Financing for universal health coverage in small island states: Evidence from the Fiji Islands

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. Background: Universal health coverage (UHC) is critical to global poverty alleviation and equity of health systems. Many low-income and middle-income countries, including small island states in the Pacific, have committed to UHC and reforming their health financing systems to better align with UHC goals. This study provides the first comprehensive evidence on equity of the health financing system in Fiji, a small Pacific island state. The health systems of such states are poorly covered in the international literature. Methods: The study employs benefit and financing incidence analyses to evaluate the distribution of health financing benefits and burden across the public and private sectors. Primary data from a cross-sectional survey of 2000 households were used to assess healthcare benefits and secondary data from the 2008–2009 Fiji Household Income and Expenditure Survey to assess health financing contributions. These were analysed by socioeconomic groups to determine the relative benefit and financing incidence across these groups. Findings: The distribution of healthcare benefits in Fiji slightly favours the poor—around 61% of public spending for nursing stations and 26% of spending for government hospital inpatient care were directed to services provided to the poorest 20% of the population. The financing system is significantly progressive with wealthier groups bearing a higher share of the health financing burden. Conclusions: The healthcare system in Fiji achieves a degree of vertical equity in financing, with the poor receiving a higher share of benefits from government health spending and bearing a lower share of the financing burden than wealthier groups

Equity In Health care financing in low-and middle-income countries: A systematic review of evidence from studies using benefit and financing incidence analyses

© 2016 Asante et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction: Health financing reforms in low-and middle-income countries (LMICs) over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA. Methods and Findings: Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA) and/or financing incidence analysis (FIA) as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing. Conclusion: Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance equity. The results overall suggest that there are impediments to making health care more accessible to the poor and this must be addressed if universal health coverage is to be a reality

Advances in structure elucidation of small molecules using mass spectrometry

The structural elucidation of small molecules using mass spectrometry plays an important role in modern life sciences and bioanalytical approaches. This review covers different soft and hard ionization techniques and figures of merit for modern mass spectrometers, such as mass resolving power, mass accuracy, isotopic abundance accuracy, accurate mass multiple-stage MS(n) capability, as well as hybrid mass spectrometric and orthogonal chromatographic approaches. The latter part discusses mass spectral data handling strategies, which includes background and noise subtraction, adduct formation and detection, charge state determination, accurate mass measurements, elemental composition determinations, and complex data-dependent setups with ion maps and ion trees. The importance of mass spectral library search algorithms for tandem mass spectra and multiple-stage MS(n) mass spectra as well as mass spectral tree libraries that combine multiple-stage mass spectra are outlined. The successive chapter discusses mass spectral fragmentation pathways, biotransformation reactions and drug metabolism studies, the mass spectral simulation and generation of in silico mass spectra, expert systems for mass spectral interpretation, and the use of computational chemistry to explain gas-phase phenomena. A single chapter discusses data handling for hyphenated approaches including mass spectral deconvolution for clean mass spectra, cheminformatics approaches and structure retention relationships, and retention index predictions for gas and liquid chromatography. The last section reviews the current state of electronic data sharing of mass spectra and discusses the importance of software development for the advancement of structure elucidation of small molecules

Who benefits from healthcare spending in Cambodia? Evidence for a universal health coverage policy

© 2019 The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. Cambodia's healthcare system has seen significant improvements in the last two decades. Despite this, access to quality care remains problematic, particularly for poor rural Cambodians. The government has committed to universal health coverage (UHC) and is reforming the health financing system to align with this goal. The extent to which the reforms have impacted the poor is not always clear. Using a system-wide approach, this study assesses how benefits from healthcare spending are distributed across socioeconomic groups in Cambodia. Benefit incidence analysis was employed to assess the distribution of benefits from health spending. Primary data on the use of health services and the costs associated with it were collected through a nationally representative cross-sectional survey of 5000 households. Secondary data from the 2012-14 Cambodia National Health Accounts and other official documents were used to estimate the unit costs of services. The results indicate that benefits from health spending at the primary care level in the public sector are distributed in favour of the poor, with about 32% of health centre benefits going to the poorest population quintile. Public hospital outpatient benefits are quite evenly distributed across all wealth quintiles, although the concentration index of -0.058 suggests a moderately pro-poor distribution. Benefits for public hospital inpatient care are substantially pro-poor. The private sector was significantly skewed towards the richest quintile. Relative to health need, the distribution of total benefits in the public sector is pro-poor while the private sector is relatively pro-rich. Looking across the entire health system, health financing in Cambodia appears to benefit the poor more than the rich but a significant proportion of spending remains in the private sector which is largely pro-rich. There is the need for some government regulation of the private sector if Cambodia is to achieve its UHC goals

Direct Experimental Constraints on the Spatial Extent of a Neutrino Wavepacket

International audienceDespite their high relative abundance in our Universe, neutrinos are the least understood fundamental particles of nature. They also provide a unique system to study quantum coherence in fundamental systems due to their extremely weak interaction probabilities. The quantum properties of neutrinos emitted in experimentally relevant sources are virtually unknown and theoretical predictions for the spatial width of neutrino wavepackets vary by many orders of magnitude. In weak nuclear decay, the size of a neutrino wavepacket, $\sigma_{\nu,x}$, is related to the spatial wavefunction of its parent at production. Here, we present the first direct limits of this quantity through a new experimental concept to extract the energy width, $\sigma_{\textrm{N},E}$, of the recoil daughter nucleus emitted in the nuclear electron capture (EC) decay of $^7$Be. The final state in the EC decay process contains a recoiling $^7$Li nucleus and an electron neutrino ($\nu_e$) which are entangled at their creation. The $^7$Li energy spectrum is measured to high precision by directly embedding $^7$Be radioisotopes into a high resolution superconducting tunnel junction that is operated as a cryogenic charge sensitive detector. The lower limit on the spatial coherence of the recoil daughter was found to be $\sigma_{\textrm{N}, x} \geq 6.2$ pm, which implies the system remains in a spatially coherent state much larger than the nuclear scale. Further, this implies a lower limit on the size of a neutrino wavepacket, $\sigma_{\nu,x} \geq 35$ nm, which is more than five orders of magnitude more stringent than the limits from all combined reactor oscillation experiments. These results have wide-reaching implications in several areas including quantum coherence, the nature of spatial localization at sub-atomic scales, interpretation of neutrino physics data, and the potential reach of future large-scale experiments

Direct Experimental Constraints on the Spatial Extent of a Neutrino Wavepacket

International audienceDespite their high relative abundance in our Universe, neutrinos are the least understood fundamental particles of nature. They also provide a unique system to study quantum coherence in fundamental systems due to their extremely weak interaction probabilities. The quantum properties of neutrinos emitted in experimentally relevant sources are virtually unknown and theoretical predictions for the spatial width of neutrino wavepackets vary by many orders of magnitude. In weak nuclear decay, the size of a neutrino wavepacket, $\sigma_{\nu,x}$, is related to the spatial wavefunction of its parent at production. Here, we present the first direct limits of this quantity through a new experimental concept to extract the energy width, $\sigma_{\textrm{N},E}$, of the recoil daughter nucleus emitted in the nuclear electron capture (EC) decay of $^7$Be. The final state in the EC decay process contains a recoiling $^7$Li nucleus and an electron neutrino ($\nu_e$) which are entangled at their creation. The $^7$Li energy spectrum is measured to high precision by directly embedding $^7$Be radioisotopes into a high resolution superconducting tunnel junction that is operated as a cryogenic charge sensitive detector. The lower limit on the spatial coherence of the recoil daughter was found to be $\sigma_{\textrm{N}, x} \geq 6.2$ pm, which implies the system remains in a spatially coherent state much larger than the nuclear scale. Further, this implies a lower limit on the size of a neutrino wavepacket, $\sigma_{\nu,x} \geq 35$ nm, which is more than five orders of magnitude more stringent than the limits from all combined reactor oscillation experiments. These results have wide-reaching implications in several areas including quantum coherence, the nature of spatial localization at sub-atomic scales, interpretation of neutrino physics data, and the potential reach of future large-scale experiments