scholarly journals The patient voice: a survey of worries and anxieties during health system transition in HIV services in Vietnam

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shoko Matsumoto ◽  
Hoai Dung Thi Nguyen ◽  
Dung Thi Nguyen ◽  
Giang Van Tran ◽  
Junko Tanuma ◽  
...  
Keyword(s):  
Health System ◽  
Current System ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Health Facilities ◽  
Local Health ◽  
Hiv Services ◽  
The Public ◽  
System Transition ◽  
Lack Of Information

Abstract Background Vietnam is shifting toward integrating HIV services into the public health system using social health insurance (SHI), and the HIV service delivery system is becoming decentralized. The study aim was to investigate current SHI coverage and patients’ perspectives on this transition. Methods A survey of 1348 HIV-positive patients on antiretroviral therapy (aged ≥18 years) was conducted at an HIV outpatient clinic at a central-level hospital in Hanoi, Vietnam, in October and November 2018. Insurance coverage, reasons for not having a SHI card, perceived concerns about receiving HIV services in SHI-registered local health facilities, and willingness to continue regularly visiting the current hospital were self-reported. Logistic regression analyses were performed to analyze factors associated with not having a SHI card and having concerns about receiving HIV services in SHI-registered hospitals/clinics. Results SHI coverage was 78.0%. The most frequently reported reason for not having a SHI card was that obtaining one was burdensome, followed by lack of information on how to obtain a card, and financial problems. Most patients (86.6%) had concerns about receiving HIV services at SHI-registered local health facilities, and disclosure of HIV status to neighbors and low quality of HIV services were the main concerns reported. Participants aged < 40 years old and unmarried were more likely to report lack of SHI cards, and women and those aged ≥40 years were more likely to have concerns. However, 91.4% of patients showed willingness to continue regular visits to the current hospital. Conclusions Although SHI coverage has been rapidly improving among HIV patients, most participants had concerns about the current system transition in Vietnam. In response to their voiced concerns, strengthening the link between higher-level and lower-level facilities may help to ensure good quality HIV services at all levels while mitigating patients’ worries and anxieties.

Central COVID-19 Coordination Centers in Germany: Description, economic evaluation and systematic review (Preprint)

2021 ◽  
Author(s):  
Nikolas Schopow ◽  
Georg Osterhoff ◽  
Nikolaus von Dercks ◽  
Felix Girrbach ◽  
Christoph Josten ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
University Hospital ◽  
Local Health ◽  
The Public ◽  
Important Benefit ◽  
Economic Analyses ◽  
Management Institutions ◽  
Local Health System ◽  
Regional Hospitals

BACKGROUND During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCC) have been established at several hospitals across Germany with the intention to assist local healthcare professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals, and therefore to prevent the collapse of local health system structures. In addition, they coordinate interhospital transfers of COVID-19 patients and provide or arrange specialized telemedical consultations. OBJECTIVE This study describes the establishment and management of a CCCC at a German university hospital. METHODS We perform economic analyses (cost, cost-effectiveness, use and utility) according to the CHEERS criteria. Additionally, a systematic review was conducted to identify publications on similar institutions worldwide. RESULTS The two months with the highest local incidence (12/2020 and 01/2021) of COVID-19 cases were considered. During this time, 17.3 requests per day were made to CCCC regarding admission or transfer of COVID-19 patients. The majority of requests was made by emergency medical services (56.3%), patients with an average age of 71.8 years were involved and 69.0% of cases had already positive PCR detection. In 59.8% of the concerning patients, further treatment by the general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% of patients were admitted to normal wards and 12.9% were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than €52,000 per month. 90.4% of all patients presented to the hospital were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. CONCLUSIONS Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefit of the CCCC is that it prevents hospitals from being overrun by patients and that it avoids situations in which doctors have to weigh up one patient’s life against another´s.

scholarly journals Inequality in Health Services for Internal Migrants in China: A National Cross-Sectional Study on the Role of Fund Location of Social Health Insurance

2020 ◽  
Vol 17 (17) ◽  
pp. 6327
Author(s):  
Qiang Yao ◽  
Chaojie Liu ◽  
Ju Sun
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Health Insurance Coverage ◽  
Social Health ◽  
Local Health ◽  
Public Health Services ◽  
Internal Migrants ◽  
Use Of Health Services

On-the-spot settlements of medical bills for internal migrants enrolled with a social health insurance program outside of their residential location have been encouraged by the Chinese government, with the intention to improve equality in healthcare services. This study compared the use of health services between the internal migrants who had local health insurance coverage and those who did not. Data (n = 144,956) were obtained from the 2017 China Migrants Dynamic Survey. Use of health services was assessed by two indicators: visits to physicians when needed and registration (shown as health records) for essential public health services. Multi-level logistic regression models were established to estimate the effect size of fund location on the use of health services after controlling for variations in other variables. The respondents who enrolled with a social health insurance scheme locally were more likely to visit physicians when needed (adjusted odds ratio (AOR) = 1.18, 95% CI = 1.06–1.30) and to have a health record (AOR = 1.47, 95% CI = 1.30–1.65) compared with those who enrolled outside of their residential location: a gap of 3.5 percentage points (95% CI: 1.3%–5.8%) and 6.1 percentage point (95% CI: 4.3%–7.8%), respectively. The gaps were larger in the rural-to-urban migrants than those in the urban-to-urban migrants (AOR = 1.17, 95% CI = 0.93–1.48 for visiting physicians when needed; AOR = 0.71, 95% CI = 0.54–0.93 for having a health record). The on-the-spot medical bill settlement system has yet to fully achieve its proposed potential as inequalities in both medical and public health services remain between the internal migrants with and without local health insurance coverage. Further studies are needed to investigate how on-the-spot settlements of medical bills are implemented through coordination across multiple insurance funds.

scholarly journals WE’RE TRAINING THE MASTER’S PUBLIC HEALTH

2020 ◽  
Vol 45 (2) ◽  
Author(s):  
І. S. Mironyuk ◽  
G. O. Slabkiy ◽  
V. Y. Bilak-Lukyanchuk ◽  
V. V. Kruchanytsya
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
Bachelor's Degree ◽  
Ministry Of Education ◽  
Legal Basis ◽  
Prospective Students ◽  
The Public ◽  
Study Materials ◽  
Lack Of Information

Abstract Purpose of the study. The legal basis of training of specialists for the public health system and to determine the general methodological approaches and problems during the preparation of masters with specialization in «Public health» was study. Materials and methods. Materials: Legislation basis and statistics of the Ministry of Education and Science of Ukraine on admission of students with specialization in «Public Health». Methods: systematic approach, structural-logical analysis, content and statistical analysis. Results and methods. In order to ensure the effective functioning of the system in the country, «Public Health» specialty was approved and there was started the training of specialists of the first level – bachelor, and the second educational level – master. National educational standards for the training of specialists in the public health system have been approved. Licensed volumes of preparation of specialists have been approved. The enrollment of students in 2019 for the public health speciality (bachelor's degree 6,9% of licensed admission, master's degree 7,0% of licensed admission) clearly shows that this specialty does not have prestige with prospective students. The low demand for public health specialty among prospective students can be justified by the lack of information about postgraduation employment. Conclusions. Preparation of future pofessionals is carried out in accordance with the state standard, but there is no modern educational and methodological support in educational institutions. Keywords: public health, masters, preparation, number, legal basis, problems.

Healthcare System Challenges in Asia

2019 ◽  
Author(s):  
Winnie Yip
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Financial Risk ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
The Philippines ◽  
Social Health ◽  
Equitable Access ◽  
Financial Risk Protection ◽  
Risk Protection

Important health system challenges in the east and southeast Asian countries/territories of Japan, South Korea, Taiwan, Hong Kong, Malaysia, China, Thailand, Vietnam, Indonesia, the Philippines, Laos, Myanmar, and Cambodia exist. The most commonly adopted health system among these areas is social health insurance. The high-income, aging societies of Japan, South Korea, and Taiwan have adopted single-payer/single-pipe systems with a single uniform benefit package and a single fee schedule for paying providers for services included in the benefit package. All three have achieved universal coverage with relatively equitable access to affordable care. All grapple with overutilization, aging populations, and hospital-centric and curative-focused care that is ill-suited for addressing an increasing chronic disease burden. Rising patient expectations and demand for expensive technologies contribute to rising costs. Korea also faces comparatively poorer financial risk protection. China, Thailand, Vietnam, Indonesia, and the Philippines have also adopted social health insurance, though not single-payer systems. China and Thailand have established noncontributory schemes, whereby the government heavily subsidizes poor and non-poor populations. General tax revenue is used to extend coverage to those outside formal-sector employment. Both countries use multiple, unintegrated schemes to cover their populations. Thailand has improved access to care and financial risk protection. While China has improved insurance coverage, financial risk protection gains have been limited due to low levels of service coverage, fee-for-service payment systems, poor gatekeeping, and the fee schedule that incentivizes overprescription of tests and medicine. Indonesia, Vietnam, and the Philippines use contributory schemes. Government revenue provides insurance coverage for the poor, near-poor, and selected vulnerable populations; the rest of the population must contribute to enroll. Therefore, expanding insurance coverage to the informal sector has been a significant challenge. Instead of social health insurance, Hong Kong and Malaysia have two-tiered health systems where the public sector is financed by general tax revenue and the private sector is financed primarily by out-of-pocket payments and limited private insurance. There is universal access to care; free or subsidized, good-quality public-sector services provide financial risk protection. However, Hong Kong and Malaysia have fragmented delivery systems, weak primary care, budgetary strains, and inequitable access to private care (which may offer shorter wait times and better perceived quality). Laos, Cambodia, and Myanmar’s health systems feature high out-of-pocket spending, low government investment in health, and reliance on external aid. User fees, low insurance coverage, unequal distribution of health services, and fragmented financing pose pressing challenges to achieving equitable access and adequate financial risk protection. These countries/territories are diverse in terms of demographics, epidemiological profiles, and stages of economic development, and thus they face different health system challenges and opportunities. This diversity also suggests that these nations/territories will utilize different types of health systems to achieve universal health coverage, whereby all people have equitable access to affordable, good-quality care with adequate financial risk protection.

Indian Plural Health System and Resilience: Lessons from COVID-19

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Unnikrishnan Payyappallimana
Keyword(s):  
Health System ◽  
Health Systems ◽  
Local Health ◽  
Potential Core ◽  
The Public ◽  
Integrative Health ◽  
Indian Health ◽  
Indian Context ◽  
Rigorous Research ◽  
History Of

Beginning with a brief recent history of plural health systems in the Indian context, this is a commentary on the idea of resilience from the perspectives of AYUSH and local health traditions (LHTs) as witnessed historically and during the COVID pandemic. By narrating the AYUSH systems’ experiences during COVID-19, in providing health care and in attempts at building rigorous research and evidence, it examines their potential future engagement in the public health scenario in the country. The article contextualizes the potential core functions of plural and integrative health systems for the resilience of the Indian health system.

Kosovo

2021 ◽  
pp. 958-966
Author(s):  
Arta Uka
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Social Insurance ◽  
Social Health Insurance ◽  
Healthcare Services ◽  
Social Health ◽  
The Public ◽  
Insurance System ◽  
Building Process ◽  
Kosovo War

This chapter offers an in-depth look at health politics and the tax-financed health system in Kosovo, a system which is in a process of transition towards social health insurance. It traces the development of Kosovo’s healthcare system, characterized by the establishment of a decentralized free-for-all-at-point-of-delivery health system during communism. After the end of the Kosovo War in 1999, Kosovo started actively seeking independence. Until the declaration of independence in 2008, politics in the country was mainly focused on the state-building process, while health policy was not a priority. Although facilitated by international organizations, legislation for establishing a social health insurance has been passed, the social health insurance system has not been implemented yet. Thus, healthcare services still remain financed by state and municipal budgets, medical professionals are public employees, and the private sector is not integrated into the public insurance system. Key healthcare issues have been high out-of-pocket payments, mainly for pharmaceuticals and private services, inequalities in health access, and high unemployment rates, which are likely to undermine the collection of social insurance contributions in the future.

Prediction of attendance to the "60 days law" within the patient navigation program to breast cancer in Rio de Janeiro, Brazil.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13100-e13100
Author(s):  
Sandra Gioia ◽  
Lindsay Krush ◽  
Sandra San Miguel ◽  
Renata Galdino ◽  
Lucia Brigagao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health System ◽  
Rio De Janeiro ◽  
Patient Navigation ◽  
Local Health ◽  
Model Learning ◽  
The Public ◽  
Navigation Program ◽  
The Law ◽  
Compliance With The Law

e13100 Background: An applied study was conducted on how the use of machine learning techniques can help in the process of identifying compliance with the "60 Day Law", which states that all patients with cancer within the public system must initiate the treatment within 60 days after the diagnosis of cancer. Within the Patient Navigation Program (PNP) for breast cancer in Rio de Janeiro, the study aims to: 1) identify barriers to compliance with the Law; 2) ensure that at least 70% of patients recruited with breast cancer initiate treatment within the mandatory 60-day period; and 3) to construct a model that accurately predicts whether or not a patient meets the period established in the Law. Methods: From August 2017 to May 2018, 105 patients aged 33-80 years (mean 59 years) were recruited for navigation. For the development of the statistical analysis, three learning models were used AdaBoost, Decision Tree and GaussianNB. Results: Patients presented 0-I (17%), II-III (78%) and IV (5%) staging. The main barriers to compliance with the Law were fear and fatalistic thoughts (99%), financial problems (79%), and uncoordinated health care (76%).The PNP had 100% patient satisfaction and in 52% of the cases it helped at the beginning of the treatment within the period established by law. The AdaBoost learning model had superior results in relation to accuracy and f-score (0.8889 and 0.8333, respectively). Conclusions: The PNP generated a positive experience in the public health system, because it is an intentional and proactive process of individual assistance through the health system, accessing services, and actively overcoming the barriers to quality care. The study did not reach the success rate of 70% compliance with the Law as intended (having reached 52%). However, the barriers that NP cannot overcome, such as the lack of human resources and medical supplies, have been reported to health authorities and hospital administrators. We identified 38 important attributes for compliance with the Law, which simplifies the information required for model learning. In the Brazilian context, the PNP may represent an opportunity to adequately implement existing legislation and, as such, would have great potential for integration into federal, state, and local health systems. Clinical trial information: 62728616.5.0000.5274.

The US Public Health System and Ethics

2019 ◽  
pp. 62-76
Author(s):  
Debra DeBruin ◽  
Jonathon P. Leider
Keyword(s):  
Public Health ◽  
United States ◽  
Health System ◽  
Disease Control ◽  
Public Health System ◽  
The United States ◽  
Health Improvement ◽  
Local Health ◽  
The Public ◽  
Health Accounts

The public health enterprise is responsible for the protection and promotion of population health across the United States. Approximately 2,800 local health departments join state and territorial health agencies, federal agencies, and other government organizations in constituting the core of the governmental public health system in the United States. Spending on governmental public health accounts for less than 3 percent of the nation’s multi-trillion-dollar health budget. Yet it is responsible for health improvement, infectious disease control, pandemic planning, chronic disease control, environmental health, maternal and child health, and more. This chapter reviews the genesis and structure of the public health system. It examines the implications of that organizational structure for the many and varied ethical considerations that arise in the practice of public health.

scholarly journals (P1-16) Local Health-Related Capacities in the Northern Haiti Post-Earthquake Response

2011 ◽  
Vol 26 (S1) ◽  
pp. s104-s104 ◽  
Author(s):  
R.A. King ◽  
D.S.K. Thomas ◽  
S. Montas ◽  
P. Minn ◽  
D. Varda ◽  
...  
Keyword(s):  
Health System ◽  
Disaster Preparedness ◽  
Current System ◽  
Health Sector ◽  
Local Health ◽  
Healthcare Organizations ◽  
Existing Structures ◽  
The North ◽  
Response Capacity ◽  
Health Related

BackgroundThe January 2010 earthquake affected many services in Haiti, including health care. After the disaster, top-down response from international sources seemed like the only solution. While the existing health system was fragile, opportunities likely existed for incorporating bottom-up approaches in the capital and other cities, such as Cap Haitien in the North.ObjectiveThe study aims to: (1) identify available local health-related resources; (2) examine how these were, or were not, utilized in response efforts; and (3) evaluate the level of coordination among health delivery groups, particularly preparedness and recovery.MethodsThis case study included 11 key informant interviews at two hospitals (six at Justinian and five at Milot) and an organizational analysis of cooperation among 16 health-related organizations operating in northern Haiti. Disaster preparedness and recovery data for the health-sector organizations were obtained using a validated survey instrument and the Program to Analyze, Record, and Track Networks to Enhance Relationships (PARTNER) tool that uses the principles of Social Network Analysis (SNA) to elucidate the makeup of collaborative relationships.ResultsDuring the response phase, command-and-control approaches from international healthcare organizations had a roll given the numbers of people affected and the overwhelmed local response capabilities. Pre-disaster vulnerabilities limited response capacity. Even during response, opportunities existed for integrating established groups. Generally, this was not a model utilized by international organizations, although some examples were present.ConclusionsThe external infusion of money, priorities, and forces potentially may harm the current system, rather than build upon it. International aid provides free health services beyond treatment of earthquake-related injuries, taking the place of some service functions of the Haitian system. Eventually, this could erode aspects of the Haitian health system. Alternative models of aid may better incorporate and integrate existing structures. Disaster planning is linked intrinsically to strengthening the health system as a whole.

scholarly journals Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study

2019 ◽  
Vol 8 (4) ◽  
pp. 233-244 ◽  
Author(s):  
Yazan Douedari ◽  
Natasha Howard
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Facilities ◽  
Local Health ◽  
Governance Mechanisms ◽  
Health Authorities ◽  
Governance Challenges ◽  
Health System Governance ◽  
Local Health Authorities ◽  
Sustainable Health

Background: Ongoing conflict and systematic targeting of health facilities and personnel by the Syrian regime in opposition-controlled areas have contributed to health system and governance mechanisms collapse. Health directorates (HDs) were established in opposition-held areas in 2014 by the interim (opposition) Ministry of Health (MoH), to meet emerging needs. As the local health authorities responsible for health system governance in opposition-controlled areas in Syria, they face many challenges. This study explores ongoing health system governance efforts in 5 oppositioncontrolled areas in Syria. Methods: A qualitative study design was selected, using in-depth key informant interviews with 20 participants purposely sampled from HDs, non-governmental organisations (NGOs), donors, and service-users. Data were analysed thematically. Results: Health system governance elements (ie, strategic vision, participation, transparency, responsiveness, equity, effectiveness, accountability, information) were considered important, but not interpreted or addressed equally in opposition-controlled areas. Participants identified HDs as primarily responsible for health system governance in opposition-controlled areas. Main health system governance challenges identified were security (eg, targeting of health facilities and personnel), funding, and capacity. Suggested solutions included supporting HDs, addressing health-worker loss, and improving coordination. Conclusion: Rebuilding health system governance in opposition-controlled areas in Syria is already progressing, despite ongoing conflict. Local health authorities need support to overcome identified challenges and build sustainable health system governance mechanisms.

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