Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries.

BACKGROUND: Several studies have indicated that universal health coverage (UHC) improves health service utilization and outcomes in countries. These studies, however, have primarily assessed UHC's peacetime impact, limiting our understanding of UHC's potential protective effects during public health crises such as the Coronavirus Disease 2019 (COVID-19) pandemic. We empirically explored whether countries' progress toward UHC is associated with differential COVID-19 impacts on childhood immunization coverage. METHODS AND FINDINGS: Using a quasi-experimental difference-in-difference (DiD) methodology, we quantified the relationship between UHC and childhood immunization coverage before and during the COVID-19 pandemic. The analysis considered 195 World Health Organization (WHO) member states and their ability to provision 12 out of 14 childhood vaccines between 2010 and 2020 as an outcome. We used the 2019 UHC Service Coverage Index (UHC SCI) to divide countries into a "high UHC index" group (UHC SCI ≥80) and the rest. All analyses included potential confounders including the calendar year, countries' income group per the World Bank classification, countries' geographical region as defined by WHO, and countries' preparedness for an epidemic/pandemic as represented by the Global Health Security Index 2019. For robustness, we replicated the analysis using a lower cutoff value of 50 for the UHC index. A total of 20,230 country-year observations were included in the study. The DiD estimators indicated that countries with a high UHC index (UHC SCI ≥80, n = 35) had a 2.70% smaller reduction in childhood immunization coverage during the pandemic year of 2020 as compared to the countries with UHC index less than 80 (DiD coefficient 2.70; 95% CI: 0.75, 4.65; p-value = 0.007). This relationship, however, became statistically nonsignificant at the lower cutoff value of UHC SCI <50 (n = 60). The study's primary limitation was scarce data availability, which restricted our ability to account for confounders and to test our hypothesis for other relevant outcomes. CONCLUSIONS: We observed that countries with greater progress toward UHC were associated with significantly smaller declines in childhood immunization coverage during the pandemic. This identified association may potentially provide support for the importance of UHC in building health system resilience. Our findings strongly suggest that policymakers should continue to advocate for achieving UHC in coming years.

Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic.

The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. During a pandemic, the lives saved and economic benefits of a single-payer universal healthcare system relative to the status quo would be even greater. For Americans who are uninsured and underinsured, financial barriers to COVID-19 care delayed diagnosis and exacerbated transmission. Concurrently, deaths beyond COVID-19 accrued from the background rate of uninsurance. Universal healthcare would alleviate the mortality caused by the confluence of these factors. To evaluate the repercussions of incomplete insurance coverage in 2020, we calculated the elevated mortality attributable to the loss of employer-sponsored insurance and to background rates of uninsurance, summing with the increased COVID-19 mortality due to low insurance coverage. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved about 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a single-payer universal healthcare system over the course of the pandemic. These economic benefits are in addition to US$438 billion expected to be saved by single-payer universal healthcare during a nonpandemic year.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

We are calling for adoption of universal, redistributive and solidarity-based policies with a rights-oriented approach to leave no one behind.

Serving in her present role since the economic crisis of 2008, Alicia Bárcena is no newcomer to regional and global emergencies, economic or otherwise. She also has extensive experience in the UN system, including as chief of staff to the UN Secretary-General and later, during Ban Ki-moon's tenure in that position, as Under-Secretary General for Management. From 2016 to 2017, she co-chaired the International Resource Panel at the UN Environment Program. A biologist trained in her home country of Mexico, she later received a master's degree in public administra-tion from Harvard University, USA. For decades, Ms Bárcena has devoted her professional career to issues of sustainable development, fi nancing of public policies, and the environment. She has received Doctor Honoris Causa degrees from the University of Oslo, Norway (2014); the University of Havana, Cuba (2016); and the Universidad Autónoma de México (2019). Today, she is a board member of the Global Partnership for Sus-tainable Development Data and a member of the University of Oslo/The Lancet Independent Panel on Global Governance for Health.

The evolution of the Italian National Health Service.

40 years ago, Italy saw the birth of a national, universal health-care system (Servizio Sanitario Nazionale [SSN]), which provides a full range of health-care services with a free choice of providers. The SSN is consistently rated within the Organisation for Economic Co-operation and Development among the highest countries for life expectancy and among the lowest in health-care spending as a proportion of gross domestic product. Italy appears to be in an envious position. However, a rapidly ageing population, increasing prevalence of chronic diseases, rising demand, and the COVID-19 pandemic have exposed weaknesses in the system. These weaknesses are linked to the often tumultuous history of the nation and the health-care system, in which innovation and initiative often lead to spiralling costs and difficulties, followed by austere cost-containment measures. We describe how the tenuous balance of centralised versus regional control has shifted over time to create not one, but 20 different health systems, exacerbating differences in access to care across regions. We explore how Italy can rise to the challenges ahead, providing recommendations for systemic change, with emphasis on data-driven planning, prevention, and research; integrated care and technology; and investments in personnel. The evolution of the SSN is characterised by an ongoing struggle to balance centralisation and decentralisation in a health-care system, a dilemma faced by many nations. If in times of emergency, planning, coordination, and control by the central government can guarantee uniformity of provider behaviour and access to care, during non-emergency times, we believe that a balance can be found provided that autonomy is paired with accountability in achieving certain objectives, and that the central government develops the skills and, therefore, the legitimacy, to formulate health policies of a national nature. These processes would provide local governments with the strategic means to develop local plans and programmes, and the knowledge and tools to coordinate local initiatives for eventual transfer to the larger system.

Отчет Регионального директора: работа Европейского регионального бюро ВОЗ в 2020–2021 гг

В настоящем отчете приводится обзор деятельности Европейского регионального бюро ВОЗ (ЕРБ ВОЗ) с сентября 2020 г. Деятельность ЕРБ ВОЗ в течение прошедшего года определялась принципами Европейской программы работы на 2020–2025 гг. «Совместные действия для улучшения здоровья», ее четырьмя флагманскими инициативами и целевыми ориентирами Тринадцатой общей программы работы ВОЗ (ОПР-13). В отчете рассказывается о деятельности в рамках каждого из трех основополагающих элементов ОПР-13 – чрезвычайные ситуации в области здравоохранения, всеобщий охват услугами здравоохранения и здоровье и благополучие, а также четвертого, вспомогательного элемента – лучше соответствовать поставленным задачам. Вся деятельность рассматривается в контексте пандемии COVID-19, которая по-прежнему требует пристального внимания и максимальной отдачи от всей Организации.

Bericht des Regionaldirektors: Die Arbeit des WHO-Regionalbüros für Europa im Zeitraum 2020–2021

Dieser Bericht soll einen kurzen Überblick über die wichtigsten Tätigkeiten des WHO-Regionalbüros für Europa (WHO/Europa) seit September 2020 geben. Die Arbeit von WHO/Europa in den vergangenen zwölf Monaten war am Europäischen Arbeitsprogramm 2020–2025 – „Gemeinsam für mehr Gesundheit in Europa“ und seinen vier Flaggschiff-Initiativen sowie an den Zielvorgaben des Dreizehnten Allgemeinen Arbeitsprogramms 2019–2023 (GPW 13) ausgerichtet. In dem Bericht wird die Arbeit anhand der drei Säulen des GPW 13 – gesundheitliche Notlagen, allgemeine Gesundheitsversorgung und Gesundheit und Wohlbefinden – sowie der unterstützenden vierten Säule, der Erhöhung der Zwecktauglichkeit von WHO/Europa, vorgestellt. Die Schilderung erfolgt jeweils vor dem Hintergrund der COVID19-Pandemie, die der gesamten Organisation weiter ein Höchstmaß an Aufmerksamkeit und Mobilisierung abverlangt hat.

Rapport du directeur régional : les activités du Bureau régional de l’OMS pour l’Europe en 2020-2021

Le présent rapport vise à donner un aperçu des principales activités menées par le Bureau régional de l’OMS pour l’Europe (OMS/Europe) depuis septembre 2020. Les travaux de l’OMS/Europe au cours de l’année écoulée ont été réalisés sur la base du Programme de travail européen 2020-2025 – « Une unité d’action pour une meilleure santé en Europe », de ses quatre initiatives phares, et des cibles du Treizième Programme général de travail 2019-2023 (treizième PGT). Le rapport présente les activités relevant de chacun des trois piliers du treizième PGT (les situations d’urgence sanitaire, la couverture sanitaire universelle, et la santé et le bien-être) ainsi que du pilier porteur relatif à une meilleure adaptation aux besoins. Chacun de ces piliers est abordé dans le contexte de la pandémie de COVID-19 qui continue d’exiger la plus grande attention et la mobilisation de l’Organisation dans son ensemble.

Report of the Regional Director: the work of the WHO Regional Office for Europe in 2020–2021

The present report aims to give a snapshot of the key activities of the WHO Regional Office for Europe (WHO/Europe) since September 2020. The work of WHO/Europe over the past year has been guided by the European Programme of Work, 2020–2025 – “United Action for Better Health in Europe”; its four flagship initiatives; and the targets of the Thirteenth General Programme of Work, 2019–2023 (GPW 13). The report presents activities within the scope of each of the three pillars of GPW 13: health emergencies, universal health coverage, and health and well-being, along with the supporting pillar of becoming more fit for purpose. Each is covered in the context of the COVID-19 pandemic, which continued to require the highest attention and mobilization across the entire Organization.

Universal health care and political economy, neoliberalism and effects of COVID-19: A view of systems and complexity.

Sturmberg and Martin's application of systems and complexity theory to understanding Universal Health Care (UHC) and Primary Health Care (PHC) is evaluated in the light of the influence of political economy on health systems. Furthermore, the role that neoliberal approaches to governance have had in creating increased inequities is seen as a key challenge for UHC. COVID-19 has emphasized long standing discrepancies in health and these disadvantages require government will and cooperation together with adequate social services to redress these discrepancies in UHC.