Health Security System Research Articles

3.Y.2. Road traffic injuries, disability burden and implications for compensation schemes in Europe

Abstract Reducing traffic fatalities and injuries is a complex challenge, but it is one that is of paramount importance for public health and safety worldwide. In recent years, there have been improvements in trauma care and injury prevention efforts, which reduced mortality rates and increased survival after serious injury. However, an increased heterogeneity in recovery times is observed with survivors of road traffic injuries differing in their adjustment compared to other traumas in terms of symptoms’ onset, variability and chronicity. The recovery trajectory seems to vary widely with a large percentage of survivors in need of extensive time periods for full recovery. Attention has now been shifted towards the adverse effects of non-fatal injuries on functional, mental health, economic and societal outcomes. The capacity of a person to continue functioning, inability to work, sickness absence and reliance on welfare benefits to compensate for loss of income are some of the injury-related long-term consequences, causing great concern for health and social security systems across Europe, as they have been shown to account for more than one third of total road traffic incident costs. These figures fail to include individuals who sustain “minor” injuries, which do not require hospitalisation, yet still impair their ability to work. Despite the rapidly growing epidemiological and clinical attention, there are still several issues missing from research, policy and practice. A universal definition of recovery after a road traffic injury is still missing, and this has been seen as critical for improved understanding of risk factors of poor recovery as well as improved identification of those in need of welfare benefits. Furthermore, long-term sickness absence and disability following road traffic injury in Europe is still understudied and evidence on the different return to work pathways and compensation schemes is scarce. Evidence is still limited on the context in which return to work occurs, the injury profiles most dependent on long term compensation schemes and the policy settings of injury compensation schemes that impact return to work outcomes post injury. Data availability and data linkage issues often cause misclassification errors when granting disability pensions and this remains unattended long after an injury. Welfare benefits are often poorly connected with the injury or other medical diagnoses and this makes it difficult to assess the contribution of injuries on disability pensions and other welfare benefits, especially in comorbid and multimorbid conditions. The current workshop aims to improve our understanding of the long-term consequences and the challenges faced by those injured in road traffic injuries and aid the development of interventions that seek to enable sustained recovery, and help inform policy and practice of healthcare and injury compensation systems. Key messages • Timely access to quality healthcare, rehabilitation therapies, and assistive technologies can significantly improve outcomes and reduce the strain on social security and compensation systems. • Ensuring equitable access to social security benefits for injured individuals, requires efficient compensation schemes that recognize the full impact of the disability on individuals’ life.

The relationship between visual health and influencing factors among primary and secondary school students: a survey based in the Ningxia Hui Autonomous Region of China.

The myopia rate of young people around the world, especially in China, has continued to rise, and the vision health of primary and secondary school students has gradually become a global concern. It was to explore the current characteristics of vision status and their intrinsic links to influencing factors of the Ningxia Hui Autonomous Region primary and secondary school students under regional characteristics. 1,670 primary and secondary school students in Ningxia Hui Autonomous Region were surveyed using Vision examination, International Physical Activity Scale, Lifestyle Behavior Scale. The data were analyzed using SPSS 25.0 and AMOS 23.0. The prevalence of myopia among primary and secondary school students in the Ningxia Hui Autonomous Region was 27.3%, with rates of 31.5% for girls and 23.4% for boys. There was a significant negative correlation between lifestyle behaviors (r = -0.36, p < 0.01) and physical activity level (r = -0.06, p < 0.05) with vision status. The physical activity level played a significant masking effect between lifestyle behaviors and vision status (a*b = 0.002, c' = -0.044). Gender moderated the effects of lifestyle behaviors on physical activity level and vision status, as well as the effects of physical activity level on vision status. These factors constituted a mixed model with mediating and moderation. The model fitted well (RMSEA = 0.028, CFI = 0.951, NFI = 0.918). The prevalence of myopia among primary and secondary school students in this region is lower than the national average in China, and it is associated with lifestyle behaviors, physical activity level, and gender. When effectively controlled, the physical activity level significantly will reduce the prevalence of myopia as a masking variable. Gender, as a moderating variable, provides theoretical support for the classification and prevention of myopia. Regional surveys enriched the global database on adolescent myopia research, revealing the characteristics and common factors of visual problems in adolescents. Relevant departments and schools should integrate eye care into the national health security system, implement policies related to myopia prevention and control and safeguard the visual health of primary and secondary school students.

Public Health Security Systems Empowered by Artificial Intelligence for Early Monitoring and Prevention of Epidemics

Artificial intelligence (AI) methods have been extensively used for detecting and predicting Infectious Disease (ID) outbreaks as time series and modeling and evaluating Public Health responses. The significant tasks of PH monitoring and intervention present distinct technical difficulties, including limited data availability, absence of sufficient positive training examples, challenges in establishing benchmarks, measuring the effectiveness of management policies, complex relationships between spatial and time series elements, and more detailed risk assessments involving interaction and social networks. Conventional PH monitoring mainly depends on statistical methods. In recent years, there has been a significant expansion of approaches that AI enables. This research presents an AI method called Early Monitoring and Prevention of Epidemics (AI-EMPE) for enhancing PH security systems. The suggested approach converts a substantial amount of collected PH security incidents into separate incident characteristics and utilizes a Deep Learning (DL)--based detection technique to enhance EMPE. AI-EMPE incorporates sophisticated AI methods, including integrated Convolutional Neural Networks (CNN) and Backpropagation Neural Networks (BP-NN). These findings indicate that the integrated method is the most efficient in improving PH security systems.

Proposal of a Knowledge Management Model for Complex Systems: Case of the Supervision and Control Subsystem of the Colombian Health System.

Considering regulatory, supervision, and control health policy, an innovative knowledge management model is proposed for the Colombian health system, which is recognized as a complex system. A model is constructed through a comparative analysis of various theoretical and conceptual frameworks, and an original methodology is proposed based on an analysis of the macroprocesses of the Supervision and Control System (SSC) of the Colombian General Social Security System in Health (SGSSS). After formulating hypotheses and conceptual references, information errors are determined within the different macroprocesses of the SGSSS, including those of governance and the SSC. The risks of generating duplicate, wrong, hidden, or non-existent information arise when the associated regulations need more specificity to be applied in all cases, thus leading to the risk of different interpretations by some actors. In this way, it is possible to hinder the generation of unified information, as there is no clarity as to who is responsible for the generation or creation of certain data. The proposed model is characterized by its flexibility and adaptability, integrating several processes that can be executed simultaneously or cyclically (depending on the system's needs) and allowing for the generation and feedback of knowledge at different stages, with some processes simultaneously executed to complement each other.

NFS-16. NOVEL AUSTRIAN CARE AND PREVENTION GUIDE FOR CHILDREN AND ADOLESCENTS WITH NF1

Abstract BACKGROUND Unified strategies for the care of children and adolescents affected by Neurofibromatosis type 1 (NF1) are lacking in Europe. While ERN GENTURIS developed guidelines for the tumour surveillance and management in NF1, these recommendations do not cover all other aspects of the disease. This holds not only true on an international level, but also on the national level in Austria. Despite being a small country with a uniform health and social security system, approaches to patient care may be comparable but not identical. AIM In order to standardise and improve patient care for children with NF1 in Austria, a care and prevention sheet was developed. METHODS In close cooperation with the Austrian patient organisation NF Kinder the Austrian NF network was established. This network is composed of dedicated health-care providers (medical as well as psychosocial) involved in the care of patients with NF1 in ten Austrian centres as well as patient representatives, some of whom were also involved in drafting the novel ERN GENTURIS recommendations. This network undertook the task of reviewing existing guidelines and incorporate the national healthcare structure and best practice guidelines into a consensus document. RESULTS The recommendations were condensed into a single sheet that is divided in four sections: clinical examination, lab investigations, imaging, additional consultations. For each parameter, the document advises on the age specific intervals for screening. Furthermore, it indicates the appropriate time points during follow-up (e.g. at initial presentation, at transition, if clinically indicated, …). The recommendations thereby focus not only on the inherent tumour risk but address the broad spectrum of possible symptoms (such as orthopaedic or surgical), specifically emphasising also psychosocial and neurocognitive issues. CONCLUSION The novel Austrian care and prevention guide for children and adolescents with NF1 will facilitate uniform best practice care for affected kids on a national level

Research on health expenditure in Kazakhstan

Objective To understand and study Kazakhstan's resource planning and budget allocation in the field of health care through data related to Kazakhstan's health expenditure, to ensure the sustainable development of the health field between China and Kazakhstan, and to promote the medical and health undertakings among countries along the Belt and Road Initiative. Learn from each other's strengths and complement each other's weaknesses to promote cooperation. Methods Using the literature review method and comparative method, the per capita health expenditure in Kazakhstan and the other five Central Asian countries and China from 2001 to 2021 was compared with the proportion of GDP per capita, the proportion of self-pay expenditure in per capita health expenditure, and the total government health expenditure in the country. The proportion of GDP, per capita health expenditure and its proportion to per capita GDP, and the average actual growth average of per capita government health transfer expenditure and self-pay expenditure are compared with each other's medical and health security systems, health expenditures, national health levels and health resources. Results From 2001 to 2021, Kazakhstan's per capita health expenditure accounted for per capita GDP fluctuated between 2% and 4%, while other countries had growth trends of varying degrees. China's growth trend was relatively stable; Kazakhstan's per capita out- of -pocket health expenditure grew on average. The value is the lowest, only 1.05%, and the growth of government health transfer expenditures is at a medium level; the proportion of Kazakhstan's self-pay expenditures in per capita health expenditures and the proportion of total government health expenditures in GDP are also at a medium level. Conclusion (a) Kazakhstan's medical and health security system has certain effectiveness, and China's medical and health security system also has its advantages. There is a need for in-depth cooperation and development between China and Kazakhstan. (b)Kazakhstan needs to maintain a low proportion of per capita health expenditure in per capita GDP. The low growth rate of self-pay health expenditure and the low proportion of self-pay expenditure in per capita health expenditure are conducive to maintaining social equity and social welfare levels. (c)It is necessary for Kazakhstan to increase investment in the health field, promote medical research and innovation, and deepen cooperation in the medical and health field with countries along the "Belt and Road".

Fuzzy clustering of the healthy life expectancy decomposition: A multi-population analysis

This work analyses healthy life expectancy, which combines information on the period life table with the age-specific disability prevalence data in a single indicator. We quantify how much mortality and disability contributed to changes in healthy life expectancy over a fixed time horizon by age group and population to understand if life expectancy is increasing faster than the decline of disability. The prominent heterogeneity in mortality and health worldwide calls for a cross-country comparative analysis. The methodology used is decomposition, which splits the difference between two times of an aggregate index by assigning the difference to its components. Besides, through a cluster analysis, we categorize countries according to the age-specific contributions of mortality and disability simultaneously, using the healthy life expectancy decomposition results. This allows us to ease the interpretation and better outline the outcomes. Since health is increasingly considered a crucial aspect of economic growth, monitoring health expectancies is essential to assess the financial sustainability of the health and social security system. Some policy implications are finally discussed.

Dose the increasing burden of social endowment affect sustainable development of economy?

The rapid increase in the number of older people under the background of population aging has gradually changed the disease spectrum of society, making aging diseases more prevalent, and increasing the demand for health care services, medical and health services, and health insurance among older people, ultimately leading to increasing household and social spending on old age. This study is conducted to assess the impact of those spending burden on the sustainable development of economy and find out some practical and effective solutions. This paper constructs a theoretical model to illustrate the relationship between the old-age dependency ratio and the marginal product of capital (MPK), and then establishes a two-way fixed effect model based on transnational panel data of 81 countries from 1981 to 2017 to verify this relationship empirically. This paper finds that, after controlling a series of variables, an increased burden of old-age dependency leads to a decline in the MPK, a key macroeconomic variable and also a sustainable development criteria, but in which health care, health security systems, and technological innovation play a key and moderating role. The conclusion is also valid after tackling the problem of endogeneity with different methods, like two-stage least squares (TSLS) and the generalized methods of moments (GMM). Overall, before population aging, countries that are old-but-not-rich should encourage more supply-side investments in public health system or technological innovation, and adjust retirement system, or gradually encourage childbearing to strive for time and space for later sustainable development of public health system and economy.

Economic burden of Cardiac Arrest in Spain: analyzing healthcare costs drivers and treatment strategies cost-effectiveness

BackgroundCardiac arrest is a major public health issue in Europe. Cardiac arrest seems to be associated with a large socioeconomic burden in terms of resource utilization and health care costs. The aim of this study is the analysis of the economic burden of cardiac arrest in Spain and a cost-effectiveness analysis of the key intervention identified, especially in relation to neurological outcome at discharge.MethodsThe data comes from the information provided by 115 intensive care and cardiology units from Spain, including information on the care of patients with out-of-hospital cardiac arrest who had a return of spontaneous circulation. The information reported by theses 115 units was collected by a nationwide survey conducted between March and September 2020. Along with number of patients (2631), we also collect information about the structure of the units, temperature management, and prognostication assessments. In this study we analyze the potential association of several factors with neurological outcome at discharge, and the cost associated with the different factors. The cost-effectiveness of using servo-control for temperature management is analyzed by means of a decision model, based on the results of the survey and data collected in the literature, for a one-year and a lifetime time horizon.ResultsA total of 109 cardiology units provided results on neurological outcome at discharge as evaluated with the cerebral performance category (CPC). The most relevant factor associated with neurological outcome at discharge was ‘servo-control use’, showing a 12.8% decrease in patients with unfavorable neurological outcomes (i.e., CPC3-4 vs. CPC1-2). The total cost per patient (2020 Euros) was €73,502. Only “servo-control use” was associated with an increased mean total cost per hospital. Patients treated with servo-control for temperature management gained in the short term (1 year) an average of 0.039 QALYs over those who were treated with other methods at an increased cost of €70.8, leading to an incremental cost-effectiveness ratio of 1,808 euros. For a lifetime time horizon, the use of servo-control is both more effective and less costly than the alternative.ConclusionsOur results suggest the implementation of servo-control techniques in all the units that are involved in managing the cardiac arrest patient from admission until discharge from hospital to minimize the neurological damage to patients and to reduce costs to the health and social security system.

A Comparative Study on the Efficiency of Health Care Systems in OECD Countries Against COVID-19

Abstract Background COVID-19 has resulted in more than 670 million confirmed cases and more than 6.8 million deaths worldwide as of March 2023. This pandemic situation has put a significant strain on health care systems in each country, and the crises experienced by the USA, Britain and Italy have shown that even developed countries’ systems can collapse. This this study aims to measure and evaluate the performance of OECD countries’ health care systems against COVID-19 in terms of relative efficiency. Methods This study uses DEA to measure and compare the relative efficiency of national health care systems in response to COVID-19. We calculate technical, pure technical, scale, and super efficiency ranks based on the CCR, BCC, and Super-SBM models. The input variables are COVID-19-related health expenses, ICUs, facilities and equipment, and the number of examiners, and the output variable is the excess mortality rate due to COVID-19 of 2020, one year. Results According to the CCR model, two of the 20 analyzed countries, including Denmark and Iceland, are 100% efficient, and the remaining 18 countries are relatively inefficient. The average of technological efficiency is 0.26. According to the BCC model, a total of 10 countries are 100% efficient. The average of pure technical efficiency is 0.71. As a result of measuring the efficiency of scale, Denmark and Iceland are 100% efficient, and the remaining 18 countries are relatively inefficient. The average scale efficiency is 0.28. The super-efficiency ranking was followed by Denmark, Iceland, Korea and, etc. Conclusions When the analysis results were classified by health security system again, efficiency was high in the order of NHS, NHI, and SHI. When classified by financing sources and service provider, it was confirmed that tax-type countries were more efficient than insurance-type countries, and public supply-oriented countries were more efficient than private supply-oriented countries. Key messages • The efficiency of health care system of OECD countries against COVID-19 was measured, and the causes of performance were explored in terms of the structure of the system. • Through this, we intend to derive policy implications that can maintain the sustainability of the health care system in the face of health security crises such as the pandemic.

Comparative approach in public health social security: a legal case study of the Indonesian, France, and Singapore health systems

PurposeThis research paper aimed to study the legal structure of top-performing health governance systems and compare them with the Indonesian health social security system to identify the main differences and provide recommendations for Indonesian and other developing countries’ health policymakers and administrators.Design/methodology/approachUsing formative research with a conceptual approach and statute approach as method in this study. Data was gathered using the document study technique, which studies various documents, especially legal documents related to health law, linked to legal purpose theories. Moreover, the World Health Organization ranking was considered to choose the two countries (France and Singapore) with a high social health security system for comparative analysis. All data collected has been analyzed using a qualitative and theoretical basis. Content analysis was performed by analyzing the legal documents, and the regulatory framework of all three countries was deeply analyzed to draw conclusions and recommendations.FindingsIndonesia has specific laws to implement a social security system in the health sector. However, the lack of the best medical facilities and infrastructure and weak implementation of existing laws were identified as major reasons behind the poor health security system compared to comparative countries. Also, as a developing nation Indonesian Government face budgetary pressures and huge population challenges to meet required standards. Thus, the financing approaches used by Singapore and France may help developing countries meet these challenges effectively. Therefore, there is a dire need to strengthen the social health security system all over the country with amendments to laws and ensure the implementation of prevailing laws and regulations.Practical implicationsProviding understanding related to the social security health system in Indonesia along with a detailed description of the sound social health security system in France and Singapore will further provide an avenue for the researchers to critically analyze this line of study to devise some valuable suggestions further and to draw loopholes in the system.Originality/valueA comparative approach for legal studies in the health sector is rare. So, this research advanced the social security health system-related literature and legal studies on the health sector by using this comparative approach to develop policy insights and future research directions, which will further help the field to grow.

Trajectory monitoring method based on optical sensing spectral energy and adaptive threshold

Distributed optical fiber sensing technology is widely used in structural health monitoring, security systems and other fields. The traditional monitoring method of electrical measurement can ensure monitoring accuracy of train trajectory, while this method is easily affected by thunderstorm weather. In order to simultaneously improve the anti-interference ability and monitoring accuracy, this paper proposes a trajectory monitoring method based on optical sensing spectral energy and adaptive threshold. This method only needs to monitor the backward Rayleigh scattering optical signal of a redundant communication fiber, and perform Fourier transform and spectral energy operation to analyze vibration signals of the entire line. An adaptive threshold algorithm is utilized to autonomously locate fiber position of the train and form a spatial–temporal trajectory map. The method proposed in this paper is a passive monitoring method using optical sensing, which greatly improves system’s ability to resist electromagnetic interference, reduces the monitoring cost of the entire system, and effectively ensures the positioning accuracy. Experimental results demonstrate the effectiveness, safety, and accuracy of the train trajectory monitoring method based on optical sensing spectral energy and adaptive threshold.

Quality of life and labor inclusion of people with disabilities

Introduction: Disability is a generic term that includes deficits, limitations in activity and restrictions in participation indicate the negative aspects of the interaction between an individual and its contextual factors, environmental and personal factors. Objective: The objective of this study was to identify the characteristics of labor inclusion and health-related quality of life of people with disabilities in a population group from the city of Neiva (Colombia). Materials and methods: Descriptive, analytical, cross-sectional study with quantitative approach and non-experimental design, in a sample of 64 people with disabilities. Demographic variables such as age, sex, marital status, education, socioeconomic status, link to the social security system in health, and type of disability were considered. The WHOQOL-BREF, 2004 quality of life scale was applied. Central tendency measures were also calculated with their dispersions and 95% confidence intervals in the continuous quantitative variables. Results: The most frequent disability was physical with 78.13%, followed by visual with 17.18%. The highest percentage of impairment of the quality of life concerning disability is given by the need to move from one place to another, to feel dissatisfaction with their sexual life and the perception of an unhealthy environment. Conclusions: The main factors for the labor inclusion of a person with a disability are subject to sex, the type of disability, access to decent employment, and remuneration according to their potentialities.

Current Status of Psychiatric Care in Thailand

Abstract Background: Psychiatric care in Thailand has been established for a long time. It started with Thai traditional medicine and care, and later, it has been integrated with Western knowledge. In this review, the authors intended to highlight how clinical services and training in Thailand have been adjusted in regard to a changing society, environment, and the world. Methods: The authors collected information from the literature relevant to psychiatric care in Thailand, including organizations in charge of the mental well-being of health-care professionals and the general public, prescribing patterns of psychotropic drugs, psychotherapy, other interventions, and gender diversity issues. Results: Psychiatric care in Thailand is consistently improving in collaborating and networking among organizations and societies to unite psychiatrists with common interests. New specialty and sub-specialty trainings are also offered in response to the demands of residents and fellows as well as patients. There are also more training centers in the central and regional areas of Thailand. Adjusting and strategically managing psychiatric care have been done to deal with service disruption from the COVID-19 pandemic. Interventions, including pharmacological management, different types of psychotherapy, repetitive transcranial magnetic stimulation, and electroconvulsive therapy, have combined with Western knowledge and Eastern wisdom to deliver appropriate approaches for Thai people, including mental health care for patients with gender diversity. But the health security system and access to mental health care are areas are still needed to be further improved. Conclusion: Over the decades since mental health care has been recognized and increasingly aware, there are improvements in clinical services and academic training. The implementation of those services is still required to be monitored and improved for all populations in Thailand without discrimination.

Acceder a los servicios de salud: la mirada de migrantes del Chocó a Medellín

Introduction: Internal migration implies facing a series of conditions that prevent or delay the use of health services; objective: Understand barriers to health services access from the perspective of Chocó migrants living in Medellín.; methodology: Qualitative study, two focus groups were carried out in which 13 people with migratory experience from the department of Chocó to Medellín participated-; results: Afro-Colombian migrant population experiences barriers to entry due to not being insured by the general social security system in health, denial of service provision, lack of information, and unfavorable geographical accessibility. In health services, the barriers are associated with the color of skin and barriers due to delay or denial of authorization for procedures; conclusions: Migrant population experiences barriers to access to health services. An intersectoral approach to this problem is required, considering the particularities of the migratory context in the country where issues such as employment, education, and violence by armed actors, amongothers, are mainstreamed.

Recurrence stroke of ischemic stroke patients in Thailand: a nationwide study

Stroke is a global health problem and a leading cause of mortality and disability. Patients who survived an initial stroke are at risk for a recurrence stroke of the same type or another. However, few studies have documented at a national level. This research aimed to investigate the magnitude of recurrence stroke among ischemic stroke patients. This descriptive study used the data from neurology database collected between 2006 to 2020 in hospitals under the National Health Security System (NHSO) of Thailand. Among 511,322 ischemic stroke patients, recurrence of all types of strokes occurred in 85,968 patients or 16.81% (95% CI: 16.71-16.92). The prevalence was highest among patients with hypertension and diabetes mellitus at 18.89% (95% CI: 18.54-19.26), atrial fibrillation at 18.79% (95% CI: 18.42-19.15), and ischemic heart disease at 18.59% (95% CI: 18.05- 19.15). Furthermore, patients who received recombinant tissue plasminogen activator (rt-PA) treatment (12.15% %, 95%CI: 11.75-12.55) and rehabilitation (14.39%, 95% CI: 14.25-14.54) had a lower prevalence. Co- morbidities were an important factor had a high recurrence and treatment factors that patients receive had a low recurrence. Therefore, policymakers and health institutions could use these findings to implement treatment and monitoring policies for recurrence stroke.

Physical activity's impact on rural older adult health: The multiple mediating effects of education, income, and psychological capital.

This study aims to explore the influence mechanism of rural older adult health. By examining the mediating roles of education, income, and psychological capital in physical activity's impact on health, this study provides a reference for lifestyle interventions to improve the health level of rural older adults. The analysis was conducted on a sample of 1778 rural older adults from CGSS2017, and data were analyzed using PROCESS V4.2 for multiple mediating effects. The findings indicate that physical activity impacts rural older adult health through multiple mediating pathways. The mediating role includes seven paths, comprising the independent effects of three mediating variables of income, education, and psychological capital, and the chain mediating effects generated together. Based on the influence mechanism of health on rural older adults, optimizing policy focus and developing a precise, interconnected, and sustainable health security system for older adults is necessary. These research results are of practical significance for advancing healthy aging in rural areas.

카자흐스탄 건강보장제도의 변화: 세마스코에서 사회보험으로

카자흐스탄 건강보장제도의 변화: 세마스코에서 사회보험으로

Can the establishment of national sanitary cities better resist the impact of COVID-19?

The global spread of COVID-19 has led to profound reflection on building a global public health security system. This paper uses the urban data collected during the COVID-19 epidemic in China in 2020 to evaluate the effect of the National Sanitary City (NSC) policy on the prevention and control of that epidemic at different stages. We found that the NSC policy was able to curb the occurrence and transmission of the epidemic the epidemic effectively after controlling a series of factors such as urban characteristics, population mobility and pathogen transmission. Compared with non-NSCs, the NSCs were better able to control the number of infected people and the infection rate and transmission rate, and this performance was even more impressive when the epidemic gradually entered the sporadic distribution stage. The heterogeneity analysis shows that the impact of the NSC policy on the prevention and control of COVID-19 differs according to the economic development level and population size. To a certain extent, the NSC policy has blocked the spread of viruses by continuously improving the urban medical and health system and strengthening the publicity concerning infectious disease prevention and control knowledge.

Possible future scenarios of the general health social security system in Colombia for the year 2033

This article formulates possible future scenarios for the Colombian General Health and Social Security System (GHSSS) in 2033 when it reaches its 40th anniversary. The research draws on intuitive logic from the School of Human and Social Foresight (Masini, Penser le futur, 2000). The approach considers that in contexts of high instability and high conflict of interests, a combination of methods is required for the analysis of relevant transformations. It entails applying methods based on evidence, expertise, interaction, and creativity as discussed by Keenan and Popper (Foresight 10:16–36, 2008). Three scenarios are devised with the participation of real actors representing a plurality of visions from the public, private, academic, and social sectors. Finally, two future scenarios are featured, the one chosen by the experts before the triumph of the current government and the one that the Ministry of Health will present to the Colombian Congress for approval in 2023.