BMC Health Services Research
(Accessed 30 May 2015)
Making health insurance pro-poor: evidence from a household panel in rural China
Mateusz Filipski, Yumei Zhang, Kevin Chen BMC Health Services Research 2015, 15:210 (29 May 2015)
In 2002, China launched the largest public health insurance scheme in the world, the New Cooperative Medical Scheme (NCMS). It is intended to enable rural populations to access health care services, and to curb medical impoverishment. Whether the scheme can reach its equity goals depends on how it is used, and by whom. Our goal is to shed light on whether and how income levels affect the ability of members to reap insurance benefits.
We exploit primary panel data consisting of a complete census (over 3500 individuals) in three villages in Puding County, Guizhou province, collected in 2004, 2006, 2009 and 2011. Data was collected during in-person interviews with household member(s). The data include yearly gross and net medical expenses for all individuals, and socio-economic information. We apply probit, ordinary least squares, and tobit multivariate regression analyses to the three waves in which NCMS was active (2006, 2009 and 2011). Explained variables include obtainment, levels and rates of NCMS reimbursement. Household income is the main explanatory variable, with household- and individual-level controls. We restrict samples to rule out self-selection, and exploit the 2009 NCMS reform to highlight equity-enhancing features of insurance.
Prior to 2009 reforms, higher income in our sample was statistically significantly related to higher probability of obtaining reimbursement, as well as higher levels and rates of reimbursement. These relations all disappear after the reform, suggesting lower-income households were better able to reap insurance benefits after the scheme was reformed. Regression results suggest this is partly explained by reimbursement for chronic diseases.
The post-reform NCMS distributed benefits more equitably in our study area. Making health insurance pro-poor may require a focus on outpatient costs, credit constraints and chronic diseases, rather than catastrophic illnesses.
BMC Medical Ethics
(Accessed 30 May 2015)
Research partnerships between high and low-income countries: are international partnerships always a good thing?
John D Chetwood, Nimzing G Ladep, Simon D Taylor-Robinson BMC Medical Ethics 2015, 16:36 (28 May 2015)
International partnerships in research are receiving ever greater attention, given that technology has diminished the restriction of geographical barriers with the effects of globalisation becoming more evident, and populations increasingly more mobile.
In this article, we examine the merits and risks of such collaboration even when strict universal ethical guidelines are maintained. There has been widespread examples of outcomes beneficial and detrimental for both high and low –income countries which are often initially unintended.
The authors feel that extreme care and forethought should be exercised by all involved parties, despite the fact that many implications from such international work can be extremely hard to predict. However ultimately the benefits gained by enhancing medical research and philanthropy are too extensive to be ignored
BMC Public Health
(Accessed 30 May 2015)
Effects of cash transfers on Children’s health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets
Thomas Crea, Andrew Reynolds, Aakanksha Sinha, Jeffrey Eaton, Laura Robertson, Phyllis Mushati, Lovemore Dumba, Gideon Mavise, J. Makoni, Christina Schumacher, Constance Nyamukapa, Simon Gregson BMC Public Health 2015, 15:511 (28 May 2015)
Unconditional and conditional cash transfer programmes (UCT and CCT) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS (OVC). We address the gap in current understanding about the extent to which household-based cash transfers differentially impact individual children’s outcomes, according to risk or protective factors such as orphan status and household assets.
Data were obtained from a cluster-randomised controlled trial in eastern Zimbabwe, with random assignment to three study arms – UCT, CCT or control. The sample included 5,331 children ages 6-17 from 1,697 households. Generalized linear mixed models were specified to predict OVC health vulnerability (child chronic illness and disability) and social protection (birth registration and 90% school attendance). Models included child-level risk factors (age, orphan status); household risk factors (adults with chronic illnesses and disabilities, greater household size); and household protective factors (including asset-holding). Interactions were systematically tested.
Orphan status was associated with decreased likelihood for birth registration, and paternal orphans and children for whom both parents’ survival status was unknown were less likely to attend school. In the UCT arm, paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans. Effects of study arms on outcomes were not moderated by any other risk or protective factors. High household asset-holding was associated with decreased likelihood of child’s chronic illness and increased birth registration and school attendance, but household assets did not moderate the effects of cash transfers on risk or protective factors.
Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based settings. UCT and CCT each produced direct effects on children’s social protection which are not moderated by other child- and household-level risk factors, but orphans are less likely to attend school or obtain birth registration. The effects of UCT and CCT are not moderated by asset-holding, but greater household assets predict greater social protection outcomes. Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children. These efforts might include caregiver education, and additional incentives based on efforts made specifically for orphaned children.
Disability and Rehabilitation: Assistive Technology
Volume 10, Number 4 (July 2015)
Special Section: Assistive Technology Access to Assistive Technology in Resource Limited Environments
Guest Editors – Mark Harniss and Deepti Samant Raja
Assistive technology access and service delivery in resource-limited environments: introduction to a special issue of Disability and Rehabilitation: Assistive Technology
July 2015, Vol. 10, No. 4 , Pages 267-270 (doi:10.3109/17483107.2015.1039607)
Mark Harniss, Deepti Samant Raja, and Rebecca Matter
1Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA, 2Burton Blatt Institute, Syracuse University, Washington, DC, USA, 3Center for Technology and Disability Studies, University of Washington, Seattle, WA, USA, and 4School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
This special issue addresses access to and service delivery of assistive technology (AT) in resource-limited environments (RLEs). Access to AT is complicated not simply by limited funds to purchase AT, but by larger ecosystem weaknesses in RLEs related to legislation and policy, supply, distribution, human resources, consumer demand and accessible design. We present eight diverse articles that address various aspects of the AT ecosystem. These articles represent a wide range of AT, many different countries and different research methods. Our goal is to highlight a topic that has received scant research investigation and limited investment in international development efforts, and offer an insight into how different countries and programs are promoting access to AT. We encourage researchers, funders and non-profit organizations to invest additional effort and resources in this area.
Users’ perspectives on the provision of assistive technologies in Bangladesh: awareness, providers, costs and barriers
Johan Borg, Per-Olof Östergren
Disability and Rehabilitation: Assistive Technology Jul 2015, Vol. 10, No. 4: 301–308.
Comparison between performances of three types of manual wheelchairs often distributed in low-resource settings
Karen Rispin, Joy Wee
Disability and Rehabilitation: Assistive Technology Jul 2015, Vol. 10, No. 4: 316–322.
The use of mobile devices as assistive technology in resource-limited environments: access for learners with visual impairments in Kenya
Alan R. Foley, Joanna O. Masingila
Disability and Rehabilitation: Assistive Technology Jul 2015, Vol. 10, No. 4: 332–339.
Using SMS as a tool to reduce exclusions experienced by caregivers of people with disabilities in a resource-limited Colombian community
Tim Barlott, Kim Adams, Francene Rodríguez Díaz, Mónica Mendoza Molina
Disability and Rehabilitation: Assistive Technology Jul 2015, Vol. 10, No. 4: 347–354.
Volume 7, Issue 3, June 2015
Special Theme: Strengthening the links between nutrition and health outcomes and agricultural research
This special section has three groups of papers. The first three set the stage by laying out the context of the enabling socio-political environment, and desired outcomes of the food system: improving multiple aspects of nutrition simultaneously, and sustainably within environmental boundaries The second set of papers deals with increasing access to nutritious, safe food through markets, as well as non-market channels. The last two papers synthesize what this current research means for agricultural research and policy.
Globalization and Health
[Accessed 30 May 2015]
Tracking Global Fund HIV/AIDS resources used for sexual and reproductive health service integration: case study from Ethiopia
Mookherji S, Ski S and Huntington D Globalization and Health 2015, 11:21 (27 May 2015)
The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) strives for high value for money, encouraging countries to integrate synergistic services and systems strengthening to maximize investments. The GF needs to show how, and how much, its grants support more than just HIV/AIDS, TB and malaria. Sexual and Reproductive Health (SRH) has been part of HIV/AIDS grants since 2007. Previous studies showed the GF PBF system does not allow resource tracking for SRH integration within HIV/AIDS grants. We present findings from a resource tracking case study using primary data collected at country level.
Ethiopia was the study site. We reviewed data from four HIV/AIDS grants from January 2009-June 2011 and categorized SDAs and activities as directly, indirectly, or not related to SRH integration. Data included: GF PBF data; financial, performance, in-depth interview and facility observation data from Ethiopia.
All HIV/AIDS grants in Ethiopia support SRH integration activities (12-100%). Using activities within SDAs, expenditures directly supporting SRH integration increased from 25% to 66% for the largest HIV/AIDS grant, and from 21% to 34% for the smaller PMTCT-focused grant. Using SDAs to categorize expenditures underestimated direct investments in SRH integration; activity-based categorization is more accurate. The important finding is that primary data collection could not resolve the limitations in using GF GPR data for resource tracking. The remedy is to require existing activity-based budgets and expenditure reports as part of PBF reporting requirements, and make them available in the grant portfolio database. The GF should do this quickly, as it is a serious shortfall in the GF guiding principle of transparency.
Showing high value for money is important for maximizing impact and replenishments. The Global Fund should routinely track HIV/AIDs grant expenditures to disease control, service integration, and overall health systems strengthening. The current PBF system will not allow this. Real-time expenditure analysis could be achieved by integrating existing activity-based financial data into the routine PBF system. The GF’s New Funding Model and the 2012-2016 strategy present good opportunities for over-hauling the PBF system to improve transparency and allow the GF to monitor and maximize value for money.
Health Economics, Policy and Law
Volume 10 – Issue 03 – July 2015
The impact of Universal Health Coverage on health care consumption and risky behaviours: evidence from Thailand
Simone Ghislandi, Wanwiphang Manachotphong and Viviana M.E. Perego
Health Economics, Policy and Law / Volume 10 / Issue 03 / July 2015, pp 251 – 266
Thailand is among the first non-OECD countries to have introduced a form of Universal Health Coverage (UHC). This policy represents a natural experiment to evaluate the effects of public health insurance on health behaviours. In this paper, we examine the impact of Thailand’s UHC programme on preventive activities, unhealthy or risky behaviours and health care consumption using data from the Thai Health and Welfare Survey. We use doubly robust estimators that combine propensity scores and linear regressions to estimate differences-in-differences (DD) and differences-in-DD models. Our results offer important insights. First, UHC increases individuals’ likelihood of having an annual check-up, especially among women. Regarding health care consumption, we observe that UHC increases hospital admissions by over 2% and increases outpatient visits by 13%. However, there is no evidence that UHC leads to an increase in unhealthy behaviours or a reduction of preventive efforts. In other words, we find no evidence of ex ante moral hazard. Overall, these findings suggest positive health impacts among the Thai population covered by UHC.