Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

Background. Countries around the world are using health technology assessment (HTA) for health benefit package design. Evidence-informed deliberative processes (EDPs) are a practical and stepwise approach to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. This paper reports on the development of practical guidance on EDPs, while the conceptual framework of EDPs is described in a companion paper. Methods. The first guide on EDPs (2019) is further developed based on academic knowledge exchange, surveying 27 HTA bodies and 66 experts around the globe, and the implementation of EDPs in several countries. We present the revised steps of EDPs and how selected HTA bodies (in Australia, Brazil, Canada, France, Germany, Scotland, Thailand and the United Kingdom) organize key issues of legitimacy in their processes. This is based on a review of literature via PubMed and HTA bodies’ websites. Results. HTA bodies around the globe vary considerable in how they address legitimacy (stakeholder involvement ideally through participation with deliberation; evidence-informed evaluation; transparency; and appeal) in their processes. While there is increased attention for improving legitimacy in decision-making processes, we found that the selected HTA bodies are still lacking or just starting to develop activities in this area. We provide recommendations on how HTA bodies can improve on this. Conclusion. The design and implementation of EDPs is in its infancy. We call for a systematic analysis of experiences of a variety of countries, from which general principles on EDPs might subsequently be inferred.

Evidence-Informed Deliberative Processes for Legitimate Health Benefit Package Design − Part I: Conceptual Framework

Background. Countries around the world are increasingly rethinking the design of their health benefit packages to achieve universal health coverage and health technology assessment (HTA) bodies support governments in these decisions. Coverage decision-making is an intrinsically complex and value-laden political process, but value frameworks currently employed by HTA bodies do not sufficiently account for this complex reality. Methods. Several years ago, evidence-informed deliberative processes (EDPs) were developed to address this issue. An EDP is a practical and stepwise approach for HTA bodies to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, and to interpret available evidence on these values. We further developed the conceptual framework and initial 2019 guidance based on academic knowledge exchange, analysing practices of HTA bodies, surveying HTA bodies and experts around the globe, and implementation of EDPs in several countries around the world. Results. EDPs stem from the general concept of legitimacy, which is translated into four elements – stakeholder involvement ideally operationalised through stakeholder participation with deliberation; evidence-informed evaluation; transparency; and appeal. The 2021 practical guidance distinguishes six practical steps of a HTA process and provides recommendations on how these elements can be implemented in each of these steps. Conclusion. There is an increased attention for legitimacy, deliberative processes for HTA and health benefit package design, but the development of theories and methods for such processes remain behind. The added value of EDPs lies in the operationalisation of the general concept of legitimacy into practical guidance for HTA bodies.

The experiences of merging health insurance funds in South Korea, Turkey, Thailand, and Indonesia: a cross-country comparative study

Background Fragmentation in health insurance system may lead to inequity in financial access to and utilization of health care services. One possible option to overcome this challenge is merging the existing health insurance funds together. This article aims to review and compare the experience of South Korea, Turkey, Thailand and Indonesia regarding merging their health insurance funds. Methods This was a cross-country comparative study. The countries of the study were selected purposefully based on the availability of data to review their experience regarding merging health insurance funds. To find the most relevant documents about the subject, different sources of information including books, scientific papers, dissertations, reports, and policy documents were studied. Research databases including PubMed, Scopus, Google Scholar, Science Direct and ProQuest were used to find relevant articles. Documents released by international organizations such as WHO and World Bank were analyzed as well. The content of documents was analyzed using a data-driven conventional content analysis approach and all details regarding the subject were extracted. The extracted information was reviewed by all authors several times and nine themes emerged. Results The findings show that improving equity in health financing and access to health care services among different groups of population was one of the main triggers to merge health insurance funds. Resistance by groups enjoying better benefit package and concerns of workers and employers about increasing the contribution rates were among challenges ahead of merging health insurance funds. Improving equity in the health care financing; reducing inequity in access to and utilization of health care services; boosting risk pooling; reducing administrative costs; higher chance to control total health care expenditures; and enhancing strategic purchasing were the main advantages of merging health insurance funds. The experience of these countries also emphasizes that political commitment and experiencing a reliable economic growth to enhance benefit package and support the single national insurance scheme financially after merging are required to facilitate implementation of merging health insurance funds. Conclusions Other contributing health reforms should be implemented simultaneously or sequentially in both supply side and demand side of the health system if merging is going to pave the way reaching universal health coverage.

Timelines of Philhealth Z Benefit Package for Standard Risk Coronary Artery Bypass Graft (CABG) Surgery at the University of the Philippines- Philippine General Hospital

Objective. The study evaluates the clinical profile of patients who underwent coronary artery bypass graft surgery (CABG) under the Philippine Health Insurance Corporation (Philhealth) Z Benefit Package (PZBP), as well as time intervals between PZBP screening, approval, and timing of surgery. Methods. A review of medical records was done to collect data on time intervals between the screening process and Philhealth approval in CABG patients under PZBP. The clinical profile and surgical outcomes of patients were also evaluated. Results. Sixty-three patients were included from March 2017 to December 2018. Most patients were under 61-70 years old. Hypertension was the most commonly observed comorbidity. Time intervals were analyzed including identification for surgery to eligibility screening (2–217 days, median 25 days), Philhealth approval (8–266 days, median 20 days), and surgery (9-403 days, median 33 days). Postoperative atrial fibrillation was seen in 22.58%. The most commonly observed complication prolonging hospitalization was pneumonia. Conclusion. This is the first local study which evaluated the timelines of PZBP. Results may be use as basis of follow up study in the future for identification of an acceptable timeline intervals. Several modifiable factors affecting time intervals were identified for further improvement of healthcare services. The leading cause of increase length in hospitalization were HAP and AF.

Financing Healthcare in Central and Eastern European Countries: How Far Are We from Universal Health Coverage?

After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the role of government and households in financing healthcare in eight countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied to collect quantitative data on healthcare expenditures and qualitative data on gaps in universal health coverage. A linear regression analysis was used to analyze a trend in health expenditure over the years 2000–2018. Our results indicate that a high reliance on out-of-pocket payments persists in many EU-8 countries, and only a few countries have shown a significant downward trend over time. The gaps in universal coverage in the EU-8 countries are due to explicit rationing (a limited benefit package, patient cost sharing) and implicit mechanisms (wait times). There is need to increase the role of public financing in CEE countries through budget prioritization, reducing patient co-payments for medical products and medicines, and extending the benefit package for these goods, as well as improving the quality of care.

Factors Affecting Job Satisfaction: An Exploratory Analysis among Public Bank Employees in Selected Cities of Bangladesh

This exploratory study aims to determine the factors affecting the overall perceived job satisfaction of the employees working at different public banks in Bangladesh. The authors carefully selected seven such factors after searching the existing literature. Those seven factors: working hour, fair competition, equal treatment, psychological support & fun, promotional opportunity, benefit package and co-working relationship were considered as the independent variables while overall job satisfaction was considered as the single dependent variable. Primary data were collected from a valid sample of 360 public sector bank employers through a structured questionnaire. Exploratory factor analysis (EFA) using SPSS (24) was utilized in order to validate the items of independent variables and structural equation modeling using AMOS (24) was utilized in order to test the hypothesized relationships between each independent variable and the dependent one. After proper statistical analysis, it was revealed that fair competition, equal treatment, promotional opportunity and working hour can positively and sufficiently influence the perceived overall job satisfaction of Bangladesh public bank employees while the other three factors, psychological stress & frustration, co-working relationship and benefit package were found to have insufficient influence over job satisfaction. The authors are well confident that this explorative study will guide the bank management in satisfying their competent employees in a more effective manner. Implications, limitations, and future directions have been also discussed in the study.

Job Satisfaction and Its Associated Factors Among Governmental Health Workers in West Shoa Zone, Oromia, Ethiopia

Background: Job satisfaction is an important determinant of workers' motivation, retention, and performance. Each individual working in different segments of the health sector has an impact on the quality and accessibility of the services the health care system provides to the community. Many studies assessed health care workers' job satisfaction. However, the majority of previous studies focused on specific health professionals and facilities. The present study assessed job satisfaction and its associated factors among governmental health workers in West Shoa Zone, Oromia, EthiopiaMethods: An institutional-based cross-sectional study was conducted in West Shoa, Oromia Regional State, Ethiopia, from March 23/2020 to April 15/2020. A total of 429 health workers were identified from type A, B, and C districts. Participants were proportionally allocated for each district and the individual participant was selected using simple random sampling methods. Data was collected using a self-administered structured questionnaire and entered into EpiInfo 7. Data analysis was done using SPSS version 22 software. Mean and/or median were used for continuous variables, whereas; the percentage was used for categorical variables. Bivariate logistic regression analysis was done to assess the association between each independent variable and outcome variable. Multivariate binary logistic regression using adjusted odds ratios and 95% confidence intervals were estimated to assess the strength of association. Results: From the total of 429 study participants, 422 of them were fully responded to the survey with a response rate of 98.3%. The overall level of job satisfaction was 46%. Management. The policy of the worker organization [AOR 0.07, 95% CI: 0.03-.21)], the relationship among the workers [AOR 0.08(95% CI .03-.23], presence of benefit package [AOR 0.07, (95% CI .02-.22], work environment [AOR 0.11, (95% CI: 0. 04-.31], personal growth and development [AOR 0.11 (95% CI: 0.04-.33], supportive supervision from immediate supervisor [AOR 0.04 (95% CI: 0.014-.14] and the nature of work category [AOR 0.03 (95% CI: 0.01-.1] were independently associated with job satisfaction. Conclusions: The overall job satisfaction of health workers in the study area was low. Management and policy of the worker organization, the relationship among the workers, presence of benefit package, work conditioning, personal growth, and development, supportive supervision from immediate supervisor and the nature of work category were among the predictor of job satisfaction.

Metabolic abnormalities among HIV-infected patients: The rational of national health security for people living with HIV

In the era of highly active antiretroviral therapy (ART), traditional risk factors for metabolic syndrome are presented as increasing age. In low- and middle-income countries, the restricted benefit package of national health security for human immunodeficiency virus (HIV) does not facilitate the early detection of metabolic disorders. In order to assess the rational of national health security for metabolic abnormalities among people living with HIV (PLHIV), this retrospective study aims to determine the occurrence of metabolic abnormalities and its predicting factors. The study was approved by the hospital ethics committee and conducted at the internal medicine clinic, Pathum Thani Hospital, Thailand. Patients with HIV having had at least 1 year of first-line ART, and having their fasting glucose, fasting lipid profile, and blood pressure assessed before ART were recruited into the study. Those with any abnormal metabolic component prior to ART or absent history of ART were excluded. The metabolic abnormalities were defined as any of the following: elevated triglyceride, reduced high-density lipoprotein (HDL), elevated blood pressure, elevated fasting glucose, or on drug treatment for these metabolic abnormalities. The occurrence of metabolic abnormalities was found in 102 of 340 patients (30.0%). Hypertension (11.4%) was the most common abnormality. Age became the single predictor of metabolic abnormalities (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.00–1.06). Aging patients with HIV should be the target group for monitoring and treating metabolic abnormalities. The revision of the benefit package on metabolic abnormalities is urgently needed to promote a better quality of life.