4 research outputs found
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
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Family therapy for autism spectrum disorders
Background
Autism spectrum disorders (ASDs) are characterised by impairments in communication and reciprocal social interaction. These impairments can impact on relationships with family members, augment stress and frustration, and contribute to behaviours that can be described as challenging. Family members of individuals with ASD can experience high rates of carer stress and burden, and poor parental efficacy. While there is evidence to suggest that individuals with ASD and family members derive benefit from psychological interventions designed to reduce stress and mental health morbidity, and enhance coping, most studies to date have targeted the needs of either individuals with ASD, or family members. We wanted to examine whether family (systemic) therapy, aimed at enhancing communication, relationships or coping, is effective for individuals with ASD and their wider family network.
Objectives
To evaluate the clinical effectiveness and acceptability of family therapy as a treatment to enhance communication or coping for individuals with ASD and their family members. If possible, we will also seek to establish the economic costs associated with family therapy for this clinical population.
Search methods
On 16 January 2017 we searched CENTRAL, MEDLINE, Embase, 10 other databases and three trials registers. We also handsearched reference lists of existing systematic reviews and contacted study authors in the field.
Selection criteria
Randomised controlled trials (RCTs) and quasi-RCTs investigating the effectiveness of family therapy for young people or adults with ASD or family members, or both, delivered via any modality and for an unspecified duration, compared with either standard care, a wait-list control, or an active intervention such as an alternative type of psychological therapy.
Data collection and analysis
Two authors independently screened each title and abstract and all full-text reports retrieved. To enhance rigour, 25% of these were independently screened by a third author.
Main results
The search yielded 4809 records. Of these, we retrieved 37 full-text reports for further scrutiny, which we subsequently excluded as they did not meet the review inclusion criteria, and identified one study awaiting classification.
Authors' conclusions
Few studies have examined the effectiveness of family therapy for ASD, and none of these are RCTs. Further research studies employing methodologically robust trial designs are needed to establish whether family therapy interventions are clinically beneficial for enhancing communication, strengthening relationships, augmenting coping and reducing mental health morbidity for individuals with ASD and family members