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11. Hospital Global Budgeting: Lessons from Maryland and Selected Nations

Author:
Bob Atlas
Publication Date:
06-2024
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Issue: Maryland has utilized hospital global budgeting for a decade, but the approach is rarely used elsewhere in this country. The Centers for Medicare and Medicaid Services now hopes to test global budgeting in more states to help scale up this form of cost containment. Goals: Examine the ways Maryland, Canada, the Netherlands, New Zealand, and Norway employ hospital global budgeting and the lessons they offer to those hoping to see wider adoption in the United States. Methods: Analysis of the various health systems and expert interviews. Key Findings and Conclusion: Maryland and the four selected countries vary significantly in their approaches to hospital global budgeting. With its previous experience using price controls and current global budgeting approach, Maryland has succeeded in holding hospital spending growth steady for nearly a decade. While Norway combines fixed and variable payments to support global budgeting, the Netherlands and Canada’s province of Ontario are moving away from global budgeting in favor of other approaches. Meanwhile, New Zealand has added multiyear rolling forecasts and budgets to support its own model. Future approaches in the U.S. could prove more effective by factoring in the complexities, conflicting incentives, and potential unintended consequences of global budgeting.
Topic:
Public Health, Healthcare System, and Budgeting
Political Geography:
Canada, Maryland, Netherlands, New Zealand, and United States of America

12. Health for everyone, everywhere?

Author:
Lionel Osse Essima and Matthias Krönke
Publication Date:
04-2024
Content Type:
Policy Brief
Institution:
Afrobarometer
Abstract:
The theme of World Health Day 2024 (7 April) is “My health, my right” (World Health Organization, 2024). A key component of the message is to encourage governments to deliver on citizens’ right to health by making health services “available, accessible, acceptable and of good quality for everyone, everywhere.” How close are African governments to meeting this ambitious goal? Since 1990, the burden of disease has decreased substantially in Africa (Roser, Ritchie, & Spooner, 2024; also see Figure A.1 in the Appendix). Between 2000 and 2019, Africa recorded the world’s greatest growth in healthy life expectancy, which rose from 46 to 56 years (Adepoju & Fletcher, 2022). Further, between 2015 and 2021, the under-5 mortality rate fell from 87 to 74 deaths per 1,000 live births across sub-Saharan Africa (United Nations, 2023). According to the World Health Organization, these gains were achieved through increased provision of essential health services and better access to care and disease prevention services (Adepoju & Fletcher, 2022). Despite these important advances, however, many Africans still do not have access to high quality health care. Compared to other world regions, the gap is particularly acute when it comes to communicable, neonatal, maternal, and nutritional diseases (as opposed to non communicable diseases and injuries) (see Figure A.2 in the Appendix). While sub-Saharan Africa saw the world’s fastest growth between 2015 and 2022 in the proportion of births attended by skilled health personnel, from 59% to 70%, the continent also recorded about 70% of the world’s maternal deaths (United Nations, 2023). At least part of the explanation is a lack of health workers; as of 2021, sub-Saharan Africa had an average of 2.3 medical doctors and 12.6 nursing/midwifery personnel per 10,000 people, compared to 39.4 and 89.5 in Europe (United Nations, 2023).
Topic:
Education, Public Opinion, Social Services, Public Health, and Healthcare System
Political Geography:
Africa

13. India’s Medical Devices Sector: A Window of Opportunity for South Korea

Author:
Ram Singh
Publication Date:
07-2023
Content Type:
Policy Brief
Institution:
Korea Institute for International Economic Policy (KIEP)
Abstract:
The medical devices sector in India has been rapidly growing and evolving, driven by factors such as increasing healthcare expenditure, rising awareness of advanced medical technologies, government initiatives, and a growing population with a rising demand for healthcare services. The Indian medical devices market was valued at approximately $12 billion in 2021 and is expected to reach $50 billion by 2025, indicating significant growth potential. The sector covers a wide range of products, such as diagnostic imaging equipment, surgical instruments, patient monitoring devices, implants, consumables, and healthcare IT solutions. The market is primarily driven by imports, with domestic manufacturing accounting for a smaller share (Dang and Sharma 2019). However, the government has been promoting domestic manufacturing with an aim to reduce import dependency, the Medical Devices Policy-2023 of India should be seen in the same context.
Topic:
Markets, Trade, Industry, Healthcare System, and Medical Devices
Political Geography:
South Asia, India, Asia, and South Korea

14. Betting on Legality: Latin American and Caribbean Responses to the Venezuelan Displacement Crisis

Author:
Luciana Gandini and Andrew Selee
Publication Date:
05-2023
Content Type:
Special Report
Institution:
Migration Policy Institute (MPI)
Abstract:
More than half, and as many as two-thirds, of the estimated 6.4 million displaced Venezuelans who have settled in Latin America and the Caribbean since 2016 have been granted legal status in their host country. Most of the receiving countries in the region have responded with pragmatic measures that offer some form of legal status as well as the right to access the labor market, basic education, and emergency health care. The measures implemented are uneven and often not fully institutionalized, but they have been surprisingly generalized for a region with limited experience with large-scale immigration. This report explores the response to Venezuelan displacement in the 15 principal host countries in Latin America and the Caribbean between 2016 and 2022. It examines the reach of different mechanisms for providing legal status and humanitarian protection—asylum systems, mobility and residence agreements, regular visas, and regularization campaigns that offer temporary status—and offers estimates of the share of Venezuelans in each country who have obtained legal status. The report also considers the trend of governments coupling measures to provide legal status with new visa requirements that have made it increasingly difficult for more Venezuelans to arrive, pushing some into irregular migration channels. Finally, the report looks at variations in Venezuelans’ access to education and health care across the 15 countries.
Topic:
Education, Governance, Border Control, Employment, Displacement, Immigration Policy, Healthcare System, and Refugee Policy
Political Geography:
Latin America, Caribbean, and Venezuela

15. The Contribution of Private Health Insurance to the Financing of Healthcare in Cameroon

Author:
Jean Bruni Essono Oyono
Publication Date:
03-2023
Content Type:
Working Paper
Institution:
The Nkafu Policy Institute
Abstract:
By definition, health insurance is part of personal insurance. The purpose of health insurance is to protect the insured against the risks associated with illness, or more precisely, against all events leading to medical intervention. Elsewhere, in the event that a medical intervention is necessary, the health expenditure linked to this intervention is shared between the patient and the social protection system. However, social security does not have the economic capacity to support and reimburse each individual for all the costs related to their personal consumption of medical care. It covers only a percentage of the medical expenses incurred. Health insurance has therefore been set up to allow people to take out a contract that will reimburse them for the share of treatment costs not covered by social security. It is therefore intended, as its name suggests, to insure people against the economic consequences of a state of health that requires treatment.
Topic:
Public Policy, Health Insurance, and Healthcare System
Political Geography:
Africa and Cameroon

16. Overcoming Barriers to Improve Antimicrobial Access, Innovation, and Stewardship in India

Author:
Parshuram Hotkar, Deepak Jena, Mohammed Abdul Rahman, Snigdha Das Sweety Shreyashi, and Javier Guzman
Publication Date:
07-2023
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
India is racing against the clock in its fight against antimicrobial resistance. A combination of complex regulatory and procurement systems, a lack of health insurance penetration, and little groundwork on state and national action plans has stymied progress. A multi-fold approach is needed to improve access to, and innovation of next-generation antimicrobials and enhance stewardship practices. Improving access to the World Health Organization’s list of Watch and Reserve categories of antimicrobials through existing and new procurement channels, strengthening stewardship and diagnostic facilities in hospitals, and developing an environment conducive to antimicrobial research and development is key to achieving these goals.
Topic:
World Health Organization, Innovation, Public Health, Global Health, Healthcare System, and Antimicrobial Resistance
Political Geography:
South Asia and India

17. Violence against women: A public health crisis

Author:
Victoria Pedjasaar
Publication Date:
11-2023
Content Type:
Working Paper
Institution:
European Policy Centre (EPC)
Abstract:
In the EU, a third of women over the age of 15 have experienced physical or sexual violence and over half have been sexually harassed. Although often overlooked, the majority of (workplace) violence takes place in the healthcare sector as healthcare professionals are 16 times more at risk of violence in comparison to other occupations. Violence does not only manifest in abusive behaviour toward workers on duty but can also be perpetrated on women as receivers of healthcare. High rates of violence in healthcare, brought on and exacerbated by gender stereotypes and inequality, point to dysfunctional health systems. This Discussion Paper provides policy recommendations on the way forward for the EU member states, taking a closer look at: Gender-based violence against healthcare workers. Obstetric and gynaecological violence against women. Gender-based violence as a story of gender inequality. Legislation and policies that protect women.
Topic:
European Union, Gender Based Violence, Sexual Violence, Healthcare System, and Violence Against Women (VAW)
Political Geography:
Europe

18. A Study on Humanitarian Aid to North Korea

Author:
Juhyun Um
Publication Date:
07-2022
Content Type:
Commentary and Analysis
Institution:
East Asia Institute (EAI)
Abstract:
In this Commentary, Juhyun Um, Secretary General at Medical Aid for Children, provides an overview of international and South Korean aid initiatives in North Korea and examines North Korea’s current perspective on humanitarian assistance. The author analyzes that Pyongyang’s official refusal of humanitarian assistance in 2014 is a multidimensional issue that encompasses the health and welfare of North Koreans, the regime’s commitment to remain self-reliant, and the new Cold War order. Dr. Um proposes that in pursuing peace on the Korean peninsula, Seoul should strive to find ways that mutually respect the interests of both Koreas rather than push for a unilateral humanitarian assistance policy.
Topic:
Humanitarian Aid, United Nations, Malnutrition, and Healthcare System
Political Geography:
Asia and North Korea

19. Experimental Field Evidence of Common Pool Resources: The Water Judge in Bolivia

Author:
Gabriela Agafitei
Publication Date:
05-2022
Content Type:
Working Paper
Institution:
Institute for Advanced Development Studies (INESAD)
Abstract:
In 2019, the Bolivian government began implementation of the Universal Health Insurance (SUS) scheme, with critics claiming the unpreparedness of the healthcare system to provide universal and free services. To date, there is no research that assesses the effects of the reform and to what extent it is providing universal, free services. The objective of this study is to fill this research gap by providing a diagnosis on access to public healthcare services after the SUS’s adoption. In this study, access is operationalized according to a theoretical framework developed by the World Health Organization (2010). The study has been conducted according to a combined method that compares data from before and after the SUS approval. First, data from the National Household Survey has been analyzed to provide an overview of dimensions related to access at the macro level. Secondly, the macro perspective is integrated with data collected through semi-structured interviews that provide a detailed analysis of the qualitative dimensions of accessing healthcare at the micro level, which are often not reflected by quantitative indicators. The results showed that on the one hand access to public healthcare services has increased in the first year of the SUS’s implementation compared to previous years. However, despite the supply of additional human resources and physical infrastructure, the sufficiency in availability of human resources remains questionable, as the values disaggregated per 1,000 inhabitants remained roughly the same. Similarly, spending at the macroeconomic level did not reach recommended levels for universal coverage. Data from the case study deepens the understanding of the findings at the macro level. In fact, access appears as characterized by considerable challenges, such as long waiting times, lack of medicines and of beds, and low-quality services that overall restrain access to the public services. The study has concluded that despite the fact that access has increased, insufficiency of resources and the structural characteristics of the Bolivian healthcare system represent severe limitations for the universal outreach of SUS.
Topic:
Services, Insurance, Healthcare System, and Universal Healthcare
Political Geography:
South America and Bolivia

20. The War Economy of the Fragmented Healthcare System in Syria

Author:
Omar Dewachi, Duncan McLean, and Aula Abbara
Publication Date:
02-2022
Content Type:
Video
Institution:
Center for Security, Race and Rights (CSRR), Rutgers University School of Law
Abstract:
This devastating conflict that has had a profound impact in Syria, the region and beyond, caused immense suffering. At least 400,000 Syrians have lost their lives. More than 6 million refugees, out of a pre-war population of 22 million, have fled the country and 6.7 million are internally displaced. Over 13 million people continue to need assistance, and yet Syria seems to have dropped off the radar. In this panel discussion, hosted by the Centre for Security, Race and Rights (CSRR) at Rutgers University, experts with in-depth knowledge of Syria and the region will examine some of the challenges humanitarian organisations faced as consequence of the war in Syria. Panellists will examine the relationship between health-care provision on the one hand, and the state’s claim to sovereignty and legitimacy on the other, and how the humanitarian response became quickly entangled into the polarized sides of the Syria war. They will look at how the protracted conflict in Syria has fragmented the country’s health system. They will also describe how, in the absence of a meaningful foreign policy, aid delivery came to fuel Syria’s war economy raising troubling questions as to the limits humanitarian organizations are prepared to accept when operating in a broader system of corruption, predation and denial of access. Guest speakers all contributed separate chapters to the book on Syria edited by MSF “Everybody’s war: politics of aid in the Syria crisis”
Topic:
Sovereignty, Economy, Syrian War, Humanitarian Organizations, and Healthcare System
Political Geography:
Middle East and Syria