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2.
Lancet Oncol ; 22(11): e474-e487, 2021 11.
Article in English | MEDLINE | ID: covidwho-1488012

ABSTRACT

The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.


Subject(s)
COVID-19/epidemiology , Neoplasms/prevention & control , SARS-CoV-2 , Caribbean Region/epidemiology , Cost of Illness , Delivery of Health Care/economics , Early Detection of Cancer , Health Services Accessibility , Humans , Latin America/epidemiology , Medical Oncology/education , Neoplasms/epidemiology
6.
PLoS One ; 16(9): e0257423, 2021.
Article in English | MEDLINE | ID: covidwho-1406754

ABSTRACT

Health Care Leaders (HCLs) faced unprecedented challenges during the initial phases of the COVID-19 pandemic. Leaders played an important role in shaping the experiences of Health Care Workers (HCWs) during this time. However, research is needed on how HCWs experienced and characterized HCLs' response and support. The aim of our study was to examine HCWs' experiences with leadership and to identify aspects of HCLs' response that were effective in supporting HCWs in their roles during the early phases of the pandemic. This was a qualitative study based on open-ended semi-structured interviews conducted (June 1- July 18, 2020) with frontline HCWs during the first wave of the COVID-19 pandemic in Connecticut, USA. Participants (N = 45) included physicians, nurses, respiratory therapists and patient care assistants who worked in inpatient and outpatient settings in various specialties, roles and 3 health systems across Connecticut, USA during the COVID-19 pandemic. Participants were offered a $25 gift card as an incentive for participation. We used inductive techniques derived from grounded theory to develop themes. We identified 6 main themes related to leadership response and support of HCWs during the pandemic namely: 1) Effective communication and transparency; 2) Prioritizing their health and safety; 3) Employee scheduling considerations: autonomy, assignment support and respite; 4) Appreciation- financial and nonfinancial; 5) Showing up and listening and 6) Stepping up with resources. Our findings can inform leadership responses to future pandemics and other unanticipated crises leading to strengthening of the health care system as a whole.


Subject(s)
COVID-19 , Delivery of Health Care , Health Personnel , Leadership , Pandemics , Communication , Connecticut/epidemiology , Delivery of Health Care/economics , Delivery of Health Care/organization & administration , Humans
7.
Pan Afr Med J ; 39: 111, 2021.
Article in English | MEDLINE | ID: covidwho-1377120

ABSTRACT

COVID-19 has impacted health systems globally with varying impacts across regions. In Zimbabwe, a country with perennial problems of shortage of healthcare workers and resources, the pandemic has caused substantial strain on the public health system. The ability to share experiences on what has worked and what has not can be valuable as scientists, policymakers, and others determine steps forward and reflect backward to determine lessons learned in the pandemic response. We describe the setup and function of a COVID-19 rapid response team in the context of a limited resource setting. The response had to be tailored to make maximal use of the resources available and manage the outbreak. In this article, we share notes from the field and discuss the process of setting up a rapid response protocol in a limited resource provincial hospital, the challenges encountered, improvised interventions and recommendations for managing a COVID-19 resurgence and future similar pandemics.


Subject(s)
COVID-19/therapy , Delivery of Health Care/organization & administration , Hospital Rapid Response Team/organization & administration , Delivery of Health Care/economics , Health Personnel/organization & administration , Hospital Rapid Response Team/economics , Humans , Zimbabwe
8.
World Neurosurg ; 155: e142-e149, 2021 11.
Article in English | MEDLINE | ID: covidwho-1356487

ABSTRACT

BACKGROUND: The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil. METHODS: We analyzed 112 different types of neurosurgical procedures, with special detail in 11 neurooncology procedures, listed in the Brazilian Hospital Information System records in the DATASUS database between February and July 2019 and the same period in 2020. Linear regression and paired t-test analyses were performed and considered statistically significant at P < 0.05. RESULTS: There was an overall decrease of 21.5% (28,858 cases) in all neurosurgical procedures, impacting patients needing elective procedures (-42.46%) more than emergency surgery (-5.93%). Neurooncology procedures decreased by 14.89%. Nonetheless, the mortality rate during hospitalization increased by 21.26%. Linear regression analysis in hospitalizations (Slope = 0.9912 ± 0.07431; CI [95%] = 0.8231-1.159) and total cost (Slope = 1.03 ± 0.03501; CI [95%] = 0.9511-1.109) in the 11 different types of neurooncology procedures showed a P < 0.0001. The mean cost per type of procedure showed an 11.59% increase (P = 0.0172) between 2019 and 2020. CONCLUSIONS: The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/trends , Developing Countries , Hospital Information Systems/trends , Neurosurgical Procedures/trends , Brazil/epidemiology , COVID-19/economics , COVID-19/prevention & control , Delivery of Health Care/economics , Developing Countries/economics , Health Personnel/economics , Health Personnel/trends , Hospital Information Systems/economics , Humans , Neurosurgical Procedures/economics , Personal Protective Equipment/economics , Personal Protective Equipment/trends
9.
Ann Glob Health ; 87(1): 72, 2021.
Article in English | MEDLINE | ID: covidwho-1335340

ABSTRACT

COVID-19 has infected hundreds of millions of people across the globe. The pandemic has also inflicted serious damages on global and regional governing political structures to a degree meriting a revisit of their own raison d'etre. The global economic fallout is also unprecedented as the flows of goods and people got severely disrupted while lockdowns hit the transport, services and retail industries, among others. We argue that three realities need to be genuinely addressed for building a post COVID-19 order that has to be amply equipped to deal with the next global crisis, as well as the ones on-going for decades. First, there is need to shelf-away the hitherto practiced doctrine that global crises and problems are confronted through local responses. Second, the COVID-19 pandemic has cautioned us on the need to (re)invest in basic, many may consider naïve and simple, public health functions such as sanitation as well as transparent national and global health monitoring. Third, the pandemic is a clear reprimand to discard the mantra that privatization of healthcare delivery system is the solution in favor of viewing health as a public good that needs to be managed and executed by the state and its public sector, be it national, sub-regional or local. It is critical that we learn from such pandemic and advance our societies to become stronger.


Subject(s)
COVID-19 , Civil Defense/organization & administration , Communicable Disease Control , Delivery of Health Care , Global Health , Public Health , COVID-19/economics , COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care/economics , Delivery of Health Care/standards , Delivery of Health Care/trends , Forecasting , Global Health/standards , Global Health/trends , Humans , SARS-CoV-2 , Social Medicine/trends
10.
Sci Rep ; 11(1): 15450, 2021 07 29.
Article in English | MEDLINE | ID: covidwho-1333986

ABSTRACT

The pandemic of COVID-19 has become one of the greatest threats to human health, causing severe disruptions in the global supply chain, and compromising health care delivery worldwide. Although government authorities sought to contain the spread of SARS-CoV-2, by restricting travel and in-person activities, failure to deploy time-sensitive strategies in ramping-up of critical resource production exacerbated the outbreak. Here, we developed a mathematical model to analyze the effects of the interaction between supply chain disruption and infectious disease dynamics using coupled production and disease networks built on global data. Analysis of the supply chain model suggests that time-sensitive containment strategies could be created to balance objectives in pandemic control and economic losses, leading to a spatiotemporal separation of infection peaks that alleviates the societal impact of the disease. A lean resource allocation strategy can reduce the impact of supply chain shortages from 11.91 to 1.11% in North America. Our model highlights the importance of cross-sectoral coordination and region-wise collaboration to optimally contain a pandemic and provides a framework that could advance the containment and model-based decision making for future pandemics.


Subject(s)
COVID-19/economics , COVID-19/epidemiology , Delivery of Health Care/statistics & numerical data , Food Supply/statistics & numerical data , Models, Theoretical , Delivery of Health Care/economics , Food Supply/economics , Global Health , Humans , Pandemics/economics , Quarantine , SARS-CoV-2/isolation & purification , Travel
11.
Milbank Q ; 99(2): 542-564, 2021 06.
Article in English | MEDLINE | ID: covidwho-1280253

ABSTRACT

Policy Points We compared the structure of health care systems and the financial effects of the COVID-19 pandemic on health care providers in the United States, England, Germany, and Israel: systems incorporating both public and private insurers and providers. The negative financial effects on health care providers have been more severe in the United States than elsewhere, owing to the prevalence of activity-based payment systems, limited direct governmental control over available provider capacity, and the structure of governmental financial relief. In a pandemic, activity-based payment reverses the conventional financial positions of payers and providers and may prevent providers from prioritizing public health because of the desire to avoid revenue loss caused by declines in patient visits.


Subject(s)
COVID-19/economics , Delivery of Health Care/economics , COVID-19/epidemiology , COVID-19/therapy , Delivery of Health Care/organization & administration , England/epidemiology , Germany/epidemiology , Humans , Insurance, Health/organization & administration , Israel/epidemiology , Pandemics/economics , Reimbursement Mechanisms/organization & administration , SARS-CoV-2 , United States/epidemiology
13.
J Med Internet Res ; 23(6): e27345, 2021 06 17.
Article in English | MEDLINE | ID: covidwho-1249624

ABSTRACT

By applying advanced health information technology to the health care field, health informatization helps optimize health resource allocation, improve health care services, and realize universal health coverage. COVID-19 has tested the status quo of China's health informatization, revealing challenges to the health care system. This viewpoint evaluates the development, status quo, and practice of China's health informatization, especially during COVID-19, and makes recommendations to address the health informatization challenges. We collected, assessed, and evaluated data on the development of China's health informatization from five perspectives-health information infrastructure, information technology (IT) applications, financial and intellectual investment, health resource allocation, and standard system-and discussed the status quo of the internet plus health care service pattern during COVID-19. The main data sources included China's policy documents and national plans on health informatization, commercial and public welfare sources and websites, public reports, institutional reports, and academic papers. In particular, we extracted data from the 2019 National Health Informatization Survey released by the National Health Commission in China. We found that China developed its health information infrastructure and IT applications, made significant financial and intellectual informatization investments, and improved health resource allocations. Tested during COVID-19, China's current health informatization system, especially the internet plus health care system, has played a crucial role in monitoring and controlling the pandemic and allocating medical resources. However, an uneven distribution of health resources and insufficient financial and intellectual investment continue to challenge China's health informatization. China's rapid development of health informatization played a crucial role during COVID-19, providing a reference point for global pandemic prevention and control. To further promote health informatization, China's health informatization needs to strengthen top-level design, increase investment and training, upgrade the health infrastructure and IT applications, and improve internet plus health care services.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/methods , Health Promotion/methods , Program Evaluation , China/epidemiology , Delivery of Health Care/economics , Delivery of Health Care/standards , Health Promotion/economics , Health Promotion/standards , Humans , Pandemics , SARS-CoV-2
14.
Nat Biotechnol ; 38(7): 798-805, 2020 07.
Article in English | MEDLINE | ID: covidwho-1241981
15.
Am J Manag Care ; 26(5): 192-193, 2020 05.
Article in English | MEDLINE | ID: covidwho-1218775

ABSTRACT

To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. For the May issue, we turned to Larry Levitt, MPP, executive vice president for health policy for the Kaiser Family Foundation.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/organization & administration , Health Policy , Delivery of Health Care/economics , Humans , Medicaid/economics , Pandemics , SARS-CoV-2 , United States
16.
World Neurosurg ; 153: e1-e10, 2021 09.
Article in English | MEDLINE | ID: covidwho-1213564

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has changed health care delivery across the United States. Few analyses have specifically looked at quantifying the financial impact of the pandemic on practicing neurosurgeons. A survey analysis was performed to address this need. METHODS: A 19-question survey was distributed to practicing neurosurgeons in the United States and its territories. The questions evaluated respondents' assessments of changes in patient and procedural volume, salary and benefits, practice expenses, staffing, applications for government assistance, and stroke management. Responses were stratified by geographic region. RESULTS: The response rate was 5.1% (267/5224). Most respondents from each region noted a >50% decrease in clinic volume. Respondents from the Northeast observed a 76% decrease in procedure volume, which was significantly greater than that of other regions (P = 0.003). Northeast respondents were also significantly more likely to have been reassigned to nonneurosurgical clinical duties during the pandemic (P < 0.001). Most respondents also noted decreased salary and benefits but experienced no changes in overall practice expenses. Most respondents did not experience significant reductions in nursing or midlevel staffing. These trends were not significantly different between regions. CONCLUSIONS: The COVID-19 pandemic has led to decreases in patient and procedural volume and physician compensation despite stable practice expenses. Significantly more respondents in the Northeast region noted decreases in procedural volume and reassignment to nonneurosurgical COVID-related medical duties. Future analysis is necessary as the pandemic evolves and the long-term clinical and economic implications become clear.


Subject(s)
COVID-19 , Delivery of Health Care/economics , Neurosurgeons/economics , Neurosurgery/economics , Personal Protective Equipment/economics , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19/therapy , Elective Surgical Procedures/statistics & numerical data , Humans , Neurosurgical Procedures/statistics & numerical data , SARS-CoV-2/pathogenicity
17.
Glob Public Health ; 16(8-9): 1334-1345, 2021.
Article in English | MEDLINE | ID: covidwho-1203509

ABSTRACT

Although a highly ambiguous and contested idea, Universal Health Coverage (UHC) is the hegemonic concept in international debates on health system reforms. States' difficulties to provide adequate and comprehensive response to people's health needs arising from the COVID-19 pandemic strengthened the impetus for UHC implementation. But while featured as the way to achieve justice in health, analyses of UHC-kind reform experiences since the 1990s show that it may be comprehended rather as a new facet of neoliberalism in the health policies' arena. Its insurance arrangements are aimed to finance packages of health goods and services for the poor, while states play mainly a role of public funds administrators, buying from public and private providers competing in the market. UHC contributes to health system fragmentation and segmentation, weakens public structures and opens new markets for corporations to capture public funds. COVID-19 pandemic subjected health systems to unforeseen stress, underscoring the crucial role that a well-funded public health system plays in people's lives. Assessing pandemic's challenges may be an opportunity to build more egalitarian health systems, based on dignity and not people's money. However, the unreflecting adoption of technocratic health paradigms and solutions may, instead, ultimately pave the way for further health financialisation and injustice.


Subject(s)
COVID-19 , Delivery of Health Care , Pandemics , Universal Health Insurance , COVID-19/epidemiology , COVID-19/therapy , Delivery of Health Care/economics , Humans
18.
Am J Manag Care ; 27(4): 137-139, 2021 04.
Article in English | MEDLINE | ID: covidwho-1194878

ABSTRACT

Low-value services are a major problem in the US health care system. We believe that the coronavirus disease 2019 pandemic's unprecedented impact on the health system, and society writ large, offers an opportunity to reshape the conversation and incentives around low-value services. This article explores current barriers to and opportunities for accelerating progress toward high-value care delivery. We examine how financial and nonfinancial incentives, uncertainty in clinical decision-making, and insufficient partnering with patients and families contribute to the delivery of low-value care. We then explore potential solutions, including making it easier for clinicians to forgo low-value services and providing them with actionable information to make those decisions, expanding payer efforts to develop "value report cards," developing measures that map the adverse health and economic effects of low-value services, and training clinicians and health care leaders to engage in conversations with patients about the personal medical, financial, and psychological harms of low-value services.


Subject(s)
Delivery of Health Care/economics , Health Services Misuse/prevention & control , Quality of Health Care/economics , Humans
19.
Healthc Policy ; 16(3): 6-15, 2021 02.
Article in English | MEDLINE | ID: covidwho-1187157

ABSTRACT

In 2020, the COVID-19 pandemic unexpectedly upended everyone's life, from sudden mass unemployment to family separations. In spite of this upheaval, health systems and services research carried on. Often, these efforts supported public health efforts to slow the spread of the virus.


Subject(s)
COVID-19/prevention & control , Delivery of Health Care/economics , Delivery of Health Care/organization & administration , Health Services Research/economics , Health Services Research/organization & administration , COVID-19/epidemiology , Canada/epidemiology , Costs and Cost Analysis , Humans
20.
Ann Vasc Surg ; 76: 1-9, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1174100

ABSTRACT

INTRODUCTION: The novel coronavirus SARS-CoV-2 (COVID-19) has spread rapidly since it was identified. We sought to understand its effects on vascular surgery practices stratified by VASCON surgical readiness level and determine how these effects have changed during the course of the pandemic. METHODS: All members of the Vascular and Endovascular Surgery Society were sent electronic surveys questioning the effects of COVID-19 on their practices in the early pandemic in April (EP) and four months later in the pandemic in August (LP) 2020. RESULTS: Response rates were 206/731 (28%) in the EP group and 108/731 (15%) in the LP group (P < 0.0001). Most EP respondents reported VASCON levels less than 3 (168/206,82%), indicating increased hospital limitations while 6/108 (6%) in the LP group reported this level (P < 0.0001). The EP group was more likely to report a lower VASCON level (increased resource limitations), and decreased clinic, hospital and emergency room consults. Despite an increase of average cases/week to pre-COVID-19 levels, 46/108 (43%) of LP report continued decreased compensation, with 57% reporting more than 10% decrease. Respondents in the decreased compensation group were more likely to have reported a VASCON level 3 or lower earlier in the pandemic (P = 0.018). 91/108(84%) of LP group have treated COVID-19 patients for thromboembolic events, most commonly acute limb ischemia (76/108) and acute DVT (76/108). While the majority of respondents are no longer delaying the vascular surgery cases, 76/108 (70%) feel that vascular patient care has suffered due to earlier delays, and 36/108 (33%) report a backlog of cases caused by the pandemic. CONCLUSIONS: COVID-19 had a profound effect on vascular surgery practices earlier in the pandemic, resulting in continued detrimental effects on the provision of vascular care as well as compensation received by vascular surgeons.


Subject(s)
COVID-19 , Delivery of Health Care/trends , Practice Patterns, Physicians'/trends , Surgeons/trends , Vascular Surgical Procedures/trends , Adult , Delivery of Health Care/economics , Fee-for-Service Plans/trends , Female , Health Care Surveys , Humans , Income/trends , Male , Middle Aged , Practice Patterns, Physicians'/economics , Quality Indicators, Health Care/trends , Surgeons/economics , Time Factors , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/economics
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