Добірка наукової літератури з теми "Universal Health Cover"

President Obama’s ambitious universal health care plan aims to provide affordable and accessible health care for all. The plan to cover the estimated 46.5 million uninsured, however, ignores the over thirty million non-citizens living in the United States. If the United States passes universal health care coverage, Congress should repeal the prohibitions of the Welfare Reform Act, extend Medicaid coverage to non-citizens, and allow non-citizens to purchase employer-based insurance coverage.President Obama’s plan follows the lead of state universal health care legislation by retaining private, employer-sponsored insurance coverage and expanding the eligibility requirements of the Medicaid program. This strategy will not aid uninsured immigrants or overburdened states and hospitals, though, because current law excludes most non-citizens from nonemergency health care services.

As countries throughout the world move towards universal health coverage, the obligation to realise the right to health for undocumented migrants has often been overlooked. With unprecedented millions on the move – including refugees, asylum seekers, internally displaced persons, and returnees – undocumented migrants represent a uniquely vulnerable subgroup, experiencing particular barriers to health related to their background as well as insecure living and working conditions. Their legal status under national law often restricts access to, and affordability of, healthcare services. While striving to ensure health for all, national governments face challenging priority setting dilemmas in deciding: who to include, which services to provide, and how to cover out-of-pocket expenses. Building on comparative experiences in Norway, Thailand and the United States – which reflect varied approaches to achieving universal health coverage – we assess whether these national approaches provide rights-based access to affordable essential healthcare services for undocumented migrants. To meet the shared Sustainable Development Goal on universal health coverage, the right to health must be realised for all persons – including undocumented migrants. To ensure universal health coverage in accordance with the right to health, governments must evaluate laws, regulations, policies and practices to evaluate: whether undocumented migrants are included, to which services they have access, and if these services are affordable. Achieving universal health coverage for everyone will require rights-based support for undocumented migrants.

Background: Government of India flagged off a very big health scheme for poor in the name of ‘Ayushman Bharat’ (AB) with a huge increase in medical cover for poorer section of the society from Sep 2018. This covers secondary and tertiary hospitalization care to approximately 40% of the population. Objectives: As the scheme involves huge financial outlay, this paper attempts to evaluate performance and understand whether the core objectives are met on the lines of Universal Health. Methods: A exhaustive survey of related literatures and published data on the official web site of AB is made. Results: The scheme is reasonably successful in providing financial relief but need to look at areas concerning quality delivery. Conclusions: With the larger objective of ‘Universal Health’, the beneficiaries list need to be reviewed. The scheme should look at bringing down the out of pocket expenses.

Universal health coverage means every person has access to quality health care without suffering financial hardships. The basis of universal health coverage lies in the primary health care concept, which was envisioned way back in 1978, as mentioned in Alma Ata Declaration1. The "World Health Report" published by the World Health Organization (WHO) in 2008 structures primary health care reforms in four groups. One of the crucial reforms was universal coverage reform to improve health equity2. WHO and UNICEF in 2018 documented how primary health care will be in the 21st century? The approach was towards universal health coverage and sustainable development goals. Sustainable development goals were to be achieved by 2030, and they were a continuation of millennium development goals 2000–20153. The resolution on Transforming our world: the 2030 Agenda for Sustainable Development adopted the target of universal health coverage by 2030, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all4. Currently, many developing nations do not have access to health services. About 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health. To make health for all, we need individuals and communities to have high-quality health services to take care of their families health. Skilled health workers providing quality, people-centred care and policy-makers should be committed to investing in universal health coverage. Universal health coverage should be based on intense, people-centred primary health care. Good health systems are rooted in the communities they serve. They focus not only on preventing and treating disease and illness but also on helping to improve well-being and quality of life5. Pakistan, the developing country, is struggling to provide good quality health services, mostly availed from the out-of-pocket expenditure. Both private and public sector hospitals were trying to deliver health services, but poor people failed to have access to many services due to poverty. To overcome this obstacle and address indicator 3.8 of SDGs, the current government developed a five-year program to improve the targeted population's health by increasing their access to quality health services. The initiative will also reduce poverty, as the government will cover most of their health budget through the "Sehat Sahulat Program". The program was part of the National vision to ensure Universal Health Coverage (UHC) for all Pakistani families. No one is denied quality healthcare services only because of financial constraints. Initially, it was piloted in selected four districts of Khyber Pakhtunkhwa, which was later extended to all over the province. Currently, 7.2 million families are getting free in-patient health care services, and the program's annual cost is 18 billion. It was a bold initiative of the current government, which helped improve access to UHC, thus addressing one of the sustainable development goals6,7.

Based on qualitative and quantitative data collected from the research project "Differences in Access to Healthcare Services among the Population during the Implementation of Universal Health Insurance Policies" (Case study in Vinh City, Nghe An Province), this paper explores strategies used by poor households to mobilize economic resources to cover their healthcare costs. It also highlights the difficulties these households face in mobilizing economic resources. What strategies have they chosen to meet their expectations, and what are the outcomes of these mobilization efforts? Despite significant efforts, poor households are still considered fragile beneficiaries in the context of implementing universal health insurance policies in Vietnam nowadays.

Abstract The Pan American Health Organization (PAHO) Workers' Health team promotes workers' health equity in the Americas by providing technical assistance to strengthen regulatory frameworks and the leadership of the health sector; promote workers' health and the development of safe, productive and healthy workplaces; prevent and register diseases, injuries and deaths at work; achieve access to universal healthcare and support critical economic sectors related to workers' health. PAHO collaborates with a broad range of stakeholders to implement the Plan of Action on Workers' Health 2015-2025, using a Health in All Policies approach, responding to national, regional and global priorities for workers' health, and contributing to the achievement of the Sustainable Development Goals (SDGs) 1, 3, and 8. This presentation will cover the activities of the WHO Collaborating Centres for Occupational Health in the PAHO region / Region of the Americas (AMRO).

In less than ten years, India has launched colossal biometric databases. One among them is related to the first ‘free’ health coverage scheme offered by the government of India: the Rashtriya Swasthya Bima Yojna (RSBY). Based on a public–private partnership between government and private companies, RSBY national scheme was launched in 2008, as a first step towards universal health coverage in a country where households endorse 70% of health expenses. The first phase of RSBY offers to cover ₹30,000 ($600) of inpatient expenses per year for five members of a below poverty line household and is now piloted in several Indian States to include outpatient expenses and above poverty line families too. RSBY relies exclusively on a centralised digital artefact to function, made visible by the ‘RSBY Smart Card’, a chip enabled plastic card containing personal data of individual and their family counting and conditioning the granting of health services to them; thus, no smart card means no health coverage. Till date 120 million Indians have been registered in the RSBY database. This article analyses how health accessibility is crafted under the RSBY scheme by questioning two central dimensions of this data-driven digital health scheme: the smart card technology and the public–private partnership, whereas RSBY scheme promises health coverage for all, its digital infrastructures may complicate access to health services, and reveal new patterns of exclusion of individuals. Thus, we will detail how smartcards technologies and private providers condition access to health care in India.

: Background: the main aim of the study is to find if the National Health Insurance Scheme (NHIS) in Ghana is achieving universal health coverage (UHC) or not. The study gives the trajectories of health policies in Ghana and their implications on long term health financing. NHIS in Ghana was implemented in 2004, with the aim of increasing subscribers’ access to health care services and reduce financial barriers to health care. On equity access to healthcare, it addresses two core concerns: (1) enrolling particular groups (persons exempted from annual premium payments) and (2) achieving UHC for all citizens and persons with legal residence. It utilizes a multifactor approach to the conceptualization of UHC. The research question: is Ghana’s NHIS on course to deliver or achieve universal health coverage? Methods: we used qualitative methods. In doing so, the study engaged participants in in-depth interviews, focus group discussions and direct observations of participants in their natural settings, like hospitals, clinics, offices and homes, with purposive and snowball techniques. This data triangulation approach aims to increase the reliability and validity of findings. Results: the empirical evidence shows NHIS performed relatively well in enrolling more exempt groups (particular groups) than enrolling all persons in Ghana (UHC). The biggest challenge for the implementation of NHIS from the perspectives of health insurance officials is inadequate funding. The health insurance beneficiaries complained of delays during registrations and renewals. They also complained of poor attitude of some health insurance officials and health workers at facilities. Conclusions: both health insurance officials and beneficiaries emphasized the need for increased public education and for implementers to adopt a friendly attitude towards clients. To move towards achieving UHC, there is a need to redesign the policy, to move it from current voluntary contributions, to adopt a broad tax-based approach to cover all citizens and persons with legal residence in Ghana. Also, to adopt a flexible premium payment system (specifically ‘payments by installation’ or ‘part payments’) and widen the scope of exempt groups as a way of enrolling more into the NHIS.

L'accès aux soins de santé, notamment des plus pauvres, est une préoccupation au coeur des réflexions dans tous les systèmes politiques et juridiques nationaux. La question se pose davantage sur le continent africain où il existe peu de mécanismes de couverture santé. Les différents projets de Couverture maladie universelle initiés dans un certain nombre de pays africains tentent d'y apporter des solutions, mais peinent encore à se déployer. C'est le cas en Côte d'Ivoire depuis l'entrée en vigueur, le 1er octobre 2019, de la loi n°2014-131 du 24 mars 2014 instituant la Couverture maladie universelle. En dehors des travailleurs salariés et des fonctionnaires en activité ou à la retraite, les populations intègrent lentement et difficilement la CMU pourtant obligatoire pourtous. Il faut dire que le projet fait l'objet de critiques et de peu d'adhésion de la part de la population. Il pèche également par ses dispositions qui alimentent ces critiques, notamment sur la durée du délai de carence s’imposant à l’assuré, le caractère obligatoire de l'activité professionnelle pour les étrangers, le manque d'ouverture à d'autres formes de médecine telle que la médecine traditionnelle. Cela dit, l'exercice du droit fondamental à la santé dans un environnement marqué par un secteur informel important et une population à majorité pauvre passe par un système obligatoire et solidaire de mutualisation du risque comme la CMU. Reste à déterminer le modèle adéquat, notamment en termes de financement, afin de mettre en adéquation son objectifd’universalité et le contexte dans lequel il est mis en oeuvre
Access to health care, particularly for the poorest, is a central concern in all national political and legal systems. The issue is more acute on the African continent, where there are few health coverage mechanisms. The various Universal Health Coverage projects initiated in a number of African countries are attempting to provide solutions, but are still struggling to get off the ground. This has been the case in Côte d'Ivoire since law no. 2014-131 of 24 March 2014 instituting Universal Health Coverage came into force on 1 October 2019. Apart from salaried workers and civil servants, both active and retired, people are slowly and painstakingly integrating the CMU, despite the fact that it is compulsory for everyone. It has to be said that the project is the subject of criticism and little support from the population. It is also flawed by its provisions, which fuel these criticisms, in particular the length of the waiting period imposed on the insured, the compulsory nature of professional activity for foreigners, and the lack of openness to other forms of medicine such as traditionalmedicine. That said, if the fundamental right to health is to be exercised in an environment characterised by a large informal sector and a predominantly poor population, a compulsory, solidarity-based risk-pooling system such as the CMU is needed. What remains to be done is to determine the appropriate model, particularly in terms of funding, so as to match its universal objective with the context in which it is implemented

This chapter discusses health and safety, as ensuring health and safety is one of the most important functions of management. Health and safety rules are, generally speaking, universal: they cover employees and others in the workplace. Employees have a responsibility to take reasonable care of both themselves and others while at work, and to comply with all relevant laws and regulations pertaining to their work. Employers and managers have a duty to provide a safe working environment, and to ensure that employees are properly trained and have access to all relevant information to enable them to carry out their work without risk to their or others health. It is important to understand the chain of delegation: while it is possible to delegate the authority to a subordinate to deal with health and safety issues, the responsibility itself is not delegated. In this chapter, requirements for health and safety are discussed briefly, with examples.

Each nation in the UK has a child health programme, based on the principle of proportionate universalism. This chapter covers the common shared themes and principles, and summarizes the four individual programmes and their policy context. An appraisal of the evidence underpinning the programmes is not included.

As the world moves from vertical programs to Universal Health Coverage, governments must address health financing to develop systems. This chapter focuses on the financing of health care in impoverished countries. Health care is funded by a mix of financing—government expenditure, donor financing, out-of-pocket expenditures, and health insurance. From the Paris Declaration on Aid Effectiveness of 2005 to the newly developed Framework Convention on Global Health, there is a growing movement for the shared global responsibility to finance the right to health. This chapter covers the evolution of health financing, from the Commission on Macroeconomics and Health, the Gleneagles summit of 2005, and the Abuja Declaration in 2001, to recent novel financing and insurance schemes. The basic measures of macroeconomics are highlighted. Government, off-budget, and out-of-pocket expenditure are explained. Insurance and novel sources of health financing are discussed as they relate to financing and health as a human right.

Edited by a clinical psychologist who has been on the ground helping to develop psychosocial support for Ebola survivors in one of the hardest-hit regions of West Africa, this book explains the devastating emotional aspects of the epidemic and its impact on survivors and the population in West Africa, families in the diaspora, and people in the United States and other countries. It also describes lessons learned from past epidemics like HIV/AIDS and SARS, and valuable approaches to healing from future epidemics. While the devastating Ebola epidemic has been contained, the effects of this outbreak—referred to by the World Health Organization as “the most severe acute public health emergency seen in modern times”—have wreaked a tremendous emotional toll on the populations of West Africa as well as on families and survivors worldwide. This groundbreaking book covers the psychosocial needs, programs, and policies related to the Ebola epidemic and examines broader lessons of the outbreak, such as changes in the ways in which healing from future epidemics can be handled. Edited by Judy Kuriansky, PhD, a noted clinical psychologist and United Nations NGO representative with extensive experience helping after disasters worldwide, and direct experience gained from being "on the ground" in West Africa in the midst of the epidemic, this book identifies and explains universal psychological factors at play in all such crises. It debunks myths regarding Ebola and describes the resulting psychological and social harm caused by the epidemic. The chapters cover overarching emotional issues and problems as well as the long-term impact on at-risk groups, such as children, women, and health workers; the impact of emotional issues on social and economic life; responses of government officials, media, and various aid organizations; and solutions being offered by groups worldwide, including service and humanitarian organizations, politicians, policymakers, and public health education groups.

Chapter 9 covers information on recognition of a biological incident, natural disease outbreaks, accidental release of pathogenic organisms, bioterrorism incidents, features of an intentional biological agent release, recognition of an intentional biological agent release, bioterrorism surveillance, and biological agent biodromes, initial management of a suspected biological agent release incident, general incident management principles, universal (standard) precautions, personal protective equipment, decontamination at scene, biological agent transmissibility and public health impact, mathematical models of infection spread, pre- and post-exposure prophylaxis, the hospital response to a biological incident, primary care, cardinal signs and tips for key biological agents, the role of hospital clinicians, and the unidentified biological agent and ‘white powder’ incidents.

Over the last generation, inequality has risen, wages have fallen, and confidence that children will have a better future is at an all-time low. To be sure, a new generation is speaking up in support of universal health care, better public schools, affordable housing, and livable wages. But until the United States adopts and adheres to policies that ensure dignity and decency for all, people need to get by. This book addresses that imperative. Getting By offers an integrated, critical account of the programs, rights, and legal protections that most directly affect poor and low-income people in the United States, whether they are unemployed, underemployed, or employed, and whether they work within the home or outside the home. Although frayed and incomplete, the American safety net nevertheless is critical to those who can access and obtain its benefits—indeed, in some cases, those benefits can make the difference between life and death. The book covers cash assistance programs, employment and labor rights, food assistance, health care, housing programs, education, consumer and banking laws, rights in public spaces, judicial access, and the right to vote. The book primarily focuses on federal laws and programs, but in some contexts invites attention to state laws and programs. The rules and requirements are complicated, often unnecessarily so, and popular know-how is essential to prevent a widening gap between rights that exist on paper and their enforcement on the ground. The central goal of this volume is to provide a resource to individuals, groups, and communities that wish to claim existing rights and mobilize for progressive change.

Booksellers, authors, and academics have been talking about world literature since Goethe made the term fashionable in the early nineteenth century. Yet amidst all the talk of books that ‘circulate’ and literature as a kind of ‘universal property’ that can function as a ‘window on the world’, how do we account for the people who live in real places, and who write, translate, market, and read the texts that travel on these global journeys? This handbook breaks new ground by showing how to bring together the real-world contexts of authorship with the literary worlds of fiction through the concept of the world author. ‘World authorship’ is a practical update on Michel Foucault’s ‘author function’ that significantly expands the network of people and practices involved with literature and is at the same time more grounded in the study of actual literary texts. The concept is set out in detail in a rigorous introduction followed by twenty-five keyword chapters that cover all core aspects of world authorship, from ‘Beginnings’ to ‘Voice’, and have been written by professionals who work right across the sector. In its entirety, the handbook illuminates how literature is made and shared in different parts of the world and at different times of world history. At the heart of all contributions, however, is one key question: where is the human element in world literature? Established authors, translators, publishers, prize judges, and festival coordinators as well as academics from a range of different disciplinary backgrounds collectively give us the answer.

TOWARDS THE NEW LIFE Theology and Importance of Christian Initiation for the Life of Faith The book is in equal parts a presentation and an invitation. The subject matter of both is the mystagogical initiation leading to the personal encounter with God and eventually to the union within the Church in Christ, which happens initially and particualry in the sacramental liturgy. Mystagogy was the essential experience of life in the early Church and now is being so intensely discussed and postulated by the ecclesial Magisterium and through the teaching of the recent popes and synods. Within the ten chapters of this book the reader proceeds through the aspects strictly associated with Christian initiation, noticeable in catechumenate and suggestive for further Christian life. It is not surprising then, that the study begins with answering the question about the sense of dealing with catechumenate at all. The response developed in the first chapter covers four key points: the contemporary state of our faith, the need for dialogue in evangelization, the importance of liturgy in the renewal of faith and the obvious requirement of follo- wing the Church’s Magisterium, quite explicit in the subject undertaken within this book. The introductory chapter is meant to evoke interest in catechumenate as such and encourage comprehension of its essence, in order to keep it in mind while planning contemporary evangelization. For doing this with success and avoiding pastoral archeology, we need a competent insight into the main message and goal of Christian initiation. Catechumenate is the first and most venerable model of formation and growth in faith and therefore worth knowing. The second chapter tries to cope with the reasons and ways of the present return to the sources of catechumenate with respect to Christian initiation understood to be the building of the relationship with God. The example of catechumenate helps us to discover, how to learn wisely from the history. This would definitely mean to keep the structure and liturgy of catechumenate as a vehicle of God’s message, which must be interpreted and adapted always anew and with careful and intelligent consideration of the historical flavour on particular stages within the history of salvation and cultural conditions of the recipients. For that reason we refer to the Biblical resources and to the historical examples of catechumenate including its flourishing and declining periods, after which we are slowly approaching the present reinterpretation of the catechumenal process enhanced by the official teaching of the Church. As the result of the latter, particularly owing to the Vatican Council II, we are now dealing with the renewed liturgy of baptism displayed in two liturgical books: The Rite of Baptism for Children and the Rite of Christian Initiation of Adults (RCIA). This version for adults is the subjectmatter of the whole chapter, in which a reader can find theological analyses of the particular rites as well as numerous indications for improving one’s life with Christ in the Church. You can find interesting associations among the rites of initiation themselves and astounding coherence between those rites and the sacraments of the Eucharist, penance and other sacraments, which simply means the ordinary life of faith. Deep and convincing theology of the process of initiation proves the inspiring spiritual power of the initial and constitutive sacraments of baptism and confirmation, which may seem attractive not only for catechumens but also for the faithful baptized in their infancy, and even more, since they might have not yet had a chance to see what a plausible treasure they have been conveying in their baptismal personality. How much challenge for further and constant realization in life may offer these introductory events of Christian initiation, yet not sufficiently appreciated by those who have already been baptized and confirmed! We all should submit to permanent re-evangelization according to this primary pattern, which always remains essential and fundamental. Very typical and very post-conciliar approach to Christian formation appears in the communal dimension, which guards and guarantees the ecclesial profile of initiation and prepares a person to be a living member of the Church. The sixth chapter of the book is dealing with ecclesial issues in liturgy. They refer to comprehending the word of God, especially in the context of liturgy, which brings about a peculiar theological sense to it and giving a special character to proclaiming the Gospel, which the Pope Francis calls “liturgical proclamation”. The ecclesial premises influence the responsibility for the fact of accompanying the candidates, who aim at becoming Christ’s disciples. As the Church is teaching also in the theological and pastoral introduction to the RCIA, this is the duty of all Christians, which means: priests, religious and the lay, because the Church is one organism in whose womb the new members are conceived and raised. As this fact is strongly claimed by the Church the method of initiation arises to great importance. The seventh chapter is dedicated to the analysis of the catechumenal method stemming from Christ’s pedagogy and His mystery of Incarnation introducing a very important issue of implementing the Divine into the human. The chapter concerning this method opens a more practical part of the book. The crucial message of it is to make mystagogy a natural and obvious method which is the way of building bonds with Christ in the community of the people who already have these bonds and who are eager to tighten them and are aware of the beauty and necessity of closeness with Christ. Christian initiation is the process of entering the Kingdom of God and meeting Christ up to the union with Him – not so much learning dogmas and moral requirements. This is a special time when candidates-catechumens-elected mature in love and in their attitude to Christ and people, which results in prayer and new way of life. As in the past catechumenate nowadays inspires the faithful in their imagination of love and mercy as well as reminds us about various important details of the paschal way of life, which constitute our baptismal vocation, but may be forgotten and now with the help of catechumenate can be recognized anew, while accompanying adults on their catechumenal way. The book is meant for those who are already involved in catechumenal process and are responsible for the rites and formation as well as for those who are interested in what the Church is offering to all who consciously decide to know and follow Christ. You can learn from this book, what is the nature and specificity of the method suggested by the Rite itself for guiding people to God the Saviour and to the community of His people. The aim of the study is to present the universal way of evangelization, which was suggested and revealed by God in His pedagogy, particularly through Jesus Christ and smoothly adopted by the early Church. This way, which can be called a method, is so complete, substantial and clear that it deserves rediscovery, description and promotion, which has already started in the Church’s teaching by making direct references to such categories as: initiation, catechumenate, liturgical formation, the rereading the Mystery of Christ, the living participation in the Mystery and faith nourished by the Mystery. The most engaging point with Christian initiation is the fact, that this seems to be the most effective way of reviving the parish, taking place on the solid and safe ground of liturgy with the most convincing and objective fact that is our baptism and our new identity born in baptismal regenerating bath. On the grounds of our personal relationship with God and our Christian vocation we can become active apostles of Christ. Evangelization begins with ourselves and in our hearts. Thinking about the Church’s mission, we should have in mind our personal mission within the Church and we should refer to it’s roots – first to our immersion into Christ’s death and resurrection and to the anointment with the Holy Spirit. In this Spirit we have all been sent to follow Christ wherever He goes, not necessarily where we would like to direct our steps, but He would. Let us cling to Him and follow Him! Together with the constantly transforming and growing Church! Towards the new life!

AbstractFormal labour and affiliation to Ecuador’s social security system is the main gateway for access to social protection benefits, especially in the case of migrants. However, a large informal labour market and low levels on inclusion in the social security system forces large sectors of society to rely on family and community arrangements for the management of risk and economic uncertainty. The state provides some non-contributory benefits through cash transfer programs but, with the exception of health care, these only cover people living in conditions of extreme poverty. Universal, non-means tested programs are limited to the public health and education systems. Overall, migrants face several obstacles to access social protection benefits. Gaining the right to work legally is mostly reserved for white-collar and highly educated immigrants, excluding impoverished immigrants. Paired to the inability to access labour-related benefits and government programs for the so-called poor, immigrants lack the safety nets provided by extended family and a community setting. Nationals residing abroad have restricted access to social benefits, having access only to the contributory pension system on a voluntary basis. This chapter discusses the social protection system in Ecuador and focuses on eligibility criteria to show the extent of migrants’ access to the social benefits.

This chapter explores the governance issues in the implementation of insurance coverage for the informal labour sector in the context of universal health coverage (UHC). The COVID-19 pandemic highlights the vulnerabilities of the informal sector that remain overlooked by employer health insurance and are not targeted by the government’s cash transfer programmes for the poor. While universal health coverage may, on paper, assure every one of the basic minimum health care packages, issues of capturing subsidies for and availing of similar no user charges for the poor may be a Gordian knot before universal coverage is achieved. The chapter interrogates this issue as follows—firstly, we present key health financing features of the Philippine efforts to cover the informal sector in the national health insurance programme; and secondly, based on a concept approach, we analyse the elements of a social contract that may enhance or break down relationships in informal sector health insurance—with the market, bureaucratic and networks in health systems. Implications are drawn on the design of institutional arrangements to capture subsidies, contributions, and provider payments as part of a post-pandemic new normal of greater health security through the financing of health in the context of a social contract.

Abstract This chapter reaches some concrete conclusions concerning how health care should be arranged, but it does not address detailed questions concerning what health insurance policies should cover. The chapter argues in defense of universal health care (UHC) on the grounds of efficiency, fairness, freedom, and solidarity and discusses how UHC should be structured. It then argues that for reasons of efficiency, freedom, and solidarity, cost-effectiveness should be an important consideration governing UHC. The chapter examines how the criticisms alleging that cost-effectiveness allocation can be unfair apply in practice to actual cost-effectiveness analyses. The chapter then draws more general conclusions concerning what can be said about fair health care allocations, and it offers a concluding assessment of the use and limits of cost-effectiveness as a guide to the allocation of health-related resources.

Abstract This ending chapter of the book will cover an endings topic. Bereavement is the state of having lost a close friend or relative to death. It is a universal experience, a process that affects more people than any other subject in this book. Ten million people are bereaved each year in the United States (Hansson & Stroebe, 2007). Five percent of children lose one or both parents before age fifteen, and by age sixty-five more than half of women have been widowed at least once. Although bereavement is a normal process, psychoeducation can help survivors to make constructive life adjustments.

Eight years following the first democratically elected government in South Africa in 1994, most public sector employees remained unable to access private health insurance and care due to high cost. In 2002, the Parliamentary Cabinet approved a policy framework on a restricted medical insurance scheme for public sector employees. This policy centered around the principles of equity, efficiency, and differentiation. Employees would have access to essential healthcare benefits across different option plans under equitable remuneration structures based on their health needs. The establishment of the Government Employees Medical Scheme (GEMS) was approved by the Cabinet in 2004 and was then registered and operationalised in January 2005. This chapter aims to describe the evolution of GEMS as the largest closed medical insurance scheme within South Africa over the past 18 years, and how it improved access to care by embracing Universal Health Coverage (UHC) principles. We present the socio-demographic evolution of the Scheme and how it and the employer have provided affordable contributions and expanded healthcare benefits to universally cover members, their immediate and extended families during their active working years and retirement. We also expand on member-centric benefit design and the critical role of organised labor and government, as both employer and policy maker.

This chapter addresses the issue of health care for low-income people. The United States, virtually alone among developed nations, does not offer universal access to health care, leaving many millions of individuals without health insurance or other means of obtaining necessary medical services. In 2010, Congress enacted the landmark Patient Protection and Affordable Care Act (ACA)—popularly known as “Obamacare”—marking an important but incomplete response to the nation’s health care crisis. This chapter examines the ACA in detail, including its impact on Medicaid and Medicare, the major government health programs in the United States, its creation of Health Insurance Exchanges and tax credits to help low-income households obtain private health coverage, and the reform of private health insurance markets through a patient’s bill of rights, which, among other measures, prohibits insurance companies from refusing coverage for preexisting medical conditions. Perhaps the most critical aspect of the ACA was its expansion of Medicaid to cover virtually all low-income citizens (and certain immigrants) who do not qualify for other health coverage. Although several states opted out of the ACA’s Medicaid expansion, the Medicaid program nevertheless remains the largest single provider of health coverage in the United States. This chapter also provides a detailed description of Medicaid, its eligibility criteria and scope of coverage; the Child Health Insurance Program (CHIP), a government-funded health insurance program for children in households with too much income to qualify for Medicaid; and Medicare, the federal health insurance program for aged, blind, and disabled individuals.

This chapter discusses the historical context of SDG 3, the goal of health and well-being for all. Its 13 targets are wide-ranging, spanning curative and preventive medicine, physical and mental health, infectious and non-communicable diseases, and universal health coverage. We therefore delimit our discussion to the history of health improvement as an object of international policy, with a temporal focus on the twentieth century, albeit with backward glances. The first main section provides an outline history of the management of infectious diseases and health system building, moving from colonial health policies to early cross-national conferences, then to the permanent international organizations established by states or philanthropists. Detailed sections then cover maternal and child health, including programs addressing reproduction; non-communicable diseases related to human behaviors such as consumption habits and road safety; and universal health coverage. We delineate four main factors of change through time: political economy in a world of unequal power distributions; the growth of transnational expertise and advocacy; the impetus of humanitarianism and voluntary action; and the ideal of health as a human right. We close with reflections on whether the health SDG can indeed be fulfilled “leaving no one behind.”

Abstract Basically, the principles and the objectives for the provision of occupational health are universal, but what are usually variable are the administrative methods for the provision of such services and the extent of the services provided. The administrative process and the extent of occupational health services cover areas such as methods for the provision of services, organization and financing, legislation, the responsibilities of governmental and other agencies, the nature and extent of the administrative and technical supervision, the coverage for different groups of workers, the quality and quantity of coverage, and training and research facilities. To a great extent, the particular administrative pathway chosen for the delivery of occupational health services is in many instances historically determined–in such situations, even if the administrative system is not optimally efficient, it is relatively difficult to effect change. However, in countries where no occupational health services exist, or where the development of such services is relatively recent, it is possible that an administrative pathway considered to be most appropriate for the efficient delivery of occupational health services could be chosen. The responsibility for occupational health services basically devolves around (1) the state and (2) the private-sector organizations.

In 1984, Portugal was a middle-income country, developing the primary health care system, based on family doctors, health centres and health posts, reaching almost all population, with infectious diseases as one of the main health problems. In 2006, Mozambique was a low-income country, with a national health service attaining 60% of the population (40% in rural areas), with a double burden of disease (infectious and non-communicable diseases). Working in primary health care in Europe and Africa, we compare several experiences of family medicine practice in rural populations, different in context, time, and methods: Portugal 1984–2006 and Mozambique 2007–2020, all with a strong component of community health education. Our descriptive case studies, summarise strategies, interventions, and results, reviewing reports and articles. Population’ health indicators, and quality of life have improved, in different contexts with culturally tailored approaches. Participative societal diagnosis and multidisciplinary interventions are necessary to improve rural population health. Different rural populations and cultures are ready to learn and to participate in health promotion; empowering rural populations on health issues is an affordable strategy to better health indicators and services. Family Medicine is effective to extend primary health care to all rural populations, aiming universal health cover.

Abstract This chapter aims to identify the distributional burdens of paying for health care in the US and the distribution of the beneficiaries of that system. Our focus on who pays and who benefits is motivated by two issues that have dominated discussions in the US in recent years: (1) the lack of universal insurance cover; and (2) the rapid increase in medical care costs that have led to medical expenditures accounting for more than 12 per cent of GNP. The thrust of much of this discussion is that high costs may have led to limited access for those who are not covered by public or private insurance. If it is the (non-elderly) lower-middle class that are caught between having incomes too high for public insurance but too low to afford private insurance then their access is limited by income. Added to this are those with low income not insured by public coverage, who are also likely to be caught. Furthermore, if public insurance is largely financed by the middle class, then they are the ones paying for the services they are the least likely to utilize.

The heat pipe augmented solar heating system significantly reduces heating loads relative to other conventional passive space heating systems [1–3]. Yet unwanted thermal gains during the cooling season from passive solar systems increase cooling loads and, in extreme cases, may even increase overall space conditioning loads relative to a nonsolar building. The objective of this study was to compare the effectiveness of several design modifications and control strategies for the heat pipe wall to reduce unwanted gains. MATLAB was used to simulate four different unwanted gains reduction mechanisms: 1. shading to block beam radiation from striking the collector, 2. an opaque cover to block all radiation from striking the collector, 3. a mechanical valve in the adiabatic section to eliminate convective heat transfer through the heat pipe into the room, and 4. switching the elevations of the evaporator and condenser sections of the heat pipe to provide heat transfer out of the room during the cooling season. For each mechanism, three different control strategies were evaluated: 1. Seasonal control, for which the prescribed mechanism is deployed at the beginning and removed at the end of the cooling season, 2. ambient temperature-based control, for which the mechanism is deployed if the forecast for the next hour (based on TMY3 weather data) is greater than 65°F, and 3. room temperature-based control, for which the mechanism is deployed if auxiliary cooling was required for the previous hour. For the seasonal strategy, the months for which the unwanted gains reduction mechanism should be deployed to minimize overall space conditioning loads were estimated with a season determination ratio (SD), defined as the monthly ratio of unwanted gains to heating load. Results suggested that SD may be a ‘universal’ parameter that can be applied across a range of climates for quick assessment of its optimal cooling season. With TMY3 data for Louisville, KY, the heat pipe system performed best with ambient temperature-based control. The mechanical valve was the best single mechanism. While in many cases the combination of the valve with a cover or shading produced slightly better performance than the mechanical valve alone, these additional reductions were small. Switching elevations of the evaporator and condenser sections produced little cooling, because of the low thermal emittance of the absorber and low thermal transmittance of the cover, and for the Louisville climate, small diurnal temperature swings during the summer.

This study is conducted to assess the transition in outdoor thermal comfort (OTC) due to the synergistic effects of high-density high-rise development in urban regions and increasing global temperature. The shifting climate of urban spaces impacts Outdoor thermal comfort (OTC), thus human behaviour and accessibility to outdoor spaces. Central Business District (CBD), located in the centre of a growing metro city, Ahmedabad, in a hot and dry climate, is the case study site. The on-site measurement and simulation method has been adopted to analyze the microclimate condition for current and future development scenarios of 2050 with increased Floor area ratio (FAR) and tree cover. To understand and quantify the heat stress on the human body produced by the surrounding meteorological circumstances, the Universal Thermal Climate Index (UTCI) has been used. The on-site collected data and simulation results provide a basis for studying the physiological and physical attributes related to OTC. The results suggest a significant impact of the sky view factor and the role of mean radiant temperature on OTC in all development scenarios. The shading due to the increased height of building stock imparts a favourable impact on thermal stress in outdoor urban areas.

Several researches dealing with the single-phase forced convection heat transfer in micro tubes have been published in the past years. Most of their tests results are significantly departed from those of the traditional forced convection heat transfer coefficients in larger tubes. Some recent work reported that measurement accuracy is one of the most important factors that may cause this discrepancy. Since the diameter of the sensor for measuring micro tubes surface temperature is comparable to the size of the micro-tubes, the tubes surface temperature can not be accurately measured due to the effect of sensor wire thermal shunt. In this work some recent experimental results on heat transfer and frictional losses in mini/micro channel of semi-circular configurations using water as working fluid are investigated numerically by comparing the measured and predicted data. The flow conditions considered here cover a wide range of Reynolds number (300–4000), which corresponds to laminar, transitional and turbulent flow. Since the flow considered here is turbulent in nature emphasis is put on the physics based turbulent model. In this study, a high order LES turbulent model in which in a dynamic eddy viscosity model, transfer of information between the sub-grid and large scale eddies is improved by solving an additional transport equation for turbulent kinetic energy in the grid scale level. Here, sub-grid-scale turbulent stresses are closed using a dynamic turbulent kinetic energy transport model. The sub-grid scale length scale is represented by the minimum of the universal length scale lu and the grid scale. The universal length scale lu, which represents the blending of the length scales of cascade of eddies starting from the near wall small scale all the way to the sub-grid scale, is defined on the basis of turbulent Reynolds number Ret. A test filter was used for the dynamic procedure, which is applicable to stretched grid near the body surface. Also the thermal convection problem is coupled with thermal conduction within the material to obtain the overall solution. Predicted results agreed well with the measured data. The results helped to have a good understanding of how the flow and thermal phenomena attributed to the overall heat transfer and frictional loss mechanism. The comparison of measured and predicted data based on single phase N-S equations showed a very good agreement and the visualization of the three-dimensional results of computation led to a good understanding of the physics based mechanism associated with the laminar to turbulent transitional phenomena inside the micro/mini channels.

Oxygen is an essential therapeutic agent used extensively in all hospitals for patients with compromised function of the respiratory or cardiac systems. All patients (with the exception of neonates with certain heart diseases) are resuscitated with 100% oxygen. The American Heart Association Guidelines for Resuscitation state that it is essential in the post-resuscitative phase to decrease the concentration of O2 provided to keep oxyhemoglobin saturation (SpO2) > 94%, with a goal of avoiding hyperoxia while ensuring adequate oxygen delivery. Hyperoxia has been shown to be responsible for worsening tissue injury via oxidative damage following ischemia-reperfusion. Therefore, it is important in the post-resuscitative phase to use the lowest inspired oxygen concentration (FiO2) that will maintain SpO2 ≥ 94%. To address this, clinicians use oxygen blenders: devices that mix room air (21% O2) and medical grade oxygen (100% O2) to create a desirable FiO2. Current oxygen blenders have the disadvantage of being wall-mounted, bulky, and are limited to a small set of oxygen delivery devices (nebulizers, mechanical ventilators) with which they can interface. We developed an oxygen blending device capable of mixing room air and 100% O2 using the venturi principle. The device features a cylindrical body with a venturi nozzle and an entrainment window. It is handheld, portable, and machined from acrylic plastic. An oxygen blender with these features allows for appropriate oxygen therapy during patient transport. As oxygen flows through the device from the inlet orifice, atmospheric air is drawn in through the window, mixed, and then delivered to the patient through the outlet orifice. We designed the outlet orifice to have the same dimensions as the inlet orifice, allowing for universal integration with any device that connects to standard oxygen tubing. The entrainment window area can be adjusted by twisting a cover over the body of the blender, thus adjusting the FiO2 delivery. Using a venturi nozzle of 6.35 mm in diameter and an entrainment window area of 97 mm2, we achieved FiO2 ranging from 40% to 50% using input flow of 100% O2 at 6 L/min at 50 psi (via rotameter). The key feature of this device is that it can be interposed between any standard oxygen tubing allowing control of FiO2 at the bedside of the patient in hospital or during transport. Further work is needed to achieve a wider FiO2 range.

The monitoring and evaluation (M&E) Guidelines and Framework presented in this document (and in the accompanying M&E Indicator Framework) aim to encourage stakeholders in the rural sanitation and hygiene sector to take a more comprehensive, comparable and people focused approach to monitoring and evaluation. Many M&E frameworks currently reflect the interests and ambitions of particular implementing agencies – that is, community-led total sanitation (CLTS) interventions focused on open-defecation free (ODF) outcomes in triggered communities; market-based sanitation interventions focused on the number of products sold and whether sanitation businesses were profitable; and sanitation finance interventions reporting the number of facilities built using financial support. Few M&E frameworks have been designed to examine the overall sanitation and hygiene situation – to assess how interventions have affected sanitation and hygiene outcomes across an entire area (rather than just in specific target communities); to look at who (from the overall population) benefitted from the intervention, and who did not; to report on the level and quality of service used; or examine whether public health has improved. Since 2015, the Sustainable Development Goals (SDGs) have extended and deepened the international monitoring requirements for sanitation and hygiene. The 2030 SDG sanitation target 6.2 includes requirements to: • Achieve access to adequate sanitation and hygiene for all • Achieve access to equitable sanitation and hygiene for all • End open defecation • Pay special attention to the needs of women and girls • Pay special attention to those in vulnerable situations The 2030 SDG sanitation target calls for universal use of basic sanitation services, and for the elimination of open defecation, both of which require M&E systems that cover entire administration areas (i.e. every person and community within a district) and which are able to identify people and groups that lack services, or continue unsafe practices. Fortunately, the SDG requirements are well aligned with the sector trend towards system strengthening, in recognition that governments are responsible both for the provision of sustainable services and for monitoring the achievement of sustained outcomes. This document provides guidelines on the monitoring and evaluation of rural sanitation and hygiene, and presents an M&E framework that outlines core elements and features for reporting on progress towards the 2030 SDG sanitation target (and related national goals and targets for rural sanitation and hygiene), while also encouraging learning and accountability. Given wide variations in the ambition, capacity and resources available for monitoring and evaluation, it is apparent that not all of the M&E processes and indicators described will be appropriate for all stakeholders. The intention is to provide guidelines and details on useful and progressive approaches to monitoring rural sanitation and hygiene, from which a range of rural sanitation and hygiene duty bearers and practitioners – including governments, implementation agencies, development partners and service providers – can select and use those most appropriate to their needs. Eventually, it is hoped that all of the more progressive M&E elements and features will become standard, and be incorporated in all sector monitoring systems.

The monitoring and evaluation (M&E) Guidelines and Framework presented in this document (and in the accompanying M&E Indicator Framework) aim to encourage stakeholders in the rural sanitation and hygiene sector to take a more comprehensive, comparable and people focused approach to monitoring and evaluation. Many M&E frameworks currently reflect the interests and ambitions of particular implementing agencies – that is, community-led total sanitation (CLTS) interventions focused on open-defecation free (ODF) outcomes in triggered communities; market-based sanitation interventions focused on the number of products sold and whether sanitation businesses were profitable; and sanitation finance interventions reporting the number of facilities built using financial support. Few M&E frameworks have been designed to examine the overall sanitation and hygiene situation – to assess how interventions have affected sanitation and hygiene outcomes across an entire area (rather than just in specific target communities); to look at who (from the overall population) benefitted from the intervention, and who did not; to report on the level and quality of service used; or examine whether public health has improved. Since 2015, the Sustainable Development Goals (SDGs) have extended and deepened the international monitoring requirements for sanitation and hygiene. The 2030 SDG sanitation target 6.2 includes requirements to: • Achieve access to adequate sanitation and hygiene for all • Achieve access to equitable sanitation and hygiene for all • End open defecation • Pay special attention to the needs of women and girls • Pay special attention to those in vulnerable situations The 2030 SDG sanitation target calls for universal use of basic sanitation services, and for the elimination of open defecation, both of which require M&E systems that cover entire administration areas (i.e. every person and community within a district) and which are able to identify people and groups that lack services, or continue unsafe practices. Fortunately, the SDG requirements are well aligned with the sector trend towards system strengthening, in recognition that governments are responsible both for the provision of sustainable services and for monitoring the achievement of sustained outcomes. This document provides guidelines on the monitoring and evaluation of rural sanitation and hygiene, and presents an M&E framework that outlines core elements and features for reporting on progress towards the 2030 SDG sanitation target (and related national goals and targets for rural sanitation and hygiene), while also encouraging learning and accountability. Given wide variations in the ambition, capacity and resources available for monitoring and evaluation, it is apparent that not all of the M&E processes and indicators described will be appropriate for all stakeholders. The intention is to provide guidelines and details on useful and progressive approaches to monitoring rural sanitation and hygiene, from which a range of rural sanitation and hygiene duty bearers and practitioners – including governments, implementation agencies, development partners and service providers – can select and use those most appropriate to their needs. Eventually, it is hoped that all of the more progressive M&E elements and features will become standard, and be incorporated in all sector monitoring systems.