International Journal of Health Policy and Management
Year:2014 | Volume:2 | Issue:2|Papers Count:13

We are on the eve of a revolution in health policy that will forever change our way of thinking about health and healthcare. A few years from now, our vision of the organization and the administration of healthcare services will be transformed.This is not a revolution born out of crisis, albeit the financial pressure on public and private funders of healthcare is clearly at play. It has not been induced by technological change, even if new means of acquiring and analyzing large amount of data-and consequently, unforeseen possibilities of testing hypotheses and answering puzzling questions-are among the most evident determinants of innovation. It is not a revolution driven by a clique or a conspiracy, although I will mention a few (intellectually) leading figures without whom the movement might have been less decisive.

Aligning Financial Incentives (FIs) to health policy goals is becoming increasingly popular. In many cases, such initiatives have failed to deliver anticipated benefits. Attributing this to the actions of self-interested and resistant professionals is not an entirely helpful approach. It is important to avoid simplistic assumptions to build knowledge of how and why schemes are implemented in practice to inform future policy in this area.

Japan, known as a pro-choice country in terms of abortion, is currently facing the increase of “selective abortions” thanks to new prenatal screening. Efforts to restrict proliferation of new technology has not been successful and it is likely that Japan will turn pro-life by strictly enforcing the Maternity Protection Act (MPA), which prohibits abortions due to “fetal cause”.

War has devastating implications for families, communities, cultures, economies, and state infrastructure. Similarly, the last decade has seen an increase in the number of attacks against health workers in conflict zones and unstable environments. Unfortunately, these attacks have grave consequences for local populations which often rely on foreign aid programs for their health and well-being. As such, this paper will examine why aid-workers have increasingly been targeted for abductions, ambushes, assassinations, and various forms of intimidation. Furthermore, examples of terminated health programs, as well as populations served by current medical and humanitarian interventions, will be provided to impart a sense of magnitude and importance of health programs to the reader. Lastly, suggestions will be presented which could serve to minimize aid-workers’ risk and exposure to acts of violence in the field.

Background: Provincial Health Accounts (PHA) as a subset of National Health Accounts (NHA) present financial information for health sectors. It leads to a logical decision making for policy-makers in order to achieve health system goals, especially Fair Financial Contribution (FFC). This study aimed to examine Health Accounts in Kerman Province.Methods: The present analytical study was carried out retrospectively between 2008 and 2011. The research population consisted of urban and rural households as well as providers and financial agents in health sectors of Kerman Province. The purposeful sampling included 16 provincial organizations. To complete data, the report on Kerman household expenditure was taken as a data source from the Governor-General’s office. In order to classify the data, the International Classification for Health Accounts (ICHA) method was used, in which data set was adjusted for the province.Results: During the study, the governmental and non-governmental fund shares of the health sector in Kerman were 27.22% and 72.78% respectively. The main portion of financial sources (59.41) was related to private household funds, of which the Out-of-Pocket (OOP) payment mounted to 92.35%. Overall, 54.86% of all financial sources were covered by OOP. The greatest portion of expenditure of Total Healthcare Expenditures (THEs) (65.19%) was related to curative services.Conclusion: The major portion of healthcare expenditures was related to the OOP payment which is compatible with the national average rate in Iran. However, health expenditure per capita, was two and a half times higher than the national average. By emphasizing on Social Determinant of Health (SDH) approach in the Iranian health system, the portion of OOP payment and curative expenditure are expected to be controlled in the medium term. It is suggested that PHA should be examined annually in a more comprehensive manner to monitor initiatives and reforms in healthcare sector.

Background: Epidemiological information on tuberculosis (TB) is required to plan control and prevention strategies and to inform service delivery systems. The aim of present study was to determine the epidemiological status of TB in Hamadan Province covering a seven-year period.Methods: In this cross-sectional study all registered TB patients suffering from any form of smear-positive, smear-negative or extra pulmonary from 2005 to 2011 were assessed. Age-adjusted incidence trend was studied. The Cochran-Armitage (C-A) test was used for testing the trends over time.Results: The mean age of TB patients was 57.0 (±21.1), 49.9% were males, 52.8% were aged 61 years or older and 39.7% were rural residents. Previous history of jailed was present in 13 (2.2%) patients and 12 (2.0%) were HIV positive. From all TB patients, 60.8% were smear-positive, 87.6% were new cases, and 87.3% of smear-positive patients were cured cases. Also, 23.6% patients had history of hospitalization for TB. More than half (55.4%) of TB patients were reported by public health system. Age-adjusted incidence rates of all TB cases during 2005-11 was 3.4, 3.2, 3.6, 4.7, 3.3, 4.4 and 7.3 in 100,000 respectively (C-A trend test, P<0.001).Conclusion: Although, the incidence rate of TB in Hamadan Province is lower than country’s average, increasing trend of TB incidence is not concordant with its decreasing trend in Iran. An epidemiological study is required to evaluate risk factors associated with TB to identify ways to decrease the prevalence of TB.

Despite the fact that HIV epidemic is mainly driven by injection drug use in Iran, partners of People Who Inject Drugs (PWID) have been seriously neglected in terms of effective preventive interventions. Currently, sexual partners of PWID might have access to some harm reduction services at Voluntary Counselling and Testing (VCT) centers; however, their needs have not been effectively targeted and met. Unfortunately, the current programs implemented by the Ministry of Health have overlooked the importance of this population in the course of the HIV epidemic throughout the country. In this policy brief, we are trying to draw the health policy-makers’ attention to this overlooked population and while reviewing the advantages and disadvantages of some of the readily available options on the table, come up with a recommended action to tackle this problem. Our recommended action that seems to have had promising results elsewhere in Asia would try to implement preventive interventions targeting this particular population through peer prevention programs.

What does libertarian theory, Murray Rothbard’s theory in particular, tell us about the rights of children? The two foundational principles of Rothbardian libertarianism are the sanctity of private property and the rule of non-aggression. Persons, including children, are “self-owners”. Yet children, at a young age, are not yet capable of functioning fully as “self-owners.” They must be cared for, and the caring will necessarily involve some degree of aggression in the form of supervision and restraint. Parents and other caregivers play the role of trustees; and just as the beneficiary of a trust has the right to petition a court to change trustees or terminate the trustee relationship, so a child, able to express his preferences when it comes to the nature and degree of supervision and restraint to which he will be subjected, should equally enjoy that right while, in terms of property rights, a biological caregiver may have better “title” than an adoptive caregiver to be the child’s “trustee” given the child’s inability to express a preference for one or the other. What may seem to a contemporary sensibility as an extreme degree of childhood independence in the choice of caregivers and other freedom from supervision and restraint was common in pre-industrial America and continues to be the rule in some native cultures.

The article by Cheri Wilson, “Patient Safety and Healthcare Quality: The Case for Language Access”, highlights the challenges of providing Culturally and Linguistically Appropriate Services (CLAS) to patients with Limited English Proficiency (LEP). As the US pursues high-value, high-performance healthcare, our ability to meet the needs of our most vulnerable will determine whether we succeed or fail in the long run. With the implementation of the Affordable Care Act (ACA), this is more important than ever before, as it is estimated that the newly insured are more likely to be minority and less likely to speak English than their currently insured counterparts. As such, we must create a safe, high-quality healthcare system for all, especially in this time of incredible healthcare transformation and unprecedented diversity. Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals provides a blueprint for achieving this goal, and Massachusetts General Hospital (MGH) is taking action.

Many countries are turning their attention to the use of explicit financial incentives to drive desired improvements in healthcare performance. However, we have only a weak evidence-base to inform policy in this area. The research challenge is to generate robust evidence on what financial incentives work, under what circumstances, for whom and with what intended and unintended consequences.

McDonough’s perspective on healthcare reform in the US provides a clear, coherent analysis of the mix of access and delivery reforms in the Affordable Care Act (ACA) aka Obamacare. As noted by McDonough, this major reform bill is designed to expand access for health coverage that includes both prevention and treatment benefits among uninsured Americans. Additionally, this legislation includes several financial strategies (e.g. incentives and penalties) to improve care coordination and quality in the hospital and outpatient settings while also reducing healthcare spending and costs. This commentary is intended to discuss this mix of access and delivery reform in terms of its potential to achieve the Triple Aim: population health, quality, and costs. Final remarks will include the role of the US federal government to reform the American private health industry together with that of an informed consumer.

Dear Editor, ‘One Health’ is the “collaborative effort of multiple disciplines -working locally, nationally, and globally-to attain optimal health for people, animals and our environment”. The concept of ‘One Health’ is not as new as it may seem at the first glance, as its pioneer supporters used to live in the 19th century. Looking back in history, Louis Pasteur and Robert Koch’s achievements are good examples of practicing ‘One Health’.

This article is a review of the book “Health in All Policies: Seizing opportunities, implementing policies” edited by Kimmo Leppo, Eeva Ollila, Sebastian Pena, Matthias Wismar, and Sarah Cook. This book (printed and online publication) was published by the Finnish Ministry of Social Affairs and Health, Finland in 2013. The book is freely available at http://www.euro.who.int/__data/assets/pdf_file/0007/188809/Health-in-All-Policies-final.pdf. The main features, structure, and highlighted contents of the book are briefly sketched out in this review.