Population ageing and sustainability of healthcare financing in China.

BACKGROUND: In China, the healthcare financing structure involves multiple parties, including the government, society and individuals. Medicare Fund is an important way for the Government and society to reduce the burden of individual medical costs. However, with the aging of the population, the demand of Medicare Fund is increasing. Therefore, it is necessary to explore the sustainability of the healthcare financing structure in the context of population ageing. OBJECTIVE: The purpose of this paper is to organize the characteristics of population ageing as well as healthcare financing in China. On this basis, it analyzes the impact mechanism of population ageing on healthcare financing and the sustainability of existing healthcare financing. METHODS: This paper mainly adopts the method of literature research and inductive summarization. Extracting data from Health Statistics Yearbook of China and Labor and Social Security Statistics Yearbook of China. Collected about 60 pieces of relevant literature at home and abroad. RESULTS: China has already entered a deeply ageing society. Unlike developed countries in the world, China's population ageing has distinctive feature of ageing before being rich. A healthcare financing scheme established by China, composing of the government, society, and individuals, is reasonable. However, under the pressure of population ageing, China's current healthcare financing scheme will face enormous challenges. Scholars are generally pessimistic about the sustainability of China's healthcare financing scheme. CONCLUSIONS: Population ageing will increase the expenditure and reduce the income of the Medicare Fund. This will further affect the sustainability of the healthcare financing structure. As a consequence, the state should pay particular attention to this issue and take action to ensure that the Fund continues to operate steadily.

Comparison of the healthcare system of Chile and Brazil: strengths, inefficiencies, and expenditures.

BACKGROUND: Governments in Latin America are constantly facing the problem of managing scarce resources to satisfy alternative needs, such as housing, education, food, and healthcare security. Those needs, combined with increasing crime levels, require financial resources to be solved. OBJECTIVE: The objective of this review was to characterizar the health system and health expenditure of a large country (Brazil) and a small country (Chile) and identify some of the challenges these two countries face in improving the health services of their population. METHODS: A literature review was conducted by searching journals, databases, and other electronic resources to identify articles and research publications describing health systems in Brazil and Chile. RESULTS: The review showed that the economic restriction and the economic cycle have an impact on the funding of the public health system. This result was true for the Brazilian health system after 2016, despite the change to a unique health system one decade earlier. In the case of Chile, there are different positions about which one is the best health system: a dual public and private or just public one. As a result, a referendum on September 4, 2022, of a new constitution, which incorporated a unique health system, was rejected. At the same time, the Government ended the copayment in the public health system in September 2022, excluding illnesses referred to the private sector. Another issue detected was the fragility of the public and private sector coverage due to the lack of funding. CONCLUSIONS: The health care system in Chile and Brazil has improved in the last decades. However, the public healthcare systems still need additional funding and efficiency improvement to respond to the growing health requirements needed from the population.

Healthcare system development in the Middle East and North Africa region: Challenges, endeavors and prospective opportunities.

Background: Countries in the Middle East and North Africa (MENA) region have been investing in the development of their health systems through implementing reforms to improve health care delivery for their nations. However, these countries are still facing challenges in providing equitable, high quality healthcare services. There is limited published literature supporting the previous and ongoing attempts that have been made to improve health system performance in MENA countries. Aims: This review aims to describe experiences of health system development efforts in the MENA region, highlight progress, identify challenges that need be addressed and future opportunities to achieve responsive and efficient health systems. It also aimed to provide recommendations to further support these health systems toward evolution and performance improvement. Methods: A literature review was conducted by searching different databases including PubMed, Scopus, Google Scholar and other electronic resources to identify articles and publications describing health systems development in the MENA region from 1975 to 2022. It also included grey literature, reports and policy and planning documents by international organizations. The identified references were reviewed to extract, analyze, organize and report the findings. Results: The review revealed emerging evidence describing governmental initiatives to introduce health system reforms at different levels in the MENA countries. These include initiatives targeting the various elements controlling health system reform: financing, payment, organization, regulation and behavior of providers and consumers. There are several challenges facing the health systems of MENA countries including the rising burden of chronic diseases, inequitable access to health services, deficiency in health workforce, shortage in the use of effective health information systems and leadership challenges. The review identified several key areas that can benefit from further improvement to support health system reforms. These include improving the structure, organization and financing of health systems, health workforce development, effective data management and engagement of key stakeholders to achieve adequate health system reforms. Conclusion: The MENA countries have made significant steps to improve the performance of their health systems; yet achieving a comprehensive health reform will require collaboration of various stakeholders including health policy makers, healthcare professionals, and central to the success of the reform, the patients.

Factors explaining the fear of being infected with COVID-19.

BACKGROUND: The prevalence of COVID-19 has a social and economic impact on people, leaving them distressed and fearful of getting infected. OBJECTIVE: To determine the variables attributable to the fear of contracting COVID-19. DESIGN: This is a quantitative study based on an online cross-sectional self-administered survey in Chile between 10 July 2020 and 10 August 2020. SETTING AND PARTICIPANTS: A sample of 531, comprising over 18-year-old participants from middle- and high-income levels, was selected. OUTCOME MEASURES: Estimations were obtained using a probit regression model with marginal effects. RESULTS: Fear prevailed mainly in women. It has a positive relationship with variables such as chronic illnesses, infectious family or relatives, reduction in economic activity and perception of bad government response to a pandemic. Fear has a negative relationship with knowledge about COVID-19, education level and ageing. Moreover, those who consider socioeconomic impact less important than health care do not fear a COVID-19 infection. DISCUSSIONAND CONCLUSION: The socioeconomic and health aspects help predict fears. Thus, the government should prioritize these variables in implementing policies. The government's credibility and communication systems can also reduce fears of contracting COVID-19. PATIENT OR PUBLIC CONTRIBUTION: A pilot focus group of COVID-19-recuperated individuals and some members of our interest groups were consulted in the design stage of the study; this helped in constructing the survey questions. Additionally, three independent individuals volunteered to read and comment on the draft manuscript.

Hesitation and Refusal Factors in Individuals' Decision-Making Processes Regarding a Coronavirus Disease 2019 Vaccination.

Introduction: Considering the global prevalence of coronavirus disease 2019 (COVID-19), a vaccine is being developed to control the disease as a complementary solution to hygiene measures-and better, in social terms, than social distancing. Given that a vaccine will eventually be produced, information will be needed to support a potential campaign to promote vaccination. Objective: The aim of this study was to determine the variables affecting the likelihood of refusal and indecision toward a vaccine against COVID-19 and to determine the acceptance of the vaccine for different scenarios of effectiveness and side effects. Materials and Methods: A multinomial logistic regression method based on the Health Belief Model was used to estimate the current methodology, using data obtained by an online anonymous survey of 370 respondents in Chile. Results: The results indicate that 49% of respondents were willing to be vaccinated, with 28% undecided or 77% of individuals who would potentially be willing to be inoculated. The main variables that explained the probability of rejection or indecision were associated with the severity of COVID-19, such as, the side effects and effectiveness of the vaccine; perceived benefits, including immunity, decreased fear of contagion, and the protection of oneself and the environment; action signals, such as, responses from ones' family and the government, available information, and specialists' recommendations; and susceptibility, including the contagion rate per 1,000 inhabitants and relatives with COVID-19, among others. Our analysis of hypothetical vaccine scenarios revealed that individuals preferred less risky vaccines in terms of fewer side effects, rather than effectiveness. Additionally, the variables that explained the indecision toward or rejection of a potential COVID-19 vaccine could be used in designing public health policies. Conclusions: We discovered that it is necessary to formulate specific, differentiated vaccination-promotion strategies for the anti-vaccine and undecided groups based on the factors that explain the probability of individuals refusing or expressing hesitation toward vaccination.

Willingness to Pay for a COVID-19 Vaccine.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has considerably affected the lives of people worldwide, impacting their health and economic welfare, and changing the behavior of our society significantly. This situation may lead to a strong incentive for people to buy a vaccine. Therefore, a relevant study to assess individuals' choices and the value of change in welfare from a COVID-19 vaccine is essential. OBJECTIVE: This study aimed to estimate the willingness-to-pay (WTP) value for a vaccine for COVID-19. We also identify the variables that influence individual vaccination decisions, which could be used in the design of vaccination promotion strategies. METHODS: We use the contingent valuation method in its double-bounded dichotomous choice format. The estimation coefficients are calculated according to the maximum likelihood method under the assumption of a probit distribution. The sample consisted of 531 individuals, mainly from middle- and high-income socioeconomic groups from Chile between enrolled between 10 July and 10 August 2020. RESULTS: The results show a high WTP for the COVID-19 vaccine, with a value up to US$232. Income and education levels and having family members with COVID-19 increased the likelihood of persons paying for a vaccine. There is also a greater fear as the pandemic progresses that people will get sick from COVID-19. CONCLUSIONS: The high WTP value creates an opportunity for formulating public health policy. The results of this study suggest that governments can provide the vaccine free to low-income groups and allow those with higher incomes to acquire the vaccine through the private sector by paying. This will be useful especially for countries with economic difficulties.

Contingent assessment of the COVID-19 vaccine.

The COVID-19 pandemic has not only had a negative impact on people's health and life behavior, but also on economies around the world. At the same time, laboratories and institutions are working hard to obtain a COVID-19 vaccine, which we hope will be available soon. However, there has been no assessment of whether an individual and society value ​​a vaccine monetarily, and what factors determine this value. Therefore, the objective of this research was to estimate the individual's willingness to pay (WTP) for a hypothetical COVID-19 vaccine and, at the same time, find the main factors that determine this valuation. For this, we used the contingent valuation approach, in its single and double-bounded dichotomous choice format, which was based on a hypothetical market for a vaccine. The sample used was obtained through an online survey of n = 566 individuals from Chile. The main results showed that the WTP depends on the preexistence of chronic disease (p≤0.05), knowledge of COVID-19 (p≤0.05), being sick with COVID-19 (p≤0.05), perception of government performance (p≤0.01), employment status (p≤0.01), income (p≤0.01), health care (p≤0.05), adaptation to quarantine with children at home (p≤0.01) and whether the person has recovered from COVID-19 (p≤0.10). According to our discrete choice model in double-bounded dichotomous format, it was concluded that the individuals' WTP is US$184.72 (CI: 165.52-203.92; p < 0.01). This implies a social valuation of approximately US$2232 million, corresponding to 1.09% of the GNP per capita.

[Parents willingness to pay for a human papillomavirus vaccine to protect their adolescent daughters: Maule Region, Chile]. / Disposición de los padres a pagar por una vacuna contra el virus del papiloma humano para sus hijas adolescentes: región del Maule, Chile.

OBJECTIVE: To determine the willingness to pay of parents of teenage daughters for a vaccine against human papillomavirus in the Maule Region, Chile. MATERIALS AND METHODS: A sample of 386 parents with daughters between 12 and 18 years old, representing the five largest cities of the Region of Maule, socioeconomically stratified. WTP was obtained using the contingent valuation method in double bounded format. RESULTS: Parents are willing to pay an average of US$ 252.71 to vaccinate their daughters against virus, where the price and number of daughters negatively affects the probability of willingness to pay, and family income positively affects the probability. CONCLUSION: There is a possibility of using shared funding between the government and the parents of potential daughter to be affected by the human papillomavirus to reduce cervical cancer events.

Disposición de los padres a pagar por una vacuna contra el virus del papiloma humano para sus hijas adolescentes: región del Maule, Chile / Parents willingness to pay for a human papillomavirus vaccine to protect their adolescent daughters: maule Region, Chile

Objetivo. Determinar la disposición de los padres de hijas adolescentes a pagar por una vacuna contra el virus del papiloma humano en la Región del Maule, Chile. Material y métodos. Se utilizó una muestra de 386 padres con hijas entre 12 y 18 años, representativa de las cinco ciudades de mayor población de la Región del Maule, estratificada socioeconómicamente. La disposición a pagar se obtuvo usando el método de valoración contingente en su formato dicotómico doble. Resultados. Los padres están dispuestos a pagar en promedio 126.538 pesos chilenos para vacunar a sus hijas contra el virus; el precio y número de hijas afecta negativamente la probabilidad de la disposición a pagar, y el ingreso familiar afecta positivamente dicha probabilidad. Conclusión. Existe la posibilidad de utilizar financiamiento compartido entre el Estado y los padres de las potenciales hijas que puedan recibir la vacuna contra el virus del papiloma humano para reducir la incidencia de cáncer de cuello uterino.

Objective. To determine the willingness to pay of parents of teenage daughters for a vaccine against human papillomavirus in the Maule Region, Chile. Materials and methods. A sample of 386 parents with daughters between 12 and 18 years old, representing the five largest cities of the Region of Maule, socioeconomically stratified. WTP was obtained using the contingent valuation method in double bounded format. Results. Parents are willing to pay an average of US$ 252.71 to vaccinate their daughters against virus, where the price and number of daughters negatively affects the probability of willingness to pay, and family income positively affects the probability. Conclusion. There is a possibility of using shared funding between the government and the parents of potential daughter to be affected by the human papillomavirus to reduce cervical cancer events.

[Willingness to pay for human papillomavirus vaccine in Metropolitan Santiago, Chile]. / Disposición a pagar por vacunas contra el virus papiloma humano en la Región Metropolitana de Santiago de Chile.

BACKGROUND: Human papillomavirus (HPV) infection is a risk factor for cervical cancer and can be prevented with the HPV vaccine. AIM: To explore the willingness of parents to pay for HPV vaccine for their offspring. MATERIAL AND METHODS: A survey about the willingness to pay for HPV vaccine was answered by 386 individuals of the highest socioeconomic level who had a daughter aged between 12 and 18 years. The survey included information about the risks of HPV infection. RESULTS: Parents would pay a mean of US$ 758 for the vaccine. Twenty five percent of parents were not willing to pay for it. If the cost of the vaccine would be reduced by 50%, only 4% of parents would not pay for it. The willingness to pay is associated with the price of the vaccine, the income level of respondents and the size of the family. CONCLUSIONS: Most respondents would pay for HPV vaccine for their daughters, despite the relatively high cost.

Disposición a pagar por vacunas contra el virus papiloma humano en la Región Metropolitana de Santiago de Chile / Willingness to pay for human papillomavirus vaccine in Metropolitan Santiago, Chile

Background: Human papillomavirus (HPV) infection is a risk factor for cervical cancer and can be prevented with the HPV vaccine. Aim: To explore the willingness of parents to pay for HPV vaccine for their offspring. Material and Methods: A survey about the willingness to pay for HPV vaccine was answered by 386 individuals of the highest socioeconomic level who had a daughter aged between 12 and 18 years. The survey included information about the risks of HPV infection. Results: Parents would pay a mean of US$ 758 for the vaccine. Twenty five percent of parents were not willing to pay for it. If the cost of the vaccine would be reduced by 50%, only 4% of parents would not pay for it. The willingness to pay is associated with the price of the vaccine, the income level of respondents and the size of the family. Conclusions: Most respondents would pay for HPV vaccine for their daughters, despite the relatively high cost.

Contaminación del aire en la Florida (Talca, Chile): Beneficios económicos en salud por la reducción de los niveles PM10 / Hypothetical health and economic benefits associated with a reduction in air pollution in a Chilean city (Talca)

Background: Environmental air pollution is associated with a higher incidence of respiratory diseases, absenteeism and costs. Aim: To model the health related economic benefits associated to a reduction in air pollution and the resulting lower prevalence of respiratory diseases, in a Chilean city. Material and Methods: A time series model for year 2006 was elaborated. The dependent variable was the number of consultations for respiratory disease. The independent variables were air pollution expressed as particulate matter of 10 micrometers or less (PM10), minimum and maximum environmental temperatures, environmental humidity and number of consultations for chronic diseases. Results: The variables that best explained the number of consultations for respiratory diseases were PM10, minimal environmental temperatures and preexisting respiratory diseases. In a hypothetical scenery of a 67 percent reduction in PM10, 69 percent of medical consultations for respiratory diseases would be avoided. This would result in a net saving of US$ 345,000 per year. Conclusions: The reduction in PM10 emissions would result in an important reduction in consultations for respiratory diseases and monetary savings.

[Hypothetical health and economic benefits associated with a reduction in air pollution in a Chilean city (Talca)]. / Contaminación del aire en la Florida (Talca, Chile): Beneficios económicos en salud por la reducción de los niveles PM10.

BACKGROUND: Environmental air pollution is associated with a higher incidence of respiratory diseases, absenteeism and costs. AIM: To model the health related economic benefits associated to a reduction in air pollution and the resulting lower prevalence of respiratory diseases, in a Chilean city. MATERIAL AND METHODS: A time series model for year 2006 was elaborated. The dependent variable was the number of consultations for respiratory disease. The independent variables were air pollution expressed as particulate matter of 10 micrometers or less (PM10), minimum and maximum environmental temperatures, environmental humidity and number of consultations for chronic diseases. RESULTS: The variables that best explained the number of consultations for respiratory diseases were PM10, minimal environmental temperatures and preexisting respiratory diseases. In a hypothetical scenery of a 67% reduction in PM10, 69% of medical consultations for respiratory diseases would be avoided. This would result in a net saving of US$ 345,000 per year. CONCLUSIONS: The reduction in PM10 emissions would result in an important reduction in consultations for respiratory diseases and monetary savings.