Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
3
2020
03
01
Universal Pharmacare in Canada: A Prescription for Equity in Healthcare
91
95
EN
Mohammad
Hajizadeh
0000-0002-4591-8531
School of Health Administration, Dalhousie University, Halifax, NS, Canada
m.hajizadeh@dal.ca
Sterling
Edmonds
Schulich School of Law, Dalhousie University, Halifax, NS, Canada
sterling.edmonds@dal.ca
10.15171/ijhpm.2019.93
<span class="fontstyle0">Despite progressive universal drug coverage and pharmaceutical policies found in other countries, Canada remains the only developed nation with a publicly funded healthcare system that does not include universal coverage for prescription drugs. In the absence of a national pharmacare plan, a province may choose to cover a specific sub-population for certain drugs. Although different provinces have individually attempted to extend coverage to certain subpopulations within their jurisdictions, out-of-pocket expenses on drugs and pharmaceutical products (OPEDP) accounts for a large proportion of out-of-pocket health expenses (OPHE) that are catastrophic in nature. Pharmaceutical drug coverage is a major source of public scrutiny among politicians and policy-makers in Canada. In this editorial, we focus on social inequalities in the burden of OPEDP in Canada. Prescription drugs are inconsistently covered under patchworks of public insurance coverage, and this inconsistency represents a major source of inequity of healthcare financing. Residents of certain provinces, rural households and Canadians from poorer households are more likely to be affected by this inequity and suffer disproportionately higher proportions of catastrophic out-of-pocket expenses on drugs and pharmaceutical products (COPEDP). Universal pharmacare would reduce COPEDP and promote a more equitable healthcare system in Canada.</span>
Universal Pharmacare,Health Policy,Equity,Canada
https://www.ijhpm.com/article_3680.html
https://www.ijhpm.com/article_3680_02e541aef09dbfd33bb8f4dc8c515aac.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
3
2020
03
01
Long Waiting Times for Elective Hospital Care – Breaking the Vicious Circle by Abandoning Prioritisation
96
107
EN
Solbjørg Makalani Myrtveit
Sæther
0000-0002-5948-3794
Department of Health Promotion, Norwegian Institute of Public Health, Bergen,
Norway
makalani@myrtveit.com
Torhild
Heggestad
Department of Research and Development, Haukeland University Hospital,
Bergen, Norway
torhild.heggestad@helse-bergen.no
John-Helge
Heimdal
Department of Clinical Medicine, University of Bergen,
Bergen, Norway
john-helge.heimdal@helse-bergen.no
Magne
Myrtveit
0000-0001-7730-0173
Dynaplan AS, Manger, Norway (https://www.dynaplan.com/en/)
magne@myrtveit.com
10.15171/ijhpm.2019.84
Background<br /> Policies assigning low-priority patients treatment delays for care, in order to make room for patients of higher priority arriving later, are common in secondary healthcare services today. Alternatively, each new patient could be granted the first available appointment. We aimed to investigate whether prioritisation can be part of the reason why waiting times for care are often long, and to describe how departments can improve their waiting situation by changing away from prioritisation.<br /> <br /> Methods<br /> We used patient flow data from 2015 at the Department of Otorhinolaryngology, Haukeland University Hospital, Norway. In Dynaplan Smia, Dynaplan AS, dynamic simulations were used to compare how waiting time, size and shape of the waiting list, and capacity utilisation developed with and without prioritisation. Simulations were started from the actual waiting list at the beginning of 2015, and from an empty waiting list (simulating a new department with no initial patient backlog).<br /> <br /> Results<br /> From an empty waiting list and with capacity equal to demand, waiting times were built 7 times longer when prioritising than when not. Prioritisation also led to poor resource utilisation and short-lived effects of extra capacity. Departments where prioritisation is causing long waits can improve their situation by temporarily bringing capacity above demand and introducing “first come, first served” instead of prioritisation.<br /> <br /> Conclusion<br /> A poor appointment allocation policy can build long waiting times, even when capacity is sufficient to meet demand. By bringing waiting times down and going away from prioritisation, the waiting list size and average waiting times at the studied department could be maintained almost 90% below the current level – without requiring permanent change in the capacity/demand ratio.
Appointment Allocation,Waiting Time,Waiting List Management,Prioritisation,Dynaplan Smia
https://www.ijhpm.com/article_3682.html
https://www.ijhpm.com/article_3682_db5fcd43e0c9b4c66615f604acca5cd8.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
3
2020
03
01
HIV Modes of Transmission in Sudan in 2014
108
115
EN
Maryam
Nasirian
0000-0002-8365-3845
Epidemiology and Biostatistics Department, Health School, Isfahan University
of Medical Sciences, Isfahan, Iran
maryamnasirian@who-hivhub.org
Sina
Kianersi
0000-0003-0950-2675
Department of Epidemiology and Biostatistics, Indiana University School of
Public Health-Bloomington, Bloomington, IN, USA
sinakianersi@gmail.com
Mohammad
Karamouzian
0000-0002-5631-4469
School of Population and
Public Health, Faculty of Medicine, University of British Columbia, Vancouver,
BC, Canada
karamouzian.m@gmail.com
Mohammed
Sidahmed
World Health Organization, Sudan Office, Khartoum, Sudan
abdelrahimm@sud.emro.who.int
Mohammad Reza
Baneshi
0000-0002-6405-8688
Modeling in Health Research Center, Institute for Futures Studies in Health,
Kerman University of Medical Sciences, Kerman, Iran
rbaneshi2@gmail.com
Ali Akbar
Haghdoost
0000-0003-4628-4849
HIV/STI Surveillance
Research Center, and WHO Collaborating Center for HIV Surveillance, Institute
for Futures Studies in Health, Kerman University of Medical Sciences, Kerman,
Iran
ahaghdoost@gmail.com
Hamid
Sharifi
0000-0002-9008-7618
HIV/STI Surveillance
Research Center, and WHO Collaborating Center for HIV Surveillance, Institute
for Futures Studies in Health, Kerman University of Medical Sciences, Kerman,
Iran
sharifihami@gmail.com
10.15171/ijhpm.2019.91
<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">In Sudan, where studies on HIV dynamics are few, model projections provide an additional source of information for policy-makers to identify data collection priorities and develop prevention programs. In this study, we aimed to estimate the distribution of new HIV infections by mode of exposure and to identify populations who are disproportionately contributing to the total number of new infections in Sudan.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">We applied the modes of transmission (MoT) mathematical model in Sudan to estimate the distribution of new HIV infections among the 15-49 age group for 2014, based on the main routes of exposure to HIV. Data for the MoT model were collected through a systematic review of peer-reviewed articles, grey literature, interviews with key participants and focus groups. We used the MoT uncertainty module to represent uncertainty in model projections and created one general model for the whole nation and 5 sub-models for each region (Northern, Central, Eastern, Kurdufan, and Khartoum regions). We also examined how different service coverages could change HIV incidence rates and distributions in Sudan.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">The model estimated that about 6000 new HIV infections occurred in Sudan in 2014 (95% CI: 4651-7432). Men who had sex with men (MSM) (30.52%), female sex workers (FSW) (16.37%), and FSW’s clients accounted (19.43%) for most of the new HIV cases. FSW accounted for the highest incidence rate in the Central, Kurdufan, and Khartoum regions; and FSW’s clients had the highest incidence rate in the Eastern and Northern regions. The annual incidence rate of HIV in the total adult population was estimated at 330 per 1 000 000 populations. The incidence rate was at its highest in the Eastern region (980 annual infections per 1 000 000 populations).<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Although the national HIV incidence rate estimate was relatively low compared to that observed in some sub-Saharan African countries with generalized epidemics, a more severe epidemic existed within certain regions and key populations. HIV burden was mostly concentrated among MSM, FSW, and FSW’s clients both nationally and regionally. Thus, the authorities should pay more attention to key populations and Eastern and Northern regions when developing prevention programs. The findings of this study can improve HIV prevention programs in Sudan.</span>
Sudan,Modes of Transmission (MoT),HIV
https://www.ijhpm.com/article_3688.html
https://www.ijhpm.com/article_3688_26d017a2b02361253acf611ac346d5be.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
3
2020
03
01
Neo-Liberalism, Policy Incoherence and Discourse Coalitions Influencing Non-Communicable Disease Strategy; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”
116
118
EN
Samantha
Battams
0000-0003-4433-0530
Southgate Institute for Health, Society and Equity, Flinders University, SA, Australia
sam.battams@flinders.edu.au
10.15171/ijhpm.2019.95
<span class="fontstyle0">Lencucha and Thow have highlighted the way in which neo-liberalism is enshrined within institutional mechanisms and conditions the policy environment to shape public policy on non-communicable diseases (NCDs). They critique the strong (but important) focus of public health policy research on corporate interests and influence over NCD policy, and point toward neo-liberal policy paradigms shaping the relationship between the state, market and society as an area for critique and further exploration. They also importantly underline the way in which the neo-liberal policy paradigm shapes the supply of unhealthy goods and argue that health advocates have not engaged enough with supply side issues in critiques of policy debates on NCDs. This is an important consideration especially in the Asia-Pacific where trade and agricultural policies have markedly shaped production and what is being produced within countries. In this commentary, I reflect upon how neoliberalism shapes intersectoral action across trade, development and health within and across institutions. I also consider scope for international civil society to engage in advocacy on NCDs, especially where elusive ‘discourse coalitions’ influenced by neoliberalism may exist, rather than coordinated ‘advocacy coalitions.’</span>
Neoliberalism,Non-communicable Disease,Policy,Discourse
https://www.ijhpm.com/article_3681.html
https://www.ijhpm.com/article_3681_c2bdc7bb5b938f6ec3db79a9b047c2d6.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
3
2020
03
01
Calls for Stricter Legislation and Fear in the European Immigrant Community: Reflections of the Public Charge Debate Ongoing in the United States; Comment on “A Crisis of Humanitarianism: Refugees at the Gates of Europe”
119
120
EN
Jimmy
Efird
0000-00024890-5111
Cooperative Studies Program Epidemiology Center, Health Services Research and Development, DVAHCS (Duke Affiliate), Durham, NC, USA
jimmy.efird@stanfordalumni.org
10.15171/ijhpm.2019.97
<span class="fontstyle0">In the editorial, “A Crisis of Humanitarianism: Refugees at the Gates of Europe,” Marianna Fotaki elegantly highlights the changing dynamics of governmental policy toward refugees, forced migrants into Europe and the move away from the principles of humanitarianism.</span><span class="fontstyle0">1 </span><span class="fontstyle0">The perceived threats to economy, security, and concerns of globalization and multiculturalism often are manifested as a “cry of wolf ” about alleged health risks. This in effect has raised concerns of inadmissibility on health-related grounds and calls for stricter legislation for determining who is eligible for legal permanent residence, precipitated in part by the “public charge” debate occurring in the United States.</span><span class="fontstyle0">2 </span><span class="fontstyle0">As Marianna notes “anti-migration rhetoric is now a permanent fixture of European politics.”</span>
Refugees,Immigrants,Public Charge
https://www.ijhpm.com/article_3683.html
https://www.ijhpm.com/article_3683_318f27bdf43ecb9932e9e7dfc75f35ba.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
3
2020
03
01
Towards Critical Analysis of the Political Determinants of Health; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”
121
123
EN
Julia
Smith
0000-0002-5175-1109
Simon Fraser University, Burnaby, BC, Canada
jhs6@sfu.ca
10.15171/ijhpm.2019.102
<span class="fontstyle0">The recent perspective article “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention,” by Lencucha and Throw, interrogates how the dominant neoliberal paradigm restricts meaningful policy action to prevent non-communicable diseases (NCDs). It contributes an NCD perspective to the existing literature on neoliberalism and health, which to date has been dominated by a focus on HIV, gender and trade agreements. It further advances the emerging commercial determinants of health (CDoH) scholarship by calling for more nuanced analysis of how the governance of both health and the economy facilitates corporate influence in policy-making. In political science terms, Lencucha and Throw are calling for greater structural analysis. However, their focus on the pragmatic, as opposed to political, aspects of neoliberalism reflects a hesitancy within health scholarship to engage in political analysis. This depoliticization of health serves neoliberal interests by delegitimizing critical questions about who sustains and benefits from current institutional norms. Lencucha and Throw’s call for greater interrogation of the structures of neoliberalism forms a basis from which to advance analysis of the political determinants of health.</span>
Neoliberalism,Governance,Politics,Global Health,Critical
https://www.ijhpm.com/article_3684.html
https://www.ijhpm.com/article_3684_f3088d66f2b038a6c70459e0fdb5fd59.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
3
2020
03
01
Paradigm Shift: New Ideas for a Structural Approach to NCD Prevention; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”
124
127
EN
Ashley
Schram
0000-0001-5231-6291
School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
ashley.schram@anu.edu.au
Sharni
Goldman
School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
sharni.goldman@anu.edu.au
10.15171/ijhpm.2019.105
<span class="fontstyle0">It is a well-documented fact that transnational corporations engaged in the production and distribution of health-harmful commodities have been able to steer policy approaches to address the associated burden of non-communicable diseases (NCDs). While the political influence that corporations wield stems in part from significant financial resources, it has also been enabled and magnified by what has been referred to as global health’s neoliberal deep core, which has subjected health policy to the individualisation of risk and responsibility and the privileging of market-based policy responses. The accompanying perspective article from Lencucha and Thow draws attention to neoliberalism in the NCD space and the way it has historically structured patterns of thinking and doing that foreground economic interests over health considerations. In this commentary, we explore how shifting from a focus on material power to discursive power creates space to see the NCD agenda as a battle of economic ideas as well as dollars, and consequently the importance of public health engagement in the next vision for the economy.</span>
Non-Communicable Diseases,Neoliberalism,Health Policy
https://www.ijhpm.com/article_3691.html
https://www.ijhpm.com/article_3691_a441d183fdd9824a0115688e467bcfc9.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
3
2020
03
01
Corruption in Health Systems: The Conversation Has Started, Now Time to Continue it; Comment on “We Need to Talk About Corruption in Health Systems”
128
132
EN
Hongsheng S.
Lu
0000-0001-6416-7465
Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu,
China
baobei08@gmail.com
Bing X.
Ho
Trinity College for Arts & Sciences, Duke University, Durham, NC, USA
bh121098@gmail.com
J. Jaime
Miranda
0000-0002-4738-5468
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana
Cayetano Heredia, Lima, Peru
jaime.miranda@upch.pe
10.15171/ijhpm.2019.104
<span class="fontstyle0">Holistic and multi-disciplinary responses should be prioritized given the depth and breadth through which corruption in the healthcare sector can cover. Here, taking the Peruvian context as an example, we will reflect on the issue of corruption in health systems, including corruption with roots within and outside the health sector, and ongoing efforts to combat it. Our reflection of why corruption in health systems in settings with individual and systemic corruption should be an issue that is taken more seriously in Peru and beyond aligns with broader global health goals of improving health worldwide. Addressing corruption also serves as a pragmatic approach to health system strengthening and weakens a barrier to achieving universal health coverage and Sustainable Development Goals related to health and justice. Moreover, we will argue that by pushing towards a practice of normalizing the conversation about corruption in health has additional benefits, including expanding the problematization to a wider audience and therefore engaging with communities. For young researchers and global health professionals with interests in improving health systems in the early career stages, corruption in health systems is an issue that could move to the forefront of the list of global health challenges. This is a challenge that is uniquely multi-disciplinary, spanning the health, economy, and legal sectors, with wider societal implications.</span>
Corruption,Health Systems,Global Health,Peru
https://www.ijhpm.com/article_3692.html
https://www.ijhpm.com/article_3692_f84715a5299f529bbdcc0fbe28efc5b8.pdf