An Investigation of the Pay-As-You-Go Financing Method Using a Contingency Fund and Optimal Control Techniques

In many countries, aging populations are expected to lead to substantial rises in the cost of public pension systems financed by the pay-as-you-go (PAYGO) method. These systems will need to be adapted to cope with these changes. This paper considers one approach to reform, described in the literature as “parametric” (see, e.g., Disney 2000), and develops a model for adapting the PAYGO method using a contingency fund and optimal control techniques. The solution of the original model is investigated within two different frameworks: a deterministic-continuous one and a stochastic-discrete one. Finally, a case study applied to Greece is discussed, leading to a potentially acceptable proposal of a smooth path for contribution rates and the age of eligibility for the normal retirement pension

Advances in oral health knowledge of Greek navy recruits and their socioeconomic determinants

BACKGROUND: The aim of the present study was to evaluate temporal changes on oral health knowledge and attitudes among two populations of young Greek males (age 19–29 years) undergoing their military training. A secondary aim was to identify socioeconomic trends that may have influenced the above. METHODS: A total of 2,764 healthy subjects (1511 in 1985, and 1253 in 1996) answered a standardized questionnaire of oral health issues. Respondents were stratified in 3 groups, according to their educational status (ES); their responses were compared using the chi-square statistic. The evaluation of socioeconomic indicators utilized longitudinal data from the national Household Expenditures Survey. RESULTS: An overall improvement was noted in the majority of "Knowledge" and "Attitudes" variables in 1996, as compared to 1985. Education seems to play an important role in both knowledge and attitudes. These changes may also be partially attributed to a shift in consuming standards from the coverage of main needs to income disposal directed towards the achievement of better quality of life

Health System Support for Childbirth care in Southern Tanzania: Results from a Health Facility Census.

Progress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth offered at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth. Health centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2--3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months. Essential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries have both low staffing and low caseload which constraints the ability to provide high-quality childbirth care. Improvements in quality of care are essential so that women delivering in facility receive "skilled attendance" and adequate care for common obstetric complications such as post-partum haemorrhage

Distorted policy transfer? South Korea’s adaptation of UK social enterprise policy

This study draws upon communicative processes in policy transfer to consider the ways in which policy may be adapted to context or distorted. The theoretical framework is used to investigate exactly what the South Korean government borrowed from UK social enterprise policy. Despite claims that the UK was the source of both the general policy direction and the particular regulatory device, the Korean government did not learn about the specific contexts of the British policy, nor attempt two-way communication with domestic stakeholders. Rather, the UK policy was interpreted in accordance with the Korean government’s own ideas about how to utilize social enterprise. Historical legacies of top-down decision-making played an important role in this process, as did the state’s role as a regulator which mobilizes the private sector to achieve policy goals. The consequences have been negative for those organizations refused social enterprise status under the Ministry of Labor’s strict approval system, as well as for the original target population: the socially disadvantaged and vulnerable. It is suggested that the model advanced may help to illuminate the reasons why some borrowed policies differ considerably from the originals, and the use of policy transfer as a means of legitimizatio

Determinants of self-rated health in women: a population-based study in Armavir Marz, Armenia, 2001 & 2004

<p>Abstract</p> <p>Background</p> <p>The former soviet Republic of Armenia entered a turbulent and long-lasting economic transition when it declared its independence in 1991. This analysis sought to identify the determinants of poor self-rated health as an indirect measure of health status and mortality prognosis in an adult female population during a period of socio-economic transition in Armenia.</p> <p>Methods</p> <p>Differences in self-rated health in women respondents were analyzed along three main dimensions: social, behavioral/attitudinal, and psychological. The data used were generated from cross-sectional household health surveys conducted in Armavir <it>marz </it>in 2001 and 2004. The surveys utilized the same instruments and study design (probability proportional to size, multistage cluster sampling with a combination of interviewer-administered and self-administered surveys) and generated two independent samples of households representative of Armavir <it>marz</it>. Binary logistic regression models with self-rated health as the outcome were fitted to the 2001 and 2004 datasets and a combined 2001/2004 dataset.</p> <p>Results</p> <p>Overall, 2 038 women aged 18 and over participated in the two surveys (1 019 in each). The rate of perceived "poor" health was relatively high in both surveys: 38.1% in 2001 and 27.0% in 2004. The sets of independent predictors of poor self-rated health were similar in all three models and included severe and moderate material deprivation, probable and possible depression, low level of education, and having ever smoked. These predictors mediated the effect of women's economic activity (including unemployment), ethnicity, low access to/utilization of healthcare services, and living alone on self-rated health.</p> <p>Conclusion</p> <p>Material deprivation was the most influential predictor of self-rated health. Thus, social reforms to decrease the gap between the rich and poor are recommended as a powerful tool for reducing health inequalities and improving the health status of the population.</p

Preterm cranial ultrasound scanning is both feasible and effective in a middle-income country

© 2016 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.Aim Cranial ultrasound is seldom used in middle-income countries, and the burden of preterm brain injury and its relationship to perinatal data is unknown. We assessed cranial ultrasound abnormalities in very low-birthweight (VLBW) infants and correlated the findings with perinatal data. Methods VLBW Armenian infants receiving neonatal intensive care in 2012 were scanned from birth to term-equivalent age (TEA). Clinical data were collected prospectively. Results We studied 100 VLBW infants with a median gestation of 30 weeks. Periventricular white matter echogenicity (PVE) lasting more than two weeks was seen in 34 infants, grade III intraventricular haemorrhage (IVH) in 10, haemorrhagic parenchymal infarction (HPI) in seven and cystic periventricular leukomalacia in two. Caudothalamic notch echogenicity appeared in 36 infants after two to three weeks, with cystic transformation in 22. At TEA, 17 infants had persisting PVEs and 55 had increased basal ganglia/thalamic (BGT) echogenicity. Lack of antenatal steroids was significantly associated with IVH and HPI and intubation at birth with IVH. Late BGT echogenicity was generally seen in infants without perinatal problems. Conclusion Our study demonstrated that cranial ultrasound can be used effectively in a middle-income country to identify high-risk infants and monitor quality of care

Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model

Background models projecting future disease burden have focussed on one or two diseases. Little is known on how risk factors of younger cohorts will play out in the future burden of multi-morbidity (two or more concurrent long-term conditions). Design a dynamic microsimulation model, the Population Ageing and Care Simulation (PACSim) model, simulates the characteristics (sociodemographic factors, health behaviours, chronic diseases and geriatric conditions) of individuals over the period 2014–2040. Population about 303,589 individuals aged 35 years and over (a 1% random sample of the 2014 England population) created from Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II. Main outcome measures the prevalence of, numbers with, and years lived with, chronic diseases, geriatric conditions and multi-morbidity. Results between 2015 and 2035, multi-morbidity prevalence is estimated to increase, the proportion with 4+ diseases almost doubling (2015:9.8%; 2035:17.0%) and two-thirds of those with 4+ diseases will have mental ill-health (dementia, depression, cognitive impairment no dementia). Multi-morbidity prevalence in incoming cohorts aged 65–74 years will rise (2015:45.7%; 2035:52.8%). Life expectancy gains (men 3.6 years, women: 2.9 years) will be spent mostly with 4+ diseases (men: 2.4 years, 65.9%; women: 2.5 years, 85.2%), resulting from increased prevalence of rather than longer survival with multi-morbidity. Conclusions our findings indicate that over the next 20 years there will be an expansion of morbidity, particularly complex multi-morbidity (4+ diseases). We advocate for a new focus on prevention of, and appropriate and efficient service provision for those with, complex multi-morbidity