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Impact of transition to an individualised funding model on allied health support of participation opportunities

FOLEY, Kristen
ATTRILL, Stacie
MCALLISTER, Sue
BREBNER, Chris
February 2019

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Introduction: The National Disability Insurance Scheme is the new consumer-controlled funding system for people with disability in Australia, and is expected to enhance participation outcomes of people with disability. This research explored participation opportunities for people with disability during the formative period of transition to the scheme, through stakeholder accounts of changes in allied health service contexts.

 

Materials and methods: Qualitative data were generated during interviews, workshops and meetings with industry, policy, practice and education stakeholders involved in scheme services. Inductive coding explored key themes within the data. The International Classification of Functioning model was then applied as a deductive coding framework to illuminate how the scheme was perceived to be impacting participation opportunities for recipients of scheme funding.

 

Results and discussion: Using the International Classification of Functioning helped us illuminate whether changes resulting from scheme transition posed participation opportunities or barriers for scheme recipients. Research participants often framed these changes negatively, even when examples suggested that changes had removed participation barriers for scheme recipients. Some participants viewed changes as obstructing equitable and quality professional practice. We explore potential opportunities to resolve tensions that also optimise the participation outcomes of individuals who receive services through individualised funding.

Right to health: Reality of persons with spina bifida and hydrocephalus

MCPHERSON. Amy
January 2017

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"This report maps the situation of persons with SBH in relation to healthcare access and is a follow up of the CRPD Concluding Observations Art.25. Through a comprehensive survey, IF collected valuable data on the experiences, satisfaction, and perceptions of healthcare coverage of individuals with SBH across Europe. Based on its findings, the financial coverage of treatment and assistive products for patients with SBH is grossly insufficient across the EU. Europe as a whole lacks multidisciplinary care and specialised SBH teams, which translates into long waiting times and insufficient knowledge of the SBH specificities. 

Considering these findings, IF urges the EU Member States to adequately support the healthcare needs of persons with SBH, and to invest more substantially into creating multidisciplinary clinics that can help avoid preventable complications 11 and may reduce the overall burden 12 on the patient and the system. In addition, the Member States should actively support creation of the European Reference Networks as a way of improving care for persons with SBH. IF also calls on the European institutions for support in training medical professionals on rights of persons with disabilities."

Inequalities in access to health care for people with disabilities in Chile: the limits of universal health coverage

ROTAROU, Elena S
SAKELLARIOU, Dikaios
2017

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We analysed cross-sectional data collected as part of the National Socioeconomic Characterisation Survey (2013) in Chile, in order to explore if there are differences in access to health care between adult Chileans with and without disability. The study included 7459 Chilean adults with disability and 68,695 people without disability. Logistic regressions were performed in order to determine the adjusted odds ratios for the associated variables. We found that despite universal health coverage, Chileans with disabilities are more likely to report worse access to health care, even when controlling for socio-economic and demographic variables, including age, gender and income. Specifically, they are more likely to face greater difficulty arriving at a health facility, obtaining a doctor’s appointment, being attended to in a health facility, paying for treatment due to cost, and obtaining necessary medicine. Both people with and without disability are more likely to face difficulties in accessing health services if they are affiliated with the public health provider, an indication of the economic factors at play in accessing health care. This study shows that universal health coverage does not always lead to accessibility of health services and underlines the disadvantaged position of disabled people in Chile in accessing health services. While efforts have been made recently to improve equity in health care access, disability in Chile poses an additional burden on people’s access to health care, emphasising the necessity for policy to address this perpetual cycle of disadvantage for disabled people.

Stroke Rehabilitation in the Philippines: An Audit Study

Gonzalez–Suarez, Consuelo
et al
2015

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Purpose: Although cerebrovascular accident is a leading cause of mortality in the Philippines, there has never been a national survey of stroke client descriptors and rehabilitation practices. This paper reports on data from the audit of stroke care for inpatients in hospitals serviced by physiatrists.

 

Method: Audit was done of the medical records of stroke clients admitted to hospitals with rehabilitation units. Performance indicators for timely referral to rehabilitation were applied.

 

Results: A total of 1683 records were audited. The majority of clients had cerebral infarct followed by cerebral haemorrhage. The median length of stay was 7 days; stay was lengthier for haemorrhagic strokes. Only 54.1% of the clients were referred to rehabilitation, with a median delay of 3 days between admission and referral to rehabilitation. 25.4% of the clients had early referral to rehabilitation. 39.2% of the 1397 clients were referred to rehabilitation earlier than 2 days before discharge.

 

Conclusion: This Filipino study provides valuable information on stroke types and prevalence, demographics and rehabilitation practices. Despite the prevalence of post-stroke rehabilitation, it has been underutilised in the management of stroke.

Financial Access to Healthcare among Persons with Disabilities in the Kumasi Metropolis, Ghana

Badu, Eric
Opoku, Maxwell Peprah
Appiah, Seth Christopher Yaw
Agyei-Okyere, Elvis
2015

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Purpose: According to the World Health Organisation, 10% to 15% of the population of every developing country lives with disability. This amounts to about 2.4 - 3.6 million Ghanaians with disability. Since their contribution is important for the development of the country, this study aimed to assess the financial access to healthcare among persons with disabilities in the Kumasi Metropolis of Ghana.

 

Methods: A cross-sectional study, involving administration of a semi- structured questionnaire, was conducted among persons with all kinds of disabilities (physically challenged, hearing and visually impaired) in the Kumasi Metropolis. Multi-stage sampling was used to randomly select 255 persons with disabilities from 5 clusters of communities - Oforikrom, Subin, Asewase, Tafo and Asokwa. Data analysis involved descriptive and analytical statistics at 95% CI using SPSS software version 20.

 

Results: There were more male than female participants, nearly one-third of them had no formal education and 28.6% were unemployed. The average monthly expenditure on healthcare was GHC 21.46 (USD 6.0) which constituted 9.8% of the respondents’ income. Factors such as age, gender, disability type, education, employment, and whether or not they stayed with family members had significant bearing on the average monthly expenses on healthcare (p<0.05).Transportation cost, the travel distance to facilities, and the regular sources of payment for healthcare, had significant relationship with access to healthcare (p<0.05). Although about 63.5% of the respondents used the National Health Insurance Scheme as the regular source of payment for healthcare, 94.1% reported that sources of payment did not cover all their expenses and equipment.

 

Conclusion: Financial access to healthcare remains a major challenge for persons with disabilities. Measures to finance all healthcare expenses of persons with disabilities are urgently needed to improve their access to healthcare.

Nonparametric estimation of a compensating variation : the cost of disability

HANCOCK, Ruth
MORCIANO, Marcello
PUDNEY, Stephen
December 2013

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This paper proposes a nonparametric matching approach to estimation of implicit costs based on the compensating variation (CV) principle. The paper aims to introduce the matching approach, compare its properties with those of the conventional indirect parametric approach, and demonstrate its application in an important policy area. The authors apply the method to estimate the additional personal costs experienced by disabled older people in Great Britain, finding that those costs are substantial, averaging in the range £48-61 a week, compared with the mean level of state disability benefit (£28) or total public support (£47) received. Estimated costs rise strongly with the severity of disability. The authors compare the nonparametric approach with the standard parametric method, finding that the latter tends to generate large overestimates unless conditions are ideal, and recommend the nonparametric approach

ISER Working Paper Series, No. 2013-26

Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia

LAGOMARSION, G
GARABRANT, A
ADYAS, A
OTOO, N
MUGA, R
September 2012

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The implementation of national health insurance reforms designed to move towards universal health coverage by 9 low-income and lower-middle-income countries in Africa and Asia  is reported. Five countries at intermediate stages of reform (Ghana, Indonesia, the Philippines, Rwanda, and Vietnam) and four at earlier stages (India, Kenya, Mali, and Nigeria) are considered. These countries’ approaches to raising prepaid revenues, pooling risk, and purchasing services are described using the functions-of-health-systems framework. Their progress across three dimensions of coverage: who, what services, and what proportion of health costs is assessed using the coverage-box framework. Patterns in the structure of these countries’ reforms including use of tax revenues to subsidise target populations and steps towards broader risk pools are identified. Trends in progress towards universal coverage, including increasing enrolment in government health insurance and a movement towards expanded benefits packages are reported. Common, comparable indicators of progress towards universal coverage are needed.

Towards equitable access to medicines for the rural poor : analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan

WANING, Brenda
et al
December 2009

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This article examines medicines price competition that ensued in a rural village in Kyrgyzstan after the opening of a small network of non-profit pharmacies created and managed by an NGO. While the rural pharmacies were created to increase access to medicines in villages where no pharmacies existed, the project had unexpected, substantial spillover effects, spurring medicines price reductions in pharmacies quite far away

Child health : generating the will

WORLD VISION
2009

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This edition of Global Future explores the nature of political will and what is required to reduce rates of under-five mortality and realise Millennium Development Goals (MDG) four (to reduce under-five mortality) and five (to improve maternal health). Authors from around the world lay out the "why, who, what and how" of the actions needed to realise these MDGs and get more countries on track quickly. At the time of publication only 16 of the 68 countries with the highest rates of child death were on track to reach MDG four

Measuring medicine prices, availability, affordability and price components

WORLD HEALTH ORGANIZATION (WHO)
HEALTH ACTION INTERNATIONAL (HAI)
2008

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This manual is to help governments, civil society groups and others concerned about the prices of medicines to collect and analyse: medicine prices (patient prices and government procurement prices) across sectors and regions in a country; medicine availability; treatment affordability; and all price components in the supply chain from manufacturer to patient (taxes, mark-ups etc.). It is accompanied by a CD-ROM which contains a more extensive collection resources and tools, such as sample training materials, frequently asked questions, and a report template for use in developing national survey reports

Closing the gap in a generation : health equity through action on the social determinants of health|Final report of the Commission on the Social Determinants of Health

WORLD HEALTH ORGANIZATION (WHO)
2008

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This is the final report of the World Health Organization’s Commission on the Social Determinants of Health (2005-2008). The report gives three main recommendations: 1 improve daily living conditions 2. Tackle the inequitable distribution of power, money, and resources 3. Measure and understand the problem and assess the impact of action. The Commission was created to provide evidence on policies that improve health by addressing the social conditions in which people live and work. The report is addressed to WHO, national governments, civil society, and other global organizations

Cost-effectiveness analysis in health. A practical approach (2nd edition)

MUENNIG, Peter
BOUNTHAVONG, Mark
2008

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Cost-effectiveness analysis is used to evaluate medical interventions worldwide, in both developed and developing countries. This book provides process-specific instruction in a concise, structured format to provide a robust working knowledge of common methods and techniques. Each chapter includes real-world examples and tips that highlight key information. Calculations concerning disability life adjusted years are covered. The third edition contains new discussion on meta-analysis and advanced modelling techniques and a long worked example.

Act now to get malaria treament that works to Africa

COX, Ingrid
HAKAGONGAS, Laura
MAYBAUM, Jennifer
April 2003

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This report calls on international donors to join with African countries in implemeting World Health Organization (WHO) guidelines on the treatment of malaria. WHO recommends that African countries facing resistance to classical antimalarials introduce drug combinations containing artemisinin derivatives - artemisinin-based combination therapy (ACT). This report defines the malaria problem, looks at what works in malaria treatment and outlines what needs to be done to make ACT work in reality

Medicine prices : a new approach to measurement

HEALTH ACTION INTERNATIONAL (HAI)
WORLD HEALTH ORGANIZATION (WHO)
2003

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This manual describes a new approach to measuring the prices people have to pay for a selection of important medicines in different medicine outlets. The manual also describes how to collect information on price composition (taxes, mark-ups, fees) and assess the affordability and availability of medicines

The new public/private mix in health : exploring the changing landscape

SÖDERLUND, Neil
MENDOZA-ARANA, Pedro
GOUDGE, Jane
ALLIANCE FOR HEALTH POLICY AND SYSTEMS RESEARCH
Eds
2003

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This book, aimed at researchers and policy-makers in developing countries, explores strategies which may be used to develop and implement the regulation of private health care provision.
The book is divided into four sections, with examples drawn from Africa, Latin America and Asia and dealing with: regulation of private health providers; contribution of private providers to public health goals; public/private mix in health insurance; and quality and affordability of care in public and private settings

Integrating intellectual property rights and development policy : report of the commission on intellectual property rights

COMMISSION ON INTELLECTUAL PROPERTY RIGHTS (CIPR)
September 2002

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This detailed and thorough report considers whether and how intellectual property rights (IPRs) can play a role in achieving the Millenium Development Goals. It explores the potential benefits of IPRs in stimulating economic growth, and the associated benefits in terms of productivity and reduced poverty. It considers also the barriers that IPRs may present to developing economies, including discouraging invention, research, technology transfer, domestic production and driving up the costs of medicines and agricultural inputs. Key issues covered in successive chapters include: current evidence about the impact of IPRs in developing countries; development of and access to medicines; protection of plants and genetic resources; the Convention on Biological Diversity, traditional knowledge, cultural expressions and geographic indicators; copyright and patents; IPR legislation for developing countries; international and national institutional framework for IPRs

Current issues in sector-wide approaches for health development : Tanzania case study

BROWN, Adrienne
2000

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[Publisher's abstract:] A case study of experiences with an advanced sector-wide approach for health development in Tanzania, where a significant number of activities in the health sector are supported by pooled donor funds disbursed through the government system. These funds are integrated into the government budget cycle, with donors increasingly agreeing to make commitments and disbursements in line with government budgetary requirements. The case study opens with an overview of the country's economic, political, and health situation, concentrating on the implications of recent public sector and government reforms. The next section explains the financing, monitoring, and management of the country's sector-wide approach to donor coordination and budgeting. Eight strategies, adopted to improve the availability and quality of essential health services, are also briefly discussed to illustrate how adoption of a sector-wide approach can help tackle inequities in the health system. Having examined key features of the country's advanced sector-wide approach, the case study considers lessons learned and their applicability to similar efforts in other countries. Questions discussed include the importance of government leadership and ownership, the role of donor involvement in joint disbursement procedures, and the extent to which signed agreements can make donor funds more predictable. The study concludes that, despite high aid dependency, government ownership of the programme is growing, and national commitment to sector programmes and public expenditure reform has created a positive environment for expansion. The high costs of transactions and the additional administrative burden imposed on governments remain major problems

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