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Purpose – To assess the claim of moral hazard proponents that individuals insulated from paying for the health care they use tend to demand more, often unnecessary, services, or engage in unhealthier behaviors than they otherwise would, collectively driving up demand and increasing health care spending (HCS).

Methodology/Approach – To test the hypothesis that moral hazard increases rather than decreases HCS, I apply a multivariate analysis to examine data from 21 OECD countries over a 20-year period, using out-of-pocket spending (OPS) as a proxy for moral hazard and as the key variable predicting HCS, controlling for other potential drivers of spending.

Findings – OPS is independently associated with HCS, yet in the direction opposite to what moral hazard theory predicts – about $13 higher HCS per additional $10 OPS (p = 0.000).

Research limitations – As with other cross-national studies, limitations include (1) inability to assess differences in health care delivery and quality within and across countries; (2) differences in the measurement and availability of variables across countries; (3) lack of access to data of potential significance, and (4) hard to evaluate cross-national political and cultural differences with implications for health policy.

Policy implications – At least in the United States, unless a fully publicly financed system to cover medically necessary services is implemented, the policy goals of extending adequate health insurance to a national population and controlling HCS nationally will not be met.

Originality/Value of Paper – Most research on moral hazard in US health care has drawn from comparisons within rather than among national health systems. Therefore, the originality and value of this cross-national study lies in its ability to identify variables that could not be included in single nation studies and which have the ability to inform policy and political action.

Purpose – The purpose of this article is to investigate one core research question: How can health information technology (HIT) be assessed in a national health care system context?

Design/methodology – We examine this question by taking a systematic approach within a national care system, in which the purpose of HIT is to contribute to a common national health care system's goal: to promote population health in an efficient way. Based on this approach we first develop a framework and our criteria of assessment, and then using Taiwan as a case study, demonstrate how one can apply this framework to assess a national system's HIT. The five criteria we developed are how well does the HIT (1) provide accessible and accurate public health and health care information to the population; (2) collect and provide population health and health care data for government and researchers to analyze population health and processes and outcomes of health care services; (3) provide accessible and timely information that helps to improve provision of cost-effective health care at an institutional level and promotes system-wide efficiency; (4) minimize transaction and administrative costs of the health care system; and (5) establish channels for population participation in governance while also protecting individual privacy.

Findings – The results indicate that Taiwan has high levels of achievement in two criteria while falling short in the other three. Major lessons we learned from this study are that HIT exists to serve a health care system, and the national health care system context dictates how one assesses its HIT.

Originality/value – There is a large body of literature published on the implementation of HIT and its impact on the quality and cost of health care delivery. The vast majority of the literature, however, is focused on a micro institutional level such as a hospital or a bit higher up, on an HMO or health insurance firm. Few have gone further to evaluate the implementation of HIT and its impact on a national health care system. The lack of such research motivated this study. The major contributions of this study are (i) to develop a framework that follows systems thinking principles and (ii) propose a process through which a nation can identify its objectives for HIT and systematically assess its national HIT system. Using Taiwan's national health care system as a case study, this paper demonstrated how it can be done.

Tertiary hospitals have registered an incremental rise in expenditure mostly because of the increasing demands by ageing populations. Reducing the length of stay (LOS) of patients within tertiary hospitals is one of the strategies, which has been used in the last decades to ensure health care systems’ sustainability. Furthermore, LOS is one of the key performance indicators, which is widely used to assess hospital efficiency. Hence, it is crucial that policy makers use evidence-based practices in health care to aim for optimal LOS. The purpose of this paper is to identify and summarize empirical research that brings together studies on the various variables that directly or indirectly impact on LOS within tertiary hospitals so as to develop a LOS causal systems model.

This scoping review was guided by the following research question: “What is affecting the LOS of patients within tertiary-level health care?” and by the guidelines specified by Arksey and O’Malley (2005), and by Armstrong et al. (2011). Relevant current literature was retrieved by searching various electronic databases. The PRISMA model provided the process guidelines to identify and select eligible studies.

An extensive literature search yielded a total of 30,350 references of which 46 were included in the final analysis. These articles yielded variables, which directly/indirectly are linked to LOS. These were then organized according to the Donabedian model – structure, processes and outcomes. The resultant LOS causal model reflects its complexity and confirms the consideration by scholars in the field that hospitals are complex adaptive systems, and that hospital managers must respond to LOS challenges holistically.

This paper illustrates a complex LOS causal model that emerged from the scoping review and may be of value for future research. It also highlighted the complexity of the construct under study.

This study aims to shed some light on the subject matter of the exploration of public medical coverage and elderly done as such far across the world. To achieve this objective, a comprehensive bibliometric examination was used to investigate papers published between the years 1960 and 2020. An aggregate of 366 papers was selected and analysed for the same. The investigation endeavours to recognise the journals with outstanding performance in this field, distribution of papers concerning the year of their publication, most referred to papers. Then various maps depicting bibliometric networks are provided, namely, the joint-authorship network map, inter-country joint-authorship network map and keyword co-occurrence network map.

To achieve the objective of this study, the Scopus database was used for comprehending the vast magnitude of information about numerous papers included in this paper. VOSviewer has been used to create a joint-authorship network map, inter-country joint-authorship network map and keywords concurrences network map.

The result of this investigation demonstrates that the highest number of publications came out in the year 2019, the most notable journal is Journal of Aging and Social Policy, and the most referred to research paper is about long-term care insurance (LTCI) in Japan. The USA is the most productive nation with the most elevated number of papers published under its name. Tamiya N. has teamed up with the highest number of authors, which is 29. Again the USA is the nation that participated with the highest number of authors of different countries in the research paper.

This paper accord with the current writing on public health insurance and elderly. A much far-reaching and solid image of this sector is given using the bibliometric analysis technique. The authors keen on directing future exploration on this topic can take guidance from the results of this study.

This paper aims to examine the issue of quality of care in the US managed care system and to compare state‐level policies and programs. Specifically, it aims to describe five states which are making the most quality of care improvements.

This study examines the literature to identify states' care quality rankings. Additionally, five state case studies are presented to illustrate various programs approach to quality.

The paper finds that some states are better than others in their strategies to enhance quality of care. California, Florida, Maryland, Minnesota and Rhode Island are considered among the best. Thus, their programs are described.

From a research perspective the study brings a renewed focus on various methods in which states invest to improve residents' quality of care.

From a practical standpoint, since quality of care is an important topic and interesting to all stakeholders in health care – policymakers, consumers, providers, and payers – readers can use the study's results to compare states' strategies and develop new ways to increase quality.

This study's value lies in the way it helps states to compare their performance over time and against other states as they make improvements to enhance quality.

Governance of e-government is rarely discussed in the initial digitization stage, especially in developing countries where the government’s focus is mainly to pursue rapid proliferation of digital adoption rather than to implement governance. This study aims to explore the consequences of this absence of governance at local level conditions.

An in-depth exploratory case study is conducted at a municipal health government in a southern city in Kalimantan Island, Indonesia, examining the conditions of local actors in response to various nationwide health digitization imperatives. The postcolonial theory with the critical paradigm is used to interpret and conceptualize the empirical findings.

This study identifies two critical failures of digitization governance that represent the mainstream condition: horizontal sectoral ego and vertical asymmetry and misalignment. These failures have resulted in undesirable consequences at the subalterns indicated by diverse ambivalence and de-voiced constructs displayed by the local actors.

This paper suggests that various issues that emerge from local level implementation in nationwide digitization agenda might not always be issues of local technology adoption, but rather negative impacts due to the absence of governance practice at the strategic level.

Through a critical perspective, this study unearths the underlying power and structural inequity responsible for generating the various issues and undesirable consequences that emerge at local levels related to the nationwide digitization agenda.

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the equity of the whole financing system.

Lorenz dominance analysis and Kakwani progressivity index were applied on data from 2010/2011 Household Income, Expenditure, and Consumption Survey and the National Health Accounts 2011 using Stata to evaluate the progressivity of each source of health-care finance and the financing system overall.

The data show that Egypt’s health-care system, which is largely financed by out-of-pocket (OOP) payments, is slightly regressive, with an overall Kakwani index of −0.079. The overall regressive effect was the result of three regressive sources (OOP payments, an earmarked cigarette tax and direct taxes), one proportional finance source (social health insurance) and two slightly progressive sources (indirect taxes and private health insurance). This shows that the burden of financing health care falls more on the poor. These results signal the need for reform of health-care financing in Egypt to reduce dependence on OOP payments to achieve more equitable financing.

The paper seeks to augment the literature on health-care financing in Egypt by calculating specific progressivity estimates for all five sources of financing the Egyptian health-care system and analyzing the overall equity of this financing system. It will, therefore, provide a benchmark for monitoring the equity of finance in the Egyptian health-care system in future studies and allow one to assess the impact of implemented financing reforms in the future on the level of progressivity of health system financing.

The brain drain challenge has become a cankerworm confronting not only the public health-care sector in Nigeria but almost all sectors of the national economy. This study aims to explore the push factors responsible for brain drain incidence among the migrated, JAPA, physicians to other global work environments. The study investigates the mediating role of capacity development among migrated, JAPA, physicians between the health-care infrastructural deficit and brain drain syndrome.

This study used a survey cross-sectional research design to examine the 214 migrated physicians in four notable perceived countries (UK, USA, Canada and Australia). The study used a probability sampling strategy to survey a self-administered online research instrument. The study adapted a battery of scales from several authors to measure the relevant constructs of this study. Hierarchical multiple regression was used to examine factors that provoke the incidence of brain drain burden among the JAPA Physicians. While Macro Hayes Process was used to investigate the mediating role of capacity development among migrated physicians.

The study revealed from the “JAPA” physicians that working conditions are turbulent and utterly poor which led to the incidence of brain drain. The study indicated that poor remuneration and benefits are the predominant reason for JAPA physicians to European countries and USA/UK. The findings of the study demonstrated that restricted opportunities and poor standard of living in the country were additional factors responsible for the brain drain of Nigerian physicians to other international countries. The outcome of the study also illustrated that inadequate infrastructure and facilities are the dominant variables that pushed physicians to foreign nations. It was revealed that there is a toxic mix of several issues that led to a brain drain albatross among the migrated physicians from Nigeria. The last part of the study indicated that physicians’ capacity development was a game changer that would discourage brain drain incidence and establish motivation for working in Nigeria's public health-care sector.

The study has given a direction for providing succinct solutions to the cankerworm of brain drain that has depleted the Nigerian public health-care industry. It has proffered a possible trajectory that will reverse the JAPA syndrome among the professional health-care workforce. This will not only benefit the public health-care personnel but also be significant for all the human capital across all the sectors of the national economy of Nigeria.

This study aims to gain an understanding of how caring for an ageing population affects caregivers’ psychological well-being, quality of life and ability to tolerate distress. This study provides valuable insights into the challenges faced by family caregivers and underscores the critical need for comprehensive support systems.

A correlational method and cross-sectional research design was used for the study. For this, a sample of 200 caregivers in the age range of 25–60 years who were taking care of the geriatric population above the age of 70 years for a minimum of one year were chosen. Four questionnaires − Burden Scale for Family Caregivers, Psychological Well-Being Scale, World Health Organization’s Quality of Life Scale-BRIEF version and Distress Tolerance Scale were chosen. Correlation and multivariate regression were calculated using statistical package for social sciences (SPSS) 21 and Jamovi 3.4.1.

This study found that there is a negative correlation of caregiver burden with psychological well-being, quality of life and distress tolerance. The sub-domains of self-acceptance, psychological health and tolerance levels were most impacted for the caregivers. Through multivariate regression, it was found that the caregiver burden significantly predicted psychological well-being and quality of life.

This study focuses on the English-speaking caregivers which may overlook the diverse linguistic and cultural variations within the broader caregiver community in India and the data collection exclusively targeted family caregivers providing support to geriatric population without chronic illnesses. This restriction could potentially limit the generalizability of the findings to the broader caregiving context.

The implications of this research are that for caregivers, this study underscores the importance of tailored support programmes that address the negative impact of caregiver burden on psychological well-being and quality of life. Health-care professionals can use the findings to incorporate mental health assessments and interventions within caregiving contexts, recognizing the interconnected nature of these variables. Policymakers can use the findings to inform policies related to caregiver support and health-care resource allocation.

In India, the social norm is that children are expected to take care of their parents when they become old. Taking care of elderly parents can be challenging, even emotionally. As a result, this study will focus on how caregivers’ psychological well-being, quality of life and ability to tolerate distress are affected. Consequently, promoting the creation of community support groups and workplace mental health programmes which could give caregivers a forum to voice their concerns.

Objective – Measurement of the incidence of health financing contributions across socio-economic groups has proven valuable in informing health care financing reforms. However, there is little evidence as to how to carry out financing incidence analysis (FIA) in lower income settings. We outline some of the challenges faced when carrying out a FIA in Ghana, Tanzania and South Africa and illustrate how innovative techniques were used to overcome data weaknesses in these settings.

Methodology – FIA was carried out for tax, insurance and out-of-pocket (OOP) payments. The primary data sources were Living Standards Measurement Surveys (LSMS) and household surveys conducted in each of the countries; tax authorities and insurance funds also provided information. Consumption expenditure and a composite index of socio-economic status (SES) were used to assess financing equity. Where possible conventional methods of FIA were applied. Numerous challenges were documented and solution strategies devised.

Results – LSMS are likely to underestimate financial contributions to health care by individuals. For tax incidence analysis, reported income tax payments from secondary sources were severely under-reported. Income tax payers and shareholders could not be reliably identified. The use of income or consumption expenditure to estimate income tax contributions was found to be a more reliable method of estimating income tax incidence. Assumptions regarding corporate tax incidence had a huge effect on the progressivity of corporate tax and on overall tax progressivity. LSMS consumption categories did not always coincide with tax categories for goods subject to excise tax (e.g. wine and spirits were combined, despite differing tax rates). Tobacco companies, alcohol distributors and advertising agencies were used to provide more detailed information on consumption patterns for goods subject to excise tax by income category. There was little guidance on how to allocate fuel levies associated with ‘public transport’ use. Hence, calculations of fuel tax on public transport were based on individual expenditure on public transport, the average cost per kilometre and average rates of fuel consumption for each form of transport. For insurance contributions, employees will not report on employer contributions unless specifically requested to and are frequently unsure of their contributions. Therefore, we collected information on total health insurance contributions from individual schemes and regulatory authorities. OOP payments are likely to be under-reported due to long recall periods; linking OOP expenditure and illness incidence questions – omitting preventive care; and focusing on the last service used when people may have used multiple services during an illness episode. To derive more robust estimates of financing incidence, we collected additional primary data on OOP expenditures together with insurance enrolment rates and associated payments. To link primary data to the LSMS, a composite index of SES was used in Ghana and Tanzania and non-durable expenditure was used in South Africa.

Policy implications – We show how data constraints can be overcome for FIA in lower income countries and provide recommendations for future studies.