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1.
Artigo em Inglês | MEDLINE | ID: mdl-31500288

RESUMO

The aim of this study is to measure universal health coverage in Emerging 7 (E7) economies. Within this framework, five different dimensions and 14 different criteria are selected by considering the explanations of World Health Organization and United Nations regarding universal health coverage. While weighting the dimensions and criteria, the Decision-making Trial and Evaluation Laboratory (DEMATEL) is considered with the triangular fuzzy numbers. Additionally, Multi-Objective Optimization on the basis of Ratio Analysis (MOORA) approach is used to rank E7 economies regarding Universal Health Coverage (UHC) performance. The novelty of this study is that both service and financial based factors are taken into consideration at the same time. Additionally, fuzzy DEMATEL and MOORA methodologies are firstly used in this study with respect to the evaluation of universal health coverage. The findings show that catastrophic out of pocket health spending, pushed below an international poverty line and annual growth rate of real Gross Domestic Product (GDP) per capita are the most significant criteria for universal health coverage performance. Moreover, it is also concluded that Russia is the country that has the highest universal health coverage performance whereas China, India and Brazil are in the last ranks. It can be understood that macroeconomic conditions play a very significant role on the performance of universal health coverage. Hence, economic conditions should be improved in these countries to have better universal health coverage performance. Furthermore, it is necessary to establish programs that provide exemptions or lower out-of-pocket expenditures which will not prevent the use of health services. This situation can protect people against the financial risks related to health expenditures. In addition to them, it is also obvious that high population has also negative influence on the countries such as, China and India. It indicates that it would be appropriate for these countries to make population planning for this purpose.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Administração de Serviços de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Tomada de Decisões , Humanos , Organização Mundial da Saúde
2.
Infect Dis Poverty ; 8(1): 74, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31484553

RESUMO

This commentary highlights the value of community-engaged social innovations to advance health care delivery in low- and middle-income countries and to accelerate universal health coverage. It emphasizes the importance of research to guide the innovators on what works, what does not work to make their innovations sustainable and to replicate and scale them up as relevant. It also helps to demonstrate impact and to enhance uptake within the health systems.


Assuntos
Participação da Comunidade/tendências , Assistência à Saúde/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Humanos , Pobreza/estatística & dados numéricos
3.
J Bone Joint Surg Am ; 101(17): 1546-1553, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31483397

RESUMO

BACKGROUND: There have been few large studies involving multiethnic cohorts of patients treated with anterior cruciate ligament reconstruction (ACLR), and therefore, little is known about the role that race/ethnicity may play in the differential risk of undergoing revision surgery following primary ACLR. The purpose of this study was to evaluate whether differences exist by race/ethnicity in the risk of undergoing the elective procedure of aseptic revision in a universally insured cohort of patients who had undergone ACLR. METHODS: This was a retrospective cohort study conducted using our integrated health-care system's ACLR registry and including primary ACLRs from 2008 to 2015. Race/ethnicity was categorized into the following 4 groups: non-Hispanic white, black, Hispanic, and Asian. Multivariable Cox proportional-hazard models were used to evaluate the association between race/ethnicity and revision risk while adjusting for age, sex, highest educational attainment, annual household income, graft type, and geographic region in which the ACLR was performed. RESULTS: Of the 27,258 included patients,13,567 (49.8%) were white, 7,713 (28.3%) were Hispanic, 3,725 (13.7%) were Asian, and 2,253 (8.3%) were black. Asian patients (hazard ratio [HR] = 0.72; 95% confidence interval [CI] = 0.57 to 0.90) and Hispanic patients (HR = 0.83; 95% CI = 0.70 to 0.98) had a lower risk of undergoing revision surgery than did white patients. Within the first 3.5 years postoperatively, we did not observe a difference in revision risk when black patients were compared with white patients (HR = 0.86; 95% CI = 0.64 to 1.14); after 3.5 years postoperatively, black patients had a lower risk of undergoing revision (HR = 0.23; 95% CI = 0.08 to 0.63). CONCLUSIONS: In a large, universally insured ACLR cohort with equal access to care, we observed Asian, Hispanic, and black patients to have a similar or lower risk of undergoing elective revision compared with white patients. These findings emphasize the need for additional investigation into barriers to equal access to care. Because of the sensitivity and complexity of race/ethnicity with surgical outcomes, continued assessment into the reasons for the differences observed, as well as any differences in other clinical outcomes, is warranted. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Lesões do Ligamento Cruzado Anterior/etnologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Grupos de Populações Continentais/etnologia , Adulto , Distribuição por Idade , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Estados Unidos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adulto Jovem
4.
BMC Health Serv Res ; 19(1): 580, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426781

RESUMO

BACKGROUND: Care-seeking behavior is widely acknowledged to have strong influences on health outcomes among individuals with chronic conditions including diabetes. Despite its dynamic nature, care seeking behavior are often considered as time invariant in most studies. The likelihood of patients changing their regularity and source of chronic care over time is often neglected. This study aimed to determine the long-term trajectories of care-seeking patterns of both care-seeking regularity and health provider choices; and their associated factors among patients with type 2 diabetes under the National Health Insurance (NHI) program in Taiwan. METHODS: We utilized population-based data from the National Health Insurance Research Database (NHIRD) in Taiwan. Three thousand, nine hundred and eighty-seven adult patients with newly diagnosed type 2 diabetes in 1999 were enrolled in the cohort. We assessed their trajectories of regular care visits and sources of diabetes care from 2000 to 2010. A group-based trajectory model was applied. RESULTS: Seven distinct groups of long-term care-seeking patterns were identified. Only 51.44% of patients with newly diagnosed diabetes had regularly visited their providers over time. Among them, 56.41 and 16.09% had persistently sought care from generalized and specialized providers, respectively. 27.50% had sought care from different levels of providers. Patients who were male, elderly, low-income, and had a higher baseline diabetes severity were significantly more likely to either continue with their irregular care-seeking behavior or fail to maintain their regular care seeking behavior over time. Those who were younger, had a higher socioeconomic status, and lived in an urban area were significantly more likely to persistently seek care from specialized care settings. CONCLUSIONS: This study is the first population-based assessment of long-term care-seeking behaviors of type 2 diabetes patients under a single-payer system with a comprehensive benefit coverage. The most alarming finding was that, despite the existence of the comprehensive universal health insurance coverage in Taiwan, almost 50% of patients did not seek or maintain regular visits to providers over time as recommended. Understanding variations in the long-term trajectories of care adherence and sources of care may help to identify gaps in diabetes care management.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sistema de Fonte Pagadora Única/estatística & dados numéricos , Adulto , Idoso , Doença Crônica , Diabetes Mellitus Tipo 2/economia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Pobreza/economia , Pobreza/estatística & dados numéricos , Estudos Retrospectivos , Taiwan , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adulto Jovem
5.
Rev Peru Med Exp Salud Publica ; 36(2): 196-206, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31460630

RESUMO

OBJECTIVE.: To describe the trends in health insurance coverage (HIC) in Peru during the period 2009-2017 and evaluate associations with demographic, social and economic factors. MATERIALS AND METHODS.: We carried out a secondary data-analysis from the Peruvian National Household Survey. For each year, we estimated the global HIC, for the Integral Health Insurance (SIS) and the Social Security system (EsSalud). In addition, we performed a trend analysis. For 2009 (Universal Health Insurance Act), 2013 (health care reform act) and 2017, we used a polytomous variable for the insurance type (SIS/EsSalud/Non-affiliated). We performed logistic multinomial regressions to estimate relative prevalence ratios (RPR) and their 95% CI with correction for complex sampling. RESULTS.: We observed an increasing trend in the global HIC (2009:60.5%; 2013:65.5%; 2017:76.4%), SIS coverage (2009:34%; 2013:35.4%; 2017:47%) and EsSalud coverage (2009:22.8%; 2013:26.4%; 2017:26.3%). Multinomial logistic regressions showed that being a woman increased the likelihood to be affiliated to the SIS (RPR= 2009:1.64 and 2017:1.53), while people between 18 and 39 years old, living in Lima Metropolitan area under non-poverty conditions reduced the likelihood to be affiliated to the SIS (RPR= 2009:0.16 and 2017:0.31; 2009:0.17 and 2017:0.37; 2009:0.51 and 2017:0.53; respectively). Furthermore, being a woman, 65 years old or over, living in urban Lima, and under non-poverty conditions increased the likelihood of being affiliated with the EsSalud (RPR= 2013:1.12 and 2017:1.24; 2013:1.32 and 2017:1.34; 2009:2.18 and 2017:2.08; 2009:2.14 and 2017:2.54; 2009:3.57 and 2017:2.53; respectively). CONCLUSIONS.: HIC has increased during the period 2009-2017. However, the characteristics of those affiliated are different between the various types of health insurance.


Assuntos
Cobertura do Seguro/tendências , Seguro Saúde/tendências , Cobertura Universal do Seguro de Saúde/tendências , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Peru , Pobreza , População Rural , Fatores Sexuais , Inquéritos e Questionários , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , População Urbana , Adulto Jovem
6.
PLoS One ; 14(8): e0219731, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31461458

RESUMO

BACKGROUND: Expanding public health insurance seeks to attain several desirable objectives, including increasing access to healthcare services, reducing the risk of catastrophic healthcare expenditures, and improving health outcomes. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years. METHODS: We reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. No language restrictions were applied. Our focus was on both randomised and observational studies, particularly those including explicitly attempts to tackle selection bias in estimating the treatment effect of health insurance. The main outcomes are: (1) utilisation of health services, (2) financial protection for the target population, and (3) changes in health status. FINDINGS: 8755 abstracts and 118 full-text articles were assessed. Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. Overall, health insurance schemes in low- and middle-income countries (LMICs) have been found to improve access to health care as measured by increased utilisation of health care facilities (32 out of 40 studies). There also appeared to be a favourable effect on financial protection (26 out of 46 studies), although several studies indicated otherwise. There is moderate evidence that health insurance schemes improve the health of the insured (9 out of 12 studies). INTERPRETATION: Increased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage.


Assuntos
Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Nível de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Humanos
7.
Asian Pac J Cancer Prev ; 20(6): 1797-1802, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31244302

RESUMO

Background: Evidence from healthcare studies demonstrates that patients' health insurance affects service accessibility and the outcome of treatment. However, assessment on how colorectal cancer survival relates to health insurance is limited. Objective: The study examined the association between health insurance and colorectal cancer survival in Khon Kaen, Thailand. Methods: The retrospective cohort study was conducted with 1,931 colorectal cancer patients from Khon Kaen cancer registry between January 1, 2003 and December 31, 2012, and was followed-up until December 31, 2015. Relative survival was used to estimate the survival rate. Cox proportional hazard regression was used to estimate the relationship between health insurance and colorectal cancer survival, represented with the hazard ratio. Result: Most of the participants were males, and the median age was 62 years. The median survival time was 2.25 years (95% CI: 2.00-2.51). The five-year observed survival rate and relative survival rate were 36.87 (95% CI: 34.66-39.08) and, 42.28 (95% CI: 39.75-44.81), respectively. The factors that showed significant associations with poorer survival after adjustment for gender and age were non-surgical treatments (HRadj=1.88;95%CI=1.45-2.45), advanced stage (III+IV) (HRadj=2.50; 95%CI=2.00-3.12), histological grading in poorly differentiated (HRadj=1.84; 95%CI=1.32-2.56), and Universal Coverage Scheme (HRadj=1.37;95%CI=1.09-1.72). Conclusion: The survival of colorectal cancer patients in the Universal Coverage Scheme was likely to be poorer than in the Civil Servant Medical Benefit Scheme. This indicates an urgent need for a national program for colorectal cancer screening in the general population and access to health insurance.


Assuntos
Neoplasias Colorretais/economia , Neoplasias Colorretais/mortalidade , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Neoplasias Colorretais/terapia , Feminino , Seguimentos , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores Socioeconômicos , Taxa de Sobrevida , Tailândia
8.
Int J Equity Health ; 18(1): 92, 2019 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208413

RESUMO

BACKGROUND: Fair financial contribution in healthcare financing is one of the main goals and challengeable subjects in the evaluation of world health system functions. This study aimed to investigate the equity in healthcare financing in Shiraz, Iran in 2018. MATERIALS AND METHODS: This was a cross- sectional survey conducted on the Shiraz, Iran households. A sample of 740 households (2357 persons) was selected from 11 municipal districts using the multi-stage sampling method (stratified sampling method proportional to size, cluster sampling and systematic random sampling methods). The required data were collected using the Persian format of "World Health Survey" questionnaire. The collected data were analyzed using Stata14.0 and Excel 2007. The Gini coefficient and concentration and Kakwani indices were calculated for health insurance premiums (basic and complementary), inpatient and outpatient services costs, out of pocket payments and, totally, health expenses. RESULTS: The Gini coefficient was obtained based on the studied population incomes equal to 0.297. Also, the results revealed that the concentration index and Kakwani index were, respectively, 0.171 and - 0.125 for basic health insurance premiums, 0.259 and - 0.038 for health insurance complementary premiums, 0.198 and - 0.099 for total health insurance premiums, 0.126 and - 0.170 for outpatient services costs, 0.236 and - 0.061 for inpatient services costs, 0.174 and - 0.123 for out of pocket payments (including the sum of costs related to the inpatient and outpatient services) and 0.185 and - 0.112 for the health expenses (including the sum of out of pocket payments and health insurance premiums). CONCLUSION: The results showed that the healthcare financing in Shiraz, Iran was regressive and there was vertical inequity and, accordingly, it is essential to making more efforts in order to implement universal insurance coverage, redistribute incomes in the health sector to support low-income people, strengthening the health insurance schemes, etc.


Assuntos
Gastos em Saúde/ética , Gastos em Saúde/estatística & dados numéricos , Financiamento da Assistência à Saúde/ética , Cobertura do Seguro/ética , Seguro Saúde/ética , Cobertura Universal do Seguro de Saúde/ética , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Irã (Geográfico) , Masculino
9.
Int J Equity Health ; 18(1): 91, 2019 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200716

RESUMO

BACKGROUND: The Chinese government has now achieved universal coverage of medical insurance through two systems: the Basic Medical Insurance System for Urban Employees (BMISUE) and the Basic Medical Insurance System for Urban and Rural Residents (BMISURR). This paper aims to identify the impact of China's current medical insurance system on equity in the use of health services by the floating elderly population from two aspects: institutional differences and geographical disparity. METHODS: The data used in the study are from the China Migrants Dynamic Survey (CMDS) conducted by the National Health and Wellness Council of China. This study uses the Logit model to estimate the impact of the medical insurance system on the utilization of health services and the Propensity Score Matching (PSM) method to further test the robustness of the results. RESULTS: The study found that the type of medical insurance does not affect health services utilization by the floating elderly population in China. However, for those participating in the same medical insurance, participation in different regions will significantly affect the use of health service resources. For the BMISURR, when the place of the insurance is the same as the place of residence, the proportion of the floating elderly population that will see a doctor when they are sick will increase by 4.80%. For the BMISUE, when the place of the insurance is the same as the place of residence, the proportion of the floating elderly population that will see a doctor when they are sick will increase by 10.30%. CONCLUSIONS: The difference between the place of insurance and the place of residence results in the unbalanced utilization of health services by the floating elderly population participating in the same medical insurance system.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Adulto Jovem
10.
PLoS One ; 14(5): e0209126, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31116754

RESUMO

Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators in Ghana from 1995 to 2015 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analyses estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, we calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for the prevention services, the same cannot be applied to the treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9-3.5) and 0.4% (95%CrI: 0.2-0.8), respectively. These are projected to reduce to 0.4% (95% CrI: 0.1-1.3) and 0.2% (0.0-0.5) respectively by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection over the years. However, inequalities across wealth quintiles and regions continue to be cause of concerns. Further efforts are needed to narrow these gaps.


Assuntos
Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/tendências , Gana/epidemiologia , Gastos em Saúde , Serviços de Saúde , Indicadores Básicos de Saúde , História do Século XX , História do Século XXI , Humanos , Programas Nacionais de Saúde , Vigilância em Saúde Pública , Fatores Socioeconômicos , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/história
11.
WHO South East Asia J Public Health ; 8(1): 10-17, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30950424

RESUMO

Universal health coverage (UHC) is one of the targets within the Sustainable Development Goals that the Member States of the United Nations have pledged to achieve by 2030. Target 3.8 has two monitoring indicators: 3.8.1 for coverage of essential health services, for which a compound index from 16 tracer indicators has recently been developed; and 3.8.2 for catastrophic expenditure on health. The global baseline monitoring of these two indicators in 2017 shows that the progress in many low- and middle-income countries is unlikely to be on track and achieved by 2030. The monitoring and evaluation mechanism for UHC progress is a crucial function to hold governments accountable and guide countries along their paths towards UHC. This paper outlines key monitoring and evaluation tools that Thailand uses to track UHC progress; compares the strengths and limitations of each tool; and discusses monitoring gaps and enabling factors related to development of the tools. Thailand uses several data sources to monitor three UHC dimensions: population coverage; service coverage; and financial risk protection. The four key sources are: (i) national surveys; (ii) health facility and administrative data; (iii) specific disease registries; and (iv) research. Each source provides different advantages and is used concurrently to complement the others. Despite initially being developed to track progress for national health priorities, these tools are able to monitor most of the global UHC indicators. Key enabling factors of Thai monitoring systems are a supportive infrastructure and information system; a policy requirement for routine patient data records; ownership and commitment of the key responsible organizations; multisectoral collaboration; and sustainable in-country capacities. The areas for improvement are monitoring in the non-Thai population; tracking access to essential medicines; and maximizing the use of collected data. Lessons learnt from the Thai experience could be useful for other low- and middle-income countries in developing their UHC monitoring platforms.


Assuntos
Desenvolvimento Sustentável/tendências , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Assistência à Saúde/métodos , Assistência à Saúde/tendências , Humanos , Vigilância da População/métodos , Tailândia , Cobertura Universal do Seguro de Saúde/normas
12.
WHO South East Asia J Public Health ; 8(1): 18-20, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30950425

RESUMO

In common with other countries in the World Health Organization South-East Asia Region, disease patterns in India have rapidly transitioned towards an increased burden of noncommunicable diseases. This epidemiological transition has been a major driver impelling a radical rethink of the structure of health care, especially with respect to the role, quality and capacity of primary health care. In addition to the Pradhan Mantri Jan Arogya Yojana insurance scheme, covering 40% of the poorest and most vulnerable individuals in the country for secondary and tertiary care, Ayushman Bharat is based on an ambitious programme of transforming India's 150 000 public peripheral health centres into health and wellness centres (HWCs) delivering universal, free comprehensive primary health care by the end of 2022. This transformation to facilities delivering high-quality, efficient, equitable and comprehensive care will involve paradigm shifts, not least in human resources to include a new cadre of mid-level health providers. The design of HWCs and the delivery of services build on the experiences and lessons learnt from the National Health Mission, India's flagship programme for strengthening health systems. Expanding the scope of these components to address the expanded service delivery package will require reorganization of work processes, including addressing the continuum of care across facility levels; moving from episodic pregnancy and delivery, newborn and immunization services to chronic care services; instituting screening and early treatment programmes; ensuring high-quality clinical services; and using information and communications technology for better reporting, focusing on health promotion and addressing health literacy in communities. Although there are major challenges ahead to meet these ambitious goals, it is important to capitalize on the current high level of political commitment accorded to comprehensive primary health care.


Assuntos
Assistência Integral à Saúde/métodos , Academias de Ginástica/tendências , Cobertura Universal do Seguro de Saúde/normas , Assistência Integral à Saúde/tendências , Academias de Ginástica/organização & administração , Academias de Ginástica/estatística & dados numéricos , Humanos , Índia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
13.
Artigo em Inglês | MEDLINE | ID: mdl-30950426

RESUMO

Since the late 1920s, the Sri Lankan health system has been based on a firm foundation of primary health care, and it has been recognized internationally as a highly successful low-cost model. However, rethinking the future health-care model has been essential, owing to the country having one of the fastest ageing populations in the world, coupled with a high premature mortality from noncommunicable diseases. To sustain past gains and meet new challenges, several models centred on an expanded primary health-care system have been trialled and refined in the past decade. Primary health care was identified as a key priority in the National Health Strategic Master Plan 2016-2025, and in 2018 the Cabinet approved the Policy on healthcare delivery for universal health coverage. This policy introduces the "shared care cluster" system, whereby an apex specialist institution serves the local primary care referral institutions. The catchment population is divided into populations of approximately 5000, for which one family doctor is responsible. Strengthening and retaining human resources at these primary-level curative institutions will be essential, especially in rural locations. Also critical will be initiatives to orient the population's health-seeking behaviours. Sustained political commitment, an effective communication strategy, a tailored health workforce policy, performance monitoring and evaluation, coordination mechanisms, and changes in administrative and financial regulations are some of the future factors that will be critical to realizing the full potential of primary health care and accelerating universal health coverage in Sri Lanka.


Assuntos
Reforma dos Serviços de Saúde/normas , Atenção Primária à Saúde/normas , Cobertura Universal do Seguro de Saúde/normas , Assistência à Saúde/economia , Assistência à Saúde/métodos , Assistência à Saúde/tendências , Reforma dos Serviços de Saúde/métodos , Reforma dos Serviços de Saúde/tendências , Política de Saúde/tendências , Humanos , Atenção Primária à Saúde/tendências , Sri Lanka , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
14.
Lancet ; 393(10186): 2168-2174, 2019 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-30981536

RESUMO

The USA is home to more immigrants than any other country-about 46 million, just less than a fifth of the world's immigrants. Immigrant health and access to health care in the USA varies widely by ethnicity, citizenship, and legal status. In recent decades, several policy and regulatory changes have worsened health-care quality and access for immigrant populations. These changes include restrictions on access to public health insurance programmes, rhetoric discouraging the use of social services, aggressive immigration enforcement activities, intimidation within health-care settings, decreased caps on the number of admitted refugees, and rescission of protections from deportation. A receding of ethical norms has created an environment favourable for moral and public health crises, as evident in the separation of children from their parents at the southern US border. Given the polarising immigration rhetoric at the national level, individual states rather than the country as a whole might be better positioned to address the barriers to improved health and health care for immigrants in the USA.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Emigrantes e Imigrantes/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/estatística & dados numéricos , Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Disparidades nos Níveis de Saúde , Humanos , Medicaid/legislação & jurisprudência , Medicaid/estatística & dados numéricos , Estados Unidos , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
15.
Acta Gastroenterol Belg ; 82(1): 43-52, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30888753

RESUMO

BACKGROUND AND STUDY AIMS: Direct-acting antivirals provide interferon-free treatments for chronic hepatitis C (CHC) virus infection. In Belgium, in 2016, access to these agents was limited to patients with advanced liver fibrosis stages F3 and F4. This study is the first to describe Belgium's patient population ineligible for interferon-free treatment. PATIENTS AND METHODS: This was an observational, cross-sectional, multicentre study that enrolled adult patients with CHC ineligible for interferon-free treatment. Patient data recorded at a single visit included demographic data, disease characteristics, comorbidities, co-medications, treatment status, and laboratory data. RESULTS: Three hundred and three patients from 16 centres in Belgium were included in the statistical analysis. On average, patients were aged 53.5 years and 50.2% were women ; 94.1% had health insurance and 99.0% resided in Belgium. The current hepatitis C virus (HCV) infection was the first infection for 96.0% of patients and the mean time since infection was 20.0 years. Liver fibrosis stage was F0 for 23.7%, F0/F1 or F1 for 38.3%, F1/F2 or F2 for 25.8%, F3 for 7.1%, and F4 for 5.1% of patients ; 28.4% of patients were CHC treatment-experienced. The main reason for ineligibility for interferon-free treatment was lack of reimbursement (84.8%). Other reasons included no treatment urgency or medical decision to wait (27.1%), waiting for future treatment option (8.3%), and no social insurance coverage (3.6%). CONCLUSIONS: This study provides recent data on the CHC patient population and disease characteristics in Belgium that could help medical communities and government agencies manage CHC disease burden.


Assuntos
Antivirais/uso terapêutico , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Hepacivirus , Hepatite C Crônica/tratamento farmacológico , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adulto , Antivirais/economia , Bélgica/epidemiologia , Estudos Transversais , Feminino , Genótipo , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/virologia , Humanos , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/epidemiologia , Pessoa de Meia-Idade , Cobertura Universal do Seguro de Saúde/economia
16.
Health Serv Res ; 54(2): 367-378, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30729507

RESUMO

OBJECTIVE: To examine the factors explaining primary care physicians' (PCPs) decision to leave patient-centered medical homes (PCMHs). DATA SOURCES: Five-year longitudinal data on all the 906 PCPs who joined a PCMH in the Canadian province of Quebec, known there as a Family Medicine Group. STUDY DESIGN: We use fixed-effects and random-effects logit models, with a variety of regression specifications and various subsamples. In addition to these models, we examine the robustness of our results using survival analysis, one lag in the regressions and focusing on a matched sample of quitters and stayers. DATA COLLECTION/EXTRACTION METHODS: We extract information from Quebec's universal health insurer billing data on all the PCPs who joined a PCMH between 2003 and 2005, supplemented by information on their elderly and chronically ill patients. PRINCIPAL FINDINGS: About 17 percent of PCPs leave PCMHs within 5 years of follow-up. Physicians' demographics have little influence. However, those with more complex patients and higher revenues are less likely to leave the medical homes. These findings are robust across a variety of specifications. CONCLUSION: As expected, higher revenue favors retention. Importantly, our results suggest that PCMH may provide appropriate support to physicians dealing with complex patients.


Assuntos
Assistência Centrada no Paciente/estatística & dados numéricos , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Assistência Centrada no Paciente/economia , Médicos de Atenção Primária/economia , Atenção Primária à Saúde/economia , Quebeque , Fatores Socioeconômicos , Cobertura Universal do Seguro de Saúde/economia
17.
BMC Health Serv Res ; 19(1): 86, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709376

RESUMO

BACKGROUND: WhatsApp (WA) is the most recent and attractive applicative among Smartphone users. The use of WA in healthcare environment has been shown of multiple benefices. Mozambique team involved in 2017 bed nets universal coverage campaign (UCC) implemented a distant mentoring strategy using WA. This study aims to perform a descriptive analysis of the use of WA as a supplementary tool for mentoring provincial and district health teams during bed nets universal coverage campaign in Mozambique. METHODS: Using WA, a qualitative study was carried out between March and July 2017. Seven WA groups were created. One group for central-level team, and six groups corresponding to each implementation province. The WA content was analyzed, grouped into separate themes, and subject to information triangulation among researchers and group participants. Saturation guided the quantity and quality of information. RESULTS: A total of 511 members were included in all WA groups. Of these, 96% were provincial WA groups. A total of 24,897 messages (text and images) were exchanged in all WA groups. The main communication form was text (22,660-91%), followed by images (2237-9%). Five themes emerged from content analyses: 1) administrative/financial, 2) logistic, 3) planning and implementation, 4) monitoring and evaluation, and 5) best practice. CONCLUSIONS: The use of WA during universal coverage bed nets campaign implementation in Mozambique fostered central-level coordination, providing implementation support to district and provincial teams, and promoting wider and timely information sharing among group members.


Assuntos
Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Malária/prevenção & controle , Aplicativos Móveis/estatística & dados numéricos , Comunicação , Estudos Transversais , Confiabilidade dos Dados , Assistência à Saúde/normas , Utilização de Equipamentos e Suprimentos , Humanos , Mentores , Controle de Mosquitos/estatística & dados numéricos , Moçambique , Pesquisa Qualitativa , Projetos de Pesquisa , Pesquisadores , Smartphone/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
18.
BMC Med ; 17(1): 36, 2019 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-30755209

RESUMO

BACKGROUND: Financial risk protection (FRP) is a key objective of national health systems and a core pillar of universal health coverage (UHC). Yet, little is known about the disease-specific distribution of catastrophic health expenditure (CHE) at the national level. METHODS: Using the World Health Surveys (WHS) from 39 countries, we quantified CHE, or household health spending that surpasses 40% of capacity-to-pay by key disease areas. We restricted our analysis to households in which the respondent used health care in the last 30 days and categorized CHE into disease areas included as WHS response options: maternal and child health (MCH); high fever, severe diarrhea, or cough; heart disease; asthma; injury; surgery; and other. We compared disease-specific CHE estimates by income, pooled funding as a share of total health expenditure, share of the population affected by the different diseases, and poverty status. RESULTS: Across countries, an average of 45.1% of CHE cases could not be tied to a specific cause; 37.6% (95% UI 35.4-39.9%) of CHE cases were associated with high fever, severe cough, or diarrhea; 3.9% (3.0-4.9%) with MCH; and 4.1% (3.3-4.9%) with heart disease. Injuries constituted 5.2% (4.2-6.4%) of CHE cases. The distribution of CHE varied substantially by national income. A 10% increase in heart disease prevalence was associated with a 1.9% (1.3-2.4%) increase in heart disease CHE, an association stronger than any other disease area. CONCLUSIONS: Our approach is comparable, comprehensive, and empirically based and highlights how financial risk protection may not be aligned with disease burden. Disease-specific CHE estimates can illuminate how health systems can target reform to best protect households from financial risk.


Assuntos
Doença Catastrófica/economia , Gastos em Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Cobertura Universal do Seguro de Saúde/economia , Doença Catastrófica/epidemiologia , Feminino , Saúde Global/economia , Saúde Global/estatística & dados numéricos , Humanos , Masculino , Prevalência , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
19.
Transplantation ; 103(5): 1024-1035, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30247444

RESUMO

BACKGROUND: Conflicting evidence exists regarding the relationship between socioeconomic status (SES) and outcomes after kidney transplantation. METHODS: We conducted a population-based cohort study in a publicly funded healthcare system using linked administrative healthcare databases from Ontario, Canada to assess the relationship between SES and total graft failure (ie, return to chronic dialysis, preemptive retransplantation, or death) in individuals who received their first kidney transplant between 2004 and 2014. Secondary outcomes included death-censored graft failure, death with a functioning graft, all-cause mortality, and all-cause hospitalization (post hoc outcome). RESULTS: Four thousand four hundred-fourteen kidney transplant recipients were included (median age, 53 years; 36.5% female), and the median (25th, 75th percentile) follow-up was 4.3 (2.1-7.1) years. In an unadjusted Cox proportional hazards model, each CAD $10000 increase in neighborhood median income was associated with an 8% decline in the rate of total graft failure (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.87-0.97). After adjusting for recipient, donor, and transplant characteristics, SES was not significantly associated with total or death-censored graft failure. However, each CAD $10000 increase in neighborhood median income remained associated with a decline in the rate of death with a functioning graft (adjusted (a)HR, 0.91; 95% CI, 0.83-0.98), all-cause mortality (aHR, 0.92; 95% CI, 0.86-0.99), and all-cause hospitalization (aHR, 0.95; 95% CI, 0.92-0.98). CONCLUSIONS: In conclusion, in a universal healthcare system, SES may not adversely influence graft health, but SES gradients may negatively impact other kidney transplant outcomes and could be used to identify patients at increased risk of death or hospitalization.


Assuntos
Rejeição de Enxerto/epidemiologia , Disparidades nos Níveis de Saúde , Transplante de Rim/efeitos adversos , Mortalidade/tendências , Classe Social , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Seguimentos , Rejeição de Enxerto/terapia , Hospitalização/estatística & dados numéricos , Humanos , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
20.
PLoS One ; 13(12): e0209774, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30589885

RESUMO

OBJECTIVE: To compare access to healthcare services for people with disabilities to those without disabilities, within a national case-control study in Guatemala. METHODS: We undertook a population-based case-control study, nested within a national survey in Guatemala. Cases with disabilities were people with self-reported difficulties in functioning. One control without disabilities was selected per case, matched by age, gender and cluster. Information was collected on: health status, access to health services and rehabilitation, and socioeconomic status. RESULTS: The study included 707 people with disabilities, and 465 controls. People with disabilities were more likely to report a serious health problem (aOR 2.8, 2.2-3.7) or doctor-diagnosis of one of 17 general health conditions (aOR 2.9, 2.2-3.8) as compared to controls without disabilities. People with disabilities were twice as likely as controls to have received treatment for a diagnosed condition (aOR 2.2, 1.7-2.8). Coverage of treatment for impairment-related health conditions was low, as was awareness and access to rehabilitation services. People with disabilities were more likely than controls to report being disrespected (aOR 1.9, 1.0-3.7) or finding it difficult to understand information given (aOR 1.6, 1.1-1.4). CONCLUSION: Efforts are needed to raise awareness about rehabilitation services and improve quality of health services for people with disabilities in Guatemala, to ensure that their rights are fulfilled and to assist in the achievement of Universal Health Coverage. Better tools are needed to measure healthcare access, including consideration of geographic access, quality and affordability, to allow the generation of comparable data on access to healthcare among people with disabilities.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Guatemala , Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Classe Social , Adulto Jovem
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