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4.
Can J Public Health ; 112(2): 186-190, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33625685

RESUMO

Inspired by Fiset-Laniel et al.'s (2020) article entitled "Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada", we assessed public health investments since the establishment of the Nova Scotia provincial health authority in 2015. We analyzed Nova Scotia Department of Health and Wellness budgets from 2015-2016 to 2019-2020 and observed that less than 1% of funding was budgeted for public health annually, an amount well below the recommendation that 5-6% of healthcare funding be spent on public health. Healthcare spending has increased annually since 2015-2016, but proportions of funding to different programs and services have remained static. Specifically, we did not observe a change in investment in public health over time, suggesting that while the government does not necessarily spend too much or too little on healthcare, it spends far too little on public health. This chronic under-funding is problematic given the high rates of non-communicable diseases in Nova Scotia and health inequities experienced within the population. The 2020 COVID-19 pandemic has highlighted the importance of public health work, and the need for a pandemic recovery plan that prioritizes investment in all areas of public health in Nova Scotia.


Assuntos
Orçamentos/tendências , Financiamento Governamental/economia , Saúde Pública/economia , Disparidades nos Níveis de Saúde , Humanos , Doenças não Transmissíveis/epidemiologia , Nova Escócia/epidemiologia
8.
Acad Med ; 96(4): 558-567, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33332904

RESUMO

PURPOSE: This qualitative study examined fiscal and administrative (i.e., pre- and post-award grants process) barriers and facilitators to community-engaged research among stakeholders across 4 Clinical and Translational Science Awards (CTSA) institutions. METHOD: A purposive sample of 24 key informants from 3 stakeholder groups-community partners, academic researchers, and research administrators-from the CTSA institutions at the University of North Carolina at Chapel Hill, Medical University of South Carolina, Vanderbilt University Medical Center, and Yale University participated. Semistructured interviews were conducted in March-July 2018, including questions about perceived challenges and best practices in fiscal and administrative processes in community-engaged research. Transcribed interviews were independently reviewed and analyzed using the Rapid Assessment Process to facilitate key theme and quote identification. RESULTS: Community partners were predominantly Black, academic researchers and research administrators were predominantly White, and women made up two-thirds of the overall sample. Five key themes were identified: level of partnership equity, partnership collaboration and communication, institutional policies and procedures, level of familiarity with varying fiscal and administrative processes, and financial management expectations. No stakeholders reported best practices for the institutional policies and procedures theme. Cross-cutting challenges included communication gaps between stakeholder groups; lack of or limits in supporting community partners' fiscal capacity; and lack of collective awareness of each stakeholder group's processes, procedures, and needs. Cross-cutting best practices centered on shared decision making and early and timely communication between all stakeholder groups in both pre- and post-award processes. CONCLUSIONS: Findings highlight the importance of equitable processes, triangulated communication, transparency, and recognizing and respecting different financial management cultures within community-engaged research. This work can be a springboard used by CTSA institutions to build on available resources that facilitate co-learning and discussions between community partners, academic researchers, and research administrators on fiscal readiness and administrative processes for improved community-engaged research partnerships.


Assuntos
Pesquisa Participativa Baseada na Comunidade/economia , Pesquisa Participativa Baseada na Comunidade/estatística & dados numéricos , Relações Comunidade-Instituição , Financiamento Governamental/economia , Pesquisa Médica Translacional/economia , Pesquisa Médica Translacional/estatística & dados numéricos , Universidades/estatística & dados numéricos , Adulto , Connecticut , Feminino , Financiamento Governamental/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Pesquisa Qualitativa , South Carolina , Tennessee , Estados Unidos
9.
Front Public Health ; 8: 588852, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33364225

RESUMO

The COVID-19 pandemic has shocked the world causing more victims than the latest global epidemics such as Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) in 2003, and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012. Italy has been one of the most affected countries, and it had to deal with an already weak economic condition and cuts to public health services due to budgetary requirements from the last decade-something that made the situation even more dramatic. Deaths have exceeded 600.000 worldwide. During the emergency, regulatory measures were taken to counter the situation. This study highlights the main anti-COVID-19 government measures to support doctors and healthcare professionals, and it analyzes how to respond to the many requests complaining about neglectful healthcare professionals during the spread of the infection. For all those healthcare workers who died on duty, a compensation plan is assumed through a solidarity fund. The same solution cannot be granted to all patients, given the difficulty in assessing the responsibility of the doctor not only during an emergency but with insufficient instruments to cope with it as well.


Assuntos
Financiamento Governamental/economia , Pessoal de Saúde/estatística & dados numéricos , Política , Saúde Pública , /epidemiologia , Feminino , Humanos , Itália/epidemiologia , Masculino
12.
PLoS One ; 15(9): e0239118, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946474

RESUMO

INTRODUCTION: In 2012, bedaquiline became the first new treatment from a novel class to be approved for tuberculosis in nearly five decades and is now a core component of the standard of care for multidrug-resistant tuberculosis. In addition to the originator pharmaceutical company, Janssen, a range of governmental and non-profit entities have contributed to the development of bedaquiline. MATERIALS AND METHODS: We identified various avenues of public investments in the development of bedaquiline: direct funding of clinical trials and a donation programme, tax credits and deductions, and revenues resulting from the priority review voucher (PRV) awarded to the originator. Data on investments were gathered through contact with study leads and/or funders; for non-responses, published average costs were substituted. The originator company's expenses were estimated by similar methods. Tax credits and deductions were calculated based on estimated originator trial costs and donation expenses. The value of the PRV was estimated by application of a published model. RESULTS: Public contributions through clinical trials funding were estimated at US$109-252 million, tax credits at US$22-36 million, tax deductions at US$8-27 million, administration of a donation programme at US$5 million, PRV revenues at US$300-400 million. Total public investments were US$455-747 million and originator investments were US$90-240 million (if capitalized and risk-adjusted, US$647-1,201 million and US$292-772 million, respectively). CONCLUSIONS: Estimating the investments in the development of a medicine can inform discussions regarding fair pricing and future drug development. We estimated that total public investments exceeded the originator's by a factor of 1.6-5.1.


Assuntos
Antituberculosos/economia , Diarilquinolinas/economia , Desenvolvimento de Medicamentos/economia , Financiamento Governamental/economia , Organizações sem Fins Lucrativos/economia , Antituberculosos/uso terapêutico , Ensaios Clínicos como Assunto/economia , Diarilquinolinas/uso terapêutico , Custos de Medicamentos , Indústria Farmacêutica/economia , Humanos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico
13.
Am J Public Health ; 110(10): 1472-1475, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816543

RESUMO

Following the devastation of the Greater New Orleans, Louisiana, region by Hurricane Katrina, 25 nonprofit health care organizations in partnership with public and private stakeholders worked to build a community-based primary care and behavioral health network. The work was made possible in large part by a $100 million federal award, the Primary Care Access Stabilization Grant, which paved the way for innovative and sustained public health and health care transformation across the Greater New Orleans area and the state of Louisiana.


Assuntos
Redes Comunitárias/tendências , Tempestades Ciclônicas , Reforma dos Serviços de Saúde/organização & administração , Atenção Primária à Saúde , Assistência à Saúde/estatística & dados numéricos , Desastres , Financiamento Governamental/economia , Humanos , Louisiana , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências
15.
PLoS One ; 15(7): e0236332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702048

RESUMO

INTRODUCTION: Adequate and sustainable funding of national medicine regulatory agencies (NMRAs) is key for assurance of quality, safety and efficacy of medical products circulating in a market. The study aimed to determine factors affecting NMRAs funding in five East African Community (EAC) countries namely: Burundi, Kenya, Rwanda, Tanzania (Mainland and Zanzibar) and Uganda. METHODOLOGY: An exploratory, mixed method design using both qualitative and quantitative data, was employed. Data from six NMRAs was collected through a combination of semi-structured interviews, questionnaires, and checklists for the period 2011/12-2014/15 while 2010/11 data served as baseline. Interviews were conducted with heads of NMRAs and monitoring and evaluation experts of the respective agencies. NMRA's financing was assessed using six indicators namely, funding policy, financial autonomy, the total annual budget, actual funding per annum, funds received from various sources, and the NMRA expenditure. RESULTS: The average total annual budget for all the EAC countries during the study period 2011-2015 ranged from USD 824,328.67 to USD 10,724,536.50. The low budget in Zanzibar may be attributed to population and pharmaceutical market size. Uganda's attainment of 98.75% (USD 10,656,704) revenue from industry fees is a result of deliberate government policy change from 100% reliance on donor funding over a period of 10 years (1995-2015). On average, the proportion of revenue against budget per annum is 54.8% (USD 458,970.11), 98.7% (USD 10,302,295.25) and 100% (USD 7,375,802.08) for Zanzibar Food & Drugs Agency (ZFDA), Uganda National Drug Authority (NDA) and Tanzania Medicines and Medical Devices Authority (TMDA) respectively. Governments, industry fees and donors are the major sources of funding across all NMRAs in the EAC region, with TMDA and Uganda NDA relying more on industry fees by 73.20% (USD 4,664,777.59) and 98.25% (USD 8,077,238.20) respectively. While Burundi relies solely on government funding, ZFDA, on the other hand, received on average 50.40% (USD 252,557.22) from government and 40.60% (USD 165,303.34) from industry fees and the remaining 9% from donors and other sources. An overall contribution of funds received from donors by each NMRA was the least among other sources of financing. Observation of expenditure patterns indicated operational costs to be the major expense in the majority of the NMRAs, followed by salaries and infrastructure development. The Kenya NMRA has the highest degree of average expenditure across all three categories, with the least average expenditures being marked by Burundi NMRA. The operational costs on average increased considerably in all the NMRAs during the study period. CONCLUSION: Evidence from the EAC suggests that government and industry fees are the main sources of funding while donor contributions vary from country to country. Government policy, legal framework, and fees structure are the key enablers of NMRAs funding sustainability.


Assuntos
Orçamentos , Financiamento Governamental/economia , Gastos em Saúde , Serviços de Saúde/economia , Burundi , Países em Desenvolvimento/economia , Humanos , Quênia , Ruanda , Tanzânia , Uganda
17.
Artigo em Inglês | MEDLINE | ID: mdl-32560518

RESUMO

To solve information asymmetry, we adopted the principal-agent framework to design the incentive mechanisms between the remanufacturer and the collector in the construction and demolition (C&D) waste-recycling industry. By using the model of reciprocity, we analyzed how the entities' behavioral motives affect their decisions in terms of the incentive mechanisms. The findings showed that the collector responds to their perception of the remanufacturer's intentions. If the perception is positive, they will make more effort in the collection work. If not, less effort will be put forth. Most importantly, we found that reciprocity helps to save the remanufacturer cost in the incentive mechanisms and makes the collector choose a higher effort level in the collection work. This finding showed that reciprocity serves to solve information asymmetry. By conducting a numerical simulation, we found that although a high subsidy policy can achieve rapid improvement of recycling-supply-chain performance, it is inefficient in maintaining friendly cooperation between the remanufacturer and the collector.


Assuntos
Indústria da Construção/economia , Comportamento Cooperativo , Financiamento Governamental/economia , Resíduos Industriais/economia , Reciclagem/economia , Eliminação de Resíduos/economia , Materiais de Construção/economia , Tomada de Decisões , Financiamento Governamental/organização & administração , Intenção , Modelos Organizacionais , Modelos Teóricos , Princípios Morais , Motivação , Gerenciamento de Resíduos/economia
18.
G Ital Nefrol ; 37(3)2020 Jun 10.
Artigo em Italiano | MEDLINE | ID: mdl-32530146

RESUMO

The aim of this editorial is to illustrate the new public funding framework of the Italian National Health System following the Covid-19 pandemic. The document reviews the measures put in place by the Italian Government and European Institutions such as the European Commission (EC), the European Central Bank (ECB) and the European Stability Mechanism (ESM) to deal with this health crisis and subsequent severe economic recession, with particular reference to sources and uses of resources. The use of new budgetary financial spaces in deficit entails greater attention to the assessment of interventions and makes it necessary to keep expenditure under strict control. At the same time, the remodeling of expenditure within its aggregates, public investment in innovation, and the removal of administrative obstacles can strengthen the capacity of the healthcare system to meet the extraordinary needs deriving from the spread of Covid-19 and its resilience to future health shocks.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/economia , Financiamento Governamental/economia , Programas Nacionais de Saúde/economia , Pandemias/economia , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/economia , Recessão Econômica , Europa (Continente) , Gastos em Saúde , Recursos em Saúde , Humanos , Itália/epidemiologia , Pneumonia Viral/economia , Saúde Pública
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