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Universal health coverage

Stéphane Verguet, Solomon Tessema Memirie, Ole Frithjof Norheim
BACKGROUND: Out-of-pocket (OOP) medical expenses often lead to catastrophic expenditure and impoverishment in low- and middle-income countries. Yet, there has been no systematic examination of which specific diseases and conditions (e.g., tuberculosis, cardiovascular disease) drive medical impoverishment, defined as OOP direct medical costs pushing households into poverty. METHODS: We used a cost and epidemiological model to propose an assessment of the burden of medical impoverishment in Ethiopia, i...
October 21, 2016: BMC Medicine
Paibul Suriyawongpaisal, Wichai Aekplakorn, Samrit Srithamrongsawat, Chaisit Srithongchai, Orawan Prasitsiriphon, Rassamee Tansirisithikul
BACKGROUND: Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. METHODS: Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review), we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001...
October 21, 2016: BMC Health Services Research
Jianhua Chen, Hai Yu, Hengjin Dong
BACKGROUND: Many countries are developing health mechanisms to pursue the goal of universal coverage. In China, a rural health insurance system entitled New Cooperative Medical System (NCMS) has being developed since 2003. This paper aims to explore the changes in the health service needs and utilization among rural residents in Ningbo, China after the implementation of the new rural cooperative medical system (NCMS), and provide evidence to further improve the strategies of NCMS in China...
October 20, 2016: BMC Health Services Research
Gifty Apiung Aninanya, Natasha Howard, John E Williams, Benjamin Apam, Helen Prytherch, Svetla Loukanova, Eunice Karanja Kamara, Easmon Otupiri
BACKGROUND: Lack of an adequate and well-performing health workforce has emerged as the biggest barrier to scaling up health services provision in sub-Saharan Africa. As the global community commits to the Sustainable Development Goals and universal health coverage, health workforce challenges are critical. In northern Ghana, performance-based incentives (PBIs) were introduced to improve health worker motivation and service quality. OBJECTIVE: The goal of this study was to determine the impact of PBIs on maternal health worker motivation in two districts in northern Ghana...
2016: Global Health Action
Andrea Sprockett
Measuring and tracking the quality of healthcare is a critical part of improving service delivery, clinic efficiency and health outcomes. However, no standardized or widely accepted tool exists to assess the quality of clinic-based family planning services in low- and middle-income countries. The objective of this literature review was to identify widely used public domain quality assessment tools with existing or potential application in clinic-based family planning programmes. Using PubMed, PopLine, Google Scholar and Google, key terms such as 'quality assessment tool', 'quality assessment method', 'quality measurement', 'LMIC', 'developing country', 'family planning' and 'reproductive health' were searched for articles, identifying 20 relevant tools...
October 13, 2016: Health Policy and Planning
Md Sadik Pavel, Sayan Chakrabarty, Jeff Gow
BACKGROUND: A central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness. In a low income country like Bangladesh the cost burden of health care in tertiary facilities is likely to be significant for most citizens. This cost of an episode of illness is a relatively unexplored policy issue in Bangladesh. The objective of this study was to estimate an outpatient's total cost of illness as result of treatment in private and public hospitals in Sylhet, Bangladesh...
October 10, 2016: International Journal for Equity in Health
Adam Fusheini, John Eyles
BACKGROUND: Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy...
October 7, 2016: BMC Health Services Research
Till Bärnighausen, David E Bloom, Salal Humair
Shortages of human resources for treating HIV/AIDS (HRHA) are a fundamental barrier to reaching universal antiretroviral treatment (ART) coverage in developing countries. Previous studies suggest that recruiting HRHA to attain universal ART coverage poses an insurmountable challenge as ART significantly increases survival among HIV-infected individuals. While new evidence about ART's prevention benefits suggests fewer infections may mitigate the challenge, new policies such as treatment-as-prevention (TasP) will exacerbate it...
2016: PloS One
Ileana Vilcu, Lilli Probst, Bayarsaikhan Dorjsuren, Inke Mathauer
BACKGROUND: Many low- and middle-income countries with a social health insurance system face challenges on their road towards universal health coverage (UHC), especially for people in the informal sector and vulnerable population groups or the informally employed. One way to address this is to subsidize their contributions through general government revenue transfers to the health insurance fund. This paper provides an overview of such health financing arrangements in Asian low- and middle-income countries...
October 4, 2016: International Journal for Equity in Health
Jennifer A Price, Ana I F Sousa Soares, Augustine D Asante, Joao S Martins, Kate Williams, Virginia L Wiseman
BACKGROUND: Despite public health care being free at the point of delivery in Timor-Leste, wealthier patients access hospital care at nearly twice the rate of poorer patients. This study seeks to understand the barriers driving inequitable utilisation of hospital services in Timor-Leste from the perspective of community members and health care managers. METHODS: This multisite qualitative study in Timor-Leste conducted gender segregated focus groups (n = 8) in eight districts, with 59 adults in urban and rural settings, and in-depth interviews (n = 8) with the Director of community health centres...
September 30, 2016: BMC Health Services Research
Yves Jackson, Juan Carlos Lozano Becerra, Marc Carpentier
BACKGROUND: Socioeconomic disadvantage is associated with an increased risk of adverse diabetes outcomes. In Switzerland, a country with theoretical universal healthcare coverage, people without health insurance face barriers in accessing to and in receiving standard quality care. The Geneva University Hospitals (HUG) have implemented policies aiming at reducing these gaps. We compared quality of diabetes care and ambulatory healthcare services utilization among insured and uninsured diabetic patients...
October 3, 2016: BMC Health Services Research
Yvonne Tam, Luis Huicho, Carlos A Huayanay-Espinoza, María Clara Restrepo-Méndez
BACKGROUND: Peru has made great improvements in reducing stunting and child mortality in the past decade, and has reached the Millennium Development Goals 1 and 4. The remaining challenges or missed opportunities for child survival needs to be identified and quantified, in order to guide the next steps to further improve child survival in Peru. METHODS: We used the Lives Saved Tool (LiST) to project the mortality impact of proven interventions reaching every women and child in need, and the mortality impact of eliminating inequalities in coverage distribution between wealth quintiles and urban-rural residence...
October 4, 2016: BMC Public Health
Carlos E Pinzón Flórez, Evelina Chapman, Ulysses Panisset, Armando Arredondo, James Fitzgerald, Ludovic Reveiz
Objective The objective of this study was to identify the availability of health indicators for validly measuring advances in the attainment of "universal health" in Latin America and the Caribbean (LAC). Methods A systematic search was undertaken for scientific evidence and available technical and scientific documents on assessing health system performance and advances in universal health in the following phases: phase 1, mapping of indicators; phase 2, classification of indicators; and phase 3, mapping the availability of selected indicators in LAC...
June 2016: Revista Panamericana de Salud Pública, Pan American Journal of Public Health
Egdda Patricia Vanegas, Ángela Patricia Acosta, Claudia Patricia Vaca González, José Julián López Gutiérrez, Laura Angélica Pineda, Javier Humberto Guzmán, Alejandro Gaviria, Fernando Ruiz
The use of drugs for unregistered indications, known as "off-label" use, is a practice that creates problems of rational use and access when other options are not available. Health systems should address this situation, particularly in connection with decisions concerning coverage, while trying to minimize health risks and clearly define the roles and responsibilities of the parties involved. Colombia's Ministry of Health and Social Protection (MinSalud), together with the National University of Colombia and national experts, developed a proposal for a model for managing drugs being used for unregistered indications (off-label) and their potential reimbursement with public resources, taking into account international practices and country characteristics...
May 2016: Revista Panamericana de Salud Pública, Pan American Journal of Public Health
Matthew Morton, Somil Nagpal, Rajeev Sadanandan, Sebastian Bauhoff
The routine data generated by India's universal coverage programs offer an important opportunity to evaluate and track the quality of health care systematically and on a large scale. We examined the potential and challenges of measuring the quality of hospital care through claims data from India's hospital insurance program for the poor, Rashtriya Swasthya Bima Yojana (RSBY). Using data from one district in India, we illustrate how these data already provide useful insights and show that simple efforts to enhance data quality and an effort to expand the data captured could facilitate RSBY's ability to track quality of care...
October 1, 2016: Health Affairs
Faheem Ahmed, Sophia Michelen, Rashad Massoud, Haytham Kaafarani
The World Health Organisation (WHO) has set out its new aims for the post-2015 global agenda in the form of the Sustainable Development Goals (SDGs). Discussions around the historically neglected role of emergency and essential surgical interventions in global health has attracted widespread attention with the help of well-timed, high-profile reports including the Lancet Commission for Global Surgery [1]. The case for promoting safe surgery is clear with evidence suggesting that at least two-thirds of the years of life lost globally will be attributed to surgical conditions by 2025 [1]...
October 1, 2016: International Journal of Surgery
Andreas A Reis
This article provides a commentary to Ole Norheim' s editorial entitled "Ethical perspective: Five unacceptable trade-offs on the path to universal health coverage." It reinforces its message that an inclusive, participatory process is essential for ethical decision-making and underlines the crucial importance of good governance in setting fair priorities in healthcare. Solidarity on both national and international levels is needed to make progress towards the goal of universal health coverage (UHC).
June 7, 2016: International Journal of Health Policy and Management
Adam Fusheini
BACKGROUND: National/social health insurance schemes have increasingly been seen in many low- and middle-income countries (LMICs) as a vehicle to universal health coverage (UHC) and a viable alternative funding mechanism for the health sector. Several countries, including Ghana, have thus introduced and implemented mandatory national health insurance schemes (NHIS) as part of reform efforts towards increasing access to health services. Ghana passed mandatory national health insurance (NHI) legislation (ACT 650) in 2003 and commenced nationwide implementation in 2004...
April 27, 2016: International Journal of Health Policy and Management
Stéphane Verguet
The World Health Organization's (WHO's) World Health Report 2010, "Health systems financing, the path to universal coverage," promoted universal health coverage (UHC) as an aspirational objective for country health systems. Yet, in addition to the dimensions of services and coverage, distribution of coverage in the population, and financial risk protection highlighted by the report, the consideration of the budget constraint should be further strengthened in the ensuing debate on resource allocation toward UHC...
May 11, 2016: International Journal of Health Policy and Management
Bakhtiar Piroozi, Ghobad Moradi, Bijan Nouri, Amjad Mohamadi Bolbanabad, Hossein Safari
BACKGROUND: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE...
March 14, 2016: International Journal of Health Policy and Management
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