Analisis Kebijakan Pembiayaan Program Pengendalian Penyakit Tuberkulosis di Provinsi Daerah Istimewa Yogyakarta

Masalah pembiayaan TB masih menjadi kendala besar di Dinas Kesehatan Provinsi maupun Kabupaten/Kota terutama saat sumber dari pendonor semakin turun jumlahnya dan tidak menutup kemungkinan dihentikan. Tujuan penelitian ini adalah untuk mengidentifikasi permasalahan dan strategi pembiayaan program TB. Rancangan penelitian menggunakan mixed method (kuantitatif kualitatif) dengan desain studi kasus. Subjek penelitian 11 orang dari Dinas Kesehatan, BPJS Kesehatan, rumah sakit dan puskesmas. Hasil analisis didapatkan bahwa sumber utama anggaran TB di Dinas Kesehatan Provinsi berasal dari pendonor lebih dari 50% global fund. Dinas Kesehatan wajib (1) menyusun standar, mengesahkan, dan mensosialiasikan standar alur rujukan TB yang wajib dilakukan oleh pelayanan kesehatan swasta dalam rangka penegakan diagnosis TB; (2) melakukan sosialisasi tentang tanggung jawab dan batasan pelayanan kesehatan yang dibiayai oleh JKN dan pemerintah ke seluruh jajaran kesehatan dengan melibatkan pihak BPJS Kesehatan. Puskesmas dapat melakukan lobbying, negosiasi, dan advokasi ke pemerintah desa untuk sharing pembiayaan program pengendalian penyakit TB. Peran lintas sektor serta pemberdayaan masyarakat dalam bentuk Gerduda TB tetap dipertahankan. Strategi pembiayaan TB dilakukan dengan menganalisis berbagai revenue collection yang melibatkan public-private mix untuk mem-backup kegiatan yang semula dibiayai oleh pendonor sehingga tujuan prioritas kesehatan nasional dapat dicapai sesuai dengan target para pengambil kebijakan.

Mobile Health Technologies could enhance Public Private Mix for Tuberculosis care in Rural Southwestern Uganda: Qualitative Findings

Background Despite some global progress in the implementation of the public-private mix for Tuberculosis care, the engagement of private healthcare providers remains wanting especially in high incidence countries such as Uganda. Although mobile health technologies are low-cost approaches that can enhance Tuberculosis care, there is a dearth of research about their application in fostering public-private mix. Objective To explore the potentials of mobile health technologies in fostering public-private mix for Tuberculosis care in Uganda. Methods This was a qualitative study design that involved in-depth interviews with 13 key informants (private healthcare workers) purposively selected between June and July 2020 due to their active involvement in Tuberculosis care from four private hospitals in Mbarara City. The interviews were transcribed and coded to identify key themes for analysis using content analysis. Results Mobile Health technologies (such as mobile apps, text messages) have the potential to map and link patients from private hospitals to the referral units, support patient medication adherence, notify and report Tuberculosis cases to the Ugandan Ministry of Health, and enhance patient care and monitoring. Conclusion Mobile Health technologies have the potential to revolutionize Tuberculosis care by establishing a centralized pathway for linking the referred patients from private hospitals to public hospitals. Future research should focus on assessing the utilization of mobile health technologies in enhancing access to referral units by presumptive Tuberculosis patients referred from private hospitals in low-resource settings.

Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective

Introduction: Pakistan ranks fifth in the globally estimated burden of tuberculosis (TB) case incidence. Annually, a gap of 241,688 patients with TB exists between estimated TB incidence and actual TB case notification in Pakistan. These undetected/missed TB cases initiate TB care from providers in the private healthcare system who are less motivated to notify patients to the national database that leads to significant underdetection of actual TB cases in the Pakistani community. To engage these private providers in reaching out to missing TB cases, a national implementation trial of the Public–Private Mix (PPM) model was cohesively launched by National TB Control Program (NTP) Pakistan in 2014. The study aims to assess the implementation, contribution, and relative treatment outcomes of cohesively implemented PPM model in comparison to the non-PPM model.Methods: A retrospective record review of all forms (new and relapse) patients with TB notified from July 2015 to June 2016 was conducted both for PPM- and non-PPM models.Results: The PPM model was implemented in 92 districts in total through four different approaches and contributed 25% (81,016 TB cases) to the national TB case notification. The PPM and non-PPM case notification showed a strong statistical difference in proportions among compared variables related to gender (p < 0.001), age group (p < 0.000), and province (p < 0.000). Among PPM approaches, general practitioners and non-governmental-organization facilities achieve a treatment success of 94–95%; private hospitals achieve 82% success, whereas Parastatals are unable to follow more than half of their notified TB cases.Discussion: The PPM model findings in Pakistan are considerably consistent with countries that have prioritized PPM for an increasing trend in the TB case notification to their national TB control programs. Different PPM approaches need to be scaled up in terms of PPM implemented districts, PPM coverage, PPM coverage efficiency, and PPM coverage outcome in the Pakistani healthcare system in the future.

Evaluating the impact of the nationwide public–private mix (PPM) program for tuberculosis under National Health Insurance in South Korea: A difference in differences analysis

Background Public–private mix (PPM) programs on tuberculosis (TB) have a critical role in engaging and integrating the private sector into the national TB control efforts in order to meet the End TB Strategy targets. South Korea’s PPM program can provide important insights on the long-term impact and policy gaps in the development and expansion of PPM as a nationwide program. Methods and findings Healthcare is privatized in South Korea, and a majority (80.3% in 2009) of TB patients sought care in the private sector. Since 2009, South Korea has rapidly expanded its PPM program coverage under the National Health Insurance (NHI) scheme as a formal national program with dedicated PPM nurses managing TB patients in both the private and public sectors. Using the difference in differences (DID) analytic framework, we compared relative changes in TB treatment outcomes—treatment success (TS) and loss to follow-up (LTFU)—in the private and public sector between the 2009 and 2014 TB patient cohorts. Propensity score matching (PSM) using the kernel method was done to adjust for imbalances in the covariates between the 2 population cohorts. The 2009 cohort included 6,195 (63.0% male, 37.0% female; mean age: 42.1) and 27,396 (56.1% male, 43.9% female; mean age: 45.7) TB patients in the public and private sectors, respectively. The 2014 cohort included 2,803 (63.2% male, 36.8% female; mean age: 50.1) and 29,988 (56.5% male, 43.5% female; mean age: 54.7) patients. In both the private and public sectors, the proportion of patients with transfer history decreased (public: 23.8% to 21.7% and private: 20.8% to 17.6%), and bacteriological confirmed disease increased (public: 48.9% to 62.3% and private: 48.8% to 58.1%) in 2014 compared to 2009. After expanding nationwide PPM, absolute TS rates improved by 9.10% (87.5% to 93.4%) and by 13.6% (from 70.3% to 83.9%) in the public and private sectors. Relative to the public, the private saw 4.1% (95% confidence interval [CI] 2.9% to 5.3%, p-value < 0.001) and −8.7% (95% CI −9.7% to −7.7%, p-value <0.001) higher rates of improvement in TS and reduction in LTFU. Treatment outcomes did not improve in patients who experienced at least 1 transfer during their TB treatment. Study limitations include non-longitudinal nature of our original dataset, inability to assess the regional disparities, and verify PPM program’s impact on TB mortality. Conclusions We found that the nationwide scale-up of the PPM program was associated with improvements in TB treatment outcomes in the private sector in South Korea. Centralized financial governance and regulatory mechanisms were integral in facilitating the integration of highly diverse South Korean private sector into the national TB control program and scaling up of the PPM intervention nationwide. However, TB care gaps continued to exist for patients who transferred at least once during their treatment. These programmatic gaps may be improved through reducing administrative hurdles and making programmatic amendments that can help facilitate management TB patients between institutions and healthcare sectors, as well as across administrative regions.

Public-Private Mix Implementation and Achievements of Tuberculosis Control Program at Puskesmas in Pekanbaru

Public-Private Mix (PPM) is a strategy implemented in countries with a high burden of tuberculosis, including Indonesia. This study aims to identify PPM implementation at the Puskesmas and the success of the TB control program at the Puskesmas that have implemented the PPM strategy. The research was conducted in 2019 in Pekanbaru Municipality. It was an observational study that collected quantitative and qualitative data. The implementation of PPM was assessed through guided interviews. The success of the Tuberculosis control program was assessed through the Case Notification Rate and Success Rate using secondary data from 2010 to 2017. The results showed that PPM had been implemented in six health centers in Pekanbaru. However, there were obstacles such as a lack of human resources, NGOs, private clinics, and local governments. The Case Notification Rate and Success Rate showed an increasing trend after the PPM implementation. However, these indicators had not yet reached the national target. It can be concluded that PPM in Pekanbaru had been implemented but needed to be improved at all Puskesmas by involving more partnerships and following up on obstacles encountered. Furthermore, the Tuberculosis Control Indicator had shown an increasing trend, but it needed to reach the national target.

Health Politics Today

This chapter sets the stage for Health Politics in Europe: A Handbook by explaining the motivation for the HEALTHDOX study upon which it is based, introducing the key themes and concepts, and providing an overview of the historical development and institutions of European healthcare systems, as well as current political conflicts and policy trends. The chapter explains how European health systems have been shaped by several centuries of political development, featuring a series of regime crises and challenges. It takes a closer look at political and policy developments since 1989, which importantly included the privatization of most Eastern European healthcare systems and experiments with new public management in Western Europe, recapping the highlights of the book’s thirty-five country cases. The chapter provides definitions and examples of the main types of healthcare financing in Europe and highlights the variation in the public–private mix and extent of out-of-pocket payment. The main theories for analyzing health politics are presented, including the concept of political veto points, and their significance for health politics.

Portugal

This chapter provides an extended look at health politics and the health system in Portugal, characterized by overlapping tiers of coverage including a national health service. The chapter traces the historical development of the Portuguese healthcare system through a series of regime changes, particularly the transition from conservative dictatorship to democracy beginning in 1974. Since the 1979 foundation of the National Health Service, the main issues facing the health system have been the relationship between public and private provision of services and the system’s fiscal solvency. A 1989 constitutional revision, which redefined healthcare from being a constitutional right to universal free healthcare to one which “tended towards” no cost at the time of treatment and was based on individuals’ particular social and economic situation, shifted the system away from universalism, removed obstacles to privatization, and allowed the introduction of other forms of market mechanisms. As the chapter argues, though left and right political parties have differed in their approaches, actors in health politics seem to have largely agreed to move in the direction of a public–private mix of service providers.