Publications
582 results found
Andrade MV, Coelho AQ, Neto MX, et al., 2021, Brazil's Family Health Strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012) (vol 33, pg 368, 2018), HEALTH POLICY AND PLANNING, Vol: 36, Pages: 997-997, ISSN: 0268-1080
Bulstra CA, Reddy CL, Atun R, et al., 2021, Impact of the coronavirus disease 2019-related global recession on the financing of the global HIV response, AIDS, Vol: 35, Pages: 1143-1146, ISSN: 0269-9370
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- Citations: 4
Rocha R, Atun R, Massuda A, et al., 2021, Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis, LANCET GLOBAL HEALTH, Vol: 9, Pages: E782-E792, ISSN: 2214-109X
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- Citations: 135
Flood D, Seiglie JA, Dunn M, et al., 2021, The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults, LANCET HEALTHY LONGEVITY, Vol: 2, Pages: E340-E351, ISSN: 2666-7568
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- Citations: 61
Andrade MV, Coelho AQ, Neto MX, et al., 2021, Transition to universal primary health care coverage in Brazil: Analysis of uptake and expansion patterns of Brazil's Family Health Strategy (1998-2012) (vol 13, e0201723, 2018), PLOS ONE, Vol: 16, ISSN: 1932-6203
Anindya K, Ng N, Atun R, et al., 2021, Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis, BMC Health Services Research, Vol: 21, ISSN: 1472-6963
BackgroundMultimorbidity (the presence of two or more non-communicable diseases) is a major growing challenge for many low-income and middle-income countries (LMICs). Yet, its effects on health care costs and financial burden for patients have not been adequately studied. This study investigates the effect of multimorbidity across the different percentiles of healthcare utilisation and out-of-pocket expenditure (OOPE).MethodsWe conducted a secondary data analysis of the 2014/2015 Indonesian Family Life Survey (IFLS-5), which included 13,798 respondents aged ≥40 years. Poisson regression was used to assess the association between sociodemographic characteristics and the total number of non-communicable diseases (NCDs), while multivariate logistic regression and quantile regression analysis was used to estimate the associations between multimorbidity, health service use and OOPE.ResultsOverall, 20.8% of total participants had two or more NCDs in 2014/2015. The number of NCDs was associated with higher healthcare utilisation (coefficient 0.11, 95% CI 0.07–0.14 for outpatient care and coefficient 0.09 (95% CI 0.02–0.16 for inpatient care) and higher four-weekly OOPE (coefficient 27.0, 95% CI 11.4–42.7). The quantile regression results indicated that the marginal effect of having three or more NCDs on the absolute amount of four-weekly OOPE was smaller for the lower percentiles (at the 25th percentile, coefficient 1.0, 95% CI 0.5–1.5) but more pronounced for the higher percentile of out-of-pocket spending distribution (at the 90th percentile, coefficient 31.0, 95% CI 15.9–46.2).ConclusionMultimorbidity is positively correlated with health service utilisation and OOPE and has a significant effect, especially among those in the upper tail of the utilisation/costs distribution. Health financing strategies are urgently required to meet the needs of patients with multimorbidity, particularly for vulnerable groups that have a higher leve
Lebcir R, Atun R, 2021, Resources management impact on neonatal services performance in the United Kingdom: A system dynamics modelling approach, INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Vol: 36, Pages: 793-812, ISSN: 0749-6753
Hricak H, Abdel-Wahab M, Atun R, et al., 2021, Medical imaging and nuclear medicine: a Lancet Oncology Commission, LANCET ONCOLOGY, Vol: 22, Pages: E136-E172, ISSN: 1470-2045
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- Citations: 82
Sudharsanan N, Theilmann M, Kirschbaum TK, et al., 2021, Variation in the Proportion of Adults in Need of Blood Pressure-Lowering Medications by Hypertension Care Guideline in Low- and Middle-Income Countries A Cross-Sectional Study of 1 037 215 Individuals From 50 Nationally Representative Surveys, CIRCULATION, Vol: 143, Pages: 991-1001, ISSN: 0009-7322
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- Citations: 10
Lee TY, Hulse E, Atun R, et al., 2021, Use of social impact bonds in financing health systems responses to non-communicable diseases: scoping review, BMJ Global Health, Vol: 6, Pages: 1-15, ISSN: 2059-7908
There is an interest to understand how social impact bonds (SIBs), a type of innovative financing instrument used in impact investment, can be used to finance the prevention of non-communicable diseases (NCDs). This is the first scoping review that explores the evidence of SIBs for NCDs and their key characteristics and performance. The review used both published and grey literature from eight databases (MEDLINE, NCBI, Elsevier, Cochrane Library, Google, Google Scholar, WHO publications and OECD iLibrary). A total of 83 studies and articles were eligible for inclusion, identifying 11 SIBs implemented in eight countries. The shared characteristics of the SIBs used for NCDs were impact investment companies as investors, local governments as outcome payers, not-for-profit service providers and an average US$2 015 456 private initial investment. The review revealed a lack of empirical evidence on SIBs for NCDs. Conflict of interest and lack of public disclosure were common issues in both the published and grey literature on SIBs. Furthermore, only three SIBs implemented for financing NCDs were meeting all their target outcomes. The common characteristics of the SIBs meeting their target outcomes were evidence-based interventions, multiple service providers and an intermediated structure. Overall, there is a need for more high-quality studies, particularly economic evaluations and qualitative studies on the benefits to target populations, and greater transparency from the private sector, in order to ensure improved SIBs for preventing NCDs.
Peiris D, Ghosh A, Manne-Goehler J, et al., 2021, Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level survey data, PLOS MEDICINE, Vol: 18, ISSN: 1549-1277
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- Citations: 18
Howell J, Pedrana A, Schroeder SE, et al., 2021, A global investment framework for the elimination of hepatitis B, JOURNAL OF HEPATOLOGY, Vol: 74, Pages: 535-549, ISSN: 0168-8278
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- Citations: 31
Ward ZJ, Scott AM, Hricak H, et al., 2021, Global costs, health benefits, and economic benefits of scaling up treatment and imaging modalities for survival of 11 cancers: a simulation-based analysis, LANCET ONCOLOGY, Vol: 22, Pages: 341-350, ISSN: 1470-2045
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- Citations: 23
Pan T, Mercer S, Zhao Y, et al., 2021, The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis, BMC Public Health, Vol: 21, ISSN: 1471-2458
BackgroundThe co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China.MethodsPanel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes.ResultsAfter adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39; 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss.ConclusionMental-physical multimorbidity poses substantial negative health and economic effects on individuals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of int
Marthias T, Anindya K, Ng N, et al., 2021, Impact of noncommunicable disease multimorbidity on health service use, catastrophic health expenditure, and productivity loss in Indonesia: a population-based panel data analysis study, BMJ Open, Vol: 11, ISSN: 2044-6055
Objectives To examine non-communicable diseases (NCDs) multimorbidity level and its relation to households’ socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss.Design This study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5).Setting The original sampling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population.Participants We included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents.Primary outcome measures We examined three main outcomes; health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables,Results Women were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for individuals with >3 NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for individuals with >3 NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for >3 NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD.Conclusions NCD multimorbidity is associated with substantial direct and indirect costs to individuals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbi
Reddy CL, Miranda E, Atun R, 2021, Barriers and enablers to country adoption of National Surgical, Obstetric, and Anesthesia Plans, Journal of Public Health and Emergency, Vol: 5
This paper examines the adoption and diffusion of National Surgical Obstetric and Anaesthesia Plans (NSOAPs), a policy instrument, to improve surgical healthcare services in low- and middle-income countries (LMICs). It draws on recent trends in health system reform and empiricism to understand NSOAP effectiveness for large-scale improvement in surgical system objectives (surgical outcomes, patient satisfaction and financial risk protection). While the study reveals that NSOAP adoption has occurred in several countries, its translation into effective, responsive and equitable coverage of surgical healthcare services (diffusion) with enduring impact has yet to occur on a large-scale. NSOAP adoption and diffusion has been constrained by two principal considerations: (I) suboptimal funding allocation to develop NSOAPs and implement within a health system context; (II) inadequate translation of the NSOAP into implementable activities that lead to improved health system performance. We argue that a systems perspective-dynamically optimizing the NSOAP in relation to specific health system, adoption system, and contextual factors-may enhance the scale-up of NSOAPs and lead to sustainably funded programs that enhance the effectiveness, efficiency, responsiveness and equity of surgical healthcare service over the long-term. We explore three specific areas-technology, financing, governance-which could be harnessed to enhance the adoption and diffusion of NSOAPs.
Atun R, Moore G, 2021, Building a high-value health system, ISBN: 9780197528563
Building a High-Value Health System presents a practical, general approach to designing a health system that provides comprehensive, effective, and affordable healthcare for nations across the globe. This book systematically leads readers through the steps of designing a system around a developed country's needs by describing what a health systems is, how to analyze a country's health system performance, how to evaluate the needs of a population, how to assess the key capacities available, and how to develop and implement health system improvements tailored to a constituent population. A textually rich workbook drawing on case examples from across the globe, Building a High-Value Health System will provide readers with a deeper understanding of their own health system and provide the framework for the necessary actions toward building a better one.
Lebcir R, Hill T, Atun R, et al., 2021, Stakeholders' views on the organisational factors affecting application of artificial intelligence in healthcare: a scoping review protocol, BMJ OPEN, Vol: 11, ISSN: 2044-6055
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- Citations: 8
Preker AS, Cotlear D, Kwon S, et al., 2021, Universal health care in middle-income countries: Lessons from four countries, JOURNAL OF GLOBAL HEALTH, Vol: 11, ISSN: 2047-2978
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- Citations: 7
Virk A, Croke K, Mohd Yusoff M, et al., 2020, Hybrid Organizations in Health Systems: The Corporatization of Malaysia's National Heart Institute, HEALTH SYSTEMS & REFORM, Vol: 6, ISSN: 2328-8604
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- Citations: 1
Kim J, Keshavjee S, Atun R, 2020, Trends, patterns and health consequences of multimorbidity among South Korea adults: Analysis of nationally representative survey data 2007-2016, JOURNAL OF GLOBAL HEALTH, Vol: 10, ISSN: 2047-2978
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- Citations: 16
Reddy CL, Vervoort D, Meara JG, et al., 2020, Surgery and universal health coverage: Designing an essential package for surgical care expansion and scale-up, JOURNAL OF GLOBAL HEALTH, Vol: 10, ISSN: 2047-2978
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- Citations: 4
Ishida M, Hulse ESG, Mahar RK, et al., 2020, The Joint Effect of Physical Multimorbidity and Mental Health Conditions Among Adults in Australia, PREVENTING CHRONIC DISEASE, Vol: 17, ISSN: 1545-1151
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- Citations: 8
Husin M, Ab Rahman N, Wong XC, et al., 2020, Recruitment and participation of a survey in a public-private primary care setting: experience from the QUALICOPC Malaysia, PRIMARY HEALTH CARE RESEARCH AND DEVELOPMENT, Vol: 21, ISSN: 1463-4236
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- Citations: 1
Haacker M, Hallett T, Atun R, 2020, On time horizons in health economic evaluations, Health Policy and Planning, Vol: 35, Pages: 1237-1243, ISSN: 0268-1080
The issue of time horizons has received scant attention in discussions pertaining to health economic evaluations unlike discounting or translation of health outcomes into life-cycle measures (e.g. Quality Adjusted Life Years (QALYs) or Disability Adjusted Life Years (DALYs)). The available guidelines do not offer clear and consistent guidance for many problems addressed in health economic evaluations. In practice, variation of time horizons between studies for the same diseases is a matter of concern, as results on cost-effectiveness depend on the time horizon. Our paper contributes to establishing a consistent approach to setting time horizons across common types of health economic evaluations and mitigating potential bias where the choice of a time horizon may affect results of the evaluation. We find that available guidance is clear only for patient-focused interventions, but not in the presence of population-level effects owing to transmission of infections or other linkages. We distinguish between a policy period – over which an intervention is delivered or initiated – and an evaluation period over which the effects are measured. One important challenge in establishing a time horizon for evaluation is that, at least for infectious diseases, the state of the epidemic at the end of the policy period cannot be evaluated precisely and incorporated in the results of an economic evaluation. While longer policy periods partly mitigate this challenge, they are subject to greater uncertainty, and outcomes may not adequately reflect the cost-effectiveness of current policies because outcomes reflect an average over the policy period. Incremental analysis on interventions implemented in sub-periods of the policy period (especially at the beginning) potentially improves accuracy and helps to identify potential for improving cost-effectiveness by varying the path of implementation or the mix of interventions offered over time.
Davies JI, Reddiar SK, Hirschhorn LR, et al., 2020, Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries: A multicountry analysis of survey data, PLOS MEDICINE, Vol: 17, ISSN: 1549-1277
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- Citations: 12
Garcia PJ, Alarcon A, Bayer A, et al., 2020, COVID-19 Response in Latin America, AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, Vol: 103, Pages: 1765-1772, ISSN: 0002-9637
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- Citations: 82
Lemp JM, De Neve J-W, Bussmann H, et al., 2020, Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle-Income Countries, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 324, Pages: 1532-1542, ISSN: 0098-7484
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- Citations: 62
Bukhman G, Mocumbi AO, Atun R, et al., 2020, The <i>Lancet</i> NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion, LANCET, Vol: 396, Pages: 991-1044, ISSN: 0140-6736
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- Citations: 126
Pedrana A, Howell J, Scott N, et al., 2020, Global hepatitis C elimination: an investment framework, LANCET GASTROENTEROLOGY & HEPATOLOGY, Vol: 5, Pages: 927-939
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- Citations: 19
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