Why does healthcare utilisation differ between socioeconomic groups in OECD countries with universal healthcare coverage? A protocol for a systematic review

IntroductionEven in advanced economies with universal healthcare coverage (UHC), a social gradient in healthcare utilisation has been reported. Many individual, community and healthcare system factors have been considered that may be associated with the variation in healthcare utilisation between socioeconomic groups. Nevertheless, relatively little is known about the complex interaction and relative contribution of these factors to socioeconomic differences in healthcare utilisation. In order to improve understanding of why utilisation patterns differ by socioeconomic status (SES), the proposed systematic review will explore the main mechanisms that have been examined in quantitative research.Methods and analysisThe systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and will be conducted in Embase, PubMed, Scopus, Web of Science, Econlit and PsycInfo. Articles examining factors associated with the differences in primary and specialised healthcare utilisation between socioeconomic groups in Organisation for Economic Co-operation and Development (OECD) countries with UHC will be included. Further restrictions concern specifications of outcome measures, factors of interest, study design, population, language and type of publication. Data will be numerically summarised, narratively synthesised and thematically discussed. The factors will be categorised according to existing frameworks for barriers to healthcare access.Ethics and disseminationNo primary data will be collected. No ethics approval is required. We intend to publish a scientific article in an international peer-reviewed journal.

Who Manipulates Data During Pandemics? Evidence From Newcomb-Benford Law

The COVID-19 pandemic has spurred controversies related to whether countries manipulate reported data for political gains. We study the association between accuracy of reported COVID-19 data and developmental indicators. We use the Newcomb-Benford law (NBL) to gauge data accuracy. We run an OLS regression of developmental indicators (EIU index, GDP per capita, healthcare expenditures, and universal healthcare coverage index) on goodness-of-fit measures to the NBL. We find that democratic countries, countries with the higher gross domestic product (GDP) per capita, higher healthcare expenditures, and better universal healthcare coverage are less likely to deviate from the Newcomb-Benford law. The relationship holds for the cumulative number of reported deaths and total cases but is more pronounced for the death toll. The findings are robust for second-digit tests, for a sub-sample of countries with regional data, and in relation to the previous swine flu (H1N1) 2009–2010 pandemic. The NBL provides a first screening for potential data manipulation during pandemics. Our study indicates that data from autocratic regimes and less developed countries should be treated with more caution. The paper further highlights the importance of independent surveillance data verification projects.JEL classification: F5, I10, I18, O1, O57, P52.

The federal spending power: Building forward after the pandemic

The phrase, “the federal spending power,” identifies the federal government’s ability to spend in areas beyond its constitutional authority to legislate—a power that has supported the development of a national system of universal healthcare coverage in Canada. Even before the COVID-19 pandemic, this power was critical to the expansion of Canada’s narrow but deep basket of universally covered services. The challenges exposed by the pandemic mean that still more federal investment will be required. Yet for traditionalists, the material basis of this power is now constrained: the federal government may possess the constitutional authority to invest, but it lacks the fiscal capacity; some form of belt tightening—even austerity—will be necessary. As debates over public spending intensify, health leaders will need to address these questions. Depending on how they do so, health leaders will either support or detract from a healthy recovery.

Obstacles and Challenges affecting the move towards Universal Healthcare Coverage in Nigeria

There is increasing pressure for low and middle-income countries to move towards achieving universal healthcare coverage (UHC). According to WHO (2013), UHC guarantees the right to affordable health care for every individual, without financial hardship. The Director-General to the World Health Organization, Margaret Chan (WHO, 2010 p. 1), says UHC “is the single most powerful concept that public health has to offer”. In recent years, UHC has come onto the policy agenda, but Nigeria has been criticised for its slow progress. This study investigates why and how the UHC policy is developed by focusing on the roles and interactions of policy actors, their policy setting, and ‘how’ their actions influence the policy process and outcome of UHC so far in Nigeria. It will provide evidence of Nigeria’s policy process that will enhance the understanding of the politics of such health care policy implementation processes, which is fundamental to the success of policy networks of UHC in low- and middle-income settings. This is an empirical study using a mixed method approach involving quantitative and qualitative research components. The study combines the social network analysis (the quantitative component) with a more general policy process framework (the qualitative component). Data collected between March 2016 and February 2017 involved face-to-face structured interviews, face-to-face semi-structured interviews and documentary analysis to identify members of relevant policy networks and describe the pattern of relationships and influence within the UHC discourse. The SNA analysis displayed a full structural network taxonomy of the UHC policy process and identified key members of the UHC discourse into four key institutions and organisations- such as the power actors, peripheral actors, gatekeepers or brokers, isolated actors, and policy actors connected to the power actors. The theoretical policy process framework highlights five key gaps that exist as challenges and obstacles which impedes the implementation process of UHC Nigeria. These challenges and obstacles include, changing political climate, concerns about system capacity and finance, poor coordination between federal and state levels, corruption and problems with the private sector – HMOs. These challenges and obstacles limit the government’s ability to provide social and financial risk protection and access to quality health services to vulnerable Nigerian communities. Drawing on the theoretical framework and intervention, this thesis concludes that the political, policy, financial and organizational constraints of the health system limit UHC Nigeria implementation progress. Addressing the reasons why these issues ensue would be helpful in taking strategic steps towards achieving financial protection and access to basic health services through UHC for many Nigerians.

PP422 Including Empowering Community Into Primary Healthcare Team Scope Of Practice – A Technology For Ensuring Universal Healthcare Coverage

IntroductionConsidering the World Health Organization (WHO) Astana Declaration, in order to provide universal healthcare coverage, Kazakhstan through ongoing healthcare reform committed to the promotion of a people-centered Primary Healthcare (PHC) system. Since the implemented top-down policies showed low buy-in from community members and put more constraints on PHC facilities and teams, the Kazakh National Medical University, the Medeo district mayor's office and the WHO European Centre for PHC supported the initiative of a local non-governmental organization “Community health committee” and Outpatient clinic of Almaty State hospital #5, for creation of an integrated plan to develop people-centered PHC through better coverage and engagement of patients with non-communicable disease and enhancing the health literacy of the population above 65 years.MethodsWe used a community-based participatory approach. The process consisted of: forming a steering committee with at least one member from each stakeholder group; two interactive workshops where the community worked jointly with PHC professionals in defining priority health needs and proposing actions to address selected priorities; and, after, joint development by all stakeholders of an action plan for empowerment of the community, and for assessment and review of the scope of practice of PHC teams.ResultsThe interactive workshops identified priority health needs such as low health literacy, low responsibility for health, low engagement of the elderly in prevention and self-management of non-communicable diseases. The main findings of semi-structured interviews were that there are no planning approaches (neither shared planning by a PHC team, or individually by PHC professionals) for addressing defined priority needs of the community, families and/or patients, and that the role of a PHC team in community empowerment is very limited.ConclusionsUsing results of the review on PHC teams’ scope of practice, we will develop, discuss and agree with the national and local stakeholders’ proposal of a conceptual model of PHC service delivery. Further, we will implement and evaluate the results of implementation.

Universal Healthcare Coverage Does Not Ensure Adherence to Initial Colorectal Cancer Screening Guidelines

Introduction Colorectal cancer is the second leading cause of cancer deaths in the USA, and screening tests are underutilized. The aim of this study was to determine the proportion of individuals at average risk who utilized a recommended initial screening test in a universal healthcare coverage system. Materials and Methods This is a retrospective cohort study of active duty and retired military members as well as civilian beneficiaries of the Military Health System. Individuals born from 1960 to 1962 and eligible for full benefits on their 50th birthday were evaluated. Military rank or rank of benefits sponsor was used to determine socioeconomic status. Adherence to the U.S. Preventive Services Task Force guidelines for initial colorectal cancer screening was determined using “Current Procedural Terminology” and “Healthcare Common Procedure Coding System” codes for colonoscopy, sigmoidoscopy, fecal occult blood test, and fecal immunohistochemistry test. Average risk individuals who obtained early screening ages 47 to 49 were also identified. Results This study identified 275,665 individuals at average risk. Of these, 105,957 (38.4%) adhered to screening guidelines. An additional 19,806 (7.2%) individuals were screened early. Colonoscopy (82.7%) was the most common screening procedure. Highest odds of screening were associated with being active duty military (odds ratio [OR] 3.63, 95% confidence interval [CI] 3.43 to 3.85), having highest socioeconomic status (OR 2.37, 95% CI 2.31 to 2.44), and having managed care insurance (OR 4.36, 95% CI 4.28 to 4.44). Conclusions Universal healthcare coverage does not ensure initial colorectal cancer screening utilization consistent with guidelines no does it eliminate disparities.

Leukemia mortality in children from Latin America: trends and predictions to 2030

Background Reports suggest that Latin American and Caribbean (LAC) countries have not reduced leukemia mortality compared to high-income countries. However, updated trends remain largely unknown in the region. Given that leukemia is the leading cause of cancer-related death in LAC children, we evaluated mortality trends in children (0-14y) from 15 LAC countries for the period 2000–2017 and predicted mortality to 2030. Methods We retrieved cancer mortality data using the World Health Organization Mortality Database. Mortality rates (standardized to the world standard SEGI population) were analyzed for 15 LAC countries. We evaluated the average mortality rates for the last 5 years (2013–2017). Joinpoint regression analysis was used to evaluate leukemia mortality trends and provide an estimated annual percent change (EAPC). Nordpred was utilized for the calculation of predictions until 2030. Results Between 2013 and 2017, the highest mortality rates were reported in Venezuela, Ecuador, Nicaragua, Mexico, and Peru. Upward mortality trends were reported in Nicaragua (EAPC by 2.9% in boys, and EAPC by 2.0% in girls), and Peru (EAPC by 1.4% in both sexes). Puerto Rico experienced large declines in mortality among both boys (EAPC by − 9.7%), and girls (EAPC by − 6.0%). Leukemia mortality will increase in Argentina, Ecuador, Guatemala, Panama, Peru, and Uruguay by 2030. Conclusion Leukemia mortality is predicted to increase in some LAC countries by 2030. Interventions to prevent this outcome should be tailor to reduce the socioeconomic inequalities and ensure universal healthcare coverage.