Does the healthcare decentralization provide better public health security capacity and health services satisfaction? An analysis of OECD countries.

PURPOSE: Decentralization has profound implications for many health systems. This study investigates the effect of health system decentralization in Organization for Economic Co-operation and Development (OECD) countries on public health security capacity and health service satisfaction. DESIGN/METHODOLOGY/APPROACH: Multiple linear regression analyses were employed for variables related to the level of health security capacity and satisfaction with the healthcare system while controlling for all socio-demographic variables from the European Social Survey, including over 44,000 respondents from 25 OECD countries. The Health Systems in Transition series of countries were used for assessing the decentralization level. FINDINGS: The result of multiple linear regression analyses showed that the level of decentralization in health systems was significantly associated with higher health security capacity (ß-coefficient 3.722, 95% confidence interval (CI) [3.536 3.908]; p=<0.001) and health service satisfaction (ß-coefficient 1.463, 95% CI [1.389 1.536]; p=<0.001) in the study. Countries with a higher level of decentralization in health policy tasks and areas were significantly likely to have higher health services satisfaction, whereas this satisfaction had a significant negative relation with the lower level of decentralization status of secondary/tertiary care services in OECD countries (ß-coefficient -5.250, 95% CI [-5.757-4.743]; p = 0.001). ORIGINALITY/VALUE: This study contributes to a better understanding of the extent to which decentralization of health services affects public health safety capacity and satisfaction with health services, whereas the level of decentralization in OECD countries varies considerably. Overall, the findings highlight the importance of public health security and satisfaction with health care delivery in assessing the effects of decentralization in health services.

The prevalence of mental distress changes before and during the COVID-19 pandemic: a study on physicians in Turkey.

BACKGROUND: The emergence of the COVID-19 pandemic may adversely affect the physicians' mental health differently. AIMS: This study aimed to investigate the degree of changes in mental distress in physicians through two cross-sectional studies before and during the COVID-19 pandemic and explore factors associated with the change of mental distress status of participants between two-time periods. METHODS: This cross-sectional, web-based survey collected demographic data and mental health measurements with the 12-item General Health Questionnaire from 416 and 522 physicians before and during COVID-19, respectively. Mixed-effects ordinal logistic regression analyses were performed to assess the factors associated with the change of mental distress status. RESULTS: During the outbreak, a total of 319 of the 522 participants reported a clinically significant level of mental distress compared with 123 of 416 participants before COVID-19. Higher levels of mental distress were observed in all socio-demographic groups during COVID-19 compared with before, with more than two-fold higher prevalence of mental health deterioration in general. CONCLUSIONS: This study suggests a significant deterioration in mental health status after the occurrence of COVID-19 compared with before. The mental health of physicians working in all medical specialty groups, especially those in internal and surgical specialties, may require special attention.

Does the Public Health Security Capacity Provide Better Preparedness for Health Emergencies? A Cross-Sectional Analysis of 180 Countries During the COVID-19 Outbreak.

OBJECTIVES: This study aimed to investigate the association between the health security capacities at the national level and preparedness for health emergencies in response to the COVID-19 outbreak. METHODS: Data were extracted from the GHS report to evaluate the global health security capabilities in 180 countries. A linear regression analysis was performed with COVID-19 outcomes, as measured by the rate of incidence and vaccination doses, CFR, and PCR tests. Spearman correlation was used among potential explanatory factors. FINDINGS: The GHS Index was inversely correlated with CFR and incidence rates, whereas it was positively associated with the vaccination and the PCR test rates. Countries with high health security capacities were significantly more likely to provide better preparedness for health emergencies in response to the outbreak. However, the vaccination doses' rate and the number of PCR tests were significantly differ depending on countries' income levels. CONCLUSIONS: Although health security capacity is essential to control public health emergencies effectively, it cannot predict whether or how well a country will use them in a crisis. Policymakers should identify their risk factors and capacity gaps and take into consideration the building of health security capacities in national budgets for long-term public health preparedness.