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1.
BMC Med ; 19(1): 127, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34059069

RESUMEN

BACKGROUND: Reducing poverty and improving access to health care are two of the most effective actions to decrease maternal mortality, and conditional cash transfer (CCT) programmes act on both. The aim of this study was to evaluate the effects of one of the world's largest CCT (the Brazilian Bolsa Familia Programme (BFP)) on maternal mortality during a period of 11 years. METHODS: The study had an ecological longitudinal design and used all 2548 Brazilian municipalities with vital statistics of adequate quality during 2004-2014. BFP municipal coverage was classified into four levels, from low to consolidated, and its duration effects were measured using the average municipal coverage of previous years. We used negative binomial multivariable regression models with fixed-effects specifications, adjusted for all relevant demographic, socioeconomic, and healthcare variables. RESULTS: BFP was significantly associated with reductions of maternal mortality proportionally to its levels of coverage and years of implementation, with a rate ratio (RR) reaching 0.88 (95%CI 0.81-0.95), 0.84 (0.75-0.96) and 0.83 (0.71-0.99) for intermediate, high and consolidated BFP coverage over the previous 11 years. The BFP duration effect was stronger among young mothers (RR 0.77; 95%CI 0.67-0.96). BFP was also associated with reductions in the proportion of pregnant women with no prenatal visits (RR 0.73; 95%CI 0.69-0.77), reductions in hospital case-fatality rate for delivery (RR 0.78; 95%CI 0.66-0.94) and increases in the proportion of deliveries in hospital (RR 1.05; 95%CI 1.04-1.07). CONCLUSION: Our findings show that a consolidated and durable CCT coverage could decrease maternal mortality, and these long-term effects are stronger among poor mothers exposed to CCT during their childhood and adolescence, suggesting a CCT inter-generational effect. Sustained CCT coverage could reduce health inequalities and contribute to the achievement of the Sustainable Development Goal 3.1, and should be preserved during the current global economic crisis due to the COVID-19 pandemic.


Asunto(s)
Mortalidad Materna/tendencias , Atención Prenatal/economía , Atención Primaria de Salud/economía , Asistencia Pública/economía , Adolescente , Adulto , Brasil , COVID-19/economía , Femenino , Financiación Gubernamental , Humanos , Pobreza/economía , Embarazo , SARS-CoV-2
2.
MMWR Morb Mortal Wkly Rep ; 70(22): 811-817, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34081689

RESUMEN

Early models predicted substantial COVID-19-associated morbidity and mortality across Africa (1-3). However, as of March 2021, countries in Africa are among those with the lowest reported incidence of COVID-19 worldwide (4). Whether this reflects effective mitigation, outbreak response, or demographic characteristics, (5) or indicates limitations in disease surveillance capacity is unclear (6). As countries implemented changes in funding, national policies, and testing strategies in response to the COVID-19 pandemic, surveillance capacity might have been adversely affected. This study assessed whether changes in surveillance operations affected reporting in South Sudan; testing and case numbers reported during April 6, 2020-February 21, 2021, were analyzed relative to the timing of funding, policy, and strategy changes.* South Sudan, with a population of approximately 11 million, began COVID-19 surveillance in February 2020 and reported 6,931 cases through February 21, 2021. Surveillance data analyzed were from point of entry screening, testing of symptomatic persons who contacted an alert hotline, contact tracing, sentinel surveillance, and outbound travel screening. After travel restrictions were relaxed in early May 2020, international land and air travel resumed and mandatory requirements for negative pretravel test results were initiated. The percentage of all testing accounted for by travel screening increased >300%, from 21.1% to 91.0% during the analysis period, despite yielding the lowest percentage of positive tests among all sources. Although testing of symptomatic persons and contact tracing yielded the highest percentage of COVID-19 cases, the percentage of all testing from these sources decreased 88%, from 52.6% to 6.3% after support for these activities was reduced. Collectively, testing increased over the project period, but shifted toward sources least likely to yield positive results, possibly resulting in underreporting of cases. Policy, funding, and strategy decisions related to the COVID-19 pandemic response, such as those implemented in South Sudan, are important issues to consider when interpreting the epidemiology of COVID-19 outbreaks.


Asunto(s)
COVID-19/prevención & control , Toma de Decisiones , Financiación Gubernamental , Vigilancia en Salud Pública , Salud Pública/economía , Política Pública , COVID-19/epidemiología , Humanos , Sudán del Sur/epidemiología
3.
BMJ Open ; 11(5): e044383, 2021 05 24.
Artículo en Inglés | MEDLINE | ID: mdl-34031111

RESUMEN

OBJECTIVES: The objective of this study is to explore the association of health financing indicators with the proportion of births by caesarean section (CS) across countries. DESIGN: Ecological cross-country study. SETTING: This study examines CS proportions across 172 countries. MAIN OUTCOME MEASURES: The primary outcome was the percentage excess of CS proportion, defined as CS proportions above the global target of 19%. We also analysed continuous CS proportions, as well as excess proportion with a more restrictive 9% global target. Multivariable linear regressions were performed to test the association of health financing factors with the percentage excess proportions of CS. The health financing factors considered were total available health system resources (as percentage of gross domestic product), total contributions from private households (out-of-pocket, compulsory and voluntary health insurance contributions) and total national income. RESULTS: We estimate that in 2018 there were a total of 8.8 million unnecessary CS globally, roughly two-thirds of which occurred in upper middle-income countries. Private health financing was positively associated with percentage excess CS proportion. In models adjusted for income and total health resources as well as human resources, each 10 per cent increase in out-of-pocket expenditure was associated with a 0.7 per cent increase in excess CS proportions. A 10 per cent increase in voluntary health insurance was associated with a 4 per cent increase in excess CS proportions. CONCLUSIONS: We have found that health system finance features are associated with CS use across countries. Further monitoring of these indicators, within countries and between countries will be needed to understand the effect of financial arrangements in the provision of CS.


Asunto(s)
Cesárea , Financiación de la Atención de la Salud , Femenino , Financiación Gubernamental , Salud Global , Producto Interno Bruto , Gastos en Salud , Humanos , Seguro de Salud , Embarazo
4.
Vaccine ; 39(25): 3410-3418, 2021 06 08.
Artículo en Inglés | MEDLINE | ID: mdl-34020816

RESUMEN

BACKGROUND: Coverage rates for immunization have dropped in lower income countries during the COVID-19 pandemic, raising concerns regarding potential outbreaks and premature death. In order to re-invigorate immunization service delivery, sufficient financing must be made available from all sources, and particularly from government resources. This study utilizes the most recent data available to provide an updated comparison of available data sources on government spending on immunization. METHODS: We examined data from WHO/UNICEF's Joint Reporting Form (JRF), country Comprehensive Multi-Year Plan (cMYP), country co-financing data for Gavi, and WHO National Health Accounts (NHA) on government spending on immunization for consistency by comparing routine and vaccine spending where both values were reported. We also examined spending trends across time, quantified underreporting and utilized concordance analyses to assess the magnitude of difference between the data sources. RESULTS: Routine immunization spending reported through the cMYP was nearly double that reported through the JRF (rho = 0.64, 95% 0.53 to 0.77) and almost four times higher than that reported through the NHA on average (rho = 3.71, 95% 1.00 to 13.87). Routine immunization spending from the JRF was comparable to spending reported in the NHA (rho = 1.30, 95% 0.97 to 1.75) and vaccine spending from the JRF was comparable to that from the cMYP data (rho = 0.97, 95% 0.84 to 1.12). Vaccine spending from both the JRF and cMYP was higher than Gavi co-financing by a at least two (rho = 2.66, 95% 2.45 to 2.89) and (rho = 2.66, 95% 2.15 to 3.30), respectively. IMPLICATIONS: Overall, our comparative analysis provides a degree of confidence in the validity of existing reporting mechanisms for immunization spending while highlighting areas for potential improvements. Users of these data sources should factor these into consideration when utilizing the data. Additionally, partners should work with governments to encourage more reliable, comprehensive, and accurate reporting of vaccine and immunization spending.


Asunto(s)
COVID-19 , Pandemias , Países en Desarrollo , Financiación Gubernamental , Gobierno , Humanos , Inmunización , Programas de Inmunización , SARS-CoV-2
5.
Health Aff (Millwood) ; 40(5): 829-836, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33939505

RESUMEN

The federal government provides grants to states to assist with their efforts to ameliorate the opioid epidemic. However, it is not currently understood how well these funds are targeted toward the areas with the greatest need. To address this, we constructed a database of federal grants addressing opioid and other substance use problems and investigated how closely grant dollars awarded in fiscal years 2017 and 2018 aligned with the severity of state opioid problems. Using our preferred measure, roughly one-sixth of funds, totaling $1.5 billion, would need to have been reallocated to provide equal opioid severity-adjusted funding across states; less populous states were typically the most generously funded. Grant targeting could be improved with more rigorous efforts to account for geographic differences in the severity of opioid problems. We identify problems in some frequently used targeting benchmarks, where state prevalence rates are measured with low precision.


Asunto(s)
Analgésicos Opioides , Administración Financiera , Financiación Gubernamental , Humanos , Estados Unidos
6.
Lancet ; 397(10288): 2012-2022, 2021 05 22.
Artículo en Inglés | MEDLINE | ID: mdl-33965068

RESUMEN

The health and care sector plays a valuable role in improving population health and societal wellbeing, protecting people from the financial consequences of illness, reducing health and income inequalities, and supporting economic growth. However, there is much debate regarding the appropriate level of funding for health and care in the UK. In this Health Policy paper, we look at the economic impact of the COVID-19 pandemic and historical spending in the UK and comparable countries, assess the role of private spending, and review spending projections to estimate future needs. Public spending on health has increased by 3·7% a year on average since the National Health Service (NHS) was founded in 1948 and, since then, has continued to assume a larger share of both the economy and government expenditure. In the decade before the ongoing pandemic started, the rate of growth of government spending for the health and care sector slowed. We argue that without average growth in public spending on health of at least 4% per year in real terms, there is a real risk of degradation of the NHS, reductions in coverage of benefits, increased inequalities, and increased reliance on private financing. A similar, if not higher, level of growth in public spending on social care is needed to provide high standards of care and decent terms and conditions for social care staff, alongside an immediate uplift in public spending to implement long-overdue reforms recommended by the Dilnot Commission to improve financial protection. COVID-19 has highlighted major issues in the capacity and resilience of the health and care system. We recommend an independent review to examine the precise amount of additional funds that are required to better equip the UK to withstand further acute shocks and major threats to health.


Asunto(s)
COVID-19/economía , Gastos en Salud/estadística & datos numéricos , Política de Salud/economía , Medicina Estatal/economía , Financiación Gubernamental , Humanos , Apoyo Social , Reino Unido
9.
BMJ Open ; 11(4): e049069, 2021 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-33849861

RESUMEN

OBJECTIVE: To investigate the association between participation in government subsidies for domestic travel (subsidise up to 50% of all travel expenses) introduced nationally in Japan on 22 July 2020 and the incidence of symptoms indicative of COVID-19 infections. DESIGN: Cross-sectional analysis of nationally representative survey data. SETTING: Internet survey conducted between 25 August and 30 September 2020 in Japan. Sampling weights were used to calculate national estimates. PARTICIPANTS: 25 482 survey respondents (50.3% (12 809) women; mean (SD) age, 48.8 (17.4) years). MAIN OUTCOME MEASURES: Incidence rate of five symptoms indicative of the COVID-19 infection (high fever, sore throat, cough, headache, and smell and taste disorder) within the past month of the survey, after adjustment for characteristics of individuals and prefecture fixed effects (effectively comparing individuals living in the same prefecture). RESULTS: At the time of the survey, 3289 (12.9%) participated in the subsidy programme. After adjusting for potential confounders, we found that participants in the subsidy programme exhibited higher incidence of high fever (adjusted rate, 4.7% for participants vs 3.7% for non-participants; adjusted OR (aOR) 1.83; 95% CI 1.34 to 2.48; p<0.001), sore throat (19.8% vs 11.3%; aOR 2.09; 95% CI 1.37 to 3.19; p=0.002), cough (19.0% vs 11.3%; aOR 1.96; 95% CI 1.26 to 3.01; p=0.008), headache (29.2% vs 25.5%; aOR 1.24; 95% CI 1.08 to 1.44; p=0.006) and smell and taste disorder (2.6% vs 1.8%; aOR 1.98; 95% CI 1.15 to 3.40; p=0.01) compared with non-participants. These findings remained qualitatively unaffected by additional adjustment for the use of 17 preventative measures (eg, social distancing, wearing masks and handwashing) and fear against the COVID-19 infection. CONCLUSIONS: The participation of the government subsidy programme for domestic travel was associated with a higher probability of exhibiting symptoms indicative of the COVID-19 infection.


Asunto(s)
COVID-19/epidemiología , Financiación Gubernamental , Viaje/economía , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad
11.
Cad Saude Publica ; 37(3): e00244719, 2021.
Artículo en Portugués, Español | MEDLINE | ID: mdl-33852665

RESUMEN

Since the Declaration of Alma-Ata in 1978, primary healthcare (PHC) is considered an essential component of health systems. In the Chilean case, management of primary care was municipalized during the dictatorship and maintained by the subsequent governments, with some reforms. The aim of this article was to estimate and analyze spending in PHC in Chile, during the governments of Sebastián Piñera and Michelle Bachelet. Collection of financial data was oriented by the model of National Health Accounts (CNS), and later the amounts were deflated according to the Consumer Price Index. The principal source of information was the National System of Municipal Information (SINIM). The results show that during the period there was a permanent increase in spending in PHC; however, the average percent change was slightly higher in the first government compared to the second. The percentage of spending in PHC in relation to public spending in health was 21.4% for the eight years, with few variations. Indicators show that inequalities between administrative and health regions are increasing steadily. Therefore, although transfers to fund primary care services are increasing, they may be poorly distributed. This and other problems like the commodification of services and dismantlement of the network compromise the consolidation of PHC, especially in a health system based on contributive insurance like the Chilean system.


Asunto(s)
Financiación Gubernamental , Atención Primaria de Salud , Brasil , Chile , Gobierno , Humanos
15.
Kennedy Inst Ethics J ; 31(1): 77-99, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33716228

RESUMEN

What just societies owe to non-citizen immigrants is a controversial question. This paper considers three accounts of the requirements of distributive justice for non-citizens to determine what they might suggest about the provision of publicly funded health care to pregnant undocumented immigrants. These accounts are compared to locate an overlapping consensus on the duty of the state to provide care to pregnant undocumented immigrants. The aim of this paper is not to take a substantive position on the "right" prenatal policy, but rather to explore the moral space that this issue occupies and suggest that real moral progress can be achieved through the consistent application of shared values.


Asunto(s)
Financiación Gubernamental/ética , Accesibilidad a los Servicios de Salud/economía , Servicios de Salud Materna/economía , Inmigrantes Indocumentados , Consenso , Femenino , Política de Salud , Humanos , Obligaciones Morales , Principios Morales , Embarazo , Justicia Social , Problemas Sociales , Estados Unidos
16.
Healthc Policy ; 16(3): 16-25, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33720820

RESUMEN

Canada's provinces are without a publicly funded psychotherapy program for common mental disorders despite evidence that psychological services help reduce the length and number of depressive episodes, symptoms of post-traumatic stress and associated negative outcomes (hospitalizations and suicide attempts). Studies also show that including psychological services as part of the service package offered under the public health plan for those without access pays for itself. We posit that a publicly funded psychotherapy program in Canada, including digitized self-guided psychotherapy platforms for common mental disorders, will lead to improved population health useful in the COVID-19 context and beyond.


Asunto(s)
Práctica Clínica Basada en la Evidencia/economía , Financiación Gubernamental , Trastornos Mentales/terapia , Psicoterapia/economía , COVID-19/epidemiología , COVID-19/psicología , Canadá/epidemiología , Humanos
19.
Health Aff (Millwood) ; 40(4): 664-671, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33764801

RESUMEN

The COVID-19 pandemic has prompted concern about the integrity of the US public health infrastructure. Federal, state, and local governments spend $93 billion annually on public health in the US, but most of this spending is at the state level. Thus, shoring up gaps in public health preparedness and response requires an understanding of state spending. We present state spending trends in eight categories of public health activity from 2008 through 2018. We obtained data from the Census Bureau for all states except California and coded the data by public health category. Although overall national health expenditures grew by 4.3 percent in this period, state governmental public health spending saw no statistically significant growth between 2008 and 2018 except in injury prevention. Moreover, state spending levels on public health were not restored after cuts experienced during the Great Recession, leaving states ill equipped to respond to COVID-19 and other emerging health needs.


Asunto(s)
COVID-19/epidemiología , Gastos en Salud , Salud Pública/economía , COVID-19/economía , Financiación Gubernamental , Humanos , Pandemias , Estados Unidos/epidemiología
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