Unaffordability of COVID-19 tests: assessing age-related inequalities in 83 countries.

BACKGROUND: Diagnostic testing for SARS-CoV-2 is critical to manage the pandemic and its different waves. The requirement to pay out-of-pocket (OOP) for testing potentially represents both a financial barrier to access and, for those who manage to make the payment, a source of financial hardship, as they may be forced to reduce spending on other necessities. This study aims to assess age-related inequality in affordability of COVID-19 tests. METHODS: Daily data from the Global COVID-19 Trends and Impact Survey among adult respondents across 83 countries from July 2020 to April 2021 was used to monitor age-related inequalities across three indicators: the experiences of, first, reducing spending on necessities because of paying OOP for testing, second, facing financial barriers to get tested (from January to April 2021), and third, having anxiety related to household finance in the future. Logistic regressions were used to assess the association of age with each of these. RESULTS: Among the population ever tested, the adjusted odds of reducing spending on necessities due to the cost of the test decreased non-linearly with age from 2.3 [CI95%: 2.1-2.5] among ages 18-24 to 1.6 [CI95%: 1.5-1.8] among ages 45-54. Among the population never tested, odds of facing any type of barrier to testing were highest among the youngest age group 2.5 [CI95%:2.4-2.5] and decreased with age. Finally, among those reporting reducing spending on necessities, the odds of reporting anxiety about their future finances decreased non-linearly with age, with the two younger groups being 2.4-2.5 times more anxious than the oldest age group. Among those reporting financial barriers due to COVID-19 test cost, there was an inverse U-shape relationship. CONCLUSIONS: COVID-19 testing was associated with a reduction in spending on necessities at varying levels by age. Younger people were more likely to face financial barrier to get tested. Both negative outcomes generated anxiety across all age-groups but more frequently among the younger ones. To reduce age-related inequalities in the affordability of COVID-19 test, these findings support calls for exempting everyone from paying OOP for testing and, removing other type of barriers than financial ones.

The G20 and development assistance for health: historical trends and crucial questions to inform a new era.

One of the most important gatherings of the world's economic leaders, the G20 Summit and ministerial meetings, takes place in June, 2019. The Summit presents a valuable opportunity to reflect on the provision and receipt of development assistance for health (DAH) and the role the G20 can have in shaping the future of health financing. The participants at the G20 Summit (ie, the world's largest providers of DAH, emerging donors, and DAH recipients) and this Summit's particular focus on global health and the Sustainable Development Goals offers a unique forum to consider the changing DAH context and its pressing questions. In this Health Policy perspective, we examined trends in DAH and its evolution over time, with a particular focus on G20 countries; pointed to persistent and emerging challenges for discussion at the G20 Summit; and highlighted key questions for G20 leaders to address to put the future of DAH on course to meet the expansive Sustainable Development Goals. Key questions include how to best focus DAH for equitable health gains, how to deliver DAH to strengthen health systems, and how to support domestic resource mobilisation and transformative partnerships for sustainable impact. These issues are discussed in the context of the growing effects of climate change, demographic and epidemiological transitions, and a global political shift towards increasing prioritisation of national interests. Although not all these questions are new, novel approaches to allocating DAH that prioritise equity, efficiency, and sustainability, particularly through domestic resource use and mobilisation are needed. Wrestling with difficult questions in a changing landscape is essential to develop a DAH financing system capable of supporting and sustaining crucial global health goals.

US Spending on Personal Health Care and Public Health, 1996-2013.

Importance: US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time. Objective: To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care. Design and Setting: Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis. Exposures: Encounter with US health care system. Main Outcomes and Measures: National spending estimates stratified by condition, age and sex group, and type of care. Results: From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion-$64.4 billion) and $64.4 billion (UI, $57.8 billion-$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%-6.4%] and 5.6% [UI, 5.6%-5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%-2.8%] and nursing facility care (2.5% [UI, 2.5%-2.5%]). Conclusions and Relevance: Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.

National health accounts data from 1996 to 2010: a systematic review.

OBJECTIVE: To collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010. METHODS: We downloaded country-generated NHA reports from the World Health Organization global health expenditure database and the Organisation for Economic Co-operation and Development (OECD) StatExtract website. We also obtained reports from Abt Associates, through contacts in individual countries and through an online search. We compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider. We combined and adjusted data to conform with OECD's first edition of A system of health accounts manual, (2000). FINDINGS: We identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types. Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types. Thirty-eight countries reported an average not-specified-by-kind value greater than 20% for all data types and years. Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes. All study data are publicly available at http://vizhub.healthdata.org/nha/. CONCLUSION: Data from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality. Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems.

Regional variation in the allocation of development assistance for health.

BACKGROUND: The Global Burden of Disease (GBD) 2010 Study has published disability-adjusted life year (DALY) data at both regional and country levels from 1990 to 2010. Concurrently, the Institute for Health Metrics and Evaluation (IHME) has published estimates of development assistance for health (DAH) at the country-disease level for this same period of time. FINDINGS: We use disease burden data from the GBD 2010 study and financing data from IHME to calculate ratios of DAH to DALYs across regions and diseases. We examine the magnitude of these ratios and how they have varied over time. We hypothesize that the variation in this ratio across regions would be relatively small. However, from 2006 to 2010, we find there was considerable variation in the levels of DAH per DALY across regions. For total funding, the relative standard deviation (standard deviation as a percentage of the mean) across regions was 50%. For DAH specific to HIV/AIDS, malaria and tuberculosis, the relative standard deviations were 50%, 200% and 60%, respectively. While these deviations are high, with the exception of malaria, they have decreased since the 1990s. CONCLUSIONS: There are no evident explanations for so much variation in funding across regions, especially holding the purpose of the funding constant. This suggests donors' allocation processes have not been particularly sensitive to disease burdens. To maximize health gains, donors should explicitly incorporate new disease burden data along with the relative costs and efficacy of interventions into their allocation process.

Vaccine resource tracking systems.

BACKGROUND: From 1999 to 2010, annual disbursements of development assistance for health for vaccinations increased from $0.5 billion to $2.0 billion (all financial values USD 2010). In its 2012 Global Vaccine Action Plan (GVAP), the World Health Assembly recommended establishing a comprehensive vaccination resource tracking system to better understand the source and recipients of these funds, and ultimately their impact on outcomes. This systematic review aims to respond to the GVAP recommendation in reviewing and assessing the state of the data and literature on vaccination resource tracking. METHODS: We scrutinized all relevant vaccination resource tracking systems identified in the literature and by practitioners in the field. We examined schemes used elsewhere in the health sector and by other sectors. Informant interviews were also conducted to determine what data exists and how it might be utilized. With this information, we completed a qualitative assessment of existing approaches to vaccination resources tracking. RESULTS: Tracking systems provide information about some vaccine-related activity in the majority of low- and middle-income countries. Data are generally available for the period of 2006-2010. Levels of granularity vary. Interviewees were concerned about the degree of rigor used to validate the data and the lack of verification. Data are often presented in tabular form, which may be unwieldy for non-technical audiences. CONCLUSIONS: The schemes currently in place to track the resources available for vaccinations were fairly advanced relative to other mechanisms in the health sector. Nonetheless, the coverage, validity, and accessibility of vaccination resource tracking data could be ameliorated. Establishing improved feedback loops and verification mechanisms that connect country-level administrators and the international organizations that support reporting efforts would enhance data quality.

Estimating health expenditure shares from household surveys.

OBJECTIVE: To quantify the effects of household expenditure survey characteristics on the estimated share of a household's expenditure devoted to health. METHODS: A search was conducted for all country surveys reporting data on health expenditure and total household expenditure. Data on total expenditure and health expenditure were extracted from the surveys to generate the health expenditure share (i.e. fraction of the household expenditure devoted to health). To do this the authors relied on survey microdata or survey reports to calculate the health expenditure share for the particular instrument involved. Health expenditure share was modelled as a function of the survey's recall period, the number of health expenditure items, the number of total expenditure items, the data collection method and the placement of the health module within the survey. Data exists across space and time, so fixed effects for territory and year were included as well. The model was estimated by means of ordinary least squares regression with clustered standard errors. FINDINGS: A one-unit increase in the number of health expenditure questions was accompanied by a 1% increase in the estimated health expenditure share. A one-unit increase in the number of non-health expenditure questions resulted in a 0.2% decrease in the estimated share. Increasing the recall period by one month was accompanied by a 6% decrease in the health expenditure share. CONCLUSION: The characteristics of a survey instrument examined in the study affect the estimate of the health expenditure share. Those characteristics need to be accounted for when comparing results across surveys within a territory and, ultimately, across territories.

COVID-19 disparities by gender and income: Evidence from the Philippines.

The COVID-19 pandemic and the resulting containment policies have hit the Philippines harder than most developing countries. The government lockdown is among the strictest in the world, and blanket school closures are the lengthiest. This article uses a novel simulation model to estimate the gendered and regional impacts of these factors on labour, income and poverty, and a case study of school closures points to the losses in employment among private school teachers and in the income of parents with young children. The authors find that the pandemic has had unprecedented implications for economic activity and has disproportionately affected women.