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1 – 10 of over 1000Rauf Kord, Enayatollah Homaie Rad and Ali Davoudi Kiakalayeh
This study aims to calculate the inequity in out of pocket expenditures and utilization of laboratory tests in Iran. Equal access to health services is an important part of human…
Abstract
Purpose
This study aims to calculate the inequity in out of pocket expenditures and utilization of laboratory tests in Iran. Equal access to health services is an important part of human rights in health care. Out-of-pocket payment is a part of financial access to health care. In this study, the authors tried to find inequity in out-of-pocket payments and utilization of medical laboratory tests (MLTs) as a part of human rights in Iran in 2016.
Design/methodology/approach
Gini and concentration indices were calculated for this purpose, and regression models were estimated to show the relationship between different factors and utilization and out-of-pocket.
Findings
The average out-of-pocket payment for all of the households was US$1.56 (urban areas: 1.97 and rural areas: 1.31). Moreover, the average utilization of MLTs was 0.079 (urban areas: 0.0908 and rural areas: 0.0753). Gini and concentration indices for out-of-pocket payments were 0.522 and 0.0701, respectively.
Originality/value
Out-of-pocket and utilization were low in lower in less developed regions of ease and southeast regions of the country and were related to access to health insurance, income and wealth deciles.
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Akshay R. Rao, Amna Kirmani and Haipeng Chen
Purpose – Although some literature exists on how consumers may interpret firm-generated signals about the unobservable quality of their product, there has been little effort to…
Abstract
Purpose – Although some literature exists on how consumers may interpret firm-generated signals about the unobservable quality of their product, there has been little effort to examine whether and how managers deploy signals about unobservable quality to compete.Design/methodology/approach – In this chapter, we address this issue by examining whether managers consciously use signals to compete with other firms, and how they choose between the vast number of signals available to them. We develop a formal model that allows us to generate a set of predictions drawn from information economics and behavioral decision theory. The predictions specify a pattern of managerial behavior according to which signals belonging to some categories are relatively attractive (for economic as well as psychological reasons).Findings – We report on the results of a series of three experiments in which executives are given the opportunity to deploy signals to communicate unobservable quality to skeptical consumers in a competitive market.Value/originality – The results of the studies provide compelling evidence in support of the formal argument.
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The paper demonstrates prejudicial effects of the rising private participation and the lacuna of state in ensuring the accessibility and affordability of healthcare.
Abstract
Purpose
The paper demonstrates prejudicial effects of the rising private participation and the lacuna of state in ensuring the accessibility and affordability of healthcare.
Design/methodology/approach
Secondary data analysis from national and international databases is employed to demonstrate the low government spending and the alternate healthcare financing mechanisms in the country. The company reports of six Indian pharma companies are examined to map the profits and revenues, and also taking into account the sales growth and return on investment.
Findings
The paper observes the pharmaceutical sector, via its spiralling drug prices, is the primary contributor to the huge out-of-pocket expenses borne by households. The study findings indicate that there is an increased divergence between the out-of-pocket expenses of households and exorbitant profits of the private drug companies in the country over the years.
Research limitations/implications
Amidst debates on the importance of public health in the aftermath of the pandemic, the paper examines the rising hands of private sector in healthcare, and implores – who benefits? The authors study the implications via looking into the rise in the wealth of pharma giants; at the time of crisis when the lives of common citizens in the country were at stake.
Originality/value
The paper emphasises the repercussions of the higher markup of the pharma industry in raising the healthcare costs of households. The authors emphasise that the nonregulation of the pharma sector leads to high medical debts/poverty, in the wake of growing out-of-pocket expenditures of the citizens.
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The purpose of this paper is to quantify the impact of socio‐economic characteristics on out‐of pocket expenditures for prescribed medications in Tajikistan and provide…
Abstract
Purpose
The purpose of this paper is to quantify the impact of socio‐economic characteristics on out‐of pocket expenditures for prescribed medications in Tajikistan and provide recommendations for healthcare sector reform. The research question in this paper is: what household, personal, economic, and health factors help explain expenditures on medications? From a theoretical perspective, this paper contributes to the on‐going discussion of out‐of‐pocket expenditures in Tajikistan. From a practical perspective, in line with this recent development in the Tajikistan healthcare sector, it helps to develop evidence‐based decision‐making by answering practical questions: what factors affect pattern of out‐of‐pocket expenditures for prescribed medication? Which groups of the population should be granted a discount or fee‐waiver when buying them?
Design/methodology/approach
Based on micro‐file data from the most recent cross‐sectional nationally‐representative survey of Tajik households, this paper develops and tests a multivariate model of identifying determinants of out‐of‐pocket expenditures on prescribed medications in Tajikistan.
Findings
The paper finds that economic status, chronic illness, disability, number of small children, short supply of necessary drugs, and cardiac and acute illnesses are the strongest determinants of spending for prescribed medications in the country.
Originality/value
This paper demonstrates that to ensure accessibility to and affordability of prescribed medications, discounts or fee‐waivers should be granted to specific categories of households, those in poverty, with chronically ill members and with small children. These discounts or fee‐waivers should cover prescribed medications for children, long‐standing illness as well as for cardiac and acute infectious diseases. Administrative and economic measures should be taken to reduce the extra costs incurred due to the shortage of prescribed medications. Hence, these findings can be used in developing and designing reforms in the Tajikistan healthcare sector.
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Rasoul Tabari-Khomeiran, Sajad Delavari, Satar Rezaei, Enayatollah Homaie Rad and Mostafa Shahmoradi
In May 2014, a new reform in the health sector of Iran was implemented called “health evolution plan.” In the first phase of this reform, the government reduced out-of-pocket…
Abstract
Purpose
In May 2014, a new reform in the health sector of Iran was implemented called “health evolution plan.” In the first phase of this reform, the government reduced out-of-pocket payments for service delivery by paying subsidies to the services and after that a revision was done to the medical services values book to improve equity and increase motivation of health professions. One of the affected services in this reform was coronary artery bypass surgery. The purpose of this paper is to show the effects of HEP on costs of coronary artery bypass surgery.
Design/methodology/approach
A before-after study was done for this purpose and 167 patients’ total costs and out-of-pocket payments were calculated for the years 2013 (before) and 2014 (after) the reform in three private hospitals of Rasht city, Iran. Econometrics models were estimated after adjustment of confounding variables.
Findings
The results of this study showed that surgery costs increased significantly from $1,643.3 to 2,119.5. Nursing and other costs increased significantly from $290.3 to 414.2 and anesthetize costs increased from $619.2 to 947.01. The results of regression model showed that total costs increased $3,008.6 after adjustment of confounders (p-value=0.037). However, no significant changes were found for out-of-pocket payments and out-of-pocket percentage.
Originality/value
The study findings revealed that HTP was not successful enough in financial protection in the private sector.
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Ali Kazemi Karyani, Enayatollah Homaie Rad, Abolghasem Pourreza and Faramarz Shaahmadi
Health can be influenced by many factors. One of the factors is the political context of the country and democracy. The purpose of this paper is to examine the effects of freedom…
Abstract
Purpose
Health can be influenced by many factors. One of the factors is the political context of the country and democracy. The purpose of this paper is to examine the effects of freedom in press and polity index in overall, public, private and out of pocket health expenditures.
Design/methodology/approach
A long-term panel data approach has been used to examine the relationship between democracy and health expenditures. The authors inserted polity and freedom into press indexes in the health expenditure model.
Findings
Increase in freedom of the press and democracy will increase the overall, public and private health expenditures while they decrease out of pocket health expenditures.
Originality/value
Polity and freedom index has a significant impact on all the health expenditure models.
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Based upon estimates of the change in consumption due to a change in out-of-pocket-health expenses (dC/dOOPHE) for 43 countries, this paper aims to argue for a reevaluation of…
Abstract
Purpose
Based upon estimates of the change in consumption due to a change in out-of-pocket-health expenses (dC/dOOPHE) for 43 countries, this paper aims to argue for a reevaluation of what constitutes OOPHE when determining health insurance especially in the wake of Covid-19.
Design/methodology/approach
Reiterative truncated projected least squares (RTPLS), a statistical technique designed to handle the omitted variables problem of regression analysis.
Findings
If budgets are binding than dC/dOOPHE should be 0; if OOPHE merely adds to current consumption than dC/dOOPHE should be 1. However, merely plotting consumption versus OOPHE for the 43 countries for which organization for economic cooperation and development has the required data clearly shows a dC/dOOPHE much greater than one. This paper’s estimates of dC/dOOPHE for 2000 to 2017 range from 15.6 for Switzerland (in 2016) to 225.2 for Columbia (in 2003).
Research limitations/implications
RTPLS cannot determine what part of the results are due to an increase in income causing both consumption and OOPHE to increase and what part is because of actual OOPHE far exceeding official OOPHE. However, the latter is involved.
Practical implications
As Covid-19 sickens millions while depriving millions of their normal means of generating income, what constitutes OOPHE should be expanded when determining health insurance. This paper’s results imply that even prior to Covid-19 health insurance covered much less than the optimal amount of actual OOPHE.
Originality/value
This is the first paper to use RTPLS to estimate dC/dOOPHE.
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This paper presents three models of funding health care in 130 developing countries, based upon a public system, a private system and personal remittances.
Abstract
Purpose
This paper presents three models of funding health care in 130 developing countries, based upon a public system, a private system and personal remittances.
Design/methodology/approach
The authors trace the funding of health from foreign aid to health funding and health outcomes in the public system, foreign direct investment to health funding in the private system, and personal remittances to health outcomes. This is followed by panel data, fixed effects models subjected to 2-, 3- and 4-stage least squares regressions.
Findings
Findings from the first model were that aid in the form of Technical Cooperation Grants funded Infrastructure. Infrastructure Spending due to aid funds Government Health Plans, which reduced the Incidence of Tuberculosis, which in turn reduced Undernourishment and increases Life Expectancy. Other positive health outcomes included reduced Birth Rate and reduced Maternal Mortality. In the second model, Foreign Direct Investment increased Female Employment and GDP per Person, funding Private Health Plans, which increase Life Expectancy, reduced Undernourishment, increased Skilled Care at Birth, increased the Number of Hospital Beds, reduced Maternal Mortality and increased the Birth Rate. In the third model, Remittances influenced both Out-of-Pocket Medical Expenses and Private Plans.
Social implications
Publicly funded programs may be directed to nutrition, increasing life expectancy. Private funding may be directed to improving maternal conditions, with remittances removing the liquidity constraints.
Originality/value
This paper is the first attempt to trace health funding from its sources of foreign aid, foreign direct investment and personal remittances using three separate paths.
Kristina Rosengren, Petra Brannefors and Eric Carlstrom
This study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge…
Abstract
Purpose
This study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge, Bismarck, out of pocket).
Design/methodology/approach
A literature review inspired by the SPICE model, using both scientific studies (CINHAL, Medline, Scopus) and grey literature (Google), was conducted. A total of 1,194 documents from CINHAL (n = 139), Medline (n = 245), Scopus (n = 493) and Google (n = 317) were analysed for content and scope of person-centred care in each country. Countries were grouped based on healthcare systems.
Findings
Results from descriptive statistics (percentage, range) revealed that person-centred care was most common in the United Kingdom (n = 481, 40.3%), Sweden (n = 231, 19.3%), the Netherlands (n = 80, 6.7%), Northern Ireland (n = 79, 6.6%) and Norway (n = 61, 5.1%) compared with Poland (0.6%), Hungary (0.5%), Greece (0.4%), Latvia (0.4%) and Serbia (0%). Based on healthcare systems, seven out of ten countries with the Beveridge model used person-centred care backed by scientific literature (n = 999), as opposed to the Bismarck model, which was mostly supported by grey literature (n = 190).
Practical implications
Adoption of the concept of person-centred care into discourse requires a systematic approach at the national (politicians), regional (guidelines) and local (specific healthcare settings) levels visualised by decision-making to establish a well-integrated phenomenon in Europe.
Social implications
Evidence-based knowledge as well as national regulations regarding person-centred care are important tools to motivate the adoption of person-centred care in clinical practice. This could be expressed by decision-making at the macro (law, mission) level, which guides the meso (policies) and micro (routines) levels to adopt the scope and content of person-centred care in clinical practice. However, healthcare systems (Beveridge, Bismarck and out-of-pocket) have different structures and missions owing to ethical approaches. The quality of healthcare supported by evidence-based knowledge enables the establishment of a well-integrated phenomenon in European healthcare.
Originality/value
Our findings clarify those countries using the Beveridge healthcare model rank higher on accepting/adopting the concept of person-centered care in discourse. To adopt the concept of person-centred care in discourse requires a systematic approach at all levels in the organisation—from the national (politicians) and regional (guideline) to the local (specific healthcare settings) levels of healthcare.
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