Health Systems & Reform最新文献

{"title":"Strategic Health Purchasing Progress Mapping: A Spotlight on Ghana’s National Health Insurance Scheme","authors":"E. Amporfu, P. Agyei-Baffour, A. Edusei, J. Novignon, Eric Arthur","doi":"10.1080/23288604.2022.2058337","DOIUrl":"https://doi.org/10.1080/23288604.2022.2058337","url":null,"abstract":"ABSTRACT Ghana is a lower-middle-income economy that has made significant efforts to improve its health system, in order to achieve universal health coverage. Ghana has adopted strategic health purchasing as an important tool for efficient utilization of resources. This paper focuses on Ghana’s National Health Insurance Scheme (NHIS) analyzing its governance arrangements and purchasing functions; and providing recommendations for improvement. The study applied the Strategic Health Purchasing Progress Tracking Framework co-created by the Strategic Purchasing Africa Resource Center (SPARC) and its partners to collect data from secondary and primary sources between September 2019 and June 2020. A descriptive and narrative approach was used to synthesize information on the NHIS governance arrangements and purchasing functions based on the framework. Benchmarks were used to describe the NHIS on the continuum from passive to strategic purchasing and to identify steps to make purchasing more strategic. Strengths and weaknesses were found in governance and purchasing functions. Progress was seen in how the NHIS selects the services in the benefit package, regularly reviewing the package to respond to the health needs of the population, and in how it selectively contracts with providers, particularly private providers, to ensure that standards for quality of care are met. However, challenges remain in performance monitoring, due to claims being mostly processed manually, and provider payment, due to frequent unbundling and upcoding of services Ghana has made significant strides toward the achievement of universal health coverage, but there is room for improvement in provider payment and performance monitoring. Video Abstract Read the transcript Lire la transcription Watch the video on Vimeo © 2022 The Author(s). Published with license by Taylor&Francis Group, LLC","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86774030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategic Health Purchasing in Nigeria: Investigating Governance and Institutional Capacities within Federal Tax-Funded Health Schemes and the Formal Sector Social Health Insurance Programme","authors":"U. Ezenwaka, A. Gatome-Munyua, Chikezie Nwankwor, Nkechi Olalere, Nneka Orji, Uchenna Ewelike, B. Uzochukwu, O. Onwujekwe","doi":"10.1080/23288604.2022.2074630","DOIUrl":"https://doi.org/10.1080/23288604.2022.2074630","url":null,"abstract":"ABSTRACT For Nigeria to make progress on its commitment to universal health coverage, additional public funding will be required. But more resources alone will not be enough. Government health spending must be more efficient and effective, through more strategic purchasing—a critical policy tool. Studies on health purchasing in Nigeria’s health financing schemes are limited, however. This study examines the purchasing arrangements in schemes funded by the federal budget and in the Formal Sector Social Health Insurance Programme (FSSHIP) within the National Health Insurance Scheme. We adopted a qualitative, descriptive case-study approach and collected data through document reviews and key informant interviews based on the Strategic Health Purchasing Progress Tracking Framework. Our analysis used a thematic framework approach. Our findings reveal that legal frameworks and governance structures for strategic purchasing are in place for both schemes. Steps toward strategic purchasing are more advanced in FSSHIP, particularly in the design of benefit packages, accreditation and monitoring of health maintenance organizations (HMOs) and providers, and provider payment mechanisms. The limited share of health funding flowing through these mechanisms, and further fragmentation of that funding, impede strategic purchasing. Strategic purchasing is also hampered by weak regulation and monitoring of providers and purchasers, delays in provider payment, and corrupt practices by HMOs. Improving strategic purchasing in Nigeria will require a concerted effort to reduce fragmentation of health spending, significant investment in human resources, technical know-how, and information systems of purchasing institutions, and actions to improve the accountability of all actors in the system. Video Abstract Read the transcript Lire la transcription Watch the video on Vimeo © 2022 The Author(s). Published with license by Taylor&Francis Group, LLC","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89420025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengths and Weaknesses of Strategic Health Purchasing for Universal Health Coverage in Rwanda","authors":"Stella M Umuhoza, S. Musange, Alypio Nyandwi, A. Gatome-Munyua, A. Mumararungu, R. Hitimana, Alexis Rulisa, P. Uwaliraye","doi":"10.1080/23288604.2022.2061891","DOIUrl":"https://doi.org/10.1080/23288604.2022.2061891","url":null,"abstract":"ABSTRACT In the context of scarce resources and increasing health care costs, strategic purchasing is viewed as a key mechanism to spur countries’ progress toward universal health coverage (UHC), by using limited resources more effectively. We applied the Strategic Health Purchasing Progress Tracking Framework to examine the health purchasing arrangements in three health financing schemes in Rwanda—the Community Based Health Insurance (CBHI) scheme, the Rwanda Social Security Board (RSSB) medical scheme, and performance-based financing (PBF). Data were collected from secondary and primary sources between September 2020 and March 2021.The objective of the study was to identify areas of progress in strategic purchasing that can be built on, and to identify areas of overlap, duplication, or conflict that limit progress in strategic purchasing to advance UHC goals. This study found that Rwanda has made progress in many areas of strategic purchasing and has a strong foundation for building further. However, some overlaps and duplication of functions weaken the power of purchasers to improve resource allocation, incentives for providers, and accountability. In addition, some of the policies within the purchasing functions could be made more strategic. In particular, open-ended fee-for-service payment in the CBHI scheme not only threatens the scheme’s financial sustainability but also imposes a high administrative burden. Better alignment and integration of contracting, incentives, and information system design to provide timely and relevant information for purchasing decisions would contribute to more strategic health purchasing and ensure that Rwanda’s health sector achievements are sustained and expanded.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80180252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commercial and Social Value of Pharmaceutical Industry-led Access Programs: Conceptual Framework and Descriptive Analysis","authors":"Joshua Smith-Sreen, A. C. Heerdegen, V. Wirtz, Priyanka Kulkarni, Melissa Machado, P. Rockers","doi":"10.1080/23288604.2022.2057831","DOIUrl":"https://doi.org/10.1080/23288604.2022.2057831","url":null,"abstract":"ABSTRACT Pharmaceutical industry-led access programs are growing in number globally and are increasingly adopting a hybrid approach intended to generate commercial and social value in parallel. We developed and applied a new conceptual framework in a descriptive analysis of observable indicators measuring commercial and social value for 91 programs registered in the Access Observatory. We found that most programs had features consistent with the generation of commercial value, directly through revenue generation (50.0%), or indirectly by creating competitive advantage (70.3%). We also found that most programs were implemented in countries where the company has commercial products registered (85.5%). While many programs had features consistent with the generation of social value, it was difficult to ascertain the level of that value because most did not share data (83.5%) and had not been evaluated (74.7%). Future efforts by the global health community and the pharmaceutical industry should focus on strengthening measurement and reporting on commercial and social indicators of industry-led access programs.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88197454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Venezuelan Migrants into the Colombian Health System during COVID-19","authors":"D. Bowser, Priya Agarwal-Harding, Anna G. Sombrio, D. Shepard, Arturo Harker Roa","doi":"10.1080/23288604.2022.2079448","DOIUrl":"https://doi.org/10.1080/23288604.2022.2079448","url":null,"abstract":"ABSTRACT Colombia provides a unique setting to understand the complicated interaction between health systems, health insurance, migrant populations, and COVID-19 due to its system of Universal Health Coverage and its hosting of the second-largest population of displaced persons globally, including approximately 1.8 million Venezuelan migrants. We surveyed 8,130 Venezuelan migrants and Colombian nationals across 60 municipalities using a telephone survey during the first wave of the pandemic (September through November 2020). Using self-reported enrollment in one of the several Colombian health insurance schemes, we analyzed the access to and disparities in the use of health-care services for both Colombians and Venezuelan migrants by insurance status, including access to formal health services, virtual visits, and COVID-19 testing for both groups. We found that compared with 3.6% of Colombians, 73.6% of Venezuelan telephone survey respondents remain uninsured, despite existing policies that allow legally present migrants to enroll in national health insurance schemes. Enrolling migrants in either the subsidized or contributory regime increases their access to health-care services, and equality between Colombians and Venezuelans within the same insurance schemes can be achieved for some services. Colombia’s experience integrating Venezuelan migrants into their current health system through various insurance schemes during the first wave of their COVID-19 pandemic shows that access and equality can be achieved, although there continue to be challenges.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75865861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of User Benefit Awareness in Health Coverage Utilization among the Poor in Cambodia","authors":"I. Feldhaus, Somil Nagpal, Sebastian Bauhoff","doi":"10.1080/23288604.2022.2058336","DOIUrl":"https://doi.org/10.1080/23288604.2022.2058336","url":null,"abstract":"ABSTRACT The objective of this study was to understand the steps to health coverage benefit utilization in Cambodia toward improving access to health care and financial risk protection for the poor. We particularly examine the role of user awareness in the pathway to care seeking and benefit utilization with respect to the Health Equity Funds (HEF). Using 2016 survey data that were nationally representative of households with children under two years of age, we used a series of logistic regression models to evaluate associations between respondents’ awareness of benefits, public health care seeking behaviors, coverage benefit claims, and out-of-pocket expenditures. Beneficiaries were generally aware of their entitlements, although their awareness of specific benefits, such as transport reimbursement, was relatively lower. Awareness of free services at public health centers was associated with twice the odds of having ever visited a public provider for outpatient care, while awareness of free services at public hospitals was associated with higher odds of always seeking inpatient care in the public sector. Study findings point to the decision of where to seek care as the critical point in the pathway to HEF utilization. If the decision had already been made to go to a public provider, it was likely that HEF benefits were claimed. Interventions that prompt appropriate care seeking in the public sector may do the most to improve HEF utilization and subsequently improve access to care through sufficient financial risk protection.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79565124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amending the Law for Licensing Medical Practitioners of China in 2021: A Commentary","authors":"Chengxiang Tang, Jiayi Jiang, Yuanyuan Gu, Gordon Liu","doi":"10.1080/23288604.2022.2048438","DOIUrl":"https://doi.org/10.1080/23288604.2022.2048438","url":null,"abstract":"ABSTRACT The Law for Licensing Medical Practitioners of the People’s Republic of China, enacted in 1999, was amended in 2021. This commentary reviews the key points of the amendment and raises doubts as to one of its points. Specifically, we argue that the minimum education level required to take the physicians’ licensing examination should be set to completion of a bachelor degree, instead of a vocational diploma or junior college graduation as in the 2021 amendment. China adopted a system of multi-tiered medical education more than 70 years ago. This policy has resulted in a threshold of entry-level medical education far below the global standards. The highly heterogeneous education background of physicians in China has led to low standards of practicing physicians, which in turn have significantly negative impacts on the health care market. We illustrate changes over time in the educational distribution and regional distribution of practicing physicians in China, and present reasons to improve entry-level educational standards, by setting the physician licensing threshold at an appropriate level. This will not only improve the overall quality of physicians but will also help address equity and efficiency issues in the health care market.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78944568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Remittances and Women’s Reproductive Health Care: Evidence from Pakistan","authors":"T. Mahmood, Ramesh Kumar, Asad ur Rehman, S. Pongpanich","doi":"10.1080/23288604.2022.2064792","DOIUrl":"https://doi.org/10.1080/23288604.2022.2064792","url":null,"abstract":"ABSTRACT This paper determines the effect of international remittances on the healthcare utilization of childbearing mothers in Pakistan using the Pakistan Social and Living Standards Measurement (PSLM) survey, 2018–19. The study reports a significant and positive effect of international remittances on the healthcare outcomes of childbearing mothers. Importantly, the remittance-receiving households have 0.615, 0.208 and 0.306 times the odds of the non-receiving households, utilizing prenatal healthcare, postnatal healthcare, and healthcare decision making, respectively, and all of them are statistically significant. Consequently, the analysis confirms that remittance receiving-households do in fact influence and increase the likelihood of utilizing prenatal healthcare, postnatal healthcare and decisions about medical treatment for women. As regression-based estimation of remittances is prone to selection bias due to the nature of the non-experimental data set, we also used propensity score matching methods, which also confirmed a significant and positive effect of international remittances on healthcare outcomes of the childbearing mothers. Thus, financial support or social development programs by the government or non-governmental organization are pivotal in enhancing the healthcare outcomes and ultimately the living standards of childbearing mothers.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88179234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decentralization Can Improve Equity, but Can It Be Sustained?","authors":"T. Bossert, Rony Lenz, Ramiro Guerrero, Rene Miranda, Victoria Eugenia Soto Rojas, Norman Danilo Maldonado Vargas","doi":"10.1080/23288604.2022.2064793","DOIUrl":"https://doi.org/10.1080/23288604.2022.2064793","url":null,"abstract":"Abstract A major theoretical issue about health system reform involving decentralization has been whether it promotes equity of health system funding. An article by the principal author and others in 2003 showed that, under certain conditions and policies, decentralization improved the equity of allocation of financial resources to different income levels of municipalities in Colombia and Chile. Another recurring issue has been whether reforms can be sustained over time. In a follow-up study in 2015, we found that the equity of national allocations was sustained even though the allocation rules for intergovernmental transfers and insurance funding sources had changed, as long as per capita allocation rules were retained. Nevertheless, the wealthier municipalities in Chile were able to increase their own source funding contributing to a larger gap between wealthy and poor municipalities, suggesting that in order to assure continued equity some compensation for these funds be included in intergovernmental transfer rules or that local source funding be restricted by national policy. These reforms may be more likely to be sustained if they become embedded in existing financial systems and if they receive support of status quo constituencies.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78164578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adam Wagstaff: Celebrating a Full and Impactful Life","authors":"M. Murthi, Muhammad Ali Pate","doi":"10.1080/23288604.2021.1967258","DOIUrl":"https://doi.org/10.1080/23288604.2021.1967258","url":null,"abstract":"Dr. Adam Wagstaff joined the World Bank in 1999 as a Lead Economist in the Bank’s principal research department, the Development Research Group. From 2009 until his passing on May 10, 2020, he led and managed the group’s research on the economics of health, education, and social protection as Research Manager of Human Development. At the time he joined the Bank, Adam was already a preeminent scholar in health economics with groundbreaking contributions to the conceptualization and measurement of equity in health and healthcare access. However, being a highly successful academic alone was not Adam’s goal. Instead, driven by his deep, lifelong commitment to improving the lives of the poor, he was passionate about putting his and others’ research into practice. He did so in many ways, all of which have profoundly and lastingly influenced health policy worldwide. Adam was instrumental in shaping strategic policy goals both in and outside the Bank. In the early 2000s, he was deeply involved in transitioning the Bank’s mission from a focus on monetary measures of poverty to a broader agenda that emphasizes human development and other non-monetary indicators of well-being. More recently, his work on the economic dividends of a healthy population helped shape the Bank’s Human Capital Project, which centers on health and education spending as high-yield investments. Adam was also a key contributor to the development of the healthrelated Millennium Development Goals, where he successfully championed the inclusion of equity. And he was critically involved in including, operationalizing, and tracking Universal Health Coverage as a Sustainable Development Goal—a concept firmly based on his seminal work on equity in healthcare access and financial protection in health. Adam also profoundly influenced the Bank’s country operations, staunchly advocating for evidence-based decision-making and the application of economic principles as a member of the Health and Social Protection Sector Boards and as a candid peer reviewer of many project proposals. An avid mentor who was gifted with exceptional clarity as a writer and outstanding wit as a presenter, Adam maximized the impact of his work by making it accessible to both technical and non-technical audiences that spanned colleagues, government officials, academics, and students alike. Even more important to him was to empower others to conduct their own research into health equity and financial protection. To this end, he developed publicly available databases and easy-to-operate software tools, taught their application across the globe, and initiated many scientific collaborations between researchers in lowand middleand high-income countries. Despite this strong commitment to practice, Adam remained a prolific writer of scientific papers, books, reports, and blogs throughout his career at the Bank, putting him among the top 20 most cited health economists in the world. Adam epitomized intellectual curiosity, rigor a","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84173735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}