High Out-Of-Pocket Medical Spending Among the Poor and Elderly in Nine Developed Countries

Objective: The design of health insurance, and the role out-of-pocket (OOP) payments play in it, is a key policy issue as rising health costs have encouraged greater cost-sharing measures. This paper compares the percentage of Americans spending large amounts OOP to meet their health needs with percentages in eight other developed countries. By disaggregating by age and income, the paper focuses on the poor and elderly populations within each. Data Source: The study uses nationally representative household survey data made available through the Luxembourg Income Study. It includes nations with high, medium, and low levels of OOP spending. Study Design: Households have high medical spending when their OOP expenditures exceed a threshold share of income. I calculate the share of each nation\u27s population, as well as subpopulations within it, with high OOP expenditures. Principal Findings: The United States is not alone in exposing large numbers of citizens to high OOP expenses. In six of the other eight countries, one-quarter or more of low-income citizens devoted at least 5 percent of their income to OOP expenses, and in all but two countries, more than 1 in 10 elderly citizens had high medical expenses. Conclusions: For some populations in the sample nations, health insurance does not provide adequate financial protection and likely contributes to inequities in health care delivery and outcomes. © Health Research and Educational Trus

The political role of service delivery in state-building: Exploring the relevance of European history for developing countries

Concerns about failed and fragile states have put state- and nation-building firmly on the academic and policy agenda, but the crucial role of public services in this process has remained underexplored. The 1960s and '70s generated a substantial set of literature that is largely missing from current writing. It identified state penetration, standardisation and accommodation as key processes in the state- and nation-building sequence. This article analyses these three processes in Western Europe in the seventeenth to nineteenth centuries, and the role of public services therein, to explore how they may help us to understand the success and failure of state- and nation-building in developing countries and fragile states. © The Authors 2011. Development Policy Revie

Multi-donor trust funds and fragile states: assessing the aid effectiveness of the Zimbabwe multi-donor trust fund

It is widely acknowledged that multi-donor trust funds (MDTFs) contribute to aid effectiveness. This paper challenges this assertion through assessing the aid effectiveness of the Zimbabwe Multi-Donor Trust Fund. The paper makes four key arguments. First, political relations between recipient and donor countries are vital in the functioning of MDTFs. Second, the design of MDTFs affects the delivery and functioning of the trust fund. Third, whilst the legitimacy of national governments in fragile states is often contested, targeting legitimate and credible institutions can offer tangible and life changing results. Fourth, MDTFs focusing on the recovery of key sectors such as water, sanitation and energy have direct impacts to economic recovery and people’s lives

Reading, metacognition, and motivation: A follow-up study of German students in Grades 7 and 8

This follow-up study to van Kraayenoord and Schneider (1999) examined the performance in reading, metacognition and motivation related to reading of students in Grades 7 and 8. Results showed significant correlations between all of the variables. A multivariate analysis of variance showed that good and poor readers differed in reading self-concept and metacognitive measures related to reading and memory. A stepwise regression analysis suggested that the metacognitive variables were the best predictors of reading. Furthermore, a comparison of the results of the previous study with those of the current investigation revealed that the findings were stable over time. Since the period between the two studies is the time during which students make important decisions related to enrolment in one of three distinct school-types in Germany, we examined the results of various groups of students: those in Gymnasium (high educational track), Realschule (middle educational track), and Hauptschule (low educational track). Students in the Gymnasium scored significantly better than students in the other two groups on almost all variables related to reading. A re-analysis of the data from our first investigation found that the results of the Gymnasium students in the second study could be predicted from their results obtained during elementary school