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Sample records for health decentralization financing

  1. Effects of health decentralization, financing and governance in Mexico

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    Armando Arredondo

    2006-02-01

    Full Text Available OBJECTIVE: To identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers. METHODS: A cross-sectional study was carried out in four states that were selected according to geopolitical and administrative criteria. Four indicators were assessed: changes and effects on governance, financing sources and funds, the final destination of resources, and fund allocation mechanisms. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. The interviews were transcribed and analyzed by thematic segmentation. RESULTS: The results show different effectiveness levels for the four states regarding changes in financing policies and community participation. Effects on health financing after decentralization were identified in each state, including: greater participation of municipal and state governments in health expenditure, increased financial participation of households, greater community participation in low-income states, duality and confusion in the new mechanisms for coordination among the three government levels, absence of an accountability system, lack of human resources and technical skills to implement, monitor and evaluate changes in financing. CONCLUSIONS: In general, positive and negative effects of decentralization on health financing and governance were identified. The effects mentioned by health service providers and users were related to a diversification of financing sources, a greater margin for decisions around the use and final destination of financial resources and normative development for the use of resources. At the community level, direct financial contributions were mentioned, as well as in-kind contributions, particularly in the form of community work.

  2. Considerations on hospital financing in the context of health care decentralization

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    Cătălin BULGARIU

    2012-08-01

    Full Text Available 2010 represented the moment when the reform was applied in the health field by decentralizing the management ofthe health units with beds (hospitals. This analysis points out the way hospital financing was carried out after that and the main problems the health care system of Romania has to deal with. In the end there are presented a few personal considerations on the main challenges for the future

  3. Efectos de la descentralización en el financiamiento de la salud en México Impact of decentralization on health financing in Mexico

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    Armando Arredondo

    2004-02-01

    Full Text Available OBJETIVO: Identificar las tendencias y los efectos de la descentralización en las políticas de financiamiento de la salud en México. MÉTODOS: La población de estudio incluyó cuatro estados seleccionados bajo criterios técnicos: diferente desarrollo socio-económico; implementación de la descentralización; base de datos sobre información económica; confiabilidad y validéz de las bases de datos; y apoyo de un equipo interdisciplinario de investigación. Las técnicas de recopilación de información se basaron en entrevistas a profundidad con personal clave y análisis de documentos y bases de datos sobre los presupuestos estatales en salud para el período 1990-2000. RESULTADOS: El modelo de análisis propuesto permitió identificar las tendencias y efectos de la descentralización sobre las principales fuentes de financiamiento en salud: Hogares, Gobiernos Federal, Estatal y Municipal. Hay evidencias de niveles de efectividad muy variada en cuanto a los cambios en las políticas de financiamiento, particularmente en lo que se refiere a las tendencias en los montos económicos por tipo de fuente de financiamiento. CONCLUSIONES: Hay estados donde los hogares, los municipios y el mismo gobierno estatal han hecho efectivo un incremento importante en el financiamiento de la salud, pero también hay Estados donde continúa la dependencia económica del nivel federal y donde Hogares, Municipios y Estados no están dispuestos ni capacitados para asumir responsabilidad económica en materia de salud.OBJECTIVE: To identify trends and to describe the impact of health care decentralization on health financing policies in Mexico. METHODS: The study population comprised four states selected according with six technical criteria: socioeconomic development, implementation of decentralization process, database on economical features, data consistency and reliability, and technical support from a multidisciplinary team. In-depth interviews with key

  4. Effects of health decentralization, financing and governance in Mexico Efeitos da descentralização, financiamento e governabilidade em saúde no México

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    Armando Arredondo

    2006-02-01

    Full Text Available OBJECTIVE: To identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers. METHODS: A cross-sectional study was carried out in four states that were selected according to geopolitical and administrative criteria. Four indicators were assessed: changes and effects on governance, financing sources and funds, the final destination of resources, and fund allocation mechanisms. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. The interviews were transcribed and analyzed by thematic segmentation. RESULTS: The results show different effectiveness levels for the four states regarding changes in financing policies and community participation. Effects on health financing after decentralization were identified in each state, including: greater participation of municipal and state governments in health expenditure, increased financial participation of households, greater community participation in low-income states, duality and confusion in the new mechanisms for coordination among the three government levels, absence of an accountability system, lack of human resources and technical skills to implement, monitor and evaluate changes in financing. CONCLUSIONS: In general, positive and negative effects of decentralization on health financing and governance were identified. The effects mentioned by health service providers and users were related to a diversification of financing sources, a greater margin for decisions around the use and final destination of financial resources and normative development for the use of resources. At the community level, direct financial contributions were mentioned, as well as in-kind contributions, particularly in the form of community work.OBJETIVO: Identificar os efeitos da descentralização no financiamento e na governabilidade da saúde no

  5. Health financing changes in the context of health care decentralization: the case of three Latin American countries Mudanças no financiamento da saúde no contexto de descentralização da saúde: o caso de três países latino-americanos

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    Armando Arredondo

    2000-10-01

    Full Text Available OBJECTIVE: The results of an evaluative longitudinal study, which identified the effects of health care decentralization on health financing in Mexico, Nicaragua and Peru are presented in this article. METHODS: The methodology had two main phases. In the first, secondary sources of data and documents were analyzed with the following variables: type of decentralization implemented, source of financing, funds for financing, providers, final use of resources, mechanisms for resource allocation. In the second phase, primary data were collected by a survey of key personnel in the health sector. RESULTS: Results of the comparative analysis are presented, showing the changes implemented in the three countries, as well as the strengths and weaknesses of each country in matters of financing and decentralization. CONCLUSIONS: The main financing changes implemented and quantitative trends with respect to the five financing indicators are presented as a methodological tool to implement corrections and adjustments in health financing.OBJETIVO: São apresentados os resultados de um estudo longitudinal com o objetivo de identificar os efeitos da descentralização nas políticas de financiamento em três países da América Latina: México, Nicarágua e Peru. MÉTODOS: A metodologia teve duas fases principais. Na primeira, foram analisadas as fontes de dados secundários, referentes às seguintes variáveis: tipo de descentralização implementada, fontes de financiamento, provedores de serviços, mecanismos de alocação de recursos e destino final de recursos. Na segunda fase, foram analisadas as fontes de dados primários obtidos por meio de entrevistas diretas com pessoal-chave do setor de saúde, tomando como guia as mesmas variáveis da primeira etapa. RESULTADOS: Os resultados identificaram as fortalezas e as debilidades de cada país em matéria de políticas de financiamento e de descentralização. CONCLUSÕES: As principais mudanças no

  6. Conceptualizing decentralization in European health systems: a functional perspective.

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    Saltman, Richard B; Bankauskaite, Vaida

    2006-04-01

    Although decentralization has been widely implemented in health systems, there is little agreement as to how it should be defined or the outcomes it should produce. This article develops a functional typology based on political, administrative, and fiscal dimensions of decentralization. It utilizes these three categories to identify and highlight key theoretical issues concerning decentralization, emphasizing the likely advantages and disadvantages that decentralization can be expected to generate. It then examines the usefulness of this functional framework in explaining recent policy-making decisions within a number of tax-based health systems in Western Europe. The article concludes by suggesting that this three-part typology can be helpful to both policy makers and academics in evaluating the effectiveness of decentralization as a policy mechanism within health care systems.

  7. [The decentralization and municipalization of health services in Säo Paulo, Brazil].

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    Mercadante, O A; Yunes, J; Chorny, A H

    1994-05-01

    The health system in Brazil has undergone profound changes since the 1980s. In the state of São Paulo, the processes of decentralization to the municipio and regional levels, as well as integration of health services, began in 1983. This study describes the strategies adopted by the Ministry of Health of the state of São Paulo to implement these processes and create 65 regional health offices, and discusses the role of these offices in the new unified health system. It is concluded that decentralization has resulted in increased local government participation in financing the health system, that production of medical and community health services has grown, and that health indicators have improved.

  8. Human resources for health and decentralization policy in the Brazilian health system

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    Pierantoni Celia

    2011-05-01

    Full Text Available Abstract Background The Brazilian health reform process, following the establishment of the Unified Health System (SUS, has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH, through the Secretary of Labour Management and Health Education, is responsible for establishing national policy guidelines for health labour management, and also for implementing strategies for the decentralization of management of labour and education in the federal states. This paper assesses whether the process of decentralizing human resources for health (HRH management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level. Methods The research methods used comprise a survey of HRH managers of states and major municipalities (including capitals and focus groups with these HRH managers - all by geographic region. The results were obtained by combining survey and focus group data, and also through triangulation with the results of previous research. Results The results of this evaluation showed the evolution policy, previously restricted to the field of 'personnel administration', now expanded to a conceptual model for health labour management and education-- identifying progress, setbacks, critical issues and challenges for the consolidation of the decentralized model for HRH management. The results showed that 76.3% of the health departments have an HRH unit. It was observed that 63.2% have an HRH information system. However, in most health departments, the HRH unit uses only the payroll and administrative records as data sources. Concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them

  9. Financing the health care Internet.

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    Robinson, J C

    2000-01-01

    Internet-related health care firms have accelerated through the life cycle of capital finance and organizational destiny, including venture capital funding, public stock offerings, and consolidation, in the wake of heightened competition and earnings disappointments. Venture capital flooded into the e-health sector, rising from $3 million in the first quarter of 1998 to $335 million two years later. Twenty-six e-health firms went public in eighteen months, raising $1.53 billion at initial public offering (IPO) and with post-IPO share price appreciation greater than 100 percent for eighteen firms. The technology-sector crash hit the e-health sector especially hard, driving share prices down by more than 80 percent for twenty-one firms. The industry now faces an extended period of consolidation between e-health and conventional firms.

  10. Redistributive effects in public health care financing.

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    Honekamp, Ivonne; Possenriede, Daniel

    2008-11-01

    This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.

  11. 财政分权、地方财政赤字与土地财政%Fiscal Decentralization, Local Deficit Financing and Land Finance

    Institute of Scientific and Technical Information of China (English)

    吴正海

    2014-01-01

    From the perspective of local deficit financing ,this paper tries to ex-pound the internal logic between fiscal decentralization and local government ’s land fi-nance. Theoretical analysis shows that: fiscal decentralization in China aggravates local deficit financing, and the latter becomes an incentive for local governments to grab off-budgetary financial revenue, which will impel them to take active land finance strategy to increase local fiscal revenue. At the same time, our empirical test among them using provincial panel data shows that fiscal decentralization and local deficit financing both have obvious positive driving effects on land finance. Finally, we put forward a series of suggestions on land finance governance respectively from the following 5 aspects:deepen-ing tax distribution reform, improving local fiscal revenue structure, changing land fi-nance formation mechanism, promoting administrative performance evaluation mechanism and strengthening budget supervision.%基于地方财政赤字的视角,研究财政分权与地方政府土地财政策略的内在作用逻辑,通过理论分析发现:地方财政赤字激励了地方政府在利益觉醒后利用预算制度缺口,用“扭曲之手”来攫取预算外财政收益,进而驱动地方政府实施积极的土地财政策略来实现财政增收的政策目标。省际面板数据的实证结果进一步验证了财政分权、地方财政赤字对土地财政的正向驱动作用。土地财政的治理从深化分税制改革、改善地方财政收入结构、变革土地财政形成机制、完善行政绩效考核体制、加强预算监管等方面入手。

  12. Human resources for health at the district level in Indonesia: the smoke and mirrors of decentralization.

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    Heywood, Peter F; Harahap, Nida P

    2009-02-03

    In 2001 Indonesia embarked on a rapid decentralization of government finances and functions to district governments. One of the results is that government has less information about its most valuable resource, the people who provide the services. The objective of the work reported here is to determine the stock of human resources for health in 15 districts, their service status and primary place of work. It also assesses the effect of decentralization on management of human resources and the implications for the future. We enumerated all health care providers (doctors, nurses and midwives), including information on their employment status and primary place of work, in each of 15 districts in Java. Data were collected by three teams, one for each province. Provider density (number of doctors, nurses and midwives/1000 population) was low by international standards--11 out of 15 districts had provider densities less than 1.0. Approximately half of all three professional groups were permanent public servants. Contractual employment was also important for both nurses and midwives. The private sector as the primary source of employment is most important for doctors (37% overall) and increasingly so for midwives (10%). For those employed in the public sector, two-thirds of doctors and nurses work in health centres, while most midwives are located at village-level health facilities. In the health system established after Independence, the facilities established were staffed through a period of obligatory service for all new graduates in medicine, nursing and midwifery. The last elements of that staffing system ended in 2007 and the government has not been able to replace it. The private sector is expanding and, despite the fact that it will be of increasing importance in the coming decades, government information about providers in private practice is decreasing. Despite the promise of decentralization to increase sectoral "decision space" at the district level, the

  13. Human resources for health at the district level in Indonesia: the smoke and mirrors of decentralization

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    Harahap Nida P

    2009-02-01

    Full Text Available Abstract Background In 2001 Indonesia embarked on a rapid decentralization of government finances and functions to district governments. One of the results is that government has less information about its most valuable resource, the people who provide the services. The objective of the work reported here is to determine the stock of human resources for health in 15 districts, their service status and primary place of work. It also assesses the effect of decentralization on management of human resources and the implications for the future. Methods We enumerated all health care providers (doctors, nurses and midwives, including information on their employment status and primary place of work, in each of 15 districts in Java. Data were collected by three teams, one for each province. Results Provider density (number of doctors, nurses and midwives/1000 population was low by international standards – 11 out of 15 districts had provider densities less than 1.0. Approximately half of all three professional groups were permanent public servants. Contractual employment was also important for both nurses and midwives. The private sector as the primary source of employment is most important for doctors (37% overall and increasingly so for midwives (10%. For those employed in the public sector, two-thirds of doctors and nurses work in health centres, while most midwives are located at village-level health facilities. Conclusion In the health system established after Independence, the facilities established were staffed through a period of obligatory service for all new graduates in medicine, nursing and midwifery. The last elements of that staffing system ended in 2007 and the government has not been able to replace it. The private sector is expanding and, despite the fact that it will be of increasing importance in the coming decades, government information about providers in private practice is decreasing. Despite the promise of decentralization to

  14. Maternal health-seeking behavior: the role of financing and organization of health services in Ghana.

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    Aboagye, Emmanuel; Agyemang, Otuo Serebour

    2013-05-30

    This paper examines how organization and financing of maternal health services influence health-seeking behavior in Bosomtwe district, Ghana. It contributes in furthering the discussions on maternal health-seeking behavior and health outcomes from a health system perspective in sub-Saharan Africa. From a health system standpoint, the paper first presents the resources, organization and financing of maternal health service in Ghana, and later uses case study examples to explain how Ghana's health system has shaped maternal health-seeking behavior of women in the district. The paper employs a qualitative case study technique to build a complex and holistic picture, and report detailed views of the women in their natural setting. A purposeful sampling technique is applied to select 16 women in the district for this study. Through face-to-face interviews and group discussions with the selected women, comprehensive and in-depth information on health- seeking behavior and health outcomes are elicited for the analysis. The study highlights that characteristics embedded in decentralization and provision of free maternal health care influence health-seeking behavior. Particularly, the use of antenatal care has increased after the delivery exemption policy in Ghana. Interestingly, the study also reveals certain social structures, which influence women's attitude towards their decisions and choices of health facilities.

  15. The Experience of Implementing the Board of Trustees’ Policy in Teaching Hospitals in Iran: An Example of Health System Decentralization

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    Leila Doshmangir

    2015-04-01

    Full Text Available Background In 2004, the health system in Iran initiated an organizational reform aiming to increase the autonomy of teaching hospitals and make them more decentralized. The policy led to the formation of a board of trustees in each hospital and significant modifications in hospitals’ financing. Since the reform aimed to improve its predecessor policy (implementation of hospital autonomy began in 1995, it expected to increase user satisfaction, as well as enhance effectiveness and efficiency of healthcare services in targeted hospitals. However, such expectations were never realized. In this research, we explored the perceptions and views of expert stakeholders as to why the board of trustees’ policy did not achieve its perceived objectives. Methods We conducted 47 semi-structured face-to-face interviews and two focus group discussions (involving 8 and 10 participants, respectively with experts at high, middle, and low levels of Iran’s health system, using purposive and snowball sampling. We also collected a comprehensive set of relevant documents. Interviews were transcribed verbatim and analyzed thematically, following a mixed inductive-deductive approach. Results Three main themes emerged from the analysis. The implementation approach (including the processes, views about the policy and the links between the policy components, using research evidence about the policy (local and global, and policy context (health system structure, health insurers capacity, hospitals’ organization and capacity and actors’ interrelationships affected the policy outcomes. Overall, the implementation of hospital decentralization policies in Iran did not seem to achieve their intended targets as a result of assumed failure to take full consideration of the above factors in policy implementation into account. Conclusion The implementation of the board of trustees’ policy did not achieve its desired goals in teaching hospitals in Iran. Similar

  16. The tradeoff between centralized and decentralized health services: evidence from rural areas in Mexico.

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    Vargas Bustamante, Arturo

    2010-09-01

    This study investigates the effectiveness of centralized and decentralized health care providers in rural Mexico. It compares provider performance since both centralized and decentralized providers co-exist in rural areas of the country. The data are drawn from the 2003 household survey of Oportunidades, a comprehensive study of rural families from seven states in Mexico. The analyses compare out-of-pocket health care expenditures and utilization of preventive care among rural households with access to either centralized or decentralized health care providers. This study benefits from differences in timing of health care decentralization and from a quasi-random distribution of providers. Results show that overall centralized providers perform better. Households served by this organization report less regressive out-of-pocket health care expenditures (32% lower), and observe higher utilization of preventive services (3.6% more). Decentralized providers that were devolved to state governments in the early 1980s observe a slightly better performance than providers that were decentralized in the mid-1990s. These findings are robust to decentralization timing, heterogeneity in per capita government health expenditures, state and health infrastructure effects, and other confounders. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  17. Poverty & health: criticality of public financing.

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    Duggal, Ravi

    2007-10-01

    Countries with universal or near universal access to healthcare have health financing mechanisms which are single-payer systems in which either a single autonomous public agency or a few coordinated agencies pool resources to finance healthcare. This contributes to both equity in healthcare as well as to low levels of poverty in these countries. It is only in countries like India and a number of developing countries, which still rely mostly on out-of-pocket payments, where universal access to healthcare is elusive. In such countries those who have the capacity to buy healthcare from the market most often get healthcare without having to pay for it directly because they are either covered by social insurance or buy private insurance. In contrast, a large majority of the population, who suffers a hand-to-mouth existence, is forced to make direct payments, often with a heavy burden of debt, to access healthcare from the market because public provision is grossly inadequate or non existent. Thus, the absence of adequate public health investment not only results in poor health outcomes but it also leads to escalation of poverty. This article critically reviews the linkages of poverty with healthcare financing using evidence from national surveys and concludes that public financing is critical to good access to healthcare for the poor and its inadequacy is closely associated with poverty levels in the country.

  18. Emerging trends in health care finance.

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    Sterns, J B

    1994-01-01

    Access to capital will become more difficult. Capital access is dependent on ability to repay debt, which, in turn, is dependent on internally generated cash flows. Under any health care reform proposal, revenue inflows will be slowed. The use of corporate finance techniques to limit financial risk and lower cost will be a permanent response to fundamental changes to the health care system. These changes will result in greater balance sheet management, centralized capital allocation, and alternative sources of capital.

  19. Financing reproductive health in Bangladesh

    NARCIS (Netherlands)

    Khanna, A.; Pradhan, J.; Rashid, H.A.; Beekink, E.; Gupta, M.; Sharma, A.

    2013-01-01

    Bangladesh is the signatory of both, International Conference on Population and Development (ICPD) programme of action and Millennium Development goals (MDGs). The Government of Bangladesh has set ambitious agendas for improving Reproductive Health (RH) services, to achieve the targets till 2015. In

  20. Empowering health personnel for decentralized health planning in India: The Public Health Resource Network.

    Science.gov (United States)

    Kalita, Anuska; Zaidi, Sarover; Prasad, Vandana; Raman, V R

    2009-07-20

    The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated though often isolated health

  1. Empowering health personnel for decentralized health planning in India: The Public Health Resource Network

    Directory of Open Access Journals (Sweden)

    Prasad Vandana

    2009-07-01

    Full Text Available Abstract The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated

  2. Redistributive effects of Swedish health care finance.

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    Gerdtham, U G; Sundberg, G

    1998-01-01

    This paper investigates the redistributive effects of the Swedish health care financing system in 1980 and 1990 for four different financial sources: county council taxes, payroll taxes, direct payments and state grants. The redistributive effects are decomposed into vertical, horizontal and 'reranking' segments for each of the four financial sources. The data used are based on probability samples of the Swedish population, from the Level of Living Survey (LNU) from 1981 and 1991. The paper concludes that the Swedish health care financing system is weakly progressive, although direct payments are regressive. There is some horizontal inequity and 'reranking', which mainly comes from the county council taxes, since those tax rates vary for each county council. The implication is that, to some extent, people with equal incomes are treated unequally.

  3. Decentralization's impact on the health workforce: Perspectives of managers, workers and national leaders

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    Kolehmainen-Aitken Riitta-Liisa

    2004-05-01

    Full Text Available Abstract Designers and implementers of decentralization and other reform measures have focused much attention on financial and structural reform measures, but ignored their human resource implications. Concern is mounting about the impact that the reallocation of roles and responsibilities has had on the health workforce and its management, but the experiences and lessons of different countries have not been widely shared. This paper examines evidence from published literature on decentralization's impact on the demand side of the human resource equation, as well as the factors that have contributed to the impact. The elements that make such an impact analysis exceptionally complex are identified. They include the mode of decentralization that a country is implementing, the level of responsibility for the salary budget and pay determination, and the civil service status of transferred health workers. The main body of the paper is devoted to examining decentralization's impact on human resource issues from three different perspectives: that of local health managers, health workers themselves, and national health leaders. These three groups have different concerns in the human resource realm, and consequently, have been differently affected by decentralization processes. The paper concludes with recommendations regarding three key concerns that national authorities and international agencies should give prompt attention to. They are (1 defining the essential human resource policy, planning and management skills for national human resource managers who work in decentralized countries, and developing training programs to equip them with such skills; (2 supporting research that focuses on improving the knowledge base of how different modes of decentralization impact on staffing equity; and (3 identifying factors that most critically influence health worker motivation and performance under decentralization, and documenting the most cost-effective best

  4. Transformation of China's rural health care financing.

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    Liu, Y; Hsiao, W C; Li, Q; Liu, X; Ren, M

    1995-10-01

    In the late 1970s China launched its agricultural reforms which initiated a decade of continued economic growth and significant transformation of the Chinese society. The agricultural reforms altered the peasants' incentives, weakened community organization and lessened the central government's control over local communities. These changes largely caused the collapse of the widely acclaimed rural cooperative medical system in China. Consequently China experienced a decreased supply of rural health workers, increased burden of illnesses, disintegration of the three tier medical system, reduced primary health care, and an increased demand for hospital medical services. More than ten years have elapsed since China changed its agricultural economic system and China is still struggling to find an equitable, efficient and sustainable way of financing and organizing its rural health services. The Chinese experiences provided several important lessons for other nations: there is a need to understand the limits of the market forces and to redefine the role of the government in rural health care under a market economy; community participation in and control of local health financing schemes is essential in developing a sustainable rural health system; the rural health system needs to be dynamic, rather than static, to keep pace with changing demand and needs of the population.

  5. Equity in health care financing: The case of Malaysia

    OpenAIRE

    Sach Tracey H; Whynes David K; Yu Chai

    2008-01-01

    Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implication...

  6. Fiscal Decentralization, Local Deficit Financing and Land Finance---Based on China's Provincial Panel Data of 1998-2010%财政分权、地方财政赤字与土地财政

    Institute of Scientific and Technical Information of China (English)

    郭贯成; 汪勋杰

    2014-01-01

    From the perspective of local deficit financing, this paper explores the internal logic working between fiscal de-centralization and local government's land finance.Theoretical analysis shows that local deficit expansion caused by fiscal de-centralization in China has become an incentive for local governments to grab off-budgetary financial revenue, which impels them to take an active land finance strategy to increase local fiscal revenue.The empirical test supported by provincial panel data also proves that the fiscal decentralization and local deficit financing both have obvious positive driving effects on the land finance.%本文基于地方财政赤字的视角,研究了财政分权与地方政府土地财政策略的内在作用逻辑。理论分析表明:中国式财政分权所造成的地方财政赤字扩大化,激励了地方政府在利益觉醒后利用预算制度缺口,用“扭曲之手”来攫取预算外财政收益,进而驱动地方政府通过积极的土地财政手段来实现财政增收的政策目标。省际面板数据的实证结果进一步验证了财政分权、地方财政赤字对土地财政的正向驱动作用。

  7. Equity in health care financing: The case of Malaysia.

    Science.gov (United States)

    Yu, Chai Ping; Whynes, David K; Sach, Tracey H

    2008-06-09

    Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help

  8. Equity in health care financing: The case of Malaysia

    Directory of Open Access Journals (Sweden)

    Sach Tracey H

    2008-06-01

    Full Text Available Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO and a regressive finance source (indirect taxes. Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers

  9. Equity in health care financing: The case of Malaysia

    Science.gov (United States)

    Yu, Chai Ping; Whynes, David K; Sach, Tracey H

    2008-01-01

    Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth

  10. Fiscal decentralization of public mental health care and the Robert Wood Johnson Foundation program on chronic mental illness.

    Science.gov (United States)

    Frank, R G; Gaynor, M

    1994-01-01

    Organizational change for local mental health systems has been advanced as an important aspect of improving the performance of public mental health systems. Fiscal decentralization is a central element of many proposals for organizational change. We employ data from the states of Ohio and Texas to examine some of the consequences of fiscal decentralization of public mental health care. The data analysis shows that local mental health systems respond to financial incentives, even when they are modest; that fiscal decentralization leads to increased fiscal effort by localities; and that decentralization also results in greater inequality in service between poorer and wealthier localities.

  11. Resource allocation and budgetary mechanisms for decentralized health systems: experiences from Balochistan, Pakistan.

    Science.gov (United States)

    Green, A; Ali, B; Naeem, A; Ross, D

    2000-01-01

    This paper identifies key political and technical issues involved in the development of an appropriate resource allocation and budgetary system for the public health sector, using experience gained in the Province of Balochistan, Pakistan. The resource allocation and budgetary system is a critical, yet often neglected, component of any decentralization policy. Current systems are often based on historical incrementalism that is neither efficient nor equitable. This article describes technical work carried out in Balochistan to develop a system of resource allocation and budgeting that is needs-based, in line with policies of decentralization, and implementable within existing technical constraints. However, the development of technical systems, while necessary, is not a sufficient condition for the implementation of a resource allocation and decentralized budgeting system. This is illustrated by analysing the constraints that have been encountered in the development of such a system in Balochistan.

  12. Governing decentralization in health care under tough budget constraint: what can we learn from the Italian experience?

    Science.gov (United States)

    Tediosi, Fabrizio; Gabriele, Stefania; Longo, Francesco

    2009-05-01

    In many European countries, since the World War II, there has been a trend towards decentralization of health policy to lower levels of governments, while more recently there have been re-centralization processes. Whether re-centralization will be the new paradigm of European health policy or not is difficult to say. In the Italian National Health Service (SSN) decentralization raised two related questions that might be interesting for the international debate on decentralization in health care: (a) what sort of regulatory framework and institutional balances are required to govern decentralization in health care in a heterogeneous country under tough budget constraints? (b) how can it be ensured that the most advanced parts of the country remain committed to solidarity, supporting the weakest ones? To address these questions this article describes the recent trends in SSN funding and expenditure, it reviews the strategy adopted by the Italian government for governing the decentralization process and discusses the findings to draw policy conclusions. The main lessons emerging from this experience are that: (1) when the differences in administrative and policy skills, in socio-economic standards and social capital are wide, decentralization may lead to undesirable divergent evolution paths; (2) even in decentralized systems, the role of the Central government can be very important to contain health expenditure; (3) a strong governance of the Central government may help and not hinder the enforcement of decentralization; and (4) supporting the weakest Regions and maintaining inter-regional solidarity is hard but possible. In Italy, despite an increasing role of the Central government in steering the SSN, the pattern of regional decentralization of health sector decision making does not seem at risk. Nevertheless, the Italian case confirms the complexity of decentralization and re-centralization processes that sometimes can be paradoxically reinforcing each other.

  13. How federalism shapes public health financing, policy, and program options.

    Science.gov (United States)

    Ogden, Lydia L

    2012-01-01

    In the United States, fiscal and functional federalism strongly shape public health policy and programs. Federalism has implications for public health practice: it molds financing and disbursement options, including funding formulas, which affect allocations and program goals, and shapes how funding decisions are operationalized in a political context. This article explores how American federalism, both fiscal and functional, structures public health funding, policy, and program options, investigating the effects of intergovernmental transfers on public health finance and programs.

  14. Does fiscal decentralization improve health outcomes? Evidence from infant mortality in Italy.

    Science.gov (United States)

    Cavalieri, Marina; Ferrante, Livio

    2016-09-01

    Despite financial and decision-making responsibilities having been increasingly devolved to lower levels of government worldwide, the potential impact of these reforms remains largely controversial. This paper investigates the hypothesis that a shift towards a higher degree of fiscal autonomy of sub-national governments could improve health outcomes, as measured by infant mortality rates. Italy is used as a case study since responsibilities for healthcare have been decentralized to regions, though the central government still retains a key role in ensuring all citizens uniform access to health services throughout the country. A linear fixed-effects regression model with robust standard errors is employed for a panel of 20 regions over the period 1996-2012 (340 observations in the full sample). Decentralization is proxied by two different indicators, capturing the degree of decision-making autonomy in the allocation of tax revenues and the extent to which regions rely on fiscal transfers from the central government. The results show that a higher proportion of tax revenues raised and/or controlled locally as well as a lower transfer dependency from the central government are consistently associated with lower infant mortality rates, ceteris paribus. The marginal benefit from fiscal decentralization, however, is not constant but depends on the level of regional wealth, favouring poorest regions. In terms of policy implications, this study outlines how the effectiveness of decentralization in improving health outcomes is contingent on the characteristics of the context in which the process takes place.

  15. Challenges to the implementation of health sector decentralization in Tanzania: experiences from Kongwa district council

    Science.gov (United States)

    Frumence, Gasto; Nyamhanga, Tumaini; Mwangu, Mughwira; Hurtig, Anna-Karin

    2013-01-01

    Background During the 1990s, the government of Tanzania introduced the decentralization by devolution (D by D) approach involving the transfer of functions, power and authority from the centre to the local government authorities (LGAs) to improve the delivery of public goods and services, including health services. Objective This article examines and documents the experiences facing the implementation of decentralization of health services from the perspective of national and district officials. Design The study adopted a qualitative approach, and data were collected using semi-structured interviews and were analysed for themes and patterns. Results The results showed several benefits of decentralization, including increased autonomy in local resource mobilization and utilization, an enhanced bottom-up planning approach, increased health workers’ accountability and reduction of bureaucratic procedures in decision making. The findings also revealed several challenges which hinder the effective functioning of decentralization. These include inadequate funding, untimely disbursement of funds from the central government, insufficient and unqualified personnel, lack of community participation in planning and political interference. Conclusion The article concludes that the central government needs to adhere to the principles that established the local authorities and grant more autonomy to them, offer special incentives to staff working in the rural areas and create the capacity for local key actors to participate effectively in the planning process. PMID:23993021

  16. International health financing and the response to AIDS.

    Science.gov (United States)

    Lieberman, Samuel; Gottret, Pablo; Yeh, Ethan; de Beyer, Joy; Oelrichs, Robert; Zewdie, Debrework

    2009-11-01

    Efforts to finance HIV responses have generated large increases in funding, catalyzed activism and institutional innovation, and brought renewed attention to health issues and systems. The benefits go well beyond HIV programs. The substantial increases in HIV funding are a tiny percentage of overall increases in health financing, with other areas also seeing large absolute increases. Data on health funding suggest an improved "pro-poor" distribution, with Africa benefiting relatively more from increased external flows. A literature review found few evidence-based analyses of the impact of AIDS programs and funding on broader health financing. Conceptual frameworks that would facilitate such analysis are summarized.

  17. Innovative financing for health: what is truly innovative?

    Science.gov (United States)

    Atun, Rifat; Knaul, Felicia Marie; Akachi, Yoko; Frenk, Julio

    2012-12-08

    Development assistance for health has increased every year between 2000 and 2010, particularly for HIV/AIDS, tuberculosis, and malaria, to reach US$26·66 billion in 2010. The continued global economic crisis means that increased external financing from traditional donors is unlikely in the near term. Hence, new funding has to be sought from innovative financing sources to sustain the gains made in global health, to achieve the health Millennium Development Goals, and to address the emerging burden from non-communicable diseases. We use the value chain approach to conceptualise innovative financing. With this framework, we identify three integrated innovative financing mechanisms-GAVI, Global Fund, and UNITAID-that have reached a global scale. These three financing mechanisms have innovated along each step of the innovative finance value chain-namely resource mobilisation, pooling, channelling, resource allocation, and implementation-and integrated these steps to channel large amounts of funding rapidly to low-income and middle-income countries to address HIV/AIDS, malaria, tuberculosis, and vaccine-preventable diseases. However, resources mobilised from international innovative financing sources are relatively modest compared with donor assistance from traditional sources. Instead, the real innovation has been establishment of new organisational forms as integrated financing mechanisms that link elements of the financing value chain to more effectively and efficiently mobilise, pool, allocate, and channel financial resources to low-income and middle-income countries and to create incentives to improve implementation and performance of national programmes. These mechanisms provide platforms for health funding in the future, especially as efforts to grow innovative financing have faltered. The lessons learnt from these mechanisms can be used to develop and expand innovative financing from international sources to address health needs in low-income and middle

  18. An analysis of equity in Brazilian health system financing.

    Science.gov (United States)

    Ugá, Maria Alicia Domínguez; Santos, Isabela Soares

    2007-01-01

    Health care in Brazil is financed from many sources--taxes on income, real property, sales of goods and services, and financial transactions; private insurance purchased by households and firms; and out-of-pocket payments by households. Data on household budgets and tax revenues allow the burden of each source except firms' insurance purchases for their employees to be allocated across deciles of adjusted per capita household income, indicating the progressivity or regressivity of each kind of payment. Overall, financing is approximately neutral, with progressive public finance offsetting regressive payments. This last form of finance pushes some households into poverty.

  19. City School District Reorganization: An Annotated Bibliography. Centralization and Decentralization in the Government of Metropolitan Areas with Special Emphasis on the Organization, Administration, and Financing of Large-City School Systems. Educational Research Series No. 1.

    Science.gov (United States)

    Rideout, E. Brock; Najat, Sandra

    As a guide to educational administrators working in large cities, abstracts of 161 books, pamphlets, papers, and journal articles published between 1924 and 1966 are classified into five categories: (1) Centralization versus decentralization, (2) local government, (3) metropolitan organization, (4) the financing of education, and (5) the…

  20. The logic of tax-based financing for health care.

    Science.gov (United States)

    Bodenheimer, T; Sullivan, K

    1997-01-01

    Employment-based health insurance faces serious problems. For the first time, the number of Americans covered by such health insurance is falling. Employers strongly oppose the employer mandate approach to extending health insurance. Employment-based financing is regressive and complex. Serious debate is needed on an alternative solution to financing health care for all Americans. Taxation represents a clear alternative to employment-based health care financing. The major criterion for choosing a tax is equity, with simplicity a second criterion. An earmarked, progressive individual income tax is a fair and potentially simple tax with which to finance health care. The political feasibility of such a tax is greater than that of employer mandate legislation.

  1. Equity in the finance of health care: Some international comparisons

    NARCIS (Netherlands)

    A. Wagstaff (Adam); E.K.A. van Doorslaer (Eddy)

    1992-01-01

    textabstractThis paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Sp

  2. Principles of Child Health Care Financing.

    Science.gov (United States)

    Hudak, Mark L; Helm, Mark E; White, Patience H

    2017-09-01

    health financing outlined in this statement. Espousing the core principle to do no harm, the AAP believes that the United States must not sacrifice any of the hard-won gains for our children. Medicaid, as the largest single payer of health care for children and young adults, should remain true to its origins as an entitlement program; in other words, future fiscal or regulatory reforms of Medicaid should not reduce the eligibility and scope of benefits for children and young adults below current levels nor jeopardize children's access to care. Proposed Medicaid funding "reforms" (eg, institution of block grant, capped allotment, or per-capita capitation payments to states) will achieve their goal of securing cost savings but will inevitably compel states to reduce enrollee eligibility, trim existing benefits (such as Early and Periodic Screening, Diagnostic, and Treatment), and/or compromise children's access to necessary and timely care through cuts in payments to providers and delivery systems. In fact, the AAP advocates for increased Medicaid funding to improve access to essential care for existing enrollees, fund care for eligible but uninsured children once they enroll, and accommodate enrollment growth that will occur in states that choose to expand Medicaid eligibility. The AAP also calls for Congress to extend funding for the Children's Health Insurance Program, a plan vital to the 8.9 million children it covered in fiscal year 2016, for a minimum of 5 years. Copyright © 2017 by the American Academy of Pediatrics.

  3. Is a decentralized continuing medical education program feasible for Chinese rural health professionals?

    Directory of Open Access Journals (Sweden)

    Guijie Hu

    2016-04-01

    Full Text Available Purpose: Rural health professionals in township health centers (THCs tend to have less advanced educational degrees. This study aimed to ascertain the perceived feasibility of a decentralized continuing medical education (CME program to upgrade their educational levels. Methods: A cross-sectional survey of THC health professionals was conducted using a self-administered, structured questionnaire in Guangxi Zhuang Autonomous Region, China. Results: The health professionals in the THCs were overwhelmingly young with low education levels. They had a strong desire to upgrade their educational degrees. The decentralized CME program was perceived as feasible by health workers with positive attitudes about the benefit for license examination, and by those who intended to improve their clinical diagnosis and treatment skills. The target groups of such a program were those who expected to undertake a bachelor’s degree and who rated themselves as “partially capable” in clinical competency. They reported that 160-400 USD annually would be an affordable fee for the program. Conclusion: A decentralized CME program was perceived feasible to upgrade rural health workers’ education level to a bachelor’s degree and improve their clinical competency.

  4. Sources of project financing in health care systems.

    Science.gov (United States)

    Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L

    2000-01-01

    Through discussions with chief financial officers of leading health care systems, insights are offered on preferences for project financing and development efforts. Data from these same systems provide at least anecdotal evidence in support of pecking-order theory.

  5. Equity in the finance of health care: some international comparisons.

    Science.gov (United States)

    Wagstaff, A; van Doorslaer, E; Calonge, S; Christiansen, T; Gerfin, M; Gottschalk, P; Janssen, R; Lachaud, C; Leu, R E; Nolan, B

    1992-12-01

    This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues.

  6. Contextual determinants of decentralization of epidemiological surveillance for the family health team

    Directory of Open Access Journals (Sweden)

    Silvone Santa Barbara da Silva Santos

    2015-09-01

    Full Text Available This study examines the contextual determinants of implementing decentralization of epidemiological surveillance for the family health team, in a municipality in the state of Bahia, Brazil. This was an evaluative study using the political model of implementation analysis. Data were obtained through document analysis and semi-structured interviews with managers and healthcare workers. Five themes emerged: planning; training of human resources; organization of the work process; linkage within institutions; and organization of family healthcare units. The results revealed that there are difficulties such as poor infrastructure of healthcare units, creation of flexibility in labor relations and healthcare worker turnover. The study shows that there is a need for stakeholder participation in the process of implementing the policy of decentralization of epidemiological surveillance for the micro-area of intervention that comprises the family health program.

  7. Urgency of Capacity Building in Local Finance Management on Decentralization Era (The Dynamic of Parking Taxes Management at Banguntapan District, Bantul Region DI Yogyakarta Province

    Directory of Open Access Journals (Sweden)

    Bambang Sunaryo

    2014-12-01

    Full Text Available Capacity building of local finance management becomes important on decentralizations era. Empirically this research is aim to show that the parking tax management at glance seen as an administrative- procedural policy domain cannot release from phenomena on the existence of problematic pathology for regional financial management. District of Bantul Banguntapan characteristic as its suburbs form the main attraction in the selection of research because of the general locus in sub-urban area, began to metamorphose into a parking tax revenues from regions that contribute to the area though not as big financial contribution income tax parking tax in urban areas. The Banguntapan sub district was chosen as analysis unit in this research to represent the issue of parking tax management in sub urban area of Bantul. This was due to the characteristic of Bantul area as sub urban area that can be seen from the characteristics of sub urban in Banguntapan sub district. Moreover, the Banguntapan sub district is the only area in Bantul which has a parking tax subject that the cost is self-assessment and flat thus the dynamic of local finance managing problems can be observed and in-depth analysed in Banguntapan sub district to seek the comparison of those 2 parking tax collection systems.

  8. Health care financing in Nigeria: Implications for achieving universal health coverage.

    Science.gov (United States)

    Uzochukwu, B S C; Ughasoro, M D; Etiaba, E; Okwuosa, C; Envuladu, E; Onwujekwe, O E

    2015-01-01

    The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.

  9. Synthetic real estate: bringing corporate finance to health care.

    Science.gov (United States)

    Varwig, D; Smith, J

    1998-01-01

    The changing landscape of health care has caused hospitals, health care systems, and other health care organizations to look for ways to finance expansions and acquisitions without "tainting" their balance sheets. This search has led health care executives to a financing technique that has been already embraced by Fortune 500 companies for most of this decade and more recently adopted by high-tech companies: synthetic real estate. Select case studies provide examples of the more creative financial structures currently being employed to meet rapidly growing and increasingly complex funding needs.

  10. Health system performance at the district level in Indonesia after decentralization

    Directory of Open Access Journals (Sweden)

    Choi Yoonjoung

    2010-03-01

    Full Text Available Abstract Background Assessments over the last two decades have showed an overall low level of performance of the health system in Indonesia with wide variation between districts. The reasons advanced for these low levels of performance include the low level of public funding for health and the lack of discretion for health system managers at the district level. When, in 2001, Indonesia implemented a radical decentralization and significantly increased the central transfer of funds to district governments it was widely expected that the performance of the health system would improve. This paper assesses the extent to which the performance of the health system has improved since decentralization. Methods We measured a set of indicators relevant to assessing changes in performance of the health system between two surveys in three areas: utilization of maternal antenatal and delivery care; immunization coverage; and contraceptive source and use. We also measured respondents' demographic characteristics and their living circumstances. These measurements were made in population-based surveys in 10 districts in 2002-03 and repeated in 2007 in the same 10 districts using the same instruments and sampling methods. Results The dominant providers of maternal and child health in these 10 districts are in the private sector. There was a significant decrease in birth deliveries at home, and a corresponding increase in deliveries in health facilities in 5 of the 10 districts, largely due to increased use of private facilities with little change in the already low use of public facilities. Overall, there was no improvement in vaccination of mothers and their children. Of those using modern contraceptive methods, the majority obtained them from the private sector in all districts. Conclusions There has been little improvement in the performance of the health system since decentralization occurred in 2001 even though there have also been significant increases in

  11. Analysis of health promotion and prevention financing mechanisms in Thailand.

    Science.gov (United States)

    Watabe, Akihito; Wongwatanakul, Weranuch; Thamarangsi, Thaksaphon; Prakongsai, Phusit; Yuasa, Motoyuki

    2016-03-17

    In the transition to the post-2015 agenda, many countries are striving towards universal health coverage (UHC). Achieving this, governments need to shift from curative care to promotion and prevention services. This research analyses Thailand's financing system for health promotion and prevention, and assesses policy options for health financing reforms. The study employed a mixed-methods approach and integrates multiple sources of evidence, including scientific and grey literature, expenditure data, and semi-structured interviews with key stakeholders in Thailand. The analysis was underpinned by the use of a well-known health financing framework. In Thailand, three agencies plus local governments share major funding roles for health promotion and prevention services: the Ministry of Public Health (MOPH), the National Health Security Office, the Thai Health Promotion Foundation and Tambon Health Insurance Funds. The total expenditure on prevention and public health in 2010 was 10.8% of the total health expenditure, greater than many middle-income countries that average 7.0-9.2%. MOPH was the largest contributor at 32.9%, the Universal Coverage scheme was the second at 23.1%, followed by the local governments and ThaiHealth at 22.8 and 7.3%, respectively. Thailand's health financing system for promotion and prevention is strategic and innovative due to the three complementary mechanisms in operation. There are several methodological limitations to determine the adequate level of spending. The health financing reforms in Thailand could usefully inform policymakers on ways to increase spending on promotion and prevention. Further comparative policy research is needed to generate evidence to support efforts towards UHC.

  12. Decentralized health care priority-setting in Tanzania

    DEFF Research Database (Denmark)

    Maluka, Stephen; Kamuzora, Peter; Sebastiån, Miguel San

    2010-01-01

    care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents......Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health...... not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level...

  13. [Mental health financing in Chile: a pending debt].

    Science.gov (United States)

    Errázuriz, Paula; Valdés, Camila; Vöhringer, Paul A; Calvo, Esteban

    2015-09-01

    In spite of the high prevalence of mental health disorders in Chile, there is a significant financing deficit in this area when compared to the world's average. The financing for mental health has not increased in accordance with the objectives proposed in the 2000 Chilean National Mental Health and Psychiatry Plan, and only three of the six mental health priorities proposed by this plan have secure financial coverage. The National Health Strategy for the Fulfilment of Health Objectives for the decade 2011-2020 acknowledges that mental disorders worsen the quality of life, increase the risk of physical illness, and have a substantial economic cost for the country. Thus, this article focuses on the importance of investing in mental health, the cost of not doing so, and the need for local mental health research. The article discusses how the United States is trying to eliminate the financial discrimination suffered by patients with mental health disorders, and concludes with public policy recommendations for Chile.

  14. Public and private donor financing for health in developing countries.

    Science.gov (United States)

    Howard, L M

    1991-06-01

    Among the many variables that influence the outcome of national health status in both developed and developing countries, the availability and efficiency of financing is critical. For 148 developing countries, annual public and private expenditures from domestic sources (1983) were estimated to be approximately $100 billion. For the United States alone, annual public and private costs for medical care are almost five times larger ($478 billion, 1988). In contrast to domestic expenditures, the total flow of donor assistance for health in 1986 was estimated to be $4 billion, approximately 5% of total current domestic expenditures by developing countries. Direct donor assistance for development purposes by the United States Government approximates 0.5% of the US federal budget (1988). Approximately 10% of all United States development assistance is allocated for health, nutrition, and population planning purposes. While the total health sector contribution is on the order of $500 million annually, the US contribution represents about 13% of health contributions by all external donors. In sub-Saharan Africa, all donor health allocations only reach 3.4% of total development assistance. While available data suggest that private and voluntary organizations contribute approximately 20% of total global health assistance, data reporting methods from private agencies are not sufficiently specific to provide accurate global estimates. Clearly, developing countries as a whole are dependent on the efficient use of their own resources because external financing remains a small fraction of total domestic financing. Nevertheless, improvement in health sector performance often depends on the sharing of western experience and technology, services available through external donor cooperation. In this effort, the available supply of donor financing for health is not restricted entirely by donor policy, but also by the official demand for external financing as submitted by developing

  15. Finance

    OpenAIRE

    2013-01-01

    Voici la 17e édition du Rapport moral sur l’argent dans le monde, publié chaque année depuis 1994 par l’Association d’économie financière avec le soutien de la Caisse des Dépôts. Abordant une nouvelle fois les grands débats qui traversent actuellement le monde de la finance, il se consacre dans un premier temps à la lutte contre la criminalité et les délits financiers, et plus particulièrement à la lutte contre la corruption, la délinquance dans la finance et la fraude fiscale. Dans un second...

  16. Finance

    OpenAIRE

    2011-01-01

    Ces deux ouvrages tirent les enseignements de l’impact de la crise de la finance mondiale sur l’économie réelle et se focalisent, dans ce contexte, sur le financement du Mittelstand. Le banquier JASCHINSKI, lorsqu’il passe en revue le système bancaire allemand, constate ainsi que si les moyennes entreprises trouvent les crédits nécessaires auprès de leurs solides partenaires de toujours que sont les Sparkassen, les grandes sociétés, internationales, que compte le Mittelstand n’ont pas de part...

  17. [Decentralization of the health sector in Mexico. Scope and limitations of local health systems].

    Science.gov (United States)

    González-Block, M A

    1992-01-01

    This paper is a product of the reflection on the decentralization and sectorization experiences in Mexico since 1917 with particular emphasis on the 1980s. The historical analysis included the creation of an analytical model designed to identify the relationship between the distinct sanitary policies implemented in Mexico and the tendencies towards decentralization and integration. This analysis is combined with a critical review of the recent decentralization experiences undertaken in the states of Guerrero, Oaxaca and Nuevo León. While comparing Guerrero and Oaxaca, restitution and deconcentration under similar socio-economic conditions were discussed. The comparison between Guerrero and Nuevo Leon allowed the discussion of the benefits and limits of restitution under different socio-economic conditions. In addition, with this model the author discusses a few generalizations regarding the possible future of decentralization.

  18. Decentralization and health system performance – a focused review of dimensions, difficulties, and derivatives in India

    Directory of Open Access Journals (Sweden)

    Bhuputra Panda

    2016-10-01

    Full Text Available Abstract Introduction One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of ‘decision space’ at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of ‘trust’, ‘convenience’ and ‘mutual benefits’ to explain, define and measure components of governance in health. In the emerging ‘continuum of health services’ model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc. through the prism of decentralization in the first place, and in establishing directed relationships among them. Methods This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. Results Evaluation of local decision making and its effect on health system performance has been

  19. Decentralization and health system performance - a focused review of dimensions, difficulties, and derivatives in India.

    Science.gov (United States)

    Panda, Bhuputra; Thakur, Harshad P

    2016-10-31

    One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of 'decision space' at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of 'trust', 'convenience' and 'mutual benefits' to explain, define and measure components of governance in health. In the emerging 'continuum of health services' model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc.) through the prism of decentralization in the first place, and in establishing directed relationships among them. This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers) were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. Evaluation of local decision making and its effect on health system performance has been studied in a compartmentalized manner. There is sparse evidence about innovations

  20. Maternal Health-Seeking Behavior: The Role of Financing and Organization of Health Services in Ghana

    OpenAIRE

    Aboagye, Emmanuel; Agyemang, Otuo Serebour

    2013-01-01

    This paper examines how organization and financing of maternal health services influence health-seeking behavior in Bosomtwe district, Ghana. It contributes in furthering the discussions on maternal health-seeking behavior and health outcomes from a health system perspective in sub-Saharan Africa. From a health system standpoint, the paper first presents the resources, organization and financing of maternal health service in Ghana, and later uses case study examples to explain how Ghana's hea...

  1. Maternal Health-Seeking Behavior: The Role of Financing and Organization of Health Services in Ghana

    OpenAIRE

    Aboagye, Emmanuel; Agyemang, Otuo Serebour

    2013-01-01

    This paper examines how organization and financing of maternal health services influence health-seeking behavior in Bosomtwe district, Ghana. It contributes in furthering the discussions on maternal health-seeking behavior and health outcomes from a health system perspective in sub-Saharan Africa. From a health system standpoint, the paper first presents the resources, organization and financing of maternal health service in Ghana, and later uses case study examples to explain how Ghana's hea...

  2. The rise of governmentality in the Italian National Health System: physiology or pathology of a decentralized and (ongoing) federalist system?

    Science.gov (United States)

    Lega, Federico; Sargiacomo, Massimo; Ianni, Luca

    2010-11-01

    In this paper, we aim to discuss the implications and lessons that can be learnt from the ongoing process of federalism affecting the Italian National Health System (INHS). Many countries are currently taking decisions concerning the decentralization or re-centralization of their health-care systems, with several key issues that are illustrated in the recent history of the INHS. The decentralization process of INHS has produced mixed results, as some regions took advantage of it to strengthen their systems, whereas others were not capable of developing an effective steering role. We argue that the mutual reinforcement of the decentralization and recentralization processes is not paradoxical, but is actually an effective way for the State to maintain control over the equity and efficiency of its health-care system while decentralizing at a regional level. In this perspective, we provide evidence backing up some of the assumptions made in previous works as well as new food-for thought - specifically on how governmentality and federalism should meet - to reshape the debate on decentralization in health care.

  3. Finance

    OpenAIRE

    Spremann, Klaus

    2007-01-01

    Bisher veröffentlicht unter dem Titel: "Modern Finance" Das Buch beinhaltet ebenso einige Portraits: Die didaktische Erfahrung lehrt, dass man sich wissenschaftliche Ergebnisse und Ansätze besser merken kann, wenn eine Assoziation zu jener Person bildlich konkret wird, der wir den betreffenden Denkansatz verdanken. Aus Fragen der Finanzierung und der Investitionsentscheidungen von Unternehmen ist in der Verschmelzung mit der Analyse von Kapitalmärkten ein grosses Gebiet entstanden, da...

  4. Financing Mental Health Care in Spain: Context and critical issues

    Directory of Open Access Journals (Sweden)

    L. Salvador-Carulla

    2006-03-01

    Full Text Available BACKGROUND: Financing and the way in which funds are then allocated are key issues in health policy. They can act as an incentive or barrier to system reform , can prioritise certain types or sectors of care and have long term consequences for the planning and delivery of services. The way in which these issues can impact on the funding of mental health services across Europe has been a key task of the Mental Health Economics European Network. (MHEEN This paper draws on information prepared for MHEEN and provides an analysis of the context and the main issues related to mental health financing in Spain. METHODS: A structured questionnaire developed by the MHEEN group was used to assess the pattern of financing, eligibility and coverage for mental healthcare. In Spain contacts were made with the Mental Health agencies of the 17 Autonomous Communities (ACs, and available mental health plans and annual reports were reviewed. A direct collaboration was set up with four ACs (Madrid, Navarre, Andalusia, Catalonia. RESULTS: In Spain, like many other European countries mental healthcare is an integral part of the general healthcare with universal coverage funded by taxation. Total health expenditure accounted for 7.7% of GDP in 2003 (public health expenditure was 5.6% of GDP. Although the actual percentage expended in mental care is not known and estimates are unreliable, approximately 5% of total health expenditure can be attributed to mental health. Moreover what is often overlooked is that many services have been shifted from the health to the social care sector as part of the reform process. Social care is discretionary, and provides only limited coverage. This level of expenditure also appears low by European standards, accounting for just 0.6% of GDP. COMMENTS: In spite of its policy implications, little is known about mental healthcare financing in Spain. Comparisons of expenditure for mental health across the ACs are problematic, making it

  5. Sub-national health care financing reforms in Indonesia.

    Science.gov (United States)

    Sparrow, Robert; Budiyati, Sri; Yumna, Athia; Warda, Nila; Suryahadi, Asep; Bedi, Arjun S

    2017-02-01

    Indonesia has seen an emergence of local health care financing schemes over the last decade, implemented and operated by district governments. Often motivated by the local political context and characterized by a large degree of heterogeneity in scope and design, the common objective of the district schemes is to address the coverage gaps for the informal sector left by national social health insurance programs. This paper investigates the effect of these local health care financing schemes on access to health care and financial protection. Using data from a unique survey among District Health Offices, combined with data from the annual National Socioeconomic Surveys, the study is based on a fixed effects analysis for a panel of 262 districts over the period 2004-10, exploiting variation in local health financing reforms across districts in terms of type of reform and timing of implementation. Although the schemes had a modest impact on average, they do seem to have provided some contribution to closing the coverage gap, by increasing outpatient utilization for households in the middle quintiles that tend to fall just outside the target population of the national subsidized programs. However, there seems to be little effect on hospitalization or financial protection, indicating the limitations of local health care financing policies. In addition, we see effect heterogeneity across districts due to differences in design features. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Finance

    OpenAIRE

    2013-01-01

    Régulièrement au cœur de l'actualité, les trois agences de notation (Standard & Poor's, Moody's et Fitch) règnent sur le monde de la finance internationale. Mais quelles sont-elles et à qui appartiennent-elles véritablement ? Détenues par de puissants fonds d'investissements, elles ont progressivement renforcé leurs rôles et pouvoirs. L'auteur interpelle le citoyen sur un système dans lequel les fonds d'investissements profitent des agences de notation (et de leur rôle de « gardien des marché...

  7. Finance

    OpenAIRE

    2008-01-01

    Les investisseurs financiers et a fortiori les hedge fonds sont accusés de tous les maux. Ces « sauterelles » tomberaient sur les entreprises allemandes pour s’enrichir en les dépeçant. Un journaliste économique du quotidien des affaires Frankfurter Allgemeine Zeitung publie là un portrait objectif et factuel de ces « nouvelles stars » de la finance mondiale. Un portrait de branche, doublé d’une analyse de l’impact sur le « capitalisme rhénan » de la montée en puissance de ces nouveaux acteur...

  8. Health financing for universal coverage and health system performance: concepts and implications for policy.

    Science.gov (United States)

    Kutzin, Joseph

    2013-08-01

    Unless the concept is clearly understood, "universal coverage" (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization's World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.

  9. Policies to Spur Energy Access. Executive Summary; Volume 1, Engaging the Private Sector in Expanding Access to Electricity; Volume 2, Case Studies to Public-Private Models to Finance Decentralized Electricity Access

    Energy Technology Data Exchange (ETDEWEB)

    Walters, Terri [National Renewable Energy Lab. (NREL), Golden, CO (United States); Rai, Neha [International Institute for Environment and Development (IIED), London (England); Esterly, Sean [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cox, Sadie [National Renewable Energy Lab. (NREL), Golden, CO (United States); Reber, Tim [National Renewable Energy Lab. (NREL), Golden, CO (United States); Muzammil, Maliha [Univ. of Oxford (United Kingdom); Mahmood, Tasfiq [International Center for Climate Change and Development, Baridhara (Bangladesh); Kaur, Nanki [International Institute for Environment and Development (IIED), London (England); Tesfaye, Lidya [Echnoserve Consulting (Ethiopia); Mamuye, Simret [Echnoserve Consulting (Ethiopia); Knuckles, James [Univ. of London (England). Cass Business School; Morris, Ellen [Columbia Univ., New York, NY (United States); de Been, Merijn [Delft Univ. of Technology (Netherlands); Steinbach, Dave [International Institute for Environment and Development (IIED), London (England); Acharya, Sunil [Digo Bikas Inst. (Nepal); Chhetri, Raju Pandit [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bhushal, Ramesh [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-09-01

    Government policy is one of the most important factors in engaging the private sector in providing universal access to electricity. In particular, the private sector is well positioned to provide decentralized electricity products and services. While policy uncertainty and regulatory barriers can keep enterprises and investors from engaging in the market, targeted policies can create opportunities to leverage private investment and skills to expand electricity access. However, creating a sustainable market requires policies beyond traditional electricity regulation. The report reviews the range of policy issues that impact the development and expansion of a market for decentralized electricity services from establishing an enabling policy environment to catalyzing finance, building human capacity, and integrating energy access with development programs. The case studies in this report show that robust policy frameworks--addressing a wide range of market issues--can lead to rapid transformation in energy access. The report highlights examples of these policies in action Bangladesh, Ethiopia, Mali, Mexico, and Nepal.

  10. The cost conundrum: financing the business of health care insurance.

    Science.gov (United States)

    Kelly, Annemarie

    2013-01-01

    Health care spending in both the governmental and private sectors skyrocketed over the last century. This article examines the rapid growth of health care expenditures by analyzing the extent of this financial boom as well some of the reasons why health care financing has become so expensive. It also explores how the market concentration of insurance companies has led to growing insurer profits, fewer insurance providers, and less market competition. Based on economic data primarily from the Government Accountability Office, the Kaiser Family Foundation, and the American Medical Associa tion, it has become clear that this country needs more competitive rates for the business of health insurance. Because of the unique dynamics of health insurance payments and financing, America needs to promote affordability and innovation in the health insurance market and lower the market's high concentration levels. In the face of booming insurance profits, soaring premiums, many believe that in our consolidated health insurance market, the "business of insurance" should not be exempt from antitrust laws. All in all, it is in our nation's best interest that Congress restore the application of antitrust laws to health sector insurers by passing the Health Insurance Industry Antitrust Enforcement Act as an amendment to the McCarran-Ferguson Act's "business of insurance" provision.

  11. Health care financing in Malaysia: A way forward

    Directory of Open Access Journals (Sweden)

    Ashutosh Kumar Verma

    2015-01-01

    Full Text Available Malaysia has a two-tier health care system consisting of the public and private sectors. The Ministry of Health is the main provider of health care services in the country. The private health care sector provides services on a nonsubsidized, fee-for-service basis, and mainly serves for those who can afford to pay. For financing health care two types of health insurances are available currently: Private and employee based (aka SOCSO. SOCSO and Employee Provident Fund provide some coverage to private-sector employees. There are several challenges in pure Bismarckian model (private insurance etc. like smaller portion of total population will be "economically active," international competition to attract firms, and maintain/increase employment will put downward pressure on labor taxes. How to sustain universal coverage in this context? In a population setting where unemployment is high informal sector, payroll taxes will not be a major source of funds. However, it is possible to create a universal health financing system by transforming the role of budget funding from directly subsidizing provision to subsidizing the purchase of services on behalf of the entire population. The integration of services between the public and private sector is very much needed, at a cost the people can afford. At present, there is no national health insurance scheme in place. Although there are many models proposed, the main question that the policymakers need to be aware of is that of the equity of access to holistic health services for all Malaysians.

  12. Future financial impact of the current health financing system.

    Science.gov (United States)

    Badham, J

    1998-01-01

    Major political parties remain publicly committed to Medicare and community-rated voluntary health insurance. It is important to understand the future financial consequences of this policy in order to assist community debate about whether such a commitment is appropriate or some other policy should be developed. This paper describes development of, and results from, the APHA health financing model. It suggests that health expenditure would represent 12.9% of gross domestic product by 2021, compared to 8.5% in 1995. Increasing per capita expenditure is the major contributor to the growth, with demographic changes responsible for only 14.3%.

  13. Financing reform and structural change in the health services industry.

    Science.gov (United States)

    Higgins, C W; Phillips, B U

    1986-08-01

    This paper reviews the major trends in financing reform, emphasizing their impact on those characteristics of the market for health services that economists have viewed as monopolistic, and discusses the implications of structural change for the allied health professions. Hopefully, by understanding the fundamental forces of change and responding to uncertainty with flexibility and imagination, the allied health professions can capitalize on the opportunities afforded by structural change. Overall, these trends should result in the long-term outlook for use of allied health services to increase at an average annual rate of 9% to 10%. Allied health professionals may also witness an increase in independent practice opportunities. Finally, redistribution of jobs will likely occur in favor of outpatient facilities, home health agencies, and nontraditional settings. This in turn will have an impact on allied health education, which will need to adapt to these types of reforms.

  14. Evaluating the sub-national fidelity of national Initiatives in decentralized health systems: Integrated Primary Health Care Governance in Nigeria.

    Science.gov (United States)

    Eboreime, Ejemai Amaize; Abimbola, Seye; Obi, Felix Abrahams; Ebirim, Obinna; Olubajo, Olalekan; Eyles, John; Nxumalo, Nonhlanhla Lynette; Mambulu, Faith Nankasa

    2017-03-21

    Policy making, translation and implementation in politically and administratively decentralized systems can be challenging. Beyond the mere sub-national acceptance of national initiatives, adherence to policy implementation processes is often poor, particularly in low and middle-income countries. In this study, we explore the implementation fidelity of integrated PHC governance policy in Nigeria's decentralized governance system and its implications on closing implementation gaps with respect to other top-down health policies and initiatives. Having engaged policy makers, we identified 9 core components of the policy (Governance, Legislation, Minimum Service Package, Repositioning, Systems Development, Operational Guidelines, Human Resources, Funding Structure, and Office Establishment). We evaluated the level and pattern of implementation at state level as compared to the national guidelines using a scorecard approach. Contrary to national government's assessment of level of compliance, we found that sub-national governments exercised significant discretion with respect to the implementation of core components of the policy. Whereas 35 and 32% of states fully met national criteria for the structural domains of "Office Establishment" and Legislation" respectively, no state was fully compliant to "Human Resource Management" and "Funding" requirements, which are more indicative of functionality. The pattern of implementation suggests that, rather than implementing to improve outcomes, state governments may be more interested in executing low hanging fruits in order to access national incentives. Our study highlights the importance of evaluating implementation fidelity in providing evidence of implementation gaps towards improving policy execution, particularly in decentralized health systems. This approach will help national policy makers identify more effective ways of supporting lower tiers of governance towards improvement of health systems and outcomes.

  15. Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya.

    Science.gov (United States)

    Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

    2016-03-01

    In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in

  16. Insurance Accounts: The Cultural Logics of Health Care Financing.

    Science.gov (United States)

    Mulligan, Jessica

    2016-03-01

    The financial exuberance that eventually culminated in the recent world economic crisis also ushered in dramatic shifts in how health care is financed, administered, and imagined. Drawing on research conducted in the mid-2000s at a health insurance company in Puerto Rico, this article shows how health care has been financialized in many ways that include: (1) privatizing public services; (2) engineering new insurance products like high deductible plans and health savings accounts; (3) applying financial techniques to premium payments to yield maximum profitability; (4) a managerial focus on shareholder value; and (5) prioritizing mergers and financial speculation. The article argues that financial techniques obfuscate how much health care costs, foster widespread gaming of reimbursement systems that drives up prices, and "unpool" risk by devolving financial and moral responsibility for health care onto individual consumers. © 2015 by the American Anthropological Association.

  17. Guidelines for Analysis of Health Sector Financing in Developing Countries. Volume 8: Health Sector Financing in Developing Countries. International Health Planning Methods Series.

    Science.gov (United States)

    Robertson, Robert L.; And Others

    Intended to assist Agency for International Development officers, advisors, and health officials in incorporating health planning into national plans for economic development, this eighth of ten manuals in the International Health Planning Methods series provides a methodology for conducting a study of health sector financing. It presents an…

  18. Application of disease burden to quantitative assessment of health hazards for a decentralized water reuse system.

    Science.gov (United States)

    Gao, Tingting; Chen, Rong; Wang, Xiaochang; Ngo, Huu Hao; Li, Yu-You; Zhou, Jinhong; Zhang, Lu

    2016-05-01

    The aim of this article is to introduce the methodology of disease burden (DB) to quantify the health impact of microbial regrowth during wastewater reuse, using the case study of a decentralized water reuse system in Xi'an Si-yuan University, located in Xi'an, China. Based on field investigation findings, Escherichia coli (E. coli), Salmonella and rotavirus were selected as typical regrowth pathogens causing potential health hazards during the reuse of reclaimed water. Subsequently, major exposure routes including sprinkler irrigation, landscape fountains and toilet flushing were identified. Mathematical models were established to build the relationship between exposure dose and disease burden by calculating the disability adjusted life year (DALY). Results of disease burden for this case study show that DALYs attributed to E. coli were significantly greater than those caused by other pathogens, and DALYs associated with sprinkler irrigation were higher than those originating from other routes. A correlation between exposure dose and disease was obtained by introducing a modified calculation of morbidity, which can extend the assessment endpoint of health risk to disease burden from the conventional infection rate.

  19. U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization?; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”

    Directory of Open Access Journals (Sweden)

    Arturo Vargas Bustamante

    2016-09-01

    Full Text Available For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization.

  20. Speculating on health: public health meets finance in 'health impact bonds'.

    Science.gov (United States)

    Rowe, Rachel; Stephenson, Niamh

    2016-11-01

    Where modern public health developed techniques to calculate probability, potentiality, risk and uncertainty, contemporary finance introduces instruments that redeploy these. This article traces possibilities for interrogating the connection between health and financialisation as it is arising in one particular example - the health impact bond. It locates the development of this very recent financial innovation in an account of public health's role within governance strategies over the 20th century to the present. We examine how social impact bonds for chronic disease prevention programmes bring two previously distinct ways of thinking about and addressing risk into the same domain. Exploring the derivative-type properties of health impact bonds elucidates the financial processes of exchange, hedging, bundling and leveraging. As tools for speculation, the functions of health impact bonds can be delinked from any particular outcome for participants in health interventions. How public health techniques for knowing and acting on risks to population health will contest, rework or be subsumed within finance's speculative response to risk, is to be seen. © 2016 Foundation for the Sociology of Health & Illness.

  1. Financing health care for all: challenges and opportunities.

    Science.gov (United States)

    Kumar, A K Shiva; Chen, Lincoln C; Choudhury, Mita; Ganju, Shiban; Mahajan, Vijay; Sinha, Amarjeet; Sen, Abhijit

    2011-02-19

    India's health financing system is a cause of and an exacerbating factor in the challenges of health inequity, inadequate availability and reach, unequal access, and poor-quality and costly health-care services. Low per person spending on health and insufficient public expenditure result in one of the highest proportions of private out-of-pocket expenses in the world. Citizens receive low value for money in the public and the private sectors. Financial protection against medical expenditures is far from universal with only 10% of the population having medical insurance. The Government of India has made a commitment to increase public spending on health from less than 1% to 3% of the gross domestic product during the next few years. Increased public funding combined with flexibility of financial transfers from centre to state can greatly improve the performance of state-operated public systems. Enhanced public spending can be used to introduce universal medical insurance that can help to substantially reduce the burden of private out-of-pocket expenditures on health. Increased public spending can also contribute to quality assurance in the public and private sectors through effective regulation and oversight. In addition to an increase in public expenditures on health, the Government of India will, however, need to introduce specific methods to contain costs, improve the efficiency of spending, increase accountability, and monitor the effect of expenditures on health.

  2. The role of institutional design and organizational practice for health financing performance and universal coverage.

    Science.gov (United States)

    Mathauer, Inke; Carrin, Guy

    2011-03-01

    Many low- and middle income countries heavily rely on out-of-pocket health care expenditure. The challenge for these countries is how to modify their health financing system in order to achieve universal coverage. This paper proposes an analytical framework for undertaking a systematic review of a health financing system and its performance on the basis of which to identify adequate changes to enhance the move towards universal coverage. The distinctive characteristic of this framework is the focus on institutional design and organizational practice of health financing, on which health financing performance is contingent. Institutional design is understood as formal rules, namely legal and regulatory provisions relating to health financing; organizational practice refers to the way organizational actors implement and comply with these rules. Health financing performance is operationalized into nine generic health financing performance indicators. Inadequate performance can be caused by six types of bottlenecks in institutional design and organizational practice. Accordingly, six types of improvement measures are proposed to address these bottlenecks. The institutional design and organizational practice of a health financing system can be actively developed, modified or strengthened. By understanding the incentive environment within a health financing system, the potential impacts of the proposed changes can be anticipated.

  3. Dual indices for prioritizing investment in decentralized HIV services at Nigerian primary health care facilities.

    Science.gov (United States)

    Fronczak, Nancy; Oyediran, Kola' A; Mullen, Stephanie; Kolapo, Usman M

    2016-04-01

    Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect-that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and

  4. Public health services and systems research: current state of finance research.

    Science.gov (United States)

    Ingram, Richard C; Bernet, Patrick M; Costich, Julia F

    2012-11-01

    There is a growing recognition that the US public health system should strive for efficiency-that it should determine the optimal ways to utilize limited resources to improve and protect public health. The field of public health finance research is a critical part of efforts to understand the most efficient ways to use resources. This article discusses the current state of public health finance research through a review of public health finance literature, chronicles important lessons learned from public health finance research to date, discusses the challenges faced by those seeking to conduct financial research on the public health system, and discusses the role of public health finance research in relation to the broader endeavor of Public Health Services and Systems Research.

  5. Organization and Finance of China’s Health Sector

    Directory of Open Access Journals (Sweden)

    Hui Li PhD

    2016-01-01

    Full Text Available China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP. Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China’s shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China’s evolution, adding another layer of

  6. The coming changes in tax-exempt health care finance.

    Science.gov (United States)

    Carlile, L L; Serchuk, B M

    1995-01-01

    On December 30, 1994, the Internal Revenue Service (IRS) published proposed regulations (Proposed Regulations) that if enacted would significantly change the climate and rules of federal income tax law controlling the issuance and maintenance of tax-exempt bonds for governmental and 501(c)(3) health care borrowers. This article (1) summarizes the aspects of the Proposed Regulations dealing with private activity tests, management contracts, allocation and accounting rules, change in use of financed facilities, and antiabuse rules, and (2) summarizes the possible interrelationship of the IRS's audit program for tax-exempt bonds and the Proposed Regulations. The article reviews features of the Proposed Regulations that will affect either the costs or administrative burdens of managing the federal tax compliance of future tax-exempt health care borrowings.

  7. General practitioners' perspectives on referring patients to decentralized acute health care.

    Science.gov (United States)

    Leonardsen, Ann-Chatrin L; Del Busso, Lilliana; Grøndahl, Vigdis A; Ghanima, Waleed; Jelsness-Jørgensen, Lars-Petter

    2016-12-01

    Municipality acute wards (MAWs) have recently been introduced in Norway. Their mandate is to provide treatment for patients who otherwise would have been hospitalized. Even though GPs are key stakeholders, little is known about how they perceive referring patients to these wards. The aim of this study was to investigate GPs' perspectives on factors relevant for their decision-making when referring patients to MAWs. We used a qualitative approach, conducting semi-structured interviews with 23 GPs from five different MAW catchment areas in the southeastern part of Norway. The data were analysed using thematic analysis. The GPs experienced challenges in deciding which patients were suitable for treatment at a MAW, including whether patients could be regarded as medically clarified, and whether these services were sufficient and safe. GPs were also under pressure from several other stakeholders when deciding where to refer their patients. Moreover, the MAWs were viewed not merely as an alternative to hospitals, but also as a service in addition to hospitals. This study improves our understanding of how GPs experience decentralized acute health care services, by identifying factors that influence and challenge their referral decisions. For these services to be used as intended in the collaboration reform, integrating the perspectives of GPs in the development and implementation of these services may be beneficial. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. The impact of health care financing on family budgets.

    Science.gov (United States)

    Rasell, E; Bernstein, J; Tang, K

    1994-01-01

    Although businesses, federal and state governments, and insurance companies are major funding sources for health care, they are just intermediate sources. Ultimately, individuals and families pay all health care costs through out-of-pocket spending, insurance premiums, or federal, state, and local taxes. Using a microsimulation model with data from the 1987 National Medical Expenditure Survey, the Internal Revenue Service's Individual Tax Model, and the Consumer Expenditure Survey, the authors examine the distribution of health care spending, by decile, among families and individuals. They find that the distribution of health expenditures is very regressive, with low-income families paying twice the share of income paid by high-income families. The distribution of out-of-pocket expenditures, which comprise 24 percent of total spending, is the most regressive, with low-income families paying 8.5 times the share of income paid by high-income families. Spending on premiums is also regressive, and the regressivity would increase if everyone had private insurance. Expenditures through the public sector are progressive. Regressivity is greater among the elderly than the nonelderly. Out-of-pocket expenditures account for 41 percent of all health care spending by the elderly. A more equitably financed health care system would increase the share of funding raised through progressive taxes, and decrease reliance on expenditures made out of pocket and on premiums.

  9. Financial Stress, Shaming Experiences and Psychosocial Ill-Health: Studies into the Finances-Shame Model

    Science.gov (United States)

    Starrin, Bengt; Aslund, Cecilia; Nilsson, Kent W.

    2009-01-01

    The aim of the study was to test the Finances-Shame model and its explanatory power regarding the prevalence of psychosocial ill-health. The Finances-Shame model postulates that (i) the greater the financial stress and the more experiences of having been shamed, the greater the risk for psychosocial ill-health, (ii) the lesser the financial stress…

  10. Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates

    OpenAIRE

    Hamidi S

    2015-01-01

    Samer Hamidi School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates Introduction: A national health account (NHA) provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Duba...

  11. Health financing in Africa: overview of a dialogue among high level policy makers

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    Sambo Luis

    2011-06-01

    Full Text Available Abstract Background Even though Africa has the highest disease burden compared with other regions, it has the lowest per capita spending on health. In 2007, 27 (51% out the 53 countries spent less than US$50 per person on health. Almost 30% of the total health expenditure came from governments, 50% from private sources (of which 71% was from out-of-pocket payments by households and 20% from donors. The purpose of this article is to reflect on the proceedings of the African Union Side Event on Health Financing in the African continent. Methods Methods employed in the session included presentations, panel discussion and open public discussion with ministers of health and finance from the African continent. Discussion The current unsatisfactory state of health financing was attributed to lack of clear vision and plan for health financing; lack of national health accounts and other evidence to guide development and implementation of national health financing policies and strategies; low investments in sectors that address social determinants of health; predominance of out-of-pocket spending; underdeveloped prepaid health financing mechanisms; large informal sectors vis-à-vis small formal sectors; and unpredictability and non-alignment of majority of donor funds with national health priorities. Countries need to develop and adopt a comprehensive national health policy and a costed strategic plan; a comprehensive evidence-based health financing strategy; allocate at least 15% of the national budget to health development; use GFATM and PEPFAR funds for health systems strengthening; strengthen intersectoral collaboration to address health determinants; advocate among donors to implement the Paris Declaration on Aid Effectiveness and its Accra Agenda for Action; ensure universal access to health services for pregnant women, lactating mothers and children aged under five years; strengthen financial management capacities; and develop prepaid health

  12. The problems and directions of financing mechanisms’ development in Health Assistance System

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    Gheorghe Costandachi

    2007-12-01

    Full Text Available The essay discloses the main problem of Moldovan public health system is the significant gap between state free public health maintenance and its financial support. Here're the problems are met moldovan public health during reforming financing mechanisms in the transition period, also are presented interests of subjects of this system and informal sources of incomes. Author describes the interests of head physicians of medical institutions in relation to system of financing of public health services consist. In the final of work is making conclusions and is offered wais of the solutions created present situation and financing mechanisms'development in Health Assistance System on Moldova.

  13. Medical savings accounts - in search of an alternative method of health care financing in European countries

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    Marta Borda

    2011-09-01

    Full Text Available In times of increasing health care expenditure and insufficient cover provided by publicly financed health systems additional, alternative methods of health care financing become more and more considerable. The purpose of the paper is to present the concept of Medical Savings Accounts (MSAs and possibilities of their application in the health care systems of European countries. First, the author describes the idea of MSAs and reviews positive and negative findings about the effects of implementing this method into the health systems. Next, two main approaches to the application of MSAs in health care financing are considered. In the last part of the paper, the possibilities of introducing MSAs into health care systems in European countries are discussed. The author takes into consideration the existing health care financing conditions and other specific institutional, socio-economic and cultural factors as the main determinants for successful designing and implementation of the MSA scheme in a given country.

  14. The global health financing revolution: why maternal health is missing the boat.

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    Ooms, G; Hammonds, R; Richard, F; De Brouwere, V

    2012-01-01

    The first decade of the new millennium saw an upsurge in global financing for health. When the world took stock of progress on the Millennium Development Goals in mid-2010 the one addressing maternal health showed the least progress. Did maternal health miss the boat? In mid-2010 the Secretary-General of the United Nations launched a "Global Strategy for Women's and Children's Health", also known as the "Every Woman Every Child" initiative. Has the tide now turned in favour of maternal health? The authors try to answer this question by first examining whether maternal health really missed out with respect to increased global funding and why this may have occurred. They then assess whether the new initiative will make a difference by comparing several elements of the approach taken by HIV/AIDS activist to that of maternal health activists. They suggest that real progress requires international financing, thus pledges must become robust and reliable commitments. They conclude that the absence of an organisational structure in the current initiative means the global maternal health financing revolution will probably not happen.

  15. Health Care Finance Executive Personalities Revisited: A 10-Year Follow-up Study.

    Science.gov (United States)

    Lieneck, Cristian; Nowicki, Michael

    2015-01-01

    A dynamic health care industry continues to call upon health care leaders to possess not one but multiple competencies. Inherent personality characteristics of leaders often play a major role in personal as well as organizational success to include those in health care finance positions of responsibility. A replication study was conducted to determine the Myers-Briggs personality-type differences between practicing health care finance professionals in 2014, as compared with a previous 2003 study. Results indicate a significant shift between both independent samples of health care finance professionals over the 10-year period from original high levels of introversion to that of extraversion, as well as higher sensing personality preferences, as compared with the original sample's high level of intuition preferences. Further investigation into the evolving role of the health care finance manager is suggested, while continued alignment of inherent, personal characteristics is suggested to meet ongoing changes in the industry.

  16. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

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    Lars Henrik Myklebust

    2011-12-01

    Full Text Available Background: The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention.Aims: To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model.  Method: The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Results: Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Conclusion: Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a

  17. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

    Directory of Open Access Journals (Sweden)

    Lars Henrik Myklebust

    2011-12-01

    Full Text Available Background: The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. Aims: To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model.   Method: The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization.  Results: Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care.  Conclusion: Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore

  18. Extensions to decomposition of the redistributive effect of health care finance.

    Science.gov (United States)

    Zhong, Hai

    2009-10-01

    The total redistributive effect (RE) of health-care finance has been decomposed into vertical, horizontal and reranking effects. The vertical effect has been further decomposed into tax rate and tax structure effects. We extend this latter decomposition to the horizontal and reranking components of the RE. We also show how to measure the vertical, horizontal and reranking effects of each component of the redistributive system, allowing analysis of the RE of health-care finance in the context of that system. The methods are illustrated with application to the RE of health-care financing in Canada.

  19. Private finance of services covered by the National Health Insurance package of benefits in Israel.

    Science.gov (United States)

    Engelchin-Nissan, Esti; Shmueli, Amir

    2015-01-01

    Private health expenditure in systems of national health insurance has raised concern in many countries. The concern is mainly about the accessibility of care to the poor and the sick, and inequality in use and in health. The concern thus refers specifically to the care financed privately rather than to private health expenditure as defined in the national health accounts. To estimate the share of private finance in total use of services covered by the national package of benefits. and to relate the private finance of use to the income and health of the users. The Central Bureau of Statistics linked the 2009 Health Survey and the 2010 Incomes Survey. Twenty-four thousand five hundred ninety-five individuals in 7175 households were included in the data. Lacking data on the share of private finance in total cost of care delivered, we calculated instead the share of uses having any private finance-beyond copayments-in total uses, in primary, secondary, paramedical and total care. The probability of any private finance in each type of care is then related, using random effect logistic regression, to income and health state. Fifteen percent of all uses of care covered by the national package of benefits had any private finance. This rate ranges from 10 % in primary care, 16 % in secondary care and 31 % in paramedical care. Twelve percent of all uses of physicians' services had any private finance, ranging from 10 % in family physicians to 20 % in pulmonologists, psychiatrists, neurologists and urologists. Controlling for health state, richer individuals are more likely to have any private finance in all types of care. Controlling for income, sick individuals (1+ chronic conditions) are 30 % in total care and 60 % in primary care more likely to have any private finance compared to healthy individuals (with no chronic conditions). The national accounts' "private health spending" (39 % of total spending in 2010) is not of much use regarding equity of and

  20. Equity in the finance of health care: some further international comparisons.

    Science.gov (United States)

    Wagstaff, A; van Doorslaer, E; van der Burg, H; Calonge, S; Christiansen, T; Citoni, G; Gerdtham, U G; Gerfin, M; Gross, L; Häkinnen, U; Johnson, P; John, J; Klavus, J; Lachaud, C; Lauritsen, J; Leu, R; Nolan, B; Perán, E; Pereira, J; Propper, C; Puffer, F; Rochaix, L; Rodríguez, M; Schellhorn, M; Winkelhake, O

    1999-06-01

    This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al. [Wagstaff, A., van Doorslaer E., et al., 1992. Equity in the finance of health care: some international comparisons, Journal of Health Economics 11, pp. 361-387] but extends it in a number of directions: we modify the methodology used there and achieve a higher degree of cross-country comparability in variable definitions; we update and extend the cross-section of countries; and we present evidence on trends in financing mixes and progressivity.

  1. Understanding the working relationships between National Health Service clinicians and finance staff.

    Science.gov (United States)

    Minogue, Virginia; McCaffry, Rebecca

    2017-03-13

    Purpose The Department of Health and the National Health Service (NHS) Future Focused Finance (FFF) programme promotes effective engagement between clinical and finance staff. Surveys undertaken by the Department of Health between 2013 and 2015 found few NHS Trusts reported high levels of engagement. The purpose of this paper is to gain a better understanding of current working relationships between NHS clinical and finance professionals and how they might be supported to become more effective. Design/methodology/approach Ipsos MORI were commissioned by the NHS FFF programme to undertake an online survey of NHS clinical and finance staff between June and August 2015. Findings The majority of clinicians had a member of a finance team linked to their speciality or directorate. Clinical and finance professionals have a positive view of joint working preferring face-to-face contact. Clinician's confidence in their understanding of finance was generally good and finance staff felt they had a good understanding of clinical issues. Effective working relationships were facilitated by face-to-face contact, a professional relationship, and the availability of clear, well presented finance and activity data. Research limitations/implications Data protection issues limited the accessibility of the survey team to NHS staff resulting in a relatively low-response rate. Other forms of communication, including social media, were utilised to increase access to the survey. Originality/value The FFF programme is a unique programme aimed at making the NHS finance profession fit for the future. The close partnering work stream brings together the finance and clinical perspective to share knowledge, evidence, training, and to develop good practice and engagement.

  2. Financing national policy on oral health in Brazil in the context of the Unified Health System

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    Gilberto Alfredo Pucca Junior

    2010-01-01

    Full Text Available This article discusses the model of oral health care implemented in the Unified Health System of Brazil in the last decade. This model was conceived as a sub-sector policy that, over the years, has sought to improve the quality of life of the Brazilian population. Through a chronological line, the study presents the National Policy on Oral Health as a counter-hegemonic patient care model for the dentistry practices existing in the country before this policy was implemented. The reorganization of the levels of oral health care, the creation of reference facilities for secondary and tertiary care, through Centers of Dental Specialties and Regional Dental Prosthesis Laboratories, and the differential funding and decentralized management of financial resources were able to expand the actions of oral health for more than 90 million inhabitants. The evolution shown after the deployment of the National Oral Health Policy, as of 2004, demonstrates the greater integration of oral health care under the Unified Health System and provides feedback information to help this policy to continue to be prioritized by the Federal Government and receive more support from the state and local levels in the coming years.

  3. Commune Health Workers' Methadone Maintenance Treatment (MMT) Knowledge and Perceived Difficulties Providing Decentralized MMT Services in Vietnam.

    Science.gov (United States)

    Lin, Chunqing; Tuan, Nguyen Anh; Li, Li

    2017-07-13

    With the initial establishment of countrywide methadone maintenance therapy (MMT) system, Vietnam is in the process of expanding and decentralizing the MMT program to community-based healthcare settings. The study aimed to measure the MMT-related knowledge and perceived difficulties in treating patient who use drugs (PWUD) among community-based healthcare providers, e.g., commune health workers (CHW), and examine its correlated factors. A total of 300 CHW from 60 communes in two provinces of Vietnam completed a survey using Audio Computer-Assisted Self-Interview (ACASI) method. Twelve true-or-false questions were used to assess the CHW's MMT-related knowledge. The CHW's background characteristics and perceived difficulties treating PWUD were recorded. The mean MMT knowledge score was 8.2 (SD = 1.2; range: 5-11). Misconceptions toward the benefits, procedure, and side effects of MMT were prevalent. The participants perceived varying degrees of difficulties in recruiting, engaging, and communicating with PWUD. With all covariates holding constant, younger age (standardized ẞ = -0.166; p = 0.0078) was associated with less MMT-related knowledge. Number of PWUD seen in a month and MMT-related knowledge was associated with less perceived difficulties treating PWUD. Conclusions/importance: The finding shed lights on the CHW's knowledge gap, which need to be addressed to facilitate the decentralization of MMT services in Vietnam. In preparation for a decentralized MMT service delivery model, specially designed training is warranted to equip CHW with knowledge and confidence to provide MMT-related services to PWUD.

  4. Financing reforms of public health services in China: lessons for other nations.

    Science.gov (United States)

    Liu, Xingzhu; Mills, Anne

    2002-06-01

    Financing reforms of China's public health services are characterised by a reduction in government budgetary support and the introduction of charges. These reforms have changed the financing structure of public health institutions. Before the financing reforms, in 1980, government budgetary support covered the full costs of public health institutions, while after the reforms by the middle of the 1990s, the government's contribution to the institutions' revenue had fallen to 30-50%, barely covering the salaries of health workers, and the share of revenue generated from charges had increased to 50-70%. These market-oriented financing reforms improved the productivity of public health institutions, but several unintended consequences became evident. The economic incentives that were built into the financing system led to over-provision of unnecessary services, and under-provision of socially desirable services. User fees reduced the take-up of preventive services with positive externalities. The lack of government funds resulted in under-provision of services with public goods' characteristics. The Chinese experience has generated important lessons for other nations. Firstly, a decline in the role of government in financing public health services is likely to result in decreased overall efficiency of the health sector. Secondly, levying charges for public health services can reduce demand for these services and increase the risk of disease transmission. Thirdly, market-oriented financing reforms of public health services should not be considered as a policy option. Once this step is made, the unintended consequences may outweigh the intended ones. Chinese experience strongly suggests that the government should take a very active role in financing public health services.

  5. Decentralization of the provision of health services to people living with HIV/AIDS in rural China: the case of three counties

    Directory of Open Access Journals (Sweden)

    Zhang Yurong

    2011-02-01

    Full Text Available Abstract This study is based on a large-scale household survey and in-depth interviews of key informants that was conducted in villages in three counties of two provinces in China. We assess the new decentralized service provision system for people living with HIV/AIDS in rural populations in China. Since 2003, new social assistance schemes, and, more importantly, decentralization of routine treatment and care to community health stations, were progressively implemented in rural areas most affected by the HIV/AIDS epidemic. Though some problems remain, such as persistent discrimination towards infected patients and the lack of sufficient training of medical staff, the new decentralized pattern of service provision has lowered barriers to health access and alleviated economic pressure on affected households.

  6. Public/private financing in the Greek health care system: implications for equity.

    Science.gov (United States)

    Liaropoulos, L; Tragakes, E

    1998-02-01

    The 1983 health reforms in Greece were indirectly aimed at increasing equity in financing through expansion of the role of the public sector and restriction of the private sector. However, the rigid application of certain measures, the failure to change health care financing mechanisms, as well as growing dissatisfaction with publicly provided services actually increased the private share of health care financing relative to that of the public share. The greatest portion of this increase involved out-of-pocket payments, which constitute the most regressive form of financing, and hence resulted in reduced equity. The growing share of private insurance financing, though as yet quite small, has also contributed to reducing equity. Within public funding, while a small shift has occurred in favor of tax financing, it is questionable whether this has contributed to increased equity in view of widespread tax evasion. On balance, it is most unlikely that the 1983 health care reforms have led to increased equity; it is rather more likely that the system in operation today is more inequitable from the point of view of financing than the highly inequitable system that was in place in the early 1980s.

  7. How changes to Irish healthcare financing are affecting universal health coverage.

    Science.gov (United States)

    Briggs, Adam D M

    2013-11-01

    In 2010, the World Health Organisation (WHO) published the World Health Report - Health systems financing: the path to universal coverage. The Director-General of the WHO, Dr Margaret Chan, commissioned the report "in response to a need, expressed by rich and poor countries alike, for practical guidance on ways to finance health care". Given the current context of global economic hardship and difficult budgetary decisions, the report offered timely recommendations for achieving universal health coverage (UHC). This article analyses the current methods of healthcare financing in Ireland and their implications for UHC. Three questions are asked of the Irish healthcare system: firstly, how is the health system financed; secondly, how can the health system protect people from the financial consequences of ill-health and paying for health services; and finally, how can the health system encourage the optimum use of available resources? By answering these three questions, this article argues that the Irish healthcare system is not achieving UHC, and that it is unclear whether recent changes to financing are moving Ireland closer or further away from the WHO's ambition for healthcare for all.

  8. The role of ethical banks in health care policy and financing in Spain.

    Science.gov (United States)

    Salvador-Carulla, Luis; Solans, Josep; Duaigues, Mónica; Balot, Jordi; García-Gutierrez, Juan Carlos

    2009-01-01

    Ethical, social, or civic banks, constitute a secondary source of financing, which is particularly relevant in Southern and Central Europe. However there is no information on the scientific literature on this source of health care financing. We review the characteristics of saving banks in Spain and illustrate the contribution of one institution "Obra Social Caixa Catalunya" (OS-CC) to the health care financing in Spain. Savings bank health care funding was equivalent to 3 percent of the public health expenditure for 2008. The programs developed by OS-CC illustrate the complex role of savings banks in health financing, provision, training, and policy, particularly in the fields of integrated care and innovation. Financing is a basic tool for health policy. However, the role of social banking in the development of integrated care networks has been largely disregarded, in spite of its significant contribution to complementary health and social care in Southern and Central Europe. Decision makers both at the public health agencies and at the social welfare departments of savings banks should become aware of the policy implications and impact of savings bank activities in the long-term care system.

  9. Health system barriers to strengthening vaccine-preventable disease surveillance and response in the context of decentralization: evidence from Georgia

    Directory of Open Access Journals (Sweden)

    Silvestre Eva A

    2006-07-01

    Full Text Available Abstract Background A critical challenge in the health sector in developing countries is to ensure the quality and effectiveness of surveillance and public health response in an environment of decentralization. In Georgia, a country where there has been extensive decentralization of public health responsibilities over the last decade, an intervention was recently piloted to strengthen district-level local vaccine-preventable disease surveillance and response activities through improved capacity to analyze and use routinely collected data. The purpose of the study is 1 to assess the effectiveness of the intervention on motivation and perceived capacity to analyze and use information at the district-level, and 2 to assess the role that individual- and system-level factors play in influencing the effectiveness of the intervention. Methods A pre-post quasi-experimental research design is used for the quantitative evaluation. Data come from a baseline and two follow-up surveys of district-level health staff in 12 intervention and 3 control Center of Public Health (CPH offices. These data were supplemented by record reviews in CPH offices as well as focus group discussions among CPH and health facility staff. Results The results of the study suggest that a number of expected improvements in perceived data availability and analysis occurred following the implementation of the intervention package, and that these improvements in analysis could be attributable to the intervention package. However, the study results also suggest that there exist several health systems barriers that constrained the effectiveness of the intervention in influencing the availability of data, analysis and response. Conclusion To strengthen surveillance and response systems in Georgia, as well as in other countries, donor, governments, and other stakeholders should consider how health systems factors influence investments to improve the availability of data, analysis, and

  10. A Study on Sources of Health Financing in Nigeria: Implications for Health care Marketers and Planners

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    Rotimi Ayodele Gbadeyan

    2016-01-01

    Full Text Available There have been increasing difficulties in providing qualitative health care services to the public in Nigeria. The development has called for the need to examine ways through which government and other stakeholders resolve these crises in the health sector. The objective of this paper is to examine the level of Government spending to total Health expenditures in Nigeria. This study basically employs secondary data for analysis. The secondary data are provided from the World Bank Development indicators and Internet. The data was analyzed using the Pearson Correlation Coefficient Statistical technique. The result revealed a strong positive Correlation (r = 0.634 between Government Health Spending and Total Health Spending. This indicates that Government Health Spending constitutes a significant proportion of the Total Health Expenditures in Nigeria; despite complains about inadequate health financing. In conclusion, the Nigerian Health sector would become more vibrant, if the Government and the Private sector are ready to give the necessary commitments required to achieve the laudable objective of qualitative health for all. The study recommends for more Government Health funding towards tackling the prevalence of some chronic diseases such as HIV, Asthma, Tuberculosis, Meningitis and Paralysis, etc.

  11. The convergence of health care financing structures: empirical evidence from OECD-countries.

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    Leiter, Andrea M; Theurl, Engelbert

    2012-02-01

    The convergence/divergence of health care systems between countries is an interesting facet of the health care system research from a macroeconomic perspective. In this paper, we concentrate on an important dimension of every health care system, namely the convergence/divergence of health care financing (HCF). Based on data from 22 OECD countries in the time period 1970-2005, we use the public financing ratio (public financing in % of total HCF) and per capita public HCF as indicators for convergence. By applying different concepts of convergence, we find that HCF is converging. This conclusion also holds when we look at smaller subgroups of countries and shorter time periods. However, we find evidence that countries do not move towards a common mean and that the rate of convergence is decreasing over time.

  12. An analysis of joint finance in seven non-London health authorities

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    Karen Gerard

    1987-01-01

    Joint finance is a source of National Health Service money which has been targeted by the department of Health and Social Security to be spent on community care. In particular it is to be used by agencies (statutory and non-statutory) in collaboration with the health service to facilitate the phasing out of long-stay hospital institutions by replacing these services with more appropriate facilities in the community. Joint finance has come under much criticism over the role it plays in support...

  13. Equity during an economic crisis: financing of the Argentine health system.

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    Cavagnero, Eleonora; Bilger, Marcel

    2010-07-01

    This article analyses the redistributive effect caused by health financing and the distribution of healthcare utilization in Argentina before and during the severe 2001/2002 economic crisis. Both dramatically changed during this period: the redistributive effect became much more positive and utilization shifted from pro-poor to pro-rich. This clearly demonstrates that when utilization is contingent on financing, changes can occur rapidly; and that an integrated approach is required when monitoring equity. From a policy perspective, the Argentine health system appears vulnerable to economic downturns mainly due to high reliance on out-of-pocket payments and the strong link between health insurance and employment.

  14. Health financing reform in Uganda: How equitable is the proposed National Health Insurance scheme?

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    Orem Juliet

    2010-10-01

    Full Text Available Abstract Background Uganda is proposing introduction of the National Health Insurance scheme (NHIS in a phased manner with the view to obtaining additional funding for the health sector and promoting financial risk protection. In this paper, we have assessed the proposed NHIS from an equity perspective, exploring the extent to which NHIS would improve existing disparities in the health sector. Methods We reviewed the proposed design and other relevant documents that enhanced our understanding of contextual issues. We used the Kutzin and fair financing frameworks to critically assess the impact of NHIS on overall equity in financing in Uganda. Results The introduction of NHIS is being proposed against the backdrop of inequalities in the distribution of health system inputs between rural and urban areas, different levels of care and geographic areas. In this assessment, we find that gradual implementation of NHIS will result in low coverage initially, which might pose a challenge for effective management of the scheme. The process for accreditation of service providers during the first phase is not explicit on how it will ensure that a two-tier service provision arrangement does not emerge to cater for different types of patients. If the proposed fee-for-service mechanism of reimbursing providers is pursued, utilisation patterns will determine how resources are allocated. This implies that equity in resource allocation will be determined by the distribution of accredited providers, and checks put in place to prohibit frivolous use. The current design does not explicitly mention how these two issues will be tackled. Lastly, there is no clarity on how the NHIS will fit into, and integrate within existing financing mechanisms. Conclusion Under the current NHIS design, the initial low coverage in the first years will inhibit optimal achievement of the important equity characteristics of pooling, cross-subsidisation and financial protection. Depending

  15. Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses.

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    Augustine Asante

    Full Text Available Health financing reforms in low- and middle- income countries (LMICs over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA.Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA and/or financing incidence analysis (FIA as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing.Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance

  16. National health financing policy in Eritrea: a survey of preliminary considerations

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    Kirigia Joses

    2012-08-01

    Full Text Available Abstract Background The 58th World Health Assembly and 56th WHO Regional Committee for Africa adopted resolutions urging Member States to ensure that health financing systems included a method for prepayment to foster financial risk sharing among the population and avoid catastrophic health-care expenditure. The Regional Committee asked countries to strengthen or develop comprehensive health financing policies. This paper presents the findings of a survey conducted among senior staff of selected Eritrean ministries and agencies to elicit views on some of the elements likely to be part of a national health financing policy. Methods This is a descriptive study. A questionnaire was prepared and sent to 19 senior staff (Directors in the Ministry of Health, Labour Department, Civil Service Administration, Eritrean Confederation of Workers, National Insurance Corporation of Eritrea and Ministry of Local Government. The respondents were selected by the Ministry of Health as key informants. Results The key findings were as follows: the response rate was 84.2% (16/19; 37.5% (6/16 and 18.8% said that the vision of Eritrean National Health Financing Policy (NHFP should include the phrases ‘equitable and accessible quality health services’ and ‘improve efficiency or reduce waste’ respectively; over 68% indicated that NHFP should include securing adequate funding, ensuring efficiency, ensuring equitable financial access, protection from financial catastrophe, and ensuring provider payment mechanisms create positive incentives to service providers; over 80% mentioned community participation, efficiency, transparency, country ownership, equity in access, and evidence-based decision making as core values of NHFP; over 62.5% confirmed that NHFP components should consist of stewardship (oversight, revenue collection, revenue pooling and risk management, resource allocation and purchasing of health services, health economics research, and development of

  17. [Decentralization and how to conduct it as a revolution or an evolution? County public health and management capacity building as a prerequisite for successful decentralization in the Republic of Croatia].

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    Sogorić, Selma; Dzakula, Aleksandar; Polasek, Ozren; Grozić-Zivolić, Sonja; Lang, Slobodan

    2010-12-01

    Based on the results of the first phase of the County Public Health Capacity Building Program named Health-Plan for It, implemented in the Republic of Croatia during the 2002-2008 period, this article analyzes the relationship between training of the county teams and their ability to develop health policy. Our hypothesis was that decentralized model of health planning and management would not occur just by changing legislation alone. Counties in Croatia needed educational support (learning-by-doing training) in order to improve public health practices at the county level. During the 2002-2005 period, the first 15 county teams (so-called first cycle counties) completed their training. The teams consisted of 12 to 15 members, representatives of political and executive component, technical component (public health professionals, representatives of health and social welfare institutions) and community members (non-government sector and media). Teams were trained in cohorts. Three counties passed together through the six-month process of modular training (four education modules, with four days of intensive training and "homework" between modules) at the time. The remaining 5 counties (second-cycle counties) completed the same kind of training in 2007-2008. The Public Health Performance Matrix (the Local Public Health Practice Performance Measures instrument developed by the US CDC Public Health Practice Program Office) was used as an evaluation instrument. Each county team had to fill it out at the beginning of education. Comparison of the Public Health Performance Matrices of first cycle counties (training in 2002-2005) with those of the second cycle counties (trained several years later) yielded no differences. Although training materials were publicly available (accessible through the Croatian Healthy Cities web pages) for years, the second cycle counties did not spontaneously (without training) increase their county-level capacities for participative health needs

  18. Community financed and operated health services: the case of the Ajo-Lukeville Health Service District.

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    Lopes, P M; Nichols, A W

    1990-07-01

    The concept of a health service district, as a variation of the special tax district, is described and discussed. Tax districts have traditionally been used to support both capital construction (revenue bonds) and operational expenses of single-purpose governmental entities. The health service district, where authorized by state laws, may be used by local areas to subsidize the delivery of ambulatory health care. A particular case, the Ajo-Lukeville Health Service District in Arizona, illustrates what can be accomplished by this mechanism with the cooperation of local residents and outside agencies. Both the process of establishing such a district and the outcome of the Ajo-Lukeville experience is described. Reasons why health service districts may prove potentially attractive at this time are reviewed. Impediments to the development of more health service districts are also explored, including the lack of technical assistance, an inadequate awareness of the potential of health service districts, and the absence of a widespread orientation toward community financed and controlled health care. Movement in this direction should facilitate the development of additional health service districts.

  19. Health financing lessons from Thailand for South Africa on the path towards universal health coverage.

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    Blecher, Mark; Pillay, Anban; Patcharanarumol, Walaiporn; Panichkriangkrai, Warisa; Tangcharoensathien, Viroj; Teerawattananon, Yot; Pannarunothai, Supasit; Davén, Jonatan

    2016-05-10

    Five years after the release of its Green Paper on National Health Insurance (NHI),years after the institution of NHI pilot sites and following the recent release of the White Pa 4 per on NHI, South Africa (SA) needs to move beyond the phase 1 plans of policy making and healthening activities to phase 2 - putting into place the legal and institutional frameth system strengworks and systems for implementation of its universal health coverage (UHC) system. In doing so, SA can draw on considerable practical lessons from other countries' reforms in managing UHC with favourable equity outcomes over the past decade. We outline some potentially significant lessons from the Thai health financing system for SA.

  20. The effects of Global Fund financing on health governance in Brazil

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    Gómez Eduardo J

    2012-07-01

    Full Text Available Abstract Objectives The impact of donors, such as national government (bi-lateral, private sector, and individual financial (philanthropic contributions, on domestic health policies of developing nations has been the subject of scholarly discourse. Little is known, however, about the impact of global financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on policies and health governance of countries receiving funding from such initiatives. Methods This study employs a qualitative methodological design based on a single case study: Brazil. Analysis at national, inter-governmental and community levels is based on in-depth interviews with the Global Fund and the Brazilian Ministry of Health and civil societal activists. Primary research is complemented with information from printed media, reports, journal articles, and books, which were used to deepen our analysis while providing supporting evidence. Results Our analysis suggests that in Brazil, Global Fund financing has helped to positively transform health governance at three tiers of analysis: the national-level, inter-governmental-level, and community-level. At the national-level, Global Fund financing has helped to increased political attention and commitment to relatively neglected diseases, such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-governmental-level, Global Fund financing has motivated the National Tuberculosis Programme to strengthen its ties with state and municipal health departments, and non-governmental organisations (NGOs; while at the community-level, the Global Fund’s financing of civil societal institutions has encouraged the emergence of new civic movements, participation, and the creation of new municipal participatory institutions designed to monitor the disbursement of funds for Global Fund grants. Conclusions Global Fund financing can help deepen health governance at multiple levels. Future work

  1. [The decentralization of the Secretaría de Salud de México. The case of local health systems 1989-1994].

    Science.gov (United States)

    González-Block, M A

    1997-01-01

    This article constitutes an analysis of the decentralization of the Ministry of Health of Mexico though the project to develop its jurisdictions to strengthen Local Health System (SILOS) implemented between 1989 and 1994. The relationship between decentralization and jurisdictional socioeconomic, demographic and resource availability differences was studied using qualitative and quantitative methods. The impact of jurisdictional strengthening on deconcentration and their combined effect on primary health care (PHC) and coverage were measured. The strengthening of technical capacity within the jurisdictions increased moderately but did not show a significant association with primary health care efficiency. However, when jurisdictions attain more autonomy, a significant association between strengthening and PHC efficiency appears. Deconcentration is a key factor to guarantee the strengthening of technical capacity and to assure that greater efficiency impacts on poverty reduction: however, deconcentration was limited due to the fact that the general strategies of the project were not differentiated according to the inequality across jurisdictions. To decentralize the Ministry of Health effectively, the federation must formulate objectives and strategies according to jurisdictional socioeconomic conditions and service need and capacity. Jurisdictions must be restructured and rescaled to improve their interaction with municipal governments, the health sector and the community.

  2. The 'diagonal' approach to Global Fund financing: a cure for the broader malaise of health systems?

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    Baker Brook K

    2008-03-01

    Full Text Available Abstract Background The potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results and 'horizontal' financing (aiming for improved health systems of health services in developing countries has found its way to the pages of Foreign Affairs and the Financial Times. The opportunity offered by 'diagonal' financing (aiming for disease-specific results through improved health systems seems to be obscured in this polarisation. In April 2007, the board of the Global Fund to fight AIDS, Tuberculosis and Malaria agreed to consider comprehensive country health programmes for financing. The new International Health Partnership Plus, launched in September 2007, will help low-income countries to develop such programmes. The combination could lead the Global Fund to fight AIDS, Tuberculosis and Malaria to a much broader financing scope. Discussion This evolution might be critical for the future of AIDS treatment in low-income countries, yet it is proposed at a time when the Global Fund to fight AIDS, Tuberculosis and Malaria is starved for resources. It might be unable to meet the needs of much broader and more expensive proposals. Furthermore, it might lose some of its exceptional features in the process: its aim for international sustainability, rather than in-country sustainability, and its capacity to circumvent spending restrictions imposed by the International Monetary Fund. Summary The authors believe that a transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund is feasible, but only if accompanied by a substantial increase of donor commitments to the Global Fund. The transformation of the Global Fund into a 'diagonal' and ultimately perhaps 'horizontal' financing approach should happen gradually and carefully, and be accompanied by measures to safeguard its exceptional features.

  3. Towards Establishing Fiscal Legitimacy Through Settled Fiscal Principles in Global Health Financing.

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    Waris, Attiya; Latif, Laila Abdul

    2015-12-01

    Scholarship on international health law is currently pushing the boundaries while taking stock of achievements made over the past few decades. However despite the forward thinking approach of scholars working in the field of global health one area remains a stumbling block in the path to achieving the right to health universally: the financing of heath. This paper uses the book Global Health Law by Larry Gostin to reflect and take stock of the fiscal support provided to the right to health from both a global and an African perspective. It then sets out the key fiscal challenges facing global and African health and proposes an innovative solution for consideration: use of the domestic principles of tax to design the global health financing system.

  4. Time-trends in the utilization of decentralized mental health services in Norway - A natural experiment: The VELO-project

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    Bjorbekkmo Svein

    2010-03-01

    Full Text Available Abstract Background There are few reports on the effects of extensive decentralization of mental health services. We investigated the total patterns of utilization in a local-bed model and a central-bed model. Methods In a time-trend case-registry design, 7635 single treatment episodes, from the specialist and municipality services in 2003-2006, were linked to 2975 individual patients over all administrative levels. Patterns of utilization were analyzed by univariate comparisons and multivariate regressions. Results Total treated prevalence was consistently higher for the central-bed system. Outpatient utilization increased markedly, in the central-bed system. Utilization of psychiatric beds decreased, only in the central-bed system. Utilization of highly supported municipality units increased in both systems. Total utilization of all types of services, showed an additive pattern in the local-bed system and a substitutional pattern in the central-bed system. Only severe diagnoses predicted inpatient admission in the central-bed system, whereas also anxiety-disorders and outpatient consultations predicted inpatient admission in the local-bed system. Characteristics of the inpatient populations changed markedly over time, in the local-bed system. Conclusions Geographical availability is not important as a filter in patients' pathway to inpatient care, and the association between distance to hospital and utilization of psychiatric beds may be an historical artefact. Under a public health-insurance system, local psychiatric personnel as gatekeepers for inpatient care may be of greater importance than the availability of local psychiatric beds. Specialist psychiatric beds and highly supported municipality units for people with mental health problems do not work together in terms of utilization. Outpatient and day-hospital services may be filters in the pathway to inpatient care, however this depends on the structure of the whole service-system. Local

  5. Effectiveness of community health financing in meeting the cost of illness.

    Science.gov (United States)

    Preker, Alexander S; Carrin, Guy; Dror, David; Jakab, Melitta; Hsiao, William; Arhin-Tenkorang, Dyna

    2002-01-01

    How to finance and provide health care for the more than 1.3 billion rural poor and informal sector workers in low- and middle-income countries is one of the greatest challenges facing the international development community. This article presents the main findings from an extensive survey of the literature of community financing arrangements, and selected experiences from the Asia and Africa regions. Most community financing schemes have evolved in the context of severe economic constraints, political instability, and lack of good governance. Micro-level household data analysis indicates that community financing improves access by rural and informal sector workers to needed heath care and provides them with some financial protection against the cost of illness. Macro-level cross-country analysis gives empirical support to the hypothesis that risk-sharing in health financing matters in terms of its impact on both the level and distribution of health, financial fairness and responsiveness indicators. The background research done for this article points to five key policies available to governments to improve the effectiveness and sustainability of existing community financing schemes. This includes: (a) increased and well-targeted subsidies to pay for the premiums of low-income populations; (b) insurance to protect against expenditure fluctuations and re-insurance to enlarge the effective size of small risk pools; (c) effective prevention and case management techniques to limit expenditure fluctuations; (d) technical support to strengthen the management capacity of local schemes; and (e) establishment and strengthening of links with the formal financing and provider networks.

  6. Equity and financing for sexual and reproductive health service delivery: current innovations.

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    Montagu, Dominic; Graff, Maura

    2009-07-01

    National and international decisions on financing for sexual and reproductive health (SRH) services have profound effects on the type, unit costs and distribution of SRH commodities and services produced, and on their availability and consumption. Much international and national funding is politically driven and is doing little for equity and quality improvement. Financing remains a significant challenge in most developing countries and demands creative responses. While no "one-size-fits-all" solution exists, there are numerous ongoing examples of successful innovations, many of which are focusing on resource pooling and on purchasing or subsidising SRH services. In this article we have used interviews, grey literature and presentations made at a range of recent public fora to identify new and innovative ways of financing SRH services so as to increase equity in developing countries. Because SRH services are often of low value as a personal good but high value as a public good, we summarise the issues from a societal perspective, highlighting the importance of financing and policy decisions for SRH services. We provide a structured overview of what novel approaches to financing appear to have positive effects in a range of developing countries. Targeting, government payment mechanisms, subsidy delivery and co-financing for sustainability are highlighted as showing particular promise. Examples are used throughout the article to illustrate innovative strategies.

  7. The future of the health care financing in the aspect of projected demographic changes – selected problems

    OpenAIRE

    Mitek, Anna

    2014-01-01

    This article presents the health care system in Poland, in particular the organisation, principles of functioning and financing. The financial results of the Polish system have been compared against European countries, in order to analyze the effectiveness of the system. The analysis assumes that the Polish system is not enough financed and poorly adapted to the changing socio-economic trends. Results of the analysis confirm no sufficient health care financing in Poland. Some of changes are o...

  8. Progressivity of health care financing and incidence of service benefits in Ghana.

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    Akazili, James; Garshong, Bertha; Aikins, Moses; Gyapong, John; McIntyre, Di

    2012-03-01

    The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.

  9. Moving from ideas to action - developing health financing systems towards universal coverage in Africa.

    Science.gov (United States)

    Musango, Laurent; Orem, Juliet Nabyonga; Elovainio, Riku; Kirigia, Joses

    2012-11-08

    Accelerating progress towards universal coverage in African countries calls for concrete actions that reinforce social health protection through establishment of sustainable health financing mechanisms. In order to explore possible pathways for moving past the existing obstacles, panel discussions were organized on health financing bringing together Ministers of health and Ministers of finance with the objective of creating a discussion space where the different perspectives on key issues and needed actions could meet. This article presents a synthesis of panel discussions focusing on the identified challenges and the possible solutions. The overview of this paper is based on the objectives and proceedings of the panel discussions and relies on the observation and study of the interaction between the panelists and on the discourse used. The discussion highlighted that a large proportion of the African population has no access to needed health services with significant reliance on direct out of pocket payments. There are multiple obstacles in making prepayment and pooling mechanisms operational. The relatively strong political commitment to health has not always translated into more public spending for health. Donor investment in health in low income countries still falls below commitments. There is need to explore innovative domestic revenue collection mechanisms. Although inadequate funding for health is a fundamental problem, inefficient use of resources is of great concern. There is need to generate robust evidence focusing on issues of importance to ministry of finance. The current unsatisfactory state of health financing was mainly attributed to lack of clear vision; evidence based plans and costed strategies. Based on the analysis of discussion made, there are points of convergence and divergence in the discourse and positions of the two ministries. The current blockage points holding back budget allocations for health can be solved with a more evidence based

  10. Moving from ideas to action - developing health financing systems towards universal coverage in Africa

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    Musango Laurent

    2012-11-01

    Full Text Available Abstract Background Accelerating progress towards universal coverage in African countries calls for concrete actions that reinforce social health protection through establishment of sustainable health financing mechanisms. In order to explore possible pathways for moving past the existing obstacles, panel discussions were organized on health financing bringing together Ministers of health and Ministers of finance with the objective of creating a discussion space where the different perspectives on key issues and needed actions could meet. This article presents a synthesis of panel discussions focusing on the identified challenges and the possible solutions. The overview of this paper is based on the objectives and proceedings of the panel discussions and relies on the observation and study of the interaction between the panelists and on the discourse used. Summary The discussion highlighted that a large proportion of the African population has no access to needed health services with significant reliance on direct out of pocket payments. There are multiple obstacles in making prepayment and pooling mechanisms operational. The relatively strong political commitment to health has not always translated into more public spending for health. Donor investment in health in low income countries still falls below commitments. There is need to explore innovative domestic revenue collection mechanisms. Although inadequate funding for health is a fundamental problem, inefficient use of resources is of great concern. There is need to generate robust evidence focusing on issues of importance to ministry of finance. The current unsatisfactory state of health financing was mainly attributed to lack of clear vision; evidence based plans and costed strategies. Discussion Based on the analysis of discussion made, there are points of convergence and divergence in the discourse and positions of the two ministries. The current blockage points holding back budget

  11. [Sources of finance for provincial occupational health services. Theory and practice].

    Science.gov (United States)

    Rydlewska-Liszkowska, I; Jugo, B

    1999-01-01

    The financing of occupational health services (OHS) at the provincial level is an important issue in view of the transformation process going on not only in OHS but also in the overall health care system in Poland. New principles of financing must be now based on the cost and effects analyses. Thus, the question arises on how to provide financial means adequate to needs of health care institutions resulting from their tasks and responsibilities. The gaps existing in the information system have encouraged us to examine the situation in regard to the structure of financing and internal allocation of financial means. The objectives were formulated as follows: to characterise the sources of financial means received by provincial OHS centres; to analyse the structure of financial means derived from various sources, taking into account forms of financial administration, using the data provided by selected centres; to define the relation between the financial means being at the disposal of OHS centres and the scope of their activities; The information on the financing system was collected using a questionnaire mailed to directors of selected OHS centres. The information collected proved to be a valuable source of knowledge on the above mentioned issues as well as on how far the new system of financing associated with a new form of financial administration--an independent public health institution--has already been implemented. The studies indicated that at the present stage of the OHS system transformation it is very difficult to formulate conclusions on the financing administration in provincial OHS centres.

  12. Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil.

    Science.gov (United States)

    Barbieri, Raquel Rodrigues; Sales, Anna Maria; Hacker, Mariana Andrea; Nery, José Augusto da Costa; Duppre, Nádia Cristina; Machado, Alice de Miranda; Moraes, Milton Ozório; Sarno, Euzenir Nunes

    2016-10-01

    We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals. This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy. Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis. The results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.

  13. Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil.

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    Raquel Rodrigues Barbieri

    2016-10-01

    Full Text Available We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals.This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy.Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis.The results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.

  14. Responsibility-sensitive fairness in health financing: judgments in four European countries.

    Science.gov (United States)

    Le Clainche, Christine; Wittwer, Jerome

    2015-04-01

    Risky health behaviours substantially increase medical and social costs. We document the extent to which a sample of European students (from Denmark, France, Italy and Sweden) consider that individuals should assume the financial burden of paying the costs of risky behaviour. We test the acceptability of different ways of financing costs because of ill health that is more or less associated with risky behaviour in accordance with a normative framework relating to responsibility-sensitive fairness. We find that the majority of students agree with assuming financial responsibility for risky behaviours and that there should be compensation for unfavourable circumstances. Students agree that two individuals with the same responsibility variables should make an equal financial contribution and that more effort in maintaining health for given circumstances should be rewarded with a lower financial contribution. The specific health context and the type of risky behaviours involved matter in determining perceptions of justice in health financing. Copyright © 2014 John Wiley & Sons, Ltd.

  15. The inequity of the Swiss health care system financing from a federal state perspective

    Science.gov (United States)

    2014-01-01

    Introduction Previous studies have shown that Swiss health-care financing is particularly regressive. However, as it has been emphasized in the 2011 OECD Review of the Swiss Health System, the inter cantonal variations of income-related inequities are still broadly unexplored. The present paper aims to fill this gap by analyzing the differences in the level of equity of health-care system financing across cantons and its evolution over time using household data. Methods Following the methodology proposed by Wagstaff et al. (JHE 11:361–387, 1992) we use the Kakwani index as a summary measure of regressivity and we compute it for each canton and for each of the sources that have a role in financing the health care system. We graphed concentration curves and performed relative dominance tests, which utilize the full distribution of expenditures. The microdata come from the Swiss Household Income and Expenditure Survey (SHIES) based on a sample of the Swiss population (about 3500 households per year), for the years 1998 - 2005. Results The empirical evidence confirms that the health-care financing in Switzerland has remained regressive since the major reform of 1996 and shows that the variations in equity across cantons are quite significant: the difference between the most and the least regressive canton is about the same as between two extremely different financing systems like the US and Sweden. There is no evidence, instead, of a clear evolution over time of regressivity. Conclusions The significant variation in equity across cantons can be explained by fiscal federalism and the related autonomy in the design of tax and social policies. In particular, the results highlight that earmarked subsidies, the policy adopted to smooth the regressivity of the premiums, appear to be not enough; in the practice of federal states the combination of allowances with mandatory community-rated health insurance premiums might lead to a modest outcome in terms of equity. PMID

  16. Progressivity, horizontal equity and reranking in health care finance: a decomposition analysis for the Netherlands

    NARCIS (Netherlands)

    A. Wagstaff (Adam); E.K.A. van Doorslaer (Eddy)

    1997-01-01

    textabstractThis paper employs the method of Aronson et al. (1994) to decompose the redistributive effect of the Dutch health care financing system into three components: a progressivity component, a classical horizontal equity component and a reranking component. Results are presented for the

  17. Modeling health and mortality dynamics, and their effects on public finance

    NARCIS (Netherlands)

    Yang, Y.

    2014-01-01

    The primary motivation of this dissertation is to provide insights into the future developments of mortality and population health, and the associated effects on public finance in the United States. The U.S. has experienced increases in life expectancy and the accompanying population ageing over the

  18. [Decentralization and equity: public health expenditure in the municipalities of the Province of Buenos Aires].

    Science.gov (United States)

    Lago, Fernando Pablo; Moscoso, Nebel Silvana; Elorza, María Eugenia; Ripari, Nadia Vanina

    2012-12-01

    In this paper we analyze the degree of equity in access to the public health care system in the Province of Buenos Aires (Argentina). Through a quantitative retrospective study, we analyze the inequalities in the distribution of the total public health expenditure per capita. This variable is used as a proxy for the ability of the inhabitants of each jurisdiction to access health care services. The results indicate the existence of large disparities in the levels of expenditure devoted to the population without health coverage. Moreover, the existence of greater health care needs (estimated using infant mortality rates and percentage of homes with basic needs unmet) does not translate into higher levels of public expenditure. Finally, we detect a positive association between the relative wealth of municipalities (measured by the gross geographic product per capita) and the public health expenditure per capita.

  19. Health financing in the African Region: 2000–2009 data analysis

    Science.gov (United States)

    2013-01-01

    Background In order to raise African countries probability of achieving the United Nations Millennium Development Goals by 2015, there is need to increase and more efficiently use domestic and external funding to strengthen health systems infrastructure in order to ensure universal access to quality health care. The objective of this paper is to examine the changes that have occurred in African countries on health financing, taking into account the main sources of funding over the period 2000 to 2009. Methods Our analysis is based on the National Health Accounts (NHA) data for the 46 countries of the WHO African Region. The data were obtained from the WHO World Health Statistics Report 2012. Data for Zimbabwe was not available. The analysis was done using Excel software. Results Between 2000 and 2009, number of countries spending less than 5% of their GDP on health decreased from 24 to 17; government spending on health as a percentage of total health expenditure increased in 31 countries and decreased in 13 countries; number of countries allocating at least 15% of national budgets on health increased from 2 to 4; number of countries partially financing health through social security increased from 19 to 21; number of countries where private spending was 50% and above of total health expenditure decreased from 29 (64%) to 23 (51%); over 70% of private expenditure on health came from household out-of-pocket payments (OOPS) in 32 (71%) countries and in 27 (60%) countries; number of countries with private prepaid plans increased from 29 to 31; number of countries financing more than 20% of their total health expenditure from external sources increased from 14 to 19; number of countries achieving the Commission for Macroeconomics and Health recommendation of spending at least US$34 per person per year increased from 11 to 29; number of countries achieving the International Taskforce on Innovative Financing recommendation of spending at least US$44 per person per year

  20. Health financing in the African Region: 2000-2009 data analysis.

    Science.gov (United States)

    Sambo, Luis Gomes; Kirigia, Joses Muthuri; Orem, Juliet Nabyonga

    2013-03-06

    In order to raise African countries probability of achieving the United Nations Millennium Development Goals by 2015, there is need to increase and more efficiently use domestic and external funding to strengthen health systems infrastructure in order to ensure universal access to quality health care. The objective of this paper is to examine the changes that have occurred in African countries on health financing, taking into account the main sources of funding over the period 2000 to 2009. Our analysis is based on the National Health Accounts (NHA) data for the 46 countries of the WHO African Region. The data were obtained from the WHO World Health Statistics Report 2012. Data for Zimbabwe was not available. The analysis was done using Excel software. Between 2000 and 2009, number of countries spending less than 5% of their GDP on health decreased from 24 to 17; government spending on health as a percentage of total health expenditure increased in 31 countries and decreased in 13 countries; number of countries allocating at least 15% of national budgets on health increased from 2 to 4; number of countries partially financing health through social security increased from 19 to 21; number of countries where private spending was 50% and above of total health expenditure decreased from 29 (64%) to 23 (51%); over 70% of private expenditure on health came from household out-of-pocket payments (OOPS) in 32 (71%) countries and in 27 (60%) countries; number of countries with private prepaid plans increased from 29 to 31; number of countries financing more than 20% of their total health expenditure from external sources increased from 14 to 19; number of countries achieving the Commission for Macroeconomics and Health recommendation of spending at least US$34 per person per year increased from 11 to 29; number of countries achieving the International Taskforce on Innovative Financing recommendation of spending at least US$44 per person per year increased from 11 to 24

  1. Equity in health care finance in Palestine: the triple effects revealed.

    Science.gov (United States)

    Abu-Zaineh, Mohammad; Mataria, Awad; Luchini, Stéphane; Moatti, Jean-Paul

    2009-12-01

    This paper presents an application of the Urban and Lambert "upgraded-AJL Decomposition" approach that was designed to deal with the problem of close-income equals in equity analysis, and as applied to the area of health care finance. Contrary to most previous studies, vertical and horizontal inequities and the triple effects of inter-groups, intra-group and entire-group reranking of various financing schemes are estimated, with statistical significance calculated using the bootstrap method. Application is made on the three financing schemes present in the case of the Occupied Palestinian Territory. Results demonstrate the relative importance of the three forms of reranking in determining overall inequality. The paper offers policy recommendations to limit the existing inequalities in the system and to enhance the capacity of the governmental insurance scheme.

  2. Challenges facing the finance reform of the health system in Chile.

    Science.gov (United States)

    Herrera, Tania

    2014-05-28

    Financing is one of the key functions of health systems, which includes the processes of revenue collection, fund pooling and acquisitions in order to ensure access to healthcare for the entire population. The article analyzes the financing model of the Chilean health system in terms of the first two processes, confirming low public spending on healthcare and high out-of-pocket expenditure, in addition to an appropriation of public resources by private insurers and providers. Insofar as pooling, there is lack of solidarity and risk sharing leading to segmentation of the population that is not consistent with the concept of social security, undermines equity and reduces system-wide efficiency. There is a pressing need to jumpstart reforms that address these issues. Treatments must be considered together with public health concerns and primary care in order to ensure the right to health of the entire population.

  3. Survey Based Needs Assessment; A Paradigm for Planning the Decentralization of Continuing Health Professional Education.

    Science.gov (United States)

    Fryer, George E., Jr.; Krugman, Richard D.

    1981-01-01

    Efforts of the SEARCH/AHEC (Statewide Education Activities for Rural Colorado's Health/Area Health Education Center) Program to base the conduct of administration of its most important program component on results of a survey of potential recipients of its services are described. (Author/GK)

  4. Analysis of Developing Public Health Service Sector with Private Finance Initiative in Guangxi

    Institute of Scientific and Technical Information of China (English)

    王宇

    2006-01-01

    In Guangxi Public Health Service Sector (GPHSS), because lack of budget, it has caused a number of problems, such as weakened public health service in rural areas, poor professional quality of medical personnel in public health units at village and township levels, current urban public health service could not meet the health demand for urban residents. This paper is a secondary research. Through analysis of the financial problem and both of the advantages and disadvantages of using the Private Finance Initiative (PFI), it intend to demonstrate that using the PFI could be considered as a good way for the Guangxi government.

  5. A roadmap to parity in mental health financing: the case of Lebanon.

    Science.gov (United States)

    Yehia, Farah; Nahas, Ziad; Saleh, Shadi

    2014-09-01

    Inadequate access to mental health (MH) services in Lebanon, where prevalence is noteworthy, is a concern. Although a multitude of factors affects access to services, lack of financial coverage of MH services is one that merits further investigation. This study aims at providing a systematic description of MH financing systems with a special focus on Lebanon, presenting stakeholder viewpoints on best MH financing alternatives/strategies and recommending options for enhancing financial coverage. A comprehensive review of existing literature on MH financing systems was conducted, with a focus on the system in Lebanon. In addition, key stakeholders were interviewed to assess MH organizational and financing arrangements. Finally, a national round table was organized with the aim of discussing findings (from the review and interviews) and developing an action roadmap. Taxation and out-of-pocket payments are the most common MH financing sources worldwide and in the Eastern Mediterranean Region. In Lebanon, all funding entities, except private insurance and mutual funds, cover inpatient and outpatient MH services, albeit with inconsistencies in levels of coverage. The national roundtable recommended two main MH financing enhancements: (i) creating a knowledge-sharing committee between insurers and MH specialists, and (ii) convincing labor unions/representatives to lobby for MH coverage as part of the negotiated benefit package. There are concerns regarding the equity, effectiveness and efficiency of the MH financing system in Lebanon. The fragmented system in Lebanon leads to differences in MH coverage across different financing intermediaries, which is inequitable. The fact that one out of four Lebanese suffer a mental disorder throughout their lives and very low percentages of those obtain treatment signals a problem in effectiveness. As for efficiency, the inefficient fragmentation of MH financing among seven intermediaries is a problematic characteristic of the

  6. Financing Reproductive and Child Health Services at the Local ...

    African Journals Online (AJOL)

    The paper analyzes the financial resources for reproductive and child health related ..... roof at Prime Minister's Office, Regional Administration and Local ..... Provision Assessment Survey 2006," NBS & Macro International Inc.: Dar es Salaam.

  7. Financing the Canterbury Health System post-disaster.

    Science.gov (United States)

    Reid, Matthew; Pink, Ramon

    2016-12-16

    The Canterbury Health System has invested substantially in its transformation to a patient-centred, integrated system, enabling improved performance despite the significant and long-term impacts of the Christchurch earthquakes in 2010 and 2011. Questions have been raised about whether this transformation is sustainable and affordable. We argue that there is a need for a post-disaster health funding strategy that takes into account the challenge of following population movements after a large natural disaster, and higher costs resulting from the disruption and the effect on the population. Such a strategy should also provide stability in an unstable environment. However, funding for health in Canterbury has followed a 'business as usual' model using the population-based funding formula, which we view as problematic. Additionally, increases in funding using that formula have been below the national average, which we believe is perverse. Canterbury has received an additional $84 million government in deficit funding since 2010/11, and this has covered part of the extra cost attributable to the earthquake. However, without system-wide integration and innovation that was underway before, and that has continued since the earthquakes, it is likely the Canterbury Health System would not have been able to meet the health needs of its population. If health funding for Canterbury had continued to increase at the average rate applied across New Zealand over the past five years, deficit funding would not have been required.

  8. Capital finance and ownership conversions in health care.

    Science.gov (United States)

    Robinson, J C

    2000-01-01

    This paper analyzes the for-profit transformation of health care, with emphasis on Internet start-ups, physician practice management firms, insurance plans, and hospitals at various stages in the industry life cycle. Venture capital, conglomerate diversification, publicly traded equity, convertible bonds, retained earnings, and taxable corporate debt come with forms of financial accountability that are distinct from those inherent in the capital sources available to nonprofit organizations. The pattern of for-profit conversions varies across health sectors, parallel with the relative advantages and disadvantages of for-profit and nonprofit capital sources in those sectors.

  9. The Economics of New Health Technologies Incentives, Organization, and Financing

    CERN Document Server

    Costa-Font, Joan; McGuire, Alistair

    2009-01-01

    Technological change in healthcare has led to huge improvements in health services and the health status of populations. It is also pinpointed as the main driver of healthcare expenditure. Although offering remarkable benefits, changes in technology are not free and often entail significant financial, as well as physical or social risks. These need to be balanced out in the setting of government regulations, insurance contracts, and individuals' decisions to use and consume certaintechnologies. With this in mind, this book addresses the following important objectives: to provide a detailed ana

  10. impact of health care financing reforms on the management of ...

    African Journals Online (AJOL)

    2001-12-12

    Dec 12, 2001 ... a 'cash and carry' system in which all patients attending government health services had to pay in full for drugs ... that only token fees should be charged for registration and other services. ... malaria are diagnosed on clinical grounds without laboratory confirmation of parasitaemia(7,8,10,ll). Although this ...

  11. The changing landscape of health care financing and delivery: how are rural communities and providers responding?

    Science.gov (United States)

    Mueller, K J; Coburn, A; Cordes, S; Crittenden, R; Hart, J P; McBride, T; Myers, W

    1999-01-01

    Rural communities have not kept pace with the recent dramatic changes in health care financing and organization. However, the Medicare provisions in the Balanced Budget Act of 1997 will require rural providers to participate in the new systems. Case studies revealed the degree of readiness for change in six rural communities and charted their progress along a continuum, as reflected in three sets of activities: the development of networking; the creation of new strategies for managing patient care; and the adoption of new methods for contracting with health insurers. Some communities had constructed highly integrated systems, whereas others were just beginning to change their billing practices; a few were signing contracts for capitated care, in contrast to those that were resisting discounts in current fee structures. These six rural areas still have considerable ground to cover before their health care organization and financing reach the levels achieved by urban communities.

  12. Health financing to promote access in low income settings-how much do we know?

    Science.gov (United States)

    Palmer, Natasha; Mueller, Dirk H; Gilson, Lucy; Mills, Anne; Haines, Andy

    In this article we outline research since 1995 on the impact of various financing strategies on access to health services or health outcomes in low income countries. The limited evidence available suggests, in general, that user fees deterred utilisation. Prepayment or insurance schemes offered potential for improving access, but are very limited in scope. Conditional cash payments showed promise for improving uptake of interventions, but could also create a perverse incentive. The largely African origin of the reports of user fees, and the evidence from Latin America on conditional cash transfers, demonstrate the importance of the context in which studies are done. There is a need for improved quality of research in this area. Larger scale, upfront funding for evaluation of health financing initiatives is necessary to ensure an evidence base that corresponds to the importance of this issue for achieving development goals.

  13. Financing the Millennium Development Goals for health and beyond: sustaining the 'Big Push'

    Directory of Open Access Journals (Sweden)

    Basu Sanjay

    2010-10-01

    Full Text Available Abstract Many of the Millennium Development Goals are not being achieved in the world's poorest countries, yet only five years remain until the target date. The financing of these Goals is not merely insufficient; current evidence indicates that the temporary nature of the financing, as well as challenges to coordinating its delivery and directing it to the most needy recipients, hinder achievement of the Goals in countries that may benefit most. Traditional approaches to providing development assistance for health have not been able to address both prevalent and emergent public health challenges captured in the Goals; these challenges demand sustained forms of financial redistribution through a coordinated mechanism. A global social health protection fund is proposed to address recurring failures in the modern aid distribution mechanism. Such a Fund could use established and effective strategies for aid delivery to mitigate many financial problems currently undermining the Millennium Development Goals initiative.

  14. Financing the Millennium Development Goals for health and beyond: sustaining the 'Big Push'.

    Science.gov (United States)

    Ooms, Gorik; Stuckler, David; Basu, Sanjay; McKee, Martin

    2010-10-08

    Many of the Millennium Development Goals are not being achieved in the world's poorest countries, yet only five years remain until the target date. The financing of these Goals is not merely insufficient; current evidence indicates that the temporary nature of the financing, as well as challenges to coordinating its delivery and directing it to the most needy recipients, hinder achievement of the Goals in countries that may benefit most. Traditional approaches to providing development assistance for health have not been able to address both prevalent and emergent public health challenges captured in the Goals; these challenges demand sustained forms of financial redistribution through a coordinated mechanism. A global social health protection fund is proposed to address recurring failures in the modern aid distribution mechanism. Such a Fund could use established and effective strategies for aid delivery to mitigate many financial problems currently undermining the Millennium Development Goals initiative.

  15. New Zealand's health system: national policy goals and decentralized service planning and delivery.

    Science.gov (United States)

    Gauld, Robin

    2007-01-01

    To inaugurate the fifth year of its publication, The American Heart Hospital Journal (AHHJ) focused its Winter 2007 issue on health care systems from around the world, with 8 articles contributed by national leaders in their respective countries. Due to the interest and wide range of expertise in the international cardiac community, we will continue to publish Special Reports throughout 2007 on this topic. We invite members of the international community to share with readers of the AHHJ, their insights on the strengths and weaknesses of their respective health care and cardiac care systems, as well as their ideas and aspirations for future change.

  16. A SWOT analysis of the organization and financing of the Danish health care system.

    Science.gov (United States)

    Christiansen, Terkel

    2002-02-01

    The organization and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of Strengths, Weaknesses, Opportunities and Threats) by a panel of five members with a background in health economics. The present paper describes the methods and materials used for the evaluation: selection of panel members, structure of the evaluation task according to the health care triangle model, selection of background material consisting of documents and literature on the Danish health care system, and a 1-week study visit.

  17. Financing the World Health Organisation: global importance of extrabudgetary funds.

    Science.gov (United States)

    Vaughan, J P; Mogedal, S; Kruse, S; Lee, K; Walt, G; de Wilde, K

    1996-03-01

    From 1948, when WHO was established, the Organisation has relied on the assessed contributions of its member states for its regular budget. However, since the early 1980s the WHO World Health Assembly has had a policy of zero real growth for the regular budget and has had to rely increasingly, therefore, on attracting additional voluntary contributions, called extrabudgetary funds (EBFs). Between 1984-85 and 1992-93 the real value of the EBFs apparently increased by more than 60% and in the 1990-91 biennium expenditure of extrabudgetary funds exceeded the regular budget for the first time. All WHO programmes, except the Assembly and the Executive Board, receive some EBFs. However, three cosponsored and six large regular programmes account for about 70% of these EBFs, mainly for vertically managed programmes in the areas of disease control, health promotion and human reproduction. Eighty percent of all EBFs received by WHO for assisted activities have been contributed by donor governments, with the top 10 countries (in Europe, North America and Japan) contributing about 90% of this total, whereas the UN funds and the World Bank have donated only about 6% of the total to date. By contrast, about 70% of the regular budget expenditure has been for organisational expenses and for the support of programmes in the area of health systems. Despite the fact that the more successful programmes are heavily reliant on EBFs, there are strong indications that donors, particularly donor governments, are reluctant to maintain the current level of funding without major reforms in the leadership and management of the Organisation. This has major implications for WHO's international role as the leading UN specialised agency for health.

  18. Healthcare financing reform in Latvia: switching from social health insurance to NHS and back?

    Science.gov (United States)

    Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm

    2014-11-01

    In the 1990s, Latvia aimed at introducing Social Health Insurance (SHI) but later changed to a National Health Service (NHS) type system. The NHS is financed from general taxation, provides coverage to the entire population, and pays for a basic service package purchased from independent public and private providers. In November 2013, the Cabinet of Ministers passed a draft Healthcare Financing Law, aiming at increasing public expenditures on health by introducing Compulsory Health Insurance (CHI) and linking entitlement to health services to the payment of income tax. Opponents of the reform argue that linking entitlement to health services to the payment of income tax does not have the potential to increase public expenditures on health but that it can contribute to compromising universal coverage and access to health services of certain population groups. In view of strong opposition, it is unlikely that the law will be adopted before parliamentary elections in October 2014. Nevertheless, the discussion around the law is interesting because of three main reasons: (1) it can illustrate why the concept of SHI remains attractive - not only for Latvia but also for other countries, (2) it shows that a change from NHS to SHI does not imply major institutional reforms, and (3) it demonstrates the potential problems of introducing SHI, i.e. of linking entitlement to health services to the payment of contributions.

  19. Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Hamidi S

    2015-02-01

    Full Text Available Samer Hamidi School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates Introduction: A national health account (NHA provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Dubai with schemes in Qatar and selected member countries of the Organization for Economic Cooperation and Development (OECD. Methods: The author analyzed secondary data published in NHAs of Dubai and Qatar and data collected by the OECD countries and publicly available from Eurostat (Statistical Office of the European Union of 25 OECD countries for comparative analysis. All health financing indicators used were as defined in the international System of Health Accounts (SHA. Results: In Dubai, spending on inpatient care was the highest-costing component, with 30% of current health expenditures (CHE. Spending on outpatient care was the second highest-costing component and accounted for about 23% of the CHE. Household spending accounted for about 22% of CHE (equivalent to US$187 per capita, compared to an average of 20% of CHE of OECD countries. Dubai spent 0.02% of CHE on long-term care, compared to an average of 11% of CHE of OECD countries. Dubai spent about 6% of CHE on prevention and public health services, compared to an average of 3.2% of CHE of OECD countries. Conclusion: The findings point to potential opportunities for growth and improvement in several health policy issues in Dubai, including increasing focus and funding of preventive services; shifting from inpatient care to day surgery, outpatient, and home-based services and strengthening long-term care; and introducing cost-containment measures for pharmaceuticals. More investment in the translation of

  20. A consistent decomposition of the redistributive, vertical, and horizontal effects of health care finance by factor components.

    Science.gov (United States)

    Hierro, Luis A; Gómez-Álvarez, Rosario; Atienza, Pedro

    2014-01-01

    In studies on the redistributive, vertical, and horizontal effects of health care financing, the sum of the contributions calculated for each financial instrument does not equal the total effects. As a consequence, the final calculations tend to be overestimated or underestimated. The solution proposed here involves the adaptation of the Shapley value to achieve additive results for all the effects and reveals the relative contributions of different instruments to the change of whole-system equity. An understanding of this change would help policy makers attain equitable health care financing. We test the method with the public finance and private payments of health care systems in Denmark and the Netherlands.

  1. Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates.

    Science.gov (United States)

    Hamidi, Samer

    2015-01-01

    A national health account (NHA) provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Dubai with schemes in Qatar and selected member countries of the Organization for Economic Cooperation and Development (OECD). The author analyzed secondary data published in NHAs of Dubai and Qatar and data collected by the OECD countries and publicly available from Eurostat (Statistical Office of the European Union) of 25 OECD countries for comparative analysis. All health financing indicators used were as defined in the international System of Health Accounts (SHA). In Dubai, spending on inpatient care was the highest-costing component, with 30% of current health expenditures (CHE). Spending on outpatient care was the second highest-costing component and accounted for about 23% of the CHE. Household spending accounted for about 22% of CHE (equivalent to US$187 per capita), compared to an average of 20% of CHE of OECD countries. Dubai spent 0.02% of CHE on long-term care, compared to an average of 11% of CHE of OECD countries. Dubai spent about 6% of CHE on prevention and public health services, compared to an average of 3.2% of CHE of OECD countries. The findings point to potential opportunities for growth and improvement in several health policy issues in Dubai, including increasing focus and funding of preventive services; shifting from inpatient care to day surgery, outpatient, and home-based services and strengthening long-term care; and introducing cost-containment measures for pharmaceuticals. More investment in the translation of NHA data into policy is suggested for future researchers.

  2. Defining care products to finance health care in the Netherlands.

    Science.gov (United States)

    Westerdijk, Machiel; Zuurbier, Joost; Ludwig, Martijn; Prins, Sarah

    2012-04-01

    A case-mix project started in the Netherlands with the primary goal to define a complete set of health care products for hospitals. The definition of the product structure was completed 4 years later. The results are currently being used for billing purposes. This paper focuses on the methodology and techniques that were developed and applied in order to define the casemix product structure. The central research question was how to develop a manageable product structure, i.e., a limited set of hospital products, with acceptable cost homogeneity. For this purpose, a data warehouse with approximately 1.5 million patient records from 27 hospitals was build up over a period of 3 years. The data associated with each patient consist of a large number of a priori independent parameters describing the resource utilization in different stages of the treatment process, e.g., activities in the operating theatre, the lab and the radiology department. Because of the complexity of the database, it was necessary to apply advanced data analysis techniques. The full analyses process that starts from the database and ends up with a product definition consists of four basic analyses steps. Each of these steps has revealed interesting insights. This paper describes each step in some detail and presents the major results of each step. The result consists of 687 product groups for 24 medical specialties used for billing purposes.

  3. The Changing Landscape of Health Care Financing and Delivery: How Are Rural Communities and Providers Responding?

    OpenAIRE

    Mueller, Keith J.; Coburn, Andy; Cordes, Sam; Crittenden, Robert; Hart, J. Patrick; McBride, Timothy; Myers, Wayne

    1999-01-01

    Rural communities have not kept pace with the recent dramatic changes in health care financing and organization. However, the Medicare provisions in the Balanced Budget Act of 1997 will require rural providers to participate in the new systems. Case studies revealed the degree of readiness for change in six rural communities and charted their progress along a continuum, as reflected in three sets of activities: the development of networking; the creation of new strategies for managing patient...

  4. Analysis of capital spending and capital financing among large US nonprofit health systems.

    Science.gov (United States)

    Stewart, Louis J

    2012-01-01

    This article examines the recent trends (2006 to 2009) in capital spending among 25 of the largest nonprofit health systems in the United States and analyzes the financing sources that these large nonprofit health care systems used to fund their capital spending. Total capital spending for these 25 nonprofit health entities exceeded $41 billion for the four-year period of this study. Less than 3 percent of total capital spending resulted in mergers and acquisition activities. Total annual capital spending grew at an average annual rate of 17.6 percent during the first three year of this study's period of analysis. Annual capital spending for 2009 fell by more than 22 percent over prior year's level due to the impact of widespread disruption in US tax-exempt variable rate debt markets. While cash inflow from long-term debt issues was a significant source of capital financing, this study's primary finding was that operating cash flow was the predominant source of capital spending funding. Key words: nonprofit, mergers and acquisitions (M&A), capital spending, capital financing.

  5. Mudanças significativas no processo de descentralização do sistema de saúde no Brasil Significant changes in the health system decentralization process in Brazil

    Directory of Open Access Journals (Sweden)

    Ana Luiza d'Ávila Viana

    2002-01-01

    Full Text Available O artigo discute as tendências e os limites do processo de descentralização da política de saúde no Brasil, identificando os três elementos constitutivos da indução estratégica conduzida pelo gestor nacional, nos preceitos das Normas Operacionais do SUS: racionalidade sistêmica, financiamento intergovernamental e dos prestadores de serviço e modelo de atenção à saúde. Os efeitos das regulações federais são analisados com base nos resultados da Pesquisa de Avaliação da Instituição da Gestão Plena do Sistema Municipal. A estratégia de descentralização, induzida pela Norma Operacional Básica 96, vem conseguindo melhorar as condições institucionais, de autonomia gerencial e de oferta ­ aferidas pelos recursos financeiros federais transferidos, capacidade instalada, produção e cobertura dos serviços ambulatoriais e hospitalares ­ nos sistemas de saúde dos municípios habilitados em gestão plena, sem alterar os padrões de iniqüidade existentes na distribuição dos recursos para os municípios mais carentes.This article discusses the trends and limits of the Brazilian health system decentralization process, identifying the three elements that constitute the strategic induction performed by the national system administrator in accordance with the guidelines contained in the Operational Norms of the Unified National Health System: systemic rationality, intergovernmental and service provider financing, and health care model. The effects of the Federal regulations are analyzed based on the results of the evaluation study focused on the implementation of the full management scheme at the Municipal level. The decentralization strategy induced by Basic Operational Norm 96 has succeeded in improving institutional conditions, management autonomy, and supply, as measured by the Federal resources transferred, installed capacity, production, and coverage of outpatient and hospital services, with the Municipalities authorized

  6. Differences in health between Americans and Western Europeans: Effects on longevity and public finance.

    Science.gov (United States)

    Michaud, Pierre-Carl; Goldman, Dana; Lakdawalla, Darius; Gailey, Adam; Zheng, Yuhui

    2011-07-01

    In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.

  7. HEALTH & FINANCE

    African Journals Online (AJOL)

    raise prices to make up for the decreased. MEDICAL ... behind this is that savings would change members' behaviour and that this ... Accountants issued accounting guidelines for medical funds. ... out to treat such amounts as reserves. Cost ...

  8. The impact of competition among health care financing authorities on market yields and issuer interest expenses.

    Science.gov (United States)

    Bernet, Patrick M; Carpenter, Caryl E; Saunders, Warren

    2011-01-01

    The main source of capital for non-for-profit health care organizations is tax-exempt municipal bonds. The tax-exempt nature of this debt requires that they be issued through financing authorities, which are run by, or affiliated with, state or local government agencies. In some states, all tax-exempt health care bonds must be issued through a single financing authority, but in other states the issuing health care organization has a choice of multiple authorities. Using a Herfindahl index of issuer concentration, prior research has found that greater competition among authorities results in lower interest costs to the issuing health care organization. We pick up where this earlier study left off, examining the links between authority competition, the interest expenses to the issuer, and the yield to the market investor. Although our analysis of all hospital bonds issued between 1994 and 2002 corroborates earlier findings with regard to interest expenses to the issuing health care organization, we also find market yield is lower for statewide authorities where issuer concentration is lower. Thus, authority competition is good from the issuers' point of view, but holds no favor in the investors' eyes. On the other hand, the lower market yield associated with statewide authorities does not make its way down to the issuer in the form of lower interest costs. To help sort through this paradox, we explore our findings through interviews of executives in state issuing authorities.

  9. Funding the promise: monitoring Uganda's health sector financing from an HIV/AIDS perspective.

    Science.gov (United States)

    Agaba, E

    2009-10-01

    HIV/AIDS prevalence in Uganda is beginning to show an upward trend despite increased inflow of funds to fight HIV/AIDS in Uganda. To monitor health sector financing from an HIV/AIDS perspective so as to produce recommendations for effective health service delivery mechanisms in Uganda We reviewed the literature and conducted key interviews with service users, policy makers and HIV/AIDS program managers at national and local government levels. Thematic and content analysis guided the presentation of results. While efforts have been put in place to meet its national minimum health care package, much of the support in HIV/AIDS is from donors and NGOs. There is still no clear harmonisation of funding mechanisms and big short fall in health sector budgeting especially at local government level. At this rate Uganda may not achieve its targets HIV/AIDS funding in Uganda is largely dependant on donors. There is need for increased and sustained financing from the government if the impact of HIVAIDS is to be reduced.

  10. Equity in health care financing in Palestine: the value-added of the disaggregate approach.

    Science.gov (United States)

    Abu-Zaineh, Mohammad; Mataria, Awad; Luchini, Stéphane; Moatti, Jean-Paul

    2008-06-01

    This paper analyzes the redistributive effect and progressivity associated with the current health care financing schemes in the Occupied Palestinian Territory, using data from the first Palestinian Household Health Expenditure Survey conducted in 2004. The paper goes beyond the commonly used "aggregate summary index approach" to apply a more detailed "disaggregate approach". Such an approach is borrowed from the general economic literature on taxation, and examines redistributive and vertical effects over specific parts of the income distribution, using the dominance criterion. In addition, the paper employs a bootstrap method to test for the statistical significance of the inequality measures. While both the aggregate and disaggregate approaches confirm the pro-rich and regressive character of out-of-pocket payments, the aggregate approach does not ascertain the potential progressive feature of any of the available insurance schemes. The disaggregate approach, however, significantly reveals a progressive aspect, for over half of the population, of the government health insurance scheme, and demonstrates that the regressivity of the out-of-pocket payments is most pronounced among the worst-off classes of the population. Recommendations are advanced to improve the performance of the government insurance schemes to enhance its capacity in limiting inequalities in health care financing in the Occupied Palestinian Territory.

  11. Restructuring brain drain: strengthening governance and financing for health worker migration

    Directory of Open Access Journals (Sweden)

    Tim K. Mackey

    2013-01-01

    Full Text Available Background: Health worker migration from resource-poor countries to developed countries, also known as ‘‘brain drain’’, represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Methods: Using acceptable methods of policy analysis, we first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Results: Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. Conclusions: In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.

  12. Multitarget survey on the Finance Police personnel: assessment of the health condition.

    Science.gov (United States)

    Barraco, Giancarlo; Pagano, Stefano; Lupoli, Grazia; Dolci, Alessandro; Colagrosso, Beniamino

    2014-01-01

    Over the past 10-15 years, Italy has undergone a social transformation, and the class of employees and workers has become more economically stable with a higher buying power. Along with the increased expectations of patients on the quality of life, it has now become a priority to make health and social services ready to face users bearing new requirements and different needs. To provide a description of the state of health of the operating personnel of the Finance Police (Guardia di Finanza), including elements for planning the most appropriate interventions for health promotion and prevention. The study analyzed the health condition of a group of soldiers (178 subjects, divided into different age classes) by evaluating the effectiveness of a training and information program and subsequently the level of benefit. The study population showed a good state of health correlated to the quality of life. Although the population voluntarily submitted to health assessment, the rigour of the calls and briefings carried out in the military health unit and the attention of the group to follow instructions on prevention underlined a positive trend, even in behaviours considered as health-risky. Socio-cultural components and the work environment influence the quality of life. In the case of military health care, the specific military organization was useful to monitor the health condition of the population, maximizing the effectiveness of services, enhancing the information and carrying out prevention strategies and demand of care, which should be an example for the public health services.

  13. Does decentralization influence efficiency of health units? A study of opinion and perception of health workers in Odisha

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    Bhuputra Panda

    2016-10-01

    Full Text Available Abstract Background Health systems in low and middle income countries are struggling to improve efficiency in the functioning of health units of which workforce is one of the most critical building blocks. In India, Rogi Kalyan Samiti (RKS was established at every health unit as institutions of local decision making in order to improve productive efficiency and quality. Measuring efficiency of health units is a complex task. This study aimed at assessing the perception (opinion and satisfaction of health workers about influence of RKS on improving efficiency of peripheral decision making health units (DMHU; examining differences between priority and non-priority set-ups; identifying predictors of satisfaction at work; and discussing suggestions to improve performance. Methods Following a cross-sectional, comparative study design, 130 health workers from 30 institutions were selected through a multi-stage stratified random sampling. A semi-structured questionnaire was administered to assess perception and opinion of health workers about influence of RKS on efficiency of decision making at local level, motivation and performance of staff, and availability of funds; improvement of quality of services, and coordination among co-workers; and participation of community in local decision making. Three districts with highest infant mortality rate (IMR, one each, from 3 zones of Odisha and 3 with lowest IMR were selected on the basis of IMR estimates of 2011. The former constituted priority districts (PD and the latter, non-priority districts (NPD. Composite scores were developed and compared between PD and NPD. Adjusted linear regression was conducted to identify predictors of satisfaction at work. Results A majority of respondents felt that RKS was efficient in decision making that resulted in improvement of all critical parameters of health service delivery, including quality; this was significantly higher in PD. Further, higher proportion of

  14. Quality of Services and Health Financing efficiency of Community Health Insurance (Jamkesmas at 21 General and Specialty Hospitals in Indonesia

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    Ristrini Ristrini

    2014-08-01

    Full Text Available Background: Community Health Insurance (Jamkesmas has been implementing maintained since 2008 with 76.4million individual quota increased to 86.4 million in 2012. The major problem of involved is unfairness (inequity in the quality and financing of health services for participants. This study aims to analyse the quality and financing of health perspective of Jamkesmas participants in the hospital. Method: This study was conducted in 21 general and specialty hospitals in Indonesia, The sample were selected purposively They were 9 Central Government hospitals (RSUP, Regional hospital and 3 specialty hospital ie cancer hospital, cardiologie hospital and stroke hospital. Those hospital involved covers 8 RSU Class A General Hospital. 8 RSU Class B, 2 RSU Class Cand 3 Specialty Hospital. Primary data wascollected by interviewing 1700 outpatient and inpatients, and 280 hospital staffs. Secondary data were human resources, finance and coverage. Results: Quality of services review on the adequacy of the physician’s quality was very varied.There were 570–2372 outpatient visits per physician, and 37-674 inpatients per doctor visit. Adequacy of nursing staff(nurses and midwives was better, 123–671 outpatient visits per nursing staff and 3–127 inpatient visits per nursing staff.Quality of services according to health officers perceptions on equipment and facilities was good and complete. Quality ofservices according to patients’ expectations and reality was appropriate, never the less the direct heath services, were low. Hospital financing was very large, 33–460 billion, and one third for Jamkesmas and Regency Community Health Insurance (Jamkesda services. Proportion Jamkesda funding in RSUD was larger than Jamkesmas while in RSUP, Jamkesda was smaller than Jamkesmas. Jamkesmas financing perspective according to the staff, was most of them stated that funding for Jamkesmas was matched and appropriate the number of served patients served

  15. [Challenges to decentralization and local participation within the health rights protection framework: Experience of the SUSALUD Northern Macro-regional Intendance].

    Science.gov (United States)

    Rebaza-Iparraguirre, Henry; Vela-López, Miguel; Villegas-Ortega, José; Lozada-Urbano, Michelle; Munares-García, Oscar

    2016-01-01

    In Peru, health protection rights and the National Health Authority (SUSALUD) coexist with the aim to ensure that every Peruvian may exercise his/her rights. According to the L.D. (Spanish: Decreto legislativo) N° 1158, strategies must be deployed to ensure effective decentralization and ensure compliance with user rights. As a result, the Northern Macro-regional Intendance (IMRN) was created, with headquarters in the city of Chiclayo, and a coverage area including Lambayeque, Tumbes, Piura, Cajamarca, La Libertad, and Amazonas. The northern macro-region promotes information dissemination, coordination, and local participation in health activities, with an emphasis on handling complaints and claims as well as implementation and operation support of user boards (JUS). After 6 months, implementation of the IMRN experience is undergoing consolidation.

  16. [Health financing in Lebanon. I. Organization of health care services, coverage system and contribution of the Ministry of Public Health].

    Science.gov (United States)

    Ammar, W; Mechbal A el-H; Awar, M

    1998-01-01

    This paper intends to analyze the health care system in Lebanon from the organizational and financial points of view. It allows for an understanding of the health services' market by tackling it from different angles: supply versus demand, private versus public sectors, curative versus preventive services, hospital versus ambulatory care. This study necessitated a review of all previous surveys made in this field, during the after-war period. It also needed the daily collection and follow-up of pertinent data with all private and public agencies and concerned ministries, over a one-year period. In addition, a critical analysis has been made to the survey Conditions de vie des ménages, en 1997, that was carried out by the Central Administration of Statistics, that came to complete the missing data concerning household expenditures on insurance and health services. Especially that this survey covered the same period (1997), subject of this study. The paper reveals that, although the private sector is the main provider of both hospital and ambulatory care, private hospitals are flourishing on public money, whereas outpatients care is mainly financed by the households. Evidence shows that the Lebanese health care system succeeded in resolving the problem of accessibility to primary, secondary and tertiary health care, responding thus to the value of equity. But, at the price of an ever escalating cost, threatening the sustainability of the system. This is what is attained in this paper, as it shows clearly that expenditures on health have reached an alarming level of the GDP share. Our purpose being providing solid arguments in favor of reforming the health system.

  17. Reproductive health financing in Kenya: an analysis of national commitments, donor assistance, and the resources tracking process

    NARCIS (Netherlands)

    Sidze, E.M.; Pradhan, J.; Beekink, E.; Maina, T.M.; Maina, B.W.

    2013-01-01

    Understanding the flow of resources at the country level to reproductive health is essential for effective financing of this key component of health. This paper gives a comprehensive picture of the allocation of resources for reproductive health in Kenya and the challenges faced in the resource-trac

  18. Plansalud: Plan sectorial concertado y descentralizado para el desarrollo de capacidades en salud, Perú 2010 - 2014 Plansalud: Decentralized and agreed sector plan for the capacity development in health, Peru 2010-2014

    Directory of Open Access Journals (Sweden)

    Lizardo Huamán-Angulo

    2011-06-01

    Full Text Available Los recursos humanos son el eje del accionar del sector salud; sin embargo, no necesariamente son el aspecto mejor atendido, por ello el Ministerio de Salud del Perú (MINSA conjuntamente con los gobiernos regionales generó el Plan Sectorial Concertado y Descentralizado para el Desarrollo de Capacidades en Salud 2010-2014 (PLANSALUD con el propósito de fortalecer las capacidades de los Recursos Humanos en Salud (RHUS y contribuir para que la atención de salud se desarrolle con eficiencia, calidad, pertinencia, equidad e interculturalidad en el marco de la descentralización, el Aseguramiento Universal de la Salud (AUS y las políticas de la salud. Con ese objeto se han propuesto tres componentes (asistencia técnica, capacitación y articulación educación - salud que agrupan a un conjunto importante de intervenciones, las cuales son planteadas y definidas de acuerdo al contexto nacional, regional y local, contribuyendo de ese modo a la mejora de las capacidades de gobierno, de gestión por competencias y la prestación de servicios de salud. El presente artículo muestra una primera aproximación de PLANSALUD, incluyendo aspectos relacionados a su planificación, gestión, financiamiento, estructura y funcionamiento, así como las medidas de monitoreo y evaluación.Human resources are the backbone of health sector actions; however, they are not necessarily the area with the greatest attention, therefore, the Ministry of Health of Peru (MINSA together with regional governments, led the Decentralized and Agreed Sector Plan for the Capacity Development in Health 2010-2014 (PLANSALUD with the aim of strengthening the capacities of Human Resources for Health (HRH and contribute to health care efficient development, quality, relevance, equity and multiculturalism, in the context of descentralization, the Universal Health Insurance (AUS and health policies. To achieve this goal, they have proposed three components (technical assistance, joint

  19. Setting performance-based financing in the health sector agenda: a case study in Cameroon.

    Science.gov (United States)

    Sieleunou, Isidore; Turcotte-Tremblay, Anne-Marie; Fotso, Jean-Claude Taptué; Tamga, Denise Magne; Yumo, Habakkuk Azinyui; Kouokam, Estelle; Ridde, Valery

    2017-08-01

    More than 30 countries in sub-Saharan Africa have introduced performance-based financing (PBF) in their healthcare systems. Yet, there has been little research on the process by which PBF was put on the national policy agenda in Africa. This study examines the policy process behind the introduction of PBF program in Cameroon. The research is an explanatory case study using the Kingdon multiple streams framework. We conducted a document review and 25 interviews with various types of actors involved in the policy process. We conducted thematic analysis using a hybrid deductive-inductive approach for data analysis. By 2004, several reports and events had provided evidence on the state of the poor health outcomes and health financing in the country, thereby raising awareness of the situation. As a result, decision-makers identified the lack of a suitable health financing policy as an important issue that needed to be addressed. The change in the political discourse toward more accountability made room to test new mechanisms. A group of policy entrepreneurs from the World Bank, through numerous forms of influence (financial, ideational, network and knowledge-based) and building on several ongoing reforms, collaborated with senior government officials to place the PBF program on the agenda. The policy changes occurred as the result of two open policy windows (i.e. national and international), and in both instances, policy entrepreneurs were able to couple the policy streams to effect change. The policy agenda of PBF in Cameroon underlined the importance of a perceived crisis in the policy reform process and the advantage of building a team to carry forward the policy process. It also highlighted the role of other sources of information alongside scientific evidence (eg.: workshop and study tour), as well as the role of previous policies and experiences, in shaping or influencing respectively the way issues are framed and reformers' actions and choices.

  20. The Financing Mechanism of the Social Health Insurance System in Romania and in other European Countries

    Directory of Open Access Journals (Sweden)

    Constantin AFANASE

    2010-08-01

    Full Text Available The social insurance system is part of the social security system and it works based on the payment of a contribution through which risks and services defined by the law are insured. The social security system, independent of the structure or political and economical order of a state, has the attribution of giving help to those in conditions of social helplessness, as well as preventing such circumstances. In this paper we made a comparative analysis of the financing mechanism of the social health insurance system in Romania with other European countries.

  1. Descentralización de los servicios de salud: estudios de caso en seis estados mexicanos Decentralization of health services: case studies in six Mexican states

    Directory of Open Access Journals (Sweden)

    Nuria Homedes

    2011-12-01

    Full Text Available OBJETIVO: Este artículo presenta los resultados de la segunda descentralización de la Secretaría de Salud de México (1994-2000. MATERIAL Y MÉTODOS: Además de revisar documentos oficiales y de archivo, estadísticas de salud y de productividad, se realizaron observaciones en los centros asistenciales y 232 entrevistas de profundidad en los estados de Baja California Sur, Colima, Guanajuato, Nuevo León, Sonora y Tamaulipas con directivos de las secretarías de salud estatales y jurisdiccionales, dirigentes de sindicatos, prestadores de servicios y representantes de la sociedad civil. RESULTADOS: Se identifican los problemas que los estados tuvieron que enfrentar para implementar la descentralización. CONCLUSIONES: No se alcanzaron los objetivos trazados por los promotores de la descentralización.OBJECTIVE: This article discusses the effects of the second decentralization of the Mexican Ministry of Health (1994-2000. MATERIAL AND METHODS: It is based on a review of official and archival documents, health and productivity statistics, observations in clinics and hospitals, and 232 in-depth interviews in the states of Baja California Sur, Colima, Guanajuato, Nuevo León, Sonora and Tamaulipas. The interviewees included high-level administrators of state and district health systems, leaders of workers unions, health providers and representatives of civil society. RESULTS: The article identifies the problems that offices of health at state level had to overcome to implement the decentralization. CONCLUSIONS: Descentralizacion failed to achieve the objectives stated by its promoters.

  2. Innovative financing for health: what are the options for South Africa?

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    Robert J. Fryatt

    2012-10-01

    Full Text Available The paper assesses the options for additional innovative financing that could be considered in South Africa, covering both raising new funds and linking funds to results. New funds could come from: i the private sector, including the mining and mobile phone industry; ii from voluntary sources, through charities and foundations; iii and through further expanding health (sin levies on products such as tobacco, alcohol and unhealthy food and drinks. As in other countries, South Africa could earmark some of these additional sources for investment in interventions and research to reduce unhealthy behaviors and influence the determinants of health. South Africa could also expand innovative linking of funds to improve overall performance of the health sector, including mitigating the risks for non-state investment and exploring different forms of financial incentives for providers and patients. All such innovations would require rigorous monitoring and evaluation to assess whether intended benefits are achieved and to look for unintended consequences.

  3. Equity in health care financing in Portugal: findings from the Household Budget Survey 2010/2011.

    Science.gov (United States)

    Quintal, Carlota; Lopes, José

    2016-07-01

    Equity in health care financing is recognised as a main goal in health policy. It implies that payments should be linked to capacity to pay and that households should be protected against catastrophic health expenditure (CHE). The risk of CHE is inversely related to the share of out-of-pocket payments (OOP) in total health expenditure. In Portugal, OOP represented 26% of total health expenditure in 2010 [one of the highest among Organisation for Economic Co-operation and Development (OECD) countries]. This study aims to identify the proportion of households with CHE in Portugal and the household factors associated with this outcome. Additionally, progressivity indices are calculated for OOP and private health insurance. Data were taken from the Portuguese Household Budget Survey 2010/2011. The prevalence of CHE is 2.1%, which is high for a developed country with a universal National Health Service. The main factor associated with CHE is the presence of at least one elderly person in households (when the risk quadruples). Payments are particularly regressive for medicines. Regarding the results by regions, the Kakwani index for total OOP is larger (negative) for the Centre and lower, not significant, for the Azores. Payments for voluntary health insurance are progressive.

  4. Summary of the SWOT panel's evaluation of the organisation and financing of the Danish health care system.

    Science.gov (United States)

    Christiansen, Terkel

    2002-02-01

    The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weaknesses, opportunities and threats) by a panel of five members with a background in health economics. This paper systematically summarises the panel's assessments, within the framework of the triangular model of health care. The members of the panel are in agreement on a number of aspects, while their views on other aspects differ. In general they find many strength in the way the system is organised and financed more so in the primary sector than in the hospital sector.

  5. Financing the package of services during the first decade of the national health insurance law in Israel: trends and issues.

    Science.gov (United States)

    Shmueli, Amir; Achdut, Leah; Sabag-Endeweld, Miri

    2008-09-01

    In 1995, a National Health Insurance Law (NHIL) was enacted in Israel. It specified a mandatory package of services to be provided by the four competing private non-profit sickness funds, and secured the financing of that provision. This review discusses the main issues associated with financing of--and the sickness funds' expenditure on--the package of services and analyzes the trends during the first decade of the implementation of the NHIL. The main findings indicate that between 1995 and 2005 the "real value" of the budget of the package of services has eroded by more than a third, most of it being due to the under-updating with regard to technological advances. The steep rise in the co-payment paid by users of health services and in voluntary supplementary health insurance ownership which is offered by the sickness funds partially financed that erosion. The growth of private spending on health, including on voluntary supplementary insurance, took place in all population groups and in the lowest income-quintile in particular. Indices of the progressivity of the financing of the package of services indicate that the burden of financing has been slightly regressive. In spite of the increase in the share of the regressive private expenditure between 1997 and 2003, overall, the finance became less regressive due to the health tax becoming less regressive. In conclusion, the introduction of the Israeli NHIL was a promising social achievement, but, during its first decade and facing tight national budgets and receiving lower national priority, subsequent regulation eroded the real value of its benefits, and its principles of solidarity and equity in finance. After 10 years of experience, the system might need refreshment and policy amendments that will correspond to its original aspirations.

  6. The other crisis: the economics and financing of maternal, newborn and child health in Asia.

    Science.gov (United States)

    Anderson, Ian; Axelson, Henrik; Tan, B-K

    2011-07-01

    The Global Financial Crisis (GFC) of 2008/2009 was the largest economic slowdown since the Great Depression. It undermined the growth and development prospects of developing countries. Several recent studies estimate the impact of economic shocks on the poor and vulnerable, especially women and children. Infant and child mortality rates are still likely to continue to decline, but at lower rates than would have been the case in the absence of the GFC. Asia faces special challenges. Despite having been the fastest growing region in the world for decades, and even before the current crisis, this region accounted for nearly 34% of global deaths of children under 5, more than 40% of maternal deaths and 60% of newborn deaths. Global development goals cannot be achieved without much faster and deeper progress in Asia. Current health financing systems in much of Asia are not well placed to respond to the needs of women and their children, or the recent global financial and economic slowdown. Public expenditure is often already too low, and high levels of out-of-pocket health expenditure are an independent cause of inequity and impoverishment for women and their children. The GFC highlights the need for reforms that will improve health outcomes for the poor, protect the vulnerable from financial distress, improve public expenditure patterns and resource allocation decisions, and so strengthen health systems. This paper aims to highlight the most recent assessments of how economic shocks, including the GFC, affect the poor in developing countries, especially vulnerable women and children in Asia. It concludes that conditional cash transfers, increasing taxation on tobacco and increasing the level, and quality, of public expenditure through well-designed investment programmes are particularly relevant in the context of an economic shock. That is because these initiatives simultaneously improve health outcomes for the poor and vulnerable, protect them from further financial

  7. Actor management in the development of health financing reform: health insurance in South Africa, 1994-1999.

    Science.gov (United States)

    Thomas, Stephen; Gilson, Lucy

    2004-09-01

    Health reform is inherently political. Sound technical analysis is never enough to guarantee the adoption of policy. Financing reforms aimed at promoting equity are especially likely to challenge vested interests and produce opposition. This article reviews the Health Insurance policy development in South Africa between 1994 and 1999. Despite more than 10 years of debate, analysis and design, no set of social health insurance (SHI) proposals had, by 1999, secured adequate support to become the basis for an implementation plan. In contrast, proposals to re-regulate the health insurance industry were speedily developed and implemented at the end of this period. The processes of actor engagement and management, set against policy goals and design details, were central to this experience. Adopting a grounded approach to analysis of primary interview data and a range of documentary material, this paper explores the dynamics between reform drivers engaged in directing policy change and a range of other actors. It describes the processes by which actors were drawn into health insurance policy development, the details of their engagement with each other, and it identifies where deliberate strategies of actor management were attempted and the results for the reform process. The primary drivers of this process were the Minister of Health and the unit responsible for health financing and economics in the national Department of Health Directorate of Health Financing and Economics, with support from members of the South African academic community. These actors worked within and through a series of four ad hoc policy advisory committees which were the main fora for health insurance policy development and the regulation of private health insurance. The different experiences in each committee are reviewed and contrasted through the lens of actor management. Differences between these drivers and opposition from other actors ultimately derailed efforts to establish adequate support

  8. Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand.

    Science.gov (United States)

    Seeberg, Jens; Pannarunothai, Supasit; Padmawati, Retna Siwi; Trisnantoro, Laksono; Barua, Nupur; Pandav, Chandrakant S

    2014-02-01

    This article presents a comparative analysis of socio-economic disparities in relation to treatment-seeking strategies and healthcare expenditures in poor neighbourhoods within larger health systems in four cities in India, Indonesia and Thailand. About 200 households in New Delhi, Bhubaneswar, Jogjakarta and Phitsanulok were repeatedly interviewed over 12 months to relate health problems with health seeking and health financing at household level. Quantitative data were complemented with ethnographic studies involving the same neighbourhoods and a number of private practitioners at each site. Within each site, the higher and lower income groups among the poor were compared. The lower income group was more likely than the higher income group to seek care from less qualified health providers and incur catastrophic health spending. The study recommends linking quality control mechanisms with universal health coverage (UHC) policies; to monitor the impact of UHC among the poorest; intervention research to reach the poorest with UHC; and inclusion of private providers without formal medical qualification in basic healthcare.

  9. Health planners and local public finance--the case for revenue sharing.

    Science.gov (United States)

    Rocheleau, B; Warren, S

    1980-01-01

    Little attention has been paid by health planners or researchers to questions of local public finance. However, a review of the literature concerning general revenue sharing (GRS) funds indicated that about $400 million per year from this source is spent on health services and resources. GRS funds, about $6.4 billion per year, are distributed to more than 39,000 State, county, and city governments. The 1976 amendments to the General Revenue Sharing Act eliminated restrictions on the use of the funds, and they can be employed as matching funds for other Federal monies. An exploratory study of the use of GRS funds for health purposes was conducted in several localities, with particular attention to the health systems agencies. Its results confirmed that there are wide variations among localities in the use of revenue-sharing funds to support health services. Also, not only did the health systems agencies' officials have little impact on the allocation of revenue sharing funds, but only in one locale had an HSA official taken a direct role in the budgetary process. Health planners, who were interviewed during the study, described what they considered their agencies' proper role in local budgetary matters.

  10. Organization and Finance of China's Health Sector: Historical Antecedents for Macroeconomic Structural Adjustment.

    Science.gov (United States)

    Li, Hui; Hilsenrath, Peter

    2016-01-01

    China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP). Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China's shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China's evolution, adding another layer of complexity to policy. © The

  11. The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries

    NARCIS (Netherlands)

    Wees, P.J. van der; Wammes, J.J.G.; Westert, G.P.; Jeurissen, P.P.T.

    2015-01-01

    BACKGROUND: Both rising healthcare costs and the global financial crisis have fueled a search for policy tools in order to avoid unsustainable future financing of essential health benefits. The scope of essential health benefits (the range of services covered) and depth of coverage (the proportion o

  12. Translating Dutch: challenges and opportunities in reforming health financing in Ireland.

    Science.gov (United States)

    Ryan, P; Thomas, S; Normand, C

    2009-09-01

    In 2006, Dutch authorities introduced a new health financing system of compulsory private for-profit insurance with strong government regulation. This system has recently attracted attention in Ireland. This paper assesses the theoretical arguments and evidence for applying the Dutch ideas to Ireland. In particular, the authors address how it would help the stated health system policy objectives of improving value for money, fairness and capacity. While the current Dutch reform is still a work in progress, it offers the headline attraction of a single tier system with few waiting lists. Nevertheless, the Dutch system of managed competition may entail risks for Ireland relating to ensuring sufficient system capacity, protecting those on low-incomes and ensuring cost control.

  13. Health financing in Brazil, Russia and India: what role does the international community play?

    Science.gov (United States)

    Sridhar, Devi; Gómez, Eduardo J

    2011-01-01

    In this paper we examine whether Brazil, Russia and India have similar financing patterns to those observed globally. We assess how national health allocations compare with epidemiological estimates for burden of disease. We identify the major causes of burden of disease in each country, as well as the contribution HIV/AIDS, tuberculosis and malaria make to the total burden of disease estimates. We then use budgetary allocation information to assess the alignment of funding with burden of disease data. We focus on central government allocations through the Ministry of Health or its equivalent. We found that of the three cases examined, Brazil and India showed the most bias when it came to financing HIV/AIDS over other diseases. And this occurred despite evidence indicating that HIV/AIDS (among all three countries) was not the highest burden of disease when measured in terms of age-standardized DALY rates. We put forth several factors building on Reich's (2002) framework on 'reshaping the state from above, from within and from below' to help explain this bias in favour of HIV/AIDS in Brazil and India, but not in Russia: 'above' influences include the availability of external funding, the impact of the media coupled with recognition and attention from philanthropic institutions, the government's close relationship with UNAIDS (UN Joint Programme on HIV/AIDS), WHO (World Health Organization) and other UN bodies; 'within' influences include political and bureaucratic incentives to devote resources to certain issues and relationships between ministries; and 'below' influences include civil society activism and relationships with government. Two additional factors explaining our findings cross-cutting all three levels are the strength of the private sector in health, specifically the pharmaceutical industry, and the influence of transnational advocacy movements emanating from the USA and Western Europe for particular diseases.

  14. Forensic services, public mental health policy, and financing: charting the course ahead.

    Science.gov (United States)

    Pinals, Debra A

    2014-01-01

    High-quality forensic evaluations can be critical for criminal cases brought before the court. In addition, forensic practitioners and mental health and forensic administrators have increasingly taken a broader view of the revolving door between the mental health and criminal justice systems. More attention is now paid to why individuals with mental disorders, including co-occurring substance use, come into the criminal justice system and the challenges that they face on re-entry into the community. In particular, individuals who receive care across civil, forensic, and correctional systems are at especially increased risk of disrupted health care access and coverage. With health care reform on the horizon, it is important to understand public financing and its impact on forensic services for this crossover population. This article is a review of historical and future trends in public mental health funding focused on Medicaid and other federal resources, the movement toward community-based services, and the impact of these areas on forensic practice and forensic systems. Tensions between recovery principles and legal mandates are also addressed as community services are emphasized, even in forensic contexts. This article calls forensic practitioners to action and offers suggested areas of focus for training to increase knowledge of public mental health funding, policy, and practice from a forensic perspective.

  15. Mental health research in Brazil: policies, infrastructure, financing and human resources

    Directory of Open Access Journals (Sweden)

    Mari Jair de Jesus

    2006-01-01

    Full Text Available The objective of this descriptive study was to map mental health research in Brazil, providing an overview of infrastructure, financing and policies mental health research. As part of the Atlas-Research Project, a WHO initiative to map mental health research in selected low and middle-income countries, this study was carried out between 1998 and 2002. Data collection strategies included evaluation of governmental documents and sites and questionnaires sent to key professionals for providing information about the Brazilian mental health research infrastructure. In the year 2002, the total budget for Health Research was US$101 million, of which US$3.4 million (3.4 was available for Mental Health Research. The main funding sources for mental health research were found to be the São Paulo State Funding Agency (Fapesp, 53.2% and the Ministry of Education (CAPES, 30.2%. The rate of doctors is 1.7 per 1,000 inhabitants, and the rate of psychiatrists is 2.7 per 100,000 inhabitants estimated 2000 census. In 2002, there were 53 postgraduate courses directed to mental health training in Brazil (43 in psychology, six in psychiatry, three in psychobiology and one in psychiatric nursing, with 1,775 students being trained in Brazil and 67 overseas. There were nine programs including psychiatry, neuropsychiatry, psychobiology and mental health, seven of them implemented in Southern states. During the five-year period, 186 students got a doctoral degree (37 per year and 637 articles were published in Institute for Scientic Information (ISI-indexed journals. The investment channeled towards postgraduate and human resource education programs, by means of grants and other forms of research support, has secured the country a modest but continuous insertion in the international knowledge production in the mental health area.

  16. Mental health research in Brazil: policies, infrastructure, financing and human resources

    Directory of Open Access Journals (Sweden)

    Jair de Jesus Mari

    2006-02-01

    Full Text Available The objective of this descriptive study was to map mental health research in Brazil, providing an overview of infrastructure, financing and policies mental health research. As part of the Atlas-Research Project, a WHO initiative to map mental health research in selected low and middle-income countries, this study was carried out between 1998 and 2002. Data collection strategies included evaluation of governmental documents and sites and questionnaires sent to key professionals for providing information about the Brazilian mental health research infrastructure. In the year 2002, the total budget for Health Research was US$101 million, of which US$3.4 million (3.4 was available for Mental Health Research. The main funding sources for mental health research were found to be the São Paulo State Funding Agency (Fapesp, 53.2% and the Ministry of Education (CAPES, 30.2%. The rate of doctors is 1.7 per 1,000 inhabitants, and the rate of psychiatrists is 2.7 per 100,000 inhabitants estimated 2000 census. In 2002, there were 53 postgraduate courses directed to mental health training in Brazil (43 in psychology, six in psychiatry, three in psychobiology and one in psychiatric nursing, with 1,775 students being trained in Brazil and 67 overseas. There were nine programs including psychiatry, neuropsychiatry, psychobiology and mental health, seven of them implemented in Southern states. During the five-year period, 186 students got a doctoral degree (37 per year and 637 articles were published in Institute for Scientic Information (ISI-indexed journals. The investment channeled towards postgraduate and human resource education programs, by means of grants and other forms of research support, has secured the country a modest but continuous insertion in the international knowledge production in the mental health area.

  17. How Should We Finance Medical Education? Health Manpower Policy Discussion Paper Series. No.: A7.

    Science.gov (United States)

    Wright, George E., Jr.

    The thrust of this paper is to suggest that the major alternative to the present system of financing medical education is to allow tuitions to rise but to interfere in capital markets, so that students can finance their expenses. Any such system of student finance should: introduce an element of competition between schools and encourage more…

  18. End-stage renal disease and economic incentives: the International Study of Health Care Organization and Financing (ISHCOF).

    Science.gov (United States)

    Dor, Avi; Pauly, Mark V; Eichleay, Margaret A; Held, Philip J

    2007-09-01

    End-stage renal disease (ESRD) is a debilitating, costly, and increasingly common condition. Little is known about how different financing approaches affect ESRD outcomes and delivery of care. This paper presents results from a comparative review of 12 countries with alternative models of incentives and benefits, collected under the International Study of Health Care Organization and Financing, a substudy within the Dialysis Outcomes and Practice Patterns Study. Variation in spending per ESRD patient is relatively small, but correlated with overall per capita health care spending. Remaining differences in costs and outcomes do not seem strongly linked to differences in incentives.

  19. Organizational decentralization in radiology.

    Science.gov (United States)

    Aas, I H Monrad

    2006-01-01

    At present, most hospitals have a department of radiology where images are captured and interpreted. Decentralization is the opposite of centralization and means 'away from the centre'. With a Picture Archiving and Communication System (PACS) and broadband communications, transmitting radiology images between sites will be far easier than before. Qualitative interviews of 26 resource persons were performed in Norway. There was a response rate of 90%. Decentralization of radiology interpretations seems less relevant than centralization, but several forms of decentralization have a role to play. The respondents mentioned several advantages, including exploitation of capacity and competence. They also mentioned several disadvantages, including splitting professional communities and reduced contact between radiologists and clinicians. With the new technology decentralization and centralization of image interpretation are important possibilities in organizational change. This will be important for the future of teleradiology.

  20. From State Control to Governance: Decentralization and Higher Education in Guangdong, China

    Science.gov (United States)

    Mok, Joshua Ka-Ho

    2001-03-01

    In China there has been a strong trend to diversification and decentralization of education in the post-Mao period. This paper examines how the policy of decentralization has affected the governance of universities in Guangdong. More specifically, the paper focuses on reform of the financing and management structure, the merging of universities, and joint development programmes to enhance competitiveness. Despite these changes, the state's role as a regulator and overall service coordinator has been strengthened rather than weakened under the policy of decentralization. This paper not only examines the recent developments in Guangdong's higher education but also analyses such developments in light of the global trend towards decentralization in educational governance.

  1. Tax levy financing for local public health: fiscal allocation, effort, and capacity.

    Science.gov (United States)

    Riley, William J; Gearin, Kimberly J; Parrotta, Carmen D; Briggs, Jill; Gyllstrom, M Elizabeth

    2013-12-01

    Local health departments (LHDs) rely on a wide variety of funding sources, and the level of financing is associated with both LHD performance in essential public health services and population health outcomes. Although it has been shown that funding sources vary across LHDs, there is no evidence regarding the relationship between fiscal allocation (local tax levy); fiscal effort (tax capacity); and fiscal capacity (community wealth). The purpose of this study is to analyze local tax levy support for LHD funding. Three research questions are addressed: (1) What are tax levy trends in LHD fiscal allocation? (2) What is the role of tax levy in overall LHD financing? and (3) How do local community fiscal capacity and fiscal effort relate to LHD tax levy fiscal allocation? This study focuses on 74 LHDs eligible for local tax levy funding in Minnesota. Funding and expenditure data for 5 years (2006 to 2010) were compiled from four governmental databases, including the Minnesota Department of Health, the State Auditor, the State Demographer, and the Metropolitan Council. Trends in various funding sources and expenditures are described for the time frame of interest. Data were analyzed in 2012. During the 2006-2010 time period, total average LHD per capita expenditures increased 13%, from $50.98 to $57.63. Although the overall tax levy increase in Minnesota was 25%, the local tax levy for public health increased 5.6% during the same period. There is a direct relationship between fiscal effort and LHD expenditures. Local funding reflects LHD community priorities and the relative importance in comparison to funding other local programs with tax dollars. In Minnesota, local tax levy support for local public health services is not keeping pace with local tax support for other local government services. These results raise important questions about the relationship between tax levy resource effort, resource allocation, and fiscal capacity as they relate to public health

  2. Decentralized energy studies: bibliography

    Energy Technology Data Exchange (ETDEWEB)

    Ohi, J.M.; Unseld, C.T.; Levine, A.; Silversmith, J.A.

    1980-05-01

    This bibliography is a compilation of literature on decentralized energy systems. It is arranged according to topical (e.g., lifestyle and values, institutions, and economics) and geographical scale to facilitate quick reference to specific areas of interest. Also included are articles by and about Amory B. Lovins who has played a pivotal role in making energy decentralization an important topic of national debate. Periodicals, other bibliographies, and directories are also listed.

  3. U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization?

    Science.gov (United States)

    Bustamante, Arturo Vargas

    2016-01-01

    For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form) is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form) is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization. PMID:27694684

  4. Equity in health financing of Guangxi after China's universal health coverage: evidence based on health expenditure comparison in rural Guangxi Zhuang autonomous region from 2009 to 2013.

    Science.gov (United States)

    Qin, Xianjing; Luo, Hongye; Feng, Jun; Li, Yanning; Wei, Bo; Feng, Qiming

    2017-09-29

    Healthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China's medical sector reform. Socio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions. The overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay. Our study

  5. [Alternatives for the financing of health care in Latin America and the Caribbean].

    Science.gov (United States)

    Campino, A C

    1995-06-01

    Latin America and the Caribbean (LAC) countries are experiencing both an economic crisis and a crisis in the public sector. As a result it is impossible to increase the amount of resources available to the health sector, unless there is a drastic restructuring of the way in which financing occurs. The measures so far referred to in the economic debate - user fees, cost recovery, privatization - at best represent partial solutions. Given the magnitude of health problem in LAC countries, they are unable to generate the amount of money needed to cover the deficit of financial resources for medical treatment. The central idea behind this article is that in order to cover the deficit of resources for medical it is necessary to utilize fiscal resources. It is shown that it is possible to increase the amount of financial resources available for medical treatment either through increases in taxes and/or through an increase in the proportion of the government budget dedicated to medical treatment. Increases in taxes collected provide a feasible alternative. In some of the poor countries of Latin America and the Caribbean, the proportion of the Gross National Product that goes for the payment of taxes is well below the figure for that proportion found in developed countries. To increase the proportion of the government budget dedicated to medical treatment is a political decision that depends solely upon the discretion of the governments concerned. The potential of Social Emergency Funds and debt swaps to finance innovations in the production of medical treatment services, thus maintaining the current level to activity in the sector, is discussed.

  6. Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities.

    Science.gov (United States)

    Snowden, Lonnie R; Wallace, Neal; Cordell, Kate; Graaf, Genevieve

    2017-09-01

    Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services. We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites. Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs. Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities. EPSDT expanded funding increased proportional

  7. Restructuring American health care financing: first of all, do no harm!

    Science.gov (United States)

    Berk, P D

    1993-07-01

    Health care costs are climbing throughout the western world. Aging populations and the costs of advanced technology are the principal forces behind much of this global increase. No country has yet succeeded in containing these growing costs other than by some form of rationing. A variety of experimental strategies, including managed competition, are being considered or tested, but none is clearly effective. American health care expenditures differ, not in that they are rising, but in their enormously high starting point. Among other things, our higher costs reflect administrative costs of more than 20%, double those of Canada and nearly triple the European average; a malpractice system that, whatever its possible advantages, costs more than 10 times as much as it pays out to the injured; the enormous medical costs of poverty; maldistribution of physician specialties and incomes; and reimbursement systems that eliminate consumer input and oversight. Restructuring the system of health care financing to bring administrative costs in line with those of other nations could save at least $70 billion annually; another $25 billion or more could be saved by replacing the malpractice system with more cost-effective alternatives. These savings could defray the costs of insuring all those not now covered, without increasing either costs to the middle class, through taxation of benefits, or total health care expenditures. With all Americans covered, the necessary restructuring of the system of health care delivery could be conducted without the current pressure for immediate drastic reform, which carries with it the risk of serious error. In dealing with the sick, physicians are taught to apply two maxims: "primum non nocere" or "first of all, do no harm!"; and the rule of therapeutic restraint. The latter states that a severe chronic illness may respond better, and with fewer complications, to gradual corrective measures than to highly aggressive therapy. Both rules could well

  8. Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil.

    Science.gov (United States)

    Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Ferreira da Silva, Maria Rejane; Unger, Jean-Pierre; Vázquez, María-Luisa

    2016-07-01

    Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen

  9. Applying spatio-temporal models to assess variations across health care areas and regions: Lessons from the decentralized Spanish National Health System

    Science.gov (United States)

    Librero, Julián; Martínez-Lizaga, Natalia; Peiró, Salvador; Bernal-Delgado, Enrique

    2017-01-01

    Objective To illustrate the ability of hierarchical Bayesian spatio-temporal models in capturing different geo-temporal structures in order to explain hospital risk variations using three different conditions: Percutaneous Coronary Intervention (PCI), Colectomy in Colorectal Cancer (CCC) and Chronic Obstructive Pulmonary Disease (COPD). Research design This is an observational population-based spatio-temporal study, from 2002 to 2013, with a two-level geographical structure, Autonomous Communities (AC) and Health Care Areas (HA). Setting The Spanish National Health System, a quasi-federal structure with 17 regional governments (AC) with full responsibility in planning and financing, and 203 HA providing hospital and primary care to a defined population. Methods A poisson-log normal mixed model in the Bayesian framework was fitted using the INLA efficient estimation procedure. Measures The spatio-temporal hospitalization relative risks, the evolution of their variation, and the relative contribution (fraction of variation) of each of the model components (AC, HA, year and interaction AC-year). Results Following PCI-CCC-CODP order, the three conditions show differences in the initial hospitalization rates (from 4 to 21 per 10,000 person-years) and in their trends (upward, inverted V shape, downward). Most of the risk variation is captured by phenomena occurring at the HA level (fraction variance: 51.6, 54.7 and 56.9%). At AC level, the risk of PCI hospitalization follow a heterogeneous ascending dynamic (interaction AC-year: 17.7%), whereas in COPD the AC role is more homogenous and important (37%). Conclusions In a system where the decisions loci are differentiated, the spatio-temporal modeling allows to assess the dynamic relative role of different levels of decision and their influence on health outcomes. PMID:28166233

  10. Are current debt relief initiatives an option for scaling up health financing in beneficiary countries?

    Science.gov (United States)

    Kaddar, M; Furrer, E

    2008-11-01

    One central goal of the enhanced Heavily Indebted Poor Countries (HIPC) Initiative and the more recent Multilateral Debt Relief Initiative (MDRI) is to free up additional resources for public spending on poverty reduction. The health sector was expected to benefit from a considerable share of these funds. The volume of released resources is important enough in certain countries to make a difference for priority programmes that have been underfunded so far. However, the relevance of these initiatives in terms of boosting health expenditure depends essentially, at the global level, on the compliance of donors with their aid commitments and, at the domestic level, on the success of health officials in advocating for an adequate share of the additional fiscal space. Advocacy efforts are often limited by a state of asymmetric information whereby some ministries are not well aware of the economic consequences of debt relief on public finances and of the management systems in place to deal with savings from debt relief. A thorough comprehension of these issues seems essential for health advocates to increase their bargaining power and for a wider public to readjust expectations of what debt relief can realistically achieve and of what can be measured. This paper intends to narrow the information gap by classifying debt relief savings management systems observed in practice. We illustrate some of the major advantages and stated drawbacks and outline the policy implications for health officials operating in the countries concerned. There should be careful monitoring of fungibility (i.e. where untraceable funds risk substitution) and additionality (i.e. the extent to which new inputs add to existing inputs at national and international level).

  11. Current problems in national hospitals of Phnom Penh: finance and health care.

    Science.gov (United States)

    Uy, Sophoat; Akashi, Hidechika; Taki, Kazumi; Ito, Katsuki

    2007-01-01

    The current problems in Cambodia's national hospitals subsist in a geographic imbalance in the location of staff and health facilities, and low staff motivation largely due to inadequate payment. This paper aims to investigate the associations among hospital performance, hospital finances, and other related issues in five national hospitals in Phnom Penh, using annual reports of the five hospitals and annual statistics of the Ministry of Health, from 2000 to 2004. The bed occupancy rates (BOR), average lengths of stay (ALS), hospital mortality rates (HMR), maternal and neonatal mortality rates, numbers of patients, main health problems of inpatients, numbers of health personnel, staff incentives, and annual hospital income were used in this study as indicators of five hospitals in Phnom Penh city. The ALS varied from 3.8 to 9 days. The numbers of health personnel (physician, medical assistant, secondary nurses, primary nurses, secondary midwives, and primary midwives) per 100 beds were from 114 to 282. Supplemental salary per staff also differed greatly among these hospitals; the salaries were the highest at Calmette hospital (US$ 212.8) and the lowest at Preah Kossamak (US$ 12.4). In the five hospitals, the average BOR was 58.8%, and the mean of total annual income was US$ 1,427,852 per year. Although not significant, there was a tendency for higher supplemental salaries to be associated with higher BOR (Spearman rank correlation coefficient 0.70, p = 0.188). This study showed the differences in the hospital indicators among five national hospitals in Phnom Penh city, and the tendency of higher BOR in the hospitals paying higher supplemental salaries to the staff. Higher supplemental salary to the staff seemed to contribute the better hospital performance.

  12. Performance-based financing for monitoring and evaluation of health system in Cameroon

    Directory of Open Access Journals (Sweden)

    Zakariaou Njoumemi

    2013-09-01

    Full Text Available Objective: To describe the context of, types of and approaches to monitoring and evaluation and the stakeholders’ perceptions of Performance-based financing (PBF in Cameroon.Methods: This research used secondary data, both qualitative and quantitative, from the PBF monitoring and evaluation plan, reports and documents, and information from 380 qualitative interviews of stakeholders. Data was analysed using a systematic process of triangulation of responses in tabular form to assess the contribution of PBF towards strengthening the national system of monitoring and evaluation. Descriptive statistics were presented in form of frequencies.Results: The context of decentralisation and results-based management put monitoring and evaluation at the centre of public policy actions. Performance is measured in terms of effectiveness, efficiency, equity, accountability and transparency. The expected effect of PBF is not to reinforce the monitoring and evaluation system but to increase its performance. In conception, the design of PBF relies on substantial efforts of systematic monitoring and evaluation that can strengthen the national health system. The PBF brought changes to all the organisational systems of the supply of health services according to the monitoring and evaluation objectives, which were aligned to those of the national health system and management health information. Stakeholders were positive about the resulting performance of the central tool for monitoring and evaluation of PBF.Conclusion: Several types of monitoring and evaluation are conducted in the implementation of the PBF scheme, showing great potential to strengthen the national system through the harmonisation and standardisation of indicators and norms at all levels of the national health system pyramid.

  13. South African health financing reform 2000-2010: understanding the agenda-setting process.

    Science.gov (United States)

    Pillay, Timesh D; Skordis-Worrall, Jolene

    2013-03-01

    Governments around the world are struggling to address persistent disparities in health care access. However, this priority competes with many others for support in moving onto and up the political agenda. In this paper, a novel method of agenda-setting analysis is developed by merging and modifying the Hall and Kingdon models. As a case study, this method is used to explore how health financing reform reached the policy agenda in South Africa between the years 2000 and 2010. Certain factors are identified that could have determined the agenda-setting process: a change in government, increase in the cost of private medical schemes, and increase in support for reform from various stakeholders. Further analysis, using a conceptual framework of interacting trends and shocks, identifies the growing middle class, the private sector, and workers unions as powerful actors and outlines further factors that may have contributed to the process: a broad political shift in the second half of the decade and the changing prioritisation of HIV/AIDS. Study findings have relevance to academics and policy makers in South Africa and beyond.

  14. Decentralization and Governance in Indonesia

    NARCIS (Netherlands)

    Holzhacker, Ronald; Wittek, Rafael; Woltjer, Johan

    2016-01-01

    I. Theoretical Reflections on Decentralization and Governance for Sustainable Society 1. Decentralization and Governance for Sustainable Society in Indonesia Ronald Holzhacker, Rafael Wittek and Johan Woltjer 2. Good Governance Contested: Exploring Human Rights and Sustainability as Normative Goals

  15. Decentralizing Agricultural Extension: Alternative Strategies.

    Science.gov (United States)

    Rivera, William M.

    1997-01-01

    Examines government strategies for decentralizing agricultural extension, concluding that such changes are largely determined by the country's constitutional status. Reviews decentralization guidelines for structural and fiscal reforms and participatory management systems. (SK)

  16. Decentralized Ground Staff Scheduling

    DEFF Research Database (Denmark)

    Sørensen, M. D.; Clausen, Jens

    2002-01-01

    Typically, ground staff scheduling is centrally planned for each terminal in an airport. The advantage of this is that the staff is efficiently utilized, but a disadvantage is that staff spends considerable time walking between stands. In this paper a decentralized approach for ground staff...... scheduling is investigated. The airport terminal is divided into zones, where each zone consists of a set of stands geographically next to each other. Staff is assigned to work in only one zone and the staff scheduling is planned decentralized for each zone. The advantage of this approach is that the staff...... work in a smaller area of the terminal and thus spends less time walking between stands. When planning decentralized the allocation of stands to flights influences the staff scheduling since the workload in a zone depends on which flights are allocated to stands in the zone. Hence solving the problem...

  17. A Study on Sources of Health Financing in Nigeria: Implications for Health care Marketers and Planners

    OpenAIRE

    Rotimi Ayodele Gbadeyan; Mukaila Ayanda Aremu; Johnson Olabode Adeoti

    2016-01-01

    There have been increasing difficulties in providing qualitative health care services to the public in Nigeria. The development has called for the need to examine ways through which government and other stakeholders resolve these crises in the health sector. The objective of this paper is to examine the level of Government spending to total Health expenditures in Nigeria. This study basically employs secondary data for analysis. The secondary data are provided from the World Bank Development...

  18. Health Care Performance and Health Financing Systems in Countries from Central and Eastern Europe

    Directory of Open Access Journals (Sweden)

    Sorin Gabriel ANTON

    2012-02-01

    Full Text Available A common feature of all health systems from emerging economies is the shortage of financial resources. This fact is currently exacerbated by the economic crisis that has led many governments to reconsider the level of public spending in the health sector. Starting from the Romanian experience, the paper aims to highlight the linkage between the performance of the health system and the total health spending for selected countries from Central and Eastern Europe. Romania has the lowest level of health expenditure as percentage of GDP in Europe, even if its growth rate for 2003-2008 was the highest. In addition, empirical evidence shows that these resources are used inefficiently. Despite the increasing resources allocated to the health sector, statistical analysis shows that health system efficiency, as measured by under-5 (child mortality rate, is still low. We use regression analysis based on crosssection data in order to explain the differences in health expenditure and their implication on the system efficiency. Health data have been provided by international organizations. Crosssection regression results suggest that totalhealth spending and GDP per capita are the most important factors explaining differences in health status across Central and Eastern European countries, though other lifestyle factors could play important roles.

  19. Rethinking Decentralization in Education in terms of Administrative Problems

    Directory of Open Access Journals (Sweden)

    Vasiliki Papadopoulou

    2013-11-01

    Full Text Available The general purpose of this study is to thoroughly examine decentralization in education according to the literature and previous research, and to discuss the applicability of educational decentralization practices in Turkey. The literature was reviewed for the study and findings reported. It has been observed that decentralization in education practices were realized in many countries after the 1980’s. It is obvious that the educational system in Turkey has difficulty in meeting the needs, and encounters many problems due to its present centralist state. Educational decentralization can provide effective solutions for stakeholder engagement, educational financing and for problems in decision making and operation within the education system. However, the present state of local governments, the legal framework, geographical, cultural and social features indicate that Turkey’s conditions are not ready for decentralization in education. A decentralization model realized in the long run according to Turkey’s conditions, and as a result of a social consensus, can help resolve the problems of the Turkish education system.

  20. Territorial Decentration and Geographic Learning.

    Science.gov (United States)

    Stoltman, Joseph P.

    Territorial decentration is a question of major significance to geographic educators. This paper reports the findings of a research project designed to determine the territorial decentration of an American sample of children. The primary purpose of the research was to determine if Piaget's territorial decentration stages are appropriate for…

  1. Health-resort fee and a stay in a health-resort hospital – comments based on the general interpretation of the Minister of Finance

    Directory of Open Access Journals (Sweden)

    Jacek Wantoch-Rekowski

    2016-03-01

    Full Text Available The publication presents the argumentation of the Minister of Finance included in the general interpretation of 3 October 2014 concerning the interpretation of Article 17 paragraph 2 clause 2 of the Act on Local Taxes and Fees. It was explained what was understood by the term “hospital” before 3 October 2014 and what changed in this subject after the general interpretation of the Minister of Finance was issued. It was emphasized that now the health-resort fee should not be charged from legal persons staying in health resort hospitals.

  2. An examination of contemporary financing practices and the global financial crisis on nonprofit multi-hospital health systems.

    Science.gov (United States)

    Stewart, Louis J; Smith, Pamela C

    2011-01-01

    This study examines the impact of the 2008 global financial crisis on large US nonprofit health systems. We proceed from an analysis of the contemporary capital financing practices of 25 of the nation's largest nonprofit hospitals and health systems. We find that these institutions relied on operating cash flows, public issues of insured variable rate debt, and accumulated investment to meet their capital financing needs. The combined use of these three financial instruments provided these organizations with $22.4 billion of long-term capital at favorable terms and the lowest interest rates. Our analysis further indicates that the extensive utilization of bond insurance, auction rate debt, and interest rate derivatives created significant risk exposures for these health systems. These risks were realized by the broader global financial crisis of 2008. Findings indicate these health systems incurred large losses from the early retirement of their variable rate debt. In addition, many organizations were forced to post nearly $1 billion of liquid collateral due to the falling values of their interest rate derivatives. Finally, the investment portfolios of these large nonprofit health systems suffered millions of dollars of unrealized capital losses, which may minimize their ability to finance future capital investment requirements.

  3. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review.

    Science.gov (United States)

    Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

    2017-01-01

    Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or

  4. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review

    Science.gov (United States)

    Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

    2017-01-01

    Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or

  5. The Rhetoric of Decentralization

    Science.gov (United States)

    Ravitch, Diane

    1974-01-01

    Questions the rationale for and possible consequences of political decentralization of New York City. Suggests that the disadvantages--reduced level of professionalism, increased expense in multiple government operation, "stabilization" of residential segregation, necessity for budget negotiations because of public disclosure of tax structure and…

  6. Book review of Introduction to U.S. Health Policy: The Organization, Financing and Delivery of Health Care in America by Donald A. Barr

    Directory of Open Access Journals (Sweden)

    Chapman Audrey R

    2008-03-01

    Full Text Available Abstract Donald A. Barr's Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America (second edition, 2007 offers a lucid and informative overview of the U.S. health system and the dilemmas policy makers currently face. Barr has provided a balanced introduction to the way health care is organized, financed, and delivered in the United States. The thirteen chapters of the book are quite comprehensive in the topics they cover. Even those knowledgeable about the U.S. health care system are likely to find much to stimulate their thinking in the text. The book can also appropriately serve as a basic text for a health policy course or in the medical or nursing school curriculum.

  7. 欧洲卫生筹资模式的改革%Health financing reform in European countries

    Institute of Scientific and Technical Information of China (English)

    鲁菁; 方红娟; 王小万

    2011-01-01

    Based on the health reform framework of WHO European Commission “increasing wealth and the promotion of a healthy health system - Tallinn charter”, Health financing has been the key point in the European health care reforms. The paper introduced the policies and measures of health care financing reforms in European countries in recent years. European countries have increased public financial investment, established a diversified funding patterns and risk-sharing mechanisms, maintained the stability of health care system, improved the overall fundˊs risk-resistance ability,taken health services purchasing patterns and changed payment methods to enhance government health financing. These policies and methods have provided experiences for us to learn from in our deepening health reform process.%基于WHO欧洲委员会"增加财富与增进健康的卫生系统--塔林宪章"的卫生改革框架,卫生服务的筹资模式已经成为欧洲卫生改革的重点.本文从卫生筹资的角度系统地介绍了欧洲国家近年来所实施的改革政策与措施.通过增加公共财政投入、建立多元化的筹资模式、维护医疗保险制度的稳定性、提高统筹基金的抗风险能力以及改变支付方式来加强政府卫生筹资,为我国深化卫生改革提供了可借鉴经验.

  8. The effect of financing hospital health care providers through updated Diagnosis Related Groups. Case studies: the municipal hospitals in Romania

    OpenAIRE

    Emil OLTEANU; Attila TAMAS SZORA; Iulian Bogdan DOBRA

    2014-01-01

    In our scientific approach we tried to develop a model with which to highlight the effect of financing hospital health care providers using the hospital 's Diagnosis Related Groups (DRG) and Mean Relative Values (MRV). The econometric model used is simple linear regression model form. Development of the model was performed by using the EViews 7 to the municipal hospitals in Romania during 2010 - 2012, being considered DRG dependent variable and independent variabl...

  9. Does Decentralized Leadership Influence the Performance of Czech Museums?

    Directory of Open Access Journals (Sweden)

    Plaček Michal

    2017-06-01

    Full Text Available This study tests whether decentralized leadership influences the efficiency of running selected cultural institutions, specifically museums in the Czech Republic. For the analysis, data from 2015 from 187 museums spread around the whole Czech Republic are used. The method for the evaluation of efficiency is data envelope analysis, and for identifying the influence of decentralized leadership, a regression analysis is used. Museums established by municipalities reach higher efficiency than museums established by regions and central government. The causes may be found in the ability to better estimate the local demand as well as in the rational behavior of municipalities that prefer a cost-minimization strategy. The benefits of decentralization cannot be seen only in the field of finance but also in reinforcing local traditions, trust and the effects of social capital that is generated by a strong regional cultural identity.

  10. School Finance in a Transformed Education System.

    Science.gov (United States)

    Pipho, Chris

    1992-01-01

    Discussion of the impact of systemic educational change on the school funding mechanism addresses the forces driving school finance and examines new outcome-driven funding models. The implications of decentralization of school districts are considered; and advantages, disadvantages, and implementation of voucher and incentive models are presented.…

  11. Health-resort fee and a stay in a health-resort hospital – comments based on the general interpretation of the Minister of Finance

    OpenAIRE

    Jacek Wantoch-Rekowski

    2016-01-01

    The publication presents the argumentation of the Minister of Finance included in the general interpretation of 3 October 2014 concerning the interpretation of Article 17 paragraph 2 clause 2 of the Act on Local Taxes and Fees. It was explained what was understood by the term “hospital” before 3 October 2014 and what changed in this subject after the general interpretation of the Minister of Finance was issued. It was emphasized that now the health-resort fee should not be charged from legal ...

  12. Richer but fatter: the unintended consequences of microcredit financing on household health and expenditure in Jamaica.

    Science.gov (United States)

    Gordon-Strachan, Georgiana; Cunningham-Myrie, Colette; Fox, Kristin; Kirton, Claremont; Fraser, Raphael; McLeod, Georgia; Forrester, Terrence

    2015-01-01

    To determine whether there was a difference in wealth and cardiovascular disease (CVD) risk between microcredit loan beneficiaries and community-matched non-beneficiaries (controls). Seven hundred and twenty-six households of microcredit loan beneficiaries were matched with 726 controls by age, sex and community. A standardised interviewer administered questionnaire was used to collect data on health and household expenditure. Weights, heights, waist circumference and blood pressure measurements were taken for an adult and one child (6-16 years) from each household. Amongst adults, there was no difference in the prevalence of pre-hypertension and hypertension. More male (68.1% vs. 47.8%) and female beneficiaries (84.5% vs. 77.9%) were overweight/obese. More male (17.2% vs. 7.1%; P < 0.05) and female beneficiaries (68.5% vs. 63.3%; P < 0.05) exhibited substantially increased risk for CVD. Children of beneficiaries displayed higher mean BMI-for-age z-scores than their control peers: males 0.56 [95% CI 0.40-0.72] vs. 0.18 [95% CI 0.02-0.35] (P < 0.001) and females 0.66 [95% CI 0.52-0.80] vs. 0.42 [95% CI 0.29-0.56] (P < 0.001). Based on BMI-for-age z-scores, children of beneficiaries had greater odds of being overweight/obese (OR = 1.46; 95% CI 1.18-1.82) Beneficiaries were economically better off; their mean total annual expenditure and house ownership were significantly higher than controls (P < 0.001). Microcredit financing is positively associated with wealth acquisition but worsened cardiovascular risk status. © 2014 John Wiley & Sons Ltd.

  13. Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in Spain

    National Research Council Canada - National Science Library

    Alvaro Hidalgo-Vega

    2017-01-01

    Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in SpainThe editorial addresses the current use of economic evaluation...

  14. Centralized versus Decentralized Provision of Local Public Goods: a Political Economy Analysis

    OpenAIRE

    Besley, Timothy J.; Coate, Stephen

    2000-01-01

    This paper takes a fresh look at the trade-off between centralized and decentralized provision of local public goods. The point of departure is to model a centralized system as one in which public spending is financed by general taxation, but districts can receive different levels of local public goods. In a world of benevolent governments, the disadvantages of centralization stressed in the existing literature disappear, suggesting that the case for decentralization must be driven by politic...

  15. Decentralized Portfolio Management

    Directory of Open Access Journals (Sweden)

    Benjamin Miranda Tabak

    2003-12-01

    Full Text Available We use a mean-variance model to analyze the problem of decentralized portfolio management. We find the solution for the optimal portfolio allocation for a head trader operating in n different markets, which is called the optimal centralized portfolio. However, as there are many traders specialized in different markets, the solution to the problem of optimal decentralized allocation should be different from the centralized case. In this paper we derive conditions for the solutions to be equivalent. We use multivariate normal returns and a negative exponential function to solve the problem analytically. We generate the equivalence of solutions by assuming that different traders face different interest rates for borrowing and lending. This interest rate is dependent on the ratio of the degrees of risk aversion of the trader and the head trader, on the excess return, and on the correlation between asset returns.

  16. Decentralized Constraint Satisfaction

    CERN Document Server

    Duffy, K R; Leith, D J

    2011-01-01

    Constraint satisfaction problems (CSPs) lie at the heart of many modern industrial and commercial tasks. An important new collection of CSPs has recently been emerging that differ from classical problems in that they impose constraints on the class of algorithms that can be used to solve them. In computer network applications, these constraints arise as the variables within the CSP are located at physically distinct devices that cannot communicate. At each instant, every variable only knows if all its constraints are met or at least one is not. Consequently, the CSP's solution must be found using a decentralized approach. Existing algorithms for solving CSPs are either centralized or distributed, both of which violate these algorithmic constraints. In this article we present the first algorithm for solving CSPs that fulfills these new requirements. It is fully decentralized, making no use of a centralized controller or message-passing between variables. We prove that this algorithm converges with probability ...

  17. Taking a Step Forward in Public Health Finance: Establishing Standards for a Uniform Chart of Accounts Crosswalk.

    Science.gov (United States)

    Honoré, Peggy A; Leider, Jonathon P; Singletary, Vivian; Ross, David A

    2015-01-01

    In its 2012 report on the current and future states of public health finance, the Institute of Medicine noted, with concern, the relative lack of capacity for practitioners and researchers alike to make comparisons between health department expenditures across the country. This is due in part to different accounting systems, service portfolios, and state- or agency-specific reporting requirements. The Institute of Medicine called for a uniform chart of accounts, perhaps building on existing efforts such as the Public Health Uniform National Data Systems (PHUND$). Shortly thereafter, a group was convened to work with public health practitioners and researchers to develop a uniform chart of accounts crosswalk. A year-long process was undertaken to create the crosswalk. This commentary discusses that process, challenges encountered along the way and provides a draft crosswalk in line with the Foundational Public Health Services model that, if used by health departments, could allow for meaningful comparisons between agencies.

  18. Policy Implementation Decentralization Government in Indonesia

    Directory of Open Access Journals (Sweden)

    Kardin M. Simanjuntak

    2015-06-01

    Full Text Available Decentralization in Indonesia is that reforms not completed and until the current implementation is not maximized or have not been successful. The essence of decentralization is internalising cost and benefit' for the people and how the government closer to the people. That's the most important essence of essence 'decentralization’. However, the implementation of decentralization in Indonesia is still far from the expectations. It is shown that only benefits of decentralization elite and local authorities, decentralization is a neo-liberal octopus, decentralization of public services are lacking in character, decentralization without institutional efficiency, decentralization fosters corruption in the area, and quasi-fiscal decentralization.

  19. Evidence on equity, governance and financing after health care reform in Mexico: lessons for Latin American countries

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    2015-06-01

    Full Text Available This article includes evidence on equity, governance and health financing outcomes of the Mexican health system. An evaluative research with a cross-sectional design was oriented towards the qualitative and quantitative analysis of financing, governance and equity indicators. Taking into account feasibility, as well as political and technical criteria, seven Mexican states were selected as study populations and an evaluative research was conducted during 2002-2010. The data collection techniques were based on in-depth interviews with key personnel (providers, users and community leaders, consensus technique and document analysis. The qualitative analysis was done with ATLAS TI and POLICY MAKER softwares. The Mexican health system reform has modified dependence at the central level; there is a new equity equation for resources allocation, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. Inequality on resources allocation in some regions and catastrophic expenditure for users is unequal in all states, producing more negative effects on states with high social marginalization. Special emphasis is placed on the analysis of the main strengths and weaknesses, as relevant evidences for other Latin American countries which are designing, implementing and evaluating reform strategies in order to achieve equity, good governance and a greater financial protection in health.

  20. Decentral Smart Grid Control

    Science.gov (United States)

    Schäfer, Benjamin; Matthiae, Moritz; Timme, Marc; Witthaut, Dirk

    2015-01-01

    Stable operation of complex flow and transportation networks requires balanced supply and demand. For the operation of electric power grids—due to their increasing fraction of renewable energy sources—a pressing challenge is to fit the fluctuations in decentralized supply to the distributed and temporally varying demands. To achieve this goal, common smart grid concepts suggest to collect consumer demand data, centrally evaluate them given current supply and send price information back to customers for them to decide about usage. Besides restrictions regarding cyber security, privacy protection and large required investments, it remains unclear how such central smart grid options guarantee overall stability. Here we propose a Decentral Smart Grid Control, where the price is directly linked to the local grid frequency at each customer. The grid frequency provides all necessary information about the current power balance such that it is sufficient to match supply and demand without the need for a centralized IT infrastructure. We analyze the performance and the dynamical stability of the power grid with such a control system. Our results suggest that the proposed Decentral Smart Grid Control is feasible independent of effective measurement delays, if frequencies are averaged over sufficiently large time intervals.

  1. Descentralização, universalidade e eqüidade nas reformas da saúde Decentralization, universal access, and equity in health reforms

    Directory of Open Access Journals (Sweden)

    Hésio Cordeiro

    2001-01-01

    Full Text Available Este artigo contextualiza as políticas aplicadas ao campo da saúde na década de 1990 a partir de dois eixos contraditórios: o mandato da Constituição Federal de 1988 e da Lei Orgânica da Saúde (LOAS de 1990; e a onda neoliberal que influenciou as reformas de Estado em toda a América Latina. O texto detalha os percursos e os percalços do setor saúde na implantação de uma agenda de descentralização fundamentada nos princípios constitucionais de universalização, eqüidade e participação cidadã. E conclui que a reforma da saúde, tal como prevista na LOAS, está se realizando com oscilações, avanços e recuos que traduzem ambigüidades, conflitos e contradições em relação às mudanças no papel do Estado brasileiro a partir da década de 1990. Ele perdeu sua capacidade de formular e implementar políticas nacionais de desenvolvimento, centrou-se no ajuste fiscal e está permeado pelas pressões da globalização do capital.This article analyzes Brazilian policies applied to the field of health in the 1990s from two contradictory angles: the mandate of the 1988 Federal Constitution and the 1990 National Health Act (LOAS on the one hand and the neoliberal wave that influenced public sector reforms throughout Latin America on the other. The paper discusses pathways and obstacles in the health sector during the implementation of a decentralization agenda based on the constitutional principles of universal access, equity, and citizens' participation. It concludes that the health reform provided for under the National Health Act is being achieved with ups and downs that express contradictions related to changes in the role of the Brazilian public sector beginning in the 1990s. The state lost its capacity to formulate and implement national development policies, focused on fiscal adjustment, and is permeated by pressure from globalization of capital.

  2. The 2010 U.S. health care reform: approaching and avoiding how other countries finance health care.

    Science.gov (United States)

    White, Joseph

    2013-07-01

    This article describes and analyzes the U.S. health care legislation of 2010 by asking how far it was designed to move the U.S. system in the direction of practices in all other rich democracies. The enacted U.S. reform could be described, extremely roughly, as Japanese pooling with Swiss and American problems at American prices. Its policies are distinctive, yet nevertheless somewhat similar to examples in other rich democracies, on two important dimensions: how risks are pooled and the amount of funds redistributed to subsidize care for people with lower incomes. Policies about compelling people to contribute to a finance system would be further from international norms, as would the degree to which coverage is set by clear and common substantive standards--that is, standardization of benefits. The reform would do least, however, to move the United States toward international practices for controlling spending. This in turn is a major reason why the results would include less standard benefits and incomplete coverage. In short, the United States would remain an outlier on coverage less because of a failure to make an effort to redistribute--a lack of solidarity--than due to a failure to control costs.

  3. Low Decision Space Means No Decentralization in Fiji

    Science.gov (United States)

    Faguet, Jean-Paul

    2016-01-01

    Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decision-making in five functional areas analysed remains highly centralized. They surmise that the benefits of decentralization in terms of services and outcomes will be limited. This paper invokes Faguet’s (2012) model of local government responsiveness and accountability to explain why this is so – not only for Fiji, but in any country that decentralizes workloads but not the decision space of local governments. A competitive dynamic between economic and civic actors that interact to generate an open, competitive politics, which in turn produces accountable, responsive government can only occur where real power and resources have been devolved to local governments. Where local decision space is lacking, by contrast, decentralization is bound to fail because it has not really happened in the first place. PMID:27801361

  4. The snow system: A decentralized medical data processing system.

    Science.gov (United States)

    Bellika, Johan Gustav; Henriksen, Torje Starbo; Yigzaw, Kassaye Yitbarek

    2015-01-01

    Systems for large-scale reuse of electronic health record data is claimed to have the potential to transform the current health care delivery system. In principle three alternative solutions for reuse exist: centralized, data warehouse, and decentralized solutions. This chapter focuses on the decentralized system alternative. Decentralized systems may be categorized into approaches that move data to enable computations or move computations to the where data is located to enable computations. We describe a system that moves computations to where the data is located. Only this kind of decentralized solution has the capabilities to become ideal systems for reuse as the decentralized alternative enables computation and reuse of electronic health record data without moving or exposing the information to outsiders. This chapter describes the Snow system, which is a decentralized medical data processing system, its components and how it has been used. It also describes the requirements this kind of systems need to support to become sustainable and successful in recruiting voluntary participation from health institutions.

  5. Medical Student Financing and the Armed Forces Health Professions Scholarship Program

    Science.gov (United States)

    1982-01-01

    Newark 6 California, Irvine 67 CMONJ-Rutgers, Piscataway I Lomow Lirda. Lomna Linda 8 Californi4. Los Angeleý NM 68 Nec Mexico . Plbuquerque 9 Southern...financing your medical school educacion this ear (76-77). Assume that you were eligible and that each of these alternatives had een available to you at

  6. Improving health services in India: a different perspective.

    Science.gov (United States)

    Schweitzer, Julian

    2008-01-01

    Two papers in this volume focus on public finance and decentralization as central to resolving India's systemic public health crisis. However, some states and districts have achieved success despite serious financial and administrative deficits; this suggests that factors such as political commitment, community participation, human resource management, women's empowerment, and governance may be as or more important. The success of the National Rural Health Mission will depend on state and local institutional capacity, including strong partnerships with civil society organizations and private-sector actors. Increased resources and decentralization will not be sufficient by themselves.

  7. Human trafficking, labor brokering, and mining in southern Africa: responding to a decentralized and hidden public health disaster.

    Science.gov (United States)

    Steele, Sarah

    2013-01-01

    Many southern African economies are dependent on the extractive industries. These industries rely on low-cost labor, often supplied by migrants, typically acquired through labor brokers. Very little attention has so far been paid to trafficking of men into extractive industries or its connection with trafficked women in the region's mining hubs. Recent reports suggest that labor-brokering practices foster human trafficking, both by exposing migrant men to lack of pay and exploitative conditions and by creating male migratory patterns that generate demand for sex workers and associated trafficking of women and girls. While trafficking in persons violates human rights, and thus remains a priority issue globally, there is little or no evidence of an effective political response to mine-related trafficking in southern Africa. This article concludes with recommendations for legal and policy interventions, as well as an enhanced public health response, which if implemented would help reduce human trafficking toward mining sites.

  8. Decentralization matters – Differently organized mental health services relationship to staff competence and treatment practice: the VELO study

    Directory of Open Access Journals (Sweden)

    Molvik Stian

    2009-05-01

    Full Text Available Abstract Background The VELO study is a comparative study of two Community Mental Health Centres (CMHC in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs. Methods 167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression. Results We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression. Conclusion The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed.

  9. Demand-side financing measures to increase maternal health service utilisation and improve health outcomes: a systematic review of evidence from low- and middle-income countries.

    Science.gov (United States)

    Murray, Susan F; Hunter, Benjamin M; Bisht, Ramila; Ensor, Tim; Bick, Debra

    2012-01-01

    In many countries financing for health services has traditionally been disbursed directly from governmental and non-governmental funding agencies to providers of services: the 'supply-side' of healthcare markets. Demand-side financing offers a supplementary model in which some funds are instead channelled through, or to, prospective users. In this review we considered evidence on five forms of demand-side financing that have been used to promote maternal health in developing countries: OBJECTIVES: The overall review objective was to assess the effects of demand-side financing interventions on maternal health service utilisation and on maternal health outcomes in low- and middle-income countries. Broader effects on perinatal and infant health, the situation of underprivileged women and the health care system were also assessed. This review considered poor, rural or socially excluded women of all ages who were either pregnant or within 42 days of the conclusion of pregnancy, the limit for postnatal care as defined by the World Health Organization. The review also considered the providers of services.The intervention of interest was any programme that incorporated demand-side financing as a mechanism to increase the consumption of goods and services that could impact on maternal health outcomes. This included the direct consumption of maternal health care goods and services as well as related 'merit goods' such as improved nutrition. We included systems in which potential users of maternal health services are financially empowered to make restricted decisions on buying maternal health-related goods or services - sometimes known as consumer-led demand-side financing. We also included programmes that provided unconditional cash benefits to pregnant women (for example in the form of maternity allowances), or to families with children under five years of age where there was evidence concerning maternal health outcomes.We aimed to include quantitative studies (experimental

  10. On Decentralization and Life Satisfaction

    DEFF Research Database (Denmark)

    Bjørnskov, Christian; Dreher, Axel; Fischer, Justina A.V.

    2008-01-01

    We empirically analyze the impact of fiscal and political decentralization on subjective well-being in a cross-section of 60,000 individuals from 66 countries. More spending or revenue decentralization raises well-being while greater local autonomy is beneficial only via government consumption...

  11. On Decentralization and Life Satisfaction

    DEFF Research Database (Denmark)

    Bjørnskov, Christian; Dreher, Axel; Fischer, Justina A.V.

    2008-01-01

    We empirically analyze the impact of fiscal and political decentralization on subjective well-being in a cross-section of 60,000 individuals from 66 countries. More spending or revenue decentralization raises well-being while greater local autonomy is beneficial only via government consumption...

  12. Trends in the distribution of health care financing across developed countries: the role of political economy of states.

    Science.gov (United States)

    Calikoglu, Sule

    2009-01-01

    Since the 1980s, major health care reforms in many countries have focused on redefining the boundaries of government through increasing emphasis on private sources of finance and delivery of health care. Apart from managerial and financial choices, the reliance on private sources reflects the political character of a country. This article explores whether the public-private mix of health care financing differs according to political traditions in a sample of 18 industrialized countries, analyzing a 30-year period. The results indicate that despite common trends in all four political traditions during the study period, the overall levels of expenditure and the rates of growth in public and private expenditures were different. Christian democratic countries had public expenditure levels as high as those in social democracies, but high levels of private expenditure differentiated them from the social democracies. Christian democratic countries also relied on both private insurance and out-of-pocket payments, while private insurance expenditures were very limited in social democratic countries. The level of public spending increased at much higher rates among ex-authoritarian countries over the 30 years, bringing these countries to the level of liberal countries by 2000.

  13. Development of Public School Finance in New York State. Occasional Paper #14.

    Science.gov (United States)

    Burke, Arvid J.

    Since the establishment of school districts in 1812, a number of inequalities in public school finance have emerged in New York State. These inequalities result from decentralization within the system as a whole, and large-scale centralization of New York City schools. In a decentralized system, where districts have taxing power, rich districts…

  14. Trends in scale and structure of Korea's health expenditure over last three decades (1980-2009): financing, functions and providers.

    Science.gov (United States)

    Jeong, Hyoung-Sun; Shin, Jeong-Woo

    2012-05-01

    This paper introduces statistics related to the size and composition of Korea's total health expenditure. The figures produced were tailored to the OECD's system of health accounts. Korea's total health expenditure in 2009 was estimated at 73.7 trillion won (US$ 57.7 billion). The annual per capita health expenditure was equivalent to US$ PPP 1,879. Korea's total health expenditure as a share of gross domestic product was 6.9% in 2009, far below the OECD average of 9.5%. Korea's public financing share of total health expenditure increased rapidly from less than 50% before 2000 to 58.2% in 2009. However, despite this growth, Korea's share remained the fourth lowest among OECD countries that had an average public share of 71.5%. Inpatient, outpatient, and pharmaceutical care accounted for 32.1%, 33.0%, and 23.7% of current health expenditure in 2009, respectively. A total of 41.1% of current health expenditure went to hospitals, 28.1% to providers of ambulatory healthcare (15.9% on doctor's clinics), and 17.9% to pharmacies. More investment in the translation of national health account data into policy-relevant information is suggested for future progress.

  15. The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries

    Directory of Open Access Journals (Sweden)

    Philip J. van der Wees

    2016-01-01

    Full Text Available Background Both rising healthcare costs and the global financial crisis have fueled a search for policy tools in order to avoid unsustainable future financing of essential health benefits. The scope of essential health benefits (the range of services covered and depth of coverage (the proportion of costs of the covered benefits that is covered publicly are corresponding variables in determining the benefits package. We hypothesized that a more comprehensive health benefit package may increase user costsharing charges. Methods We conducted a desktop research study to assess the interrelationship between the scope of covered health benefits and the height of statutory spending in a sample of 8 European countries: Belgium, England, France, Germany, the Netherlands, Scotland, Sweden, and Switzerland. We conducted a targeted literature search to identify characteristics of the healthcare systems in our sample of countries. We analyzed similarities and differences based on the dimensions of publicly financed healthcare as published by the European Observatory on Health Care Systems. Results We found that the scope of services is comparable and comprehensive across our sample, with only marginal differences. Cost-sharing arrangements show the most variation. In general, we found no direct interrelationship in this sample between the ranges of services covered in the health benefits package and the height of public spending on healthcare. With regard to specific services (dental care, physical therapy, we found indications of an association between coverage of services and cost-sharing arrangements. Strong variations in the volume and price of healthcare services between the 8 countries were found for services with large practice variations. Conclusion Although reducing the scope of the benefit package as well as increasing user charges may contribute to the financial sustainability of healthcare, variations in the volume and price of care seem to have

  16. Consumer-led demand side financing in health and education and its relevance for low and middle income countries.

    Science.gov (United States)

    Ensor, Tim

    2004-01-01

    There is increasing awareness that supply subsidies for health and education services often fail to benefit those that are most vulnerable in a community. This recognition has led to a growing interest in and experimentation with, consumer-led demand side financing systems (CL-DSF). These mechanisms place purchasing power in the hands of consumers to spend on specific services at accredited facilities. International evidence in education and health sectors suggest a limited success of CL-DSF in raising the consumption of key services amongst priority groups. There is also some evidence that vouchers can be used to improve targeting of vulnerable groups. There is very little positive evidence on the effect of CL-DSF on service quality as a consequence of greater competition. Location of services relative to population means that areas with more provider choice, particularly in the private sector, tend to be dominated by higher and middle-income households. Extending CL-DSF in low-income countries requires the development of capacity in administering these financing schemes and also accrediting providers. Schemes could focus primarily on fixed packages of key services aimed at easily identifiable groups. Piloting and robust evaluation is required to fill the evidence gap on the impact of these mechanisms. Extending demand financing to less predictable services, such as hospital coverage for the population, is likely to require the development of a voucher scheme to purchase insurance. This suggests an already developed insurance market and is unlikely to be appropriate in most low-income countries for some time.

  17. The impact of fiscal decentralization on infant mortality rates: evidence from OECD countries.

    Science.gov (United States)

    Jiménez-Rubio, Dolores

    2011-11-01

    This study re-examines the hypothesis that shifts towards more decentralization would be accompanied by improvements in population health on a panel of 20 OECD countries over a thirty year period (1970-2001). Decentralization is proxied using a conventional indicator of revenue decentralization and a new measure of fiscal decentralization that reflects better than previous measures the existence of autonomy in the decision-making authority of lower tiers of government, a crucial issue in the decentralization process. The results show a considerable and positive effect of fiscal decentralization on infant mortality only if a substantial degree of autonomy in the sources of revenue is devolved to local governments. The proportion of health care expenditure on GDP and, in particular, education, were found to have a larger contribution to the reduction of infant mortality in the sample of OECD countries analysed over the period of study.

  18. Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa.

    Science.gov (United States)

    Macha, Jane; Harris, Bronwyn; Garshong, Bertha; Ataguba, John E; Akazili, James; Kuwawenaruwa, August; Borghi, Josephine

    2012-03-01

    In Ghana, Tanzania and South Africa, health care financing is progressive overall. However, out-of-pocket payments and health insurance for the informal sector are regressive. The distribution of health care benefits is generally pro-rich. This paper explores the factors influencing these distributions in the three countries. Qualitative data were collected through focus group discussions and in-depth interviews with insurance scheme members, the uninsured, health care providers and managers. Household surveys were also conducted in all countries. Flat-rate contributions contributed to the regressivity of informal sector voluntary schemes, either by design (in Tanzania) or due to difficulties in identifying household income levels (in Ghana). In all three countries, the regressivity of out-of-pocket payments is due to the incomplete enforcement of exemption and waiver policies, partial or no insurance cover among poorer segments of the population and limited understanding of entitlements among these groups. Generally, the pro-rich distribution of benefits is due to limited access to higher level facilities among poor and rural populations, who rely on public primary care facilities and private pharmacies. Barriers to accessing health care include medical and transport costs, exacerbated by the lack of comprehensive insurance coverage among poorer groups. Service availability problems, including frequent drug stock-outs, limited or no diagnostic equipment, unpredictable opening hours and insufficient skilled staff also limit service access. Poor staff attitudes and lack of confidence in the skills of health workers were found to be important barriers to access. Financing reforms should therefore not only consider how to generate funds for health care, but also explicitly address the full range of affordability, availability and acceptability barriers to access in order to achieve equitable financing and benefit incidence patterns.

  19. Centralized versus Decentralized Information Systems

    Science.gov (United States)

    Hugoson, Mats-Åke

    This paper brings into question whether information systems should be centralized or decentralized in order to provide greater support for different business processes. During the last century companies and organizations have used different approaches for centralization and decentralization; a simple answer to the question does not exist. This paper provides a survey of the evolution of centralized and decentralized approaches, mainly in a Nordic perspective. Based on critical reflections on the situation in the end of the century we can discuss what we can learn from history to achieve alignment between centralized and decentralized systems and the business structure. The conclusion is that theories, management and practice for decisions on centralization or decentralization of information systems must be improved. A conscious management and control of centralization /decentralization of IT support is a vital question in the company or the organization, and this is not a task that can be handled only by IT-specialists. There is a need for business oriented IT management of centralization/decentralization.

  20. Consumer Finance

    OpenAIRE

    Peter Tufano

    2009-01-01

    Although consumer finance is a substantial element of the economy, it has had a smaller footprint within financial economics. In this review, I suggest a functional definition of the subfield of consumer finance, focusing on four key functions: payments, risk management, moving funds from today to tomorrow (saving/investing), and from tomorrow to today (borrowing). I provide data showing the economic importance of consumer finance in the American economy. I propose a historical explanation fo...

  1. Coalition or decentralization

    DEFF Research Database (Denmark)

    Mahdiraji, Hannan Amoozad; Govindan, Kannan; Zavadskas, Edmundas Kazimieras

    2014-01-01

    Supply chains have become the major and dominant paradigm of business and competition. The main challenge is how to act in multi-echelon supply chains considering the levels involved. Making a choice independently or integrating with some or all levels will be a critical decision, and therefore...... affects the overall profit of the chain. This article proposes a non-cooperative game theory approach to helping in making a better decision in the supply chain and gaining the most accessible benefit. Our research considers unlimited three-echelon supply chains with S suppliers, M manufacturers and K...... retailers. The Nash equilibrium and definition are used bearing in mind inventory and pricing and marketing cost as decision variables for this matter. This paper studies a three-echelon supply chain network and focuses on the value of integrating a pair of partners in the chain. In the decentralized case...

  2. Coalition or decentralization

    DEFF Research Database (Denmark)

    Mahdiraji, Hannan Amoozad; Govindan, Kannan; Zavadskas, Edmundas Kazimieras

    2014-01-01

    retailers. The Nash equilibrium and definition are used bearing in mind inventory and pricing and marketing cost as decision variables for this matter. This paper studies a three-echelon supply chain network and focuses on the value of integrating a pair of partners in the chain. In the decentralized case...... affects the overall profit of the chain. This article proposes a non-cooperative game theory approach to helping in making a better decision in the supply chain and gaining the most accessible benefit. Our research considers unlimited three-echelon supply chains with S suppliers, M manufacturers and K......, the supplier sets its own price, the manufacturer points out order quantity, wholesale price and backorder quantity, and the retailer charges the final retail price of the product and marketing product. Though there are multiple players at a single echelon level, each manufacturer supplies only a specific...

  3. Twelve months of implementation of health care performance-based financing in Burkina Faso: A qualitative multiple case study.

    Science.gov (United States)

    Ridde, Valéry; Yaogo, Maurice; Zongo, Sylvie; Somé, Paul-André; Turcotte-Tremblay, Anne-Marie

    2017-07-03

    To improve health services' quantity and quality, African countries are increasingly engaging in performance-based financing (PBF) interventions. Studies to understand their implementation in francophone West Africa are rare. This study analysed PBF implementation in Burkina Faso 12 months post-launch in late 2014. The design was a multiple and contrasted case study involving 18 cases (health centres). Empirical data were collected from observations, informal (n = 224) and formal (n = 459) interviews, and documents. Outside the circle of persons trained in PBF, few in the community had knowledge of it. In some health centres, the fact that staff were receiving bonuses was intentionally not announced to populations and community leaders. Most local actors thought PBF was just another project, but the majority appreciated it. There were significant delays in setting up agencies for performance monitoring, auditing, and contracting, as well as in the payment. The first audits led rapidly to coping strategies among health workers and occasionally to some staging beforehand. No community-based audits had yet been done. Distribution of bonuses varied from one centre to another. This study shows the importance of understanding the implementation of public health interventions in Africa and of uncovering coping strategies. © 2017 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

  4. The cost of free health care for all Kenyans: assessing the financial sustainability of contributory and non-contributory financing mechanisms.

    Science.gov (United States)

    Okungu, Vincent; Chuma, Jane; McIntyre, Di

    2017-02-27

    The need to provide quality and equitable health services and protect populations from impoverishing health care costs has pushed universal health coverage (UHC) to the top of global health policy agenda. In many developing countries where the majority of the population works in the informal sector, there are critical debates over the best financing mechanisms to progress towards UHC. In Kenya, government health policy has prioritized contributory financing strategy (social health insurance) as the main financing mechanism for UHC. However, there are currently no studies that have assessed the cost of either social health insurance (SHI) as the contributory approach or an alternative financing mechanism involving non-contributory (general tax funding) approaches to UHC in Kenya. The aim of this study was to critically assess the financial requirements of both contributory and non-contributory mechanisms to financing UHC in Kenya in the context of large informal sector populations. SimIns Basic® model, Version 2.1, 2008 (WHO/GTZ), was used to assess the feasibility of UHC in Kenya and provide estimates of financial resource needs for UHC over a 17-year period (2013-2030). Data sources included review of national and international literature on inflation, demography, macro-economy, health insurance, health services unit costs and utilization rates. The data were triangulated across geographic regions for accuracy and integrity of the simulation. SimIns models for 10 years only so data from the final year of the model was used to project for another 7 years. The 17-year period was necessary because the Government of Kenya aims to achieve UHC by 2030. The results show that SHI is financially sustainable (Sustainability in this study is used to mean that expenditure does not outstrip revenue.) (revenues and expenditure match) within the first five years of implementation, but it becomes less sustainable with time. Modelling for a non-contributory scenario, on the

  5. Restructuring brain drain: strengthening governance and financing for health worker migration

    OpenAIRE

    2013-01-01

    Background: Health worker migration from resource-poor countries to developed countries, also known as ‘‘brain drain’’, represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses.Methods: Using acceptable methods of policy analysis, we first assess c...

  6. Health and economic benefits of public financing of epilepsy treatment in India: An agent-based simulation model.

    Science.gov (United States)

    Megiddo, Itamar; Colson, Abigail; Chisholm, Dan; Dua, Tarun; Nandi, Arindam; Laxminarayan, Ramanan

    2016-03-01

    An estimated 6-10 million people in India live with active epilepsy, and less than half are treated. We analyze the health and economic benefits of three scenarios of publicly financed national epilepsy programs that provide: (1) first-line antiepilepsy drugs (AEDs), (2) first- and second-line AEDs, and (3) first- and second-line AEDs and surgery. We model the prevalence and distribution of epilepsy in India using IndiaSim, an agent-based, simulation model of the Indian population. Agents in the model are disease-free or in one of three disease states: untreated with seizures, treated with seizures, and treated without seizures. Outcome measures include the proportion of the population that has epilepsy and is untreated, disability-adjusted life years (DALYs) averted, and cost per DALY averted. Economic benefit measures estimated include out-of-pocket (OOP) expenditure averted and money-metric value of insurance. All three scenarios represent a cost-effective use of resources and would avert 800,000-1 million DALYs per year in India relative to the current scenario. However, especially in poor regions and populations, scenario 1 (which publicly finances only first-line therapy) does not decrease the OOP expenditure or provide financial risk protection if we include care-seeking costs. The OOP expenditure averted increases from scenarios 1 through 3, and the money-metric value of insurance follows a similar trend between scenarios and typically decreases with wealth. In the first 10 years of scenarios 2 and 3, households avert on average over US$80 million per year in medical expenditure. Expanding and publicly financing epilepsy treatment in India averts substantial disease burden. A universal public finance policy that covers only first-line AEDs may not provide significant financial risk protection. Covering costs for both first- and second-line therapy and other medical costs alleviates the financial burden from epilepsy and is cost-effective across wealth

  7. From State Control to Governance: Decentralization and Higher Education in Guangdong, China.

    Science.gov (United States)

    Mok, Joshua Ka-Ho

    2001-01-01

    Examines how the policy of decentralization has affected the governance of universities in Guangdong, China. Focuses on the reform of the financing and management structure, the merging of universities, and joint development programs to enhance competitiveness. Asserts that the state role as a regulator has actually been strengthened. (Contains 79…

  8. Decentralization Calls for Internal Audits.

    Science.gov (United States)

    DiCello, Jim

    1995-01-01

    Outlines internal-auditing strategies necessitated by decentralization. Describes the following areas of concern: the student activities account, student attendance, and funding delegated to the site level. Guidelines for conducting an internal audit are also included. (LMI)

  9. Decentralization Calls for Internal Audits.

    Science.gov (United States)

    DiCello, Jim

    1995-01-01

    Outlines internal-auditing strategies necessitated by decentralization. Describes the following areas of concern: the student activities account, student attendance, and funding delegated to the site level. Guidelines for conducting an internal audit are also included. (LMI)

  10. Regional Development and Decentralization – two Options to Overcome Lack of Funding

    Directory of Open Access Journals (Sweden)

    Dubravka JURLINA ALIBEGOVIC

    2014-11-01

    Full Text Available Decentralization can be generally described as a process in which selected functions are assigned to sub-national units. The literature identifies a number of positive consequences of decentralization which all lead to a better satisfaction of citizens’ needs for public services. Although the decentralization process in Croatia started more than ten years ago, it has not yet been completed. While leading to a new allocation of authorities and responsibilities to local government units, the level of fiscal decentralization remained lower than in the EU countries.In this paper we analyze the fiscal capacity of local government units to provide an insight into the main problems of decentralization in Croatia. We show that most local government units have very low fiscal capacity, which is insufficient for financing basic public functions with their own resources. The paper presents the results of a survey relating to the decentralization process conducted among local councilors at the regional level in Croatia. We explore how local councilors at the regional level evaluate different goals of decentralization. With the lack of fiscal capacity in mind, we identify two possible solutions for an optimal provision of public functions. The first one is the level of political will for a joint provision of public functions by different local units, and the second one is a change in the territorial organization of the country. We measure the difference in the attitudes toward these questions across counties.

  11. Behavioral finance

    Directory of Open Access Journals (Sweden)

    Kapor Predrag

    2014-01-01

    Full Text Available This paper discuss some general principles of behavioral finance Behavioral finance is the dynamic and promising field of research that mergers concepts from financial economics and cognitive psychology in attempt to better understand systematic biases in decision-making process of financial agents. While the standard academic finance emphasizes theories such as modern portfolio theory and the efficient market hypothesis, the behavioral finance investigates the psychological and sociological issues that impact the decision-making process of individuals, groups and organizations. Most of the research behind behavioral finance has been empirical in nature, concentrating on what people do and why. The research has shown that people do not always act rationally, nor they fully utilise all information available to them.

  12. The effect of financing hospital health care providers through updated Diagnosis Related Groups. Case studies: the municipal hospitals in Romania

    Directory of Open Access Journals (Sweden)

    Emil OLTEANU

    2014-11-01

    Full Text Available In our scientific approach we tried to develop a model with which to highlight the effect of financing hospital health care providers using the hospital 's Diagnosis Related Groups (DRG and Mean Relative Values (MRV. The econometric model used is simple linear regression model form. Development of the model was performed by using the EViews 7 to the municipal hospitals in Romania during 2010 - 2012, being considered DRG dependent variable and independent variables: C and MRV. Analyzing in detail the results recorded by providers following simple regression model is observed that there are units which, although recorded low values in the number of patients discharged, they were able to achieve a relatively high VRM or to contract a level of TAC over average of the entire sample.

  13. Organisation and financing of the health care systems of Bulgaria and Greece – what are the parallels?

    Directory of Open Access Journals (Sweden)

    Exadaktylos Nikolaos M

    2005-05-01

    Full Text Available Abstract Background The Bulgarian and Greek Medical Care systems have been reformated the last fifteen years. The aim of this study was an examination and comparison of the Bulgarian and Greek Medical Care Systems. Methods This study was prepared by using all the published data related to both Bulgarian and Greek Medical Care systems. Besides, personal communications with related offices such as administration offices of hospitals and Ministries of Health were made. Results In both countries, besides the compulsory insurance there is also additional voluntary insurance which is provided by private companies. The most important difference is the family doctor (specialist in general medicine existing in Bulgaria. Every insured person needs a 'referral form' completed by the family doctor before visiting a hospital for medical attention (except emergencies. In contrast, in Greece an insured person can directly visit any hospital without needing any forms and independent of the severity of their health problem. An important disadvantage of the Greek health system is the low number of hospitals (139, in relation to population. In contrast, there are 211 hospitals in Bulgaria, although its population is lower than in Greece. Conclusion In both Greek and Bulgarian health systems changes must be done to solve the problems related to informal payments, limited financing, large debts, lack of appropriate investment policy, lack of an objective method for the costing of medical activities and inefficient management.

  14. Financing Investment

    DEFF Research Database (Denmark)

    Hirth, Stefan; Flor, Christian Riis

    Intuition suggests that corporate investment should be decreasing in financing constraints. We show that even when financing is obtained using a standard debt contract and there is symmetric information between the firm and outside investors, the relation is actually U-shaped. We thus provide a new...... theoretical explanation for the recent empirical findings of Cleary et al. (2007). We split up the endogenously implied financing costs and propose a trade-off between expected liquidation costs and second-best investment costs. For rather unconstrained firms, the risk of costly liquidation dominates the cost...

  15. Terrorist financing beyond 9/11

    OpenAIRE

    Loretta Napoleoni

    2007-01-01

    This article analyzes the impact of counter-terrorism policies, e.g., the Patriot Act and the war in Iraq, on the financial structure of European terror networks and argues that such policies, far from defeating Jihadist activities, ended up boosting them. In response to such measures, terror finances have been skillfully restructured, the main changes being the decentralization of funding activity in Europe and in the Middle East and the declining cost of terrorist attacks.

  16. Procedures and Criteria for the regulation of innovative non-medicinal technologies into the benefit catalogue of solidly financed health care insurances

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2007-01-01

    Full Text Available Because great interest in an efficient range of effective medicinal innovations and achievements has arisen, many countries have introduced procedures to regulate the adoption of innovative non-medicinal technologies into the benefit catalogue of solidly financed health care insurances. With this as a background, this report will describe procedures for the adoption of innovative non-medicinal technologies by solidly financed health care insurances in Germany, England, Australia and Switzerland. This report was commissioned by the German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information.In order to find the relevant literature and information, systematic literature research, a hand search and a written survey were carried out. All the selected documents (chosen according to defined criteria for inclusion and exclusion were qualitatively evaluated, summarized and presented on a chart using a framework developed for this purpose. All the countries in this report require that some innovative non-medicinal technologies undergo evaluation by a central governing body. This evaluation is a prerequisite for adoption into the benefit catalogue. The process of evaluation can differ (e. g. the people and institutions concerned, the division of the synthesis of evidence and overall evaluation, processing the evidence. Similarities do exist, such as the size and composition of the governing bodies or the overreaching criteria according to which institutions must make their recommendations. This is how all the countries examined in this report determine how the benefits and effectiveness of the innovations, as well as their cost-effectiveness, can be chosen as criteria for the evaluation. Furthermore, there are many criteria which differ from country to country (social and ethical aspects, possible effects on the health system, etc. and which are also relevant to an evaluation. The preferred types of

  17. Hospital-based home health: weighing finances and philosophy of care.

    Science.gov (United States)

    Yarkony, Lisa

    2010-02-01

    As we begin a new decade, hospital-based home health agencies have been waning over the last one, and for a number of reasons. An examination of hospital-based home health since its beginnings in this country yields some answers, but also reveals the importance of many of these home health programs in the communities they serve. There are often more components to consider when weighing the value of these programs than financial statements alone can illuminate.

  18. 某省卫生筹资系统公平性案例研究%Case Study on Equity of Health Financing System in a Province

    Institute of Scientific and Technical Information of China (English)

    杨学来; 徐凌忠; 张毓辉

    2013-01-01

      目的:测量和分析某省卫生筹资系统公平性。方法:根据卫生筹资公平系统框架,利用某省第四次家庭卫生服务调查数据从卫生资金筹集公平、资金分配公平和筹资风险保护3个维度简要分析该省卫生筹资公平性状况。结果:某省综合卫生筹资Kakwani指数为0.0345,卫生资金筹集具有累进性,但存在公共筹资比重不高、不同人群医疗保障水平存在差异的问题;政府补助分布向富裕人群倾斜,低收入人群受益较少;与筹资和受益公平状况相对应,该省18.32%的家庭发生灾难性卫生支出,3.67%的人因为就医花费陷入贫困。结论:某省在筹资风险保护方面需要进一步改善。%Objective:To measure and analyze the equity of health financing system in a province. Methods:Analyzing the status of health financing equity in a province under the systematic framework of health financing equity. Equity in health financing, allocation equity and financial risk protection were analyzed using related quantitative methods based on the 4th Household Health Survey data. Results: The Kakwani Index for overall health financing is 0.034 5 indicating a progressive financing, but there are differences in the level of health security among different population groups at different economic levels as well as relative low share of public finance;more government subsidy was allocated to richer people and the low-income people benefit lower; the catastrophic payment headcount was 18.32% and 3.67% the patients were pushed into poverty due to out-of-pocket payment. Conclusion: Financial risk protection should be further improved in a province.

  19. The Effect of Fiscal Decentralization on Under-five Mortality in Iran: A Panel Data Analysis.

    Science.gov (United States)

    Samadi, Ali Hussein; Keshtkaran, Ali; Kavosi, Zahra; Vahedi, Sajad

    2013-11-01

    Fiscal Decentralization (FD) in many cases is encouraged as a strong means of improving the efficiency and equity in the provision of public goods, such as healthcare services. This issue has urged the researchers to experimentally examine the relationship between fiscal decentralization indicators and health outcomes. In this study we examine the effect of Fiscal Decentralization in Medical Universities (FDMU) and Fiscal Decentralization in Provincial Revenues (FDPR) on Under-Five Mortality Rate (U5M) in provinces of Iran over the period between 2007 and 2010. We employed panel data methods in this article. The results of the Pesaran CD test demonstrated that most of the variables used in the analysis were cross-sectionally dependent. The Hausman test results suggested that fixed-effects were more appropriate to estimate our model. We estimated the fixed-effect model by using Driscoll-Kraay standard errors as a remedy for cross-sectional dependency. According to the findings of this research, fiscal decentralization in the health sector had a negative impact on U5M. On the other hand, fiscal decentralization in provincial revenues had a positive impact on U5M. In addition, U5M had a negative association with the density of physicians, hospital beds, and provincial GDP per capita, but a positive relationship with Gini coefficient and unemployment. The findings of our study indicated that fiscal decentralization should be emphasized in the health sector. The results suggest the need for caution in the implementation of fiscal decentralization in provincial revenues.

  20. Donor Financing of Global Mental Health, 1995—2015: An Assessment of Trends, Channels, and Alignment with the Disease Burden

    Science.gov (United States)

    Dieleman, J.; Singh, L.; Whiteford, H. A.

    2017-01-01

    Background A recent report by the Institute for Health Metrics and Evaluation (IHME) highlights that mental health receives little attention despite being a major cause of disease burden. This paper extends previous assessments of development assistance for mental health (DAMH) in two significant ways; first by contrasting DAMH against that for other disease categories, and second by benchmarking allocated development assistance against the core disease burden metric (disability-adjusted life year) as estimated by the Global Burden of Disease Studies. Methods In order to track DAH, IHME collates information from audited financial records, project level data, and budget information from the primary global health channels. The diverse set of data were standardised and put into a single inflation adjusted currency (2015 US dollars) and each dollar disbursed was assigned up to one health focus areas from 1990 through 2015. We tied these health financing estimates to disease burden estimates (DALYs) produced by the Global Burden of Disease 2015 Study to calculated a standardised measure across health focus areas—development assistance for health (in US Dollars) per DALY. Findings DAMH increased from USD 18 million in 1995 to USD 132 million in 2015, which equates to 0.4% of total DAH in 2015. Over 1990 to 2015, private philanthropy was the most significant source (USD 435 million, 30% of DAMH), while the United States government provided USD 270 million of total DAMH. South and Southeast Asia received the largest proportion of funding for mental health in 2013 (34%). DAMH available per DALY in 2013 ranged from USD 0.27 in East Asia and the Pacific to USD 1.18 in the Middle East and North Africa. HIV/AIDS received the largest ratio of funds to burden—approximately USD150 per DALY in 2013. Mental and substance use disorders and its broader category of non-communicable disease received less than USD1 of DAH per DALY. Interpretation Combining estimates of disease burden

  1. Provincial Health Accounts in Kerman, Iran: An Evidence of a “Mixed” Healthcare Financing System

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Mehrolhassani

    2014-02-01

    Full Text Available Background Provincial Health Accounts (PHA as a subset of National Health Accounts (NHA present financial information for health sectors. It leads to a logical decision making for policy-makers in order to achieve health system goals, especially Fair Financial Contribution (FFC. This study aimed to examine Health Accounts in Kerman Province. Methods The present analytical study was carried out retrospectively between 2008 and 2011. The research population consisted of urban and rural households as well as providers and financial agents in health sectors of Kerman Province. The purposeful sampling included 16 provincial organizations. To complete data, the report on Kerman household expenditure was taken as a data source from the Governor-General’s office. In order to classify the data, the International Classification for Health Accounts (ICHA method was used, in which data set was adjusted for the province. Results During the study, the governmental and non-governmental fund shares of the health sector in Kerman were 27.22% and 72.78% respectively. The main portion of financial sources (59.41 was related to private household funds, of which the Out-of-Pocket (OOP payment mounted to 92.35%. Overall, 54.86% of all financial sources were covered by OOP. The greatest portion of expenditure of Total Healthcare Expenditures (THEs (65.19% was related to curative services. Conclusion The major portion of healthcare expenditures was related to the OOP payment which is compatible with the national average rate in Iran. However, health expenditure per capita, was two and a half times higher than the national average. By performing the Family Physician Program (FPP and emphasizing Social Determinant of Health (SDH approach in the Iranian health system, the portion of OOP payment and curative expenditure are expected to be controlled in the medium term. It is suggested that PHA should be examined annually in a more comprehensive manner to monitor

  2. Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso.

    Science.gov (United States)

    Ridde, Valéry; Turcotte-Tremblay, Anne-Marie; Souares, Aurélia; Lohmann, Julia; Zombré, David; Koulidiati, Jean Louis; Yaogo, Maurice; Hien, Hervé; Hunt, Matthew; Zongo, Sylvie; De Allegri, Manuela

    2014-10-12

    The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications. The study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods. Performance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.

  3. International Study of Health Care Organization and Financing of renal services in England and Wales.

    Science.gov (United States)

    Nicholson, Tricia; Roderick, Paul

    2007-12-01

    In England and Wales, the quantity and quality of renal services have improved significantly in the last decade. While acceptance rates for renal replacement therapy appear low by international standards, they are now commensurate with many other northern European countries. The major growth in renal services has been in hemodialysis, especially at satellite units. Health care is predominantly publicly funded through a tax-based National Health Service, and such funding has increased in the last 10 years. Improvements in health outcomes in England and Wales are expected to continue due to the recent implementation of standards, initiatives, and monitoring mechanisms for renal transplantation, vascular access, and patient transport.

  4. The Impact of the Aging Population on the Health Care Financing

    OpenAIRE

    Schejbal, Radek

    2014-01-01

    The population ageing is a phenomenon that appears sooner or later in any population. In the Czech Republic this process has intensively been going on since the end of the last century and it will continue in this century. My thesis reveals possible impacts of this development on services providing health care. It is estimated that the changing demographic structure of the population in the Czech Republic will significantly affect the revenues and the expenses of health insurance companies. T...

  5. Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation.

    Science.gov (United States)

    Witter, Sophie; Toonen, Jurrien; Meessen, Bruno; Kagubare, Jean; Fritsche, György; Vaughan, Kelsey

    2013-09-29

    Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars. All of these are also framed within

  6. Health and Climate-Relevant Pollutant Concentrations from a Carbon-Finance Approved Cookstove Intervention in Rural India.

    Science.gov (United States)

    Aung, Ther W; Jain, Grishma; Sethuraman, Karthik; Baumgartner, Jill; Reynolds, Conor; Grieshop, Andrew P; Marshall, Julian D; Brauer, Michael

    2016-07-05

    Efforts to introduce more efficient stoves increasingly leverage carbon-finance to scale up dissemination of interventions. We conducted a randomized intervention study to evaluate a Clean Development Mechanism approved stove replacement impact on fuelwood usage, and climate and health-relevant air pollutants. We randomly assigned 187 households to either receive the intervention or to continue using traditional stoves. Measurements of fine particulate matter (PM2.5) and absorbance were conducted in cooking areas, village center and at upwind background site. There were minor and overlapping seasonal differences (post- minus preintervention change) between control and intervention groups for median (95% CI) fuel use (-0.60 (-1.02, -0.22) vs -0.52 (-1.07, 0.00) kg day(-1)), and 24 h absorbance (35 (18, 60) vs 36 (22, 50) × 10(-6) m(-1)); for 24 h PM2.5, there was a higher (139 (61,229) vs 73(-6, 156) μg m(-3))) increase in control compared to intervention homes between the two seasons. Forty percent of the intervention homes continued using traditional stoves. For intervention homes, absorbance-to-mass ratios suggest a higher proportion of black carbon in PM2.5 emitted from intervention compared with traditional stoves. Absent of field-based evaluation, stove interventions may be pursued that fail to realize expected carbon reductions or anticipated health and climate cobenefits.

  7. Partial decentralization as a safeguard against favoritism

    OpenAIRE

    Cortés Cortés, Darwin Fauricio

    2010-01-01

    In this paper I investigate the optimal level of decentralization of tasks for the provision of a local public good. I enrich the well-known trade-off between internalization of spillovers (that favors centralization) and accountability (that favors decentralization) by considering that public goods are produced through multiple tasks. This adds an additional institutional setting, partial decentralization, to the classical choice between full decentralization and full centralization. The mai...

  8. An evaluation of two large scale demand side financing programs for maternal health in India: the MATIND study protocol.

    Science.gov (United States)

    Sidney, Kristi; de Costa, Ayesha; Diwan, Vishal; Mavalankar, Dileep V; Smith, Helen

    2012-08-27

    High maternal mortality in India is a serious public health challenge. Demand side financing interventions have emerged as a strategy to promote access to emergency obstetric care. Two such state run programs, Janani Suraksha Yojana (JSY)and Chiranjeevi Yojana (CY), were designed and implemented to reduce financial access barriers that preclude women from obtaining emergency obstetric care. JSY, a conditional cash transfer, awards money directly to a woman who delivers in a public health facility. This will be studied in Madhya Pradesh province. CY, a voucher based program, empanels private obstetricians in Gujarat province, who are reimbursed by the government to perform deliveries of socioeconomically disadvantaged women. The programs have been in operation for the last seven years. The study outlined in this protocol will assess and compare the influence of the two programs on various aspects of maternal health care including trends in program uptake, institutional delivery rates, maternal and neonatal outcomes, quality of care, experiences of service providers and users, and cost effectiveness. The study will collect primary data using a combination of qualitative and quantitative methods, including facility level questionnaires, observations, a population based survey, in-depth interviews, and focus group discussions. Primary data will be collected in three districts of each province. The research will take place at three levels: the state health departments, obstetric facilities in the districts and among recently delivered mothers in the community. The protocol is a comprehensive assessment of the performance and impact of the programs and an economic analysis. It will fill existing evidence gaps in the scientific literature including access and quality to services, utilization, coverage and impact. The implementation of the protocol will also generate evidence to facilitate decision making among policy makers and program managers who currently work with or

  9. An evaluation of two large scale demand side financing programs for maternal health in India: the MATIND study protocol

    Directory of Open Access Journals (Sweden)

    Sidney Kristi

    2012-08-01

    Full Text Available Abstract Background High maternal mortality in India is a serious public health challenge. Demand side financing interventions have emerged as a strategy to promote access to emergency obstetric care. Two such state run programs, Janani Suraksha Yojana (JSYand Chiranjeevi Yojana (CY, were designed and implemented to reduce financial access barriers that preclude women from obtaining emergency obstetric care. JSY, a conditional cash transfer, awards money directly to a woman who delivers in a public health facility. This will be studied in Madhya Pradesh province. CY, a voucher based program, empanels private obstetricians in Gujarat province, who are reimbursed by the government to perform deliveries of socioeconomically disadvantaged women. The programs have been in operation for the last seven years. Methods/designs The study outlined in this protocol will assess and compare the influence of the two programs on various aspects of maternal health care including trends in program uptake, institutional delivery rates, maternal and neonatal outcomes, quality of care, experiences of service providers and users, and cost effectiveness. The study will collect primary data using a combination of qualitative and quantitative methods, including facility level questionnaires, observations, a population based survey, in-depth interviews, and focus group discussions. Primary data will be collected in three districts of each province. The research will take place at three levels: the state health departments, obstetric facilities in the districts and among recently delivered mothers in the community. Discussion The protocol is a comprehensive assessment of the performance and impact of the programs and an economic analysis. It will fill existing evidence gaps in the scientific literature including access and quality to services, utilization, coverage and impact. The implementation of the protocol will also generate evidence to facilitate decision making

  10. Decentralized Decision-Making. ERS Information Aid.

    Science.gov (United States)

    Powell, Janet F.

    In this paper, the current debate over decentralized decisionmaking is highlighted and facts, figures, and models based on a recent nationwide survey are presented. Decentralization in decisionmaking is defined as the involvement of building-level principals in district-wide decisions. Advantages and disadvantages of decentralization, the nature…

  11. Rethinking Partnerships on a Decentralized Campus

    Science.gov (United States)

    Dufault, Katie H.

    2017-01-01

    Decentralization is an effective approach for structuring campus learning and success centers. McShane & Von Glinow (2007) describe decentralization as "an organizational model where decision authority and power are dispersed among units rather than held by a single small group of administrators" (p. 237). A decentralized structure…

  12. Capitation-Based Financing Hampers the Provision of Preventive Services in Primary Health Care

    Science.gov (United States)

    Sándor, János; Kósa, Karolina; Papp, Magor; Fürjes, Gergő; Kőrösi, László; Jakovljevic, Mihajlo; Ádány, Róza

    2016-01-01

    Mortality caused by non-communicable diseases has been extremely high in Hungary, which can largely be attributed to not performed preventive examinations (PEs) at the level of primary health care (PHC). Both structures and financial incentives are lacking, which could support the provision of legally defined PEs. A Model Programme was launched in Hungary in 2012 to adapt the recommendations for PHC of the World Health Organization. A baseline survey was carried out to describe the occurrence of not performed PEs. A sample of 4320 adults representative for Hungary by age and gender was surveyed. Twelve PEs to be performed in PHC as specified by a governmental decree were investigated and quantified. Not performed PEs per person per year with 95% confidence intervals were computed for age, gender, and education strata. The number of not performed PEs for the entire adult population of Hungary was estimated and converted into expenses according to the official reimbursement costs of the National Health Insurance Fund. The rate of service use varied between 16.7 and 70.2%. There was no correlation between the unit price of examinations and service use (r = 0.356; p = 0.267). The rate of not performed PEs was not related to gender, but older age and lower education proved to be risk factors. The total number of not performed PEs was over 17 million in the country. Of the 31 million euros saved by not paying for PEs, the largest share was not spent on those in the lowest educational category. New preventive services offered in the reoriented PHC model program include systematic and scheduled health examination health promotion programs at community settings, risk assessment followed by individual or group care, and/or referral and chronic care. The Model Programme has created a pressure for collaborative work, consultation, and engagement at each level, from the GPs and health mediators up to the decision-making level. It channeled the population into preventive

  13. Financing Investment

    DEFF Research Database (Denmark)

    Hirth, Stefan; Flor, Christian Riis

    Intuition suggests that corporate investment should be decreasing in financing constraints. We show that even when financing is obtained using a standard debt contract and there is symmetric information between the firm and outside investors, the relation is actually U-shaped. We thus provide a new...... theoretical explanation for the recent empirical findings of Cleary et al. (2007). We split up the endogenously implied financing costs and propose a trade-off between expected liquidation costs and second-best investment costs. For rather unconstrained firms, the risk of costly liquidation dominates the cost...... of underinvestment and, hence, induces cutting down investment. On the other hand, severely constrained firms benefit more by getting closer to the first-best investment implying higher investment....

  14. La reforma del sector salud, descentralización, prevención y control de enfermedades transmitidas por vectores Health system, decentralization, and the control of vector-borne diseases

    Directory of Open Access Journals (Sweden)

    Gabriel A. Schmunis

    2000-01-01

    Full Text Available Con las nuevas macropolíticas mundiales, la salud en América Latina ha sufrido importante transición en direción a la decentralización, sin compatibilizar la salud pública con la lógica de las economías de mercado. Con esto, el control decentralizado de las enfermedades endémicas presenta dificultades políticas y operativas. Aunque la decentralización se justifica por los presupuestos teóricos, no hay tradición de este control en los niveles municipales, lo que dificulta la simple o burocrática transferencia de encargos para estos niveles. La falta de expertise, el turn-over político y la corrupción son dificultades adicionales, conllevando a una extinción de varias instituiciones y programas. La falta de efectividad en el enfrentamiento del dengue, de la malaria y de la enfermedad de Chagas son algunos ejemplos. Requierese una modernización con responsabilidad, con una transición compartida entre los niveles y garantizada por acciones continuadas. Sugierese mantener estructuras regionales para referencia, consolidación epidemiológica, normatización, capacitación y supervisión, incluso con reserva técnica para acciones finalísticas supletivas.Economic policies are changing Latin American health programs, particularly promoting decentralization. Numerous difficulties thus arise for the control of endemic diseases, since such activities traditionally depend on vertical, and centralized structures. Theoretical arguments in favor of decentralization notwithstanding, no such tradition exists at the county level. The lack of program expertise at peripheral levels, intensive staff turnover, and even corruption are additional difficulties. Hence, the simple bureaucratic transfer of activities from the Federal to county level is often irresponsible. The loss of priority for control of endemic diseases in Latin America may mean the inexorable extinction of traditional control services. Malaria, dengue fever, and Chagas disease

  15. Fiscal decentralization and the challenges of public ecological services delivery

    Directory of Open Access Journals (Sweden)

    N.V. Kotenko

    2015-06-01

    Full Text Available The aim of the article. The aim of the article is to define and propose the directions to solve the recent problems of financing public ecological services in the conditions of fiscal decentralization. The results of the analysis. This paper analyzes the decentralization reform impact on the possibilities of local authorities to finance the public ecological services in Ukraine. Advantages and threats of decentralizing reform are defined on the basis of theoretical vision of fiscal federalism in different state structures. The authors assessed basic central government documents in which the strategy and tactic of development. The lack of particular measures that are directed to the sustainable nature use on state level is defined. In practice, this means transference of financing powers from central to local government. Such process needs to be conducted with respective changes of financial flows directions and establishing effective forming and distributive tools. Traditionally, one of such tools, which are most appropriate to accumulate public environmental funds, is ecological tax. The study revealed that the enhancement of general fund of local budget revenues by local tax make the Local Environmental foundations' work impossible. Another initiative of central government is to transfer more than half revenues from the tax to the regional level. Such decision will be practicable only if impartial, formula based mechanism of subsequent allocation of funds between basic local authorities is developed. Scale projects now are funded by regional authorities. Authors proved that the better way to finance public ecological services on complementary basis is the local authorities’ cooperation. One of the advantages of such cooperation is the considering of the opportunities of self-taxation. This voluntary fiscal tool in Ukrainian European future must be stable source for financing of public ecological services. Decentralization reform also

  16. Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand

    DEFF Research Database (Denmark)

    Seeberg, Jens; Pannarunothai, Supasit; Padmawati, Retna S

    2014-01-01

    This article presents a comparative analysis of socio-economic disparities in relation to treatment-seeking strategies and healthcare expenditures in poor neighbourhoods within larger health systems in four cities in India, Indonesia and Thailand. About 200 households in New Delhi, Bhubaneswar...

  17. PUBLIC FINANCING OF HEALTHCARE SERVICES

    Directory of Open Access Journals (Sweden)

    Agnieszka Bem

    2013-10-01

    Full Text Available Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ, state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions.

  18. Quantum Finance

    Science.gov (United States)

    Baaquie, Belal E.

    2007-09-01

    Foreword; Preface; Acknowledgements; 1. Synopsis; Part I. Fundamental Concepts of Finance: 2. Introduction to finance; 3. Derivative securities; Part II. Systems with Finite Number of Degrees of Freedom: 4. Hamiltonians and stock options; 5. Path integrals and stock options; 6. Stochastic interest rates' Hamiltonians and path integrals; Part III. Quantum Field Theory of Interest Rates Models: 7. Quantum field theory of forward interest rates; 8. Empirical forward interest rates and field theory models; 9. Field theory of Treasury Bonds' derivatives and hedging; 10. Field theory Hamiltonian of forward interest rates; 11. Conclusions; Appendix A: mathematical background; Brief glossary of financial terms; Brief glossary of physics terms; List of main symbols; References; Index.

  19. Does training on performance based financing make a difference in performance and quality of health care delivery? Health care provider's perspective in Rungwe Tanzania.

    Science.gov (United States)

    Manongi, Rachel; Mushi, Declare; Kessy, Joachim; Salome, Saria; Njau, Bernard

    2014-04-04

    In recent years, Performance Based Financing (PBF); a form of result based financing, has attracted a global attention in health systems in developing countries. PBF promotes autonomous health facilities, motivates and introduces financial incentives to motivate health facilities and health workers to attain pre-determined targets. To achieve this, the Tanzanian government through the Christian Social Services Commission initiated a PBF pilot project in Rungwe district, Mbeya region. Kilimanjaro Christian Medical Center was given the role of training health workers on PBF principles in Rungwe. The aim of this study was to explore health care providers' perception on a three years training on PBF principles in a PBF pilot project at Rungwe District in Mbeya, Tanzania. This was an explorative qualitative study, which took place at Rungwe PBF pilot area in October 2012. Twenty six (26) participants were purposively selected. Six took part in- depth interviews (IDIs) and twenty (20) in the group discussions. Both the IDIs and the GDs explored the perceived benefit and challenges of implementing PBF in their workplace. Data were manually analyzed using content analysis approach. Overall informants had positive perspectives on PBF training. Most of the health facilities were able to implement some of the PBF concepts in their work places after the training, such as developing job descriptions for their staff, creating quarterly business plans for their facilities, costing for their services and entering service agreement with the government, improved record keeping, customer care and involving community as partners in running their facilities. The most common principle of paying individual performance bonuses was mentioned as a major challenge due to inadequate funding and poor design of Rungwe PBF pilot project. Despite poor design and inadequate funding, our findings have shown some promising results after PBF training in the study area. The findings have highlighted

  20. Local Stakeholders’ Perceptions about the Introduction of Performance-Based Financing in Benin: A Case Study in Two Health Districts

    Directory of Open Access Journals (Sweden)

    Elisabeth Paul

    2014-09-01

    Full Text Available Background Performance-Based Financing (PBF has been advanced as a solution to contribute to improving the performance of health systems in developing countries. This is the case in Benin. This study aims to analyse how two PBF approaches, piloted in Benin, behave during implementation and what effects they produce, through investigating how local stakeholders perceive the introduction of PBF, how they adapt the different approaches during implementation, and the behavioural interactions induced by PBF. Methods The research rests on a socio-anthropological approach and qualitative methods. The design is a case study in two health districts selected on purpose. The selection of health facilities was also done on purpose, until we reached saturation of information. Information was collected through observation and semi-directive interviews supported by an interview guide. Data was analysed through contents and discourse analysis. Results The Ministry of Health (MoH strongly supports PBF, but it is not well integrated with other ongoing reforms and processes. Field actors welcome PBF but still do not have a sense of ownership about it. The two PBF approaches differ notably as for the organs in charge of verification. Performance premiums are granted according to a limited number of quantitative indicators plus an extensive qualitative checklist. PBF matrices and verification missions come in addition to routine monitoring. Local stakeholders accommodate theoretical approaches. Globally, staff is satisfied with PBF and welcomes additional supervision and training. Health providers reckon that PBF forces them to depart from routine, to be more professional and to respect national norms. A major issue is the perceived unfairness in premium distribution. Even if health staff often refer to financial premiums, actually the latter are probably too weak—and ‘blurred’—to have a lasting inciting effect. It rather seems that PBF motivates health

  1. Vouchers as demand side financing instruments for health care: a review of the Bangladesh maternal voucher scheme.

    Science.gov (United States)

    Schmidt, Jean-Olivier; Ensor, Tim; Hossain, Atia; Khan, Salam

    2010-07-01

    Demand side financing (DSF) mechanisms transfer purchasing power to specified groups for defined goods and services in order to increase access to specified services. This is an important innovation in health care systems where access remains poor despite substantial subsidies towards the supply side. In Bangladesh, a maternal health DSF pilot in 33 sub-districts was launched in 2007. We report the results of a rapid review of this scheme undertaken during 2008 after 1 year of its setup. Quantitative data collected by DSF committees, facilities and national information systems were assessed alongside qualitative data, i.e. key informant interviews and focus group discussions with beneficiaries and health service providers on the operation of the scheme in 6 sub-districts. The scheme provides vouchers to women distributed by health workers that entitle mainly poor women to receive skilled care at home or a facility and also provide payments for transport and food. After initial setbacks voucher distribution rose quickly. The data also suggest that the rise in facility based delivery appeared to be more rapid in DSF than in other non-DSF areas, although the methods do not allow for a strict causal attribution as there might be co-founding effects. Fears that the financial incentives for surgical delivery would lead to an over emphasis on Caesarean section appear to be unfounded although the trends need further monitoring. DSF provides substantial additional funding to facilities but remains complex to administer, requiring a parallel administrative mechanism putting additional work burden on the health workers. There is little evidence that the mechanism encourages competition due to the limited provision of health care services. The main question outstanding is whether the achievements of the DSF scheme could be achieved more efficiently by adapting the regular government funding rather than creating an entirely new mechanism. Also, improving the quality of health

  2. Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in Spain

    Directory of Open Access Journals (Sweden)

    Alvaro Hidalgo-Vega

    2017-01-01

    Full Text Available Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in SpainThe editorial addresses the current use of economic evaluation in the assessment and potential funding and reimbursement of health technologies. Cost-effectiveness ratio and the acceptability thresholds are analyzed, pointing out the limitations that the current approach has for capturing the value of new technologies. A potential shift from National Health Systems to value-based prices is discussed, with a focus on health economics outcomes where multi-criteria analyses can be a complementary tool to traditional cost-effectiveness approaches.

  3. Financing medical care for the underserved in an era of Federal retrenchment: the health service district.

    Science.gov (United States)

    Nichols, A W; Silverstein, G

    1987-01-01

    Federal funding programs have, since the 1960s, been available in a variety of forms to deal with problems of access to medical care for the medically underserved. Certain programs, such as the National Health Service Corps, have recently pulled back from their points of maximal impact in terms of numbers of obligated physicians in the field. This change leaves a need for greater contributions by State and local entities in the face of Federal retrenchment. The health service district (HSD) is one such mechanism for filling the gap. It has been available under this name in Arizona law since 1977, but the first such district in the State in only now under development in a small copper mining community. Similar to school districts in concept, the HSDs allow residents in their catchment areas to tax themselves for the purpose of delivering primary health care. Two successful HSDs--or similar entities--in other States are described. One program is in Stickney, IL, and other in Condon, OR. The political success and financial viability of the Condon program are documented.

  4. Computerized Systems: Centralized or Decentralized?

    Science.gov (United States)

    Seitz, Linda Ludington

    1985-01-01

    Computerized management information systems have long been used in business, and data integration and sophisticated programing now enable many businesses to decentralize their information operations. This approach has advantages and disadvantages that colleges and universities must weigh and plan for carefully. (MSE)

  5. Music Libraries: Centralization versus Decentralization.

    Science.gov (United States)

    Kuyper-Rushing, Lois

    2002-01-01

    Considers the decision that branch libraries, music libraries in particular, have struggled with concerning a centralized location in the main library versus a decentralized collection. Reports on a study of the Association of Research Libraries that investigated the location of music libraries, motivation for the location, degrees offered,…

  6. Ukraine: Health system review.

    Science.gov (United States)

    Lekhan, Valery; Rudiy, Volodymyr; Richardson, Erica

    2010-01-01

    The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Ukrainian health system has preserved the fundamental features of the Soviet Semashko system against a background of other changes, which are developed on market economic principles. The transition from centralized financing to its extreme decentralization is the main difference in the health system in comparison with the classic Soviet model. Health facilities are now functionally subordinate to the Ministry of Health, but managerially and financially answerable to the regional and local self-government, which has constrained the implementation of health policy and fragmented health financing. Health care expenditure in Ukraine is low by regional standards and has not increased significantly as a proportion of gross domestic product (GDP) since the mid 1990s; expenditure cannot match the constitutional guarantees of access to unlimited care. Although prepaid schemes such as sickness funds are growing in importance, out-of-pocket payments account for 37.4% of total health expenditure. The core challenges for Ukrainian health care therefore remain the ineffective protection of the population from the risk of catastrophic health care costs and the structural inefficiency of the health system, which is caused by the inefficient system of health care financing. Health system weaknesses are highlighted by increasing rates of avoidable mortality. Recent political impasse has complicated health system reforms and policy-makers face significant challenges in overcoming popular distrust and

  7. Sustainable finance

    NARCIS (Netherlands)

    dr. Margreet F. Boersma-de Jong

    2012-01-01

    Presentation for Springschool of Strategy, University of Groningen, 10 October 2012. The role of CSR is to stimulate ethical behaviour, and as a result, mutual trust in society. Advantage of CSR for the company and the evolution of CSR. From CSR to Sustainable Finance: how does CSR influence

  8. Computational Finance

    DEFF Research Database (Denmark)

    Rasmussen, Lykke

    One of the major challenges in todays post-crisis finance environment is calculating the sensitivities of complex products for hedging and risk management. Historically, these derivatives have been determined using bump-and-revalue, but due to the increasing magnitude of these computations does...

  9. Computational Finance

    DEFF Research Database (Denmark)

    Rasmussen, Lykke

    One of the major challenges in todays post-crisis finance environment is calculating the sensitivities of complex products for hedging and risk management. Historically, these derivatives have been determined using bump-and-revalue, but due to the increasing magnitude of these computations does...

  10. Sustainable finance

    NARCIS (Netherlands)

    Boersma-de Jong, Margreet F.

    2012-01-01

    Presentation for Springschool of Strategy, University of Groningen, 10 October 2012. The role of CSR is to stimulate ethical behaviour, and as a result, mutual trust in society. Advantage of CSR for the company and the evolution of CSR. From CSR to Sustainable Finance: how does CSR influence Sustai

  11. Investigating the Effectiveness of Programs on Health Financing Based on Audit Procedures

    Directory of Open Access Journals (Sweden)

    Ionel BOSTAN

    2016-10-01

    Full Text Available Background: The present paper focuses on approaching the context and the actual manner of applying a method, known to be efficient and with a solid scientific background, on the institutional level of healthcare in Romania.Methods: The analyses and correlations developed by the author have taken into account the latest editions of the journals and publications of these institutions, such as statistical papers, standards, procedural guidebooks, reports. Most of the data (easily identifiable in the electronic environment have been selected to enable the subsequent further investigation.Results: The payments made in 2012 for the audited NHP1-4, have increased by 82 282.66 thousand € (39.2% as compared to 2010, and by 50578.22 thousand € (20.9% as compared to 2011. The amounts paid for NHP1-4 have had an ascending trend starting with 2010, but, during 2010-2012, as the contribution of the Ministry of Health from the state budget has decreased from 152590.66 thousand € to 95328.22 thousand €, CNAS’s funding from the FNUASS resources has increased by 2.4 times.Conclusion: Following the analysis conducted on the NHP1-4, the findings based on representative samples are: (i the specific legal standards related to the development of the NHP1-4, did not provide all the mechanisms that would ensure the certain procurement of medication and medical supplies as needed and did not ensure the efficient use of the allocated funds; (ii clear discontinuities have been identified in the funding of NHP1-4, etc. Keywords: Health network, Public health funding, National programmes, External audit  

  12. Decentralized neural control application to robotics

    CERN Document Server

    Garcia-Hernandez, Ramon; Sanchez, Edgar N; Alanis, Alma y; Ruz-Hernandez, Jose A

    2017-01-01

    This book provides a decentralized approach for the identification and control of robotics systems. It also presents recent research in decentralized neural control and includes applications to robotics. Decentralized control is free from difficulties due to complexity in design, debugging, data gathering and storage requirements, making it preferable for interconnected systems. Furthermore, as opposed to the centralized approach, it can be implemented with parallel processors. This approach deals with four decentralized control schemes, which are able to identify the robot dynamics. The training of each neural network is performed on-line using an extended Kalman filter (EKF). The first indirect decentralized control scheme applies the discrete-time block control approach, to formulate a nonlinear sliding manifold. The second direct decentralized neural control scheme is based on the backstepping technique, approximated by a high order neural network. The third control scheme applies a decentralized neural i...

  13. Wage Dispersion and Decentralization of Wage Bargaining

    DEFF Research Database (Denmark)

    Dahl, Christian M.; Le Maire, Christian Daniel; Munch, Jakob Roland

    This paper studies how decentralization of wage bargaining from sector to firm level influences wage levels and wage dispersion. We use a detailed panel data set covering a period of decentralization in the Danish labor market. The decentralization process provides exogenous variation in the indi......This paper studies how decentralization of wage bargaining from sector to firm level influences wage levels and wage dispersion. We use a detailed panel data set covering a period of decentralization in the Danish labor market. The decentralization process provides exogenous variation...... in the individual worker's wage-setting system that facilitates identification of the effects of decentralization. Consistent with predictions we find that wages are more dispersed under firm-level bargaining compared to more centralized wage-setting systems. However, the differences across wage-setting systems...

  14. The Two Edge Knife of Decentralization

    Directory of Open Access Journals (Sweden)

    Ahmad Khoirul Umam

    2011-07-01

    Full Text Available A centralistic government model has become a trend in a number of developing countries, in which the ideosycretic aspect becomes pivotal key in the policy making. The situation constitutes authoritarianism, cronyism, and corruption. To break the impasse, the decentralized system is proposed to make people closer to the public policy making. Decentralization is also convinced to be the solution to create a good governance. But a number of facts in the developing countries demonstrates that decentralization indeed has ignite emerges backfires such as decentralized corruption, parochialism, horizontal conflict, local political instability and others. This article elaborates the theoretical framework on decentralization's ouput as the a double-edge knife. In a simple words, the concept of decentralization does not have a permanent relationship with the creation of good governance and development. Without substantive democracy, decentralization is indeed potential to be a destructive political instrument threating the state's future.

  15. Willingness to pay for publicly financed health care services in Central and Eastern Europe: evidence from six countries based on a contingent valuation method.

    Science.gov (United States)

    Tambor, Marzena; Pavlova, Milena; Rechel, Bernd; Golinowska, Stanisława; Sowada, Christoph; Groot, Wim

    2014-09-01

    The increased interest in patient cost-sharing as a measure for sustainable health care financing calls for evidence to support the development of effective patient payment policies. In this paper, we present an application of a stated willingness-to-pay technique, i.e. contingent valuation method, to investigate the consumer's willingness and ability to pay for publicly financed health care services, specifically hospitalisations and consultations with specialists. Contingent valuation data were collected in nationally representative population-based surveys conducted in 2010 in six Central and Eastern European (CEE) countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine) using an identical survey methodology. The results indicate that the majority of health care consumers in the six CEE countries are willing to pay an official fee for publicly financed health care services that are of good quality and quick access. The consumers' willingness to pay is limited by the lack of financial ability to pay for services, and to a lesser extent by objection to pay. Significant differences across the six countries are observed, though. The results illustrate that the contingent valuation method can provide decision-makers with a broad range of information to facilitate cost-sharing policies. Nevertheless, the intrinsic limitations of the method (i.e. its hypothetical nature) and the context of CEE countries call for caution when applying its results.

  16. Public and private responsibility for health: a comparative analysis of attitudes towards financing and the right for health care.

    NARCIS (Netherlands)

    Abel, T.; Zee, J. van der

    1995-01-01

    The present study focuses on values that directly relate to issues of health care. It will observe specific patterns of health values and compare their distribution across selected social groups within and across four European nations. Studying these issues, new insights are expected into Eurpean we

  17. Does tax-based health financing offer protection from financial catastrophe? Findings from a household economic impact survey of ischaemic heart disease in Malaysia.

    Science.gov (United States)

    Sukeri, Surianti; Mirzaei, Masoud; Jan, Stephen

    2017-01-01

    Malaysia is an upper-middle income country with a tax-based health financing system. Health care is relatively affordable, and safety nets are provided for the needy. The objectives of this study were to determine the out-of-pocket health spending, proportion of catastrophic health spending (out-of-pocket spending >40% of non-food expenditure), economic hardship and financial coping strategies among patients with ischaemic heart disease (IHD) in Malaysia under the present health financing system. A cross-sectional study was conducted at the National Heart Institute of Malaysia involving 503 patients who were hospitalized during the year prior to the survey. The mean annual out-of-pocket health spending for IHD was MYR3045 (at the time US$761). Almost 16% (79/503) suffered from catastrophic health spending (out-of-pocket health spending ≥40% of household non-food expenditures), 29.2% (147/503) were unable to pay for medical bills, 25.0% (126/503) withdrew savings to help meet living expenses, 16.5% (83/503) reduced their monthly food consumption, 12.5% (63/503) were unable to pay utility bills and 9.0% (45/503) borrowed money to help meet living expenses. Overall, the economic impact of IHD on patients in Malaysia was considerable and the prospect of economic hardship likely to persist over the years due to the long-standing nature of IHD. The findings highlight the need to evaluate the present health financing system in Malaysia and to expand its safety net coverage for vulnerable patients. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Household Finance

    OpenAIRE

    Campbell, John

    2006-01-01

    The welfare benefits of financial markets depend in large part on how effectively households use these markets. The study of household finance is challenging because household behavior is difficult to measure accurately, and because households face constraints that are not captured by textbook models, including fixed costs, uninsurable income risk, borrowing constraints, and contracts that are non-neutral with respect to inflation. Evidence on participation, diversification, and the exercise ...

  19. Innovation, development, and financing of institutions of Higher Education in health.

    Science.gov (United States)

    Poz, Mario Roberto Dal; Couto, Maria Helena Costa; Franco, Thais de Andrade Vidaurre

    2016-11-03

    The article analyzes the configuration and trends in institutions of Higher Education and their relationship as components of the Health Economic-Industrial Complex (HEIC). The expansion of higher education is part of the transition from elite to mass systems, with tensions between quantitative and qualitative aspects. Such changes reflect different cultures and are related to international phenomena such as globalization, economic transformations, the development of new information and communication technologies, and the emergence of an international knowledge network. The scale and content of these changes vary according to the expansion and institutional reconfiguration of educational systems, as well as the link between state and society. Market expansion for private higher education stirs competition, shapes business clusters, modifies training processes, and raises new public policy challenges. Resumo: Este artigo analisa a configuração e as tendências das instituições de Ensino Superior de saúde no seu relacionamento enquanto componentes do Complexo Econômico Industrial da Saúde (CEIS). A expansão do Ensino Superior é parte da transição de sistemas de elite para sistemas de massa, com tensionamentos entre aspectos quantitativos e qualitativos. Essas mudanças refletem diferentes culturas e se relacionam com fenômenos de escopo mundial como globalização, transformações econômicas, desenvolvimento de novas tecnologias de comunicação e informação, e emergência de uma rede internacional de conhecimento. A escala e o conteúdo dessas mudanças variam com a ampliação dos sistemas de ensino e na reconfiguração institucional, bem como na articulação entre Estado e sociedade. A ampliação do mercado privado no ensino acirra a competitividade, conformando conglomerados empresariais, alterando processos de formação e forjando novos desafios para as políticas públicas.

  20. A enfermeira no processo de descentralização do sistema de saúde La enfermera en el proceso de descentralización del sistema de salud The nurse in the decentralization process of the health system

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Santa Fé Borges

    2004-12-01

    Full Text Available Estudo sobre o processo de descentralização do sistema de saúde nas décadas de 80 e 90 no município de Itabuna-BA; com o objetivo de descrever o processo de descentralização da saúde no município, identificando a inserção/participação da enfermeira nesse processo. Estudo descritivo, qualitativo de caráter exploratório, que utilizou para coleta de dados a entrevista semi-estruturada, e a análise documental. Os resultados apontam que a inserção da enfermeira no processo da descentralização seguiu-se de acordo com as mudanças transcorridas a cada gestão municipal, onde ela atuou mais efetivamente conforme foi o cenário estabelecido e sofreu influência das diversas conjunturas conformadas pelas políticas implantadas ou implementadas em cada contexto da gestão do Sistema de saúde municipal.Estudio sobre el proceso de descentralización del sistema de salud en las décadas de 80 y 90 en el municipio de Itabuna-BA; con el objetivo de describir el proceso de descentralización de la salud en el municipio, identificando la inserción/participación de la enfermera en este proceso. Estudio descriptivo cualitativo de carácter exploratorio, que utilizó para la coleta de datos la entrevista semiestructurada, y el análisis documental. Los resultados apuntan que la inserción de la enfermera en el proceso de descentralización se siguió de acuerdo con los cambios transcurridos en cada gestión municipal, donde actuó más efectivamente, conforme fue el escenario establecido y sufrió influencia de las diversas coyunturas conformadas por las políticas implantadas o implementadas en cada contexto de gestión del Sistema de salud municipal.Study about the decentralization process of the health system in the '80s and '90s in the city of Itabuna-BA. It is aimed at describing the city's health decentralization process, identifying the nurse's insertion/participation in this process. Descriptive/qualitative study of exploratory nature

  1. Regional Decentralization, Fiscal Incentives and Privatization of Public-Owned Enterprises

    Institute of Scientific and Technical Information of China (English)

    HengpengZhu

    2004-01-01

    The tax-sharing system reform since 1994 has hardened budgetary constraints on local governments, but has not derailed the fiscal decentralization trend since China started the reform and opening up. This fiscal decentralization has provided a strong impetus to local finance, so that local governments have become quite enthusiastic in pursuing local economic development and improving local economic efficiency. As market competition intensifies, the public-owned enterprises have gradually become a financial burden on local finance. Meanwhile, the non-state sector has made an increasing contribution to the local economy and to local coffers. Therefore, it has become the optimal choice for local governments, in pursuit of their own interests, to reform the ownership structure of public-owned enterprises.

  2. Dilemas do processo de gestão descentralizada da vigilância sanitária no Estado do Rio de Janeiro Dilemmas of the process of decentralized management of health surveillance in Rio de Janeiro State

    Directory of Open Access Journals (Sweden)

    Mirian Miranda Cohen

    2009-01-01

    Full Text Available Com a criação do Sistema Único de Saúde, em 1990, o Ministério da Saúde tomou as primeiras medidas para descentralizar as ações de vigilância sanitária, o que significou decisiva inovação na tradicional institucionalidade dessa área e grande desafio para os gestores nos três níveis da Federação. Os efeitos dessa determinação somente foram sentidos após criação da Agência Nacional de Vigilância Sanitária, em fins de 1999, quando foi possível estruturar o atual Sistema Nacional de Vigilância Sanitária numa concepção que incentiva o papel diretor, coordenador e executor das ações de maior complexidade das Secretarias Estaduais de Saúde. Este estudo analisa a descentralização da gestão da VISA empreendida pela Secretaria de Estado de Saúde do Rio de Janeiro no período 2002-2006 e as condições das Secretarias Municipais no exercício das respectivas funções, através de pesquisa baseada em análise dos relatórios de avaliação da descentralização elaborados pelo Centro de Vigilância Sanitária. Entre as conclusões, destaca a fragilidade da própria Secretaria de Saúde do estado para assumir os encargos a ela atribuídos e questões subjacentes ao exercício municipal. Tais constatações refletem as muitas dificuldades enfrentadas nas relações intergovernamentais diante do imperativo de as partes agirem solidariamente numa área fundamental para a saúde individual e coletiva e para o bem-estar da população. O estudo informa requisitos básicos do processo de estruturação de um órgão de VISA e constitui importante contribuição para melhor compreender os entraves políticos, institucionais, técnicos, materiais e humanos que desafiam os gestores, para implementar as inovações ensejadas com a descentralização neste complexo campo.With the creation of the Unified Health System in 1990, the Ministry of Health has taken the first steps to decentralize health surveillance actions, which meant a

  3. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries

    Science.gov (United States)

    Reeves, Aaron; Gourtsoyannis, Yannis; Basu, Sanjay; McCoy, David; McKee, Martin; Stuckler, David

    2015-01-01

    Summary Background How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. Methods We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995–2011. Findings Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9·86 (95% CI 3·92–15·8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16·7, 9·16 to 24·3), but not for consumption taxes on goods and services (−$4·37, −12·9 to 4·11). In countries with low tax revenues (tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6·74 percentage points (95% CI 0·87–12·6) and the extent of financial coverage by 11·4 percentage points (5·51–17·2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive. Interpretation Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax

  4. Decentralization and REDD+ in Brazil

    Directory of Open Access Journals (Sweden)

    Fabiano Toni

    2011-01-01

    Full Text Available Recent discussions on REDD+ (Reducing Emissions from Deforestation and Forest Degradation, plus conservation, sustainable management of forests and enhancement of forest carbon stocks have raised optimism about reducing carbon emissions and deforestation in tropical countries. If approved under the United Nations Framework Convention on Climate Change (UNFCCC, REDD+ mechanisms may generate a substantial influx of financial resources to developing countries. Some authors argue that this money could reverse the ongoing process of decentralization of forest policies that has spread through a large number of developing countries in the past two decades. Central states will be accountable for REDD+ money, and may be compelled to control and keep a significant share of REDD+ funds. Supporters of decentralization argue that centralized implementation of REDD+ will be ineffective and inefficient. In this paper, I examine the relation between subnational governments and REDD+ in Brazil. Data show that some state governments in the Brazilian Amazon have played a key role in creating protected areas (PAs after 2003, which helped decrease deforestation rates. Governors have different stimuli for creating PAs. Some respond to the needs of their political constituency; others have expectations to boost the forest sector so as to increase fiscal revenues. Governors also have led the discussion on REDD+ in Brazil since 2008. Considering their interests and political power, REDD+ is unlikely to curb decentralization in Brazil.

  5. Descentralización del sector de salud y conflictos con el gremio médico en México Health sector decentralization and divergences with the medical society in Mexico

    Directory of Open Access Journals (Sweden)

    Raquel Abrantes Pêgo

    2002-06-01

    Full Text Available OBJETIVO: Investigar la percepción y acción del gremio médico en el marco de la descentralización del Sector de Salud en dos estados de México, Guanajuato y Sonora. MÉTODOS: Se han utilizado técnicas cualitativas de investigación. Fueron realizadas 35 entrevistas, semiestructuradas, en total entre los dos estados, a médicos colegiados, Guanajuato y Sonora, tanto de instituciones públicas como privadas y representantes de las asociaciones gremiales y sindicales. RESULTADOS: Para el gremio médico de los dos estados investigados, la descentralización ha implicado en inseguridad, como resultado de la falta de claridad en la regulación del Sector de Salud. La acción de los Colegios de Médicos de ambos estados, se tradujo en una mayor politización de los Colegios de Médicos estatales, en la elaboración de propuestas con el objetivo de incidir en el control del mercado laboral médico de dichos estados y participación en la estructura de poder regional. CONCLUSIONES: La investigación comprueba una readaptación del gremio médico en el ámbito regional, indicando su permanencia como grupo de poder. Contrariamente a lo que informa la literatura estadounidense en México, los médicos han logrado influenciar en la regulación, con la finalidad de no perder su status privilegiado dentro de la competencia existente.OBJECTIVE: To evaluate the medical society's perception and actions in the context of health sector decentralization in the states of Guanajuato and Sonora, Mexico. METHODS: Qualitative research techniques were applied. Thirty-five semi-structured interviews were conducted with medical college members of both public and private institutions, and collegiate and union representatives of both states studied. RESULTS: Members of medical society in both states acknowledged that decentralization implied in insecurity due to the lack of clarity of health sector regulations. As a result of actions of the medical college in both

  6. Education Finance in Egypt: Problems and a Possible Solution. Occasional Paper. RTI Press Publication OP-0017-1401

    Science.gov (United States)

    Healey, F. Henry; Crouch, Luis; Hanna, Rafik

    2014-01-01

    Egypt, currently in the throes of major political change, will likely undergo reforms of various sorts in the next few years. Some of these reforms are likely to give local entities, including schools, greater control over education finances. In 2007, the Government of Egypt began to decentralize some non-personnel recurrent finances from the…

  7. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries.

    Science.gov (United States)

    Stenberg, Karin; Hanssen, Odd; Edejer, Tessa Tan-Torres; Bertram, Melanie; Brindley, Callum; Meshreky, Andreia; Rosen, James E; Stover, John; Verboom, Paul; Sanders, Rachel; Soucat, Agnès

    2017-09-01

    domestic product spent on health would increase to a mean of 7·5% (2·1-20·5). Around 75% of costs are for health systems, with health workforce and infrastructure (including medical equipment) as the main cost drivers. Despite projected increases in health spending, a financing gap of $20-54 billion per year is projected. Should funds be made available and used as planned, the ambitious scenario would save 97 million lives and significantly increase life expectancy by 3·1-8·4 years, depending on the country profile. All countries will need to strengthen investments in health systems to expand service provision in order to reach SDG 3 health targets, but even the poorest can reach some level of universality. In view of anticipated resource constraints, each country will need to prioritise equitably, plan strategically, and cost realistically its own path towards SDG 3 and universal health coverage. WHO. Copyright © 2017 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

  8. Is decentralization good for logistics systems? Evidence on essential medicine logistics in Ghana and Guatemala.

    Science.gov (United States)

    Bossert, Thomas J; Bowser, Diana M; Amenyah, Johnnie K

    2007-03-01

    Efficient logistics systems move essential medicines down the supply chain to the service delivery point, and then to the end user. Experts on logistics systems tend to see the supply chain as requiring centralized control to be most effective. However, many health reforms have involved decentralization, which experts fear has disrupted the supply chain and made systems less effective. There is no consensus on an appropriate methodology for assessing the effectiveness of decentralization in general, and only a few studies have attempted to address decentralization of logistics systems. This paper sets out a framework and methodology of a pioneering exploratory study that examines the experiences of decentralization in two countries, Guatemala and Ghana, and presents suggestive results of how decentralization affected the performance of their logistics systems. The analytical approach assessed decentralization using the principal author's 'decision space' approach, which defines decentralization as the degree of choice that local officials have over different health system functions. In this case the approach focused on 15 different logistics functions and measured the relationship between the degree of choice and indicators of performance for each of the functions. The results of both studies indicate that less choice (i.e. more centralized) was associated with better performance for two key functions (inventory control and information systems), while more choice (i.e. more decentralized) over planning and budgeting was associated with better performance. With different systems of procurement in Ghana and Guatemala, we found that a system with some elements of procurement that are centralized (selection of firms and prices fixed by national tender) was positively related in Guatemala but negatively related in Ghana, where a system of 'cash and carry' cost recovery allowed more local choice. The authors conclude that logistics systems can be effectively

  9. Patient Experiences of Decentralized HIV Treatment and Care in Plateau State, North Central Nigeria: A Qualitative Study

    Science.gov (United States)

    Kolawole, Grace O.; Gilbert, Hannah N.; Dadem, Nancin Y.; Genberg, Becky L.; Agbaji, Oche O.

    2017-01-01

    Background. Decentralization of care and treatment for HIV infection in Africa makes services available in local health facilities. Decentralization has been associated with improved retention and comparable or superior treatment outcomes, but patient experiences are not well understood. Methods. We conducted a qualitative study of patient experiences in decentralized HIV care in Plateau State, north central Nigeria. Five decentralized care sites in the Plateau State Decentralization Initiative were purposefully selected. Ninety-three patients and 16 providers at these sites participated in individual interviews and focus groups. Data collection activities were audio-recorded and transcribed. Transcripts were inductively content analyzed to derive descriptive categories representing patient experiences of decentralized care. Results. Patient participants in this study experienced the transition to decentralized care as a series of “trade-offs.” Advantages cited included saving time and money on travel to clinic visits, avoiding dangers on the road, and the “family-like atmosphere” found in some decentralized clinics. Disadvantages were loss of access to ancillary services, reduced opportunities for interaction with providers, and increased risk of disclosure. Participants preferred decentralized services overall. Conclusion. Difficulty and cost of travel remain a fundamental barrier to accessing HIV care outside urban centers, suggesting increased availability of community-based services will be enthusiastically received. PMID:28331636

  10. Health financing for the poor produces promising short-term effects on utilization and out-of-pocket expenditure: evidence from Vietnam

    Science.gov (United States)

    Axelson, Henrik; Bales, Sarah; Minh, Pham Duc; Ekman, Björn; Gerdtham, Ulf-G

    2009-01-01

    Background Vietnam introduced the Health Care Fund for the Poor in 2002 to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities. It is often argued that effects of financing reforms take a long time to materialize. This study evaluates the short-term impact of the program to determine if pro-poor financing programs can achieve immediate effects on health care utilization and out-of-pocket expenditure. Method Considering that the program is a non-random policy initiative rolled out nationally, we apply propensity score matching with both single differences and double differences to data from the Vietnam Household Living Standards Surveys 2002 (pre-program data) and 2004 (first post-program data). Results We find a small, positive impact on overall health care utilization. We find evidence of two substitution effects: from private to public providers and from primary to secondary and tertiary level care. Finally, we find a strong negative impact on out-of-pocket health expenditure. Conclusion The results indicate that the Health Care Fund for the Poor is meeting its objectives of increasing utilization and reducing out-of-pocket expenditure for the program's target population, despite numerous administrative problems resulting in delayed and only partial implementation in most provinces. The main lessons for low and middle-income countries from Vietnam's early experiences with the Health Care Fund for the Poor are that it managed to achieve positive outcomes in a short time-period, the need to ensure adequate and sustained funding for targeted programs, including marginal administrative costs, develop effective targeting mechanisms and systems for informing beneficiaries and providers about the program, respond to the increased demand for health care generated by the program, address indirect costs of health care utilization, and establish and maintain routine and systematic monitoring and

  11. El impacto de la financiación de la asistencia sanitaria en las desigualdades The impact of healthcare financing on health inequalities

    Directory of Open Access Journals (Sweden)

    Rosa M. Urbanos

    2004-05-01

    Full Text Available El presente trabajo examina el impacto de la financiación de la asistencia sanitaria sobre las desigualdades en la oferta, el acceso y la utilización de los servicios de salud. El nuevo modelo de financiación autonómica y sanitaria, pese a las iniciales ganancias de equidad y suficiencia en el momento de su puesta en funcionamiento, introduce incertidumbre con respecto al volumen de recursos que en el futuro podrán dedicar las comunidades autónomas a la financiación de la sanidad, lo que puede originar desigualdades en la oferta de servicios y en el acceso a la asistencia sanitaria. El Fondo de Cohesión Sanitaria, diseñado para financiar la atención a los desplazados, no parece el instrumento adecuado para garantizar la igualdad de acceso a las prestaciones en el conjunto del Sistema Nacional de Salud. Por otra parte, el cambio en la composición de las fuentes de financiación de la sanidad, en la medida en que otorgue más peso a los impuestos indirectos, puede acarrear pérdidas de equidad o progresividad. Finalmente, este trabajo discute el posible impacto de la actual asignación funcional del presupuesto sanitario, excesivamente sesgada hacia el ámbito de la atención especializada, en las desigualdades en su utilización.This article summarizes the impact of health care financing instruments on inequalities of supply, access and use of health care services. Firstly, the new scheme of regional and health care financing, apart from the initial gains in terms of equity and sufficiency, introduces uncertainty about the volume of resources that will be devoted to health care facilities by the regions. This fact may cause some inter-territorial inequalities in the health care supply and the access to public services. The Health Care Cohesion Fund, which was designed to guarantee equality of access to the National Health Service, is not the optimal instrument to achieve such an ambitious goal. Secondly, the change in composition of

  12. Decentralization and Economic Growth per capita in Europe

    OpenAIRE

    Crucq, Pieter; Hemminga, Hendrik-Jan

    2007-01-01

    In this paper the relationship between decentralization and economic growth is investigated. The focus is on decentralization from the national government to the highest substate level in a country, which we define as regional decentralization. Section 2 discusses the different dimensions of decentralization. Political decentralization refers to the degree to which central governments allow non-central government entities to implement certain political functions. Fiscal decentralization in a ...

  13. 广西壮族自治区城镇居民卫生筹资公平性研究%Study on equity of urban health financing in Guangxi Zhuang Autonomous Region

    Institute of Scientific and Technical Information of China (English)

    郭振友; 石武祥

    2013-01-01

    OBJECTIVE To study on the equity of urban health finance resource in Guangxi. METHODS Evaluated the equity of health finance through scaling method and progressivity (concentration curve, Kakwani index). RESULTS The portion of individual health expenditure was too high. The equity of the health finance resource by cash was better than tax from 2000 to 2008. The health finance resource by tax and cash didn't have good extent of equity, and were all regressive. CONCLUSION The government should increase the health finance, and expand health finance resource to reduce the portion of individual health expenditure. The health finance resource of tax should be reinforced.%目的 研究广西城镇居民各种卫生筹资渠道的公平程度.方法 利用比例法、累进性分析(集中曲线、kakwani指数)等方法分析广西城镇居民各种卫生筹资渠道的公平性.结果 广西卫生总费用中个人卫生支出的比例过高.2000~2008年广西城镇居民现金卫生支出筹资的公平性优于通过税收筹资的公平性.税收和现金卫生支出的kakwani指数均为负值,表现为累退性,卫生筹资的公平性较差.结论 政府应加大卫生投入,拓展社会筹资渠道,降低个人卫生支出的比例.加强利用税收进行卫生筹资,从而提高卫生筹资的公平性.

  14. A utilização de serviços de saúde por sistema de financiamento An analysis of health services utilisation, by financing system

    Directory of Open Access Journals (Sweden)

    Silvia Marta Porto

    2006-12-01

    Full Text Available Este artigo analisa, a partir de microdados de 1998 e 2003 da PNAD/IBGE, a utilização de serviços de saúde sob a perspectiva de seu financiamento ou, em outras palavras, sob o prisma do sistema de proteção à saúde pelo qual o serviço foi utilizado: se pelo Sistema Único de Saúde (SUS, ou seja, pelo sistema público financiado por meio de tributos; se por planos e seguros de saúde privados e financiados por prêmios pagos por beneficiários e/ou seus empregadores; ou, finalmente, se mediante a compra direta de serviços (pagamento direto no ato da utilização de serviços. Entre os principais resultados da análise, destacam-se os seguintes: 1 o SUS financia a maioria dos atendimentos e das internações realizados no País, participação que aumentou significativamente entre 1998 e 2003; 2 embora o número absoluto de atendimentos realizados pelos três sistemas de financiamento tenha aumentado, a expansão do SUS foi muito mais significativa e a ela correspondeu uma desaceleração do crescimento do gasto privado direto; 3 o SUS é o principal financiador dos dois níveis extremos de complexidade da atenção à saúde: o de atenção básica e o da alta complexidade.This article analyses, from micro-data of the National Sample Household Survey (PNAD/IBGE from 1998 and 2003, the utilisation of health services according to different financing systems. In other words, it analyses if this utilisation has been done through the National Health System SUS (public and universal health insurance, financed by taxes, through private health insurance (premiums paid by the insured population and/or their employers or through out-of-pocket payments. The main results are: 1 SUS finances most of inpatient and outpatient utilisation and its participation has strongly increased from 1998 to 2003; 2 although the absolute number of outpatient utilisation made through the three systems has increased, SUS expansion has been much stronger (it increased

  15. AN ANALYSIS OF THE CHARACTERISTICS OF PUBLIC HEALTH SYSTEM AT REGIONAL LEVEL USING PANEL DATA

    Directory of Open Access Journals (Sweden)

    CATALINA LILIANA ANDREI

    2011-04-01

    Full Text Available Reforming the public health system is a complex and long process, involving different categories of people. To accelerate the process of integration into the European Union, Romania is currently implementing strategies and programs aimed to increase the quality of public services. In the medical field a series of measures have been undertaken aimed at accelerating the decentralization process and optimize the activities of medical institutions. During the transition period a series of measures have been taken to decentralization and privatization of health services. However, currently we are witnessing a fragmentation of the system, which stressed the inequality in the distribution of medical personnel and reduced people's access to certain types of medical services. Please note that the number of doctors per capita in rural areas is only 20% of the urban area. Another major shortcoming of the system is linked to the financing system and its correlation with the strategies of decentralization. Frequently, decentralization has emerged as a way of placing the central tasks in the task of local government. Using panel data from developing regions we highlight a number of implications of the decentralization process.

  16. Educational Decentralization: Weak State or Strong State?

    Science.gov (United States)

    McGinn, Noel; Street, Susan

    1986-01-01

    A government is a complex system of competing factions that adopts a decentralization policy when the dominant group sees current government structures or procedures as an obstacle to the realization of group interests. Case studies of educational decentralization in Peru, Chile, and Mexico demonstrate that the "state" tends to share…

  17. What supervisors want to know about decentralization.

    Science.gov (United States)

    Boissoneau, R; Belton, P

    1991-06-01

    Many organizations in various industries have tended to move away from strict centralization, yet some centralization is still vital to top management. With 19 of the 22 executives interviewed favoring or implementing some form of decentralization, it is probable that traditionally centralized organizations will follow the trend and begin to decentralize their organizational structures. The incentives and advantages of decentralization are too attractive to ignore. Decentralization provides responsibility, clear objectives, accountability for results, and more efficient and effective decision making. However, one must remember that decentralization can be overextended and that centralization is still viable in certain functions. Finding the correct balance between control and autonomy is a key to decentralization. Too much control and too much autonomy are the primary reasons for decentralization failures. In today's changing, competitive environment, structures must be continuously redefined, with the goal of finding an optimal balance between centralization and decentralization. Organizations are cautioned not to seek out and install a single philosopher-king to impose unified direction, but to unify leadership goals, participation, style, and control to develop improved methods of making all responsible leaders of one mind about the organization's needs and goals.

  18. Wind Farm Decentralized Dynamic Modeling With Parameters

    DEFF Research Database (Denmark)

    Soltani, Mohsen; Shakeri, Sayyed Mojtaba; Grunnet, Jacob Deleuran;

    2010-01-01

    Development of dynamic wind flow models for wind farms is part of the research in European research FP7 project AEOLUS. The objective of this report is to provide decentralized dynamic wind flow models with parameters. The report presents a structure for decentralized flow models with inputs from...

  19. Wage Dispersion and Decentralization of Wage Bargaining

    DEFF Research Database (Denmark)

    Dahl, Christian Møller; le Maire, Christian Daniel; Munch, Jakob R.

    2013-01-01

    's wage-setting system that facilitates identification of the effects of decentralization. We find a wage premium associated with firm-level bargaining relative to sector-level bargaining and that the return to skills is higher under the more decentralized wage-setting systems. Using quantile regression...

  20. Financiamento do setor saúde: uma retrospectiva recente com uma abordagem para a odontologia Financing in Brazilian health care system: a recent retrospective and dentistry approach

    Directory of Open Access Journals (Sweden)

    Carolina Bezerra Cavalcanti Nóbrega

    2010-06-01

    Full Text Available As políticas orientadas para a mudança no sistema de saúde ocorreram em três fases: a implantação das Ações Integradas de Saúde (AIS em 1983; o Sistema Unificado e Descentralizado de Saúde (SUDS em 1987 e a promulgação da Constituição em 1988, surgindo assim o SUS (Sistema Único de Saúde, uma estrutura organizacional baseada em princípios de cidadania e justiça social. Com o surgimento do SUS, houve a necessidade de definir objetivos e diretrizes estratégicas para o processo de descentralização, tratando dos aspectos das responsabilidades, relações entre os gestores e critérios de transferência de recursos federais para estados e municípios. Desse modo, o objetivo desse trabalho foi realizar uma retrospectiva recente do plano orçamentário destinado à saúde após a reorganização do SUS, realizando também uma abordagem na área da odontologia. Trata-se de um estudo retrospectivo, no qual foram utilizados dados coletados do banco de dados em saúde do Ministério da Saúde do Brasil (DATASUS no período de 1998 a 2005. Observou-se que pelo menos no que diz respeito a valores de repasse anuais, a situação é positiva, esperando-se dessa forma que a tão sonhada reorganização e estruturação financeira do sistema de saúde brasileiro esteja começando a acontecer.The guided policies designed to modify the health care system occurred in three stages: the first occurred at the end of the military regimen with the implantation of the Integrated Actions of Health (AIS; the second came with the implantation of the Unified and Decentralized Health System (SUDS in 1987; and the third was the promulgation of the Constitution in 1988, when the Brazilian Unified Health System (SUS, an organizational structure based on principles of citizenship and social justice, was then created. With the creation of SUS, there was the need for defining objectives and strategic lines of direction for the decentralization process

  1. Behavioral finance: Finance with normal people

    Directory of Open Access Journals (Sweden)

    Meir Statman

    2014-06-01

    Behavioral finance substitutes normal people for the rational people in standard finance. It substitutes behavioral portfolio theory for mean-variance portfolio theory, and behavioral asset pricing model for the CAPM and other models where expected returns are determined only by risk. Behavioral finance also distinguishes rational markets from hard-to-beat markets in the discussion of efficient markets, a distinction that is often blurred in standard finance, and it examines why so many investors believe that it is easy to beat the market. Moreover, behavioral finance expands the domain of finance beyond portfolios, asset pricing, and market efficiency and is set to continue that expansion while adhering to the scientific rigor introduced by standard finance.

  2. Decentralization and Economic Growth per capita in Europe

    NARCIS (Netherlands)

    Crucq, Pieter; Hemminga, Hendrik-Jan

    2007-01-01

    In this paper the relationship between decentralization and economic growth is investigated. The focus is on decentralization from the national government to the highest substate level in a country, which we define as regional decentralization. Section 2 discusses the different dimensions of decentr

  3. Centralized versus Decentralized Infrastructure Networks

    CERN Document Server

    Hines, Paul D H; Schläpfer, Markus

    2015-01-01

    While many large infrastructure networks, such as power, water, and natural gas systems, have similar physical properties governing flows, these systems tend to have distinctly different sizes and topological structures. This paper seeks to understand how these different size-scales and topological features can emerge from relatively simple design principles. Specifically, we seek to describe the conditions under which it is optimal to build decentralized network infrastructures, such as a microgrid, rather than centralized ones, such as a large high-voltage power system. While our method is simple it is useful in explaining why sometimes, but not always, it is economical to build large, interconnected networks and in other cases it is preferable to use smaller, distributed systems. The results indicate that there is not a single set of infrastructure cost conditions under which optimally-designed networks will have highly centralized architectures. Instead, as costs increase we find that average network size...

  4. Bitcoin as a decentralized currency

    Directory of Open Access Journals (Sweden)

    Dinić Vladimir

    2014-01-01

    Full Text Available Bitcoin is the first decentralized peer-to-peer crypto-currency founded in 2009. Its main specificity is the fact that there is no issuer of this currency. On the other hand, the supply of this currency is software-programmed and limited. Among other things, its main features are relatively secure payments, low transaction costs, anonymity, inability of counterfeiting, irreversibility of transactions, but also extremely unstable exchange rate. Despite many advantages, the use of this currency is subject of numerous discussions, as this currency offers the possibility of performing various abuses and criminal activities. The future of this and other currencies in this regard depends on both security and privacy of these currencies, and legal regulation of such payments.

  5. Decentralized Procurement in Light of Strategic Inventories

    DEFF Research Database (Denmark)

    Arya, Anil; Frimor, Hans; Mittendorf, Brian

    2014-01-01

    The centralization versus decentralization choice is perhaps the quintessential organizational structure decision. In the operations realm, this choice is particularly critical when it comes to the procurement function. Why firms may opt to decentralize procurement has been often studied...... and confirmed to be a multifaceted choice. This paper complements existing studies by detailing the trade-offs in the centralization versus decentralization decision in light of firm's decision to cede procurement choices to its individual devisions can help moderate inventory levels and provide a natural salve...

  6. Financing strategic healthcare facilities: the growing attraction of alternative capital.

    Science.gov (United States)

    Zismer, Daniel K; Fox, James; Torgerson, Paul

    2013-05-01

    Community health system leaders often dismiss use of alternative capital to finance strategic facilities as being too expensive and less strategically useful, preferring to follow historical precedent and use tax-exempt bonding to finance such facilities. Proposed changes in accounting rules should cause third-party-financed facility lease arrangements to be treated similarly to tax-exempt debt financings with respect to the income statement and balance sheet, increasing their appeal to community health systems. An in-depth comparison of the total costs associated with each financing approach can help inform the choice of financing approaches by illuminating their respective advantages and disadvantages.

  7. 陕西省农村地区卫生筹资累进性研究%Research of Progressivity of Health Financing in Rural Areas of Shaanxi Province

    Institute of Scientific and Technical Information of China (English)

    闫菊娥; 闫永亮; 高建民; 郝妮娜; 钱玉燕; 杨晓玮

    2012-01-01

    目的:探究陕西省农村地区不同筹资方式的累进性.方法:利用微观和宏观数据,采用集中曲线、Kakwani指数等,比较不同筹资方式的累进性.结果:税收公平性较好,现金卫生支出公平性较差,新农合传统的固定数额的筹资方式不具有公平性,总卫生筹资略微累退.结论:改变新农合传统筹资方式,提高补偿水平,减少低收入人群现金卫生支出,改变累退筹资现状,逐步改善卫生筹资公平性.%Objective: To explore the progressivity of health financing in rural areas of Shaanxi Province. Methods: Comparing the progressivity of all the health financing methods by using concentration curve and Kakwani indices with the macro and micro data. Results: The tax is progressive and it has vertical equity, however, the OOP is regressive and needs to be improved on vertical equity. The traditional financing method of NRCMS is strongly regressive and total health financing is also slightly regressive. Conclusion: The government should change the traditional financing method of NRCMS and improve the compensation level. Besides, it is important to reduce OOP of low-income groups to change the regressive financing methods and gradually improve the equity of health financing.

  8. Evaluación de la descentralización de la salud y la reforma de la Seguridad Social en Colombia Evaluation of health system decentralization and reform of the Social Security system in Colombia

    Directory of Open Access Journals (Sweden)

    I. Jaramillo

    2002-02-01

    Full Text Available El objetivo de este trabajo es presentar los resultados de las reformas al sector salud en Colombia acaecidas desde 1990. Con ellas se sustituyó el antiguo Sistema Nacional de Salud y el denominado modelo «bismarckiano» de la Seguridad Social. El nuevo sistema tiene tres características básicas: a el sistema público y de subsidios fiscales se encuentra descentralizado en las entidades territoriales departamentales y municipales; b los hospitales públicos se han convertido en empresas sociales del Estado y se les ha conducido hacia un manejo gerencial, y c se ha desmonopolizado el sistema de seguridad social en salud y se ha creado un régimen subsidiado de salud para los más pobres. Este artículo es una recopilación sistemática de información secundaria, extraída de los estudios más importantes que se han realizado para evaluar las reformas del sector salud en Colombia. En algunos de ellos ha participado el autor. La reforma ha conseguido multiplicar los recursos financieros, lo cual ha permitido incrementar los recursos humanos públicos y su remuneración, así como la disponibilidad de recursos presupuestarios por parte de los hospitales y la ampliación de la cobertura de la seguridad social, incluyendo al 20% de la población más pobre, beneficiaria de subsidios a demanda. El acceso y la equidad en los servicios personales de salud ha mejorado significativamente; sin embargo, se registra una caída de los indicadores de salud pública y los profesionales asumen una posición critica frente al nuevo sistema basado en la intermediación, que favorece el incremento de los costes de transacción.The aim of this study is to present the results of the reforms in the health sector that have taken place in Colombia since 1990. These reforms replaced the previous national health system and the so-called Bismarkian social security system. The new system has three basic characteristics: a the public subsidies are decentralized in the

  9. The effects of fiscal decentralization in Albania

    Directory of Open Access Journals (Sweden)

    Dr.Sc. Blerta Dragusha

    2012-06-01

    Full Text Available “Basically decentralization is a democratic reform which seeks to transfer the political, administrative, financial and planning authority from central to local government. It seeks to develop civic participation, empowerment of local people in decision making process and to promote accountability and reliability: To achieve efficiency and effectiveness in the collection and management of resources and service delivery”1 The interest and curiosity of knowing how our country is doing in this process, still unfinished, served as a motivation forme to treat this topic: fiscal decentralization as a process of giving 'power' to local governments, not only in terms of rights deriving from this process but also on the responsibilities that come with it. Which are the stages before and after decentralization, and how has it affected the process in several key indicators? Is decentralization a good process only, or can any of its effects be seen as an disadvantage?

  10. Modeling Decentralized Organizational Change in Honeybee Societies

    OpenAIRE

    Hoogendoorn, Mark; Schut, Martijn; Treur, Jan

    2006-01-01

    Multi-agent organizations in dynamic environments, need to have the ability to adapt to environmental changes to ensure a continuation of proper functioning. Such adaptations can be made through a centralized decision process or come from the individuals within the organization. In the domain of social insects, such as honeybees and wasps, organizations are known to adapt in a decentralized fashion to environmental changes. An organizational model for decentralized organizational change is pr...

  11. The Two Edge Knife of Decentralization

    OpenAIRE

    Ahmad Khoirul Umam

    2011-01-01

    A centralistic government model has become a trend in a number of developing countries, in which the ideosycretic aspect becomes pivotal key in the policy making. The situation constitutes authoritarianism, cronyism, and corruption. To break the impasse, the decentralized system is proposed to make people closer to the public policy making. Decentralization is also convinced to be the solution to create a good governance. But a number of facts in the developing countries demonstrates that dec...

  12. Decentralized network management based on mobile agent

    Institute of Scientific and Technical Information of China (English)

    李锋; 冯珊

    2004-01-01

    The mobile agent technology can be employed effectively for the decentralized management of complex networks. We show how the integration of mobile agent with legacy management protocol, such as simple network management protocol (SNMP), leads to decentralized management architecture. HostWatcher is a framework that allows mobile agents to roam network, collect and process data, and perform certain adaptive actions. A prototype system is built and a quantitative analysis underlines the benefits in respect to reducing network load.

  13. Contribution analysis as an evaluation strategy in the context of a sector-wide approach: Performance-based health financing in Rwanda

    Directory of Open Access Journals (Sweden)

    Martin Noltze

    2014-12-01

    Full Text Available Sector-wide approaches (SWAps emerged as a response to donor fragmentation and non-adjusted and parallel programming. In the health sector, SWAps have received considerable support by the international donor community due to their potential to reduce inefficiencies through alignment to common procedures and hence to increase development effectiveness. Evaluating development cooperation in the context of a SWAp, however, translates into methodological challenges for evaluators who have to disentangle the cumulative effects in strongly donor-aligned, complex sector environments. In this article the authors discussed the application of a methodological strategy for evaluating development interventions in complex settings – for example in the context of a SWAp –and reflected the suitability of the approach. The authors conducted a contribution analysis, a theory-based approach to evaluation, and exemplified the approach for an intervention of performance-based financing for Rwandan health workers supported by the Rwanda-German cooperation. The findings suggested that the Rwandan system of performance based financing increased service orientation and outputs of health professionals, but also indicated that negative motivational side effects and resource constraints are real. With regard to the methodological approach, the authors conclude that contribution analysis has a high potential to evaluate development cooperation in the context of a SWAp dueto its high flexibility to use different data collection tools and its capability to assess risks and rival explanations. Challenges can be identified with regard to the efficiency of the evaluation strategy and a remaining trade-off between scope and causal strength ofevidence.

  14. Decentralized Consistent Updates in SDN

    KAUST Repository

    Nguyen, Thanh Dang

    2017-04-10

    We present ez-Segway, a decentralized mechanism to consistently and quickly update the network state while preventing forwarding anomalies (loops and blackholes) and avoiding link congestion. In our design, the centralized SDN controller only pre-computes information needed by the switches during the update execution. This information is distributed to the switches, which use partial knowledge and direct message passing to efficiently realize the update. This separation of concerns has the key benefit of improving update performance as the communication and computation bottlenecks at the controller are removed. Our evaluations via network emulations and large-scale simulations demonstrate the efficiency of ez-Segway, which compared to a centralized approach, improves network update times by up to 45% and 57% at the median and the 99th percentile, respectively. A deployment of a system prototype in a real OpenFlow switch and an implementation in P4 demonstrate the feasibility and low overhead of implementing simple network update functionality within switches.

  15. Decentralized and Modular Electrical Architecture

    Science.gov (United States)

    Elisabelar, Christian; Lebaratoux, Laurence

    2014-08-01

    This paper presents the studies made on the definition and design of a decentralized and modular electrical architecture that can be used for power distribution, active thermal control (ATC), standard inputs-outputs electrical interfaces.Traditionally implemented inside central unit like OBC or RTU, these interfaces can be dispatched in the satellite by using MicroRTU.CNES propose a similar approach of MicroRTU. The system is based on a bus called BRIO (Bus Réparti des IO), which is composed, by a power bus and a RS485 digital bus. BRIO architecture is made with several miniature terminals called BTCU (BRIO Terminal Control Unit) distributed in the spacecraft.The challenge was to design and develop the BTCU with very little volume, low consumption and low cost. The standard BTCU models are developed and qualified with a configuration dedicated to ATC, while the first flight model will fly on MICROSCOPE for PYRO actuations and analogue acquisitions. The design of the BTCU is made in order to be easily adaptable for all type of electric interface needs.Extension of this concept is envisaged for power conditioning and distribution unit, and a Modular PCDU based on BRIO concept is proposed.

  16. Expanding Pharmacist Services in Québec: A Health Reform Analysis of Bill 41 and its Implications for Equity in Financing Care

    Directory of Open Access Journals (Sweden)

    Renée Carter

    2014-12-01

    Full Text Available On 8 December 2011, Québec’s Minister of Health and Social Services amended the province’s Pharmacy Act by introducing Bill 41 to expand pharmacists’ role in patient care. Québec is the only Canadian province with a legal mandate for prescription drug insurance coverage for all residents, with public coverage offered only to those who do not have access to private health insurance through their employer. Bill 41 aims to increase access to health care and reduce physician wait times by extending the scope of pharmacist services to mirror that of physicians (e.g., modify the form of the medication and its dosage. The reform is currently pending due to disputes between the Ministry of Health and Social Services and the Quebec Association of Pharmacy Owners over remuneration for pharmacists. Should Bill 41 come into force, it is unclear whether the expansion of pharmacists’ roles, which in principle would duplicate physician services, should be considered part of the public basket of medically necessary care. Current negotiations suggest that only those with public coverage will also be covered for expanded services thereby placing equity of finance for those with private insurance in question.

  17. Expanding Pharmacist Services in Québec: A Health Reform Analysis of Bill 41 and its Implications for Equity in Financing Care

    Directory of Open Access Journals (Sweden)

    Renée Carter

    2014-12-01

    Full Text Available On 8 December 2011, Québec’s Minister of Health and Social Services amended the province’s Pharmacy Act by introducing Bill 41 to expand pharmacists’ role in patient care. Québec is the only Canadian province with a legal mandate for prescription drug insurance coverage for all residents, with public coverage offered only to those who do not have access to private health insurance through their employer. Bill 41 aims to increase access to health care and reduce physician wait times by extending the scope of pharmacist services to mirror that of physicians (e.g., modify the form of the medication and its dosage. The reform is currently pending due to disputes between the Ministry of Health and Social Services and the Quebec Association of Pharmacy Owners over remuneration for pharmacists. Should Bill 41 come into force, it is unclear whether the expansion of pharmacists’ roles, which in principle would duplicate physician services, should be considered part of the public basket of medically necessary care. Current negotiations suggest that only those with public coverage will also be covered for expanded services thereby placing equity of finance for those with private insurance in question.

  18. [Capacity of response of the health system to the expectations of populations in zones exposed to results-based financing in Benin in 2015].

    Science.gov (United States)

    Salami, Lamidhi; Dona Ouendo, Edgard-Marius; Fayomi, Benjamin

    2017-07-10

    Introduction: The increased use of results-based financing (RBF) services was the basis for this study designed to evaluate the contribution of RBF to the capacity of response of the health system to the population’s expectations. Methods: This study, conducted in six Benin health zones randomly selected in two strata exposed to RBF (FBR_PRPSS and FBR_PASS) and one zone not exposed to RBF (Non_FBR), examined the seven dimensions of reactivity. A score, followed by weighting of their attributes, was used to calculate the index of reactivity (IR). Results: Sixty-seven health care units and 653 people were observed and interviewed. The FBR_PRPSS and FBR_PASS strata, managed by the new provisions of RBF, displayed good performances for the “rapidity of management” (70% and 80%) and “quality of the health care environment” dimensions, with a more marked improvement for the PRPSS model, which provides greater resources. Poor access to social welfare networks in the three strata led to renouncing of health care. The capacity of response to expectations was moderate and similar in the Non_FBR (IR = 0.53), FBR_PASS (IR = 0.62) and FBR_PRPSS (IR = 0.61) strata (p > 0.05). Conclusion: The FBR_PRPSS and FBR_PASS models have a non-significant effect on the capacity of response. Their success probably depends on the health system context, the combination of targeted interventions, such as universal health insurance, but also the importance and the use of the new resources that they provide.

  19. Crowding out or no crowding out? A Self-Determination Theory approach to health worker motivation in performance-based financing.

    Science.gov (United States)

    Lohmann, Julia; Houlfort, Nathalie; De Allegri, Manuela

    2016-11-01

    Performance-based financing (PBF) is a common health system reform approach in low and middle income countries at present. Although increasing evidence on the effectiveness of PBF and knowledge of principles of good design are available, research is still lacking in regards to other aspects. Among these are a yet limited understanding of the complex role of health worker motivation in PBF and of potential side effects, for instance on intrinsic motivation. Our article aims to support meaningful future research by advancing the theoretical discussion around health worker motivation and PBF. We argue that an in-depth understanding of the motivational mechanisms and consequences of PBF at health worker level are of high practical relevance and should be at the heart of the PBF research agenda, and that predominant unidimensional conceptualizations of health worker motivation and descriptive rather than explanatory research approaches are insufficient to fully understand whether, how, and why PBF schemes alter health workers' motivational structures, mindsets, affect, and behavior. We introduce and apply Self-Determination Theory to the context of PBF as a valuable theoretical framework for future empirical exploration. From this, we conclude that PBF interventions are unlikely to have a generally adverse effect on intrinsic motivation as feared by parts of the PBF community. Rather, we posit that PBF can have positive and negative effects on both intrinsic and extrinsic motivation, to varying degrees depending on the specific design, implementation, and results of a particular intervention and on health workers' perceptions and evaluations of it. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Statistics for Finance

    DEFF Research Database (Denmark)

    Lindström, Erik; Madsen, Henrik; Nielsen, Jan Nygaard

    Statistics for Finance develops students’ professional skills in statistics with applications in finance. Developed from the authors’ courses at the Technical University of Denmark and Lund University, the text bridges the gap between classical, rigorous treatments of financial mathematics...

  1. Statistics for Finance

    DEFF Research Database (Denmark)

    Lindström, Erik; Madsen, Henrik; Nielsen, Jan Nygaard

    Statistics for Finance develops students’ professional skills in statistics with applications in finance. Developed from the authors’ courses at the Technical University of Denmark and Lund University, the text bridges the gap between classical, rigorous treatments of financial mathematics...

  2. Hardship financing of healthcare among rural poor in Orissa, India

    NARCIS (Netherlands)

    E. Binnendijk (Erica); R. Koren (Ruth); D.M. Dror (David)

    2012-01-01

    textabstractBackground: This study examines health-related "hardship financing" in order to get better insights on how poor households finance their out-of-pocket healthcare costs. We define hardship financing as having to borrow money with interest or to sell assets to pay out-of-pocket healthcare

  3. Essays in household finance

    NARCIS (Netherlands)

    Djordjevic, Ljubica

    2015-01-01

    Household finance is a young and vibrant research field that continuously attracts public attention. There may be very few matters that people care so much about as their personal finance. Recent rise of academic interest in household finance is to a great extent due to households’ more active role

  4. SME Finance in Africa

    OpenAIRE

    Beck, T.; Cull, R

    2014-01-01

    This paper uses cross-country firm-level surveys to gauge access to financial services and the importance of financing constraints for African enterprises. The paper compares access to finance in Africa and other developing regions of the world, within Africa across countries, and across different groups of firms. It relates firms' access to finance to firm and banking system characteristi...

  5. Sustainability evaluation of decentralized electricity generation

    Energy Technology Data Exchange (ETDEWEB)

    Karger, Cornelia R.; Hennings, Wilfried [Research Centre Juelich, Programme Group Humans, Environment, Technology (MUT), 52425 Juelich (Germany)

    2009-04-15

    Decentralized power generation is gaining significance in liberalized electricity markets. An increasing decentralization of power supply is expected to make a particular contribution to climate protection. This article investigates the advantages and disadvantages of decentralized electricity generation according to the overall concept of sustainable development. On the basis of a hierarchically structured set of sustainability criteria, four future scenarios for Germany are assessed, all of which describe different concepts of electricity supply in the context of the corresponding social and economic developments. The scenarios are developed in an explorative way according to the scenario method and the sustainability criteria are established by a discursive method with societal actors. The evaluation is carried out by scientific experts. By applying an expanded analytic hierarchy process (AHP), a multicriteria evaluation is conducted that identifies dissent among the experts. The results demonstrate that decentralized electricity generation can contribute to climate protection. The extent to which it simultaneously guarantees security of supply is still a matter of controversy. However, experts agree that technical and economic boundary conditions are of major importance in this field. In the final section, the article discusses the method employed here as well as implications for future decentralized energy supply. (author)

  6. Water Finance Forum-Texas

    Science.gov (United States)

    Regional Finance Forum: Financing Resilient and Sustainable Water Infrastructure, held in Addison, Texas, September 10-11, 2015.Co-sponsored by EPA's Water Infrastructure and Resiliency Finance Center and the Environmental Finance Center Network.

  7. Analysis of pan-African Centres of excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent

    Directory of Open Access Journals (Sweden)

    Nwaka Solomon

    2012-07-01

    Full Text Available Abstract A pool of 38 pan-African Centres of Excellence (CoEs in health innovation has been selected and recognized by the African Network for Drugs and Diagnostics Innovation (ANDI, through a competitive criteria based process. The process identified a number of opportunities and challenges for health R&D and innovation in the continent: i it provides a direct evidence for the existence of innovation capability that can be leveraged to fill specific gaps in the continent; ii it revealed a research and financing pattern that is largely fragmented and uncoordinated, and iii it highlights the most frequent funders of health research in the continent. The CoEs are envisioned as an innovative network of public and private institutions with a critical mass of expertise and resources to support projects and a variety of activities for capacity building and scientific exchange, including hosting fellows, trainees, scientists on sabbaticals and exchange with other African and non-African institutions.

  8. Desafios e dificuldades do financiamento em saúde bucal: uma análise qualitativa Challenges and difficulties of financing oral health: a qualitative analysis

    Directory of Open Access Journals (Sweden)

    Suzely Adas Saliba Moimaz

    2008-12-01

    Full Text Available Os princípios de universalidade, integralidade e eqüidade do SUS só podem ser viabilizados com a construção de um modelo de financiamento flexível e transparente que permita o controle social e ofereça a agilidade no uso dos recursos. Este artigo analisa as dificuldades e desafios do financiamento da saúde bucal na ótica de gestores e técnicos da área. A coleta de dados ocorreu por meio de entrevistas, queforam gravadas e transcritas para análise qualitativa, preconizada por Bardin. As dificuldades relatadas pelos entrevistados foram expressas em frases como: "Procuro cumprir a agenda, porém muita coisa não consegui devido à falta de recursos", "não se sabe o quanto pode gastar", "escassez de recursos para procedimentos de média e grande complexidades", "falta de recurso para troca de equipamento" e "prioridade para compra de materiais". No que tange aos desafios foi relatada a necessidade de "capacitação", "formação" e "organização" dos recursos humanos em saúde pública. Observa-se a dificuldade na realização completa do plano previsto de gestão, assim como a necessidade de compromisso por parte dos gestores em acompanhar as etapas de todo processo de repasse financeiro e aplicação do mesmo.The principles of universality, completeness, and equity of the Unified Health System (SUS only can be made viable with the construction of a flexible and transparent financing model that allows social control and offers agility in the use of resources. This article analyzes the difficulties and challenges of oral health financing in the perspective of managers and technicians who work in the Unique Health System. Data was collected through interviews, which were recorded and transcribed for qualitative analysis, according to Bardin's method. The difficulties reported by all interviewees were expressed by phrases such as "I try to fulfill my commitments, but I don't succeed due the lack of resources", "I don't know how much

  9. Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: a recipe for good practice.

    Science.gov (United States)

    Erreygers, Guido; Van Ourti, Tom

    2011-07-01

    The tools to be used and other choices to be made when measuring socioeconomic inequalities with rank-dependent inequality indices have recently been debated in this journal. This paper adds to this debate by stressing the importance of the measurement scale, by providing formal proofs of several issues in the debate, and by lifting the curtain on the confusing debate between adherents of absolute versus relative health differences. We end this paper with a 'matrix' that provides guidelines on the usefulness of several rank-dependent inequality indices under varying circumstances. Copyright © 2011 Elsevier B.V. All rights reserved.

  10. Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review

    National Research Council Canada - National Science Library

    Akl, Elie A; El-Jardali, Fadi; Bou Karroum, Lama; El-Eid, Jamale; Brax, Hneine; Akik, Chaza; Osman, Mona; Hassan, Ghayda; Itani, Mira; Farha, Aida; Pottie, Kevin; Oliver, Sandy

    2015-01-01

    .... The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing...

  11. Convergent Double Auction Mechanism for a Prosumers' Decentralized Smart Grid

    National Research Council Canada - National Science Library

    Tadahiro Taniguchi; Tomohiro Takata; Yoshiro Fukui; Koki Kawasaki

    2015-01-01

    ...) for a prosumers' decentralized smart grid. The target decentralized smart grid is a regional electricity network that consists of many prosumers that have a battery and a renewable energy-based generator, such as photovoltaic cells...

  12. Transition-Independent Decentralized Markov Decision Processes

    Science.gov (United States)

    Becker, Raphen; Silberstein, Shlomo; Lesser, Victor; Goldman, Claudia V.; Morris, Robert (Technical Monitor)

    2003-01-01

    There has been substantial progress with formal models for sequential decision making by individual agents using the Markov decision process (MDP). However, similar treatment of multi-agent systems is lacking. A recent complexity result, showing that solving decentralized MDPs is NEXP-hard, provides a partial explanation. To overcome this complexity barrier, we identify a general class of transition-independent decentralized MDPs that is widely applicable. The class consists of independent collaborating agents that are tied up by a global reward function that depends on both of their histories. We present a novel algorithm for solving this class of problems and examine its properties. The result is the first effective technique to solve optimally a class of decentralized MDPs. This lays the foundation for further work in this area on both exact and approximate solutions.

  13. Partially decentralized control for ALSTOM gasifier.

    Science.gov (United States)

    Tan, Wen; Lou, Guannan; Liang, Luping

    2011-07-01

    The gasifier plays a key role in the operation of the whole IGCC power plant. It is a typical multivariable control system with strict constraints on the inputs and outputs which makes it very difficult to control. This paper presents a partially decentralized controller design method based on the stabilizer idea. The method only requires identifying some closed-loop transfer functions and solving an H(∞) optimization problem. The final partially decentralized controller is easy to implement and test in practice. Two partially decentralized controllers are designed for the ALSTOM gasifier benchmark problem, and simulation results show that they both meet the design specifications. Copyright © 2011 ISA. Published by Elsevier Ltd. All rights reserved.

  14. Towards Automatic Decentralized Control Structure Selection

    DEFF Research Database (Denmark)

    for decentralized control is determined automatically, and the resulting decentralized control structure is automatically tuned using standard techniques. Dynamic simulation of the resulting process system gives immediate feedback to the process design engineer regarding practical operability of the process......A subtask in integration of design and control of chemical processes is the selection of a control structure. Automating the selection of the control structure enables sequential integration of process and controld esign. As soon as the process is specified or computed, a structure....... The control structure selection problem is formulated as a special MILP employing cost coefficients which are computed using Parseval's theorem combined with RGA and IMC concepts. This approach enables selection and tuning of large-scale plant-wide decentralized controllers through efficient combination...

  15. Elements for a Theory of Decentralized Governance

    Directory of Open Access Journals (Sweden)

    Cristian-Ion POPA

    2013-06-01

    Full Text Available This year the Romanian Government has triggered a wide-ranging political process in order to revise the existing Constitution and, in this context, an ambitious program of decentralization-regionalization of the Romanian state administration. The article proposes a brief critical analysis of these generous objectives of the Government, and the means of achieving them, using a part of the academic literature devoted to decentralized governance. The two main sections of the article will attempt to address, in turn, and as realistic as possible, (1 the potential advantages of decentralized governance, and (2 some risks of this type of government, as they are described in the relevant literature of public economy.

  16. Towards Automatic Decentralized Control Structure Selection

    DEFF Research Database (Denmark)

    Jørgensen, John Bagterp; Jørgensen, Sten Bay

    2000-01-01

    A subtask in integration of design and control of chemical processes is the selection of a control structure. Automating the selection of the control structure enables sequential integration of process and control design. As soon as the process is specified or computed, a structure...... for decentralized control is determined automatically, and the resulting decentralized control structure is automatically tuned using standard techniques. Dynamic simulation of the resulting process system gives immediate feedback to the process design engineer regarding practical operability of the process....... The control structure selection problem is formulated as a special MILP employing cost coefficients which are computed using Parseval's theorem combined with RGA and IMC concepts. This approach enables selection and tuning of large-scale plant-wide decentralized controllers through efficient combination...

  17. What is project finance?

    Directory of Open Access Journals (Sweden)

    João M. Pinto

    2017-05-01

    Full Text Available Project finance is the process of financing a specific economic unit that the sponsors create, in which creditors share much of the venture’s business risk and funding is obtained strictly for the project itself. Project finance creates value by reducing the costs of funding, maintaining the sponsors financial flexibility, increasing the leverage ratios, avoiding contamination risk, reducing corporate taxes, improving risk management, and reducing the costs associated with market imperfections. However, project finance transactions are complex undertakings, they have higher costs of borrowing when compared to conventional financing and the negotiation of the financing and operating agreements is time-consuming. In addition to describing the economic motivation for the use of project finance, this paper provides details on project finance characteristics and players, presents the recent trends of the project finance market and provides some statistics in relation to project finance lending activity between 2000 and 2014. Statistical analysis shows that project finance loans arranged for U.S. borrowers have higher credit spreads and upfront fees, and have higher loan size to deal size ratios when compared with loans arranged for borrowers located in W.E. On the contrary, loans closed in the U.S. have a much shorter average maturity and are much less likely to be subject to currency risk and to be closed as term loans.

  18. Financial management systems under decentralization and their effect on malaria control in Uganda.

    Science.gov (United States)

    Kivumbi, George W; Nangendo, Florence; Ndyabahika, Boniface Rutagira

    2004-01-01

    A descriptive case study with multiple sites and a single level of analysis was carried out in four purposefully selected administrative districts of Uganda to investigate the effect of financial management systems under decentralization on malaria control. Data were primarily collected from 36 interviews with district managers, staff at health units and local leaders. A review of records and documents related to decentralization at the central and district level was also used to generate data for the study. We found that a long, tedious, and bureaucratic process combined with lack of knowledge in working with new financial systems by several actors characterized financial flow under decentralization. This affected the timely use of financial resources for malaria control in that there were funds in the system that could not be accessed for use. We were also told that sometimes these funds were returned to the central government because of non-use due to difficulties in accessing them and/or stringent conditions not to divert them to other uses. Our data showed that a cocktail of bureaucratic control systems, corruption and incompetence make the financial management system under decentralization counter-productive for malaria control. The main conclusion is that good governance through appropriate and efficient financial management systems is very important for effective malaria control under decentralization.

  19. Fiscal decentralization and its effects on macroeconomic performance

    OpenAIRE

    Yalım, Derya

    2003-01-01

    Cataloged from PDF version of article. Decentralization has become an important policy issue in recent years. International organizations allocate more space for fiscal decentralization in their agenda. In the literature, there are vast amount of studies that concentrate on the advantages or disadvantages of fiscal decentralization. The literature suggested that with a good policy design of the fiscal decentralization, especially developing countries might achieve desired ou...

  20. The optical axis optimization in measurement of decentration of lens

    Science.gov (United States)

    Wang, Yajing; Yang, Lin; Wang, Chunyu

    2013-09-01

    Measure of optical decentration plays an important role in inspection, installation and adjustment of optical system. This article describes optical measurement principle of decentration, analyzes the reason of the decentration measurement accuracy, and indicates the necessity of optimizing the optical axis. Finally, because of the error of the decentration optical axis fitting. A new method of optical axis optimization is put forward here. A mathematical model to find the best optical axis is established, which improved the optical performance of the system.

  1. Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?

    Science.gov (United States)

    Hunter, Benjamin M; Murray, Susan F

    2017-08-31

    Demand-side financing (DSF) interventions, including cash transfers and vouchers, have been introduced to promote maternal and newborn health in a range of low- and middle-income countries. These interventions vary in design but have typically been used to increase health service utilisation by offsetting some financial costs for users, or increasing household income and incentivising 'healthy behaviours'. This article documents experiences and implementation factors associated with use of DSF in maternal and newborn health. A secondary analysis (using an adapted Supporting the Use of Research Evidence framework - SURE) was performed on studies that had previously been identified in a systematic review of evidence on DSF interventions in maternal and newborn health. The article draws on findings from 49 quantitative and 49 qualitative studies. The studies give insights on difficulties with exclusion of migrants, young and multiparous women, with demands for informal fees at facilities, and with challenges maintaining quality of care under increasing demand. Schemes experienced difficulties if communities faced long distances to reach participating facilities and poor access to transport, and where there was inadequate health infrastructure and human resources, shortages of medicines and problems with corruption. Studies that documented improved care-seeking indicated the importance of adequate programme scope (in terms of programme eligibility, size and timing of payments and voucher entitlements) to address the issue of concern, concurrent investments in supply-side capacity to sustain and/or improve quality of care, and awareness generation using community-based workers, leaders and women's groups. Evaluations spanning more than 15 years of implementation of DSF programmes reveal a complex picture of experiences that reflect the importance of financial and other social, geographical and health systems factors as barriers to accessing care. Careful design of DSF

  2. Hospitals, finance, and health system reform in Britain and the United States, c. 1910-1950: historical revisionism and cross-national comparison.

    Science.gov (United States)

    Gorsky, Martin

    2012-06-01

    Comparative histories of health system development have been variously influenced by the theoretical approaches of historical institutionalism, political pluralism, and labor mobilization. Britain and the United States have figured significantly in this literature because of their very different trajectories. This article explores the implications of recent research on hospital history in the two countries for existing historiographies, particularly the coming of the National Health Service in Britain. It argues that the two hospital systems initially developed in broadly similar ways, despite the very different outcomes in the 1940s. Thus, applying the conceptual tools used to explain the U.S. trajectory can deepen appreciation of events in Britain. Attention focuses particularly on working-class hospital contributory schemes and their implications for finance, governance, and participation; these are then compared with Blue Cross and U.S. hospital prepayment. While acknowledging the importance of path dependence in shaping attitudes of British bureaucrats toward these schemes, analysis emphasizes their failure in pressure group politics, in contrast to the United States. In both countries labor was also crucial, in the United States sustaining employment-based prepayment and in Britain broadly supporting system reform.

  3. Decentralization of Government Agencies: What Does It Accomplish?

    Science.gov (United States)

    Yin, Robert K.

    1979-01-01

    Focuses on the decentralization of governmental agencies from the perspective of both municipal and federal experiences. The article first discusses the main lessons from municipal decentralization, then outlines the characteristics of recent federal initiatives, and concludes with comments on the likely effects of decentralization. (Author)

  4. Costs and financing of improvements in the quality of maternal health services through the Bamako Initiative in Nigeria.

    Science.gov (United States)

    Ogunbekun, I; Adeyi, O; Wouters, A; Morrow, R H

    1996-12-01

    This paper reports on a study to assess the quality of maternal health care in public health facilities in Nigeria and to identify the resource implications of making the necessary quality improvements. Drawing upon unifying themes from quality assurance, basic microeconomics and the Bamako Initiative, locally defined norms were used to estimate resource requirements for improving the quality of maternal health care. Wide gaps existed between what is required (the norm) and what was available in terms of fixed and variable resources required for the delivery of maternal health services in public facilities implementing the Bamako Initiative in the Local Government Areas studied. Given such constraints, it was highly unlikely that technically acceptable standards of care could be met without additional resource inputs to meet the norm. This is part of the cost of doing business and merits serious policy dialogue. Revenue generation from health services was poor and appeared to be more related to inadequate supply of essential drugs and consumables than to the use of uneconomic fee scales. It is likely that user fees will be necessary to supplement scarce government budgets, especially to fund the most critical variable inputs associated with quality improvements. However, any user fee system, especially one that raises fees to patients, will have to be accompanied by immediate and visible quality improvements. Without such quality improvements, cost recovery will result in even lower utilization and attempts to generate new revenues are unlikely to succeed.

  5. What makes health demand-side financing schemes work in low- and middle-income countries? A realist review

    Directory of Open Access Journals (Sweden)

    Saji S. Gopalan

    2014-12-01

    Full Text Available This realist review explored causal pathways of the possible consumer effects of health sector demand-side financial (DSF incentives, their contextual factors and mechanisms in low-and-middle-income countries. We searched six electronic data bases and identified 659 abstracts with different evaluation designs. Based on methodological rigor and content relevance, only 24 studies published up to April 2013 were selected for the final review. A conceptual framework consisting of various program theories on potential context-mechanism-outcome (C-M-O configuration of DSF initiative was designed, tested and adapted during the review. Synthesized results were presented as a C-M-O configuration for each of the consumer-side effect. DSF was effective to improve health seeking behaviour considerably and health status to some extent. The causal pathway of DSF’s functioning and effectiveness was not linear. Key demand-side contextual factors which affected DSF’s consumer-side effects were background characteristics of the beneficiaries including their socio-cultural beliefs, motivations, and level of health awareness. At the supply-side, service availability status and provider incentives were contextual determinants. The mechanisms which enabled the interaction of contextual influence were consumer and provider accountability and consumer trust on providers. In order to enhance DSF programs’ effectiveness, their design and implementation should carefully consider the potential contextual elements that may influence the causal pathways.

  6. Decentralization and Participation: the Montevidian Experience

    Directory of Open Access Journals (Sweden)

    María del Rosario Revello

    1999-10-01

    Full Text Available Beginning with the proposition that a true process of decentralization must necessarily be a process of democratization, such a process is understood as a privileged instrument for participation. Indeed, for a deepening of democratic practices, the ways which should be taken are via decentralization and social participation. This article describes and analyzes the experience of decentralization in Montevideo, a fundamental project created by the coalition of leftist parties that have governed the capital of Uruguay since 1990, a project which had no historical antecedents in the country. The department of Montevideo divided into 18 zones and created juntas locales (local boards - local, decentralized politicalorgans with representation from all the parties - and neighborhood councils. The Neighborhood Councils are representative organs that voice the neighborhood’s interests. Not integrated in the public municipal structure, these constitute private civil society organizations. They are consultative and consultancy bodies with the important tasks of initiative and proposal, planning, consultation, evaluation and the control over the communal management. Also described in the article is the methodology for the project’s improvement and progressive sophistication, which is in function of, among other factors, the degree of effectiveness and reaching of objectives that emerge from the permanent control and evaluation carried out year to year. The strategy presented emphasizes the need for ensuring that the community directly monitors and controls the process of municipal management to safeguard the democratic character of the process.

  7. Harsh Realities about Decentralized Decision Making.

    Science.gov (United States)

    Patterson, Jerry

    1998-01-01

    To increase their odds for successful decentralized decision making, leaders must operate from a different set of realities about organizational change and design appropriate strategies to create more resilient organizations. Most people act first in their own self-interest; resist understanding the meaning of organizational change; and are…

  8. Decentralized forest governance in central Vietnam

    NARCIS (Netherlands)

    Tran Nam, T.; Burgers, P.P.M.

    2012-01-01

    A major challenge in decentralized forest governance in Vietnam is developing a mechanism that would support both reforestation and poverty reduction among people in rural communities. To help address this challenge, Forest Land Allocation (FLA) policies recognize local communities and individuals a

  9. Towards a Decentralized Magnetic Indoor Positioning System

    Directory of Open Access Journals (Sweden)

    Zakaria Kasmi

    2015-12-01

    Full Text Available Decentralized magnetic indoor localization is a sophisticated method for processing sampled magnetic data directly on a mobile station (MS, thereby decreasing or even avoiding the need for communication with the base station. In contrast to central-oriented positioning systems, which transmit raw data to a base station, decentralized indoor localization pushes application-level knowledge into the MS. A decentralized position solution has thus a strong feasibility to increase energy efficiency and to prolong the lifetime of the MS. In this article, we present a complete architecture and an implementation for a decentralized positioning system. Furthermore, we introduce a technique for the synchronization of the observed magnetic field on the MS with the artificially-generated magnetic field from the coils. Based on real-time clocks (RTCs and a preemptive operating system, this method allows a stand-alone control of the coils and a proper assignment of the measured magnetic fields on the MS. A stand-alone control and synchronization of the coils and the MS have an exceptional potential to implement a positioning system without the need for wired or wireless communication and enable a deployment of applications for rescue scenarios, like localization of miners or firefighters.

  10. GDCluster: A General Decentralized Clustering Algorithm

    NARCIS (Netherlands)

    Mashayekhi, Hoda; Habibi, Jafar; Khalafbeigi, Tania; Voulgaris, Spyros; van Steen, Martinus Richardus

    In many popular applications like peer-to-peer systems, large amounts of data are distributed among multiple sources. Analysis of this data and identifying clusters is challenging due to processing, storage, and transmission costs. In this paper, we propose GDCluster, a general fully decentralized

  11. Securing data accountability in decentralized systems

    NARCIS (Netherlands)

    Corin, Ricardo; Galindo, David; Hoepman, Jaap-Henk

    2006-01-01

    We consider a decentralized setting in which agents exchange data along with usage policies. Agents may violate the intended usage policies, although later on auditing authorities may verify the agents’ data accountability with respect to the intended policies. Using timestamping and signature schem

  12. Afterword: The Politics of School Decentralization

    Science.gov (United States)

    Peterson, Paul E.

    1975-01-01

    Summarizes the organizational process and political bargaining models of policy change, and considers the rational decision-making model as an alternative. Models are interrelated with each other to show how each reveals a dimension of the politics of school decentralization. (Author/AM)

  13. Decentralization and the local development state

    DEFF Research Database (Denmark)

    Emmenegger, Rony Hugo

    2016-01-01

    between the 2005 and 2010 elections. Based on ethnographic field research, the empirical case presented discloses that decentralization and state-led development serve the expansion of state power into rural areas, but that state authority is simultaneously constituted and undermined in the course...

  14. Medico-economic evaluation of health products in the context of the Social Security Financing Act for 2012.

    Science.gov (United States)

    Dervaux, Benoît; Baseilhac, Eric; Fagon, Jean-Yves; Ameye, Véronique; Angot, Pierre; Audry, Antoine; Becquemont, Laurent; Borel, Thomas; Cazeneuve, Béatrice; Courtois, Jocelyn; Detournay, Bruno; Favre, Pascal; Granger, Muriel; Josseran, Anne; Lassale, Catherine; Louvet, Olivier; Pinson, Jean; de Pouvourville, Gérard; Rochaix, Lise; Rumeau-Pichon, Catherine; de Saab, Rima; Schwarzinger, Mickaël; Sun, Aristide

    2013-01-01

    The participants in round table 6 of the Giens Workshops 2012 drafted recommendations based on the collective interpretation of important elements of the decree concerning the medico-economic evaluation of health products published a few days earlier (02 October 2012). The medico-economic evaluation (MEE), becomes an additional determinant for fixing the prices of health products by the Health products economic committee (Comité économique des produits de santé, CEPS) via the hierarchisation of treatment strategies, and thus modifies the market access conditions. Limiting the analysis to medicinal products and medical devices for which a major, important or moderate improvement in the medical service rendered (ASMR) or of the expected service (ASA) has been requested and presenting a significant budget impact on the Social Security expenses, excludes health products with ASMR or ASA with a lower level requested which often create complex price fixing problems and often have a major budget impact. This latter concept remains to be defined in detail. The MEE envisaged for the first registration must include the need to confirm or refute the initial hypotheses especially concerning the actual position in the therapeutic strategy at the time of renewal of the registration. For the first registration, the conventional reference to European prices guaranteeing a minimum price to innovative medicinal products, the medico-economic models submitted by the industry to the French Drug Authority (Haute autorité de santé, HAS) must be used to guide the compilation of new data to be requested at the time of the registration renewal and to negotiate the level of the discounts in the framework of a price-volume agreement, if applicable. The MEE will allow comparing the result of the analysis to the model hypothesis at the time of the renewal of the registration, which may contribute to the renegotiation (either up or down) of the price of health goods. The costs related to

  15. Descentralização das ações de Vigilância Sanitária nos municípios em Gestão Plena, Estado do Rio de Janeiro Decentralization of Health Surveillance actions in cities with local health managment in the State of Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Mirian Miranda Cohen

    2004-09-01

    Full Text Available O Centro de Vigilância Sanitária da Secretaria de Estado da Saúde do Rio de Janeiro pretende, com a descentralização das ações de vigilância sanitária para os Municípios, atender condições mínimas para fortalecer o sistema estadual de Vigilância Sanitária, criando estrutura de apoio ao processo de descentralização. Este trabalho objetiva apresentar o diagnóstico situacional dos órgãos de vigilância sanitária dos municípios em Gestão Plena do Sistema Municipal, discutindo os principais resultados. A metodologia compreende a análise dos 22 órgãos de vigilância sanitária em Gestão Plena do Sistema Municipal, conforme a Norma Operacional Básica 96, no período de julho a dezembro de 2002, através de questionário padrão aplicado pelo Centro de Vigilância Sanitária e de observação participante. Com base nos resultados, conclui-se que a maioria dos órgãos de vigilância sanitária municipais em Gestão Plena do Sistema Municipal, possuem profundas dificuldades técnico-operacionais no desenvolvimento das ações descentralizadas, denotando a fragilidade do processo de descentralização das ações de Vigilância Sanitária no Estado e a necessidade de sensibilizar os gestores para a efetiva estruturação das vigilâncias sanitárias locais, em parceria com o órgão estadual de Vigilância Sanitária.The Health Surveillance Center of the State of Rio de Janeiro intends, with the decentralization of low complexity health surveillance actions for Cities, to meet the minimum requirements to strengthen the state health surveillance system, creating a support structure for the descentraliztion process. The objective of this paper is to present the situational diagnosis of the health surveillance agencies that have adopted the System Full Management. The methodology encompasses the analysis of 22 municipal health surveillance agencies that use the System Full Management, according to the Unified Health System's Basic

  16. FINANCING OF INTERNATIONAL TRANSACTIONS

    Directory of Open Access Journals (Sweden)

    RADU NICOLAE BĂLUNĂ

    2013-02-01

    Full Text Available Financing (funding is essentially the purchase of funds necessary for a business. This can be done from internal sources (company’s own funds or external (borrowed funds. The high value of goods traded in international trade makes revenues generated from internal resources not sufficient to settle the value of the goods. Thus, it is frequent to resort to borrowed funds. In International Business Transactions, external financing is done both by classical techniques of credit (credit supplier and buyer credit and modern techniques of financing (factoring, forfeiting, leasing all trade tailored. In terms of the length of financing, accounting funding is short-term (1-12 months and long-term financing (over a year. In principle, export and import operations prevailing short-term financing techniques, while international investment and industrial cooperation actions are specific long-term funding

  17. What is Project Finance?

    OpenAIRE

    Pinto, João

    2017-01-01

    Project finance is the process of financing a specific economic unit that the sponsors create, in which creditors share much of the venture’s business risk and funding is obtained strictly for the project itself. Project finance creates value by reducing the costs of funding, maintaining the sponsors financial flexibility, increasing the leverage ratios, avoiding contamination risk, reducing corporate taxes, improving risk management, and reducing the costs associated with market ...

  18. Digitally Financed Energy

    OpenAIRE

    Waldron, Daniel; Faz, Xavier

    2016-01-01

    The expansion of digital finance systems in the developing world has altered this financial context and enabled new business models that rely on small, regular payments. In the off-grid energy sector a group of solar companies, primarily in East Africa and South Asia, are leveraging digital finance to offer pay-as-you-go (PAYG) energy. This brief explains how digital finance is enabling PA...

  19. Geothermal Financing Workbook

    Energy Technology Data Exchange (ETDEWEB)

    Battocletti, E.C.

    1998-02-01

    This report was prepared to help small firm search for financing for geothermal energy projects. There are various financial and economics formulas. Costs of some small overseas geothermal power projects are shown. There is much discussion of possible sources of financing, especially for overseas projects. (DJE-2005)

  20. Solar thermal financing guidebook

    Energy Technology Data Exchange (ETDEWEB)

    Williams, T.A.; Cole, R.J.; Brown, D.R.; Dirks, J.A.; Edelhertz, H.; Holmlund, I.; Malhotra, S.; Smith, S.A.; Sommers, P.; Willke, T.L.

    1983-05-01

    This guidebook contains information on alternative financing methods that could be used to develop solar thermal systems. The financing arrangements discussed include several lease alternatives, joint venture financing, R and D partnerships, industrial revenue bonds, and ordinary sales. In many situations, alternative financing arrangements can significantly enhance the economic attractiveness of solar thermal investments by providing a means to efficiently allocate elements of risk, return on investment, required capital investment, and tax benefits. A net present value approach is an appropriate method that can be used to investigate the economic attractiveness of alternative financing methods. Although other methods are applicable, the net present value approach has advantages of accounting for the time value of money, yielding a single valued solution to the financial analysis, focusing attention on the opportunity cost of capital, and being a commonly understood concept that is relatively simple to apply. A personal computer model for quickly assessing the present value of investments in solar thermal plants with alternative financing methods is presented in this guidebook. General types of financing arrangements that may be desirable for an individual can be chosen based on an assessment of his goals in investing in solar thermal systems and knowledge of the individual's tax situation. Once general financing arrangements have been selected, a screening analysis can quickly determine if the solar investment is worthy of detailed study.

  1. When Art & Finance Collide

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Fine art and big finance are proving a profitable combination in China but questions of authenticity need to be addressed CHINA’S art market is on fire.As sales and prices break records,a new force has appeared in the market - organized art finance in the form of art trust funds and artwork exchanges.

  2. POST BEHAVIORAL FINANCE ADOLESCENCE

    Directory of Open Access Journals (Sweden)

    ADRIAN MITROI

    2016-12-01

    Full Text Available The study of behavioral finance combines the investigation and expertise from research and practice into smart portfolios of individual investors’ portfolios. Understanding cognitive errors and misleading emotions drive investors to their long-term goals of financial prosperity and capital preservation. 10 years ago, Behavioral Finance was still considered an incipient, adolescent science. First Nobel Prize in Economics awarded to the study of Behavioral Economics in 2002 established the field as a new, respected study of economics. 2013 Nobel Prize was awarded to three economists, one of them considered the one of the founders of the Behavioral Finance. As such, by now we are entering the coming of age of behavioral finance. It is now recognized as a science of understanding investors behaviors and their biased patterns. It applies quantitative finance and provides practical models grounded on robust understanding of investors behavior toward financial risk. Financial Personality influences investment decisions. Behavioral portfolio construction methods combine classic finance with rigorously quantified psychological metrics and improves models for financial advice to enhance investors chances in reaching their lifetime financial goals. Behavioral finance helps understanding psychological profile dissimilarities of individuals and how these differences manifest in investment decision process. This new science has become now a must topic in modern finance.

  3. Caring finance practices

    NARCIS (Netherlands)

    I.P. van Staveren (Irene)

    2013-01-01

    textabstractThe 2008 financial crisis has demonstrated the failure of both utilitarian and deontological ethics in finance. Alternatives do not need to be created from nothing, because the crisis itself has stimulated the emergence of ethically sound finance practices from within the sector. This ar

  4. Public Library Finance.

    Science.gov (United States)

    Mason, Marilyn Gell

    This study reviews trends in public library finance; examines recent political, economic, and technological changes; and assesses the impact of these changes on public library services. A history of the public library in America is presented, as well as an analysis of the principles of economics and public finance which reveals that current…

  5. Caring finance practices

    NARCIS (Netherlands)

    I.P. van Staveren (Irene)

    2013-01-01

    textabstractThe 2008 financial crisis has demonstrated the failure of both utilitarian and deontological ethics in finance. Alternatives do not need to be created from nothing, because the crisis itself has stimulated the emergence of ethically sound finance practices from within the sector. This

  6. Public Education Finances, 2006

    Science.gov (United States)

    US Census Bureau, 2008

    2008-01-01

    The United States Census Bureau conducts an Annual Survey of Government Finances as authorized by law under Title 13, United States Code, Section 182. The 2006 survey, similar to other annual surveys and censuses of governments conducted for many years, covers the entire range of government finance activities--revenue, expenditure, debt, and…

  7. Public Education Finances, 2008

    Science.gov (United States)

    US Census Bureau, 2010

    2010-01-01

    The United States Census Bureau conducts an Annual Survey of Government Finances as authorized by law under Title 13, United States Code, Section 182. The 2008 survey, similar to other annual surveys and censuses of governments conducted for many years, covers the entire range of government finance activities--revenue, expenditure, debt, and…

  8. Public Education Finances, 2007

    Science.gov (United States)

    US Census Bureau, 2009

    2009-01-01

    Every five years, the U.S. Census Bureau conducts a Census of Government Finance, as authorized by law under Title 13, U.S. Code, Section 182. The 2007 Census, similar to annual surveys and censuses of governments conducted for many years, covers the entire range of government finance activities--revenue, expenditure, debt, and assets (cash and…

  9. Public Education Finances, 2003

    Science.gov (United States)

    US Department of Commerce, 2005

    2005-01-01

    The United States Census Bureau conducts an Annual Survey of Government Finances as authorized by law under Title 13, United States Code, Section 182. The 2003 survey, similar to other annual surveys and censuses of governments conducted for many years, covers the entire range of government finance activities--revenue, expenditure, debt, and…

  10. Public Education Finances, 2005

    Science.gov (United States)

    US Census Bureau, 2007

    2007-01-01

    The United States Census Bureau conducts an Annual Survey of Government Finances as authorized by law under Title 13, United States Code, Section 182. The 2005 survey, similar to other annual surveys and censuses of governments conducted for many years, covers the entire range of government finance activities--revenue, expenditure, debt, and…

  11. What drives public health care expenditure growth? Evidence from Swiss cantons, 1970-2012.

    Science.gov (United States)

    Braendle, Thomas; Colombier, Carsten

    2016-09-01

    A better understanding of the determinants of public health care expenditures is key to designing effective health policies. We integrate demand and supply-side determinants and factors from political economy into an empirical analysis of the highly decentralized Swiss health care system and control for major health care finance reforms. We compile a novel data set of the cantonal health care expenditure in Switzerland, which currently amounts to about one fifth of total health care expenditure. We analyze the period 1970-2012 and use dynamic panel estimation methods. We find that per capita income, the unemployment rate and the share of foreigners are positively related to public health care expenditure growth. With regard to political economy aspects, public health care expenditures increase with the share of women elected to parliament. However, institutional restrictions for politicians, such as fiscal rules, do not appear to limit public health care expenditure growth. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Participation and the right to health: lessons from Indonesia.

    Science.gov (United States)

    Halabi, Sam Foster

    2009-01-01

    The right to participation is the "the right of rights"--the basic right of people to have a say in how decisions that affect their lives are made. All legally binding international human rights treaties explicitly recognize the essential role of participation in realizing fundamental human rights. While the substance of the human right to health has been extensively developed, the right to participation as one of its components has remained largely unexplored. Should rights-based health advocacy focus on participation because there is a relationship between an individual's or a community's active involvement in health care decision-making and the highest attainable standard of health? In the context of the human right to health, does participation mean primarily political participation, or should we take the right to participation to mean more specifically the right of persons, individually and as a group, to shape health care policy for society and for themselves as patients? Decentralization of health care decision-making promises greater participation through citizen involvement in setting priorities, monitoring service provision, and finding new and creative ways to finance public health programs. Between 1999 and 2008, Indonesia decentralized health care funding and delivery to regional governments, resulting in substantial exclusion of its poor and uneducated citizens from the health care system while simultaneously expanding the opportunities for political participation for educated elites. This article explores the tension between the right to participation as an underlying determinant of health and as a political right by reviewing the experience of Indonesia ten years after its decision to decentralize health care provision. It is ultimately argued that rights-based advocates must be vigilant in retaining a unified perspective on human rights, resisting the persistent tendency to separate and prioritize the civil and political aspects of participation

  13. Debt Financing: Academia's Funding Alternative.

    Science.gov (United States)

    Baum, Rudy M.

    1981-01-01

    Discusses debt financing as a way to help universities alleviate the problems of obsolete scientific equipment and facilities for research. Reviews several forms of tax-exempt financing and takes note of some of the advantages of debt financing. (CS)

  14. Water Finance Forum - New Jersey

    Science.gov (United States)

    Presentations and materials from the Regional Finance Forum, Financing Resilient and Sustainable Water Infrastructure, held in Iselin, New Jersey, on December 2, 2015. The forum was co-sponsored by EPA's Water Infrastructure and Resiliency Finance Center,

  15. (DeCentralization of the Global Informational Ecosystem

    Directory of Open Access Journals (Sweden)

    Johanna Möller

    2017-09-01

    Full Text Available Centralization and decentralization are key concepts in debates that focus on the (antidemocratic character of digital societies. Centralization is understood as the control over communication and data flows, and decentralization as giving it (back to users. Communication and media research focuses on centralization put forward by dominant digital media platforms, such as Facebook and Google, and governments. Decentralization is investigated regarding its potential in civil society, i.e., hacktivism, (encryption technologies, and grass-root technology movements. As content-based media companies increasingly engage with technology, they move into the focus of critical media studies. Moreover, as formerly nationally oriented companies now compete with global media platforms, they share several interests with civil society decentralization agents. Based on 26 qualitative interviews with leading media managers, we investigate (decentralization strategies applied by content-oriented media companies. Theoretically, this perspective on media companies as agents of (decentralization expands (decentralization research beyond traditional democratic stakeholders by considering economic actors within the “global informational ecosystem” (Birkinbine, Gómez, & Wasko, 2017. We provide a three-dimensional framework to empirically investigate (decentralization. From critical media studies, we borrow the (decentralization of data and infrastructures, from media business research, the (decentralization of content distribution.

  16. Management Methods of Decentralized Public Services

    Directory of Open Access Journals (Sweden)

    BILOUSEAC Irina Adriana

    2013-05-01

    Full Text Available The purpose of the article, having as theme the typology of public services management and the implications on decentralization, is the foundation of theoretical concepts, but also the analysis from a practical point of view of both types of management applied in the management of public services in Romania and of the effects they cause on the Romanian public administration capacity to provide efficient public services. Although the users of decentralized public services don’t have the possibility of choosing the service provider, the analysis of the management methods is important, because depending on the type of management chosen there are advantages and disadvantages for the local community. It has to be analyzed for each particularly case which type of management leads to a greater satisfaction of a social need appeared.

  17. Centralized, Decentralized, and Hybrid Purchasing Organizations

    DEFF Research Database (Denmark)

    Bals, Lydia; Turkulainen, Virpi

    illustrate with our empirical analysis on global sourcing organization design at Global Chemical Company (GCC, a pseudonym) that revisiting the conventional wisdom about global sourcing organization designs is required; by engaging in a detailed, subfirm level of analysis on the design of the purchasing......This paper addresses one of the focal issues in purchasing and supply management – global sourcing – from an organizational design perspective. In particular, we elaborate the traditional classification of global sourcing organization designs into centralized, decentralized, and hybrid models. We...... organization we can identify organization designs beyond the classical centralization-decentralization continuum. We also provide explanations for the observed organization design at GCC. The study contributes to research on purchasing and supply management as well as research on organization design....

  18. Problems in Decentralized Decision making and Computation.

    Science.gov (United States)

    1984-12-01

    Wald ) problem [Teneketzis, 1983], as well as problems involving communication of zero-one messages from certain sensors to others [Ekchian and Tenney...that the development of results for pseudo-gradient algorithms leads easily to results for broader classes of algorithms, such as Kiefer- Wolfowitz ...Decentralized Wald Problem," Proceedings of the 1983 American Control Conference, San Francisco, CA. Teneketzis, D., P. Varaiya, (1984), "Consensus in

  19. Centralization Versus Decentralization in Credit Lending

    OpenAIRE

    Idriss Ghodbane, Mohamed

    2002-01-01

    This paper explores different organizational forms in terms of their ability to generate information about investment projects and allocate capital to these projects efficiently. A decentralized approach - with small, single-manager firms - is most likely to be attractive when information about individual projects is "non-verifiable" and cannot be credibly trasmitted. Moreover, holding fixed firm size, non-verifiable information also favors flatter organizations with fewer layers of manage...

  20. Analyzing Von Neumann machines using decentralized symmetries

    Science.gov (United States)

    Fang, Jie

    2013-10-01

    The artificial intelligence method to e-business is defined not only by the study of fiber-optic cables, but also by the unproven need for vacuum tubes. Given the current status of virtual archetypes, theorists clearly desire the exploration of semaphores, which embodies the compelling principles of cryptoanalysis. We present an algorithm for probabilistic theory (Buck), which we use to disprove that write-back caches can be made decentralized, lossless, and reliable.

  1. Fiscal Decentralization and Soft Budget Constraints

    OpenAIRE

    Timofeev Andrey

    2002-01-01

    Liberalization policies of transition have led to the mass reduction of enterprise subsidization which prevailed in socialist economies. However, in some sectors of the economy, subsidies associated with price controls remain due to "social" and "political" factors. Moreover in multi-tier governments, subnational levels seem to be more sensitive to these factors because of their proximity to the constituency. Thus decentralization of fiscal resources might interfere with the elimination of re...

  2. Rural Roads: The Challenge of Decentralized Implementation

    OpenAIRE

    Simon D. Ellis; Aurelio Menendez

    2014-01-01

    This paper will review the key elements required for effective decentralized implementation of rural roads programs. It will review the range of options available and the evidence for successful implementation where it exists. Section 2 makes the case for the importance of rural roads and sets out the evidence for the socio-economic benefits. Section 3 addresses the responsibilities for implementation and critical importance of having clarity over network ownership. Section 4 highlights the d...

  3. Model for valuating decentralized energy production

    OpenAIRE

    Cider, Muammer

    2008-01-01

    Ankara : The Department of Economics, Bilkent University, 2008. Thesis (Master's) -- Bilkent University, 2008. Includes bibliographical references leaves 78-79. The purpose of this thesis is to assess decentralized production technologies in an economical framework. Throughout the thesis, technological aspects such as smart metering or connectivity issues are ignored. All assumptions are based on specification sheets by the producers of the technologies to provide an imparti...

  4. Private Housing or Alternative Financing?

    Science.gov (United States)

    Bruno, Nick

    1999-01-01

    Explores the history of privatizing university housing and some current financing options, including use of developer and private foundations. Examples of successful alternative financing methods are highlighted. (GR)

  5. File Transfer Algorithm for Autonomous Decentralized System

    Institute of Scientific and Technical Information of China (English)

    GUI Xun; TAN Yong-dong; Qian Qing-quan

    2008-01-01

    A file transfer algorithm based on ADP (autonomous decentralized protocol) was proposed to solve the problem that the ADS (autonomous decentralized system) middleware (NeXUS/Dlink) lacks of file transfer functions for Windows. The algorithm realizes the peer-to-peer file transfer, one-to-N inquiry/multi-response file transfer and one-to-N file distribution in the same data field based on communication patterns provided by the ADP. The peer-to-peer file transfer is implemented through a peer-to-peer communication path, one-to-N inquiry/multi-response file transfer and one-to-N file distribution are implemented through multicast commtmieation. In this algorithm, a file to be transferred is named with a GUID ( global unique identification), every data packet is marked with a sequence number, and file-receiving in parallel is implemented by caching DPOs (data processing objects) and multithread technologies. The algorithm is applied in a simulation system of the decentralized control platform, and the test results and long time stable mrming prove the feasibility of the algorithm.

  6. Query Optimizations over Decentralized RDF Graphs

    KAUST Repository

    Abdelaziz, Ibrahim

    2017-05-18

    Applications in life sciences, decentralized social networks, Internet of Things, and statistical linked dataspaces integrate data from multiple decentralized RDF graphs via SPARQL queries. Several approaches have been proposed to optimize query processing over a small number of heterogeneous data sources by utilizing schema information. In the case of schema similarity and interlinks among sources, these approaches cause unnecessary data retrieval and communication, leading to poor scalability and response time. This paper addresses these limitations and presents Lusail, a system for scalable and efficient SPARQL query processing over decentralized graphs. Lusail achieves scalability and low query response time through various optimizations at compile and run times. At compile time, we use a novel locality-aware query decomposition technique that maximizes the number of query triple patterns sent together to a source based on the actual location of the instances satisfying these triple patterns. At run time, we use selectivity-awareness and parallel query execution to reduce network latency and to increase parallelism by delaying the execution of subqueries expected to return large results. We evaluate Lusail using real and synthetic benchmarks, with data sizes up to billions of triples on an in-house cluster and a public cloud. We show that Lusail outperforms state-of-the-art systems by orders of magnitude in terms of scalability and response time.

  7. Financing universal coverage in Malaysia: a case study.

    Science.gov (United States)

    Chua, Hong Teck; Cheah, Julius Chee Ho

    2012-01-01

    One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges.The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population.Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand preventive

  8. Essays in Household Finance

    DEFF Research Database (Denmark)

    Hanspal, Tobin

    This Ph.D. thesis, entitled Essays in Household Finance, analyzes the determinants and implications of investment biases, personal experiences in financial markets, and financing disruptions on households, individual investors, and entrepreneurs and small business owners. The first essay...... on risk taking is the potential bias resulting from inertia and inattention, which has been shown to be endemic in household finance. If individuals are inert or inattentive, it is difficult to establish whether changes in risk taking are caused by personal experiences or whether the change in risk taking...

  9. Essays in Household Finance

    DEFF Research Database (Denmark)

    Hanspal, Tobin

    This Ph.D. thesis, entitled Essays in Household Finance, analyzes the determinants and implications of investment biases, personal experiences in financial markets, and financing disruptions on households, individual investors, and entrepreneurs and small business owners. The first essay...... on risk taking is the potential bias resulting from inertia and inattention, which has been shown to be endemic in household finance. If individuals are inert or inattentive, it is difficult to establish whether changes in risk taking are caused by personal experiences or whether the change in risk taking...

  10. Dynamic Teams and Decentralized Control Problems with Substitutable Actions

    OpenAIRE

    Asghari, Seyed Mohammad; Nayyar, Ashutosh

    2016-01-01

    This paper considers two problems -- a dynamic team problem and a decentralized control problem. The problems we consider do not belong to the known classes of "simpler" dynamic team/decentralized control problems such as partially nested or quadratically invariant problems. However, we show that our problems admit simple solutions under an assumption referred to as the substitutability assumption. Intuitively, substitutability in a team (resp. decentralized control) problem means that the ef...

  11. Political decentralization and corruption: Evidence from around the world

    OpenAIRE

    Fan, CS; Lin, C.; Treisman, D

    2009-01-01

    How does political decentralization affect the frequency and costliness of bribe extraction by corrupt officials? Previous empirical studies, using subjective indexes of perceived corruption and mostly fiscal indicators of decentralization, have suggested conflicting conclusions. In search of more precise findings, we combine and explore two new data sources—an original cross-national data set on particular types of decentralization and the results of a firm level survey conducted in 80 count...

  12. Decentralized Energy Studies: compendium of U. S. studies and projects

    Energy Technology Data Exchange (ETDEWEB)

    Quinn, J.; Ohi, J.M.

    1980-06-01

    This compendium was prepared as a part of the Decentralized Energy Studies task at the Solar Energy Research Institute. The compendium lists and briefly describes a number of studies, programs, and projects that involve decentralized energy systems. The purpose is to provide information about research activities in decentralized energy systems to researchers, government officials, and interested citizens. A contact person or address is given for each of the activities listed so that interested readers can obtain more information.

  13. Access to finance from different finance provider types

    NARCIS (Netherlands)

    Wulandari, Eliana; Meuwissen, Miranda P.M.; Karmana, Maman H.; Oude Lansink, Alfons G.J.M.

    2017-01-01

    Analysing farmer knowledge of the requirements of finance providers can provide valuable insights to policy makers about ways to improve farmers’ access to finance. This study compares farmer knowledge of the requirements to obtain finance with the actual requirements set by different finance

  14. Poland health system review.

    Science.gov (United States)

    Sagan, Anna; Panteli, Dimitra; Borkowski, W; Dmowski, M; Domanski, F; Czyzewski, M; Gorynski, Pawel; Karpacka, Dorota; Kiersztyn, E; Kowalska, Iwona; Ksiezak, Malgorzata; Kuszewski, K; Lesniewska, A; Lipska, I; Maciag, R; Madowicz, Jaroslaw; Madra, Anna; Marek, M; Mokrzycka, A; Poznanski, Darius; Sobczak, Alicja; Sowada, Christoph; Swiderek, Maria; Terka, A; Trzeciak, Patrycja; Wiktorzak, Katarzyna; Wlodarczyk, Cezary; Wojtyniak, B; Wrzesniewska-Wal, Iwona; Zelwianska, Dobrawa; Busse, Reinhard

    2011-01-01

    Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) the sole payer in the system is in charge of health care financing and contracts with public and non-public health care providers. The Ministry of Health is the key policy-maker and regulator in the system and is supported by a number of advisory bodies, some of them recently established. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. In 2009, Poland spent 7.4% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance covers 98% of the population and guarantees access to a broad range of health services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall at most proportional: while financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures

  15. Health Related Policy Reform in Nigeria;- Empirical Analysis From 2001 to 2010; The Past, Trend and Future Directions For Sustainable Health Financing and Development

    Directory of Open Access Journals (Sweden)

    M. J. Saka

    2012-03-01

    Full Text Available The study was carried out to demonstrate the impact of National weight on the process of health sector reform from 2001 to 2010 and to specifically determine Health policies and plans initiated at Federal level and adopted or adapted at State level including capacity for implementation. Multiple data collection was used to collate data. A tool was developed and sent to trained interviewers each for each state including Federal Capital Territory (FCT to administer on the States within their span of work. Reportedly, at least 21 States in Nigeria had either started or are implementing various types of reforms. However, it is not very clear how much of these efforts may be attributed to an interest groups, professional groups, Talkawa group, Eminent personality group (EPG, and other elite groups. National, State and LGAs levels elite had dominated policy through their control of resources, but more importantly through their ‘control of the terms of debate through expert knowledge, support of research, and occupation of key nodes’ in the network. The findings were not that a small group of leaders shaped the policy debates, but rather that the leadership was not representative of the interest at stake: ‘the national policy network on health sector reform had been narrowly based in a small number of institutions. We concluded that without continuous and sustained institutional or structural reform in health, it is unlikely that existing organizational structures and management systems in health sector will be able to deal adequately with the weak and fragile National Health Care Delivery System and improving its performance. It is recommended that health sector reform should therefore be concerned with defining priorities, refining policies and reforming the institutions through which those policies are implemented.

  16. Interacting agents in finance

    NARCIS (Netherlands)

    C. Hommes

    2008-01-01

    Interacting agents in finance represent a behavioural, agent-based approach in which financial markets are viewed as complex adaptive systems consisting of many boundedly rational agents interacting through simple heterogeneous investment strategies, constantly adapting their behaviour in response t

  17. PUBLIC FINANCE FUNCTIONS

    Directory of Open Access Journals (Sweden)

    VEZURE OANA SABINA

    2011-09-01

    Full Text Available The emergence of public finances is due to objective causes needs and determined their main function being to obtain the financial resources it needs for the State to exercise its powers and on the way to intervene in the economy and society general. Public finances are necessary, subjectively and objectively, as it contributes to accomplishing the tasks and functions of the state, which could not be realized without financial leverage. Public finances are inextricably linked to the existence of the state, and public sector's role in the economy. Thus, they express "social relations, economic arising in the establishment and use of public funds between the state, on the one hand, and members of society on the other hand, to meet the needs of general interest of society" [1]. Thus, the role of public finance is to meet the needs of general interest or collective needs.

  18. Interacting agents in finance

    NARCIS (Netherlands)

    Hommes, C.; Durlauf, S.N.; Blume, L.E.

    2008-01-01

    Interacting agents in finance represent a behavioural, agent-based approach in which financial markets are viewed as complex adaptive systems consisting of many boundedly rational agents interacting through simple heterogeneous investment strategies, constantly adapting their behaviour in response

  19. Clean Energy Finance Tool

    Science.gov (United States)

    This tool is for state and local governments interested in developing a financing program to support energy efficiency and clean energy improvements for large numbers of buildings within their jurisdiction.

  20. Financing Professional Sports Facilities

    OpenAIRE

    Baade, Robert A.; Victor A. Matheson

    2011-01-01

    This paper examines public financing of professional sports facilities with a focus on both early and recent developments in taxpayer subsidization of spectator sports. The paper explores both the magnitude and the sources of public funding for professional sports facilities.

  1. Financing Sustainable Development

    DEFF Research Database (Denmark)

    Fejerskov, Adam Moe; Funder, Mikkel; Engberg-Pedersen, Lars

    In the fall of 2015, world leaders adopted the most ambitious global development agenda in history. Meeting the aspiring targets of the Sustainable Development Goals will require financing far beyond traditional aid. At the same time, aid itself is under major pressure as European governments cut...... aid budgets or divert them to meet refugee and migration issues. In this context of massive global ambition and concurrent uncertainty on the future of aid, other actors and sources of development financing seem ever more critical, such as the private sector, private foundations and the BRICS....... But what are in fact the interests and modes of operation of such actors in the context of development financing, and to what extent do they align with the aims of the SDGs? And how do national governments of developing countries themselves perceive and approach these new sources of financing?...

  2. Financing Public Service Broadcasting

    DEFF Research Database (Denmark)

    Berg, Christian Edelvold; Lund, Anker Brink

    2012-01-01

    Broadcasting (PSB) financing regimes in Europe, concluding that Denmark, Finland, Iceland, Norway, and Sweden may still be considered conventional, licence fee PSB countries, but with some interesting differences in relation to competitive and market oriented alternatives of resource provision...

  3. Health Care Financing: Consumers’ Perspectives

    Directory of Open Access Journals (Sweden)

    Soe Moe

    2011-05-01

    Full Text Available Objectives: To explore the client perspectives of “individualfinancing” at private hospital and government hospital undercommunity cost-sharing scheme.Materials and Methods: A cross sectional study was done in agovernment hospital, namely Yangon General Hospital andBosi private hospital in Yangon, Myanmar. All the new patientsundergoing surgical operations/ procedures were approachedfor their potential participation in the study. A consent wastaken from those willing to participate in this study. A total of83 surgical cases, (35 from private and 48 from governmenthospital were interviewed using a structured Data collectionform. Quantitative analyses were done for the structuredquestions and qualitative analysis was made for the openended questions. Chi square test was applied to see thestatistical differences in socio demographic characteristics ofYangon General Hospital and Bosi Hospital. P value of 0.05 wasset at 95% confident level.Results: findings of the current study demonstrated that thepatients with High family income (P=>0.001 were more likelyto use the private hospital compare to low family incomegroup. The main reasons behind choosing the private hospitalwere better accommodation, shorter waiting time, andminimum restriction of visiting hours and perceived lackof free services at government hospital. However, thoseattending the public hospital have justified it by statingthat they are familiar with the government hospital andthe services in private hospitals are expensive. For thepatient from the low income group the hospitalexpenditure were managed with family’s monthlyincome, support from non-family members and somesecured the payment with borrowed money or by sellingthe personal assets.Conclusion: It is seen that the socioeconomic status ofthe patients was the main factors responsible for theselection of the hospitals. Those with low income statusprefer public hospitals because of low cost on the medicalservices.

  4. FINANCING OF KABUPATEN HEALTH SERVICES

    Directory of Open Access Journals (Sweden)

    J. Blanc

    2012-09-01

    Full Text Available Biaya untuk dinas kesehatan kabupaten diadakan analisa melalui survey yang dilakukan pada empat propinsi dimana hasil-hasil utamanya dapat disampaikan berikut ini. Biaya dari pemerintah daerah tingkat II merupakan sumber utama untuk kegiatan pelayanan kesehatan, di daerah tersebut, tetapi biaya yang diberikan oleh pemerintah daerah tingkat II adalah rendah (Rp. 20 - Rp. 60 per kapita per tahun. Biaya yang berasal dari pemerintah daerah tingkat II untuk usaha-usaha kesehatan berbeda dari satu pemerintah daerah tingkat II dengan pemerintah daerah tingkat II yang lain (berkisar antara 5-20 per cent dari jumlah seluruh anggaran. Pemberian biaya yang berbeda dari satu pemerintah daerah tingkat II dengan pemerintah daerah lingual II lainnya, pada dasarnya tidak semata-mata disebabkan oleh tersedianya anggaran, tetapi pemberian biaya untuk sektor kesehatan tersebut pada hakekatnya hanyalah ditentukan oleh bupati sebagai penguasa di aaerah tingkat II. Biaya pembangunan lebih rendah dan tidak teratur dari pada biaya rutin, dimana biaya rutin dipergunakan untuk kegiatan pelayanan kesehatan. Untuk kegiatan usaha-usaha kesehatan masyarakat lainnya didapat pula biaya dari pemerintah daerah tingkat I maupun pusat.

  5. Financiamento da saúde pública no Brasil: a experiência do Siops Public health financing in Brazil: the Siops experience

    Directory of Open Access Journals (Sweden)

    Hugo Vocurca Teixeira

    2003-01-01

    Full Text Available Este artigo apresenta características do Sistema de Informações sobre Orçamentos Públicos de Saúde (Siops, tece breves comentários sobre a estratégia de coleta e os dados coletados, e exemplifica algumas de suas potencialidades como instrumento de apoio à gestão. O Siops reúne informações sobre o financiamento e o gasto com saúde pública dos municípios, dos estados e da União, constituindo-se em banco de dados único no âmbito das políticas sociais no Brasil. Produzindo informações com regularidade e com qualidade crescente, o sistema conforma-se como uma importante fonte de dados para a realização de estudos pelas instituições de pesquisa, para o exercício do acompanhamento e fiscalização pelos órgãos de controle e para a gestão e avaliação das ações no âmbito do Sistema Único de Saúde. Tais informações podem viabilizar o aprimoramento da gestão, a disseminação de experiências bem-sucedidas entre os entes federados, e a adequada distribuição dos gastos entre investimento e custeio e entre as esferas governamentais, tendo em vista o dimensionamento das redes de atenção, dentre outras questões.This article presents information about public budgets for a health system, called SIOPS, and it's basic features. It briefly comments a SIOPS's strategy of collect data, and it exemplifies some of it's potential as an instrument for helping health management. SIOPS focuses on information about the financing and expenses of public health in municipalities, states and in the Union, being therefore a unique data bank in the social policy field in Brazil. The data bank is growing on a steady basis and is as well improving in terms of information reliability. It produces information increasing in regularity and quality. The SIOPS is presented as an important data source for researches of health policies, as an instrument for control agencies to exert the attendance and fiscal inspection, and as an instrument for

  6. [The health system of Brazil].

    Science.gov (United States)

    Montekio, Víctor Becerril; Medina, Guadalupe; Aquino, Rosana

    2011-01-01

    This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.

  7. Descentralização e regionalização: dinâmica e condicionantes da implantação do Pacto pela Saúde no Brasil Decentralization and regionalization: dynamics and conditioning factors for the implementation of the Health Pact in Brazil

    Directory of Open Access Journals (Sweden)

    Luciana Dias de Lima

    2012-07-01

    Full Text Available A descentralização e a regionalização representam diretrizes constitucionais de organização do Sistema Único de Saúde que exigiram, nos últimos vinte anos, a adoção de mecanismos de coordenação e acomodação das tensões federativas em saúde no Brasil. O artigo analisa a implantação nacional do Pacto pela Saúde, estratégia que reconfigura as relações intergovernamentais no setor, de 2006 a 2010. A pesquisa envolveu análise de documentos, de dados oficiais e realização de entrevistas com dirigentes federais, estaduais e municipais nos estados brasileiros. Inicialmente discorre-se sobre o conteúdo da proposta nacional e seus desdobramentos para a política de saúde. A seguir, analisam-se os diferentes ritmos e graus de implantação do Pacto pela Saúde, no que concerne à adesão dos estados e municípios e à conformação de Colegiados de Gestão Regional. Por fim, sistematizam-se os fatores condicionantes da multiplicidade das experiências observadas no país e discutem-se os desafios para o avanço da descentralização e da regionalização no sistema de saúde brasileiro.Decentralization and regionalization represent constitutional guidelines for the organization of the Unified Health System, which in the last 20 years has required the adoption of mechanisms to coordinate and accommodate federative tensions in Brazil's healthcare sector. This paper analyzes the national implementation of the Health Pact between 2006 and 2010 involving a strategy that reconfigures intergovernmental relations in the sector. The study involved the analysis of documents, official data and interviews with federal, state and municipal managers in the Brazilian states. The content of the national proposal is initially discussed, including its implications for health policy. The different rhythms and degrees of implementation of the Health Pact are then reviewed, with respect to adherence by states and municipalities and the formation of

  8. Private sector finance for adaptation

    NARCIS (Netherlands)

    Atteridge, A.; Pauw, W.P.; Terpstra, P.; Bedini, F.; Bosi, L; Costella, C.

    2016-01-01

    An emphasis on private finance has emerged in climate finance discussions, particularly in the context of international climate change negotiations. This is partly because the overall volume of finance needed to support adaptation in developing countries is beyond what many expect public finance to

  9. Exploring Higher Education Financing Options

    Science.gov (United States)

    Nkrumah-Young, Kofi K.; Powell, Philip

    2011-01-01

    Higher education can be financed privately, financed by governments, or shared. Given that the benefits of education accrue to the individual and the state, many governments opt for shared financing. This article examines the underpinnings of different options for financing higher education and develops a model to compare conditions to choices and…

  10. Private sector finance for adaptation

    NARCIS (Netherlands)

    Atteridge, A.; Pauw, W.P.; Terpstra, P.; Bedini, F.; Bosi, L; Costella, C.

    2016-01-01

    An emphasis on private finance has emerged in climate finance discussions, particularly in the context of international climate change negotiations. This is partly because the overall volume of finance needed to support adaptation in developing countries is beyond what many expect public finance to

  11. Topographical Evaluation of the Decentration of Orthokeratology Lenses

    Institute of Scientific and Technical Information of China (English)

    Xiao Yang; Xingwu Zhong; Xiangming Gong; Junwen Zeng

    2005-01-01

    Purpose: To evaluate the amount of lens decentration and various factors affecting decentration after orthokeratology lens wear and to observe the effect of decentration on the visual functions.Methods: Two kinds of orthokeratology lenses were fitted to 270 eyes of 135 patients [initial mean refractive error: (-3.98±1.51)D]. Humphery Instruments ATLAS 990 was used for the computer-assisted analysis of corneal topographical maps. The examination of corneal topography was performed on patients before and after 6 months of wearing orthokeratology lenses. The amount of decentration of orthokeratology lenses was measured by finding the distance between center of optic zone and the pupil center. The factors influencing the amount of decentration were analyzed, including the initial refraction error, astigmatism, keratometry values, corneal eccentricity, and the diameter of lens.Visual symptoms including monocular diplopia, glare around lights were recorded to evaluate the effects of decentration on visual functions.Results: The mean amount of decentration was (0.49±0.34) mm after one night's wear.The mean amount of decentration after 1 month, 3 months and 6 months was (0.57±0.41) mm, (0.55±0.48) mm and (0.59±0.39) mm, respectively. After one month, the amount of decentration was less than 0.50 mm in 51.1% eyes, 0.50~1.0 mm in 35.6% eyes and more than 1.00 mm in 13.3% eyes. The direction of decentration of more than 0.50 mm was mainly in the temporal quadrant (48.5%). Patients with greater initial astigmatism and smaller lenses showed greater decentration (P<0.05). There was no statistically significant difference in decentration between the two groups with different corneal eccentricities and keratometry values (P>0.05). The amount of decentration was greater in patients who complained of monocular diplopia and glare.Conclusions: The amount of decentration of orthokeratology depends on the initial refractive error, astigmatism and the design of orthokeratology

  12. Tractable problems in optimal decentralized control

    Science.gov (United States)

    Rotkowitz, Michael Charles

    2005-07-01

    This thesis considers the problem of constructing optimal decentralized controllers. The problem is formulated as one of minimizing the closed-loop norm of a feedback system subject to constraints on the controller structure. The notion of quadratic invariance of a constraint set with respect to a system is defined. It is shown that quadratic invariance is necessary and sufficient for the constraint set to be preserved under feedback. It is further shown that if the constraint set has this property, this allows the constrained minimum-norm problem to be solved via convex programming. These results are developed in a very general framework, and are shown to hold for continuous-time systems, discrete-time systems, or operators on Banach spaces, for stable or unstable plants, and for the minimization of any norm. The utility of these results is then demonstrated on some specific constraint classes. An explicit test is derived for sparsity constraints on a controller to be quadratically invariant, and thus amenable to convex synthesis. Symmetric synthesis is also shown to be quadratically invariant. The problem of control over networks with delays is then addressed as another constraint class. Multiple subsystems are considered, each with its own controller, such that the dynamics of each subsystem may affect those of other subsystems with some propagation delays, and the controllers may communicate with each other with some transmission delays. It is shown that if the communication delays are less than the propagation delays, then the associated constraints are quadratically invariant, and thus optimal controllers can be synthesized. We further show that this result still holds in the presence of computational delays. This thesis unifies the few previous results on specific tractable decentralized control problems, identifies broad and useful classes of new solvable problems, and delineates the largest known class of convex problems in decentralized control.

  13. Decentralized Pricing in Minimum Cost Spanning Trees

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Moulin, Hervé; Østerdal, Lars Peter

    In the minimum cost spanning tree model we consider decentralized pricing rules, i.e. rules that cover at least the ecient cost while the price charged to each user only depends upon his own connection costs. We de ne a canonical pricing rule and provide two axiomatic characterizations. First......, the canonical pricing rule is the smallest among those that improve upon the Stand Alone bound, and are either superadditive or piece-wise linear in connection costs. Our second, direct characterization relies on two simple properties highlighting the special role of the source cost....

  14. Decentralized Coordinated Control Strategy of Islanded Microgrids

    DEFF Research Database (Denmark)

    Wu, Dan

    as grid voltage/frequency regulation. In order to enhance the reliability of overall islanded Microgrid operation, basic functions of coordinated control which taking into account the state of charge (SoC) limitation and power availability of renewable energy sources is implemented in a distributed level...... control strategies in this thesis, in order to promote the decentralization of the overall system. Especially the consensus algorithm based secondary level is investigated in the thesis in order to simplify the communication configuration which only flood information through the neighboring units...

  15. P2P Techniques for Decentralized Applications

    CERN Document Server

    Pacitti, Esther

    2012-01-01

    As an alternative to traditional client-server systems, Peer-to-Peer (P2P) systems provide major advantages in terms of scalability, autonomy and dynamic behavior of peers, and decentralization of control. Thus, they are well suited for large-scale data sharing in distributed environments. Most of the existing P2P approaches for data sharing rely on either structured networks (e.g., DHTs) for efficient indexing, or unstructured networks for ease of deployment, or some combination. However, these approaches have some limitations, such as lack of freedom for data placement in DHTs, and high late

  16. Innovative financing for HIV response in sub–Saharan Africa

    Science.gov (United States)

    Atun, Rifat; Silva, Sachin; Ncube, Mthuli; Vassall, Anna

    2016-01-01

    Background In 2015 around 15 million people living with HIV were receiving antiretroviral treatment (ART) in sub–Saharan Africa. Sustained provision of ART, though both prudent and necessary, creates substantial long–term fiscal obligations for countries affected by HIV/AIDS. As donor assistance for health remains constrained, novel financing mechanisms are needed to augment funding domestic sources. We explore how Innovative Financing has been used to co–finance domestic HIV/AIDS responses. Based on analysis of non–health sectors, we identify innovative financing instruments that could be used in the HIV response. Methods We undertook a systematic review to identify innovative financing instruments used for (1) domestic HIV/AIDS financing in sub–Saharan Africa (2) international health financing and (3) financing in non–health sectors. We analyzed peer–reviewed and grey literature published between 2002 and 2014. We examined the nature and volume of funds mobilized with innovative financing, then in consultation with leading experts, identified instruments that held potential for financing the HIV response. Results Our analysis revealed three innovative financing instruments in use: Zimbabwe’s AIDS Trust Fund (a tax/levy–based instrument), Botswana’s National HIV/AIDS Prevention Support (BNAPS) International Bank for Reconstruction and Development (IBRD) Buy–Down (a debt conversion instrument), and Côte d'Ivoire's Debt2Health Debt Swap Agreement (a debt conversion instrument). Zimbabwe’s AIDS Trust Fund generated US$ 52.7 million between 2008 and 2011, Botswana’s IBRD Buy–Down generated US$ 20 million, and Côte d’Ivoire’s Debt2Health Debt Swap Agreement generated US$ 27 million, at least half of which was to be invested in HIV/AIDS programs. Four additional categories of innovative financing instruments met our criteria for future use: (1) remittances and diaspora bonds (2) social and development impact bonds (3) sovereign wealth

  17. Providing leadership to a decentralized total quality process.

    Science.gov (United States)

    Diederich, J J; Eisenberg, M

    1993-01-01

    Integrating total quality management into the culture of an organization and the daily work of employees requires a decentralized leadership structure that encourages all employees to become involved. This article, based upon the experience of the University of Michigan Hospitals Professional Services Divisional Lead Team, outlines a process for decentralizing the total quality management process.

  18. Decentralized energy studies: compendium of international studies and research

    Energy Technology Data Exchange (ETDEWEB)

    Wallace, C.

    1980-03-01

    The purpose of the compendium is to provide information about research activities in decentralized energy systems to researchers, government officials, and interested citizens. The compendium lists and briefly describes a number of studies in other industrialized nations that involve decentralized energy systems. A contact person is given for each of the activities listed so that interested readers can obtain more information.

  19. School Administration: Optimal Ratio of Centralization to Decentralization.

    Science.gov (United States)

    Kapto, A. E.

    1990-01-01

    Compares advantages and disadvantages of centralized and decentralized control in Soviet public schools. Recognizes that centralization concentrates the forces, funds, and available resources necessary for maximum achievement. Suggests that decentralization of administration can be optimized by delegating rights, duties, and responsibilities to…

  20. Microflora of drinking water distributed through decentralized supply systems (Tomsk)

    Science.gov (United States)

    Khvaschevskaya, A. A.; Nalivaiko, N. G.; Shestakova, A. V.

    2016-03-01

    The paper considers microbiological quality of waters from decentralized water supply systems in Tomsk. It has been proved that there are numerous microbial contaminants of different types. The authors claim that the water distributed through decentralized supply systems is not safe to drink without preliminary treatment.

  1. Study on Concept of Centralization and Decentralization Group Decision Making

    Institute of Scientific and Technical Information of China (English)

    ZHANG Qin-sheng; XI You-min; WANG Ying-luo

    2002-01-01

    The paper extracts the concept of Centralization Group Decision Making (CGDM) and Decentralization Group Decision Making (DGDM) from management systems on bases of studies on Informational Centralization Process (ICP) and Informational Decentralization Process (IDP), then the similarities and differences between CGDM and DGDM are presented. Further, the taxonomy of CGDM and DGDM is researched.

  2. An index of political support for decentralization: the Spanish case.

    OpenAIRE

    2010-01-01

    This paper presents a method to make measurable what was not: the discourses of politicians regarding decentralization. For this purpose, we develop a matrix of arguments and a set of indexes, and apply them to provide a snapshot of the politicians views on the General Law of Budgetary Stability, a landmark for the process of decentralization in Spain.

  3. Setting the Governmental Agenda for State Decentralization of Higher Education.

    Science.gov (United States)

    McLendon, Michael K.

    2003-01-01

    State decentralization of higher education emerged as a significant governance trend of the 1980s to 1990s. Yet little is known about how or why decentralization first became an issue to which state governments paid serious attention. This study employs multiple theories to analyze the agenda-setting stage of policy formation in three states…

  4. Decentralized Consistency Checking in Cross-organizational Workflows

    NARCIS (Netherlands)

    Wombacher, Andreas

    Service Oriented Architectures facilitate loosely coupled composed services, which are established in a decentralized way. One challenge for such composed services is to guarantee consistency, i.e., deadlock-freeness. This paper presents a decentralized approach to consistency checking, which

  5. Decentralized Event-triggered Control with Asynchronous Updates

    NARCIS (Netherlands)

    Mazo Jr., Manuel; Cao, Ming

    2011-01-01

    We propose taking event-triggered control actions to implement decentralized control over wireless sensor/actuator networks without requiring synchronized measurement updates. In comparison with the existing results on event-triggered decentralized control, the proposed implementation does not rely

  6. Decentralized Consistency Checking in Cross-organizational Workflows

    NARCIS (Netherlands)

    Wombacher, A.

    2006-01-01

    Service Oriented Architectures facilitate loosely coupled composed services, which are established in a decentralized way. One challenge for such composed services is to guarantee consistency, i.e., deadlock-freeness. This paper presents a decentralized approach to consistency checking, which utiliz

  7. Centralization Versus Decentralization: A Location Analysis Approach for Librarians.

    Science.gov (United States)

    Shishko, Robert; Raffel, Jeffrey

    One of the questions that seems to perplex many university and special librarians is whether to move in the direction of centralizing or decentralizing the library's collections and facilities. Presented is a theoretical approach, employing location theory, to the library centralization-decentralization question. Location theory allows the analyst…

  8. Centralization vs. Decentralization: A Location Analysis Approach for Librarians

    Science.gov (United States)

    Raffel, Jeffrey; Shishko, Robert

    1972-01-01

    An application of location theory to the question of centralized versus decentralized library facilities for a university, with relevance for special libraries is presented. The analysis provides models for a single library, for two or more libraries, or for decentralized facilities. (6 references) (Author/NH)

  9. Environmental systems and local actors: decentralizing environmental policy in Uganda.

    Science.gov (United States)

    Oosterveer, Peter; Van Vliet, Bas

    2010-02-01

    In Uganda, environmental and natural resource management is decentralized and has been the responsibility of local districts since 1996. This environmental management arrangement was part of a broader decentralization process and was intended to increase local ownership and improve environmental policy; however, its implementation has encountered several major challenges over the last decade. This article reviews some of the key structural problems facing decentralized environmental policy in this central African country and examines these issues within the wider framework of political decentralization. Tensions have arisen between technical staff and politicians, between various levels of governance, and between environmental and other policy domains. This review offers a critical reflection on the perspectives and limitations of decentralized environmental governance in Uganda. Our conclusions focus on the need to balance administrative staff and local politicians, the mainstreaming of local environmental policy, and the role of international donors.

  10. Decentralization and Participatory Rural Development: A Literature Review

    Directory of Open Access Journals (Sweden)

    Muhammad Shakil Ahmad

    2011-12-01

    Full Text Available Most of the developing nations are still struggling for efficient use of their resources. In order to overcome physical and administrative constraints of the development, it is necessary to transfer the power from the central government to local authorities. Distribution of power from improves the management of resources and community participation which is considered key to sustainable development. Advocates of decentralization argue that decentralized government is source to improve community participation in rural development. Decentralized government is considered more responsive towards local needs and development of poor peoples. There are many obstacles to expand the citizen participation in rural areas. There are many approaches for participatory development but all have to face the same challenges. Current paper highlights the literature about Decentralization and participatory rural development. Concept and modalities of Decentralization, dimensions of participation, types of rural participation and obstacles to participation are also the part of this paper.

  11. Decentralized control experiments on NASA's flexible grid

    Science.gov (United States)

    Ozguner, U.; Yurkowich, S.; Martin, J., III; Al-Abbass, F.

    1986-01-01

    Methods arising from the area of decentralized control are emerging for analysis and control synthesis for large flexible structures. In this paper the control strategy involves a decentralized model reference adaptive approach using a variable structure control. Local models are formulated based on desired damping and response time in a model-following scheme for various modal configurations. Variable structure controllers are then designed employing co-located angular rate and position feedback. In this scheme local control forces the system to move on a local sliding mode in some local error space. An important feature of this approach is that the local subsystem is made insensitive to dynamical interactions with other subsystems once the sliding surface is reached. Experiments based on the above have been performed for NASA's flexible grid experimental apparatus. The grid is designed to admit appreciable low-frequency structural dynamics, and allows for implementation of distributed computing components, inertial sensors, and actuation devices. A finite-element analysis of the grid provides the model for control system design and simulation; results of several simulations are reported on here, and a discussion of application experiments on the apparatus is presented.

  12. Batch Delivery Scheduling with Multiple Decentralized Manufacturers

    Directory of Open Access Journals (Sweden)

    Shi Li

    2014-01-01

    Full Text Available This paper addresses an integrated decision on production scheduling and delivery operations, which is one of the most important issues in supply chain scheduling. We study a model in which a set of jobs ordered by only one customer and a set of decentralized manufacturers located at different locations are considered. Specifically, each job must be assigned to one of the decentralized manufacturers to process on its single machine facility. Then, the job is delivered to the customer directly in batch without intermediate inventory. The objective is to find a joint schedule of production and distribution to optimize the customer service level and delivery cost. In our work, we discuss this problem considering two different situations in terms of the customer service level. In the first one, the customer service is measured by the maximum arrival time, while the customer service is measured by the total arrival time in the second one. For each situation, we develop a dynamic programming algorithm to solve, respectively. Moreover, we identify a special case for the latter situation by introducing its corresponding solutions.

  13. Decentralized asset management for collaborative sensing

    Science.gov (United States)

    Malhotra, Raj P.; Pribilski, Michael J.; Toole, Patrick A.; Agate, Craig

    2017-05-01

    There has been increased impetus to leverage Small Unmanned Aerial Systems (SUAS) for collaborative sensing applications in which many platforms work together to provide critical situation awareness in dynamic environments. Such applications require critical sensor observations to be made at the right place and time to facilitate the detection, tracking, and classification of ground-based objects. This further requires rapid response to real-world events and the balancing of multiple, competing mission objectives. In this context, human operators become overwhelmed with management of many platforms. Further, current automated planning paradigms tend to be centralized and don't scale up well to many collaborating platforms. We introduce a decentralized approach based upon information-theory and distributed fusion which enable us to scale up to large numbers of collaborating Small Unmanned Aerial Systems (SUAS) platforms. This is exercised against a military application involving the autonomous detection, tracking, and classification of critical mobile targets. We further show that, based upon monte-carlo simulation results, our decentralized approach out-performs more static management strategies employed by human operators and achieves similar results to a centralized approach while being scalable and robust to degradation of communication. Finally, we describe the limitations of our approach and future directions for our research.

  14. Centralized versus decentralized lunar PMAD study

    Science.gov (United States)

    Metcalf, Kenneth J.

    A study of proposed lunar base architectures was performed to identify issues concerning centralized and decentralized power system deployment options. The power management and distribution (PMAD) system analysis is addressed. The PMAD system consists of power conditioning components that convert the generated power into the form desired for transmission, transmission lines that conduct this power from the power sources to the loads, and power conditioning hardware that converts the power into the form selected for secondary distribution to the loads. Three PMAD architecture configurations were evaluated: centralized, hybrid, and decentralized. Two models were created for each architecture to identify the preferred method of power transmission, DC or AC. Each model permitted the load power demands and distribution voltage level to be varied to assess the impact on power system mass. The AC power system models also allowed the distribution frequency to be changed. Finally, individual models were developed for different transmission line configurations and placements to determine the best conductor construction and installation location.

  15. Issues concerning centralized versus decentralized power deployment

    Science.gov (United States)

    Metcalf, Kenneth J.; Harty, Richard B.; Robin, James F.

    1991-03-01

    The results of a study of proposed lunar base architectures to identify issues concerning centralized and decentralized power system deployment options are presented. The power system consists of the energy producing system (power plant), the power conditioning components used to convert the generated power into the form desired for transmission, the transmission lines that conduct this power from the power sources to the loads, and the primary power conditioning hardware located at the user end. Three power system architectures, centralized, hybrid, and decentralized, were evaluated during the course of this study. Candidate power sources were characterized with respect to mass and radiator area. Two electrical models were created for each architecture to identify the preferred method of power transmission, dc or ac. Each model allowed the transmission voltage level to be varied at assess the impact on power system mass. The ac power system models also permitted the transmission line configurations and placements to determine the best conductor construction and installation location. Key parameters used to evaluate each configuration were power source and power conditioning component efficiencies, masses, and radiator areas; transmission line masses and operating temperatures; and total system mass.

  16. Medicare and Medicaid programs; physicians' referrals to health care entities with which they have financial relationships. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

    Science.gov (United States)

    2001-01-04

    This final rule with 90-day comment period (Phase I of this rulemaking) incorporates into regulations the provisions in paragraphs (a), (b), and (h) of section 1877 of the Social Security Act (the Act). Under section 1877, if a physician or a member of a physician's immediate family has a financial relationship with a health care entity, the physician may not make referrals to that entity for the furnishing of designated health services (DHS) under the Medicare program, unless an exception applies. The following services are DHS: clinical laboratory services; physical therapy services; occupational therapy services; radiology services, including magnetic resonance imaging, computerized axial tomography scans, and ultrasound services; radiation therapy services and supplies; durable medical equipment and supplies; parenteral and enteral nutrients, equipment, and supplies; prosthetics, orthotics, and prosthetic devices and supplies; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services. In addition, section 1877 of the Act provides that an entity may not present or cause to be presented a Medicare claim or bill to any individual, third party payer, or other entity for DHS furnished under a prohibited referral, nor may we make payment for a designated health service furnished under a prohibited referral. Paragraph (a) of section 1877 of the Act includes the general prohibition. Paragraph (b) of the Act includes exceptions that pertain to both ownership and compensation relationships, including an in-office ancillary services exception. Paragraph (h) includes definitions that are used throughout section 1877 of the Act, including the group practice definition and the definitions for each of the DHS. We intend to publish a second final rule with comment period (Phase II of this rulemaking) shortly addressing, to the extent necessary, the remaining sections of the Act. Phase II of this rulemaking will address comments

  17. The Finance Curse

    DEFF Research Database (Denmark)

    Christensen, John; Shaxson, Nick; Wigan, Duncan

    2016-01-01

    The Global Financial Crisis placed the utility of financial services in question. The crash, great recession, wealth transfers from public to private, austerity and growing inequality cast doubt on the idea that finance is a boon to the host economy. This article systematizes these doubts...... to highlight the perils of an oversized financial sector. States failing to harness natural resources for development led to the concept of the Resource Curse. In many countries, resource dependence generated slower growth, crowding out, reduced economic diversity, lost entrepreneurialism, unemployment......, economic instability, inequality, conflict, rent-seeking and corruption. The Finance Curse produces similar effects, often for similar reasons. Beyond a point, a growing financial sector can do more harm than good. Unlike the Resource Curse, these harms transcend borders. The concept of a Finance Curse...

  18. Guidebook to Geothermal Finance

    Energy Technology Data Exchange (ETDEWEB)

    Salmon, J. P.; Meurice, J.; Wobus, N.; Stern, F.; Duaime, M.

    2011-03-01

    This guidebook is intended to facilitate further investment in conventional geothermal projects in the United States. It includes a brief primer on geothermal technology and the most relevant policies related to geothermal project development. The trends in geothermal project finance are the focus of this tool, relying heavily on interviews with leaders in the field of geothermal project finance. Using the information provided, developers and investors may innovate in new ways, developing partnerships that match investors' risk tolerance with the capital requirements of geothermal projects in this dynamic and evolving marketplace.

  19. Rethinking SMEs’ Financing Predicament

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    A waveofsharpcriticism has been aimed atthebanks concerning the difficulties for China’ss mallandmedium-sized enterprises(SMEs)in acquiring financing,whilethe Central Government began to strongly urge banks to provide loans for SMEs.Shouldall SMEs be financed while the bankst ake theblame?Is there anyother viable way to pull SMEs outof the financial predicament?Qiu Haiping,a professor with the School of Economics at Renmin University of China,recentlye xamined the issue and offered insights in the Guangming Daily.Edited excerpts follow

  20. Switzerland: Health System Review.

    Science.gov (United States)

    De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm

    2015-01-01

    This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to

  1. Finance Law Reviews

    Science.gov (United States)

    Journal of Education Finance, 1975

    1975-01-01

    Reviews recent state and federal court decisions dealing with issues relevant to educational finance. Within the broad area of elementary-secondary education, specific cases involve allocation of federal school aid, fees charged by public schools for textbooks and instructional materials, property acquisition and school construction, and…

  2. Campaign Finance: Reporter Guide

    Science.gov (United States)

    Wieder, Ben

    2014-01-01

    Campaign finance might seem like the exclusive province of political reporters, but there are many good reasons why authors should be paying attention--both in races for education positions and in other key races at the local, state, and federal levels with implications for education. Basic math is a necessary skill and familiarity with a…

  3. Nuclear Physicists in Finance

    Science.gov (United States)

    Mattoni, Carlo

    2017-01-01

    The financial services industry presents an interesting alternative career path for nuclear physicists. Careers in finance typically offer intellectual challenge, a fast pace, high caliber colleagues, merit-based compensation with substantial upside, and an opportunity to deploy skills learned as a physicist. Physicists are employed at a wide range of financial institutions on both the ``buy side'' (hedge fund managers, private equity managers, mutual fund managers, etc.) and the ``sell side'' (investment banks and brokerages). Historically, physicists in finance were primarily ``quants'' tasked with applying stochastic calculus to determine the price of financial derivatives. With the maturation of the field of derivative pricing, physicists in finance today find work in a variety of roles ranging from quantification and management of risk to investment analysis to development of sophisticated software used to price, trade, and risk manage securities. Only a small subset of today's finance careers for physicists require the use of advanced math and practically none provide an opportunity to tinker with an apparatus, yet most nevertheless draw on important skills honed during the training of a nuclear physicist. Intellectually rigorous critical thinking, sophisticated problem solving, an attention to minute detail and an ability to create and test hypotheses based on incomplete information are key to both disciplines.

  4. THE POLISH HEALTH CARE SYSTEM’S ENDLESS JOURNEY TO PERFECTION – A NEVER ENDING STORY

    Directory of Open Access Journals (Sweden)

    Paulina Pieprzyk

    2013-06-01

    Full Text Available Purpose: The main aim of this paper is to show the Polish health care system’s transformation process in recent years and to answer the question whether is there a simple path from centralization to decentralization or another form of centralization. The transformation process has changed the health care system’s financing from budget planning to compulsory health insurance deducted from workers’ and employers’ premiums. In addition, the transformation has strengthened the autonomy of the health care at a local level and made it less dependent from the public sector. Different health care system corresponds to each period respectively. It is believed that the main change in Polish health care took place in 1999 when the function of the payer which formerly belonged to the government administration was overtaken by an independent institution (Health Care Fund. The article not only describes and explains functioning of each health care model existing in Poland in the past but also puts them in the international context. In addition, the article shows difficulties each model had to face and cope with and indicates the underlying reasons for changes in the Polish health care and theirs consequences. Design/methodology/approach: A range of recently published (1990-2012 works, which aim to provide both theoretical and practical view on the health care system in Poland, has been analyzed. Findings: The final thesis stated in this article presents a way of interpretation changes that the Polish health care system has been undergoing in recent years. This paper challenges a thesis according to which the polish health care system is decentralized. Research limitations/implications: The scope of this article is limited and does not allow to perform further research. Additionally, the research was based on the very scare literature on the issue of health care system in transition. Practical implications: This paper reveals several practical

  5. Energy and air emission implications of a decentralized wastewater system

    Science.gov (United States)

    Shehabi, Arman; Stokes, Jennifer R.; Horvath, Arpad

    2012-06-01

    Both centralized and decentralized wastewater systems have distinct engineering, financial and societal benefits. This paper presents a framework for analyzing the environmental effects of decentralized wastewater systems and an evaluation of the environmental impacts associated with two currently operating systems in California, one centralized and one decentralized. A comparison of energy use, greenhouse gas emissions and criteria air pollutants from the systems shows that the scale economies of the centralized plant help lower the environmental burden to less than a fifth of that of the decentralized utility for the same volume treated. The energy and emission burdens of the decentralized plant are reduced when accounting for high-yield wastewater reuse if it supplants an energy-intensive water supply like a desalination one. The centralized facility also reduces greenhouse gases by flaring methane generated during the treatment process, while methane is directly emitted from the decentralized system. The results are compelling enough to indicate that the life-cycle environmental impacts of decentralized designs should be carefully evaluated as part of the design process.

  6. LOCAL BUDGETS UNDER CURRENT DECENTRALIZATION: UKRAINE AND FOREIGN EXPERIENCE

    Directory of Open Access Journals (Sweden)

    O. Cheberyako

    2016-04-01

    Full Text Available The article is devoted to the major trends and issues of development of local budgets in Ukraine. A study of the essence of fiscal decentralization as one of the components of the management, aimed at reducing the dependence of local governments from the central government with regard to foreign experience. Particular attention is paid to local budgets under decentralization of own and delegated financial powers. The theoretical principles of fiscal decentralization and its proven impact on the socio-economic development. Studied the European countries model of local budgets. The features of formation of revenues of local budgets under decentralization. The role in shaping tax revenues of local budgets in foreign countries and Ukraine. The analysis of state policy of financial support for regional development in Ukraine. The structure of tax revenue in the context of changes in the budget and tax legislation in a decentralized tax powers. Systematized features of fiscal decentralization in Ukraine. Problems and grounded main ways of optimizing the formation of local budgets in a decentralized tax powers. Formed selection of areas targeted as ways to increase economic and financial independence of regions of Ukraine.

  7. Water Finance Webinars and Forums

    Science.gov (United States)

    The Center hosts a series of water finance forums. These forums bring together communities with drinking water, wastewater, and stormwater project financing needs in an interactive peer-to-peer networking format.

  8. From Finance Capitalism to Financialization

    DEFF Research Database (Denmark)

    Hansen, Per H.

    2014-01-01

    In this article I interpret 150 years of financial history with a focus on shifts in the role of finance in society. I argue that over time the role of finance has shifted twice from that of servant to that of master of society, and that this process has been driven by sense making through narrat...... narratives that legitimized and shaped these changes. When finance became a master rent seeking, cultural capture and out-of control financial innovation resulted in financial and social instability. Finance as a master was the characteristic of finance capitalism from around 1900......–1931 and of financialization from around 1980 to today. Finance capitalism and financialization were enabled by a dominant narrative that legitimized the power of finance. The shifts in the role of finance happened when crises undermined the meaning of the existing narrative and created for a new narrative able to make sense...

  9. [Project financing in public hospital trusts].

    Science.gov (United States)

    Contarino, F; Grosso, G; Mistretta, A

    2009-01-01

    The growing debate in recent years over how to finance public works through private capital has progressively highlighted the role of project finance (PF) and publicprivate partnerships (PPP) in general. More and more European countries are turning to PF to finance their public infrastructure development. The UK, which pioneered the adoption of project finance in this field, has been followed by Italy, Spain, France, Portugal and Germany and more recently by Greece, Czech Republic and Poland. Beginning in the late 1990's, Italy has steadily amplified its use of PF and PPPs in key sectors such as healthcare as an alternative way of funding the modernisation of its health facilities and hospitals. The trend reveal an average annual growth of 10.9% since 2002 with peaks of varying intensity over the five year period. Project finance and PPPs represent an effective response to the country's infrastructure gap and support the competitiveness of local systems and the quality of public services. None of this will transpire, however without energetic new planning efforts and adequate policy at the centre.

  10. Decentralized manufacturing of cell and gene therapies: Overcoming challenges and identifying opportunities.

    Science.gov (United States)

    Harrison, Richard P; Ruck, Steven; Medcalf, Nicholas; Rafiq, Qasim A

    2017-10-01

    Decentralized or "redistributed" manufacturing has the potential to revolutionize the manufacturing approach for cell and gene therapies (CGTs), moving away from the "Fordist" paradigm, delivering health care locally, customized to the end user and, by its very nature, overcoming many of the challenges associated with manufacturing and distribution of high volume goods. In departing from the traditional centralized model of manufacturing, decentralized manufacturing divides production across sites or geographic regions. This paradigm shift imposes significant structural and organisational changes on a business presenting both hidden challenges that must be addressed and opportunities to be embraced. By profoundly adapting business practices, significant advantages can be realized through a democratized value chain, creation of professional-level jobs without geographic restriction to the central hub and a flexibility in response to external pressures and demands. To realize these potential opportunities, however, advances in manufacturing technology and support systems are required, as well as significant changes in the way CGTs are regulated to facilitate multi-site manufacturing. Decentralized manufacturing is likely to be the manufacturing platform of choice for advanced health care therapies-in particular, those with a high degree of personalization. The future success of these promising products will be enhanced by adopting sound business strategies early in development. To realize the benefits that decentralized manufacturing of CGTs has to offer, it is important to examine both the risks and the substantial opportunities present. In this research, we examine both the challenges and the opportunities this shift in business strategy represents in an effort to maximize the success of adoption. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  11. Norway: health system review.

    Science.gov (United States)

    Ringard, Ånen; Sagan, Anna; Sperre Saunes, Ingrid; Lindahl, Anne Karin

    2013-01-01

    Norways five million inhabitants are spread over nearly four hundred thousand square kilometres, making it one of the most sparsely populated countries in Europe. It has enjoyed several decades of high growth, following the start of oil production in early 1970s, and is now one of the richest countries per head in the world. Overall, Norways population enjoys good health status; life expectancy of 81.53 years is above the EU average of 80.14, and the gap between overall life expectancy and healthy life years is around half the of EU average. The health care system is semi decentralized. The responsibility for specialist care lies with the state (administered by four Regional Health Authorities) and the municipalities are responsible for primary care. Although health care expenditure is only 9.4% of Norways GDP (placing it on the 16th place in the WHO European region), given Norways very high value of GDP per capita, its health expenditure per head is higher than in most countries. Public sources account for over 85% of total health expenditure; the majority of private health financing comes from households out-of-pocket payments.The number of practitioners in most health personnel groups, including physicians and nurses, has been increasing in the last few decades and the number of health care personnel per 100 000 inhabitants is high compared to other EU countries. However, long waiting times for elective care continue to be a problem and are cause of dissatisfaction among the patients. The focus of health care reforms has seen shifts over the past four decades. During the 1970s the focus was on equality and increasing geographical access to health care services; during the 1980s reforms aimed at achieving cost containment and decentralizing health care services; during the 1990s the focus was on efficiency. Since the beginning of the millennium the emphasis has been given to structural changes in the delivery and organization of health care and to policies

  12. The Challenge of Islamic Finance

    OpenAIRE

    Sheng, Andrew; Singh, Ajit

    2012-01-01

    From its humble beginnings in the 1990s, Islamic finance has become a trillion US dollar industry. The market consensus is that Islamic finance has a bright future due to favourable demographics and rising incomes in the Muslim community. Moreover, despite voices sceptical of an accommodation between Islamic and global finance, leading global banks are buying Islamic bonds and forming subsidiaries specially to conduct Islamic finance business. Special laws have been passed in non-Muslim fi...

  13. TAXATION AND FINANCE CONSTRAINED FIRMS

    OpenAIRE

    Iris Claus

    2006-01-01

    This paper develops an open economy model to assess the long-run effects of taxation where firms are finance constrained. Finance constraints arise because of imperfect information between borrowers and lenders. Only borowers (firms) can costlessly observe actual returns from production. Imperfect information and finance constraints magnify the effects of taxation. A reduction (rise) in income taxation increases (lowers) firms' internal funds and their ability to assess external finance to ex...

  14. Fractional Power Control for Decentralized Wireless Networks

    CERN Document Server

    Jindal, Nihar; Andrews, Jeffrey G

    2007-01-01

    We propose and analyze a new paradigm for power control in decentralized wireless networks, termed fractional power control. Transmission power is chosen as the current channel quality raised to an exponent -s, where s is a constant between 0 and 1. Choosing s = 1 and s = 0 correspond to the familiar cases of channel inversion and constant power transmission, respectively. Choosing s in (0, 1) allows all intermediate policies between these two extremes to be evaluated, and we see that neither extreme is ideal. We prove that using an exponent of s = 1/2 optimizes the transmission capacity of an ad hoc network, meaning that the inverse square root of the channel strength is the optimal transmit power scaling. Intuitively, this choice achieves the optimal balance between helping disadvantaged users while making sure they do not flood the network with interference.

  15. Rollout Sampling Policy Iteration for Decentralized POMDPs

    CERN Document Server

    Wu, Feng; Chen, Xiaoping

    2012-01-01

    We present decentralized rollout sampling policy iteration (DecRSPI) - a new algorithm for multi-agent decision problems formalized as DEC-POMDPs. DecRSPI is designed to improve scalability and tackle problems that lack an explicit model. The algorithm uses Monte- Carlo methods to generate a sample of reachable belief states. Then it computes a joint policy for each belief state based on the rollout estimations. A new policy representation allows us to represent solutions compactly. The key benefits of the algorithm are its linear time complexity over the number of agents, its bounded memory usage and good solution quality. It can solve larger problems that are intractable for existing planning algorithms. Experimental results confirm the effectiveness and scalability of the approach.

  16. Decentralized Overlay for Federation of Enterprise Clouds

    CERN Document Server

    Ranjan, Rajiv

    2008-01-01

    This chapter describes Aneka-Federation, a decentralized and distributed system that combines enterprise Clouds, overlay networking, and structured peer-to-peer techniques to create scalable wide-area networking of compute nodes for high-throughput computing. The Aneka-Federation integrates numerous small scale Aneka Enterprise Cloud services and nodes that are distributed over multiple control and enterprise domains as parts of a single coordinated resource leasing abstraction. The system is designed with the aim of making distributed enterprise Cloud resource integration and application programming flexible, efficient, and scalable. The system is engineered such that it: enables seamless integration of existing Aneka Enterprise Clouds as part of single wide-area resource leasing federation; self-organizes the system components based on a structured peer-to-peer routing methodology; and presents end-users with a distributed application composition environment that can support variety of programming and execu...

  17. Load scheduling for decentralized CHP plants

    DEFF Research Database (Denmark)

    Nielsen, Henrik Aalborg, orlov 31.07.2008; Madsen, Henrik; Nielsen, Torben Skov

    This report considers load scheduling for decentralized combined heat and power plants where the revenue from selling power to the transmission company and the fuel cost may be time-varying. These plants produce both heat and power with a fixed ratio between these outputs. A heat storage facility...... is used to be able to deviate from this restriction. The load scheduling must be performed with only approximate knowledge about the future. At present in Denmark this uncertainty is only associated with the heat demand, but in the future revenues of produced energy and the fuel costs might also...... be uncertain and dependent on time. It is suggested to use a combination of background knowledge of the operator and computer tools to solve the scheduling problem. More specificly it is suggested that the plant is equipped with (i) an automatic on-line system for forecasting the heat demand, (ii...

  18. Decentralized energy systems for clean electricity access

    Science.gov (United States)

    Alstone, Peter; Gershenson, Dimitry; Kammen, Daniel M.

    2015-04-01

    Innovative approaches are needed to address the needs of the 1.3 billion people lacking electricity, while simultaneously transitioning to a decarbonized energy system. With particular focus on the energy needs of the underserved, we present an analytic and conceptual framework that clarifies the heterogeneous continuum of centralized on-grid electricity, autonomous mini- or community grids, and distributed, individual energy services. A historical analysis shows that the present day is a unique moment in the history of electrification where decentralized energy networks are rapidly spreading, based on super-efficient end-use appliances and low-cost photovoltaics. We document how this evolution is supported by critical and widely available information technologies, particularly mobile phones and virtual financial services. These disruptive technology systems can rapidly increase access to basic electricity services and directly inform the emerging Sustainable Development Goals for quality of life, while simultaneously driving action towards low-carbon, Earth-sustaining, inclusive energy systems.

  19. Influence of cardiac decentralization on cardioprotection.

    Directory of Open Access Journals (Sweden)

    John G Kingma

    Full Text Available The role of cardiac nerves on development of myocardial tissue injury after acute coronary occlusion remains controversial. We investigated whether acute cardiac decentralization (surgical modulates coronary flow reserve and myocardial protection in preconditioned dogs subject to ischemia-reperfusion. Experiments were conducted on four groups of anesthetised, open-chest dogs (n = 32: 1- controls (CTR, intact cardiac nerves, 2- ischemic preconditioning (PC; 4 cycles of 5-min IR, 3- cardiac decentralization (CD and 4- CD+PC; all dogs underwent 60-min coronary occlusion and 180-min reperfusion. Coronary blood flow and reactive hyperemic responses were assessed using a blood volume flow probe. Infarct size (tetrazolium staining was related to anatomic area at risk and coronary collateral blood flow (microspheres in the anatomic area at risk. Post-ischemic reactive hyperemia and repayment-to-debt ratio responses were significantly reduced for all experimental groups; however, arterial perfusion pressure was not affected. Infarct size was reduced in CD dogs (18.6 ± 4.3; p = 0.001, data are mean ± 1 SD compared to 25.2 ± 5.5% in CTR dogs and was less in PC dogs as expected (13.5 ± 3.2 vs. 25.2 ± 5.5%; p = 0.001; after acute CD, PC protection was conserved (11.6 ± 3.4 vs. 18.6 ± 4.3%; p = 0.02. In conclusion, our findings provide strong evidence that myocardial protection against ischemic injury can be preserved independent of extrinsic cardiac nerve inputs.

  20. Macroeconomic Effects In Centralized And Decentralized Wage Setting Systems

    OpenAIRE

    Sorolla, Valeri

    2000-01-01

    We present a model of a monetary economy with two systems of wage setting: a decentralized system and a centralized system. In the decentralized system there is a union per firm that sets the firm's wage. In the centralized system there is a unique union that sets a common wage for all firms. We find that, when there is unemployment, the equilibrium wage set in the centralized wage setting system is lower than the one set in the decentralized wage setting and that both depend on the size of t...