The impact of healthcare system quality and economic factors on the older adult population: a health economics perspective.

Purpose: This study investigates the influence of economic conditions, healthcare system capacity, and health-related variables on the proportion of the older adult population (Population ages 65 and above) in European Union countries. It aims to identify how factors such as GDP, unemployment, inflation, healthcare expenditure, hospital bed availability, and the prevalence of chronic diseases impact the aging demographic. Methods: This study explores the dynamic interactions and temporal relationships between economic stability, healthcare capacity, chronic disease prevalence, and demographic aging patterns. The research employs a mixed-method approach, utilizing System GMM and wavelet coherence analysis on panel data from 27 EU countries between 2000 and 2021. Results: The findings reveal significant positive associations between economic prosperity and healthcare resources with the size of the older adult population. Increased GDP, efficient healthcare spending, and hospital bed availability are positively correlated with a larger older adult demographic. In contrast, high unemployment and inflation are linked to negative outcomes for the older adult population, reducing available resources and access to healthcare. Wavelet coherence analysis further uncovers how fluctuations in the prevalence of chronic diseases influence aging trends across different periods and frequencies. Conclusion: The study highlights the importance of integrated economic and healthcare policies to support the growing older adult population. Ensuring economic stability, enhancing healthcare infrastructure, and effectively managing chronic diseases are essential for improving quality of life and promoting sustainable aging in EU societies.

Transforming Health Care Delivery: Innovations in Payment Models for Interprofessional Team-Based Care.

By examining the strengths, limitations, and implications of different payment models we seek to inform policymakers, practitioners, and educators on the path toward patient-cen-tered, efficient, and sustainable primary health care deliv-ery. Health care payment model reform should be viewed as an investment in future health asset capacity and equity production rather than an immediate return on investment for short-term health care cost reduction.

Healthcare System Sustainability Challenges in Nepal and Opportunities Offered by Alternative Healthcare Delivery Arrangements.

ABSTRACT: The burden of chronic diseases in Nepal is increasing due to demographic and epidemiological transitions; alongside the persistent impact of communicable, maternal, newborn, and child health diseases, this critical situation acts as the precursor to rising healthcare costs. Nepal struggles to sustain its healthcare system amidst political instability, pandemics, natural disasters, and slow economic growth, particularly when healthcare funding is mainly dependent on out-of-pocket payments. Nepal requires lower-cost alternative healthcare delivery arrangements to provide high-value care while relieving economic sustainability pressures. Alternative healthcare delivery arrangements have a broad potential scope; they can involve strategic changes in how care is delivered and by whom, or they can also involve the application of information and communication technologies, e.g., telemedicine. This paper highlights the specific challenges to healthcare system sustainability in Nepal and the potential for high-value, lower-cost alternative healthcare delivery models to improve system performance in the longer term.

Analysis of social investment in health systems reform: a case study of results-based financing in Marondera District, Zimbabwe.

Introduction: suboptimal use of donor funds and poor health systems performance is rife across most developing countries; to address this, results-based financing (RBF) models were developed. However, it is imperative to explore the emic and context specific influence of results-based financing in health systems performance. This study therefore sought to explore the influence of results-based financing on health worker motivation and governance, temporal perspective, distributional principle, and policy coherence. Finally, the influence of results-based financing on interrelations across donors, technical partners, and health workers was explored. Methods: the study adopted a qualitative, exploratory, descriptive, phenomenological design using audio-recorded face-to-face semi-structured interviews to capture diverse perspectives from the remaining and available two health financing experts, two technical partner organization representatives, and six health workers who have been implementing results-based financing from 2011 to 2022 in the Marondera district of Zimbabwe. Data was transcribed and collectively analyzed using NVIVO software. Results: improved staff motivation, better governance, health system development, equity, and policy consistency were attributable to results-based financing, notwithstanding several challenges including understaffing, increased workload, procurement red tape, financial rigidity, and delays in subsidy payments, which eroded gains of better performance. Additionally, a lack of continuum of care due to user fees faced by the poor at higher levels of care, and limited engagement between donors and healthcare facility workers were also observed. Conclusion: reinforcing pinpointed positives is vital for sustaining realized health gains; however, urgent attention is required to address the challenges to safeguard the milestones achieved thus far.

[Expert consensus on pharmacoeconomic evaluations alongside clinical trials (2024 edition)].

As a technical tool to guide the optimal allocation of healthcare resources, pharmacoeconomic evaluation has been gradually applied to national healthcare decisions, including the adjustment of the National Reimbursement Drug List in China. With the acceleration of drug market approval and access to insurance coverage, the demand for pharmacoeconomic evaluation in healthcare decision-making is also increasing. Designing a pharmacoeconomic evaluation alongside clinical trials has become an important research direction and the source of evidence. In order to facilitate the standardization of this research field, the current consensus focuses on the topic of how to conduct a pharmacoeconomic evaluation alongside clinical trials from the Chinese healthcare system and decision-making context. The consensus group reconciled expert opinions and developed recommendations covering the entire process of study design, data collection and management, data analysis, and methods and results reporting. A total of 24 recommendations regarding to methodology and practice were developed from eighteen aspects including target population, selection of comparators, calculation of sample size, data collection of healthcare resource utilization, data collection of health-related quality of life, cost analysis, health outcome analysis, addressing the missing and censored data, etc., with the aim to provide reference for scholars and decision makers in this research filed.

European structural funds to finance healthcare in Italian regions.

In this work, we explore the extensive utilization of European Union Structural Funds to enhance regional healthcare systems in Italy over the period 2014-2020. These funds serve as vital instruments for financing the construction, renovation, and modernization of healthcare facilities, as well as supporting medical research and technological innovation. They enable the implementation of disease prevention and health promotion programs and provide essential income support to vulnerable families through the European Social Fund. Our analysis found that EU funding allocated to "health-related" projects during the 2014-2020 programming period, amounts to just over 6.19 billion euros [5.1 billion financed by the European Regional Development Fund (ERDF) and just over 1 billion financed by the European Social Fund (ESF)], of which 65.88% is funded by European resources. These funds supported a total of 26,739 projects, with 22,529 funded by the ERDF, primarily focusing on infrastructure projects and the acquisition of new technologies in the healthcare sector. Meanwhile, the 4,210 projects funded by the ESF were dedicated to personnel training and public health policies in the regions. The European co-financing provided by the ERDF exceeded 63%, while for the ESF, the European share was approximately 77%. Notably, some regions have leveraged these funds to pioneer telemedicine and healthcare technologies, improving healthcare accessibility, especially in remote areas. However, regional disparities in fund allocation and utilization persist and coordinated strategies and cross-regional collaboration, emphasizing the sharing of best practices and the reinforcement of transnational projects, need to successfully address these calls and to promote convergence not only in economic but also in healthcare terms.

Framework for responsive financing of district hospitals of India.

Introduction: The current financing of public-sector district hospitals in India relies on historical budget allocations rather than actual utilization or healthcare needs. We utilized empirical data on healthcare delivery costs to develop the financing framework for these hospitals using a blended payment approach. Methods: The primary data on cost of delivering services in 27 district hospitals across nine states of India was analysed along with indicators influencing the demand and supply of health services. Payment for outpatient, inpatient, and indirect services was assessed using the risk adjusted global budget, case-based bundled payment, and per-bed-global budget, respectively. Risk adjustment weights were computed by regressing the cost of outpatient care with demand and supply side factors which are likely to influence the utilization or the prices. Budget impact analysis was conducted to assess the fiscal implications of this payment approach, accounting for current care standards and two scenarios: upgrading district hospitals to Indian Public Health Standards (IPHS) or medical colleges. Results: The average annual budget for a district hospital in India is estimated at ₹326 million (US$3.35 million), ranging from ₹66 million to ₹2.57 billion (US$0.8-31.13 million). Inpatient care comprises the largest portion (78%) of the budget. Upgrading to IPHS-compliant secondary hospitals or medical colleges would increase average budgets by 131 and 91.5%, respectively. Conclusion: Implementing a blended payment approach would align funding with healthcare needs, enhance provider performance, and support ongoing financing reforms aimed at strategic purchasing and universal health coverage.

A Vision For the Future of Cardiovascular Medicine Practise in Ghana: Inspiration From the Yale-New Haven Health System.

The Ghana Physicians and Surgeons Foundation (GPSF) of North America sponsors Ghanaian clinical fellows to undertake an eight-weeklong clinical observation with the Yale University School of Medicine and Yale-New Haven Health (YNHH) annually, through the Residents in Training Educational Stipend (RITES) programme. This offers the opportunity to appreciate new perspectives in clinical care to improve Ghana's healthcare standard. The cardiovascular medicine workforce at the YNHH is heterogenous, with significant reliance on non-doctor cadres of health workers who demonstrate competence. This is contrasted from the Ghanaian system which despite having a poorer physician-patient ratio, is heavily dependent on doctors. Technological advancements are minimal in Ghana, posing diagnostic and therapeutic challenges which are otherwise minimised at the YNHH. A strong patient-centred culture, coupled with a coordinated emergency response system that ensures appropriate timely transfers, culminate in good care and outcomes. Ideas on how the experience can be translated to Ghanaian clinical practise in cardiovascular medicine, after participating in the RITES programme, are shared in this paper with an emphasis on task sharing, strengthening emergency response systems and improving technological sophistication through capacity building, mentorship and improved health financing.

Efficiency of health systems in middle-income countries and determinants of efficiency in Latin America and the Caribbean.

We estimate the efficiency of health spending in 145 middle and high-income and the potential gains from improving efficiency for a range of health system outputs using Robust Data Envelopment Analysis for 2010-2014 and 2015-2019 and examine associations with health system characteristics. Focusing on Latin American and Caribbean countries, we find large variability in efficiency and overall substantial potential gains in the later period, despite improvements over time. Our results suggest that, for example, improving spending efficiency could increase life expectancy at birth by 3.5 years (4.6%), or slightly more than the 3.4-year improvement in average life expectancy in the region between 2000 and 2015. Similarly, improved efficiency could reduce neonatal mortality by 6.7 per 1,000 live births (62%), increase service coverage by 6 percentage points (8.7%), and reduce the rich-poor gap in birth attendance by 10 percentage points (12.6%). We find that governance quality is positively associated with efficiency. Overall, the findings indicate an urgent need to improve efficiency in the region and substantial scope for realizing the potential gains of such improvements.

Medical Debt-The Canary in the Coal Mine for Health Care Affordability.

This JAMA Forum discusses the issues surrounding medical debt in the US and reflects on policy efforts made in recent years to solve some of the root causes.

Analysis of the costs of adverse events in the public healthcare system of the Lombardy Region over five-year period 2016-2021.

The monitoring of litigation (i.e., claims received by the public healthcare system of the Lombardy Region) is started following the implementation of the "Circolare 46/SAN/2004" by evaluating the risk management activities carried out over a five-year period (2016-2021) and following a systematic approach by the regional risk management coordination group. The paper presents a risks analyzed belong to the following 4 categories: Clinical Risk, Worker Risk Facility Accidental Damage. The trend of the Average Settled (cash analysis) shows an increase of the amounts over the years. The average amount paid is from about €45k in 2017 to over €71k in 2021, with a 16% decrease in the average amount paid in 2021 compared to the previous year (2020). The trend of the average amounts paid (analysis by accrual) shows a significant natural decrease over the years. The average amount settled is from about €74K in 2016 to almost 30K in 2021, recording a 30% decrease in the average amount liquidated in 2021 compared to the previous year (2020). As presented in the paper, the analysis shows a decrease in the magnitude of claims over time, as a positive factor that could be explained by the centralization and continuous monitoring of financial statement data, and the presence of claims evaluation committees (CVS) that includes different skills, such as: broker, loss adjuster, risk manager, medical examiner, lawyers, company management , etc., and the insurance expertise that works in the revaluation of reserves linked to the budget reform.

A global overview of health system financing and available infrastructure and oversight for kidney care.

BACKGROUND: Governance, health financing, and service delivery are critical elements of health systems for provision of robust and sustainable chronic disease care. We leveraged the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to evaluate oversight and financing for kidney care worldwide. METHODS: A survey was administered to stakeholders from countries affiliated with the ISN from July to September 2022. We evaluated funding models utilized for reimbursement of medications, services for the management of chronic kidney disease, and provision of kidney replacement therapy (KRT). We also assessed oversight structures for the delivery of kidney care. RESULTS: Overall, 167 of the 192 countries and territories contacted responded to the survey, representing 97.4% of the global population. High-income countries tended to use public funding to reimburse all categories of kidney care in comparison with low-income countries (LICs) and lower-middle income countries (LMICs). In countries where public funding for KRT was available, 78% provided universal health coverage. The proportion of countries that used public funding to fully reimburse care varied for non-dialysis chronic kidney disease (27%), dialysis for acute kidney injury (either hemodialysis or peritoneal dialysis) (44%), chronic hemodialysis (45%), chronic peritoneal dialysis (42%), and kidney transplant medications (36%). Oversight for kidney care was provided at a national level in 63% of countries, and at a state/provincial level in 28% of countries. CONCLUSION: This study demonstrated significant gaps in universal care coverage, and in oversight and financing structures for kidney care, particularly in in LICs and LMICs.

Challenges in traumatic spinal cord injury care in developing countries - a scoping review.

Objective: To evaluate the leading challenges in developing countries' traumatic spinal cord injury (TSCI) care. Methods: We conducted a systematic search in electronic databases of PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane Library on 16 April 2023. Studies that investigated challenges associated with the management of TSCI in developing countries were eligible for review. We extracted related outcomes and categorized them into four distinct parts: injury prevention, pre-hospital care, in-hospital care, and post-hospital care. Results: We identified 82 articles that met the eligibility criteria including 13 studies on injury prevention, 25 on pre-hospital care, 32 on in-hospital care, and 61 on post-hospital care. Challenges related to post-hospital problems including the personal, financial, and social consequences of patients' disabilities and the deficiencies in empowering people with TSCI were foremost studied. Lack of trained human resources, insufficient public education and delays in care delivery were barriers in the acute and chronic management of TSCI. A well-defined pre-hospital network and standard guidelines for the management of acute neurotrauma are needed. Critical challenges in injury prevention include deficiencies in infrastructure and supportive legislation. Conclusion: Studies focusing on injury prevention and pre-hospital care in TSCI management in developing countries warrant further investigation. It is imperative to develop systematic and evidence-based initiatives that are specifically tailored to the unique circumstances of each country to address these challenges effectively. By understanding the primary obstacles, policymakers and healthcare providers can establish goals for improving education, planning, legislation, and resource allocation.

Linking social capital and the political economy of substance treatment delivery: The case of recovery-oriented systems of care in Illinois.

BACKGROUND: Recovery-oriented systems of care have been a widely supported approach to transforming existing substance treatment programs across different states through developing recovery programs and interagency networks. However, little is known about the facilitators and barriers influencing their development and implementation. METHODS: Qualitative study of 5 different recovery-oriented systems of care in Illinois. Nineteen respondents completed individual interviews. RESULTS: A total of 124 codes and 2 themes were identified, reflecting constraints and opportunities. Theme 1 focused on how ROSC programs developed bonding, bridging, and linking social capital. Theme 2 focused on the ROSC coordinator and lead agency's power and accountability. CONCLUSIONS: The roles of lead agencies and ROSC coordinators were highlighted in the development and implementation of ROSCs. ROSC membership structures allow for bonding, bridging, and linking social capital. Still, additional technical support is needed to improve accountability, reduce power differentials and turf battles, and ensure greater participation among more diverse stakeholders.

Spending on Healthcare: What Is the Right Number?

Healthcare is canada's favourite punching bag. Admittedly, Canadian healthcare has many problems and, sometimes, it feels as though the system cannot get anything right. But is all the criticism fair?

Human resources for health: a framework synthesis to put health workers at the centre of healthcare.

BACKGROUND: Human resources are a key determinant for the quality of healthcare and health outcomes. Several human resource management approaches or practices have been proposed and implemented to better understand and address health workers' challenges with mixed results particularly in low- and middle-income countries (LMICs). The aim of this framework synthesis was to review the human resources frameworks commonly available to address human resources for health issues in LMIC. METHODS: We searched studies in Medline, Embase, CAB Global Health, CINAHL (EBSCO) and WHO global Index Medicus up to 2021. We included studies that provided frameworks to tackle human resources for health issues, especially for LMICs. We synthesised the findings using a framework and thematic synthesis methods. RESULTS: The search identified 8574 studies, out of which 17 were included in our analysis. The common elements of different frameworks are (in descending order of frequency): (1) functional roles of health workers; (2) health workforce performance outcomes; (3) human resource management practises and levers; (4) health system outcomes; (5) contextual/cross-cutting issues; (6) population health outcomes and (7) the humanness of health workers. All frameworks directly or indirectly considered themes around the functional roles of health workers and on the outcomes of health workforce activities, while themes concerning the humanness of health workers were least represented. We propose a synthesised Human-Centred Health Workforce Framework. CONCLUSIONS: Several frameworks exist providing different recurring thematic areas for addressing human resources for health issues in LMIC. Frameworks have predominantly functional or instrumental dimensions and much less consideration of the humanness of health workers. The paradigms used in policy making, development and funding may compromise the effectiveness of strategies to address human resources challenges in LMIC. We propose a comprehensive human resources for health framework to address these pitfalls.