Waivers and exemptions for health services in developing countries

In response to shortages in public budgets for government health services, many developing countries around the world, have adopted formal, or informal systems of user fees for health care. In most countries, user fee proceeds seldom represent more than 15 percent of total costs in hospitals, and health centers, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial, or full waivers to the poor, often results in inequity in access to medical care. The dilemma, then, is how to make a much needed system of user fees, compatible with the goal of preserving equitable access to services. Different countries have tried different approaches. Those which have carefully designed, and implemented waiver systems (e.g., Thailand and Indonesia) have had much greater success in terms of benefits incidence, than countries that have improvised such systems (Ghana, Kenya, Zimbabwe). Key to the success of a waiver system is its financing. Systems that compensate providers for the revenue forgone from granting exemptions (Thailand, Indonesia, and Cambodia) have been more successful than those who expect the provider to absorb the cost of exemptions (Kenya). Where waiver system exist, performance will improve with the timeliness of the reimbursement. Other success factors include the widespread dissemination among potential beneficiaries, about waiver availability, and procedures; the awarding of financial support to poor patients for non-fee costs of care, such as food and transportation (as in Cambodia); and, the existence of clear criteria for the granting of waivers, thereby reducing confusion, and ambiguity among those responsible for managing the system, and among potential recipients. The review examines various approaches taken by countries, but assessing their relative practical merits is difficult, as the evidence is scattered and mixed.Health Systems Development&Reform,Pharmaceuticals&Pharmacoeconomics,Health Monitoring&Evaluation,Public Sector Economics,Health Economics&Finance

The determinants of hospital costs : an analysis of Ethiopia

The problem of financing health care in poor countries has become increasingly acute. In the context of health financing, hospitals are viewed with skepticism as facilities are not cost-effective in the provision of primary health care services. Given this view, it is increasingly thought that such institutions should become financially independent from government subsidies and find other ways to finance both their recurrent and capital costs. The purpose of this paper is to analyze the determinants of hospital costs in a poor country by conducting a case study using data from Ethiopia. It analyzes the issues of economies of scale and scope in the delivery of hospital based health care services in a poor country. A translog-like cost function specification is used in the analysis. It shows that the number of inpatient days, deliveries and laboratory exams had a positive and statistically significant effect on total cost. A negative and statistically significant coefficient associated with the output interaction term indicated the existence of economies of scope between the number of inpatient days and the number of first outpatient visits. Finally, the number of total beds in a hospital appeared to have a positive and significant independent effect on total hospital cost.Economic Theory&Research,Business Environment,Business in Development,Environmental Economics&Policies,Health Systems Development&Reform

How Jewish Students at Binghamton University Mediate Discrepancies between Judaism and Capitalism

Capitalism, as ideology, exists subconsciously within individuals and influences an individual’s perspective on the world. Although capitalism thrives on exploitation—its fundamental logic, as Marxist analysis shows—it is noticeable that there is no dominant revolution against it, even by those whose core religious beliefs—they believe—motivate their lives. To investigate the paradox of how individuals connected to their religion rationalize their existence among potentially conflicting personal core religious truths and core truths of systemic capitalism, this presentation examines Jewish students at Binghamton University. For the research method, interviews of Jewish students at Binghamton University who affiliate themselves with the Hillel organization on campus and are familiar to the author of this research were performed. Within each interview lay 3 steps. First, expose the subject to the core truths of capitalism, as expressed by Marx and Marxist thinkers. Second, have the subject explain their core truths of Judaism. Third, discuss with the subject how they manage the disparities (if they find any) between the two sets of ideas. Through the interviews from the 5 participants, one can see that these Jewish students recognize the contradictions between the core truths of Judaism and capitalism. It can also be surmised that for Jewish students at Binghamton University, their religion proves to counterbalance capitalism’s abuses in society, and most participants demonstrated that their core Jewish values, especially pertaining to ideas such as tzedakah, or the giving of charity, incentivize them to work to lessen—not eliminate—the injustices they see.https://orb.binghamton.edu/research_days_posters_2022/1041/thumbnail.jp

Managing customer relationships through price and service quality

This paper examines the ways in which a service provider's policies on pricing and service level affect the size of its customer base and profitability. The analysis begins with the development of a customer behavior model that uses customer satisfaction and depth of relationship as mediators of the impact of price and service level on profitability. Based on this model of customer behavior, the system is analyzed as a queuing network from which the properties of the aggregate population's behavior are derived. The analysis reveals the counterintuitive result that a policy that involves a decrease in prices or an increase in service level may lead to a smaller customer base. However, this policy may also lead to higher profits. The novelty of this result lies in the explanation of the phenomenon: that when the customer base decreases due to a change in prices or service quality, companies may experience gains in profit that result not from a decrease in costs associated with serving fewer customers but from an increase in revenues resulting from the indirect effects of the lower prices or higher level of service on customer behavior. The application of optimization techniques to the model developed in this paper yields optimality conditions through which managers can assess the long-term profitability of their pricing and service-level policies.Customer relationship management; operations/marketing interface; two-part tariffs; service operations management; service quality;

The Development, Management and Support of Smart Strategic Alliances

Despite the increasing number of strategic alliances, how to ensure their success is poorly understood. Studies suggest that up to seventy-five percent of alliances fail to meet their initial objectives due to a multitude of cultural, political, technological and human factors. If such an eclectic set of competencies is required for success, alliance management is clearly a difficult task for today’s manager. Traditionally, managers wishing to develop strategic alliance competencies have relied on ad-hoc consultancy services and training. This has not, to date, resulted in a notable improvement in alliance success. The SMART project redresses this growing need by developing a knowledge-based software support system to help managers conceptualise, implement and manage strategic alliances. First, this paper introduces the field of strategic alliances; then the foundations of knowledgebased support systems are discussed. Finally, how the SMART approach will create value for managers is relayed

Duality Based Characterizations of Efficient Facets

Most practical applications of multicriteria decision making can be formulated in terms of efficient points determined by preference cones with polyhedral closure. Using linear approximations and duality from mathematical programming, we characterize a family of supporting hyperplanes that define the efficient facets of a set of alternatives with respect to such preference cones. We show that a subset of these hyperplanes generate maximal efficient facets. These characterizations permit us to devise a new algorithm for generating all maximal efficient facets of multicriteria optimization problems with polyhedral structure.Supported in part by the National Science Foundation grant MCS77-24654. Supported in part by the Army Research Office (Durham) contract DAAG29-76-C-0064