rural China used more health services. This seemingly pro-poor income-related inequality was due in large part to the greater health care need among low-income groups. Government policies aimed at increasing access to health services, particularly primary health care had helped to make health care utilization in rural China more equitable. It is necessary to design better health policies for disadvantaged groups to reduce future inequities in the use of health services by rural populations.

The "No bed syndrome" in Ghana - what, how and why? A literature, electronic and print media review.

"No bed syndrome" has become a familiar phrase in Ghana. Yet, there is very little in medical texts or the peer reviewed literature about it. This review aimed to document what the phrase means in the Ghanaian context, how and why it occurs, and potential solutions. A qualitative desk review using a thematic synthesis of grey and published literature, print and electronic media content covering the period January 2014 to February 2021. Text was coded line by line to identify themes and sub-themes related to the research questions. Analysis was manual and with Microsoft Excel to sort themes. Ghana. Not applicable. "No bed syndrome" describes the turning away by hospitals and clinics of people seeking walk in or referral emergency care with the stated reasons "no bed available" or "all beds are full". There are reported cases of people dying while going round multiple hospitals seeking help and being repeatedly turned away because there is "no bed". The situation appears to be most acute in the highly urbanized and densely populated Greater Accra region. It is driven by a complex of factors related to context, health system functions, values, and priorities. The solutions that have been tried are fragmented rather than well-coordinated whole system reform. The "no bed syndrome" describes the challenge of a poorly functioning emergency health care system rather than just the absence of a bed on which to place an emergency case. Many low and middle income countries have similar challenges with their emergency health care systems and this analysis from Ghana is potentially valuable in attracting global attention and thinking about emergency health systems capacity and reform in low and middle income countries. The solution to the "no bed syndrome" in Ghana requires reform of Ghana's emergency healthcare system that takes a whole system and integrated approach. All the components of the health system such as human resource, information systems, financing, equipment tools and supplies, management and leadership need to be examined and addressed together alongside health system values such as accountability, equity or fairness in the formulation, implementation, continuous monitoring and evaluation of policies and programs for system reform to expand and strengthen emergency healthcare system capacity and responsiveness. Despite the temptation to fall back on them as low hanging fruit, piecemeal and ad-hoc solutions cannot solve the problem.

Policy developer’s perceptions on the implementation of National Health Insurance in South Africa: a qualitative study

BackgroundUniversal health coverage has gained significant momentum internationally as the policy solution to address healthcare system deficiencies and promote equitable distribution of quality healthcare. The South African government has adopted this option and developed policy papers for discussion on a National Health Insurance (NHI) system for South Africa. A large part of the policy has been focused on promoting functionality of the primary healthcare system (PHC); to promote an efficient referral pathway. This study sought to explore potential barriers perceived by policy developers that could hinder achieving the NHI goal. Furthermore, given that a large focus is centred on PHC re-engineering, it was imperative to understand participant’s opinions and perspectives on the role of a pharmacist at this level.MethodsA qualitative research design was adopted in this study. Semi-structured interviews were conducted with ten policy developers that were selected via a referral technique. These were audio recorded using a digital voice recorder on an online platform, transcribed verbatim and saved on Microsoft Word® documents. NVivo®, was utilized to facilitate the analysis of data. A thematic analytical approach was used to categorize codes into themes.ResultsThe findings revealed that participants were in agreement that healthcare system reform is crucial in promoting equitable distribution of healthcare services in South Africa. However, the reality of this is dependent on addressing key concerns perceived by participants that have been reported as three major themes: (1) the benefit of NHI implementation; (2) concerns about NHI implementation; (3) implications for pharmacy.ConclusionsSouth Africa is in the second phase of NHI implementation. This phase is focused on the development of sound NHI legislation and structures. This study identified a number of concerns regarding legislative anomalies and role-player involvement that could compromise the efficient implementation of NHI.

Analysis of the changing trend of economic burden of patients with chronic diseases under the Integrated Medical and Health Service System

BackgroundIntegrating medical resources is one of the explorations of medical mechanism reform to meet the needs of whole-cycle health management and is an important initiative in the current round of China's healthcare system reform. 2015 saw the construction of county medical communities to promote the balanced layout of medical resources, which opened a new exploration of the construction of an integrated healthcare service system in China. 2017 saw the promotion of the pilot construction of compact county medical communities in Zhejiang Province, China.ObjectiveFrom the perspective of alleviating the financial burden on those in need of health services, the characteristics of chronic disease patients' access to health care and the composition and changing curve of the medical cost burden are analyzed to provide a basis for the construction path of an integrated health care service system.MethodsA retrospective cohort study was conducted to select 5739 permanent residents who met the inclusion and exclusion criteria in Z town, H city, Zhejiang province. This population's health insurance utilization data from 2015 to 2018 were retrieved, and their average annual costs, cost composition, and health insurance payments were analyzed.ResultsThe average annual growth rates of medical insurance and out-of-pocket costs before and after the implementation of the Medical Community were 12.85% and 9.72%, respectively. The increase narrowed significantly after the construction of the Medical Community, with the ringgit growth rate dropping to 2.73% in 2018. The top three medical expenses that accounted for the highest percentage were drug, consultation, and treatment fees. The frequency of visits to primary health care consulting hospitals has increased yearly.ConclusionsBy implementing various measures to strengthen the grassroots level, patients' choice of primary care has increased year by year in the early stages of the construction of the Medical Community. From the perspective of cost control, strengthening the regulation of drugs and tests and restricting the use of high-value consumables can further reduce medical costs and ease their financial burden.