RESUMO
This study compares graduate medical education (GME) payments between nonprofit and for-profit hospitals between 2011 and 2020 to assess how hospitals value GME.
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Economia Hospitalar , Educação de Pós-Graduação em Medicina , Financiamento Governamental , Administração Hospitalar , Educação de Pós-Graduação em Medicina/economia , Hospitais , Internato e Residência/economia , Estados Unidos , Economia Hospitalar/organização & administração , Organizações sem Fins Lucrativos/economia , Organizações sem Fins Lucrativos/organização & administração , Administração Hospitalar/economia , Hospitais com Fins Lucrativos/economia , Hospitais com Fins Lucrativos/organização & administração , Financiamento Governamental/economia , Financiamento Governamental/organização & administração , Governo FederalAssuntos
Doenças da Aorta/genética , Doenças Raras/genética , Doenças da Aorta/diagnóstico , Doenças da Aorta/terapia , Pesquisa Biomédica/economia , Financiamento Governamental/organização & administração , Fundações/organização & administração , Humanos , National Institutes of Health (U.S.)/economia , Doenças Raras/diagnóstico , Doenças Raras/terapia , Estados UnidosRESUMO
BACKGROUND: The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. METHODS: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. FINDINGS: In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7-8·8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5-0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0-25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. INTERPRETATION: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. FUNDING: Bill & Melinda Gates Foundation.
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COVID-19/prevenção & controle , Países em Desenvolvimento/economia , Desenvolvimento Econômico , Financiamento da Assistência à Saúde , Agências Internacionais/economia , COVID-19/economia , COVID-19/epidemiologia , Financiamento Governamental/economia , Financiamento Governamental/organização & administração , Saúde Global/economia , Programas Governamentais/economia , Programas Governamentais/organização & administração , Programas Governamentais/estatística & dados numéricos , Programas Governamentais/tendências , Produto Interno Bruto , Gastos em Saúde/estatística & dados numéricos , Gastos em Saúde/tendências , Humanos , Agências Internacionais/organização & administração , Cooperação InternacionalAssuntos
Erradicação de Doenças/organização & administração , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Acessibilidade aos Serviços de Saúde/organização & administração , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Antirretrovirais/uso terapêutico , Financiamento Governamental/organização & administração , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Liderança , Política , Grupos Raciais , Minorias Sexuais e de Gênero , Estigma Social , Fatores Socioeconômicos , Estados UnidosRESUMO
To promote postpandemic recovery, many countries have adopted economic packages that include fiscal, monetary, and financial policy measures; however, the effects of these policies may not be known for several years or more. There is an opportunity for decision makers to learn from past policies that facilitated recovery from other disease outbreaks, crises, and natural disasters that have had a devastating effect on economies around the world. To support the development of the United Nations Research Roadmap for COVID-19 Recovery, this review examined and synthesized peer-reviewed studies and gray literature that focused on macroeconomic policy responses and multilateral coalition strategies from past pandemics and crises to provide a map of the existing evidence. We conducted a systematic search of academic and gray literature databases. After screening, we found 22 records that were eligible for this review. The evidence found demonstrates that macroeconomic and multilateral coalition strategies have various impacts on a diverse set of countries and populations. Although the studies were heterogeneous in nature, most did find positive results for macroeconomic intervention policies that addressed investments to strengthen health and social protection systems, specifically cash and unconventional/nonstandard monetary measures, in-kind transfers, social security financing, and measures geared toward certain population groups.
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COVID-19/economia , COVID-19/epidemiologia , Financiamento Governamental/organização & administração , Saúde Global , Cooperação Internacional , Comportamento Cooperativo , Humanos , SARS-CoV-2 , Nações UnidasAssuntos
COVID-19/economia , Atenção à Saúde/economia , Financiamento Governamental/economia , Custos de Cuidados de Saúde , Neoplasias/economia , COVID-19/epidemiologia , COVID-19/terapia , Atenção à Saúde/organização & administração , Financiamento Governamental/organização & administração , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Formulação de PolíticasRESUMO
In Nigeria, drug financing by the public has been challenged by financial constraints through public fund due to a limited fund available to the government to meet all its demands. The objectives of this study were to determine the variability of the hospital patient prices of same drugs under the PublicPrivate Partnership (PPP) and in Private Retail Community Pharmacy (PRCP), and to investigate the perceived efficiency and effectiveness of the PPP by comparing it with the Drug Revolving Fund (DRF) model in drug supply financing. This study was conducted in Nigeria utilizing a mixed method. Mann-Whitney U test analysis was used to compare the median drug price of the two facilities. The majority (76.19%) of the drugs were sold at a cheaper rate in the hospital than what was obtained in the PRCP with no significance difference (p > 0.05). Dominant responses from the focused group discussions supported the PPP model. This study shows that the median patient price of the basket of matched pairs of same drugs in the hospital under the PPP and in the PRCP was identical. Overall, the participants were of the opinion that the PPP model was more efficient and effective than DRFin the financing drug supply
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Farmacêuticos/ética , Preço de Medicamento , Parcerias Público-Privadas , Financiamento Governamental/organização & administração , Hospitais Públicos/estatística & dados numéricos , Pacientes , Farmácias/organização & administração , Estatísticas não Paramétricas , Aprovisionamento , Administração Financeira/classificação , Governo , Nigéria/etnologiaRESUMO
BACKGROUND: The US 21st Century Cures Act provided $7.5 billion in grant funding to states and territories for evidence-based responses to the opioid epidemic. Currently, little is known about optimal strategies for sustaining these programs beyond this start-up funding. METHODS: Using an inductive, conventional content analysis, we conducted key informant interviews with former and current state leaders (n = 16) about barriers/facilitators to sustainment and strategies for sustaining time-limited grants. RESULTS: Financing and reimbursement, service integration, and workforce capacity were the most cited barriers to sustainment. Status in state government structure, public support, and spending flexibility were noted as key facilitators. Effective levers to increase chances for sustainment included strong partnerships with other state agencies, workforce and credentialing changes, and marshalling advocacy through public awareness campaigns. CONCLUSIONS: Understanding the strategies that leaders have successfully used to sustain programs in the past can inform how to continue future time-limited, grant-funded initiatives.
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Atenção à Saúde/organização & administração , Liderança , Epidemia de Opioides , Governo Estadual , Adulto , Comportamento Cooperativo , Atenção à Saúde/economia , Feminino , Financiamento Governamental/organização & administração , Mão de Obra em Saúde/organização & administração , Humanos , Reembolso de Seguro de Saúde , Relações Interinstitucionais , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estados UnidosRESUMO
PURPOSE: Many health systems face challenges such as rising costs and lacking quality, both of which can be addressed by improving the integration of different health care sectors and professions. The purpose of this viewpoint is to present the German health care Innovation Fund (IF) initiated by the Federal Government to support the development and diffusion of integrated health care. DESIGN/METHODOLOGY/APPROACH: This article describes the design and rationale of the IF in detail and provides first insights into its limitations, acceptance and implementation by relevant stakeholders. FINDINGS: In its first period, the IF offered 1.2 billion as start-up funding for model implementation and evaluation over a period of four years (2016-2019). This period was recently extended to a second round until 2024, offering 200 million a year as from 2020. The IF is triggering the support of relevant insurers for the development of new integrated care models. In addition, strict evaluation requirements have led to a large number of health service research projects which assess structural and process improvements and thus enable evidence-based policy decisions. ORIGINALITY/VALUE: This article is the first of its kind to present the German IF to the international readership. The IF is a political initiative through which to foster innovations and promote integrated health care.
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Prestação Integrada de Cuidados de Saúde , Difusão de Inovações , Financiamento Governamental/organização & administração , Motivação , Inovação Organizacional/economia , Alemanha , Pesquisa sobre Serviços de SaúdeAssuntos
Desenvolvimento de Medicamentos/economia , Controle de Medicamentos e Entorpecentes , Administração Financeira , Financiamento Governamental/organização & administração , Acessibilidade aos Serviços de Saúde , Medicamentos sob Prescrição/economia , Custos e Análise de Custo , Indústria Farmacêutica/economia , Indústria Farmacêutica/legislação & jurisprudência , Administração Financeira/métodos , Administração Financeira/organização & administração , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Humanos , Formulação de Políticas , Estados UnidosRESUMO
The Government of Thailand was prompt to launch social and economic measures to mitigate the effects on the general population following lockdown measures to counter coronavirus disease 2019 (COVID-19). However, sex workers were one of the vulnerable groups who were unable to access state support. A rapid survey of sex workers in Thailand showed that almost all had become unemployed and lost their income as a consequence of the lockdown, restrictions on international flights into the country and the closure of entertainment venues. Most were unable to cover the costs of food and shelter for themselves and their dependents. COVID-19 had also disrupted testing and treatment for sexually transmitted infections and HIV services for sex workers. As in other countries, community-based organizations were essential to providing an immediate, short-term COVID-19 response for sex workers. Also as in other countries, the pandemic has demonstrated that many people's health and well-being depends on very fragile foundations. This presents a clear opportunity to build back better by committing to a longer-term vision for the overall societal inclusion of sex workers. Thailand should advocate for decriminalization of sex work and ensure sex workers are entitled to equal labour rights and inclusion in the government social protection programme. Progress in innovative government initiatives aimed at ending HIV stigma and discrimination show how structural change can come about through harnessing community-based organizations. In turn, HIV services for sex workers need to expand and incorporate targeted interventions to reduce sex workers' occupational susceptibility to COVID-19.
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Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Profissionais do Sexo , COVID-19 , Serviços de Saúde Comunitária/organização & administração , Feminino , Financiamento Governamental/organização & administração , Infecções por HIV/prevenção & controle , Humanos , Masculino , Profissionais do Sexo/legislação & jurisprudência , Profissionais do Sexo/estatística & dados numéricos , Inquéritos e Questionários , Tailândia/epidemiologiaRESUMO
To solve information asymmetry, we adopted the principal-agent framework to design the incentive mechanisms between the remanufacturer and the collector in the construction and demolition (C&D) waste-recycling industry. By using the model of reciprocity, we analyzed how the entities' behavioral motives affect their decisions in terms of the incentive mechanisms. The findings showed that the collector responds to their perception of the remanufacturer's intentions. If the perception is positive, they will make more effort in the collection work. If not, less effort will be put forth. Most importantly, we found that reciprocity helps to save the remanufacturer cost in the incentive mechanisms and makes the collector choose a higher effort level in the collection work. This finding showed that reciprocity serves to solve information asymmetry. By conducting a numerical simulation, we found that although a high subsidy policy can achieve rapid improvement of recycling-supply-chain performance, it is inefficient in maintaining friendly cooperation between the remanufacturer and the collector.
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Indústria da Construção/economia , Comportamento Cooperativo , Financiamento Governamental/economia , Resíduos Industriais/economia , Reciclagem/economia , Eliminação de Resíduos/economia , Materiais de Construção/economia , Tomada de Decisões , Financiamento Governamental/organização & administração , Intenção , Modelos Organizacionais , Modelos Teóricos , Princípios Morais , Motivação , Gerenciamento de Resíduos/economiaRESUMO
Conditional cash transfer (CCT) is a compelling policy alternative for reducing poverty and improving health, and its effectiveness is promising. CCT programmes have been widely deployed across geographical, economic and political contexts, but not without contestation. Critics argue that CCTs may result in infringements on freedom and dignity, gender discrimination and disempowerment and power imbalances between programme providers and beneficiaries. In this analysis, we aim to identify the ethical concepts applicable to CCTs and to contextualize these by mapping the tensions of the debate, allowing us to understand the separate contributions as parts of a larger whole. We searched a range of databases for records on public health CCT. Strategies were last run in January 2017. We included 31 dialectical articles deliberating the ethics of CCTs and applied a meta-ethnographic approach. We identified 22 distinct ethical concepts. By analysing and mapping the tensions in the discourse, the following four strands of debate emerged: (1) responsibility for poverty and health: personal vs public duty, (2) power balance: autonomy vs paternalism, (3) social justice: empowerment vs oppression and (4) marketization of human behaviour and health: 'fair trade' vs moral corruption. The debate shed light on the ethical ideals, principles and doctrines underpinning CCT. These were consistent with a market-oriented liberal welfare regime ideal: privatization of public responsibilities; a selective rather than a universal approach; empowerment by individual entrepreneurship; marketization of health with a conception of human beings as utility maximizing creatures; and limited acknowledgement of the role of structural injustices in poverty and health. Identification of key tensions in the public health ethics debate may expose underpinning ideological logics of health and social programmes that may be at odds with public values and contemporary political priorities. Decisions about CCTs should therefore not be considered a technical exercise, but a context-dependent process requiring transparent, informed and deliberative decision-making.
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Financiamento Governamental/ética , Promoção da Saúde/ética , Pobreza , Antropologia Cultural , Financiamento Governamental/organização & administração , Promoção da Saúde/economia , Humanos , Motivação/ética , Comportamento de Redução do Risco , Justiça SocialRESUMO
Originally broadcast live on 01 April 2020, the daily press briefing on coronavirus COVID-19, direct from WHO Headquarters, Geneva Switzerland with Dr Tedros WHO Director-General, Dr Micheal Ryan, Executive Director of the Health Emergencies Programme, and Dr Maria Van Kerkhove, Technical lead, WHO Health Emergencies Programme
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Setor Público/economia , Setor Público/organização & administração , Quarentena/economia , Financiamento Governamental/organização & administração , Fatores Socioeconômicos , Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Pandemias/economia , Betacoronavirus , Equipamento de Proteção Individual/provisão & distribuição , Brasil , Pneumonia Viral/transmissão , Processos Grupais , Isolamento Social , Portador Sadio/epidemiologiaRESUMO
BACKGROUND: Saudi Arabia has invested heavily in its health care system by establishing health care infrastructures to improve health of the nation. However, it remains to be seen whether it is efficient and effective in providing health care services needed. Primary health care, which is the basis of universal health coverage, needs to be assessed on its performance, challenges and future opportunities to serve the Saudi Arabian population. AIMS: This review aimed to identify challenges within the Saudi Arabian health care system with a focus on primary health care services, and to analyse the interrelated factors in order to suggest remedial reforms to further strengthen and improve the health care system. METHODS: A narrative review of previous studies and governmental reports was undertaken to extract, analyse, synthesize and report the findings. RESULTS: The review found a number of key areas for improvement in the primary health care system. These areas include: the scope, structure, infrastructure, financing, increased demand, increased costs and workforce capacity. Other critical challenges include inequitable access to health services, quality and safety of services, the growing burden of chronic diseases, lack of an effective information system, management and leadership issues, and gaps in the referral system. CONCLUSION: The Saudi Arabian health care system needs comprehensive reform with a focus on primary health care.
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Atenção Primária à Saúde/organização & administração , Medicina Estatal/organização & administração , Eficiência Organizacional , Financiamento Governamental/organização & administração , Gastos em Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/organização & administração , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Sistemas de Informação/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/normas , Arábia Saudita , Medicina Estatal/economia , Medicina Estatal/normasRESUMO
OBJECTIVE: The need to align investments in health research and development (R&D) with public health needs is one of the most important public health challenges in Japan. We examined the alignment of disease-specific publicly competitive R&D funding to the disease burden in the country. METHODS: We analyzed publicly available data on competitive public funding for health in 2015 and 2016 and compared it to disability-adjusted life year (DALYs) in 2016, which were obtained from the Global Burden of Disease (GBD) 2017 study. Their alignment was assessed as a percentage distribution among 22 GBD disease groups. Funding was allocated to the 22 disease groups based on natural language processing, using textual information such as project title and abstract for each research project, while considering for the frequency of information. RESULTS: Total publicly competitive funding in health R&D in 2015 and 2016 reached 344.1 billion JPY (about 3.0 billion USD) for 32,204 awarded projects. About 49.5% of the funding was classifiable for disease-specific projects. Five GDB disease groups were significantly and relatively well-funded compared to their contributions to Japan's DALY, including neglected tropical diseases and malaria (funding vs DALY = 1.7% vs 0.0%, p<0.01) and neoplasms (28.5% vs 19.2%, p<0.001). In contrast, four GDB disease groups were significantly under-funded, including cardiovascular diseases (8.0% vs 14.8%, p<0.001) and musculoskeletal disorders (1.0% vs 11.9%, p<0.001). These percentages do not include unclassifiable funding. CONCLUSIONS: While caution is necessary as this study was not able to consider public in-house funding and the methodological uncertainties could not be ruled out, the analysis may provide a snapshot of the limited alignment between publicly competitive disease-specific funding and the disease burden in the country. The results call for greater management over the allocation of scarce resources on health R&D. DALYs will serve as a crucial, but not the only, consideration in aligning Japan's research priorities with the public health needs. In addition, the algorithms for natural language processing used in this study require continued efforts to improve accuracy.
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Pesquisa Biomédica/economia , Doença/economia , Competição Econômica , Apoio Financeiro , Carga Global da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Biomédica/estatística & dados numéricos , Doença/classificação , Financiamento Governamental/classificação , Financiamento Governamental/organização & administração , Financiamento Governamental/normas , Carga Global da Doença/economia , Carga Global da Doença/organização & administração , Carga Global da Doença/normas , Carga Global da Doença/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Investimentos em Saúde/economia , Investimentos em Saúde/estatística & dados numéricos , Japão/epidemiologia , Saúde Pública/economia , Anos de Vida Ajustados por Qualidade de Vida , Pesquisa/economia , Pesquisa/estatística & dados numéricosRESUMO
Background: A corruption event in 2009 led to changes in how donors supported the Zambian health system. Donor funding was withdrawn from the district basket mechanism, originally designed to pool donor and government financing for primary care. The withdrawal of these funds from the pooled financing mechanism raised questions from Government and donors regarding the impact on primary care financing during this period of aid volatility.Objectives: To examine the budgets and actual expenditure allocated from central Government to the district level, for health, in Zambia from 2006 to 2017 and determine trends in funding for primary care.Methods: Financial data were extracted from Government documents and adjusted for inflation. Budget and expenditure for the district level over the period 2006 to 2017 were disaggregated by programmatic area for analysis.Results: Despite the withdrawal of donor funding from the district basket after 2009, funding for primary care allocated to the district level more than doubled from 2006 to 2017. However, human resources accounted for this increase. The operational grant, on the other hand, declined.Conclusion: The increase in the budget allocated to primary care could be an example of 'reverse fungibility', whereby Government accounted for the gap left by donors. However, the decline in the operational grant demonstrates that this period of aid volatility continued to have an impact on how primary care was planned and financed, with less flexible budget lines most affected during this period. Going forward, Government and donors must consider how funding is allocated to ensure that primary care is resilient to aid volatility; and that the principles of aid effectiveness are prioritised to continue to provide primary health care and progress towards achieving health for all.