Universal Coverage Research Articles

Health Care Expenditure of Patients With Type 2 Diabetes Mellitus in Bangladesh: A Review

The main objectives of this review are to offer an in-depth examination of the analysis of health care expenditure of patients with type 2 diabetes mellitus in covering its epidemiology, causes, clinical manifestations, diagnostic techniques, treatment approaches, and prognosis in Bangladesh. Most of the information and data are mainly involved in a critical review of various studies from sample groups of different ethnicities, age groups and genders. This study employs a systematic review and meta-analysis approach to compile and analyze existing research on health care expenditure of patients with type 2 diabetes mellitus. The study follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to ensure comprehensive and transparent reporting of the review process. Results on the basis of various reports showed that the length of diabetes and the number of co-morbidities and complications raise the cost of healthcare. The data confirms the previously reported conclusion that patients treated with insulin monotherapy or an insulin and oral hypoglycemic agents (OHAs) combination had higher direct costs and overall costs than patients treated with OHAs alone. Overall, it was discovered that the main contributing factors to the cost of therapy were the length of diabetes, the quantity of co-morbidities and complications, and the type of treatment. The prevalence of type 2 diabetes is increasing in Bangladesh, where out-of-pocket medical expenses are higher and universal health insurance is not available to the general public. Planning cost-effective diabetes management and prevention measures is necessary. A suitable insurance plan should be created with special services for diabetic patients. To reduce the negative effects of the condition, early detection of diabetes is essential as reported by several studies compiled herein. This can be accomplished through raising awareness and eradicating the social stigma, especially for women in Bangladesh. J. Bio-Sci. 32(2): 93-106, 2024

Escaping the Energy Poverty Trap: Policy Assessment

AbstractClimate change and the ongoing energy transition can increase energy poverty rates. To date, the main tool employed to alleviate energy poverty has involved income transfers to vulnerable households. However, measures that seek to improve a home’s energy efficiency have recently gained increasing relevance. In this study we assess the effectiveness of these two types of policy, assuming universal coverage and optimal behaviour. Results points that income transfers and energy efficiency measures have the potential to decrease the proportion of households in energy poverty; however, the magnitude of their respective effects differs greatly. The average impact of energy efficiency measures provides for a greater reduction in energy poverty rates than income transfer policies. Although the greatest reduction in energy poverty is obtained by combining both measures, this combination of tools leads to overlapping effects with income transfers making only a marginal contribution once total retrofit have been implemented.

Inequality in Public Provision of Healthcare: Do Fiscal Transfers Matter?

ABSTRACTIn this paper, we investigate the inequality in the public provision of healthcare in India and assess whether states are converging over time. We locate the equalization of public provision within the framework of fiscal federalism. Departing from previous work, we gauge disparity in public provision by scrutinizing the provision in terms of primary and community health centers. The and convergence analysis indicate no substantial reduction in inter‐state disparities, raising concerns regarding the attainment of universal healthcare access. In addition, the club convergence analysis identifies states converging into multiple clubs in the public provision of health centers, indicating the persistence of inter‐state disparity. The panel regression estimates indicate the prominence of own revenue over fiscal transfers in determining the public provision of healthcare. The findings underscore the necessity of reforms in fiscal devolution, with a particular emphasis on tax devolution and revamping sector‐specific grants to achieve national targets. The present paper contributes to a long‐standing debate on unconditional versus conditional transfers for public provision.

Medicine and the Law.

On 15 May 2024, the National Health Insurance Act No. 20 of 2023 (the Act) was signed into law, and South Africa (SA) officially adopted a national health insurance (NHI) system as part of its efforts to achieve universal healthcare across the country. While NHI has been controversial and much talked about, plenty of how the scheme will operate remains an unknown, and has not been defined within the Act. However, it is evident that, with SA's limited healthcare budget, the NHI scheme is not going to cover everything for everyone. Some decisions will need to be made about what kinds of healthcare and other benefits South Africans can expect to have covered by the scheme - in other words, decisions about what will be included under NHI and what will be excluded. This paper does not aim to discuss the constitutionality or legality of the NHI Act, but focuses only on the issue of how government ought to consider making decisions about what services the NHI covers.

The Relationship Between Diet Quality and 21-Year Cumulative Health Care Costs Among Australian Women: A Longitudinal Cohort Study

BackgroundThe relationships between diet quality and health care costs have not been explored beyond 15 years. ObjectiveTo investigate relationships between both baseline diet quality and change in diet quality over time with cumulative data on health care claims and costs over 21 years among Australian women. DesignThis is a secondary analysis of data from a cohort study, the Australian Longitudinal Study on Women’s Health. Participants/SettingData for women born between 1946 and 1951 included diet quality data at baseline (2001, n = 8228), change in diet quality (2001–2013, n = 6553), and cumulative administrative health care data (2001–2021). Main OutcomesDiet quality was assessed using the Australian Recommended Food Score (ARFS) and the Fruit and Vegetable Variety Score. Twenty-one–year cumulative Medicare Benefits Schedule data (number of claims; total charges [$USD]), Australia’s universal health care coverage, were reported by baseline ARFS quintile and category of diet quality change (“diet quality worsened” [ARFS decrease ≤ –4 points], “remained stable” [–3 ≤ change in ARFS ≤ 3 points] or “improved” [ARFS increase ≥ 4 points]). Statistical AnalysisLinear regression analyses were conducted and adjusted for socioeconomic, health, and lifestyle factors. ResultsHigher baseline vegetable ARFS were correlated with fewer 21-year cumulative Medicare claims (β = –4.9, 95% CI, –7.3, –2.4) and charges (β = –$214; 95% CI, –$341; –$88). Baseline higher dairy scores were correlated with higher Medicare claims (β = 17.2; 95% CI, 11.1, 23.3) and charges (β = $762; 95% CI, $448, $1076). Compared with women whose diet quality score remained stable, those whose diet quality worsened over time made significantly more claims and higher charges; median (Q1, Q3) 413 (277, 588) claims, $17 868 ($11 037, $27 808) cumulative charges, compared with 387 (259, 559) claims, and $16 953 ($10 033, $26 604) cumulative charges. Change in total ARFS and ARFS subscales were predictors of 21-year cumulative health care claims. For each 1-point increase in ARFS over time, 1.2 fewer health care claims were made (95% CI, 0.3–2.2). Increasing vegetable and dairy ARFS scores were correlated with significantly fewer claims. ConclusionsBaseline greater variety of vegetables was correlated with fewer 21-year health care claims and costs. Worsening diet quality over time was correlated with greater cumulative health care claims and costs. Consideration of dietary quality and variety in national policy is suggested to potentially reduce national health care claims and costs.

Gender and Advertising: Europe, Latin America, and North America

Abstract: This article captures the perspectives of three advertising experts who spoke at Michigan State University on gender and advertising for an international advertising course. Christina Noble Knight, executive creative director of UKnight in Sweden, discussed Sweden's advancements in gender equality, highlighting how advertising both reflects and shapes societal norms. She pointed out that while Sweden leads many countries in progressive policies like universal healthcare and parental leave, challenges such as gender pay gaps and limited numbers of women in leadership persist in advertising agencies, especially regarding race, ethnicity, and disability. Dr. Marta Mensa, from the University of North Texas, examined gender disparities in Latin American advertising, focusing on systemic barriers that women face in creative roles in Brazil, Mexico, Chile, and Peru. Her research revealed low female representation and pervasive discrimination. Dr. Jean Grow, professor emerita at Marquette University, critiqued the state of American advertising, especially after the #MeToo movement. Grow emphasized the industry's slow progress in addressing gender inequality and holding company's lack of accountability. Across the talks, the speakers stressed the importance of structural changes, the need for diversity, equity, and inclusion (DEI) in advertising, and the role that advertising can play in empowering underrepresented groups and promoting societal change.

The interweaving of threads in the fabric of care.

There are different motivations that induce a human being to take care of another, and it is from their intertwining, integrated into an organic fabric, that care in its entirety takes shape. The cure that is nourished by pietas, which refers us above all to the relationships that develop within the family, can be preached, but it is not possible to force the reluctant to practice it; and when it fails or takes on complex aspects, other methods of care appear on the social scene, in particular that which is inspired by a philanthropic ideal. Even in this context we cannot talk about rights and legal obligations, and it is in this context that we place volunteering, an indispensable completion of the care that has its roots in pietas. But when the limits of volunteering are outlined (difficulty in planning and precariousness) we see the emergence of care provided by professional caregivers. Those who carry out care professionally have received adequate training and undertake to keep it updated, and are also bound by a set of rules, which have the value of ethical commitments. The most important of these is not to make care depend on the human quality of those who receive it: everyone has the right to be cared on the basis of need, not merit, at least in societies that have adopted the model of universal healthcare. Care is the bond that holds together the society that has made solidarity its founding value.

Inequalities and Trends in Under-Five Mortality Between Formal and Informal Areas in Ouagadougou, Burkina Faso.

The physical expansion of the city of Ouagadougou, the capital and largest city of Burkina Faso, subsided in 2015 after the government banned land speculation that contributed to the growth and entrenchment of informal areas. The government subsequently implemented social policies such as free health care for pregnant women and children under 5years of age. Against this background, we tested the convergence of under-5 mortality trends between formal and informal areas in the city between 2010 and 2019; data covering that period came from the Ouagadougou Health and Demographic Surveillance System (HDSS). The analyses included the calculation of all-cause and cause-specific mortality rates, the implementation of a Poisson regression model, and competing risk models. Over the study period, children in formal areas had lower mortality than those in informal areas. However, the inequality gap decreased over time due to a faster mortality decline in informal areas. This decline was explained by a rapid decline in deaths from malaria and other causes including sepsis, HIV/AIDS, measles, meningitis, and encephalitis. The pursuit of upgrading informal areas and the implementation of social policies targeting the poorest are likely to accelerate the mortality decline in Ouagadougou overall.

Immunization Status of Children in Urban Slums of Rawalpindi and Barriers to Immunization

Objective: To determine immunization status of children residing in urban slums of Rawalpindi and identify the barriers to immunization. Study Design: Cross sectional study. Place and Duration of Study: Slums of Takht Pari, Rawalpindi Pakistan, from Jan to Mar 2020. Methodology: Children, aged 12-23 months, residing at Takht Pari were enrolled. Two sessions of a free medical camp were arranged at Takht Pari by Department of Community Medicine, Foundation University, Islamabad. Data was collected from parents visiting the medical camp with the mother labelled as the primary respondent. Immunization cards and mother’s recall were used to assess the immunization status of children. Results: Two hundred ninety-one (72.9%) children were completely immunized, partially immunized were 106(26.6%) while 2(0.5%) were unimmunized. Three hundred eighty-eight (97.2%) children were vaccinated through government centers while those who received vaccination through private clinics were 9(2.3%). Factors associated with incomplete immunization were education of parents (p<0.001), number of children (p<0.001), gender of child (p=0.001), access to TV or Radio (p<0.001), and site of immunization (government/private) (p<0.001). Conclusion: Immunization status of 73% shows that unremitting efforts are essential for attaining universal coverage of immunization with extra attention to underprivileged areas. Planning and placement of public facilities for preventive services needs to be an urgent priority improving service utilization and enhancing coverage as people tend to follow ease of accessibility for using immunization services.

Social Welfare as “Legitimation”: National Health Insurance Service (NHIS) and the Politics of Health Reform in South Korea, from 1977 to the Time of COVID-19

With the perceived “success” of its K-COVID approach, relying heavily on the use of contact tracing, South Korea has received extensive praise since 2020. In part, this perception also extends to health coverage (NHIS), for which the nation has provided universal coverage since the late 1980s. This article re-examines the politics of Korean health care, looking at the circumstances under which the coverage was first adopted. At the time, it was enormously controversial, and there was a great deal of debate about how the government might pay for the system. Its cost-cutting measures continue to influence care (e.g. multiple beds per room) in ways that influence recent disease outbreaks such as MERS (2015) and COVID (2020-present).

Advancing healthcare with artificial intelligence: diagnostic accuracy of machine learning algorithm in diagnosis of diabetic retinopathy in the Brazilian population

BackgroundIn healthcare systems in general, access to diabetic retinopathy (DR) screening is limited. Artificial intelligence has the potential to increase care delivery. Therefore, we trained and evaluated the diagnostic accuracy of a machine learning algorithm for automated detection of DR.MethodsWe included color fundus photographs from individuals from 4 databases (primary and specialized care settings), excluding uninterpretable images. The datasets consist of images from Brazilian patients, which differs from previous work. This modification allows for a more tailored application of the model to Brazilian patients, ensuring that the nuances and characteristics of this specific population are adequately captured. The sample was fractionated in training (70%) and testing (30%) samples. A convolutional neural network was trained for image classification. The reference test was the combined decision from three ophthalmologists. The sensitivity, specificity, and area under the ROC curve of the algorithm for detecting referable DR (moderate non-proliferative DR; severe non-proliferative DR; proliferative DR and/or clinically significant macular edema) were estimated.ResultsA total of 15,816 images (4590 patients) were included. The overall prevalence of any degree of DR was 26.5%. Compared with human evaluators (manual method of diagnosing DR performed by an ophthalmologist), the deep learning algorithm achieved an area under the ROC curve of 0.98 (95% CI 0.97–0.98), with a specificity of 94.6% (95% CI 93.8–95.3) and a sensitivity of 93.5% (95% CI 92.2–94.9) at the point of greatest efficiency to detect referable DR.ConclusionsA large database showed that this deep learning algorithm was accurate in detecting referable DR. This finding aids to universal healthcare systems like Brazil, optimizing screening processes and can serve as a tool for improving DR screening, making it more agile and expanding care access.

Role of Health Insurance Policies in Access to Healthcare Services in Bangladesh

Purpose: To aim of the study was to analyze the role of health insurance policies in access to healthcare services in Bangladesh. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The role of health insurance policies in Bangladesh is crucial in improving access to healthcare services, particularly for low-income populations. Health insurance has been found to reduce the financial barriers to accessing care, leading to increased utilization of essential health services. However, challenges such as limited coverage, awareness, and administrative inefficiencies persist, hindering the full potential of these policies. Expanding and refining health insurance schemes could significantly enhance healthcare accessibility and reduce out-of-pocket expenditures, ultimately contributing to better health outcomes across the country. Unique Contribution to Theory, Practice and Policy: The health belief model (HBM), the theory of planned behavior (TPB) & Andersen’s behavioral model of health services may be used to anchor future studies on the role of health insurance policies in access to healthcare services in Bangladesh. Health insurance providers should develop targeted outreach and education programs to inform underserved populations about available health insurance options and their benefits. Policymakers should consider implementing universal health insurance coverage mandates to ensure that all individuals, regardless of socioeconomic status, have access to healthcare services.

Effectiveness and cost-effectiveness of a community intervention in enhancing access to care and improving clinical outcomes for depression: a protocol for a cluster randomised controlled trial in India

BackgroundAlthough depression is the leading cause of disability worldwide, treatment coverage for the condition is inadequate. Supply-side barriers (e.g. shortage of specialist mental health professionals) and demand-side barriers (e.g. lack of awareness about depression) lead to limited availability of evidence-based interventions, poor demand for care, and low levels of adherence to care. The aim of our study is to examine if the addition of a community intervention delivered by community volunteers enhances the population-level impact of an evidence based psychosocial intervention (Healthy Activity Program [HAP]) in routine primary care by increasing demand for HAP and improving HAP adherence and effectiveness.MethodsA hybrid type 2 effectiveness implementation cluster randomised controlled trial will be implemented in the state of Goa, India. Twenty-eight clusters of villages and their associated public sector health centres will be randomly allocated through restricted randomisation. Clusters will be randomly allocated to the ‘Community Model’ or ‘Facility Model’ arms. All clusters will offer the HAP and clusters in the ‘Community Model’ arm will additionally receive activities delivered by community volunteers (“Sangathis”) to increase awareness about depression and support demand for and adherence to HAP. The primary outcomes are Contact Coverage (Patient Health Questionnaire [PHQ-9] score > 4 as a proportion of those screened) and Effectiveness Coverage (mean PHQ-9 score amongst those who score ≥ 15 at baseline, i.e. those who have moderately severe to severe depression) at 3 months post-recruitment. Additional outcomes at 3 and 6 months will assess sustained effectiveness, remission, response to treatment, depression awareness, social support, treatment completion, and activation levels. Economic and disability outcomes will be assessed to estimate incremental cost-effectiveness ratios. Implementation will be evaluated through process data and qualitative data informed by the RE-AIM framework. A minimum of 79488 primary care attenders will be screened for the Contact Coverage outcome, and 588 individuals with PHQ-9 ≥ 15 will be recruited for the Effectiveness Coverage outcome.DiscussionIf effective, our community intervention will have relevance to India’s Ayushman Bharat universal healthcare programme which is scaling up care for depression in primary care, and also to other low- and middle- income countries.Trial registrationRegistered on ClincalTrials.gov (NCT05890222.) on 12/05/2023.

Enhancing interprofessional collaboration for unattached patients in primary care.

This project explored an interprofessional collaboration initiative at Clinique Indigo which aimed to improve comprehensive care for unattached patients in Quebec's primary care system. Throughout the project, physicians and non-physician health professionals alike became more actively engaged in the care of patients lacking a regular primary care provider. The project successfully demonstrated that defining a common vision for "well care" within the clinic and integrating diverse professionals could significantly improve quality of care for unattached patients, evidenced by an increase from 13% to 43% in comprehensive care provision. However, the initiative also faced challenges, including professional turnover and gaps in primary care training, suggesting critical areas for future improvement in healthcare policy and practice. These results support expanded interprofessional approaches in primary care to address systemic care disparities in universal healthcare settings such as this one caused by the differential or absence of attachment to a primary care provider.

Global Neurosurgery: A Path Forward Through Health System Strengthening.

The future of global neurosurgery should focus on addressing the unmet neurosurgical need from a health system approach should we hope to achieve sustainable and ethical change. In this article, we review the global building blocks, as defined by the World Health Organization, and use this framework to propose strategies to strengthen neurosurgical care on the global frontier. The targets for Universal Healthcare Coverage by 2030, as outlined by the United Nations Sustainable Development Goals, are reviewed, and the role of neurosurgeons in addressing the global targets is discussed. Surgical indicators according to the Lancet Commission on Global Surgery are also reviewed, and neurosurgical indicators are proposed according to the 6 surgical indicators of the commission. The execution of these global targets and indicators within the context of health system strengthening will be a persistent challenge, given the complexity of health system and its components. The neurosurgical community must continue to support, promote, and diversify collaborations, especially among deserts of neurosurgical care across the world. Innovative technology and education are essential to this global dilemma.

How do free healthcare policies impact utilization of maternal and child health services in fragile settings? Evidence from a controlled interrupted time series analysis in Burkina Faso.

Burkina Faso has implemented a nationwide free healthcare policy (gratuité) for pregnant and lactating women and children under 5 years since April 2016. Studies have shown that free healthcare policies can increase healthcare service use. However, the emerging coronavirus disease 2019 pandemic, escalating insecurity and the political situation in recent years might have affected the implementation of such policies. No studies have looked at whether the gratuité maintained high service use under such changing circumstances. Our study aimed to assess the effects of gratuité on the utilization of facility-based delivery and curative care of children under 5 years in light of this changing context. We employed a controlled interrupted time series analysis using data from the Health Management Information System and annual statistical reports of 2560 primary health facilities from January 2013 to December 2021. We focused on facility-based deliveries and curative care for children under 5 years, with antenatal care and curative care for children over 5 years as non-equivalent controls. We employed segmented regression with the generalized least square model, accounting for autocorrelation and monthly seasonality. The monthly utilization rate among children under 5 years compared to those above 5 years (controls) immediately increased by 111.19 visits per 1000 children (95% CI: 91.12, 131.26) due to the gratuité. This immediate effect declined afterwards with a monthly change of 0.93 per 1000 children (95% CI: -1.57, -0.29). We found no significant effects, both immediate and long-term, on the use of maternal care services attributable to the gratuité. Our findings suggest that free healthcare policies can be instrumental in improving healthcare, yet more comprehensive strategies are needed to maintain healthcare utilization. Our findings reflect the overall situation in the country, while localized research is needed to understand the effect of insecurity and the pandemic at the local level and the effects of gratuité across geographies and socioeconomic statuses.

Impact of a financial incentive on early rehabilitation and outcomes in ICU patients: a retrospective database study in Japan

BackgroundEarly mobilisation of intensive care unit (ICU) patients has been recommended in clinical practice guidelines. Therefore, the Japanese universal health insurance system introduced an additional fee for early mobilisation and/or...

Early-Stage Lung Cancer in the Era of Lung Cancer Screening: Veterans Health Administration Outperforms Other Insurance Models

BackgroundLung cancer screening guidelines were introduced in the United States in 2013, with variable implementation. This study evaluated temporal diagnostic trends in non-small cell lung cancer (NSCLC) diagnosis since the introduction of these guidelines. MethodsThis retrospective cohort analysis used data from the Veterans Administration Corporate Data Warehouse and the National Cancer Database. We evaluated temporal trends in the distribution of NSCLC stage at the time of diagnosis along with differences based on insurance coverage type, including uninsured, privately insured, Medicare, Medicaid, and Veterans Affairs (VA) coverage, with adjustment for clinically relevant variables. ResultsAmong 1,450,965 patients diagnosed from 2006 to 2020, the proportion of NSCLC cases diagnosed at stage I increased in all insurance groups by 12.74%, 2%, 0.25%, and 2.57% for the VA, Medicare, private insurance, and Medicaid, respectively. If all insurance systems achieved the unadjusted stage distribution seen in the Veterans Health Administration, an additional 45,684 patients would be diagnosed with stage I NSCLC and 65,933 fewer patients would be diagnosed with stage IV disease. ConclusionsFor patients with any form of insurance, there has been an increase in the proportion of early-stage NSCLC (stage I and II) and a corresponding decrease in the proportion of stage III and IV since the introduction of national lung cancer screening guidelines. As the largest integrated single-payer health care system in the United States, the VA dramatically outperforms other insurance types, perhaps attributable to universal coverage and robust lung cancer screening programs.

Pregnancy Outcomes in Survivors of Adolescent and Young Adult Breast Cancer: A Population-Based Cohort Study

ObjectivesTo evaluate the association between adolescent and young adult (AYA) breast cancer (BC) and the adverse pregnancy outcomes of preterm birth, small for gestational age birth, cesarean delivery, and preeclampsia, and the effect of fertility treatment on this association. MethodsPopulation-based cohort study with universal coverage health data for Ontario, Canada. BC was identified from the Ontario Cancer Registry. All births >220 weeks gestation between April 2006 to March 2018 were included. Modified Poisson regression generated risk ratios between AYA BC and adverse pregnancy outcomes, adjusted for maternal characteristics. Models were stratified by fertility treatment. ResultsAmong 1 189 980 deliveries, 474 mothers had AYA BC history (exposed), while 1 189 506 had no cancer history (unexposed). AYA BC was associated with cesarean delivery (adjusted risk ratio [aRR] 1.26; 95% CI 1.14–1.39). There was no association between AYA BC and other adverse outcomes. Modelling cesarean delivery subtypes, AYA BC was associated with increased risk of planned (aRR 1.27; 95% CI 1.08–1.49) and unplanned cesarean delivery (aRR 1.41; 95% CI 1.20–1.66). An increased risk of cesarean delivery in exposed persisted among singleton pregnancies (aRR 1.27; 95% CI 1.15–1.41), but not in models stratified by mode of conception (fertility treatment: aRR 1.07; 95% CI 0.84–1.36; unassisted conception: aRR 1.30; 95% CI 1.16–1.46). ConclusionsA history of AYA BC did not confer an elevated risk of adverse pregnancy outcomes, except for planned and unplanned cesarean delivery. The risk of adverse pregnancy outcomes does not appear to be an indication for delayed pregnancy after AYA BC diagnosis.

Impact of health policy changes on population health

Recent health policy changes have had a profound impact on population health, reflecting diverse approaches and outcomes across different regions. The affordable care act (ACA) in the United States expanded healthcare coverage, improving access to preventive services and chronic disease management. Despite these advancements, disparities in health outcomes persist, particularly among minority and low-income populations. In Europe, universal healthcare systems like those in Germany and the Netherlands have achieved near-universal coverage and high public satisfaction. However, socioeconomic inequalities continue to influence health outcomes, necessitating policies that address broader social determinants of health. Low- and middle-income countries (LMICs) have implemented universal health coverage (UHC) initiatives, such as Thailand's UHC scheme and Rwanda's community-based health insurance. These reforms have led to significant improvements in maternal and child health, reduced out-of-pocket expenditures, and increased healthcare utilization among the poor. However, disparities between urban and rural populations remain a challenge, underscoring the need for comprehensive strategies that strengthen healthcare systems and infrastructure. Future directions for health policy improvement include addressing health disparities, integrating technology, and promoting preventive care. Community-based interventions and cultural competency training for healthcare providers can reduce disparities and enhance patient satisfaction. The integration of telemedicine, electronic health records, and health information exchanges can improve care coordination and access to services, although equitable access to digital health tools is essential. Emphasizing preventive care through increased funding, incentivizing providers, and raising public awareness can significantly reduce the burden of chronic diseases. Engaging patients in their healthcare decisions and promoting shared decision-making fosters a collaborative and effective healthcare environment. Policymakers must adopt comprehensive and adaptable strategies to address persistent disparities, integrate technology, and promote preventive care, ultimately leading to more equitable and effective health outcomes for diverse populations.