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...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.展开更多
Background:Access to surgical care in Low-and Middle-Income Countries(LMICs)such as Tanzania is extremely limited.Northern Tanzania is served by a single tertiary referral hospital,Kilimanjaro Christian Medical Centre...Background:Access to surgical care in Low-and Middle-Income Countries(LMICs)such as Tanzania is extremely limited.Northern Tanzania is served by a single tertiary referral hospital,Kilimanjaro Christian Medical Centre(KCMC).The surgical volumes,workflow,and payment mechanisms in this region have not been characterized.Understanding these factors is critical in expanding access to healthcare.The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa.Methods:The 2018 case volume and specialty distribution(general,orthopaedic,and gynecology)in the main operating theaters at KCMC was retrieved through retrospective review of operating report books.Detailed workflow(i.e.planned and cancelled cases,lengths of procedures,lengths of operating days)and financing data(patient payment methods)from the five KCMC operating theater logs were retrospectively reviewed for the available fivemonth period of March 2018 to July 2018.Descriptive statistics and statistical analysis were performed.Results:In 2018,the main operating theaters at KCMC performed 3817 total procedures,with elective procedures(2385)outnumbering emergency procedures(1432).General surgery(1927)was the most operated specialty,followed by orthopaedics(1371)and gynecology(519).In the five-month subset analysis period,just 54.6%of planned operating days were fully completed.There were 238 cancellations(20.8%of planned operations).Time constraints(31.1%,74 cases)was the largest reason;lack of patient payment accounted for as many cancellations as unavailable equipment(6.3%,15 cases each).Financing for elective theater cases included insurance 45.5%(418 patients),and cash 48.4%(445 patients).Conclusion:While surgical volume is high,there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity.Improving physical resources is not enough to improve access to care in this region,and likely in many LMIC settings.Patient financing and workflow will be critical considerations to truly improve access to surgical care.展开更多
This paper introduces the background,aim and objectives of the project entitled“China—the Gates Foundation Collaboration on TB Control in China”that has been underway for many years.It also summarizes the key findi...This paper introduces the background,aim and objectives of the project entitled“China—the Gates Foundation Collaboration on TB Control in China”that has been underway for many years.It also summarizes the key findings of the nine papers included in this special issue,which used data from the baseline survey of Phase II of the project.Data were collected from the survey of TB and MDR-TB patients,from designated hospitals,health insurance agencies and the routine health information systems,as well as key informant interviews and focus group discussions with relevant key stakeholders.Key issues discussed in this series of papers include the uses of TB services and anti-TB medicines and their determining factors related to socio-economic and health systems development;expenditures on TB care and the financial burden incurred on TB patients;and the impact of health insurance schemes implemented in China on financial protection.展开更多
This is a theoretical paper examining the effect of user fee on patients’ welfare and social welfare under three forms of provider reimbursements: full cost, prospective payment and cost sharing. The paper extends Ri...This is a theoretical paper examining the effect of user fee on patients’ welfare and social welfare under three forms of provider reimbursements: full cost, prospective payment and cost sharing. The paper extends Rickman and McGuire (1999) by introducing user fee to the public sector and maintaining the assumption that providers can work in both the private and public health sectors. Contrary to previous studies, this study shows that efficiency is possible under the full cost reimbursement. The paper also shows the conditions under which efficiency is possible under each reimbursement scheme. Patient’s welfare can improve with the introduction of user fee when services in the public and private sector are complementary.展开更多
This article explores the progress of the healthcare sector in the Kingdom of Saudi Arabia over the past two decades. Through continuous coordination and efforts to improve the quality and quantity of health services,...This article explores the progress of the healthcare sector in the Kingdom of Saudi Arabia over the past two decades. Through continuous coordination and efforts to improve the quality and quantity of health services, the government has significantly increased the availability of health facilities across the nation. This steady growth has allowed the country to maintain an upward trajectory in healthcare sector development in comparison to other countries. The Saudi Arabian government is preparing to implement Accountable Care Organizations (ACOs) as part of their “Vision 2030.” By aligning with the goals of this visionary roadmap, the government aims to address the challenges faced by the existing healthcare system under the Ministry of Health (MOH). This strategic move is expected to transform the healthcare sector, positioning Saudi Arabia at par with its international counterparts and bolstering its economic competitiveness. This article highlights the historical context of Saudi Arabia’s healthcare system, and compares it with the forthcoming ACO implementation under “Vision 2030.” This information provides valuable insights into the trajectory of the country’s healthcare landscape and the potential impact of ACOs in shaping the Kingdom’s future in healthcare and economic development overall.展开更多
The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, ...The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.展开更多
文摘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.
文摘Background:Access to surgical care in Low-and Middle-Income Countries(LMICs)such as Tanzania is extremely limited.Northern Tanzania is served by a single tertiary referral hospital,Kilimanjaro Christian Medical Centre(KCMC).The surgical volumes,workflow,and payment mechanisms in this region have not been characterized.Understanding these factors is critical in expanding access to healthcare.The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa.Methods:The 2018 case volume and specialty distribution(general,orthopaedic,and gynecology)in the main operating theaters at KCMC was retrieved through retrospective review of operating report books.Detailed workflow(i.e.planned and cancelled cases,lengths of procedures,lengths of operating days)and financing data(patient payment methods)from the five KCMC operating theater logs were retrospectively reviewed for the available fivemonth period of March 2018 to July 2018.Descriptive statistics and statistical analysis were performed.Results:In 2018,the main operating theaters at KCMC performed 3817 total procedures,with elective procedures(2385)outnumbering emergency procedures(1432).General surgery(1927)was the most operated specialty,followed by orthopaedics(1371)and gynecology(519).In the five-month subset analysis period,just 54.6%of planned operating days were fully completed.There were 238 cancellations(20.8%of planned operations).Time constraints(31.1%,74 cases)was the largest reason;lack of patient payment accounted for as many cancellations as unavailable equipment(6.3%,15 cases each).Financing for elective theater cases included insurance 45.5%(418 patients),and cash 48.4%(445 patients).Conclusion:While surgical volume is high,there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity.Improving physical resources is not enough to improve access to care in this region,and likely in many LMIC settings.Patient financing and workflow will be critical considerations to truly improve access to surgical care.
基金The study based on which this paper was written is part of the program entitled“China National Health and Family Planning Commission and the Gates Foundation TB Project”-a collaboration between the Government of China and the Melinda and Bill Gates Foundation(Grant No.51914)implemented by the China Center of Disease Control and Prevention(CDC).
文摘This paper introduces the background,aim and objectives of the project entitled“China—the Gates Foundation Collaboration on TB Control in China”that has been underway for many years.It also summarizes the key findings of the nine papers included in this special issue,which used data from the baseline survey of Phase II of the project.Data were collected from the survey of TB and MDR-TB patients,from designated hospitals,health insurance agencies and the routine health information systems,as well as key informant interviews and focus group discussions with relevant key stakeholders.Key issues discussed in this series of papers include the uses of TB services and anti-TB medicines and their determining factors related to socio-economic and health systems development;expenditures on TB care and the financial burden incurred on TB patients;and the impact of health insurance schemes implemented in China on financial protection.
文摘This is a theoretical paper examining the effect of user fee on patients’ welfare and social welfare under three forms of provider reimbursements: full cost, prospective payment and cost sharing. The paper extends Rickman and McGuire (1999) by introducing user fee to the public sector and maintaining the assumption that providers can work in both the private and public health sectors. Contrary to previous studies, this study shows that efficiency is possible under the full cost reimbursement. The paper also shows the conditions under which efficiency is possible under each reimbursement scheme. Patient’s welfare can improve with the introduction of user fee when services in the public and private sector are complementary.
文摘This article explores the progress of the healthcare sector in the Kingdom of Saudi Arabia over the past two decades. Through continuous coordination and efforts to improve the quality and quantity of health services, the government has significantly increased the availability of health facilities across the nation. This steady growth has allowed the country to maintain an upward trajectory in healthcare sector development in comparison to other countries. The Saudi Arabian government is preparing to implement Accountable Care Organizations (ACOs) as part of their “Vision 2030.” By aligning with the goals of this visionary roadmap, the government aims to address the challenges faced by the existing healthcare system under the Ministry of Health (MOH). This strategic move is expected to transform the healthcare sector, positioning Saudi Arabia at par with its international counterparts and bolstering its economic competitiveness. This article highlights the historical context of Saudi Arabia’s healthcare system, and compares it with the forthcoming ACO implementation under “Vision 2030.” This information provides valuable insights into the trajectory of the country’s healthcare landscape and the potential impact of ACOs in shaping the Kingdom’s future in healthcare and economic development overall.
文摘The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.
