Healthcare in UzbekistanUzbekistan is a former Soviet country and many consider it to be the population center of Asia with a young population. Since its independence in 1991, the country has diversified its agriculture, while keeping a significant agricultural base to its economy. The quality of healthcare in Uzbekistan endured a drop after its independence from the USSR but now is on the upward trend, even though it remains low in global rankings. Here are seven facts about healthcare in Uzbekistan.

7 Facts About Healthcare in Uzbekistan

  1. Under Soviet control, all healthcare in Uzbekistan was free. However, the government focused on access and less on outcome, leading to weaknesses when dealing with sickness and disease, especially in rural communities. Meanwhile, about 27% of hospitals in rural areas had no sewage and 17% had no access to running water, while doctors received 70% of the salary of a farmer, a common Uzbek job. Now, reforms focused on rural areas have improved conditions in all hospitals, and doctors now make 26 times the amount of a rural farmer.
  2. In Uzbekistan, most people rely on public healthcare providers, organized in three layers: national, regional and city. Private healthcare is minimal due to unsafe practices in treatment and surgery. As a result, the government is the principal employer of health workers, as well as the primary purchaser and provider of health-related goods and services.
  3. Spending on healthcare in Uzbekistan has increased from the country’s independence in 1991, as the country aimed to westernize and reform. Uzbekistan’s current health expenditure is 6.4%. The government health spending increased from $36 to $85 per person; out of pocket spending almost doubled from $37 to $69 per person, and developmental assistance doubled from $3 to $7 per person in the 30 years from its independence. The increased funding led to higher availability in healthcare, especially in rural areas, and better quality of care.
  4. In the past 30 years, Uzbekistan has implemented healthcare reforms in rural areas. Some improvements include increasing sanitation levels in hospitals and healthcare availability, allowing for all patients to get better care. Overall, the under-5 mortality rate has decreased by 50%, and healthcare access and quality (HAQ) grew from 50.3 to 62.9 from 1990 to now.
  5. The physician’s density is low, at 2.37/1000 people, mostly due to the emigration of skilled professionals, even though the median pay for physicians has sharply increased to about $13,000 a year. On the other hand, the hospital bed density is higher than in some highly developed countries, such as the United States, at four for every 1,000 people.
  6. Uzbekistan ranks low in maternal and infant mortality. At 29 deaths out of 100,000, it ranks 114 in maternal mortality. At 16.3 deaths out of 1,000, it ranks 93 in infant mortality. Although its healthcare system has gotten better with reforms in sanitation and access to healthcare, Uzbekistan still needs to create more improvements, as the mortality rate is still high.
  7. Uzbekistan is also low-ranking in adult health. The country holds the rank of 125 in life expectancy, with an average lifespan of 74.8 years. As for the quality of health, Uzbekistan ranks 115 in HIV/AIDS, with a prevalence of 0.2% and ranks 123 in obesity, with a prevalence of 16.6%.

Project Hope

Uzbekistan has not accomplished everything on its own. Many charities have worked with Uzbekistan, such as Project Hope. In 1999, Project Hope established its first office in Uzbekistan, with a focus on reducing child and maternal mortality rates, through the Child Survival Program and Healthy Family Program. It created initiatives, as well as opportunities for sexual education for the new mothers. Since then, under the Global Fund to Fight AIDS, Project Hope has focused on creating opportunities for AIDS-focused healthcare and education.

Uzbekistan has made progress in healthcare from the time of its independence, but it still has a long way to go. As Uzbekistan’s government continues to implement reforms heavily focusing on rural areas, it will most likely continue on its upward trajectory and create a health system that is beneficial to all of its citizens. As healthcare grows, poverty will decrease. Currently, Uzbekistan’s most poor are in rural areas, the areas with the least access to healthcare, as well as the lowest levels of sanitation. If Uzbekistan continues making reforms, rural areas will receive more healthcare, decreasing the disadvantage of living there, and therefore increasing the quality of life for Uzbekistan’s poor.

Seona Maskara
Photo: Flickr

dementia in developing countriesThough dementia is traditionally thought of as being prevalent only in the developed world, it is now occurring at higher rates in developing countries. Currently, 67% of people with dementia worldwide reside in low- and middle-income nations, and researchers predict that number will reach 75% by 2050 in tandem with these nations’ aging populations. Because health and social care services in these countries are already strained or non-existent, dementia in developing countries poses a unique set of challenges.

Dementia and Alzheimer’s

The most common cause of dementia is Alzheimer’s Disease. But as with nearly all forms of dementia, there is progressive brain cell death, so as its symptoms progress, cognitive functions become severely impaired. As early as the second stage of mild dementia, individuals may require intensive care and supervision from others with tasks in their daily life. However, healthcare systems are stretched thin in many developing countries. Often, their frontline providers may not be adequately trained in providing the long-term care needed for these conditions. Even when assisted-living arrangements in a medical facility are an option, people with dementia have limited autonomy over their care because there are few systems in place to monitor the quality of dementia care in poorer nations.

Treating Dementia in Developing Countries

Due to the lack of formal care, people with dementia in the developing world tend to rely upon systems of “informal” care by family, friends, or other community members. These support mechanisms are under great strain due to the economic, emotional and physical demands of unpaid, and often unsubsidized, caregiving. Caring for someone with dementia can demand up to 74 hours a week and cost around $4600 a year. Furthermore, symptoms associated with the later stages of dementia, such as aggression, depression and hallucinations can have distressful psychological effects for these caregivers. In fact, 45% of family caregivers report experiencing distress, and 39% have feelings of depression.

Social Stigmas Surrounding Dementia

The social stigma associated with mental health diagnoses as well as general health illiteracy and unfamiliarity with dementia also contributes to inequities within the quality of dementia care. A study conducted in India suggested that 90% of dementia cases in low and middle-income nations go undiagnosed. Even healthcare professionals may lack the awareness to identify early signs of dementia. The wide-spread myth that dementia is not a medical issue in developing countries can mislead providers to dismiss dementia’s symptoms as characteristics indicative of normal aging.

Furthermore, in some parts of Sub-Saharan Africa, such as rural Kenya and Namibia where knowledge of dementia is not widespread, people may associate dementia with witchcraft or punishment for previous wrongdoings. Such beliefs further entrench the stigma surrounding it into the broader culture, discouraging people with dementia from seeking an official diagnosis. Organizations like the Strengthening Responses to Dementia in Developing Countries (STRiDE) Project have worked specifically towards reducing this stigma.

Understanding Poverty and Dementia

The immense prevalence of undiagnosed cases is particularly detrimental, considering poverty may increase one’s risk of dementia. Poverty is linked with many risk factors for dementia — one of which is stressful experiences like financial insecurity and education difficulties. Incidence of dementia has also been linked to lower levels of education since early development of neural networks can help the brain combat damages to its pathology later in life. A study on the rural Chinese island of Kinmen, where the median level of education is one year, showed dementia rates rising as people turned 60. This trend is earlier than in developed nations, and implies that illiteracy and lack of education can bring on dementia sooner.

Looking Forward

It remains unclear whether there is a correlation or direct causation between education level and the likelihood of dementia later in life. But one thing, however, is clear — low education levels serve as a frequent marker for other socioeconomic issues that are more common in developing nations, such as poverty, malnutrition, and toxic environmental exposures. Furthermore, the most commonly recommended strategy for reducing the risk of Alzheimer’s is maintaining overall health, which is more difficult in poorer countries due to malnutrition and unequal access to health care.

Moving forward, we must expand the support available to informal care systems, while ensuring healthcare providers receive dementia-specific training and health literacy. Women often the ones left to provide the majority of dementia care, but their efforts largely go ignored by their governments. Incentives, like universal social pensions, disability benefits and carer’s allowances, could support family and friends who house and care for people with dementia. Still, formal health systems too need to be bolstered to supplement and eventually substitute the role of informal carers. Policy-makers worldwide need to prioritize and anticipate the growing number of people with dementia as it remains the only leading cause of death still on the rise.

– Christine Mui
Photo: Flickr

Apps that aid in healthcare in developing countries It can sometimes be difficult for people in developing countries to access healthcare, specifically those living in poverty. In order to address this problem, healthcare apps are being used to provide greater access. Here are 10 healthcare aid apps that are impacting access in developing countries.

10 Apps That Aid Healthcare in Developing Countries

  1. Peek has its sights set on helping people with vision impairment issues and blindness, a problem exacerbated in developing countries by a lack of resources. Peek can identify people with vision problems. The app then works with healthcare providers to pinpoint an economically feasible way to supply the treatment they need, before allocating the appropriate resources. Currently, Peek is being used by the International Centre for Eye Health at the London School of Hygiene and Tropical Medicine, which is administering a population-based survey of blindness and visual impairments in Cambodia.
  2. SASAdoctor focuses on making healthcare consultations more accessible in Kenya. In the country, only 12% of people are insured. About 8 million are reliant on the National Hospital Insurance Fund, leaving 35 million Kenyans uninsured. Available to all Kenyans with an Android smartphone or tablet (65% of Kenyans have one), SASAdoctor decreases the cost of an in-person consultation for the uninsured and makes it free for those with insurance. Patients will have their medical history, list of medications and other such medical notes in their ‘file’ on the app, so that whoever tele-consults with them will have the information they need to create an informed medical opinion. SASAdoctor can decrease the cost of uninsured visits with a doctor to Kes 495 (the equivalent of $4.66) for a projected 80% of Kenyans who are predicted to have smartphones in the next few years.
  3. iWander allows people to keep track of Alzheimer’s patients. Set with tracking technology that can be discretely worn by the patient, it offers whoever uses the app several options on how to deal with situations involving the patient. Solutions can range from a group calling session to making an emergency medical call or summoning a caregiver. iWander gives families more control over the care of a loved one, which can have a positive impact in countries where healthcare may be less accessible. In the US, the average cost of care for a single person is $174,000 annually. About 7 out of 10 individuals with dementia remain at home to receive care, where 75% of the costs fall to the family to pay. In helping families be proactive instead of reactive to crises, iWander can help in cutting these costs, especially in poorer countries, where many families are struggling to keep up with the high costs of at-home care.
  4. Kenek O2 allows the user to monitor their oxygen and heart rate while they sleep. Kenek O2, built for the iPhone, also requires a pulse oximeter which connects to the phone and retrieves the data to be stored in the app. Together, the cost for these two items is around $100, compared to the price of a regular hospital oximeter and other similar products, which could easily cost more than $500. Having effectively been used in North America, South America, Asia and Africa, Kenek O2 is currently working on developing a special COVID-19 device to watch for early signs of hypoxia, or the deficiency of oxygen reaching tissues.
  5. First Derm is an app that requires a smartphone-connected device, called a dermatoscope. This allows detailed pictures to be taken of skin conditions and lesions to better allow for remote, teleconsultations. In places where doctors are few and far between, and public transport is less reliable, this can make getting a second medical opinion much easier. So far, First Derm has helped in more than 15,000 cases from Sweden, Chile, China, Australia and Ghana, ranging from ages of just 3 days old to 98 years. Of these cases, 70% could be treated without a doctor, most often by over-the-counter treatments available at local pharmacies.
  6. Ada takes user-input symptoms and provides appropriate measures to take as a result, like a personal health assistant. It’s intended to assist those who don’t have the means to seek an in-person consultation right away. The app has been released in several languages, which makes it more accessible. Currently, 10 million people around the world are using Ada for symptom evaluation.
  7. Babylon is intended to mitigate the obstacle of going to see a doctor in person by allowing users to input symptoms or solve common health problems via teleconsultation with a doctor. Babylon specializes in non-emergent medicine, allowing patients to skip a trip to the doctor’s office entirely if their condition allows it. This is beneficial in places where doctors are sparse, or the patient lacks the financial means or a method of transportation in getting to the hospital. Babylon caters to users across the U.S., U.K., Canada, Rwanda and several countries across Asia-Pacific and the Middle East. The app aims to expand to more countries in the upcoming years.
  8. MobiSante, through its ultrasound device, allows versatility in diagnostic imaging by bringing the ultrasound to the patient. This allows quality, diagnostic imaging to be done outside the confines of a hospital or clinic. As a result, it provides more holistic and informed treatment where people may need it most but have previously struggled in accessing a healthcare center with the necessary technology. While having a computer at home with a desk is much less common in developing countries, the world’s increasing reliance on the internet is shifting the status of internet technology from a luxury to a basic necessity. This means that technology such as smartphones are becoming somewhat of a necessity in impoverished countries, making an app like MobiSante effective in using smartphones to make diagnostic imaging more accessible.
  9. Go.Data is a tool released by the WHO. It is specifically for collecting data during global health emergencies. During the Ebola outbreak in Africa, Go.Data was praised for tracing points of contact. The app also tracked infection trends and helped in arranging post-contact follow up.
  10. Mobile Midwife is a digital charting app that stores information in a cloud so that healthcare workers have access to all pertinent patient information. It works even in cases of power outages, or home births where internet connection may be less reliable. This app can help in areas where mother and infant mortality is higher, ensuring that healthcare providers can efficiently access patient information to ensure the best care. It can also cut the extra time it takes to find records that could otherwise make procedures more dangerous for both mother and child.

Bridging healthcare accessibility with smartphone apps isn’t a perfect solution, as it comes with accessibility issues of its own. However, these healthcare aid apps can help people without insurance, or who are physically unable to visit a physician, access health consultations. As a result, more people are provided access to healthcare, empowering a healthier (and more health-conscious) population.

– Catherine Lin
Photo: Flickr

Healthcare in NorwayWhile many countries struggle to create and maintain an effective healthcare system, Norway has become a symbol of what a successful national healthcare system can look like. Norway is one of the kingdoms of the Scandinavian subregion of Europe. The country of 5.2 million people borders Sweden on the west and is east of the Shetland Islands. “Norwegian values are rooted in egalitarian ideals,” meaning that everyone should have equal opportunities. These principles are reflected in the country’s healthcare system.

Healthcare in Norway is designed for equal access, but it is by no means free. The country’s universal healthcare system is heavily subsidized by the government through taxation. Such high taxes have allowed Norway to run a broad welfare system that provides sickness coverage, unemployment coverage, social security and pension benefits that often allow even those who are low-income or impoverished to participate in healthcare. Here are eight facts about healthcare in Norway.

8 Facts About Healthcare in Norway

  1. All participants in the Norwegian healthcare system must cover all medical expenses up to 2040 krone (about $210) before they receive an exemption card. Then their treatment for the rest of the year is free.
  2. Norwegian spending on healthcare on a per head basis, which is currently at $6,187 per person, is the fourth highest in the world. The United States is highest at $10,600 per person.
  3. The Norwegian National Insurance Scheme is centrally controlled by the Norwegian Health Economics Administration (Helseøkonomiforvaltningen, HELFO); the administration of healthcare, however, is decentralized and handled by local municipal authorities. When Norwegians are traveling or living abroad, the country’s membership in the European Economic Area (EEA), a similar economic agreement to the European Union, and possession of the European Health Insurance Card allows them the same healthcare as the country they are staying in. After six months in Norway, documented immigrants can access healthcare. Visitors to Norway who are not members of the EEA are expected to pay in full.
  4. People can opt-out of the public system and choose private insurance instead. People will sometimes choose private insurance if they want to have certain procedures done quicker than the public system can handle. Nine percent of Norway’s population has private insurance at an average cost of 508 krone ($56) a month, and 91% of this insurance is covered by their jobs — making it relatively affordable.
  5. The Norwegian government has created a “Qualification Program” to deal with extended joblessness and poverty that might restrict affording healthcare. The program is designed to overcome social obstacles and a lack of skills through various activities. Participants usually find employment after four years.
  6. In Norway, life expectancy is 81 years old for men and 84 years old for women. This ranks the country 17th in the world. This longevity is attributed to a generally active lifestyle, a diet high in fish — specifically salmon —and a strong healthcare system.
  7. Although healthcare is robust in Norway, there are still areas of concern. Tobacco smoking has decreased, but there has been an increase in the use of a smokeless tobacco powder called snus, which is inhaled and can potentially increase the risk of oral cancers. In addition, childhood obesity is on the rise in Norway. Obesity among five to 19-year-olds has increased by more than 50% over the past decade.
  8. From 2013 to 2017, spending on pharmaceuticals increased by 40% in Norway, as national prescription drug use has increased. The Norwegian Health Economics Administration handles the reimbursement of the cost of pharmaceuticals. Distribution is highly regulated, as only community and hospital pharmacies can distribute medicine in the Norway health system.

Norway’s egalitarian and progressive ideals have helped make its healthcare system one of the best in the world. The country still faces challenges, including high rates of childhood obesity and cancer risk from smokeless tobacco. Norway is working to address these problems, for example by prohibiting the advertising of all tobacco products. The heavy taxation required for funding many public programs, including healthcare, often falls more heavily on those in lower-income brackets, but the government provides a thorough safety net to assist them. Norway has made great advances. The country remains a model of what a strong welfare state and an effectively run universal healthcare system can achieve.

Joseph Maria
Photo: Flickr

healthcare in turkeyResting in the middle of three continents, not only is Turkey’s economy promising but so is their cultural impact. Turkey houses one of the largest refugee populations, with over 3.6 million registered Syrians amongst the 82 million Turkish citizens. With the country’s inconsistent conflict, the citizens require constant care due to the aftermaths of war, diseases and recently, coronavirus. Thus, healthcare in Turkey is at the forefront of global evaluation.

COVID-19

As of July 23rd, 2020, COVID-19 had infected more than 220,000 people in Turkey. The virus reached the peak of the first wave in April and has gradually sedated ever since with only one thousand cases nationally. Turkey restricted access across the borders and made it mandatory to wear masks in public. People above the age of 65 and below the age of 18 are required to follow a curfew under lockdown. The immediate action and the meticulous COVID-19 management by Turkey set a high example for the strength of a developing country.

Common Diseases

Apart from the coronavirus, Turkey sees many deaths from viral infections, circulatory system disorders, respiratory diseases and cancer. In 2016, non-communicable diseases caused 89% of deaths. Not only does the warm oceanic climate foster the spread of communicable diseases, but Turkey’s location between Africa, Asia, and Europe also promotes the spread of foreign diseases. Despite those factors, Turkey’s expansive healthcare system nurses their patients to their best ability.

Universal Healthcare System

The healthcare system in Turkey is not only affordable but of high quality. They are the regions leading provider for healthcare, providing citizens with the most care possible. While a heart bypass surgery would cost $129,750 in the United States, it only costs $12,000 in Turkey. Many infamous pharmaceutical companies and internationally-competitive medical facilities are all situated in Turkey. Turkish residents can receive free universal healthcare when registered with the social security system in contracted hospitals. Foreigners living in Turkey pay around $30 a month for unlimited healthcare.

Refugees and People in Poverty

Since the beginning of Syria’s refugee crisis, WHO has partnered with Turkey’s Ministry of Health to provide “culturally and linguistically sensitive” free healthcare. The WHO Refugee Health Program trained more than 2000 Syrian health workers in seven training facilities for the workers to be hired into 178 different hospitals. Syrian asylum seekers and refugees receive free healthcare to treat traumatized patients.

With Turkey’s 9.2% poverty rate, many cannot afford private health insurance or even pay their taxes. Turkey has created a system to include access to high-quality healthcare for all. In 2012, 98% of Turkish residents had access to healthcare because of The Health Transformation Program led by the government of Turkey and the World Bank.

The advancing system of Turkey aims for 100% access to quality healthcare. With an accepting atmosphere, people in poverty no longer have to worry about paying hospital bills or skipping doctor appointments. Healthcare fosters a system where everybody is strong and able-bodied to take on work. This creates an opportunity for people in poverty, refugees, and other vulnerable populations to rise above the poverty line.

Zoe Chao
Photo: Flickr

healthcare centers in MadagascarSince the coup in 2009, Madagascar’s newly elected government has been working with outside organizations, such as Project HOPE, to improve healthcare centers in Madagascar. In 2020, the country partnered with the Ministry of Public Health and the United Nations Population Fund to provide free transportation for pregnant women during the COVID-19 pandemic.

Healthcare Centers in Madagascar

USAID reported that more than 60% of Madagascar’s population — 27.7 million people — lives more than five kilometers from a healthcare center. This distance takes about one hour to walk. According to the World Bank, the cost of treatment and transportation to healthcare centers can be a barrier for people in poverty to access healthcare. The World Bank reported that about 75% of Madagascar’s population lives below the international poverty line, on less than $1.90 per day. This directly impacts the ability of people to access and pay for treatment at healthcare centers. UN Women statistics show that 75.9% of employed women in Madagascar are below the international poverty line, compared to 73.7% of men.

Released in 2017, a Project HOPE study examined the effects of removing fees at health centers in Madagascar. According to the study, citizens located within five kilometers became more likely to seek treatment. They account for 15-35% of those who reported illness. Fee exemptions for certain medicines and treatments likewise increased the use of healthcare services for maternity consultations by 25%.

Impacts of Limited Transportation

In a report from June 2018, the World Bank wrote that many rural citizens of Madagascar are disconnected from main roads, which limits their access to healthcare centers. Madagascar has a low road density. This means the country’s complete network of roads is small compared to the country’s total land area. As a result, 25% of healthcare centers in Madagascar are located more than five kilometers from the road network.

According to the World Bank report, poor road conditions in rural areas also impact network connectivity. Transportation of medical supplies can be unreliable, specifically during rainy seasons, when roads can be flooded and hard to cross. This makes it difficult for health centers to consistently send supplies to those who cannot access the centers.

Lack of access to transportation can also contribute to keeping people in poverty. The World Bank and the Department for International Development wrote that isolation due to difficulty accessing roads and transportation can limit the ability of people in poverty to participate in local markets. This decreases their economic opportunity.

The Effects of COVID-19

With 908 confirmed cases and six total deaths from COVID-19, the Centers for Disease Control and Prevention has classified Madagascar as warning level three for the pandemic. The country is in partial lockdown. On April 5, President Andry Nirina Rajoelina announced that only vehicles transporting goods were allowed to circulate in the three regions impacted by COVID-19 — Matsiatra, Ambonym Analamanga and Atsinanana. All other public transport was suspended. For some, without public transport, the nearest health center is two hours away.

Solutions

The United Nations Population Fund reported that 44% of women in Madagascar give birth with the help of healthcare professionals. Madagascar’s maternal death rate is 353 for every 100,000 births. According to UNFPA, this rate is high compared to the global average of 216 maternal deaths for every 100,000 births.

The Ministry of Public Health and the UN Population Fund partnered to help pregnant women access healthcare centers in Madagascar. These organizations are providing free, 24-hour transportation for women living in the cities of Antananarivo and Toamasina during COVID-19. By the end of Madagascar’s partial lockdown, this free transportation is projected to help around 5,000 pregnant women.

Poverty impacts peoples’ ability to access healthcare centers in Madagascar due to restricted transportation and high fees. Statistics show this lack of accessibility impacts women slightly more than men. With even fewer transportation options during COVID-19, free transportation for pregnant women is making a positive impact on healthcare accessibility.

Melody Kazel 
Photo: Flickr

Health Care in SwedenSweden has the highest income tax rate in the world. More than 57% is annually deducted from people’s incomes. However, Sweden placed seventh out of 156 countries in the World Happiness Report 2019, and its healthcare system is one of the best in the world.

In 1995, Sweden joined the European Union and its population recently reached over 10 million people. Healthcare is financed through taxes and most health fees are very low. Sweden operates on the principle that those who need medical care most urgently are treated first. Higher education is also free, not only to Swedes, but also to those who reside in the rest of the European Union, the European Economic Area, and Switzerland. Like healthcare, it is largely financed by tax revenue. Here are 10 facts about healthcare in Sweden.

 10 Facts About Healthcare in Sweden

  1. Sweden has a decentralized universal healthcare system for everyone. The Ministry of Health and Social Affairs dictates health policy and budgets, but the 21 regional councils finance health expenditures through tax funding; an additional 290 municipalities take care of individuals who are disabled or elderly. To service 10.23 million people, Sweden has 70 regionally-owned public hospitals, seven university hospitals, and six private hospitals.

  2. Most medical fees are capped and have a high-cost ceiling. According to the Swedish law, hospitalization fees are not allowed to surpass 100 kr (Swedish Krona), which is equivalent to $10.88, a day and, in most regions, the charge for ambulance or helicopter service is capped at 1,100 kr ($120). Prescription drugs have a fee cap and patients never pay more than 2,350 kr ($255) in a one-year period. In the course of one year, the maximum out-of-pocket cost is 1,150 kr ($125) for all medical consultations. If the person exceeds the cap, all other consultations will be free. Additionally, medical services are free for all people under the age of 18.

  3. The cost for medical consultations not only has a price cap, but is generally low. The average cost of a primary care visit is 150 kr-300 kr ($16-$33) and the cost of a specialist consultation, including mental health services, ranges from 200 kr-400 kr ($22-$42). The cost of hospitalization, including pharmaceuticals, does not exceed 100 kr ($11) per day and people under the age of 20 are exempt from all co-payments. Healthcare services, such as immunizations, cancer screenings, and maternity care, are also free and have no co-payments.

  4. All dental care for people under the age of 23 is free. When a person turns 23, they no longer qualify for free dental health care in Sweden and must pay out of pocket. However, the government pays them annual subsidies, or an allowance, of 600 kr ($65) to pay for dental expenses. In Sweden, the cost of a tooth extraction is 950 kr ($103) and the cleaning and root filling for a single root canal costs 3,150 kr ($342). If dental care costs total anywhere between 3,000 kr-15,000 kr ($326-$1,632), the patient is reimbursed 50% of the cost. If it exceeds 15,000 kr, 85% of the cost is reimbursed.

  5. To battle its large medical waiting lists, Sweden has implemented a 0-30-90-90 rule. The wait-time guarantee, or the 0-30-90-90 rule, ensures that there will be zero delays, meaning patients will receive immediate access to health care advice and a seven-day waiting period to see a general practitioner. The rule also guarantees that a patient will not wait more than 90 days to see a specialist and will receive surgical treatment, like cataract removal or hip-replacement surgery, a maximum of 90 days after diagnosis. Sweden’s government also committed 500 kr million ($55 million) to significantly decrease wait time for all cancer treatments. In 2016, Sweden developed a plan to further improve its health services by 2025 through the adoption of e-health.

  6. In 2010, Sweden made private healthcare insurance available. The use of private health insurance has been increasing due to the low number of hospitals, long waiting times to receive healthcare, and Sweden’s priority treatment of emergency cases first. In Sweden, one in 10 people do not rely on Sweden’s universal healthcare but instead purchase private health insurance. While the costs for private plans vary, one can expect to pay 4,000 kr ($435) annually for one person, on average.

  7. Sweden’s life expectancy is 82.40 years old. This surpasses the life expectancies in Germany, the UK, and the United States. Maternal healthcare in Sweden is particularly strong because both parents are entitled to a 480-day leave at 80% salary and their job is guaranteed when they come back. Sweden also has one of the lowest maternal and child mortality rates in the world. Four in 100,000 women die during childbirth and there are 2.6 deaths per 1,000 live births. There are 5.4 physicians per 1,000 people, which is twice as great as in the U.S and the U.K, and 100% of births are assisted by medical personnel.

  8. The leading causes of death are Ischemic heart disease, Alzheimer’s disease, stroke, lung cancer, chronic obstructive pulmonary disease and colorectal cancer. While the biggest risk factors that drive most deaths are tobacco, dietary risks, high blood pressure and high body-mass index, only 20.6% of the Swedish population is obese and 85% of Swedes do not smoke. The Healthcare Access and Quality Index (HAQ Index) also estimates that, in 2016, the rate of amenable mortality, or people with potentially preventable diseases, were saved at a rate of 95.5% in Sweden. The HAQ Index estimates how well healthcare in Sweden functions; the index shows that it is one of the best in the world.

  9. Sweden’s health expenditure represents a little over 11% of its GDP, most of which is funded by municipal and regional taxes. Additionally, in Sweden, all higher education is free, including medical schools. There are no tuition fees and a physician can expect to have an average monthly salary of 77,900 kr ($8,500).

  10. In Sweden, 1 in 5 people is 65 or older, but the birth rate and population size are still growing. Because Sweden has one of the best social welfare and healthcare systems in the world, people live longer and therefore 20% of the population does not generate income or pay taxes from their salary. This dynamic stagnates social welfare benefits and slows down the economy. Increasing immigration and a rise in births are the two solutions to ensure that the younger generations will receive the same benefits. Swedish-born women have an average of 1.7 children and foreign-born women have an average of 2.1 children. In 1990, Sweden broke the 2.1 children fertility rate but quickly dropped below 2.0 in 2010. Since 2010, Sweden has seen an increase of 100,000-150,000 immigrants and has seen 45,000 citizens emigrate.

In 2018, Sweden reached its record highest GDP (PPP) per capita of almost $50,000. Despite having the highest taxes in the world, the living conditions and healthcare in Sweden are some of the best. With time, its population will continue to grow and the healthcare system will continue to advance.

Anna Sharudenko
Photo: Flickr

Healthcare in the Russian Federation
The Russian Federation is the biggest country in the world, covering more than 6.6 million square miles. It is also the ninth most populated country with almost 146 million citizens. Despite Russia having universal healthcare, most people are unable to obtain an adequate form of it. After the fall of the Soviet Union in 1991, healthcare conditions have not improved and many expect it will worsen due to government corruption, consequences of COVID-19 and a lack of government funding for medical supplies. Here are 10 facts about healthcare in the Russian Federation.

10 Facts About Healthcare in the Russian Federation

  1. Life expectancy increased by eight years over the past 20 years but still remains lower in males than in females. In 2000, estimates determined that the average lifespan of both genders was 65 years old, but in 2018, the number increased to 73 years old. In 2020, estimates identified that females live to 77.8 years old, while males only live to an average of 66.3 years.
  2. The Russian Federation provides its citizens with compulsory insurance, known as OMC, or free universal healthcare. Russia also allows its citizens to purchase privately-owned insurance or DMC. People who are on the OMC do not receive coverage for the majority of vital treatments and everyone has to pay in full for the provided medical services. Poor healthcare in the Russian Federation stems from a lack of governmental funding, hence more than 17,500 Russian villages and towns have no medical infrastructure and salaries for doctors and nurses are often as low as $250 a month.
  3. In 2019, a large number of imported medicines disappeared from Russian pharmacies and the sanctions against Russia further escalated the drug shortage problem. The Russian government failed to supply basic drugs like glucose, Prednisone and Lamivudine to its hospitals. There is also a painkiller deficit for terminally ill patients which is linked to the suicides of 40 terminally ill cancer patients in Russia in 2014. The problem with drug shortages and low wages has escalated in the previous years because Russia has implemented policies that not only cut spending on imported Western products but also only promote domestic businesses.
  4. The Russian government plans to cut its healthcare budget by 33% in the near future, bringing it down to $5.8 billion a year. Russia’s current health expenditure from GDP is only 5.3%, which is less than Guatemala and Madagascar’s annual GDP healthcare spending. The current global average health expenditure is at 10%. According to a 2014 Bloomberg report, healthcare in the Russian Federation placed last out of 55 developed nations.
  5. Moscow, the capital of the Russian Federation, has the best hospitals in the country, some of which have national rankings. Moscow’s Children Hospital ranks 250th in the world, while the Bakulev Center for Cardiovascular Surgery ranks 291st. Despite dire shortages of medicine, both hospitals operate at a national level. Russia also has more than 17,000 pharmacies and 17% of them are privately owned, while the rest either belong to the city’s authorities or regional governments.
  6. In Russia, 98% of children between the ages of 12-23 months receive vaccinations for measles and skilled health staff attend 99% of all births. However, the general rate of vaccinated children has recently declined because not only did the parents receive the option to not vaccinate their children, but many citizens noticed that their children get ill more frequently after receiving the vaccines. Because the measles vaccine became widespread since 1993, cases in Russia have drastically decreased, dropping from almost 80,000 to only 2,539 in 2018. In addition, there were 51 births per 1,000 women between the ages of 15-19 in 1990, but in 2018, it has decreased to 20 births per 1,000 women. Russia’s teenage pregnancy rate is decreasing because of an increase in contraceptive counseling and laws, one of which stipulates young women older than 15 years old to receive sexual health consultations without their parents’ permission.
  7. Only 5% of people hold private medical insurance or use private healthcare in the Russian Federation because many are unable to afford it. The cost of private health insurance in Russia can vary from 10,000 to 45,000 rubles per year, and on average, a living wage family has an income of 23,700 rubles per month. There were no governmental attempts to make insurance more affordable and the Russian Federation will cut its health expenditure next year by 33%. In addition, many Russian citizens have to seek appropriate healthcare in neighboring countries.
  8. There are only 8.4 psychiatrists, 2.4 social workers and 4.6 psychologists per 100,000 people. Despite the Russian law guaranteeing psychiatric care to its citizens as a civil right, Russia underfunds medical programs due to its corruption. The Corruption Perceptions Index ranks Russia 137th out of 180 countries worldwide, and the Global Corruption Barometer also estimates that 27% of public service users paid a bribe in 2016. In 2018, the Russian government added new amendments to its Administrative Code, which allows courts to freeze one’s assets if they are under investigation for bribery. It also exempts businesses from liability if they are willing to cooperate with the authorities to uncover other criminal schemes. Both actions are promising in terms of battling corruption. Unlike the seeming battle with corruption, Russian psychiatric hospitals have been struggling immensely from governmental underfunding. Psychologists and social workers are unavailable in 13 territories within Russia, and findings determined that one-third of Russian in-patient psychiatric hospitals have unsanitary conditions. It has been numerously reported that Russian psychiatric hospitals have 15 people in one room, which has bars on all windows and no partitions or toilet access.
  9. In 2017, the seven leading causes of death were ischemic heart disease, stroke, Alzheimer’s disease, cardiomyopathy, Cirrhosis and lung cancer. Many of them decreased in frequency since 2007. Only Alzheimer’s has increased by 34% between 2007-2017, while strokes have decreased by 19.2% and cardiomyopathy by 29.5%, despite the lack of improvements in Russia’s medical system.
  10. Small Russian nonprofit organizations and civil societies like Patient Control, Eurasian Women’s Network on AIDS and the EVA Association have been fighting an uphill battle with the Russian government. The EVA Association is a nonprofit organization that helps women with HIV or any other immunodeficiency disorder, by bringing together a network of activists, 72 medical specialists and eight other nonprofits from more than 39 cities in Russia. Patient Control, on the other hand, advocates for citizens who have not received the necessary medication for tuberculosis, Hepatitis C and HIV due to significant healthcare budget cuts in Russia. In 2016, the Russian Red Cross branch also worked closely with the Regional Health Initiative, a Red Cross program, and it worked to supply civilians, particularly in Sochi, Irkutsk, Belorechensk and Tula, with food parcels and tuberculosis screenings.

While some are addressing the problems regarding healthcare in Russia, it is impossible to eradicate poor healthcare all at once because of corruption and lack of funds. As of June 2020, the quality of healthcare in the Russian Federation remains low. With anticipated health expenditure budget cuts and consequences of COVID-19, experts do not expect the situation to improve in the near future. However, because the nation’s citizens are staying united and helping one another through various associations and nonprofits, there is hope at the end of a very long tunnel.

– Anna Sharudenko
Photo: Flickr

Healthcare in HungarySince the year 2000, Hungary has made strides to improve its healthcare system, which for decades has lagged behind the healthcare systems of other countries in the European Union (EU). Unequal issuing of medical equipment, the prevalence of smoking, drinking and obesity and an unstable political system have resulted in systematic healthcare issues in Hungary, which disproportionately affect citizens living in poverty. Here are seven facts everyone should know about healthcare in Hungary.

7 Facts About Healthcare in Hungary

  1. Hungary has one of the lowest life expectancies in the EU. In 2017, life expectancy in Hungary averaged 76 years, a four-year increase since the year 2000. Despite the improvement, the Hungarian life expectancy is still 4.9 years behind that of other Europeans. Hungarians have higher rates of risk factors, such as smoking, obesity and underage alcohol consumption than other countries in the EU, which can contribute to an early death.
  2. As of 2017, Hungary’s rate of amenable mortality is twice that of the rest of the EU. Amenable mortality refers to deaths from diseases and conditions that are nonfatal when given appropriate medical care.
  3. Socioeconomic inequalities in Hungary contribute to lower life expectancy. Lower-income Hungarians are more likely to report unmet medical needs than those with a higher income. Out-of-pocket spending in the country is double the EU average and medical care is most readily available to those who can afford to pay. Though access to medical care is not an issue across the board, lower-income Hungarians are 11 times more likely to complain of unmet healthcare needs.
  4. Healthcare in Hungary suffers from an unequal distribution of equipment. According to the Organization for Economic Cooperation and Development, the Hungarian counties with the lowest health status tend to also have the lowest numbers of necessary medical supplies. The distribution of resources is concentrated largely in the capital of Budapest and the counties with the highest health status. The city of Budapest alone has 87% more doctors and 64% more hospital bed space than the rest of the country.
  5. Healthcare in Hungary does excel in some areas but still has systematic problems. In 2016, the Euro Health Consumer Index ranked the Hungarian healthcare system 30th out of 35 countries in the EU. Though Hungary does excel in infant vaccination and physical education, it has some of the EU’s highest waiting times for CT scans and a higher than average occurrence of lung disease, infections and cancer deaths. It also had the second-highest prevalence of bribery among hospital workers. Hungarian physicians are particularly susceptible to this form of corruption due to their low pay. Their acceptance of these so-called “gratitude payments” puts those who cannot afford to pay extra at a disadvantage.
  6. The World Health Organization (WHO) rewarded the government’s anti-tobacco initiatives. In 2013, the WHO awarded Prime Minister Viktor Orbán with its WHO Special Recognition award for “accomplishments in the area of tobacco control.” In recent years, the Hungarian government has developed anti-tobacco campaigns to quell the high percentage of smokers in the country. These reforms include changing the labels on tobacco products to include warnings of the potential side effects of smoking and banning smoking in public spaces. The country has also taken steps to ban advertisements for tobacco products and, since then, has seen a reduction of smoking-related deaths.
  7. Reforms to increase the healthcare workforce are in progress. In November 2018, the government rolled out a plan to increase physicians’ pay 72% by 2022, and, in early 2020, announced government scholarships for 3,200 people in order to bring more Hungarians into the understaffed nursing profession.

Healthcare in Hungary today is still behind many other countries in the European Union. Hungarians have lower life expectancies than other Europeans and the country is in need of more skilled doctors and nurses to properly treat all of its people. However, in recent years, the Hungarian government has invested more money to reduce the country’s high rates of smoking-related deaths and increase the healthcare workforce. Healthcare in Hungary has experienced a positive change in recent years and, with more investments in the healthcare sector, more necessary reforms can be made.

Jackie McMahon
Photo: Flickr

healthcare in South Korea
South Korea is one of the many countries in the world that provides universal health care for its citizens. This universal health care is both a source of relief and national pride for many South Koreans. This pride is further amplified by the fact that modern health care in South Korea rose out of the devastation of the Korean War. With the recent COVID-19 global pandemic, South Koreans rely, now more than ever, on their health care system.

History of the South Korean Health Care System

South Korea’s health care system was developed at the end of the Korean War in 1953. One of the first projects that aimed to help South Korea was the Minnesota Project, launched in September 1954. Under the Minnesota Project, Seoul National University agreed to receive medical education and equipment from the University of Minnesota. The U.S. Department of State also contracted the University of Minnesota to assist Seoul University with staff improvement and equipment aid.

This project allowed the health care system to grow and flourish over tte next couple of decades. In 1977, the Korean government mandated all companies with more than 500 employees to provide health insurance programs for employees.

How South Korean Health Care Works

Established in 2000, the National Health Insurance Corporation (NHIC) is still in charge of national insurance enrollment, collecting contributions and setting medical fee schedules. To provide coverage for all Korean citizens, the NHIC gathers contribution payment from all citizens as part of their taxes. In addition to the contribution payment, the NHIC gather their funds through government subsidies, outside contributions and tobacco surcharges. This wide range of funding sources allows South Korea to provide clinics that are both modern and efficient.

Prevailing Issues

The South Korean health care system does have some issues, however. While the overall quality of health care in South Korea is excellent, access to high-quality medical care can still be difficult for rural residents. According to a WHO case study of South Korea, 88.8% of physicians in South Korea were employed by non-governmental clinics. These non-governmental clinics are usually located in urban areas. About 25% of all elderly over the age of 65 years reside in rural areas, where they are at high risk of falling and other physical injuries. With physicians mainly located in urban areas, the South Korean government recognizes the need to improve health care in rural areas.

A more recent issue that the South Korea health care system is facing is the treatment of foreign nationals. In the past, there were some foreigners who forewent payment after their medical treatment in South Korea. Termed “health care dine and dash,” the Korean government now requires all foreign nationals to sign up for the National Health Insurance scheme within their first six months of living in the country. Once a foreign national receives their Alien Registration Card, they can benefit from Korea’s National Health Insurance Scheme and private insurance.

A Model of Universal Health Care For the World

Developing out of the devastation of the Korean War, the excellent quality of health care in South Korea is a prime example of how a country can implement and sustain universal health care. Despite needs for improvement, the South Korean health care system remains an international model for universal health care. With the recent COVID-19 pandemic, South Koreans recognize the importance of their continuous support for the universal health care system.

 – YongJin Yi 
Photo: Pixabay