Global Health Systems

The analysis of different national models of health systems and how they measure up in achieving equitable access to health care and improving health outcomes. 

Psychological Reactance Is A Novel Risk Factor For Adolescent Antiretroviral Treatment Failure

Robert Gross, MD, MSCE
Aug. 4, 2020

Elizabeth Lowenthal, Mitchelle Matesva, Tafireyi Marukutira, One Bayani, Jennifer Chapman, Ontibile Tshume, Mogomotsi Matshaba, Meredith Hickson, Robert Gross

Abstract [from journal]

Psychological reactance is an aversive response to perceived threats against personal agency. For adolescents receiving HIV treatment in Botswana, we utilized a two-question, medication-specific reactance tool to assess whether: (1) verbal reminders to take medicines made adolescents want to avoid taking them, and, (2) whether adolescents felt anger when reminded to take medicines. Reactant adolescents had 2.05-fold (95% CI 1.23, 3.41) greater odds of treatment failure than non-reactant adolescents (p = 0.03). Adjusted risk of


Unemployment Insurance And Food Insecurity Among People Who Lost Employment In The Wake Of COVID-19

Jul. 30, 2020

Julia Raifman, Jacob Bor, Atheendar Venkataramani

Abstract [from journal]

Forty million U.S. residents lost their jobs in the first two months of the coronavirus disease 2019 (COVID-19) pandemic. In response, the Federal Government expanded unemployment insurance benefits in both size ($600/week supplement) and scope (to include caregivers and self-employed workers). We assessed the relationship between unemployment insurance and food insecurity among people who lost their jobs during the COVID-19 pandemic in the period when the federal unemployment insurance supplement was in place. We analyzed data from


Payment and Pricing Decisions in Health Care Reform

Issue Brief
Jun. 23, 2020

Any effort to reform health insurance in the United States must tackle the prices we pay for health care. There are many complex challenges to addressing prices. Some proposals build on the existing Medicare fee schedule, while others suggest promoting alternative payment mechanisms—or even starting from scratch. The stakes are substantial, as many reform proposals rely on reining in prices to achieve the savings necessary to expand health insurance to the uninsured. At Penn’s LDI Medicare for All and Beyond conference, a panel of researchers, hospital administrators, and policy experts considered issues related to health care payment and pricing that any health care reform proposal must address, including the implications of rate setting for providers and patients. At what level should these rates be set to assure access and quality of care, while incentivizing innovation and rewarding excellence?

A Pilot Randomized Trial Of Incentive Strategies To Promote HIV Retesting In Rural Uganda

May. 29, 2020

Gabriel Chamie, Alex Ndyabakira, Kara G. Marson, Devy M. Emperador, Moses R. Kamya, Diane V. Havlir, Dalsone Kwarisiima, Harsha Thirumurthy

Abstract [from journal]

Background: Retesting for HIV is critical to identifying newly-infected persons and reinforcing prevention efforts among at-risk adults. Incentives can increase one-time HIV testing, but their role in promoting retesting is unknown. We sought to test feasibility and acceptability of incentive strategies, including commitment contracts, to promote HIV retesting among at-risk adults in rural Uganda.

Methods: At-risk HIV-negative adults were enrolled in a pilot trial assessing feasibility and


Policy Options for Financing Long-Term Care in the U.S.

Issue Brief
Apr. 15, 2020

Unlike many other developed nations, the U.S. has no system that protects its residents against the high costs of long-term care, which many people will need as they age. Medicaid coverage kicks in only after families have exhausted their resources. Until then, families bear the financial and caregiving burden of LTC themselves. In the absence of a national system, several states have considered or passed programs that offer some support for LTC. Many peer nations have more comprehensive systems to spread the risk for LTC costs across their population, through social insurance or other mechanisms. This Issue Brief reviews international models of financing LTC, as well as recent state efforts, to help U.S. policymakers design a program that can meet the LTC challenges of an aging population.

10 Years of Health-Care Reform in China: Progress and Gaps in Universal Health Coverage

Angela Chen, MA
Oct. 4, 2019

Prof Winnie Yip, Hongqiao Fu, Angela Chen, Tiemin Zhai, Weiyan Jian, Prof Roman Xu, Prof Jay Pan, Min Hu, Prof Zhongliang Zhou, Qiulin Chen, Wenhui Mao, Prof Qiang Sun, Prof Wen Chen

Summary [from journal]

In 2009, China launched a major health-care reform and pledged to provide all citizens with equal access to basic health care with reasonable quality and financial risk protection. The government has since quadrupled its funding for health. The reform's first phase (2009–11) emphasised expanding social health insurance coverage for all and strengthening infrastructure. The second phase (2012 onwards) prioritised reforming its health-care delivery system through: (1) systemic reform of public hospitals by removing mark-up for


Opioid Prescribing After Surgery in the United States, Canada, and Sweden

Mark D. Neuman, MD
Sep. 4, 2019

Karim S. Ladha, Mark D. Neuman, Gabriella Broms, Jennifer Bethell, Brian T. Bateman, Duminda N. Wijeysundera, Max Bell, Linn Hallqvist, Tobias Svensson, Craig W. Newcomb, Colleen M. Brensinger, Lakisha J. Gaskins, Hannah Wunsch

Abstract [from journal]

Importance: Small studies and anecdotal evidence suggest marked differences in the use of opioids after surgery internationally; however, this has not been evaluated systematically across populations receiving similar procedures in different countries.

Objective: To determine whether there are differences in the frequency, amount, and type of opioids dispensed after surgery among the United States, Canada, and Sweden.

Design, Setting, and Participants: This cohort study included patients...

Penn’s Gant Family Precision Medicine Consortium Takes on Sustainable Targeted Oncology

Sep. 20, 2018

Biomedical advances in genomics and oncology, combined with rising costs for targeted cancer therapies, challenge the way we currently deliver and pay for cancer care. To foster the economic sustainability of targeted therapies, the University of Pennsylvania convened the Gant Family Precision Cancer Medicine Consortium, a multidisciplinary work group of experts from health care economics, policy, law, regulation, biomedical research, patient advocacy, and the pharmaceutical and insurance industry.

Implementation Strategies to Improve Cervical Cancer Prevention in Sub-Saharan Africa: A Systematic Review

Mar. 8, 2018

Lauren G. Johnson, Allison Armstrong, Caroline M. Joyce, Anne M. Teitelman, and Alison M. Buttenheim

ABSTRACT [From Journal]

BackgroundDeveloped countries, such as the USA, have achieved significant decreases in cervical cancer burden since the introduction of Pap smear-based programs in the 1960s. Due to implementation barriers and limited resources, many countries in sub-Saharan Africa (SSA) have been unable to attain such reductions. The purpose of this review is to evaluate implementation strategies used to improve the uptake and sustainability of cervical cancer prevention programs in SSA....

A Qualitative Exploration of Co-location as an Intervention to Strengthen Home Visiting Implementation in Addressing Maternal Child Health

Feb. 28, 2018

Katherine S. Kellom, Meredith Matone, Aderinola Adejare, Frances K. Barg, David M. Rubin, Peter F. Cronholm

Abstract [from journal]

Objectives: The aim of this paper is to explore the process and impact of co-locating evidence-based maternal and child service models to inform future implementation efforts.

Methods: As part of a state-wide evaluation of maternal and child home visiting programs, we conducted semi-structured interviews with administrators and home visitors from home visiting agencies across Pennsylvania. We collected 33 interviews from 4 co-located agencies. We used the Consolidated Framework for...

Cognition, Health, and Well-Being in a Rural Sub-Saharan African Population

Iliana Kohler
Nov. 7, 2017

Collin F. Payne, Iliana V. Kohler, Chiwoza Bandawe, Kathy Lawler, Hans-Peter Kohler

Abstract [from journal]

Cognitive health is an important dimension of well-being in older ages, but few studies have investigated the demography of cognitive health in sub-Saharan Africa’s growing population of mature adults (= persons aged 45+). We use data from the Malawi Longitudinal Study of Families and Health to document the age and gender patterns of cognitive health, the contextual and life-course correlates of poor cognitive health, and the understudied linkages between cognitive and physical/mental well-being. Surprisingly, the age pattern of decline in cognitive health...