Improving the economic value of photographic screening for optical coherence tomography-detectable macular oedema : a prospective, multicentre, UK study

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Municipal service delivery: the role of transaction costs in the choice between alternative governance mechanisms

Service provision by local governments can be delivered using in-house bureaucracies, private firms, and partnerships with other governments or the not-for-profit sector. This production decision has been a major focus of discussion among scholars, practitioners and political agents for the last quarter of a century. The transaction costs framework is an important tool to analyse decisions regarding the production of local services. In this paper, the authors employ this framework to analyse service delivery in Portugal and find that service characteristics and the local political environment play a key role in local officials’ choice among the three governance mechanisms to deliver public service

Diarrhea, Pneumonia, and Infectious Disease Mortality in Children Aged 5 to 14 Years in India

Background: Little is known about the causes of death in children in India after age five years. The objective of this study is to provide the first ever direct national and sub-national estimates of infectious disease mortality in Indian children aged 5 to 14 years. Methods: A verbal autopsy based assessment of 3 855 deaths is children aged 5 to 14 years from a nationally representative survey of deaths occurring in 2001–03 in 1?1 million homes in India. Results: Infectious diseases accounted for 58 % of all deaths among children aged 5 to 14 years. About 18 % of deaths were due to diarrheal diseases, 10 % due to pneumonia, 8 % due to central nervous system infections, 4 % due to measles, and 12 % due to other infectious diseases. Nationally, in 2005 about 59 000 and 34 000 children aged 5 to 14 years died from diarrheal diseases and pneumonia, corresponding to mortality of 24?1 and 13?9 per 100 000 respectively. Mortality was nearly 50 % higher in girls than in boys for both diarrheal diseases and pneumonia. Conclusions: Approximately 60 % of all deaths in this age group are due to infectious diseases and nearly half of these deaths are due to diarrheal diseases and pneumonia. Mortality in this age group from infectious diseases, and diarrhea i

Health Outcomes and Policy in India

After reviewing health outcomes and policy in India, this chapter concludes that there are at least six sets of issues to be addressed with regard to improving the quantity and quality of health services, and ipso facto improving health outcomes, in India. First, the amount of resources earmarked for health needs to increase. Second, health resources need to be used in a fair and just manner and, in particular, complaints relating to egregious health outcomes need to be addressed. Predominant in this set of issues is oversight and regulation of private sector health provision. The third set of issues relates to the allocation of health resources and, in particular, to the imbalance in the allocation of health resources between towns and villages. A fourth issue is the accessibility of rural areas since it is the most remote areas that have the lowest density of health workers. Another issue is the more efficient use of health workers in order to make them more productive. Finally, Indian health policy is stronger on rhetoric and aspiration than it is on action and implementation. The successful implementation of policy requires the explicit recognition that objectives are often competing (primary versus tertiary care) and the acknowledgement that, with budgetary constraints, one cannot have more of one without having less of the other. The first role of policy is to then choose the optimal mix of objectives with respect to these trade-offs. Secondly, policies come up against vested interests which agitate (often with the support of opposition politicians) and litigate against proposed changes. Lastly, policies in India are made against a background of poor governance with the predatory presence of corruption looming over every policy initiative. In implementing, rather than simply articulating, policy it is important to address these governance issue