Barriers and Facilitators of Use of Hydroxyurea among Children with Sickle Cell Disease: Experiences of Stakeholders in Tanzania

Factors contributing to low use of HU among SCD patients exist in high-income countries. The latter leaves a drift of literature on factors for low utilization of HU in developing countries. This study aimed to explore the factors influencing the use of HU in the management of SCD in Tanzania. A qualitative study was employed to interview purposively selected participants for this study. The in-depth interviews were conducted with 11 parents of children with SCD, four medical doctors working at sickle cell clinics, and two representatives of the national health insurance fund (NHIF). Interviews were audio-recorded, transcribed, and thematically analysed. Barriers identified were misconception of parents on SCD, financial constraints, regulatory restrictions, worries and fears of medical doctors on the acceptability of HU, shortages of laboratory equipment and consumables, and limited availability of HU. Adequate knowledge of the parents and medical doctors on SCD and HU and opportunities for HU accessibility were the facilitators identified. The utilization of HU by the individual with SCD is affected by several factors, from individual to policy level. Nevertheless, parents of children with SCD and medical doctors working in sickle cell clinics demonstrated good knowledge of the diseases and HU.

Prevalence of chronic conditions and multimorbidity in Estonia: a population-based cross-sectional study

ObjectivesPrevalence estimates for specific chronic conditions and multimorbidity (MM) in eastern Europe are scarce. This national study estimates the prevalence of MM by age group and sex in Estonia.DesignA population-based cross-sectional study, using administrative data.SettingData were collected on 55 chronic conditions from the Estonian Health Insurance Fund from 2015 to 2017. MM was defined as the coexistence of two or more conditions.ParticipantsThe Estonian Health Insurance Fund includes data for approximately 95% of the Estonian population receiving public health insurance.Primary and secondary outcome measuresPrevalence and 95% CIs for MM stratified by age group and sex.ResultsNearly half (49.1%) of the individuals (95% CI 49.0 to 49.3) had at least 1 chronic condition, and 30.1% (95% CI 30.0 to 30.2) had MM (2 or more chronic conditions). The number of conditions and the prevalence of MM increased with age, ranging from an MM prevalence of 3.5% (3.5%–3.6%) in the youngest (0–24 years) to as high as 80.4% (79.4%–81.3%) in the oldest (≥85 years) age group. Half of all individuals had MM by 60 years of age, and 75% of the population had MM by 75 years of age. Women had a higher prevalence of MM (34.9%, 95% CI 34.7 to 35.0) than men (24.4%, 95% CI 24.3 to 24.5). Hypertension was the most frequent chronic condition (24.5%), followed by chronic pain (12.4%) and arthritis (7.7%).ConclusionsHypertension is an important chronic condition amenable to treatment with lifestyle and therapeutic interventions. Given the established correlation between uncontrolled hypertension and exacerbation of other cardiovascular conditions as well as acute illnesses, this most common condition within the context of MM may be suitable for targeted public health interventions.

Effectiveness of an interactive web-based health program for adults: a study protocol for three concurrent controlled-randomized trials (EVA-TK-Coach)

Background A healthy lifestyle can help prevent diseases that impair quality of life and lead to premature death. The Techniker health insurance fund offers a comprehensive online health program to support users in achieving their health goals of Increasing Fitness, Losing and Maintaining Weight, or Smoking Cessation. Methods The aim of this study is to test the long-term effectiveness of the web-based TK-HealthCoach with regard to the primary outcomes of increased physical activity, sustainable weight reduction, and smoking abstinence. We are conducting three interconnected, randomized controlled trials (RCT), one for each health goal, within which participants are allocated to an intervention group (interactive online health program) or a control group (non-interactive online health program). The effects of the intervention groups compared to the control groups will be analyzed by multi-level models for change. Participants’ data are captured via online questionnaires before the program starts (baseline t0), again when it ends (t1), and later at two follow-up surveys (t2 and t3); the latter 12 months after t1. We are documenting socio-demographic, health-related, and psychological variables as well as usage behavior data of the programs. According to our sample size calculation, we have to enroll 1114 participants in each Losing and Maintaining Weight and Increasing Fitness RCT and 339 participants in the Smoking Cessation RCT. Additionally, 15–20 participants in the interactive smoking-cessation program will be invited to qualitative telephone interviews with the aim to obtain detailed information concerning utilization, compliance, and satisfaction. The online RCTs’ inclusion criteria are: adults of each gender regardless of whether they are insured with Techniker health insurance fund. Persons with impairments or pre-existing conditions require a medical assessment as to whether the program is suitable for them. Specific exclusion criteria apply to each program/RCT. Discussion We assume that study participants will improve their health behavior by using the offered online health programs and that each health goal’s intervention group will reveal advantages regarding the outcome variables compared to the control groups. Study enrollment started on January 1, 2020. Trial registration German Clinical Trials Register, Universal Trial Number (UTN): U1111-1245-0273. Registered on 11 December 2019

Uptake of hepatitis C virus screening and treatment in persons under opioid substitution therapy between 2008 and 2013 in Belgium

Background: Hepatitis C is a viral infection caused by the hepatitis C virus (HCV) with people who inject drugs as the main group at risk worldwide. Aim: This study investigated the differences in uptake for HCV screening and treatment between persons in opioid substitution therapy (OST) and the other members of the Christian Health Insurance Fund in Belgium. Methods: Invoice data were retrospectively collected from the Christian Health Insurance Fund, representing 42% of the healthcare users. Information on demographics, screening, diagnostic tests, treatment and disease progression was obtained from 2008 till 2013. All people in this study were aged 20-65 year. Persons in the OST group were identified as having at least one prescription reimbursed for methadone. This group was compared to the other members of the Insurance Fund not on OST (NOST). Results: The Insurance Fund registered 8,409 unique OST and 3,525,190 members in the general group. HCV RNA screening rate was higher in the OST group after correction for age and gender (4.3% vs. 0.2%). Ribavirin reimbursement, did not differ between the OST and NOST group screened for HCV RNA (16.9% vs. 14.4%), though the probability of having ribavirin reimbursed was smaller for females than for males. Procedures concerning disease progression were reimbursed less frequently in the HCV RNA screened OST group compared to the NOST group (0.3% vs. 1.2%). Conclusion: People on OST were screened more often for HCV RNA. However, the general uptake for HCV screening and treatment in both populations remained suboptimal.

A Comparative study on the cost effectiveness of intervention of noncommunicable disease in south Darfur 2017

Background: This study conducted to assess the cost effectiveness of common interventions used to control Noncommunicable diseases in south Darfur. Noncommunicable diseases are becoming an increasing public health concern due to their economic significance, and their great impact on the ability of affected individuals to contribute to their communities, and the high burden it represents on the health system. Objectives: To evaluate the role of health insurance fund in controlling Noncommunicable diseases. To assess cost effectiveness of the management of Noncommunicable disease within the National Health insurance fund system. Methods: This study is designed to use secondary data from the national health insurance fund in south Darfur, comparing the cost for the management of 3 selected Noncommunicable diseases (Hypertension, Heart disease, and Diabetes). I have reviewed the entire data of the year 2017 and compared the cost effectiveness of the currently used interventions against health promotion and coordinated approach within the national health insurance fund. Results: The 3 selected disease (Heart Disease, Hypertension and Diabetes) has significant burden on the health system, both financially and operationally. The NHIF concentrates on the management of Noncommunicable diseases without paying due attention to the importance of prevention strategies such as health promotion, community based integrated management of NCDs, and coordination among other sectors. Conclusion: To effectively reduce the financial burden of Noncommunicable disease; the NHIF needs to concentrate on prevention of Noncommunicable diseases through extensive health promotion campaigns, promotion of healthy lifestyle, and coordinated approach to controlling Noncommunicable disease.

Is Prescription Nonredemption a Source of Poor Health Among the Roma? Cross-Sectional Analysis of Drug Consumption Data From the National Health Insurance Fund of Hungary

Background: The health status of the Roma is inferior to that of the general population. The causes of poor health among this population are still ambiguous, but they include low utilization of healthcare services. Our study aimed to investigate prescription redemptions in segregated Roma colonies (SRC) where the most disadvantaged quartile of Roma people are living.Methods: A cross-sectional study was carried out with data obtained from the National Institute of Health Insurance Fund Management in the settlements belonging to the study area of the “Public Health-Focused Model Program for Organizing Primary Care Services.” The study included 4,943 residents of SRC and 62,074 residents of the complementary area (CA) of the settlements where SRC were located. Crude and age- and sex-standardized redemption ratios for SRC and CA were calculated for each Anatomic Therapeutic Chemical (ATC) group and for the total practice by ATC group. Standardized relative redemptions (RR) with 95% confidence intervals were calculated for SRC, with CA as a reference.Results: The crude redemption ratios were 73.13% in the SRC and 71.15% in the CA. RRs were higher in the SRC than in the CA for cardiovascular, musculoskeletal system, and alimentary tract and metabolism drugs (11.5, 3.7, and 3.5%, respectively). In contrast, RRs were lower in the SRC than in the CA for anti-infective agents (22.9%) due to the poor redemption of medicines prescribed for children or young adults. Despite the overall modest differences in redemption ratios, some ATC groups showed remarkable differences. Those include cardiovascular, alimentary and musculoskeletal drugs.Conclusion: Redemption of prescriptions was significantly higher among Roma people living in SRC than among those living in CA. The better redemption of cardiovascular and alimentary tract drugs was mainly responsible for this effect. These findings contradict the stereotype that the Roma do not use health services properly and that prescription non-redemption is responsible for their poor health.

Analysis of the Current Situation after the Introduction of Compulsory Social Health Insurance System іn Kazakhstan

The aim of the study: To assess the current state, the balance of functions and development trends of Social Health Insurance Fund NJSC. Methods. In order to study the level of awareness of the population about the implementation of the compulsory social health insurance system (CSHI), a mass survey was conducted twice during 2019 (in May and September) with a total sample of 2,150 respondents, including all regions of Kazakhstan. Also, within the framework of the study, such indicators of the activity of the Social Health Insurance Fund as the availability of funding for 2019-2020, the amount of funding by service providers, and coverage of the population were analyzed. Results. There is a positive trend in the compulsory health insurance system: awareness of the population is growing; the population positively assesses the changes in the provision of health services; there is a twofold increase in PHC visits; the share of private spending on health is twice the ceiling recommended by WHO; the level of coverage of the population with the compulsory health insurance system is quite high - 84%. However, about 3 million of the country's citizens remain uncovered. Conclusions. It is necessary to create a system for monitoring the effectiveness of the implementation of compulsory health insurance on the basis of information systems with the further adoption of managerial decisions both at the regional level and at the republican level. The introduction of mechanisms for proactive monitoring of the quality of medical care will protect the rights of patients, as well as improve feedback with them. Key words: Compulsory social health insurance, Medical services, Health care financing, Kazakhstan

Assisted reproductive technologies in centers for biomedical assisted fertilization within and outside the network plans in the Republic of Serbia and their financing

INTRODUCTION: Assisted reproduction technologies (ART) are technologies that are used today, in the treatment of infertility, on human germ cells (oocytes and sperm) and embryos. Currently in the Republic of Serbia, there are various procedures of assisted reproduction technologies that are used to treat infertility in patients depending on medical indications. The availability of assisted reproduction technologies has been evolving over the years, and their application differs in biomedically assisted fertilization centers that are in the Network Plan (state institutions) and outside the Network Plan (private institutions). The aim of this article is to analyze available ART methods in Fertility centers within and outside the Network plan regulated by the Law on the Treatment of Infertility Procedures of Biomedical Assisted Fertilization (Official Gazette of the Republic of Serbia", No. 72/2009), their financing and availability to patients in the Republic of Serbia. METHOD:This article is assembled upon seeking documents using the Internet and based on analyzed literature available on the Internet. RESULTS: The results were gathered by analyzing official ART centers' websites and analyzing available external secondary data from the National health insurance fund and the Institute for public health "Dr Milan Jovanovic Batut". Fertility clinics in the Republic of Serbia have access to all the important technologies for ART. ART technologies funded by National health insurance fund include in vitro fertilitation, intracytoplasmic sperm injection and frozen embryo transfer. Patients whose medical indications require for some other technology may approach Fertility Centers outside the Network plan on their own budget. CONCLUSION: Based on the available and updated data we can conclude that Fertility centers in the Republic of Serbia have access to all the important technologies for ART. Fertility centers within the Network plan can implement only the technologies financed and invoiced by the Fund.