The Impact of School Finance Litigation on Resource Distribution: A Comparison of Court-Mandated Equity and Adequacy Reforms

ERIC Educational Resources Information Center

Springer, Matthew G.; Liu, Keke; Guthrie, James W.

2008-01-01

While there is a wealth of research on school finance equity and adequacy, and school finance theory clearly documents differences between the two concepts, no study has examined whether the reforms engendered by each approach actually differ in terms of resource distribution. This study examines the issues using district level data on expenditure…

Educational Finance Policy: A Search for Complementarities.

ERIC Educational Resources Information Center

Geske, Terry G.

1983-01-01

An overview of recent state level policy developments and policy analysis research as related to equity and efficiency objectives in public school finance is presented. Emphasis is placed on identifying complementarities, rather than the tradeoffs, between equity and efficiency criteria. (Author/LC)

Rethinking Equity--There Are Alternatives.

ERIC Educational Resources Information Center

Picus, Lawrence O.

1998-01-01

Defines "equity" in terms of three concepts (horizontal equity, vertical equity, and fiscal neutrality), summarizes school finance litigation history, and presents alternative distribution formats to improve student achievement. Enhancing equity and efficiency requires reallocation of existing resources, incentives for improved performance, a more…

Equity in health care financing: The case of Malaysia

PubMed Central

Yu, Chai Ping; Whynes, David K; Sach, Tracey H

2008-01-01

Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help shape health financing strategies for the nation. PMID:18541025

New evidence on financing equity in China's health care reform - A case study on Gansu province, China

PubMed Central

2012-01-01

Background In the transition from a planned economy to a market-oriented economy, China’s state funding for health care declined and traditional coverage plans collapsed, leaving China’s poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Methods Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households) and the second in 2008 (12,973 individuals in 3958 households). Household socio-economic, health care payment, and utilization information were recorded in household interviews. Results Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were −0.0024 (urban) and −0.0281 (rural) in 2002, and −0.0177 (urban) and −0.0097 (rural) in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: –0.0615 in 2002,–0.1436 in 2007.). Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Conclusions Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve financing equity considerably. Optimizing benefit packages in public health insurance is as important as expanding coverage, both for health care financing and for utilization management as well. Although they are progressive, out-of-pocket payments are not equitable in China and have the effect of excluding the poor from health care as they cannot afford to pay for medical care and so withdraw from treatment. PMID:23244513

New evidence on financing equity in China's health care reform--a case study on Gansu province, China.

PubMed

Chen, Mingsheng; Chen, Wen; Zhao, Yuxin

2012-12-18

In the transition from a planned economy to a market-oriented economy, China's state funding for health care declined and traditional coverage plans collapsed, leaving China's poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households) and the second in 2008 (12,973 individuals in 3958 households). Household socio-economic, health care payment, and utilization information were recorded in household interviews. Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were -0.0024 (urban) and -0.0281 (rural) in 2002, and -0.0177 (urban) and -0.0097 (rural) in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: -0.0615 in 2002,-0.1436 in 2007.). Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve financing equity considerably. Optimizing benefit packages in public health insurance is as important as expanding coverage, both for health care financing and for utilization management as well. Although they are progressive, out-of-pocket payments are not equitable in China and have the effect of excluding the poor from health care as they cannot afford to pay for medical care and so withdraw from treatment.

A Study of the Utah Public School Finance System: Findings and Recommendations of the Utah School Finance Task Force.

ERIC Educational Resources Information Center

Utah State Office of Education, Salt Lake City.

Equity effects of program growth and diversification on the Utah public education finance system are examined. The degree to which student and taxpayer equity are achieved by district formulas of the Minimum School Program are assessed by analysis of school-related taxation and spending over time, current distribution patterns of state support,…

Human Rights and the Political Economy of Universal Health Care: Designing Equitable Financing.

PubMed

Rudiger, Anja

2016-12-01

Health system financing is a critical factor in securing universal health care and achieving equity in access and payment. The human rights framework offers valuable guidance for designing a financing strategy that meets these goals. This article presents a rights-based approach to health care financing developed by the human right to health care movement in the United States. Grounded in a human rights analysis of private, market-based health insurance, advocates make the case for public financing through progressive taxation. Financing mechanisms are measured against the twin goals of guaranteeing access to care and advancing economic equity. The added focus on the redistributive potential of health care financing recasts health reform as an economic policy intervention that can help fulfill broader economic and social rights obligations. Based on a review of recent universal health care reform efforts in the state of Vermont, this article reports on a rights-based public financing plan and model, which includes a new business tax directed against wage disparities. The modeling results suggest that a health system financed through equitable taxation could produce significant redistributive effects, thus increasing economic equity while generating sufficient funds to provide comprehensive health care as a universal public good.

Strategies for promoting equity: experience with community financing in three African countries.

PubMed

Gilson, L; Kalyalya, D; Kuchler, F; Lake, S; Oranga, H; Ouendo, M

2001-10-01

Although the need for a pro-poor health reform agenda in low and middle income countries is increasingly clear, implementing such policy change is always difficult. This paper seeks to contribute to thinking about how to take forward such an agenda by reflection on the community financing activities of the UNICEF/WHO Bamako Initiative. It presents findings from a three-country study, undertaken in Benin, Kenya and Zambia in 1994/95, which was initiated in order to better understand the nature of the equity impact of community financing activities as well as the factors underlying this impact. The sustained relative affordability gains achieved in Benin emphasise the importance of ensuring that financing change is used as a policy lever for strengthening health service management in support of quality of care improvements. All countries, however, failed in protecting the most poor from the burden of payment, benefiting this group preferentially and ensuring that their views were heard in decision-making. Tackling these problems requires, amongst other things, an appropriate balance between central and local-level decision-making as well as the creation of local decision-making structures which have representation from civil society groups that can voice the needs of the most poor. Leadership, strategy and tactics are also always important in securing any kind of equity gain-such as establishing equity goals to drive implementation. In the experiences examined, the dominance of the goal of financial sustainability contributed to their equity failures. Further research is required to understand what equity goals communities themselves would prefer to guide financing policy.

Human Rights and the Political Economy of Universal Health Care

PubMed Central

2016-01-01

Abstract Health system financing is a critical factor in securing universal health care and achieving equity in access and payment. The human rights framework offers valuable guidance for designing a financing strategy that meets these goals. This article presents a rights-based approach to health care financing developed by the human right to health care movement in the United States. Grounded in a human rights analysis of private, market-based health insurance, advocates make the case for public financing through progressive taxation. Financing mechanisms are measured against the twin goals of guaranteeing access to care and advancing economic equity. The added focus on the redistributive potential of health care financing recasts health reform as an economic policy intervention that can help fulfill broader economic and social rights obligations. Based on a review of recent universal health care reform efforts in the state of Vermont, this article reports on a rights-based public financing plan and model, which includes a new business tax directed against wage disparities. The modeling results suggest that a health system financed through equitable taxation could produce significant redistributive effects, thus increasing economic equity while generating sufficient funds to provide comprehensive health care as a universal public good. PMID:28559677

An Algorithm for Deriving Fiscal Equity Indicators of a School Financing Structure: Application to Nebraska.

ERIC Educational Resources Information Center

Hayden, F. Gregory

1980-01-01

By algebraically defining a school finance structure as a total budget system, partial derivatives can be used to find the kinds of rewards, incentives, and distributions the structure defines for individual districts and among districts. Equity concerns can also be answered. (Author/IRT)

Ohio School Finance: Continuing Challenges to Adequacy and Equity of Funding.

ERIC Educational Resources Information Center

Payne, Gary L.; Cambron-McCabe, Nelda H.

1999-01-01

Recent research and a 1996 PBS documentary concluded that Ohio's educational finance system remains inequitable. Guarantees to districts facilitated equity, but assessed property valuation per pupil significantly predicted current operating expenditures during the 1980s. Effects of state loans, property tax limitations, and the lottery are…

PV Project Finance in the United States, 2016

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feldman, David; Lowder, Travis; Schwabe, Paul

This brief is a compilation of data points and market insights that reflect the state of the project finance market for solar photovoltaic (PV) assets in the United States as of the third quarter of 2016. This information can generally be used as a simplified benchmark of the costs associated with securing financing for solar PV as well as the cost of the financing itself (i.e., the cost of capital). Three sources of capital are considered -- tax equity, sponsor equity, and debt -- across three segments of the PV marketplace.

Measuring equity in household's health care payments (Tehran-Iran 2013): technical points for health policy decision makers.

PubMed

Rezapour, Aziz; Ebadifard Azar, Farbod; Azami Aghdash, Saber; Tanoomand, Asghar; Hosseini Shokouh, Seyed Morteza; Yousefzadeh, Negar; Atefi Manesh, Pezhman; Sarabi Asiabar, Ali

2015-01-01

Households' financial protection against health payments and expenditures and equity in utilization of health care services are of the most important tasks of governments. This study aims to measuring equity in household's health care payments according to fairness in financial contribution (FFC) and Kakwani indices in Tehran-Iran, 2013. This cross-sectional study was conducted in 2014.The study sample size was estimated to be 2200 households. Households were selected using stratified-cluster sampling including typical families who reside in the city of Tehran. The data were analyzed through Excel and Stata v.11software. Recall period for the inpatient care was 1 year and for outpatient1 month. The indicator of FFC for households in health financing was estimated to be 0.68 and the trend of the indicator was ascending by the rise in the ranking of households' financial level. The Kakwani index was estimated to be a negative number (-0.00125) which indicated the descending trend of health financing system. By redistribution of incomes or the exempt of the poorest quintiles from health payments, Kakwani index was estimated to be a positive number (0.090555) which indicated the ascending trend of health financing system. According to this study, the equity indices in health care financing denote injustice and a descending trend in the health care financing system. This finding clearly shows that deliberate policy making in health financing by national health authorities and protecting low-income households against health expenditures are required to improve the equity in health.

Assessment of equity in healthcare financing in Fiji and Timor-Leste: a study protocol

PubMed Central

Asante, Augustine D; Price, Jennifer; Hayen, Andrew; Irava, Wayne; Martins, Joao; Guinness, Lorna; Ataguba, John E; Limwattananon, Supon; Mills, Anne; Jan, Stephen; Wiseman, Virginia

2014-01-01

Introduction Equitable health financing remains a key health policy objective worldwide. In low and middle-income countries (LMICs), there is evidence that many people are unable to access the health services they need due to financial and other barriers. There are growing calls for fairer health financing systems that will protect people from catastrophic and impoverishing health payments in times of illness. This study aims to assess equity in healthcare financing in Fiji and Timor-Leste in order to support government efforts to improve access to healthcare and move towards universal health coverage in the two countries. Methods and analysis The study employs two standard measures of equity in health financing increasingly being applied in LMICs—benefit incidence analysis (BIA) and financing incidence analysis (FIA). In Fiji, we will use a combination of secondary and primary data including a Household Income and Expenditure Survey, National Health Accounts, and data from a cross-sectional household survey on healthcare utilisation. In Timor-Leste, the World Bank recently completed a health equity and financial protection analysis that incorporates BIA and FIA, and found that the distribution of benefits from healthcare financing is pro-rich. Building on this work, we will explore the factors that influence the pro-rich distribution. Ethics and dissemination The study is approved by the Human Research Ethics Committee of University of New South Wales, Australia (Approval number: HC13269); the Fiji National Health Research Committee (Approval # 201371); and the Timor-Leste Ministry of Health (Ref MS/UNSW/VI/218). Results Study outcomes will be disseminated through stakeholder meetings, targeted multidisciplinary seminars, peer-reviewed journal publications, policy briefs and the use of other web-based technologies including social media. A user-friendly toolkit on how to analyse healthcare financing equity will be developed for use by policymakers and development partners in the region. PMID:25468509

Assessment of equity in healthcare financing in Fiji and Timor-Leste: a study protocol.

PubMed

Asante, Augustine D; Price, Jennifer; Hayen, Andrew; Irava, Wayne; Martins, Joao; Guinness, Lorna; Ataguba, John E; Limwattananon, Supon; Mills, Anne; Jan, Stephen; Wiseman, Virginia

2014-12-02

Equitable health financing remains a key health policy objective worldwide. In low and middle-income countries (LMICs), there is evidence that many people are unable to access the health services they need due to financial and other barriers. There are growing calls for fairer health financing systems that will protect people from catastrophic and impoverishing health payments in times of illness. This study aims to assess equity in healthcare financing in Fiji and Timor-Leste in order to support government efforts to improve access to healthcare and move towards universal health coverage in the two countries. The study employs two standard measures of equity in health financing increasingly being applied in LMICs-benefit incidence analysis (BIA) and financing incidence analysis (FIA). In Fiji, we will use a combination of secondary and primary data including a Household Income and Expenditure Survey, National Health Accounts, and data from a cross-sectional household survey on healthcare utilisation. In Timor-Leste, the World Bank recently completed a health equity and financial protection analysis that incorporates BIA and FIA, and found that the distribution of benefits from healthcare financing is pro-rich. Building on this work, we will explore the factors that influence the pro-rich distribution. The study is approved by the Human Research Ethics Committee of University of New South Wales, Australia (Approval number: HC13269); the Fiji National Health Research Committee (Approval # 201371); and the Timor-Leste Ministry of Health (Ref MS/UNSW/VI/218). Study outcomes will be disseminated through stakeholder meetings, targeted multidisciplinary seminars, peer-reviewed journal publications, policy briefs and the use of other web-based technologies including social media. A user-friendly toolkit on how to analyse healthcare financing equity will be developed for use by policymakers and development partners in the region. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage.

PubMed

Mills, Anne; Ataguba, John E; Akazili, James; Borghi, Jo; Garshong, Bertha; Makawia, Suzan; Mtei, Gemini; Harris, Bronwyn; Macha, Jane; Meheus, Filip; McIntyre, Di

2012-07-14

Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of financing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of different financing mechanisms, and patterns of service use. We report a whole-system analysis--integrating both public and private sectors--of the equity of health-system financing and service use in Ghana, South Africa, and Tanzania. We used primary and secondary data to calculate the progressivity of each health-care financing mechanism, catastrophic spending on health care, and the distribution of health-care benefits. We collected qualitative data to inform interpretation. Overall health-care financing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefits in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries. Analyses of the equity of financing and service use provide guidance on which financing mechanisms to expand, and especially raise questions over the appropriate financing mechanism for the health care of people outside the formal sector. Physical and financial barriers to service access must be addressed if universal coverage is to become a reality. European Union and International Development Research Centre. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Conceptualization and Measurement of Equity in School Finance in Virginia.

ERIC Educational Resources Information Center

Verstegen, Deborah A.; Salmon, Richard G.

1989-01-01

Employed various statistical techniques to measure fiscal equity in Virginia. The new state aid system for financing education was unable to mitigate large and increasing disparities in education revenues between more and less affluent localities and a strong and growing linkage between revenue and wealth. Includes 34 footnotes. (MLH)

The Equity of New York State's System of Financing Schools: An Update.

ERIC Educational Resources Information Center

Scheuer, Joan

1983-01-01

This statistical analysis of the equity and efficiency of New York's complex school finance system concludes that legislation since 1975 has neither significantly reduced wide disparities in local spending nor weakened the link between wealth and expenditure because the system cannot be improved without a substantial funding increase. (MJL)

Equity in Texas Public School Finance: Some Historical Perspectives.

ERIC Educational Resources Information Center

Walker, Billy D.

The history of equity concerns in Texas public school finance, spanning over a century, is reviewed in this report. Three issues related to three reform eras are discussed: equitable availability of public schooling, equal resources for schools, and school effectiveness. State responses to the issues included equalization of opportunities in rural…

Superintendent's Advisory Committee on School Finance. Final Report.

ERIC Educational Resources Information Center

Illinois State Office of the Superintendent of Public Instruction, Springfield. Advisory Committee on School Finance.

This report concentrates on the equity problem in Illinois public school finance. Central to this report is the thesis that there are three basic strategies for attacking the equity problem: make adjustments in the existing "foundation level" grant-in-aid system, abandon the "foundation" idea for a grant-in-aid system, and…

The Student Equity Effects of the Public School Finance System in Louisiana.

ERIC Educational Resources Information Center

Geske, Terry G.; LaCost, Barbara Y.

1990-01-01

Investigates the student equity effects of Louisiana's public school finance program in terms of fiscal neutrality and revenue inequality over a nine-year period, using regression techniques. Overall, Louisiana's system became less equal over the time period examined, while revenue distribution became more equal. Includes 35 references. (MLH)

Equity, governance and financing after health care reform: lessons from Mexico.

PubMed

Arredondo, Armando; Orozco, Emanuel

2008-01-01

To determine, from the perspective of providers, community leaders and users of health services, equity, governance and health financing outcomes of the Mexican health system reform.Cross-sectional study oriented towards the qualitative analysis of financing, governance and equity indicators for the uninsured population. Taking into account feasibility, as well as political and technical criteria, six Mexican states were selected as study populations and a qualitative research was conducted during 2004-2006. Two hundred and forty in-depth interviews were applied, in all selected states, to 60 decision-makers, including medical and administrative personnel; 60 service providers at health centres; 60 representatives of civil organizations, including municipal representatives and, finally, 60 members of health committees and users of services at second and first levels of care units. The analysis of interviews was performed using ATLAS-Ti software. An outcome mapping of health reform was developed. For political actors, Mexican health system reform has not modified dependence on the central level; ignorance about reform strategies and lack of participation in the search for financial resources to finance health systems were evidenced. Also, in all states under study, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Health strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. There are relevant positive and negative effects of the reform on equity, governance and financing in health. Special emphasis is placed on the analysis of lessons learned in Mexico and the usefulness of the main strengths and weaknesses, as relevant evidences for other middle-income countries which are designing, implementing and evaluating reform strategies in order to achieve equity in resource allocation, good levels of governance and a greater financial protection in health.

Equity in the finance of health care: some further international comparisons.

PubMed

Wagstaff, A; van Doorslaer, E; van der Burg, H; Calonge, S; Christiansen, T; Citoni, G; Gerdtham, U G; Gerfin, M; Gross, L; Häkinnen, U; Johnson, P; John, J; Klavus, J; Lachaud, C; Lauritsen, J; Leu, R; Nolan, B; Perán, E; Pereira, J; Propper, C; Puffer, F; Rochaix, L; Rodríguez, M; Schellhorn, M; Winkelhake, O

1999-06-01

This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al. [Wagstaff, A., van Doorslaer E., et al., 1992. Equity in the finance of health care: some international comparisons, Journal of Health Economics 11, pp. 361-387] but extends it in a number of directions: we modify the methodology used there and achieve a higher degree of cross-country comparability in variable definitions; we update and extend the cross-section of countries; and we present evidence on trends in financing mixes and progressivity.

Education Loans and Financing Higher Education in India: Addressing Equity

ERIC Educational Resources Information Center

Rani, P. Geetha

2014-01-01

The education loan programme since its inception has been rapidly growing both in terms of number of students who have taken education loans for pursuing higher education and the amount of education loans released. Nevertheless, these financing mechanisms of higher education do not appear to improve access and equity in the higher education system…

Human Capital Contracts: "Equity-Like" Instruments for Financing Higher Education. Policy Analysis.

ERIC Educational Resources Information Center

Palacios, Miguel

Human capital contracts are "equity-like" instruments for financing higher education. Since repayment depends on earning and adjusts to student capital to pay, these contracts should be more attractive to students than traditional loans. By making transparent the relative economic value of certain fields of study or the value of degrees from…

The Equity Challenge in China's Higher Education Finance Policy

ERIC Educational Resources Information Center

Sun, Fengshou; Barrientos, Armando

2009-01-01

Sustaining China's rapid economic growth in the future will come to depend in large part on the quantity and quality of the human resources it can mobilize. The paper considers the prospects for higher education financing, and highlights the importance of improving equity in access to higher education as a precondition for a sustainable expansion…

The equity impacts of community financing activities in three African countries.

PubMed

Gilson, L; Kalyalya, D; Kuchler, F; Lake, S; Oranga, H; Ouendo, M

2000-01-01

Although the Bamako Initiative from its very beginning was caught up in wider debates about the potential equity impact of any form of user financing, to date there has been little empirical investigation of this impact. This three-country study, undertaken in Benin, Kenya and Zambia in 1994/95, was initiated to add to the body of relevant evidence. It sought to understand not only what had been the equity impacts of community financing activities in these countries but also how they had been brought about. As a result, it investigated equity primarily through consideration of the design of these financing activities and through the perceptions of different actors, within a limited number of purposively selected geographical areas in each country, about their strengths and weaknesses. Additional data on utilization were either collected during the course of the study (Kenya) or drawn from other available studies (Benin and Zambia). Key issues considered in the studies' assessment of equity were the extent to which both relative and absolute affordability gains were achieved, as well as as an influence over both the distributional and procedural justice of the financing activities, the pattern of decision-making. Across countries there was evidence of relative affordability gains in Benin and Kenya, but Kenyan gains were not sustained over time and no such gains were identified in Zambia. In addition, no country had given attention either to the issue of absolute affordability, through the implementation of effective exemption mechanisms to protect the poorest from the burden of payment, or to the establishment of community decision-making bodies that effectively represented the interests of all groups including the poorest. Overall, therefore, although the Benin Bamako Initiative programme might be judged as successful in terms of what appear to be its own equity objectives, the other two countries' schemes had clear equity problems even in these terms. The experience across countries also highlights the unresolved question of whether equity is concerned with the greatest good for the greatest number or with promoting the interests of the most disadvantaged.

Implications of Financing Higher Education for Access and Equity: The Case of Syria

ERIC Educational Resources Information Center

Kabbani, Nader; Salloum, Siba

2011-01-01

This article examines the implications for access and equity of the Syrian government's efforts to reform higher education in the country over the past decade. In the context of social and economic reforms that are moving the county from a state-controlled to a social market economy, it focuses on adequacy in financing higher education, as well as…

An Empirical Analysis of Horizontal and Vertical Equity in the Public Schools of Tennessee, 1994-2003

ERIC Educational Resources Information Center

Rolle, Anthony; Liu, Keke

2007-01-01

In the 1990s, Tennessee transformed its educational finance landscape through a series of equity litigation known as "Small Schools v. Tennessee I, II, and III," yet there has been no longitudinal evaluation of the efficacy of the changes in the state's education finance mechanism or the concomitant expenditure distributions. Therefore,…

The Political Economy of Education Finance: The Case of Texas

ERIC Educational Resources Information Center

Husted, Thomas; Kenny, Lawrence

2014-01-01

Texas has one of the largest primary and secondary school systems in the United States. Funding equity has been a concern in the state courts, and significant legislative actions have been taken. We examine two votes taken in the Texas State Legislature in 1993 and 2006 that follow the directives from a series of education finance equity legal…

Leaving Equity Behind? A Quantitative Analysis of Fiscal Equity in Nevada's Public Education Finance System

ERIC Educational Resources Information Center

Verstegen, Deborah A.

2013-01-01

Over time, issues of justice and fairness in education finance have been addressed by the courts in all but five states. The key focus has been on illegitimate disparities in funding between rich and poor school districts caused by the happenstance of unequal local wealth. Recently, attention has turned to the relationship between funding gaps and…

31 CFR 29.523 - Equity and good conscience.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Equity and good conscience. 29.523... Standards for Waiver of Overpayments § 29.523 Equity and good conscience. Recovery is against equity and good conscience when there is substantial evidence that— (a) It would cause financial hardship to the...

A Review of Wind Project Financing Structures in the USA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bolinger, Mark A; Harper, John; Karcher, Matthew

2008-09-24

The rapid pace of wind power development in the U.S. over the last decade has outstripped the ability of most project developers to provide adequate equity capital and make efficient use of project-related tax benefits. In response, the sector has created novel project financing structures that feature varying combinations of equity capital from project developers and third-party tax-oriented investors, and in some cases commercial debt. While their origins stem from variations in the financial capacity and business objectives of wind project developers, as well as the risk tolerances and objectives of equity and debt providers, each structure is, at itsmore » core, designed to manage project risk and allocate federal tax incentives to those entities that can use them most efficiently. This article surveys the six principal financing structures through which most new utility-scale wind projects (excluding utility-owned projects) in the U.S. have been financed from 1999 to the present. These structures include simple balance-sheet finance, several varieties of all-equity special allocation partnership 'flip' structures, and two leveraged structures. In addition to describing each structure's mechanics, the article also discusses its rationale for use, the types of investors that find it appealing and why, and its relative frequency of use in the market. The article concludes with a generalized summary of how a developer might choose one structure over another.« less

Financing for universal health coverage in small island states: evidence from the Fiji Islands

PubMed Central

Asante, Augustine D; Irava, Wayne; Limwattananon, Supon; Hayen, Andrew; Martins, Joao; Guinness, Lorna; Ataguba, John E; Price, Jennifer; Jan, Stephen; Mills, Anne; Wiseman, Virginia

2017-01-01

Background Universal health coverage (UHC) is critical to global poverty alleviation and equity of health systems. Many low-income and middle-income countries, including small island states in the Pacific, have committed to UHC and reforming their health financing systems to better align with UHC goals. This study provides the first comprehensive evidence on equity of the health financing system in Fiji, a small Pacific island state. The health systems of such states are poorly covered in the international literature. Methods The study employs benefit and financing incidence analyses to evaluate the distribution of health financing benefits and burden across the public and private sectors. Primary data from a cross-sectional survey of 2000 households were used to assess healthcare benefits and secondary data from the 2008–2009 Fiji Household Income and Expenditure Survey to assess health financing contributions. These were analysed by socioeconomic groups to determine the relative benefit and financing incidence across these groups. Findings The distribution of healthcare benefits in Fiji slightly favours the poor—around 61% of public spending for nursing stations and 26% of spending for government hospital inpatient care were directed to services provided to the poorest 20% of the population. The financing system is significantly progressive with wealthier groups bearing a higher share of the health financing burden. Conclusions The healthcare system in Fiji achieves a degree of vertical equity in financing, with the poor receiving a higher share of benefits from government health spending and bearing a lower share of the financing burden than wealthier groups. PMID:28589017

Financing for universal health coverage in small island states: evidence from the Fiji Islands.

PubMed

Asante, Augustine D; Irava, Wayne; Limwattananon, Supon; Hayen, Andrew; Martins, Joao; Guinness, Lorna; Ataguba, John E; Price, Jennifer; Jan, Stephen; Mills, Anne; Wiseman, Virginia

2017-01-01

Universal health coverage (UHC) is critical to global poverty alleviation and equity of health systems. Many low-income and middle-income countries, including small island states in the Pacific, have committed to UHC and reforming their health financing systems to better align with UHC goals. This study provides the first comprehensive evidence on equity of the health financing system in Fiji, a small Pacific island state. The health systems of such states are poorly covered in the international literature. The study employs benefit and financing incidence analyses to evaluate the distribution of health financing benefits and burden across the public and private sectors. Primary data from a cross-sectional survey of 2000 households were used to assess healthcare benefits and secondary data from the 2008-2009 Fiji Household Income and Expenditure Survey to assess health financing contributions. These were analysed by socioeconomic groups to determine the relative benefit and financing incidence across these groups. The distribution of healthcare benefits in Fiji slightly favours the poor-around 61% of public spending for nursing stations and 26% of spending for government hospital inpatient care were directed to services provided to the poorest 20% of the population. The financing system is significantly progressive with wealthier groups bearing a higher share of the health financing burden. The healthcare system in Fiji achieves a degree of vertical equity in financing, with the poor receiving a higher share of benefits from government health spending and bearing a lower share of the financing burden than wealthier groups.

Medicare financing and redistribution in british columbia, 1992 and 2002.

PubMed

McGrail, Kimberlyn

2007-05-01

Equity in healthcare in British Columbia is defined as the provision of services based on need rather than ability to pay and a separation of contributions to financing from the use of services. Physician and hospital services in Canada are financed mainly through general tax revenues, and there is a perception that this financing is progressive. This paper uses Gini coefficients, concentration indexes and Kakwani indexes of progressivity to assess the progressivity of medicare financing in British Columbia in 1992 and 2002. It also measures the overall redistributive effect of medicare services, considering both contributions to financing and use of hospital and physician services. The conclusion is that medicare does redistribute across income groups, but this redistribution is the result solely of the positive correlation between health status and income; financing is nearly proportionate across income groups, but use is higher among lower-income groups. Informed public debate requires a better understanding of these concepts of equity.

Who Pays for Health Care in China? The Case of Heilongjiang Province

PubMed Central

Chen, Mingsheng; Zhao, Yuxin; Si, Lei

2014-01-01

Background Health spending by the Chinese government has declined and traditional social health insurance collapsed after economic reforms in the early 1980s; accordingly, the low-income population is exposed to potentially significant healthcare costs. Financing an equitable healthcare system represents a major policy objective in China’s current healthcare reform efforts. The current research presents an examination of the distribution of healthcare financing in a north-eastern Chinese province to compare equity status between urban and rural areas at two different times. Methods To analyze the progressivity of healthcare financing in terms of ability-to-pay, the Kakwani index was used to assess four healthcare financing channels: general taxes, social and commercial health insurance, and out-of-pocket payments. Two rounds of surveys were conducted in 2003 (11,572 individuals in 3841 households) and 2008 (15,817 individuals in 5530 households). Household socioeconomic status, healthcare payment, and utilization information were recorded using household interviews. Results China’s healthcare financing equity is unsound. Kakwani indices for general taxation were -0.0212 (urban) and -0.0297 (rural) in 2002, and -0.0097 (urban) and -0.0112 (rural) in 2007. Social health insurance coverage has expanded, however different financing distributions were found with respect to urban (0.0969 in 2002 vs. 0.0984 in 2007) and rural (0.0283 in 2002 vs. -0.3119 in 2007) areas. While progressivity of out-of-pocket payments decreased in both areas, the equity of financing was found to have improved among poorer respondents. Conclusions Overall, China’s healthcare financing distribution is unequal. Given the inequity of general taxes, decreasing the proportion of indirect taxes would considerably improve healthcare financing equity. Financial contribution mechanisms to social health insurance are equally significant to coverage extension. The use of flat rate contributions for healthcare funding places a disproportionate pressure upon the poor. Out-of-pocket payments have become equitable, but progressivity has decreased. PMID:25271768

Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses.

PubMed

Asante, Augustine; Price, Jennifer; Hayen, Andrew; Jan, Stephen; Wiseman, Virginia

2016-01-01

Health financing reforms in low- and middle- income countries (LMICs) over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA. Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA) and/or financing incidence analysis (FIA) as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing. Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance equity. The results overall suggest that there are impediments to making health care more accessible to the poor and this must be addressed if universal health coverage is to be a reality.

Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses

PubMed Central

Price, Jennifer; Hayen, Andrew; Jan, Stephen; Wiseman, Virginia

2016-01-01

Introduction Health financing reforms in low- and middle- income countries (LMICs) over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA. Methods and Findings Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA) and/or financing incidence analysis (FIA) as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing. Conclusion Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance equity. The results overall suggest that there are impediments to making health care more accessible to the poor and this must be addressed if universal health coverage is to be a reality. PMID:27064991

Who pays for and who benefits from health care services in Uganda?

PubMed

Kwesiga, Brendan; Ataguba, John E; Abewe, Christabel; Kizza, Paul; Zikusooka, Charlotte M

2015-02-01

Equity in health care entails payment for health services according to the capacity to pay and the receipt of benefits according to need. In Uganda, as in many African countries, although equity is extolled in government policy documents, not much is known about who pays for, and who benefits from, health services. This paper assesses both equity in the financing and distribution of health care benefits in Uganda. Data are drawn from the most recent nationally representative Uganda National Household Survey 2009/10. Equity in health financing is assessed considering the main domestic health financing sources (i.e., taxes and direct out-of-pocket payments). This is achieved using bar charts and standard concentration and Kakwani indices. Benefit incidence analysis is used to assess the distribution of health services for both public and non-public providers across socio-economic groups and the need for care. Need is assessed using limitations in functional ability while socioeconomic groups are created using per adult equivalent consumption expenditure. Overall, health financing in Uganda is marginally progressive; the rich pay more as a proportion of their income than the poor. The various taxes are more progressive than out-of-pocket payments (e.g., the Kakwani index of personal income tax is 0.195 compared with 0.064 for out-of-pocket payments). However, taxes are a much smaller proportion of total health sector financing compared with out-of-pocket payments. The distribution of total health sector services benefitsis pro-rich. The richest quintile receives 19.2% of total benefits compared to the 17.9% received by the poorest quintile. The rich also receive a much higher share of benefits relative to their need. Benefits from public health units are pro-poor while hospital based care, in both public and non-public sectors are pro-rich. There is a renewed interest in ensuring equity in the financing and use of health services. Based on the results in this paper, it would seem that in order to safeguard such equity, there is a need for policy that focuses on addressing the health needs of the poor while continuing to ensure that the burden of financing health services does not rest disproportionately on the poor.

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis.

PubMed

Zandian, Hamed; Takian, Amirhossein; Rashidian, Arash; Bayati, Mohsen; Zahirian Moghadam, Telma; Rezaei, Satar; Olyaeemanesh, Alireza

2018-03-01

One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households' income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis

PubMed Central

Bayati, Mohsen

2018-01-01

Objectives One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing. PMID:29631352

Financing Opportunities for Renewable Energy Development in Alaska

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ardani, K.; Hillman, D.; Busche, S.

2013-04-01

This technical report provides an overview of existing and potential financing structures for renewable energy project development in Alaska with a focus on four primary sources of project funding: government financed or supported (the most commonly used structure in Alaska today), developer equity capital, commercial debt, and third-party tax-equity investment. While privately funded options currently have limited application in Alaska, their implementation is theoretically possible based on successful execution in similar circumstances elsewhere. This report concludes that while tax status is a key consideration in determining appropriate financing structure, there are opportunities for both taxable and tax-exempt entities to participatemore » in renewable energy project development.« less

Progress toward School Finance Equity Goals in Indiana, Iowa, and Illinois.

ERIC Educational Resources Information Center

Hickrod, G. Alan; And Others

1980-01-01

Concludes that a state may make very uneven progress toward some general equity goal if that equity goal is operationalized in different ways. A preference for tax disparity, expenditure disparity reduction, or wealth neutrality gains may have to be expressed. (Author/IRT)

Equity and financing for sexual and reproductive health service delivery: current innovations.

PubMed

Montagu, Dominic; Graff, Maura

2009-07-01

National and international decisions on financing for sexual and reproductive health (SRH) services have profound effects on the type, unit costs and distribution of SRH commodities and services produced, and on their availability and consumption. Much international and national funding is politically driven and is doing little for equity and quality improvement. Financing remains a significant challenge in most developing countries and demands creative responses. While no "one-size-fits-all" solution exists, there are numerous ongoing examples of successful innovations, many of which are focusing on resource pooling and on purchasing or subsidising SRH services. In this article we have used interviews, grey literature and presentations made at a range of recent public fora to identify new and innovative ways of financing SRH services so as to increase equity in developing countries. Because SRH services are often of low value as a personal good but high value as a public good, we summarise the issues from a societal perspective, highlighting the importance of financing and policy decisions for SRH services. We provide a structured overview of what novel approaches to financing appear to have positive effects in a range of developing countries. Targeting, government payment mechanisms, subsidy delivery and co-financing for sustainability are highlighted as showing particular promise. Examples are used throughout the article to illustrate innovative strategies.

24 CFR 241.1010 - Feasibility letter.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SUPPLEMENTARY FINANCING FOR INSURED PROJECT MORTGAGES Insurance for Equity Loans and Acquisition Loans... Commissioner's estimate of the supportable loan amount, based upon the project's equity in the case of an equity loan and based on the project's purchase price in the case of an acquisition loan, but such...

Equity for Children: Linking Education and Children's Services.

ERIC Educational Resources Information Center

Kirst, Michael W.

1994-01-01

Educational equity must be reconceptualized and merged with children's conditions and a broader concept of children's services than schooling. National goals, particularly learning readiness, demand a broader definition of children's finance and equity. School-linked services can be funded by converging existing public and private funding streams…

The progressivity of health-care financing in Kenya.

PubMed

Munge, Kenneth; Briggs, Andrew Harvey

2014-10-01

Health-care financing should be equitable. In many developing countries such as Kenya, changes to health-care financing systems are being implemented as a means of providing equitable access to health care with the aim of attaining universal coverage. Vertical equity means that people of dissimilar ability to pay make dissimilar levels of contribution to the health-care financing system. Vertical equity can be analysed by measuring progressivity. The aim of this study was to analyse progressivity by measuring deviations from proportionality in the relationship between sources of health-care financing and ability to pay using Kakwani indices applied to data from the Kenya Household Health Utilisation and Expenditure Survey 2007. Concentration indices and Kakwani indices were obtained for the sources of health-care financing: direct and indirect taxes, out of pocket (OOP) payments, private insurance contributions and contributions to the National Hospital Insurance Fund. The bootstrap method was used to analyse the sensitivity of the Kakwani index to changes in the equivalence scale or the use of an alternative measure of ability to pay. The overall health-care financing system was regressive. Out of pocket payments were regressive with all other payments being proportional. Direct taxes, indirect taxes and private insurance premiums were sensitive to the use of income as an alternative measure of ability to pay. However, the overall finding of a regressive health-care system remained. Reforms to the Kenyan health-care financing system are required to reduce dependence on out of pocket payments. The bootstrap method can be used in determining the sensitivity of the Kakwani index to various assumptions made in the analysis. Further analyses are required to determine the equity of health-care utilization and the effect of proposed reforms on overall equity of the Kenyan health-care system. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

24 CFR 241.1000 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SUPPLEMENTARY FINANCING FOR INSURED PROJECT MORTGAGES Insurance for Equity Loans and Acquisition Loans... the owner of an eligible multifamily project to capture a portion of the project's equity, in...

Equity and Entrepreneurialism: The Impact of Tax Increment Financing on School Finance.

ERIC Educational Resources Information Center

Weber, Rachel

2003-01-01

Describes tax increment financing (TIF), an entrepreneurial strategy with significant fiscal implications for overlapping taxing jurisdictions that provide these functions. Statistical analysis of TIF's impact on the finances of one Illinois county's school districts indicates that municipal use of TIF depletes the property tax revenues of schools…

Financing Higher Education after Tax Reform.

ERIC Educational Resources Information Center

Anderson, Richard E.; Meyerson, Joel W.

1987-01-01

Capital finance, once limited to financing physical plant, today includes all assets and aspects of institutional life. It now encompasses a wide range of approaches and techniques including pooled debt, capital leases, futures contracts, equity investments, and research partnerships. (MLW)

77 FR 20871 - Praesidian Capital Opportunity Fund III, LP; License No. 02/02-0647; Notice Seeking Exemption...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-06

... and preferred equity financing to CB Restaurants, Inc. The financing is follow-on financing... of Praesidian Capital Opportunity Fund III, LP, holds an ownership position in CB Restaurants, Inc...

Expenditure Equity in the Public Schools of Atlantic Canada.

ERIC Educational Resources Information Center

Lake, Philip

1983-01-01

Using three determinants of equity--disparity, wealth neutrality, and sufficiency--this study examines public school financing in four Canadian provinces (Nova Scotia, Prince Edward Island, Newfoundland, and New Brunswick) to find whether equity as defined in the United States has been achieved and what the state role has been. (JW)

What Is Fair? Special Education and Financial Equity.

ERIC Educational Resources Information Center

Parrish, Thomas B.

1995-01-01

Examines equity issues pertaining to special-education students, finance systems, and taxpayers. The major student equity focus is "inclusion." After passage of IDEA, reducing the number of restrictive special-education placements has become a clearly articulated policy objective. There is a movement away from cost-based to census-based…

Education Resourcing in Post-Apartheid South Africa: The Impact of Finance Equity Reforms in Public Schooling: Research Article

ERIC Educational Resources Information Center

Motala, Shireen

2006-01-01

Through an analysis of recent quantitative data on equity and school funding in South Africa, this article aims to explicate the patterns and typology of inequality in post-apartheid South Africa, and to deepen our understanding of the construct of equity. It also aims to understand the application of equity in the context of public schooling…

24 CFR 241.1068 - Renegotiation of an equity loan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AUTHORITIES SUPPLEMENTARY FINANCING FOR INSURED PROJECT MORTGAGES Insurance for Equity Loans and Acquisition... the project for which a loan closing occurred if— (a) The loan closing occurred between September 28...

[Spending and financing in health care: situation and trends].

PubMed

Molina, R; Pinto, M; Henderson, P; Vieira, C

2000-01-01

Being knowledgeable about national health expenditures and sources of financing is essential for decision-making. This awareness also makes it possible to evaluate the equity of allocation and the efficiency of utilization of these resources. Changes in financing have been a substantial component of health sector reform in the Americas. The goal has shifted from merely one of financial sustainability to simultaneously seeking equitable access to quality services. In this article the Pan American Health Organization (PAHO) presents a proposal for analyzing and designing a policy on health financing. The aim of the policy is to identify the mix of financing mechanisms most likely to simultaneously produce financial sustainability, equity, access, and efficiency. The PAHO proposal combines traditional mechanisms for generating resources (public funds from taxes, as well as private health insurance, national health insurance, and user fees) with complementary subsidy mechanisms for vulnerable groups. Health financing strategies ought to explicitly consider the financing both of care for individuals and of health interventions for the general public good, for which public financing is the most equitable and efficient approach.

Equity during an economic crisis: financing of the Argentine health system.

PubMed

Cavagnero, Eleonora; Bilger, Marcel

2010-07-01

This article analyses the redistributive effect caused by health financing and the distribution of healthcare utilization in Argentina before and during the severe 2001/2002 economic crisis. Both dramatically changed during this period: the redistributive effect became much more positive and utilization shifted from pro-poor to pro-rich. This clearly demonstrates that when utilization is contingent on financing, changes can occur rapidly; and that an integrated approach is required when monitoring equity. From a policy perspective, the Argentine health system appears vulnerable to economic downturns mainly due to high reliance on out-of-pocket payments and the strong link between health insurance and employment.

Equity Goals in Illinois School Finance: 1973-1979.

ERIC Educational Resources Information Center

Hickrod, G. Alan; And Others

This paper uses the year 1972-73 as a base line in evaluating the progress of Illinois toward certain "equity goals." In determining the equity goals, two dimensions are studied--disparity and wealth neutrality. One measure of disparity is the permissible variance in school district expenditures expressed in the coefficient of variation,…

Improving equity in health care financing in China during the progression towards Universal Health Coverage.

PubMed

Chen, Mingsheng; Palmer, Andrew J; Si, Lei

2017-12-29

China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. Improving financing equity is a major policy goal of health care system during the progression towards universal coverage. We used progressivity analysis and dominance test to evaluate the financing channels of general taxation, pubic health insurance, and out-of-pocket (OOP) payments. In 2012 a survey of 8854 individuals in 3008 households recorded the socioeconomic and demographic status, and health care payments of those households. The overall Kakwani index (KI) of China's health care financing system is 0.0444. For general tax KI was -0.0241 (95% confidence interval (CI): -0.0315 to -0.0166). The indices for public health schemes (Urban Employee Basic Medical Insurance, Urban Resident's Basic Medical Insurance, New Rural Cooperative Medical Scheme) were respectively 0.1301 (95% CI: 0.1008 to 0.1594), -0.1737 (95% CI: -0.2166 to -0.1308), and -0.5598 (95% CI: -0.5830 to -0.5365); and for OOP payments KI was 0.0896 (95%CI: 0.0345 to 0.1447). OOP payments are still the dominant part of China's health care finance system. China's health care financing system is not really equitable. Reducing the proportion of indirect taxes would considerably improve health care financing equity. The flat-rate contribution mechanism is not recommended for use in public health insurance schemes, and more attention should be given to optimizing benefit packages during China's progression towards UHC.

Diminishing musyarakah investment model based on equity

NASA Astrophysics Data System (ADS)

Jaffar, Maheran Mohd; Zain, Shaharir Mohamad; Jemain, Abdul Aziz

2017-11-01

Most of the mudharabah and musyarakah contract funds are involved in debt financing. This does not support the theory that profit sharing contract is better than that of debt financing due to the sharing of risks and ownership of equity. Indeed, it is believed that Islamic banking is a financial model based on equity or musyarakah which emphasis on the sharing of risks, profit and loss in the investment between the investor and entrepreneur. The focus of this paper is to introduce the mathematical model that internalizes diminishing musyarakah, the sharing of profit and equity between entrepreneur and investor. The entrepreneur pays monthly-differed payment to buy out the equity that belongs to the investor (bank) where at the end of the specified period, the entrepreneur owns the business and the investor (bank) exits the joint venture. The model is able to calculate the amount of equity at any time for both parties and hence would be a guide in helping to estimate the value of investment should the entrepreneur or investor exit before the end of the specified period. The model is closer to the Islamic principles for justice and fairness.

Distributional consequences of the transition from age-based to income-based prescription drug coverage in British Columbia, Canada.

PubMed

Hanley, Gillian E; Morgan, Steve; Hurley, Jeremiah; van Doorslaer, Eddy

2008-12-01

In May, 2003, British Columbia transitioned from an age-based public drug program, with public subsidy primarily based on age, to an age-irrelevant income-based drug program, in which public subsidy is based primarily on household income. As one of the specific aims of the policy change was to improve fairness by increasing the extent to which payment for drugs is based on ability to pay, we measure the progressivity of pharmaceutical financing before and after the policy change in BC using Kakwani indices. Our results suggest that pharmaceutical financing became less regressive after the policy change. However, this decrease in regressivity arose primarily because high-income seniors were making greater direct contributions to pharmaceutical financing and not because low-income households were making smaller direct contributions. Our results also suggest that if the public financing of pharmaceuticals were maintained or increased, a change from age-based to income-based eligibility can unambiguously improve equity in finance. As populations in developed countries age, governments will increasingly consider reforms to publicly financed health-care programs with age-based eligibility. In assessing policy options, financial equity is likely to be a key consideration. These results suggest that income-based pharmacare can improve financial equity especially when implemented with a commitment to maintain or increase public funding for prescription drugs.

Viewing the Kenyan health system through an equity lens: implications for universal coverage

PubMed Central

2011-01-01

Introduction Equity and universal coverage currently dominate policy debates worldwide. Health financing approaches are central to universal coverage. The way funds are collected, pooled, and used to purchase or provide services should be carefully considered to ensure that population needs are addressed under a universal health system. The aim of this paper is to assess the extent to which the Kenyan health financing system meets the key requirements for universal coverage, including income and risk cross-subsidisation. Recommendations on how to address existing equity challenges and progress towards universal coverage are made. Methods An extensive review of published and gray literature was conducted to identify the sources of health care funds in Kenya. Documents were mainly sourced from the Ministry of Medical Services and the Ministry of Public Health and Sanitation. Country level documents were the main sources of data. In cases where data were not available at the country level, they were sought from the World Health Organisation website. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. Results The Kenyan health sector relies heavily on out-of-pocket payments. Government funds are mainly allocated through historical incremental approach. The sector is largely underfunded and health care contributions are regressive (i.e. the poor contribute a larger proportion of their income to health care than the rich). Health financing in Kenya is fragmented and there is very limited risk and income cross-subsidisation. The country has made little progress towards achieving international benchmarks including the Abuja target of allocating 15% of government's budget to the health sector. Conclusions The Kenyan health system is highly inequitable and policies aimed at promoting equity and addressing the needs of the poor and vulnerable have not been successful. Some progress has been made towards addressing equity challenges, but universal coverage will not be achieved unless the country adopts a systemic approach to health financing reforms. Such an approach should be informed by the wider health system goals of equity and efficiency. PMID:21612669

Equity in health care finance in Palestine: the triple effects revealed.

PubMed

Abu-Zaineh, Mohammad; Mataria, Awad; Luchini, Stéphane; Moatti, Jean-Paul

2009-12-01

This paper presents an application of the Urban and Lambert "upgraded-AJL Decomposition" approach that was designed to deal with the problem of close-income equals in equity analysis, and as applied to the area of health care finance. Contrary to most previous studies, vertical and horizontal inequities and the triple effects of inter-groups, intra-group and entire-group reranking of various financing schemes are estimated, with statistical significance calculated using the bootstrap method. Application is made on the three financing schemes present in the case of the Occupied Palestinian Territory. Results demonstrate the relative importance of the three forms of reranking in determining overall inequality. The paper offers policy recommendations to limit the existing inequalities in the system and to enhance the capacity of the governmental insurance scheme.

From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?

PubMed

Till, Brian M; Peters, Alexander W; Afshar, Salim; Meara, John

2017-01-01

Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group.

Revenue Generation in the Wake of Welfare Reform: Summary of the Pilot Learning Cluster on Early Childhood Finance.

ERIC Educational Resources Information Center

Finance Project, Washington, DC.

Creating more comprehensive, community-based support systems and reforming early childhood financing systems are critical to advancing the goal of having all children enter school ready to learn. The Finance Project is a national initiative to improve effectiveness, efficiency, and equity of financing for education, children's services, and…

The equity impact of the universal coverage policy: lessons from Thailand.

PubMed

Prakongsai, Phusit; Limwattananon, Supon; Tangcharoensathien, Viroj

2009-01-01

This chapter assesses health equity achievements of the Thai health system before and after the introduction of the universal coverage (UC) policy. It examines five dimensions of equity: equity in financial contributions, the incidence of catastrophic health expenditure, the degree of impoverishment as a result of household out-of-pocket payments for health, equity in health service use and the incidence of public subsidies for health. The standard methods proposed by O'Donnell, van Doorslaer, and Wagstaff (2008b) were used to measure equity in financial contribution, healthcare utilization and public subsidies, and in assessing the incidence of catastrophic health expenditure and impoverishment. Two major national representative household survey datasets were used: Socio-Economic Surveys and Health and Welfare Surveys. General tax was the most progressive source of finance in Thailand. Because this source dominates total financing, the overall outcome was progressive, with the rich contributing a greater share of their income than the poor. The low incidence of catastrophic health expenditure and impoverishment before UC was further reduced after UC. Use of healthcare and the distribution of government subsidies were both pro-poor: in particular, the functioning of primary healthcare (PHC) at the district level serves as a "pro-poor hub" in translating policy into practice and equity outcomes. The Thai health financing reforms have been accompanied by nationwide extension of PHC coverage, mandatory rural health service by new graduates and systems redesign, especially the introduction of a contracting model and closed-ended provider payment methods. Together, these changes have led to a more equitable and more efficient health system. Institutional capacity to generate evidence and to translate it into policy decisions, effective implementation and comprehensive monitoring and evaluation are essential to successful system-level reforms.

Defense Department Profit and Contract Finance Policies and Their Effects on Contract and Contractor Performance

DTIC Science & Technology

2009-02-01

cost of capital ( WACC ). WACC is the cost of debt plus the cost of equity both weighted by the market values debt and equity, respectively. The cost...Beta WACC Technical Risk CPFF/CPAF …. FFP/ MYP - Contract Choice (FAR 16.1) Margin – (p = f(NBV, n, α, risk)) Payments (α) FCOM ( = f(NBV, Treasury...projections, layers on the profit and contract financing policy, estimates the levered WACC as the discount rate, and finally calculates the NPV of the

13 CFR 107.850 - Restrictions on redemption of Equity Securities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... SMALL BUSINESS INVESTMENT COMPANIES Financing of Small Businesses by Licensees Structuring Licensee's Financing of An Eligible Small Business: Terms and Conditions of Financing § 107.850 Restrictions on... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Restrictions on redemption of...

Health financing for universal coverage and health system performance: concepts and implications for policy

PubMed Central

2013-01-01

Abstract Unless the concept is clearly understood, “universal coverage” (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization’s World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level. PMID:23940408

Health financing for universal coverage and health system performance: concepts and implications for policy.

PubMed

Kutzin, Joseph

2013-08-01

Unless the concept is clearly understood, "universal coverage" (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization's World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.

31 CFR 352.12 - Waiver.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Waiver. 352.12 Section 352.12 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT... would not be inconsistent with law or equity; (b) It does not impair any existing rights; and (c) The...

31 CFR 353.90 - Waiver of regulations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Waiver of regulations. 353.90 Section 353.90 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL... such action would not be inconsistent with law or equity, (b) if it does not impair any existing rights...

From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?

PubMed Central

Till, Brian M; Peters, Alexander W; Afshar, Salim; Meara, John G

2017-01-01

Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group. PMID:29177101

Equity in Educational Finance and A Study of the Impact of Block Grants in a Selected State.

ERIC Educational Resources Information Center

Moody, Charles D., Sr.; Kearney, C. Philip

1984-01-01

The 1981 enactment of the Education Consolidation and Improvement Act Chapter 2 (ECIA-Chapter 2), which consolidated 28 separate categorical federal aid programs into a single block grant, has had policy and fiscal impacts in Michigan. Policy debate centers on the inherent tension between equity, particularly equity defined as equal treatment of…

Outcome Equity in Education. Fifteenth Yearbook of the American Education Finance Association.

ERIC Educational Resources Information Center

Berne, Robert, Ed.; Picus, Lawrence O., Ed.

Papers from an Equity Study Group are compiled to give a real-world look at an evolving school system. The Equity Study Group was formed by the New York State Board of Regents to investigate how the allocation of resources contributes to the disparity in outcome for New York school children. The following papers are included: (1) "Educational…

The inequity of the Swiss Health Care system financing from a federal state perspective.

PubMed

Crivelli, Luca; Salari, Paola

2014-02-14

Previous studies have shown that Swiss health-care financing is particularly regressive. However, as it has been emphasized in the 2011 OECD Review of the Swiss Health System, the inter cantonal variations of income-related inequities are still broadly unexplored. The present paper aims to fill this gap by analyzing the differences in the level of equity of health-care system financing across cantons and its evolution over time using household data. Following the methodology proposed by Wagstaff et al. (JHE 11:361-387, 1992) we use the Kakwani index as a summary measure of regressivity and we compute it for each canton and for each of the sources that have a role in financing the health care system. We graphed concentration curves and performed relative dominance tests, which utilize the full distribution of expenditures.The microdata come from the Swiss Household Income and Expenditure Survey (SHIES) based on a sample of the Swiss population (about 3500 households per year), for the years 1998 - 2005. The empirical evidence confirms that the health-care financing in Switzerland has remained regressive since the major reform of 1996 and shows that the variations in equity across cantons are quite significant: the difference between the most and the least regressive canton is about the same as between two extremely different financing systems like the US and Sweden. There is no evidence, instead, of a clear evolution over time of regressivity. The significant variation in equity across cantons can be explained by fiscal federalism and the related autonomy in the design of tax and social policies. In particular, the results highlight that earmarked subsidies, the policy adopted to smooth the regressivity of the premiums, appear to be not enough; in the practice of federal states the combination of allowances with mandatory community-rated health insurance premiums might lead to a modest outcome in terms of equity.

The inequity of the Swiss health care system financing from a federal state perspective

PubMed Central

2014-01-01

Introduction Previous studies have shown that Swiss health-care financing is particularly regressive. However, as it has been emphasized in the 2011 OECD Review of the Swiss Health System, the inter cantonal variations of income-related inequities are still broadly unexplored. The present paper aims to fill this gap by analyzing the differences in the level of equity of health-care system financing across cantons and its evolution over time using household data. Methods Following the methodology proposed by Wagstaff et al. (JHE 11:361–387, 1992) we use the Kakwani index as a summary measure of regressivity and we compute it for each canton and for each of the sources that have a role in financing the health care system. We graphed concentration curves and performed relative dominance tests, which utilize the full distribution of expenditures. The microdata come from the Swiss Household Income and Expenditure Survey (SHIES) based on a sample of the Swiss population (about 3500 households per year), for the years 1998 - 2005. Results The empirical evidence confirms that the health-care financing in Switzerland has remained regressive since the major reform of 1996 and shows that the variations in equity across cantons are quite significant: the difference between the most and the least regressive canton is about the same as between two extremely different financing systems like the US and Sweden. There is no evidence, instead, of a clear evolution over time of regressivity. Conclusions The significant variation in equity across cantons can be explained by fiscal federalism and the related autonomy in the design of tax and social policies. In particular, the results highlight that earmarked subsidies, the policy adopted to smooth the regressivity of the premiums, appear to be not enough; in the practice of federal states the combination of allowances with mandatory community-rated health insurance premiums might lead to a modest outcome in terms of equity. PMID:24524216

75 FR 4713 - Purchases of Certain Equity Securities by the Issuer and Others

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-29

... Stock Repurchases?,'' 13 Journal of Applied Corporate Finance, pp. 31-51 (2000) (noting issuers... Price Discovery,'' Journal of Empirical Finance 15, 839-849 (2008). \\45\\ See, e.g., Security Traders...

24 CFR 241.1005 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SUPPLEMENTARY FINANCING FOR INSURED PROJECT MORTGAGES Insurance for Equity Loans and Acquisition Loans... qualified purchaser of an eligible low income housing project, which owner receives and becomes primarily... organization or a limited equity cooperative, which entity is purchasing an eligible low income housing project...

Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis

PubMed Central

2013-01-01

Background Nigeria and Ghana have recently introduced a National Health Insurance Scheme (NHIS) with the aim of moving towards universal health care using more equitable financing mechanisms. This study compares health and economic indicators, describes the structure of each country’s NHIS within the wider healthcare system, and analyses impacts on equity in financing and access to health care. Methods The World Bank and other sources were used to provide comparative health and economic data. Pubmed, Embase and EconLit were searched to locate studies providing descriptions of each NHIS and empirical evidence regarding equity in financing and access to health care. A diagrammatical representation of revenue-raising, pooling, purchasing and provision was produced in order to analyse the two countries’ systems. Results Over the period 2000–2010, Ghana maintained a marked advantage in life expectancy, infant mortality, under-5 year mortality, and has a lower burden of major diseases. Health care expenditure is about 5% of GDP in both countries but public expenditure in 2010 was 38% of total expenditure in Nigeria and 60% in Ghana. Financing and access are less equitable in Nigeria as, inter alia, private out-of-pocket expenditure has fallen from 80% to 66% of total spending in Ghana since the introduction of its NHIS but has remained at over 90% in Nigeria; NHIS membership in Nigeria and Ghana is approximately 3.5% and 65%, respectively; Nigeria offers a variable benefits package depending on membership category while Ghana has uniform benefits across all beneficiaries. Both countries exhibit improvements in equity but there is a pro-rich and pro-urban bias in membership. Conclusions Major health indicators are more favourable in Ghana and overall equity in financing and access are weaker in Nigeria. Nigeria is taking steps to expand NHIS membership and has potential to expand its public spending to achieve greater equity. However, heavy burdens of poverty, disease and remote settings make this a substantial challenge. Ghana’s relative success has to be tempered by the high number of exemptions through taxation and the threat of moral hazard. The results and methods are anticipated to be informative for policy makers and researchers in both countries and other developing countries more widely. PMID:23339606

Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis.

PubMed

Odeyemi, Isaac A O; Nixon, John

2013-01-22

Nigeria and Ghana have recently introduced a National Health Insurance Scheme (NHIS) with the aim of moving towards universal health care using more equitable financing mechanisms. This study compares health and economic indicators, describes the structure of each country's NHIS within the wider healthcare system, and analyses impacts on equity in financing and access to health care. The World Bank and other sources were used to provide comparative health and economic data. Pubmed, Embase and EconLit were searched to locate studies providing descriptions of each NHIS and empirical evidence regarding equity in financing and access to health care. A diagrammatical representation of revenue-raising, pooling, purchasing and provision was produced in order to analyse the two countries' systems. Over the period 2000-2010, Ghana maintained a marked advantage in life expectancy, infant mortality, under-5 year mortality, and has a lower burden of major diseases. Health care expenditure is about 5% of GDP in both countries but public expenditure in 2010 was 38% of total expenditure in Nigeria and 60% in Ghana. Financing and access are less equitable in Nigeria as, inter alia, private out-of-pocket expenditure has fallen from 80% to 66% of total spending in Ghana since the introduction of its NHIS but has remained at over 90% in Nigeria; NHIS membership in Nigeria and Ghana is approximately 3.5% and 65%, respectively; Nigeria offers a variable benefits package depending on membership category while Ghana has uniform benefits across all beneficiaries. Both countries exhibit improvements in equity but there is a pro-rich and pro-urban bias in membership. Major health indicators are more favourable in Ghana and overall equity in financing and access are weaker in Nigeria. Nigeria is taking steps to expand NHIS membership and has potential to expand its public spending to achieve greater equity. However, heavy burdens of poverty, disease and remote settings make this a substantial challenge. Ghana's relative success has to be tempered by the high number of exemptions through taxation and the threat of moral hazard. The results and methods are anticipated to be informative for policy makers and researchers in both countries and other developing countries more widely.

Money and Education: A Guide to Illinois School Finance.

ERIC Educational Resources Information Center

McMaster, Donald; Sinkin, Judy G.

Illinois' education finance plan is described in the first of this report's two chapters, and the second chapter considers the finance plan's equity. Chapter 1 covers the state's Resource Equalizer Aid Program and the tax revenue it guarantees districts; the calculation of maximum tax guarantees and local shares; the apportionment of state aid;…

Q&A: The Basics of California's School Finance System

ERIC Educational Resources Information Center

EdSource, 2006

2006-01-01

In a state as large and complex as California, education financing can become as complicated as rocket science. This two-page Q&A provides a brief, easy-to-understand explanation of California's school finance system and introduces the issues of its adequacy and equity. A list of resources providing additional information is provided.

Squeezing the funding you need from today's capital sources.

PubMed

Gordon, Deborah C

2010-04-01

Healthcare providers need to understand traditional and nontraditional financing options and other potential strategies for accessing capital. Common financing options include bonds, commercial lending, acquisition financing, and financing through the Department of Housing and Urban Development's Section 232 program. Alternative strategies for accessing capital include joint ventures, equity, sale of assets, fund-raising, capital leases, internal capital, public grants, and grants from foundations.

The Three Basic Questions of School Finance: Who Should Pay? Who Should Benefit? Who Should Govern?

ERIC Educational Resources Information Center

Garms, Walter I.

This paper attempts both to provide a way of looking at school finance in order to make wiser decisions about it and to discuss some alternative ways to finance the public schools of New York State. The New York school finance system is examined in terms of equity, efficiency, and responsiveness, as are some of the characteristics of the…

Equity in health financing of Guangxi after China's universal health coverage: evidence based on health expenditure comparison in rural Guangxi Zhuang autonomous region from 2009 to 2013.

PubMed

Qin, Xianjing; Luo, Hongye; Feng, Jun; Li, Yanning; Wei, Bo; Feng, Qiming

2017-09-29

Healthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China's medical sector reform. Socio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions. The overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay. Our study demonstrates an inequitable distribution of government healthcare subsidies in China from 2009 to 2013, and the inequity was reduced, especially in rural areas. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

Willingness to pay for the maintenance of equity in a local ivermectin distribution scheme in Toro, Northern Nigeria.

PubMed

Onwujekwe, O E; Shu, E N; Okonkwo, P O

1999-07-01

The willingness to pay (WTP) for the maintenance of equity in a local ivermectin distribution scheme in the context of a community financing framework was determined in Toro, Northern Nigeria, using 214 randomly selected heads of households, or their representatives. Though WTP of the respondents for their own households was elicited, the focus of this paper is on WTP to maintain equity in a community financing scheme. Contingent valuation was used for the exercise, and WTP was elicited using an open-ended question. 97.2% of the respondents were in favour of allowing those that lack the ability to pay, to benefit from the scheme and the maximum WTP amounts they were willing to contribute annually so that those who lack the ability to pay could benefit from the scheme ranged from 5 Naira ($0. 06) to 100 Naira ($1.25). The mean WTP to maintain equity was 29.00 Naira ($0.36) while the median was 20.00 Naira ($0.25). This study shows that a community financing scheme for local ivermectin distribution will not be inequitable, since enough funds will be realised from well-to-do community members to cover the costs for those who are unable to pay.

Health financing reform in Uganda: How equitable is the proposed National Health Insurance scheme?

PubMed

Orem, Juliet Nabyonga; Zikusooka, Charlotte Muheki

2010-10-13

Uganda is proposing introduction of the National Health Insurance scheme (NHIS) in a phased manner with the view to obtaining additional funding for the health sector and promoting financial risk protection. In this paper, we have assessed the proposed NHIS from an equity perspective, exploring the extent to which NHIS would improve existing disparities in the health sector. We reviewed the proposed design and other relevant documents that enhanced our understanding of contextual issues. We used the Kutzin and fair financing frameworks to critically assess the impact of NHIS on overall equity in financing in Uganda. The introduction of NHIS is being proposed against the backdrop of inequalities in the distribution of health system inputs between rural and urban areas, different levels of care and geographic areas. In this assessment, we find that gradual implementation of NHIS will result in low coverage initially, which might pose a challenge for effective management of the scheme. The process for accreditation of service providers during the first phase is not explicit on how it will ensure that a two-tier service provision arrangement does not emerge to cater for different types of patients. If the proposed fee-for-service mechanism of reimbursing providers is pursued, utilisation patterns will determine how resources are allocated. This implies that equity in resource allocation will be determined by the distribution of accredited providers, and checks put in place to prohibit frivolous use. The current design does not explicitly mention how these two issues will be tackled. Lastly, there is no clarity on how the NHIS will fit into, and integrate within existing financing mechanisms. Under the current NHIS design, the initial low coverage in the first years will inhibit optimal achievement of the important equity characteristics of pooling, cross-subsidisation and financial protection. Depending on the distribution of accredited providers and utilisation patterns, the NHIS could worsen existing disparities in access to services, given the fee-for-service reimbursement mechanisms currently proposed. Lastly, if equity in financing and resource allocation are not explicit objectives of the NHIS, it might inadvertently worsen the existing disparities in service provision.

Cost of Equity Estimation in Fuel and Energy Sector Companies Based on CAPM

NASA Astrophysics Data System (ADS)

Kozieł, Diana; Pawłowski, Stanisław; Kustra, Arkadiusz

2018-03-01

The article presents cost of equity estimation of capital groups from the fuel and energy sector, listed at the Warsaw Stock Exchange, based on the Capital Asset Pricing Model (CAPM). The objective of the article was to perform a valuation of equity with the application of CAPM, based on actual financial data and stock exchange data and to carry out a sensitivity analysis of such cost, depending on the financing structure of the entity. The objective of the article formulated in this manner has determined its' structure. It focuses on presentation of substantive analyses related to the core of equity and methods of estimating its' costs, with special attention given to the CAPM. In the practical section, estimation of cost was performed according to the CAPM methodology, based on the example of leading fuel and energy companies, such as Tauron GE and PGE. Simultaneously, sensitivity analysis of such cost was performed depending on the structure of financing the company's operation.

School Finance Reform: Past, Present and Future. Issuegram 26.

ERIC Educational Resources Information Center

Odden, Allan

This paper examines past school finance reforms of the 1970's, current reforms in the 1980's, and future reforms in the 1990's. Fiscal inequities targeted in the reforms of the seventies resulted in major structural changes in the school finance systems of over 30 states. The reforms not only improved fiscal equity but helped increase…

Educational Equity, Adequacy, and Equal Opportunity in the Commonwealth: An Evaluation of Pennsylvania's School Finance System

ERIC Educational Resources Information Center

Baker, Bruce; Levin, Jesse

2014-01-01

Pennsylvania has historically operated one of the nation's least equitable state school finance systems, and within that system exist some of the nation's most fiscally disadvantaged public school districts. The persistent inequalities of Pennsylvania's school finance system are not entirely a result of simple lack of effort, as policies intended…

System-wide analysis of health financing equity in Cambodia: a study protocol

PubMed Central

Wiseman, Virginia; Asante, Augustine; Ir, Por; Limwattananon, Supon; Jacobs, Bart; Liverani, Marco; Hayen, Andrew; Jan, Stephen

2017-01-01

Background To assess progress towards universal health coverage, countries like Cambodia require evidence on equity in the financing and distribution of healthcare benefits. This evidence must be based on a system-wide perspective that recognises the complex roles played by the public and private sectors in many contemporary healthcare systems. Objective To undertake a system-wide assessment of who pays and who benefits from healthcare in Cambodia and to understand the factors influencing this. Methods Financing and benefit incidence analysis will be used to calculate the financing burden and distribution of healthcare benefits across socioeconomic groups. Data on healthcare usage, living standards and self-assessed health status will be derived from a cross-sectional household survey designed for this study involving a random sample of 5000 households. This will be supplemented by secondary data from the Cambodian National Health Accounts 2014 and the Cambodian Socioeconomic Survey (CSES) 2014. We will also collect qualitative data through focus group discussions and in-depth interviews to inform the interpretation of the quantitative analyses. Potential impact This study will produce previously unavailable information on who pays for, and who benefits from, health services across the entire health system of Cambodia. This evidence comes at a critical juncture in healthcare reform in South-East Asia with so many countries seeking guidance on the equity impact of their current financing arrangements that include a complex mix of public and private providers. PMID:28589000

[Determinants of equity in financing medicines in Argentina: an empirical study].

PubMed

Dondo, Mariana; Monsalvo, Mauricio; Garibaldi, Lucas A

2016-01-01

Medicines are an important part of household health spending. A progressive system for financing drugs is thus essential for an equitable health system. Some authors have proposed that the determinants of equity in drug financing are socioeconomic, demographic, and associated with public interventions, but little progress has been made in the empirical evaluation and quantification of their relative importance. The current study estimated quantile regressions at the provincial level in Argentina and found that old age (> 65 years), unemployment, the existence of a public pharmaceutical laboratory, treatment transfers, and a health system orientated to primary care were important predictors of progressive payment schemes. Low income, weak institutions, and insufficient infrastructure and services were associated with the most regressive social responses to health needs, thereby aggravating living conditions and limiting development opportunities.

The Canada Pension Plan's experience with investing its portfolio in equities.

PubMed

Sarney, M; Preneta, A M

For the past few years, the Canada Pension Plan (CPP) has been investing some of its assets in equities. Without changes, an imbalance between revenues and outlays would exhaust the CPP reserve fund by 2015. Creating an entity that was independent of government was one of several changes the federal and provincial governments enacted to achieve fuller funding. The governments created an independent Investment Board (the CPP Investment Board, or "CPPIB") to oversee the new investments. Because the plan already owned a large government bond portfolio, the CPPIB decided to invest new CPP funds in broad equity indices in March 1999. In 2000, the CPPIB began actively investing a portion of the CPP funds. Key features of that policy and some observations about its implementation include the following: In addition to investing CPP revenues in equities, reform also included contribution rate increases, benefit reductions, and a financing stabilizer. The new investment policy accounted for 25 percent of the total effect of all the reforms. It is premature to know if the investments will achieve their long-term performance objective. The new equity investments are projected by the Chief Actuary, in his most recent Actuarial Report, to earn a 4.5 percent real rate of return on Canadian equity and 5.0 percent real return on foreign equity for a blended real return of 4.65 percent based on an equity mix of 70 percent Canadian and 30 percent non-Canadian. However, it is too early to tell if the equity investments will achieve that goal over the long run. The Investment Board's mandate is to maximize returns. The Investment Board, which oversees the CPP's new investments, has broad discretion to pursue maximum returns on its assets without incurring undue risk of loss while keeping in mind the financial obligations and other assets of the CPP. Furthermore, it has developed into a professional investment organization staffed with private-sector experts in finance and investment. The board is designed to be independent of government. The federal and provincial governments designed the board to operate at arm's length from themselves. The process for selecting directors includes public- and private-sector participation, and the board is in compliance with several sets of governance guidelines for corporations. CPPIB management, with the support of its board of directors, has decided to implement a virtual corporation model involving a small team of senior executives setting strategies for implementation primarily by external professional firms. Consequently, as a virtual corporation, the board currently relies on external fund managers to make investments and vote proxies. Several measures are designed to ensure accountability to the public. The investment legislation subjects the board to overlapping layers of oversight to ensure accountability to the public. The features of this oversight include public meetings in each province as well as quarterly statements and annual reports to Parliament, the federal and provincial finance ministers, and the public. The 10 finance ministers review the CPPIB's mandate and regulations every 3 years, and the CPPIB is subject to a special examination every 6 years by an auditor appointed by the Federal Minister of Finance.

12 CFR 998.2 - Registration and periodic disclosures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Section 998.2 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK DISCLOSURES REGISTRATION OF FEDERAL HOME LOAN BANK EQUITY SECURITIES § 998.2 Registration and periodic disclosures. (a... class of its equity securities pursuant to the provisions of section 12(g)(1) of the 1934 Act. Each Bank...

31 CFR 351.85 - May Public Debt waive any provision in this part?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false May Public Debt waive any provision in this part? 351.85 Section 351.85 Money and Finance: Treasury Regulations Relating to Money and Finance... hardship: (a) If such action would not be inconsistent with law or equity; (b) If it does not impair any...

31 CFR 359.70 - May Public Debt waive any provision in this part?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false May Public Debt waive any provision in this part? 359.70 Section 359.70 Money and Finance: Treasury Regulations Relating to Money and Finance... such action would not be inconsistent with law or equity; (b) If it does not impair any material...

Constructing New Finance Models That Balance Equity, Adequacy and Efficiency with Responsiveness. Education Finance in the States: Its Past, Present and Future. ECS Issue Paper.

ERIC Educational Resources Information Center

Guthrie, James W.

Policymakers continue to face major challenges in education finance, despite a history of reforms. Today's challenges include ensuring financial adequacy, maintaining gains in distributional equality, coping with the increasing need for teachers, satisfying public preference for diversity in schools and programs, and devising performance…

Assessing Success in School Finance Litigation: The Case of New Jersey. Education, Equity, and the Law. No. 1

ERIC Educational Resources Information Center

Goertz, Margaret E.; Weiss, Michael

2009-01-01

Education finance policy in New Jersey has been shaped by over 30 years of school finance litigation. Through its decisions in "Robinson v. Cahill" (1973-1976) and "Abbott v. Burke" (1985-2005), the justices of New Jersey's supreme court have defined the state's constitutional guarantee of a "thorough and efficient"…

Is Robin Hood the "Prince of Thieves" or a Pathway to Equity?: Applying Critical Race Theory to Finance Political Discourse

ERIC Educational Resources Information Center

Aleman, Enrique, Jr.

2006-01-01

In this article, Aleman examines how Mexican American district leaders conceptualize and argue for a more equitable system of school finance. The superintendents studied are politically active educational leaders who participate in the school finance debate while advocating for their Mexican American constituency. The author addresses the nature…

Equity Financing: Real Estate.

ERIC Educational Resources Information Center

Thomas, Richard; Davies, Jonathan

1987-01-01

Many small, private colleges are examining aggressive ways of economically developing their land and other physical assets by strategies ranging from direct ownership of tangible property to joint and participating ownership arrangements consisting of leases, financing, and partnerships. In all cases, however, potential tax consequences should be…

77 FR 38125 - Emergence Capital Partners SBIC, L.P.; Notice Seeking Exemption Under Section 312 of the Small...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-26

.../equity security financing to Fox Run Holdings, Inc., 1907 Stout Drive, Warminster, PA 18974 (``Fox Run... of Fox Run, and therefore this transaction is considered a financing of an Associate requiring prior...

Indiana's New and (Somewhat) Improved K-12 School Finance System. School Choice Issues in the State

ERIC Educational Resources Information Center

Aud, Susan L.

2005-01-01

Education finance policy has become an urgent concern in many state legislatures. Demands for greater equity and accountability have forced states to review, and in many cases to revise, the method by which schools are funded. This study sheds light on Indiana's financing of public K-12 education by providing a clear explanation of the components…

Financing Opportunity for Post-Secondary Education in the U.S.: The Equity Investment in America Program.

ERIC Educational Resources Information Center

Bluestone, Barry; And Others

A proposal written by a group of economists suggests investing a portion of the Social Security surplus in a revolving loan fund designed to enable American students and workers to finance their own post-secondary education, vocational training, or re-training. The plan would make available to every American a line of credit to finance the costs…

Biblical Antecedents to Fiscal Equity: Policy Implications for Education.

ERIC Educational Resources Information Center

Furst, Lyndon G.

Most arguments for fiscal equity in financing America's schools have been based on constitutional provisions and on the socio-political dogma that underlies a democratic society. This paper approaches the subject using as its theoretical basis a document even more basic to the founding of the republic than the Constitution--the Bible. Using the…

Information Technology Curriculum Development for Participation and Equity Programs.

ERIC Educational Resources Information Center

Post, Maarten; And Others

A study explored ways in which training in information technology could be included in Participation and Equity Programs (PEP) in the areas of hospitality/tourism, retailing, and business and finance. The research team conducted a literature search, obtained completed questionnaires from 10 colleges offering a total of 22 PEPs, visited an…

A stochastic delay model for pricing debt and equity: Numerical techniques and applications

NASA Astrophysics Data System (ADS)

Tambue, Antoine; Kemajou Brown, Elisabeth; Mohammed, Salah

2015-01-01

Delayed nonlinear models for pricing corporate liabilities and European options were recently developed. Using self-financed strategy and duplication we were able to derive a Random Partial Differential Equation (RPDE) whose solutions describe the evolution of debt and equity values of a corporate in the last delay period interval in the accompanied paper (Kemajou et al., 2012) [14]. In this paper, we provide robust numerical techniques to solve the delayed nonlinear model for the corporate value, along with the corresponding RPDEs modeling the debt and equity values of the corporate. Using financial data from some firms, we forecast and compare numerical solutions from both the nonlinear delayed model and classical Merton model with the real corporate data. From this comparison, it comes up that in corporate finance the past dependence of the firm value process may be an important feature and therefore should not be ignored.

Seven Things a Principal Should Know about School Finance.

ERIC Educational Resources Information Center

Sharp, William L.

1994-01-01

Secondary school principals should understand school finance basics, including property tax components (tax base, assessment practice, and tax rate); allowable tax reductions and exemptions; common arguments against the property tax; cost and valuation per pupil formulas; educational equity arguments; state foundation programs; and various types…

Renewable Energy Project Financing: Impacts of the Financial Crisis and Federal Legislation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schwabe, P.; Cory, K.; Newcomb, J.

2009-07-01

Extraordinary financial market conditions have disrupted the flows of equity and debt investment into U.S. renewable energy (RE) projects since the fourth quarter of 2008. The pace and structure of renewable energy project finance has been reshaped by a combination of forces, including the financial crisis, global economic recession, and major changes in federal legislation affecting renewable energy finance. This report explores the impacts of these key market events on renewable energy project financing and development.

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Topics covered include: energy security; clean energy and low carbon; energy for growth and poverty reduction in Africa; financing of energy efficiency; SMEs for decentralised energy service provision; potential for biofuels in developing countries; clean energy and sustainable development; clean energy finance and private equity funds; power generation and low carbon technologies; beyond traditional finance; rehabilitation and emission control in thermal power plants; and carbon finance. The presentations are mainly in ppt (Power Point) or pdf (Acrobat) format. Some videos of the conference are also available on the website.

Analysis of Project Finance | Energy Analysis | NREL

Science.gov Websites

project finance is complex, requiring knowledge of federal tax credits, state-level incentives, renewable and in lieu of the 30% federal investment tax credit, as follows: Less-established renewable power that lack extensive operational track records may be slowed because many tax equity investors are seen

Financing Schools: Evolving Patterns of Autonomy and Control

ERIC Educational Resources Information Center

Levacic, Rosalind

2008-01-01

The article tracks the evolution of the English school finance system from 1988 to 2007. Three main periods are distinguished: Establishing Local Management of Schools (1988-1997); New Labour and Consolidation (1997-2002); and Centralizing Labour (2002-2007). Three key criteria are applied in assessing the system--efficiency, equity and…

Equity and Adequacy Challenges in Rural Schools and Communities.

ERIC Educational Resources Information Center

Mathis, William J.

A meeting of education finance scholars discussed finance issues relevant to rural schools and communities. This paper summarizes major themes that emerged during the meeting. Notions of efficiency and economies of scale have contributed to widespread consolidation of rural schools and school districts. The value of community is not easily…

78 FR 39820 - Notice Seeking Exemption Under the Small Business Investment Act, Conflicts of Interest

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-02

... Seeking Exemption Under the Small Business Investment Act, Conflicts of Interest Notice is hereby given... Section 107.730, Financings which Constitute Conflicts of Interest of the Small Business Administration...'s equity. Therefore this transaction is considered a financing constituting a conflict of interest...

Performance-Based Funding: Equity Analysis of Funding Distribution among State Universities

ERIC Educational Resources Information Center

Ellis, Robin Ann

2015-01-01

How to finance higher education remains controversial among policy makers and constituencies across the United States. Texas is not exempt from the controversy. With increasingly strained state finances, institutions of higher education and the Texas Higher Education Coordinating Board (THECB) have come under pressure to increase performance…

An Equitable Framework for Corporate Participation in the Public Schools.

ERIC Educational Resources Information Center

Caldwell, Richard Allen

Business partnership with public schools, while holding great promise for educational improvement, is hindered by legal questions about equity. Disagreement on how to apply this value to education has produced much litigation over school finance. Some allege that property tax financing violates the equal protection clause of the Fourteenth…

Section 1603 Treasury Grant Expiration. Industry Insight on Financing and Market Implications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mendelsohn, Michael; Harper, John

In the wake of the 2008-2009 financial crises, tax equity investors largely withdrew from the market, resulting in stagnation of project development. In response, Congress established the Treasury grant program pursuant to Section 1603 of the American Recovery and Reinvestment Act (Section 1603 Program) to offer a cash payment in lieu of a production and investment tax credit. This study addresses the likely project financing and market impacts from the expiration of the Section 1603 Program. The authors assembled an array of insights offered by financial executives active in the renewable energy (RE) market during conference panel discussions and inmore » presentations, direct interviews, and email correspondences. This analysis found that the Section 1603 Program alleviated the need to monetize the tax credit incentives through specialized investors, helped lower the transaction and financing costs associated with renewable electricity projects, and generally supported an extensive build-out of renewable power generation capacity. With the expiration of the Section 1603 Program, smaller or less-established renewable power developers will have more difficulty attracting needed financial capital and completing their projects, development of projects relying on newer or 'innovative' technologies will likely slow as traditional tax equity investors are known to be highly averse to technology risk in the projects they fund, and, finally, projects relying on tax equity may be more expensive to develop due to higher transaction costs and potentially higher yields required to attract tax equity.« less

Section 1603 Treasury Grant Expiration: Industry Insight on Financing and Market Implications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mendelsohn, M.; Harper, J.

In the wake of the 2008-2009 financial crises, tax equity investors largely withdrew from the market, resulting in stagnation of project development. In response, Congress established the Treasury grant program pursuant to Section 1603 of the American Recovery and Reinvestment Act (..Section..1603 Program) to offer a cash payment in lieu of a production and investment tax credit. This study addresses the likely project financing and market impacts from the expiration of the ..Section..1603 Program. The authors assembled an array of insights offered by financial executives active in the renewable energy (RE) market during conference panel discussions and in presentations, directmore » interviews, and email correspondences. This analysis found that the ..Section..1603 Program alleviated the need to monetize the tax credit incentives through specialized investors, helped lower the transaction and financing costs associated with renewable electricity projects, and generally supported an extensive build-out of renewable power generation capacity. With the expiration of the ..Section..1603 Program, smaller or less-established renewable power developers will have more difficulty attracting needed financial capital and completing their projects, development of projects relying on newer or 'innovative' technologies will likely slow as traditional tax equity investors are known to be highly averse to technology risk in the projects they fund, and, finally, projects relying on tax equity may be more expensive to develop due to higher transaction costs and potentially higher yields required to attract tax equity.« less

Can Interest-Free Finance Limit the Frequency of Crises and the Volatility of the Business Cycle?

DTIC Science & Technology

2011-05-14

free economics. Scholars from the International Monetary Fund ( IMF ) researched theoretical interest-free finance a great deal during the 1980s. In...inevitably comes, their assets devalue and their leverage increases. Moreover, a higher proportion of firms become critically leveraged. The interest...to currency crises. Whereas high interest payments might send an otherwise profitable firm to bankruptcy and foreclosure, equity financing may

The Status of School Finance Equity in Texas: A 2009 Update

ERIC Educational Resources Information Center

Cortez, Albert

2009-01-01

In Texas, all students are equal, but once again some are more equal than others. This policy update provides a description of the key elements of the existing Texas school funding system, identifies features that contribute to equity and those that maintain and expand inequity, and includes recommended reforms that would reinstate critical…

Fiscal Equalization and Access to Educational Resources in the New England States.

ERIC Educational Resources Information Center

Fastrup, Jerry C.

1997-01-01

Analyzes 1990-91 school finance data for six New England states. Examines state support for local education, distribution of state aid in relation to local wealth differences, these policies' effect on funding equity for local taxpayers, and the relationship between taxpayer equity and per-pupil spending disparities. Only Maine and Vermont have…

Measuring Equity: Creating a New Standard for Inputs and Outputs

ERIC Educational Resources Information Center

Knoeppel, Robert C.; Della Sala, Matthew R.

2013-01-01

The purpose of this article is to introduce a new statistic to capture the ratio of equitable student outcomes given equitable inputs. Given the fact that finance structures should be aligned to outcome standards according to judicial interpretation, a ratio of outputs to inputs, or "equity ratio," is introduced to discern if conclusions can be…

76 FR 35263 - Founders Equity SBIC I, L.P.; Notice Seeking Exemption Under Section 312 of the Small Business...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-16

... SMALL BUSINESS ADMINISTRATION [License No. 02/72-0625] Founders Equity SBIC I, L.P.; Notice Seeking Exemption Under Section 312 of the Small Business Investment Act, Conflicts of Interest Notice is... 107.730, Financings Which Constitute Conflicts of Interest of the Small Business Administration (``SBA...

The Search for Equity in School Funding. Education Partners Working Papers.

ERIC Educational Resources Information Center

Crampton, Faith; Whitney, Terry

After decades of media attention, study, and lawsuits, the solution to inequities in school funding remains elusive. This paper examines several strategies that states have used to try to close the funding disparities in per-pupil spending. It explains the two definitions of equity in the school-finance arena and identifies some important trends…

Health care of people in homelessness: a comparative study of mobile units in Portugal, United States and Brazil.

PubMed

Borysow, Igor da Costa; Conill, Eleonor Minho; Furtado, Juarez Pereira

2017-03-01

This paper describes and analyzes the legal and normative framework guiding the use of mobile units in Portugal, United States and Brazil, which seek to improve access and continuity of care for people in homelessness. We used a comparative analysis through literature and documentary review relating three categories: context (demographic, socio-economic and epidemiological), services system (access, coverage, organization, management and financing) and, specifically, mobile units (design, care and financing model). The analysis was based on the theory of convergence/divergence between health systems from the perspective of equity in health. Improving access, addressing psychoactive substances abuse, outreach and multidisciplinary work proved to be common to all three countries, with the potential to reduce inequities. Relationships with primary healthcare, use of vehicles and the type of financing are considered differently in the three countries, influencing the greater or lesser extent of equity in the analyzed proposals.

Contribution of Targeted Subsidies Law to the Equity in Healthcare Financing in Iran: Exploring the Challenges of Policy Process

PubMed Central

Zandian, Hamed; Olyaeemanesh, Alireza; Takian, Amirhossein; Hosseini, Mostafa

2016-01-01

Introduction The Targeted Subsidies Law (TSL) was implemented in 2010 with a platform of improving equity in the Iran’s society. One of the objectives of the TSL was improving equity in Healthcare Financing (HCF), but a significant change has not occurred since then. The aim of this study was to analyze the challenges of the TSL to equity in the HCF in Iran. Methods In this interpretive qualitative study, 31 policy makers and health system experts were interviewed face to face from September 2014 to June 2015. A purposeful and snowball sampling method was used to select participants. Also, a document analysis was conducted on upstream documents. Assisted by MAXQDA 10, recorded interviews were transcribed verbatim and analyzed based on Framework Approach. Results Content analysis identified two themes and five sub-themes. Lack of justice in the healthcare system and lack of equity in the total socioeconomic structure of Iran were sub-themes identified as barriers to equity in HCF. Shortcomings in the formulation, implementation, and evaluation of the TSL were sub-themes identified as barriers in the policy process. The TSL did not achieve its intended objectives in the health sector because of the above-mentioned barriers, Conclusion The TSL, according to established goals, had no effect on the equity in HCF in Iran because of problems in the structure of the health system, socioeconomic status, and the policy process. To reach a more equitable HCF, it is advised that, when defining the related policies, various barriers be considered, such as those identified in our research. PMID:27053996

An analysis of equity in Brazilian health system financing.

PubMed

Ugá, Maria Alicia Domínguez; Santos, Isabela Soares

2007-01-01

Health care in Brazil is financed from many sources--taxes on income, real property, sales of goods and services, and financial transactions; private insurance purchased by households and firms; and out-of-pocket payments by households. Data on household budgets and tax revenues allow the burden of each source except firms' insurance purchases for their employees to be allocated across deciles of adjusted per capita household income, indicating the progressivity or regressivity of each kind of payment. Overall, financing is approximately neutral, with progressive public finance offsetting regressive payments. This last form of finance pushes some households into poverty.

Politicians, Judges, and City Schools. Reforming School Finance in New York.

ERIC Educational Resources Information Center

Berke, Joel S.; And Others

This book is designed to provide public officials, leaders of organizations concerned with school funding issues, and citizens active in educational affairs with information about the political, economic, and equity issues that underlie the school finance reform debate in New York State. It discusses present inequities and potential approaches to…

A Reply to the "Forbs" Article or the Political Theory of School Finance Revisited: A Victorian Essay.

ERIC Educational Resources Information Center

Hickrod, G. Alan

1987-01-01

Examines a "Forbes" cover story on educational expenditures that poses questions related to three current research guidelines for educational finance: adequacy, equity, and efficiency. Different "production functions" must be sought for children of differing family backgrounds. Without adequate education, the world's armies,…

Capital Outlay: A Critical Concern in Rural Education. ERIC Digest.

ERIC Educational Resources Information Center

Hunter, James; Howley, Craig B.

This digest, which is based primarily on the 1989 ERIC/CRESS monograph entitled "Achievement of Equity in Capital Outlay Financing: A Policy Analysis for the States," by D. Thompson G. Stewart, D. Honeyman, and R. Wood, addresses possible solutions to the emerging problem of capital outlay financing, with special attention to facilities…

A Comparative Assessment of Higher Education Financing in Six Arab Countries

ERIC Educational Resources Information Center

El-Araby, Ashraf

2011-01-01

This study analyses the policies for financing higher education in six Arab countries: Egypt, Jordan, Lebanon, Morocco, Syria, and Tunisia. It assesses the adequacy of spending on higher education, the efficiency with which resources are utilized, and the equity implications of resource allocations. Based on six detailed case studies, this…

Paying for Equity: The Role of Taxation in Driving Canada's Educational Success

ERIC Educational Resources Information Center

Freiler, Christa

2011-01-01

Using research conducted by the federal government's own finance department, social policy groups released the report, "Paying for Canada: Perspectives on Public Finance and National Programs." It showed that deliberate government policy to reduce taxation levels for some of the most economically advantaged groups in Canada had resulted…

The Black Child and Equity in School Finance: Analysis and Alternatives; [and Seminar Discussion].

ERIC Educational Resources Information Center

Singleton, Robert

The purposes of this paper are to discuss the legal, economic and other implications of a 1971 landmark court ruling from a Black perspective; to advocate a position to which Black educators and others concerned with equity in educational opportunities of Black children might react; and to outline further needed research that ought to be…

24 CFR 241.1065 - Maximum loan amount-loans insured in connection with a plan of action under subpart C of part 248...

Code of Federal Regulations, 2010 CFR

2010-04-01

... SUPPLEMENTARY FINANCING FOR INSURED PROJECT MORTGAGES Insurance for Equity Loans and Acquisition Loans... percent of the owner's equity in the project, as determined by the Commissioner. Notwithstanding the above... property, can be supported by 90 percent of the projected net operating income of the project, as...

24 CFR 241.1067 - Maximum loan amount-loans insured in connection with a plan of action under subpart B of part 248...

Code of Federal Regulations, 2010 CFR

2010-04-01

... SUPPLEMENTARY FINANCING FOR INSURED PROJECT MORTGAGES Insurance for Equity Loans and Acquisition Loans... (2) The lesser of 70 percent of the extension preservation equity of the project; or (3) The amount the Commissioner determines can be supported by the project on the basis of an 8 percent return on...

School Choice and Market Failure: How Politics Trumps Economics in Education and Elsewhere

ERIC Educational Resources Information Center

Viteritti, Joseph P.

2010-01-01

This essay traces the roots of the equity approach to school choice to the work of Coons & Sugarman, which began as an outgrowth of their involvement with the landmark California school finance case, "Serrano v. Priest" (1971). Comparing the equity approach to the market model espoused by Milton Friedman, the author argues that the former is…

The Equity Impact of Public Finance of Private Education Provision in Cote d'Ivoire

ERIC Educational Resources Information Center

Sakellariou, Chris; Patrinos, Harry Anthony

2009-01-01

The equity effects of public subsidization of private schools in Cote d'Ivoire are analyzed. The subsidy per student in private (and public) schools increases as one goes to higher household per capita expenditure groups. Students from families in the highest expenditure quartile receive twice the subsidy received by students from families in the…

Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector.

PubMed

Gordeev, Vladimir S; Pavlova, Milena; Groot, Wim

2011-10-01

This paper reviews the empirical evidence on the outcomes of the financial reforms in the Russian public healthcare sector. A systematic literature review identified 37 relevant publications that presented empirical evidence on changes in quality, equity, efficiency and sustainability in public healthcare provision due to the Russian public healthcare financial reforms. Evidence suggests that there are substantial inter-regional inequalities across income groups both in terms of financing and access to public healthcare services. There are large efficiency differences between regions, along with inter-regional variations in payment and reimbursement mechanisms. Informal and quasi-formal payments deteriorate access to public healthcare services and undermine the overall financing sustainability. The public healthcare sector is still underfinanced, although the implementation of health insurance gave some premises for future increases of efficiency. Overall, the available empirical data are not sufficient for an evidence-based evaluation of the reforms. More studies on the quality, equity, efficiency and sustainability impact of the reforms are needed. Future reforms should focus on the implementation of cost-efficiency and cost-control mechanisms; provide incentives for better allocation and distribution of resources; tackle problems in equity in access and financing; implement a system of quality controls; and stimulate healthy competition between insurance companies. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Commercializing biomedical research through securitization techniques.

PubMed

Fernandez, Jose-Maria; Stein, Roger M; Lo, Andrew W

2012-10-01

Biomedical innovation has become riskier, more expensive and more difficult to finance with traditional sources such as private and public equity. Here we propose a financial structure in which a large number of biomedical programs at various stages of development are funded by a single entity to substantially reduce the portfolio's risk. The portfolio entity can finance its activities by issuing debt, a critical advantage because a much larger pool of capital is available for investment in debt versus equity. By employing financial engineering techniques such as securitization, it can raise even greater amounts of more-patient capital. In a simulation using historical data for new molecular entities in oncology from 1990 to 2011, we find that megafunds of $5–15 billion may yield average investment returns of 8.9–11.4% for equity holders and 5–8% for 'research-backed obligation' holders, which are lower than typical venture-capital hurdle rates but attractive to pension funds, insurance companies and other large institutional investors.

Financial Structure of Mining Sector Companies During an Economic Slowdown /Struktura Finansowania Przedsiębiorstw W Sektorze Górniczym I Wydobywczym W Okresie Spowolnienia Gospodarczego

NASA Astrophysics Data System (ADS)

Sierpińska, Maria; Bąk, Patrycja

2012-12-01

The global economic crisis that started in 2007 in the area of finance, expanded over the subsequent years to the business sphere, and resulted in a drop of demand and production almost in any field of business activity. Access to foreign sources of finance, especially to loans, has become more difficult and expensive. In such circumstances, enterprises have had to resort more often to their own capital generated by the issue of shares, and to retained profit. Banks have limited their loans for business entities, reduced credit periods, and raised credit margins as well as their levels of collaterals. The McKinsey research into the changes that occur in the structures of sources of finance confirms that the share of equity capital in the structure of financing of non-financial enterprises has visibly grown, and their crediting scopes have been limited all over the European Union as well as in the euro zone. The global tendencies as regards directions of changes in the structure of the sources of corporate financing have also been reflected in Poland. The economic slowdown has resulted in changes in the structures of corporate financing. Mining companies have risen the shares of their equity capital in their general sources of financing. This tendency corresponds to the changes of structure of corporate financing in Poland and Europe. Enterprises have resorted to bank loans to a lesser degree than in times of better market situation. In mining, public companies have increased their crediting, while in private sector the tendency has been reverse. Enterprises tend to use more flexible debiting forms as compared to credits by way of issue of long-term corporate bonds. Mining companies have developed issue programs that are to be implemented over three-year periods. Before, only Katowicki Holding Węglowy [Katowice Mining Holding] had issued bonds. The present publication is an attempt at assessing the changes in the structure of corporate financing within the mining sector in the circumstances of economic slowdown. The changes have been assessed against the background of changes in the structure of financing of other business entities. Three problems have been identified and subjected to research. The first concerns the increasing share of equity capital in the structure of corporate financing in mining enterprises. The second issue concerns the scope of corporate crediting. And the third issue relates to the time structure of corporate debt. The said issues have been analysed in the conditions of economic slowdown

Analysis of government investment in primary healthcare institutions to promote equity during the three-year health reform program in China.

PubMed

Zhang, Xiaopeng; Xiong, Yuqi; Ye, Jing; Deng, Zhaohua; Zhang, Xinping

2013-03-25

The World Health Report 2000 stated that increased public financing for healthcare was an integral part of the efforts to achieve equity of access. In 2009, the Chinese government launched a three-year health reform program to achieve equity of access. Through this reform program, the government intended to increase its investment in primary healthcare institutions (PHIs). However, reports about the outcome and the improvement of the equity of access have yet to be presented. Stratified sampling was employed in this research. The samples used for the study comprised 34 community health service centers (CHSCs) and 92 township hospitals (THs) from six provinces of China. Collected data, which were publicly available, consisted of the total revenue, financial revenue, and the number of people for the periods covering January 2010 to September 2010 and January 2011 to September 2011. Revenue information for 2009 and 2010 was obtained from China's Health Statistics Yearbook.By using indicators such as government investment, government finance proportion and per capita revenue, t-tests for paired and independent samples were used to analyze the changes in government investment. Government invest large amount of money to the primary healthcare institutions. Government finance proportion in 2008 was 18.2%. This percentage increased to 38.84% in 2011, indicating statistical significance (p = 0.000) between 2010 and 2011. The per capita financial input was 20.92 yuan in 2010 and 31.10 yuan in 2011. Compared with the figures from 2008 to 2010, the gap in different health sectors narrowed in 2011, and differences emerged. The government finance proportion in CHSCs revenue was 6.9% higher than that of THs, while the per capita revenue of CHSCs was higher. In 2011, the highest and lowest government finance proportions were 48.80% (Shaanxi) and 19.36% (Shandong), respectively. In that same year, the per capita revenue of Shaanxi (40.69 Yuan) was higher than that of Liaoning (28.79 Yuan). Comparing the 2011 figures with those from 2008 to 2010, the gap in 2011 clearly narrowed. In the three-year health reform program, the Chinese government increased its investment to PHIs gradually and significantly. Thus promote equity to access and universal coverage. However, the increase in government investment stemmed from political desire and from the lack of institutionalization of practice and experience. Hence, a mode of financial allocation must be formulated to promote consistency in government input after the three-year health reform program.

Analysis of government investment in primary healthcare institutions to promote equity during the three-year health reform program in China

PubMed Central

2013-01-01

Background The World Health Report 2000 stated that increased public financing for healthcare was an integral part of the efforts to achieve equity of access. In 2009, the Chinese government launched a three-year health reform program to achieve equity of access. Through this reform program, the government intended to increase its investment in primary healthcare institutions (PHIs). However, reports about the outcome and the improvement of the equity of access have yet to be presented. Methods Stratified sampling was employed in this research. The samples used for the study comprised 34 community health service centers (CHSCs) and 92 township hospitals (THs) from six provinces of China. Collected data, which were publicly available, consisted of the total revenue, financial revenue, and the number of people for the periods covering January 2010 to September 2010 and January 2011 to September 2011. Revenue information for 2009 and 2010 was obtained from China’s Health Statistics Yearbook. By using indicators such as government investment, government finance proportion and per capita revenue, t-tests for paired and independent samples were used to analyze the changes in government investment. Results Government invest large amount of money to the primary healthcare institutions. Government finance proportion in 2008 was 18.2%. This percentage increased to 38.84% in 2011, indicating statistical significance (p = 0.000) between 2010 and 2011. The per capita financial input was 20.92 yuan in 2010 and 31.10 yuan in 2011. Compared with the figures from 2008 to 2010, the gap in different health sectors narrowed in 2011, and differences emerged. The government finance proportion in CHSCs revenue was 6.9% higher than that of THs, while the per capita revenue of CHSCs was higher. In 2011, the highest and lowest government finance proportions were 48.80% (Shaanxi) and 19.36% (Shandong), respectively. In that same year, the per capita revenue of Shaanxi (40.69 Yuan) was higher than that of Liaoning (28.79 Yuan). Comparing the 2011 figures with those from 2008 to 2010, the gap in 2011 clearly narrowed. Conclusion In the three-year health reform program, the Chinese government increased its investment to PHIs gradually and significantly. Thus promote equity to access and universal coverage. However, the increase in government investment stemmed from political desire and from the lack of institutionalization of practice and experience. Hence, a mode of financial allocation must be formulated to promote consistency in government input after the three-year health reform program. PMID:23530658

Minorities, the Poor and School Finance Reform. Vol. 1: An Impact Study of Six States.

ERIC Educational Resources Information Center

Brischetto, Robert; Vaughan, David

To study the impact of school finance reform on minorities and the poor, researchers gathered data on educational revenues and spending, tax effort, district wealth and income, ethnicity, and urban location in California, Colorado, Florida, Michigan, New Mexico, and Texas. Their data analysis used various measures of educational equity and fiscal…

The Equity of Public School Finance in Missouri: 1977-1981. A Research Report.

ERIC Educational Resources Information Center

Ryan, Sharon; Walker, Anne

Updated were statistics of an earlier study done by the Education Commission of the States (ECS) in 1980, entitled "The Missouri School Finance Study." The recent results differed from the earlier study's, illustrating the extent to which revenues per pupil depended on local property wealth and income. The results of the first study…

The Road Ahead for School Finance Reform: Legislative Trends 2011 and beyond

ERIC Educational Resources Information Center

Crampton, Faith E.; Thompson, David C.

2011-01-01

The reform of education funding systems to achieve greater equity and adequacy is an ongoing struggle in many states. Because funding of public elementary and secondary education is constitutionally a state responsibility, the struggle plays out largely in state legislatures. At the same time, education finance reform does not take place in a…

76 FR 76474 - Emergence Capital Partners SBIC, L.P.; Notice Seeking Exemption Under Section 312 of the Small...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-07

..., L.P. proposes to provide equity financing to Lithium Technologies, Inc., 6121 Hollis Street, Suite 4, Emeryville, CA 94608 (``Lithium''). The financing is contemplated for working capital and general operating... Partners SBIC, L.P., own more than ten percent of Lithium. Therefore, Lithium is considered an Associate of...

Financing EU Student Mobility: A Proposed Credit Union Scheme for Europe. Research & Occasional Paper Series: CSHE.17.10

ERIC Educational Resources Information Center

Hoareau, Cecile

2010-01-01

Governments worldwide face the challenge of financing a growing student population with limited resources, especially in the current context of difficult economic recovery. Student loan schemes, because they appear as cost-efficient and are defendable on the lines of social equity (students invest in their future), are increasingly politically…

Equity in the financing of social security for health in Chile.

PubMed

Bitran, R; Mu?oz, J; Aguad, P; Navarrete, M; Ubilla, G

2000-01-01

Real public health spending has more than doubled since 1990, raising concerns about the targeting of public subsidies. This study examined the degree of equity in the financing of FONASA, the public insurer, which in 1995 covered 8.6 million beneficiaries, or 62% of the country's population. Study results, covering calendar year 1995, indicated that (1) government health subsidies were well-targeted, with about 90% reaching the indigent and 8% going to other, low-income beneficiaries; (2) only 2.5% of government subsidies leaked to higher-income, non-beneficiaries of FONASA (people covered by private insurers known as ISAPRES, otherwise covered, or without any coverage); (3) overall, FONASA's contributing beneficiaries (i.e. the indigent aside) self-financed their health benefits, although higher-income beneficiaries were providing significant cross-subsidies to low-income ones, making the internal financing of FONASA somewhat progressive; (4) the indigent received the highest amount of annual net benefits per capita, followed by low-income beneficiaries; and (5) the evasion of FONASA's payroll tax was pervasive, although public providers delivered care on an equal basis irrespective of the patients' contributions to FONASA. FONASA's finances would improve significantly if affiliation to health social security by both dependent and independent workers was made compulsory.

Igualdad y suficiencia en las finanzas de la educacion (Equity and Adequacy in Educational Finance). ERIC Digest.

ERIC Educational Resources Information Center

Hadderman, Margaret

This digest in Spanish discusses efforts to achieve financial equity in education. It describes the extent of financial disparity and how, after 3 decades of litigation, such disparities among districts and among states remain high. In New Jersey alone, the per-pupil expenditures ranged from $5,900 to $11,950. Even with such inequities, some…

[The new strategy of the British health system: reflections on the changes in British health care system in the light of the WHO report on the financing of health systems worldwide].

PubMed

Vaccari, Vittorio; Passerino, Costantino; Giagnorio, Maria Laura

2011-01-01

The search for a strategy that can optimise resources far the financing of health systems is currently the subject of numerous worldwide experiments. This interest stems from the fact that in most countries, although having each one different specific characteristics, governments try to improve the efficiency and equity of health care. This worle analyses how innovative financing options at national level can be combined with decision-making processes typical of quality management to devise strategies far funding health services that are oriented towards their continuous improvement. The paper discusses, in particular, the strategy adopted in England, where the new law Equity and Excellence, liberating the NHS radically changes the management of the NHS, giving patients the choice of using different types of structures and therefore the possibility to find the most convenient combination in order to obtain the required service.

Equity in health personnel financing after Universal Coverage: evidence from Thai Ministry of Public Health's hospitals from 2008-2012.

PubMed

Ruangratanatrai, Wilailuk; Lertmaharit, Somrat; Hanvoravongchai, Piya

2015-07-18

Shortage and maldistribution of the health workforce is a major problem in the Thai health system. The expansion of healthcare access to achieve universal health coverage placed additional demand on the health system especially on the health workers in the public sector who are the major providers of health services. At the same time, the reform in hospital payment methods resulted in a lower share of funding from the government budgetary system and higher share of revenue from health insurance. This allowed public hospitals more flexibility in hiring additional staff. Financial measures and incentives such as special allowances for non-private practice and additional payments for remote staff have been implemented to attract and retain them. To understand the distributional effect of such change in health workforce financing, this study evaluates the equity in health workforce financing for 838 hospitals under the Ministry of Public Health across all 75 provinces from 2008-2012. Data were collected from routine reports of public hospital financing from the Ministry of Public Health with specific identification on health workforce spending. The components and sources of health workforce financing were descriptively analysed based on the geographic location of the hospitals, their size and the core hospital functions. Inequalities in health workforce financing across provinces were assessed. We calculated the Gini coefficient and concentration index to explore horizontal and vertical inequity in the public sector health workforce financing in Thailand. Separate analyses were carried out for funding from government budget and funding from hospital revenue to understand the difference between the two financial sources. Health workforce financing accounted for about half of all hospital non-capital expenses in 2012, about a 30 % increase from the level of spending in 2008. Almost one third of the workforce financing came from hospital revenue, an increase from only one fourth 5 years earlier. The study reveals a big difference in health workforce expenditure per capita across provinces. Health workforce spending from government budget was less equal than that from hospital revenues as shown by the higher Gini coefficient. The concentration indices show that the financing of hospital workforce was higher per capita in lower resource provinces. Our analysis of equalities in health workforce spending shows an improving trend in equity across provinces from 2008-2012. Expansion of healthcare and health insurance coverage and financing reform towards a demand-side financing helped improve the distribution of funding for health workforce across the provinces. The findings from this study can be useful for other countries with ongoing reform towards universal health coverage.

Education Exclusion in a Social-Class Framework: An Inquiry into the Major Sub-Sectors of the Professional Self-Financing Sector in Kerala

ERIC Educational Resources Information Center

Rajasenan, D.; Bijith, G. A.; Rajeev, B.

2016-01-01

Education and education exclusion are two mammoth social and political challenges in a society characterized by diverse social groups. Although "self-financing regime" helped to barricade the outflow of money from the state, it also hampered the "social equity" in education and hence germinated the seed of education exclusion…

Adequacy, Efficiency and Equity of Higher Education Financing: The Case of Egypt

ERIC Educational Resources Information Center

Fahim, Yasmine; Sami, Noha

2011-01-01

To meet its future challenges in financing higher education, Egypt has no option but to search for alternative funding arrangements. This article considers the question of how to do so, keeping in mind the need to ensure equitable access to good quality education for those who cannot afford it. To this end, the article begins by assessing public…

Redesigning School Finance Systems: Lessons from CPRE Research. CPRE Policy Briefs. RB-50

ERIC Educational Resources Information Center

Odden, Allan

2007-01-01

This policy brief describes how the Consortium for Policy Research in Education (CPRE) has approached the objectives of educational equity and adequacy over the past decade and a half, and reveals how their current finance research has begun to explicitly link the level and use of resources with strategies that districts and schools can deploy to…

From Segregation to School Finance: The Legal Context for Language Rights in the United States

ERIC Educational Resources Information Center

Powers, Jeanne M.

2014-01-01

In this chapter, the author reviews the legal trajectory of language rights in public schooling in the United States and how language has been intertwined with other policy issues in court cases aimed at expanding access and equity for minority students: desegregation and school finance. Most of these cases originated in the Southwestern United…

Financing strategic plans for not-for-profits.

PubMed

Wong-Hammond, Laca; Damon, Lorie

2013-07-01

To succeed in today's complex economic environment, a not-for-profit health system requires an effective strategic capital planning process that harmonizes three elements: The organization's long-term business plan and mission. Existing financial resources and finance options available to support the organization's business plan. Financial risk and return on equity to the organization's stakeholders (within acceptable parameters for business risk).

The Search for Equity in School Finance: Michigan School District Response to a Guaranteed Tax Base.

ERIC Educational Resources Information Center

Park, Rolla Edward; Carroll, Stephen J.

Part of a three-volume report on the effects of school finance reform, this volume examines the effects of reform on Michigan school districts' budgets from 1971 to 1976. Econometric models were used. Researchers found a very small "price" effect--an elasticity of -.02. The data provide no evidence that state matching grants stimulate…

Women's Career Choice Equity Legislation. Hearing before the Subcommittee on Social Security and Income Maintenance Programs of the Committee on Finance. United States Senate, Ninety-Eighth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Finance.

These Congressional hearings contain testimony pertaining to the passage of women's career choice equity legislation. The hearings were convened to determine whether federal law, either directly or indirectly, regulates economic opportunities for women in such a way as to alter their career choice between paid employment and homemaking. During the…

The logic of tax-based financing for health care.

PubMed

Bodenheimer, T; Sullivan, K

1997-01-01

Employment-based health insurance faces serious problems. For the first time, the number of Americans covered by such health insurance is falling. Employers strongly oppose the employer mandate approach to extending health insurance. Employment-based financing is regressive and complex. Serious debate is needed on an alternative solution to financing health care for all Americans. Taxation represents a clear alternative to employment-based health care financing. The major criterion for choosing a tax is equity, with simplicity a second criterion. An earmarked, progressive individual income tax is a fair and potentially simple tax with which to finance health care. The political feasibility of such a tax is greater than that of employer mandate legislation.

Home Modifications

MedlinePlus

... income and ability to pay. Public and private financing options may also be available. Sources of support ... Learn more by visiting https://www.ncoa.org/economic-security/home-equity/ . Search for additional resources in ...

Financing Facilities.

ERIC Educational Resources Information Center

Silverstein, Justin; Augenblick, John

2002-01-01

Reviews several issues having implications for the future nature and funding of school construction, including recent state educational adequacy and equity litigation, smaller class sizes, full-day kindergartens, educational technology, and charter schools. (PKP)

The response of public and private credit markets to typhoons in China

NASA Astrophysics Data System (ADS)

Bao, X.; Hsiang, S. M.

2011-12-01

When natural disasters strike, both public and private credit markets may finance the reconstruction of lost capital. We examine the response of public and private credit markets to cyclone events in China, using provincial fiscal data from 1978 to 2008, and find striking differences in the sectors targeted by public and private creditors. Following a cyclone event, public loans to the agricultural sector expand 2% for every additional 10 m/s in local wind exposure, while private loans to industrial and commercial sectors grow 7% for the same event. In addition, we find that these expansions to local credit markets persist at these levels for at least one year following exposure to a storm. We then demonstrate that these results are consistent with a model in which private creditors maximize profits and the government maximizes equity. In this stylized model, we show that when governments value short-term equity and finance risky sectors with plausibly negative net present value, this may have the perverse effect of encouraging populations and capital to remain in disaster-prone regions and lower equity in the long-run.

Design, implementation, and evaluation of a community financing scheme for hospital care in developing countries: a pre-paid health plan in the Bwamanda health zone, Zaire.

PubMed

Moens, F

1990-01-01

Unless scarce resources can be mobilized and used efficiently, health for all by the year 2000 will remain a vain attempt. Innovative financing schemes exploring increased cost recovery from the users of the health system are explored throughout the world. In Bwamanda, Zaire, a community financing scheme for hospital care was developed through the application of operations research. A preference heuristic with considerable involvement of health providers and the community was used to identify the type of financing scheme and resulted in a pre-paid health plan, while a mathematical model was developed to determine the premiums to charge. The implementation of the health plant is briefly described. An evaluation of the effects of the pre-paid plan on the accessibility and equity of health care, as well as on the financial sustainability of the hospital, is presented and discussed: a steadily increasing membership of the health plan illustrates its appropriateness, while a doubling of the cost recovery of the hospital's operating costs after two years seems promising; the hospitalization rate of members of the health plan was significantly higher than for non-members. These findings suggest that a health zone may be an appropriate level for the organization of a regional pre-paid health plan. Problems of equity, full cost recovery, and replicability of the financing scheme are discussed.

What We Don't Know Can't Hurt Us? Equity Consequences of Financing Special Education on the Untested Assumption of Uniform Needs

ERIC Educational Resources Information Center

Baker, Bruce D.; Ramsey, Matthew J.

2010-01-01

Over the past few decades, a handful of states have chosen to provide state financing of special education programs through a method referred to as "Census-Based" funding--an approach which involves allocated block-grant funding on an assumed basis of uniform distribution of children with disabilities across school districts. The…

Resolved, That the Federal Government Should Fully Finance a Defensible Minimum Education for All Children in the Public Schools. An Affirmative Position.

ERIC Educational Resources Information Center

Hack, Walter G.

This report discusses several kinds of Federal aid to education and decides that a Federal foundation program is the best type. Arguments in favor of such a program are that (1) contemporary societal problems require a national policy (including a federally financed education program), (2) equity of financial responsibility for the educational…

Education Funding and Student Outcomes: A Conceptual Framework for Measurement of the Alignment of State Education Finance and Academic Accountability Policies

ERIC Educational Resources Information Center

Knoeppel, Robert C.; Della Sala, Matthew R.

2015-01-01

The conceptualization and measurement of education finance equity and adequacy has engaged researchers for more than three decades. At the same time, calls for increased academic accountability and higher student achievement in K-12 public education have reached new levels at both the national and state levels. Aligning these represents an…

California on the Verge of a Fourth Wave of School Finance Reform

ERIC Educational Resources Information Center

Slater, Charles L.; Scott, James

2011-01-01

Equity issues in public school finance have been discussed in terms of three waves. The first wave was a challenge to the U.S. Supreme Court to provide equal education to all students as a fundamental right. After a ruling against the plaintiffs in "San Antonio v Rodriguez" (1973), the fight shifted to a second wave in the state courts.…

Wind Power Finance and Investment Workshop 2004

DOE Office of Scientific and Technical Information (OSTI.GOV)

anon.

2004-11-01

The workshop had 33 presentations by the leading industry experts in the wind finance and investment area. The workshop presented wind industry opportunities and advice to the financial community. The program also included two concurrent sessions, Wind 100, which offered wind energy novices a comprehensive introduction to wind energy fundamentals, and Transmission Policy and Regulations. Other workshop topics included: Bringing environmental and other issues into perspective; Policy impacts on wind financing; Technical/wind issues; Monetizing green attributes (Sale of green tags); Contractual issues; Debt issues; and Equity issues. There were approximately 230 attendees.

Efficiency and equity implications of the health care reforms.

PubMed

Carr-Hill, R A

1994-11-01

The purpose of the paper is to reflect on the recent health care reforms in both developed and developing countries, in the light of the evidence that has accumulated over the last few years about the efficiency and equity of different fiscal and organisational arrangements. The scene is set by a brief review of the definitions of efficiency and equity and of the confusions that often arise; and of the problems of making assessments in practice with real data. The evidence about effectiveness, efficiency and equity at the macro level are reviewed: among OECD countries, there is little evidence that variations in the levels and composition of health service expenditure actually affect levels of health; equity in financing and delivery appears to mirror equity in other sectors in the same countries; about the only solid--although rather limp--conclusion which is transferable is that costs can be contained best via global budgeting. The range of reforms in the North is sketched: despite calls to give people 'freedom' to opt out, public finances continues to be preferred among OECD countries; and the evidence that health care markets can actually function is 'weak'. Whilst geographical redistribution of finance has proved to be possible, inequalities in health remain in most countries. But the overwhelming impression is that the quality of the data base for many of these studies is appalling, and the analytice techniques used are simplistic. The move to introduce user charges in the South is discussed. It seems unlikely that they will raise a significant fraction of overall revenue; exemptions intended for the poor do not always work; and other trends are likely to exacerbate the patchy coverage of health care systems in the South. The final section reflects on the pressures for increased accountability. The emphasis on consumerism in the North has led to an increasing number of poorly designed 'patient satisfaction' surveys; in the South, there has been an increasing rhetoric on community participation, but little sign of actual devolution of control. The flavour of the decade is 'outcome measurement' which has been promoted feverish but with little rigour. We must also be concerned that this emphasis will, once again, be hijacked by the most articulate.

Attempted Tax Freeze Highlights Complexity of State/Local Control in Education Finance. Research Brief, Volume 91, Number 6, August 18, 2003

ERIC Educational Resources Information Center

Public Policy Forum, 2003

2003-01-01

During the 1990's, education shifted from a primarily local function, to one of give-and-take system of finance between local and state governments. Revenue limits are imposed on school districts with the primary purposes of limiting property tax increases and increasing equity in school spending. In turn, the state has agreed to fund two-thirds…

47 CFR 1.2111 - Assignment or transfer of control: unjust enrichment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... nonattributable equity investments, debt financing, revenue from operations or other investments, business... after restructuring or entry into a material relationship), plus interest based on the rate for ten year...

47 CFR 1.2111 - Assignment or transfer of control: unjust enrichment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... nonattributable equity investments, debt financing, revenue from operations or other investments, business... after restructuring or entry into a material relationship), plus interest based on the rate for ten year...

47 CFR 1.2111 - Assignment or transfer of control: unjust enrichment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... nonattributable equity investments, debt financing, revenue from operations or other investments, business... after restructuring or entry into a material relationship), plus interest based on the rate for ten year...

And Poor Children Continue to Wait: An Analysis of Horizontal and Vertical Equity among North Carolina School Districts in the Face of Judicially Mandated Policy Restraints 1996-2006

ERIC Educational Resources Information Center

Rolle, Anthony; Houck, Eric A.; McColl, Ann

2008-01-01

During the late 1990s, North Carolina's education finance mechanism--known as the Public School Fund (PSF)--was challenged in a series of litigation known as "Leandro v. State of North Carolina". Though the State Supreme Court's analyses left the state's finance mechanism unchanged, there remains to date no systematic evaluation of the…

Capital investment analysis: three methods.

PubMed

Gapenski, L C

1993-08-01

Three cash flow/discount rate methods can be used when conducting capital budgeting financial analyses: the net operating cash flow method, the net cash flow to investors method, and the net cash flow to equity holders method. The three methods differ in how the financing mix and the benefits of debt financing are incorporated. This article explains the three methods, demonstrates that they are essentially equivalent, and recommends which method to use under specific circumstances.

Banking on Solar: Debt Finance in Today's Distributed Market (Poster)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Louder, T.

Over the last two years, several entities - from banks to credit unions to solar finance companies -have rolled out distributed solar-specific loan programs in the United States. These solar-specific loans are a distinct loan in that the underwriting, loan terms, lender security interest, and other programmatic aspects are designed exclusively for the financing of solar installations. Until recently, loan financing for distributed solar installations was largely through home equity loans, commercial loans, and other standardized loan products available to homeowners and businesses for general expenditures. However, as the U.S. solar market matures, so too are its financing options, andmore » solar-specific loans stand to gain market share. This poster was presented at the Solar Power International conference in Las Vegas, NV in October 2014.« less

Frizzled to finance: one PhD’s path from a Drosophila lab to Wall Street

PubMed Central

Taylor, Job

2016-01-01

An equity research analyst’s job is to determine whether the price of a stock is likely to go up or down. For science-based businesses, particularly biotechnology companies, a PhD in the life sciences can be very helpful in making this determination. I transitioned from a postdoc position to working in equity research. Here I present information on how I made the transition, an overview of the day-to-day activities of an analyst, and thoughts on how to prepare to look for a job in finance. There are significant positives to working on Wall Street, including exposure to cutting-edge clinical/translational research, access to some of the best scientists in the world, a dynamic work environment, and compensation that generally exceeds academic salaries. This comes at the cost of some independence and the satisfaction of being able to call oneself a scientist. PMID:27235096

Mobilizing Public Markets to Finance Renewable Energy Projects: Insights from Expert Stakeholders

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schwabe, P.; Mendelsohn, M.; Mormann, F.

Financing renewable energy projects in the United States can be a complex process. Most equity investment in new renewable power production facilities is supported by tax credits and accelerated depreciation benefits, and is constrained by the pool of potential investors that can fully use these tax benefits and are willing to engage in complex financial structures. For debt financing, non-government lending has largely been provided by foreign banks that may be under future lending constraints due to economic and regulatory conditions. To discuss renewable energy financing challenges and to identify new sources of capital to the U.S. market, two roundtablemore » discussions were held with renewable energy and financing experts in April 2012. This report summarizes the key messages of those discussions and is designed to provide insights to the U.S. market and inform the international conversation on renewable energy financing innovations.« less

Efficiency, new equity capital enable systems to compete.

PubMed

Brown, M; McCool, B P

1985-01-01

Because of limited cash, sponsors of some community and religious hospitals have sought to sell or lease their institutions to a not-for-profit (NFP) system or to a for-profit system. A number of national alliances address the capital formation problem of NFP institutions. Until now they have been almost exclusively concerned with acquiring less costly debt. Without new equity capital, market influence is difficult to obtain. Even well-managed voluntary systems face a serious threat from well-capitalized investor-owned systems. Increased competition among hospitals and physicians will force future advantages to those who have capital. It will also restrict funding of certain programs and services by voluntary enterprises. In anticipation of this, various forms of partnerships have developed with investor-owned systems. To regain the initiative as the premier sponsors of health care, religious and other voluntary systems must go beyond merely competing in their markets to acquiring weaker institutions. They also must revitalize private giving and excel in efficiency to offset threats from ambulatory, day-care operations and from high-technology hospitals. Structural changes in the industry can be predicted, including the following: The trend toward integration for production, financing, and marketing will continue. Public market equity capital will be increasingly used to finance medical practice. Hospitals that sell their equity values will establish service foundations. National alliances will continue, but strictly local systems will maintain operation. Investor-owned systems will move increasingly into high-technology tertiary care.

A consistent decomposition of the redistributive, vertical, and horizontal effects of health care finance by factor components.

PubMed

Hierro, Luis A; Gómez-Álvarez, Rosario; Atienza, Pedro

2014-01-01

In studies on the redistributive, vertical, and horizontal effects of health care financing, the sum of the contributions calculated for each financial instrument does not equal the total effects. As a consequence, the final calculations tend to be overestimated or underestimated. The solution proposed here involves the adaptation of the Shapley value to achieve additive results for all the effects and reveals the relative contributions of different instruments to the change of whole-system equity. An understanding of this change would help policy makers attain equitable health care financing. We test the method with the public finance and private payments of health care systems in Denmark and the Netherlands. Copyright © 2013 John Wiley & Sons, Ltd.

Problems and Issues Related to Alternative Education.

ERIC Educational Resources Information Center

Pilat, Mary

1997-01-01

Symposium participants identified policy issues in these areas related to alternative education for at-risk youth: choice, equity, public perception, definition, philosophy, stakeholder involvement, evaluation, staffing, curriculum, governance, and financing. Public discourse and policy discussion were considered essential to implementing…

76 FR 23505 - Defense Federal Acquisition Regulation Supplement; Accelerate Small Business Payments (DFARS Case...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-27

..., distributive impacts, and equity). Executive Order 13563 emphasizes the importance of quantifying both costs... Regulations System. Therefore, 48 CFR part 232 is amended as follows: PART 232--CONTRACT FINANCING 0 1. The...

School Finance. Trends and Issues.

ERIC Educational Resources Information Center

Hadderman, Margaret, Comp.

During the past several years, policymakers and practitioners have concentrated their energies on resolving equity/adequacy issues, reforming school tax structures, improving schools' efficiency and cost-effectiveness, developing school-based accountability, and exploring alternative cost-cutting and fundraising strategies. Total expenditures for…

Technology Solutions for Schools.

ERIC Educational Resources Information Center

Association of School Business Officials International, Reston, VA.

This publication is the third of three publications to assist school business officials with the challenges of improving school facilities. This report explores issues relating to technology implementation in school buildings, including cost and finance issues, space requirements, classroom configuration, equity in technology availability,…

Impact of health financing policies in Cambodia: A 20 year experience.

PubMed

Ensor, Tim; Chhun, Chhim; Kimsun, Ton; McPake, Barbara; Edoka, Ijeoma

2017-03-01

Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups. Demand side financing policies including health equity funds, vouchers and community health insurance have been complemented by supply side measures to improve service delivery incentives through contracting. Multiple rounds of the Cambodia Socio-Economic Survey are used to investigate the impact of financing policies on health service utilisation and out of pocket payments both over time using commune panel data from 1997 to 2011 and across groups using individual data from 2004 and 2009. Policy combinations including areas with multiple interventions were examined against controls using difference-in-difference and panel estimation. Widespread roll-out of financing policies combined with user charge formalisation has led to a general reduction in health spending by the poor. Equity funds are associated with a reduction in out of pocket payments although the effect of donor schemes is larger than those financed by government. Vouchers, which are aimed only at reproductive health services, has a more modest impact that is enhanced when combined with other schemes. At the aggregate level changes are less pronounced although there is evidence that policies take a number of years to have substantial effect. Health financing policies and the supportive systems that they require provide a foundation for more radical extension of coverage already envisaged by a proposed social insurance system. A policy challenge is how disparate mechanisms can be integrated to ensure that vulnerable groups remain protected. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Impact of Inter-Governmental Grants and Municipal Overburden on School Spending and Simulations of the Impact of Alternative Grant Formulas. [and] Policy Proposals Resulting from Research on "The Impact of Intergovernmental Grants and Municipal Overburden on School Finance Equity."

ERIC Educational Resources Information Center

Conte, Michael; And Others

In five chapters, this document's first part reports on research on the interrelationship of school and municipal finance in New Hampshire. The document's second part briefly summarizes the research report and discusses policy changes suggested by the results. Chapter 1 of the research report describes New Hampshire schools and the state aid…

The Energy Economics of Financial Structuring for Renewable Energy Projects

NASA Astrophysics Data System (ADS)

Rana, Vishwajeet

2011-12-01

This dissertation focuses on the various financial structuring options for the renewable energy sector. The projects in this sector are capital-intensive to build but have relatively low operating costs in the long run when compared to traditional energy resources. The large initial capital requirements tend to discourage investors. To encourage renewable investments the government needs to provide financial incentives. Since these projects ultimately generate returns, the government's monetary incentives go to the sponsors and tax equity investors who build and operate such projects and invest capital in them. These incentives are usually in the form of ITCs, PTCs and accelerated depreciation benefits. Also, in some parts of the world, carbon credits are another form of incentive for the sponsors and equity investors to invest in such turnkey projects. The relative importance of these various considerations, however, differs from sponsor to sponsor, investor to investor and from project to project. This study focuses mainly on the US market, the federal tax benefits and incentives provided by the government. This study focuses on the energy economics that are used for project decision-making and parties involved in the transaction as: Project Developer/Sponsor, Tax equity investor, Debt investor, Energy buyer and Tax regulator. The study fulfils the knowledge gap in the decision making process that takes advantage of tax monetization in traditional after-tax analysis for renewable energy projects if the sponsors do not have the tax capacity to realize the total benefits of the project. A case-study for a wind farm, using newly emerging financial structures, validates the hypothesis that these renewable energy sources can meet energy industry economic criteria. The case study also helps to validate the following hypotheses: a) The greater a sponsor's tax appetite, the tower the sponsor's equity dilution. b) The use of leverage increases the cost of equity financing and the financing fee. c) Capital contributions by the sponsor are not relevant to the rate of return (IRR) over the life of the project. Overall conclusion is that financial structures can have a major impact on renewable energy, meeting energy demand in an economic manner. At the end, the dissertation lays down the foundation for future research that can be conducted in this field. Key Words: Renewable energy investments, structured finance, financial structuring

Ethics and geographical equity in health care

PubMed Central

Rice, N.; Smith, P.

2001-01-01

Important variations in access to health care and health outcomes are associated with geography, giving rise to profound ethical concerns. This paper discusses the consequences of such concerns for the allocation of health care finance to geographical regions. Specifically, it examines the ethical drivers underlying capitation systems, which have become the principal method of allocating health care finance to regions in most countries. Although most capitation systems are based on empirical models of health care expenditure, there is much debate about which needs factors to include in (or exclude from) such models. This concern with legitimate and illegitimate drivers of health care expenditure reflects the ethical concerns underlying the geographical distribution of health care finance. Key Words: Health economics • resource allocation • ethics of regional health care finance • capitation systems PMID:11479357

The redistributive effect of health care finance in twelve OECD countries.

PubMed

van Doorslaer, E; Wagstaff, A; van der Burg, H; Christiansen, T; Citoni, G; Di Biase, R; Gerdtham, U G; Gerfin, M; Gross, L; Häkinnen, U; John, J; Johnson, P; Klavus, J; Lachaud, C; Lauritsen, J; Leu, R; Nolan, B; Pereira, J; Propper, C; Puffer, F; Rochaix, L; Schellhorn, M; Sundberg, G; Winkelhake, O

1999-06-01

The OECD countries finance their health care through a mixture of taxes, social insurance contributions, private insurance premiums and out-of-pocket payments. The various payment sources have very different implications for both vertical and horizontal equity and on redistributive effect which is a function of both. This paper presents results on the income redistribution consequences of the health care financing mixes adopted in twelve OECD countries by decomposing the overall income redistributive effect into a progressivity, horizontal inequity and reranking component. The general finding of this study is that the vertical effect is much more important than horizontal inequity and reranking in determining the overall redistributive effect but that their relative importance varies by source of payment. Public finance sources tend to have small positive redistributive effects and less differential treatment while private financing sources generally have (larger) negative redistributive effects which are to a substantial degree caused by differential treatment.

Poverty, equity, human rights and health.

PubMed

Braveman, Paula; Gruskin, Sofia

2003-01-01

Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.

Poverty, equity, human rights and health.

PubMed Central

Braveman, Paula; Gruskin, Sofia

2003-01-01

Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector. PMID:12973647

Strengthening institutional and organizational capacity for social health protection of the informal sector in lesser-developed countries: a study of policy barriers and opportunities in Cambodia.

PubMed

Annear, Peter Leslie; Ahmed, Shakil; Ros, Chhun Eang; Ir, Por

2013-11-01

Reaching out to the poor and the informal sector is a major challenge for achieving universal coverage in lesser-developed countries. In Cambodia, extensive coverage by health equity funds for the poor has created the opportunity to consolidate various non-government health financing schemes under the government's proposed social health protection structure. This paper identifies the main policy and operational challenges to strengthening existing arrangements for the poor and the informal sector, and considers policy options to address these barriers. Conducted in conjunction with the Cambodian Ministry of Health in 2011-12, the study reviewed policy documents and collected qualitative data through 18 semi-structured key informant interviews with government, non-government and donor officials. Data were analysed using the Organizational Assessment for Improving and Strengthening Health Financing conceptual framework. We found that a significant shortfall related to institutional, organisational and health financing issues resulted in fragmentation and constrained the implementation of social health protection schemes, including health equity funds, community-based health insurance, vouchers and others. Key documents proposed the establishment of a national structure for the unification of the informal-sector schemes but left unresolved issues related to structure, institutional capacity and the third-party status of the national agency. This study adds to the evidence base on appropriate and effective institutional and organizational arrangements for social health protection in the informal sector in developing countries. Among the key lessons are: the need to expand the fiscal space for health care; a commitment to equity; specific measures to protect the poor; building national capacity for administration of universal coverage; and working within the specific national context. Copyright © 2013 Elsevier Ltd. All rights reserved.

Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso.

PubMed

Ridde, Valéry; Turcotte-Tremblay, Anne-Marie; Souares, Aurélia; Lohmann, Julia; Zombré, David; Koulidiati, Jean Louis; Yaogo, Maurice; Hien, Hervé; Hunt, Matthew; Zongo, Sylvie; De Allegri, Manuela

2014-10-12

The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications. The study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods. Performance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.

12 CFR 1207.3 - Limitations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Limitations. 1207.3 Section 1207.3 Banks and Banking FEDERAL HOUSING FINANCE AGENCY ORGANIZATION AND OPERATIONS MINORITY AND WOMEN INCLUSION (Eff. Jan... any right or benefit, substantive or procedural, enforceable at law, in equity, or through...

12 CFR 930.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS DEFINITIONS APPLYING TO RISK MANAGEMENT AND CAPITAL REGULATIONS § 930.1 Definitions. As used in this.... Charges against the capital of the Bank means an other than temporary decline in the Bank's total equity...

Financing Education: Overcoming Inefficiency and Inequity.

ERIC Educational Resources Information Center

McMahon, Walter W., Ed.; Geske, Terry G., Ed.

Fiscal inefficiency in education is addressed in this book and ideas for achieving increased efficiency while more effectively using resources to maintain reasonable equality of opportunity in higher education are examined. Fourteen articles and authors that consider social efficiency, equity, and policy implications are as follows: "Efficiency…

Shifting the burden of health care finance: a case study of public-private partnership in Singapore.

PubMed

Lim, Meng-Kin

2004-07-01

Since becoming independent in 1965, Singapore has attained high standards in health care provision while successfully transferring a substantial portion of the health care burden to the private sector. The government's share of total health care expenditure contracted from 50% in 1965 to 25% in 2000. At first glance, the efficiency-driven health care financing reforms which emphasize individual over state responsibility appear to have been implemented at the expense of equity. On closer examination, however, Singaporeans themselves seem unconcerned about any perceived inequity of the system. Indeed, they appear content to pay part of their medical expenses, plus additional monies if they demand a higher level of services. In fact, access to needed care for the poor is explicitly guaranteed. Mechanisms also exist to protect against financial impoverishment resulting from catastrophic illness. Singapore's experience provides an interesting case study in public-private partnership, illustrating how a hard-headed approach to health policy can achieve national health goals while balancing efficiency and equity concerns.

Bookending the Opportunity to Lower Wind’s LCOE by Reducing the Uncertainty Surrounding Annual Energy Production

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bolinger, Mark

Reducing the performance risk surrounding a wind project can potentially lead to a lower weighted-average cost of capital (WACC), and hence a lower levelized cost of energy (LCOE), through an advantageous shift in capital structure, and possibly also a reduction in the cost of capital. Specifically, a reduction in performance risk will move the 1-year P99 annual energy production (AEP) estimate closer to the P50 AEP estimate, which in turn reduces the minimum debt service coverage ratio (DSCR) required by lenders, thereby allowing the project to be financed with a greater proportion of low-cost debt. In addition, a reduction inmore » performance risk might also reduce the cost of one or more of the three sources of capital that are commonly used to finance wind projects: sponsor or cash equity, tax equity, and/or debt. Preliminary internal LBNL analysis of the maximum possible LCOE reduction attainable from reducing the performance risk of a wind project found a potentially significant opportunity for LCOE reduction of ~$10/MWh, by reducing the P50 DSCR to its theoretical minimum value of 1.0 (Bolinger 2015b, 2014) and by reducing the cost of sponsor equity and debt by one-third to one-half each (Bolinger 2015a, 2015b). However, with FY17 funding from the U.S. Department of Energy’s Atmosphere to Electrons (A2e) Performance Risk, Uncertainty, and Finance (PRUF) initiative, LBNL has been revisiting this “bookending” exercise in more depth, and now believes that its earlier preliminary assessment of the LCOE reduction opportunity was overstated. This reassessment is based on two new-found understandings: (1) Due to ever-present and largely irreducible inter-annual variability (IAV) in the wind resource, the minimum required DSCR cannot possibly fall to 1.0 (on a P50 basis), and (2) A reduction in AEP uncertainty will not necessarily lead to a reduction in the cost of capital, meaning that a shift in capital structure is perhaps the best that can be expected (perhaps along with a modest decline in the cost of cash equity as new investors enter the market).« less

Community Wind: Once Again Pushing the Envelope of Project Finance

DOE Office of Scientific and Technical Information (OSTI.GOV)

bolinger, Mark A.

In the United States, the 'community wind' sector - loosely defined here as consisting of relatively small utility-scale wind power projects that sell power on the wholesale market and that are developed and owned primarily by local investors - has historically served as a 'test bed' or 'proving grounds' for up-and-coming wind turbine manufacturers that are trying to break into the U.S. wind power market. For example, community wind projects - and primarily those located in the state of Minnesota - have deployed the first U.S. installations of wind turbines from Suzlon (in 2003), DeWind (2008), Americas Wind Energy (2008)more » and later Emergya Wind Technologies (2010), Goldwind (2009), AAER/Pioneer (2009), Nordic Windpower (2010), Unison (2010), and Alstom (2011). Thus far, one of these turbine manufacturers - Suzlon - has subsequently achieved some success in the broader U.S. wind market as well. Just as it has provided a proving grounds for new turbines, so too has the community wind sector served as a laboratory for experimentation with innovative new financing structures. For example, a variation of one of the most common financing arrangements in the U.S. wind market today - the special allocation partnership flip structure (see Figure 1 in Section 2.1) - was first developed by community wind projects in Minnesota more than a decade ago (and is therefore sometimes referred to as the 'Minnesota flip' model) before being adopted by the broader wind market. More recently, a handful of community wind projects built over the past year have been financed via new and creative structures that push the envelope of wind project finance in the U.S. - in many cases, moving beyond the now-standard partnership flip structures involving strategic tax equity investors. These include: (1) a 4.5 MW project in Maine that combines low-cost government debt with local tax equity, (2) a 25.3 MW project in Minnesota using a sale/leaseback structure, (3) a 10.5 MW project in South Dakota financed by an intrastate offering of both debt and equity, (4) a 6 MW project in Washington state that taps into New Markets Tax Credits using an 'inverted' or 'pass-through' lease structure, and (5) a 9 MW project in Oregon that combines a variety of state and federal incentives and loans with unconventional equity from high-net-worth individuals. In most cases, these are first-of-their-kind structures that could serve as useful examples for other projects - both community and commercial wind alike. This report describes each of these innovative new financing structures in some detail, using a case-study approach. The purpose is twofold: (1) to disseminate useful information on these new financial structures, most of which are widely replicable; and (2) to highlight the recent policy changes - many of them temporary unless extended - that have facilitated this innovation. Although the community wind market is currently only a small sub-sector of the U.S. wind market - as defined here, less than 2% of the overall market at the end of 2009 (Wiser and Bolinger 2010) - its small size belies its relevance to the broader market. As such, the information provided in this report has relevance beyond its direct application to the community wind sector. The next two sections of this report briefly summarize how most community wind projects in the U.S. have been financed historically (i.e., prior to this latest wave of innovation) and describe the recent federal policy changes that have enabled a new wave of financial innovation to occur, respectively. Section 4 contains brief case studies of how each of the five projects mentioned above were financed, noting the financial significance of each. Finally, Section 5 concludes by distilling a number of general observations or pertinent lessons learned from the experiences of these five projects.« less

Distributional effects of environmental policies in Greece

NASA Astrophysics Data System (ADS)

Lekakis, Joseph N.

1990-07-01

Environmental protection policies generate an equity question concerning the fair allocation of environmental benefits and costs. This paper presents evidence from Greece during the 1980s. The findings reveal that Greek environmental policies, in the form of government self-regulatory programs, are mostly regressive in nature. At the regional level these programs combine all forms of vertical equity. Since the public sector finances the majority of related expenditures out of taxes, the regressive elements of environmental policies have been reinforced by discretionary fiscal measures and tax evasion, accompanied by inflation, which have distorted the country's progressive tax system.

Government health insurance and privatization: an examination of the concept and of equity.

PubMed

Anderson, O W

1988-01-01

After almost a century of the evolution of welfare capitalism in the liberal-democratic countries, and the spread of government intervention in the financing and provision of health services, the debate is now whether or not government can, or should, be as all-encompassing as it has clearly become. What is emerging with greater force is a pattern of private insurance and private provision, though its future is not easy to predict. What is clear, however, is that a modified version of a politically acceptable concept of equity will have to be formulated.

Principles of a Sound State School Finance System.

ERIC Educational Resources Information Center

National Conference of State Legislatures, Denver, CO.

Funding for public elementary and secondary education is a significant portion of most state budgets, representing on average approximately one-third of general fund appropriations. This booklet provides policymakers with five broad principles for the design of state school funding systems--equity, efficiency, adequacy, accountability, and…

Cost Sharing in Public Universities: A Kenyan Case Study.

ERIC Educational Resources Information Center

Rodrigues, Anthony J.; Wandiga, Shem O.

1997-01-01

Presents an analysis of government policy on higher education finance in Kenya, outlines parameters of an appropriate tuition policy (cost recovery, equity, equal access, affordability, student loan program objectives), and provides a model for simulating loan program outcomes. Suggests several proposed policy and administrative reforms concerning…

Value-Added Tax -- Can Schools Use It?

ERIC Educational Resources Information Center

Salmon, Richard G.

1973-01-01

Defines the value-added tax and examines it in light of equity, economic effects, cost of administration, and stability and yield. Compares the tax with the property tax and suggests alternative ways in which States and the Federal Government may participate in the financing of education. (DN)

Integrating Photovoltaic Systems into Low-Income Housing Developments: A Case Study on the Creation of a New Residential Financing Model and Low-Income Resident Job Training Program, September 2011 (Brochure)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dean, J.; Smith-Dreier, C.; Mekonnen, G.

2011-09-01

This case study covers the process of successfully integrating photovoltaic (PV) systems into a low-income housing development in northeast Denver, Colorado, focusing specifically on a new financing model and job training. The Northeast Denver Housing Center (NDHC), working in cooperation with Del Norte Neighborhood Development Corporation, Groundwork Denver, and the National Renewable Energy Laboratory (NREL), was able to finance the PV system installations by blending private equity funding with utility rebates, federal tax credits, and public sector funding. A grant provided by the Governor's Energy Office allowed for the creation of the new financing model. In addition, the program incorporatedmore » an innovative low-income job training program and an energy conservation incentive program.« less

An equity analysis of performance-based financing in Rwanda: are services reaching the poorest women?

PubMed

Priedeman Skiles, Martha; Curtis, Siân L; Basinga, Paulin; Angeles, Gustavo

2013-12-01

Maternal health services continue to favour the wealthiest in lower and middle income countries. Debate about the potential of performance-based financing (PBF) to address these disparities continues. As PBF is adopted by countries, it is critical to understand the equity effects for maternal services. The aim of this study is to examine the effects of PBF on equity in maternal health service use when no specific provisions target the poorest in the population. In Rwanda, PBF was designed to increase health service use, which was universally low. Paired districts were randomly assigned to intervention and control for PBF implementation. Using Rwanda's Demographic Health Survey data from 2005 (pre-intervention) and 2007-8 (post-intervention), a cluster-level panel dataset of 7899 women 15-49 years of age from intervention (4477) and control districts (3422) was created. The impact of PBF on reported use of facility deliveries, antenatal care (ANC) and modern contraceptive use was estimated using a difference-in-differences model with community fixed effects. Interaction terms between wealth quintiles and PBF were estimated to identify the differential effect of PBF among poorer women. The probability of a facility delivery increased by 10 percentage points in the intervention when compared with the control districts (P = 0.014), while no significant effects were noted for ANC visits or modern contraceptive use. Service use increased for intervention and control populations and across all wealth quintiles from 2005 to 2007, with no evidence that PBF was a pro-poor or a pro-rich strategy. Insurance remained a positive predictor of service use. This research suggests that if service use is uniformly low then a PBF programme that incentivizes select services, such as facility deliveries, may improve service use overall. However, if the equity gap is extreme, then a PBF programme without equity targets will do little to alleviate disparities.

Health care and equity in India.

PubMed

Balarajan, Y; Selvaraj, S; Subramanian, S V

2011-02-05

In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population. Copyright © 2011 Elsevier Ltd. All rights reserved.

Capital Outlay as an Educational Equity Issue: A Review of Educational Research and Legal Opinion.

ERIC Educational Resources Information Center

Thompson, David C.; And Others

1989-01-01

Examines issues of how school districts finance facility needs. Reviews numerous recent legal decisions addressing capital outlay; discusses implications for educational policymakers. Concludes that court proceedings and research literature suggest an important association between wealth dependency and unmet needs in funding school district…

Rates of Return to Education in Botswana.

ERIC Educational Resources Information Center

Siphambe, Happy Kufigwa

2000-01-01

Using Botswana household income data, shows that education's rates of return rise by education level. The human capital model remains robust. Education is not income-equalizing; women are paid less than men despite being more highly educated. Private educational financing, job creation, and increased gender equity are needed. (Contains 27…

Craig Thomas Rural Hospital and Provider Equity Act of 2014

THOMAS, 113th Congress

Sen. Franken, Al [D-MN

2014-05-20

Senate - 05/20/2014 Read twice and referred to the Committee on Finance. (All Actions) Notes: For further action, see H.R.4067, which became Public Law 113-198 on 12/4/2014. Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Comparable Wages, Inflation, and School Finance Equity

ERIC Educational Resources Information Center

Taylor, Lori L.

2006-01-01

A Comparable Wage Index (CWI) is an attractive mechanism for measuring geographic variations in the cost of education. A CWI measures uncontrollable variations in educator pay by observing systematic variations in the earnings of comparable workers who are not educators. Together, the 2000 census and the Occupational Employment Statistics survey…

Centralization for Equity: A Fair Price?

ERIC Educational Resources Information Center

Malkiewich, Chris; McEwen, John

This paper analyzes educational finance reforms initiated in Ontario. It outlines the changes in governance, funding, and curriculum and states that reforms were implemented without proper support and forethought, resulting in chaos. The report details how the rise of a conservative government in the province led to a desire to reduce taxation and…

24 CFR 241.1015 - Processing of applications and required fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AND OTHER AUTHORITIES SUPPLEMENTARY FINANCING FOR INSURED PROJECT MORTGAGES Insurance for Equity Loans... acquisition loan on a project shall be submitted by an approved lender and by the owner or purchaser of the project to the Commissioner on a form prescribed by the Commissioner. No application shall be considered...

COBRE Research Workshop on Higher Education: Equity and Efficiency.

ERIC Educational Resources Information Center

Chicago Univ., IL.

This document comprises 8 papers presented at the COBRE Research Workshop on Higher Education. The papers are: (1) "Schooling and Equality from Generation to Generation;" (2) "Time Series Changes in Personal Income Inequality: The United States Experience, 1939 to 1985;" (3) "Education, Income, and Ability;" (4) "Proposals for Financing Higher…

77 FR 5295 - Over-the-Road Bus Accessibility Program Announcement of Project Selections

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-02

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Over-the-Road Bus Accessibility...-Road Bus (OTRB) Accessibility Program, authorized by Section 3038 of the Transportation Equity Act for... of over-the-road buses to help finance the incremental capital and training costs of complying with...

Conditional Wealth Neutrality as a School Finance Equity Criterion in Illinois.

ERIC Educational Resources Information Center

Schmink, David P.; And Others

This study looks at the relationship between district wealth and revenues available for education in Illinois using a "conditional" conception of wealth neutrality that holds constant the operational tax rate. Data used were demographic data of Illinois school districts. An analysis of beta weights suggested an undesirable relationship…

Four Takes on Tough Times

ERIC Educational Resources Information Center

Rebell, Michael A.; Odden, Allan; Rolle, Anthony; Guthrie, James W.

2012-01-01

Educational Leadership talks with four experts in the fields of education policy and finance about how schools can weather the current financial crisis. Michael A. Rebell focuses on the recession and students' rights; Allan Odden suggests five steps schools can take to improve in tough times; Anthony Rolle describes the tension between equity and…

12 CFR 998.3 - Reservation of authority.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Reservation of authority. 998.3 Section 998.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK DISCLOSURES REGISTRATION OF FEDERAL HOME LOAN BANK EQUITY SECURITIES § 998.3 Reservation of authority. The requirements of this part...

Financing and Political Economy of Higher Education: The Case of Lebanon

ERIC Educational Resources Information Center

Nahas, Charbel

2011-01-01

This paper assesses the adequacy, efficiency, and equity of higher education in Lebanon in both the public and private sectors, while highlighting challenges that are specific to Lebanon. It concludes by discussing various approaches and strategies to remedy the challenges facing higher education in Lebanon.

The Importance of the Assistant Principal.

ERIC Educational Resources Information Center

Landmeier, Ralph W.

Because of the difficulty of current and emerging school problems, the assistant principal needs to be knowledgeable in such diverse areas as accounting, school finance, school law, student rights, book censorship, and women's equity. In addition, it is necessary that the assistant principal be involved in curriculum improvement, evaluations,…

13 CFR 124.515 - Can a Participant change its ownership or control and continue to perform an 8(a) contract, and...

Code of Federal Regulations, 2010 CFR

2010-01-01

... of a majority of the voting stock of the concern in order to raise equity capital, but only if— (i... financing; (2) Ownership and control of the concern that is performing the 8(a) contract will pass to...

76 FR 76895 - Conduit Financing Arrangements

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-09

.... Steven T. Miller, Deputy Commissioner for Services and Enforcement. Approved: November 29, 2011. Emily S... an entity disregarded as an entity separate from its owner for U.S. tax purposes as a person for...'' (instruments treated as debt for foreign law purposes and equity for U.S. purposes) should constitute per se...

Continuing Care Retirement Communities: An Analysis of Financial Viability and Health Care Coverage.

ERIC Educational Resources Information Center

Ruchlin, Hirsch S.

1988-01-01

Calculated financial ratios for 109 Continuing Care Retirement Communities (CCRCs). Noted problems with regard to asset productivity, profitability, and equity levels. Found that a risk-spreading charge structure for financing health care needs appeared to exist among CCRCs providing a full-care contract. (Author/ABL)

School Funding System and Equity

ERIC Educational Resources Information Center

Tabatadze, Shalva; Gorgadze, Natia

2014-01-01

The aim of this research is to study the effectiveness of general education funding system from the perspective of equal and equal educational opportunities for all in Georgia. Following the objective, the research aimed to respond three main research questions: 1. is the school financing formula effective and efficient enough to be administrated…

Public finance of rotavirus vaccination in India and Ethiopia: an extended cost-effectiveness analysis.

PubMed

Verguet, Stéphane; Murphy, Shane; Anderson, Benjamin; Johansson, Kjell Arne; Glass, Roger; Rheingans, Richard

2013-10-01

An estimated 4% of global child deaths (approximately 300,000 deaths) were attributed to rotavirus in 2010. About a third of these deaths occurred in India and Ethiopia. Public finance of rotavirus vaccination in these two countries could substantially decrease child mortality and also reduce rotavirus-related hospitalizations, prevent health-related impoverishment and bring significant cost savings to households. We use a methodology of 'extended cost-effectiveness analysis' (ECEA) to evaluate a hypothetical publicly financed program for rotavirus vaccination in India and Ethiopia. We measure program impact along four dimensions: 1) rotavirus deaths averted; 2) household expenditures averted; 3) financial risk protection afforded; 4) distributional consequences across the wealth strata of the country populations. In India and Ethiopia, the program would lead to a substantial decrease in rotavirus deaths, mainly among the poorer; it would reduce household expenditures across all income groups and it would effectively provide financial risk protection, mostly concentrated among the poorest. Potential indirect benefits of vaccination (herd immunity) would increase program benefits among all income groups, whereas potentially decreased vaccine efficacy among poorer households would reduce the equity benefits of the program. Our approach incorporates financial risk protection and distributional consequences into the systematic economic evaluation of vaccine policy, illustrated here with the case study of public finance for rotavirus vaccination. This enables selection of vaccine packages based on the quantitative inclusion of information on equity and on how much financial risk protection is being bought per dollar expenditure on vaccine policy, in addition to how much health is being bought. Copyright © 2013 Elsevier Ltd. All rights reserved.

Is health care financing in Uganda equitable?

PubMed

Zikusooka, C M; Kyomuhang, R; Orem, J N; Tumwine, M

2009-10-01

Health care financing provides the resources and economic incentives for operating health systems and is a key determinant of health system performance. Equitable financing is based on: financial protection, progressive financing and cross-subsidies. This paper describes Uganda's health care financing landscape and documents the key equity issues associated with the current financing mechanisms. We extensively reviewed government documents and relevant literature and conducted key informant interviews, with the aim of assessing whether Uganda's health care financing mechanisms exhibited the key principles of fair financing. Uganda's health sector remains significantly under-funded, mainly relying on private sources of financing, especially out-of-pocket spending. At 9.6 % of total government expenditure, public spending on health is far below the Abuja target of 15% that GoU committed to. Prepayments form a small proportion of funding for Uganda's health sector. There is limited cross-subsidisation and high fragmentation within and between health financing mechanisms, mainly due to high reliance on out-of-pocket payments and limited prepayment mechanisms. Without compulsory health insurance and low coverage of private health insurance, Uganda has limited pooling of resources, and hence minimal cross-subsidisation. Although tax revenue is equitable, the remaining financing mechanisms for Uganda are inequitable due to their regressive nature, their lack of financial protection and limited cross-subsidisation. Overall, Uganda's current health financing is inequitable and fragmented. The government should take explicit action to promote equitable health care financing by establishing pre-payment schemes, enhancing cross-subsidisation mechanisms and through appropriate integration of financing mechanisms.

Ten best resources for conducting financing and benefit incidence analysis in resource-poor settings.

PubMed

Wiseman, Virginia; Asante, Augustine; Price, Jennifer; Hayen, Andrew; Irava, Wayne; Martins, Joao; Guinness, Lorna; Jan, Stephen

2015-10-01

Many low- and middle-income countries are seeking to reform their health financing systems to move towards universal coverage. This typically means that financing is based on people's ability to pay while, for service use, benefits are based on the need for health care. Financing incidence analysis (FIA) and benefit incidence analysis (BIA) are two popular tools used to assess equity in health systems financing and service use. FIA studies examine who pays for the health sector and how these contributions are distributed according to socioeconomic status (SES). BIA determines who benefits from health care spending, with recipients ranked by their relative SES. In this article, we identify 10 resources to assist researchers and policy makers seeking to undertake or interpret findings from financing and benefit incidence analyses in the health sector. The article pays particular attention to the data requirements, computations, methodological challenges and country level experiences with these types of analyses. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

A fuzzy logic approach toward solving the analytic enigma of health system financing.

PubMed

Chernichovsky, Dov; Bolotin, Arkady; de Leeuw, David

2003-09-01

Improved health, equity, macroeconomic efficiency, efficient provision of care, and client satisfaction are the common goals of any health system. The relative significance of these goals varies, however, across nations, communities and with time. As for health care finance, the attainment of these goals under varying circumstances involves alternative policy options for each of the following elements: sources of finance, allocation of finance, payment to providers, and public-private mix. The intricate set of multiple goals, elements and policy options defies human reasoning, and, hence, hinders effective policymaking. Indeed, "health system finance" is not amenable to a clear set of structural relationships. Neither is there a universe that can be subject to statistical scrutiny: each health system is unique. "Fuzzy logic" models human reasoning by managing "expert knowledge" close to the way it is handled by human language. It is used here for guiding policy making by a systematic analysis of health system finance. Assuming equal welfare weights for alternative goals and mutually exclusive policy options under each health-financing element, the exploratory model we present here suggests that a German-type health system is best. Other solutions depend on the welfare weights for system goals and mixes of policy options.

Major Topics of School Business Management.

ERIC Educational Resources Information Center

Clark, James E., Ed.; Hertz, Karl V., Ed.

Thirteen articles on major topics facing school business officials in the 1980s are presented in this book. The titles and their authors are (1) "The Pursuit of Equity in Financing Public Education," by R. Craig Wood, Helene B. Jones, and William L. Riley; (2) "Facilities: Major Issues Ahead," by C. William Day; (3)…

24 CFR 941.610 - Evidentiary materials and other documents.

Code of Federal Regulations, 2010 CFR

2010-04-01

... record, that will assure to HUD's satisfaction that the public housing units will be available for use by...) for use in carrying out the proposal, and that such commitment is in the amount required under the... HUD (together with all financing documents) to ensure that they do not provide equity investors...

District-Level Black--White Funding Disparities in the United States, 1987?2002

ERIC Educational Resources Information Center

Bifulco, Robert

2005-01-01

A large body of literature examines disparities in school funding across districts. Berne and Stiefel (1984) developed the standard framework for measuring school finance equity, and the measures catalogued there have been applied extensively to assess funding disparities across districts. Much of this literature has focused on measures of…

Gaining Equalization Leverage by Diverting Property Tax Revenues to the State Basic Aid Fund.

ERIC Educational Resources Information Center

Gensemer, Bruce L.

Under Ohio's existing educational finance plan, the power of school districts to purchase the educational resources commensurate with each district's educational needs is far from equal. Consideration of four specific potential reforms, separately and in combination, indicates that greater equity can be obtained. If Ohio is to avoid substantial…

State-Local Revenue Systems and Educational Finance.

ERIC Educational Resources Information Center

Myers, Will S.; And Others

This study analyzes the self-help capabilities of the States to equip themselves with a highly productive State-local revenue system that could underwrite a major share of school costs. The present state-local revenue system is said to be impaired in its productivity and equity by: (1) the regressive impact of property, general sales, and…

31 CFR 800.212 - Foreign entity.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Foreign entity. 800.212 Section 800... TAKEOVERS BY FOREIGN PERSONS Definitions § 800.212 Foreign entity. (a) The term foreign entity means any... majority of the equity interest in such entity is ultimately owned by U.S. nationals is not a foreign...

12 CFR 932.5 - Market risk capital requirement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 932.5 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND..., commodity prices, and equity prices that could occur during periods of market stress, where the market value... options, to a comparable degree of stress for such factors as will be required for an internal market risk...

12 CFR 932.5 - Market risk capital requirement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 932.5 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND..., commodity prices, and equity prices that could occur during periods of market stress, where the market value... options, to a comparable degree of stress for such factors as will be required for an internal market risk...

12 CFR 932.5 - Market risk capital requirement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 932.5 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND..., commodity prices, and equity prices that could occur during periods of market stress, where the market value... options, to a comparable degree of stress for such factors as will be required for an internal market risk...

12 CFR 932.5 - Market risk capital requirement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 932.5 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND..., commodity prices, and equity prices that could occur during periods of market stress, where the market value... options, to a comparable degree of stress for such factors as will be required for an internal market risk...

Equity in Student Finance: Cross-UK Comparisons

ERIC Educational Resources Information Center

Blackburn, Lucy Hunter

2016-01-01

Comparisons with other parts of the United Kingdom have played an important role in justifying decisions made in relation to student funding in Scotland since devolution. This article considers first what comparative claims have been made for the content of student funding policy in four areas: fees, debt, total living cost support and…

Financing Rural and Small Schools: Issues of Adequacy and Equity.

ERIC Educational Resources Information Center

Honeyman, David S.; And Others

This monograph investigates issues related to the financial support of rural schools. The first section describes various state formulas and the methods used to distribute funds to rural schools. It considers questions about the adequacy of funding adjustments based on sparsity and the relationship of such adjustments to equal educational…

An Exploratory Analysis of the Equity of Ohio School Funding

ERIC Educational Resources Information Center

Sweetland, Scott R.

2014-01-01

This research briefly summarizes a series of Ohio Supreme Court litigation known as "DeRolph v. State" and then measures the equality of expenditures among Ohio school districts. "DeRolph v. State" was a high-profile school finance adequacy case. Nevertheless, the high court continuously expressed concern for the financial…

75 FR 16848 - Application Nos. and Proposed Exemptions; D-11533 and D-11534; CUNA Mutual Pension Plan for Non...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-02

... Applicant represents that during his career, Mr. Bayston managed a wide range of corporate finance and business valuation assignments for publicly-traded and privately-held corporate clients and ERISA..., shareholder liquidity analyses, private equity and debt placements, and corporate valuation matters. The...

43 CFR 404.39 - What factors will Reclamation consider in evaluating my capability to pay 25 percent or more of...

Code of Federal Regulations, 2014 CFR

2014-10-01

... and depreciation, maintenance and repair); (6) Cash flow from operating activities (positive value... financial obligations; (9) Collateral/equity as appropriate; (10) Cash flows from capital and related financing activities (negative value from principle paid on bonds and interest payments); (11) Net cash flow...

43 CFR 404.39 - What factors will Reclamation consider in evaluating my capability to pay 25 percent or more of...

Code of Federal Regulations, 2011 CFR

2011-10-01

... and depreciation, maintenance and repair); (6) Cash flow from operating activities (positive value... financial obligations; (9) Collateral/equity as appropriate; (10) Cash flows from capital and related financing activities (negative value from principle paid on bonds and interest payments); (11) Net cash flow...

43 CFR 404.39 - What factors will Reclamation consider in evaluating my capability to pay 25 percent or more of...

Code of Federal Regulations, 2012 CFR

2012-10-01

... and depreciation, maintenance and repair); (6) Cash flow from operating activities (positive value... financial obligations; (9) Collateral/equity as appropriate; (10) Cash flows from capital and related financing activities (negative value from principle paid on bonds and interest payments); (11) Net cash flow...

43 CFR 404.39 - What factors will Reclamation consider in evaluating my capability to pay 25 percent or more of...

Code of Federal Regulations, 2013 CFR

2013-10-01

... and depreciation, maintenance and repair); (6) Cash flow from operating activities (positive value... financial obligations; (9) Collateral/equity as appropriate; (10) Cash flows from capital and related financing activities (negative value from principle paid on bonds and interest payments); (11) Net cash flow...

31 CFR 537.411 - Purchase of shares in economic development projects in Burma.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Purchase of shares in economic... SANCTIONS REGULATIONS Interpretations § 537.411 Purchase of shares in economic development projects in Burma... Burma of shares of ownership, including an equity interest, in the economic development of resources...

Vermont's Act 60: Early Effects of Comprehensive School Finance Reform.

ERIC Educational Resources Information Center

Mathis, William J.

A unanimous 1997 state Supreme Court decision declaring Vermont's educational funding system unconstitutional prompted the legislature to pass Act 60 establishing state block grants and a guaranteed tax-yield system. Act 60 is working to provide equity in tax burdens and in tax rates. A variety of transitional features have helped to buffer…

Building Political Will to Overhaul California's School Finance System. Forum Report

ERIC Educational Resources Information Center

EdSource, 2004

2004-01-01

Calls for changes in California's complex state-run school funding system, provided the backdrop for "Overhauling School Funding in California: The Push for Greater Adequacy, Equity, and Accountability," the EdSource 27th Annual Forum in March 2004. Participants discussed approaches for determining what would constitute adequate funding,…

31 CFR 537.411 - Purchase of shares in economic development projects in Burma.

Code of Federal Regulations, 2010 CFR

2010-07-01

... SANCTIONS REGULATIONS Interpretations § 537.411 Purchase of shares in economic development projects in Burma... Burma of shares of ownership, including an equity interest, in the economic development of resources... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Purchase of shares in economic...

Implementing California's School Funding Formula: Will High-Need Students Benefit?

ERIC Educational Resources Information Center

Hill, Laura; Ugo, Iwunze

2015-01-01

The Local Control Funding Formula (LCFF) reformed California's K-12 school finance system. It replaced a patchwork of formulas and specific (or "categorical") programs with a focus on local control, funding equity, and additional support for the large share of students (63%) who are "high needs"--that is, low-income, English…

Ownership, financing, and management strategies of the ten largest for-profit nursing home chains in the United States.

PubMed

Harrington, Charlene; Hauser, Clarilee; Olney, Brian; Rosenau, Pauline Vaillancourt

2011-01-01

This study examined the ownership, financing, and management strategies of the 10 largest for-profit nursing home chains in the United States, including the four largest chains purchased by private equity corporations. Descriptive data were collected from Internet searches, company reports, and other sources for the decade 1998-2008. Since 1998, the largest chains have made many changes in their ownership and structure, and some have converted from publicly traded companies to private ownership. This study shows the increasing complexity of corporate nursing home ownership and the lack of public information about ownership and financial status. The chains have used strategies to maximize shareholder and investor value that include increasing Medicare revenues, occupancy rates, and company diversification, establishing multiple layers of corporate ownership, developing real estate investment trusts, and creating limited liability companies. These strategies enhance shareholder and investor profits, reduce corporate taxes, and reduce liability risk. There is a need for greater transparency in ownership and financial reporting and for more government oversight of the largest for-profit chains, including those owned by private equity companies.

Introduction of performance-based financing in burundi was associated with improvements in care and quality.

PubMed

Bonfrer, Igna; Soeters, Robert; Van de Poel, Ellen; Basenya, Olivier; Longin, Gashubije; van de Looij, Frank; van Doorslaer, Eddy

2014-12-01

Several governments in low- and middle-income countries have adopted performance-based financing to increase health care use and improve the quality of health services. We evaluated the effects of performance-based financing in the central African nation of Burundi by exploiting the staggered rollout of this financing across provinces during 2006-10. We found that performance-based financing increased the share of women delivering their babies in an institution by 22 percentage points, which reflects a relative increase of 36 percent, and the share of women using modern family planning services by 5 percentage points, a relative change of 55 percent. The overall quality score for health care facilities increased by 45 percent during the study period, but performance-based financing was found to have no effect on the quality of care as reported by patients. We did not find strong evidence of differential effects of performance-based financing across socioeconomic groups. The performance-based financing effects on the probability of using care when ill were found to be even smaller for the poor. Our findings suggest that a supply-side intervention such as performance-based financing without accompanying access incentives for poor people is unlikely to improve equity. More research into the cost-effectiveness of performance-based financing and how best to target vulnerable populations is warranted. Project HOPE—The People-to-People Health Foundation, Inc.

Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns.

PubMed

Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas

2015-08-31

In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of HSEP and especially the key element of progressive tax should be considered properly in the coming sixth national development plan (2016-2021). © 2015 by Kerman University of Medical Sciences.

France: Health System Review.

PubMed

Chevreul, Karine; Berg Brigham, Karen; Durand-Zaleski, Isabelle; Hernandez-Quevedo, Cristina

2015-01-01

This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending. World Health Organization 2015 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns

PubMed Central

Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas

2015-01-01

In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers’ concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of HSEP and especially the key element of progressive tax should be considered properly in the coming sixth national development plan (2016-2021). PMID:26673172

Determining Equity in Household's Health Care Payments in Hamedan Province, Iran.

PubMed

Rezapour, Aziz; Arabloo, Jalal; Tofighi, Shahram; Alipour, Vahid; Sepandy, Mojtaba; Mokhtari, Payam; Ghanbary, Abbas

2016-07-01

Financial protection of household against the consequences of the health care expenditures is one of the most important functions of health care systems. The objective of this study was to determine the equity in health care payments and determining factors among households in Hamedan, a province in Iran. In this cross-sectional study, 772 families of patients, who were being discharged from hospitals in Hamedan, were selected for study by using a stratified random sampling method. Required data regarding households' health and non-health expenditures were collected through World Health Organization standard questionnaire by interviews and observation method. According to the findings, 20.7% of households experienced catastrophic health expenditure. The incidence of impoverishment due to out-of-pocket payments for health care was 2.8% among studied households. The highest incidence rate of out-of-pocket health payment indices occurred in the first quintile (poorest or Q1). Variables such as having members under 6 years or over 60 years in household, household size, employment of household head, households' income quintile, existence of the disabled member in households and the education level of the household's head are the most important factors that affect the incidence of out-of-pocket health payment indices. There is considerable inequity in health care financing as well as households' health payments. This requires designing and implementing the operative and protective programs for understanding the important factors that affect equity in health financing, especially for poor households, against the unexpected health expenditures through the health care system.

On multilevel RBF collocation to solve nonlinear PDEs arising from endogenous stochastic volatility models

NASA Astrophysics Data System (ADS)

Bastani, Ali Foroush; Dastgerdi, Maryam Vahid; Mighani, Abolfazl

2018-06-01

The main aim of this paper is the analytical and numerical study of a time-dependent second-order nonlinear partial differential equation (PDE) arising from the endogenous stochastic volatility model, introduced in [Bensoussan, A., Crouhy, M. and Galai, D., Stochastic equity volatility related to the leverage effect (I): equity volatility behavior. Applied Mathematical Finance, 1, 63-85, 1994]. As the first step, we derive a consistent set of initial and boundary conditions to complement the PDE, when the firm is financed by equity and debt. In the sequel, we propose a Newton-based iteration scheme for nonlinear parabolic PDEs which is an extension of a method for solving elliptic partial differential equations introduced in [Fasshauer, G. E., Newton iteration with multiquadrics for the solution of nonlinear PDEs. Computers and Mathematics with Applications, 43, 423-438, 2002]. The scheme is based on multilevel collocation using radial basis functions (RBFs) to solve the resulting locally linearized elliptic PDEs obtained at each level of the Newton iteration. We show the effectiveness of the resulting framework by solving a prototypical example from the field and compare the results with those obtained from three different techniques: (1) a finite difference discretization; (2) a naive RBF collocation and (3) a benchmark approximation, introduced for the first time in this paper. The numerical results confirm the robustness, higher convergence rate and good stability properties of the proposed scheme compared to other alternatives. We also comment on some possible research directions in this field.

Health financing at district level in Malawi: an analysis of the distribution of funds at two points in time.

PubMed

Borghi, Josephine; Munthali, Spy; Million, Lameck B; Martinez-Alvarez, Melisa

2018-01-01

There is growing attention to tracking country level resource flows to health, but limited evidence on the sub-national allocation of funds. We examined district health financing in Malawi in 2006 and 2011, and equity in the allocation of funding, together with the association between financing and under five and neonatal mortality. We explored the process for receiving and allocating different funding sources at district level. We obtained domestic and external financing data from the Integrated Financial Management Information System (2006-11) and AidData (2000-12) databases. Out-of-pocket payment data came from two rounds of integrated household budget surveys (2005; 2010). Mortality data came from the Multiple Indicator Cluster Survey (2006) and Demographic and Health Survey (2010). We described district level health funding by source, ran correlations between funding and outcomes and generated concentration curves and indices. 41 semi-structured interviews were conducted at the national level and in 10 districts with finance and health managers. Per capita spending from all sources varied substantially across districts and doubled between 2006 and 2011 from 7181 Kwacha to 15 312 Kwacha. In 2011, external funding accounted for 74% of funds, with domestic funding accounting for 19% of expenditure, and out of pocket (OOP) funding accounting for 7%. All funding sources were concentrated among wealthier districts, with OOP being the most pro-rich, followed by domestic expenditure and external funding. Districts with higher levels of domestic and external funding had lower levels of post-neonatal mortality, and those with higher levels of out-of-pocket payments had higher levels of 1-59 month mortality in 2006. There was no association between changes in financing and outcomes. Districts reported delayed receipt of lower-than-budgeted funds, forcing them to scale-down activities and rely on external funding. Governments need to track how resources are allocated sub-nationally to maximize equity and ensure allocations are commensurate to health need. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Health financing at district level in Malawi: an analysis of the distribution of funds at two points in time

PubMed Central

Borghi, Josephine; Munthali, Spy; Million, Lameck B; Martinez-Alvarez, Melisa

2018-01-01

Abstract There is growing attention to tracking country level resource flows to health, but limited evidence on the sub-national allocation of funds. We examined district health financing in Malawi in 2006 and 2011, and equity in the allocation of funding, together with the association between financing and under five and neonatal mortality. We explored the process for receiving and allocating different funding sources at district level. We obtained domestic and external financing data from the Integrated Financial Management Information System (2006–11) and AidData (2000–12) databases. Out-of-pocket payment data came from two rounds of integrated household budget surveys (2005; 2010). Mortality data came from the Multiple Indicator Cluster Survey (2006) and Demographic and Health Survey (2010). We described district level health funding by source, ran correlations between funding and outcomes and generated concentration curves and indices. 41 semi-structured interviews were conducted at the national level and in 10 districts with finance and health managers. Per capita spending from all sources varied substantially across districts and doubled between 2006 and 2011 from 7181 Kwacha to 15 312 Kwacha. In 2011, external funding accounted for 74% of funds, with domestic funding accounting for 19% of expenditure, and out of pocket (OOP) funding accounting for 7%. All funding sources were concentrated among wealthier districts, with OOP being the most pro-rich, followed by domestic expenditure and external funding. Districts with higher levels of domestic and external funding had lower levels of post-neonatal mortality, and those with higher levels of out-of-pocket payments had higher levels of 1–59 month mortality in 2006. There was no association between changes in financing and outcomes. Districts reported delayed receipt of lower-than-budgeted funds, forcing them to scale-down activities and rely on external funding. Governments need to track how resources are allocated sub-nationally to maximize equity and ensure allocations are commensurate to health need. PMID:29088357

The Board and the Budget: What Every School Board Member Should Know about Sound School Financial Management.

ERIC Educational Resources Information Center

Disario, Paul

Information on California public school finance and basic financial principles vital to effective school financial management is provided in this guidebook for school board members. As a result of recent legislative and judicial actions, knowledge about budgeting and financial equity is crucial for policy makers. Five chapters discuss financial…

Economic environment - housing bubbles: no national bubble, some regions vulnerable

Treesearch

Al Schuler

2005-01-01

Since 2001, a combination of low mortgage rates and "boring" equity markets have helped to fuel record-setting home sales, contributing to substantial price increases in the U.S. and many other parts of the world (see Table 1). Economists are concerned about riskier mortgage financing and the increasing incidence of speculative demand in some regions....

The Forgotten Side of School Finance Equity: The Role of Infrastructure Funding in Student Success

ERIC Educational Resources Information Center

Crampton, Faith E.; Thompson, David C.; Vesely, Randall S.

2004-01-01

Traditionally, local school districts have shouldered the burden of funding school infrastructure in the name of local control, relying upon local property tax revenues and the willingness of local voters to approve bond issues. Given vast disparities in school districts' property wealth, gross inequities in school facilities will remain without…

13 CFR 120.102 - Funds not available from alternative sources, including personal resources of principals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... accounts, CDs, stocks, bonds, or other similar assets. Equity in real estate holdings and other fixed... source) when that owner's liquid assets exceed the amounts specified in paragraphs (a) (1) through (3) of... applicant must inject any personal liquid assets which are in excess of two times the total financing...

Analysis of Income/Commercial Real Estate Transactions.

ERIC Educational Resources Information Center

Apfelberg, Robert S.

Basic concepts in long- and short-term financing of real estate property are discussed in this text for real estate personnel. Two of the more important of these are leverage, the relationship between the return received by the equity and mortgage investors, and risk, the assessment of the probability that all or part of the investment may be…

Policy Brief: The Four Horsemen

ERIC Educational Resources Information Center

Hickrod, G. Alan

2006-01-01

In this policy brief, the author contends that there are four other principal causes of the collective poor showing on reaching state equity goals in the United States. These are the Four Horsemen of the Apocalypse in the school finance world. The first horseman rides an economic horse, the second a sociological horse, the third a political horse,…

State School Finance Inequities and the Limits of Pursuing Teacher Equity through Departmental Regulation

ERIC Educational Resources Information Center

Baker, Bruce D.; Weber, Mark

2016-01-01

New federal regulations (State Plans to Ensure Equitable Access to Excellent Educators)1 place increased pressure on states and local public school districts to improve their measurement and reporting of gaps in teacher qualifications across schools and the children they serve. Yet a sole focus on resource disparities between schools within a…

75 FR 54661 - Main Street Mezzanine Fund, LP; Notice of Exemption Under Section 312 of the Small Business...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-08

... SMALL BUSINESS ADMINISTRATION [License No. 06/06-0326] Main Street Mezzanine Fund, LP; Notice of Exemption Under Section 312 of the Small Business Investment Act, Conflicts of Interest Notice is hereby...), Financings which Constitute Conflicts of Interest. Main Street Mezzanine Fund, LP provided a debt/equity...

7 CFR 1717.854 - Advance approval-100 percent private financing of distribution, subtransmission and headquarters...

Code of Federal Regulations, 2014 CFR

2014-01-01

... mortgage, the RUS loan contract, the borrower's wholesale power contract, any debt restructuring agreement... debt; (2) The ratio of the borrower's equity, less deferred expenses, to total assets, less deferred...-term debt is not less than 1.0, after adding the principal amount of the proposed loan to the existing...

7 CFR 1717.854 - Advance approval-100 percent private financing of distribution, subtransmission and headquarters...

Code of Federal Regulations, 2013 CFR

2013-01-01

... mortgage, the RUS loan contract, the borrower's wholesale power contract, any debt restructuring agreement... debt; (2) The ratio of the borrower's equity, less deferred expenses, to total assets, less deferred...-term debt is not less than 1.0, after adding the principal amount of the proposed loan to the existing...

7 CFR 1717.854 - Advance approval-100 percent private financing of distribution, subtransmission and headquarters...

Code of Federal Regulations, 2011 CFR

2011-01-01

... mortgage, the RUS loan contract, the borrower's wholesale power contract, any debt restructuring agreement... debt; (2) The ratio of the borrower's equity, less deferred expenses, to total assets, less deferred...-term debt is not less than 1.0, after adding the principal amount of the proposed loan to the existing...

7 CFR 1717.854 - Advance approval-100 percent private financing of distribution, subtransmission and headquarters...

Code of Federal Regulations, 2012 CFR

2012-01-01

... mortgage, the RUS loan contract, the borrower's wholesale power contract, any debt restructuring agreement... debt; (2) The ratio of the borrower's equity, less deferred expenses, to total assets, less deferred...-term debt is not less than 1.0, after adding the principal amount of the proposed loan to the existing...

Education Reform and the Limits of Policy: Lessons from Michigan

ERIC Educational Resources Information Center

Addonizio, Michael F.; Kearney, C. Philip

2012-01-01

During the last 20 years, the United States has experienced more attempts at education reform than at any other time in its history. Efforts to reform financing, the assessment of student performance, accountability and equity, and school choice have all been implemented--with varying levels of success. Michael F. Addonizio and C. Philip Kearney…

Equity for Rural School Districts: The Final Report of the Countryside Council's School Finance Task Force.

ERIC Educational Resources Information Center

Wiener, Steve

Soaring values of agricultural land have created inequities in funding between urban and rural school districts in Minnesota. The state's Foundation Aid to school districts is formulated so that districts of high property valuation receive less Foundation Aid than those districts with low property valuation. In recent years inflation has had…

77 FR 76586 - Founders Equity SBIC I, L.P.; Notice Seeking Exemption Under Section 312 of the Small Business...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-28

... Seeking Exemption Under Section 312 of the Small Business Investment Act, Conflicts of Interest Notice is... 107.730, Financings which Constitute Conflicts of Interest of the Small Business Administration (``SBA... given that any interested person may submit written comments on the transaction to the Associate...

Moving toward Equity in School Funding within Districts: A Comparison of Traditional Funding Policies and More Equitable Formulas.

ERIC Educational Resources Information Center

Roza, Marguerite; Miles, Karen Hawley

Reform efforts involving school finance have focused on the state's role in equalizing expenditures across all districts within a state. Despite these efforts, little attention has been given to differing expenditures among school within districts. In analyzing differences in spending across schools and students in Cincinnati, Seattle, and…

31 CFR 586.514 - Divestiture of U.S. person's equity investment in the territory of the Republic of Serbia.

Code of Federal Regulations, 2010 CFR

2010-07-01

... investment in the territory of the Republic of Serbia. 586.514 Section 586.514 Money and Finance: Treasury... TREASURY FEDERAL REPUBLIC OF YUGOSLAVIA (SERBIA & MONTENEGRO) KOSOVO SANCTIONS REGULATIONS Licenses... the territory of the Republic of Serbia. Notwithstanding the prohibition in § 586.204 against the...

The Challenges of Advancing Fiscal Equity in a Resource-Strained Context

ERIC Educational Resources Information Center

Malen, Betty; Dayhoff, Justin; Egan, Laura; Croninger, Robert G.

2017-01-01

Weighted student funding (WSF) is a multifaceted school finance, management, and governance reform that is gaining attention. While WSF has a number of goals, its primary objective is to redress intra-district funding inequities. This article draws on a mixed-methods study of WSF in Prince George's County Public Schools to examine the initiative's…

Institutional and financial guide to geothermal district heating, serial no. 2

NASA Astrophysics Data System (ADS)

1982-03-01

General planning considerations which affect nearly every community are reviewed, and alternative operating structures which are available to communities are reviewed, including local governments, nonprofit cooperatives, private enterprises, and joint ventures. The financing options available to publicly-owned and privately-owned district heating systems are then summarized. The geothermal production and distribution activities most appropriate to each type of operating structure are reviewed, along with typical equity and debt funding sources. The tax advantages for private developers are described, as are the issues of customer contracts and service prices, and customer retrofit financing. The treatment is limited to an introductory overview.

Patterns of financing for the largest hospital systems in the United States.

PubMed

Cleverley, William O; Baserman, Sarah Jane

2005-01-01

The ten large systems reviewed in this column have greater degrees of financial leverage than do most freestanding hospitals. Larger firms typically have both greater capital access and lower costs of financing. Both voluntary and IO systems make extensive use of variable rate financing, but the percentage of variable rate financing is slightly higher for voluntary systems. This difference may be attributable to larger yield curve spreads for tax-exempt versus taxable securities. Interest rate swaps were used by 70 percent of the systems, but the actual amount swapped was relatively minor. This may change in the future as financial officers become more comfortable and familiar with interest rate swap arrangements. When compared to IO systems, voluntary systems have extensive levels of cash relative to their debt positions. Cash balances are more critical in the bond-rating process for voluntary hospitals, and the ability to raise new equity is much more limited in the voluntary sector. Very little capital leasing was used in any of the systems.

Equity for Cities in School Finance Reform: A Case for an "Equal Educational Offering" Standard in Public Education.

ERIC Educational Resources Information Center

Silard, John; And Others

In this study, focus is upon the question of the standard for educational expenditure rather than on the alternative taxing methods for securing school district funding equalization. Chapter I begins by examining the major issues vital to urban education which the "Serrano" principle leaves unresolved. Then in Chapter II, particular elements of…

Are Equity and Efficiency Irreconcilable Goals in Education? A General Equilibrium Analysis of Basic Education Finance in China

ERIC Educational Resources Information Center

Ding, Weili; Lu, Ming

2007-01-01

Lacking guidance of general equilibrium (GE) theories in public economics and the corresponding proper mechanisms, China has not surprisingly witnessed an inequality in educational expenditures across regions as well as insufficiency of funds for education in poor areas. It is wrongly thought that what happens is due to the decentralized financing…

The Effect of the Composition of the Property Tax Base on Educational Expenditures in Pennsylvania.

ERIC Educational Resources Information Center

Richard, Mark R.

Pennsylvania state policymakers have taken steps to address issues of educational equity across school districts by amending the school-finance funding system. Pennsylvania relies on local property tax revenues as a major source of funding. This paper examines the effect of the property-tax-base formula on educational expenditures in the state.…

76 FR 28843 - Emergence Capital Partners SBIC, L.P.; Notice Seeking Exemption Under Section 312 of the Small...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

..., CA 94402, a Federal Licensee under the Small Business Investment Act of 1958, as amended (``the Act... to provide equity financing to Genius.com , Inc., 1400 Fashion Island Blvd., Suite 500, San Mateo, CA...., own more than ten percent of Genius.com , Inc. Therefore, Genius.com , Inc. is considered an Associate...

Building a Sustained School Facilities Remedy: Arizona's Innovative Blueprint for Capital Funding. Education, Equity, and the Law. No. 3

ERIC Educational Resources Information Center

Hunter, Molly A.

2010-01-01

For over ten years, the State of Arizona has implemented an innovative statewide process for financing and building school facilities and purchasing other capital items for its schools. Spawned by an education quality lawsuit, the 1998 Students FIRST Act established the School Facilities Board, which succeeded in helping rural, suburban, and urban…

The Emergence of a Market-Driven Funding Mechanism in K-12 Education in British Columbia: Creeping Privatization and the Eclipse of Equity

ERIC Educational Resources Information Center

Fallon, Gerald; Poole, Wendy

2014-01-01

Since 2002, British Columbia's education system has undergone extensive change following amendments to the "BC School Act" ("Bill 34"). This article presents a critical analysis of policy changes to the K-12 education finance system, particularly the expansion of the legal capacity of school districts to create "'school…

Higher Education in Kenya: An Assessment of Current Responses to the Imperative of Widening Access

ERIC Educational Resources Information Center

Odhiambo, George

2016-01-01

Higher education is a key factor in a nation's effort to develop a highly skilled workforce for competing in the global economy. In this paper, current trends in accessibility, equity, participation and financing of higher education in Kenya are examined. The paper explores the challenges which need to be confronted and discusses the way forward…

Equity Implications of Methods of Funding State Teachers' Retirement Systems. Working Paper in Education Finance No. 30.

ERIC Educational Resources Information Center

Wendling, Wayne

Current methods of funding teachers' retirement systems, which base pensions on final salaries, are inequitable because they are not related to school districts' ability to pay and because they require some teachers to subsidize others. A five-state survey shows it is common for pensions to be funded by school districts and teachers, sometimes…

Response to the DEEWR Discussion Paper: "An Indicator Framework for Higher Education Performance Funding". Go8 Position Paper

ERIC Educational Resources Information Center

Group of Eight (NJ1), 2009

2009-01-01

The Higher Education Performance Funding to be introduced in 2011 is a key development in the policy and financing framework for Australian Higher Education. The performance funding framework, along with mission-based compacts, the new equity initiatives, the relaxing of caps on Commonwealth supported places and the establishment of the Tertiary…

Frizzled to finance: one PhD's path from a Drosophila lab to Wall Street.

PubMed

Taylor, Job

2016-06-01

An equity research analyst's job is to determine whether the price of a stock is likely to go up or down. For science-based businesses, particularly biotechnology companies, a PhD in the life sciences can be very helpful in making this determination. I transitioned from a postdoc position to working in equity research. Here I present information on how I made the transition, an overview of the day-to-day activities of an analyst, and thoughts on how to prepare to look for a job in finance. There are significant positives to working on Wall Street, including exposure to cutting-edge clinical/translational research, access to some of the best scientists in the world, a dynamic work environment, and compensation that generally exceeds academic salaries. This comes at the cost of some independence and the satisfaction of being able to call oneself a scientist. © 2016 Taylor. This article is distributed by The American Society for Cell Biology under license from the author(s). Two months after publication it is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

National health financing policy in Eritrea: a survey of preliminary considerations

PubMed Central

2012-01-01

Background The 58th World Health Assembly and 56th WHO Regional Committee for Africa adopted resolutions urging Member States to ensure that health financing systems included a method for prepayment to foster financial risk sharing among the population and avoid catastrophic health-care expenditure. The Regional Committee asked countries to strengthen or develop comprehensive health financing policies. This paper presents the findings of a survey conducted among senior staff of selected Eritrean ministries and agencies to elicit views on some of the elements likely to be part of a national health financing policy. Methods This is a descriptive study. A questionnaire was prepared and sent to 19 senior staff (Directors) in the Ministry of Health, Labour Department, Civil Service Administration, Eritrean Confederation of Workers, National Insurance Corporation of Eritrea and Ministry of Local Government. The respondents were selected by the Ministry of Health as key informants. Results The key findings were as follows: the response rate was 84.2% (16/19); 37.5% (6/16) and 18.8% said that the vision of Eritrean National Health Financing Policy (NHFP) should include the phrases ‘equitable and accessible quality health services’ and ‘improve efficiency or reduce waste’ respectively; over 68% indicated that NHFP should include securing adequate funding, ensuring efficiency, ensuring equitable financial access, protection from financial catastrophe, and ensuring provider payment mechanisms create positive incentives to service providers; over 80% mentioned community participation, efficiency, transparency, country ownership, equity in access, and evidence-based decision making as core values of NHFP; over 62.5% confirmed that NHFP components should consist of stewardship (oversight), revenue collection, revenue pooling and risk management, resource allocation and purchasing of health services, health economics research, and development of human resources for health; over 68.8% indicated cost-sharing, taxation and social health insurance as preferred revenue collection mechanisms; and 68.75% indicated their preferred provider payment mechanism to be a global (lump sum) budget. Conclusion This study succeeded in gathering the preliminary views of senior staff of selected Eritrean ministries and agencies regarding the likely elements of the NHFP, i.e. the vision, objectives, components, provider payment mechanisms, and health financing agency and its governance. In addition to stakeholder surveys, it would be helpful to inform the development of the NHFP with other pieces of evidence, including cost-effectiveness analysis of health services and interventions, financial feasibility analysis of financing options, a survey of the political and professional acceptability of financing options, national health accounts, and equity analyses. PMID:22929308

National health financing policy in Eritrea: a survey of preliminary considerations.

PubMed

Kirigia, Joses Muthuri; Zere, Eyob; Akazili, James

2012-08-28

The 58th World Health Assembly and 56th WHO Regional Committee for Africa adopted resolutions urging Member States to ensure that health financing systems included a method for prepayment to foster financial risk sharing among the population and avoid catastrophic health-care expenditure. The Regional Committee asked countries to strengthen or develop comprehensive health financing policies. This paper presents the findings of a survey conducted among senior staff of selected Eritrean ministries and agencies to elicit views on some of the elements likely to be part of a national health financing policy. This is a descriptive study. A questionnaire was prepared and sent to 19 senior staff (Directors) in the Ministry of Health, Labour Department, Civil Service Administration, Eritrean Confederation of Workers, National Insurance Corporation of Eritrea and Ministry of Local Government. The respondents were selected by the Ministry of Health as key informants. The key findings were as follows: the response rate was 84.2% (16/19); 37.5% (6/16) and 18.8% said that the vision of Eritrean National Health Financing Policy (NHFP) should include the phrases 'equitable and accessible quality health services' and 'improve efficiency or reduce waste' respectively; over 68% indicated that NHFP should include securing adequate funding, ensuring efficiency, ensuring equitable financial access, protection from financial catastrophe, and ensuring provider payment mechanisms create positive incentives to service providers; over 80% mentioned community participation, efficiency, transparency, country ownership, equity in access, and evidence-based decision making as core values of NHFP; over 62.5% confirmed that NHFP components should consist of stewardship (oversight), revenue collection, revenue pooling and risk management, resource allocation and purchasing of health services, health economics research, and development of human resources for health; over 68.8% indicated cost-sharing, taxation and social health insurance as preferred revenue collection mechanisms; and 68.75% indicated their preferred provider payment mechanism to be a global (lump sum) budget. This study succeeded in gathering the preliminary views of senior staff of selected Eritrean ministries and agencies regarding the likely elements of the NHFP, i.e. the vision, objectives, components, provider payment mechanisms, and health financing agency and its governance. In addition to stakeholder surveys, it would be helpful to inform the development of the NHFP with other pieces of evidence, including cost-effectiveness analysis of health services and interventions, financial feasibility analysis of financing options, a survey of the political and professional acceptability of financing options, national health accounts, and equity analyses.

Knowledge for better health: a conceptual framework and foundation for health research systems.

PubMed Central

Pang, Tikki; Sadana, Ritu; Hanney, Steve; Bhutta, Zulfiqar A.; Hyder, Adnan A.; Simon, Jonathon

2003-01-01

Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity. We propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity. In this framework, the intrinsic goals of the HRS are the advancement of scientific knowledge and the utilization of knowledge to improve health and health equity. Its four principal functions are stewardship, financing, creating and sustaining resources, and producing and using research. The framework, as it is applied in consultation with countries, will provide countries and donor agencies with relevant inputs to policies and strategies for strengthening HRSs and using knowledge for better health. PMID:14758408

Hospital profitability and capital structure: a comparative analysis.

PubMed Central

Valvona, J; Sloan, F A

1988-01-01

This article compares the financial performance of hospitals by ownership type and of five publicly traded hospital companies with other industries, using such indicators as profit margins, return on equity (ROE) and total capitalization, and debt-to-equity ratios. We also examine stock returns to investors for the five hospital companies versus other industries, as well as the relative roles of debt and equity in new financing. Investor-owned hospitals had substantially greater margins and ROE than did other hospital types. In 1982, investor-owned chain hospitals had a ROE of 26 percent, 18 points above the average for all hospitals. Stock returns on the five selected hospital companies were more than twice as large as returns on other industries between 1972 and 1983. However, after 1983, returns for these companies fell dramatically in absolute terms and relative to other industries. We also found investor-owned hospitals to be much more highly levered than their government and voluntary counterparts, and more highly levered than other industries as well. PMID:3403274

Knowledge for better health: a conceptual framework and foundation for health research systems.

PubMed

Pang, Tikki; Sadana, Ritu; Hanney, Steve; Bhutta, Zulfiqar A; Hyder, Adnan A; Simon, Jonathon

2003-01-01

Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity. We propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity. In this framework, the intrinsic goals of the HRS are the advancement of scientific knowledge and the utilization of knowledge to improve health and health equity. Its four principal functions are stewardship, financing, creating and sustaining resources, and producing and using research. The framework, as it is applied in consultation with countries, will provide countries and donor agencies with relevant inputs to policies and strategies for strengthening HRSs and using knowledge for better health.

On the Path to SunShot: Emerging Opportunities and Challenges in Financing Solar

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feldman, David; Bolinger, Mark

This report analyzes solar financing strategies and their role in achieving the U.S. Department of Energy's SunShot goals. Financing is critical to solar deployment, because the costs of solar technologies are paid up front, while their benefits are realized over decades. Solar financing has been shaped by government solar incentives, particularly federal tax incentives, which have spawned complex tax-equity structures that monetize tax benefits for project sponsors who otherwise could not use them efficiently. Although these structures have helped expand solar deployment, they are relatively costly and inefficient. This has spurred solar stakeholders to develop lower-cost financing solutions such asmore » securitization of solar project portfolios, solar-specific loan products, and methods for incorporating residential solar's value into home values. To move solar further toward an unsubsidized SunShot future, additional financial innovation must occur. Development of a larger, more mature U.S. solar industry will likely increase financial transparency and investor confidence, which in turn will enable simpler, lower-cost financing methods. Utility-scale solar might be financed more like conventional generation assets are today, non-residential solar might be financed more like a new roof, and residential solar might be financed more like an expensive appliance. Assuming a constant, SunShot-level installed photovoltaic (PV) system price, such financing innovations could reduce PV's levelized cost of electricity (LCOE) by an estimated 25%-50% compared with historical financing approaches. These results suggest that financing can adapt to changing conditions and might ease the transition away from a reliance on tax incentives while driving solar's LCOE toward the SunShot goals.« less

Challenges facing the finance reform of the health system in Chile.

PubMed

Herrera, Tania

2014-05-28

Financing is one of the key functions of health systems, which includes the processes of revenue collection, fund pooling and acquisitions in order to ensure access to healthcare for the entire population. The article analyzes the financing model of the Chilean health system in terms of the first two processes, confirming low public spending on healthcare and high out-of-pocket expenditure, in addition to an appropriation of public resources by private insurers and providers. Insofar as pooling, there is lack of solidarity and risk sharing leading to segmentation of the population that is not consistent with the concept of social security, undermines equity and reduces system-wide efficiency. There is a pressing need to jumpstart reforms that address these issues. Treatments must be considered together with public health concerns and primary care in order to ensure the right to health of the entire population.

Alternative financing sources. ECRI. Emergency Care Research Institute.

PubMed

1987-01-01

A number of new capital sources have been developed and used by health care institutions unable to finance high-tech projects with equity or conventional tax-exempt debt instruments; these include REITs, MLPs, per-use rentals, venture capital, and banks as brokers. However, there are no magic capital acquisition solutions. Institutions with good credit will continue to find a number of doors open to them; poorer credit risks will have fewer options, and those available will carry greater risk, allow for less provider control over projects, and limit potential return on investment to some extent. It is essential to examine carefully the drawbacks inherent in each type of alternative financing source. Venture capital in particular requires specific analysis because of the wide variety of possible arrangements that exist. If you cannot find either traditional or alternative sources of funding for a proposed project, you should reexamine the project and its underlying utilization projections and reimbursement assumptions.

Impact of Research and Development, Analysis, and Standardization on PV Project Financing Costs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feldman, David J; Margolis, Robert M; Jones-Albertus, Rebecca

The technical report discusses how R and D efforts focused on removing perceived risk from cash flows to investors have the potential to lower the cost of capital and increase the amount of leverage in a solar project. It also discusses how creating business efficiencies that allow financing transactions to occur more quickly with less effort can reduce the upfront costs associated with arranging financing for a solar project or group of projects. The paper then assesses the impact that these R and D activities might have on the volatility of PV asset cash flows and asset value, as wellmore » as the upfront costs of arranging a financial transaction. Finally, we insert these assumptions into financial models to analyze their impacts on the cost of capital for equity and debt investors, project leverage, and upfront financial transaction costs.« less

On the Path to SunShot - Emerging Opportunities and Challenges in Financing Solar

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feldham, David; Bolinger, Mark

Financial innovations—independent of technology-cost improvements—could cut the cost of solar energy to customers and businesses by 30%–60% (see Feldman and Bolinger 2016). Financing is critical to solar deployment, because the costs of solar technologies are paid up front, while their benefits are realized over decades. Solar financing has been shaped by the government incentives designed to accelerate solar deployment. This is particularly true for federal tax incentives, which have spawned complex tax-equity structures that monetize tax benefits for project sponsors who otherwise could not use them efficiently. Although these structures have helped expand solar deployment, they are relatively costly andmore » inefficient. This has spurred solar stakeholders to develop lower-cost financing solutions such as securitization of solar project portfolios, solar-specific loan products, and methods for incorporating residential PV’s value into home values. To move solar further toward an unsubsidized SunShot future, additional financial innovation must occur. Development of a larger, more mature U.S. solar industry will likely increase financial transparency and investor confidence, which in turn will enable simpler, lower-cost financing methods. Utility-scale solar might be financed more like conventional generation assets are today, non-residential solar might be financed more like a new roof, and residential solar might be financed more like an expensive appliance. Assuming a constant, SunShot-level installed PV system price, such financing innovations could reduce PV’s LCOE by an estimated 30%–60% (depending on the sector) compared with historical financing approaches.« less

Health care providers under pressure: making the most of challenging times.

PubMed

Davis, Scott B; Robinson, Phillip J

2010-01-01

Whether the slowing economic recovery, tight credit markets, increasing costs, or the uncertainty surrounding health care reform, the health care industry faces some sizeable challenges. These factors have put considerable strain on the industry's traditional financing options that the industry has relied on in the past--bonds, banks, finance companies, private equity, venture capital, real estate investment trusts, private philanthropy, and grants. At the same time, providers are dealing with rising costs, lower reimbursement rates, shrinking demand for elective procedures, higher levels of charitable care and bad debt, and increased scrutiny of tax-exempt hospitals. Providers face these challenges against a back ground of uncertainty created by health care reform.

Health-financing reforms in southeast Asia: challenges in achieving universal coverage.

PubMed

Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Ir, Por; Aljunid, Syed Mohamed; Mukti, Ali Ghufron; Akkhavong, Kongsap; Banzon, Eduardo; Huong, Dang Boi; Thabrany, Hasbullah; Mills, Anne

2011-03-05

In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide expansion. For Thailand, the Philippines, Indonesia, and Vietnam, social health insurance financed by payroll tax is commonly used for formal sector employees (excluding Malaysia), with varying outcomes in terms of financial protection. Alternative payment methods have different implications for provider behaviour and financial protection. Two alternative approaches for financial protection of the non-poor outside the formal sector have emerged-contributory arrangements and tax-financed schemes-with different abilities to achieve high population coverage rapidly. Fiscal space and mobilisation of payroll contributions are both important in accelerating financial protection. Expanding coverage of good-quality services and ensuring adequate human resources are also important to achieve universal coverage. As health-financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened. Copyright © 2011 Elsevier Ltd. All rights reserved.

A model of the demand for Islamic banks debt-based financing instrument

NASA Astrophysics Data System (ADS)

Jusoh, Mansor; Khalid, Norlin

2013-04-01

This paper presents a theoretical analysis of the demand for debt-based financing instruments of the Islamic banks. Debt-based financing, such as through baibithamanajil and al-murabahah, is by far the most prominent of the Islamic bank financing and yet it has been largely ignored in Islamic economics literature. Most studies instead have been focusing on equity-based financing of al-mudharabah and al-musyarakah. Islamic bank offers debt-based financing through various instruments derived under the principle of exchange (ukud al-mu'awadhat) or more specifically, the contract of deferred sale. Under such arrangement, Islamic debt is created when goods are purchased and the payments are deferred. Thus, unlike debt of the conventional bank which is a form of financial loan contract to facilitate demand for liquid assets, this Islamic debt is created in response to the demand to purchase goods by deferred payment. In this paper we set an analytical framework that is based on an infinitely lived representative agent model (ILRA model) to analyze the demand for goods to be purchased by deferred payment. The resulting demand will then be used to derive the demand for Islamic debt. We also investigate theoretically, factors that may have an impact on the demand for Islamic debt.

76 FR 76802 - Riverside Micro-Cap Fund II, L.P.; Notice Seeking Exemption Under Section 312 of the Small...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-08

... SMALL BUSINESS ADMINISTRATION [License No. 02/02-0646] Riverside Micro-Cap Fund II, L.P.; Notice... hereby given that Riverside Micro-Cap Fund II, L.P., 45 Rockefeller Center, New York, NY 10111, a Federal... Regulations (13 CFR 107.730). Riverside Micro-Cap Fund II, L.P. proposes to provide equity security financing...

77 FR 7655 - Riverside Micro-Cap Fund II, L.P.; Notice Seeking Exemption Under Section 312 of the Small...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

... SMALL BUSINESS ADMINISTRATION [License No. 02/02-0646] Riverside Micro-Cap Fund II, L.P.; Notice... hereby given that Riverside Micro-Cap Fund II, L.P., 45 Rockefeller Center, New York, NY 10111, a Federal... Regulations (13 CFR 107.730). Riverside Micro-Cap Fund II, L.P. proposes to provide equity security financing...

Annual NASSGP/NCHELP Research Conference on Student Financial Aid Research (4th, St. Louis, Missouri, June 3-5, 1987). The Proceedings, Volume 2.

ERIC Educational Resources Information Center

New York State Higher Education Services Corp., Albany.

The following papers from the National Association of State Scholarship and Grant Programs/National Council of Higher Education Loan Programs conference on student aid are provided: (1) "The Equity of Higher Education Subsidies" (John B. Lee); (2) "The Economics and Financing of Higher Education: The Tension between Quality and…

Health care and equity in India

PubMed Central

Balarajan, Yarlini; Selvaraj, S; Subramanian, S V

2011-01-01

India’s health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing pushing around 39 million Indians into poverty each year. In this paper, we identify key challenges to equity in service delivery, and equity in financing and financial risk protection in India. These include imbalanced resource allocation, limited physical access to quality health services and inadequate human resources for health; high out-of-pocket health expenditures, health spending inflation, and behavioral factors that affect the demand for appropriate health care. Complementing other paper in this Series, we argue for the application of certain principles in the pursuit of equity in health care in India. These are the adoption of equity metrics in monitoring, evaluation and strategic planning, investment in developing a rigorous knowledge-base of health systems research; development of more equity-focused process of deliberative decision-making in health reform, and redefinition of the specific responsibilities and accountabilities of key actors. The implementation of these principles, together with strengthening of public health and primary care services, provide an approach for ensuring more equitable health care for India’s population. PMID:21227492

Nuclear Physicists in Finance

NASA Astrophysics Data System (ADS)

Mattoni, Carlo

2017-01-01

The financial services industry presents an interesting alternative career path for nuclear physicists. Careers in finance typically offer intellectual challenge, a fast pace, high caliber colleagues, merit-based compensation with substantial upside, and an opportunity to deploy skills learned as a physicist. Physicists are employed at a wide range of financial institutions on both the ``buy side'' (hedge fund managers, private equity managers, mutual fund managers, etc.) and the ``sell side'' (investment banks and brokerages). Historically, physicists in finance were primarily ``quants'' tasked with applying stochastic calculus to determine the price of financial derivatives. With the maturation of the field of derivative pricing, physicists in finance today find work in a variety of roles ranging from quantification and management of risk to investment analysis to development of sophisticated software used to price, trade, and risk manage securities. Only a small subset of today's finance careers for physicists require the use of advanced math and practically none provide an opportunity to tinker with an apparatus, yet most nevertheless draw on important skills honed during the training of a nuclear physicist. Intellectually rigorous critical thinking, sophisticated problem solving, an attention to minute detail and an ability to create and test hypotheses based on incomplete information are key to both disciplines.

Evidences on weaknesses and strengths from health financing after decentralization: lessons from Latin American countries.

PubMed

Arredondo, Armando; Orozco, Emanuel; De Icaza, Esteban

2005-01-01

The main objective was to identify trends and evidence on health financing after health care decentralization. Evaluative research with a before-after design integrating qualitative and quantitative analysis. Taking into account feasibility, political and technical criteria, three Latin American countries were selected as study populations: Mexico, Nicaragua and Peru. The methodology had two main phases. In the first phase, the study referred to secondary sources of data and documents to obtain information about the following variables: type of decentralization implemented, source of finance, funds of financing, providers, final use of resources and mechanisms for resource allocation. In the second phase, the study referred to primary data collected in a survey of key personnel from the health sectors of each country. The trends and evidence reported in all five financing indicators may identify major weaknesses and strengths in health financing. Weaknesses: a lack of human resources trained in health economics who can implement changes, a lack of financial resource independence between the local and central levels, the negative behavior of the main macro-economic variables, and the difficulty in developing new financing alternatives. Strengths: the sharing between the central level and local levels of responsibility for financing health services, the implementation of new organizational structures for the follow-up of financial changes at the local level, the development and implementation of new financial allocation mechanisms taking as a basis the efficiency and equity principles, new technique of a per-capita adjustment factor corrected at the local health needs, and the increase of financing contributions from households and local levels of government.

Engendering the bureaucracy? Challenges and opportunities for mainstreaming gender in Ministries of Health under sector-wide approaches.

PubMed

Theobald, Sally; Tolhurst, Rachel; Elsey, Helen; Standing, Hilary; Standing, Helen

2005-05-01

The increasing ascendancy of 'gender mainstreaming' as the central approach to improving gender equity has largely determined strategies to integrate a gender focus in sector-wide approaches (SWAps). This paper explores the impetus for and process of gender mainstreaming in SWAps in the Ministries of Health in Uganda, Ghana, Malawi and Mozambique, and outlines some achievements and challenges. The shifting and contested relationships between the Ministry of Health, donors and other government ministries (such as Ministries of Finance and Ministries of Women's Affairs/Gender) are important in shaping the opportunities and constraints faced in gender mainstreaming. The refocusing of resource allocation to different sectors has led to changes in the balance of power between the various actors at the national level, with diverse implications for promoting gender equity in health. Some of the achievements to date and ongoing challenges are explored through concrete examples from different countries. These include: the development of structures for mainstreaming, including the dilemmas of the 'focal points' approach and the role of national gender mainstreaming machinery; the need for training and building capacity to identify and address gender issues, which involves engaging with new languages and concepts, and developing new skills; building alliances, consensus and momentum; integrating gender concerns into policy and planning documents; and promoting gender equity in human resources in the health sector. Cross-cutting themes underlying these challenges are the need for gender-specific information and ways to finance mainstreaming strategies. Implications are drawn for ways forward, without losing sight of the challenge of translating discourses of gender mainstreaming, and its central ideal of social transformation, into pragmatic strategies in the bureaucratic environment.

Daily stock index return for the Canadian, UK, and US equity markets, compiled by Morgan Stanley Capital International, obtained from Datastream.

PubMed

Li, Leon

2018-02-01

The data presented in this article are related to the research article entitled "Testing and comparing the performance of dynamic variance and correlation models in value-at-risk estimation. North American Journal of Economics and Finance, 40, 116-135. doi:10.1016/j.najef.2017.02.006 (Li, 2017) [1]. Data on daily stock index return for the Canadian, UK, and US equity markets, as compiled by Morgan Stanley Capital International, are provided in this paper. The country indices comprise at least 80% of the stock market capitalization of each country. The data cover the period from January 1, 1990, through September 8, 2016, and include 6963 observations. All stock prices are stated in dollars.

Ovation Pharmaceuticals, Inc.

PubMed

Deutsch, Barry

2002-11-01

Ovation Pharmaceuticals, Inc. is a privately held specialty pharmaceutical company that focuses on products in central nervous system (CNS) disorders, oncology and other therapeutic areas where a small number of specialized physicians treat patients. Ovation serves unmet medical needs by acquiring underpromoted branded pharmaceutical products and promising late-stage development products no longer being actively promoted or developed by larger companies. Ovation supports acquired products through active sales and marketing activities and a clinical development program focused on new formulations, new indications and other product improvements. In April 2002, Ovation received a US$150 million commitment in private equity financing, believed to be the largest private equity investment received to date by an early-stage specialty pharmaceutical firm. Ovation used a portion of those funds to purchase its first two products from a major pharmaceutical company in August 2002.

On emissions trading, toxic debt and the Australian power market

DOE Office of Scientific and Technical Information (OSTI.GOV)

Simshauser, Paul

2009-03-15

Implementation of emissions trading will have profound effects on the financial stability of coal generators. While the impact on equity capital is well understood, the potential fallout in the market for project finance is not. During the current global financial crisis, the form and quantum of transitional assistance to coal generators will be crucial to ensure ongoing participation of domestic and foreign project banks in the power markets. (author)

Education and the Market: Which Parts of the Neo Liberal Solution Are Correct? Innocenti Occasional Papers. Special Subseries "Fiscal Policy and the Poor," Economic Policy Series.

ERIC Educational Resources Information Center

Colclough, Christopher

This paper examines the argument that education systems in development countries should be financed more directly by private households. It finds that cost-recovery policies are likely to be harmful to efficiency and equity if significant resources were to be generated by these means. User fees at primary and secondary levels would increase…

The European Union Joint Procurement Agreement for cross-border health threats: what is the potential for this new mechanism of health system collaboration?

PubMed

Azzopardi-Muscat, Natasha; Schroder-Bäck, Peter; Brand, Helmut

2017-01-01

The Joint Procurement Agreement (JPA) is an innovative instrument for multi-country procurement of medical countermeasures against cross-border health threats. This paper aims to assess its potential performance. A literature review was conducted to identify key features of successful joint procurement programmes. Documentary analysis and a key informants' interview were carried out to analyse the European Union (EU) JPA. Ownership, equity, transparency, stable central financing, standardisation, flexibility and gradual development were identified as important prerequisites for successful establishment of multi-country joint procurement programmes in the literature while security of supply, favourable prices, reduction of operational costs and administrative burden and creation of professional expert networks were identified as desirable outcomes. The EU JPA appears to fulfil the criteria of ownership, transparency, equity, flexibility and gradual development. Standardisation is only partly fulfilled and central EU level financing is not provided. Security of supply is an important outcome for all EU Member States (MS). Price savings, reduction in administrative burden and creation of professional networks may be particularly attractive for the smaller MS. The JPA has the potential to increase health system collaboration and efficiency at EU level provided that the incentives for sustained commitment of larger MS are sufficiently attractive.

If they get sick, they are in trouble: health care restructuring, user charges, and equity in Vietnam.

PubMed

Sepehri, Ardeshir; Chernomas, Robert; Akram-Lodhi, A Haroon

2003-01-01

The transition from a centrally planned economy in the 1980s and the implementation of a series of neoliberal health policy reform measures in 1989 affected the delivery and financing of Vietnam's health care services. More specifically, legalization of private medical practice, liberalization of the pharmaceutical industry, and introduction of user charges at public health facilities have effectively transformed Vietnam's near universal, publicly funded and provided health services into a highly unregulated private-public mix system, with serious consequences for Vietnam's health system. Using Vietnam's most recent household survey data and published facility-based data, this article examines some of the problems faced by Vietnam's health sector, with particular reference to efficiency, access, and equity. The data reveal four important findings: self-treatment is the dominant mode of treatment for both the poor and nonpoor; there is little or no regulation to protect patients from financial abuse by private medical providers, pharmacies, and drug vendors; in the face of a dwindling share of the state health budget in public hospital revenues and low salaries, hospitals increasingly rely on user charges and insurance premiums to finance services, including generous staff bonuses; and health care costs, especially hospital costs, are substantial for many low- and middle-income households.

Venture Capital Investment in the Life Sciences in Switzerland.

PubMed

Hosang, Markus

2014-12-01

Innovation is one of the main driving factors for continuous and healthy economic growth and welfare. Switzerland as a resource-poor country is particularly dependent on innovation, and the life sciences, which comprise biotechnologies, (bio)pharmaceuticals, medical technologies and diagnostics, are one of the key areas of innovative strength of Switzerland. Venture capital financing and venture capitalists (frequently called 'VCs') and investors in public equities have played and still play a pivotal role in financing the Swiss biotechnology industry. In the following some general features of venture capital investment in life sciences as well as some opportunities and challenges which venture capital investors in Switzerland are facing are highlighted. In addition certain means to counteract these challenges including the 'Zukunftsfonds Schweiz' are discussed.

The Dynamics of Catastrophic and Impoverishing Health Spending in Indonesia: How Well Does the Indonesian Health Care Financing System Perform?

PubMed

Aji, Budi; Mohammed, Shafiu; Haque, Md Aminul; Allegri, Manuela De

2017-09-01

Our study examines the incidence and intensity of catastrophic and impoverishing health spending in Indonesia. A panel data set was used from 4 waves of the Indonesian Family Life Surveys 1993, 1997, 2000, and 2007. Catastrophic health expenditure was measured by calculating the ratio of out-of-pocket payments to household income. Then, we calculated poverty indicators as a measure of impoverishing spending in the health care financing system. Head count, overshoot, and mean positive overshoot for each given threshold in 2000 were lower than other surveyed periods; otherwise, fraction headcount in 2007 of households were the higher. Between 1993 and 2007, the percentage of households in poverty decreased, both in gross and net of health payments. However, in each year, the percentages of households in poverty using net health payments were higher than the gross. The estimates of poverty gap, normalized poverty gap, and normalized mean positive gap decreased across the survey periods. The health care financing system performance has shown positive evidence for financial protection offerings. A sound relationship between improvements of health care financing performance and the existing health reform demonstrated a mutual reinforcement, which should be maintained to promote equity and fairness in health care financing in Indonesia.

Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing.

PubMed

Molla, Azaher Ali; Chi, Chunhuei

2017-09-06

The relationship between payments towards healthcare and ability to pay is a measure of financial fairness. Analysis of progressivity is important from an equity perspective as well as for macroeconomic and political analysis of healthcare systems. Bangladesh health systems financing is characterized by high out-of-pocket payments (63.3%), which is increasing. Hence, we aimed to see who pays what part of this high out-of-pocket expenditure. To our knowledge, this was the first progressivity analysis of health systems financing in Bangladesh. We used data from Bangladesh Household Income and Expenditure Survey, 2010. This was a cross sectional and nationally representative sample of 12,240 households consisting of 55,580 individuals. For quantification of progressivity, we adopted the 'ability-to-pay' principle developed by O'Donnell, van Doorslaer, Wagstaff, and Lindelow (2008). We used the Kakwani index to measure the magnitude of progressivity. Health systems financing in Bangladesh is regressive. Inequality increases due to healthcare payments. The differences between the Gini coefficient and the Kakwani index for all sources of finance are negative, which indicates regressivity, and that financing is more concentrated among the poor. Income inequality increases due to high out-of-pocket payments. The increase in income inequality caused by out-of-pocket payments is 89% due to negative vertical effect and 11% due to horizontal inequity. Our findings add substantial evidence of health systems financing impact on inequitable financial burden of healthcare and income. The heavy reliance on out-of-pocket payments may affect household living standards. If the government and people of Bangladesh are concerned about equitable financing burden, our study suggests that Bangladesh needs to reform the health systems financing scheme.

New Research on Securing Educational Excellence & Equity for English Language Learners in Texas Secondary Schools. IDRA Jose A. Cardenas School Finance Fellows Program 2015 Symposium Proceedings (San Antonio, Texas, February 2, 2015)

ERIC Educational Resources Information Center

Intercultural Development Research Association, 2015

2015-01-01

English language learners make up the fastest growing segment of the student population, but they are one of the lowest academically performing groups of students and the achievement gap widens as students progress through school. Dr. Oscar Jimenez-Castellanos, the Intercultural Development Research Association's (IDRA's) inaugural Jose A.…

Consumer Law Guide

DTIC Science & Technology

1994-06-01

Consumer Finance Act by making short-term advances to customers who write personal checks in return for substantially smaller amounts of on-the-spot case...practices lawsuit with H&R Block, Inc. forcing tax return company to advertise its "Rapid Refund" program is actually a loan program charging customers ...home equity loans/lines of credit/home improvement loans, etc.) 2. A consumer can have only 9M principal dwelling at a time (includes mobile homes

The EPSA Project Finance Mapping Tool

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hadley, Stanton W.; Chinthavali, Supriya

The Energy Policy and Systems Analysis Office of DOE has requested a tool to compare the impact of various Federal policies on the financial viability of generation resources across the country. Policy options could include production tax credits, investment tax credits, solar renewable energy credits, tax abatement, accelerated depreciation, tax-free loans, and others. The tool would model the finances of projects in all fifty states, and possibly other geographic units like utility service territories and RTO/ISO territories. The tool would consider the facility s cost, financing, production, and revenues under different capital and market structures to determine things like levelizedmore » cost of energy, return on equity, and cost impacts on others (e.g., load-serving entities, society.) The tool would compare the cost and value of the facility to the local regional alternatives to determine how and where policy levers may provide sufficient incremental value to motivate investment. The results will be displayed through a purpose-built visualization that maps geographic variations and shows associated figures and tables.« less

Rethinking the private-public mix in health care: analysis of health reforms in Israel during the last three decades.

PubMed

Filc, Dani; Davidovitch, Nadav

2016-10-01

To analyse the process of health care privatization using the case of Israeli health care reforms during the last three decades. We used mixed methods including quantitative analysis of trends in health expenditures in Israel and qualitative critical analysis of documents describing the main health reforms. Israel epitomizes how boundaries between the private and public sector become blurred when health care services are subject to privatization, both of finance and supply. Additionally, the continuous growth of public-private relationships in health care results in systems that lack both equity and efficiency. More than three decades of experience show that such private-public partnerships increase both inequality and inefficiency. While most discussion surrounding the private-public mix in health care focuses on financing infrastructure, in Israel, the public-private mix has become a central way of financing and delivering services, making its damaging influence more pervasive. © The Author(s) 2016.

Analysis of agency relationships in the design and implementation process of the equity fund in Madagascar.

PubMed

Honda, Ayako

2015-02-04

There are large gaps in the literature relating to the implementation of user fee policy and fee exemption measures for the poor, particularly on how such schemes are implemented and why many have not produced expected outcomes. In October 2003, Madagascar instituted a user fee exemption policy which established "equity funds" at public health centres, and used medicine sales revenue to subsidise the cost of medicine for the poor. This study examines the policy design and implementation process of the equity fund in Madagascar in an attempt to explore factors influencing the poor equity outcomes of the scheme. This study applied an agency-incentive framework to investigate the equity fund policy design and implementation practices. It analysed agency relationships established during implementation; examined incentive structures given to the agency relationships in the policy design; and considered how incentive structures were shaped and how agents responded in practice. The study employed a case-study approach with in-depth analysis of three equity fund cases in Madagascar's Boeny region. Policy design problems, triggering implementation problems, caused poor equity performance. These problems were compounded by the re-direction of policy objectives by health administrators and strong involvement of the administrators in the implementation of policy. The source of the policy design and implementation failure was identified as a set of principal-agent problems concerning: monitoring mechanisms; facility-based fund management; and the nature and level of community participation. These factors all contributed to the financial performance of the fund receiving greater attention than its ability to financially protect the poor. The ability of exemption policies to protect the poor from user fees can be found in the details of the policy design and implementation; and implications of the policy design and implementation in a specific context determine whether a policy can realise its objectives. The equity fund experience in Madagascar, which illustrates the challenges of beneficiary identification, casts doubts on the application of the 'targeting' approach in health financing and raises issues to be considered in universal health policy formulation. The agency framework provides a useful lens through which to examine policy process issues.

Effective financing of maternal health services: a review of the literature.

PubMed

Ensor, Tim; Ronoh, Jeptepkeny

2005-12-01

Health care can be funded in a number of ways ranging from direct user charges (out of pocket) payments to indirect methods that pool across time (prepayment) and across different risk and wealth groups (insurance and general taxation). All these methods can be used to finance maternal health services. When assessing the impact of financing mechanisms it is important to be aware of the different ways they effect service delivery patterns and utilisation. Specifically most systems have both equity and efficiency aspects that combine to impact on health service utilisation and health status. In general indirect methods that help families to pool the costs of maternal health services are preferable to direct methods of payment. It is also clear, however, that user charges may sometimes help to mitigate deficiencies in systems of pooled funding. Available literature suggests that financing mechanisms for maternal health services could be improved by systems that increase transparency, help to mitigate demand-side costs of services and provide funding for that promote transparent charging for services. While the limited experience of demand-side mechanisms for improving access to maternal health services more evaluation is required.

Private health insurance: a role model for European health systems.

PubMed

Arentz, Christine; Eekhoff, Johann; Kochskämper, Susanna

2012-10-01

European health care systems will face major challenges in the near future. Demographic change and technological progress induce rising costs. In order to deal with these developments and to preserve the current level of health care provision, health care systems need to be highly efficient. Yet existing health care systems show a lot of inefficiencies that result in waste of scarce resources. Therefore, improvements in performance are necessary. In this article, we argue that a change in financing health care accompanied by the liberalisation of the market for health care service providers offers a promising solution. We develop a market-based model for financing health care and show how it can be put into practice without generating additional costs for society while meeting social equity criteria.

Crowdsourced Microfinance for Energy Efficiency in Underserved Communities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baird, Donnel; Cox, Morris; Harmarneh, Sarey

BlocPower’s mission is to provide access to energy efficiency financing for underserved communities across the United States. This project, “Crowdsourced Microfinance for Energy Efficiency in Underserved Communities,” is an extension of that goal and is grounded in the principles of providing engineering and financing services to those in need. The project is based on the creation of a BlocPower Marketplace as a central hub for connecting shovel-ready green buildings to institutional investors. This ‘connection’ entails using online crowdfunding to aggregate debt and equity capital from institutional investors to connect to customers (building owners) across various financial portfolios. BlocPower Marketplace ismore » intended to bring social, environmental, and financial returns to investors while also decreasing investor risk by loaning out funds for energy installations in individual buildings. In detail, the intended benefits of crowdsourcing are two-sided. Firstly, for building owners, clean energy retrofit installations improve building operations, reduce utility costs, and reduce harmful impacts to their surrounding environment. Secondly, for institutional investors, they gain access to a new market of energy efficiency and are able to provide debt or equity capital with high financial returns. This gives investors the opportunity to create social and environmental impact in communities around the country as well. With this in mind, BlocPower designed the marketplace to specifically answer exploratory research questions with respect to the pricing of energy financing. Institutional investors typically charge high rates on project financing solutions in the energy space, particularly in low and middle-income communities, because of fears that required debt service will not be made. This makes access to energy capital exorbitantly difficult for those that need it the most. Through this project, BlocPower tested investor appetite to determine if crowdsourcing would lower prices and subsequently lower barriers to entry for underserved communities’ access to energy capital. BlocPower’s results in this project were extremely informative for the industry. The project demonstrates that the marketplace is a scalable tool to help overcome barriers to entry for small building owners in underserved communities to access energy efficiency financing, but that crowdfunding by itself does not necessarily lower interest rates and make energy efficiency projects feasible. For that, we need a repayment mechanism that lowers perceived risk. That mechanism is on bill repayment.« less

Developing Viable Financing Models for Space Tourism

NASA Astrophysics Data System (ADS)

Eilingsfeld, F.; Schaetzler, D.

2002-01-01

Increasing commercialization of space services and the impending release of government's control of space access promise to make space ventures more attractive. Still, many investors shy away from going into the space tourism market as long as they do not feel secure that their return expectations will be met. First and foremost, attracting investors from the capital markets requires qualifying financing models. Based on earlier research on the cost of capital for space tourism, this paper gives a brief run-through of commercial, technical and financial due diligence aspects. After that, a closer look is taken at different valuation techniques as well as alternative ways of streamlining financials. Experience from earlier ventures has shown that the high cost of capital represents a significant challenge. Thus, the sophistication and professionalism of business plans and financial models needs to be very high. Special emphasis is given to the optimization of the debt-to-equity ratio over time. The different roles of equity and debt over a venture's life cycle are explained. Based on the latter, guidelines for the design of an optimized loan structure are given. These are then applied to simulating the financial performance of a typical space tourism venture over time, including the calculation of Weighted Average Cost of Capital (WACC) and Net Present Value (NPV). Based on a concluding sensitivity analysis, the lessons learned are presented. If applied properly, these will help to make space tourism economically viable.

Financing the package of services during the first decade of the national health insurance law in Israel: trends and issues.

PubMed

Shmueli, Amir; Achdut, Leah; Sabag-Endeweld, Miri

2008-09-01

In 1995, a National Health Insurance Law (NHIL) was enacted in Israel. It specified a mandatory package of services to be provided by the four competing private non-profit sickness funds, and secured the financing of that provision. This review discusses the main issues associated with financing of--and the sickness funds' expenditure on--the package of services and analyzes the trends during the first decade of the implementation of the NHIL. The main findings indicate that between 1995 and 2005 the "real value" of the budget of the package of services has eroded by more than a third, most of it being due to the under-updating with regard to technological advances. The steep rise in the co-payment paid by users of health services and in voluntary supplementary health insurance ownership which is offered by the sickness funds partially financed that erosion. The growth of private spending on health, including on voluntary supplementary insurance, took place in all population groups and in the lowest income-quintile in particular. Indices of the progressivity of the financing of the package of services indicate that the burden of financing has been slightly regressive. In spite of the increase in the share of the regressive private expenditure between 1997 and 2003, overall, the finance became less regressive due to the health tax becoming less regressive. In conclusion, the introduction of the Israeli NHIL was a promising social achievement, but, during its first decade and facing tight national budgets and receiving lower national priority, subsequent regulation eroded the real value of its benefits, and its principles of solidarity and equity in finance. After 10 years of experience, the system might need refreshment and policy amendments that will correspond to its original aspirations.

Impact of Financing Instruments and Strategies on the Wind Power Production Costs: A Case of Lithuania

NASA Astrophysics Data System (ADS)

Bobinaite, V.; Konstantinaviciute, I.

2018-04-01

The paper aims at demonstrating the relevance of financing instruments, their terms and financing strategies in relation to the cost of wind power production and the ability of wind power plant (PP) to participate in the electricity market in Lithuania. The extended approach to the Levelized Cost of Energy (LCOE) is applied. The feature of the extended approach lies in considering the lifetime cost and revenue received from the support measures. The research results have substantiated the relevance of financing instruments, their terms and strategies in relation to their impact on the LCOE and competitiveness of wind PP. It has been found that financing of wind PP through the traditional financing instruments (simple shares and bank loans) makes use of venture capital and bonds coming even in the absence of any support. It has been estimated that strategies consisting of different proportions of hard and soft loans, bonds, own and venture capital result in the average LCOE of 5.1-5.7 EURct/kWh (2000 kW), when the expected electricity selling price is 5.4 EURct/kWh. The financing strategies with higher shares of equity could impact by around 6 % higher LCOE compared to the strategies encompassing higher shares of debt. However, seeking to motivate venture capitalists, bond holders or other new financiers entering the wind power sector, support measures (feed-in tariff or investment subsidy) are relevant in case of 250 kW wind PP. It has been estimated that under the unsupported financing strategies, the average LCOE of 250 kW wind PP will be 7.8-8.8 EURct/kWh, but it will reduce by around 50 % if feed-in tariff or 50 % investment subsidy is applied.

Promoting universal financial protection: how the Thai universal coverage scheme was designed to ensure equity.

PubMed

Tangcharoensathien, Viroj; Pitayarangsarit, Siriwan; Patcharanarumol, Walaiporn; Prakongsai, Phusit; Sumalee, Hathaichanok; Tosanguan, Jiraboon; Mills, Anne

2013-08-06

Empirical evidence demonstrates that the Thai Universal Coverage Scheme (UCS) has improved equity of health financing and provided a relatively high level of financial risk protection. Several UCS design features contribute to these outcomes: a tax-financed scheme, a comprehensive benefit package and gradual extension of coverage to illnesses that can lead to catastrophic household costs, and capacity of the National Health Security Office (NHSO) to mobilise adequate resources. This study assesses the policy processes related to making decisions on these features. The study employs qualitative methods including reviews of relevant documents, in-depth interviews of 25 key informants, and triangulation amongst information sources. Continued political and financial commitments to the UCS, despite political rivalry, played a key role. The Thai Rak Thai (TRT)-led coalition government introduced UCS; staying in power 8 of the 11 years between 2001 and 2011 was long enough to nurture and strengthen the UCS and overcome resistance from various opponents. Prime Minister Surayud's government, replacing the ousted TRT government, introduced universal renal replacement therapy, which deepened financial risk protection.Commitment to their manifesto and fiscal capacity pushed the TRT to adopt a general tax-financed universal scheme; collecting premiums from people engaged in the informal sector was neither politically palatable nor technically feasible. The relatively stable tenure of NHSO Secretary Generals and the chairs of the Financing and the Benefit Package subcommittees provided a platform for continued deepening of financial risk protection. NHSO exerted monopsonistic purchasing power to control prices, resulting in greater patient access and better systems efficiency than might have been the case with a different design.The approach of proposing an annual per capita budget changed the conventional line-item programme budgeting system by basing negotiations between the Bureau of Budget, the NHSO and other stakeholders on evidence of service utilization and unit costs. Future success of Thai UCS requires coverage of effective interventions that address primary and secondary prevention of non-communicable diseases and long-term care policies in view of epidemiologic and demographic transitions. Lessons for other countries include the importance of continued political support, evidence informed decisions, and a capable purchaser organization.

Poverty & health: criticality of public financing.

PubMed

Duggal, Ravi

2007-10-01

Countries with universal or near universal access to healthcare have health financing mechanisms which are single-payer systems in which either a single autonomous public agency or a few coordinated agencies pool resources to finance healthcare. This contributes to both equity in healthcare as well as to low levels of poverty in these countries. It is only in countries like India and a number of developing countries, which still rely mostly on out-of-pocket payments, where universal access to healthcare is elusive. In such countries those who have the capacity to buy healthcare from the market most often get healthcare without having to pay for it directly because they are either covered by social insurance or buy private insurance. In contrast, a large majority of the population, who suffers a hand-to-mouth existence, is forced to make direct payments, often with a heavy burden of debt, to access healthcare from the market because public provision is grossly inadequate or non existent. Thus, the absence of adequate public health investment not only results in poor health outcomes but it also leads to escalation of poverty. This article critically reviews the linkages of poverty with healthcare financing using evidence from national surveys and concludes that public financing is critical to good access to healthcare for the poor and its inadequacy is closely associated with poverty levels in the country.

Why bankers force feed the coal market: Differential economics among fuels, between coals, and within coal blends make coal forecasting a very hazardous profession indeed

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tinsley, C.R.

1993-07-01

When bankers try to assess which natural resources are [open quote]safe[close quote] lending targets for project financing, market risk-especially price volatility-is the primary concern. However, coal appears to provide the ingredients to lower this risk perception, namely: stable prices; ability to get long-term [open quotes]contracts[close quotes]; economic rent. Value of energy in thermal coal; direct link to GNP (steel) for coking/metallurgical coal; economies of scale-large unit mining operations; established seaborne trade infrastructure; huge reserves; and straightforward design, estimation, feasibility. Eighteen mine project financings in the 1965-1981 period were analyzed and it was found that of the three coal cases examined,more » two had problems. One of these never achieved the designed production level and the other came in three years late and 50% over budget. (Both were in North America). Of the 18 mines, 13 had severe problems. Despite this gloomy picture, no banks have lost money on their project financings since the sponsors gave direct credit support or injected new equity. In spite of this risky profile, banks again became hot-to-trot on project financings in the early 1980s and it is this era when the basket cases examined were financed to development.« less

Exploring the barriers to implementing National Health Insurance in South Africa: The people's perspective.

PubMed

Passchier, R V

2017-09-22

This article explores the challenges of implementing the proposed National Health Insurance for South Africa (SA), based on the six building blocks of the World Health Organization Health System Framework. In the context of the current SA health system, leadership, finance, workforce, technologies, information and service delivery are explored from the perspective of the people at ground level. Through considerations such as these, the universal health coverage goals of health equity, efficiency, responsiveness and financial risk protection, might be realised.

Defense Department Profit and Contract Finance Policies and Their Effects on Contract and Contractor Performance

DTIC Science & Technology

2008-02-01

liabilities (e.g., accounts payable). This ratio can be compared to the firm’s weighted average cost of capital ( WACC ). WACC is the cost of debt plus the cost...RatioCost of Debt Marginal Tax Rate Risk-Free Rate Cost of Equity Risk Premium Industry Beta WACC Technical Risk CPFF/CPAF …. FFP/ MYP - Contract Choice...estimates the levered WACC as the discount rate, and finally calculates the NPV of the contract. Specific model input includes profit policy levers

Determinants of the cost of capital for privately financed hospital projects in the UK.

PubMed

Colla, Paolo; Hellowell, Mark; Vecchi, Veronica; Gatti, Stefano

2015-11-01

Many governments make use of private finance contracts to deliver healthcare infrastructure. Previous work has shown that the rate of return to investors in these markets often exceeds the efficient level. Our focus is on the factors that influence that return. We examine the effect of macroeconomic, project- and firm-level variables using a detailed sample of 84 UK private finance initiative (PFI) contracts signed between 1997 and 2010. Of the above variables, macroeconomic conditions and lead sponsor size are related to the investor return. However, our results show a remarkable degree of stability in the return to investors over the 14-year period. We find evidence of a 'prevailing norm' that is robust to project- and firm-level variation. The sustainability of excess returns over a long period is indicative of a concentrated market structure. We argue that policymakers should consider new mechanisms for increasing competition in the equity market, while ensuring that authorities have the specialist resources required to negotiate efficient contract prices. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

What does equity in health mean?

PubMed

Mooney, G

1987-01-01

The author posits some ethical concerns and theories of distribution in order to gain some insight into the meaning of equity in health, as referred to in WHO documents. It is pointed out that the lack of clarity in the WHO positions is evidenced by examining 1) the European strategy document, which focuses on giving equal health to all and equity access to health care, and 2) the Global Strategy for Health, which talks about reducing inequality and health as a human right. The question raised in document 1 is whether more equal sharing of health might mean less health for the available quantity of resources. The question raised in document 2 is whether there is a right to health per se. The question is how does one measure health policy effects. Health effects are different for an 8-year-old girl and an octogenarian. How does one measure the fairness of access to health care in remote mountain villages versus an urban area? Is equal utilization which is more easily measured comparable to equal need as a measure? How does one distribute doctors equitably? The author espouses the determinant of health as Aday's illness and health promotion, which is not biased by class and controversy. The Aday definition embraces both demand and need, although his definition is still open to question. Concepts of health with distinction between need and demand are made. Theories of Veatch which relate to distributive justice and equity in health care are provided as entitlement theory (market forces determine allocation of resources), utilitarianism (greatest good for the greatest number regardless of redistribution issues), maximum theory (maximize the minimum position or giver priority to the least well off), and equality (fairness in distribution). Different organizational and financing structures will influence the approach to equity. The conclusion is that equity is a value laden concept which has no uniquely correct definition. 5 theories of equity in distribution of health resources are discussed: 1) a theory of maximum (Rawl's theory modified to include health care institutions providing opportunity as the social good), 2) altruism as a basis for equity (Titmuss' Kantian view of national responsibility to provide equitable service delivery altruistically or equal access), 3) a fair share theory of distribution (Margolis' process utility theory of doing one's fair share or equality of access for equal need, 4) commitment to equity (Sen's focus on sympathy and commitment to another's ill health status and access), and 5) equity as externality (Culyer's health care consumption where government determines the merit good or extent of consumption). If policy objectives are not clear and the definitions muddy, resources may be badly wasted or misdirected and the pursuit of equity unfulfilled, even though there is agreement in principle.

Regional inequity in financing New Cooperative Medical Scheme in Jiangsu, China.

PubMed

Dai, Baozhen; Zhou, Lulin; Mei, Y John; Zhan, Changchun

2014-01-01

This study examined the regional inequity in the New Cooperative Medical Scheme (NCMS) financing in Jiangsu, China. Counties were classified into three categories according to socio-economic development level: South Jiangsu, Middle Jiangsu and North Jiangsu. Five counties (Changshu, Danyang, Gaoyou, Jiangyan and Ganyu) were selected on the basis of the following criteria: (i) NCMS had been implemented before 2005; (ii) county governments were willing and able to collaborate with the research team; and (iii) counties had different socio-economic development status representing the low, medium and high level of socio-economic development in Jiangsu. As shown in this study, local governments in Jiangsu took the major NCMS financing responsibilities (75.2% in 2009), and local governments (county and lower) subsidies ranged from 220 RMB per capita in South Jiangsu to 18 RMB per capita in North Jiangsu in 2009, with a larger contribution (73.3%) in South than that in Middle (40.0%) and North Jiangsu (18.0%). For achieving more equity in NCMS financing and carrying NCMS forward, we propose that provincial and municipal governments should increase their contribution to NCMS for balancing the regional inequity in subsidies from county and lower-level governments, and the risk pool of NCMS should be promoted to a higher level (e.g., provincial). Copyright © 2013 John Wiley & Sons, Ltd.

Small Aircraft Transportation System (SATS): A Collaborative Effort Between Nebraska EPSCoR and NASA Langley Research Center

NASA Technical Reports Server (NTRS)

2000-01-01

Implementing SATS in Nebraska will require a number of changes, both technical and administrative. SATS will require major improvements in the infrastructure of Nebraska airports. Improving airport infrastructure so that it can accommodate SATS is first and most obvious goal. A second goal is to make airports financially sustainable over the long term with limited federal assistance. A third goal, closely related to the second, is to link the implementation of SATS with anticipated local economic growth. This can leverage local funds without tax increases, enhance the equity of the finance approach, improve planning of facility size, and reduce long-term per unit cost. Many of these goals are national issues, and presumably federal policy will determine how these goals are addressed. This study examines several financing options and discusses their ease of application to Nebraska's airports.

Assessing income redistributive effect of health financing in Zambia.

PubMed

Mulenga, Arnold; Ataguba, John Ele-Ojo

2017-09-01

Ensuring an equitable health financing system is a major concern particularly in many developing countries. Internationally, there is a strong debate to move away from excessive reliance on direct out-of-pocket (OOP) spending towards a system that incorporates a greater element of risk pooling and thus affords greater protection for the poor. This is a major focus of the move towards universal health coverage (UHC). Currently, Zambia with high levels of poverty and income inequality is implementing health sector reforms for UHC through a social health insurance scheme. However, the way to identify the health financing mechanisms that are best suited to achieving this goal is to conduct empirical analysis and consider international evidence on funding universal health systems. This study assesses, for the first time, the progressivity of health financing and how it impacts on income inequality in Zambia. Three broad health financing mechanisms (general tax, a health levy and OOP spending) were considered. Data come from the 2010 nationally representative Zambian Living Conditions and Monitoring Survey with a sample size of 19,397 households. Applying standard methodologies, the findings show that total health financing in Zambia is progressive. It also leads to a statistically significant reduction in income inequality (i.e. a pro-poor redistributive effect estimated at 0.0110 (p < 0.01)). Similar significant pro-poor redistribution was reported for general taxes (0.0101 (p < 0.01)) and a health levy (0.0002 (p < 0.01)). However, the redistributive effect was not significant for OOP spending (0.0006). These results further imply that health financing redistributes income from the rich to the poor with a greater potential via general taxes. This points to areas where government policy may focus in attempting to reduce the high level of income inequality and to improve equity in health financing towards UHC in Zambia. Copyright © 2017 Elsevier Ltd. All rights reserved.

Converting existing real estate assets to cash through off-balance sheet financing.

PubMed

Cella, M D

1994-01-01

Hospitals are realizing that they can tap hidden equity tied up in their medical office buildings and other ancillary facilities and use the capital to grow their core health care business, retool patient rooms, purchase equipment, technology, and physician practices, or simply pay down debt. Through selling their ancillary real estate assets, they can generate much-needed capital liquidity, yet still retain the control they need through restrictive covenants on uses and tenancies, repurchase options, rights of first refusal, and master leasing with creative options to expand or contract.

Capital finance and ownership conversions in health care.

PubMed

Robinson, J C

2000-01-01

This paper analyzes the for-profit transformation of health care, with emphasis on Internet start-ups, physician practice management firms, insurance plans, and hospitals at various stages in the industry life cycle. Venture capital, conglomerate diversification, publicly traded equity, convertible bonds, retained earnings, and taxable corporate debt come with forms of financial accountability that are distinct from those inherent in the capital sources available to nonprofit organizations. The pattern of for-profit conversions varies across health sectors, parallel with the relative advantages and disadvantages of for-profit and nonprofit capital sources in those sectors.

A primer on EVA for health care providers.

PubMed

Grant, James L

2007-01-01

Unlike accounting earnings, economic profit (EVA) is a measure of a company's true earnings because it fully "accounts" for the costs of all forms of financing, including debt and equity. In the EVA view, a company is not truly profitable unless it earns a return on capital that bests the opportunity cost of capital. That being said, the question addressed here is how to measure the economic profit of providers in the health care sector, which is largely comprised of not-for-profit organizations such as clinics, laboratories, and hospitals.

Equity in out-of-pocket payment in Chile

PubMed Central

Mondaca, Alicia Lorena Núñez; Chi, Chunhuei

2017-01-01

ABSTRACT OBJECTIVE To assess the distribution of financial burden in Chile, with a focus on the burden and progressivity of out-of-pocket payment. METHODS Based on the principle of ability to pay, we explore factors that contribute to inequities in the health system finance and issues about the burden of out-of-pocket payment, as well as the progressivity and redistributive effect of out-of-pocket payment in Chile. Our analysis is based on data from the 2006 National Survey on Satisfaction and Out-of-Pocket Payments. RESULTS Results from this study indicate evidence of inequity, in spite of the progressivity of the healthcare system. Our analysis also identifies relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. CONCLUSIONS In order to reduce the detected disparities among income groups, healthcare priorities should target low-income groups. Furthermore, policies should explore changes in the access to education and its impact on equity. PMID:28492762

Equity in out-of-pocket payment in Chile.

PubMed

Mondaca, Alicia Lorena Núñez; Chi, Chunhuei

2017-05-04

To assess the distribution of financial burden in Chile, with a focus on the burden and progressivity of out-of-pocket payment. Based on the principle of ability to pay, we explore factors that contribute to inequities in the health system finance and issues about the burden of out-of-pocket payment, as well as the progressivity and redistributive effect of out-of-pocket payment in Chile. Our analysis is based on data from the 2006 National Survey on Satisfaction and Out-of-Pocket Payments. Results from this study indicate evidence of inequity, in spite of the progressivity of the healthcare system. Our analysis also identifies relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. In order to reduce the detected disparities among income groups, healthcare priorities should target low-income groups. Furthermore, policies should explore changes in the access to education and its impact on equity.

Health financing and integration of urban and rural residents' basic medical insurance systems in China.

PubMed

Zhu, Kun; Zhang, Luying; Yuan, Shasha; Zhang, Xiaojuan; Zhang, Zhiruo

2017-11-07

China is in the process of integrating the new cooperative medical scheme (NCMS) and the urban residents' basic medical insurance system (URBMI) into the urban and rural residents' basic medical insurance system (URRBMI). However, how to integrate the financing policies of NCMS and URBMI has not been described in detail. This paper attempts to illustrate the differences between the financing mechanisms of NCMS and URBMI, to analyze financing inequity between urban and rural residents and to identify financing mechanisms for integrating urban and rural residents' medical insurance systems. Financing data for NCMS and URBMI (from 2008 to 2015) was collected from the China health statistics yearbook, the China health and family planning statistics yearbook, the National Handbook of NCMS Information, the China human resources and social security statistics yearbook, and the China social security yearbook. "Ability to pay" was introduced to measure inequity in health financing. Individual contributions to NCMS and URBMI as a function of per capita disposable income was used to analyze equity in health financing between rural and urban residents. URBMI had a financing mechanism that was similar to that used by NCMS in that public finance accounted for more than three quarters of the pooling funds. The scale of financing for NCMS was less than 5% of the per capita net income of rural residents and less than 2% of the per capita disposable income of urban residents for URBMI. Individual contributions to the NCMS and URBMI funds were less than 1% of their disposable and net incomes. Inequity in health financing between urban and rural residents in China was not improved as expected with the introduction of NCMS and URBMI. The role of the central government and local governments in financing NCMS and URBMI was oscillating in the past decade. The scale of financing for URRBMI is insufficient for the increasing demands for medical services from the insured. The pooling fund should be increased so that it can better adjust to China's rapidly aging population and epidemiological transitions as well as protect the insured from poverty due to illness. Individual contributions to the URBMI and NCMS funds were small in terms of contributors' incomes. The role of the central government and local governments in financing URRBMI was not clearly identified. Individual contributions to the URRBMI fund should be increased to ensure the sustainable development of URRBMI. Compulsory enrollment should be required so that URRBMI improves the social medical insurance system in China.

Health financing in fragile and post-conflict states: what do we know and what are the gaps?

PubMed

Witter, Sophie

2012-12-01

There has been a growing concern with post-conflict and fragile states over the past decade, both in relation to their high level of health and development needs but also for the risk they pose to the wider international community. This paper presents an exploratory literature review to analyse the themes and findings of recent writing on one important pillar of the health system--health financing--in these countries. It finds that here is a growing but still very limited literature. Most of the insights from existing literature relate to the role of donors. There is a need for more work on access to care and equity over the post-conflict period, the mix and sequencing of financing mechanisms, resource allocation, regulation, public financial management, payment systems and incentives at facility and health worker levels, and on overall health financing strategies and their possible contribution to wider state-building. Topics which have received attention, such as contracting and non-state actors, could benefit from more rigorous analysis with a longer time perspective. A longitudinal approach, which examines how decisions taken in the immediate post-conflict period may or may not influence longer term developments, would provide important insights. As health systems in fragile and post-conflict states are often forced to innovate, they can generate useful lessons for other settings too. Copyright © 2012 Elsevier Ltd. All rights reserved.

Resource allocation in Pakistan's health sector: a critical appraisal and a path toward the Millennium Development Goals.

PubMed

Shaikh, Babar Tasneem; Ejaz, Irum; Mazhar, Arslan; Hafeez, Assad

2013-01-01

Pakistan is trying hard to sustain its progress toward the Millennium Development Goals. However, because of a lack of political commitment to innovative solutions to improve its financing mechanism, the health system is unable to provide even essential and basic services to the people. The country, with more than 70% of the population living on less than two US dollars a day, largely depends on direct taxes for its revenue. Because of inadequate financing, the quality of government services is inexcusably poor; therefore, a majority of people seek healthcare in the private sector. This has led to a horde of issues pertaining to equity, accessibility and fairness. High out-of-pocket expenses on health jeopardize a family's livelihood, pushing it into a vicious circle of poverty. In the wake of recent devolution, this paper presents options for future health financing that enables the provinces to exert their autonomy to safeguard the health of the most vulnerable in the country. Our recommendations follow the vision of the World Health Organization and the Commission on Macroeconomics and Health, to achieve universal health coverage and social protection for the poor. Copyright © 2013 Longwoods Publishing.

Potential of Securitization in Solar PV Finance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lowder, Travis; Mendelsohn, Michael

This report aims to demonstrate, hypothetically and at a high level, what volumes of solar deployment could be supported given solar industry access to the capital markets in the form of security issuance. Securitization is not anticipated to replace tax equity in the near- to mid-term, but it could provide an additional source of funds that would be comparatively inexpensive and could reduce the weighted average cost of capital for a given solar project or portfolio. Thus, the potential to securitize solar assets and seek financing in the capital markets could help to sustain the solar industry when the investmentmore » tax credit (ITC) -- one of the federal incentives that has leveraged billions of dollars of private capital in the solar industry -- drops from 30% to 10% at the close of 2016. The report offers analysis on the size of the U.S. third-party financed solar market, as well as on the volumes (in MW) of solar asset origination possible through a $100 million securitization fund (assuming no overcollateralization). It also provides data on the size of the relevant securities markets and how the solar asset class may fit into these markets.« less

Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia's Experience.

PubMed

Rannan-Eliya, Ravindra P; Anuranga, Chamara; Manual, Adilius; Sararaks, Sondi; Jailani, Anis S; Hamid, Abdul J; Razif, Izzanie M; Tan, Ee H; Darzi, Ara

2016-05-01

Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources. Project HOPE—The People-to-People Health Foundation, Inc.

Health sector reforms in Argentina and the performance of the health financing system.

PubMed

Cavagnero, Eleonora

2008-10-01

In Argentina, health sector reforms put particular emphasis on decentralization and self-management of the tax-funded health sector, and the restructuring of the social health insurance during the 1990s. Unlike other countries in the region, there was no comprehensive plan to reform and unify the sector. In order to assess the effects of the reforms on the performance of the health financing system, this study looks at impacts on the three inter-related functions of revenue collection, pooling, and purchasing/provision of health services. Data from various sources are used to illustrate the findings. It was found that the introduction of cost recovery by self-managed hospitals increased their budgets only marginally and competition among social health insurance funds did not reduce fragmentation as expected. Although reforming the Solidarity Redistribution Fund and implementing a single basic package for the insured was an important step towards equity and transparency, the extent of risk pooling is still very limited. This study also provides recommendations regarding strengthening reimbursement mechanisms for public hospitals, and regulating the private sector as approaches to improving the fairness of the health financing system and protecting people from financial hardship as a result of illness.

Can performance-based financing help reaching the poor with maternal and child health services? The experience of rural Rwanda.

PubMed

Lannes, Laurence; Meessen, Bruno; Soucat, Agnes; Basinga, Paulin

2016-07-01

More than 20 countries in Africa are scaling up performance-based financing (PBF), but its impact on equity in access to health services remains to be documented. This paper draws on evidence from Rwanda to examine the capacity of PBF to ensure equal access to key health interventions especially in rural areas where most of the poor live. Specifically, it focuses on maternal and child health services, distinguishing two wealth groups, and uses data from a rigorous impact evaluation. Difference-in-difference technique is used, and different model specifications are tested: control for unobserved heterogeneity and common random error using linear probability model, seemingly unrelated regression equations, and clustering and fixed effects. Results suggest that in Rwanda, PBF improved efficiency rather than equity for most health services. We find that PBF achieved efficiency gains by improving access to health services for those easier to reach, generally the relatively more affluent. It turns out to be less effective in reaching the poorest. Our results illustrate the advantages of rigorous randomized impact evaluation data as results published earlier using a nationally representative survey (Demographic and Health Survey) were not able to capture the pro-rich nature of the PBF scheme in Rwanda. Our paper advocates for building mechanisms targeting the vulnerable groups in PBF strategies. It also highlights the need to understand the impact of PBF together with the specific development of health insurance coverage and the organization of the health system. Copyright © 2015 John Wiley & Sons, Ltd.

Health systems performance in sub-Saharan Africa: governance, outcome and equity.

PubMed

Olafsdottir, Anna E; Reidpath, Daniel D; Pokhrel, Subhash; Allotey, Pascale

2011-04-16

The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health outcome measure, as well as the geographical generalizability of the results.

Health systems performance in sub-Saharan Africa: governance, outcome and equity

PubMed Central

2011-01-01

Background The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Methods Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Results Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. Conclusion This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health outcome measure, as well as the geographical generalizability of the results. PMID:21496303

Variety of Behavior of Equity Returns in Financial Markets

NASA Astrophysics Data System (ADS)

Bonanno, Giovanni; Lillo, Fabrizio; Mantegna, Rosario N.

2001-03-01

The price dynamics of a set of equities traded in an efficient market is pretty complex. It consists of almost not redundant time series which have (i) long-range correlated volatility and (ii) cross-correlation between each pair of equities. We perform a study of the statistical properties of an ensemble of equities returns which is fruitful to elucidate the nature and role of time and ensemble correlation. Specifically, we investigate a statistical ensemble of daily returns of n equities traded in United States financial markets. For each trading day of our database, we study the ensemble return distribution. We find that a typical ensemble return distribution exists in most of the trading days [1] with the exception of crash and rally days and of the days following to these extreme events [2]. We analyze each ensemble return distribution by extracting its first two central moments. We call the second moment of the ensemble return distribution the variety of the market. We choose this term because high variety implies a variated behavior of the equities returns in the considered day. We observe that the mean return and the variety are fluctuating in time and are stochastic processes themselves. The variety is a long-range correlated stochastic process. Customary time-averaged statistical properties of time series of stock returns are also considered. In general, time-averaged and portfolio-averaged returns have different statistical properties [1]. We infer from these differences information about the relative strength of correlation between equities and between different trading days. We also compare our empirical results with those predicted by the single-index model and we conclude that this simple model is unable to explain the statistical properties of the second moment of the ensemble return distribution. Correlation between pairs of equities are continuously present in the dynamics of a stock portfolio. Hence, it is relevant to investigate pair correlation in a efficient and original way. We propose to investigate these correlations at a daily and intra daily time horizon with a method based on concepts of random frustrated systems. Specifically, a hierarchical organization of the investigated equities is obtained by determining a metric distance between stocks and by investigating the properties of the subdominant ultrametric associated with it [3]. The high-frequency cross-correlation existing between pairs of equities are investigated in a set of 100 stocks traded in US equity markets. The decrease of the cross-correlation between the equity returns observed for diminishing time horizons progressively changes the nature of the hierarchical structure associated to each different time horizon [4]. The nature of the correlation present between pairs of time series of equity returns collected in a portfolio has a strong influence on the variety of the market. We finally discuss the relation between pair correlation and variety of an ensemble return distribution. References [1] Fabrizio Lillo and Rosario N. Mantegna, Variety and volatility in financial markets, Phys. Rev. E 62, 6126-6134 (2000). [2] Fabrizio Lillo and Rosario N. Mantegna, Symmetry alteration of ensemble return distribution in crash and rally days of financial market, Eur. Phys. J. B 15, 603-606 (2000). [3] Rosario N. Mantegna, Hierarchical structure in financial markets, Eur. Phys. J. B 11, 193-197 (1999). [4] Giovanni Bonanno, Fabrizio Lillo, and Rosario N. Mantegna, High-frequency cross-correlation in a set of stocks, Quantitative Finance (in press).

Methodological challenges in evaluating health care financing equity in data-poor contexts: lessons from Ghana, South Africa and Tanzania.

PubMed

Borghi, Josephine; Ataguba, John; Mtei, Gemini; Akazili, James; Meheus, Filip; Rehnberg, Clas; Di, McIntyre

2009-01-01

Measurement of the incidence of health financing contributions across socio-economic groups has proven valuable in informing health care financing reforms. However, there is little evidence as to how to carry out financing incidence analysis (FIA) in lower income settings. We outline some of the challenges faced when carrying out a FIA in Ghana, Tanzania and South Africa and illustrate how innovative techniques were used to overcome data weaknesses in these settings. FIA was carried out for tax, insurance and out-of-pocket (OOP) payments. The primary data sources were Living Standards Measurement Surveys (LSMS) and household surveys conducted in each of the countries; tax authorities and insurance funds also provided information. Consumption expenditure and a composite index of socioeconomic status (SES) were used to assess financing equity. Where possible conventional methods of FIA were applied. Numerous challenges were documented and solution strategies devised. LSMS are likely to underestimate financial contributions to health care by individuals. For tax incidence analysis, reported income tax payments from secondary sources were severely under-reported. Income tax payers and shareholders could not be reliably identified. The use of income or consumption expenditure to estimate income tax contributions was found to be a more reliable method of estimating income tax incidence. Assumptions regarding corporate tax incidence had a huge effect on the progressivity of corporate tax and on overall tax progressivity. LSMS consumption categories did not always coincide with tax categories for goods subject to excise tax (e.g., wine and spirits were combined, despite differing tax rates). Tobacco companies, alcohol distributors and advertising agencies were used to provide more detailed information on consumption patterns for goods subject to excise tax by income category. There was little guidance on how to allocate fuel levies associated with 'public transport' use. Hence, calculations of fuel tax on public transport were based on individual expenditure on public transport, the average cost per kilometre and average rates of fuel consumption for each form of transport. For insurance contributions, employees will not report on employer contributions unless specifically requested to and are frequently unsure of their contributions. Therefore, we collected information on total health insurance contributions from individual schemes and regulatory authorities. OOP payments are likely to be under-reported due to long recall periods; linking OOP expenditure and illness incidence questions--omitting preventive care; and focusing on the last service used when people may have used multiple services during an illness episode. To derive more robust estimates of financing incidence, we collected additional primary data on OOP expenditures together with insurance enrolment rates and associated payments. To link primary data to the LSMS, a composite index of SES was used in Ghana and Tanzania and non-durable expenditure was used in South Africa. We show how data constraints can be overcome for FIA in lower income countries and provide recommendations for future studies.

Reforming health care financing in Bulgaria: the population perspective.

PubMed

Balabanova, Dina; McKee, Martin

2004-02-01

Health financing reform in Bulgaria has been characterised by lack of political consensus on reform direction, economic shocks, and, since 1998, steps towards social insurance. As in other eastern European countries, the reform has been driven by an imperative to embrace new ideas modelled on systems elsewhere, but with little attention to whether these reflect popular values. This study explores underlying values, such as views on the role of the state and solidarity, attitudes to, and understanding of compulsory and voluntary insurance, and co-payments. The study identifies general principles (equity, transparency) considered important by the population and practical aspects of implementation of reform. Data were obtained from a representative survey (n=1547) and from 58 in-depth interviews and 6 focus groups with users and health professionals, conducted in 1997 before the actual reform of the health financing system in Bulgaria. A majority supports significant state involvement in health care financing, ranging from providing safety net for the poor, through co-subsidising or regulating the social insurance system, to providing state-financed universal free care (half of all respondents). Collectivist values in Bulgaria remain strong, with support for free access to services regardless of income, age, or health status and progressive funding. There is strong support (especially among the well off) for a social insurance system based on the principle of solidarity and accountability rather than the former tax-based model. The preferred health insurance fund was autonomous, state regulated, financing only health care, and offering optional membership. Voluntary insurance and, less so, co-payments were acceptable if limited to selected services and better off groups. In conclusion, a health financing system under public control that fits well with values and population preferences is likely to improve compliance and be more sustainable. Universal health insurance appears to attract most support, but a broader public debate involving less empowered people is needed to resolve misunderstandings and create realistic expectations.

Private finance of services covered by the National Health Insurance package of benefits in Israel.

PubMed

Engelchin-Nissan, Esti; Shmueli, Amir

2015-01-01

Private health expenditure in systems of national health insurance has raised concern in many countries. The concern is mainly about the accessibility of care to the poor and the sick, and inequality in use and in health. The concern thus refers specifically to the care financed privately rather than to private health expenditure as defined in the national health accounts. To estimate the share of private finance in total use of services covered by the national package of benefits. and to relate the private finance of use to the income and health of the users. The Central Bureau of Statistics linked the 2009 Health Survey and the 2010 Incomes Survey. Twenty-four thousand five hundred ninety-five individuals in 7175 households were included in the data. Lacking data on the share of private finance in total cost of care delivered, we calculated instead the share of uses having any private finance-beyond copayments-in total uses, in primary, secondary, paramedical and total care. The probability of any private finance in each type of care is then related, using random effect logistic regression, to income and health state. Fifteen percent of all uses of care covered by the national package of benefits had any private finance. This rate ranges from 10 % in primary care, 16 % in secondary care and 31 % in paramedical care. Twelve percent of all uses of physicians' services had any private finance, ranging from 10 % in family physicians to 20 % in pulmonologists, psychiatrists, neurologists and urologists. Controlling for health state, richer individuals are more likely to have any private finance in all types of care. Controlling for income, sick individuals (1+ chronic conditions) are 30 % in total care and 60 % in primary care more likely to have any private finance compared to healthy individuals (with no chronic conditions). The national accounts' "private health spending" (39 % of total spending in 2010) is not of much use regarding equity of and accessibility to medical care by the population. The mean share of uses financed privately in 2010, a more relevant measure, is 15 % with large variation between types of care and physicians. While, as under national health insurance, richer persons contribute more into the finance of (private) medical care , and sicker persons are more likely to use it, the solidarity principle-cross subsidization from the rich to the sick, which is a fundamental principle of national health insurance systems, is clearly violated.

Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam

PubMed Central

2012-01-01

Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance. PMID:22376290

Post-2020 climate agreements in the major economies assessed in the light of global models

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tavoni, Massimo; Kriegler, Elmar; Riahi, Keywan

2014-12-15

Integrated assessment models can help in quantifying the implications of international climate agreements and regional climate action. This paper reviews scenario results from model intercomparison projects to explore different possible outcomes of post-2020 climate negotiations, recently announced pledges and their relation to the 2°C target. We provide key information for all the major economies, such as the year of emission peaking, regional carbon budgets and emissions allowances. We highlight the distributional consequences of climate policies, and discuss the role of carbon markets for financing clean energy investments, and achieving efficiency and equity.

[International financial cooperation in the fight against AIDS in Latin America and the Caribbean].

PubMed

Leyva-Flores, René; Castillo, José Gabriel; Serván-Mori, Edson; Ballesteros, Maria Luisa Gontes; Rodríguez, Juan Francisco Molina

2014-07-01

This study analyzed the financial contribution by the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria and its relationship to eligibility criteria for funding in Latin America and the Caribbean in 2002-2010. Descriptive analysis (linear regression) was conducted for the Global Fund financial contributions according to eligibility criteria (income level, burden of disease, governmental co-investment). Financial contributions totaled US$ 705 million. Lower-income countries received higher shares; there was no relationship between Global Fund contributions and burden of disease. The Global Fund's international financing complements governmental expenditure, with equity policies for financial allocation.

The diversity of regulation and public financing of IVF in Europe and its impact on utilization.

PubMed

Berg Brigham, K; Cadier, B; Chevreul, K

2013-03-01

How do the different forms of regulation and public financing of IVF affect utilization in otherwise similar European welfare state systems? Countries with more liberal social eligibility regulations had higher levels of IVF utilization, which diminished as the countries' policies became more restrictive. Europe is a world leader in the development and utilization of IVF, yet surveillance reveals significant differences in uptake among countries which have adopted different approaches to the regulation and and public financing of IVF. A descriptive and comparative analysis of legal restrictions on access to IVF in 13 of the EU15 countries that affirmatively regulate and publicly finance IVF. Using 2009 data from the European Society of Human Reproduction and Embryology study of regulatory frameworks in Europe and additional legislative research, we examined and described restrictions on access to IVF in terms of general eligibility, public financing and the scope of available services. Multiple correspondence analysis was used to identify patterns of regulation and groups of countries with similar regulatory patterns and to explore the effects on utilization of IVF, using data from the most recent European and international IVF monitoring reports. Regulations based on social characteristics of treatment seekers who are not applicable to other medical treatments, including relationship status and sexual orientation, appear to have the greatest impact on utilization. Countries with the most generous public financing schemes tend to restrict access to covered IVF to a greater degree. However, no link could be established between IVF utilization and the manner in which coverage was regulated or the level of public financing. Owing to the lack of data regarding the actual level of public versus private financing of IVF it is impossible to draw conclusions regarding equity of access. Moreover, the regulatory and utilization data were not completely temporally matched in what can be a quickly changing regulatory landscape. Whether motivated by cost, eligility restrictions or the availability of particular services, cross-border treatment seeking is driven by regulatory policies, underscoring the extra-territorial implications of in-country political decisions regarding access to IVF. There was no funding source for this study. The authors have no conflicts of interest to declare.

Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh.

PubMed

Ahmed, Shakil; Khan, M Mahmud

2011-05-01

Demand-side financing (DSF) is used in the less-developed countries of the world to improve access to healthcare and to encourage market supply. Under DSF, households receive vouchers that can be used to pay for healthcare services. This study evaluated the effects of a universal DSF on maternal healthcare service utilization in Bangladesh. A household survey was conducted in and around the voucher scheme area one year after the initiation of the project. Women who gave birth within a year prior to the survey were interviewed. The utilization rates of maternal health services were found to be higher for all socioeconomic groups in the project area than in the comparison areas. Voucher recipients in the project area were 3.6 times more likely to be assisted by skilled health personnel during delivery, 2.5 times more likely to deliver the baby in a health facility, 2.8 times more likely to receive postnatal care (PNC), 2.0 times more likely to get antenatal care (ANC) services and 1.5 times more likely to seek treatment for obstetric complications than pregnant women not in the program. The degree of socioeconomic inequality in maternal health service utilization was also lower in the project area than in the comparison area. The use of vouchers evidenced much stronger demand-increasing effects on the poor. Poor voucher recipients were 4.3 times more likely to deliver in a health facility and two times more likely to use skilled health personnel at delivery than the non-poor recipients. Contrary to the inverse equity hypothesis, the voucher scheme reduced inequality even in the short run. Despite these improvements, socioeconomic disparity in the use of maternal health services has remained pro-rich, implying that demand-side financing alone will be insufficient to achieve the Millennium Development Goal for maternal health. A comprehensive system-wide approach, including supply-side strengthening, will be needed to adequately address maternal health concerns in poor developing countries. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Trends in hospital care].

PubMed

Vecina Neto, Gonzalo; Malik, Ana Maria

2007-01-01

This paper analyses trends in the delivery of hospital services in Brazil, considering the setting, the current situation and its challenges, examining what still remains to be done. The variables studied for the analysis of the setting are: demography, epidemiological profile, human resources, technology, medicalization, costs, review of the role of the citizen, legislation, equity, hospital-centricity and regionalization, care fractioning and bed availability. The Brazilian setting was studied through the supplementary healthcare model, financing and the healthcare area production chain. The observations of the current situation present external evaluation models, outsourcing, public-private relationships, de-hospitalization and financing. The analysis of the challenges examines the need for long range planning, the quest for new legal models for the 'business', the use of information and information systems, cost controls and the need for enhanced efficiency and compliance with legal directives, guaranteed universal access to full healthcare facilities, the inclusion of primary prevention in healthcare procedures, integrating the public and private sectors and engaging physicians in solving problems.

Financing translation: analysis of the NCATS rare-diseases portfolio.

PubMed

Fagnan, David E; Yang, N Nora; McKew, John C; Lo, Andrew W

2015-02-25

The portfolio of the National Center for Advancing Translational Sciences (NCATS) rare-diseases therapeutic development program comprises 28 research projects initiated at the preclinical stage. Historical data reveal substantially lower costs and higher success rates but longer preclinical timelines for the NCATS projects relative to the industry averages for early-stage translational medical research and development (R&D) typically cited in literature. Here, we evaluate the potential risks and rewards of investing in a portfolio of rare-disease therapeutics. Using a "megafund" financing structure, NCATS data, and valuation estimates from a panel of industry experts, we simulate a hypothetical megafund in which senior and junior debt yielded 5 and 8%, respectively. The simulated expected return to equity was 14.7%, corresponding to a modified internal rate of return of 21.6%. These returns and the likelihood of private-sector funding can be enhanced through third-party funding guarantees from philanthropies, patient advocacy groups, and government agencies. Copyright © 2015, American Association for the Advancement of Science.

Pluralism, public choice, and the state in the emerging paradigm in health systems.

PubMed

Chernichovsky, Dov

2002-01-01

Today in developed nations, the public pays for most medical care, with the state and the medical profession or providers determining its nature, form, and level. But there is no well-defined institutional framework for revealing consumer preferences and enabling client choice about the nature and form of public entitlement. This thwarts the efforts of health system reformers to satisfy their clients and consequently promote equity and control costs--the raison d'être of publicly supported care. Consumers can be empowered in the emerging paradigm, however, in which the publicly financed system also contains competing fund-holding institutions that organize and manage the consumption of care (OMCC), such as HMOs and sickness funds. In a system in which individuals are entitled to health coverage, OMCC institutions can play an essential role in both shaping the entitlement and in expressing members' preferences. To do this, the OMCCs need to be financed through capitation and endowed with appropriate constitutional rights on how to use the funds.

State health care financing strategies for children with intellectual and developmental disabilities.

PubMed

Bachman, Sara S; Comeau, Margaret; Tobias, Carol; Allen, Deborah; Epstein, Susan; Jantz, Kathryn; Honberg, Lynda

2012-06-01

We provide the first descriptive summary of selected programs developed to help expand the scope of coverage, mitigate family financial hardship, and provide health and support services that children with intellectual and developmental disabilities need to maximize their functional status and quality of life. State financing initiatives were identified through interviews with family advocacy, Title V, and Medicaid organizational representatives. Results showed that states use myriad strategies to pay for care and maximize supports, including benefits counseling, consumer- and family-directed care, flexible funding, mandated benefits, Medicaid buy-in programs, and Tax Equity and Fiscal Responsibility Act of 1982 funding. Although health reform may reduce variation among states, its impact on families of children with intellectual and developmental disabilities is not yet clear. As health reform is implemented, state strategies to ameliorate financial hardship among families of children with intellectual and developmental disabilities show promise for immediate use. However, further analysis and evaluation are required to understand their impact on family and child well-being.

[Reflection on the psychiatric financial allocation in France].

PubMed

Boyer, L; Fond, G; Devictor, B; Samuelian, J-C; Lancon, C; Rouillon, F; Gaillard, R; Zendjidjian, X; Llorca, P-M

2016-08-01

For 25years work has been underway in France for the implementation of an alternative to public financing of health care. In the absence of progress, some regional health agencies are engaged in work related to the reallocation of public finances between psychiatric institutions. We propose a reflection with suggestion on the method proposed by the Provence Alpes Côte d'Azur Regional Health Agency. Without questioning the need for a reallocation of resources between psychiatric institutions, the method proposed here needs to evolve further to be applied in a legitimate and appropriate manner. There is a kind of urgency for a reallocation of resources between psychiatric institutions in France, but it implies a collective thinking and especially the definition of evaluation procedures for the selected models. These conditions are necessary to guarantee the quality of French psychiatry and equity in access to psychiatric care. Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

[Financing healthcare in low-income countries: recurring questions, new challenges].

PubMed

Audibert, M; Mathonnat, J; de Roodenbeke, E

2004-01-01

Healthcare financing policies in low-income countries have gone through three successive phases. In the first phase the dominant approach was based on free access to healthcare and focused first on development of vertical programs and then on the necessity of providing primary care to all. While maintaining the emphasis on accessibility to primary care, the second policy phase introduced user fees and attempted to integrate healthcare programs into district-based healthcare structures. The third phase has been strongly influenced by the relationship between healthcare and development and the Millenium Objectives and places strong emphasis on necessity of developing insurance schemes. Recent studies on the relationship between healthcare spending and health status indicate that the efficiency and effectiveness of healthcare spending plays a more determinant role than the amount. At the same time an effort is being made to develop synergy between the different players in the health care systems and to clarify the role of each player by hinging financing decisions on operating criteria such as "public welfare", externalities, catastrophic costs, and equity. Although many countries have made significant progress, there are still several lagging areas, i.e., coverage for the poorest segment of the population (despite the rhetoric), follow-up of financing, and governance. Increasing external aid already initiated by several states may have a non-negligible impact on the macroeconomic balance. Since these changes could lead to adverse effects on health, there is a need to implement careful non-dogmatic policies.

Capacity Building and Financing Oral Health in the African and Middle East Region.

PubMed

Mumghamba, E G; Joury, E; Fatusi, O; Ober-Oluoch, J; Onigbanjo, R J; Honkala, S

2015-07-01

Many low- and middle-income countries do not yet have policies to implement effective oral health programs. A reason is lack of human and financial resources. Gaps between resource needs and available health funding are widening. By building capacity, countries aim to improve oral health through actions by oral health care personnel and oral health care organizations and their communities. Capacity building involves achieving measurable and sustainable results in training, research, and provision of care. Actions include advancement of knowledge, attitudes and skills, expansion of support, and development of cohesiveness and partnerships. The aim of this critical review is to review existing knowledge and identify gaps and variations between and within different income levels in relation to the capacity building and financing oral health in the African and Middle East region (AMER). A second aim is to formulate research priorities and outline a research agenda for capacity building and financing to improve oral health and reduce oral health inequalities in the AMER. The article focuses on capacity building for oral health and oral health financing in the AMER of the IADR. In many communities in the AMER, there are clear and widening gaps between the dental needs and the existing capacity to meet these needs in terms of financial and human resources. Concerted efforts are required to improve access to oral health care through appropriate financing mechanisms, innovative health insurance schemes, and donor support and move toward universal oral health care coverage to reduce social inequality in the region. It is necessary to build capacity and incentivize the workforce to render evidence-based services as well as accessing funds to conduct research on equity and social determinants of oral health while promoting community engagement and a multidisciplinary approach. © International & American Associations for Dental Research 2015.

Assessing health system performance in developing countries: a review of the literature.

PubMed

Kruk, Margaret Elizabeth; Freedman, Lynn P

2008-03-01

With the setting of ambitious international health goals and an influx of additional development assistance for health, there is growing interest in assessing the performance of health systems in developing countries. This paper proposes a framework for the assessment of health system performance and reviews the literature on indicators currently in use to measure performance using online medical and public health databases. This was complemented by a review of relevant books and reports in the grey literature. The indicators were organized into three categories: effectiveness, equity, and efficiency. Measures of health system effectiveness were improvement in health status, access to and quality of care and, increasingly, patient satisfaction. Measures of equity included access and quality of care for disadvantaged groups together with fair financing, risk protection and accountability. Measures of efficiency were appropriate levels of funding, the cost-effectiveness of interventions, and effective administration. This framework and review of indicators may be helpful to health policy makers interested in assessing the effects of different policies, expenditures, and organizational structures on health outputs and outcomes in developing countries.

Armenia: health system review.

PubMed

Richardson, Erica

2013-01-01

This analysis of the Armenian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2006. Armenia inherited a Semashko style health system on independence from the Soviet Union in 1991. Initial severe economic and sociopolitical difficulties during the 1990s affected the population health, though strong economic growth from 2000 benefited the populations health. Nevertheless, the Armenian health system remains unduly tilted towards inpatient care concentrated in the capital city despite overall reductions in hospital beds and concerted efforts to reform primary care provision. Changes in health system financing since independence have been more profound, as out-of-pocket (OOP) payments now account for over half of total health expenditure. This reduces access to essential services for the poorest households - particularly for inpatient care and pharmaceuticals - and many households face catastrophic health expenditure. Improving health system performance and financial equity are therefore the key challenges for health system reform. The scaling up of some successful recent programmes for maternal and child health may offer solutions, but require sustained financial resources that will be challenging in the context of financial austerity and the low base of public financing. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Equity in health care financing in Palestine: the value-added of the disaggregate approach.

PubMed

Abu-Zaineh, Mohammad; Mataria, Awad; Luchini, Stéphane; Moatti, Jean-Paul

2008-06-01

This paper analyzes the redistributive effect and progressivity associated with the current health care financing schemes in the Occupied Palestinian Territory, using data from the first Palestinian Household Health Expenditure Survey conducted in 2004. The paper goes beyond the commonly used "aggregate summary index approach" to apply a more detailed "disaggregate approach". Such an approach is borrowed from the general economic literature on taxation, and examines redistributive and vertical effects over specific parts of the income distribution, using the dominance criterion. In addition, the paper employs a bootstrap method to test for the statistical significance of the inequality measures. While both the aggregate and disaggregate approaches confirm the pro-rich and regressive character of out-of-pocket payments, the aggregate approach does not ascertain the potential progressive feature of any of the available insurance schemes. The disaggregate approach, however, significantly reveals a progressive aspect, for over half of the population, of the government health insurance scheme, and demonstrates that the regressivity of the out-of-pocket payments is most pronounced among the worst-off classes of the population. Recommendations are advanced to improve the performance of the government insurance schemes to enhance its capacity in limiting inequalities in health care financing in the Occupied Palestinian Territory.

Dabhol resumes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burr, M.T.

1997-01-01

Shockwaves were felt throughout the global business community when political forces in India stalled out the Dabhol power project. Lenders and investors felt even less secure about the risks involved with developing infrastructure projects in emerging economies, and Dabhol came to symbolize the sinkholes that lie in wait for even the best-devised projects with the strongest sponsors. The project resumed in early December, however, after the Bombay High Court dismissed the only remaining lawsuit filed against Dabhol Power Co. Now, the Dabhol project is set to become an example of how a project can succeed in a big way ifmore » it has developers with integrity, skill, flexibility, and--above all--a great deal of patience. Originally a 695 MW facility, Dabhol was renegotiated so the complex totals 2,450 MW, with one 740 MW phase and another 1,710 MW phase. {open_quotes}The additional capacity allowed us to recover the costs we incurred during cancellation,{close_quotes} says Rebecca Mark, CEO of Enron Development Corp. in Houston, Texas. {open_quotes}We reduced rates for the second phase, and we`ll handle it on a competitive basis when it comes to specifying equipment.{close_quotes} Enron is the lead developer of the project, with an 80 percent equity stake. GE Capital of Stamford, Conn., USA, and Bechtel Enterprises of San Francisco, Calif., each hold a 10 percent share in the project. {open_quotes}The changes in the project have had little effect on the financing arrangements. Additional project costs which resulted from the delays were funded by the equity group, and the debt levels and terms remain consistent with those of the original closing,{close_quotes} says Everett Smith III, executive vice president and director-international, for GE Capital Services Structured Finance Group.« less

Financing institutional long-term care for the elderly in China: a policy evaluation of new models.

PubMed

Yang, Wei; Jingwei He, Alex; Fang, Lijie; Mossialos, Elias

2016-12-01

A rapid ageing population coupled with changes in family structure has brought about profound implications to social policy in China. Although the past decade has seen a steady increase in public funding to long-term care (LTC), the narrow financing base and vast population have created significant unmet demand, calling for reforms in financing. This paper focuses on the financing of institutional LTC care by examining new models that have emerged from local policy experiments against two policy goals: equity and efficiency. Three emerging models are explored: Social Health Insurance (SHI) in Shanghai, LTC Nursing Insurance (LTCNI) in Qingdao and a means-tested model in Nanjing. A focused systematic narrative review of academic and grey literature is conducted to identify and assess these models, supplemented with qualitative interviews with government officials from relevant departments, care home staff and service users. This paper argues that, although SHI appears to be a convenient solution to fund LTC, this model has led to systematic bias in affordable access among participants of different insurance schemes, and has created a powerful incentive for the over-provision of unnecessary services. The means-tested method has been remarkably constrained by narrow eligibility and insufficiency of funding resources. The LTCNI model is by far the most desirable policy option among the three studied here, but the narrow definition of eligibility has substantively excluded a large proportion of elders in need from access to care, which needs to be addressed in future reforms. This paper proposes three lines of LTC financing reforms for policy-makers: (1) the establishment of a prepaid financing mechanism pooled specifically for LTC costs; (2) the incorporation of more stringent eligibility rules and needs assessment; and (3) reforming the dominant fee-for-service methods in paying LTC service providers. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Health equity in Lebanon: a microeconomic analysis

PubMed Central

2010-01-01

Background The health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes. Methods We use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region. Results We find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender). However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62) on health a year in excess of the uninsured, they devote a smaller proportion of their expenditures to health. Conclusions The lowest quintiles of expenditures per adult have less of an ability to pay out-of-pocket for healthcare, and yet incur healthcare expenditures more often than the wealthy. They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles. PMID:20398278

The Perceived Implications of an Outsourcing Model on Governance within British Columbia Provincial Parks in Canada: A Quantitative Study

NASA Astrophysics Data System (ADS)

Eagles, Paul; Havitz, Mark; McCutcheon, Bonnie; Buteau-Duitschaever, Windekind; Glover, Troy

2010-06-01

Good governance is of paramount importance to the success of parks and protected areas. This research utilized a questionnaire for 10 principles of governance to evaluate the outsourcing model used by British Columbia Provincial Parks, where profit-making corporations provide all front country visitor services. A total of 246 respondents representing five stakeholder groups evaluated the model according to each principle, using an online survey. Principal component analysis resulted in two of the 10 principles (equity and effectiveness) each being split into two categories, leading to 12 governance principles. Five of the 12 criteria received scores towards good governance: effectiveness outcome; equity general; strategic vision; responsiveness; and effectiveness process. One criterion, public participation, was on the neutral point. Six criteria received scores below neutral, more towards weak governance: transparency; rule of law; accountability; efficiency; consensus orientation; and, equity finance. The five stakeholder groups differed significantly on 10 of the 12 principles ( P < .05). The 2 exceptions were for efficiency and effectiveness process. Seven of the 12 criteria followed a pattern wherein government employees and contractors reported positive scores, visitors and representatives of NGOs reported more negative scores, and nearby residents reported mid-range scores. Three criteria had government employees and contractors reporting the most positive scores, residents and visitors the most negative scores, and NGO respondents reporting mid-range scores. This research found evidence that perceptions of governance related to this outsourcing model differed significantly amongst various constituent groups.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bolinger, Mark

In the relatively brief history of utility-scale wind generation, the 'community wind' sector - defined here as consisting of relatively small utility-scale wind power projects that are at least partly owned by one or more members of the local community - has played a vitally important role as a 'test bed' or 'proving ground' for wind turbine manufacturers. In the 1980s and 1990s, for example, Vestas and other now-established European wind turbine manufacturers relied heavily on community wind projects in Scandinavia and Germany to install - and essentially field-test - new turbine designs. The fact that orders from community windmore » projects seldom exceeded more than a few turbines at a time enabled the manufacturers to correct any design flaws or manufacturing defects fairly rapidly, and without the risk of extensive (and expensive) serial defects that can accompany larger orders. Community wind has been slower to take root in the United States - the first such projects were installed in the state of Minnesota around the year 2000. Just as in Europe, however, the community wind sector in the U.S. has similarly served as a proving ground - but in this case for up-and-coming wind turbine manufacturers that are trying to break into the broader U.S. wind power market. For example, community wind projects have deployed the first U.S. installations of wind turbines from Suzlon (in 2003), DeWind (2008), Americas Wind Energy (2008) and later Emergya Wind Technologies (2010),1 Goldwind (2009), AAER/Pioneer (2009), Nordic Windpower (2010), Unison (2010), and Alstom (2011). Just as it has provided a proving ground for new turbines, so too has the community wind sector in the United States served as a laboratory for experimentation with innovative new financing structures. For example, a variation of one of the most common financing arrangements in the U.S. wind market today - the 'partnership flip structure' - was first developed by community wind projects in Minnesota more than a decade ago (and is therefore sometimes referred to as the 'Minnesota flip' model) before being adapted by the broader wind market. More recently, a handful of community wind projects built in the United States over the past year have been financed via new and creative structures that push the envelope of wind project finance in the U.S. - in many cases, moving beyond the now-standard partnership flip structures. These projects include: (1) a 4.5 MW project in Maine that combines low-cost government debt with local tax equity, (2) a 25.3 MW project in Minnesota using a sale/leaseback structure, (3) a 10.5 MW project in South Dakota financed by an intrastate offering of both debt and equity, (4) a 6 MW project in Washington state that taps into 'New Markets Tax Credits' using an 'inverted' or 'pass-through' lease structure, and (5) a 9 MW project in Oregon that combines a variety of state and federal incentives and loans with unconventional equity from high-net-worth individuals. In most cases, these are first-of-their-kind financing structures that could serve as useful examples for other projects - both community and commercial wind alike. This new wave of financial innovation occurring in the community wind sector has been facilitated by policy changes, most of them recent. Most notably, the American Recovery and Reinvestment Act of 2009 ('the Recovery Act') enables, for a limited time, wind power (and other types of) projects to elect either a 30% investment tax credit ('ITC') or a 30% cash grant (the 'Section 1603 grant') in lieu of the federal incentive that has historically been available to wind projects in the U.S. - a 10-year production tax credit ('PTC'). This flexibility, in turn, enables wind power projects to pursue lease financing for the first time - leasing is not possible under the PTC. Because they are based on a project's cost rather than energy generation, the 30% ITC and Section 1603 grant also reduce performance risk relative to the PTC - this, too, is an important enabler of lease financing. Finally, by providing a cash rather than tax incentive, the Section 1603 grant alone reduces (but does not eliminate) the need for tax appetite among project owners. All of these policy changes can be particularly useful to community wind projects, and have helped to support the different financial structures mentioned above. This special report - which is distilled from a longer Berkeley Lab report - briefly describes just two of these innovative new financing structures: the sale/leaseback structure used in Minnesota and the intrastate offering conducted in South Dakota. Readers interested in more detail on these two structures, as well as the other three projects not covered here, are encouraged to reference the full Berkeley Lab report.« less

Managed competition in health care and the unfinished agenda

PubMed Central

Enthoven, Alain C.

1986-01-01

A market made up of health care financing and delivery plans and individual consumers, without a carefully drawn set of rules to mitigate market failures, and without mediation by collective action on the demand side, cannot produce efficiency and equity. The concept of competition that can achieve these goals, at least to a satisfactory approximation, is managed competition, with intelligent active agents on the demand side, called sponsors, that contract with the competing health care plans and continuously structure and adjust the market to overcome its tendencies to failure. A great deal remains to be done to achieve the goals envisioned by the “procompetition reformers.” PMID:10311922

Liquidity, Technological Opportunities, and the Stage Distribution of Venture Capital Investments.

PubMed

Lahr, Henry; Mina, Andrea

2014-06-01

This paper explores the determinants of the stage distribution of European venture capital investments from 1990 to 2011. Consistent with liquidity risk theory, we find that the likelihood of investing in earlier stages increases relative to all private equity investments during liquidity crisis years. While liquidity is the main driver of acquisition investments and, to some extent, of expansion financings, technological opportunities are overall the main driver of early and late stage venture capital investments. In contrast to the dotcom crash, the recent financial crisis negatively affected the relative likelihood of expansion investments, but not of early and late stage investments.

Liquidity, Technological Opportunities, and the Stage Distribution of Venture Capital Investments

PubMed Central

Lahr, Henry; Mina, Andrea

2014-01-01

This paper explores the determinants of the stage distribution of European venture capital investments from 1990 to 2011. Consistent with liquidity risk theory, we find that the likelihood of investing in earlier stages increases relative to all private equity investments during liquidity crisis years. While liquidity is the main driver of acquisition investments and, to some extent, of expansion financings, technological opportunities are overall the main driver of early and late stage venture capital investments. In contrast to the dotcom crash, the recent financial crisis negatively affected the relative likelihood of expansion investments, but not of early and late stage investments. PMID:26166906

Blurring of the public/private divide: the Canadian chapter.

PubMed

Flood, Colleen M; Thomas, Bryan

2010-06-01

Blurring of public/private divide is occurring in different ways around the world, with differential effects in terms of access and equity. In Canada, one pathway towards privatization has received particular attention: duplicative private insurance, allowing those with the financial means to bypass queues in the public system. We assess recent legal and policy developments on this front, but also describe other trends towards the blurring of public and private in Canada: the reliance on mandated private insurance for pharmaceutical coverage; provincial governments' reliance on public-private partnerships to finance hospitals; and the incorporation of for-profit clinics within the public health care system.

New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China.

PubMed

Ma, Jingdong; Xu, Juan; Zhang, Zhiguo; Wang, Jing

2016-05-04

Subsidizing healthcare costs through insurance schemes is crucial to overcome financial barriers to health care and to avoid high medical expenditures for patients in China. The health insurance could decrease financial risk by less out-of-pocket (OOP) payment, but not promise the protection equity. With the growth of New Cooperative Medical Scheme (NCMS) financing and coverage since 2008, the protection effectiveness and equity of the modified NCMS policies on financial burden should be further evaluated. A cross-sectional household survey was conducted in Zhejiang, Hubei, and Chongqing provinces by multi-stage stratified random sampling in 2011. A total of 1,525 households covered by the NCMS were analyzed. The protection effectiveness and protection equity of NCMS was analyzed by comparing the changes in health care utilization and medical expenditures, and the changes in the prevalence of catastrophic health expenditure (CHE) and its concentration indices (CIs) between pre- and post-NCMS reimbursement, respectively. The medical financial burden was still remarkably high for the low income rural residents in China due to high OOP payment, even after NCMS reimbursement. In Hubei province, the OOP payment of the poorest quintile was almost same as their households' annual expenditures. Even it was higher than their annual expenditures in Chongqing municipality. Effective reimbursement ratio of both outpatient and inpatient services were far lower than nominal reimbursement ratio originally designed by NCMS plans. After NCMS reimbursement, the prevalence of CHE was considerably high in all three provinces, and the absolute values of CIs were even higher than those before reimbursement, indicating the inequity exaggerated. Policymakers should further modify NCMS policy in rural China. The high OOP payment could be decreased by expanding the drug list and check directory for benefit package of NCMS to minimize the gap between nominal reimbursement ratio and effective reimbursement ratio. And the increase in medical expenditures should be controlled by monitoring excess demand from both medical service providers and patients, and changing fee-for-service payment for providers to a prospective payment system. Service accessibility and affordability for vulnerable rural residents should be protected by modifying regressive financing in NCMS, and by providing extra financial aid and reimbursement from government.

A note on the theory of fast money flow dynamics

NASA Astrophysics Data System (ADS)

Sokolov, A.; Kieu, T.; Melatos, A.

2010-08-01

The gauge theory of arbitrage was introduced by Ilinski in [K. Ilinski, preprint arXiv:hep-th/9710148 (1997)] and applied to fast money flows in [A. Ilinskaia, K. Ilinski, preprint arXiv:cond-mat/9902044 (1999); K. Ilinski, Physics of finance: gauge modelling in non-equilibrium pricing (Wiley, 2001)]. The theory of fast money flow dynamics attempts to model the evolution of currency exchange rates and stock prices on short, e.g. intra-day, time scales. It has been used to explain some of the heuristic trading rules, known as technical analysis, that are used by professional traders in the equity and foreign exchange markets. A critique of some of the underlying assumptions of the gauge theory of arbitrage was presented by Sornette in [D. Sornette, Int. J. Mod. Phys. C 9, 505 (1998)]. In this paper, we present a critique of the theory of fast money flow dynamics, which was not examined by Sornette. We demonstrate that the choice of the input parameters used in [K. Ilinski, Physics of finance: gauge modelling in non-equilibrium pricing (Wiley, 2001)] results in sinusoidal oscillations of the exchange rate, in conflict with the results presented in [K. Ilinski, Physics of finance: gauge modelling in non-equilibrium pricing (Wiley, 2001)]. We also find that the dynamics predicted by the theory are generally unstable in most realistic situations, with the exchange rate tending to zero or infinity exponentially.

Closing the health and nutrition gap in Odisha, India: A case study of how transforming the health system is achieving greater equity.

PubMed

Thomas, Deborah; Sarangi, Biraj Laxmi; Garg, Anu; Ahuja, Arti; Meherda, Pramod; Karthikeyan, Sujata R; Joddar, Pinaki; Kar, Rajendra; Pattnaik, Jeetendra; Druvasula, Ramesh; Dembo Rath, Alison

2015-11-01

Health equity is high on the international agenda. This study provides evidence of how health systems can be strengthened to improve health equity in a low-income state. The paper presents a case study of how the Government of Odisha in eastern India is transforming the health system for more equitable health and nutrition outcomes. Odisha has a population of over 42 million, high levels of poverty, and poor maternal and child health concentrated in its Southern districts and among Scheduled Tribe and Scheduled Caste communities. Conducted between 2008 and 2012 with the Departments of Health and Family Welfare, and Women and Child Development, the study reviewed a wide range of literature including policy and programme documents, evaluations and studies, published and grey material, and undertook secondary analysis of state level household surveys. It identifies innovative and expanded provision of health services, reforms to the management and development of human resources for health, and the introduction of a number of cash transfer and entitlement schemes as contributing to closing the gap between maternal and child health and nutrition outcomes of Scheduled Tribes, and the Southern districts, compared to the state average. The institutional delivery rate for Scheduled Tribes has risen from 11.7% in 2005-06 to 67.3% in 2011, and from 35.6% to 79.8% for all women. The social gradient has also closed for antenatal and postnatal care and immunisation. Nutrition indicators though improving are proving slower to budge. The paper identifies how political will, committed policy makers and fiscal space energised the health system to promote equity. Sustained political commitment will be required to continue to address the more challenging human resource, health financing and gender issues. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Restructuring brain drain: strengthening governance and financing for health worker migration.

PubMed

Mackey, Tim K; Liang, Bryan A

2013-01-15

Health worker migration from resource-poor countries to developed countries, also known as ''brain drain'', represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Using acceptable methods of policy analysis, we first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.

Buying cures versus renting health: Financing health care with consumer loans.

PubMed

Montazerhodjat, Vahid; Weinstock, David M; Lo, Andrew W

2016-02-24

A crisis is building over the prices of new transformative therapies for cancer, hepatitis C virus infection, and rare diseases. The clinical imperative is to offer these therapies as broadly and rapidly as possible. We propose a practical way to increase drug affordability through health care loans (HCLs)-the equivalent of mortgages for large health care expenses. HCLs allow patients in both multipayer and single-payer markets to access a broader set of therapeutics, including expensive short-duration treatments that are curative. HCLs also link payment to clinical benefit and should help lower per-patient cost while incentivizing the development of transformative therapies rather than those that offer small incremental advances. Moreover, we propose the use of securitization-a well-known financial engineering method-to finance a large diversified pool of HCLs through both debt and equity. Numerical simulations suggest that securitization is viable for a wide range of economic environments and cost parameters, allowing a much broader patient population to access transformative therapies while also aligning the interests of patients, payers, and the pharmaceutical industry. Copyright © 2016, American Association for the Advancement of Science.

Reestablishing healthy food retail: changing the landscape of food deserts.

PubMed

Karpyn, Allison; Young, Candace; Weiss, Stephanie

2012-02-01

The term "food desert" was formally introduced into the lexicon in 1995 and has come to describe areas with limited access to affordable nutritious foods, particularly areas in lower-income neighborhoods. The definition has led to the development of national and regional maps that focus efforts on equity in food access. Recognition of food deserts also marks a strategic change in public health's approach to obesity prevention. Today's emphasis on prevention has shifted away from individual responsibility to the role of the environment in health promotion. A number of solutions are underway to address food deserts, including public–private financing programs, industry commitments, as well as local and regional efforts to put healthy food within reach. The promise of financing programs to facilitate development of healthy food markets in underserved communities is rooted in their potential to alleviate the grocery gap and address underlying environmental contributors to obesity and diet-related diseases, such as obesity and diabetes. As food desert mapping and related interventions expand, there remains a need for ongoing investigation of impacts and the mechanisms by which impacts are achieved.

Health seeking behavior in karnataka: does micro-health insurance matter?

PubMed

Savitha, S; Kiran, Kb

2013-10-01

Health seeking behaviour in the event of illness is influenced by the availability of good health care facilities and health care financing mechanisms. Micro health insurance not only promotes formal health care utilization at private providers but also reduces the cost of care by providing the insurance coverage. This paper explores the impact of Sampoorna Suraksha Programme, a micro health insurance scheme on the health seeking behaviour of households during illness in Karnataka, India. The study was conducted in three randomly selected districts in Karnataka, India in the first half of the year 2011. The hypothesis was tested using binary logistic regression analysis on the data collected from randomly selected 1146 households consisting of 4961 individuals. Insured individuals were seeking care at private hospitals than public hospitals due to the reduction in financial barrier. Moreover, equity in health seeking behaviour among insured individuals was observed. Our finding does represent a desirable result for health policy makers and micro finance institutions to advocate for the inclusion of health insurance in their portfolio, at least from the HSB perspective.

Restructuring brain drain: strengthening governance and financing for health worker migration

PubMed Central

Mackey, Tim K.; Liang, Bryan A.

2013-01-01

Background Health worker migration from resource-poor countries to developed countries, also known as ‘‘brain drain’’, represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Methods Using acceptable methods of policy analysis, we first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Results Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. Conclusions In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed. PMID:23336617

Increasing stress on disaster-risk finance due to large floods

NASA Astrophysics Data System (ADS)

Jongman, Brenden; Hochrainer-Stigler, Stefan; Feyen, Luc; Aerts, Jeroen C. J. H.; Mechler, Reinhard; Botzen, W. J. Wouter; Bouwer, Laurens M.; Pflug, Georg; Rojas, Rodrigo; Ward, Philip J.

2014-04-01

Recent major flood disasters have shown that single extreme events can affect multiple countries simultaneously, which puts high pressure on trans-national risk reduction and risk transfer mechanisms. So far, little is known about such flood hazard interdependencies across regions and the corresponding joint risks at regional to continental scales. Reliable information on correlated loss probabilities is crucial for developing robust insurance schemes and public adaptation funds, and for enhancing our understanding of climate change impacts. Here we show that extreme discharges are strongly correlated across European river basins. We present probabilistic trends in continental flood risk, and demonstrate that observed extreme flood losses could more than double in frequency by 2050 under future climate change and socio-economic development. We suggest that risk management for these increasing losses is largely feasible, and we demonstrate that risk can be shared by expanding risk transfer financing, reduced by investing in flood protection, or absorbed by enhanced solidarity between countries. We conclude that these measures have vastly different efficiency, equity and acceptability implications, which need to be taken into account in broader consultation, for which our analysis provides a basis.

Community investment in wind farms: funding structure effects in wind energy infrastructure development.

PubMed

Beery, Joshua A; Day, Jennifer E

2015-03-03

Wind energy development is an increasingly popular form of renewable energy infrastructure in rural areas. Communities generally perceive socioeconomic benefits accrue and that community funding structures are preferable to corporate structures, yet lack supporting quantitative data to inform energy policy. This study uses the Everpower wind development, to be located in Midwestern Ohio, as a hypothetical modeling environment to identify and examine socioeconomic impact trends arising from corporate, community and diversified funding structures. Analysis of five National Renewable Energy Laboratory Jobs and Economic Development Impact models incorporating local economic data and review of relevant literature were conducted. The findings suggest that community and diversified funding structures exhibit 40-100% higher socioeconomic impact levels than corporate structures. Prioritization of funding sources and retention of federal tax incentives were identified as key elements. The incorporation of local shares was found to mitigate the negative effects of foreign private equity, local debt financing increased economic output and opportunities for private equity investment were identified. The results provide the groundwork for energy policies focused to maximize socioeconomic impacts while creating opportunities for inclusive economic participation and improved social acceptance levels fundamental to the deployment of renewable energy technology.

Changing choices in health care: implications for equity, efficiency and cost.

PubMed

Bevan, Gwyn; Helderman, Jan-Kees; Wilsford, David

2010-07-01

Although choice may be seen as an end in itself, the papers included in this special issue of Health Economics, Policy and Law, examine choice policies in European systems of health care, which aim to be effective instruments for ameliorating the systemic pressures from the iron triangle of equity, efficiency, and cost. Three papers consider the nature of differences between and within countries following the Beveridge and Bismarck models of financing and organising the delivery of care, and how choices are changing within different systems. Within countries following the Beveridge model, current policies in England, Denmark and Sweden emphasise increasing patient choice of provider. Within countries following the Bismarck model, current policies in France and Germany seek to restrict choice of specialists by introducing 'soft' gatekeeping; and in the Netherlands there is a system of managed competition with choice of insurer that, in principle, allows insurers to contract selectively with providers. A fourth paper considers how government policies that seek to restrict choice within systems of universal coverage have been subject to challenges in the courts. A commentary explores the implications of the fraught and complex nature of choices between insurers and providers of health care for designing effective choice policies.

Equity and adequacy of international donor assistance for global malaria control: an analysis of populations at risk and external funding commitments.

PubMed

Snow, Robert W; Okiro, Emelda A; Gething, Peter W; Atun, Rifat; Hay, Simon I

2010-10-23

Financing for malaria control has increased as part of international commitments to achieve the Millennium Development Goals (MDGs). We aimed to identify the unmet financial needs that would be biologically and economically equitable and would increase the chances of reaching worldwide malaria-control ambitions. Populations at risk of stable Plasmodium falciparum or Plasmodium vivax transmission were calculated for 2007 and 2009 for 93 malaria-endemic countries to measure biological need. National per-person gross domestic product (GDP) was used to define economic need. An analysis of external donor assistance for malaria control was done for the period 2002-09 to compute overall and annualised per-person at-risk-funding commitments. Annualised malaria donor assistance was compared with independent predictions of funding needed to reach international targets of 80% coverage of best practices in case-management and effective disease prevention. Countries were ranked in relation to biological, economic, and unmet needs to examine equity and adequacy of support by 2010. International financing for malaria control has increased by 166% (from $0·73 billion to $1·94 billion) since 2007 and is broadly consistent with biological needs. African countries have become major recipients of external assistance; however, countries where P vivax continues to pose threats to control ambitions are not as well funded. 21 countries have reached adequate assistance to provide a comprehensive suite of interventions by 2009, including 12 countries in Africa. However, this assistance was inadequate for 50 countries representing 61% of the worldwide population at risk of malaria-including ten countries in Africa and five in Asia that coincidentally are some of the poorest countries. Approval of donor funding for malaria control does not correlate with GDP. Funding for malaria control worldwide is 60% lower than the US$4·9 billion needed for comprehensive control in 2010; this includes funding shortfalls for a wide range of countries with different numbers of people at risk and different levels of domestic income. More efficient targeting of financial resources against biological need and national income should create a more equitable investment portfolio that with increased commitments will guarantee sustained financing of control in countries most at risk and least able to support themselves. Wellcome Trust. Copyright © 2010 Elsevier Ltd. All rights reserved.

Equity and adequacy of international donor assistance for global malaria control: an analysis of populations at risk and external funding commitments

PubMed Central

Snow, Robert W; Okiro, Emelda A; Gething, Peter W; Atun, Rifat; Hay, Simon I

2010-01-01

Summary Background Financing for malaria control has increased as part of international commitments to achieve the Millennium Development Goals (MDGs). We aimed to identify the unmet financial needs that would be biologically and economically equitable and would increase the chances of reaching worldwide malaria-control ambitions. Methods Populations at risk of stable Plasmodium falciparum or Plasmodium vivax transmission were calculated for 2007 and 2009 for 93 malaria-endemic countries to measure biological need. National per-person gross domestic product (GDP) was used to define economic need. An analysis of external donor assistance for malaria control was done for the period 2002–09 to compute overall and annualised per-person at-risk-funding commitments. Annualised malaria donor assistance was compared with independent predictions of funding needed to reach international targets of 80% coverage of best practices in case-management and effective disease prevention. Countries were ranked in relation to biological, economic, and unmet needs to examine equity and adequacy of support by 2010. Findings International financing for malaria control has increased by 166% (from $0·73 billion to $1·94 billion) since 2007 and is broadly consistent with biological needs. African countries have become major recipients of external assistance; however, countries where P vivax continues to pose threats to control ambitions are not as well funded. 21 countries have reached adequate assistance to provide a comprehensive suite of interventions by 2009, including 12 countries in Africa. However, this assistance was inadequate for 50 countries representing 61% of the worldwide population at risk of malaria—including ten countries in Africa and five in Asia that coincidentally are some of the poorest countries. Approval of donor funding for malaria control does not correlate with GDP. Interpretation Funding for malaria control worldwide is 60% lower than the US$4·9 billion needed for comprehensive control in 2010; this includes funding shortfalls for a wide range of countries with different numbers of people at risk and different levels of domestic income. More efficient targeting of financial resources against biological need and national income should create a more equitable investment portfolio that with increased commitments will guarantee sustained financing of control in countries most at risk and least able to support themselves. Funding Wellcome Trust. PMID:20889199

Equity in health in unequal societies: meeting health needs in contexts of social change.

PubMed

Bloom, G

2001-09-01

The paper explores the implications for health policy of the segmentation of society into social groups with very different levels of income and wealth. Discourses on equity in health are presently dominated by a debate between 'European' and 'American' models of health delivery. This has led to a focus on ideal outcomes rather than practical options for organising and financing health services in poor countries undergoing rapid change. The paper argues for a more explicit acknowledgement of the dynamic character of health development and the political nature of the negotiations regarding the use of government powers. Unregulated markets for health care are neither equitable nor efficient. Government must play a role in supporting the organisation of health services used by different social groups. Countries with low levels of inequality may be able to provide universal access to relatively sophisticated health services. Otherwise, governments need to operate within a segmented system. This means the negotiation of strategies to reduce the burden of sickness and premature death, whilst meeting the needs of different social groups. The discussion is organised in terms of the powers of government to require individuals and institutions to transfer resources for social uses, enforce regulations and generate and disseminate information. The paper concludes that governments committed to equity-enhancing health development need to increase their capacity to facilitate coalition building and manage change. It proposes an international public health legal framework that might include a definition of minimum standards for certain health services, to be underwritten by national and international financial commitments.

The economic value of an improved malaria treatment programme in Zambia: results from a contingent valuation survey.

PubMed

Masiye, Felix; Rehnberg, Clas

2005-12-15

Zambia is facing a double crisis of increasing malaria burden and dwindling capacity to deal with the endemic malaria burden. The pursuit of sustainable but equity mechanisms for financing malaria programmes is a subject of crucial policy discussion. This requires that comprehensive accounting of the economic impact of the various malaria programmes. Information on the economic value of programmes is essential in soliciting appropriate funding allocations for malaria control. This paper specifically seeks to elicit a measure of the economic benefits of an improved malaria treatment programme in Zambia. The paper also studies the equity implications in malaria treatment given that demand or malaria treatment is determined by household socio-economic status. A contingent valuation survey of about 300 Zambian households was conducted in four districts. Willingness-to-pay (WTP) was elicited for an improved treatment programme for malaria in order to generate a measure of the economic benefits of the programme. The payment card method was used in eliciting WTP bids. The study reports that malaria treatment has significant economic benefits to society. The total economic benefits of an improved treatment programme were estimated at an equivalent of USD 77 million per annum, representing about 1.8% of Zambia's GDP. The study also reports the theoretically anticipated association between WTP and several socio-economic factors. Our income elasticity of demand is positive and similar in magnitude to estimates reported in similar studies. Finally, from an equity standpoint, the constraints imposed by income and socio-economic status are discussed.

The economic value of an improved malaria treatment programme in Zambia: results from a contingent valuation survey

PubMed Central

Masiye, Felix; Rehnberg, Clas

2005-01-01

Background Zambia is facing a double crisis of increasing malaria burden and dwindling capacity to deal with the endemic malaria burden. The pursuit of sustainable but equity mechanisms for financing malaria programmes is a subject of crucial policy discussion. This requires that comprehensive accounting of the economic impact of the various malaria programmes. Information on the economic value of programmes is essential in soliciting appropriate funding allocations for malaria control. Aims and objectives This paper specifically seeks to elicit a measure of the economic benefits of an improved malaria treatment programme in Zambia. The paper also studies the equity implications in malaria treatment given that demand or malaria treatment is determined by household socio-economic status. Methods A contingent valuation survey of about 300 Zambian households was conducted in four districts. Willingness-to-pay (WTP) was elicited for an improved treatment programme for malaria in order to generate a measure of the economic benefits of the programme. The payment card method was used in eliciting WTP bids. Findings The study reports that malaria treatment has significant economic benefits to society. The total economic benefits of an improved treatment programme were estimated at an equivalent of US$ 77 million per annum, representing about 1.8% of Zambia's GDP. The study also reports the theoretically anticipated association between WTP and several socio-economic factors. Our income elasticity of demand is positive and similar in magnitude to estimates reported in similar studies. Finally, from an equity standpoint, the constraints imposed by income and socio-economic status are discussed. PMID:16356176

[How to improve resource allocation in health care for better equity in Africa? Some directions for the future].

PubMed

Marek, Tonia

2008-12-01

Most projects financed by governments often end in deceptive results; certain indicators of health improve little, and certain not at all. Why? One cause could be the concentration of initiatives in the public sector, whereas half of heath care spending in Africa is in the private sector. It is time to consider the health care system in its entirety, and not just the public part. In this article the private sector is defined as all service provision provided by non-governmental supplier, either in the formal private sector (pharmacy, private hospital, etc.) or in the informal private sector (local, traditional therapists, informal consultations, for example).

Medicaid Disproportionate Share and Other Special Financing Programs

PubMed Central

Ku, Leighton; Coughlin, Teresa A.

1995-01-01

Medicaid disproportionate share hospital (DSH) and related programs, such as provider-specific taxes or intergovernmental transfers (IGTs), help support uncompensated care and effectively reduce State Medicaid expenditures by increasing Federal matching funds. We analyze the uses of these funds, based on a survey completed by 39 States and case studies of 6 States. We find that only a small share of these funds were available to cover the costs of uncompensated care. One method to ensure that funds are used for health care would be to reprogram funds into health insurance subsidies. An alternative to improve equity of funding across the Nation would be to create a substitute Federal grant program to directly support uncompensated care. PMID:10142580

Incentives and provider payment methods.

PubMed

Barnum, H; Kutzin, J; Saxenian, H

1995-01-01

The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

Addressing inequity in health and health care in Mexico.

PubMed

Barraza-Lloréns, Mariana; Bertozzi, Stefano; González-Pier, Eduardo; Gutiérrez, Juan Pablo

2002-01-01

Despite the fact that life expectancy at birth in Mexico has improved from forty-two years in 1940 to seventy-three in 2000, major inequalities persist in health and access to health care. The Mexican health care system has evolved into a series of disjointed subsystems that are incapable of delivering universal health insurance. Without greatly restructuring the way health care is financed, performance with respect to equity will remain poor. This paper presents the inequities of the system and describes how the current system contributes to the status quo rather than redressing the situation. After tracing the origins of the present system, we discuss policy initiatives for moving toward universal health insurance.

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya

PubMed Central

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-01-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility’s bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers’ motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. PMID:25920355

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya.

PubMed

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-03-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

The Danish health care system from a British perspective.

PubMed

Hurst, Jeremy

2002-02-01

The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weakness, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a one-week visit to health care authorities, providers and key persons. The present paper includes the main findings by one of the panel members. The dominance of tax financing helps to achieve control over the level of health care expenditure, as well as securing equity in financing the services. The reliance on local government for financing and running health care has both advantages and disadvantages, and the split between county and municipal responsibility leads to problems of co-ordination. The remuneration of general practitioners by a mix of capitation payment and fee for services has the advantage of capping expenditure whilst leaving the GPs with an incentive to compete for patients by providing them with good services. The GP service is remarkably economical. The hospital sector displays much strength, but there seem to be problems with respect to: (i) perceived lack of resources and waiting lists; (ii) impersonal care, lack of continuity of care and failures in communication between patients and staff; (iii) management problems and sometimes demotivated staff. The relationship between patients and providers is facilitated by free access to GPs and absence of any charges for hospital treatment. The biggest threat is continuation of avoidable illness caused by poor health habits in the population. The biggest opportunity is to strengthen public health measures to tackle these poor health habits.

Inequalities in financial risk protection in Bangladesh: an assessment of universal health coverage.

PubMed

Islam, Md Rashedul; Rahman, Md Shafiur; Islam, Zobida; Nurs, Cherri Zhang B; Sultana, Papia; Rahman, Md Mizanur

2017-04-04

Financial risk protection and equity are major components of universal health coverage (UHC), which is defined as ensuring access to health services for all citizens without any undue financial burden. We investigated progress towards UHC financial risk indicators and assessed variability of inequalities in financial risk protection indicators by wealth quintile. We further examined the determinants of different financial hardship indicators related to healthcare costs. A cross-sectional, three-stage probability survey was conducted in Bangladesh, which collected information from 1600 households from August to November 2011. Catastrophic health payments, impoverishment, and distress financing (borrowing or selling assets) were treated as financial hardship indicators in UHC. Poisson regression models were used to identify the determinants of catastrophic payment, impoverishment and distress financing separately. Slope, relative and concentration indices of inequalities were used to assess wealth-based inequalities in financial hardship indicators. The study found that around 9% of households incurred catastrophic payments, 7% faced distress financing, and 6% experienced impoverishing health payments in Bangladesh. Slope index of inequality indicated that the incidence of catastrophic health payment and distress financing among the richest households were 12 and 9 percentage points lower than the poorest households respectively. Multivariable Poisson regression models revealed that all UHC financial hardship indicators were significantly higher among household that had members who received inpatient care or were in the poorest quintile. The presence of a member with chronic illness in a household increased the risk of impoverishment by nearly double. This study identified a greater inequality in UHC financial hardship indicators. Rich households in Bangladesh were facing disproportionately less financial hardship than the poor ones. Households can be protected from financial hardship associated with healthcare costs by implementing risk pooling mechanism, increasing GDP spending on health, and properly monitoring subsidized programs in public health facilities.

A roadmap to parity in mental health financing: the case of Lebanon.

PubMed

Yehia, Farah; Nahas, Ziad; Saleh, Shadi

2014-09-01

Inadequate access to mental health (MH) services in Lebanon, where prevalence is noteworthy, is a concern. Although a multitude of factors affects access to services, lack of financial coverage of MH services is one that merits further investigation. This study aims at providing a systematic description of MH financing systems with a special focus on Lebanon, presenting stakeholder viewpoints on best MH financing alternatives/strategies and recommending options for enhancing financial coverage. A comprehensive review of existing literature on MH financing systems was conducted, with a focus on the system in Lebanon. In addition, key stakeholders were interviewed to assess MH organizational and financing arrangements. Finally, a national round table was organized with the aim of discussing findings (from the review and interviews) and developing an action roadmap. Taxation and out-of-pocket payments are the most common MH financing sources worldwide and in the Eastern Mediterranean Region. In Lebanon, all funding entities, except private insurance and mutual funds, cover inpatient and outpatient MH services, albeit with inconsistencies in levels of coverage. The national roundtable recommended two main MH financing enhancements: (i) creating a knowledge-sharing committee between insurers and MH specialists, and (ii) convincing labor unions/representatives to lobby for MH coverage as part of the negotiated benefit package. There are concerns regarding the equity, effectiveness and efficiency of the MH financing system in Lebanon. The fragmented system in Lebanon leads to differences in MH coverage across different financing intermediaries, which is inequitable. The fact that one out of four Lebanese suffer a mental disorder throughout their lives and very low percentages of those obtain treatment signals a problem in effectiveness. As for efficiency, the inefficient fragmentation of MH financing among seven intermediaries is a problematic characteristic of the healthcare financing system as a whole. Moreover, the orientation of the general healthcare system towards curative rather than preventive care is reflected in MH financing as well. Limitations of the study include the lack of access to data about the MH expenditure of every financing intermediary in Lebanon; therefore it was not possible to calculate a total annual MH spending on a country level. Another limitation was the inability to map the sources of funding with the MH service provision sector, as more extensive data about the MH services provided by each of the public, private, voluntary and informal sectors is needed. Providing a clear description of the current MH financing system helps policymakers recognize the disparities present in the coverage of MH, guiding them into making informed decisions on allocation of funds. This study therefore constitutes the first step towards achieving more equitable and socially just coverage, advances knowledge and provides well-needed locally relevant research. Findings are expected to inform policymaking and have already contributed to influencing a change in the policy of the Internal Security Forces Health Fund. As a result of the roundtable discussion and follow up that ensued, the fund has removed the suicide attempt exclusion from its insurance policy.

Universal health coverage in Turkey: enhancement of equity.

PubMed

Atun, Rifat; Aydın, Sabahattin; Chakraborty, Sarbani; Sümer, Safir; Aran, Meltem; Gürol, Ipek; Nazlıoğlu, Serpil; Ozgülcü, Senay; Aydoğan, Ulger; Ayar, Banu; Dilmen, Uğur; Akdağ, Recep

2013-07-06

Turkey has successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in financing, health service access, and health outcomes. We trace the trajectory of health system reforms in Turkey, with a particular emphasis on 2003-13, which coincides with the Health Transformation Program (HTP). The HTP rapidly expanded health insurance coverage and access to health-care services for all citizens, especially the poorest population groups, to achieve universal health coverage. We analyse the contextual drivers that shaped the transformations in the health system, explore the design and implementation of the HTP, identify the factors that enabled its success, and investigate its effects. Our findings suggest that the HTP was instrumental in achieving universal health coverage to enhance equity substantially, and led to quantifiable and beneficial effects on all health system goals, with an improved level and distribution of health, greater fairness in financing with better financial protection, and notably increased user satisfaction. After the HTP, five health insurance schemes were consolidated to create a unified General Health Insurance scheme with harmonised and expanded benefits. Insurance coverage for the poorest population groups in Turkey increased from 2·4 million people in 2003, to 10·2 million in 2011. Health service access increased across the country-in particular, access and use of key maternal and child health services improved to help to greatly reduce the maternal mortality ratio, and under-5, infant, and neonatal mortality, especially in socioeconomically disadvantaged groups. Several factors helped to achieve universal health coverage and improve outcomes. These factors include economic growth, political stability, a comprehensive transformation strategy led by a transformation team, rapid policy translation, flexible implementation with continuous learning, and simultaneous improvements in the health system, on both the demand side (increased health insurance coverage, expanded benefits, and reduced cost-sharing) and the supply side (expansion of infrastructure, health human resources, and health services). Copyright © 2013 Elsevier Ltd. All rights reserved.

The consequences of health service privatisation for equality and equity in health care in South Africa.

PubMed

Price, M

1988-01-01

The trend towards the privatisation of health services in South Africa reflects a growing use of private sources of finance and the growing proportion of privately owned fee-for-service providers and facilities. Fee-for-service methods of reimbursement aggravate the geographical maldistribution of personnel and facilities, and the competition for scarce personnel resources aggravates the difference in the quality of the public and private services. Thus the growth in demand for these types of providers may be expected to increase inequality of access in these two respects. The potential expansion of medical scheme coverage is shown to be limited to well under 50% of the population, leaving the majority of the population without access to private sector health care. Even for members of the medical schemes, benefits are linked to income, thus clashing with the principle of equal care for equal need. The public funds needed to overcome financial obstacles to access to private providers could be more efficiently deployed by financing publicly owned and controlled health services directly. Taxation also offers the most equitable method of financing health services. Finally, attention is drawn to the dilemma resulting from the strengthening of the private health sector; while in the short term this can offer better care to more people on a racially non-discriminatory basis, in the long term, health care for the population as a whole may become more unequal and for those dependent on the public sector it may even deteriorate.

The role of private hospitals in South Africa. Part II. Towards a national policy on private hospitals.

PubMed

Broomberg, J

1993-05-01

This paper reviews some aspects of present state policy on private hospitals and sets out broad policy guidelines, as well as specific policy options, for the future role of private hospitals in South Africa. Current state policy is reviewed via an examination of the findings and recommendations of the two major Commissions of Inquiry into the role of private hospitals over the last 2 decades, and comparison of these with the present situation. The analysis confirms that existing state policy on private hospitals is inadequate, and suggests some explanations for this. Policy options analysed include the elimination of the private hospital sector through nationalization; partial integration of private hospitals into a centrally financed health care system (such as a national health insurance system); and the retention of separate, privately owned hospitals that will remain privately financed and outside the system of national health care provision. These options are explained and their merits and the associated problems debated. While it is recognised that, in the long term, public ownership of hospitals may be an effective way of attaining equity and efficiency in hospital services, the paper argues that elimination of private hospitals is not a realistic policy option for the foreseeable future. In this scenario, partial integration of private hospitals under a centrally financed system is argued to be the most effective way of improving the efficiency of the private hospital sector, and of maximising its contribution to national health care resources.

Academic general internal medicine: a mission for the future.

PubMed

Armstrong, Katrina; Keating, Nancy L; Landry, Michael; Crotty, Bradley H; Phillips, Russell S; Selker, Harry P

2013-06-01

After five decades of growth that has included advances in medical education and health care delivery, value cohesion, and integration of diversity, we propose an overarching mission for academic general internal medicine to lead excellence, change, and innovation in clinical care, education, and research. General internal medicine aims to achieve health care delivery that is comprehensive, technologically advanced and individualized; instills trust within a culture of respect; is efficient in the use of time, people, and resources; is organized and financed to achieve optimal health outcomes; maximizes equity; and continually learns and adapts. This mission of health care transformation has implications for the clinical, educational, and research activities of divisions of general internal medicine over the next several decades.

Capitation and risk adjustment in health care financing: an international progress report.

PubMed

Rice, N; Smith, P C

2001-01-01

In every system of health care, capitation payments have become the accepted tool used by health care purchasers in much of the developed world to determine prospective budgets. The policy prescription of capitation is perceived to address both equity objectives (of great importance in publicly funded systems of health care) and efficiency objectives (the dominant concern in competitive insurance markets). An examination of the current state of the art in 20 countries outside the United States in which health care capitation has been implemented confirms that capitation has assumed central importance within diverse systems of health care. In practice, however, the setting of capitation payments has been heavily constrained to date by poor data availability and unsatisfactory analytic methodology.

Health care costs and financing in world perspective.

PubMed Central

Roemer, M. I.

1991-01-01

Expenditures for health services, as a percentage of national wealth (gross national product, or GNP), have been rising throughout the world. Data to quantify this trend are available for many industrialized countries. The share of health spending derived from governmental sources has also been increasing. Mandatory or social insurance has developed to support health services in 70 nations. While widely used for paying doctors on a fee basis or by capitation, in Latin America doctors are organized in polyclinics and paid by salaries. General revenues are used to support Ministry of Health programs. Among health expenditures, the largest share goes to hospitalization. Cost sharing by patients is widely used to control rising costs. World trends have promoted equity in health care delivery. PMID:1814057

Health-system reform and universal health coverage in Latin America.

PubMed

Atun, Rifat; de Andrade, Luiz Odorico Monteiro; Almeida, Gisele; Cotlear, Daniel; Dmytraczenko, T; Frenz, Patricia; Garcia, Patrícia; Gómez-Dantés, Octavio; Knaul, Felicia M; Muntaner, Carles; de Paula, Juliana Braga; Rígoli, Felix; Serrate, Pastor Castell-Florit; Wagstaff, Adam

2015-03-28

Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens--with defined and enlarged benefits packages--and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Evolution and new perspectives of health care financing in developing countries].

PubMed

Audibert, Martine; Mathonnat, Jacky; de Roodenbeke, Eric

2003-01-01

Over the last twenty five years, the perspective of health care financing has dramatically changed in developing countries. In this context, it is worth reviewing the literature and the experiences in order to understand the major shifts on this topic. During the sixties, health care policies focused on fighting major epidemics. Programs were dedicated to reduce the threat to population health. Financing related to the mobilization of resources for these programs and most of them were not managed within national administrations. The success of these policies was not sustainable. After Alma Ata, primary health care became a priority but it took some years before the management of the health care district was introduced as a major topic. In the eighties, with the district policy and the Bamako Initiative, the economic approach became a major part of all health care policies. At that time, most of health care financing was related to cost recovery strategies. All the attention was then drawn on how it worked: Fee policies, distribution of revenues, efficient use of resources and so on. In the second half of the nineties, cost recovery was relegated to the back scene, health care financing policy then becoming a major front scene matter. Two major reasons may explain this change in perspective: HIV which causes a major burden on the whole health system, and fighting poverty in relation with debts reduction. In most developing countries, with high HIV prevalence, access to care is no longer possible within the framework of the ongoing heath care financing scheme. Health plays a major role in poverty reduction strategies but health care officials must take into account every aspect of public financing. New facts also have to be taken into account: Decentralization/autonomy policies, the growing role of third party payment and the rising number of qualified health care professionals. All these facts, along with a broader emphasis given to the market, introduce a need for a better management of resources through financing mechanisms. Some major reports from WHO and the World Bank are the landmarks of the evolution on how to approach health care financing: The 1993 World Bank report on investing in health, the 2000 WHO report on health in the world and the WHO report on macroeconomics and health. In this early millenium, there is a general agreement on some major aspects of health care financing such as: Lack of resources for financing health care; cost recovery as a part of any sustainable health care system; health as a public good needing some extended subsidies; protecting people from the burden of disease as a part of financing schemes; equity in relation with the public private mix at the center of many debates; financing as a key mechanism for the regulation of the whole health care system and not only as a resource mobilization; HIV in bringing up new problems clearly shows how all these matters are related. Health care financing is at the heart of ongoing questions on health care reforms. Although developing countries have low insurance coverage and weak modern medical care, they share the same questions as developed countries: How to promote technical and allocative efficiency? What place for incentives? What role for the public sector? How can market and contracting bring results? What progress through stewardship and better governance?

Approaches to appropriate care delivery from a policy perspective: A case study of Australia, England and Switzerland.

PubMed

Robertson-Preidler, Joelle; Anstey, Matthew; Biller-Andorno, Nikola; Norrish, Alexandra

2017-07-01

Appropriateness is a conceptual way for health systems to balance Triple Aim priorities for improving population health, containing per capita cost, and improving the patient experience of care. Comparing system approaches to appropriate care delivery can help health systems establish priorities and facilitate appropriate care practices. We conceptualized system appropriateness by identifying policies that aim to achieve the Triple Aim and their consequent trade-offs for financing, clinical practice, and the individual patient. We used secondary data sources to compare the appropriate care approaches of Australia, England, and Switzerland according to financial, clinical, and individual appropriateness policies. Health system approaches to appropriate care delivery varied. England prioritizes public health, equity and efficiency at the expense of individual choice, while Switzerland focuses on individual patient preferences, but has higher per capita and out of pocket costs. Australia provides equity in public care access and private health care options that allows for more patient choice, with health care costs falling between the two. Integrating the Triple Aim into health system design and policy can facilitate appropriate care delivery at the system, clinical, and individual levels. Approaches will vary and require countries to negotiate and justify priorities and trade-offs within the context of thehealth system. Copyright © 2017 Elsevier B.V. All rights reserved.

The effects of MCH insurance cards on improving equity in access and use of maternal and child health care services in Tanzania: a mixed methods analysis.

PubMed

Kuwawenaruwa, August; Mtei, Gemini; Baraka, Jitihada; Tani, Kassimu

2016-11-18

Inequity in access and use of child and maternal health services is impeding progress towards reduction of maternal mortality in low-income countries. To address low usage of maternal and newborn health care services as well as financial protection of families, some countries have adopted demand-side financing. In 2010, Tanzania introduced free health insurance cards to pregnant women and their families to influence access, use, and provision of health services. However, little is known about whether the use of the maternal and child health cards improved equity in access and use of maternal and child health care services. A mixed methods approach was used in Rungwe district where maternal and child health insurance cards had been implemented. To assess equity, three categories of beneficiaries' education levels were used and were compared to that of women of reproductive age in the region from previous surveys. To explore factors influencing women's decisions on delivery site and use of the maternal and child health insurance card and attitudes towards the birth experience itself, a qualitative assessment was conducted at representative facilities at the district, ward, facility, and community level. A total of 31 in-depth interviews were conducted on women who delivered during the previous year and other key informants. Women with low educational attainment were under-represented amongst those who reported having received the maternal and child health insurance card and used it for facility delivery. Qualitative findings revealed that problems during the current pregnancy served as both a motivator and a barrier for choosing a facility-based delivery. Decision about delivery site was also influenced by having experienced or witnessed problems during previous birth delivery and by other individual, financial, and health system factors, including fines levied on women who delivered at home. To improve equity in access to facility-based delivery care using strategies such as maternal and child health insurance cards is necessary to ensure beneficiaries and other stakeholders are well informed of the programme, as giving women insurance cards only does not guarantee facility-based delivery.

An overview of health financing patterns and the way forward in the WHO African Region.

PubMed

Kirigia, J M; Preker, A; Carrin, G; Mwikisa, C; Diarra-Nama, A J

2006-09-01

The way a health system is financed affects the performance of its other functions of stewardship, input (or resource) creation and services provision, and ultimately, the achievement of health system goals of health improvement (or maintenance), responsiveness to people's non-medical expectations and fair financial contributions. To analyse the changes between 1998 and 2002,in health financing from various sources; and to propose ways of improving the performance of health financing function in the WHO African Region. A retrospective analysis of data obtained from the World Health Report, 2005. The analysis reported in this paper is based on the National Health Accounts (NHA) data for the 46 WHO Member States in the African Region. The data were obtained from the World Health Report 2005. It consisted of information on: levels of per capita expenditure on health; total expenditure on health as a percentage of gross domestic product (GDP); general government expenditure on health as a percentage of total expenditure on health; private expenditure on health as a percentage of total expenditure on health; general government expenditure on health as a percentage of total government expenditure; external expenditure as a percentage of total expenditure on health; social security expenditure on health as a percentage of general government expenditure on health; out-of-pocket expenditure as a percentage of private expenditure on health; and private prepaid plans as a percentage of private expenditure on health. The analysis was done using Lotus SmartSuite software. The analysis revealed that: fifteen countries spent less than 4.5% of their GDP on health; forty four countries spent less than 15% of their national annual budget on health; sixty three percent of the governments in the Region spent less than US$10 per person per year; fifty per cent of the total expenditure on health in 24 countries came from government sources; prepaid health financing mechanisms cover only a small proportion of populations in the Region; private spending constituted over 40% of the total expenditure on health in 31; direct out-of-pocket expenditures constituted over 50% of the private health expenditure in 38 countries. Every country needs to develop clear pro-poor health financing policy and a comprehensive health financing strategic plan with a clear roadmap of how it plans to transit from the current health financing state dominated by inequitable, catastrophic and impoverishing direct out-of-pocket payments to a visionary scenario of universal coverage. The strategic plan should strengthening of health sector advocacy and health financing capacities, health economics evidence generation and utilisation in decision-making, making better use of available and expected resources, monitoring of equity in financing, strengthening of the exemption mechanisms, managed removal of direct out-of-pocket payments (for countries that choose to), and improving country-led sectoral coordination mechanisms (e.g. Sector Wide Approaches).

Private sector contributions and their effect on physician emigration in the developing world

PubMed Central

Ugarte-Gil, Cesar; Darko, Kwame

2013-01-01

Abstract The contribution made by the private sector to health care in a low- or middle-income country may affect levels of physician emigration from that country. The increasing importance of the private sector in health care in the developing world has resulted in newfound academic interest in that sector’s influences on many aspects of national health systems. The growth in physician emigration from the developing world has led to several attempts to identify both the factors that cause physicians to emigrate and the effects of physician emigration on primary care and population health in the countries that the physicians leave. When the relevant data on the emerging economies of Ghana, India and Peru were investigated, it appeared that the proportion of physicians participating in private health-care delivery, the percentage of health-care costs financed publicly and the amount of private health-care financing per capita were each inversely related to the level of physician expatriation. It therefore appears that private health-care delivery and financing may decrease physician emigration. There is clearly a need for similar research in other low- and middle-income countries, and for studies to see if, at the country level, temporal trends in the contribution made to health care by the private sector can be related to the corresponding trends in physician emigration. The ways in which private health care may be associated with access problems for the poor and therefore reduced equity also merit further investigation. The results should be of interest to policy-makers who aim to improve health systems worldwide. PMID:23476095

Fiscal transfers based on inputs or outcomes? Lessons from the Twelfth and Thirteenth Finance Commission in India

PubMed Central

Iyer, Smriti; Kapur, Avani; Mahbub, Rifaiyat; Mukherjee, Anit

2017-01-01

Summary Background There is limited empirical evidence about the efficacy of fiscal transfers for a specific purpose, including for health which represents an important source of funds for the delivery of public services especially in large populous countries such as India. Objective To examine two distinct methodologies for allocating specific‐purpose centre‐to‐state transfers, one using an input‐based formula focused on equity and the other using an outcome‐based formula focused on performance. Materials and Methods We examine the Twelfth Finance Commission (12FC)'s use of Equalization Grants for Health (EGH) as an input‐based formula and the Thirteenth Finance Commission (13FC)'s use of Incentive Grants for Health (IGH) as an outcome‐based formula. We simulate and replicate the allocation of these two transfer methodologies and examine the consequences of these fiscal transfer mechanisms. Results The EGH placed conditions for releasing funds, but states varied in their ability to meet those conditions, and hence their allocations varied, eg, Madhya Pradesh received 100% and Odisha 67% of its expected allocation. Due to the design of the IGH formula, IGH allocations were unequally distributed and highly concentrated in 4 states (Manipur, Sikkim, Tamil Nadu, Nagaland), which received over half the national IGH allocation. Discussion The EGH had limited impact in achieving equalization, whereas the IGH rewards were concentrated in states which were already doing better. Greater transparency and accountability of centre‐to‐state allocations and specifically their methodologies are needed to ensure that allocation objectives are aligned to performance. PMID:28857284

Private sector contributions and their effect on physician emigration in the developing world.

PubMed

Loh, Lawrence C; Ugarte-Gil, Cesar; Darko, Kwame

2013-03-01

The contribution made by the private sector to health care in a low- or middle-income country may affect levels of physician emigration from that country. The increasing importance of the private sector in health care in the developing world has resulted in newfound academic interest in that sector's influences on many aspects of national health systems. The growth in physician emigration from the developing world has led to several attempts to identify both the factors that cause physicians to emigrate and the effects of physician emigration on primary care and population health in the countries that the physicians leave. When the relevant data on the emerging economies of Ghana, India and Peru were investigated, it appeared that the proportion of physicians participating in private health-care delivery, the percentage of health-care costs financed publicly and the amount of private health-care financing per capita were each inversely related to the level of physician expatriation. It therefore appears that private health-care delivery and financing may decrease physician emigration. There is clearly a need for similar research in other low- and middle-income countries, and for studies to see if, at the country level, temporal trends in the contribution made to health care by the private sector can be related to the corresponding trends in physician emigration. The ways in which private health care may be associated with access problems for the poor and therefore reduced equity also merit further investigation. The results should be of interest to policy-makers who aim to improve health systems worldwide.

Fiscal transfers based on inputs or outcomes? Lessons from the Twelfth and Thirteenth Finance Commission in India.

PubMed

Fan, Victoria Y; Iyer, Smriti; Kapur, Avani; Mahbub, Rifaiyat; Mukherjee, Anit

2018-01-01

There is limited empirical evidence about the efficacy of fiscal transfers for a specific purpose, including for health which represents an important source of funds for the delivery of public services especially in large populous countries such as India. To examine two distinct methodologies for allocating specific-purpose centre-to-state transfers, one using an input-based formula focused on equity and the other using an outcome-based formula focused on performance. We examine the Twelfth Finance Commission (12FC)'s use of Equalization Grants for Health (EGH) as an input-based formula and the Thirteenth Finance Commission (13FC)'s use of Incentive Grants for Health (IGH) as an outcome-based formula. We simulate and replicate the allocation of these two transfer methodologies and examine the consequences of these fiscal transfer mechanisms. The EGH placed conditions for releasing funds, but states varied in their ability to meet those conditions, and hence their allocations varied, eg, Madhya Pradesh received 100% and Odisha 67% of its expected allocation. Due to the design of the IGH formula, IGH allocations were unequally distributed and highly concentrated in 4 states (Manipur, Sikkim, Tamil Nadu, Nagaland), which received over half the national IGH allocation. The EGH had limited impact in achieving equalization, whereas the IGH rewards were concentrated in states which were already doing better. Greater transparency and accountability of centre-to-state allocations and specifically their methodologies are needed to ensure that allocation objectives are aligned to performance. © 2017 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

Markets and medical care: the United States, 1993-2005.

PubMed

White, Joseph

2007-09-01

Many studies arguing for or against markets to finance medical care investigate "market-oriented" measures such as cost sharing. This article looks at the experience in the American medical marketplace over more than a decade, showing how markets function as institutions in which participants who are self-seeking, but not perfectly rational, exercise power over other participants in the market. Cost experience here was driven more by market power over prices than by management of utilization. Instead of following any logic of efficiency or equity, system transformations were driven by beliefs about investment strategies. At least in the United States' labor and capital markets, competition has shown little ability to rationalize health care systems because its goals do not resemble those of the health care system most people want.

Markets and Medical Care: The United States, 1993–2005

PubMed Central

White, Joseph

2007-01-01

Many studies arguing for or against markets to finance medical care investigate “market-oriented” measures such as cost sharing. This article looks at the experience in the American medical marketplace over more than a decade, showing how markets function as institutions in which participants who are self-seeking, but not perfectly rational, exercise power over other participants in the market. Cost experience here was driven more by market power over prices than by management of utilization. Instead of following any logic of efficiency or equity, system transformations were driven by beliefs about investment strategies. At least in the United States' labor and capital markets, competition has shown little ability to rationalize health care systems because its goals do not resemble those of the health care system most people want. PMID:17718663

[Economics of health system transformation].

PubMed

González Pier, Eduardo

2012-01-01

Health conditions in Mexico have evolved along with socioeconomic conditions. As a result, today's health system faces several problems characterized by four overlapping transitions: demand, expectations, funding and health resources. These transitions engender significant pressures on the system itself. Additionally, fragmentation of the health system creates disparities in access to services and generates problems in terms of efficiency and use of available resources. To address these complications and to improve equity in access and efficiency, thorough analysis is required in how the right to access health care should be established at a constitutional level without differentiating across population groups. This should be followed by careful discussion about what rules of health care financing should exist, which set of interventions ought to be covered and how services must be organized to meet the health needs of the population.

Incentives for solar energy in industry

NASA Astrophysics Data System (ADS)

Bergeron, K. D.

1981-05-01

Several issues are analyzed on the effects that government subsidies and other incentives have on the use of solar energy in industry, as well as on other capital-intensive alternative energy supplies. Discounted cash flow analysis is used to compare tax deductions for fuel expenses with tax credits for capital investments for energy. The result is a simple expression for tax equity. The effects that market penetration of solar energy has on conventional energy prices are analyzed with a free market model. It is shown that net costs of a subsidy program to the society can be significantly reduced by price. Several government loan guarantee concepts are evaluated as incentives that may not require direct outlays of government funds; their relative effectiveness in achieving loan leverage through project financing, and their cost and practicality, are discussed.

Status review and prospects for solar industrial process heat (SIPH)

NASA Astrophysics Data System (ADS)

Kreith, F.; Davenport, R.; Feustel, J.

1983-11-01

Solar energy systems and components are presently available for industrial process hot air, hot water, and steam applications at temperatures up to about 300 C. Systems capable of operating at temperatures up to about 1000 C are approaching commercialization. A careful matching of the characteristics of the solar system and the industrial process in question has been found by field tests to be an important determinant of the amount of useful energy that can be delivered. While the thermal performance of solar collectors is not expected to improve significantly, better manufacturing, plumbing, and installation techniques may reduce both system and delivered energy costs significantly. Tax credits for solar installations, together with limited partnership financing, can offset the high initial cost of solar energy systems and provide equity between solar and fossil-fueled systems.

A comparison of the capital structures of nonprofit and proprietary health care organizations.

PubMed

Trussel, John

2012-01-01

The relative amount of debt used by an organization is an important determination of the organization's likelihood of financial problems and its cost of capital. This study addresses whether or not there are any differences between proprietary and nonprofit health care organizations in terms of capital structure. Controlling for profitability, risk, growth, and size, analysis of covariance is used to determine whether or not proprietary and nonprofit health care organizations use the same amount of leverage in their capital structures. The results indicate that there is no difference in the amount of leverage between the two institutional types. Although nonprofit and proprietary organizations have unique financing mechanisms, these differences do not impact the relative amount of debt and equity in their capital structures.

Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review.

PubMed

Akl, Elie A; El-Jardali, Fadi; Bou Karroum, Lama; El-Eid, Jamale; Brax, Hneine; Akik, Chaza; Osman, Mona; Hassan, Ghayda; Itani, Mira; Farha, Aida; Pottie, Kevin; Oliver, Sandy

2015-01-01

Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field.

Minding the gaps: health financing, universal health coverage and gender

PubMed Central

Witter, Sophie; Govender, Veloshnee; Ravindran, TK Sundari; Yates, Robert

2017-01-01

Abstract In a webinar in 2015 on health financing and gender, the question was raised why we need to focus on gender, given that a well-functioning system moving towards Universal Health Coverage (UHC) will automatically be equitable and gender balanced. This article provides a reflection on this question from a panel of health financing and gender experts. We trace the evidence of how health-financing reforms have impacted gender and health access through a general literature review and a more detailed case-study of India. We find that unless explicit attention is paid to gender and its intersectionality with other social stratifications, through explicit protection and careful linking of benefits to needs of target populations (e.g. poor women, unemployed men, female-headed households), movement towards UHC can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity. Political trade-offs are made on the road to UHC and the needs of less powerful groups, which can include women and children, are not necessarily given priority. We identify the need for closer collaboration between health economists and gender experts, and highlight a number of research gaps in this field which should be addressed. While some aspects of cost sharing and some analysis of expenditure on maternal and child health have been analysed from a gender perspective, there is a much richer set of research questions to be explored to guide policy making. Given the political nature of UHC decisions, political economy as well as technical research should be prioritized. We conclude that countries should adopt an equitable approach towards achieving UHC and, therefore, prioritize high-need groups and those requiring additional financial protection, in particular women and children. This constitutes the ‘progressive universalism’ advocated for by the 2013 Lancet Commission on Investing in Health. PMID:28973503

Minding the gaps: health financing, universal health coverage and gender.

PubMed

Witter, Sophie; Govender, Veloshnee; Ravindran, T K Sundari; Yates, Robert

2017-12-01

In a webinar in 2015 on health financing and gender, the question was raised why we need to focus on gender, given that a well-functioning system moving towards Universal Health Coverage (UHC) will automatically be equitable and gender balanced. This article provides a reflection on this question from a panel of health financing and gender experts.We trace the evidence of how health-financing reforms have impacted gender and health access through a general literature review and a more detailed case-study of India. We find that unless explicit attention is paid to gender and its intersectionality with other social stratifications, through explicit protection and careful linking of benefits to needs of target populations (e.g. poor women, unemployed men, female-headed households), movement towards UHC can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity. Political trade-offs are made on the road to UHC and the needs of less powerful groups, which can include women and children, are not necessarily given priority.We identify the need for closer collaboration between health economists and gender experts, and highlight a number of research gaps in this field which should be addressed. While some aspects of cost sharing and some analysis of expenditure on maternal and child health have been analysed from a gender perspective, there is a much richer set of research questions to be explored to guide policy making. Given the political nature of UHC decisions, political economy as well as technical research should be prioritized.We conclude that countries should adopt an equitable approach towards achieving UHC and, therefore, prioritize high-need groups and those requiring additional financial protection, in particular women and children. This constitutes the 'progressive universalism' advocated for by the 2013 Lancet Commission on Investing in Health. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review

PubMed Central

Akl, Elie A.; El-Jardali, Fadi; Bou Karroum, Lama; El-Eid, Jamale; Brax, Hneine; Akik, Chaza; Osman, Mona; Hassan, Ghayda; Itani, Mira; Farha, Aida; Pottie, Kevin; Oliver, Sandy

2015-01-01

Background Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. Methods We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. Results Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. Conclusion This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field. PMID:26332670

Distributive justice in American healthcare: institutions, power, and the equitable care of patients.

PubMed

Putsch, Robert W; Pololi, Linda

2004-09-01

The authors argue that the American healthcare system has developed in a fashion that permits and may support ongoing, widespread inequities based on poverty, race, gender, and ethnicity. Institutional structures also contribute to this problem. Analysis is based on (1) discussions of a group of experts convened by the Office of Minority Health, US Department of Health and Human Services at a conference to address healthcare disparities; and (2) review of documentation and scientific literature focused on health, health-related news, language, healthcare financing, and the law. Institutional factors contributing to inequity include the cost and financing of American healthcare, healthcare insurance principles such as mutual aid versus actuarial fairness, and institutional power. Additional causes for inequity are bias in decision making by healthcare practitioners, clinical training environments linked to abuse of patients and coworkers, healthcare provider ethnicity, and politics. Recommendations include establishment of core attributes of trust, relationship and advocacy in health systems; universal healthcare; and insurance systems based on mutual aid. In addition, monitoring of equity in health services and the development of a set of ethical principles to guide systems change and rule setting would provide a foundation for distributive justice in healthcare. Additionally, training centers should model the behaviors they seek to foster and be accountable to the communities they serve.

Economic policy, intergenerational equity, and the Social Security Trust Fund buildup.

PubMed

Hambor, J C

1987-10-01

For the next 75 years, the Old-Age, Survivors, and Disability Insurance (OASDI) system is projected to be close to in balance, on average. For approximately the next 40 years, under current projections, the combined OASDI Trust Fund is expected to continually have excesses of income over outgo, creating a buildup that will peak in 2030 at about +12 1/2 trillion (roughly 23 percent of the gross national product). Thereafter, the system is projected to be in annual deficit continually until the trust fund is exhausted in 2051. This article focuses on two fundamental issues that must be understood if the potential economic consequences of this buildup are to be evaluated properly. The first issue deals with the fact that the nature of Federal economic policy during the buildup period will determine the ultimate economic impact of the buildup. The second issue concerns the effect of the buildup, and its disposition, on the Social Security program's treatment of one generation of workers compared with another. If a fund is actually accumulated as projected, part of the retirement benefits of the "baby-boom" generation will, in effect, be self-financed. If, however, that fund is used for other purposes--directly or indirectly--future cohorts of workers will be required to fully finance benefits promised to the baby-boom retirees.

Rotavirus vaccines contribute towards universal health coverage in a mixed public-private healthcare system.

PubMed

Loganathan, Tharani; Jit, Mark; Hutubessy, Raymond; Ng, Chiu-Wan; Lee, Way-Seah; Verguet, Stéphane

2016-11-01

To evaluate rotavirus vaccination in Malaysia from the household's perspective. The extended cost-effectiveness analysis (ECEA) framework quantifies the broader value of universal vaccination starting with non-health benefits such as financial risk protection and equity. These dimensions better enable decision-makers to evaluate policy on the public finance of health programmes. The incidence, health service utilisation and household expenditure related to rotavirus gastroenteritis according to national income quintiles were obtained from local data sources. Multiple birth cohorts were distributed into income quintiles and followed from birth over the first five years of life in a multicohort, static model. We found that the rich pay more out of pocket (OOP) than the poor, as the rich use more expensive private care. OOP payments among the poorest although small are high as a proportion of household income. Rotavirus vaccination results in substantial reduction in rotavirus episodes and expenditure and provides financial risk protection to all income groups. Poverty reduction benefits are concentrated amongst the poorest two income quintiles. We propose that universal vaccination complements health financing reforms in strengthening Universal Health Coverage (UHC). ECEA provides an important tool to understand the implications of vaccination for UHC, beyond traditional considerations of economic efficiency. © 2016 John Wiley & Sons Ltd.

Implementing differential pricing for essential medicines via country-specific bilateral negotiated discounts.

PubMed

Tetteh, Ebenezer Kwabena

2009-01-01

It is widely acknowledged that limited access to essential medicines undermines efforts at improving the health and economic well-being of low-income populations. This has spurred on a number of solutions, including differential pricing based on the economics of price discrimination. A desirable feature of differential pricing is its potential ability to reconcile static and dynamic efficiency concerns. There are, however, various shades of differential pricing and this paper aims to evaluate their consistency with economic theory. Starting with the report of the workshop on 'Differential Pricing and Financing of Essential Drugs' held by secretariats of the World Trade Organization and WHO in Hosbjor, Norway, in 2001, this paper takes issue with how differential pricing has been defined as a tool for improving access to essential drug benefits. The paper notes that inadequate attention has been given to policies and institutional arrangements for creating, expressing and maintaining 'truly' price-elastic demands in low-income nations and for segmenting markets. In addition, considerations of equity and solidarity have distracted policy advocates from balancing conflicting, yet well intended, views and general rules. The paper argues why differential pricing should be implemented via country-specific bilateral negotiated discounts. It maintains that it is feasible to muster an environment conducive to profitable differential pricing whilst satisfying general rules and concerns about self-reliance, transparency, accountability, equity and solidarity.

Financing strategies to improve essential public health equalization and its effects in China.

PubMed

Yang, Li; Sun, Li; Wen, Liankui; Zhang, Huyang; Li, Chenyang; Hanson, Kara; Fang, Hai

2016-12-01

In 2009, China launched a health reform to promote the equalization of national essential public health services package (NEPHSP). The present study aimed to describe the financing strategies and mechanisms to improve access to public health for all, identify the strengths and weaknesses of the different approaches, and showed evidence on equity improvement among different regions. We reviewed the relevant literatures and identified 208 articles after screening and quality assessment and conducted six key informants' interviews. Secondary data on national and local government health expenditures, NEPHSP coverage and health indicators in 2003-2014 were collected, descriptive and equity analyses were used. Before 2009, the government subsidy to primary care institutions (PCIs) were mainly used for basic construction and a small part of personnel expenses. Since 2009, the new funds for NEPHSP have significantly expanded service coverage and population coverage. These funds have been allocated by central, provincial, municipal and county governments at different proportions in China's tax distribution system. Due to the fiscal transfer payment, the Central Government allocated more subsides to less-developed western regions and all the funds were managed in a specific account. Several types of payment methods have been adopted including capitation, pay for performance (P4P), pay for service items, global budget and public health voucher, to address issues from both the supply and demand sides. The equalization of NEPHSP did well through the establishment of health records, systematic care of children and maternal women, etc. Our data showed that the gap between the eastern, central and western regions narrowed. However the coverage for migrants was still low and performance was needed improving in effectiveness of managing patients with chronic diseases. The delivery of essential public health services was highly influenced by public fiscal policy, and the implementation of health reform since 2009 has led the public health development towards the right direction. However China still needs to increase the fiscal investments to expand service coverage as well as promote the quality of public health services and equality among regions. Independent scientific monitoring and evaluation are also needed.

Political decision-making in health care: the Dutch case.

PubMed

Elsinga, E

1989-01-01

In many western countries health care is a subject of increasing importance on the political agenda. Issues such as aging, development of medical technologies, equity and efficiency of care, increasing costs, market elements, etc. are leading to a review of existing health care systems. In The Netherlands the government has proposed fundamental changes in the structure and financing of care, based on a report by the so-called Dekker Committee. The final result of a step-wise process of change should be the introduction of a new insurance scheme and the strengthening of market elements. After a short description of the government proposals, this article gives an analysis of the process of decision-making for a restructuring of health care in the Netherlands. The analysis is based on a bureaupolitical model, as originally described by Allison.

Business strategy and financial structure: an empirical analysis of acute care hospitals.

PubMed

Ginn, G O; Young, G J; Beekun, R I

1995-01-01

This study investigated the relationship between business strategy and financial structure in the U.S. hospital industry. We studied two dimensions of financial structure--liquidity and leverage. Liquidity was assessed by the acid ratio, and leverage was assessed using the equity funding ratio. Drawing from managerial, finance, and resource dependence perspectives, we developed and tested hypotheses about the relationship between Miles and Snow strategy types and financial structure. Relevant contextual financial and organizational variables were controlled for statistically through the Multivariate Analysis of Covariance technique. The relationship between business strategy and financial structure was found to be significant. Among the Miles and Snow strategy types, defenders were found to have relatively high liquidity and low leverage. Prospectors typically had low liquidity and high leverage. Implications for financial planning, competitive assessment, and reimbursement policy are discussed.

Addressing Social Determinants Of Health Through Medical-Legal Partnerships.

PubMed

Regenstein, Marsha; Trott, Jennifer; Williamson, Alanna; Theiss, Joanna

2018-03-01

The US health care system needs effective tools to address complex social and environmental issues that perpetuate health inequities, such as food insecurity, education and employment barriers, and substandard housing conditions. The medical-legal partnership is a collaborative intervention that embeds civil legal aid professionals in health care settings to address seemingly intractable social problems that contribute to poor health outcomes and health disparities. More than three hundred health care organizations are home to medical-legal partnerships. This article draws upon national survey data and field research to identify three models of the medical-legal partnership that health care organizations have adopted and the core elements of infrastructure that they share. Financing and commitment from health care organizations are key considerations for sustaining and scaling up the medical-legal partnership as a health equity intervention.

Analysis of alternative strategies for energy conservation in new buildings

NASA Astrophysics Data System (ADS)

Fang, J. M.; Tawil, J.

1980-12-01

The policy instruments considered include: greater reliance on market forces; research and development; information, education and demonstration programs; tax incentives and sanctions; mortgage and finance programs; and regulations and standards. The analysis starts with an explanation of the barriers to energy conservation in the residential and commercial sectors. Individual policy instruments are described and evaluated with respect to energy conservation, economic efficiency, equity, political impacts, and implementation and other transitional impacts. Five possible strategies are identified: (1) increased reliance on the market place; (2) energy consumption tax and supply subsidies; (3) Building Energy Performance Standards (BEPS) with no sanctions and no incentives; (4) BEPS with sanctions and incentives (price control); and (5) BEPS with sanctions and incentives (no price controls). A comparative analysis is performed. Elements are proposed for inclusion in a comprehensive strategy for conservation in new buildings.

International Impacts of Global Climate Change: Testimony to House Appropriations Subcommittee on Foreign Operations, Export Financing and Related Programs

DOE R&D Accomplishments Database

Fulkerson, W.; Cushman, R. M.; Marland, G.; Rayner, S.

1989-02-21

International impacts of global climate change are those for which the important consequences arise because of national sovereignty. Such impacts could be of two types: (1) migrations across national borders of people, of resources (such as agricultural productivity, or surface water, or natural ecosystems), of effluents, or of patterns of commerce; and (2) changes to the way nations use and manage their resources, particularly fossil fuels and forests, as a consequence of international concern over the global climate. Actions by a few resource-dominant nations may affect the fate of all. These two types of international impacts raise complex equity issues because one nation may perceive itself as gaining at the expense of its neighbors, or it may perceive itself as a victim of the actions of others.

An exploratory study on equity in funding allocation for essential medicines and health supplies in Uganda's public sector.

PubMed

Kusemererwa, Donna; Alban, Anita; Obua, Ocwa Thomas; Trap, Birna

2016-08-30

To ascertain equity in financing for essential medicines and health supplies (EMHS) in Uganda, this paper explores the relationships among government funding allocations for EMHS, patient load, and medicines availability across facilities at different levels of care. We collected data on EMHS allocations and availability of selected vital medicines from 43 purposively sampled hospitals and the highest level health centers (HC IV), 44 randomly selected lower-level health facilities (HC II, III), and from over 400 facility health information system records and National Medical Stores records. The data were analyzed to determine allocations per patient within and across levels of care and the effects of allocations on product availability. EMHS funding allocations per patient varied widely within facilities at the same level, and allocations per patient between levels overlapped considerably. For example, HC IV allocations per patient ranged from US$0.25 to US$2.14 (1:9 ratio of lowest to highest allocation), and over 75 % of HC IV facilities had the same or lower average allocation per patient than HC III facilities. Overall, 43 % of all the facilities had optimal stock levels, 27 % were understocked, and 30 % were overstocked. Using simulations, we reduced the ratio between the highest and lowest allocations per patient within a level of care to less than two and eliminated the overlap in allocation per patient between levels. Inequity in EMHS allocation is demonstrated by the wide range of funding allocations per patient and the corresponding disparities in medicines availability. We show that using patient load to calculate EMHS allocations has the potential to improve equity significantly. However, more research in this area is urgently needed. The article does not report any results of human participants. It is implemented in collaboration with the Uganda's Ministry of Health, Pharmacy Division.

Fairness in healthcare finance and delivery: what about Tunisia?

PubMed

Abu-Zaineh, Mohammad; Arfa, Chokri; Ventelou, Bruno; Ben Romdhane, Habiba; Moatti, Jean-Paul

2014-07-01

Anecdotal evidence on hidden inequity in health care in North African countries abounds. Yet firm empirical evidence has been harder to come by. This article fills the gap. It presents the first analysis of equity in the healthcare system using the particular case of Tunisia. Analyses are based on an unusually rich source of data taken from the Tunisian HealthCare Utilization and Morbidity Survey. Payments for health care are derived from the total amount of healthcare spending which was incurred by households over the last year. Utilization of health care is measured by the number of physical units of two types of services: outpatient and inpatient. The measurement of need for health care is apprehended through a rich set of ill-health indicators and demographics. Findings are presented and compared at both the aggregate level, using the general summary index approach, and the disaggregate level, using the distribution-free stochastic dominance approach. The overall picture is that direct out-of-pocket payments, which constitute a sizeable share in the current financing mix, emerge to be a progressive means of financing health care overall. Interestingly, however, when statistical testing is applied at the disaggregate level progressivity is retained over the top half of the distribution. Further analyses of the distributions of need for--and utilization of--two types of health care--outpatient and inpatient--reveal that the observed progressivity is rather an outcome of the heavy use, but not need, for health care at the higher income levels. Several policy relevant factors are discussed, and some recommendations are advanced for future reforms of the health care in Tunisia. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Imagining Global Health with Justice: In Defense of the Right to Health.

PubMed

Friedman, Eric A; Gostin, Lawrence O

2015-12-01

The singular message in Global Health Law is that we must strive to achieve global health with justice--improved population health, with a fairer distribution of benefits of good health. Global health entails ensuring the conditions of good health--public health, universal health coverage, and the social determinants of health--while justice requires closing today’s vast domestic and global health inequities. These conditions for good health should be incorporated into public policy, supplemented by specific actions to overcome barriers to equity. A new global health treaty grounded in the right to health and aimed at health equity--a Framework Convention on Global Health (FCGH)--stands out for its possibilities in helping to achieve global health with justice. This far-reaching legal instrument would establish minimum standards for universal health coverage and public health measures, with an accompanying national and international financing framework, require a constant focus on health equity, promote Health in All Policies and global governance for health, and advance the principles of good governance, including accountability. While achieving an FCGH is certainly ambitious, it is a struggle worth the efforts of us all. The treaty’s basis in the right to health, which has been agreed to by all governments, has powerful potential to form the foundation of global governance for health. From interpretations of UN treaty bodies to judgments of national courts, the right to health is now sufficiently articulated to serve this role, with the individual’s right to health best understood as a function of a social, political, and economic environment aimed at equity. However great the political challenge of securing state agreement to the FCGH, it is possible. States have joined other treaties with significant resource requirements and limitations on their sovereignty without significant reciprocal benefits from other states, while important state interests would benefit from the FCGH. And from integrating the FCGH into the existing human rights system to creative forms of compliance and enforcement and strengthened domestic legal and political accountability mechanisms, the treaty stands to improve right to health compliance. The potential for the FCGH to bring the right to health nearer universal reality calls for us to embark on the journey towards securing this global treaty.

Patterns of Health Expenditures and Financial Protections in Vietnam 1992-2012.

PubMed

Hoang, Van Minh; Oh, Juhwan; Tran, Tuan Anh; Tran, Thi Giang Huong; Ha, Anh Duc; Luu, Ngoc Hoat; Nguyen, Thi Kim Phuong

2015-11-01

Health financing has been considered as an important building block of a health system and has a key role in promoting universal health coverage in the Vietnam. This paper aims to describe the pattern of health expenditure, including total health expenditure and composition of health expenditure, over the last two decades in Vietnam. The paper mainly uses the data from Vietnam National Health Account and Vietnam Living Standards Survey. We also included data from other relevant published literature, reports and statistics about health care expenditure in Vietnam. The per capita health expenditure in Vietnam increased from US$ 14 in 1995 to US$ 86 in 2012. The total health expenditure as a share of GDP also rose from 5.2% in 1995 to 6.9% in 2012. Public health expenditure as percentage of government expenditure rose from 7.4% in 1995 to nearly 10% in 2012. The coverage of health insurance went up from 10% in 1995 to 68.5% in 2012. However, health financing in Vietnam was depending on private expenditures (57.4% in 2012). As a result, the proportion of households with catastrophic expenditure in 2012 was 4.2%. The rate of impoverishment in 2012 was 2.5%. To ensure equity and efficient goal of health system, policy actions for containing the health care out-of-pocket payments and their poverty impacts are urgently needed in Vietnam.

[Social protection in Latin America and the Caribbean: changes, contradictions, and limits].

PubMed

Viana, Ana Luiza d'Avila; Fonseca, Ana Maria Medeiros da; Silva, Hudson Pacifico da

2017-07-27

Recent studies suggest that governments in the majority of Latin American and Caribbean countries were able to expand social investments and introduce innovations in social protection policies in the last two decades with positive results in the actions' coverage and impact. However, the restrictions imposed by the current fiscal crisis and the rise of governments more ideologically aligned with the neoliberal discourse in various countries in the region point to a new retreat of the state from the social area, thereby compromising recent advances. The article aims to discuss the changes, contradictions, and limits of recent social protection standards in Latin America and the Caribbean. The discussion includes three items: a description of the history of social protection in the region, seeking to identify its principal historical periods and characteristics (benefits, target public, and financing); the social protection models that have been implemented in the region; and the specific case of health. We argue that although countries have adopted different solutions in the field of social protection, the policies' hybrid nature (with extensive private sector participation in the financing, supply, and management of services) and the prevalence of segmented models (with differential access according to individuals' social status) have been predominant traits in social protection in Latin America and the Caribbean, thus limiting the possibilities for greater equity and social justice.

Increasing stress on disaster risk finance due to large floods

NASA Astrophysics Data System (ADS)

Jongman, Brenden; Hochrainer-Stigler, Stefan; Feyen, Luc; Aerts, Jeroen; Mechler, Reinhard; Botzen, Wouter; Bouwer, Laurens; Pflug, Georg; Rojas, Rodrigo; Ward, Philip

2014-05-01

Recent major flood disasters have shown that single extreme events can affect multiple countries simultaneously, which puts high pressure on trans-national risk reduction and risk transfer mechanisms. To date, little is known about such flood hazard interdependencies across regions, and the corresponding joint risks at regional to continental scales. Reliable information on correlated loss probabilities is crucial for developing robust insurance schemes and public adaptation funds, and for enhancing our understanding of climate change impacts. Here we show that extreme discharges are strongly correlated across European river basins and that these correlations can, or should, be used in national to continental scale risk assessment. We present probabilistic trends in continental flood risk, and demonstrate that currently observed extreme flood losses could more than double in frequency by 2050 under future climate change and socioeconomic development. The results demonstrate that accounting for tail dependencies leads to higher estimates of extreme losses than estimates based on the traditional assumption of independence between basins. We suggest that risk management for these increasing losses is largely feasible, and we demonstrate that risk can be shared by expanding risk transfer financing, reduced by investing in flood protection, or absorbed by enhanced solidarity between countries. We conclude that these measures have vastly different efficiency, equity and acceptability implications, which need to be taken into account in broader consultation, for which our analysis provides a basis.

Financing Strategies For A Nuclear Fuel Cycle Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

David Shropshire; Sharon Chandler

2006-07-01

To help meet the nation’s energy needs, recycling of partially used nuclear fuel is required to close the nuclear fuel cycle, but implementing this step will require considerable investment. This report evaluates financing scenarios for integrating recycling facilities into the nuclear fuel cycle. A range of options from fully government owned to fully private owned were evaluated using DPL (Decision Programming Language 6.0), which can systematically optimize outcomes based on user-defined criteria (e.g., lowest lifecycle cost, lowest unit cost). This evaluation concludes that the lowest unit costs and lifetime costs are found for a fully government-owned financing strategy, due tomore » government forgiveness of debt as sunk costs. However, this does not mean that the facilities should necessarily be constructed and operated by the government. The costs for hybrid combinations of public and private (commercial) financed options can compete under some circumstances with the costs of the government option. This analysis shows that commercial operations have potential to be economical, but there is presently no incentive for private industry involvement. The Nuclear Waste Policy Act (NWPA) currently establishes government ownership of partially used commercial nuclear fuel. In addition, the recently announced Global Nuclear Energy Partnership (GNEP) suggests fuels from several countries will be recycled in the United States as part of an international governmental agreement; this also assumes government ownership. Overwhelmingly, uncertainty in annual facility capacity led to the greatest variations in unit costs necessary for recovery of operating and capital expenditures; the ability to determine annual capacity will be a driving factor in setting unit costs. For private ventures, the costs of capital, especially equity interest rates, dominate the balance sheet; and the annual operating costs, forgiveness of debt, and overnight costs dominate the costs computed for the government case. The uncertainty in operations, leading to lower than optimal processing rates (or annual plant throughput), is the most detrimental issue to achieving low unit costs. Conversely, lowering debt interest rates and the required return on investments can reduce costs for private industry.« less

Does the private sector receive an excessive return from investments in health care infrastructure projects? Evidence from the UK.

PubMed

Vecchi, Veronica; Hellowell, Mark; Gatti, Stefano

2013-05-01

This paper is concerned with the cost-efficiency of Private Finance Initiatives (PFIs) in the delivery of hospital facilities in the UK. We outline a methodology for identifying the "fair" return on equity, based on the Weighted Average Cost of Capital (WACC) of each investor. We apply this method to assess the expected returns on a sample of 77 contracts signed between 1997 and 2011 by health care provider organisations in the UK. We show that expected returns are in general in excess of the WACC benchmarks. The findings highlight significant problems in current procurement practices and the methodologies by which bids are assessed. To minimise the financial impact of hospital investments on health care systems, a regulatory regime must ensure that expected returns are set at the "fair" rate. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Women and social security: social policy adjusts to social change.

PubMed

Kahne, H

1981-01-01

Women age sixty-five and over now constitute about three fifths of the elderly population. They live longer than men and over time that longevity gap is increasing. Yet their income in later years is woefully inadequate. Poverty status is greater for elderly women than for elderly men; over half of aged women in poverty are widows. This paper describes the social security program, the cornerstone of our retirement income, and the lack of congruence of its provisions with contemporary social roles of women. It analyzes alternative proposals of two-tier, double decker and homemaker benefits, and earnings sharing, and their possible impact on women's economic status. It recommends improvements for this transition period while more basic structural reform is under discussion. Reform based on societal consensus could increase equity of treatment and adequacy of benefits for women. It is an essential prelude to consideration of long range financing needs of social security.

A Review of Literature to Understand the Complexity of Equity, Ethics and Management for Achieving Public Health Goals in India

PubMed Central

Garg, Pankaj; Nagpal, Jitender

2014-01-01

In the context of inadequate public spending on health care in India (0.9% of the GDP); government liberalized its policies in the form of subsidized lands and tax incentives, resulting in the mushrooming of private hospitals and clinics in India. Paradoxically, a robust framework was not developed for the regulation of these health care providers, resulting in disorganized health sector, inadequate financing models, and lack of prioritization of services, as well as a sub-optimal achievement of the Millennium Development Goals (MDG). We systematically reviewed the evidence base regarding regulation of private hospitals, applicability of private-public mix, state of health insurance and effective policy development for India, while seeking lessons on regulation of private health systems, from South African (a developing country) and Australian (a developed country) health care systems. PMID:24701465

Equity in specialist waiting times by socioeconomic groups: evidence from Spain.

PubMed

Abásolo, Ignacio; Negrín-Hernández, Miguel A; Pinilla, Jaime

2014-04-01

In countries with publicly financed health care systems, waiting time--rather than price--is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients' socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients' reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.

Having it all: national benefit equity and local payment parity in Medicare.

PubMed

Dowd, Bryan; Feldman, Roger

2002-01-01

The Medicare Payment Advisory Commission (MedPAC) has identified two important problems with the Medicare+Choice (M+C) program: nationwide geographic inequity in government-financed benefits, and unequal government payments for M+C plans versus fee-for-service (FFS) Medicare in the same market area. MedPAC concludes that both problems cannot be solved simultaneously. We argue that both problems could be solved if Congress discontinued its policy of underwriting the cost of FFS Medicare. Instead, Congress should define a national entitlement benefit package and have all health plans submit bids on the package in each market area. The government's premium contribution should be equal to the lowest bid submitted by a qualified health plan in each market area. The contribution could be adjusted for health risk, the special obligations of FFS Medicare, and welfare enhancements associated with FFS Medicare that are valued by both beneficiaries and taxpayers but unrelated to beneficiaries' health status.

76 FR 58849 - Legg Mason Partners Equity Trust, et al.;

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-22

...] Legg Mason Partners Equity Trust, et al.; Notice of Application September 15, 2011. AGENCY: Securities... Trust (``LMP Equity Trust''), Legg Mason Partners Variable Equity Trust (``LMP Variable Equity Trust'' and together with LMP Equity Trust, the ``Trusts''), Legg Mason Partners Fund Advisor, LLC (``LMPFA...

Protocol for the development of a CONSORT-equity guideline to improve reporting of health equity in randomized trials.

PubMed

Welch, Vivian; Jull, J; Petkovic, J; Armstrong, R; Boyer, Y; Cuervo, L G; Edwards, Sjl; Lydiatt, A; Gough, D; Grimshaw, J; Kristjansson, E; Mbuagbaw, L; McGowan, J; Moher, D; Pantoja, T; Petticrew, M; Pottie, K; Rader, T; Shea, B; Taljaard, M; Waters, E; Weijer, C; Wells, G A; White, H; Whitehead, M; Tugwell, P

2015-10-21

Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT). A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying "equity-relevant trials," (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension. This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies.

Equity in the delivery of community healthcare to older people: findings from 10/66 Dementia Research Group cross-sectional surveys in Latin America, China, India and Nigeria

PubMed Central

2011-01-01

Background To describe patterns of recent health service utilisation, and consequent out-of-pocket expenses among older people in countries with low and middle incomes, and to assess the equity with which services are accessed and delivered. Methods 17,944 people aged 65 years and over were assessed in one-phase population-based cross-sectional surveys in geographically-defined catchment areas in nine countries - urban and rural sites in China, India, Mexico and Peru, urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and a rural site in Nigeria. The main outcome was use of community health care services in the past 3 months. Independent associations were estimated with indicators of need (dementia, depression, physical impairments), predisposing factors (age, sex, and education), and enabling factors (household assets, pension receipt and health insurance) using Poisson regression to generate prevalence ratios and fixed effects meta-analysis to combine them. Results The proportion using healthcare services varied from 6% to 82% among sites. Number of physical impairments (pooled prevalence ratio 1.37, 95% CI 1.26-1.49) and ICD-10 depressive episode (pooled PR 1.21, 95% CI 1.07-1.38) were associated with service use, but dementia was inversely associated (pooled PR 0.93, 95% CI 0.90-0.97). Other correlates were female sex, higher education, more household assets, receiving a pension, and health insurance. Standardisation for age, sex, physical impairments, depression and dementia did not explain variation in service use. There was a strong borderline significant ecological correlation between the proportion of consultations requiring out-of-pocket costs and the prevalence of health service use (r = -0.50, p = 0.09). Conclusions While there was little evidence of ageism, inequity was apparent in the independent enabling effects of education and health insurance cover, the latter particularly in sites where out-of-pocket expenses were common, and private health insurance an important component of healthcare financing. Variation in service use among sites was most plausibly accounted for by stark differences in the extent of out-of-pocket expenses, and the ability of older people and their families to afford them. Health systems that finance medical services through out-of-pocket payments risk excluding the poorest older people, those without a secure regular income, and the uninsured. PMID:21711546

Equity in the delivery of community healthcare to older people: findings from 10/66 Dementia Research Group cross-sectional surveys in Latin America, China, India and Nigeria.

PubMed

Albanese, Emiliano; Liu, Zhaorui; Acosta, Daisy; Guerra, Mariella; Huang, Yueqin; Jacob, K S; Jimenez-Velazquez, Ivonne Z; Llibre Rodriguez, Juan J; Salas, Aquiles; Sosa, Ana L; Uwakwe, Richard; Williams, Joseph D; Borges, Guilherme; Jotheeswaran, A T; Klibanski, Milagros G; McCrone, Paul; Ferri, Cleusa P; Prince, Martin J

2011-06-28

To describe patterns of recent health service utilisation, and consequent out-of-pocket expenses among older people in countries with low and middle incomes, and to assess the equity with which services are accessed and delivered. 17,944 people aged 65 years and over were assessed in one-phase population-based cross-sectional surveys in geographically-defined catchment areas in nine countries - urban and rural sites in China, India, Mexico and Peru, urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and a rural site in Nigeria. The main outcome was use of community health care services in the past 3 months. Independent associations were estimated with indicators of need (dementia, depression, physical impairments), predisposing factors (age, sex, and education), and enabling factors (household assets, pension receipt and health insurance) using Poisson regression to generate prevalence ratios and fixed effects meta-analysis to combine them. The proportion using healthcare services varied from 6% to 82% among sites. Number of physical impairments (pooled prevalence ratio 1.37, 95% CI 1.26-1.49) and ICD-10 depressive episode (pooled PR 1.21, 95% CI 1.07-1.38) were associated with service use, but dementia was inversely associated (pooled PR 0.93, 95% CI 0.90-0.97). Other correlates were female sex, higher education, more household assets, receiving a pension, and health insurance. Standardisation for age, sex, physical impairments, depression and dementia did not explain variation in service use. There was a strong borderline significant ecological correlation between the proportion of consultations requiring out-of-pocket costs and the prevalence of health service use (r = -0.50, p = 0.09). While there was little evidence of ageism, inequity was apparent in the independent enabling effects of education and health insurance cover, the latter particularly in sites where out-of-pocket expenses were common, and private health insurance an important component of healthcare financing. Variation in service use among sites was most plausibly accounted for by stark differences in the extent of out-of-pocket expenses, and the ability of older people and their families to afford them. Health systems that finance medical services through out-of-pocket payments risk excluding the poorest older people, those without a secure regular income, and the uninsured.

Equity Index in the School Systems of Selected OECD Countries

ERIC Educational Resources Information Center

Ozmusul, Mustafa

2013-01-01

The purpose of this study is to analysis the equity in the school systems of selected OECD countries. For this purpose, the international data for selected OECD countries was analyzed in terms of four dimensions of equity as learning equity, school resource equity, participating in education, and digital equity. When analyzing data, the equity…

Examining Equity Sensitivity: An Investigation Using the Big Five and HEXACO Models of Personality.

PubMed

Woodley, Hayden J R; Bourdage, Joshua S; Ogunfowora, Babatunde; Nguyen, Brenda

2015-01-01

The construct of equity sensitivity describes an individual's preference about his/her desired input to outcome ratio. Individuals high on equity sensitivity tend to be more input oriented, and are often called "Benevolents." Individuals low on equity sensitivity are more outcome oriented, and are described as "Entitleds." Given that equity sensitivity has often been described as a trait, the purpose of the present study was to examine major personality correlates of equity sensitivity, so as to inform both the nature of equity sensitivity, and the potential processes through which certain broad personality traits may relate to outcomes. We examined the personality correlates of equity sensitivity across three studies (total N = 1170), two personality models (i.e., the Big Five and HEXACO), the two most common measures of equity sensitivity (i.e., the Equity Preference Questionnaire and Equity Sensitivity Inventory), and using both self and peer reports of personality (in Study 3). Although results varied somewhat across samples, the personality variables of Conscientiousness and Honesty-Humility, followed by Agreeableness, were the most robust predictors of equity sensitivity. Individuals higher on these traits were more likely to be Benevolents, whereas those lower on these traits were more likely to be Entitleds. Although some associations between Extraversion, Openness, and Neuroticism and equity sensitivity were observed, these were generally not robust. Overall, it appears that there are several prominent personality variables underlying equity sensitivity, and that the addition of the HEXACO model's dimension of Honesty-Humility substantially contributes to our understanding of equity sensitivity.

Examining Equity Sensitivity: An Investigation Using the Big Five and HEXACO Models of Personality

PubMed Central

Woodley, Hayden J. R.; Bourdage, Joshua S.; Ogunfowora, Babatunde; Nguyen, Brenda

2016-01-01

The construct of equity sensitivity describes an individual's preference about his/her desired input to outcome ratio. Individuals high on equity sensitivity tend to be more input oriented, and are often called “Benevolents.” Individuals low on equity sensitivity are more outcome oriented, and are described as “Entitleds.” Given that equity sensitivity has often been described as a trait, the purpose of the present study was to examine major personality correlates of equity sensitivity, so as to inform both the nature of equity sensitivity, and the potential processes through which certain broad personality traits may relate to outcomes. We examined the personality correlates of equity sensitivity across three studies (total N = 1170), two personality models (i.e., the Big Five and HEXACO), the two most common measures of equity sensitivity (i.e., the Equity Preference Questionnaire and Equity Sensitivity Inventory), and using both self and peer reports of personality (in Study 3). Although results varied somewhat across samples, the personality variables of Conscientiousness and Honesty-Humility, followed by Agreeableness, were the most robust predictors of equity sensitivity. Individuals higher on these traits were more likely to be Benevolents, whereas those lower on these traits were more likely to be Entitleds. Although some associations between Extraversion, Openness, and Neuroticism and equity sensitivity were observed, these were generally not robust. Overall, it appears that there are several prominent personality variables underlying equity sensitivity, and that the addition of the HEXACO model's dimension of Honesty-Humility substantially contributes to our understanding of equity sensitivity. PMID:26779102

Personality correlates of equity sensitivity for samples of Canadian, Bulgarian, and Mexican business people.

PubMed

Mintu-Wimsatt, Alma; Madjourova-Davri, Anna; Lozada, Héctor R

2008-02-01

Equity sensitivity concerns perceptions of what is or is not equitable. Previous studies have shown that equity sensitivity is associated with one's relationship orientation. Relationships are also influenced by personality variables. As both personality and equity sensitivity influence relationships, equity sensitivity and personality may be correlated also; so, this study examined that possibility. The relations of equity sensitivity with 3 personality variables were explored across three culturally different samples. This allowed validation across cultures of the proposed equity-personality relationship which has traditionally been assessed in a U.S. setting. In general, personality-equity sensitivity relationship was not supported across the samples.

Financial Burden of Cancer Clinical Trial Participation and the Impact of a Cancer Care Equity Program

PubMed Central

Lee, Hang; Powell, Elizabeth; Birrer, Nicole E.; Poles, Emily; Finkelstein, Daniel; Winkfield, Karen; Percac-Lima, Sanja; Chabner, Bruce; Moy, Beverly

2016-01-01

Introduction. Cancer clinical trial (CT) participation rates are low and financial barriers likely play a role. We implemented a cancer care equity program (CCEP) to address financial burden associated with trial participation. We sought to examine the impact of the CCEP on CT enrollment and to assess barriers to participation. Methods. We used an interrupted time series design to determine trends in CT enrollment before and after CCEP implementation. Linear regression models compared trial enrollment before and after the CCEP. We also compared patient characteristics before and after the CCEP and between CCEP and non-CCEP participants. We surveyed CCEP and non-CCEP participants to compare pre-enrollment financial barriers. Results. After accounting for increased trial availability and the trends in accrual for prior years, we found that enrollment increased after CCEP implementation (18.97 participants per month greater than expected; p < .001). A greater proportion of CCEP participants were younger, female, in phase I trials, lived farther away, had lower incomes, and had metastatic disease. Of 87 participants who completed the financial barriers survey, 49 CCEP and 38 matched, non-CCEP participants responded (63% response rate). CCEP participants were more likely to report concerns regarding finances (56% vs. 11%), medical costs (47% vs. 14%), travel (69% vs. 11%), lodging (60% vs. 9%), and insurance coverage (43% vs. 14%) related to trial participation (all p < .01). Conclusion. CT participation increased following implementation of the CCEP and the program enrolled patients experiencing greater financial burden. These findings highlight the need to address the financial burden associated with CT participation. Implications for Practice: Financial barriers likely discourage patients from participating in clinical trials. Implementation of a cancer care equity program (CCEP) seeking to reduce financial barriers by assisting with travel and lodging costs was associated with increased trial accrual. The CCEP provided assistance to patients particularly in need, including those living farther away, those with lower incomes, and those reporting financial barriers related to trial participation. These findings suggest that financial concerns represent a major barrier to patient participation in clinical trials and underscore the importance of efforts to address these concerns. PMID:26975867

Financial Burden of Cancer Clinical Trial Participation and the Impact of a Cancer Care Equity Program.

PubMed

Nipp, Ryan D; Lee, Hang; Powell, Elizabeth; Birrer, Nicole E; Poles, Emily; Finkelstein, Daniel; Winkfield, Karen; Percac-Lima, Sanja; Chabner, Bruce; Moy, Beverly

2016-04-01

Cancer clinical trial (CT) participation rates are low and financial barriers likely play a role. We implemented a cancer care equity program (CCEP) to address financial burden associated with trial participation. We sought to examine the impact of the CCEP on CT enrollment and to assess barriers to participation. We used an interrupted time series design to determine trends in CT enrollment before and after CCEP implementation. Linear regression models compared trial enrollment before and after the CCEP. We also compared patient characteristics before and after the CCEP and between CCEP and non-CCEP participants. We surveyed CCEP and non-CCEP participants to compare pre-enrollment financial barriers. After accounting for increased trial availability and the trends in accrual for prior years, we found that enrollment increased after CCEP implementation (18.97 participants per month greater than expected; p < .001). A greater proportion of CCEP participants were younger, female, in phase I trials, lived farther away, had lower incomes, and had metastatic disease. Of 87 participants who completed the financial barriers survey, 49 CCEP and 38 matched, non-CCEP participants responded (63% response rate). CCEP participants were more likely to report concerns regarding finances (56% vs. 11%), medical costs (47% vs. 14%), travel (69% vs. 11%), lodging (60% vs. 9%), and insurance coverage (43% vs. 14%) related to trial participation (all p < .01). CT participation increased following implementation of the CCEP and the program enrolled patients experiencing greater financial burden. These findings highlight the need to address the financial burden associated with CT participation. Financial barriers likely discourage patients from participating in clinical trials. Implementation of a cancer care equity program (CCEP) seeking to reduce financial barriers by assisting with travel and lodging costs was associated with increased trial accrual. The CCEP provided assistance to patients particularly in need, including those living farther away, those with lower incomes, and those reporting financial barriers related to trial participation. These findings suggest that financial concerns represent a major barrier to patient participation in clinical trials and underscore the importance of efforts to address these concerns. ©AlphaMed Press.

Income-related inequity in the use of GP services by children: a comparison of Ireland and Scotland.

PubMed

Layte, Richard; Nolan, Anne

2015-06-01

Equity of access to health care is a key component of national and international health policy, with most countries subscribing to the principle that health care should be allocated on the basis of need, rather than ability to pay or other criteria. The issue of health care entitlements for children is particularly pertinent given the strong causal links that have been demonstrated between eligibility for free care, utilisation and health outcomes. The Irish health care system is unusual in requiring the majority of the population to pay the full out-of-pocket cost of GP care. In contrast, all Scottish residents are entitled to free GP care at the point of use. This difference in public health care entitlements between Ireland and Scotland allows us to examine the impact of differences in financing structures on equity in GP care. In this paper, we use data from two nationally representative surveys of children in Ireland and Scotland to examine the degree of income-related inequity in the utilisation of GP services in both countries. We find that while the distribution of GP care is significantly pro-poor in Ireland, even after adjustment for health need, there is little or no significant inequity in GP utilisation among Scottish children. However, focusing just on children who pay the full price of GP care in Ireland, we find some evidence for a significant pro-rich distribution of GP visits. These results reflect the particular structure of health care entitlements that exist in two systems.

Value acceleration: lessons from private-equity masters.

PubMed

Rogers, Paul; Holland, Tom; Haas, Dan

2002-06-01

The most successful private-equity firms regularly spearhead dramatic business transformations, creating exceptional returns for their investors. To understand how those firms do it, the authors studied more than 2,000 PE transactions over the past ten years and discovered that the top performers' success stems from the rigor with which they manage their businesses. This article describes the four management disciplines vital to the success of the best PE firms. First, for each business, they define an investment thesis: a brief, clear statement of how to make the business more valuable within three to five years. The thesis, which guides all actions by the company, usually focuses on growth. PE firms know that the demonstration of a path to strong growth produces the big returns on investment. Second, they don't measure too much. They zero in on a few financial indicators that most clearly reveal the business's progress in increasing its value. They watch cash more closely than earnings and tailor performance measures to each business, rather than imposing one set of measures across their entire portfolio. Third, they work their balance sheets, mining undervalued assets, turning fixed assets into sources of financing, and aggressively managing their physical capital. Last, they make the center the shareholder. Corporate staffs in PE firms make unsentimental investment decisions, buying and selling businesses when the price is right and bringing in new management when performance falters. These firms also keep their corporate centers extremely lean. By adopting these four disciplines, executives at public companies should be able to reap significantly greater returns from their own business units.

Task-sharing or public finance for the expansion of surgical access in rural Ethiopia: an extended cost-effectiveness analysis.

PubMed

Shrime, Mark G; Verguet, Stéphane; Johansson, Kjell Arne; Desalegn, Dawit; Jamison, Dean T; Kruk, Margaret E

2016-07-01

Despite a high burden of surgical disease, access to surgical services in low- and middle-income countries is often limited. In line with the World Health Organization's current focus on universal health coverage and equitable access to care, we examined how policies to expand access to surgery in rural Ethiopia would impact health, impoverishment and equity. An extended cost-effectiveness analysis was performed. Deterministic and stochastic models of surgery in rural Ethiopia were constructed, utilizing pooled estimates of costs and probabilities from national surveys and published literature. Model calibration and validation were performed against published estimates, with sensitivity analyses on model assumptions to check for robustness. Outcomes of interest were the number of deaths averted, the number of cases of poverty averted and the number of cases of catastrophic expenditure averted for each policy, divided across wealth quintiles. Health benefits, financial risk protection and equity appear to be in tension in the expansion of access to surgical care in rural Ethiopia. Health benefits from each of the examined policies accrued primarily to the poor. However, without travel vouchers, many policies also induced impoverishment in the poor while providing financial risk protection to the rich, calling into question the equitable distribution of benefits by these policies. Adding travel vouchers removed the impoverishing effects of a policy but decreased the health benefit that could be bought per dollar spent. These results were robust to sensitivity analyses. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

The Danish health care system: it ain't broke... so don't fix it.

PubMed

Mooney, Gavin

2002-02-01

The organisation and financing of the Danish health care system was evaluated within a framework of analysis of strengths, weaknesses, opportunities and threats (a SWOT analysis) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a 1 week-visit to health care authorities, providers and key persons. This paper includes the main findings by one of the panel members. The international competition 'wave' passed by Denmark, and the Danish might rightly say 'thank goodness'. Funding is very largely public and there is a single dominant authority, i.e. the county, which makes planning easier. Low levels of patient payments and the smaller size of the private sector reflect Danish 'solidarity' and promote equity. Planning is good. Exceptions to this are the over-concern with hospital waiting lists and the flirting with DRG based funding. Greater investment in planning approaches would make the system yet better. The GP blended remuneration system with capitation and fee for service is a major strength. The fact that the system has such potential for technical and allocative efficiency and also equity but is not fully exploited suggests the need for more investment in health services research. While there is scope for improving the health care system in Denmark, the rest of the world has as much to learn from the Danes as the Danes have from the rest of the world.

Health equity in humanitarian emergencies: a role for evidence aid.

PubMed

Pottie, Kevin

2015-02-01

Humanitarian emergencies require a range of planned and coordinated actions: security, healthcare, and, as this article highlights, health equity responses. Health equity is an evidence-based science that aims to address unfair and unjust health inequality outcomes. New approaches are using health equity to guide the development of community programs, equity methods are being used to identify disadvantaged groups that may face health inequities in a humanitarian emergency, and equity is being used to prevent unintended harms and consequences in interventions. Limitations to health equity approaches include acquiring sufficient data to make equity interpretations, integrating disadvantage populations in to the equity approach, and ensuring buy-in from decision-makers. This article uses examples from World Health Organization, Refugee Health Guidelines and Health Impact Assessment to demonstrate the emerging role for health equity in humanitarian emergencies. It is based on a presentation at the Evidence Aid Symposium, on 20 September 2014, at Hyderabad, India. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

Equity trade-offs in conservation decision making.

PubMed

Law, Elizabeth A; Bennett, Nathan J; Ives, Christopher D; Friedman, Rachel; Davis, Katrina J; Archibald, Carla; Wilson, Kerrie A

2018-04-01

Conservation decisions increasingly involve multiple environmental and social objectives, which result in complex decision contexts with high potential for trade-offs. Improving social equity is one such objective that is often considered an enabler of successful outcomes and a virtuous ideal in itself. Despite its idealized importance in conservation policy, social equity is often highly simplified or ill-defined and is applied uncritically. What constitutes equitable outcomes and processes is highly normative and subject to ethical deliberation. Different ethical frameworks may lead to different conceptions of equity through alternative perspectives of what is good or right. This can lead to different and potentially conflicting equity objectives in practice. We promote a more transparent, nuanced, and pluralistic conceptualization of equity in conservation decision making that particularly recognizes where multidimensional equity objectives may conflict. To help identify and mitigate ethical conflicts and avoid cases of good intentions producing bad outcomes, we encourage a more analytical incorporation of equity into conservation decision making particularly during mechanistic integration of equity objectives. We recommend that in conservation planning motivations and objectives for equity be made explicit within the problem context, methods used to incorporate equity objectives be applied with respect to stated objectives, and, should objectives dictate, evaluation of equity outcomes and adaptation of strategies be employed during policy implementation. © 2017 Society for Conservation Biology.

Modelling the affordability and distributional implications of future health care financing options in South Africa.

PubMed

McIntyre, Di; Ataguba, John E

2012-03-01

South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. Modelling the resource and revenue generation requirements of alternative reform options is critical to inform decision-making. This paper considers three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependents with the remainder using tax-funded services; and maintaining the status quo. Each scenario was modelled over a 15-year period using a spreadsheet model. Statistical analyses were also undertaken to evaluate the impact of options on the distribution of health care financing burden and benefits from using health services across socio-economic groups. Universal coverage would result in total health care spending levels equivalent to 8.6% of gross domestic product (GDP), which is comparable to current spending levels. It is lower than the status quo option (9.5% of GDP) and far lower than the option of expanding private insurance cover (over 13% of GDP). However, public funding of health services would have to increase substantially. Despite this, universal coverage would result in the most progressive financing system if the additional public funding requirements are generated through a surcharge on taxable income (but not if VAT is increased). The extended private insurance scheme option would be the least progressive and would impose a very high payment burden; total health care payments on average would be 10.7% of household consumption expenditure compared with the universal coverage (6.7%) and status quo (7.5%) options. The least pro-rich distribution of service benefits would be achieved under universal coverage. Universal coverage is affordable and would promote health system equity, but needs careful design to ensure its long-term sustainability.

Essays in public economics

NASA Astrophysics Data System (ADS)

Seligman, Jason Scott

2002-01-01

Three essays in the field of public economics are included in this thesis. Chapter 1 begins this work with an introduction to public economics and places the remaining chapters in context. Like all economic agents, the government must manage its cash position. Chapter 2 considers this activity. Short-term financial requirements cause the government to solicit the market for bills not previously scheduled (Cash Management Bills). Using data from the US Treasury's Proprietary Domestic Finance Database, this chapter shows that these bills have higher costs than normal bills, suggesting that both Treasury and financial markets appreciate that demand is more inelastic for these instruments. In addition, this research identifies several factors that increase finance costs for Treasury in meeting short-term financial need. Chapter 3 explores location choices for generation investment in a re-regulated electricity market. Recently, there have been significant changes in the regulation of electricity in the State of California. These changes may affect generation investment behavior within the State, an important consideration for policy makers. This work identifies the impact of public sector regulatory change on private sector investment outcomes, by comparing the location and scope of electricity generation projects before and after two specific regulatory changes in air quality management and transmission tariff charges, while controlling for expected population growth patterns within the State. Significant changes in location preference are identified using factors for the northern and southern transmission zones, NP15 and SP15, the intermediate zone ZP26, and for areas outside of ISO control. Chapter 4 considers Disability Insurance and individual public pension investment accounts. Current debate on the Social Security Administration's long-term finance of benefits includes proposals for independent private investment via individual accounts. The author investigates what implications disability might have for account balances. A behavioral model is developed to consider incentives for early retirement when a defined benefit program for disability insurance continues to be available. The included simulation uses historic wage series, historic equity market performance, and current OASDI regulations.

The effect of performance-based financing on illness, care-seeking and treatment among children: an impact evaluation in Rwanda.

PubMed

Skiles, Martha Priedeman; Curtis, Siân L; Basinga, Paulin; Angeles, Gustavo; Thirumurthy, Harsha

2015-09-14

Performance-based financing (PBF) strategies are promoted as a supply-side, results-based financing mechanism to improve primary health care. This study estimated the effects of Rwanda's PBF program on less-incentivized child health services and examined the differential program impact by household poverty. Districts were allocated to intervention and comparison for PBF implementation in Rwanda. Using Demographic Health Survey data from 2005 to 2007-08, a community-level panel dataset of 5781 children less than 5 years of age from intervention and comparison districts was created. The impacts of PBF on reported childhood illness, facility care-seeking, and treatment received were estimated using a difference-in-differences model with community fixed effects. An interaction term between poverty and the program was estimated to identify the differential effect of PBF among children from poorer families. There was no measurable difference in estimated probability of reporting illness with diarrhea, fever or acute respiratory infections between the intervention and comparison groups. Seeking care at a facility for these illnesses increased over time, however no differential effect by PBF was seen. The estimated effect of PBF on receipt of treatment for poor children is 45 percentage points higher (p = 0.047) compared to the non-poor children seeking care for diarrhea or fever. PBF, a supply-side incentive program, improved the quality of treatment received by poor children conditional on patients seeking care, but it did not impact the propensity to seek care. These findings provide additional evidence that PBF incentivizes the critical role staff play in assuring quality services, but does little to influence consumer demand for these services. Efforts to improve child health need to address both supply and demand, with additional attention to barriers due to poverty if equity in service use is a concern.

Poverty and access to health care in developing countries.

PubMed

Peters, David H; Garg, Anu; Bloom, Gerry; Walker, Damian G; Brieger, William R; Rahman, M Hafizur

2008-01-01

People in poor countries tend to have less access to health services than those in better-off countries, and within countries, the poor have less access to health services. This article documents disparities in access to health services in low- and middle-income countries (LMICs), using a framework incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services. Whereas the poor in LMICs are consistently at a disadvantage in each of the dimensions of access and their determinants, this need not be the case. Many different approaches are shown to improve access to the poor, using targeted or universal approaches, engaging government, nongovernmental, or commercial organizations, and pursuing a wide variety of strategies to finance and organize services. Key ingredients of success include concerted efforts to reach the poor, engaging communities and disadvantaged people, encouraging local adaptation, and careful monitoring of effects on the poor. Yet governments in LMICs rarely focus on the poor in their policies or the implementation or monitoring of health service strategies. There are also new innovations in financing, delivery, and regulation of health services that hold promise for improving access to the poor, such as the use of health equity funds, conditional cash transfers, and coproduction and regulation of health services. The challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for in ways that demonstrate improvements in access by the poor.

Household financial contribution to the health System in Shiraz, Iran in 2012.

PubMed

Kavosi, Zahra; Keshtkaran, Ali; Hayati, Ramin; Ravangard, Ramin; Khammarnia, Mohammad

2014-10-01

One common challenge to social systems is achieving equity in financial contributions and preventing financial loss. Because of the large and unpredictable nature of some costs, achieving this goal in the health system presents important and unique problems. The present study investigated the Household Financial Contributions (HFCs) to the health system. The study investigated 800 households in Shiraz. The study sample size was selected using stratified sampling and cluster sampling in the urban and rural regions, respectively. The data was collected using the household section of the World Health Survey (WHS) questionnaire. Catastrophic health expenditures were calculated based on the ability of the household to pay and the reasons for the catastrophic health expenditures by a household were specified using logistic regression. The results showed that the fairness financial contribution index was 0.6 and that 14.2% of households were faced with catastrophic health expenditures. Logistic regression analysis revealed that household economic status, the basic and supplementary insurance status of the head of the household, existence of individuals in the household who require chronic medical care, use of dental and hospital care, rural location of residences, frequency of use of outpatient services, and Out-of-Pocket (OOP) payment for physician visits were effective factors for determining the likelihood of experiencing catastrophic health expenditure. It appears that the current method of health financing in Iran does not adequately protect households against catastrophic health expenditure. Consequently, it is essential to reform healthcare financing.

Confronting the Equity "Learning Problem" through Practitioner Inquiry

ERIC Educational Resources Information Center

Ching, Cheryl D.

2018-01-01

This study examined how participation in an inquiry-based workshop on assessing course syllabi for equity-mindedness and cultural inclusivity fostered community college math faculty learning about racial/ethnic equity and equity-mindedness. Findings show that the workshop prompted reflection on what equity means and how participants' teaching…

GRADE equity guidelines 4: considering health equity in GRADE guideline development: evidence to decision process.

PubMed

Pottie, Kevin; Welch, Vivian; Morton, Rachael; Akl, Elie A; Eslava-Schmalbach, Javier H; Katikireddi, Vittal; Singh, Jasvinder; Moja, Lorenzo; Lang, Eddy; Magrini, Nicola; Thabane, Lehana; Stanev, Roger; Matovinovic, Elizabeth; Snellman, Alexandra; Briel, Matthias; Shea, Beverly; Tugwell, Peter; Schunemann, Holger; Guyatt, Gordon; Alonso-Coello, Pablo

2017-10-01

The aim of this paper is to provide detailed guidance on how to incorporate health equity within the GRADE (Grading Recommendations Assessment and Development Evidence) evidence to decision process. We developed this guidance based on the GRADE evidence to decision framework, iteratively reviewing and modifying draft documents, in person discussion of project group members and input from other GRADE members. Considering the impact on health equity may be required, both in general guidelines and guidelines that focus on disadvantaged populations. We suggest two approaches to incorporate equity considerations: (1) assessing the potential impact of interventions on equity and (2) incorporating equity considerations when judging or weighing each of the evidence to decision criteria. We provide guidance and include illustrative examples. Guideline panels should consider the impact of recommendations on health equity with attention to remote and underserviced settings and disadvantaged populations. Guideline panels may wish to incorporate equity judgments across the evidence to decision framework. This is the fourth and final paper in a series about considering equity in the GRADE guideline development process. This series is coming from the GRADE equity subgroup. Copyright © 2017 Elsevier Inc. All rights reserved.

A Racial Equity Toolkit for Midwifery Organizations.

PubMed

Gordon, Wendy M

2016-11-01

Midwifery associations are increasing awareness and commitment to racial equity in the profession and in the communities we serve. Moving these commitments from words into action may be facilitated by a racial equity toolkit to help guide midwifery organizations to consider all policies, initiatives, and actions with a racial equity lens. Racial equity impact analyses have been used in recent years by various governmental agencies in the United States and abroad with positive results, and emerging literature indicates that nonprofit organizations are having similarly positive results. This article proposes a framework for midwifery organizations to incorporate a racial equity toolkit, starting with explicit intentions of the organization with regard to racial equity in the profession. Indicators of success are elucidated as the next step, followed by the use of a racial equity impact analysis worksheet. This worksheet is applied by teams or committees when considering new policies or initiatives to examine those actions through a racial equity lens. An organizational change team and equity advisory groups are essential in assisting organizational leadership to forecast potential negative and positive impacts. Examples of the components of a midwifery-specific racial equity toolkit are included. © 2016 by the American College of Nurse-Midwives.