Social epidemiologists are interested in determining the causal relationship between income and health. Natural experiments in which individuals or groups receive income randomly or quasi-randomly from financial credits (e.g., tax credits or cash transfers) are increasingly being analyzed using instrumental variable analysis. For example, in this issue of the Journal, Hamad and Rehkopf (Am J Epidemiol. 2016;183(9):775-784) used an in-work tax credit called the Earned Income Tax Credit as an instrument to estimate the association between income and child development. However, under certain conditions, the use of financial credits as instruments could violate 2 key instrumental variable analytic assumptions. First, some financial credits may directly influence health, for example, through increasing a psychological sense of welfare security. Second, financial credits and health may have several unmeasured common causes, such as politics, other social policies, and the motivation to maximize the credit. If epidemiologists pursue such instrumental variable analyses, using the amount of an unconditional, universal credit that an individual or group has received as the instrument may produce the most conceptually convincing and generalizable evidence. However, other natural income experiments (e.g., lottery winnings) and other methods that allow better adjustment for confounding might be more promising approaches for estimating the causal relationship between income and health. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: email@example.com.
Kono, Kumi; Eskandarieh, Sharareh; Obayashi, Yoshihide; Arai, Asuna; Tamashiro, Hiko
We attempted to identify the risk factors that may affect mental health status of the international students and we conducted the survey using a self-administered questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. The students were divided into two groups; (1) those who received scholarships and (2) those who didn't since we thought the division represented practical patterns of their financial status. The associations of socio-demographic characteristics with depressive symptoms were examined. Of the 726 students, 480 (66.1%) responded and 207 (43.1%) had depressive symptoms. The logistic regression analysis indicated that quality of sleep, amount of exercise, and housing conditions--but not financial status--were statistically associated with the risk of developing depressive symptoms. Although the inversion of the cause and effect is yet to be ascertained, the students who are unsatisfied with their housing conditions, quality of sleep and less exercise need more attention.
Honoré, Peggy A; Costich, Julia F
The absence of appropriate financial management competencies has impeded progress in advancing the field of public health finance. It also inhibits the ability to professionalize this sector of the workforce. Financial managers should play a critical role by providing information relevant to decision making. The lack of fundamental financial management knowledge and skills is a barrier to fulfilling this role. A national expert committee was convened to examine this issue. The committee reviewed standards related to financial and business management practices within public health and closely related areas. Alignments were made with national standards such as those established for government chief financial officers. On the basis of this analysis, a comprehensive set of public health financial management competencies was identified and examined further by a review panel. At a minimum, the competencies can be used to define job descriptions, assess job performance, identify critical gaps in financial analysis, create career paths, and design educational programs.
Research purpose: The objective of the study was to explore the relationship between psychological wellness as operationalised in the SOC construct and in financial health. Motivation for the study: Financial pressure can be a major stressor in the workplace, affecting employees’ ability to function optimally. The debt crisis in South Africa is therefore necessitating employers to invest in the financial health of their employees. In light of the National Credit Act 34 of 2005, employers should, in fact, provide debt counselling to employees struggling with financial problems. In the South African context, however, studies investigating the potential influence of psychological-wellness constructs on financial health are lacking. Research design, approach and method: A cross-sectional survey design was applied and a quantitative-relational approach followed. From the 1 100 employees in a financial insurance company, 435 completed questionnaires were received. Main findings: The empirical results indicated a significant relationship between the variables, confirming that a stronger SOC impacts positively on employees’ financial health. A stronger SOC therefore relates positively to more effective debt management and retirement planning. Practical/managerial implications: The findings emphasised the importance of debt management and retirement planning being addressed and integrated into employee-assistance strategies and programmes. Contribution/value-add: This study is a significant step in addressing financial health from a psychological perspective.
Schiozer, Rafael Felipe; Saito, Cristiana Checchia; Saito, Richard
This paper analyzes the relationship between the financial health and organizational form of private health care providers in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organizational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health care providers and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health care providers benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a significant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction.
Maria Victoria Zunzunegui
Conclusion: The results suggest that financial fraud is detrimental to health. Further research should examine the mechanisms through which financial fraud impacts health. If our results are confirmed psychological and medical care should be provided, in addition to financial compensation.
Kim Karlsson, Hyunjoo
This dissertation consists of an introductory chapter and four papers dealing with financial issues of open economies, which can be in two broad categorizations: 1) exchange rate movements and 2) stock market interdependence. The first paper covers how the exchange rate changes affect the prices of internationally traded goods. With the variables (the price of exports in exporters’ currency and the exchange rate, both of which are in logarithmic form) being cointegrated, a model with both lon...
Changes in economic conditions and healthcare delivery models have shifted more healthcare costs to patients, resulting in greater patient financial responsibilities. As a result, it is important to understand the potential impact of financial literacy on patients' healthcare behavior. With the focus on delivering better health outcomes at lower costs, factors that influence patient behavior are important considerations for healthcare providers. Although researchers have proposed a variety of conceptual models that identify influential factors, those models do not fully address financial literacy and its potential impact patients' healthcare decisions. This article examines existing models of patient healthcare decision-making and current research on factors affecting patient decision-making and behavior and then presents recommendations for closing the identified gap in our current knowledge.
Full Text Available The purpose of this research is to test the effect of financial and non-financial variables to firm performances between Indonesia and Thailand. The observation data used in this study is manufacturing companies from several sectors. Secondary data was used, collected from Indonesia Stock Exchange and Stock Exchange of Thailand during 2011 - 2013. By combining 3 years research, there are 55 Indonesian companies and 50 Thailand companies that meet predetermined criteria. Multiple Regression was used to analyze. This study uses Return on Equity, Earnings per Share, Market Value Added as financial variables and Earnings Quality, Institutional Ownership, Independent Commissioner, Audit Committee, Corporate Social Responsibility as non-financial variables. Test results show that both financial and non-financial variables can effect to firm performance.
McAtee, Robin E; Crandall, Debra; Wright, Larry D; Beverly, Claudia J
Are hospital-based outpatient interdisciplinary clinics a financially viable alternative for caring for our burgeoning population of older adults in America? Although highly popular, with high patient satisfaction rates among older adults and their families, senior health clinics (SHCs) can be expensive to operate, with limited quantifiable health outcomes. This study analyzed three geriatric hospital-based interdisciplinary clinics in rural Arkansas by examining their patient profiles, revenues, and expenses. It closely examined the effects of the downstream revenue using the multiplier effect and acknowledged other factors that weigh heavily on the success of SHCs and the care of older adults. The findings highlight the similarities and differences in the three clinics' operating and financial structures in addition to the clinics' and providers' productivity. The analysis presents an evidence-based illustration that SHCs can break even or lose large amounts of money.
Barnes, Kayleigh; Mukherji, Arnab; Mullen, Patrick; Sood, Neeraj
This paper estimates the impact of social health insurance on financial risk by utilizing data from a natural experiment created by the phased roll-out of a social health insurance program for the poor in India. We estimate the distributional impact of insurance on of out-of-pocket costs and incorporate these results with a stylized expected utility model to compute associated welfare effects. We adjust the standard model, accounting for conditions of developing countries by incorporating consumption floors, informal borrowing, and asset selling which allow us to separate the value of financial risk reduction from consumption smoothing and asset protection. Results show that insurance reduces out-of-pocket costs, particularly in higher quantiles of the distribution. We find reductions in the frequency and amount of money borrowed for health reasons. Finally, we find that the value of financial risk reduction outweighs total per household costs of the insurance program by two to five times. Copyright © 2017. Published by Elsevier B.V.
Full Text Available Financial development is correlated with several underlying regulatory variables (such as indicators of investor protection, market transparency variables for corporate governance growth and rules for capital market development, which are under the control of national legislators and EU directives. This paper provides estimates of the relationship between financial market development and corporate growth and assesses the impact of financial market integration on this relationship with reference to European Union (EU countries. The regression results obtained using this panel support the hypothesis that financial development promotes growth particularly in industries that are more financially dependent on external finance. For policy purposes, analyzing changes in these regulatory variables may be a more interesting exercise than analyzing integration of the financial systems themselves. Since assuming that EU countries will raise its regulatory and legal standards to the U.S. standards appears unrealistic, in this case we examine a scenario where EU countries raise their standards to the highest current EU standard.
Judit Creixans Tenas
Full Text Available Purpose: The present study reflects the economic and financial analysis of private hospitals with non-charitable character in Catalonia 2008-2013. The private health sector is considered to be a service activity that develops an important social role. The study positions these analysed centers in the Catalan and Spanish health sector and presents the main economic and financial indicators to diagnose the situation of these companies during the period indicated by analysing short and long-term results and analysis of changes in equity and cash flows of the wineries. Design/methodology/approach: The data used comes from the statements of the Catalan hospital centers in the period 2008-2013 and in particular, it contains a sample of 94 Catalan private hospitals, that mostly are considered large-level accounting (according to the General Accounting Plan. The economic and financial analysis has carried out using descriptive statistics and analysis results and conclusions have been reached. Findings: The study noted that enables private hospitals in this period have a healthy economic and financial status, although it should improve the management of assets. Most sales are concentrated with a small number of hospitals and, regarding the evolution of the results, produces two distinct stages, the first period of decrease (2008-2010 and the second period of growth and recovery from 2011.. Research limitations/implications: It would be desirable to perform the same study by the Spanish private hospitals in order to compare the economic and financial analysis of the Catalan private sector with the Spanish private sector. Practical implications: It allows us to assess the projection of this sector in recent years in Catalonia in order to take the appropriate economic decisions in this regard. Social implications: The results show the changes that have occurred over the years in the economic crisis of the period analysed. Originality / value: For
Baumbach, Anja; Gulis, Gabriel
A number of health outcomes were affected by previous financial crises, e.g. suicides, homicides and transport accident mortality. Aim of this study was to analyse the effects of the current financial crisis on selected health outcomes at population level in Europe. A mixed approach of ecologic and time trend design was applied, including correlation analysis. For eight countries, data on the economic situation (unemployment rate and economic growth) and health indicators (overall mortality, suicide and transport accident mortality) was drawn from EUROSTAT database for 2000-10. Spearman's rank correlation was applied to analyse the influence of social protection on the association between exposure and outcome variables. The financial crisis had no visible effect on overall mortality in any of the eight countries until 2010. Transport accident mortality decreased in all eight countries, in the range of 18% in Portugal to 52% in Slovenia. In contrast, suicide mortality increased in Germany (+5.3%), Portugal (+5.2%), Czech Republic (+7.6%), Slovakia (+22.7%) and Poland (+19.3%). The effect of unemployment on suicide is higher in countries with lower social spending (Spearman's r = -0.83). Clear cause-effect relations could not be established owing to the ecological study design and issues concerning data availability. However, there are clear changes in suicide and transport accident mortality after onset of the crisis, and findings are consistent with previous work. As part of this work, a comprehensive framework was developed, which can be applied to analyse health effects of financial crises in more detail. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Full Text Available The primary objective of this study is to investigate the effect of growth and financial strength variables on the financial leverage for some listed companies in the Tehran Stock Exchange. For this purpose, a sample of 700 firm-years among listed companies in the Tehran Stock Exchange over the period 2006-2010 was examined. In the present study, the growth variables, including asset growth, profit growth and sales growth; and financial strength calculated by the Altman Z-bankruptcy model have been considered as independent variables. In addition, the ratios of long-term debt to total assets, long-term debt to fixed assets, total long-term debt and short-term receivable facilities to equity capital and total long-term debt and short-term receivable facilities to total assets are used as measures of financial leverage and dependent variables. The results indicate that there is a negative and significant relationship between assets growth and some indexes of financial leverage. There is also a positive and significant relationship between the variables of profit growth, sales growth and financial strength with financial leverage measures.
Ginn, Gregory O; Shen, Jay J; Moseley, Charles B
The objective of this study was to examine the relationship between financial position and adoption of electronic health records (EHRs) in 2442 acute care hospitals. The study was cross-sectional and utilized a general linear mixed model with the multinomial distribution specification for data analysis. We verified the results by also running a multinomial logistic regression model. To measure our variables, we used data from (1) the 2007 American Hospital Association (AHA) electronic health record implementation survey, (2) the 2006 Centers for Medicare and Medicaid Cost Reports, and (3) the 2006 AHA Annual Survey containing organizational and operational data. Our dependent variable was an ordinal variable with three levels used to indicate the extent of EHR adoption by hospitals. Our independent variables were five financial ratios: (1) net days revenue in accounts receivable, (2) total margin, (3) the equity multiplier, (4) total asset turnover, and (5) the ratio of total payroll to total expenses. For control variables, we used (1) bed size, (2) ownership type, (3) teaching affiliation, (4) system membership, (5) network participation, (6) fulltime equivalent nurses per adjusted average daily census, (7) average daily census per staffed bed, (8) Medicare patients percentage, (9) Medicaid patients percentage, (10) capitation-based reimbursement, and (11) nonconcentrated market. Only liquidity was significant and positively associated with EHR adoption. Asset turnover ratio was significant but, unexpectedly, was negatively associated with EHR adoption. However, many control variables, most notably bed size, showed significant positive associations with EHR adoption. Thus, it seems that hospitals adopt EHRs as a strategic move to better align themselves with their environment.
Sharp, Linda; O'Leary, Eamonn; O'Ceilleachair, Alan; Skally, Mairead; Hanly, Paul
The financial impact and consequences of cancer on the lives of survivors remain poorly understood. This is especially true for colorectal cancer. We investigated objective cancer-related financial stress, subjective cancer-related financial strain, and their association with health-related quality of life in colorectal cancer survivors. This was a cross-sectional postal survey. The study was conducted in Ireland, which has a mixed public-private healthcare system. Colorectal cancer survivors, diagnosed 6 to 37 months prior, were identified from the population-based National Cancer Registry. Cancer-related financial stress was assessed as impact of cancer on household ability to make ends meet and cancer-related financial strain by feelings about household financial situation since cancer diagnosis. Health-related quality of life was based on European Organisation for Research and Treatment of Cancer QLQ-C30 global health status. Logistic regression was used to identify associations between financial stress and strain and low health-related quality of life (lowest quartile, score ≤50). A total of 493 survivors participated. Overall, 41% reported cancer-related financial stress and 39% cancer-related financial strain; 32% reported both financial stress and financial strain. After adjustment for sociodemographic and clinical variables, the odds of low health-related quality of life were significantly higher in those who reported cancer-related financial stress postdiagnosis compared with those who reported no change in financial stress postcancer (OR = 2.54 (95% CI, 1.62-3.99)). The odds of low health-related quality of life were also significantly higher in those with worse financial strain postdiagnosis (OR =1.73 (95% CI, 1.09-2.72)). The OR for those with both cancer-related financial stress and financial strain was 2.59 (95% CI, 1.59-4.22). Survey responders were younger, on average, than nonresponders. Responders and nonresponders may have differed in cancer
O'Neill, Barbara; Xiao, Jing Jian; Ensle, Karen
This study explored relationships between the practice of following a hand-written or computer-generated budget and the frequency of performance of positive personal health and financial practices. Data were collected from an online quiz completed by 942 adults, providing a simultaneous assessment of individuals' health and financial practices.…
Braun, Bonnie; Kim, Jinhee; Anderson, Elaine A.
Families are at-risk of or experiencing a diminished quality of living and life in current economic times and difficult decisions are required. Health and financial literacy are the basis for wise personal and public decision making. Family and consumer sciences (FCS) professionals can forge connections between health and financial literacy to…
C-L. Chang (Chia-Lin); M.J. McAleer (Michael); W.-K. Wong (Wing-Keung)
textabstractThis Opinion article briefly reviews some of the literature in behavioural and financial economics that are related to health & medical economics. We then discuss some of the research on behavioural and financial economics that could be extended to health & medical economics beyond the
Chang, Chia-Lin; McAleer, Michael; Wong, Wing-Keung
textabstractThis Opinion article briefly reviews some of the literature in behavioural and financial economics that are related to health & medical economics. We then discuss some of the research on behavioural and financial economics that could be extended to health & medical economics beyond the existing areas in theory, statistics and econometrics.
U.S. Department of Health & Human Services — This study assesses the financial performance of health plans that enroll Medicaid members across the key plan traits, specifically Medicaid dominant, publicly...
Havránek, T.; Horváth, R.; Matějů, Jakub
Roč. 9, č. 2 (2011), s. 14-17 ISSN 1803-7089 Institutional research plan: CEZ:MSM0021620846 Keywords : macroeconomic environment * monetary restriction * financial system Subject RIV: AH - Economics http://www.cnb.cz/miranda2/export/sites/www.cnb.cz/en/research/research_publications/erb/download/ERB_No2_2011.pdf
Giotakos, O; Karabelas, D; Kafkas, A
Several studies indicate an association between economic crises and psychological burden. To investigate the possible impact of the current economic crisis on mental health in Greece, the association between two economic indicators (unemployment and average income) and mental health variables (psychiatric clinic admittance, visits to outpatients' departments and emergency units, suicides, homicides, mortality rates and divorces) was studied. The data were gathered by the Greek Statistical Service and some others were provided by the following hospitals: Eginition Hospital, Psychiatric Hospital of Attica, Athens General Hospital and Evaggelismos Hospital. Simple and multiple regression analyses were performed on the data. There was no significant correlation between the level of unemployment, as well as the average income, and admittance to the psychiatric clinics. A significant correlation was isolated between unemployment and visits to outpatients' department (R2 = 0.40, p = 0.001) and emergency unit (R2 = 0.49, p = 0.0002) of Eginition Hospital. The unemployment rate during the period 1981-2008 was positively associated with the number of homicides (R2 = 0.16, beta = 0.000049, p = 0.03), as well as the number of divorces (R2 = 0.20, beta = 0.005, p = 0.02) during the same period. The average income showed positive association with the visits to both outpatients' department (R2 = 0.55, p positive correlation between the average income and divorce rates (R2 = 0.73, p impact of economic crisis on citizens' mental health.
Hogan, Christopher; Sunshine, Jonathan H
To evaluate variation in financial ratios for radiology practices nationwide and trends in these ratios and in payments. In 1999, the American College of Radiology surveyed radiology practices by mail. The final response rate was 66%. Weighting was used to make responses representative of all radiology practices in the United States. Self-reported financial ratios (payments, charges, accounts receivable turnover) were analyzed; 449 responses had usable data on these ratios. Comparison with results of a similar 1992 survey and combined analysis with Medicare data on billed charges provided information on trends. All measures of payment collections declined sharply from 1992 to 1999, with the gross collections rate (revenues as percentage of billed charges) decreasing from 71% to 55%. Average payment for a typical radiology service decreased approximately 4% in dollar terms or approximately 19% in inflation-adjusted terms. In 1999, nonmetropolitan practices appeared to fare better than others. Among insurers, Medicaid stood out as a low and slow payer, but neither managed care nor Medicare had a consistent effect on financial ratios. The gross collections rate varied substantially across geographic areas, as did, in an inverse pattern, the level of billed charges. One-quarter of practices had accounts receivable equal to 90 or more days of billings. The opposing geographic pattern of billed charges and gross collection rate suggests that geographic variation in the latter is driven more by variation in billed charges than by variation in payment levels. Radiologists saw a substantial decrease in the real (inflation-adjusted) value of payment per service during the 1990s. The large fraction of practices with accounts receivable of 90 or more days of billings-a level considered potentially imprudent by financial management advisors-suggests that many practices should improve financial management and that state prompt-payment laws have not had a substantial positive
Orfaly Cadigan, Rebecca; Stevenson, David G; Caudry, Daryl J; Grabowski, David C
To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998-2010. Regression specification incorporating facility and time fixed effects. We found little impact on the financial health of nursing homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired nursing home chains in good financial health, possibly to derive profit from the company's real estate holdings. Private investment acquired facilities are an important feature of today's nursing home sector. Although we did not observe a negative impact on the financial health of nursing homes, this development raises important issues about ownership oversight and transparency for the entire nursing home sector. © Health Research and Educational Trust.
Nudges, creating simple processes or structures that guide people toward a particular behaviour choice, are potentially a powerful tool for health promotion. User financial incentives could be a monetary form of such nudges. Given the challenges of chronic disease prevention, interventions such as nudges should be explored further. However, there would appear to be limited rationale for pursuing financial incentives as nudges.
Rasmussen, Anne-Sofie Reng
Recent evidence of mean reversion in stock returns has led to an explosion in the development of forecasting variables. This paper evaluates the relative performance of these many variables in both time-series and cross-sectional setups. We collect the different measures and compare their forecas......Recent evidence of mean reversion in stock returns has led to an explosion in the development of forecasting variables. This paper evaluates the relative performance of these many variables in both time-series and cross-sectional setups. We collect the different measures and compare...... their forecasting ability for stock returns, and we examine the forecasting variables' ability to reduce pricing errors in the conditional C-CAPM. A key result of the analysis is that the traditional pricedividend ratio performs surprisingly well compared to the many new forecasting variables. We also find...
Cadigan, Rebecca Orfaly; Stevenson, David G; Caudry, Daryl J; Grabowski, David C
Objective To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Data Sources Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998–2010. Study Design Regression specification incorporating facility and time fixed effects. Principal Findings We found little impact on the financial health of nursing homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired nursing home chains in good financial health, possibly to derive profit from the company’s real estate holdings. Conclusions Private investment acquired facilities are an important feature of today’s nursing home sector. Although we did not observe a negative impact on the financial health of nursing homes, this development raises important issues about ownership oversight and transparency for the entire nursing home sector. PMID:25104476
Full Text Available One of the most important decisions in every bank is approving loans to firms, which is based on evaluated credit risk and collateral. Namely, it is necessary to evaluate the risk that client will be unable to repay the obligations according to the contract. After Beaver's (1967 and Altman's (1968 seminal papers many authors extended the initial research by changing the methodology, samples, countries, etc. But majority of business failure papers as predictors use financial ratios, while in the real life banks combine financial and nonfinancial variables. In order to test predictive power of nonfinancial variables authors in the paper compare two insolvency prediction models. The first model that used financial rations resulted with classification accuracy of 82.8%, while the combined model with financial and nonfinancial variables resulted with classification accuracy of 88.1%.
Health spending, illicit financial flows and tax incentives in Malawi. B O'Hare, M Curtis. Abstract. This analysis examines the gaps in health care financing in Malawi and how foregone taxes could fill these gaps. It begins with an assessment of the disease burden and government health expenditure. Then it analyses the tax ...
Caplan, Mary Ager
Mental health consumers depend on social benefits in the forms of supplemental security income and social security disability insurance for their livelihood. Although these programs pay meager benefits, little research has been undertaken into how this population makes ends meet. Using a qualitative approach, this study asks what are the financial coping strategies of mental health consumers? Seven approaches were identified: subsidies, cost-effective shopping, budgeting, prioritizing, technology, debt management, and saving money. Results illustrate the resourcefulness of mental health consumers in managing meager social benefits and highlight the need to strengthen community mental health efforts with financial capabilities education.
Low, Alexander F H; Phillips, Andrew B; Ancker, Jessica S; Patel, Ashwin R; Kern, Lisa M; Kaushal, Rainu
Health information technology (HIT) is widely viewed as an important lever with which to improve the quality and efficiency of the healthcare system. However, there has long been debate about its financial effects. To characterize the existing data on the financial effects of HIT and to consider the implications for the effect of HIT on healthcare spending. Systematic literature review. We identified articles by (1) searching PubMed using the intersection of terms related to HIT applications and terms related to financial or economic effect; and (2) reviewing the reference lists of the included articles as well as additional policy articles and literature reviews. A total of 57 articles met our inclusion criteria, including 43 articles (75%) reporting financial benefits to a stakeholder associated with HIT. These included 26 articles (46%) reporting cost savings, 6 articles (11%) reporting revenue gains, and 11 articles (19%) reporting a mixture of cost savings and revenue gains. Among articles with experimental study designs, 22 of 34 (65%) reported financial benefits; and among articles explicitly measuring costs and benefits, 19 of 21 (90%) reported financial benefits. The most prevalent mechanisms were savings on administrative goods and/or personnel, savings on pharmaceuticals, and revenue gains through improved billing. Overall there is a dearth of articles on this topic, especially ones with strong study designs and financial analyses. HIT can have financial benefits, but more research is required, especially on HIT's effects under emerging delivery and payment reform efforts.
This study retrospectively surveyed the financial impact of deployments on 17 U.S. Army Reserve health care providers. Due to multiple mobilizations, 29 separate deployments were reported. The deployments, mostly between 2001 and 2005, typically lasted 3 months during which 86% reported no civilian income and 76% reported no civilian benefits. Solo practice providers reported the greatest financial losses due to continuing financial responsibility related to their civilian practice despite being deployed. Overall, 2 deployments did not change, 9 increased, and 16 decreased the medical officer's income. Two were not reported. In this small retrospective convenience sample study, solo practice U.S. Army Reserve health care providers were found to be at highest risk of financial losses during military deployments. This being said, no price can be put on the privilege of serving our men and women in uniform.
In the 1991 National Health Service reforms, health authorities became responsible for the health of their resident population, and they contract for health services from NHS providers - trusts and primary care services. A case study in Camden and Islington, an inner London health district, during 1996-1997 shows that contracting was directed more towards achieving financial balance than health objectives. Reasons include the inflationary effect of competition within an internal market, the power of administrators in decision-making within the health authority, and lack of adequate financial accounting in the NHS to relate costs to health outcomes. The introduction of programme budgets for districts would provide more cost-effective use of the nation's resources.
Full Text Available Purpose of the article: The main purpose of the article is to define the term “financial health of a commercial insurance company” and identify the factors that influence management and its economic results of a commercial insurance company. The above mentioned term will be faced with other similar terms such as financial stability, financial strength, solvency, liquidity or profitability (always with emphasis on the insurance sector. Related to this purpose, this hypothesis is formulated: “Financial health of a commercial insurance company can be identified in the long perspective with the term financial stability and as its synonym the concept of solvency can be stated.” Methodology/methods: The methods of description, analysis, deduction and induction will be used in the article. The research part is based on a qualitative basis. It combines three methods of qualitative research: interviews with experts, a structured interview with open questions, a questionnaire with open questions. Its subject is a managed conversation with leading experts in the field of insurance and related branches, who answered questions related to the topic. Evaluation of interviews was done by method of interview analysis, respectively thematic analysis and subsequent synthesis based on respondents’ answers. The synthesis is used as a method to gain new knowledge. The conclusions are the basis for discussion for the theory completion in the case of the term mentioned above and for statements to other contexts that are defined in the objectives of the article. Synthetic approach is applied in the formulation of conclusions of the research. Significant findings for the theory are obtained by abstraction, as derived from observations of the issues, i.e. financial health of a commercial insurance company. The evaluation also includes a summary of significant matters and it reflects the opinion of the author devised throughout literature and based on interviews
Stanton, Mary Ellen; Higgs, Elizabeth S; Koblinsky, Marge
Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives (e.g. performance-based financing, user fees, and various insurance mechanisms) and demand-side incentives (e.g. conditional cash transfers, vouchers, user fee exemptions, and subsidies for care-seeking). At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured
Stewart, Louis J; Owhoso, Vincent
This article examines the extent of derivative financial instrument use among US nonprofit health systems and the impact of these financial instruments on their cash flows, reported operating results, and financial risks. Our examination is conducted through a case study of New Jersey hospitals and health systems. We review the existing literature on interest rate derivative instruments and US hospitals and health systems. This literature describes the design of these derivative financial instruments and the theoretical benefits of their use by large health care provider organizations. Our contribution to the literature is to provide an empirical evaluation of derivative financial instruments usage among a geographically limited sample of US nonprofit health systems. We reviewed the audited financial statements of the 49 community hospitals and multi-hospital health systems operating in the state of New Jersey. We found that 8 percent of New Jersey's nonprofit health providers utilized interest rate derivatives with an aggregate principle value of $229 million. These derivative users combine interest rate swaps and caps to lower the effective interest costs of their long-term debt while limiting their exposure to future interest rate increases. In addition, while derivative assets and liabilities have an immaterial balance sheet impact, derivative related gains and losses are a material component of their reported operating results. We also found that derivative usage among these four health systems was responsible for generating positive cash flows in the range of 1 percent to 2 percent of their total 2001 cash flows from operations. As a result of our admittedly limited samples we conclude that interest rate swaps and caps are effective risk management tools. However, we also found that while these derivative financial instruments are useful hedges against the risks of issuing long-term financing instruments, they also expose derivative users to credit, contract
Richardson, Thomas; Elliott, Peter; Roberts, Ron; Jansen, Megan
Previous research has shown a relationship between financial difficulties and poor mental health in students, but most research is cross-sectional. To examine longitudinal relationships over time between financial variables and mental health in students. A national sample of 454 first year British undergraduate students completed measures of mental health and financial variables at up to four time points across a year. Cross-sectional relationships were found between poorer mental health and female gender, having a disability and non-white ethnicity. Greater financial difficulties predicted greater depression and stress cross-sectionally, and also predicted poorer anxiety, global mental health and alcohol dependence over time. Depression worsened over time for those who had considered abandoning studies or not coming to university for financial reasons, and there were effects for how students viewed their student loan. Anxiety and alcohol dependence also predicted worsening financial situation suggesting a bi-directional relationship. Financial difficulties appear to lead to poor mental health in students with the possibility of a vicious cycle occurring.
Conradie, Christina Susanna; van der Merwe Smit, Eon; Malan, Daniel Pieter
Objective: The research objective was to test the hypothesis that corporate health and wellness contributed positively to South African companies’ financial results. Methods: The past share market performance of eligible healthy companies, based on Discovery's Healthy Company Index, was tracked under three investment scenarios and compared with the market performance on the basis of the JSE FTSE All Share Index. Results: The evidence supports the hypothesis that a culture of health and wellness provides a financial advantage, in so far as the portfolio of healthy companies consistently outperformed the market over the selected simulations. Conclusions: Given the limitations of the investigation, namely small sample size, the brevity of the period of investigation, and the reliance on accessibility sampling, the research provides the first and preliminary evidence supportive of the direct financial benefits of companies’ wellness programs. PMID:26849271
Meyer, Cynthia; Smith, Michael C
Employers and employees are navigating major changes in health insurance benefits, including the move to high-deductible health plans in conjunction with health savings accounts (HSAs). The HSA offers unique benefits that could prove instrumental in helping workers both navigate current health care expenses and build a nest egg for much larger health care costs in retirement. Yet employees often don't understand the HSA and how to best use it. How can employers help employees make wise benefits choices that work for their personal financial circumstances?
Lavigne, Jill E; Brown, Jack; Matzke, Gary R
The financial and policy levers of population health and potential opportunities for pharmacists are described. Three long-standing problems drive the focus on population health: (1) the United States suffers far worse population health outcomes compared with those of other developed nations that spend significantly less on healthcare, (2) the U.S. healthcare system's focus on "sick care" fails to address upstream prevention and population health improvement, and (3) financial incentives for healthcare delivery are poorly aligned with improvements in population health outcomes. The Patient Protection and Affordable Care Act of 2010 (ACA) was arguably the first major healthcare legislation since 1965 and had 3 main strategies for improving population health: expand health insurance coverage, control healthcare costs, and improve the healthcare delivery system. Federal and state legislation as well as Medicare and Medicaid financing strategies have designated mechanisms to reward advances in population outcomes since the passage of the ACA. States are responsible for many of the factors that affect population health, and a bipartisan effort that builds upon state and federal collaboration will likely be needed to implement the necessary health policy initiative. Population health issues affect productivity in the United States; conversely, improvements in population health may increase productivity, helping to offset the rising federal debt. Employers are in a position to improve population health and consequently help reduce the federal debt by addressing lifestyle, chronic disease, poverty, and inequality. National pharmacy organizations, regulatory bodies, and journal editors need to collectively agree to a threshold of quality and rigor for publication and endorsement. Knowledge of the policy and financial drivers of population health may both support pharmacists' efforts to improve population outcomes and identify opportunities for professional advancement
2007/2008 FASB introduction of FIN 46/R variable interest consolidation model proved revolutionary as it ties up the accounting to the economic/financial frameworks and the judicial one. Legal structures and agreements among stakeholders of entities, creating net assets’ variability, have from now on to be compared with expected losses and expected returns distribution, prior to identify which stakeholder will need to consolidate pursuant this Interpretation. As a result, return variabilit...
Amalia Novoa Hoyos; Mauricio Sabogal Salamanca; Camilo Vargas Walteros
This article shows a first estimate about the relationship between investment in digital media and some financial variables in Colombia. First, a literature review is made about the impact of marketing and digital marketing in Company performance. Then, an analysis of the sectorial variables such as liquidity, profitability, indebtedness and concentration in sectors like food, personal grooming, automotive, drinking and tobacco, construction, entertainment, furniture, services, telecommunicat...
Burgoon, B.; Demetriades, P.; Underhill, G.
We challenge recent findings by Abiad and Mody (2005) which suggest that financial liberalization has little to do with political variables. This analysis is at odds with some of the established literature, and only with difficulty comes to terms with the considerable cross-national variation in the
Since its implementation, unsubstantiated reports indicate increasing health care and administra-tive costs of the various DMHIS across the country without any corresponding increase in the premium level. We sought to assess the financial viability of the DMHIS in Lawra (LDMHIS) and Sissala East (SEDMHIS) districts, ...
Costich, Julia F; Honoré, Peggy A; Scutchfield, F Douglas
The work reported here builds on the identification of public health financial management practice competencies by a national expert panel. The next logical step was to provide a validity check for the competencies and identify priority areas for educational programming. We developed a survey for local public health finance officers based on the public health finance competencies and field tested it with a convenience sample of officials. We asked respondents to indicate the importance of each competency area and the need for training to improve performance; we also requested information regarding respondent education, jurisdiction size, and additional comments. Our local agency survey sample drew on the respondent list from the National Association of County and City Health Officials 2005 local health department survey, stratified by agency size and limited to jurisdiction populations of 25,000 to 1,000,000. Identifying appropriate respondents was a major challenge. The survey was fielded electronically, yielding 112 responses from 30 states. The areas identified as most important and needing most additional training were knowledge of budget activities, financial data interpretation and communication, and ability to assess and correct the organization's financial status. The majority of respondents had some postbaccalaureate education. Many provided additional comments and recommendations. Health department finance officers demonstrated a high level of general agreement regarding the importance of finance competencies in public health and the need for training. The findings point to a critical need for additional training opportunities that are accessible, cost-effective, and targeted to individual needs.
Stubbs, Thomas; Kentikelenis, Alexander
Serving as lender of last resort to countries experiencing unsustainable levels of public debt, international financial institutions have attracted intense controversy over the past decades, exemplified most recently by the popular discontent expressed in Eurozone countries following several rounds of austerity measures. In exchange for access to financial assistance, borrowing countries must settle on a list of often painful policy reforms that are aimed at balancing the budget. This practice has afforded international financial institutions substantial policy influence on governments throughout the world and in a wide array of policy areas of direct bearing on human rights. This article reviews the consequences of policy reforms mandated by international financial institutions on the enjoyment of human rights, focusing on the International Monetary Fund and World Bank. It finds that these reforms undermine the enjoyment of health rights, labour rights, and civil and political rights, all of which have deleterious implications for public health. The evidence suggests that for human rights commitments to be met, a fundamental reorientation of international financial institutions' activities will be necessary.
The main topic of this paper is "information variables" (or "indicators") of monetary policy, which work as criteria for setting the direction of monetary policy. After briefly surveying the notion and candidates of information variables, according to the studies mainly in the United States, empirical tests using Japan's data are conducted. It can be said that some information variables seem to be useful, but the results are mixed in general.
Tucker-Seeley, Reginald D; Harley, Amy E; Stoddard, Anne M; Sorensen, Glorian G
Self-rated health (SRH) has been shown to be predictive of morbidity and mortality. Evidence also shows that SRH is socioeconomically patterned, although this association differs depending on the indicator of socioeconomic status used. The purpose of this study was to determine the association between SRH and financial hardship among residents of low-income housing. We analyzed cross-sectional data from the Health in Common Study (N = 828), an observational study to investigate social and physical determinants of cancer risk-related behaviors among residents of low-income housing in three cities in the Boston metropolitan area. Modified Poisson regression models were used to obtain the relative risk of low SRH (fair or poor), adjusting for demographic and socioeconomic characteristics. Unadjusted models revealed that the respondents reporting financial hardship were 53% more likely to report low SRH compared with those not reporting financial hardship. After controlling for demographic characteristics, socioeconomic characteristics, and psychological distress, the results showed that those reporting financial hardship were 44% more likely to report low SRH. Our results suggest that financial hardship is a robust predictor of SRH; and over and above the influence of demographic and traditional socioeconomic indicators, and even psychological distress, financial hardship remains strongly associated with low SRH. Additional research needs to be conducted to further elucidate this pathway and to better understand the determinants of variability in financial hardship among low-income housing residents to ensure the most appropriate policy levers (e.g., housing-related policy, food-related policy) are chosen to improve health outcomes in this population.
Jordan, S; von der Lippe, E; Starker, A; Hoebel, J; Franke, A
The statutory health insurance can offer their insured incentive programmes that will motivate for healthy behaviour through a financial or material reward. This study will show results about what factors influence financial incentive programme participation (BPT) including all sorts of statutory health insurance funds and taking into account gender differences. For the cross-sectional analysis, data were used from 15,858 participants in the study 'Germany Health Update' (GEDA) from 2009, who were insured in the statutory health insurance. The selection of potential influencing variables for a BPT is based on the "Behavioural Model for Health Service Use" of Andersen. Accordingly, various factors were included in logistic regression models, which were calculated separately by gender: predisposing factors (age, education, social support, and health awareness), enabling factors (income, statutory health insurance fund, and family physician), and need factors (smoking, fruit and vegetable consumption, sports, body mass index, and general health status). In consideration of all factors, for both sexes, BPT is associated with age, health awareness, education, use of a family physician, smoking, and sports activities. In addition, income, body mass index, and diet are significant in women and social support and kind of statutory health insurance fund in men. It is found that predisposing, enabling and need factors are relevant. Financial incentive programmes reach population groups with greatest need less than those groups who already have a health-conscious behaviour, who receive a reward for this. In longitudinal studies, further research on financial incentive programmes should investigate the existence of deadweight effects and whether incentive programmes can contribute to the reduction of the inequity in health. © Georg Thieme Verlag KG Stuttgart · New York.
Shippee, Nathan D; Shippee, Tetyana P; Hess, Erik P; Beebe, Timothy J
Emergency department (ED) use is costly, and especially frequent among publicly insured populations in the US, who also disproportionately encounter financial (cost/coverage-related) and non-financial/practical barriers to care. The present study examines the distinct associations financial and non-financial barriers to care have with patterns of ED use among a publicly insured population. This observational study uses linked administrative-survey data for enrollees of Minnesota Health Care Programs to examine patterns in ED use-specifically, enrollee self-report of the ED as usual source of care, and past-year count of 0, 1, or 2+ ED visits from administrative data. Main independent variables included a count of seven enrollee-reported financial concerns about healthcare costs and coverage, and a count of seven enrollee-reported non-financial, practical barriers to access (e.g., limited office hours, problems with childcare). Covariates included health, health care, and demographic measures. In multivariate regression models, only financial concerns were positively associated with reporting ED as usual source of care, but only non-financial barriers were significantly associated with greater ED visits. Regression-adjusted values indicated notable differences in ED visits by number of non-financial barriers: zero non-financial barriers meant an adjusted 78% chance of having zero ED visits (95% C.I.: 70.5%-85.5%), 15.9% chance of 1(95% C.I.: 10.4%-21.3%), and 6.2% chance (95% C.I.: 3.5%-8.8%) of 2+ visits, whereas having all seven non-financial barriers meant a 48.2% adjusted chance of zero visits (95% C.I.: 30.9%-65.6%), 31.8% chance of 1 visit (95% C.I.: 24.2%-39.5%), and 20% chance (95% C.I.: 8.4%-31.6%) of 2+ visits. Financial barriers were associated with identifying the ED as one's usual source of care but non-financial barriers were associated with actual ED visits. Outreach/literacy efforts may help reduce reliance on/perception of ED as usual source of care
Mathauer, Inke; Musango, Laurent; Sibandze, Sibusiso; Mthethwa, Khosi; Carrin, Guy
The Government of Swaziland decided to explore the feasibility of social health insurance (SHI) in order to enhance universal access to health services. We assess the financial feasibility of a possible SHI scheme in Swaziland. The SHI scenario presented is one that mobilises resources additional to the maintained Ministry of Health and Social Welfare (MOHSW) budget. It is designed to increase prepayment, enhance overall health financing equity, finance quality improvements in health care, and eventually cover the entire population. The financial feasibility assessment consists of calculating and projecting revenues and expenditures of the SHI scheme from 2008 to 2018. SimIns, a health insurance simulation software, was used. Quantitative data from government and other sources and qualitative data from discussions with health financing stakeholders were gathered. Policy assumptions were jointly developed with and agreed upon by a MOHSW team. SHI would take up an increasing proportion of total health expenditure over the simulation period and become the dominant health financing mechanism. In principle, and on the basis of the assumed policy variables, universal coverage could be reached within 6 years through the implementation of an SHI scheme based on a mix of contributory and tax financing. Contribution rates for formal sector employees would amount to 7% of salaries and the Ministry of Health and Social Welfare budget would need to be maintained. Government health expenditure including social health insurance would increase from 6% in 2008 to 11% in 2018.
Kern, Lisa M; Wilcox, Adam; Shapiro, Jason; Dhopeshwarkar, Rina V; Kaushal, Rainu
The financial effects of electronic health records (EHRs) and health information exchange (HIE) are largely unknown, despite unprecedented federal incentives for their use. We sought to understand which components of EHRs and HIE are most likely to drive financial savings in the ambulatory, inpatient, and emergency department settings. Framework development and a national expert panel. We searched the literature to identify functionalities enabled by EHRs and HIE across the 3 healthcare settings. We rated each of 233 functionality-setting combinations on their likelihood of having a positive financial effect. We validated the top-scoring functionalities with a panel of 28 national experts, and we compared the high-scoring functionalities with Stage 1 meaningful use criteria. We identified 54 high-scoring functionality- setting combinations, 27 for EHRs and 27 for HIE. Examples of high-scoring functionalities included providing alerts for expensive medications, providing alerts for redundant lab orders, sending and receiving imaging reports, and enabling structured medication reconciliation. Of the 54 high-scoring functionalities, 25 (46%) are represented in Stage 1 meaningful use. Many of the functionalities not yet represented in meaningful use correspond with functionalities that focus directly on healthcare utilization and costs rather than on healthcare quality per se. This work can inform the development and selection of future meaningful use measures; inform implementation efforts, as clinicians and hospitals choose from among a "menu" of measures for meaningful use; and inform evaluation efforts, as investigators seek to measure the actual financial impact of EHRs and HIE.
Kutin, Jozica; Russell, Roslyn; Reid, Mike
Economic abuse is a form of domestic violence that has a significant impact on the health and financial wellbeing of victims, but is understudied. This study determined the lifetime prevalence of economic abuse in Australia by age and gender, and the associated risk factors. The 2012 ABS Personal Safety Survey was used, involving a cross-sectional population survey of 17,050 randomly selected adults using face-to-face interviews. The survey-weighted prevalence of economic abuse was calculated and analysed by age and gender. Logistic regression was used to adjust odds ratios for possible confounding between variables. The lifetime prevalence of economic abuse in the whole sample was 11.5%. Women in all age groups were more likely to experience economic abuse (15.7%) compared to men (7.1%). Disability, health and financial stress status were significant markers of economic abuse. For women, financial stress and disability were important markers of economic abuse. However, prevalence rates were influenced by the measures used and victims' awareness of the abuse, which presents a challenge for screening and monitoring. Implications for public health: Social, health and financial services need to be aware of and screen for the warning signs of this largely hidden form of domestic violence. © 2017 The Authors.
Peipert, Benjamin J; Goswami, Sneha; Helenowski, Irene; Yount, Susan E; Sturgeon, Cord
Health-related quality of life and financial burden among patients with multiple endocrine neoplasia type 1 is poorly described. It is not known how financial burden influences health-related quality of life in this population. We hypothesized that the financial burden attributable to multiple endocrine neoplasia type 1 is associated with worse health-related quality of life. United States adults (≥18 years) with multiple endocrine neoplasia type 1 were recruited from the AMENSupport MEN online support group. Patient demographics, clinical characteristics, and financial burden were assessed via an online survey. The instrument Patient-Reported Outcomes Measurement Information System 29-item profile measure was used to assess health-related quality of life. Multivariable linear regression was used to identify significant variables in each Patient-Reported Outcomes Measurement Information System domain. Out of 1,378 members in AMENSupport, our survey link was accessed 449 times (33%). Of 153 US respondents who completed our survey, 84% reported financial burden attributable to multiple endocrine neoplasia type 1. The degree of financial burden had a linear relationship with worse health-related quality of life across all Patient-Reported Outcomes Measurement Information System domains (r = 0.36-0.55, P financial event(s). Borrowing money from friends/family (30%), unemployment (13%), and spending >$100/month out-of-pocket on prescription medications (46%) were associated consistently with impaired health-related quality of life (ß = 3.75-6.77, P times more likely to be unemployed and declare bankruptcy than the US population, respectively. This study characterizes the financial burden in patients with multiple endocrine neoplasia type 1. Individuals with multiple endocrine neoplasia type 1 report a high degree of financial burden, negative financial events, and unemployment. Each of these factors was associated with worse health-related quality of life
Krech, Rüdiger; Kickbusch, Ilona; Franz, Christian; Wells, Nadya
The world faces multiple health financing challenges as the global health burden evolves. Countries have set an ambitious health policy agenda for the next 15 years with prioritisation of universal health coverage under the Sustainable Development Goals. The scale of investment needed for equitable access to health services means global health is one of the key economic opportunities for decades to come. New financing partnerships with the private sector are vital. The aim of this study is to unlock additional financing sources, acknowledging the imperative to link financial returns to the providers of capital, and create profitable, sustainable financing structures. This paper outlines the global health investment opportunity exploring intersections of financial and health sector interests, and the role investment in health can play in economic development. Considering increasing demand for impact investments, the paper explores responsible financing initiatives and expansion of the global movement for sustainable capital markets. Adding an explicit health component (H) to the Environmental, Social and Governance (ESG) investment criteria, creating the ESG+H initiative, could serve as catalyst for the inclusion of health criteria into mainstream financial actors' business practices and investment objectives. The conclusion finds that health considerations directly impact profitability of the firm and therefore should be incorporated into financial analysis. Positive assessment of health impact, at a broad societal or environmental level, as well as for a firm's employees can become a value enhancing competitive advantage. An ESG+H framework could incorporate this into mainstream financial decision-making and into scalable investment products.
Albertus Girik Allo
Full Text Available Institution has been investigated having indirect role on economic growth. This paper aims to evaluate whether the quality of institution matters for economic growth. By applying institution as instrumental variable at Foreign Direct Investment (FDI, quality of institution significantly influence economic growth. This study applies two set of data period, namely 1985-2013 and 2000-2013, available online in the World Bank (WB. The first data set, 1985-2013 is used to estimate the role of financial sector on economic growth, focuses on 67 countries. The second data set, 2000-2013 determine the role of institution on financial sector and economic growth by applying 2SLS estimation method. We define institutional variables as set of indicators: Control of Corruption, Political Stability and Absence of Violence, and Voice and Accountability provide declining impact of FDI to economic growth.
Shen, Jay J; Ginn, Gregory O
Financial barriers are a major factor of slow electronic health record (EHR) adoption among US hospitals. All existing literature focuses on relationships between current or short-term financial position and EHR adoption. This study examines relationship between financial position in previous years and the current level of EHR adoption. Retrospective longitudinal data were extracted from (1) the 2009 American Hospital Association (AHA) EHR implementation survey; (2) the 2002 and 2006 Centers for Medicare & Medicaid Cost Reports; and (3) the 2002 and 2006 AHA Annual Survey containing organizational and operational data. The final sample was 2,701 acute care hospitals in the United States. General ordinal logistic regression was used for data analysis with a three-level dependent variable to measure adoption, five independent variables to measure financial position, and 11 control variables to measure structure and environment. For 2006, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover was significantly and negatively associated with EHR adoption. For 2002, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover and higher equity multiplier were both significantly and negatively associated with EHR adoption. In addition, lower net days revenue in accounts receivable was significantly and positively associated with EHR adoption. For both the 2002 and 2006 control variables, human resource intensity and bed size were significant and positively related to adoption, and percentage Medicare patients and investor ownership were significant and negatively related to adoption. Financial position does relate to EHR adoption in mid-term and long-term planning.
Oliver, Adam; Brown, Lawrence D
Health inequalities and user financial incentives to encourage health-related behavior change are two topical issues in the health policy discourse, and this article attempts to combine the two; namely, we try to address whether the latter can be used to reduce the former in the contexts of the United Kingdom and the United States. Payments for some aspects of medical adherence may offer a promising way to address, to some extent, inequalities in health and health care in both countries. However, payments for more sustained behavior change, such as that associated with smoking cessation and weight loss, have thus far shown little long-term effect, although more research that tests the effectiveness of different incentive mechanism designs, informed by the findings of behavioral economics, ought to be undertaken. Many practical, political, ethical, and ideological objections can be waged against user financial incentives in health, and this article reviews a number of them, but the justifiability of and limits to these incentives require more academic and public discourse so as to gain a better understanding of the circumstances in which they can legitimately be used.
Amalia Novoa Hoyos
Full Text Available This article shows a first estimate about the relationship between investment in digital media and some financial variables in Colombia. First, a literature review is made about the impact of marketing and digital marketing in Company performance. Then, an analysis of the sectorial variables such as liquidity, profitability, indebtedness and concentration in sectors like food, personal grooming, automotive, drinking and tobacco, construction, entertainment, furniture, services, telecommunication, tourism and clothing using the technique of ordinary squared minimums (OSM in the years 2011, 2012, 2013 and 2014. For this study, investment in digital media in the above- mentioned years is also taken into account.
Full Text Available The financial sustainability of the health systems often reveals the ability of policy makers to finance healthcare in the face of growing cost pressures, with populations ageing, new technologies and increased patient expectations for healthcare coverage and quality. Thus, the healthcare systems need to reinvent themselves by using innovative financing mechanisms coupled with electronic information and communication systems, while offering greater transparency, flexibility and choice and increasing access to the services available. The paper analyses the healthcare financing models: the national health system, the social insurance or the private insurance model so that the Romanian health care reform should preserve the best elements of its existing system while selectively adapt techniques and processes that seemed to have been successful in other countries. Moreover, the application of information and communication technologies – eHealth offers new possibilities for improving almost every aspect of healthcare, from making medical systems more powerful and responsive to providing better health information to all.
Higher Education Funding Council for England, 2016
This report provides an overview of the financial health of the Higher Education Funding Council for England (HEFCE) funded higher education sector in England. The analysis covers the financial results for 2015-16. This does not include further education or sixth-form colleges, or alternative providers of higher education.
Higher Education Funding Council for England, 2015
This report provides an overview of the financial health of the Higher Education Funding Council for England (HEFCE)-funded higher education sector in England. The analysis covers financial results for the academic year 2013-14, as submitted to HEFCE in December 2014, as well as the outcomes from the sector's Transparent Approach to Costing (TRAC)…
Huston, Sandra J.
In the article, "Enhancing links between research and practice to improve consumer financial education and well-being" Billy J. Hensley, Director of Education at National Endowment for Financial Education® (NEFE®), outlines his perspective on the current relation between financial education and financial outcome (downstream financial…
Bennett, Kevin J; Dismuke, Clara E
High out-of-pocket expenditures for health care can put individuals and families at financial risk. Several groups, including racial/ethnic minority groups, the uninsured, rural residents, and those in poorer health are at risk for this increased burden. The analysis utilized 2004-2005 MEPS data. The dependent variables were the out-of-pocket health care spending to total income ratios for total spending, office-based visits, and prescription drugs. Multivariate analyses with instrumental variables controlled for respondent characteristics. Gender, age, rurality, insurance coverage, health status, and health care utilization were all associated with higher out-of-pocket to income ratios. Certain groups, such as women, the elderly, those in poor health, and rural residents, are at a greater financial risk due to their higher out-of-pocket to total income spending ratios. Policymakers must be aware of these increased risks in order to provide adequate resources and targeted interventions to alleviate some of this burden.
SHI would take up an increasing proportion of total health expenditure over the simulation period and become the dominant health financing mechanism. In principle, and on the basis of the assumed policy variables, universal coverage could be reached within 6 years through the implementation of an SHI scheme based ...
Kotelchuck, Ronda; Lowenstein, Daniel; Tobin, Jonathan N
Community health centers and community development financial institutions share similar origins and missions and are increasingly working together to meet community needs. Addressing the social and economic determinants of health is a common focus. The availability of new federal grants and tax credits has led these financial institutions to invest in the creation and expansion of community health centers. This article reviews the most recent trends in these two sectors and explores opportunities for further collaboration to transform the health and well-being of the nation's low-income communities.
Ju, Brian L; Miller, Christopher P; Whang, Peter G; Grauer, Jonathan N
In recent years, greater attention has been directed toward determining how potential financial conflicts of interest may affect the integrity of biomedical research. To address this issue, various disclosure policies have been adopted in an attempt to increase the transparency of this process. However, the consistency of such reporting among spine surgeons remains unknown. This study quantifies the variability in the self-reported disclosures of individual authors presenting at multiple spine conferences during the same year. The author disclosure information published for the 2008 North American Spine Society (NASS), Cervical Spine Research Society (CSRS), and Scoliosis Research Society (SRS), conferences were compiled into a database. We evaluated the disclosure policy for each society and compared the disclosure listings of authors who presented at more than one of these meetings. Disclosure records were available for 1,231 authors at NASS, 550 at CSRS, and 642 at SRS. Of these individuals, 278 (NASS), 129 (CSRS), and 181 (SRS) presented at one of the other conferences and 40 presented at all three conferences. North American Spine Society and CSRS required disclosure of all financial relationships, whereas SRS only requested disclosures pertinent to authors' presentations. Of the 153 authors who presented at the NASS and CSRS meetings, 51% exhibited discrepancies in their disclosure information. In contrast, only 9% of the 205 individuals whose data was listed at both the NASS and SRS conferences demonstrated irregularities. Similarly, 18% of the 56 authors who had provided information to both CSRS and SRS were inconsistent in their reporting. These findings emphasize the significant variability that currently exists in the reporting of financial conflicts of interest by authors who presented at three major spine conferences within the past year. We believe these discrepancies are likely because of confusion regarding what relationships should be acknowledged
McCue, Michael J
The aim of this study was to assess the performance of health plans sponsored by provider organizations, with respect to plans generating strong positive cash flow relative to plans generating weaker cash flow. A secondary aim was to assess their capital adequacy. The study identified 24 provider-sponsored health plans (PSHPs) with an average positive cash flow margin from 2011 through 2013 at or above the top 75th percentile, defined as "strong cash flow PSHPs:" This group was compared with 72 PSHPs below the 75th percentile, defined as "weak cash flow PSHPs:" Atlantic Information Services Directory of Health Plans was used to identify the PSHPs. Financial ratios were computed from 2013 National Association of Insurance Commissioners Financial Filings. The study conducted a t test mean comparison between strong and weak cash flow PSHPs across an array of financial performance and capital adequacy measures. In 2013, the strong cash flow PSHPs averaged a cash-flow margin ratio of 6.6%. Weak cash flow PSHPs averaged a cash-flow margin of -0.4%. The net worth capital position of both groups was more than 4.5 times authorized capital. The operational analysis shows that strong cash-flow margin PSHPs are managing their medical costs to achieve this position. Although their medical loss ratio increased by almost 300 basis points from 2011 to 2013, it was still statistically significantly lower than the weaker cash flow PSHP group (P<.001). In terms of capital adequacy, both strong and weak cash-flow margin PSHP groups possessed sufficient capital to ensure the viability of these plans.
O'Hare, B; Curtis, M
This analysis examines the gaps in health care financing in Malawi and how foregone taxes could fill these gaps. It begins with an assessment of the disease burden and government health expenditure. Then it analyses the tax revenues foregone by the government of Malawi by two main routes: Illicit financial flows (IFF) from the country, Tax incentives. We find that there are significant financing gaps in the health sector; for example, government expenditure is United States Dollars (USD) 177 million for 2013/2014 while projected donor contribution in 2013/2014 is USD 207 million and the total cost for the minimal health package is USD 535 million. Thus the funding gap between the government budget for health and the required spending to provide the minimal package for 2013/2014 is USD 358 million. On the other hand we estimate that almost USD 400 million is lost through IFF and corporate utilization of tax incentives each year. The revenues foregone plus the current government health spending would be sufficient to cover the minimal public health package for all Malawians and would help tackle Malawi's disease burden. Every effort must be made, including improving transparency and revising laws, to curtail IFF and moderate tax incentives.
Kickbusch, Ilona; Franz, Christian; Wells, Nadya
The world faces multiple health financing challenges as the global health burden evolves. Countries have set an ambitious health policy agenda for the next 15 years with prioritisation of universal health coverage under the Sustainable Development Goals. The scale of investment needed for equitable access to health services means global health is one of the key economic opportunities for decades to come. New financing partnerships with the private sector are vital. The aim of this study is to unlock additional financing sources, acknowledging the imperative to link financial returns to the providers of capital, and create profitable, sustainable financing structures. This paper outlines the global health investment opportunity exploring intersections of financial and health sector interests, and the role investment in health can play in economic development. Considering increasing demand for impact investments, the paper explores responsible financing initiatives and expansion of the global movement for sustainable capital markets. Adding an explicit health component (H) to the Environmental, Social and Governance (ESG) investment criteria, creating the ESG+H initiative, could serve as catalyst for the inclusion of health criteria into mainstream financial actors’ business practices and investment objectives. The conclusion finds that health considerations directly impact profitability of the firm and therefore should be incorporated into financial analysis. Positive assessment of health impact, at a broad societal or environmental level, as well as for a firm’s employees can become a value enhancing competitive advantage. An ESG+H framework could incorporate this into mainstream financial decision-making and into scalable investment products. PMID:29736278
Monson, Samantha Pelican; Sheldon, J Christopher; Ivey, Laurie C; Kinman, Carissa R; Beacham, Abbie O
The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.
Macinati, Manuela S; Anessi-Pessina, E
Reforms of the public health-care sector have emphasised the role of management accounting (MA). However, there is little systematic evidence on its use and benefits. To fill this gap, we propose a contingency-based model which addresses three related issues, that is, whether: (i) MA use is influenced by contextual variables and MA design; (ii) top-management satisfaction with MA mediates the relationship between MA design and MA use; and (iii) financial performance is influenced by MA use. A questionnaire was mailed out to all Italian public health-care organisations. Structural equation modelling was performed to validate the research hypotheses. The response rate was 49%. Our findings suggest that: (i) cost-containment strategies encourage more sophisticated MA designs; (ii) MA use is directly and indirectly influenced by contingency, organisational, and behavioural variables; (iii) a weakly significant positive relationship exists between MA use and financial performance. These findings are relevant from the viewpoint of both top managers and policymakers. The former must make sure that MA is not only technically advanced, but also properly understood and appreciated by users. The latter need to be aware that MA may improve performance in ways and along dimensions that may not fully translate into better financial results. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Patel, Minal R; Caldwell, Cleopatra H; Song, Peter X K; Wheeler, John R C
Given the complexity of the health insurance market in the United States and the confusion that often stems from these complexities, patient perception about the value of health insurance in managing chronic disease is important to understand. To examine differences between public and private health insurance in perceptions of financial burden with managing asthma, outcomes, and factors that explain these perceptions. Secondary analysis was performed using baseline data from a randomized clinical trial that were collected through telephone interviews with 219 African American women seeking services for asthma and reporting perceptions of financial burden with asthma management. Path analysis with multigroup models and multiple variable regression analyses were used to examine associations. For public (P financial burden through different explanatory pathways. When adjusted for multiple morbidities, asthma control, income, and out-of-pocket expenses, those with private insurance used fewer inpatient (P financial burden was associated with more urgent office visits (P financial burden regardless of health insurance report more urgent health care visits and lower quality of life. Burden may be present despite having and being able to generate economic resources and health insurance. Further policy efforts are indicated and special attention should focus on type of coverage. Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Bailit, Howard L; Devitto, Judy; Myne-Joslin, Ronnie; Beazoglou, Tryfon; McGowan, Taegan
Federally Qualified Health Center (FQHC) dental clinics are a major component of the dental safety net system, providing care to 3.75 million patients annually. This study describes the financial and clinical operations of a sample of FQHCs. In cooperation with the National Network for Oral Health Access, FQHC dental clinics that could provide 12 months of electronic dental record information were asked to participate in the study. Based on data from 28 dental clinics (14 FQHCs), 50 percent of patients were under 21 years of age. The primary payers were Medicaid (72.4 percent) and sliding-scale/self-pay patients (17.5 percent). Sites averaged 3.1 operatories, 0.66 dental hygienists, and 1.9 other staff per dentist. Annually, each FTE dentist and hygienist provided 2,801 and 2,073 patient visits, respectively. Eighty percent of services were diagnostic, preventive, and restorative. Patient care accounted for 82 percent of revenues, and personnel (64.2 percent) and central administration (13.4 percent) accounted for most expenses. Based on a small convenience sample of FQHC dental clinics, this study presents descriptive data on their clinical and financial operations. Compared with data from the UDS (Uniform Data System) report, study FQHCs were larger in terms of space, staff, and patients served. However, there was substantial variation among clinics for almost all measures. As the number and size of FQHC dental clinics increase, the Health Resources and Services Administration needs to provide them access to comparative data that they can use to benchmark their operations. © 2013 American Association of Public Health Dentistry.
Zakariah, Sahidah; Pyeman, Jaafar; Ghazali, Rahmat; Rahman, Ibrahim A.; Rashid, Ahmad Husni Mohd; Shamsuddin, Sofian
The primary concern of this study is to analyse the impact against macroeconomic variables upon the financial performance, particularly in the case of public listed logistics companies in Malaysia. This study incorporated five macroeconomic variables and four proxies of financial performance. The macroeconomic variables selected are gross domestic product (GDP), total trade (XM), foreign direct investment (FDI), inflation rate (INF), and interest rate (INT). This study is extended to the usage of ratio analysis to predict financial performance in relation to the changes upon macroeconomic variables. As such, this study selected four (4) ratios as proxies to financial performance, which is Operating Profit Margin (OPM), Net Profit Margin (NPM), Return on Asset (ROA), Return on Equity (ROE). The findings of this study may appear non-controversial to some, but it resulted in the following important consensus; (1) GDP is found to be highly impacting NPM and least of ROA, (2) XM has high positive impact on OPM and least on ROE, (3) FDI appear to have insignificant impact towards NPM, and (4) INF and INT show similar negative impact on financial performance, precisely highly negative on OPM and least on ROA. Such findings also conform to the local logistic industry settings, specifically in regards to public listed logistics companies in relation to its financial performance.
Wheeler, J R; Smith, D G
To understand better the financial management practices and strategies of modern health care organizations, we conducted interviews with chief financial officers (CFOs) of several leading health care systems. The constraints imposed on health care systems by both capital and product markets has made the role of the CFO a challenge.
Conclusions: Results suggest that in late life longitudinal negative changes in perceptions of financial wellbeing may occur together with decreases levels of self-reported health. Future research on health inequalities in elderly should pay specific attention to the link between financial wellbeing and health from a self-reported perspective.
Issel, L Michele; Olorunsaiye, Comfort; Snebold, Laura; Handler, Arden
We explored the relationships between local health department (LHD) structure, capacity, and macro-context variables and performance of essential public health services (EPHS). In 2012, we assessed a stratified, random sample of 195 LHDs that provided data via an online survey regarding performance of EPHS, the services provided or contracted out, the financial strategies used in response to budgetary pressures, and the extent of collaborations. We performed weighted analyses that included analysis of variance, pairwise correlations by jurisdiction population size, and linear regressions. On average, LHDs provided approximately 13 (36%) of 35 possible services either directly or by contract. Rather than cut services or externally consolidating, LHDs took steps to generate more revenue and maximize capacity. Higher LHD performance of EPHS was significantly associated with delivering more services, initiating more financial strategies, and engaging in collaboration, after adjusting for the effects of the Affordable Care Act and jurisdiction size. During changing economic and health care environments, we found that strong structural capacity enhanced local health department EPHS performance for maternal, child, and adolescent health.
Full Text Available Providing sufficient financial accessibility to low-income individuals is considered a way to decrease income inequality and could be a key factor in sustainable economic growth. To make the financial accessibility policy more effective, analyses of individuals’ understanding of financial risk within low-income groups need to be conducted. The current authors investigated individuals’ attitudes towards loan financial risk in terms of gender difference. Using South Korean survey data, we examined the relationship between gender and attitude towards loan financial risk with a regression analysis. We found that within a low-income group, males were more willing to pay higher interest rates than females. In addition, males’ willingness to pay high interest rates became stronger when their current financial costs were high. The results indicate that males are less careful with the risks that high interest rates can bring. Thus, the results imply that interventions, such as more substantial financial education, are required for males to make financial accessibility polices more effective.
The aim of this study is to document financial compliance to WHO reform of WHO Zambia with government. Methods: This was a desk review of financial activities from the WHO country office from January to December 2015. Findings and recommendations from the November 2015 External Audit conducted on the financial ...
Howard, L M
By direct consulation and review of published sources, a study of 16 selected official sources of international financial cooperation was conducted over the August 1979 to August 1980 period in order to assess the policies, programs, and prospects for support of established international health goals. This study demonstrated that approximately 90% of the external health sector funds are provided via development oriented agencies. The major agencies providing such assistance concur that no sector, including health, should be excluded "a priori," providing that the requesting nation conveys its proposals through the appropriate national development planning authority. The agencies in the study also were found to be supporting health related programs in all the geographic regions of the World Health Organization (WHO). An associated review of 30 external funding agencies revealed that only 5 reported providing health assistance in more than half of the countries where they provided assistance for general development purposes. Interviewed sources attributed this to the limited manner in which health proposals have been identified, prepared, and forwarded (with national development authority approval) to international agencies. In 1979 concessional development financing totaled approximately US$29.9 billion, US$24.2 billion being provided by 17 major industrial nations, US$4.7 billion by Organization of Petroleum Exporting (OPEC) countries, and less than US$1 billion by the countries of Eastern Europe. Approximately 2/3 of such concessional financing is administered bilaterally, only 1/3 passing through multilateral institutions. UN agencies receive only 12% of these total concessional development financing resources. In 1979, concessional funding for health totaled approximately US$3 billion, approximately 1/10 of which was administered by WHO and its regional offices. It is anticipated that future international funding for health in developing countries will continue
Han, S Duke; Boyle, Patricia A; James, Bryan D; Yu, Lei; Bennett, David A
Literacy is an important determinant of financial and health outcomes in old age, and cognitive decline has been linked with lower literacy. We tested the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial and health literacy. Participants (n = 730) from the Rush Memory and Aging Project were given a clinical evaluation and an assessment of total, financial, and health literacy. Regression was used to examine whether MCI was associated with lower literacy. In secondary analyses, we investigated the association of particular cognitive systems with literacy. MCI was associated with lower total, financial, and health literacy. An interaction was observed such that higher education reduced the effect of MCI on total and financial literacy. Multiple cognitive systems were associated with literacy in participants with MCI, and semantic memory accounted for the most variance. Persons with MCI exhibit poorer financial and health literacy, and education mitigates this effect. © The Author(s) 2015.
Jadhav, Emmanuel D; Holsinger, James W; Mays, Glen; Fardo, David
The delivery of programs by local health departments (LHDs) has shifted from "if we do not have the money we don't do it" to LHD directors should "identify and fund public health priorities." This shift has subsequently increased performance expectations of LHD leaders. In the for-profit sector the leaders' failure to perform has resulted in a shortening tenure trend. Tenure is a proxy for human capital accumulation. In LHDs, the nature of association, if any, between leader tenure and agency performance is unknown. Examine association between financial performance of LHDs with short-, average-, and long-tenured LHD leaders. Variation in leader characteristics and percent change in expenditure were examined using a longitudinal cohort design and positive deviance methodology. Bivariate analysis of LHD financial performance and leader characteristics was conducted, and a logistic regression model was developed to test association between leader tenure and LHDs that experienced a positive percentage expenditure change. From a total of 2523 LHDs, 1453 were examined. The cross-sectional surveys of US public health agencies conducted by the National Association of County and City Health Officials in 2008 and 2010 contain the leader and LHD variables. Approximately 44% of LHDs experienced a positive percentage expenditure change. Leader tenure, age, gender, and education status were significantly associated with a positive percentage expenditure change using a chi-square test of independence. From the logistic regression analysis tenure, educational status, employment status, area population, governance, classification, and jurisdiction were statistically significant. Local health departments with leaders whose tenure was less than 2 years were less likely than those with average tenure to experience a positive percentage expenditure change. The odds ratios for tenure suggest that tenure is positively associated up to a threshold level and then declines. Implying that
Yoshino, Koichi; Suzuki, Seitaro; Ishizuka, Yoichi; Takayanagi, Atsushi; Sugihara, Naoki; Kamijyo, Hideyuki
The aim was to assess subjective oral health symptoms and job stress, as measured by self-assessment of how demanding the job is, in male financial workers. The participants were recruited by applying screening procedures to a pool of Japanese registrants in an online database. For the stress check, 7 items about how demanding the job is were selected from The Brief Job Stress Questionnaire (BJSQ). Participants comprised a total of 950 financial male workers, ages 25 to 64. Participants who answered "I can't complete my work in the required time" had more decayed teeth (p=0.010). Participants who felt that their job is highly demanding (answered affirmatively to 6 or all 7 items) were more likely to report "often get food stuck between teeth" (p=0.030), "there are some foods I can't eat" (p=0.005), "bad breath" (p=0.032), and "jaw makes clicking sound" (p=0.032). The independent variable of total stress score of 24-28 was found to be correlated to at least three oral health symptoms (OR: 3.25; 95%CI: 1.66-6.35). These results indicate that certain job stress factors are associated with certain oral health symptoms, and that oral health symptoms are likely predictors of job stress.
Patel, Minal R; Kruger, Daniel J; Cupal, Suzanne; Zimmerman, Marc A
Little is known about the role of positive financial behaviors (behaviors that allow maintenance of financial stability with financial resources) in mitigating cost-related nonadherence (CRN) to health regimens. This study examined the relationships between positive financial behaviors, financial stress, and CRN. Data came from the 2011 Speak to Your Health! Community Survey (n = 1,234). Descriptive statistics were computed to examine financial stress and CRN, by chronic condition and health insurance status. We used multivariate logistic regression models to examine the relationship between positive financial behaviors and financial stress and their interaction on a composite score of CRN, controlling for health insurance status, educational level, age, marital status, number of chronic conditions, and employment status. Thirty percent of the sample engaged in CRN. Participants reported moderate financial stress (mean, 13.85; standard deviation [SD] = 6.97), and moderate positive financial behavior (mean, 8.84; SD = 3.24). Participants with employer-sponsored insurance, Medicaid, Medicare, the Genesee Health Plan, high blood pressure, asthma, and diabetes had the highest proportion of CRN. The relationship between financial stress and CRN was not significantly different between those who reported lower versus higher levels of positive financial behavior (P = .32). Greater financial stress was associated with a greater likelihood of CRN (odds ratio [OR] = 2.49; 95% confidence interval [CI], 2.08-2.99). Higher level of positive financial behavior was associated with a lower likelihood of CRN (OR = 0.80; 95% CI, 0.67-0.94). Financial literacy as a means of promoting positive financial behavior may help reduce CRN. An intervention strategy focused on improving financial literacy may be relevant for high-risk groups who report high levels of financial stress.
Honoré, Peggy A; Clarke, Richard L; Mead, Dean Michael; Menditto, Susan M
Financial transparency is based on concepts for valid, standardized information that is readily accessible and routinely disseminated to stakeholders. While Congress and others continuously ask for an accounting of public health investments, transparency remains an ignored concept. The objective of this study was to examine financial transparency practices in other industries considered as part of the public health system. Key informants, regarded as financial experts on the operations of hospitals, school systems, and higher education, were a primary source of information. Principal findings were that system partners have espoused some concepts for financial transparency beginning in the early 20th century--signifying an 80-year implementation gap for public health. Critical features that promote accountability included standardized data collection methods and infrastructures, uniform practices for quantitative analysis of financial performance, and credentialing of the financial management workforce. Recommendations are offered on the basis of these findings to aid public health to close this gap by framing a movement toward transparency.
Gingerich, Stefan B; Anderson, David R; Koland, Heidi
To examine the impact of financial incentives on behavior change program registration, completion, and risk improvement rates. Retrospective cohort study conducted to observe the relationship between financial incentives and behavior change program registration, completion, and risk improvement rates. Large public- or private-sector employers. Twenty-four organizations (n = 511,060 eligible employees) that offered comprehensive worksite health promotion (WHP) programs. Financial incentives offered for completion of a behavior change program as part of a WHP program. Behavior change program registration and completion data were obtained from standard reports. Company-level risk change was calculated from the average per-person number of risks on baseline and follow-up health risk assessments. Incentive design was determined from questionnaires completed by WHP program managers. Average registration rates, program completion rates, and risk improvement rates were compared using t-tests for companies that did versus did not offer incentives. Comparisons were also made between companies with incentives of less than $100 and those with incentives of $100 or more. Correlations between incentive value and outcome variables were assessed using Pearson correlations. Companies that offered incentives had significantly higher health coaching completion rates than companies not offering an incentive (82.9% vs. 76.4%, respectively, p = .017) but there was no significant association with registration (p = .384) or risk improvement rates (p = .242). Incentive values were not significantly associated with risk improvement rates (p = .240). Offering incentives for completing behavior change programs may increase completion rates, but increased health improvement does not necessarily follow.
Gold, Marsha R; Lake, Timothy; Hurley, Robert; Sinclair, Michael
The transfer of financial risk from health maintenance organizations (HMOs) to providers is controversial. To provide timely national data on these practices, we conducted a telephone survey in 1999 of a multi-staged probability sample of HMOs in 20 of the nation's 60 largest markets, accounting for 86% of all HMO enrollees nationally. Among those sampled, 82% responded. We found that HMOs' provider networks with physicians, hospitals, skilled nursing homes, and home health agencies are complex and multi-tiered Seventy-six percent of HMOs in our study use contracts for their HMO products that involve global, professional services, or hospital risk capitation to intermediate entities. These arrangements account for between 24.5 million and 27.4 million of the 55.9 million commercial and Medicare HMO enrollees in the 60 largest markets. While capitation arrangements are particularly common in California, they are more common elsewhere than many assume. The complex layering of risk sharing and delegation of care management responsibility raise questions about accountability and administrative costs in managed care. Do complex structures provide a way to involve providers more directly in managed care, or do they diffuse authority and add to administrative costs?
Full Text Available This article aimed to examine the influence of Corporate Social Responsibility (CSR disclosure to the financial performance proxy on Return on Assets (ROA, Return on Equity (ROE, and company value proxy on Price to Book Value (PBV empirically as well as knowing the existence of the audit quality as moderating variable whether it will affect the relationship between CSR disclosure on ROA, ROE, and PBV. The object of this study was mining companies listed on the Indonesia Stock Exchange period 2010-2012. The sample was selected using a purposive sampling method and obtained samples as many as 26 companies with a total data of 78 data. Hypothesis testing methods used were simple regression analysis and moderated regression analysis. The results of this study showed that Corporate Social Responsibility (CSR disclosure had an effect on ROA, but had no effect on ROE and PBV, and audit quality as a moderating variable could not affect the relationship of CSR disc losure on ROA, ROE, and PBV.
Bennett, Jarred S; Boyle, Patricia A; James, Bryan D; Bennett, David A
Recent research has begun to recognize the important influence of literacy levels and how they affect health and wellbeing, especially in older adults. Our study focuses on health and financial literacy, two domains of literacy which previous research has suggested may be significantly related to health and wellbeing. Our study examines the relation of health and financial literacy with health promoting behaviors and health status among community-based older persons. We conducted a cross-sectional study using data from the Rush Memory and Aging Project, a community-based cohort study of aging in northeastern Illinois. The study consisted of 556 older persons without dementia, each determined by a clinical evaluation. Health and financial literacy were measured using a series of questions designed to assess the ability to understand and process health and financial information, concepts, and numeracy; the two scores were averaged to yield a total literacy score. Health promoting behaviors, including engagement in cognitive, physical, and social activities, were assessed using self report measures. Indicators of heath status, including cognition (global cognition and five specific cognitive abilities), functional status (basic and instrumental activities of daily living, mobility disability), and mental health (depressive symptoms, loneliness) were assessed. In a series of regression models adjusted for age, sex, and education, higher total literacy scores were associated with more frequent participation in health promoting behaviors, including cognitive, physical and social activities (all p values literacy scores were associated with higher cognitive function, less disability, and better mental health (all p values Literacy remained associated with health promoting behaviors and health status in fully adjusted models that also controlled for income and the number of chronic medical conditions. Most of the findings were similar for health and financial literacy
Wilson, Robert S; Yu, Lei; James, Bryan D; Bennett, David A; Boyle, Patricia A
We tested the hypothesis that higher financial and health literacy is associated with better cognitive health in 755 older persons who completed a literacy measure (M = 67.9, SD = 14.5) and then had annual clinical evaluations for a mean of 3.4 years. In proportional hazards models, higher literacy was associated with decreased risk of developing incident Alzheimer's disease (n = 68) and results were similar for financial and health literacy subscales and after adjustment for potential confounders. In mixed-effects models, higher literacy was related to higher baseline level of cognition and reduced cognitive decline in multiple domains. Among the 602 persons without any cognitive impairment at baseline, higher literacy was associated with a reduced rate of cognitive decline and risk of developing incident mild cognitive impairment (n = 142). The results suggest that higher levels of financial and health literacy are associated with maintenance of cognitive health in old age.
Stewart, Louis J; Smith, Pamela C
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.
Tucker-Seeley, Reginald D; Mitchell, Jamie A; Shires, Deirdre A; Modlin, Charles S
Health self-efficacy (the confidence to take care of one's health) is a key component in ensuring that individuals are active partners in their health and health care. The purpose of this study was to determine the association between financial hardship and health self-efficacy among African American men and to determine if unmet medical need due to cost potentially mediates this association. Cross-sectional analysis was conducted using data from a convenience sample of African American men who attended a 1-day annual community health fair in Northeast Ohio (N = 279). Modified Poisson regression models were estimated to obtain the relative risk of reporting low health self-efficacy. After adjusting for sociodemographic characteristics, those reporting financial hardship were 2.91 times, RR = 2.91 (confidence interval [1.24, 6.83]; p financial hardship and low health self-efficacy was no longer statistically significant. Our results suggest that the association between financial hardship and health self-efficacy can be explained by unmet medical need due to cost. Possible intervention efforts among African American men with low financial resources should consider expanding clinical and community-based health assessments to capture financial hardship and unmet medical need due to cost as potential contributors to low health self-efficacy. © 2014 Society for Public Health Education.
This paper explains how the current architecture of the pharmaceutical markets has created a misalignment of financial incentives and public health that is a central cause of harmful practices. It explores three possible solutions to address that misalignment: taxes, increased financial penalties, and drug pricing based on value. Each proposal could help to partly realign financial incentives and public health. However, because of the limits of each proposal, there is no easy solution to fixing the problem of financial incentives. © 2013 American Society of Law, Medicine & Ethics, Inc.
Tucker-Seeley, Reginald D.; Mitchell, Jamie A.; Shires, Deirdre A.; Modlin, Charles S., Jr.
Background: Health self-efficacy (the confidence to take care of one's health) is a key component in ensuring that individuals are active partners in their health and health care. The purpose of this study was to determine the association between financial hardship and health self-efficacy among African American men and to determine if unmet…
Temple, Jeromey B; Williams, Ruth
Given recent rises in out-of-pocket health expenses, we examined the financial well-being of older Australians with multiple health conditions and disabilities. The 2014 General Social Survey was used to measure the: (i) current financial position; (ii) propensity to experience financial difficulties; and (iii) types of behaviours older people with multiple health conditions engage in to improve financial resilience. Compared to older Australians with no health conditions, respondents with multiple health conditions had lower incomes and assets and a higher propensity to hold consumer debt (once controls were included). They were at a higher risk of cash flow difficulties, dissaving to meet day-to-day living expenses and exclusion from financial providers. However, the majority of people with multiple health conditions engaged in financially resilient behaviours. Many older Australians with multiple health conditions were in a financially precarious situation with implications for the ability to afford ongoing increases in out-of-pocket health-care costs. © 2018 AJA Inc.
Vadim Anatolyevich Malyshenko
Full Text Available The subject matter of the research is the system of strategically focused financial analysis regarding an assessment of the financial condition of the enterprise. The hypothesis of the study is to assume the possibility of developing the financial and strategic model of the comprehensive assessment of the financial condition taking into account the integrated impact of environmental factors (general for the most Crimean health resorts. The methodology of the work is based on the most general principles of system analysis. The basic method of the research is the matrix method as the most common one for the system analysis. The graphical and statistical methods are also used. The result of the work is the comprehensive method of financial analysis developed as a model based on the matrix relation between the original visual profile of the internal environment and the dynamic type of external environment. The difference of the visual model of financial state from the existing graphic methods consists in fixing of the new strategic types of financial state on the basis of financial stability in visually grouped areas of financial coefficients in theme groups (configurationsprofiles with certain combinations of the forms and sizes. The new analytical instrument of «frigate model» can be applied in all analytical activities of the health resorts departments related to the analytical assessment of financial state. The advantage of «frigate model» in comparison with a classical method of the forming of the types of financial condition is that the proposed model allows to allocate more differentiated types and in addition, to identify the stages of enterprise life cycle based on the relative indicators of the analysis of financial state (objects-coefficients, and not just on the financial management. Through this, the consistency of interaction between the financial analysis and management is achieved.
Full Text Available t Every investor wants his company’s financial statement to be in accordance with the condition of the company. In practice, it often occurs that a company does profit management to attract investors’ interest. The factors which can increase the practice of profit management are leverage and financial distress. The objective of the research was to find out and to analyze the influence of leverage and financial distress on profit management with good corporate governance as moderating variable in banking companies in Indonesia. The research used descriptive explanatory method. The data were gathered by conducting documentary study. The population was 42 banking companies listed in BEI (Indonesia Stock Exchange and the population target was 30 companies. The gathered data were analyzed by using path analysis with E-views 7.0 Software program. The result of the first model showed that leverage and financial distress simultaneously had positive and significant influence on profit management in banking companies in Indonesia at the coefficient determination (R2 of 0.1243 or 12.43%. Partially, leverage had positive and significant influence on profit management, and financial distress had negative but significant influence on profit management in banking companies in Indonesia. The result of the second model showed that institutional ownership as moderating variable could not weaken and strengthen the influence of financial distress on profit management and was considered as potential moderation. The result of the third model showed that managerial ownership as moderating variable could weaken the influence of leverage on profit management and was stated as quasi moderation. It can also weaken the influence of financial distress on profit management and was stated as quasi moderation. The result of the fourth model showed that independent commissioners as moderating variable could not weaken or strengthen the influence of leverage on profit
John Thalassinos; Konstantinos Liapis
The main aim of this article is to demonstrate a holistic framework for measuring a bank’s financial health by classifying its main responsibilities between conformance and performance. Responsibilities are classified into five categories as follows: First, Corporate Financial Reporting (CFR) that integrates General Accepted Accounting Principles (GAAP), Generally Accepted Auditing Standards (GAAS), Securities Exchange Commission (SEC), Financial Services Authority (FSA), and International Ac...
Aristide, Adrien; Gobert, Yann; Bailey, Christopher
This publication reports an analysis of the financial situation of 15 European electric power producing companies which represent 55 per cent of the electricity production. In a crisis context (decrease of turnover and of EBITDA between 2013 and 2015), three strategies seem to emerge: a model based on renewable production, orientation towards renewable production, and focus on an operational efficiency of the energy mix. As the installed production capacity has increased, electric power consumption has decreased. Thus, the financial situation of power utilities is strongly affected by the economic context, and companies are trying to maintain their financial ratios (control of financial debt and preservation of asset profitability) while they are facing a loss of confidence from investors as revealed by their performance on the stock exchange market. In response, they diversify their activities and redefine their strategy as mentioned here above. These elements are first presented with commented graphs, and then more precisely discussed
Sulaberidze, Lela; Green, Stuart; Chikovani, Ivdity; Uchaneishvili, Maia; Gotsadze, George
Whilst there is recognition that the global burden of disease associated with mental health disorders is significant, the economic resources available, especially in Low and Middle Income Countries, are particularly scarce. Identifying the economic (system) and financial (individual) barriers to delivering mental health services and assessing the opportunities for reform can support the development of strategies for change. A mixed methods study was developed, which engaged with a range of stakeholders from mental health services, including key informants, service managers, healthcare professional and patients and their care-takers. Data generated from interviews and focus groups were analysed using an existing framework that outlines a range of economic and financial barriers to improving mental health practice. In addition, the study utilised health financing and programmatic data. The analysis identified a variety of local economic barriers, including: the inhibition of the diversification of the mental health workforce and services due to inflexible resources; the variable and limited provision of services across the country; and the absence of mechanisms to assess the delivery and quality of existing services. The main financial barriers identified were related to out-of pocket payments for purchasing high quality medications and transportation to access mental health services. Whilst scarcity of financial resources exists in Georgia, as in many other countries, there are clear opportunities to improve the effectiveness of the current mental health programme. Addressing system-wide barriers could enable the delivery of services that aim to meet the needs of patients. The use of existing data to assess the implementation of the mental health programme offers opportunities to benchmark and improve services and to support the appropriate commissioning and reconfiguration of services.
Lugo-Palacios, David G; Cairns, John
Objective. To estimate the financial and health burden of diabetic ambulatory care sensitive hospitalisations (ACSH) in Mexico during 2001-2011. Materials and methods. We identified ACSH due to diabetic complications in general hospitals run by local health ministries and estimated their financial cost using diagnostic related groups. The health burden estimation assumes that patients would not have experienced complications if they had received appropriate primary care and computes the assoc...
Arik - Susbiyani
Full Text Available Abstract This study aimed to examine the influence of the financial statements on local revenue by using the results of the examination opinion as moderating variable. The study used Legitimacy Theory to explain and analyze the relationship between variables. The population in the study was all the districts and cities in Indonesia totaling 497 county and city governments. The sampling method used in the study was judgment sampling. Samples that met the criteria of the study were 116 local governments. The analytical tool used in this research was the analysis of MRA (Moderated Regression Analysis. The results showed that the effects of the partial test of the quality of financial reports to local revenues were not significant positive effects. While the partial test results stating the influence of audit opinion on local revenue having positive effects were not significant. Other results showed that the interaction between the results of the examination opinion to the quality of financial statements was insignificant on the quality of financial statements. In other words, the results of the examination opinions moderated (strengthened the relationship between quality of financial report on local revenue of district and city governments in Indonesia.
Complex systems inspired analysis suggests a hypothesis that financial meltdowns are abrupt critical transitions that occur when the system reaches a tipping point. Theoretical and empirical studies on climatic and ecological dynamical systems have shown that approach to tipping points is preceded by a generic phenomenon called critical slowing down, i.e. an increasingly slow response of the system to perturbations. Therefore, it has been suggested that critical slowing down may be used as an early warning signal of imminent critical transitions. Whether financial markets exhibit critical slowing down prior to meltdowns remains unclear. Here, our analysis reveals that three major US (Dow Jones Index, S&P 500 and NASDAQ) and two European markets (DAX and FTSE) did not exhibit critical slowing down prior to major financial crashes over the last century. However, all markets showed strong trends of rising variability, quantified by time series variance and spectral function at low frequencies, prior to crashes. These results suggest that financial crashes are not critical transitions that occur in the vicinity of a tipping point. Using a simple model, we argue that financial crashes are likely to be stochastic transitions which can occur even when the system is far away from the tipping point. Specifically, we show that a gradually increasing strength of stochastic perturbations may have caused to abrupt transitions in the financial markets. Broadly, our results highlight the importance of stochastically driven abrupt transitions in real world scenarios. Our study offers rising variability as a precursor of financial meltdowns albeit with a limitation that they may signal false alarms. PMID:26761792
Sinclair, Robert R; Cheung, Janelle H
Money is arguably the most important resource derived from work and the most important source of stress for contemporary employees. A substantial body of research supports the relationship between access to financial resources and health and well-being, both at individual and aggregated (e.g. national) levels of analysis. Yet, surprisingly little occupational health psychology research has paid attention to financial issues experienced specifically by those in the labour force. With these issues in mind, the overarching goal of the present paper was to address conceptual and measurement issues in the study of objective and subjective aspects of financial stress and review several assessment options available to occupational health psychology researchers for both aspects of financial stress. Where appropriate, we offer guidance to researchers about choices among various financial stress measures and identify issues that require further research attention. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Rainer, S R; Papp, E
The occupational and environmental health nurse entrepreneur can avoid business failure by engaging in a planning process that maximizes financial resources. Successful financial management involves understanding key financial reports and using those reports as management tools to "keep score" on the business. The prices the occupational and environmental health nurse entrepreneur charges for services will have a direct effect on the success of the business. Payroll, earnings, and expense records are useful management tools to help the occupational and environmental health nurse entrepreneur track the business and meet legal requirements.
Mujasi, Paschal N; Puig-Junoy, Jaume
A key policy question for the government of Uganda is how to equitably allocate primary health care pharmaceutical budgets to districts. This paper seeks to identify variables influencing current primary health care pharmaceutical expenditure and their usefulness in allocating prospective pharmaceutical budgets to districts. This was a cross sectional, retrospective observational study using secondary administrative data. We collected data on the value of pharmaceuticals procured by primary health care facilities in each district from National Medical Stores for the financial year 2011/2012. The dependent variable was expressed as per capita district pharmaceutical expenditure. By reviewing literature we identified 26 potential explanatory variables. They include supply, need and demand, and health system organization variables that may influence the demand and supply of health services and the corresponding pharmaceutical expenditure. We collected secondary data for these variables for all the districts in Uganda (n = 112). We performed econometric analysis to estimate parameters of various regression models. There is a significant correlation between per capita district pharmaceutical expenditure and total district population, rural poverty, access to drinking water and outpatient department (OPD) per capita utilisation.(P Uganda (Adjusted R(2) = 0.528). All variables in the model are significant (p Uganda are: district outpatient department attendance per capita, total district population, total number of government health facilities in the district and the district human poverty index.
McClung, Nancy; Glidewell, Jill; Farr, Sherry L
To examine the financial burdens and mental health needs of families of children with special healthcare needs (CSHCN) with congenital heart disease (CHD). Data from the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) were used to examine parent-reported financial burdens (out-of-pocket expenses, financial problems, employment impact, caregiving hours) and family members' need for mental health services in families of CSHCN with CHD. Multivariable logistic regression was used to compare financial burdens and family members' need for mental health services among CSHCN with and without CHD. Among CSHCN with CHD, multivariable logistic regression, stratified by age (0-5 and 6-17 years), was used to assess characteristics associated with the outcomes. Overall, families of 89.1% of CSHCN with CHD experienced at least one financial burden and 14.9% needed mental health services due to the child's condition. Compared with CSHCN without CHD, those with CHD had families with a higher prevalence of all financial burdens (adjusted prevalence ratio [aPR] range: 1.4-1.8) and similar family member need for mental health services (aPR = 1.3, 95% CI [1.0, 1.6]). Across both age groups, insurance type, activity limitations, and comorbidities were significantly associated with financial burdens and/or family members' need for mental health services. CSHCN with CHD, compared with those without CHD, lived in families with more financial burdens. Interventions that reduce financial burdens and improve mental health of family members are needed, especially among CSHCN with CHD who are uninsured and have comorbidities or activity limitations. © 2018 Wiley Periodicals, Inc.
Sweet, Elizabeth; Nandi, Arijit; Adam, Emma K; McDade, Thomas W
Household financial debt in America has risen dramatically in recent years. While there is evidence that debt is associated with adverse psychological health, its relationship with other health outcomes is relatively unknown. We investigate the associations of multiple indices of financial debt with psychological and general health outcomes among 8400 young adult respondents from the National Longitudinal Study of Adolescent Health (Add Health). Our findings show that reporting high financial debt relative to available assets is associated with higher perceived stress and depression, worse self-reported general health, and higher diastolic blood pressure. These associations remain significant when controlling for prior socioeconomic status, psychological and physical health, and other demographic factors. The results suggest that debt is an important socioeconomic determinant of health that should be explored further in social epidemiology research. Copyright © 2013 Elsevier Ltd. All rights reserved.
Runeson, Roma; Vingård, Eva; Lampa, Erik; Wahlstedt, Kurt
The present study is part of a 3-year longitudinal study on work and health among employees in the public sector in Sweden. The aim was to study associations between self-rated health (SRH) and financial situation, education, and managerial responsibility. Of the 9003 employees, 7533 answered the baseline questionnaires (84%). Altogether 9373 subjects received the follow-up questionnaire, and 6617 subjects responded (71%). In total 4240 completed the questionnaire on both occasions, and this group comprised the study population. SRH consisted of the response to a single question: 'In general, would you say your health is excellent, very good, good, poor, or very poor?' The health was investigated in terms of the development of health status in the 3-year follow-up. The exposure factors were: financial situation, education, and managerial responsibility. Odds ratios were analysed using logistic regressions. Good financial situation and further education were predictors in maintaining good health and in avoiding poor health. The analysis also indicated the following determinants of sustained good SRH: having a good financial situation (OR 1.99 at baseline and OR 1.87 at follow-up), having a further education compared to lower education (OR 1.17 at baseline), and not having a worsening financial situation between baseline and follow-up (OR 0.53). Financial situation and educational level were important factors that influence the subjective perception of health.
Association between lifestyle and health variables with nutritional status of the elderly in the Northern ... PROMOTING ACCESS TO AFRICAN RESEARCH ... Keywords: nutritional status, elderly, health, lifestyle, dietary intake, body mass index ...
Murphy, John L
This study uses data from the Health and Retirement Study (HRS) to analyze the psychological and social variables associated with financial literacy. The HRS is a nationally representative longitudinal survey of individuals older than age 50 and their spouses. An ordinary least squares linear regression analysis explores the relationship between financial literacy and several economic and psychosocial variables. After controlling for earnings, level of education, and other socioeconomic variables in this exploratory study, I find that financial satisfaction and religiosity are correlated with financial literacy.
Zallman, Leah; Nardin, Rachel; Sayah, Assaad; McCormick, Danny
Under the Massachusetts health reform, low income residents (those with incomes below 150 % of the Federal Poverty Level [FPL]) were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums. Those with slightly higher incomes (150 %-300 % FPL) were eligible for exchange-based plans that required cost-sharing and premium payments. We conducted face to face surveys in four languages with a convenience sample of 976 patients seeking care at three hospital emergency departments five years after Massachusetts reform. We compared perceived affordability of insurance, financial burden, and satisfaction among low cost sharing plan recipients (recipients of Medicaid and insurance exchange-based plans with minimal cost-sharing and no premiums), high cost sharing plan recipients (recipients of exchange-based plans that required cost-sharing and premium payments) and the commercially insured. We found that despite having higher incomes, higher cost-sharing plan recipients were less satisfied with their insurance plans and perceived more difficulty affording their insurance than those with low cost-sharing plans. Higher cost-sharing plan recipients also reported more difficulty affording medical and non-medical health care as well as insurance premiums than those with commercial insurance. In contrast, patients with low cost-sharing public plans reported higher plan satisfaction and less financial concern than the commercially insured. Policy makers with responsibility for the benefit design of public insurance available under health care reforms in the U.S. should calibrate cost-sharing to income level so as to minimize difficulty affording care and financial burdens.
Htet, Soe; Fan, Victoria; Alam, Khurshid; Mahal, Ajay
The government of Myanmar, with support from international donors, plans to address household financial risks from ill health and expand coverage. But evidence to design policy is limited. WHS (World Health Survey) data for 6045 households were used to investigate the association of out-of-pocket (OOP) health spending, catastrophic expenditures, and household borrowing and asset sales associated with illness with key socioeconomic and demographic correlates in Myanmar. Households with elderly and young children and chronically ill individuals, poor households, and ethnic minorities face higher financial stress from illness. Rural households use less care, suggesting their lower OOP health spending may be at the cost of health. Poorer groups rely more on public sector health services than richer groups. Better targeting, increased budgetary allocations, and more effective use of resources via designing cost-effective benefits packages appear key to sustainably addressing financial risks from ill health in Myanmar. © 2014 APJPH.
Lugo-Palacios, David G; Cairns, John
To estimate the financial and health burden of diabetic ambulatory care sensitive hospitalisations (ACSH) in Mexico during 2001-2011. We identified ACSH due to diabetic complications in general hospitals run by local health ministries and estimated their financial cost using diagnostic related groups. The health burden estimation assumes that patients would not have experienced complications if they had received appropriate primary care and computes the associated Disability-Adjusted Life Years (DALYs). The financial cost of diabetic ACSH increased by 125% in real terms and their health burden in 2010 accounted for 4.2% of total DALYs associated with diabetes in Mexico. Avoiding preventable hospitalisations could free resources within the health system for other health purposes. In addition, patients with ACSH suffer preventable losses of health that should be considered when assessing the performance of any primary care intervention.
David G Lugo-Palacios
Full Text Available Objective.To estimate the financial and health burden of diabetic ambulatory care sensitive hospitalisations (ACSH in Mexico during 2001-2011. Materials and methods. We identified ACSH due to diabetic complications in general hospitals run by local health ministries and estimated their financial cost using diagnostic related groups. The health burden estimation assumes that patients would not have experienced complications if they had received appropriate primary care and computes the associated DisabilityAdjusted Life Years (DALYs. Results. The financial cost of diabetic ACSH increased by 125% in real terms and their health burden in 2010 accounted for 4.2% of total DALYs associated with diabetes in Mexico. Conclusion. Avoiding preventable hospitalisations could free resources within the health system for other health purposes. In addition, patients with ACSH suffer preventable losses of health that should be considered when assessing the performance of any primary care intervention.
Hall, Mark A; McCue, Michael J; Palazzolo, Jennifer R
Many insurers incurred financial losses in individual markets for health insurance during 2014, the first year of Affordable Care Act mandated changes. This analysis looks at key financial ratios of insurers to compare profitability in 2014 and 2013, identify factors driving financial performance, and contrast the financial performance of health insurers operating in state-run exchanges versus the federal exchange. Overall, the median loss of sampled insurers was -3.9%, no greater than their loss in 2013. Reduced administrative costs offset increases in medical losses. Insurers performed better in states with state-run exchanges than insurers in states using the federal exchange in 2014. Medical loss ratios are the underlying driver more than administrative costs in the difference in performance between states with federal versus state-run exchanges. Policy makers looking to improve the financial performance of the individual market should focus on features that differentiate the markets associated with state-run versus federal exchanges.
Emma L. Giles
Full Text Available Abstract Background Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI. Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. Methods We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. Results Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential ‘gaming’, and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI – including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for ‘gaming the system’. Secondly, a tension between participants’ own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants’ personal distaste of HPFI; and their professional view that
Giles, Emma L; Sniehotta, Falko F; McColl, Elaine; Adams, Jean
Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI). Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential 'gaming', and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI - including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for 'gaming the system'. Secondly, a tension between participants' own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants' personal distaste of HPFI; and their professional view that they could be a valuable behaviour change tool. There are aspects of
To examine the literature from the past 20 years and identify those studies that support the economic merit of health promotion. A panel of experts was used to identify the top studies supporting the purpose of this article. Studies were chosen based on the following criteria: the study (1) examined the relationship between health risks and financial outcomes, or health promotion programs and financial outcomes; (2) provided strong and compelling financial data supporting the worth of health promotion; (3) had a high-quality methodology; (4) answered an important question or replicated important findings with superior methodology; and (5) represented U.S.-based initiatives published since 1980. After initially nominating a group of studies for consideration, panelists rated each on a scale from 1 to 3 representing their opinion of importance. Studies rating the highest were included for this discussion. Studies were analyzed by population characteristics, design, statistical tests, limitations, and results. This information was summarized for each identified article. A relationship between modifiable health risk factors and health care costs is supported by research. Health promotion interventions appear to provide positive financial returns, most notably for health care costs and absenteeism reduction. Private sector initiatives seem to be driving economic-based research. Overall, health promotion shows promising results for providing financial advantages for its sponsors; however, if this discipline is to show its true worth, considerable funding is needed from government or philanthropic sources to cover the substantial costs of quality research.
Wilkinson, Lindsay R
The economic recession has garnered the interest of many scholars, with much attention being drawn to how the recession has affected labor force participation, household wealth, and even retirement decisions. Certainly, the Great Recession has influenced the financial well-being of older adults, but has it had discernible effects on mental health? This study draws on 5,366 respondents from the Health and Retirement Study (2006-2010) to examine objective and subjective measures of financial well-being in the period surrounding the Great Recession. Guided by cumulative inequality theory, this research investigates whether the economic downturn contributed to worsening anxiety and depressive symptoms over a 4-year period. Results from linear fixed effects models reveal that decreases in objective financial resources were associated with increased financial strain during the Great Recession. Unlike the objective indicators, however, financial strain was a strong and robust predictor of worsening mental health between 2006 and 2010. Building on prior research, this study elucidates the factors that shape financial strain and provides evidence that the Great Recession not only affected the financial well-being of older adults but also had adverse effects on mental health. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Çakmak, S. Serdar
Ankara : Department of Management and Graduate School of Business Administration of Bilkent University, 1996. Thesis (Master's) -- Bilkent University, 1996. Includes bibliographical references leaves 22-24 Announcements of financial statement informations provide valuable signals for investors. There are evidences documenting the changes in trading volume and stock returns at the time of annual and interim financial statement announcements in comparison to those in non-announcement p...
Palta, Priya; Szanton, Sarah L; Semba, Richard D; Thorpe, Roland J; Varadhan, Ravi; Fried, Linda P
Elevated oxidative stress levels may be one mechanism contributing to poor health outcomes. Financial strain and oxidative stress are each predictors of morbidity and mortality, but little research has investigated their relationship. Community-dwelling older adults (n = 728) from the Women's Health and Aging Studies I and II were included in this cross-sectional analysis. Financial strain was ascertained as an ordinal response to: "At the end of the month, do you have more than enough money left over, just enough, or not enough?" Oxidative stress was measured using serum protein carbonyl concentrations. Linear regression was used to quantify the relationship between financial strain and oxidative stress. Participants who reported high financial strain exhibited 13.4% higher protein carbonyl concentrations compared to individuals who reported low financial strain (p = 0.002). High financial strain may be associated with increased oxidative stress, suggesting that oxidative stress could mediate associations between financial strain and poor health. Copyright © 2015 Elsevier Inc. All rights reserved.
James, Bryan D; Boyle, Patricia A; Bennett, Jarred S; Bennett, David A
Health and financial literacy have been linked to the health and well-being of older adults, yet there are few data on how health and financial literacy actually impact decision making regarding healthcare and economic choices in advanced age. To examine the association of health and financial literacy with decision making in older adults. Data came from 525 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Health and financial literacy were assessed via a series of questions designed to measure comprehension of health and financial information and concepts. The two scores were averaged to yield a total literacy score. A modified, 12-item version of the Decision-Making Competence Assessment Tool was used to measure financial and healthcare decision making (6 items each), using materials designed to approximate those used in real world settings. All 12 items were summed to yield a total decision-making score. Associations were tested via linear regression models adjusted for age, sex and education. Secondary models adjusted for global cognitive function, income, depression and chronic medical conditions. On average, participants correctly answered 67% of the literacy questions (health literacy = 61.6%, SD = 18.8% and financial literacy = 72.5%, SD = 16.0%). After adjustment for cognitive function, the total literacy score was positively associated with the decision-making total score (estimate = 0.64, SE = 0.08, p financial decision making (estimate = 0.28, SE = 0.05, p literacy, health and financial literacy all were independently associated with decision making in models adjusted for covariates including income, depression, and chronic medical conditions (all p values literacy and healthcare decision making was stronger among older persons, poorer persons and persons at the lower ranges of cognitive ability. Among community based older persons without dementia, higher levels of health
Bennett Jarred S
Full Text Available Abstract Background Recent research has begun to recognize the important influence of literacy levels and how they affect health and wellbeing, especially in older adults. Our study focuses on health and financial literacy, two domains of literacy which previous research has suggested may be significantly related to health and wellbeing. Our study examines the relation of health and financial literacy with health promoting behaviors and health status among community-based older persons. Methods We conducted a cross-sectional study using data from the Rush Memory and Aging Project, a community-based cohort study of aging in northeastern Illinois. The study consisted of 556 older persons without dementia, each determined by a clinical evaluation. Health and financial literacy were measured using a series of questions designed to assess the ability to understand and process health and financial information, concepts, and numeracy; the two scores were averaged to yield a total literacy score. Health promoting behaviors, including engagement in cognitive, physical, and social activities, were assessed using self report measures. Indicators of heath status, including cognition (global cognition and five specific cognitive abilities, functional status (basic and instrumental activities of daily living, mobility disability, and mental health (depressive symptoms, loneliness were assessed. Results In a series of regression models adjusted for age, sex, and education, higher total literacy scores were associated with more frequent participation in health promoting behaviors, including cognitive, physical and social activities (all p values Conclusions Health and financial literacy are associated with more frequent engagement in health promoting behaviors and better health status in older persons without dementia.
Birch, Stephen; Murphy, Gail Tomblin; MacKenzie, Adrian; Cumming, Jackie
The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Higher Education Funding Council for England, 2016
This report provides an overview of the current financial health of the Higher Education Funding Council for England (HEFCE) funded higher education sector in England. This does not include directly funded further education or other colleges, or alternative providers of higher education. The analysis covers financial results for the academic year…
Dong, Gang Nathan
Amid increasing interest in how government regulation and market competition affect the cost and financial sustainability in health care sector, it remains unclear whether health care providers behave similarly to their counterparts in other industries. The goal of this chapter is to study the degree to which health care providers manipulate accruals in periods of financial difficulties caused, in part, by the rising costs of labor. We collected the financial information of health care provider in 43 countries from 1984 to 2013 and conducted a pooled cross-sectional study with country and year fixed-effects. The empirical evidence shows that health care providers with higher wage costs are more likely to smooth their earnings in order to maintain financial sustainability. The finding of this study not only informs regulators that earnings management is pervasive in health care organizations around the world, but also contributes to the studies of financial booktax reporting alignment, given the existing empirical evidence linking earnings management to corporate tax avoidance in this very sector.
Full Text Available Background One common challenge to social systems is achieving equity in financial contributions and preventing financial loss. Because of the large and unpredictable nature of some costs, achieving this goal in the health system presents important and unique problems. The present study investigated the Household Financial Contributions (HFCs to the health system. Methods The study investigated 800 households in Shiraz. The study sample size was selected using stratified sampling and cluster sampling in the urban and rural regions, respectively. The data was collected using the household section of the World Health Survey (WHS questionnaire. Catastrophic health expenditures were calculated based on the ability of the household to pay and the reasons for the catastrophic health expenditures by a household were specified using logistic regression. Results The results showed that the fairness financial contribution index was 0.6 and that 14.2% of households were faced with catastrophic health expenditures. Logistic regression analysis revealed that household economic status, the basic and supplementary insurance status of the head of the household, existence of individuals in the household who require chronic medical care, use of dental and hospital care, rural location of residences, frequency of use of outpatient services, and Out-of-Pocket (OOP payment for physician visits were effective factors for determining the likelihood of experiencing catastrophic health expenditure. Conclusion It appears that the current method of health financing in Iran does not adequately protect households against catastrophic health expenditure. Consequently, it is essential to reform healthcare financing.
Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris
The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome
financing of health care services and a weak health system. Malawi is one of the ... and two-thirds of adults, who need antiretroviral treatment for HIV are ... health service delivery”4. There are two ... estimated the cost for the provision of minimal services .... However, the key issue is to differentiate between tax incentives that.
Smit, Madelein; Wilders, Cilas J.; Moss, S.J.
The aim of this study was to determine the relation between physical activity and selected physical health components. A total of 9860 employees of a financial institution in South Africa, between the ages 18 and 64 (x̄ =35.3 ± 18.6 years), voluntary participated in the study. Health risk factors and physical activity was determined by using the Health Risk Assessment (HRA) and Monitored Health Risk (MHM). Assessment included a physical activity, diabetes risk and cardiovascular risk question...
Pink, G H; Coyte, P C
The curricula of graduate health administration programs have, historically, not articulated the theoretical links between health economics and health finance, although an understanding of these links could enhance comprehension of both disciplines. We provide a pedagogical approach that can be used to clarify these interconnections. It compares the standard neoclassical microeconomic concept of the hospital with the financial concept of the hospital, for the purpose of relating the optimal output decision in microeconomic theory to the optimal investment decision in financial theory. This approach can be taught in an advanced course in either economics or finance.
Kirigia, Joses M; Nganda, Benjamin M; Mwikisa, Chris N; Cardoso, Bernardino
effects of the global financial crisis on a few variables, is important to alert the Ministry of Health on the looming danger of cuts in health funding from domestic and external sources. However, it is even more important for national governments to monitor the effects of the economic crisis and the policy responses on the social determinants of health, health inputs, health system outputs and health system outcomes, e.g. health.
Brønnum-Hansen, Henrik; Baadsgaard, Mikkel; Eriksen, Mette Lindholm
in expected lifetime in self-rated good health increased by 1.3 years for men and 1.2 years for women. CONCLUSIONS: The social inequality in DFLE for men and expected lifetime in self-rated good health for both genders increased slightly during the short period. The financial crisis did not seem to indicate...
Collum, Taleah H; Menachemi, Nir; Sen, Bisakha
The aim of this study was to examine the impact of electronic health record (EHR) adoption on hospital financial performance. We constructed a longitudinal panel using data from the three secondary sources: (a) the 2007-2010 American Hospital Association (AHA) Annual Survey, (b) the 2007-2010 AHA Annual Survey Information Technology Supplement, and (c) the 2007-2011 Medicare Cost Reports from Centers for Medicare and Medicaid Services. Because potential financial benefits attributable to EHR adoption may take some time to accrue, we ran regressions with lags of 1 and 2 years that included hospital and year fixed effects to examine the relationship between the level of EHR adoption and three hospital financial performance measures. A change in the level of EHR adoption was not associated with changes in operating margin or return on assets within hospitals. However, total margin was significantly improved, after 2 years, in hospitals that moved from no EHR to having a comprehensive EHR in all areas of their hospital (β = 0.030, p financial performance measures examined. The improvements in total margin, as opposed to operating margin, are likely due to hospital incentive payments under the Health Information Technology for Economic and Clinical Health Act that are reflected in nonpatient revenues and therefore show up in total margin calculations. Thus, after 2 years of EHR adoption, hospital financial performance is observed to improve based only on meaningful use incentive payments. More research will be needed to determine whether EHR adoption impacts financial performance on a longer time horizon.
Nelson, Kenneth; Tøge, Anne Grete
The financial crisis that hit Europe in 2007-2008 and the corresponding austerity policies have generated concern about increasing health inequalities, although impacts have been less salient than initially expected. One explanation could be that health inequalities emerged first a few years into the crisis. This study investigates health trends in the wake of the financial crisis and analyses health inequalities across a number of relevant population subgroups, including those defined by employment status, age, family type, gender, and educational attainment. This study uses individual-level panel data (EU-SILC, 2010-2013) to investigate trends in self-rated health. By applying individual fixed effects regression models, the study estimates the average yearly change in self-rated health for persons aged 15-64 years in 28 European countries. Health inequalities are investigated using stratified analyses. Unemployed respondents, particularly those who were unemployed in all years of observation, had a steeper decline in self-rated health than the employed. Respondents of prime working age (25-54 years) had a steeper decline than their younger (15-24) and older (55-64) counterparts, while single parents had a more favorable trend in self-rated health than dual parents. We did not observe any increasing health inequalities based on gender or educational attainment. Health inequalities increased in the wake of the financial crisis, especially those associated with employment status, age, and family type. We did not observe increasing health inequalities in terms of levels of educational attainment and gender.
Coyne, Joseph S; Singh, Sher G
This article presents a series of pertinent predictors of financial failure based on analysis of solvent and bankrupt health systems to identify which financial measures show the clearest distinction between success and failure. Early warning signals are evident from the longitudinal analysis as early as five years before bankruptcy. The data source includes seven years of annual statements filed with the Securities and Exchange Commission by 13 health systems before they filed bankruptcy. Comparative data were compiled from five solvent health systems for the same seven-year period. Seven financial solvency ratios are included in this study, including four cash liquidity measures, two leverage measures, and one efficiency measure. The results show distinct financial trends between solvent and bankrupt health systems, in particular for the operating-cash-flow-related measures, namely Ratio 1: Operating Cash Flow Percentage Change, from prior to current period; Ratio 2: Operating Cash Flow to Net Revenues; and Ratio 4: Cash Flow to Total Liabilities, indicating sensitivity in the hospital industry to cash flow management. The high dependence on credit from third-party payers is cited as a reason for this; thus, there is a great need for cash to fund operations. Five managerial policy implications are provided to help health system managers avoid financial solvency problems in the future.
Health related quality of life and psychological variables among a sample of asthmatics in Ile-Ife South-Western Nigeria. ... Sociodemographic and clinical variables were also obtained from the patients, the lung function was assessed using Peak Expiratory Flow Rate (PEFR). Results: Mean age of all the patients was 35.22 ...
Full Text Available Background/Aim. The main goal of every health policy is not merely the establishment of the health system sustainability, but the accessibility of health services to the whole population, as well. This objective is shared in European Union countries, and the consequence is the implementation of National Health Accounts (NHA. NHA, as a tool for evidence-based management, provides data regarding financial flow in health at national level and alows international comparability. The aim of this study was to determine Serbian overall health spending patterns by National Health Accounts, and to determine health care indices to provide policy makers with internationally comparable health indicators. Methods. A retrospective analysis of healthcare expenditures was obtained from the published final financial reports of relevant state institutions during a period of 2003 to 2006. The various sources of data on healthcare expenditures were connected according to instructions by the OECD 'A System of Health Accounts (SHA' Version 1.0. Results. The obtained results showed: health expenditures in Serbia made up 8.6%, 8.3%, 8.7% and 9 % of the GDP in 2003, 2004, 2005 and 2006, respectively; the Health Insurance Fund was a predominant financing source of the public sector with 93% in 2006; the largest part of the total health expenditures went towards hospitals and for health services; the expenditure per capita in 2006 was 365 US$; Serbian population finances the state institutions 'out of pocket' with 21.28% of their sources, which was 7.3% of the total healthcare expenditures, and the private institutions with 78.72% of their financial sources, which is 27% of the total healthcare expenditures. In 2006 Serbia allocated financial resources out of GDP in the amount similar to the European Unity, while comparing to the countries of the region, these funds were less only than in Bosnia and Herzegovina. This allocating of financial resources in total, however, was
Lennerz, Jochen K; McLaughlin, Heather M; Baron, Jason M; Rasmussen, David; Sumbada Shin, Meini; Berners-Lee, Nancy; Miller Batten, Julie; Swoboda, Kathryn J; Gala, Manish K; Winter, Harland S; Schmahmann, Jeremy D; Sweetser, David A; Boswell, Marianne; Pacula, Maciej; Stenzinger, Albrecht; Le, Long P; Hynes, William; Rehm, Heidi L; Klibanski, Anne; Black-Schaffer, Stephen W; Golden, Jeffrey A; Louis, David N; Weiss, Scott T; Iafrate, A John
Next-generation sequencing has evolved technically and economically into the method of choice for interrogating the genome in cancer and inherited disorders. The introduction of procedural code sets for whole-exome and genome sequencing is a milestone toward financially sustainable clinical implementation; however, achieving reimbursement is currently a major challenge. As part of a prospective quality-improvement initiative to implement the new code sets, we adopted Agile, a development methodology originally devised in software development. We implemented eight functionally distinct modules (request review, cost estimation, preauthorization, accessioning, prebilling, testing, reporting, and reimbursement consultation) and obtained feedback via an anonymous survey. We managed 50 clinical requests (January to June 2015). The fraction of pursued-to-requested cases (n = 15/50; utilization management fraction, 0.3) aimed for a high rate of preauthorizations. In 13 of 15 patients the insurance plan required preauthorization, which we obtained in 70% and ultimately achieved reimbursement in 50%. Interoperability enabled assessment of 12 different combinations of modules that underline the importance of an adaptive workflow and policy tailoring to achieve higher yields of reimbursement. The survey confirmed a positive attitude toward self-organizing teams. We acknowledge the individuals and their interactions and termed the infrastructure: human pipeline. Nontechnical barriers currently are limiting the scope and availability of clinical genomic sequencing. The presented human pipeline is one approach toward long-term financial sustainability of clinical genomics. Copyright © 2016 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.
Ruckert, Arne; Labonté, Ronald
It is widely acknowledged that austerity measures in the wake of the global financial crisis are starting to undermine population health results. Yet, few research studies have focused on the ways in which the financial crisis and the ensuing 'Great Recession' have affected health equity, especially through their impact on social determinants of health; neither has much attention been given to the health consequences of the fiscal austerity regime that quickly followed a brief period of counter-cyclical government spending for bank bailouts and economic stimulus. Canada has not remained insulated from these developments, despite its relative success in maneuvering the global financial crisis. The study draws on three sources of evidence: A series of semi-structured interviews in Ottawa and Toronto, with key informants selected on the basis of their expertise (n = 12); an analysis of recent (2012) Canadian and Ontario budgetary impacts on social determinants of health; and documentation of trend data on key social health determinants pre- and post the financial crisis. The findings suggest that health equity is primarily impacted through two main pathways related to the global financial crisis: austerity budgets and associated program cutbacks in areas crucial to addressing the inequitable distribution of social determinants of health, including social assistance, housing, and education; and the qualitative transformation of labor markets, with precarious forms of employment expanding rapidly in the aftermath of the global financial crisis. Preliminary evidence suggests that these tendencies will lead to a further deepening of existing health inequities, unless counter-acted through a change in policy direction. This article documents some of the effects of financial crisis and severe economic decline on health equity in Canada. However, more research is necessary to study policy choices that could mitigate this effect. Since the policy response to a similar set of
Grundy, Quinn; Held, Fabian; Bero, Lisa
To identify the major stakeholders in mobile health app development and to describe their financial relationships using social network analysis. We conducted a structured content analysis of a purposive sample of prominent health and fitness apps available in November 2015 in the United States, Canada, and Australia. We conducted a social network analysis of apps' developers, investors, other funding sources, and content advisors to describe the financial relationships underpinning health app development. Prominent health and fitness apps are largely developed by private companies based in North America, with an average of 4.7 (SD = 5.5) financial relations, including founders, external investors, acquiring companies, and commercial partnerships. Network analysis revealed a core of 41 sampled apps connected to 415 other entities by 466 financial relations. This core largely comprised apps published by major technology, pharmaceutical, and fashion corporations. About one third of apps named advisors, many of whom had commercial affiliations. Public health needs to extend its scrutiny and advocacy beyond the health messages contained within apps to understanding commercial influences on health and, when necessary, challenging them.
Ifende, V.I.; Derks, M.; Hooijer, G.A.; Hogeveen, H.
Veterinary herd health management (VHHM) programmes are meant to support herd health and farmers’ income (Brand and Guard 1996). They were introduced in the Netherlands in the 1970s (Sol and Renkema 1984) and at present many veterinarians provide them to farmers. VHHM comprises a basic structure of
Mia Andika Sari
Full Text Available This research conducted to examine the influence of intrinsic factors which being peroxided with Capital Structure, Firm Size, Firm Age and Financial factors that being peroxided with liquidity, profitability also with another activities using triple bottom lines as Intervening Variable against Firm Value of Property Industries. The data that being used in this study were obtained from published financial statements during the period 2010 to 2013, as well as annual reports that can be accessed through the IDX website. Data analysis technique used in this study is a regression with panel data and path analysis. The results of this research showed that intrinsic factors and financial variables have a significant influence on the firm value, as well as intrinsic factors and financial variables have a significant influence on the triple bottom lines. From the results of path analysis demonstrated that the indirect effect using the triple bottom lines as a intervening variable was greater than the direct effect.
Lower, Tony; Pollock, Kirrily
This study aimed to quantify the burden of fatal and workers' compensation-related injuries on the dairy sector in Australia and to assess current financial inputs for work health and safety actions. The first and second phases entailed a review of the financial costs associated with fatal (2001-2013) and workers' compensation cases (2008-2009 to 2012-2013). The third element was a case-study approach focusing on actual production and cost data from a small sample of dairy farms (n = 6) to ascertain an estimate for current financial inputs to work health and safety. The estimated financial impact was approximately AUD$12.4 million each year, comprising AUD$6.8 million for fatalities and AUD$5.6 million for compensable injuries. All sample businesses were investing in health and safety initiatives; however, this was modest and on average represented 0.4% of total expenditure (AUD$4,472) or financial case to increase strategic investments into work health and safety by dairy farmers in Australia. Increased investment has the potential to not only minimize the burden of injury and costs to dairy farmers, but will also significantly reduce the devastating impacts that these incidents have on individuals, their families and communities.
Khamis, Assem M; Hakoum, Maram B; Bou-Karroum, Lama; Habib, Joseph R; Ali, Ahmed; Guyatt, Gordon; El-Jardali, Fadi; Akl, Elie A
The requirements of the health policy and services journals for authors to report their financial and non-financial conflicts of interest (COI) are unclear. The present article aims to assess the requirements of health policy and services journals for authors to disclose their financial and non-financial COIs. This is a cross-sectional study of journals listed by the Web of Science under the category of 'Health Policy and Services'. We reviewed the 'Instructions for Authors' on the journals' websites and then simulated the submission of a manuscript to obtain any additional relevant information made available during that step. We abstracted data in duplicate and independently using a standardised form. Out of 72 eligible journals, 67 (93%) had a COI policy. A minority of policies described how the disclosed COIs of authors would impact the editorial process (34%). None of the policies had clear-cut criteria for rejection based on the content of the disclosure. Approximately a fifth of policies (21%) explicitly stated that inaccurate or incomplete disclosures might lead to manuscript rejection or retraction. No policy described whether the journal would verify the accuracy or completeness of authors' disclosed COIs. Most journals' policies (93%) required the disclosure of at least one form of financial COI. While the majority asked for specification of source of payment (71%), a minority asked for the amount (18%). Overall, 81% of policies explicitly required disclosure of non-financial COIs. A majority of health policy and services journal policies required the disclosure of authors' financial and non-financial COIs, but few required details on disclosed COIs. Health policy journals should provide specific definitions and instructions for disclosing non-financial COIs. A framework providing clear typology and operational definitions of the different types of COIs will facilitate both their disclosure by authors and reviewers and their assessment and management by
... office financial services from India and the Philippines. Based on these findings, the Department is..., Financial Shared Services West, Including On- Site Leased Workers From Aerotek, eXcel Staffing, Experis..., applicable to workers of Cardinal Health, Financial Shared Services West, including on-site leased workers...
DoD health care managers should read this report. Military health care data is used for a variety of critical purposes, including managing patient care, determining the optimal health care system, and for financial management...
Full Text Available Research demonstrates an association between poverty and health. Populations in poverty suffer from poor mental and physical health, and thus, poor health-related quality of life. Research also indicates people living in the lower socio-economic categories experience higher levels of stress that are associated with these health declines. Family Scholar House, a local community intervention designed to alleviate poverty and improve socio-economic status by providing college education and support to single parents, combats these health outcomes by addressing the five social determinants of health (economic stability, education, social and community context, health care, and neighborhood and built environment. Quantitative analysis indicates an improvement in mental health among Family Scholar House participants: 0-12 month participants reported significantly more mentally unhealthy days than a control group; however, this difference is no longer significant at the end of participant’s time in the program. Qualitative analysis suggests this improvement may be due to stress reduction related to increased economic stability and financial security gained through an intentional implementation of a financial empowerment curriculum within the Family Scholar House program. Implementation of financial empowerment into community programs designed to alleviate poverty may improve mental health and thus health-related quality of life.
Full Text Available After many reforms of the Polish health care system, the current entity responsible for financing medical services to the insured patients is the National Health Fund. Despite the constantly increasing funds being allocated to the health care system, it still remains underfunded. A tool that facilitates the evaluation and assessment of the viability, stability and profitability of a business is called the financial analysis. The primary source of data necessary for the preparation of the financial analysis comes from the financial statement which includes the balance sheets, profit and loss account, notes, cash flow statement, and statement of changes in equity. On the basis of the information contained in these documents one can understand the structure of assets, earnings, revenues and expenses, as well as the level of indebtedness and liquidity. The National Health Fund has a monopoly on the health insurance market. Therefore, the financial management conducted by this entity should be based on the rationalization of the expenditure in terms of revenue and stable income generation. The financial analysis carried out between 2005 and 2011 showed that the total assets of the entity were dominated by the current assets which can be justified by the nature of the business. The structure of equity relative compared to the foreign capital did not show positive trends. Since 2009, the bad financial situation was manifested by the profit and loss accounts, which reached negative values and costs exceeding the revenue. The ratio analysis showed a high debt rates experienced by the health care payers. At the same time, however, the liquidity has been maintained.
It becomes a great concern if mental health status has something to do with high sexual risk behaviour in this population. For a more specific and dynamic intervention in reducing cases of HIV and AIDS in Nigeria, the study therefore examines depression, anxiety and stress as mental health variables influencing sexual risk ...
Awunyo-Vitor, Dadson; Al-Hassan, Ramatu M.; Sarpong, Daniel B.
The study examined maize farmers’ participation in the formal financial market and its impact on farm size and expenditure on variable farm inputs. A multistage sampling method was used in selecting 595 maize farmers from the seven districts in Ashanti and Brong Ahafo Regions of Ghana. A structured questionnaire and interview schedule were used to elicit information from the respondents. The impact of formal financial market participation on farm size and expenditure on variable inputs was es...
Friedman, Lee; Friedman, Michael
To date, there is no comprehensive analysis of the relationship between financial conflict of interest (COI) and a potential publication bias in environmental and occupational health studies. We analyzed original research articles published in 2012 in 17 peer-reviewed journals. Multivariable ordinal logistic regression models were developed to evaluate the relationship between financial COI and the study outcome. Of the 373 studies included in the analysis, 17.2% had a financial COI associated with organizations involved with the processing, use, or disposal of industrial and commercial products, and studies with this type of COI were more likely to report negative results (Adjusted Odds Ratio = 4.31), as were studies with any COI associated with the military (employment or funding; Adjusted Odds Ratio = 9.15). Our findings show a clear relationship between direction of reported findings and specific types of financial COI.
Wiysonge, Charles S; Paulsen, Elizabeth; Lewin, Simon; Ciapponi, Agustín; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Oxman, Andrew D
Background One target of the Sustainable Development Goals is to achieve "universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". A fundamental concern of governments in striving for this goal is how to finance such a health system. This concern is very relevant for low-income countries. Objectives To provide an overview of the evidence from...
Baisunova, G; Turdaliyeva, B; Tulebayev, K; Zagulova, D
Aim of the study was to explore the relationships between health literacy (HL) and financial wellbeing in residents of Almaty oblast (region). The survey was conducted among 826 residents of Almaty region aged 18 y.o. Over 56.5% were female residents. To estimate health literacy, self assessed health, financial wellbeing and attitude towards health /work -questionnaire HLS-EU-Q was used. The results confirmed a significant relationship between financial wellbeing, health literacy and health outcomes residents of Almaty region. Relationships between HL and self- assessed health and attitudes towards health /work balance were observed only in respondents with low financial deprivation index, in respondents with low financial wellbeing (high financial deprivation index) no such relationships were observed. Higher financial deprivation index and lower health literacy were observed in respondents for whom work meant more than health. Lower financial deprivation index and higher health literacy were in those respondents for whom health meant more than work. Improvement of HL and motivation for healthy behavior are important challenges for public health. To answer them population's financial wellbeing improvement alone is not enough, as complex change of consumer behavior in healthcare system is needed. HL enhancing in disadvantaged population groups should inform about possibilities of free healthcare services, medications and about the structure of public healthcare service.
Vianna, Cid Manso de Mello; Caetano, Rosângela; Ortega, José Antonio; Façanha, Luiz Otávio de Figueiredo; Mosegui, Gabriela Bittencourt Gonzalez; Siqueira, Marien; Costa, Tiago Barros
To map and measure the flows of financial resources for health research and development in Brazil for the years 2000-2002. After adapting the methodology developed for the Center for Economic Policy Research, data were collected on the sources and uses of resources for health research and development. The annual average value of resources apportioned to health research and development was approximately 573 million US dollars. The public sector as a whole invested 417.3 million US dollars and the health department 51.1 million US dollars. Expressed in percentages, the public sector invested 4.15% of the health department's budget although the Ministry of Health assigned only 0.3% of its budget to health research in the country. The universities and the research institutes are the main users of the resources allocated to health research and development, receiving 91.6% of the total public spending, while the private sector receives a small share of around 0.69% of the total. The private sector invested 135.6 million US dollars per year, and the international organizations 20.1 million US dollars per year. Besides measuring the financial resources made available for health research and development, the results allowed the filling of gaps in national information; the identification of the flows of applied financial resources; and the testing and adaptation of the proposed methodology, generating information suitable for international comparisons.
Sílvia Maria Dias Pedro Rebouças
Full Text Available Advances in information technologies have led to the storage of large amounts of data by organizations. An analysis of this data through data mining techniques is important support for decision-making. This article aims to apply techniques for the classification of the beneficiaries of an operator of health insurance in Brazil, according to their financial sustainability, via their sociodemographic characteristics and their healthcare cost history. Beneficiaries with a loss ratio greater than 0.75 are considered unsustainable. The sample consists of 38875 beneficiaries, active between the years 2011 and 2013. The techniques used were logistic regression and classification trees. The performance of the models was compared to accuracy rates and receiver operating Characteristic curves (ROC curves, by determining the area under the curves (AUC. The results showed that most of the sample is composed of sustainable beneficiaries. The logistic regression model had a 68.43% accuracy rate with AUC of 0.7501, and the classification tree obtained 67.76% accuracy and an AUC of 0.6855. Age and the type of plan were the most important variables related to the profile of the beneficiaries in the classification. The highlights with regard to healthcare costs were annual spending on consultation and on dental insurance.
Full Text Available Out-of-pocket payments in health care have been shown to impose significant burden on households in Sub-Saharan Africa, leading to constrained access to health care and impoverishment. In an effort to reduce the financial burden imposed on households by user fees, some countries in Sub-Saharan Africa have abolished user fees in the health sector. Zambia is one of few countries in Sub-Saharan Africa to abolish user fees in primary health care facilities with a view to alleviating financial burden of out-of-pocket payments among the poor. The main aim of this paper was to examine the extent and patterns of financial protection from fees following the decision to abolish user fees in public primary health facilities.Our analysis is based on a nationally representative health expenditure and utilization survey conducted in 2014. We calculated the incidence and intensity of catastrophic health expenditure based on households' out-of-pocket payments during a visit as a percentage of total household consumption expenditure. We further show the intensity of the problem of catastrophic health expenditure (CHE experienced by households.Our analysis show that following the removal of user fees, a majority of patients who visited public health facilities benefitted from free care at the point of use. Further, seeking care at public primary health facilities is associated with a reduced likelihood of incurring CHE after controlling for economic wellbeing and other covariates. However, 10% of households are shown to suffer financial catastrophe as a result of out-of-pocket payments. Further, there is considerable inequality in the incidence of CHE whereby the poorest expenditure quintile experienced a much higher incidence.Despite the removal of user fees at primary health care level, CHE is high among the poorest sections of the population. This study also shows that cost of transportation is mainly responsible for limiting the protective effectiveness of
Bassani, Diego G; Arora, Paul; Wazny, Kerri; Gaffey, Michelle F; Lenters, Lindsey; Bhutta, Zulfiqar A
Financial incentives are widely used strategies to alleviate poverty, foster development, and improve health. Cash transfer programs, microcredit, user fee removal policies and voucher schemes that provide direct or indirect monetary incentives to households have been used for decades in Latin America, Sub-Saharan Africa, and more recently in Southeast Asia. Until now, no systematic review of the impact of financial incentives on coverage and uptake of health interventions targeting children under 5 years of age has been conducted. The objective of this review is to provide estimates on the effect of six types of financial incentive programs: (i) Unconditional cash transfers (CT), (ii) Conditional cash transfers (CCT), (iii) Microcredit (MC), (iv) Conditional Microcredit (CMC), (v) Voucher schemes (VS) and (vi) User fee removal (UFR) on the uptake and coverage of health interventions targeting children under the age of five years. We conducted systematic searches of a series of databases until September 1st, 2012, to identify relevant studies reporting on the impact of financial incentives on coverage of health interventions and behaviors targeting children under 5 years of age. The quality of the studies was assessed using the CHERG criteria. Meta-analyses were undertaken to estimate the effect when multiple studies meeting our inclusion criteria were available. Our searches resulted in 1671 titles identified 25 studies reporting on the impact of financial incentive programs on 5 groups of coverage indicators: breastfeeding practices (breastfeeding incidence, proportion of children receiving colostrum and early initiation of breastfeeding, exclusive breastfeeding for six months and duration of breastfeeding); vaccination (coverage of full immunization, partial immunization and specific antigens); health care use (seeking healthcare when child was ill, visits to health facilities for preventive reasons, visits to health facilities for any reason, visits for health
Kilbourne, Amy M; Greenwald, Devra E; Hermann, Richard C; Charns, Martin P; McCarthy, John F; Yano, Elizabeth M
This study assessed the extent to which mental health leaders perceive their programs as being primarily accountable for monitoring general medical conditions among patients with serious mental illness, and it assessed associations with modifiable health system factors. As part of the Department of Veterans Affairs (VA) 2007 national Mental Health Program Survey, 108 mental health program directors were queried regarding program characteristics. Perceived accountability was defined as whether their providers, as opposed to external general medical providers, were primarily responsible for specific clinical tasks related to serious mental illness treatment or high-risk behaviors. Multivariable logistic regression was used to determine whether financial incentives or other system factors were associated with accountability. Thirty-six percent of programs reported primary accountability for monitoring diabetes and cardiovascular risk after prescription of second-generation antipsychotics, 10% for hepatitis C screening, and 17% for obesity screening and weight management. In addition, 18% and 27% of program leaders, respectively, received financial bonuses for high performance for screening for risk of diabetes and cardiovascular disease and for alcohol misuse. Financial bonuses for diabetes and cardiovascular screening were associated with primary accountability for such screening (odds ratio=5.01, pFinancial incentives to improve quality performance may promote accountability in monitoring diabetes and cardiovascular risk assessment within mental health programs. Integrated care strategies (co-location) might be needed to promote management of high-risk behaviors among patients with serious mental illness.
Jiang, Chunhong; Ma, Jingdong; Zhang, Xiang; Luo, Wujin
As the world's largest developing country, China has entered into the epidemiological phase characterized by high life expectancy and high morbidity and mortality from chronic diseases. Cardiovascular diseases, chronic obstructive pulmonary diseases, and malignant tumors have become the leading causes of death since the 1990s. Constant payments for maintaining the health status of a family member who has chronic diseases could exhaust household resources, undermining fiscal support for other necessities and eventually resulting in poverty. The purpose of this study is to probe to what degree health expenditure for chronic diseases can impoverish rural families and whether the New Cooperative Medical Scheme can effectively protect families with chronic patients against catastrophic health expenditures. We used data from the 4th National Health Services Survey conducted in July 2008 in China. The rural sample we included in the analysis comprised 39,054 households. We used both households suffering from medical impoverishment and households with catastrophic health expenditures to compare the financial protection for families having a chronic patient with different insurance coverage statuses. We used a logistic regression model to estimate the impact of different benefit packages on health financial protection for families having a chronic patient. An additional 10.53% of the families with a chronic patient were impoverished because of healthcare expenditure, which is more than twice the proportion in families without a chronic patient. There is a higher catastrophic health expenditure incidence in the families with a chronic patient. The results of logistic regression show that simply adding extra benefits did not reduce the financial risks. There is a lack of effective financial protection for healthcare expenditures for families with a chronic patient in rural China, even though there is a high coverage rate with the New Cooperative Medical Schemes. Given the
Economic events of the past year are beginning to create hardships for tens of thousands of Canadians. There are likely to be health effects as well, to the extent that unemployment and poverty rates rise. Conditions, however, will be much worse for those living in poorer countries. High-income countries are committing trillions of dollars in countercyclical spending and banking bail-outs. Poorer countries need to do the same, but lack the resources to do so. Yet foreign aid and fairer trade are widely expected to be among the first high-income country victims of the recession fallout as nations turn inwards and protectionist. This is neither good for global health nor necessary given the scale of untaxed (or unfairly taxed) wealth that could be harnessed for a truly global rescue package. Policy choices confront us. The Canadian public health community must hold our political leadership accountable for making those choices that will improve health globally and not further imperil the well-being of much of the world's population in efforts to secure our own future economic revival.
Rannan-Eliya, Ravindra P; Anuranga, Chamara; Manual, Adilius; Sararaks, Sondi; Jailani, Anis S; Hamid, Abdul J; Razif, Izzanie M; Tan, Ee H; Darzi, Ara
Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources. Project HOPE—The People-to-People Health Foundation, Inc.
Conradie, Christina Susanna; van der Merwe Smit, Eon; Malan, Daniel Pieter
The research objective was to test the hypothesis that corporate health and wellness contributed positively to South African companies' financial results. The past share market performance of eligible healthy companies, based on Discovery's Healthy Company Index, was tracked under three investment scenarios and compared with the market performance on the basis of the JSE FTSE All Share Index. The evidence supports the hypothesis that a culture of health and wellness provides a financial advantage, in so far as the portfolio of healthy companies consistently outperformed the market over the selected simulations. Given the limitations of the investigation, namely small sample size, the brevity of the period of investigation, and the reliance on accessibility sampling, the research provides the first and preliminary evidence supportive of the direct financial benefits of companies' wellness programs.
Duncan, Dustin T; Hyun Park, Su; Al-Ajlouni, Yazan A; Hale, Lauren; Jean-Louis, Girardin; Goedel, William C; Chaix, Basile; Elbel, Brian
Previous studies have identified an association between socioeconomic status and sleep health. While some research has studied this association among sexual minority groups, including men who have sex with men (MSM), they exclusively focused on US-based populations. The interplay between the two in shaping sleep health has not been previously examined on populations residing outside the US. This study considers both determinants, by investigating whether financial hardship is associated with sleep health among a sample of MSM in Paris, France. Broadcast advertisements were placed on a popular geosocial-networking smartphone application for MSM to direct users in Paris to a web-based survey measuring financial hardship and five dimensions of sleep health as well as socio-demographic characteristics. Modified Poisson models with robust error variance were computed to estimate risk ratios (RRs) and 95% confidence intervals (CI) for the associations between financial hardship and the following self-reported outcomes: 1) poor sleep quality, 2) short sleep duration; and 3) sleep problems. In total, 580 respondents completed the survey. In this sample, both financial hardship and poor sleep health were common - 45.5% reported that it was extremely, very, or somewhat difficult for them to meet their monthly payments on bills (referred to as "high financial hardship") and 30.1% rated their sleep as fairly bad or very bad (referred to as "poor sleep quality"). Multivariate models revealed that, compared to participants who reported low financial hardship, those who reported high financial hardship were more likely to report poor sleep quality (aRR: 1.35, 95% CI: 1.04, 1.77), to report problems falling asleep (aRR: 1.23, 95% CI: 1.02, 1.49), and to report problems staying awake in the daytime (aRR: 3.12, 95% CI: 1.83, 5.31). Future research should investigate whether this relationship is causal and determine whether interventions to reduce financial hardships could promote
Dustin T. Duncan
Full Text Available Previous studies have identified an association between socioeconomic status and sleep health. While some research has studied this association among sexual minority groups, including men who have sex with men (MSM, they exclusively focused on US-based populations. The interplay between the two in shaping sleep health has not been previously examined on populations residing outside the US. This study considers both determinants, by investigating whether financial hardship is associated with sleep health among a sample of MSM in Paris, France. Broadcast advertisements were placed on a popular geosocial-networking smartphone application for MSM to direct users in Paris to a web-based survey measuring financial hardship and five dimensions of sleep health as well as socio-demographic characteristics. Modified Poisson models with robust error variance were computed to estimate risk ratios (RRs and 95% confidence intervals (CI for the associations between financial hardship and the following self-reported outcomes: 1 poor sleep quality, 2 short sleep duration; and 3 sleep problems. In total, 580 respondents completed the survey. In this sample, both financial hardship and poor sleep health were common - 45.5% reported that it was extremely, very, or somewhat difficult for them to meet their monthly payments on bills (referred to as “high financial hardship” and 30.1% rated their sleep as fairly bad or very bad (referred to as “poor sleep quality”. Multivariate models revealed that, compared to participants who reported low financial hardship, those who reported high financial hardship were more likely to report poor sleep quality (aRR: 1.35, 95% CI: 1.04, 1.77, to report problems falling asleep (aRR: 1.23, 95% CI: 1.02, 1.49, and to report problems staying awake in the daytime (aRR: 3.12, 95% CI: 1.83, 5.31. Future research should investigate whether this relationship is causal and determine whether interventions to reduce financial hardships
Riley, William; Briggs, Jill; McCullough, Mac
This study presents a model for determining total funding needed for individual local health departments. The aim is to determine the financial resources needed to provide services for statewide local public health departments in Minnesota based on a gaps analysis done to estimate the funding needs. We used a multimethod analysis consisting of 3 approaches to estimate gaps in local public health funding consisting of (1) interviews of selected local public health leaders, (2) a Delphi panel, and (3) a Nominal Group Technique. On the basis of these 3 approaches, a consensus estimate of funding gaps was generated for statewide projections. The study includes an analysis of cost, performance, and outcomes from 2005 to 2007 for all 87 local governmental health departments in Minnesota. For each of the methods, we selected a panel to represent a profile of Minnesota health departments. The 2 main outcome measures were local-level gaps in financial resources and total resources needed to provide public health services at the local level. The total public health expenditure in Minnesota for local governmental public health departments was $302 million in 2007 ($58.92 per person). The consensus estimate of the financial gaps in local public health departments indicates that an additional $32.5 million (a 10.7% increase or $6.32 per person) is needed to adequately serve public health needs in the local communities. It is possible to make informed estimates of funding gaps for public health activities on the basis of a combination of quantitative methods. There is a wide variation in public health expenditure at the local levels, and methods are needed to establish minimum baseline expenditure levels to adequately treat a population. The gaps analysis can be used by stakeholders to inform policy makers of the need for improved funding of the public health system.
Yarbro, Jessica L; Mehlenbeck, Robyn
This article addresses a current need in psychological practice by describing a financially feasible model that moves toward integrated care of behavioral health services in a pediatric endocrinology clinic. Financial information (costs and revenue associated with behavioral health services) for the clinic, over an 18-month period (July 2012 to December 2013), was obtained through the hospital's financial department. The clinic meets one half day per week. Over the 18-month period, the behavioral health services generated a net gain of $3661.45 in the favor of the clinic. We determined that the psychologist and clinical psychology residents needed to see a total of four patients per half-day clinic for the clinic to "break-even." We describe one financially feasible way of integrating behavioral health services into a pediatric endocrinology clinic in the hope that this will be generalizable to other medical settings. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: email@example.com.
Ruckert, Arne; Labonté, Ronald
In this article, we interrogate the policy response of the International Monetary Fund (IMF) to the global financial crisis, and discuss the likely global health implications, especially in low-income countries. In doing so, we ask if the IMF has meaningfully loosened its fiscal deficit targets in light of the economic challenges posed by the financial crisis and adjusted its macro-economic policy advice to this new reality; or has the rhetoric of counter-cyclical spending failed to translate into additional fiscal space for IMF loan-recipient countries, with negative health consequences? To answer these questions, we assess several post-crisis IMF lending agreements with countries requiring financial assistance, and draw upon recent academic studies and civil society reports examining policy conditionalities still being prescribed by the IMF. We also reference recent studies examining the health impacts of these conditionalities. We demonstrate that while the IMF has been somewhat more flexible in its crisis response than in previous episodes of financial upheaval, there has been no meaningful rethinking in the application of dominant neoliberal macro-economic policies. After showing some flexibility in the initial crisis response, the IMF is pushing for excessive contraction in most low and middle-income countries. We conclude that there remains a wide gap between the rhetoric and the reality of the IMF's policy and programming advice, with negative implications for global health.
Wind, A. de; Geuskens, G.A.; Ybema, J.F.; Blatter, B.M.; Burdorf, A.; Bongers, P.M.; Beek, A.J. van der
Objectives The aim of this study was to investigate the relative contribution of health, job characteristics, skills and knowledge, social factors, and financial factors to the transition from work to early retirement. Methods Employees aged 59–63 years (N=2317) were selected from the Study on
Tucker-Seeley, Reginald D.; Harley, Amy E.; Stoddard, Anne M.; Sorensen, Glorian G.
Background: Self-rated health (SRH) has been shown to be predictive of morbidity and mortality. Evidence also shows that SRH is socioeconomically patterned, although this association differs depending on the indicator of socioeconomic status used. The purpose of this study was to determine the association between SRH and financial hardship among…
Buckingham-Howes, Stacy; Holmes, Katherine; Glenn Morris, J; Grattan, Lynn M
The economic impact of disasters is well known; however, the link between financial loss and behavioral health problems is unknown. Participants included 198 adults of ages 21 to 82, living within 10 miles of the Gulf Coast during the Deepwater Horizon Oil Spill and were involved in the fishing, harvesting, seafood processing, or service/tourism industries. The functional impact of financial resource loss at 2.5 years post spill was measured using the 26-item Financial Life Events Checklist (FLEC). Individuals responded to financial distress by reducing social events and utility bills and changing food-shopping habits. The FLEC significantly predicted higher drug use (Drug Abuse Screening Test), alcohol use (Alcohol Use Disorders Identification Test), mood problems (Profile of Mood States), and depressive symptoms (Beck Depression Inventory II) (p values ≤ 0.05) 4.5 years after the spill. This preliminary study supports the notion that the functional impact of financial loss has a long-term impact on behavioral health after an oil spill.
Dulin, Mary Katherine; Olive, Kenneth E; Florence, Joseph A; Sliger, Carolyn
There has been little discussion in the literature regarding the financial value of the services provided to the participants in health fairs. This article examines the financial value of preventive services provided through a community health fair in an economically depressed area of southwest Virginia. Current Procedural Terminology codes were assigned to the services provided in order to estimate costs participants might incur for such services. An average 50-year-old man would have paid up to $320 to obtain commonly recommended preventive services available free at the fair. An average 50-year-old woman would have paid up to $495. Overall, over $58,000 in services were provided through the health fair. This community health fair provided preventive services that many participants otherwise might have found to be cost-prohibitive.
Full Text Available Autonomy of public health insurance scheme comprises political, financial, organizational, normative and contractual aspects. The paper analyses the role and position of a health insurance scheme (HIS within the overall healthcare system in Albania, the relationship to all other institutions, stakeholders and actors. By analyesing published literature and collected data through secondary sources, the paper focuses on financial autonomy, which refers first of all to a certain level of budgetary independence regarding source generation and spending on health services. For assuring effective and efficient performance of the single payer for health care services in Albania, need effective changes in the legislation do take into account the various levels of autonomy mentioned above.
Noorein Inamdar, S
Use theory and data to examine the scope of corporate strategies for multibusiness health care firms, also known as organized or integrated health care delivery systems. Data are from the 2000 HIMSS Analytics Annual Survey of integrated health care delivery systems (IHDS), which provides complete information on businesses owned by IHDS. Scope defined as the breadth and type of businesses in which a firm chooses to compete is measured across seven separate business areas: (1) health plans, (2) ambulatory, (3) acute, (4) subacute, (5) home health, (6) other related nonpatient care businesses, and (7) external collaborations. Theories on strategy and organizational configurations along with measures of scope and a novel dataset were used to classify 796 firms into five mutually exclusive groups. The bases for classification were two competitive dimensions of scope: (1) breadth of businesses and (2) mix of existing core businesses versus new noncore businesses. Unit of analysis is the multibusiness health care firm. Sample consists of 796 firms, defined as nonprofit organizations that own two or more direct patient care businesses in two or more separate areas across the health care value chain. Firms were clustered into five mutually exclusive organizational configurations with unique scope characteristics revealing a new taxonomy of corporate strategies. Analysis of the scope variables revealed five strategic types (along with the number of firms and distinguishing features of each strategy) defined as follows: (1) Core Service Provider (340 firms with the smallest scope providing core set of patient care services), (2) Mission Based (52 firms with the next smallest scope offering core set of services to underserved populations), (3) Contractor (266 firms with medium scope and contracting with physician groups), (4) Health Plan Focus (83 firms with large scope and providing health plans), and (5) Entrepreneur (55 firms with the largest scope offering both a core set
Nour, Sabrina; Labonté, Ronald; Bancej, Christina
Despite a clear impact on the Canadian economy, little is known about the subsequent health impacts of the 2008 global financial crisis (GFC) in this country. This study fills this gap in knowledge by conducting a repeated cross-sectional analysis of the Canadian Community Health Survey (CCHS). Data from 7 cycles (2007-2013) of the CCHS were combined to form a large data set representative of the Canadian working-age population (15-64 years) residing in 1 of 10 provinces. A logistic regression model was used to determine whether exposure to various periods of the GFC resulted in increased odds of reporting poor mental health. Exposure was categorised into 4 periods based on political and economic indicators, as follows: precrisis period (baseline), initial crisis period, stimulus period and austerity period. Other outcomes investigated included: anxiety disorders (AD), mood disorders (MD), poor physical health and health-related behaviours (heavy alcohol drinking (HAD) and decreased fruit/vegetable consumption (FVC)). A significant increased odds of reporting poor mental health was observed during the austerity period compared with the precrisis period (OR=1.26 (1.16 to 1.32)); findings remain significant when adjusted for sex, marital status and education. Exposure to the austerity period was also significantly associated with increased odds of reporting AD, MD, HAD and decreased odds of FVC. No significant associations were observed for the poor self-perceived physical health variable. Statistically significant associations were observed between several negative health outcomes and the austerity period when compared with the precrisis period. Austerity has been linked to worsening health in other studies and represents an example of how the policy response can have greater detrimental impact on health than the financial crisis itself. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
Lambert-Evans, Sophie; Ponsar, Frederique; Reid, Tony; Bachy, Catherine; Van Herp, Michel; Philips, Mit
In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty.
Pearson, Steven D; Lieber, Sarah R
As health care costs continue to rise, an increasing number of self-insured employers are using financial rewards or penalties to promote healthy behavior and control costs. These incentive programs have triggered a backlash from those concerned that holding employees responsible for their health, particularly through the use of penalties, violates individual liberties and discriminates against the unhealthy. This paper offers an ethical analysis of employee health incentive programs and presents an argument for a set of conditions under which penalties can be used in an ethical and responsible way to contain health care costs and encourage healthy behavior among employees.
Vujicic, Marko; Buchmueller, Thomas; Klein, Rachel
The Affordable Care Act is improving access to and the affordability of a wide range of health care services. While dental care for children is part of the law's essential health benefits and state Medicaid programs must cover it, coverage of dental care for adults is not guaranteed. As a result, even with the recent health insurance expansion, many Americans face financial barriers to receiving dental care that lead to unmet oral health needs. Using data from the 2014 National Health Interview Survey, we analyzed financial barriers to a wide range of health care services. We found that irrespective of age, income level, and type of insurance, more people reported financial barriers to receiving dental care, compared to any other type of health care. We discuss policy options to address financial barriers to dental care, particularly for adults. Project HOPE—The People-to-People Health Foundation, Inc.
Albertus Girik Allo
Institution has been investigated having indirect role on economic growth. This paper aims to evaluate whether the quality of institution matters for economic growth. By applying institution as instrumental variable at Foreign Direct Investment (FDI), quality of institution significantly influence economic growth. This study applies two set of data period, namely 1985-2013 and 2000-2013, available online in the World Bank (WB). The first data set, 1985-2013 is used to estimate the role of fin...
Ifende, V I; Derks, M; Hooijer, G A; Hogeveen, H
Veterinary herd health management (VHHM) programmes have been shown to be economically effective in the past. However, no current information is available on costs and benefits of these programmes. This study compared economics and farm performance between participants and non-participants in VHHM programmes in 1013 dairy farms with over 40 cows. Milk Production Registration (MPR) data and a questionnaire concerning VHHM were used. Based on the level of participation in VHHM (as indicated in the questionnaire), costs of the programmes were calculated using a normative model. The economic value of the production effects was similarly calculated using normative modelling based on MPR data. Participants in VHHM had a better performance with regard to production, but not with regard to reproduction. Over 90 per cent of the VHHM participants were visited at least once every six weeks and most participants discussed at least three topics. In most farms, the veterinarian did the pregnancy checks as part of the VHHM programmes. There was a benefit to cost ratio of about five per cow per year for VHHM participants, and a mean difference in net returns of €30 per cow per year after adjusting for the cost of the programme. This portrays that participation in a VHHM programme is cost-efficient. There is, however, much unexplained variation in the net returns, possibly due to diverse approaches by veterinarians towards VHHM or by other factors not included in this analysis, like nutritional quality or management abilities of the farmer. British Veterinary Association.
This paper reports the results of a study to investigate the relative influence of some sociodemographic variables on oral hygiene and health of primary school children in Ibadan, Nigeria. The pupils were from two different socioeconomic strata of the society and their ages ranged between 7 and 16 years. They were ...
Dieleman, Joseph L; Schneider, Matthew T; Haakenstad, Annie; Singh, Lavanya; Sadat, Nafis; Birger, Maxwell; Reynolds, Alex; Templin, Tara; Hamavid, Hannah; Chapin, Abigail; Murray, Christopher J L
Disbursements of development assistance for health (DAH) have risen substantially during the past several decades. More recently, the international community's attention has turned to other international challenges, introducing uncertainty about the future of disbursements for DAH. We collected audited budget statements, annual reports, and project-level records from the main international agencies that disbursed DAH from 1990 to the end of 2015. We standardised and combined records to provide a comprehensive set of annual disbursements. We tracked each dollar of DAH back to the source and forward to the recipient. We removed transfers between agencies to avoid double-counting and adjusted for inflation. We classified assistance into nine primary health focus areas: HIV/AIDS, tuberculosis, malaria, maternal health, newborn and child health, other infectious diseases, non-communicable diseases, Ebola, and sector-wide approaches and health system strengthening. For our statistical analysis, we grouped these health focus areas into two categories: MDG-related focus areas (HIV/AIDS, tuberculosis, malaria, child and newborn health, and maternal health) and non-MDG-related focus areas (other infectious diseases, non-communicable diseases, sector-wide approaches, and other). We used linear regression to test for structural shifts in disbursement patterns at the onset of the Millennium Development Goals (MDGs; ie, from 2000) and the global financial crisis (impact estimated to occur in 2010). We built on past trends and associations with an ensemble model to estimate DAH through the end of 2040. In 2015, US$36·4 billion of DAH was disbursed, marking the fifth consecutive year of little change in the amount of resources provided by global health development partners. Between 2000 and 2009, DAH increased at 11·3% per year, whereas between 2010 and 2015, annual growth was just 1·2%. In 2015, 29·7% of DAH was for HIV/AIDS, 17·9% was for child and newborn health, and 9·8
Ehn, Mattias; Wahlqvist, Moa; Danermark, Berth; Dahlström, Örjan; Möller, Claes
Research has demonstrated that persons with Usher syndrome type 1 (USH1) have significantly poorer physical and psychological health compared to a reference group. To explore the relation between work, health, social trust, and financial situation in USH1 compared to a reference group. Sixty-six persons (18-65 y) from the Swedish Usher database received a questionnaire and 47 were included, 23 working and 24 non-working. The reference group comprised 3,049 working and 198 non-working persons. The Swedish Health on Equal Terms questionnaire was used and statistical analysis with multiple logistic regression was conducted. The USH1 non-work group had a higher Odds ratio (95% CI) in poor psychological and physical health, social trust, and financial situation compared to the USH1 work group and reference groups. Age, gender, hearing, and vision impairment did not explain the differences. The relation between the USH1 work and non-work groups showed the same pattern as the reference groups, but the magnitude of problems was significantly higher. Both disability and unemployment increased the risk of poor health, social trust and financial situation in persons with USH1, but having an employment seemed to counteract the risks related to disability.
Portela, Gustavo Zoio; Ribeiro, José Mendes
The universalization of basic care and commitment budget of the Ministry of Health with the Family Health Strategy (ESF) through new systematic financing incentives have been highlighted in the Brazilian health policy scenario. One of the great problems observed is the expansion of the strategy for large urban centres. This paper studies the economic-financial sustainability of ESF in Brazilian municipalities of more than 100 thousand inhabitants according to some selected indicators, considering the geographical region to which they belong, their population size and participation in Project for the Expansion and Consolidation Family Health (Proesf). Municipalities belonging to the Southeast region, more developed of the country, have on average better economic-financial performance, but lower average values of coverage of ESF. Municipalities from the North and Northeast, with the lowest average for economic-financial sustainability indicators, were the ones that made more effort to developments in the period. Thus, we observed the dynamics between bigger fiscal capacity and budgetary commitment with the Health Sector for biggest municipalities and in more economically developed regions, and greater vulnerability and dependence of federative transferences for municipalities with less people, in less developed areas.
Stuckler, David; Basu, Sanjay
In April 2009, the G20 countries committed US $750 billion to the International Monetary Fund (IMF), which has assumed a central role in global economic management. The IMF provides loans to financially ailing countries, but with strict conditions, typically involving a mix of privatization, liberalization, and fiscal austerity programs. These loan conditions have been extremely controversial. In principle, they are designed to help countries balance their books. In practice, they often translate into reductions in social spending, including spending on public health and health care delivery. As more countries are being exposed to IMF policies, there is a need to establish what we know and do not know about the IMF's effects on global health. This article introduces a series in which contributors review the evidence on the relationship between the IMF and public health and discuss potential ways to improve the Fund's effects on health. While more evidence is needed for some regions, there is sufficient evidence to indicate that IMF programs have been significantly associated with weakened health care systems, reduced effectiveness of health-focused development aid, and impeded efforts to control tobacco, infectious diseases, and child and maternal mortality. Reforms are urgently needed to prevent the current wave of IMF programs from further undermining public health in financially ailing countries and limiting progress toward the health Millennium Development Goals.
Jegede, Kolawole A; Ju, Brian; Miller, Christopher P; Whang, Peter; Grauer, Jonathan N
In the study reported here, we compared self-reported industry relationships of authors who attended 3 major orthopedic sports medicine conferences during a single calendar year. Our goal was to calculate the variability between disclosure information over time. A significant percentage of authors who attended these meetings were inconsistent in submitting their disclosure information. In addition, most authors with irregularities had more than 1 discrepancy. We believe that the vast majority of the observed discrepancies did not result from intentional deception on the part of the authors but instead from ongoing confusion regarding which industry relationships should be acknowledged for particular meetings (some specialty societies require that all relationships be divulged, whereas others require only those affiliations directly applicable to research being presented). In the absence of a uniform disclosure policy that is widely adopted by many specialty societies, these findings suggest that the disclosure process will continue to be plagued by inconsistent reporting of financial conflicts of interest.
Lyudmila Valentinovna Tokun
Full Text Available This article discusses the features of the mandatory health insurance, the financial resources of health care and the characteristics of the Russian health care system. The article defines the need to apply the SWOT-analysis to the activities of medical organizations, it analyses the interconnection between the criteria of quality, availability and payment for services and their accordance to the sector of economics, which produces or pays for the service. Goal / Objectives: The goal of this article is to study the compulsory health insurance system, its pros and cons in the health system. The objectives of this paper is to identify the sources of financing of compulsory health insurance, the definition of the stages of formation of financial flows, the designation of the role of insurance companies in the compulsory health insurance system, the study of the processes of formation of funds of health insurance companies, the definition of the role of the compulsory health insurance in the risk protection and study of the positive and negative aspects of the modern health care system. Methodology: Methods of comparison, analysis and synthesis are used in this article. Results: as a result of the conducted research authors have made conclusions about the need for the major changes in the financing of public health care. The scope of work of health insurance companies requires increase in number of staff , premises, additional hardware and software. Health insurance companies should be motivated to maintain the health of the population and its improvement. Conclusions: The results of this research can be used to build a system of motivation in the health insurance organizations.
Turingan, Erin M; Mekoba, Bijan C; Eberwein, Samuel M; Roberts, Patricia A; Pappas, Ashley L; Cruz, Jennifer L; Amerine, Lindsey B
Background: Drug manufacturers change distribution models based on patient safety and product integrity needs. These model changes can limit health-system access to medications, and the financial impact on health systems can be significant. Objective: The primary aim of this study was to determine the health-system financial impact of a manufacturer's change from open to limited distribution for bevacizumab (Avastin), rituximab (Rituxan), and trastuzumab (Herceptin). The secondary aim was to identify opportunities to shift administration to outpatient settings to support formulary change. Methods: To assess the financial impact on the health system, the cost minus discount was applied to total drug expenditure during a 1-year period after the distribution model change. The opportunity analysis was conducted for three institutions within the health system through chart review of each inpatient administration. Opportunity cost was the sum of the inpatient administration cost and outpatient administration margin. Results: The total drug expenditure for the study period was $26 427 263. By applying the cost minus discount, the financial effect of the distribution model change was $1 393 606. A total of 387 administrations were determined to be opportunities to be shifted to the outpatient setting. During the study period, the total opportunity cost was $1 766 049. Conclusion: Drug expenditure increased for the health system due to the drug distribution model change and loss of cost minus discount. The opportunity cost of shifting inpatient administrations could offset the increase in expenditure. It is recommended to restrict bevacizumab, rituximab, and trastuzumab through Pharmacy & Therapeutics Committees to outpatient use where clinically appropriate.
Kusi, Anthony; Hansen, Kristian Schultz; Asante, Felix A; Enemark, Ulrika
Excessive healthcare payments can impede access to health services and also disrupt the welfare of households with no financial protection. Health insurance is expected to offer financial protection against health shocks. Ghana began the implementation of its National Health Insurance Scheme (NHIS) in 2004. The NHIS is aimed at removing the financial barrier to healthcare by limiting direct out-of-pocket health expenditures (OOPHE). The study examines the effect of the NHIS on OOPHE and how it protects households against catastrophic health expenditures. Data was obtained from a cross-sectional representative household survey involving 2,430 households from three districts across Ghana. All OOPHE associated with treatment seeking for reported illness in the household in the last 4 weeks preceding the survey were analysed and compared between insured and uninsured persons. The incidence and intensity of catastrophic health expenditures (CHE) among households were measured by the catastrophic health payment method. The relative effect of NHIS on the incidence of CHE in the household was estimated by multiple logistic regression analysis. About 36% of households reported at least one illness during the 4 weeks period. Insured patients had significantly lower direct OOPHE for out-patient and in-patient care compared to the uninsured. On financial protection, the incidence of CHE was lower among insured households (2.9%) compared to the partially insured (3.7%) and the uninsured (4.0%) at the 40% threshold. The incidence of CHE was however significantly lower among fully insured households (6.0%) which sought healthcare from NHIS accredited health facilities compared to the partially insured (10.1%) and the uninsured households (23.2%). The likelihood of a household incurring CHE was 4.2 times less likely for fully insured and 2.9 times less likely for partially insured households relative to being uninsured. The NHIS has however not completely eliminated OOPHE for the
.... The DoD Agency Wide financial statements include financial statements for a reporting entity called "Other Defense Organizations," a consolidation of financial information from various Defense...
In these financial difficult years many European governments used global ceilings to control costs of health services. Two scenarios are thinkable. The first is that all individual providers get a budget for their own costs: general practitioners, specialists, hospitals, nursing homes and mental health institutes. The second scenario is to work with global budgets for health care providers servicing a total population. Scientists and policy makers in Europe, North America and Asia need time to design new payment systems based on the idea of global budgeting, bundled payment and shared savings.
Bredenkamp, Caryn; Buisman, Leander R
The objective of this article is to assess the progress of the Philippines health sector in providing financial protection to the population, as measured by estimates of health insurance coverage, out-of-pocket spending, catastrophic payments and impoverishing health expenditures. Data are drawn from eight household surveys between 2000 and 2013, including two Demographic and Health Surveys, one Family Health Survey and five Family Income and Expenditure Surveys. We find that out-of-pocket spending increased by 150% (real) from 2000 to 2012, with the sharpest increases occurring in recent years. The main driver of health spending is medicines, accounting for almost two-thirds of total health spending, and as much as three-quarters among the poor. The incidence of catastrophic payments has tripled since 2000, from 2.5% to 7.7%. The percentage of people impoverished by health spending has also increased and, in 2012, out-of-pocket spending on health added 1.5 percentage points to the poverty rate, pushing more than 1.5 million people into poverty. In light of these findings, recent policies to enhance financial risk protection-such as the expansion of government-subsidized health insurance from the poor to the near-poor, a policy of zero copayments for the poor, a deepening of the benefit package and provider payment reform aimed at cost-containment-are to be commended. Indeed, between 2008 and 2013, self-reported health insurance coverage increased across all quintiles and its distribution became more pro-poor. To speed progress toward financial protection goals, quick wins could include issuing health insurance cards to the poor to increase awareness of coverage and limiting out-of-pocket spending by clearly defining a clear copayment structure for non-poor members. An in-depth analysis of the pharmaceutical sector would help to shed light on why medicines impose such a large financial burden on households. © The Author 2016. Published by Oxford University Press
Full Text Available The purpose of the paper is to analysis of the modern state of accounting of non-financial assets and present accounting in health institutions protection during the period of medical reforms. The account of nonfinancial assets has his specific in medical establishments. Reforms, which implemented in Ukraine, affecting the account of non-financial assets. Medical institutions relate to the General government. Methodology. The survey is based on a comparison of data from the national and international reforms in medical industry. Results of the survey showed that in the dictionary of V. Raizberg next determination is driven: "public sector – it is a set of business units, that carry out economic activity, are in a public domain, controlled by public authorities or designated and hired persons" (Raizberg, 1999. In the Commercial code of Ukraine it is indicated: "The subjects of public sector of economy are subjects that operate on the basis of only public domain, and also subjects, which state share in authorized capital exceeds fifty percents or be value that provides a right to the state for decisive influence on economic activity of these subjects" (СС, 2003. Practical implications. Public sector structure specifies data of International Public Sector Accounting Standards. Substancial load concept "public sector" in national and international practice are relevant (Poznyakovska, 2009. Accounting in health institutions has specific terms, inherent to the government sector. They are determined by the types of activity and terms of assignation (Pasichnik, 2005. Medical services must be accessible to all stratum of population. They must have free basis. They come forward as a public benefit independent of individual possibility to pay for him. Therefore lion's part of general charges for health protection is used on the grant of medical services to the population. At the same time "upgrading of medical services lies inplane providing of
Casper, Tim; Kindig, David A
The variation in health outcomes among communities results largely from different levels of financial and nonfinancial policy investments over time; these natural experiments should offer investment and policy guidance for a business model on population health. However, little such guidance exists. We examined the availability of data in a sample of Wisconsin counties for expenditures in selected categories of health care, public health, human services, income support, job development, and education. We found, as predicted by the National Committee on Vital and Health Statistics in 2002, that availability is often limited by the challenges of difficulty in locating useable data, a lack of resources among public agencies to upgrade information technology systems for making data more usable and accessible to the public, and a lack of enterprise-wide coordination and geographic detail in data collection efforts. These challenges must be overcome to provide policy-relevant information for optimal population health resource allocation.
Yarbrough, Wendell G; Sewell, Andrew; Tickle, Erin; Rhinehardt, Eric; Harkleroad, Rod; Bennett, Marc; Johnson, Deborah; Wen, Li; Pfeiffer, Matthew; Benegas, Manny; Morath, Julie
Hospital leaders lack tools to determine the financial impact of poor patient outcomes and adverse events. To provide health-care leaders with decision support for investments to improve care, we created a tool, the Healthcare Quality Calculator (HQCal), which uses institution-specific financial data to calculate impact of poor patient outcomes or quality improvement on present and future margin. Excel and Web-based versions of the HQCal were based on a cohort study framework and created with modular components including major drivers of cost and reimbursement. The Healthcare Quality Calculator (HQCal) compares payment, cost, and profit/loss for patients with and without poor outcomes or quality issues. Cost and payment information for groups with and without quality issues are used by the HQCal to calculate profit or loss. Importantly, institution-specific payment and cost data are used to calculate financial impact and attributable cost associated with poor patient outcomes, adverse events, or quality issues. Because future cost and reimbursement changes can be forecast, the HQCal incorporates a forward-looking component. The flexibility of the HQCal was demonstrated using surgical site infections after abdominal surgery and postoperative surgical airway complications. The Healthcare Quality Calculator determines financial impact of poor patient outcomes and the benefit of initiatives to improve quality. The calculator can identify quality issues that would provide the largest financial benefit if improved; however, it cannot identify specific interventions. The calculator provides a tool to improve transparency regarding both short- and long-term financial consequences of funding, or failing to fund, initiatives to close gaps in quality or improve patient outcomes.
Boyle, Patricia A; Yu, Lei; Wilson, Robert S; Segawa, Eisuke; Buchman, Aron S; Bennett, David A
Literacy is an important determinant of health and well-being across the life span but is critical in aging, when many influential health and financial decisions are made. Prior studies suggest that older persons exhibit lower literacy than younger persons, particularly in the domains of financial and health literacy, but the reasons why remain unknown. The objectives of this study were to: (a) examine pathways linking diverse resources (i.e., education, word knowledge, cognitive function, and decision making style) to health and financial literacy among older persons and determine the extent to which the relation of age with literacy represents a direct effect versus an indirect effect due to decrements in specific cognitive functions (i.e., executive functions and episodic memory); and (b) test the hypothesis that declines in executive function and episodic memory are associated with lower literacy among older persons without dementia. Six-hundred and forty-five community-based older persons without dementia underwent detailed assessments of diverse resources, including education, word knowledge, cognitive function (i.e., executive function, episodic memory) and decision making style (i.e., risk aversion), and completed a measure of literacy that included items similar to those used in the Health and Retirement Study, such as numeracy, financial concepts such as compound inflation and knowledge of stocks and bonds, and important health concepts such as understanding of drug risk and Medicare Part D. Path analysis revealed a strong effect of age on literacy, with about half of the effect of age on literacy due to decrements in executive functions and episodic memory. In addition, executive function had an indirect effect on literacy via decision making style (i.e., risk aversion), and education and word knowledge had independent effects on literacy. Finally, among (n = 447) persons with repeated cognitive assessments available for up to 14 years, regression
Wiysonge, Charles S; Paulsen, Elizabeth; Lewin, Simon; Ciapponi, Agustín; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Oxman, Andrew D
Background One target of the Sustainable Development Goals is to achieve "universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". A fundamental concern of governments in striving for this goal is how to finance such a health system. This concern is very relevant for low-income countries. Objectives To provide an overview of the evidence from up-to-date systematic reviews about the effects of financial arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on financial arrangements, and informing refinements in the framework for financial arrangements presented in the overview. Methods We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language, or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of financial arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment, or financial burden of patients, e.g. out-of-pocket payment, catastrophic disease expenditure) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries. Main results We
Kouser, Shahzad; Qaim, Matin
Data from a farm survey and choice experiment are used to value the benefits of Bt cotton in Pakistan. Unlike previous research on the economic impacts of Bt, which mostly concentrated on financial benefits in terms of gross margins, we also quantify and monetize positive externalities associated with technology adoption. Due to lower chemical pesticide use on Bt cotton plots, there are significant health advantages in terms of reduced incidence of acute pesticide poisoning, and environmental...
Mita Giacomini; Jeremiah Hurley; J Lomas; V Bhatia; L Goldsmith
Health funding reforms often fail to change organizations’ and individuals’ behaviour in the way that policy makers intend. This is perhaps because financial incentive systems traditionally have been designed according to a “reward-punishment,” or behaviourist, model of influencing human behaviour. We argue that this model inadequately captures the way that funding reforms work in real institutional environments. To supplement the behaviourist view, we propose a “communication model” for unde...
This study assessed 11 determinants of health coaching program participation. A cross-sectional study design used secondary data to assess the role of six employee-level and five worksite-level variables on telephone-based coaching enrollment, active participation, and completion. Data was provided by a national provider of worksite health promotion program services for employers. A random sample of 34,291 employees from 52 companies was selected for inclusion in the study. Survey-based measures included age, gender, job type, health risk status, tobacco risk, social support, financial incentives, comprehensive communications, senior leadership support, cultural support, and comprehensive program design. Gender-stratified multivariate logistic regression models were applied using backwards elimination procedures to yield parsimonious prediction models for each of the dependent variables. Employees were more likely to enroll in coaching programs if they were older, female, and in poorer health, and if they were at worksites with fewer environmental supports for health, clear financial incentives for participation in coaching, more comprehensive communications, and more comprehensive programs. Once employees were enrolled, program completion was greater among those who were older, did not use tobacco, worked at a company with strong communications, and had fewer environmental supports for health. Both worksite-level and employee-level factors have significant influences on health coaching engagement, and there are gender differences in the strength of these predictors.
Angeli, Federica; Maarse, Hans
Recent policy developments in Western European health care - for example in the Netherlands - aim to enhance efficiency and curb public expenditures by strengthening the role of private sector. Mergers and acquisitions (M&As) play an important role in this respect. This article presents an analysis of 1606 acquisition deals targeting health care provider organizations in Western Europe between 1990 and 2009. We particularly investigate the role of financial services organisations as acquirers. Our analysis highlights (a) a rise of M&As in Western Europe since 2000, (b) an increase of M&As with financial service organisations acting as acquirer in absolute terms, and (c) a dominant role of the latter type of M&As in cross-border deals. To explain these developments, we make a distinction between an integration and a diversification rationale for M&As and we argue that the deals with financial services organisations in the role of acquirer are driven by a diversification rationale. We then provide arguments why health care, from the acquirer's perspective, can be considered as an interesting target in a diversification strategy and we advance reasons why health care providers may welcome this development. Although caution in drawing conclusions is needed, our findings suggest a penetration of private capital into health care provision that may be interpreted as a specific form of privatisation. Furthermore, they point to a rising internationalisation of health care. Both findings may entail far-reaching implications for health care, as they may induce both cultural privatisation and cultural internationalisation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
McPake, Barbara; Witter, Sophie; Ensor, Tim; Fustukian, Suzanne; Newlands, David; Martineau, Tim; Chirwa, Yotamu
The last decade has seen widespread retreat from user fees with the intention to reduce financial constraints to users in accessing health care and in particular improving access to reproductive, maternal and newborn health services. This has had important benefits in reducing financial barriers to access in a number of settings. If the policies work as intended, service utilization rates increase. However this increases workloads for health staff and at the same time, the loss of user fee revenues can imply that health workers lose bonuses or allowances, or that it becomes more difficult to ensure uninterrupted supplies of health care inputs.This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health. We undertook case studies in five countries (Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe). In each we reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors. We question a number of common assumptions about the financing and human resource inter-relationships. The impact of fee removal on utilization levels is mostly not sustained or supported by all the evidence. Shortages of human resources for health at the national level are not universal; maldistribution within countries is the greater problem. Low salaries are not universal; most of the countries pay health workers well by national benchmarks. The interconnectedness between user fee policy and HRH situations proves difficult to assess. Many policies have been changing over the relevant period, some clearly and others possibly in response to problems identified associated with financing policy change. Other relevant variables have also changed.However, as is now well
The rational planning and financing of occupational health services at the national level have to be based on an appropriate system of information about individual units and their financial status that could illustrate their financial administration. This is required not only in view of the internal needs of public money management, but also in view of the national health accounts. The major task in this regard is to assess the level and structure of financing to individual units and to check the soundness of criteria used in the process of supplying financial means. The results of such an analysis can be a valuable source of information for planning carried out also by the institutions which provide funds to cover the cost of tasks performed by individual units. The aim of the project implemented by the Nofer Institute of Occupational Medicine was to collect, process and analyze data on the level and structure of financing of provincial occupational medicine centers. In this paper, the objectives, methodology and analytical tools are discussed. The results and structural data on the level and structure of financing of regional occupational health services centers covering a two-year period are presented. At the same time, the criteria for allocating funds were identified, which made it possible to evaluate the situation and to propose new solutions.
Smith, Pam; Mackintosh, Maureen; Ross, Fiona; Clayton, Julie; Price, Linnie; Christian, Sara; Byng, Richard; Allan, Helen
This paper examines how the interaction between financial and clinical risk at two critical phases of health care reform in England has been experienced by frontline staff caring for vulnerable patients with long term conditions. The paper draws on contracting theory and two interdisciplinary and in-depth qualitative research studies undertaken in 1995 and 2007. Methods common to both studies included documentary analysis and interviews with managers and front line professionals. The 1995 study employed action-based research and included observation of community care; the 2007 study used realistic evaluation and included engagement with service user groups. In both reform processes, financial risk was increasingly devolved to frontline practitioners and smaller organizational units such as GP commissioning groups, with payment by unit of activity, aimed at changing professionals' behaviour. This financing increased perceived clinical risk and fragmented the delivery of health and social care services requiring staff efforts to improve collaboration and integration, and created some perverse incentives and staff demoralisation. Health services reform should only shift financial risk to frontline professionals to the extent that it can be efficiently borne. Where team work is required, contracts should reward collaborative multi-professional activity.
Gunnarsdóttir, Hrafnhildur; Hensing, Gunnel; Povlsen, Lene
BACKGROUND: The Nordic welfare system has been acknowledged as favourable for children, successfully contributing to low child mortality and poverty rates. Nevertheless, mental health problems among children and adolescents are common and the economic situation of the family has been highlighted...... as an important determinant. In spite of similar social, political and cultural structures, the Nordic countries differ; Iceland was most affected by the global financial crisis in 2008. The aim of this study was to examine potential differences in parental financial stress and the associations to child mental...... to measure mental health problems. RESULTS: In Iceland, 47.7% of the parents reported financial stress while ≤20% did so in the other countries except for Finland (33.5%). However, in case of parental financial stress the OR of mental health problems comparing children to parents with and without financial...
BACKGROUND: Like many other medical technologies and treatments, there is a lack of reliable evidence on treatment effectiveness of mental health care. Increasingly, data from non-experimental settings are being used to study the effect of treatment. However, as in a number of studies using non-experimental data, a simple regression of outcome on treatment shows a puzzling negative and significant impact of mental health care on the improvement of mental health status, even after including a large number of potential control variables. The central problem in interpreting evidence from real-world or non-experimental settings is, therefore, the potential "selection bias" problem in observational data set. In other words, the choice/quantity of mental health care may be correlated with other variables, particularly unobserved variables, that influence outcome and this may lead to a bias in the estimate of the effect of care in conventional models. AIMS OF THE STUDY: This paper addresses the issue of estimating treatment effects using an observational data set. The information in a mental health data set obtained from two waves of data in Puerto Rico is explored. The results using conventional models - in which the potential selection bias is not controlled - and that from instrumental variable (IV) models - which is what was proposed in this study to correct for the contaminated estimation from conventional models - are compared. METHODS: Treatment effectiveness is estimated in a production function framework. Effectiveness is measured as the improvement in mental health status. To control for the potential selection bias problem, IV approaches are employed. The essence of the IV method is to use one or more instruments, which are observable factors that influence treatment but do not directly affect patient outcomes, to isolate the effect of treatment variation that is independent of unobserved patient characteristics. The data used in this study are the first (1992
Jones, Dee; Horner, Beth
The North Carolina State Health Plan provides health care coverage to more than 700,000 members, including teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents. The State Health Plan is a division of the North Carolina Department of State Treasurer, self-insured, and exempt from the Employee Retirement Income Security Act as a government-sponsored plan. With health care costs rising at rates greater than funding, the Plan must take measures to stem cost growth while ensuring access to quality health care. The Plan anticipates focusing on strategic initiatives that drive results and cost savings while improving member health to protect the Plan's financial future. ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.
Galizzi, Matteo M; Miraldo, Marisa; Stavropoulou, Charitini
We present results from a hypothetical framed field experiment assessing whether risk preferences significantly differ across the health and financial domains when they are elicited through the same multiple price list paired-lottery method. We consider a sample of 300 patients attending outpatient clinics in a university hospital in Athens during the Greek financial crisis. Risk preferences in finance were elicited using paired-lottery questions with hypothetical payments. The questions were adapted to the health domain by framing the lotteries as risky treatments in hypothetical health care scenarios. Using maximum likelihood methods, we estimated the degree of risk aversion, allowing for the estimates to be dependent on domain and individual characteristics. The subjects in our sample, who were exposed to both health and financial distress, tended to be less risk averse in the financial domain than in the health domain. © The Author(s) 2016.
Wiysonge, Charles S; Paulsen, Elizabeth; Lewin, Simon; Ciapponi, Agustín; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Oxman, Andrew D
One target of the Sustainable Development Goals is to achieve "universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". A fundamental concern of governments in striving for this goal is how to finance such a health system. This concern is very relevant for low-income countries. To provide an overview of the evidence from up-to-date systematic reviews about the effects of financial arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on financial arrangements, and informing refinements in the framework for financial arrangements presented in the overview. We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language, or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of financial arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment, or financial burden of patients, e.g. out-of-pocket payment, catastrophic disease expenditure) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries. We identified 7272 reviews and included 15 in this
Madison, Kristin M; Volpp, Kevin G; Halpern, Scott D
The Patient Protection and Affordable Care Act (ACA) turns to a nontraditional mechanism to improve public health: employer-provided financial incentives for healthy behaviors. Critics raise questions about incentive programs' effectiveness, employer involvement, and potential discrimination. We support incentive program development despite these concerns. The ACA sets the stage for a broad-based research and implementation agenda through which we can learn to structure incentive programs to not only promote public health but also address prevalent concerns. © 2011 American Society of Law, Medicine & Ethics, Inc.
Saver, Richard S
The Physician Payments Sunshine Act ("Sunshine Act"), enacted to address financial conflicts in health care, is the first comprehensive federal legislation mandating public reporting of payments between drug companies, device manufacturers, and medicine. This article analyzes the Sunshine Act's uneven record, exploring how the law serves as an intriguing example of the uncertain case for transparency regulation in health care. The Sunshine Act's bumpy rollout demonstrates that commanding transparency through legislation can be arduous because of considerable implementation challenges. Capturing all the relevant information about financial relationships and reporting it with sufficient contextual and comparative data has proven disappointingly difficult. In addition, the law suffers from uncertainty and poor design as to the intended audience. Indeed, there is strong reason to believe that it will not significantly impact decision-making of primary recipients like patients. Yet the Sunshine Act nonetheless retains important and perhaps underappreciated value. From the almost four years of information generated, we have learned that industry-medicine financial ties vary significantly by physician specialty, and somewhat by physician gender. In many medical fields the distribution of top dollar payments tends to be heavily skewed to a few recipients, all of which have important implications for optimal management of financial conflicts and for health policy more generally. Accordingly, the Sunshine Act's greatest potential is not guiding decisions of individual patients or physicians, but its downstream effects. This Article traces how secondary audiences, such as regulators, watchdogs, and counsel are already starting to make productive use of Sunshine Act information. Public reporting has, for example, made more feasible linking industry payment information with Medicare reimbursement data. As a result, policymakers can more closely examine correlations between
Fronstin, Paul; Roebuck, M Christopher
This paper analyzes data from a large employer that enhanced financial incentives to encourage participation in its workplace wellness programs. It examines, first, the effect of financial incentives on wellness program participation, and second, it estimates the impact of wellness program participation on utilization of health care services and spending. The Patient Protection and Affordable Care Act of 2010 (PPACA) allows employers to provide financial incentives of as much as 30 percent of the total cost of coverage when tied to participation in a wellness program. Participation in health risk assessments (HRAs) increased by 50 percentage points among members of unions that bargained in the incentive, and increased 22 percentage points among non-union employees. Participation in the biometric screening program increased 55 percentage points when financial incentives were provided. Biometric screenings led to an average increase of 0.31 annual prescription drug fills, with related spending higher by $56 per member per year. Otherwise, no significant effects of participation in HRAs or biometric screenings on utilization of health care services and spending were found. The largest increase in medication utilization as a result of biometric screening was for statins, which are widely used to treat high cholesterol. This therapeutic class accounted for one-sixth of the overall increase in prescription drug utilization. Second were antidepressants, followed by ACE inhibitors (for hypertension), and thyroid hormones (for hypothyroidism). Biometric screening also led to significantly higher utilization of biologic response modifiers and immunosuppressants. These specialty medications are used to treat autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, and are relatively expensive compared with non-specialty medications. The added spending associated with the combined increase in fills of 0.02 was $27 per member per year--about one-half of the
Makdissi, Paul; Yazbeck, Myra
When assessing socioeconomic health inequalities, researchers often draw upon measures of income inequality that were developed for ratio scale variables. As a result, the use of categorical data (such as self-reported health status) produces rankings that may be arbitrary and contingent to the numerical scale adopted. In this paper, we develop a method that overcomes this issue by providing conditions for which these rankings are invariant to the numerical scale chosen by the researcher. In doing so, we draw on the insight provided by Allison and Foster (2004) and extend their method to the dimension of socioeconomic inequality by exploiting the properties of rank-dependent indices such as Wagstaff (2002) achievement and extended concentration indices. We also provide an empirical illustration using the National Institute of Health Survey 2012. Copyright © 2017 John Wiley & Sons, Ltd.
Daansen, P J; van Schilt, J
As from 2014 Dutch health insurance companies will bear the full financial risk for their clients in mental health care. Over the next years the existing risk settlement shared between insurance companies will gradually be brought to a close. Municipalities and the Ministry of Justice are already responsible for or will soon become responsible for financing health care for adolescents, patients with severe psychiatric disorders and forensic psychiatric patients. As a result, the health insurance companies are beginning to impose ever stricter conditions regarding the care 'product' they are 'buying'. To study the possible consequences, for mental health care institutions, of the increased risk to be borne by health care insurers. Use was made of relevant marketing literature and literature relating to mental health care. Studies of Dutch mental health care literature indicate that in the future the purchasing procedure will no longer consider the immediate treatment outcome as the sole performance indicator but will also take into account additional factors such as long-term improvements in patients' health, customer satisfaction and degree of patient participation, patient empowerment and autonomy. In formulating the details of their health products and business strategies, health care providers will now have to take into account not only the efficacy of the treatment they provide but also the purchasing policy and strategy of the health insurance companies.
Shi, Zumin; Taylor, Anne W; Goldney, Robert; Winefield, Helen; Gill, Tiffany K; Tuckerman, Jane; Wittert, Gary
This study aimed to describe trends in a range of mental health indicators in South Australia where a surveillance system has been in operation since July 2002 and assess the impact of the global financial crisis (GFC). Data were collected using a risk factor surveillance system. Participants, aged 16 years and above, were asked about doctor-diagnosed anxiety, stress or depression, suicidal ideation, psychological distress (PD), demographic and socioeconomic factors using Computer-Assisted Telephone Interviewing (CATI). Overall, there was a decreasing trend in the prevalence of PD between 2002 and 2009. Stress has decreased since 2004 although anxiety has increased. Comparing 2008 or 2009 (the economic crisis period) with 2005 or 2007, there was significant increase in anxiety for part-time workers but a decrease for full-time workers. There were significant differences for stress by various demographic variables. The overall prevalence of mental health conditions has not increased during the GFC. Some subgroups in the population have been disproportionately impacted by changes in mental health status. The use of a surveillance system enables rapid and specifically targeted public health and policy responses to socioeconomic and environmental stressors, and the evaluation of outcomes.
Liu, Sandra S; Lu, Jui-Fen Rachel; Guo, Kristina L
In this study, a conceptual framework was developed to show that social entrepreneurial practices can be effectively translated to meet the social needs in health care. We used a theory-in-use case study approach that encompasses postulation of a working taxonomy from literature scanning and a deliberation of the taxonomy through triangulation of multilevel data of a case study conducted in a Taiwan-based hospital system. Specifically, we demonstrated that a nonprofit organization can adopt business principles that emphasize both financial and social value. We tested our model and found comprehensive accountability across departments throughout the case hospital system, and this led to sustainable and continual growth of the organization. Through social entrepreneurial practices, we established that both financial value creation and fulfilling the social mission for the case hospital system can be achieved.
The revolutions in Egypt and Tunisia appeared to herald a re-casting of International Monetary Fund and World Bank policy across the region. Public pronouncements by the heads of both institutions in the months following February 2011 acknowledged flaws in their approach to macroeconomic advice, against a background of worsening socioeconomic indicators, widespread youth unemployment, and widening health inequalities. Evidence on the ground, however, suggests continuity rather than change in international financial institution policies in Egypt and Tunisia, notwithstanding the emergence of a powerful new player-the European Bank for Reconstruction and Development. In the long term, new electoral realities and hardening public opposition in both countries seem likely to force a fundamentally different relationship between regional governments and the major international financial institutions than existed before 2011.
Based on the current financial status and forthcoming changes in the health care system, governing boards give chief executive officers the responsibility to manage human, financial, and physical resources. The role and degree of involvement of chief executive officers in managing resources--the resource allocation process, retention and recruitment, technology adaptation, reimbursement, and expansion of the outpatient program--are illustrated in this article. A new strategy for diverting resources to tap into the outpatient market is the appropriate direction to choose during days when the economy is down and people are not seeking inpatient treatment as in the past. Reimbursement in the future will depend on customer satisfaction scores; therefore, a dedicated and loyal staff is the most important resource for any service organization.
Yu, Hao; Dick, Andrew W; Szilagyi, Peter G
Health care costs grew rapidly since 2001, generating substantial economic pressures on families, especially those with children with special health care needs (CSHCN). To examine how the growth of health care costs affected financial burden for families of CSHCN between 2001 and 2004 and to determine the extent to which health insurance coverage protected families of CSHCN against financial burden. In 2001-2004, 5196 families of CSHCN were surveyed by the national Medical Expenditure Panel Survey (MEPS). The main outcome was financial burden, defined as the proportion of family income spent on out-of-pocket (OOP) health care expenditures for all family members, including OOP costs and premiums. Family insurance coverage was classified as: (1) all members publicly insured, (2) all members privately insured, (3) all members uninsured, (4) partial coverage, and (5) a mix of public and private with no uninsured periods. An upward trend in financial burden for families of CSHCN occurred and was associated with growth of economy-wide health care costs. A multivariate analysis indicated that, given the economy-wide increase in medical costs between 2001 and 2004, a family with CSHCN was at increased risk in 2004 for having financial burden exceeding 10% of family income [odds ratio (OR) = 1.39; P financial burden exceeding 20% of family income. Over 15% of families with public insurance had financial burden exceeding 10% of family income compared with 20% of families with private insurance (P financial burden of >10% or 20% of family income than privately-insured families. Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.
González-Block, Miguel Ángel; Figueroa, Alejandro; García-Téllez, Ignacio; Alarcón, José
The financial coordination of the System of Social Protection in Health (SPSS) was analyzed to assess its support to strategic purchasing. Official reports and surveys were analyzed. SPSS covers a capita of 2 765 Mexican pesos, equivalent to 0.9% of GDP. The Ministry of Health contributed 35% of the total, state governments 16.7% and beneficiaries 0.06%. The National Commission for Social Protection in Health received 48.3% of resources, allocating 38% to State Social Protection Schemes in Health and paying 7.4% of the total directly to providers.The state contribution is in deficit while family contributions tend not to be charged. SPSS has not built funds specialized in strategic purchasing, capable of transforming historical budgets.The autonomy of providers is key to reduce out-of-pocket spending through the supply of quality services.
Vermeeren, Brenda; Steijn, Bram; Tummers, Lars; Lankhaar, Marcel; Poerstamper, Robbert-Jan; van Beek, Sandra
One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. This study uses a unique dataset, based on the 'ActiZ Benchmark in Healthcare', a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the 'black box' between HRM and performance. The results underscore the importance of HRM in the health care sector, especially for HR and organizational outcomes. Further analyses of HRM
Sahrakorpi, Niina; Koivusalo, Saila B; Eriksson, Johan G; Kautiainen, Hannu; Stach-Lempinen, Beata; Roine, Risto P
Objectives To assess the associations of perceived financial satisfaction and health-related quality of life (HRQoL) and depressive symptoms in an unselected pregnant population in early pregnancy. Methods 750 consecutive pregnant women attending the first communal ultrasound examination before gestational week 14 were invited to participate. Questionnaires assessing HRQoL (15D), depressive symptoms (Edinburgh Depression Scale, EPDS), medical, obstetric, and socioeconomic status were handed out. The participants were divided into three groups according to their satisfaction with their financial status, (unsatisfied, somewhat satisfied, and satisfied). Main outcome measures were 15D and EPDS-scores and dimensions of HRQoL. Results 325 (43,3%) questionnaires were returned. The mean 15D-score for HRQoL was 0,926 (SD 0,056). The financially unsatisfied women had lower HRQoL than women in more satisfied groups (0.906, 0.923 and 0.931, p = 0.012). The result remained significant, even after adjusting for age and education(p = 0.032). The unsatisfied women had a higher mean body mass index (BMI) (25.4, 24.4 and 23.2 kg/m 2 , p for linearity = 0.002), were more often smokers, (13 vs. 4 and 3%, p = 0.029), and had experienced at least one abortion (18, 14 and 7%, p = 0.017). Dimensions of depression, distress and sleep explained the differences between the groups. 27% of unsatisfied women scored EPDS ≥10 points suggesting increased risk of depression. Conclusions Financial satisfaction in early pregnancy associates with HRQoL and risk of perinatal depressive symptoms. Unsatisfied women more often have risk factors for unfavourable pregnancy outcomes which may influence the later health and wellbeing of the mother and child.
McCue, Michael J; Hall, Mark A
The Affordable Care Act (ACA) transformed the market for individual health insurance, so it is not surprising that insurers' transition was not entirely smooth. Insurers, with no previous experience under these market conditions, were uncertain how to price their products. As a result, they incurred significant losses. Based on this experience, some insurers have decided to leave the ACA’s subsidized market, although others appear to be thriving. Examine the financial performance of health insurers selling through the ACA's marketplace exchanges in 2015--the market’s most difficult year to date. Analysis of financial data for 2015 reported by insurers from 48 states and D.C. to the Centers for Medicare and Medicaid Services. Although health insurers were profitable across all lines of business, they suffered a 10 percent loss in 2015 on their health plans sold through the ACA's exchanges. The top quarter of the ACA exchange market was comfortably profitable, while the bottom quarter did much worse than the ACA market average. This indicates that some insurers were able to adapt to the ACA's new market rules much better than others, suggesting the ACA's new market structure is sustainable, if supported properly by administrative policy.
Brook, Judith S; Brook, David W; Zhang, Chenshu; Seltzer, Nathan; Finch, Stephen J
There is a scarcity of longitudinal studies of adolescents with attention-deficit/hyperactivity disorder (ADHD) followed until adulthood. We studied the relationship between ADHD in adolescence and impaired general physical health, impaired general mental health, antisocial personality disorder, impaired work performance, and high financial stress in adulthood. A prospective design incorporated 6 assessments of participants spanning mean ages from 14 to 37 years. Two baseline assessments were taken between ages 14 and 16 years, and 5 outcome assessments were taken at mean age 37 years. Participants were assessed with structured interviews and questionnaires. The participants were from a community sample of individuals initially drawn in 1975 and followed to a mean age of 37 years in 2009. The adjusted odds ratios and 95% confidence intervals (CIs) for ADHD in adolescence as related to internal stress in adulthood were 1.82 (95% CI = 1.01-3.25; P health, 2.36 (95% CI = 1.23-4.51; P mental health, and 3.28 (95% CI = 1.51-7.13; P stress were 2.46 (95% CI = 1.37-4.43; P work performance and 3.33 (95% CI = 1.70-6.55; P stress. Clinicians should focus on early diagnosis and treatment of adolescent ADHD because it is a major predictor of an array of physical, mental, work, and financial problems in adulthood.
Brønnum-Hansen, Henrik; Baadsgaard, Mikkel; Eriksen, Mette Lindholm; Andersen-Ranberg, Karen; Jeune, Bernard
To investigate educational differentials in health expectancy among 50-year-old Danes before and during the financial crisis. Nationwide register data on mortality were combined with data from SHARE surveys in 2006/2007 and 2010/2011 to estimate disability-free life expectancy (DFLE) and expected lifetime in self-rated good health by educational level. The difference in life expectancy between 50-year-old men and women with high and low educational levels increased by 0.3 and 0.8 years, respectively. The overall educational differentials in DFLE did not change much for women, whereas for men the tendency was that DFLE increased for those with high educational level and decreased for those with less education ascending the difference by almost 2 years (from 5.9 to 7.8 years), although the difference was not statistically significant. The educational disparity in expected lifetime in self-rated good health increased by 1.3 years for men and 1.2 years for women. The social inequality in DFLE for men and expected lifetime in self-rated good health for both genders increased slightly during the short period. The financial crisis did not seem to indicate a change in the persistent trend of the widening social gap.
Humburg, Dawn Ann
The phrase "survival of the fittest" is coming to fruition in higher education today. Less than strategic financial moves have no place in post-secondary education. Facing the realities of our current economy is dictating major changes in how colleges are "doing business." These changes present enormous challenges to community…
Kiyak, H A
The importance of recognising psychosocial characteristics of older people that influence their oral health behaviours and the potential success of dental procedures is discussed. Three variables and instruments developed and tested by the author and colleagues are presented. A measure of perceived importance of oral health behaviours has been found to be a significant predictor of dental service utilization in three studies. Self-efficacy regarding oral health has been found to be lower than self-efficacy regarding general health and medication use among older adults, especially among non-Western ethnic minorities. The significance of self-efficacy for predicting changes in caries and periodontal disease is described. Finally, a measure of expectations regarding specific dental procedures has been used with older people undergoing implant therapy. Studies with this instrument reveal that patients have concerns about the procedure far different than those focused on by dental providers. All three instruments can be used in clinical practice as a means of understanding patients' values, perceived oral health abilities, and expectations from dental care. These instruments can enhance dentist-patient rapport and improve the chances of successful dental outcomes for older patients.
Full Text Available Although cancer patients may incur a wide range of cancer-related out-of-pocket costs and experience reduced income, the consequences of this financial burden are poorly understood. We investigated: financial adjustments needed to cope with the cancer-related financial burden; financial distress (defined as a reaction to the state of personal finances; and factors that increase risk of financial difficulties. Two sets of semi-structured face-to-face interviews were conducted with 20 patients with breast, lung and prostate cancer and 21 hospital-based oncology social workers (OSWs in Ireland, which has a mixed public-private healthcare system. Participants were asked about: strategies to cope with the cancer-related financial burden; the impact of the financial burden on the family budget, other aspects of daily life, and wellbeing. OSWs were also asked about patient groups they thought were more likely to experience financial difficulties. The two interview sets were analysed separately using a thematic approach. Financial adjustments included: using savings; borrowing money; relying on family and friends for direct and indirect financial help; and cutting back on household spending. Financial distress was common. Financial difficulties were more likely for patients who were older or younger, working at diagnosis, lacked social support, had dependent children, had low income or had few savings. These issues often interacted with one another. As has been seen in predominantly publically and predominantly privately-funded healthcare settings, a complex mixed public-private healthcare system does not always provide adequate financial protection post-cancer. Our findings highlight the need for a broader set of metrics to measure the financial impact of cancer (and to assess financial protection in health more generally; these should include: out-of-pocket direct medical and non-medical costs; changes in income; financial adjustments (including
Timmons, Aileen; Gooberman-Hill, Rachael; Sharp, Linda
Although cancer patients may incur a wide range of cancer-related out-of-pocket costs and experience reduced income, the consequences of this financial burden are poorly understood. We investigated: financial adjustments needed to cope with the cancer-related financial burden; financial distress (defined as a reaction to the state of personal finances); and factors that increase risk of financial difficulties. Two sets of semi-structured face-to-face interviews were conducted with 20 patients with breast, lung and prostate cancer and 21 hospital-based oncology social workers (OSWs) in Ireland, which has a mixed public-private healthcare system. Participants were asked about: strategies to cope with the cancer-related financial burden; the impact of the financial burden on the family budget, other aspects of daily life, and wellbeing. OSWs were also asked about patient groups they thought were more likely to experience financial difficulties. The two interview sets were analysed separately using a thematic approach. Financial adjustments included: using savings; borrowing money; relying on family and friends for direct and indirect financial help; and cutting back on household spending. Financial distress was common. Financial difficulties were more likely for patients who were older or younger, working at diagnosis, lacked social support, had dependent children, had low income or had few savings. These issues often interacted with one another. As has been seen in predominantly publically and predominantly privately-funded healthcare settings, a complex mixed public-private healthcare system does not always provide adequate financial protection post-cancer. Our findings highlight the need for a broader set of metrics to measure the financial impact of cancer (and to assess financial protection in health more generally); these should include: out-of-pocket direct medical and non-medical costs; changes in income; financial adjustments (including financial coping
Johri, Mira; Chung, Ryoa; Dawson, Angus; Schrecker, Ted
The governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and public debate on donor responsibilities for global health. We undertook a critical review of contemporary accounts of justice. We selected theories that: (i) articulate important and widely held moral intuitions; (ii) have had extensive impact on debates about global justice; (iii) represent diverse approaches to moral reasoning; and (iv) present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks. Consequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities. Despite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important foundation to strengthen collective action.
Full Text Available Abstract Background The governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and public debate on donor responsibilities for global health. Methods We undertook a critical review of contemporary accounts of justice. We selected theories that: (i articulate important and widely held moral intuitions; (ii have had extensive impact on debates about global justice; (iii represent diverse approaches to moral reasoning; and (iv present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks. Results Consequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities. Conclusions Despite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important
Hu, Dan; Zhu, Weiming; Fu, Yaqun; Zhang, Minmin; Zhao, Yang; Hanson, Kara; Martinez-Alvarez, Melisa; Liu, Xiaoyun
Since 1968, China has trained about 1.5 million barefoot doctors in a few years' time to provide basic health services to 0.8 billion rural population. China's Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then, village doctors have kept on playing an irreplaceable role in China's rural health, even though the number of village doctors has fluctuated over the years and they face serious challenges. United Nations declared Sustainable Development Goals in 2015 to achieve universal health coverage by 2030. Under this context, development of Community Health workers (CHWs) has become an emerging policy priority in many resource-poor developing countries. China's experiences and lessons learnt in developing and maintaining village doctors may be useful for these developing countries. This paper aims to synthesis lessons learnt from the Chinese CHW experiences. It summarizes China's experiences in exploring and using strategic partnership between the community and the formal health system to develop CHWs in the two stages, the barefoot doctor stage (1968 -1985) and the village doctor stage (1985-now). Chinese and English literature were searched from PubMed, CNKI and Wanfang. The information extracted from the selected articles were synthesized according to the four partnership strategies for communities and health system to support CHW development, namely 1) joint ownership and design of CHW programmes; 2) collaborative supervision and constructive feedback; 3) a balanced package of incentives, both financial and non-financial; and 4) a practical monitoring system incorporating data from the health system and community. The study found that the townships and villages provided an institutional basis for barefoot doctor policy, while the formal health system, including urban hospitals, county health schools, township health centers, and mobile medical teams provided training to the barefoot
Fleury, Marie-Josée; Grenier, Guy; Bamvita, Jean-Marie; Chiocchio, François
This study investigates work performance among 79 mental health teams in Quebec (Canada). We hypothesized that work performance was positively associated with the use of standardized clinical tools and clinical approaches, integration strategies, "clan culture," and mental health funding per capita. Work performance was measured using an adapted version of the Work Role Questionnaire. Variables were organized into four key areas: (1) team attributes, (2) organizational culture, (3) inter-organizational interactions, and (4) external environment. Work performance was associated with two types of organizational culture (clan and hierarchy) and with two team attributes (use of standardized clinical tools and approaches). This study was innovative in identifying associations between work performance and best practices, justifying their implementation. Recommendations are provided to develop organizational cultures promoting a greater focus on the external environment and integration strategies that strengthen external focus, service effectiveness, and innovation.
We performed this audit in response to the Chief Financial Officers Act of 1990, as amended by the Federal Financial Management Act of 1994, which requires DoD to prepare annual audited financial statements...
... annual audited financial statements. The FY 1999 DoD Agency-Wide financial statements included the financial statements of a reporting entity entitled "Other Defense Organizations-General Funds...
Faghri, Pouran D; Simon, Julia; Huedo-Medina, Tania; Gorin, Amy
To evaluate if self-efficacy (SE) and financial incentives (FI) mediate the effect of health behavior on weight loss in a group of overweight and obese nursing-home employees participating in a 16-week weight-loss intervention with 12-week follow-up. Ninety nine overweight/obese (body mass index [BMI] > 25) employees from four nursing-homes participated, with a mean age of 46.98 years and BMI of 35.33. Nursing-homes were randomized to receiving an incentive-based intervention (n = 51) and no incentive (n = 48). Participants' health behaviors and eating and exercise self-efficacy (Ex-SE) were assessed at week 1, 16, and 28 using a self-reported questionnaire. Mediation and moderated mediation analysis assessed relationships among these variables. Eating self-efficacy (Eat-SE) and Ex-SE were significant mediators between health behaviors and weight loss (P self-efficacy (P = 0.00) on weight loss. Self-efficacy and FI may affect weight loss and play a role in weight-loss interventions.
Stuckler, David; Basu, Sanjay; Suhrcke, Marc; McKee, Martin
What will the current economic crisis mean for the health of the people of Northern Ireland? We review the experience of three major economic crises in the 20(th) century: the Great Depression (1929), the Post-communist Depression (early 1990 s) and the East Asian financial crisis (late 1990 s). Available evidence suggests that health is at risk in times of rapid economic change, in both booms and busts. However the impact on mortality is exacerbated where people have easy access to the means to harm themselves and is ameliorated by the presence of strong social cohesion and social protection systems. On this basis, Northern Ireland may escape relatively unscathed in the short term but as every crisis also provides an opportunity, this is an appropriate time for the Northern Ireland Executive to reflect on whether they are making a sufficient investment in the long term health of their population.
Flores, Gabriela; Ir, Por; Men, Chean R; O'Donnell, Owen; van Doorslaer, Eddy
Public providers have no financial incentive to respect their legal obligation to exempt the poor from user fees. Health Equity Funds (HEFs) aim to make exemptions effective by giving NGOs responsibility for assessing eligibility and compensating providers for lost revenue. We use the geographic spread of HEFs over time in Cambodia to identify their impact on out-of-pocket (OOP) payments. Among households with some OOP payment, HEFs reduce the amount paid by 35%, on average. The effect is larger for households that are poorer and mainly use public health care. Reimbursement of providers through a government operated scheme also reduces household OOP payments but the effect is not as well targeted on the poor. Both compensation models raise household non-medical consumption but have no impact on health-related debt. HEFs reduce the probability of primarily seeking care in the private sector. Copyright © 2013 Elsevier B.V. All rights reserved.
Musich, Shirley; McCalister, Tre'; Wang, Sara; Hawkins, Kevin
To investigate the effectiveness of the Well at Dell comprehensive health management program in delivering health care and productivity cost savings relative to program investment (i.e., return on investment). A quasi-experimental design was used to quantify the financial impact of the program and nonexperimental pre-post design to evaluate change in health risks. Ongoing worksite health management program implemented across multiple U.S. locations. Subjects were 24,651 employees with continuous medical enrollment in 2010-2011 who were eligible for 2011 health management programming. Incentive-driven, outcomes-based multicomponent corporate health management program including health risk appraisal (HRA)/wellness, lifestyle management, and disease management coaching programs. Medical, pharmacy, and short-term disability pre/post expenditure trends adjusted for demographics, health status, and baseline costs. Self-reported health risks from repeat HRA completers. Analysis: Propensity score-weighted and multivariate regression-adjusted comparison of baseline to post trends in health care expenditures and productivity costs for program participants and nonparticipants (i.e., difference in difference) relative to programmatic investment. The Well at Dell program achieved an overall return on investment of 2.48 in 2011. Most of the savings were realized from the HRA/wellness component of the program. Cost savings were supported with high participation and significant health risk improvement. An incentive-driven, well-managed comprehensive corporate health management program can continue to achieve significant health improvement while promoting health care and productivity cost savings in an employee population.
Gómez, Eduardo J
In recent years, several emerging economies have introduced national health insurance programs ensuring access to health care while offering financial protection from out-of-pocket and catastrophic expenses. Nevertheless, in several nations these expenses continue to increase. While recent research has emphasized the lack of funding, poor policy design and corruption as the main culprits, little is known about the politics of establishing federal regulatory agencies ensuring that state governments adhere to national insurance reimbursement and coverage procedures. This article fills in this lacuna by providing an alternative perspective, one that accounts for differences between nations in the creation of regulatory institutions, with an emphasis instead on governing elite strategies to campaign on access to health care during transitions to democracy, civil societal mobilization, constitutional constraints and the national electoral incentives to overcome ineffective decentralization processes. The cases of Indonesia and China are introduced as examples of how and why their differences in this political process accounted for Indonesia's success and China's failure to ensure financial protection.
Dhillon, Ranu S.; Bonds, Matthew H.; Fraden, Max; Ndahiro, Donald; Ruxin, Josh
This study investigates the impact of subsidising community-based health insurance (mutuelle) enrolment, removing point-of-service co-payments, and improving service delivery on health facility utilisation rates in Mayange, a sector of rural Rwanda of approximately 25,000 people divided among five ‘imidugudu’ or small villages. While comprehensive service upgrades were introduced in the Mayange Health Centre between April 2006 and February 2007, utilisation rates remained similar to comparison sites. Between February 2007 and April 2007, subsidies for mutuelle enrolment established virtually 100% coverage. Immediately after co-payments were eliminated in February 2007, patient visits levelled at a rate triple the previous value. Regression analyses using data from Mayange and two comparison sites indicate that removing financial barriers resulted in about 0.6 additional annual visits for curative care per capita. Although based on a single local pilot, these findings suggest that in order to achieve improved health outcomes, key short-term objectives include improved service delivery and reduced financial barriers. Based on this pilot, higher utilisation rates may be affected if broader swaths of the population are enrolled in mutuelle and co-payments are eliminated. Health leaders in Rwanda should consider further studies to determine if the impact of eliminating co-payments and increasing subsidies for mutuelle enrolment as seen in Mayange holds at greater levels of scale. Broader studies to better elucidate the impact of enrolment subsidies and co-payment subsidies on utilisation, health outcomes, and costs would also provide policy insights. PMID:21732708
Olaussen, Mathias Rove
The Tanzanian health commodity supply chain has gradually improved since the decentralisation of the health information system began in 1999. As a part of the decentralisation process, the supply chain management has improved in terms of making information timelier available to decision-makers at lower-level health care units. Still, access and use of information are limited at some levels of the health hierarchy. This thesis examines the role of financial information in health commodity proc...
Gunawan, Pricilia Sandra
Penelitian ini bertujuan untuk mengetahui pengaruh langsung dari job satisfaction terhadap financial performance melalui employee engagement dan competitive advantage sebagai intervening variabel pada Perusahaan manufaktur di Surabaya. Penelitian ini menggunakan data primer yang diperoleh dari hasil penyebaran kuesioner pada 30 Perusahaan manufaktur publik di Surabaya dan juga menggunakan data sekunder yaitu laporan keuangan Perusahaan yang digunakan untuk mengukur financial performance Perus...
Maughan, Daniel L; Patel, Alisha; Parveen, Tahmina; Braithwaite, Isobel; Cook, Jonathan; Lillywhite, Rob; Cooke, Matthew
Aim To assess the effects of a social prescribing service development on healthcare use and the subsequent economic and environmental costs. Social prescribing services for mental healthcare create links with support in the community for people using primary care. Social prescribing services may reduce future healthcare use, and therefore reduce the financial and environmental costs of healthcare, by providing structured psychosocial support. The National Health Service (NHS) is required to reduce its carbon footprint by 80% by 2050 according to the Climate Change Act (2008). This study is the first of its kind to analyse both the financial and environmental impacts associated with healthcare use following social prescribing. The value of this observational study lies in its novel methodology of analysing the carbon footprint of a service at the primary-care level. An observational study was carried out to assess the impact of the service on the financial and environmental impacts of healthcare use. GP appointments, psychotropic medications and secondary-care referrals were measured. Findings Results demonstrate no statistical difference in the financial and carbon costs of healthcare use between groups. Social prescribing showed a trend towards reduced healthcare use, mainly due to a reduction in secondary-care referrals compared with controls. The associations found did not achieve significance due to the small sample size leading to a large degree of uncertainty regarding differences. This study demonstrates that these services are potentially able to pay for themselves through reducing future healthcare costs and are effective, low-carbon interventions, when compared with cognitive behavioral therapy or antidepressants. This is an important finding in light of Government targets for the NHS to reduce its carbon footprint by 80% by 2050. Larger studies are required to investigate the potentials of social prescribing services further.
Full Text Available Objectives To relieve the financial burden faced by households, the Korean National Health Insurance (NHI system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. Methods This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. Results The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. Conclusions The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.
Lee, Tae-Jin; Cheong, Chelim
To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a "copayment ceiling," which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients' income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.
The development of a corporate health marketing program for the Medical Pavilion was based on three assumptions. 1. Medical Pavilion will contribute positively to health care cost containment for employers by providing convenient, quality medical care which will help to reduce employee time lost from work due to physician visits, and through health screening, early diagnosis, and out-patient procedures, decrease unnecessary hospitalization. 2. The level of awareness among chief executive officers, benefits directors, corporate medical directors, and employees will be positively related to utilization of health services at the Medical Pavilion. 3. The Medical Pavilion will be organized on a private practice model; although special programs related to employer coverage and specific benefits may be considered separately. The recommended goals of the corporate health program of the Medical Pavilion were as follows: 1. To develop demographic profiles based on current utilization of medical services in a random sample to corporations in the Financial District. 2. To design a survey of corporate leadership to determine a needs assessment strategy for the development of preventive health services programs to be offered at the Medical Pavilion. 3. To select an advertising and public relations agency; and determine the marketing bridges, for the first year and the following five year period. 4. To evaluate effectiveness of the corporate health marketing plan referral data collected through the Management Information System to be established at the Medical Pavilion.
Goncharuk Svitlana M.
Full Text Available The objectives of the article are: defining the theoretical and methodological foundations for financial support for health care institutions; disclosure of the concept and substance of the targeted budget programs in the health care system; a critical analysis of the current practice in the use of performance indicators for the targeted budget programs; improving the methods for managerial decision-making in the course of implementation of the targeted budget programs; determining ways to improve the effectiveness and efficiency of the targeted budget programs in the health care system. In order to develop the health care sector, there’s a necessity to define the order and mechanisms for the priority financing, as well as the personnel and material-technical provision of health care institutions. There is also a need for the State support and regulation of an adequate financing for health care programs to achieve equal access in different regions of Ukraine. It is important further to define the specifics of the health sector’s targeted programs that will facilitate management of them.
Özgen Narcı, Hacer; Şahin, İsmet; Yıldırım, Hasan Hüseyin
To determine the prevalence of catastrophic health payments, examine the determinants of catastrophic expenditures, and assess the poverty impact of out-of-pocket (OOP) payments. Data came from the 2004 to 2010 Household Budget Survey. Catastrophic health spending was defined by health payments as percentage of household consumption expenditures and capacity to pay at a set of thresholds. The poverty impact was evaluated by poverty head counts and poverty gaps before and after OOP health payments. The percentage of households that catastrophically spent their consumption expenditure and capacity to pay increased from 2004 to 2010, regardless of the threshold used. Households with a share of more than 40% health spending in both consumption expenditure and capacity to pay accounted for less than 1% across years. However, when a series of potential confounders were taken into account, the study found statistically significantly increased risk for the lowest threshold and decreased risk for the highest threshold in 2010 relative to the base year. Household income, size, education, senior and under 5-year-old members, health insurance, disabled members, payment for inpatient care and settlement were also statistically significant predictors of catastrophic health spending. Overall, poverty head counts were below 1%. Poverty gaps reached a maximum of 0.098%, with an overall increase in 2010 compared to 2004. Catastrophe and poverty increased from 2004 to 2010. However, given that the realization of some recent policies will affect the financial burden of OOP payments on households, the findings of this study need to be replicated.
Full Text Available There is a positive relationship between financial development and economic growth in short-run and long-run. Financial development is beneficial to the reduction of poverty. But the financial instability which accompanies financial development is is costly for the poor and reduces the positive effect of financial development on the reduction of poverty. The paper aims to analyze in detail the relationship and the (direct and indirect effects between these variables, taking into account their economic and social importance. It is also highlighted the correlation between the financial economy and the real economy, emphasizing the impact on social welfare involved by the interaction of the above mentioned variables.
Avčin, Bojana Avguštin; Kučina, Andrea Užmah; Sarotar, Brigita Novak; Radovanović, Mirjana; Plesničar, Blanka Kores
The global financial and economic crisis starting in 2007 led to a deterioration of several socio-economic determinants of mental health. The aim of this cross-sectional study was to examine the impact of the present economic crisis on the depression and anxiety levels of the employed in the private and public sector in Slovenia. Altogether 1592 employees completed an internet based self-reported questionnaire. Data about perceived impact of the economic crisis, several socio-demographic, socioeconomic, and health parameters were collected. Depression symptoms were assessed by the Center for Epidemiological Studies-Depression Scale and anxiety symptoms by the Spielberger State-Inventory. Regression models were used 1) to explore the associations of the economic crisis with the level of depression and anxiety symptoms while controlling for some sociodemographic and work characteristic variables, and 2) to understand the relationship between some potentially important socioeconomic variables and the perception of the economic crisis. Depressive and anxiety scores were significantly increased among 590 (46.6%) employees being affected by the economic crisis. The level of depressive symptoms was significantly associated with perceived impact by the crisis, recent sick leave, reported injuries sustained at work, benzodiazepine and analgesic use, the lack of emotional support, and trust in crisis telephone lines. The level of anxiety symptoms yielded the robust association with the level of depression symptoms, reported injuries sustained on the way to work and education. The economic crisis poses an additional risk factor for mental health problems which clinicians should internalize and become more aware of them. Symptoms of depression and anxiety can be masked in high-utilizers of medical care with physical complaints or psychoactive drug use.
Bowser, Diana M; Figueroa, Ramon; Natiq, Laila; Okunogbe, Adeyemi
Over the last 10 years, Belize has implemented a National Health Insurance (NHI) program that uses performance-based contracts with both public and private facilities to improve financial sustainability, efficiency and service provision. Data were collected at the facility, district and national levels in order to assess trends in financial sustainability, efficiency payments, year-end bonuses and health system and health outcomes. A difference-in-difference approach was used to assess the difference in technical efficiency between private and public facilities. The results show that per capita spending on services provided by the NHI program has decreased over the period 2006-2009 from BZ$177 to BZ$136. The private sector has achieved higher levels of technical efficiency, but lower percentages of efficiency and year-end bonus payments. Districts with contracts through the NHI program showed greater improvements in facility births, nurse density, reducing maternal mortality, diabetes deaths and morbidity from bronchitis, emphysema and asthma than districts without contracts over the period 2006-2010. This preliminary assessment of Belize's pay-for-performance system provides some positive results, however further research is needed to use the lessons learned from Belize to implement similar reforms in other systems.
Greb, Stefan; Focke, Axel; Hessel, Franz; Wasem, Jürgen
As a result of recent health care reforms sickness funds and health care providers in German social health insurance face increased financial incentives for implementing disease management and integrated care. Sickness funds receive higher payments form the risk adjustment system if they set up certified disease management programmes and induce patients to enrol. If health care providers establish integrated care projects they are able to receive extra-budgetary funding. As a consequence, the number of certified disease management programmes and the number of integrated care contracts is increasing rapidly. However, contracts about disease management programmes between sickness funds and health care providers are highly standardized. The overall share of health care expenses spent on integrated care still is very low. Existing integrated care is mostly initiated by hospitals, is based on only one indication and is not fully integrated. However, opportunity to invest in integrated care may open up innovative processes, which generate considerable productivity gains. What is more, integrated care may serve as gateway for the introduction of more widespread selective contracting.
Stewart, Christopher C; Boyle, Patricia A; James, Bryan D; Yu, Lei; Han, S Duke; Bennett, David A
Older adults often exhibit low health and financial literacy, but the reasons why remain unclear. One possibility is that those older adults at high risk for developing dementia demonstrate low literacy even in the absence of marked cognitive impairment. We therefore examined associations of health and financial literacy with the APOE ε4 allele, the chief genetic risk factor for Alzheimer's disease, among older adults without dementia. Participants were 487 older adults without dementia enrolled in the Rush Memory and Aging Project (mean age = 83, mean years of education = 15, 77% female, 91% non-Hispanic White). Participants underwent APOE genotyping and assessments of cognition, health literacy, and financial literacy. Health and financial literacy scores were also averaged into a total literacy score. ε4 was associated with lower total and health literacy, with a trend toward an association with lower financial literacy, after adjustment for age, sex, and education. Associations of ε4 with lower total and health literacy persisted after further adjustment for global cognitive function and 5 specific cognitive domains. ε4 affects literacy even in the absence of clinical dementia and does so relatively independent of performance on traditional cognitive tests. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Conrad, Douglas A; Perry, Lisa
This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery.
Mitchell, Marc; Faulkner, Guy
A comprehensive, multi-level approach to curb chronic disease-related costs in Canada is needed. One target for intervention is the economic domain. The emergence of user financial incentives (UFI) in public health policy as well as their broad implementation in corporate settings has stimulated a growing but limited body of research in this area. The authors'position is that the jury is still out on the question of their effectiveness in sustaining long-term health behaviour change, given the nature of the UFI that have been designed and delivered to date--that is, UFI with limited theoretical and contextual consideration. It is their contention that manipulating UFI design features (there are seven core features with a range of attributes) to exploit contextual (e.g., personal income) and theoretical (e.g., self-efficacy) factors may optimize UFI effectiveness over the long term. Although UFI are not the solution, they might very well be apart.
Sofaer, S; Abel, E
Elderly women and men have different patterns of disease and utilize health services differently. This essay examines the extent to which Medicare covers the specific conditions and services associated with women and men. Elderly women experience higher rates of poverty than elderly men; consequently, elderly women are especially likely to be unable to pay high out-of-pocket costs for health care. Using a new method for simulating out-of-pocket costs, the Illness Episode Approach, the essay shows that Medicare provides better coverage for illnesses which predominate among men than for those which predominate among women. In addition, women on Medicare who supplement their basic coverage by purchasing a typical private insurance "Medigap" policy do not receive as much of an advantage from their purchases as do men. The calculations also show that the Medicare Catastrophic Coverage Act would have had little impact on the gender gap in financial vulnerability.
Homer, Jack; Milstein, Bobby; Hirsch, Gary B; Fisher, Elliott S
Leaders across the United States face a difficult challenge choosing among possible approaches to transform health system performance in their regions. The ReThink Health Dynamics Model simulates how alternative scenarios could unfold through 2040. This article compares the likely consequences if four interventions were enacted in layered combinations in a prototypical midsize US city. We estimated the effects of efforts to deliver higher-value care; reinvest savings and expand global payment; enable healthier behaviors; and expand socioeconomic opportunities. Results suggest that there may be an effective and affordable way to unlock much greater health and economic potential, ultimately reducing severe illness by 20 percent, lowering health care costs by 14 percent, and improving economic productivity by 9 percent. This would require combined investments in clinical and population-level initiatives, coupled with financial agreements that reduce incentives for costly care and reinvest a share of the savings to ensure adequate long-term financing. Project HOPE—The People-to-People Health Foundation, Inc.
Bacikova-Sleskova, Maria; van Dijk, Jitse P.; Geckova, Andrea Madarasova; Nagyova, Iveta; Salonna, Ferdinand; Reijneveld, Sijmen A.; Groothoff, Johan W.
Objectives: The main purpose of this paper is to explore whether unemployment influences adolescents' subjective perception of health and whether perceived financial stress and social contacts can mediate the effect of employment status on health. We are also interested in the differences in
Full Text Available Objective: This study analysed data from the Household Income and Labour Dynamics in Australia (HILDA Survey to examine the relationship between employment status and mental health, and the mediating effects of financial hardship, mastery and social support. In addition, the study sought to explore the effects of duration of unemployment on mental health. Methods: The primary analysis used three waves of data from the HILDA Survey with 4965 young adult respondents. Longitudinal population-averaged logistic regression models assessed the association of employment status and mental health, including the contribution of mastery, financial hardship and social support in explaining this association between employment groups (unemployed vs. employed; under employed vs. employed. Sensitivity analyses utilised a fixed-effects approach and also considered the full-range of working-age respondents. Regression analysis was used to explore the effect of duration of unemployment on mental health. Results: Respondents’ who identified as unemployed or underemployed were at higher risk of poor mental health outcomes when compared to their employed counterparts. This association was ameliorated when accounting for mastery, financial hardship and social support for the unemployed, and was fully mediated for the underemployed. The fixed-effects models showed the transition to unemployment was associated with a decline in mental health and that mastery in particular contributed to that change. The same results were found with a broader age range of respondents. Finally, the relationship between duration of unemployment and mental health was not linear, with mental health showing marked decline across the first 9 weeks of unemployment. Conclusions and implications: Mastery, social support and financial hardship are important factors in understanding the association of poor mental health with both unemployment and underemployment. Furthermore, the results suggest
Souliotis, Kyriakos; Golna, Christina; Tountas, Yannis; Siskou, Olga; Kaitelidou, Daphne; Liaropoulos, Lycourgos
Under-the-table informal payments are commonplace as reimbursements for health care services in Greece. As the country faces a severe financial crisis, the need to investigate the extent of such payments, their incidence and their impact on household income is pressing. A survey of 2,741 persons from across the country was conducted between December 2011 and February 2012. The sample was defined via a multistage selection process using a quota for municipality of residence, sex and age. The maximum error margin was 2.41% with a confidence interval of 95%. The survey reports under-the-table payments for approximately 32.4% of public hospital admissions. Private clinics, which display the bulk of out-of-pocket payments, naturally display the lowest under-the-table payments. The highest percentage of under-the-table payments in the private sector appears at visits to private practitioners and dentists (36%). Informal payments are most frequently made upon request, prior to service provision, to facilitate access to care and to reduce waiting times, and at a much lower percentage, to post-service provision, and out of gratitude. This survey reveals that, due to severe financial pressure, there is a growing unwillingness of citizens to pay informally and an increasing demand for these payments as a prerequisite for access to services or to redeem services provided. This "hidden" financial burden of at least 27% impacts negatively on the living conditions of households and is not reported as purchasing ability or cost of living.
Nasiripour, Amir Ashkan; Toloie-Ashlaghy, Abbas; Ta-Bibi, Seyed Jamaleddin; Maleki, Mohammad Reza; Gorji, Hassan Abolghasem
Universities of Medical Science and Health Services (UMSHSs) are among the main organizations in Iran's health-care section. Improving their efficiency in financial resource management through creating an appropri-ate coordination between consumption and resources is strategically vital. Investigating the financial performance as well as ranking the Iranian UMSHSs is the research objective. The study is of descriptive and applied type. The study population includes the UMSHSs of Iran (n=42) among which 24 UMSHSs are selected. DEA is used with the aim to model and assess the financial performance in-cluding 4 inputs and 3 outputs. Also, linear regression is applied to determine the effectiveness of the applied indices as well as the level of the financial performance. Data are obtained from the Budgeting Center in the Ministry of Health and Medical Education, during 2010 mainly through forms designed based on the available balance sheets. The average score of financial performance assessment for UMSHSs based on the DEA of input-oriented data is 0.74, assuming a constant scale of DEA-CRS. Thus, approximately 25% of the studied UMSHSs have maxi-mum relative performance and totally, there is about a 30% capacity to increase the financial performance in these UMSHSs. Most Iranian UMSHSs do not have high financial performance. This can be due to problems in financial resource management especially in asset combining. Therefore, compilation and execution of a comprehensive pro-gram for organizational change and agility with the aim to create a kind of optimized combination of resources and assets is strongly recommended.
Andersen, Hans H. K.; Bach, Elsa
The onset of the financial crisis in 2008 has put pressure on enterprises that in turn have downsized and reorganized. Research has shown that economic recession has an effect on psychological and behavioral health that is attributed to working environment problems. The objective of this study is...... focus on the management of preventive workplace health and safety activities in enterprises during a period of economic recession....... is to unravel whether the onset of a general economic recession has had an impact on companies’ and public institutions’ preventive occupational health and safety activities. Hypotheses of the role of pro-cyclical and countercyclical effects are presented. This study is based on a survey of enterprise...... preventive occupational health safety activities. The baseline for the survey was established, in 2006 before the onset of the recession, with a follow up in 2011. Findings are discussed that support both the pro-cyclical and the countercyclical hypotheses. It is concluded that there is a need for a special...
Kalomo, Eveline Ndii; Lee, Kyoung Hag; Lightfoot, Elizabeth; Freeman, Rachel
Namibia has one of the highest human immunodeficiency virus (HIV) prevalence rates and one of the highest rates of orphanhood in the world, and older caregivers provide much of the care to Namibians living with HIV and acquired immune deficiency syndrome (AIDS) (UNAIDS, 2014). In this study, the authors explore how financial status, social support, and health were related to the resilience of caregivers caring for people affected by HIV and AIDS in rural northern Namibia, Africa. Data were collected through a structured interview from (N = 147) caregivers from the Zambezi region. Findings from this study show that employment and physical health were significantly associated with increased resilience in older caregivers. Our findings point to the need for employment assistance and health services to improve the resilience of caregivers caring for people living with HIV and AIDS. We conclude that there is a need for more vigorous concerted efforts from public and private sector practitioners and policy makers to create more sustained formal employment opportunities and intervention programs aimed at improving the overall health of older HIV caregivers, especially those residing in rural HIV endemic communities in developing countries.
Zoidze, Akaki; Rukhazde, Natia; Chkhatarashvili, Ketevan; Gotsadze, George
The present study focuses on the program "Medical Insurance for the Poor (MIP)" in Georgia. Under this program, the government purchased coverage from private insurance companies for vulnerable households identified through a means testing system, targeting up to 23% of the total population. The benefit package included outpatient and inpatient services with no co-payments, but had only limited outpatient drug benefits. This paper presents the results of the study on the impact of MIP on access to health services and financial protection of the MIP-targeted and general population. With a holistic case study design, the study employed a range of quantitative and qualitative methods. The methods included document review and secondary analysis of the data obtained through the nationwide household health expenditure and utilisation surveys 2007-2010 using the difference-in-differences method. The study findings showed that MIP had a positive impact in terms of reduced expenditure for inpatient services and total household health care costs, and there was a higher probability of receiving free outpatient benefits among the MIP-insured. However, MIP insurance had almost no effect on health services utilisation and the households' expenditure on outpatient drugs, including for those with MIP insurance, due to limited drug benefits in the package and a low claims ratio. In summary, the extended MIP coverage and increased financial access provided by the program, most likely due to the exclusion of outpatient drug coverage from the benefit package and possibly due to improper utilisation management by private insurance companies, were not able to reverse adverse effects of economic slow-down and escalating health expenditure. MIP has only cushioned the negative impact for the poorest by decreasing the poor/rich gradient in the rates of catastrophic health expenditure. The recent governmental decision on major expansion of MIP coverage and inclusion of additional drug
Li, Rui; Gregg, Edward W; Barker, Lawrence E; Zhang, Ping; Zhang, Fang; Zhuo, Xiaohui; Williams, Desmond E; Soumerai, Steven B
Medicare Part D, implemented in 2006, provided coverage for prescription drugs to all Medicare beneficiaries. To examine the effect of Part D on the financial burden of persons with diagnosed diabetes. We conducted an interrupted time-series analysis using data from the 1996 to 2008 Medical Expenditure Panel Survey (11,178 persons with diabetes who were covered by Medicare, and 8953 persons aged 45-64 y with diabetes who were not eligible for Medicare coverage). We then compared changes in 4 outcomes: (1) annual individual out-of-pocket expenditure (OOPE) for prescription drugs; (2) annual individual total OOPE for all health care services; (3) annual total family OOPE for all health care services; and (4) percentage of persons with high family financial burden (OOPE ≥10% of income). For Medicare beneficiaries with diabetes, Part D was associated with a 28% ($530) decrease in individual annual OOPE for prescription drugs, a 23% ($560) reduction in individual OOPE for all health care, a 23% ($863) reduction in family OOPE for all health care, and a 24% reduction in the percentage of families with high financial burden in 2006. There were similar reductions in 2007 and 2008. By 2008, the percentage of Medicare beneficiaries with diabetes living in high financial burden families was 37% lower than it would have been had Part D not been in place. Introduction of Part D coverage was associated with a substantial reduction in the financial burden of Medicare beneficiaries with diabetes and their families.
Higher Education Funding Council for England, 2016
This report provides an overview of the forecast financial health of the HEFCE-funded higher education (HE) sector in England. The analysis covers the financial forecasts for the period 2015-16 to 2018-19, based on information submitted by higher education institutions (HEIs) to HEFCE in July 2016. Financial Reporting Standard (FRS) 102 is the new…
Luiz Sérgio Silva
Full Text Available OBJECTIVE: To assess the association between exposure to adverse psychosocial working conditions and poor self-rated health among bank employees. METHODS: A cross-sectional study including a sample of 2,054 employees of a government bank was conducted in 2008. Self-rated health was assessed by a single question: "In general, would you say your health is (...." Exposure to adverse psychosocial working conditions was evaluated by the effort-reward imbalance model and the demand-control model. Information on other independent variables was obtained through a self-administered semi-structured questionnaire. A multiple logistic regression analysis was performed and odds ratio calculated to assess independent associations between adverse psychosocial working conditions and poor self-rated health. RESULTS: The overall prevalence of poor self-rated health was 9%, with no significant gender difference. Exposure to high demand and low control environment at work was associated with poor self-rated health. Employees with high effort-reward imbalance and overcommitment also reported poor self-rated health, with a dose-response relationship. Social support at work was inversely related to poor self-rated health, with a dose-response relationship. CONCLUSIONS: Exposure to adverse psychosocial work factors assessed based on the effort-reward imbalance model and the demand-control model is independently associated with poor self-rated health among the workers studied.
Fazaeli, Amir Abbas; Seyedin, Hesam; Vosoogh Moghaddam, Abbas; Delavari, Alireza; Salimzadeh, H; Varmazyar, Hasan; Fazaeli, Ali Akbar
Social systems are dealing with the challenge of achieving fairness in the distribution of financial burden and protecting the risk of financial loss. The purpose of this paper is to present a trend analysis for the indicators related to fairness in healthcare's financial burden in rural and urban population of Iran during the eight years period of 2003 to 2010. We used the information gathered by statistical center of Iran through sampling processes for the household income and expenditures. The indicators of fairness in financial contribution of healthcare were calculated based on the WHO recommended methodology. The indices trend analysis of eight-year period for the rural, urban areas and the country level were computed. This study shows that in Iran the fairness of financial contribution index during the eight-year period has been decreased from 0.841 in 2003 to above 0.827 in 2010 and The percentage of people with catastrophic health expenditures has been increased from 2.3% to above 3.1%. The ratio of total treatment costs to the household overall capacity to pay has been increased from 0.055 to 0.068 and from 0.072 to 0.0818 in urban and rural areas respectively. There is a decline in fairness of financial contribution index during the study period. While, a trend stability of the proportion of households who suffered catastrophic health expenditures was found.
Fazaeli, Amir Abbas; Seyedin, Hesam; Moghaddam, Abbas Vosoogh; Delavari, Alireza; Salimzadeh, H.; Varmazyar, Hasan; Fazaeli, Ali Akbar
Background: Social systems are dealing with the challenge of achieving fairness in the distribution of financial burden and protecting the risk of financial loss. The purpose of this paper is to present a trend analysis for the indicators related to fairness in healthcare’s financial burden in rural and urban population of Iran during the eight years period of 2003 to 2010. Methods: We used the information gathered by statistical center of Iran through sampling processes for the household income and expenditures. The indicators of fairness in financial contribution of healthcare were calculated based on the WHO recommended methodology. The indices trend analysis of eight-year period for the rural, urban areas and the country level were computed. Results: This study shows that in Iran the fairness of financial contribution index during the eight-year period has been decreased from 0.841 in 2003 to above 0.827 in 2010 and The percentage of people with catastrophic health expenditures has been increased from 2.3% to above 3.1%. The ratio of total treatment costs to the household overall capacity to pay has been increased from 0.055 to 0.068 and from 0.072 to 0.0818 in urban and rural areas respectively. Conclusion: There is a decline in fairness of financial contribution index during the study period. While, a trend stability of the proportion of households who suffered catastrophic health expenditures was found. PMID:26156920
Bacikova-Sleskova, Maria; Benka, Jozef; Orosova, Olga
The paper deals with parental employment status and its relationship to adolescents' self-reported health. It studies the role of the financial situation, parent-adolescent relationship and adolescent resilience in the relationship between parental employment status and adolescents' self-rated health, vitality and mental health. Multiple regression analyses were used to analyse questionnaire data obtained from 2799 adolescents (mean age 14.3) in 2006. The results show a negative association of the father's, but not mother's unemployment or non-employment with adolescents' health. Regression analyses showed that neither financial strain nor a poor parent-adolescent relationship or a low score in resilience accounted for the relationship between the father's unemployment or non-employment and poorer adolescent health. Furthermore, resilience did not work as a buffer against the negative impact of fathers' unemployment on adolescents' health.
Etemadi, Manal; Gorji, Hasan Abolghasem; Kangarani, Hannaneh Mohammadi; Ashtarian, Kioomars
The extent of universal health coverage in terms of financial protection is worrisome in Iran. There are challenges in health policies to guarantee financial accessibility to health services, especially for poor people. Various institutions offer support to ensure that the poor have financial access to health services. The aim of this study is to investigate the relationship network among the institutions active in this field. This study is a policy document analysis. It evaluates the country's legal documents in the field of financial support to the poor for healthcare after the Islamic Revolution in Iran. The researchers looked for the documents on the related websites and referred to the related organizations. The social network analysis approach was chosen for the analysis of the documents. Block-modelling and multi-dimensional scaling (MDS) was used to determine the network structures. The UCINET software was employed to analyse the data. Most the main actors of this network are chosen from the government budget. There is no legal communication and cooperation among some of the actors because of their improper position in the network. Seven blocks have been clustered by CONCOR in terms of the actor's degree of similarity. The social distance among the actors of the seven blocks is very short. Power distribution in the field of financial support to the poor has a fragmented structure; however, it is mainly run by a dominant block consisting of The Supreme Council of Welfare and Social Security, Health Insurance Organization, and the Ministry of Health and Medical Education. The financial support for the poor network involves multiple actors. This variety has created a series of confusions in terms of the type, level, and scope of responsibilities among the actors. The weak presence legislative and regulatory institutions and also non-governmental institutions are the main weak points of this network. Copyright © 2017 Elsevier Ltd. All rights reserved.
Jenkins, Brooke N; Hunter, John F; Cross, Marie P; Acevedo, Amanda M; Pressman, Sarah D
This study addresses methodological and theoretical questions about the association between affect and physical health. Specifically, we examine the role of affect variability and its interaction with mean levels of affect to predict antibody (Ab) levels in response to an influenza vaccination. Participants (N=83) received the vaccination and completed daily diary measures of affect four times a day for 13days. At one and four months post-vaccination, blood was collected from the participants to assess Ab levels. Findings indicate that affect variability and its interaction with mean levels of affect predict an individual's immune response. Those high in mean positive affect (PA) who had more PA variability were more likely to have a lower Ab response in comparison to those who had high mean PA and less PA variability. Although it did not interact with mean negative affect (NA), NA variability on its own was associated with Ab response, whereby those with less NA variability mounted a more robust immune response. Affect variability is related to immune response to an influenza vaccination and, in some cases, interacts with mean levels of affect. These oscillations in affective experiences are critical to consider in order to unpack the intricacies of how affect influences health. These findings suggest that future researchers should consider the important role of affect variability on physical health-relevant outcomes as well as examine the moderating effect of mean affect levels. Copyright © 2017 Elsevier Inc. All rights reserved.
De Vogli, Roberto
In 2009, Europe was hit by one of the worst debt crises in history. Although the Eurozone crisis is often depicted as an effect of government mismanagement and corruption, it was a consequence of the 2008 U.S. banking crisis which was caused by more than three decades of neoliberal policies, financial deregulation and widening economic inequities.Evidence indicates that the Eurozone crisis disproportionately affected vulnerable populations in society and caused sharp increases of suicides and deaths due to mental and behavioral disorders especially among those who lost their jobs, houses and economic activities because of the crisis. Although little research has, so far, studied the effects of the crisis on health inequities, evidence showed that the 2009 economic downturn increased the number of people living in poverty and widened income inequality especially in European countries severely hit by the debt crisis. Data, however, also suggest favorable health trends and a reduction of traffic deaths fatalities in the general population during the economic recession. Moreover, egalitarian policies protecting the most disadvantaged populations with strong social protections proved to be effective in decoupling the link between job losses and suicides.Unfortunately, policy responses after the crisis in most European countries have mainly consisted in bank bailouts and austerity programs. These reforms have not only exacerbated the debt crisis and widened inequities in wealth but also failed to address the root causes of the crisis. In order to prevent a future financial downturn and promote a more equitable and sustainable society, European governments and international institutions need to adopt new regulations of banking and finance as well as policies of economic redistribution and investment in social protection. These policy changes, however, require the abandonment of the neoliberal ideology to craft a new global political economy where markets and gross
Bertone, Maria Paola; Witter, Sophie
Human resources for health represent an essential component of health systems and play a key role to accelerate progress towards universal health coverage. Many countries in sub-Saharan Africa face challenges regarding the availability, distribution and performance of health workers, which could be in part addressed by providing effective financial incentives. Based on an overview of the existing literature, the paper highlights the gaps in the existing research in low-income countries exploring the different components of health workers' incomes. It then proposes a novel approach to the analysis of financial incentives and delineates a research agenda, which could contribute to shed light on this topic. The article finds that, while there is ample research that investigates separately each of the incomes health workers may earn (for example, salary, fee-for-service payments, informal incomes, "top-ups" and per diems, dual practice and non-health activities), there is a dearth of studies which look at the health workers' "complex remuneration", that is, the whole of the financial incentives available. Little research exists which analyses simultaneously all revenues of health workers, quantifies the overall remuneration and explores its complexity, its multiple components and their features, as well as the possible interaction between income components. However, such a comprehensive approach is essential to fully comprehend health workers' incentives, by investigating the causes (at individual and system level) of the fragmentation in the income structure and the variability in income levels, as well as the consequences of the "complex remuneration" on motivation and performance. This proposition has important policy implications in terms of devising effective incentive packages as it calls for an active consideration of the role that "complex remuneration" plays in determining recruitment, retention and motivation patterns, as well as, more broadly, the
Tin, K Y K; Tsoi, P K O; Lee, Y H; Tsui, E L H; Lam, D W S; Chui, A W M; Lo, S V
This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2009/10, cross-stratified and categorised by financing source, provider and function. Total expenditure on health (TEH) was HK$88,721 million in financial year 2009/10, which represents an increase of HK$5031 million or 6.0% over the preceding year. As a result of a slow revival in the economy from the financial tsunami in 2008, TEH grew faster relative to gross domestic product (GDP) leading to a marked increase in TEH as a percentage of GDP from 5.0% in 2008/09 to 5.2% in 2009/10. During the period 1989/90 to 2009/10, total health spending per capita (at constant 2010 prices) grew at an average annual rate of 4.9%, which was faster than the average annual growth rate of per capita GDP by 2.0 percentage points. In 2009/10, public and private expenditure on health increased by 6.2% and 5.8% when compared with 2008/09, reaching HK$43,823 million and HK$44,898 million, respectively. Consequently, public and private shares of total health expenditure stayed at similar levels (49% and 51% respectively) in the 2 years. With respect to private spending, the most important source of health financing was out-of-pocket payments by households (34.9% of TEH), followed by employer-provided group medical benefits (7.4%) and private insurance (6.8%). During the period, a growing number of households (mostly in middle to high income groups) have taken out pre-payment plans to finance health care. As such, private insurance has taken on an increasingly important role in financing private spending. Of the HK$88,721 million total health expenditure in 2009/10, current expenditure comprised HK$84,874 million (95.7%), whereas HK$3847 million (4.3%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share (66.2%), which was made up of ambulatory services (33.5%), in
Onarheim, Kristine Husøy; Norheim, Ole Frithjof; Miljeteig, Ingrid
High healthcare costs make illness precarious for both patients and their families' economic situation. Despite the recent focus on the interconnection between health and financial risk at the systemic level, the ethical conflict between concerns for potential health benefits and financial risk protection at the household level in a low-income setting is less understood. Using a seven-step ethical analysis, we examine a real-life dilemma faced by families and health workers at the micro level in Ethiopia and analyse the acceptability of limiting treatment for an ill newborn to protect against financial risk. We assess available evidence and ethical issues at stake and discuss the dilemma with respect to three priority setting criteria: health maximisation, priority to the worse-off and financial risk protection. Giving priority to health maximisation and extra priority to the worse-off suggests, in this particular case, that limiting treatment is not acceptable even if the total well-being gain from reduced financial risk is taken into account. Our conclusion depends on the facts of the case and the relative weight assigned to these criteria. However, there are problematic aspects with the premise of this dilemma. The most affected parties-the newborn, family members and health worker-cannot make free choices about whether to limit treatment or not, and we thereby accept deprivations of people's substantive freedoms. In settings where healthcare is financed largely out-of-pocket, families and health workers face tragic trade-offs. As countries move towards universal health coverage, financial risk protection for high-priority services is necessary to promote fairness, improve health and reduce poverty. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Crowe, Laura; Butterworth, Peter; Leach, Liana
This study analysed data from the Household Income and Labour Dynamics in Australia (HILDA) Survey to examine the relationship between employment status and mental health, and the mediating effects of financial hardship, mastery and social support. In addition, the study sought to explore the effects of duration of unemployment on mental health. The primary analysis used three waves of data from the HILDA Survey with 4965 young adult respondents. Longitudinal population-averaged logistic regression models assessed the association of employment status and mental health, including the contribution of mastery, financial hardship and social support in explaining this association between employment groups (unemployed vs. employed; under employed vs. employed). Sensitivity analyses utilised a fixed-effects approach and also considered the full-range of working-age respondents. Regression analysis was used to explore the effect of duration of unemployment on mental health. Respondents' who identified as unemployed or underemployed were at higher risk of poor mental health outcomes when compared to their employed counterparts. This association was ameliorated when accounting for mastery, financial hardship and social support for the unemployed, and was fully mediated for the underemployed. The fixed-effects models showed the transition to unemployment was associated with a decline in mental health and that mastery in particular contributed to that change. The same results were found with a broader age range of respondents. Finally, the relationship between duration of unemployment and mental health was not linear, with mental health showing marked decline across the first 9 weeks of unemployment. Mastery, social support and financial hardship are important factors in understanding the association of poor mental health with both unemployment and underemployment. Furthermore, the results suggest that the most deleterious effects on mental health may occur in the first two
Neprash, Hannah T; Chernew, Michael E; Hicks, Andrew L; Gibson, Teresa; McWilliams, J Michael
Financial integration between physicians and hospitals may help health care provider organizations meet the challenges of new payment models but also may enhance the bargaining power of provider organizations, leading to higher prices and spending in commercial health care markets. To assess the association between recent increases in physician-hospital integration and changes in spending and prices for outpatient and inpatient services. Using regression analysis, we estimated the relationship between changes in physician-hospital integration from January 1, 2008, through December 31, 2012, in 240 metropolitan statistical areas (MSAs) and concurrent changes in spending. Adjustments were made for patient, plan, and market characteristics, including physician, hospital, and insurer market concentration. The study population included a cohort of 7,391,335 nonelderly enrollees in preferred-provider organizations or point-of-service plans included in the Truven Health MarketScan Commercial Database during the study period. Data were analyzed from December 1, 2013, through July 13, 2015. Physician-hospital integration, measured using Medicare claims data as the share of physicians in an MSA who bill for outpatient services with a place-of-service code indicating employment or practice ownership by a hospital. Annual inpatient and outpatient spending per enrollee and associated use of health care services, with utilization measured by price-standardized spending (the sum of annual service counts multiplied by the national mean of allowed charges for the service). Among the 240 MSAs, physician-hospital integration increased from 2008 to 2012 by a mean of 3.3 percentage points, with considerable variation in increases across MSAs (interquartile range, 0.8-5.2 percentage points). For our study sample of 7,391,335 nonelderly enrollees, an increase in physician-hospital integration equivalent to the 75th percentile of changes experienced by MSAs was associated with a mean
Tøge, Anne Grete
Unemployment has a number of negative consequences, such as decreased income and poor self-rated health. However, the relationships between unemployment, income, and health are not fully understood. Longitudinal studies have investigated the health effect of unemployment and income separately, but the mediating role of income remains to be scrutinized. Using longitudinal data and methods, this paper investigates whether the effect of unemployment on self-rated health (SRH) is mediated by income, financial strain and unemployment benefits. The analyses use data from the longitudinal panel of European Union Statistics on Income and Living Conditions (EU-SILC) over the 4 years of 2008 to 2011. Individual fixed effects models are applied, estimating the longitudinal change in SRH as people move from employment to unemployment, and investigating whether this change is reduced after controlling for possible mediating mechanisms, absolute income change, relative income change, relative income rank, income deprivation, financial strain, and unemployment benefits. Becoming unemployed is associated with decreased SRH (-0.048, SE 0.012). This decrease is 19 % weaker (-0.039, SE 0.010) after controlling for change in financial strain. Absolute and relative changes in household equalized income, as well as changes in relative rank and transitions into income deprivation, are not found to be associated with change in SRH. Financial strain is found to be a potential mediator of the individual health effect of unemployment, while neither absolute income, relative income, relative rank, income deprivation nor unemployment benefits are found to be mediators of this relationship.
Lynagh, Marita C; Sanson-Fisher, Rob W; Bonevski, Billie
The use of financial incentives or pay-for-performance programs for health care providers has triggered emerging interest in the use of financial incentives for encouraging health behaviour change. This paper aims to identify key conditions under which the use of financial incentives for improvements in public health outcomes is most likely to be effective and appropriate. We review recent systematic reviews on their effectiveness in changing health behaviour and identify existing moral concerns concerning personal financial incentives. Current evidence indicates that incentives can be effective in driving health behaviour change under certain provisos, while a number of misgivings continue to be deliberated on. We outline a number of key principles for consideration in decisions about the potential use of incentives in leading to public health improvements. These key principles can assist policy makers in making decisions on the use of financial incentives directed at achieving improvements in public health.
Riggs, Kevin R; Buttorff, Christine; Alexander, G Caleb
The Affordable Care Act (ACA) mandates that all private health insurance include out-of-pocket spending caps. Insurance purchased through the ACA's Health Insurance Marketplace may qualify for income-based caps, whereas group insurance will not have income-based caps. Little is known about how out-of-pocket caps impact individuals' health care financial burden. We aimed to estimate what proportion of non-elderly individuals with group insurance will benefit from out-of-pocket caps, and the effect that various cap levels would have on their financial burden. We applied the expected uniform spending caps, hypothetical reduced uniform spending caps (reduced by one-third), and hypothetical income-based spending caps (similar to the caps on Health Insurance Marketplace plans) to nationally representative data from the Medical Expenditure Panel Survey (MEPS). Participants were non-elderly individuals (aged health insurance in the 2011 and 2012 MEPS surveys (n =26,666). (1) The percentage of individuals with reduced family out-of-pocket spending as a result of the various caps; and (2) the percentage of individuals experiencing health care services financial burden (family out-of-pocket spending on health care, not including premiums, greater than 10% of total family income) under each scenario. With the uniform caps, 1.2% of individuals had lower out-of-pocket spending, compared with 3.8% with reduced uniform caps and 2.1% with income-based caps. Uniform caps led to a small reduction in percentage of individuals experiencing financial burden (from 3.3% to 3.1%), with a modestly larger reduction as a result of reduced uniform caps (2.9%) and income-based caps (2.8%). Mandated uniform out-of-pocket caps for those with group insurance will benefit very few individuals, and will not result in substantial reductions in financial burden.
Gunnarsdóttir, Hrafnhildur; Hensing, Gunnel; Povlsen, Lene; Petzold, Max
The Nordic welfare system has been acknowledged as favourable for children, successfully contributing to low child mortality and poverty rates. Nevertheless, mental health problems among children and adolescents are common and the economic situation of the family has been highlighted as an important determinant. In spite of similar social, political and cultural structures, the Nordic countries differ; Iceland was most affected by the global financial crisis in 2008. The aim of this study was to examine potential differences in parental financial stress and the associations to child mental health between the Nordic countries as well as age and gender differences. The study sample consisted of 6330 children aged 4-16 years old included in the 2011 version of the Nordic Study of Children's Health, Wellbeing and Quality of life. The Strengths and Difficulties Questionnaire was used to measure mental health problems. In Iceland, 47.7% of the parents reported financial stress while ≤20% did so in the other countries except for Finland (33.5%). However, in case of parental financial stress the OR of mental health problems comparing children to parents with and without financial stress was significantly lower among the Icelandic children (OR 1.60, 95% CI 1.15-2.24) than among the others: Denmark OR 3.07 (95% CI 2.15-4.39), Finland OR 2.28 (95% CI 1.60-3.25), Norway OR 2.77 (95% CI 1.86-4.12), Sweden OR 3.31(95% CI 2.26-4.86). No significant age or gender differences in the ORs were observed. Besides socioeconomic situation, relative deprivation should be considered an important determinant of child mental health. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Tin, K Y K; Tsoi, P K O; Lee, Y H; Tsui, E L H; Lam, D W S; Chui, A W M; Lo, S V
This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2008/09, cross-stratified and categorised by financing source, provider and function. Total expenditure on health (TEH) was HK$84,391 million in financial year 2008/09, which represents an increase of HK$5030 million or 6.3% over the preceding year. Amid the financial tsunami in late 2008, TEH grew faster relative to gross domestic product (GDP) leading to a marked increase as a percentage of GDP from 4.8% in 2007/08 to 5.1% in 2008/09. During the period 1989/90 to 2008/09, TEH per capita (at constant 2009 prices) grew at an average annual rate of 4.9%, which was faster than that of per capita GDP by 2.0 percentage points. 6.4% when compared with 2007/08, reaching HK$41 257 million and HK$43 134 million, respectively. Consequently, public and private shares of total health expenditure remained the same in the 2 years at 48.9% and 51.1%, respectively. Regarding private spending, the most important source of health financing was out-of-pocket payments by households (35.4% of TEH), followed by employer-provided group medical benefits (7.5%) and private insurance (6.4%). During the period, a growing number of households (mostly in middle to high-income groups) subscribed to pre-payment plans for financing health care. As such, private insurance has taken on an increasingly important role for financing private spending. Of the HK$84 391 million total health expenditure in 2008/09, current expenditure comprised HK$81 186 million (96.2%), whereas HK$3206 million (3.8%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share of total health spending (66.1%), which was made up of ambulatory services (32.8%), in-patient curative care (28.8%), day patient hospital services (3.9%) and home care (0.5%). Notwithstanding the small share of total spending for day patient
Janssens, Wendy; Goedecke, Jann; de Bree, Godelieve J.; Aderibigbe, Sunday A.; Akande, Tanimola M.; Mesnard, Alice
Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. A household survey was conducted in rural Kwara State,
Vargas Bustamante, Arturo; V Shimoga, Sandhya
As middle-income countries become more affluent, economically sophisticated and productive, health expenditure patterns are likely to change. Other socio-demographic and political changes that accompany rapid economic growth are also likely to influence health spending and financial protection. This study investigates the relationship between growth on per-capita healthcare expenditure and gross domestic product (GDP) in a group of 27 large middle-income economies and compares findings with those of 24 high-income economies from the Organization for Economic Cooperation and Development (OECD) group. This comparison uses national accounts data from 1995-2014. We hypothesize that the aggregated income elasticity of health expenditure in middle-income countries would be less than one (meaning healthcare is a normal good). An initial exploratory analysis tests between fixed-effects and random-effects model specifications. A fixed-effects model with time-fixed effects is implemented to assess the relationship between the two measures. Unit root, Hausman and serial correlation tests are conducted to determine model fit. Additional explanatory variables are introduced in different model specifications to test the robustness of our regression results. We include the out-of-pocket (OOP) share of health spending in each model to study the potential role of financial protection in our sample of high- and middle-income countries. The first-difference of study variables is implemented to address non-stationarity and cointegration properties. The elasticity of per-capita health expenditure and GDP growth is positive and statistically significant among sampled middle-income countries (51 per unit-growth in GDP) and high-income countries (50 per unit-growth in GDP). In contrast with previous research that has found that income elasticity of health spending in middle-income countries is larger than in high-income countries, our findings show that elasticity estimates can change if
Vargas Bustamante, Arturo; Shimoga, Sandhya V.
Background: As middle-income countries become more affluent, economically sophisticated and productive, health expenditure patterns are likely to change. Other socio-demographic and political changes that accompany rapid economic growth are also likely to influence health spending and financial protection. Methods: This study investigates the relationship between growth on per-capita healthcare expenditure and gross domestic product (GDP) in a group of 27 large middle-income economies and compares findings with those of 24 high-income economies from the Organization for Economic Cooperation and Development (OECD) group. This comparison uses national accounts data from 1995-2014. We hypothesize that the aggregated income elasticity of health expenditure in middle-income countries would be less than one (meaning healthcare is a normal good). An initial exploratory analysis tests between fixed-effects and random-effects model specifications. A fixed-effects model with time-fixed effects is implemented to assess the relationship between the two measures. Unit root, Hausman and serial correlation tests are conducted to determine model fit. Additional explanatory variables are introduced in different model specifications to test the robustness of our regression results. We include the out-of-pocket (OOP) share of health spending in each model to study the potential role of financial protection in our sample of high- and middle-income countries. The first-difference of study variables is implemented to address non-stationarity and cointegration properties. Results: The elasticity of per-capita health expenditure and GDP growth is positive and statistically significant among sampled middle-income countries (51 per unit-growth in GDP) and high-income countries (50 per unit-growth in GDP). In contrast with previous research that has found that income elasticity of health spending in middle-income countries is larger than in high-income countries, our findings show that
Tin, K Y K; Tsoi, P K O; Lee, Y H; Chong, D S Y; Lam, D W S; Yeung, A Y T; Ma, E S K; Maw, C K C
This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2011/12, cross-stratified and categorized by financing source, provider, and function. Total expenditure on health (TEH) was HK$101 985 million in financial year 2011/12, which represents an increase of HK$8580 million or 9.2% over the preceding year. TEH grew faster relative to gross domestic product (GDP) leading to a rise in TEH as a percentage of GDP from 5.1% in 2010/11 to 5.2% in 2011/12. During the period 1989/90 to 2011/12, total health spending per capita (at constant 2012 prices) grew at an average annual rate of 4.8%, which was faster than the average annual growth rate of per capita GDP by 1.8 percentage points. In 2011/12, public and private expenditure on health increased by 8.3% and 10.0% when compared with 2010/11, reaching HK$49,262 million and HK$52,723 million respectively. Consequently, public share of total health expenditure dropped slightly from 48.7% to 48.3% over the year. Of private spending, the most important source of health financing was out-of-pocket payments by households (34.9% of TEH), followed by employer-provided group medical benefits (7.5%) and private insurance (7.4%). It is worth noting that private insurance will likely take over employers as the second largest private payer if the insurance market continues to expand at the current rate. Of the HK$101,985 million total health expenditure in 2011/12, current expenditure comprised HK$96,572 million (94.7%), whereas HK$5413 million (5.3%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services of curative care accounted for the largest share of total health spending (65.2%), which was made up of ambulatory services (33.6%), in-patient curative care (26.9%), day patient hospital services (4.1%), and home care (0.5%). Notwithstanding its small share, the total spending for day patient hospital services shows an
The current study uses six annual waves of the Longitudinal Labor Market Study (LLMS) covering the 2008-2013 period to obtain longitudinal estimations suggesting statistically significant negative effects from unemployment on self-reported health and mental health in Greece. The specifications suggest that unemployment results in lower health and the deterioration of mental health during the 2008-2009 period compared with the 2010-2013 period, i.e., a period in which the country's unemployment doubled as a consequence of the financial crisis. Unemployment seems to be more detrimental to health/mental health in periods of high unemployment, suggesting that the unemployment crisis in Greece is more devastating as it concerns more people. Importantly, in all specifications, comparable qualitative patterns are found by controlling for unemployment due to firm closure, which allows us to minimize potential bias due to unemployment-health related reverse causality. Moreover, in all cases, women are more negatively affected by unemployment in relation to their health and mental health statuses than are men. Greece has been more deeply affected by the financial crisis than any other EU country, and this study contributes by offering estimates for before and during the financial crisis and considering causality issues. Because health and mental health indicators increase more rapidly in a context of higher surrounding unemployment, policy action must place greater emphasis on unemployment reduction and supporting women's employment. Copyright © 2014 Elsevier Ltd. All rights reserved.
Ashcroft, Richard E
This paper reviews the ethical controversy concerning the use of monetary incentives in health promotion, focussing specifically on the arguments relating to the impact on personal autonomy of such incentives. Offering people small amounts of money in the context of health promotion and medical care has been attempted in a number of settings in recent years. This use of personal financial incentives has attracted a degree of ethical controversy. One form of criticism is that such schemes interfere with the autonomy of the patient or citizen in an illegitimate way. This paper presents a thematic analysis of the main arguments concerning personal autonomy and the use of monetary incentives in behaviour change. The main moral objections to the uses of incentives are that they may be in general or in specific instances paternalistic, coercive, involve bribery, or undermine the agency of the person. While incentive schemes may engage these problems on occasion, there is no good reason to think that they do so inherently and of necessity. We need better behavioural science evidence to understand how incentives work, in order to evaluate their moral effects in practice. © 2011 Blackwell Publishing Ltd.
Moos, Rudolf H.; Brennan, Penny L.; Schutte, Kathleen K.; Moos, Bernice S.
This study examined how older adults cope with negative life events in health, interpersonal, and financial/work domains and whether common stress and coping processes hold across these three domains. On three occasions, older adults identified the most severe negative event they faced in the last year and described how they appraised and coped…
Naghdi, Seyran; Moradi, Tayebeh; Tavangar, Fateh; Bahrami, Giti; Shahboulaghi, Mohammadi; Ghiasvand, Hesam
The move to universal health coverage and consequently health promotion is influenced by political, socio-economic and other contextual factors in a country. Iran, as a developing country with an upper-middle national income, has developed policies to achieve universal health coverage through financial protection. This study aims to investigate barriers to develop financial protection as a requirement to achieve universal health coverage. This qualitative study was conducted using 20 in-depth interviews with experts in social welfare, health insurance and financing. The framework analysis method was used to analyze the data. The results have been categorized in three major themes that were extracted from ten sub-themes. The major themes included the political, social and economic context of the country, the context and structure of healthcare system and dimensions of UHC. Achieving financial protection as a long-term objective should be considered as a priority among Iranian policy makers that requires an inter-sectoral collaboration with a defined in-charge body. Health policy makers in Iran should develop a more comprehensive benefits package for diseases and health conditions with catastrophic consequences. They also should develop a plan to cover the poor people.
Gill, J S; Delmonico, F; Klarenbach, S; Capron, A M
Organ donation should neither enrich donors nor impose financial burdens on them. We described the scope of health care required for all living kidney donors, reflecting contemporary understanding of long-term donor health outcomes; proposed an approach to identify donor health conditions that should be covered within the framework of financial neutrality; and proposed strategies to pay for this care. Despite the Affordable Care Act in the United States, donors continue to have inadequate coverage for important health conditions that are donation related or that may compromise postdonation kidney function. Amendment of Medicare regulations is needed to clarify that surveillance and treatment of conditions that may compromise postdonation kidney function following donor nephrectomy will be covered without expense to the donor. In other countries lacking health insurance for all residents, sufficient data exist to allow the creation of a compensation fund or donor insurance policies to ensure appropriate care. Providing coverage for donation-related sequelae as well as care to preserve postdonation kidney function ensures protection against the financial burdens of health care encountered by donors throughout their lives. Providing coverage for this care should thus be cost-effective, even without considering the health care cost savings that occur for living donor transplant recipients. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.
Full Text Available Background: Health financial reforms began in 2005 through four phases in order to achieve the maximum efficiency and effectiveness in this sector. The first phase was accrual accounting implementation instead of cash method. Objective: The aim of this study was to determine the most important improvement spaces of the first phase of reform in financial management (accrual accounting in the viewpoints of financial experts employed in middle and operational levels of Universities of Medical Sciences. Methods: This qualitative study was conducted in Universities of Medical Sciences in 2013 using non-probability sampling method (snowball. Saturation was achieved only after 25 semi-structured interviews. Data were analyzed using content analysis by Kruger model. Findings: Seven areas of improvement including staffs, managers, information system, organizational culture, structure, process, and financial were identified as main themes. Each theme contained several sub-themes. Conclusion: Attempts and planning should be considered by decision makers in order to improve modifiable determinants through practical mechanisms in the first phase of health system financial management.
Cyprus entered a prolonged financial recession in 2011 and by early 2013 it applied for an international bail-out agreement. This presupposed massive reforms in public governance. Health sector was considerably reformed and one of the measures was the introduction of co-payment for outpatient visits to public health care sector. The scope of this study is to assess the impact of financial crisis and co-payment to public outpatient visits in Nicosia urban and greater Nicosia region. An Interrupted time-series analysis. All outpatient visits to public health care family doctor/general practitioners in Nicosia urban and greater Nicosia region from January 2011 until May of 2014 were registered and analysed. Financial crisis did not alter outpatient visits. Introduction of co-payment led to a statistically significant decrease from the second month after its introduction (p = 0.048) (R(2) = 0.329, Q = 23.75, p = 0.137). This decrease was consistent until the end of the observational period and it did not level off. Financial crisis did not affect outpatient visits while co-payment can be considered as a potent cost containment measure during financial recession, by normalising utilisation of healthcare resources. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Ghiasvand, Hesam; Olyaeemanesh, Alireza; Majdzadeh, Reza; Abdi, Zhaleh; Mobinizadeh, Mohammadreza
The financial protection against catastrophic and impoverishing health expenditures is one of the main aspects of the universal health coverage. This study aimed to present a clear picture of the financial protection situation in Iran from 2003-2014. This is an analytical study on secondary data of Statistical Center of Iran (SCI). The study has some policy implications for policy makers; therefore, it is an applied one. Data related to the Iranian rural and urban household payments on health expenditures was obtained from annual surveys of the SCI. WHO researchers' approach was used to calculate the Fairness of Financial Contribution Indicator (FFCI), the headcount and overshoot ratios of catastrophic and impoverishing health expenditures. A logistic regression was conducted to identify the determinants of probability of occurrence of catastrophic health expenditure among Iranian households in 2014. The mean of FFCI for rural and urban households was 0.854 (0.41) and 0.867 (0.32), respectively. The average headcount ratios of catastrophic and impoverishing health expenditures were 1.32% (0.24) and 0.33% (P=0.006) for rural households and 1.4% (0.6) and 0.28% (P=0.001) for urban households. Concerning rural households, the overshoot of catastrophic and impoverishing health expenditures was 14.94% (P=0.001) and 7.22% (0.53); it was 15.59% (1.54) and 7.76% (0.52) for urban households. No significant and considerable change was found in the headcount ratios of catastrophic and impoverishing health expenditure and in their overshoot or gap amounts. This suggested a lack of well-designed and effective schemes for materializing the financial protection in Iran.
Tin, K Y K; Tsoi, P K O; Lee, Y H; Tsui, E L H; Lam, D W S; Yeung, A Y T; Chui, A W M; Tay, M S M
This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2010/11, cross-stratified and categorised by financing source, provider, and function.Total expenditure on health (TEH) was HK$93 433 million in financial year 2010/11, which represents an increase of HK$5364 million or 6.1% over the preceding year. As a result of a gradual recovery from the financial tsunami in 2008, gross domestic product (GDP) grew faster relative to TEH leading to a drop in TEH as a percentage of GDP from 5.2% in 2009/10 to 5.1% in 2010/11.During the period 1989/90 to 2010/11, TEH per capita (at constant 2011 prices)grew at an average annual rate of 4.8%, which was faster than the average annual growth rate of per capita GDP by 1.8 percentage points.Compared to 2009/10, in 2010/11 public and private expenditure on health increased by 3.7% and 8.5% and reached HK$45 491 million and HK$47 943 million, respectively. Consequently, the public share of TEH dropped slightly from 49.8% to 48.7% over the year. Regarding private spending, the most important source was out-of-pocket payments by households (35.0% of TEH),followed by employer-provided group medical benefits (7.4%), and private insurance (7.2%). It is worth noting that private insurance will likely overtake employer benefits as the second largest private payer if the insurance market continues to expand at the current rate.Of the HK$93 433 million TEH in 2010/11, HK$88 987 million (95.2%) was current expenditure and HK$4446 million (4.8%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share of TEH (65.8%), which was made up of ambulatory services (34.0%), in-patient curative care (27.0%), day patient hospital services (4.2%), and home care (0.5%). Notwithstanding its small share,the total spending for day patient hospital services shows an increasing trend over the period 1989
Background Despite its importance in providing evidence for health-related policy and decision-making, an insufficient amount of health systems research (HSR) is conducted in low-income countries (LICs). Schools of public health (SPHs) are key stakeholders in HSR. This paper, one in a series of four, examines human and financial resources capacities, policies and organizational support for HSR in seven Africa Hub SPHs in East and Central Africa. Methods Capacity assessment done included document analysis to establish staff numbers, qualifications and publications; self-assessment using a tool developed to capture individual perceptions on the capacity for HSR and institutional dialogues. Key informant interviews (KIIs) were held with Deans from each SPH and Ministry of Health and non-governmental officials, focusing on perceptions on capacity of SPHs to engage in HSR, access to funding, and organizational support for HSR. Results A total of 123 people participated in the self-assessment and 73 KIIs were conducted. Except for the National University of Rwanda and the University of Nairobi SPH, most respondents expressed confidence in the adequacy of staffing levels and HSR-related skills at their SPH. However, most of the researchers operate at individual level with low outputs. The average number of HSR-related publications was only capacity. This study underscores the need to form effective multidisciplinary teams to enhance research of immediate and local relevance. Capacity strengthening in the SPH needs to focus on knowledge translation and communication of findings to relevant audiences. Advocacy is needed to influence respective governments to allocate adequate funding for HSR to avoid donor dependency that distorts local research agenda. PMID:24888371
.... Specifically, we reviewed financial accounting procedures and related management controls to determine whether the Defense Finance and Accounting Service Denver Center Operating Location can produce...
Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh
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
Seyed Saeed Hashemi Nazari
Conclusions: Correlation of segregation of determinants of socioeconomic status with segregation of health indices is an indicator of existence of hot zones of health problems across some provinces. Further studies using multilevel modeling and individual data in health outcomes at individual level and segregation measures at appropriate geographic levels are required to confirm these relations.
Eshak, E S; Kamal, N N; Seedhom, A E; Kamal, N N
Egypt's economic reform is accompanied by both financial and social strains. Due to lack of evidence, we examined the associations between work-family conflict in its 2 directions, work-to-family conflicts (WFCs), and family-to-work conflicts (FWCs) and self-rated health in Minia, Egypt, and whether the association will vary by being financially responsible for others and by the level of perceived social support. A cross-sectional study that included 1021 healthy participants aged 18-60 years from Minia district. Data on participants' work-family conflict, social, and demographic data and individual self-rated health were collected by a questionnaire survey. Multivariable logistic regression analyses were used to calculate the odds ratios (ORs) with its 95% confidence intervals (CIs) for poor self-rated health according to categories of work-family conflict. There were significant positive associations between the poor self-rated health and both high WFC and FWC. Compared with participants with low WFC and low FWC, participants with high WFC low FWC, low WFC high FWC, and high WFC high FWC had multivariable-adjusted ORs (95% CIs) for poor self-rated health of 6.93 (3.02-13.13), 2.09 (1.06-4.12), and 10.05 (4.98-20.27), respectively. Giving financial support to others but not the level of perceived social support from others was an effect modifier of the association. Work-family conflict was positively associated with the self-report of poor health, especially in those who were financially responsible for other family members. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Townsley, Michael K.
In this timely book, financial consultant and experienced college administrator Mike Townsley examines the financial and strategic resources that private colleges and universities must have in place to withstand the storm. Small college presidents, CFOs, planners, chief academic officers, and board members all have a hand on the tiller and will…
Schindler, Holly S.
This study explores the relationship between residential, biological fathers' parental engagement, financial contributions, and psychological well-being in 2-parent families. Specifically, this study focuses on how fathers' parental engagement and financial contributions are related to their self-esteem, self-efficacy, and psychological distress.…
Habib, Shifa Salman; Perveen, Shagufta; Khuwaja, Hussain Maqbool Ahmed
Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting. We conducted a systematic search for published literature using the search terms "Community based health insurance AND developing countries", "Micro health insurance AND developing countries", "Mutual health insurance AND developing countries", "mutual OR micro OR community based health insurance" "Health insurance AND impact AND poor" "Health insurance AND financial protection" and "mutual health organizations" on three databases, Pubmed, Google Scholar and Science Direct (Elsevier). Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization. Twenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa). Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure, household borrowings and poverty. MHI also had a positive safeguarding effect on
Shifa Salman Habib
Full Text Available Abstract Background Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting. Methods We conducted a systematic search for published literature using the search terms “Community based health insurance AND developing countries”, “Micro health insurance AND developing countries”, “Mutual health insurance AND developing countries”, “mutual OR micro OR community based health insurance” “Health insurance AND impact AND poor” “Health insurance AND financial protection” and “mutual health organizations” on three databases, Pubmed, Google Scholar and Science Direct (Elsevier. Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization. Results Twenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa. Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure
Jürges, Hendrik; Köberlein, Juliane
We use the introduction of diagnosis related groups (DRGs) in German neonatology to study the determinants of upcoding. Since 2003, reimbursement is based inter alia on birth weight, with substantial discontinuities at eight thresholds. These discontinuities create incentives to upcode preterm infants into classes of lower birth weight. Using data from the German birth statistics 1996-2010 and German hospital data from 2006 to 2011, we show that (1) since the introduction of DRGs, hospitals have upcoded at least 12,000 preterm infants and gained additional reimbursement in excess of 100 million Euro; (2) upcoding rates are systematically higher at thresholds with larger reimbursement hikes and in hospitals that subsequently treat preterm infants, i.e. where the gains accrue; (3) upcoding is systematically linked with newborn health conditional on birth weight. Doctors and midwives respond to financial incentives by not upcoding newborns with low survival probabilities, and by upcoding infants with higher expected treatment costs. Copyright © 2015 Elsevier B.V. All rights reserved.
Yu, Lei; Wilson, Robert S.; Schneider, Julie A.; Bennett, David A.; Boyle, Patricia A.
Background Domain specific literacy is a multidimensional construct that requires multiple resources including cognitive and non-cognitive factors. Objective We test the hypothesis that domain specific literacy is associated with AD dementia and AD pathology after controlling for cognition. Methods Participants were community based older persons who completed a baseline literacy assessment, underwent annual clinical evaluations for up to 8 years and agreed to organ donation after death. Financial and health literacy was measured using 32 questions and cognition was measured using 19 tests. Annual diagnosis of AD dementia followed standard criteria. AD pathology was examined post-mortem by quantifying plaques and tangles. Cox models examined the association of literacy with incident AD dementia. Performance of model prediction for incident AD dementia was assessed using indices for integrated discrimination improvement and continuous net reclassification improvement. Linear regression models examined the independent association of literacy with AD pathology in autopsied participants. Results All 805 participants were free of dementia at baseline and 102 (12.7%) developed AD dementia during the follow-up. Lower literacy was associated with higher risk for incident AD dementia (pliteracy measure had better predictive performance than the one with demographics and cognition only. Lower literacy also was associated with higher burden of AD pathology after controlling for cognition (β=0.07, p=0.035). Conclusion Literacy predicts incident AD dementia and AD pathology in community-dwelling older persons, and the association is independent of traditional measures of cognition. PMID:28157101
Yu, Lei; Wilson, Robert S; Schneider, Julie A; Bennett, David A; Boyle, Patricia A
Domain specific literacy is a multidimensional construct that requires multiple resources including cognitive and non-cognitive factors. We test the hypothesis that domain specific literacy is associated with Alzheimer's disease (AD) dementia and AD pathology after controlling for cognition. Participants were community-based older persons who completed a baseline literacy assessment, underwent annual clinical evaluations for up to 8 years, and agreed to organ donation after death. Financial and health literacy was measured using 32 questions and cognition was measured using 19 tests. Annual diagnosis of AD dementia followed standard criteria. AD pathology was examined postmortem by quantifying plaques and tangles. Cox models examined the association of literacy with incident AD dementia. Performance of model prediction for incident AD dementia was assessed using indices for integrated discrimination improvement and continuous net reclassification improvement. Linear regression models examined the independent association of literacy with AD pathology in autopsied participants. All 805 participants were free of dementia at baseline and 102 (12.7%) developed AD dementia during the follow-up. Lower literacy was associated with higher risk for incident AD dementia (p literacy measure had better predictive performance than the one with demographics and cognition only. Lower literacy also was associated with higher burden of AD pathology after controlling for cognition (β= 0.07, p = 0.035). Literacy predicts incident AD dementia and AD pathology in community-dwelling older persons, and the association is independent of traditional measures of cognition.
You, Chuanmei; Yao, Lan; Fu, Jiakang; Wang, Fang; Wang, Hongqing; Dai, Tao
The separation of revenue and expenditure budgets (SREB) is a new financial budgetary system that is being implemented in community health services (CHS) institutions in some areas in China. Through literature review, it was found that, derived from the traditional separation of revenue and expenditure budgets (TSREB) implemented in administrative public services units, SREB and TSREB have something in common and yet many more differences. On the basis of some quantitative and qualitative data that were collected by field survey, it was also found that implementation of SREB in CHS institutions brings positive outcomes in terms of the quantity, quality and efficiency of services; residents' satisfaction; and the behavior of CHS institutions. The conclusion can be suggested that SREB, as a system having impact upon the incentives facing CHS institutions and the nature of governmental responsibility for developing CHS in China, will promote CHS institutions to fulfill basic service functions if implemented well. Therefore, it is a system that is worth further development and evaluation. Copyright © 2011 John Wiley & Sons, Ltd.
Correia, Tiago; Dussault, Gilles; Pontes, Carla
The public health sector has been the target of austerity measures since the global financial crisis started in 2008, while health workforce costs have been a source of rapid savings in most European Union countries. This article aims to explore how health workforce policies have evolved in three southern European countries under external constraints imposed by emergency financial programmes agreed with the International Monetary Fund, Central European Bank and European Commission. The selected countries, Greece, Portugal and Cyprus, show similarities with regard to corporatist systems of social protection and comprehensive welfare mechanisms only recently institutionalized. Based on document analysis of the Memoranda of Understanding agreed with the Troika, our results reveal broadly similar policy responses to the crisis but also important differences. In Cyprus, General Practitioners have a key position in reducing public expenditure through gatekeeping and control of users' access, while Portugal and Greece seeks to achieve cost containment by constraining the decision-making powers of professionals. All three countries lack innovation as well as monitoring and assessment of the effects of the financial crisis in relation to the health workforce. Consequently, there is a need for health policy development to use human resources more efficiently in healthcare. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Full Text Available This article starts from the critical review of the concept of financial capital. I consider it is necessary not to confuse this category with of financialization, which has acquired a certificate of naturalization from the rise of neoliberalism. Although financial monopoly-financial capital is the hegemonic segment of the bourgeoisie in the major capitalist countries, their dominance does not imply, a fortiori, financialization of economic activity, since it depends of the conditions of the process reproduction of capital. The emergence of joint stock companies modified the formation of the average rate of profit. The "promoter profit" becomes one of the main forms of income of monopoly-financial capital. It is postulated that financial profit is a kind of "extraordinary surplus-value" which is appropriated by monopoly-financial capital by means of the monopolistic control it exerts on the issue and circulation of fictitious capital.
Meyer, Melanie A; Hudak, Ronald P
We investigated the relationship between financial literacy and patient engagement while considering the possible interaction effects due to patient financial responsibility and patient-physician shared decision making, and the impact of personal attributes. Participants consisted of an Internet-based sample of American adults (N = 160). Hierarchical multiple linear regression analysis was conducted to examine the relationship of the study variables on patient engagement. We found that patient financial responsibility (β = -.19, p financial literacy and patient engagement; moreover, the moderation effects of patient financial responsibility and shared decision making with financial literacy also were not statistically significant. Increasing patient financial responsibility and patient-physician shared decision making can impact patient engagement. Understanding the predictors of patient engagement and the factors that influence financial behaviors may allow for the development of interventions to enable patients to make better healthcare decisions, and ultimately, improve health outcomes.
Wiersma, Miriam; Kerridge, Ian; Lipworth, Wendy
Non-financial interests, and the conflicts of interest that may result from them, are frequently overlooked in biomedicine. This is partly due to the complex and varied nature of these interests, and the limited evidence available regarding their prevalence and impact on biomedical research and clinical practice. We suggest that there are no meaningful conceptual distinctions, and few practical differences, between financial and non-financial conflicts of interest, and accordingly, that both require careful consideration. Further, a better understanding of the complexities of non-financial conflicts of interest, and their entanglement with financial conflicts of interest, may assist in the development of a more sophisticated approach to all forms of conflicts of interest. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
U.S. Department of Health & Human Services — This section contains the annual CMS financial statements as required under the Chief Financial Officers (CFO) Act of 1990 (P.L. 101-576). The CFO Act marked a major...
Haile, Fisaha; Yemane, Dejen; Gebreslassie, Azeb
Volunteer community health workers (VCHW) are health care providers who are trained but do not have any professional certification. They are intended to fill the gap for unmet curative, preventative, and health promotion health needs of communities. This study aims to investigate the non-financial incentives for VCHWs and factors affecting their motivation. A cross-sectional quantitative study was performed from February to March 2013. A total of 400 randomly selected female VCHWs were included using the district health office registers. Finally, multivariate logistic regression was used to determine the independent predictors of VCHW motivation. Significant numbers (48%) of study participants have mentioned future training as a major non-financial incentive. Age between 20 and 36 years old (adjusted odds ratio (AOR) = 1.45, 95% CI = 1.18, 2.13), married VCHWs (AOR = 3.84, 95% CI = 1.73, 5.02), presence of children under five years old (AOR = 0.2, 95% CI = 0.09, 0.71), allowing volunteer withdrawal (AOR = 1.35, 95% CI = 1.06, 2.47), and establishment of a local endowment fund for community health workers after they left volunteerism (AOR = 1.11, 95% CI = 1.05, 1.91) are all factors associated with VCHW motivation. Future training was mentioned as the prime non-financial incentive. Age, marital status, presence of children under five, allowing volunteer withdrawal, and establishment of a local endowment fund were identified as the independent predictors of motivation. Therefore, considering a non-financial incentive package, including further training and allowing volunteer withdrawal, would be helpful to sustain volunteerism.
Lexchin, Joel; Sekeres, Melanie; Gold, Jennifer; Ferris, Lorraine E; Kalkar, Sunila R; Wu, Wei; Van Laethem, Marleen; Chan, An-Wen; Moher, David; Maskalyk, M James; Taback, Nathan; Rochon, Paula A
Conflicts of interest (COI) in research are an important emerging topic of investigation and are frequently cited as a serious threat to the integrity of human participant research. To study financial conflicts of interest (FCOI) policies for individual investigators working in Canadian academic health centers. Survey instrument containing 61 items related to FCOI. All Canadian academic health science centers (universities with faculties of medicine, faculties of medicine and teaching hospitals) were requested to provide their three primary FCOI policies. Number of all centers and teaching hospitals with policies addressing each of the 61 items related to FCOI. Only one item was addressed by all 74 centers. Thirteen items were present in fewer than 25% of centers. Fewer than one-quarter of hospitals required researchers to disclose FCOI to research participants. The role of research ethics boards (REBs) in hospitals was marginal. Asking centers to identify only three policies may not have inclusively identified all FCOI policies in use. Additionally, policies at other levels might apply. For instance, all institutions receiving federal grant money must comply with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Canadian centers within the same level (for instance, teaching hospitals) differ significantly in the areas that their policies address and these policies differ widely in their coverage. Presently, no single policy in any Canadian center informs researchers about the broad range of individual FCOI issues. Canadian investigators need to understand the environment surrounding FCOI, be able to access and follow the relevant policies and be confident that they can avoid entering into a FCOI.
Basu, Sanjay; Kiernan, Michaela
While increasingly popular among mid- to large-size employers, using financial incentives to induce health behavior change among employees has been controversial, in part due to poor quality and generalizability of studies to date. Thus, fundamental questions have been left unanswered: To generate positive economic returns on investment, what level of incentive should be offered for any given type of incentive program and among which employees? We constructed a novel modeling framework that systematically identifies how to optimize marginal return on investment from programs incentivizing behavior change by integrating commonly collected data on health behaviors and associated costs. We integrated "demand curves" capturing individual differences in response to any given incentive with employee demographic and risk factor data. We also estimated the degree of self-selection that could be tolerated: that is, the maximum percentage of already-healthy employees who could enroll in a wellness program while still maintaining positive absolute return on investment. In a demonstration analysis, the modeling framework was applied to data from 3000 worksite physical activity programs across the nation. For physical activity programs, the incentive levels that would optimize marginal return on investment ($367/employee/year) were higher than average incentive levels currently offered ($143/employee/year). Yet a high degree of self-selection could undermine the economic benefits of the program; if more than 17% of participants came from the top 10% of the physical activity distribution, the cost of the program would be expected to always be greater than its benefits. Our generalizable framework integrates individual differences in behavior and risk to systematically estimate the incentive level that optimizes marginal return on investment. © The Author(s) 2015.
Anagnostopoulos, Dimitris C; Giannakopoulos, George; Christodoulou, Nikos G
The current global financial crisis that started in 2008 resulted in a significant decline in global trade, slowing/reversing economic growth worldwide, and a dramatic increase in public sector debt. At the same time, the global migrant/refugee crisis has reached extreme rates, with millions of people being forced to abandon their homes and communities because of war, political violence or related threats. There is a broad consensus about the deleterious consequences of these crises on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse and suicidal behavior. Although the separate consequences of economic recession and immigration are extensively discussed in previous research, we know very little about the processes through which the intersection of economic crisis and migrant crisis contributes to the vulnerabilities of natives and migrants during these crises. Of particular concern is the status of children, adolescents and their families, who constitute one of the most vulnerable groups in society. To discuss the contexts that economic and migrant crises shape and suggest possible effects of this intersection on mental health risks, especially among children, adolescents and their families, through reflecting on the recent experience in Greece. Review of the literature and critical analysis of the effects of the confluent crises. The interactive effects of these two crises need further exploration. Novel and diverse models of psychological understanding need to be developed in order to manage the effects of the confluent crises. The role of mental health professionals is crucial in this respect, offering culturally flexible, accommodating and empathetic approaches, allowing healing and acceptance in the face of adversity.
Full Text Available Abstract Background One of the key functions of health insurance is to provide financial protection against high costs of health care, yet evidence of such protection from developing countries has been inconsistent. The current study uses the case of Ghana to contribute to the evidence pool about insurance's financial protection effects. It evaluates the impact of the country's National Health Insurance Scheme on households' out-of-pocket spending and catastrophic health expenditure. Methods We use data from a household survey conducted in two rural districts, Nkoranza and Offinso, in 2007, two years after the initiation of the Ghana National Health Insurance Scheme. To address the skewness of health expenditure data, the absolute amount of out-of-pocket spending is estimated using a two-part model. We also conduct a probit estimate of the likelihood of catastrophic health expenditures, defined at different thresholds relative to household income and non-food consumption expenditure. The analysis controls for chronic and self-assessed health conditions, which typically drive adverse selection in insurance. Results At the time of the survey, insurance coverage was 35 percent. Although the benefit package of insurance is generous, insured people still incurred out-of-pocket payment for care from informal sources and for uncovered drugs and tests at health facilities. Nevertheless, they paid significantly less than the uninsured. Insurance has been shown to have a protective effect against the financial burden of health care, reducing significantly the likelihood of incurring catastrophic payment. The effect is particularly remarkable among the poorest quintile of the sample. Conclusions Findings from this study confirm the positive financial protection effect of health insurance in Ghana. The effect is stronger among the poor group than among general population. The results are encouraging for many low income countries who are considering a
Shippee, Nathan D; Shippee, Tetyana P; Hess, Erik P; Beebe, Timothy J
Background Emergency department (ED) use is costly, and especially frequent among publicly insured populations in the US, who also disproportionately encounter financial (cost/coverage-related) and non-financial/practical barriers to care. The present study examines the distinct associations financial and non-financial barriers to care have with patterns of ED use among a publicly insured population. Methods This observational study uses linked administrative-survey data for enrollees of Minn...
Full Text Available Abstract Background Socio-economic variations in health, including variations in health according to wealth and income, have been widely reported. A potential method of improving the health of the most deprived groups is to increase their income. State funded welfare programmes of financial benefits and benefits in kind are common in developed countries. However, there is evidence of widespread under claiming of welfare benefits by those eligible for them. One method of exploring the health effects of income supplementation is, therefore, to measure the health effects of welfare benefit maximisation programmes. We conducted a systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings. Methods Published and unpublished literature was accessed through searches of electronic databases, websites and an internet search engine; hand searches of journals; suggestions from experts; and reference lists of relevant publications. Data on the intervention delivered, evaluation performed, and outcome data on health, social and economic measures were abstracted and assessed by pairs of independent reviewers. Results are reported in narrative form. Results 55 studies were included in the review. Only seven studies included a comparison or control group. There was evidence that welfare rights advice delivered in healthcare settings results in financial benefits. There was little evidence that the advice resulted in measurable health or social benefits. This is primarily due to lack of good quality evidence, rather than evidence of an absence of effect. Conclusion There are good theoretical reasons why income supplementation should improve health, but currently little evidence of adequate robustness and quality to indicate that the impact goes beyond increasing income.
Arredondo, Armando; Duarte, Maria Beatriz; Cuadra, Silvia Magali
This study estimated the epidemiological and financial indicators of hypertension in order to identify challenges in strategic planning and management for health systems in Latin America. This is a longitudinal study with a population base of 187 326 reported cases of older adults with hypertension, diagnosed at public health institutions in Mexico. The cost-evaluation method that was used was based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2015-2017, time series analyses and probabilistic models were constructed according to the Box-Jenkins technique. Regarding epidemiological changes for 2015 versus 2017, an increase of 8-12% is expected (p financial requirements. The total amount estimated for hypertension in 2015 (in US dollars) was $1 575 671 330. It included $747 527 259 as direct costs and $829 144 071 as indirect costs. If the risk factors and the different healthcare services for older adults remain as they are currently, the financial consequences of epidemiological changes in older adults will have a major impact on the users' pockets, following in order of importance, on social security providers and on public assistance providers. The challenges and implications of our findings in the context of universal coverage reforms in Latin America reinforce the urgent need to develop more and better strategic planning for the prevention of chronic diseases. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Leach-Kemon, Katherine; Chou, David P; Schneider, Matthew T; Tardif, Annette; Dieleman, Joseph L; Brooks, Benjamin P C; Hanlon, Michael; Murray, Christopher J L
How has funding to developing countries for health improvement changed in the wake of the global financial crisis? The question is vital for policy making, planning, and advocacy purposes in donor and recipient countries alike. We measured the total amount of financial and in-kind assistance that flowed from both public and private channels to improve health in developing countries during the period 1990-2011. The data for the years 1990-2009 reflect disbursements, while the numbers for 2010 and 2011 are preliminary estimates. Development assistance for health continued to grow in 2011, but the rate of growth was low. We estimate that assistance for health grew by 4 percent each year from 2009 to 2011, reaching a total of $27.73 billion. This growth was largely driven by the World Bank's International Bank for Reconstruction and Development and appeared to be a deliberate strategy in response to the global economic crisis. Assistance for health from bilateral agencies grew by only 4 percent, or $444.08 million, largely because the United States slowed its development assistance for health. Health funding through UN agencies stagnated, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria announced that it would make no new grants for the next two years because of declines in funding. Given the international community's focus on meeting the Millennium Development Goals by 2015 and persistent economic hardship in donor countries, continued measurement of development assistance for health is essential for policy making.
Full Text Available Abstract Background There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non-financial incentives. This study assesses the role of non-financial incentives for motivation in two cases, in Benin and Kenya. Methods The study design entailed semi-structured qualitative interviews with doctors and nurses from public, private and NGO facilities in rural areas. The selection of health professionals was the result of a layered sampling process. In Benin 62 interviews with health professionals were carried out; in Kenya 37 were obtained. Results from individual interviews were backed up with information from focus group discussions. For further contextual information, interviews with civil servants in the Ministry of Health and at the district level were carried out. The interview material was coded and quantitative data was analysed with SPSS software. Results and discussion The study shows that health workers overall are strongly guided by their professional conscience and similar aspects related to professional ethos. In fact, many health workers are demotivated and frustrated precisely because they are unable to satisfy their professional conscience and impeded in pursuing their vocation due to lack of means and supplies and due to inadequate or inappropriately applied human resources management (HRM tools. The paper also indicates that even some HRM tools that are applied may adversely affect the motivation of health workers. Conclusion The findings confirm the starting hypothesis that non-financial incentives and HRM tools play an important role with respect to increasing motivation of health professionals. Adequate HRM tools can uphold and strengthen the
Mathauer, Inke; Imhoff, Ingo
There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non-financial incentives. This study assesses the role of non-financial incentives for motivation in two cases, in Benin and Kenya. The study design entailed semi-structured qualitative interviews with doctors and nurses from public, private and NGO facilities in rural areas. The selection of health professionals was the result of a layered sampling process. In Benin 62 interviews with health professionals were carried out; in Kenya 37 were obtained. Results from individual interviews were backed up with information from focus group discussions. For further contextual information, interviews with civil servants in the Ministry of Health and at the district level were carried out. The interview material was coded and quantitative data was analysed with SPSS software. The study shows that health workers overall are strongly guided by their professional conscience and similar aspects related to professional ethos. In fact, many health workers are demotivated and frustrated precisely because they are unable to satisfy their professional conscience and impeded in pursuing their vocation due to lack of means and supplies and due to inadequate or inappropriately applied human resources management (HRM) tools. The paper also indicates that even some HRM tools that are applied may adversely affect the motivation of health workers. The findings confirm the starting hypothesis that non-financial incentives and HRM tools play an important role with respect to increasing motivation of health professionals. Adequate HRM tools can uphold and strengthen the professional ethos of doctors and nurses. This entails acknowledging their
Baptista, Isaurinda; Irvine, Brian; Fleskens, Luuk; Geissen, Violette; Ritsema, Coen
Field trials have demonstrated the potential of soil conservation technologies but have also shown significant spatial-temporal yield variability. This study considers the Pan-European Soil Erosion Risk Assessment - Desertification Mitigation Cost-Effectiveness modelling approach to capture a
Taylor, R B
With trustees, investors, regulatory agencies, and others paying close attention to hospital finances, healthcare financial managers must detect problems before they grow out of control. Liquidity, capital structure, activity, and profitability ratios can provide pieces to the puzzle.
Christopher Bumcrot; Judy Lin; Annamaria Lusardi
This paper explores how well equipped today’s households are to make complex financial decisions in the face of often high-cost and high-risk financial instruments. Specifically we focus on financial literacy. Most importantly, we describe the geography of financial literacy, i.e., how financial literacy is distributed across the fifty US states. We describe the correlation of financial literacy and some important aggregate variables, such as state-level poverty rates. Finally, we examine the...
Li, Zhihui; Li, Mingqiang; Fink, Günther; Bourne, Paul; Bärnighausen, Till; Atun, Rifat
The impact of user-fee policies on the equity of health care utilization and households' financial burdens has remained largely unexplored in Latin American and the Caribbean, as well as in upper-middle-income countries. This paper assesses the short- and long-term impacts of Jamaica's user-fee-removal for children in 2007. This study utilizes 14 rounds of data from the Jamaica Survey of Living Conditions (JSLC) for the periods 1996 to 2012. JSLC is a national household survey, which collects data on health care utilization and among other purposes for planning. Interrupted time series (ITS) analysis was used to examine the immediate impact of the user-fee-removal policy on children's health care utilization and households' financial burdens, as well as the impact in the medium- to long-term. Immediately following the implementation of user-fee-removal, the odds of seeking for health care if the children fell ill in the past 4 weeks increased by 97% (odds ratio 2.0, 95% confidence interval (CI) 1.1 to 3.5, P = 0.018). In the short-term (2007-2008), health care utilization increased at a faster rate among children not in poverty than children in poverty; while this gap narrowed after 2008. There was minimal difference in health care utilization across wealth groups in the medium- to long-term. The household's financial burden (health expenditure as a share of household's non-food expenditures) reduced by 6 percentage points (95% CI: -11 to -1, P = 0.020) right after the policy was implemented and kept at a low level. The difference in financial burden between children in poverty and children not in poverty shrunk rapidly after 2007 and remained small in subsequent years. User-fee-removal had a positive impact on promoting health care utilization among children and reducing their household health expenditures in Jamaica. The short-term and the medium- to long-term results have different indications: In the short-term, the policy deteriorated the equity of
Hammerman, Ariel; Feder-Bubis, Paula; Greenberg, Dan
Risk-sharing is being considered by many health care systems to address the financial risk associated with the adoption of new technologies. We explored major stakeholders' views toward the potential implementation of a financial risk-sharing mechanism regarding budget-impact estimates for adding new technologies to the Israeli National List of Health Services. According to our proposed scheme, health plans will be partially compensated by technology sponsors if the actual use of a technology is substantially higher than what was projected and health plans will refund the government for budgets that were not fully utilized. By using a semi-structured protocol, we interviewed major stakeholders involved in the process of updating the National List of Health Services (N = 31). We inquired into participants' views toward our proposed risk-sharing mechanism, whether the proposed scheme would achieve its purpose, its feasibility of implementation, and their opinion on the other stakeholders' incentives. Participants' considerations were classified into four main areas: financial, administrative/managerial, impact on patients' health, and influence on public image. Most participants agreed that the conceptual risk-sharing scheme will improve the accuracy of early budget estimates and were in favor of the proposed scheme, although Ministry of Finance officials tended to object to it. The successful implementation of risk-sharing schemes depends mainly on their perception as a win-win situation by all stakeholders. The perception exposed by our participants that risk-sharing can be a tool for improving the accuracy of early budget-impact estimates and the challenges pointed by them are relevant to other health care systems also and should be considered when implementing similar schemes. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Lynagh, Sanson-Fisher and Bonevski's article entitled "What's good for the goose is good for the gander. Guiding principles for the use of financial incentives in health behaviour change" (Int J Behav Med 20:114-120, 2012) reviews evidence for the use of financial incentives for encouraging health behaviour change. Their discussion of the practical and moral issues involved is a timely contribution which will encourage consideration of the implications of such interventions. In this response to their paper, I suggest that there are also broader aspects that we must consider before developing principles for public policy intervention. First, we must include good theories that explain in a great deal more depth what we mean by health-related behaviours, and secondly, we need to understand the location of these behaviours in social life and within structural inequalities. To ignore these fundamental aspects of health is to risk increasing social injustice and worsening health inequalities, a facet of the morality of health promotion activities which is not touched upon by the Lynagh et al. paper.
Dr. Reginald Tucker-Seeley joined the faculty at the University of Southern California (USC) Leonard Davis School of Gerontology in June 2017. Prior to joining USC, Dr. Tucker-Seeley was an Assistant Professor at the Dana-Farber Cancer Institute (DFCI) and the Harvard T.H. Chan School of Public Health (HSPH). He completed master and doctoral degrees at HSPH and a postdoctoral fellowship in cancer prevention and control at HSPH and DFCI. Dr. Tucker-Seeley’s research focuses primarily on social determinants of health, such as the association between the neighborhood environment and health behavior; and on individual-level socioeconomic determinants of multi-morbidity, mortality, self-rated health, and health self-efficacy. His current work focuses on financial well-being across the cancer continuum, from prevention to end-of-life care. He has received R21 and K01 grants from the National Cancer Institute (NCI) to develop measures of financial well-being at two points along the cancer continuum: prevention and following diagnosis. He was also funded by the Academy Health/Aetna Foundation Scholars in Residence Fellowship Program to develop measures of neighborhood economic well-being. Dr. Tucker-Seeley’s research has been published in journals such as the American Journal of Public Health, Preventive Medicine, Journal of National Cancer Institute, Cancer Causes and Control, and the American Journal of Preventive Medicine. Dr. Tucker-Seeley is also committed to community service that targets the elimination of health disparities. He served for three years on the Rhode Island Commission for Health Advocacy and Equity. Based on his experience on this Commission, Dr. Tucker-Seeley developed a new course at HSPH called “Measuring and Reporting Health Disparities;” and in 2016, he received the HSPH teaching award for this course.
Full Text Available This paper tests the relative strength of three objective measures of financial health (using the solvency, liquidity, and investment asset ratio in predicting a household’s subjective feeling of current financial satisfaction. Using a sample of 6,923 respondents in the 2008 Health and Retirement Study this paper presents evidence of two main findings: 1 the solvency ratio is most strongly associated with financial satisfaction levels based on a cross-sectional design and 2 changes in the investment asset ratio are most strongly associated with changes in financial satisfaction over time.
Azevedo, Fernanda Reis de; Brito, Bruna Cristina
Obesity is a recurring theme in current scientific literature. This can easily be explained by its exponential increase in all layers of society. The popularity of this subject has also given rise to associated questions, which have achieved greater prominence in health-related publications. In order to assess what has been studied in the field of obesity and nutrition, an overview of all articles published on these subjects in some of the main Brazilian scientific journals over the past two years was performed. Among the subthemes selected for this study, those related to childhood obesity attracted attention due to their greater frequency. These were subdivided into: prevalence, intrauterine and breastfeeding influences that may lead to the development of this condition, impact on quality of life, cardiovascular system and metabolism, and possible prevention strategies. Furthermore, issues related to obesity in adults were explored, such as risk factors and new strategies for prevention, with special attention given to the many studies evaluating different aspects of bariatric surgery. Finally, the subject of malnutrition and the impact of the deficiency of specific micronutrients such as selenium, vitamin D, and vitamin B12 were assessed. Based on the results, it was possible to assess the actual importance of obesity and nutrition in health maintenance, and also the several lines of research regarding these issues. Thus, it is essential to create new methods, which must be quick and efficient, to update health professionals involved in the treatment of obesity.
T. V. Teplova
Full Text Available In this paper as the main feature of innovation in the financial health of a company analyst view the shift to two circuits of key interests of owners of capital (financial stakeholders. Justifi ed by differences key financial systems within the contour ownership interest and the lender three projections: liquidity, the current economic efficiency and growth. In the paper as the main feature of the innovation in the analysis of the financial health of a company is considered a transition to the two circuits of the interests of the key owners of financial capital (financial stakeholders. Justifi ed differences of key financial indicator systems in the framework of the outline of the interests of the owner and the lender by three projections: liquidity, efficiency and the quality of growth. The examples of Russian companies have different interpretations of financial targets and indicators with a choice of activities.
Kigume, Ramadhani; Maluka, Stephen; Kamuzora, Peter
While decentralisation of health systems has been on the policy agenda in low-income and middle-income countries since the 1970s, many studies have focused on understanding who has more decision-making powers but less attention is paid to understand what those powers encompass. Using the decision space approach, this study aimed to understand the amount of decision-making space transferred from the central government to institutions at the periphery in the decentralised health system in Tanzania. The findings of this study indicated that the decentralisation process in Tanzania has provided authorities with a range of decision-making space. In the areas of priority setting and planning, district health authorities had moderate decision space. However, in the financial resource allocation and expenditure of funds from the central government, the districts had narrow decision-making space. The districts, nevertheless, had wider decision-making space in mobilising and using locally generated financial resources. However, the ability of the districts to allocate and use locally generated resources was constrained by bureaucratic procedures of the central government. The study concludes that decentralisation by devolution which is being promoted in the policy documents in Tanzania is yet to be realised at the district and local levels. The study recommends that the central government should provide more space to the decentralised district health systems to incorporate locally defined priorities in the district health plans. Copyright © 2018 John Wiley & Sons, Ltd.
Molema, Claudia C.M.; Wendel-Vos, G.C Wanda; Pujik, Lisanne
was to provide insight in the effectiveness of financial incentives used for promoting physical activity in the healthcare setting. Methods: A systematic literature search was performed in three databases: Medline, EMBASE and SciSearch. In total, 1395 papers published up until April 2015 were identified. Eleven......Introduction: A substantial amount of the western population is inactive according to current physical activity guidelines, which is an important risk factor for chronic conditions and mortality. Financial incentives may encourage people to become more active. The objective of this review...... of them were screened on in- and exclusion criteria based on the full-text publication. Results: Three studies were included in the review. Two studies have combined a financial incentive with nutrition classes or motivational interviewing. One of which provided a free membership to a sports facility...
Wang, Xin; Sun, Yuanling; Mu, Xin; Guan, Li; Li, Jingjie
We simulate and analyze Total Health Expenditure (THE) in financial sources and other economic indicators (such as THE per capita, GDP, etc.) in a province of China from 2002 to 2012 on System Dynamics. Based on actual data and certain mathematical methods, we use system dynamic software to construct a logic model for THE and changing proportions, and thus simulate the actual conditions of development and changes in THE. According to the simulation results, the government possess the largest investment in the average annual growth rate of THE, which was 25.16% in 2012. Social investment comprises the majority of the possession ratio, which was up to 41.20%. The personal investment growth rate decreased by almost 21%, but the total amount of personal investment increased by 28075 million yuan, which is far higher than the increase in government investment. Individuals are still the main carriers of health care expenses. The equity of health financial sources is still poor. The System Dynamics method used in this paper identifies a dynamic measurement process, provides a scientific basis for simulation and analysis of the changes in THE and its key constraining factors, as well as put forward suggestions for the improvement of equity of health financial sources.
Kale, Hrishikesh P; Carroll, Norman V
Cancer-related financial burden has been linked to cancer survivors (CS) forgoing/delaying medical care, skipping follow-up visits, and discontinuing medications. To the authors' knowledge, little is known regarding the effect of financial burden on the health-related quality of life of CS. The authors analyzed 2011 Medical Expenditure Panel Survey data. Financial burden was present if one of the following problems was reported: borrowed money/declared bankruptcy, worried about paying large medical bills, unable to cover the cost of medical care visits, or other financial sacrifices. The following outcomes were evaluated: Physical Component Score (PCS) and Mental Component Score (MCS) of the 12-Item Short-Form Health Survey (SF-12), depressed mood, psychological distress, and worry related to cancer recurrence. The authors also assessed the effect of the number of financial problems on these outcomes. Of the 19.6 million CS analyzed, 28.7% reported financial burden. Among them, the average PCS (42.3 vs 44.9) and MCS (48.1 vs 52.1) were lower for those with financial burden versus those without. In adjusted analyses, CS with financial burden had significantly lower PCS (β = -2.45), and MCS (β = -3.05), had increased odds of depressed mood (odds ratio, 1.95), and were more likely to worry about cancer recurrence (odds ratio, 3.54). Survivors reporting ≥ 3 financial problems reported statistically significant and clinically meaningful differences (≥3 points) in the mean PCS and MCS compared with survivors without financial problems. Cancer-related financial burden was associated with lower health-related quality of life, increased risk of depressed mood, and a higher frequency of worrying about cancer recurrence among CS. © 2015 American Cancer Society.
Full Text Available The term agency has been defined as a sense of responsibility for one’s life course, the belief that one is in control of one’s decisions and is responsible for their outcomes, and the confidence that one will be able to overcome obstacles that impede one’s progress along one’s chosen life course. Agency is an upper psychological structure which consists of self-esteem, purpose in life, self-efficacy (ego strength, and internal locus of control. Literature offers quite different explanations for agency concept. The reason of this situation may be the attribution of different meanings to the concept by psychologists and sociologists. When considering the agency literature in Turkey and other countries, it can be said that the number of studies on agency subject is lower than the number of studies on other psychosocial study subjects. Agency should be taken into consideration as a psychosocial variable in the studies to be made in Turkey.
Chan, Alexandre; Chiang, Yu Yan; Low, Xiu Hui; Yap, Kevin Yi-Lwern; Ng, Raymond
With the expected rise in newly diagnosed cancer cases among the elderly in Singapore, the affordability of cancer treatments, particularly of targeted therapies, will be a growing concern for patients. This study examines the perspectives of aging cancer patients on the financial burden of their cancer treatments. A single-center, prospective study was conducted in the largest ambulatory cancer center in Singapore. Older (50 years old and above) cancer patients receiving treatment were recruited. Patients completed three sets of self-reporting tools assessing their (a) demographics and lifestyles, (b) health-related quality of life, and (c) perceptions of cancer treatment costs. The association between targeted therapy utilities and their perceived financial burden was evaluated using a multivariable logistic regression. Five hundred and sixteen patients were included in the study. The majority of the respondents (69.6 %) were between 50 and 64 years old. The majority were Singaporeans (97.7 %), belonged to the ethnic Chinese group (88.4 %), and most were female (59.1 %). The users of targeted therapies were 2.92 times more likely to perceive that the amount of cash that they spent on cancer treatment was more than expected and 2.52 times more likely to have difficulty paying for cancer treatments. Fortunately, the majority of the respondents (70.6 %) found their existing financial schemes helpful in reducing the necessary out-of-pocket expenses. Although aging cancer patients feel that the financial schemes in Singapore have helped them tremendously, the general perception is that they require further help to offset their out-of-pocket expenses. This is especially true for users of targeted therapies and those who have a poorer health status.
Meng, Qun; Xu, Ling; Zhang, Yaoguang; Qian, Juncheng; Cai, Min; Xin, Ying; Gao, Jun; Xu, Ke; Boerma, J Ties; Barber, Sarah L
In the past decade, the Government of China initiated health-care reforms to achieve universal access to health care by 2020. We assessed trends in health-care access and financial protection between 2003, and 2011, nationwide. We used data from the 2003, 2008, and 2011 National Health Services Survey (NHSS), which used multistage stratified cluster sampling to select 94 of 2859 counties from China's 31 provinces and municipalities. The 2011 survey was done with a subset of the NHSS sampling frame to monitor key indicators after the national health-care reforms were announced in 2009. Three sets of indicators were chosen to measure trends in access to coverage, health-care activities, and financial protection. Data were disaggregated by urban or rural residence and by three geographical regions: east, central, and west, and by household income. We examined change in equity across and within regions. The number of households interviewed was 57,023 in 2003, 56,456 in 2008, and 18,822 in 2011. Response rates were 98·3%, 95·0%, and 95·5%, respectively. The number of individuals interviewed was 193,689 in 2003, 177,501 in 2008, and 59,835 in 2011. Between 2003 and 2011, insurance coverage increased from 29·7% (57,526 of 193,689) to 95·7% (57,262 of 59,835, pservices and insurance coverage across and within regions. However, these increases have not been accompanied by reductions in catastrophic health expenses. With the achievement of basic health-services coverage, future challenges include stronger risk protection, and greater efficiency and quality of care. None. Copyright Â© 2012 Elsevier Ltd. All rights reserved.
Full Text Available The aim of this paper is to empirically study the concept of financial stability in Romania, from both a monetary policy perspective and a financial perspective. In this paper, I also compute an aggregate index of financial stability, for the period 2008-2013, explaining the correlations between several extremely important macroeconomic and sectorial variables and financial stability. The article also debates the aspect of policy instruments that aim to promote, highlighting the undertaken measures and also giving some measures recommendations, pointing out the main pillars: crises management; cross-sectoral challenges; banking sector; securities markets and capital markets; insurance sector; pensions sector; access to financial services.
Noubiap, Jean Jacques N; Joko, Walburga Yvonne A; Obama, Joel Marie N; Bigna, Jean Joel R
For the last two decades, promoted by many governments and international number in sub-Saharan Africa. In 2005 in Cameroon, there were only 60 Community-based health insurance (CBHI) schemes nationwide, covering less than 1% of the population. In 2006, the Cameroon government adopted a national strategy aimed at creating at least one CBHI scheme in each health district and covering at least 40% of the population with CBHI schemes by 2015. Unfortunately, there is almost no published data on the awareness and the implementation of CBHI schemes in Cameroon. Structured interviews were conducted in January 2010 with 160 informal sectors workers in the Bonassama health district (BHD) of Douala, aiming at evaluating their knowledge, concern and preferences on CBHI schemes and their financial plan to cover health costs. The awareness on the existence of CHBI schemes was poor awareness schemes among these informal workers. Awareness of CBHI schemes was significantly associated with a high level of education (p = 0.0001). Only 4.4% of respondents had health insurance, and specifically 1.2% were involved in a CBHI scheme. However, 128 (86.2%) respondents thought that belonging to a CBHI scheme could facilitate their access to adequate health care, and were thus willing to be involved in CBHI schemes. Our respondents would have preferred CBHI schemes run by missionaries to CBHI schemes run by the government or people of the same ethnic group (p). There is a very low participation in CBHI schemes among the informal sector workers of the BHD. This is mainly due to the lack of awareness and limited knowledge on the basic concepts of a CBHI by this target population. Solidarity based community associations to which the vast majority of this target population belong are prime areas for sensitization on CBHI schemes. Hence these associations could possibly federalize to create CBHI schemes.
Nguyen, Quang Charles X.; Anderson, Louis P.
This study examined the relation between culturally based variables and attitudes toward seeking mental health services among a community sample of Vietnamese Americans (N = 148) with at least 8 years' residence in the United States (U.S.). Variables included Stigma, Traditional Beliefs about Mental Illness, Help-Seeking Preferences, Problem…
Clara C. Pregitzer; Nancy F. Sonti; Richard A. Hallett
Reforesting degraded urban landscapes is important due to the many benefits urban forests provide. Urban soils are highly variable, yet little is known about how this variability in urban soils influences tree seedling performance and survival. We conducted a greenhouse study to assess health, growth, and survival of four native tree species growing in native glacial...
Haff, Nancy; Patel, Mitesh S; Lim, Raymond; Zhu, Jingsan; Troxel, Andrea B; Asch, David A; Volpp, Kevin G
To evaluate the use of behavioral economics to design financial incentives to promote health behavior change and to explore associations with demographic characteristics. Studies performed by the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania published between January 2006 and March 2014. Randomized, controlled trials with available participant-level data. Studies that did not use financial incentives to promote health behavior change were excluded. Participant-level data from seven studies were pooled. Meta-analysis on the pooled sample using a random-effects model with interaction terms to examine treatment effects and whether they varied by incentive structure or demographic characteristics. The pooled study sample comprised 1403 participants, of whom 35% were female, 70% were white, 24% were black, and the mean age was 48 years (standard deviation 11.2 years). In the fully adjusted model, participants offered financial incentives had higher odds of behavior change (odds ratio [OR]: 3.96; p financial incentives and gender, age, race, income, or education. When further adjusting for incentive structure, blacks had higher odds than whites of achieving behavior change (OR: 1.67; p Financial incentives designed using concepts from behavioral economics were effective for promoting health behavior change. There were no large and consistent relationships between the effectiveness of financial incentives and observable demographic characteristics. Second-order examinations of incentive structure suggest potential relationships among the effectiveness of financial incentives, incentive structure, and the demographic characteristics of race and income.
Prinja, Shankar; Bahuguna, Pankaj; Gupta, Rakesh; Sharma, Atul; Rana, Saroj Kumar; Kumar, Rajesh
India aims to achieve universal access to institutional delivery. We undertook this study to estimate the universality of institutional delivery care for pregnant women in Haryana state in India. To assess the coverage of institutional delivery, we analyze service coverage (coverage of public sector institutional delivery), population coverage (coverage among different districts and wealth quintiles of the population) and financial risk protection (catastrophic health expenditure and impoverishment as a result of out-of-pocket expenditure for delivery). We analyzed cross-sectional data collected from a randomly selected sample of 12,191 women who had delivered a child in the last one year from the date of data collection in Haryana state. Five indicators were calculated to evaluate coverage and financial risk protection for institutional delivery--proportion of public sector deliveries, out-of-pocket expenditure, percentage of women who incurred no expenses, prevalence of catastrophic expenditure for institutional delivery and incidence of impoverishment due to out-of-pocket expenditure for delivery. These indicators were calculated for the public and private sectors for 5 wealth quintiles and 21 districts of the state. The coverage of institutional delivery in Haryana state was 82%, of which 65% took place in public sector facilities. Approximately 63% of the women reported no expenditure on delivery in the public sector. The mean out-of-pocket expenditures for delivery in the public and private sectors in Haryana were INR 771 (USD 14.2) and INR 12,479 (USD 229), respectively, which were catastrophic for 1.6% and 22% of households, respectively. Our findings suggest that there is considerably high coverage of institutional delivery care in Haryana state, with significant financial risk protection in the public sector. However, coverage and financial risk protection for institutional delivery vary substantially across districts and among different socio
Glad Mohesh, M I; Sundaramurthy, A
India is the third largest salt producing country in the World, with a global annual production of 230 million tonnes. Large number of salt workers get employed in these salt milling plants risking their life from the effects of salt. Recent foreign evidences reported that these salt workers are exposed to aerosol salt particles that disturb their lung and cardiovascular autonomic control. To compare the status of lung health, cardiovascular autonomic control and biochemical changes in a group of salt industry workers with that of the age-matched normal subjects. Volunteers of both sexes (25-35 years) were divided into Group I (n=10) controls and Group II (n=10) non-brine salt workers in salt milling plants. From fasting blood sample, complete blood count, plasma electrolyte and lipid profile estimation were done. After resting for 15min, blood pressure and lead II ECG were recorded. Spirometry was done using RMS Helios spirometer. Data collected were later analysed using GraphPad Prism 5.0 with statistical significance set at p4.0, 112.8±1.7, pindustry has shown a little or no impact on the respiratory system, however there are changes in the blood and cardiovascular system, which need to be further studied to understand the long-term influences of salt in this population. Copyright © 2015 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.
Adwin Surja Atmadja
Full Text Available This study seeks to examine the existence of Granger-causality among stock prices indices and macroeconomic variables in five ASEAN countries, Indonesia; Malaysia; the Philippines; Singapore; and Thailand with particular attention to the 1997 Asian financial crisis and period onwards. Using monthly time series data of the countries, a Granger-causality test based on the vector autoregressive (VAR analytical framework was employed to empirically reveal the causality among the variables. This research finds that there were few Granger causalities found between the country's wtock price index and macroeconomic variables. This indicates that the linkages between domestic stock price movements and macroeconomic factors were very. Due to that, the ASEAN stock markets were crelatively unable to efficiently capture changes in economic fundamentals during the observation period in most of the countries in accordance to the literature in emerging stock markets, and that the influence of specific macroeconomic factors on the domestic economies differ across countries. This also implies that the stock markets do not seem to have played a significant role in most countries' economies, and macroeconomic variables are unlikely to be appropriate indicators to predict not only the future behaviour of other macroeconomic variables, but also that of the stock market price indices. Abstract in Bahasa Indonesia : Makalah ini mencoba untuk menganalisis keberadaan Granger-causality antara indeks harga saham dan variabel-variabel ekonomi makro di lima negara ASEAN, yaitu Indonesia; Malaysia; Filipina; Singapore; dan Thailand yang berfokus pada periode terjadinya krisis keuangan Asia pada tahun 1997 dan sesudahnya. Dengan mempergunakan data time series bulanan dari setiap negara tersebut, tes Granger-causality yang didasarkan pada kerangka analisa VAR (vector autoregressive diaplikasikan untuk mengungkap secara empiris hubungan kausal antar variabel. Dari hasil tes
McKenna, Caoimhe; Law, Catherine; Pearce, Anna
There is a growing body of evidence associating financial strain (FS) with poor health but most of this research has been cross-sectional and adult-focused. During the 'Great Recession' many UK households experienced increased FS. The primary aim of this study was to determine the impact of increased FS on child health. We analysed the Millennium Cohort Study, a longitudinal study of children born in the UK between 2000 and 2002. Surveys at 7 years (T1, 2008) and 11 years (T2, 2012) spanned the 'Great Recession'. Three measures of increased FS were defined; 'became income poor' (self-reported household income dropped below the 'poverty line' between T1 and T2); 'developed difficulty managing' (parental report of being 'financially comfortable' at T1 and finding it 'difficult to manage' at T2); 'felt worse off' (parental report of feeling financially 'worse off' at T2 compared with T1). Poisson regression was used to estimate risk ratios (RR), adjusted risk ratios (aRR) and 95% CIs for six child health outcomes: measured overweight/obesity, problematic behaviour as scored by parents and teachers, and parental reports of fair/poor general health, long-standing illness and bedwetting at T2 (N=13 112). In subanalyses we limited our sample to those who were above the poverty line at T2. Compared with those who were not financially strained at both time points, children in households which experienced increased FS were at an increased risk of all unhealthy outcomes examined. In most cases, these increased risks persisted after adjustment for confounding and when limiting the sample to those above the poverty line. FS is associated with a range of new or continued poor child health outcomes. During times of widespread economic hardship, such as the 'Great Recession', measures should be taken to buffer children and their families from the impact of FS, and these should not be limited to those who are income poor. Published by the BMJ Publishing Group Limited. For
Turner, John D.
This essay looks at the bidirectional relationship between financial history and financial economics. It begins by giving a brief history of financial economics by outlining the main topics of interest to financial economists. It then documents and explains the increasing influence of financial economics upon financial history, and warns of the dangers of applying financial economics unthinkingly to the study of financial history. The essay proceeds to highlight the many insights that financi...
Higgs, Elizabeth S; Stammer, Emily; Roth, Rebecca; Balster, Robert L
Recognizing the need for evidence to inform US Government and governments of the low- and middle-income countries on efficient, effective maternal health policies, strategies, and programmes, the US Government convened the Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives in April 2012 in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the evidence used for achieving the goals of the Summit. The goal of the Summit was to obtain multidisciplinary expert review of literature to inform both US Government and governments of the low- and middle-income countries on evidence-informed practice, policies, and strategies for financial incentives. Several steps were undertaken to define the tasks for the Summit and identify the appropriate evidence for review. The process began by identifying focal questions intended to inform governments of the low-and middle-income countries and the US Government about the efficacy of supply- and demand-side financial incentives for enhanced provision and use of quality maternal health services. Experts were selected representing the research and programme communities, academia, relevant non-governmental organizations, and government agencies and were assembled into Evidence Review Teams. This was followed by a systematic process to gather relevant peer-reviewed literature that would inform the focal questions. Members of the Evidence Review Teams were invited to add relevant papers not identified in the initial literature review to complete the bibliography. The Evidence Review Teams were asked to comply with a specific evaluation framework for recommendations on practice and policy based on both expert opinion and the quality of the data. Details of the search processes and methods used for screening and quality reviews are described.
In the allocation of resources in academic settings, hierarchies of tradition and status often supersede documented need. Nursing programs sometimes have difficulty in getting what they need to maintain quality programs and to grow. The budget is the crucial tool in documenting nursing program needs and its contributions to the entire academic enterprise. Most nursing programs administrators see only an operating expense budget that may grow or shrink by a rubric that may not fit the reality of the situation. A budget is a quantitative expression of how well a unit is managed. Educational administrators should be paying as much attention to analyzing financial outcomes as they do curricular outcomes. This article describes the development of a model for tracking revenue and expense and a simple rubric for analyzing the relationship between the two. It also discusses how to use financial data to improve the fiscal performance of nursing units and to leverage support during times of growth.
Archuleta, Kristy L; Britt, Sonya L; Tonn, Teresa J; Grable, John E
Using a sample of 310 married respondents from one U.S. Midwestern state, a test was conducted to examine the association of financial satisfaction and financial stressors in a spouse's decision to stay married to the same person or leave the relationship. The role of demographic and socioeconomic variables, religiosity, psychological constructs, financial satisfaction, and financial stressors as factors influencing marital satisfaction was tested. Financial stressors were measured using a list of financial stressors adapted from the literature. Financial satisfaction was measured with a one-item scale. The Kansas Marital Satisfaction Scale was used as a validation tool to assess whether individuals would marry or not marry again. Religiosity and financial satisfaction were positively associated with marital satisfaction. A negative interaction between financial satisfaction and financial stressors was also noted. Findings suggest that respondents who are financially satisfied tend to be more stable in their marriages.
Waweru, Evelyn; Opwora, Antony; Toda, Mitsuru; Fegan, Greg; Edwards, Tansy; Goodman, Catherine; Molyneux, Sassy
Community participation in peripheral public health facilities has in many countries focused on including community representatives in Health Facility Management Committees (HFMCs). In Kenya, HFMC roles are being expanded with the phased implementation of the Health Sector Services Fund (HSSF). Under HSSF, HFMCs manage facility funds which are dispersed directly from central level into facility bank accounts. We assessed how prepared HFMCs were to undertake this new role in advance of HSSF roll out, and considered the implications for Kenya and other similar settings. Data were collected through a nationally representative sample of 248 public health centres and dispensaries in 24 districts in 2010. Data collection included surveys with in-charges (n = 248), HFMC members (n = 464) and facility users (n = 698), and record reviews. These data were supplemented by semi-structured interviews with district health managers in each district. Some findings supported preparedness of HFMCs to take on their new roles. Most facilities had bank accounts and HFMCs which met regularly. HFMC members and in-charges generally reported positive relationships, and HFMC members expressed high levels of motivation and job satisfaction. Challenges included users' low awareness of HFMCs, lack of training and clarity in roles among HFMCs, and some indications of strained relations with in-charges. Such challenges are likely to be common to many similar settings, and are therefore important considerations for any health facility based initiatives involving HFMCs. Most HFMCs have the basic requirements to operate. However to manage their own budgets effectively and meet their allocated roles in HSSF implementation, greater emphasis is needed on financial management training, targeted supportive supervision, and greater community awareness and participation. Once new budget management roles are fully established, qualitative and quantitative research on how HFMCs are adapting to
training can be better targeted. 13 References Boak, J., & Rugaber, C. (2014). As US Job Market Strengthens, Many Don’t Feel...underwater-as-home-price-growth-slows . 14 Grefer, J. E. (2008). Comparing Military and Civilian Compensation Packages ( CRM D0016569.A4). Alexandria...you MOST right now? Problems in the financial markets Declining real estate values Rising prices The job situation q16 q17 q18 q19 q20 q21 A-5 Other
Vermeeren, Brenda; Steijn, Bram; Tummers, Lars; Lankhaar, Marcel; Poerstamper, Robbert-Jan; Beek, Sandra
markdownabstractBackground: One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these o...
Gilson, Nicholas D.; Pavey, Toby G; Wright, Olivia RL; Vandelanotte, Corneel; Duncan, Mitch J; Gomersall, Sjaan; Trost, Stewart G.; Brown, Wendy J.
Abstract Background Chronic diseases are high in truck drivers and have been linked to work routines that promote inactivity and poor diets. This feasibility study examined the extent to which an m-Health financial incentives program facilitated physical activity and healthy dietary choices in Australian truck drivers. Methods Nineteen men (mean [SD] age = 47.5 [9.8] years; BMI = 31.2 [4.6] kg/m2) completed the 20-week program, and used an activity tracker and smartphone application (Jawbone ...
Shao, Kan; Allen, Bruce C; Wheeler, Matthew W
Human variability is a very important factor considered in human health risk assessment for protecting sensitive populations from chemical exposure. Traditionally, to account for this variability, an interhuman uncertainty factor is applied to lower the exposure limit. However, using a fixed uncertainty factor rather than probabilistically accounting for human variability can hardly support probabilistic risk assessment advocated by a number of researchers; new methods are needed to probabilistically quantify human population variability. We propose a Bayesian hierarchical model to quantify variability among different populations. This approach jointly characterizes the distribution of risk at background exposure and the sensitivity of response to exposure, which are commonly represented by model parameters. We demonstrate, through both an application to real data and a simulation study, that using the proposed hierarchical structure adequately characterizes variability across different populations. © 2016 Society for Risk Analysis.
Syed Jawad Hussain Shahzad
Full Text Available The objective of this study is to investigate the impact of financial leverage on corporate financial performance of Pakistan’s textile sector from 1999-2012 using panel data. The leverage-performance relationship is examined with a special focus on the Global Financial Crisis of 2007-2008. Both accounting-based (Return on Assets - ROA and market-based (Tobin’s Q measures of corporate financial performance are used. Regression analysis is performed with and without inclusion of financial crisis dummy. Total Debt to Total Assets (TDTA, Long Term Debt to Total Assets (LDTA, Short Term Debt to Total Assets (SDTA and Debt to Equity (DE ratios are used as proxies for financial leverage whereas firm’s size and firm’s efficiency are used as control variables. The results indicate that financial leverage has a negative impact on corporate performance when measured with ROA. Whereas in case of Tobin’s Q, SDTA coefficient is positive. It can be concluded that since cost of borrowing is high in Pakistan and debt capital markets are less developed, firms are forced to resort to banks as their source of debt finance and thus have to repay huge amount of principal and interest which has a heavy toll on their financial health. In addition to this, financial crisis was found to have a negative impact on corporate performance and also affect the leverage-performance relationship.
Pachana, Nancy A; Byrne, Gerard J; Wilson, Jill; Tilse, Cheryl; Pinsker, Donna M; Massavelli, Bronwyn; Vearncombe, Katharine J; Mitchell, Leander K
Declines in financial capacity in later life may arise from both neurocognitive and/or psychiatric disorders. The influence of socio-demographic, cognitive, health, and psychiatric variables on financial capacity performance was explored. Seventy-six healthy community-dwelling adults and 25 older patients referred for assessment of financial capacity were assessed on pertinent cognitive, psychiatric, and financial capacity measures, including Addenbrooke's Cognitive Examination - Revised (ACE-R), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), selected Neuropsychiatric Inventory (NPI) items, Financial Competence Assessment Inventory (FCAI), and Social Vulnerability Scale (SVS). The internal consistency of the debt management subscale of the FCAI was relatively poor in our sample. Financial capacity performance differed between controls and patients. In our sample, performance on the FCAI was predicted by Mini-Mental State Examination, IQCODE, and GAI, but not by ACE-R, GDS, NPI items, or SVS (adjusted R(2) = 0.7059). Anxiety but not depression predicted financial capacity performance, possibly reflecting relatively low variance of depressive symptoms in this sample. Current cognitive decline as measured by the informant-rated IQCODE was more highly correlated to financial capacity than either educational attainment or ACE-R scores. Lack of significance of ACE-R data may reflect the instrument's decreased sensitivity to domains relevant to financial capacity, compared with more detailed neuropsychological assessment tools. The FCAI displayed fairly robust psychometric properties apart from the debt management subscale.
Background The number of Master of Public Health (MPH) programmes in low- and middle-income countries (LMICs) is increasing, but questions have been raised regarding the relevance of their outcomes and impacts on context. Although processes for validating public health competencies have taken place in recent years in many high-income countries, validation in LMICs is needed. Furthermore, impact variables of MPH programmes in the workplace and in society have not been developed. Method A set of public health competencies and impact variables in the workplace and in society was designed using the competencies and learning objectives of six participating institutions offering MPH programmes in or for LMICs, and the set of competencies of the Council on Linkages Between Academia and Public Health Practice as a reference. The resulting competencies and impact variables differ from those of the Council on Linkages in scope and emphasis on social determinants of health, context specificity and intersectoral competencies. A modified Delphi method was used in this study to validate the public health competencies and impact variables; experts and MPH alumni from China, Vietnam, South Africa, Sudan, Mexico and the Netherlands reviewed them and made recommendations. Results The competencies and variables were validated across two Delphi rounds, first with public health experts (N = 31) from the six countries, then with MPH alumni (N = 30). After the first expert round, competencies and impact variables were refined based on the quantitative results and qualitative comments. Both rounds showed high consensus, more so for the competencies than the impact variables. The response rate was 100%. Conclusion This is the first time that public health competencies have been validated in LMICs across continents. It is also the first time that impact variables of MPH programmes have been proposed and validated in LMICs across continents. The high degree of consensus between
David M Dror
Full Text Available Background & objectives: The evidence-base of the impact of community-based health insurance (CBHI on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar s0 tates of India on insured households′ self-medication and financial position. Methods: Data originated from (i household surveys, and (ii the Management Information System of each CBHI. Study design was "staggered implementation" cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the households that were offered to enroll joined. The benefits-packages covered outpatient care in all three locations and in-patient care in two locations. To overcome self-selection enrollment bias, we constructed comparable control and treatment groups using Kernel Propensity Score Matching (K-PSM. To quantify impact, both difference-in-difference (DiD, and conditional-DiD (combined K-PSM with DiD were used to assess robustness of results. Results: Post-intervention (2013, self-medication was less practiced by insured HHs. Fewer insured households than uninsured households reported borrowing to finance care for non-hospitalization events. Being insured for two years also improved the HH′s location along the income distribution, namely insured HHs were more likely to experience income quintile-upgrade in one location, and less likely to experience a quintile-downgrade in two locations. Interpretation & conclusions: The realized benefits of insurance included better access to healthcare, reduced financial risks and improved economic mobility, suggesting that in our context health insurance creates welfare gains. These findings have implications for theoretical, ethical, policy and practice considerations.
Lucey, Catherine R; Thibault, George E; Ten Cate, Olle
Health care systems around the world are transforming to align with the needs of 21st-century patients and populations. Transformation must also occur in the educational systems that prepare the health professionals who deliver care, advance discovery, and educate the next generation of physicians in these evolving systems. Competency-based, time-variable education, a comprehensive educational strategy guided by the roles and responsibilities that health professionals must assume to meet the needs of contemporary patients and communities, has the potential to catalyze optimization of educational and health care delivery systems. By designing educational and assessment programs that require learners to meet specific competencies before transitioning between the stages of formal education and into practice, this framework assures the public that every physician is capable of providing high-quality care. By engaging learners as partners in assessment, competency-based, time-variable education prepares graduates for careers as lifelong learners. While the medical education community has embraced the notion of competencies as a guiding framework for educational institutions, the structure and conduct of formal educational programs remain more aligned with a time-based, competency-variable paradigm.The authors outline the rationale behind this recommended shift to a competency-based, time-variable education system. They then introduce the other articles included in this supplement to Academic Medicine, which summarize the history of, theories behind, examples demonstrating, and challenges associated with competency-based, time-variable education in the health professions.
Janssens, Wendy; Goedecke, Jann; de Bree, Godelieve J; Aderibigbe, Sunday A; Akande, Tanimola M; Mesnard, Alice
Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. A household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. Data were obtained using biomedical and socio-economic questionnaires. Health care utilization, NCCD-related health expenditures and distances to health care providers were compared by sex and by wealth quintile, and a Heckman regression model was used to estimate health expenditures taking selection bias in health care utilization into account. The prevalence of NCCDs in our sample was 6.2%. NCCD-affected individuals from the wealthiest quintile utilized formal health care nearly twice as often as those from the lowest quintile (87.8% vs 46.2%, p = 0.002). Women reported foregone formal care more often than men (43.5% vs. 27.0%, p = 0.058). Health expenditures relative to annual consumption of the poorest quintile exceeded those of the highest quintile 2.2-fold, and the poorest quintile exhibited a higher rate of catastrophic health spending (10.8% among NCCD-affected households) than the three upper quintiles (4.2% to 6.7%). Long travel distances to the nearest provider, highest for the poorest quintile, were a significant deterrent to seeking care. Using distance to the nearest facility as instrument to account for selection into health care utilization, we estimated out-of-pocket health care expenditures for NCCDs to be significantly higher in the lowest wealth quintile compared to the three upper quintiles. Facing potentially high health care costs and poor accessibility of health care facilities, many individuals suffering from NCCDs-particularly women and the poor-forego formal care, thereby increasing the risk of more severe illness in the future. When seeking care, the poor spend less on treatment than the rich, suggestive of lower
..., many in the mental health and behavioral health communities as well as long- term and [[Page 21312...; clinical support and information services related to patient care (but not separate research or marketing...
Bomberg, E; Birch, L; Endenburg, N; German, A J; Neilson, J; Seligman, H; Takashima, G; Day, M J
components of interconnected systems that influence obesity-related behaviours) and internal factors (i.e. biological determinants of obesity) that may influence the development of both childhood and pet obesity, and poverty may intersect with these variables to exacerbate obesity in low-income environments. This review discusses the costs, behaviours and psychology related to obesity in people and pets, and also proposes potential techniques that can be considered for prevention and treatment of this disease in pets. A 'One Health' approach to obesity suggests that an understanding of human obesity may elucidate some of the factors driving the more recent rise in pet obesity. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Villacrés, Tatiana; Mena, Ana Cristina
Analyze the proposal by the Ministry of Public Health to reform the public financing model in Ecuador with regard to pooling of funds and payment mechanisms. A literature review was done of the financing model, the current legal framework, and the budgetary bases in Pubmed, SciELO, LILACS Ecuador, and regional LILACS using the key words health financing, health financing systems, capitation, pooling of funds, health system reform Ecuador, health system Ecuador, and health payment mechanisms. Books and other documents suggested by health systems experts were also included. Review of the financing model enabled identifying the historical segmentation of Ecuador's health system; out of this, the Ministry of Public Health conceived its proposal to reform the financing model. The Ministry's proposed solutions are pooling of funds and payment of services at the first level of care through payment per capita adjusted for socioeconomic and demographic risks. Progress made in reforming the financing model includes design of the proposals and their implementation mechanisms, and discussions with stakeholders. Implementation of these changes may produce improvements for the health system in efficiency, spreading of risks, incentives for meeting health objectives, as well as contribute to its sustainability and advance toward universal health coverage. Nevertheless, legal, political, and operational constraints are hampering their implementation.
Robb, Cliff A.; Woodyard, Ann S.
The current research examines the relationship between personal financial knowledge (both objective and subjective), financial satisfaction, and selected demographic variables in terms of best practice financial behavior. Data are taken from the Financial Industry Regulatory Authority's (FINRA) National Financial Capability Study, a nationally…
may reduce the effectiveness of the policy. Conclusions Implementation analysis in the context of improving financial access to health care in African countries is still scarce, especially at the micro level. The strained relations of the providers with patients and the communities may have an influence on the implementation process and on the effects of this health policy. Therefore, power relations between actors of the health system and the community should be taken into consideration. More studies are needed to better understand the influence of power relations on the implementation process in low-income countries.
Belaid, Loubna; Ridde, Valéry
. Implementation analysis in the context of improving financial access to health care in African countries is still scarce, especially at the micro level. The strained relations of the providers with patients and the communities may have an influence on the implementation process and on the effects of this health policy. Therefore, power relations between actors of the health system and the community should be taken into consideration. More studies are needed to better understand the influence of power relations on the implementation process in low-income countries.
Hernández, Gilma; Moriña, David; Navarro, Albert
The presence of missing data in collected variables is common in health surveys, but the subsequent imputation thereof at the time of analysis is not. Working with imputed data may have certain benefits regarding the precision of the estimators and the unbiased identification of associations between variables. The imputation process is probably still little understood by many non-statisticians, who view this process as highly complex and with an uncertain goal. To clarify these questions, this note aims to provide a straightforward, non-exhaustive overview of the imputation process to enable public health researchers ascertain its strengths. All this in the context of dichotomous variables which are commonplace in public health. To illustrate these concepts, an example in which missing data is handled by means of simple and multiple imputation is introduced. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
Sargent-Cox, Kerry; Butterworth, Peter; Anstey, Kaarin J
Economic stress and uncertainty is argued to increase older adults' vulnerability to physical health decline and mental distress. Nevertheless, there is a paucity of research that examines the relationship between a large historical economic event, such as the recent global financial crisis (GFC), and health outcomes for older adults. This study provides a unique opportunity to compare self-reported health status and psychological functioning (number of depression and anxiety symptoms) in 1973 older Australian adults (mean age of 66.58 years (SD = 1.5)) prior to the GFC (2005-2006), with their status four years later during the GFC period (2009-2010). Latent difference score models revealed a significant difference in depression and anxiety symptoms over the two measurement occasions, indicating poorer psychological functioning for those who reported an impact as a result of the economic slowdown. These effects were not explained by demographic or socio-economic factors. Interaction effects showed that those participants who were surveyed within the acute salience period of the GFC (April to September 2009) were significantly less likely to report poorer psychological health over time compared to those who were surveyed after September 2009. This interesting timing effect is discussed in terms of potential time-lags in the negative effects of economic stress on health outcomes, as well as the possible protective effects of social norms that may be created by a large scale economic crisis. Copyright © 2011 Elsevier Ltd. All rights reserved.
Karanikolos, Marina; Heino, Pia; McKee, Martin; Stuckler, David; Legido-Quigley, Helena
A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups. © The Author(s) 2016.
Mauss, Daniel; Jarczok, Marc N; Fischer, Joachim E
Commuting to work is thought to have a negative impact on employee health. We tested the association of work commute and different variables of health in German industrial employees. Self-rated variables of an industrial cohort (n = 3805; 78.9 % male) including absenteeism, presenteeism and indices reflecting stress and well-being were assessed by a questionnaire. Fasting blood samples, heart-rate variability and anthropometric data were collected. Commuting was grouped into one of four categories: 0-19.9, 20-44.9, 45-59.9, ≥60 min travelling one way to work. Bivariate associations between commuting and all variables under study were calculated. Linear regression models tested this association further, controlling for potential confounders. Commuting was positively correlated with waist circumference and inversely with triglycerides. These associations did not remain statistically significant in linear regression models controlling for age, gender, marital status, and shiftwork. No other association with variables of physical, psychological, or mental health and well-being could be found. The results indicate that commuting to work has no significant impact on well-being and health of German industrial employees.
Jan Willem Slingenberg; Jakob de Haan
This paper uses a Financial Stress Index (FSI) for 13 OECD countries to examine which variables can help predicting financial stress. A stress index measures the current state of stress in the financial system and summarizes it in a single statistic. We employ three criteria for indicators to be used in constructing a multi-country FSI (the index covers the entire financial system, indicators used are available at a high frequency for many countries for a long period, and are comparable) to c...
Full Text Available Background: Comzmercialization of health care has contributed to widen inequities between the rich and the poor, especially in settings with suboptimal regulatory frameworks of the health sector. Poorly regulated fee-for-service payment systems generate inequity and initiate a vicious circle in which access to quality health care gradually deteriorates. Although the abolition of user fees is high on the international health policy agenda, the sudden removal of user fees may have disrupting effects on the health system and may not be affordable or sustainable in resource-constrained countries, such as the Democratic Republic of Congo. Methods and Results: Between 2008 and 2011, the Belgian development aid agency (BTC launched a set of reforms in the Kisantu district, in the province of Bas Congo, through an action-research process deemed appropriate for the implementation of change within open complex systems such as the Kisantu local health system. Moreover, the entire process contributed to strengthen the stewardship capacity of the Kisantu district management team. The reforms mainly comprised the rationalization of resources and the regulation of health services financing. Flat fees per episode of disease were introduced as an alternative to fee-for-service payments by patients. A financial subsidy from BTC allowed to reduce the height of the flat fees. The provision of the subsidy was made conditional upon a range of measures to rationalize the use of resources. Conclusions: The results in terms of enhancing people access to quality health care were immediate and substantial. The Kisantu experience demonstrates that a systems approach is essential in addressing complex problems. It provides useful lessons for other districts in the country.
M. Prosper Lutala
Full Text Available Background: Health and social services utilisation is seen to be more closely related to age than to other socio-demographic characteristics. Many health problems are known to increase with age and this demographic trend may lead to an increase in the absolute number of health conditions in this population. However, questions are still emerging as to how the elderly seek care in response to their needs in the context of a war-torn region. Objectives: The aim of this study was to determine the behaviour of the elderly in seeking care during a time of conflict. Method: A descriptive cross-sectional study was carried out in the health district Goma, in the Democratic Republic of the Congo (DRC, using a multistage sampling of 500 senior citizens. Eight trained field-workers were deployed in the field where they administered a structured questionnaire. Results: The public health sector was well known and preferred by 186 participants (37.2%, but only used by 16 (3.2% participants. Financial support received by the elderly came from their own relatives and fellow believers in 33.5% and 20.2% of cases, respectively. Almost 71% of monetary support is the result of begging and unknown sources – there is no government involvement whatsoever. Much of the external support that the elderly receive involves support in the form of food. Disease expenses remain a main concern of the elderly themselves. Conclusion: Government support for the elderly in the DRC is non-existent. There is an overuse of private sector and traditional medicine, despite the preference indicated for the public health sector. As a recommendation, a general increase in income-related activities could contribute to alleviating the health state of the elderly in a war situation. Further studies might explore in future the contribution of those results on the health of elders.
Bierman, A S; Bubolz, T A; Fisher, E S; Wasson, J H
Responses to simple questions that predict subsequent health care utilization are of interest to both capitated health plans and the payer. To determine how responses to a single question about general health status predict subsequent health care expenditures. Participants in the 1992 Medicare Current Beneficiary Survey were asked the following question: "In general, compared to other people your age, would you say your health is: excellent, very good, good, fair or poor?" To obtain each participant's total Medicare expenditures and number of hospitalizations in the ensuing year, we linked the responses to this question with data from the 1993 Medicare Continuous History Survey. Nationally representative sample of 8775 noninstitutionalized Medicare beneficiaries 65 years of age and older. Annual age- and sex-adjusted Medicare expenditures and hospitalization rates. Eighteen percent of the beneficiaries rated their health as excellent, 56% rated it as very good or good, 17% rated it as fair, and 7% rated it as poor. Medicare expenditures had a marked inverse relation to self-assessed health ratings. In the year after assessment, age- and sex-adjusted annual expenditures varied fivefold, from $8743 for beneficiaries rating their health as poor to $1656 for beneficiaries rating their health as excellent. Hospitalization rates followed the same pattern: Respondents who rated their health as poor had 675 hospitalizations per 1000 beneficiaries per year compared with 136 per 1000 for those rating their health as excellent. The response to a single question about general health status strongly predicts subsequent health care utilization. Self-reports of fair or poor health identify a group of high-risk patients who may benefit from targeted interventions. Because the current Medicare capitation formula does not account for health status, health plans can maximize profits by disproportionately enrolling beneficiaries who judge their health to be good. However, they are at
Universal screening for mental health concerns, as part of the preparticipation examination in collegiate sports medicine settings, can be an important and feasible strategy for facilitating early detection of mental health disorders. To assess whether sports medicine departments at National Collegiate Athletic Association (NCAA) member colleges have policies related to identifying student-athlete mental health problems, the nature of preparticipation examination screening related to mental health, and whether other departmental or institutional screening initiatives are in place. I also aimed to characterize the variability in screening by institutional characteristics. Cross-sectional study. College sports medicine departments. Team physicians and head athletic trainers at NCAA member colleges (n = 365, 30.3% response rate). Electronic survey of departmental mental health screening activities. A total of 39% of respondents indicated that their institution had a written plan related to identifying student-athletes with mental health concerns. Fewer than half reported that their sports medicine department administers a written or verbal screening instrument for symptoms of disordered eating (44.5%), depression (32.3%), or anxiety (30.7%). The strongest predictors of mental health screening were the presence of a written plan related to identifying student-athlete mental health concerns and the employment of a clinical psychologist. Additionally, Division I institutions and institutions with a greater ratio of athletic trainers to student-athletes tended to engage in more screening. The substantial among-institutions variability in mental health screening suggests that opportunities exist to make these practices more widespread. To address this variability, recent NCAA mental health best-practice guidelines suggested that institutions should screen for a range of mental health disorders and risk behaviors. However, at some institutions, staffing deficits may need to
.... The Defense Health Program funds the operations of the Military Departments' medical treatment facilities, the development of DoD medical systems software, and congressionally directed research...
Abolhallaje, Masoud; Jafari, Mehdi; Seyedin, Hesam; Salehi, Masoud
Financial management and accounting reform in the public sectors was started in 2000. Moving from cash-based to accrual-based is considered as the key component of these reforms and adjustments in the public sector. Performing this reform in the health system is a part of a bigger reform under the new public management. The current study aimed to analyze the movement from cash-based to accrual-based accounting in the health sector in Iran. This comparative study was conducted in 2013 to compare financial management and movement from cash-based to accrual-based accounting in health sector in the countries such as the United States, Britain, Canada, Australia, New Zealand, and Iran. Library resources and reputable databases such as Medline, Elsevier, Index Copernicus, DOAJ, EBSCO-CINAHL and SID, and Iranmedex were searched. Fish cards were used to collect the data. Data were compared and analyzed using comparative tables. Developed countries have implemented accrual-based accounting and utilized the valid, reliable and practical information in accrual-based reporting in different areas such as price and tariffs setting, operational budgeting, public accounting, performance evaluation and comparison and evidence based decision making. In Iran, however, only a few public organizations such as the municipalities and the universities of medical sciences use accrual-based accounting, but despite what is required by law, the other public organizations do not use accrual-based accounting. There are advantages in applying accrual-based accounting in the public sector which certainly depends on how this system is implemented in the sector.
Abolhallaje, Masoud; Jafari, Mehdi; Seyedin, Hesam; Salehi, Masoud
Background: Financial management and accounting reform in the public sectors was started in 2000. Moving from cash-based to accrual-based is considered as the key component of these reforms and adjustments in the public sector. Performing this reform in the health system is a part of a bigger reform under the new public management. Objectives: The current study aimed to analyze the movement from cash-based to accrual-based accounting in the health sector in Iran. Patients and Methods: This comparative study was conducted in 2013 to compare financial management and movement from cash-based to accrual-based accounting in health sector in the countries such as the United States, Britain, Canada, Australia, New Zealand, and Iran. Library resources and reputable databases such as Medline, Elsevier, Index Copernicus, DOAJ, EBSCO-CINAHL and SID, and Iranmedex were searched. Fish cards were used to collect the data. Data were compared and analyzed using comparative tables. Results: Developed countries have implemented accrual-based accounting and utilized the valid, reliable and practical information in accrual-based reporting in different areas such as price and tariffs setting, operational budgeting, public accounting, performance evaluation and comparison and evidence based decision making. In Iran, however, only a few public organizations such as the municipalities and the universities of medical sciences use accrual-based accounting, but despite what is required by law, the other public organizations do not use accrual-based accounting. Conclusions: There are advantages in applying accrual-based accounting in the public sector which certainly depends on how this system is implemented in the sector. PMID:25763194
L. Rajmil (Luis); M.-J.F. de Sanmamed (María-José Fernandez); I. Choonara (Imti); T. Faresjö (Tomas); A. Hjern (Anders); A. Kozyrskyj (Anita); P.J. Lucas (Patricia); H. Raat (Hein); L. Séguin (Louise); N. Spencer (Nick); D. Taylor-Robinson (David)
textabstractThe aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children,
DeMuro, Paul R; Ash, Joan; Middleton, Blackford; Fletcher, Justin; Madison, Cecelia J
Little research has been conducted about the quality, benefits, costs, and financial considerations associated with health information technology (HIT), particularly informatics technologies, such as e-prescribing, from the perspective of all its stakeholders. This research effort sought to identify the stakeholders involved in e-prescribing and to identify and rank-order the positives and the negatives from the perspective of the stakeholders to create a framework to assist in the development of incentives and payment mechanisms which result in better managed care. The Delphi method was employed by enlisting a panel of experts. They were presented with the results of initial research in an online survey of questions which sought to prioritize the quality, benefit, cost, and financial effects of e-prescribing from the perspective of each stakeholder. From the results of this study, a framework was presented to framework experts. The experts added stakeholders and positives and negatives to the initial lists and rank-ordered the positives and negatives of e-prescribing from the perspective of each stakeholder. The aggregate results were summarized by category of stakeholder. The framework experts evaluated the framework. Positives and negatives can be rank-ordered from the perspective of each stakeholder. A useful framework was created.
Michele C. Lim
Full Text Available Purpose. To examine financial and clinical work productivity outcomes associated with the use of the electronic health record (EHR. Methods. 191,360 billable clinical encounters were analyzed for 12 clinical providers over a 9-year study period during which an EHR was implemented. Main outcome measures were clinical revenues collected per provider and secondary outcomes were charge capture, patient visit coding levels, transcription costs, patient visit volume per provider, digital drawing, and digital imaging volume. Results. The difference in inflation adjusted net clinical revenue per provider per year did not change significantly in the period after EHR implementation (mean = $404,198; SD = $17,912 than before (mean = $411,420; SD = $39,366 (P=0.746. Charge capture, the proportion of higher- and lower-level visit codes for new and established patients, and patient visits per provider remained stable. A total savings of $188,951 in transcription costs occurred over a 4-year time period post-EHR implementation. The rate of drawing the ophthalmic exam in the EHR was low (mean = 2.28%; SD = 0.05% for all providers. Conclusions. This study did not show a clear financial gain after EHR implementation in an academic ophthalmology practice. Ophthalmologists do not rely on drawings to document the ophthalmic exam; instead, the ophthalmic exam becomes text-driven in a paperless world.
Martin-Moreno, Jose M; Anttila, Ahti; von Karsa, Lawrence; Alfonso-Sanchez, Jose L; Gorgojo, Lydia
The aim of this paper is to elucidate the rationale for sustaining and expanding cost-effective, population-based screening services for breast, cervical and colorectal cancers in the context of the current financial crisis. Our objective is not only to promote optimal delivery of high-quality secondary cancer prevention services, but also to underline the importance of strengthening comprehensive cancer control, and with it, health system response to the complex care challenges posed by all chronic diseases. We focus primarily on issues surrounding planning, organisation, implementation and resources, arguing that given the growing cancer burden, policymakers have ample justification for establishing and expanding population-based programmes that are well-organised, well-resourced and well-executed. In a broader economic context of rescue packages, deficits and cutbacks to government entitlements, health professionals must intensify their advocacy for the protection of vital preventive health services by fighting for quality services with clear benefits for population health outcomes. Copyright © 2012 Elsevier Ltd. All rights reserved.
Kirschenbaum, Bonnie E
To discuss the role of restricted drug distribution systems in the implementation of risk evaluation and mitigation strategies (REMS), health-system pharmacists' concerns associated with the use of specialty pharmacies and other restricted drug distribution systems, reimbursement policies for high-cost specialty drugs, supply chain models for traditional and specialty drugs, and emerging trends in the management of and reimbursement for specialty pharmaceuticals. Restricted drug distribution systems established by pharmaceutical manufacturers, specialty pharmacies, or other specialty suppliers may be a component of REMS, which are required by the Food and Drug Administration for the management of known or potential serious risks from certain drugs. Concerns of health-system pharmacists using specialty suppliers include access to pharmaceuticals, operational challenges, product integrity, financial implications, continuity of care, and patient safety. An ambulatory care patient taking a specialty drug product from home to a hospital outpatient clinic or inpatient setting for administration, a practice known as "brown bagging," raises concerns about product integrity and institutional liability. An institution's finances, tolerance for liability, and ability to skillfully manage the processes involved often determine its choice between an approach that prohibits brown bagging but is costly and one that permits the practice under certain conditions and is less costly. The recent shift from a traditional supply chain model to a specialty pharmacy supply chain model for high-cost pharmaceuticals has the potential to increase pharmaceutical costs for health systems. A dialogue is needed between health-system pharmacists and group purchasing organizations to address the latter's role in mitigating the financial implications of this change and to help clarify the safety issues. Some health plans have shifted part of the cost of expensive drugs to patients by establishing a
Leung, G M; Tin, K Y K; Yeung, G M K; Leung, E S K; Tsui, E L H; Lam, D W S; Tsang, C S H; Fung, A Y K; Lo, S V
This report presents the latest estimates of Hong Kong's domestic health spending between fiscal years 1989/90 and 2004/05, cross-stratified and categorised by financing source, provider and function on an annual basis. Total expenditure on health was HK$67,807 million in fiscal year 2004/05. In real terms, total expenditure on health showed positive growth averaging 7% per annum throughout the period covered in this report while gross domestic product grew at 4% per annum on average, indicating a growing percentage of health spending relative to gross domestic product, from 3.5% in 1989/90 to 5.2% in 2004/05. This increase was largely driven by the rise in public spending, which rose 9% per annum on average in real terms over the period, compared with 5% for private spending. This represents a growing share of public spending from 40% to 55% of total expenditure on health during the period. While public spending was the dominant source of health financing in 2004/05, private household out-of-pocket expenditure accounted for the second largest share of total health spending (32%). The remaining sources of health finance were employer-provided group medical benefits (8%), privately purchased insurance (5%), and other private sources (1%). Of the $67,807 million total health expenditure in 2004/05, current expenditure comprised $65,429 million (96%) while $2378 million (4%) were capital expenses (ie investment in medical facilities). Services of curative care accounted for the largest share of total health spending (67%) which were made up of ambulatory services (35%), in-patient curative care (28%), day patient hospital services (3%), and home care (1%). The next largest share of total health expenditure was spent on medical goods outside the patient care setting (10%). Analysed by health care provider, hospitals accounted for the largest share (46%) and providers of ambulatory health care the second largest share (30%) of total health spending in 2004/05. We
Reddy, Karuna Garan; Khan, Mohammad G M; Khan, Sabiha
Using convenient stratification criteria such as geographical regions or other natural conditions like age, gender, etc., is not beneficial in order to maximize the precision of the estimates of variables of interest. Thus, one has to look for an efficient stratification design to divide the whole population into homogeneous strata that achieves higher precision in the estimation. In this paper, a procedure for determining Optimum Stratum Boundaries (OSB) and Optimum Sample Sizes (OSS) for each stratum of a variable of interest in health surveys is developed. The determination of OSB and OSS based on the study variable is not feasible in practice since the study variable is not available prior to the survey. Since many variables in health surveys are generally skewed, the proposed technique considers the readily-available auxiliary variables to determine the OSB and OSS. This stratification problem is formulated into a Mathematical Programming Problem (MPP) that seeks minimization of the variance of the estimated population parameter under Neyman allocation. It is then solved for the OSB by using a dynamic programming (DP) technique. A numerical example with a real data set of a population, aiming to estimate the Haemoglobin content in women in a national Iron Deficiency Anaemia survey, is presented to illustrate the procedure developed in this paper. Upon comparisons with other methods available in literature, results reveal that the proposed approach yields a substantial gain in efficiency over the other methods. A simulation study also reveals similar results.
The global financial crisis poses a threat to global health, and may exacerbate diseases of poverty, e.g. HIV, malaria and tuberculosis. Exploring the implications of the global financial crisis for the health sector response to tuberculosis is useful to illustrate the practical problems and propose possible solutions. The response to tuberculosis is considered in the context of health sector development. Problems and solutions are considered in five key areas: financing, prioritization, government regulation, integration and decentralization. Securing health gains in global tuberculosis control depends on protecting expenditure by governments of countries badly affected by tuberculosis and by donors, taking measures to increase efficiencies, prioritizing health expenditures and strengthening government regulation. Lessons learned will be valuable for stakeholders involved in the health sector response to tuberculosis and other diseases of poverty.
Girish K. Nair; Lewlyn Lester Raj Rodrigues
There are several ratios which define the financial health of an organization but the importance of Net cash flow, Gross income, Net income, Pending bills, Receivable bills, Debt, and Book value can never be undermined as they give the exact picture of the financial condition. While there are several approaches to study the dynamics of these variables, system dynamics based modelling and simulation is one of the modern techniques. The paper explores this method to simulate the before mentione...
To improve understanding of variables impacting health promotion behaviors among urban Black women. A cross-sectional survey was used. Urban Black women (N = 132) between the ages of 30 to 64 years participated. The study was conducted in a U.S. metropolitan region in 2015. Health literacy (Newest Vital Sign [NVS]), self-efficacy (New General Self-Efficacy Scale [NGSE]), and readiness for change (Health Risk Instrument [HRI]) were correlated with health promotion behaviors (Health Promotion Lifestyle Profile II [HPLPII]). Univariate statistics addressed demographic characteristics; bivariate/simultaneous linear regression determined the relationships between the NVS, NGSE, and HRI to health promotion behaviors (HPLPII). Demographics: 72.6% completed high school and 25% completed college, and the mean body mass index (BMI) was >32. Positive correlations existed between each variable to health promotion behaviors: NVS (r = .244, p promotion behaviors. Education and health literacy were also correlated (r s = .414, p = .001). Although health literacy, self-efficacy, and readiness for change are associated with health promotion behaviors, readiness for change was the most highly correlated. The development and incorporation of interventions to promote health promotion behaviors should include readiness for change, health literacy, BMI, and education, especially among urban Black women in order to reduce critical health disparities. Community-based and culturally relevant strategies in promoting health that are integrated into existing lifestyles and designed to impact readiness for change will have the greatest impact on reducing health disparities both in the United States and in countries experiencing rapid urbanization. For example, healthy eating behaviors or increased physical activity may be best adopted when integrated into existing community-based spiritual or cultural events via trusted community leaders. Replication of this study in other populations of Black
Patel, Minal R; Nelson, Belinda W; Id-Deen, Effat; Caldwell, Cleopatra H
The purpose of this study was to define perceptions of health-related financial burden based on the views of individuals who report these perceptions through qualitative approaches. Four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview was employed by facilitators. Coded transcripts were analyzed for themes regarding dimensions of the meaning of financial burden. Major domains of financial burden identified included (1) high out-of-pocket expenses; (2) lost wages from exacerbations, inability to maintain a stable job and stress from making decisions about taking a sick day or coming to work; (3) transport costs; (4) both costs and stress of managing insurance eligibility and correcting erroneous bills. Greater awareness of factors that add to perceptions of financial burden might better equip researchers to develop interventions to help care teams manage such concerns with their patients.
E. V. Sinicyna
Full Text Available Organization of the health system of theRussian Federationin the conditions of limited fi nancial resources needed to develop and implement new methods and management mechanisms. Conducted a study in the article allowed to formulate the basic problems of development management of medical organizations and off er possible solutions through the formation of the fi nancial basis for government guarantees of health care inRussia. The article deals with the current reform in the Russian budget-insurance model of health care fi nancing, reveals the content and direction of the program of state guarantees of medical care in the new fi nancing mechanism of public services. Development and implementation of a new funding system in the management of medical organization will help to reduce costs, improve staff effi ciency, improve the quality of public health services.
Koretskiy, V L
Based on the newly developed concept of multilevel functional system of primary health care which is to replace the current multicomponent system, the author discusses the computer-aided realization of the system for estimation and analysis of the integral model of outpatient and inpatient medical care of the population of the Ukraine. This system is intended to solve the problems associated with intensification of the resources of the public health system of the Republic (district).
Yen, Louis; Schultz, Alyssa; Schnueringer, Elaine; Edington, Dee W
The objective of this study was to examine the health risk-related excess costs of time away from work, medical claims, pharmacy claims, and total costs with and without considering the prevalence of health risks. A total of 2082 of 4266 employees of a Midwest utility participated in a health risk appraisal (HRA). Individuals were classified by their HRA participation status and also by 15 health risks. Total and excess costs were analyzed for all employees. There were significant excess costs due to individual risks and overall excess health risks in all cost measures. Both excess cost per risk and prevalence of the risk were important factors in determining the excess costs in the population. As compared with low-risk participants, HRA nonparticipants and the medium- and high-risk participants were 1.99, 2.22, and 3.97 times more likely to be high cost status. Approximately one third of corporate costs in medical claims, pharmacy claims, and time away from work could be defined as excess costs associated with excess health risks.
Kim, Daniel; Baum, Christopher F; Ganz, Michael L; Subramanian, S V; Kawachi, Ichiro
Past research on the associations between area-level/contextual social capital and health has produced conflicting evidence. However, interpreting this rapidly growing literature is difficult because estimates using conventional regression are prone to major sources of bias including residual confounding and reverse causation. Instrumental variable (IV) analysis can reduce such bias. Using data on up to 167,344 adults in 64 nations in the European and World Values Surveys and applying IV and ordinary least squares (OLS) regression, we estimated the contextual effects of country-level social trust on individual self-rated health. We further explored whether these associations varied by gender and individual levels of trust. Using OLS regression, we found higher average country-level trust to be associated with better self-rated health in both women and men. Instrumental variable analysis yielded qualitatively similar results, although the estimates were more than double in size in both sexes when country population density and corruption were used as instruments. The estimated health effects of raising the percentage of a country's population that trusts others by 10 percentage points were at least as large as the estimated health effects of an individual developing trust in others. These findings were robust to alternative model specifications and instruments. Conventional regression and to a lesser extent IV analysis suggested that these associations are more salient in women and in women reporting social trust. In a large cross-national study, our findings, including those using instrumental variables, support the presence of beneficial effects of higher country-level trust on self-rated health. Previous findings for contextual social capital using traditional regression may have underestimated the true associations. Given the close linkages between self-rated health and all-cause mortality, the public health gains from raising social capital within and across
Full Text Available Background Resiliency is defined as a relatively permanent personality trait, which may be assigned to the category of health resources. The aim of this study was to determine conditions in which resiliency poses a significant health resource (moderation, thereby broadening knowledge of the specifics of the relationship between resiliency and subjective health assessment. Participants and procedure The study included 142 individuals. In order to examine the level of resiliency, the Assessment Resiliency Scale (SPP-25 by N. Ogińska-Bulik and Z. Juczyński was used. Participants evaluated subjective health state by means of an analogue-visual scale. Additionally, in the research the following moderating variables were controlled: sex, objective health status, having a partner, professional activity and age. These data were obtained by personal survey. Results The results confirmed the relationship between resiliency and subjective health assessment. Multiple regression analysis revealed that sex, having a partner and professional activity are significant moderators of associations between level of resiliency and subjective health evaluation. However, statistically significant interaction effects for health status and age as a moderator were not observed. Conclusions Resiliency is associated with subjective health assessment among adults, and selected socio-demographic features (such as sex, having a partner, professional activity moderate this relationship. This confirms the significant role of resiliency as a health resource and a reason to emphasize the benefits of enhancing the potential of individuals for their psychophysical wellbeing. However, the research requires replication in a more homogeneous sample.
Full Text Available The aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children, published since 2007 and related to the 2008 economic crisis were included. Two reviewers independently assessed studies for inclusion. Data were synthesised as a narrative review. Five hundred and six titles and abstracts were reviewed, from which 22 studies were included. The risk of bias for quantitative studies was mixed while qualitative studies showed low risk of bias. An excess of 28,000–50,000 infant deaths in 2009 was estimated in sub-Saharan African countries, and increased infant mortality in Greece was reported. Increased price of foods was related to worsening nutrition habits in disadvantaged families worldwide. An increase in violence against children was reported in the U.S., and inequalities in health-related quality of life appeared in some countries. Most studies suggest that the economic crisis has harmed children’s health, and disproportionately affected the most vulnerable groups. There is an urgent need for further studies to monitor the child health effects of the global recession and to inform appropriate public policy responses.
de Wind, Astrid; Geuskens, Goedele A; Ybema, Jan Fekke; Blatter, Birgitte M; Burdorf, Alex; Bongers, Paulien M; van der Beek, Allard J
This study aimed to investigate the relative contribution of health, job characteristics, skills and knowledge, and social and financial factors to the transition from work to (non-disability) early retirement. Employees aged 59-63 years (N=2317) were selected from the Study on Transitions in Employment, Ability and Motivation in the Netherlands (STREAM). Individual characteristics, health, job characteristics, skills and knowledge, and social and financial factors were measured using a questionnaire at baseline. Information on early retirement was derived from the one-year follow-up questionnaire. Logistic regression analyses were used to identify predictors of early retirement. Population Attributable Fractions (PAF) were calculated. Older age [odds ratio (OR) 1.79], poor physical health (OR 1.78), a positive attitude of the partner with respect to early retirement (OR 3.85), and the financial possibility to stop working before the age of 65 (OR 10.2) predicted the transition to early retirement, whereas employees that reported high appreciation at work (OR 0.58) and higher focus on development of skills and knowledge (OR 0.54) were less likely to retire early. PAF were 0.75 for the financial possibility to stop working, 0.43 for a positive attitude of the partner with respect to early retirement, 0.27 for low appreciation at work, 0.23 for a low focus on development, and 0.21 for poor health. The financial possibility to stop working before the age of 65 importantly contributes to early retirement. In the context of rapidly diminishing financial opportunities to retire early in the Netherlands, the prolongation of working life might be promoted by workplace health promotion and disability management, and work-related interventions focusing on appreciation and the learning environment.
Costa, Giovanni; Sartori, Samantha; Akerstedt, Torbjorn
Flexible working hours can have several meanings and can be arranged in a number of ways to suit the worker and/or employer. Two aspects of "flexible" arrangement of working hours were considered: one more subjected to company control and decision (variability) and one more connected to individual discretion and autonomy (flexibility). The aim of the study was to analyze these two dimensions in relation to health and well-being, taking into consideration the interaction with some relevant background variables related to demographics plus working and social conditions. The dataset of the Third European Survey on working conditions, conducted in 2000 and involving 21,505 workers, was used. Nineteen health disorders and four psycho-social conditions were tested by means of multiple logistic regression analysis, in which mutually adjusted odds ratios were calculated for age, gender, marital status, number of children, occupation, mode of employment, shift work, night work, time pressure, mental and physical workload, job satisfaction, and participation in work organization. The flexibility and variability of working hours appeared inversely related to health and psycho-social well-being: the most favorable effects were associated with higher flexibility and lower variability. The analysis of the interactions with the twelve intervening variables showed that physical work, age, and flexibility are the three most important factors affecting health and well-being. Flexibility resulted as the most important factor to influence work satisfaction; the second to affect family and social commitment and the ability to do the same job when 60 years old, as well as trauma, overall fatigue, irritability, and headache; and the third to influence heart disease, stomachache, anxiety, injury, and the feeling that health being at risk because of work. Variability was the third most important factor influencing family and social commitments. Moreover, shift and night work confirmed to
George, Gavin; Rhodes, Bruce
International migration is one of the factors resulting in the shortage of Human Resources for Health (HRH) in India. Literature suggests that migration is fuelled by the prospect of higher salaries available abroad. The extent of these salary differentials are unknown, and this study seeks to examine the salaries of selected HRH in India and four popular destination countries (United States of America, United Kingdom, Canada and the United Arab Emirates), whilst accounting for the in-country cost of living. This study will therefore determine truer financial incentives for Indian HRH to migrate abroad. A purchasing power parity (PPP) ratio is employed to equalise the international price of buying a representative basket of commonly bought goods (including food, entertainment, fuel and utilities). Using the PPP index, real differences in salaries are directly compared for selected work categories and different levels of work experience in the four respective countries. Nurses in the USA can earn up to 82.7% more than their Indian counterparts. Nurses in Canada and the UAE reveal more modest salary differentials, yet still significant better off by up to 28 and 20% respectively. Only nurses in the UK are potentially materially worse off than nurses working in India. We observe significant potential PPP gains of up to 57.4, 99.1 and 94.4% for medical doctors in the USA, Canada and the UAE respectively. Medical specialists potentially experience the greatest income disparities with anaesthetists potentially earning up to 600% more than their counterparts in India. Radiologists operating in the UK and general surgeons working in the USA can potentially earn more than double that of their counterparts working in India. We observe more modest positive or negligible PPP gains in other selected countries for health specialists. Even when considering the differences in the cost of living, the financial incentive for selected cadres of Indian HRH to seek work abroad remains
Vargas, Juan Rafael; Muiser, Jorine
This paper explores the implementation and sustenance of universal health coverage (UHC) in Costa Rica, discussing the development of a social security scheme that covered 5% of the population in 1940, to one that finances and provides comprehensive healthcare to the whole population today. The scheme is financed by mandatory, tri-partite social insurance contributions complemented by tax funding to cover the poor. The analysis takes a historical perspective and explores the policy process including the key actors and their relative influence in decision-making. Data were collected using qualitative research instruments, including a review of literature, institutional and other documents, and in-depth interviews with key informants. Key lessons to be learned are: i) population health was high on the political agenda in Costa Rica, in particular before the 1980s when UHC was enacted and the transfer of hospitals to the social security institution took place. Opposition to UHC could therefore be contained through negotiation and implemented incrementally despite the absence of real consensus among the policy elite; ii) since the 1960s, the social security institution has been responsible for UHC in Costa Rica. This institution enjoys financial and managerial autonomy relative to the general government, which has also facilitated the UHC policy implementation process; iii) UHC was simultaneously constructed on three pillars that reciprocally strengthened each other: increasing population coverage, increasing availability of financial resources based on solidarity financing mechanisms, and increasing service coverage, ultimately offering comprehensive health services and the same benefits to every resident in the country; iv) particularly before the 1980s, the fruits of economic growth were structurally invested in health and other universal social policies, in particular education and sanitation. The social security institution became a flagship of Costa Rica
Fleury, Marie-Josée; Grenier, Guy; Bamvita, Jean-Marie; Chiocchio, François
Using a structural analysis, this study examines the relationship between job satisfaction among 315 mental health professionals from the province of Quebec (Canada) and a wide range of variables related to provider characteristics, team characteristics, processes, and emergent states, and organizational culture. We used the Job Satisfaction Survey to assess job satisfaction. Our conceptual framework integrated numerous independent variables adapted from the input-mediator-output-input (IMOI) model and the Integrated Team Effectiveness Model (ITEM). The structural equation model predicted 47% of the variance of job satisfaction. Job satisfaction was associated with eight variables: strong team support, participation in the decision-making process, closer collaboration, fewer conflicts among team members, modest knowledge production (team processes), firm affective commitment, multifocal identification (emergent states) and belonging to the nursing profession (provider characteristics). Team climate had an impact on six job satisfaction variables (team support, knowledge production, conflicts, affective commitment, collaboration, and multifocal identification). Results show that team processes and emergent states were mediators between job satisfaction and team climate. To increase job satisfaction among professionals, health managers need to pursue strategies that foster a positive climate within mental health teams.
de Jong, Merel; Tamminga, Sietske J; Frings-Dresen, Monique H W; de Boer, Angela G E M
This study aimed to (1) describe the Quality of Working Life (QWL) of cancer survivors and (2) explore associations between the QWL of cancer survivors and health- and work-related variables. Employed and self-employed cancer survivors were recruited through hospitals and patient organizations. They completed the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS) and health- and work-related variables in this cross-sectional study. The QWL scores of cancer survivors were described, and associations between QWL and health- and work-related variables were assessed. The QWLQ-CS was completed by 302 cancer survivors (28% male) with a mean age of 52 ± 8 years. They were diagnosed between 0 and 10 years ago with various types of cancer, such as breast cancers, gastrointestinal cancers, urological cancers, and haematological cancers. The QWL mean score of cancer survivors was 75 ± 12 (0-100). Cancer survivors had statistically significant lower QWL scores when they had been treated with chemotherapy or when they reported co-morbidity (p ≤ 0.05). Cancer survivors without managerial positions, with low incomes or physically demanding work, and who worked a proportion of their contract hours had statistically significantly lower QWL scores (p ≤ 0.05). This study described the QWL of cancer survivors and associations between QWL and health- and work-related variables. Based on these variables, it is possible to indicate groups of cancer survivors who need more attention and support regarding QWL and work continuation.
... considerable disadvantage in the marketplace because of ``the need for [electronic health records technology... records software or information technology and training services. The final rule for this exception was... permits certain entities to provide to physicians certain software and information technology and training...
Paul D. Loprinzi
Full Text Available Background: Few population-based studies have examined the association between physical activity (PA and cardiovascular disease risk factors, demographic variables, and perceptions of health status, and we do not have a clear understanding of the dose-response relationship among these variables. Methods: Data from the 2003-2006 National Health and Nutrition Examination Survey was used to examine the dose-response relationship between objectively measured PA and metabolic syndrome (and its individual cardiovascular disease risk factors, demographic variables, and perceptions of health. After exclusions, 5,538 participants 18 years or older were included in the present study, with 2,538 participants providing fasting glucose and 2,527 providing fasting triglyceride data. PA was categorized into deciles. Results: Overall, the health benefits showed a general pattern of increase with each increasing levels of PA. Of the ten PA classifications examined, participants in the highest moderate-to-vigorous physical activity (MVPA category (at least 71 min/day had the lowest odds of developing metabolic syndrome. Conclusion: At a minimum, sedentary adults should strive to meet current PA guidelines (i.e., 150 min/week of MVPA, with additional positive benefits associated with engaging in three times this level of PA.
Full Text Available The first part of the paper deals with the influence of individual commodities on the profitability and risks of farms. Production structure was given thought share of twelve basic crops in total agricultural production yield. Volume of accumulated profit for five-year income was chosen as viability criterion. The research did not show that specialization in one of the commodities had significantly influenced achieved profitability. The only exception is the production of milk, which clearly lead to lower profitability. Production structure determined the risk of farms. Farms were constantly threatened by both negative profitability, and also steep fluctuations of cash flow (in other of long-term positive profitability, leading to temporary loss of solvency. The analysis showed that different types of production structures lead to different types of threats. The probability of falling into production losses, or that the loss is so great that not even cover variable costs (a farm finds itself under the point of termination of production was calculated using the EaR method. The results again supported previous findings. Loss is highly likely to be achieved in commodities of animal production. For commodities of crop production the probability of loss was roughly a half, but the probability of exceeding a period of variable costs is higher.
Osvaldo Costa Moreira
Full Text Available AbstractObjective To verify the behavior of anthropometric, cardiovascular and functional variables as indicators of health-related physical fitness in university professors and perform a comparison of these variables between sexes.Materials and methods We conducted an observational epidemiological cross-sectional study in 145 professors (45.86 ± 9.7 years, 103 men (71.03%, which were evaluated by measuring heart rate (HR and systolic (SBP and diastolic (DBP pressure at rest, body weight, height, body mass index (BMI, body fat percentage (BF%, handgrip strength (HGS, flexibility and cardiorespiratory fitness (CRF. We proceeded to the descriptive analysis, Student t-test for comparison between sexes and multiple regression analysis to verify the association between the variables analyzed. It was adopted a significance level of p < 0.05.Results The sex affected all variables. Women had better levels of BMI, flexibility, SBP and DBP. The BF% and CRF were associated with SBP and BMI in both sexes.Conclusion The behavior of anthropometric, cardiovascular and functional variables indicated unsatisfactory values for flexibility, HGS and BMI, with the worst levels among men. Furthermore, the variables that showed better association with HRPF were BF% and CRF.
Health and work are complex processes. Besides, they are multiple considering the forms they take. These two processes are linked to each other and they are influenced by each other. According to this, it is possible to establish that work world is extremely complex and heterogeneous. In this world, "old" or traditional risks coexist with "modern risks", derived from the new models of work organization and the incorporation of new technologies. Unemployment, work relationships precariousness and work risks outsourcing are results of neoliberal strategies. Some negative results of health-sickness process derived from transformation in work world and current global economic crisis have been noticed in current work conditions. Finally, the need for reconstructing policies focusing on this situation derived from work world is suggested.
Dongen, J.M. van; Proper, K.I.; Wier, M.F. van; Beek, A.J. van der; Bongers, P.M.; Mechelen, W. van; Tulder, M.W. van
Summary: This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011.
de Wind, Astrid; Geuskens, Goedele A.; Ybema, Jan Fekke; Blatter, Birgitte M.; Burdorf, Alex; Bongers, Paulien M.; van der Beek, Allard J.
Objective This study aimed to investigate the relative contribution of health, job characteristics, skills and knowledge, and social and financial factors to the transition from work to (non-disability) early retirement. Methods Employees aged 59-63 years (N=2317) were selected from the Study on
de Wind, A.; Geuskens, G.A.; Ybema, J.F.; Blatter, B.M.; Burdorf, A.; Bongers, P.M.; van der Beek, A.J.
Objective This study aimed to investigate the relative contribution of health, job characteristics, skills and knowledge, and social and financial factors to the transition from work to (non-disability) early retirement. Methods Employees aged 59-63 years (N=2317) were selected from the Study on
Wind, A. de; Geuskens, G.A.; Ybema, J.F.; Blatter, B.M.; Burdorf, A.; Bongers, P.M.; Beek, A.J. van der
Objectives This study aimed to investigate the relative contribution of health, job characteristics, skills and knowledge, and social and financial factors to the transition from work to (non-disability) early retirement. Methods Employees aged 59–63 years (N=2317) were selected from the Study on
Ausín, Berta; Muñoz, Manuel; Castellanos, Miguel A
Loneliness is a risk factor for morbidity as well as mortality. Older people are more vulnerable to feeling alone due to age-associated changes and losses they might experience. This study aimed to analyze sociodemographic, psychosocial, and mental health variables related to loneliness in the elderly. A random sample of 419 people over 65 years old from the Community of Madrid was used. The UCLA Loneliness Scale, the CIDI65+ Diagnostic Interview, and the WHOQOL-BREF Quality of Life Measure were administered. A regression p model was estimated to identify the variables that best predict loneliness associated with old age. Loneliness-associated variables included living alone t(161.41) = 2.07; p social relationships F(4, 405) = 19.50; p anxiety disorder (t(51.11) = 2.19; p loneliness in older people that could be useful in intervention, to minimize harmful conditions that can lead to loneliness in people over 65.
McCord, Gordon C; Liu, Anne; Singh, Prabhjot
To provide cost guidance for developing a locally adaptable and nationally scalable community health worker (CHW) system within primary-health-care systems in sub-Saharan Africa. The yearly costs of training, equipping and deploying CHWs throughout rural sub-Saharan Africa were calculated using data from the literature and from the Millennium Villages Project. Model assumptions were such as to allow national governments to adapt the CHW subsystem to national needs and to deploy an average of 1 CHW per 650 rural inhabitants by 2015. The CHW subsystem described was costed by employing geographic information system (GIS) data on population, urban extents, national and subnational disease prevalence, and unit costs (from the field for wages and commodities). The model is easily replicable and configurable. Countries can adapt it to local prices, wages, population density and disease burdens in different geographic areas. The average annual cost of deploying CHWs to service the entire sub-Saharan African rural population by 2015 would be approximately 2.6 billion (i.e. 2600 million) United States dollars (US$). This sum, to be covered both by national governments and by donor partners, translates into US$ 6.86 per year per inhabitant covered by the CHW subsystem and into US$ 2.72 per year per inhabitant. Alternatively, it would take an annual average of US$ 3750 to train, equip and support each CHW. Comprehensive CHW subsystems can be deployed across sub-Saharan Africa at cost that is modest compared with the projected costs of the primary-health-care system. Given their documented successes, they offer a strong complement to facility-based care in rural African settings.
Moore, Keith; Coddington, Dean; Byrne, Deirdre
There are five reasons that today's economic downturn will have a much broader impact on U.S. health care than did past recessions: This downturn is likely to be more severe and last longer. Healthcare organizations are experiencing problems from several directions simultaneously. Healthcare organizations entered this downturn more heavily leveraged and more vulnerable. This downturn is notjust a recession, but a major realignment for financing practices. As the realignment occurs and the new financing order sorts itself out, healthcare organizations are not likely to receive the favorable treatment they had in the past.
Mendez, Oscar; Cutler, David; Knaul, Felicia; Lozano, Rafael; Zurita, Beatriz
We study the impact of economic crisis on health in Mexico. There have been four wide-scale economic crises in Mexico in the past two decades, the most recent in 1995â€“96. We find that mortality rates for the very young and the elderly increase or decline less rapidly in crisis years as compared with non-crisis years. In the 1995â€“96 crisis, mortality rates were about 5 to 7 percent higher in the crisis years compared to the years just prior to the crisis. This translates into a 0.4 percent...
Harrison, Mark; Milbers, Katherine; Mihic, Tamara; Anis, Aslam H
Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.
Financial Statements and accompanying notes provided on .... to good governance principles. there is the risk that ...... responsibilities of the centre's internal auditor includes reviewing internal controls, including accounting and financial.
Full Text Available Introduction: Osteoporosis is one of the most common musculoskeletal problem and a metabolic bone disorder that normally is without sign and is shown with fragile bone in the absence of prevention and treatment. This study was aimed to determine social variables affected the health belief model in adopting preventive behaviors of osteoporosis. Methods: This descriptive study was carried out on 278 women referring to 6 health Centers of Yazd city with random sampling. Data collection was using a self-reported questionnaire. Data were analyzed by SPSS 16 software including Kruskall Wallis, Dunn Tests, Mann Whitney, Spearman correlation coefficient and regression. Results: Among the osteoporosis preventive behaviors, the most frequency was related to non smoking actions or exposure to cigarette and the lowest frequency was related to regular physical activity during every weeks. According to spearman's correlation coefficient, it was occurred a direct significant correlation between knowledge, perceived benefits, practical guide, self efficacy and preventive behaviors of women. In addition, a reverse significant correlation was occurred between perceived barrier and women's behavior (P<0.001. Overall, variables of the model predicted 0.36 of preventive behavior's variables and finally self-efficacy was the strongest prediction of behavior (P=0.000. Conclusion: according to the results, the presentation of suitable educational program with emphasize on promotion of knowledge and upgrade of HBM's level in addition increasing barriers in the context of diseases such as osteoporosis by staff of health centers is suggested.
Sarazin, Marianne; El Merini, Amine; Staccini, Pascal
In France, medicalization of information systems program (PMSI) is an essential tool for the management planning and funding of health. The performance of encoding data inherent to hospital stays has become a major challenge for health institutions. Some studies have highlighted the impact of organizations set up on encoding quality and financial production. The aim of this study is to evaluate a computerized information system and new staff organization impact for treatment of the encoded information.
1 Abstract/ Financial derivatives The purpose of this thesis is to provide an introduction to financial derivatives which has been, from the legal perspective, described in a not satisfactory manner as quite little literature that can be found about this topic. The main objectives of this thesis are to define the term "financial derivatives" and its particular types and to analyse legal nature of these financial instruments. The last objective is to try to draft future law regulation of finan...
Onoka, Chima A; Onwujekwe, Obinna E; Uzochukwu, Benjamin S; Ezumah, Nkoli N
The National Health Insurance Scheme (NHIS) in Nigeria was launched in 2005 as part of efforts by the federal government to achieve universal coverage using financial risk protection mechanisms. However, only 4% of the population, and mainly federal government employees, are currently covered by health insurance and this is primarily through the Formal Sector Social Health Insurance Programme (FSSHIP) of the NHIS. This study aimed to understand why different state (sub-national) governments decided whether or not to adopt the FSSHIP for their employees. This study used a comparative case study approach. Data were collected through document reviews and 48 in-depth interviews with policy makers, programme managers, health providers, and civil servant leaders. Although the programme's benefits seemed acceptable to state policy makers and the intended beneficiaries (employees), the feasibility of employer contributions, concerns about transparency in the NHIS and the role of states in the FSSHIP, the roles of policy champions such as state governors and resistance by employees to making contributions, all influenced the decision of state governments on adoption. Overall, the power of state governments over state-level health reforms, attributed to the prevailing system of government that allows states to deliberate on certain national-level policies, enhanced by the NHIS legislation that made adoption voluntary, enabled states to adopt or not to adopt the program. The study demonstrates and supports observations that even when the content of a programme is generally acceptable, context, actor roles, and the wider implications of programme design on actor interests can explain decision on policy adoption. Policy implementers involved in scaling-up the NHIS programme need to consider the prevailing contextual factors, and effectively engage policy champions to overcome known challenges in order to encourage adoption by sub-national governments. Policy makers and
The future of healthcare technologies, and what they mean for investors and entrepreneurs The healthcare technology revolution is just around the corner. And when it arrives, it will change and enrich our lives in ways we can only begin to imagine. Doctors will perform blood pressure readings via video chat and nutritionists will analyze diet based on photos taken with cellphone cameras. Transforming Health Care combines healthcare, technology, and finance in an innovative new way that explains the future of healthcare and its effects on patient care, exploring the emergence of electronic tools that will transform the medical industry. Explaining how technology, not politics, will lead the future of the healthcare revolution, author and healthcare technology expert Phil Fasano presents real-life examples that show how the next generation of medical breakthroughs will come from the instant exchange of information across the world Explores how new technologies will radically change the future of healthcare by m...
Full Text Available Abstract Background As a harm reduction strategy in response to HIV epidemics needle and syringes programs (NSPs were initiated throughout China in 2002. The effectiveness of NSPs in reducing the spread of infection in such an established epidemic is unknown. In this study we use data from Yunnan province, the province most affected by HIV in China, to (1 estimate the population benefits in terms of infections prevented due to the programs; (2 calculate the cost-effectiveness of NSPs. Methods We developed a mathematical transmission model, informed by detailed behavioral and program data, which accurately reflected the unique HIV epidemiology among Yunnan injecting drug users (IDUs in the presence of NSPs. We then used the model to estimate the likely epidemiological and clinical outcomes without NSPs and conducted a health economics analysis to determine the cost-effectiveness of the program. Results It is estimated that NSPs in Yunnan have averted approximately 16-20% (5,200-7,500 infections of the expected HIV cases since 2002 and led to gains of 1,300-1,900 DALYs. The total $1.04 million spending on NSPs from 2002 to 2008 has resulted in an estimated cost-saving over this period of $1.38-$1.97 million due to the prevention of HIV and the associated costs of care and management. Conclusion NSPs are not only cost-effective but cost-saving in Yunnan. Significant scale-up of NSPs interventions across China and removal of the societal and political barriers that compromise the effects of NSPs should be a health priority of the Chinese government.
Lewin, Daniel S; Wang, Guanghai; Chen, Yao I; Skora, Elizabeth; Hoehn, Jessica; Baylor, Allison; Wang, Jichuan
Improving sleep health among adolescents is a national health priority and implementing healthy school start times (SSTs) is an important strategy to achieve these goals. This study leveraged the differences in middle school SST in a large district to evaluate associations between SST, sleep health, and academic performance. This cross-sectional study draws data from a county-wide surveillance survey. Participants were three cohorts of eighth graders (n = 26,440). The school district is unique because SST ranged from 7:20 a.m. to 8:10 a.m. Path analysis and probit regression were used to analyze associations between SST and self-report measures of weekday sleep duration, grades, and homework controlling for demographic variables (sex, race, and socioeconomic status). The independent contributions of SST and sleep duration to academic performance were also analyzed. Earlier SST was associated with decreased sleep duration (χ 2 = 173, p academic performance, and academic effort. Path analysis models demonstrated the independent contributions of sleep duration, SST, and variable effects for demographic variables. This is the first study to evaluate the independent contributions of SST and sleep to academic performance in a large sample of middle school students. Deficient sleep was prevalent, and the earliest SST was associated with decrements in sleep and academics. These findings support the prioritization of policy initiatives to implement healthy SST for younger adolescents and highlight the importance of sleep health education disparities among race and gender groups. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Gilson, Nicholas D; Pavey, Toby G; Wright, Olivia Rl; Vandelanotte, Corneel; Duncan, Mitch J; Gomersall, Sjaan; Trost, Stewart G; Brown, Wendy J
Chronic diseases are high in truck drivers and have been linked to work routines that promote inactivity and poor diets. This feasibility study examined the extent to which an m-Health financial incentives program facilitated physical activity and healthy dietary choices in Australian truck drivers. Nineteen men (mean [SD] age = 47.5 [9.8] years; BMI = 31.2 [4.6] kg/m 2 ) completed the 20-week program, and used an activity tracker and smartphone application (Jawbone UP™) to regulate small positive changes in occupational physical activity, and fruit, vegetable, saturated fat and processed/refined sugar food/beverage choices. Measures (baseline, end-program, 2-months follow-up; April-December 2014) were accelerometer-determined proportions of work time spent physically active, and a workday dietary questionnaire. Statistical (repeated measures ANOVA) and thematic (interviews) analyses assessed program impact. Non-significant increases in the mean proportions of work time spent physically active were found at end-program and follow-up (+1%; 7 mins/day). Fruit (p = 0.023) and vegetable (p = 0.024) consumption significantly increased by one serve/day at end-program. Non-significant improvements in saturated fat (5%) and processed/refined sugar (1%) food/beverage choices were found at end-program and follow-up. Overall, 65% (n = 11) of drivers demonstrated positive changes in physical activity, and at least one dietary choice (e.g. saturated fat) at follow-up. Drivers found the financial incentives component of the program to be a less effective facilitator of change than the activity tracker and smartphone application, although this technology was easier to use for monitoring of physical activity than healthy dietary choices. Not all drivers benefitted from the program. However, positive changes for different health behaviours were observed in the majority of participants. Outcomes from this feasibility study inform future intervention development for
Nicholas D. Gilson
Full Text Available Abstract Background Chronic diseases are high in truck drivers and have been linked to work routines that promote inactivity and poor diets. This feasibility study examined the extent to which an m-Health financial incentives program facilitated physical activity and healthy dietary choices in Australian truck drivers. Methods Nineteen men (mean [SD] age = 47.5 [9.8] years; BMI = 31.2 [4.6] kg/m2 completed the 20-week program, and used an activity tracker and smartphone application (Jawbone UP™ to regulate small positive changes in occupational physical activity, and fruit, vegetable, saturated fat and processed/refined sugar food/beverage choices. Measures (baseline, end-program, 2-months follow-up; April–December 2014 were accelerometer-determined proportions of work time spent physically active, and a workday dietary questionnaire. Statistical (repeated measures ANOVA and thematic (interviews analyses assessed program impact. Results Non-significant increases in the mean proportions of work time spent physically active were found at end-program and follow-up (+1%; 7 mins/day. Fruit (p = 0.023 and vegetable (p = 0.024 consumption significantly increased by one serve/day at end-program. Non-significant improvements in saturated fat (5% and processed/refined sugar (1% food/beverage choices were found at end-program and follow-up. Overall, 65% (n = 11 of drivers demonstrated positive changes in physical activity, and at least one dietary choice (e.g. saturated fat at follow-up. Drivers found the financial incentives component of the program to be a less effective facilitator of change than the activity tracker and smartphone application, although this technology was easier to use for monitoring of physical activity than healthy dietary choices. Conclusions Not all drivers benefitted from the program. However, positive changes for different health behaviours were observed in the majority of participants. Outcomes from this
Effect of social mobility in family financial situation and housing tenure on mental health conditions among South Australian adults: results from a population health surveillance system, 2009 to 2011.
Dal Grande, Eleonora; Chittleborough, Catherine R; Wu, Jing; Shi, Zumin; Goldney, Robert D; Taylor, Anne W
To assess the association of socioeconomic position (SEP), measured by family financial situation and housing tenure in childhood and adulthood, with mental health conditions in adulthood. Representative cross-sectional population data were collected using a risk factor surveillance system in South Australia, Australia. Each month, a random sample were selected from the Electronic White Pages. Participants aged 25 years and above (n = 10429) were asked about doctor diagnosed anxiety, stress or depression, suicidal ideation, psychological distress, demographic and socioeconomic factors using Computer Assisted Telephone Interviewing (CATI). Social mobility measures were derived from housing status and perceived financial situation during adulthood and at 10 years of age. The prevalence of psychological distress was 8.1 %, current diagnosed mental health condition was 14.8 % and suicidal ideation was 4.3 %. Upward mobility in family financial situation and housing tenure was experienced by 28.6 % and 19.3 %, of respondents respectively. Downward mobility was experienced by 9.4 % for housing tenure and 11.3 % for family financial situation. In the multivariable analysis, after adjusting for age, sex, childhood family structure and adult education, downward social mobility and stable low SEP (both childhood and adulthood), in terms of both housing tenure and financial situation, were positively associated with all three mental health conditions. People with low SEP in adulthood had poor mental health outcomes regardless of their socioeconomic circumstances in childhood. Policies to improve SEP have the potential to reduce mental health conditions in the population.
Phillips, Janet F
As we are all well aware, health care expenditures in the United States are out of control and growing at epic proportions. Since private industry shoulders a significant burden of paying these rising health care costs, the huge and ever increasing sum paid by these corporations continues to impact the US economy translating into higher prices of services and manufactured goods and reduced job opportunities when companies outsource jobs or locate manufacturing facilities to avoid paying health care benefits for workers. As a result, health care expenditures have become a centerpiece of an enormous public policy debate as Congress is currently working on several versions of a bill to completely revise health care from the ground up. This research project was accomplished to examine the effectiveness of one approach to control rising health care costs and contain corporate financial responsibility--the establishment of wellness and health risk screening programs to improve the health of employees. Total health care cost per insured individual was gathered through an online survey directly from health care benefit administrators. The survey also asked information about wellness and health risk screening programs and the related responses were used to determine if there were a relationship between health care costs and health prevention programs. While statistical analysis was hampered in the current study because of the small sample size, some valid conclusions were reached. The study was successful in identifying a benchmark of Average Total Health Care Cost per Individual from $5,100 to $5,800 for 2005 through 2007. This is especially interesting in light of the fact that an average of $7,026 was spent on health care per person in 2006 in the United States. The study was also able to contribute an estimate of the increase realized in these expenditures of 6 percent in 2007 over 2006, and 4 percent in 2006 over 2005, which were in fact similar to the national average
This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates. Published by Elsevier B.V.
Archuleta, Kristy L.; Dale, Anita; Spann, Scott M.
The impact of financial concerns on overall mental health has become a popular topic among researchers and practitioners. In this exploratory study, possible associations of financial anxiety were explored using a sample of 180 college students who sought services at a university peer financial counseling center in a Midwestern state. Of…
Jagjit Singh Dhaliwal
Full Text Available Background: The literature is replete with reports that pregnant women have an increased level of periodontal disease as compared with non-pregnant women of the same age. There are many studies correlating the effect of periodontal disease on the adverse pregnancy outcomes. The development of periodontal diseases during pregnancy can be influenced by factors such as preexisting oral conditions, general health, and socio-cultural background. There is very little data studying the effect of socio-demographic factors on the periodontal health of pregnant women. This study evaluated the periodontal status of a sample of pregnant women of Chandigarh and adjoining areas. The study also investigated the relationship between these variables and a series of demographic and clinical variables. Materials and Methods: The participants were 190 pregnant women attending Gynecology and Obstetrics outpatient department of Government Medical College and Hospital, Chandigarh. The participants were examined for their periodontal health and various socio-demographic variables were recorded on performas designed for the purpose of study. Statistical analysis was done. Results: The results revealed that the mean bleeding index scores and probing depth increased with statistical significance when the socio-economic status was lower ( P0.1. The plaque index was not significantly associated with the socio-economic status, profession, place of residence, and trimester of pregnancy ( P>0.1. Conclusion: In the population of pregnant women investigated under this study, the clinical and socio-demographic characteristics showed non-significant correlation except socio-economic status which showed statistically significant correlation with bleeding on probing and pocket depth. Further studies may be required in Indian population to determine the association of periodontal diseases in pregnant women with socio-demographic variables.
Stability in financial institutions and in financial markets are closely intertwined. Banks and other financial institutions need liquid markets through which to conduct risk management. And markets need the back-up liquidity lines provided by financial institutions. Market liquidity depends not only on objective, exogenous factors, but also on endogenous market dynamics. Central banks responsible for systemic stability need to consider how far their traditional responsibility for the health ...
Full Text Available The goal of this research is to establish a connection and a mutual influence between the expenditure of funds of the Croatian Health Insurance Fund in Croatia from 2000 to 2014, expenditure per levels of healthcare, and the trend of services provided. This method uses the determination coefficient. Despite the increased spending of the CHIF in Croatia by as much as 80.6% (from 13.4 billion in 2001 to 24.2 billion in 2014, the primary healthcare shares, as well as hospital and polyclinic healthcare shares, have been reduced in the same time period. Contrary to that, expenses for medicaments are rising, as well as the expenses for the ‘other expenses’ group. Primary healthcare (PH, Croatian: Primarna zdravstvena zaštita has significantly reduced price per service. Hospital healthcare (HH, Croatian: Bolnička zdravstvena zaštita has the same number of hospitalizations, but their length has been significantly reduced. In processing the public publication data of the CHIF, the structure of data portrayed has been changing every few years so some data is impossible to track continuously. It is also impossible to understand the reason for such an attitude. PH, HH, and polyclinic advisory healthcare (PAH, Croatian: Poliklinička konzilijarna zdravstvena zaštita are levels with the strongest and most decisive influence on the quality of the healthcare system on the one hand, and they are showing a strong negative trend in expenses with regard to medicaments and other expenses on the other hand.
Penelitian ini bertujuan untuk mengetahui pengaruh langsung yang signifikan dan positif dari job satisfaction terhadap employee engagement, employee engagement terhadap competitive advantage, dan competitive advantage terhadap financial performance, pada Perusahaan retail publik di Surabaya. Penelitian ini berbentuk penelitian kuantitatif, dimana data diperoleh melalui penyebaran kuisioner dan menggunakan rasio analisa laporan keuangan kepada Perusahaan retail publik di Surabaya. Data yang di...
Sayinzoga, Aussi; Bulte, Erwin H.; Lensink, Robert
We organise a field experiment with smallholder farmers in Rwanda to measure the impact of financial literacy training on financial knowledge and behaviour. The training increased financial literacy of participants, changed their savings and borrowing behaviour and had a positive effect on the
Meshefedjian, Garbis A; Leaune, Viviane; Simoneau, Marie-Ève; Drouin, Mylène
Study disparities in lifestyle habits and health characteristics of Canadian born population and immigrants with different duration of residence. Data are extracted from 2009 to 2010 public use micro-data files of Canadian Community Health Survey representing about 1.5 million people. Sixty-one percent of the study sample was born in Canada; 49 % males and 59 % below age 50. Amongst lifestyle habits, recent immigrants were less likely to be regular smokers, RR (95 % CI) 0.56 (0.36-0.88) and frequent consumers of alcohol 0.49 (0.27-0.89), but more likely to consume less fruits and vegetables 1.26 (1.04-1.53) than those born in Canada. Amongst health related factors, recent immigrants were less likely to be overweight 0.79 (0.62-0.99) and suffer from chronic diseases 0.59 (0.44-0.80), but more likely to have limited access to family medicine 1.24 (1.04-1.47) than Canada-born population. Immigration status is an important population characteristic which influenced distribution of health indicators. Prevention and promotion strategies should consider immigration status as an exposure variable in the development and implementation of public health programs.
Okechukwu, Cassandra A; El Ayadi, Alison M; Tamers, Sara L; Sabbath, Erika L; Berkman, Lisa
We evaluated the association of household-level stressors with depressive symptoms among low-wage nursing home employees. Data were collected in 2006 and 2007 from 452 multiethnic primary and nonprimary wage earners in 4 facilities in Massachusetts. We used logistic regression to estimate the association of depressive symptoms with household financial strain, food insufficiency, and work-family spillover (preoccupation with work-related concerns while at home and vice versa). Depressive symptoms were significantly associated with household financial strain (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.03, 3.21) and food insufficiency (OR = 2.10; 95% CI = 1.10, 4.18). Among primary earners, stratified analyses showed that food insufficiency was associated with depressive symptoms (OR = 3.60; 95% CI = 1.42, 9.11) but financial strain was not. Among nonprimary wage earners, depressive symptoms correlated with financial strain (OR = 3.65; 95% CI = 1.48, 9.01) and work-family spillover (OR = 3.22; 95% CI = 1.11, 9.35). Household financial strain, food insufficiency, and work-family spillover are pervasive problems for working populations, but associations vary by primary wage earner status. The prevalence of food insufficiency among full-time employees was striking and might have a detrimental influence on depressive symptoms and the health of working-class families.
Brinkman, Henk-Jan; de Pee, Saskia; Sanogo, Issa; Subran, Ludovic; Bloem, Martin W
A global economic and financial crisis is engulfing the developing world, coming on top of high food and fuel prices. This paper assesses the impact of the crises on food consumption, nutrition, and health. Several methods were applied, including risk analysis using the cost of the food basket, assessment surveys, simulations, regression analysis using a food consumption score (FCS), reflecting diet frequency and diversity, and a review of the impact of such dietary changes on nutritional status and health. The cost of the food basket increased in several countries, forcing households to reduce quality and quantity of food consumed. The FCS, which is a measure of diet diversity, is negatively correlated with food prices. Simulations show that energy consumption declined during 2006-2010 in nearly all developing regions, resulting potentially in an additional 457 million people (of 4.5 billion) at risk of being hungry and many more unable to afford the dietary quality required to perform, develop, and grow well. As a result of the crises, large numbers of vulnerable households have reduced the quality and quantity of foods they consume and are at risk of increased malnutrition. Population groups most affected are those with the highest requirements, including young children, pregnant and lactating women, and the chronically ill (particularly people with HIV/AIDS and tuberculosis). Because undernutrition during the first 2 y of life has life-long consequences, even short-term price rises will have long-term effects. Thus, measures to mitigate the impact of the crises are urgently required.
Valtorta, Nicole K; Hanratty, Barbara
Chronic disease has financial consequences for older adults, but it is unclear how this varies between conditions with different disease trajectories. The aim of this study was to review evidence on the financial burden associated with cancer, heart failure or stroke in older people, to identify those most at risk of financial adversity. We systematically searched nine databases for studies with data on the illness-related financial burden (objective), or on the perception of financial hardship (subjective), of older patients and/or their informal caregivers in high-income countries. We identified thirty-eight papers published in English between 1984 and 2012. Studies fell into three categories: those reporting direct, out of pocket, costs (medical and/or non-medical); studies of the indirect costs associated with illness (such as wage or income loss); and papers reporting general financial or economic burdens secondary to illness. Three out of four studies focused on people with cancer. More affluent people had greater out of pocket costs, but were less financially burdened by illness, compared with older adults from lower socioeconomic backgrounds. Disadvantaged patients and families were more likely to report experiences of financial hardship, and spend a higher proportion of their income on all expenses related to their diagnoses. This review illustrates how little is known about the financial adversity experienced by patients with some common chronic conditions. It raises the possibility that higher expenditure by more affluent older people may be creating inequalities in how chronic illness is experienced. The development of effective strategies for financial protection at older ages will require more information on who is affected and at which point in their illness trajectory. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Enayatollah Homaie Rad
Full Text Available OBJECTIVES The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program’s important goals were to improve the equity of payments and to reduce out-of-pocket (OOP payments and catastrophic health expenditures (CHE. In this study, these goals were evaluated using a before-and-after analysis. METHODS Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated. RESULTS Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%. CONCLUSIONS The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.
Homaie Rad, Enayatollah; Yazdi-Feyzabad, Vahid; Yousefzadeh-Chabok, Shahrokh; Afkar, Abolhasan; Naghibzadeh, Ahmad
The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis. Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated. Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%). The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.
Zimlichman, Eyal; Henderson, Daniel; Tamir, Orly; Franz, Calvin; Song, Peter; Yamin, Cyrus K; Keohane, Carol; Denham, Charles R; Bates, David W
Health care-associated infections (HAIs) account for a large proportion of the harms caused by health care and are associated with high costs. Better evaluation of the costs of these infections could help providers and payers to justify investing in prevention. To estimate costs associated with the most significant and targetable HAIs. For estimation of attributable costs, we conducted a systematic review of the literature using PubMed for the years 1986 through April 2013. For HAI incidence estimates, we used the National Healthcare Safety Network of the Centers for Disease Control and Prevention (CDC). Studies performed outside the United States were excluded. Inclusion criteria included a robust method of comparison using a matched control group or an appropriate regression strategy, generalizable populations typical of inpatient wards and critical care units, methodologic consistency with CDC definitions, and soundness of handling economic outcomes. Three review cycles were completed, with the final iteration carried out from July 2011 to April 2013. Selected publications underwent a secondary review by the research team. Costs, inflated to 2012 US dollars. Using Monte Carlo simulation, we generated point estimates and 95% CIs for attributable costs and length of hospital stay. On a per-case basis, central line-associated bloodstream infections were found to be the most costly HAIs at $45,814 (95% CI, $30,919-$65,245), followed by ventilator-associated pneumonia at $40,144 (95% CI, $36,286-$44,220), surgical site infections at $20,785 (95% CI, $18,902-$22,667), Clostridium difficile infection at $11,285 (95% CI, $9118-$13,574), and catheter-associated urinary tract infections at $896 (95% CI, $603-$1189). The total annual costs for the 5 major infections were $9.8 billion (95% CI, $8.3-$11.5 billion), with surgical site infections contributing the most to overall costs (33.7% of the total), followed by ventilator-associated pneumonia (31.6%), central line
Tsofa, Benjamin; Molyneux, Sassy; Gilson, Lucy; Goodman, Catherine
A common challenge for health sector planning and budgeting has been the misalignment between policies, technical planning and budgetary allocation; and inadequate community involvement in priority setting. Health system decentralisation has often been promoted to address health sector planning and budgeting challenges through promoting community participation, accountability, and technical efficiency in resource management. In 2010, Kenya passed a new constitution that introduced 47 semi-autonomous devolved county governments, and a substantial transfer of responsibility for healthcare from the central government to these counties. This study analysed the effects of this major political decentralization on health sector planning, budgeting and overall financial management at county level. We used a qualitative, case study design focusing on Kilifi County, and were guided by a conceptual framework which drew on decentralisation and policy analysis theories. Qualitative data were collected through document reviews, key informant interviews, and participant and non-participant observations conducted over an eighteen months' period. We found that the implementation of devolution created an opportunity for local level prioritisation and community involvement in health sector planning and budgeting hence increasing opportunities for equity in local level resource allocation. However, this opportunity was not harnessed due to accelerated transfer of functions to counties before county level capacity had been established to undertake the decentralised functions. We also observed some indication of re-centralisation of financial management from health facility to county level. We conclude by arguing that, to enhance the benefits of decentralised health systems, resource allocation, priority setting and financial management functions between central and decentralised units are guided by considerations around decision space, organisational structure and capacity, and
Mendoza-Pérez, Juan Carlos; Ortiz-Hernández, Luis
In this study, we explored the role of sex as an effect-modifying variable in the association between sexual orientation and mental health in Mexican youth. In addition, we tested if violent experiences in the family and the school and attitudes toward homosexuality could act as mediating variables in such association. Data from three representative surveys performed in 2007, 2009, and 2013 among Mexican high school students were analyzed. Two dimensions of sexual orientation were evaluated: romantic partnership and sexual behavior. The outcomes were negative and positive mood, suicidal ideation and intent, self-concept, and self-esteem. There were differences by gender because in males, there were more disparities in mental health associated with sexual orientation (suicidal ideation and attempt, negative and positive mood, negative self-concept, and family-related self-esteem) than in females (suicidal ideation and negative mood). Experiences of school violence were mediators in the relationship between sexual orientation and most health outcomes in males.
Deo J.W. Strümpfer
Full Text Available In an exploratory study on a sample of convenience (n = 165, 11 self-report variables with presumed organisational relevance were related, as predictors, to the three subscores and summed score of the Keyes (2005a, 2005b; 2007 Mental Health Continuum scale (long form. Keyes's scale was administered five to seven days after the first set of scales. The predictor scores were reduced to three factorial scores, labelled positive orientation, negative orientation and positive striving. When classified thus, the predictor variables showed significant and meaningful relationships with some or all of the Keyes subscores and the total score, although few reached medium effect sizes.
van Dongen, J M; Proper, K I; van Wier, M F; van der Beek, A J; Bongers, P M; van Mechelen, W; van Tulder, M W
This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011. Two reviewers independently assessed the risk of bias of included studies. Three metrics were (re-)calculated per study: the net benefits, benefit cost ratio (BCR) and return on investment (ROI). Metrics were averaged, and a post hoc subgroup analysis was performed to compare financial return estimates between study designs. Four randomized controlled trials (RCTs), 13 non-randomized studies (NRSs) and one modelling study were included. Average financial return estimates in terms of absenteeism benefits (NRS: ROI 325%, BCR 4.25; RCT: ROI -49%, BCR 0.51), medical benefits (NRS: ROI 95%, BCR 1.95; RCT: ROI -112%, BCR -0.12) or both (NRS: ROI 387%, BCR 4.87; RCT: ROI -92%, BCR 0.08) were positive in NRSs, but negative in RCTs. Worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity generate financial savings in terms of reduced absenteeism costs, medical costs or both according to NRSs, whereas they do not according to RCTs. Since these programmes are associated with additional types of benefits, conclusions about their overall profitability cannot be made. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.
Van Minh, Hoang; Kim Phuong, Nguyen Thi; Saksena, Priyanka; James, Chris D; Xu, Ke
In Viet Nam, household direct out-of-pocket (OOP) health expenditure as a share of the total health expenditure has been always high, ranging from 50% to 70%. The high share of OOP expenditure has been linked to different inequity problems such as catastrophic health expenditure (households must reduce their expenditure on other necessities) and impoverishment. This paper aims to examine catastrophic and poverty impacts of household out-of-pocket health expenditure in Viet Nam over time and identify socio-economic indicators associated with them. Data used in this research were obtained from a nationally representative household survey, Viet Nam Living Standard Survey 2002, 2004, 2006, 2008 and 2010. The findings revealed that there were problems in health care financing in Viet Nam - many households encountered catastrophic health expenditure and/or were pushed into poverty due to health care payments. The issues were pervasive over time. Catastrophic expenditure and impoverishment problems were more common among the households who had more elderly people and those located in rural areas. Importantly, the financial protection aspect of the national health insurance schemes was still modest. Given these findings, more attention is needed on developing methods of financial protection in Viet Nam. Copyright © 2012 Elsevier Ltd. All rights reserved.
Full Text Available Condition monitoring (CM is used to assess the health status of wind turbines (WT by detecting turbine failure and predicting maintenance needs. However, fluctuating operating conditions cause variations in monitored features, therefore increasing the difficulty of CM, for example, the frequency-domain analysis may lead to an inaccurate or even incorrect prediction when evaluating the health of the WT components. In light of this challenge, this paper proposed a method for the health evaluation of WT components based on vibration signals. The proposed approach aimed to reduce the evaluation error caused by the impact of the variable operating condition. First, the vibration signal was decomposed into a set of sub-signals using variational mode decomposition (VMD. Next, the sub-signal energy and the probability distribution were obtained and normalized. Finally, the concept of entropy was introduced to evaluate the health condition of a monitored object to provide an effective guide for maintenance. In particular, the health evaluation for CM was based on a performance review over a range of operating conditions, rather than at a certain single operating condition. Experimental investigations were performed which verified the efficiency of the evaluation method, as well as a comparison with the previous method.
Jothi, A Lenin
Financial services, particularly banking and insurance services is the prominent sector for the development of a nation. After the liberalisation of financial sector in India, the scope of getting career opportunities has been widened. It is heartening to note that various universities in India have introduced professional courses on banking and insurance. A new field of applied mathematics has come into prominence under the name of Financial Mathematics. Financial mathematics has attained much importance in the recent years because of the role played by mathematical concepts in decision - m
Cumurovic, Aida; Hyll, Walter
In this paper, we study the relationship between financial literacy and self-employment. We use established financial knowledge-based questions to measure financial literacy levels. The analysis shows a highly significant correlation between self-employment and financial literacy scores. To investigate the impact of financial literacy on being self-employed, we apply instrumental variable techniques based on information on economic education before entering the labour market and education of ...
Martire, Kristy A; Mattick, Richard P; Doran, Christopher M; Hall, Wayne D
This paper models the predicted impact of tobacco price increases proposed in the United States and Australia during 2009 on smoking prevalence in 2010 while taking account of the effects of financial stress among smokers on cessation rates. Two models of smoking prevalence were developed for each country. In model 1, prevalence rates were determined by price elasticity estimates. In model 2 price elasticity was moderated by financial stress. Each model was used to estimate smoking prevalence in 2010 in Australia and the United States. Proposed price increases resulted in a 1.89% and 7.84% decrease in smoking participation among low socio-economic status (SES) groups in the United States and Australia, respectively. Model 1 overestimated the number of individuals expected to quit in both the United States (0.13% of smokers) and Australia (0.36% of smokers) by failing to take account of the differential effects of the tax on financially stressed smokers. The proportion of low-income smokers under financial stress increased in both countries in 2010 (by 1.06% in the United States and 3.75% in Australia). The inclusion of financial stress when modelling the impact of price on smoking prevalence suggests that the population health returns of increased cigarette price will diminish over time. As it is likely that the proportion of low-income smokers under financial stress will also increase in 2010, future population-based approaches to reducing smoking will need to address this factor. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.
The Impact of Community Based Health Insurance in Enhancing Better Accessibility and Lowering the Chance of Having Financial Catastrophe Due to Health Service Utilization: A Case Study of Savannakhet Province, Laos.
Bodhisane, Somdeth; Pongpanich, Sathirakorn
The Lao population mostly relies on out-of-pocket expenditures for health care services. This study aims to determine the role of community-based health insurance in making health care services accessible and in preventing financial catastrophe resulting from personal payment for inpatient services. A cross-sectional study design was applied. Data collection involved 126 insured and 126 uninsured households in identical study sites. Two logistic regression models were used to predict and compare the probability of hospitalization and financial catastrophe that occurred in both insured and uninsured households within the previous year. The findings show that insurance status does not significantly improve accessibility and financial protection against catastrophic expenditure. The reason is relatively simple, as catastrophic health expenditure refers to a total out-of-pocket payment equal to or more than 40% of household income minus subsistence. When household income declines as a result of inability to work due to illness, the 40% threshold is quickly reached. Despite this, results suggest that insured households are not significantly better off under community-based health insurance. However, compared to uninsured households, insured households do have better accessibility and a lower probability of reaching the financial catastrophe threshold.
Lisiecka-Biełanowicz, Mira; Biechowska, Daria; Cianciara, Dorota
The main objective of the study was to verify the hypothesis about the high growth rate of expenditure on the provision of mental health in the past few years. High dynamics of the expenditure increase will result in the development of a model of community psychiatry and a gradual move away from the hosp