Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

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Impact and paybacks of biomedical research findings in Malaysia 2005–2015

Evidence & Policy A Journal of Research Debate and Practice ◽

10.1332/174426421x16328403229964 ◽

2021 ◽

Author(s):

Pei Kuan Lai ◽

S Nalliah ◽

CL Teng ◽

NLP Chen

Keyword(s):

Decision Making ◽

Health System ◽

Capacity Building ◽

Biomedical Research ◽

Knowledge Production ◽

Future Research ◽

Relevant Research ◽

Research Findings ◽

The Impact ◽

Health System Policy

Background: Impact in research encompasses health, economic, and cultural benefits beyond adding to the knowledge base. Funders are under immense pressure to be accountable for the paybacks from funded research.Aims and objectives: The aim of this study was to look into the impact of funded biomedical research between the years 2005 and 2015 in Malaysia from the aspects of knowledge production, research targeting and capacity building, as well as health system policy and decision making.Methods: This study employed a convergent parallel mixed-methods research design. Biomedical projects related to breast cancer, coronary heart disease, and dengue, funded by the Ministry of Health (MOH), Ministry of Higher Education (MOHE), and Ministry of Science, Technology, and Innovation (MOSTI) between the years 2005 and 2015, were included.Findings: From the questionnaire responses (n=58), on average each funded project managed to produce two outputs and one higher degree student. More than half (61.4%) of the funded projects led to subsequent future research. However, low citations in systematic reviews (10.3%), health policies (6.9%), and clinical practice guidelines (5.2%) were reported. In-depth interviews with the key opinion leaders also saw that most of the local research findings were found to be irrelevant to be adopted into policies by the policymakers.Discussion and conclusions: Paybacks on knowledge production as well as research targeting and capacity building had been achieved, but impact on health system policy and decision making had not been well attained, due to the lack of relevant research findings needed by the policymakers. Key messages <ul><li>Payback on knowledge production was achieved, as there had been a lot of new knowledge generated as captured in academic publications, conference proceedings, policy briefs, technical reports, and research highlights, which is important to advance the frontiers of knowledge.</li> <li>Payback on research targeting was achieved, with the current research leading to future study with identification of the knowledge gap and generation of new ideas for new research.</li> <li>Payback on capacity building was achieved with the training of researchers, building up research capacity and competencies, production of MSc and PhD graduates, promotion of lecturers, and development of new partnerships and networks.</li> <li>Impact on health system policy and decision making was not well attained. There had been a lack of relevant research data and findings being incorporated into policymaking, due to the basic and fundamental nature of most of the funded biomedical research in Malaysia.</li></ul>

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Access to medicines by patients of the primary health care in the Brazilian Unified Health System

Revista de Saúde Pública ◽

10.11606/s1518-8787.2017051007139 ◽

2017 ◽

Vol 51 ◽

pp. 20s ◽

Cited By ~ 3

Author(s):

Juliana Álvares ◽

Augusto Afonso Guerra Junior ◽

Vânia Eloisa de Araújo ◽

Alessandra Maciel Almeida ◽

Carolina Zampirolli Dias ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Health System ◽

Developed Countries ◽

Access To Medicines ◽

Essential Medicines ◽

Unified Health System ◽

Primary Health ◽

Significant Difference ◽

Good For

OBJECTIVE: To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective. METHODS: This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS: For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS: Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population

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Global health spending good for U.S. security and economy, National Academies say

Science ◽

10.1126/science.aal1194 ◽

2017 ◽

Author(s):

Ryan Cross

Keyword(s):

Global Health ◽

Health Spending ◽

Good For

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Mental health system costs, resources and constraints in South Africa: a national survey

Health Policy and Planning ◽

10.1093/heapol/czz085 ◽

2019 ◽

Vol 34 (9) ◽

pp. 706-719 ◽

Cited By ~ 14

Author(s):

Sumaiyah Docrat ◽

Donela Besada ◽

Susan Cleary ◽

Emmanuelle Daviaud ◽

Crick Lund

Keyword(s):

Public Health ◽

Mental Health ◽

South Africa ◽

Health System ◽

National Survey ◽

Mental Health System ◽

Scale Up ◽

Health Spending ◽

Mental Healthcare ◽

Mental Health Expenditure

Abstract The inclusion of mental health in the Sustainable Development Goals represents a global commitment to include mental health among the highest health and development priorities for investment. Low- and middle-income countries (LMICs), such as South Africa, contemplating mental health system scale-up embedded into wider universal health coverage-related health system transformations, require detailed and locally derived estimates on existing mental health system resources and constraints. The absence of these data has limited scale-up efforts to address the burden of mental disorders in most LMICs. We conducted a national survey to quantify public expenditure on mental health and evaluate the constraints of the South African mental health system. The study found that South Africa’s public mental health expenditure in the 2016/17 financial year was USD615.3 million, representing 5.0% of the total public health budget (provincial range: 2.1–7.7% of provincial health budgets) and USD13.3 per capita uninsured. Inpatient care represented 86% of mental healthcare expenditure, with nearly half of total mental health spending occurring at the psychiatric hospital-level. Almost one-quarter of mental health inpatients are readmitted to hospital within 3 months of a previous discharge, costing the public health system an estimated USD112 million. Crude estimates indicate that only 0.89% and 7.35% of the uninsured population requiring care received some form of public inpatient and outpatient mental healthcare, during the study period. Further, mental health human resource availability, infrastructure and medication supply are significant constraints to the realization of the country’s progressive mental health legislation. For the first time, this study offers a nationally representative reflection of the state of mental health spending and elucidates inefficiencies and constraints emanating from existing mental health investments in South Africa. With this information at hand, the government now has a baseline for which a rational process to planning for system reforms can be initiated.

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Methods for assessing the need for health financing: international experience (analytical review)

Health Care of the Russian Federation ◽

10.47470/0044-197x-2021-65-3-261-268 ◽

2021 ◽

Vol 65 (3) ◽

pp. 261-268

Author(s):

Elena G. Potapchik

Keyword(s):

Health System ◽

Health Spending ◽

Demographic Factors ◽

Health Financing ◽

Developed Countries ◽

International Experience ◽

World Health ◽

Free Text ◽

Spending Growth ◽

The Government

There has been an active discussion on estimating the need for public funding of the domestic health system. An analysis of international experience can be helpful to determine methodological approaches to estimate the market for government spending on the Russian health system. Aim. To systemize and summarize approaches and methods used in international practice to estimate the need for health financing; to highlight the most important factors dictating the need for additional funding. Material and methods. A systematic search with the developed protocol for publications, a comprehensive analysis and systematization of the obtained information. The protocol included databases of peer-reviewed publications, search terms, and search restrictions. The search for publications was carried out in the databases of Embase, Pubmed, Medline, Global Health, etc., on the websites of international organizations (World Health Organization (WHO), Organization for Economic Cooperation and Development (OECD), etc.). The search strategy included a combination of the terms “free text” and “Medical subject heading”, which refer to the definition of the need for health financing. The main limitations of the search were the language of publications (English and Russian) and the date of publication (not earlier than 2000). Results. Of the two used in international practice approaches to estimate the need for health financing, a system based on the use of the current level of funding and its forecasting under several factors is used in developed countries. Forecasting health expenditures is one of the most effective tools to identify critical factors affecting needs for sector financing. Despite the variety of indicators and methods used, most studies agree that non-demographic factors, such as GDP growth and technology development, influence health spending growth to the greatest extent. Demographic factors per se, including population ageing, affect health spending growth to a lesser extent. Conclusion. Conducting scenario forecasts contributes to a better understanding of what can happen in the future if the government does not act. This also contributes to a more clear determining of the main spheres for government interventions in the health sector.

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Cognitive impairment in aging physicians

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000829 ◽

2020 ◽

pp. 10.1212/CPJ.0000000000000829

Author(s):

Gayatri Devi ◽

Darren R. Gitelman ◽

Daniel Press ◽

Kirk R. Daffner

Keyword(s):

Patient Safety ◽

Cognitive Impairment ◽

Occupational Health ◽

Health System ◽

Cognitive Disorders ◽

Cognitively Impaired ◽

Occupational Health Physicians ◽

Risks And Benefits ◽

Health System Policy ◽

Practicing Physicians

Aging physicians are at a higher risk of cognitive impairment, undermining patient safety and unraveling physicians' careers. Neurologists, occupational health physicians, and psychiatrists will participate in both health system policy decisions and individual patient evaluations. We address cognitive impairment in aging physicians and attendant risks and benefits. If significant cognitive impairment is found after an appropriate evaluation, precautions to confidentially support physicians' practicing safely for as long as possible should be instituted. Understanding that there is heterogeneity and variability in the course of cognitive disorders is crucial to supporting cognitively impaired, practicing physicians. Physicians who are no longer able to practice clinically have other meaningful options.

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