Descriptive Study Investigating Impact of Transition to Universal Health Insurance Coverage on Utilization of Healthcare in Sudan, 2016 - 2021

Objectives: Since 2016, Sudan was transitioning from limited healthcare subsidization to universal health coverage (UHC). Increasing healthcare access was widely considered beneficial, but some worried that UHC would overwhelm clinical services. In 2020 and 2021 UHC faced the challenge of Covid-19. We undertook a review of national healthcare utilization and enrolment data in order to better understand the impact of UHC in Sudan. Method(s): We conducted a descriptive study using National Health Insurance Fund databases. We analyzed annual enrolment, participating facilities, prescription volume and utilization from 2016 to 2021. Enrolment was stratified by employment status (government, informal sector, private sector, pensioner, impoverished). Utilization was assessed by type of care: primary, specialty, chronic disease and other;we calculated the ratio of primary to specialty care visits. We used the Mann-Kendall test for evaluating trends. Result(s): Participating facilities increased from 2,083 in 2016 to 3,549 in 2019, with slight contraction to 3,495 during 2020-21. Annual enrolment increased significantly, from 16.4 million in 2016 to 36.5 million in 2021 (p value < 0.01). The impoverished sector had the largest increase in enrolment (217%);informal sector had the lowest enrolment growth rate (7%). Volume of primary healthcare visits and prescriptions increased every year, except 2020, the first year of Covid-19 in Sudan. Specialty healthcare visits decreased over the same period, from 2,461,424 to 1,249,585 (p < 0.01). The ratio of primary to specialty visits increased from 6.0 in 2016 to 15.7 in 2021 (p < 0.001). Conclusion(s): In Sudan, transition to UHC increased utilization of primary care services, but at a slower rate than enrolment growth. The ratio of primary to specialty visits increased and specialty visits declined, suggesting that more primary care may have prevented specialist-requiring disease states and sequelae. Fears of overwhelming the health system were unfounded indicating that other barriers to healthcare might exist.Copyright © 2023

Impact of the Coronavirus Disease 2019 Pandemic on Dental Visits in Japan.

PURPOSE: This study aimed to clarify the impact of the coronavirus disease 2019 (COVID-19) pandemic on individual dental-visit behaviour and examine the difference between elderly and other individuals regarding the impact on dental visits. MATERIALS AND METHODS: An interrupted time-series analysis was performed to examine the change in data from the national database before and after the first declaration of a state of emergency. RESULTS: The number of patients visiting a dental clinic (NPVDC), number of dental treatment days (NDTD) and dental expenses (DE) during the first declaration of a state of emergency decreased by 22.1%, 17.9%, and 12.5% in the group under 64 years of age and 26.1%, 26.3%, and 20.1% in the group over 65 years of age, respectively, compared with those in the same month of the previous year. Between March and June 2020, the monthly NPVDC and NDTD were significantly reduced (p < 0.001, p = 0.013) in those over 65 years of age. The DE did not change statistically significantly in either the under 64 group or the over 65 group. There was no statistically significant change in the slope of the regression line in the NPVDC, NDTD, and DE before and after the first state-of-emergency declaration. CONCLUSION: The first state of emergency greatly reduced the NPVDC, NDTD, and DE compared to those in the previous year. In people aged over 65 years, it might still be unresolved 2 years after the postponement of dental treatment owing to the first declaration of a state of emergency.

Monitoring Indicators of Universal Access to Accessible and Safe Anesthetic and Surgical Care in a Peruvian Region: An Ambispective Study.

INTRODUCTION: The Lancet Commission on Global Surgery indicators for monitoring anesthetic and surgical care allow the identification of access barriers, evaluate the safety of surgeries, facilitate planning, and assess changes over time. The primary objective was to measure these indicators in all health facilities of a Peruvian region in 2020. METHODS: This was an ambispective observational study to measure the anesthetic and surgical care indicators in Piura, a region in Peru, between January 2020 and June 2021. Public and private health facilities in the Piura region that performed surgical care or had specialists from any surgical specialty participated in the study. Data were collected from all regional health facilities that provided surgical care to estimate the density of surgical workforce. Likewise, the percentage of the population with access to an operating room within 2 h was estimated using georeferenced tools. Finally, a public database was accessed to determine the surgical volume, the percentage of the regional population protected with health insurance. RESULTS: In 2020, 88.4% of the inhabitants of this Peruvian region had access to timely essential surgery. There were 18.4 surgical specialists and 1174 surgeries per 100,000 populations, and 91% of the population had health insurance. In addition, there was a rate of 2.1 working operating rooms per 100,000 inhabitants in 2021. CONCLUSIONS: This Peruvian region presented an increasing trend with respect to the population's access to essential and timely surgical care, and health insurance coverage. However, the workforce distribution was inequitable among the provinces of the region, the surgical volume was reduced, and timely access was hindered because of the SARS-CoV-2 pandemic.

Impact of COVID-19 on ophthalmic surgery in Australia

Purpose : The effect of coronavirus disease 2019 (COVID-19) on ophthalmic surgical case numbers in Australia and globally remains poorly characterised. Increased incidence of COVID-19 in Australia between March and April 2020 led to a national lockdown and elective surgery restrictions. The aim of this population-based study was to quantify the early impact of COVID-19 on ophthalmic surgery in Australia, comparing surgical service rates in 2019 and 2020. Methods : Retrospective analysis of the number of ophthalmic surgical services in 2019 and 2020 in all Australian States and Territories, as recorded by Medicare (Australian Government-funded universal health insurance scheme subsidising healthcare costs for Australian residents). Monthly surgical service rates were calculated and Poisson regression was used to compare the change in service rates between months. Results : Between March and April 2020, surgical service rates decreased for: cataract surgery (by 71%, 95% CI: 70-72%), cataract surgery with minimally invasive glaucoma surgical device insertion (by 71%, 95% CI: 65-75%), pterygium removal (by 67%, 95% CI: 60- 72%), corneal transplantation (by 31%, 95% CI: 9-48%), and collagen crosslinking for corneal ectasias (by 35%, 95% CI: 18-48%). Comparatively, service rates for these surgeries did not differ or decreased less between March and April 2019. Interestingly, glaucoma filtration surgery rates decreased between March and April in 2020 (by 44%, 95% CI: 29- 56%) and also in 2019 (by 45%, 95% CI: 31-55%), whilst retinal detachment surgery rates were unchanged between these months in 2020 (crude decrease 9%, 95% CI: -28 to 16%) and 2019 (crude decrease 11%, 95% CI: -26 to 9%). Conclusions : Despite relatively low rates of COVID-19 community transmission in Australia in 2020, ophthalmic surgical service rates decreased during months in lockdown and with restrictions, largely for non-time-critical conditions. These data may have health planning implications as the pandemic continues, with future lockdowns and restrictions possible, especially as COVID-19 variants emerge.

Universal Health Insurance Coverage and the Economic Burden of Disease in Eastern China: A Pooled Cross-Sectional Analysis From the National Health Service Survey in Jiangsu Province.

China has achieved universal social health insurance coverage, but it is unclear whether this has alleviated the economic burden of disease for individuals. This was investigated in the present study by analyzing National Health Service Survey (2008-2018) data from Jiangsu province. Ordinary least squares and binary multivariate logistic regression of pooled cross-sectional data were carried out to evaluate the effect of universal health insurance coverage and other socioeconomic factors on the economic burden of disease. Total health expenses (THE) first increased and then decreased during the survey period while out-of-pocket health expenses (OOP) decreased except for urban residents, for whom OOP increased after 2013. Household catastrophic health expenditure (HCHE) was stable between 2008 and 2013 but increased after 2013. Social health insurance had a significant positive effect on the annual THE and OOP and a negative effect on HCHE, however, universal health insurance coverage could alleviated THE and the economic burden of disease on individuals (OOP) while it was insufficient to protect against the economic risk of diseases (HCHE), with greater benefits for urban as compared to rural residents. Other socioeconomic factors including age, marital status, education, income, and health status also influenced the economic burden of disease.

Effect of COVID-19 on dental telemedicine in Japan.

BACKGROUND/PURPOSE: In Japan, medical and dental care is provided by the universal health insurance system. The Ministry of Health, Labour, and Welfare (MHLW) in Japan sets the rules for health care services provided by health insurance. The MHLW issued a notice in 2020 permitting telemedicine and dental telemedicine for the first visit and for follow-up visits to prevent the spread of COVID-19 infection. We conducted this study to clarify the status of dental telemedicine during 2020. MATERIALS AND METHODS: We used data from lists obtained on the MHLW website in the analysis. We investigated the number of dental institutions conducing dental telemedicine for the first visit and for follow-up visits by prefecture. RESULTS: In each prefecture, fewer dental institutions conducted telemedicine for the first visit than for follow-up visits. Regions with large metropolitan areas had higher numbers of dental institutions conducting dental telemedicine for the first visit and follow-up visits. Private dental clinics provided the largest proportion of dental telemedicine for the first visit, and general hospitals provided the largest proportion for follow-up visits. CONCLUSION: Our study findings indicated that many dental institutions in Japan made efforts to provide dental services via dental telemedicine using the telephone or online with video to help prevent the spread of COVID-19 infection. Dental telemedicine can help patients to access dental services and dental care, thereby expanding the potential of dental telemedicine in Japan.

COVID-19 International Collaborative Research by the Health Insurance Review and Assessment Service Using Its Nationwide Real-world Data: Database, Outcomes, and Implications.

This article aims to introduce the inception and operation of the COVID-19 International Collaborative Research Project, the world's first coronavirus disease 2019 (COVID-19) open data project for research, along with its dataset and research method, and to discuss relevant considerations for collaborative research using nationwide real-world data (RWD). COVID-19 has spread across the world since early 2020, becoming a serious global health threat to life, safety, and social and economic activities. However, insufficient RWD from patients was available to help clinicians efficiently diagnose and treat patients with COVID-19, or to provide necessary information to the government for policy-making. Countries that saw a rapid surge of infections had to focus on leveraging medical professionals to treat patients, and the circumstances made it even more difficult to promptly use COVID-19 RWD. Against this backdrop, the Health Insurance Review and Assessment Service (HIRA) of Korea decided to open its COVID-19 RWD collected through Korea's universal health insurance program, under the title of the COVID-19 International Collaborative Research Project. The dataset, consisting of 476 508 claim statements from 234 427 patients (7590 confirmed cases) and 18 691 318 claim statements of the same patients for the previous 3 years, was established and hosted on HIRA's in-house server. Researchers who applied to participate in the project uploaded analysis code on the platform prepared by HIRA, and HIRA conducted the analysis and provided outcome values. As of November 2020, analyses have been completed for 129 research projects, which have been published or are in the process of being published in prestigious journals.

COVID-19 Has Clarified 2 Foundational Policy Questions in Dentistry.

KNOWLEDGE TRANSFER STATEMENT: This commentary can be used by governments, regulators, professional groups, and other stakeholders in their considerations of what constitutes essential or medically necessary dental care and how to best allocate dental care resources.