From office to digital primary care services: analysing income-related inequalities in utilization.

The use of digital technologies to deliver primary health care has increased over the past decade. While some technologies have been shown to be medically effective and efficient, the effects of digital primary care on the policy goal of equality in the use of such types of care have not been studied using large register data. The aim of this study was to analyse how digital contacts differ from officebased visits by income as an indicator of socioeconomic status. Specifically, we estimated differences in primary care utilization across income, factors of contribution to these inequalities, and applied a needs-based standardisation of utilization to estimate differences in equity.We used a purposively built consultation level dataset with 726 000 Swedish adult patients diagnosed with an infection, including clinical and sociodemographic variables. Applying concentration indexes (CI) and graphical illustrations we measured how the two types of services are distributed relative to income. We estimated how much of the inequalities were attributed to different sociodemographic factors by decomposing the concentration indexes. Standardised utilization for sex, age and comorbidity allowed for the estimation of horizontal inequity indexes for both types of services.Utilization by the two types of care showed large income inequalities. Office-based visits were propoor (CI -0.116), meaning lowincome patients utilized relatively more of these services, while digital contacts were prorich (CI 0.205). However, within the patient group who had at least one digital contact, the utilization was also propoor (CI -0,101), although these patients had higher incomes on average. The standardised utilization showed a smaller prorich digital utilization (CI 0.143), although large differences remained. Decomposing the concentration indexes showed that education level and being born in Sweden were strong attributes of prorich digital service utilization.The prorich utilization effects of digital primary care may risk undermining the policy goals of access and utilization to services regardless of socioeconomic status. As digital health technologies continue to expand, policy makers need to be aware of the risk.

Фазои буҷетӣ барои тандурустӣ дар Ҷумҳурии Тоҷикистон: имкониятҳои ҷалби захираҳои давлатии иловагӣ

Барномаи ислоҳоти соҳаи тандурустии Ҷумҳурии Тоҷикистон ҷиҳати ноил шудан ба фарогирии умумӣ бо хизматрасониҳои тандурустӣ (ФУХТ) аз беҳтар намудани дастрасии тамоми аҳолӣ ба хизматрасонии тиббии баландсифат ва истифодаи самараноки захираҳои давлатӣ иборат аст. Стратегияи миллии тандурустии ба наздикӣ қабулшуда (Стратегияи ҳифзи солимии аҳолии Ҷумҳурии Тоҷикистон барои давраи то соли 2030) ба далелҳо ва тавсияҳои глобалӣ пайравӣ намуда, ба тавсеаи кумаки аввалияи тиббию санитарӣ такя мекунад. Барои татбиқи стратегия ба Ҷумҳурии Тоҷикистон лозим аст, ки маблағгузории давлатиро ба соҳаи тандурустӣ ба таври қобили мулоҳиза зиёд намояд ва захираҳоро ба он соҳае ҷудо намояд, ки онҳо самараи бештар доранд. Дар айни замон, захираҳои буҷетӣ барои кӯмаки аввалияи тиббию санитарӣ кофӣ нестанд ва дар саросари кишвар нобаробар тақсим карда мешаванд, ки дар натиҷа камбудиҳои ноодилона дар дастрасии хизматрасонии тиббӣ ба вуҷуд меоянд. Аз ин рӯ, дар истифодаи соҳаи тандурустӣ фарқиятҳои беасос вуҷуд доранд. Дар гузориши мазкур имкониятҳои алтернативии зиёд кардани фазои буҷетӣ барои саломатӣ, аз ҷумла захираҳои кӯмаки аввалияи тиббию санитарӣ тавсиф, таҳлил ва муқоиса шудаанд.

Фискальное пространство для сектора здравоохранения в Республике Таджикистан: варианты получения дополнительных финансовых ресурсов

Программа реформы здравоохранения Республики Таджикистан для достижения всеобщего охвата услугами здравоохранения (ВОУЗ) включает в себя улучшение доступа к качественной медицинской помощи для всего населения и более эффективное использование государственных ресурсов. Недавно принятая Национальная стратегия здравоохранения (Стратегия охраны здоровья населения Республики Таджикистан на период до 2030 г.) следует глобальным фактическим данным и рекомендациям и основывается на расширении первичной медико-санитарной помощи. Для реализации стратегии Республике Таджикистан необходимо в значительной степени увеличить государственное финансирование здравоохранения и направить ресурсы туда, где они дадут наибольший эффект. В настоящее время бюджетные ресурсы на первичную медико-санитарную помощь отстают и неравномерно распределяются по стране, что приводит к несправедливым пробелам в доступе к медицинской помощи. Следовательно, существуют необоснованные различия в использовании медицинских услуг. В этом отчете описываются, анализируются и сравниваются альтернативные возможности увеличения фискального пространства для здравоохранения, в частности ресурсов для первичной медико-санитарной помощи.

Budgetary space for health in the Republic of Tajikistan: options for more public resources

The Republic of Tajikistan’s health reform agenda to achieve universal health coverage includes improved access to high-quality health care for the entire population and more efficient use of public resources. The recently adopted National Health Strategy (Strategy for the Healthcare of the Population of the Republic of Tajikistan, 2021–2030) follows global evidence and recommendations, and builds on expanding primary health care. To implement the strategy, Tajikistan needs to increase considerably public funding for health and allocate resources to where they will have the most effect. Currently, budget resources for primary health care are lagging behind, and are unevenly distributed across the country, resulting in unjust gaps in health care access. Consequently, there are unjustified differences in health care utilization.This report describes, analyses and compares alternative opportunities to increase budgetary space for health, in particular resources for primary health care.

Study protocol: effects, costs and distributional impact of digital primary care for infectious diseases-an observational, registry-based study in Sweden.

INTRODUCTION: The ability to provide primary care with the help of a digital platform raises both opportunities and risks. While access to primary care improves, overuse of services and medication may occur. The use of digital care technologies is likely to continue to increase and evidence of its effects, costs and distributional impacts is needed to support policy-making. Since 2016, the number of digital primary care consultations for a range of conditions has increased rapidly in Sweden. This research project aims to investigate health system effects of this development. The overall research question is to what extent such care is a cost-effective and equitable alternative to traditional, in-office primary care in the context of a publicly funded health system with universal access. Three specific areas of investigation are identified: clinical effect; cost and distributional impact. This protocol describes the investigative approach of the project in terms of aims, design, materials, methods and expected results. METHODS AND ANALYSIS: The research project adopts a retrospective study design and aims to apply statistical analyses of patient-level register data on key variables from seven regions of Sweden over the years 2017-2018. In addition to data on three common infectious conditions (upper respiratory tract infection; lower urinary tract infection; and skin and soft-tissue infection), information on other healthcare use, socioeconomic status and demography will be collected. ETHICS AND DISSEMINATION: This registry-based study has received ethical approval by the Swedish Ethical Review Authority. Use of data will follow the Swedish legislation and practice with regards to consent. The results will be disseminated both to the research community, healthcare decision makers and to the general public.

Utilization of digital primary care in Sweden: Descriptive analysis of claims data on demographics, socioeconomics, and diagnoses.

OBJECTIVE: As digital technologies for health continue to develop, the ability to provide primary care services to patients with new symptoms will grow. In Sweden, two providers of digital primary care have expanded rapidly over the past years giving rise to a heated debate with clear policy implications. The purpose of the study is to present a descriptive review of digital primary care as currently under development in Sweden. METHODS: Descriptive analysis of national coverage data on the utilization of digital care by sex, age, place of residence, socioeconomic status, and most common diagnoses. The data are compared with samples of corresponding data on traditional, office-based primary care, out-of-hours care, and on non-emergency telephone consultations to obtain a comparative analysis of digital care. RESULTS: Digital primary care in Sweden has increased rapidly over the past two years. Currently, more than 30,000 digital consultations are made per month, equivalent to around two percent of all physician-led primary care. Digital care differs in some ways to that of traditional care as users are generally younger and seek for different conditions compared with office-based primary care. Digital care is also similar to traditional care as utilization is higher in metropolitan areas compared with rural areas. Similar to general health care use, there is a negative correlation between use of digital care and socioeconomic status. User profiles by age and sex of digital care are also similar to those of out-of-hours care and non-emergency telephone medical consultations. CONCLUSIONS: By providing a detailed description of the development of digital primary care the study contributes to a growing understanding of the contributions that digital technologies can make to health care. Based on current trends digital primary care is likely to continue to increase in frequency over the coming years. As technologies develop and the public becomes more familiar to interacting with medical providers over the Internet also the scope of digital care is likely to expand. As the provision of digital primary care expands across Europe and beyond, policy makers will need to develop regulating capacities to ensure its safe, effective and equitable integration into existing health systems.

The 2015 National Cancer Program in Sweden: Introducing standardized care pathways in a decentralized system.

Starting in 2015, the Swedish government has initiated a national reform to standardize cancer patient pathways and thereby eventually speed up treatment of cancer. Cancer care in Sweden is characterized by high survival rates and a generally high quality albeit long waiting times. The objective with the new national program to standardize cancer care pathways is to reduce these waiting times, increase patient satisfaction with cancer care and reduce regional inequalities. A new time-point for measuring the start of a care process is introduced called well-founded suspicion, which is individually designed for each cancer diagnosis. While medical guidelines are well established earlier, the standardisation is achieved by defining time boundaries for each step in the process. The cancer reform program is a collaborative effort initiated and incentivized by the central government while multi-professional groups develop the time-bound standardized care pathways, which the regional authorities are responsible for implementing. The broad stakeholder engagement and time-bound guidelines are interesting approaches to study for other countries that need to streamline care processes.