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Gadelha CAG, Maretto G, Nascimento MAC, Kamia F. The health economic-industrial complex: production and innovation for universal health access, Brazil. Bull World Health Organ 2024; 102:352-356. [PMID: 38680461 PMCID: PMC11046161 DOI: 10.2471/blt.23.290838] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/06/2024] [Accepted: 02/27/2024] [Indexed: 05/01/2024] Open
Abstract
Problem The coronavirus disease 2019 (COVID-19) pandemic has highlighted global disparities in accessing essential health products, demonstrating the critical need for low- and middle-income countries to develop local production and innovation capabilities. Approach The health economic-industrial complex approach changed the values that guided innovation and industrial policies in Brazil. The approach directed health production and innovation to universal access; the health ministry led a whole-of-government approach; and public procurement was strategically applied to stimulate productive public and private investments. The institutional, technological and productive capacities built up by the health economic-industrial complex allowed the country to quickly establish local COVID-19 vaccines production and guarantee access for the population. Local setting Brazil has a universal health system that guarantees access to health for its 215 million population. Relevant changes Public policies and actions, based on the health economic-industrial complex, guided investment projects in line with health demands, strengthened local producers, and increased autonomy in the production of health products in areas of greater technological dependence. During the COVID-19 pandemic, the country was able to rapidly scale up local vaccine production. By August 2021, Brazil had produced 74.8% (151 463 502/202 437 516) of the vaccine doses used in the country. Lessons learnt The Brazilian example shows that low- and middle-income countries can build systemic development policies that increase their capability to produce and innovate in concert with universal health systems. This increased capacity can guarantee access to health products and supplies that are critical during global health emergencies.
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Affiliation(s)
- Carlos AG Gadelha
- Secretary of Science, Technology, Innovation and Health Economic-Industrial Complex, Ministry of Health, Esplanada dos Ministérios, Bloco G, 70058-900, Brasília, DF, Brazil
| | | | | | - Felipe Kamia
- Secretary of Science, Technology, Innovation and Health Economic-Industrial Complex, Ministry of Health, Esplanada dos Ministérios, Bloco G, 70058-900, Brasília, DF, Brazil
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Bomfim RA, Della Bona A, Cury JA, Celeste RK. Brazilian primary dental care in a universal health system: Challenges for training and practice. J Dent 2024; 144:104932. [PMID: 38499281 DOI: 10.1016/j.jdent.2024.104932] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES To report the challenges for training and practice for the Brazilian primary dental care in a universal health system. METHODS Health, education and protection rights against poverty are guaranteed by the 1988 Brazilian Constitution and public health in Brazil is provided by the Unified Health System (SUS), one of the largest public health systems in the world. According to SUS, every Brazilian citizen has the right to free primary oral health care as secondary and tertiary care, offering a unique opportunity to integrate oral care within general health care. RESULTS The Brazilian undergraduate Dental curriculum was updated in 2021 aiming to graduate general practitioners with a major in comprehensive health care in primary health care, integrated with public and general health. This curriculum update requires at least 20% of the academic hours to be exercised outside the university walls (extramural or community work), preferably within the SUS. CONCLUSIONS Considering the World Health Organization (WHO) agenda, Brazil needs to advance the innovative oral health workforce, the integration of oral health into primary care, the population access to essential dental medicines and optimal fluorides for caries control. CLINICAL SIGNIFICANCE It is necessary political action and the engagement of multiple stakeholders, mainly from the health and education sectors, to improve primary health care.
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Affiliation(s)
- Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Alvaro Della Bona
- Postgraduate Program in Dentistry, School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil.
| | | | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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The Lancet Healthy Longevity. Universal palliative care for healthy longevity. Lancet Healthy Longev 2024; 5:e303. [PMID: 38705147 DOI: 10.1016/s2666-7568(24)00070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
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Huang V, Obrizan M, Jardon-Pina J. A taxonomy for the financing of health for all. Bull World Health Organ 2024; 102:360-362. [PMID: 38680464 PMCID: PMC11046149 DOI: 10.2471/blt.24.291362] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Vanessa Huang
- Strand 50, 60 Bonham Strand, Sheung Wan, Hong Kong Special Administrative Region, China
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Ventres WB, Stone LA, South-Paul JE, Campbell KM, Petty AR, Ekanadham H, Stange KC, Etz RS, Miller WL, Ferrer RL, Kong M, Bodenheimer T, Strasser R, Reece SCM, Freeman J, Westfall JM. Storylines of family medicine XII: family medicine and the healthcare system. Fam Med Community Health 2024; 12:e002829. [PMID: 38609091 PMCID: PMC11029432 DOI: 10.1136/fmch-2024-002829] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/23/2024] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'XII: Family medicine and the future of the healthcare system', authors address the following themes: 'Leadership in family medicine', 'Becoming an academic family physician', 'Advocare-our call to act', 'The paradox of primary care and three simple rules', 'The quadruple aim-melding the patient and the health system', 'Fit-for-purpose medical workforce', 'Universal healthcare-coverage for all', 'The futures of family medicine' and 'The 100th essay.' May readers of these essays feel empowered to be part of family medicine's exciting future.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | | | - Kendall M Campbell
- Family Medicine, University of Texas Medical Branch at Galveston School of Medicine, Galveston, Texas, USA
| | - Aerial R Petty
- Family Medicine Residency Program, New York-Presbyterian Columbia University Medical Center, New York, New York, USA
| | - Hima Ekanadham
- Center for Family and Community Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Kurt C Stange
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Rebecca S Etz
- Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - William L Miller
- Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Robert L Ferrer
- Family and Community Medicine, UT Health San Antonio Long School of Medicine, San Antonio, Texas, USA
| | - Marianna Kong
- Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Thomas Bodenheimer
- Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Roger Strasser
- Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Sharon C M Reece
- Family Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Joshua Freeman
- Family Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Tammemägi MC, Darling GE, Schmidt H, Walker MJ, Langer D, Leung YW, Nguyen K, Miller B, Llovet D, Evans WK, Buchanan DN, Espino-Hernandez G, Aslam U, Sheppard A, Lofters A, McInnis M, Dobranowski J, Habbous S, Finley C, Luettschwager M, Cameron E, Bravo C, Banaszewska A, Creighton-Taylor K, Fernandes B, Gao J, Lee A, Lee V, Pylypenko B, Yu M, Svara E, Kaushal S, MacNiven L, McGarry C, Della Mora L, Koen L, Moffatt J, Rey M, Yurcan M, Bourne L, Bromfield G, Coulson M, Truscott R, Rabeneck L. Risk-based lung cancer screening performance in a universal healthcare setting. Nat Med 2024; 30:1054-1064. [PMID: 38641742 DOI: 10.1038/s41591-024-02904-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
Globally, lung cancer is the leading cause of cancer death. Previous trials demonstrated that low-dose computed tomography lung cancer screening of high-risk individuals can reduce lung cancer mortality by 20% or more. Lung cancer screening has been approved by major guidelines in the United States, and over 4,000 sites offer screening. Adoption of lung screening outside the United States has, until recently, been slow. Between June 2017 and May 2019, the Ontario Lung Cancer Screening Pilot successfully recruited 7,768 individuals at high risk identified by using the PLCOm2012noRace lung cancer risk prediction model. In total, 4,451 participants were successfully screened, retained and provided with high-quality follow-up, including appropriate treatment. In the Ontario Lung Cancer Screening Pilot, the lung cancer detection rate and the proportion of early-stage cancers were 2.4% and 79.2%, respectively; serious harms were infrequent; and sensitivity to detect lung cancers was 95.3% or more. With abnormal scans defined as ones leading to diagnostic investigation, specificity was 95.5% (positive predictive value, 35.1%), and adherence to annual recall and early surveillance scans and clinical investigations were high (>85%). The Ontario Lung Cancer Screening Pilot provides insights into how a risk-based organized lung screening program can be implemented in a large, diverse, populous geographic area within a universal healthcare system.
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Affiliation(s)
- Martin C Tammemägi
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada.
- Brock University, St. Catharines, ON, Canada.
| | - Gail E Darling
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Heidi Schmidt
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Deanna Langer
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Yvonne W Leung
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Kathy Nguyen
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Beth Miller
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Diego Llovet
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Usman Aslam
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Aisha Lofters
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Erin Cameron
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Caroline Bravo
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Julia Gao
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Alex Lee
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Van Lee
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Monica Yu
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Erin Svara
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Lynda MacNiven
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Liz Koen
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Michelle Rey
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Marta Yurcan
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Laurie Bourne
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Linda Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
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Linnane D, Cumming C, Kinner SA. Challenges for Medicare and universal health care in Australia since 2000. Med J Aust 2024; 220:276. [PMID: 38366282 DOI: 10.5694/mja2.52229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/08/2023] [Indexed: 02/18/2024]
Affiliation(s)
- Damien Linnane
- Centre for Law and Social Justice, University of Newcastle, Newcastle, NSW
| | - Craig Cumming
- Centre for Health Services Research, University of Western Australia, Perth, WA
| | - Stuart A Kinner
- Curtin School of Population Health, Curtin University, Perth, WA
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Solanki G, Wilkinson T, Myburgh NG, Cornell JE, Brijlal V. South African healthcare reforms towards universal healthcare - where to next? S Afr Med J 2024; 114:e1571. [PMID: 38525573 DOI: 10.7196/samj.2024.v114i3.1571] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Indexed: 03/26/2024] Open
Abstract
The National Assembly approval of the National Health Insurance (NHI) Bill represents an important milestone, but there are many uncertainties concerning its implementation and timeline. The challenges faced by the South African healthcare system are huge, and we cannot afford to wait for NHI to address them all. It is critical that the process of strengthening the health system to advance universal healthcare (UHC) begins now, and there are several viable initiatives that can be implemented without delay. This article examines potential scenarios after the Bill is passed and ways in which UHC could be advanced. It begins with an overview of the trajectory of health system reform since 1994, then examines the scenarios that may emerge once the Bill is passed by Parliament and makes a case for finding ways in which UHC could be advanced within the country, regardless of any legal or financial barriers that may delay or limit NHI implementation.
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Affiliation(s)
- G Solanki
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; NMG Consultants and Actuaries, Cape Town, South Africa.
| | - T Wilkinson
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - N G Myburgh
- Faculty of Dentistry and World Heath Organization Collaborating Centre for Oral Health, University of the Western Cape, Cape Town, South Africa.
| | - J E Cornell
- Nelson Mandela School of Public Governance, University of Cape Town, South Africa.
| | - V Brijlal
- Clinton Health Access Initiative, Pretoria, South Africa.
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Sukhampha R. Diffusion of global health norms through a national medical professional movement in the universal healthcare of Thailand. Front Public Health 2024; 12:1249497. [PMID: 38515593 PMCID: PMC10956689 DOI: 10.3389/fpubh.2024.1249497] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
Commonly, research investigations on social policy reform primarily examine the national processes at the core of policy formation rather than considering their global context. Concerns are raised regarding the diffusion and influence of global health norms on Thai universal health coverage policymaking. The findings demonstrate that global health ideas and actors have an impact on national policymaking and that they can share ideas in a variety of ways, including glocalization, vernacularization, policy learning, and policy entrepreneur intervention, in setting the agenda for national universal health coverage. Global and universal health coverage (UHC) concepts have existed for decades; success would not be possible without the efforts of policy entrepreneurs such as the Rural Doctor Movement, who localize and vernacularize global concepts for implementation. These concepts must be compatible with the national and local sociopolitical contexts in which they exist. The Thai case contributed to a better understanding of the influences of global ideas and actors on transnational health policy transfer, as well as the intervention of the national medical professional movement as policy entrepreneurs in healthcare policymaking and policy change for equity in health.
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Affiliation(s)
- Rangsan Sukhampha
- Faculty of Sociology, Bielefeld University, Bielefeld, Germany
- Department of Public Administration, Faculty of Humanities and Social Sciences, Valaya Alongkorn Rajabhat University, Pathum Thani, Thailand
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Doutchi M, Ghousmane A, Zampaligre F, Moussa B, Ishagh EK, Talatou Marc O, Oumarou B, Kaya MS, Diawara GA, Camara AM, Moussa S, Bienvenu K, Toko J, Harouna H, Moussa H, Kofi N, Tamuzi JL, Katoto PDMC, Wiysonge CS, Melanga Anya BP. Health transformation toward universal healthcare coverage amidst conflict: examining the impact of international cooperation in Niger. Front Public Health 2024; 12:1303168. [PMID: 38515600 PMCID: PMC10956617 DOI: 10.3389/fpubh.2024.1303168] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/05/2024] [Indexed: 03/23/2024] Open
Abstract
Background Approximately 70% of Sub-Saharan African countries have experienced armed conflicts with significant battle-related fatalities in the past two decades. Niger has witnessed a substantial rise in conflict-affected populations in recent years. In response, international cooperation has aimed to support health transformation in Niger's conflict zones and other conflict-affected areas in Sub-Saharan Africa. This study seeks to review the available evidence on health interventions facilitated by international cooperation in conflict zones, with a focus on Niger. Methods We conducted a systematic literature review (SLR) adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted from 2000 to 4 September 2022 using MeSH terms and keywords to identify relevant studies and reports in Sub-Saharan Africa and specifically in Niger. Databases such as PubMed (Medline), Google Scholar, Google, and gray literature were utilized. The findings were presented both narratively and through tables and a conceptual framework. Results Overall, 24 records (10 studies and 14 reports) that highlighted the significant role of international cooperation in promoting health transformation in conflict zones across Sub-Saharan Africa, including Niger, were identified. Major multilateral donors identified were the World Health Organization (WHO), United Nations Children's Fund (UNICEF), United Nations Fund for Population Activities (UNFPA), World Bank, United States Agency for International Development (USAID), European Union, European Commission Humanitarian Aid (ECHO), Global Fund, and Global Alliance for Vaccines and Immunization (GAVI). Most supports targeted maternal, newborn, child, adolescent, and youth health, nutrition, and psycho-social services. Furthermore, interventions were in the form of public health initiatives, mobile clinic implementation, data management, human resource capacity building, health information systems, health logistics, and research funding in conflict zones. Conclusion This literature review underscores the significant engagement of international cooperation in strengthening and transforming health services in conflict-affected areas across Sub-Saharan Africa, with a particular focus on Niger. However, to optimize the effectiveness of healthcare activities from short- and long-term perspectives, international partners and the Ministry of Public Health need to re-evaluate and reshape their approach to health intervention in conflict zones.
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Affiliation(s)
| | | | | | - Bizo Moussa
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | - El Khalef Ishagh
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | | | - Batouré Oumarou
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | | | | | | | - Seyni Moussa
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | | | - Joseph Toko
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | - Hamidou Harouna
- Direction de la Surveillance et la Réponse aux Epidémies du Ministère de la Santé Publique, de la Population et des Affaires Sociale, Chargé de la Surveillance, Niamey, Niger
| | - Haladou Moussa
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | - N’Zue Kofi
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | - Jacques Lukenze Tamuzi
- Department of Public Health, Université de Zinder, Zinder, Niger
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Patrick D. M. C. Katoto
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa
- Centre for Tropical Diseases and Global Health, Department of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
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Sparano F, Giesinger JM, Gaidano G, Anota A, Cavo M, Brini A, Voso MT, Venditti A, Perrone F, Di Maio M, Luppi M, Baron F, Platzbecker U, Fazi P, Vignetti M, Efficace F. Financial Toxicity and Health-Related Quality of Life Profile of Patients With Hematologic Malignancies Treated in a Universal Health Care System. JCO Oncol Pract 2024; 20:438-447. [PMID: 38207239 DOI: 10.1200/op.23.00434] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/24/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE We investigated the association of financial toxicity (FT) with the health-related quality of life (HRQoL) profile of patients with hematologic malignancies treated in a universal health care system. METHODS We did a secondary analysis of six multicenter studies enrolling patients with hematologic malignancies. FT was evaluated using the financial difficulties item of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Multivariable linear regression models were used to assess the mean differences in HRQoL scores between patients with or without FT, while adjusting for key potential confounding factors. We also examined the prevalence of clinically important problems and symptoms by the experience of FT, using established thresholds for the EORTC QLQ-C30. Multivariable binary logistic regression analysis was performed to explore the risk factors associated with FT. RESULTS Overall, 1,847 patients were analyzed, of whom 441 (23.9%) reported FT. We observed statistically and clinically relevant worse scores for patients with FT compared with those without FT for all the EORTC QLQ-C30 scales. The three largest clinically relevant mean differences between patients with and without FT were observed in pain (∆ = 19.6 [95% CI, 15.7 to 23.5]; P < .001), social functioning (∆ = -18.9 [95% CI, -22.5 to -15.2]; P < .001), and role functioning (Δ = -17.7 [95% CI, -22.1 to -13.3]; P < .001). Patients with FT tended to report a higher prevalence of clinically important problems and symptoms across all EORTC QLQ-C30 scales. In the univariable and multivariable analyses, the presence of FT was associated with the presence of comorbidities, an Eastern Cooperative Oncology Group performance status ≥1, and not receiving a salary. CONCLUSION Patients with hematologic malignancies treated in the setting of a universal health care system who experience FT have a worse HRQoL profile compared with those without FT.
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Affiliation(s)
- Francesco Sparano
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
| | - Johannes M Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Amelie Anota
- Biostatistics Unit, Direction of Clinical Research and Innovation, Human and Social Sciences Department, and French National Platform Quality of Life and Cancer, Centre Léon Bérard, Lyon, France
| | - Michele Cavo
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Università di Bologna, Bologna, Italy
| | - Alberto Brini
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Adriano Venditti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - Massimo Di Maio
- Department of Oncology, Oncology Unit, University of Torino, Ordine Mauriziano Hospital, Torino, Italy
| | - Mario Luppi
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Frederic Baron
- Department of Hematology, University and CHU of Liège, Liège, Belgium
| | - Uwe Platzbecker
- Clinic and Policlinic of Hematology and Cellular Therapy, Oncology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Paola Fazi
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
| | - Marco Vignetti
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
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Pickwell-Smith B, Greenley S, Lind M, Macleod U. Where are the inequalities in ovarian cancer care in a country with universal healthcare? A systematic review and narrative synthesis. J Cancer Policy 2024; 39:100458. [PMID: 38013132 DOI: 10.1016/j.jcpo.2023.100458] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Patients diagnosed with ovarian cancer from more deprived areas may face barriers to accessing timely, quality healthcare. We evaluated the literature for any association between socioeconomic group, treatments received and hospital delay among patients diagnosed with ovarian cancer in the United Kingdom, a country with universal healthcare. METHODS We searched MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED, PsycINFO and HMIC from inception to January 2023. Forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts, and full-text articles. UK-based studies were included if they reported socioeconomic measures and an association with either treatments received or hospital delay. The inclusion of studies from one country ensured greater comparability. Risk of bias was assessed using the QUIPS tool, and a narrative synthesis was conducted. The review is reported to PRISMA 2020 and registered with PROSPERO [CRD42022332071]. RESULTS Out of 2876 references screened, ten were included. Eight studies evaluated treatments received, and two evaluated hospital delays. We consistently observed socioeconomic inequalities in the likelihood of surgery (range of odds ratios 0.24-0.99) and chemotherapy (range of odds ratios 0.70-0.99) among patients from the most, compared with the least, deprived areas. There were no associations between socioeconomic groups and hospital delay. POLICY SUMMARY Ovarian cancer treatments differed between socioeconomic groups despite the availability of universal healthcare. Further research is needed to understand why, though suggested reasons include patient choice, health literacy, and financial and employment factors. Qualitative research would provide a rich understanding of the complex factors that drive these inequalities.
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Affiliation(s)
- Benjamin Pickwell-Smith
- Hull York Medical School, University of Hull, Hull, United Kingdom; Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals, Hull, United Kingdom.
| | - Sarah Greenley
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Michael Lind
- Hull York Medical School, University of Hull, Hull, United Kingdom; Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, United Kingdom
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Tam MW, Davis VH, Ahluwalia M, Lee RS, Ross LE. Impact of COVID-19 on access to and delivery of sexual and reproductive healthcare services in countries with universal healthcare systems: A systematic review. PLoS One 2024; 19:e0294744. [PMID: 38394146 PMCID: PMC10889625 DOI: 10.1371/journal.pone.0294744] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/01/2023] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic has caused unforeseen impacts on sexual and reproductive healthcare (SRH) services worldwide, and the nature and prevalence of these changes have not been extensively synthesized. We sought to synthesise reported outcomes on the impact of COVID-19 on SRH access and delivery in comparable countries with universal healthcare systems. METHODS Following PRISMA guidelines, we searched MEDLINE, Embase, PsycInfo, and CINAHL from January 1st, 2020 to June 6th, 2023. Original research was eligible for inclusion if the study reported on COVID-19 and SRH access and/or delivery. Twenty-eight OECD countries with comparable economies and universal healthcare systems were included. We extracted study characteristics, participant characteristics, study design, and outcome variables. The methodological quality of each article was assessed using the Quality Assessment with Diverse Studies (QuADS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for reporting the results. This study was registered on PROSPERO (#CRD42021245596). SYNTHESIS Eighty-two studies met inclusion criteria. Findings were qualitatively synthesised into the domains of: antepartum care, intrapartum care, postpartum care, assisted reproductive technologies, abortion access, gynaecological care, sexual health services, and HIV care. Research was concentrated in relatively few countries. Access and delivery were negatively impacted by a variety of factors, including service disruptions, unclear communication regarding policy decisions, decreased timeliness of care, and fear of COVID-19 exposure. Across outpatient services, providers favoured models of care that avoided in-person appointments. Hospitals prioritized models of care that reduced time and number of people in hospital and aerosol-generating environments. CONCLUSIONS Overall, studies demonstrated reduced access and delivery across most domains of SRH services during COVID-19. Variations in service restrictions and accommodations were heterogeneous within countries and between institutions. Future work should examine long-term impacts of COVID-19, underserved populations, and underrepresented countries.
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Affiliation(s)
- Michelle W. Tam
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Victoria H. Davis
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Monish Ahluwalia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, 1 King’s College Circle, Toronto, ON, Canada
| | - Rachel S. Lee
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Lori E. Ross
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
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Gurney J, Davies A, Stanley J, Cameron L, Costello S, Dawkins P, Henare K, Jackson CG, Lawrenson R, Whitehead J, Koea J. Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context. JCO Glob Oncol 2024; 10:e2300258. [PMID: 38301179 PMCID: PMC10846779 DOI: 10.1200/go.23.00258] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE Lung cancer is the biggest cancer killer of indigenous peoples worldwide, including Māori people in New Zealand. There is some evidence of disparities in access to lung cancer treatment between Māori and non-Māori patients, but an examination of the depth and breadth of these disparities is needed. Here, we use national-level data to examine disparities in access to surgery, radiation therapy and systemic therapy between Māori and European patients, as well as timing of treatment relative to diagnosis. METHODS We included all lung cancer registrations across New Zealand from 2007 to 2019 (N = 27,869) and compared access with treatment and the timing of treatment using national-level inpatient, outpatient, and pharmaceutical records. RESULTS Māori patients with lung cancer appeared less likely to access surgery than European patients (Māori, 14%; European, 20%; adjusted odds ratio [adj OR], 0.82 [95% CI, 0.73 to 0.92]), including curative surgery (Māori, 10%; European, 16%; adj OR, 0.72 [95% CI, 0.62 to 0.84]). These differences were only partially explained by stage and comorbidity. There were no differences in access to radiation therapy or systemic therapy once adjusted for confounding by age. Although it appeared that there was a longer time from diagnosis to radiation therapy for Māori patients compared with European patients, this difference was small and requires further investigation. CONCLUSION Our observation of differences in surgery rates between Māori and European patients with lung cancer who were not explained by stage of disease, tumor type, or comorbidity suggests that Māori patients who may be good candidates for surgery are missing out on this treatment to a greater extent than their European counterparts.
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Affiliation(s)
| | - Anna Davies
- University of Otago, Wellington, New Zealand
| | | | - Laird Cameron
- Te Whatu Ora—Te Toka Tumai Auckland, Auckland, New Zealand
| | | | - Paul Dawkins
- Te Whatu Ora—Counties Manukau, Auckland, New Zealand
| | | | | | - Ross Lawrenson
- Population and Public Health, Te Whatu Ora—Waikato, Hamilton, New Zealand
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Pickwell-Smith BA, Spencer K, Sadeghi MH, Greenley S, Lind M, Macleod U. Where are the inequalities in colorectal cancer care in a country with universal healthcare? A systematic review and narrative synthesis. BMJ Open 2024; 14:e080467. [PMID: 38171631 PMCID: PMC10773363 DOI: 10.1136/bmjopen-2023-080467] [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] [Received: 10/02/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Patients diagnosed with colorectal cancer living in more deprived areas experience worse survival than those in more affluent areas. Those living in more deprived areas face barriers to accessing timely, quality healthcare. These barriers may contribute to socioeconomic inequalities in survival. We evaluated the literature for any association between socioeconomic group, hospital delay and treatments received among patients with colorectal cancer in the UK, a country with universal healthcare. DESIGN MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED and PsycINFO were searched from inception to January 2023. Grey literature, including HMIC, BASE and Google Advanced Search, and forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts and full-text articles. Observational UK-based studies were included if they reported socioeconomic measures and an association with either hospital delay or treatments received. The QUIPS tool assessed bias risk, and a narrative synthesis was conducted. The review is reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. RESULTS 41 of the 7209 identified references were included. 12 studies evaluated 7 different hospital intervals. There was a significant association between area-level deprivation and a longer time from first presentation in primary care to diagnosis. 32 studies evaluated treatments received. There were socioeconomic inequalities in surgery and chemotherapy but not radiotherapy. CONCLUSION Patients with colorectal cancer face inequalities across the cancer care continuum. Further research is needed to understand why and what evidence-based actions can reduce these inequalities in treatment. Qualitative research of patients and clinicians conducted across various settings would provide a rich understanding of the complex factors that drive these inequalities. Further research should also consider using a causal approach to future studies to considerably strengthen the interpretation. Clinicians can try and mitigate some potential causes of colorectal cancer inequalities, including signposting to financial advice and patient transport schemes. PROSPERO REGISTRATION NUMBER CRD42022347652.
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Affiliation(s)
| | - Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Michael Lind
- University of Hull, Hull, UK
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Clausen A, Christensen ER, Jakobsen PR, Søndergaard J, Abrahamsen B, Rubin KH. Digital solutions for decision support in general practice - a rapid review focused on systems developed for the universal healthcare setting in Denmark. BMC Prim Care 2023; 24:276. [PMID: 38097998 PMCID: PMC10720123 DOI: 10.1186/s12875-023-02234-y] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Digital health solutions hold the potential for supporting general practitioners in decision-making, and include telemedicine systems, decision support systems, patient apps, wearables, fitness trackers, etc. AIM: This review aimed to identify digital solutions developed for, tested, or implemented in general practice to support the decisions of GPs in disease detection and management, using Denmark as an example country of a universal healthcare setting. METHODS This study was conducted as a rapid review. The primary search included a database search conducted in Embase and MEDLINE. The supplementary search was conducted in Infomedia and additionally included a snowball search in reference lists and citations of key articles identified in the database search. Titles were screened by two reviewers. RESULTS The review included 15 studies as key articles describing a total of 13 digital solutions for decision support in general practice in Denmark. 1.123 titles were identified through the database search and 240 titles were identified through the supplementary and snowball search. CONCLUSIONS The review identified 13 digital solutions for decision support in general practice in a Danish healthcare setting aimed at detection and/or management of cancer, COPD, type 2 diabetes, depression, liver disease or multiple lifestyle-related diseases. Implementation aspects should be reported more transparently in future publications to enable applicability of digital solutions as decision support to aid general practitioners in disease detection and management.
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Affiliation(s)
- Anne Clausen
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
- Research Unit OPEN, Department of Clinical Research, University of Southern, Odense, Denmark.
| | | | - Pernille Ravn Jakobsen
- The Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- The Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Bo Abrahamsen
- Department of Medicine, Holbaek Hospital, Holbaek, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern, Odense, Denmark
| | - Katrine Hass Rubin
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern, Odense, Denmark
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Beck da Silva Etges AP, de Lara LR, Sapper SL, Frankenberg Berger AV, Streck M, Zardo L, Linhares A, Nassif M, Zanotto A, Pereira Lima MN, Vargas R, Polanczyk CA. Redesign of radiotherapy for prostate cancer: a proposal for universal healthcare systems. J Comp Eff Res 2023; 12:e230023. [PMID: 37916706 PMCID: PMC10734317 DOI: 10.57264/cer-2023-0023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023] Open
Abstract
Aim: This study was designed to recommend strategies to improve prostate patients' access to radiotherapy treatment in the Brazilian Unified Health System, along with a cost-tool to support radiotherapy care pathways' lead times and costs. Methods: Data was collected prospectively from patients with prostate cancer receiving radiotherapy in two Brazilian centers to provide data to apply design thinking and process reengineering techniques. The current status of the radiotherapy pathway was determined and the length of time taken for in-hospital activities was measured using data exported from ARIA®. Interviews with patients were used to estimate their waiting periods. This provided the data used to provide recommended strategies and the cost tool based on time-driven activity-based costing. The strategies were classified according to priority. Results: Data from 47 patients were analyzed. The mean interval from diagnosis to start of radiotherapy was 349 days (SD581), and the mean interval from seeking medical attention to starting treatment was 635 days (SD629). Twelve strategies affecting in-hospital processes and 11 impacting patients' care pathways and experiences are recommended, mostly focused on system improvement opportunities. A time-driven activity-based costing monitoring using data extracted from ARIA was coded and can be used by centers as a cost assessment guide. Conclusion: This study uses reengineering and design techniques to introduce priority strategies to allow more efficient and patient-centered radiotherapy.
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Affiliation(s)
- Ana Paula Beck da Silva Etges
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
- Avant-garde Health, Boston, MA 02111, USA
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, RS, 90035-002, Brazil
| | - Luciana Rodrigues de Lara
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
| | - Stella Lisboa Sapper
- Crialab, Tecnopuc, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, 90619-900, Brazil
| | - Ana Von Frankenberg Berger
- Crialab, Tecnopuc, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, 90619-900, Brazil
| | - Melissa Streck
- Crialab, Tecnopuc, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, 90619-900, Brazil
| | - Laise Zardo
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, 90020-090, Brazil
| | - Armani Linhares
- Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
- Medicine course, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Porto Alegre, RS, 90050-170, Brazil
| | - Marina Nassif
- Universidade Federal do Rio Grande do Sul School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
| | - Angélica Zanotto
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
| | - Marta Nassif Pereira Lima
- Universidade Federal do Rio Grande do Sul School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
| | - Rafael Vargas
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
- Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, 90020-090, Brazil
| | - Carisi Anne Polanczyk
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, RS, 90035-002, Brazil
- Universidade Federal do Rio Grande do Sul School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
- Hospital Moinhos de Vento, Porto Alegre, RS, 90035-000, Brazil
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Chen H, Liu C, Hsu SE, Huang DH, Liu CY, Chiou WK. The Effects of Animation on the Guessability of Universal Healthcare Symbols for Middle-Aged and Older Adults. Hum Factors 2023; 65:1740-1758. [PMID: 34969321 DOI: 10.1177/00187208211060900] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate whether animation can help to improve the comprehension of universal healthcare symbols for middle-aged and older adults. BACKGROUND The Hablamos Juntos (HJ) healthcare symbol system is a set of widely used universal healthcare symbols that were developed in the United States. Some studies indicated that HJ healthcare symbols are not well-understood by users in non-English-speaking areas. Other studies found that animations can improve users' comprehension of complex symbols. Thus, we wanted to test whether animation could help to improve users' comprehension of HJ symbols. METHODS The participants included 40 middle-aged and 40 older adults in Taiwan. We redesigned the 12 HJ symbols into three visual formats-static, basic animation, and detailed animation-and compared them to find which best improved the participants' guessability scores. RESULTS (1) Middle-aged adults' comprehension of static and basic animated symbols was significantly better than that of older adults, but there was no significant difference in the guessability scores between the two age groups in terms of detailed animated symbols; (2) In general, both basic animation and detailed animation significantly improved the guessability score, but the effect with detailed animation was significantly greater than that with basic animation; (3) Older women were more receptive to detailed animation and showed better guessing performance. CONCLUSION Detailed animation contains more details and provides a more complete explanation of the concept of the static symbols, helping to improve the comprehension of HJ symbols for middle-aged and older adult users. APPLICATION Our findings provide a reference for the possibility of new style symbol design in the digital and aging era, which can be applied to improve symbol comprehension.
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Affiliation(s)
- Hao Chen
- Graduate Institute of Business and Management, Chang Gung University, Taoyuan City, Taiwan
| | - Chao Liu
- Graduate Institute of Business and Management, Chang Gung University, Taoyuan City, Taiwan, College of Aviation, Hua Qiao University, Xiamen City, China
| | - Szu-Erh Hsu
- Department of Industrial Design, Chang Gung University, Taoyuan City, Taiwan
| | - Ding-Hau Huang
- Institute of Creative Design and Management, National Taipei University of Business, Taoyuan City, Taiwan
| | - Chia-Yi Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Taipei City, Taiwan
| | - Wen-Ko Chiou
- Department of Industrial Design, Chang Gung University, Taoyuan City, Taiwan, Department of Psychiatry, Chang Gung Memorial Hospital, Taipei City, Taiwan
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Rudiger A. The Equity Effect of Universal Health Care. Health Hum Rights 2023; 25:171-176. [PMID: 38145143 PMCID: PMC10733771] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Affiliation(s)
- Anja Rudiger
- Political theorist and serves as a research and policy consultant to economic, social, and racial justice organizations in the United States
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De Foo C, Verma M, Tan SY, Hamer J, van der Mark N, Pholpark A, Hanvoravongchai P, Cheh PLJ, Marthias T, Mahendradhata Y, Putri LP, Hafidz F, Giang KB, Khuc THH, Van Minh H, Wu S, Caamal-Olvera CG, Orive G, Wang H, Nachuk S, Lim J, de Oliveira Cruz V, Yates R, Legido-Quigley H. Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries. Lancet Glob Health 2023; 11:e1964-e1977. [PMID: 37973344 PMCID: PMC10664823 DOI: 10.1016/s2214-109x(23)00448-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develop a framework for resilient health financing, and use this pandemic to argue a case to move towards universal health coverage (UHC). METHODS In this case study, we examined the national health financing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing. FINDINGS Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. We observed that five key financing policies were implemented across the countries-namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. INTERPRETATION Our findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Duke NUS Graduate Medical School, Singapore.
| | - Monica Verma
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Si Ying Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jess Hamer
- Centre for Universal Health, Chatham House, London, UK
| | | | - Aungsumalee Pholpark
- Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Piya Hanvoravongchai
- National Health Foundation, Bangkok, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Tiara Marthias
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Yodi Mahendradhata
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Likke Prawidya Putri
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Firdaus Hafidz
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Kim Bao Giang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
| | - Thi Hong Hanh Khuc
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
| | | | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - Jeremy Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Rob Yates
- Centre for Universal Health, Chatham House, London, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Imperial College and the George Institute for Global Health, London, UK
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Kuckelman J, Dezube A, Jacobson F, Learn PA, Miller D, Mody G, Jaklitsch M. Incidence of Clinically Relevant Solitary Pulmonary Nodules Utilizing a Universal Health Care System. Mil Med 2023; 188:e3635-e3640. [PMID: 37192143 DOI: 10.1093/milmed/usad153] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/27/2023] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Solitary pulmonary nodules (SPNs) are common, but the clinical relevance of these nodules is unknown. Utilizing current screening guidelines, we sought to better characterize the national incidence of clinically important SPNs within the largest universal health care system in the nation. MATERIALS AND METHODS TRICARE data were queried to identify SPNs for ages 18-64 years. SPNs that had been diagnosed within a year with no prior oncologic history were included to ensure true incidence. A proprietary algorithm was applied to determine clinically significant nodules. Further analysis characterized incidence by age grouping, gender, region, military branch, and beneficiary status. RESULTS A total of 229,552 SPNs were identified with a 60% reduction seen after application of the clinical significance algorithm (N = 88,628). The incidence increased in each decade of life (all P < 0.01). Adjusted incident rate ratios were significantly higher for SPNs detected in the Midwest and Western regions. The incident rate ratio was also higher in females (1.05, confidence interval [CI] 1.018, P = 0.001) as well as non-active duty members (dependents = 1.4 and retired = 1.6, respectively, CIs 1.383-1.492 and 1.591-1.638, P < 0.01). The incidence calculated per 1,000 patients overall was 3.1/1,000. Ages 44-54 years had an incidence of 5.5/1,000 patients, which is higher than the previously reported incidence of < 5.0 nationally for the same age group. CONCLUSIONS This analysis represents the largest evaluation of SPNs to date combined with clinical relevance adjustment. These data suggest a higher incidence of clinically significant SPNs starting at an age of 44 years in nonmilitary or retired women localized to the Midwest and Western regions of the United States.
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Affiliation(s)
- John Kuckelman
- Division of Cardiothoracic Surgery, Dwight D. Eisenhower Army Medical Center, Augusta, GA 30905, USA
| | - Aaron Dezube
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Francine Jacobson
- Division of Thoracic Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Peter A Learn
- Department of Surgery, USAF, USUHS, Bethesda, MD 20814, USA
| | - Daniel Miller
- Division of Cardiothoracic Surgery, Augusta University, Augusta, GA 30912, USA
| | - Gita Mody
- Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Michael Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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Rubinger L, Gazendam AM, Wood TJ. Marginalization Influences Access, Outcomes, and Discharge Destination Following Total Joint Arthroplasty in Canada's Universal Healthcare System. J Arthroplasty 2023; 38:2204-2209. [PMID: 37286053 DOI: 10.1016/j.arth.2023.05.075] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The influence of socioeconomic status on outcomes following total joint arthroplasty (TJA) in the Canadian single-payer healthcare system is yet to be elucidated. The objective of the present study was to evaluate the impact of socioeconomic status on TJA outcomes. METHODS This was a retrospective review of 7,304 consecutive TJA (4,456 knees and 2,848 hips) performed between January 1, 2001 and December 31, 2019. The primary independent variable was the average census marginalization index. The primary dependent variable was functional outcome scores. RESULTS The most marginalized patients in both the hip and knee cohorts had significantly worse preoperative and postoperative functional scores. Patients in the most marginalized quintile (V) showed a decreased odds of achieving a minimal important difference in functional scores at 1-year follow-up (odds ratio [OR] 0.44; 95% confidence interval [CI] [0.20, 0.97], P = .043). Patients in the knee cohort in the most marginalized quintiles (IV and V) had increased odds of being discharged to an inpatient facility with an OR of 2.07 (95% CI [1.06, 4.04], P = .033) and OR of 2.57 (95% CI [1.26, 5.22], P = .009), respectively. Patients in the hip cohort in V quintile (most marginalized) had increased odds of being discharged to an inpatient facility with an OR of 2.24 (95% CI [1.02, 4.96], P = .046). CONCLUSION Despite being a part of the Canadian universal single-payer healthcare system, the most marginalized patients had worse preoperative and postoperative function, and had increased odds of being discharged to another inpatient facility. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Luc Rubinger
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aaron M Gazendam
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Thomas J Wood
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences Juravinski Hospital, Hamilton, Ontario, Canada
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Prinja S, Chugh Y, Garg B, Guinness L. National hospital costing systems matter for universal healthcare: the India PM-JAY experience. BMJ Glob Health 2023; 8:e012987. [PMID: 37963613 PMCID: PMC10649618 DOI: 10.1136/bmjgh-2023-012987] [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] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/21/2023] [Indexed: 11/16/2023] Open
Abstract
India envisions achieving universal health coverage to provide its people with access to affordable quality health services. A breakthrough effort in this direction has been the launch of the world's largest health assurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the implementation of which resides with the National Health Authority. Appropriate provider payment systems and reimbursement rates are an important element for the success of PM-JAY, which in turn relies on robust cost evidence to support pricing decisions. Since the launch of PM-JAY, the health benefits package and provider payment rates have undergone a series of revisions. At the outset, there was a relative lack of cost data. Later revisions relied on health facility costing studies, and now there is an initiative to establish a national hospital costing system relying on provider-generated data. Lessons from PM-JAY experience show that the success of such cost systems to ensure regular and routine generation of evidence is contingent on integrating with existing billing or patient information systems or management information systems, which digitise similar information on resource consumption without any additional data entry effort. Therefore, there is a need to focus on building sustainable mechanisms for setting up systems for generating accurate cost data rather than relying on resource-intensive studies for cost data collection.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yashika Chugh
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Basant Garg
- National Health Authority, Government of India, New Delhi, India
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, London, UK
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Busnelli A, Ciani O, Caroselli S, Figliuzzi M, Poli M, Levi-Setti PE, Tarricone R, Capalbo A. Implementing preconception expanded carrier screening in a universal health care system: A model-based cost-effectiveness analysis. Genet Med 2023; 25:100943. [PMID: 37489580 DOI: 10.1016/j.gim.2023.100943] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE The limited evidence available on the cost-effectiveness (CE) of expanded carrier screening (ECS) prevents its widespread use in most countries, including Italy. Herein, we aimed to estimate the CE of 3 ECS panels (ie, American College of Medical Genetics and Genomics [ACMG] Tier 1 screening, "Focused Screening," testing 15 severe, highly penetrant conditions, and ACMG Tier 3 screening) compared with no screening, the health care model currently adopted in Italy. METHODS The reference population consisted of Italian couples seeking pregnancy with no increased personal/familial genetic risk. The CE model was developed from the perspective of the Italian universal health care system and was based on the following assumptions: 100% sensitivity of investigated screening strategies, 77% intervention rate of at-risk couples (ARCs), and no risk to conceive an affected child by risk-averse couples opting for medical interventions. RESULTS The incremental CE ratios generated by comparing each genetic screening panel with no screening were: -14,875 ± 1,208 €/life years gained (LYG) for ACMG1S, -106,863 ± 2,379 €/LYG for Focused Screening, and -47,277 ± 1,430 €/LYG for ACMG3S. ACMG1S and Focused Screening were dominated by ACMG3S. The parameter uncertainty did not significantly affect the outcome of the analyses. CONCLUSION From a universal health care system perspective, all the 3 ECS panels considered in the study would be more cost-effective than no screening.
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Affiliation(s)
- Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
| | - Oriana Ciani
- Center for Research on Health and Social Care Management, SDA Bocconi, Milan, Italy
| | | | | | | | - Paolo Emanuele Levi-Setti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Rosanna Tarricone
- Center for Research on Health and Social Care Management, SDA Bocconi, Milan, Italy; Department of Social and Political Science, Bocconi University, Milan, Italy
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25
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Ricciardi R. The roadmap to universal healthcare: Grit and fortitude. Nurse Pract 2023; 48:6-7. [PMID: 37751607 DOI: 10.1097/01.npr.0000000000000101] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- Richard Ricciardi
- Richard Ricciardi is a professor at the Center for Health Policy and Media Engagement at George Washington University in Washington, D.C
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26
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Study identifies prostate cancer-related disparities between Indigenous and non-Indigenous men in a universal health care system. Neurosciences (Riyadh) 2023; 28:284. [PMID: 37844948] [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: 10/18/2023]
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Carlson MS, Romo ML, Kelvin EA. Impact of the First Year of the COVID-19 on Unmet Healthcare Need among New York City Adults: a Universal Healthcare Experiment. J Urban Health 2023; 100:962-971. [PMID: 37583004 PMCID: PMC10618138 DOI: 10.1007/s11524-023-00752-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 08/17/2023]
Abstract
We examined the impact of the first year of the COVID-19 pandemic on unmet healthcare need among New Yorkers and potential differences by race/ethnicity and health insurance. Data from the Community Health Survey, collected in 2018, 2019, and 2020, were merged to compare unmet healthcare need within the past 12 months during the pandemic versus the 2 years prior to 2020. Univariate and multivariable logistic regression models evaluated change in unmet healthcare need overall, and we assessed whether race/ethnicity or health insurance status modified the association. Overall, 12% of New Yorkers (N = 27,660) experienced unmet healthcare during the 3-year period. In univariate and multivariable models, the first year of the pandemic (2020) was not associated with change in unmet healthcare need compared with 2018-2019 (OR = 1.04, p = 0.548; OR = 1.03, p = 0.699, respectively). There was no statistically significant interaction between calendar year and race/ethnicity, but there was significant interaction with health insurance status (interaction p = 0.009). Stratifying on health insurance status, those uninsured had borderline significant lower odds of experiencing unmet healthcare need during 2020 compared to the 2 years prior (OR = 0.72, p = 0.051) while those with insurance had a slight increase that was not significant (OR = 1.12, p = 0.143). Unmet healthcare need among New Yorkers during the first year of the pandemic did not differ significantly from 2018-2019. Federal pandemic relief funding, which offered no-cost COVID-19 testing and care to all, irrespective of health insurance or legal status, may have helped equalized access to healthcare.
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Affiliation(s)
- Madelyn S Carlson
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
| | - Matthew L Romo
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Occupational Health, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, NY, USA
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Price A, Bryson H, Mensah FK, Kenny B, Wang X, Orsini F, Gold L, Kemp L, Bruce T, Dakin P, Noble K, Makama M, Goldfeld S. Embedding nurse home visiting in universal healthcare: 6-year follow-up of a randomised trial. Arch Dis Child 2023; 108:824-832. [PMID: 37399321 DOI: 10.1136/archdischild-2023-325662] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Nurse home visiting (NHV) is designed to redress child and maternal health inequities. Of the previous trials to investigate NHV benefits beyond preschool, none were designed for populations with universal healthcare. To address this evidence gap, we investigated whether the Australian 'right@home' NHV programme improved child and maternal outcomes when children turned 6 and started school. METHODS A screening survey identified pregnant women experiencing adversity from antenatal clinics across two states (Victoria, Tasmania). 722 were randomised: 363 to the right@home programme (25 visits promoting parenting and home learning environment) and 359 to usual care. Child measures at 6 years (first school year): Strengths and Difficulties Questionnaire (SDQ), Social Skills Improvement System (SSIS), Childhood Executive Functioning Inventory (CHEXI) (maternal/teacher-reported); general health and paediatric quality of life (maternal-reported) and reading/school adaptation items (teacher-reported). Maternal measures: Personal Well-being Index (PWI), Depression Anxiety Stress Scales, warm/hostile parenting, Child-Parent Relationship Scale (CPRS), emotional abuse and health/efficacy items. Following best-practice methods for managing missing data, outcomes were compared between groups (intention-to-treat) using regression models adjusted for stratification factors, baseline variables and clustering (nurse/site level). RESULTS Mothers reported on 338 (47%) children, and teachers on 327 (45%). Patterns of group differences favoured the programme arm, with small benefits (effect sizes ranging 0.15-0.26) evident for SDQ, SSIS, CHEXI, PWI, warm parenting and CPRS. CONCLUSIONS Four years after completing the right@home programme, benefits were evident across home and school contexts. Embedding NHV in universal healthcare systems from pregnancy can offer long-term benefits for families experiencing adversity. TRIAL REGISTRATION NUMBER ISRCTN89962120.
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Affiliation(s)
- Anna Price
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia
| | - Hannah Bryson
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Fiona K Mensah
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia
| | - Bridget Kenny
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Xiaofang Wang
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, Vic, Australia
| | - Lynn Kemp
- Ingham Institute, Western Sydney University, Penrith South, New South Wales, Australia
| | - Tracey Bruce
- Ingham Institute, Western Sydney University, Penrith South, New South Wales, Australia
| | - Penny Dakin
- Policy & Projects, Australian Research Alliance for Children and Youth, Canberra, Australian Capital Territory, Australia
| | - Kristy Noble
- Policy & Projects, Australian Research Alliance for Children and Youth, Canberra, Australian Capital Territory, Australia
| | - Maureen Makama
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia
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Kiciak A, Clark W, Uhlich M, Letendre A, Littlechild R, Lightning P, Vasquez C, Singh R, Broomfield S, Martin AM, Huang G, Fairey A, Kolinsky M, Wallis CJD, Fung C, Hyndman E, Yip S, Bismar TA, Lewis J, Ghosh S, Kinnaird A. Disparities in prostate cancer screening, diagnoses, management, and outcomes between Indigenous and non-Indigenous men in a universal health care system. Cancer 2023; 129:2864-2870. [PMID: 37424308 DOI: 10.1002/cncr.34812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Indigenous Peoples have higher morbidity rates and lower life expectancies than non-Indigenous Canadians. Identification of disparities between Indigenous and non-Indigenous men regarding prostate cancer (PCa) screening, diagnoses, management, and outcomes was sought. METHODS An observational cohort of men diagnosed with PCa between June 2014 and October 2022 was studied. Men were prospectively enrolled in the province-wide Alberta Prostate Cancer Research Initiative. The primary outcomes were tumor characteristics (stage, grade, and prostate-specific antigen [PSA]) at diagnosis. Secondary outcomes were PSA testing rates, time from diagnosis to treatment, treatment modality, and metastasis-free, cancer-specific, and overall survivals. RESULTS Examination of 1,444,974 men for whom aggregate PSA testing data were available was performed. Men in Indigenous communities were less likely to have PSA testing performed than men outside of Indigenous communities (32 vs. 46 PSA tests per 100 men [aged 50-70 years] within 1 year; p < .001). Among 6049 men diagnosed with PCa, Indigenous men had higher risk disease characteristics: a higher proportion of Indigenous men had PSA ≥ 10 ng/mL (48% vs. 30%; p < .01), TNM stage ≥ T2 (65% vs. 47%; p < .01), and Gleason grade group ≥ 2 (79% vs. 64%; p < .01) compared to non-Indigenous men. With a median follow-up of 40 months (interquartile range, 25-65 months), Indigenous men were at higher risk of developing PCa metastases (hazard ratio, 2.3; 95% CI, 1.2-4.2; p < .01) than non-Indigenous men. CONCLUSIONS Despite receiving care in a universal health care system, Indigenous men were less likely to receive PSA testing and more likely to be diagnosed with aggressive tumors and develop PCa metastases than non-Indigenous men.
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Affiliation(s)
- Alex Kiciak
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Wayne Clark
- Indigenous Health Initiatives, University of Alberta, Edmonton, Alberta, Canada
| | - Maxwell Uhlich
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
| | - Angeline Letendre
- Cancer Prevention and Screening Innovations, Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Patrick Lightning
- Indigenous Health Initiatives, University of Alberta, Edmonton, Alberta, Canada
| | - Catalina Vasquez
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
| | - Raja Singh
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
| | - Stacey Broomfield
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | - Guocheng Huang
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Fairey
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
- Alberta Centre for Urologic Research and Excellence, Edmonton, Alberta, Canada
| | - Michael Kolinsky
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Fung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Hyndman
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven Yip
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tarek A Bismar
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John Lewis
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Adam Kinnaird
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada
- Alberta Centre for Urologic Research and Excellence, Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada
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He A, Manouchehrinia A, Glaser A, Ciccarelli O, Butzkueven H, Hillert J, McKay KA. Premorbid Sociodemographic Status and Multiple Sclerosis Outcomes in a Universal Health Care Context. JAMA Netw Open 2023; 6:e2334675. [PMID: 37751208 PMCID: PMC10523174 DOI: 10.1001/jamanetworkopen.2023.34675] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/11/2023] [Indexed: 09/27/2023] Open
Abstract
Importance Multiple sclerosis (MS) severity may be informed by premorbid sociodemographic factors. Objective To determine whether premorbid education, income, and marital status are associated with future MS disability and symptom severity, independent of treatment, in a universal health care context. Design, Setting, and Participants This nationwide observational cohort study examined data from the Swedish MS Registry linked to national population registries from 2000 to 2020. Participants included people with MS onset from 2005 to 2015 and of working age (aged 23 to 59 years) 1 year and 5 years preceding disease onset. Exposures Income quartile, educational attainment, and marital status measured at 1 and 5 years preceding disease onset. Main Outcome and Measures Repeated measures of Expanded Disability Status Scale (EDSS) scores and patient-reported Multiple Sclerosis Impact Scale (MSIS-29) scores. Models were adjusted for age, sex, relapses, disease duration, and treatment exposure. Secondary analyses further adjusted for comorbidity. All analyses were stratified by disease course (relapse onset and progressive onset). Results There were 4557 patients (mean [SD] age, 37.5 [9.3] years; 3136 [68.8%] female, 4195 [92.1%] relapse-onset MS) with sociodemographic data from 1-year preonset of MS. In relapse-onset MS, higher premorbid income and education correlated with lower disability (EDSS, -0.16 [95% CI, -0.12 to -0.20] points) per income quartile; EDSS, -0.47 [95% CI, -0.59 to -0.35] points if tertiary educated), physical symptoms (MSIS-29 physical subscore, -14% [95% CI, -11% to -18%] per income quartile; MSIS-29 physical subscore, -43% [95% CI, -35% to -50%] if tertiary educated), and psychological symptoms (MSIS-29 psychological subscore, -12% [95% CI, -9% to -16%] per income quartile; MSIS-29 psychological subscore, -25% [95% CI, -17% to -33%] if tertiary educated). Marital separation was associated with adverse outcomes (EDSS, 0.34 [95% CI, 0.18 to 0.51]; MSIS-29 physical subscore, 35% [95% CI, 12% to 62%]; MSIS-29 psychological subscore, 25% [95% CI, 8% to 46%]). In progressive-onset MS, higher income correlated with lower EDSS (-0.30 [95% CI, -0.48 to -0.11] points per income quartile) whereas education correlated with lower physical (-34% [95% CI, -53% to -7%]) and psychological symptoms (-33% [95% CI, -54% to -1%]). Estimates for 5-years preonset were comparable with 1-year preonset, as were the comorbidity-adjusted findings. Conclusions and relevance In this cohort study of working-age adults with MS, premorbid income, education, and marital status correlated with disability and symptom severity in relapse-onset and progressive-onset MS, independent of treatment. These findings suggest that socioeconomic status may reflect both structural and individual determinants of health in MS.
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Affiliation(s)
- Anna He
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
- National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Kyla A. McKay
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
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Study identifies prostate cancer-related disparities between Indigenous and non-Indigenous men in a universal health care system. Saudi Med J 2023; 44:944. [PMID: 37717970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
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Grover A, Bhargava B, Srivastava S, Sharma LK, Cherian JJ, Tandon N, Chandershekhar S, Ofrin RH, Bekedam H, Pandhi D, Mukherjee A, Dhaliwal RS, Singh M, Rajshekhar K, Roy S, Rasaily R, Saraf D, Kumar D, Parmar N, Kabra SK, Chaudhry D, Deorari A, Tandon R, Singh R, Khaitan B, Agrawala S, Gupta S, Goel SC, Bhansali A, Dutta U, Seth T, Singh N, Awasthi S, Seth A, Pandian J, Jha V, Dwivedi SK, Tripathi R, Thakar A, Jindal S, Gangadhar BN, Bajaj A, Kant M, Chatterjee A. Developing Standard Treatment Workflows-way to universal healthcare in India. Front Public Health 2023; 11:1178160. [PMID: 37663866 PMCID: PMC10472454 DOI: 10.3389/fpubh.2023.1178160] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/22/2023] [Indexed: 09/05/2023] Open
Abstract
Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80-90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.
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Affiliation(s)
- Ashoo Grover
- Division of NCD, Indian Council of Medical Research, New Delhi, India
| | - Balram Bhargava
- Department of Cardio Neuro Centre, Indian Council of Medical Research, New Delhi, India
| | - Saumya Srivastava
- Division of NCD, Indian Council of Medical Research, New Delhi, India
| | | | | | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Deepika Pandhi
- Department of Dermatology, University College of Medical Sciences, New Delhi, India
| | - Aparna Mukherjee
- Division of ECD, Indian Council of Medical Research, New Delhi, India
| | | | - Manjula Singh
- Division of ECD, Indian Council of Medical Research, New Delhi, India
| | | | - Sudipto Roy
- Indian Council of Medical Research, New Delhi, India
| | - Reeta Rasaily
- Division of NCD, Indian Council of Medical Research, New Delhi, India
- Division of BMI, Indian Council of Medical Research, New Delhi, India
| | - Deepika Saraf
- Department of Paediatrics, AIIMS, New Delhi, India
- Department of Pulmonology, PGIMER, Chandigarh, India
| | - Dhiraj Kumar
- Indian Council of Medical Research, New Delhi, India
| | - Neeraj Parmar
- Indian Council of Medical Research, New Delhi, India
| | | | - Dhruva Chaudhry
- Pandit Bhagwat Dayal Sharma PG Institute of Medical Sciences, Rohtak, India
| | - Ashok Deorari
- Himalayan Institute of Medical Sciences, Baksar Wala, Dehradun, India
| | - Radhika Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Binod Khaitan
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Anil Bhansali
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Haematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Seth
- All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- All India Institute of Medical Sciences, New Delhi, India
| | - Shally Awasthi
- Department of Paediatrics, King George's Medical University, Lucknow, India
- Department of Urology, King George's Medical University, Lucknow, India
- Department of Neurology, King George's Medical University, Lucknow, India
- Department of Nephrology, King George's Medical University, Lucknow, India
- Department of Cardiology, King George's Medical University, Lucknow, India
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, India
- Department of ENT, King George's Medical University, Lucknow, India
- Department of Pulmonology, King George's Medical University, Lucknow, India
- Department of Psychiatry, King George's Medical University, Lucknow, India
- Department of Gastroenterology, King George's Medical University, Lucknow, India
| | - Amlesh Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, India
| | | | | | - Alok Thakar
- All India Institute of Medical Sciences, New Delhi, India
| | - Surinder Jindal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anjali Bajaj
- Government of Himachal Pradesh, Himachal Pradesh, India
| | - Mohan Kant
- Department of Paediatrics, Indian Council of Medical Research, New Delhi, India
- Department of Opthalmology, Indian Council of Medical Research, New Delhi, India
- Department of General Surgery, Indian Council of Medical Research, New Delhi, India
- Dermatology, Indian Council of Medical Research, New Delhi, India
- Paediatric Surgery, Indian Council of Medical Research, New Delhi, India
- Oncology, Indian Council of Medical Research, New Delhi, India
- Orthopaedics, Indian Council of Medical Research, New Delhi, India
- Endocrinology, Indian Council of Medical Research, New Delhi, India
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Ravelojaona V, Ma X, Samison MF, Rabemalala D, Ayala R, Ramamonjisoa A, Andriamanjato HH, Ravoniaritsoa V, Jumbam DT, Andriamanarivo LM. Incorporating surgical and anesthesia care into universal health care: a national plan for the development of surgery in Madagascar. Can J Anaesth 2023; 70:1131-1154. [PMID: 37378826 DOI: 10.1007/s12630-023-02500-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/09/2022] [Accepted: 10/26/2022] [Indexed: 06/29/2023] Open
Abstract
Efforts have been made to strengthen national health systems for safe, affordable, and timely surgical, obstetric, trauma, and anesthesia (SOTA) care since 2015 when the Lancet Commission on Global Surgery (LCoGS) identified critical needs in improving access to essential surgical care for five billion people worldwide. Several governments have developed National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) as a commitment to ensuring safe and accessible surgical care for all of their population. The Ministry of Public Health (MoPH) of Madagascar launched its NSOAP in May 2019, named Le Plan National de Développement de la Chirurgie a Madagascar (PNDCHM). This policy established Madagascar as the first African francophone country to define concrete objectives for the Malagasy health system to meet the targets set by the LCoGS by 2030. The PNDCHM outlined the following priorities and specific action points to be implemented from 2019 to 2023: improving technical capacity, training human resources, developing a health information system, ensuring adequate governance and leadership, offering quality care, creating specific surgical services, and financing and mobilizing resources for implementation. Challenges encountered in the process included complex coordination between different stakeholders, allocating a sufficient budget for its implementation, frequent turnover within the MoPH, and the COVID-19 pandemic. The PNDCHM is a first of its kind in francophone Africa and the many lessons learned can serve as guidance for countries aspiring to build NSOAPs of their own.
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Affiliation(s)
| | - Xiya Ma
- Division of Plastic Surgery, Université de Montréal, Montreal, QC, Canada
| | - Marie-Fidèle Samison
- Department of Standard of Care, Ministry of Public Health, Antananarivo, Madagascar
| | - Dominique Rabemalala
- Technical Direction of University Hospital of Befelatanana Maternity, Antananarivo, Madagascar
| | - Ruben Ayala
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA
| | - Anjaramamy Ramamonjisoa
- Department of Policy, Research and Innovation, Operation Smile Madagascar, Antananarivo, Madagascar
| | | | | | - Desmond T Jumbam
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA.
- Operation Smile Ghana, Accra, Greater Accra Region, Ghana.
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d'Entremont MA, Ko D, Yan AT, Goodman SG, Ni J, Poirier P, Tardif JC, Grégoire JC, Couture ÉL, Nguyen M, Thanassoulis G, Sharma A, Huynh T. Race and Ethnicity With Atherosclerotic Cardiovascular Disease Outcomes Within a Universal Health Care System: Insights From the CARTaGENE Study. Can J Cardiol 2023; 39:925-932. [PMID: 36914033 DOI: 10.1016/j.cjca.2023.03.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND It remains unclear whether racial and ethnic disparities for atherosclerotic cardiovascular disease (ASCVD) persist within universal health care systems. We aimed to explore long-term ASCVD outcomes within a single-payer health care system with extensive drug coverage in Québec, Canada. METHODS CARTaGENE (CaG) is a population-based prospective cohort study of individuals aged 40 to 69 years. We included only participants without previous ASCVD. The primary composite endpoint was time to the first ASCVD event (cardiovascular death, acute coronary syndrome, ischemic stroke-transient ischemic attack, or peripheral arterial vascular event). RESULTS The study cohort included 18,880 participants followed for a median of 6.6 years (2009 to 2016). The mean age was 52 years, and 52.4% were female. After further adjustment for socioeconomic and cardiovascular factors, the increase in ASCVD risk for South Asians (SAs) was attenuated (hazard ratio [HR], 1.41; 95% confidence interval [CI], 0.75, 2.67), whereas Black participants' risk was lower (HR, 0.52; 95% CI, 0.29, 0.95) compared with White participants. After similar adjustments, there were no significant differences in ASCVD outcomes among the Middle Eastern, Hispanic, East-Southeast Asian, Indigenous, and mixed race-ethnicities participants and the White participants. CONCLUSIONS After adjustment for CV risk factors, the risk of ASCVD was attenuated in the SA CaG participants. Intensive risk-factor modification may mitigate the ASCVD risk of the SAs. Within a universal health care context and comprehensive drug coverage, the ASCVD risk was lower among Black compared with White CaG participants. Future studies are needed to confirm whether universal and liberal access to health care and medications can reduce the rates of ASCVD among the Black population.
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Affiliation(s)
- Marc-André d'Entremont
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Dennis Ko
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | | | - Shaun G Goodman
- St Michael's Hospital, Toronto, Ontario, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Jiayi Ni
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montréal, Québec, Canada; Montreal Heart Institute Research Center, Montréal, Québec, Canada
| | - Jean C Grégoire
- Montreal Heart Institute, Montréal, Québec, Canada; Montreal Heart Institute Research Center, Montréal, Québec, Canada
| | - Étienne L Couture
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
| | - Michel Nguyen
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
| | | | - Abhinav Sharma
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada; McGill University Health Centre, Montréal, Québec, Canada
| | - Thao Huynh
- McGill University Health Centre, Montréal, Québec, Canada.
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Chioro A, Gomes Temporão J, Massuda A, Costa H, Castro MC, Lima NTD. From Bolsonaro to Lula: The opportunity to rebuild universal healthcare in Brazil in the government transition. Int J Health Plann Manage 2023; 38:569-578. [PMID: 36840964 DOI: 10.1002/hpm.3627] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
This paper takes the government transition that took place between 2022 and 2023 in Brazil as a case study and aims to analyse how a cycle of radical right-wing populist government acted to dismantle Brazil's national health system foundations. It describes how governance was built based on political-clientelism and market-privatising interests and on the adoption of long-term fiscal austerity policies, whose results are public defunding and weakening and disorganisation of the country's national health system, with a significant worsening of health indicators and the capacity to respond to the population health needs. The lessons from recent experience in Brazil should serve as learning and a source of academic and political reflection, since there is an ongoing international movement and signs of rise of radical right-wing populist regimes in several countries, which endanger the Democratic Rule of Law, institutions, and social policies. It allows putting into perspective how political cycles of this nature can affect national universal health systems, including those that have experienced substantial progress towards universal access and universal health coverage. Keeping in mind the Brazilian experience, it was possible to observe the progressive structuring of a radical right-wing neo-populism and in the sanitarian.
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Affiliation(s)
- Arthur Chioro
- Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
| | - José Gomes Temporão
- Centro de Estudos Estratégicos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Adriano Massuda
- Fundacao Getulio Vargas Escola de Administracao de Empresas de Sao Paulo, Sao Paulo, Brazil
| | | | - Marcia C Castro
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Botwright S, Sutawong J, Kingkaew P, Anothaisintawee T, Dabak SV, Suwanpanich C, Promchit N, Kampang R, Isaranuwatchai W. Which interventions for alcohol use should be included in a universal healthcare benefit package? An umbrella review of targeted interventions to address harmful drinking and dependence. BMC Public Health 2023; 23:382. [PMID: 36823618 PMCID: PMC9948368 DOI: 10.1186/s12889-023-15152-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND This study aimed to identify targeted interventions for the prevention and treatment of harmful alcohol use. Umbrella review methodology was used to summarise the effectiveness across a broad range of interventions, in order to identify which interventions should be considered for inclusion within universal health coverage schemes in low- and middle-income countries. METHODS AND FINDINGS We included systematic reviews with meta-analysis of randomised controlled trials (RCTs) on targeted interventions addressing alcohol use in harmful drinkers or individuals with alcohol use disorder. We only included outcomes related to alcohol consumption, heavy drinking, binge drinking, abstinence, or alcohol-attributable accident, injury, morbidity or mortality. PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and the International HTA Database were searched from inception to 3 September 2021. Risk of bias of reviews was assessed using the AMSTAR2 tool. After reviewing the abstracts of 9,167 articles, results were summarised narratively and certainty in the body of evidence for each intervention was assessed using GRADE. In total, 86 studies met the inclusion criteria, of which the majority reported outcomes for brief intervention (30 studies) or pharmacological interventions (29 studies). Overall, methodological quality of included studies was low. CONCLUSIONS For harmful drinking, brief interventions, cognitive behavioural therapy, and motivational interviewing showed a small effect, whereas mentoring in adolescents and children may have a significant long-term effect. For alcohol use disorder, social network approaches and acamprosate showed evidence of a significant and durable effect. More evidence is required on the effectiveness of gamma-hydroxybutyric acid (GHB), nalmefene, and quetiapine, as well as optimal combinations of pharmacological and psychosocial interventions. As an umbrella review, we were unable to identify the extent to which variation between studies stemmed from differences in intervention delivery or variation between country contexts. Further research is required on applicability of findings across settings and best practice for implementation. Funded by the Thai Health Promotion Foundation, grant number 61-00-1812.
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Affiliation(s)
- Siobhan Botwright
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand.
| | - Jiratorn Sutawong
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand.
| | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Thunyarat Anothaisintawee
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Saudamini Vishwanath Dabak
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Chotika Suwanpanich
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Nattiwat Promchit
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Roongnapa Kampang
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Hjörleifsson S, Getz LO. The sustainability of universal health care. Tidsskr Nor Laegeforen 2023; 143:23-0025. [PMID: 36811428 DOI: 10.4045/tidsskr.23.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Kehr J. The moral economy of universal public healthcare. On healthcare activism in austerity Spain. Soc Sci Med 2023; 319:115363. [PMID: 36443121 DOI: 10.1016/j.socscimed.2022.115363] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/06/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022]
Abstract
Spain has a national health service, universal in access and free at the point of use. The global economic crisis of 2008, with its subsequent austerity policies, has put the universality of public healthcare at risk. This has led to an increase in healthcare activism, whose aim is to fight healthcare cuts and privatization to safeguard the national health service for all. This article addresses such healthcare activism. Drawing on long-term fieldwork with a heterogeneous set of actors ranging from individual activists and unions to ad hoc activist collectives, I will analyze the moral economy of healthcare activists in Madrid, to understand why and in which terms they defend universal healthcare as a common good and challenge its marketization. In Spain, since the democratic transition, struggles around what constitutes a common weal have been highly politicized and affect-laden. The national health system stands as one example here, as it is closely linked to the emergence of the democratic welfare state in the late 1970s, following decades of Franco's dictatorship. This makes Spain a particularly interesting case, as the widely acknowledged understanding of public healthcare as a public and social good is intimately linked to democratization and welfare. Therefore, struggles over the nature of health systems are also struggles over the political, moral and economic organization of society, over (il)legitimate forms of power and over ways of caring for each other. In such struggles, visions of the public, the state and the political economy come to the fore. In Spain, there is ambivalence about the state's role as both protector and provider of the public good, but also as facilitator of capitalism, which this article will address.
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Affiliation(s)
- Janina Kehr
- University of Vienna, Department of Social and Cultural Anthropology, Universitätsstraße 7, 1010, Wien, Austria.
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Brown H, Bryder L. Universal healthcare for all? Māori health inequalities in Aotearoa New Zealand, 1975-2000. Soc Sci Med 2023; 319:115315. [PMID: 36089552 DOI: 10.1016/j.socscimed.2022.115315] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022]
Abstract
Despite establishing a so-called universal, taxpayer funded health system from 1938, New Zealand's health system has never delivered equitable health outcomes for its indigenous population, the Māori people. This article, using a case study approach focusing on Māori, documents these historic inequalities and discusses policy attempts to address them from the 1970s when the principles of the Treaty of Waitangi were first introduced in legislation. This period is one of increasing self-determination for Māori, but notwithstanding this, Māori continued to have significantly shorter life expectancy than the population as a whole and suffered poor health at much higher rates. Neo-liberal policies were introduced and expanded during the 1980s and 1990s in New Zealand, including in healthcare from the early 1990s. The introduction of the purchaser-provider split in health services and the focus on devolving responsibility to communities provided an opportunity for Māori health providers to be established. However, the neo-liberal economic and social welfare policies implemented during this time also worked against Māori and adversely affected their health. By analysing attempts to reduce inequity in health outcomes for Māori, we explore why these collective attempts, including by Māori themselves, did not result in overall improved health and increased life expectancy for Māori. There was often a significant gap between government rhetoric and action, and we suggest that a predominantly universal healthcare system did not accommodate cultural and ethnic differences, and this is a potential explanation for the failure to reduce inequities. While this is true for all minority ethnic groups it is even more crucial for Māori as New Zealand's tangata whenua (first people) who had been progressively disadvantaged under colonialism. However, the seeds of ideas around Māori-led healthcare were planted in this period and have become part of the current Labour Government's policy on health reform.
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Affiliation(s)
- Hayley Brown
- London School of Hygiene and Tropical Medicine, 15-17, Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Linda Bryder
- University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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Kehr J, Muinde JVS, Prince RJ. Health for all? Pasts, presents and futures of aspirations for universal healthcare. Soc Sci Med 2023; 319:115660. [PMID: 36697329 DOI: 10.1016/j.socscimed.2023.115660] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In this special issue, we bring together anthropological and historical work that considers successive aspirations towards 'health for all': their pasts, their futures, and their diverse meanings and iterations. Across the world, hopes for providing 'health for all' were central to nation building in the long 20th century, and for international relations, particularly after the second world war and the establishment of the WHO. Health became seen as a fundamental good by citizens of North and South and has remained a central force shaping global and national politics until today. But what does 'health for all' actually mean, and how did it come to matter? In this introduction we approach 'health for all as a situated, multi-faceted phenomenon, that - while having a shared aspiration towards universality of access and equality of care - comes into focus in partial, diverse and contentious policies, programmes, projects and practices. Beyond homogenising narratives that frame 'health for all' in terms of either success or failure, the special issue highlights the diverse iterations that 'health for all' has taken on the ground for different subjects and groups of people, exploring exclusions and limitations as well as dreams and aspirations.
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Affiliation(s)
- Janina Kehr
- Institute for Social and Cultural Anthropology, University of Vienna, Austria
| | - Jacinta Victoria Syombua Muinde
- University of Oslo, Institute of Health and Society, P O Box 1130, Blindern, Oslo, 0317, Norway; Department of Social Anthropology, University of Oslo, Norway
| | - Ruth J Prince
- University of Oslo, Institute of Health and Society, P O Box 1130, Blindern, Oslo, 0317, Norway.
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Wester G. Health, Health Care, and Equality of Opportunity: The Rationale for Universal Health Care. Camb Q Healthc Ethics 2023; 32:26-33. [PMID: 36691353 DOI: 10.1017/s0963180122000469] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This article discusses what arguments best support universal health care (UHC), with a focus on Norman Daniels' equality of opportunity account. This justification for UHC hinges on the assumption of a close relationship between health care and health. But in light of empirical research that suggests that health outcomes are shaped to a large extent by factors other than health care, such as income, education, housing, and working conditions, the question arises to what extent health care is really necessary to protect and promote health, and thereby opportunity. The author argues that, although this challenge to the equality of opportunity rationale is legitimate, it is not sufficiently specified to allow us to adequately assess the extent to which universal health succeeds in protecting equality of opportunity. The article concludes by outlining a more promising strategy for developing a viable rationale for UHC.
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Johnston EM, Samaratunga N, Prasad R, Birkland B, Von Pressentin KB, Prasad S. Building the foundation for universal healthcare: Academic family medicine’s ability to train family medicine practitioners to meet the needs of their community across the globe. Afr J Prim Health Care Fam Med 2022; 14:e1-e7. [PMID: 36073127 PMCID: PMC9453143 DOI: 10.4102/phcfm.v14i1.3506] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/16/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background The Declaration of Astana marked a revived global interest in investing in primary care as a means to achieve universal healthcare. Family medicine clinicians are uniquely trained to provide high-quality, comprehensive primary care throughout the lifespan. Yet little focus has been placed on understanding the needs of family medicine training programs. Aim This study aims to assess broad patterns of strengths and resource challenges faced by academic programs that train family medicine clinicians. Methods An anonymous online survey was sent to family medicine faculty using World Organization of Family Doctors (WONCA) listservs. Results Twenty-nine representatives of academic family medicine programs from around the globe answered the survey. Respondents cited funding for the program and/or individual trainees as one of either their greatest resources or greatest limitations. Frequently available resources included quality and quantity of faculty and reliable clinical training sites. Frequently noted limitations included recruitment capacity and social capital. Over half of respondents reported their program had at some point faced a disruption or gap in its ability to recruit or train, most often because of loss of government recognition. Reflecting on these patterns, respondents expressed strong interest in partnerships focusing on faculty development and research collaboration. Lessons learnt This study provides a better understanding of the challenges family medicine training programs face and how to contribute to their sustainability and growth, particularly in terms of areas for investment, opportunities for government policy and action and areas of collaboration. Keywords family medicine; primary care; medical education; global health; community medicine.
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Affiliation(s)
- Esther M Johnston
- National Family Medicine Residency Program, HealthPoint, The Wright Center, Auburn, United States of America.
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Kim S, Headley TY, Tozan Y. Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries. PLoS Med 2022; 19:e1004060. [PMID: 35972985 PMCID: PMC9380914 DOI: 10.1371/journal.pmed.1004060] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several studies have indicated that universal health coverage (UHC) improves health service utilization and outcomes in countries. These studies, however, have primarily assessed UHC's peacetime impact, limiting our understanding of UHC's potential protective effects during public health crises such as the Coronavirus Disease 2019 (COVID-19) pandemic. We empirically explored whether countries' progress toward UHC is associated with differential COVID-19 impacts on childhood immunization coverage. METHODS AND FINDINGS Using a quasi-experimental difference-in-difference (DiD) methodology, we quantified the relationship between UHC and childhood immunization coverage before and during the COVID-19 pandemic. The analysis considered 195 World Health Organization (WHO) member states and their ability to provision 12 out of 14 childhood vaccines between 2010 and 2020 as an outcome. We used the 2019 UHC Service Coverage Index (UHC SCI) to divide countries into a "high UHC index" group (UHC SCI ≥80) and the rest. All analyses included potential confounders including the calendar year, countries' income group per the World Bank classification, countries' geographical region as defined by WHO, and countries' preparedness for an epidemic/pandemic as represented by the Global Health Security Index 2019. For robustness, we replicated the analysis using a lower cutoff value of 50 for the UHC index. A total of 20,230 country-year observations were included in the study. The DiD estimators indicated that countries with a high UHC index (UHC SCI ≥80, n = 35) had a 2.70% smaller reduction in childhood immunization coverage during the pandemic year of 2020 as compared to the countries with UHC index less than 80 (DiD coefficient 2.70; 95% CI: 0.75, 4.65; p-value = 0.007). This relationship, however, became statistically nonsignificant at the lower cutoff value of UHC SCI <50 (n = 60). The study's primary limitation was scarce data availability, which restricted our ability to account for confounders and to test our hypothesis for other relevant outcomes. CONCLUSIONS We observed that countries with greater progress toward UHC were associated with significantly smaller declines in childhood immunization coverage during the pandemic. This identified association may potentially provide support for the importance of UHC in building health system resilience. Our findings strongly suggest that policymakers should continue to advocate for achieving UHC in coming years.
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Affiliation(s)
- Sooyoung Kim
- School of Global Public Health, New York University, New York, New York, United States of America
| | | | - Yesim Tozan
- School of Global Public Health, New York University, New York, New York, United States of America
- * E-mail:
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Galvani AP, Parpia AS, Pandey A, Sah P, Colón K, Friedman G, Campbell T, Kahn JG, Singer BH, Fitzpatrick MC. Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic. Proc Natl Acad Sci U S A 2022; 119:e2200536119. [PMID: 35696578 PMCID: PMC9231482 DOI: 10.1073/pnas.2200536119] [Citation(s) in RCA: 6] [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] [Indexed: 01/17/2023] Open
Abstract
The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. During a pandemic, the lives saved and economic benefits of a single-payer universal healthcare system relative to the status quo would be even greater. For Americans who are uninsured and underinsured, financial barriers to COVID-19 care delayed diagnosis and exacerbated transmission. Concurrently, deaths beyond COVID-19 accrued from the background rate of uninsurance. Universal healthcare would alleviate the mortality caused by the confluence of these factors. To evaluate the repercussions of incomplete insurance coverage in 2020, we calculated the elevated mortality attributable to the loss of employer-sponsored insurance and to background rates of uninsurance, summing with the increased COVID-19 mortality due to low insurance coverage. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved about 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a single-payer universal healthcare system over the course of the pandemic. These economic benefits are in addition to US$438 billion expected to be saved by single-payer universal healthcare during a nonpandemic year.
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Affiliation(s)
- Alison P. Galvani
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- 1To whom correspondence may be addressed. or
| | - Alyssa S. Parpia
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Abhishek Pandey
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Pratha Sah
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
| | - Kenneth Colón
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- bMaxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY 13244
| | - Gerald Friedman
- cDepartment of Economics, College of Social and Behavioral Sciences, University of Massachusetts Amherst, Amherst, MA 01002
| | - Travis Campbell
- cDepartment of Economics, College of Social and Behavioral Sciences, University of Massachusetts Amherst, Amherst, MA 01002
| | - James G. Kahn
- dInstitute for Health Policy Studies, School of Medicine, University of California, San Francisco, CA 94118
| | - Burton H. Singer
- eEmerging Pathogens Institute, University of Florida, Gainesville, FL 32610
- 1To whom correspondence may be addressed. or
| | - Meagan C. Fitzpatrick
- aCenter for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510
- fCenter for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
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Kiragu ZW, Rockers PC, Onyango MA, Mungai J, Mboya J, Laing R, Wirtz VJ. Household access to non-communicable disease medicines during universal health care roll-out in Kenya: A time series analysis. PLoS One 2022; 17:e0266715. [PMID: 35443014 PMCID: PMC9020677 DOI: 10.1371/journal.pone.0266715] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/26/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives This study aims to describe trends and estimate impact of county-level universal health coverage expansion in Kenya on household availability of non-communicable disease medicines, medicine obtainment at public hospitals and proportion of medicines obtained free of charge. Methods Data from phone surveillance of households in eight Kenyan counties between December 2016 and September 2019 were used. Three primary outcomes related to access were assessed based on patient report: availability of non-communicable disease medicines at the household; non-communicable disease medicine obtainment at a public hospital versus a different outlet; and non-communicable disease medicine obtainment free of cost versus at a non-zero price. Mixed models adjusting for fixed and random effects were used to estimate associations between outcomes of interest and UHC exposure. Results The 197 respondents with universal health coverage were similar on all demographic factors to the 415 respondents with no universal health coverage. Private chemists were the most popular place of purchase throughout the study. Adjusting for demographic factors, county and time fixed effects, there was a significant increase in free medicines (aOR 2.55, 95% CI 1.73, 3.76), significant decrease in medicine obtainment at public hospitals (aOR 0.68, 95% CI 0.47, 0.97), and no impact on the availability of non-communicable disease medicines in households (aβ -0.004, 95% CI -0.058, 0.050) with universal health coverage. Conclusions Access to universal health coverage caused a significant increase in free non-communicable disease medicines, indicating financial risk protection. Interestingly, this is not accompanied with increases in public hospitals purchases or household availability of non-communicable disease medicines, with public health centers playing a greater role in supply of free medicines. This raises the question as to the status of supply-side investments at the public hospitals, to facilitate availability of quality-assured medicines.
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Affiliation(s)
- Zana Wangari Kiragu
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Peter C. Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Monica A. Onyango
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - John Mungai
- Innovation for Poverty Action, Nairobi, Kenya
| | - John Mboya
- Innovation for Poverty Action, Nairobi, Kenya
| | - Richard Laing
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- School of Public Health, University of Western Cape, Bellville, South Africa
| | - Veronika J. Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Butalia S, Chen G, Duan Q, Anderson TJ. Care gaps in achieving cholesterol targets in people with diabetes: A population-based study in a universal health care setting. Diabetes Res Clin Pract 2022; 184:109177. [PMID: 34923023 DOI: 10.1016/j.diabres.2021.109177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/01/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022]
Abstract
AIMS Statins are first line therapy in people with diabetes. Little is known about real-world statin intensity use and low-density lipoprotein cholesterol (LDL-C) levels achieved. We aimed to describe statin intensity used, achievement of LDL-C targets, and factors associated with achieving targets among adults with diabetes. METHODS This population based (∼4.3 million), retrospective observational study, used clinical and administrative databases. Statin use by intensity, adherence, and achievement of LDL-C targets in adults with diabetes were described. Multiple logistic regression assessed the factors associated with achieving targets. RESULTS Out of 331,312 individuals with diabetes, 88% had an index LDL-C test. At follow up, 31% overall did not achieve LDL-C targets and overall adherence was 66%. Failure to achieve targets was 49%, 30%, and 25% in low-, moderate-, and high-intensity statin groups, respectively. Those who were older, males, had a history of myocardial infarction, stroke, congestive heart failure, renal disease, better adherence, and higher intensity statin users were more likely to achieve targets. CONCLUSIONS One-third of people on statins did not achieve targets. Strategies to fill the gap between ideal and current levels of LDL-C achieved are needed if the benefits of statins demonstrated in trials are to be translated into practice.
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Affiliation(s)
- Sonia Butalia
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, 9th Floor, 1403 - 29th Street NW, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, Calgary, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, Heritage Medical Research Building (HMRB), Room 72, Foothills Campus, University of Calgary, 3310 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
| | - Guanmin Chen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, Heritage Medical Research Building (HMRB), Room 72, Foothills Campus, University of Calgary, 3310 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Data & Analytics, Alberta Health Services, 4520 16 Avenue NW, Calgary, AB T3B 0M6, Canada.
| | - Qiuli Duan
- Data & Analytics, Alberta Health Services, 4520 16 Avenue NW, Calgary, AB T3B 0M6, Canada.
| | - Todd J Anderson
- Libin Cardiovascular Institute, Cumming School of Medicine, Heritage Medical Research Building (HMRB), Room 72, Foothills Campus, University of Calgary, 3310 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
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Tordrup D, Smith R, Kamenov K, Bertram MY, Green N, Chadha S. Global return on investment and cost-effectiveness of WHO's HEAR interventions for hearing loss: a modelling study. Lancet Glob Health 2022; 10:e52-e62. [PMID: 34919856 PMCID: PMC8692586 DOI: 10.1016/s2214-109x(21)00447-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 09/07/2021] [Accepted: 09/21/2021] [Indexed: 12/20/2022]
Abstract
Background To address the growing prevalence of hearing loss, WHO has identified a compendium of key evidence-based ear and hearing care interventions to be included within countries’ universal health coverage packages. To assess the cost-effectiveness of these interventions and their budgetary effect for countries, we aimed to analyse the investment required to scale up services from baseline to recommended levels, and the return to society for every US$1 invested in the compendium. Methods We did a modelling study using the proposed set of WHO interventions (summarised under the acronym HEAR: hearing screening and intervention for newborn babies and infants, pre-school and school-age children, older adults, and adults at higher risk of hearing loss; ear disease prevention and management; access to technologies such as hearing aids, cochlear implants, or hearing assistive technologies; and rehabilitation service provision), which span the life course and include screening and management of hearing loss and related ear diseases, costs and benefits for the national population cohorts of 172 countries. The return on investment was analysed for the period between 2020 and 2030 using three scenarios: a business-as-usual scenario, a progress scenario with a scale-up to 50% of recommended coverage, and an ambitious scenario with scale-up to 90% of recommended coverage. Using data for hearing loss burden from the Global Burden of Disease Study 2019, a transition model with three states (general population, diagnosed, and those who have died) was developed to model the national populations in countries. For the return-on-investment analysis, the monetary value of disability-adjusted life-years (DALYs) averted in addition to productivity gains were compared against the investment required in each scenario. Findings Scaling up ear and hearing care interventions to 90% requires an overall global investment of US$238·8 billion over 10 years. Over a 10-year period, this investment promises substantial health gains with more than 130 million DALYs averted. These gains translate to a monetary value of more than US$1·3 trillion. In addition, investment in hearing care will result in productivity benefits of more than US$2 trillion at the global level by 2030. Together, these benefits correspond to a return of nearly US$15 for every US$1 invested. Interpretation This is the first-ever global investment case for integrating ear and hearing care interventions in countries’ universal health coverage services. The findings show the economic benefits of investing in this compendium and provide the basis for facilitating the increase of country's health budget for strengthening ear and hearing care services. Funding None.
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Affiliation(s)
- David Tordrup
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands; Triangulate Health, Doncaster, UK.
| | - Robert Smith
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kaloyan Kamenov
- WHO Sensory Functions, Disability, and Rehabilitation Unit, World Health Organization, Geneva, Switzerland
| | - Melanie Y Bertram
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Nathan Green
- Department of Statistical Science, University College London, London, UK
| | - Shelly Chadha
- WHO Sensory Functions, Disability, and Rehabilitation Unit, World Health Organization, Geneva, Switzerland
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Abstract
40 years ago, Italy saw the birth of a national, universal health-care system (Servizio Sanitario Nazionale [SSN]), which provides a full range of health-care services with a free choice of providers. The SSN is consistently rated within the Organisation for Economic Co-operation and Development among the highest countries for life expectancy and among the lowest in health-care spending as a proportion of gross domestic product. Italy appears to be in an envious position. However, a rapidly ageing population, increasing prevalence of chronic diseases, rising demand, and the COVID-19 pandemic have exposed weaknesses in the system. These weaknesses are linked to the often tumultuous history of the nation and the health-care system, in which innovation and initiative often lead to spiralling costs and difficulties, followed by austere cost-containment measures. We describe how the tenuous balance of centralised versus regional control has shifted over time to create not one, but 20 different health systems, exacerbating differences in access to care across regions. We explore how Italy can rise to the challenges ahead, providing recommendations for systemic change, with emphasis on data-driven planning, prevention, and research; integrated care and technology; and investments in personnel. The evolution of the SSN is characterised by an ongoing struggle to balance centralisation and decentralisation in a health-care system, a dilemma faced by many nations. If in times of emergency, planning, coordination, and control by the central government can guarantee uniformity of provider behaviour and access to care, during non-emergency times, we believe that a balance can be found provided that autonomy is paired with accountability in achieving certain objectives, and that the central government develops the skills and, therefore, the legitimacy, to formulate health policies of a national nature. These processes would provide local governments with the strategic means to develop local plans and programmes, and the knowledge and tools to coordinate local initiatives for eventual transfer to the larger system.
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Affiliation(s)
| | - Rosanna Tarricone
- Department of Social and Political Science, Bocconi University, Milan, Italy; Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy.
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Meulman I, Uiters E, Polder J, Stadhouders N. Why does healthcare utilisation differ between socioeconomic groups in OECD countries with universal healthcare coverage? A protocol for a systematic review. BMJ Open 2021; 11:e054806. [PMID: 34815290 PMCID: PMC8611423 DOI: 10.1136/bmjopen-2021-054806] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Even in advanced economies with universal healthcare coverage (UHC), a social gradient in healthcare utilisation has been reported. Many individual, community and healthcare system factors have been considered that may be associated with the variation in healthcare utilisation between socioeconomic groups. Nevertheless, relatively little is known about the complex interaction and relative contribution of these factors to socioeconomic differences in healthcare utilisation. In order to improve understanding of why utilisation patterns differ by socioeconomic status (SES), the proposed systematic review will explore the main mechanisms that have been examined in quantitative research. METHODS AND ANALYSIS The systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and will be conducted in Embase, PubMed, Scopus, Web of Science, Econlit and PsycInfo. Articles examining factors associated with the differences in primary and specialised healthcare utilisation between socioeconomic groups in Organisation for Economic Co-operation and Development (OECD) countries with UHC will be included. Further restrictions concern specifications of outcome measures, factors of interest, study design, population, language and type of publication. Data will be numerically summarised, narratively synthesised and thematically discussed. The factors will be categorised according to existing frameworks for barriers to healthcare access. ETHICS AND DISSEMINATION No primary data will be collected. No ethics approval is required. We intend to publish a scientific article in an international peer-reviewed journal.
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Affiliation(s)
- Iris Meulman
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Ellen Uiters
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Johan Polder
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Niek Stadhouders
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Abstract
BACKGROUND In this paper, we review lessons learned about Universal Health Coverage (UHC) in middle-income countries, with specific reference to achievements and challenges observed during recent years in four middle-income to upper-middle-income countries - Mexico, Turkey, The Republic of Korea and Ukraine. Three of these countries - Mexico, the Republic of Korea, Turkey are members of the Organization for Economic Cooperation and Development (OECD). Ukraine has aspired to join Western institutions like the OECD since its independence in 1991. METHODS The research included a combination of cross-sectional and longitudinal reviews of both statistical and contextual data, available from both published sources and available "grey literature" reports. RESULTS Based on the research, we conclude the following. First, reaching UHC is achievable in middle-income and upper-middle-income countries. It is not an unattainable goal reserved for upper income countries. Second, successes and failures are evident both in the case of countries that pursue a contributory health insurance path to UHC and those that pursue a core government funding path. Third, the devil is often in the detail. De jure constitutional guarantees and national health legislation are often a necessary but do not constitute a guaranteed path to success without accompanying institutional measure to secure sustainability (political and economic) and supply and demand constraints in service provision and consumer/patient behavior. De facto, in most countries expansion in health insurance coverage does not happen "with the stroke of a pen" but require years of commitment and efforts to change the supply and demand after critical legislation has been enacted. Fourth, two major approaches dominate: incremental and "big bang" health system reforms. CONCLUSIONS We caution against the pitfalls of over-attribution from drawing too strong conclusion from individual longitudinal country experiences ("over-determinism") and over-generalization from broad sweeping cross-sectional statistical analysis ("reductionism"). Every country is different and needs to find its own path towards UHC considering their contextual specificities, learning from the achievements and failures of others, but not try to copy their experiences.
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Affiliation(s)
| | | | - Soonman Kwon
- Graduate School of Public Health, Department of Health Policy and Management, Professor and Former Dean, Seoul National University, Seoul, South Korea
| | - Rifat Atun
- T.H. Chan School of Public Health, Department of Global Health and Population, Director of Global Health Systems Cluster/Professor of Global Health Systems, Harvard University, Boston, Massachusetts, USA
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