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The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion.

ABSTRACT:

SUBMITTER: Bukhman G

PROVIDER: S-EPMC7489932 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion.

Bukhman Gene G Mocumbi Ana O AO Atun Rifat R Becker Anne E AE Bhutta Zulfiqar Z Binagwaho Agnes A Clinton Chelsea C Coates Matthew M MM Dain Katie K Ezzati Majid M Gottlieb Gary G Gupta Indrani I Gupta Neil N Hyder Adnan A AA Jain Yogesh Y Kruk Margaret E ME Makani Julie J Marx Andrew A Miranda J Jaime JJ Norheim Ole F OF Nugent Rachel R Roy Nobhojit N Stefan Cristina C Wallis Lee L Mayosi Bongani B

Lancet (London, England) 20200914 10256

PMID: 32941823

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Project description:BackgroundIndia recently launched the largest universal health coverage scheme in the world to address the gaps in providing healthcare to its population. Health technology assessment (HTA) has been recognised as a tool for setting priorities as the government seeks to increase public health expenditure. This study aims to understand the current situation for healthcare decision-making in India and deliberate on the opportunities for introducing HTA in the country.MethodsA paper-based questionnaire, adapted from a survey developed by the International Decision Support Initiative (iDSI), was administered on the second day of the Topic Selection Workshop that was conducted as part of the HTA Awareness Raising Workshop held in New Delhi on 25-27 July, 2016. Participants were invited to respond to questions covering the need, demand and supply for HTA in their context as well as the role of their organisation vis-à-vis HTA. The response rate for the survey was about 68% with 41 participants having completed the survey.ResultsThree quarters of the respondents (71%) stated that the government allocated healthcare resources on the basis of expert opinion. Most respondents indicated reimbursement of individual health technologies and designing a basic health benefit package (93% each) were important health policy areas while medical devices and screening programmes were cited as important technologies (98% and 92%, respectively). More than half of the respondents noted that relevant local data was either not available or was limited. Finally, technical capacity was seen as a strength and a constraint facing organisations.ConclusionThe findings from this study shed light on the current situation, the opportunities, including potential topics, and challenges in conducting HTA in India. There are limitations to the study and further studies may need to be conducted to inform the role that HTA will play in the design or implementation of universal health coverage in India.

Project description:IntroductionThe poorest in Burkina Faso face numerous barriers to healthcare access, including financial and geographic obstacles, as well as a high burden of chronic conditions and multimorbidity. This study estimates the average cost of providing curative outpatient consultations at first-level healthcare facilities to the poorest in Burkina Faso. It also estimates the budgetary impact of scaling up free access to these services nationwide. The findings provide essential evidence on cost structures to inform decision-makers in developing policies aimed at achieving universal health coverage and ensuring that no one is left behind.MethodsWe conducted a micro-costing study to estimate the economic costs of providing curative outpatient healthcare services to the poorest at first-level healthcare facilities, considering a health system perspective. We measured the consumption of capital costs (building and equipment) using survey data from 32 primary health facilities and recurrent costs (drugs and consumables) from medical records of 1380 poor patients in Diébougou district. These individuals were targeted and exempted from user fees through a community-based targeting approach. We obtained unit costs from official price lists, pharmacy registries, and expert interviews. We calculated the national budget for providing curative care services to the exempted poorest based on the average cost per first-level consultation.ResultsThe estimated capital and recurrent costs of providing curative care services ranged between USD 0.59 - USD 0.61 and USD 2.58 - USD 5.00, respectively. The total cost ranged between USD 3.17 - USD 5.61 per first-level consultation. Providing curative care to the bottom 20% of the population, assuming 0.25 healthcare contacts per person per year, would result in an annual expense ranging from USD 2.77 M to USD 5.38 M (0.74-1.43% of the healthcare budget in 2019). With 2 healthcare contacts per person per year, costs increase to USD 22.19 M to USD 43.05 M (5.91-11.45% of the healthcare budget).ConclusionThe results can inform policies aimed at expanding access to curative care for the poorest in Burkina Faso, contributing to the goals of universal health coverage and leaving no one behind. Further research is needed to enhance cost estimation and budgeting for higher-level care in the country.

Dataset Information

The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion.

Publications

The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion.

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