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The substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.

A systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.

Chronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.

The present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.

Given the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.

Out-of-pocket (OOP) payments continue to be a major method of financing healthcare in many low- and middle-income countries including Malaysia. Although macro-level data show that this is a substantial percentage of national health expenditure, at the grassroots level, the amount spent on health by households remains unknown in Malaysia. The purpose of this paper is to assess the validity and reliability of an adapted-for-purpose questionnaire designed to capture urban household health expenditures (HHEs) among Malaysian households.

This two-part study assessed content validity of the questionnaire using three experts and the reliability of the questionnaire through a test-retest study among 50 OOP-paying patients followed up at one private primary care clinic in Kuala Lumpur. This study was approved by the Malaysian Research Ethics Committee (NMRR-16-172-29311-IIR).

The validity of the 83-item questionnaire was high, with an item content validity index of 1.00 and a scale content validity index average score of 1.0 agreed to among the evaluating experts. In the test-retest reliability study, the majority of the categorical questionnaire items had perfect agreement values (k=0.81-1.00). Continuous questionnaire items were also found to be highly reliable with no significant differences between the test-retest segments and high correlation coefficient values (intra-class correlation coefficient>0.7).

The HHE questionnaire had excellent content validity and very high test-retest reliability. The results of this study suggest that this questionnaire could be used in Malaysian studies to determine actual urban HHE which is a first step toward developing universal health coverage for all.

To develop a framework for estimating the economic benefits of an accessible and inclusive society and implement it for the Canadian context. The framework measures the gap between the current situation in terms of accessibility and inclusiveness, and a counterfactual scenario of a fully accessible and inclusive society.

The method consists of three steps. First, the conceptual framework was developed based on a literature review and expert knowledge. Second, the magnitudes for each domain of the framework was estimated for the reference year 2017 using data from various sources. Third, several sensitivity analyses were run using different assumptions and scenarios.

It was estimated that moving to a fully accessible and inclusive society would create a value of $337.7bn (with a range of $252.8–$422.7bn) for Canadian society in the reference year of 2017. This is a sizeable proportion of gross domestic product (17.6%, with a range of 13.1–22.0%) and is likely a conservative estimate of the potential benefits.

Understanding the magnitude of the economic benefits of an accessible and inclusive society can be extremely useful for governments, disability advocates and industry leaders as it provides invaluable information on the benefits of efforts, such as legislation, policies, programs and practices, to improve accessibility and inclusion of persons with disabilities. Furthermore, the total economic benefits and the benefits per person with a disability can serve as inputs in economic evaluations and impact assessments.

The paper aims to analyze the coverage of health insurance and its correlates in the north-eastern region of India.

The study accessed the raw data of the National Family Health Survey (NFHS-4) (2015–16), which was an extensive, multiround survey conducted in a representative sample of households throughout India, which included socioeconomic, demographic and information on coverage of health insurance of any member of the household. The multivariate analysis of logistic regression was adopted to find the correlates of health insurance for all the eight (8) north-eastern states of India.

The results observed that among the north-eastern states, the coverage of health insurance was highest in Arunachal Pradesh (59%) followed by Tripura (58%), Mizoram (47%) surpassing the all India level of 27%, whereas the lowest was in Manipur (4%) followed by Nagaland (6%) and Assam (10%). The multivariate analysis of logistic regression found that the socioeconomic and demographic factors, households with a bank account and below poverty line (BPL) cardholders played a significant role in the coverage of health insurance in the north-eastern states of India.

The study focuses only on the coverage and correlates of health insurance. Further evaluation studies on each scheme of the social health insurance are needed for proper assessment of the health insurance schemes in the region.

There has been evidence around the world (South Korea, Taiwan and Thailand) that health insurance could be a protective shield from the entrapment into poverty due to high health expenditure. The NFHS-4 put up the finding that in the north-eastern part of India, the coverage of health insurance had been low. This implied that the region could fall into poverty due to high medical expenses on health. Taking account of multiple health insurance providers, risk pooling and consolidation of health insurance providers have become the need of the hour.

The study is different from other studies of health insurance since it covered all the eight (8) north-eastern states of India, which are ethnically, culturally and historically distinct from the rest of India in general and within the region and states in particular and examines the impact of each of the independent variables with the dependent variables. The study has shown that the variation in health insurance coverage associated with socioeconomic and other household-level demographic attributes (although not very strong).

Chronic kidney disease (CKD) is a worldwide public health problem which imposes a significant financial burden not only on patients but also on the healthcare systems, especially under the pressure of the rapid growth of the elderly population in China. The purpose of this paper is to examine the hospitalization costs of patients with CKD between two urban health insurance schemes and investigate the factors that were associated with their inpatient costs in Guangzhou, China.

This was a prevalence-based, observational study using data derived from two insurance claims databases during the period from January 2010 to December 2012 in the largest city, Guangzhou in Southern China. The authors identified 5,803 hospitalizations under two urban health insurance schemes. An extension of generalized linear model – the extended estimating equations approach – was performed to identify the main drivers of total inpatient costs.

Among 5,803 inpatients with CKD, the mean age was 60.6. The average length of stay (LOS) was 14.4 days. The average hospitalization costs per inpatient were CNY15,517.7. The mean inpatient costs for patients with Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY15,582.0) were higher than those under Urban Resident-based Basic Medical Insurance (URBMI) scheme (CNY14,917.0). However, the percentage of out-of-pocket expenses for the UEBMI patients (19.8 percent) was only half of that for the URBMI patients (44.5 percent). Insurance type, age, comorbidities, dialysis therapies, severity of disease, LOS and hospital levels were significantly associated with hospitalization costs.

The costs of hospitalization for CKD were high and differed by types of insurance schemes. This was the first study to compare the differences in hospitalization costs of patients with CKD under two different urban insurance schemes in China. The findings of this study could provide economic evidence for understanding the burden of CKD and evaluating different treatment of CKD (dialysis therapy) in China. Such useful information could also be used by policy makers in health insurance program evaluation and health resources allocation.

This paper aims to evaluate the technical efficiency of the health-care systems in 21 selected middle-income countries during the period (2000–2017) and determine the source of inefficiency whether it is transient (short run) or persistent (long run).

The study uses the stochastic frontier analysis technique through employing the generalized true random effects model which overcomes the drawbacks of the previously introduced stochastic frontier models and allows for the separation between unobserved heterogeneity, persistent inefficiency and transient inefficiency.

Persistent efficiency is lower than the transient efficiency; hence, there are more efficiency gains that can be made by the selected countries by adopting long-term policies that aim at reforming the structure of the health-care system in the less efficient countries such as South Africa and Russia. The most efficient countries are Vietnam, Mexico and China which adopted a social health insurance that covers almost the whole population with the aim of increasing access to health-care services. Also, decentralization in health-care has assisted in adopting health-care policies that are suitable for both the rural and urban areas based on their specific conditions and health-care needs. A key success in the implementation of the adopted long-term policies by those countries is the continuous monitoring and evaluation of their outcomes and comparing them with the predefined targets and conducting any necessary modifications to ensure their movement in the right path to achieve their goals.

Although several studies have evaluated the technical efficiency both across and within countries using non-parametric (data envelopment analysis) and parametric (stochastic frontier analysis) approaches, to the best of the authors’ knowledge, this is the first attempt to evaluate the technical efficiency of selected middle-income countries during the period (2000–2017) using the generalized true random effects stochastic frontier analysis model.

There is more to primary care than solely medical and nursing services. Models of Child Health Appraised (MOCHA) explored the role of the professions of pharmacy, dental health and social care as examples of affiliate contributors to primary care in providing health advice and treatment to children and young people. Pharmacies are much used, but their value as a resource for children seems to be insufficiently recognised in most European Union (EU) and European Economic Area (EEA) countries. Advice from a pharmacist is invaluable, particularly because many medicines for children are only available off-label, or not available in the correct dose, access to a pharmacist for simple queries around certain health issues is often easier and quicker than access to a primary care physician or nursing service. Preventive dentistry is available throughout the EU and EEA, but there are few targeted incentives to ensure all children receive the service, and accessibility to dental treatment is variable, particularly for disabled children or those with specific health needs. Social care services are an essential part of health care for many extremely vulnerable children, for example those with complex care needs. Mapping social care services and the interaction with health services is challenging due to their fragmented provision and the variability of access across the EU and EEA. A lack of coherent structure of the health and social care interface requires parents or other family members to navigate complex systems with little assistance. The needs of pharmacy, dentistry and social care are varied and interwoven with needs from each other and from the healthcare system. Yet, because this inter-connectivity is not sufficiently recognised in the EU and EEA countries, there is a need for improvement of coordination and with the need for these services to focus more fully on children and young people.