Health equity funds as the pathway to universal coverage in Cambodia: care seeking and financial risk protection

2020 ◽  
Author(s):  
Theepakorn Jithitikulchai ◽  
Isabelle Feldhaus ◽  
Sebastian Bauhoff ◽  
Somil Nagpal
Keyword(s):  
Health Services ◽  
Health System ◽  
Health Equity ◽  
Universal Coverage ◽  
Healthcare Services ◽  
Care Seeking ◽  
Health Coverage ◽  
Access To Health Services ◽  
Financial Risk Protection ◽  
Access To Health

Abstract Cambodia has developed the health equity fund (HEF) system to improve access to health services for the poor, and this strengthens the health system towards the universal health coverage goal. Given rising healthcare costs, Cambodia has introduced several innovations and accomplished considerable progress in improving access to health services and catastrophic health expenditures for the targeted population groups. Though this is improving in recent years, HEF households remain at the higher risk of catastrophic spending as measured by the higher share of HEF households with catastrophic health expenses being at 6.9% compared to the non-HEF households of 5.5% in 2017. Poverty targeting poses another challenge for the health system. Nevertheless, HEF appeared to be more significantly associated with decreased out-of-pocket expenditure per illness among those who sought care from public providers. Increasing population and cost coverages of the HEF and effectively attracting beneficiaries to the public sector will further enhance the financial protection and pave the pathway towards universal coverage. Our recommendations focus on leveraging the HEF experience for expanding coverage and increasing equitable access, as well as strengthening the quality of healthcare services.

scholarly journals Financial Barriers to Access to Health Services for Adult People with Disability in Iran: The Challenges for Universal Health Coverage

2019 ◽  
Author(s):  
Shahin SOLTANI ◽  
Amirhossein TAKIAN ◽  
Ali AKBARI SARI ◽  
Reza MAJDZADEH ◽  
Mohammad KAMALI
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Healthcare Services ◽  
Health Coverage ◽  
Access To Health Services ◽  
Financial Barriers ◽  
Access To Health ◽  
People With Disability ◽  
Universal Health

Background: Reducing inequities in access to healthcare is one of the most important goals for all health systems. Financial barriers play a fundamental role here. People with disability (PWD) experience further financial barriers in access to their needed healthcare services. This study aimed to explore the causes of barriers in access to health services for PWD in Tehran, Iran. Methods: In this qualitative study, we used semi-structured in-depth interviews to collect data and selected participants through purposeful sampling with maximum variation. We conducted 56 individual interviews with people with disability, healthcare providers and policymakers from Sep 2015 until May 2016, at different locations in Tehran, Iran. Results: We identified four categories and eight subcategories of financial barriers affecting access to healthcare services among PWD. Four categories were related to health insurance (i.e. lack of insurance coverage for services like dentistry, occupational therapy and speech therapy), affordability (low income for PWD and their family), financial supports (e.g. low levels of pensions for people with disabilities) and transportation costs (high cost of transportation to reach healthcare facilities for PWD). Conclusion: Financial problems can lead to poor access to health care services. To achieve universal health coverage, government should reduce health insurance barriers and increase job opportunities and sufficient financial support for PWD. 

scholarly journals Equitable access to health services for children aged 5 to 9 in a medium city of northeasth of Brazil: a result of Family Health Strategy

2014 ◽  
Vol 17 (suppl 2) ◽  
pp. 39-52 ◽  
Author(s):  
Adriana Xavier de Santiago ◽  
Ivana Cristina de Holanda Cunha Barreto ◽  
Ana Cecília Silveira Lins Sucupira ◽  
José Wellington de Oliveira Lima ◽  
Luiz Odorico Monteiro de Andrade
Keyword(s):  
Health Services ◽  
Health System ◽  
Family Health ◽  
Northeastern Brazil ◽  
Local Health ◽  
Access To Health Services ◽  
Care Services ◽  
Health Strategy ◽  
Access To Health ◽  
Family Health Strategy

INTRODUCTION: The Brazilian National Health System may reduce inequalities in access to health services through strategies that can reach those most in need with no access to care services. OBJECTIVE: To identify factors associated with the use of health service by children aged 5 to 9 years in the city of Sobral, Ceará, northeastern Brazil. RESULTS: Only 558 (17.0%) children used health care services in the 30 days preceding this survey. Children with any health condition (OR = 3.90) who were frequent attenders of primary care strategy of organization (the Family Health Strategy, FHS) (OR = 1.81) and living in the city's urban area (OR = 1.51) were more likely to use health services. Almost 80% of children used FHS as their referral care service. Children from poorer families and with easier access to services were more likely to be FHS users. CONCLUSION: The study showed that access to health services has been relatively equitable through the FHS, a point of entry to the local health system.

scholarly journals Evaluation of Access on the perspective of adult users of Primary Health Care in Fortaleza, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Borges Costa ◽  
C Salles Gazeta Vieira Fernandes ◽  
T Custódio Mota ◽  
E Torquato Santos ◽  
M Moura de Almeida ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
Assessment Tool ◽  
Health Coverage ◽  
Access To Health Services ◽  
Primary Health ◽  
Care Assessment ◽  
The City

Abstract The Alma-Ata Conference promoted Primary Health Care (PHC) worldwide as a form of universal and continuous access to quality and effective health services. In Brazil, PHC, through the Family Health Strategy (FHS), aims to be the gateway to the health system and its structuring axis. For this, it is necessary to promote access, an essential condition for the quality of health care services, following the attributes systematized by Barbara Starfield. The aim of this study was to evaluate the presence of the attribute “First Contact Access” on the perspective of adult users of public PHC services in the city of Fortaleza, Ceará, Brazil. A transversal study was carried out, in 19 PHC Units, from June to December 2019, using the Primary Care Assessment Tool (PCATool) Brazil version for adult users. Kruskal-Wallis test was used for statistical analysis. 233 users participated, mostly women (69.5%), aged 30 to 59 years old (55.3%), mixed-race (69.5%), with complete high school (38.2%), without private health coverage (89.3%), homeowners (68.7%) and belonging to families of up to 4 members (87.9%). The “Accessibility” component had the lowest score, 2.83, and the “Utilization” had the highest score, 8.06. Older age was associated with higher “Accessibility” scores (p = 0,018), while lower values of “Utilization” were associated with higher education (p = 0,004). The main problems observed were: low access for acute demand consultations, lack of access at nighttime and weekends, little access through non-personal ways, bureaucratic barriers and a long time for scheduling appointments. We conclude that, although there was an improvement in PHC coverage in the city over the years, mainly due to FHS, there is still a lot to improve to ensure timely access to health services. Key messages Users consider PHC as the usual source of care, demonstrated by the high score of 'Utilization', however, they are unable to use it when necessary, demonstrated by the low score of 'Accessibility'. Expanding forms of access is essential to contribute to the strengthening of PHC in Fortaleza, Brazil, facilitating the entry to its national Universal Health System.

Practices employed by South African healthcare providers to obtain consent for treatment from children

2016 ◽  
Vol 25 (5) ◽  
pp. 640-652
Author(s):  
Michelle Bester ◽  
Yolanda Havenga ◽  
Zea Ligthelm
Keyword(s):  
Health Services ◽  
South African ◽  
Research Design ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Mental Capacity ◽  
Access To Health Services ◽  
Structured Interviews ◽  
Medical Practitioners ◽  
Access To Health

Background: The ability to consent promotes children’s access to health services. Healthcare providers should assess and arrive at a clinical judgement about the child’s maturity and mental capacity to obtain valid consent. Research objective: The objective of the study was to determine practices employed by South African healthcare providers to obtain consent for treatment from children. Research design: A qualitative, explorative, descriptive research design was used and the study was contextual. Participants and research context: In all, 24 healthcare providers (professional nurses and medical practitioners) were purposively sampled from a hospital and primary health clinics. Semi-structured interviews were used. Ethical consideration: Ethical approval was obtained from the Institutional Review Board and gatekeepers. Written informed consent was obtained from each participant. Findings: Healthcare providers’ current practices in obtaining consent from children revealed inconsistency in implementation as well as the yardstick used to determine children’s mental capacity. Building trust with children, sharing information and assessment were interlinked in obtaining consent. Discussion: The inconsistent practice has implications for children’s access to healthcare services. Conclusion: Inconsistent practices in the implementation of consent laws have the potential to violate children’s rights to bodily and psychological integrity, access to health services and having their opinions heard and be taken into consideration. Through uncovering the current perceptions and practices and a literature review, guidelines intended for use by the Department of Health could be developed.

The use of health services by non-resident patients in a border region with mixed health systems

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Pumi Alliana ◽  
F Nampo
Keyword(s):  
Health Services ◽  
Health System ◽  
Health Systems ◽  
Healthcare Services ◽  
Border Region ◽  
Local Health ◽  
High Complexity ◽  
Access To Health Services ◽  
Unified Health System ◽  
International Border

Abstract Background Access to health services in Brazil is universal, comprehensive, and equate, offering free healthcare to anyone, regardless of its country of residence. Cross-border patients may theoretically overload the healthcare services, mainly when the health systems or healthcare quality differ between countries. Sometimes, Brazilian politicians of border areas claim that non-residents overload local health services. Methods We collected data on the medium and high complexity Oncology and Cardiology care provided to in-patients by a reference Brazilian hospital located in the most populous international border of the country. This border is a conurbation that includes the cities of Foz do Iguassu (Brazil), Ciudad del Este (Paraguay), and Puerto Iguazu (Argentina), totaling around 900,000 inhabitants, of which 264,044 live in Foz do Iguassu. In addition to the poor migration control of citizens crossing these borders - especially the border with Paraguay - the Brazilian Unified Health System differs from that of the other two countries for being free of charge, and also for offering better healthcare. Results From January 2014 to December 2018, 107,434 procedures were performed, of which 240 (0.22%) on non-resident patients (Paraguay, [n = 236]; Argentina [n = 4]). Additionally, 238 (0.22%) other procedures were performed on foreign patients who did not declare their city/country of origin (Paraguay [n = 229]; Argentina [n = 8]; Portugal [n = 1]). Conclusions The use of medium and high complexity procedures by the non-residents on the Brazilian side of its most populous international border is low. Non-residents may benefit from medium and high complexity healthcare services of neighboring countries without overloading the health system. Key messages Advocating that non-residents overload medium and high complexity health services in Brazil is dishonest and may segregate people. Efforts should move toward integrating healthcare in border regions.

scholarly journals Integrative literature review: access to primary healthcare services

2018 ◽  
Vol 71 (3) ◽  
pp. 1178-1188 ◽  
Author(s):  
Maura Cristiane e Silva Figueira ◽  
Wellington Pereira da Silva ◽  
Eliete Maria Silva
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Primary Healthcare ◽  
Healthcare Services ◽  
Health Plans ◽  
Access To Health Services ◽  
Primary Health ◽  
Study Selection ◽  
Access To Health ◽  
Access To Primary Care

ABSTRACT Objective: Analyze the scientific production that describes the type of access to primary healthcare services and identify specific populations that have differentiated access to health services. Method: An integrative review. For study selection, the following databases were used: PubMed, Scopus, Bireme, and Cinahl. The sample included 22 national and international articles. Results: The results describe the access of specific populations to health services, the access to primary care through health plans and proposed improvements to the access to primary care. Conclusion: The access to services is a challenge in many countries and some strategies and policies are implemented to solve and improve primary health care.

scholarly journals Presence and extent of the primary health care attributes among children hospitalized for pneumonia

2015 ◽  
Vol 23 (3) ◽  
pp. 512-519 ◽  
Author(s):  
Juliana Coelho Pina ◽  
Suzana Alves de Moraes ◽  
Maria Cândida de Carvalho Furtado ◽  
Débora Falleiros de Mello
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
Family Counseling ◽  
Coordination Of Care ◽  
Access To Health Services ◽  
Unified Health System ◽  
Primary Health ◽  
Access To Health

OBJECTIVE: to analyze the presence and extent of the primary health care attributes among children hospitalized for pneumonia.METHOD: observational and retrospective study with hospital-based case-control design, developed in three hospitals associated to the Brazilian Unified Health System, located in a city of the State of São Paulo, Brazil. The study included 690 children under five years old, with 345 cases and 345 controls.RESULTS: both groups scored high for access to health services. In contrast, high scores for attributes such as longitudinality and coordination of care were observed for the controls. Despite low scores, integrality and family counseling were also high for the controls.CONCLUSION: knowledge of the aspects involving the primary health care attributes and its provision for child care are very important because they have the potential to support professionals and managers of the Brazilian Unified Health System in the organization of health services.

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