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Objective – The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health financing in poor countries. In particular, we analyze the introduction of social health insurance (SHI) in Kyrgyzstan and Moldova. To some extent, the intent of SHI introduction in these countries was similar to that in LMIs elsewhere: increase prepaid revenues for health and incorporate the entire population into the new system. But the approach taken to universality was different. In particular, the SHI fund in each country was used as the key instrument in a comprehensive reform of the health financing system, with the new revenues from payroll taxation used in an explicitly complementary manner to general budget revenues. From a functional perspective, the reforms in these countries involved not only the introduction of a new source of funds, but also the centralization of pooling, a shift from input- to output-based provider payment methods, specification of a benefit package, and greater autonomy for public sector health care providers. Hence, their reforms were not simply the introduction of an SHI scheme, but rather the use of an SHI fund as an instrument to transform the entire system of health financing.

Methodology/approach – The study uses administrative and household data to demonstrate the impact of the reforms on regional inequality and household financial burden.

Findings – The approach used in these two countries led to improved equity in the geographic distribution of government health spending, improved financial protection, and reduced informal payments.

Implications for policy – The comprehensive approach taken to reform in these two countries, and particularly the redirection of general budget revenues to the new SHI funds, explain much of the success that was achieved. This experience offers potentially useful lessons for LMIs elsewhere in the world, and for shifting the global debate away from what we see as a false dichotomy between SHI and general revenue-funded systems. By demonstrating that sources are not systems, these cases illustrate how, in particular by careful design of pooling and coverage arrangements, the introduction of SHI in an LMI context can avoid the fragmentation problem often associated with this reform instrument.

In December 1989, the Government of Kenya implemented cost sharing reforms in a substantial portion of public health facilities. In September 1990 the Government suspended registration fees for out‐patient treatments, but reintroduced them in April 1992 after a lapse of a 20‐month period. Assesses the effects of these policy changes on demand for out‐patient services using a small data set from a rural district in central Kenya. Finds that, although medical services are inelastic with respect to user charges, cost sharing led to a significant reduction in out‐patient attendance: demand for out‐patient care declined by about 40 per cent. Consistent with this finding, suspension of registration fees in 1990 is associated with a 30 per cent increase in attendance. This increase occurred despite the retention of fees for diagnostic services. By March 1991, seven months after the suspension of fees, service demand had recovered remarkably and was only about 20 per cent below its original level. Further, finds that patients are more sensitive to fees for diagnostic services than they are to registration fees.

Healthcare service is a process that comprises a series of touchpoints underlying the key facets of service delivery, collectively shaping the users' (i.e. patients, hospital staff, and visitors) experiences. Departing from most sensory studies dedicated to understanding the retail environment and hedonic service, this study focuses on how sensory knowledge can contribute to understanding the sensory-based experiences of hospital users and their interactions with healthcare services at multiple touchpoints.

This study employs a multi-method approach comprising two studies involving semi-structured interviews and a qualitative online survey of past patients.

Drawing upon the user-centered theory, the authors (1) consulted healthcare experts on hospital service touchpoints and standards around medical protocol; (2) explored users' needs, experiences, expectations, and evaluations of healthcare services; and (3) identified the issues and challenges faced by healthcare service users at various service touchpoints. Based on these insights, the authors proposed sensory tactics across healthcare service touchpoints that promote the well-being of major hospital users.

The proposed sensory tactics require follow-up empirical evidence. Future research could adopt robust methodological designs on healthcare environmental interventions and progress with a transdisciplinary approach to advance this research area.

The authors' experience-based framework forms the basis of a valuable toolkit for healthcare service management.

This study advances services literature by integrating sense-based marketing knowledge with healthcare service research to understand the dynamic and interactive relationship between hospital users and the environment.

The purpose of this study is to evaluate the association between economic activity in a country, as measured by the gross domestic product (GDP) and the control of the COVID-19 pandemic outcomes, as measured by the rate of incidence and mortality increase per 100,000 population in different countries using up-to-date data, in the light of public health security capacities including prevention, detection, respond, enabling function, operational readiness, as measured by the 2019 State Party self-assessment annual reporting (SPAR) submissions of 100 countries.

For this analytical study, multiple linear regression analyses were performed for each variable with the COVID-19 incidence and mortality rates, while controlling for Human Development Index (HDI) and GDP.

Countries with higher income levels were significantly more likely to have a higher incidence and mortality rate per 100,000 population. Among the public health capacity categories, prevention of the infectious disease and detection of the pathogens were significantly associated with lower incidence and mortality of the COVID-19 pandemic. The country-level income was found to be an important negative predictor of COVID-19 control.

These findings present to decision-makers in organizing mitigation strategies to struggle emerging infectious pandemics and highlight the role of country-level income while trying to control COVID-19. In order to determine the priority settings for the fight against pandemic, national policy-makers and international organizations should notice that countries in a high-income group had better health security capacities than that of other income groups, particularly in low- and lower-middle-income groups. The results of the capabilities of health security by the income group can assist health policy makers and other international agencies in resource allocation decisions and in mitigating risk with more informed resource planning.

The income level of countries may have a positive effect on public health strategies to mitigate the risk of infection of COVID-19. This study may assist the local public authorities to gain a better level of understanding on the relationship country-level income and COVID-19 outcomes in order to take appropriate measures at the local level. The results also highlighted the importance role of public health security capacities for the pandemic control policy.

Although previous studies have examined to assess the public health capability by country-level and to describe cases and deaths by continent and by country, very limited studies have evaluated the rate of incidence and mortality of COVID-19 by country-level income and by health expenditure using the data on the health security capacities with analytical and practical approaches.