304 research outputs found
Estimating catastrophic health expenditures: Need for improved methodology and interpretation
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Universal Health Insurance in India: Ensuring equity, efficiency, and quality
No full textIndian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India′s workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete
Episodic absorption in the outflow of V603 Aquilae
No full textWe report on the time-dependent behaviour of ultraviolet spectral lines in Hubble Space Telescope Goddard High-Resolution Spectrograph data of the classical nova V603 Aql. In particular, episodic blueshifted absorption (extending to ∼−2500 km s−1) is present, with a variability time-scale down to ∼1 min. The data provide a rare opportunity to study the rapid evolution of absorption structures that may be associated with accretion-disc winds in cataclysmic variables. At least three absorption events are recorded (at blueward velocities only) over ∼5 h, each lasting ∼10–15 min. The derived velocity, acceleration and optical depth properties provide an empirical picture of stochastically variable structures in the outflow, with no evidence for short-term (less than ∼1 h) cyclic or modulated behaviour in the overall absorption properties. In contrast, the emission components of the ultraviolet resonance lines are very stable in velocity and strength in this low-inclination system. On at least two occasions there is an intriguing short-term ‘flare’ in the ultraviolet continuum flux (of up to ∼40 per cent). Though there is no clear one-to-one relation in these data between the continuum fluctuations and the occurrence of the absorption events, the time-scales for the two variable phenomena are essentially the same. The irregular absorption episodes in the ultraviolet data of V603 Aql presently defy a clear physical interpretation. Their overall characteristics are discussed in the context of instabilities in radiation-pressure-driven disc winds
Role of health economics in developing efficient universal health care system
No full textApplication of economic principles can bring about a significant change in the performance of health system. An in-depth understanding of how to generate resources, how to pool funds, how to purchase health services and pay providers of health care, will affect how the health system delivers on its two important objectives, i.e. efficiency and equity. The economic underpinnings of health system are important structural and functional factors to aid in planning and delivery of health care services. Health economics can help in making informed decisions by explaining the factors that affect consumption and utilization of health services both from the demand and supply side using the principles of microeconomics. This is vital for improving the ‘coverage’ of all desired preventive and curative health care services. Most of the recent health system interventions such as increased public health subsidy, creating demand side financing mechanisms like conditional cash transfers schemes such as Janani Suraksha Yojana, performance based payments to Accredited Social Health Activist (ASHAs), incentivizing health workforce in rural and difficult areas, are all grounded in economic theories. Despite years of advocacy, resources have been and will continue to be scarce in health sector. On the contrary, demands for increasing the coverage of existing programs and introduction of newer interventions and technology are increasing. As a result hard choices need to be made for rational allocation of resources for maximizing the value of money spent. Despite a strong felt need among policy makers and program managers for health economists, there is an acute shortage of professionals who have requisite knowledge of health economics. This calls for introduction of health economics in the curriculum of medical and public health courses. Health professionals should also be encouraged to undertake research in this field of health economics and health financing
Impact and cost-effectiveness evaluation of nutritional supplementation and complementary interventions for tuberculosis treatment outcomes under mukti pay-for-performance model in Madhya Pradesh, India: A study protocol
No full textBackground: A “pay-for-performance” (P4P) intervention model for improved tuberculosis (TB) outcomes, called “Mukti,” has been implemented in an underdeveloped tribal area of central India. The target of this project is to improve nutritional status, quality of life (QoL), and treatment outcomes of 1000 TB patients through four interventions: food baskets, personal counseling, peer-to-peer learning and facilitation for linkage to government schemes. The current study aims to assess the success of this model by evaluating its impact and cost-effectiveness using a quasi-experimental approach. Methods: Data for impact assessment have been collected from 1000 intervention and control patients. Study outcomes such as treatment completion, sputum negativity, weight gain, and health-related QoL will be compared between matched samples. Micro costing approach will be used for assessing the cost of routine TB services provision under the national program and the incremental cost of implementing our interventions. A decision and Markov hybrid model will estimate long-term costs and health outcomes associated with the use of study interventions. Measures of health outcomes will be mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per quality-adjusted life-years gained and cost per unit increase in patient weight in intervention versus control groups. Results: The evidence generated from the present study in terms of impact and cost-effectiveness estimates will thus help to identify not only the effectiveness of these interventions but also the optimal mode of financing such measures. Our estimates on scale-up costs for these interventions will also help the state and the national government to consider scale-up of such interventions in the entire state or country. Discussion: The study will generate important evidence on the impact of nutritional supplementation and other complementary interventions for TB treatment outcomes delivered through P4P financing models and on the cost of scaling up these to the state and national level in India
Economics of Smokeless Tobacco (SLT) in India
No full textDespite the high prevalence of Smokeless Tobacco (SLT) in India, cost-effective interventions to curb smokeless tobacco use are very low. Taxation is considered as one of the most cost-effective intervention to curb overall tobacco use but taxation on SLT product is very complex and is on ad-valorem basis. Further, Goods and Service Tax has increased the price from 0.8/gram to 1.06/gram, but still the impact of increasing the tax needs to be explored so that harmony between excise revenue generated from these products and decrease in demand of these products can be maintained. Therefore, we carried out a literature review, which involved literature search, data extraction, and synthesis. The evidence suggests that the price elasticity of SLT products has gone closer to the inelastic nature with the passing time suggesting the increasing affordability of these products. The macroeconomic impact of the disease burden resulting from these SLT products is far greater than excise revenue generated by these products. More research is required in this field with updated data. The agricultural aspect of SLT products also need to be explored to determine cost-effective alternative crops for tobacco farming. Also, as the use of SLT is culturally accepted in India, appropriate public awareness program and cost-effective interventions are required to curb SLT use along with increased tax and cessation services
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