Investigating sustainability challenges for the National Health Insurance Fund in Tanzania: a modelling approach.

OBJECTIVE: This study aimed to model the long-term cost associated with expanding public health insurance coverage in Tanzania. DESIGN, SETTING AND PARTICIPANTS: We analysed the 2016 claims of 2 923 524 beneficiaries of the National Health Insurance Fund in Tanzania. The analysis focused on determining the average cost per beneficiary across 5-year age groups separated by gender, and grouped by broad health condition categories. We then modelled three different insurance coverage scenarios from 2020 to 2050 and we estimated the associated costs. OUTCOME MEASURES: Average cost per beneficiary and the projected financing requirements, projected from 2020 to 2050. RESULTS: The analysis revealed that the average per beneficiary cost for insurance claims was $38.58. Among males over 75 years, the average insurance claims costs were highest, amounting to $125. The total estimated annual cost of claims in 2020 was $151 million. Under the status quo coverage scenario, total claims were projected to increase to $415 million by 2050. Increasing coverage from 7% to 50% would result in an additional financing requirement of $2.27 billion. If coverage would increase by 10% annually, reaching 56% of the population by 2050, the additional financing need would amount to $2.84 billion. CONCLUSION: This study highlights the critical importance of assessing the long-term financial viability of health insurance schemes aimed to cover large segments of the population in low-income countries. The findings demonstrate that even without expansion of coverage, financing requirements for insurance will more than triple by 2050. Furthermore, increasing coverage is likely to substantially escalate the cost of claims, potentially requiring significant government or external contributions to finance these additional costs. Policymakers and stakeholders should carefully evaluate the sustainability of insurance schemes to ensure adequate financial support for expanding coverage and improving healthcare access in low-income settings.

Influence of Social Support, Financial Status, and Lifestyle on the Disparity Between Inflammation and Disability in Rheumatoid Arthritis.

OBJECTIVE: To investigate how social support, financial status, and lifestyle influence the development of excess disability in rheumatoid arthritis (RA). METHODS: Data were obtained from the Étude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) cohort study of people with RA. A previous analysis identified groups with similar inflammation trajectories but markedly different disability over 10 years; those in the higher disability trajectory groups were defined as having "excess disability." Self-reported data regarding contextual factors (social support, financial situation, lifestyle) were obtained from participants, and they completed patient-reported outcome measures (pain, fatigue, anxiety, depression) at baseline. The direct effect of the contextual factors on excess disability and the effect mediated by patient-reported outcome measures were assessed using structural equation models. Findings were validated in 2 independent data sets (Norfolk Arthritis Register [NOAR], Early Rheumatoid Arthritis Network [ERAN]). RESULTS: Of 538 included ESPOIR participants (mean age ± SD 48.3 ± 12.2 years; 79.2% women), 200 participants (37.2%) were in the excess disability group. Less social support (ß = 0.17 [95% confidence interval (95% CI) 0.08, 0.26]), worse financial situation (ß = 0.24 [95% CI 0.14, 0.34]), less exercise (ß = 0.17 [95% CI 0.09-0.25]), and less education (ß = 0.15 [95% CI 0.06, 0.23]) were associated with excess disability group membership; smoking, alcohol consumption, and body mass index were not. Fatigue and depression mediated a small proportion of these effects. Similar results were seen in NOAR and ERAN. CONCLUSION: Greater emphasis is needed on the economic and social contexts of individuals with RA at presentation; these factors might influence disability over the following decade.

Evaluation of Financial and Nonfinancial Conflicts of Interest and Quality of Evidence Underlying Psoriatic Arthritis Clinical Practice Guidelines: Analysis of Personal Payments From Pharmaceutical Companies and Authors' Self-Citation Rate in Japan and the United States.

OBJECTIVE: To assess financial conflicts of interest (COI) and nonfinancial COI among psoriatic arthritis (PsA) clinical practice guideline (CPG) authors in Japan and the US, and to evaluate the quality of evidence and strength of recommendations of PsA CPGs. METHODS: We performed a retrospective analysis using payment data from major Japanese pharmaceutical companies and the US Open Payments Database from 2016 to 2018. All authors of PsA CPGs issued by the Japanese Dermatological Association (JDA) and American College of Rheumatology (ACR) were included. RESULTS: Of 23 CPG authors in Japan, 21 (91.3%) received at least 1 payment, with a combined total of $3,335,413 between 2016 and 2018. Regarding 25 US authors, 21 (84.0%) received at least 1 payment, with a combined total of $4,081,629 during the same period. The 3-year combined mean ± SD payment per author was $145,018 ± $114,302 in Japan and $162,825 ± $259,670 in the US. A total of 18 authors (78.3%) of the JDA PsA CPG and 12 authors (48.0%) of the ACR PsA CPG had undisclosed financial COI worth $474,663 and $218,501, respectively. The percentage of citations with at least 1 CPG author relative to total citations was 3.4% in Japan and 33.6% in the US. In sum, 71.4% and 88.8% of recommendations for PsA in the JDA and ACR were supported by low or very low quality of evidence. CONCLUSION: More rigorous cross-checking of information disclosed by pharmaceutical companies and self-reported by physicians and more stringent and transparent COI policies are necessary.

Financial conflicts of interest of OncoAlert: An informal oncology professional network.

IMPORTANCE: Social media platforms have allowed the formation of informal professional healthcare networks. Transparency in funding, membership requirements, financial conflicts of interest (FCOI), and messaging are necessary to ensure best practices for similar networks in the future. OBJECTIVE: To analyze the FCOIs of US-based physician members of the OncoAlert Network and appraise the content of their public Twitter account. DESIGN, SETTING, PARTICIPANTS: This cross-sectional study assessed the FCOIs among US-based physician members of the OncoAlert Network between 2015 and 2020. FCOI data were obtained through the Open Payments Database. Additionally, tweets were examined for content analysis. MAIN OUTCOMES AND MEASURES: The number of US-based physician members with FCOIs with the pharmaceutical industry; the amount of general, research, and associated research payments; and the perceived attitude of tweet content from the OncoAlert Network Twitter account. RESULTS: Of 34 US physician members of the OncoAlert Network, 31 (91.2%) received general payments from pharmaceutical companies according to the Open Payments Database. Between 2015 and 2020, US physician members of the OncoAlert Network received a median of $83,600 in general payments (interquartile range [IRQ], $7,200-$221,500). Fourteen members (41.1%) received more than $100,000 in general payments. Additionally, 480 (15.7 %) of 3064 tweets retrieved from the OncoAlert Twitter account mentioned a drug or clinical trial. Of these, 31.6 % (n = 152) had a positive disposition and 3.3 % (n = 16) were negative or critical. CONCLUSIONS AND RELEVANCE: Over 90% of US physician members of the OncoAlert Network had FCOIs between 2015 and 2020. Despite the network's non-profit status, FCOIs amongst its members may influence content produced on the network's social media platforms, such as Twitter, where content discussing drugs and clinical trials are often positive and seldom negative or critical. For future informal professional networks, further research is required to establish best practices for issues such as membership requirements, funding, and FCOI disclosure.

Two Semiconductor Companies' Financial Support Compensation (FSC) Programs for Semiconductor Workers with Suspected Work-Related Diseases (WRDs).

This study described two companies' financial compensation programs for semiconductor workers with suspected work-related diseases (WRDs) and discussed the major related issues. The key contents of the programs found on the websites opened by two semiconductor companies (Samsung and SK Hynix) were cited. In order to select the suspected WRDs for the FSC, all available epidemiologic studies related to health problems conducted in the semiconductor industry were reviewed. Most program contents are similar, although the amount of financial compensation and a few types of disease available for compensation differ between the companies. The group of cancer, rare disease, childhood rare disease among children born to semiconductor workers (hereafter selected diseases among offspring), and fetal loss, including spontaneous abortion (SAB) and stillbirth, were considered for compensation. An employment duration of longer than one year on a semiconductor production line is required for FSC for cancer or rare disease. The FSC for SAB and offspring disease require a period of employment longer than one month, either before three months prior to conception or between conception and childbirth. The maximum amount of compensation per type of cancer and rare disease was fixed based on the medical treatment fee. The FSC programs of the two companies have been operated successfully to date. These programs are arguably considered to contribute to resolving the conflict between companies and workers with WRDs.

Mudanças e continuidades entre o Chile Solidario e o Ingreso Ético Familiar / Cambios y continuidades entre el programa Chile Solidario e Ingreso Ético Familiar / Change and continuity between Chile Solidario and Ingreso Ético Familiar

Resumo Este artigo apresenta e discute os programas de transferência monetária condicionada implementadas no Chile, o Chile Solidario (2002-2013) e o Ingreso Ético Familiar (2013-presente), procurando identificar continuidades e diferenças entre as duas iniciativas. Tendo por base a literatura sobre mudanças em políticas públicas e, em particular, a tipologia proposta por Howlett e Cashore (2009), que distinguem entre fins e meios, faz-se uma comparação entre os dois programas, de modo a identificar objetivos e mecanismos que se mantêm, quais se alteram, bem como as novidades introduzidas. Argumenta-se que, apesar de ter sido apresentado como um programa inovador em relação ao seu antecessor, o Ingreso Ético Familiar, o Chile Solidario mantém os atributos daquele, aos quais se adicionam alguns novos elementos. O artigo traz contributos em duas áreas: traça a evolução da política de transferência condicionada no Chile nas duas últimas décadas e dialoga com a literatura sobre mudança em política social.

Resumen El artículo presenta y discute los programas de transferencia condicionada chilenas - el Chile Solidario (2002-2013) y el Ingreso Ético Familiar (2013-presente) - y busca identificar continuidades y diferencias entre las dos iniciativas. Teniendo como base la literatura acerca de cambio en políticas públicas y, en particular, la tipología propuesta por Howlett y Cashore (2009) que distingue entre fines y medios, se realizar un análisis comparado entre ambos programas, buscando identificar los objetivos y mecanismos que persisten, los que se modifican y si se introducen innovaciones. Como resultado, pese a que haya sido presentado como un programa innovador en relación al anterior, el Ingreso Ético Familiar mantiene los principales atributos de Chile Solidario, a los cuales son añadidos algunos nuevos elementos. El artículo busca hacer contribuciones en dos áreas: (1) mapear la evolución de los programas de transferencia condicionada en las dos últimas décadas y (2) dialogar con la literatura sobre cambios en política social.

Abstract This article presents and discusses the two conditional cash transfer initiatives implemented in Chile - Chile Solidario (2002-2013) and Ingreso Ético Solidario (2013-present) - and aim at identifying continuities and change between the two. A comparison of the two programmes, based on Howlett and Cashore's (2009) tipology for analysing policy change that distinguished between ends and means, allows the identification of continuities and changes regarding the goals and mechanisms present in the two programmes. The article argues that despite being announced as an innovative measure in regard to the previous programme, Ingreso Etico Familiar maintains the core characteristics of Chile Solidario and includes some additional elements. This article makes two different contributions: (1) it traces the evolution of conditional cash transfers programmes in Chile over the past two decades and (2) it establishes a dialogue with the literatures on changes to social policy.

Caring Needs of Cancer Patients from the Perspective of Home Care Nurses: A Qualitative Study.

OBJECTIVE: Cancer is the third leading cause of death in Iran. Todays, caregiving to patients with cancer is shifting towards home based care, and home care needs from a caregiver's perspective can help improve the patient care. This qualitative study aimed to examine the home care needs of cancer patients from the perspective of home care nurses. METHODS: This is a qualitative descriptive study carried out at home care centers in the northwest of Iran. A total of 15 participants were recruited through purposive sampling and underwent face-to-face semi-structured interviews. Data were analyzed through Conventional content analysis method in MAXQDA software.  Measures of trustworthiness were established throughout the study using Lincoln and Guba's (1985) criteria (dependability, credibility, transferability, and confirmability). RESULTS: Data analysis resulted in the extraction of four main categories including physical needs (pain relief, gastrointestinal problems including nausea and anorexia and nutritional problems, lethargy, wound care), psychological support (need for hope and emotional support), educational needs (need for information and self-care) and financial support (service insurance coverage, charity support). To promote these patients home care, insurance coverage of nursing home care services was emphasized by the participants. CONCLUSION: Various aspects of cancer patients home care needs were identified. Interdisciplinary home-based palliative care collaboration is needed to address their physical, psychological, and moral needs.

Tobacco Advertising, Promotion and Sponsorship in India and Indonesia: Present Regime and the Way Forward.

One of the important factors contributing to tobacco epidemic is tobacco advertising, promotion, and sponsorship (TAPS). TAPS is employed by tobacco industry to increase demand for its products, often through targeting specific groups or market segments. The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) recommends implementation of comprehensive bans on TAPS as part of an effective set of tobacco control policies. Article 13 of the WHO FCTC and its guidelines mandate a comprehensive ban on all TAPS. Besides, TAPS ban is one of the MPOWER strategy and is included in the 'Best Buys' for effective tobacco control. However, many countries, especially low-income and middle-income countries, primarily implement only partial TAPS bans, allowing the tobacco industry to directly or indirectly advertise and promote its products via multiple media. This review article analyzes the current state of affairs in respect of TAPS in India and Indonesia, the two of the largest countries in the WHO South-East Asia Region of the world, and discusses the way forward to address the identified gaps in TAPS ban policy formulation and implementation focusing on strengthening its compliance and enforcement at the country level.

[Establishment of Hematopoietic cell transplantation program in developing countries : Guidelines from the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC)]. / Mise en place d'un programme de greffe de cellules souches hématopoïétiques dans les pays en voie de développement. Recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC).

Hematopoietic cell transplantation (HCT) is the curative treatment for many malignant and non-malignant blood disorders and some solid cancers. However, transplant procedures are considered tertiary level care requiring a high degree of technicality and expertise and generating very high costs for hospital structures in developing countries as well as for patients without health insurance. During the 11th annual harmonization workshops of the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to elaborate unified guidelines, for developing the transplant activity in emerging countries. Access to infrastructure must comply with international standards and therefore requires a hospital system already in place, capable of accommodating and supporting the HCT activity. In addition, the commitment of the state and the establishment for the financing of the project seems essential.

Salud, beneficencia y mutualismo: la colonia española en la Ciudad de México durante el Porfiriato / Health, beneficence and mutualism: the Spanish colony in Mexico City during the Porfirio Díaz regime

Resumen El artículo se acerca a las iniciativas de salud impulsadas por la colonia española en la capital mexicana durante el Porfiriato. Primero, se explica la importancia que adquirió la Sociedad de Beneficencia Española (SBE) durante este periodo. Se ubica la SBE en el contexto de expansión y profesionalización de los servicios médicos por el Estado, y la red de relaciones sociales, políticas y económicas entre los individuos prominentes de la colonia y el gobierno de Porfirio Díaz. Posteriormente, se indaga en las insatisfacciones que generó la SBE, que dio lugar a la fundación de un efímero proyecto de características mutuales, protagonizado por dependientes de comercio españoles: la Quinta de Salud.

Politics, pandemics, and support: the role of political actors in Dutch state aid during COVID-19 / Políticas, pandemias e auxílio do estado: o papel dos atores políticos no auxílio governamental oferecido pelos Países Baixos durante a pandemia da COVID-19 / Políticas, pandemias y apoyo del estado: el papel de los actores políticos en la ayuda gubernamental ofrecida por los Países Bajos durante la pandemia de COVID-19

Abstract How do governments distribute resources across economic sectors during a crisis? And why do some sectors receive more than others? The recent COVID-19 pandemic has highlighted the urgency of these questions. In this paper, we explore the extent to which a political economy perspective can help explain the characteristics of sector-specific state aid in the Netherlands, a traditionally corporatist country. While KLM, the biggest player in the Dutch aviation sector, was promised loans worth €3.4 billion, the horeca (hospitality) sector was denied a similar deal. Limited cross-case analysis eliminates purely economic accounts. We employed process-tracing and analyzed hundreds of national media articles to understand the influence of elected leaders, interest groups, and experts. We find that, against the backdrop of economic concerns, vote-seeking behavior by elected leaders as well as the strength and organization of interest groups influenced how much each sector could expect. Meanwhile, policy-seeking behavior helps explain the form that aid took. Our findings highlight the need to consider fiscal support in political economy terms, even during crises, and to explore the composition of state aid, not just its presence or amount.

Resumo Como são distribuídos os recursos de auxílio governamental entre os vários setores econômicos durante uma crise? E por que alguns sectores recebem mais do que outros? A recente pandemia da COVID-19 sublinhou a urgência destas questões. Neste artigo, discutimos como uma perspectiva de economia política pode ajudar a explicar as caraterísticas do auxílio estatal setorial nos Países Baixos, uma nação tradicionalmente corporativista. Enquanto o governo prometeu à KLM, o maior ator no setor da aviação holandês, empréstimos no valor de 3,4 mil milhões de euros, o horeca (sector da hotelaria) não recebeu um pacote de auxílio semelhante. A análise de casos elimina explicações puramente técnicas para esse fenômeno. Utilizamos process-tracing e fizemos uma análise de centenas de artigos publicados na mídia do país para compreender a influência dos líderes políticos, lobbies e peritos. Descobrimos que, num contexto de crise econômica, o comportamento eleitoreiro dos líderes políticos e a força e organização dos lobbies, determinaram a quantia que cada setor poderia esperar receber. Entretanto, os interesses no campo das políticas públicas ajudam a explicar a forma específica do auzílio. Nossas conclusões sublinham a necessidade de considerar o apoio fiscal em termos de economia política, mesmo durante crises, e de explorar não somente a existência ou o montante dos auxílios oferecidos pelo estado, mas também sua composição.

Resumen ¿Cómo se distribuyen los recursos de ayuda gubernamental entre los diferentes sectores económicos durante una crisis? ¿Y por qué algunos sectores reciben más que otros? La reciente pandemia de COVID-19 puso de relieve la importancia de estas cuestiones. En este artículo, exploramos cómo una perspectiva de economía política puede ayudar a entender la distribución del apoyo estatal en diferentes sectores en los Países Bajos, un país de tradición corporativista. Mientras que a KLM ‒el actor más importante del sector de aviación holandés‒ el gobierno le prometió préstamos de alrededor de 3.400 millones de euros, al sector HORECA (que congrega hoteles, restaurantes y cafeterías) se le denegó una ayuda similar. A través de un análisis cruzado de casos eliminamos razones puramente técnicas para este fenómeno. A continuación, utilizamos la metodología process-tracing y analizamos cientos de artículos de medios de comunicación holandeses para entender la influencia de líderes políticos, lobbies y expertos. Descubrimos que, en un contexto de crisis económica, el comportamiento electorero de los líderes políticos y el poder y organización de los lobbies determinaron la suma que cada sector podría esperar. Por otro lado, la estructura de dichas ayudas se explica a través del alineamiento político de los decisores políticos. Nuestros resultados subrayan la necesidad de estudiar el apoyo gubernamental en términos de economía política, inclusive durante crisis, y de explorar no solo la existencia o la cuantía de dichas ayudas sino también su composición.

Crowdfunding for anticancer therapies: an analysis of non-US GoFundMe pages.

BACKGROUND: Crowdfunding is the internet practice of funding a project or person by requesting online monetary donations from people. We set out to analyse the current non-US GoFundMe cancer pages in order to get deeper understanding of this unregulated activity. METHODS: We identified 150 non-US GoFundMe webpages between November 2019 and January 2020. Data collected included clinicopathological details such as age, gender, cancer type and stage of the disease along with other parameters. RESULTS: Of 150 pages reviewed, 83% requestors were adults, 64% were female and the median age was 33 years (2-60). The majority of requestors had brain cancer, followed by breast cancer and ovarian cancer. The median amount of money requested was €48,205 (€1171-€588,759). The majority of pages were from the UK (59%) and Ireland (16%). Financial support for cancer patients was the largest group identified (25%). Requests for immunotherapy were the second most common (21%) followed by alternative therapies (19%) and funding for anticancer drug not financed by specific health system but approved elsewhere (12%). The largest amount of money requested was for immunotherapy (median €187,064). CONCLUSION: Our GoFundMe analysis has identified that crowdfunding platforms are predominantly used for requesting financial support, but worryingly, a large proportion are requesting immunotherapy for unlicensed indications and alternative therapies with no evidence. Future efforts to improve patient education, and possibly online donation page regulation, are required to better manage this route of cancer funding.