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To update the impact of these changes on tx provisions in Southeast Asia, we reviewed the tx rate, the burden of organ shortage, organ access, legislation framework, reimbursement, and clinical outcome data in this continent.
We also examined the causes of the unmet needs for organ tx in this region, compared to similar data from the US as an international benchmark, with a view to understanding regional pressures that can help to improve access and outcomes of organ transplantation in this region.
We searched the PUBMED electronic database for English-language peer-reviewed reports, computerized databases, government reports, dissertations, and online national registries in each of the countries in Southeast Asia.
Relevant articles between and were reviewed for additional information as the databases and registries may not provide complete data due to the voluntary nature of their reporting.
What Is The Basis Of Philhealth Contribution
The Southeast Asian continent has several strata of countries with wide variations in the gross national income per capita statistics from the World Bank 11 and human development index HDI from United Nations Development Program 12 , HDI is a composite index of the achievement in longevity, education, and income, which are three key dimensions of human development 13 — There is evidence for an association of organ tx access with national income and HDI Thus, we also provide income and HDI at a glance before exploring tx services in different countries in this region.
The Southeast Asian region has been defined following the division of geographic areas as assessed by the United Nations Statistic Division revised September 26th, Southeast Asia consists of 11 members Figure 1 ranked from high-income economies like Singapore and Brunei Darussalam to low-income economies like Cambodia, Laos, Myanmar, and Timor-Leste.
Singapore is in the very high HDI while Myanmar is in the lowest. The trend of increased incidence of treated ESRD in developing countries is marked in this region Figure 2. The reasons are because of improved standards of clinical care 17 , 18 , increased access to medical treatment 9 , and longer life expectancy Singapore Organ Access, Legislation, and Reimbursement Singapore is fully equipped for serving transplantation needs for its residents.
The rate of kidney tx reached a peak at Despite the revision of the organ donation law in , the deceased donation rate runs between 3 and 6 ppmp in Singapore Table 1 ; Figure 3 , versus a comparison of 25—26 ppmp in the US Figure 3. Thus, the tx waiting list numbers of patients in Singapore continues to rise. This act allows for the kidneys of all non-Muslim Singapore citizens and permanent residents between the ages of 21—60 without mental disorders, to be donated in the event of accidental death for tx unless they explicitly opt out.
HOTA increased the deceased donor kidney tx rate from an average of 4. To expand the eligible donor pool, HOTA was amended in January to also allow transplantation of liver, heart, and cornea 24 , This bill extended organ donation from donors with non-accidental causes of death and added the regulation for organ donation from living both related and unrelated organ donors.
It was later amended in August to include Muslim organ donors, and then in March to remove the upper age limit for potential deceased donors, paired kidney exchange permission, increased penalties for organ trading, and donor compensation 21 , This law allowed any person to donate organs in the event of death for the purpose of treatment, education, or research 20 — The Singapore government has also provided the criteria for determining death by brain death or cardiac death under The Interpretation Act Certification and Determination of Death Singapore established the National Organ Transplant Unit in This body regulates the national organ waiting list and maintains the national registry of recipients and donors To date, kidney, liver, lungs, heart, corneas, skin, bone, and bone marrow tx are available in both public and private hospitals.
Living donor tx are performed in both the public and private hospitals while deceased donor tx are carried out only in the public hospitals Singaporeans receiving overseas tx return to follow-up in Singapore and are registered in national renal registry database if they have a functioning tx after 30 days Singapore has an excellent health financing system, where the public and the private sector work in cooperation for affordable health care 28 that utilizes 4.
Singaporean employees contribute to individual medical saving accounts, the Medisave program, which is a national healthcare savings scheme to afford payment for personal and family hospitalization costs. The Ministry of Health subsidizes lower- and middle-income patients for dialysis costs as well as selected immunosuppressive drugs in public healthcare institutions Those patients also use the Medisave benefits to pay for their dialysis or immunosuppressive drugs after the government subsidies 28 — To protect the poor, low-income patients have a right to apply for and get additional subsidies from the government, and welfare or charity organizations 29 , such as the National Kidney Foundation, the Kidney Dialysis Foundation, and the Khoo Foundation.
Health expenditures, financing policies for dialysis, and transplantation in the transplanted Southeast Asian countries. Tx Outcomes The unadjusted 1- and 5-year kidney graft survival for living donor are excellent at Paired kidney donation can be undertaken after the last HOTA amendment in The first case was enrolled in the Paired Exchange Registry in and operated in early Hepatitis B virus HBV -infected, human immunodeficiency virus-infected patients, and alcoholic patients are excluded from tx in Singapore Organ Access, Legislation, and Reimbursement Dialysis started in Brunei in and had progressively increased to more than active cases at present Organ tx became available within the country in , with access only to living-related kidney tx.
Prior to , eligible ESRD patients were screened and matched with available living-related donors and sent overseas for tx, under government support 35 , Despite these efforts, problems exist with transplant tourism. The country has no official cell, tissue, and organ tx law 36 , and tx growth in this region is limited due to poor public awareness, cultural concepts about brain death, and poor local transplant facilities Nevertheless, the Brunei government is taking steps to improve access to health and tx care by increasing subsidies for health-care services 37 , 38 , and the establishment of 15 national health centers It expands access to primary care, with 1.
The first Brunei Dialysis and Transplant Registry was initiated in 35 , 38 and shows the high incidence ppmp and prevalence 1, ppmp rates of ESRD with the predominant cause of ESRD being due to diabetes 35 , Tx Outcomes There have been 49 cases of kidney tx from to All of them were performed in foreign centers because the local tx activity only began in The 5- and year overall graft survival rates are Kidney allograft survival in the major Southeast Asian countries.
Malaysia Malaysia is a multicultural and multi-faith country, consisting of Muslims, Buddhists, Christians, and Hindus, with Malay, Chinese, and Indian ethnicity It has pursued economic growth and reached upper middle income Organ Access, Legislation, and Reimbursement Renal replacement therapy was introduced in Malaysia in Due to increased acceptance of dialysis as a mainstay therapy for ESRD in Malaysia, the prevalence of dialysis increased from 13, in to 35, in 46 Figure 2.
Malaysia is a welfare-oriented state The Malaysian government is the principal payer of renal replacement therapy by a public—private partnership model 48 , 49 , and the government subsidizes both public dialysis centers and non-governmental organizations 48 such as the National Kidney Foundation.
The Private Healthcare Facilities and Services Act, enacted in , allowed hemodialysis facilities to be set up outside hospitals areas, which resulted in the rapid growth of private dialysis units and increased hemodialysis access 46 , 48 , Tx was initially performed in Malaysia in the s Malaysia provides kidney, liver, and lung tx mostly in public medical centers under the National Organ, Tissue, and Cell Transplantation Policy, which was enacted in 50 , Organ tx programs are overseen by the National Transplant Council The National Transplant Procurement Management Unit helps with deceased donor allocation and is supported by the local Tissue Organ Procurement Team in each donor hospital Brain death diagnosis and certification is done under guidance from the Brain Death Committee The National Transplant Waiting list is managed by The National Transplantation Unit, which was established within the Ministry of Health for regulating financial support and monitoring ethical standards for tx 51 , The percentage change in IPD infections among unvaccinated individuals was based on the percentage decline of IPD incidence in the United States following the introduction of routine vaccination of PCV7 for infants and young children [ 4 ], adjusted for the difference between the USA and the Philippine serotype coverage.
In order to estimate the percentage change for pneumonia among unvaccinated populations, it was assumed that pneumonia incidence decreases proportionally to the IPD fall for respective age groups, adjusted by the ratio of pneumococcal pneumonia to hospitalized pneumonia cases.
Duration of vaccine protection was assumed to be 5 years for both direct and indirect effects, which is in line with other PCV economic evaluations [ 40 — 42 ]. Vaccine costs. Additional costs for syringe, storage, warehousing, delivery and program implementation were considered Table 1.
Taxes, handling fee and freight cost incurred through UNICEF procurement were excluded since the national program is considering local bidding as its mode of procurement. Individuals vaccinated through PhilHealth coverage received the vaccine including its administration free of charge. Only a single-dose vial presentation is currently available for PCV13, whereas PCV10 is available as a single dose and a two-dose vial presentation, with all presentations of both vaccines being prequalified by the WHO.
The two dose preservative-free presentation of PCV10 is only available through UN procurement; the implementation of this vaccine presentation requires specific training for immunization staff as well as formal post-introduction monitoring [ 45 ].
For this analysis, it was assumed that a single-dose vial presentation for both vaccines would be procured. Because of data and contextual limitations in the use of horizontal inequality index concentration index adjusting to need [ 28 ], Concentration Curve and Concentration Index C was used instead [ 25 ].
C is defined as twice the area between the concentration curve and the link of equality. In case where there is no socio-economic inequality, the concentration index is zero. However when the concentration curve lies above the equity line, it reflects a negative value, indicating a pro-poor inequality in health service use in the context of this paper, indicates that more poor women delivered in a facility, received complete ANC services, etc.
Alternately, pro-rich use of services reflects a positive value [ 25 ]. The dependent variable y in this paper reflects health service use indicator as described. Further exploring determinants of inequalities, decomposing the C follows almost naturally. Decomposing the C as previously demonstrated by Wagstaff, van Doorslaer and Watanabe was used in this study [ 25 , 29 ].
Exploring contributions of individual factors to the concentration index, the product of the sensitivity of health with respect to the individual factors and the degree of income-related inequality in that factor was determined.
The linear additive regression of health y is expressed in Eq. In Eq. The residual component reflects the income-related inequality in health services use that is not explained by systematic variations in the regressors by income [ 25 ].
Despite the binary nature of the dependent variables, a linear probability model is used. Available literatures suggest decomposition of C shows no significant differences whenever linear and non-linear models are used [ 30 , 31 ].
Further, the concentration curve of each dependent variables used is also shown. In figures, the concentration curve displays the share of health accounted for by cumulative proportions of individuals in the population ranked from poorest to richest [ 25 ].
Results In absolute figures, women who delivered in health facilities increased from to Little change was noted for women who received complete antenatal care and caesarean births. For those who are insured, use of facilities increased but so as for the uninsured where in absolute difference — the rate of increase is even higher.Members under this category can pay either P2, for the annual contributions or P1, for the 6 months contributions.
While the overall improvements in maternal health globally had been remarkable, the poor and the vulnerable were unfortunately left behind [ 1 ]. The dependent variable y in this paper reflects health service use indicator as described.
We then suggest some elements of developing this area of research and policy based on a narrative review of relevant studies combined with the management, consulting and field experience of all authors and outline areas of further research. Yan and colleagues [ 26 ] report on a qualitative study about the extent and impact of county level managerial capacity to manage the New Cooperative Medical Scheme in China. Hart showed that the poor use lesser health services compared to its higher income counterpart, despite the poor having more needs for specific health services.
HDI is a composite index of the achievement in longevity, education, and income, which are three key dimensions of human development 13 — To expand the eligible donor pool, HOTA was amended in January to also allow transplantation of liver, heart, and cornea 24 , Table 7. PhilHealth's contribution to total health expenditures is currently small 11 percent in , a.
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