Health Policy Open最新文献

States retain significant power over key components of Affordable Care Act implementation. Using data from the US Census from 2010 to 2018, we examine how states’ decisions to either establish state-run marketplaces or to default to the federal marketplace influenced the distribution of health insurance types within states. We find, somewhat counterintuitively, that state-based marketplaces are associated with greater change in enrollment for Medicaid compared to the federal marketplace. These findings confirm that, at least until 2018, the most significant increases in insurance coverage resulting from the ACA were in public insurance, rather than private insurance. We explore a number of possible explanations to help explain these findings, raising important questions about the efficacy of the individual mandate (a key mechanism in legislative efforts to reduce the numbers of uninsured), the related administrative burdens associated with state and federal marketplaces, and, equally as important, differential access to Medicaid entitlements among citizens living in different states—access that hinges not only or always on Medicaid expansion, but also and perhaps more importantly, on policy decisions about insurance marketplaces.

The COVID-19 pandemic has resulted in calls for an increased integration of community health workers (CHWs) into the health system response. Historically, CHWs can play an important role in ensuring the sustainability of health policy implementation – by addressing social determinants of health and maintaining care for ongoing health problems. Their frontline work, with close contact to populations, places CHWs in a position of increased vulnerability to becoming infected and to being the target of abuse and violence. These vulnerabilities compound underlying problems faced by CHWs, who often come from poor backgrounds, are insufficiently paid and receive inadequate training. Speaking to a scarcity of studies on how CHWs are impacted by the pandemic, this paper conducts a systematic study of CHWs in Brazil. Based on quantitative and qualitative data collected during June and July 2020, it considers perceptions and experiences of CHWs, comparing them with other health professionals. We study the extent to which the pandemic added to existing vulnerabilities and created new problems and imbalances in the work of CHWs. We conclude that COVID-19 led to a deterioration of the working conditions of CHWs, of their relations with other health professionals, and of their ability to carry out their essential work in the public health system.

Introduction

The COVID-19 pandemic is an unprecedented and unique fallout worldwide and creates colossal disruption in human survival. During the pandemic, social networking sites (SNS) played a significant role in disseminating news related to the pandemic.

Methods

This research is based on primary data collected from 400 successful respondents via online Google Form. Bivariate Pearson's Chi-square and multivariate binary logistic regression analysis were performed to determine the impact of the explanatory variables on the study variables.

Results

This study reveals that most respondents (n = 360, 90 %) use SNS to get up-to-date news, and 72.5 % (n = 290) read health-related information. The highest number of participants (n = 386, 96.5 %) were Facebook users. Multivariate binary logistic regression reveals that “reading news on SNS” and “sharing information related to COVID-19 on social media” significantly influence the spread of awareness of COVID-19. “Unauthentic news sources” and “stop using social media to stay away from panic” also have a substantial impact on the spread of panic during the COVID-19 pandemic.

Conclusion

SNS has become an inevitable medium of information carrier nowadays. Social media users are found significantly aware of the COVID-19 pandemic. The findings of this study might assist the concerned persons in taking the necessary steps to propagate authentic news and regulate appropriate policies to prevent spreading misinformation.

A range of public health and social measures have been employed in response to the disproportionate impact of COVID-19 in Latin America and the Caribbean (LAC). Yet, pandemic responses have varied across the region, particularly during the first 6 months of the pandemic, with Uruguay effectively limiting transmission during this crucial phase. This review describes features of pandemic responses which may have contributed to Uruguay’s early success relative to 10 other LAC countries - Argentina, Chile, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Panama, Paraguay, and Trinidad and Tobago. Uruguay differentiated its early response efforts from reviewed countries by foregoing strict border closures and restrictions on movement, and rapidly implementing a suite of economic and social measures. Our findings describe the importance of supporting adherence to public health interventions by ensuring that effective social and economic safety net measures are in place to permit compliance with public health measures.

Background and Objectives

The Pacific Island Countries face some of the highest rates of Noncommunicable Diseases (NCDs). This study estimates the economic costs of NCDs for each year from 2015 to 2040, focusing on eleven Pacific Island nations.

Data and Methods:

Two methods were used to estimate the mortality and morbidity costs using a ‘value of lost output’ and ‘cost of illness’ approach respectively.

Results

Five results stand out in terms of projected economic costs of NCD mortality and morbidity analyses in the Pacific: (i) The economic burden of NCDs in the Pacific is greater than expected for middle-income countries; (ii) Although cardiovascular disease is the biggest contributor to the mortality burden in the region, diabetes plays a far greater role in the Pacific countries compared to the global average; (iii) The economic burden of NCDs is increasing with time, especially as incomes rise; (iv)The biggest driver of lost output is the potential loss of labor due to early death from NCDs; and (v) The cost of illness due to diabetes is high across the Pacific countries, with highest among the Polynesian countries.

Conclusions

NCDs alone can put enormous threat to the small Pacific economies. Targeted interventions to reduce disease prevalence, as outlined in the Pacific NCDs Roadmap, are vital to reduce the long-term costs associated with NCD mortality and morbidity.

Objectives

The study investigated the relationship between electricity access and infant mortality at the subnational level in Ghana, controlling for correlates such as birth interval, children living with both parents, women’s education, and income distribution.

Methods

The study employed a pooled cross-section regression approach using data from the Ghana Demographic and Health Survey (GDHS) for 10 administrative regions from 1993 to 2014. The GDHS is a detailed data set that provides comprehensive information on households and their socio-economic and demographic characteristics in Ghana.

Results

The results show that in regions with low incidence of infant mortality, a 10% improvement in electricity access reduces infant death by 11.8 per 1,000 live births, whereas in high mortality regions, improvement in electricity access has no impact on infant death. Birth interval reduces the risk of infant death in low mortality regions but not in high mortality regions. Children living with both parents have a high probability of survivorship in high mortality regions. Women’s median years of education lowers the likelihood of infant death in high mortality regions but increases the likelihood in low mortality regions. Wealth distribution is inconsequential for infant death in low mortality regions, but in high mortality regions, both the wealthiest and the poorest experienced significant decline in infant death.

Conclusions

The findings underscore the fruitfulness of investigating the effects of electricity access and other correlates on infant mortality at the subnational level. The study recommends that the provision of reliable access to electricity is needed to improve infant mortality rates. However, policies that seek to improve access to reliable electricity should be implemented together with health infrastructure development policies, especially in the regions with high infant mortality rates, for electricity access to have the desired effect.

Background

In recent years, there has been a significant worldwide increase in the use of generic drugs. China has committed to a consistency evaluation of generic drugs, with the aim to improve the rate of substitution. However, there is little research on physicians’ perceptions of generic drugs in China.

Objective

The study aimed to explore the perceptions of physicians in China toward generic drugs.

Methods

Perceptions of Chinese physicians towards generic drugs were evaluated by a cross-sectional study from June to July 2020. The online survey tool Sojump was adopted to distribute the questionnaires using convenience sampling. A total of 598 questionnaires were analyzed.

Results

Perceptions of Chinese physicians towards generic drugs are generally positive. However, not all physicians appear to have sufficient knowledge about generic drugs and some of them expressed negative perceptions of generic drugs, such as perceiving generic drugs as less effective and more likely to cause side effects compared to brand-name drugs. There were significant differences in physicians’ opinions about generic drugs according to age group, years in practice, educational background, clinical specialty and residential area.

Conclusion

It is imperative to provide physicians with more extensive education about the consistency evaluation of generic drugs to meet the policy goal of reducing overall national medical healthcare costs.

Introduction

Rural Unqualified Health Practitioners (RUHPs) are more common in the village health system in India and other developing countries. They only provides primary care to patients with diarrhea, cough, malaria, dengue, ARI/pneumonia, skin diseases, etc. As they are unqualified so their quality of health practices is substandard and inappropriate to practices.

Objective and contribution

The intention of this work was to assess the Knowledge, Attitude, and Practices (KAP) of diseases among RUHPs and proposing a blueprint of potential intervention strategies for improving their knowledge and practice.

Materials and methods

The study has used a cross-sectional primary data and adopted quantitative approach. For assessment purpose, a composite KAP Score was constructed for two diseases (malaria and dengue).

Results

The study observed that the KAP Score amongst the RUHPs are on average (about 50%) in most of the individual variables and composite scores for malaria and dengue in West Bengal, India. Their KAP score increased with age, level of education, working experiences, type of practitioners, using android mobile, work satisfaction, organization membership, attending RMP/Government workshop, heard WHO/IMC treatment protocol.

Conclusion

The study suggested multistage interventions includes targeting young practitioners, allopathic and homeopathic quack, launching ubiquitous app-based medical-learning, and government-sponsored workshop should be significant interventions to improve the level of knowledge, change positive attitudes, and adhere to standard health practice.

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.