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Fulltext Making Fair Choices on the Path to Universal Health Coverage: Applying Principles to Difficult Cases

Voorhoeve A, Tan-Torres Edejer T, Kapiriri L, Norheim OF, Snowden J, Basenya O, et al.

Health Syst Reform, 2017 Oct 02;3(4):301-312.
PMID: 30359178 DOI: 10.1080/23288604.2017.1324938

Abstract-Progress toward universal health coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the World Health Organization (WHO) Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases, and how should one adjudicate between them when their demands conflict? This article by some members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three key dimensions of progress toward UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to prepayment with pooling of funds. Our cases are simplified to highlight common trade-offs. Though we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC.

Matched MeSH terms: Health Expenditures
Gut microbiome: Microflora association with obesity and obesity-related comorbidities

Lone JB, Koh WY, Parray HA, Paek WK, Lim J, Rather IA, et al.

Microb Pathog, 2018 Nov;124:266-271.
PMID: 30138755 DOI: 10.1016/j.micpath.2018.08.036

Obesity and obesity-related comorbidities have transformed into a global epidemic. The number of people suffering from obesity has increased dramatically within the past few decades. This rise in obesity cannot alone be explained by genetic factors; however, diet, environment, lifestyle, and presence of other diseases undoubtedly contribute towards obesity etiology. Nevertheless, evidence suggests that alterations in the gut microbial diversity and composition have a role to play in energy assimilation, storage, and expenditure. In this review, the impact of gut microbiota composition on metabolic functionalities, and potential therapeutics such as gut microbial modulation to manage obesity and its associated comorbidities are highlighted. Optimistically, an understanding of the gut microbiome could facilitate the innovative clinical strategies to restore the normal gut flora and improve lifestyle-related diseases in the future.

Matched MeSH terms: Health Expenditures
Fulltext Homeownership affordability: an analysis of household socio‐economic

Norizan Rameli, Dani Salleh, Mazlan Ismail

Malaysian Journal of Social Sciences and Humanities, 2016;1(1):10-16.
MyJurnal

Homeownership affordability is not only the ability of households to pay the housing cost. But homeownership affordability is also involving the ability of households to pay housing costs as well as to maintain the basic needs in the continuity of life. Thus, affordability aspect is important in home ownership. Meanwhile, home ownership is the biggest decision for a household in a term. The combination of affordability and homeownership led to research on factors that affect the affordability of homeownership, especially in terms of socio-economic households inclusively. Socio-economic factors as discussed include income, household expenditures, job type, education level, number of dependents, monthly housing loan and financial savings. Each factor plays the role of its own to ensure the affordability level of homeownership. In fact, the factors that affect the homeownership affordability is different between households. Analysis of the socio-economic factors is necessary because homeownership affordability issues impact the quality life of mankind.

Matched MeSH terms: Health Expenditures
Out-of-Pocket Costs of Complementary Medicine Following Cancer and the Financial Impact in a Setting With Universal Health Coverage: Findings From a Prospective Cohort Study

Bhoo-Pathy N, Subramaniam S, Khalil S, Kimman M, Kong YC, Ng CW, et al.

JCO Oncol Pract, 2021 10;17(10):e1592-e1602.
PMID: 34077232 DOI: 10.1200/OP.20.01052

PURPOSE: To determine household spending patterns on complementary medicine following cancer and the financial impact in a setting with universal health coverage.
METHODS: Country-specific data from a multinational prospective cohort study, Association of Southeast Asian Nations Costs in Oncology Study, comprising 1,249 cancer survivors were included. Household costs of complementary medicine (healthcare practices or products that are not considered as part of conventional medicine) throughout the first year after cancer diagnosis were measured using cost diaries. Study outcomes comprised (1) shares of household expenditures on complementary medicine from total out-of-pocket costs and health costs that were respectively incurred in relation to cancer, (2) incidence of financial catastrophe (out-of-pocket costs related to cancer ≥ 30% of annual household income), and (3) economic hardship (inability to pay for essential household items or services).
RESULTS: One third of patients reported out-of-pocket household expenditures on complementary medicine in the immediate year after cancer diagnosis, accounting to 20% of the total out-of-pocket costs and 35% of the health costs. Risk of financial catastrophe was higher in households reporting out-of-pocket expenditures on complementary medicine (adjusted odds ratio: 1.39 [95% CI, 1.05 to 1.86]). Corresponding odds ratio within patients from low-income households showed that they were substantially more vulnerable: 2.28 (95% CI, 1.41 to 3.68). Expenditures on complementary medicine were, however, not associated with economic hardship in the immediate year after cancer diagnosis.
CONCLUSION: In settings with universal health coverage, integration of subsidized evidence-based complementary medicine into mainstream cancer care may alleviate catastrophic expenditures. However, this must go hand in hand with interventions to reduce the use of nonevidence-based complementary therapies following cancer.

Matched MeSH terms: Health Expenditures
Fulltext Nonlinearity in the relationship between COVID-19 cases and carbon damages: controlling financial development, green energy, and R&D expenditures for shared prosperity

Anser MK, Godil DI, Khan MA, Nassani AA, Askar SE, Zaman K, et al.

Environ Sci Pollut Res Int, 2022 Jan;29(4):5648-5660.
PMID: 34424465 DOI: 10.1007/s11356-021-15978-w

The world faces a high alert of coronavirus disease 2019 (COVID-19), leading to a million deaths and could become infected to reach a billion numbers. A sizeable amount of scholarly work has been available on different aspects of social-economic and environmental factors. At the same time, many of these studies found the linear (direct) causation between the stated factors. In many cases, the direct relationship is not apparent. The world is unsure about the possible determining factors of the COVID-19 pandemic, which need to be known through conducting nonlinearity (indirect) relationships, which caused the pandemic crisis. The study examined the nonlinear relationship between COVID-19 cases and carbon damages, managing financial development, renewable energy consumption, and innovative capability in a cross section of 65 countries. The results show that inbound foreign direct investment first increases and later decreases because of the increasing coronavirus cases. Further, the rise and fall in the research and development expenditures and population density exhibits increasing coronavirus cases across countries. The continued economic growth initial decreases later increase by adopting standardized operating procedures to contain coronavirus disease. The inter-temporal relationship shows that green energy source and carbon damages would likely influence the coronavirus cases with a variance of 17.127% and 5.440%, respectively, over a time horizon. The policymakers should be carefully designing sustainable healthcare policies, as the cost of carbon emissions leads to severe healthcare issues, which are likely to get exposed to contagious diseases, including COVID-19. The sustainable policy instruments, including renewable fuels in industrial production, advancement in cleaner production technologies, the imposition of carbon taxes on dirty production, and environmental certifications, are a few possible remedies that achieve healthcare sustainability agenda globally.

Matched MeSH terms: Health Expenditures
Assessing progressivity of out-of-pocket payment: with illustration to Malaysia

Yu CP, Whynes DK, Sach TH

Int J Health Plann Manage, 2006 10 19;21(3):193-210.
PMID: 17044546

Throughout the world, policy makers are considering or implementing financing strategies that are likely to have a substantial impact on the equity of health financing. The assessment of the equity implication is clearly important, given the potential impact that alternative finance sources have on households. Households incur out-of-pocket payment directly from their budget, apart from their public or private insurance. Out-of-pocket payment is the primary concern, given their undesirable impact on households. Progressivity measures departures from proportionality in the relationship between out-of-pocket payment and ability to pay. It is the most frequently used yardstick to assess the equity of out-of-pocket payments in empirical studies. This paper provides an evaluation of such progressivity measures, undertaken using four approaches (proportion approach, tabulation approach, concentration curve and Kakwani's index), in order to reveal their usefulness and underlying notion. It is illustrated empirically with data on out-of-pocket payment for health care in Malaysia for 1998/ 1999, based on the nationally representative Household Expenditure Survey. Results indicate that out-of-pocket payments are mildly progressive, whilst the four approaches have their benefits and limitations in assessing equity implications. This analysis is of interest from a policy perspective, given Malaysia's heavy reliance on out-of-pocket payments to finance health care.

Matched MeSH terms: Health Expenditures/trends; Health Expenditures/statistics & numerical data*
Fulltext Determinants of antiretroviral therapy coverage in Sub-Saharan Africa

Furuoka F, Hoque MZ

PeerJ, 2015;3:e1496.
PMID: 26664812 DOI: 10.7717/peerj.1496

Among 35 million people living with the human immunodeficiency virus (HIV) in 2013, only 37% had access to antiretroviral therapy (ART). Despite global concerted efforts to provide the universal access to the ART treatment, the ART coverage varies among countries and regions. At present, there is a lack of systematic empirical analyses on factors that determine the ART coverage. Therefore, the current study aimed to identify the determinants of the ART coverage in 41 countries in Sub-Saharan Africa. It employed statistical analyses for this purpose. Four elements, namely, the HIV prevalence, the level of national income, the level of medical expenditure and the number of nurses, were hypothesised to determine the ART coverage. The findings revealed that among the four proposed determinants only the HIV prevalence had a statistically significant impact on the ART coverage. In other words, the HIV prevalence was the sole determinant of the ART coverage in Sub-Saharan Africa.

Matched MeSH terms: Health Expenditures
Managing post stroke hyperglycaemia: moderate glycaemic control is better? An update

Wan Sulaiman WA, Hashim HZ, Che Abdullah ST, Hoo FK, Basri H

EXCLI J, 2014;13:825-33.
PMID: 26417305

Post stroke hyperglycaemia (PSH) is prevalent in acute ischaemic stroke (AIS) patients and it has been associated with a dismal outcome of death and disability. Insulin has been proven to attenuate glucose effectively in stroke patients, thus many trials over the years had studied the efficacy of intensive treatment aiming at normalization of blood sugar level in order to improve the bleak outcomes of PSH. However, tight glycaemic control failed to be translated into clinical benefits and the outcomes are no different from the conventional approach, despite the costly healthcare expenditure invested. On the contrary, it brings more significant harm than the intended benefit, as 1 in every 9 treated patients had symptomatic hypoglycaemia. Thus, the benefits of tight glucose control, if any, are overshadowed by this potential risk of hypoglycaemia causing permanent neurological injury. Therefore, international practice guidelines recommend for less aggressive treatment to maintain blood glucose level within an appropriate range in AIS patients. However, there are limited details for stroke-specific glycaemic management and this made management of PSH particularly difficult. This review is to discuss and provide suggestions concerning glycaemic control in acute ischaemic stroke; the direction of its future prospective clinical trials and the treatment strategy required based on recent literature.

Matched MeSH terms: Health Expenditures
Fulltext How payment scheme affects patients' adherence to medications? A systematic review

Aziz H, Hatah E, Makmor Bakry M, Islahudin F

Patient Prefer Adherence, 2016;10:837-50.
PMID: 27313448 DOI: 10.2147/PPA.S103057

BACKGROUND: A previous systematic review reported that increase in patients' medication cost-sharing reduced patients' adherence to medication. However, a study among patients with medication subsidies who received medication at no cost found that medication nonadherence was also high. To our knowledge, no study has evaluated the influence of different medication payment schemes on patients' medication adherence.
OBJECTIVE: This study aims to review research reporting the influence of payment schemes and their association with patients' medication adherence behavior.
METHODS: This study was conducted using systematic review of published articles. Relevant published articles were located through three electronic databases Medline, ProQuest Medical Library, and ScienceDirect since inception to February 2015. Included articles were then reviewed and summarized narratively.
RESULTS: Of the total of 2,683 articles located, 21 were included in the final analysis. There were four types of medication payment schemes reported in the included studies: 1) out-of-pocket expenditure or copayments; 2) drug coverage or insurance benefit; 3) prescription cap; and 4) medication subsidies. Our review found that patients with "lower self-paying constraint" were more likely to adhere to their medication (adherence rate ranged between 28.5% and 94.3%). Surprisingly, the adherence rate among patients who received medication as fully subsidized was similar (rate between 34% and 84.6%) as that of other payment schemes. The studies that evaluated patients with fully subsidized payment scheme found that the medication adherence was poor among patients with nonsevere illness.
CONCLUSION: Although medication adherence was improved with the reduction of cost-sharing such as lower copayment, higher drug coverage, and prescription cap, patients with full-medication subsidies payment scheme (received medication at no cost) were also found to have poor adherence to their medication. Future studies comparing factors that may influence patients' adherence to medication among patients who received medication subsidies should be done to develop strategies to overcome medication nonadherence.
KEYWORDS: drug cost; medication adherence; medication payment scheme

Matched MeSH terms: Health Expenditures
Fulltext Editorial: on whom and how shall we spend our dollars?

Chen PCY

Med J Malaysia, 1980 Dec;35(2):102-8.
PMID: 6790916
Matched MeSH terms: Health Expenditures
Fulltext Does military spending stifle economic growth? The empirical evidence from non-OECD countries

Azam M

Heliyon, 2020 Dec;6(12):e05853.
PMID: 33426342 DOI: 10.1016/j.heliyon.2020.e05853

Undeniably, peace and long-term sustainable economic development are the prime agenda of all countries. This study aims to empirically evaluate the impact of military spending on economic growth for a panel of 35 non-OECD countries over 1988-2019. A multivariate regression model based on the augmented production function is used to achieve the objective of the study. The panel autoregressive distributed lag (ARDL)/pooled mean group (PMG) technique is employed, while, in addition the robust least squares and fixed-effect estimators are implemented for the robustness of the results. This study found a clear negative effect of military spending on economic growth. The pairwise Dumitrescu Hurlin panel causality test results exhibit bi-directional causality between military expenses and economic growth. Overall, these estimates provide strong support that military expenditure is not beneficial rather detrimental to economic growth. The empirical findings of this study suggest that policymakers need to redesign the military budget to stimulate economic growth and improve social welfare.

Matched MeSH terms: Health Expenditures
Fulltext ‘Smartfan’ – An energy saving innovation for workplace

Nur Jannah Azman, Wan Mohd Rizlan Wan Idris, Alice Shanthi

Jurnal Inovasi Malaysia, 2019;2(2):111-122.
MyJurnal

Circular 10/2016 issued by UiTM Vice-Chancellor’s office comprises a clear guideline for 2017 Strategic Budget Planning. The guidelines can help the Head of PTJ’s to plan and take necessary cost effective measures to reduce on utility expenditure especially to counter the rising monthly electricity bills related to the use of air conditioners on campuses. Looking at the figures drawn from the energy management office in UiTM Negeri Sembilan Branch, UiTM Kuala Pilah campus has spent an average of RM153, 028.88 monthly in 2016. As of August 2016, the cost of electricity consumption in UiTM Kuala Pilah has reached RM1,224,231.03. This amount has surpassed the overall approved allocation of RM 800,000.00 for 2016 electricity bill. In order to reduce spending and encourage saving, as well as responding to the ‘Energy Savings Campaign’ held at the campus level, various efforts have been taken at the departmental levels. One of the innovative products that came about from the campaign is the ‘Smartfan’ project pioneered by the Physics and Materials Science Unit. The main objective of this project is the production of a “smartfan” or a mini air conditioner which is a simple, cost-effective and an energy saving device. In addition, products and ideas from the campaign can be piloted and taken to innovative, inventions and design contests at national and international levels.

Matched MeSH terms: Health Expenditures
Estimation of national stress index using socioeconomic antecedents - a case of MIMIC model

Arshed N, Ahmad W, Munir M, Farooqi A

Psychol Health Med, 2021 Mar 21.
PMID: 33749455 DOI: 10.1080/13548506.2021.1903051

Developed economies are at the forefront of facing the brunt of non-communicable diseases (NCD). The majority of the health expenditures are routed in managing obesity and mental disorder-related patients, and there is a fall in the productivity of the distressed and NCD prone labour. Several indicators of stress are used in literature to assess its implications. However, empirically no database has maintained the longitudinal data of national stress level. This study focused on constructing the socioeconomic antecedent of non-communicable stress which is leading to several NCDs. For this Multiple Indicator and Multiple Causes (MIMIC) model is utilized for 151 countries between 2008 and 2018. The results show that macroeconomic conditions, trade, and environmental quality follow fundamentals in explaining stress. While, national stress index is a significant source of smoking and mental disorder prevalence.

Matched MeSH terms: Health Expenditures
Fulltext Sociodemographic factors as determinants of fruit and vegetable consumption in Malaysia

Lung, Wei Foon, Yong, Kang Cheah, Nor Azam Abdul Razak

Jurnal Sains Kesihatan Malaysia, 2020;18(2):19-29.
MyJurnal

The present study examines the factors affecting fruit and vegetable (FV) consumption in Malaysia. A nationally representative data that consists of a large sample size is used. Hence, the findings can provide inferential information. The present study uses secondary data from the Malaysian Household Expenditure Survey 2009/2010. The survey was carried out using a two-stage stratified sampling. The first stage was based on Enumeration Blocks, while the second stage was based on Living Quarters. A lognormal hurdle model is used to estimate the consumption decision and amount decision of FV across ethnic groups. The results suggest that household size, income, gender, marital status, age and education play significant roles in FV consumption. The probability of consuming FV and amount spent increase with household size (p

Matched MeSH terms: Health Expenditures
Fulltext A review on Malaysia's solar energy pathway towards carbon-neutral Malaysia beyond Covid'19 pandemic

Vaka M, Walvekar R, Rasheed AK, Khalid M

J Clean Prod, 2020 Nov 10;273:122834.
PMID: 32834565 DOI: 10.1016/j.jclepro.2020.122834

COVID'19 pandemic has devastated several industries and solar energy is no exception. In its economic relief package, Malaysia has announced approximately US$ 2.9 billion in expenditure for the installation of new grids, LED street lights and rooftop solar panels. The Government will also open the tender for a 1400 MW solar power project in the year 2020, which is expected to generate 5 billion ringgit (US$1.1 billion) in investments. As these measures are intended to sustain the existing growth of solar energy potential in the country, it is vital to assess its status quo. Hence, this paper aims to review the current status of renewable energy in Malaysia as well as the initiatives taken before the pandemic to promote solar photovoltaic (PV) technology to meet the energy demands through the low-carbon pathway.

Matched MeSH terms: Health Expenditures
Budget impact analysis of medicines: estimated values versus real-world evidence and the implications

Faleiros DR, Alvares-Teodoro J, Nunes da Silva E, Godman BB, Gonçalves Pereira R, Gurgel Andrade EI, et al.

Expert Rev Pharmacoecon Outcomes Res, 2021 May 27.
PMID: 33971778 DOI: 10.1080/14737167.2021.1927716

Objectives: Budget Impact Analyses (BIA) of medicines helps managers in promoting health systems' sustainability when assessing the role and value of new medicines. However, it is not clear whether BIAs typically underestimate or overestimate the impact on real-world budgets. This retroactive analysis seeks to compare estimated values obtained by a BIA and Real-World Evidence (RWE) to guide discussions.Methods: The estimated values were obtained through a BIA concerning the incorporation of adalimumab for the treatment of Rheumatoid Arthritis into the Brazilian Unified Health System (SUS) carried out retroactively and per international guidelines. RWE data was extracted from SUS computerized systems. We subsequently compared the number of treatments, costs, and Incremental Budget Impact (IBI).Results - The total number of treatments was underestimated by 10% (6,243) and the total expenditure was overestimated by 463% (US$ 4.7 billion). In five years, the total difference between the estimated values and real IBI reached US$ 1.1 billion. A current expenditure of US$ 1.0 was observed for every US$ 5.60 of estimated expenditure.Conclusion - The higher estimates from the BIA might cause decision makers to be more cautious with the introduction of a new medicine to reduce the opportunity costs for other interventions.

Matched MeSH terms: Health Expenditures
Fulltext Demand for beef in Malaysia: preference for quantity, quality or lean?

Tey, Y.S., Mad Nasir, S., Alias, R., Zainalabidin, M., Amin, M.A.

International Food Research Journal, 2008;15(3):347-353.
MyJurnal

Using the Malaysian Household Expenditure Survey 2004/2005 data, this study investigated Malaysian consumers’ preference for beef quantity, quality, and lean beef. Demand and price models that incorporated consumer socio-economic variables were estimated via two-stage least squares (2SLS). This study showed that Malaysian consumers tend to demand for more quantity rather than quality of beef products. Malaysian consumers are also more responsive to price changes rather than fat reduction in beef products. It is more profitable for beef market players to increase their production as Malaysian consumers are expected to consume increasing amounts of beef products.

Matched MeSH terms: Health Expenditures
Fulltext The introduction of subsidised health insurance for the poor in the city of Padang, Indonesia: does the gap on health payment and health service utilisation still exist?

Ade Suzana Eka Putri, Syed Mohamed Aljunid, Amrizal Muhammad Nur

Malaysian Journal of Public Health Medicine, 2015;15(3):132-138.
MyJurnal

Indonesian government secures the access of the poor towards health services through subsidised schemes. This study is aimed to describe the pattern of health expenditure by households and to describe the pattern of health service utilisation across household’s socioeconomic level in the city of Padang after seven years of the introduction of subsidised schemes. A household survey was conducted involving 918 households, with multistage random sampling method. The proportion of out-of-pocket (OOP) health spending as a share of household’s capacity to pay was regressive across consumption quintiles. The proportion of households with catastrophic health expenditure was 1.6% while 1.1% faced impoverished health expenses. Among those who need health care, the utilisation among the rich was higher than the poor. Health insurance schemes in Padang provides financial protection, however with regards to household’s capacity to pay, the poor has the higher burden of health payment. The gap on health service utilisation between the poor and the better-offs was still apparent for outpatient services and it has been narrowed for inpatient care. This study suggests that the subsidised schemes for the poor are highly needed and the possibility of the leakage of subsidies to the rich should be considered by the government.

Matched MeSH terms: Health Expenditures
Fulltext Cost implication analysis of concrete and Masonry waste in construction project

Kasvar, K.K., Nagapan, S., Abdullah, A.H., Ullah, K., Deraman, R., Yunus, R., et al.

Pertanika Journal of Science & Technology, 2017;25(105):177-184.
MyJurnal

Concrete and masonry waste are the main types of waste typically generated at a construction project. There is a lack of studies in the country regarding the cost implication of managing these types of construction waste To address this need in Malaysia, the study is carried out to measure the disposal cost of concrete and masonry waste. The study was carried out by a site visit method using an indirect measurement approach to quantify the quantity of waste generated at the project. Based on the recorded number of trips for waste collection, the total expenditure to dispose the waste were derived in three construction stages. Data was collected four times a week for the period July 2014 to July 2015. The total waste generated at the study site was 762.51 m3 and the cost incurred for the 187 truck trips required to dispose the waste generated from the project site to the nearby landfill was RM22,440.00. The findings will be useful to both researchers and policy makers concerned with construction waste.

Matched MeSH terms: Health Expenditures
Fulltext Modern medical devices and hospital decision making: a review of ethical and social considerations during the manufacture and the use of advanced medical devices

Choudhury, Shudipta

JUMMEC, 2019;22(1):1-7.
MyJurnal

Background: The adoption of technologically advanced medical devices assisted healthcare providers to
examine and treat diseases. However, technological advancements could increase the threats to safety,
security, and reliability of the devices from complications associated with manufacturing, functionality, and
the clinical application of the devices.

Aim: To examine the safety threats, cost implication, and bioethical standards of the manufacturing processes
and the functionality of advanced medical devices.

Subject and Methods: The study was a narrative review through a qualitative research methodology. The
secondary data was gathered from online databases including ProQuest, ResearchGate, CINAHL/EBSCOhost,
PubMed, and ScienceDirect, from books, journals, conference proceedings, and other web publications
between 2007 and 2017.

Results:There were safety hazards from human errors in the interpretation and the use of the advanced medical
devices. Equipment imperfections and poor processes of maintenance and procurement affected the effective
functionality of these medical devices. Healthcare expenditure was high, Social and bioethical considerations,
users’ complaints and post-market surveillance were essential in ensuring the safety of the devices and the
maintenance of quality life for the users.

Conclusion: Safety hazards and cost implications of the use of technologically advanced medical devices were
significantly high Social and bioethical standards in the manufacturing of medical devices contributed towards
the production of safer devices.

Matched MeSH terms: Health Expenditures

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