Achieving high-quality universal health coverage: a perspective from the National Health Service in England

Friebel, Rocco; Molloy, Aoife; Leatherman, Sheila; Dixon, Jennifer; Bauhoff, Sebastian; Chalkidou, Kalipso

doi:10.1136/bmjgh-2018-000944

Cited by 25 publications

(24 citation statements)

References 29 publications

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“…24 Underdiagnosed depression is also more likely in China than in England owing to differences in universal health care coverage. While England achieved universal health coverage in 1948, 37 China is working to achieve this by 2020. 38 Therefore, comparing clinically-diagnosed cases between the two countries could have lbiased the results.…”

Section: Discussionmentioning

confidence: 99%

Life course socioeconomic position and incidence of mid–late life depression in China and England: a comparative analysis of CHARLS and ELSA

Ruiz

Martikainen

et al. 2019

J Epidemiol Community Health

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BackgroundDespite the growing prevalence of depression in the Chinese elderly, there is conflicting evidence of life course socioeconomic position (SEP) and depression onset in China, and whether this association is akin to that observed in Western societies. We compared incident risk of mid–late life depression by childhood and adulthood SEP in China and England, a country where mental health inequality is firmly established.MethodsDepression-free participants from the China Health and Retirement Longitudinal Study (N=8508) and the English Longitudinal Study of Ageing (N=6184) were studied over 4 years. Depressive symptoms were classified as incident cases using the Center for Epidemiologic Studies Depression Scale criteria. Associations between SEP (education, wealth, residence ownership and childhood/adolescent deprivation) and depression symptom onset were assessed using Cox proportional hazards models. In China, we also investigated children’s government employment status as a SEP marker.ResultsHigher education and wealth predicted lower incidence of depression in both countries. The association with non-ownership of residence appeared stronger in England (HR 1.61, 95% CI 1.41 to 1.86) than in China (HR 1.11, 95% CI 0.95 to 1.29), while that with childhood/adolescent deprivation was stronger in China (HR 1.43, 95% CI 1.29 – 1.60) than in England (HR 1.33, 95% CI 0.92 to 1.92). Chinese adults whose children were employed in high-status government jobs, had lower rates of depression onset.ConclusionsConsistent findings from China and England demonstrate that SEP is a pervasive determinant of mid–late life depression in very diverse social contexts. Together with conventional measures of SEP, the SEP of children also affects the mental health of older Chinese.

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Section: Discussionmentioning

confidence: 99%

Life course socioeconomic position and incidence of mid–late life depression in China and England: a comparative analysis of CHARLS and ELSA

Ruiz

Martikainen

et al. 2019

J Epidemiol Community Health

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“…In many healthcare settings, inspection is done by external personnel who make sure that laws and standards are adhered to by practitioners [ 4 ]. In public health care settings, inspection is offered in an orderly and well-structured manner with clear audit-and-feedback channels which have proved to complement training leading to desired treatment outcomes [ 5 ]. On the contrary, evidence reveals great uncertainty of whether inspection of private for-profit healthcare providers in low- and middle-income countries improves quality of care [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Regulatory inspection of registered private drug shops in East-Central Uganda—what it is versus what it should be: a qualitative study

Bagonza

Peterson

Mårtensson

et al. 2020

J of Pharm Policy and Pract

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Background Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers. Methods Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done. Results Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection. Conclusion The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.

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“…First, continued political support is the most important enabling condition for achieving UHC. Efforts through national-level initiatives of different governments show that the political will to drive better healthcare is crucial, such as the 2017 National Health Policy in India and Rwanda’s Vision 2020 67. China’s commitment to UHC remains unchanged since the healthcare reform in 2009, and progress through three phases step by step focusing on the overall goal.…”

Section: Lessons From China’s Experiencementioning

confidence: 99%

Towards universal health coverage: lessons from 10 years of healthcare reform in China

et al. 2020

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Universal health coverage (UHC) is driving the global health agenda. Many countries have embarked on national policy reforms towards this goal, including China. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. The year of 2019 marks the 10th anniversary of China’s most recent healthcare reform. Sharing China’s experience is especially timely for other countries pursuing reforms to achieve UHC. This study describes the social, economic and health context in China, and then reviews the overall progress of healthcare reform (1949 to present), with a focus on the most recent (2009) round of healthcare reform. The study comprehensively analyses key reform initiatives and major achievements according to four aspects: health insurance system, drug supply and security system, medical service system and public health service system. Lessons learnt from China may have important implications for other nations, including continued political support, increased health financing and a strong primary healthcare system as basis.

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Achieving high-quality universal health coverage: a perspective from the National Health Service in England

Cited by 25 publications

References 29 publications

Life course socioeconomic position and incidence of mid–late life depression in China and England: a comparative analysis of CHARLS and ELSA

Life course socioeconomic position and incidence of mid–late life depression in China and England: a comparative analysis of CHARLS and ELSA

Regulatory inspection of registered private drug shops in East-Central Uganda—what it is versus what it should be: a qualitative study

Towards universal health coverage: lessons from 10 years of healthcare reform in China

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