Search Results (180)

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

Against the backdrop of evolving global climate patterns, the frequency and intensity of extreme weather events have increased significantly, posing unprecedented threats to agricultural production. This change has particularly profound impacts on agricultural systems in developing countries, making the enhancement of farmers’ capacity to withstand extreme weather events a crucial component for achieving sustainable agricultural development. As an essential safeguard for agricultural production, agricultural insurance plays an indispensable role in risk management. However, a pronounced gap persists between policy aspirations and actual adoption rates among farmers in developing economies. This study employs the integrated theory of planned behavior (TPB) and protection motivation theory (PMT) to construct an analytical framework incorporating psychological, socio-cultural, and risk-perception factors. Using Jiangsu Province—a representative high-risk agricultural region in China—as a case study, we administered 608 structured questionnaires to farmers. Structural equation modeling was applied to identify determinants influencing insurance adoption decisions. The findings reveal that farmers’ agricultural insurance purchase decisions are influenced by multiple factors. At the individual level, risk perception promotes purchase intention by activating protection motivation, while cost–benefit assessment enables farmers to make rational evaluations. At the social level, subjective norms can significantly enhance farmers’ purchase intention. Further analysis indicates that perceived severity indirectly enhances purchase intention by positively influencing attitude, while response costs negatively affect purchase intention by weakening perceived behavior control. Although challenges such as cognitive gaps and product mismatch exist in the intention-behavior transition, institutional trust can effectively mitigate these issues. It not only strengthens the positive impact of psychological factors on purchase intention, but also significantly facilitates the transformation of purchase intention into actual behavior. To promote targeted policy interventions for agricultural insurance, we propose corresponding policy recommendations from the perspective of public intervention based on the research findings. 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

Amid the global drive to enhance public sector performance in the digital economy era, improving government spending efficiency has become a critical governance objective. This study investigates the impact of digital inclusive finance on government spending efficiency from a digital finance systems perspective using county-level panel data in China’s Yangtze River Delta for the period 2014–2022 and constructing the fixed-effects model and instrumental variable method to estimate the effect of digital inclusive finance and explore its underlying mechanisms. Heterogeneity across regions with varying economic development levels is analyzed, and fiscal pressure is examined as a potential mediating factor. The results indicate that (1) digital inclusive finance significantly enhances government spending efficiency, primarily through broad service coverage and deep usage of digital financial services such as mobile payments, digital credit, and insurance; (2) the positive effect is more pronounced in counties with lower government spending efficiency and economic development; and (3) fiscal pressure acts as a key transmission channel, with broader digital inclusive finance coverage helping to alleviate fiscal stress and improve government spending efficiency. These findings offer empirical insights into the role of digital finance in promoting effective and adaptive public financial governance. Full article

Objectives: This study investigates the presence of crowding-in or crowding-out effects of long-term care insurance (LTCI) on older adults’ care in Korea. Additionally, it examines the influence of old-age income security and private systems, including private transfer income and private health insurance, on these effects. The analysis focuses on three aspects: family-provided care, private non-family care, and total care expenses. Methods: This study conducted logistic and linear regression. Logistic regression was used to examine the likelihood of receiving family-provided and private non-family care, while linear regression analyzed factors associated with total care expenditures. Results: The results reveal a crowding-in effect for family care, as greater utilization of public LTCI is positively associated with family-provided care. However, the relationship between public LTCI and private non-family care was not statistically significant, suggesting that the crowding-in effect on private care systems remains limited. Lastly, LTCI utilization was significantly associated with higher care expenditures. It is noteworthy that the current public LTCI in Korea has low coverage, resulting in insufficient care provision. Consequently, there is growing activity in the private care sector. Conclusions: These findings highlight the need for a more integrated approach to long-term care in Korea, balancing public, private, and family care resources. To achieve quality integrated long-term care for older people, policymakers should focus on expanding public LTCI coverage while fostering coordination between family caregivers and professional care services, ensuring a comprehensive and high-quality care system that meets the diverse needs of Korea’s aging population. Full article

Background/Objectives: High-flux online hemodiafiltration (OL-HDF) appears to be associated with better survival than hemodialysis (HD). In Brazil, OL-HDF is only affordable for patients with private health insurance. Although observational studies have shown a survival advantage with OL-HDF, even in Brazil, it is unclear whether this benefit applies to patients without private health insurance. We compared overall and cardiovascular mortality between OL-HDF and HD in patients treated exclusively through the public health care system. We hypothesized that patients on OL-HDF would have a higher survival rate than those on HD. Methods: This is an observational cohort study. Adult patients on maintenance hemodialysis or OL-HDF for at least one month during the period between 1 September 2022 and 1 December 2024 were enrolled into the study. The primary outcome was all-cause mortality. The secondary outcome was cardiovascular mortality. Fine-Gray sub-distribution hazard models were used to evaluate survival in the presence of competing events (kidney transplant and recovery of renal function). Results: Patients on HD (N = 321) and OL-HDF (N = 48) were similar in age, race, sex, and vascular access. Patients on HD were more likely to have diabetes (54.0% vs. 29.2%, p = 0.001) and spent more hours per week on dialysis (11.2 ± 1.8 vs. 10.5 ± 1.6 h, p = 0.006). In an adjusted Fine-Gray model, the hazard of death for patients on OL-HDF was 68% lower than that for patients on HD, and the risk of death for patients with an arteriovenous fistula was 55% lower compared to those with a catheter. Cardiovascular mortality did not differ between the groups. Conclusions: These findings suggest that OL-HDF is associated with an overall higher survival rate compared to HD, even for patients without private health insurance. 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/Objective: Systemic investigation into treatment for early-stage glottic cancer (EGC) has demonstrated similar functional and oncologic outcomes between transoral laser microsurgery (TLM) and external beam radiotherapy (XRT). In this study, we aim to identify longitudinal trends in treatment decisions and patient demographics. Methods: This is a retrospective longitudinal study on all cases of T1-2N0M0 glottic carcinoma queried from the NCDB between 2004 and 2017. The ratio of TLM to XRT (TLM/XRT) performed per year was calculated and further stratified by insurance status, education, income, and treatment facility location. Univariable and multivariable linear regressions were used to assess the trend of TLM/XRT over time and evaluate the effect of demographic characteristics on the TLM/XRT ratio. Results: A total of 38,428 EGC patients were analyzed: 2169 (5.6%) received TLM; 36,259 (94.4%) underwent XRT. The overall ratio of TLM/XRT increased over time from 0.04 in 2004 to 0.08 in 2017. Significant increases were observed in the higher-income quartiles (Q4: p < 0.001, Q3: p = 0.02, Q2 < 0.001) and among patients with private (p < 0.02) or public (p = 0.003) insurance. TLM/XRT rose significantly over time in the highest (Q4), third (Q3), and lowest (Q1) education quartiles but not in the second (Q2). Regionally, increases were observed in the Northeast (p < 0.001) and West (p = 0.008), with no significant change in the South or Midwest. By T stage, only T1 tumors showed a significant increase in TLM/XRT over time (p < 0.001). Conclusions: While the majority of patients receive XRT as the initial treatment for EGC, the proportion of TLM has been slowly increasing over time. Patient insurance status, education, income, facility geography, and T stage are correlated with increasing use of TLM. Full article

(1) Background: This study aims to identify the sociodemographic, behavioural, and systemic predictors of colorectal cancer (CRC) screening among primary healthcare attendees in Riyadh, Saudi Arabia, to inform targeted interventions and policy strategies. (2) Methods: This cross-sectional study was conducted between March and July 2023 across 48 randomly selected primary healthcare centers in Riyadh, Saudi Arabia. The target population for this study was adults aged 18 and above attending primary healthcare centers in Riyadh. Multi-stage random sampling was used to recruit participants. Multivariate logistic regression was performed to identify independent predictors of CRC screening. (3) Results: CRC screening uptake was found to be only 4.2%. Age was a significant predictor, with individuals aged 50–75 years (adjusted odds ratio [AOR]: 1.90, 95% confidence interval [CI]: 1.50–2.42) and those aged 75 years or older (AOR: 1.37, 95% CI: 1.01–1.87) being more likely to undergo screening compared to younger individuals. Insurance coverage strongly influenced screening behaviour (AOR: 1.64, 95% CI: 1.37–1.96). Smokers were nearly four times more likely to participate in screening than non-smokers (AOR: 3.87, 95% CI: 3.21–4.69), and physical activity was positively associated with screening (AOR: 1.43, 95% CI: 1.11–1.82). (4) Conclusions: CRC screening uptake in Riyadh is critically low, highlighting the need for targeted public health interventions. Key predictors such as age, insurance coverage, smoking, and physical activity underscore the importance of addressing sociodemographic disparities and promoting health awareness. The findings emphasize the need for culturally tailored educational campaigns, improved healthcare access, and enhanced screening programs to increase uptake. Full article

Background: The rapid rise of e-commerce has intensified last-mile logistics challenges, fueling the need for sustainable, efficient solutions. Parcel locker crowdshipping systems, integrated with public transport networks, show promise in reducing congestion, emissions, and delivery costs. However, operational and physical constraints (e.g., crowded stations) and liability complexities remain significant barriers to broad adoption. This study investigates the demographic and operational factors that influence the adoption and scalability of these systems. Methods: A mixed-methods design was employed, incorporating survey data from 368 participants alongside insights from 20 semi-structured interviews. Quantitative analysis identified demographic trends and operational preferences, while thematic analysis offered in-depth contextual understanding. Results: Younger adults (18–34), particularly gig-experienced males, emerged as the most engaged demographic. Females and older individuals showed meaningful potential if safety and flexibility concerns were addressed. System efficiency depended on locating parcel lockers within 1 km of major origins and destinations, focusing on moderate parcel weights (3–5 kg), and offering incentives for minor route deviations. Interviews emphasized ensuring that lockers avoid station congestion, clearly defining insurance/liability protocols, and allowing task refusals during peak passenger hours. Conclusions: By leveraging public transport infrastructure, parcel locker crowdshipping requires robust policy frameworks, strategic station-space allocation, and transparent incentives to enhance feasibility. Full article

In recent years, global climate and environmental issues have become prominent, making green housing a major focus. However, during the development of green housing, there is a tendency to prioritize design while neglecting the operation. Meanwhile, house owners’ green rights and interests during the operation stage are not well protected. In response, some countries have promoted green housing insurance. However, this type of insurance remains immature because of insufficient public awareness, a lack of supporting policies, and limited practical application. These challenges result in low acceptance among house owners, hindering the development of green insurance and green housing sector. To address this issue, this study applies the push–pull theory to establish a driver system for house owners’ acceptance of green housing, considering internal push and external pull drivers. Structural equation modeling (SEM) is then used to analyze the mechanisms that drive house owners’ acceptance. The key findings are as follows: (1) drivers in the pull dimension have a stronger impact on acceptance than drivers in the push dimension; and (2) premium subsidies and economic compensation play a crucial role in driving house owners to accept green housing insurance. This study identifies the key drivers and pathways that influence the acceptance of green housing insurance, providing valuable insights for increasing public recognition and acceptance. The findings can contribute to the development of the green housing industry. Full article

Background/Objectives: Primary healthcare (PHC) plays a central role in the promotion of universal healthcare coverage within the Brazilian health system. Nevertheless, inequalities across municipalities represent substantial barriers to achieving equity in access to health, particularly due to disparities in the quality of healthcare delivered to patients. Thus, the study aimed to investigate factors associated with perception of PHC quality among adult individuals using private and public facilities within the Brazilian health system. Methods: The empirical approach was based on quantitative analysis of cross-sectional data from five nationally representative surveys conducted by the Brazilian Institute for Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE) in 1998, 2003, 2008, 2013, and 2019. Pairwise comparisons and marginal analyses allowed for the assessment of differences in patients’ perception of healthcare quality according to source of funding and type of healthcare quality. A logistic regression model was estimated to identify factors associated with the perception of good quality of care. Model discrimination, calibration, and goodness-of-fit were assessed to ensure the robustness of analyses. Results: The results indicate that patients’ satisfaction was positively associated with level of implementation of the national program based on payment for performance in public healthcare facilities, PMAQ-AB (OR = 3.376; p < 0.001), self-assessment of good health status (OR = 3.209; p < 0.001), and healthcare financed through health insurance (OR = 2.344; p < 0.001). Contrarily, receiving healthcare in a public facility (OR = 0.358; p < 0.001) was negatively associated with the evaluation of good quality. Conclusions: The findings showed that patients’ perception of quality of care presents significant associations with patients’ health characteristics, healthcare funding source, and implementation of the PMAQ-AB. Furthermore, patients generally perceived lower healthcare quality in public facilities. The study indicates the need for evidence-based decision-making in public policies of health, particularly regarding further advances in payment for performance programs designed to foster improvements in quality of care within public PHC facilities in Brazil. Full article

The ongoing debate over whether polycentric urban structures reduce commuting times has yielded conflicting conclusions, highlighting the need for empirical findings in diverse urban contexts and analyses that consider a range of influencing factors. This study analyzed the effects of employment center characteristics on commuting times, using the Seoul Metropolitan Area (SMA) as a case study. A cutoff method identified employment centers within the SMA. Differences in commuting behavior, including average commuting time and mode share, were observed among workers at different employment centers. A multilevel regression model estimated the effect of employment center characteristics, such as industry composition and nearby housing prices, on workers’ commuting time. Key findings include a positive relationship between public transportation (PT) density and commuting time, suggesting that well-designed PT systems may encourage longer commutes. Manufacturing and finance, insurance, and real estate (FIRE) industries negatively impacted commuting times, with manufacturing being associated with the geographic location of centers and FIRE industries being associated with high-income workers, which likely contributed to shorter commutes. On the other hand, the positive relationship between housing prices and commuting times highlights the need for affordable housing near employment centers to reduce commuting times. These findings underscore the complex interactions between each employment center’s characteristics and workers’ socioeconomic factors in shaping commuting behavior. Full article