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1.
Cost Eff Resour Alloc ; 18: 20, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32612458

RESUMEN

BACKGROUND: Building upon decades of continuous reforms, Iran has been implementing various initiatives to reach universal health coverage (UHC). Improving efficiency is a crucial intermediate policy objective for UHC. Therefore, this article aimed to measure the efficiency and productivity changes of the Iranian health system in making progress towards UHC during 2010-2015 in comparison with 36 selected other upper-middle-income countries. METHODS: We used panel data to measure the variations in technical efficiency (TE) and total factor productivity (TFP) through an extended data envelopment analysis (EDEA) and Malmquist productivity index, respectively. General government health expenditure (GGHE) per capita (International dollar) was selected as the input variable. Service coverage of diphtheria, tetanus and pertussis; family planning; antiretroviral therapy; skilled attendants at birth; Tuberculosis treatment success rate; and GGHE as  % of total health expenditure (THE) were considered as output variables. The data for each indicator were taken from the Global Health Observatory data repository and World Development Indicator database, for 6 years (2010-2015). RESULTS: The TE scores of Iran's health system were 0.75, 0.77, 0.74, 0.74, 0.97, and 0.84 in the period 2010-2015, respectively. TFP improved in 2011 (1.02), 2013 (1.01), and 2014 (1.30, generally). The overall efficiency and TFP increased in 2014. Changes made in CCHE per capita and GGHE/THE attributed to the increase of efficiency. CONCLUSION: There is a growing demand for efficiency improvements in the health systems to achieve UHC. While there are no defined set of indicators or precise methods to measure health system efficiency, EDEA helped us to draw the picture of health system efficiency in Iran. Our findings highlighted the essential need for targeted and sustained interventions, i.e., allocation of enough proportion of public funds to the health sector, to improve universal financial coverage against health costs aiming to enhance the future performance of Iran's health system, ultimately. Such tailored interventions may also be useful for settings with similar context to speed up their movement towards improving efficiency, which in turn might lead to more resources to reach UHC.

2.
BMJ Glob Health ; 8(Suppl 1)2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-37197791

RESUMEN

Since no country or health system can provide every possible health service to everyone who might benefit, the prioritisation of a defined subset of services for universal availability is intrinsic to universal health coverage (UHC). Creating a package of priority services for UHC, however, does not in itself benefit a population-packages have impact only through implementation. There are inherent tensions between the way services are formulated to facilitate criteria-driven prioritisation and the formulations that facilitate implementation, and service delivery considerations are rarely well incorporated into package development. Countries face substantial challenges bridging from a list of services in a package to the elements needed to get services to people. The failure to incorporate delivery considerations already at the prioritisation and design stage can result in packages that undermine the goals that countries have for service delivery. Based on a range of country experiences, we discuss specific choices about package structure and content and summarise some ideas on how to build more implementable packages of services for UHC, arguing that well-designed packages can support countries to bridge effectively from intent to implementation.


Asunto(s)
Servicios de Salud , Cobertura Universal del Seguro de Salud , Humanos
3.
Assist Technol ; 33(sup1): 109-123, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34951829

RESUMEN

Having predictable, stable and adequate financial resources is essential for achieving universal coverage of essential health products and services, including assistive products. Access to such resources would enable governments and participating organizations to initiate and maintain a system for providing assistive products and associated services, as well as to grow the scope and scale of their operations over time. While limited funding is not the only reason to explain the shortfall in the provision of assistive products globally, unpredictable and inadequate public funding has been cited as the primary cause of poor access to these products in many countries. Several financing options have been presented in this paper that could be considered by decision-makers to initiate or supplement the financing of assistive products.


Asunto(s)
Cobertura Universal del Seguro de Salud , Humanos
4.
BMJ Glob Health ; 5(10)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33115858

RESUMEN

INTRODUCTION: Maximising efficiency of resources is critical to progressing towards universal health coverage (UHC) and the sustainable development goal (SDG) for health. This study estimates the technical efficiency of national health spending in progressing towards UHC, and the environmental factors associated with efficient UHC service provision. METHODS: A two-stage efficiency analysis using Simar and Wilson's double bootstrap data envelopment analysis investigates how efficiently countries convert health spending into UHC outputs (measured by service coverage and financial risk protection) for 172 countries. We use World Bank and WHO data from 2015. Thereafter, the environmental factors associated with efficient progress towards UHC goals are identified. RESULTS: The mean bias-corrected technical efficiency score across 172 countries is 85.7% (68.9% for low-income and 95.5% for high-income countries). High-achieving middle-income and low-income countries such as El Salvador, Colombia, Rwanda and Malawi demonstrate that peer-relative efficiency can be attained at all incomes. Governance capacity, income and education are significantly associated with efficiency. Sensitivity analysis suggests that results are robust to changes. CONCLUSION: We provide a 2015 baseline for cross-country UHC technical efficiency scores. If countries wish to improve their UHC outputs within existing budgets, they should identify their current efficiency and try to emulate more efficient peers. Policy-makers should focus on strengthening institutions and implementing known best practices to replicate efficient systems. Using resources more efficiently is likely to positively impact UHC coverage goals and health outcomes, and without addressing gaps in efficiency progress towards achieving the SDGs will be impeded.


Asunto(s)
Cobertura Universal del Seguro de Salud , Humanos
5.
Health Syst Reform ; 6(1): 1-14, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31567005

RESUMEN

The World Health Report 2010 encourages countries to reduce wastage and increase efficiency to achieve Universal Health Coverage (UHC). This research examines the efficiency of divisions (sub-provincial geographic units) in Pakistan in moving towards UHC using Data Envelop Analysis. We have used data from the Pakistan National Accounts 2011-12 and the Pakistan Social Living and Measurement Survey 2012-13 to measure per capita pooled public health spending in the divisions as inputs, and a set of UHC indicators (health service coverage and financial protection) as outputs. Sensitivity analysis for factors outside the health sector influencing health outcomes was conducted to refine the main model specification. Spider radar graphs were generated to illustrate differences between divisions with similar public spending but different performances for UHC. Pearson product-moment correlation was used to explore the strength and direction of the associations between proxy health systems organization variables and efficiency scores.The results showed a large variation in performance of divisions for selected UHC outputs. The results of the sensitivity analysis were also similar. Overall, divisions in Sindh province were better performing and divisions in Balochistan province were the least performing. Access to health care, the responsiveness of health systems, and patients' satisfaction were found to be correlated with efficiency scores.This research suggests that progress towards UHC is possible even at relatively low levels of public spending. Given the devolution of health system responsibilities to the provinces, this analysis will be a timely reference for provinces to gauge the performance of their divisions and plan the ongoing reforms to achieve UHC.


Asunto(s)
Reforma de la Atención de Salud/normas , Cobertura Universal del Seguro de Salud/normas , Eficiencia Organizacional/normas , Eficiencia Organizacional/estadística & datos numéricos , Programas de Gobierno/normas , Programas de Gobierno/estadística & datos numéricos , Reforma de la Atención de Salud/métodos , Reforma de la Atención de Salud/tendencias , Humanos , Pakistán , Cobertura Universal del Seguro de Salud/tendencias
6.
Soc Sci Med ; 232: 209-219, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31102931

RESUMEN

Over the last few years, there has been growing attention to health systems research in fragile and conflict-affected setting (FCAS) from both researchers and donors. In 2012, an exploratory literature review was conducted to analyse the main themes and findings of recent literature focusing on health financing in FCAS. Seven years later, this paper presents an update of that review, reflecting on what has changed in terms of the knowledge base, and what are the on-going gaps and new challenges in our understanding of health financing in FCAS. A total of 115 documents were reviewed following a purposeful, non-systematic search of grey and published literature. Data were analysed according to key health financing themes, ensuring comparability with the 2012 review. Bibliometric analysis suggests that the field has continued to grow, and is skewed towards countries with a large donor presence (such as Afghanistan). Aid coordination remains the largest single topic within the themes, likely reflecting the dominance of external players, not just substantively but also in relation to research. Many studies are commissioned by external agencies and in addition to concerns about independence of findings there is also likely a neglect of smaller, more home-grown reforms. In addition, we find that despite efforts to coordinate approaches across humanitarian and developmental settings, the literature remains distinct between them. We highlight research gaps, including empirical analysis of domestic and external financing trends across FCAS and non-FCAS over time, to understand better common health financing trajectories, what drives them and their implications. We highlight a dearth of evidence in relation to health financing goals and objectives for UHC (such as equity, efficiency, financial access), which is significant given the relevance of UHC, and the importance of the social and political values which different health financing arrangements can communicate, which also merit in-depth study.


Asunto(s)
Atención a la Salud/organización & administración , Organización de la Financiación/organización & administración , Cooperación Internacional , Altruismo , Conflictos Armados , Bibliometría , Atención a la Salud/economía , Humanos
7.
Eur J Health Econ ; 9(4): 343-9, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17952477

RESUMEN

International technical and financial cooperation for health-sector reform is usually a one-way street: concepts, tools and experiences are transferred from more to less developed countries. Seldom, if ever, are experiences from less developed countries used to inform discussions on reforms in the developed world. There is, however, a case to be made for considering experiences in less developed countries. We report from the Philippines, a country with high population growth, slow economic development, a still immature democracy and alleged large-scale corruption, which has embarked on a long-term path of health care and health financing reforms. Based on qualitative health-related action research between 2002 and 2005, we have identified three crucial factors for achieving progress on reforms in a challenging political environment: (1) strive for local solutions, (2) make use of available technology and (3) work on the margins towards pragmatic solutions whilst having your ethical goals in mind. Some reflection on these factors might stimulate and inform the debate on how health care reforms could be pursued in developed countries.


Asunto(s)
Países en Desarrollo , Reforma de la Atención de Salud , Política , Ética Médica , Recursos en Salud , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Ciencia del Laboratorio Clínico , Filipinas
8.
Glob Health Action ; 11(1): 1483638, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29914319

RESUMEN

BACKGROUND: Achieving Universal Health Coverage (UHC) has by now become a key health policy goal in many countries and some form of National Health Insurance (NHI) is often used for this. The Philippines has had more than 50 years' experience with social health insurance and in 1995 established PhilHealth, the country's national health insurer. OBJECTIVES: Analyzing the role of the Philippine NHI scheme in moving towards UHC, identifying potential avenues for improvement as well as indicating challenges and areas for further development. METHODS: This paper is based on a mixed methods approach including extensive literature search, data from PhilHealth and other sources, and key informant interviews with staff at PhilHealth, health care providers, and policy experts at national and international level. RESULTS: Major achievements were the expansion of population coverage using an earmarked revenue source ('Sin Tax'), the introduction of the no-balance-billing to prevent co-payments, and the Health Facilities Enhancement Program to improve quality. The share of PhilHealth in total health expenditures is still only 14%, managing quality and cost of providers remains insufficient, the benefit coverage does not reflect the country's burden of disease, and financial protection for PhilHealth members is low. The UHC bill would provide a massive jump forward as all Filipinos would then be automatically enrolled in and thus entitled to the benefits of PhilHealth. CONCLUSIONS: For expanding a contribution-based NHI beyond formal employment there needs to be a large increase in budget transfers to cover for citizens unable to contribute. The Philippine UHC bill shifts from the idea of contribution leading to entitlement to the idea of citizenship leading to entitlement and can thus be seen as a paradigmatic change in thinking about NHI. There are three areas that we believe are of key importance in developing further NHI: (i) governance, (ii) financial impact, and (iii) strategic purchasing.


Asunto(s)
Política de Salud , Programas Nacionales de Salud , Cobertura Universal del Seguro de Salud , Presupuestos , Bases de Datos Factuales , Gastos en Salud , Humanos , Entrevistas como Asunto , Filipinas , Investigación Cualitativa , Cobertura Universal del Seguro de Salud/economía
10.
Soc Sci Med ; 62(12): 3177-85, 2006 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-16406248

RESUMEN

Very little is known about the Philippine health care system, and in particular its experience with social health insurance (SHI). Having initiated an SHI programme 35 years ago, the Philippines hold many lessons for the development of such schemes in other low and middle-income countries. We analyse the challenges currently facing PhilHealth, the national health insurer. PhilHealth was formed in 1995 as a successor to the Medicare programme and was given a mandate to achieve universal coverage by 2010. To date, PhilHealth has been quite successful in some areas (e.g. enrollment), but lags behind in others (e.g. quality and price control). We conclude that SHI in the Philippines has been a success story so far and provides lessons for countries in a similar situation. For example: (i) SHI is based on value decisions and the clear statement of societal goals can give guidance in the technical execution, (ii) SHI is a financing institution and needs to be treated accordingly, (iii) SHI can be implemented independently of the current economic situation and might actually contribute to economic development, (iv) community-based health care financing schemes should be merged with the national SHI in the long run, and (v) there is a strong need to push for high quality care and improved physical access. No clear suggestions can be given with respect to the benefit catalogue and the balance between economies of scale and decentralisation. Although riddled with many inadequacies, PhilHealth was set up as a strong and largely politically independent institution for the development of SHI. SHI can act as a stabilizing institution in a politically and economically volatile environment.


Asunto(s)
Programas Nacionales de Salud , Política , Seguridad Social , Países en Desarrollo , Predicción , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Programas Nacionales de Salud/historia , Programas Nacionales de Salud/legislación & jurisprudencia , Programas Nacionales de Salud/organización & administración , Filipinas , Formulación de Políticas , Garantía de la Calidad de Atención de Salud , Método de Control de Pagos , Seguridad Social/historia , Seguridad Social/legislación & jurisprudencia , Seguridad Social/organización & administración , Cobertura Universal del Seguro de Salud
12.
Int J Health Plann Manage ; 20(1): 67-84, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15799458

RESUMEN

Malaria is the cause of more mortality and morbidity in Tanzania than any other disease, in large part due to growing resistance to anti-malarial drugs. This study estimates that over 1% of GDP is devoted to the disease, representing US$2.2 per capita, and 39% of total health expenditure nationally. Government facilities devote almost one-third of their resources to the disease. Private expenditure, primarily on drugs, coils, sprays and bed-nets, represents 71% of total expenditures. Given the dominance of malaria treatment outside Government facilities, strategies to control behaviour in the private sector are critical. Together with regulations on private providers, and other interventions such as promoting the use of bed-nets in rural areas, greater research into and use of information strategies is required. Public policies should be designed to influence behaviour, to encourage households to seek adequate diagnosis of fever and to complete appropriate treatment with the right drugs.


Asunto(s)
Costo de Enfermedad , Política de Salud , Malaria/economía , Gastos en Salud , Humanos , Formulación de Políticas , Tanzanía
13.
Health Econ ; 13(9): 845-57, 2004 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-15362177

RESUMEN

This paper analyses the effect of being insured under the voluntary component of Vietnamese Health Insurance, on patterns of treatment seeking behaviour. A multinomial logit model is estimated using household survey data from three provinces in Vietnam. Decisions regarding both the type of provider sought and type of care received are analysed. Insurance status is treated as both exogenous and endogenous to account for potential selection bias. The results indicate that, overall, insured patients are more likely to use outpatient facilities, and public providers, an effect that is particularly strong at lower income levels.


Asunto(s)
Países en Desarrollo/economía , Seguro de Salud/economía , Aceptación de la Atención de Salud , Pobreza , Adulto , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Toma de Decisiones , Femenino , Financiación Gubernamental/organización & administración , Financiación Personal/organización & administración , Encuestas de Atención de la Salud , Gastos en Salud/estadística & datos numéricos , Hospitalización/economía , Humanos , Renta , Funciones de Verosimilitud , Modelos Logísticos , Masculino , Modelos Econométricos , Modelos Psicológicos , Motivación , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Pobreza/economía , Pobreza/psicología , Sector Público/economía , Sector Público/estadística & datos numéricos , Sesgo de Selección , Vietnam
17.
Копенгаген; Всемирная организация здравоохранения. Европейское региональное бюро; 2015.
Monografía en Ruso | WHOLIS | ID: who-332137

RESUMEN

Экономические потрясения представляют угрозу для здоровья населения и деятельности системы здравоохранения, поскольку они приводят к росту потребности населения в услугах здравоохранения, но ограничивают доступ к медицинской помощи. Данная ситуация сопровождается сокращениямигосударственных расходов на дравоохранение и другие социальные нужды. Однако при использовании своевременных стратегических действий этих негативных последствий можно избежать. Ответные меры систем здравоохранения имеют большое значение, несмотря на то, что важные рычаги государственной политики находятся за пределами сектора здравоохранения в сфере ответственности руководителей бюджетной политики и социальной защиты. В рамках данной публикации рассмотрены ответные меры систем здравоохранения европейских стран на сложности, возникшие в результате финансового и экономического кризиса, начавшегося в 2008 г. На основе опыта более 45 стран авторы: анализируют ответные меры систем здравоохранения на кризис в трех стратегических областях: 1) государственное финансирование сектора здравоохранения; 2) охват государственными услугами здравоохранения; 3) планирование, закупка и предоставление услуг здравоохранения; оценивают последствия этих ответных мер для систем здравоохранения и здоровья населения; определяют меры политики, которые могут способствовать стабилизациидеятельности систем здравоохранения, столкнувшихся с бюджетными проблемами; исследуют меры стратегической экономии внедрения реформ в условиях кризиса. Данное издание предоставляет необходимую информацию для понимания возможностей, имеющихся у руководителей, и последствий неспособности обеспечить защиту состояния здоровья населения или устойчивость деятельности систем здравоохранения в условиях экономического шока или другого рода потрясений.


Asunto(s)
Atención a la Salud , Recesión Económica , Política de Salud , Planes de Sistemas de Salud , Financiación de la Atención de la Salud , Europa (Continente)
18.
Copenhagen; World Health Organization. Regional Office for Europe; 2015.
Monografía en Inglés | WHOLIS | ID: who-174010

RESUMEN

The financial and economic crisis has had a visible but varied impact on many health systems in Europe, eliciting a wide range of responses from governments faced with increased financial and other pressures. This book maps health system responses by country, providing a detailed analysis of policy changes in nine countries and shorter overviews of policy responses in 47 countries. It draws on a large study involving over 100 health system experts and academic researchers across Europe. Focusing on policy responses in three areas – public funding of the health system, health coverage and health service planning, purchasing and delivery – this book gives policy-makers, researchers and others valuable, systematic information about national contexts of particular interest to them, ranging from countries operating under the fiscal and structural conditions of international bailout agreements to those that, while less severely affected by the crisis, still have had to operate in a climate of diminished public sector spending since 2008. Along with a companion volume that analyses the impact of the crisis across countries, this book is part of a wider initiative to monitor the effects of the crisis on health systems and health, to identify those policies most likely to sustain the performance of health systems facing fiscal pressure and to gain insight into the political economy of implementing reforms in a crisis.


Asunto(s)
Atención a la Salud , Europa (Continente) , Financiación de la Atención de la Salud , Planificación en Salud
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