Health Programme Evaluation by Propensity Score Matching: Accounting for Treatment Intensity and Health Externalities with an Application to Brazil

Most of the literature on health programme evaluation has estimated average programme impacts relying on either: (i) data on the presence or absence of an intervention in a particular locality, or (ii) data on individual participation in the health programme. By estimating an average health impact which is independent of the programmes population coverage, the empirical approaches of these studies overlook the important fact that public health interventions create externalities whose magnitude depends crucially on the number of covered individuals in a locality. The lain contributions of this paper are to suggest and apply an empirical approach for the impact evaluation of public health interventions which also takes into account treatment externalities, when non-experimental, routine data are available and under the assumption of average treatment effects by a propensity score matching-difference-in-differences estimator adapted to the case of multiple treatments, jointly evaluating the impact of different programme coverage levels. The methods are used to conduct an impact evaluation of the Family Health Programme (Programa Saude da Familia PSF), the broadest health programme ever launched in Brazil, on adult and child health. --health programme evaluation,multiple treatments,propensity score matching,Brazil

Europe and Central Asia's great post-communist social health insurance experiment : impacts on health sector and labor market outcomes

The post-communist transition to social health insurance in many of the Central and Eastern European and Central Asian countries provides a unique opportunity to try to answer some of the unresolved issues in the debate over the relative merits of social health insurance and tax-financed health systems. This paper employs a regression-based generalization of the difference-in-differences method and instrumental variables on panel data from 28 countries for the period 1990-2004. The authors find that, controlling for any concurrent provider payment reforms, adoption of social health insurance increased national health spending and hospital activity rates, but did not lead to better health outcomes. The authors also find that adoption of social health insurance reduced employment in the economy as a whole and increased unemployment, although it did not apparently increase the size of the informal economy.Health Monitoring&Evaluation,Health Systems Development&Reform,Population Policies,Health Economics&Finance,Disease Control&Prevention

System-wide impacts of hospital payment reforms : evidence from central and eastern Europe and central Asia

Although there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian countries shifted from paying hospitals through historical budgets to fee-for-service or patient-based-payment methods (mostly variants of diagnosis-related groups). Using panel data on 28 countries over the period 1990-2004, the authors of this study exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. They use a regression version of difference-in-differences and two variants that relax the difference-in-differences parallel trends assumption. The results show that fee-for-service and patient-based-payment methods both increased national health spending, including private (out-of-pocket) spending. However, they had different effects on inpatient admissions (fee-for-service increased them; patient-based-payment had no effect), and average length of stay (fee-for-service had no effect; patient-based-payment reduced it). Of the two methods, only patient-based-payment appears to have had any beneficial effect on"amenable mortality,"but there were significant impacts for only a couple of causes of death, and not in all model specifications.Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Health Law,Population Policies

Death by Market Power. Reform, Competition and Patient Outcomes in the National Health Service

The effect of competition on the quality of health care remains a contested issue. Most empirical estimates rely on inference from non experimental data. In contrast, this paper exploits a pro-competitive policy reform to provide estimates of the impact of competition on hospital outcomes. The English government introduced a policy in 2006 to promote competition between hospitals. Patients were given choice of location for hospital care and provided information on the quality and timeliness of care. Prices, previously negotiated between buyer and seller, were set centrally under a DRG type system. Using this policy to implement a difference-in-differences research design we estimate the impact of the introduction of competition on not only clinical outcomes but also productivity and expenditure. Our data set is large, containing information on approximately 68,000 discharges per year per hospital from 160 hospitals. We find that the effect of competition is to save lives without raising costs. Patients discharged from hospitals located in markets where competition was more feasible were less likely to die, had shorter length of stay and were treated at the same cost.competition, hospitals, quality

Multi-modal joint embedding for fashion product retrieval

© 20xx IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.Finding a product in the fashion world can be a daunting task. Everyday, e-commerce sites are updating with thousands of images and their associated metadata (textual information), deepening the problem, akin to finding a needle in a haystack. In this paper, we leverage both the images and textual meta-data and propose a joint multi-modal embedding that maps both the text and images into a common latent space. Distances in the latent space correspond to similarity between products, allowing us to effectively perform retrieval in this latent space, which is both efficient and accurate. We train this embedding using large-scale real world e-commerce data by both minimizing the similarity between related products and using auxiliary classification networks to that encourage the embedding to have semantic meaning. We compare against existing approaches and show significant improvements in retrieval tasks on a large-scale e-commerce dataset. We also provide an analysis of the different metadata.Peer ReviewedPostprint (author's final draft

BCA2/Rabring7 Targets HIV-1 Gag for Lysosomal Degradation in a Tetherin-Independent Manner

BCA2 (Rabring7, RNF115 or ZNF364) is a RING-finger E3 ubiquitin ligase that was identified as a co-factor in the restriction imposed by tetherin/BST2 on HIV-1. Contrary to the current model, in which BCA2 lacks antiviral activity in the absence of tetherin, we found that BCA2 possesses tetherin-independent antiviral activity. Here we show that the N-terminus of BCA2 physically interacts with the Matrix region of HIV-1 and other retroviral Gag proteins and promotes their ubiquitination, redistribution to endo-lysosomal compartments and, ultimately, lysosomal degradation. The targeted depletion of BCA2 in tetherin-expressing and tetherin-deficient cells results in a significant increase in virus release and replication, indicating that endogenous BCA2 possesses antiviral activity. Therefore, these results indicate that BCA2 functions as an antiviral factor that targets HIV-1 Gag for degradation, impairing virus assembly and release

Towards improved measurement of financial protection in health

Christopher Millett and colleagues argue that new metrics are needed to better inform policy development on financial protection in health