Challenges with pediatric surgical financing and universal health coverage in Guatemala: A qualitative analysis.

Autor:	Landrum KR; Duke Global Health Institute, Durham, North Carolina, United States of America., Hall BJ; Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America., Smith ER; Duke Global Health Institute, Durham, North Carolina, United States of America.; Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States of America., Flores W; Centro De Estudios Para La Equidad y Gobernanza En Los Sistema De Salud, Guatemala City, Guatemala., Lou-Meda R; Department of Pediatrics, Roosevelt Hospital, Guatemala City, Guatemala., Rice HE; Duke Global Health Institute, Durham, North Carolina, United States of America.; Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2022 Sep 21; Vol. 2 (9), pp. e0000220. Date of Electronic Publication: 2022 Sep 21 (Print Publication: 2022).
DOI:	10.1371/journal.pgph.0000220
Abstrakt:	The financing of surgical care for children in low- and middle-income countries (LMICs) remains challenging and may restrict adherence to universal health coverage (UHC) frameworks. Our aims were to describe Guatemala's national pediatric surgical financing structure, to identify financing challenges, and to develop recommendations to improve the financing of surgical care for children. We conducted a qualitative study of the financing of surgical care for children in Guatemala's public health system with key informant interviews (n = 20) with experts in the medical, financial, and political health sectors. We used this data to generate recommendations to improve surgical care financing for children. We identified several systemic challenges to the financing of surgical care for children, including passive purchasing structures, complex political contexts, health system fragmentation, widespread use of informal fees for surgical services, and lack of earmarked funding for surgical care. Patient and provider challenges include lack of provider input in non-personnel funding decisions, and patients functioning as both financing agents and beneficiaries in the same financing stream. Key recommendations include reducing health finance system fragmentation through resource pooling, increasing earmarked funding for surgical care with quantifiable outcome measures, engagement with clinical providers in non-personnel budgetary decision-making, and use of innovative financing instruments such as resource pooling. Surgical financing for children in Guatemala requires substantial remodeling to increase access to timely, affordable, and safe surgical care and improve alignment with Guatemala's UHC scheme. Competing Interests: The authors declare that they have no competing interests. (Copyright: © 2022 Landrum et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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