Comparing Public and Provider Preferences for Setting Healthcare Priorities: Evidence from Kuwait

As attempts are made to allocate health resources more efficiently, understanding the acceptability of these changes is essential. This study aims to compare the priorities of the public with those of health service providers in Kuwait. It also aims to compare the perceptions of both groups regarding key health policies in the country. Members of the general public and a sample of health service providers, including physicians, dentists, nurses, and technicians, were randomly selected to complete a structured, self-administered questionnaire. They were asked to rank health services by their perceived importance, rank preferred sources of additional health funding, and share their perceptions of the current allocation of health resources, including current healthcare spending choices and the adequacy of total resources allocated to healthcare. They were also asked for their perception of the current local policies on sending patients abroad for certain types of treatments and the policy of providing private health insurance for retirees. The response rate was above 75% for both groups. A higher tax on cigarettes was preferred by 73% of service providers as a source of additional funding for healthcare services, while 59% of the general public group chose the same option. When asked about the sufficiency of public sector health funding, 26.5% of the general public thought that resources were sufficient to meet all healthcare needs, compared with 40% of service providers. The belief that the public should be offered more opportunities to influence health resource allocation was held by 56% of the general public and 75% of service providers. More than half of the respondents from both groups believed that the policy on sending patients abroad was expensive, misused, and politically driven. Almost 64% of the general public stated that the provision of private health insurance for retirees was a ‘good’ policy, while only 34% of service providers agreed with this statement. This study showed similarities and differences between the general public and health service providers’ preferences. Both groups showed a preference for treating the young rather than the old. The general public preferred more expensive health services that had immediate effects rather than health promotion activities with delayed benefits and health services for the elderly. These findings suggest that the general public may not accept common allocative efficiency improvements in public health spending unless the challenges in this sector and the gains from reallocation are clearly communicated

The contributions of public health policies and healthcare quality to gender gap and country differences in life expectancy in the UK

Background: In many high-income countries, life expectancy (LE) has increased, with women outliving men. This gender gap in LE (GGLE) has been explained with biological factors, healthy behaviours, health status, and sociodemographic characteristics, but little attention has been paid to the role of public health policies that include/affect these factors. This study aimed to assess the contributions of avoidable causes of death, as a measure of public health policies and healthcare quality impacts, to the GGLE and its temporal changes in the UK. We also estimated the contributions of avoidable causes of death into the gap in LE between countries in the UK. // Methods: We obtained annual data on underlying causes of death by age and sex from the World Health Organization mortality database for the periods 2001–2003 and 2014–2016. We calculated LE at birth using abridged life tables. We applied Arriaga’s decomposition method to compute the age- and cause-specific contributions into the GGLE in each period and its changes between two periods as well as the cross-country gap in LE in the 2014–2016 period. // Results: Avoidable causes had greater contributions than non-avoidable causes to the GGLE in both periods (62% in 2001–2003 and 54% in 2014–2016) in the UK. Among avoidable causes, ischaemic heart disease (IHD) followed by injuries had the greatest contributions to the GGLE in both periods. On average, the GGLE across the UK narrowed by about 1.0 year between 2001–2003 and 2014–2016 and three avoidable causes of IHD, lung cancer, and injuries accounted for about 0.8 years of this reduction. England & Wales had the greatest LE for both sexes in 2014–2016. Among avoidable causes, injuries in men and lung cancer in women had the largest contributions to the LE advantage in England & Wales compared to Northern Ireland, while drug-related deaths compared to Scotland in both sexes. // Conclusion: With avoidable causes, particularly preventable deaths, substantially contributing to the gender and cross-country gaps in LE, our results suggest the need for behavioural changes by implementing targeted public health programmes, particularly targeting younger men from Scotland and Northern Ireland

Pure and social disparities in distribution of dentists: a cross-sectional province-based study in Iran

During past decades, the number of dentists has continuously increased in Iran. Beside the quantity, the distribution of dentists affects the oral health status of population. The current study aimed to assess the pure and social disparities in distribution of dentists across the provinces in Iran in 2009. Data on provinces' characteristics, including population and social situation, were obtained from multiple sources. The disparity measures (including Gini coefficient, index of dissimilarity, Gaswirth index of disparity and relative index of inequality (RII)) and pairwise correlations were used to evaluate the pure and social disparities in the number of dentists in Iran. On average, there were 28 dentists per 100,000 population in the country. There were substantial pure disparities in the distribution of dentists across the provinces in Iran. The unadjusted and adjusted RII values were 3.82 and 2.13, respectively; indicating area social disparity in favor of people in better-off provinces. There were strong positive correlations between density of dentists and better social rank. It is suggested that the results of this study should be considered in conducting plans for redistribution of dentists in the country. In addition, further analyses are needed to explain these disparities

Learning Online: A Case Study Exploring Student Perceptions and Experience of a Course in Economic Evaluation

This study explored the perceptions and experiences of a group of students enrolled in an online course in Economic Evaluation. A mixed methods approach was adopted for the data collection, and thematic analysis was used to synthesize the data collected and highlight key findings. The participants identified several positive and negative perceived attributes of online learning, many of which are well documented in the literature. In addition, after exposure to the course, participants reported several factors that affected their learning experience on this course, some of which have not yet been reported in the wider literature. The five main factors affecting learning on this course include; 1) Pace of learning in an online environment, 2) Learning style, 3) Immediacy of feedback, 4) Method of content delivery, and 5) Issues around navigating content. These findings could help improve online teaching practice and learning quality in future courses

Cost and cost-effectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: a protocol for a systematic review

INTRODUCTION: Type 2 diabetes mellitus (T2DM) remains one of the most common chronic diseases of adulthood which creates high degrees of morbidity and mortality worldwide. The incidence of T2DM continues to rise and recently, mHealth interventions have been increasingly used in the prevention, monitoring and management of T2DM. The aim of this study is to systematically review the published evidence on cost and cost-effectiveness of mHealth interventions for T2DM, as well as assess the quality of reporting of the evidence. METHODS AND ANALYSIS: A comprehensive review of PubMed, EMBASE, Science Direct and Web of Science of articles published until January 2019 will be conducted. Included studies will be partial or full economic evaluations which provide cost or cost-effectiveness results for mHealth interventions targeting individuals diagnosed with, or at risk of, T2DM. The quality of reporting evidence will be assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results will be presented using a flowchart following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Graphical and tabulated representations of the results will be created for both descriptive and numerical results. The cost and cost-effectiveness values will be presented as reported by the original studies as well as converted into international dollars to allow comparability. As we are predicting heterogenous results, we will conduct a narrative and interpretive analysis of the data. ETHICS AND DISSEMINATION: No formal approval or review of ethics is required for this systematic review as it will involve the collection and analysis of secondary data. This protocol follows the current PRISMA-P guidelines. The review will provide information on the cost and cost-effectiveness of mHealth interventions targeting T2DM. These results will be disseminated through publication and submission to conferences for presentations and posters. PROSPERO REGISTRATION NUMBER: CRD42019123476

Cost effectiveness of HIV and sexual reproductive health interventions targeting sex workers: a systematic review

BACKGROUND: Sex workers have high incidences of HIV and other sexually transmitted diseases. Although, interventions targeting sex workers have shown to be effective, evidence on which strategies are most cost-effective is limited. This study aims to systematically review evidence on the cost-effectiveness of sexual health interventions for sex workers on a global level. It also evaluates the quality of available evidence and summarizes the drivers of cost effectiveness. METHODS: A search of published articles until May 2018 was conducted. A search strategy consisted of key words, MeSH terms and other free text terms related to economic evaluation, sex workers and sexual and reproductive health (SRH) was developed to conduct literature search on Medline, Web of Science, Econlit and the NHS Economic Evaluation Database. The quality of reporting the evidence was evaluated using the CHEERS checklist and drivers of cost-effectiveness were reported. RESULTS: Overall, 19 studies met the inclusion criteria. The majority of the studies were based in middle-income countries and only three in low-income settings. Most of the studies were conducted in Asia and only a handful in Sub-Saharan Africa and Latin America. The reviewed studies mainly evaluated the integrated interventions, i.e. interventions consisted a combination of biomedical, structural or behavioural components. All interventions, except for one, were highly cost-effective. The reporting quality of the evidence was relatively good. The strongest drivers of cost-effectiveness, reported in the studies, were HIV prevalence, number of partners per sex worker and commodity costs. Furthermore, interventions integrated into existing health programs were shown to be most cost-effective. CONCLUSION: This review found that there is limited economic evidence on HIV and SRH interventions targeting sex workers. The available evidence indicates that the majority of the HIV and SRH interventions targeting sex workers are highly cost-effective, however, more effort should be devoted to improving the quality of conducting and reporting cost-effectiveness evidence for these interventions to make them usable in policy making. This review identified potential factors that affect the cost-effectiveness and can provide useful information for policy makers when designing and implementing such interventions

Economic and Gender Inequalities are Important Determinants of Anaemia and Acute Malnutrition in Children aged <5 years in Low- and Middle-Income Countries

Background: Poverty is a known determinant of malnutrition, especially in less-affluent countries. However the large variance in malnutrition, prevalence noted across these countries cannot be fully explained by differences in national wealth alone. Therefore, additional socioeconomic factors e.g. inequalities, are likely to also contribute towards this variance. This study aimed to explore the possible associations between economic and gender inequalities with malnutrition in children aged <5years, specifically anaemia and global acute malnutrition (GAM), using data from Low and Middle-Income Countries. / Methods: Anaemia and GAM prevalence data was obtained for 48 countries from the DHS STATcompiler and for 7 countries for which this data was unavailable, it was obtained from the World Bank, WHO and UNICEF data. The World Bank’s Gini Index and UNDP’s Gender Inequality Index (GII) were used to measure economic inequality and gender inequality respectively. The World Bank’s GDP/Capita adjusted for purchasing power parity was used as the measure of countries’ wealth.Maternal biological factors (average women’s height, total fertility rate and maternal age at first birth) and demographic factors (women’s literacy rate and percentage of people living in urban settings) were mostly obtained from the DHS STATcompiler, with some few from the World Bank databases. Concentration curves and indices were used to measure and display the magnitude of inequalities in the distribution of anaemia and GAM across countries, when ranked by Human Development Index (HDI) and GII. Associations between GII and income inequality and anaemia and GAM were explored, separately, using linear regression. The associations were later adjusted for countries’ wealth and maternal biological and demographic factors. A final multivariable model was constructed, each for anaemia and GAM, including all significant factors observed in the initial analysis. / Results: When ranked by GII, the prevalence distribution of both anaemia and GAM were highly unequal across countries, being higher and lower in countries with high and low GII scores respectively. A similar pattern was observed when ranking by HDI, with malnutrition prevalence concentrating more in countries with lower HDI scores. After adjusting for country’s wealth level and maternal biological and demographic factors, GII showed a significant, independent and positive association with anaemia prevalence, explaining 50% of the variance between countries. The Gini index showed a significant, independent and negative association with GAM, explaining about 30% of the variance. Conclusions: Gender inequality and/or low women’s status in society may explain, independently, the high anaemia prevalence in many low- and middle-income countries. In contrast, poverty appears to be more important than income inequality for explaining GAM prevalence. Future analysis using a larger sample of countries, or using multilevel modelling for analysis, may provide further insights into the associations between wealth and inequalities and the global burden of malnutrition