Impact of Dialysis Coverage on the Provision of Universal Health Insurance in the Republic of the Congo

Introduction: The launch of health insurance in the Republic of the Congo took place against a backdrop of extremely high costs for dialysis, which was not one of the services financed within this framework. The aim of this study is to assess the impact of including dialysis in the health insurance package in Congo. Methodology: This is a descriptive cross-sectional study with an evaluative aim, analyzing the impact of dialysis on the financing capacity of health insurance and health facilities to provide this type of care. Results: The results show that including dialysis in the universal health insurance package will require an additional financial effort of 6.20% of the current total financing capacity of the care basket. Most dialysis sessions are provided by the private health sector (87.5%), whose health facilities are unevenly distributed across the country, and concentrated in the country’s two major cities. This problem is the dual consequence of the very high cost of a dialysis session (average cost 140,234,375 FCFA or 229 US Dollars) and the number of patients under care, which will increase in the absence of effective and ongoing prevention efforts against chronic diseases in general and end-stage renal failure in particular. Conclusion: Dialysis is a high-impact public health intervention. The impact of its inclusion in the universal health insurance care package is difficult to bear financially. For dialysis to be covered by universal health insurance, additional funding and improved technical facilities are needed.

Uptake of hepatitis C direct-acting antiviral treatment in China:a retrospective study from 2017 to 2021

Background Direct-acting antivirals(DAAs)for hepatitis C treatment in China became available since 2017.This study expects to generate evidence to inform decision-making in a nationwide scale-up of DAA treatment in China.Methods We described the number of standard DAA treatment at both national and provincial levels in China from 2017 to 2021 based on the China Hospital Pharmacy Audit(CHPA)data.We performed interrupted time series analysis to estimate the level and trend changes of the monthly number of standard DAA treatment at national level.We also adopted the latent class trajectory model(LCTM)to form clusters of the provincial-level administrative divisions(PLADs)with similar levels and trends of number of treatment,and to explore the potential enablers of the scale-up of DAA treatment at provincial level.Results The number of 3-month standard DAA treatment at national level increased from 104 in the last two quarters of 2017 to 49,592 in the year of 2021.The estimated DAA treatment rates in China were 1.9%and 0.7%in 2020 and 2021,which is far below the global target of 80%.The national price negotiation at the end of 2019 resulted in DAA inclusion by the national health insurance in January 2020.In that month,the number of treatment increased 3668 person-times(P<0.05).LCTM fits the best when the number of trajectory class is four.PLADs as Tianjin,Shanghai and Zhejiang that had piloted DAA price negotiations before the national negotiation and that had explored integration of hepatitis service delivery with prevention and control programme of hepatitis C within the existing services demonstrated earlier and faster scale-up of treatment.Conclusions Central negotiations to reduce prices of DAAs resulted in inclusion of DAA treatment under the universal health insurance,which are critical elements that support scaling up access to hepatitis C treatment in China.However,the current treatment rates are still far below the global target.Targeting the PLADs lagged behind through raising public awareness,strengthening capacity of the healthcare providers by roving training,and integrate prevention,screening,diagnosis,treatment and follow-up management of hepatitis C into the existing services are needed.