فهرست مطالب

Health Policy and Management - Volume:9 Issue:1, 2020
  • Volume:9 Issue:1, 2020
  • تاریخ انتشار: 1398/10/11
  • تعداد عناوین: 8
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  • Steven Lewis * Pages 1-5

    One of the glaring gaps in Canada’s universal healthcare system is the low level of public financing of prescription drugs - 42.7% of total spending in 2018. At the federal level there is renewed interest in moving towards universal coverage, supported by a recently commissioned report on how to achieve it. It will take superb political navigation to extract Canadian pharmaceutical policy and practice from the grasp of interests that profit handsomely from the status quo. This perspective suggests the conditions under which a genuinely fair, effective, and efficient pharmacare plan can emerge.

    Keywords: Universal Coverage, Pharmaceuticals, Cost Containment, Implementation
  • My Fridell *, Sanna Edwin, Johan Von Schreeb, Dell D. Saulnier Pages 6-16

    Background Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept.   Methods and Analysis A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords “health system” and “resilience” for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience.   Discussion No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.

    Keywords: Health System Resilience, Scoping Review, Shocks, Health System
  • Essa Tawfiq *, Sayed Ali Shah Alawi, Kayhan Natiq Pages 17-26
    Background Training courses in integrated management of childhood illness (IMCI) have been conducted for health workers for nearly one and half decades in Afghanistan. The objective of the training courses is to improve quality of care in terms of health workers communication skills and clinical performance when they provide health services for under-5 children in public healthcare facilities. This paper presents our findings on the effects of IMCI training courses on quality of care in public primary healthcare facilities in Afghanistan.   Methods We used a cross-sectional post-intervention design with regression-adjusted difference-in-differences (DiD) analysis, and included 2 groups of health workers (treatment and control). The treatment group were those who have received training in IMCI recently (in the last 12 months), and the control group were those who have never received training in IMCI. The assessment method was direct observation of health workers during patient-provider interaction. We used data, collected over a period of 3 years (2015–2017) from primary healthcare facilities, and investigated training effects on quality of care. The outcome variables were 4 indices of quality care related to history taking, information sharing, counseling/medical advice, and physical examination. Each index was formed as a composite score, composed of several inter-related tasks of quality of care carried out by health workers during patient-provider interaction for under-5 children.   Results Data were collected from 733 primary healthcare facilities with 5818 patients. Quality of care was assessed at the level of patient-provider interaction. Findings from the regression-adjusted DiD multivariate analysis showed significant effects of IMCI training on 2 indices of quality care in 2016, and on 4 indices of quality care in 2017. In 2016 two indices of quality care showed improvement. There was an increase of 8.1% in counseling/medical advice index, and 8.7% in physical examination index. In 2017, there was an increase of 5.7% in history taking index, 8.0% in information sharing index, 10.9% in counseling/medical advice index, and 17.2% in physical examination index.   Conclusion Conducting regular IMCI training courses for health workers can improve quality of care for under-5 children in primary healthcare facilities in Afghanistan. Findings from our study have the potential to influence policy and strategic decisions on IMCI programs in developing countries.
    Keywords: IMCI, Training, Quality of Care, Primary Healthcare, Afghanistan
  • Wija Oortwijn *, Maarten Jansen, Rob Baltussen Pages 27-33
    Background Evidence-informed deliberative processes (EDPs) were recently introduced to guide health technology assessment (HTA) agencies to improve their processes towards more legitimate decision-making. The EDP framework provides guidance that covers the HTA process, ie, contextual factors, installation of an appraisal committee, selecting health technologies and criteria, assessment, appraisal, and communication and appeal. The aims of this study were to identify the level of use of EDPs by HTA agencies, identify their needs for guidance, and to learn about best practices.   Methods A questionnaire for an online survey was developed based on the EDP framework, consisting of elements that reflect each part of the framework. The survey was sent to members of the International Network of Agencies for Health Technology Assessment (INAHTA). Two weeks following the invitation, a reminder was sent. The data collection took place between September-December 2018.   Results Contact persons from 27 member agencies filled out the survey (response rate: 54%), of which 25 completed all questions. We found that contextual factors to support HTA development and the critical elements regarding conducting and reporting on HTA are overall in place. Respondents indicated that guidance was needed for specific elements related to selecting technologies and criteria, appraisal, and communication and appeal. With regard to best practices, the Canadian Agency for Drugs and Technologies and the National Institute for Health and Care Excellence (NICE, UK) were most often mentioned.   Conclusion This is the first survey among HTA agencies regarding the use of EDPs and provides useful information for further developing a practical guide for HTA agencies around the globe. The results could support HTA agencies in improving their processes towards more legitimate decision-making, as they could serve as a baseline measurement for future monitoring and evaluation.
    Keywords: Health Technology Assessment, Evidence-Informed Deliberative Processes, Legitimate, Decision-Making, Guidance
  • Reinhard Huss * Pages 34-38

    The health sector often appears prominent in surveys of perceived corruption, because citizens experience the symptoms of systemic corruption most distressingly during their interaction with frontline health workers. However, the underlying drivers of systemic corruption in society may be located in other social systems with the health system demonstrating the symptoms but not the path how to exit the situation. We need to understand the mechanisms of systemic corruption including the role of corrupt national and international leaders, the role of transnational corporations and international financial flows. We require a corruption definition which goes beyond an exclusive focus on the corrupt individual and considers social systems and organisations facilitating corruption. Finally there is an urgent need to address the serious lack of funding and research in the area of systemic corruption, because it undermines the achievement of the Sustainable Development Goals (SDGs) in many low income countries with the most deprived populations.

    Keywords: Systemic Corruption, Health Sector, Leadership, Finance, Research
  • Martin Eling * Pages 39-41

    Ikegami reviews the implementation of mandatory long-term care insurance systems in Germany and Japan, which are organized as pay-as-you-go systems. I propose to go one step further and implement a multi-pillar, mandatory and voluntary long-term care financing system, which combines pay-as-you-go with capital-funded elements. The proposal is based on the observation that Switzerland has implemented a three-pillar system for financing retirement provisions that can be adapted to finance long-term care in a fair and sustainable way.

    Keywords: Long-term Care, Social Security, Insurance, Switzerland
  • Pamela Nadash * Pages 42-44

    The need for long-term care (LTC) represents a “new social risk,” one that overlaps with and complements systems of care that pre-date such programs, complicating LTC program design. This commentary expands on Ikegami’s discussion of how these structural factors must be accommodated, as well as historical and cultural factors that influence public expectations of such a program. The commentary specifically focuses on the role of cash payments, caregiver benefits, and the sometimes indistinct line between LTC and health systems. The experiences of countries operating LTC program in a wide range of contexts can illuminate common challenges, as well as some potential solutions to these vexing design and operational issues.

    Keywords: Long-term Care, Social Insurance, Aging, Entitlements, Cash for Care, Caregiver Benefits
  • Pascale Lehoux *, Federico Roncarolo, Hudson Silva, Antoine Boivin, Jean, Louis Denis, Rejean Hebert Pages 45-46