Equity in health care financing: The case of Malaysia

Background: Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective: The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods: Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results: Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Conclusion: Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help shape health financing strategies for the nation

Character sums for primitive root densities

It follows from the work of Artin and Hooley that, under assumption of the generalized Riemann hypothesis, the density of the set of primes $q$ for which a given non-zero rational number $r$ is a primitive root modulo $q$ can be written as an infinite product $\prod_p \delta_p$ of local factors $\delta_p$ reflecting the degree of the splitting field of $X^p-r$ at the primes $p$, multiplied by a somewhat complicated factor that corrects for the `entanglement' of these splitting fields. We show how the correction factors arising in Artin's original primitive root problem and some of its generalizations can be interpreted as character sums describing the nature of the entanglement. The resulting description in terms of local contributions is so transparent that it greatly facilitates explicit computations, and naturally leads to non-vanishing criteria for the correction factors. The method not only applies in the setting of Galois representations of the multiplicative group underlying Artin's conjecture, but also in the GL$_2$-setting arising for elliptic curves. As an application, we compute the density of the set of primes of cyclic reduction for Serre curves.Comment: 23 pages. This version is to appear in the Mathematical Proceedings of the Cambridge Philosophical Societ

Exploratory Analysis of Highly Heterogeneous Document Collections

We present an effective multifaceted system for exploratory analysis of highly heterogeneous document collections. Our system is based on intelligently tagging individual documents in a purely automated fashion and exploiting these tags in a powerful faceted browsing framework. Tagging strategies employed include both unsupervised and supervised approaches based on machine learning and natural language processing. As one of our key tagging strategies, we introduce the KERA algorithm (Keyword Extraction for Reports and Articles). KERA extracts topic-representative terms from individual documents in a purely unsupervised fashion and is revealed to be significantly more effective than state-of-the-art methods. Finally, we evaluate our system in its ability to help users locate documents pertaining to military critical technologies buried deep in a large heterogeneous sea of information.Comment: 9 pages; KDD 2013: 19th ACM SIGKDD Conference on Knowledge Discovery and Data Minin

Equity in the finance and delivery of health care: some tentative cross-country comparisons

Equity is widely acknowledged to be an important goal in the field of health care. Indeed, McLachlan and Maynard (1982) have gone so far as to suggest that' the vast majority of the population would elect for equity to be the prime consideration' (p. 556)—a view endorsed by Mooney (1986, p. 145). Several researchers have investigated how successful their own country's delivery and/or financing system is in achieving its stated equity goals. In general the strategy of these studies is to compare the current situation with some ideal or 'target* situation. Le Grand (1978), for example, in what has become a classic study in the field, compares the distributions across socio-economic groups of illness and public expenditure on health care in Britain in 1972, and concludes that the National Health Service (NHS) has failed to achieve equity in the delivery of health care

Horizontal equity in the delivery of health care

This paper offers a critical appraisal of the various methods used to date to investigate inequity in the delivery of health care. It concludes that none of the methods used to date is particularly well equipped to provide unbiassed estimates of the extent of inequity. It also concludes that Le Grand's (1978) approach is likely to point towards inequity favouring the rich even when none exists. The paper offers an alternative approach, which builds on the approaches to date but seeks to overcome their deficiencies

A biodegradable polyurethane dermal matrix in reconstruction of free flap donor sites: a pilot study

We have developed a biodegradable temporizing matrix (BTM) capable of supporting secondary split-skin graft-take in animal studies. We report its first long-term implantation and use as a dermal scaffold in humans. This preliminary study assesses its ability to integrate, its ease of delamination, its ability to sustain split-skin graft in complex wounds, the degree of wound contraction, and ultimately the quality of the scar at 1 year postimplantation. Ten patients were recruited, each requiring elective free flap reconstruction. Free flap donor sites created were anterolateral thigh flaps, fibular osseocutaneous flaps, or radial/ulnar forearm (RF/UF) flaps. The BTM was implanted when the flap was detached from its donor site. Dressing changes were performed twice weekly. The time elapsed between implantation and delamination depended on the type of flap and thus the wound bed left. Once integrated, the BTMs were delaminated in theatre, and the surface of the "neodermis" was refreshed by dermabrasion, prior to application of a split-skin graft. The BTM integration occurred in all patients (100% in 6 patients, with 90%, 84%, 76%, and 60% integration in the remainder). Integrated BTM sustained successful graft-take in all patients. Complete take was marred in 2 patients, over areas of BTM that had not integrated and graft application was performed too early. The BTM can be applied into wounds in humans and can integrate, persist in the presence of infection, and sustain split-skin overgrafting, despite the trial group presenting with significant comorbidities.Marcus J.D. Wagstaff, Bradley J. Schmitt, Patrick Coghlan, James P. Finkemeyer, Yugesh Caplash and John E. Greenwoo

Red Light Is Effective in Reducing Nitrate Concentration in Rocket by Increasing Nitrate Reductase Activity, and Contributes to Increased Total Glucosinolates Content

Rocket cultivation is increasing to supply the expanding ready-to-eat market because of its unique taste, but crops are often over fertilized to avoid nitrogen deficiencies. This leads to nitrate accumulation in leaves, and the products of their degradation (nitrites and nitrosamines) have been related to several health problems. Nitrate concentrations in rocket and other leafy vegetables are subject to limits by the EU legislation, yet rocket holds a great nutritional value. Degradation products of glucosinolates (isothiocyanates) have been consistently linked with benefits to human health. We investigated the influence of nitrogen application (1 and 8 mM), species [Eruca sativa (L.) Cav. and Diplotaxis tenuifolia (L.) DC.] and light spectrum (full spectrum, red, blue and red + blue) on the nitrate concentration, nitrate reductase activity and glucosinolate content of rocket grown in a soil-less system. Red light decreased the nitrate concentration with respect to the blue spectrum (4,270 vs. 7,100 mg⋅kg–1 of fresh weight, respectively), but such reduction was influenced by the species and the nitrogen level (significantly higher in D. tenuifolia and with the higher concentration of N). The nitrate reductase activity increased under red light in D. tenuifolia, with the lower N concentration. Rocket is known to contain several health-promoting compounds mainly antioxidants and glucosinolates, as secondary metabolites that act as part of plant defense mechanisms. The total content of glucosinolates was mainly affected by the species (D. tenuifolia showed the highest concentrations). Our results will help growers to tailor light spectra with the aim of reducing nitrate concentration and to remain within EU legislative limits, without any detrimental influence on other qualitative parameters in rocket

Semi-Supervised Data Summarization: Using Spectral Libraries to Improve Hyperspectral Clustering

Hyperspectral imagers produce very large images, with each pixel recorded at hundreds or thousands of different wavelengths. The ability to automatically generate summaries of these data sets enables several important applications, such as quickly browsing through a large image repository or determining the best use of a limited bandwidth link (e.g., determining which images are most critical for full transmission). Clustering algorithms can be used to generate these summaries, but traditional clustering methods make decisions based only on the information contained in the data set. In contrast, we present a new method that additionally leverages existing spectral libraries to identify materials that are likely to be present in the image target area. We find that this approach simultaneously reduces runtime and produces summaries that are more relevant to science goals

TimeSets: temporal sensemaking in intelligence analysis

TimeSets is a temporal data visualization technique designed to reveal insights into event sets, such as all the events linked to one person or organization. In this paper we describe two TimeSets-based visual analytics tools for intelligence analysis. In the first case, TimeSets is integrated with other visual analytics tools to support open-source intelligence analysis with Twitter data, particularly the challenge of finding the right questions to ask. The second case uses TimeSets in a participatory design process with analysts that aims to meet their requirements of uncertainty analysis involving fake news. Lessons learned are potentially beneficial to other application domains

Late Cenozoic diversification of the austral genus <i>Lagenophora</i> (Astereae, Asteraceae)

Lagenophora (Astereae, Asteraceae) has 14 species in New Zealand, Australia, Asia, southern South America, Gough Island and Tristan da Cunha. Phylogenetic relationships in Lagenophora were inferred using nuclear and plastid DNA regions. Reconstruction of spatio-temporal evolution was estimated using parsimony, Bayesian inference and likelihood methods, a Bayesian relaxed molecular clock and ancestral area and habitat reconstructions. Our results support a narrow taxonomic concept of Lagenophora including only a core group of species with one clade diversifying in New Zealand and another in South America. The split between the New Zealand and South American Lagenophora dates from 11.2Mya [6.1-17.4 95% highest posterior density (HPD)]. The inferred ancestral habitats were openings in beech forest and subalpine tussockland. The biogeographical analyses infer a complex ancestral area for Lagenophora involving New Zealand and southern South America. Thus, the estimated divergence times and biogeographical reconstructions provide circumstantial evidence that Antarctica may have served as a corridor for migration until the expansion of the continental ice during the late Cenozoic. The extant distribution of Lagenophora reflects a complex history that could also have involved direct long-distance dispersal across southern oceans.Facultad de Ciencias Naturales y MuseoInstituto de Limnología "Dr. Raúl A. Ringuelet