The impact of universal health coverage and COVID-19 pandemic on out-of-pocket expenses in Thailand: an analysis of household survey from 1994 to 2021.

OBJECTIVES: After Thailand achieved Universal Health Coverage (UHC) in 2002, the extent of financial risk protection has not been assessed in the long term, especially after the COVID-19 pandemic. Therefore, this study aims to revisit the impact of UHC on out-of-pocket expenses (OOPE) for health and to descriptively explore the impact of COVID-19 on OOPE. METHODS: This study was a secondary data analysis and used data from the Socio-Economic Survey from 1994 to 2021 in Thailand. The effect of UHC on the percentage of OOPE in total health expenditures (THE) from 1994 to 2019 was investigated with an interrupted time-series analysis. Descriptive analyses of OOPE in absolute value during the COVID-19 were conducted. RESULTS: The percentage of OOPE in THE significantly decreased both before (ß -2.02%; 95% CI: -2.70% to - 1.33%) and during (ß 1.41%; 95% CI: 0.70% to 2.11%) the UHC period. During the pandemic, total household OOPE for medical equipment was found to have rapidly increased from 643 million THB in 2019 to 9.4 billion THB in 2020. CONCLUSIONS: The trend of providing financial risk protection (measured by OOPE/THE) in Thailand continues until 2019. Providing medical equipment in sufficient and equally accessible manners should be prioritized during the future pandemic.

COVID-19 Aftermath: Direction Towards Universal Health Coverage in Low-Income Countries Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective".

Progressive realization of universal health coverage (UHC) requires health systems capacity to provide quality service and financial risk protection which supports access to services without financial hardship. Government health spending in low-income countries (LICs) has been low and heavily relied on external donor resources and out-of-pocket payment. This has resulted in high prevalence of catastrophic health spending or foregone care by those who cannot afford. Under fiscal constraints posed by pandemic, reforms in LICs should focus on efficiency through health resource waste reduction. Targeting the poor even with low level of health spending can make a significant health gain. Investment in primary healthcare and health workforce is the foundation for realizing UHC which cannot be postponed. Innovative tax on health hazardous products, conditional debt relief can increase fiscal space for health; while international collaboration to accelerate coronavirus disease 2019 (COVID-19) vaccine coverage can bring LICs out of acute phase of pandemic.

Determinants of life expectancy at birth: a longitudinal study on OECD countries.

This paper analyses the influence of several determinants on life expectancy at birth in 36 OECD countries over the 1999-2018 period. We utilized a cross-country fixed-effects multiple regression analysis with year and country dummies and used dynamic models, backward stepwise selection, and Arellano-Bond estimators to treat potential endogeneity issues. The results show the influence of per capita health-care expenditure, incidence of out-of-pocket expenditure, physician density, hospital bed density, social spending, GDP level, participation ratio to labour, prevalence of chronic respiratory diseases, temperature, and total size of the population on life expectancy at birth. In line with previous studies, this analysis confirms the relevance of both health care expenditure and health care system (physicians and hospital beds in our analysis) in influencing a country's population life expectancy. It also outlines the importance of other factors related to population behaviour and social spending jointly considered on this outcome. Policy makers should carefully consider these mutual influences when allocating public funds, particularly after the COVID-19 pandemic period.

Impact of COVID‐19 pandemic on financial health and food security in Nigeria: A survey‐based analysis

This study investigates the impact of COVID‐19 pandemic on the health, food security and financial lives of Nigerian households. The data for the study were collected from 813 households from the six geo‐political zones in Nigeria using a questionnaire and the results were analysed using descriptive statistics and andordinal logistic regression model. The ordinal regression model is appropriate for regression results with ordinal scales as the dependent variable. The findings reveal that the COVID‐19 pandemic has affected households' personal savings significantly. The majority of the households' healthcare financing is borne out of their personal income and savings in the absence of a health insurance scheme. Households experiencing worsening financial status largely did not have food during the pandemic. Many households have a positive expectation that they will recover from the unfavourable financial condition they are currently experiencing and there is a strong traditional support system existing in the localities during the study period. Furthermore, food insecurity during the pandemic was significantly occasioned by an increase in prices, a fall in income, adverse financial well‐being and insufficient welfare benefit provisions. The study recommends, amongst others, the need to urgently enhance the economic and financial well‐being of the Nigerian populace to guide against the devastating impact of the COVID‐19 pandemic on food security in Nigerian households.This can be achieved through robust fiscal and monetary policy mix in ensuring sustained development trajectory. [ FROM AUTHOR] Copyright of Journal of Public Affairs (14723891) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Local Fiscal Pressure and Public Health: Evidence from China.

Under the dual challenges of global downward economic pressure and the COVID-19 pandemic, studying the impact of local government fiscal pressure on public health is a meaningful endeavor. First, this paper analyzes the impact of local government fiscal pressure on public health and clarifies its impact mechanisms. Second, by utilizing panel data of 31 Chinese provinces from 2000 to 2020, two-way fixed-effects and mediating-effects models are developed to identify the effects and impact mechanisms of local government fiscal pressure on public health. The results show that local government fiscal pressure can be detrimental to public health through three main mechanisms: reducing public health fiscal expenditures, hindering industrial structure upgrading, and exacerbating environmental pollution. Heterogeneity analysis finds that the negative effects of local government fiscal pressure on public health mainly exist in Central and Western China. Accordingly, three policy implications are proposed: optimizing the fiscal system, accelerating industrial upgrading, and improving the appraisal system of local officers.

Phase and wave dependent analysis of health expenditure efficiency: A sample of OECD evidence.

Introduction: Health expenditures are a factor that reflects the government's public health policy and contributes to the protection of national health. Therefore, this study focuses on measuring the effectiveness of health expenditures in order to evaluate and improve the public health system and policy during the pandemic period. Method: In order to examine the effectiveness of health expenditures, the behaviors of the pandemic process were analyzed in two stages. The number of daily cases is analyzed in the first stage by dividing it into waves and phases according to the transmission coefficient (R). For this classification, the discrete cumulative Fourier function estimation is used. In the second stage, the unit root test method was used to estimate the stationarity of the number of cases in order to examine whether the countries made effective health expenditures according to waves and phases. The series being stationary indicates that the cases are predictable and that health expenditure is efficient. Data consists of daily cases from February 2020 to November 2021 for 5 OECD countries. Conclusion: The general results are shown that cases cannot be predicted, especially in the first stage of the pandemic. In the relaxation phase and at the beginning of the second wave, the countries that were seriously affected by the epidemic started to control the number of cas es by taking adequate measures, thus increasing the efficiency of their health systems. The common feature of all the countries we examined is that phase 1, which represents the beginning of the waves, is not stationary. After the waves fade, it can be concluded that the stationary number of health cases cannot be sustainable in preventing new waves' formation. It is seen that countries cannot make effective health expenditures for each wave and stage. According to these findings, the periods in which countries made effective health expenditures during the pandemic are shown. Discussion: The study aims to help countries make effective short- and long-term decisions about pandemics. The research provides a view of the effectiveness of health expenditures on the number of cases per day in 5 OECD countries during the COVID-19 Pandemic.

Effects of Vertical Fiscal Imbalance on Fiscal Health Expenditure Efficiency-Evidence from China.

Improving fiscal health expenditure efficiency is an inherent requirement of the strategy of "healthy China" and "high-quality development". The outbreak of COVID-19 has highlighted the importance of efficient health system. First, this paper systematically sorts out the multiple theoretical mechanisms of the positive and negative relationship between vertical fiscal imbalance and fiscal health expenditure efficiency. Secondly, a comprehensive index system, including the quantity and quality of medical services, is constructed, and the super-efficiency DEA model is used to measure fiscal health expenditure efficiency. There are obvious differences between eastern and western regions. Finally, the fixed effect model is constructed to carry out empirical research and it is found that the vertical fiscal imbalance in China has an overall positive and significant impact on the fiscal health expenditure efficiency, which is mainly achieved by optimizing the resources allocation between primary medical institutions and hospitals. Heterogeneity analysis shows that transfer payment scale has a corrective effect on the vertical fiscal imbalance's effect. The result of quantile regression shows that the impact of vertical fiscal imbalance is not constant, and it gradually turns from positive to negative along with the improvement of fiscal health expenditure efficiency.

Risk Characteristics of Catastrophic Health Expenditure in Multidimensional Borderline Poor Households in China.

Background: Ending poverty and realizing common prosperity are the essential requirements for the localization of Marxism in China. The ongoing COVID-19 pandemic in the post-poverty era further aggravates the risk of catastrophic health expenditure for borderline poor households and increases the uncertainty of returning to poverty due to illness, potentially undermining decades of hard-won efforts to eradicate poverty in China. Methods: Based on the latest data released by China Health and Retirement Longitudinal Survey (CHARLS) database, this paper uses the Logit model to empirically explore the risk characteristics of catastrophic health expenditure of multidimensional borderline poor households based on identifying multidimensional borderline poor households. Results: The results show that factors such as family income level, child support, and medical insurance have different impacts on catastrophic health expenditure, and the risk of catastrophic health expenditure of multidimensional borderline poor households is much higher than that of non- multidimensional borderline poor households, and there is a certain difference between urban and rural areas. Discussion: The government should strengthen and improve the social security system and health service system, such as medical insurance, and more resources should be allocated to multidimensional borderline poor households, especially in rural areas.

Does Technical and Democratic Governance Have the Potential to Enhance Health Spending Allocations?

Nowadays, the medical systems of the EU Member States have a need for more efficient public policies and strategies to integrate the new societal challenges, the fragile economic recovery from the COVID-19 pandemic, and sustain the development of health systems. This research explores the relationship between public governance and health expenditures allocation, under the theory of welfare economics and the concern for economic development. The research approaches both qualitative and quantitative methodologies. The first refers to bibliometric analysis and review of the existing literature, followed by data mapping process to rank the EU countries based on the variables employed. The quantitative approach also includes advanced empirical analyses (principal component analysis - PCA and regression analysis) performed over the period 2007-2020. Two indices were created through PCA, technical governance and democratic governance, gathering the effects from different world governance indicators. The main results reveal that both governance indices have a direct influence on health expenditures per capita, while GDP growth, applied as a control variable, negatively influences health expenditures. Our results emphasise a need to redesign the public governance of health systems in terms of health spending allocations and increase investments in healthcare to support economic growth in the long run. © 2022 Sorana Vătavu et al., published by Sciendo.

Household catastrophic health expenditure for COVID-19 during March-August 2021, in South India: a cross-sectional study.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic increased the utilisation of healthcare services. Such utilization could lead to higher out-of-pocket expenditure (OOPE) and catastrophic health expenditures (CHE). We estimated OOPE and the proportion of households that experienced CHE by conducting a cross-sectional survey of 1200 randomly selected confirmed COVID-19 cases. METHODS: A cross-sectional survey was conducted by telephonic interviews of 1200 randomly selected COVID-19 patients who tested positive between 1 March and 31 August 2021. We collected household-level information on demographics, income, expenditure, insurance coverage, direct medical and non-medical costs incurred toward COVID-19 management. We estimated the proportion of CHE with a 95% confidence interval. We examined the association of household characteristics; COVID-19 cases, severity, and hospitalisation status with CHE. A multivariable logistic regression analysis was conducted to ascertain the effects of variables of interest on the likelihood that households face CHE due to COVID-19. RESULTS: The mean (95%CI) OOPE per household was INR 122,221 (92,744-1,51,698) [US$1,643 (1,247-2,040)]. Among households, 61.7% faced OOPE, and 25.8% experienced CHE due to COVID-19. The odds of facing CHE were high among the households; with a family member over 65 years [OR = 2.89 (2.03-4.12)], with a comorbid individual [OR = 3.38 (2.41-4.75)], in the lowest income quintile [OR = 1.82 (1.12-2.95)], any member visited private hospital [OR = 11.85 (7.68-18.27)]. The odds of having CHE in a household who have received insurance claims [OR = 5.8 (2.81- 11.97)] were high. Households with one and more than one severe COVID-19 increased the risk of CHE by more than two-times and three-times respectively [AOR = 2.67 (1.27-5.58); AOR = 3.18 (1.49-6.81)]. CONCLUSION: COVID-19 severity increases household OOPE and CHE. Strengthening the public healthcare and health insurance with higher health financing is indispensable for financial risk protection of households with severe COVID-19 from CHE.

Changes in Expenditures of the National Health Insurance of Korea during the COVID-19 Pandemic and the Financial Implications Thereof.

As the number of coronavirus disease 2019 (COVID-19) patients increased rapidly, the Korean government decided to pay most of the related medical expenses with finances from the National Health Insurance (NHI). We aimed to document changes in NHI medical expenses during the COVID-19 pandemic period. We also sought to compare how Japan and Taiwan, neighboring countries with NHI systems, responded to COVID-19 and to discuss policy implications.

Unaffordability of COVID-19 tests: assessing age-related inequalities in 83 countries.

BACKGROUND: Diagnostic testing for SARS-CoV-2 is critical to manage the pandemic and its different waves. The requirement to pay out-of-pocket (OOP) for testing potentially represents both a financial barrier to access and, for those who manage to make the payment, a source of financial hardship, as they may be forced to reduce spending on other necessities. This study aims to assess age-related inequality in affordability of COVID-19 tests. METHODS: Daily data from the Global COVID-19 Trends and Impact Survey among adult respondents across 83 countries from July 2020 to April 2021 was used to monitor age-related inequalities across three indicators: the experiences of, first, reducing spending on necessities because of paying OOP for testing, second, facing financial barriers to get tested (from January to April 2021), and third, having anxiety related to household finance in the future. Logistic regressions were used to assess the association of age with each of these. RESULTS: Among the population ever tested, the adjusted odds of reducing spending on necessities due to the cost of the test decreased non-linearly with age from 2.3 [CI95%: 2.1-2.5] among ages 18-24 to 1.6 [CI95%: 1.5-1.8] among ages 45-54. Among the population never tested, odds of facing any type of barrier to testing were highest among the youngest age group 2.5 [CI95%:2.4-2.5] and decreased with age. Finally, among those reporting reducing spending on necessities, the odds of reporting anxiety about their future finances decreased non-linearly with age, with the two younger groups being 2.4-2.5 times more anxious than the oldest age group. Among those reporting financial barriers due to COVID-19 test cost, there was an inverse U-shape relationship. CONCLUSIONS: COVID-19 testing was associated with a reduction in spending on necessities at varying levels by age. Younger people were more likely to face financial barrier to get tested. Both negative outcomes generated anxiety across all age-groups but more frequently among the younger ones. To reduce age-related inequalities in the affordability of COVID-19 test, these findings support calls for exempting everyone from paying OOP for testing and, removing other type of barriers than financial ones.

Spatial effects of air pollution on the economic burden of disease: implications of health and environment crisis in a post-COVID-19 world.

BACKGROUND: Air pollution has been identified as related to the diseases of susceptible population, but the spatial heterogeneity of its economic burden and its determinants are rarely investigated. The issue is of great policy significance, especially after the epidemic of COVID-19, when human are facing the joint crisis of health and environment, and some areas is prone to falling into poverty. METHODS: The geographical detector was adopted to study the spatial distribution characteristics of the incidence of catastrophic health expenditure (ICHE) for older adults in 100 rural areas in China at the prefecture-city level. The health factors, sociological factors, policy factors and environmental factors and their interactions are identified. RESULTS: First, most health service factors had strong explanatory power for ICHE whether it interacts with air pollution. Second, 50 single-factor high-risk areas of ICHE were found in the study, but at the same time, there were 21 areas dominated by multiple factors. CONCLUSION: The different contributions and synergy among the factors constitute the complex mechanism of factors and catastrophic health expenditure. Moreover, during this process, air pollution aggravates the contribution of health service factors toward ICHE. In addition, the leading factors of ICHE are different among regions. At the end, this paper also puts forward some policy suggestions from the perspective of health and environment crisis in the post-COVID-19 world: environmental protection policies should be combined with the prevention of infectious diseases; advanced health investment is the most cost-effective policy for the inverse health sequences of air pollution and infectious diseases such as coronavirus disease 2019 (COVID-19); integrating environmental protection policy into healthy development policy, different regions take targeted measures to cope with the intertwined crisis.

Study on the Impact of Government Health Expenditure Equity on Residents' Health Level in the Chengdu-Chongqing Economic Circle of China.

BACKGROUND: When the global COVID-19 epidemic continues to spread, residents pay more attention to their health. This paper studies the relationship between the equity of government health expenditure and the health level of residents. METHODS: The Theil index and a principal component analysis were used to measure the equity of government health expenditure and the health level of residents in the Chengdu-Chongqing economic circle. Then, an empirical study on the relationship between the equity of government health expenditure and the health level of residents in this region was conducted with the System GMM model. RESULTS: 1. The Theil index rose from 0.0115 in 2015 to 0.0231 in 2017 and gradually decreased to 0.0106 in 2020. 2. The overall health level of residents showed an upward trend, rising from 1.95 in 2015 to 2.33 in 2017, then remained high and fluctuated slightly. 3. There was a positive correlation between the Theil index and the health level of residents at a significance level of 1% (ß = 0.903, p < 0.01). CONCLUSIONS: 1. The Theil index was close to 0, indicating that the equity of government health expenditure in the Chengdu-Chongqing economic circle was generally good. 2. The health level of residents in the Chengdu-Chongqing economic circle had improved compared to before. 3. The fairer the government's health expenditure, the higher the residents' health level.

Providing long‐term care: Options for a better workforce

Older people and their care workers have been disproportionately affected by the COVID‐19 pandemic. Many OECD Member countries have taken measures to contain the spread of the infection and improve the care workforce. Yet the health crisis is highlighting and exacerbating pre‐existing structural problems in the long‐term care (LTC) sector. In many OECD Member countries, recruiting enough workers in LTC remains a challenge and care workers experience difficult working conditions. Skills mismatch and poor integration with the rest of health care lie at the root of preventable hospital admissions even in normal times. Such challenges are likely to become ever more acute if no further action is taken given the speed of population ageing. Policies to improve recruitment and which also address retention through training, improvements in coordination and productivity, leveraging the effect of digital technologies, are needed.Alternate :Les personnes âgées et leurs soignants ont été touchés de manière disproportionnée par la pandémie de COVID‑19. De nombreux pays de l’OCDE ont pris des mesures pour empêcher la propagation de l’infection et augmenter le nombre de soignants. Néanmoins la crise sanitaire met en lumière et exacerbe les problèmes structuraux existants dans le secteur des soins de longue durée. Dans de nombreux pays membres de l’OCDE, le recrutement d’un nombre de travailleurs suffisants dans le domaine des soins de longue durée demeure un défi et les soignants ont des conditions de travail difficiles. L’inadéquation des compétences et une mauvaise intégration avec le reste des soins de santé donnent lieu à des hospitalisations évitables, même en temps normal. Compte tenu de la vitesse à laquelle la population vieillit, ces défis sont susceptibles de s’accentuer encore plus si aucune autre action n’est entreprise. Il est nécessaire de mettre en œuvre des politiques visant à améliorer le recrutement et permettant de maintenir les effectifs via la formation, des améliorations dans la coordination et la productivité, tout en tirant parti de l’effet des technologies numériques.Alternate :La pandemia de COVID‐19 ha afectado de forma desproporcionada a las personas de la tercera edad y sus proveedores de cuidados. Muchos países miembros de la Organización de Cooperación y Desarrollo Económicos (OCDE) han adoptado medidas encaminadas a evitar que la infección se propague y aumentar el número de proveedores de cuidados. A pesar de ello, la crisis sanitaria está poniendo de relieve y agravando los problemas estructurales existentes en el sector de los cuidados de larga duración. En muchos países miembros de la OCDE, la contratación de un número suficiente de proveedores de cuidados de larga duración sigue constituyendo un desafío y las condiciones de trabajo de dichos proveedores son complejas. Incluso en circunstancias normales, se registran hospitalizaciones evitables debido a competencias inadecuadas y a la escasa integración con el resto del sistema de atención de salud. Habida cuenta de la velocidad a la que envejece la población, es probable que estos problemas se agraven si no se adoptan medidas al respecto. Se precisan políticas que tengan por objetivo mejorar la contratación y abordar la retención mediante programas de formación, mejoras en materia de coordinación y de productividad, e iniciativas de aprovechamiento de las tecnologías digitales.Alternate :Ältere Menschen und ihre Pflegekräfte sind von der COVID‐19‐Pandemie unverhältnismäßig stark betroffen worden. Viele OECD‐Mitgliedstaaten haben Maßnahmen ergriffen, um die Ausbreitung der Infektion einzudämmen und das Pflegepersonal zu fördern. Die Gesundheitskrise verdeutlicht und verschärft jedoch bereits bestehende strukturelle Probleme im Langzeitpflegebereich. In vielen OECD‐Mitgliedstaaten ist es nach wie vor eine Herausforderung, genügend Arbeitskräfte für die Langzeitpflege zu finden, und die Arbeitsbedingungen für Pflegekräfte si d schwierig. Ein Qualifikationsdefizit und eine unzureichende Einbindung in die übrige Gesundheitsversorgung sind die Ursache für vermeidbare Krankenhauseinweisungen selbst in normalen Zeiten. Diese Herausforderungen werden wahrscheinlich immer akuter werden, wenn angesichts der raschen Alterung der Bevölkerung keine weiteren Maßnahmen ergriffen werden. Es bedarf Strategien zur Verbesserung der Personalrekrutierung und der Personalbindung durch Fortbildung, Verbesserung der Koordinierung und der Produktivität unter Nutzung der Wirkung digitaler Technologien.Alternate :Пандемия COVID‑19 оказала неравнозначное влияние на пожилых людей и персонал по уходу за ними. Многие страны‐члены ОЭСР принимают меры, чтобы контролировать распространение инфекции и улучшать качество рабочей силы в сфере ухода. Однако кризис в области здравоохранения выдвигает на первый план и усугубляет ранее существовавшие структурные проблемы в области долгосрочного ухода (ДУ). Во многих странах‐членах ОЭСР найм достаточного количества работников для ДУ остаётся проблемой, а сами работники в сфере ухода имеют тяжёлые условия труда. Даже и в обычные времена несоответствие навыков и плохое взаимодействие с остальными службами здравоохранения лежат в основе предотвратимых госпитализаций. Учитывая скорость старения населения, такие проблемы, вероятно, ещё сильнее обострятся, если в дальнейшем не будут приниматься соответствующие меры. Необходимы меры по улучшению ситуации с набором персонала, а также по удержанию работников посредством тренингов, улучшения координации работы и продуктивности, эффективного использования цифровых технологий.Alternate :老年人及其照护工作人员遭受了新冠肺炎大流行病不成比例的影响。许多经合组织成员国已采取措施控制感染传播并改善照护人员队伍。然而, 这场健康危机正凸显并加剧长期照护部门业已存在的结构性问题。在许多经合组织成员国, 招聘足够的长期照护工作人员仍然是一项挑战, 照护人员也面临着艰难的工作条件。即使在正常情况下,可避免入院问题的根源在于技能不匹配以及与其他卫生健康部门的整合不力。鉴于人口老龄化速度, 如不采取进一步行动, 这些挑战可能会变得更加严峻。需要制定政策来改善招聘, 并通过培训、改善协调和生产力以及利用数字技术成果来留住人才。Alternate :تأثر كبار السن والعاملين في مجال رعايتهم بشكل غير متناسب بجائحة كوفيد‐19. واتخذت العديد من البلدان الأعضاء في منظمة التعاون والتنمية في الميدان الاقتصادي ، لا يزال توظيف عدد كافٍ من العاملين في مجال الرعاية طويلة الأمد يمثل تحديًا ويواجه العاملون في المجال ذاته ظروف عمل صعبة. ويكمن عدم تطابق المهارات وضعف التكامل مع بقية جوانب الرعاية الصحية في أساسمنظمة التعاون والتنمية في الميدان الاقتصاديتدابير لاحت٠اء انتشار العدوى وتحسين القوى العاملة في مجال الرعاية. ومع ذلك، فإن الأزمة الصحية تسلط الضوء على المشاكل الهيكلية الموجودة مسبقًا وتؤدي إلى تفاقمها في قطاع الرعاية طويلة الأمد. وفي العديد من البلدان الأعضاء في الإستشفاءات التي يمكن الوقاية منها، حتى في الأوقات العادية. ومن المرجح أن تصبح مثل هذه التحديات أكثر حدة إذا لم يتم اتخاذ مزيد من الإجراءات بالنظر إلى سرعة شيخوخة السكان. وهناك حاجة إلى سياسات لتحسين التوظيف والتي تتناول الاستبقاء من خلال التدريب، وتحسين التنسيق والإنتاجية، والاستفادة من تأثير التكنولوجيات الرقمية.Alternate :Os idosos e seus profissionais de saúde foram desproporcionalmente afetados pela pandemia de Covid‐19. Muitos países membros da OCDE tomaram medidas para conter a propagação da infecção e melhorar a mão de obra assistencial. No entanto, a crise da saúde está destacando e agravando os problemas estruturais preexistentes no setor de cuidados de longa duração (LTC). Em muitos países membros da OCDE, o recrutamento de trabalhadores suficientes para LTC continua sendo um desafio e os profissionais de saúde vivenciam condições de trabalho difíceis. A incompatibilidade de competências e a integração deficiente com o restante dos cuidados de saúde estão na raiz das internações hospitalares evitáveis, até mesmo em tempos normais. Esses desafios provavelmente se tornarão cada vez mais intensos se nenhuma ação adicional for tomada, considerando‐se a velocidade do envelhecimento da população. Há necessidade de políticas para melhorar o recrutamento e que também abordem a retenção por meio de treinamento, melhorias na coordenação e na produtividade, aproveitando o efeito das tecnologias digitais.

COVID-19 pandemic in India

India being the most populous country had to tailor made its approaches to tackle the coronavirus disease 2019 (COVID-19) pandemic. Public health expenditure in India is just above 1% of gross domestic product. The warning signs of pandemic arrival in India were knocking our health-care system since the first few cases surfaced in Kerala. Social distancing as a method of keeping the virus at bay was first officially flagged by the Prime Minister Narendra Modi on March 19 in order to call for a 1-day “Janata Curfew” on March 22. The Epidemic Disease Act was implemented, and special task force was developed to draft guidelines for personal hygiene, surveillance, contact tracing, quarantine, diagnosis, laboratory tests, and the management of COVID-19. The Aarogya Setu app was developed to alert the public about COVID-19 symptoms, contact tracing, and the nearest contact of health-care center. We need to strive to extricate our country from this situation as advised by Krishna, “Uddharet Atmanatmanam—a person has to lift himself up;a man is his own best friend as also enemy.” © 2022 Elsevier Inc. All rights reserved.

Evaluation of the Results of China's Fiscal Medical and Health Expenditure.

Purpose: To evaluate the resulting level of fiscal medical and health expenditure in China, and to provide the scientific basis for further improving fiscal medical and health service capacity in China. Patients and Methods: The data envelopment method and Gini coefficient method were used to analyze the efficiency and regional fairness of fiscal medical and health expenditure results by using the relevant provincial and municipal data of China from 2007 to 2019. Results: 1.Overall, from 2007 to 2019, the total expenditure continued to increase, the expenditure efficiency increased first and then decreased, and the expenditure fairness continued to improve. 2. From the perspective of subregions, there are apparent differences between regions in terms of total expenditure, expenditure efficiency, and expenditure fairness, showing a better situation in the central, western, northeast and a lower situation in the east. Conclusion: The overall level of fiscal medical and health expenditure in China shows an upward trend, but there is still much room for improvement. At the same time, there are pronounced regional differences, and the problems of efficiency and fairness coexist among regions. Therefore, in the future, we should increase medical and health investment and enhance the government's close attention; Improve the expenditure performance appraisal system; Formulate policies according to local conditions and avoid "one size fits all.".

Dynamic relationship between energy efficiency, health expenditure and economic growth: in pursuit for SDGs in Malaysia

Purpose This paper aims to examine the dynamic relationship among energy efficiency, health expenditure and economic growth in Malaysia over the sample period of 1980-2016. Design/methodology/approach This study uses autoregressive distributed lag cointegration analysis and the causality approach by the vector error correction model to analyse the relationship among energy efficiency, which is proxied by energy intensity and the determinant factors. Findings The findings of this paper suggest long-run cointegration causal links between economic growth and health expenditure. However, a mixed conclusion for both determinants exists: an increase in real income contributes to more efficient use of energy sources, whereas an increase in government spending on health intensifies energy usage. Originality/value Most previous relevant research has focussed on energy efficiency as measured by economic intensity and economic growth and do not relate to the issue of health expenditure. The recent health catastrophe brought on by the COVID-19 epidemic emphasises the significance of allocating more resources to health care. The findings will be helpful in the development of energy efficiency and economic policies in pursuit of sustainable development goals.

COST-EFFECTIVENESS OF LABORATORY TESTING IN AL ZAHRAA TEACHING HOSPITAL, AL NAJAF AL-ASHRAF, IRAQ.

OBJECTIVE: The aim: To develop a quantitative tool to identify the cost and benefits of the appropriate and inappropriate laboratory tests. PATIENTS AND METHODS: Materials and methods: This is a retrospective study, conducted in Al Zahraa teaching hospital for children's health and maternity in a period between March 2021 to March 2022. We study the total laboratory investigation done in three years; before the COVID-19 era (1-3-2018 to 1-3-2019) and two consecutive years (1-3-2020 to 1-3-2021 and 1-3-2021 to 1-3-2022) to exclude the effect of COVID-19 pandemic on the results. And try to divide these test numbers according to each hospital department and the position of the test ordering doctor (senior or junior). We compare the total number of laboratory investigations with the total patient seeking medical care in Al Zahraa hospital, out or inpatient, i.e., ORDERING INDEX. Also, we calculate the (AVERAGE ORDERING INDEX) by dividing the number of all ordered tests by one specific test. RESULTS: Results: The total number of laboratory tests ordered in three (pre and peri COVID-19 pandemic) years show a significant increment in the last year (78249, 73600, and 1740249) respectively. Test ordering index, in the same way, shows significant increments over years (0.65, 0.64 Aand11.2) respectively. Biochemistry investigations constitute the largest proportion (50%) of all investigations that have been ordered last year. CBC is the most commonly ordered single test, in outpatient clinics, it is done 19510 times (Obstetrics and Gynecology 11850 vs Pediatric 7660). The positive (abnormal) results were only 4.8%. CONCLUSION: Conclusion: For more and more years, laboratory investigations have been overused. A large number of normal results indicate that the test order was chosen at random. The most commonly overused test is the complete blood count.

Financial Burden and Catastrophic Health Expenditure Associated with COVID-19 Hospitalizations in Kerala, South India.

Introduction: Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households, especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the out of pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditure due to COVID-19 hospitalization in Kerala, South India. Materials and Methods: A cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalized patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participants during hospitalization and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of the household's capacity to pay. Results: From the study, median and mean OOP expenditure was obtained as USD 93.57 and USD 502.60 respectively. The study revealed that 49.7% of households had catastrophic health expenditure, with 32.9% having incurred distress financing. Multivariate analysis revealed being below poverty line, hospitalization in private healthcare facility, and presence of co-morbid conditions as significant determinants of catastrophic health expenditure. Conclusion: High levels of catastrophic health expenditure and distress financing revealed by the study have unveiled major unaddressed challenges in the road to universal health coverage.