Health care expenditure for hospital-based delivery care in Lao PDR

<p>Abstract</p> <p>Background</p> <p>Delivery by a skilled birth attendant (SBA) in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs) in Lao PDR.</p> <p>Methods</p> <p>A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed.</p> <p>Results</p> <p>Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD) than for vaginal delivery (59 USD). After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care.</p> <p>Conclusions</p> <p>Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family incomes were able to pay for more non-medical care expenses. The effect of health insurance on service utilization was noted by women and SBAs. To achieve the goal of utilizing delivery care in the hospitals, coverage of health insurance needs to be expanded.</p

Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care

Background: There is considerable interest in exploring the potential of social health insurance in Africa where a number of countries are currently experimenting with different approaches. Since these schemes have been introduced recently and are continuously evolving, it is important to evaluate their effectiveness in the enhancement of health care utilization and reduction of out-of-pocket expenses for potential policy suggestions.Objective: To investigate how the National Health Insurance Schemes (NHIS) in Ghana affects the utilization of maternal health care services and medical out-of-pocket expenses.Methods: We used nationally-representative household data from the Ghana Demographic and Health Survey (GDHS). We analyzed the 2014 GDHS focusing on four outcome variables, i.e. antenatal check up, delivery in a health facility, delivery assisted by a trained person and out-of-pocket expenditure. We estimated probit and bivariate probit models to take into account the issue of self selection into the health insurance schemes.Results: The results suggest that, also taking into account the issue of self selection into the health insurance schemes, the NHIS enrollment positively affects the probability of formal antenatal check-ups before delivery, the probability of delivery in an institution and the probability of being assisted during delivery by a trained person. On the contrary, we find that, once the issue of self-selection is taken into account, the NHIS enrollment does not have a significant effect on out-of-pocket expenditure at the extensive margin.Conclusion: Since a greater utilization of health-care services has a strong positive effect on the current and future health status of women and their children, the health-care authorities in Ghana should make every effort to extend this coverage. In particular, since the results of the first step of the bivariate probit regressions suggest that the educational attainment of women is a strong determinant of enrollment, and those with low education and unable to read are less likely to enroll, information on the NHIS should be disseminated in ways that reach those with little or no education. Moreover, the availability of government health facilities in a region is associated with higher likelihood of enrollment in the NHIS. Accordingly, extending geographical access is an important strategy for expanding NHIS membership and improving access to health-care

Packages of Care for Alcohol Use Disorders in Low- And Middle-Income Countries

In the fourth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Vivek Benegal and colleagues discuss the treatment of alcohol use disorders

Taxing times: taxation, divided societies and the informal economy in Northern Nigeria

This paper challenges the notion that taxing the informal economy provides a mechanism for increasing popular political voice and rebuilding the social contract. It contends that current arguments for taxing the informal economy suffer from a Eurocentric understanding of taxation and state formation, and a fiscally essentialist and undifferentiated notion of the informal economy. Drawing on fieldwork in northern Nigeria, this paper shows that history, gender, wealth and ethno-religious identity influence how taxing the informal economy shapes governance outcomes. Evidence from Nigeria suggests an inverse relationship between informal economy taxation and political voice, posing the risk that increased taxation will exacerbate social divisions rather than rebuild the social contract

Checking Algorithms for Pure Type Systems

this paper. 1.1 Pure Type System

Explicit Universes for the Calculus of Constructions

The implicit universe hierarchy implemented in proof assistants such as Coq and Lego, although really needed, is painful, both for the implementer and the user: it interacts badly with modularity features, errors are difficult to report and to understand. Moreover, typechecking is quite complex