Previne brasil e financiamento da atenção primária: facilidades e dificuldades de gestores municipais de saúde / Previne Brasil and primary care financing: facilities and difficulties for municipal health managers / Previne Brasil y financiamiento de la atención primaria: facilidades y dificultades para los gestores municipales de salud

Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.

Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.

Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.

A mixed methods study examining the impact of primary health care financing transitions on facility functioning and service delivery in Kenya: a study protocol.

Background: Kenya has experienced several health financing changes that have implications for financing primary healthcare (PHC). These include transitions from funding by two key donors (the World Bank and the Danish International Development Agency (DANIDA)) and the abolishment of conditional grants that were earmarked for financing primary healthcare facilities. This protocol lays out study plans to evaluate the impact and implementation experience of these financing changes on PHC facility functioning and service delivery in Kenya. Methods/design: A sequential mixed methods design will be applied to address our research objectives. Firstly, we will perform a document review to understand the evolution of policy changes understudy. Second, we will conduct an interrupted time series analysis across all 47 counties in Kenya to assess these financing changes' impact on health service utilization in all public primary healthcare facilities (level 2 and 3 facilities). Data for this analysis will be obtained from the Kenya Health Information System (KHIS). Third, we will carry out in-depth interviews with health financing stakeholders at the national, county, and health facility levels to examine their perceptions of the experiences with these changes in health financing. Discussion: This mixed methods study will contribute to evidence on the sustainability of financing primary healthcare in low and middle-income countries facing financing changes and donor transitions.

Evaluating the Impact of Primary Healthcare Financing Transitions on PHC Facilities in Kenya. In 2020, funding allocated for public primary healthcare (PHC) facilities was eliminated as conditional grants in Kenya. Through the support of the PHC-specific conditional grants, public PHC facilities would provide free healthcare services to patients. Additionally, the World Bank and Danish International Development Agency (DANIDA) are transitioning from providing funding support to PHC facilities in Kenya. DANIDA's PHC support grant will be terminated at a 25% yearly rate over four years, coinciding with the end of the World Bank Transforming Health Systems programme for Universal Health Care. Before obtaining the financing, these grants had county-specific requirements known as service performance objectives. These financing changes will likely impact the level of financing that PHC health facilities will access. Hence, the proposed study examines the impact of these financing changes on PHC facilities functioning and service delivery in Kenya, as well as the implementation experience of stakeholders in the health sector.

Financial resource curse and firms' accessibility to financing in resource-based countries.

This study delves into the paradox of the financial resource curse, exploring how the abundance of natural resources in a country paradoxically constrains firms' accessibility to financing. Despite the potential economic boon natural resources represent, evidence suggests that they can lead to less diversified economies, making it challenging for firms outside the resource sector to access financing. Our research aims to dissect this phenomenon by analyzing microeconomic statistics on the financial accessibility of enterprises, juxtaposed with macroeconomic statistics across 170 countries, encompassing over 10,000 firms surveyed from 1990 to 2022. The panel regression analysis allows us to control for both time-invariant country characteristics and global economic trends, providing insights into the causal relationship between resource dependence and financial access for firms. The results are striking, revealing that, indeed, countries with significant natural resource wealth tend to exhibit reduced financial accessibility for firms outside the resource extraction sector. The panel regression models indicate a robust negative correlation between the extent of a country's resource wealth and the ease with which non-resource firms can access financial capital. This suggests that the financial resource curse is not only a real phenomenon but also one that has significant implications for economic diversification and sustainable development. Moreover, findings underscore the need for targeted policy interventions. Countries with abundant natural resources should implement strategies that foster economic diversification, enhance the financial infrastructure to support a broader range of industries, and encourage the development of financial instruments tailored to the needs of non-resource sectors.

The temporal and spatial interpretation of China's health financing: what do Chinese' government 'do' in new healthcare reform?

OBJECTIVE: The analysis of health expenditure and its structure takes on a critical significance in national health policy research, and the public welfare of national health undertakings can be manifested by the government's investment in health. In this study, the aim was to analyze total health care costs, the structure of health financing, and the government's investment in health, so as to provide a reference for China's health policy adjustment. METHODS: Description and cluster analysis were conducted using R language to analyze total health care costs and the structure of health financing of 31 regions in China between 1990 and 2020 to gain insights into the temporal and spatial changes total health care costs and the structure of health financing in China. The government's investment in health was analyzed using description and abundance heatmap to know the temporal and spatial changes of the government's health investment. RESULTS: The total health expenditure per capita reached 5112.3 yuan in 2020, and the total health expenditure accounted for 7.10% of GDP. The government health expenditure took up a significantly lower share of the total health expenditure in 1993-2006 (17.09% [16.30,17.88]), whereas it has been nearly 30% (29.56% [28.73,30.3]) over the past few years. As to 31 regions in China, the government health expenditure per total health expenditure reached 67.94% in Tibet, whereas a level of 27.866% (25.629-30.103) were maintained in other regions. Beijing and Shanghai have achieved over 50.00% of social health expenditure per total health expenditure in recent five years, it was significantly higher than other regions. The per capita government expenditure as a fraction of GDP of Tibet (6.842%) was the highest region in 2011-2019, while Jiangsu (only 0.937%) was the lowest region. CONCLUSIONS: Sustainable increases in total health expenditure as a percent of GDP take on a critical significance to adequate health financing. Equity in health financing has been insufficient in China, and spatial and temporal differences of China's health financing structure are significant. The region' governments should adjust policy based on typical regions to weaken the differences.

Balancing the scales? Evaluating the impact of results-based financing on maternal health outcomes and related inequality of opportunity in Zimbabwe.

This study evaluates the impact of results-based financing (RBF) on maternal health outcomes and the inequality of opportunity (IOP) in these outcomes in Zimbabwe. We employ a difference-in-differences approach that leverages the staggered implementation of the programme across 60 districts, exploiting temporal variation in the introduction of RBF and individual-level variation in birth timing. Our analysis uses nationally representative, pooled cross-sectional data from the 2005/2006, 2010/2011, and 2015 Zimbabwe demographic and health surveys. Employing the extended two-way fixed effects (ETWFE) estimator to address biases associated with staggered rollouts, we find significant positive effects of RBF on maternal health outcomes. The programme is associated with an increase in the number of prenatal care visits by 0.185 units (p < 0.01), first-trimester care by 7.7 percentage points (pp) (p < 0.01), facility births by 8.6 pp (p < 0.01), and professional delivery assistance by 3.4 pp (p < 0.01), while reducing C-section rates by 1.3 pp (p < 0.01). Additionally, RBF is associated with reductions in IOP in prenatal care visits, early prenatal care, facility births, and professional delivery assistance by 3.8, 1.3, 8.4, and 4.9 pp (p < 0.01), respectively. These findings underscore the potential of RBF to enhance maternal health outcomes and promote health equity. Integrating equity considerations into health system strengthening initiatives is essential. Policymakers should ensure that health interventions improve access and balance opportunities across various socio-economic and demographic groups. This evidence suggests that RBF schemes can improve access to and equity in healthcare services, particularly in low-income settings such as Zimbabwe.

'The national health insurance policy provides little to no benefit to young persons living with type 1 diabetes (T1D)': a qualitative study of T1D management cost-burden in Southern Ghana.

BACKGROUND: Type 1 diabetes (T1D) management exerts a considerable financial burden on patients, caregivers, and developing nations at large. In Ghana, a key governments effort to attenuate the financial burden of T1D on patients was to fashion safety-net mechanisms through financial risk pooling/sharing known as the National Health Insurance Scheme (NHIS). However, there is limited research on patients and caregivers' experiences with the cost of managing T1D within the NHIS in Ghana. OBJECTIVE: This study explored the cost of T1D management, and the impact of the NHIS policy on mitigating costs of care. METHODS: A semi-structured interview guide was developed to collect qualitative data from 28 young people living with T1D (PLWD), 12 caregivers, 6 healthcare providers, and other stakeholders in Western, Central and the Greater Accra regions. Multiple data collection techniques including mystery client and in-depth interviews were used to collect data. Thematic content analysis was performed with QSR NVivo 14. RESULTS: Five key domains/themes which are: cost of T1D management supplies; cost of clinical care; cost of transportation; cost of diet; and NHIS were identified. The daily cost of blood glucose testing and insulin injection per day was between GHC 5-7 (US$ 0.6 to 1.0). The NHIS did not cover supplies such as strips, glucometers, HbA1c tests, and periodic medical tests. Even for those cost which were covered by the NHIS (mainly pre-mixed insulin), marked government delays in funds reimbursement to accredited NHIS facilities compelled providers to push the financial obligation onto patients and caregivers. Such cost obligations were fulfilled through out-of-pocket top-up or full payment of insulin of about GHC 15-25 (US$ 2-4), and GHC 25-50 (US$4-8) depending on the region and place of residence. CONCLUSION: The cost of managing T1D was a burden for patients and their caregivers. There was a commodification of life-saving insulin on the Ghanaian market, and the NHIS did not function well to ease the cost-burden of T1D management on patients and caregivers. The findings call for the need to scale up NHIS services to include simple supplies, particularly test strips, and always ensure the availability of life-saving insulin in healthcare facilities.

Can environmental protection tax alleviate the mismatch of financing and investment maturities of heavily polluting enterprises?

The gradual implementation of environmental protection tax policies has incentivized enterprises to engage in green production, effectively promoting China's accelerated achievement of the "dual­carbon" goal. Although environmental protection tax has an important impact on the investment and financing decisions of heavily polluting enterprises (HPE), few studies have focused on the relationship between environmental protection tax and mismatch of financing and investment maturities. In this paper, we consider China's environmental protection tax reform as a "quasi-natural experiment", and utilize the data of A-share listed companies from 2013 to 2022, and use a difference-in-differences (DID) model to assess the impact of this policy on the degree of mismatch of financing and investment maturities of HPE. The study shows that the implementation of the environmental protection tax policy (EPTP) significantly reduces the investment and financing maturities mismatch of the HPE, but this effect "fails" in the high tax rate area, and the policy is difficult to reverse the financing difficulties of the enterprises with a large degree of their own investment and financing maturities mismatch. The mediation mechanism test proves the EPTP acts on the mismatch of financing and investment maturities through two paths: alleviating the financing constraints faced by enterprises and increasing external supervision pressure; the impact of the policy has a time-differentiated effect, which is weakened year by year.

Variations in out-of-pocket spending and factors influencing catastrophic health expenditure of households with patients suffering from chronic conditions in four districts in Sri Lanka.

INTRODUCTION: Healthcare financing systems, dependent on out-of-pocket expenditure(OOPE), impose a heavy burden on those who use the services regularly, such as patients suffering from chronic diseases. High OOPE for health services leads to decreased utilization of the services and/or catastrophic health expenditure, which would significantly impede the achievement of Universal Health coverage. OBJECTIVE: We aimed to determine variations in OOPE and factors associated with Catastrophic Health Expenditure (CHE) of households with patients suffering from non-communicable diseases(NCDs) in four districts. METHODS: A survey was conducted among 2344 adult patients having selected NCD/s. Multi-stage stratified cluster sampling selected respondents from 4 districts representing urban, rural, semi-urban, and estate. Data was collected using a validated interviewer-administered questionnaire. Logistic regression identified the predictors of CHE(> 40%). Significance was considered as 0.05. RESULTS: Common NCDs were hypertension(29.1%), diabetes(26.8.0%), hyperlipidaemia(9.8%) and asthma(8.2%). Only 13% reported complications associated with NCDs. Fifty-six percent(N = 1304) were on regular clinic follow-up, and majority utilized western-medical government hospitals(N = 916,70.2%). There were 252 hospital admissions for chronic-disease management in the past 12 months. Majority(86%) were admitted to government sector hospitals. Most patients incurred nearly SLR 3000 per clinic visit and SLR 3300 per hospital admission. CHE was beyond 40% for 13.5% of the hospital admissions and 6.1% of the regular clinic follow-up. Patients admitted to private sector hospitals had 2.61 times higher CHE than those admitted to government sector hospitals. CONCLUSIONS: Patients with NCDs incurred high OOPE and faced CHE during healthcare seeking in Sri Lanka. The prevalence of NCDs and complications were high among the participants. Patients with chronic conditions incur high OOPE for a single clinic visit and a hospital admission. Patients incur high OOPE on direct medical costs, and district-wise variations were observed. The proportion with more than 40% CHE on monthly clinic care was high. Patients being followed up in the government sector are more likely to have CHE when obtaining healthcare and are more likely to face barriers in obtaining needed health services. The services rendered to patients with chronic conditions warrant a more integrative approach to reduce the burden of costs and related complications.

Iran's health insurance ecosystem: challenges and strategies.

INTRODUCTION: Identifying and exploiting stewardship and financing challenges in Iran's health insurance system as an ecosystem is essential to achieving predetermined goals. This study aimed to determine the challenges and strategies in the Iranian health insurance ecosystem to provide relevant evidence to healthcare managers and policymakers to improve its functions and perform necessary reforms. METHOD: This qualitative study was conducted at the national level in Iran. Data were collected using semi-structured interviews and analyzed using the directed content analysis method. The study participants included managers and experts in health insurance and faculty of universities of medical sciences, who were selected by purposive sampling. RESULTS: The challenges and strategies expressed by participants were categorized into two functions: stewardship and financing. Four main themes, ten subthemes, 22 challenges, and 24 strategies were identified in the stewardship function, along with three main themes, 12 subthemes, 17 challenges, and 16 strategies in the financing function. The major challenge in the Iranian health insurance ecosystem was the complexity and conflict of interests between multiple actors with different roles, which led to fragmentation, diverse structures, and a gap between other functions and objectives, hindering the effective functioning of the ecosystem. CONCLUSION: In order to deal with the challenges of the health insurance ecosystem, it is suggested to create a coherent insurance system through a single utility system, and by paying more attention to health-oriented services, the health insurance ecosystem becomes a health-oriented system instead of being treatment-oriented. In addition, in order to strengthen the governance of the country's health insurance ecosystem, the number of actors with multiple roles should be reduced and the roles of the actors should be clarified and separated in order to prevent conflicts of interest and structural corruption in this ecosystem.

Analysis of the implementation of the Federal Incentive for Physical Activity in Primary Care: equity in focus / La búsqueda de equidad en las políticas públicas de salud: análisis de la implementación de incentivos a la actividad física en la Atención Primaria en Brasil / Análise da implementação do Incentivo Federal à Atividade Física na Atenção Primária: a equidade em foco

The objectives of this study were to present a national overview of the first year of implementation of the Financial Incentive for Physical Activity in Primary Health Care (PHC) of the Unified Health System (SUS) and to analyze whether the municipal prioritization score was an effective criterion for greater equity in the distribution of resources. This is an ecological study with analyses of the number of municipalities and health units approved for the Physical Activity Incentive in PHC and the amounts paid between May 2022 and September 2023. To assess equity, measures of absolute and relative inequalities were calculated between health units, grouped into quartiles according to the municipal prioritization score. The percentage of health units funded did not exceed 37.6%, and the establishment of goals reduced the number of health units that received resources from the Physical Activity Incentive in PHC by 68.9% and the amount of resources paid by 44.0%. Significant inequalities were observed in the allocation of resources, with a higher percentage of health units located in municipalities with lower priority. Thus, the criteria adopted were insufficient to ensure equity in the distribution of resources.

Las políticas de salud pública apuntan a brindar acceso equitativo a los servicios de salud como un derecho fundamental. En 2022, el Ministerio de Salud creó un incentivo financiero para promover la actividad física (IAF) en la Atención Primaria de Salud del SUS. El presente trabajo tuvo como objetivo presentar el panorama nacional del primer año de implementación del IAF y analizar si el puntaje de priorización municipal, creado considerando la disponibilidad presupuestaria existente, fue un criterio efectivo para una mayor equidad en la distribución de los recursos en los diferentes períodos de implementación (sin y con metas). Se trata de un estudio descriptivo con análisis del número absoluto y relativo de municipios y unidades de salud aprobadas, unidades de salud que recibieron recursos y los montos pagados. Para analizar la equidad se calcularon medidas de desigualdades absolutas y relativas entre unidades de salud, agrupadas en cuartiles según el puntaje de priorización municipal. Se demostró que el 74% de los municipios y el 16,7% de las unidades de salud elegibles fueron aprobados por el IAF. El porcentaje de unidades de salud aprobadas que recibieron recursos no superó el 37,6%, siendo pagados R$ 18,05 millones (período sin metas) y R$ 10,10 millones (con metas). Hubo una reducción del 68,9% en las unidades de salud que recibieron recursos luego de establecer metas. Se revelaron importantes desigualdades en la recepción de recursos, con un mayor porcentaje de unidades de salud ubicadas en municipios con menor prioridad. Por tanto, los criterios adoptados por el Ministerio de Salud fueron insuficientes para garantizar la equidad en la asignación de recursos para promover la actividad física.

O trabalho teve como objetivos apresentar o panorama nacional do primeiro ano de implementação do Incentivo Financeiro à Atividade Física na Atenção Primária à Saúde (APS) do Sistema Único de Saúde (SUS) e analisar se a nota de priorização municipal foi um critério efetivo para maior equidade na distribuição dos recursos. Trata-se de um estudo ecológico com análises sobre o número de municípios e unidades de saúde homologadas ao Incentivo à Atividade Física na APS e dos valores pagos no período entre maio de 2022 e setembro de 2023. Para avaliar a equidade, foram calculadas as medidas de desigualdades absolutas e relativas entre as unidades de saúde, agrupadas em quartis conforme a nota de priorização municipal. O percentual de unidades de saúde custeadas não passou de 37,6% e o estabelecimento de metas reduziu em 68,9% o número de unidades de saúde que receberam recursos do Incentivo à Atividade Física na APS e em 44,0% o montante de recursos pagos. Foram observadas importantes desigualdades na alocação de recursos, com maior percentual de unidades de saúde localizadas em municípios com menor prioridade. Assim, os critérios adotados foram insuficientes para garantir equidade na distribuição de recursos.

The global and national energy systems techno-economic (GNESTE) database: Cost and performance data for electricity generation and storage technologies.

Power sector and energy systems models are widely used to explore the impacts of demographic, socio-economic or policy changes on the cost and emissions of electricity generation. Technology cost and performance data are essential inputs to such models. Despite the ubiquity and importance of these parameters, there is no standardised database which collates the variety of values from across the literature, so modellers must collect them independently each time they populate or update model inputs, leading to duplicated efforts and inconsistencies which can profoundly influence model results. Technology cost and performance varies between countries, regions and over time, meaning that data must be country- or region-specific and frequently updated. Values also vary widely between sources, so obtaining a broad consensus view is critical. Here, we present a database which collates historical, current, and future cost and performance data and assumptions for the six most prominent electricity generation technologies; coal, gas, hydroelectric, nuclear, solar photovoltaic (PV) and wind power, which together accounted for over 92 % of installed generation capacity in 2022. In addition, we provide the same data for utility-scale battery energy storage systems (BESS), regarded as critical to the integration of variable renewables such as wind and solar PV. The data are global in scope but with regional and national specificity, covers the years 2015 through to 2050, and span 5518 datapoints from 56 sources. The database enables modellers to select and justify model input data and provides a benchmark for comparing assumptions and projections to other sources across the literature to validate model inputs and outputs. It is designed to be easily updated with new sources of data, ensuring its utility, comprehensiveness, and broad applicability in future.

A global overview of health system financing and available infrastructure and oversight for kidney care.

BACKGROUND: Governance, health financing, and service delivery are critical elements of health systems for provision of robust and sustainable chronic disease care. We leveraged the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to evaluate oversight and financing for kidney care worldwide. METHODS: A survey was administered to stakeholders from countries affiliated with the ISN from July to September 2022. We evaluated funding models utilized for reimbursement of medications, services for the management of chronic kidney disease, and provision of kidney replacement therapy (KRT). We also assessed oversight structures for the delivery of kidney care. RESULTS: Overall, 167 of the 192 countries and territories contacted responded to the survey, representing 97.4% of the global population. High-income countries tended to use public funding to reimburse all categories of kidney care in comparison with low-income countries (LICs) and lower-middle income countries (LMICs). In countries where public funding for KRT was available, 78% provided universal health coverage. The proportion of countries that used public funding to fully reimburse care varied for non-dialysis chronic kidney disease (27%), dialysis for acute kidney injury (either hemodialysis or peritoneal dialysis) (44%), chronic hemodialysis (45%), chronic peritoneal dialysis (42%), and kidney transplant medications (36%). Oversight for kidney care was provided at a national level in 63% of countries, and at a state/provincial level in 28% of countries. CONCLUSION: This study demonstrated significant gaps in universal care coverage, and in oversight and financing structures for kidney care, particularly in in LICs and LMICs.

A Mixed-Methods Exploration of the Implementation of Policies That Earmarked Taxes for Behavioral Health.

Policy Points Earmarked tax policies for behavioral health are perceived as having positive impacts related to increasing flexible funding, suggesting benefits to expand this financing approach. Implementation challenges related to these earmarked taxes included tax base volatility that impedes long-term service delivery planning and inequities in the distribution of tax revenue. Recommendations for designing or revising earmarked tax policies include developing clear guidelines and support systems to manage the administrative aspects of earmarked tax programs, cocreating reporting and oversight structures with system and service delivery agents, and selecting revenue streams that are relatively stable across years. CONTEXT: Over 200 cities and counties in the United States have implemented policies earmarking tax revenue for behavioral health services. This mixed-methods study was conducted with the aim of characterizing perceptions of the impacts of these earmarked tax policies, strengths and weaknesses of tax policy designs, and factors that influence decision making about how tax revenue is allocated for services. METHODS: Study data came from surveys completed by 274 officials involved in behavioral health earmarked tax policy implementation and 37 interviews with officials in a sample of jurisdictions with these taxes-California (n = 16), Washington (n = 12), Colorado (n = 6), and Iowa (n = 3). Interviews primarily explored perceptions of the advantages and drawbacks of the earmarked tax, perceptions of tax policy design, and factors influencing decisions about revenue allocation. FINDINGS: A total of 83% of respondents strongly agreed that it was better to have the tax than not, 73.2% strongly agreed that the tax increased flexibility to address complex behavioral health needs, and 65.1% strongly agreed that the tax increased the number of people served by evidence-based practices. Only 43.3%, however, strongly agreed that it was easy to satisfy tax-reporting requirements. Interviews revealed that the taxes enabled funding for services and implementation supports, such as training in the delivery of evidence-based practices, and supplemented mainstream funding sources (e.g., Medicaid). However, some interviewees also reported challenges related to volatility of funding, inequities in the distribution of tax revenue, and, in some cases, administratively burdensome tax reporting. Decisions about tax revenue allocation were influenced by goals such as reducing behavioral health care inequities, being responsive to community needs, addressing constraints of mainstream funding sources, and, to a lesser degree, supporting services considered to be evidence based. CONCLUSIONS: Earmarked taxes are a promising financing strategy to improve access to, and quality of, behavioral health services by supplementing mainstream state and federal financing.

Shareholder heterogeneity, financing constraints, and organizational resilience: Mixed-ownership reform in Chinese private enterprises.

Private enterprise development encounters numerous challenges. China encourages state-owned enterprises to acquire equity stakes in private enterprises, thereby facilitating development of private enterprises through reverse mixed-ownership reform. To test the effectiveness of this approach, we focus on the impact of state-owned equity on the organizational resilience of private enterprises. Using empirical research methods and data from A-share listed Chinese companies from 2009 to 2022, we find that reverse mixed-ownership reform is significantly and positively correlated with the organizational resilience of private enterprises. Further analysis reveals that involvement of shareholders from state-owned enterprises can bolster the organizational resilience of private enterprises by mitigating their financing constraints. This paper extends the research on the mechanism by which a heterogeneous ownership structure can impact the organizational resilience of private enterprises and offers insights for private enterprises on how to bolster their organizational resilience through mixed-ownership reform.

[Using diagnosis-related groups in Chile: lessons and challengesLições e desafios do uso de grupos de diagnósticos relacionados no Chile]. / Lecciones y desafíos del uso de los grupos relacionados por el diagnóstico en Chile.

Objective: Analyze the implementation of diagnosis-related groups (DRGs) in Chile with a view to optimizing the distribution of public resources. Methods: A chronological narrative analysis of the main milestones was complemented by simulated application of DRGs through emulated competition and cluster analysis for evaluative purposes. Results: In 2001, DRGs were introduced in Chile in an academic context. The National Health Fund (FONASA) began using DRGs in the private sector. A public sector pilot was launched in 2015. After nearly two decades of progress, in 2020 FONASA established the DRG program as a payment mechanism for public hospitals. However, the COVID-19 pandemic slowed its development. In 2022, implementation was resumed. After evaluating the program, it was evident that the hospital clusters that had been predefined for differentiated payment did not successfully differentiate homogeneous groups. In 2023, the program was reformed, financing was increased, a single cluster and base rate were defined, and greater hospital complexity was recognized, compared to previous years. Three hospitals were added to the program, for a total of 68. Conclusions: This experience shows that it is possible to sustain a public health financing policy that achieves greater efficiency and equity in the health system, based on the existence of robust institutions that continuously develop and improve.

Objetivo: Analisar a implementação de grupos de diagnósticos relacionados (DRG, na sigla em inglês) no Chile, com o objetivo de otimizar a distribuição de recursos públicos. Método: Foi utilizada uma análise narrativa cronológica dos principais marcos, complementada por simulações da implementação de DRG usando concorrência simulada (yardstick competition) e análise de agrupamento para fins de avaliação. Resultados: O modelo de DRG foi introduzido no Chile em 2001, em um contexto acadêmico. Em 2015, o Fundo Nacional de Saúde (FONASA) começou a utilizá-lo no setor privado e, com um projeto-piloto, no setor público. Após quase duas décadas de progresso, em 2020, o programa de DRG foi implementado como mecanismo de pagamento do FONASA para os hospitais públicos. No entanto, a pandemia de COVID-19 interrompeu seu desenvolvimento. Em 2022, a aplicação foi retomada e, após uma avaliação do programa, ficou claro que os grupos hospitalares predefinidos para o pagamento diferenciado por DRG não formavam grupos homogêneos. Em 2023, o programa foi reformulado, com aumento dos recursos financeiros e a definição de um único agrupamento e de uma taxa básica, reconhecendo-se uma maior complexidade hospitalar do que nos anos anteriores. Além disso, três hospitais foram adicionados ao programa, elevando o total para 68. Conclusões: A experiência mostra que é possível dar continuidade a uma política pública de financiamento da saúde para alcançar maior eficiência e equidade no sistema de saúde com base na existência de instituições sólidas que persistam em seu desenvolvimento e contínuo aprimoramento.

Aligning Ambition and Reality: A Multiple Case Study Into Synergistic Influences of Financial and Other Factors on the Outcomes of Integrated Care Projects.

Introduction: While the benefits of integrated care are widely acknowledged, its implementation has proven difficult. Together with other factors, financial factors are known to influence progress towards care integration, but in-depth insight in their influence on the envisioned outcomes of integrated care projects is limited. Methods: We conducted a multiple case study of four integrated care projects in the Netherlands. The projects were purposely sampled to be representative of integrated care in its different forms. A total of 29 semi-structured interviews were held with project members, both medical and non-medical staff. In addition, 141 documents were analyzed, including scientific publications and minutes of meetings. Based on elaborate project descriptions we deduced the synergistic influences of financial and other factors on the outcomes of the projects. Results: Financial factors have an important influence on integrated care projects, though this influence is neither deterministic nor isolated. This is because the likelihood of realizing a positive outcome is affected by the degree to which four key conditions are fulfilled: 1) willingness to change, 2) alignment of interests and uniformity goal, 3) availability of resources to change, and 4) effectiveness of management of external actors. Conclusion: Financial factors have an impact on the outcomes of integrated care projects and must be viewed in synergy with interrelated other factors. Crucial for realizing success in integrated care, a balance must be struck between the level of ambition set in a project and the reality of the prevailing key conditions.

The inverted U-shaped relationship between corporate social responsibility and default risk: The role of financing constraints.

With increased corporate liquidity and debt repayment pressure, CSR's "insurance" role has received more attention. We conducted a comprehensive empirical analysis of 4988 listed companies in the Chinese context during 2011-2020. Our research has three findings: First, the initial increase in CSR will lead to a rise in default risk. However, once the CSR level exceeds a specific threshold, the default risk decreases as the CSR rises. We tested the robustness of the results by replacing the explanatory and the explained variables and taking into account the lag time effect, which proved the reliability of our research conclusions. Second, the mediation analysis shows financing constraints play an important mediating role in this inverted U-shaped relationship. On the left side of the U-shape, CSR performance intensifies financing constraints, while on the right side, increasing CSR reduces financing constraints. Finally, we confirm heterogeneity in the impact of CSR on the default risk of different enterprises' ownership and size. Our study complements the current literature on the effects of CSR on default risk. We are making policymakers and stakeholders aware of the importance of mandatory CSR disclosure.

Disaster risk financing and insurance for earthquake-prone state buildings in Indonesia.

Indonesia situated within the volatile Ring of Fire, faces recurring and devastating earthquakes that pose significant economic threats. The Government of Indonesia (GoI) has initiated a disaster risk financing strategy to address these challenges. However, the implementation of disaster insurance within this strategy remains limited. This study examined the GoI's disaster risk financing methods, assessed the effectiveness of existing disaster insurance practices, and proposed strategies for improving disaster risk reduction (DRR). Literature review was used to analyse disaster fund and insurance implementation. A building vulnerability simulation, based on Federal Emergency Management Agency's (FEMA) P-154 rapid visual screening, determined the appropriate financing strategy. State buildings were assessed using nine vulnerability factors and categorised by seismicity. The research found that disaster financing mostly relied on national funds to cover all disaster damages. Existing disaster insurance lacked clarity in defining insurable buildings, resulting in broad inclusion. Vulnerability assessments showed that each building type exhibited different potential earthquake damage levels. Consequently, insurance coverage is recommended for high-damage categories but discouraged for low to moderately vulnerable buildings. Contribution: This study offered insights into Indonesia's current disaster risk financing and insurance landscape, and provides a strategic framework for optimising these mechanisms to better protect state buildings from earthquake-related risks.

Investment and financing maturity mismatch: Moderating role of financialization in regulatory context for A-share listed Chinese companies.

As the financialization issue is getting more and more attention, the behavioral motives and effects behind this appearance should not be ignored, and it is of great practical significance for the high-quality development of China's real economy to explore the impact and mechanism of the financialization trend on the investment and financing maturity mismatch of China's real enterprises. Using sample data of Chinese A-share listed companies from 2013 to 2020, this article empirically examines the impact of financialization on the investment and financing maturity structure from a new perspective of asset classification by using a fixed-effect model, and explores the mechanism of the financial regulatory environment's moderating effect on the relationship between the two mentioned above. The study shows that: there is an inverted U-shaped nonlinear relationship between the financialization of investment income and fixed income and "maturity mismatch ". The term mismatch of investment and financing increases with the degree of financialization, after reaching the critical point, it eases with the deepening of financialization. However, the specific point of view is different. In the sample interval, the investment income financialization exacerbates the investment and financing maturity mismatch more obviously; the fixed income financialization inhibits the investment and financing maturity mismatch more obviously. Under the different perspectives of the firms' ownership nature, financing constraints, and principal-agent problems, there are differences in the impact of firms' allocation of different types of financial assets on the investment and financing term structure. In addition, the regulatory effect of financial supervision weakens the inverted U-shaped relationship of investment income financialization with investment and financing maturity mismatch; it enhances the inverted U-shaped relationship between fixed income financialization and investment and financing maturity mismatch. In general, financial supervision has had a significant positive effect on investment and financing maturity mismatches. The findings have important policy implications in terms of corporate real investment, financial market development, and financial regulation, which can help promote China's economic development and stability.

Health-led growth hypothesis and health financing systems: an econometric synthesis for OECD countries.

Introduction: This study investigates the Health-Led Growth Hypothesis (HLGH) within OECD countries, examining how health expenditures influence economic growth and the role of different health financing systems in this relationship. Methods: Utilizing a comprehensive analysis spanning 2000 to 2019 across 38 OECD countries, advanced econometric methodologies were employed. Both second-generation panel data estimators (Dynamic CCEMG, CS-ARDL, AMG) and first-generation models (Panel ARDL with PMG, FMOLS, DOLS) were utilized to test the hypothesis. Results: The findings confirm the positive impact of health expenditures on economic growth, supporting the HLGH. Significant disparities were observed in the ability of health expenditures to stimulate economic growth across different health financing systems, including the Bismarck, Beveridge, Private Health Insurance, and System in Transition models. Discussion: This study enriches the ongoing academic dialog by providing an exhaustive analysis of the relationship between health expenditures and economic growth. It offers valuable insights for policymakers on how to optimize health investments to enhance economic development, considering the varying effects of different health financing frameworks.