Waivers and exemptions for health services in developing countries

In response to shortages in public budgets for government health services, many developing countries around the world, have adopted formal, or informal systems of user fees for health care. In most countries, user fee proceeds seldom represent more than 15 percent of total costs in hospitals, and health centers, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial, or full waivers to the poor, often results in inequity in access to medical care. The dilemma, then, is how to make a much needed system of user fees, compatible with the goal of preserving equitable access to services. Different countries have tried different approaches. Those which have carefully designed, and implemented waiver systems (e.g., Thailand and Indonesia) have had much greater success in terms of benefits incidence, than countries that have improvised such systems (Ghana, Kenya, Zimbabwe). Key to the success of a waiver system is its financing. Systems that compensate providers for the revenue forgone from granting exemptions (Thailand, Indonesia, and Cambodia) have been more successful than those who expect the provider to absorb the cost of exemptions (Kenya). Where waiver system exist, performance will improve with the timeliness of the reimbursement. Other success factors include the widespread dissemination among potential beneficiaries, about waiver availability, and procedures; the awarding of financial support to poor patients for non-fee costs of care, such as food and transportation (as in Cambodia); and, the existence of clear criteria for the granting of waivers, thereby reducing confusion, and ambiguity among those responsible for managing the system, and among potential recipients. The review examines various approaches taken by countries, but assessing their relative practical merits is difficult, as the evidence is scattered and mixed.Health Systems Development&Reform,Pharmaceuticals&Pharmacoeconomics,Health Monitoring&Evaluation,Public Sector Economics,Health Economics&Finance

The determinants of hospital costs : an analysis of Ethiopia

The problem of financing health care in poor countries has become increasingly acute. In the context of health financing, hospitals are viewed with skepticism as facilities are not cost-effective in the provision of primary health care services. Given this view, it is increasingly thought that such institutions should become financially independent from government subsidies and find other ways to finance both their recurrent and capital costs. The purpose of this paper is to analyze the determinants of hospital costs in a poor country by conducting a case study using data from Ethiopia. It analyzes the issues of economies of scale and scope in the delivery of hospital based health care services in a poor country. A translog-like cost function specification is used in the analysis. It shows that the number of inpatient days, deliveries and laboratory exams had a positive and statistically significant effect on total cost. A negative and statistically significant coefficient associated with the output interaction term indicated the existence of economies of scope between the number of inpatient days and the number of first outpatient visits. Finally, the number of total beds in a hospital appeared to have a positive and significant independent effect on total hospital cost.Economic Theory&Research,Business Environment,Business in Development,Environmental Economics&Policies,Health Systems Development&Reform

Managing customer relationships through price and service quality

This paper examines the ways in which a service provider's policies on pricing and service level affect the size of its customer base and profitability. The analysis begins with the development of a customer behavior model that uses customer satisfaction and depth of relationship as mediators of the impact of price and service level on profitability. Based on this model of customer behavior, the system is analyzed as a queuing network from which the properties of the aggregate population's behavior are derived. The analysis reveals the counterintuitive result that a policy that involves a decrease in prices or an increase in service level may lead to a smaller customer base. However, this policy may also lead to higher profits. The novelty of this result lies in the explanation of the phenomenon: that when the customer base decreases due to a change in prices or service quality, companies may experience gains in profit that result not from a decrease in costs associated with serving fewer customers but from an increase in revenues resulting from the indirect effects of the lower prices or higher level of service on customer behavior. The application of optimization techniques to the model developed in this paper yields optimality conditions through which managers can assess the long-term profitability of their pricing and service-level policies.Customer relationship management; operations/marketing interface; two-part tariffs; service operations management; service quality;

On Service Level Measures in Stochastic Inventory Control

We consider the issue of modeling service level measures in stochastic decision making via chance constraints. More specifically we focus on service level measures in production/inventory control under stochastic demand and alpha service level constraints, which are constraints enforcing a prescribed non-stockout probability for the system. We introduce multiple ways of expressing these chance constraints by using conditional probability. Then we demonstrate that, when these constraints are formulated by using expressions that do not involve a conditional probability, a base stock policy is optimal for this problem only under a number of assumptions. To demonstrate this, we discuss a number of examples for simple cases in which it is possible to find better policies and we also present some analytical results. In contrast, when our novel measure involving a conditional probability is used. A base stock policy is optimal under much less restrictive assumptions, although the cost performance of the system tends to deteriorate

Coordination of Supply Chain Networks and the Emergence of Mini-maestros

Abstract Companies recognize international sourcing as a business practice useful to reduce product prices, deal with supply shortages and identify new competitive suppliers. Effective international sourcing implies the integration and coordination of materials, processes, information flows and multiple producers at each buying location. Many companies do not have the capabilities or the willingness to develop and manage such sourcing networks; therefore, other entities have assumed these responsibilities. These coordinators are in charge of the integration of many suppliers to develop full-package production, serve as liaisons between suppliers’ capabilities and market demands, and provide the technical and financial support to sustain the sourcing network. The review of the industrial clustering and global supply chain literature allowed the identification of such coordinators in Mexico. The emergence and profile of these coordinators is associated with corporate strategies of multinational firms, the efforts of industrial groups, and the governmental policies for the development of dynamic industrial regions. This paper analyzes the characteristics of four coordination models identified in the Mexican context, focusing on their contribution to the participation and upgrading of national suppliers. The profile of the coordinator firm, the type of relations that this firm sustains with producers and the support offered to suppliers is also discussed. A particular emphasis is given to the fourth model where a third party, a knowledge and service company, assumes the coordinator role. The interest on this model is due to its novelty, the flexibility of the sourcing network, and the potential impact on regional development that could result from the intervention of a neutral third party as coordinator of the activities of multiple local and specialized suppliers

Duality Based Characterizations of Efficient Facets

Most practical applications of multicriteria decision making can be formulated in terms of efficient points determined by preference cones with polyhedral closure. Using linear approximations and duality from mathematical programming, we characterize a family of supporting hyperplanes that define the efficient facets of a set of alternatives with respect to such preference cones. We show that a subset of these hyperplanes generate maximal efficient facets. These characterizations permit us to devise a new algorithm for generating all maximal efficient facets of multicriteria optimization problems with polyhedral structure.Supported in part by the National Science Foundation grant MCS77-24654. Supported in part by the Army Research Office (Durham) contract DAAG29-76-C-0064

Multiplicity of nuclear dust lanes and dust lane shocks in the Milky Way bar

Aims: We show the existence of a small family of inner-galaxy dust lanes and dust lane standing shocks beyond the two major ones that were previously known to exist Methods: We analyze images of CO emission in the inner regions of the Galaxy Results: The peculiar kinematics of the major dust lane features are repeated in several other distinct instances at l > 0deg, in one case at a contrary location 100 pc above the galactic equator at l > 3degr at the upper extremity of Clump 2. Like the previously-known dust lanes, these new examples are alsoassociated with localized, exceptionally broad line profiles believed to be characteristic of the shredding of neutral gas at the standing dust lane shocks. Conclusions: There may be secondary dust lane and standing shocks in the Milky Way bulge. The vertical structure provides a temporal sequence for understanding the secular evolution of gas flow in the bar

Anamorphic Fractional Fourier Transforming--Optical Implementation and Applications

Cataloged from PDF version of article.An additional degree of freedom is introduced to fractional-Fourier-transform systems by use of anamorphic optics. A different fractional Fourier order along the orthogonal principal directions is performed. A laboratory experimental system shows preliminary results that demonstrate the proposed theory. Applications such as anamorphic fractional correlation and multiplexing in fractional domains are briefly suggested. (C) 1995 Optical Society of Americ

Chirp filtering in the fractional Fourier Domain

Cataloged from PDF version of article.In the Wigner domain of a one-dimensional function, a certain chirp term represents a rotated line delta function. On the other hand, a fractional Fourier transform (FRT) can be associated with a rotation of the Wigner-distribution function by an angle connected with the FRT order. Thus with the FRT tool a chirp and a delta function can be transformed one into the other. Taking the chirp as additive noise, the FRT is used for filtering the line delta function in the appropriate fractional Fourier domain. Experimental filtering results for a Gaussian input function, which is modulated by an additive chirp noise, are shown. Excellent agreement between experiments and computer simulations is achieved