Health Policy Open最新文献

In 2005, Ukraine embarked on hospital financing reforms that included the introduction of a Diagnosis Related Group (DRG) based payment system for acute inpatient care. The primary purpose of introducing activity-based funding was to provide incentives for hospitals to use their limited resources more efficiently.

Following an extended period of preparation and planning during which technical assistance was provided by various development agencies, Ukraine took action to implement the DRG system at a national level in April 2018, through a World Bank project. While some progress was made, the execution of the reform faced challenges with the organisation and administration of the implementation process, and duplication of effort. The consequence of these shortcomings was that the newly introduced system was not capable of measuring inpatient DRG activity at a level of accuracy necessary for the determination of hospital performance and the subsequent calculation of payments.

If the expected outcomes of DRG implementation in Ukraine are to be realised, stakeholders including both beneficiary agencies and development organisations, will need to improve program governance through better coordination of their activities towards a common goal.

We assess the impact of the Brazilian government’s conditional cash transfer program Bolsa Família on unhealthy consumption by households, proxied by expenses with ultra-processed food, alcohol, and tobacco products. Using machine learning techniques to improve the propensity score estimation, we analyze the intensive and extensive margin effects of participating in the program on the household purchase of unhealthy products. Our results reveal that program participants spend more on food in general, but not necessarily more on unhealthy options. While we find evidence that participants increase their probability of spending more on food away from home, they do not significantly alter their expenditures on packaged food, alcohol, or tobacco products.

Cross-border healthcare is an international agreement for the provision of out of country healthcare for citizens of partnered countries. The European Union (EU) has established itself as a world leader in cross-border healthcare. During the Coronavirus disease of 2019 (COVID-19) pandemic, the EU used this system to maximize utilization of resources. Countries with capacity accepted critically ill patients from overwhelmed nations, borders remained open to healthcare workers and those seeking medical care in an effort to share the burden of this pandemic. Significant research into the challenges and successes of cross-border healthcare was completed prior to COVID-19, which demonstrated significant benefit for patients.

In North America, the response to the COVID-19 crisis has been more isolationist. The Canada-United States border has been closed and bans placed on healthcare workers crossing the border for work. Prior to COVID-19, cross-border healthcare was rare in North America despite its need. We reviewed the literature surrounding cross-border healthcare in the EU, as well as the need for a similar system in North America. We found the EU cross-border healthcare agreements are generally mutually beneficial for participating countries. The North American literature suggested a cross-border healthcare system is feasible. A number of challenges could be identified based on the EU experience. A prior agreement may have been beneficial during the COVID-19 crisis as many Canadian healthcare institutions-maintained capacity to accept critically ill patients.

This cross-sectional study aimed to determine job satisfaction among the Jordanian dietitians, the factors associated with job satisfaction, and the relationship between job satisfaction and intent to stay. A convenience sample of 600 dieticians performed a self-reported online survey. Most of the participants were females (83.2%), <30 years of age (68.3%) with a BSc degree in nutrition (77.3%). Results revealed that 20% of the dietitians were dissatisfied at work, 69.8% were neither dissatisfied nor satisfied, and 10.2% were satisfied. The satisfaction for the total score in all examined domains was neither dissatisfaction nor satisfaction, except for the salary. Participants with higher monthly salaries were 1.53 more likely to have higher job satisfaction than those with lower monthly salaries (CI 95%, (0.503–2.55)). Intention to stay was positively correlated with the total job satisfaction and all domains except the knowledge and skills domain (p-value = 0.22). The main aspect that needs to be addressed and re-evaluated is to improve dietitians job satisfaction is the salary. The findings of this study point to improving dietitians' work status to attain the best possible health care achievements.

Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.

Several low and lower- middle income countries have been using Performance-Based Financing (PBF) to motivate health workers to increase the quantity and quality of health services. Studies have demonstrated that PBF can contribute to improved health service delivery and health outcomes, but there is limited evidence on the mechanisms through which PBF can necessitate changes in the health system. Using difference-in-difference and synthetic control analytical approaches, we investigated the effect of PBF on autonomy and accountability at service delivery level using data from a 3-arm cluster randomised trial in Zambia. The arms consisted of PBF where financing is linked to outputs in terms of quality and quantity (intervention 1), input financing where funding is fully provided to finance all required inputs regardless of performance (intervention 2), and the current standard of care where there is input financing but with possible challenges in funding (pure control). The results show an increase in autonomy at PBF sites compared to sites in the pure control arm and an increase in accountability at PBF sites compared to sites in both the input-financing and pure control arms. On the other hand, there were no effects on autonomy and accountability in the input-financing sites compared to the pure control sites. The study concludes that PBF can improve financial and managerial autonomy and accountability, which are important for improving health service delivery. However, within the PBF districts, the magnitude of change was different, implying that management and leadership styles matter. Future research could examine whether personal attributes, managerial capacities of the facility managers, and the operating environment have an effect on autonomy and accountability.

Effective obesity prevention requires intervening at all levels of society, including the governmental level. Policy interventions at the governmental level are especially promising as they tend to involve minimal individual effort while, at the same time, reach many people. The amount of state-level obesity-related legislation in the United States has increased over the years, and several laws were installed in contexts that reach young people, such as schools. Given this increase in state-level obesity-related legislation targeting youth, we tested whether the quantity of obesity-related legislation in U.S. states was associated with adolescent BMI and overweight/obesity prevalence. Linear and multilevel analyses showed that the quantity of physical activity-related legislation was associated with lower overweight/obesity prevalence yet with very modest effect size (b = -0.002, p = .042). Our results underline the likely importance of obesity-related legislation. In addition, the value of examining both BMI and overweight/obesity prevalence when evaluating interventions is demonstrated.

Objectives

The ongoing COVID-19 pandemic, caused by a novel coronavirus SARS-CoV-2, has created a severe threat to global human health. We are extremely lucky because within the first year of the COVID-19 pandemic, scientists developed a number of vaccines against COVID-19. In this paper, the authors discuss the difficulties and challenges faced in different low-and middle-income countries due to the ongoing pandemic.

Study design and methods

This research is primarily based on secondary data and existing literature reviews. The authors use maps and graphical representations to show information about vaccination coverage.

Results

The lacking vaccination coverage and insufficient supply of oxygen tanks in hospitals of low- and middle-income countries (LMICs) raise the likelihood of death of the critical COVID-19 patients. Developed countries vaccinate their citizens more quickly than LMICs. In comparison to wealthy countries, LMICs usually lack the resources and capacity to obtain the required vaccination doses.

Conclusion

It is frequently observed that hospitals in low- and middle-income nations with a dearth of oxygen tanks result in increased suffering and mortality. To avoid a worldwide disaster, LMICs urgently require COVID-19 vaccinations since viruses have no borders, and no one is safe until every one is protected in our interconnected world. Therefore, more national and international collaborative supports are urgently necessary for LMICs in this regard.

The diagnosis related group (DRG) was the most commonly used prospective hospital payment platform in developed countries. One of the major limitations of the DRG system is that the DRG grouping is not sufficiently homogeneous in benchmarking underlying resource needs. We developed a novel hospital payment and management system called Big Data Diagnosis & Intervention Packet (BD-DIP) by applying the similar case mix index (CMI) principles but the grouping is based on unique combination of ICD-10 and ICD-9 v3 codes. The initial prototype of BD-DIP was developed using hospital discharge records in Shanghai and then piloted in Guangzhou, China. The average coefficient of variation of the DB-DIP is about one-third smaller than the US DRG system. Results from the pilot evaluation showed that introduction of the BD-DIP lead to about 5% hospital budget savings and notable improvement in hospital care efficiency, including increased institutional CMI, lower admission rates, smaller variation in hospital charges, and lower patient cost-sharing burdens. The implementation of hospital monitoring tools resulted in identification of potential irregular practices to enable further auditing and investigation. The BD-DIP platform has a number of advantages over DRG-based payment models in terms of more homogeneous resource utilization within groups, design simplicity, dynamic in grouping, and reimbursement value in reflecting real-world treatment pathways and costs, and easy to implement.