Income related inequalities in self assessed health in Britain: 1979-1995

Study objective: To measure and decompose income related inequalities in self assessed health in England, Scotland, and Wales, 1979-1995. Design: The relation between individual health and a non-linear transformation of equivalised income, allowing for sex, age, country, and year effects, was estimated by multiple regression. The share of health attributable to transformed income and the Gini coefficient for transformed income were calculated. Inequality in health was measured by the partial concentration index, which is the product of the. Gini coefficient and the share of health attributable to transformed income. Participants and setting: Representative annual samples of the adult population living in private households in Great Britain 1979-1995. The total analysed sample was 299 968 people. Main results: Pro-rich health inequality was largest in Wales and smallest in England over the period because the effect of increased income on health was greatest in Wales and least in England. In all three countries, pro-rich health inequality increased throughout the period. In the early 1980s this was primarily attributable to increases in income inequality. Thereafter the increased share of health attributable to income was the principal cause. Conclusions: Reductions in pro-rich health inequality can be achieved by reducing income inequality, reducing the effect of income on health, or both

Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes

Objective To investigate the impact of factors outside the control of primary care on performance indicators proposed as measures of the quality of primary care. Design Multiple regression analysis relating admission rates standardised for age and sex for asthma, diabetes, and epilepsy to socioeconomic population characteristics and to the supply of secondary care resources. Setting 90 family health services authorities in England, 1989-90 to 1994-5. Results At health authority level socioeconomic characteristics, health status, and secondary care supply factors explained 45% of the variation in admission rates for asthma, 33% for diabetes, and 55% for epilepsy. When health authorities were ranked, only four of the 10 with the highest age-sex standardised admission rates for asthma in 1994-5 remained in the top 10 when allowance was made for socioeconomic characteristics, health status, and secondary care supply factors. There was also substantial year to year variation in the rates. Conclusion Health outcomes should relate to crude rates of adverse events in the population. These give the best indication of the size of a health problem. Performance indicators, however, should relate to those aspects of care which can be altered by the staff whose performance is being measured

Corporate Leadership

Corporations can initiate an emergent form of leadership that encompasses the importance of values and relationships into the philosophies that articulate the organizational direction. This thesis established the most and least often articulated values from the mission statements of the Fortune 50 corporations. One of the observations noted by this research is that profit is the most frequent and loyalty is the least. The author finds this problematic and states that establishing an emergent form of leadership can be beneficial to organizations by redefining the practice of leadership within the organization, thus redefining the culture. Furthermore, the organizational transformation can then be articulated through the mission statements

Income, relative income, and self-reported health in Britain 1979-2000

According to the relative income hypothesis, an individual’s health depends on the distribution of income in a reference group, as well as on the income of the individual. We use data on 231,208 individuals in Great Britain from 19 rounds of the General Household Survey between 1979 and 2000 to test alternative specifications of the hypothesis with different measures of relative income, national and regional reference groups, and two measures of self assessed health. All models include individual education, social class, housing tenure, age, gender and income. The estimated effects of relative income measures are usually weaker with regional reference groups and in models with time trends. There is little evidence for an independent effect of the Gini coefficient once time trends are allowed for. Deprivation relative to mean income and the Hey-Lambert-Yitzhaki measures of relative deprivation are generally negatively associated with individual health, though most such models do not perform better on the Bayesian Information Criterion than models without relative income. The only model which performs better than the model without relative income and which has a positive estimated effect of absolute income on health has relative deprivation measured as income proportional to mean income. In this model the increase in the probability of good health from a ceteris paribus reduction in relative deprivation from the upper quartile to zero is 0.010, whereas as an increase in income from the lower to the upper quartile increases the probability by 0.056. Measures of relative deprivation constructed by comparing individual income with incomes within a regional or national reference group will always be highly correlated with individual income, making identification of the separate effects of income and relative deprivation problematic

Company Taxation in the European Union

This paper investigates different measures of corporate tax burden ranging from the most basic ones such as the statutory tax rate to the effective tax rates. Each of these measures has advantages and disadvantages and they may lead to different rankings of countries. One of the reasons lies the fact that they measure different things. The comparison of the statutory tax rates to the effective ones for the EU-27 during the period of 1998-2009 sometimes reveals very significant differences between these indicators. Taking this into consideration, the paper suggests that corporate tax burden analysis should not be limited to the most basic and readily available measure in the form of the statutory tax rate. Different measures are tailored to answer different research questions. Moreover, the article presents changes of company taxation for the EU-27 within 1998-2009.W artykule dokonano przeglądu miar obciążenia podatkowego przedsiębiorstw. Rozpoczynając od wielkości najprostszych, jak stopa nominalna, a kończąc na miarach efektywnych. Każdy ze wskaźników ma wady i zalety, a jego wykorzystanie może prowadzić do różnego uszeregowania państw ze względu na poziom opodatkowania. Jedną z przyczyn jest fakt, iż wielkości te mierzą inne rzeczy. Porównanie stóp nominalnych i efektywnych w krajach UE-27, w latach 1998-2009, wskazuje na istnienie niekiedy bardzo istotnych różnic pomiędzy analizowanymi wskaźnikami. W związku z tym artykuł sugeruje, iż nie należy ograniczać analiz opodatkowania przedsiębiorstw, do najprostszego i najłatwiej dostępnego wskaźnika w postaci ustawowej stopy podatkowej a rozszerzyć je o miary efektywne. Wielkości te, stanowiące lepszy instrument do porównań międzynarodowych, umożliwiają przeprowadzenie wszechstronnych badań

Why we must tie satellite positioning to tide gauge data

Accurate measurements of changes in sea and land levels with location and time require making precise, repeated geodetic ties between tide gauges and satellite positioning system equipment

Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study.

OBJECTIVE: To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs). DESIGN: Controlled longitudinal study. SETTING: English National Health Service between 1998/99 and 2010/11. PARTICIPANTS: Populations registered with each of 6975 family practices in England. MAIN OUTCOME MEASURES: Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs. RESULTS: Incentivised ACSC admissions showed a relative reduction of 2.7% (95% confidence interval 1.6% to 3.8%) in the first year of the Quality and Outcomes Framework compared with ACSCs that were not incentivised. This increased to a relative reduction of 8.0% (6.9% to 9.1%) in 2010/11. Compared with conditions that are not regarded as being influenced by the quality of ambulatory care (non-ACSCs), incentivised ACSCs also showed a relative reduction in rates of emergency admissions of 2.8% (2.0% to 3.6%) in the first year increasing to 10.9% (10.1% to 11.7%) by 2010/11. CONCLUSIONS: The introduction of a major national pay for performance scheme for primary care in England was associated with a decrease in emergency admissions for incentivised conditions compared with conditions that were not incentivised. Contemporaneous health service changes seem unlikely to have caused the sharp change in the trajectory of incentivised ACSC admissions immediately after the introduction of the Quality and Outcomes Framework. The decrease seems larger than would be expected from the changes in the process measures that were incentivised, suggesting that the pay for performance scheme may have had impacts on quality of care beyond the directly incentivised activities