scholarly journals Maintaining fair and efficient health care during the COVID-19 pandemic: Theoretical context and practical implications

2021 ◽  
Vol 24 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Charalampos Milionis ◽  
Maria Ntzigani ◽  
Stella Olga Milioni ◽  
Ioannis Ilias

Coronavirus disease 2019 is a respiratory infection that has evolved to a pandemic with an enormous burden both on human life and health care. States throughout the world have pursued strategies to restrict the transmission of the virus in the community. Health systems have a crucial dual role as they are at the frontline of the fight against the pathogen and at the same time they must continue to offer emergency and routine health services. The provision of health care in the context of the COVID-19 pandemic finds certain barriers. The simultaneous protection of both universal health coverage and health care efficiency is a difficult task due to conflicting challenges of these two goals. Key actions need to be decided and implemented in the fields of health policy, operation of health services, and clinical interaction between health personnel and patients, so that health care continues to perform its mission in a sustainable manner. As the scientific community prepares for the widespread production and application of effective protective and therapeutic agents against COVID-19, it is vital for the general population to remain safe and for the health systems to survive. Allocation of resources and priority setting need to be applied fairly and efficiently for the achievement of the maximum benefit.

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  

Abstract Oral health is a central element of general health with significant impact in terms of pain, suffering, impairment of function and reduced quality of life. Although most oral disease can be prevented by health promotion strategies and routine access to primary oral health care, the GBD study 2017 estimated that oral diseases affect over 3.5 billion people worldwide (Watt et al, 2019). Given the importance of oral health and its potential contribution to achieving universal health coverage (UHC), it has received increased attention in public health debates in recent years. However, little is known about the large variations across countries in terms of service delivery, coverage and financing of oral health. There is a lack of international comparison and understanding of who delivers oral health services, how much is devoted to oral health care and who funds the costs for which type of treatment (Eaton et al., 2019). Yet, these aspects are central for understanding the scope for improvement regarding financial protection against costs of dental care and equal access to services in each country. This workshop aims to present the comparative research on dental care coverage in Europe, North America and Australia led by the European Observatory on Health Systems and Policies. Three presentations will look at dental care coverage using different methods and approaches. They will compare how well the population is covered for dental care especially within Europe and North America considering the health systems design and expenditure level on dental care, using the WHO coverage cube as analytical framework. The first presentation shows results of a cross-country Health Systems in Transition (HiT) review on dental care. It provides a comparative review and analysis of financing, coverage and access in 31 European countries, describing the main trends also in the provision of dental care. The second presentation compares dental care coverage in eight jurisdictions (Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States) with a particular focus on older adults. The third presentation uses a vignette approach to map the extent of coverage of dental services offered by statutory systems (social insurance, compulsory insurance, NHS) in selected countries in Europe and North America. This workshop provides the opportunity of a focussed discussion on coverage of dental care, which is often neglected in the discussion on access to health services and universal health coverage. The objectives of the workshop are to discuss the oral health systems in an international comparative setting and to draw lessons on best practices and coverage design. The World Conference on Public Health is hence a good opportunity for this workshop that contributes to frame the discussion on oral health systems in a global perspective. Key messages There is large degree of variation in the extent to which the costs of dental care are covered by the statutory systems worldwide with implications for oral health outcomes and financial protection. There is a need for a more systematic collection of oral health indicators to make analysis of reliable and comparable oral health data possible.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Arrivillaga

Abstract Background Colombia has an insurance-based, private and public health care system, with the intermediation of health insurance agencies that control the resources. At present, the Universal Health Coverage (UHC) is around 97%. However, there is wide scientific evidence that criticizes the structure and operation of the system due to the persistent differences between the UHC indicator and real accessibility to health services. This study aimed to analyze the concept of accessibility of health services in order to design and validate alternatives instruments for its assessment beyond UHC. Methods A mixed methods approach with concurrent design in three phases was conducted between 2014 and 2017: 1) systematic review of literature and documentary research; 2) design, content validation with experts and pilot test of instruments to assess health care accessibility and 3) definition of a route to assess accessibility. Results The reviewed literature revealed five conceptual logics to define accessibility: decent minimum of health care, health care market, factors and multicausality, needs and, social justice and human right to health. A Household Survey on Accessibility to Health Care Services and a Health Care Services Availability Questionnaire was designed and validated with experts and pilot test in representative samples of households and care centers in three cities in Colombia was conducted. Those instruments were designed under the conceptual logic of human right to health. Finally, an alternative route to assess accessibility in Colombia was proposed. Conclusions The route for assessing accessibility with primary data, territorial approach and without intermediation of health insurance agencies allow obtaining an overview of the real situation beyond the UHC indicator. The instruments included in this assessing process can be useful to monitor progress in guaranteeing the human right to health, declared in Colombia and other countries. Key messages The UHC indicator is not enough to assess real accessibility to health services. This study presents an alternative route and two validated instruments for its assessment with primary data and territory-based approach, applicable to countries with public-private health systems.


2020 ◽  
Vol 54 (6) ◽  
Author(s):  
Hilton Y. Lam ◽  
Ma-Ann M. Zarsuelo ◽  
Katrina Loren R. Rey ◽  
Ma. Esmeralda C. Silva ◽  
Michael Antonio F. Mendoza ◽  
...  

Background. As the Philippines moves toward universal health coverage, it is imperative to examine how to eliminate inefficiencies, particularly misuse, overutilization, and risks of fraudulent claims. This position statement aimed to identify health services requiring copayments for cost-efficient health financing for the Universal Health Care Act. Methods. A qualitative study was employed using a systematic review of literature, and thematic analysis of policy roundtable discussion (RTD) was conducted. The systematic review of literature generated evidence for the policy brief and critical points for discussion in the stakeholders’ RTD forum. The RTD was organized by the UP Manila Health Policy Development Hub (UPM HPDH) with the Department of Health (DOH) and was participated by key stakeholders of the policy issue to attain consensus recommendations and develop criteria for identifying services requiring copayments. Results. An algorithm is proposed by the UPM HPDH based on collective expertise as a guide for policymakers to assess each benefit package in terms of overutilization, the danger of depleting government funds, and the risk of fraud. The use of clinical pathways is suggested to assess the misuse and overutilization of health services. In addition to copayments, benefits packages prone to fraudulent activities should be subjected to fraud prevention processes. Copayment should be linked inversely to the preventability level of the disease or condition. Conclusion. There were gaps in the current policies to identify services requiring copayment services. Copayment schemes should be carefully determined to prevent misuse, overuse, and fraud of appropriate and necessary health services, while at the same time not limit access to needed care.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  

Abstract Very often, important health system reforms are delayed, rendered ineffective or they simply go badly wrong. All too often this happens not because of a lack of money, health workers or health care facilities but because we adopt unfit ideas and decision and/or implement them insufficiently. The incapacity to develop, adopt and implement good decision is quintessentially the definition of bad governance. If we are to develop our health systems towards Universal Health Coverage and health systems performance improvement, we will need to strengthen our health system governance. Governance is vitally important to health systems reform and refers to how decisions are made and implemented - everything from the ability of policy-makers to take evidence-based and relevant decisions to their ability to implement policies and create alignment between different actors. In this workshop we will share experiences from a governance spring course for policy makers from Eastern Europe and Central Asia. Connected to this we will also share preliminary results of a study on National Level Health Systems Governance. The panelists will address five key issues The contribution of governance to Universal Health Coverage. This contribution will focus on a) the concept of governance defined as the way societies make and implement collective decisions and b) its 5 main domains including transparency, accountability, participation, integrity and capacity. (S Greer)Governance improvement needs in Eastern Europe and Central Asia: experiences from working with policy makers including countries like Azerbaijan, Georgia, Kyrgyzstan, Moldova Tajikistan, Ukraine and Uzbekistan. For purpose of peer-learning and contrasting experiences we have paired these countries with policy makers from Austria, Finland and Ireland (G Pastorino)Stakeholder participation in decision making and implementation: Very often, powerful stakeholders, like the medical profession, is over-represented and exerts immense veto power, while the voice of other professions, patients, and citizens remained unheard. What are the governance strategies and instruments to harness those underrepresented stakeholders for Universal Health Coverage? (G Fattore)Governing centralized and decentralized budgets in primary, social and hospital care: population-based health care in larger countries requires decentralization of part of the health care budget. What are the accountability lines and instruments that ensure that regional and local budget holders aligning with national policies for Universal Health Coverage? (L Hawkins)Governance contribution addressing corruption: According to surveys health systems are perceived prone to corruption. What is the contribution of governance to heal corruption and make the system work according to rules? (D Clarke) Key messages If we are to make progress towards Universal Health Coverage, we will need to strengthen health systems governance. Without strengthening health systems governance we will fail to manage stakeholders, budgets and corruption.


2020 ◽  
Vol 7 (4) ◽  
pp. p14
Author(s):  
Alfred A. Osoro ◽  
Edwine B. Atitwa ◽  
John K. Moturi

Universal Health Coverage has attracted global attention as an ideal vehicle that will drive health care services to the individuals, families, and communities globally. Good health systems are capable of serving the needs of entire populations, including the availability of infrastructure, human resources, health technologies, and medicines. This study seeks to identify the barriers and challenges which have hindered the provision of basic health care to communities and suggest ways of addressing some of them. Literature search reviewed 40 materials which were more relevant. Results revealed that there have been disparities in the provision of healthcare. Challenges in service provision include; lack of political commitment, weak health system resulting from limited financial allocation and poor leadership, lack of adequate number of skilled human resources, equipment and supplies and poor infrastructures. For UHC to be successful, an effective and well-functioning Primary Health Care (PHC) system is essential. Thus health systems can be strengthened through financial allocation; training of skilled and well-motivated healthcare workers. Also provision of right equipment and supplies, equity in resource distribution, improvement of infrastructures to meet the needs of the people is fundamental.


2021 ◽  
Vol 27 (4) ◽  
pp. 269-280
Author(s):  
Zh. V. Pisarenko ◽  
Thi Mai Doan

Aim. The presented study aims to analyze and identify the “bottlenecks” Vietnam may face on the way to achieving the goal of universal health coverage of the country’s population.Tasks. The authors analyze the situation regarding the implementation of sustainable development goals in terms of ensuring the availability of health services; assess the situation regarding the availability of health services in Vietnam; assess the potential of health insurance to achieve universal health coverage as a goal of Vietnam’s socio-economic development.Methods. This study uses statistical, empirical, and comparative analysis.Results. Achieving the goal of universal health coverage in the country requires more than just financing health care. It reflects the importance of ensuring equal access to quality health services and enforcing the right to health, especially for vulnerable groups. The authors analyze population coverage, the organization of the financing system, and the cost of medical care for households. Funding for health programs in Vietnam is increasing. However, due to the enduring poverty in the country, households spending a large share of their own funds on health services, and the number of challenges associated with the COVID-19 new coronavirus pandemic, there is still a risk of not achieving the goal of universal coverage in the near term.Conclusions. To achieve the set goal, Vietnam needs to introduce effective mechanisms of compulsory and voluntary health insurance (VHI). This additional financial protection is seen as a way to enable more people to use the necessary services without the risk of catastrophic health care costs, thus effectively approaching the goal of universal health coverage for the citizens of the Socialist Republic of Vietnam (SRV).


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  

Abstract Universal health coverage (UHC) is part of the global WHO strategy to improve health. UHC and equity in access to care fall within the shared principles and values of EU health systems. However, as reported in 2016 by the Expert panel on effective ways of investing in health (EXPH), significant amount of unmet needs persisted both between and within EU member states. Access to health services encompasses the dimensions of affordability, user experience and availability of services with potential barriers arising at individual, providers or health systems levels. Health needs are constantly evolving as a consequence of population ageing and of health care technology development. Consequently access to care does not simply mean availability of a single component of care, but rather to an array of pertinent, coordinated, cost-effective and timely primary and specialized health and social interventions. Measuring performance in that respect is beyond the ability of commonly used “national level” indicators of access. Available research suggests that achieving ubiquitous access to optimal care across territories and populations (eg socioeconomic groups) is hard to achieve. This applies to the whole spectrum of health interventions, from preventive care such as immunizations to multidisciplinary interventions required for the management of chronic diseases. In this context, the workshop proposes to present examples of policy initiatives and results from research projects focusing on access and use of health care conducted in a variety of settings. The aims are to share knowledge about methods used in measuring variations of access, to improve understanding of their determinants and to identify avenues for improving performance. The workshop is proposed by a multidisciplinary and international group of research teams. It will start with a short introduction from the chair (5 minutes, Olivier Grimaud) followed by five presentations (10 minutes) addressing the issues of variations in access and use of care from different research teams and in a variety of settings. The first presentation will report on an innovative policy aiming at improving UHC in India. The following presentations will illustrate the challenges of providing access in high income countries, including, Scotland, France and Australia. In the last part of the workshop (30 minutes) comments from Prof Helmut Brand (former expert panel member of the EXPH) will introduce a general discussion with the audience moderated by the chair. Key messages Even when the conditions for universal health coverage are in place, providing equitable access to quality care remains a challenge. Understanding variations in access to care would help improve performance and equity.


2020 ◽  
Author(s):  
Most. Zannatul Ferdous ◽  
Ummay Soumayia Islam

AbstractBackgroundLike many other countries around the world, Bangladesh adopts Universal Health Coverage (UHC) as a national aspiration. The central theme of its providing quality and affordable health services which is a significant element of social protection. This paper was aimed to provide a narrative understanding of the perspectives of UHC in Bangladesh towards COVID-19 based on the existing literature.MethodsWe conducted a review combining articles and abstracts with full HTML and PDF format. We searched Google Scholar, ScienceDirect and Google using multiple terms related to UHC, COVID-19 and Bangladesh without any date boundary and without any basis of types of studies, that is, all types of studies were scrutinized.ResultsThis short description highlights that the current pandemic COVID-19 holds lessons that health systems and economies in several countries like Bangladesh are not in enough preparation to tackle a massive public health crisis. It reports the shortage of health workers, scarcity of personal protective equipment, limited and ineffective diagnostic facilities, inadequate infrastructure of health care facilities, scarcity of drugs, and underfunded health services. Further, COVID-19 pandemic highlights the country’s health system needs an ongoing rehab post-COVID-19 with strong coordination in governance, in health economics, in health systems, in information systems, as well as in community participation in health to achieve UHC.ConclusionsAddressing the needs for UHC achievement, it is important to break down the access barriers and keeping up to date all the activities addressing public health crisis like COVID-19.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Kujundžić Tiljak ◽  
S Orešković ◽  
H Tiljak

Abstract Background Andrija Štampar implemented innovative healthcare solutions in Croatia at the beginning of the 20th century, advocating principles of comprehensiveness, continuity, and availability. These principles are globally challenged at ideological, social and policy levels, reflecting discussions in the USA and EU on whether a single-payer, mandatory health insurance (MHI) system and universal health coverage (UHC) are optimal solutions for the sustainable health system of the 21st century? Methods Analyzing the impact of the Croatian Health Insurance Fund (CHIF) as a single-payer on the performance of Croatia's health care system through the analysis of the financial and health outcomes for the 2000-2020 period to assess allocative efficiency, organizational effectiveness, and economic sustainability. Results The CHIF is the single purchaser of all publicly financed individual health services, delivered through both public and private providers. Although the broad scope of the MHI scheme, patients must pay towards the costs of many goods and services, and the right to free health care services has been systematically reduced in the last twenty years. The financial sustainability of the system is decreasing mainly caused by the model focusing on the tertiary care and payment scheme based on monthly hospital limits. However, the incidence of catastrophic and impoverishing payments is lower in Croatia than in many other EU13 countries. Conclusions The solution might be in the development of integrated health services, implementation of health promotion, education, and awareness, diseases prevention, and focus on the outcomes. The funding should follow the population needs in accordance with public health priorities and not only the structural demand of the existing system. The alternative is to face additional financial burden and impoverishment of the population in need of healthcare services. Key messages Modern universal health coverage strives to integrate health care and focuses on the outcomes. Single-payer system is not an obstacle for integration or source of fragmentation.


10.36469/9869 ◽  
2013 ◽  
Vol 1 (3) ◽  
pp. 224-238
Author(s):  
Darius Erlangga ◽  
Lizheng Shi

Purpose: In 2010, the World Health Organization (WHO) released its report about health system financing and identified universal coverage as the best way to attain the right of every human being to enjoy “the highest attainable standard of health”. Over the past decade, Thailand has successfully implemented a universal health coverage scheme for its population, while its neighbor country, Indonesia, is still struggling to achieve the same goal. The purpose of this paper is to compare the health financing systems between Thailand and Indonesia. Both countries almost have similar socioeconomic conditions and suffered from severe financial crisis during the late 1990s. The objective of this study is to examine health systems in each country and to determine lessons on how health care financing can affect the health status of a population. Methods: The study is based on statistical data from various publicly available resources. For analysis, the authors followed The Health Systems Assessment Approach: A How-To Manual Version 1.0 issued by Health Systems 20/20 supported by United States Agency for International Development (USAID). The countries were compared using three groups of indicators in health systems performance and functioning: 1. Health Insurance System, 2. Amount and Sources of Financial Resources, and 3. Health Outcomes and Health Workforce Density. Results: In comparing the health financing of the two countries, we found that Thailand initiated much earlier health systems reforms in order to achieve universal health coverage. Indonesia, while on the right track, has moved at a slower pace than Thailand. Thailand and Indonesia have shown improving trends over time in all indicators, but Thailand outperformed Indonesia, especially in the groups of indicators regarding the amount and sources of financial resources. Conclusions: One important lesson identified in this study is that health care reform is unlikely to succeed without strong political support and constant pressure from the nation as a whole, which can be represented by local organizations or professional associations. However, the mere increase of available resources devoted to the health sector does not guarantee significant improvements of health outcomes of a population.


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