Health Policy Open最新文献

In 2020, COVID-19 threatened to overwhelm healthcare capacity, forcing policymakers to enact temporary waivers of licensing restrictions. Research finds that occupational licensing reduces the supply of professionals in a regulated field, and reduces geographic mobility, contributing to the primary care professional shortage. Scope of practice laws reduce the flexibility of practitioners, exacerbating these shortages. Given the fact that policymakers and healthcare professionals recognized the shortcomings to our current licensing regime during the COVID-19 pandemic, we should consider alternatives that still ensure quality care for patients without restricting access and reducing flexibility. We rank six alternatives currently being considered to address the primary care shortage from most to least effective. While efforts to expand the supply of physicians or NPs and PAs would be the most effective reforms to expand access to primary care, others that better utilize our existing supply of healthcare professionals are worth considering.

Background

The COVID-19 pandemic has significantly disrupted health systems and exacerbated pre-existing resource gaps in the Eastern Mediterranean Region (WHO-EMRO). Active humanitarian and refugee crises have led to mass population displacement and increased health system fragility, which has implication for equitable priority setting (PS). We examine whether and how PS was included in national COVID-19 pandemic plans within EMRO.

Methods

An analysis of COVID-19 pandemic response and preparedness planning documents from a sample of 12/22 countries in WHO-EMRO. We assessed the degree to which documented PS processes adhere to twenty established quality parameters of effective PS.

Results

While all reviewed plans addressed some aspect of PS, none included all quality parameters. Yemen’s plan included the highest number (9) of quality parameters, while Egypt’s addressed the lowest (3). Most plans used evidence in their planning processes. While no plans explicitly identify equity as a criterion to guide PS; many identified vulnerable populations - a key component of equitable PS. Despite high concentrations of refugees, migrants, and IDPs in EMRO, only a quarter of the plans identified them as vulnerable.

Conclusion

PS setting challenges are exacerbated by conflict and the resulting health system fragmentation. Systematic and quality PS is essential to tackle long-term health implications of COVID-19 for vulnerable populations in this region, and to support effective PS and equitable resource allocation.

The study assessed willingness to join and willingness to pay for health-insurance in Afghanistan and identified associated determinants. A household survey was conducted. Two health-insurance and two medicine-insurance packages were explained to respondents, who were then asked if they would be willing to join the packages and pay for them. The double-bounded dichotomous choice contingent valuation method was used to elicit the maximum amount respondents would be willing to pay for the various benefit packages. Logistic and linear regression models were used to examine determinants of willingness to join and willingness to pay. Most respondents had never heard of health insurance. And yet, when they were told about it, the vast majority of respondents said they would be willing to join one of the four benefit packages and pay for them, ranging from 70.7% for a medicine-only package that included only essential medicines, to 92.4% for a health-insurance package that would cover only primary and secondary care. The average willingness to pay cost was 1,236 (US$21.3), 1,512 (US$26.0), 778 (US$13.4) and 430 (US$7.4) Afghani per person, per year for the primary and secondary; comprehensive primary, secondary and some tertiary; all medicine; and essential medicine packages; respectively. Key determinants of willingness to join, and to pay were similar, including the provinces where respondents were located, wealth status, health expenditures and some demographic characteristics.

COVID-19 vaccines are an effective tool in preventing severe disease. Most states used an age-based prioritization for vaccine rollout. We examined the impact of a primarily age-based prioritization policy on reductions of severe disease in different racial and ethnic groups. We calculated age-specific rates of COVID-19 hospitalization and death by race/ethnicity in Denver, Colorado. To assess potentially averted hospitalizations and deaths by race/ethnicity, we then applied the first three phases of Colorado’s primarily age-based vaccine rollout criteria to historical 2020 COVID-19 hospitalizations and deaths in Denver, Colorado. In the first 3 phases, 40% (1403/3473) of hospitalizations and 83% (503/604) of deaths occurred among those meeting age and long-term care facility criteria and could have been averted. Impacts varied by race/ethnicity with only 28% (440/1587) of hospitalizations and 74% (131/178) of deaths averted among Hispanic or Latino residents, compared to 57% (619/1094) of hospitalizations and 92% (252/274) of deaths among non-Hispanic White residents. We demonstrate using local data and policy that early age-based prioritization decisions disproportionately promoted reductions in severe disease among non-Hispanic White residents irrespective of COVID-19 risk in Denver, Colorado. These findings suggest that more equitable future vaccine prioritization policies, which lead with a goal of reducing health disparities through prioritizing susceptibility to adverse health outcomes rather than overall population-based cutoffs, are necessary. Our results have implications for future vaccination rollouts in limited vaccine resource conditions.

Introduction

In Ethiopia; even though utilization of health care services has been improved after the introduction of user fee exemption, little is known about the quality of the services. There are fragmented studies on the output dimension of quality of health care services particularly on clients’ satisfaction. Therefore this study aims to assess overall quality (in terms of clients’ satisfaction) and its disparity among users of selected exempted health care services provided in Ethiopia.

Methods

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was used to undertake this study. Both published and unpublished articles conducted in Ethiopia on the quality of health care services in terms of clients’ satisfaction dimensions were searched. A total of 750 articles were retrieved through international databases (Scopus, MEDLINE/PubMed, Science Direct, Google Scholar and Cochrane Library) and national digital library repositories (Addis Ababa University’s digital library repository); 703 of which were excluded while only 47 articles were included in the meta-analysis. The search for articles was conducted during the period 03 December 2019 to 28 January 2020. For methodological qualities of the included articles assessment, a modified version of the Newcastle-Ottawa Scale adapted for cross-sectional studies was used. R version 3.6.1 and stata version 14 soft wares were used for analysis. A random-effects model was used to calculate pooled estimates. The I2 tests were used to assess the heterogeneity of the studies.

Results

The pooled overall prevalence of included 47 studies revealed that clients’ satisfaction among users of selected exempted health care services in Ethiopia was 70% (95% CI: 64, 74%). In subgroup analysis; the lowest prevalence of clients’ satisfaction was observed among users of obstetrics maternal health care services with the prevalence of 65.04% (95% CI: 57.50, 72.58).

Conclusion

This study found that more than one-third of respondents; was not satisfied with exempted health care services. There is slight difference in satisfaction of clients across type of exempted health care services and regions. Policy and decision makers in Ethiopia shall design strategies to optimize quality of health care services besides exemption of its costs.it is also strongly recommend that a special emphasis shall be given to obstetric health care services provision. Moreover, concerned stakeholders’ (ministry of health, etc.) should strengthen compassionate respectful care provision in public health facilities; beside to removing user fees.

Despite the consensus on the importance of evidence based health information for decision28 making and health policy formulation, quality information is not always available. This situation led the WHO in 2009 to recommend the establishment of an African Health Observatory and National Health Observatories. The WHO recommended 4 phases approach for the establishment of National Health Observatories was used in Cameroon: the preliminary phase, start-up, strengthening and full operation. Despite a non-optimal institutional positioning, the Cameroon’s Health Observatory is in the strengthening phase and contributes to evidence-based decision making in the health system. A strong political commitment is fundamental from the beginning of the project. The establishment of National Health Observatories calls for genuine national ownership, both of the process as a whole and of the tool itself. WHO should regularly assess the progress made in the establishment of National Health Observatories in different countries and provide feedback to them. A step-by-step approach, jointly validated by national stakeholders in a roll-out plan, would be more appropriate for the sustainability of the work of National Health Observatories.

Background

The World Health Organization- South-East Asia Region (WHO-SEARO) accounted for almost 17% of all the confirmed cases and deaths of COVID-19 worldwide. While the literature has documented a weak COVID-19 response in the WHO-SEARO, there has been no discussion of the degree to which this could have been influenced/ mitigated with the integration of priority setting (PS) in the region’s COVID-19 response. The purpose of this paper is to describe the degree to which the COVID-19 plans from a sample of WHO-SEARO countries included priority setting.

Methods

The study was based on an analysis of national COVID-19 pandemic response and preparedness planning documents from a sample of seven (of the eleven) countries in WHO-SEARO. We described the degree to which the documented priority setting processes adhered to twenty established quality indicators of effective PS and conducted a cross-country comparison.

Results

All of the reviewed plans described the required resources during the COVID-19 pandemic. Most, but not all of the plans demonstrated political will, and described stakeholder involvement. However, none of the plans presented a clear description of the PS process including a formal PS framework, and PS criteria. Overall, most of the plans included only a limited number of quality indicators for effective PS.

Discussion and conclusion

There was wide variation in the parameters of effective PS in the reviewed plans. However, there were no systematic variations between the parameters presented in the plans and the country’s economic, health system and pandemic and PS context and experiences. The political nature of the pandemic, and its high resource demands could have influenced the inclusion of the parameters that were apparent in all the plans. The finding that the plans did not include most of the evidence-based parameters of effective PS highlights the need for further research on how countries operationalize priority setting in their respective contexts as well as deeper understanding of the parameters that are deemed relevant. Further research should explore and describe the experiences of implementing defined priorities and the impact of this decision-making on the pandemic outcomes in each country.

Using data from the European Social Survey 1 (2002) and 9 (2018) we show the development of self-rated health of older persons in 17 countries. We find a considerable increase of older persons reporting good or very good health between 2002 and 2018; this increase is similar in all groups examined. Absolute differences between income groups remained vastly stable. Further, in 2018 the high-income tercile of those between 65 and 80 years still reported better health than the low-income tercile of those between 49 and 64 years. Overall, self-rated health seems to have improved in Europe but there are still signs of a considerable gap between low-income groups and high-income groups.

The Coronavirus disease 19 (COVID-19) pandemic has profoundly affected economic and health systems around the world. This paper aims to assess household access to basic foods and health care and food security attainment during the COVID-19 pandemic in Burkina Faso. We use the COVID-19 High-Frequency Phone Survey 2020 panel data supported by the World Bank and conducted by Institut National de la Statistique et de la Démographie (INSD). The pooled multinomial logistic, the panel logistic, and the panel ordered logistic regressions are used to analyse the access to basic foods, the access to health care and the food security of the households, respectively. The results show that during COVID-19, female-headed households, poor households and farm households remain the most vulnerable in terms of access to basic foods, health services and food insecurity. Furthermore, the results indicate that households living outside the capital, particularly in the other urbans, experience fewer difficulties obtaining basic foods than those residing in the capital and are also unlikely to experience food insecurity. For more effective policy responses to the COVID-19 or similar shocks, the interventions should focus on household socioeconomic conditions and distinguish between urban and rural areas.

Objective

Building on the premise that health authorities should govern their health systems in partnership with the full community of stakeholders, we document the contribution of national hospital associations to health policy processes, before and during the COVID-19 crisis.

Methods

This research followed a rapid cross-sectional comparative design. Data were collected through an online survey targeting hospital associations. Eighteen of them shared information on their institutional profile, their areas of activity, their position and participation as policy actors before and during the COVID-19 crisis, the barriers and enablers affecting their participation and the impact of the crisis on their own financial situation.

Findings

We have documented a spectrum of situations both for national policy platforms and hospital associations. In some countries, there is the ideal match of well-established associations and national participatory health policy platforms. In others, hospital associations have modest staffing and may struggle to get access to policy platforms of importance. Being a well-established and respected contributor seems to have been an enabling factor for the contribution of the hospital associations to the COVID-19 response. For most associations, the crisis has led to an increased effort to be present in the policy arena; an issue they follow closely is the negative impact of the lockdown on the hospitals’ revenue.

Conclusion

The growing pluralism characterizing our societies calls for the establishment of health policy platforms allowing for broader participation. Encouraging hospitals to set up their association for the latter to represent them in decision processes could be one of the components of the rebuilding of national health systems post pandemic.