IMPLEMENTING HEALTH INSURANCE FOR THE POOR: THE ROLLOUT OF RSBY IN KARNATAKA

The National Health Insurance Scheme (Rashtriya Swasthya Bima Yojana, RSBY) aims to improve poor people's access to quality health care in India. This paper looks at the implementation of the scheme in Karnataka, drawing on a large survey of eligible households and interviews with empanelled hospitals in the state. Six months after initiation, an impressive 85% of eligible households in the sample were aware of the scheme, and 68% had been enrolled. However, the scheme was hardly operational and utilisation was virtually zero. A large proportion of beneficiaries were yet to receive their cards, and many did not know how and where to obtain treatment under the scheme. Moreover, hospitals were not ready to treat RSBY patients. Surveyed hospitals complained of a lack of training and delays in the reimbursement of their expenses. Many were refusing to treat patients under the scheme until the issues were resolved, and others were asking cardholders to pay cash. As is typical for the implementation of a government scheme, many of the problems discussed can be related to a misalignment of incentives.

Motivating knowledge agents : can incentive pay overcome social distance?

This paper studies the interaction of incentive pay and social distance in the dissemination of information. We analyse theoretically as well as empirically the e ect of incentive pay when agents have pro-social objectives, but also preferences over dealing with one social group relative to another. In a randomised eld experiment undertaken across 151 villages in South India, local agents were hired to spread information about a public health insurance programme. Relative to at pay, incentive pay improves knowledge transmission to households that are socially distant from the agent, but not to households similar to the agent

Implementing health insurance for the poor: the rollout of RSBY in Karnataka

The National Health Insurance Scheme (Rashtriya Swasthya Bima Yojana, RSBY) aims to improve poor people’s access to quality health care in India. This paper looks at the implementation of the scheme in Karnataka, drawing on a large survey of eligible households and interviews with empanelled hospitals in the state. Six months after initiation, an impressive 85% of eligible households in the sample were aware of the scheme, and 68% had been enrolled. However, the scheme was hardly operational and utilisation was virtually zero. A large proportion of beneficiaries were yet to receive their cards, and many did not know how and where to obtain treatment under the scheme. Moreover, hospitals were not ready to treat RSBY patients. Surveyed hospitals complained of a lack of training and delays in the reimbursement of their expenses. Many were refusing to treat patients under the scheme until the issues were resolved, and others were asking cardholders to pay cash. As is typical for the implementation of a government scheme, many of the problems discussed can be related to a misalignment of incentives

High sensitivity C-reactive protein levels across spectrum and severity of coronary artery disease

Background: C-reactive protein (CRP) is an acute-phase reactant protein synthesized by the liver in response to acute\ud stress in a wide range of acute and chronic inflammatory conditions. In healthy subjects and patients presenting with\ud coronary artery disease (CAD), elevated levels of CRP has repeatedly been demonstrated to predict future cardiovascular\ud events.\ud Methods: We measured high sensitivity C-reactive protein (hs-CRP) levels in 382 consecutive patients with CAD and 60 healthy controls by immunoturbidimetry method. Risk factors like hypertension, diabetes mellitus, dyslipidaemia,smoking, obesity and family history of premature CAD were assessed.\ud Results: The mean age of patients with CAD was 53.5±11.8 years (303 males) and that of control group was 50.83±8.07(28 males). The patient group had significant higher concentration of mean hs-CRP levels when compared\ud with the healthy control group (1.8±1.9 mg/L vs 0.35±1.1 mg/L, p<0.001). The mean hs-CRP levels of unstable angina\ud (USA) and myocardial infarction (MI) patients was higher than chronic stable angina (CSA) patients (p<0.05). Based\ud on the disease severity, we found a significantly higher hs-CRP levels in patients of triple vessel disease when compared\ud to patients with single vessel disease (p=0.01).\ud Conclusions: Elevated serum hs-CRP levels provide a useful marker for cardiovascular risk which, when combined\ud with traditional risk factors, may help improve global risk prediction. Our study showed a significant contribution of\ud hs-CRP to coronary risk prediction with better discrimination

PRESCRIBING PATTERN OF ANTIHYPERTENSIVE DRUGS BASED ON COMPELLING INDICATIONS WITH HYPERTENSION

Objective: The aim of the study is to assess the various prescribing patterns in hypertension with different compelling indications.Methods: It is a prospective observational study and carried out for a period of 1 y from Feb-2014 to Feb-2015. All the required data was collected from patients through personal interview and prescriptions. The data collected from the participants was entered into Microsoft excel spreadsheet and descriptive statistics were used. The mean and standard deviation (SD) were calculated.Results: A total of 394 hypertensive patients with different comorbidities were included in which 251(63.70%) males and 143(36.29%) females were present with a mean (SD) age of 59.21±1.54. The most commonly reported first three co-morbidities along with hypertension were diabetes mellitus 191 (48.47%), stroke accounts for 57 (14.46%) and coronary artery disease in 32 (8.12%). Monotherapy was given in almost 200 (50.76%) patients and dual drug therapy was indicated in 166 (42.13%) patients, triple therapy was used only in 24 (6.09%) patients in the total sample size. Quadruple therapy is the least preferred combination therapy accounts only in 4 (1.01%) patients.Conclusion: We conclude that calcium channel blockers and angiotensin II receptor blockers were the most commonly prescribed class of drugs either alone or in combination with other class of drugs for effective control of blood pressure patients with different compelling indications. Monotherapy was preferred than combination therapy.Â

Echocardiographic assessment of Left Atrial Appendage function in patients with Mitral Stenosis by Tissue Doppler Velocity Imaging.

Introduction Rheumatic heart disease is one of the commonest cardiac conditions in India in both children and adults, accounting for 30 - 40% of cardiac cases admitted in hospital. Approximately 25% of all patients with rheumatic heart disease have pure or predominant mitral stenosis (MS). Thromboembolism develops in atleast 20% of mitral stenosis patients, at sometime during the course of their disease. Thromboembolism remains an important cause of morbidity and mortality in rheumatic MS. Echocardiography is the widely used method for detecting left atrial and left atrial appendage thrombi. Trans thoracic echocardiography (TTE) is only 50% sensitive in detecting LA and LAA thrombi.Transesophageal echocardiography (TEE) is 99% sensitive and specific in detecting LA and LAA thrombi. Echocardiography when combined with spectral and colour flow Doppler is well established as a safe, non-invasive, and versatile diagnostic modality in cardiology, and is now the predominant technique used for evaluation of left ventricular function and for the assessment and quantification of valvar heart lesions. When combined with physiological or pharmacological stress, echocardiography also enables the identification of reversible myocardial ischaemia and myocardial contractile reserve. However, assessment of regional cardiac dysfunction at rest and during stress remains subjective and semiquantitative, with high interobserver variability. Doppler measurement of myocardial motion,using pulsed wave Doppler, was first proposed in 1989 but this technique allowed realtime visualisation of only a single myocardial segment and its potential was not realised.Only later, with the development of colour flow algorithms to visualise myocardial motion,did the technique begin to gain clinical acceptability. TDI can be performed in pulsed-wave and color modes. Pulsed-wave TDI is used to measure peak myocardial velocities and is particularly well suited to the measurement of long-axis ventricular motion because the longitudinally oriented endocardial fibers are most parallel to the ultrasound beam in the apical views. Because the apex remains relatively stationary throughout the cardiac cycle, mitral annular motion is a good surrogate measure of overall longitudinal left ventricular (LV) contraction and relaxation. AIM OF THE STUDY: The most widely accepted method for assessing the left atrial appendage (LAA) function is the measurement of left atrial appendage late peak emptying velocity (LAAEV) by using pulse wave Doppler (PWD) on Transesophageal echocardiography (TEE) and reduced left atrial appendage late peak emptying velocity represents left atrial appendage dysfunction. The magnitude and pattern of left atrial appendage flow velocities are dependent on acute changes in loading conditions. Left atrial appendage flow velocities may also be affected by left atrial appendage size and morphology which are highly variable. Myocardial velocities obtained by Tissue Doppler imaging (TDI) are less dependent on preload and left atrial appendage (LAA) tissue velocities may help in more accurate risk prediction. CONCLUSION: Left Atrial Appendage function is depressed in patients with mitral stenosis as assessed by Left Atrial Appendage late peak Emptying Velocity and Left Atrial Appendage late peak Systolic velocity. The deterioration of Left Atrial Appendage function is more prominent among patients with Atrial fibrillation and those with embolic events. Left Atrial Appendage late peak Systolic velocity as assessed by Tissue Doppler imaging seems to be more reliable than Left Atrial Appendage late peak Emptying Velocity assessed with Pulse Doppler imaging in assessing Left Atrial Appendage function. Left Atrial Appendage late peak Systolic velocity is a useful parameter in evaluating Left Atrial Appendage function in patients with mitral stenosis

Human α2β1HI CD133+VE epithelial prostate stem cells express low levels of active androgen receptor

Stem cells are thought to be the cell of origin in malignant transformation in many tissues, but their role in human prostate carcinogenesis continues to be debated. One of the conflicts with this model is that cancer stem cells have been described to lack androgen receptor (AR) expression, which is of established importance in prostate cancer initiation and progression. We re-examined the expression patterns of AR within adult prostate epithelial differentiation using an optimised sensitive and specific approach examining transcript, protein and AR regulated gene expression. Highly enriched populations were isolated consisting of stem (α(2)β(1)(HI) CD133(+VE)), transiently amplifying (α(2)β(1)(HI) CD133(-VE)) and terminally differentiated (α(2)β(1)(LOW) CD133(-VE)) cells. AR transcript and protein expression was confirmed in α(2)β(1)(HI) CD133(+VE) and CD133(-VE) progenitor cells. Flow cytometry confirmed that median (±SD) fraction of cells expressing AR were 77% (±6%) in α(2)β(1)(HI) CD133(+VE) stem cells and 68% (±12%) in α(2)β(1)(HI) CD133(-VE) transiently amplifying cells. However, 3-fold lower levels of total AR protein expression (peak and median immunofluorescence) were present in α(2)β(1)(HI) CD133(+VE) stem cells compared with differentiated cells. This finding was confirmed with dual immunostaining of prostate sections for AR and CD133, which again demonstrated low levels of AR within basal CD133(+VE) cells. Activity of the AR was confirmed in prostate progenitor cells by the expression of low levels of the AR regulated genes PSA, KLK2 and TMPRSS2. The confirmation of AR expression in prostate progenitor cells allows integration of the cancer stem cell theory with the established models of prostate cancer initiation based on a functional AR. Further study of specific AR functions in prostate stem and differentiated cells may highlight novel mechanisms of prostate homeostasis and insights into tumourigenesis