Background: By the turn of the new millennium 84% of families in rural coastal Ecuador had difficulties to access health services. A health reform some years earlier to improve this situation had not been implemented. In 2001, the non-governmental organization (NGO) Foundation Human Nature together with a rural population established a primary health care center in North-Western Ecuador. A public private partnership with the Ministry of Public Health was formed. Services depended on out-ofpocket payments, restricting the poor’s access to care. In order to increase access to primary and emergency care, Foundation Human Nature planned to establish a community-based health insurance. In the meantime, a major health reform was initiated by a new government in 2008. It aimed at universal health coverage, providing qualitative services for all based on primary health care, while ensuring protection from financial hardship. The aims of this thesis were to appraise the feasibility of community- based health insurance in Ecuador; to study how rural stakeholders perceived the 2008 reform and its effects on rural health services; to explore the local population’s perception of the NGO in service delivery; and to measure the scope and describe the nature of perceived emergencies, the related health care seeking behavior and health expenditure. Methods: Quantitative and qualitative methods were applied to tackle the research objectives. Data collection for the health insurance study and the study of perceived emergencies was carried out through cross-sectional household surveys. For each of the studies 210 households were sampled with two-stage cluster sampling. Structured questionnaires were used with on the spot household interviews. Focus group discussions with local stakeholders were performed to explore their perceived effects of the 2008 health reform. The population’s perception of the NGO was also studied through focus group discussions, which were complemented by key-informant interviews with local stakeholders. Inductive qualitative content analysis, focusing on the manifest content was applied. Results: 69% of interviewees were willing to join the presented community- based health insurance scheme for 30 US$ per household and year. Attitudes towards the scheme were positive and 92% of interviewees stated they would increase their health service utilization with affiliation. The implementation of the 2008 health reform was perceived as topdown, lacking communication. However, the reform’s effects were mainly perceived as positive with free medical attendance and drugs. Increased service utilization was described as leading to a relative shortage of drugs and appointments. Access problems for remote dwellers were found, who were described of having to seek private care, also in emergencies. The NGO and its services were perceived positively by the population due to health care improvements in the region. The structure of the public private partnership was unclear, leading to dissatisfaction. Community participation was found to be rather weak. Perceived emergencies occurred to at least 90/1,000 inhabitants in the past year. Fever, traumatic injury and abdominal pain were the most frequent chief complaints. The first contacted providers in 57% of all cases were private for-profit providers, including traditional healers. Public health services treated one third of all cases. Health expenditure was found to be high and catastrophic health expenditure occurred in 24% of all cases. Conclusions: Prior to the 2008 reform community-based health insurance was found to be feasible in the study region. This financing instrument may have a role in the post-reform system, to cover services that the government does not yet sufficiently provide. The effects of the 2008 reform were mainly perceived positively, but an adjustment of the system is needed to improve the relative lack of drugs and appointments, especially for remote dwellers. Free health services may not be sufficient to reach universal health coverage for patients with perceived emergencies. Changes in public emergency departments and improved financial protection for emergency patients may improve the situation. The NGO’s role was perceived positively by the population. A lack of communication about the public private partnership and relatively weak community participation restricted the NGO’s full potential and should be improved.

The climate crisis and the COVID-19 pandemic remind us that we cannot face down our challenges alone—our solutions must be global. The European Investment Bank is at the heart of the push to turn EU policy initiatives into real development solutions on the ground. This report provides insights into our vital projects and initiatives outside the European Union, data on their impact and ideas for the future of development through a series of expert essays.

This book is a thorough, balanced, and insightful study of what is happening and what should be happening in health care financing. Americans want unlimited access to the best care at affordable prices. Fiscal pressures in American health care point in all different directions, like a pile of jackstraws. This important book analyzes how new payment incentives stimulate planned competition or reregulation; and the far-reaching impact these changes have on hospitals, physicians, long-term care facilities, HMOs, public health clinics, and multihospital systems. Tools for survival include better financial planning, productivity improvement, better scheduling systems, and total quality management. Steven R. Eastaugh begins his book with a general overview of cost management, accounting, product-line selection, and new payment incentives. Part II provides an in-depth survey of fiscal trends in long-term care, managed care, HMOs, and PPOs. Part III analyzes five basic strategies that a provider may consider; with special focus on market analysis, diversification, and pricing. The next part reviews physician payment options, the new Medicare 1992 payment systems for hospitals and physicians, and cost analysis of hospital patient care, research, and education. Part V considers productivity enhancement methods, incentives to assist productivity programs, and the Deming method of total quality management. Part VI focuses on investment, financing, and capital structure decisions in health care institutions and also in large multifacility systems. The last part summarizes major strategies for success in the 1990s, future policy alternatives, and suggests a number of alternative roads to universal entitlement and national health care reform. As Eastaugh suggests in this book, Our health system faces . . . immense opportunity and danger in a reformation on four fronts: access, efficiency, effectiveness, and quality of life. The challenge for providers and managers during this period of unparalleled opportunity is to win a clear victory on all four fronts, and not erode either access or quality in the name of efficiency. The range of coverage in Health Care Finance is extremely wide and detailed--making it essential and useful reading for health care professionals and students alike.

This practical and handy textbook offers a succinct yet comprehensive overview of the main challenges, issues and solutions in global health in relation to the UN’s Sustainable Development Goals (SDG) 2030 agenda. Subdivided into 11 parts, devoted each to a macro-topic, the book opens with an introduction to Global Health followed by an overview of the global burden of disease – from child and maternal health to communicable and non-communicable diseases. The authors further examine the social determinants of health, health systems’ features as well as innovations, governance and methods in Global Health. In consideration of the emerging discussions and ideas, and beyond the more traditional and essential elements of global health, the book also looks at the need to re-think the whole concept of global health and the importance of a “decolonized” approach that engages low and lower-middle countries fully. One entire part is then devoted to analyzing the major threats to the health of humanity such as climate change, the need for an ecological approach to health (including “One Health” approaches), and, ultimately, planetary health. Written by an international panel of more than 100 experts, this manual will be an excellent resource for students in a broad range of disciplines – from medicine and other scientific studies to economics, social science, anthropology and international relations. Pragmatic and reader-friendly, it will further be a valuable tool for policymakers, program implementers and those wishing to build knowledge on the meaning, principles and practices of global health.

Global inequality has been a burning issue for years now. As the economies progress, it is expected that the benefits of growth will percolate to the lower sections of society. However, this percolation takes place in a discriminating manner. Inequality can be observed in terms of health, income, education, wealth, gender, availability of opportunities, and other socio-economic parameters. The governing authorities and international agencies have been taking various corrective measures to reduce the widening levels of inequality. However, certain external factors like the pandemic can wash away the efforts taken and deteriorate the progress made on the inequality levels in economies. Emerging Trends and Insights on Economic Inequality in the Wake of Global Crises discusses the impact of global disasters and crises on economic inequality. It provides an overview of the evolution of global inequality over the years, increasing different forms of inequalities amidst crises, the corrective measures taken by the national and international agencies, and the way forward for economies with worsening inequalities. Covering topics such as crisis management, digital agriculture, and economic welfare, this premier reference source is an essential resource for economists, business leaders and executives, government officials, students and educators of higher education, sociologists, researchers, and academicians.

Playing Doctor is an engaging and highly perceptive history of the medical TV series from its inception to the present day. Turow offers an inside look at the creation of iconic doctor shows as well as a detailed history of the programs, an analysis of changing public perceptions of doctors and medicine, and an insightful commentary on how medical dramas have both exploited and shaped these perceptions. Originally published in 1989 and drawing on extensive interviews with creators, directors, and producers, Playing Doctor immediately became a classic in the field of communications studies. This expanded edition includes a new introduction placing the book in the contemporary context of the health care crisis, as well as new chapters covering the intervening twenty years of television programming. Turow draws on recent research and interviews with principals in contemporary television doctor shows such as ER, Grey's Anatomy, Private Practice, and Scrubs to illuminate the extraordinary ongoing cultural influence of medical shows. Playing Doctor situates the television vision of medicine as a limitless high-tech resource against the realities underlying the health care debate, both yesterday and today. Joseph Turow is Robert Lewis Shayon Professor at the Annenberg School for Communication, University of Pennsylvania. He was named a Distinguished Scholar by the by the National Communication Association and a Fellow of the International Communication Association in 2010. He has authored eight books, edited five, and written more than 100 articles on mass media industries. He has also produced a DVD titled Prime Time Doctors: Why Should You Care? which has been distributed to all first-year medical students with the support of the Robert Woods Johnson Foundation.

Disobedience : doctor workers unite! / Howard Waitzkin -- Becoming employees : the deprofessionalization and emerging social class position of health professionals / Matt Anderson -- The degradation of medical labor and the meaning of quality in health care / Gordon Schiff and Sarah Winch -- The political economy of health reform / David Himmelstein and Steffie Woolhandler -- The transformation of the medical industrial complex : financialization, the corporate sector, and monopoly capital / Matt Anderson and Robb Burlage -- The pharmaceutical industry in the context of contemporary capitalism / Joel Lexchin -- Obamacare : the neoliberal model comes home to roost in the United States, if we let it / Howard Waitzkin and Ida Hellander -- Austerity and health / Adam Gaffney and Carles Muntaner -- Imperialism's health component / Howard Waitzkin and Rebeca Jasso-Aguilar -- U.S. philanthrocapitalism and the global health agenda : the Rockefeller and Gates foundations, past and present / Anne-Emanuelle Birn and Judith Richter -- Resisting the imperial order and building an alternative future in medicine and public health / Rebeca Jasso-Aguilar and Howard Waitzkin -- The failure of Obamacare and a revision of the single payer proposal after a quarter century of struggle / Adam Gaffney, David Himmelstein, and Steffie Woolhandler -- Overcoming pathological normalcy : mental health challenges in the coming transformation / Carl Ratner -- Confronting the social and environmental determinants of health / Carles Muntaner and Rob Wallace -- Conclusion : moving beyond capitalism for our health / Adam Gaffney and Howard Waitzkin