Crowding-out or crowding-in? Effects of LEAP 1000 unconditional cash transfer program on household and community support among women in rural Ghana

Social protection programs are not introduced in a vacuum and it is important to understand what effects such programs have on existing informal support networks of family, friends and community members. A social cash transfer may reduce receipt of informal financial support, which can water down part of the program's impact. However, cash transfers can also reduce barriers to social participation and enable participants to engage in reciprocal support systems. We use data from the quasi-experimental mixed method impact evaluation of Ghana's Livelihood Empowerment Against Poverty (LEAP) 1000 program, a social cash transfer program for pregnant women and mothers of children under one year living in poverty, to estimate program effects on social support and participation. Using a difference-in-differences approach we find that LEAP 1000 increases overall social support, as well as both emotional and instrumental support. In addition, program beneficiaries are more likely to participate in community groups. In in-depth interviews, participants confirmed increased support with descriptions of improved access to financial markets, such as borrowing money or contributing to local savings schemes, and strengthening of social participation in local groups and gatherings. Beneficiary women also highlighted reduced need for economic support and new opportunities to support others. By creating opportunities for additional social support within the household and community, LEAP 1000 crowded-in support, rather than reducing existing sources of support or crowding-out support

National trends in resource utilization associated with ED visits for syncope

BackgroundOver the last 20 years, numerous research articles and clinical guidelines aimed at optimizing resource utilization for emergency department (ED) patients presenting with syncope have been published.HypothesisWe hypothesized that there would be temporal trends in syncope-related ED visits and associated trends in imaging, hospital admissions, and diagnostic frequencies.MethodsThe ED component of National Hospital Ambulatory Medical Care Survey was analyzed from 2001 through 2010, comprising more than 358000 visits (representing an estimated 1.18 billion visits nationally). We selected ED visits with a reason for visit of syncope or fainting and calculated nationally representative weighted estimates for prevalence of such visits and associated rates of advanced imaging utilization and admission. For admitted patients from 2005 to 2010, the most frequent hospital discharge diagnoses were tabulated.ResultsDuring the study period, there were more than 3500 actual ED visits (representing 11.9 million visits nationally) related to syncope, representing roughly 1% of all ED visits. Admission rates for syncope patients ranged from 27% to 35% and showed no significant downward trend (P = .1). Advanced imaging rates increased from about 21% to 45% and showed a significant upward trend (P < .001). For admitted patients, the most common hospital discharge diagnosis was the symptomatic diagnosis of "syncope and collapse" (36.4%).ConclusionsDespite substantial efforts by medical researchers and professional societies, resource utilization associated with ED visits for syncope appears to have actually increased. There have been no apparent improvements in diagnostic yield for admissions. Novel strategies may be needed to change practice patterns for such patients