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1.
Health Aff (Millwood) ; 40(11): 1740-1748, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34724415

RESUMO

With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.


Assuntos
Medicaid , Patient Protection and Affordable Care Act , Governo Federal , Gastos em Saúde , Humanos , Estados Unidos , Washington
2.
J Prim Health Care ; 13(2): 116-120, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34620292

RESUMO

During the first months of the coronavirus disease 2019 (COVID-19) pandemic in early 2020, South Korea stood as one of the most successful in preventing a nationwide outbreak. The country was unique in that it did so without enforcing massive border restrictions and tight social distancing measures, instead focusing on maximal testing, contact tracing, and treatment. But as the year 2020 went on, the country has suffered second and third waves, each one being larger and harder to combat than the last. The Korean government, however, has been unwilling to impose stringent measures due to potential economic consequences and has still relied on its initial strategies in an attempt to prevent further disease transmission. It is therefore crucial to revisit their position beyond their early successes to re-evaluate the effectiveness of their strategy, and to finally decide if it is time to move on to more drastic measures.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Pandemias/prevenção & controle , Teste para COVID-19 , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , Busca de Comunicante , Governo Federal , Humanos , Distanciamento Físico , República da Coreia
7.
Biomed Res Int ; 2021: 5763003, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34485519

RESUMO

Background: The dominant view in the literature is that informal payments in healthcare universally are a negative phenomenon. By contrast, we theorize that the motivation healthcare users for making informal payments (IP) can be classified into three categories: (1) a cultural norm, (2) "grease the wheels" payments if users offered to pay to get better services, and (3) "sand the wheels" payments if users were asked to pay by healthcare personnel or felt that payments were expected. We further hypothesize that these three categories of payments are differently associated with a user's outcomes, namely, satisfaction with healthcare, local and national government, satisfaction with life, and satisfaction with life of children in the future. Methods: We used microdata from the 2016 Life-in-Transition survey. Multivariate regression analysis is used to quantify relationships between these categories of payments and users' outcomes. Results: Payments that are the result of cultural norms are associated with better outcomes. On the contrary, "sand the wheel" payments are associated with worse outcomes. We find no association between making "grease the wheels" payments and outcomes. Conclusions: This is the first paper which evaluates association between three different categories of informal payments with a wide range of users' outcomes on a diverse sample of countries. Focusing on informal payments in general, rather than explicitly examining specific motivations, obscures the true outcomes of making IP. It is important to distinguish between three different motivations for informal payment, namely, cultural norms, "grease the wheels," and "sand the wheels" since they have varying associations with user outcomes. From a policy making standpoint, variation in the links between different motivations for making IP and measures of satisfaction suggest that decision-makers should put their primary focus on situations where IP are explicitly asked for or are implied by the situation and that they should differentiate this from cases of gratitude payments. If such measures are not implemented, then policy makers may unintentionally ban the behaviour that is linked with increased satisfaction with healthcare, government, and life (i.e., paying gratitude).


Assuntos
Gastos em Saúde/estatística & dados numéricos , Instalações de Saúde/economia , Motivação , Qualidade da Assistência à Saúde/economia , Governo Federal , Pesquisas sobre Serviços de Saúde , Instalações de Saúde/normas , Humanos , Satisfação Pessoal
13.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 29(Special Issue): 713-719, 2021 Jun.
Artigo em Russo | MEDLINE | ID: mdl-34327950

RESUMO

The objectives of this research are to explore foreign experience of interaction of various levels of public authority in federal states in the context of the COVID-19 pandemic, to determine the prospects for the development and improvement of the activities of the public authority system in Russia in this part. MATERIALS AND METHODS: The regulatory legal acts and the practice of interaction of various levels of public authority during the COVID-19 pandemic in federations (Australia, India, Canada, USA) were research. RESULTS: It has been established that a dual federal system with strict rules for the distribution of powers and responsibilities between the federation and its regions impedes a coordinated national response in the fight against the COVID-19 pandemic, while various forms of executive federalism serve as the key to successfully countering this threat. The latter can be based on historically strong centralist tendencies, the existing negotiating practices of interaction between the executive branch at all levels, the experience of implementing federal programs and the work of emergency intergovernmental mechanisms. CONCLUSIONS: It has been substantiated that the optimal organization of managerial decision-making in the context of countering a pandemic presupposes a complex interagency approach with a strong federal presence.


Assuntos
COVID-19 , Governo Federal , Pandemias , Governo Estadual , Austrália , Canadá , Política de Saúde , Humanos , Índia , Administração em Saúde Pública , Federação Russa , Estados Unidos
14.
BMC Health Serv Res ; 21(1): 738, 2021 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-34304743

RESUMO

BACKGROUND: Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the views, current practice, training needs and challenges faced by CPG developers in the production and use of HEE for CPGs in South Africa. METHODS: This mixed-methods study comprised an online survey and a focus group discussion. The survey was piloted and subsequently sent to CPG role players - evidence reviewers, CPG panellists, academics involved with training in relevant disciplines like health economics and public health, implementers and funders. The focus group participants hold strategic roles in CPG development and health economic activities nationally. The survey evaluated mean values, measures of variability, and percentages for Likert scales, while narrative components were thematically analysed. Focus group data were manually coded, thematically analysed and verified. RESULTS: The survey (n = 55 respondents to 245 surveys distributed) and one focus group (n = 5 participants from 10 people invited) occurred between October 2018 and February 2019. We found the most consistent reason why HEE should inform CPG decisions was 'making more efficient use of limited financial resources'. This was explained by numerous context and methodological barriers. Focus groups participants noted that consideration of complex HEE are not achievable without bolstering skills in applying evidence-based medicine principles. Further concerns include lack of clarity of standard methods; inequitable and opaque topic selection across private and public sectors; inadequate skills of CPG panel members to use HEE; and the ability of health economists to communicate results in accessible ways. Overall, in the absence of clarity about process and methods, politics and interests may drive CPG decisions about which interventions to implement. CONCLUSIONS: HEE should ideally be considered in CPG decisions in South Africa. However, this will remain hampered until the CPG community agree on methods and processes for using HEE in CPGs. Focused investment by national government to address the challenges identified by the study is imperative for a better return on investment as National Health Insurance moves forward.


Assuntos
Economia Médica , Medicina Baseada em Evidências , Governo Federal , Humanos , Programas Nacionais de Saúde , África do Sul
16.
N Z Med J ; 134(1538): 102-110, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239149

RESUMO

AIM: To (1) describe the distribution of Ministry of Health (MOH) COVID-19 emergency funding to general practices in March and April 2020 and (2) consider whether further funding to general practices should be allocated differently to support equity for patients. METHODS: Emergency funding allocation criteria and funding amounts by general practice were obtained from the MOH. Practices were stratified according to their proportion of high-needs enrolled patients (Maori, Pacific or living in an area with the highest quintile of socioeconomic deprivation). Funding per practice was calculated for separate and total payments according to practice stratum of high-needs enrolled patients. RESULTS: The median combined March and April funding for general practices with 80% high-needs patients was 28% higher per practice ($36,674 vs $28,686) and 48% higher per patient ($10.50 vs $7.11) compared with the funding received by general practices with fewer than 20% high-needs patients. Although the March allocation did increase funding for high-needs patients, the April allocation did not. CONCLUSIONS: Emergency support funding for general practices was organised by the MOH at short notice and in exceptional circumstances. In the future, the MOH should apply pro-equity resource allocation in all emergencies, as with other circumstances.


Assuntos
COVID-19/economia , Financiamento Governamental/estatística & dados numéricos , Medicina Geral/economia , Equidade em Saúde/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/prevenção & controle , Criança , Pré-Escolar , Emergências , Governo Federal , Financiamento Governamental/economia , Medicina Geral/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Nova Zelândia , Grupo com Ancestrais Oceânicos , Áreas de Pobreza , SARS-CoV-2 , Populações Vulneráveis , Adulto Jovem
17.
Environ Sci Technol ; 55(16): 10923-10927, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34310109

RESUMO

In the United States (U.S.), chemical evaluations and assessments are conducted by seven federal agencies responding to distinct statutory requirements and focusing on different exposure scenarios. While risk assessment is a fundamental concept in public health practice and policy, there is no clear, central, and concise summary of these processes. The novel infographic presented here depicts more than 30 different evaluation and assessment processes conducted by federal agencies for chemicals found in the environment, workplace, consumer products, hazardous waste sites, food, and/or cosmetics. The majority of these assessments are statutorily required. Most serve as sources of authoritative information to provide public health guidance or recommendations. Less than half directly result in risk management actions or regulations. Understanding these roles and processes can facilitate engagement from the broader community, including by highlighting priority areas for research to inform public health policy. This infographic also illustrates the opportunity and need for further intra- and interagency collaboration and coordination - including a particular focus on aggregate risk assessment, given that the population regularly experiences exposures from multiple sources crossing agency domains.


Assuntos
Saúde Pública , Gestão de Riscos , Saúde Ambiental , Governo Federal , Medição de Risco , Estados Unidos , Local de Trabalho
18.
PLoS One ; 16(7): e0254001, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34288913

RESUMO

Health, disease, and mortality vary greatly at the county level, and there are strong geographical trends of disease in the United States. Healthcare is and has been a top priority for voters in the U.S., and an important political issue. Consequently, it is important to determine what relationship voting patterns have with health, disease, and mortality, as doing so may help guide appropriate policy. We performed a comprehensive analysis of the relationship between voting patterns and over 150 different public health and wellbeing variables at the county level, comparing all states, including counties in 2016 battleground states, and counties in states that flipped from majority Democrat to majority Republican from 2012 to 2016. We also investigated county-level health trends over the last 30+ years and find statistically significant relationships between a number of health measures and the voting patterns of counties in presidential elections. Collectively, these data exhibit a strong pattern: counties that voted Republican in the 2016 election had overall worse health outcomes than those that voted Democrat. We hope that this strong relationship can guide improvements in healthcare policy legislation at the county level.


Assuntos
Governo Federal , Geografia Médica , Empregados do Governo , Política , Saúde Pública , Gastos em Saúde/estatística & dados numéricos , Política de Saúde , Indicadores Básicos de Saúde , Humanos , Morbidade , Mortalidade , Estados Unidos
19.
PLoS One ; 16(7): e0253624, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34288930

RESUMO

BACKGROUND: Revelations that some members of Congress, including members of key health care committees, hold substantial personal investments in the health care industry have raised concerns about lawmakers' financial conflicts of interest (COI) and their potential impact on health care legislation and oversight. AIMS: 1) To assess historical trends in both the number of legislators holding health care-related assets and the value and composition of those assets. 2) To compare the financial holdings of members of health care-focused committees and subcommittees to those of other members of the House and Senate. METHODS: We analyzed 11 years of personal financial disclosures by all members of the House and Senate. For each year, we calculated the percentage of members holding a health care-related asset (overall, by party, and by committee); the total value of all assets and health care-related assets held; the mean and median values of assets held per member; and the share of asset values attributable to 9 health asset categories. FINDINGS: During the study period, over a third of all members of Congress held health care-related assets. These assets were often substantial, with a median total value per member of over $43,000. Members of health care-focused committees and subcommittees in the House and Senate did not hold health care-related assets at a higher rate than other members of their respective chambers. CONCLUSIONS: These findings suggest that lawmakers' health care-related COI warrant the same level of attention that has been paid to the COI of other actors in the health care system.


Assuntos
Atenção à Saúde/economia , Governo Federal , Empregados do Governo/estatística & dados numéricos , Investimentos em Saúde/tendências , Conflito de Interesses , Revelação , Humanos , Investimentos em Saúde/economia , Investimentos em Saúde/estatística & dados numéricos , Política , Estados Unidos
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