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Economic Crisis and Healthcare Services

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 39041

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Guest Editor
Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece
Interests: socioeconomic impact of COVID-19; access to healthcare; healthcare services utilization; healthcare provider choice; unmet healthcare needs; catastrophic health spending; health status measurement; health services research; impact of economic crises on healthcare
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Special Issue Information

Dear Colleagues,

Economic crises cause sudden decreases in disposable income and the purchasing power of salaries and well-documented reductions in living conditions. They deplete public finance resources, including in healthcare, harm private business profitability and sustainability, and lead to increased unemployment. In such an environment of generalized uncertainty, healthcare establishments often make restructuring decisions that alter the delivery of care and the ability to care for the most vulnerable.

At the individual level, salary reductions and associated drops in disposable income, unemployment, and loss of insurance coverage all have detrimental effects on the person’s ability to seek affordable, quality, and accessible care. Reduced healthcare affordability coupled with the inability to pay for services results in unmet healthcare needs that have negative consequences on health. Some adverse effects on the population’s physical and psychological health and on overall wellbeing have been documented previously, pointing to the need for more research on the social determinants of health. 

At the global level, economic crises challenge healthcare’s ability to provide quality, affordable healthcare services that meet patients’ needs and expectations. The effects seem to be universal, although the severity of the effects does present significant variation. Decision making at the level of the healthcare system becomes more difficult due to increased uncertainty and alternatives which are more difficult to identify. The political landscape of individual countries and the boundaries on which healthcare operates make the comparison of national policies difficult. More discussion is needed along with appropriate analysis of empirical evidence to disentangle the effects of national policies and the identification of best practices.

The healthcare sector, more than any other sector of the economy, has limited margins of error or opportunities for delayed action or reaction. In addition to production goals, its complex governance must satisfy principles of equity, efficiency, effectiveness, and quality. Responding to economic downturns requires reflective, real-time collaboration at the level of policy making between governments, health professionals, researchers, academicians, patients’ communities, and stakeholders. However, this is not an easy task.

Thus, this Special Issue attempts to highlight the mechanisms upon which economic crises affect health, health outcomes, and healthcare-seeking behavior. It documents the need for expeditious and efficient interventions. In addition, it presents the empirical experience from policies that have been implemented to counterbalance the effects of a rapidly slowing economy and critically evaluates their results on health and healthcare. Evidence-based suggestions on the causes, the effects, and the response to the problem are within the scope of this Issue.

Furthermore, this Special Issue focuses on the economic consequences of the COVID-19 pandemic on individuals and households, healthcare providers, and healthcare systems. Decreases in incomes, increases in unemployment, financial uncertainty, reductions in living conditions, and the pressure exerted on healthcare systems are only some of such COVID-19 consequences, indicating humanity’s broad range of challenges attributed to the pandemic.

High-quality scientific and policy papers, both empirical and theoretical, from academicians and researchers are welcomed.


Dr. Dimitris J. Zavras
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • economic crises
  • income
  • unemployment
  • health status
  • healthcare services
  • healthcare affordability
  • healthcare seeking behavior
  • health policy
  • uncertainty
  • decision making

Published Papers (11 papers)

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Editorial

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4 pages, 269 KiB  
Editorial
Access to the COVID-19 Vaccine
by Dimitris Zavras
Int. J. Environ. Res. Public Health 2022, 19(17), 11054; https://doi.org/10.3390/ijerph191711054 - 3 Sep 2022
Cited by 3 | Viewed by 1360
Abstract
As of 31 August 2022, 599,825,400 confirmed coronavirus disease 2019 (COVID-19) cases and 6,469,458 deaths have been reported globally [...] Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)

Research

Jump to: Editorial

16 pages, 1929 KiB  
Article
An Unethical Organizational Behavior for the Sake of the Family: Perceived Risk of Job Insecurity, Family Motivation and Financial Pressures
by Ibrahim A. Elshaer, Marwa Ghanem and Alaa M. S. Azazz
Int. J. Environ. Res. Public Health 2022, 19(11), 6541; https://doi.org/10.3390/ijerph19116541 - 27 May 2022
Cited by 4 | Viewed by 2586
Abstract
In organizations, unethical behaviors are pervasive and costly, and considerable recent research attention has been paid to various types of workplace unethical behavior. This study examines employees’ behaviors that are carried out for the benefit of one’s family but violate societal and organizational [...] Read more.
In organizations, unethical behaviors are pervasive and costly, and considerable recent research attention has been paid to various types of workplace unethical behavior. This study examines employees’ behaviors that are carried out for the benefit of one’s family but violate societal and organizational moral standards. Drawing upon the self-maintenance and bounded ethicality theories, this study examines the engagement of unethical organization behaviors (UOB) in the name of the family during the COVID-19 pandemic. It examines the influence of job instability and the mediating role of family financial pressure and family motivation. A total of 770 employees in hotels and travel agents in Egypt were targeted, and the data were analyzed using structural equation modeling. The results posit that perceived risk of job insecurity predicts engagement in unethical organizational behaviors, while intentions of UOB increase by high family motivation and financial pressures. Toward the end of this paper, a discussion on the theoretical and practical implications and are presented. Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)
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12 pages, 331 KiB  
Article
Factors Associated with the Implementation of an Improved Community Health Fund in the Ubungo Municipality Area, Dar es Salaam Region, Tanzania
by Goodluck Mselle, Peter Nsanya, Kennedy Diema Konlan, Yuri Lee, Jongsoo Ryu and Sunjoo Kang
Int. J. Environ. Res. Public Health 2022, 19(9), 5606; https://doi.org/10.3390/ijerph19095606 - 5 May 2022
Cited by 2 | Viewed by 2583
Abstract
Community-based health insurance schemes help households to afford healthcare services. This paper describes healthcare facilities and community factors that are associated with the Improved Community Health Fund (iCHF) scheme in the Ubungo district of Tanzania. A cross-sectional descriptive study was conducted using online [...] Read more.
Community-based health insurance schemes help households to afford healthcare services. This paper describes healthcare facilities and community factors that are associated with the Improved Community Health Fund (iCHF) scheme in the Ubungo district of Tanzania. A cross-sectional descriptive study was conducted using online questionnaires that were completed by healthcare providers and community members in public-owned healthcare facilities in the Ubungo Municipal Council district of Dar es Salaam, Tanzania, between October and November 2021. The data were analyzed using descriptive statistics and the chi-squared test of association. We found a statistically significant relationship between income level and satisfaction with the iCHF scheme. For community-related factors, income level was statistically significant in the level of involvement in iCHF implementation among local leaders. Further, income level was statistically significant in relation to community behavior/culture toward the iCHF. Occupation was statistically significant in iCHF implementation, iCHF premiums, and iCHF membership size. A statistically significant relationship was also found between income, iCHF membership size, and iCHF premiums. Moreover, people would be willing to pay the required premiums if the quality of the healthcare services under the iCHF scheme improves. Therefore, the government should allocate resources to reduce the challenges that are facing iCHF implementation, such as the preference for a user fee scheme over the iCHF, the issues that are faced by enrollment officers, and inadequate iCHF premiums and membership size. Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)
15 pages, 972 KiB  
Article
Amid the COVID-19 Pandemic, Unethical Behavior in the Name of the Company: The Role of Job Insecurity, Job Embeddedness, and Turnover Intention
by Ibrahim A. Elshaer and Alaa M. S. Azazz
Int. J. Environ. Res. Public Health 2022, 19(1), 247; https://doi.org/10.3390/ijerph19010247 - 27 Dec 2021
Cited by 28 | Viewed by 6700
Abstract
The worldwide economic crisis initiated by the COVID-19 pandemic certainly altered the perception of regular job insecurity dimensions and brought these to the ultimate level. When employees feel insecure, they may decide to participate in unethical behavior in the name of the company [...] Read more.
The worldwide economic crisis initiated by the COVID-19 pandemic certainly altered the perception of regular job insecurity dimensions and brought these to the ultimate level. When employees feel insecure, they may decide to participate in unethical behavior in the name of the company to avoid layoff and become retained employees. This study investigated the relationship between job insecurity and unethical organizational behavior through the mediating role of job embeddedness and turnover intention. A total of 685 employees working in five- and four-star hotels and category A travel agents participated in this study. Data were analyzed using structural equation modeling. Job embeddedness and turnover intention were found to be partially mediated by the impact of job insecurity on unethical organizational behavior. Theoretical and practical implications were identified and discussed. Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)
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14 pages, 675 KiB  
Article
Exploring the Role of Health Expenditure and Maternal Mortality in South Asian Countries: An Approach towards Shaping Better Health Policy
by Noshaba Aziz, Jun He, Tanwne Sarker and Hongguang Sui
Int. J. Environ. Res. Public Health 2021, 18(21), 11514; https://doi.org/10.3390/ijerph182111514 - 2 Nov 2021
Cited by 13 | Viewed by 2795
Abstract
Accomplishing unremitting favorable health outcomes, especially reducing maternal mortality, remains a challenge for South Asian countries. This study explores the relationship between health expenditure and maternal mortality by using data set consisting of 18 years from 2000 to 2017. Fully modified ordinary least [...] Read more.
Accomplishing unremitting favorable health outcomes, especially reducing maternal mortality, remains a challenge for South Asian countries. This study explores the relationship between health expenditure and maternal mortality by using data set consisting of 18 years from 2000 to 2017. Fully modified ordinary least squares (FMOLS) and dynamic ordinary least squares (DOLS) models were employed for the empirical analysis. The outcomes revealed that a 1% rise in health expenditure increased the maternal mortality rate by 1.95% in the case of FMOLS estimator and 0.16% in the case of DOLS estimator. This reflects that the prevailing health care system is not adequate for reducing maternal mortality. Moreover, the meager system and the priorities established by an elitist system in which the powerless and poor are not considered may also lead to worsen the situation. In addition, the study also added population, economic growth, sanitation, and clean fuel technology in the empirical model. The findings revealed that population growth has a significant long-term effect on maternal mortality—an increase of 40% in the case of FMOLS and 10% in the case of DOLS—and infers that an increase in population growth has also dampened efforts towards reducing maternal mortality in the South Asian panel. Further, the results in the case of economic growth, sanitation, and clean fuel technologies showed significant long-term negative effects on maternal mortality by 94%, 7.2%, and 11%, respectively, in the case of the FMOLS estimator, and 18%, 1.9%, and 5%, respectively, in the case of the DOLS estimator. The findings imply that GDP and access to sanitation and clean fuel technologies are more nuanced in declining maternal mortality. In conclusion, the verdict shows that policymakers should formulate policies considering the fundamental South Asian aspects warranted to reduce maternal mortality. Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)
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30 pages, 8943 KiB  
Article
Global Challenges vs. the Need for Regional Performance Models under the Present Pandemic Crisis
by Romeo-Victor Ionescu, Monica Laura Zlati and Valentin Marian Antohi
Int. J. Environ. Res. Public Health 2021, 18(19), 10254; https://doi.org/10.3390/ijerph181910254 - 29 Sep 2021
Viewed by 1538
Abstract
The present study uses the analysis of the EU’s regional performance structure based on clusters to test the versatility of the regional administrative capacity in relation to three disruptive global phenomena: the economic crisis, the coronavirus epidemic and the phenomenon of refugee migration [...] Read more.
The present study uses the analysis of the EU’s regional performance structure based on clusters to test the versatility of the regional administrative capacity in relation to three disruptive global phenomena: the economic crisis, the coronavirus epidemic and the phenomenon of refugee migration to Europe. We defined a regional performance model based on maintaining sustainability indicators in the 240 EU regions. The objectives of the study are aimed primarily at a structured assessment of regional administrative capacity in the initial version, based on statistical indicators, and in the current version, after the outbreak of the pandemic, based on quantifying the impact of the disturbing factors. Secondly, the objectives of the study are to evaluate the reaction of the administrative units according to their ability to respond to the economic problems in the region, in the sense of improving the performance of the regional economies. The methods used in this paper will be empirical (the study of the specialized literature), analytical and will contain econometric modelling and statistical processing of the data. The results of the study will allow the identification of the necessary traits to train a leader in regional performance, traits that will be useful to European decision makers in adjusting the EU regional policy. Moreover, the need to redefine the EU in terms of performance will be substantiated once again. The study is current and is based on the latest Eurostat information, pertinent tables and diagrams. Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)
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12 pages, 1360 KiB  
Article
The Impact of the SARS-CoV-19 Pandemic on the Global Gross Domestic Product
by Piotr Korneta and Katarzyna Rostek
Int. J. Environ. Res. Public Health 2021, 18(10), 5246; https://doi.org/10.3390/ijerph18105246 - 14 May 2021
Cited by 13 | Viewed by 3099
Abstract
The rapid, unexpected, and large-scale expansion of the SARS-CoV-19 pandemic has led to a global health and economy crisis. However, although the crisis itself is a worldwide phenomenon, there have been considerable differences between respective countries in terms of SARS-CoV-19 morbidities and fatalities [...] Read more.
The rapid, unexpected, and large-scale expansion of the SARS-CoV-19 pandemic has led to a global health and economy crisis. However, although the crisis itself is a worldwide phenomenon, there have been considerable differences between respective countries in terms of SARS-CoV-19 morbidities and fatalities as well as the GDP impact. The object of this paper was to study the influence of the SARS-CoV-19 pandemic on global gross domestic product. We analyzed data relating to 176 countries in the 11-month period from February 2020 to December 2020. We employed SARS-CoV-19 morbidity and fatality rates reported by different countries as proxies for the development of the pandemic. The analysis employed in our study was based on moving median and quartiles, Kendall tau-b coefficients, and multi-segment piecewise-linear approximation with Theil–Sen trend lines. In the study, we empirically confirmed and measured the negative impact of the SARS-CoV-19 pandemic on the respective national economies. The relationship between the pandemic and the economy is not uniform and depends on the extent of the pandemic’s development. The more intense the pandemic, the more adaptive the economies of specific countries become. Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)
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16 pages, 1404 KiB  
Article
Performance Evaluation of the Chinese Healthcare System
by Muhammad Umar, Mário Nuno Mata, Adnan Abbas, José Moleiro Martins, Rui Miguel Dantas and Pedro Neves Mata
Int. J. Environ. Res. Public Health 2021, 18(10), 5193; https://doi.org/10.3390/ijerph18105193 - 13 May 2021
Cited by 2 | Viewed by 2960
Abstract
This study aims to evaluate the performance of the Chinese healthcare system. It uses sustainable development goal (SDG) 3, set by the United Nations to ensure healthy lives and promote well-being for all at all ages as a benchmark. It uses data of [...] Read more.
This study aims to evaluate the performance of the Chinese healthcare system. It uses sustainable development goal (SDG) 3, set by the United Nations to ensure healthy lives and promote well-being for all at all ages as a benchmark. It uses data of 17 variables ranging from the year 2000 to 2017 and uses a multistage methodology to evaluate the performance. In the first stage, it uses difference in mean test to know whether or not the indicators show an improvement in the second decade of the 21st century compared to the first decade. In the second phase, simple linear regression has been used to know the rate of change of performance of every indicator over the sample period. The third step compares the performance of the healthcare sector with the sustainable goals set by the UN and the fourth phase attempts to forecast performance for the next five years i.e., 2018 to 2022. As per the results, the Chinese healthcare sector has performed very well on many fronts except alcohol consumption in males, road accidents and the incidence of non-communicable diseases. Alcohol consumption by males is touching dangerous levels. Therefore, the policies should focus on educating males to lower their alcohol consumption to stay fit and healthy. Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)
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13 pages, 1145 KiB  
Article
Competency Model for the Middle Nurse Manager (MCGE-Logistic Level)
by Alberto González-García, Arrate Pinto-Carral, Jesús Sanz Villorejo and Pilar Marqués-Sánchez
Int. J. Environ. Res. Public Health 2021, 18(8), 3898; https://doi.org/10.3390/ijerph18083898 - 8 Apr 2021
Cited by 4 | Viewed by 7050
Abstract
Healthcare systems are immersed in transformative processes, influenced by economic changes, together with social and health instability. The middle nurse manager plays a fundamental role, since he or she is responsible for translating the strategic vision, values and objectives of the organization. The [...] Read more.
Healthcare systems are immersed in transformative processes, influenced by economic changes, together with social and health instability. The middle nurse manager plays a fundamental role, since he or she is responsible for translating the strategic vision, values and objectives of the organization. The objective of this study was to propose the model of competencies to be developed by the middle nurse manager in the Spanish healthcare system. Our methodology consisted in the application of the Delphi method in order to reach an agreement on the necessary competencies, and principal component analysis (PCA) was used to determine the construct validity, reducing the dimensionality of the set of data. Fifty-one competencies were identified for the definition of the model, highlighting decision-making, leadership and communication. The PCA pointed out the structural validity of the proposed model through the saturation of the main components (α Cronbach > 0.631). The results show the model of competencies which the middle nurse manager in the Spanish healthcare system must develop. Middle nurse managers may use these as criteria to plan their professional strategies in the context of management. This model of competencies can be applied to establishing selection processes or training programs for the role of middle nurse manager. Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)
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10 pages, 345 KiB  
Article
How Do Pharmaceutical Companies Overcome a Corporate Productivity Crisis? Business Diversification into Medical Devices for Growth Potential
by Yoonje Euh and Daeho Lee
Int. J. Environ. Res. Public Health 2021, 18(3), 1045; https://doi.org/10.3390/ijerph18031045 - 25 Jan 2021
Cited by 2 | Viewed by 2796
Abstract
The purpose of this study was to analyze the performance of pharmaceutical companies’ business diversification into medical devices in terms of their technical efficiency (TE) as compared to that of traditional pharmaceutical companies. For a total of 174 externally audited pharmaceutical companies engaged [...] Read more.
The purpose of this study was to analyze the performance of pharmaceutical companies’ business diversification into medical devices in terms of their technical efficiency (TE) as compared to that of traditional pharmaceutical companies. For a total of 174 externally audited pharmaceutical companies engaged in the drug product business between 2008 and 2019, pharmaceutical companies were classified into two groups according to medical device business diversification. The TE of pharmaceutical companies that diversify the medical device business was lower than that of traditional pharmaceutical companies. However, in terms of the meta-technology ratio (MTR) calculated using meta-frontier analysis, pharmaceutical companies diversified into medical devices showed higher MTR than the traditional pharmaceutical company group. The results imply that the corporate performance growth potential of traditional pharmaceutical companies is lower than that of pharmaceutical companies that have diversified into the medical device business. Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)
21 pages, 540 KiB  
Article
Studying Healthcare Affordability during an Economic Recession: The Case of Greece
by Dimitris Zavras
Int. J. Environ. Res. Public Health 2020, 17(21), 7790; https://doi.org/10.3390/ijerph17217790 - 24 Oct 2020
Cited by 4 | Viewed by 3081
Abstract
The significant deterioration of economic prosperity in Greece during the economic crisis decreased patients’ ability to pay. Thus, the objective of this study is to determine the factors affecting healthcare affordability in Greece during an economic recession. This study used data from the [...] Read more.
The significant deterioration of economic prosperity in Greece during the economic crisis decreased patients’ ability to pay. Thus, the objective of this study is to determine the factors affecting healthcare affordability in Greece during an economic recession. This study used data from the European Union Statistics on Income and Living Conditions (EU-SILC) 2016. The sample consisted of 18,255 households. Healthcare affordability was regressed on geographic characteristics as well as several variables that refer to the households’ financial condition. Region of residence, ability to make ends meet, and capacity to cope with unexpected financial expenses were found to be statistically significant. Using sample sizes of 1000 and 1096 adults, respectively, the European Quality of Life Surveys (EQLS) of 2007 and 2016 were also used as data sources. Economic crisis was expressed with a dummy variable: (1) 0: 2007, and (2) 1: 2016. Difficulty in responding to healthcare costs was regressed on survey year and several demographic, socioeconomic, and health characteristics, revealing that individuals were more likely to face difficulties in responding to healthcare costs during the economic crisis. These results confirm the mechanism on the basis of which economic crises affect healthcare access: primarily through the effects of demand-side barriers. Full article
(This article belongs to the Special Issue Economic Crisis and Healthcare Services)
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