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Dzhygyr Y, Dale E, Voorhoeve A, Gopinathan U, Maynzyuk K. Procedural fairness and the resilience of health financing reforms in Ukraine. Health Policy Plan 2023; 38:i59-i72. [PMID: 37963081 PMCID: PMC10645049 DOI: 10.1093/heapol/czad062] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/28/2023] [Accepted: 07/26/2023] [Indexed: 11/16/2023] Open
Abstract
In 2017, Ukraine's Parliament passed legislation establishing a single health benefit package for the entire population called the Programme of Medical Guarantees, financed through general taxes and administered by a single national purchasing agency. This legislation was in line with key principles for financing universal health coverage. However, health professionals and some policymakers have been critical of elements of the reform, including its reliance on general taxes as the source of funding. Using qualitative methods and drawing on deliberative democratic theory and criteria for procedural fairness, this study argues that the acceptance and sustainability of these reforms could have been strengthened by making the decision-making process fairer. It suggests that three factors limited the extent of stakeholders' participation in this process: first, a perception among reformers that fast-paced decision-making was required because there was only a short political window for much needed reforms; second, a lack of trust among reformers in the motives, representativeness, and knowledge of some stakeholders; and third, an under-appreciation of the importance of dialogic engagement with the public. These findings highlight a profound challenge for policymakers. In retrospect, some of those involved in the reform's design and implementation believe that a more meaningful engagement with the public and stakeholders who opposed the reform might have strengthened its legitimacy and durability. At the same time, the study shows how difficult it is to have an inclusive process in settings where some actors may be driven by unconstrained self-interest or lack the capacity to be representative or knowledgeable interlocutors. It suggests that investments in deliberative capital (the attitudes and behaviours that facilitate good deliberation) and in civil society capacity may help overcome this difficulty.
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Affiliation(s)
- Yuriy Dzhygyr
- Independent Expert, 54a Pivnichna Str, Kyiv 04213, Ukraine
| | - Elina Dale
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Alex Voorhoeve
- Department of Philosophy, Logic and Scientific Method, London School of Economics and Political Science (LSE), Houghton Street, London WC2A 2AE, United Kingdom
| | - Unni Gopinathan
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
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Wachholz P, Giacomin K. Dignity in the care of older adults living in nursing homes and long-term care facilities. F1000Res 2023; 11:1208. [PMID: 38434004 PMCID: PMC10904933 DOI: 10.12688/f1000research.126144.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 03/05/2024] Open
Abstract
Depending on the fields and actors involved, dignity may involve, signify, and encompass different meanings. This fundamental right can be subjectively experienced and rooted in a person's perception of being treated and cared for. Care refers to a set of specific activities combined in a complex life-sustaining network, including long-term Care, which involves various services designed to meet a person's health or personal care needs. However, older residents' human rights have been disrespected and widened the gaps between theory and practice regarding the precarious protection of their rights and dignity inside long-term facilities and nursing homes. This paper aims to discuss threats to dignity and elucidate some strategies to promote and conserve dignity in care, including the person-centered practice in long-term care. Some barriers to the dignity of older residents involve the organizational culture, restraints of time, heavy workload, burnout, and lack of partnership between the residents, their families, and the long-term care homes' staff. Person-centered integrated care quality frameworks are core components of a good quality of care in these spaces in high-income countries. Unfortunately, the COVID-19 pandemic highlighted how weak long-term care policies were and demonstrated that much progress in the dignity of care in long-term care facilities and nursing homes is needed. In low- and middle-income countries, long-term care policies do not accompany the accelerated and intense aging process, and there are other threats, like their invisibility to the public sector and the prejudices about this service model. It's urgent to create strategies for designing and implementing sustainable and equitable long- term care systems based on a person-centered service with dignity to everyone who needs it.
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Affiliation(s)
- Patrick Wachholz
- Programa de Pós-Graduação em Pesquisa Clínca, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, 18618687, Brazil
| | - Karla Giacomin
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
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Li Y, Choi H, Leung K, Jiang F, Graham DY, Leung WK. Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2023; 8:553-564. [PMID: 37086739 DOI: 10.1016/s2468-1253(23)00070-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Few studies have examined the temporal trends of Helicobacter pylori prevalence worldwide. We aimed to identify the changes in global prevalence of H pylori infection between 1980 and 2022. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, MEDLINE, Scopus, and Web of Science, with no language restrictions, for observational studies on the prevalence of H pylori infection published between Jan 1, 1980, and Dec 31, 2022. Conference papers, meta-analyses, reviews, and case reports were excluded. We divided the study timeframe into four periods: 1980-90, 1991-2000, 2001-10, and 2011-22. Summary data were extracted from each selected publication. The prevalence of H pylori and its temporal trend were analysed according to WHO region, World Bank income level, WHO universal health coverage service coverage index of the country or region, sex and age of the patient, study type, and diagnostic method. The pooled prevalence was estimated by a random-effect meta-analysis, and the significance of the associated factors was analysed by multivariable meta-regression. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 2022100026. FINDINGS Of the 56 967 records identified, 5236 were included in the quality assessment stage and 224 studies-from 71 countries or regions from all six WHO regions and including 2 979 179 individuals-were included in the final analysis. Significant heterogeneity was found between studies (I2=99·9%). The estimated global prevalence of H pylori infection decreased from 58·2% (95% CI 50·7-65·8) in the 1980-90 period to 43·1% (40·3-45·9) in the 2011-22 period. Prevalence was relatively static between 1991 and 2010 but declined sharply between 2011 and 2022, with the largest decline in the WHO African region. Overall, a lower prevalence of H pylori infection was reported in younger people, high-income countries, or countries with high levels of universal health coverage, and by retrospective studies. Studies based on serological diagnostic methods generally reported higher H pylori prevalence than studies based on non-serological methods (53·2% [49·8-56·6] vs 41·1% [38·1-44·2]) and fluctuated less over time. INTERPRETATION This meta-analysis shows a declining trend of H pylori prevalence globally, particularly in the 2011-22 period. These results could help to inform future health policy on prevention and management of this important infection. However, a considerable degree of heterogeneity exists between studies and further population-based epidemiological studies are needed. FUNDING None.
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Affiliation(s)
- Yunhao Li
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Horace Choi
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China
| | - Kathy Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China; Department of Research, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Fang Jiang
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - David Y Graham
- Department of Medicine, Michael DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Wai K Leung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Askarzade E, Nabizade Z, Goharinezhad S, Mostaghim S. Universal Health Coverage in Iran: A Review of Strengths, Weaknesses, Opportunities, and Threats. Med J Islam Repub Iran 2023; 37:6. [PMID: 37123342 PMCID: PMC10134088 DOI: 10.47176/mjiri.37.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Indexed: 05/02/2023] Open
Abstract
Background Universal health coverage (UHC) aims to provide access to basic health services with no financial constraints. In Iran, the major challenges to the implementation of the UHC plan include aggregation and augmentation of resources, something which could threaten the dimension of population coverage and health service delivery. Therefore, this study reviews the strengths and weaknesses of the internal environment as well as the opportunities and threats of the external environment in the UHC plan to help policymakers and decision-makers of the health system. Methods In this review study, reputable databases were searched for all the relevant papers on UHC to collect data. After that, the strengths, weaknesses, opportunities and threats (SWOT) analysis was conducted to organize, collect, and analyze data. The SWOT analysis is a process that has 4 components and 2 dimensions. The 4 components are strengths, weaknesses, opportunities, and threats. In fact, strengths and weaknesses are considered internal factors and organizational features, whereas opportunities and threats are considered external factors and environmental features. The listed items were then categorized for clarification and transparency within the framework of the 6 building blocks of the World Health Organization (WHO). Results The relevant studies were reviewed to analyze the strengths and weaknesses of internal environments as well as the opportunities and threats of external environments. The necessary points for better planning and policymaking were then presented. Conclusion The success of Iran's UHC plan can be guaranteed by regular capacity building, ongoing education, and empowerment of society in addition to improving intersectoral collaboration and acquiring political commitment to develop more effective and more accountable systems matching variable and dynamic health requirements.
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Affiliation(s)
- Elahe Askarzade
- Department of Health Care Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Nabizade
- Department of Health Management and Economics, School of Public Health, Tehran
University of Medical Sciences, Tehran, Iran
| | - Salime Goharinezhad
- Pereventive Medicine and Public Health Research Center, Psychosocial Health
Research Insttitute, Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Mostaghim
- Department of Health Care Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author:Somayeh Mostaghim,
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Fan X, Su M, Zhao Y, Si Y, Wang D. Effect of Health Insurance Policy on the Health Outcomes of the Middle-Aged and Elderly: Progress Toward Universal Health Coverage. Front Public Health 2022; 10:889377. [PMID: 35937260 PMCID: PMC9354596 DOI: 10.3389/fpubh.2022.889377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
This population-based study aims to explore the effect of the integration of the Urban and Rural Residents' Basic Medical Insurance (URRBMI) policy on the health outcomes of the middle-aged and elderly. A total of 13,360 participants in 2011 and 15,082 participants in 2018 were drawn from the China Health and Retirement Longitudinal Study. Health outcomes were evaluated using the prevalence of chronic diseases. A generalized linear mixed model was used to analyze the effect of the URRBMI policy on the prevalence of chronic disease. Prior to the introduction of the URRBMI policy, 67.09% of the rural participants and 73.00% of the urban participants had chronic diseases; after the policy's implementation, 43.66% of the rural participants and 45.48% of the urban participants had chronic diseases. When adjusting for the confounding factors, the generalized linear mixed model showed that the risk of having a chronic disease decreased by 81% [odds ratio (OR) = 0.19; 95% confidence interval (CI): 0.16, 0.23] after the introduction of the policy in the urban participants; in the rural participants, the risk of having a chronic disease was 30% lower (OR = 0.70; 95% CI: 0.60, 0.82) than the risk in the urban participants before the policy and 84% lower (OR = 0.16; 95% CI: 0.14, 0.19) after the implementation of the policy; the differences in the ORs decreased from 0.30 prior to the policy to 0.03 after the policy had been introduced between rural and urban participants when adjusting for the influence of socioeconomic factors on chronic diseases. This study provides evidence of the positive effects of the URRBMI policy on improving the rural population's health outcomes and reducing the gap in health outcomes between rural and urban populations, indicating that the implementation of the URRBMI policy has promoted the coverage of universal health.
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Affiliation(s)
- Xiaojing Fan
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China
- *Correspondence: Min Su
| | - Yaxin Zhao
- School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Yafei Si
- School of Risk and Actuarial Studies and Centre of Excellence in Population Aging Research (CEPAR), University of New South Wales, Kensington, NSW, Australia
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Rabbani A, Mehareen J, Chowdhury IA, Sarker M. Mandatory employer-sponsored health financing scheme for semiformal workers in Bangladesh: An experimental assessment. Soc Sci Med 2021; 292:114590. [PMID: 34871854 DOI: 10.1016/j.socscimed.2021.114590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/07/2021] [Accepted: 11/18/2021] [Indexed: 11/27/2022]
Abstract
In this study, we present findings from an experimental evaluation of a mandatory employer-sponsored health insurance scheme in Bangladesh. We randomly introduced the scheme to female artisans to understand the impacts on healthcare utilisation, expenditure and subjective well-being using both survey and administrative data. Our findings suggest that the scheme broke even; however, it covered only six percent of the overall health expenditure and 16 percent of the hospitalisation costs. We find higher inpatient care utilisation, particularly among women, and in favour of empanelled hospitals causally associated with the intervention, consistent with the design of the scheme. We do not find significant healthcare savings or improvement in subjective well-being, consistent with low coverage. The findings suggest the scheme to be financially sustainable and it changes the healthcare seeking behaviours as the scheme incentivises. However, meaningful savings and protection against catastrophic health expenditures will require a higher level of coverage.
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Affiliation(s)
- Atonu Rabbani
- Department of Economics, University of Dhaka, Dhaka, 1000, Bangladesh; BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka,1213, Bangladesh.
| | - Jeenat Mehareen
- Department of Economics, East West University, Dhaka, Bangladesh
| | - Imran Ahmed Chowdhury
- Health, Nutrition and Population Programme, BRAC, 75 Mohakhali, Dhaka, 1212, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka,1213, Bangladesh; Global Health Institute, ImNeuenheimer Feld 130.3, MarsiliusArkaden - 6. Stock, 69120, Heidelberg, Germany
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Huckel Schneider C. Health system governance and the UHC agenda: key learnings from the COVID-19 pandemic. BMJ Glob Health 2021; 6:bmjgh-2021-006519. [PMID: 34261760 PMCID: PMC8282416 DOI: 10.1136/bmjgh-2021-006519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Sacks E, Schleiff M, Were M, Chowdhury AM, Perry HB. Communities, universal health coverage and primary health care. Bull World Health Organ 2020; 98:773-780. [PMID: 33177774 PMCID: PMC7607457 DOI: 10.2471/blt.20.252445] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022] Open
Abstract
Universal health coverage (UHC) depends on a strong primary health-care system. To be successful, primary health care must be expanded at community and household levels as much of the world's population still lacks access to health facilities for basic services. Abundant evidence shows that community-based interventions are effective for improving health-care utilization and outcomes when integrated with facility-based services. Community involvement is the cornerstone of local, equitable and integrated primary health care. Policies and actions to improve primary health care must regard community members as more than passive recipients of health care. Instead, they should be leaders with a substantive role in planning, decision-making, implementation and evaluation. Advancing the science of primary health care requires improved conceptual and analytical frameworks and research questions. Metrics used for evaluating primary health care and UHC largely focus on clinical health outcomes and the inputs and activities for achieving them. Little attention is paid to indicators of equitable coverage or measures of overall well-being, ownership, control or priority-setting, or to the extent to which communities have agency. In the future, communities must become more involved in evaluating the success of efforts to expand primary health care. Much of primary health care has taken place, and will continue to take place, outside health facilities. Involving community members in decisions about health priorities and in community-based service delivery is key to improving systems that promote access to care. Neither UHC nor the Health for All movement will be achieved without the substantial contribution of communities.
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Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E8011, Baltimore, Maryland, 21205, United States of America
| | - Meike Schleiff
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E8011, Baltimore, Maryland, 21205, United States of America
| | | | | | - Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E8011, Baltimore, Maryland, 21205, United States of America
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