Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries?

In this paper, we focus on those policy instruments with monetary incentives that are used to contain public health expenditure in high-income countries. First, a schematic view of the main cost-containment methods and the variables in the health system they intend to influence is presented. Two types of instruments to control the level and growth of public health expenditure are considered: (i) provider payment methods that influence the price and quantity of health care, and (ii) cost-containment measures that influence the behaviour of patients. Belonging to the first type of instruments, we have: fee-for-service, per diem payment, case payment, capitation, salaries and budgets. The second type of instruments consists of patient charges and reference price systems for pharmaceuticals. Secondly, we provide an overview of experience in high-income countries that use or have used these particular instruments. Finally, the paper assesses the overall potential of these instruments in cost-containment policies

The influence of hydrological regimes on sex ratios and spatial segregation of the sexes in two dioecious riparian shrub species in northern Sweden

River management practices have altered the hydrological regimes of many rivers and also altered the availability of regeneration niches for riparian species. We investigated the impact of changed hydrological regimes on the sex ratios and the Spatial Segregation of the Sexes (SSS) in the dioecious species Salix myrsinifolia Salisb.–phylicifolia L. and S. lapponum L. by studying the free-flowing Vindel River and the regulated Ume River in northern Sweden. We surveyed sex ratios of these species in 12 river reaches on the Vindel River and in 17 reaches on the Ume River. In addition, we surveyed the sex and location above mean river stage of 1,002 individuals across both river systems to investigate the SSS of both species. Cuttings were collected from male and female individuals of S. myrsinifolia–phylicifolia from both rivers and subjected to four different water table regimes in a greenhouse experiment to investigate growth response between the sexes. We found an M/F sex ratio in both river systems similar to the regional norm of 0.62 for S. myrsinifolia–phylicifolia and of 0.42 for S. lapponum. We found no evidence of SSS in either the free-flowing Vindel River or the regulated Ume River. In the greenhouse experiment, hydrological regime had a significant effect on shoot and root dry weight and on root length. Significantly higher shoot dry weights were found in females than in males and significantly different shoot and root dry weights were found between cuttings taken from the two rivers. We concluded that changed hydrological regimes are likely to alter dimensions of the regeneration niche and therefore to influence sex ratios and SSS at an early successional stage, making it difficult to find clear spatial patterns once these species reach maturity and can be sexed

Sandplay, clay and sticks:multi-sensory research methods to explore the long-term influence of childhood play experience on mental well-being.

In this contribution we discuss the advantages of using multi-sensory methodologies in our study into the long-term mental health effects of different kinds of childhood play space. Working with a small group of young people aged 16-21 years old; we used a multi-method approach including practical workshops where the young people took part in a day of woodland activities and artwork sessions. We argue that use of such practical methodologies is particularly appropriate in research with teenagers and young adults, helping to overcome their self-consciousness and supporting their need to explore and articulate memories, feelings and ideas

Conditional cash transfer programmes: the recent experience in Latin America and the Caribbean

Includes BibliographySpanish version available at the LibraryForeword Alicia BárcenaThis document summarizes experience with conditional cash transfer or "co-responsibility" (CCT) programmes in Latin America and the Caribbean, over a period lasting more than 15 years. During this time, CCTs have consolidated and spread through the region's various countries as a tool of choice for poverty-reduction policy. This document, which it is hoped will serve as a basis and input for discussion and progress in building social-protection systems premised on inclusion and universal rights, provides detailed information on the different components of CCTs. It also reviews their main characteristics in terms of the definition and registration of programme users, the targeting mechanisms used, the various types of benefits provided, and the conditionalities attached to them. It then analyses the historical trend of the indicators of CCT investment and coverage, and the information available 8 ECLAC on their effects in different domains. Lastly, it makes an assessment of the experience and the main challenges that these programmes pose in terms of their sustainability, legal framework, accountability, participation, institutionality and inter-sectoral characteristics