Inequalities in Out-of-Pocket Health Expenditure Measured Using Financing Incidence Analysis (FIA): A Systematic Review.

Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure inequalities measured by the FIA across different territories, in the context of achieving UHC by 2030. A comprehensive systematic search was conducted in the PubMed, Scopus, and Web of Science databases to identify original quantitative and mixed-method studies published in the English language between 2016 and 2022. A total of 336 articles were initially identified, and after the screening process, 15 articles were included in the systematic review, following the removal of duplicates and articles not meeting the inclusion criteria. Despite the overall regressivity, insurance systems have generally improved population coverage and reduced inequality in out-of-pocket health expenditures among the employed population, but regional studies highlight the importance of examining the situation at a micro level. The results of the study provide further evidence supporting the notion that healthcare financing systems relying less on public funding and direct tax financing and more on private payments are associated with a higher prevalence of catastrophic health expenditures and demonstrate a more regressive pattern in terms of healthcare financing, highlighting the need for policy interventions to address these inequities. Governments face significant challenges in achieving universal health coverage due to inequalities experienced by financially vulnerable populations, including high out-of-pocket payments for pharmaceutical goods, informal charges, and regional disparities in healthcare financing administration.

An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021.

Universal health coverage relies on providing essential medical services and shielding individuals from financial risks. Our study assesses the progressivity of out-of-pocket (OOP) payments, identifies factors contributing to healthcare expenditure inequality, and examines catastrophic health expenditures (CHE) prevalence in Kazakhstan from 2018 to 2021. Using retrospective analysis of National Statistics Bureau data, we employed STATA 13 version for calculations CHE incidence, progressivity, Lorenz and concentration curves. In 2020-2021, OOP expenditures in Kazakhstan decreased, reflecting a nearly twofold reduction in the CHE incidence to 1.32% and 1.24%, respectively. However, during these years, we observe a transition towards a positive trend in the Kakwani index to 0.003 and 0.005, respectively, which may be explained by household size and education level factors. Increased state financing and quarantine measures contributed to reduced OOP payments. Despite a low healthcare expenditure share in gross domestic product, Kazakhstan exhibits a relatively high private healthcare spending proportion. The low CHE incidence and proportional expenditure system suggest private payments do not significantly impact financial resilience, prompting considerations about the role of government funding and social health insurance in the financing structure.

The Association between Parental Child Vaccination Refusal Rate and the Impact of Mass Vaccination against COVID-19 in Kazakhstan: An Interrupted Time Series Analysis with Predictive Modelling of Nationwide Data Sources from 2013 to 2022.

Despite well-established evidence supporting vaccination efficacy in reducing morbidity and mortality among infants and children, there is a global challenge with an increasing number of childhood vaccination refusals. This issue has intensified, especially during the COVID-19 pandemic. Our study aims to forecast mandatory childhood vaccination refusal trends in Kazakhstan until 2030, assessing the impact of mass COVID-19 vaccination on these rates. Utilizing annual official statistical data from 2013 to 2022 provided by the Ministry of Health of Kazakhstan, the study reveals a significant surge in refusals during the pandemic and post-pandemic periods, reaching record levels of 42,282 cases in 2021 and 44,180 cases in 2022. Notably, refusal rates sharply rose in specific regions, like Aktobe (13.9 times increase) and Atyrau (4.29 times increase), emphasizing the need for increased public healthcare attention in these areas. However, despite a decade of data, our forecasting analysis indicates a lack of volatility in childhood vaccine refusal trends for all vaccine types up to 2030, highlighting the statistical significance of the obtained results. The increasing trend in vaccine refusals underscores the necessity to enhance crisis response and support health initiatives, particularly in regions where a substantial rise in refusals has been observed in recent years.

Worldwide Child Routine Vaccination Hesitancy Rate among Parents of Children Aged 0-6 Years: A Systematic Review and Meta-Analysis of Cross-Sectional Studies.

Routine vaccine hesitancy is a major global health challenge observed in over 190 countries worldwide. This meta-analysis aims to determine the worldwide prevalence of routine vaccination hesitancy among parents of children aged 0-6. An extensive search was conducted in four scientific databases: PubMed, Scopus, Web of Science, and the Cochrane Library. Studies were included if they reported hesitancy related to WHO-recommended routine immunizations for children under 7 years of age. A single-arm meta-analysis was performed using the OpenMeta[Analyst] software. An initial search retrieved 5121 articles, of which only 23 publications, involving 29,131 parents, guardians, and caregivers from over 30 countries met the inclusion criteria and quality assessment. The cumulative prevalence of parental vaccine hesitancy was found to be 21.1% (95% CI = 17.5-24.7%, I2 = 98.86%, p < 0.001). When stratifying the prevalence of vaccine hesitancy per WHO region, significant variations were observed, ranging from 13.3% (95% CI = 6.7-19.9%, I2 = 97.72%, p < 0.001) in the Region of the Americas to 27.9% (95% CI = 24.3-31.4%) in the Eastern Mediterranean region. The study findings highlight the need for healthcare providers and governments to develop and improve comprehensive programs with communication strategies to reduce parental vaccine hesitancy.

Incidence and Mortality of Cardiovascular Disease in the Republic of Kazakhstan: 2004-2017.

Background: We aimed to evaluate the impact of national health programs implemented in Kazakhstan from 2011 on CVD incidence and mortality. Methods: Incidence and mortality rates from CVD were studied in Kazakhstan from 2004 to 2017. The official data obtained from "Medinform" company were analyzed based on the annual population statistics. Results: There was an increase in the incidence of cardiovascular disease among the population of Kazakhstan from 1845.4 per 100,000 in 2004 to 2597.5 per 100,000 in 2017. This might be attributed to the implementation of the national health programs, which improved early CVD identification. Incidence of ischemic heart disease (IHD) was grown almost in all provinces of Kazakhstan during the study period. The mortality from cardiovascular disease had a considerable decline over the study period, in particular after 2010, it might be influenced by early diagnosis and provision of timely treatment. Conclusion: The experience of Kazakhstan national health programs shows improved identification of CVD and IHD and timely treatment for cardiovascular disease. A significant variation in incidence and mortality rates of cardiovascular disease was observed between the country provinces.

Assessment of primary healthcare accessibility and inequality in north-eastern Kazakhstan.

Out of the many aspects of health care, the concept of physical accessibility is a priority that not only encompasses availability of health care resources, but also requires that they are easily accessible for all. To assess this factor as expressed in terms of the number of available physicians in the north-eastern part of Kazakhstan, we used the enhanced two-step float catchment area in a geographic information system approach. The Gini index and the Lorentz curve were used to evaluate the economic inequality within this region. Based on the data obtained, we developed models to increase the availability of health care considering allocation of additional primary health care resources. A low to zero index was found to be typical for most rural settlements, which currently make up less than 15% of the total population. We also identified a correlation between the index of accessibility and that of inequality, which indicates that areas with high accessibility show a more equitable distribution of resources. The developed location/ allocation models of additional primary health care resources can be useful in implementing government initiatives to improve the availability of primary health care in rural areas.