Enrollment in community based health insurance schemes in rural Bihar and Uttar Pradesh, India

This paper assesses insurance uptake in three community based health insurance (CBHI) schemes located in rural parts of two of India’s poorest states and offered through women’s self-help groups (SHGs). We examine what drives uptake, the degree of inclusive practices of the schemes, and the influence of health status on enrollment. The most important finding is that a household’s socio-economic status does not appear to substantially inhibit uptake. In some cases Scheduled Caste/ Scheduled Tribe (SC/ST) households are more likely to enroll. Second, households with greater financial liabilities find insurance more attractive. Third, access to the hospital insurance scheme (RSBY) does not dampen CBHI uptake, suggesting that the potential for greater development of insurance markets and products beyond existing ones would respond to a need. Fourth, recent episodes of illness and selfassessed health status do not influence uptake. Fifth, insurance coverage is prioritized within households, with the household head, the spouse of the household head and both male and female children of the household head, more likely to be insured as compared to other relatives. Sixth, offering insurance through women’s SHGs appears to mitigate concerns about the inclusiveness and sustainability of CBHI schemes. Given the pan-Indian spread of SHGs, offering insurance through such groups offers the potential to scale-up CBHI

Renewing membership in three community-based health insurance schemes in rural India

Low renewal rate is a key challenge facing the sustainability of Community-based Health Insurance (CBHI) schemes. While there is a large literature on initial enrolment into such schemes, there is limited evidence on the factors that impede renewal. This paper uses longitudinal data to analyse what determines renewal, both one and two years after the introduction of three CBHI schemes, which have been operating in rural Bihar and Uttar Pradesh since 2011. We find that initial scheme uptake is about 23-24 % and that two years after scheme operation, only about 20 % of the initial enrolees maintain their membership. A household’s socio-economic status does not seem to play a large role in impeding renewal. In some instances, a greater understanding of the scheme boosts renewal. The link between health status and use of health care in maintaining renewal is mixed. The clearest effect is that individuals living in households that have received benefits from the scheme are substantially more likely to renew their contracts. We find that having access to a national health insurance scheme is not a substitute for the CBHI. We conclude that the low retention rates may be attributed to limited benefit packages, slow claims processing times and the gaps between the amounts claimed and amounts paid out by insurance

The effect of consensus on demand for voluntary micro health insurance in rural India

Introduction: This study deals with examining factors that catalyze demand for community-based micro health insurance (MHI) schemes. We hypothesize that demand for health insurance is a collective decision in the context of informality and poverty. Our hypothesis challenges the classical theory of demand which posits individual expected diminishing utility. We examine factors beyond the traditional exogenous variables. Methods: This study uses data collected through a household survey conducted among self-h

Evidence for Reflected Light from the Most Eccentric Exoplanet Known

This is an author-created, un-copyedited version of an article published in The Astrophysical Journal. IOP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at https://doi.org/10.3847/0004-637X/821/1/65.Planets in highly eccentric orbits form a class of objects not seen within our solar system. The most extreme case known among these objects is the planet orbiting HD20782, with an orbital period of 597days and an eccentricity of 0.96. Here we present new data and analysis for this system as part of the Transit Ephemeris Refinement and Monitoring Survey. We obtained CHIRON spectra to perform an independent estimation of the fundamental stellar parameters. New radial velocities from Anglo-Australian Telescope and PARAS observations during periastron passage greatly improve our knowledge of the eccentric nature of the orbit. The combined analysis of our Keplerian orbital and Hipparcos astrometry show that the inclination of the planetary orbit is >1.22, ruling out stellar masses for the companion. Our long-term robotic photometry show that the star is extremely stable over long timescales. Photometric monitoring of the star during predicted transit and periastron times using Microvariability and Oscillations of STars rule out a transit of the planet and reveal evidence of phase variations during periastron. These possible photometric phase variations may be caused by reflected light from the planet’s atmosphere and the dramatic change in star–planet separation surrounding the periastron passage.Peer reviewedFinal Accepted Versio

Evidence for reflected light from the most eccentric exoplanet known

Planets in highly eccentric orbits form a class of objects not seen within our Solar System. The most extreme case known amongst these objects is the planet orbiting HD 20782, with an orbital period of 597 days and an eccentricity of 0.96. Here we present new data and analysis for this system as part of the Transit Ephemeris Refinement and Monitoring Survey (TERMS). We obtained CHIRON spectra to perform an independent estimation of the fundamental stellar parameters. New radial velocities from AAT and PARAS observations during periastron passage greatly improve the our knowledge of the eccentric nature of the orbit. The combined analysis of our Keplerian orbital and Hipparcos astrometry show that the inclination of the planetary orbit is > 1.25 degrees, ruling out stellar masses for the companion. Our long-term robotic photometry show that the star is extremely stable over long timescales. Photometric monitoring of the star during predicted transit and periastron times using MOST rule out a transit of the planet and reveal evidence of phase variations during periastron. These possible photometric phase variations are likely caused by reflected light from the planet's atmosphere and the dramatic change in star--planet separation surrounding the periastron passage

The role of the mammalian DNA end-processing enzyme polynucleotide kinase 3'-phosphatase in spinocerebellar ataxia Type 3 pathogenesis

DNA strand-breaks (SBs) with non-ligatable ends are generated by ionizing radiation, oxidative stress, various chemotherapeutic agents, and also as base excision repair (BER) intermediates. Several neurological diseases have already been identified as being due to a deficiency in DNA end-processing activities. Two common dirty ends, 3'-P and 5'-OH, are processed by mammalian polynucleotide kinase 3'-phosphatase (PNKP), a bifunctional enzyme with 3'-phosphatase and 5'-kinase activities. We have made the unexpected observation that PNKP stably associates with Ataxin-3 (ATXN3), a polyglutamine repeat-containing protein mutated in spinocerebellar ataxia type 3 (SCA3), also known as Machado-Joseph Disease (MJD). This disease is one of the most common dominantly inherited ataxias worldwide; the defect in SCA3 is due to CAG repeat expansion (from the normal 14-41 to 55-82 repeats) in the ATXN3 coding region. However, how the expanded form gains its toxic function is still not clearly understood. Here we report that purified wild-type (WT) ATXN3 stimulates, and by contrast the mutant form specifically inhibits, PNKP's 3' phosphatase activity in vitro. ATXN3-deficient cells also show decreased PNKP activity. Furthermore, transgenic mice conditionally expressing the pathological form of human ATXN3 also showed decreased 3'-phosphatase activity of PNKP, mostly in the deep cerebellar nuclei, one of the most affected regions in MJD patients' brain. Finally, long amplicon quantitative PCR analysis of human MJD patients' brain samples showed a significant accumulation of DNA strand breaks. Our results thus indicate that the accumulation of DNA strand breaks due to functional deficiency of PNKP is etiologically linked to the pathogenesis of SCA3/MJD.This research was supported by USPHS grant NS073976 (TKH) and P30 ES 06676 that support the NIEHS Center Cell Biology Core and Molecular Genomics Core of UTMB’s NIEHS Center for DNA sequencing. TKP is supported by CA129537 and CA154320. This work was also supported by Fundação para a Ciência e Tecnologia through the project [PTDC/SAU-GMG/101572/2008] and through fellowships [SFRH/BPD/91562/2012 to ASF, SFRH/BD/51059/2010 to ANC]. IB is supported by NIEHS R01 ES018948 and NIAID/AI06288

Impact of community-based health insurance in rural India on self-medication & financial protection of the insured

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 States 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

Evidence for Reflected Light From the Most Eccentric Exoplanet Known

Planets in highly eccentric orbits form a class of objects not seen within our solar system. The most extreme case known among these objects is the planet orbiting HD 20782, with an orbital period of 597 days and an eccentricity of 0.96. Here we present new data and analysis for this system as part of the Transit Ephemeris Refinement and Monitoring Survey. We obtained CHIRON spectra to perform an independent estimation of the fundamental stellar parameters. New radial velocities from Anglo-Australian Telescope and PARAS observations during periastron passage greatly improve our knowledge of the eccentric nature of the orbit. The combined analysis of our Keplerian orbital and Hipparcos astrometry show that the inclination of the planetary orbit is $\gt 1\_\_AMP\_\_fdg;22$, ruling out stellar masses for the companion. Our long-term robotic photometry show that the star is extremely stable over long timescales. Photometric monitoring of the star during predicted transit and periastron times using Microvariability and Oscillations of STars rule out a transit of the planet and reveal evidence of phase variations during periastron. These possible photometric phase variations may be caused by reflected light from the planet\u27s atmosphere and the dramatic change in star–planet separation surrounding the periastron passage