ržište privatnog zdravstvenog osiguranja u debatama o reformi zdravstvenog sistema u postsocijalističkim zemljama

Debates on the reform of health care fi nancing in the former socialist countries during the period of social transformation were conducted as part of a wider debate regarding changes in the overall social system. Existing financing models and innovative measures were reviewed. As part of such discussions, the voluntary health insurance market also received a lot of the attention. Diff erent views were expressed in the debates that were conducted during the 1990s, from seeing a suitable supplementary source of health care funding to those who highlighted the constraints in its implementation and modest results that can be expected. As one of the criteria for assessing the suitability of this mechanism, we could review what has been achieved so far in its application. Th e paper looks at the ground covered and the situation in the former socialist countries at the end of the second decade of this century, with particular reference to Serbia and countries in its surroundings. When it comes to Serbia it can be expected that the limiting factors from the last ten years will be still manifested in the future. It is estimated that there are weak prospects of activating voluntary health insurance as a way to alleviate the problems of insuffi cient fi nancing of the health care system.

DEVELOPMENT OF PERSONAL INSURANCE IN UKRAINE IN THE CONDITIONS OF COVID-19

The article examined the theoretical foundations of personal insurance, the basic types of personal insurance and comparison of social and personal insurance and their insurance risks. Including the current state and development of personal insurance in Ukraine in conditions of Covid-19. Analyzed the main statistical indicators of personal insurance, in particular the dynamics of life insurance companies, set of insurance premiums and insurance payments of medical and personal voluntary insurance. Rankings of life insurance companies from Covid-19 are built during the onset of the pandemic. Health care funding that provides health care fees between different groups of the population is carried out through medical insurance. World experience shows that the insurance market contributes not only to the development of the economy, but also to the solution of social problems. This reduces the effect on the expenditure part of the budget is reduced and state spending on social security of citizens, thereby opening up the possibility of solving problems of protection of the most disadvantaged groups. However, world best practices in combating pandemic Covid-19. In particular, the experience of China was considered, which showed that health insurance coverage should be provided to all to segments of the population, which greatly affected the fight against the pandemic during the fight against it. The experience of Italy showed that the country was not ready for fight against a coronavirus pandemic. The country has taken urgent measures that are aimed at supporting the most affected, both citizens and industries economics. Italian insurers offer their customers a reprieve for motor insurance, life insurance and insurance contracts entrepreneurial risks. The US experience showed that the country spends on Healthcare 11.5% of gross profit, that’s more than any country in the world. At the same time, more than 15% of citizens do not have financial protection from high costs, for medical care due to lack of insurance health policies due to high prices. The article highlights the main shortcomings and proposes certain recommendations for solving problems of personal insurance in Ukraine using certain elements of foreign experience.

Mental Health Care Funding Systems and their Impact on Access to Psychotherapy

Resource scarcity forces health care systems to set priorities and navigate trade-offs in how they choose to fund different services. Distributive justice principles can help guide health systems to fairly allocate scarce resources in a society. In most countries, mental health care and psychotherapy, in particular, tend to be under-prioritized even though psychotherapy can be an effective treatment for mental health disorders. To create ethical funding systems that support appropriate access to psychotherapy, health care funding systems must consider how they allocate and distribute health care resources through health care financing, coverage criteria, and reimbursement mechanisms. Five health care systems are assessed according to how they finance and reimburse psychotherapy. These health systems use various and often pluralistic approaches that encompass differing distributive justice principles. Although distribution priorities and values may differ, fair and transparent processes that involve all key stakeholders are vital for making ethical decisions on access and distribution.

Refugee health care funding in Canada

Due to a steady rise in the number of refugees accepted by Canada in recent years, the need for government funding to cover the health care needs of this population has similarly increased. Despite this increased need, government funding via the Interim Federal Health Program (IFHP) was cut dramatically in 2012 by the Conservative government. In 2016, the Liberal government restored full refugee health care coverage. This article provides an overview of refugee health care funding decisions in Canada over the past decade, and explores the impact that such decisions have on the health outcomes of this population. Furthermore, this article compares and contrasts refugee health care funding in Canada with that in other world regions with high refugee influx. Key potential areas for funding improvement are identified.

Zmiana liczby zgonów i trwania życia w latach 2016–2018. Przyczynek do analizy zgonów w Polsce

Since the 1990s, life expectancy at birth in Poland has increased by over three months on average each year for both sexes. However, in recent years there has been a decrease in life expectancy, and the number of deaths increased by 6% for men and 8% for women between 2016 and 2018. The aim of this study is to identify the subpopulations most sensitive to the recent changes in mortality in Poland. The increase in deaths is described with regard to changes in age distribution of the population and age at death contributing to life expectancy changes in recent years is analysed. The findings serve as a basis for making references to theoretical knowledge and proposals for future research directions as well as recommendations for public statistics and social policy. The increase in the number of deaths is a new phenomenon that cannot be accounted for by the size differences between the cohorts born between the two world wars and during the Second World War or the ageing of the baby-boom generations. The greatest contributors to the decreasing life expectancy are deaths at older age. This and the fast growing population aged 85 years and more indicate a need to devote more research attention to analysing mortality in the oldest age groups. It is also emphasised that the elderly are potentially the most prone to various threats associated with an excessive number of deaths, including inadequate health care funding.

Eficiência e financiamento nas ações em média e alta complexidade

RESUMOObjetivo: elucidar a relevância do financiamento do Sistema Único de Saúde sobre a eficiência das ações na média e alta complexidades nos serviços. Método: trata-se de um estudo bibliográfico, tipo revisão integrativa da literatura. Selecionaram-se os artigos no período de 2007 a 2016, nas bases de dados a LILACS, MEDLINE e ColecionaSUS, no idioma português. Estruturou-se a pesquisa em seis etapas metodológicas. Após a leitura sistematizada dos artigos os estudos foram analisados e apresentados em forma de figuras. Resultados: selecionaram-se três estudos que revelam que a produção científica apresentada é bastante reduzida e necessita de maior aprofundamento em relação à investigação e às inferências de contribuição para a melhoria dos processos em nível da média e alta complexidades, sobretudo nas consequências que os entraves causam aos serviços hospitalares. Conclusão: necessita-se de maior aprofundamento no tocante às lacunas existentes na atual metodologia de financiamento dos serviços para que sejam fomentadas ferramentas que possibilitem a melhoria contínua dos processos e garantam a real eficiência da distribuição de recursos para um sistema que gere resultados positivos em saúde. Descritores: Financiamento da Assistência à Saúde; Alocação de Recursos; Políticas de Saúde; Serviços de Saúde; Sistema Único de Saúde; Enfermagem.ABSTRACT Objective: to elucidate the relevance of the funding of the Unified Health System on the efficiency of medium and high complexity actions in the services. Method: it is a bibliographical study, of integrative review of the literature type. The articles were selected from 2007 to 2016, in the databases LILACS, MEDLINE and ColecionaSUS, in the Portuguese language. The research was structured in six methodological stages. After the systematized reading of the articles, the studies were analyzed and presented in the form of figures. Results: three studies were selected that show that the scientific production presented is very small and needs to be deepened in relation to the research and the inferences of contribution to the improvement of the processes in the medium and high complexity levels, especially in the consequences that the obstacles to hospital services. Conclusion: there is a need to deepen the existing gaps in the current methodology for financing services so that tools can be fostered that enable continuous improvement of processes and ensure the real efficiency of the distribution of resources to a system that generates positive health outcomes. Descriptors: Health Care Funding; Resource allocation; Health policies; Health services; Unified Health System; Nursing.RESUMEN Objetivo: elucidar la relevancia del financiamiento del Sistema Único de Salud sobre la eficiencia de las acciones en la media y alta complejidad en los servicios. Método: se trata de un estudio bibliográfico, tipo revisión integrativa de la literatura. Se seleccionaron los artículos 2007 a 2016, en las bases de datos LILACS, MEDLINE y ColecionaSUS, en el idioma portugués. Se estructuró la investigación en seis etapas metodológicas. Después de la lectura sistematizada de los artículos los estudios fueron analizados y presentados en forma de figuras. Resultados: se seleccionaron tres estudios que revelan que la producción científica presentada es bastante reducida y necesita una mayor profundización en relación a la investigación y las inferencias de contribución para la mejora de los procesos a nivel de la media y alta complejidades, sobre todo en las consecuencias que los obstáculos causan a los servicios hospitalarios. Conclusión: se necesita mayor profundización en cuanto a las lagunas existentes en la actual metodología de financiamiento de los servicios para que se fomenten herramientas que posibiliten la mejora continua de los procesos y garanticen la real eficiencia de la distribución de recursos para un sistema que genere resultados positivos en salud Descritores: Financiación de la Atención de la Salud; Asignación de Recursos; Política de Salud; Servicios de Salud; Sistema Único de Salud; Enfermería.

Secondary Prevention Three and Six Years after Stroke Using the French National Insurance Healthcare System Database

Background: Secondary prevention is inadequate in the first 2 years after stroke but what happens after that is less documented. The aim of this study was to assess the use and the adherence to preventive drugs 3 and 6 years after experiencing a transient ischemic attack (TIA) or an ischemic stroke (IS). Methods: The population study was from the AVC69 cohort (IS or TIA admitted in an emergency or stroke unit in the Rhône area, France, for an IS or a TIA during a 7-month period). Medication use was defined as ≥1 purchase during the studied year and adherence as Continuous Measure of Medication Acquisition ≥0.8 using the French medical insurance health care funding database. Results: The study population consisted of 210 patients at 3 years and 163 patients at 6 years. Medication use at 3 and 6 years was, respectively, 80.9 and 79.8% for antithrombotics, 69.1 and 66.3% for antihypertensives, 60.5 and 55.2% for statins and 48.6 and 46.6% for optimal treatment defined as the treatment achieved by the use of the 3 drugs. Adherence to each class was good at 3 years and tends to decrease at 6 years. Conclusions: More than one patient out of 2 do not use the optimal preventive treatment.

Caesarean birth rates in public and privately funded hospitals: a cross-sectional study

OBJECTIVE: To examine maternal and obstetric factors influencing births by cesarean section according to health care funding. METHODS: A cross-sectional study with data from Southeastern Brazil. Caesarean section births from February 2011 to July 2012 were included. Data were obtained from interviews with women whose care was publicly or privately funded, and from their obstetric and neonatal records. Univariate and multivariate analyses were conducted to generate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI) for caesarean section births. RESULTS: The overall caesarean section rate was 53% among 9,828 women for whom data were available, with the highest rates among women whose maternity care was privately funded. Reasons for performing a c-section were infrequently documented in women’s maternity records. The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications. Older maternal age, university education, and higher socioeconomic status were only associated with c-section in the public system. CONCLUSIONS: Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics. Maternal socioeconomic status and private healthcare funding continue to drive high rates of caesarean section births in Brazil, with women who have a higher socioeconomic status more likely to have a caesarean section birth in all birth settings.