Willingness to Pay to Improve Quality of Public Healthcare Services in Mauritius

Mauritius has a universal free healthcare system, based on the Beveridge model which is financed by taxpayers. There are growing considerations over improving quality of healthcare services. The purpose of the study is to employ a contingency valuation (CV) to investigate the willingness of Mauritians people to pay to improve the quality of public healthcare services and the associated determinants using the double-bounded dichotomous choice model. A drop off survey with a sample size of 974 respondents from the working population is used. The empirical analysis shows that the majority of the sample was willing to pay for improving quality of public healthcare services. Other than the conventional determinants of respondents’ demographic and socioeconomic characteristics, the findings support the assertion that psycho-social constructs such as the Theory of Planned Behaviour, Norm-Activation, Public Good Theory, and Perceived Response Efficacy are found to significantly affect Willingness-to-Pay (WTP). The results of this study might be of use to policymakers to help with both priority setting and fund allocation.

How Equitable Is Health Spending On Curative Services And Institutional Delivery In Malawi? Evidence From A Quasi-Longitudinal Benefit Incidence Analysis

Background: Malawi is one of a handful of countries that had resisted the implementation of user fees, showing a commitment to providing free healthcare to its population even before the concept of Universal Health Coverage (UHC) acquired global popularity. Several evaluations have investigated the effects of key policies, such as the essential health package or performance-based financing, in sustaining and expanding access to quality health services in the country. Understanding the distributional impact of health spending over time due to these policies has received limited attention. Our study fills this knowledge gap by assessing the distributional incidence of public and overall health spending between 2004 and 2016.Methods: We relied on a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies. We used data from household surveys and National Health Accounts. We used a concentration index (CI) to determine the health benefits accrued by each socioeconomic group. Results: Socioeconomic inequality in both public and overall health spending substantially decreased over time, with higher inequality observed in overall spending, non-public health facilities, curative health services, and at higher levels of care. Between 2004 and 2016, the inequality in public spending on curative services decreased from a CI of 0.037 (SE 0.013) to a CI of 0.004 (SE 0.011). Whiles, it decreased from a CI of 0.084 (SE 0.014) to a CI of 0.068 (SE 0.015) for overall spending in the same period. For institutional delivery, inequality in public and overall spending decreased between 2004 and 2016 from a CI of 0.032 (SE 0.028) to a CI of -0.057 (SE 0.014) and from a CI of 0.036 (SE 0.022) to a CI of 0.028 (SE 0.018), respectively. Conclusion: Through its free healthcare policy, Malawi has reduced socioeconomic inequality in health spending over time, but some challenges still need to be addressed to achieve a truly egalitarian health system. Our findings indicate a need to increase public funding for the health sector to ensure access to care and financial protection.

Infant and Young Child Feeding Practices among Mothers in Lahore, Pakistan: A Cross-Sectional Study

Background: Inadequate child feeding practices lead to malnutrition, higher under-five mortality rates and adverse effects on quality of life. This study aimed to assess the breastfeeding and complementary feeding practices of mothers as well as the influence of various sociodemographic factors on them in local families of Lahore. Methods: This is a cross-sectional, descriptive study. It was conducted in CMH (Combined Military Hospital), Lahore in 2018. It comprises a sample of 203 mothers with children of at least two years of age, from various urban areas of Lahore. The subjects were selected on the basis of the inclusion criteria. Mothers with psychiatric illnesses and children with congenital anomalies were excluded from the study. Mothers were approached in the paediatric outpatient departments of four tertiary care hospitals of Lahore. Responses were recorded using a modified version of the Action Contre La Faim (ACF) questionnaire. Independent sample t-test and chi-square test were applied for analysis of the data. Results: Early initiation of breastfeeding within one hour from birth was observed in 83.3% children. Most children were administered colostrum (69.5%). The rate of exclusive breastfeeding for the first six months was 45.3%. A child was being breastfed 8.21 ± 6.67 (mean ± SD) times a day. Maternal educational status, total number of adults in a household, and access to free healthcare were identified as important factors influencing the practice of breastfeeding. Porridge, khichdi, eggs, fruit and yoghurt were the most frequently used complementary foods. Conclusions: A high rate of an early start of breastfeeding and a low rate of exclusive breastfeeding for at least six months were predominant in our population. Administration of colostrum was observed in approximately two-thirds of the study participants. Education of the mother, type of the family system (nuclear or combined), and access to free healthcare strongly influence the breastfeeding practices.

Policy implementation analysis on access to healthcare among undocumented immigrants in seven autonomous communities of Spain, 2012–2018

BackgroundIn 2012, the Government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 excluding undocumented immigrants from publicly funded healthcare services. We conducted a policy implementation analysis to describe and evaluate the legal and regulatory actions taken at the autonomous community (AC) level after enactment of 2012 RDL and RD and their impact on access to general healthcare and HIV services among undocumented immigrants.MethodsWe reviewed documents published by the governments of seven ACs (Andalucía, Aragón, Euskadi (Basque Country), Castilla-La Mancha, Galicia, Madrid, Valencia) from April 2012 to July 2018, describing circumstances under which undocumented immigrants would be able to access free healthcare services. We developed indicators according to the main systemic barriers presented in official documents to analyse access to free healthcare across the participating ACs. ACs were grouped under five access categories: high, medium-high, medium, medium-low and low.ResultsAndalucía provided the highest access to free healthcare for undocumented immigrants in both general care and HIV treatment. Medium-high access was provided by Euskadi and medium access by Aragón, Madrid and Valencia. Castilla-La Mancha provided medium-low access. Galicia had low access. Only Madrid and Galicia provided different and higher level of access to undocumented migrants in HIV care compared with general healthcare.ConclusionsImplementation of 2012 RDL and RD across the ACs varied significantly, in part due to the decentralisation of the Spanish healthcare system. The challenge of healthcare access among undocumented immigrants included persistent systemic restrictions, frequent and unclear rule changes, and the need to navigate differences across ACs of Spain.

Socioeconomic inequalities in curative healthcare-seeking for children under five before and after the free healthcare initiative in Sierra Leone: analysis of population-based survey data

Background Socioeconomic inequalities between and within countries lead to disparities in the use of health services. These disparities could lead to child mortality in children under 5 years by depriving them of healthcare. Therefore, initiatives to remove healthcare fees such as the Free Healthcare Initiative (FHCI) adopted in Sierra Leone can contribute to reducing these inequities in healthcare-seeking for children. This study aimed to assess the socioeconomic inequalities in healthcare-seeking for children under 5 years of age before and after the implementation of the FHCI. Methods Data were included on 1207, 2815, 1633, and 1476 children under 5 years of age with fever from the 2008, 2013, 2016, and 2019 nationwide surveys, respectively. Concentration curves were drawn for the period before (2008) and after (2013–2019) the implementation of the FHCI to assess socioeconomic inequalities in healthcare-seeking. Finally, Erreyger’s corrected concentration indices were calculated to understand the magnitude of these inequalities. Results Before the implementation of the FHCI, there were inequalities in healthcare-seeking for children under five (Erreyger’s corrected concentration index (CI) = 0.168, standard error (SE) = 0.049; p < 0.001) in favor of the wealthy households. These inequalities decreased after the implementation of the FHCI (CI = 0.061, SE = 0.033; p = 0.06 in 2013, CI = 0.039, SE = 0.04; p = 0.32 in 2016, and CI = − 0.0005, SE = 0.362; p = 0.98 in 2019). Furthermore, before the implementation of the FHCI, a significant pro-rich inequality in the districts of Kenema (CI = 0.117, SE = 0.168, p = 0.021), Kono (CI = 0.175, SE = 0.078, p = 0.028) and Western Area Urban (CI = 0.070, SE = 0.032, p = 0.031) has been observed. After the implementation of the FHCI in 2019, these disparities were reduced, 11 of the 14 districts had a CI around the value of equality, and only in 2 districts the pro-rich inequality were significant (Western Area Urban (CI = 0.035, SE = 0.016, p = 0.039) and Western Area Rural (CI = 0.066, SE = 0.030, p = 0.027)). Conclusion The results of this study demonstrated that socio-economic inequalities in healthcare-seeking for children have been considerably reduced after the FHCI in Sierra Leone. To further reduce these inequalities, policy actions can focus on the increase of availability of health services in the districts where the healthcare-seeking remained pro-rich.

SARS-CoV-2 Screening Among Symptom-Free Healthcare Workers

ABSTRACT Transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is possible among symptom-free individuals. Patients are avoiding medically necessary healthcare visits for fear of becoming infected in the healthcare setting. We screened 489 symptom-free healthcare workers for SARS-CoV-2 and found no positive results, strongly suggesting the prevalence of SARS-CoV-2 was <1%.

A Moral Perspective on Refugee Healthcare

There is currently an increasing number of international refugees due to political warfare and natural calamities. Over the recent years, countries are shying away from assisting with the provision of healthcare to this vulnerable population either in their home country through humanitarian aid and services or in the host country by providing free healthcare coverage. World leaders and politicians have attempted to ignore the morality behind these decisions and have put forth a false narrative of scarcity and racism to appeal to the population of developed countries. As this question remains unsolved, we have attempted to look at the question from the perspective of our moral obligations as a species. We have discussed some of the popular moral theories that support providing healthcare services to global refugees and refuted theories that object to the same. We conclude with a brief look at the direction that countries could take without violating established moral code while attempting (without evidence) to prioritize the welfare of their citizens.