Ferraris Kevin Paul, Yap Maria Eufemia C, Bautista Maria Cristina G, Wardhana Dewa Putu Wisnu, Maliawan Sri, Wirawan I Made Ady, Rosyidi Rohadi Muhammad, Seng Kenny, Navarro Joseph Erroll
Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila, Philippines.
Department of Surgery, Las Piñas General Hospital and Satellite Trauma Center, Las Piñas, Philippines.
Front Surg. 2021 Sep 10;8:690851. doi: 10.3389/fsurg.2021.690851. eCollection 2021.
Which conditions treated by neurosurgeons cause the worst economic hardship in low middle-income in countries? How can public health financing be responsive to the inequities in the delivery of neurosurgical care? This review article frames the objectives of equity, quality, and efficiency in health financing to the goals of global neurosurgery. In order to glean provider perspectives on the affordability of neurosurgical care in low-resource settings, we did a survey of neurosurgeons from Indonesia and the Philippines and identified that the care of socioeconomically disadvantaged patients with malignant intracranial tumors were found to incur the highest out-of-pocket expenses. Additionally, the surveyed neurosurgeons also observed that treatment of traumatic brain injury may have to require greater financial subsidies. It is therefore imperative to frame health financing alongside the goals of equity, efficiency, and quality of neurosurgical care for the impoverished. Using principles and perspectives from managerial economics and public health, we conceptualize an implementation framework that addresses both the supply and demand sides of healthcare provision as applied to neurosurgery. For the supply side, strategic purchasing enables a systematic and contractual management of payment arrangements that provide performance-based economic incentives for providers. For the demand side, conditional cash transfers similarly leverages on financial incentives on the part of patients to reward certain health-seeking behaviors that significantly influence clinical outcomes. These health financing strategies are formulated in order to ultimately build neurosurgical capacity in LMICs, improve access to care for patients, and ensure financial risk protection.
神经外科医生所治疗的哪些病症在低收入和中等收入国家造成了最严重的经济困难？公共卫生融资如何应对神经外科护理提供方面的不平等问题？这篇综述文章将卫生融资中的公平、质量和效率目标与全球神经外科的目标联系起来。为了了解医疗服务提供者对资源匮乏地区神经外科护理可承受性的看法，我们对来自印度尼西亚和菲律宾的神经外科医生进行了一项调查，发现为社会经济弱势的恶性颅内肿瘤患者提供护理的自付费用最高。此外，接受调查的神经外科医生还观察到，创伤性脑损伤的治疗可能需要更多的财政补贴。因此，必须将卫生融资与为贫困人口提供神经外科护理的公平、效率和质量目标联系起来。利用管理经济学和公共卫生的原则和观点，我们构思了一个实施框架，该框架涉及应用于神经外科的医疗服务提供的供需双方。对于供应方，战略采购能够对支付安排进行系统的合同管理，为医疗服务提供者提供基于绩效的经济激励。对于需求方，有条件现金转移同样利用患者方面的经济激励措施，以奖励某些对临床结果有重大影响的就医行为。制定这些卫生融资战略的最终目的是在低收入和中等收入国家建立神经外科能力，改善患者获得护理的机会，并确保财务风险保护。
