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Author(s): Stéphane Verguet [sup.1] , Alemayehu Hailu [sup.2] [sup.3] , Getachew Teshome Eregata [sup.2] [sup.3] , Solomon Tessema Memirie [sup.4] , Kjell Arne Johansson [sup.3] , Ole Frithjof Norheim [sup.1] [...], All countries worldwide have signed up to the United Nations Sustainable Development Goals and have committed to the objective of achieving 'universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all'. During the COVID-19 pandemic and beyond, advancement toward universal health coverage (UHC) will become more difficult for many countries, demonstrating that locally led priority setting is urgently needed to provide health services with appropriate financial protection to all. Because resources are limited and no national constituency can provide an unlimited number of services to their whole population in a sustainable manner, rationing and setting priorities for the selection of interventions to be included in a defined package of services is critical. In this Perspective, we discuss how packages of essential health services can be developed in resource-constrained settings, and detail how experts and the public can decide on principles and criteria, use a comprehensive array of analytical methods and choose which services to be provided free of charge. We illustrate these main steps while drawing on a recently conducted exercise of revising the national essential health services package in Ethiopia, which we compare with examples from other countries that have defined their essential benefits packages. This Perspective also provides recommendations for other low- and middle-income countries on their pathway to UHC. All countries worldwide have signed up to the United Nations Sustainable Development Goals and committed to the objective of achieving universal health coverage. Getting there will require understanding how packages of essential health services can be developed in resource-constrained settings and how experts and the public can make decisions about which health services should be provided free of charge.

How Much Does the United States Spend on Health Care? The United States spends approximately 18% of our gross domestic product on health care, more than any other industrialized country [...], Introduction: Under the current payment environment, the challenges to implementing and sustaining integrated behavioral health care are substantial. One key barrier for clinicians, administrators, researchers, and patients/families is a lack of clarity about who pays for integrated health care in the United States, and a lack of consensus about whether bending the health care cost curve is a fundamental goal of integrated care, and for whom. Clinicians caring for patients and families in integrated care settings would benefit from honing their "payment reform literacy skills" in order to advocate for integrated care. Method: This paper offers a primer on the current state of health care spending in the United States, an overview of public and private payers, and the challenges each faces in paying for integrated care. Discussion: Future journal articles in the FSH Policy and Management Department will describe key payment policy and management opportunities for integrated care payment reform. Keywords: integrated behavioral health, payment reform, Medicare, Medicaid, commercial insurance

Physicians are increasingly dealing with payer policies that interfere with their delivery of healthcare. Meanwhile, patients are seeing their physicians second-guessed and blocked by insurance companies, leaving them to wonder [...]

Author(s): Amitabh Bipin Suthar 1,*, Aleya Khalifa 1, Sherry Yin 1, Kristen Wenz 2, Doris Ma Fat 3, Samuel Lantei Mills 4, Erin Nichols 5, Carla AbouZahr 6, Srdjan Mrkic [...], Background Civil registration and vital statistics (CRVS) systems play a key role in upholding human rights and generating data for health and good governance. They also can help monitor progress in achieving the United Nations Sustainable Development Goals. Although many countries have made substantial progress in strengthening their CRVS systems, most low- and middle-income countries still have underdeveloped systems. The objective of this systematic review is to identify national policies that can help countries strengthen their systems. Methods and findings The ABI/INFORM, Embase, JSTOR, PubMed, and WHO Index Medicus databases were systematically searched for policies to improve birth and/or death registration on 24 January 2017. Global stakeholders were also contacted for relevant grey literature. For the purposes of this review, policies were categorised as supply, demand, incentive, penalty, or combination (i.e., at least two of the preceding policy approaches). Quantitative results on changes in vital event registration rates were presented for individual comparative articles. Qualitative systematic review methodology, including meta-ethnography, was used for qualitative syntheses on operational considerations encompassing acceptability to recipients and staff, human resource requirements, information technology or infrastructure requirements, costs to the health system, unintended effects, facilitators, and barriers. This study is registered with PROSPERO, number CRD42018085768. Thirty-five articles documenting experience in implementing policies to improve birth and/or death registration were identified. Although 25 countries representing all global regions (Africa, the Americas, Southeast Asia, the Western Pacific, Europe, and the Eastern Mediterranean) were reflected, there were limited countries from the Eastern Mediterranean and Europe regions. Twenty-four articles reported policy effects on birth and/or death registration. Twenty-one of the 24 articles found that the change in registration rate after the policy was positive, with two supply and one penalty articles being the exceptions. The qualitative syntheses identified 15 operational considerations across all policy categories. Human and financial resource requirements were not quantified. The primary limitation of this systematic review was the threat of publication bias wherein many countries may not have documented their experience; this threat is most concerning for policies that had neutral or negative effects. Conclusions Our systematic review suggests that combination policy approaches, consisting of at least a supply and demand component, were consistently associated with improved registration rates in different geographical contexts. Operational considerations should be interpreted based on health system, governance, and sociocultural context. More evaluations and research are needed from the Eastern Mediterranean and Europe regions. Further research and evaluation are also needed to estimate the human and financial resource requirements required for different policies.

The Liverpool Care Pathway (LCP) is an integrated care pathway used to manage terminally ill patients in their final days or hours of life. It was developed by the Marie [...]

This article describes two initiatives from the National Patient Safety Agency, which were developed to address important areas of harm to patients. This harm stems from failing to recognise or [...]

In April 2010, just days before the election that led to the coalition government, then prime minister Gordon Brown, Liberal Democrat leader Nick Clegg and shadow health secretary Andrew Lansley [...]

The Cancer Reform Strategy (Department of Health 2007) states that 'commissioners and providers should ensure that the critical roles of clinical nurse specialists (CNSs) in information delivery, communication and co-ordination [...]

GIVEN THE CHORUS of approval for primary care emanating from every party to the health reform debate, one might suppose that the future for primary physicians is bright. Yet this [...]

The article puts forth the reasons for changes to be made in the health care system being followed in the U.S. to achieve universal coverage and subsequently lower costs. A plan should be formulated that will be able to address rising costs due to an aging population besides giving better value for money.

The diversification and aging of the US population has been at the root of many political and policy debates in recent years. Of particular interest has been the place of immigrants in an aging society, and what rights these immigrants are entitled to. The objective of this article is to describe the current avenues and barriers to access of services for immigrant elders and examine potential solutions for reform. The article begins with a historical overview of the policy issue, followed by the current status of the issue in the United States and suggestions for reform. KEYWORDS Immigrants, access to services, elderly, policy

At the turn of the 20th century, Wall street financial Clifford W. Beers was so distraught over of illness and death of his brother that he attempted to take his [...]

Une traduction en francais de ce resume figure a, la fin de l'article. Al final de/articulo se facilita una traduccion al espanol Introduction Every year approximately 10 million children under [...], Objective To assess whether traditional measures of access to health care (distance and travel time to a facility) and non-traditional measures (social and financial support indicators) are associated with mortality among children under 5 years of age in the Gambia. Methods We conducted a case-control study in a population under demographic surveillance. Cases (n = 140) were children under 5 years of age who died between 31 December 2003 and 30 April 2006. Each case was matched in age and sex to five controls (n = 700). Information was gathered by interviewing primary caregivers. The data were analysed using conditional logistic regression. Findings Of traditional measures of access, only rural versus urban/periurban residence was important: children from rural areas were more likely to die (OR: 4.9; 95% confidence interval, Ch 1.2-20.2). For non-traditional measures, children were more likely to die if their primary caregivers lacked help with meal preparation (OR: 2.3; 95% Ch 1.2-4.1), had no one to relax with (OR: 1.8; 95% Ch 1.1-2.9), had no one who could offer good advice (OR: 23.1; 95% Ch 4.3-123.4), had little say over how earned money was spent (OR: 12.7; 95% Ch 1.3-127.6), were unable to cut spending for health care (OR: 2.5; 95% Ch 1.5-4.2) or had to carry out odd jobs to pay for the care (OR: 3.4; 95% Ch 2.1-5.5). A protective effect was observed when the caregiver had other children to care for (OR: 0.2; 95% Cl: 0.1-0.5). Conclusion Improving access to health-care for children in the Gambia and similar settings is not simply a matter of reducing travel time and distance to a health facility, but requires improvements in caregivers' support networks and their access to the financial resources they need. Objectif Evaluer les eventuelles associations entre les mesures classiques de l'acces aux soins (distance et duree du trajet jusqu'a l'etablissement) ou les mesures non conventionnelles (indicateurs de soutien social et financier) et la mortalito des enfants de moins de 5 ans en Gambie. Methodes Nous avons mene une etude cas-tomoins dans une population sous surveillance demographique. Les cas (n = 140) etaient des enfants de moins de 5 ans, decedes entre le 31 decembre 2003 et le 30 avril 2006. Chaque cas etait apparie selon l'age et le sexe a 5 tomoins (n = 700). Des informations ont eto recueillies en interrogeant les aidants principaux. Les donnees ont ete analysees par regression logistique classique. Resultats Parmi les mesures classiques de l'acces aux soins, seule la distinction entre residence en milieu rural et residence en milieu urbain ou periurbain etait importante :les enfants provenant de zones rurales avaient une plus grande probabilito de mourir (OR: 4,9; IC a 95 % 1,2-20,2). S'agissant des mesures non conventionnelles, la probabilito de deces des enfants etait plus forte si leur aidant principal manquait d'aide pour la preparation des repas (OR : 2,3 ;IC a 95 % : 1,2-4,1), n'avait personne avec qui se detendre (OR : 1,8 ; IC a 95 % : 1,1-2,9), n'avait personne pour lui prodiguer de bons conseils (OR: 23,1 ; IC a 95 % : 4,3-123,4), n'avait pas son mot a dire sur la facon dont l'argent gagne etait depense (OR: 12,7 ; IC a 95 % : 1,3-127,6), etait dans l'incapacito de reduire les depenses de santo (OR :2,5 ;IC a 95% : 1,5-4,2) ou devait effectuer des << petits boulots >> pour payer ces depenses (OR : 3,4 ;IC a 95 % : 2,1-5,5). Un effet protecteur a ete observe lorsque l'aidant principal devait egalement s'occuper d'autres enfants (OR : 0,2 ; IC a 95 % : 0,1-0,5). Conclusion Ameliorer l'acces aux soins des enfants en Gambie ou dans d'autres contextes similaires ne signifie pas seulement reduire le temps de trajet et la distance jusqu'a l'etablissement de soins, mais suppose un renforcement des reseaux de soutien aux aidants et un meilleur acces pour eux aux ressources financieres dont ils ont besoin. Objetivo Determinar si las medidas tradicionales (distancia y tiempo de viaje hasta un establecimiento) y no tradicionales (indicadores de apoyo social y financiero) de acceso a la atencion de salud guardan relacion con la mortalidad entre les menores de 5 anos en Gambia. Metodos Llevamos a cabo un estudio de casos y controles en una poblacion sometida a vigilancia demografica. Les casos (n = 140) fueron ninos menores de 5 anos fallecidos entre el 31 de diciembre de 2003 y e130 de abril de 2006. Cada case se emparejo por edad y sexo con cinco controles (n = 700). Se entrevisto a les cuidadores principales para reunir la informacion pertinente, analizandose luego les datos mediante regresion Iogistica condicional. Resultados De las medidas tradicionales de acceso, solo la residencia rural frente a la urbana/periurbana tenia un efecto importante: los ninos de las zonas rurales tenian mas probabilidades de morir (OR: 4,9; intervalo de confianza (IC) del 95%: 1,2-20,2). En cuanto a las medidas no tradicionales, los ninos tenian mas probabilidades de morir cuando sus cuidadores principales carecian de ayuda para preparar las comidas (OR: 2,3; IC95%: 1,2-4,1), no disponian de nadie con quien distenderse (OR: 1,8; IC95%: 1,1-2,9), no tenian a nadie que pudiera ofrecerles buenos consejos (OR: 23,1; IC95%: 4,3-123,4), no podian influir apenas en las decisiones de gasto det dinero ganado (OR: 12,7; IC95%: 1,3-127,6), no podian reducir el gasto en atencion de salud (OR: 2,5; IC95%: 1,5-4,2) o tenian que desempenar trabajos poco corrientes para pagar la atencion (OR: 3,4; IC95%: 2,1-5,5). Un efecto protector rue que el cuidador tuviera que ocuparse tambien de otros ninos (OR: 0,2; IC95%: 0,1-0,5). Conclusion La mejora del acceso a la atencion sanitaria para les ninos de Gambia y entornos similares no estriba simplemente en reducir el tiempo de viaje y la distancia a les centros de salud. Es preciso mejorar las redes de apoyo a les cuidadores y su acceso a les recursos financieros que necesitan.

Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facita una traduccionn al espanal. Introduction The Integrated Management of Childhood Illness [...], Objective To assess the sensitivity of an Integrated Management of Childhood Illness (IMCI) algorithm to detect common skin conditions in children in Fiji. Methods We collected data from the assessments of children aged between 2 months and 5 years who presented to one of two health clinics. Every child was assessed by a nurse trained in the use of the IMCI algorithm and also an expert paediatrician. We used a kappa statistic to measure agreement between the nurse/algorithm assessment method and the paediatrician's diagnosis. Findings High sensitivity for identifying skin problems (sensitivity: 98.7%; 95% confidence interval, CI: 95.5-99.9) was found for the algorithm applied by IMCI-trained nurses, who were able to identify the one child with a severe skin infection and all three children with periorbital cellulitis. Sensitivity was high for the classification of abscess/cellulitis (sensitivity: 95%; 95% CI: 75.1-99.9) and infected scabies (sensitivity: 89.1%; 95% Ch 77.8-95.9), but lower for identification of impetigo, fungal infection and, in particular, non-infected scabies. Conclusion The IMCI skin algorithm is a robust tool that should be incorporated into the IMCI after some modifications relating to scabies and impetigo. Its use by primary health-care workers will reduce the burden of skin diseases in children in Fiji through improved case identification and management. The algorithm should be considered in other countries where skin diseases in children are a priority, particularly in the Pacific region. Objectif Evaluer la sensibilite d'un algorithme de gestion integree des maladies infantiles (PCIME) pour la detection des maladies de peau courantes chez les enfants des iles Fidji. Methodes Nous avons recueilli des donnees sur l'evaluation d'enfants de 2 mois a 5 ans, presentes dans un des deux dispensaires participant a l'etude. Chaque enfant a ete evalue par une infirmiere formee a l'utilisation de I'algorithme de PCIME et par un pediatre expert. Nous avons utilise un test statistique Kappa pour mesurer l'accord entre l'evaluation par l'infirmiere s'aidant de l'algorithme et le diagnostic du pediatre. Resultats Nous avons releve une forte sensibilite de l'algorithme pour l'identification des problemes de peau (sensibilite: 98,7 %; intervalle de confiance a 95 %, IC: 95,5-99,9) dans le cadre de son application par les infirmieres formees a la PCIME, qui ont ete capables d'identifier parmi les enfants un cas d'affection cutanee severe et les trois cas de cellulite periorbitale. La sensibilite etait egalement bonne pour la classification des abces et des cellulites (sensibilite: 95 %, IC a 95 %: 75,1-99,9) et celle des gales infectees (sensibilite: 89,1%, IC a 95 %: 77,8-95,9), mais etait en revanche plus faible pour l'identification des impetigos et des infections fongiques, notamment des gales non infectees. Conclusion L'algorithme de PCIME pour les maladies de la peau est un outil solide, qui devrait etre integre a la PCIME apres certaines modifications concernant la gale et l'impetigo. Son utilisation par les agents de sante primaire devrait reduire la charge d'affections cutanees chez les enfants des iles Fidji en ameliorant l'identification des cas et la prise en charge. Il conviendrait d'envisager l'emploi de cet algorithme dans d'autres pays ou les affections cutanees infantiles sont une priorite, notamment dans la region Pacifique. Objetivo Determinar la sensibilidad de un algoritmo de la Atencien Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI) para manejar enfermedades cutaneas comunes en les ninos en Fiji. Metodos Reunimos datos de las exploraciones a que se sometio a ninos de entre 2 meses y 5 anos atendidos en alguno de les dos dispensarios considerados. Todos les ninos fueron examinados por una enfermera adiestrada en la aplicacien del algoritmo AIEPI, asi como por un especialista en pediatria. Empleamos el estadistico kappa para medir el grade de concordancia entre el metodo de evaluacien algoritmica empleado por la enfermera y el diagnostico realizado por el pediatra. Resultados Se observe una alta sensibilidad para la deteccion de problemas cutaneos (sensibilidad: 98,7%; intervalo de confianza del 95%: 95,5-99,9) con el algoritmo aplicado por las enfermeras adiestradas en la AIEPI, que fueron capaces de identificar al unico nino que tenia una infeccion cutanea grave y a los tres ninos que padecian celulitis periorbitaria. La sensibilidad tambien fue alta en Io referente a la clasificacien de les abscesos/celulitis (sensibilidad: 95%; IC95%: 75,1-99,9) y la escabiosis infectada (sensibilidad: 89,1%; IC95%: 77,8-95,9), pero fue mas baja en la deteccion del impetigo, las micosis y, en particular, la escabiosis no infectada. Conclusion El algoritmo de diagnostico cutaneo AIEPI es un valioso instrumente que deberia integrarse en la AIEPI previa introduccien de algunos cambios relacionados con la escabiosis y el impetigo. Su aplicacien por el personal de atencien primaria permitira reducir la carga de enfermedades cutaneas en la poblacion infantil de Fiji mediante una mejor identificacion y gestion de les casos. EI uso de ese algoritmo es una posibilidad que merece considerarse tambien en otros paises donde las enfermedades cutaneas constituyen una prioridad, sobre todo en la regien riel Pacifico.

Background: The provision of effective health care to people with HIV and those from usually marginalised backgrounds, such as drug users and sex workers is a growing concern in Nepal, because these populations often do not seek health care, as willingly as the general population. Exploration of the factors, which hinder them seeking health care is crucial. The ‘lived' experiences of the usually marginalized participants in this research will reflect on the constraining factors, and contribute to the development of appropriate strategies, which will facilitate people with HIV and other marginal populations to seek more readily appropriate health services. Methods: This study explored the healthcare‐seeking experiences of 20 HIV‐positive participants in Nepal, as well as 10 drug‐using participants who had never had an HIV test and did not know their HIV status. Using grounded theory, this study investigated the perceptions and experiences of HIV‐positive persons, or those perceived to be at risk for HIV, as they sought health care services in locations around Kathmandu Valley. Results: Health professionals were perceived to lack knowledge and sensitivity in providing health care to often marginalized and stigmatized injecting drug users, sex workers and HIV‐positive people. Stigma and marginalization seem to interfere with doctors' and other health professionals' decisions to voluntarily treat persons who they perceive to be at high risk for HIV infections. Doctors and other health professionals appear suspicious, even unaware, of contemporary biomedical knowledge as it relates to HIV. The fear that certain marginalized groups, such as injecting drug users and sex workers, would be infected with HIV has further intensified stigma against these groups. Conclusion: The study identified the beginning of a change in the experiences of HIV‐positive people, or those at risk of HIV, in their seeking of health care. With focused, contemporary HIV education and training, the beginning of positive changes in the knowledge base and attitude of health providers seemed to be apparent to some participants of this study., Background The literature reveals that many health care providers still hesitate to provide care to people at high risk of HIV due to a fear of contracting HIV themselves [1‐4]. [...]

There is a need for developing a new federal-state partnership, as states cannot reform health care on their own. The federal government will have to take the initiative to achieve successful and sustainable reform.

Everyone is in agreement that the U.S. health care system is in need of urgent reforms. The completely opposite heath care reform strategies of both U.S. presidential candidates Senators Barack Obama and John McCain are also highlighted.

Reasons for the decline of quality of care under National Health Service's (NHS) plan in United Kingdom are analyzed.

This paper provides a few historical notes on government involvement in health, followed by a summary of the theoretical arguments that economists offer in its support. Irving Fisher's views and recommendations about health are examined in the light of today's perceptions concerning health, health economics, and health policy. The wide variety of roles that the U.S. and other governments currently play in health is reviewed, and the ability of economics to explain these roles is assessed. The consequences of government involvement for the health of populations, for expenditures on health care, and for political and social stability are examined. The paper concludes with an overview of new worldwide trends in health policy and some probable explanations for these trends.

Estonia began to reform its health care system by reorganizing primary health care (PHC). Ten years ago, the health care system was inefficient, supply was biased towards institutional care, and PHC was almost non-existent in the western understanding: it was provided by different specialists in policlinics, and the financial basis of the system was in crisis. The reform had the following aims: to develop PHC by introducing family medicine, to guarantee the whole population access to family doctors' services, and to secure stable funding for these services. In 1998, a new phase in the reform was introduced through the creation of a new funding system for primary care services. The aim of this paper is to present a practically applicable set of indicators to evaluate PHC reform in terms of health economics criteria and then to apply these indicators in evaluation of the Estonian PHC reform. Keywords: Estonia; Primary health care reform; Evaluation; Set of indicators

Employers were a major cause of the failure of President Clinton's Health Security bill. This did not have to be so. The substantive and political factors that caused employers to turn against the Clinton Plan could prove instructive in the next reform effort. The unwillingness of employers who do provide benefits to engage seriously in the struggle over health care reform contributes to maintaining the status quo that penalizes them while rewarding employers who fail to provide coverage. The lessons that can be learned from the Clinton Plan debate, if heeded by both employers and health reform advocates, raise hope that key elements of the business community can play a positive role in the next comprehensive health reform effort.

The health care crisis is back. There is intensifying sentiment across the country that universal coverage is our only way out. The labor movement has used historically such opportunities for change to win health benefits at the bargaining table and strengthen the social safety net. Eighty years of incremental victories and many failed attempts at major health reform have taught labor a crucial lesson: we must build a powerful grassroots movement to drive our effort to achieve universal coverage, or it is doomed to be corrupted by those wedded to the status quo. Now is the right time for reform.

Because of the importance of grassroots social movements, or 'change from below,' in the history of US reform, the relationship between social movements and demands for universal health care is a critical one. National health reform campaigns in the 20th century were initiated and run by elites more concerned with defending against attacks from interest groups than with popular mobilization, and grassroots reformers in the labor, civil rights, feminist, and AIDS activist movements have concentrated more on immediate and incremental changes than on transforming the health care system itself. However, grassroots health care demands have also contained the seeds of a wider critique of the American health care system, leading some movements to adopt calls for universal coverage.

US health care reform is compared to 'The Wizard of Oz'.