Commercial Health Care Financing: The Cause of U.S., Dutch, and Swiss Health Systems Inefficiency?

Interrelatedness of Family and Parenting Risk Factors for Juvenile Delinquency: A Network Study in U.S. and Dutch Juveniles

Family interventions that address a diversity of family and parenting factors are often used to prevent juvenile delinquency, but are effective to only a limited extent. This study applied a network approach to risk factors for juvenile delinquency and examined the interrelatedness of specifically family and parenting risk factors in a U.S. and separate Dutch sample of juveniles and their family members. Differences in interrelatedness between these samples were examined as well. Secondary analyses were conducted on data collected in the United States with the Washington State Juvenile Court Assessment (WSJCA) and on data collected in the Netherlands with a Dutch-adapted translation of the WSJCA. Network analyses were performed, separately for the U.S. (N = 13,613) and Dutch (N = 3,630) sample, on seven risk factors that were assessed with a three-point Likert scale ranging from each factor's protective side to a corresponding risk side. In the U.S. sample network, "inadequate parental punishment" and "lack of parental supervision" that both refer to an authoritarian parenting style were the most "central" factors and had the strongest associations with the other risk factors. In the Dutch sample network, "the family not providing opportunities" and "inadequate parental reward" were the most "central" factors, which refer to an authoritative parenting style. The family and parenting factors identified as most central in the networks may be promising to address in family interventions, as it can be expected that both the directly addressed problems and their correlated problems will improve. The current results may inform attempts to strengthen family interventions for juvenile delinquency in the United States and the Netherlands.

How regulatory frameworks drive differences in home-care agencies: Results from a national multicenter cross-sectional study in Switzerland

INTRODUCTION

The sustainability and rising costs of the health-care system are of concern. Although health-care reforms impact various areas of care, there is only limited evidence on how regulations affect home-care agencies and health-care delivery.

OBJECTIVES

The primary aim was to explore different financial and regulatory mechanisms and how they drive differences in the organizational structures, processes, and work environment of home-care agencies.

DESIGN AND METHODS

We used data from a national multicenter cross-sectional study of Swiss home care that included a random sample of 88 home-care agencies with a total of 3223 employees. Data was collected in 2021 through agency and personnel questionnaires including geographic characteristics, financial and regulatory mechanisms, service provision, financing, work environment, resources and time allocation, and personnel recruitment. We first conducted a cluster analysis to build agency groups with similar financial and regulatory mechanisms. We then performed Fisher's exact, ANOVA, and Kruskal-Wallis tests to determine group differences in organizational structures, processes, and work environments. Finally, we performed a lasso regression to determine which variables were predictive for the groups.

RESULTS

Four agency groups were built, differing in view of financial and regulatory mechanisms and we found differences in the range and amount of services provided, with regard to employment conditions and cost structures.

DISCUSSION

The most prominent differences were found between agency groups with versus agency groups without a service obligation. Financial incentives must be well aligned with the goal of achieving and maintaining financially sustainable, accessible, and high-quality home care.

Social determinants of the non-use of the explicit health guarantees plan (the GES plan)

INTRODUCTION

The public policy called Explicit health guarantees (GES) could serve as a basis for the future implementation of universal health coverage in Chile. An improvement in the quality of health of the Chilean population has been observed since the launching of the GES, which has a high adherence (84% of the beneficiary population uses this health program). This work seeks the social determinants related to a portion of the remaining 16% of people who do not use the GES.

METHODS

This secondary analysis study used a sample of GES recipients (n = 164,786) from the National Socioeconomic Characterization Survey (CASEN) 2020. The GES recipients included in the study responded that they had been under medical treatment for 20 of the 85 pathologies included in the GES, and they had not had access to such policy due to "trust in physician/facility," "decided not to wait," or "lack of information." The CASEN survey chose the 20 pathologies. The Average Marginal Effects of social determinants of the non-use of the GES health plan were predicted using multivariable and panel multinomial probit regression analyses, where the outcome variable assumed three possible values (the three reasons for not accessing) while taking those variables reported in previous studies as independent variables.

RESULTS

A higher probability of non-access due to distrust in the physician/facility among adults with higher economic income was found. Among those who prefer not to wait are vulnerable groups of people: women, people with a lower-middle income, those who belong to groups with longer waiting times, and ethnic groups. The people who least access the GES due to lack of information correspond to part of the migrant population and those belonging to the lowest income group.

CONCLUSIONS

The GES policy must necessarily improve the timeliness and quality of the services to make them attractive to groups that currently do not have access to them, managing waiting times rather than referrals and using patient-centered evaluations, especially in those most vulnerable groups that do not access GES because they choose not to wait or lack the necessary information, thereby improving their health literacy.

Policy Discourses: Shifting the Burden of Healthcare from the State to the Market in the Kingdom of Saudi Arabia

Saudi Arabia has modified from a predominantly free, public, and comprehensive system under a welfare model to more of a mixed-economy model of healthcare. The welfare state slowly moved to a liberal model, emphasizing market forces to dominate in the provision of healthcare and the private sector was trusted to provide a better provision of healthcare. The country has to confront enormous problems in the health sector due to population growth, lifestyle changes, the shift of disease patterns, elevated expectations, escalated healthcare costs, limited infrastructure and resources, and poor management practice in the provision of healthcare. Moreover, the government has been emphasizing the need to bring in private sector investment to improve quality and efficiency, development of manpower, and standardization of services. As the current pattern of healthcare is unsustainable, the country is planning to restructure the present healthcare system toward institutionalizing it to meet future challenges. The governments must make an appropriate amount of effort to build their healthcare systems by transforming and modifying the challenges faced by society and its political-economic systems. The government should encourage equity, and fairness in the provision of healthcare.

Comparison of COVID-19 Health Risks With Other Viral Occupational Hazards

The European Commission periodically classifies viruses on their occupational hazards to define the level of protection that workers are entitled to claim. Viruses belonging to Groups 3 and 4 can cause severe human disease and hazard to workers, as well as a spreading risk to the community. However, there is no effective prophylaxis or treatment available for Group 4 viruses. European trade unions and the Commission are negotiating the classification of the COVID-19 virus along these 2 categories. This article weighs the reasons to classify it in Group 3 or 4 while comparing its risks to those of the most significant viruses classified in these 2 categories. COVID-19 characteristics justify its classification in Group 4. Contaminated workers in contact with the public play an important role in disseminating the virus. In hospitals and nursing homes, they increase the overall case fatality rate. By strongly protecting these workers and professionals, the European Union would not only improve health in work environments, but also activate a mechanism key to reducing the COVID-19 burden in the general population. Admittedly, the availability of a new vaccine or treatment would change this conclusion, which was reached in the middle of the first pandemic.

Objectives, methods, and results in critical health systems and policy research: evaluating the healthcare market

BACKGROUND

Since the 1980s, markets have turned increasingly to intangible goods - healthcare, education, the arts, and justice. Over 40 years, the authors investigated healthcare commoditisation to produce policy knowledge relevant to patients, physicians, health professionals, and taxpayers. This paper revisits their objectives, methods, and results to enlighten healthcare policy design and research.

MAIN TEXT

This paper meta-analyses the authors' research that evaluated the markets impact on healthcare and professional culture and investigated how they influenced patients' timely access to quality care and physicians' working conditions. Based on these findings, they explored the political economic of healthcare. In low-income countries the analysed research showed that, through loans and cooperation, multilateral agencies restricted the function of public services to disease control, with subsequent catastrophic reductions in access to care, health de-medicalisation, increased avoidable mortality, and failure to attain the narrow MDGs in Africa. The pro-market reforms enacted in middle-income countries entailed the purchaser-provider split, privatisation of healthcare pre-financing, and government contracting of health finance management to private insurance companies. To establish the materiality of a cause-and-effect relationship, the authors compared the efficiency of Latin American national health systems according to whether or not they were pro-market and complied with international policy standards. While pro-market health economists acknowledge that no market can offer equitable access to healthcare without effective regulation and control, the authors showed that both regulation and control were severely constrained in Asia by governance and medical secrecy issues. In high-income countries they questioned the interest for population health of healthcare insurance companies, whilst comparing access to care and health expenditures in the European Union vs. the U.S., the Netherlands, and Switzerland. They demonstrated that commoditising healthcare increases mortality and suffering amenable to care considerably and carries professional, cultural, and ethical risks for doctors and health professionals. Pro-market policies systems cause health systems inefficiency, inequity in access to care and strain professionals' ethics.

CONCLUSION

Policy research methodologies benefit from being inductive, as health services and systems evaluations, and population health studies are prerequisites to challenge official discourse and to explore the historical, economic, sociocultural, and political determinants of public policies.

Neo-Hippocratic healthcare policies: professional or industrial healthcare delivery? A choice for doctors, patients, and their organisations

BACKGROUND

Ethical medical practice requires managing health services to promote professionalism and secure accessibility to care. Commercially financed and industrially managed services strain the physicians' clinical autonomy and ethics because the industry's profitability depends on commercial, clinical standardisation. Private insurance companies also reduce access to care whilst fragmenting and segmenting health systems. Against this background, given the powerful, symbolic significance of their common voice, physicians' and patients' organisations could effectively leverage together political parties and employers' organisations to promote policies favouring access to professional care.

MAIN TEXT

To provide a foundation for negotiations between physicians' and patients' organisations, we propose policy principles derived from an analysis of rights-holders and duty-bearers' stakes, i.e., patients, physicians and health professionals, and taxpayers. Their concerns are scrutinised from the standpoints of public health and right to health. Illustrated with post-WWII European policies, these principles are formulated as inputs for tentative action-research. The paper also identifies potential stumbling blocks for collective doctor/patient negotiations based on the authors' personal experience. The patients' concerns are care accessibility, quality, and price. Those of physicians and other professionals are problem-solving capacity, autonomy, intellectual progress, ethics, work environment, and revenue. The majority of taxpayers have an interest in taxes being progressive and public spending on health regressive. Mutual aid associations tend to under-estimate the physician's role in delivering care. Physicians' organisations often disregard the mission of financing care and its impact on healthcare quality.

CONCLUSION

The proposed physicians-patients' alliance could promote policies in tune with professional ethics, prevent European policies' putting industrial concerns above suffering and death, bar care financing from the ambit of international trade treaties, and foster international cooperation policies consistent with the principles that inspire the design of healthcare policies at home and so reduce international migration. To be credible partners in this alliance, physicians' associations should promote a public health culture amongst their members and a team culture in healthcare services. To promote a universal health system, patients' organisations should strive to represent universal health interests rather than those of patients with specific diseases, ethnic groups, or social classes.

Universal Healthcare in the United States of America: A Healthy Debate

This commentary offers discussion on the pros and cons of universal healthcare in the United States. Disadvantages of universal healthcare include significant upfront costs and logistical challenges. On the other hand, universal healthcare may lead to a healthier populace, and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation. In particular, substantial health disparities exist in the United States, with low socio–economic status segments of the population subject to decreased access to quality healthcare and increased risk of non-communicable chronic conditions such as obesity and type II diabetes, among other determinants of poor health. While the implementation of universal healthcare would be complicated and challenging, we argue that shifting from a market-based system to a universal healthcare system is necessary. Universal healthcare will better facilitate and encourage sustainable, preventive health practices and be more advantageous for the long-term public health and economy of the United States.

Employment based health financing does not support gender equity in universal health coverage

Health financing and entitlement systems linked to employment can disadvantage women, argue Lavanya Vijayasingham and colleagues

The Privatization of Health Care System in Saudi Arabia

Saudi Arabia's Vision 2030 highlights the development of the health care sector through privatization. This study examines the factors that prompted the privatization of the health care sector in Saudi Arabia. This is a scoping review based on an extensive review of both published and unpublished documents. We have accessed different search engines and databases to collect various research publications, journal articles, government reports, policy and planning documents, and relevant press reports/articles. While privatization of the health care sector in Saudi Arabia has experienced an upward trend, the public health care sector remains vital to bring in overall improvements in the health of all sections of Saudi Arabia's population. Keeping this in view, the government must strengthen its public health care sector to ensure affordable, accessible, and high-quality health care for all. This manuscript focuses on the policy aspect of the privatization of health care and is based on secondary research material. Increased privatization leads to rising expenses in health care, while adversely affecting equity and accountability in the provision of its services. Although this study is an independent analysis of Saudi Arabia's health care system, lessons learned from this context could be used widely for policy-making in other countries with similar socioeconomic settings.