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…

Reform towards National Health Insurance in Malaysia: the equity implications.

PubMed

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

2011-05-01

This paper assesses the potential equity impact of Malaysia's projected reform of its current tax financed system towards National Health Insurance (NHI). The Kakwani's progressivity index was used to assess the equity consequences of the new NHI system (with flat rate NHI scheme) compared to the current tax financed system. It was also used to model a proposed system (with a progressive NHI scheme) that can generate the same amount of funding more equitably. The new NHI system would be less equitable than the current tax financed system, as evident from the reduction of Kakwani's index to 0.168 from 0.217. The new flat rate NHI scheme, if implemented, would reduce the progressivity of the health finance system because it is a less progressive finance source than that of general government revenue. We proposed a system with a progressive NHI scheme that generates the same amount of funding whilst preserving the equity at the Kakwani's progressivity index of 0.213. A NHI system with a progressive NHI scheme is proposed to be implemented to raise health funding whilst preserving the equity in health care financing. Copyright © 2010 Elsevier Ireland 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.

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.

78 FR 46661 - Self-Regulatory Organizations; New York Stock Exchange LLC; NYSE MKT LLC; Order Instituting...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-01

..., Lecturer in Management, London School of Economics and Yuval Millo, Professor of Social Studies of Finance... promote just and equitable principles of trade, and would be in the public interest.\\22\\ According to this... and manipulative acts and practices, to promote just and equitable principles of trade, to remove...

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…

Equity in health care financing: The case of Malaysia.

PubMed

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

2008-06-09

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. 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. 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 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). 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.

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.

State of the States '92: Bridging Troubled Finance Waters. Proceedings of the Fiscal Issues, Policy, and Education Finance Special Interest Group of the American Educational Research Association (San Francisco, California, April 20-24, 1992).

ERIC Educational Resources Information Center

Westbrook, Kathleen C., Ed.

This document contains the proceedings of presentations made by the Fiscal Issues, Policy and Education Finance Special Interest Group of the American Education Research Association (AERA). Ten articles focus on equitable funding systems for K-12 education and examine school financing in the following states: Florida, Illinois, New York,…

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.

Vermont's Act 60: Comprehensive School Finance Reform--Effects in the First Year of Full Implementation.

ERIC Educational Resources Information Center

Mathis, William J.; Fleming, Brenda L.

Vermont's Act 60 received national attention not only because of the controversy surrounding the sharing pool (or recapture provision) but also because of its "potential for being the most equitable system in the country." For fiscal years 1998 to 2001, tax rates have become more equitable, and a direct relationship has appeared between…

The Purpose of the Cataloging for Matters of Equitable Access: Spanish-Language Cataloging and "Everyday" Approaches of Non-Native English Speakers

ERIC Educational Resources Information Center

Adamich, Tom

2009-01-01

While teacher-librarians embrace the concept of equitable access when they select "multicultural" materials to include in their collections, plan special programs, and teach lessons on a variety of topics, what do they do to make equitable access a part of their online catalogs? Have they achieved (or nearly achieved) a consistent level of…

13 CFR 107.730 - Financings which constitute conflicts of interest.

Code of Federal Regulations, 2010 CFR

2010-01-01

... interests (including potential interests), of at least five percent. (2) Other Financings with Associates... were) fair and equitable to you, taking into account any differences in the timing of each party's... direct or indirect financial interest in the Portfolio Concern that exceeds, or has the potential to...

13 CFR 107.730 - Financings which constitute conflicts of interest.

Code of Federal Regulations, 2012 CFR

2012-01-01

... interests (including potential interests), of at least five percent. (2) Other Financings with Associates... were) fair and equitable to you, taking into account any differences in the timing of each party's... direct or indirect financial interest in the Portfolio Concern that exceeds, or has the potential to...

Educational Adequacy Litigation in the American South: 1973-2009

ERIC Educational Resources Information Center

Dishman, Mike; Redish, Traci

2010-01-01

Prior to the United States Supreme Court's decision in "Brown v. Board of Education" (1954), educational finance litigation focused almost entirely on the equitable distribution of state educational financing, ending preferential disbursement of state funds. This ended in 1973, with the United States Supreme Court's decision in "San…

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…

How to do (or not to do) … a health financing incidence analysis

PubMed Central

Asante, Augustine D; Limwattananon, Supon; Wiseman, Virginia

2018-01-01

Abstract Financing incidence analysis (FIA) assesses how the burden of health financing is distributed in relation to household ability to pay (ATP). In a progressive financing system, poorer households contribute a smaller proportion of their ATP to finance health services compared to richer households. A system is regressive when the poor contribute proportionately more. Equitable health financing is often associated with progressivity. To conduct a comprehensive FIA, detailed household survey data containing reliable information on both a cardinal measure of household ATP and variables for extracting contributions to health services via taxes, health insurance and out-of-pocket (OOP) payments are required. Further, data on health financing mix are needed to assess overall FIA. Two major approaches to conducting FIA described in this article include the structural progressivity approach that assesses how the share of ATP (e.g. income) spent on health services varies by quantiles, and the effective progressivity approach that uses indices of progressivity such as the Kakwani index. This article provides some detailed practical steps for analysts to conduct FIA. This includes the data requirements, data sources, how to extract or estimate health payments from survey data and the methods for assessing FIA. It also discusses data deficiencies that are common in many low- and middle-income countries (LMICs). The results of FIA are useful in designing policies to achieve an equitable health system. PMID:29346547

How to do (or not to do) … a health financing incidence analysis.

PubMed

Ataguba, John E; Asante, Augustine D; Limwattananon, Supon; Wiseman, Virginia

2018-04-01

Financing incidence analysis (FIA) assesses how the burden of health financing is distributed in relation to household ability to pay (ATP). In a progressive financing system, poorer households contribute a smaller proportion of their ATP to finance health services compared to richer households. A system is regressive when the poor contribute proportionately more. Equitable health financing is often associated with progressivity. To conduct a comprehensive FIA, detailed household survey data containing reliable information on both a cardinal measure of household ATP and variables for extracting contributions to health services via taxes, health insurance and out-of-pocket (OOP) payments are required. Further, data on health financing mix are needed to assess overall FIA. Two major approaches to conducting FIA described in this article include the structural progressivity approach that assesses how the share of ATP (e.g. income) spent on health services varies by quantiles, and the effective progressivity approach that uses indices of progressivity such as the Kakwani index. This article provides some detailed practical steps for analysts to conduct FIA. This includes the data requirements, data sources, how to extract or estimate health payments from survey data and the methods for assessing FIA. It also discusses data deficiencies that are common in many low- and middle-income countries (LMICs). The results of FIA are useful in designing policies to achieve an equitable health system.

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…

GPE's Engagement on Domestic Financing for Education. Policy Brief

ERIC Educational Resources Information Center

Martinez, Raphaelle; Terway, Arushi

2016-01-01

The Global Partnership for Education (GPE) is a global, multi-stakeholder partnership that seeks to strengthen education systems in low- and lower-middle-income countries and in countries affected by fragility and conflict to ensure equitable, quality education for all. GPE plays a unique role in helping governments to develop and finance the…

Reflections from the GPE Financing Conference in Dakar: A Model of Education Diplomacy

ERIC Educational Resources Information Center

Golden, April Michelle

2018-01-01

Providing inclusive and equitable quality education for all children will require sustained cooperation and investment from donor and partner nations worldwide. As a multi-stakeholder funding mechanism, the Global Partnership for Education (GPE) is an important Education Diplomacy model. The 2018 Dakar Financing Conference is a vibrant…

Funding Nebraska's Schools: Toward a More Rational and Equitable School Finance System for the 1990s. Final Report of the Nebraska School Financing Review Commission to the State Legislature.

ERIC Educational Resources Information Center

Nebraska Legislative Council, Lincoln. Legislative Research Div.

This final report of the Nebraska School Financing Review Commission includes the following items: (1) an examination of the role of income as a revenue source and indicator of wealth; (2) investigation of ways to reduce reliance on property tax for school support; and (3) consideration of alternate state aid distribution formulas. Also included…

Progressivity of health care financing and incidence of service benefits in Ghana.

PubMed

Akazili, James; Garshong, Bertha; Aikins, Moses; Gyapong, John; McIntyre, Di

2012-03-01

The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.

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

Getting beyond the Facts: Reforming California School Finance. Issue Brief

ERIC Educational Resources Information Center

Bersin, Alan; Kirst, Michael W.; Liu, Goodwin

2008-01-01

California's school finance system is long overdue for reform. The authors propose a new system that is more rational, more equitable, and, they believe, politically feasible. At its core, their proposal aims to link district revenue to student needs and regional costs while ensuring that all districts are held harmless at current funding levels.…

Gaps in Capacity in Primary Care in Low-Resource Settings for Implementation of Essential Noncommunicable Disease Interventions

PubMed Central

Mendis, S.; Al Bashir, Igbal; Dissanayake, Lanka; Varghese, Cherian; Fadhil, Ibtihal; Marhe, Esha; Sambo, Boureima; Mehta, Firdosi; Elsayad, Hind; Sow, Idrisa; Algoe, Maltie; Tennakoon, Herbert; Truong, Lai Die; Lan, Le Thi Tuyet; Huiuinato, Dismond; Hewageegana, Neelamni; Fahal, Naiema A. W.; Mebrhatu, Goitom; Tshering, Gado; Chestnov, Oleg

2012-01-01

Objective. The objective was to evaluate the capacity of primary care (PC) facilities to implement basic interventions for prevention and management of major noncommunicable diseases (NCDs), including cardiovascular diseases and diabetes. Methods. A cross-sectional survey was done in eight low- and middle-income countries (Benin, Bhutan, Eritrea, Sri Lanka, Sudan, Suriname, Syria, and Vietnam) in 90 PC facilities randomly selected. The survey included questions on the availability of human resources, equipment, infrastructure, medicines, utilization of services, financing, medical information, and referral systems. Results and Conclusions. Major deficits were identified in health financing, access to basic technologies and medicines, medical information systems, and the health workforce. The study has provided the foundation for strengthening PC to address noncommunicable diseases. There are important implications of the findings of this study for all low- and middle-income countries as capacity of PC is fundamental for equitable prevention and control of NCDs. PMID:23251789

Problems facing Korean hospitals and possible countermeasures.

PubMed

Kim, Kwang-Tae

2004-07-01

Korea has a unique health care system, of which the private sector comprises most of the country's health resources: 88% of the beds and 91% of specialists in Korea, but are funded by public financing, such as national health insurance and the national aid program. However, the public financing pays only 50% of actual costs and the patient's co-payment is still high. Healthcare organizations in Korea are categorized into four types; tertiary care hospitals, general hospitals, hospitals and clinics by scale of operator: number of beds. General hospitals must have 100 beds and over, and compulsorily specialties in internal medicine, surgery, obstetrics-gynecology, pediatrics, dental service, other ancillary service units and an emergency care unit. General hospitals with 300 beds and more must operate an intensive care unit. There are many challenges facing the Korean healthcare system, such as reformation of primary healthcare system, enhancing hospitals' competitiveness, and permission of for-profit hospital, introduction of private health insurance, enhancement of geriatric care. These challenges can be resolved with long-term vision, willingness and strategies of the Korean government to ensure equitable financing and access to healthcare, combined with the active participation and utilization of the private sector.

Private health insurance and access to healthcare.

PubMed

Duggal, Ravi

2011-01-01

The health insurance business in India has seen a growth of over 25% per annum in the last few years with the expansion of the private health insurance sector. The premium incomes of health insurance have crossed the Rs 8,000 crore mark with the share of private companies increasing to over 41%. This is despite the fact that from the perspective of patients, health insurance is not a good deal, especially when they need it most. This raises a number of ethical issues regarding how the health insurance business runs and how medical practice adjusts to it for profiteering. This article uses the personal experience of the author to argue that health insurance in an unregulated environment can only lead to unethical practices, further victimising the patient. Further, publicly financed healthcare which operates in an environment regulating both public and private healthcare provisioning is the only way to assure access to ethical and equitable healthcare to people.

Paying for and receiving benefits from health services in South Africa: is the health system equitable?

PubMed

Ataguba, John E; McIntyre, Di

2012-03-01

There is a global challenge for health systems to ensure equity in both the delivery and financing of health care. However, many African countries still do not have equitable health systems. Traditionally, equity in the delivery and the financing of health care are assessed separately, in what may be termed 'partial' analyses. The current debate on countries moving toward universal health systems, however, requires a holistic understanding of equity in both the delivery and the financing of health care. The number of studies combining these aspects to date is limited, especially in Africa. An assessment of overall health system equity involves assessing health care financing in relation to the principles of contributing to financing according to ability to pay and benefiting from health services according to need for care. Currently South Africa is considering major health systems restructuring toward a universal system. This paper examines together, for both the public and the private sectors, equity in the delivery and financing of health care in South Africa. Using nationally representative datasets and standard methodologies for assessing progressivity in health care financing and benefit incidence, this paper reports an overall progressive financing system but a pro-rich distribution of health care benefits. The progressive financing system is driven mainly by progressive private medical schemes that cover a small portion of the population, mainly the rich. The distribution of health care benefits is not only pro-rich, but also not in line with the need for health care; richer groups receive a far greater share of service benefits within both public and private sectors despite having a relatively lower share of the ill-health burden. The importance of the findings for the design of a universal health system is discussed.

Access to prenatal care: inequalities in a region with high maternal mortality in southeastern Brazil.

PubMed

Martinelli, Katrini Guidolini; Santos Neto, Edson Theodoro Dos; Gama, Silvana Granado Nogueira da; Oliveira, Adauto Emmerich

2016-05-01

Aim This article aims to evaluate access to prenatal care according to the dimensions of availability, affordability and acceptability in the SUS microregion of southeastern Brazil. Methods A cross-sectional study conducted in 2012-2013 that selected 742 postpartum women in seven hospitals in the region chosen for the research. The information was collected, processed and submitted to the chi-square test and the nonparametric Spearman's test, with p-values less than 5% (p < 0.05). Results Although the SUS constitutionally guarantees universal access to health care, there are still inequalities between pregnant women from rural and urban areas in terms of the availability of health care and among families earning up to minimum wage and more than one minimum wage per month in terms of affordability; however, the acceptability of health care was equal, regardless of the modality of the health services. Conclusion The location, transport resources and financing of health services should be reorganised, and the training of health professionals should be enhanced to provide more equitable health care access to pregnant women.

Water access, water scarcity, and climate change.

PubMed

Mukheibir, Pierre

2010-05-01

This article investigates the approaches of the various discourses operating in the water sector and how they address the issues of scarcity and equitable access under projected climate change impacts. Little synergy exists between the different approaches dealing with these issues. Whilst being a sustainable development and water resources management issue, a holistic view of access, scarcity and the projected impacts of climate change is not prevalent in these discourses. The climate change discourse too does not adequately bridge the gap between these issues. The projected impacts of climate change are likely to exacerbate the problems of scarcity and equitable access unless appropriate adaptation strategies are adopted and resilience is built. The successful delivery of accessible water services under projected climate change impacts therefore lies with an extension of the adaptive water management approach to include equitable access as a key driver.

An equitable way to pay for universal coverage.

PubMed

Rasell, E

1999-01-01

This article describes a way to finance universal health care coverage that preserves much of the current financing system and replaces funds obtained from regressive sources with revenue from more progressive ones. New funding would be needed for 24 percent of health expenditures and would be raised through an increase in the federal personal income tax. Premiums are eliminated since their cost is the same to everyone regardless of income. Cost sharing and out-of-pocket spending for medically necessary services are also abolished. In a more equitably financed system, employers would pay a new payroll tax that raised the same amount of money they currently spend for employee health insurance premiums; this would require a payroll tax of about 7 percent. Revenue from an increase in federal personal income taxes would replace household out-of-pocket expenditures for medically necessary services and payments for insurance premiums. For the average, middle-income family, the tax increase would total $731 in 1998. In exchange for the tax increase, no American or American employer would need to buy health insurance or face out-of-pocket charges for any medically indicated health care.

Strong Collaborative Relationships for Strong Community Schools

ERIC Educational Resources Information Center

Daniel, Julia

2017-01-01

Community schools have gained attention as mechanisms to bring about equitable access to high-quality educational resources, extended learning time and opportunities, integrated student supports, and collaborative engaging relationships with parents and communities. In order to effectively create conditions that provide equitable access to such…

Robert E. Lamitie Series. "Research and Action Needs in Rural School Finance," by Robert E. Lamitie, a Response by Austin D. Swanson and Stephen L. Jacobson, and Comments by David H. Monk.

ERIC Educational Resources Information Center

Lamitie, Robert E.; And Others

1989-01-01

Examines research and trends related to equitable financing of rural schools, problems common to rural school districts, and an emerging "technology of individualization" that may negate any relationship between school effectiveness and school size. Commentaries discuss the value of district consolidation without school consolidation, and…

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.

Banking for health: the role of financial sector actors in investing in global health

PubMed Central

Kickbusch, Ilona; Franz, Christian; Wells, Nadya

2018-01-01

The world faces multiple health financing challenges as the global health burden evolves. Countries have set an ambitious health policy agenda for the next 15 years with prioritisation of universal health coverage under the Sustainable Development Goals. The scale of investment needed for equitable access to health services means global health is one of the key economic opportunities for decades to come. New financing partnerships with the private sector are vital. The aim of this study is to unlock additional financing sources, acknowledging the imperative to link financial returns to the providers of capital, and create profitable, sustainable financing structures. This paper outlines the global health investment opportunity exploring intersections of financial and health sector interests, and the role investment in health can play in economic development. Considering increasing demand for impact investments, the paper explores responsible financing initiatives and expansion of the global movement for sustainable capital markets. Adding an explicit health component (H) to the Environmental, Social and Governance (ESG) investment criteria, creating the ESG+H initiative, could serve as catalyst for the inclusion of health criteria into mainstream financial actors’ business practices and investment objectives. The conclusion finds that health considerations directly impact profitability of the firm and therefore should be incorporated into financial analysis. Positive assessment of health impact, at a broad societal or environmental level, as well as for a firm’s employees can become a value enhancing competitive advantage. An ESG+H framework could incorporate this into mainstream financial decision-making and into scalable investment products. PMID:29736278

Banking for health: the role of financial sector actors in investing in global health.

PubMed

Krech, Rüdiger; Kickbusch, Ilona; Franz, Christian; Wells, Nadya

2018-01-01

The world faces multiple health financing challenges as the global health burden evolves. Countries have set an ambitious health policy agenda for the next 15 years with prioritisation of universal health coverage under the Sustainable Development Goals. The scale of investment needed for equitable access to health services means global health is one of the key economic opportunities for decades to come. New financing partnerships with the private sector are vital. The aim of this study is to unlock additional financing sources, acknowledging the imperative to link financial returns to the providers of capital, and create profitable, sustainable financing structures. This paper outlines the global health investment opportunity exploring intersections of financial and health sector interests, and the role investment in health can play in economic development. Considering increasing demand for impact investments, the paper explores responsible financing initiatives and expansion of the global movement for sustainable capital markets. Adding an explicit health component (H) to the Environmental, Social and Governance (ESG) investment criteria, creating the ESG+H initiative, could serve as catalyst for the inclusion of health criteria into mainstream financial actors' business practices and investment objectives. The conclusion finds that health considerations directly impact profitability of the firm and therefore should be incorporated into financial analysis. Positive assessment of health impact, at a broad societal or environmental level, as well as for a firm's employees can become a value enhancing competitive advantage. An ESG+H framework could incorporate this into mainstream financial decision-making and into scalable investment products.

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

Transportation finance : Kentucky's structure and national trends

DOT National Transportation Integrated Search

2002-05-01

Studies state Road Fund tax structures, like studies of state General Funds, tend to focus on a state's current tax structure compared to surrounding states and identifying possible tax changes that may make a tax system simpler, more equitable, more...

Equitable Access by Design. A Conceptual Framework for Integrated Student Supports within Linked Learning Pathways

ERIC Educational Resources Information Center

de Velasco, Jorge Ruiz; Newman, Elizabeth; Borsato, Graciela

2016-01-01

This report proposes a conceptual framework for defining and implementing a system of integrated student supports that provides equitable access to college and career readiness via Linked Learning pathways in high schools. The framework emphasizes the central commitment of the Linked Learning approach to challenge prevailing norms of…

When Choice Fosters Inequality: Can Research Help?

ERIC Educational Resources Information Center

Ayscue, Jennifer B.; Siegel-Hawley, Genevieve; Woodward, Brian; Orfield, Gary

2017-01-01

The Civil Rights Project was hired to identify barriers to equitable access in Buffalo (New York) Public Schools' criteria schools and propose solutions, which, if accepted by both parties, could resolve the civil rights violations and create more equitable access to those schools. The researchers found that students of color, low-income students,…

Cost-Effective, Equitable and Flexible Higher Education through Open and Distance Learning in Bangladesh

ERIC Educational Resources Information Center

Islam, Tofazzal

2011-01-01

This paper examines how this mega-university offers increasing access to cost-effective, equitable and flexible higher education by analyzing data from primary and secondary sources, identifies challenges impacting the continued growth of enrollment in distance education, and outlines opportunities for increasing access to higher education through…

Inequities in coverage of preventive child health interventions: the rural drinking water supply program and the universal immunization program in Rajasthan, India.

PubMed

Mohan, Pavitra

2005-02-01

I assessed whether the Rural Drinking Water Supply Program (RDWSP) and the Universal Immunization Program (UIP) have achieved equitable coverage in Rajasthan, India, and explored program characteristics that affect equitable coverage of preventive health interventions. A total of 2460 children presenting at 12 primary health facilities in one district of Rajasthan were enrolled and classified into economic quartiles based on possession of assets. Immunization coverage and prime source of drinking water were compared across quartiles. A higher access to piped water by wealthier families (P< .001) was compensated by higher access to hand pumps by poorer families (P<.001), resulting in equal access to a safe source (P=.9). Immunization coverage was inequitable, favoring the wealthier children (P<.001). The RDWSP has achieved equitable coverage, while UIP coverage remains highly inequitable. Programs can make coverage more equitable by formulating explicit objectives to ensure physical access to all, promoting the intervention's demand by the poor, and enhancing the support and monitoring of frontline workers who deliver these interventions.

Design of an impact evaluation using a mixed methods model--an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi.

PubMed

Brenner, Stephan; Muula, Adamson S; Robyn, Paul Jacob; Bärnighausen, Till; Sarker, Malabika; Mathanga, Don P; Bossert, Thomas; De Allegri, Manuela

2014-04-22

In this article we present a study design to evaluate the causal impact of providing supply-side performance-based financing incentives in combination with a demand-side cash transfer component on equitable access to and quality of maternal and neonatal healthcare services. This intervention is introduced to selected emergency obstetric care facilities and catchment area populations in four districts in Malawi. We here describe and discuss our study protocol with regard to the research aims, the local implementation context, and our rationale for selecting a mixed methods explanatory design with a quasi-experimental quantitative component. The quantitative research component consists of a controlled pre- and post-test design with multiple post-test measurements. This allows us to quantitatively measure 'equitable access to healthcare services' at the community level and 'healthcare quality' at the health facility level. Guided by a theoretical framework of causal relationships, we determined a number of input, process, and output indicators to evaluate both intended and unintended effects of the intervention. Overall causal impact estimates will result from a difference-in-difference analysis comparing selected indicators across intervention and control facilities/catchment populations over time.To further explain heterogeneity of quantitatively observed effects and to understand the experiential dimensions of financial incentives on clients and providers, we designed a qualitative component in line with the overall explanatory mixed methods approach. This component consists of in-depth interviews and focus group discussions with providers, service user, non-users, and policy stakeholders. In this explanatory design comprehensive understanding of expected and unexpected effects of the intervention on both access and quality will emerge through careful triangulation at two levels: across multiple quantitative elements and across quantitative and qualitative elements. Combining a traditional quasi-experimental controlled pre- and post-test design with an explanatory mixed methods model permits an additional assessment of organizational and behavioral changes affecting complex processes. Through this impact evaluation approach, our design will not only create robust evidence measures for the outcome of interest, but also generate insights on how and why the investigated interventions produce certain intended and unintended effects and allows for a more in-depth evaluation approach.

Achieving Equitable Access to Strong Teachers: A Guide for District Leaders

ERIC Educational Resources Information Center

Bromberg, Marni

2016-01-01

The purpose of this guide is to help district leaders take on the challenge of ensuring that students have equitable access to excellent teachers. It shares some early lessons the Education Trust has learned from districts about the levers available to prioritize low-income students and students of color in teacher quality initiatives. The guide…

Financing universal coverage in Malaysia: a case study.

PubMed

Chua, Hong Teck; Cheah, Julius Chee Ho

2012-01-01

One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges.The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population.Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand preventive care, in better managing escalating healthcare costs associated with the increasing trend of non-communicable diseases. In tandem, health financing policies need to infuse the element of cost-effectiveness to better manage the purchasing of new medical supplies and equipment. Ultimately, good governance and leadership are needed to ensure adequate public spending on health and maintain the focus on the attainment of universal coverage, as well as making healthcare financing more accountable to the public, particularly in regards to inefficiencies and better utilisation of public funds and resources.

Financing Universal Coverage in Malaysia: a case study

PubMed Central

2012-01-01

One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges. The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population. Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand preventive care, in better managing escalating healthcare costs associated with the increasing trend of non-communicable diseases. In tandem, health financing policies need to infuse the element of cost-effectiveness to better manage the purchasing of new medical supplies and equipment. Ultimately, good governance and leadership are needed to ensure adequate public spending on health and maintain the focus on the attainment of universal coverage, as well as making healthcare financing more accountable to the public, particularly in regards to inefficiencies and better utilisation of public funds and resources. PMID:22992444

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.

Answering the Call for Equitable Access to Effective Teachers: Lessons Learned from State-Based Teacher Preparation Efforts in Georgia, Indiana, Michigan, New Jersey, and Ohio

ERIC Educational Resources Information Center

Woodrow Wilson National Fellowship Foundation, 2015

2015-01-01

The nation's teacher education programs are not producing the quantity or quality of teachers needed, particularly in needed subjects. The only way to ensure a strong enough pipeline of effective teachers to ensure equitable access is to dramatically increase how states are preparing prospective educators. The Woodrow Wilson National Fellowship…

Examining Deaf Students' Equitable Access to Science vis-a-vis Contemporary Pedagogical Practices

ERIC Educational Resources Information Center

Ross, Annemarie D.

2017-01-01

As a Deaf individual, it is important to ensure the growth of the Deaf community as science-literate members of society. While many predecessors have contributed to the body of research in Deaf pedagogy, there is still much to be done in safeguarding Deaf learners' equitable access to science education. One area of concern is in narrowing the…

Deriving Appropriate Educational Program Costs in Illinois.

ERIC Educational Resources Information Center

Parrish, Thomas B.; Chambers, Jay G.

This document describes the comprehensive analytical framework for school finance used by the Illinois State Board of Education to assist policymakers in their decisions about equitable distribution of state aid and appropriate levels of resources to meet the varying educational requirements of differing student populations. This framework, the…

Low Tuition, Progressive Taxation.

ERIC Educational Resources Information Center

Mingle, James R.

1992-01-01

The strategy for financing public higher education of using high tuition and student aid assumes, erroneously, that targeting subsidies directly to the needy makes a more equitable system, that the public will support the high-aid end of the equation, and that current and future students can repay debt. (MSE)

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.

How Much Tuition Should State Universities Charge?

ERIC Educational Resources Information Center

Bloustein, Edward J.

1990-01-01

Higher tuition coupled with more financial aid for those in need is more equitable than the low-tuition model where rich and poor pay the same tuition. Higher education, particularly public higher education, should be collaboratively financed by all those who benefit: federal government, the states, business, students, graduates, and families.…

48 CFR 32.608-2 - Interest credits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Interest credits. 32.608-2... REQUIREMENTS CONTRACT FINANCING Contract Debts 32.608-2 Interest credits. (a) An equitable interest credit... contract at some time during the period to which the interest charge applied, provided an interest penalty...

48 CFR 32.608-2 - Interest credits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Interest credits. 32.608-2... REQUIREMENTS CONTRACT FINANCING Contract Debts 32.608-2 Interest credits. (a) An equitable interest credit... contract at some time during the period to which the interest charge applied, provided an interest penalty...

School Finance as a Moral Dilemma

ERIC Educational Resources Information Center

Pijanowski, John C.

2017-01-01

Alternative approaches to raising funds for public schools have long been critiqued for their approach to providing an equitable and adequate distribution of educational goods. Inherent in these core concepts of fairness are ethical questions that drive how policy and practice evolve to generate revenue for the education of children. This paper…

Costs and determinants of privately financed home-based health care in Ontario, Canada.

PubMed

Guerriere, Denise N; Wong, Ada Y M; Croxford, Ruth; Leong, Vivian W; McKeever, Patricia; Coyte, Peter C

2008-03-01

The Canadian context in which home-based healthcare services are delivered is characterised by limited resources and escalating healthcare costs. As a result, a financing shift has occurred, whereby care recipients receive a mixture of publicly and privately financed home-based services. Although ensuring that care recipients receive efficient and equitable care is crucial, a limited understanding of the economic outcomes and determinants of privately financed services exists. The purposes of this study were (i) to determine costs incurred by families and the healthcare system; (ii) to assess the determinants of privately financed home-based care; and (iii) to identify whether public and private expenditures are complements or substitutes. Two hundred and fifty-eight short-term clients (<90 days of service utilisation) and 256 continuing care clients (>90 days of utilisation) were recruited from six regions across the province of Ontario, Canada, from November 2003 to August 2004. Participants were interviewed by telephone once a week for 4 weeks and asked to provide information about time and monetary costs of care, activities of daily living (ADL), and chronic conditions. The mean total cost of care for a 4-week period was $7670.67 (in 2004 Canadian dollars), with the overwhelming majority of these costs (75%) associated with private expenditures. Higher age, ADL impairment, being female, and a having four or more chronic conditions predicted higher private expenditures. While private and public expenditures were complementary, private expenditures were somewhat inelastic to changes in public expenditures. A 10% increase in public expenditures was associated with a 6% increase in private expenditures. A greater appreciation of the financing of home-based care is necessary for practitioners, health managers and policy decision-makers to ensure that critical issues such as inequalities in access to care and financial burden on care recipients and families are addressed.

Spectral partitioning in equitable graphs.

PubMed

Barucca, Paolo

2017-06-01

Graph partitioning problems emerge in a wide variety of complex systems, ranging from biology to finance, but can be rigorously analyzed and solved only for a few graph ensembles. Here, an ensemble of equitable graphs, i.e., random graphs with a block-regular structure, is studied, for which analytical results can be obtained. In particular, the spectral density of this ensemble is computed exactly for a modular and bipartite structure. Kesten-McKay's law for random regular graphs is found analytically to apply also for modular and bipartite structures when blocks are homogeneous. An exact solution to graph partitioning for two equal-sized communities is proposed and verified numerically, and a conjecture on the absence of an efficient recovery detectability transition in equitable graphs is suggested. A final discussion summarizes results and outlines their relevance for the solution of graph partitioning problems in other graph ensembles, in particular for the study of detectability thresholds and resolution limits in stochastic block models.

Spectral partitioning in equitable graphs

NASA Astrophysics Data System (ADS)

Barucca, Paolo

2017-06-01

Graph partitioning problems emerge in a wide variety of complex systems, ranging from biology to finance, but can be rigorously analyzed and solved only for a few graph ensembles. Here, an ensemble of equitable graphs, i.e., random graphs with a block-regular structure, is studied, for which analytical results can be obtained. In particular, the spectral density of this ensemble is computed exactly for a modular and bipartite structure. Kesten-McKay's law for random regular graphs is found analytically to apply also for modular and bipartite structures when blocks are homogeneous. An exact solution to graph partitioning for two equal-sized communities is proposed and verified numerically, and a conjecture on the absence of an efficient recovery detectability transition in equitable graphs is suggested. A final discussion summarizes results and outlines their relevance for the solution of graph partitioning problems in other graph ensembles, in particular for the study of detectability thresholds and resolution limits in stochastic block models.

Listening for Prescriptions: A National Consultation on Pharmaceutical Policy Issues

PubMed Central

Morgan, Steve; Cunningham, Colleen M.

2010-01-01

Objectives and Methods: Pharmaceutical policy is an increasingly costly, essential and challenging component of health system management. We sought to identify priority pharmaceutical policy issues in Canada and to translate them into research priorities using key informant interviews, stakeholder surveys and a deliberative workshop. Results: We found consensus on overarching policy goals: to provide all Canadians with equitable and sustainable access to necessary medicines. We also found widespread frustration that many key pharmaceutical policy issues in Canada — including improving prescription drug financing and pricing — have been persistent challenges owing to a lack of policy coordination. The coverage of extraordinarily costly medicines for serious conditions was identified as a rapidly emerging policy issue. Conclusion: Targeted research and knowledge translation activities can help address key policy issues and, importantly, challenges of policy coordination in Canada and thereby reduce inequity and inefficiency in policy approaches and outcomes. PMID:22043223

Case mix adjusted nursing-home reimbursement: a critical review of the evidence.

PubMed

Weissert, W G; Musliner, M C

1992-01-01

Nursing-home case mix adjusted payment systems typically base payments on estimates of patients' care needs, but to date the data on their effectiveness are ambiguous. Studies mainly show that access for patients most in need of care appears to improve under these systems. Case mix based payment systems have both positive and negative effects on quality of care and require compensating mechanisms for the potentially harmful incentives they can generate. On the positive side, nursing homes are paid more equitably; the negative aspect is reflected in higher costs, particularly for administration. A Health Care Financing Administration (HCFA) demonstration project may provide insights, but its limited number of predominantly small, rural, participating states, its tandem quality assurance system, and potentially confounding market variables may restrict the value of this project. We do not yet have the data to assess the impact of instituting case mix adjustment systems.

The international right to health: state obligations and private actors in the health care system.

PubMed

O'Brien, Paula

2013-09-01

Most health systems have historically used a mix of public and private actors for financing and delivering care. But the last 30 years have seen many rich and middle-income countries moving to privatise parts of their health care systems. This phenomenon has generated concerns, especially about equitable access to health care. This article examines what the international right to the highest attainable standard of health in Art 12 of the International Covenant on Economic, Social and Cultural Rights says about the obligations of states which use private actors in health care. The article involves a close study of the primary documents of the key institutions responsible for interpreting and promoting Art 12. From this study, the article concludes that in mixed public-private health care systems, states not only retain primary responsibility for fulfilling the right to health but are subject to a range of additional specific responsibilities.

Early implementation of WHO recommendations for the retention of health workers in remote and rural areas.

PubMed

Buchan, James; Couper, Ian D; Tangcharoensathien, Viroj; Thepannya, Khampasong; Jaskiewicz, Wanda; Perfilieva, Galina; Dolea, Carmen

2013-11-01

The maldistribution of health workers between urban and rural areas is a policy concern in virtually all countries. It prevents equitable access to health services, can contribute to increased health-care costs and underutilization of health professional skills in urban areas, and is a barrier to universal health coverage. To address this long-standing concern, the World Health Organization (WHO) has issued global recommendations to improve the rural recruitment and retention of the health workforce. This paper presents experiences with local and regional adaptation and adoption of WHO recommendations. It highlights challenges and lessons learnt in implementation in two countries - the Lao People's Democratic Republic and South Africa - and provides a broader perspective in two regions - Asia and Europe. At country level, the use of the recommendations facilitated a more structured and focused policy dialogue, which resulted in the development and adoption of more relevant and evidence-based policies. At regional level, the recommendations sparked a more sustained effort for cross-country policy assessment and joint learning. There is a need for impact assessment and evaluation that focus on the links between the rural availability of health workers and universal health coverage. The effects of any health-financing reforms on incentive structures for health workers will also have to be assessed if the central role of more equitably distributed health workers in achieving universal health coverage is to be supported.

State Financial Aid: Policies to Enhance Articulation and Transfer

ERIC Educational Resources Information Center

Long, Bridget Terry

2005-01-01

Financing and financial aid issues in higher education continue to plague state policymakers and higher education leaders. Every year, they struggle with questions of how to meet growing needs through state allocations, how best to ensure shared and equitable responsibility for paying for higher education, and how best to use subsidies such as…

Can State Policy Deliver Equitable and Adequate Funding?

ERIC Educational Resources Information Center

Quinn, Rand; Steinberg, Matthew P.

2015-01-01

Sooner or later, talk of closing achievement gaps turns to education finance--specifically, fixing widespread disparities in school funding within individual states. The difference between the resources that a district needs to educate all students and the amount the district actually spends is called an adequacy gap. The availability and use of…

Education in Alaska. A Report to the People, FY 1986.

ERIC Educational Resources Information Center

Alaska State Dept. of Education, Juneau.

In fiscal year (FY) 1986, the Alaska State Board of Education continued to work towards its objectives of improving education in the areas of: school finance (by developing a fair and equitable distribution system for state public school funds and funding school construction projects); fiscal accountability (by establishing a system for the entire…

48 CFR 32.608-2 - Interest credits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... following procedures: (1) Interest at the rate under 52.232-17 shall be charged on the reduced debt from the... REQUIREMENTS CONTRACT FINANCING Contract Debts 32.608-2 Interest credits. (a) An equitable interest credit... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Interest credits. 32.608-2...

Taking action on the social determinants of health: improving health access for the urban poor in Mongolia

PubMed Central

2012-01-01

Introduction In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. Methods Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. Findings The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. Conclusions Lessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor. PMID:22429615

Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia.

PubMed

Vilcu, Ileana; Probst, Lilli; Dorjsuren, Bayarsaikhan; Mathauer, Inke

2016-10-04

Many low- and middle-income countries with a social health insurance system face challenges on their road towards universal health coverage (UHC), especially for people in the informal sector and vulnerable population groups or the informally employed. One way to address this is to subsidize their contributions through general government revenue transfers to the health insurance fund. This paper provides an overview of such health financing arrangements in Asian low- and middle-income countries. The purpose is to assess the institutional design features of government subsidized health insurance type arrangements for vulnerable and informally employed population groups and to explore how these features contribute to UHC progress. This regional study is based on a literature search to collect country information on the specific institutional design features of such subsidization arrangements and data related to UHC progress indicators, i.e. population coverage, financial protection and access to care. The institutional design analysis focuses on eligibility rules, targeting and enrolment procedures; financing arrangements; the pooling architecture; and benefit entitlements. Such financing arrangements currently exist in 8 countries with a total of 14 subsidization schemes. The most frequent groups covered are the poor, older persons and children. Membership in these arrangements is mostly mandatory as is full subsidization. An integrated pool for both the subsidized and the contributors exists in half of the countries, which is one of the most decisive features for equitable access and financial protection. Nonetheless, in most schemes, utilization rates of the subsidized are higher compared to the uninsured, but still lower compared to insured formal sector employees. Total population coverage rates, as well as a higher share of the subsidized in the total insured population are related with broader eligibility criteria. Overall, government subsidized health insurance type arrangements can be effective mechanism to help countries progress towards UHC, yet there is potential to improve on institutional design features as well as implementation.

Financing State and Local Government: Future Challenges and Opportunities.

ERIC Educational Resources Information Center

Wildasin, David E.; Childress, Michael T.; Hackbart, Merl; Lynch, Lawrence K.; Martie, Charles W.

This report focuses on state and local taxation in the state of Kentucky. It looks into what "the ideal" tax system looks like and how Kentucky's system compares, whether the current system will provide adequate revenue for the long-term, whether the tax system is efficient, how fair and equitable the tax system is, and whether the state…

78 FR 68482 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Order Granting Approval of Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-14

... used to finance commercial transactions; (4) repurchase agreements,\\11\\ which involve purchases of debt... manipulative acts and practices, to promote just and equitable principles of trade, to foster cooperation and... Rule 204A-1 under the Advisers Act relating to codes of ethics. This Rule requires investment advisers...

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…

Public university entry in Ghana: Is it equitable?

NASA Astrophysics Data System (ADS)

Yusif, Hadrat; Yussof, Ishak; Osman, Zulkifly

2013-06-01

Public universities in Ghana are highly subsidised by the central government and account for about 80 per cent of university students in the country. Yet issues of fairness in terms of entry into the public university system have so far hardly been addressed. To find out whether participation in public university education is equitable, the authors of this paper carried out a binary logistic regression analysis. Individual data were collected from 1,129 (614 male and 515 female) final year senior high school (SHS) students for the 2009 cohort. The authors measured student, father and mother characteristics likely to influence admission to a public university. The results show that the major predictors of public university entry are students' academic ability, quality of SHS attended and number of siblings. This seems to suggest that there is a significant bias in the selection of students from different socio-economic groups for admission to highly subsidised public universities. The implication is that public financing of university education in Ghana may not be equitable.

[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.

Capitation funding of primary health organisations in New Zealand: are enrolled populations being funded according to need?

PubMed

Langton, Jennifer; Crampton, Peter

2008-04-18

To determine whether the three main funding formulas for Primary Health Organisations achieved a stated aim of the Primary Health Care Strategy to fund enrolled populations according to need. National data were obtained from the Ministry of Health for a 12-month period beginning in April 2004: these included demographic characteristics of the enrolled Primary Health Organisation population, plus rates tables for: First-Contact Services, Services to Improve Access, and Health Promotion. Funding for Access and Interim practices for four-quarters was calculated for each of these three funding streams. Analysis of the demographic characteristics of Access and Interim practices was undertaken. Maori and Pacific peoples made up a greater proportion of the Access population than the Interim, had higher rates of deprivation than the non-Maori/non-Pacific population, and demonstrated a younger age distribution. The first quarter (April 2004-June 2004) showed there was preferential funding for Access PHOs and in particular high-needs groups. In quarter two, this level of preferential funding had diminished, coinciding with the introduction of increased government funding for all Interim enrolees aged 65 and over. The greater funding for Access enrolees was notably eroded with the introduction of Access-level funding for those aged 65+ in Interim PHOs. Since these data were analysed all remaining Interim age groups have shifted to Access-level funding, benefiting non-Maori /non-Pacific in Interim PHOs. The rapid shift to Access-level funding for First Contact Services has seen a continued erosion of the redistributive effect of the original needs-based formulas. A system cannot be considered equitable if some members of society are not realising their health potential, and financing of primary care should remain redistributive until such a time as this objective is attained.

Providing Elementary Students Equitable Access to Notebook Computers by Empowering Three School Communities in Shared Decision Making.

ERIC Educational Resources Information Center

Despot, Paula C.

This practicum was designed to provide elementary students from low-socioeconomic school communities equitable opportunities to use notebook computer technology in the communication process. A multi-dimensional staff development program was designed and conducted to integrate computer technology in the classroom. Students and their families were…

Client/patient perceptions of achieving equity in primary health care: a mixed methods study.

PubMed

Akhavan, Sharareh; Tillgren, Per

2015-08-12

To provide health care on equal terms has become a challenge for the health system. As the front line in health services, primary care has a key role to play in developing equitable health care, responsive to the needs of different population groups. Reducing inequalities in care has been a central and recurring theme in Swedish health reforms. The aim of this study is to describe and assess client/patient experiences and perceptions of care in four primary health care units (PHCUs) involved in Sweden's national Care on Equal Terms project. Mixed Method Research (MMR) was chosen to describe and assess client/patient experiences and perceptions of health care with regard to equity. There was a focus group discussion, and individual interviews with 21 clients/patients and three representatives of patient associations. Data from the Swedish National Patient Survey (NPS), conducted in 2011 and followed up in 2013, were also used. The interview data were divided into two main categories and three subcategories. The first category "Perception of equitable health care" had two subcategories, namely "Health care providers' perceptions" and "Fairness and participation". The second category "To achieve more equitable health care" had four subcategories: "Encounter", "Access", "Interpreters and bilingual/diverse health care providers" and "Time pressure and continuity". Results from the NPS showed that two of the PHCUs improved in some aspects of patient perceived quality of care (PPQC) while two were not so successful. Clients/patients perceived health care providers' perceptions of their ethnic origin and mental health status as important for equitable health care. Discriminatory perceptions may lead to those in need of care refraining from seeking it. More equitable care means longer consultations, better accessibility in terms of longer opening hours, and ways of communicating other than just via voice mail. It also involves continuity in care and access to an interpreter if needed. Employing bilingual/diverse kinds of health providers is a way of providing more equitable primary health care.

Contextual Problem Defining: Learning to Think and Act from the Standpoint of Equity

ERIC Educational Resources Information Center

Pena, Edlyn Vallejo; Bensimon, Estela Mara; Colyar, Julia

2006-01-01

One of the most critical challenges facing institutions of higher education in the twenty-first century is the need to be more accountable for producing equitable educational outcomes for students of color. Although access to higher education has increased significantly over the past two decades, it has not translated into equitable educational…

"Assessment as Discourse": A Pre-Service Physics Teacher's Evolving Capacity to Support an Equitable Pedagogy

ERIC Educational Resources Information Center

Lyon, Edward G.

2013-01-01

One way to view "equitable pedagogy" is through an opportunity to learn (OTL) lens, meaning that regardless of race, class, or culture, a student has access to rigorous and meaningful content, as well as appropriate resources and instruction necessary to learn and demonstrate understanding of that content. Assessment holds a unique…

Advancing primary care to promote equitable health: implications for China

PubMed Central

2012-01-01

China is a country with vast regional differences and uneven economic development, which have led to widening gaps between the rich and poor in terms of access to healthcare, quality of care, and health outcomes. China's healthcare reform efforts must be tailored to the needs and resources of each region and community. Building and strengthening primary care within the Chinese health care system is one way to effectively address health challenges. This paper begins by outlining the concept of primary care, including key definitions and measurements. Next, results from a number of studies will demonstrate that primary care characteristics are associated with savings in medical costs, improvements in health outcomes and reductions in health disparities. This paper concludes with recommendations for China on successfully incorporating a primary care model into its national health policy, including bolstering the primary care workforce, addressing medical financing structures, recognizing the importance of evidence-based medicine, and looking to case studies from countries that have successfully implemented health reform. PMID:22264309

Accelerating progress towards universal health coverage in Asia and Pacific: improving the future for women and children

PubMed Central

Beattie, Allison; Yates, Robert; Noble, Douglas J

2016-01-01

Universal health coverage generates significant health and economic benefits and enables governments to reduce inequity. Where universal health coverage has been implemented well, it can contribute to nation-building. This analysis reviews evidence from Asia and Pacific drawing out determinants of successful systems and barriers to progress with a focus on women and children. Access to healthcare is important for women and children and contributes to early childhood development. Universal health coverage is a political process from the start, and public financing is critical and directly related to more equitable health systems. Closing primary healthcare gaps should be the foundation of universal health coverage reforms. Recommendations for policy for national governments to improve universal health coverage are identified, including countries spending < 3% of gross domestic product in public expenditure on health committing to increasing funding by at least 0.3%/year to reach a minimum expenditure threshold of 3%. PMID:28588989

Financing a College Education: How It Works, How It's Changing. American Council on Education/Oryx Press Series on Higher Education.

ERIC Educational Resources Information Center

King, Jacqueline E., Ed.

This collection of 15 essays by policy analysts and higher education specialists examines student financial aid, how policy and practice have changed, how student costs at U.S. colleges and universities are currently being met, and why and how enhancements to current programs would make the system more equitable. Following an introduction by D.…

The views of stakeholders on controlled access schemes for high-cost antirheumatic biological medicines in Australia

PubMed Central

Lu, Christine Y; Ritchie, Jan; Williams, Ken; Day, Ric

2007-01-01

Background In Australia, government-subsidised access to high-cost medicines is "targeted" to particular sub-sets of patients under the Pharmaceutical Benefits Scheme to achieve cost-effective use. In order to determine how this access system could be improved, the opinions of key stakeholders on access to biological agents for rheumatoid arthritis were explored. Methods Thirty-six semi-structured interviews were conducted with persons from relevant stakeholder groups. These were transcribed verbatim, and analysed thematically. Results Controlled access to expensive medicines was considered to be equitable and practical; however, there was disagreement as to the method of defining the target patient populations. Other concerns included timeliness of access, excessive bureaucracy, and the need for additional resources to facilitate the scheme. Collaboration between stakeholders was deemed important because it allows more equitable distribution of limited resources. The majority considered that stakeholder consultation should have been broader. Most wanted increased transparency of the decision-making process, ongoing and timely review of access criteria, and an increased provision of information for patients. More structured communication between stakeholders was proposed. Conclusion The Pharmaceutical Benefit Scheme is adapting to meet the changing needs of patients. Provision of subsidised access to high-cost medicines in a manner that is affordable for individuals and society, and that is equitable and efficiently managed is challenging. The views of stakeholders on targeted access to anti-rheumatic biological medicines in Australia acknowledged this challenge and provided a number of suggestions for modifications. These could serve as a basis to inform the debate on how to change the processes and policies so as to improve the scheme. PMID:18096055

Policy entrepreneurship in the reform of pediatric dentistry.

PubMed

Edelstein, Burton L; Maas, William R

2017-06-30

In a recently published IJHPR article, Cohen and Horev ask whether an individual who holds rightful governmental power is able to effectively "challenge the equilibrium" in ways that might "clash with the goals" of an influential group". This question is raised within the context of a shift in governmental policy that imposed the potential for cost management by HMOs acting as financial intermediaries for pediatric dental care in an effort to provide Israeli children better access to affordable dental care. The influential group referred to consists of Israel's private dentists and the individual seeking to challenge the equilibrium was an Israeli Minister of Health whom the authors consider to be a policy entrepreneur.The Israeli health care system is similar to that of the United States in that private benefit plans and self-pay financing dominate in dental care. This is in contrast to the substantial role of government in the financing and regulation of medical care in both countries (with Israel having universal coverage financed by government and the US having government financing the care of the elderly and the poor as well as providing subsidies through the tax system for the care of most other Americans).Efforts to expand governmental involvement in dental care in both countries have either been opposed by organized dentistry or have suffered from ineffective advocacy for increased public investment in dental care.In the U.S., philanthropic foundations have acted as or have supported health policy entrepreneurs. The recent movement to introduce the dental therapist, a type of allied dental professional trained to provide a narrow set of commonly-needed procedures, to the U.S. is discussed as an example of a successful challenge to the equilibrium by groups supported by these foundations. This is a somewhat different, and complementary, model of policy entrepreneurship from the individual policy entrepreneur highlighted in the Cohen-Horev paper.The political traction gained to change the equilibrium favored by organized dentistry - in both Israel and the U.S. - may reflect aspirations for care that is more accessible, patient-centered, accountable and equitable. Evolving aspirations may lead to policy changes to systematize the disparate, disaggregated dental care delivery system in both counties. A change in payment incentives to provide more value is being explored for medical care, and its expansion to dental care can be anticipated to be among the policies considered in the future.

Bridging miles to achieve milestones: Corporate social responsibility for primary health care.

PubMed

Gulati, Ruchie

2017-01-01

Sustainable Developmental Goals aim to provide "Good health for all". The task though immense ,requires equitable and efficient distribution of health resources to the community, reached predominantly by the Primary Health Centres. Strengthening these centres is essential to attain the goal. Adequate health financing is one of the important determinants for utilizing the optimal potential of these centres . Pooling funds from alternate financing strategies as Corporate Social Responsibility (CSR) funds may give impetus and facilitate healthcare affordability to the underserved population. This convergence of vision of corporate funding for "basic health services" may bridge the gap arising out of inadequate funding and facilitate "Good Health for all" in India.

The Impact of School Closures on Equity of Access in Chicago

ERIC Educational Resources Information Center

Lee, Jin; Lubienski, Christopher

2017-01-01

This study examines the impact of school closures on the sociospatial distribution of equitable access to schooling following the school closure policy pursued by the Chicago Public Schools in 2013. By examining access in terms of proximity between students and schools, the study estimates the changes in accessibility before and after school…

Finance for health care: part of a broad canvas.

PubMed

Evlo, K; Carrin, G

1992-01-01

The economic crisis of the 1980s led to cuts in both government and household expenditure on health in the Third World. In order to address these issues it is necessary to adopt a macroeconomic approach to the analysis of the health sector; this allows its relationship to the whole economy to be understood. The efficient and equitable utilization of resources is particularly important in times of severe financial constraint.

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.

Explanation of inequality in utilization of ambulatory care before and after universal health insurance in Thailand

PubMed Central

Yiengprugsawan, V; Carmichael, GA; Lim, LL-Y; Seubsman, S; Sleigh, AC

2011-01-01

Thailand implemented a Universal Coverage Scheme (UCS) of national health insurance in April 2001 to finance equitable access to health care. This paper compares inequalities in health service use before and after the UCS, and analyses the trend and determinants of inequality. The national Health and Welfare Surveys of 2001 and 2005 are used for this study. The concentration index for use of ambulatory care among the population reporting a recent illness is used as a measure of health inequality, decomposed into contributing demographic, socio-economic, geographic and health insurance determinants. As a result of the UCS, the uninsured group fell from 24% in 2001 to 3% in 2005 and health service patterns changed. Use of public primary health care facilities such as health centres became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off. Decomposition analysis shows that the increasingly common use of health centres among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the UCS. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes. Although the UCS scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required. PMID:20736414

A cost-based equity weight for use in the economic evaluation of primary health care interventions: case study of the Australian Indigenous population

PubMed Central

Ong, Katherine S; Kelaher, Margaret; Anderson, Ian; Carter, Rob

2009-01-01

Background Efficiency and equity are both important policy objectives in resource allocation. The discipline of health economics has traditionally focused on maximising efficiency, however addressing inequities in health also requires consideration. Methods to incorporate equity within economic evaluation techniques range from qualitative judgements to quantitative outcomes-based equity weights. Yet, due to definitional uncertainties and other inherent limitations, no method has been universally adopted to date. This paper proposes an alternative cost-based equity weight for use in the economic evaluation of interventions delivered from primary health care services. Methods Equity is defined in terms of 'access' to health services, with the vertical equity objective to achieve 'equitable access for unequal need'. Using the Australian Indigenous population as an illustrative case study, the magnitude of the equity weight is constructed using the ratio of the costs of providing specific interventions via Indigenous primary health care services compared with the costs of the same interventions delivered via mainstream services. Applying this weight to the costs of subsequent interventions deflates the costs of provision via Indigenous health services, and thus makes comparisons with mainstream more equitable when applied during economic evaluation. Results Based on achieving 'equitable access', existing measures of health inequity are suitable for establishing 'need', however the magnitude of health inequity is not necessarily proportional to the magnitude of resources required to redress it. Rather, equitable access may be better measured using appropriate methods of health service delivery for the target group. 'Equity of access' also suggests a focus on the processes of providing equitable health care rather than on outcomes, and therefore supports application of equity weights to the cost side rather than the outcomes side of the economic equation. Conclusion Cost-based weights have the potential to provide a pragmatic method of equity weight construction which is both understandable to policy makers and sensitive to the needs of target groups. It could improve the evidence base for resource allocation decisions, and be generalised to other disadvantaged groups who share similar concepts of equity. Development of this decision-making tool represents a potentially important avenue for further health economics research. PMID:19807930

Trade in health services in the ASEAN region.

PubMed

Arunanondchai, Jutamas; Fink, Carsten

2006-12-01

Promoting quality health services to large population segments is a key ingredient to human and economic development. At its core, healthcare policymaking involves complex trade-offs between promoting equitable and affordable access to a basic set of health services, creating incentives for efficiencies in the healthcare system and managing constraints in government budgets. International trade in health services influences these trade-offs. It presents opportunities for cost savings and access to better quality care, but it also raises challenges in promoting equitable and affordable access. This paper offers a discussion of trade policy in health services for the ASEAN region. It reviews the existing patterns of trade and identifies policy measures that could further harness the benefits from trade in health services and address potential pitfalls that deeper integration may bring about.

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.

Dialysis Provision and Implications of Health Economics on Peritoneal Dialysis Utilization: A Review from a Malaysian Perspective

PubMed Central

Seong Hooi, Lai; Bavanandan, Sunita

2017-01-01

End-stage renal disease (ESRD) is managed by either lifesaving hemodialysis (HD) and peritoneal dialysis (PD) or a kidney transplant. In Malaysia, the prevalence of dialysis-treated ESRD patients has shown an exponential growth from 504 per million population (pmp) in 2005 to 1155 pmp in 2014. There were 1046 pmp patients on HD and 109 pmp patients on PD in 2014. Kidney transplants are limited due to lack of donors. Malaysia adopts public-private financing model for dialysis. Majority of HD patients were treated in the private sector but almost all PD patients were treated in government facilities. Inequality in access to dialysis is visible within geographical regions where majority of HD centres are scattered around developed areas. The expenditure on dialysis has been escalating in recent years but economic evaluations of dialysis modalities are scarce. Evidence shows that health policies and reimbursement strategies influence dialysis provision. Increased uptake of PD can produce significant economic benefits and improve patients' access to dialysis. As a result, some countries implemented a PD-First or Favored Policy to expand PD use. Thus, a current comparative costs analysis of dialysis is strongly recommended to assist decision-makers to establish a more equitable and economically sustainable dialysis provision in the future. PMID:29225970

Dialysis Provision and Implications of Health Economics on Peritoneal Dialysis Utilization: A Review from a Malaysian Perspective.

PubMed

Abdul Manaf, Mohd Rizal; Surendra, Naren Kumar; Abdul Gafor, Abdul Halim; Seong Hooi, Lai; Bavanandan, Sunita

2017-01-01

End-stage renal disease (ESRD) is managed by either lifesaving hemodialysis (HD) and peritoneal dialysis (PD) or a kidney transplant. In Malaysia, the prevalence of dialysis-treated ESRD patients has shown an exponential growth from 504 per million population (pmp) in 2005 to 1155 pmp in 2014. There were 1046 pmp patients on HD and 109 pmp patients on PD in 2014. Kidney transplants are limited due to lack of donors. Malaysia adopts public-private financing model for dialysis. Majority of HD patients were treated in the private sector but almost all PD patients were treated in government facilities. Inequality in access to dialysis is visible within geographical regions where majority of HD centres are scattered around developed areas. The expenditure on dialysis has been escalating in recent years but economic evaluations of dialysis modalities are scarce. Evidence shows that health policies and reimbursement strategies influence dialysis provision. Increased uptake of PD can produce significant economic benefits and improve patients' access to dialysis. As a result, some countries implemented a PD-First or Favored Policy to expand PD use. Thus, a current comparative costs analysis of dialysis is strongly recommended to assist decision-makers to establish a more equitable and economically sustainable dialysis provision in the future.

The imperative for systems thinking to promote access to medicines, efficient delivery, and cost-effectiveness when implementing health financing reforms: a qualitative study.

PubMed

Achoki, Tom; Lesego, Abaleng

2017-03-21

Health systems across Africa are faced with a multitude of competing priorities amidst pressing resource constraints. Expansion of health insurance coverage offers promise in the quest for sustainable healthcare financing for many of the health systems in the region. However, the broader policy implications of expanding health insurance coverage have not been fully investigated and contextualized to many African health systems. We interviewed 37 key informants drawn from public, private and civil society organizations involved in health service delivery in Botswana. The objective was to determine the potential health system impacts that would result from expanding the health insurance scheme covering public sector employees. Study participants were selected through purposeful sampling, stakeholder mapping, and snowballing. We thematically synthesized their views, focusing on the key health system areas of access to medicines, efficiency and cost-effectiveness, as intermediate milestones towards universal health coverage. Participants suggested that expansion of health insurance would be characterized by increased financial resources for health and catalyze an upsurge in utilization of health services particularly among those with health insurance cover. As a result, the health system, particularly within the private sector, would be expected to see higher demand for medicines and other health technologies. However, majority of the respondents cautioned that, realizing the full benefits of improved population health, equitable distribution and financial risk protection, would be wholly dependent on having sound policies, regulations and functional accountability systems in place. It was recommended that, health system stewards should embrace efficient and cost-effective delivery, in order to make progress towards universal health coverage. Despite the prospects of increasing financial resources available for health service delivery, expansion of health insurance also comes with many challenges. Decision-makers keen to achieve universal health coverage, must view health financing reform through the holistic lens of the health system and its interactions with the population, in order to anticipate its potential benefits and risks. Failure to embrace this comprehensive approach, would potentially lead to counterproductive results.

Synthesizing qualitative and quantitative evidence on non-financial access barriers: implications for assessment at the district level.

PubMed

O'Connell, Thomas S; Bedford, K Juliet A; Thiede, Michael; McIntyre, Di

2015-06-09

A key element of the global drive to universal health coverage is ensuring access to needed health services for everyone, and to pursue this goal in an equitable way. This requires concerted efforts to reduce disparities in access through understanding and acting on barriers facing communities with the lowest utilisation levels. Financial barriers dominate the empirical literature on health service access. Unless the full range of access barriers are investigated, efforts to promote equitable access to health care are unlikely to succeed. This paper therefore focuses on exploring the nature and extent of non-financial access barriers. We draw upon two structured literature reviews on barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda. One review analyses access barriers identified in published literature using qualitative research methods; the other in published literature using quantitative analysis of household survey data. We then synthesised the key qualitative and quantitative findings through a conjoint iterative analysis. Five dominant themes on non-financial access barriers were identified: ethnicity; religion; physical accessibility; decision-making, gender and autonomy; and knowledge, information and education. The analysis highlighted that non-financial factors pose considerable barriers to access, many of which relate to the acceptability dimension of access and are challenging to address. Another key finding is that quantitative research methods, while yielding important findings, are inadequate for understanding non-financial access barriers in sufficient detail to develop effective responses. Qualitative research is critical in filling this gap. The analysis also indicates that the nature of non-financial access barriers vary considerably, not only between countries but also between different communities within individual countries. To adequately understand access barriers as a basis for developing effective strategies to address them, mixed-methods approaches are required. From an equity perspective, communities with the lowest utilisation levels should be prioritised and the access barriers specific to that community identified. It is, therefore, critical to develop approaches that can be used at the district level to diagnose and act upon access barriers if we are to pursue an equitable path to universal health coverage.

Neighborhood disparities in access to healthy foods and their effects on environmental justice

USDA-ARS?s Scientific Manuscript database

Environmental justice is concerned with an equitable distribution of environmental burdens. These burdens comprise immediate health hazards as well as subtle inequities, such as limited access to healthy foods. We reviewed the literature on neighborhood disparities in access to fast-food outlets and...

Bridging the Communication Divide: CMC and Deaf Individuals' Literacy Skills

ERIC Educational Resources Information Center

Garberoglio, Carrie Lou; Dickson, Duncan; Cawthon, Stephanie; Bond, Mark

2015-01-01

Deaf individuals frequently capitalize upon communication technologies that increase equitable access to communication in an ongoing, effortless manner. Those communication technologies create conditions that increase direct access to language and literacy. It is the lack of direct access to language that has been historically problematic for deaf…

Thoughts on Access, Differentiation, and Implementation of a Multicultural Curriculum

ERIC Educational Resources Information Center

Cavilla, Derek

2014-01-01

Identification of gifted students from diverse and underserved communities is traditionally low; however, there are ways to expand identification methods in order to make access to gifted education programs more equitable. Creation and implementation of multi-faceted and multi-dimensional assessments as well as tiered access into gifted education…

Affordable antiretroviral drugs for the under-served markets: how to expand equitable access against the backdrop of challenging scenarios?

PubMed

Dionisio, Daniele; Cao, Yunzhen; Hongzhou, Lu; Kraisintu, Krisana; Messeri, Daniela

2006-01-01

Threats by enforced Intellectual Property (IP) rights to equitable HIV treatment access by poor populations are impending. India and China's policy directions in the field will be crucial in ultimately affecting the affordability and accessibility of antiretroviral (ARV) therapy in the under-served markets. These directions, together with the exploitation level of IP-bound flexibilities and the evolutionary modelling in partnerships and trade agreements between research-based and generic pharmaceutical industry, will also affect the outcomes of self-sufficiency efforts now at their beginning in the developing world as far as domestic manufacturing of generic ARV drugs is concerned. This paper explores key issues, implications and interaction dynamics across these challenging scenarios while attempting to provide equitable solution glimpses into the near future. Access-oriented long-term drug policy strategies entitled to pass muster of governments, research-based as well as generic industries in both developed and developing countries are needed if equitable access to affordable ARV treatments by poor people has to be achieved despite enforced IP rights. Predictable dynamics between western multinationals and transitional country generic corporations let regard IP-bound Voluntary License flexibilities as a fitting measure into just mentioned needs especially if substantial incentives to generic corporations are concurrently secured. Efforts to equitably expand ARV drug access through exploiting IP opportunities should encompass attainment of self-sufficiency in domestic drug manufacturing whenever basic requirements are in place in the developing world as a whole. A credible industrial potential would act, indeed, as a boosting factor for drawing branded drug producers into technology transfer agreements, the terms of which would let all contractors enjoy substantial advantages. These perspectives consistently bind up with the foreseeable long-term trade and drug policy directions of India and China according to frontier crossing implications of their key IP management trends as well as their multifaceted penetration strategies of both the wealthy and under-served markets worldwide. As coherent with these perspectives, more disbursement by wealthy country governments and donors to basic infrastructure development in sub-Saharan African nations with stable governments in place is urged both as a priority for improving Africa's economy and a prerequisite for allowing domestic industrial plants to take off. Aiming at the targets just underscored, WHO's brokering role in negotiated agreements between wealthy and developing country-based firms as well as its technical guidance in setting international standards have always to be sought if equitable and appropriate end results are to be attained. Overall insights in this paper would mean that, while research-based corporations are to be praised whenever waiving, on humanitarian purposes, part of their profits, the trade and profit rules cannot basically be given up if long-term sustainable results are the goal to look for. Only negotiated agreements securing all contracting parties lasting advantages may ensure shifting of such a goal from mere vision to a really sustainable attainment.

Practice variation in the Dutch long-term care and the role of supply-sensitive care: Is access to the Dutch long-term care equitable?

PubMed

Duell, Daisy; Koolman, Xander; Portrait, France

2017-12-01

Universal access and generous coverage are important goals of the Dutch long-term care (LTC) system. It is a legal requirement that everyone eligible for LTC should be able to receive it. Institutional care (IC) made up for 90% of Dutch LTC spending. To investigate whether access to IC is as equitable as the Dutch government aspires, we explored practice variation in entitlements to IC across Dutch regions. We used a unique dataset that included all individual applications for Dutch LTC in January 2010-December 2013 (N = 3,373,358). This dataset enabled an accurate identification of the need for care. We examined the local variation in the probability of being granted long-term IC and in the intensity of the care granted given that individuals have applied for LTC. We also investigated whether the variation observed was related to differences in the local availability of care facilities. Although our analyses indicated the presence of some practice variation, its magnitude was very small by national and international standards (up to 3%). Only a minor part of the practice variation could be accounted for by local supply differences in care facilities. Overall, we conclude that, unlike many other developed countries, the Dutch system ensured equitable access to long-term IC. © 2017 The Authors. Health Economics Published by John Wiley & Sons Ltd.

Health care delivery in Malaysia: changes, challenges and champions

PubMed Central

Thomas, Susan; Beh, LooSee; Nordin, Rusli Bin

2011-01-01

Since 1957, there has been major reorganization of health care services in Malaysia. This article assesses the changes and challenges in health care delivery in Malaysia and how the management in health care processes has evolved over the years including equitable health care and health care financing. The health care service in Malaysia is changing towards wellness service as opposed to illness service. The Malaysian Ministry of Health (MOH), being the main provider of health services, may need to manage and mobilize better health care services by providing better health care financing mechanisms. It is recommended that partnership between public and private sectors with the extension of traditional medicine complementing western medicine in medical therapy continues in the delivery of health care. PMID:28299064

Health care delivery in Malaysia: changes, challenges and champions.

PubMed

Thomas, Susan; Beh, LooSee; Nordin, Rusli Bin

2011-09-05

Since 1957, there has been major reorganization of health care services in Malaysia. This article assesses the changes and challenges in health care delivery in Malaysia and how the management in health care processes has evolved over the years including equitable health care and health care financing. The health care service in Malaysia is changing towards wellness service as opposed to illness service. The Malaysian Ministry of Health (MOH), being the main provider of health services, may need to manage and mobilize better health care services by providing better health care financing mechanisms. It is recommended that partnership between public and private sectors with the extension of traditional medicine complementing western medicine in medical therapy continues in the delivery of health care.

Gender Equity Matters!

ERIC Educational Resources Information Center

Thorius, Kathleen King

2010-01-01

Despite remarkable progress along many indicators of equitable access, participation, and outcomes of schooling, there are still persistent, pervasive issues that must be addresses, including continued disparities in access to athletics and academic programs, sexual harassment, hate crimes, and discriminatory treatment of girls and women. This…

From Access to Success: An Integrated Approach to Quality Higher Education Informed by Social Inclusion Theory and Practice

ERIC Educational Resources Information Center

Gidley, Jennifer M.; Hampson, Gary P.; Wheeler, Leone; Bereded-Samuel, Elleni

2010-01-01

Equitable access, success and quality in higher education are examined from a variety of ideological perspectives. "Quality" is positioned as a complex generic concept while "access" and "success" are identified as key concepts in the social inclusion domain, supplemented by the concept of "participation."…

Open Access to Scientific Literature: An Assessment of Awareness Support and Usage among Academic Librarians at Historically Black Colleges and Universities

ERIC Educational Resources Information Center

Evans, Marsha Ann Johnson

2012-01-01

Open Access (OA) to scholarly communications is a critical component in providing equitable admission to scholarly information and a key vehicle toward the achievement of global access to research in the knowledge building process. A standard and universally accepted process for guaranteeing OA permits complimentary access to knowledge, research…

Improving maternal healthcare utilisation in sub-Saharan Africa through micro-finance.

PubMed

Abekah-Nkrumah, Gordon; Abor, Patience Aseweh; Abor, Joshua; Adjasi, Charles K D

2011-01-01

This paper aims to examine links between women's access to micro-finance and how they use maternal healthcare services in sub-Saharan Africa (SSA). The authors use theoretical and empirical literature to propose a framework to sustain and improve women's access to maternal healthcare services through micro-financing. It is found that improved access to micro-finance by women, combined with education may enhance maternal health service uptake. The paper does not consider empirical data in the analysis. The authors advocate empirically testing the framework proposed in other SSA countries. It is important to empower women by facilitating their access to education and micro-finance. This has implications for improving maternal healthcare utilization in SSA. The paper moves beyond poor access to maternal health services in SSA and proposes a framework for providing sustainable solutions.

Associations Between the Macroeconomic Indicators and Suicide Rates in India: Two Ecological Studies.

PubMed

Rajkumar, Anto P; Senthilkumar, P; Gayathri, K; Shyamsundar, G; Jacob, K S

2015-01-01

While western studies have focused on the importance of psychiatric illnesses in the complex pathways leading to suicides, several Indian studies have highlighted the important contributions by economic, social, and cultural factors. Hence, we tested the hypothesis that annual national suicide rates and suicide rates of the different states in India were associated with macroeconomic indices. Data from the National crime records bureau, Ministry of finance, labour bureau, Government of India, population commission, and planning commission official portals, World Bank and the United Nations were accessed. We assessed the correlations of annual national and state-wise suicide rates with macroeconomic, health, and other indices using ecological study design for India, and for its different states and union territories. We documented statistically significant associations between the suicide rates and per capita gross domestic product, consumer price index, foreign exchange, trade balance, total health expenditure as well as literacy rates. As recent economic growth in India is associated with increasing suicide rates, macroeconomic policies emphasizing equitable distribution of resources may help curtailing the population suicide rates in India.

Associations Between the Macroeconomic Indicators and Suicide Rates in India: Two Ecological Studies

PubMed Central

Rajkumar, Anto P.; Senthilkumar, P.; Gayathri, K.; Shyamsundar, G.; Jacob, K. S.

2015-01-01

Background: While western studies have focused on the importance of psychiatric illnesses in the complex pathways leading to suicides, several Indian studies have highlighted the important contributions by economic, social, and cultural factors. Hence, we tested the hypothesis that annual national suicide rates and suicide rates of the different states in India were associated with macroeconomic indices. Materials and Methods: Data from the National crime records bureau, Ministry of finance, labour bureau, Government of India, population commission, and planning commission official portals, World Bank and the United Nations were accessed. We assessed the correlations of annual national and state-wise suicide rates with macroeconomic, health, and other indices using ecological study design for India, and for its different states and union territories. Results: We documented statistically significant associations between the suicide rates and per capita gross domestic product, consumer price index, foreign exchange, trade balance, total health expenditure as well as literacy rates. Conclusions: As recent economic growth in India is associated with increasing suicide rates, macroeconomic policies emphasizing equitable distribution of resources may help curtailing the population suicide rates in India. PMID:26664075

Montana Faxnet Project. Final Report.

ERIC Educational Resources Information Center

Brander, Linda L.

This report summarizes the activities and accomplishments of the Montana Faxnet Project, which was created to design and demonstrate a statewide document delivery network utilizing telefacsimile equipment that would create equitable access for all Montanans accessing and retrieving information, and reduce the waiting time for requested materials…

Coverage and equitability of interventions to prevent child mortality in rural Jimma and West Hararghe Zones, Oromia Region, Ethiopia.

PubMed

Miller, Nathan P; Degefie, Tedbabe; Hazel, Elizabeth; Legesse, Hailemariam; Tolera, Taye; Amouzou, Agbessi

2014-10-01

Interventions to prevent childhood illnesses are important components of the Ethiopian Health Extension Program (HEP). Although the HEP was designed to reduce inequities in access to health care, there is little evidence on equitability of preventive interventions in Ethiopia. This article describes coverage of preventive interventions and how many interventions individual children received We also examined which factors were associated with the number of preventive interventions received, and assessed the extent to which interventions were equitably distributed. We conducted a cross-sectional survey in 3,200 randomly selected households in the rural Jimma and West Hararghe Zones of Ethiopia's Oromia Region. We calculated coverage of 10 preventive interventions and a composite of eight interventions (co-coverage) representing the number of interventions received by children. Mul- tiple linear regressions were used to assess associations between co-coverage and explanatory variables. Finally, we assessed the equitability of preventive interventions by comparing coverage among children in the poorest and the least poor wealth quintiles. Coverage was less than 50% for six of the 10 interventions. Children received on average only three of the eight interventions included in the co-coverage calculation. Zone, gender, caretaker age, religion, and household wealth were all significantly associated with co-coverage, controlling for key covariates. Exclusive breastfeeding, vaccine uptake, and vitamin A supplementation were all relatively equitable. On the other hand, coverage of insecticide-treated nets or indoor residual spraying (ITN/IRS) and access to safe water were significantly higher among the least poor children compared to children in the poorest quintile. Coverage of key interventions to prevent childhood illnesses is generally low in Jimma and West Hararghe. Although a number of interventions were equitably distributed, there were marked wealth-based inequities for interventions that are possessed at the household level, even among relatively homogeneous rural communities.

Exploration of instruction, assessment, and equity in the middle school science classroom

NASA Astrophysics Data System (ADS)

Szpyrka, Donna A.

2001-07-01

In order to determine equitable practices of middle school science teachers questionnaire responses, classroom observations, teacher interviews, and assessment artifacts were examined to discover relationships between classroom instruction, assessment practices, and equity. Teachers in middle school science classrooms in six different schools completed a National Center for Education Statistics questionnaire, offered assessment artifacts, and participated in interviews. Observers using a classroom observation protocol and an equity profile rated 22 lessons. The study found that a distinction could be made between teachers who were more equitable and those who were less equitable. Careful planning and organization; the incorporation of tasks, roles, and interactions consistent with investigative science; a collaborative approach to learning; and instruction that takes into account what transpired in previous lessons---appear to be characteristics of lesson design of the more equitable teachers. In addition, instructional strategies and activities that addressed access, equity, and diversity as well as, a classroom climate that was respectful of students' contributions were found to a greater extent in the more equitable teachers' classrooms. While all teachers used multiple methods of assessment, the more equitable teachers used assessment differently. They also provided written feedback to students, relied on more than one aspect of student performance for determining grades, and explicated clear and specific assessment practices.

The Evolution of Al Qaeda

DTIC Science & Technology

2007-06-15

Al Qaeda is a product of the forces of globalization. Increasing access to global finances , international travel, and sophisticated technology is...evolution. Al Qaeda is a product of the forces of globalization. Increasing access to global finances , international travel, and sophisticated technology...75 Finance

Access to finance from different finance provider types: Farmer knowledge of the requirements.

PubMed

Wulandari, Eliana; Meuwissen, Miranda P M; Karmana, Maman H; Oude Lansink, Alfons G J M

2017-01-01

Analysing farmer knowledge of the requirements of finance providers can provide valuable insights to policy makers about ways to improve farmers' access to finance. This study compares farmer knowledge of the requirements to obtain finance with the actual requirements set by different finance provider types, and investigates the relation between demographic and socioeconomic factors and farmer knowledge of finance requirements. We use a structured questionnaire to collect data from a sample of finance providers and farmers in Java Island, Indonesia. We find that the most important requirements to acquire finance vary among different finance provider types. We also find that farmers generally have little knowledge of the requirements, which are important to each type of finance provider. Awareness campaigns are needed to increase farmer knowledge of the diversity of requirements among the finance provider types.

Access to finance from different finance provider types: Farmer knowledge of the requirements

PubMed Central

Meuwissen, Miranda P. M.; Karmana, Maman H.; Oude Lansink, Alfons G. J. M.

2017-01-01

Analysing farmer knowledge of the requirements of finance providers can provide valuable insights to policy makers about ways to improve farmers’ access to finance. This study compares farmer knowledge of the requirements to obtain finance with the actual requirements set by different finance provider types, and investigates the relation between demographic and socioeconomic factors and farmer knowledge of finance requirements. We use a structured questionnaire to collect data from a sample of finance providers and farmers in Java Island, Indonesia. We find that the most important requirements to acquire finance vary among different finance provider types. We also find that farmers generally have little knowledge of the requirements, which are important to each type of finance provider. Awareness campaigns are needed to increase farmer knowledge of the diversity of requirements among the finance provider types. PMID:28877174

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.

The cost of free health care for all Kenyans: assessing the financial sustainability of contributory and non-contributory financing mechanisms.

PubMed

Okungu, Vincent; Chuma, Jane; McIntyre, Di

2017-02-27

The need to provide quality and equitable health services and protect populations from impoverishing health care costs has pushed universal health coverage (UHC) to the top of global health policy agenda. In many developing countries where the majority of the population works in the informal sector, there are critical debates over the best financing mechanisms to progress towards UHC. In Kenya, government health policy has prioritized contributory financing strategy (social health insurance) as the main financing mechanism for UHC. However, there are currently no studies that have assessed the cost of either social health insurance (SHI) as the contributory approach or an alternative financing mechanism involving non-contributory (general tax funding) approaches to UHC in Kenya. The aim of this study was to critically assess the financial requirements of both contributory and non-contributory mechanisms to financing UHC in Kenya in the context of large informal sector populations. SimIns Basic® model, Version 2.1, 2008 (WHO/GTZ), was used to assess the feasibility of UHC in Kenya and provide estimates of financial resource needs for UHC over a 17-year period (2013-2030). Data sources included review of national and international literature on inflation, demography, macro-economy, health insurance, health services unit costs and utilization rates. The data were triangulated across geographic regions for accuracy and integrity of the simulation. SimIns models for 10 years only so data from the final year of the model was used to project for another 7 years. The 17-year period was necessary because the Government of Kenya aims to achieve UHC by 2030. The results show that SHI is financially sustainable (Sustainability in this study is used to mean that expenditure does not outstrip revenue.) (revenues and expenditure match) within the first five years of implementation, but it becomes less sustainable with time. Modelling for a non-contributory scenario, on the other hand, showed greater sustainability both in the short- and long-term. The financial resource requirements for universal access to health care through general government revenue are compared with a contributory health insurance scheme approach. Although both funding options would require considerable government subsidies, given the magnitude of the informal sector in Kenya and their limited financial capacity, a tax-funded system would be less costly and more sustainable in the long-term than an insurance scheme approach. However, more innovative financing for health care as well as giving the health sector higher priority in government expenditure will be required to make the non-contributory financing mechanism more sustainable.

An Introduction to Web Accessibility, Web Standards, and Web Standards Makers

ERIC Educational Resources Information Center

McHale, Nina

2011-01-01

Librarians and libraries have long been committed to providing equitable access to information. In the past decade and a half, the growth of the Internet and the rapid increase in the number of online library resources and tools have added a new dimension to this core duty of the profession: ensuring accessibility of online resources to users with…

The importance of gender analysis in research for health systems strengthening.

PubMed

Theobald, Sally; Morgan, Rosemary; Hawkins, Kate; Ssali, Sarah; George, Asha; Molyneux, Sassy

2017-12-01

This editorial discusses a collection of papers examining gender across a range of health policy and systems contexts, from access to services, governance, health financing, and human resources for health. The papers interrogate differing health issues and core health systems functions using a gender lens. Together they produce new knowledge on the multiple impacts of gender on health experiences and demonstrate the importance of gender analyses and gender sensitive interventions for promoting well-being and health systems strengthening. The findings from these papers collectively show how gender intersects with other axes of inequity within specific contexts to shape experiences of health and health seeking within households, communities and health systems; illustrate how gender power relations affect access to important resources; and demonstrate that gender norms, poverty and patriarchy interplay to limit women's choices and chances both within household interactions and within the health sector. Health systems researchers have a responsibility to promote the incorporation of gender analyses into their studies in order to inform more strategic, effective and equitable health systems interventions, programmes, and policies. Responding to gender inequitable systems, institutions, and services in this sector requires an 'all hands-on deck' approach. We cannot claim to take a 'people-centred approach' to health systems if the status quo continues. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

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.

Essential drugs in the new international economic environment.

PubMed Central

Velásquez, G.; Boulet, P.

1999-01-01

Recent global developments in the regulation of trade and intellectual property rights threaten to hinder the access of populations in developing countries to essential drugs. The authors argue for state intervention in the health and pharmaceutical markets in order to guarantee equitable access to these products. PMID:10212525

Russian Higher Education: Who Can Afford It?

ERIC Educational Resources Information Center

Gounko, Tatiana

2012-01-01

The article explores the issue of access and equity in the Russian higher education system by examining recent government initiatives. While recently introduced measures such as the Unified State Examination and student loan project are designed to aid students and expand participation, they alone cannot ensure equitable access to higher education…

Managing intellectual property to develop medicines for the world's poorest.

PubMed

Fonteilles-Drabek, Sylvie; Reddy, David; Wells, Timothy N C

2017-04-01

It has been argued that patents impede the development and access of medicines for tropical diseases such as malaria. However, we believe that intellectual property can be a key tool to enable timely progression of drug development projects involving multiple partners and to ensure equitable access to successful products.

Digital Exclusion: Coming out from behind Closed Doors

ERIC Educational Resources Information Center

Watling, Sue

2011-01-01

Government visions of a digital future show little indication of how disabled people, reliant on access technology, will participate. Access technology has the potential to offer independent use of the Internet but many disabled people already face barriers that prevent them having equitable digital experiences. Multiple obstacles include high…

Strategies for Supporting Inclusive Education for Students with Disabilities

ERIC Educational Resources Information Center

Mumford, Vincent E.; Chandler, Judy Potter

2009-01-01

The Individuals with Disabilities Education Improvement Act (IDEA) of 2004 supports equitable access to educational opportunities for all children who have disabilities. IDEA requires that students who receive services for special needs receive a free appropriate public education, and have access to the general education curriculum, which includes…

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.

When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

PubMed

Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J

2013-01-01

Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

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.

Assessing out-of-pocket expenditures for primary health care: how responsive is the Democratic Republic of Congo health system to providing financial risk protection?

PubMed

Laokri, Samia; Soelaeman, Rieza; Hotchkiss, David R

2018-06-15

The goal of universal health coverage is challenging for chronically under-resourced health systems. Although household out-of-pocket payments are the most important source of health financing in low-income countries, relatively little is known about the drivers of primary health care expenditure and the predictability of the burden associated with high fee-for-service payments. This study describes out-of-pocket health expenditure and investigates demand- and supply-side drivers of excessive costs in the Democratic Republic of Congo (DRC), a central African country in the midst of a process of reforming its health financing system towards universal health coverage. A population-based household survey was conducted in four provinces of the DRC in 2014. Data included type, level and utilization of health care services, accessibility to care, patient satisfaction and disaggregated health care expenditure. Multivariate logistic regressions of excessive expenditure for outpatient care using alternative thresholds were performed to explore the incidence and predictors of atypically high expenditure incurred by individuals. Over 17% (17.5%) of individuals living in sample households reported an illness or injury without being hospitalized. Of 3341 individuals reporting an event in the four-week period prior to the survey, 65.6% sought outpatient care with an average of one visit (SD = 0.0). The overall mean expenditure per visit was US$ 6.7 (SD = 10.4) with 29.4% incurring excessive expenditure. The main predictors of a financial risk burden included utilizing public services offering the complementary benefit package, dissatisfaction with care received, being a member of a large household, expenditure composition, severity of illness, residence and wealth (p < .05). The insured status influenced the expenditure level, with no association with catastrophe. Those who did not seek care when needed reported financial constraints as the major reason for postponing or foregoing care. Wealth-related inequities were found in service and population coverage and in out-of-pocket payment for outpatient care. Burdensome expenditure for primary care and its key drivers are of utmost importance. Forthcoming health financing reform agendas must incorporate a strategy for getting data used in the design of financial risk protection. Realizing equitable and efficient access to outpatient care is a vital ingredient for sustainable health systems.

Funding gap for immunization across 94 low- and middle-income countries.

PubMed

Ozawa, Sachiko; Grewal, Simrun; Portnoy, Allison; Sinha, Anushua; Arilotta, Richard; Stack, Meghan L; Brenzel, Logan

2016-12-07

Novel vaccine development and production has given rise to a growing number of vaccines that can prevent disease and save lives. In order to realize these health benefits, it is essential to ensure adequate immunization financing to enable equitable access to vaccines for people in all communities. This analysis estimates the full immunization program costs, projected available financing, and resulting funding gap for 94 low- and middle-income countries over five years (2016-2020). Vaccine program financing by country governments, Gavi, and other development partners was forecasted for vaccine, supply chain, and service delivery, based on an analysis of comprehensive multi-year plans together with a series of scenario and sensitivity analyses. Findings indicate that delivery of full vaccination programs across 94 countries would result in a total funding gap of $7.6 billion (95% uncertainty range: $4.6-$11.8 billion) over 2016-2020, with the bulk (98%) of the resources required for routine immunization programs. More than half (65%) of the resources to meet this funding gap are required for service delivery at $5.0 billion ($2.7-$8.4 billion) with an additional $1.1 billion ($0.9-$2.7 billion) needed for vaccines and $1.5 billion ($1.1-$2.0 billion) for supply chain. When viewed as a percentage of total projected costs, the funding gap represents 66% of projected supply chain costs, 30% of service delivery costs, and 9% of vaccine costs. On average, this funding gap corresponds to 0.2% of general government expenditures and 2.3% of government health expenditures. These results suggest greater need for country and donor resource mobilization and funding allocation for immunizations. Both service delivery and supply chain are important areas for further resource mobilization. Further research on the impact of advances in service delivery technology and reductions in vaccine prices beyond this decade would be important for efficient investment decisions for immunization. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Crowdfunding our health: Economic risks and benefits.

PubMed

Renwick, Matthew J; Mossialos, Elias

2017-10-01

Crowdfunding is an expanding form of alternative financing that is gaining traction in the health sector. This article presents a typology for crowdfunded health projects and a review of the main economic benefits and risks of crowdfunding in the health market. We use evidence from a literature review, complimented by expert interviews, to extend the fundamental principles and established theories of crowdfunding to a health market context. Crowdfunded health projects can be classified into four types according to the venture's purpose and funding method. These are projects covering health expenses, fundraising health initiatives, supporting health research, or financing commercial health innovation. Crowdfunding could economically benefit the health sector by expanding market participation, drawing money and awareness to neglected health issues, improving access to funding, and fostering project accountability and social engagement. However, the economic risks of health-related crowdfunding include inefficient priority setting, heightened financial risk, inconsistent regulatory policies, intellectual property rights concerns, and fraud. Theorized crowdfunding behaviours such as signalling and herding can be observed in the market for health-related crowdfunding. Broader threats of market failure stemming from adverse selection and moral hazard also apply. Many of the discussed economic benefits and risks of crowdfunding health campaigns are shared more broadly with those of crowdfunding projects in other sectors. Where crowdfunding health care appears to diverge from theory is the negative externality inefficient priority setting may have towards achieving broader public health goals. Therefore, the market for crowdfunding health care must be economically stable, as well as designed to optimally and equitably improve public health. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Charter Schools: Limited Access to Facility Financing. Report to Congressional Requesters.

ERIC Educational Resources Information Center

Shaul, Marnie S.

This report determines the degree to which charter schools have access to traditional public school facility financing, and whether alternative sources of facility financing are available to charter schools. Further discussed are potential options generally available to the federal government if it were to assume a larger role in charter school…

Virtual Tutoring and Student Support Systems

ERIC Educational Resources Information Center

Geary, Jennifer Lee

2005-01-01

Virtual tutoring and student support systems may be pivotal in developing opportunities of equality and of outcome for students who study at a distance. Cookson (2002) mentions that it is important to assist students to have access to study programs. Cookson (2002) elaborates upon this and states, "If access is to be equitable, once they are…

Climate Change: Providing Equitable Access to a Rigorous and Engaging Curriculum

ERIC Educational Resources Information Center

Cardichon, Jessica; Roc, Martens

2013-01-01

This report examines how implementing rigorous and engaging curriculum aligned with college- and career-ready standards fosters positive school climates in which students are motivated to succeed, achievement gaps narrow, and learning and outcomes improve. It includes federal, state, and local recommendations for increasing access to high-quality,…

Access and benefit sharing: Best practices for the use and exchange of invertebrate biological control agents

USDA-ARS?s Scientific Manuscript database

The Convention on Biological Diversity (CBD) acknowledges the sovereign rights that countries have over their ‘genetic resources’. The Nagoya Protocol that came into force in 2014 provides a framework for implementation of and equitable process by which access to, and sharing of benefits between don...

Research into Telecommunications Options for People with Physical Disabilities

ERIC Educational Resources Information Center

Nguyen, Toan; Garrett, Rob; Downing, Andrew; Walker, Lloyd; Hobbs, David

2007-01-01

People with a disability do not have equitable access to the modern telecommunication medium. Many experience difficulty typing, handling the phone, dialing, or answering calls. For those who are unable to speak, the only option is to type messages using whatever functional control site exists on their body. The provision of accessible mobile…

Engaging Youth of Color in Applied Science Education and Public Health Promotion

ERIC Educational Resources Information Center

Sprague Martinez, Linda; Bowers, Edmond; Reich, Amanda J.; Ndulue, Uchenna J.; Le, Albert An; Peréa, Flavia C.

2016-01-01

Participation in inquiry-based science education, which focuses on student-constructed learning, has been linked to academic success. Whereas the benefits of this type of science education are evident, access to such high-quality science curriculum and programming is not equitable. Black and Latino students in particular have less access to…

Improving Information Access through Technology: A Plan for Louisiana's Public Libraries.

ERIC Educational Resources Information Center

Jaques, Thomas F.

Strengthening technology in Louisiana's public libraries will support equitable and convenient access to electronic information resources for all citizens at library sites, in homes, and in business. The plan presented in this document is intended to enhance and expand technology in the state's public libraries. After discussion of the crucial…

Incorporating Access to More Effective Teachers into Assessments of Educational Resource Equity

ERIC Educational Resources Information Center

Bastian, Kevin C.; Henry, Gary T.; Thompson, Charles L.

2013-01-01

To address gaps in achievement between more- and less-affluent students, states and districts need to ensure that high-poverty students and schools have equitable access to educational resources. Traditionally, assessments of resource equity have focused on per-pupil expenditures and more proximal inputs, such as teacher credentials and class…

EPIVAC International Conference on Financial Sustainability of Immunization Programs in sub-Saharan Africa, February 16-18, 2012, Ouidah, Benin.

PubMed

Drach, Marcel; Le Gargasson, Jean-Bernard; Mathonnat, Jacky; Da Silva, Alfred; Kaddar, Miloud; Colombini, Anaïs

2013-09-23

The introduction of new vaccines with much higher prices than traditional vaccines results in increasing budgetary pressure on immunization programs in GAVI-eligible countries, increasing the need to ensure their financial sustainability. In this context, the third EPIVAC (Epidemiology and Vaccinology) technical conference was held from February 16 to 18, 2012 at the Regional Institute of Public Health in Ouidah, Benin. Managers of ministries of health and finance from 11 West African countries (GAVI eligible countries), as well as former EPIVAC students and European experts, shared their knowledge and best practices on immunization financing at district and country level. The conference concluded by stressing five major priorities for the financial sustainability of national immunization programs (NIPs) in GAVI-eligible countries. - Strengthen public financing by increasing resources and fiscal space, improving budget processes, increasing contribution of local governments and strengthen efficiency of budget spending. - Promote equitable community financing which was recognized as a significant and essential contribution to the continuity of EPI operations. - Widen private funding by exploring prospects offered by sponsorship through foundations dedicated to immunization and by corporate social responsibility programs. - Contain the potential crowding-out effect of GAVI co-financing and ensure that decisions on new vaccine introductions are evidence-based. - Seek out innovative financing mechanisms such as taxes on food products or a national solidarity fund. Copyright © 2013. Published by Elsevier Ltd.. All rights reserved.

Financing healthcare in Gulf Cooperation Council countries: a focus on Saudi Arabia

PubMed Central

Alkhamis, Abdulwahab; Hassan, Amir; Cosgrove, Peter

2014-01-01

Background This paper presents an analysis of the main characteristics of the Gulf Cooperation Council’s (GCC) health financing systems and draws similarities and differences between GCC countries and other high-income and low-income countries, in order to provide recommendations for healthcare policy makers. The paper also illustrates some financial implications of the recent implementation of the Compulsory Employment-based Health Insurance (CEBHI) system in Saudi Arabia. Methods Employing a descriptive framework for the country-level analysis of healthcare financing arrangements, we compared expenditure data on healthcare from GCC and other developing and developed countries, mostly using secondary data from the World Health Organization health expenditure database. The analysis was supported by a review of related literature. Results There are three significant characteristics affecting healthcare financing in GCC countries: (i) large expatriate populations relative to the national population, which leads GCC countries to use different strategies to control expatriate healthcare expenditure; (ii) substantial government revenue, with correspondingly high government expenditure on healthcare services in GCC countries; and (iii) underdeveloped healthcare systems, with some GCC countries’ healthcare indicators falling below those of upper-middle-income countries. Conclusion Reforming the mode of health financing is vital to achieving equitable and efficient healthcare services. Such reform could assist GCC countries in improving their healthcare indicators and bring about a reduction in out-of-pocket payments for healthcare. PMID:23996348

23 CFR 660.511 - Eligibility.

Code of Federal Regulations, 2010 CFR

2010-04-01

... determining the eligibility of proposed improvements for financing with defense access roads funds. The... financing either in whole or in part with defense access road funds, MTMC will certify the project as important to the national defense and will authorize expenditure of defense access road funds. The Commander...

Investigations in the Science of Sports.

ERIC Educational Resources Information Center

Hammrich, Penny L.; Fadigan, Kathleen

2003-01-01

Describes the Sisters in Sport Science (SISS) program which provides equitable access for girls to science and mathematics through sports. Includes a sample SISS activity that integrates track and physical sciences. (YDS)

Equity of access to elective surgery: reflections from NZ clinicians.

PubMed

McLeod, Deborah; Dew, Kevin; Morgan, Sonya; Dowell, Anthony; Cumming, Jackie; Cormack, Donna; McKinlay, Eileen; Love, Tom

2004-10-01

To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding. The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.

31 CFR 1022.420 - Additional records to be maintained by providers and sellers of prepaid access.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Additional records to be maintained by providers and sellers of prepaid access. 1022.420 Section 1022.420 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FINANCIAL CRIMES ENFORCEMENT NETWORK, DEPARTMENT OF THE TREASURY...

31 CFR 1022.420 - Additional records to be maintained by providers and sellers of prepaid access.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Additional records to be maintained by providers and sellers of prepaid access. 1022.420 Section 1022.420 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FINANCIAL CRIMES ENFORCEMENT NETWORK, DEPARTMENT OF THE TREASURY...

31 CFR 1022.420 - Additional records to be maintained by providers and sellers of prepaid access.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Additional records to be maintained by providers and sellers of prepaid access. 1022.420 Section 1022.420 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FINANCIAL CRIMES ENFORCEMENT NETWORK, DEPARTMENT OF THE TREASURY...

31 CFR 408.3 - Rules governing access.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 408.3 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE... THE SECRET SERVICE AND TEMPORARY OFFICES OF THE PRESIDENT AND STAFF, OR OTHER PERSON PROTECTED BY THE SECRET SERVICE-RULES GOVERNING ACCESS § 408.3 Rules governing access. (a) For the purposes of 18 U.S.C...

31 CFR 408.3 - Rules governing access.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 408.3 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE... THE SECRET SERVICE AND TEMPORARY OFFICES OF THE PRESIDENT AND STAFF, OR OTHER PERSON PROTECTED BY THE SECRET SERVICE-RULES GOVERNING ACCESS § 408.3 Rules governing access. (a) For the purposes of 18 U.S.C...

31 CFR 408.3 - Rules governing access.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 408.3 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE... THE SECRET SERVICE AND TEMPORARY OFFICES OF THE PRESIDENT AND STAFF, OR OTHER PERSON PROTECTED BY THE SECRET SERVICE-RULES GOVERNING ACCESS § 408.3 Rules governing access. (a) For the purposes of 18 U.S.C...

31 CFR 408.3 - Rules governing access.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 408.3 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE... THE SECRET SERVICE AND TEMPORARY OFFICES OF THE PRESIDENT AND STAFF, OR OTHER PERSON PROTECTED BY THE SECRET SERVICE-RULES GOVERNING ACCESS § 408.3 Rules governing access. (a) For the purposes of 18 U.S.C...

31 CFR 408.3 - Rules governing access.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 408.3 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE... THE SECRET SERVICE AND TEMPORARY OFFICES OF THE PRESIDENT AND STAFF, OR OTHER PERSON PROTECTED BY THE SECRET SERVICE-RULES GOVERNING ACCESS § 408.3 Rules governing access. (a) For the purposes of 18 U.S.C...

Helping Children to Learn at Home: A Family Project to Support Young English-Language Learners

ERIC Educational Resources Information Center

Jasinski, Mary-Anne

2012-01-01

The Coalition for Equal Access to Education (CEAE) is a Calgary-based nonprofit organization committed to working with community, education, and government stakeholders to promote access to quality, equitable education and services for K-12 English-as-a-second-language (ESL) learners. CEAE is active in developing innovative projects, research…

Open Flexible Lifelong Learning as a Catalyst for Sustainable Development in Sub-Saharan Africa

ERIC Educational Resources Information Center

Olakulehin, Felix Kayode

2010-01-01

Educational provision in developing sub-Saharan Africa states has been severely hindered by the hydra-headed problems of access, cost and quality. Amidst these challenges is the pledge of regional and national education policymakers and development planners to ensure that there is maximum access equitable and qualitative education for all (EFA) in…

Faculty-Librarian Collaboration for Library Services in the Online Classroom: Student Evaluation Results and Recommended Practices for Implementation

ERIC Educational Resources Information Center

Figa, Elizabeth; Bone, Tonda; Macpherson, Janet R.

2009-01-01

Student success is influenced by their ability to access, evaluate, and use resources. Traditionally, academic librarianship has provided students with these information literacy skills. The increase in distance learning options has created the need for libraries to provide both reference services equitable to those available onsite and access to…

Digital Revolution or Digital Divide: Will Rural Teachers Get a Piece of the Professional Development Pie?

ERIC Educational Resources Information Center

Broadley, Tania

2010-01-01

In order to sustain the rural education community, access to high quality professional development opportunities must become a priority. Teachers in rural areas face many challenges in order to access professional learning equitable to their city counterparts. In the current climate, the Federal government of Australia is committed to initiatives…

Use of Tablet Computers to Improve Access to Education in a Remote Location

ERIC Educational Resources Information Center

Ally, Mohamed; Balaji, V.; Abdelbaki, Anwar; Cheng, Ricky

2017-01-01

A research project was carried out in using mobile learning to increase access to education. This project is contributing to the achievement of Goal 4 of the Sustainable Development Goals (SDGs), which is to "Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all". The mobile learning project…

School Location and Teacher Supply: Understanding the Distribution of Teacher Effects

ERIC Educational Resources Information Center

Gagnon, Douglas

2015-01-01

The U.S. Department of Education has recently called on all states to create plans to ensure equal access to excellent teachers. Although there are numerous limitations in using VAM [value-added modeling] in high-stakes contexts such as teacher evaluation, such techniques offer promise in helping states grapple with issues in equitable access.…

The US Culture Collection Network responding to the requirements of the Nagoya Protocol on Access and Benefit Sharing

USDA-ARS?s Scientific Manuscript database

The US Culture Collection Network held a meeting to share information about how collections are responding to the requirements of the recently enacted Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization to the Convention on Bio...

Financing Renewable Energy Projects in Developing Countries: A Critical Review

NASA Astrophysics Data System (ADS)

Donastorg, A.; Renukappa, S.; Suresh, S.

2017-08-01

Access to clean and stable energy, meeting sustainable development goals, the fossil fuel dependency and depletion are some of the reasons that have impacted developing countries to transform the business as usual economy to a more sustainable economy. However, access and availability of finance is a major challenge for many developing countries. Financing renewable energy projects require access to significant resources, by multiple parties, at varying points in the project life cycles. This research aims to investigate sources and new trends in financing RE projects in developing countries. For this purpose, a detail and in-depth literature review have been conducted to explore the sources and trends of current RE financial investment and projects, to understand the gaps and limitations. This paper concludes that there are various internal and external sources of finance available for RE projects in developing countries.

Ethics, economics, and public financing of health care

PubMed Central

Hurley, J.

2001-01-01

There is a wide variety of ethical arguments for public financing of health care that share a common structure built on a series of four logically related propositions regarding: (1) the ultimate purpose of a human life or human society; (2) the role of health and its distribution in society in advancing this ultimate purpose; (3) the role of access to or utilisation of health care in maintaining or improving the desired level and distribution of health among members of society, and (4) the role of public financing in ensuring the ethically justified access to and utilisation of health care by members of society. This paper argues that economics has much to contribute to the development of the ethical foundations for publicly financed health care. It focuses in particular on recent economic work to clarify the concepts of access and need and their role in analyses of the just distribution of health care resources, and on the importance of economic analysis of health care and health care insurance markets in demonstrating why public financing is necessary to achieve broad access to and utilisation of health care services. Key Words: Ethics • economics • health care financing PMID:11479353

Strategies for gender-equitable HIV services in rural India.

PubMed

Sinha, Gita; Peters, David H; Bollinger, Robert C

2009-05-01

The emergence of HIV in rural India has the potential to heighten gender inequity in a context where women already suffer significant health disparities. Recent Indian health policies provide new opportunities to identify and implement gender-equitable rural HIV services. In this review, we adapt Mosley and Chen's conceptual framework of health to outline determinants for HIV health services utilization and outcomes. Examining the framework through a gender lens, we conduct a comprehensive literature review for gender-related gaps in HIV clinical services in rural India, focusing on patient access and outcomes, provider practices, and institutional partnerships. Contextualizing findings from rural India in the broader international literature, we describe potential strategies for gender-equitable HIV services in rural India, as responses to the following three questions: (1) What gender-specific patient needs should be addressed for gender-equitable HIV testing and care? (2) What do health care providers need to deliver HIV services with gender equity? (3) How should institutions enforce and sustain gender-equitable HIV services? Data at this early stage indicate substantial gender-related differences in HIV services in rural India, reflecting prevailing gender norms. Strategies including gender-specific HIV testing and care services would directly address current gender-specific patient needs. Rural care providers urgently need training in gender sensitivity and HIV-related communication and clinical skills. To enforce and sustain gender equity, multi-sectoral institutions must establish gender-equitable medical workplaces, interdisciplinary HIV services partnerships, and oversight methods, including analysis of gender-disaggregated data. A gender-equitable approach to rural India's rapidly evolving HIV services programmes could serve as a foundation for gender equity in the overall health care system.

Strategies for gender-equitable HIV services in rural India

PubMed Central

Sinha, Gita; Peters, David H; Bollinger, Robert C

2009-01-01

The emergence of HIV in rural India has the potential to heighten gender inequity in a context where women already suffer significant health disparities. Recent Indian health policies provide new opportunities to identify and implement gender-equitable rural HIV services. In this review, we adapt Mosley and Chen's conceptual framework of health to outline determinants for HIV health services utilization and outcomes. Examining the framework through a gender lens, we conduct a comprehensive literature review for gender-related gaps in HIV clinical services in rural India, focusing on patient access and outcomes, provider practices, and institutional partnerships. Contextualizing findings from rural India in the broader international literature, we describe potential strategies for gender-equitable HIV services in rural India, as responses to the following three questions: (1) What gender-specific patient needs should be addressed for gender-equitable HIV testing and care? (2) What do health care providers need to deliver HIV services with gender equity? (3) How should institutions enforce and sustain gender-equitable HIV services? Data at this early stage indicate substantial gender-related differences in HIV services in rural India, reflecting prevailing gender norms. Strategies including gender-specific HIV testing and care services would directly address current gender-specific patient needs. Rural care providers urgently need training in gender sensitivity and HIV-related communication and clinical skills. To enforce and sustain gender equity, multi-sectoral institutions must establish gender-equitable medical workplaces, interdisciplinary HIV services partnerships, and oversight methods, including analysis of gender-disaggregated data. A gender-equitable approach to rural India's rapidly evolving HIV services programmes could serve as a foundation for gender equity in the overall health care system. PMID:19244284

Multiple crises and global health: New and necessary frontiers of health politics

PubMed Central

Schrecker, Ted

2012-01-01

The world economy is entering an era of multiple crises, involving finance, food security and global environmental change. This article assesses the implications for global public health, describes the contours of post-2007 crises in food security and finance, and then briefly indicates the probable health impacts. There follows a discussion of the crisis of climate change, one that will unfold over a longer time frame but with manifestations that may already be upon us. The article then discusses the political economy of responses to these crises, noting the formidable obstacles that exist to equitable resolution. The article concludes by noting the threat that such crises present to recent progress in global health, arguing that global health researchers and practitioners must become more familiar with the relevant social processes, and that proposed solutions that neglect the continuing importance of the nation-state are misdirected. PMID:22657093

Mental health community based funding: Ohio's experience in revising its funding allocation methodology.

PubMed

Seiber, Eric E; Sweeney, Helen Anne; Partridge, Jamie; Dembe, Allard E; Jones, Holly

2012-10-01

Over the past 20 years, states have increasingly moved away from centrally financed, state-operated facilities to financing models built around community-based service delivery mechanisms. This paper identifies four important broad factors to consider when developing a funding formula to allocate state funding for community mental health services to local boards in an equitable manner, based on local community need: (1) funding factors used by other states; (2) state specific legislative requirements; (3) data availability; and (4) local variation of factors in the funding formula. These considerations are illustrated with the recent experience of Ohio using available evidence and data sources to develop a new community-based allocation formula. We discuss opportunities for implementing changes in formula based mental health funding related to Medicaid expansions for low income adults scheduled to go into effect under the new Patient Protection and Affordable Care Act.

Multiple crises and global health: new and necessary frontiers of health politics.

PubMed

Schrecker, Ted

2012-01-01

The world economy is entering an era of multiple crises, involving finance, food security and global environmental change. This article assesses the implications for global public health, describes the contours of post-2007 crises in food security and finance, and then briefly indicates the probable health impacts. There follows a discussion of the crisis of climate change, one that will unfold over a longer time frame but with manifestations that may already be upon us. The article then discusses the political economy of responses to these crises, noting the formidable obstacles that exist to equitable resolution. The article concludes by noting the threat that such crises present to recent progress in global health, arguing that global health researchers and practitioners must become more familiar with the relevant social processes, and that proposed solutions that neglect the continuing importance of the nation-state are misdirected.

Fair and Equitable Postal Service Access Act

THOMAS, 112th Congress

Rep. Moore, Gwen [D-WI-4

2011-09-15

House - 10/03/2011 Referred to the Subcommittee on Federal Workforce, U.S. Postal Service, and Labor Policy . (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Leveraging community-based financing for women's nonmaternal health care: experiences of rural Indian women.

PubMed

Gopalan, Saji S; Durairaj, Varatharajan

2015-03-01

Given the increasing need for mainstreaming household financing for women's nonmaternal health care and evidences on community-based financing's contribution to women's health care in general, this study explored their scope for nonmaternal health care in Orissa. A qualitative assessment conducted focus group discussions with rural women who met the eligibility criteria. Community-based financing provided financial access and risk protection for women's nonmaternal health care during the previous 1 year, though not adequately. Schemes covering outpatient care (or mild illnesses) provided relatively more financial access. The major determinants of their restricted financial access were limited sum assured, noncomprehensive coverage of services, exclusion of elderly women, and the lower priority households gave to nonmaternal health care. Community-based financing requires relevant structural changes along with demand-side behavioral modifications to ensure optimal attention to women's nonmaternal health care. © 2012 APJPH.

Ethics, economics, and public financing of health care.

PubMed

Hurley, J

2001-08-01

There is a wide variety of ethical arguments for public financing of health care that share a common structure built on a series of four logically related propositions regarding: (1) the ultimate purpose of a human life or human society; (2) the role of health and its distribution in society in advancing this ultimate purpose; (3) the role of access to or utilisation of health care in maintaining or improving the desired level and distribution of health among members of society, and (4) the role of public financing in ensuring the ethically justified access to and utilisation of health care by members of society. This paper argues that economics has much to contribute to the development of the ethical foundations for publicly financed health care. It focuses in particular on recent economic work to clarify the concepts of access and need and their role in analyses of the just distribution of health care resources, and on the importance of economic analysis of health care and health care insurance markets in demonstrating why public financing is necessary to achieve broad access to and utilisation of health care services.

Diffusion across the Digital Divide: Assessing Use of the Connecticut Digital Library (ICONN) in K-12 Schools in Connecticut

ERIC Educational Resources Information Center

Bogel, Gayle

2008-01-01

State digital libraries are manifestations of the diffusion of technology that has provided both "access to" and "delivery of" digital content. Whether the content is being accessed and used equitably in K-12 schools has not been assessed. Determining patterns of the diffusion of use across socioeconomic groups in K-12 schools…

Analysis of the Higher Education Act Reauthorizations: Financial Aid Policy Influencing College Access and Choice

ERIC Educational Resources Information Center

Capt, Robin L.

2013-01-01

The original goal of the Higher Education Act of 1965, the amendments to that act in 1972, and reauthorizations through 1998 was to increase accessibility of higher education to all. Initially these system-level efforts substantially enhanced equity, but recent enrollment trends raise the question: Is our system becoming more or less equitable? By…

Understanding the Complex Dimensions of the Digital Divide: Lessons Learned in the Alaskan Arctic

ERIC Educational Resources Information Center

Subramony, Deepak Prem

2007-01-01

An ethnographic case study of Inupiat Eskimo in the Alaskan Arctic has provided insights into the complex nature of the sociological issues surrounding equitable access to technology tools and skills, which are referred to as the digital divide. These people can overcome the digital divide if they get the basic ready access to hardware and…

Quality Ratings and Improvement Systems in Early Childhood Education: Promising Approaches for Pennsylvania. A PACER Policy Brief

ERIC Educational Resources Information Center

Jenkins, Della; Englander, Katie

2016-01-01

Policymakers are recognizing that Pennsylvania has fallen behind in providing equitable access to high quality early childhood education. Governor Tom Wolf ran on a campaign promise of universal pre-k access and proposed an unprecedented budget increase for early childhood programs in 2016. In Philadelphia, Mayor Jim Kenney has made pre-k a…

To Play or Not to Play: Equitable Access to Afterschool Programs for Students with Disabilities

ERIC Educational Resources Information Center

Meade, Whitney W.; O'Brien, Jason

2018-01-01

In this case, a child with a spinal cord injury was denied access to an afterschool care program that her nondisabled siblings were allowed to attend because she did not meet "eligibility requirements." Specifically, the independent contractor who ran the program mandated that students be able to function in an environment with a student…

Equality or Equity, Player or Guardian? The Dutch Government and Its Role in Providing Access Opportunities for Government Sponsored International Secondary Education, 1979-2009

ERIC Educational Resources Information Center

Prickarts, Boris

2010-01-01

This article focuses on the Dutch government's International Baccalaureate (IB) Diploma Programme (DP) Pilot, allowing Dutch pre-university students to take part in the IB DP. Is it likely to create "equal", or rather "equitable", access opportunities for government-sponsored Dutch international secondary schools? The article…

How Should Organizations Promote Equitable Distribution of Benefits from Technological Innovation in Health Care?

PubMed

Nambisan, Satish; Nambisan, Priya

2017-11-01

Technological innovations typically benefit those who have good access to and an understanding of the underlying technologies. As such, technology-centered health care innovations are likely to preferentially benefit users of privileged socioeconomic backgrounds. Which policies and strategies should health care organizations adopt to promote equitable distribution of the benefits from technological innovations? In this essay, we draw on two important concepts-co-creation (the joint creation of value by multiple parties such as a company and its customers) and digitalization (the application of new digital technologies and the ensuing changes in sociotechnical structures and relationships)-and propose a set of policies and strategies that health care organizations could adopt to ensure that benefits from technological innovations are more equitably distributed among all target populations, including resource-poor communities and individuals. © 2017 American Medical Association. All Rights Reserved.

The impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa.

PubMed

Scheffler, Elsje; Visagie, Surona; Schneider, Marguerite

2015-06-19

Health care access is complex and multi-faceted and, as a basic right, equitable access and services should be available to all user groups. The aim of this article is to explore how service delivery impacts on access to healthcare for vulnerable groups in an urban primary health care setting in South Africa. A descriptive qualitative study design was used. Data were collected through semi-structured interviews with purposively sampled participants and analysed through thematic content analysis. Service delivery factors are presented against five dimensions of access according to the ACCESS Framework. From a supplier perspective, the organisation of care in the study setting resulted in available, accessible, affordable and adequate services as measured against the DistrictHealth System policies and guidelines. However, service providers experienced significant barriers in provision of services, which impacted on the quality of care, resulting in poor client and provider satisfaction and ultimately compromising acceptability of service delivery. Although users found services to be accessible, the organisation of services presented them with challenges in the domains of availability, affordability and adequacy, resulting in unmet needs, low levels of satisfaction and loss of trust. These challenges fuelled perceptions of unacceptable services. Well developed systems and organisation of services can create accessible, affordable and available primary healthcare services, but do not automatically translate into adequate and acceptable services. Focussing attention on how services are delivered might restore the balance between supply (services) and demand (user needs) and promote universal and equitable access.

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

12 CFR 911.6 - Persons and entities with access to unpublished information.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Persons and entities with access to unpublished information. 911.6 Section 911.6 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND OPERATIONS AVAILABILITY OF UNPUBLISHED INFORMATION § 911.6 Persons and entities with access to...

12 CFR 911.6 - Persons and entities with access to unpublished information.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Persons and entities with access to unpublished information. 911.6 Section 911.6 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND OPERATIONS AVAILABILITY OF UNPUBLISHED INFORMATION § 911.6 Persons and entities with access to...

12 CFR 911.6 - Persons and entities with access to unpublished information.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Persons and entities with access to unpublished information. 911.6 Section 911.6 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND OPERATIONS AVAILABILITY OF UNPUBLISHED INFORMATION § 911.6 Persons and entities with access to...

12 CFR 911.6 - Persons and entities with access to unpublished information.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Persons and entities with access to unpublished information. 911.6 Section 911.6 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND OPERATIONS AVAILABILITY OF UNPUBLISHED INFORMATION § 911.6 Persons and entities with access to...

Financing healthcare in Gulf Cooperation Council countries: a focus on Saudi Arabia.

PubMed

Alkhamis, Abdulwahab; Hassan, Amir; Cosgrove, Peter

2014-01-01

This paper presents an analysis of the main characteristics of the Gulf Cooperation Council's (GCC) health financing systems and draws similarities and differences between GCC countries and other high-income and low-income countries, in order to provide recommendations for healthcare policy makers. The paper also illustrates some financial implications of the recent implementation of the Compulsory Employment-based Health Insurance (CEBHI) system in Saudi Arabia. Employing a descriptive framework for the country-level analysis of healthcare financing arrangements, we compared expenditure data on healthcare from GCC and other developing and developed countries, mostly using secondary data from the World Health Organization health expenditure database. The analysis was supported by a review of related literature. There are three significant characteristics affecting healthcare financing in GCC countries: (i) large expatriate populations relative to the national population, which leads GCC countries to use different strategies to control expatriate healthcare expenditure; (ii) substantial government revenue, with correspondingly high government expenditure on healthcare services in GCC countries; and (iii) underdeveloped healthcare systems, with some GCC countries' healthcare indicators falling below those of upper-middle-income countries. Reforming the mode of health financing is vital to achieving equitable and efficient healthcare services. Such reform could assist GCC countries in improving their healthcare indicators and bring about a reduction in out-of-pocket payments for healthcare. © 2013 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.

What are the determinants of food security among regional and remote Western Australian children?

PubMed

Godrich, Stephanie L; Davies, Christina R; Darby, Jill; Devine, Amanda

2017-01-22

To explore how determinants of food security affect children in regional and remote Western Australia (WA), across food availability, access and utilisation dimensions. The Determinants of Food Security framework guided the thematic analysis (using NVivo 10) of semi-structured interviews with 20 key informants. Food availability factors included availability, price, promotion, quality, location of outlets and variety. Food access factors included social support, financial resources, transport to food outlets, distance to food outlets and mobility. Food utilisation factors included nutrition knowledge and skills, children's food preferences, storage facilities, preparation and cooking facilities and time to purchase food. Key food availability recommendations include increasing local food supply options. Food access recommendations include ensuring equitable formal social support and empowering informal support options. Food utilisation recommendations include prioritising food literacy programs focusing on quick, healthy food preparation and budgeting skills. Implications for public health: Policymakers should invest in local food supply options, equitable social support services and experiential food literacy programs. Practitioners should focus child/parent programs on improving attitude, knowledge and skills. © 2017 Public Health Association of Australia.

75 FR 77022 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-10

... evolution of technologies and systems through which data may be accessed. NASDAQ, like other data providers... just and equitable principles of trade, to foster cooperation and coordination with persons engaged in...

The U.S. Culture Collection Network Responding to the Requirements of the Nagoya Protocol on Access and Benefit Sharing

Treesearch

Kevin McCluskey; Katharine B. Barker; Hazel A. Barton; Kyria Boundy-Mills; Daniel R. Brown; Jonathan A. Coddington; Kevin Cook; Philippe Desmeth; David Geiser; Jessie A. Glaeser; Stephanie Greene; Seogchan Kang; Michael W. Lomas; Ulrich Melcher; Scott E. Miller; David R. Nobles; Kristina J. Owens; Jerome H. Reichman; Manuela da Silva; John Wertz; Cale Whitworth; David Smith; Steven E. Lindow

2017-01-01

The U.S. Culture Collection Network held a meeting to share information about how culture collections are responding to the requirements of the recently enacted Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization to the Convention on Biological Diversity (CBD). The meeting included representatives...

Innovative Approaches Address Aging and Mental Health Needs in LGBTQ Communities.

PubMed

Hoy-Ellis, Charles P; Ator, Michael; Kerr, Christopher; Milford, Jessica

2016-01-01

LGBTQ older adults have higher levels of psychological distress as compared to older adults in general. They also experience multiple barriers to accessing equitable, culturally competent mental health and aging services because of their distinct histories and particular social contexts. This article discusses this lack of access to services, and highlights an innovative way mental health services are being delivered in LGBTQ communities.

A mobile school-based HCT service - is it youth friendly?

PubMed

Lawrence, Estelle; Struthers, Patricia; Van Hove, Geert

2016-12-01

Despite an increase in HIV Counselling and Testing (HCT), few young people have been tested. It has been suggested that they do not test because formal health services (where HCT is provided) are often not youth friendly. The World Health Organisation describes a youth-friendly health service (YFHS) as one which is accessible, equitable, acceptable, appropriate, and effective. A mobile school-based model has been implemented by a non-governmental organisation in Cape Town in an attempt to make HCT more youth friendly and accessible to young people. The objective of this study was to explore whether this mobile school-based HCT service is youth friendly. The study was descriptive, using three qualitative data collection methods: observation of the HCT site at two secondary schools; interviews with six service providers; and direct observation of 21 HCT counselling sessions. The mobile school-based HCT service fulfilled some of the criteria for being a YFHS. The service was equitable in that all students, irrespective of race, gender, age, or socio-economic status, were free to use the service. It was accessible in terms of location and cost, but students were not well informed to make decisions about using the service. The service was acceptable in that confidentiality was guaranteed and the service providers were friendly and non-judgemental, but it was not considered acceptable in that there was limited privacy. The service was appropriate in that HCT is recommended as an intervention for decreasing the transmission of HIV, based on evidence and expert opinion; however, in this case, HCT was provided as a stand-alone service rather than part of a full package of services. Moreover, studies have suggested that young people want to know their HIV status. The service was ineffective in that it identified students who are HIV positive; however, these students were not assisted to access care. Providing HCT in the school setting may make HCT more accessible for students, but it needs to be provided in an equitable, accessible, acceptable, and effective way.

A mobile school-based HCT service – is it youth friendly?

PubMed Central

Lawrence, Estelle; Struthers, Patricia; Van Hove, Geert

2016-01-01

Abstract Background: Despite an increase in HIV Counselling and Testing (HCT), few young people have been tested. It has been suggested that they do not test because formal health services (where HCT is provided) are often not youth friendly. The World Health Organisation describes a youth-friendly health service (YFHS) as one which is accessible, equitable, acceptable, appropriate, and effective. A mobile school-based model has been implemented by a non-governmental organisation in Cape Town in an attempt to make HCT more youth friendly and accessible to young people. The objective of this study was to explore whether this mobile school-based HCT service is youth friendly. Methods: The study was descriptive, using three qualitative data collection methods: observation of the HCT site at two secondary schools; interviews with six service providers; and direct observation of 21 HCT counselling sessions. Key Results: The mobile school-based HCT service fulfilled some of the criteria for being a YFHS. The service was equitable in that all students, irrespective of race, gender, age, or socio-economic status, were free to use the service. It was accessible in terms of location and cost, but students were not well informed to make decisions about using the service. The service was acceptable in that confidentiality was guaranteed and the service providers were friendly and non-judgemental, but it was not considered acceptable in that there was limited privacy. The service was appropriate in that HCT is recommended as an intervention for decreasing the transmission of HIV, based on evidence and expert opinion; however, in this case, HCT was provided as a stand-alone service rather than part of a full package of services. Moreover, studies have suggested that young people want to know their HIV status. The service was ineffective in that it identified students who are HIV positive; however, these students were not assisted to access care. Conclusion: Providing HCT in the school setting may make HCT more accessible for students, but it needs to be provided in an equitable, accessible, acceptable, and effective way. PMID:27576352

U.S. Physicians’ Views on Financing Options to Expand Health Insurance Coverage: A National Survey

PubMed Central

Woolhandler, Steffie; Bose-Kolanu, Anjali; Germann, Antonio; Bor, David H.; Himmelstein, David U.

2009-01-01

BACKGROUND Physician opinion can influence the prospects for health care reform, yet there are few recent data on physician views on reform proposals or access to medical care in the United States. OBJECTIVE To assess physician views on financing options for expanding health care coverage and on access to health care. DESIGN AND PARTICIPANTS Nationally representative mail survey conducted between March 2007 and October 2007 of U.S. physicians engaged in direct patient care. MEASUREMENTS Rated support for reform options including financial incentives to induce individuals to purchase health insurance and single-payer national health insurance; rated views of several dimensions of access to care. MAIN RESULTS 1,675 of 3,300 physicians responded (50.8%). Only 9% of physicians preferred the current employer-based financing system. Forty-nine percent favored either tax incentives or penalties to encourage the purchase of medical insurance, and 42% preferred a government-run, taxpayer-financed single-payer national health insurance program. The majority of respondents believed that all Americans should receive needed medical care regardless of ability to pay (89%); 33% believed that the uninsured currently have access to needed care. Nearly one fifth of respondents (19.3%) believed that even the insured lack access to needed care. Views about access were independently associated with support for single-payer national health insurance. CONCLUSIONS The vast majority of physicians surveyed supported a change in the health care financing system. While a plurality support the use of financial incentives, a substantial proportion support single payer national health insurance. These findings challenge the perception that fundamental restructuring of the U.S. health care financing system receives little acceptance by physicians. PMID:19184240

Achieving effective universal health coverage with equity: evidence from Chile.

PubMed

Frenz, Patricia; Delgado, Iris; Kaufman, Jay S; Harper, Sam

2014-09-01

Chile's 'health guarantees' approach to providing universal and equitable coverage for quality healthcare in a dual public-private health system has generated global interest. The programme, called AUGE, defines legally enforceable rights to explicit healthcare benefits for priority health conditions, which incrementally covered 56 problems representing 75% of the disease burden between 2005 and 2009. It was accompanied by other health reform measures to increase public financing and public sector planning to secure the guarantees nationwide, as well as the state's stewardship role. We analysed data from household surveys conducted before and after the AUGE reform to estimate changes in levels of unmet health need, defined as the lack of a healthcare visit for a health problem occurring in the last 30 days, by age, sex, income, education, health insurance, residence and ethnicity; fitting logistic regression models and using predictive margins. The overall prevalence of unmet health need was much lower in 2009 (17.6%, 95% CI: 16.5%, 18.6%) than in 2000 (30.0%, 95% CI: 28.3%, 31.7%). Differences by income and education extremes and rural-urban residence disappeared. In 2009, people who had been in treatment for a condition covered by AUGE in the past year had a lower adjusted prevalence of unmet need for their recent problem (11.7%, 95% CI: 10.5%, 13.2%) than who had not (21.0%, 95% CI: 19.6%, 22.4%). Despite limitations including cross-sectional and self-reported data, our findings suggest that the Chilean health system has become more equitable and responsive to need. While these changes cannot be directly attributed to AUGE, they were coincident with the AUGE reforms. However, healthcare equity concerns are still present, relating to quality of care, health system barriers and differential access for health conditions that are not covered by AUGE. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

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.

Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?

PubMed

Hunter, Benjamin M; Murray, Susan F

2017-08-31

Demand-side financing (DSF) interventions, including cash transfers and vouchers, have been introduced to promote maternal and newborn health in a range of low- and middle-income countries. These interventions vary in design but have typically been used to increase health service utilisation by offsetting some financial costs for users, or increasing household income and incentivising 'healthy behaviours'. This article documents experiences and implementation factors associated with use of DSF in maternal and newborn health. A secondary analysis (using an adapted Supporting the Use of Research Evidence framework - SURE) was performed on studies that had previously been identified in a systematic review of evidence on DSF interventions in maternal and newborn health. The article draws on findings from 49 quantitative and 49 qualitative studies. The studies give insights on difficulties with exclusion of migrants, young and multiparous women, with demands for informal fees at facilities, and with challenges maintaining quality of care under increasing demand. Schemes experienced difficulties if communities faced long distances to reach participating facilities and poor access to transport, and where there was inadequate health infrastructure and human resources, shortages of medicines and problems with corruption. Studies that documented improved care-seeking indicated the importance of adequate programme scope (in terms of programme eligibility, size and timing of payments and voucher entitlements) to address the issue of concern, concurrent investments in supply-side capacity to sustain and/or improve quality of care, and awareness generation using community-based workers, leaders and women's groups. Evaluations spanning more than 15 years of implementation of DSF programmes reveal a complex picture of experiences that reflect the importance of financial and other social, geographical and health systems factors as barriers to accessing care. Careful design of DSF programmes as part of broader maternal and newborn health initiatives would need to take into account these barriers, the behaviours of staff and the quality of care in health facilities. Research is still needed on the policy context for DSF schemes in order to understand how they become sustainable and where they fit, or do not fit, with plans to achieve equitable universal health coverage.

Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: results from a cross-sectional survey.

PubMed

Kimani, James K; Ettarh, Remare; Kyobutungi, Catherine; Mberu, Blessing; Muindi, Kanyiva

2012-03-19

The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city. The study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program. Only 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance. The proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.

How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review.

PubMed

McCollum, Rosalind; Gomez, Woedem; Theobald, Sally; Taegtmeyer, Miriam

2016-05-20

Community health workers (CHWs) are uniquely placed to link communities with the health system, playing a role in improving the reach of health systems and bringing health services closer to hard-to-reach and marginalised groups. A systematic review was conducted to determine the extent of equity of CHW programmes and to identify intervention design factors which influence equity of health outcomes. In accordance with our published protocol, we systematically searched eight databases from 2004 to 2014 for quantitative and qualitative studies which assessed access, utilisation, quality or community empowerment following introduction of a CHW programme according to equity stratifiers (place of residence, gender, socio-economic position and disability). Thirty four papers met inclusion criteria. A thematic framework was applied and data extracted and managed, prior to charting and thematic analysis. To our knowledge this is the first systematic review that describes the extent of equity within CHW programmes and identifies CHW intervention design features which influence equity. CHW programmes were found to promote equity of access and utilisation for community health by reducing inequities relating to place of residence, gender, education and socio-economic position. CHWs can also contribute towards more equitable uptake of referrals at health facility level. There was no clear evidence for equitable quality of services provided by CHWs and limited information regarding the role of the CHW in generating community empowerment to respond to social determinants of health. Factors promoting greater equity of CHW services include recruitment of most poor community members as CHWs, close proximity of services to households, pre-existing social relationship with CHW, provision of home-based services, free service delivery, targeting of poor households, strengthened referral to facility, sensitisation and mobilisation of community. However, if CHW programmes are not well planned some of the barriers faced by clients at health facility level can replicate at community level. CHWs promote equitable access to health promotion, disease prevention and use of curative services at household level. However, care must be taken by policymakers and implementers to take into account factors which can influence the equity of services during planning and implementation of CHW programmes.

When Health Systems Are Barriers to Health Care: Challenges Faced by Uninsured Mexican Kidney Patients

PubMed Central

Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J.

2013-01-01

Background Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. Methods The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. Results In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Conclusions Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort. PMID:23349868

Compendium on Financing of Higher Education: Final Report of the Financing the Students' Future Project

ERIC Educational Resources Information Center

Payne, Bethan; Charonis, George-Konstantinos; Haaristo, Hanna-Stella; Maurer, Moritz; Kaiser, Florian; Siegrist, Rahel; McVitty, Debbie; Gruber, Angelika; Heerens, Nik; Xhomaqi, Brikena; Nötzl, Tina; Semjonov, Meeli; Primožic, Rok

2013-01-01

Higher education plays a vital role in society and the quality, accessibility, and form of higher education is highly dependent on financing. Financing of higher education is conceived to be of central importance for the future creation and dissemination of knowledge and research. Therefore, the financing of higher education is a topic that has…

Innovative Approaches Address Aging and Mental Health Needs in LGBTQ Communities

PubMed Central

Hoy-Ellis, Charles P.; Ator, Michael; Kerr, Christopher; Milford, Jessica

2016-01-01

LGBTQ older adults have higher levels of psychological distress as compared to older adults in general. They also experience multiple barriers to accessing equitable, culturally competent mental health and aging services because of their distinct histories and particular social contexts. This article discusses this lack of access to services, and highlights an innovative way mental health services are being delivered in LGBTQ communities. PMID:28366982

California's county hospitals and the University of California graduate medical education system. Current issues and future directions.

PubMed

Jameson, W J; Pierce, K; Martin, D K

1998-05-01

California's county hospitals train 45% of the state's graduate medical residents, including 33% of residents in the University of California system. This paper describes the interrelationships of California's county hospitals and the University of California (UC) graduate medical education (GME) programs, highlighting key challenges facing both systems. The mission of California's county health care systems is to serve all who need health care services regardless of ability to pay. Locating UC GME programs in county hospitals helps serve the public missions of both institutions. Such partnerships enhance the GME experience of UC residents, provide key primary care training opportunities, and ensure continued health care access for indigent and uninsured populations. Only through affiliation with university training programs have county hospitals been able to run the cost-effective, quality programs that constitute an acceptable safety net for the poor. Financial stress, however, has led county hospitals and UC's GME programs to advocate for reform in both GME financing and indigent care funding. County hospitals must participate in constructing strategies for GME reform to assure that GME funding mechanisms provide for equitable compensation of county hospitals' essential role. Joint advocacy will also be essential in achieving significant indigent care policy reform.

Exploring barriers to and enablers of adequate healthcare for Indigenous Australian prisoners with cancer: a scoping review drawing on evidence from Australia, Canada and the United States.

PubMed

Olds, Jessica; Reilly, Rachel; Yerrell, Paul; Stajic, Janet; Micklem, Jasmine; Morey, Kim; Brown, Alex

International frameworks supported by national principles in Australia stipulate that prisoners should be provided with health services equivalent to those provided in the general community. However, a number of barriers unique to the prison system may hinder the provision of equitable healthcare for this population. In Australia, Indigenous people carry a greater burden of cancer mortality, which the Cancer Data and Aboriginal Disparities (CanDAD) project is seeking to address. During the course of recruiting participants to the CanDAD study, Indigenous Australian prisoners with cancer emerged as an important, under-researched but difficult to access sub-group. This scoping review sought to identify barriers and facilitators of access to adequate and equitable healthcare for Indigenous Australian prisoners with cancer in Australia. This review demonstrated a lack of research and, as such, the scoping review was extended to prisoners with cancer in Australia, New Zealand, the United States and Canada. This approach was taken in order to summarise the existing body of evidence regarding the barriers and facilitators of access to adequate and equitable healthcare for those who are incarcerated and suffering from cancer, and highlight areas that may require further investigation. Eight studies or commentaries were found to meet the inclusion criteria. This limited set of findings pointed to a range of possible barriers faced by prisoners with cancer, including a tension between the prisons' concern with security versus the need for timely access to medical care. Findings identified here offer potential starting points for research and policy development. Further research is needed to better elucidate how barriers to adequate cancer care for prisoners may be identified and overcome, in Australia and internationally. Furthermore, given Indigenous Australians' over-burden of cancer mortality and over-representation in the prison system, further research is needed to identify whether there are a unique set of barriers for this group.

Equitable science education in urban middle schools: Do reform efforts make a difference?

NASA Astrophysics Data System (ADS)

Hewson, Peter W.; Butler Kahle, Jane; Scantlebury, Kathryn; Davies, Darleen

2001-12-01

A central commitment of current reforms in science education is that all students, regardless of culture, gender, race, and/ or socioeconomic status, are capable of understanding and doing science. The study Bridging the Gap: Equity in Systemic Reform assessed equity in systemic reform using a nested research design that drew on both qualitative and quantitative methodologies. As part of the study, case studies were conducted in two urban middle schools in large Ohio cities. The purpose of the case studies was to identify factors affecting equity in urban science education reform. Data were analyzed using Kahle's (1998) equity metric. That model allowed us to assess progress toward equity using a range of research-based indicators grouped into three categories critical for equitable education: access to, retention in, and achievement in quality science education. In addition, a fourth category was defined for systemic indicators of equity. Analyses indicated that the culture and climate of the case study schools differentially affected their progress toward equitable reform in science education.

Sharing the benefits of genetic resources: from biodiversity to human genetics.

PubMed

Schroeder, Doris; Lasén-Díaz, Carolina

2006-12-01

Benefit sharing aims to achieve an equitable exchange between the granting of access to a genetic resource and the provision of compensation. The Convention on Biological Diversity (CBD), adopted at the 1992 Earth Summit in Rio de Janeiro, is the only international legal instrument setting out obligations for sharing the benefits derived from the use of biodiversity. The CBD excludes human genetic resources from its scope, however, this article considers whether it should be expanded to include those resources, so as to enable research subjects to claim a share of the benefits to be negotiated on a case-by-case basis. Our conclusion on this question is: 'No, the CBD should not be expanded to include human genetic resources.' There are essential differences between human and non-human genetic resources, and, in the context of research on humans, an essentially fair exchange model is already available between the health care industry and research subjects. Those who contribute to research should receive benefits in the form of accessible new health care products and services, suitable for local health needs and linked to economic prosperity (e.g. jobs). When this exchange model does not apply, as is often the case in developing countries, individually negotiated benefit sharing agreements between researchers and research subjects should not be used as 'window dressing'. Instead, national governments should focus their finances on the best economic investment they could make; the investment in population health and health research as outlined by the World Health Organization's Commission on Macroeconomics and Health; whilst international barriers to such spending need to be removed.

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

Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low- and middle-income countries.

PubMed

Lassi, Zohra S; Musavi, Nabiha B; Maliqi, Blerta; Mansoor, Nadia; de Francisco, Andres; Toure, Kadidiatou; Bhutta, Zulfiqar A

2016-03-12

There is a broad consensus and evidence that shows qualified, accessible, and responsive human resources for health (HRH) can make a major impact on the health of the populations. At the same time, there is widespread recognition that HRH crises particularly in low- and middle-income countries (LMICs) impede the achievement of better health outcomes/targets. In order to achieve the Sustainable Development Goals (SDGs), equitable access to a skilled and motivated health worker within a performing health system is need to be ensured. This review contributes to the vast pool of literature towards the assessment of HRH for maternal health and is focused on interventions delivered by skilled birth attendants (SBAs). Studies were included if (a) any HRH interventions in management system, policy, finance, education, partnership, and leadership were implemented; (b) these were related to SBA; (c) reported outcomes related to maternal health; (d) the studies were conducted in LMICs; and (e) studies were in English. Studies were excluded if traditional birth attendants and/or community health workers were trained. The review identified 25 studies which revealed reasons for poor maternal health outcomes in LMICs despite the efforts and policies implemented throughout these years. This review suggested an urgent and immediate need for formative evidence-based research on effective HRH interventions for improved maternal health outcomes. Other initiatives such as education and empowerment of women, alleviating poverty, establishing gender equality, and provision of infrastructure, equipment, drugs, and supplies are all integral components that are required to achieve SDGs by reducing maternal mortality and improving maternal health.

The Case for Evaluating Student Outcomes and Equity Gaps to Improve Pathways and Programs of Study

ERIC Educational Resources Information Center

Bragg, Debra D.

2017-01-01

When linked to program review and improvement, program evaluation can help practitioners to ensure that career-technical education (CTE) and science, technology, engineering, and mathematics (STEM) programs offer equitable access and outcomes for underserved student groups.

Technology in Education. IDRA Focus.

ERIC Educational Resources Information Center

IDRA Newsletter, 1995

1995-01-01

This theme issue includes four articles on the effective use of computers and electronic technology in education, and on equitable access to educational technologies for Hispanics and other minority groups. "Teachers and Instructional Technology: Wise or Foolish Choices" (Laura Chris Green) describes three unproductive roles for computer…

Community Collaboration, Use of Universal Design in the Classroom

ERIC Educational Resources Information Center

Smith, Rachel E.; Buchannan, Tara

2012-01-01

Barriers to classroom participation for postsecondary students with disabilities are often addressed through accommodations via disability resource offices. However, the use of individualized accommodations as the sole method for resolving access barriers in the classroom is neither sustainable nor equitable. Furthermore, this somewhat flawed…

Ethnicity, Inequality, and Higher Education in Malaysia.

ERIC Educational Resources Information Center

Selvaratnam, Viswanathan

1988-01-01

Traces the development since 1957 of Malaysian education policies aimed at providing equitable access to higher education. Suggests that these policies have increased representation of the Malay underclass in tertiary institutions and the professions, but have had little effect on intraethnic class inequalities. 46 references. (SV)

75 FR 21867 - Semiannual Agenda

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

... to safeguard the U.S. financial system from the abuses of terrorist financing, money laundering, and... prepaid access as a means for furthering money laundering, terrorist financing, and other illicit... products and services posing lower risks of money laundering and terrorist financing from certain...

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.

Health Financing And Insurance Reform In Morocco

PubMed Central

Ruger, Jennifer Prah; Kress, Daniel

2010-01-01

The government of Morocco approved two reforms in 2005 to expand health insurance coverage. The first is a payroll-based mandatory health insurance plan for public-and formal private–sector employees to extend coverage from the current 16 percent of the population to 30 percent. The second creates a publicly financed fund to cover services for the poor. Both reforms aim to improve access to high-quality care and reduce disparities in access and financing between income groups and between rural and urban dwellers. In this paper we analyze these reforms: the pre-reform debate, benefits covered, financing, administration, and oversight. We also examine prospects and future challenges for implementing the reforms. PMID:17630444

The Pearl of Great Price: Achieving Equitable Access to Primary and Secondary Education and Enhancing Learning in Sri Lanka. CREATE Pathways to Access. Research Monograph No. 29

ERIC Educational Resources Information Center

Aturupane, Harsha

2009-01-01

The experience of public policy in Sri Lanka has had a profound impact on the thinking of the global development community in relation to the role of education in economic development. In particular, the example of Sri Lanka helped to persuade policy makers around the world that governments can successfully develop a general education system to…

Can innovative health financing policies increase access to MDG-related services? Evidence from Rwanda.

PubMed

Sekabaraga, Claude; Diop, Francois; Soucat, Agnes

2011-11-01

Ensuring financial access to health services is a critical challenge for poor countries if they are to reach the health Millennium Development Goals (MDGs). This article examines the case of Rwanda, a country which has championed innovative health care financing policies. Between 2000 and 2007, Rwanda has improved financial access for the poor, increased utilization of health services and reduced out-of-pocket payments for health care. Poor groups' utilization has increased for all health services, sometimes dramatically. Use of assisted deliveries, for example, increased from 12.1% to 42.7% among the poorest quintile; payments at the point of delivery have also been reduced; and catastrophic expenditures have declined. Part of these achievements is likely linked to innovative health financing policies, particularly the expansion of micro-insurance ('mutuelles') and performance-based financing. The paper concludes that the Rwanda experience provides a useful example of effective implementation of policies that reduce the financial barrier to health services, hereby contributing to the health MDGs. Today's main challenge is to build the sustainability of this system. Finally, the paper proposes a simple set of rigorous metrics to assess the impact of health financing policies and calls for implementing rigorous impact evaluation of health care financing policies in low-income countries.

Status of Indian Women in Higher Education

ERIC Educational Resources Information Center

Ghara, Tushar Kanti

2016-01-01

Women education and empowerment are the indicators of development. Women education ensures the holistic and long development. It includes equitable and increased access to technical and vocational education and training, higher education and research with due attention to quality assurance. This communication has taken a look on women…

A State Policymaker's STEM Playbook. Promising Practices

ERIC Educational Resources Information Center

Zinth, Jennifer; Goetz, Tami

2016-01-01

Science, technology, engineering and mathematics (STEM) has captured the attention of state policymakers who are concerned about equitable access to high-quality educational experiences and preparing and inspiring students to pursue STEM careers. Yet in many states, STEM policymaking efforts have not achieved their intended return on investment…

77 FR 21547 - Proposed Priorities; Disability and Rehabilitation Research Projects and Centers Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-10

... impeding more engagement in physical activity among this population is limited knowledge about safe and.... Inaccessibility of recreational equipment and environments remains a primary barrier to participation in physical... will facilitate equitable access to, and safe use of, recreational equipment, facilities, and...

Latino Student Success in Oregon High Schools

ERIC Educational Resources Information Center

Peterson, Deborah S.

2011-01-01

The public educational system has failed to adjust practices, policies, and procedures to ensure systematic, equitable access to a rigorous education for all youth, including those from diverse linguistic and racial backgrounds (Delpit, 1995; G. Gay, 2010; hooks, 1994; Ladson-Billings, 1994; Lindsey, Roberts, & Campbelljones, 2005; Nieto,…

Towards advanced risk-sharing in health care financing: with a focus on the potential of social health insurance in developing countries.

PubMed

Carrin, G

2004-01-01

In this paper, we analyse the major health financing methods and the contribution they can make to improving access to health care among all of a country's population groups. Risk-sharing in health financing is proposed as a powerful method to achieve this improvement. The larger the degree of risk-sharing in a health financing system, the less people will have to bear the financial consequences of their own health risks, and the more they are likely to have access to needed care. Ideally countries should attempt to introduce 'advanced' risk-sharing aiming at equal access among individuals to an adequate package of health services. There are two major ways to implement advanced risk-sharing: general tax revenue may be main source of financing health services, or else social health insurance may be established. An important finding is that about 60% of the world's countries still need to pursue efforts towards the introduction of advanced risk-sharing. We further focus on the potential of social health insurance as an advanced risk-sharing method. In fact, there is recent interest in developing countries such as Côte d'Ivoire, Indonesia, Iran and Kenya in this particular health financing mechanism. Compared to health financing via general tax revenue, social health insurance spreads the immediate burden of financing among various groups, including the workers, the self-employed, enterprises and Government. Time and tedious discussions between these groups may be needed, however, before a consensus is reached, not only on the relative burden of financing but also on ways to achieve overall population coverage. It is suggested that action-research be used to test the adequacy of initial social health insurance policies.

Accessing the Health Care Financing System: A Resource Guide for Local Education Agencies. Bulletin No. 91298.

ERIC Educational Resources Information Center

Wisconsin State Dept. of Public Instruction, Madison.

This guide is intended to assist Wisconsin school districts in accessing the health care financing system as a means of supporting specialized services. Topics covered include: determination of a local education agency's potential for third-party covered services; the need to become a certified provider dependent upon the funding source;…

Promoting Access to Finance by Empowering Consumers--Financial Literacy in Developing Countries

ERIC Educational Resources Information Center

Kefela, Ghirmai T.

2010-01-01

This paper is an effort to establish the financial sector in developing countries to promote financial literacy of their customers. This could have access to finance and savings, which in turn support livelihoods, economic growth, sound financial systems, and participate in the economy. The main objectives of this paper is to enhance a bank's…

Access and Finance Issues: The University of Alabama's Education Policy Center

ERIC Educational Resources Information Center

Katsinas, Stephen G.

2015-01-01

Established in the 1920s, the Education Policy Center (EPC) is the oldest center or institute at The University of Alabama. Our work centers on four interrelated areas: (a) access and finance of public higher education, (b) college completion, (c) Pell Grants, and (d) rural community colleges. As place-based institutions with service delivery…

How are hospitals financing the future? Core competencies in capital planning.

PubMed

2004-07-01

Financing the Future is a yearlong project to help hospitals take advantage of growth opportunities. Led by HFMA in partnership with GE Healthcare Financial Services, the project provides information, insights, strategies, and tools designed to help hospitals finance their future. The findings of Financing the Future are based on research conducted by HFMA and PricewaterhouseCoopers. To access the first four Financing the Future reports, visit www.financingthefuture.org.

Who benefits from public health financing in Zimbabwe? Towards universal health coverage.

PubMed

Shamu, Shepherd; January, James; Rusakaniko, Simbarashe

2017-09-01

Zimbabwe's public health financing model is mostly hospital-based. Financing generally follows the bigger and higher-level hospitals at the expense of smaller, lower-level ones. While this has tended to perpetuate inequalities, the pattern of healthcare services utilisation and benefits on different levels of care and across different socioeconomic groups remains unclear. The purpose of this study was therefore to assess the utilisation of healthcare services and benefits at different levels of care by different socioeconomic groups. We conducted secondary data analysis of the 2010 National Health Accounts survey, which had 7084 households made up of 26,392 individual observations. Results showed significant utilisation of health services by poorer households at the district level (concentration index of -0.13 [CI:-0.2 to -0.06; p < .05]), but with mission hospitals showing equitable utilisation by both groups. Provincial and higher levels showed greater utilisation by richer households (0.19; CI: 0.1-0.29; p < .05). The overall results showed that richer households benefited significantly more from public health funds than poorer households (0.26; CI: 0.2-0.4; p < .05). Richer households disproportionately benefited from public health subsidies overall, particularly at secondary and tertiary levels, which receive more funding and provide a higher level of care.

Equitable access to elective hospital services: the introduction of patient choice in a decentralised healthcare system.

PubMed

Ringard, Ånen

2012-02-01

During the 1980s and 1990s, increased waiting times for elective surgery was perceived to be a major accessibility problem in many countries. In an attempt to improve access, hospital choice reforms were introduced in a number of countries. In Norway, a nationwide reform to improve access came into effect in 2001. At the same time, renewed support was expressed for the long-standing political aim of ensuring equal access to healthcare services for all citizens regardless of their social position. The current aim is to analyse the relationship of the hospital choice reform and the goal of equitable access to hospital services. A survey conducted among Norwegian patients in 2004 provided information about whether a choice of hospital had been made. Information from the survey was merged with administrative data from the hospital that performed the treatment. The survey provided data on patients' socioeconomic position. Demographics, medical need, and prior use of healthcare services were controlled for to determine the effect of socioeconomic position on hospital choice. The patient's socioeconomic position, measured by education, was found to be significantly associated with hospital choice. The relationship resembled that of a social gradient. Patients with a primary education were less likely to have made a choice, followed by those with secondary education or a lower university degree. Patients with higher university education were most likely to have chosen. Hospital selection is a demanding task for many patients. Policymakers should therefore focus on crafting and implementing tools necessary for supporting uptake of choice in disadvantaged groups.

Health Care Financing in Ethiopia: Implications on Access to Essential Medicines.

PubMed

Ali, Eskinder Eshetu

2014-09-01

The Ethiopian health care system is under tremendous reform. One of the issues high on the agenda is health care financing. In an effort to protect citizens from catastrophic effects of the clearly high share of out-of-pocket expenditure, the government is currently working to introduce health insurance. This article aims to highlight the components of the Ethiopian health care financing reform and discuss its implications on access to essential medicines. A desk review of government policy documents and proclamations was done. Moreover, a review of the scientific literature was done via PubMed and search of other local journals not indexed in PubMed. Revenue retention by health facilities, systematizing the fee waiver system, standardizing exemption services, outsourcing of nonclinical services, user fee setting and revision, initiation of compulsory health insurance (community-based health insurance and social health insurance), establishment of a private wing in public hospitals, and health facility autonomy were the main components of the health care financing reform in Ethiopia. Although limited, the evidence shows that there is increased health care utilization, access to medicines, and quality of services as a result of the reforms. Encouraging progress has been made in the implementation of health care financing reforms in Ethiopia. However, there is shortage of evidence on the effect of the health care financing reforms on access to essential medicines in the country. Thus, a clear need exists for well-organized research on the issue. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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.

[Personalized medicine: equity and access].

PubMed

Joly, Yann; Knoppers, Bartha M

2014-11-01

Personalized medicine has seen a recent increase in popularity amongst medical researchers and policymakers. Nevertheless, there are persistent legal, ethical, and social questions that need to be explored, particularly related to the criticism that personalized medicine constitutes an elitist model of healthcare. Investigating this critique the current manuscript argues that personalized medicine has the potential to become a positive force for equitable access to better healthcare at a national and international level. © 2014 médecine/sciences – Inserm.

Lecturers' Experiences of Teaching STEM to Students with Disabilities

ERIC Educational Resources Information Center

Ngubane-Mokiwa, S. A.; Khoza, S. B.

2016-01-01

Innovative teaching is a concept based on student-centred teaching strategies. Access to Science, Technology, Engineering and Mathematics (STEM) subjects has not been equitable due to use of traditional teaching strategies. These strategies tend to exclude students with disabilities who can effectively learn in environments that appropriately and…

Creating Time for Equity Together

ERIC Educational Resources Information Center

Renée, Michelle

2015-01-01

Iin urban communities across the nation, a broad range of partners have committed to reinventing educational time together to ensure equitable access to rich learning opportunities for all young people. Across the nation, education partners are using their creativity, commitment, and unique resources to create new school and system designs that…

Integrating personalized genomic medicine into routine clinical care: addressing the social and policy issues of pharmacogenomic testing.

PubMed

Dressler, Lynn G

2013-01-01

The provision of personalized genomic medicine presents significant policy challenges, such as ensuring equitable patient access to testing, preparing clinicians to manage genomic results, justifying test reimbursement, sharing genomic information for patient care, and protecting patients against misuse of genetic information.

The Others: Equitable Access, International Students, and the Community College

ERIC Educational Resources Information Center

Viggiano, Tiffany; López Damián, Ariadna I.; Morales Vázquez, Evelyn; Levin, John S.

2018-01-01

This qualitative investigation explains the ways in which community college decision makers justify the inclusion of international students at three community colleges in the United States. We identify and explain the ways in which decision makers rationalize institutional policy--particularly recruitment strategies and motivations--related to…

Student Discipline and Access to Equal Educational Opportunities in the United States

ERIC Educational Resources Information Center

Cambron-McCabe, Nelda; McCarthy, Martha

2004-01-01

Courts and legislatures in the United States have looked closely at governmental practices that threaten students' educational opportunities. One area that has raised concerns is whether student discipline policies and procedures are equitable, fair, and effective. Substantial litigation has established that disciplinary actions must be…

Mexico's "Telesecundaria" Program and Equitable Access to Resources

ERIC Educational Resources Information Center

Craig, Dana; Etcheverry, Jose; Ferris, Stefan

2016-01-01

This Note provides an analysis of Mexico's "Telesecundaria" program within the context of Mexico's new education reform framework offering a succinct background of the project, as well as key policy lessons that can be useful for other jurisdictions interested in the development of distance education programs. This Note uses a literature…

77 FR 7998 - Semiannual Agenda and Fiscal Year 2012 Regulatory Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

... to safeguard the U.S. financial system from the abuses of terrorist financing, money laundering, and... prepaid access as a means for furthering money laundering, terrorist financing, and other illicit... products and services posing lower risks of money laundering and terrorist financing from certain...

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…

Relationship between Use of Online Support Materials and Student Performance in an Introductory Finance Course

ERIC Educational Resources Information Center

Biktimirov, Ernest N.; Klassen, Kenneth J.

2008-01-01

The authors examined the relationship between student online activity, including access to specific course materials, and performance in a traditional face-to-face introductory finance course that a class Web site supported. The authors used 6 measures: (a) total hits, (b) hit consistency, (c) number of unique files that the students accessed, (d)…

31 CFR 1010.651 - Special measures against Burma.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Special measures against Burma. 1010.651 Section 1010.651 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Law Enforcement Access to Foreign Bank Records § 1010.651 Special measures against Burma. (a...

31 CFR 1010.651 - Special measures against Burma.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Special measures against Burma. 1010.651 Section 1010.651 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Law Enforcement Access to Foreign Bank Records § 1010.651 Special measures against Burma. (a...

31 CFR 1010.651 - Special measures against Burma.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Special measures against Burma. 1010.651 Section 1010.651 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Law Enforcement Access to Foreign Bank Records § 1010.651 Special measures against Burma. (a...

31 CFR 1010.654 - Special measures against VEF Bank.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Special measures against VEF Bank. 1010.654 Section 1010.654 Money and Finance: Treasury Regulations Relating to Money and Finance... Patriot Act and Law Enforcement Access to Foreign Bank Records § 1010.654 Special measures against VEF...

Understanding the working relationships between National Health Service clinicians and finance staff.

PubMed

Minogue, Virginia; McCaffry, Rebecca

2017-03-13

Purpose The Department of Health and the National Health Service (NHS) Future Focused Finance (FFF) programme promotes effective engagement between clinical and finance staff. Surveys undertaken by the Department of Health between 2013 and 2015 found few NHS Trusts reported high levels of engagement. The purpose of this paper is to gain a better understanding of current working relationships between NHS clinical and finance professionals and how they might be supported to become more effective. Design/methodology/approach Ipsos MORI were commissioned by the NHS FFF programme to undertake an online survey of NHS clinical and finance staff between June and August 2015. Findings The majority of clinicians had a member of a finance team linked to their speciality or directorate. Clinical and finance professionals have a positive view of joint working preferring face-to-face contact. Clinician's confidence in their understanding of finance was generally good and finance staff felt they had a good understanding of clinical issues. Effective working relationships were facilitated by face-to-face contact, a professional relationship, and the availability of clear, well presented finance and activity data. Research limitations/implications Data protection issues limited the accessibility of the survey team to NHS staff resulting in a relatively low-response rate. Other forms of communication, including social media, were utilised to increase access to the survey. Originality/value The FFF programme is a unique programme aimed at making the NHS finance profession fit for the future. The close partnering work stream brings together the finance and clinical perspective to share knowledge, evidence, training, and to develop good practice and engagement.

Trends in Education Access and Financing during the Transition in Central And Eastern Europe. Social Challenges of Transition Series.

ERIC Educational Resources Information Center

Laporte, Bruno; Ringold, Dena

This paper is one in a series of reports based upon data from the "Social Challenges of Transition (SCT)" database. This cross-country study examines empirical trends in access to and financing of education in nine Central and East European countries. The study substantially improves the understanding of the impact of transition on…

Inequalities in medicine use in Central Eastern Europe: an empirical investigation of socioeconomic determinants in eight countries.

PubMed

Vogler, Sabine; Österle, August; Mayer, Susanne

2015-11-05

Equitable access to essential medicines is a major challenge for policy-makers world-wide, including Central and Eastern European countries. Member States of the European Union situated in Central and Eastern Europe have publicly funded pharmaceutical reimbursement systems that should promote accessibility and affordability of, at least essential medicines. However, there is no knowledge whether socioeconomic inequalities exist in these countries. Against this backdrop, this study analyses whether socioeconomic determinants influence the use of prescribed and non-prescribed medicines in eight Central and Eastern European countries (Bulgaria, Czech Republic, Hungary, Latvia, Poland, Romania, Slovenia, Slovakia). Further, the study discusses observed (in)equalities in medicine use in the context of the pharmaceutical policy framework and the implementation in these countries. The study is based on cross-sectional data from the first wave of the European Health Interview Survey (2007-2009). Multivariate logistic regression analyses were carried out to determine the association between socioeconomic status (measured by employment status, education, income; controlled for age, gender, health status) and medicine use (prescribed and non-prescribed medicines). This was supplemented by a pharmaceutical policy analysis based on indicators in four policy dimensions (sustainable funding, affordability, availability and accessibility, and rational selection and use of medicines). Overall, the analysis showed a gradient favouring individuals from higher socioeconomic groups in the consumption of non-prescribed medicines in the eight surveyed countries, and for prescribed medicines in three countries (Latvia, Poland, Romania). The pharmaceutical systems in the eight countries were, to varying degrees, characterized by a lack of (public) funding, thus resulting in high and growing shares of private financing (including co-payments for prescribed medicines), inefficiencies in the selection of medicines into reimbursement and limitations in medicines availability. Pharmaceutical policies aiming at reducing inequalities in medicine use require not only a consideration of the role of co-payments and other private expenditure but also adequate investment in medicines and transparent and clear processes regarding the inclusion of medicines into reimbursement.

Does HIV services decentralization protect against the risk of catastrophic health expenditures?: some lessons from Cameroon.

PubMed

Boyer, Sylvie; Abu-Zaineh, Mohammad; Blanche, Jérôme; Loubière, Sandrine; Bonono, Renée-Cécile; Moatti, Jean-Paul; Ventelou, Bruno

2011-12-01

Scaling up antiretroviral treatment (ART) through decentralization of HIV care is increasingly recommended as a strategy toward ensuring equitable access to treatment. However, there have been hitherto few attempts to empirically examine the performance of this policy, and particularly its role in protecting against the risk of catastrophic health expenditures (CHE). This article therefore seeks to assess whether HIV care decentralization has a protective effect against the risk of CHE associated with HIV infection. DATA SOURCE AND STUDY DESIGN: We use primary data from the cross-sectional EVAL-ANRS 12-116 survey, conducted in 2006-2007 among a random sample of 3,151 HIV-infected outpatients followed up in 27 hospitals in Cameroon. DATA COLLECTION AND METHODS: Data collected contain sociodemographic, economic, and clinical information on patients as well as health care supply-related characteristics. We assess the determinants of CHE among the ART-treated patients using a hierarchical logistic model (n = 2,412), designed to adequately investigate the separate effects of patients and supply-related characteristics. Expenditures for HIV care exceed 17 percent of household income for 50 percent of the study population. After adjusting for individual characteristics and technological level, decentralization of HIV services emerges as the main health system factor explaining interclass variance, with a protective effect on the risk of CHE. The findings suggest that HIV care decentralization is likely to enhance equity in access to ART. Decentralization appears, however, to be a necessary but insufficient condition to fully remove the risk of CHE, unless other innovative reforms in health financing are introduced. © Health Research and Educational Trust.

Defining pharmaceutical systems strengthening: concepts to enable measurement

PubMed Central

Hafner, Tamara; Lee, David; Aboagye-Nyame, Francis

2017-01-01

Abstract Pharmaceutical products are indispensable for improving health outcomes. An extensive body of work on access to and use of medicines has resulted in an assortment of tools measuring various elements of pharmaceutical systems. Until now however, there has been little attempt to conceptualize a pharmaceutical system as an entity and define its strengthening in a way that allows for measuring systems strengthening. The narrow focus of available tools limits their value in ascertaining which interventions result in stronger, more resilient systems. We sought to address this shortcoming by revisiting the current definitions, frameworks and assessment tools related to pharmaceutical systems. We conducted a comprehensive literature review and consulted with select pharmaceutical experts. On the basis of our review, we propose that a pharmaceutical system consists of all structures, people, resources, processes, and their interactions within the broader health system that aim to ensure equitable and timely access to safe, effective, quality pharmaceutical products and related services that promote their appropriate and cost-effective use to improve health outcomes. We further propose that pharmaceutical systems strengthening is the process of identifying and implementing strategies and actions that achieve coordinated and sustainable improvements in the critical components of a pharmaceutical system to make it more responsive and resilient and to enhance its performance for achieving better health outcomes. Finally, we established that, in addition to system performance and resilience, seven components of the pharmaceutical system are critical for measuring pharmaceutical systems strengthening: pharmaceutical products and related services; policy, laws and governance; regulatory systems; innovation, research and development, manufacturing, and trade; financing; human resources; and information. This work adds clarity to the concept of pharmaceutical systems and their strengthening by proposing holistic definitions on the basis of systems thinking. It provides a practical starting point for measuring the progress of pharmaceutical systems strengthening. PMID:28025324

Managing rapid urbanization in the third world: some aspects of policy.

PubMed

Hope, K R

1989-01-01

A priority task for developing countries is the formulation of national urbanization policies that: 1) foster the full development of national resources; 2) promote cohesion among regions, especially where there are striking inequities in per capita output; 3) prevent or correct the overconcentration of economic activity in a few urban centers; and 4) create a more efficient, equitable management of growth within cities. Although urban households tend to be served better by the health and educational sectors than their rural counterparts, the urban poor are denied these benefits in the absence of special programs to ensure universal access. The urban poor are further denied access to the benefits of urban centers through a transportation policy that is oriented more toward roads and cars than public transit systems. Of major concern are the overcrowded squatter settlements that have developed in response to massive rural-urban migration. Since the landlessness, joblessness, and demoralization in rural areas and the consequent urban influx are at the root of the urban crisis in the Third World, integrated rural development is essential to retain substantial new additions to the urban labor force in rural areas. Land reform is the single strategy with the greatest potential to improve the quality of life of the landless poor and small holders. Other needs include programs of labor-intensive rural public works to provide supplementary income-earning opportunities and improve the rural infrastructure and more widespread participation of the rural poor in the development process. Increasingly sophisticated administrative and financing systems will be required to carry out a national urbanization policy, and current politicized bureaucracies must be replaced by a reliance on technically skilled professional administrators.

Building consensus on key priorities for rural health care in South Africa using the Delphi technique.

PubMed

Versteeg, Marije; du Toit, Lilo; Couper, Ian

2013-01-24

South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

Building consensus on key priorities for rural health care in South Africa using the Delphi technique

PubMed Central

Versteeg, Marije; du Toit, Lilo; Couper, Ian

2013-01-01

Background South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. Methods The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Results Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Conclusion Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential. PMID:23364081

31 CFR 1010.655 - Special measures against Banco Delta Asia.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Special measures against Banco Delta Asia. 1010.655 Section 1010.655 Money and Finance: Treasury Regulations Relating to Money and Finance... Patriot Act and Law Enforcement Access to Foreign Bank Records § 1010.655 Special measures against Banco...

31 CFR 1010.655 - Special measures against Banco Delta Asia.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Special measures against Banco Delta Asia. 1010.655 Section 1010.655 Money and Finance: Treasury Regulations Relating to Money and Finance... Patriot Act and Law Enforcement Access to Foreign Bank Records § 1010.655 Special measures against Banco...

31 CFR 1010.655 - Special measures against Banco Delta Asia.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Special measures against Banco Delta Asia. 1010.655 Section 1010.655 Money and Finance: Treasury Regulations Relating to Money and Finance... Patriot Act and Law Enforcement Access to Foreign Bank Records § 1010.655 Special measures against Banco...

31 CFR 1010.655 - Special measures against Banco Delta Asia.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Special measures against Banco Delta Asia. 1010.655 Section 1010.655 Money and Finance: Treasury Regulations Relating to Money and Finance... Patriot Act and Law Enforcement Access to Foreign Bank Records § 1010.655 Special measures against Banco...

31 CFR 500.326 - Custody of safe deposit boxes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Custody of safe deposit boxes. 500.326 Section 500.326 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... such lessors have access to such boxes. The foregoing shall not in any way be regarded as a limitation...

31 CFR 515.326 - Custody of safe deposit boxes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Custody of safe deposit boxes. 515.326 Section 515.326 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... such lessors have access to such boxes. The foregoing shall not in any way be regarded as a limitation...

Fundraising and Corporate Donations in Schools: The Beginning of a Two-Tier Public Education System.

ERIC Educational Resources Information Center

Kidder, Annie

2002-01-01

As Canadian provinces cut funding for education, the shortfall is made up by parent fundraising, donations, or private partnerships. Equitable access to education is undermined because schools with better parent fundraisers, more effective principal wheeler-dealers, and more-advantaged populations have more resources, while disadvantaged children…

An Analysis of Specific Learning Disability Exclusionary Clause

ERIC Educational Resources Information Center

Lybarger, Pamela A.

2017-01-01

The purpose of Individuals with Disabilities Education Improvement Act (IDEIA) is to protect the rights of students with disabilities and to assure that all students receive equitable access to a free and appropriate public education; yet there are explicit exclusions written in the law for students who may have experienced environmental,…

The Impact of Consultation Models on Interpersonal Relationships during Problem Solving

ERIC Educational Resources Information Center

Neall, Michael Timothy

2012-01-01

Client-centered and consultee-centered consultation models are predominately used in K-12 schools to meet the needs of at-risk learners and ensure equitable access to educational services. Although the efficacy of both models has significant support in the literature, studies regarding relationships formed during problem solving in consultation…

The Potentials of Student Initiated Netspeak in a Middle Primary Science-Inspired Multiliteracies Project

ERIC Educational Resources Information Center

Ridgewell, Jay; Exley, Beryl

2011-01-01

There is no denying that the information technology revolution of the late twentieth century has arrived. Whilst not equitably accessible for many, others hold high expectations for the contributions online activity will make to student learning outcomes. Concurrently, and not necessarily consequentially, the number of science and technology…

Education for All: National Plan of Action, 2003-2015

ERIC Educational Resources Information Center

Online Submission, 2005

2005-01-01

Background: The Lao People's Democratic Republic (PDR) Education for All National Plan of Action (EFA NPA) for 2003-2015 seeks to accomplish three major tasks: equitable access, improved quality and relevance and strengthened education management. Purpose: To design a National Education For All Action Plan for basic education in Lao PDR which…

Routes towards Portuguese Higher Education: Students' Preferred or Feasible Choices?

ERIC Educational Resources Information Center

Tavares, Orlanda

2013-01-01

Background: An equitable and democratised higher education system should, in principle, be permeable to the flow of populations with different social and/or cultural backgrounds, allowing access to any parts of the system. However, despite the democratisation efforts that took place in Portugal after the 1974 revolution, and although the student…

78 FR 33886 - Identification of Ukraine as a Priority Foreign Country and Initiation of Section 301 Investigation

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-05

... Representative) identified Ukraine as a priority foreign country due to Ukraine's denial of adequate and effective protection of intellectual property rights and its denial of fair and equitable market access to... system for collecting societies, which are responsible for collecting and distributing royalties to U.S...

Insights on the Intersection of Health Equity and School Nutrition Policy Implementation: An Exploratory Qualitative Secondary Analysis

ERIC Educational Resources Information Center

Asada, Yuka; Hughes, Alejandro; Chriqui, Jamie

2017-01-01

Background: Recent federal policies aimed to ensure that all children have equitable access to healthy school nutrition environments. However, historically, disparities have persisted in the quality of school nutrition environments across geographic and socioeconomic groups. There is limited literature addressing if and how recent efforts to…

34 CFR 280.1 - What is the Magnet Schools Assistance Program?

Code of Federal Regulations, 2012 CFR

2012-07-01

... schools; (e) Improvement of the capacity of LEAs, including through professional development, to continue... terminated; and (f) Ensuring that all students enrolled in the magnet school programs have equitable access... 34 Education 1 2012-07-01 2012-07-01 false What is the Magnet Schools Assistance Program? 280.1...

34 CFR 280.1 - What is the Magnet Schools Assistance Program?

Code of Federal Regulations, 2014 CFR

2014-07-01

... schools; (e) Improvement of the capacity of LEAs, including through professional development, to continue... terminated; and (f) Ensuring that all students enrolled in the magnet school programs have equitable access... 34 Education 1 2014-07-01 2014-07-01 false What is the Magnet Schools Assistance Program? 280.1...

34 CFR 280.1 - What is the Magnet Schools Assistance Program?

Code of Federal Regulations, 2013 CFR

2013-07-01

... schools; (e) Improvement of the capacity of LEAs, including through professional development, to continue... terminated; and (f) Ensuring that all students enrolled in the magnet school programs have equitable access... 34 Education 1 2013-07-01 2013-07-01 false What is the Magnet Schools Assistance Program? 280.1...

Learning Equity in a University Classroom

ERIC Educational Resources Information Center

van der Westhuizen, G. J.

2012-01-01

Since 1994, education policy documents in South Africa have prioritised the goal of equity in education, understood as increased access to programmes, more equitable staff and student profiles, and curricula that are more responsive to the needs of all students. The challenge of effecting the goal of equity at levels of teaching and learning in…

Effectiveness of Asynchronous Reference Services for Distance Learning Students within Florida's Community College System

ERIC Educational Resources Information Center

Profeta, Patricia C.

2007-01-01

The provision of equitable library services to distance learning students emerged as a critical area during the 1990s. Library services available to distance learning students included digital reference and instructional services, remote access to online research tools, database and research tutorials, interlibrary loan, and document delivery.…

Sketching Up New Geographies: Open Sourcing and Curriculum Development

ERIC Educational Resources Information Center

Boyd, William; Ellis, David

2013-01-01

The functionality of web 2.0 technologies has caused academics to rethink their development of teaching and learning methods and approaches. The editable, open access nature of web 2.0 encourages the innovative collaboration of ideas, the creation of equitable visual and tactile learning environments, and opportunity for academics to develop…

Communities and School Ratings: Examining Geography of Opportunity in an Urban School District Located in a Resource-Rich City

ERIC Educational Resources Information Center

Green, Terrance L.; Sánchez, Joanna; Germain, Emily

2017-01-01

Research on geography of opportunity documents how residential patterns influence students' access to equitable educational opportunities and resources. This scholarship often highlights how geography reinforces educational inequity in urban school districts located in resource-constrained cities. Yet, less research has explored how the geography…

Perspectives in Early Childhood Education: Belize, Brazil, Mexico, El Salvador and Peru

ERIC Educational Resources Information Center

McConnell-Farmer, Judith Lynne; Cook, Pamela R.; Farmer, M. W.

2012-01-01

Early childhood education (ECE) provision is becoming a growing priority. During the past twenty years, Latin America has shown a growing recognition in the provision of educational programs for young children, birth to age eight, is essential. Urban and rural populations intimated in 2009, that many countries utilizing equitable access to…

Government Funding as Leverage for Quality Teaching and Learning: A South African Perspective

ERIC Educational Resources Information Center

Essack, Sabiha Y.; Naidoo, Indirani; Barnes, Glen

2010-01-01

The South African Higher Education Funding Framework uses funding as a lever to achieve equitable student access, quality teaching and research, and improved student retention and success. Maximising a university subsidy from the national Department of Education necessitates innovative strategies at the pre- and post-student admission stages. This…

Leading against the Grain: Lessons for Creating Just and Equitable Schools

ERIC Educational Resources Information Center

Brooks, Jeffrey S., Ed.; Normore, Anthony H., Ed.

2017-01-01

What new ideas and ways of thinking can educational leaders learn from great world leaders who have moved their societies to greater equity and expanded educational opportunity? In this lively, accessible volume, the editors have brought together an impressive group of senior and early-career educational scholars to study the lives and…

Inquiry-Based Practical Work in Physical Sciences: Equitable Access and Social Justice Issues

ERIC Educational Resources Information Center

Tsakeni, Maria

2018-01-01

Physical sciences education comes with high expectations for learners to be successfully placed in tertiary institutions in related fields, and developing countries' aspirations to develop advanced and specialised skills to drive economies. However, some of the prevailing instructional strategies in science classrooms work to marginalise learners.…

Redefining School Health Services: Comprehensive Child Health Care as the Framework.

ERIC Educational Resources Information Center

Silver, George A.

Recognizing the needs, deficiencies, and diversity of school health services is prerequisite to any analysis of need. More uniform programs and more equitable access for all school children to whatever minimal standard of health services should be provided: periodic examination, some limited medical care on the school grounds, intensive health…

Research and Policy Considerations for English Learner Equity

ERIC Educational Resources Information Center

Robinson-Cimpian, Joseph P.; Thompson, Karen D.; Umansky, Ilana M.

2016-01-01

English learners (ELs), students from a home where a language other than English is spoken and who are in the process of developing English proficiency themselves, represent over 10% of the US student population. Oftentimes education policies and practices create barriers for ELs to achieve access and outcomes that are equitable to those of their…

Data-Based Decision Making: The Road to AP Equity

ERIC Educational Resources Information Center

Edwards, Kelcey; Duggan, Odette

2012-01-01

Presented at the Advanced Placement Annual Conference (APAC) in Lake Buena Vista, FL in July 2012. This presentation reviews concepts central to achieving equitable AP access and success for all willing and academically prepared students. We analyze trends in participation and performance by race/ethnicity from the AP Report to the Nation and…

Collaborating for Equity: A Scan of the Los Angeles Educational Ecosystem. Summary

ERIC Educational Resources Information Center

Potochnik, Tracie; Romans, Angela N.

2016-01-01

Los Angeles has an educational ecosystem that is rich with partners committed to providing equitable access to learning opportunities for students. Throughout the 2014-2015 school year, the "Annenberg Institute for School Reform at Brown University" (AISR) spent time meeting with a range of partners, including the Los Angeles Unified…

Collaborating for Equity: A Scan of the Los Angeles Educational Ecosystem. Full Report

ERIC Educational Resources Information Center

Potochnik, Tracie; Romans, Angela N.

2015-01-01

Los Angeles has an educational ecosystem that is rich with partners committed to providing equitable access to learning opportunities for students. Throughout the 2014-2015 school year, the "Annenberg Institute for School Reform at Brown University" (AISR) spent time meeting with a range of partners, including the Los Angeles Unified…

Recognizing and Accommodating Employees with PTSD: The Intersection of Human Resource Development, Rehabilitation, and Psychology

ERIC Educational Resources Information Center

Hughes, Claretha; Lusk, Stephanie L.; Strause, Stephanie

2016-01-01

All employees within the workplace must be treated fairly and equitably including those with disabilities who may require accommodations that serve to increase access to and maintenance of competitive employment. Human Resource Development (HRD) researchers and practitioners have experience in accommodating employees with disabilities but are now…

School Choice and Competitive Incentives: Mapping the Distribution of Educational Opportunities across Local Education Markets

ERIC Educational Resources Information Center

Lubienski, Christopher; Gulosino, Charisse; Weitzel, Peter

2009-01-01

Competition sparked by school choice is expected to generate greater educational opportunities, particularly for disadvantaged students. The premise is that competitive incentives will change the organizational behavior of schools (and districts, dioceses, etc.) in ways that will lead to more equitable access for students across varied and often…

Transforming a Teacher Community of Practice for Underserved Students

ERIC Educational Resources Information Center

Hollins, Etta R.

2009-01-01

Migration has shifted the world's population such that hardly a monocultural society still exists. These demographic changes have brought about changes in the strategies used to maintain national unity and in the distribution of benefits, goods, and services within the society. Providing equitable access to high-quality education has been among…

Building Equity in the Birth-to-3 System: Who Is in the Room?

ERIC Educational Resources Information Center

Harris, Wendy; Horn, Benita Rodriguez; Tripp, Susan; Yasui, Barbara

2016-01-01

The Birth-to-Three Equity Initiative launched in April 2015 as a multiyear systems change process to strengthen equitable access, services, and child and family outcomes in the "early intervention" system in Martin Luther King County, Washington. This article describes the training of agency leaders and "equity facilitators"…

Equity, autonomy, and efficiency: what health care system should we have?

PubMed

Menzel, Paul T

1992-02-01

The U.S. has a wide range of options in choosing a health care system. Rational choice of a system depends on analysis and prioritization of the basic moral goals of equitable access to all citizens, the just sharing of financial costs between well and ill, respect for the values and choices of subscribers and patients, and efficiency in the delivery of costworthy care. These moral goals themselves, however, tell us little about what health care system the United States should have. Equitable access does not demand a level and scope of care for the poor equal to that rationally chosen by the middle class, and there are ways within mixed systems, though not easy ways, to achieve a fair distribution of costs between well and ill. Despite pluralistic systems' apparent advantage in allowing subscribers to choose their own forms of rationing, problems in translating serious long-term subscriber choices into actual medical practice may be greater in pluralistic than in unitary systems. Final choice of a system hinges primarily on peculiar historical facts about U.S. political culture, not on moral principle.

Equality, autonomy, and efficiency: what health care system should we have?

PubMed

Menzel, P T

1992-02-01

The U.S. has a wide range of options in choosing a health care system. Rational choice of a system depends on analysis and prioritization of the basis moral goals of equitable access to all citizens, the just sharing of financial costs between well and ill, respect for the values and choices of subscribers and patients, and efficiency in the delivery of costworthy care. These moral goals themselves, however, tell us little about what health care system the United States should have. Equitable access does not demand a level and scope of care for the poor equal to that rationally chosen by the middle class, and there are ways within mixed systems, though not easy ways, to achieve a fair distribution of costs between well and ill. Despite pluralistic systems' apparent advantage in allowing subscribers to choose their own forms of rationing, problems in translating serious long-term subscriber choices into actual medical practice may be greater in pluralistic than in unitary systems. Final choice of a system hinges primarily on peculiar historical facts about U.S. political culture, not on moral principle.

Examining Deaf Students' Equitable Access to Science vis-a-vis Contemporary Pedagogical Practices

NASA Astrophysics Data System (ADS)

Ross, Annemarie D.

As a Deaf individual, it is important to ensure the growth of the Deaf community as science-literate members of society. While many predecessors have contributed to the body of research in Deaf pedagogy, there is still much to be done in safeguarding Deaf learners' equitable access to science education. One area of concern is in narrowing the statistically significant gap in Climate Change knowledge between Deaf students' and Hearing students' at the Rochester Institute of Technology. It is within this topic that the writing-to-learn-science framework is practiced and Deaf students in the Laboratory Science Technology program at the National Technical Institute for the Deaf participate in a study to assess whether or not the use of writing-to-learn-science strategies help them become better scientists, writers and learners. In this study, the social constructivist framework (Vygotsky, 1987) is used to study the impact of the use of the Berland and Reiser (2009) argumentation framework, so that they write-to-learn-science through the steps of sense-making, articulation and persuasion.

Welfarism versus 'free enterprise': considerations of power and justice in the Philippine healthcare system.

PubMed

Sy, Peter A

2003-10-01

The just distribution of benefits and burdens of healthcare, at least in the contemporary Philippine context, is an issue that gravitates towards two opposing doctrines of welfarism and 'free enterprise.' Supported largely by popular opinion, welfarism maintains that social welfare and healthcare are primarily the responsibility of the government. Free enterprise (FE) doctrine, on the other hand, maintains that social welfare is basically a market function and that healthcare should be a private industry that operates under competitive conditions with minimal government control. I will examine the ethical implications of these two doctrines as they inform healthcare programmes by business and government, namely: (a) the Devolution of Health Services and (b) the Philippine Health Maintenance Organization (HMO). I will argue that these doctrines and the health programmes they inform are deficient in following respects: (1) equitable access to healthcare, (2) individual needs for premium healthcare, (3) optimal utilisation of health resources, and (4) the equitable assignment of burdens that healthcare entails. These respects, as considerations of justice, are consistent with an operational definition of 'power' proposed here as 'access to and control of resources.'

Neighborhood Disparities in Access to Healthy Foods and Their Effects on Environmental Justice

PubMed Central

Dave, Jayna

2012-01-01

Environmental justice is concerned with an equitable distribution of environmental burdens. These burdens comprise immediate health hazards as well as subtle inequities, such as limited access to healthy foods. We reviewed the literature on neighborhood disparities in access to fast-food outlets and convenience stores. Low-income neighborhoods offered greater access to food sources that promote unhealthy eating. The distribution of fast-food outlets and convenience stores differed by the racial/ethnic characteristics of the neighborhood. Further research is needed to address the limitations of current studies, identify effective policy actions to achieve environmental justice, and evaluate intervention strategies to promote lifelong healthy eating habits, optimum health, and vibrant communities. PMID:22813465

Access to genetic testing and genetic counseling in vulnerable populations: the d/Deaf and hard of hearing population.

PubMed

Cooke-Hubley, Sandra; Maddalena, Victor

2011-09-01

Genetic testing holds great potential for preventing morbidities and mortalities for a number of diseases through early detection and effective intervention. As the number of genetic tests expand, so will public demand for these services. Therefore, it is essential to evaluate access to genetic testing and genetic services to ensure that all Canadians, including vulnerable groups, have equitable access to all forms of health care, in keeping with the mandate of the Canadian Health Act. The purpose of this paper is to examine the literature to determine if and how the Deaf community, as a vulnerable group, is at an increased risk of inequitable access to genetic services in Canada and to discuss how those who are deaf and hard of hearing are subject to the same risks. First, we define vulnerability and describe why the Deaf community, as a social group, can be considered a vulnerable group, followed by a description of the benefits of genetic testing. Second, we describe the barriers to accessing genetic testing, and how the d/Deaf and hard of hearing population experience additional barriers. Third, we examine the difficulties incorporating genetic testing into medical practice, and how this creates additional barriers to those already at risk. Finally, we discuss the steps necessary to promote equitable access to genetic testing among the d/Deaf and hard of hearing populations within Canada, and provide recommendations for further research in this topic area. Lastly, we comment on how barriers to genetic testing vary among the d/Deaf and hard of hearing is dependent upon the type of health care system available (whether public or private).

An urgent need to improve life conditions of seniors.

PubMed

Hebert, R

2010-10-01

In the fall of 2007, the Government of Quebec set up a Public Consultation on Living Conditions of Seniors. Fifty sessions were held in 26 cities across all 17 regions of the province. More than 4000 seniors attended the sessions and 275 briefs were received from scientists and associations. Three themes were identified in the report published in 2008: supporting seniors and their caregivers, reinforcing the place of seniors in society, and preventing problems associated with aging (suicide, abuse, addictions). The main actions that I recommended included: Increasing the Guaranteed Income Supplement to prevent poverty; Modifying pension plans and working conditions to allow for progressive retirement; Making a major investment in home care to provide access to services regardless of place of residence; Introducing an Autonomy Support Benefit and autonomy insurance program for financing services to support people with disabilities; Generalizing an Integrated Service Delivery Network providing services to frail older people; Better training for professionals in gerontology. I also recommended setting up a National Policy on Seniors to align all government departments and agencies, municipalities and the private sector around a vision, objectives and a set of actions for improving the integration of seniors in an aging society. This would contribute to a more equitable, interdependent and wiser society. Unfortunately, the Government did not support these recommendations. It is now time for scientists to get involved in leading policy on seniors and in the political arena.

The incidence of high medical expenses by health status in seven developed countries.

PubMed

Baird, Katherine Elizabeth

2016-01-01

Health care policy seeks to ensure that citizens are protected from the financial risk associated with needing health care. Yet rising health care costs in many countries are leading to a greater reliance on out-of-pocket (OOP) measures. This paper uses 2010 household survey data from seven countries to measure and compare the burden OOP expenses place on individuals. It compares countries based on the extent to which citizens with health problems devote a large share of their income to OOP expenses. The paper finds that in all countries but France, and to a lesser extent Slovenia, citizens with health problems face considerably higher medical costs than do those without. As many as one-quarter of less healthy citizens in the US, Poland, Russia and Israel devote a large share of their income to OOP expenses. The paper also finds a strong cross-national correlation between the degree to which citizens face high OOP expenses, and the disparities in OOP expenses between those with and without health problems. The levels of high OOP spending uncovered, and their inequitable impact on those with health problems in the seven countries, underscore the potential for OOP measures to undermine core objectives of health care systems, including those of equitable financing, equal access, and improved health among the population. Copyright © 2015 Elsevier Ireland 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.

Poor program's progress: the unanticipated politics of Medicaid policy.

PubMed

Brown, Lawrence D; Sparer, Michael S

2003-01-01

Advocates of U.S. national health insurance tend to share an image that highlights universal standards of coverage, social insurance financing, and national administration--in short, the basic features of Medicare. Such an approach is said to be good (equitable and efficient) policy and equally good politics. Medicaid, by contrast, is often taken to exemplify poor policy and poorer politics: means-tested eligibility, general revenue financing, and federal/state administration, which encourage inequities and disparities of care. This stark juxtaposition fails, however, to address important counterintuitive elements in the political evolution of these programs. Medicare's benefits and beneficiaries have stayed disturbingly stable, but Medicaid's relatively broad benefits have held firm, and its categories of beneficiaries have expanded. Repeated alarms about "bankruptcy" have undermined confidence in Medicare's trust funding, while Medicaid's claims on the taxpayer's dollar have worn well. Medicare's national administration has avoided disparities, but at the price of sacrificing state and local flexibility that can ease such "reforms" as the introduction of managed care. That Medicaid has fared better than a "poor people's program" supposedly could has provocative implications for health reform debates.

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

Health Care Payments in Vietnam: Patients' Quagmire of Caring for Health versus Economic Destitution.

PubMed

Pekerti, Andre; Vuong, Quan-Hoang; Ho, Tung Manh; Vuong, Thu-Trang

2017-09-25

In the last three decades many developing and middle-income nations' health care systems have been financed via out-of-pocket payments by individuals. User fees charges, however, may not be the best approach or thenmost equitable approach to finance and/or reform health services in developing nations. This study investigates the status of Vietnam's current health system as a result of implementing user fees policies. A recent mandate by the government to increase the universal cover to 100% attempts to tackle inadequate insurance cover, one of the four major factors contributing to the high and increasing probability of destitution for Vietnamese patients (the other three being: non-residency, long stay in hospital, and high cost of treatment). Empirical results however suggest that this may be catastrophic for low-income earners: if insurance cover reimbursement decreases below 50% of actual health expenditures, the probability of Vietnamese falling into destitution will rise further. Our findings provide policy implications and directions to improve Vietnam's health care system, in particular by ensuring the utilization of health services and financial protection for the people.

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

Availability and accessibility of evidence-based information resources provided by medical libraries in Australia.

PubMed

Ritchie, A; Sowter, B

2000-01-01

This article reports on the results of an exploratory survey of the availability and accessibility of evidence-based information resources provided by medical libraries in Australia. Although barriers impede access to evidence-based information for hospital clinicians, the survey revealed that Medline and Cinahl are available in over 90% of facilities. In most cases they are widely accessible via internal networks and the Internet. The Cochrane Library is available in 69% of cases. The Internet is widely accessible and most libraries provide access to some full-text, electronic journals. Strategies for overcoming restrictions and integrating information resources with clinical workflow are being pursued. State, regional and national public and private consortia are developing agreements utilising on-line technology. These could produce cost savings and more equitable access to a greater range of evidence-based resources.

Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services.

PubMed

Newman, Lareen; Biedrzycki, Kate; Baum, Fran

2012-05-01

To present research findings on access to, and use of, digital information and communication technologies (ICTs) by Australians from lower income and disadvantaged backgrounds to determine implications for equitable consumer access to digitally-mediated health services and information. Focus groups were held in 2008-09 with 80 residents from lower income and disadvantaged backgrounds in South Australia, predominantly of working- and family-formation age (25 to 55 years). Qualitative analysis was conducted on a-priori and emergent themes to describe dominant categories. Access to, and use of, computers, the Internet and mobile phones varied considerably in extent, frequency and quality within and across groups due to differences in abilities, resources and life experience. Barriers and facilitators included English literacy (including for native speakers), technological literacy, education, income, housing situation, social connection, health status, employment status, and trust. Many people gained ICT skills by trial and error or help from friends, and only a few from formal programs, resulting in varied skills. The considerable variation in ICT access and use within lower income and disadvantaged groups must be acknowledged and accommodated by health initiatives and services when delivering digitally-mediated consumer-provider interaction, online health information, or online self-management of health conditions. If services require consumers to participate in a digitally-mediated communication exchange, then we suggest they might support skills and technology acquisition, or provide non-ICT alternatives, in order to avoid exacerbating health inequities.

Implications of the growth of dental education in India.

PubMed

Mahal, Ajay S; Shah, Naseem

2006-08-01

By influencing the supply of trained human resources, the dental education sector can play a significant role in influencing policy goals of ensuring good quality and equitable access to oral health services in developing countries. Our research goal was to assess quantitatively the size of the Indian dental education sector, its growth over time, and the implications of this growth for equity and quality in oral health care. Information on the location of teaching institutions, the year of establishment, type of ownership, and seat capacity was obtained from government sources, the Dental Council of India, and websites of individual institutions to estimate the growth in the undergraduate dental education sector, including the role of the private sector from 1950 to 2005. Data on location of training capacity and institutions were used to assess the geographical distribution of undergraduate dental education capacity in India. Registration data on dentists, the size of available faculty relative to regulatory requirements, and penalties imposed on offending faculty and education institutions were used to assess the impact of the growing Indian dental education sector on graduate quality and equitable access. Dental colleges and enrollment capacity have grown rapidly over the five decades since 1950, mainly due to a growing private sector. There is regional inequality in the location of dental education schools in India with a bias toward economically better-off regions. The growth in the dental education sector has translated into increased overall access, although accompanied by rising inequality in access and possibly lower quality of dental education.

Access and Equity in Financing Higher Education: The Case of Morocco

ERIC Educational Resources Information Center

Bougroum, Mohammed; Ibourk, Aomar

2011-01-01

This paper explores the higher education financing policy in Morocco in light of the central issue of equity. First, it surveys the current situation, using a critical approach to the present financing policy, and looking at the three dimensions of adequacy, efficiency, and equity. Second, it describes the principal policy challenges in financing…

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.

Challenges of medicines management in the public and private sector under Ghana's National Health Insurance Scheme - A qualitative study.

PubMed

Ashigbie, Paul G; Azameti, Devine; Wirtz, Veronika J

2016-01-01

Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services. This qualitative study examines the challenges and consequences of medicines management policies and practices under the NHIS as perceived by public and private service providers. This study was conducted in health facilities in the Eastern, Greater Accra and Volta regions of Ghana between July and August 2014. We interviewed 26 Key Informants (KIs) from a purposively selected sample of public and private sector providers (government and mission hospitals, private hospitals and private standalone pharmacies), pharmaceutical suppliers and NHIS district offices. Data was collected using semi-structured interview guides which covered facility accreditation, reimbursement practices, medicines selection, purchasing and pricing of medicines, and utilization of medicines. Codes for data analysis were developed based on the study questions and also in response to themes that emerged from the transcripts and notes. Most KIs agreed that the introduction of the NHIS has increased access to and utilization of medicines by removing cost barriers for patients; however, some pointed out the increased utilization could also be corollary to moral hazard. Common concerns across all facilities were the delays in receiving NHIS reimbursements, and low reimbursement rates for medicines which result in providers asking patients to pay supplementary fees. KIs reported important differences between private and public sectors including weak separation of prescribing and dispensing and limited use of drugs and therapeutic committees in the private sector, the disproportionate effects of unfavorable reimbursement prices for medicines, and inadequate participation of the private sector providers (especially pharmacies and licensed chemical sellers) in the NHIS. Health providers generally perceive the NHIS to have had a largely positive impact on access to medicines. However, concerns remain about equity in access to medicines and the differences in quality of pharmaceutical care delivered by private and public providers. Routine monitoring of medicines use during the implementation of health insurance schemes is important to identify and address the potential consequences of medicines policies and practices under the scheme.

Shared Housing Arrangements in Germany—An Equitable Alternative to Long Term Care Services beyond Homes and Institutions?

PubMed Central

Frisina Doetter, Lorraine; Schmid, Achim

2018-01-01

Given the saliency of socio-demographic pressures, the highly restrictive definition of “need for care” characterizing the German long-term care system at its foundations in 1994 has since been subject to various expansionary reforms. This has translated into greater interest in innovative care models that provide more choice and flexibility to beneficiaries. One such model is ‘shared housing arrangements’ (“ambulant betreute Wohngemeinschaften”), where a small group of people rent private rooms, while sharing a common space, domestic support, and nursing care. Using interview and secondary data, this study examines the potential for such arrangements to provide an equitable alternative to care that is accessible to a larger population of beneficiaries than presently seen in Germany. PMID:29443948

Dr Who? Equity and Diversity among University Postgraduate and Higher Degree Cohorts

ERIC Educational Resources Information Center

Harvey, Andrew; Andrewartha, Lisa

2013-01-01

Lack of equitable access at the higher levels of university is detrimental to individuals and more broadly to economic productivity and social cohesion. This paper considers the nature and extent of under-representation in postgraduate and higher degree study and proposes responses at both the institutional and policy levels. Particular focus is…

Education as an Ethical Concern in the Global Era

ERIC Educational Resources Information Center

Arnove, Robert; Bull, Barry L.

2015-01-01

This article examines the issue of the ethical status of education, particularly as related to individual dignity and freedom. We select cases that have been described in fine detail by social science--the education of girls and the education of all children within counter-hegemonic movements. These cases involve issues of access to equitable and…

Could Participant-Produced Photography Augment Therapeutic Interventions for People with Intellectual Disabilities? A Systematic Review of the Available Evidence

ERIC Educational Resources Information Center

Boulton, Natalie E.; Williams, Jonathan; Jones, Robert S. P.

2018-01-01

Background: People with intellectual disabilities are entitled to equitable access to psychological support. Traditional therapeutic approaches often rely on a person's ability to verbally articulate a description of their life, which can be particularly difficult for emotionally salient information. Methods: A systematic literature review was…

Lost and Found: Music Activities Delivered by Primary Classroom Generalists

ERIC Educational Resources Information Center

King, Fiona

2015-01-01

Primary classroom teachers can play a vital role in the music education of primary school students, providing a basis for lifelong learning in music and the arts. Research shows that not all Victorian primary school students have equitable access to music education and that the role of the classroom teacher becomes valuable in supplying or…

Increasing Equitable Care for Youth through Coordinated School Health

ERIC Educational Resources Information Center

Sanetti, Lisa M. Hagermoser

2017-01-01

Nearly a quarter of the students in the U.S. education system have a chronic health condition, disability, or special healthcare need. Students living in poverty and those at risk for or with disabilities have higher rates of health issues and encounter more barriers to accessing appropriate health care than their peers. The reciprocal influences…

Mentoring, Gender, and Publication among Social, Natural, and Physical Scientists. Final Report.

ERIC Educational Resources Information Center

Grant, Linda; Ward, Kathryn B.

Research has identified mentoring as a critical factor in the entry and survival of women and minorities in the social, natural, and physical sciences where they are underrepresented. Much research and many change-oriented programs in higher education have assumed that the presence of mentors is sufficient to ensure equitable access to scientific…

Updating Algebra for All?: Evidence of a Middle-Grades Math Acceleration Policy

ERIC Educational Resources Information Center

Dougherty, Shaun M.; Goodman, Joshua; Hill, Darryl; Litke, Erica; Page, Lindsay

2014-01-01

The Wake County Public School System (WCPSS) in North Carolina recently addressed the issue of advancement in and equitable access to advanced mathematics. Under a recent policy, WCPSS uses a SAS-generated predicted probabilities of students' success in obtaining a passing score on the NC Algebra I End-of-Course (EOC) exam, to determine…

Exploring the Digital Divide: The Use of Digital Technologies in Ontario Public Schools

ERIC Educational Resources Information Center

Chen, Bodong

2015-01-01

Combining data from a school principal survey with student demographics and achievement data, the present study aimed to develop a much needed understanding of ICT usage in Ontario's K-12 public schools. Results indicated equitable first-order access to technology for schools, early integration of ICT from the earliest grades, frequent application…

Expanded Learning Time and Opportunities: Key Principles, Driving Perspectives, and Major Challenges

ERIC Educational Resources Information Center

Blyth, Dale A.; LaCroix-Dalluhn, Laura

2011-01-01

If expanded learning is going to make a real difference, then three key principles must inform how communities overcome challenges and assure equitable access to learning opportunities. Much of today's debate is framed in the language of formal education systems--students, classrooms, schools--even though part of the expansion seeks to engage a…

Expected Annual Emergency Miles per Ambulance: An Indicator for Measuring Availability of Emergency Medical Services Resources

ERIC Educational Resources Information Center

Patterson, P. Daniel; Probst, Janice C.; Moore, Charity G.

2006-01-01

Context: To ensure equitable access to prehospital care, as recommended by the Rural and Frontier Emergency Medical Services (EMS) Agenda for the Future, policymakers will need a uniform measure of EMS infrastructure. Purpose and Methods: This paper proposes a county-level indicator of EMS resource availability that takes into consideration…

The Intersection of Race, Culture, Language, and Disability: Implications for Urban Education

ERIC Educational Resources Information Center

Blanchett, Wanda J.; Klingner, Janette K.; Harry, Beth

2009-01-01

To date, few researchers have sought to examine the effect of issues of race, culture, language, and disability, let alone to look specifically at the intersection of these issues, as it relates to special education identification, special education service delivery, and students of color's access to an equitable education. Thus, this article will…

Creating Joint Representations of Collaborative Problem Solving with Multi-Touch Technology

ERIC Educational Resources Information Center

Mercier, E.; Higgins, S.

2014-01-01

Multi-touch surfaces have the potential to change the nature of computer-supported collaborative learning, allowing more equitable access to shared digital content. In this paper, we explore how large multi-touch tables can be used by groups of students as an external representation of their group interaction processes. Video data from 24 groups…

Learning to Lead: A Social Justice Perspective on Understanding Elementary Teacher Leadership in Papua New Guinea

ERIC Educational Resources Information Center

Brownlee, Joanne; Scholes, Laura; Farrell, Ann; Davis, Julie; Cook, Donna

2012-01-01

Leadership in elementary education is currently recognized as a political imperative in Papua New Guinea (PNG), as the nation develops strategies towards equitable access to schooling. One recent initiative aimed at building educational leadership was an intensive Australian Leadership Award Fellowship (ALAF) program funded by AusAID, involving a…

Ecological Aspects Influencing the Implementation of Inclusive Education in Mainstream Primary Schools in the Eastern Cape, South Africa

ERIC Educational Resources Information Center

Geldenhuys, J. L.; Wevers, N. E. J.

2013-01-01

Despite efforts worldwide to ensure quality education for all learners through inclusive education, indications are that many learners, especially those that experience barriers to learning, are still excluded from full access to quality and equitable education opportunities in mainstream primary schools. This article uses a qualitative approach…

Conviction, Confrontation, and Risk in New Teachers' Advocating for Equity

ERIC Educational Resources Information Center

Athanases, Steven Z.; de Oliveira, Luciana C.

2007-01-01

Despite frustration with school constraints, new teachers who graduated from a program focused on advocacy for equity spoke for students in need in school forums and spoke up about issues of equity. Speaking for students, driven by convictions about equitable access to resources and a responsibility to act, often helped garner support and affected…

Multilingual Language Policy and School Linguistic Practice: Globalization and English-Language Teaching in India, Singapore and South Africa

ERIC Educational Resources Information Center

Hornberger, Nancy; Vaish, Viniti

2009-01-01

This paper explores tensions in translating multilingual language policy to classroom linguistic practice, and especially the paradoxical role of and demand for English as a tool of decolonization for multilingual populations seeking equitable access to a globalizing economy. We take an ecological and sociolinguistic approach, depicting tensions…

Evaluating Admission Practices as Potential Barriers to Creating Equitable Access to Undergraduate Engineering Education

ERIC Educational Resources Information Center

Myers, Beth Ann

2016-01-01

To create a more competitive and creative engineering workforce, breakthroughs in how we attract and educate more diverse engineers are mandated. Despite a programmatic focus on increasing the representation of women and minorities in engineering during the last few decades, no single solution has been identified and is probably not realistic. But…

University and Participative Democracy: Adoption, Perception and Impact--Case Study Universidad Politécnica Salesiana

ERIC Educational Resources Information Center

Buele, Irene; Pablo, Vidueira

2016-01-01

The Constitution of Ecuador was approved in 2008, and promotes the application of participatory processes for resource distribution at different levels of government. The ultimate aim of the Constitution of Ecuador is to promote sustainable development and equitable distribution of resources and wealth, and to access the "Buen Vivir."…

Perspectives on Inclusive Education with Reference to United Nations

ERIC Educational Resources Information Center

Sharma, Arvind

2015-01-01

This essay explores inclusive education and explains the role of United Nations for imparting it to different nations. Undoubtedly, the UN and the United Nations Children's Fund (UNICEF) strive for all children to have equitable access to education as a basic human right. The Convention on the Rights of the Child (CRC) combined with the Convention…

Learning Support Policy for Mathematics in Irish Primary Schools: Equal Access but Unequal Needs

ERIC Educational Resources Information Center

Travers, Joseph

2010-01-01

This paper critiques learning-support policy for mathematics in Irish primary schools. The key policy question addressed is how equitable the development of the learning-support service has been in addressing low achievement in mathematics in designated schools compared to non-designated schools. The core argument developed is that there is a link…

A Case Study of One Teach for America Corps Member's Use of Equity Pedagogy

ERIC Educational Resources Information Center

Hu, Lindsay Anne Kwock

2009-01-01

This study investigates equitable practices used by a Teach For America (TFA) corps member (CM) in her second year of teaching low income, minority students. This study's conceptual framework is based on a contemporary conceptualization of equity pedagogy that includes: (a) tools of power and access (Delpit, 1988); (b) culturally relevant…

Education Policy Reform in Sri Lanka: The Double-Edged Sword of Political Will

ERIC Educational Resources Information Center

Little, Angela W.

2011-01-01

In 1997, the Government of Sri Lanka launched a comprehensive set of education reforms designed to promote equitable access to basic education and improvements in learning outcomes. The package of reforms arose as a political response to widespread youth unrest in the late 1980s and attracted considerable "political will", a vague but…

Examining the Digital Divide in K-12 Public Schools: Four-Year Trends for Supporting ICT Literacy in Florida

ERIC Educational Resources Information Center

Hohlfeld, Tina N.; Ritzhaupt, Albert D.; Barron, Ann E.; Kemker, Kate

2008-01-01

While there is evidence that access to computers in schools has increased, there remain questions about whether low socio-economic status (SES) schools provide students with equitable supports for achieving information communication technology (ICT) literacy. This research first presents a theoretical model to examine the digital divide within…

Breaking the Cycle: A Phenomenological Approach to Broadening Access to Post-Secondary Education

ERIC Educational Resources Information Center

Cefai, Carmel; Downes, Paul; Cavioni, Valeria

2016-01-01

Over the past decades, there has been a substantial increase in post-secondary education participation in most Organisation for Economic Co-operation and Development (OECD) and European Union countries. This increase, however, does not necessarily reflect a parallel equitable growth in post-secondary education, and early school leaving is still an…

Policy Implications of a Proposed Framework to Improve the Accessibility and Effectiveness of Internships in Accounting

ERIC Educational Resources Information Center

Capka, John; Foltin, Craig

2017-01-01

Accounting internships provide substantial benefits to employers and students alike. However, opportunities for students are not equitable across all populations due to the existing policies that exist for placing interns. This inequity is particularly true for students from community colleges where there is a larger proportion of underrepresented…

Providing Worker Education and Building the Labor Movement: The Joseph S. Murphy Institute of City University of New York

ERIC Educational Resources Information Center

D'Amico, Deborah

2011-01-01

To provide equitable access to formal, nonformal and workplace learning, experts urge community, business, education and government partnerships. While membership in unions continues to decline and "opportunities for entry-level workers to become skilled workers is lessening," the partnership described in this article shows that it is…

Building Trust-Based Sustainable Networks

DTIC Science & Technology

2013-06-05

entities to build sustainable networks with limited resources or misbehaving entities by learning from the lessons in the social sciences. We discuss...their individuality); and ■ Misbehaving nodes in terms of environmental, economic, and social perspectives. The sustainable network concerns...equitable access to particular services which are otherwise abused by misbehaving or malicious users. Such approaches provide a fair and

Planning for Food Systems: Community-University Partnerships for Food-Systems Transformation

ERIC Educational Resources Information Center

Whittaker, Jennifer; Clark, Jill K.; SanGiovannni, Sarah; Raja, Samina

2017-01-01

The United Nations estimates that by 2050, more than 66% of the world's population will live in urban areas. In the face of continuing urbanization, how will communities meet the fundamental need for good food? What kinds of public policies, structures, and systems will ensure equitable and just access to food? We argue that urban universities…

Health financing to promote access in low income settings-how much do we know?

PubMed

Palmer, Natasha; Mueller, Dirk H; Gilson, Lucy; Mills, Anne; Haines, Andy

In this article we outline research since 1995 on the impact of various financing strategies on access to health services or health outcomes in low income countries. The limited evidence available suggests, in general, that user fees deterred utilisation. Prepayment or insurance schemes offered potential for improving access, but are very limited in scope. Conditional cash payments showed promise for improving uptake of interventions, but could also create a perverse incentive. The largely African origin of the reports of user fees, and the evidence from Latin America on conditional cash transfers, demonstrate the importance of the context in which studies are done. There is a need for improved quality of research in this area. Larger scale, upfront funding for evaluation of health financing initiatives is necessary to ensure an evidence base that corresponds to the importance of this issue for achieving development goals.

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.

NYSERDA's Green Jobs-Green New York Program: Extending Energy Efficiency Financing To Underserved Households

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

Zimring, Mark; Fuller, Merrian

2011-01-24

The New York legislature passed the Green Jobs-Green New York (GJGNY) Act in 2009. Administered by the New York State Energy Research and Development Authority (NYSERDA), GJGNY programs provide New Yorkers with access to free or low-cost energy assessments,1 energy upgrade services,2 low-cost financing, and training for various 'green-collar' careers. Launched in November 2010, GJGNY's residential initiative is notable for its use of novel underwriting criteria to expand access to energy efficiency financing for households seeking to participate in New York's Home Performance with Energy Star (HPwES) program.3 The GJGNY financing program is a valuable test of whether alternatives tomore » credit scores can be used to responsibly expand credit opportunities for households that do not qualify for traditional lending products and, in doing so, enable more households to make energy efficiency upgrades.« less

The prospects for national health insurance reform.

PubMed

Belcher, J R; Palley, H A

1991-01-01

This article explores the unequal access to health care in the context of efforts by the American Medical Association (AMA) and its allies to maintain a market-maximizing health care system. The coalition between the AMA and its traditional allies is breaking down, in part, because of converging developments creating an atmosphere which may be more conducive to national health care reform and the development of a reformed health care delivery system that will be accessible, adequate, and equitable in meeting the health care and related social service needs of the American people.

Redistributive effects in public health care financing.

PubMed

Honekamp, Ivonne; Possenriede, Daniel

2008-11-01

This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.

The Role of Hospice Care in the Nursing Home Setting

PubMed Central

Miller, Susan C.; Mor, Vince N.T.

2013-01-01

The last days of life for a substantial proportion of dying older adults are spent in nursing homes. Considering this, the provision of Medicare hospice care in nursing homes would appear to be an equitable use of Medicare expenditures as well as a valid investment in improving the quality of life for dying nursing home residents. However, government concerns regarding possible abuse of the hospice benefit in nursing homes, as well as suggestion that the payment for the benefit in nursing homes may be excessive, has perhaps slowed the adoption of hospice services into the nursing home setting. Currently, access to hospice care in nursing homes is inequitable across facilities, and across geographic areas. In nursing homes where hospice is available and present, however, recent research documents superior outcomes for residents enrolled in hospice, and perhaps for nonhospice residents. Still, more research is needed, particularly research focusing on the government costs associated with the provision of hospice care in nursing homes. If subsequent research continues to support the “added value” of hospice care in nursing homes and at the same or less total costs, the issue of foremost concern becomes how equitable access to Medicare hospice care in nursing homes can be achieved. Access may be increased to some extent by changing government policies, and conflicting regulations and interpretive guidelines, so they support and encourage the nursing home/hospice collaboration. PMID:12006229

Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20 years.

PubMed

Santas, Fatih; Celik, Yusuf; Eryurt, Mehmet Ali

2018-01-01

This study aimed to investigate whether there was an improvement in the equitable access to maternal and child health care services by examining the effects of socioeconomic and individual factors in Turkey from 1993 to 2013 and determine the effectiveness of health care reforms implemented mainly under the Health Transformation Program since 2003 on equitable access t;o maternal and child health care services in terms of years. The study used nationally representative 5 Turkey Demographic and Health Surveys (1993, 1998, 2003, 2008, and 2013). Prenatal care utilization rate increased from 67.0% in 1993 to 96.2% in 2013 while the rate of women giving birth at health care facilities increased from 63.8% to 98.1% in 2013. Prenatal care utilization and giving birth at health care facilities were higher among women who were under health insurance coverage, first time mothers, those staying in the western region and urban areas, and those with the highest level of wealth. The findings suggest that the issue of equity in the utilization of maternal and child health care services exists in Turkey, and the latest health care reforms under HTP are not effective in diminishing the effect of wealth. Copyright © 2017 John Wiley & Sons, Ltd.

Planning, Managing, and Financing in the 1980s. Achieving Excellence, Diversity, and Access in the Context of Stable Resources and Demands for Increased Productivity. Proceedings of the 1977 NCHEMS National Assembly (Denver, Colorado, November 6-8, 1977).

ERIC Educational Resources Information Center

Western Interstate Commission for Higher Education, Boulder, CO. National Center for Higher Education Management Systems.

The 1977 National Assembly of the National Center for Higher Education Management Systems addressed specific aspects of excellence, diversity, and access to postsecondary education and suggested ways to preserve these values in planning, managing, and financing in the 1980's. The following conference papers are presented: "Placing Value…

A Delphi Study Executive Skills 2010: A Toolbox of Competencies for Air Force Medical Service Corps Officers of the 21st Century

DTIC Science & Technology

2003-06-03

staff, health care delivery concepts, accessibility, ethics, quality / risk management , technology, and marketing (Table 5 - Hudak et al. 1993). The domain...cost/finance, healthcare delivery, access to care, quality / risk management , technology, professional staff relations, leadership, marketing, and ethics...finance was the second highest rated domain for physicians, this group included quality / risk management and technology among their top four (Hudak et al

Emerging trends in health care finance.

PubMed

Sterns, J B

1994-01-01

Access to capital will become more difficult. Capital access is dependent on ability to repay debt, which, in turn, is dependent on internally generated cash flows. Under any health care reform proposal, revenue inflows will be slowed. The use of corporate finance techniques to limit financial risk and lower cost will be a permanent response to fundamental changes to the health care system. These changes will result in greater balance sheet management, centralized capital allocation, and alternative sources of capital.

Using real-estate-based financing to access capital.

PubMed

Tobin, W C; Kryzaniak, L A

1998-07-01

One strategy employed by healthcare organizations to increase their market presence is the construction of new facilities. Accessing capital to fund such construction, however, has become more of a challenge. One relatively untapped source of building capital is real-estate-based financing. Nonrecourse mortgages, turnkey net leases, and synthetic leases can provide several advantages to healthcare organizations seeking capital, assuming issues related to building ownership, debt and balance sheet effects, and tax-exempt status have been thoroughly explored first.

Public finance policy strategies to increase access to preconception care.

PubMed

Johnson, Kay A

2006-09-01

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.

Negotiation of gender responsibilities in resettled refugee populations through Relationship Enhancement training.

PubMed

Bellinger, Goli Amin

2013-06-01

Being uprooted, displaced, and resettled can produce great tension in refugee marriages. This paper details a technique to help refugees recognize and manage changes and threats to traditional gender roles after resettlement to western countries. A case study from a multisite psycho-educational marriage project illustrates the application of the Relationship Enhancement model with a Bhutanese couple. Through empathy and structured dialogue, the couple is coached to identify their core concerns about the changes in their lives and come up with mutually beneficial solutions. Focusing on the redistribution of each gender's prescribed responsibilities allows the clinician to respond to the cultural structuring of equitable division of labor while helping families to address new responsibilities in managing household duties, parenting, employment, and finances.

Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda

PubMed Central

Shrime, Mark G.; Sekidde, Serufusa; Linden, Allison; Cohen, Jessica L.; Weinstein, Milton C.; Salomon, Joshua A.

2016-01-01

Background The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. Methods Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. Findings Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term “surgical mission trip”. These results are robust to scenario and sensitivity analyses. Interpretation The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems. PMID:28036357

Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda.

PubMed

Shrime, Mark G; Sekidde, Serufusa; Linden, Allison; Cohen, Jessica L; Weinstein, Milton C; Salomon, Joshua A

2016-01-01

The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term "surgical mission trip". These results are robust to scenario and sensitivity analyses. The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems.

Putting Making into High School Computer Science Classrooms: Promoting Equity in Teaching and Learning with Electronic Textiles in "Exploring Computer Science"

ERIC Educational Resources Information Center

Fields, Deborah Ann; Kafai, Yasmin; Nakajima, Tomoko; Goode, Joanna; Margolis, Jane

2018-01-01

Recent discussions of making have focused on developing out-of-school makerspaces and activities to provide more equitable and enriching learning opportunities for youth. Yet school classrooms present a unique opportunity to help broaden access, diversify representation, and deepen participation in making. In turning to classrooms, we want to…

Vocational Qualifications and Progression to Higher Education: The Case of the 14-19 Diplomas in the English System

ERIC Educational Resources Information Center

Hodgson, Ann; Spours, Ken

2010-01-01

Ensuring effective progression from vocational qualifications to higher education has become an important issue internationally as a part of government strategies to raise skill levels and to provide more equitable access to tertiary level study. From September 2008, the Government in England has begun to introduce a new set of qualifications for…

Gender Norms and Access to Extension Services and Training among Potato Farmers in Dedza and Ntcheu in Malawi

ERIC Educational Resources Information Center

Mudege, Netsayi N.; Chevo, Tafadzwa; Nyekanyeka, Ted; Kapalasa, Eliya; Demo, Paul

2016-01-01

Purpose: This paper explores the interaction between extension services and gender relations in order to suggest ways and strategies that can be useful in ensuring that extension services are gender-equitable and empowering for women. Design/Methodology/Approach: In total, 35 sex-disaggregated focus group discussions with farmers, and 4 interviews…

Fracturing Opportunity: Mexican Migrant Students and College-Going Literacy. Counterpoints: Studies in the Postmodern Theory of Education. Volume 362

ERIC Educational Resources Information Center

Gildersleeve, R. Evely

2010-01-01

"Fracturing Opportunity" demonstrates a simple yet profound idea--that educational opportunity is learned. And if it is learned, then it can be taught and taught more equitably. This book brings sociocultural theories of learning and development to bear on the persistent problems of inequality in college access, and presents an innovative…

Missionary Zeal: Some Problems with the Rhetoric, Vision and Approach of the AHELO Project

ERIC Educational Resources Information Center

Ashwin, Paul

2015-01-01

The OECD's Assessment of Higher Education Learning Outcomes (AHELO) project is an important contribution to discussions of how to define and measure the quality of global higher education. There is a genuine need for quality measures that can help to ensure students have equitable access to high-quality higher education wherever they study but do…

Foreign Language Instructed Programs in Public Universities in Egypt: Implications for Resource Diversification, Quality and Equity in Higher Education

ERIC Educational Resources Information Center

Sabry, Manar A.

2010-01-01

This study seeks to assess the impact of tuition fees of the Foreign language Instructed Programs (FLIP) at Cairo University on increasing other-than-governmental resources for these programs as well as for the university, increasing student satisfaction with the quality of education, and maintaining equitable access. The study uses a theoretical…

In Their Own Words: High-Achieving, Low-Income Community College Students Talk about Supports and Obstacles to Their Success

ERIC Educational Resources Information Center

Carrasquillo, Carmen Ana

2013-01-01

Open-access admissions policies and greater affordability position community colleges at the forefront in addressing equitable academic outcomes. Yet, most community college students fail to complete their certificate, degree and transfer goals. The failure rate is particularly high for low-income, Black and Latino(a) students. Much has been…

Linkages between Youth Diversity and Organizational and Program Characteristics of Out-of-School-Time Science Programs: A Mixed-Methods Study

ERIC Educational Resources Information Center

Thiry, Heather; Archie, Timothy; Arreola-Pena, Melissa; Laursen, Sandra

2017-01-01

Science opportunities in out-of-school time (OST) programs hold potential for expanding access to science, engineering, and technology (SET) pathways for populations that have not participated in these fields at equitable rates (Coalition for Science After School, 2014). This mixed-methods study examines the relationship between the diversity of…

Ensuring Equitable Access to Strong Teachers: Important Elements of an Effective State Action Plan

ERIC Educational Resources Information Center

Metz, Rachel

2015-01-01

Every community has strong teachers who help their students learn to high levels. But far too often low-income students and students of color are short-changed when it comes to teacher quality. Federal law requires states to end these disparities. But states, recognizing that most hiring, compensation, and promotional decisions, not to mention…

Middle School Math Acceleration and Equitable Access to Eighth-Grade Algebra: Evidence from the Wake County Public School System

ERIC Educational Resources Information Center

Dougherty, Shaun M.; Goodman, Joshua S.; Hill, Darryl V.; Litke, Erica G.; Page, Lindsay C.

2015-01-01

Taking algebra by eighth grade is considered an important milestone on the pathway to college readiness. We highlight a collaboration to investigate one district's effort to increase middle school algebra course-taking. In 2010, the Wake County Public Schools began assigning middle school students to accelerated math and eighth-grade algebra based…

Law and Order in School and Society: How Discipline and Policing Policies Harm Students of Color, and What We Can Do about It

ERIC Educational Resources Information Center

Scott, Janelle; Moses, Michele S.; Finnigan, Kara S.; Trujillo, Tina; Jackson, Darrell D.

2017-01-01

Systemic violence and disparate school discipline policies hinder equitable, just, and safe schooling. They also restrict access to social opportunities and civil liberties. Research shows that schooling contexts and social policies set up the conditions for young people of color to experience violence in regularized, systematic, and destructive…

Information Is Bliss: Information Use by School Choice Participants in Denver

ERIC Educational Resources Information Center

Yettick, Holly

2016-01-01

If school choice programs are to provide any degree of equitable access to educational opportunities, then useful information about academic quality needs to be available to all participants, not just those who hob knob with the school board members or chat with the superintendent over the backyard fence. This study draws upon a unique data set to…

Ontological Possibilities: Rhizoanalytic Explorations of Community Food Work in Central Appalachia

ERIC Educational Resources Information Center

D'Adamo-Damery, Philip C.

2014-01-01

In the United States, the community food movement has been put forward as a potential solution for a global food system that fails to provide just and equitable access to nutritious food. This claim has been subject to the criticism of a variety of scholars and activists, some of whom contend that the alternative food movement is complicit in the…

Standardization or Localization: A Study of Online Learning Programmes by Tertiary Institutions in Ghana

ERIC Educational Resources Information Center

Djan, Josephine; George, Babu

2016-01-01

Many universities in Ghana have had a desire to ensure equitable access to formal tertiary education for the growing number of the working public who have sought to improve or better their educational status in tertiary institutions. For many of these working public or individuals, it is almost impossible to stay off work to enrol in these…

Contrasting Disclosure Practices and Experiences of School Support for Australian Adolescents with Cancer, Cystic Fibrosis and Anorexia Nervosa: Parent Perspectives

ERIC Educational Resources Information Center

Bowtell, Evelyn Cecile; Aroni, Rosalie; Green, Julie; Sawyer, Susan M.

2018-01-01

Schools in Australia are required to promote equitable access to education and provide support services to students with chronic health conditions (CHCs). This qualitative study was conducted to explore stakeholders' experiences and perceptions regarding school-based support. In-depth interviews were conducted with 38 parents of upper secondary…

Development of American Sign Language Guidelines for K-12 Academic Assessments

ERIC Educational Resources Information Center

Higgins, Jennifer A.; Famularo, Lisa; Cawthon, Stephanie W.; Kurz, Christopher A.; Reis, Jeanne E.; Moers, Lori M.

2016-01-01

The U.S. federal Every Student Succeeds Act (ESSA) was enacted with goals of closing achievement gaps and providing all students with access to equitable and high-quality instruction. One requirement of ESSA is annual statewide testing of students in grades 3-8 and once in high school. Some students, including many deaf or hard-of-hearing (D/HH)…

Splicing the Divide: A Review of Research on the Evolving Digital Divide among K-12 Students

ERIC Educational Resources Information Center

Dolan, Jennifer E.

2016-01-01

The digital divide has narrowed with regard to one definition of access to technology--the binary view of the "haves" and "have-nots." However, use of technology at home and in school is not equitable for all students. According to recent literature, a broader and more nuanced definition of the technological divide is necessary…

Managing the changing burden of cancer in Asia.

PubMed

Sankaranarayanan, Rengaswamy; Ramadas, Kunnambath; Qiao, You-lin

2014-01-08

Asia accounts for 60% of the world population and half the global burden of cancer. The incidence of cancer cases is estimated to increase from 6.1 million in 2008 to 10.6 million in 2030, due to ageing and growing populations, lifestyle and socioeconomic changes. Striking variations in ethnicity, sociocultural practices, human development index, habits and dietary patterns are reflected in the burden and pattern of cancer in different regions. The existing and emerging cancer patterns and burden in different regions of Asia call for political recognition of cancer as an important public health problem and for balanced investments in public and professional awareness. Prevention as well as early detection of cancers leads to both better health outcomes and considerable savings in treatment costs. Cancer health services are still evolving, and require substantial investment to ensure equitable access to cancer care for all sections of the population. In this review, we discuss the changing burden of cancer in Asia, along with appropriate management strategies. Strategies should promote healthy ageing via healthy lifestyles, tobacco and alcohol control measures, hepatitis B virus (HBV) and human papillomavirus (HPV) vaccination, cancer screening services, and vertical investments in strengthening cancer healthcare infrastructure to improve equitable access to services.

Managing the changing burden of cancer in Asia

PubMed Central

2014-01-01

Asia accounts for 60% of the world population and half the global burden of cancer. The incidence of cancer cases is estimated to increase from 6.1 million in 2008 to 10.6 million in 2030, due to ageing and growing populations, lifestyle and socioeconomic changes. Striking variations in ethnicity, sociocultural practices, human development index, habits and dietary patterns are reflected in the burden and pattern of cancer in different regions. The existing and emerging cancer patterns and burden in different regions of Asia call for political recognition of cancer as an important public health problem and for balanced investments in public and professional awareness. Prevention as well as early detection of cancers leads to both better health outcomes and considerable savings in treatment costs. Cancer health services are still evolving, and require substantial investment to ensure equitable access to cancer care for all sections of the population. In this review, we discuss the changing burden of cancer in Asia, along with appropriate management strategies. Strategies should promote healthy ageing via healthy lifestyles, tobacco and alcohol control measures, hepatitis B virus (HBV) and human papillomavirus (HPV) vaccination, cancer screening services, and vertical investments in strengthening cancer healthcare infrastructure to improve equitable access to services. PMID:24400922

Tactical resource allocation and elective patient admission planning in care processes.

PubMed

Hulshof, Peter J H; Boucherie, Richard J; Hans, Erwin W; Hurink, Johann L

2013-06-01

Tactical planning of resources in hospitals concerns elective patient admission planning and the intermediate term allocation of resource capacities. Its main objectives are to achieve equitable access for patients, to meet production targets/to serve the strategically agreed number of patients, and to use resources efficiently. This paper proposes a method to develop a tactical resource allocation and elective patient admission plan. These tactical plans allocate available resources to various care processes and determine the selection of patients to be served that are at a particular stage of their care process. Our method is developed in a Mixed Integer Linear Programming (MILP) framework and copes with multiple resources, multiple time periods and multiple patient groups with various uncertain treatment paths through the hospital, thereby integrating decision making for a chain of hospital resources. Computational results indicate that our method leads to a more equitable distribution of resources and provides control of patient access times, the number of patients served and the fraction of allocated resource capacity. Our approach is generic, as the base MILP and the solution approach allow for including various extensions to both the objective criteria and the constraints. Consequently, the proposed method is applicable in various settings of tactical hospital management.

Global challenges of implementing human papillomavirus vaccines

PubMed Central

2011-01-01

Human Papillomavirus vaccines are widely hailed as a sweeping pharmaceutical innovation for the universal benefit of all women. The implementation of the vaccines, however, is far from universal or equitable. Socio-economically marginalized women in emerging and developing, and many advanced economies alike, suffer a disproportionately large burden of cervical cancer. Despite the marketing of Human Papillomavirus vaccines as the solution to cervical cancer, the market authorization (licensing) of the vaccines has not translated into universal equitable access. Vaccine implementation for vulnerable girls and women faces multiple barriers that include high vaccine costs, inadequate delivery infrastructure, and lack of community engagement to generate awareness about cervical cancer and early screening tools. For Human Papillomavirus vaccines to work as a public health solution, the quality-assured delivery of cheaper vaccines must be integrated with strengthened capacity for community-based health education and screening. PMID:21718495

A Research Agenda to Assure Equity During Periods of Emergency Department Crowding

PubMed Central

Hwang, Ula; Weber, Ellen J.; Richardson, Lynne D.; Sweet, Vicki; Todd, Knox; Abraham, Gallane; Ankel, Felix

2012-01-01

The effect of emergency department (ED) crowding on equitable care is the least studied of the domains of quality as defined by the Institute of Medicine (IOM). Inequities in access and treatment throughout the health care system are well documented in all fields of medicine. While there is little evidence demonstrating that inequity is worsened by crowding, theory and evidence from social science disciplines, as well as known barriers to care for vulnerable populations, would suggest that crowding will worsen inequities. To design successful interventions, however, it is important to first understand how crowding can result in disparities and base interventions on these mechanisms. A research agenda is proposed to understand mechanisms that may threaten equity during periods of crowding and design and test potential interventions that may ensure the equitable aspect of quality of care. PMID:22168197

Acceptable Care? Illness Constructions, Healthworlds, and Accessible Chronic Treatment in South Africa

PubMed Central

Harris, Bronwyn; Eyles, John; Moshabela, Mosa

2015-01-01

Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas—conversely—these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating “disease” to responding to “illness” by acknowledging and incorporating patients’ healthworlds in patient–provider interactions. PMID:25829509

Adverse or acceptable: negotiating access to a post-apartheid health care contract.

PubMed

Harris, Bronwyn; Eyles, John; Penn-Kekana, Loveday; Thomas, Liz; Goudge, Jane

2014-05-15

As in many fragile and post-conflict countries, South Africa's social contract has formally changed from authoritarianism to democracy, yet access to services, including health care, remains inequitable and contested. We examine access barriers to quality health services and draw on social contract theory to explore ways in which a post-apartheid health care contract is narrated, practiced and negotiated by patients and providers. We consider implications for conceptualizing and promoting more inclusive, equitable health services in a post-conflict setting. Using in-depth interviews with 45 patients and 67 providers, and field observations from twelve health facilities in one rural and two urban sub-districts, we explore access narratives of those seeking and delivering - negotiating - maternal health, tuberculosis and antiretroviral services in South Africa. Although South Africa's right to access to health care is constitutionally guaranteed, in practice, a post-apartheid health care contract is not automatically or unconditionally inclusive. Access barriers, including poverty, an under-resourced, hierarchical health system, the nature of illness and treatment, and negative attitudes and actions, create conditions for insecure or adverse incorporation into this contract, or even exclusion (sometimes temporary) from health care services. Such barriers are exacerbated by differences in the expectations that patients and providers have of each other and the contract, leading to differing, potentially conflicting, identities of inclusion and exclusion: defaulting versus suffering patients, uncaring versus overstretched providers. Conversely, caring, respectful communication, individual acts of kindness, and institutional flexibility and leadership may mitigate key access barriers and limit threats to the contract, fostering more positive forms of inclusion and facilitating easier access to health care. Building health in fragile and post-conflict societies requires the negotiation of a new social contract. Surfacing and engaging with differences in patient and provider expectations of this contract may contribute to more acceptable, accessible health care services. Additionally, the health system is well positioned to highlight and connect the political economy, institutions and social relationships that create and sustain identities of exclusion and inclusion - (re)politicise suffering - and co-ordinate and lead intersectoral action for overcoming affordability and availability barriers to inclusive and equitable health care services.

76 FR 40114 - Semiannual Agenda

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-07

... abuses of terrorist financing, money laundering, and other financial crime. The proposed changes are... services posing lower risks of money laundering and terrorist financing from certain requirements. FinCEN... Money Services Businesses to include stored value or prepaid access. In this proposed rulemaking, we are...

[Costly drugs: analysis and proposals for the Mercosur countries].

PubMed

Marín, Gustavo H; Polach, María Andrea

2011-08-01

Determine how the Mercosur countries access, regulate, and finance costly drugs and propose joint selection and financing strategies at the subregional level. Qualitative design, using content analyses of primary and secondary sources, document reviews, interviews, focus groups, and case studies. The variables selected included: selection criteria, access, financing, and regulations in the various countries. Costly drugs were divided into those that do not alter the natural course of the disease and those with demonstrated efficacy, using the defined daily dose to compare the costs of classical treatments and those involving costly drugs. The Mercosur countries generally lack formal strategies for dealing with the demand for costly drugs, and governments and insurers wind up financing them by court order. The case studies show that there are costly drugs whose efficacy has not been established but that nonetheless generate demand. The fragmentation of procurement, international commitments with regard to intellectual property, and low negotiating power exponentially increase the price of costly drugs, putting health system finances in jeopardy. Costly drugs must be regulated and rationally selected so that only those that substantively benefit people are accepted. To finance the drugs so selected, common country strategies are needed that include such options as flexible in trade agreements, the creation of national resource funds, or joint procurement by countries to enhance their negotiating power.

The Gateway Paper--financing health in Pakistan and its linkage with health reforms.

PubMed

Nishtar, Sania

2006-12-01

Pakistan currently principally uses three modes of financing health--taxation, out of pocket payments and donor contributions of which the latter is the least significant in terms of size. Less than 3.6% of the employees are covered under the social security scheme and there is a limited social protection mechanism, which collectively serves the health needs of 3.4% of the population. The main issues in health financing include low spending, lack of attention to alternate sources of financing and issues with fund mobilization and utilization. With respect to the first, health reforms proposed as part of the Gateway Paper make a strong case for promoting the reallocation of tax-based revenues and developing sustainable alternatives to low levels of public spending on health. With respect to alternative sources of health financing, the Gateway Paper lays stress on exploring policy options for private health insurance, broadening the base of Employees Social Security, creating a Federal Employees Social Security Programme, developing social health insurance within the framework of a broad-based social protection strategy, which scopes beyond the formally employed sector, establishing a widely inclusive safety net for the poor; mainstreaming philanthropic grants as a major source of health financing; developing a conducive tax configuration; generating greater corporate support for social sector causes within the framework of the concept of Corporate Social Responsibility and developing cost-sharing programmes, albeit with safeguards. The Gateway Paper regards efficient fund utilization a priority and lays stress on striking a balance between minimizing costs, controlling costs and using resources more efficiently and equitably--in other words, getting the best value for the money, on the one hand, and increasing the pool of available resources, on the other. Specific interventions such as the promotion of transparent financial administration, budgeting and cost controls and enhancing the capacity to overcome onerous financial management procedures and decentralizing decision-making are underscored as a priority as is the need for ensuring greater financial procedural clarity at the federal-provincial-district interface.

Access to essential drugs in Guyana: a public health challenge.

PubMed

Seoane-Vazquez, Enrique; Rodriguez-Monguio, Rosa

2010-01-01

Guyana's pharmaceutical sector faces major challenges that limit access to essential drugs. This study analyzes Guyana's drug policy and regulation, public financing, and drug procurement and delivery. The study also identifies main barriers to drug access and proposes alternatives to strengthen the country's public health functions. Data were collected from the country's regulatory agencies, public procurement agency, pharmacies, wholesalers, and pharmaceutical companies. The information was supplemented with interviews with a convenient sample of Guyanese health authorities and stakeholders. Data were also compiled from scientific databases, and web pages of the country's Ministries of Health, Commerce and Finance, the Bureau of Statistics, and international organizations. Major barriers to drug access include: (1) lack of national drug policy and regulation, and limited role of the regulatory authority; (2) inefficient drug selection and irrational drug use; (3) insufficient financial resources and lack of drug pricing policy; (4) inefficient planning and managing public supply system; (5) deficient epidemiological and information systems; and (6) inadequate infrastructures and human resources shortage. Improving drug access in Guyana requires the strengthening of the country's public health functions and the implementation of a national drug policy and pricing policy, streamlining the drug financing, procurement, and planning and managing drug supply; and adequate infrastructures and human resources. Copyright 2008 John Wiley & Sons, Ltd.

Promoting country ownership and stewardship of health programs: The global fund experience.

PubMed

Atun, Rifat; Kazatchkine, Michel

2009-11-01

The Global Fund to Fight AIDS, Tuberculosis and Malaria was established in 2002 to provide large-scale financing to middle- and low-income countries to intensify the fight against the 3 diseases. Its model has enabled strengthening of local health leadership to improve governance of HIV programs in 5 ways. First, the Global Fund has encouraged development of local capacity to generate technically sound proposals reflecting country needs and priorities. Second, through dual-track financing-where countries are encouraged to nominate at least one government and one nongovernment principal recipient to lead program implementation-the Global Fund has enabled civil society and other nongovernmental organizations to play a critical role in the design, implementation, and oversight of HIV programs. Third, investments to strengthen community systems have enabled greater involvement of community leaders in effective mobilization of demand and scale-up for services to reach vulnerable groups. Fourth, capacity building outside the state sector has improved community participation in governance of public health. Finally, an emphasis on inclusiveness and diversity in planning, implementation, and oversight has broadly enhanced country coordination capacity. Strengthening local leadership capacity and governance are critical to building efficient and equitable health systems to deliver universal coverage of HIV services.

Household Costs of Healthcare during Pregnancy, Delivery, and the Postpartum Period: A Case Study from Matlab, Bangladesh

PubMed Central

Sabina, Nazme; Blum, Lauren S.; Hoque, Mohammad Enamul; Ronsmans, Carine

2006-01-01

A household survey was undertaken in Matlab, a rural area of Bangladesh, to estimate the costs incurred during pregnancy, delivery, and the postpartum period for women delivering at home and in a health facility. Those interviewed included 121 women who delivered at home, 120 who delivered in an ICDDR,B basic obstetric care (BEOC) facility, 27 who delivered in a public comprehensive obstetric care (CEOC) hospital, and 58 who delivered in private hospitals. There was no significant difference in total costs incurred by those delivering at home and those delivering in a BEOC facility. Costs for those delivering in CEOC facilities were over nine times greater than for those delivering in BEOC facilities. Costs of care during delivery were predominant. Antenatal and postnatal care added between 7% and 30% to the total cost. Services were more equitable at home and in a BEOC facility compared to services provided at CEOC facilities. The study highlights the regressive nature of the financing of CEOC services and the need for a financing strategy that covers both the costs of referral and BEOC care for those in need. PMID:17591341

Brazilian healthcare in the context of austerity: private sector dominant, government sector failing.

PubMed

Costa, Nilson do Rosário

2017-04-01

This paper presents the arguments in favor of government intervention in financing and regulation of health in Brazil. It describes the organizational arrangement of the Brazilian health system, for the purpose of reflection on the austerity agenda proposed for the country. Based on the literature in health economics, it discusses the hypothesis that the health sector in Brazil functions under the dominance of the private sector. The categories employed for analysis are those of the national health spending figures. An international comparison of indicators of health expenses shows that Brazilian public spending is a low proportion of total spending on Brazilian health. Expenditure on individuals' health by out-of-pocket payments is high, and this works against equitability. The private health services sector plays a crucial role in provision, and financing. Contrary to the belief put forward by the austerity agenda, public expenditure cannot be constrained because the government has failed in adequate provision of services to the poor. This paper argues that, since the Constitution did not veto activity by the private sector segment of the market, those interests that have the greatest capacity to vocalize have been successful in imposing their preferences in the configuration of the sector.

Too poor for transplant: finance and insurance issues in transplant ethics.

PubMed

Laurentine, Kyle Alexander; Bramstedt, Katrina A

2010-06-01

Donor organs are a scarce gift. Additionally, transplantation is very expensive and the United States lacks universal health insurance for all citizens. These facts combine to make personal finance and insurance some of the criteria for wait listing at US transplant centers. Previous research has shown that the poor and the uninsured (as well as women and nonwhites) are less likely to receive a transplant. Living donor candidates are also limited by the US insurance system. To determine the effect of finance and insurance variables on access to transplant and living donation. A qualitative descriptive study of ethics consultation data contained in a research registry approved by the institutional review board at California Pacific Medical Center. This study analyzes research registry data from a large community hospital in Northern California that serves patients from California, Oregon, and Nevada. The registry data are derived from transplant ethics consultations occurring between January 1, 2007, and June 30, 2009. This study explores the restriction of access to transplantation and of participation in living donation. More than a quarter of all transplant ethics consultation reports described the restriction of transplant-related treatment for reasons rooted in finance or insurance. Individuals on the recipient side and on the donor side were hindered with regard to access. Insurance status and personal ability to pay significantly affect access to transplantation in the United States, and this theme is a frequent feature of ethics consultations at California Pacific Medical Center.

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.

76 FR 27035 - Combined Notice of Filings #1

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-10

... Power Resources Management, LLC, GDF SUEZ Energy Marketing NA, Inc., Hopewell Cogeneration Limited... & Company, Power Receivable Finance, LLC. Description: Land Acquisition Report of J. Aron & Company and Power Receivable Finance, LLC under LA11-1. Filed Date: 05/02/2011. Accession Number: 20110502-5534...

The Minamata Convention on Mercury: attempting to address the global controversy of dental amalgam use and mercury waste disposal.

PubMed

Mackey, Tim K; Contreras, John T; Liang, Bryan A

2014-02-15

In October 2013, a new international binding treaty instrument called the Minamata Convention on Mercury opened for signature in Minamata City, Japan, the site of arguably the worst public health and environmental disaster involving mercury contamination. The treaty aims to curb the significant health and environmental impacts of mercury pollution and includes provisions addressing the mining, export and import, storage, and waste management of products containing mercury. Importantly, a provision heavily negotiated in the treaty addresses the use of dental fillings using mercury amalgam, an issue that has been subject to decades of global controversy. Though use of dental amalgam is widespread and has benefits, concerns have been raised regarding the potential for human health risk and environmental damage from emissions and improper waste management. While the Minamata Convention attempts to address these issues by calling for a voluntary phase-down of dental amalgam use and commitment to other measures, it falls short by failing to require binding and measurable targets to achieve these goals. In response, the international community should begin exploring ways to strengthen the implementation of the dental amalgam treaty provisions by establishing binding phase-down targets and milestones as well as exploring financing mechanisms to support treaty measures. Through strengthening of the Convention, stakeholders can ensure equitable access to global oral health treatment while also promoting responsible environmental stewardship. Copyright © 2013 Elsevier B.V. All rights reserved.

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.

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs

PubMed Central

Wilson, David

2015-01-01

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection “Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers” highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work. PMID:26079267

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

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs.

PubMed

Wilson, David

2015-06-01

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection "Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers" highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.

Culturally Diverse and Underserved Populations of Gifted Students in the United States and in Taiwan: Equitable Access to Gifted Education

ERIC Educational Resources Information Center

Ho, Ya-Ting

2014-01-01

There is a continuing increase in the African American and Hispanic student populations in public schools. The students who are invited to gifted programs are overwhelmingly White. This is the situation in schools in the United States and also in Taiwan. Misunderstanding or unawareness of culture difference among educators might contribute to…

Advanced Placement Environmental Science and the Curriculum and Community Enterprise for Restoration Science (CCERS) Project in the New York City High School

ERIC Educational Resources Information Center

Birney, Lauren; McNamara, Denise

2018-01-01

This paper explores the issue of social justice through the lens of equitable access to Advanced Placement courses in the City of New York High Schools, with focus on Advanced Placement Environmental Science. A critical component of the Advanced Placement Environmental Science course is the incorporation of environmental fieldwork. The National…

Access or Quality? Why Do Families Living in Slums Choose Low-Cost Private Schools in Lagos, Nigeria?

ERIC Educational Resources Information Center

Härmä, Joanna

2013-01-01

Lagos is home to 12,098 private schools catering to 57% of the state's enrolled children, from ultra-rich to relatively poor households, with many schools targeting those of lower socio-economic status. Government schools were intended to provide a just and equitable option for all; however, they have not kept pace with demand in terms of both…

Disentangling Chile's Authoritarian Neoliberalism and Its Effects: The Downfall of Public Higher Education and Its Implications for Equitable Access

ERIC Educational Resources Information Center

Pitton, Viviana

2007-01-01

In recent decades, neoliberal reforms have spread across Latin America. Despite different accounts showing the adverse social impact of these reforms, what seems lacking are historical analyses of why and how neoliberal policies occurred in this region. For instance, there are only rare accounts of how dictatorships in the 1970s prepared the…

Learning Denied: The Case for Equitable Access to Effective Teaching in California's Largest School District. Policy Brief

ERIC Educational Resources Information Center

Education Trust-West, 2012

2012-01-01

Effective teachers have an enormous impact on the lives of their students. Great teachers can help students who are behind academically catch up to grade-level expectations. By accelerating student performance, they can help close the opportunity and achievement gaps that cut short the college and career dreams of so many low-income students and…

Course Access: Equitable Opportunities for College and Career Ready Students

ERIC Educational Resources Information Center

Worthen, Maria; Patrick, Susan

2014-01-01

Imagine a high school student who does not have the opportunity to take all of the courses she needs to get into college. Today, for far too many young people, this is a sobering reality. Public schools around the country may lack the resources, staff, or demand to offer a full catalog of courses. According to recent data from the U.S. Department…

Public Finance Policy Strategies to Increase Access to Preconception Care

PubMed Central

2006-01-01

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15–44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states’ experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs. PMID:16802188

Family Planning in the Context of Latin America's Universal Health Coverage Agenda.

PubMed

Fagan, Thomas; Dutta, Arin; Rosen, James; Olivetti, Agathe; Klein, Kate

2017-09-27

Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region. We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts. Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket. Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations. © Fagan et al.

Family Planning in the Context of Latin America's Universal Health Coverage Agenda

PubMed Central

Fagan, Thomas; Dutta, Arin; Rosen, James; Olivetti, Agathe; Klein, Kate

2017-01-01

ABSTRACT Background: Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region. Methods: We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts. Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket. Conclusion: Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations. PMID:28765156

Working toward equitable opportunities for science students with disabilities: using professional development and technology.

PubMed

Bargerhuff, Mary Ellen; Cowan, Heidi; Kirch, Susan A

2010-01-01

As a result of federal legislation, adolescents with disabilities and other exceptionalities are increasingly included in science and math classes alongside their peers who are typically developing. The effectiveness of this placement option, however, is largely dependent on the skill level of the general educator and the support afforded to this teacher through various channels. Efforts arising from two National Science Foundation grants address both skill and support. Center's Lesson Adaptations for Student Success (CLASS) project used summer professional development opportunities to equip teachers with the knowledge and skills needed to provide students with physical, sensory and learning disabilities equitable access to laboratory and field experiences. Second, to support teachers back in their classrooms, the Ohio Resource Center's Lesson Adaptations for Student Success (OR-CLASS) uses web resources to share high quality, peer-reviewed lesson plans, complete with specific recommendations on adaptations for students with a variety of exceptional learning needs.

Remote nursing certified practice: viewing nursing and nurse practitioner practice through a social justice lens.

PubMed

Tarlier, Denise S; Browne, Annette J

2011-06-01

Remote Nursing Certified Practice (RNCP) was introduced in 2010 to regulate nursing practice in remote, largely First Nations communities in British Columbia, Canada. These are communities that often experience profound health and health-care inequities. Typically nurses are the main health-care providers. Using a critical social justice lens, the authors explore the clinical and ethical implications of RNCP in terms of access to equitable, high-quality primary health care.They examine the fit between the level and scope of health services provided by registered nurses working under RNCP and the health needs of remote First Nations communities. In doing so, they draw comparisons between nurse practitioners (NPs) and outpost nurses working in NP roles who historically were employed to provide health care in these communities.The authors conclude by calling for nursing regulations that support equitable, high-quality primary care for all British Columbians.

31 CFR 408.2 - Designation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE... THE SECRET SERVICE AND TEMPORARY OFFICES OF THE PRESIDENT AND STAFF, OR OTHER PERSON PROTECTED BY THE SECRET SERVICE-RULES GOVERNING ACCESS § 408.2 Designation. (a) For the purpose of 18 U.S.C. 1752, the...

31 CFR 408.2 - Designation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE... THE SECRET SERVICE AND TEMPORARY OFFICES OF THE PRESIDENT AND STAFF, OR OTHER PERSON PROTECTED BY THE SECRET SERVICE-RULES GOVERNING ACCESS § 408.2 Designation. (a) For the purpose of 18 U.S.C. 1752, the...

Implementation of accessible tourism concept at museums in Jakarta

NASA Astrophysics Data System (ADS)

Wiastuti, R. D.; Adiati, M. P.; Lestari, N. S.

2018-03-01

Accessibility, sustainability and equitable participation by all makeup what is known as Tourism for All. Tourism product must be designed for all people despite the age, gender and ability as one of the requirements to comply the accessible tourism concept. Museum as one of the elements of tourism chain must adhere to accessible tourism concept thus able to be enjoyed for everyone regardless of one’s abilities. The aim of this study is to identify the implementation of accessible tourism concept at the museum in Jakarta and to provide practical accessibility- improvement measures for the museum in Jakarta towards accessible tourism concept. This research is qualitative- explorative research. Jakarta Tourism Board website was used as the main reference to obtain which museum that was selected. Primary data collect from direct field observations and interview. The results outline museum implementation of accessible tourism that classified into five criteria; information, transport, common requirements, universal design, and accessibility. The implication of this study provides recommendations to enhance museums’ accessibility performance expected to be in line with accessible tourism concept.

Report on a seminar on financing and service delivery issues in caring for the medically underserved.

PubMed Central

Tavani, C

1991-01-01

Current national activities directed toward improving access to health care and assessing the potential effectiveness of various financing and service delivery strategies were reviewed by an invited group of 39 public and private sector health policy experts. Health care access problems of the medically underserved population were defined and a range of strategies for addressing them were presented. The seminar was held at Columbia, MD, July 6-7, 1988, sponsored jointly by the Robert Wood Johnson Foundation and the Health Resources and Services Administration, PHS. PMID:1899935

Improving Access to Medicines in Low and Middle Income Countries: Corporate Responsibilities in Context

PubMed Central

Leisinger, Klaus Michael; Garabedian, Laura Faden; Wagner, Anita Katharina

2012-01-01

More than two billion people in low- and middle-income countries (LMIC) lack adequate access to essential medicines. In this paper, we make strong public health, human rights and economic arguments for improving access to medicines in LMIC and discuss the different roles and responsibilities of key stakeholders, including national governments, the international community, and non-governmental organizations (NGOs). We then establish a framework of pharmaceutical firms’ corporate responsibilities - the “must,” the “ought to,” and the “can” dimensions - and make recommendations for actionable business strategies for improving access to medicines. We discuss controversial topics, such as pharmaceutical profits and patents, with the goal of building consensus around facts and working towards a solution. We conclude that partnerships and collaboration among multiple stakeholders are urgently needed to improve equitable access to medicines in LMIC. PMID:23535994

Hospitalization among migrants in Italy: Access to health care as an opportunity for integration and inclusion.

PubMed

Barsanti, Sara

2018-03-30

This paper analyzes migrant access to health care by comparing hospitalizations of native and immigrant population with respect the Tuscany Region (Italy). In the analyses, a critical gap both for legal and undocumented migrant population is highlighted. Indeed, we found some key differences between the migrant and native populations related to the use of specific hospital services in Tuscany and, indirectly, of community and primary care services. Moreover, especially for undocumented migrants, hospitals seem to be the only point of access to the health-care system for migrant populations. The results suggest that the Italian health-care system is unable to ensure an equitable access to health services. In this context, maternity care could be a key point of access to the welfare system that allows participation in the health system not only for mothers but also for all migrant family members. Copyright © 2018 John Wiley & Sons, Ltd.

Medicaid case-mix nursing home reimbursement in three states.

PubMed

Swan, James H; Pickard, Ruth B

2003-01-01

Case-mix nursing facility payment raises issues of access, quality, equity, and cost. Case-mix should better match payment to costs, improve access, and provide incentives to increased staffing and quality of care; but it may also increase costs. This paper reports analysis of Medicaid cost-report data from three case-mix states. Case-mix did not discourage capacity building and was more equitable for providers. Medicaid access declined in one state but increased in another. There were shifts toward greater skilled care in two states, with evidence of greater focus of resources on patient care. Case-mix showed no evidence of cost-constraint and some signs of increased costs. Whether such mixed outcomes are viable in the current era remains to be seen.

Donor Financing of Basic Education: Opportunities and Constraints

ERIC Educational Resources Information Center

Steer, Liesbet; Wathne, Cecilie

2010-01-01

Much progress has been made in improving access to basic education in recent years, but international support has been less than promised and the "funding gap" to achieve universal primary education remains stubbornly present. This article identifies six interrelated factors that constrain such donor financing. Prioritization of basic education,…

Colorado Business Commission on Child Care Financing, Report.

ERIC Educational Resources Information Center

Colorado State Dept. of Human Services, Denver. Div. of Child Care.

This report examines child care from a business perspective and proposes methods to help finance affordable, accessible, and high-quality child care in Colorado. The Commission's procedures are described, and data summaries are included. The following 12 recommendations are made: (1) establish model planning and zoning programs to increase and…

Financing of a College Education: Theory vs. Reality

ERIC Educational Resources Information Center

Boyd, Joseph D.; Fenske, Robert F.

1976-01-01

A longitudinal study clearly indicates that changes over time require continual evaluation in both how students are financing their education and the impact of certain forms of student aid on both access to and choice of institutions. Parental and student attitudes toward financial support and financial independence are significant. (LBH)

Planning for Success: Developing an Economic Planning Cell for the Operational Level Commander

DTIC Science & Technology

2011-05-04

Laura Landes, “ Follow the Money : The Army Finance Corps and Iraqi Financial Independence,” Military Review (March – April 2008): 85 ii Joint...accessed 23 March, 2011). Landes, Laura. “ Follow the Money : The Army Finance Corps and Iraqi Financial Independence,” Military Review (March

31 CFR 6.7 - Delegations of authority.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Delegations of authority. 6.7 Section 6.7 Money and Finance: Treasury Office of the Secretary of the Treasury APPLICATIONS FOR AWARDS UNDER THE EQUAL ACCESS TO JUSTICE ACT General Provisions § 6.7 Delegations of authority. The Director...

Inclusion of vulnerable groups in health policies: Regional policies on health priorities in Africa

PubMed Central

Eide, Arne Henning; Amin, Mutamad; MacLachlan, Malcom; Mannan, Hasheem

2013-01-01

Background If access to equitable health care is to be achieved for all, policy documents must mention and address in some detail different needs of groups vulnerable to not accessing such health care. If these needs are not addressed in the policy documents, there is little chance that they will be addressed at the stage of implementation. Objectives This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. Method The paper applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. Each core concept mention was further analysed in terms of the vulnerable group in referred to. Results The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. Conclusion The need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all. PMID:28729986

Improving equitable access to imaging under universal-access medicine: the ontario wait time information program and its impact on hospital policy and process.

PubMed

Kielar, Ania Z; El-Maraghi, Robert H; Schweitzer, Mark E

2010-08-01

In Canada, equal access to health care is the goal, but this is associated with wait times. Wait times should be fair rather than uniform, taking into account the urgency of the problem as well as the time an individual has already waited. In November 2004, the Ontario government began addressing this issue. One of the first steps was to institute benchmarks reflecting "acceptable" wait times for CT and MRI. A public Web site was developed indicating wait times at each Local Health Integration Network. Since starting the Wait Time Information Program, there has been a sustained reduction in wait times for Ontarians requiring CT and MRI. The average wait time for a CT scan went from 81 days in September 2005 to 47 days in September 2009. For MRI, the resulting wait time was reduced from 120 to 105 days. Increased patient scans have been achieved by purchasing new CT and MRI scanners, expanding hours of operation, and improving patient throughput using strategies learned from the Lean initiative, based on Toyota's manufacturing philosophy for car production. Institution-specific changes in booking procedures have been implemented. Concurrently, government guidelines have been developed to ensure accountability for monies received. The Ontario Wait Time Information Program is an innovative first step in improving fair and equitable access to publicly funded imaging services. There have been reductions in wait times for both CT and MRI. As various new processes are implemented, further review will be necessary for each step to determine their individual efficacy. Copyright 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Linking research to global health equity: the contribution of product development partnerships to access to medicines and research capacity building.

PubMed

Pratt, Bridget; Loff, Bebe

2013-11-01

Certain product development partnerships (PDPs) recognize that to promote the reduction of global health disparities they must create access to their products and strengthen research capacity in developing countries. We evaluated the contribution of 3 PDPs--Medicines for Malaria Venture, Drugs for Neglected Diseases Initiative, and Institute for One World Health--according to Frost and Reich's access framework. We also evaluated PDPs' capacity building in low- and middle-income countries at the individual, institutional, and system levels. We found that these PDPs advance public health by ensuring their products' registration, distribution, and adoption into national treatment policies in disease-endemic countries. Nonetheless, ensuring broad, equitable access for these populations--high distribution coverage; affordability, particularly for the poor; and adoption at provider and end-user levels--remains a challenge.

31 CFR 17.149 - Program accessibility: Discrimination prohibited.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Program accessibility: Discrimination... DEPARTMENT OF THE TREASURY § 17.149 Program accessibility: Discrimination prohibited. Except as otherwise... participation in, or otherwise be subjected to discrimination under any program or activity conducted by the...

Community Science: creating equitable partnerships for the advancement of scientific knowledge for action.

NASA Astrophysics Data System (ADS)

Lewis, E. S.; Gehrke, G. E.

2017-12-01

In a historical moment where the legitimacy of science is being questioned, it is essential to make science more accessible to the public. Active participation increases the legitimacy of projects within communities (Sidaway 2009). Creating collaborations in research strengthens not only the work by adding new dimensions, but also the social capital of communities through increased knowledge, connections, and decision making power. In this talk, Lewis will discuss how engagement at different stages of the scientific process is possible, and how researchers can actively develop opportunities that are open and inviting. Genuine co-production in research pushes scientists to work in new ways, and with people from different backgrounds, expertise, and lived experiences. This approach requires a flexible and dynamic balance of learning, sharing, and creating for all parties involved to ensure more meaningful and equitable participation. For example, in community science such as that by Public Lab, the community is at the center of scientific exploration. The research is place-based and is grounded in the desired outcomes of community members. Researchers are able to see themselves as active participants in this work alongside community members. Participating in active listening, developing plans together, and using a shared language built through learning can be helpful tools in all co-production processes. Generating knowledge is powerful. Through genuine collaboration and co-creation, science becomes more relevant. When community members are equitable stakeholders in the scientific process, they are better able to engage and advocate for the changes they want to see in their communities. Through this talk, session attendees will learn about practices that promote equitable participation in science, and hear examples of how the community science process engages people in both the knowledge production, and in the application of science.

A Rising Tide of Primary School Standards--The Role of Data Systems in Improving Equitable Access for All to Quality Education in Vietnam

ERIC Educational Resources Information Center

Attfield, Ian; Vu, Binh Thanh

2013-01-01

The approach taken over the past decade to introduce minimum primary school standards in Vietnam is reviewed, with annual school audits that measured both input (quality) and output indicators. It describes a successful, context specific approach in which flexible data systems were used to support the evolution and adoption of a new set of…

Towards an Education for Social Justice: Ethics Applied to Education. New International Studies in Applied Ethics. Volume 7

ERIC Educational Resources Information Center

Cotton, Tony, Ed.

2012-01-01

This book challenges educators to envisage an education system which sees as its goal a more socially just world. It explores the question of how education, both formal and informal, can positively impact on all pupils' life chances and life experiences. The contributors to the book take the view that access to an equitable education for all is a…

Nonpublic School Students in Title I, ESEA Programs: A Question of "Equal" Services. A Special Report from the Title I District Practices Study.

ERIC Educational Resources Information Center

Jung, Richard K.

Based on data from a study of Title I of the Elementary and Secondary Education Act, this report describes the level of nonpublic school student participation in the Title I program during 1981-82, assesses whether nonpublic students receive an equitable share of Title I resources, and examines variables affecting the access of nonpublic students…

78 FR 8601 - AXA Equitable Life Insurance Company, et al; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... SECURITIES AND EXCHANGE COMMISSION [Release No. IC-30373; File No. 812-14036] AXA Equitable Life... the Act. Applicants: AXA Equitable Life Insurance Company (``AXA Equitable''), Separate Account 45 of...: Steven M. Joenk, Senior Vice President, AXA Equitable Life Insurance Company, 1290 Avenue of Americas...

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.

Policies to Spur Energy Access. Executive Summary; Volume 1, Engaging the Private Sector in Expanding Access to Electricity; Volume 2, Case Studies to Public-Private Models to Finance Decentralized Electricity Access

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

Walters, Terri; Rai, Neha; Esterly, Sean

Government policy is one of the most important factors in engaging the private sector in providing universal access to electricity. In particular, the private sector is well positioned to provide decentralized electricity products and services. While policy uncertainty and regulatory barriers can keep enterprises and investors from engaging in the market, targeted policies can create opportunities to leverage private investment and skills to expand electricity access. However, creating a sustainable market requires policies beyond traditional electricity regulation. The report reviews the range of policy issues that impact the development and expansion of a market for decentralized electricity services from establishingmore » an enabling policy environment to catalyzing finance, building human capacity, and integrating energy access with development programs. The case studies in this report show that robust policy frameworks--addressing a wide range of market issues--can lead to rapid transformation in energy access. The report highlights examples of these policies in action Bangladesh, Ethiopia, Mali, Mexico, and Nepal.« less

[Market access agreements: Definition and features. Could MAA be defined as a solution for immunotherapy funding by French health system?

PubMed

Ceyrac, T; Corny, J; Raybaut, C; Degrassat-Théas, A; Paubel, P

2018-03-21

Over the last few years, many therapeutic innovations have been approved and marketed in France, within a strained financial setting. Legal dispositions allowed manufacturers (LEEM - les enterprises du medicament) and the economic committee for health products (CEPS) to contract various confidential market access agreements to contain health product expenses. The purposes of this article are to define and describe these different existing market access agreements and to open discussion on their applicability to the problematic of immune-oncology drugs financing. Financial agreements, which led to major savings (discounts refunded to the public payer), have not responded completely to the therapeutic innovations financing problems. Performance agreements (funding based on real-life data and effectiveness of the drug) constitute a hope for health products financing, but major methodological challenges for their use in routine restrict them to rare cases only today. Even though several financial agreements could partly respond to this problematic, use of performance agreements could really constitute an interesting track to tackle this issue. Copyright © 2018. Published by Elsevier Masson SAS.

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...

Development and formative evaluation of a visual e-tool to help decision makers navigate the evidence around health financing.

PubMed

Skordis-Worrall, Jolene; Pulkki-Brännström, Anni-Maria; Utley, Martin; Kembhavi, Gayatri; Bricki, Nouria; Dutoit, Xavier; Rosato, Mikey; Pagel, Christina

2012-12-21

There are calls for low and middle income countries to develop robust health financing policies to increase service coverage. However, existing evidence around financing options is complex and often difficult for policy makers to access. To summarize the evidence on the impact of financing health systems and develop an e-tool to help decision makers navigate the findings. After reviewing the literature, we used thematic analysis to summarize the impact of 7 common health financing mechanisms on 5 common health system goals. Information on the relevance of each study to a user's context was provided by 11 country indicators. A Web-based e-tool was then developed to assist users in navigating the literature review. This tool was evaluated using feedback from early users, collected using an online survey and in-depth interviews with key informants. The e-tool provides graphical summaries that allow a user to assess the following parameters with a single snapshot: the number of relevant studies available in the literature, the heterogeneity of evidence, where key evidence is lacking, and how closely the evidence matches their own context. Users particularly liked the visual display and found navigating the tool intuitive. However there was concern that a lack of evidence on positive impact might be construed as evidence against a financing option and that the tool might over-simplify the available financing options. Complex evidence can be made more easily accessible and potentially more understandable using basic Web-based technology and innovative graphical representations that match findings to the users' goals and context.

Defining pharmaceutical systems strengthening: concepts to enable measurement.

PubMed

Hafner, Tamara; Walkowiak, Helena; Lee, David; Aboagye-Nyame, Francis

2017-05-01

Pharmaceutical products are indispensable for improving health outcomes. An extensive body of work on access to and use of medicines has resulted in an assortment of tools measuring various elements of pharmaceutical systems. Until now however, there has been little attempt to conceptualize a pharmaceutical system as an entity and define its strengthening in a way that allows for measuring systems strengthening. The narrow focus of available tools limits their value in ascertaining which interventions result in stronger, more resilient systems. We sought to address this shortcoming by revisiting the current definitions, frameworks and assessment tools related to pharmaceutical systems. We conducted a comprehensive literature review and consulted with select pharmaceutical experts. On the basis of our review, we propose that a pharmaceutical system consists of all structures, people, resources, processes, and their interactions within the broader health system that aim to ensure equitable and timely access to safe, effective, quality pharmaceutical products and related services that promote their appropriate and cost-effective use to improve health outcomes. We further propose that pharmaceutical systems strengthening is the process of identifying and implementing strategies and actions that achieve coordinated and sustainable improvements in the critical components of a pharmaceutical system to make it more responsive and resilient and to enhance its performance for achieving better health outcomes. Finally, we established that, in addition to system performance and resilience, seven components of the pharmaceutical system are critical for measuring pharmaceutical systems strengthening: pharmaceutical products and related services; policy, laws and governance; regulatory systems; innovation, research and development, manufacturing, and trade; financing; human resources; and information. This work adds clarity to the concept of pharmaceutical systems and their strengthening by proposing holistic definitions on the basis of systems thinking. It provides a practical starting point for measuring the progress of pharmaceutical systems strengthening. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Essential surgery: key messages from Disease Control Priorities, 3rd edition.

PubMed

Mock, Charles N; Donkor, Peter; Gawande, Atul; Jamison, Dean T; Kruk, Margaret E; Debas, Haile T

2015-05-30

The World Bank will publish the nine volumes of Disease Control Priorities, 3rd edition, in 2015-16. Volume 1--Essential Surgery--identifies 44 surgical procedures as essential on the basis that they address substantial needs, are cost effective, and are feasible to implement. This report summarises and critically assesses the volume's five key findings. First, provision of essential surgical procedures would avert about 1·5 million deaths a year, or 6-7% of all avertable deaths in low-income and middle-income countries. Second, essential surgical procedures rank among the most cost effective of all health interventions. The surgical platform of the first-level hospital delivers 28 of the 44 essential procedures, making investment in this platform also highly cost effective. Third, measures to expand access to surgery, such as task sharing, have been shown to be safe and effective while countries make long-term investments in building surgical and anaesthesia workforces. Because emergency procedures constitute 23 of the 28 procedures provided at first-level hospitals, expansion of access requires that such facilities be widely geographically diffused. Fourth, substantial disparities remain in the safety of surgical care, driven by high perioperative mortality rates including anaesthesia-related deaths in low-income and middle-income countries. Feasible measures, such as WHO's Surgical Safety Checklist, have led to improvements in safety and quality. Fifth, the large burden of surgical disorders, cost-effectiveness of essential surgery, and strong public demand for surgical services suggest that universal coverage of essential surgery should be financed early on the path to universal health coverage. We point to estimates that full coverage of the component of universal coverage of essential surgery applicable to first-level hospitals would require just over US$3 billion annually of additional spending and yield a benefit-cost ratio of more than 10:1. It would efficiently and equitably provide health benefits, financial protection, and contributions to stronger health systems. Copyright © 2015 Elsevier Ltd. All rights reserved.

Higher Education Financing in Nigeria: Issues and Trends

ERIC Educational Resources Information Center

Adewuyi, Jacob Olusayo; Okemakinde, Timothy

2013-01-01

The potential of the higher education system to act as an agent of growth and development in Nigeria is being challenged by the long-standing problems of limited access, inadequate financing, poor governance, declining quality and relevance. Thus, this paper provides an overview of the trends and nature of public funding of higher education in…

31 CFR 6.6 - Allowable fees and other expenses.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Allowable fees and other expenses. 6.6 Section 6.6 Money and Finance: Treasury Office of the Secretary of the Treasury APPLICATIONS FOR AWARDS UNDER THE EQUAL ACCESS TO JUSTICE ACT General Provisions § 6.6 Allowable fees and other expenses...

Financing Public School Facilities in Texas: A Case Study.

ERIC Educational Resources Information Center

Dawn, Lisa

A case study is presented of a Texas educational facilities program that was developed to provide long-term state assistance to school districts for the construction or renovation of their facilities by providing equal access to revenue for the specific purpose of repaying debt issued to finance instructional facilities. This report presents a…

The Outlook for Student Finance

ERIC Educational Resources Information Center

Breneman, David W.

1978-01-01

Comment is offered on John Silber's proposed Tuition Advance Fund, under which a student could borrow to meet college costs and repay over a working lifetime in installments geared to income. This and the tuition tax credit approach are discussed in terms of the federal role in financing higher education and student access and choice. (LB H)

31 CFR 103.187 - Special measures against Myanmar Mayflower Bank and Asia Wealth Bank.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Anti-Money Laundering Programs Law Enforcement Access to Foreign Bank Records § 103.187 Special... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Special measures against Myanmar Mayflower Bank and Asia Wealth Bank. 103.187 Section 103.187 Money and Finance: Treasury Regulations...

School Finance Litigation across the States: An Update.

ERIC Educational Resources Information Center

Verstegen, D. A., Ed.

This report is an update on eight state-level cases: (1) "School Financier Litigation in Minnesota" (Van D. Mueller), which states students are allowed enhanced access to suburban schools and to Minneapolis magnet schools; (2) "School Finance Litigation across the States--New Hampshire" (Van D. Mueller), which states the court ruled that property…

The relationship between healthcare services and the political economy with reference to the Jamaican experience.

PubMed

Maharaj, S R

2010-12-01

The availability of and equitable access to, health services have challenged healthcare providers with a greater degree of urgency since the end of World War II. Prior to that time, concepts such as equity and social justice were just that, concepts but no real attempts were ever made to operationalize them. Goods and services were still produced and distributed based on market forces, that is, one's ability and willingness to pay for something. Health in that context was a service, some say a commodity, to be bought and sold, hence its availability was not necessarily commensurate with its accessibility.

Acceptable care? Illness constructions, healthworlds, and accessible chronic treatment in South Africa.

PubMed

Fried, Jana; Harris, Bronwyn; Eyles, John; Moshabela, Mosa

2015-05-01

Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas-conversely-these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating "disease" to responding to "illness" by acknowledging and incorporating patients' healthworlds in patient-provider interactions. © The Author(s) 2015.

Differences in health care spending across countries: statistical evidence.

PubMed

Pfaff, M

1990-01-01

The empirical evidence available for OECD countries suggests that economic factors play a major role and that demographic factors play a minor role in explaining differences in health care spending across countries. When countries are grouped on the basis of their health care systems, some significant cross-country differences result: countries with higher transfer rates (a larger share of collective financing) are not generally characterized by higher health care expenditures, and conversely, countries with a larger share of private financing (including higher coinsurance rates) do not have lower expenditures. Rather, the opposite holds true. Similar conclusions apply to the share of public versus private production of health goods. Furthermore, the results do not support the claims of those critics of universal public insurance systems who consider the expansion of the coverage to be a major source of expenditure growth. These findings cast serious doubt on the claim that cost containment can be achieved via market reforms that rely heavily on direct consumer payments and cost sharing as instruments of financing. A comparative analysis of the historic record of the United States, Canada, and the Federal Republic of Germany generally supports these conclusions; it also suggests that a greater degree of public penetration offers a better chance for control of health spending, particularly in periods of austerity. There is a strong presumption that health care systems relying on some overall control of spending generally are more cost-effective than those relying more on decentralized mechanisms of control. Services are more equitably distributed in relation to health and payment for health services is far more progressive in the former type of system.

Is outpatient care benefit distribution of government healthcare subsidies equitable in rural ethnic minority areas of China? Results from cross-sectional studies in 2010 and 2013

PubMed Central

Chen, Mingsheng; Qian, Dongfu; Feng, Zhanchun; Si, Lei

2018-01-01

Objectives Government healthcare subsidies for healthcare facilities play a significant role in providing more extensive healthcare access to patients, especially poor ones. However, equitable distribution of these subsidies continues to pose a challenge in rural ethnic minority areas of China. This study aimed to evaluate the benefits distribution of outpatient services across different socioeconomic populations in China’s rural ethnic minority areas. Setting Inner Mongolia Autonomous Region, Xinjiang Autonomous Region and Qinghai Province. Design Two rounds of cross-sectional study. Participants One thousand and seventy patients in 2010 and 907 patients in 2013, who sought outpatient services prior to completing the household surveys, were interviewed. Methods Benefits incidence analysis was performed to measure the benefits distribution of government healthcare subsidies across socioeconomic groups. The concentration index (CI) for outpatient care at different healthcare facility levels in rural ethnic minority areas was calculated. Two rounds of household surveys using multistage stratified samples were conducted. Findings The overall CI for outpatient care was –0.0146 (P>0.05) in 2010 and –0.0992 (P<0.01) in 2013. In 2010, the CI was –0.0537 (P<0.01), –0.0085 (P>0.05) and −0.0034 (P>0.05) at levels of village clinics (VCs), township health centres (THCs) and county hospitals (CHs), respectively. In 2013, the CI was –0.1353 (P<0.05), –0.0695 (P>0.05) and –0.1633 (P<0.01) at the levels of VCs, THCs and CHs, respectively. Conclusion Implementation of the gatekeeper mechanism helped improve the benefits distribution of government healthcare subsidies in rural Chinese ethnic minority areas. Equitable distribution of government healthcare subsidies for VCs was improved by increasing financial input and ensuring the performance of primary healthcare facilities. Equitable distribution of subsidies for CHs was improved by policies that rationally guided patients’ care-seeking behaviour. In addition, highly qualified physicians were also a key factor in ensuring equitable benefits distribution. PMID:29431138

Promoting equitable global health research: a policy analysis of the Canadian funding landscape.

PubMed

Plamondon, Katrina; Walters, Dylan; Campbell, Sandy; Hatfield, Jennifer

2017-08-29

Recognising radical shifts in the global health research (GHR) environment, participants in a 2013 deliberative dialogue called for careful consideration of equity-centred principles that should inform Canadian funding polices. This study examined the existing funding structures and policies of Canadian and international funders to inform the future design of a responsive GHR funding landscape. We used a three-pronged analytical framework to review the ideas, interests and institutions implicated in publically accessible documents relevant to GHR funding. These data included published literature and organisational documents (e.g. strategic plans, progress reports, granting policies) from Canadian and other comparator funders. We then used a deliberative approach to develop recommendations with the research team, advisors, industry informants and low- and middle-income country (LMIC) partners. In Canada, major GHR funders invest an estimated CA$90 M per annum; however, the post-2008 re-organization of funding structures and policies resulted in an uncoordinated and inefficient Canadian strategy. Australia, Denmark, the European Union, Norway, Sweden, the United Kingdom and the United States of America invest proportionately more in GHR than Canada. Each of these countries has a national strategic plan for global health, some of which have dedicated benchmarks for GHR funding and policy to allow funds to be held by partners outside of Canada. Key constraints to equitable GHR funding included (1) funding policies that restrict financial and cost burden aspects of partnering for GHR in LMICs; and (2) challenges associated with the development of effective governance mechanisms. There were, however, some Canadian innovations in funding research that demonstrated both unconventional and equitable approaches to supporting GHR in Canada and abroad. Among the most promising were found in the International Development Research Centre and the (no longer active) Global Health Research Initiative. Promoting equitable GHR funding policies and practices in Canada requires cooperation and actions by multiple stakeholders, including government, funding agencies, academic institutions and researchers. Greater cooperation and collaboration among these stakeholders in the context of recent political shifts present important opportunities for advancing funding policies that enable and encourage more equitable investments in GHR.

Adverse or acceptable: negotiating access to a post-apartheid health care contract

PubMed Central

2014-01-01

Background As in many fragile and post-conflict countries, South Africa’s social contract has formally changed from authoritarianism to democracy, yet access to services, including health care, remains inequitable and contested. We examine access barriers to quality health services and draw on social contract theory to explore ways in which a post-apartheid health care contract is narrated, practiced and negotiated by patients and providers. We consider implications for conceptualizing and promoting more inclusive, equitable health services in a post-conflict setting. Methods Using in-depth interviews with 45 patients and 67 providers, and field observations from twelve health facilities in one rural and two urban sub-districts, we explore access narratives of those seeking and delivering – negotiating - maternal health, tuberculosis and antiretroviral services in South Africa. Results Although South Africa’s right to access to health care is constitutionally guaranteed, in practice, a post-apartheid health care contract is not automatically or unconditionally inclusive. Access barriers, including poverty, an under-resourced, hierarchical health system, the nature of illness and treatment, and negative attitudes and actions, create conditions for insecure or adverse incorporation into this contract, or even exclusion (sometimes temporary) from health care services. Such barriers are exacerbated by differences in the expectations that patients and providers have of each other and the contract, leading to differing, potentially conflicting, identities of inclusion and exclusion: defaulting versus suffering patients, uncaring versus overstretched providers. Conversely, caring, respectful communication, individual acts of kindness, and institutional flexibility and leadership may mitigate key access barriers and limit threats to the contract, fostering more positive forms of inclusion and facilitating easier access to health care. Conclusions Building health in fragile and post-conflict societies requires the negotiation of a new social contract. Surfacing and engaging with differences in patient and provider expectations of this contract may contribute to more acceptable, accessible health care services. Additionally, the health system is well positioned to highlight and connect the political economy, institutions and social relationships that create and sustain identities of exclusion and inclusion – (re)politicise suffering - and co-ordinate and lead intersectoral action for overcoming affordability and availability barriers to inclusive and equitable health care services. PMID:24885882

On Using Satellite-Based Networks for Capacity Building and Education for All: A Case Study of Rajiv Gandhi Project for EduSat-Supported Elementary Education

ERIC Educational Resources Information Center

Chaudhary, Sohanvir; Garg, Suresh

2010-01-01

One of the serious problems associated with Indian school education has been high dropout rate. The reasons are many and varied but the major constraints are: non-availability of adequate number of competent and trained teachers in most of the schools and separate room for each class. To overcome such problems and increase equitable access to all,…

The Dilemma of Inclusion: Is Full Inclusion Ethical? An Examination of the Culture of Special Education within a Semi-Rural Pre-K to Sixth Grade Elementary School District

ERIC Educational Resources Information Center

Press, Kandie A.

2010-01-01

At its core the political push for full inclusion models of special education delivery derives from the belief that inclusion provides equal access, equitable distribution of resources and increased social opportunity to children. This study focused upon the evolution of special education programming within a pre-K to sixth grade elementary school…

Illinois State Plan: Adult Education and Family Literacy. Under Title II of the Workforce Investment Act of 1998, Adult Education and Family Literacy Act

ERIC Educational Resources Information Center

Illinois Community College Board, 2014

2014-01-01

This document contains Illinois' State Plan for Adult Education and Family Literacy under Title II of the Workforce Investment Act of 1998 for July 1, 1999, through June 30, 2015. The plan is comprised of the following sections: (1) Eligible agency certifications and assurances; (2) Description of the steps to ensure direct and equitable access;…

University of Global Health Equity's Contribution to the Reduction of Education and Health Services Rationing.

PubMed

Binagwaho, Agnes

2017-05-29

The inadequate supply of health workers and demand-side barriers due to clinical practice that heeds too little attention to cultural context are serious obstacles to achieving universal health coverage and the fulfillment of the human rights to health, especially for the poor and vulnerable living in remote rural areas. A number of strategies have been deployed to increase both the supply of healthcare workers and the demand for healthcare services. However, more can be done to improve service delivery as well as mitigate the geographic inequalities that exist in this field. To contribute to overcoming these barriers and increasing access to health services, especially for the most vulnerable, Partners In Health (PIH), a US non-governmental organization specializing in equitable health service delivery, has created the University of Global Health Equity (UGHE) in a remote rural district of Rwanda. The act of building this university in such a rural setting signals a commitment to create opportunities where there have traditionally been few. Furthermore, through its state-of-the-art educational approach in a rural setting and its focus on cultural competency, UGHE is contributing to progress in the quest for equitable access to quality health services. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

31 CFR 28.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Access to schools operated by LEAs... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 28.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

12 CFR 1235.5 - Record hold.

Code of Federal Regulations, 2014 CFR

2014-01-01

... alternative storage method. (d) Access to and retrieval of records during a record hold. The record retention program of each regulated entity or the Office of Finance shall ensure access to and retrieval of records... records and existing information technology. ...

12 CFR 1235.5 - Record hold.

Code of Federal Regulations, 2013 CFR

2013-01-01

... alternative storage method. (d) Access to and retrieval of records during a record hold. The record retention program of each regulated entity or the Office of Finance shall ensure access to and retrieval of records... records and existing information technology. ...

12 CFR 1235.5 - Record hold.

Code of Federal Regulations, 2012 CFR

2012-01-01

... alternative storage method. (d) Access to and retrieval of records during a record hold. The record retention program of each regulated entity or the Office of Finance shall ensure access to and retrieval of records... records and existing information technology. ...

Public funding - a solution for technological SMEs and entrepreneurs

NASA Astrophysics Data System (ADS)

Emilia, Calefariu; Traian Alexandru, Buda

2016-11-01

Technological SMEs are in a constant struggle for growth or sometimes maintaining the production capacity, increase market share, supporting tax burden, ensuring employees' salaries, profit growth. They constantly consider short-term survival of the company, with trying to maintain a long-term uptrend for the business. Entrepreneurs are again in a position to access public financing under quite favorable conditions. The paper aims to analyze the opportunity of accessing these external financing options, which have both advantages and a series of long-term constraints which should not be excluded before the final decision to access this funding. New research is required, thus sustainable development can be maintained for the business environment in order to increase efficiency, competitiveness, sustainable development strategies that generate job security, regional growth and rewarding the risk-taking of the entrepreneur.

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.

The New and Old Europe: East-West Split in Pharmaceutical Spending.

PubMed

Jakovljevic, Mihajlo; Lazarevic, Marija; Milovanovic, Olivera; Kanjevac, Tatjana

2016-01-01

HIGHLIGHTS Since the geopolitical developments of 1989, former centrally planned economies of Eastern Europe followed distinctively different pathways in national pharmaceutical expenditure evolution as compared to their free market Western European counterparts.Long term spending on pharmaceuticals expressed as percentage of total health expenditure was falling in free market economies as of 1989. Back in early 1990s it was at higher levels in transitional Eastern European countries and actually continued to grow further.Public financing share of total pharmaceutical expenditure was steadily falling in most Central and Eastern European countries over the recent few decades. Opposed scenario were EU-15 countries which successfully increased their public funding of prescription medicines for the sake of their citizens.Pace of annual increase in per capita spending on medicines in PPP terms, was at least 20% faster in Eastern Europe compared to their Western counterparts. During the same years, CEE region was expanding their pharmaceuticals share of health spending in eight fold faster annual rate compared to the EU 15.Private and out-of-pocket expenditure became dominant in former socialist countries. Affordability issues coupled with growing income inequality in transitional economies will present a serious challenge to equitable provision and sustainable financing of pharmaceuticals in the long run.

Financing Facility Improvements for Out-of-School Time and Community School Programs. Strategy Brief. Vol. 1 No. 4.

ERIC Educational Resources Information Center

Flynn, Margaret

This strategy brief presents general principles and strategies for financing facility improvements and highlights five examples of innovative strategies found throughout the United States. The strategies described concern facility improvements for out-of-school time and community school programs and include the following: (1) accessing school…

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…

Financing Basic Education in Bangladesh. CREATE Pathways to Access. Research Monograph No. 12

ERIC Educational Resources Information Center

Al-Samarrai, Samer

2007-01-01

This paper presents education finance trends for Bangladesh since 2000. It shows that while government spending on education as a proportion of national income has stagnated, it has increased in real terms. Real increases in education spending have resulted in substantial increases in per student spending in basic education. At primary, enrolment…

31 CFR 103.185 - Summons or subpoena of foreign bank records; Termination of correspondent relationship.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRANSACTIONS Anti-Money Laundering Programs Law Enforcement Access to Foreign Bank Records § 103.185 Summons or... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Summons or subpoena of foreign bank records; Termination of correspondent relationship. 103.185 Section 103.185 Money and Finance: Treasury...

Rural School Finance: A Critical Analysis of Current Practice in Illinois.

ERIC Educational Resources Information Center

Lows, Raymond L.

School finance is basic to understanding and improving the condition of rural education. Information necessary for financial planning and policy development at the state and local levels is stored in large computer readable data bases and needs to be accessed. Pertinent data elements need to be extracted from the data base and relationships among…

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…

Health financing in Africa: overview of a dialogue among high level policy makers

PubMed Central

2011-01-01

Background Even though Africa has the highest disease burden compared with other regions, it has the lowest per capita spending on health. In 2007, 27 (51%) out the 53 countries spent less than US$50 per person on health. Almost 30% of the total health expenditure came from governments, 50% from private sources (of which 71% was from out-of-pocket payments by households) and 20% from donors. The purpose of this article is to reflect on the proceedings of the African Union Side Event on Health Financing in the African continent. Methods Methods employed in the session included presentations, panel discussion and open public discussion with ministers of health and finance from the African continent. Discussion The current unsatisfactory state of health financing was attributed to lack of clear vision and plan for health financing; lack of national health accounts and other evidence to guide development and implementation of national health financing policies and strategies; low investments in sectors that address social determinants of health; predominance of out-of-pocket spending; underdeveloped prepaid health financing mechanisms; large informal sectors vis-à-vis small formal sectors; and unpredictability and non-alignment of majority of donor funds with national health priorities. Countries need to develop and adopt a comprehensive national health policy and a costed strategic plan; a comprehensive evidence-based health financing strategy; allocate at least 15% of the national budget to health development; use GFATM and PEPFAR funds for health systems strengthening; strengthen intersectoral collaboration to address health determinants; advocate among donors to implement the Paris Declaration on Aid Effectiveness and its Accra Agenda for Action; ensure universal access to health services for pregnant women, lactating mothers and children aged under five years; strengthen financial management capacities; and develop prepaid health financing systems, especially health insurance to complement tax funding. In addition, countries need to institutionalize national health accounts; undertake feasibility studies of various health financing mechanisms; and document and share best practices in health financing. Conclusion There was consensus that every country ought to have an evidence-based comprehensive health financing strategy with a road map for attaining universal health service coverage vision; and increase physical and financial access by pregnant women, lactating mothers and by children under five years to quality health services. PMID:21810212

Health financing in Africa: overview of a dialogue among high level policy makers.

PubMed

Sambo, Luis Gomes; Kirigia, Joses Muthuri; Ki-Zerbo, Georges

2011-06-13

Even though Africa has the highest disease burden compared with other regions, it has the lowest per capita spending on health. In 2007, 27 (51%) out the 53 countries spent less than US$50 per person on health. Almost 30% of the total health expenditure came from governments, 50% from private sources (of which 71% was from out-of-pocket payments by households) and 20% from donors. The purpose of this article is to reflect on the proceedings of the African Union Side Event on Health Financing in the African continent. Methods employed in the session included presentations, panel discussion and open public discussion with ministers of health and finance from the African continent. The current unsatisfactory state of health financing was attributed to lack of clear vision and plan for health financing; lack of national health accounts and other evidence to guide development and implementation of national health financing policies and strategies; low investments in sectors that address social determinants of health; predominance of out-of-pocket spending; underdeveloped prepaid health financing mechanisms; large informal sectors vis-à-vis small formal sectors; and unpredictability and non-alignment of majority of donor funds with national health priorities.Countries need to develop and adopt a comprehensive national health policy and a costed strategic plan; a comprehensive evidence-based health financing strategy; allocate at least 15% of the national budget to health development; use GFATM and PEPFAR funds for health systems strengthening; strengthen intersectoral collaboration to address health determinants; advocate among donors to implement the Paris Declaration on Aid Effectiveness and its Accra Agenda for Action; ensure universal access to health services for pregnant women, lactating mothers and children aged under five years; strengthen financial management capacities; and develop prepaid health financing systems, especially health insurance to complement tax funding.In addition, countries need to institutionalize national health accounts; undertake feasibility studies of various health financing mechanisms; and document and share best practices in health financing. There was consensus that every country ought to have an evidence-based comprehensive health financing strategy with a road map for attaining universal health service coverage vision; and increase physical and financial access by pregnant women, lactating mothers and by children under five years to quality health services.

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.

An unfinished agenda on adolescent health: Opportunities for interventions.

PubMed

Lassi, Zohra S; Salam, Rehana A; Das, Jai K; Wazny, Kerri; Bhutta, Zulfiqar A

2015-08-01

The Millennium Development Goal era has resulted in improvements in maternal and child health worldwide. As more children are surviving past their fifth birthday, the population of adolescents is increasing. Adolescence is a time of significant developmental transition; adolescence sets the stage for adult health through risks taken and beneficial and detrimental habits that are formed and it is thus an optimal time to target health interventions. Beginning interventions in adolescence or even earlier in childhood maximizes the impact on the individual's health in adult life. Evidence suggests that interventions to promote sexual and reproductive health, physical activity and healthy lifestyle, mental health and wellbeing, safe and hazard-free environment, improving access to nutritious and healthy foods, and minimizing exposure to substance abuse can improve health outcomes in young adolescents. School-based delivery strategies appear to be the most highly evaluated for improving adolescent health; they have been used to deliver interventions such as sexual health, substance abuse prevention, and nutritional interventions. Use of social media and information technologies, cash transfers, social protection, and micro-finance initiatives are promising strategies; however, given the lack of rigorous evaluations, there is a need for further research. Additional research is also warranted to strengthen the evidence base by establishing causality, understanding the differential impacts of adolescent health in different contexts particularly in low- and middle-income countries. In addition, research and evaluation in the domain of adolescent health must focus on how to implement interventions effectively at-scale, sustain the impacts over time and ensure equitable outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Understanding and Integrating Local Perceptions of Trees and Forests into Incentives for Sustainable Landscape Management

NASA Astrophysics Data System (ADS)

Pfund, Jean-Laurent; Watts, John Daniel; Boissière, Manuel; Boucard, Amandine; Bullock, Renee Marie; Ekadinata, Andree; Dewi, Sonya; Feintrenie, Laurène; Levang, Patrice; Rantala, Salla; Sheil, Douglas; Sunderland, Terence Clarence Heethom; Urech, Zora Lea

2011-08-01

We examine five forested landscapes in Africa (Cameroon, Madagascar, and Tanzania) and Asia (Indonesia and Laos) at different stages of landscape change. In all five areas, forest cover (outside of protected areas) continues to decrease despite local people's recognition of the importance of forest products and services. After forest conversion, agroforestry systems and fallows provide multiple functions and valued products, and retain significant biodiversity. But there are indications that such land use is transitory, with gradual simplification and loss of complex agroforests and fallows as land use becomes increasingly individualistic and profit driven. In Indonesia and Tanzania, farmers favor monocultures (rubber and oil palm, and sugarcane, respectively) for their high financial returns, with these systems replacing existing complex agroforests. In the study sites in Madagascar and Laos, investments in agroforests and new crops remain rare, despite government attempts to eradicate swidden systems and their multifunctional fallows. We discuss approaches to assessing local values related to landscape cover and associated goods and services. We highlight discrepancies between individual and collective responses in characterizing land use tendencies, and discuss the effects of accessibility on land management. We conclude that a combination of social, economic, and spatially explicit assessment methods is necessary to inform land use planning. Furthermore, any efforts to modify current trends will require clear incentives, such as through carbon finance. We speculate on the nature of such incentive schemes and the possibility of rewarding the provision of ecosystem services at a landscape scale and in a socially equitable manner.

Final priority; Rehabilitation Services Administration--Assistive Technology Alternative Financing Program. Final priority.

PubMed

2014-08-14

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Assistive Technology Alternative Financing Program administered by the Rehabilitation Services Administration (RSA). The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. This priority is designed to ensure that the Department funds high-quality assistive technology (AT) alternative financing programs (AFPs) that meet rigorous standards in order to enable individuals with disabilities to access and acquire assistive technology devices and services necessary to achieve education, community living, and employment goals.

Equity in access to fortified maize flour and corn meal

PubMed Central

Zamora, Gerardo; De-Regil, Luz Maria

2014-01-01

Mass fortification of maize flour and corn meal with a single or multiple micronutrients is a public health intervention that aims to improve vitamin and mineral intake, micronutrient nutritional status, health, and development of the general population. Micronutrient malnutrition is unevenly distributed among population groups and is importantly determined by social factors, such as living conditions, socioeconomic position, gender, cultural norms, health systems, and the socioeconomic and political context in which people access food. Efforts trying to make fortified foods accessible to the population groups that most need them require acknowledgment of the role of these determinants. Using a perspective of social determinants of health, this article presents a conceptual framework to approach equity in access to fortified maize flour and corn meal, and provides nonexhaustive examples that illustrate the different levels included in the framework. Key monitoring areas and issues to consider in order to expand and guarantee a more equitable access to maize flour and corn meal are described. PMID:24329609

Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009-14.

PubMed

Zenk, Shannon N; Tarlov, Elizabeth; Wing, Coady; Matthews, Stephen A; Jones, Kelly; Tong, Hao; Powell, Lisa M

2017-08-01

In recent years, various levels of government in the United States have adopted or discussed subsidies, tax breaks, zoning laws, and other public policies that promote geographic access to healthy food. However, there is little evidence from large-scale longitudinal or quasi-experimental research to suggest that the local mix of food outlets actually affects body mass index (BMI). We used a longitudinal design to examine whether the proximity of food outlets, by type, was associated with BMI changes between 2009 and 2014 among 1.7 million veterans in 382 metropolitan areas. We found no evidence that either absolute or relative geographic accessibility of supermarkets, fast-food restaurants, or mass merchandisers was associated with changes in an individual's BMI over time. While policies that alter only geographic access to food outlets may promote equitable access to healthy food and improve nutrition, our findings suggest they will do little to combat obesity in adults. Project HOPE—The People-to-People Health Foundation, Inc.

Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health

PubMed Central

2013-01-01

Background The last decade has seen widespread retreat from user fees with the intention to reduce financial constraints to users in accessing health care and in particular improving access to reproductive, maternal and newborn health services. This has had important benefits in reducing financial barriers to access in a number of settings. If the policies work as intended, service utilization rates increase. However this increases workloads for health staff and at the same time, the loss of user fee revenues can imply that health workers lose bonuses or allowances, or that it becomes more difficult to ensure uninterrupted supplies of health care inputs. This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health. Methods We undertook case studies in five countries (Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe). In each we reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors. Results We question a number of common assumptions about the financing and human resource inter-relationships. The impact of fee removal on utilization levels is mostly not sustained or supported by all the evidence. Shortages of human resources for health at the national level are not universal; maldistribution within countries is the greater problem. Low salaries are not universal; most of the countries pay health workers well by national benchmarks. Conclusions The interconnectedness between user fee policy and HRH situations proves difficult to assess. Many policies have been changing over the relevant period, some clearly and others possibly in response to problems identified associated with financing policy change. Other relevant variables have also changed. However, as is now well-recognised in the user fee literature, co-ordination of health financing and human resource policies is essential. This appears less well recognised in the human resources literature. This coordination involves considering user charges, resource availability at health facility level, health worker pay, terms and conditions, and recruitment in tandem. All these policies need to be effectively monitored in their processes as well as outcomes, but sufficient data are not collected for this purpose. PMID:24053731

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

Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health.

PubMed

McPake, Barbara; Witter, Sophie; Ensor, Tim; Fustukian, Suzanne; Newlands, David; Martineau, Tim; Chirwa, Yotamu

2013-09-22

The last decade has seen widespread retreat from user fees with the intention to reduce financial constraints to users in accessing health care and in particular improving access to reproductive, maternal and newborn health services. This has had important benefits in reducing financial barriers to access in a number of settings. If the policies work as intended, service utilization rates increase. However this increases workloads for health staff and at the same time, the loss of user fee revenues can imply that health workers lose bonuses or allowances, or that it becomes more difficult to ensure uninterrupted supplies of health care inputs.This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health. We undertook case studies in five countries (Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe). In each we reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors. We question a number of common assumptions about the financing and human resource inter-relationships. The impact of fee removal on utilization levels is mostly not sustained or supported by all the evidence. Shortages of human resources for health at the national level are not universal; maldistribution within countries is the greater problem. Low salaries are not universal; most of the countries pay health workers well by national benchmarks. The interconnectedness between user fee policy and HRH situations proves difficult to assess. Many policies have been changing over the relevant period, some clearly and others possibly in response to problems identified associated with financing policy change. Other relevant variables have also changed.However, as is now well-recognised in the user fee literature, co-ordination of health financing and human resource policies is essential. This appears less well recognised in the human resources literature. This coordination involves considering user charges, resource availability at health facility level, health worker pay, terms and conditions, and recruitment in tandem. All these policies need to be effectively monitored in their processes as well as outcomes, but sufficient data are not collected for this purpose.

77 FR 40144 - Adoption of the Environmental Impact Statement (EIS) and Participation in the Section 106...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-06

...) obligations related to MTA's request for financing for the East Side Access project through the FRA Railroad... Statement (EIS) and Participation in the Section 106 Programmatic Agreement for the East Side Access Project... adoption and recirculation of the Final Environmental Impact Statement for the East Side Access Project and...

Female Engagement Teams: Making the Case for Institutionalization Based on U.S. Security Objectives in Africa

DTIC Science & Technology

2013-05-23

politically when men and women are afforded equitable access to health, education, economic, and political resources.8 However, a review of countries...theory; there would need to be an equal improvement in how the local community understood what the school and education more broadly represented for the...in its World Development Report 2012: Gender Equality and Development: 18LTG Michael T. Flynn, Capt Matt Pottinger, and Paul D. Batchelor, Fixing

[Debate and challenges on the topic of free medical care in Africa: "Back to the Future"?].

PubMed

Ridde, Valéry; Blanchet, Karl

2009-01-01

In its 2008 annual report, WHO affirmed the importance of resisting the temptation to depend on direct payment for primary health care. Members of the WHO committee on the social determinants of health as well as of those at the conference on primary health care in Ouagadougou in 2008 reaffirmed the need to make access to health care systems more equitable. Several decades after imposition of direct payment began, convincing data clearly demonstrate its harmful effects on the basic fairness of access to care. Accordingly, the current debate in the field of financial support for health involves the elimination of payments. More precisely, we can finally say that this is a debate about a return to the free care that existed before the widespread implementation of "cost recovery" systems. Here we want to review these discussions and prepare the ground for a debate on possible effective strategies for making health care systems more equitable from the perspective of universal coverage. We will thus note that analyses today must certainly focus more on how to eliminate direct payments than on the reasons to do so, already amply demonstrated. The international community must now undertake to support governments that want to move in this direction and ensure that the process is thoroughly documented so that it can also produce useful knowledge for the formulation of fair public policies.

31 CFR 6.8 - Contents of application.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Contents of application. 6.8 Section 6.8 Money and Finance: Treasury Office of the Secretary of the Treasury APPLICATIONS FOR AWARDS UNDER THE EQUAL ACCESS TO JUSTICE ACT Information Required From Applicants § 6.8 Contents of application. (a) An application for an award of fees and...

University Student Finances in 2012: A Study of the Financial Circumstances of Domestic and International Students in Australia's Universities

ERIC Educational Resources Information Center

Bexley, Emmaline; Daroesman, Suzanne; Arkoudis, Sophie; James, Richard

2013-01-01

The aim of the Australian University Student Finances Survey 2012 is to provide an evidence-based understanding of the financial circumstances of the student population in Australia (both international and domestic) through the collection of quantitative data on: access to income support and scholarships, income from paid employment and the impact…

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…

The Hungarian Student Loan Scheme: Six Years of Financing Access to Higher Education

ERIC Educational Resources Information Center

Ferreira, M. Luisa; Farkas, Erika

2009-01-01

Hungary's higher education system has been going through a gradual shift from an elite to a mass system: enrolment has surged in recent decades. There is growing pressure on financing, with rising costs, limited public funding and an increasing student population. In parallel, there is a growing recognition that an important part of the benefits…

Second National Immunization Congress 2010: addressing vaccine financing for the future in the US.

PubMed

Shen, Angela K; Sobzcyk, Elizabeth; Buchanan, Anna; Wu, Lauren; Duggan-Goldstein, Sarah

2011-01-01

At the 2nd National Immunization Congress held in Chicago, IL, from August 31-September 2, 2010, partners from government, provider groups, academia, and manufacturers gathered to discuss the progress made and the future of financing child, adolescent, and adult vaccines. The meeting is a continuation of a solution-oriented vaccine financing dialogue held in February 2007 at the 1st Immunization Congress. The need for this forum arose from concerns that increased costs of immunization could hinder the ability of current financing and delivery systems to maintain access without financial barriers. Preventive care and additional financial coverage for vaccines are key points in federal health reform but some populations, especially adolescents and adults, could continue to experience challenges in accessing vaccines. Congress participants discussed adequate reimbursement in the public and private sectors for vaccine delivery and the potential financial resources, data, and infrastructure needed to increase vaccine uptake in the US. Participants agreed that partners from all sectors--manufacturers, providers, public health, employers, payors, insurers, and consumers--will collectively need to leverage their efforts to address financial gaps not covered by health care reform law to ensure the preventive benefits of vaccines are fully realized for all Americans.

Equitable Access to Healthcare Services and Income Replacement for Cancer: Is Critical Illness Insurance a Help or a Hindrance?

PubMed Central

Longo, Christopher J.

2010-01-01

Canada's publicly funded healthcare system ensures that medically necessary hospital and physician services are available without financial barriers, but not all community-based care is covered. Consequently, many patients experience financial shocks (FS) related to community-based healthcare services not funded by government, and perhaps also from lost income, a situation that may be difficult for patients to avoid. Critical illness insurance (CII) offers a patient-funded alternative to those who qualify and desire protection against FS, leaving those without CII exposed. The author discusses the benefits and limitations of CII to mitigate financially derived healthcare access inequities, using cancer as an example. PMID:21532761

7 CFR 1400.8 - Equitable treatment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Equitable treatment. 1400.8 Section 1400.8... AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS General Provisions § 1400.8 Equitable treatment. (a... Administrator deems necessary to provide fair and equitable treatment to such person or legal entity. (b...

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.