Sustainability Of Healthcare Systems Research Articles

Policy Versus Practice: Facilitators and Barriers of Chronic Care Integration in Dutch General Practice – a Survey Study

Introduction: Multimorbidity challenges quality and sustainability of healthcare systems. Care groups were introduced in the Netherlands to promote integration of chronic primary care, but it remains unknown to which degree they facilitate this. This study therefore aims to determine whether Dutch general practices perceive themselves to be capable of delivering integrated chronic care and uncover the role of care groups. Methods: We performed a survey study amongst 39 care groups and 65 healthcare providers within general practices (GPs and nurse practitioners). Results: 43% of healthcare providers within general practices are (very) dissatisfied with capabilities for chronic care to patients and 56% do not feel capable of delivering integrated care. Care groups and providers show alignment in their perception of some of the most important facilitators and barriers such as motivation and lack of time, but other factors are valued differently at both levels. Discussion: Our findings show inability of general practices to deliver integrated chronic care despite a health system that is inherently supportive of care integration and point to a mismatch between barriers and facilitators amongst practices and care groups, resulting in providers partly relying on their motivation in accommodating integrated chronic care. Conclusion: General practices are not sufficiently supported by care groups and national policies in delivering integrated chronic care. The identified mismatch between policy and practice warrants redesign of support from care groups to align policies with identified barriers and facilitators at the provider level.

Voluntary Blood Donation in Modern Healthcare: Trends, Challenges, and Opportunities

Voluntary blood donation plays a crucial role in public health by ensuring a stable supply of blood and its components, essential for medical treatments including surgeries, trauma care, and chronic disease management. Voluntary donors, often healthier individuals, enhance the safety of the blood supply and play a vital role in emergency preparedness. Beyond its societal benefits, regular blood donation may offer health advantages for donors, including improved cardiovascular health due to reduced iron levels and psychological benefits stemming from altruism and a sense of social responsibility. Public health initiatives are instrumental in fostering blood donation through education, awareness campaigns, and targeted donor recruitment strategies. These efforts encourage a culture of social responsibility, inspiring community participation and improving overall healthcare system sustainability. Despite these efforts, challenges such as fluctuating donation rates, aging populations, and shifting demographics underscore the need for ongoing initiatives to ensure a sufficient blood supply. As a public health priority, voluntary blood donation demands continuous promotion and innovation to meet the growing demand for blood products and maintain healthcare system resilience. This review highlights the public health significance of voluntary blood donation, with particular focus on its benefits for donors and its role in supporting healthcare systems.

The Impact of Monetary Policy on Healthcare Affordability: A Case Study of China's Urban and Rural Basic Medical Insurance

Longer life expectancy and improved health are key indicators of economic growth. As such, strategies to bolster the medical security system are priorities in government budgeting. The government is dedicating all available resources to better healthcare in rural and underdeveloped areas, narrowing the urban-rural healthcare gap, and achieving equitable healthcare resource distribution. This study examines the effect of monetary policy on healthcare affordability, focusing on China's Urban and Rural Basic Medical Insurance (URRBMI). It investigates how macroeconomic policies, such as interest rates and inflation control, affect healthcare costs and shape URRBMI's financial protection. Using an integrated methodology, including a literature review, theoretical framework, and econometric analysis, the research uncovers how monetary policy impacts healthcare costs and URRBMI's effectiveness. The findings highlight the importance of monetary policy in healthcare affordability. The study recommends collaboration between monetary authorities and healthcare policymakers to improve China's healthcare system's sustainability and effectiveness. Furthermore, these insights are crucial for refining URRBMI and provide new understandings of optimizing macroeconomic policy interactions with social welfare programs.

ASPECTOS EMOCIONAIS E DESAFIOS NA PRÁTICA DOS PROFISSIONAIS DE SAÚDE

Introduction: The emotional challenges faced by healthcare professionals are frequent and significantly impact the quality of care provided and individual well-being. This study addresses factors such as workload, constant exposure to suffering, and the stigmatization of emotional care, highlighting the effects exacerbated by the COVID-19 pandemic. Material and Methods: A literature review was conducted based on PRISMA guidelines, covering articles published between 2016 and 2024. The consulted databases included PubMed, Scopus, Web of Science, and Google Scholar. Articles analyzing emotional aspects and coping strategies related to healthcare professionals were included, while studies outside the scope or duplicates were excluded. Results and Discussion: The review highlighted the prevalence of burnout, anxiety, and other stress-related disorders among healthcare professionals. Psychological support strategies, resilience training, and practices such as mindfulness proved effective in reducing emotional impacts. However, barriers such as stigma and the lack of adequate institutional policies limit the implementation of preventive and corrective interventions. Conclusions: Promoting the emotional well-being of healthcare professionals is an ethical and strategic priority. Public policies and integrated institutional actions, combined with the use of psychological monitoring technologies, can mitigate the identified challenges, strengthening the sustainability of healthcare systems and the quality of care provided.

Building resilience in nursing through strategic policy interventions.

In the context of a global nursing shortage, this paper explores the concept of resilience within the nursing profession, highlighting its implications for practice and policy on an international level. Although resilience is a vital concept for coping with stressors, we argue that placing the burden of resilience on individual nurses may obscure systemic issues that contribute to burnout and attrition. Resilience in nursing is a multifaceted concept that should be examined critically. Relying heavily on individual resilience may inadvertently perpetuate systemic issues and risk internalization of blame by nurses. Upon critical analysis of recent global statistics, this paper advocates for a shift toward collective resilience strategies, specifically, nurse participation in policy-making. This approach not only addresses immediate workforce challenges but also reinforces the essential role of the nursing profession in shaping health and social policies, ensuring sustainable healthcare systems worldwide.

Evolution of institutional long-term care costs based on health factors

As many developed countries face the challenges of an aging population, the need to efficiently plan and finance long-term care (LTC) becomes increasingly important. Understanding the dynamics of care requirements and their associated costs is essential for sustainable healthcare systems. In this study, we employ a multi-state Markov model to analyze the transitions between care states of elderly individuals within institutional LTC in the canton of Geneva, Switzerland. Utilizing a comprehensive dataset of 21494 elderly residents, we grouped care levels into four broader categories reflecting the range from quasi-autonomy to severe dependency. Our model considers fixed covariates at admission, such as demographic details, medical diagnoses, and levels of dependence, to forecast transitions and associated costs. The main results illustrate significant variations in care trajectories and LTC costs across different health profiles, notably influenced by gender and initial care state. Females generally require longer periods with less intensive care, while conditions like severe and nervous diseases show quicker progression to more intensive care and higher initial costs. These transitions and expected length of stay in each state directly impact LTC costs, highlighting the necessity of advanced strategies to manage the financial burden. Our findings offer insights that can be utilized to optimize LTC services in response to the specific needs of institutionalized elderly people. These findings can be applied to enhance healthcare planning, the preparedness of infrastructure, and the design of insurance products.

PROBLEMS OF THE ORGANIZATION OF THE STATE POLICY OF THE PROVISION OF MEDICAL SERVICES BY THE PRIMARY LINK OF MEDICAL AID IN UKRAINE

The article highlights key issues related to management at the level of primary health care in Ukraine. The focus is on aspects such as the growing role of primary care. Primary care is the foundation of the health care system, providing a patient's first contact with health services, prevention, diagnosis and treatment. It is especially important in the conditions of limited financial resources to continue the reforms of the medical industry in Ukraine. The article raises the issue of the availability of medical care: the relevance of management problems is due to uneven access to medical services in rural areas and remote regions. Improving the management of the medical field is necessary to overcome these difficulties. The article examines current problems in the field of primary medical care and ways to overcome them through the reform of state policy in the field of health care. The authors explore key challenges facing primary care, including insufficient funding, lack of qualified staff, uneven distribution of resources, and lack of effective governance mechanisms at various levels. Attention is paid to the issues of ensuring the availability of medical services, the quality of medical care and the implementation of new models of the organization of medical institutions. The article analyzes the reformative steps aimed at improving the functioning of the primary health care system, in particular, the introduction of family medicine and increasing the role of general practitioners. The role of state funding and the involvement of local communities in the management of medical institutions is considered separately. The conclusions emphasize the importance of improving the state's primary health care policy by strengthening financial support, infrastructure development, and improving the qualifications of medical workers to ensure a sustainable and effective health care system in Ukraine. The topic of economic challenges and management efficiency is interesting for analysis. Optimizing the use of financial resources requires their effective use, finding ways to increase the economic sustainability of healthcare institutions.

Low-value practices in primary care: a cross-sectional study comparing data between males and females in Spain

IntroductionOveruse of medical services is a challenge worldwide, posing a threat to the quality of care, patient safety and the sustainability of healthcare systems. Some data suggest that females receive...

Environmental Sustainability in Dermatological Surgery. Part 2: Reducing Activity and Future Ecological Strategies.

This two-part review addresses the pressing need for environmental sustainability in dermatological surgery, driven by the NHS's commitment to net-zero emissions. Part 2 of this review extends the discussion of sustainability in dermatological surgery by focusing on system-wide changes in service delivery and identifying future opportunities for reducing environmental impact. Building on the strategies outlined in Part 1, which explored low-carbon alternatives and operational resource optimisation, Part 2 advocates for a comprehensive shift in the skin surgery service. Key strategies include reducing overall surgical activity, advancing research and innovation, and enhancing management practices to align with sustainability goals. Reducing surgical activity mainly involves the prevention of skin cancers, in addition to optimising current patient pathways and empowering patients to take ownership of their follow-up. Outside of immediate clinical decision-making at the individual level, the review highlights the importance of managerial policy, procurement practices and supply chain factors in driving broader national and international sustainability efforts. Advancing the sustainability agenda will also require targeted research and innovation, particularly in digital health solutions using evidence-based practices. By integrating these strategies, this review aims to provide a framework for reducing the environmental footprint of dermatological surgery and advancing towards a more sustainable healthcare system.

Review of Manpower Management in Healthcare System: Strategies, Challenges, and Innovations.

Hospital manpower management (HRM) is vital for effective healthcare delivery. Unique challenges, such as managing diverse staff, ensuring clear communication, and optimizing resources, complicate HRM. Rising operational costs, workforce shortages, and employee burnout necessitate strategic approaches to manpower management. This review aims to provide a comprehensive understanding of manpower management in hospitals, focusing on identifying core components and discussing innovative strategies to address current challenges, particularly those related to workforce shortages. A literature review was conducted using databases such as PubMed, Scopus, and Google Scholar. Key terms included "hospital manpower management", "HRM challenges in healthcare", and "workforce shortages", selected for their relevance to the core focus of this review. Relevant articles published from 2019 to 2023 were selected for analysis. The review identified core components of manpower management: recruitment and staffing, workforce planning, training and development, performance management, and compensation and benefits. Strategies to address workforce shortages included strategic hiring and enhancing employee engagement. The integration of technology and ongoing training emerged as critical for maintaining high-quality patient care. Effective manpower management is essential for the sustainability of healthcare systems. This review highlighted the importance of innovative HRM strategies to tackle workforce shortages and improve employee satisfaction. By focusing on comprehensive HRM practices, healthcare organizations could enhance workforce efficiency and provide better patient care. Future research should explore the long-term impacts of these strategies on healthcare.

THE CLINICAL EFFECTIVENESS OF ADVANCED OR METASTATIC NON-SMALL CELL LUNG CANCER: A SYSTEMATIC REVIEW

Lung cancer presents a significant epidemiological and economic burden worldwide. This deadly type of cancer ranks second in incidence and first in mortality among all cancers. The rapid increase in new and expensive treatment options places a substantial financial strain on public healthcare systems. Given the limited healthcare resources, the economic evaluation of new cancer drugs is crucial for ensuring the sustainability of healthcare systems and improving patients' access to treatments. This study aims to systematically review health state utility values (HSUVs) associated with traditional chemotherapy and targeted therapies in the first-line treatment of advanced or metastatic non-small cell lung cancer (NSCLC). A search was conducted in PubMed, EMBASE, and BioMed databases to identify publications reporting HSUVs, and 10 studies were selected from 1319 based on predefined criteria. The study found that HSUVs for targeted therapies were consistently higher across all health states compared to traditional chemotherapy. The included publications provide a comprehensive framework of HSUVs applicable to this disease and highlight the need for more empirical research to obtain a broader range of HSUVs for NSCLC.

Biosimilars: What pharmacists should know and a survey

Biosimilars are biologic products that are highly similar to existing reference biologics and provide cost-effective treatment alternatives. As more biologic patents expire, biosimilars are becoming increasingly important in healthcare, requiring healthcare professionals to have a solid understanding of their development, regulatory pathways, and clinical implications. Despite their potential benefits, biosimilars face barriers such as limited awareness, concerns about safety and efficacy, and complex regulatory processes. This study aimed to evaluate the effectiveness of an educational program designed to address these challenges and enhance healthcare professionals’ knowledge and confidence in biosimilar use. Methods: The Howard University College of Pharmacy, in collaboration with the FDA, Academy of Managed Care Pharmacy (AMCP), and Biologics & Biosimilars Collective Intelligence Consortium (BBCIC), conducted a symposium on biosimilars. The program, funded by an unrestricted educational grant from Pfizer, included two primary sessions featuring expert presentations and workshops. Feedback was collected from 114 participants using post-program surveys to assess learning outcomes, program relevance, and its impact on practice. Participants included pharmacists (44.74%), students (44.74%), and other healthcare professionals (10.52%) from various states, with a strong representation from Maryland and Washington, D.C. Results: The program received highly positive feedback, with 86.96% rating the applicability of the program to their practice as "Excellent" and 13.04% as "Good." In terms of knowledge enhancement, 89.13% rated the program as "Excellent," and 10.87% as "Good." Overall, 84.78% rated the program as "Excellent" and 13.04% as "Good," with only 2.17% being "Neutral." No participants rated the program negatively. The program was effective in meeting specific educational objectives, with 89-93% of respondents marking “Strongly Agree” for understanding key biosimilar concepts, such as recognizing their role in practice and understanding development pathways. The objective on using biosimilars in practice received slightly lower ratings, with 73.91% “Strongly Agree” and 19.57% “Agree.” Conclusion: The study demonstrates the effectiveness of structured educational programs in enhancing healthcare professionals’ understanding and confidence in the use of biosimilars. The overwhelmingly positive reception underscores the need for continued education, particularly as more biosimilars enter the market. Future programs should focus on addressing remaining barriers, such as provider hesitancy and practical implementation strategies, to ensure that healthcare professionals are well-prepared to integrate biosimilars into clinical practice. This will ultimately contribute to better patient outcomes, increased adoption of cost-effective therapies, and a more sustainable healthcare system

The Role of Health Services Management in Building Sustainable Healthcare Systems: A Systematic Review

The Role of Health Services Management in Building Sustainable Healthcare Systems: A Systematic Review

3.M. Skills building seminar: Culture, Arts and Mental Health

Abstract Improving mental health is a challenge, not only for the health sector, so research into innovative ways to improve mental health in the community is necessary. The WHO Regional Office for Europe together with its expert group on the cultural contexts of health and well-being promote a culturally grounded approach to enrich policies related to health and well-being. The cultural contexts of health and well-being argues that incorporating cultural issues into policy-making is critical to the development of adaptive, equitable and sustainable health care systems, and to making general improvements in many areas of population health and well-being. Population health and well-being are influenced by actions external to health care systems, also. By health-in-all-policies approach it is given an understanding of how policies in non-health domains can foster or constrain a culture and art for health. Social prescribing and art-for -health activities are important tool for improvenment mental health. This skils building seminar will discuss some good practice and examples, and also cooperation with experts from cultural sector in the mental health field. Key messages • The innovative concept of cooperation between Culture and Health institutions brought positive experiences and impressions to all participants who used ‘culture on prescription’. • The integration of arts into healthcare and community settings offers a holistic approach to promoting health and fostering well-being.

The HEROES (HEalth woRkfOrcE to meet health challengeS) Joint Action

Abstract Background The HEROES (HEalth woRkfOrcE to meet health challengeS) Joint Action aims to advance health workforce planning across the EU, addressing the pressing need for a resilient, sustainable, and accessible health service systems. Given the evident strain on health systems demonstrated during the COVID-19 pandemic, this initiative seeks to address the critical need for strategic HWF planning. Building on previous projects, HEROES will foster the capacity of EU states in workforce planning, preparing the health systems to meet future challenges. Methods The study adopts a collaborative framework involving 19 EU countries, segmented into clusters based on health system characteristics. A stepwise approach (‘AS IS,’ ‘TO BE,’ ‘TO DO’) characterizes the methodology, incorporating extensive data collection, stakeholder engagement, and scenario forecasting. Country-level information on HWF Data and Planning will be compared both across countries in clusters and across clusters. Results Initial findings indicate significant disparities in health workforce data quality, availability, and planning methodologies among the states. Identified methodologies also involve real-world data applications and predictive analytics to refine health workforce planning. Efforts are underway to define an Advanced Minimum Dataset (AMDS) to synchronize health workforce data and define planning tools across the clusters, as country-level AS IS reports have been finalized and cross-country comparisons are ongoing. Conclusions Collaborative, data-driven health workforce planning can significantly enhance health system resilience and responsiveness. Recommended public health actions include enhancing HWF data integration, forecasting capabilities, and stakeholder participation, with the aim of shaping national health policies and practices. The public health impact is profound, as it allows to improve health service delivery and workforce adaptability in response to dynamic health demands. Key messages • The HEROES Joint Action advances EU health workforce planning, with the aim of enhancing the resilience and responsiveness of health systems. • Strategic data-driven approaches in health workforce planning are pivotal for resilient, accessible and sustainable healthcare systems.

7.G. Round table: Primary prevention and management of NCDs – the added value of joint actions across Europe

Abstract Two ambitious European joint action projects, funded through the EU4Health programme, are ongoing to reduce the burden of non-communicable diseases (NCDs) and related risk factors in Europe, targeting both individual and societal levels. Together, these projects aim to scale up effective prevention and management strategies, strengthen public health policies and promote equitable and sustainable healthcare systems across Europe. The Joint Action on CARdiovascular Diseases and DIabetes (JACARDI), with 21 participating countries and a total budget of over €66 million, is focusing on enhancing the implementation of evidence-based innovative pilot projects across the entire patient journey. This includes efforts to improve prevention, early diagnosis, and proactive management of NCDs. The Joint Action Prevent Non-Communicable Diseases (JA PreventNCD), with 25 participating countries and a total budget of over €95 million, particularly aims to enhance joint capacities of countries for implementing, scaling up and evaluating prevention policies and actions at various levels. These projects represent complementary responses to calls for action in Europe’s Beating Cancer Plan and the Healthier Together - EU NCD Initiative, with JA PreventNCD emphasizing primary prevention and policy while JACARDI focuses on secondary prevention and health systems strengthening. Both projects will generate new policy-relevant evidence based on implementation, monitoring and scaling-up of best and innovative practices and policies across Europe. The projects share a focus on equity, diversity, scalability and sustainability, while avoiding fragmentation and duplication of actions. Under the EU4Health programme, launched to strengthen European health collaboration in the wake of the COVID-19 pandemic, the EU has recently invested over €200 million in public health initiatives, with additional investments from national authorities participating in the joint actions. With this new wave of funding, real population impact should be anticipated, but what can we realistically expect to be the outcomes and what are the criteria for success? In this round table discussion 1) these two joint action projects will be presented, highlighting their innovative aspects; 2) views on the added value and potential in cross-national collaborations for prevention and management of NCDs will be debated, and 3) how synergies will be leveraged for maximum impact will be explored. Panelists will share their perspectives on the projects’ potential to change the public health landscape in Europe. Workshop participants will subsequently be encouraged to engage in the discussion with the objective that views and experiences are exchanged, opportunities for collaboration and engagement are shared and energy is mobilized to harness the benefits of such large-scale policy-relevant collaborations. Key messages • Synergies and collaboration to drive policy development and foster increased capacity are the pillars to build a healthier Europe. • Two large-scale Joint Actions drive impact by highlighting innovative NCD prevention strategies and fostering collaborative engagement.

The economic and social burden of congenital thrombotic thrombocytopenic purpura (cTTP) in Italy

Background: Congenital thrombotic thrombocytopenic purpura (cTTP) is a rare genetic disorder characterized by an abnormal clotting process leading to serious health complications such as thrombocytopenia and hemolytic anemia. Despite its clinical significance, the estimated broader economic and social impacts in Italy on patients and society remain underexplored. Methods: A detailed questionnaire, developed and validated by a panel of cTTP experts, was distributed to healthcare professionals and patient associations to gather comprehensive data on the economic and social burden of cTTP in Italy. The study was focused on direct and indirect costs associated with the disease management of 15 patients with cTTP, as well as out-of-pocket expenses incurred by patients. Results: The analysis revealed that of the 15 patients diagnosed with cTTP in Italy, 60% were adults aged 40-55 years. Productivity loss and diminished quality of life dominated the economic burden of cTTP, accounting for 81.05% of total costs. Direct medical costs, while substantial, represented a smaller portion of the overall financial impact. Additionally, out-of-pocket expenses, though constituting the smallest fraction, underscored the financial contributions made by patients towards their own care management. Conclusion: The findings underscore the need for a multidisciplinary and holistic approach to cTTP management that extends beyond the clinical treatment. Addressing the economic and social implications of the disease is crucial for improving patient well-being and ensuring the sustainability of healthcare systems. The study advocates for increased awareness, research, and access to care for cTTP patients, highlighting the importance of comprehensive support networks to mitigate the disease’s broader societal impacts, estimated to be around 2 million euro for 15 patients in 10 years.

What matters most to healthy older adults in treatment decision making: a discrete choice experiment

Abstract Introduction Shifting to a patient centered approach is crucial for a sustainable healthcare system. Understanding individuals’ priorities is essential for personalized care, especially in critical illness. Treatment decisions are often aimed at disease-specific outcomes such as life extension or survival, while patient-specific outcomes like maintaining independence may be equally vital. How healthy older adults prioritize treatment outcomes in case of a critical illness is currently unknown. Enhanced insight into their priorities can refine healthcare policy, for more personalized care. This study investigated outcomes (attributes) prioritized in hypothetical decision-making by healthy adults over 50 yr. Methods We conducted a Discrete Choice Experiment with individuals aged ≥50, comparing six pairs of hypothetical treatments with five attributes: life expectancy, independence, pain, memory complaints and societal costs. Attribute utility was analyzed using a conditional logit model, and latent class analyses were employed to explore preferences in groups. Results In 333 participants (mean age 70 +/- 7.7) all attributes emerged as impactful with independence being strongest (p < 0.05). Increased life expectancy had positive utility, but only for a two-year increase. Negative utility was found for all other attributes except mild pain and memory complaints. Latent class analyses identified two groups (22.4% and 77.6%). Group one valued life expectancy more (p .019 vs .940), whereas the second group valued independence (p .058 vs.<.001 and societal costs (p.053 vs. <.001) more. Conclusions In a hypothetical case of life-threatening disease, for people aged ≥ 50 life expectancy was not the sole relevant outcome for treatment decisions; pain, independence and societal costs are important and should be discussed in clinical decision making or healthcare policy. Key messages • Older adults find patient-specific outcomes relevant for decision making. • Societal costs are found relevant for decision making for treatment by older adults.

Exploring the Relationship Between Health Literacy and Alcohol Consumption Patterns in Tuscany

Abstract Introduction Alcohol consumption is a prevalent aspect of social and cultural life worldwide. However, high and binge consumption has become a significant public health concern. Inadequate health literacy (HL) may contribute to poor awareness and/or knowledge regarding the risks of alcohol-related behaviors. However, to date, only a few studies have examined the relationship between HL and different types of alcohol consumption. This study aimed to investigate the relationship between HL, other sociodemographic determinants, and their influence on high and binge consumption among the general population aged 18-69 in Tuscany. Methods The study analyzed data from 2017 to 2022 from a Tuscan population subsample in the Italian Behavioral Risk Factor Surveillance System PASSI. HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Results Among the 12,953 interviewees, binge drinking was reported by 8.3%, while high consumption by 3.6% of the entire sample. In the multivariate logistic regression, participants aged between 50 and 69 years with problematic or inadequate HL levels had an increased adjusted odds ratio for high alcohol consumption. Instead, females, individuals older than 34 years, and those of foreign nationality had a reduced odds ratio for binge drinking. Low HL was a predictor of high alcohol consumption but not of binge drinking. Discussion As expected, young males are more likely to engage in binge drinking, while older individuals are more likely to have high consumption. In a challenging period for healthcare system sustainability, it is mandatory to use economic resources efficiently and target the right population with tailored interventions: given that HL impacts on high consumption, research and policy should focus HL interventions specifically on high alcohol consumers. Conversely, educational campaigns aimed at increasing HL in binge drinkers risk to have a lesser impact. Key messages • Health literacy does not influence binge drinking. • Inadequate levels of health literacy predict high alcohol consumption.

Free surgery for CHD through philanthropy—a sustainable model?

AbstractAmong the multiple challenges faced by children from low- and middle-income countries (LMICs) with congenital heart disease (CHD), the economics of care remains foremost, contributing significantly to morbidity and mortality. This paper evaluates the four existing finance models available for healthcare systems and proposes a new model—the GIVE model (government, institutions and individuals, values, and engagements)—as the fifth model for global sustainable healthcare systems. The paper presents an evaluation of a chain of three paediatric cardiac hospitals in India to assess the sustainability of their philanthropy-based operational model, through which surgeries are offered completely free of cost to children with CHD. The three Sri Sathya Sai Sanjeevani Centres for Child Heart Care in India have been proponents of this philanthropic model for over a decade. From February 2013 to January 2024, 19,684 patients with CHD received surgeries at no cost. The average cost of surgery was reported to be USD (United States Dollar) 1800. A case study of one of the Sanjeevani Centres showed that 23.8% of patients were in STAT Category 3 and above, as defined by the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery, with an in-hospital mortality rate of 2.08%. The evaluation highlighted the institution’s numerous strategies to enable sustainability in key aspects of operations, economics, and social impact. Despite challenges, the Sai Sanjeevani philanthropic model, which encompasses both economic and social impact, is dependable and can be replicated. The proposed GIVE model is recommended for adoption by LMICs as a global way forward to enable free CHD surgeries through sustained philanthropy, strengthened by a shared vision and collaborations.