The impact of different benefit packages of Medical Financial Assistance Scheme on health service utilization of poor population in Rural China

<p>Abstract</p> <p>Background</p> <p>Since 2003 and 2005, National Pilot Medical Financial Assistance Scheme (MFA) has been implemented in rural and urban areas of China to improve the poorest families' accessibility to health services. Local governments of the pilot areas formulated various benefit packages. Comparative evaluation research on the effect of different benefit packages is urgently needed to provide evidence for improving policy-making of MFA. This study was based on a MFA pilot project, which was one component of Health VIII Project conducted in rural China. This article aimed to compare difference in health services utilization of poor families between two benefit package project areas: H8 towns (package covering inpatient service, some designated preventive and curative health services but without out-patient service reimbursement in Health VIII Project,) and H8SP towns (package extending coverage of target population, covering out- patient services and reducing co-payment rate in Health VIII Supportive Project), and to find out major influencing factors on their services utilization.</p> <p>Methods</p> <p>A cross-sectional survey was conducted in 2004, which used stratified cluster sampling method to select poor families who have been enrolled in MFA scheme in rural areas of ChongQing. All family members of the enrolled households were interviewed. 748 and 1129 respondents from two kinds of project towns participated in the survey. Among them, 625 and 869 respondents were included (age≥15) in the analysis of this study. Two-level linear multilevel model and binomial regressions with a log link were used to assess influencing factors on different response variables measuring service utilization.</p> <p>Results</p> <p>In general, there was no statistical significance in physician visits and hospitalizations among all the respondents between the two kinds of benefit package towns. After adjusting for major confounding factors, poor families in H8SP towns had much higher frequency of MFA use (β = 1.17) and less use of hospitalization service (OR = 0.7 (H8SP/H8), 95%CI (0.5, 1.0)) among all the respondents. While calculating use of hospital services among those who needed, there was significant difference (p = 0.032) in percentage of hospitalization use between H8SP towns (46%) and H8 towns (33%). Meanwhile, the non-use but ought-to-use hospitalization ratio of H8SP (54%) was lower than that of H8 (67 %) towns. This indicated that hospitalization utilizations had improved in H8SP towns among those who needed. Awareness of MFA detailed benefit package and presence of physician diagnosed chronic disease had significant association with frequency of MFA use and hospitalizations. There was no significant difference in rate of borrowing money for illness treatment between the two project areas. Large amount of medical debt had strong association with hospitalization utilization.</p> <p>Conclusions</p> <p>The new extended benefit package implemented in pilot towns significantly increased the poor families' accessibility to MFA package in H8SP than that of H8 towns, which reduced poor families' demand of hospitalization services for their chronic diseases, and improved the poor population's utilization of out-patient services to some degree. It can encourage poor people to use more outpatient services thus reduce their hospitalization need. Presence of chronic disease and hospitalization had strong association with the presence of large amount of medical debt, which indicated that: although establishment of MFA had facilitated accessibility of poor families to this new system, and improved service utilization of poor families to some degree, but its role in reducing poor families' medical debt resulted from chronic disease and hospitalization was still very limited. Besides, the following requirements of MFA: co-payment for in-patient services, ceiling and deductibles for reimbursement, limitations on eligibility for diseases reimbursement, also served as most important obstacles for poor families' access to health care.</p> <p>Therefore, there is great need to improve MFA benefit package design in the future, including extending to cover out-patient services, raising ceiling for reimbursement, removing deductibles of MFA, reducing co-payment rate, and integrating MFA with New Rural Cooperative Medical Scheme more closely so as to provide more protection to the poor families.</p

Solving Weighted Least Squares (WLS) problems on ARM-based architectures

TheWeighted Least Squares algorithm (WLS) is applied to numerous optimization problems, but requires the use of high computational resources, especially when complex arithmetic is involved. This work aims to accelerate the resolution of a WLS problem by reducing the computational cost (relaying on BLAS/LAPACK routines) and the computational precision from double to single. As a test case, we design an IIR filter for a Graphic Equalizer, where the numerical errors due to single precision are easily visualized. In addition, given the importance of low power architectures for this kind of implementations, we evaluate the performance, scalability, and energy efficiency of each method on two different processors implementing the ARMv7 architecture, widely used in current mobile devices with power constraints. Results show that the method that exhibits a high theoretical computational cost overcomes in efficiency other methods with lower theoretical cost in architectures of this type.This work started in spring 2016 when Jose A. Belloch was a visiting postdoctoral researcher at Budapest University of Technology and Economics thanks to the European Network COST Action IC1305 inside the program Short Term Scientific Mission with the following reference: COST-SPASM-ECOST-STSM-IC1305-020416-072431. Dr. Jose A. Belloch is supported by GVA contract APOSTD/2016/069. The researchers from Universitat Jaume I are supported by the CICYT projects TIN2014-53495-R of MINECO and FEDER. The authors from the Universitat Politecnica de Valencia are supported by MINECO Projects TEC2015-67387-C4-1-R, PROMETEOII/2014/003 and CAPAP-H5 network TIN2014-53522-REDT. The researcher from UCM is supported by the EU (FEDER) and the Spanish MINECO, under Grants TIN 2015-65277-R and TIN2012-32180. The work of Balazs Bank was supported by the UNKP-16-4-III New National Excellence Program of the Ministry of Human Capacities, Hungary.Belloch Rodríguez, JA.; Bank, B.; Igual Peña, FD.; Quintana Ortí, ES.; Vidal Maciá, AM. (2017). Solving Weighted Least Squares (WLS) problems on ARM-based architectures. Journal of Supercomputing. 73(1):530-542. https://doi.org/10.1007/s11227-016-1910-9S530542731Smith TM, van de Geijn RA, Smelyanskiy M, Hammond JR, Van Zee FG (2014) Anatomy of high-performance many-threaded matrix multiplication. In: 28th IEEE International Parallel and Distributed Processing Symposium (IPDPS 2014)Burrus CS (2012) Iterative reweighted least squares. OpenStax-CNC document, May 2012, module m45285. http://cnx.org/content/m45285/1.12 . Accessed 2 Nov 2016Khang SW (1972) Best $$L_p$$ L p approximation. Math Comput 26(118):505–508Jackson LB (2008) Frequency-domain Steiglitz-McBride method for least-squares filter design, ARMA modeling, and periodogram smoothing. IEEE Signal Process Lett 15:49–52Bank B (2012) Magnitude-priority filter design for audio applications. In: Proceedings of $$132^{{\rm nd}}$$ 132 nd AES Convention, Preprint No. 8591, Budapest, Hungary, May 2012Daubechies I, Devire R, Fornasier M, Gntrk CS (2010) Iteratively reweighted least squares minimization for sparse recovery. Comput Music J 23(2):52–69Rämö J, Välimäki V, Bank B (2014) High-precision parallel graphic equalizer. IEEE/ACM Trans Audio Speech Lange Proc 22(12):1894–1904Perez Gonzales E, Reiss J (2009) Automatic equalization of multi-channel audio using cross-adaptive methods. In: Proceedings of AES 127th Convention, New York, Oct. 2009Rämö J, Välimäki V (2013) Live sound equalization and attenuation with a headset. In: Proceedings of AES 51st International Conference, Helsinki, Finland, Aug. 2013Mäkivirta A, Antsalo P, Karjalainen M, Välimäki V (2003) Modal equalization of loudspeaker-room responses at low frequencies. J Audio Eng Soc 51(5):324–343Holters M, Zölzer U (2006) Graphic equalizer design using higher-order recursive filters. In: Proceedings of International Conference Digital Audio Effects, Montreal, QC, pp 37–40Tassart S (2013) Graphical equalization using interpolated filter banks. J Audio Eng Soc 61(5):263–279Chen Z, Geng GS, Yin FL, Hao J (2014) A pre-distortion based design method for digital audio graphic equalizer. Digital Signal Process 25:296–302Välimäki V, Reiss J (2016) All about audio equalization: solutions and frontiers. Appl Sci 6(5):129–145Belloch JA, Välimäki V (2016) Efficient target-response interpolation for a graphic equalizer. In: 2016 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP), March 2016, pp 564–568Belloch JA, Alventosa FJ, Alonso P, Quintana-Ortí ES, Vidal AM (2016) Accelerating multi-channel filtering of audio signal on arm processors. J Supercomput, pp 1–12. doi: 10.1007/s11227-016-1689-8Belloch JA, Gonzalez A, Igual FD, Mayo R, Quintana-Ortí ES (2015)Vectorization of binaural sound virtualization on the ARM cortex-A15 architecture. In: Proceedings of 23rd European Signal Processing Conference, (EUSIPCO), Nize, France, September 2015Mitra G, Johnston B, Rendell A, McCreath E, Zhou J (2013) Use of simd vector operations to accelerate application code performance on low-powered arm and intel platforms. In: IEEE 27th International Parallel and Distributed Processing Symposium Workshops PhD Forum (IPDPSW), May 2013, pp 1107–1116Tomov S, Dongarra J, Baboulin M (2008) Towards dense linear algebra for hybrid gpu accelerated manycore systems. LAPACK Working Note, Tech. Rep. 210, Oct. 2008. http://www.netlib.org/lapack/lawnspdf/lawn210.pdf . Accessed 2 Nov 2016Dongarra JJ, DuCroz J, Hammarling S, Hanson RJ (1985) A proposal for an extended set of fortran basic linear algebra subprograms. ACM Signum Newsletter, New York, pp 2–18Golub GH, Loan CFV (2013) Matrix Comput, 4th edn. The John Hopkins University Press, BaltimoreAlonso P, Badia RM, Labarta J, Barreda M, Dolz MF, Mayo R, Quintana-Ortí ES, Reyes R (2012) Tools for power-energy modelling and analysis of parallel scientific applications. In: 41st International Conference on Parallel Processing—ICPP, 2012, pp 420–42

A population-based surveillance study on severe acute maternal morbidity (near-miss) and adverse perinatal outcomes in Campinas, Brazil: The Vigimoma Project

BACKGROUND: Auditing of sentinel health events based on best-practice protocols has been recommended. This study describes a population-based investigation on adverse perinatal events including severe acute maternal morbidity (near-miss), maternal and perinatal mortality, as a health intervention to help improve the surveillance system. METHODS: From October to December 2005, all cases of maternal death (MD), near-miss (NM), fetal deaths (FD), and early neonatal deaths (END), occurring in Campinas, Brazil, were audited by maternal mortality committees. RESULTS: A total of 4,491 liveborn infants (LB) and 159 adverse perinatal events (35.4/1000 LB) were revised, consisting of 4 MD (89/100.000 LB) and 95 NM (21.1/1000 LB), 23.7 NM for each MD. In addition, 32 FD (7.1/1000 LB) and 28 END (6.2/1000 LB) occurred. The maternal death/near miss rate was 23.7:1. Some delay in care was recognized for 34%, and hypertensive complications comprised 57.8% of the NM events, followed by postpartum hemorrhage. CONCLUSION: Auditing near miss cases expanded the understanding of the spectrum from maternal morbidity to mortality and the importance of promoting adhesion to clinical protocols among maternal mortality committee members. Hypertensive disorders and postpartum hemorrhage were identified as priority topics for health providers training, and organization of care

Community-based environmental management for malaria control: evidence from a small-scale intervention in Dar es Salaam, Tanzania

Historically, environmental management has brought important achievements in malaria control and overall improvements of health conditions. Currently, however, implementation is often considered not to be cost-effective. A community-based environmental management for malaria control was conducted in Dar es Salaam between 2005 and 2007. After community sensitization, two drains were cleaned followed by maintenance. This paper assessed the impact of the intervention on community awareness, prevalence of malaria infection, and Anopheles larval presence in drains. A survey was conducted in neighbourhoods adjacent to cleaned drains; for comparison, neighbourhoods adjacent to two drains treated with larvicides and two drains under no intervention were also surveyed. Data routinely collected by the Urban Malaria Control Programme were also used. Diverse impacts were evaluated through comparison of means, odds ratios (OR), logistic regression, and time trends calculated by moving averages. Individual awareness of health risks and intervention goals were significantly higher among sensitized neighbourhoods. A reduction in the odds of malaria infection during the post-cleaning period in intervention neighbourhoods was observed when compared to the pre-cleaning period (OR = 0.12, 95% CI 0.05-0.3, p < 0.001). During the post-cleaning period, a higher risk of infection (OR = 1.7, 95% CI 1.1-2.4, p = 0.0069) was observed in neighbourhoods under no intervention compared to intervention ones. Eighteen months after the initial cleaning, one of the drains was still clean due to continued maintenance efforts (it contained no waste materials and the water was flowing at normal velocity). A three-month moving average of the percentage of water habitats in that drain containing pupae and/or Anopheles larvae indicated a decline in larval density. In the other drain, lack of proper resources and local commitment limited success. Although environmental management was historically coordinated by authoritarian/colonial regimes or by industries/corporations, its successful implementation as part of an integrated vector management framework for malaria control under democratic governments can be possible if four conditions are observed: political will and commitment, community sensitization and participation, provision of financial resources for initial cleaning and structural repairs, and inter-sectoral collaboration. Such effort not only is expected to reduce malaria transmission, but has the potential to empower communities, improve health and environmental conditions, and ultimately contribute to poverty alleviation and sustainable development

The effects of spatial population dataset choice on estimates of population at risk of disease

Background: The spatial modeling of infectious disease distributions and dynamics is increasingly being undertaken for health services planning and disease control monitoring, implementation, and evaluation. Where risks are heterogeneous in space or dependent on person-to-person transmission, spatial data on human population distributions are required to estimate infectious disease risks, burdens, and dynamics. Several different modeled human population distribution datasets are available and widely used, but the disparities among them and the implications for enumerating disease burdens and populations at risk have not been considered systematically. Here, we quantify some of these effects using global estimates of populations at risk (PAR) of P. falciparum malaria as an example.Methods: The recent construction of a global map of P. falciparum malaria endemicity enabled the testing of different gridded population datasets for providing estimates of PAR by endemicity class. The estimated population numbers within each class were calculated for each country using four different global gridded human population datasets: GRUMP (~1 km spatial resolution), LandScan (~1 km), UNEP Global Population Databases (~5 km), and GPW3 (~5 km). More detailed assessments of PAR variation and accuracy were conducted for three African countries where census data were available at a higher administrative-unit level than used by any of the four gridded population datasets.Results: The estimates of PAR based on the datasets varied by more than 10 million people for some countries, even accounting for the fact that estimates of population totals made by different agencies are used to correct national totals in these datasets and can vary by more than 5% for many low-income countries. In many cases, these variations in PAR estimates comprised more than 10% of the total national population. The detailed country-level assessments suggested that none of the datasets was consistently more accurate than the others in estimating PAR. The sizes of such differences among modeled human populations were related to variations in the methods, input resolution, and date of the census data underlying each dataset. Data quality varied from country to country within the spatial population datasets.Conclusions: Detailed, highly spatially resolved human population data are an essential resource for planning health service delivery for disease control, for the spatial modeling of epidemics, and for decision-making processes related to public health. However, our results highlight that for the low-income regions of the world where disease burden is greatest, existing datasets display substantial variations in estimated population distributions, resulting in uncertainty in disease assessments that utilize them. Increased efforts are required to gather contemporary and spatially detailed demographic data to reduce this uncertainty, particularly in Africa, and to develop population distribution modeling methods that match the rigor, sophistication, and ability to handle uncertainty of contemporary disease mapping and spread modeling. In the meantime, studies that utilize a particular spatial population dataset need to acknowledge the uncertainties inherent within them and consider how the methods and data that comprise each will affect conclusions. © 2011 Tatem et al; licensee BioMed Central Ltd.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Sframe: An Efficient System for Detailed DC Simulation of Bipolar Analog Integrated Circuits Using Continuation Methods

In this paper we describe an experimental system called sframe which is being incorporated into the design for manufacturability initiative at the Reading Works of AT&T Bell Laboratories. Our system is able to perform detailed and accurate DC analyses of integrated circuits containing several hundred transistors to be fabricated in a relatively complex junction isolated complementary technology

Organizing for impact: International organizations and global pension policy

The internal dynamics and politics of international organizations influence how international policy agendas are set and how effectively they are pursued. International organizations are open systems which respond and adapt to the external policy environment in order to remain relevant to global policymaking. Through an analysis of the internal politics of the World Bank and International Labour Organization, the leading global agenda-setters for pension reform, this article shows that internal political battles and restructuring have a decisive influence on global pensions policy. Appointment of key personnel and internal reorganization can help make certain policy ideas prominent over others. Scholars should pay greater attention to processes of change within international organizations in order to better understand the international agenda setting process