Determining the impacts of hospital cost-sharing on the uninsured near-poor households in Vietnam

Objectives: The study objective was to identify the size of different hospital financing sources for different hospital services and their impact on the uninsured. Methods: A panel dataset of 84 public general hospitals (2005–2008) with cross-section data on hospital activity and hospital revenue was created and used to calculate unit costs of different hospital services by applying multiple regression models. The resulting risk of catastrophic health expenditure (CHE) was estimated based on official income statistics. Results: Average user fees (UF) for outpatient visits and inpatient bed days were US$4.13 and US$20.27, while actual full costs (AFC) were US$8.41 and US$36.66, respectively. These unit costs were 2.5 times higher in hospitals at the central versus the provincial level. UF for surgical inpatient bed days were 3.6 times that of non-surgical treatments (US$47.50 vs. 12.87) and AFC 5.0 times (US$101.72 vs. 20.08). UF accounted for 44.6%-77.9% of the AFC, the rest (22.1%-55.4%) was provided by direct government support (DGS). One surgical inpatient treatment at either central or provincial hospital level and one non-surgical inpatient treatment at central hospital level, immediately pushed uninsured near-poor households at risk of CHE. Conclusions: Around 45% of hospital AFC was paid by DGS, the larger rest by UF. UF have become a great financial burden on the uninsured near-poor households, who have to pay for these out-of-pocket and therefore may not utilize even necessary services. If the rate of DGS were reduced, this would have the effect of increasing UF, but the savings to Government could be spent on subsidizing insurance to ensure that a larger part of the population can cover UF through insurance, especially the near-poor households

Evaluation Of Allelopathic Potential Of Cissus sicyoides Against the Growth Of Echinochloa Crus-Galli And Some Tested Plants

Many plant species in nature exert significant allelopathic potential as part of the defense mechanism system, many among their secondary metabolites (allelochemicals), including mineral constituents, which are responsible for the suppression of weeds and enhancing crop yield when directly incorporated into paddy fields. Cissus sicyoides is considered a high-potential allelopathic plant because of its invasion in nature and detected allelochemicals from the plant parts in some studies. The objective of this research was to exploit the allelopathic properties of C.sicyoides against paddy weeds and some indicator plants under laboratory bioassays and greenhouse conditions. The results demonstrated that C. sicyoides had significant inhibition on E. crus-galli, tested plants, and other paddy weeds. In the laboratory conditions, the extracts from C.sicyoides leaves inhibited the growth of Echinochloa crus-galli by 54.3%. The powders from C.sicyoides leaves inhibited the emergence of paddy weeds by approximately 100.0%. In the greenhouse conditions, the powders from C.sicyoides leaves by adding after 3 and 13 days inhibited the growth of E. crus-galli and the emergence of paddy weeds by 64.4%. Remarkably, negligible harmful effects on rice growth were observed. The findings of the study may provide useful information for the exploitation of this plant species to effectively control weeds in the rice fields for sustainable agriculture production

Determinants of Access to Credit by the Small Business at Binh Thuy District, Can Tho City, Vietnam

This paper investigates the “Determinants of households’ business access to bank credit in Binh Thuy district, Can Tho city” which is performed by using the method of directly interviewing 240 business households in 8 wards in Binh Thuy district. By using the Logistics models, the finding show that the access to credit by small business households are significantly affected by education level of householders, capital of household businesses, collateral and income of businesses household. In addition, based on given results, possible solutions to improve the access to credit for business households at Binh Thuy district, Can Tho city have been considered

Exploring Italian Consumers’ Willingness to Pay for Sustainable Fashion: The Roles of Eco-Consciousness and Vintage Preference

Studying the psychology behind the purchase of eco-friendly products and second-hand items can offer valuable insights to promote sustainable consumer behavior. This paper examines factors influencing Italian consumers’ willingness to pay regarding bio-based clothing and second-hand items. Drawing from data collected from 402 Italian participants, we examine how motivations and socio-demographic factors are associated with willingness to pay in the context of sustainable fashion. Our findings reveal that motivations related to environmental concerns are positively associated with consumers’ willingness to pay higher premiums for bio-based clothing. Higher income and education levels are also associated with the willingness to pay higher premiums. Meanwhile, motivation related to vintage appeal is associated with lower desired discounts for second-hand items, particularly among older consumers. Gender differences also influence discount preferences, with men seeking larger discounts on second-hand clothing compared to women. By providing insights into Italian consumers’ sustainable fashion choices, this study offers implications for businesses, policymakers, and researchers aiming to promote eco-conscious consumption and sustainability in the fashion industry

Effect of Silica Nanoparticles on Properties of Coatings Based on Acrylic Emulsion Resin

Effect of nanosilica size on physic-mechanical properties, thermal stability and weathering durability of coating based on acrylic emulsion. Nanocomposite coating formulas were filled by 2 wt.% nanosilica particles which were used in this study, namely: nanosilica from Sigma (15-20nm), nansilica from rice husk (~70-200 nm) and nanosilica from Arosil – Belgium (7-12 nm). Obtained results showed that viscosity flow of coating formula containing nanosilica from Arosil saw the highest flow-time while coating formulas filled other nanosilica and unfilled nanosilica experienced similar flow-time. In presence of nanosilica, coating properties were improved in comparison with neat coating. However, coating filled by nanosilica from rice husk indicated the best properties in studied coating formula. It may explained that size of nanosilica from rice husk was the largest in studied nanosilica particles and thus easily dispersing into coating formula

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

Vergleich der kosteneffektivität von neuen medizinischen Technologien zwischen einem Industrie- (Deustchland) und einem Entwicklungs- bzw. Swellenland (Vietnam)

Hintergrund: Die rasante Beschleunigung der Medizintechnik-Entwicklung trägt erheblich zum Erfolg der Leistungsfähigkeit der Gesundheitsdienste bei, waseine Qualitätsverbesserung für die Bevölkerung zur Folge hat. Auf der anderen Seite wird heute mehr als die Hälfte des gesamten Wachstums der Behandlungskosten durch den Kostenanstieg dieser neuen Technologien verursacht. Die Einführung neuer Gesundheitstechnologien (NHT) ist daher eindeutig ein vielschichtiger Prozess. Dieser Prozess verläufttypischerweise zwischen einkommensstarken Ländern und Ländern niedriger mittlerer Einkommensstufe sehr unterschiedlich, da die Verbreitung neuer Gesundheitstechnologien in letzteren geringer ist und verzögert stattfindet. Der Bedarf derBevölkerungwird deswegen nie völlig gedeckt. Der Vergleich zwischen der schon lange etablierten chirurgischen Resektion (SR) und der neuerenstereotaktischen Radiochirurgie (SRS) bei der Behandlung von Hirnmetastasen ist ein Beispiel dafür. Stereotaktische Radiochirurgie wird in Industrieländern schon seit längerer Zeit als die kostengünstigere Option angewendet. In Entwicklungsländern hingegen wird gerade erst damit begonnen, stereotaktische Radiochirurgie durchzuführen, und es mangelt noch immer an evidenzbasierten Technologiebewertungen SRS und SR vergleichend. Generell sind Gesundheitstechnologiebewertungen und Kosteneffektivitätsanalysen in einkommensstarken Ländern relativ gut etabliert. Dagegen ist in Ländern der niedrigen oder niedrigen mittleren Einkommensstufe nur wenig darüber bekannt.Methodologische Leitlinien fehlen, die die Übertragung von Wirtschaftlichkeitsanalysen länderübergreifend ermöglichten. Daher stellt sich die Frage, ob stereotaktische Radiochirurgiein Ländern der niedrigen mittleren Einkommensstufe tatsächlich wirtschaftlicher ist als chirurgische Resektion.Zu beantworten wäre ferner welche Faktoren die Unterschiede der Wirtschaftlichkeit der hier genannten Ländergruppensystematisch bestimmen. Hauptziel: Hauptziel der Arbeit war die Wirtschaftlichkeit einer neuen, krankenhausbasierten Gesundheitstechnologiein einem Land der niedrigen mittleren Einkommensstufe (Vietnam) mit der eines einkommensstarken Landes (Deutschland) zu vergleichen. Zu diesem Zweck wurden zwei Behandlungsstrategien von Hirnmetastasen (SRS und SR) in Vietnam verglichen. SpezifischeZiele: (1) Die Analyse der Wirtschaftlichkeit von SRS und SR bei der Behandlung von Hirnmetastasen in Vietnam und Deutschland aus der Perspektive der Krankenversicherung. (2) Faktoren zu identifizieren, die die Wirtschaftlichkeitsunterschiede zwischen einkommensstarken (Deutschland) und Ländern der mittleren niedrigen Einkommensstufe (Vietnam) systematisch bestimmen. Methoden: Primärdaten aus Bevölkerungsregistern, Verwaltungs-, Krankenhaus- und Patientendaten wurden erfasst. Sekundärdaten wie z.B. akademische Forschungsliteratur und unveröffentlichte Berichte („graue Literatur“) unterschiedlicher Interessensfelder wie Demografie, Epidemiologie, klinische Praxis, Patientencharakteristika, Gesundheitswesen und Gesundheitsfinanzierung wurden genutzt, um die Einführung von SRS als neue Gesundheitstechnologie im Vergleich mit der Standardtechnologie (SR) in der Behandlung von Hirnmetastasen einzuschätzen. Ergebnisse: Aus Perspektive der Gesundheitsversicherung ist in dem einkommensstarken Land, Deutschland, SRS SR überlegen. In Vietnam als Land der niedrigen mittleren Einkommensstufe gibt es dagegen große Unsicherheit über die Kosteneffektivität dieser zwei Behandlungsarten. Die erforderliche mehrfacheSRS-Behandlung bei rezidivierenden Hirntumoren in den erlaubten klinischen Konditionen beeinflusst die höhere SRS-Kosteneffektivität signifikant im Vergleich zur chirurgischen Resektion, welche in den einkommensstarken Ländern eher durchführbar ist als in Ländern der mittleren niedrigen Einkommensstufe. Der Unterschied in der Kosteneffektivität von SRS im Vergleich zu SR in diesen beiden Ländern wurde von unterschiedlichen Faktoren hervorgerufen: (1) Demographie, denn während Deutschland eine alternde Bevölkerung aufweist, besitzt Vietnam eine relativ junge Bevölkerung. (2) Epidemiologie, denndie Inzidenz von Gehirnmetastasen ist in Vietnam geringer als in Deutschland, wobei Primärtumoren, die Gehirnmetastasen bilden, häufiger sind. Beide Länder haben dennoch einen hohen SRS-Bedarf für die Behandlung von Gehirnmetastasen. (3) Klinische Praxis, denn Deutschland verfügt im Vergleich zu Vietnam über mehr standardisierte klinische Protokolle, Qualitätssicherungsmechanismen und evidenzbasierte Informationen. (4) Gesundheitsdienstleistungen, denn in Deutschland ist die Regulation der NHT-Diffusion transparenter und harmonisierter als die ausschließlich marktgesteuerte in Vietnam. Außerdem sind NHT-Leistungen in Deutschland relativ ausreichend, um den klinischen Bedarf zu decken.In Vietnam hingegen ist der Zugang zu Gesundheitstechnologiedienstleistungen von der begrenzten Zahlungsfähigkeit der Patienten bedingt. Als Ursachen können hier hauptsächlich der abweichende Versicherungsschutz und unterschiedliche Zuzahlungen in den zwei Ländern genannt werden. (5) Patientencharakteristika, wie dieFähigkeit neue Technologienabzurufen, Therapietreue und die Regelmäßigkeit der Nachkontrolluntersuchungen.Letztere wird für deutsche Patienten strenger gehandhabt. (6) Gesundheitsfinanzierung, die in beiden Ländern völlig unterschiedlich funktioniert. Ein deutsches Krankenhaus wird per DRGs vergütetund die Kosten von NHT werden unter bestimmten Umständen dem erstatteten Preishinzugefügt; es existieren ausreichend Mittel bezüglich NHT-Investitionen.In Vietnam werden Gesundheitstechnologieleistungen per Fee-for-service vergütet, und NHT-Investitionskosten belasten die öffentliche Hand sowie diePatientenauslagen.Dadurch wird ein Ressourcenmangel für NHT-Investitionen verursacht. Schlussfolgerung/ Fazit Im Fall von Gehirnmetastasen ist die Kosteneffektivität der stereotaktischen Radiochirurgie (SRS) im Vergleich zur chirurgischen Resektion (SR) niedriger für ein Land der niedrigen mittleren Einkommensstufe (Vietnam) als für ein einkommensstarkes Land (Deutschland). Um Beschlussfassungen bei der Einführung neuer Gesundheitstechnologien (NHT) besser zu informieren sollte jedes Land eigene Kosteneffektivitätsstudien durchführen, die Demographie, Epidemiologie, klinische Praxis, Patientencharakteristika, Gesundheitswesen und Gesundheitsfinanzierung landesspezifisch in Betracht ziehen. Für Länder der niedrigen mittleren Einkommensstufe (hier Vietnam) wird vorgeschlagen, die Rolle des Koordinators in der Einführung von Gesundheitstechnologien zu stärken, den Krankenversicherungsschutz zügig zu erweitern, damit Behandlungskosten gedeckt werden, den Übergang zu einer auf DRGs basierenden prospektiven Vergütung von Krankenhausleistungen anzustreben, „Best-Practice“-Leitfäden und Qualitätssicherungsmechanismen für die klinische Praxis zu etablieren sowie die Gesundheitsversorgungskenntnisse und Bewusstsein der Bevölkerung zu verbessern.Background: The rapid acceleration of medical technology development significantly contributes to the achievement of health service performance, the quality improvement of health care for the population. On the other hand, it leads to an increase of medical costs, which accounts for at least half of all medical cost growth, nowadays. New health technology (NHT) adoption is therefore a clearly complex process. It is a process that is typically different between high-income- and low-middle-income countries, as the diffusion of NHT in low-middle-income countries is far less and lagged far behind than in the high-income countries. The diffusion of NHT never fully reaches the demand of eligible population in low-middle-income countries. An example is the use of two treatment methodologies, the long established surgical resection (SR) and the newer stereotactic radiosurgery (SRS), in the treatment of brain metastasis. Whereas SRS has been used for a relatively long time and previously defined more cost-effective than SR in developed countries, it has just started to be adopted and a lack of evidence-based information on the health technology assessment of SRS versus SR in developing countries. Generally, the results of health technology assessment and cost-effectiveness analysis for particular different health technologies are relatively well defined in high-income countries, but little is known about these in low- and low-middle-income countries. There is a shortage of methodological guidance to adjust cost-effectiveness results from one to another country setting. This raises the questions of whether the NHT of SRS is or is not more cost-effective than SR in the contexts of a low-middle-income country and of a high-income country; and of what factors systematically determine differences in the cost-effectiveness between these two countries. Main objective: To compare the cost-effectiveness of a new hospital-based health technology of a low-middle-income country with a high-income country, by taking a case study of the two treatment modalities of SRS versus SR in the treatment of brain metastasis in Vietnam, which represents a low-middle-income country, and Germany, which represents a high-income country. Specific objectives (1) To analyse for SRS and SR which is more cost-effective in the treatment of brain metastases in the context of Vietnam and of Germany, from the perspective of health insurance (2) To find the factors which systematically determine the difference in cost-effectiveness between high- (Germany) and low-middle-income countries (Vietnam) Methods: A combination of primary data methods from population-based registration, administration, hospital-based, patient level data; and secondary data methods from academic and grey literature for the research in multiple fields of demography, epidemiology, clinical practice, patient characteristics, health services and health finance was used to assess the adoption of the NHT of SRS versus the standard treatment technology of SR in the treatment of brain metastasis. Results: From the perspective of health insurance, SRS is clearly dominant to SR in the treatment of brain metastasis in the high-income country of Germany, while there is high uncertainty regarding cost-effectiveness between these two methodologies in the low-middle-income country of Vietnam. The repeated treatment of the new technology of SRS for the patient with reoccurrence of brain tumors in the allowed clinical conditions significantly influences the higher cost-effectiveness of SRS comparing to surgical resection, which was more feasibly performed in the high-income rather than low-middle-income countries. The difference between the results of the cost-effectiveness of SRS versus SR in the treatment of brain metastatic in these two countries was affected by different factors which include: (1) Basic demography whereas it is an aging population in Germany on the contrary to the relatively young population in Vietnam. (2) Epidemiology of brain metastasis is rather different between two countries in the cancer incidence rate (it is lower in Vietnam than in Germany), cancer pattern (more frequent occurrence of primary tumor sites which act as main sources of brain metastasis in Vietnam than in Germany). However, both countries have high demand to the NHT of SRS for the treatment of brain metastasis. (3) Clinical practice whereas Germany has more standardized clinical protocol/practice; more strict quality accreditation; and more available medical evidence-based information than these in Vietnam. (4) Health services which are more available in Germany, where the regulation on NHT diffusion is transparent and harmonized in comparison to the market driven decision making of NHT diffusion in Vietnam. In addition, NHT services are relatively sufficient to respond to the demand as clinically required in Germany, while that is rather limited to the ability to pay of patient on the access to health technology services in Vietnam. This difference is mainly determined by the coverage of health insurance and the rate of copayment for the NHT services between two countries. (5) Patient characteristics which includes the ability to access new technology of each patient, and their adherence to the treatment, regular check-up during the follow-up period which is found more strict for the patient in Germany comparing to the patient in Vietnam. (6) Health finance, it is totally different between two countries, where German hospital get reimbursement by DRG scheme; the cost of NHT is under certain circumstances added to the price paid by public payment; there are sufficient resources in the investment of NHT which is contrary to Vietnam, where the reimbursement of the health technology service is by fee-for-service scheme, and the NHT investment cost is responsible more by Government and out-of-pocket payment of the patient, giving shortage of resources for investment of new health technology. Conclusion: The cost-effectiveness of an NHT of SRS versus SR in the treatment of brain metastasis in a low-middle income country (Vietnam) is lower than that of a high-income country (Germany). To be better advised for the decision making regarding NHT adoption, each country needs to conduct its own study of cost-effectiveness assessment of an NHT, in which an assessment of the cost-effectiveness of an NHT is examined in the broad context of demography, epidemiology, clinical practice, patient characteristics, health services and health finance. It is suggested that the low-middle-income country (Vietnam) strengthens the role of the coordinator in the medical technology adoption, rapidly increases the coverage of health insurance to cover the costs of treatment, move towards a prospective payment system based on DRG, establishes more standard protocol and quality control of clinical practices, and improve the health care knowledge and awareness of the population

A new projection-type method with nondecreasing adaptive step-sizes for pseudo-monotone Variational Inequalities

We propose a new projection-type method with inertial extrapolation for solving pseudo-monotone and Lipschitz continuous variational inequalities in Hilbert spaces. The proposed method does not require the knowledge of the Lipschitz constant as well as the sequential weak continuity of the corresponding operator. We introduce a self-adaptive procedure, which generates dynamic step-sizes converging to a positive constant. It is proved that the sequence generated by the proposed method converges weakly to a solution of the considered variational inequality with the nonasymptotic O(1/n) convergence rate. Moreover, the linear convergence is established under strong pseudo-monotonicity and Lipschitz continuity assumptions. Numerical a exmples for solving a class of Nash–Cournot oligopolistic market equilibrium model and a network equilibrium flow problem are given illustrating the efficiency of the proposed method

The Impacts of Corporate Social Resposibility Practices on Firm Financial Performance: Empirical Evidence From Asian Oil and Gas Industry

The paper aims to investigate the impact of Corporate Social Responsibility (CSR) practices on the financial performance of oil and gas firms in Asian countries by using a panel data set that includes 23 firms from 7 Asian countries from 2004 to 2017. The empirical results support the research hypothesis that CSR practices have a negative impact on the financial performance of oil and gas companies. This means CSR practices may impose a substantial burden on firms in the oil and gas industry. In addition, we find that different CSR practices have different sizes of impact on firm financial performance. In particular, environment practice has the biggest impact, social practice ranks second, and governance practice has the weakest impact. The main results are also confirmed by several robustness tests

INFLUENCE OF NICKEL ON THE MICROSTRUCTURE AND MECHANICAL PROPERTIES OF ALUMINUM COPPER ALLOY

This paper presents the results of Nickel component on the microstructure and mechanical properties of the aluminum-copper alloy. With the same heat treatment process (heated to 850oC quenching in water and tempering at 350oC in 2h) noticed: the sample was added nickel, it had phases of nickel with Al and Fe; these phases make sample’s mechanical properties better than the non-nickel sample. The samples were added Nickel, the hardness is higher than those without Nickel (105HRB and 92HRB). The abrasion results show that the Nickel alloyed samples also exhibited better than those without Nickel