Developing assessment criteria for operation control of local security health fund in the upper central area, Thailand

Background: The government's support for public health care in Thailand is very important and necessary. Therefore, there must be a supervisory process for budgeting to create the most equality and fairness to all people. At present, the instruments used to monitor health fund performance cannot be comprehensively assessed for effectiveness such as planning, organizing, leading and controlling. To address this gap, we created the Assessment Criteria for Operation control of Local security health Fund (ACOLF) which evaluates old assessment criteria, review literature and experience as separate constructs. Methods: The ACOLF is a 42-item survey with 12 old assessment criteria, 26 review literature and four experience items rated on scale from 0-9. In an observational analytical study, the survey was administered to 406 general population participants working in a provincial office for local administration. Validity and reliability were evaluated by testing construct validity. Exploratory factor analysis was conducted to confirm the item of old assessment criteria, review literature and experience. Reliability of the questionnaires was tested using Cronbach’s alpha coefficient. Results: The ACOLF demonstrated convergent construct validity (KMO = 0.88 and Bartlett's Test; p value <0.001) and explaining 88.95% of the variance of this construct. There were seven factors involved and all factors consisted of a total of 41 variables observed by the weight of the composition of the observed variables ranged from 0.780 to 0.972 at the significance level of 0.05. The reliability of the assessment criteria was tested using Cronbach’s alpha coefficient, the total results was at 0.889. Conclusions: The ACOLF is a short, cover activity, valid, and reliable instrument for assessment operation control of local security health fund. Based on research findings the tool can be used to comprehensively assess the performance of local security health fund.

Costs Associated with the Treatment of Clostridioides Difficile Infections

Background: Clostridioides difficile, as the main cause of infectious diarrhoea in hospitalised patients, is a considerable challenge for medical personnel (hospital environment) who have direct contact with the patient, as well as being of interest to public health specialists. Financial issues related to the occurrence of the above-mentioned micro-organism are being increasingly raised. Due to the scale of the phenomenon, we are beginning to pay attention to the significant system costs caused by the diagnosis and treatment of CDI infection and its complications. Studies indicate that the nosocomial infection of C. difficile complicates hospitalisation, by increasing the cost by more than half and extending patient’s stay by an average of 3.6 days. Material and methods: The aim of this study was to attempt to calculate the estimated costs associated with the prolonged hospitalisation of patients with nosocomial CDI infection, using the example of a hospital in Lodz. A total of 53 completed hospitalisations of patients treated in the period of January–August 2018 were analysed, during which hospital Clostridioides difficile infection was identified. For the purposes of this study, statistical data collected in the hospital’s IT system were also analysed, covering 44,868 hospitalisations in the Jan–Aug 2018 period, during which no hospital infection occurred. They was a control group, in which the analysed cases were compared. The obtained data in the study determined how long each patient with Clostridioides difficile infection stayed in the hospital (from the moment infection was diagnosed until the day of hospital discharge), and which diagnosis related groups (DRG) (according to National Health Fund guidelines) were assigned. The average length of patient stay without infection within a given DRG group in each hospital ward was also determined. The collected materials became the initial point for the final analysis of hospital costs and the length of hospital stay caused by Clostridioides difficile infection. Results: Clostridioides difficile infection extended the hospital stay by an average of almost 12 days. The average cost of prolonged hospitalisation due to CDI infection (according to the average cost per person-day) was about PLN 7148 (1664 EUR), which gave a total value of about PLN 378,860.6 (88,240.5 EUR) in the examined period. At the same time, the average expenditure from the National Health Fund for hospitalisation due to CDI infections increased by about PLN 6627 (1542.8 EUR), which in the analysed period translated into over PLN 351,232.0 (81,505.5 EUR) (according to settlements with the National Health Fund). The outcome indicates that there is a clear relation between CDI and the anticipated length of hospitalisation of patients without an infection.

Directions For Reconstruction of the Tax System in Poland – a Growth‑Enhancing Proposal

The paper aims to present directions for the growth‑enhancing reconstruction of the tax system in Poland. It presents a diagnosis of the main strengths and weaknesses of that system. Based on this diagnosis and a review of the literature, the authors propose a package of recommendations whose introduction would be conducive to economic growth. The recommendations include: shifting the burden of taxation from income, in particular low labour income, to consumption; exempting low earners from a part of social security contributions; the introduction of the possibility for local governments to increase the PIT‑free allowance above the centrally set base amount; the unification of the basis for the PIT, National Health Fund and Social Insurance Institution contributions; the elimination of differences in contributions for different types of contracts on the basis of which work is performed; the extension of one‑off amortisation to all machine investments; and the elimination of sectoral taxes.

The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process

Background Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania. Methods A descriptive qualitative case study was conducted in four urban districts in Tanzania in 2019. Data were collected using semi-structured interviews, focus group discussions and review of documents. A thematic approach was used to analyse the data. Results While TIKA scheme was important in increasing access to health services for the poor and other disadvantaged groups, it faced many challenges which hindered its performance. The challenges included frequent stock-out of drugs and medical supplies, which frustrated TIKA members and hence contributed to non-renewal of membership. In addition, the scheme was affected by poor collections and management of the revenue collected from TIKA members, limited benefit packages and low awareness of the community. Conclusions Similar to rural-based Community Health Fund, the TIKA scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. In order to achieve universal health coverage, the government should consider integrating or merging Community-Based Health Insurance schemes into a single national pool with decentralised arms to win national support while also maintaining local accountability.

Traumatic Knee Injuries in 2016–2019 – an Analysis of Newly Diagnosed Patients Based on NHF Data Reporting

Background. Traumatic musculoskeletal injuries are more and more frequently regarded as an important health, social and economic problem. According to WHO statistics, injuries are a major present-day health problem. The main aim of the study is to identify the number of new patients who sustained knee structure injuries during a year and to classify them based on data on services provided under National Health Fund agreements. Material and Methods. Information on the number of patients with a knee injury was obtained in a three stage process. First an inventory of relevant diagnoses was determined. Then, the National Health Fund data from 2016–2019 was queried in accordance with the adopted methodology and assumptions. The analysis was based on the report submitted by the NHF in response to the query. Results. According to the NHF reporting data, knee injuries affect approx. 244,000 people per year. There are slightly more men (approx. 52%) than women (48%). People aged 11-20 years constitute the most numerous group of patients with knee injuries, with approx. 41,342 cases per year. The most frequently reported diagnoses in both groups were S80.0 Contusion of knee (approx. 30%), S83.6 Sprain and tear of other and unspecified parts of knee (approx. 21%) and M23.8 Other internal derangements of knee (approx. 9%). According to available data, the overall rate of knee injuries in 2019 was 6.4 per 1000 population. Conclusions. 1. Knee injuries pose a major health problem. In Poland, according to the reporting data, approx. 244,000 knee injuries occur every year. 2. Knee injuries are more common among men than women, and people aged 11–20 years constitute the most numerous group of patients. 3. The National Health Fund reporting data is a very valuable source of information on the magnitude of the problem of injuries.

Poor-Quality Medicines in Cameroon: A Critical Review

Poor-quality medicines are the cause of many public health and socioeconomic problems. We conducted a review to acquire an overview of the situation concerning such medicines in Cameroon. Different searches were performed on databases from several websites of the WHO, the Ministry of Public Health of Cameroon, the Anti-Counterfeit Medicine Research Institute, the Global Pharma Health Fund, and the Infectious Disease Data Observatory. We identified 92 publications comprised of 19 peer-reviewed studies and 73 alerts. Based on studies completed, 1,664 samples were analyzed, and the prevalence of substandard and falsified (SF) medicines could be estimated for 1,440 samples. A total of 67.5% of these samples were collected from the informal sector, 20.9% from the formal sector, and 11.6% from both sectors. We found a prevalence of SF medicines across the peer-reviewed studies of 26.9%, whereas most of the SF medicines belonged to the anti-infective class. The problem of SF medicines is not studied sufficiently in Cameroon; therefore, efforts should be made to conduct adequate studies in terms of representativity and methodology.

Schizophrenic patients with type 2 diabetes: An 8-year population-based observational study

This paper presents a realistic evaluation of the prevalence of type 2 diabetes mellitus (T2DM) among Polish schizophrenic patients who have sought treatment through the Polish National Health Fund in the years 2010–2017. Data from the National Health Fund database was used and T2DM and schizophrenia groups were defined according to International Classification of Diseases (ICD-10) codes. Demographic data were collected from the web page of Statistics Poland (GUS). The annual prevalence of T2DM and schizophrenia was estimated, and the age groups were categorised into eight sets. The incidence of schizophrenia in T2DM patients in the years 2010–2017 was measured, including relative risk and 95% confidence interval (95% CI). The incidence of T2DM has been assessed in various subtypes of schizophrenia. In the eight years of follow-up study, 1,481,642 patients with schizophrenia were included, of which 185,205 were also diagnosed with T2DM. This accounted for 12.50% of all patients with schizophrenia. The trend of comorbid schizophrenia (F20) and T2DM (E11) in the general population of patients with schizophrenia, who sought treatment through the National Health Fund, was relatively stable in the years 2010–2017. The relative risk of T2DM in those with schizophrenia was 8.33 (95% CI 8.23–8.43) in 2017. Taking actions to enable the detection of diabetes in patients with concomitant schizophrenia is well-grounded, although these actions should be gender-dependent. There is also a need to take adequate actions to improve the efficiency of diabetological care among patients with schizophrenia.