Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries
Naoki
Ikegami
Keio University, Tokyo, Japan
author
text
article
2016
eng
When the Japanese government adopted Western medicine in the late nineteenth century, it left intact the infrastructure of primary care by giving licenses to the existing practitioners and by initially setting the hurdle for entry into medical school low. Public financing of hospitals was kept minimal so that almost all of their revenue came from patient charges. When social health insurance (SHI) was introduced in 1927, benefits were focused on primary care services delivered by physicians in clinics, and not on hospital services. This was reflected in the development and subsequent revisions of the fee schedule. The policy decisions which have helped to retain primary care services might provide lessons for achieving universal health coverage in low- and middle-income countries (LMICs).
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
291
293
https://www.ijhpm.com/article_3167_43cef55ccd82c326d8c79acac43dc6ee.pdf
dx.doi.org/10.15171/ijhpm.2016.22
An Implementation Research Approach to Evaluating Health Insurance Programs: Insights from India
Krishna D.
Rao
Department of International Health, Johns Hopkins University, Baltimore,
MD, USA
author
Srikant
Nagulapalli
Aarogyasri Health Care Trust, Hyderabad, India
author
Radhika
Arora
Public Health
Foundation of India, New Delhi, India
author
Mallela
Madhavi
Aarogyasri Health Care Trust, Hyderabad, India
author
Elin
Andersson
The Graduate Institute of International
and Development Studies, Geneva, Switzerland
author
Marie-Gloriose
Ingabire
International Development
Research Centre, Ottawa, ON, Canada
author
text
article
2016
eng
One of the distinguishing features of implementation research is the importance given to involve implementers in all aspects of research, and as users of research. We report on a recent implementation research effort in India, in which researchers worked together with program implementers from one of the longest serving government funded insurance schemes in India, the Rajiv Aarogyasri Scheme (RAS) in the state of undivided Andhra Pradesh, that covers around 70 million people. This paper aims to both inform on the process of the collaborative research, as well as, how the nature of questions that emerged out of the collaborative exercise differed in scope from those typically asked of insurance program evaluations. Starting in 2012, and over the course of a year, staff from the Aarogyasri Health Care Trust (AHCT), and researchers held a series of meetings to identify research questions that could serve as a guide for an evaluation of the RAS. The research questions were derived from the application of a Logical Framework Approach (“log frame”) to the RAS. The types of questions that emerged from this collaborative effort were compared with those seen in the published literature on evaluations of insurance programs in low- and middle-income countries (LMICs). In the published literature, 60% of the questions pertained to output/outcome of the program and the remaining 40%, relate to processes and inputs. In contrast, questions generated from the RAS participatory research process between implementers and researchers had a remarkably different distribution – 81% of questions looked at program input/processes, and 19% on outputs and outcomes. An implementation research approach can lead to a substantively different emphasis of research questions. While there are several challenges in collaborative research between implementers and researchers, an implementation research approach can lead to incorporating tacit knowledge of program implementers into the research process, research questions that are more relevant to the research needs of policy-makers, and greater knowledge translation of the research findings.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
295
299
https://www.ijhpm.com/article_3179_ccd15f0d65124130a3405fb4424b54e5.pdf
dx.doi.org/10.15171/ijhpm.2016.32
Inequalities in Health Status from EQ-5D Findings: A Cross-Sectional Study in Low-Income Communities of Bangladesh
Marufa
Sultana
Health Economics and Financing Research Group, Center for Equity and Health Systems, icddr,b, Dhaka, Bangladesh
author
Abdur
Sarker
Health Economics and Financing Research Group, Center for Equity and Health Systems, icddr,b, Dhaka, Bangladesh
author
Rashidul
Mahumud
Health Economics and Financing Research Group, Center for Equity and Health Systems, icddr,b, Dhaka, Bangladesh
author
Sayem
Ahmed
Health Economics and Financing Research Group, Center for Equity and Health Systems, icddr,b, Dhaka, Bangladesh
author
Wahid
Ahmed
Health Economics and Financing Research Group, Center for Equity and Health Systems, icddr,b, Dhaka, Bangladesh
author
Sanchita
Chakrovorty
Health Economics and Financing Research Group, Center for Equity and Health Systems, icddr,b, Dhaka, Bangladesh
author
Hafizur
Rahman
Health Economics Unit, Ministry
of Health and Family Welfare, Dhaka, Bangladesh
author
Ziaul
Islam
Health Economics and Financing Research Group, Center for Equity and Health Systems, icddr,b, Dhaka, Bangladesh
author
Jahangir A. M.
Khan
Liverpool School of Tropical
Medicine, Liverpool, UK; Health Economics Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm,
Sweden
author
text
article
2016
eng
Background Measuring health status by using standardized and validated instrument has become a growing concern over the past few decades throughout the developed and developing countries. The aim of the study was to investigate the overall self-reported health status along with potential inequalities by using EuroQol 5 dimensions (EQ-5D) instrument among low-income people of Bangladesh. Methods A cross-sectional household survey was conducted in Chandpur district of Bangladesh. Bangla version of the EQ-5D questionnaire was employed along with socio-demographic information. EQ-5D questionnaire composed of 2-part measurements: EQ-5D descriptive system and the visual analogue scale (VAS). For measuring health status, UK-based preference weights were applied while higher score indicated better health status. For facilitating the consistency with EQ-5D score, VASs were converted to a scale with scores ranging from 0 to 1. Multiple logistic regression models were also employed to examine differences among EQ-5D dimensions. Results A total of 1433 respondents participated in the study. The mean EQ-5D and VAS score was 0.76 and 0.77, respectively. The females were more likely to report any problem than the males (P < 0.001). Compared to the younger, elderly were more than 2-3 times likely to report any health problem in all EQ-5D dimensions (OR [odds ratio] = 3.17 for mobility, OR = 3.24 for self-care). However, the respondents of the poorest income group were significantly suffered more from every EQ-5D dimension than the richest income quintile. Conclusion Socio-economic and demographic inequalities in health status was observed in the study. Study suggests to do further investigation with country representative sample to measure the inequalities of overall health status. It would be helpful for policy-maker to find a new way aiming to reduce such inequalities.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
301
308
https://www.ijhpm.com/article_3150_aa4134ba44111d5325a1bc5f63d4a091.pdf
dx.doi.org/10.15171/ijhpm.2016.06
Power and Politics in the Global Health Landscape: Beliefs, Competition and Negotiation Among Global Advocacy Coalitions in the Policy-Making Process
Lori
McDougall
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
author
text
article
2016
eng
Background Advocacy coalitions play an increasingly prominent role within the global health landscape, linking actors and institutions to attract political attention and resources. This paper examines how coalitions negotiate among themselves and exercise hidden forms of power to produce policy on the basis of their beliefs and strategic interests. Methods This paper examines the beliefs and behaviours of health advocacy coalitions using Sabatier’s Advocacy Coalition Framework (ACF) as an informal theoretical lens. Coalitions are further explored in relation to the concept of transnational advocacy networks (Keck and Sikkink) and of productive power (Shiffman). The ACF focuses on explaining how policy change takes place when there is conflict concerning goals and technical approaches among different actors. This study uses participant observation methods, self-reported survey results and semistructured qualitative interviews to trace how a major policy project of the Millennium Development Goal (MDG) era, the Global Strategy for Women’s and Children’s Health, was constructed through negotiations among maternal, newborn, and child health (MNCH) and sexual and reproductive health and rights (SRHR) advocacy coalitions. Results The Global Strategy represented a new opportunity for high-level political attention. Despite differing policy beliefs, MNCH and SRHR actors collaborated to produce this strategy because of anticipated gains in political attention. While core beliefs did not shift fundamentally and collaboration was primarily a short-term tactical response to a time-bound opportunity, MNCH actors began to focus more on human rights perspectives and SRHR actors adopted greater use of quantifiable indicators and economic argumentation. This shift emphasises the inherent importance of SRHR to maternal and child health survival. Conclusion As opportunities arise, coalitions respond based on principles and policy beliefs, as well as to perceptions of advantage. Global health policy-making is an arena of contested interests, power and ideas, shaped by the interaction of coalitions. Although policy-making is often seen as a process that should be guided by evidence rather than interest-based politics, this study concludes that a participatory process of debate among different actorcoalitions is vital to progress and can lend greater legitimacy, accountability and transparency to the policy process.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
309
320
https://www.ijhpm.com/article_3153_bf55eee936f48cf6a78b19b83e53bf42.pdf
dx.doi.org/10.15171/ijhpm.2016.03
Improving Injectable Medicines Prescription in Outpatient Services: A Path Towards Rational Use of Medicines in Iran
Firoozeh
Bairami
Department of Health Management and Economics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
author
Fatemeh
Soleymani
Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, and Pharmaceutical Economics and Decision-Making Research Center, Tehran University of Medical Sciences, Tehran, Iran
author
Arash
Rashidian
Department of Health Management and Economics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
author
text
article
2016
eng
Injection is one of the most common medical procedures in the health sector. Annually up to 16 billion injections are prescribed in low- and middle-income countries (LMICs), many of them are not necessary for the patients, increase the healthcare costs and may result in side effects. Currently over 40% of outpatient prescriptions in Iran contain at least one injectable medicine. To address the issue, a working group was established (August 2014 to April 2015) to provide a comprehensive policy brief to be used by national decision-makers. This report is the extract of methods that were followed and the main policy options for improving injectable medicines prescribing in outpatient services. Thirty-three potential policy options were developed focusing on different stakeholders. The panel reached consensus on seven policy options, noting effectiveness, cost, durability, and feasibility of each policy. The recommended policy options are targeted at patients and public (2 policies), insurers (2), physicians (1), pharmacies (1), and the Ministry of Health and Medical Education (MoHME) (1).
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
321
324
https://www.ijhpm.com/article_3174_25fa5d92e7e1650385fb8346331e6e4f.pdf
dx.doi.org/10.15171/ijhpm.2016.24
In Search of the Third Eye, When the Two Others Are Shamefacedly Shut?; Comment on “Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development”
Ines
Keygnaert
ICRH, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
author
text
article
2016
eng
Ivanova et al explored how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies in 4 countries. They adapted the EquiFrame of Amin and colleagues of 2011, to SRH vulnerable groups which we believe could now be used for analysis of national SRH polices beyond those 4 countries. Although we fully agree with the authors’ two main findings that vulnerable groups and human rights’ principles are not sufficiently integrated in SRH policies nor granted the possibility to participate in the process of development in those four countries, we do believe that these shortcomings are not limited to those countries only nor to the identified vulnerable groups either. We are convinced that the issue of SRH as such is still framed within a very limited logic for all with vulnerable groups being perceived as an extra threat or an extra burden.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
325
327
https://www.ijhpm.com/article_3161_72f37db08894c396d57596e37661edb9.pdf
dx.doi.org/10.15171/ijhpm.2016.16
The Tip of the Iceberg of Misleading Online Advertising; Comment on “Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters”
Barbara
Mintzes
Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
author
text
article
2016
eng
Kim’s overview of Food and Drug Administration (FDA) regulatory actions from 2005 to 2014 is a comprehensive analysis of the US regulatory experience with online direct-to-consumer advertising (DTCA) of prescription medicines. This experience is of relevance internationally as online DTCA reaches the English-speaking public globally, despite the illegality of DTCA in most countries. The most common violations were omissions or minimizations of risk information, overstatements of efficacy, unsubstantiated claims, and promotion of unapproved (“off-label”) use. Nearly one fourth of violations involved cancer drugs, raising additional concerns about patient vulnerability, limited treatment advance, and high costs. Based on content analyses of online DTCA, these cases likely reflect a small proportion of unbalanced and misleading promotional information available on the web. The FDA is only able to review a small proportion of promotional materials submitted to them, due to limited staffing, and the delay between first posting and regulatory action means that many people may be exposed to messages that are found to be inaccurate and misleading. The sheer volume of online DTCA, combined with the ability for content to shift continually, poses unique regulatory challenges.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
329
331
https://www.ijhpm.com/article_3164_3e1c9634f449a99e0f656966db8c6d57.pdf
dx.doi.org/10.15171/ijhpm.2016.19
Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: Teaching Drug Marketers How to Inform Better or Spin Better?; Comment on “Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters”
Evan
Doran
Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle, Callaghan, NSW, Australia
author
text
article
2016
eng
Hyosun Kim’s report “Trouble Spots in Online Direct to Consumer Prescription Drug Promotion: A content Analysis of FDA Warning Letters”aims to teach marketers how to avoid breaching current Food and Drug Administration (FDA) guidelines in their online drug promotion. While Kim hopes to minimise the potential for online promotion to misinform consumers and the study is carefully conducted, teaching drug marketers how to avoid the common mistakes in online drug promotion is more likely to make marketers more adept at spinning information than appropriately balancing it.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
333
335
https://www.ijhpm.com/article_3165_edf6de02e707bcb04cafbb318879722c.pdf
dx.doi.org/10.15171/ijhpm.2016.20
Searching for the Right to Health in the Sustainable Development Agenda; Comment on “Rights Language in the Sustainable Development Agenda: Has Right to Health Discourse and Norms Shaped Health Goals?”
Sarah
Hawkes
Faculty of Pop Health Sciences, Institute for Global Health (IGH), University College London, London, UK
author
Kent
Buse
United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
author
text
article
2016
eng
The United Nations (UN) Sustainable Development Agenda offers an opportunity to realise the right to health for all. The Agenda’s “interlinked and integrated” Sustainable Development Goals (SDGs) provide the prospect of focusing attention and mobilising resources not just for the provision of health services through universal health coverage (UHC), but also for addressing the underlying social, structural, and political determinants of illness and health inequity. However, achieving the goals’ promises will require new mechanisms for inter-sectoral coordination and action, enhanced instruments for rational priority-setting that involve affected population groups, and new approaches to ensuring accountability. Rights-based approaches can inform developments in each of these areas. In this commentary, we build upon a paper by Forman et al and propose that the significance of the SDGs lies in their ability to move beyond a biomedical approach to health and healthcare, and to seize the opportunity for the realization of the right to health in its fullest, widest, most fundamental sense: the right to a healthpromoting and health protecting environment for each and every one of us. We argue that realizing the right to health inherent in the SDG Agenda is possible but demands that we seize on a range of commitments, not least those outlined in other goals, and pursue complementary openings in the Agenda – from inclusive policy-making, to novel partnerships, to monitoring and review. It is critical that we do not risk losing the right to health in the rhetoric of the SDGs and ensure that we make good on the promise of leaving no one behind.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
337
339
https://www.ijhpm.com/article_3166_c186ae937f58f9a09ad1f24fecf0f1ec.pdf
dx.doi.org/10.15171/ijhpm.2016.21
Health Rights and Realization; Comment on “Rights Language in the Sustainable Development Agenda: Has Right to Health Discourse and Norms Shaped Health Goals?”
Simon
Rushton
Department of Politics, University of Sheffield, Sheffield, UK
author
text
article
2016
eng
In their hypothesis published in IJHPM, Lisa Forman and colleagues examined the prominence of the right to health and sexual and reproductive health rights (as well as related language) in four of the key reports that fed into the process of negotiating the Sustainable Development Goals (SDGs). Now that the SDGs have been formally adopted, this comment builds on some of the insights of Forman and colleagues to examine the extent to which those rights have been incorporated in SDGs 3 and 5. I argue that sexual and reproductive health rights are relatively well-covered within the SDGs. In terms of the right to health, however, the picture is much less clear. Some of the elements that make up that right are present and correct, but the SDGs have delivered no coherent vision of how a ‘right to health’ might actually be realized. An important task facing global health and human rights advocates is to continue pushing human rights framings so that progress is made both on meeting the SDGs and on realizing the right to health.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
341
344
https://www.ijhpm.com/article_3169_2852a802e32ca85aa7253739ccaef07f.pdf
dx.doi.org/10.15171/ijhpm.2016.26
Towards a Global Social Support System: A Response to the Recent Commentaries
Martin
McKee
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
author
Gorik
Ooms
Protection International, Brussels, Belgium
author
David
Stuckler
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
author
Sanjay
Basu
School of Medicine, Stanford University, Stanford, CA, USA
author
text
article
2016
eng
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
345
346
https://www.ijhpm.com/article_3163_6e46eede478a3a79c02b586325b8f0e8.pdf
dx.doi.org/10.15171/ijhpm.2016.18
Correction: Expanded HTA: Enhancing Fairness and Legitimacy
Norman
Daniels
Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
author
Thalia
Porteny
Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, USA
author
Julian
Urrutia
Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, USA
author
text
article
2016
eng
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
5
v.
5
no.
2016
347
347
https://www.ijhpm.com/article_3182_ba39e309542f196f2378caa60b09c7e0.pdf
dx.doi.org/10.15171/ijhpm.2016.37