Maintaining essential health services during a pandemic: lessons from Costa Rica's COVID-19 response.

Studies on COVID-19 usually focus on health system responses to decrease the rate of COVID-19 infection and death, but patients with other diseases also require access to health services during the pandemic. This paper describes the structures and processes by which the Costa Rican Social Security Fund (CCSS) changed in response to the COVID-19 pandemic, which helped to sustain essential health services (EHSs). We conducted a desk review of the local literature and semistructured qualitative interviews with key informants from the CCSS. We found that the CCSS implemented changes in structure, such as creating a specialised COVID-19 centre and hiring additional interim health workers. The CCSS also implemented changes in processes, including leveraging its integrated network to optimise its resources and support alternative care modalities. These changes generated changes in outputs and outcomes that helped sustain EHSs for non-COVID-19 patients. These interventions were possible primarily due to Costa Rica's underlying health system, particularly its integrated nature with a single institution in charge of healthcare provision financed through mandatory health insurance, a unique digital medical record system and a contingency fund.

[Patient safety training for ward clerks of an Occupational Mutual Insurance Company collaborating with the Social Security, immediate impact and after six months]. / Formación en seguridad del paciente para el personal administrativo de una Mutua Colaboradora con la Seguridad Social, impacto inmediato y a los seis meses.

INTRODUCTION: Ward Clerks are an essential part of the healthcare team, as they provide administrative and organizational support in healthcare institutions. The aim of this study is to determine the training impact of a basic one-hour online course on patient safety for this staff. METHOD: A quasi-experimental before/after study carried out on a population of 170 administrative staff working in the centers of an Occupational Mutual Insurance Company (MC Mutual) who took the patient safety course. A convenience sample of 22 administrative professionals, who agreed to participate, was chosen from this population, which made it possible to reconstruct their knowledge before and after the course, by examination and interview, immediately after the course and at 6 months. RESULTS: Of the 170 professionals participating in the course, 167 (98.2%) completed the initial test and the post-test, with mean scores increasing from 5.7 (P1) to 7.3 (P2) (p<0.05). A total of 22 out of a sample of 42 (52.4%) agreed to participate in the interviews and all three interviews were achieved by 21 (E1), 22 (E2) and 19 (E3) professionals, whose mean scores increased from 5.9 (E1) to 7.2 (E2) and 7.5 (E3) (p<0.05). CONCLUSIONS: The results suggest that the training course was effective. The evaluation by interview 6 months after the course indicates a likely medium to long term effect. The involvement of administrative professionals in the the Company´s patients care is key. Evaluating the impact of an intervention is essential to inform its effectiveness and guide its planning.

Introducción: El personal administrativo es un colectivo esencial. El objetivo de este estudio es analizar el impacto formativo de un curso online básico sobre seguridad del paciente para administrativos.  Método: Estudio cuasi experimental antes/después en una población de 170 administrativos/as que prestaban sus servicios en los centros de la Mutua Colaboradora con la Seguridad Social MC Mutual y que realizaron un curso de seguridad del paciente. Se evaluaron los conocimientos adquiridos mediante una prueba al inicio (P1) y al final del curso (P2). Además, se eligió una muestra de conveniencia de 42 administrativos/as para evaluar sus conocimientos mediante entrevista, previos (E1) y posteriores (E2) al curso, y a los 6 meses (E3). Resultados: De los 170 administrativos/as participantes en el curso, 167 (98,2%) completaron la prueba al inicio y final, con puntuaciones medias que incrementaron de 5,7 (P1) a 7,3 (P2) (p<0,05). Aceptaron participar en las entrevistas 22 administrativos/as de una muestra de 42 (52,4%), y se consiguieron las tres entrevistas de 21 (E1), 22 (E2) y 19 (E3) administrativos/as, cuyas puntuaciones medias incrementaron desde 5,9 (E1) a 7,2 (E2) y 7,5 (E3) (p<0,05).  Conclusiones: Los resultados sugieren que el curso de formación fue efectivo. La evaluación mediante la entrevista a los seis meses del curso indica un probable efecto a medio-largo plazo. La implicación de los/as profesionales administrativos/as en la atención a los usuarios de la Mutua es clave. La evaluación del impacto de una intervención es esencial para informar sobre su efectividad y orientar su planificación.

Slipping Through the Gap: Exploring the Influence of Social Health Insurance on Access to Healthcare for Older Migrant Workers.

Objectives: Older migrant workers (OMWs) frequently confront barriers to accessing care, as their Social Health Insurance (SHI) coverage may not extend beyond their hometown. This study seeks to investigate whether Chinese OMWs can still derive benefits from SHI in accessing healthcare services, even when their SHI is not registered in the same location as their current residence. Methods: This study used data from 2015 China Migrants Dynamic Survey and focused on OMWs aged 60 years and older (N = 3,050). Logistic regression models were employed to investigate the factors influencing healthcare use. Results: Having SHI registered in current place of residence and interprovincial migration were significantly associated with increased likelihoods of doctor visits among OMWs. However, inpatient services use did not appear to be associated with the SHI registration place and migration range. Conclusion: Chinese OMWs derive fewer benefits from SHI in accessing healthcare services when their SHI is not registered in current residence. Governments in Low- and Middle-Income Countries should consider implementing targeted policies to provide adequate protection for OMWs and expand the coverage of direct reimbursement for cross-province healthcare services.

Factors Related to the Evaluation of Essential Medicines Use in Health Facilities in Indonesia

Background: Indonesia has recently implemented a national policy to ensure equitable access to medicines, promote their rational use, and maintain a reliable and quality supply, specifically for essential medicines. Several organizations have conducted evaluations on essential medicines use but have yielded varying results and cannot reflect the actual situation. Objectives: This study aims to discover the current situation regarding essential medicines and identify the most important factors to be considered during future indicator-based evaluations in health facilities in Indonesia. Methods: This qualitative study was carried out using FGDs and interview from January to February 2022. The sample population consisted of ten experts selected based on predetermined criteria. The discussions were recorded and transcribed verbatim in the original language, thematically coded with Nvivo, and analyzed for common themes. Results: This study found 32 factors related to the use of essential medicines in Indonesia, divided into three categories of components, namely access, medicine handling quality, and rational use. Furthermore, a total of 10, 8, and 14 main factors were related to access, handling quality, and rational use, respectively. The discussion provided various perspectives on measuring drug use, specifically essential medicines. Based on expert opinions, evaluating the utilization of essential medicines by relying on existing guidelines was insufficient due to superficiality and irrelevance within the Indonesian health system. Conclusion: Based on the results, one of the crucial factors to consider during evaluation was the accessibility of medicines, which encompassed their availability in health facilities and affordability to patients... (AU)

Willingness to pay for Social Health Insurance and associated factors among Public Civil Servants in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: The provision of equitable and accessible healthcare is one of the goals of universal health coverage. However, due to high out-of-pocket payments, people in the world lack sufficient health services, especially in developing countries. Thus, many low and middle-income countries introduced different prepayment mechanisms to reduce large out-of-pocket payments and overcome financial barriers to accessing health care. Though many studies were conducted on willingness to pay for social health insurance in Ethiopia, there is no aggregated data at the national level. Therefore, this systematic review and meta-analysis aimed to estimate the pooled magnitude of willingness to pay for social health insurance and its associated factors among public servants in Ethiopia. METHOD: Studies conducted before June 1, 2022, were retrieved from electronic databases (PubMed/Medline, Science Direct, African Journals Online, Google Scholar, and Web of Science) as well as from Universities' digital repositories. Data were extracted using a data extraction format prepared in Microsoft Excel and the analysis was performed using STATA 16 statistical software. The quality of the included studies was assessed using the Newcastle-Ottawa Scale for cross-sectional studies. To evaluate publication bias, a funnel plot, and Egger's regression test were utilized. The study's heterogeneity was determined using Cochrane Q test statistics and the I2 test. To determine the pooled effect size, odds ratio, and 95% confidence intervals across studies, the DerSimonian and Laird random-effects model was used. Subgroup analysis was conducted by region, sample size, and publication year. The influence of a single study on the whole estimate was determined via sensitivity analysis. RESULT: To estimate the pooled magnitude of willingness to pay for the Social Health insurance scheme in Ethiopia, twenty articles with a total of 8744 participants were included in the review. The pooled magnitude of willingness to pay for Social Health Insurance in Ethiopia was 49.62% (95% CI: 36.41-62.82). Monthly salary (OR = 6.52; 95% CI:3.67,11.58), having the degree and above educational status (OR = 5.52; 95%CI:4.42,7.17), large family size(OR = 3.69; 95% CI:1.10,12.36), having the difficulty of paying the bill(OR = 3.24; 95%CI: 1.51, 6.96), good quality of services(OR = 4.20; 95%CI:1.97, 8.95), having favourable attitude (OR = 5.28; 95%CI:1.45, 19.18) and awareness of social health insurance scheme (OR = 3.09;95% CI:2.12,4.48) were statistically associated with willingness to pay for Social health insurance scheme. CONCLUSIONS: In this review, the magnitude of willingness to pay for Social Health insurance was low among public Civil servants in Ethiopia. Willingness to pay for Social Health Insurance was significantly associated with monthly salary, educational status, family size, the difficulty of paying medical bills, quality of healthcare services, awareness, and attitude towards the Social Health Insurance program. Hence, it's recommended to conduct awareness creation through on-the-job training about Social Health Insurance benefit packages and principles to improve the willingness to pay among public servants.

[Social security disability assessments: validity tests are useful]. / Verzekeringsgeneeskundige oordeelsvorming.

Social security disability assessors are required to objectively quantify disability with regards to potential ability to work. Difficulties arise when assessments need to be performed in the absence of objective medical data relying solely on self-report regarding subjective health complaints. In such cases, validity tests provide a useful tool during an assessment. This case report illustrates this through the outcomes of 3 disability assessments.

[The precarious balance of Gestalt change due to Franco Basaglia.] / Il precario equilibrio del cambio di Gestalt dovuto a Franco Basaglia.

Franco Basaglia's passionate battle to change the state of psychiatric care in Italy resembles the experiences we know as "Gestalt change". The health and well-being of the community, both family and social, constituted the dominant figure in the scenario of psychiatric disorders; the person of the sick person - and thus his rights, his dignity… - slipped into the background. The very health of the mentally ill person was seen as a function of social security. Health, that is, the very life of the person with psychiatric problems, became the object of our social gaze. Gestalt changes occur by slow and arduous cultural transformation. Just think of the not yet completed process of change in the relationship of male and female gender roles. However: Gestalt changes are not stable; the risk is that suddenly the figure we thought we had acquired forever becomes diluted, becoming background again. This uneasy balance suggests to exercise continuous vigilance.

Process Evaluation of a Motivational Interviewing Intervention in a Social Security Setting: A Qualitative Study among Work-Disabled Patients.

Purpose Return to work (RTW) may be facilitated by motivational interviewing (MI), a counseling style designed to increase motivation towards behavior change. MI's relevance in a RTW context remains however unclear. Exploring how, for whom and in what circumstances MI works is therefore necessary. Methods Eighteen people (29-60 years; sick leave > 12 weeks) with low back pain (LBP) or medically unexplained symptoms (MUS) participated in a semi-structured interview after one MI consultation. We conducted a realist-informed process evaluation to explore MI's mechanisms of impact, its outcomes and how external factors may influence these. Data were coded using thematic analysis. Results Main mechanisms were supporting autonomy, communicating with empathy and respect, facilitating feelings of competence and focusing on RTW solutions instead of hindrances. Competence support was more salient among LBP patients, whereas MUS patients benefited more from empathy and understanding. External factors were mentioned to have impacted MI's effectiveness and/or the further RTW process, being personal (e.g. acceptance of the condition), work-related (e.g. supervisor support) and societal (e.g. possibility of gradual RTW). Conclusions These results stress the importance of self-determination theory's support for autonomy, relatedness and competence, together with a solution-focused approach when stimulating patients' engagement regarding RTW. These mechanisms' instalment during RTW counseling and their long-term impact depends on both personal and system-like external factors. Belgium's social security system's premise, based on control, might actually hinder RTW instead of facilitating it. Further longitudinal research could explore MI's long-term effects as well as its complex interaction with external factors.

The Impacts of the COVID-19 Pandemic on Receipt of Needed Medical Care and At-Home Support among U.S. Households Receiving Supplemental Security Income and Social Security Disability Insurance on the Basis of Disability.

More than 8.1 million Americans with disabilities qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Individuals with disabilities were particularly vulnerable to COVID-19, which may have altered individual and household behavior. Research on the impact of COVID-19 on individuals with disabilities and their families remains limited. Authors analyzed 2020 National Health Interview Survey data. Logistic regression models were applied, controlling for the effects of age, race, sex, income, education, employment, and health status. Households with SSI/SSDI beneficiaries with disabilities were associated with significantly greater odds of delaying or forgoing medical care and receiving needed personal and household care at home due to COVID-19 compared with households without beneficiaries. The health and well-being of households with individuals with disabilities may require more robust and inclusive social work initiatives that aim to reduce adverse pandemic impacts.

Policy interplay among social health insurance system, pension system, delayed retirement initiative and implications for the self-rated health status of older workers.

Delayed retirement initiative proposed in China attaches greater importance to the sustainability of pension systems and the labour shortage, but less to the health status of older people. The existing social health insurance and pension system are not well established to match this initiative. This study investigates the policy mix of delayed retirement, employment-based social health insurance, social pension participation for health status of older people. Results of the data from the China Health and Retirement Longitudinal Study (CHARLS-2018) show that late retirement could benefit health status among older adults. Moreover, such effect of late retirement appears more salient for those uninsured by employment-based social health insurance and those still in the pension contribution phase upon reaching the statutory retirement age. Hence, in countries with inadequate health insurance and pension systems, such as China, delayed retirement may serve as an important alternative to social security for the health of older people.

Elucidating Harm Reduction Principles in a Client-Centered Representative Payee Program.

Harm Reduction seeks to mitigate harms associated with health behaviors without the expectation that these behaviors be extinguished completely. Client-Centered Representative Payee (CCRP) is an intervention that modifies the US Social Security Administration's (SSA) Representative Payee policy by incorporating relational harm reduction. We used Human-Centered Design (HCD) methods to elucidate ways that harm reduction principles are present in and integral to CCRP and to create a blueprint for replication. Thirteen individuals familiar with CCRP brainstormed 88 statements, which were parsed, consolidated, and then independently assigned by a subgroup of participants to six principles of harm reduction. After refining the data, 29 statements aligning with harm reduction principles remained. Delineating harm reduction within CCRP, which can empower and establish trust with clients, may help other providers identify how to offer representative payee services that are respectful, compassionate, rooted in harm reduction, and ultimately improve client outcomes.

Como a pandemia de COVID-19 afetou a notificação de acidentes do trabalho em diferentes atividades econômicas e ocupações no Brasil? Um estudo ecológico usando o p-score / How did the COVID-19 pandemic affect occupational accident notification in different economic activities and occupations in Brazil? An ecological study using p-score

Resumo Objetivo: mensurar o impacto da pandemia de COVID-19 nas notificações de acidentes do trabalho (AT) no Brasil, por atividade econômica e ocupação. Métodos: estudo ecológico que utilizou os casos de AT registrados entre 2015 e 2020 no Anuário Estatístico da Previdência Social. Os AT foram analisados por setor de atividade econômica, ocupação e códigos da 10ª revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10). Uma adaptação do p-score foi aplicada para comparar os casos de AT pré-pandemia com os do primeiro ano da pandemia. Resultados: os p-scores variaram de -60,2%, para AT por nexo técnico epidemiológico, a -13,9%, para AT típico. As doenças do trabalho apresentaram p-score de 151,1%. Houve aumento notável nos casos de doenças ocupacionais dos capítulos I e X da CID-10. As notificações de AT diminuíram em todas as categorias de atividades econômicas, exceto nas de saúde humana e serviços sociais (p-score = 8,0%). Na maioria das categorias, os valores foram negativos, exceto nos subgrupos forças de segurança e profissionais de saúde de nível superior, técnico e gestores. Conclusão: houve redução geral na notificação de AT durante a pandemia de COVID-19 no Brasil, que evidenciou desigualdades entre diferentes setores de atividades e ocupações, além de mudança no perfil de adoecimento dos trabalhadores.

Abstract Objective: to assess the COVID-19 pandemic impact on Occupational Accident (OA) notifications in Brazil by economic activity and occupation. Methods: an ecological study was conducted using OA cases recorded in the Statistical Yearbook of Social Security from 2015 to 2020. Accidents were analyzed by sector of economic activity, occupation, and ICD-10 codes. Pre-pandemic cases were compared with the first year of the public health emergency scenario caused by Sars-Cov-2 using an adapted p-score. Results: p-scores ranged from -60.2% for technical-epidemiological Occupational Accidents to -13.9% for typical OA. Occupational diseases had a p-score of 151.1%. Cases of occupational diseases from ICD-10 chapters I and X showed a significant increase. OA notifications decreased in all CNAE sections, except for human health and social services activities (p-score = 8.0%). P-score values were negative in most CBO categories, except in subgroups such as security forces and high-level health professionals, technicians, and managers. Conclusion: Brazil registered a general reduction in OA notifications due to the pandemic, which evinced inequalities in different sectors and occupations, as well as changes in the illness profile of workers.

Regarding the article "Cost analysis of drug treatment in hypertensive patients at social security health care family medicine units".

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Determinants of retirement of formal and informal sector workers in Mexico: the role of health and economic security.

OBJECTIVE: We examine the socioeconomic and health drivers of retirement decisions and compare these determinants between formal and informal sector workers in Mexico. MATERIALS AND METHODS: Using data from the Mexican Health and Aging Study 2012 and 2015, we estimate conditional probit models of retirement using sociodemographic, health, health care utilization, health insurance, private pensions, and social security systems covariates. The Institutional Review Board at the University of Southern California reviewed and approved the research (IRB # UP-15-00023). RESULTS: We find that the social security systems are an important determinant for retirement age for formal sector workers. The informal sector workers, who lack access to retirement benefits of the social security system, make retirement decisions mainly based on health and access to health insurance through social security. CONCLUSION: Despite the lack of access to social security benefits, informal sector workers do not respond strongly to socioeconomic factors in determining the timing of retirement. Strengthening access to better health care services could improve health, extend working lives, and promote healthy aging for workers in the informal sector.

Association between the changes in socialsecurity continuity condition and mortality: MHAS 2001-2018 analysis.

OBJECTIVE: To analyze the association of changes in social security (SS) continuity and mortality, using the Mexican Health and Aging Study (MHAS) in people aged 60 years and more. MATERIALS AND METHODS: Retrospective cohort. We analyzed the SS continuity condition -classified as stable, unstable with SS, unstable without SS, and without SS- and its relation with mortality; a probit regression model was utilized to obtain marginal effects, taking into consideration covariates related to mortality. RESULTS: Unstable continuity with and without SS and multimorbidity (two or more diseases) increased the probability of dying by 52.9% (p = 0.000, 95%CI: 0.508,0.551), 50.3% (p = 0.000, 95%CI: 0.474,0.531) and 13.3% (p = 0.000, 95%CI: 0.108,0.159), respectively. Meanwhile, being woman, at least one year of formal education, and marriage reduced it in 8.8% (p = 0.000, 95%CI: -0.106,-0.071), 7% (p = 0.000, 95%CI: -0.091,-0.050) and 7.8% (p = 0.000, 95%CI: -0.096,-0.061), respectively. CONCLUSION: Belonging to SS was associated with higher mortality, compared to other social health determinants, like education.

Social Health Insurance and Healthcare Seeking Behavior in Urban Ethiopia.

Background: After years of planning, in 2024 the government of Ethiopia proposes to introduce a compulsory Social Health Insurance (SHI) program for formal sector employees. The proposed scheme will provide access to contracted healthcare facilities at a premium of 3% of the gross monthly income of employees with another 3% coming from the employer. Objectives: Several studies have examined the willingness to pay (WTP) this premium, however, little is known about the healthcare seeking behavior (HSB) of formal sector employees. This paper investigates both - the determinants of healthcare seeking behavior and among other aspects, WTP the premium. Through these explorations, the paper sheds light on the potential challenges for implementation of SHI. Methods: Descriptive statistics, logit, and multinomial logit (MNL) models are used to analyze retrospective survey data (2,749 formal sector employees) which covers the major regions of the country. Findings: Regarding outpatient care, a majority of the visits (55.9%) were to private healthcare providers. In the case of inpatient care, it was the opposite with a majority of healthcare seekers visiting public sector hospitals (62.5%). A majority of the sample (67%) supported the introduction of SHI but only 24% were willing to pay the proposed SHI premium. The average WTP was 1.6% of gross monthly income. Respondents in the two richest income quintiles were more likely to oppose SHI and consider it unfair. Conclusion: The prominent role of the private sector and the resistance to SHI amongst the two richest income quintiles, suggests that the SHI program needs to actively include private healthcare facilities within its ambit. Additionally, concerted efforts at enhancing the quality of care available at public health facilities, both, in terms of perception and patient-centered care and addressing drug and equipment availability bottlenecks, are needed, if SHI is to garner wider support.

Occupational accident indicators among Social Security beneficiaries: temporal trend and magnitude in Brazil and its regions, 2009-2019.

OBJECTIVE: To evaluate the temporal trend and magnitude of occupational accident indicators among Social Security beneficiaries in Brazil and its regions from 2009 to 2019. METHODS: A time series study was conducted on occupational accident indicators in the regions of Brazil, from 2009 to 2019. Data were retrieved from the Statistical Yearbook of Occupational Accidents and the Statistical Yearbook of Social Security. Prais-Winsten generalized linear regression models were used to estimate trends, and annual percentage change and their respective 95% confidence intervals were obtained. RESULTS: There were 7,253,923 occupational accidents during the study period. The average incidence rate was 16.3 per 1,000 employment relationships, with a decreasing trend (APC = 4.3%; 95%CI -5.63;-3.26). CONCLUSION: Brazil and its regions showed an overall decreasing trend in indicators representing morbidity burden and the magnitude of occupational accidents. MAIN RESULTS: In Brazil, despite regional inequalities, there has been a decrease in occupational accident rates reported to Social Security. IMPLICATIONS FOR SERVICES: The results suggest improvements in working conditions, control and prevention of occupational accidents among these workers and contribute to targeting measures to prevent and control these diseases in the regions with the highest incidence. PERSPECTIVES: Further research could explore trends according to professional category and economic activity sector, aimed at improving the monitoring of safety conditions and the wellbeing of workers in the regions of Brazil.

Psychological screening, providing social security or strengthening training? How can government and labor unions protect the mental health of young employees.

As the mental health problems of young employees become more and more prominent, the government and labor unions need to take measures to protect the mental health of young employees. Considering that the main mental health safeguard measures are divided into psychological screening, providing social security and strengthening training, this article constructs a differential game model under these three modes. The balanced efforts and social benefits of the government and labor unions under the three modes are obtained, and the applicable conditions of various mental health protection modes are compared. The results show that if the government pays a lower cost, the government gets the highest economic benefit under the training mode, followed by the security mode, and the government gets the lowest economic benefit under the psychological screening mode. If the reputation of the labor unions improved by its efforts is low, the equilibrium benefits of the labor unions under psychological screening and providing security are the same, and greater than the equilibrium benefits under the intensive training mode. If the labor unions have a higher reputation enhanced by its efforts, the balance return of the labor unions under the guarantee mode is the highest, followed by the balance return under the intensive training mode, and the balance return of the labor unions under the psychological screening mode is the lowest.

Economic Inequality, Social Determinants of Health, and the Right to Social Security.

This paper discusses economic inequality as a key social determinant of health. It highlights the potentially transformative role of social protection systems in addressing economic inequality and health inequalities. How to finance social protection and how to distribute benefits among people are key questions in the pursuit of a transformative social protection system that can adequately tackle economic inequalities. This paper argues that a human rights approach can provide a normative orientation in the political process that decides the distribution of burdens and benefits in relation to social protection, calling for an assessment of its impact on socioeconomic inequalities and on disadvantaged groups of people. While the right to social security is at the center of a human rights approach to social protection, the rights to health, education, housing, and work also provide important normative elements for social protection. A human rights-based social protection system requires comprehensive protection for major social risks and challenges throughout the life cycle; universal access to quality services such as health, education, child care, and services for older people or people with disabilities; and a progressive financing mechanism. In this regard, the International Labour Organization's Social Protection Floors Recommendation No. 202 provides strong guidance on the implementation of the right to social security for all.