Prices and protocols in public health care

The author tries to derive price and rationing rules for public health facilities. He highlights the effect on these rules of different assumptions about the objectives of government (health versus welfare), the limits of available policy instruments, and the market environment in which the public system operates. One recurrent finding: policy reform must be assessed in relation to the changes it induces relative to the status quo before reform. This point may seem obvious, but it represents a distinct gap in the literature on resource allocation in health. To assess changes, the behavior of the private sector must be known in the type of care given in a system and on how this care will change in response to the policy. Substituting for a reasonably well-functioning private sector is not as valuable as providing services that the private sector cannot be expected to sustain. Research is needed to characterize market equilibrium for medical care and its response to policy measures. The author could not examine many issues - most important, those related to uncertainty and insurance. But if the research he calls for in this paper is pursued, those issues must figure prominently as major determinants in the demand for care. This need was originally identified by Arrow, and there is still a long way to go. The author's analysis is not done in terms of preventive or curative care, and he argues for assessing interventions on the basis of changes in the stated objectives of a public system. But there could well be a connection with the preventive-curative dichotomy if there were reason to believe that preventive care will systematically lose out to curative care in a market setting. Onthe basis of people's generally acknowledged undervaluation of preventive services, this may well be the case. Other prevention activities also have many public good features, with few private alternatives, and will look good when improvements over stauts quo are examined for all interventions. But all activities must be evaluated in their improvement over market provision. It is not necessary to prejudge the case for certain types of intervention.Economic Theory&Research,Health Monitoring&Evaluation,Health Economics&Finance,Health Systems Development&Reform,Environmental Economics&Policies

Economic analysis for health projects

The author applies to the health sector an approach to analyzing projects advocated in a recent paper by Devarajan, Squire, and Suthiwart-Narueput. In the health sector, a project evaluation should: 1) Establish a firm justification for public involvement. The author identifies a number of common failures in the markets for both health services and insurance but argues that this should be the starting place for economic analysis, not a reason to ignore economics; 2) Establish the counterfactual: what happens with and without the project. Project outputs should be predicted net of the reaction of consumers and providers in the private sector. This requires knowledge of the market structure (supply, demand, and equilibrium) for health services; 3) Determine the fiscal effect of the project. The issue of appropriate levels for fees should be handled jointly with project evaluation; and 4) Acknowledge the fungibility of project resources and examine the incentives facing public servants. Ministries of health may shift their own resources away from activities that are funded by project to those that are not evaluated at all. Project outputs depend on the incentives for civil servants to provide good service--a consideration rarely taken into account in project evaluations. The author concludes that much of the analysis relevant to projects should be done before project evaluation. If the issues of fungibility and incentives are given due respect, the donors'best form of intervention may not be traditional projects at all but rather general loans with conditions related to general sector strategy and reform. For a standard project, a fair amount of information from supporting sector work is needed before evaluation. If clinical services (or anything depending on people s behavior) are part of the project, information is needed about the supply and demand for substitute services. The market structure of health care is an essential part of the background work.Public Health Promotion,Environmental Economics&Policies,Health Systems Development&Reform,Health Economics&Finance,Health Monitoring&Evaluation,Health Economics&Finance,Health Monitoring&Evaluation,Environmental Economics&Policies,Health Systems Development&Reform,Economic Theory&Research

Editorial

No aspect of the practice of pediatric anesthesia is more essential than airway management. Pediatric anesthesiologists are the ‘go to’ specialists when infants and children with difficult airways present anywhere in the hospital. To our advantage, rapid technical advances have taken place during the past decades and the number of tools available to assist us in providing and maintaining a secure and stable airway has increased significantly. Until the 1970s tracheal intubation with a conventional laryngoscope or blind nasal intubation were the mainstays of establishing an artificial airway. The choice of endotracheal tubes was limited. During the past 20 years a remarkable assortment of equipment and novel techniques to facilitate optimal airway management have been developed. These include supraglottic airways, direct and fiberoptic laryngoscopes and transtracheal devices. Improved imaging of the airway prior to initiation of airway management, with CT and MRI, for example, and during airway manipulation and instrumentation, using fiberoptic cameras and portable video displays, is now widely used. While new developments in airway management have helped us improve the quality of care of our patients, new challenges have also arisen. Which techniques should we learn, teach and employ? Which endotracheal tubes should be utilized – uncuffed or cuffed, old or new design? Which of our patients need preoperative imaging of the airway and/or sleep studies? What are the risks of newer interventions, including novel airway devices and laser instruments

Vaporization response of evaporating drops with finite thermal conductivity

A numerical computing procedure was developed for calculating vaporization histories of evaporating drops in a combustor in which travelling transverse oscillations occurred. The liquid drop was assumed to have a finite thermal conductivity. The system of equations was solved by using a finite difference method programmed for solution on a high speed digital computer. Oscillations in the ratio of vaporization of an array of repetitivity injected drops in the combustor were obtained from summation of individual drop histories. A nonlinear in-phase frequency response factor for the entire vaporization process to oscillations in pressure was evaluated. A nonlinear out-of-phase response factor, in-phase and out-of-phase harmonic response factors, and a Princeton type 'n' and 'tau' were determined. The resulting data was correlated and is presented in graphical format. Qualitative agreement with the open literature is obtained in the behavior of the in-phase response factor. Quantitatively the results of the present finite conductivity spray analysis do not correlate with the results of a single drop model

Improvement of Fourier Polarimetry for applications in tomographic photoelasticity

The use of the Fourier Polarimetry method has been demonstrated to extract the three characteristic parameters in integrated photoelasticity. In contrast to the phase-stepping method, it has been shown that the Fourier method is more accurate. However, the Fourier method isn't very efficient as it requires that a minimum of nine intensity images be collected during a whole revolution of a polarizer while the phase-stepping method only needs six intensity images. In this paper the Fourier transformation is used to derive the expression for determination of the characteristic parameters. Four Fourier coefficients are clearly identified to calculate the three characteristic parameters. It is found that the angular rotation ratio could be set arbitrarily. The angular rotation ratio is optimized to satisfy the requirements of efficiency and proper data accuracy, which results in data collection about three times faster than the methods suggested by previous researchers. When comparing their performance in terms of efficiency and accuracy, the simulated and experimental results show that these angular rotation ratios have the same accuracy but the optimized angular rotation ratio is significantly faster. The sensitivity to noise is also investigated and further improvement of accuracy is suggested

Droplet vaporization with liquid heat conduction Final report

Mathematical model for droplet vaporization with liquid heat conductio

Ghost doctors - absenteeism in Bangladeshi health facilities

The authors report on a study in which unannounced visits were made to health clinics in Bangladesh with the intention of discovering what fraction of medical professionals were present at their assigned post. This survey represents the first attempt to quantify the extent of the problem on a nationally representative scale. Nationwide the average number of vacancies over all types of providers in rural health centers is 26 percent. Regionally, vacancy rates (unfilled posts) are generally higher in the poorer parts of the country. Absentee rates at over 40 percent are particularly high for doctors. When separated into level of facility, the absentee rate for doctors at the larger clinics is 40 percent, but at the smaller sub-centers with a single doctor, the rate is 74 percent. Even though the primary purpose of this survey is to document the extent of the problem among medical staff, the authors also explore the determinants of staff absenteeism. Whether the medical provider lives near the health facility, access to a road, and rural electrification are important determinants of the rate and pattern of staff absentee rates.Public Health Promotion,Gender and Health,Health Systems Development&Reform,Health Monitoring&Evaluation,Housing&Human Habitats,Health Systems Development&Reform,Health Monitoring&Evaluation,Housing&Human Habitats,Gender and Health,Agricultural Knowledge&Information Systems

The economic control of infectious diseases

Despite interesting work on infectious diseases by such economists as Peter Francis, Michael Kremer, and Tomas Philipson, the literature does not set out the general structure of externalities involved in the prevention, and care of such diseases. The authors identify two kinds of externality. First, infectious people can infect other people, who in turn can infect others, and so on, in what the authors call the pure infection externality. In controlling their own infection, people do not take into account the social consequence of their infection. Second, in the pure prevention externality, one individual's preventive actions (such as killing mosquitoes) may directly affect the probability of others becoming infected, whether or not the preventive action succeeds for the individual undertaking it. The authors provide a general framework for discussing these externalities, and the role of government interventions to offset them. They move the discussion away from its focus on HIV (a fatal infection for which there are few interventions), and on vaccinations (which involve plausibly discrete decisions), to more general ideas of prevention, and cure applicable to many diseases for which interventions exhibit a continuum of intensities, subject to diminishing marginal returns. Infections, and actions to prevent, or cure them entail costs. Individuals balance those parts of different costs that they can actually control. In balancing costs to society, government policy should take individual behavior into account. Doing so requires a strategy combining preventive, and curative interventions, to offset both the pure infection externality, and the pure prevention externality. The relative importance of the strategy's components depends on: 1) The biology of the disease - including whether an infection is transmitted from person to person, or by vectors. 2) The possible outcomes of infection: death, recovery with susceptibility, or recovery with immunity. 3) The relative costs of the interventions. 4) Whether interventions are targeted at the population as a whole, the uninfected, the infected, or contacts between the uninfected, and the infected. 5) The behavior of individuals that leads to the two types of externalities.Disease Control&Prevention,Economic Theory&Research,Environmental Economics&Policies,Decentralization,Poverty Impact Evaluation,Economic Theory&Research,Environmental Economics&Policies,Poverty Impact Evaluation,Health Monitoring&Evaluation,Agricultural Knowledge&Information Systems

Global and local cutoff frequencies for transverse waves propagating along solar magnetic flux tubes

The propagation of linear transverse waves along a thin isothermal magnetic flux tube is affected by a global cutoff frequency that separates propagating and non-propagating waves. In this paper, wave propagation along a thin but non-isothermal flux tube is considered and a local cutoff frequency is derived. The effects of different temperature profiles on this local cutoff frequency are studied by considering different power-law temperature distributions as well as the semi-empirical VAL C model of the solar atmosphere. The results show that the conditions for wave propagation strongly depend on the temperature gradients. Moreover, the local cutoff frequency calculated for the VAL C model gives constraints on the range of wave frequencies that are propagating in different parts of the solar atmosphere. These theoretically predicted constraints are compared to observational data and are used to discuss the role played by transverse tube waves in the atmospheric heating and dynamics, and in the excitation of solar atmospheric oscillations.Comment: To be publishd in ApJ Vol. 763. 10 pages, 3 Postscript figure