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1.
Health Syst Reform ; 7(2): e1968564, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34554034

RESUMO

Some of Adam Wagstsaff's colleagues and research collaborators submitted short reflections about the different ways Adam made a difference through his amazing research output to health equity and health systems as well as a leader and mentor. The Guest Editors of this Special Issue selected a set of six essays related to dimensions of Adam's contributions.The first contribution highlights his role early on in his career, prior to joining the World Bank, in defining and expanding an important field of research on equity in health ("Adam and Equity," by Eddy van Doorslaer and Owen O'Donnell). The second contribution focuses on Adam's early work on equity and health within the World Bank and his leadership on important initiatives that have had impact far beyond the World Bank ("Adam and Health Equity at the World Bank," by Davidson Gwatkin and Abdo Yazbeck). The next contribution focuses on Adam's deep dive into providing support, through research, for country-specific programs and reforms, with a special focus on some countries in East Asia ("Adam and Country Health System Research," by Magnus Lindelow, Caryn Bredenkamp, Winnie Yip, and Sarah Bales). The next contribution highlights Adam's many ways of contributing to the International Health Economics Association, from the impressive technical contributions to leadership and organizational reform ("Adam and iHEA," by Diane McIntyre). The next to last contribution focuses on Adam's long-term leadership in the research group at the World Bank and the long-lasting influence on integrating the research produced into World Bank operations and creating an environment that rewarded producing evidence for action ("Adam the Research Manager," by Deon Filmer and Damien de Walque). The last contribution pulls on the thread found in many of the earlier ones, mentorship with honesty, directness, caring, commitment, and equity ("Adam the Mentor," by Agnes Couffinhal, Caryn Bredenkamp, and Reem Hafez).

2.
Health Syst Reform ; 7(2): e1934955, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34402412

RESUMO

Prior to the Sustainable Development Goals (SDG) era, considerable progress was made toward the Millennium Development Goals (MDGs) health indicators. Despite these achievements, many countries failed to meet the MDG target levels, between-country inequalities in health outcomes did not improve, and many countries making progress in average indicator levels did so while at the same time seeing increasing within-country inequalities. We build on the existing literature documenting levels and trends in health inequalities by expanding the number of data-points under focus, and we contribute to this literature by analyzing the extent to which inequalities in child health outcomes are related to socioeconomic inequalities, and to aggregate income growth. The objective of this paper is to examine long-run trends in average population levels and within-country inequalities for two child health outcomes-the under-five mortality rate (U5MR) and stunting-in 102 countries across 6 regions. We find that only about a third of countries in our sample managed to both reduce U5MR levels and inequalities, and only a quarter did so for stunting. The fact that inequality in service coverage seems to follow a more favorable trend than inequality in health outcomes suggests that policies aiming to reduce health inequities should not only foster more equitable service coverage but also focus on the social determinants of health. Moreover, there is no strong correlation between changes in health inequalities and income growth, suggesting that income generating development policies alone will typically not suffice to improve health outcomes and reduce health inequalities.


Assuntos
Países em Desenvolvimento , Renda , Criança , Saúde da Criança , Humanos , Avaliação de Resultados em Cuidados de Saúde , Fatores Socioeconômicos
3.
Int J Equity Health ; 18(1): 39, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31155002

RESUMO

BACKGROUND: Health is recognized as a fundamental right in Brazil's constitution. In the absence of a clearly defined benefit packages of healthcare services that are financed under the Unified Health System (Sistema Único de Saúde, SUS), courts have become important in adjudicating coverage decisions. Empirical assessments of equity and the right to health tend to focus on simple measures of access. However, these empirical perspectives belie the significant inequalities and rights violations that arise in the case of more complex health needs such as cancer. To shed light on these issues, this paper focuses on the care pathways for breast and cervical cancer and explores access and quality issues that arise at different points along the care pathway with implications for the realization of the right to health in Brazil. METHOD: A mixed method approach is used. The analysis is primarily based on a quantitative analysis of national representative administrative data principally from the cervical and breast cancer information systems and the hospital cancer registry. To gain more insights into the organization of cancer care, qualitative data was collected from the state of Bahia, through document analysis, direct observation, roundtable discussions with health workers (HWs), and structured interviews with health care administrators. RESULTS: The paper reveals that the volume of completed screening exams is well below the estimated need, and a tendency toward lower breast cancer screening rates in poorer states and for women in the lowest income brackets. Only 26% of breast cancer cases and 29% of cervical cancer cases are diagnosed at an early stage (stage 0 or I), thereby reducing the survival prospects of patients. Waiting times between confirmed diagnosis and treatment are long, despite new legislation that guarantees a maximum of 60 days. The waiting times are significantly longer for patients that follow the recommended patient pathways, and who are diagnosed outside the hospital. CONCLUSION: The study reveals that there are large variations between states and patients, where the poorest states and patients fare worse on key indicators. More broadly, the paper shows the importance of collecting data both on patient characteristics and health system performance and carry out detailed health system analysis for exposing, empirically, rights violations and for identifying how they can be addressed.


Assuntos
Neoplasias da Mama/terapia , Equidade em Saúde/legislação & jurisprudência , Direitos Humanos , Programas Nacionais de Saúde , Neoplasias do Colo do Útero/terapia , Brasil , Feminino , Humanos
4.
Health Syst Reform ; 4(4): 324-335, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30373454

RESUMO

Since 2013, the government of Malawi has been pursuing a number of health reforms, which include plans to increase domestic financing for health through "innovative financing." As part of these reforms, Malawi has sought to raise additional tax revenue through existing and new sources with a view to earmarking the revenue generated to the health sector. In this article, a systematic approach to assessing feasibility and quantifying the amount of revenue that could be generated from potential sources is devised and applied. Specifically, the study applies the Delphi forecasting method to generate a qualitative assessment of the potential for raising additional tax revenues from existing and new sources, and the gross domestic product (GDP)-based effective tax rate forecasting method to quantify the amount of tax revenue that would be generated. The results show that an annual average of 0.30 USD, 0.46 USD, and 0.63 USD per capita could be generated from taxes on fuel and motor vehicle insurance over the period 2016/2017-2021/2022 under the low, medium, and high scenarios, respectively. However, the proposed tax reform has not been officially adopted despite wide consultations and generation of empirical evidence on the revenue potential. The study concludes is that revenue generation potential of innovative financing for health mechanisms in Malawi is limited, and calls for efforts to expand fiscal space for health to focus on efficiency-enhancing measures, including strengthening of governance and public financial management.


Assuntos
Atenção à Saúde/economia , Países em Desenvolvimento , Administração Financeira , Financiamento Governamental , Financiamento da Assistência à Saúde , Renda , Impostos , Humanos , Malaui , Cobertura Universal do Seguro de Saúde
6.
Hum Resour Health ; 14: 6, 2016 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-26887693

RESUMO

BACKGROUND: Brazil has experienced difficulties in attracting health professionals (especially doctors and nurses) to practice at the primary health care (PHC) level and in rural and remote areas. This study presents two case studies, each a current initiative in contracting for primary health services in Brazil: one for the state of Bahia and the other for the city of Rio de Janeiro. The two models differ considerably in context, needs, modalities, and outcomes. This article does not attempt to evaluate the initiatives but to identify their strengths and weaknesses. METHODS: Analysis was based on indicators produced by the Brazilian health care information systems, a review of literature and other documentation, and key informant interviews. RESULTS: In the case of Bahia, the state and municipalities decided to create a State Foundation, a new institutional public entity acting under private law that centralizes the hiring of health professionals in order to offer stable positions with career plans and mobility within the state. Results have been mixed as a lower than expected municipal involvement resulted in relatively high administrative costs and consequent default on municipal financial contributions. In the case of Rio de Janeiro, the municipality opted to contract not-for-profit Social Organizations as it made a push to expand access to primary health care in the city. The approach has been successful in expanding coverage, but evidence on cost and performance is weak. CONCLUSIONS: Both cases highlight that improvements in cost and performance data will be critical for meaningful comparative evaluation of delivery arrangements in primary care. Despite the different institutional and implementation arrangements of each model, which make comparison difficult, the analysis provides important lessons for contracting out health professionals for PHC within Brazil and elsewhere.


Assuntos
Serviços Contratados , Pessoal de Saúde , Organizações , Atenção Primária à Saúde , Serviços de Saúde Rural , População Rural , Brasil , Governo , Acessibilidade aos Serviços de Saúde , Humanos , Recursos Humanos
7.
Int J Equity Health ; 14: 90, 2015 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-26616048

RESUMO

OBJECTIVE: Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness. METHODS: The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics. RESULTS: Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by their providers. CONCLUSION: The study suggested that the Dongguan model (based on insurance mandate and using family practice physicians as 'gate-keepers') seemed to work best in terms of improving access and quality for patients with chronic conditions. The study suggested adequately funded and well-organized primary care system can play a gatekeeping role and has the potential to provide a reasonable level of care to patients.


Assuntos
Doença Crônica/terapia , Centros Comunitários de Saúde/normas , Acessibilidade aos Serviços de Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Idoso , Estudos de Casos e Controles , China , Centros Comunitários de Saúde/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/normas , Inquéritos e Questionários
8.
BMC Health Serv Res ; 15: 473, 2015 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-26482171

RESUMO

BACKGROUND: In the last decade, almost every low- or middle-income country in the world has expressed support for universal health coverage (UHC). While at the beginning of the UHC movement, country strategies focused on increasing access to the formal sector as the first step of UHC, there is now consensus that countries should cover the entire population, with particular attention to covering the poor. However, it is often assumed that mandatory schemes will automatically cover their target populations, and consequently little is known about why firms comply or do not comply with enrolment requirements. Using the experience of Lao PDR, where the enrolment rate in the mandatory social security scheme is low and the capacity for regulation is weak, we conducted this study to better understand the determinants of enrolment of private sector firms in mandatory social security. METHODS: We used a cross-sectional case-comparison design, surveying 130 firms. We applied a structured questionnaire to explore determinants of enrolment, specifically looking at firm characteristics (e.g., industry category, ownership); sociodemographic characteristics of company heads; firms' risk perceptions; details of employment contracts; employee benefits; and exposure to social security. Closed ended questions were analysed quantitatively, while content analysis was applied to open-ended questions. Logistic regression was used to examine the determinants of enrolment. RESULTS: Smaller privately owned firms in the services industry were the least likely to enrol in social security, while firms in the trade industry were more likely to enrol than firms in manufacturing, construction, or services. The main reason for not enrolling was that firms offered a better package of benefits to their employees, although further investigation of company benefits showed that this was not the case in practice. Additional reasons for non-compliance were lack of knowledge and poor quality of care at government hospitals. CONCLUSIONS: The study contributes to the dialogue on how best to increase coverage in the formal sector, which is an important element of achieving UHC. It also provides much needed information about the motivation of private sector firms to comply with mandatory schemes.


Assuntos
Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Seguro Saúde , Setor Privado , Cobertura Universal do Seguro de Saúde , Estudos Transversais , Humanos , Laos , Propriedade , Previdência Social , Inquéritos e Questionários , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
9.
Health Econ ; 24(4): 379-99, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25784572

RESUMO

Community-based health insurance in Lao People's Democratic Republic targets the informal workforce. Estimates of the program's impact on utilization and out-of-pocket expenditures (OOPs) were obtained using a case-comparison study of 3000 households (14 804 individuals) in urban and semi-urban areas. We used propensity score matching to control for bias on observables and to account for heterogeneity. We check the sensitivity of the results using a weighted regression combined with propensity score matching, which leads to doubly robust treatment effect estimates. The results are robust across the two approaches and show that the insured have significantly higher utilization, lower OOPs and lower incidence of catastrophic expenditures, and are less likely to employ coping mechanisms. However, coverage of the scheme is extremely low, indicating negligible population level impact. Furthermore, the results show that the scheme provides greater protection to the better off than to the poor: the poor are less likely to enrol, and among the poor who are enrolled, there has been no significant impact on utilization of outpatient services, total OOPs or catastrophic expenditures. We discuss the policy implications in the context of the international debate regarding the prospects for the role of community-based health insurance in national financing strategies.


Assuntos
Atenção à Saúde/estatística & dados numéricos , Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Estudos de Casos e Controles , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/organização & administração , Atenção à Saúde/economia , Características da Família , Feminino , Financiamento da Assistência à Saúde , Humanos , Seguro Saúde/economia , Laos/epidemiologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão
10.
PLoS One ; 9(3): e89784, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24632592

RESUMO

A pilot eliminating user fees associated with delivery at the point of services was introduced in two districts of Laos in March 2009. Following two years of implementation, an evaluation was conducted to assess the pilot impact, as well as to document the pilot design and implementation challenges. Study results show that, even in the presence of the substantial access and cultural barriers, user fees associated with delivery at health facilities act as a serious deterrent to care seeking behavior. We find a tripling of facility-based delivery rates in the intervention areas, compared to a 40% increase in the control areas. While findings from the control region suggest that facility-based delivery rates may be on the rise across the country, the substantially higher increase in the pilot areas highlight the impact of financial burden associated with facility-based delivery fees. These fees can play an important role in rapidly increasing the uptake of facility delivery to reach the national targets and, ultimately, to improve maternal and child health outcomes. The pilot achieved important gains while relying heavily on capacity and systems already in place. However, the high cost associated with monitoring and evaluation suggest broad-scale expansion of the pilot activities is likely to necessitate targeted capacity building initiatives, especially in areas with limited district level capacity to manage funds and deliver detailed and timely reports.


Assuntos
Honorários e Preços , Acessibilidade aos Serviços de Saúde/economia , Serviços de Saúde Comunitária/economia , Humanos , Laos
11.
Health Econ ; 23(6): 706-18, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23765700

RESUMO

Using primary data from Laos, we compare a broad range of different types of shocks in terms of their incidence, distribution between the poor and the better off, idiosyncrasy, costs, coping responses, and self-reported impacts on well-being. Health shocks are more common than most other shocks, more concentrated among the poor, more idiosyncratic, more costly, trigger more coping strategies, and highly likely to lead to a cut in consumption. Household members experiencing a health shock lost, on average, 0.6 point on a five-point health scale; the wealthier are better able to limit the health impacts of a health shock.


Assuntos
Adaptação Psicológica , Desastres , Nível de Saúde , Custos e Análise de Custo , Estudos Transversais , Desastres/estatística & dados numéricos , Família , Feminino , Humanos , Renda/estatística & dados numéricos , Laos , Masculino , Satisfação Pessoal , Estudos Retrospectivos , População Rural , Classe Social , Inquéritos e Questionários , População Urbana
12.
BMC Health Serv Res ; 13: 521, 2013 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-24344925

RESUMO

BACKGROUND: The Government of Lao Peoples' Democratic Republic (Lao PDR) has embarked on a path to achieve universal health coverage (UHC) through implementation of four risk-protection schemes. One of these schemes is community-based health insurance (CBHI) - a voluntary scheme that targets roughly half the population. However, after 12 years of implementation, coverage through CBHI remains very low. Increasing coverage of the scheme would require expansion to households in both villages where CBHI is currently operating, and new geographic areas. In this study we explore the prospects of both types of expansion by examining household and district level data. METHODS: Using a household survey based on a case-comparison design of 3000 households, we examine the determinants of enrolment at the household level in areas where the scheme is currently operating. We model the determinants of enrolment using a probit model and predicted probabilities. Findings from focus group discussions are used to explain the quantitative findings. To examine the prospects for geographic scale-up, we use secondary data to compare characteristics of districts with and without insurance, using a combination of univariate and multivariate analyses. The multivariate analysis is a probit model, which models the factors associated with roll-out of CBHI to the districts. RESULTS: The household findings show that enrolment is concentrated among the better off and that adverse selection is present in the scheme. The district level findings show that to date, the scheme has been implemented in the most affluent areas, in closest proximity to the district hospitals, and in areas where quality of care is relatively good. CONCLUSIONS: The household-level findings indicate that the scheme suffers from poor risk-pooling, which threatens financial sustainability. The district-level findings call into question whether or not the Government of Laos can successfully expand to more remote, less affluent districts, with lower population density. We discuss the policy implications of the findings and specifically address whether CBHI can serve as a foundation for a national scheme, while exploring alternative approaches to reaching the informal sector in Laos and other countries attempting to achieve UHC.


Assuntos
Seguro Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/organização & administração , Adolescente , Adulto , Idoso , Atitude Frente a Saúde , Estudos de Casos e Controles , Criança , Pré-Escolar , Atenção à Saúde/organização & administração , Características da Família , Grupos Focais , Pesquisas sobre Atenção à Saúde , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Laos , Pessoa de Meia-Idade , Adulto Jovem
13.
Reprod Health Matters ; 21(42): 203-11, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24315075

RESUMO

This paper sheds light on the inter-generational changes in pregnancy and childbirth practices in remote areas of Lao PDR over a period of 30 years. The study consisted of focus group discussions with pregnant women aged 14-30, mothers and fathers of small children, and older women aged 40+ in six rural communities in two districts. Childbirth practices were gradually evolving and changing - most dramatically illustrated by the transition from forest-based to home-based delivery, and a few health facility-based deliveries when complications occurred. Today's generation of women aged 40+ did not recommend all the practices of their mothers, but saw the need to adapt due to the social and medical risks they had experienced, especially high rates of neonatal death. Their daughters are doing the same. The increase in home-based deliveries should be regarded as significant progress in this setting in rural Laos. Understanding how young women interpret their options and incorporating that knowledge and the experience of successful local outreach programmes into health system policy and practice for maternity care, e.g. by strengthening the skills of community-based health workers, could contribute to improving maternal and neonatal survival and reducing health inequalities.


Assuntos
Acessibilidade aos Serviços de Saúde/tendências , Relação entre Gerações/etnologia , Serviços de Saúde Materna/tendências , Parto/etnologia , Adolescente , Adulto , Características Culturais , Feminino , Grupos Focais , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Laos , Masculino , Mortalidade Materna , Gravidez , Fatores Socioeconômicos
14.
BMC Int Health Hum Rights ; 13: 28, 2013 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-23777408

RESUMO

BACKGROUND: Uncertainty is regarded as a central dimension in the experience of illness and in the processes of alleviating it. Few studies from resource-poor settings have investigated this and how it interacts with other factors. This study aims to shed light on how healthcare-seeking develops in the context of multiple medical alternatives and to understand what bearing uncertainty has on this process. METHODS: The study was conducted in six purposively selected rural communities in Lao PDR. In each community, two focus group discussions were held: first with mothers and then with fathers of children younger than five years old. Eleven in-depth interviews with caregivers of severely sick children were conducted. Subsequently, traditional healers, drug vendors, community health workers, nurses and medical doctors were recruited for interviews or group discussions. The data were transcribed and key themes and similarities were identified. Additional readings were conducted to better understand the interactions of factors during which uncertainty was identified as one of several factors mentioned during interviews and focus group discussions. RESULTS: Care-seekers expressed a strong preference for initially seeking local providers. Subsequently, multiple providers were consulted to increase the chances of recovery. This resulted in patients leaving the health facilities before recovery and in ending the recommended treatment regime prematurely. These healthcare-seeking decisions reflect the social significance of being a responsible caregiver and of showing respect for household norms. In general, healthcare-seeking was shrouded in uncertainty when it came to selecting the right provider, the likelihood of finding the real cause of the illness, spending savings on treatments and ultimately the likelihood of recovery. CONCLUSIONS: Care-seekers' initial strong preference for local providers irrespective of the providers' legitimacy indicates the need for a robust primary healthcare system. Care-seekers' subsequent consultations must be understood in the light of their uncertainty regarding the skills of the available providers. The social connotations of seeking healthcare including the vulnerability of poor households in public health facilities were taken into account to only a limited extent by health workers. Health workers should have greater awareness of the social and cultural aspects of seeking care.


Assuntos
Cuidadores/psicologia , Pessoal de Saúde/estatística & dados numéricos , Incerteza , Adaptação Psicológica , Criança , Mortalidade da Criança , Pré-Escolar , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/normas , Efeitos Psicossociais da Doença , Feminino , Grupos Focais , Pessoal de Saúde/economia , Pessoal de Saúde/normas , Acessibilidade aos Serviços de Saúde , Humanos , Laos/epidemiologia , Masculino , Mortalidade Materna , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/normas , Pesquisa Qualitativa , População Rural
18.
Reprod Health Matters ; 20(40): 112-21, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23245416

RESUMO

Outreach services for vaccination present a useful vehicle to deliver maternal and child health (MCH) care to hard-to-reach women and children. In Laos, uptake of MCH services inversely correlates with distance from a health facility; hence, the concurrent delivery of MCH services during community vaccination outreach has been promoted. Here we assess factors affecting delivery of MCH services during vaccination outreach in six districts of three provinces. We conducted 58 in-depth interviews with representatives of district and provincial health offices, health centre staff and village health volunteers. Vaccination outreach sessions by health centre staff were observed in eight villages, and 12 focus group discussions were held with 120 mothers on their perceptions of these sessions. The regularity and frequency of outreach sessions and the number of integrated vaccination/MCH services varied widely between sites. Availability of external financial and technical support was the major determinant of optimal delivery of integrated services, with implications for future policy. To enable concurrent delivery of a range of MCH services during vaccination outreach, the number of these services should gradually be increased in tandem with additional financial and technical support. At the same time, ways need to be found to ensure remote villages are reached and coverage of children and women receiving services increased, to reduce inequity.


Assuntos
Relações Comunidade-Instituição , Promoção da Saúde , Programas de Imunização/estatística & dados numéricos , Centros de Saúde Materno-Infantil , Desenvolvimento de Programas/métodos , Estudos de Viabilidade , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Laos , Mães/psicologia , Pesquisa Qualitativa
19.
Lancet ; 377(9767): 769-81, 2011 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-21269674

RESUMO

In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues.


Assuntos
Emigração e Imigração , Pessoal de Saúde/estatística & dados numéricos , Recursos em Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Turismo Médico , Área Carente de Assistência Médica , Sudeste Asiático , Comércio , Emigração e Imigração/estatística & dados numéricos , Emigração e Imigração/tendências , Pessoal de Saúde/educação , Recursos em Saúde/organização & administração , Recursos em Saúde/normas , Recursos em Saúde/estatística & dados numéricos , Recursos em Saúde/provisão & distribuição , Recursos em Saúde/tendências , Humanos , Turismo Médico/estatística & dados numéricos , Turismo Médico/tendências , Tocologia/estatística & dados numéricos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Médicos/estatística & dados numéricos , Política Pública/tendências
20.
Health Econ ; 18 Suppl 2: S7-23, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19551753

RESUMO

This paper provides a survey of the recent empirical research on China's 'old' health system (i.e. prior to the spate of reforms beginning in 2003). It argues that this research has enhanced our understanding of the system prior to 2003, in some cases reinforcing conclusions (e.g. the demand-inducement associated with perverse incentives) while in other cases suggesting a slightly less clear storyline (e.g. the link between insurance and out-of-pocket spending). It also concludes that the research to date points to the importance of careful evaluation of the current reforms, and its potential to modify policies as the rollout proceeds. Finally, it argues that the research on the pre-2003 system suggests that while the recently announced further reforms are a step in the right direction, the hoped-for improvements in China's health system will far more likely occur if the reforms become less timid in certain key areas, namely provider payments and intergovernmental fiscal relations.


Assuntos
Atenção à Saúde/organização & administração , Reforma dos Serviços de Saúde/organização & administração , China , Atenção à Saúde/economia , Atenção à Saúde/legislação & jurisprudência , Financiamento Governamental/economia , Financiamento Pessoal/economia , Comportamentos Relacionados com a Saúde , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Política de Saúde , Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/organização & administração , Humanos , Seguro Saúde/economia , Programas Nacionais de Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração
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