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Achieving universal health insurance in Korea: a model for other developing countries?

As developing countries explore alternative methods to provide universal health insurance coverage, one potential model is South Korea. In twelve years (from 1977 to 1989), Korea was able to achieve universal health insurance coverage first by mandating employer based health insurance coverage for medium and large firms and then by establishing regional health insurance systems for small firms, farmers and the self-employed. A government medical aid insurance program was instituted for low income citizens. The specifics of the plan and some of the issues encountered in implementing the plan may be of interest to developing countries who want to achieve universal health insurance while maintaining a significant role for the private sector.

Developing Countries↗

Predicting iron and folate deficiency anaemias from standard blood testing: the mechanism and implications for clinical medicine and public health in developing countries.

BACKGROUND: Developing countries have high prevalence of diseases, but facilities to diagnose and treat them are limited. We must use available resources in ways not needed where there are sophisticated equipment and trained staff. Anaemia is common; iron deficiency affects health and productivity; folate deficiency in pregnant women causes foetal abnormalities. Few developing countries can measure serum folate or ferritin, but standard automated blood analyses are widely available and can help predict folate and iron deficiency. The RDW-CV% (coefficient of variation of the red cell width) measures the variability in the size of red blood cells (RBC) in routine automated analysis of blood cells, but is seldom reported. Levels of RDW-CV% and haemoglobin (Hb) can predict iron deficiency anaemia. METHOD AND RESULTS: I have written a computer model based on the standard mechanism for blood formation and destruction. This shows that before anaemia develops and during recovery, there are both normal and abnormal RBC (small in iron deficiency and large in folate deficiency) in the circulation. The model calculates the abnormality in the RDW-CV% in standard automated blood analyses. In early iron deficiency and during recovery the full blood count shows the Hb near the lower limit of normal, a low MCV and a high RDW-CV%. A similar pattern, but with a higher MCV, develops in folate deficiency. Folate deficiency is often brief and may not cause anaemia. The high RDW-CV% may persist for three months. CONCLUSION: This long footprint could be medically useful for detecting folate deficiency and so limiting foetal damage in individuals and communities. Few clinicians or public health workers know about RDW-CV%. Standard blood reports for clinical use should include the RDW-CV% and note the possible significance of abnormal values.

Adult↗

Pneumoconioses: the situation in developing countries.

In developing countries, the incidence and prevalence of pneumoconioses are high and appear to be increasing. The rapid expansion of mining, mineral extraction, construction, and other industries places many new workers at risk each year. The hygienically poor working conditions often expose workers to high concentrations of respirable dust, so that pneumoconioses can develop with rapid progression after a short latency period. The health risk is increased by the high prevalence of tuberculosis in most of those countries. Accurate statistical data on occupational diseases in developing countries are rare. Although some prevalence data are available from cross-sectional studies, incidence figures and risk estimates are usually lacking because of the absence of reliable information about the size of the population at risk and exposure measurements. Some figures on pneumoconioses from countries in Africa, Asia, and South America are presented. To prevent pneumoconioses, hygienic conditions at the workplaces should be controlled and improved and appropriate dust standards developed. Medical surveillance of exposed workers should be organized. Finally, research in the field of pneumoconioses in developing countries should be promoted.

Adult↗

Spread of smoking to the developing countries.

In most developing countries, tobacco consumption was relatively low in the past. It has been increasing in recent years as developed countries have exported more cigarettes to developing countries, and as developing countries have cultivated more tobacco themselves to produce cheaper tobacco, at the sacrifice of food production. Tobacco sales are an important source of revenue for governments in the developing countries as in the developed countries. The spread of smoking to developing countries and the increase in tobacco consumption have had several adverse effects: an increase in lung cancer and other smoking-related diseases; an increase in economic burdens resulting from imports of cigarettes from developed countries and increased medical costs for smoking-related diseases; and decreases in production and import of foods. There are many obstacles and constraints to smoking control in the developing countries, but smoking control is badly needed to prevent lung cancer and other smoking-related diseases, to alleviate economic burdens and to increase the production and import of foods.

Developing Countries↗

Adapting developing country epidemiological assessment techniques to improve the quality of health needs assessments in developed countries.

BACKGROUND: We were commissioned to carry out three health assessments in urban areas of Dublin in Ireland. We required an epidemiologically robust method that could collect data rapidly and inexpensively. We were dealing with inadequate health information systems, weak planning data and a history of inadequate recipient involvement in health service planning. These problems had also been identified by researchers carrying out health assessments in developing countries. This paper reports our experience of adapting a cluster survey model originally developed by international organisations to assess community health needs and service coverage in developing countries and applying our adapted model to three urban areas in Dublin, Ireland METHODS: We adapted the model to control for socio-economic heterogeneity, to take account of the inadequate population list, to ensure a representative sample and to account for a higher prevalence of degenerative and chronic diseases. We employed formal as well as informal communication methods and adjusted data collection times to maximise participation. RESULTS: The model we adapted had the capacity to ascertain both health needs and health care delivery needs. The community participated throughout the process and members were trained and employed as data collectors. The assessments have been used by local health boards and non-governmental agencies to plan and deliver better or additional services. CONCLUSION: We were able to carry out high quality health needs assessments in urban areas by adapting and applying a developing country health assessment method. Issues arose relating to health needs assessment as part of the planning cycle and the role of participants in the process.

Censuses↗

Children and savings in less developed countries.

"A commonly cited motive for childbearing in LDCs is the support in old age provided by one's children. Alternative means of retirement support become available as a country develops. This paper presents a simple two period model in which financial institutions are allowed to substitute for children in the provision of this service. The 'quality' of financial institutions is given an operational definition and the hypotheses of the model are tested on a cross-section sample of countries."

Adolescent↗

[Classic and emerging sexually transmitted diseases in industrialized countries and in developing countries].

In industrialised countries, there has been a drastic decrease in the number of reported cases of syphilis, gonorrhoea, and tropical sexually transmitted diseases (STD) since the introduction of antibiotics in the 1950s, whereas among the general population of non-industrialised countries, the number of cases of these diseases has remained extremely high. The World Health Organization has estimated that, worldwide, 333,000,000 new cases of curable STD occur every year and that 90% of these cases come from non-industrialised countries. Moreover, viral STD, such as genital herpes, condyloma, hepatitis B infection, and HIV-1 infection, represent an even greater problem in that they are not curable. STD are also a cause of serious complications in the genital and reproductive tracts of both genders, and curing these complications requires substantial economic resources.

Developed Countries↗

Socioeconomic and behavioral factors leading to acquired bacterial resistance to antibiotics in developing countries.

In developing countries, acquired bacterial resistance to antimicrobial agents is common in isolates from healthy persons and from persons with community-acquired infections. Complex socioeconomic and behavioral factors associated with antibiotic resistance, particularly regarding diarrheal and respiratory pathogens, in developing tropical countries, include misuse of antibiotics by health professionals, unskilled practitioners, and laypersons; poor drug quality; unhygienic conditions accounting for spread of resistant bacteria; and inadequate surveillance.

Anti-Bacterial Agents↗

Role of ergonomics in the transfer of technology to industrially developing countries.

Technological development has contributed to economic growth and social progress as well as a reduction of many sources of occupational accidents, injuries and stresses. However, advanced technology has also brought new sources of work stress and injuries. Industrially developing countries (IDC) have tended to try to achieve economic growth and development by importing technology designed for IDC. However, because of several complex technical, cultural and socio-economic factors, this policy has not been always successful. Inappropriate technology transfer has led to many work environment and productivity problems. Consideration of ergonomics in the choice and utilization of the transferred technology can help to create a good fit between technology, technology users and the operating environment. Application of ergonomics is, however, not widely spread in most IDC. Ergonomics input will create the appropriate working environment in which people are safe and motivated to participate and can better utilize company resources for increasing system productivity, reliability and availability.

Developing Countries↗

Can a developed country's maternal mortality review be used as the 'gold standard' for a developing country?

BACKGROUND: Relative to other public health problems, maternal mortality ratio (MMR) differences between developed and developing countries are greater than expected. South Africa (SA) produced its first national report on maternal deaths in 1998. UK's last report covered the period 1994-1996. OBJECTIVE AND METHOD: Compare the two reports to document reasons for the MMR differences using the Safe Motherhood analytical model of maternal mortality as a template. RESULTS: The MMR for SA was estimated to be 12.3 times greater than the UK's. Under-reporting was bigger in SA. Substandard medical care was common, but other quality of care issues were not assessed. Disease pattern differences included AIDS, non-pregnancy-related infections and postpartum haemorrhage in SA compared to thromboembolism and medical disorders in the UK. Autopsies were problematic. Demographic differences centred around ethnic origins. Biological differences may involve the immune system. Socio-economic or behavioural factors were not documented. CONCLUSIONS: Awareness of the magnitude of the problem requires better data collection systems. Sepsis and HIV/AIDS are a major problem in SA. Beyond the mutually common problem of substandard medical care, other quality of care issues were inadequately assessed.

Behavior↗

Study and introduction of family planning methods in developing countries.

Research in developing countries is essential for the evaluation of the safety, efficacy and acceptability of both new and already available contraceptives. Research conducted by scientists in developing countries has also played an essential role in the development of new contraceptives. The continuous delivery of progestin at a low dose, copper IUDs, contraceptive implants, monthly injectables and vaginal rings are examples of new methods developed with the input of research conducted largely in developing countries. When research in developing countries is funded or coordinated by international agencies, local scientists have to be involved not only in its implementation, but in the planning, analysis and dissemination of such research. The World Health Organization, the Population Council and Family Health International have played an important role in supporting collaborative studies for the development, introduction and evaluation of family planning methods in developing countries.

Developing Countries↗

Technology assessment in developing countries.

Although developing countries can ill afford to make the wrong choice of technology, they usually find it difficult if not impossible to support an adequate technology assessment programme. Much of the available information on the efficacy of various products is valid for other countries, but factors such as epidemiology, cost-effectiveness and acceptability also have to be taken into account, and these vary considerably from one setting to another. There is therefore a strong case for developing national programmes as quickly as possible.

Developing Countries↗