Suchergebnisse

This study aimed to find out which countries around the world require psychosocial hazards and workplace violence to be assessed by employers through a mandatory occupational risk assessment process and to compare the type of legislation between countries. We systematically searched the International Labour Office (ILO) &ldquo ; LEGOSH&rdquo ; database for documents published during the period between December 2017 and February 2018. The search included 132 countries, of which 23 were considered as developed and 109 as developing according to the United Nations. Our review showed that most countries (85, i.e., 64%) have not included mandatory psychosocial risk assessment and prevention in their national occupational safety and health legislation. Moreover, we found differences between developed and developing countries, showing that developed countries more frequently have legislative measures. Within developed countries, we also found differences between countries following the Scandinavian model of workplace health and safety culture and other countries. Moreover, in many countries, workplace violence was prohibited only if it involves an offence to moral or religious customs. In conclusion, the marked difference in psychosocial hazards and workplace violence regulations among countries leads to unequal levels of workers&rsquo ; protection, with adverse effects on global health.

(1) Background: Health insurance and social protection in Myanmar are negligible, which leaves many citizens at risk of financial hardship in case of a serious illness. The aim of this study is to explore the views of healthcare consumers and compare them to the views of key informants on the design and implementation of a nationwide health insurance system in Myanmar. (2) Method: Data were collected through nine focus group discussions with healthcare consumers and six semi-structured interviews with key health system informants. (3) Results: The consumers supported a mandatory basic health insurance and voluntary supplementary health insurance. Tax-based funding was suggested as an option that can help to enhance healthcare utilization among the poor and vulnerable groups. However, a fully tax-based funding was perceived to have limited chances of success given the low level of government resources available. Community-based insurance, where community members pool money in a healthcare fund, was seen as more appropriate for the rural areas. (4) Conclusion: This study suggests a healthcare financing mechanism based on a mixed insurance model for the creation of nationwide health insurance. Further inquiry into the feasibility of the vital aspects of the nationwide health insurance is needed.

Due to rapid demographic ageing and to sustain its pension system, the Netherlands recently initiated a pension reform that increased the retirement age, with the intention to increase labour force participation among older workers. However, there is little evidence on the preferences of workers concerning their retirement age, and on how these preferences have changed over time. To identify personal and work-related determinants of the preference toward earlier or later retirement, and how these determinants and preferences have changed over time. We use data from three consecutive measurements (waves) of a large Dutch panel. Ordered logit regression is used to investigate the predictors of retirement preferences. Analyses are performed for two groups; all workers and a subsample of workers aged 50 years or older. Furthermore, the analyses are performed for each wave separately and for the combined dataset. A preference for later retirement is primarily related to university education, high job satisfaction, and high income. Age is only positively related to later retirement among older workers. Earlier retirement is preferred by female workers and workers living with a partner. The preference toward an earlier retirement age has increased over time. The preferences toward retirement can be primarily explained by personal characteristics, job satisfaction, and net income. Furthermore, with the increase in the retirement age defined by current legislation, the preference for an earlier retirement age has increased over time.

BACKGROUND: Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality worldwide. Over three quarters of the cardiovascular deaths take place in low and middle-income countries. Despite the benefits, Cardiac Rehabilitation (CR) is still not routinely and not universally available. Numerous studies have found that barriers to access to CR are correlated with providers, patients and environment characteristics. This first national survey on CR in Lebanon assesses the knowledge, attitudes and practices among physicians. In addition, the study identifies what the main barriers to access to CR are and provides suggestions for the implementation of CR in the country. RESULTS: The response rate was 41.5% (n = 83). Results show that the cardiologists have medium level of knowledge about CR and its multidisciplinary content. Physicians support the implementation of a comprehensive CR program in the country. 50% of the physicians recommended first to solve the financial issues before implementing a CR program. Supplementary learning about the benefits of CR is highly recommended to enroll more patients with CVD into CR. In addition, the lack of specialists in the field, lack of motivation for patients to enroll to CR and inconvenient location of the rehabilitation centers were identified as major barriers by the respondents. CONCLUSIONS: The role of physicians in promoting patient enrolment should be optimized and exploited in the country. The access barriers identified can help to develop CR programs and to improve CR referral and enrolment rates. Funds from private parties and a budget from the government are needed to launch new CR programs in the country. Further research is needed to provide evidence on the CR benefits in Lebanon and to motivate policy-makers to place priority on the establishment of a comprehensive CR program in the country. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43044-021-00212-2.

BACKGROUND AND AIMS: In line with the decentralization policy, in 2009, the central government of Burkina Faso issued a decree to transfer health resources to local governments for fulfilling their new responsibilities in health care provision. The first stage of this health care decentralization process involved the basic health care facilities, composed of primary health care facilities, maternities, dispensaries, maternal and child health centers, and essential drugs depots. This study seeks to explore the strengths, weaknesses, opportunities, and threats (SWOT) associated with the health resources transfer in Burkina Faso, from the perspective of decision makers. METHODS: We used a qualitative research approach. We conducted 17 semistructured interviews with 17 representatives of key decision‐making groups, in August to December 2017 in Burkina Faso. The participants included mayors of municipalities, health district managers, policy decision makers, and donors/partners. The data collected were subjected to a directed qualitative content analysis, and the SWOT framework was used to select themes and codes for the analysis. RESULTS: The most cited strength was the improvement of local governance, which also creates the opportunity for an enhanced partnership and decentralized cooperation. As expected, however, the limited financial capacity of local governments is an important weakness. Furthermore, misuse of financial resources threatens the resources transfer. Recommendations to improve decentralization and health resources transfer included effective enforcement of decentralization's laws and policies, strengthening local governments' capacities, adequate funding, and evaluation of the resources transfer process. CONCLUSIONS: An analysis of the preconditions for a successful resources transfer is needed to provide guidance to policy.

Abstract Background Informal payments for health care services can impose financial hardship on households. Many studies have found that the position within the household can influence the decision on how much is spent on each household member. This study analyses the intra-household differences in spending on informal payments for health care services by comparing the resources allocated between household heads, spouses and children. Methods Pooled data from two cross sectional surveys, the Albanian Living Standard Measurement Survey 2002 and 2005, are used to analyse both the probability and the amount paid in inpatient and outpatient health care services. A generalised Hausman specification test is used to compare the coefficients of probit and OLS models for nuclear and extended households. Results We find that due to the widespread informal payments there are no significant differences between households in the incidence of informal payments for households' members, but there are more differences in the amount paid informally. Results suggest that households strategically allocate their resources on health care by favouring individuals with higher earning potential who have invested more in human capital. Extended households pay higher amounts for spouses with higher education compared to nuclear households. On the other hand, nuclear households choose to pay higher amounts for children with a higher level of education compared to extended households. Conclusions The differences between households should be taken into account by public policies which should compensate this by redistribution mechanisms targeting disadvantaged groups. Governments should implement effective measures to deal with informal patient payments. JEL Codes: I10, I19, D10

BackgroundEquitable use of reproductive health care services is of critical importance since it may affect women's and children's health. Policies to reduce inequality in access to reproductive health care services are often general and frequently benefit the richer population. This is known as the inverse equity situation. We analyzed the magnitude and trends in wealth-related inequalities in the use of family planning, antenatal and delivery care services in Ghana and Nigeria. We also investigate horizontal inequalities in the determinants of reproductive health care service use over the years.MethodsWe use data from Ghana's (2003, 2008 and 2014) and Nigeria's (2003, 2008 and 2013) Demographic and Health Surveys. We use concentration curves and concentration indices to measure the magnitude of socioeconomic-related inequalities and horizontal inequality in the use of reproductive health care services.ResultsExposure to family planning information via mass media, antenatal care at private facilities are more often used by women in wealthier households. Health worker's assistance during pregnancy outside a facility, antenatal care at government facilities, childbirth at home are more prevalent among women in poor households in both Ghana and Nigeria. Caesarean section is unequally spread to the disadvantage of women in poorer households in Ghana and Nigeria. In Nigeria, women in wealthier households have considerably more unmet needs for family planning than in Ghana. Country inequality was persistent over time and women in poorer households in Nigeria experienced changes that are more inequitable over the years.ConclusionWe observe horizontal inequalities among women who use reproductive health care. These inequalities did not reduce substantially over the years. The gains made in reducing inequality in use of reproductive health care services are short-lived and erode over time, usually before the poorest population group can benefit. To reduce inequality in reproductive health care use, interventions should ...

OBJECTIVE: Our study explores the knowledge, perceptions, willingness to pay, and preferences of potential health insurance beneficiaries about health insurance in Myanmar. METHODS: Cross‐sectional survey data were collected among two samples: the general population and Social Security Scheme (SSS) member. Mann‐Whitney U test and independent sample t test were applied to compare the two samples. The data on willingness to pay for health insurance were analyzed using regression analysis. RESULTS: Low level of knowledge and weak positive perception are found in both samples. More than 90% of the SSS sample and 75% of the general sample are willing to pay health insurance premiums. The largest shares of both samples are willing to pay for monthly premiums between 2000 and 4000 MMK (1.8‐3.6 USD). Health status, age, gender, income, and trust are significantly associated with willingness to pay for health insurance among general sample while occupation, civil status, income, and positive perception on prepayment principle are found among SSS sample. CONCLUSIONS: The government of Myanmar should be aware of the preferences of beneficiaries to pay a relatively low level of monthly health insurance premiums without co‐payment.

AbstractWomen and children suffer worse health outcomes during armed conflicts. For more than a decade, Northern Nigeria has been facing one of the most violent armed conflicts in sub‐Saharan Africa. Studies on the conflict's impact on healthcare utilization in the area are few. The aim of this study is to explore the effect of the protracted armed conflicts on healthcare utilization, measured by maternal care and child immunization, in Northern Nigeria. Data from the Armed Conflict Location and Events Data set are spatially merged to birth records from the Nigerian Demographic and Health Survey. An area is classified to be a conflict cluster if it is within a 5–10 km radius of conflict event(s) with at least one fatality. The difference‐in‐differences method is applied to estimate the effect of the armed conflicts on healthcare utilization in the area. We find that residing within a conflict cluster significantly reduces the probability of utilization of healthcare services. We conclude that robust policies and strategies to mitigate the adverse effects of the armed conflicts on healthcare delivery are necessary for the short run. In the long run, systematic efforts to identify and address the root causes of the conflict with a view to finding a lasting solution are necessary to improve health‐care utilization in conflict‐affected areas.

Maternal health outcomes in Central and Eastern Europe (CEE) compare unfavorable with those in Western Europe, despite macro-indicators that suggest well-designed maternal care systems. However, macro-indicators at the system level only capture capacity, funding and utilization of care and not the actual allocation of financial and human resources, the quality of care and access to it. It is these latter which are problematic in the CEE region. In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care. This study uses a qualitative systematic literature review, analyzing information of peer-reviewed articles published since 2004. Other inclusion criteria included language, setting and publication purpose. The included articles were analyzed using a framework analysis technique and quality was assessed using standardized evaluation checklists. Results indicate improvements in maternal care. However, availability of care is limited by outdated equipment and training curricula, and the lack of professionals and pharmaceuticals. Geographical distance to healthcare institutions, inappropriate communication of providers and waiting times are the main approachability barriers. Some mothers are unaware of the importance of care or are discouraged to utilize healthcare services because of cultural aspects. Finally, a major barrier in accessing maternal care in the CEE is the inability to pay for it. Our findings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the allocation of medical staff and institutions as well as protecting vulnerable population groups to ensure universal access to care.