Expansion of health insurance in Moldova and associated improvements in access and reductions in direct payments

Background Moldova is the poorest country in Europe. Economic constraints mean that Moldova faces challenges in protecting individuals from excessive costs, improving population health and securing health system sustainability. The Moldovan government has introduced a state benefit package and expanded health insurance coverage to reduce the burden of healthcare costs for citizens. This study examines the effects of expanded health insurance by examining factors associated with health insurance coverage, likelihood of incurring out-of-pocket (OOP) payments for medicines or services, and the likelihood of forgoing healthcare when unwell. Methods Using publically available databases and the annual Moldova Household Budgetary Survey, we examine trends in health system financing, healthcare utilisation, health insurance coverage, and costs incurred by individuals for the years 2006-2012. We perform logistic regression to assess the likelihood of having health insurance, incurring a cost for healthcare, and forgoing healthcare when ill, controlling for socio-economic and demographic covariates. Findings Private expenditure accounted for 55.5% of total health expenditures in 2012. 83.2% of private health expenditures is OOP payments – especially for medicines. Healthcare utilisation is inline with EU averages of 6.93 outpatient visits per person. Being uninsured is associated with groups of those aged 25-49 years, the self-employed, unpaid family workers, and the unemployed, although we find lower likelihood of being uninsured for some of these groups over time. Overtime, the likelihood of OOP for medicines increased (OR=1.422 in 2012 compared to 2006), but fell for healthcare services (OR=0.873 in 2012 compared to 2006). No insurance and being older and male, was associated with increased likelihood of forgoing healthcare when sick, but we found the likelihood of forgoing healthcare to be increasing over time (OR=1.295 in 2012 compared to 2009). Interpretation Moldova has achieved improvements in health insurance coverage with reductions in OOP for services, which are modest but are eroded by increasing likelihood of OOP for medicines. Insurance coverage was an important determinant for healthcare costs incurred by patients and patients forgoing healthcare. Improvements notwithstanding, there is an unfinished agenda of attaining universal health coverage in Moldova to protect individuals from healthcare costs

Factors determining patients’ intentions to use point-of-care testing medical devices for self-monitoring: The case of international normalised ratio self-testing

This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. - Copyright @ 2012 Dove Medical Press LtdThis article has been made available through the Brunel Open Access Publishing Fund.Purpose: To identify factors that determine patients' intentions to use point-of-care medical devices, ie, portable coagulometer devices for self-testing of the international normalized ratio (INR) required for ongoing monitoring of blood-coagulation intensity among patients on long-term oral anticoagulation therapy with vitamin K antagonists, eg, warfarin. Methods: A cross-sectional study that applied the technology-acceptance model through a self-completed questionnaire, which was administered to a convenience sample of 125 outpatients attending outpatient anticoagulation services at a district general hospital in London, UK. Data were analyzed using descriptive statistics, factor analyses, and structural equation modeling. Results: The participants were mainly male (64%) and aged ≥ 71 years (60%). All these patients were attending the hospital outpatient anticoagulation clinic for INR testing; only two patients were currently using INR self-testing, 84% of patients had no knowledge about INR self-testing using a portable coagulometer device, and 96% of patients were never offered the option of the INR self-testing. A significant structural equation model explaining 79% of the variance in patients’ intentions to use INR self-testing was observed. The significant predictors that directly affected patients' intention to use INR self-testing were the perception of technology (β = 0.92, P < 0.001), trust in doctor (β = −0.24, P = 0.028), and affordability (β = 0.15, P = 0.016). In addition, the perception of technology was significantly affected by trust in doctor (β = 0.43, P = 0.002), age (β = −0.32, P < 0.001), and affordability (β = 0.23, P = 0.013); thereby, the intention to use INR self-testing was indirectly affected by trust in doctor (β = 0.40), age (β = −0.29), and affordability (β = 0.21) via the perception of technology. Conclusion: Patients’ intentions to use portable coagulometers for INR self-testing are affected by patients' perceptions about the INR testing device, the cost of device, trust in doctors/clinicians, and the age of the patient, which need to be considered prior to any intervention involving INR self-testing by patients. Manufacturers should focus on increasing the affordability of INR testing devices for patients’ self-testing and on the potential role of medical practitioners in supporting use of these medical devices as patients move from hospital to home testing.This study is funded by the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) program (EPSRC grant EP/GO12393/1)

Thermal Conductivity of Single Wall Carbon Nanotubes: Diameter and Annealing Dependence

The thermal conductivity, k(T), of bulk single-wall carbon nanotubes (SWNT's) displays a linear temperature dependence at low T that has been attributed to 1D quantization of phonons. To explore this issue further, we have measured the k(T) of samples with varying average tube diameters. We observe linear k(T) up to higher temperatures in samples with smaller diameters, in agreement with a quantization picture. In addition, we have examined the effect of annealing on k(T). We observe an enhancement in k(T) for annealed samples which we attribute to healing of defects and removal of impurities. These measurements demonstrate how the thermal properties of an SWNT material can be controlled by manipulating its intrinsic nanoscale properties.Comment: Proc. of the XV. Int. Winterschool on Electronic Properties of Novel Materials, Kirchberg/Tirol, Austria, 200

Algebraic entropy for algebraic maps

We propose an extension of the concept of algebraic entropy, as introduced by Bellon and Viallet for rational maps, to algebraic maps (or correspondences) of a certain kind. The corresponding entropy is an index of the complexity of the map. The definition inherits the basic properties from the definition of entropy for rational maps. We give an example with positive entropy, as well as two examples taken from the theory of Backlund transformations

Thermal transport measurements of individual multiwalled nanotubes

The thermal conductivity and thermoelectric power of a single carbon nanotube were measured using a microfabricated suspended device. The observed thermal conductivity is more than 3000 W/K m at room temperature, which is two orders of magnitude higher than the estimation from previous experiments that used macroscopic mat samples. The temperature dependence of the thermal conductivity of nanotubes exhibits a peak at 320 K due to the onset of Umklapp phonon scattering. The measured thermoelectric power shows linear temperature dependence with a value of 80 $\mu$V/K at room temperature.Comment: 4 pages, figures include

Extending twin support vector machine classifier for multi-category classification problems

© 2013 – IOS Press and the authors. All rights reservedTwin support vector machine classifier (TWSVM) was proposed by Jayadeva et al., which was used for binary classification problems. TWSVM not only overcomes the difficulties in handling the problem of exemplar unbalance in binary classification problems, but also it is four times faster in training a classifier than classical support vector machines. This paper proposes one-versus-all twin support vector machine classifiers (OVA-TWSVM) for multi-category classification problems by utilizing the strengths of TWSVM. OVA-TWSVM extends TWSVM to solve k-category classification problems by developing k TWSVM where in the ith TWSVM, we only solve the Quadratic Programming Problems (QPPs) for the ith class, and get the ith nonparallel hyperplane corresponding to the ith class data. OVA-TWSVM uses the well known one-versus-all (OVA) approach to construct a corresponding twin support vector machine classifier. We analyze the efficiency of the OVA-TWSVM theoretically, and perform experiments to test its efficiency on both synthetic data sets and several benchmark data sets from the UCI machine learning repository. Both the theoretical analysis and experimental results demonstrate that OVA-TWSVM can outperform the traditional OVA-SVMs classifier. Further experimental comparisons with other multiclass classifiers demonstrated that comparable performance could be achieved.This work is supported in part by the grant of the Fundamental Research Funds for the Central Universities of GK201102007 in PR China, and is also supported by Natural Science Basis Research Plan in Shaanxi Province of China (Program No.2010JM3004), and is at the same time supported by Chinese Academy of Sciences under the Innovative Group Overseas Partnership Grant as well as Natural Science Foundation of China Major International Joint Research Project (NO.71110107026)