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Kiros M, Memirie ST, Tolla MTT, Palm MT, Hailu D, Norheim OF. Cost-effectiveness of running a paediatric oncology unit in Ethiopia. BMJ Open 2023; 13:e068210. [PMID: 36918241 PMCID: PMC10016307 DOI: 10.1136/bmjopen-2022-068210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of running a paediatric oncology unit in Ethiopia to inform the revision of the Ethiopia Essential Health Service Package (EEHSP), which ranks the treatment of childhood cancers at a low and medium priority. METHODS We built a decision analytical model-a decision tree-to estimate the cost-effectiveness of running a paediatric oncology unit compared with a do-nothing scenario (no paediatric oncology care) from a healthcare provider perspective. We used the recently (2018-2019) conducted costing estimate for running the paediatric oncology unit at Tikur Anbessa Specialized Hospital (TASH) and employed a mixed costing approach (top-down and bottom-up). We used data on health outcomes from other studies in similar settings to estimate the disability-adjusted life years (DALYs) averted of running a paediatric oncology unit compared with a do-nothing scenario over a lifetime horizon. Both costs and effects were discounted (3%) to the present value. The primary outcome was incremental cost in US dollars (USDs) per DALY averted, and we used a willingness-to-pay (WTP) threshold of 50% of the Ethiopian gross domestic product per capita (USD 477 in 2019). Uncertainty was tested using one-way and probabilistic sensitivity analyses. RESULTS The incremental cost and DALYs averted per child treated in the paediatric oncology unit at TASH were USD 876 and 2.4, respectively, compared with no paediatric oncology care. The incremental cost-effectiveness ratio of running a paediatric oncology unit was USD 361 per DALY averted, and it was cost-effective in 90% of 100 000 Monte Carlo iterations at a USD 477 WTP threshold. CONCLUSIONS The provision of paediatric cancer services using a specialised oncology unit is most likely cost-effective in Ethiopia, at least for easily treatable cancer types in centres with minimal to moderate capability. We recommend reassessing the priority-level decision of childhood cancer treatment in the current EEHSP.
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Affiliation(s)
- Mizan Kiros
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Addis Center for Ethics and Priority Setting, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Mieraf Taddesse Taddesse Tolla
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Michael Tekle Palm
- Department of Health Financing, Clinton Health Access Initiative, Addis Ababa, Ethiopia
| | - Daniel Hailu
- Department of Pediatrics and Child Health, Pediatric Hematology/Oncology Unit, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Ole F Norheim
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Abstract
In this Viewpoint, Donald Berwick explores the pursuit of profit in US health care across sectors—such as pharmaceutical companies, insurers, hospitals, and physician practices—and its harms to patients, and then offers potential solutions.
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Affiliation(s)
- David A Ansell
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
| | - Kaitlyn Fruin
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
| | - Redia Holman
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
| | - Ayesha Jaco
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
| | - Bich Ha Pham
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
| | - David Zuckerman
- From the Department of Internal Medicine (D.A.A.) and the Care Management Program (R.H.), Rush University Medical Center, and West Side United (A.J.) - both in Chicago; the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (K.F.); and the Healthcare Anchor Network, Washington, DC (B.H.P., D.Z.)
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Goldsbury DE, Feletto E, Weber MF, Haywood P, Pearce A, Lew JB, Worthington J, He E, Steinberg J, O’Connell DL, Canfell K. Health system costs and days in hospital for colorectal cancer patients in New South Wales, Australia. PLoS One 2021; 16:e0260088. [PMID: 34843520 PMCID: PMC8629237 DOI: 10.1371/journal.pone.0260088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Colorectal cancer (CRC) care costs the Australian healthcare system more than any other cancer. We estimated costs and days in hospital for CRC cases, stratified by site (colon/rectal cancer) and disease stage, to inform detailed analyses of CRC-related healthcare. Methods Incident CRC patients were identified using the Australian 45 and Up Study cohort linked with cancer registry records. We analysed linked hospital admission records, emergency department records, and reimbursement records for government-subsidised medical services and prescription medicines. Cases’ health system costs (2020 Australian dollars) and hospital days were compared with those for cancer-free controls (matched by age, sex, geography, smoking) to estimate excess resources by phase of care, analysed by sociodemographic, health, and disease characteristics. Results 1200 colon and 546 rectal cancer cases were diagnosed 2006–2013, and followed up to June 2016. Eighty-nine percent of cases had surgery, chemotherapy or radiotherapy, and excess costs were predominantly for hospitalisations. Initial phase (12 months post-diagnosis) mean excess health system costs were $50,434 for colon and $60,877 for rectal cancer cases, with means of 16 and 18.5 excess hospital days, respectively. The annual continuing mean excess costs were $6,779 (colon) and $8,336 (rectal), with a mean of 2 excess hospital days each. Resources utilised (costs and days) in these phases increased with more advanced disease, comorbidities, and younger age. Mean excess costs in the year before death were $74,952 (colon) and $67,733 (rectal), with means of 34 and 30 excess hospital days, respectively–resources utilised were similar across all characteristics, apart from lower costs for cases aged ≥75 at diagnosis. Conclusions Health system costs and hospital utilisation for CRC care are greater for people with more advanced disease. These findings provide a benchmark, and will help inform future cost-effectiveness analyses of potential approaches to CRC screening and treatment.
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Affiliation(s)
- David E. Goldsbury
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Marianne F. Weber
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Philip Haywood
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Alison Pearce
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jie-Bin Lew
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Joachim Worthington
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Emily He
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Gastroenterology and Liver Department, Concord Hospital, Sydney, NSW, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Dianne L. O’Connell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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Chen HY, Yang CY, Hsieh CY, Yeh CY, Chen CC, Chen YC, Lai CC, Harris RC, Ou HT, Ko NY, Ko WC. Long-term neurological and healthcare burden of adults with Japanese encephalitis: A nationwide study 2000-2015. PLoS Negl Trop Dis 2021; 15:e0009703. [PMID: 34520457 PMCID: PMC8486099 DOI: 10.1371/journal.pntd.0009703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 10/01/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To assess the healthcare utilization, economic burden, and long-term neurological complications and mortality of an adult population with Japanese encephalitis (JE). Methods This study utilized two nationwide datasets in Taiwan: the Notifiable Disease Dataset of confirmed cases from the Centers for Disease Control to identify JE patients, and the National Health Insurance Research Database to obtain patients’ healthcare utilization. Survival analyses were performed to identify prognostic factors associated with the all-cause mortality of patients. Results This study included 352 adult cases with JE (aged≥20 years). The mean age of JE patients was 45 years. Stroke (event rate: 3.49/100 person-years) was the most common neurological complication, followed by epilepsy/convulsions (3.13/100 person-years), encephalopathy/delirium (2.20/100 person-years), and parkinsonism (1.97/100 person-years). Among the 336 hospitalized patients at JE diagnosis, 58.33% required intensive care. Among 79 patients who died following JE diagnosis, 48.84% of death events occurred within the year of diagnosis. The medical costs increased considerably at JE diagnosis and subsequent-year costs remained significantly higher than the costs before diagnosis (p<0.05). Having a four-dose JE vaccination (i.e., born after 1976) versus no JE vaccination history (i.e., born before 1963) was significantly associated with lower all-cause mortality (hazard ratio: 0.221 [95% confidence interval: 0.067, 0.725]). Comorbid diabetes and incident epilepsy/convulsion events significantly increased the mortality risk by 2.47- and 1.85-fold, respectively (p<0.05). Conclusion A considerable medical burden associated with JE was observed in affected adults, even in the years following JE diagnosis. Vaccination should be considered to prevent this sporadic, but lethal, viral infection. The epidemiology of adulthood Japanese encephalitis (JE) remains limited, and data on the economic burden associated with JE is lacking. This study is the first to comprehensively examine the healthcare burden (i.e., healthcare utilization and costs, neurological complications, all-cause mortality) of an adult population with JE, utilizing a nationwide cohort of JE-infected adults with up to 16 years of follow-up. In the first 6 months following JE diagnosis, a higher rate of neurological disorders was found, compared to the years after the diagnosis, with stroke being the most common neurological complication, followed by epilepsy/convulsions. The healthcare utilization of JE patients was higher in the first 6 months after the diagnosis compared to the years following the diagnosis. Medical costs increased considerably at JE diagnosis and subsequent-year costs after diagnosis remained higher than the cost before diagnosis. Having comorbid diabetes or incident epilepsy/convulsion events was a significant risk factor for mortality of adults with JE. Being born after 1976 in Taiwan, and thus likely receiving a four-dose schedule of vaccination, was associated with reduced mortality. Therefore, special attention is required for JE patients with comorbid diabetes or incident epilepsy/convulsion events, and JE vaccination should be considered to prevent this sporadic but lethal viral infection.
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Affiliation(s)
- Hsuan-Ying Chen
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Yi Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
| | - Chun-Yin Yeh
- Department of Computer Science and Information Engineering, College of Electrical Engineering and Computer Science, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Chun Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | | | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Ahmed S, Koudou GB, Bagot M, Drabo F, Bougma WR, Pulford C, Bockarie M, Harrison RA. Health and economic burden estimates of snakebite management upon health facilities in three regions of southern Burkina Faso. PLoS Negl Trop Dis 2021; 15:e0009464. [PMID: 34153048 PMCID: PMC8248599 DOI: 10.1371/journal.pntd.0009464] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/01/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Snakebite has become better recognized as a significant cause of death and disability in Sub-Saharan Africa, but the health economic consequences to victims and health infrastructures serving them remain poorly understood. This information gap is important as it provides an evidence-base guiding national and international health policy decision making on the most cost-effective interventions to better manage snakebite. Here, we assessed hospital-based data to estimate the health economic burden of snakebite in three regions of Burkina Faso (Centre-Ouest, Hauts Bassins and Sud-Ouest). Methodology Primary data of snakebite victims admitted to regional and district health facilities (eg, number of admissions, mortality, hospital bed days occupied) was collected in three regions over 17 months in 2013/14. The health burden of snakebite was assessed using Disability-Adjusted Life Years (DALYs) calculations based upon hospitalisation, mortality and disability data from admitted patients amongst other inputs from secondary sources (eg, populations, life-expectancy and age-weighting constants). An activity-based costing approach to determine the direct cost of snake envenoming included unit costs of clinical staff wages, antivenom, supportive care and equipment extracted from context-relevant literature. Findings The 10,165 snakebite victims admitted to hospital occupied 28,164 hospital bed days over 17 months. The annual rate of hospitalisation and mortality of admitted snakebite victims was 173 and 1.39/100,000 population, respectively. The estimated annual (i) DALYs lost was 2,153 (0.52/1,000) and (ii) cost to hospitals was USD 506,413 (USD 49/hospitalisation) in these three regions of Burkina Faso. These costs appeared to be influenced by the number of patients receiving antivenom (10.90% in total) in each area (highest in Sud-Ouest) and the type of health facility. Conclusion The economic burden of snake envenoming is primarily shouldered by the rural health centres closest to snakebite victims–facilities that are typically least well equipped or resourced to manage this burden. Our study highlights the need for more research in other regions/countries to demonstrate the burden of snakebite and the socioeconomic benefits of its management. This evidence can guide the most cost-effective intervention from government and development partners to meet the snakebite-management needs of rural communities and their health centres. The World Health Organisation has established a strategy to halve snakebite mortality and morbidity by 2030. Achieving this ambitious target within a decade will require substantial investment from governments of countries most affected by snakebite. The burden of snakebite however, is typically greatest in low-middle income countries with already limited health budgets. Acquiring government support to prioritise snakebite over other prevailing diseases will require evidence of the scale, causes, precise geographies and health economic impacts of snakebite. While the snakebite research community has progressed the delivery of some of these evidence types, it has been weak at providing evidence of the health economic burden of snakebite. Our hospital-based study identifies the health (Disability-Adjusted Life Years) and financial burdens of snakebite to three districts of Burkina Faso. We argue that funding of more health economic research, performed at greater depth and that includes cost-effectiveness of snakebite treatment and other remedial interventions is arguably the most effective tool to advocate for the policy support and investment required of national and international health agencies to deliver WHO’s laudable 2030 target for snakebite.
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Affiliation(s)
- Sayem Ahmed
- The Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- The Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Mathematical Modelling Group, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Guibehi B. Koudou
- The Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Centre Suisse de Recherches Scientifiques, Abidjan, Cote d’Ivoire
| | - Maïwenn Bagot
- The Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - François Drabo
- Ministère de la Santé, Direction de la Promotion de la Santé, Ouagadougou, Burkina Faso
| | - Windtaré R. Bougma
- Ministère de la Santé, Direction de la Prévention de la Santé de la Population, Programme National de lute contre les Maladies Tropicales Négligées, Ouagadougou, Burkina Faso
| | - Caisey Pulford
- The Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- National Infection Service, Public Health England Colindale, London, United Kingdom
- Institute of infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Moses Bockarie
- The Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
| | - Robert A. Harrison
- The Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- The Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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Joseph J, Sankar D. H, Nambiar D. Empanelment of health care facilities under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in India. PLoS One 2021; 16:e0251814. [PMID: 34043664 PMCID: PMC8158976 DOI: 10.1371/journal.pone.0251814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/03/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction India’s Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world’s largest health assurance scheme providing health cover of 500,000 INR (about USD 6,800) per family per year. It provides financial support for secondary and tertiary care hospitalization expenses to about 500 million of India’s poorest households through various insurance models with care delivered by public and private empanelled providers. This study undertook to describe the provider empanelment of PM-JAY, a key element of its functioning and determinant of its impact. Methods We carried out secondary analysis of cross-sectional administrative program data publicly available in PM-JAY portal for 30 Indian states and 06 UTs. We analysed the state wise distribution, type and sector of empanelled hospitals and services offered through PM-JAY scheme across all the states and UTs. Results We found that out of the total facilities empanelled (N = 20,257) under the scheme in 2020, more than half (N = 11,367, 56%) were in the public sector, while 8,157 (40%) facilities were private for profit, and 733 (4%) were private not for profit entities. State wise distribution of hospitals showed that five states (Karnataka (N = 2,996, 14.9%), Gujarat (N = 2,672, 13.3%), Uttar Pradesh (N = 2,627, 13%), Tamil Nadu (N = 2315, 11.5%) and Rajasthan (N = 2,093 facilities, 10.4%) contributed to more than 60% of empanelled PMJAY facilities: We also observed that 40% of facilities were offering between two and five specialties while 14% of empanelled hospitals provided 21–24 specialties. Conclusion A majority of the hospital empanelled under the scheme are in states with previous experience of implementing publicly funded health insurance schemes, with the exception of Uttar Pradesh. Reasons underlying these patterns of empanelment as well as the impact of empanelment on service access, utilisation, population health and financial risk protection warrant further study. While the inclusion and regulation of the private sector is a goal that may be served by empanelment, the role of public sector remains critical, particularly in underserved areas of India.
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Affiliation(s)
- Jaison Joseph
- The George Institute for Global Health, New Delhi, India
- * E-mail: ,
| | - Hari Sankar D.
- The George Institute for Global Health, New Delhi, India
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Kusama Y, Muraki Y, Tanaka C, Koizumi R, Ishikane M, Yamasaki D, Tanabe M, Ohmagari N. Characteristics and limitations of national antimicrobial surveillance according to sales and claims data. PLoS One 2021; 16:e0251299. [PMID: 33974635 PMCID: PMC8112693 DOI: 10.1371/journal.pone.0251299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 04/23/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose Antimicrobial use (AMU) is estimated at the national level by using sales data (S-AMU) or insurance claims data (C-AMU). However, these data might be biased by generic drugs that are not sold through wholesalers (direct sales) and therefore not recorded in sales databases, or by claims that are not submitted electronically and therefore not stored in claims databases. We evaluated these effects by comparing S-AMU and C-AMU to ascertain the characteristics and limitations of each kind of data. We also evaluated the interchangeability of these data by assessing their relationship. Methods We calculated monthly defined daily doses per 1,000 inhabitants per day (DID) using sales and claims data from 2013 to 2017. To assess the effects of non-electronic claim submissions on C-AMU, we evaluated trends in the S-AMU/C-AMU ratio (SCR). To assess the effects of direct sales of S-AMU, we divided AMU into generic and branded drugs and evaluated each SCR in terms of oral versus parenteral drugs. To assess the relationship between S-AMU and C-AMU, we created a linear regression and evaluated its coefficient. Results Median annual SCRs from 2013 to 2017 were 1.046, 0.993, 0.980, 0.987, and 0.967, respectively. SCRs dropped from 2013 to 2015, and then stabilized. Differences in SCRs between branded and generic drugs were significant for oral drugs (0.820 vs 1.079) but not parenteral drugs (1.200 vs 1.165), suggesting that direct sales of oral generic drugs were omitted in S-AMU. Coefficients of DID between S-AMU and C-AMU were high (generic, 0.90; branded, 0.84) in oral drugs but relatively low (generic, 0.32; branded, 0.52) in parenteral drugs. Conclusions The omission of direct sales information and non-electronically submitted claims have influenced S-AMU and C-AMU information, respectively. However, these data were well-correlated, and it is considered that both kinds of data are useful depending on the situation.
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Affiliation(s)
- Yoshiki Kusama
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
- * E-mail:
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Chika Tanaka
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryuji Koizumi
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Daisuke Yamasaki
- Department of Infection Control and Prevention, Mie University Hospital, Tsu, Mie, Japan
| | - Masaki Tanabe
- Department of Infection Control and Prevention, Mie University Hospital, Tsu, Mie, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Akweongo P, Chatio ST, Owusu R, Salari P, Tedisio F, Aikins M. How does it affect service delivery under the National Health Insurance Scheme in Ghana? Health providers and insurance managers perspective on submission and reimbursement of claims. PLoS One 2021; 16:e0247397. [PMID: 33651816 PMCID: PMC7924798 DOI: 10.1371/journal.pone.0247397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In 2003, the Government of Ghana launched the National Health Insurance Scheme (NHIS) to enable all Ghanaian residents to have access to health services at the point of care without financial difficulty. However, the system has faced a number of challenges relating to delays in submission and reimbursement of claims. This study assessed views of stakeholders on claims submission, processing and re-imbursement under the NHIS and how that affected health service delivery in Ghana. METHODS The study employed qualitative methods where in-depth interviews were conducted with stakeholders in three administrative regions in Ghana. Purposive sampling method was used to select health facilities and study participants for the interviews. QSR Nvivo 12 software was used to code the data into themes for thematic analysis. RESULTS The results point to key barriers such as lack of qualified staff to process claims, unclear vetting procedure and the failure of National Health Insurance Scheme officers to draw the attention of health facility staff to resolve discrepancies on time. Participants perceived that lack of clarity, inaccurate data and the use of non-professional staff for NHIS claims vetting prolonged reimbursement of claims. This affected operations of credentialed health facilities including the provision of health services. It is perceived that unavailability of funds led to re-use of disposable medical supplies in health service delivery in credentialed health facilities. Stakeholders suggested that submission of genuine claims by health providers and regular monitoring of health facilities reduces errors on claims reports and delays in reimbursement of claims. CONCLUSION Long delays in claims reimbursement, perceived vetting discrepancies affect health service delivery. Thus, effective collaboration of all stakeholders is necessary in order to develop a long-term strategy to address the issue under the NHIS to improve health service delivery.
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Affiliation(s)
| | - Samuel Tamti Chatio
- University of Ghana, School of Public Health, Accra, Ghana
- Navrongo Health Research Centre, Navrongo, Ghana
- * E-mail:
| | - Richmond Owusu
- University of Ghana, School of Public Health, Accra, Ghana
| | - Paola Salari
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), University of Basel, Basel, Switzerland
| | - Fabrizio Tedisio
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), University of Basel, Basel, Switzerland
| | - Moses Aikins
- University of Ghana, School of Public Health, Accra, Ghana
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11
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Tringale KR, Gennarelli RL, Gillespie EF, Mitchell AP, Zelefsky MJ. Association between Site-of-Care and the Cost and Modality of Radiotherapy for Prostate Cancer: Analysis of Medicare Beneficiaries from 2015 to 2017. Cancer Invest 2021; 39:144-152. [PMID: 33416007 PMCID: PMC8285070 DOI: 10.1080/07357907.2020.1865396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
Among 84,447 radiotherapy (RT) courses for Medicare beneficiaries age ≥ 65 with prostate cancer treated with external beam RT (EBRT), brachytherapy, or both, 42,608 (51%) were delivered in hospital-affiliated and 41,695 (49%) in freestanding facilities. Freestanding centers were less likely to use EBRT + brachytherapy than EBRT (OR 0.84 [95%CI 0.84-0.84]; p < .001). Treatment was more costly in freestanding centers (mean difference $2,597 [95%CI $2,475-2,719]; p < .001). Adjusting for modality and fractionation, RT in hospital-affiliated centers was more costly (mean difference $773 [95%CI $693-853]; p < .001). Freestanding centers utilized more expensive RT delivery, but factors unrelated to RT modality or fractionation rendered RT more costly at hospital-affiliated centers.
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Affiliation(s)
- Kathryn R Tringale
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Renee L Gennarelli
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Aaron P Mitchell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Ndagire E, Kawakatsu Y, Nalubwama H, Atala J, Sarnacki R, Pulle J, Kyarimpa R, Mwima R, Kansiime R, Okello E, Lwabi P, Beaton A, Sable C, Watkins D. Examining the Ugandan health system's readiness to deliver rheumatic heart disease-related services. PLoS Negl Trop Dis 2021; 15:e0009164. [PMID: 33591974 PMCID: PMC7909659 DOI: 10.1371/journal.pntd.0009164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/26/2021] [Accepted: 01/20/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In 2018, the World Health Assembly mandated Member States to take action on rheumatic heart disease (RHD), which persists in countries with weak health systems. We conducted an assessment of the current state of RHD-related healthcare in Uganda. METHODOLOGY/PRINCIPAL FINDINGS This was a mixed-methods, deductive simultaneous design study conducted in four districts of Uganda. Using census sampling, we surveyed health facilities in each district using an RHD survey instrument that was modeled after the WHO SARA tool. We interviewed health workers with experience managing RHD, purposively sampling to ensure a range of qualification and geographic variation. Our final sample included 402 facilities and 36 health workers. We found major gaps in knowledge of clinical guidelines and availability of diagnostic tests. Antibiotics used in RHD prevention were widely available, but cardiovascular medications were scarce. Higher levels of service readiness were found among facilities in the western region (Mbarara district) and private facilities. Level III health centers were the most prepared for delivering secondary prevention. Health worker interviews revealed that limited awareness of RHD at the district level, lack of diagnostic tests and case management registries, and absence of clearly articulated RHD policies and budget prioritization were the main barriers to providing RHD-related healthcare. CONCLUSIONS/SIGNIFICANCE Uganda's readiness to implement the World Health Assembly RHD Resolution is low. The forthcoming national RHD strategy must focus on decentralizing RHD diagnosis and prevention to the district level, emphasizing specialized training of the primary healthcare workforce and strengthening supply chains of diagnostics and essential medicines.
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Affiliation(s)
- Emma Ndagire
- Uganda Heart Institute, Kampala, Uganda
- Children’s National Hospital, Division of Cardiology, Washington, District of Columbia, United States of America
| | - Yoshito Kawakatsu
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | | | - Rachel Sarnacki
- Children’s National Hospital, Division of Cardiology, Washington, District of Columbia, United States of America
| | | | | | | | | | | | | | - Andrea Beaton
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Craig Sable
- Children’s National Hospital, Division of Cardiology, Washington, District of Columbia, United States of America
- George Washington University School of Medicine, Washington, District of Columbia, United States of America
| | - David Watkins
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Division of General Internal Medicine, University of Washington, Seattle, Washington, United States of America
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Fang Z, Judelson D, Simons J, Steppacher R, Arous E, Sideman M, Schanzer A, Aiello FA. Vascular Surgeons Are Not Adequately Valued by Traditional Productivity Metrics. Ann Vasc Surg 2020; 73:446-453. [PMID: 33359694 DOI: 10.1016/j.avsg.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reimbursements for professional services performed by clinicians are under constant scrutiny. The value of a vascular surgeon's services as measured by work relative value units (wRVUs) and professional reimbursement has decreased for some of the most common procedures performed. Hospital reimbursements, however, often remain stable or increases. We sought to evaluate fistulagrams as a case study and hypothesized that while wRVUs and professional reimbursements decrease, hospital reimbursements for these services increased over the same time period. METHODS Medicare 5% claims data were reviewed to identify all fistulagrams with or without angioplasty or stenting performed between 2015 and 2018 using current procedural terminology codes. Reimbursements were classified into 3 categories: medical center (reimbursements made to a hospital for a fistulagram performed as an outpatient procedure), professional (reimbursement for fistulagrams based on compensation for procedures: work RVUs, practice expense RVU, malpractice expense RVU), and office-based laboratory (OBL, reimbursement for fistulagrams performed in an OBL setting). Medicare's Physician Fee Schedule was used to calculate wRVU and professional reimbursement. Medicare's Hospital Outpatient Prospective Payment System-Ambulatory Payment Classification was used to calculate hospital outpatient reimbursement. RESULTS From 2015 to 2018, we identified 1,326,993 fistulagrams. During this study period, vascular surgeons experienced a 25% increase in market share for diagnostic fistulagrams. Compared with 2015, total professional reimbursements from 2017 to 2018 for all fistulagram procedures decreased by 41% (-$10.3 million) while OBL reimbursement decreased 29% (-$42.5 million) and wRVU decreased 36%. During the same period, medical center reimbursement increased by 6.6% (+$14.1 million). CONCLUSIONS Vascular surgeons' contribution to a hospital may not be accurately reflected through traditional RVU metrics alone. Vascular surgeons performed an increasing volume of fistulagram procedures while experiencing marked reductions in wRVU and reimbursement. Medical centers, on the other hand, experienced an overall increase in reimbursement during the same time period. This study highlights that professional reimbursements, taken in isolation and without consideration of medical center reimbursement, undervalues the services and contributions provided by vascular surgeons.
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Affiliation(s)
- Zachary Fang
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Dejah Judelson
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Jessica Simons
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Robert Steppacher
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Edward Arous
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Matthew Sideman
- Division of Vascular Surgery, University of Texas at San Antonio, San Antonio, TX
| | - Andres Schanzer
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Francesco A Aiello
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA.
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Armstrong-Hough M, Sharma S, Kishore SP, Akiteng AR, Schwartz JI. Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis. PLoS One 2020; 15:e0241555. [PMID: 33362249 PMCID: PMC7757794 DOI: 10.1371/journal.pone.0241555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background Availability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time. Methods We carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases. Results Availability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price. Conclusions We conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.
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Affiliation(s)
- Mari Armstrong-Hough
- School of Global Public Health, New York University, New York, NY, United States of America
- * E-mail:
| | - Srish Sharma
- Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Sandeep P. Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Young Professionals Chronic Disease Network, New York, New York, United States of America
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Affiliation(s)
- Reshma Gupta
- Costs of Care Inc, Boston, Massachusetts
- Department of Internal Medicine, UC Davis Health, Sacramento, California
| | | | - Christopher Moriates
- Costs of Care Inc, Boston, Massachusetts
- Department of Internal Medicine, Dell Medical School at The University of Texas at Austin
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16
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Myong C, Hull P, Price M, Hsu J, Newhouse JP, Fung V. The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts. PLoS One 2020; 15:e0243279. [PMID: 33270778 PMCID: PMC7714363 DOI: 10.1371/journal.pone.0243279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022] Open
Abstract
Importance Federally qualified health centers (FQHCs) receive federal funding to serve medically underserved areas and provide a range of services including comprehensive primary care, enabling services, and behavioral health care. Greater funding for FQHCs could increase the local availability of clinic-based care and help reduce more costly resource use, such as emergency department visits (ED). Objective To examine the impact of funding increases for FQHCs after the ACA on the use of FQHCs and EDs. Methods Retrospective study using the Massachusetts All Payer Claims Database (APCD) 2010–2013 that included APCD enrollees in 559 Massachusetts ZIP codes (N = 6,173,563 in 2010). We calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year, 2010–13 (N = 31). Outcomes were the number of ZIP code enrollees with visits to FQHCs and EDs, overall and for emergent and non-emergent diagnoses. Results In 2010, 4% of study subjects visited a FQHC, and they were more likely to be younger, have Medicaid, and live in low-income areas. We found that a standard deviation increase in prior year FQHC funding (+31 percentage point (pp)) at the ZIP code level was associated with a 2.3pp (95% CI 0.7pp to 3.8pp) increase in enrollees with FQHC visits and a 1.3pp (95% CI -2.3pp to -0.3pp) decrease in enrollees with non-emergent ED visits, but no significant change in emergent ED visits (0.3pp, 95% CI -0.8pp to 1.4pp). Conclusions We found that areas exposed to greater FQHC funding increases had more growth in the number of enrollees seen by FQHCs and greater reductions in ED visits for non-emergent conditions. Investment in FQHCs could be a promising approach to increase access to care for underserved populations and reduce costly ED visits, especially for primary care treatable or non-emergent conditions.
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Affiliation(s)
- Catherine Myong
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Peter Hull
- The Becker Friedman Institute, University of Chicago, Chicago, Illinois, United States of America
| | - Mary Price
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - John Hsu
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joseph P. Newhouse
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Harvard Kennedy School, Cambridge, Massachusetts, United States of America
| | - Vicki Fung
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Mas Romero M, Avendaño Céspedes A, Tabernero Sahuquillo MT, Cortés Zamora EB, Gómez Ballesteros C, Sánchez-Flor Alfaro V, López Bru R, López Utiel M, Celaya Cifuentes S, Peña Longobardo LM, Murillo Romero A, Plaza Carmona L, Gil García B, Pérez Fernández-Rius A, Alcantud Córcoles R, Roldán García B, Romero Rizos L, Sánchez Jurado PM, León Ortiz M, Atienzar Núñez P, Noguerón García A, Ruiz García MF, García Molina R, Estrella Cazalla JDD, Oliva Moreno J, Abizanda P. COVID-19 outbreak in long-term care facilities from Spain. Many lessons to learn. PLoS One 2020; 15:e0241030. [PMID: 33108381 PMCID: PMC7591018 DOI: 10.1371/journal.pone.0241030] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/08/2020] [Indexed: 12/19/2022] Open
Abstract
Background/Objectives To analyze mortality, costs, residents and personnel characteristics, in six long-term care facilities (LTCF) during the outbreak of COVID-19 in Spain. Design Epidemiological study. Setting Six open LTCFs in Albacete (Spain). Participants 198 residents and 190 workers from LTCF A were included, between 2020 March 6 and April 5. Epidemiological data were also collected from six LTCFs of Albacete for the same period of time, including 1,084 residents. Measurements Baseline demographic, clinical, functional, cognitive and nutritional variables were collected. 1-month and 3-month mortality was determined, excess mortality was calculated, and costs associated with the pandemics were analyzed. Results The pooled mortality rate for the first month and first three months of the outbreak were 15.3% and 28.0%, and the pooled excess mortality for these periods were 564% and 315% respectively. In facility A, the percentage of probable COVID-19 infected residents were 33.6%. Probable infected patients were older, frail, and with a worse functional situation than those without COVID-19. The most common symptoms were fever, cough and dyspnea. 25 residents were transferred to the emergency department, 21 were hospitalized, and 54 were moved to the facility medical unit. Mortality was higher upon male older residents, with worse functionality, and higher comorbidity. During the first month of the outbreak, 65 (24.6%) workers leaved, mainly with COVID-19 symptoms, and 69 new workers were contracted. The mean number of days of leave was 19.2. Costs associated with the COVID-19 in facility A were estimated at € 276,281/month, mostly caused by resident hospitalizations, leaves of workers, staff replacement, and interventions of healthcare professionals. Conclusion The COVID-19 pandemic posed residents at high mortality risk, mainly in those older, frail and with worse functional status. Personal and economic costs were high.
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Affiliation(s)
- Marta Mas Romero
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Almudena Avendaño Céspedes
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | | | | | | | | | - Rita López Bru
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Melisa López Utiel
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Sara Celaya Cifuentes
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | | | - Antonio Murillo Romero
- Long-term Care Facilities Coordination, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Laura Plaza Carmona
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Borja Gil García
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | | | | | - Belén Roldán García
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Luis Romero Rizos
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | - Pedro Manuel Sánchez Jurado
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | - Matilde León Ortiz
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Pilar Atienzar Núñez
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Alicia Noguerón García
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | | | - Rafael García Molina
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Juan de Dios Estrella Cazalla
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
- Vasco Núñez de Balboa Facility, Albacete, Spain
| | - Juan Oliva Moreno
- Department of Economic Analysis and Finance, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Pedro Abizanda
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
- * E-mail:
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Boro B, Saikia N. A qualitative study of the barriers to utilizing healthcare services among the tribal population in Assam. PLoS One 2020; 15:e0240096. [PMID: 33031431 PMCID: PMC7544062 DOI: 10.1371/journal.pone.0240096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/20/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We aim to explore the barriers to accessing modern healthcare services in two tribal populations in Assam. METHODS In March 2018, we conducted qualitative research through 60 in-depth interviews with men and women aged 15 to 50 from Bodo and Rabha tribes in Udalguri and Baksa districts of Assam. We interviewed a group of health-service providers from public health facilities to understand the demand-supply balance in those facilities. FINDINGS On the demand side, direct and indirect financial obstacles, distance to health facilities, poor public transportation, perceived negative behavior of hospital staff, and lack of infrastructure were the main barriers to utilizing healthcare facilities. On the supply side, doctors and nurses in government health facilities were overburdened by demand due to a lack of human resources. CONCLUSIONS Our study highlights the barriers to utilizing health facilities; these are not always driven by factors linked to the patient's socio-economic status but also depend significantly on the quality of the health services and other contextual factors. Although the government has made efforts to improve the rural healthcare system through national-level programs, our qualitative study shows that these programs have not been successful in enhancing the rural healthcare system in the study area.
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Affiliation(s)
- Bandita Boro
- Centre for the Study of Regional Development, Jawaharlal Nehru University, Delhi, India
| | - Nandita Saikia
- Centre for the Study of Regional Development, Jawaharlal Nehru University, Delhi, India
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Dubbink JH, Branco TM, Kamara KB, Bangura JS, Wehrens E, Falama AM, Goorhuis A, Jørgensen PB, Sevalie SS, Hanscheid T, Grobusch MP. COVID-19 treatment in sub-Saharan Africa: If the best is not available, the available becomes the best. Travel Med Infect Dis 2020; 37:101878. [PMID: 32927051 PMCID: PMC7485546 DOI: 10.1016/j.tmaid.2020.101878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Jan H Dubbink
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands
| | - Tiago Martins Branco
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Kelfala Bb Kamara
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - James S Bangura
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Erik Wehrens
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands; Capacare, Trondheim, Norway, and Freetown, Sierra Leone
| | - Abdul M Falama
- District Health Medical Team, District Medical Office, Magburaka, Tonkolili District, Sierra Leone
| | - Abraham Goorhuis
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands
| | - Peter B Jørgensen
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Stephen S Sevalie
- Joint Medical Unit, 34 Military Hospital, Republic of Sierra Leone Armed Forces, Free Town, Sierra Leone; National COVID-19 Emergency Response Team, National Emergency Operations Centre, Free Town, Sierra Leone
| | | | - Martin Peter Grobusch
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands.
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Obadha M, Chuma J, Kazungu J, Abiiro GA, Beck MJ, Barasa E. Preferences of healthcare providers for capitation payment in Kenya: a discrete choice experiment. Health Policy Plan 2020; 35:842-854. [PMID: 32537642 PMCID: PMC7487334 DOI: 10.1093/heapol/czaa016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 11/13/2022] Open
Abstract
Provider payment mechanisms (PPMs) are important to the universal health coverage (UHC) agenda as they can influence healthcare provider behaviour and create incentives for health service delivery, quality and efficiency. Therefore, when designing PPMs, it is important to consider providers' preferences for PPM characteristics. We set out to uncover senior health facility managers' preferences for the attributes of a capitation payment mechanism in Kenya. We use a discrete choice experiment and focus on four capitation attributes, namely, payment schedule, timeliness of payments, capitation rate per individual per year and services to be paid by the capitation rate. Using a Bayesian efficient experimental design, choice data were collected from 233 senior health facility managers across 98 health facilities in seven Kenyan counties. Panel mixed multinomial logit and latent class models were used in the analysis. We found that capitation arrangements with frequent payment schedules, timelier disbursements, higher payment rates per individual per year and those that paid for a limited set of health services were preferred. The capitation rate per individual per year was the most important attribute. Respondents were willing to accept an increase in the capitation rate to compensate for bundling a broader set of health services under the capitation payment. In addition, we found preference heterogeneity across respondents and latent classes. In conclusion, these attributes can be used as potential targets for interventions aimed at configuring capitation to achieve UHC.
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Affiliation(s)
- Melvin Obadha
- Health Economics Research Unit, KEMRI|Wellcome Trust Research Programme, P.O. Box 43640 – 00100, Nairobi, Kenya
| | - Jane Chuma
- Health Economics Research Unit, KEMRI|Wellcome Trust Research Programme, P.O. Box 43640 – 00100, Nairobi, Kenya
- The World Bank, Kenya Country Office, P.O. Box 30577-00100, Nairobi, Kenya
| | - Jacob Kazungu
- Health Economics Research Unit, KEMRI|Wellcome Trust Research Programme, P.O. Box 43640 – 00100, Nairobi, Kenya
| | - Gilbert Abotisem Abiiro
- Department of Planning, Faculty of Planning and Land Management, University for Development Studies, Wa, Ghana
| | - Matthew J Beck
- Institute of Transport and Logistics Studies, Business School, The University of Sydney, Darlington, New South Wales 2006, Australia
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI|Wellcome Trust Research Programme, P.O. Box 43640 – 00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford OX1 3SY, UK
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Harter TD, Iltis A, Clay MC, Aulisio M. COVID-19 and Financial Vulnerability: What Health Care Organizations and Society Owe Each Other. Am J Bioeth 2020; 20:139-141. [PMID: 32432515 DOI: 10.1080/15265161.2020.1764143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Ochoa-Moreno I, Bautista-Arredondo S, McCoy SI, Buzdugan R, Mangenah C, Padian NS, Cowan FM. Costs and economies of scale in the accelerated program for prevention of mother-to-child transmission of HIV in Zimbabwe. PLoS One 2020; 15:e0231527. [PMID: 32433715 PMCID: PMC7239451 DOI: 10.1371/journal.pone.0231527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/25/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Despite a growing body of literature on HIV service costs in sub-Saharan Africa, only a few studies have estimated the facility-level cost of prevention of Mother-to-Child Transmission (PMTCT) services, and even fewer provide insights into the variation of PMTCT costs across facilities. In this study, we present the first empirical costs estimation of the accelerated program for the prevention of mother-to-child transmission of HIV in Zimbabwe and investigate the determinants of heterogeneity of the facility-level average cost per service. To understand such variation, we explored the association between average costs per service and supply-and demand-side characteristics, and quality of services. One aspect of the supply-side we explore carefully is the scale of production-which we define as the annual number of women tested or the yearly number of HIV-positive women on prophylaxis. METHODS We collected rich data on the costs and PMTCT services provided by 157 health facilities out of 699 catchment areas in five provinces in Zimbabwe for 2013. In each health facility, we measured total costs and the number of women covered with PMTCT services and estimated the average cost per woman tested and the average cost per woman on either ARV prophylaxis or ART. We refer to these facility-level average costs per service as unitary costs. We also collected information on potential determinants of the variation of unitary costs. On the supply-side, we gathered data on the scale of production, staff composition and on the types of antenatal and family planning services provided. On the demand side, we measured the total population at the catchment area and surveyed eligible pairs of mothers and infants about previous use of HIV testing and prenatal care, and on the HIV status of both mothers and infants. We explored the determinants of unitary cost variation using a two-stage linear regression strategy. RESULTS The average annual total cost of the PMTCT program per facility was US$16,821 (median US$8,920). The average cost per pregnant woman tested was US$80 (median US$47), and the average cost per HIV-positive pregnant woman initiated on ARV prophylaxis or treatment was US$786 annually (median US$420). We found substantial heterogeneity of unitary costs across facilities regardless of facility type. The scale of production was a strong predictor of unitary costs variation across facilities, with a negative and statistically significant correlation between the two variables (p<0.01). CONCLUSIONS These findings are the first empirical estimations of PMTCT costs in Zimbabwe. Unitary costs were found to be heterogeneous across health facilities, with evidence consistent with economies of scale.
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Affiliation(s)
- I. Ochoa-Moreno
- National Institute of Public Health, Cuernavaca, Mexico
- University of York, York, England, United Kingdom
| | - S. Bautista-Arredondo
- National Institute of Public Health, Cuernavaca, Mexico
- University of California, Berkeley, California, United States of America
| | - S. I. McCoy
- University of California, Berkeley, California, United States of America
| | - R. Buzdugan
- University of California, Berkeley, California, United States of America
| | - C. Mangenah
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - N. S. Padian
- University of California, Berkeley, California, United States of America
| | - F. M. Cowan
- Liverpool School of Tropical Medicine, Liverpool, England, United Kingdom
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Machuki JA, Aduda DSO, Omondi AB, Onono MA. Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya. PLoS One 2019; 14:e0225194. [PMID: 31743375 PMCID: PMC6863537 DOI: 10.1371/journal.pone.0225194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022] Open
Abstract
Background Globally, pneumonia accounted for 16% of deaths among children under 5 years of age and was one of the major causes of death overall in 2018. Kenya is ranked among the top 15 countries with regard to pneumonia prevalence and contributed approximately 74% of the world's annual pneumonia cases in 2018. Unfortunately, less than 50% of children with pneumonia receive appropriate antibiotics for treatment. Homa-Bay County implemented pneumonia community case management utilizing community health workers, as recommended by the World Health Organization (WHO), in 2014. However, since implementation of the program, the relative patient-level cost of home-based and facility-based treatment of pneumonia, as well as the main drivers of these costs in Suba Subcounty, remain uncertain. Therefore, the main objective of this study was to compare the patient-level costs of home based treatment of pneumonia by a community health worker with those of health facility-based treatment. Methods and findings Using a cross-sectional study design, a structured questionnaire was used to collect quantitative data from 208 caregivers on the direct costs (consultation, medicine, transportation) and indirect costs (opportunity cost) of pneumonia treatment. The average household cost for the community managed patients was KSH 122.65 ($1.29) compared with KSh 447.46 ($4.71), a 4-fold difference, for those treated at the health facility. The largest cost drivers for home treatment and health facility treatment were opportunity costs (KSH 88.25 ($ 0.93)) and medicine costs (KSH 126.16 ($ 1.33)), respectively. Conclusion This study demonstrates that the costs incurred for home-based pneumonia management are considerably lower compared to those incurred for facility-based management. Opportunity costs (caregiver time and forgone wages) and the cost of medication were the key cost-drivers in the management of pneumonia at the health facility and at home, respectively. These findings emphasize the need to strengthen and scale community case management to overcome barriers and delays in accessing the correct treatment for pneumonia for sick children under 5 years of age.
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Affiliation(s)
- Joel Amenya Machuki
- Department of Research, Kenya Medical Research Institute, Kisumu, Kenya
- * E-mail:
| | - Dickens S. Omondi Aduda
- Department of Public Health and Community Development, University of Kabianga, Kericho, Kenya
| | - Abong’o B. Omondi
- Department of Biomedical Sciences and Technology, The National University of Lesotho, Maseru, Lesotho
- Department of Biology, National University of Lesotho, Lesotho, South Africa
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Lang’at E, Mwanri L, Temmerman M. Effects of implementing free maternity service policy in Kenya: an interrupted time series analysis. BMC Health Serv Res 2019; 19:645. [PMID: 31492134 PMCID: PMC6729061 DOI: 10.1186/s12913-019-4462-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 08/26/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Maternal and perinatal mortality is a major public health concern across the globe and more so in low and middle-income countries. In Kenya, more than 6000 maternal deaths, and 35,000 stillbirths occur each year. The Government of Kenya abolished user fee for maternity care under the Free Maternity Service policy, in June of 2013 in all public health facilities, a move to make maternity services accessible and affordable, and to reduce maternal and perinatal mortality. METHOD An observational retrospective study was carried out in 3 counties in Kenya. Six maternal health output indicators were observed monthly, 2 years pre and 2 years post- policy implementation. Data was collected from daily maternity registers in 90 public health facilities across the 3 counties all serving an estimated population of 3 million people. Interrupted Time Series Analysis (ITSA) with a single group was used to assess the effects of the policy. Standard linear regression using generalized least squares (gls) model, was used to run the results for each of the six variables of interest. Absolute and relative changes were calculated using the gls model coefficients. RESULTS Significant sustained increase of 89, 97, and 98% was observed in the antenatal care visits, health facility deliveries, and live births respectively, after the policy implementation. An immediate and significant increase of 27% was also noted for those women who received Emergency Obstetric Care (EmONC) services in either the level 5, 4 and 3 health facilities. No significant changes were observed in the stillbirth rate and caesarean section rate following policy implementation. CONCLUSION After 2 years of implementing the Free Maternity Service policy in Kenya, immediate and sustained increase in the use of skilled care during pregnancy and childbirth was observed. The study suggest that hospital cost is a major expense incurred by most women and their families whilst seeking maternity care services and a barrier to maternity care utilization. Overall, Free Maternity Service policy, as a health financing strategy, has exhibited the potential of realizing the full beneficial effects of maternal morbidity and mortality reduction by increasing access to skilled care.
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Affiliation(s)
- Evaline Lang’at
- Department of Health, County Government of Kilifi, P. O Box 9-80108, Kilifi, Kenya
| | - Lillian Mwanri
- South Australia College of Medicine and Public Health, Flinders University, Flinders University Registry Road, Bedford Park, South Australia 5042 Australia
| | - Marleen Temmerman
- Director at Centre of Excellence in Women and Child Health, Aga Khan University, Aga Khan University Hospital, P.O. Box 30270-00100, Nairobi, Kenya
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Fleming PJ, Lopez WD, Mesa H, Rion R, Rabinowitz E, Bryce R, Doshi M. A qualitative study on the impact of the 2016 US election on the health of immigrant families in Southeast Michigan. BMC Public Health 2019; 19:947. [PMID: 31307435 PMCID: PMC6631662 DOI: 10.1186/s12889-019-7290-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Given the anti-immigrant rhetoric and policy proposals by President Donald Trump during the 2016 presidential campaign and afterwards, his election to president in November 2016 and subsequent policy changes has affected immigrant families. In this study, we aim to better understand how post-election policy change may have impacted the health and well-being, including health and social service utilization, of Latino immigrants in Southeastern Michigan. METHODS We conducted 28 in-depth interviews with frontline staff at two Federally Qualified Health Centers and a non-profit agency. These staff had intimate knowledge of and insights into the lived experiences of the mixed-status immigrant families they serve. The interviews were audio recorded, transcribed, and analyzed thematically. RESULTS Our findings show three major themes: (1) An increased and pervasive fear of deportation and family separation among mixed-status immigrant clients, (2) The fear of deportation and family separation has resulted in fractures in community cohesion, and (3) Fear of deportation and family separation has had an impact on the healthcare utilization and health-related behaviors of mixed-status families. Staff members report that these three factors have had an impact on physical and mental health of these immigrant clients. CONCLUSIONS These results add to previous literature on the effect of immigration policies on the health and provide key insights for interventions to improve the health of immigrants within this socio-political environment.
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Affiliation(s)
- Paul J. Fleming
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
| | - William D. Lopez
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
| | - Hannah Mesa
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
| | | | | | - Richard Bryce
- Community Health and Social Services (CHASS) Center, Detroit, MI USA
| | - Monika Doshi
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
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Abstract
BACKGROUND Despite large investment in central and state sponsored schemes for maternal care, out-of-pocket expenditure (OOPE) and catastrophic health spending (CHS) on institutional delivery remain high over time, across states and across socio-economic groups. Though many studies have examined the OOPE and CHS, few studies have examined the nature and extent of distress financing on institutional delivery in India. DATA Data from the fourth round of National Family Health Survey (NFHS 4), 2015-16 was used for the analysis. Distress financing was defined as borrowing money or selling assets to meet the OOPE on delivery care. Composite variables, descriptive analyses, concentration index (CI), concentration curve (CC) and predicted probability were used to estimate the extent of distress financing for institutional delivery in India. RESULTS The OOPE on institutional delivery has strong economic and educational gradient. One in four mothers resorted to borrowing or selling to meet the OOPE on institutional delivery. The extent of distress financing on institutional delivery was high in poorer state of Bihar and Odisha and in the state of Telangana that had highest prevalence of caesarean delivery. Savings was more prevalent among mothers compared to those who met the OOPE by borrowing/selling of assets. Finding are robust across the states of India. The predicted probability of incurring distress financing was 0.31 among mothers belonging to the poorest wealth quintile compared to 0.09 in the richest quintile, and 0.40 for those who incurred OOPE of more than INR 20,000. The probability of incurring distress financing was higher for mothers who had caesarean birth, delivered in private health centers and incurred high OOPE on institutional delivery. CONCLUSION Distress financing on institutional delivery was higher among the less educated, poor and in private health centers. Increasing use of public health centers, reducing caesarean births, improving the availability of medicine and diagnostic services can reduce the extent of distress financing in India.
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Affiliation(s)
- Suyash Mishra
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088 India
| | - Sanjay K. Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088 India
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Abstract
Background Donor funding for HIV/AIDS services is declining in Cambodia, and domestic resources need to be mobilized to sustain and expand these services. However, the cost of delivering HIV/AIDS services is not well studied in Cambodia. This study aims to assess the costs of delivering HIV/AIDS services, identify the major components of costs, and sources of funding. Methods Four of the six highest HIV burden provinces were selected at random for this study. Within each province, four health centers and two hospitals were selected for detailed data collection. A mix of top-down and bottom-up methods were used to assess the costs for HIV testing and antiretroviral therapy (ART) from the provider perspective. We assessed the differences in the quantity and prices of inputs between health facilities of the same type to identify cost-drivers. Results The average cost per visit for HIV testing was $8.92 at health centers and $14.03 at referral hospitals. Differences in the number of visits per staff were the primary determinant of differences in the cost per visit. First-line ART costed about $250 per patient per year, and the number of patients per staff was an important cost driver. Second-line ART costed from $500 to $716 per patient per year, on average, across the types of facilities, with the quantity and mix of second-line antiretroviral drugs being an important cost driver. Inpatient care at referral and provincial hospitals in total represented less than 2 percent of costs of outpatient ART. Discussion Costs are similar to neighboring countries, but over 50% of the costs of ART are financed by donors. Cambodia now is scaling up social health insurance coverage; the data from this study could serve as one input when setting reimbursement rates for HIV/AIDS services to help ensure that providers are adequately reimbursed for their services.
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Affiliation(s)
- Kouland Thin
- Health Division, Swiss Development Cooperation, Phnom Penh, Cambodia
- * E-mail:
| | - Virak Prum
- Department of Geography, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Benjamin Johns
- International Development Division, Abt Associates, Inc., Bethesda, Maryland, United States
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Acharya Y, Dahal R, Bista NR, Khanal MC, Bista S. Regulation of Surgical Procedures and Health Care Facilities Rankings in Nepal. JNMA J Nepal Med Assoc 2019. [PMID: 31080250 PMCID: PMC8827574 DOI: 10.31729/jnma.4088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Globally, millions of surgeries are performed each year to compliment and manage a diverse set of medical conditions. Adverse surgical outcomes constitute a major proportion of avoidable death and disabilities in the hospital, especially in low-income countries like Nepal. A comprehensive study on the standards of surgical procedures and its institutional regulations is missing. We discuss here the importance of surgical regulation based on it's financial as well as healthcare implications in the Nepalese healthcare system.
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Affiliation(s)
- Yogesh Acharya
- Avalon University School of Medicine (AUSOM), Willemstad, Curacao, Netherlands Antilles
| | - Ranjan Dahal
- Saint Peters University Hospital, New Jersey, USA
- Correspondence: Dr. Ranjan Dahal, Department of Internal Medicine, Saint Peters University Hospital Saint Peters University Hospital, New Jersey, USA. , Phone: +1-4693090500
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van Rijt AM, Dik JWH, Lokate M, Postma MJ, Friedrich AW. Cost analysis of outbreaks with Methicillin-resistant Staphylococcus aureus (MRSA) in Dutch long-term care facilities (LTCF). PLoS One 2018; 13:e0208092. [PMID: 30475904 PMCID: PMC6258236 DOI: 10.1371/journal.pone.0208092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/12/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives Highly resistant microorganisms (HRMOs) are of high concern worldwide and are becoming increasingly less susceptible for antibiotics. To study the cost effectiveness of infection prevention measures in long-term care, it is essential to first fully understand the impact of HRMOs. The objective of this study is to identify the costs associated with outbreaks caused by Methicillin-resistant Staphylococcus aureus (MRSA) in Dutch long-term care facilities (LTCF). Methods After an outbreak of MRSA, Dutch LTCF can submit a reimbursement form to the Dutch Healthcare Authority (“Nederlandse Zorgautoriteit”; NZa) to get a part of the total costs reimbursed. In this study, we requested NZa forms for financial impact analysis. Details regarding the costs of the outbreak have been extracted from these forms and additionally specific LTCF have been visited in person to validate the data. Results 34 complete reimbursement forms from the period between 2011 and 2016 were received from the NZa and have been included. The median cost per patient per day was estimated at €83.80, varying between €16.89 and €1,820.09. We validated five reimbursement forms by visiting the facility and recalculating the costs. We found a non-significant positive difference of €26.07 compared with the original data (p = 0.068). Conclusions This study is to our knowledge the first to give a national overview of total costs associated with an MRSA outbreak in LTCF in the Netherlands. Overall, costs per patient per day seem lower than in a hospital setting, although total costs are much higher due to the long term of care.
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Affiliation(s)
- Antonius M. van Rijt
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Willem H. Dik
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Mariëtte Lokate
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten J. Postma
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Alex W. Friedrich
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
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Ntambue AM, Malonga FK, Dramaix-Wilmet M, Ilunga TM, Musau AN, Matungulu CM, Cowgill KD, Donnen P. Commercialization of obstetric and neonatal care in the Democratic Republic of the Congo: A study of the variability in user fees in Lubumbashi, 2014. PLoS One 2018; 13:e0205082. [PMID: 30304060 PMCID: PMC6179261 DOI: 10.1371/journal.pone.0205082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/19/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE In the Democratic Republic of the Congo, insufficient state financing of the health system produced weak progress toward targets of Millennium Development Goals 4 and 5. In Lubumbashi, almost all women pay out-of-pocket for obstetric and neonatal care. As no standard pricing system has been implemented, there is great variation in payments related to childbirth between health facilities and even within the same facility. This work investigates the determinants of this variation. METHODS We conducted a cross-sectional study including women from admission through discharge at 92 maternity wards in Lubumbashi in March 2014. The women's payments were collected and validated by triangulating interviews of new mothers and nurses with document review. We studied payments related to delivery from the perspective of women delivering. The total was the sum of the payments linked to seeking and accessing care and transport of the woman and companion. The determinants were assessed by multilevel regression. RESULTS Median payments for delivery varied by type: for an uncomplicated vaginal delivery, US$45 (range, US$17-260); for a complicated vaginal delivery US$60 (US$16-304); and for a Cesarean section, US$338 (US$163-782). Vaginal delivery was more expensive at health centers than in general referral hospitals or polyclinics. Cesarean sections done in corporate polyclinics and hospitals were more expensive than those done in the general referral hospitals. Referral of delivering women, use of more highly trained personnel, and a longer stay in the maternity unit contributed to higher expenses. A vaginal delivery in the private sector was more cost-effective than in the public sector. CONCLUSION To guarantee universal coverage of high-quality care, we suggest that the government and funders in DRC support health insurance and risk pool initiatives, and introduce and institutionalize free mother and infant care.
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Affiliation(s)
- Abel Mukengeshayi Ntambue
- Unité d’Epidémiologie et de Santé de la mère, du nouveau-né et de l’enfant, École de Santé Publique, Université de Lubumbashi, Lubumbashi, RDC
| | - Françoise Kaj Malonga
- Unité d’Epidémiologie et de Santé de la mère, du nouveau-né et de l’enfant, École de Santé Publique, Université de Lubumbashi, Lubumbashi, RDC
| | - Michèle Dramaix-Wilmet
- Centre de recherche en Epidémiologie, Biostatistiques et recherche clinique, École de Santé Publique Université Libre de Bruxelles, Brussels, Belgium
| | - Tabitha Mpoyi Ilunga
- Unité d’Epidémiologie et de Santé de la mère, du nouveau-né et de l’enfant, École de Santé Publique, Université de Lubumbashi, Lubumbashi, RDC
| | - Angel Nkola Musau
- Unité d’Epidémiologie et de Santé de la mère, du nouveau-né et de l’enfant, École de Santé Publique, Université de Lubumbashi, Lubumbashi, RDC
| | - Charles Matungulu Matungulu
- Unité d’Epidémiologie et de Santé de la mère, du nouveau-né et de l’enfant, École de Santé Publique, Université de Lubumbashi, Lubumbashi, RDC
| | - Karen D. Cowgill
- School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, and Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Philippe Donnen
- Centre de recherche en Epidémiologie, Biostatistiques et recherche clinique, École de Santé Publique Université Libre de Bruxelles, Brussels, Belgium
- Centre de Recherche en Politiques et systèmes de santé-Santé internationale, École de Santé Publique Université Libre de Bruxelles, Brussels, Belgium
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Bautista-Arredondo S, Sosa-Rubi SG, Opuni M, Contreras-Loya D, La Hera-Fuentes G, Kwan A, Chaumont C, Chompolola A, Condo J, Dzekedzeke K, Galarraga O, Martinson N, Masiye F, Nsanzimana S, Wamai R, Wang’ombe J. Influence of supply-side factors on voluntary medical male circumcision costs in Kenya, Rwanda, South Africa, and Zambia. PLoS One 2018; 13:e0203121. [PMID: 30212497 PMCID: PMC6136711 DOI: 10.1371/journal.pone.0203121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/30/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In this study, we described facility-level voluntary medical male circumcision (VMMC) unit cost, examined unit cost variation across facilities, and investigated key facility characteristics associated with unit cost variation. METHODS We used data from 107 facilities in Kenya, Rwanda, South Africa, and Zambia covering 2011 or 2012. We used micro-costing to estimate economic costs from the service provider's perspective. Average annual costs per client were estimated in 2013 United States dollars (US$). Econometric analysis was used to explore the relationship between VMMC total and unit cost and facility characteristics. RESULTS Average VMMC unit cost ranged from US$66 (SD US$79) in Kenya to US$160 (SD US$144) in South Africa. Total cost function estimates were consistent with economies of scale and scope. We found a negative association between the number of VMMC clients and VMMC unit cost with a 3% decrease in unit cost for every 10% increase in number of clients and we found a negative association between the provision of other HIV services and VMMC unit cost. Also, VMMC unit cost was lower in primary health care facilities than in hospitals, and lower in facilities implementing task shifting. CONCLUSIONS Substantial efficiency gains could be made in VMMC service delivery in all countries. Options to increase efficiency of VMMC programs in the short term include focusing service provision in high yield sites when demand is high, focusing on task shifting, and taking advantage of efficiencies created by integrating HIV services. In the longer term, reductions in VMMC unit cost are likely by increasing the volume of clients at facilities by implementing effective demand generation activities.
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Affiliation(s)
- Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
- School of Public Health, University of California, Berkeley, United States of America
| | - Sandra G. Sosa-Rubi
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
- * E-mail:
| | | | - David Contreras-Loya
- School of Public Health, University of California, Berkeley, United States of America
| | - Gina La Hera-Fuentes
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Ada Kwan
- School of Public Health, University of California, Berkeley, United States of America
| | - Claire Chaumont
- T.H. Chan School of Public Health, Harvard University, Boston, United States of America
| | | | - Jeanine Condo
- School of Public Health, National University of Rwanda, Kigali, Rwanda
| | | | - Omar Galarraga
- School of Public Health, Brown University, Providence, United States of America
| | - Neil Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Felix Masiye
- Division of Economics, University of Zambia, Lusaka, Zambia
| | | | - Richard Wamai
- College of Social Science and Humanities, Northeastern University, Boston, United States of America
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Renggli S, Mayumana I, Mboya D, Charles C, Maeda J, Mshana C, Kessy F, Tediosi F, Pfeiffer C, Schulze A, Aerts A, Lengeler C. Towards improved health service quality in Tanzania: An approach to increase efficiency and effectiveness of routine supportive supervision. PLoS One 2018; 13:e0202735. [PMID: 30192783 PMCID: PMC6128487 DOI: 10.1371/journal.pone.0202735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/08/2018] [Indexed: 11/19/2022] Open
Abstract
Effective supportive supervision of healthcare services is crucial for improving and maintaining quality of care. However, this process can be challenging in an environment with chronic shortage of qualified human resources, overburdened healthcare providers, multiple roles of district managers, weak supply chains, high donor fragmentation and inefficient allocation of limited financial resources. Operating in this environment, we systematically evaluated an approach developed in Tanzania to strengthen the implementation of routine supportive supervision of primary healthcare providers. The approach included a systematic quality assessment at health facilities using an electronic tool and subsequent result dissemination at council level. Mixed methods were used to compare the new supportive supervision approach with routine supportive supervision. Qualitative data was collected through in-depth interviews in three councils. Observational data and informal communication as well as secondary data complemented the data set. Additionally, an economic costing analysis was carried out in the same councils. Compared to routine supportive supervision, the new approach increased healthcare providers’ knowledge and skills, as well as quality of data collected and acceptance of supportive supervision amongst stakeholders involved. It also ensured better availability of evidence for follow-up actions, including budgeting and planning, and higher stakeholder motivation and ownership of subsequent quality improvement measures. The new approach reduced time and cost spent during supportive supervision. This increased feasibility of supportive supervision and hence the likelihood of its implementation. Thus, the results presented together with previous findings suggested that if used as the standard approach for routine supportive supervision the new approach offers a suitable option to make supportive supervision more efficient and effective and therewith more sustainable. Moreover, the new approach also provides informed guidance to overcome several problems of supportive supervision and healthcare quality assessments in low- and middle income countries.
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Affiliation(s)
- Sabine Renggli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Iddy Mayumana
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Dominick Mboya
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Christopher Charles
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Justin Maeda
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Christopher Mshana
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Flora Kessy
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Kavanaugh ML, Zolna MR, Burke KL. Use of Health Insurance Among Clients Seeking Contraceptive Services at Title X-Funded Facilities in 2016. Perspect Sex Reprod Health 2018; 50:101-109. [PMID: 29894024 PMCID: PMC6135668 DOI: 10.1363/psrh.12061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT As federal initiatives aim to fundamentally alter or dismantle the Affordable Care Act (ACA), evidence regarding the use of insurance among clients obtaining contraceptive care at Title X-funded facilities under ACA guidelines is essential to understanding what is at stake. METHODS A nationally representative sample of 2,911 clients seeking contraceptive care at 43 Title X-funded sites in 2016 completed a survey assessing their characteristics and insurance coverage and use. Chi-square tests for independence with adjustments for the sampling design were conducted to determine differences in insurance coverage and use across demographic characteristics and facility types. RESULTS Most clients (71%) had some form of public or private health insurance, and most of these (83%) planned to use it to pay for their services. Foreign-born clients were less likely than U.S.-born clients to have coverage (46% vs. 75%) and to use it (78% vs. 85%). Clients with private insurance were less likely than those with public insurance to plan to use their insurance (75% vs. 91%). More than one-quarter of clients not planning to use existing insurance for services indicated that the reason was that someone might find out. CONCLUSION Coverage gaps persist among individuals seeking contraceptive care within the Title X network, despite evidence indicating increases in health insurance coverage among this population since implementation of the ACA. Future research should explore the impact of altering or eliminating the ACA both on the Title X provider network and on the individuals who rely on it.
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Affiliation(s)
| | - Mia R. Zolna
- Senior research associate, at the Guttmacher Institute, New York
| | - Kristen L. Burke
- Senior research assistant, at the Guttmacher Institute, New York
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Yaya S, Bishwajit G, Uthman OA, Amouzou A. Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria. PLoS One 2018; 13:e0196896. [PMID: 29723253 PMCID: PMC5933759 DOI: 10.1371/journal.pone.0196896] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background Obstetric complications and maternal deaths can be prevented through safe delivery process. Facility based delivery significantly reduces maternal mortality by increasing women’s access to skilled personnel attendance. However, in sub-Saharan Africa, most deliveries take place without skilled attendants and outside health facilities. Utilization of facility-based delivery is affected by socio-cultural norms and several other factors including cost, long distance, accessibility and availability of quality services. This study examined country-level variations of the self-reported causes of not choosing to deliver at a health facility. Methods Cross-sectional data on 37,086 community dwelling women aged between 15–49 years were collected from DHS surveys in Ethiopia (n = 13,053) and Nigeria (n = 24,033). Outcome variables were the self-reported causes of not delivering at health facilities which were regressed against selected sociodemographic and community level determinants. In total eight items complaints were identified for non-use of facility delivery: 1) Cost too much 2) Facility not open, 3) Too far/no transport, 4) don’t trust facility/poor service, 5) No female provider, 6) Husband/family didn’t allow, 7) Not necessary, 8) Not customary. Multivariable regression methods were used for measuring the associations. Results In both countries a large proportion of the women mentioned facility delivery as not necessary, 54.9% (52.3–57.9) in Nigeria and 45.4% (42.0–47.5) in Ethiopia. Significant urban-rural variations were observed in the prevalence of the self-reported causes of non-utilisation. Women in the rural areas are more likely to report delivering at health facility as not customary/not necessary and healthy facility too far/no transport. However, urban women were more likely to complain that husband/family did not allow and that the costs were too high. Conclusion Women in the rural were more likely to regard facility delivery as unnecessary and complain about transportation and financial difficulties. In order to achieving the maternal mortality related targets, addressing regional disparities in accessing maternal healthcare services should be regarded as a priority of health promotion programs in Nigeria and Ethiopia.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- * E-mail:
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Olalekan A. Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Agbessi Amouzou
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
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Kushitor MK, Boatemaa S. The double burden of disease and the challenge of health access: Evidence from Access, Bottlenecks, Cost and Equity facility survey in Ghana. PLoS One 2018; 13:e0194677. [PMID: 29570720 PMCID: PMC5865721 DOI: 10.1371/journal.pone.0194677] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 03/07/2018] [Indexed: 11/18/2022] Open
Abstract
Despite the double burden of infectious and chronic non-communicable diseases in Africa, health care expenditure disproportionately favours infectious diseases. In this paper, we examine quantitatively the extent of this disproportionate access to diagnoses and treatment of diabetes, hypertension and malaria in Ghana. A total of 220 health facilities was surveyed across the country in 2011. Findings indicate that diagnoses and treatment of infectious diseases were more accessible than NCDs. In terms of treatment, 78% and 87% of health facilities had two of the recommended malaria drugs while less than 35% had essential diabetes and hypertension drugs. There is a significant unmet need for diagnoses and treatment of NCDs in Ghana. These inequities have implications for high morbidity and mortality from NCDs. We recommend the use of task shifting as a model to increase the delivery of NCD services.
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Affiliation(s)
| | - Sandra Boatemaa
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
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Sabde Y, Chaturvedi S, Randive B, Sidney K, Salazar M, De Costa A, Diwan V. Bypassing health facilities for childbirth in the context of the JSY cash transfer program to promote institutional birth: A cross-sectional study from Madhya Pradesh, India. PLoS One 2018; 13:e0189364. [PMID: 29385135 PMCID: PMC5791953 DOI: 10.1371/journal.pone.0189364] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 11/25/2017] [Indexed: 11/23/2022] Open
Abstract
Bypassing health facilities for childbirth can be costly both for women and health systems. There have been some reports on this from Sub-Saharan African and from Nepal but none from India. India has implemented the Janani Suraksha Yojana (JSY), a large national conditional cash transfer program which has successfully increased the number of institutional births in India. This paper aims to study the extent of bypassing the nearest health facility offering intrapartum care in three districts of Madhya Pradesh, India, and to identify individual and facility determinants of bypassing in the context of the JSY program. Our results provide information to support the optimal utilization of facilities at different levels of the healthcare system for childbirth. Data was collected from 96 facilities (74 public) and 720 rural mothers who delivered at these facilities were interviewed. Multilevel logistic regression was used to analyze the data. Facility obstetric care functionality was assessed by the number of emergency obstetric care (EmOC) signal functions performed in the last three months. Thirty eighth percent of the mothers bypassed the nearest public facility for their current delivery. Primiparity, higher education, arriving by hired transport and a longer distance from home to the nearest facility increased the odds of bypassing a public facility for childbirth. The variance partition coefficient showed that 37% of the variation in bypassing the nearest public facility can be attributed to difference between facilities. The number of basic emergency obstetric care signal functions (AOR = 0.59, 95% CI 0.37–0.93), and the availability of free transportation at the nearest facility (AOR = 0.11, 95% CI 0.03–0.31) were protective factors against bypassing. The variation between facilities (MOR = 3.85) was more important than an individual’s characteristics to explain bypassing in MP. This multilevel study indicates that in this setting, a focus on increasing the level of emergency obstetric care functionality in public obstetric care facilities will allow more optimal utilization of facilities for childbirth under the JSY program thereby leading to better outcomes for mothers.
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Affiliation(s)
- Yogesh Sabde
- Department of Community Medicine, R.D. Gardi Medical College, Ujjain, India
| | - Sarika Chaturvedi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain, India
| | - Bharat Randive
- Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain, India
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Kristi Sidney
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mariano Salazar
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Ayesha De Costa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Vishal Diwan
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain, India
- International Centre for Health Research, R.D. Gardi Medical College, Ujjain, India
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Gupta A, Fledderjohann J, Reddy H, Raman VR, Stuckler D, Vellakkal S. Barriers and prospects of India's conditional cash transfer program to promote institutional delivery care: a qualitative analysis of the supply-side perspectives. BMC Health Serv Res 2018; 18:40. [PMID: 29370798 PMCID: PMC5785836 DOI: 10.1186/s12913-018-2849-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Under the National Health Mission (NHM) of India, Janani Suraksha Yojana (JSY) offers conditional cash transfer and support services to pregnant women to use institutional delivery care facilities. This study aims to understand community health workers' (ASHAs) and program officials' perceptions regarding barriers to and prospects for the uptake of facilities offered under the JSY. METHODS Fifty in-depth interviews of a purposively selected sample of ASHAs (n = 12), members of Village Health and Sanitation Committees (n = 11), and officials at different tiers of healthcare facilities (n = 27) were conducted in three Indian states. The data were analyzed thematically using ATLAS.ti software. RESULTS Although the JSY has triggered considerable advancement on the Indian maternal and child health front, there are several barriers to be resolved pertaining to i) delivering quality care at health-facility; ii) linkages between home and health-facility; and iii) the community/household context. At the facility level, respondents cited an inability to treat birth complications as a barrier to JSY uptake, resulting in referrals to other (mostly private) facilities. Despite increased investment in health infrastructure under the program, shortages in emergency obstetric-care facilities, specialists and staff, essential drugs, diagnostics, and necessary equipment persisted. Weaker linkages between various vertical (standalone) elements of maternal and primary healthcare programs, and nearly uniform resource allocation to all facilities irrespective of caseloads and actual need also constrained the provision of quality healthcare. Barriers affecting the linkages between home and facility arose mainly due to the mismatch between the multiple demands and the availability of transport facilities, especially in emergency situations. Regarding community/household context, several socio-cultural issues such as resistance towards the ASHA's efforts of counselling, particularly from elderly family members, often adversely affected people's decision to seek healthcare. CONCLUSION Adequate interventions at the community level, capacity building for healthcare providers, and measures to address underlying structural and systemic barriers are needed to improve the uptake of institutional maternal healthcare.
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Affiliation(s)
- Adyya Gupta
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - David Stuckler
- Department of Policy Analysis and Public Management, University of Bocconi, Milan, Italy
- Department of Sociology, University of Oxford, Oxford, UK
| | - Sukumar Vellakkal
- BITS Pilani Goa Campus, Zuarinagar, Goa, 403726, India.
- Public Health Foundation of India, Gurgaon, Haryana, India.
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Gils T, Bossard C, Verdonck K, Owiti P, Casteels I, Mashako M, Van Cutsem G, Ellman T. Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV. PLoS One 2018; 13:e0191294. [PMID: 29351338 PMCID: PMC5774776 DOI: 10.1371/journal.pone.0191294] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/01/2018] [Indexed: 11/22/2022] Open
Abstract
Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29-90) and 44 days (interquartile range 24-90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction of new ART regimens needs additional planning.
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Affiliation(s)
- Tinne Gils
- Médecins sans Frontières, Southern Africa Medical Unit, Cape Town, South Africa
| | - Claire Bossard
- Médecins sans Frontières, Southern Africa Medical Unit, Cape Town, South Africa
| | | | - Philip Owiti
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Ilse Casteels
- Médecins sans Frontières, Operational Centre Brussels, Kinshasa, DRC
| | - Maria Mashako
- Médecins sans Frontières, Operational Centre Brussels, Kinshasa, DRC
| | - Gilles Van Cutsem
- Médecins sans Frontières, Southern Africa Medical Unit, Cape Town, South Africa
| | - Tom Ellman
- Médecins sans Frontières, Southern Africa Medical Unit, Cape Town, South Africa
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Macaia D, Lapão LV. The current situation of human resources for health in the province of Cabinda in Angola: is it a limitation to provide universal access to healthcare? Hum Resour Health 2017; 15:88. [PMID: 29282067 PMCID: PMC5745878 DOI: 10.1186/s12960-017-0255-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Angola is among sub-Saharan African countries dealing with a crisis of Human Resources for Health (HRH). The province of Cabinda, besides the efforts, still suffers from both HRH shortage and a badly distributed health workforce. In Cabinda, one can find urban concentration and rural shortages of healthcare professionals, many rural areas' healthcare facilities often secured only by basic or medium level HRH; and difficulties in developing HRH retention strategies in rural areas where most services are covered by foreign HRH. This study aims at analysing the situation of HRH in the province of Cabinda. It considers organizational issues, policies and practices resulting from the HRH strategy followed in the recent years, moreover the creation of a medical school. The context that affects the distribution of the health workforce is analysed to contribute to the development of evidence-based policies that promote a better HRH allocation in the poorest and distant villages in the province. METHODS A mixed-methods study was developed, combining a quantitative and qualitative approach to analyse HRH situation in the province of Cabinda. Data was collected from key informants, selected by intentional sampling from public and private health organizations, to respond to a questionnaire and a semi-structured interview. Quantitative and qualitative data was analysed with descriptive and inferential statistics and content analysis respectively. The study was complemented by a comprehensive desk review. RESULTS Results show a clear change in HRH data from 2011 to 2015 with significant fluctuations due to variations in retirement, migration and lack of regular public HRH recruitment tenders. HRH density is apparently better in rural when compared with urban areas. However, one should bear in mind that often HRH allocated to rural areas do not stay there, which leads to real geographical imbalances. Factors like lack of proper incentives for HRH retention and social support goes against significant HRH management efforts contributing to this result. Whereas HRH are financed by the State General Budget, the majority of health facilities are still dependent on the Provincial Health Secretariat budget. CONCLUSION The study provides a broader view of the current HRH situation in Cabinda Province. Geographical imbalances and other issues with impact in delivering universal access to healthcare are highlighted.
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Affiliation(s)
- Damas Macaia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Luís Velez Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Galárraga O, Wamai RG, Sosa-Rubí SG, Mugo MG, Contreras-Loya D, Bautista-Arredondo S, Nyakundi H, Wang’ombe JK. HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya. Health Policy Plan 2017; 32:1407-1416. [PMID: 29029086 PMCID: PMC5886164 DOI: 10.1093/heapol/czx121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 01/14/2023] Open
Abstract
We estimate costs and their predictors for three HIV prevention interventions in Kenya: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC). As part of the 'Optimizing the Response of Prevention: HIV Efficiency in Africa' (ORPHEA) project, we collected retrospective data from government and non-governmental health facilities for 2011-12. We used multi-stage sampling to determine a sample of health facilities by type, ownership, size and interventions offered totalling 144 sites in 78 health facilities in 33 districts across Kenya. Data sources included key informants, registers and time-motion observation methods. Total costs of production were computed using both quantity and unit price of each input. Average cost was estimated by dividing total cost per intervention by number of clients accessing the intervention. Multivariate regression methods were used to analyse predictors of log-transformed average costs. Average costs were $7 and $79 per HTC and PMTCT client tested, respectively; and $66 per VMMC procedure. Results show evidence of economies of scale for PMTCT and VMMC: increasing the number of clients per year by 100% was associated with cost reductions of 50% for PMTCT, and 45% for VMMC. Task shifting was associated with reduced costs for both PMTCT (59%) and VMMC (54%). Costs in hospitals were higher for PMTCT (56%) in comparison to non-hospitals. Facilities that performed testing based on risk factors as opposed to universal screening had higher HTC average costs (79%). Lower VMMC costs were associated with availability of male reproductive health services (59%) and presence of community advisory board (52%). Aside from increasing production scale, HIV prevention costs may be contained by using task shifting, non-hospital sites, service integration and community supervision.
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Affiliation(s)
- Omar Galárraga
- School of Public Health, Brown University, Providence, RI, USA
| | - Richard G Wamai
- Global Health Initiative, Northeastern University, Boston, MA, USA
| | - Sandra G Sosa-Rubí
- Health Economics Unit, Mexican Institute of Public Health, Cuernavaca, Mexico
| | - Mercy G Mugo
- Department of Economics, University of Nairobi, Nairobi, Kenya
| | - David Contreras-Loya
- School of Public Health, University of California at Berkeley, Berkeley, CA, USA and
| | | | - Helen Nyakundi
- School of Public Health, University of Nairobi, Nairobi, Kenya
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Mwenge L, Sande L, Mangenah C, Ahmed N, Kanema S, d’Elbée M, Sibanda E, Kalua T, Ncube G, Johnson CC, Hatzold K, Cowan FM, Corbett EL, Ayles H, Maheswaran H, Terris-Prestholt F. Costs of facility-based HIV testing in Malawi, Zambia and Zimbabwe. PLoS One 2017; 12:e0185740. [PMID: 29036171 PMCID: PMC5642898 DOI: 10.1371/journal.pone.0185740] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/14/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Providing HIV testing at health facilities remains the most common approach to ensuring access to HIV treatment and prevention services for the millions of undiagnosed HIV-infected individuals in sub-Saharan Africa. We sought to explore the costs of providing these services across three southern African countries with high HIV burden. METHODS Primary costing studies were undertaken in 54 health facilities providing HIV testing services (HTS) in Malawi, Zambia and Zimbabwe. Routinely collected monitoring and evaluation data for the health facilities were extracted to estimate the costs per individual tested and costs per HIV-positive individual identified. Costs are presented in 2016 US dollars. Sensitivity analysis explored key drivers of costs. RESULTS Health facilities were testing on average 2290 individuals annually, albeit with wide variations. The mean cost per individual tested was US$5.03.9 in Malawi, US$4.24 in Zambia and US$8.79 in Zimbabwe. The mean cost per HIV-positive individual identified was US$79.58, US$73.63 and US$178.92 in Malawi, Zambia and Zimbabwe respectively. Both cost estimates were sensitive to scale of testing, facility staffing levels and the costs of HIV test kits. CONCLUSIONS Health facility based HIV testing remains an essential service to meet HIV universal access goals. The low costs and potential for economies of scale suggests an opportunity for further scale-up. However low uptake in many settings suggests that demand creation or alternative testing models may be needed to achieve economies of scale and reach populations less willing to attend facility based services.
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Affiliation(s)
| | - Linda Sande
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Collin Mangenah
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
| | - Nurilign Ahmed
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Marc d’Elbée
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Euphemia Sibanda
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
| | - Thokozani Kalua
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | | | - Cheryl C. Johnson
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - Frances M. Cowan
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elizabeth L. Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Fern Terris-Prestholt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Fowler CI, Saraiya M, Moskosky SB, Miller JW, Gable J, Mautone-Smith N. Trends in Cervical Cancer Screening in Title X-Funded Health Centers - United States, 2005-2015. MMWR Morb Mortal Wkly Rep 2017; 66:981-985. [PMID: 28934183 PMCID: PMC5657776 DOI: 10.15585/mmwr.mm6637a4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ilboudo PG, Huang XX, Ngwira B, Mwanyungwe A, Mogasale V, Mengel MA, Cavailler P, Gessner BD, Le Gargasson JB. Cost-of-illness of cholera to households and health facilities in rural Malawi. PLoS One 2017; 12:e0185041. [PMID: 28934285 PMCID: PMC5608291 DOI: 10.1371/journal.pone.0185041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 09/05/2017] [Indexed: 11/19/2022] Open
Abstract
Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients’ households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.
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Forma L, Jylhä M, Pulkki J, Aaltonen M, Raitanen J, Rissanen P. Trends in the use and costs of round-the-clock long-term care in the last two years of life among old people between 2002 and 2013 in Finland. BMC Health Serv Res 2017; 17:668. [PMID: 28927415 PMCID: PMC5606077 DOI: 10.1186/s12913-017-2615-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The structure of long-term care (LTC) for old people has changed: care has been shifted from institutions to the community, and death is being postponed to increasingly old age. The aim of the study was to analyze how the use and costs of LTC in the last two years of life among old people changed between 2002 and 2013. METHODS Data were derived from national registers. The study population contains all those who died at the age of 70 years or older in 2002-2013 in Finland (N = 427,078). The costs were calculated using national unit cost information. Binary logistic regression and Cox proportional hazard models were used to study the association of year of death with use and costs of LTC. RESULTS The proportion of those who used LTC and the sum of days in LTC in the last two years of life increased between 2002 and 2013. The mean number of days in institutional LTC decreased, while that for sheltered housing increased. The costs of LTC per user decreased. CONCLUSIONS Use of LTC in the last two years of life increased, which was explained by the postponement of death to increasingly old age. Costs of LTC decreased as sheltered housing replaced institutional LTC. However, an accurate comparison of costs of different types of LTC is difficult, and the societal costs of sheltered housing are not well known.
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Affiliation(s)
- Leena Forma
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Marja Jylhä
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Jutta Pulkki
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
- Institute for Advanced Social Research, University of Tampere, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
- UKK-Institute for Health Promotion, Tampere, Finland
| | - Pekka Rissanen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
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Abstract
BACKGROUND Since 2000, the United Nations' Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. METHODS This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms 'obstetric care', 'access', 'barriers', 'developing countries' and 'sub-Saharan Africa' were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies. RESULTS One hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women's self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users' residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships. CONCLUSION Despite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014 CRD42014015549.
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Affiliation(s)
- Minerva Kyei-Nimakoh
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Mary Carolan-Olah
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Terence V. McCann
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
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Affiliation(s)
- Mariam Claeson
- Global Financing Facility, World Bank, Washington, DC 20433, USA.
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Conner B. Whatever happened to charity care in financial statements? Healthc Financ Manage 2017; 71:30-32. [PMID: 29901370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Kalkhof C, Bajner R. Third-party revenue and operating model integration provider and payer collaboration strategies. Healthc Financ Manage 2017; 71:42-49. [PMID: 29901375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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