Equity in the finance of health care: Some international comparisons

This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues

Equity in the delivery of health care: some international comparisons

This paper presents the results of an eight-country comparative study of equity in the delivery of health care. Equity is taken to mean that persons in equal need of health care should be treated the same, irrespective of their income. Two methods are used to investigate inequity: an index of inequity based on standardized expenditure shares, and a regression-based test. The results suggest that inequity exists in most of the eight countries, but that there is no simple one-to-one correspondence between a country's delivery system and the degree to which persons in equal need are treated the same

Equity in the finance and delivery of health care: some tentative cross-country comparisons

Equity is widely acknowledged to be an important goal in the field of health care. Indeed, McLachlan and Maynard (1982) have gone so far as to suggest that' the vast majority of the population would elect for equity to be the prime consideration' (p. 556)—a view endorsed by Mooney (1986, p. 145). Several researchers have investigated how successful their own country's delivery and/or financing system is in achieving its stated equity goals. In general the strategy of these studies is to compare the current situation with some ideal or 'target* situation. Le Grand (1978), for example, in what has become a classic study in the field, compares the distributions across socio-economic groups of illness and public expenditure on health care in Britain in 1972, and concludes that the National Health Service (NHS) has failed to achieve equity in the delivery of health care

Horizontal equity in the delivery of health care

This paper offers a critical appraisal of the various methods used to date to investigate inequity in the delivery of health care. It concludes that none of the methods used to date is particularly well equipped to provide unbiassed estimates of the extent of inequity. It also concludes that Le Grand's (1978) approach is likely to point towards inequity favouring the rich even when none exists. The paper offers an alternative approach, which builds on the approaches to date but seeks to overcome their deficiencies

SMS nudges as a tool to reduce tuberculosis treatment delay and pretreatment loss to follow-up. A randomized controlled trial

Background TB persists despite being relatively easy to detect and cure because the journey from the onset of symptoms to cure involves a series of steps, with patients being lost to follow-up at each stage and delays occurring among patients not lost to follow-up. One cause of drop-off and delay occurs when patients delay or avoid returning to clinic to get their test results and start treatment. Methods We fielded two SMS interventions in three Cape Town clinics to see their effects on whether people returned to clinic, and how quickly. One was a simple reminder; the other aimed to overcome “optimism bias” by reminding people TB is curable and many millions die unnecessarily from it. Recruits were randomly assigned at the clinic level to a control group or one of the two SMS groups (1:2:2). In addition to estimating effects on the full sample, we also estimated effects on HIV-positive patients. Results SMS recipients were more likely to return to clinic in the requested two days than the control group. The effect was smaller in the intent-to-treat analysis (52/101 or 51.5% vs. 251/405 or 62.0%, p = 0.05) than in the per-protocol analysis (50/97 or 51.5% vs. 204/318 or 64.2%, p = 0.03). The effect was larger among HIV-positives (10/35 or 28.6% vs. 97/149 or 65.1%, p<0.01). The effects of SMS messages diminished as the interval increased: significant effects at the 5% level were found at five and 10 days only among HIV-positives. The second SMS message had larger effects, albeit not significantly larger, likely due in part to lack of statistical power. Conclusions At 2 U.S. cents per message, SMS reminders are an inexpensive option to encourage TB testers to return to clinic, especially when worded to counter optimism bias

Real-Time Adaptive Event Detection in Astronomical Data Streams

A new generation of observational science instruments is dramatically increasing collected data volumes in a range of fields. These instruments include the Square Kilometer Array (SKA), Large Synoptic Survey Telescope (LSST), terrestrial sensor networks, and NASA satellites participating in "decadal survey"' missions. Their unprecedented coverage and sensitivity will likely reveal wholly new categories of unexpected and transient events. Commensal methods passively analyze these data streams, recognizing anomalous events of scientific interest and reacting in real time. Here, the authors report on a case example: Very Long Baseline Array Fast Transients Experiment (V-FASTR), an ongoing commensal experiment at the Very Long Baseline Array (VLBA) that uses online adaptive pattern recognition to search for anomalous fast radio transients. V-FASTR triages a millisecond-resolution stream of data and promotes candidate anomalies for further offline analysis. It tunes detection parameters in real time, injecting synthetic events to continually retrain itself for optimum performance. This self-tuning approach retains sensitivity to weak signals while adapting to changing instrument configurations and noise conditions. The system has operated since July 2011, making it the longest-running real-time commensal radio transient experiment to date

Detection of fast radio transients with multiple stations: a case study using the Very Long Baseline Array

Recent investigations reveal an important new class of transient radio phenomena that occur on sub-millisecond timescales. Often transient surveys' data volumes are too large to archive exhaustively. Instead, an on-line automatic system must excise impulsive interference and detect candidate events in real-time. This work presents a case study using data from multiple geographically distributed stations to perform simultaneous interference excision and transient detection. We present several algorithms that incorporate dedispersed data from multiple sites, and report experiments with a commensal real-time transient detection system on the Very Long Baseline Array (VLBA). We test the system using observations of pulsar B0329+54. The multiple-station algorithms enhanced sensitivity for detection of individual pulses. These strategies could improve detection performance for a future generation of geographically distributed arrays such as the Australian Square Kilometre Array Pathfinder and the Square Kilometre Array.Comment: 12 pages, 14 figures. Accepted for Ap

Changes in addressing inequalities in access to hospital care in Andhra Pradesh and Maharashtra states of India: a difference-in-differences study using repeated cross-sectional surveys

Objectives: To compare the effects of the Rajiv Aarogyasri Health Insurance Scheme of Andhra Pradesh (AP) with health financing innovations including the Rashtriya Swasthya Bima Yojana (RSBY) in Maharashtra (MH) over time on access to and out-of-pocket expenditure (OOPE) on hospital inpatient care. Study design: A difference-in-differences (DID) study using repeated cross-sectional surveys with parallel control. Setting: National Sample Survey Organisation of India (NSSO) urban and rural ‘first stratum units’, 863 in AP and 1008 in MH. Methods: We used two cross-sectional surveys: as a baseline, the data from the NSSO 2004 survey collected before the Aarogyasri and RSBY schemes were launched; and as postintervention, a survey using the same methodology conducted in 2012. Participants: 8623 households in AP and 10 073 in MH. Main outcome measures: Average OOPE, large OOPE and large borrowing per household per year for inpatient care, hospitalisation rate per 1000 population per year. Results: Average expenditure, large expenditures and large borrowings on inpatient care had increased in MH and AP, but the increase was smaller in AP across these three measures. DIDs for average expenditure and large borrowings were significant and in favour of AP for the rural and the poorest households. Hospitalisation rates also increased in both states but more so in AP, although the DID was not significant and the subgroup analysis presented a mixed picture. Conclusions: Health innovations in AP had a greater beneficial effect on inpatient care-related expenditures than innovations in MH. The Aarogyasri scheme is likely to have contributed to these impacts in AP, at least in part. However, OOPE increased in both states over time. Schemes such as the Aarogyasri and RSBY may result in some positive outcomes, but additional interventions may be required to improve access to care for the most vulnerable sections of the population