Charting the course:India's health expenditure projections for 2035

Objectives Understanding past trends and forecasting future changes in health spending is vital for planning and reducing reliance on out-of-pocket(OOP)expenses.The current study analyzed health expenditure patterns in India and forecasted future trends and patterns until 2035.Methods Data on health expenditure in India from 2000 to 2019 was collected from the Organisation for Economic Co-operation and Development(OECD)iLibrary and National Health Accounts 2019 databases.Gross domestic product(GDP)data from the World Bank was also utilized.Descriptive statistics analyzed the composition and pattern,while the exponential smoothing model forecasted future health expenditures.Results The findings revealed that expenditure made by OOP is the primary health financing source,followed by government and pre-paid private spending.The percentage of GDP allocated to total health expenditure remains stable,while the per capita health expenditure fluctuates.Variations in expenditure among states are observed,with Karnataka relying heavily on pre-paid private coverage.Future projections suggest a decline in per capita and total health expenditure as a share of GDP,with a slight increase in the government’s share.Pre-paid private expenditure per capita and OOP health expenditure as a share of the total is projected to remain relatively constant but still high in absolute terms.Conclusion The study highlights variations in health spending in India,characterized by high OOP spending,limited public coverage,and a need for investments,and reforms to improve healthcare access and equity.

Universal Health Coverage in Somalia: Charting the Path to Equitable Healthcare Financing and Governance

Somalia is a country facing numerous challenges in achieving universal health coverage (UHC) and ensuring adequate healthcare financing, This article explores the complexities and obstacles that Somalia must overcome in its pursuit of UHC, the paper begins by providing an overview of the current healthcare landscape in Somalia, highlighting the lack of infrastructure, political instability, and limited financial resources that hinder the establishment of a comprehensive and equitable healthcare system. It then examines the role of international aid and non-governmental organizations (NGOs) in filling the healthcare gap, while emphasizing the need for a more sustainable, domestically financed solution. Drawing on a range of data sources and case studies, the article proposes a multi-faceted approach to strengthen healthcare governance, improve resource allocation, and foster local capacity building, the study delves into the unique obstacles that Somalia faces, including a lack of infrastructure, political instability, and limited financial resources, which hinder the establishment of a comprehensive and equitable healthcare system. The paper also examines the role of international aid and non-governmental organizations (NGOs) in filling the healthcare gap, while highlighting the need for a more sustainable, domestically financed solution. The findings underscore the importance of political commitment, international cooperation, and innovative financing mechanisms in advancing towards UHC in Somalia, providing valuable insights for other low resource, conflict affected settings.

Fragility and challenges of health systems in pandemic: lessons from India's second wave of coronavirus disease 2019 (COVID-19)

The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019 (COVID-19) pandemic has almost collapsed the health care systems especially in the developing world. Given the disastrous outbreak of COVID-19 second wave in India, the health system of country was virtually at the brink of collapse. Therefore, to identify the factors that resulted into breakdown and the challenges, Indian healthcare system faced during the second wave of COVID-19 pandemic, this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization (WHO). Applying integrated review approach, we found that the factors such as poor infrastructure, inadequate financing, lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India. Although health system in India faced these challenges from the very beginning, but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic. To sum-up given the likely future challenges of pandemic, while healthcare should be prioritized with adequate financing, strong capacity-building measures and integration of public and private sectors in India. Likewise fiscal stimulus, risk assessment, data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country.

Contribution of the Tobacco Tax to the Financing of Health Systems in Democratic Republic of the Congo

Tobacco is an illicit product sold in the world and involves fatal communicable diseases and deaths. In several countries, tobacco revenue contributes to the health of victims. This study aimed to evaluate the contribution of tobacco taxes to the financing of the health system in Democratic Republic of the Congo (DRC) during the period of 3 years (from 2019 to 2021) in order to give some suggestions. A descriptive literature review on the tobacco tax was conducted from three tobacco tax collection services: the services of the General Secretariat of Health in DRC (SGSH), the Program of the National Health Account (PNHA) and the General Direction of Customs and Assizes (GDCA). The analysis revealed that no retrocession and no activity covered by the tax collected on tobacco does not contribute to the financing of the health sector, in order to reduce the burden of households already impoverished by diseases caused by tobacco.

The Financial Implications of Using Decision Tree Analysis for Publicly Funded Health Care Screening in Canada

This article demonstrates that decision trees have several applications in screening for incidences of various cancers in the publicly funded health care system of Canada. This article reviews previous research on the design of various types of decision trees to identify the relevant decision-making parameters that should be incorporated into enhanced usage of decision trees. This article proposes a methodology for screening breast and prostate cancers. While an accounting is made for various financial costs and benefits, comments are made on the limitations of the modeling exercise through identification of problems in assigning probabilities, the use of samples in ascertaining population parameters, ethical concerns, and measuring a cost per life year. This article concludes with prospects for future research including private sector versus public sector financing and the incorporation of opportunity costs into the decision-making process.

Community-Based Health Insurance： An Evolutionary Approach to Achieving Universal Coverage in Low-Income Countries

The WHO World Health Assembly, and the most recent WHO World Health Report, have called for all health systems to move toward universal coverage. However, low-income countries have made little progress in this respect. We use existing evidence to describe the evolution of community-based health insurance in low-income countries through the three stages of basic model, enhanced model, and nationwide model. We have concluded that community-based health insurance development is a potential strategy to meet the urgent need for health financing in low-income countries. With careful planning and implementation, it is possible to adopt such evolutionary approach to achieve universal coverage by extending tax-based financing/social insurance characteristics to community-based health insurance schemes.

The Efficiency of Public Health Expenditure in Turkey Between 2003 and 2013

Turkey launched a project in 2003 known as ＂Health Transformation Programme＂ （HTP）, which enabled Turkey to make considerable progress and radical changes to the health care system. The programme in 2003 included the effectiveness and the efficiency factors within the process by setting them as the primary objectives to increase the health status of the population （effectiveness） and to use resources in the best possible manner and at the lowest possible cost （efficiency）. Accessing services according to the need of patients and state benefits according to their ability to pay would be viable under these objectives. In this study, initially, Turkish National Health System will be articulated on a literature-study basis approach to measure the efficiency of public expenditure on health. Then, the measured level of the efficiency will be analysed in Turkey, The paper serves a purpose to analyse the efficiency based on the outcomes of heath service such as satisfaction with public health services over the period of 2003-2013. A simple linear regression was employed to test the degree of statistical relation between public health expenditure and satisfaction with public health care services.

The politics of the basic benefit package health reforms in Tajikistan

Background:Health reform is a fundamentally political process.Yet,evidence on the interplay between domestic politics,international aid and the technical dimensions of health systems,particularly in the former Soviet Union and Central Asia,remains limited.Little regard has been given to the political dimensions of Tajikistan’s Basic Benefit Package(BBP)reforms that regulate entitlements to a guaranteed set of healthcare services while introducing co-payments.The objective of this paper is therefore to explore the governance constraints to the introduction and implementation of the BBP and associated health management changes.Methods:This qualitative study draws on literature review and key informant interviews.Data analysis was guided by a political economy framework exploring the interplay between structural and institutional features on the one hand and agency dynamics on the other.Building on that the article presents the main themes that emerged on structure-agency dynamics,forming the key governance constraints to the BBP reform and implementation.Results:Policy incoherence,parallel and competing central government mandates,and regulatory fragmentation,have emerged as dominant drivers of most other constraints to effective design and implementation of the BBP and associated health reforms in Tajikistan:overcharging and informal payments,a weak link between budgeting and policymaking,a practice of non-transparent budget bargaining instead of a rationalisation of health expenditure,little donor harmonisation,and weak accountability to citizens.Conclusion:This study suggests that policy incoherence and regulatory fragmentation can be linked to the neopatrimonial character of the regime and donor behaviour,with detrimental consequences for the health system..These findings raise questions on the unintended effects of non-harmonised piloting of health reforms,and the interaction of health financing and management interventions with entrenched power relations.Ultimately these insights serve to underline the relevance of contextualising health programmes and addressing policy incoherence with long horizon planning as a priority.

Factors determining membership in community-based health insurance in West Africa:a scoping review

Background:In many low-income countries,households bear most of the health care costs.Community-based health insurance(CBHI)schemes have multiplied since the 1990s in West Africa.They have significantly improved their members’access to health care.However,a large proportion of users are reluctant to subscribe to a local CBHI.Identifying the major factors affecting membership will be useful for improving CBHI coverage.The objective of this research is to obtain a general overview of existing evidence on the determinants of CBHI membership in West Africa.Methods:A review of studies reporting on the factors determining membership in CBHI schemes in West Africa was conducted using guidelines developed by the Joanna Briggs Institute.Several databases were searched(PubMed,ScienceDirect,Global Health database,Embase,EconLit,Cairn.info,BDPS,Cochrane database and Google Scholar)for relevant articles available by August 15,2022,with no methodological or linguistic restrictions in electronic databases and grey literature.Results:The initial literature search resulted in 1611 studies,and 10 studies were identified by other sources.After eliminating duplicates,we reviewed the titles of the remaining 1275 studies and excluded 1080 irrelevant studies based on title and 124 studies based on abstracts.Of the 71 full texts assessed for eligibility,32 additional papers were excluded(not relevant,outside West Africa,poorly described results)and finally 39 studies were included in the synthesis.Factors that negatively affect CBHI membership include advanced age,low education,low household income,poor quality of care,lack of trust in providers and remoteness,rules considered too strict or inappropriate,low trust in administrators and inadequate information campaign.Conclusions:This study shows many lessons to be learned from a variety of countries and initiatives that could make CBHI an effective tool for increasing access to quality health care in order to achieve universal health coverage.Cover-age through CBHI schemes could be improved through communication,improved education and targeted financial support.

Impact of macro-fiscal determinants on health financing:empirical evidence from low-and middle-income countries

Background:Health financing is a major challenge in low-and middle-income counties(LMICs)for achieving Universal Health Coverage(UHC).Past studies have argued that the budgetary allocation on health financing depends on macrofiscal policies of an economy such as sustained economic growth and higher revenue mobilization.While the global financial crisis of late 2008 observed a shortage of financial resources in richer countries and adversely affected the health sector.Therefore,this study has examined the impact of macro-fiscal policies on health financing by adopting socioeconomic factors in 85 LMICs for the period 2000 to 2013.Methods:The study has employed the panel System Generalized Method of Moment model that captures the endogeneity problem in the regression estimation by adopting appropriate instrumental variables.Results:The elasticity of public health expenditure(PHE)with respect to macro-fiscal factors varies across LMICs.Tax revenue shows a positive and statistically significant relationship with PHE in full sample,pre-global financial crisis,middle-income,and coefficient value varies from 0.040 to 0.141%.Fiscal deficit and debt services payment shows a negative effect on PHE in full sample,as well as sub-samples and coefficient value,varies from 0.001 to 0.032%.Aging and per capita income show an expected positive relationship with PHE in LIMI countries.Conclusions:Favorable macro-fiscal policies would necessarily raise finance for the health sector development but the prioritization of health budget allocation during the crisis period depends on the nature of tax revenue mobilization and demand for health services.Therefore,the generation of health-specific revenues and effective usage of health budget would probably accelerate the progress towards the achievement of UHC.

The political economy of results-based financing:the experience of the health system in Zimbabwe

Background:Since 2000,results based financing(RBF)has proliferated in health sectors in Africa in particular,including in fragile and conflict affected settings(FCAS)and there is a growing but still contested literature about its relevance and effectiveness.Less examined are the political economy factors behind the adoption of the RBF policy,as well as the shifts in influence and resources which RBF may bring about.In this article,we examine these two topics,focusing on Zimbabwe,which has rolled out RBF nationwide in the health system since 2011,with external support.Methods:The study uses an adapted political economy framework,integrating data from 40 semi-structured interviews with local,national and international experts in 2018 and thematic analysis of 60 policy documents covering the decade between 2008 and 2018.Results:Our findings highlight the role of donors in initiating the RBF policy,but also how the Zimbabwe health system was able to adapt the model to suit its particular circumstances-seeking to maintain a systemic approach,and avoiding fragmentation.Although Zimbabwe was highly resource dependent after the political-economic crisis of the 2000s,it retained managerial and professional capacity,which distinguishes it from many other FCAS settings.This active adaptation has engendered national ownership over time,despite initial resistance to the RBF model and despite the complexity of RBF,which creates dependence on external technical support.Adoption was also aided by ideological retro-fitting into an earlier government performance management policy.The main beneficiaries of RBF were frontline providers,who gained small but critical additional resources,but subject to high degrees of control and sanctions.Conclusions:This study highlights resource-seeking motivations for adopting RBF in some low and middle income settings,especially fragile ones,but also the potential for local health system actors to shape and adapt RBF to suit their needs in some circumstances.This means less structural disruption in the health system and it increases the likelihood of an integrated approach and sustainability.We highlight the mix of autonomy and control which RBF can bring for frontline providers and argue for clearer understanding of the role that RBF commonly plays in these settings.

Health financing for universal health coverage in Sub-Saharan Africa:a systematic review

Background:Universal health coverage(UHC)embedded within the United Nations Sustainable Development Goals,is defined by the World Health Organization as all individuals having access to required health services,of sufficient quality,without suffering financial hardship.Effective strategies for financing healthcare are critical in achieving this goal yet remain a challenge in Sub-Saharan Africa(SSA).This systematic review aims to determine reported health financing mechanisms in SSA within the published literature and summarize potential learnings.Methods:A systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)reporting guidelines.On 19 to 30 July 2019,MEDLINE,EMBASE,Web of Science,Global Health Database,the Cochrane Library,Scopus and JSTOR were searched for literature published from 2005.Studies describing health financing approaches for UHC in SSA were included.Evidence was synthesised in form of a table and thematic analysis.Results:Of all records,39 papers were selected for inclusion.Among the included studies,most studies were conducted in Kenya(n=7),followed by SSA as a whole(n=6)and Nigeria(n=5).More than two thirds of the selected studies reported the importance of equitable national health insurance schemes for UHC.The results indicate that a majority of health care revenue in SSA is from direct out-of-pocket payments.Another common financing mechanism was donor funding,which was reported by most of the studies.The average quality score of all studies was 81.6%,indicating a high appraisal score.The interrater reliability Cohen’s kappa score,κ=0.43(p=0.002),which showed a moderate level of agreement.Conclusions:Appropriate health financing strategies that safeguard financial risk protection underpin sustainable health services and the attainment of UHC.It is evident from the review that innovative health financing strategies in SSA are needed.Some limitations of this review include potentially skewed interpretations due to publication bias and a higher frequency of publications included from two countries in SSA.Establishing evidence-based and multi-sectoral strategies tailored to country contexts remains imperative.

Health status and health systems financing in the MENA region:roadmap to universal health coverage

Background:Since the declaration of the Millennium Development Goals(MDGs)in 1990,many countries of the Middle East and North Africa(MENA)region made some improvements in maternal and child health and in tackling communicable diseases.The transition to the global agenda of Sustainable Development Goals brings new opportunities for countries to move forward toward achieving progress for better health,well-being,and universal health coverage.This study provides a profile of health status and health financing approaches in the MENA region and their implications on universal health coverage.Methods:Time-series data on socioeconomics,health expenditures,and health outcomes were extracted from databases and reports of the World Health Organization,the World Bank and the United Nations Development Program and analyzed using Stata 12 statistical software.Countries were grouped according to the World Bank income categories.Descriptive statistics,tables and charts were used to analyze temporal changes and compare the key variables with global averages.Results:Non-communicable diseases(NCDs)and injuries account for more than three quarters of the disabilityadjusted life years in all but two lower middle-income countries(Sudan and Yemen).Prevalence of risk factors(raised blood glucose,raised blood pressure,obesity and smoking)is higher than global averages and counterparts by income group.Total health expenditure(THE)per capita in most of the countries falls short of global averages for countries under similar income category.Furthermore,growth rate of THE per capita has not kept pace with the growth rate of GDP per capita.Out-of-pocket spending(OOPS)in all but the high-income countries in the group exceeds the threshold for catastrophic spending implying that there is a high risk of households getting poorer as a result of paying for health care.Conclusion:The alarmingly high prevalence of NCDs and injuries and associated risk factors,health spending falling short of the GDP and GDP growth rate,and high OOPS pose serious challenges for universal health coverage.Using multi-sector interventions,countries should develop and implement evidence-informed health system financing roadmaps to address these obstacles and move forward toward universal health coverage.

Behavioral Aspects in Obligatory Reports of Public Hospitals in Poland

The health care sector is the most difficult one to manage and control. Special units in this field are public hospitals which are required to prepare a lot of reports to various institutions, including the ownership body. The paper focuses on two issues. The first is the presence of behavioral factors in the reporting of public hospitals in Poland to the ownership bodies. This article aims to indicate the thematic areas of specific reports, most affected by behavioral factors and explain the causes and consequences of their occurrence. The second issue is the analysis of the legal status of obligatory reporting of public hospitals. Participants of the conducted research, due to their specific ownership and political and social position, were public hospitals in Poland. The paper uses the research methods of the meta-analysis of the literature, legal acts in Poland and empirical materials, and also the methods of synthesis, observation, and deduction. Data analysis focused on specific sample of reports issued by Polish public hospitals for their ownership body. The research shows that hospitals draw up a tremendous number of often thematically overlapping and redundant reports addressed to different institutions in different time periods. It is a consequence of legal regulations failing to streamline the reporting of the health care sector institutions, in particular public hospitals. The paper points to the large number of legal instruments that contain imprecise requirements resulting from the complex and obscure forms of control of public funds allocation in this sector. There are many behavioral factors that shape some fields of public hospitals＇ reports, for example, interpersonal relationships, egoism, private financial interests, strengthening of the employment status and professional position, and professional competences. There is considerable freedom in the reporting process fulfilled by public hospitals in Poland for their ownership body. It causes strong consequences, like poor-quality data, duplication of information, and its chaos, as well as high costs of obtaining information. Reporting system of financial and non-financial data of public hospitals in Poland is dysfunctional.

Drug-resistant tuberculosis control in China: progress and challenges

Background:China has the second highest caseload of multidrug-resistant tuberculosis(MDR-TB)in the world.In 2009,the Chinese government agreed to draw up a plan for MDR-TB prevention and control in the context of a comprehensive health system reform launched in the same year.Discussion:China is facing high prevalence rates of drug-resistant TB and MDR-TB.MDR-TB disproportionally affects the poor rural population and the highest rates are in less developed regions largely due to interrupted and/or inappropriate TB treatment.Most households with an affected member suffer a heavy financial burden because of a combination of treatment and other related costs.The influential Global Fund programme for MDR-TB control in China provides technical and financial support for MDR-TB diagnosis and treatment.However,this programme has a fixed timeline and cannot provide a long term solution.In 2009,the Bill and Melinda Gates Foundation,in cooperation with the National Health and Family Planning Commission of China,started to develop innovative approaches to TB/MDR-TB management and case-based payment mechanisms for treatment,alongside increased health insurance benefits for patients,in order to contain medical costs and reduce financial barriers to treatment.Although these efforts appear to be in the right direction,they may not be sufficient unless(a)domestic sources are mobilized to raise funding for TB/MDR-TB prevention and control and(b)appropriate incentives are given to both health facilities and their care providers.Summary:Along with the on-going Chinese health system reform,sustained government financing and social health protection schemes will be critical to ensure universal access to appropriate TB treatment in order to reduce risk of developing MDR-TB and systematic MDR-TB treatment and management.

Factors that associated with TB patient admission rate and TB inpatient service cost: a cross-sectional study in China

Background:China has recently adopted the“TB designated hospital model”to improve the quality of tuberculosis(TB)treatment and patient management.Considering that inpatient service often results in high patient financial burden,and therefore influences patient adherence to treatment,it is critical to better understand the TB patient admission rate and TB inpatient service cost,as well as their influential factors in this new model.Methods:Quantitative and qualitative studies were conducted in two cities,Hanzhong in Shaanxi Province and Zhenjiang in Jiangsu Province,in China.Quantitative data were obtained from a sample survey of 533 TB patients and TB inpatient records from 2010–2012 in six county designated hospitals.Qualitative information was obtained through interviews with key stakeholders(40 key informant interviews,14 focus group discussions)and reviews of health policy documents in study areas.Both univariate and multivariate statistical analyses were applied for the quantitative analysis,and the thematic framework approach was applied for the qualitative analysis.Results:The TB patient admission rates in Zhenjiang and Hanzhong were 54.8 and 55.9%,respectively.Qualitative analyses revealed that financial incentives,misunderstanding of infectious disease control and failure of health insurance regulations were the key factors associated with the admission rates and medical costs.Quantitative analyses found differences in hospitalization rate existed among patients with different health insurance and patients from different counties.Average medical costs for TB inpatients in Jurong and Zhenba were 7,215 CNY and 4,644 CNY,which was higher than the 5,500 CNY and 3,800 CNY limits set by the New Rural Cooperative Medical System.No differences in medical cost or length of stay were found between patients with and without comorbidities in county-level hospitals.Conclusions:TB patient admission rates and inpatient service costs were relatively high.Studies of related factors indicated that a package of interventions,including health education programs,reform of health insurance regulations and improvement of TB treatment guidelines,are urgently required to ensure that TB patients receive appropriate care.