Public Opinion on Healthcare

This chapter explores public opinion on healthcare from both theoretical and empirical perspectives. It critically reviews the literature surrounding public opinion on healthcare, teasing out the main concepts used—support for public healthcare provision/spending, overall evaluations of the healthcare systems, and the political salience of healthcare—while also discussing implications, gaps, and potential new research avenues. The chapter examines the operationalization of these key measures in large-scale survey items and compares trends in Europe over time. While Europeans mostly agree that it is the government’s responsibility to ensure adequate healthcare, there is much more regional variation when it comes to satisfaction with healthcare systems, and their political salience. The chapter concludes by arguing for the need to further examine the link between these key public opinion measures and their impact on health policy reform.

Luxembourg

This chapter offers an in-depth look at health politics and the compulsory health insurance system in Luxembourg, which historically was based on a long tradition of mutual aid society funds, as well as coverage by the large company fund of the main employer in the previously dominant steel sector. An unusually high proportion of the compulsorily-insured in Luxembourg are cross-border commuting workers. The chapter traces the development of the Luxembourgish healthcare system, characterized by its consensual mode of decision-making, the Quadripartite, which tends to rule out radical change. Since the early 1990s, health policy reform efforts have focused on consolidating the plurality of sickness funds into a unified scheme, introducing direct third-party payment for low-income persons, and efforts to introduce a highly controversial gatekeeping function for primary physicians. Other healthcare issues have been long-term care, cost containment, as well as assisted suicide, which caused a constitutional crisis.

Economic dynamics of epidemiological bifurcations

In this paper, we investigate the nature of rational expectations equilibria for economic epidemiological models, with a particular focus on the behavioral origins and dynamics of epidemiological bifurcations. Unlike mathematical epidemiological models, economic epidemiological models can produce regions of indeterminacy or instability around the endemic steady states due to endogenous human responses to epidemiological circumstance variation, medical technology change, or health policy reform. We consider SI, SIS, SIR and SIRS versions of economic compartmental models and show how well-intentioned public policy may contribute to disease instability, uncertainty, and welfare losses.

Bridging the gap with a gender lens: How two implementation research datasets were repurposed to inform health policy reform in Kenya

Policies as they are written often mask the power relations behind their creation (Hull, 2008). As a result, not only are policies that appear neat on the page frequently messy in their implementation on the ground, but the messiness of implementation, and implementation science, often brings these hidden power relations to light. In this paper, we examine the process by which different data sources were generated within a programme meant to increase access to quality private healthcare for the poorest populations in Kenya, how these sources were brought and analyzed together to examine gender bias in the large-scale rollout of Kenya’s National Hospital Insurance Fund (NHIF) beyond public hospitals and civil service employees, and how these findings ultimately were developed in real time to feed into the NHIF reform process. We point to the ways in which data generated for implementation science purposes and without a specific focus on gender were analyzed with a policy implementation analysis lens to look at gender issues at the policy level, and pay particular attention to the role that the ongoing close partnership between the evaluators and implementers played in allowing the teams to develop and turn findings around on short timelines. In conclusion, we discuss possibilities for programme evaluators and implementers to generate new data and feed routine monitoring data into policy reform processes to create a health policy environment that serves patients more effectively and equitably. Implementation science is generally focused on programmatic improvement; the experiences in Kenya make clear that it can, and should, also be considered for policy improvement.

Promoting equity through health services

The provision of healthcare should be in relation to the need of care, but this is not always the case, as examples given in this chapter illustrate. The impact on equity in the utilization of care of need-based resource allocation versus recent market-oriented choice reforms and changes in reimbursement systems in primary care in Sweden are discussed. Examples are given of alternative ways of providing services in primary care in disadvantaged areas. Further, the chapter describes an applied example of the concept of proportionate universalism in child healthcare services, where extra postnatal home visits are provided in a disadvantaged area of Stockholm. Finally, the emerging needs of integrated care in an ageing population are contrasted against current health policy reform, which emphasizes freedom of choice of providers, and discussed.

The socioeconomic burden of severe mental disorder in China, 2014-2017: a prevalence study

Mental illness is a chronic disease with high morbidity and mortality rate, resulting in heavy economic burden for family and society, especially the severe ones. Chinese government has taken a series of action on the treatment and management of severe mental disorder (SMD), but the scale of economic burden caused by SMD was still unclear. In this paper, we applied prevalence-based bottom-up approach to estimate the direct and indirect economic burden of SMD in Southwest China from 2014 to 2017. We used the sampled inpatient medical record data of patient with SMD to calculate the total direct cost and estimated the indirect economic burden using human capital approach.The total ecomonic burden of SMD was USD9,733 million and direct burden was contiributed for 7.5% as USD734.5 million in four years total. The growth rate of direct medical cost was declined due to the health policy reform and total cost control policy. The indirect cost was rapidly increased in four years when estimated with DALYs reported in GBD2010 and resulting USD8,998.6 million. We next estimated the indirect burden using sample DALYs and occupation wage cost approach as sensitive analysis. We found that the indirect burden was sensitive to the key variable and the estimation approach, but the estimates share same increasing trend but with different velocity. Our study suggests that SMD in China have posed substantial economic burden at individual and social levels, with the appropriate estimation of total economic burden, our reaserch would attract more attention and be helpful for health resources distribution.