Suchergebnisse

The Declaration of Alma Ata (1978) stipulated "Primary Health Care" (PHC) as the fundamental paradigm of health care systems world-wide. PHC is primarily based on community based health care (CBHC) with a high degree of participation of all stakeholders. This concept was seen as fundamental for national health systems and for the improvement of common utility. However, its implementation was hampered by a number of factors, in particular self-interests of dominant stakeholders, poor perception of the health care crisis and the costs of implementing PHC. However, the new millennium makes clear that PHC is an innovation with a potential to to achieve the Sustainable Development Goals.

Background: Microfinance is a generally accepted tool for improving the economic situation of the poor in developing countries. However, it has hardly been used to finance medical devices required by the disabled, although the incapability of these groups to buy wheelchairs and other equipment is a major source of poverty. Aim: This paper analyzes the need for microfinance as a tool for financing wheelchairs for patients suffering from a walking disability and oxygen concentrators for patients with chronic lung diseases. It is not in the scope of this study to present a comprehensive concept of implementing a microfinance instrument, but the paper intends to demonstrate that the disabled in Syria perceive a great need for such a financing tool. In addition, this paper wants to encourage microfinance institutions to go beyond their traditional field of business and start lending to the disabled so that they can buy the equipment necessary to live a productive life of higher quality. Methodology: Two groups of disabled patients in Syria were asked about their social and economic situation as well as their access to financing tools. The first sample consisted of patients suffering from a walking disability with major constraints concerning their mobility and who are in need of a wheelchair (N = 100). The second sample consisted of patients with chronic lung diseases (N = 90) and with a need of additional oxygen. All participants lived below the national poverty line. Results: Eighty-two percent of the interviewees suffering from a walking disability and 78% of the interviewees with chronic lung diseases were not health-insured. Although there was some knowledge of microfinance among the interviewees, they reported having limited or no access to such programs. Seventy-two percent of the patients with a walking disability and 68% of the patients with chronic lung diseases knew what microfinance is, but the portion of borrowers was 24% of the examined patients with a walking disability and 22% of the patients with chronic lung diseases. Ninety percent of the patients with a walking disability and 73% of the patients with a chronic lung disease are convinced that they could generate income if they could only buy a wheelchair or an oxygen concentrator. The majority, i.e., 89% of the patients with a walking disability and 95% of the patients with a chronic lung disease, believed that microfinance would be an ideal tool for them to finance these devices and that they or their family could pay back the installments. Conclusion: Microfinance has not been used as a tool for financing medical devices in Syria. However, this study shows that the disabled of this country perceive a great need for this innovative system. The majority of the disabled believe that they could gain some income and pay back the loan if they had the necessary equipment. This is a basic prerequisite for further steps to start microfinance for this group of potential clients. However, a start-up would need some support, e.g., by the government of Syria. It is likely that the financing of medical devices by microfinance can also be used for other groups of patients and needy persons in Syria as well as in comparable countries, but this statement calls for further research.

Background: Effective health care provision benefits from the support of measurement techniques. Contrary to the situation in industrialised countries efficiency analyses in the health care sector in Africa are a very recent phenomenon. Hardly any of the existing studies was conducted at the level of primary care. Aim: The purpose of this study was twofold: (1) to evaluate the relative efficiency of health centres in rural Burkina Faso and (2) to investigate reasons for inefficient performance. Methods: Data Envelopment Analysis (DEA) was applied. To account for the situation in that country, the output-oriented approach was used in connection with different returns to scale assumptions. To identify the spatial effect of the catchment area on efficiency the Tobit model was applied. Results: According to constant returns to scale, 14 health centres were relatively efficient. The DEA projections suggest that the inefficient units were too big to be efficient. Tobit regression showed that the relatively efficient health centres are located close to villages in their catchment area. Conclusions: For ethical reasons it is not appropriate to try to improve the efficiency of health centres by closing some of them. Their efficiency can be improved and lives can be saved if access to health centres is enhanced.

The aim of our research was to collect comprehensive data about the public and physician awareness, acceptance and use of Personalized Medicine (PM), as well as their opinions on PM reimbursement and genetic privacy protection in the U.S. and Germany. In order to give a better overview, we compared our survey results with the results from other studies and discussed Personalized Medicine preconditions for its wide implementation into the medical standard. For the data collection, using the same methodology, we performed several surveys in Pennsylvania (U.S.) and Bavaria (Germany). Physicians were contacted via letter, while public representatives in person. Survey results, analyzed by means of descriptive and non-parametric statistic methods, have shown that awareness, acceptance, use and opinions on PM aspects in Pennsylvania and Bavaria were not significantly different. In both states there were strong concerns about genetic privacy protection and no support of one genetic database. The costs for Personalized Medicine were expected to be covered by health insurances and governmental funds. Summarizing, we came to the conclusion that for PM wide implementation there will be need to adjust the healthcare reimbursement system, as well as adopt new laws which protect against genetic misuse and simultaneously enable voluntary data provision.

Abstract Background The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Methods Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. Results The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. Conclusions The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead, productivity will rise in particular in under-utilized private health care institutions. The results of this study also show that private-for-profit health care facilities are not only the luxurious providers catering exclusively for the rich but also play an important role in the service provision for the poorer population. The study findings also demonstrated a high degree of cost variability across private providers, suggesting differences in quality and efficiencies.

In 2009, the Democratic Republic of Congo (DRC) started its journey towards achieving Universal Health Coverage (UHC). This study examines the evolution of financial risk protection and health outcomes indicators in the context of the commitment of DRC to UHC. To measure the effects of such a commitment on financial risk protection and health outcomes indicators, we analyse whether changes have occurred over the last two decades and, if applicable, when these changes happened. Using five variables as indicators for the measurement of the financial risk protection component, there as well retained three indicators to measure health outcomes. To identify time-related effects, we applied the parametric approach of breakpoint regression to detect whether the UHC journey has brought change and when exactly the change has occurred. Although there is a slight improvement in the financial risk protection indicators, we found that the adopted strategies have fostered access to healthcare for the wealthiest quantile of the population while neglecting the majority of the poorest. The government did not thrive persistently over the past decade to meet its commitment to allocate adequate funds to health expenditures. In addition, the support from donors appears to be unstable, unpredictable and unsustainable. We found a slight improvement in health outcomes attributable to direct investment in building health centres by the private sector and international organizations. Overall, our findings reveal that the prevention of catastrophic health expenditure is still not sufficiently prioritized by the country, and mostly for the majority of the poorest. Therefore, our work suggests that DRC's UHC journey has slightly contributed to improve the financial risk protection and health outcomes indicators but much effort should be undertaken.

Objectives: The study objective was to identify the size of different hospital financing sources for different hospital services and their impact on the uninsured. Methods: A panel dataset of 84 public general hospitals (2005–2008) with cross-section data on hospital activity and hospital revenue was created and used to calculate unit costs of different hospital services by applying multiple regression models. The resulting risk of catastrophic health expenditure (CHE) was estimated based on official income statistics. Results: Average user fees (UF) for outpatient visits and inpatient bed days were US$4.13 and US$20.27, while actual full costs (AFC) were US$8.41 and US$36.66, respectively. These unit costs were 2.5 times higher in hospitals at the central versus the provincial level. UF for surgical inpatient bed days were 3.6 times that of non-surgical treatments (US$47.50 vs. 12.87) and AFC 5.0 times (US$101.72 vs. 20.08). UF accounted for 44.6%-77.9% of the AFC, the rest (22.1%-55.4%) was provided by direct government support (DGS). One surgical inpatient treatment at either central or provincial hospital level and one non-surgical inpatient treatment at central hospital level, immediately pushed uninsured near-poor households at risk of CHE. Conclusions: Around 45% of hospital AFC was paid by DGS, the larger rest by UF. UF have become a great financial burden on the uninsured near-poor households, who have to pay for these out-of-pocket and therefore may not utilize even necessary services. If the rate of DGS were reduced, this would have the effect of increasing UF, but the savings to Government could be spent on subsidizing insurance to ensure that a larger part of the population can cover UF through insurance, especially the near-poor households.