Search Results (145)

Although organizational resilience is well established, refining the systematic quantitative evaluation of health systems resilience (HSR) remains an ongoing opportunity for advancement. Research either focuses on individual HSR indicators, such as social welfare policy, public expenditure, health insurance, healthcare quality, and technology, or broadly examines socio-economic factors, highlighting the need for a more comprehensive methodological approach. This study employed the Slacks-Based Measure (SBM) within Data Envelopment Analysis (DEA) to analyze efficiency by maximizing outputs. It systematically examined key HSR factors across countries, providing insights for improved policymaking and resource allocation. Taking a five-year (2016–2020) dataset that covered 55 to 56 countries and evaluating 17 indicators across governance, health systems, and economic aspects, the paper presents that all sixteen top-ranked countries with a perfect efficiency score of 1 belonged to the high-income group, with ten in Europe, highlighting regional HSR differences. This paper concludes that adequate economic resources form the foundation of HSR and ensure stability and sustained progress. A properly supported healthcare workforce is essential for significantly enhancing health systems and delivering quality care. Last, effective governance and the equitable allocation of resources are crucial for fostering sustainable development and strengthening HSR. Full article

Introduction: Low medication adherence and low hypertension control are a public health challenge, particularly in low- and middle-income countries (LMICs). Healthcare system- and patient-related barriers hinder the successful management of hypertension. This study aimed to identify the perceptions of barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia. Materials and Methods: We conducted a qualitative, phenomenological, and interpretative study, comprising five focus groups, to explore the barriers and facilitators to managing people with hypertension. Each focus group was formed by stakeholders from territorial entities, healthcare insurers, or healthcare providers. Meetings were held between December 2022 and February 2023. The sessions were recorded and transcribed using NVivo Transcription and analyzed using NVivo version 1.6.1. Results: Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship. Of these categories, articulation and stewardship emerged as the main barriers, as revealed through axial coding and cluster analysis, which highlighted deficiencies in stewardship practices, a lack of clear objectives, and misalignment with public policy frameworks. Conclusions: Multisectoral actions extending beyond healthcare providers and aimed at improving coordination and intersectoral collaboration are essential for enhancing hypertension control in LMICs, such as Colombia. Addressing social determinants and strengthening primary healthcare through community-based strategies are critical, making stewardship and improved access key priorities. Full article

Healthcare cost acceleration and resource allocation issues have worsened across European health systems, where a small group of patients drives excessive healthcare spending. The prediction of high-cost utilization patterns is important for the sustainable management of healthcare and focused intervention measures. The aim of our study was to derive and validate machine learning algorithms for high-cost healthcare utilization prediction based on detailed administrative data and by comparing three algorithmic methods for the best risk stratification performance. The research analyzed extensive insurance beneficiary records which compile data from health group collective funds operated by non-life insurers across EU countries, across multiple service classes. The definition of high utilization was equivalent to the upper quintile of overall health expenditure using a moderate cost threshold. The research applied three machine learning algorithms, namely logistic regression using elastic net regularization, the random forest, and support vector machines. The models used a comprehensive set of predictor variables including demographics, policy profiles, and patterns of service utilization across multiple domains of healthcare. The performance of the models was evaluated using the standard train–test methodology and rigorous cross-validation procedures. All three models demonstrated outstanding discriminative ability by achieving area under the curve values at near-perfect levels. The random forest achieved the best test performance with exceptional metrics, closely followed by logistic regression with comparable exceptional performance. Service diversity proved to be the strongest predictor across all models, while dentistry services produced an extraordinarily high odds ratio with robust confidence intervals. The group of high utilizers comprised approximately one-fifth of the sample but demonstrated significantly higher utilization across all service classes. Machine learning algorithms are capable of classifying patients eligible for the high utilization of healthcare services with nearly perfect discriminative ability. The findings justify the application of predictive analytics for proactive case management, resource planning, and focused intervention measures across private group health insurance providers in EU countries. Full article

The Affordable Care Act (ACA), implemented in 2010, aimed to expand healthcare access, reduce costs, and address long-standing disparities in the U.S. healthcare system, particularly among racial and ethnic minorities. This paper reviews the ACA’s impact on healthcare utilization for these populations, with a focus on insurance coverage, preventive services, and health outcomes. While Medicaid expansion significantly reduced uninsured rates and increased access to care in states that adopted the expansion, millions of low-income individuals, many of whom are racial and ethnic minorities, remain uninsured in non-expansion states. The elimination of cost-sharing for preventive services under the ACA contributed to increased utilization of cancer screenings, vaccinations, and other preventive measures among minority groups. However, challenges persist, including affordability barriers, geographic disparities, and cultural and linguistic obstacles. This review also highlights the ongoing need for policy interventions, such as nationwide Medicaid expansion, and future research on the long-term effects of the ACA on health outcomes for minority populations. Full article

Neglecting preventive healthcare policies has contributed to the global surge in chronic diseases, increased hospitalizations, declining quality of care, and escalating costs. Non-communicable diseases (NCDs)—notably cardiovascular conditions, diabetes, and cancer—consume over 80% of healthcare expenditure and account for more than 60% of global deaths, which are projected to exceed 75% by 2030. Poor diets, sedentary lifestyles, regulatory loopholes, and underfunded public health initiatives are driving this crisis. Compounding the issue are flawed policies, congressional lobbying, and conflicts of interest that prioritize costly, hospital-based, symptom-driven care over identifying and treating to eliminate root causes and disease prevention. Regulatory agencies are failing to deliver their intended functions. For instance, the U.S. Food and Drug Administration’s (FDA) broad oversight across drugs, devices, food, and supplements has resulted in inefficiencies, reduced transparency, and public safety risks. This broad mandate has allowed the release of unsafe drugs, food additives, and supplements, contributing to the rising childhood diseases, the burden of chronic illness, and over-medicalization. The author proposes separating oversight responsibilities: transferring authority over food, supplements, and OTC products to a new Food and Nutraceutical Agency (FNA), allowing the FDA to be restructured as the Drug and Device Agency (DDA), to refocus on pharmaceuticals and medical devices. While complete reform requires Congressional action, interim policy shifts are urgently needed to improve public health. Broader structural changes—including overhauling the Affordable Care Act, eliminating waste and fraud, redesigning regulatory and insurance systems, and eliminating intermediaries are essential to reducing costs, improving care, and transforming national and global health outcomes. The information provided herein can serve as a White Paper to help reform health agencies and healthcare systems for greater efficiency and lower costs in the USA and globally. Full article

This study investigated the determinants of the Healthcare Quality Index (HQI) in Saudi Arabia over the period from 1990 to 2024. It specifically analyzed the impact of six key variables: Medical Insurance Penetration Rate (MIPR), Gross Domestic Product per Capita (GDP), Unemployment Rate (UR), Inflation Rate (IR), Government Healthcare Expenditure as a Percentage of GDP (GHE), and Foreign Direct Investment in the Healthcare Sector (FDI). Utilizing the Autoregressive Distributed Lag (ARDL) and Vector Error Correction Model (VECM) techniques, this research explored both the short-term dynamics and the long-term equilibrium relationships among these time-series variables, while also accounting for cointegration and potential endogeneity. This study contributes to the existing literature by applying the ARDL and VECM methodologies to comprehensively analyze the combined impact of these factors on HQI within the unique economic and social framework of Saudi Arabia, addressing a notable void in this specific context and exploring both transient fluctuations and sustained equilibrium relationships. The key findings revealed distinct influences across time horizons. In the short term, GDP and GHE significantly and positively affect HQI, whereas UR and IR demonstrate a significant negative impact. Short-term impacts of MIPR and FDI are found to be positive but not statistically significant. The long-term analysis indicates that MIPR, GHE, and FDI have a significant positive influence on HQI, while IR maintains a significant negative impact. GDP and UR effects are not statistically significant in the long term. Further analysis using Granger causality tests and VECM confirmed that MIPR, GDP, GHE, and FDI collectively Granger-cause HQI, with government healthcare expenditure playing a crucial role in correcting short-term deviations toward long-term equilibrium. This study concludes that long-term strategies focusing on expanding insurance coverage, increasing government healthcare investment, and attracting foreign direct investment are vital for significantly enhancing healthcare quality in Saudi Arabia. The sustained positive influence of these factors and the critical role of government spending in maintaining long-term stability underscore their importance for effective healthcare policy. While emphasizing these long-term drivers, policymakers should also remain cognizant of the significant negative short-term fluctuations caused by unemployment and inflation. Full article

Background: Health inequality is seen as a challenge for implementing the Healthy China Strategy. This study analyzes the income-related health inequality among urban–rural resident basic medical insurance (URRBMI) participants. Methods: This study utilized data from the 2019 China Household Finance Survey (CHFS), and the concentration index (CI) was employed to estimate the effects of income-related health inequality on participants. Results: Our findings provide clear evidence that health inequality among participants has fluctuated—narrowing, widening, and then narrowing again—in the areas of the contribution, medical treatment, and reimbursement of URRBMI, respectively. Overall, the analysis indicates a widening of health inequality post-reimbursement, with results remaining consistent. A heterogeneity analysis shows that health inequality is most pronounced among women and those with less than a middle school education. Finally, our study reveals a pro-rich trend in the actual utilization of medical services among participants, with persistent disparities in outpatient and inpatient service usage even after standardization, further exacerbating income-related health inequality. Conclusions: We recommend that the URRBMI design take participants’ income levels into account, with policies favoring disadvantaged individuals to enhance their medical security, improve access to healthcare services, and ultimately reduce health inequality. Full article

Flourishing in children is an indicator of positive development in the areas of emotional, social, and cognitive development. Using a recent dataset from the US National Survey of Children’s Health, this study investigates the association between access to a quality healthcare system and flourishing indicators in school-aged children with autism. The outcome variable describes the proportion of children aged 6–17 with autism meeting the flourishing criteria, which include measures related to learning, resilience, and self-regulation. The main independent variable includes six core indicators for school-aged children and adolescents, which assess whether the family feels like a partner in their child’s care, the child has a medical home, receives regular medical and dental preventive care, has adequate insurance, has no unmet needs or barriers to accessing services, and has prepared for transition to adult healthcare. Multivariable logistic regression models were used to examine the relationships between various independent variables and the outcome of interest. The results show that children with autism who receive comprehensive and coordinated care are more likely to flourish compared to those without such care for five of these six indicators, while controlling for sex, race, parental education, household income, self-reported autism severity, general health status, and the number of adverse childhood experiences. Children with autism are more likely to flourish when their families and healthcare providers work together effectively. Addressing gaps in the quality care system is essential for developing holistic approaches that empower children with autism to thrive and reach their full potential. Supportive health policies and effective coordination between families and healthcare providers are crucial for fostering the flourishing of children with autism, ensuring comprehensive, individualized, and continuous care. Full article

Healthcare disparities in cancer care remain pervasive, driven by intersecting socioeconomic, racial, and insurance-related inequities. These disparities manifest in various forms such as limited access to medical resources, underrepresentation in clinical trials, and worse cancer outcomes for marginalized groups, including low-income individuals, racial minorities, and those with inadequate insurance coverage, who face significant barriers in accessing comprehensive cancer care. This manuscript explores the multifaceted nature of these disparities, examining the roles of socioeconomic status, race, ethnicity, and insurance status in influencing cancer care access and outcomes. Historical and contemporary data highlight that minority racial status correlates with reduced clinical trial participation and increased cancer-related mortality. Barriers such as insurance coverage, health literacy, and language further hinder access to cancer treatments. Addressing these disparities requires a systemic approach that includes regulatory reforms, policy changes, educational initiatives, and innovative trial and treatment designs. This manuscript emphasizes the need for comprehensive interventions targeting biomedicine, socio-demographics, and social characteristics to mitigate these inequities. By understanding the underlying causes and implementing targeted strategies, we can work towards a more equitable healthcare system. This involves improving access to high-quality care, increasing participation in research, and addressing social determinants of health. This manuscript concludes with policy recommendations and future directions to achieve health equity in cancer care, ensuring optimal outcomes for all patients. Full article

Background/Objectives: Breast reconstruction (BR) following mastectomy plays a critical role in post-cancer care by offering both physical and psychological benefits. Despite advancements in techniques and shared decision-making (SDM), BR uptake remains inconsistent. This systematic review aims to synthesize evidence on objective (medical and socioeconomic) and subjective (psychological and personal) factors influencing BR decision-making among women undergoing mastectomy for breast cancer. Methods: A systematic search was conducted across PubMed, ScienceDirect, OVID, and Google Scholar, identifying peer-reviewed studies published between January 2013 and 25 July 2024. Eligible studies examined determinants of BR decisions in women undergoing therapeutic mastectomy, excluding perspectives of non-patient stakeholders and post-decision outcomes. The risk of bias and study quality were assessed using the Quality Appraisal for Diverse Studies (QuADS) tool. This review was registered in PROSPERO (CRD42023456198) and followed PRISMA guidelines. Results: Twenty-seven studies comprising 994,528 participants across 16 countries met the inclusion criteria. The objective factors included age, comorbidities, insurance coverage, physician recommendations, and healthcare access. The subjective factors encompassed body image concerns, self-esteem, fear of recurrence, and emotional readiness. Younger age, private insurance, and active physician counseling were associated with increased BR uptake, while older age, lack of information, and financial or logistical barriers reduced uptake. Regional disparities were noted across healthcare systems. Conclusions: BR decisions are influenced by complex, interrelated clinical, psychological, and systemic factors. Integrating SDM tools, enhancing patient education, and addressing healthcare inequities are essential for supporting informed and equitable BR decision-making. Future research should prioritize longitudinal studies and policy interventions to improve access to and patient satisfaction with BR outcomes. Full article

In Chile, lesbian-parent families have faced legal and social advancements as well as challenges, generating new dynamics through assisted reproduction. The reproductive justice framework allows for an analysis of the inequities and injustices experienced by LGBTIQA+ people in relation to their reproductive rights. Objective: To analyze the narratives of lesbian-parent families who have accessed parenthood through assisted reproduction techniques within the Chilean healthcare system, identifying barriers and facilitators in the process, as well as possible instances of discrimination. Methodology: This research adopted a qualitative approach with a descriptive scope and was based on a constructivist paradigm, utilizing a narrative design and analysis. Four lesbian-parent families participated, selected through purposive or convenience sampling. Results: The findings revealed that the main barriers were related to health insurance coverage and social and geographical factors. Among the key facilitators were support networks, educational level, and healthcare professionals’ guidance. Discussion: The study highlighted the presence of inequalities affecting the exercise of parenthood and the right to form a family, shaped by institutional and social barriers from a reproductive justice framework. Conclusions: The study underscores the need to advance inclusive public policies and systemic changes that recognize and protect family diversity in Chile. Furthermore, it highlights the role of narratives as a tool to make visible and challenge the inequalities surrounding lesbian parenthood. Full article

Public buildings are crucial to creating healthy and sustainable cities. These buildings promote social cohesion and enrich urban life by transforming existing facilities into hybrid models that integrate medical content. Historical developments highlight shifts in residential, economic, and healthcare infrastructure. The healthcare system aims to enhance public health while ensuring financial equity. Reforms in healthcare privatization, governed by public health and insurance policies, involve liberalizing service provision and are supported by the Ministry of Health and Finance. This study examines how public buildings can adapt to enhance health and social sustainability. Through case studies, it assesses architectural adaptability in analyzing spatial, economic, and social impacts. Diagrams illustrate spatial dynamics, while surveys compare efficiency, sustainability, and user experience. Statistical analysis highlights the role of spatial adaptability in fostering sustainable urban environments. The results, which express significant differences between means for different locations and citizens’ satisfaction, suggest that the hypothesis offers substantial results in every area. Besides commercial programs in commercial buildings, healthcare also gives satisfactory results. This study advocates for adaptive architecture as a key strategy, aligning with evolving societal and health demands. Hybridizing healthcare facilities and commercial spaces transforms shopping centers into sustainable models, enhancing social cohesion and economic viability. Full article

Background: Patient satisfaction is a key indicator for improving healthcare delivery, yet the influence of gender preferences on healthcare providers remains underexplored. Cultural norms and gender perceptions often shape the patient preferences, affecting access to care, patient–provider relationships, and overall satisfaction. Thus, this study investigates the patients’ gender preferences and their impact on satisfaction in Tanzania. Methods: The study utilized a cross-sectional design, collecting data from five health centres: Mikongeni, Konga, Mzumbe, Tangeni, and Mlali. A total of 240 randomly selected respondents participated in the study. Gender preferences were categorized as male, female, and both, and determinants were analyzed using a multivariate probit model (MPM), while satisfaction was analyzed using an ordered logit model (OLM). Results: Results reveal that female providers were preferred for empathy (58.30%), intimate care (50.00%), and receptionist roles (50.00%), while males were favored for surgery (50.00%), professionalism (0.86), and IT roles (41.70%). Professionalism (0.75) and communication (0.70) had the strongest positive effects on very high satisfaction. Male provider preference was strongly linked to higher satisfaction (0.84), while female preference showed a mild effect (0.23). Insurance (0.32) and care at Tangeni Health Centre (0.70) boosted satisfaction, while consultation fees (−0.26) reduced it. Conclusions: The study recommends that healthcare systems address gender stereotypes by equipping all providers with both technical and relational care skills, regardless of gender. It also highlights the need for culturally and religiously sensitive care practices that acknowledge how societal norms shape patient preferences and satisfaction. To enhance patient-centered care, policies should promote affordability, broaden insurance coverage, and integrate patient feedback on gender preferences into healthcare delivery models. Full article

Moral hazard in health insurance arises when insured individuals are incentivized to over-utilize healthcare services, especially when they face low out-of-pocket costs. While existing literature primarily addresses moral hazard through qualitative studies, this paper introduces a quantitative approach by developing a mathematical model based on quasi-arbitrage conditions. The model optimizes health insurance design, focusing on the transition from Low-Deductible Health Plans (LDHPs) to High-Deductible Health Plans (HDHPs), and seeks to mitigate moral hazard by aligning the interests of both insurers and insured. Our analysis demonstrates how setting appropriate deductible levels and offering targeted premium reductions can encourage insured to adopt HDHPs while maintaining insurer profitability. The findings contribute to the theoretical framework of moral hazard mitigation in health insurance and offer actionable insights for policy design. Full article

In this study, we provide the first estimates of the effect of COVID-19 (COVID-19 legal restrictions) on catastrophic medical expenditure and forgone medical care in Africa. Data for this study were drawn from the 2018/19 Nigeria General Household Survey (NGHS) panel and the 2020/21 Nigeria COVID-19 National Longitudinal Phone Survey panel (COVID-19 NLPS). The 2020/21 COVID-19 panel survey sample was drawn from the 2018/19 NGHS panel sample monitoring the same households. Hence, we leveraged a rich set of pre-COVID-19 and COVID-19 panel household surveys that can be merged to track the effect of the pandemic on welfare outcomes. We found that the COVID-19 legal restrictions decreased catastrophic medical expenditure (measured by out-of-pocket (OOP) expenditures exceeding 10% of total household expenditure). However, the COVID-19 legal restrictions increased the incidences of forgone medical care. The results showed a consistent positive effect on forgone medical care across waves one and two, corresponding to full and partial implementation of COVID-19 legal restrictions, respectively. However, the negative effect on catastrophic medical spending was only observed when the COVID-19 legal restrictions were fully in force, but the sign reversed when the restriction enforcement became partial. Moreover, our panel regression analyses revealed that having health insurance is associated with a reduced probability of incurring CHE and forgoing medical care relative to having no health insurance. We suggest that better policy design in terms of expanding the depth and coverage of health insurance will broaden access to quality healthcare services during and beyond the pandemic periods. Full article