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PubMedDate not supplied

Are your economic incentives self-defeating?

In a prior column (Long, H., "Group Practices May Ignore Economic Realities: Commingling of Rents and Returns," Physician Executive 14(5):33-35, Sept.-Oct. 1988), the author discussed the tendency of many group practices to ignore ordinary business economics. The examples discussed in that column was the inappropriate commingling of rents and returns from the various factors of production in medical practice. A frequent result of this is physicians who also have ownership interests and/or managerial responsibilities having an inflated perception of their worth as physicians because they are undercompensated for their ownership/management roles. In this column, the author addresses the inadvertent structuring of physician remuneration via income distribution or externally negotiated formulas that reward individual behavior that actually threatens the economic viability of the group.

Health Maintenance Organizations↗

PubMed2000

Children's health insurance: the difference policy choices make.

This paper provides estimates of the cost and coverage impacts of the new State Children's Health Insurance Program (SCHIP). The estimates reflect the many choices the states are given by the legislation: whether to use traditional Medicaid or establish separate state-run programs; how far to extend eligibility up the income distribution; and how much to use premiums. We estimate the impacts of these choices on participation by the uninsured as well as by the insured--that is, the crowd-out effect--and on public expenditures. We also estimate the savings to families and firms that substitute SCHIP for private coverage. We conclude with estimates of the cost and coverage impacts of the actual initial choices that states have made.

Child↗

PubMed1997

[Unhealthy differences. Part I. Socioeconomic deprivation and health].

Socioeconomic deprivation often concurs with deprivation in health. In this paper, the available evidence on socioeconomic health differences in The Netherlands is summarized. Furthermore explanations for the existence of these differences are given. Socioeconomic deprivation often leads to a worse health, but the reverse can also occur sometimes. Policies on the causes of these health differences usually concern fields like income distribution and employment. Health care can offer a compensation for the adverse health effects of socioeconomic deprivation.

Child↗

PubMed1990

Social structure, household strategies, and the cumulative causation of migration.

This review culls disparate elements from the theoretical and research literature on human migration to argue for the construction of a theory of migration that simultaneously incorporates multiple levels of analysis within a longitudinal perspective. A detailed review of interconnections among individual behavior, household strategies, community structures, and national political economies indicates that inter-level and inter-temporal dependencies are inherent to the migration process and give it a strong internal momentum. The dynamic interplay between network growth and individual migration labor, migration remittances, and local income distributions all create powerful feedback mechanisms that lead to the cumulative causation of migration. These mechanisms are reinforced and shaped by macrolevel relationships within the larger political economy.

Behavior↗

PubMed2003

Social structure, race, and gonorrhea rates in the southeastern United States.

OBJECTIVES: We sought to identify characteristics of counties in the southeastern United States associated with endemically high rates of gonorrhea. In particular, we were interested in aspects of race other than the proportion of Blacks in a population, including the potential influence of under-reporting of infections. DESIGN: The associations between the characteristics of counties in 1990, and the rates of reported gonorrhea from 1986 to 1995, were estimated with multivariable logistic regression. SETTING: 14 states in the southeastern region of the United States. PARTICIPANTS: 835 counties and county equivalents in the 14 southeastern states. MAIN OUTCOME MEASURES: The odds of having an endemically high county-level rate of gonorrhea. RESULTS: The variables with a strong effect on endemically high rates of gonorrhea included racial residential isolation in the absence of low income dualism (odds ratio [OR]: 210.84, 95% confidence interval [CI]: 19.35, 999.00), and Black-White income dualism in communities with few female-headed households (OR: 4.57, 95% CI: 2.68, 7.80). The percentage of Blacks in the population that was Black had little or no association with the rate of gonorrhea. These estimates were relatively robust when subjected to a sensitivity analysis of potential under-reporting of gonorrhea. CONCLUSIONS: Previous studies have demonstrated that a high percentage of Blacks in a population is the strongest predictor of high rates of gonorrhea. We found, however, that when variables measuring aspects of social structure, such as a race-based income distribution, and de facto residential segregation, were included in the model, the proportion of Blacks no longer had an effect on rates of gonorrhea. Progress in lowering endemically high disease rates will require attention being paid to community racial and class dynamics.

Black or African American↗

PubMed1992

[Aflatoxins and primary liver cancer--a population based case-control study].

A case-control study of primary liver cancer (PLC) was conducted in 1989 at Fusui County, Guangxi Province. There were 99 PLC cases and 99 age-sex-residence matched controls. There were no difference of age, sex, race, cultural, level, marital status and annual income distribution (P > 0.05). The mean dietary AFB1 intakes of cases and controls were 117.72 + 105.68 mg/d, the mean outputs of AFM1 were 22.56 and 21.62 ng per morning urine respectively. The mean sera aflatoxin-albumin adducts in both groups were 24.96 and 18.72 pg per mg albumin respectively. These indicators were of no statistical significance. Conditional Logistic regression showed that HBV infection (OR = 5.33), drinking pond-ditch water (OR = 3.70), family history of PLC (OR = 2.88), and total alcohol intakes (OR = 1.002) were statistically significant as risk factors (P > 0.05) rather than aflatoxins. This may be due to the fact that the samples selected in hyperendemic area both took high quantities of aflatoxin.

Aflatoxin B1↗

PubMedDate not supplied

[Acute disease of the lower airways in children under five years of age: role of domestic environment and maternal cigarette smoking].

OBJECTIVE: To study the prevalence of acute disease of the lower airways and the role of the domestic environment and maternal smoking. Among the recognized risk factors, passive smoking, living in crowded environments and poor housing conditions play a fundamental role in the causal chain of these diseases. METHODS: A cross-sectional study was carried out in a sample of 775 children aged between 0 and 59 months living in Rio Grande, southern Brazil. Trained interviewers applied a standardized questionnaire to the mothers or guardians of these children in their homes and gathered information about maternal characteristics, housing conditions, socio-economic status of the family and smoking habits. Environmental factors were individually studied, and classified according to a score that evaluated the intensity of their association with respiratory diseases. Bivariate analyses were performed, calculating the prevalence ratios for each risk factor, as well as multivariate ones, by means of non-conditional regression analyses. RESULTS: The main risks identified were: unfavorable environment (P<0.01), less than five years of maternal educational level (P=0.01), monthly family income under US$ 200 (P=0.04), crowded environments (P=0.02), smoking during pregnancy (P=0.03) and present maternal smoking (P=0.01). A thirty-year-old or older mother was identified as offering a protection factor (P=0.05). CONCLUSIONS: These results indicate the need to improve the income distribution, improve the rates of educational level, and combat the smoking habit, particularly concerning mothers. The programs of control of respiratory diseases must address these critical points that represent an important risk to children's health.

English Abstract↗

PubMed2004

[Poverty, social exclusion, social capital and health].

Social capital is the social structure which facilitates the actions of individuals, stimulates production and allows for success. Poverty maintains basic needs unmet (food, health, autonomy) over time and unvoluntarily. Social exclusion does not allow individuals to participate in society. The following dimensions are assessed: financial poverty, social inclusion, employment, health and education. Social participation, work integration, empowerment, self-esteem, and personal achievement should be promoted. In Europe 15% of people is exposed to poverty; in Spain corresponding figures are 13.4%, while for the elderly reached 21%. Extreme poverty affects 6.2% population and severe poverty 14.2%. Women and those living in Andalusia, Canary Islands and Extremadura are particularly affected, health inequality are for elderly, immigration, gender, social class, and should be reduced 10% for 2010. The Gini indez measures the income distribution; in the European Union (EU) it is 0.29 while in Spain is 0.33. Poverty and health are inversely correlated, health care expenditure in Spain is 7.5% og GDP. Life expectancy in U.E. is 75.5 years for men and 81.6 years for women, while in Spain it is 78 and 83.1 respectively. Infant mortality in EU is 4.5/1000, 4.1 per thousand in Spain. Lastly, the number of children per women in EU is 1.47 and in Spain 1.3.

European Union↗

PubMed1989

Nutritional impacts of an increasing fuelwood shortage in rural households in developing countries.

Developing countries face the problem of an increasing fuelwood shortage. For rural households, fuelwood is the main source of energy. As energy is essential to make food suitable for human consumption by means of cooking, the present fuelwood crisis could jeopardize the nutritional situation of rural households. This article reviews and analyses available data and information on the relationship between the availability of fuelwood and the nutritional situation of rural households. Based on analysis of emperical studies, three main strategies evolved by rural households, especially by the women within these households, to cope with a shortage of fuelwood can be distinguished: (i) increase in time and energy spent on fuelwood collection, (ii) substitution of fuelwood by alternative fuels and (iii) economizing on the consumption of fuelwood and alternative fuels. These coping-strategies affect food supply, food preservation, preparation and distribution, income generating activities and food consumption, all of which result in a decrease in quality and quantity of food consumed and in a deterioration of physical condition, especially women and their young children. Available data on fuelwood availability and nutrition are rather diffuse and incomplete. The presence of several confounding variables in the studies analysed make it difficult to establish the nutritional impact of a growing shortage of fuelwood. Nevertheless, it is concluded that a shortage of fuelwood plays at least an important role in changes in nutritional situation of rural households. If current trends continue, this role will become more important and evident. The impact of a growing fuelwood shortage should be a point of concern for rural development.

Cooking↗

PubMed1979

Physical changes of the environment and health effects with special reference to water pollution and sanitation in Malaysia.

Development of a human community are not without changes in its environment. Such changes result in either beneficial or adverse effects on human health. In Malaysia, in the wake of the New Economic Policy aimed at the redressing of the poor population and income distribution, development of the nation has brought about various changes in the environment. Some of these changes have elevated basic public health problems, while others, particularly new agricultural practices and industrialisation programmes with urbanisation trends, have brought a new set of problems due to water pollution and sanitation. Various measures are being taken to protect and to improve the environment so that progress can be realised with minimum adverse effects. This also calls for assistance from international sources, in terms of expertise, training and funds.

Communicable Diseases↗

PubMedDate not supplied

[Present population development and decision problems in the frame of social security for the aged].

Under the condition that current demographic conditions and the legislation of the old-age insurance will stay as they are now it is to calculate on a higher ratio of pensioners to work in the year 2030. The resulting financing requirements are neither only to be solved by appropriately high old-age insurance contributions nor by a reduction of the pensions level. Some measures for a relief of these problems are discussed with their advantages and disadvantages to economic growth and income distribution. But since measures partly need a decision in 20-40 years only, it is to be required for the moment that no steps are taken now which make the financing requirements more difficult at that time.

Aged↗

PubMed1993

The costs of schizophrenia. Assessing the burden.

Much has been learned about the costs of schizophrenia during the last three decades. Assessing the costs is a challenging task given the complexity of the disease. Much can be done to refine the methodologies of cost of schizophrenia studies based on the human capital approach and to develop the conceptual framework for a consistent account of the income distribution effects of the disease. The knowledge base, however, is quite extensive and data presented here indicate that although people with schizophrenia account only for about 1% of the adult population, they consume about 2.5% of total annual health care expenditures, they constitute about 10% of the totally and permanently disabled population, and comprise as high as about 14% of the homeless population in some large urban areas. These data clearly indicate the negative economic consequences of the disease: People with schizophrenia tend to be high users of medical care and tend to concentrate in subpopulations that are highly dependent on public assistance funds as a result of the disabling nature of the disease. These negative economic consequences of schizophrenia provide a powerful economic case for developing strategies to improve treatment effectiveness through biomedical and services research.

Cost of Illness↗

PubMed1995

[Breast feeding and the nutritional status of Chilean children].

The purpose of this work was to describe the diet of children under 18 months of age and its relationship to nutritional status. For this purpose, in 1993 a prevalence study was carried out on children who received care from the National Health Services System of Chile. The Chilean public health system provides care to 75% of children under 6 years of age and especially to children of families in the lower strata of income distribution in the country. Participants in the study were 9330 children under 18 months old who were randomly selected from 102 of the 320 urban clinics throughout the country. The type of food these infants had received the day prior to the interview (breast milk exclusively, breast milk plus solid food, formula exclusively, formula plus solid food) and their nutritional status relative to the standards of the National Center for Health Statistics (United States of America) and of WHO were determined. Children with z values for weight-for-age between -1.0 and -2.0 standard deviations were considered at risk for malnutrition, and those with z values under 2 standard deviations were classified as malnourished. The prevalences of exclusive breast-feeding at the first, third, and sixth months of life were 86.5%, 66.7%, and 25.3%, respectively. Some 12.1% of the participants showed low weight for age; 30.7%, low height for age; and 35.7%, overweight. The magnitude of weight-for-age deficiency was 1.2 to 5 times greater among children who were fed milk substitutes than among those who received breast milk. Breast-feeding also had a positive effect on height. These results confirm the benefits of exclusive breast-feeding until 6 months of age, the need to supplement the child's diet with solid food after that age, and the breast-feeding's protective effect on the nutritional status of children of all the ages studied.

Body Height↗

PubMedDate not supplied

Income inequality and population health.

A number of studies have suggested that inequalities in the distribution of income may be an important cause of variations in the average level of population health among rich industrial nations. However, what is missing from the debate so far is any systematic review of evidence about the relationship between different measures of income distribution and indicators of population health. This paper aims to bridge that gap. First, it summarizes the recent English language literature on this topic and illustrates the methodological problems that weaken the inferences that can be derived from it. Secondly, it presents new empirical estimates of the relationship between different measures of income distribution, infant mortality and life expectancy based on the most authoritative data published to date. In contrast to most earlier studies, we find very little support for the view that income inequality is associated with variations in average levels of national health in rich industrial countries. Some possible explanations for these differences are outlined.

Developed Countries↗

PubMed1984

Regional income differences and the definition of income: the case of Malaysia.

"Data from the Malaysian Family Life Survey are used to examine the sensitivity of urban/rural income differentials to the definition and measurement of income. Measured income differentials vary with the extent to which nonmarket activities are included in the scope of income, how the distribution of income is summarized, and whether one adjusts for differences in hours of work, household size and composition, ethnic composition, and other sociodemographic characteristics. For example, depending on the measure chosen, estimates of the amount by which urban income exceeds rural income in Malaysia range from 9 percent to 141 percent."

Asia↗

PubMed2003

Modelling health, income and income inequality: the impact of income inequality on health and health inequality.

A framework is developed to analyse the impact of the distribution of income on individual health and health inequality, with individual health modelled as a function of income and the distribution of income. It is demonstrated that the impact of income inequality can generate non-concave health production functions resulting in a non-concave health production possibility frontier. In this context, the impact of different health policies are considered and it is argued that if the distribution of income affects individual health, any policy aimed at equalising health, which does not account for income inequality, will lead to unequal distributions of health. This is an important development given current UK government attention to reducing health inequality.

Health Policy↗

PubMed1993

The distribution of urban population and income: explorations using six Asian cases.

"Urban concentration (or primacy) and inequality (in size distribution of income) are expected to follow bell shaped curves through the development process. Spatial convergence (through investments in transportation etc.) is expected to precede income convergence. Using longitudinal data from six Asian countries (Japan, Taiwan, Malaysia, the Philippines, Sri Lanka and India) this paper shows that (i) the bell shapes for urban concentration and income inequality generally hold, and (ii) the temporal relationship between the curve peaks is determined by geographical factors (for urban concentration); income inequality is seen to be more policy amenable."

Asia↗

PubMed2006

An analysis of the supplementary health sector in Brazil.

This paper addresses the efficiency of the Brazilian supplementary health sector. Analysis is carried out on the distribution of income in Brazil and the supplementary health sector in terms of geographical distribution of the users, operators and user health plans. Data envelopment analysis was used to assess the financial efficiency of companies operating in the sector. The results reveal inefficient financial performance of operators. The paper argues that a minimum level of service provided by the public health system is not achieved. The evidence reveals a major discrepancy between the government's neoliberal concept for the sector and the focus of the operators. The coverage which is incompatible with income distribution in Brazil and the low level of public investment per person result in the creation of companies which are not focused on the real purpose of the supplementary health system.

Brazil↗