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PubMed1998

Optimization of sire selection based on maximization of guaranteed income and risk associated with sire merit.

A method based on discounted income and risk assessment was developed to aid in the selection of dairy sires. The discounted profit generated from milk production of daughters was proposed as the suitable composite selection criterion to combine estimates of predicted transmitting ability (PTA) for yields of milk, fat, and protein and estimates of sire evaluations for dystocia or expected progeny difference. Steps are described to derive discounted profit (defined as expected income) for a sire with known PTA and evaluation for dystocia. The derivation of profit considered costs for semen, dystocia, heifer raising, production and maintenance of the daughter, and income from milk. Variance of income from a sire depended on the reliability of his PTA and evaluation for dystocia. Total variance from a selected set of sires was defined as the risk. A quadratic programming procedure was developed to identify the best set of sires from a given pool of sires that met a desired expected income goal with minimum risk. Combinations of sires with minimum risk for all possible levels of expected income were defined by the expected income variance frontier. The set of sires at the maximum lower boundary for 95% confidence of the expected income variance frontier was defined as the optimum set of sires to be selected; the optimum set maximized the 95% guaranteed expected income. The quadratic programming procedure provided the optimum percentage of cows to be mated to each sire in the selected set.

Animals↗
PubMed2001

Women's health in a rural setting in societal transition in Ethiopia.

There are reports indicating a worsening of women's health in transitional rural societies in sub-Saharan Africa in relation to autonomy, workload, illiteracy, nutrition and disease prevalence. Although these problems are rampant, proper documentation is lacking. The objective of this study was to reflect the health situation of women in rural Ethiopia. Furthermore, the study attempts to address the socio-demographic and cultural factors that have potential influence on the health of women in the context of a low-income setting. A combination of qualitative and quantitative research methods was utilised. In-depth interviews and a cross-sectional survey of randomly selected women were the main methods employed. The Butajira Rural Health Program demographic surveillance database provided the sampling frame. Heavy workload, lack of access to health services, poverty, traditional practices, poor social status and decision-making power, and lack of access to education were among the highly prevalent socio-cultural factors that potentially affect the health of women in Butajira. Though the majority of the women use traditional healers younger women show more tendency to use health services. No improvement of women's status was perceived by the younger generation compared to the older generation. Female genital mutilation is universal with a strong motivation to its maintenance. Nail polish has replaced the rite of nail-extraction before marriage in the younger generation. As the factors influencing the health of women are multiple and complex a holistic approach should be adopted with emphasis on improving access to health care and education, enhancing social status, and mechanisms to alleviate poverty.

Adolescent↗
PubMed1987

Economic policy, intergenerational equity, and the Social Security Trust Fund buildup.

For the next 75 years, the Old-Age, Survivors, and Disability Insurance (OASDI) system is projected to be close to in balance, on average. For approximately the next 40 years, under current projections, the combined OASDI Trust Fund is expected to continually have excesses of income over outgo, creating a buildup that will peak in 2030 at about +12 1/2 trillion (roughly 23 percent of the gross national product). Thereafter, the system is projected to be in annual deficit continually until the trust fund is exhausted in 2051. This article focuses on two fundamental issues that must be understood if the potential economic consequences of this buildup are to be evaluated properly. The first issue deals with the fact that the nature of Federal economic policy during the buildup period will determine the ultimate economic impact of the buildup. The second issue concerns the effect of the buildup, and its disposition, on the Social Security program's treatment of one generation of workers compared with another. If a fund is actually accumulated as projected, part of the retirement benefits of the "baby-boom" generation will, in effect, be self-financed. If, however, that fund is used for other purposes--directly or indirectly--future cohorts of workers will be required to fully finance benefits promised to the baby-boom retirees.

Aged↗
PubMed2001

"Voluntary" user fees in Buenos Aires hospitals: innovation or imposition?

Voluntary user fees in hospitals in Buenos Aires, which operate outside official controls, have not featured in other studies of health care in Argentina. After providing a historical overview of different hospital funding sources, the authors focus on the activity of cooperadoras--the organizations responsible for levying voluntary fees. Using detailed data from two case-study hospitals and more general financial sources, they assess the importance of these fees, identifying sharp variations between different hospitals, serious problems of under-reporting, and potential abuses. The authors also examine the means by which fees are levied and the degree of coercion involved. Voluntary fees are not a particularly successful funding strategy: the income they generate is variable; they are almost entirely unregulated; and they sometimes conflict with other, more legitimate funding sources. Most importantly, their voluntaristic aspect is largely notional: most patients are heavily pressured to make payments. The main motivation for continuing with voluntary fees is to avoid the political fallout that would probably result from introduction of a formal user fees policy.

Argentina↗
PubMed1996

The user fee debate.

The issue of user fees for health care generates a highly charged and emotional response from most Canadians. Access to health care services based on need rather than income is a feature of our system, of which we are extremely proud. Yet, there is increasing pressure on provinces to consider user fees. Are user fees the best method to cope with these financial pressures? Nurses can play a decisive role in ensuring that governments and the public are continuously well informed on this issue.

Canada↗
PubMedDate not supplied

A descriptive analysis of participant characteristics and patterns of substance use in the CSAT methamphetamine treatment project: the first six months.

The CSAT Methamphetamine Treatment Project (MTP) is a multisite study with a two-fold purpose: to assess the feasibility and outcomes generated by a technology transfer of the Matrix treatment model for methamphetamine (MA) abuse into several community-based treatment programs, and specifically to compare outcomes of treatment as usual at each site with outcomes of the Matrix model, as implemented in each site. The study comprises seven sites, geographically situated in Hawaii, Northern and Southern California, and Montana. This article presents a demographic description of the cohort, and describes patterns of drug use, abuse, and related problems among the 169 participants recruited in the first six months of the study, from April through September 1999. Specific analyses presented include: demographic composition of the sample with respect to gender, age, ethnicity, education completed, employment status, and income; primary drug used, and mean percent of days using various drugs including MA, alcohol, and marijuana; and percent of sample reporting various routes of drug administration. Mean baseline Addiction Severity Index composite scores are presented that describe medical, employment, alcohol, drug, legal, family/social, and psychiatric status for the sample. Also presented here are comparisons of this preliminary population to other populations reported in the literature. This early subset of MTP participants is similar to other methamphetamine-abusing populations described in the literature in age, years of education, income, and mean years of use. However, because of its multisite structure and the locations of its constituent sites, the MTP population has greater variation in ethnic makeup than do populations from other studies, offering an opportunity to provide useful new information about drug use patterns and treatment responses in populations not previously studied.

Adult↗
PubMed2003

Improving access to and consumption of animal source foods in rural households: the experiences of a women-focused goat development program in the highlands of Ethiopia.

Ethiopia is one of the poorest countries in Africa and its population experiences low and falling life expectancy rates, high infant, child and maternal mortality and high rates of child malnutrition. This is exacerbated by the fact that Ethiopia is not self-sufficient in animal products and is a net importer of food. For the majority of the population, most food energy (93%) is derived from vegetable products with 7% coming from animal source foods (ASF). FARM-Africa hypothesizes that the inadequate nutritional status of the population, which contributes to the high mortality rates in the country, is related to the population's low consumption of ASF, such as milk and meat. This article presents the findings of the Dairy Goat Project, the objectives of which included the improvement of family welfare through the generation of increased income and milk consumption. The project adopted an integrated approach and increased the productivity of local goats managed by women through a combination of better management techniques, genetic improvements and information exchange. Through pre- and post-intervention analysis of data of those households within the project area, FARM-Africa demonstrated a considerable improvement in the nutritional status and family welfare of project participants. There was increased appearance of milk and meat products in local diets, and the addition of other foods, such as eggs and fresh vegetables, as a result of complementary activities established with funds generated through the principal activities of the Dairy Goat Project.

Animals↗
PubMed1995

Utilization management, case management, and you.

Historically, most monitoring functions have been carried out by insurance companies. Monitoring costs was considered their fiduciary obligation to their customers. The exercise of this fiduciary obligation kept premiums low, while increasing or maintaining the benefit levels. Risk (the assumption of losses generated by services costing more than the income received from premiums) was assumed by the insurance company and eventually passed to the customer or the payer. Today, risk is being transferred more and more to the provider. This transfer was started by the creation of DRGs, the main purpose of which was to transfer risk from payers (insurance companies, employers, state and federal government, etc.) to provider health care organizations (physician groups, individual practitioners, hospitals, clinics, etc.).

Cost Control↗
PubMed2006

The costs and benefits of reforestation in Liping County, Guizhou Province, China.

Reducing greenhouse gases in the atmosphere is becoming a pressing issue for the global community. Afforestation and reforestation are promoted worldwide as an effective means of sequestering carbon. For its national interest and global concerns, China has made great efforts to protect its existing forests and develop programs of afforestation and reforestation. Based on two surveys recently conducted in Liping County, Guizhou province, this paper investigates the economic changes associated with the implementation of the "Grain For Green" policy. Based on the analytical framework of benefit cost analysis, this paper concludes that the implementation of the reforestation of sloping agricultural land policy would not be possible if there were no government subsidies for the peasants. The short term economic returns of land and labour from forestation are substantially lower than those generated from grain or cash crop production on the steep slope lands. The government subsidies provide great economic incentives for peasants to take part in the project. The subsidies in fact have elevated peasant income in rural Liping. The estimated potential economic returns of plantations over the long run indicate that the removal of the government financial subsidies would not create an economic crisis for the peasants if the current market conditions continue.

Agriculture↗
PubMedDate not supplied

Intergenerational family conversations and decision making about eating healthfully.

OBJECTIVE: To explore how youth, parents, and grandparents discuss issues related to eating healthfully and unhealthfully and to identify intergenerational strategies for educators to improve this communication. DESIGN: In three intergenerational focus groups, each with 4-8 families, a trained moderator asked questions about family practices and conversations for eating healthfully and unhealthfully. SETTING: Three focus group sites, each with Pennsylvania Nutrition Education Program sites (PANEP) programs serving low-income populations and multigenerational clientele, based in geographically and culturally diverse communities in Pennsylvania. PARTICIPANTS: Forty-four individuals (21 pre-teens, 16 parents, and 7 grandparents) from 17 families. PHENOMENON OF INTEREST: How youth, parents, and grandparents discuss and influence each other's healthful and unhealthful eating practices. ANALYSIS: "Strength" of evidence determined by repetition of ideas across focus groups and from the respondents' quotes providing in-depth information. RESULTS: Families demonstrated a wide range of ways that family communication is associated with the adoption of healthful and unhealthful patterns of eating. Parents and grandparents expressed anguish over their struggle and inability to help their children eat more healthfully. All three generations enumerated strategies for dealing with disagreement. CONCLUSIONS AND IMPLICATIONS: Grandparents, parents and children indicate that they need opportunities to learn together and communicate about ways to improve nutrition behaviors.

Adolescent↗
PubMed1999

Views about women's mental health: study in a squatter settlement of Karachi.

OBJECTIVE: Mental health of women is globally receiving particular attention. This study assessed community's view on certain aspects of women's mental health prior to introducing an intervention. SETTING: The study was conducted in an urban squatter settlement located in District West of Karachi in 1997 where the Aga Khan University has set up a Primary Health Care program in partnership with the communities. METHODS: Using convenient sampling, door to door household survey was conducted by medical students. RESULTS: Two hundred and eighty one residents were interviewed. Respondents were asked to list contributory factors which lead to mental distress in women. Two hundred and ten (75%) were able to list certain factors. The factors listed were; low family income (40%), dispute amongst spouses (30%), verbal abuse by in-laws (25%) and too many children (5%). When asked what women in the community did while they were mentally distressed 35% respondents reported that women talked to their husbands and 18% said counselling from a health provider was sought. Main channels of social support desired were; revenue generation (67%), membership of a women's group (11%) and training of local community women in counselling skills (10%). CONCLUSION: Signs of awareness about mental health issues are present even in marginalized communities of Pakistan. In order to improve the mental health of women interventions should primarily focus on raising family income.

Adolescent↗
PubMed2006

Revisiting physicians' financial incentives in Quebec: a panel system approach.

Do Primary Care Physicians (PCPs) react strategically to financial incentives and if so how? To address this question, we follow a quasi-natural experiment in Quebec, using a panel system technique. In so doing, we both correct for underestimation biases in earlier time series findings and generate new results on the issue of complementarity/substitution between consultations with varying levels of technicality. Under both techniques, we show that PCPs are sensitive to the enforcement and subsequent temporary removals of expenditure caps and more generally, to changes in consultations' relative prices over time. These results support the existence of a discretionary power over the choice of consultation, PCPs increasing strategically the number of the more technical (and therefore more lucrative) consultations when pressed to defend their income. This finding for primary care parallels the now well-established DRG creep in hospitals. The panel system approach offers a better account of the complexity surrounding PCPs' decision-making process. In particular, it successfully addresses issues of physician heterogeneity, jointness between consultations and temporal breaks and generates robust estimates of PCPs volume and quality reactions to regulatory changes.

Budgets↗
PubMed1998

Feedlot health and management.

Health programs based solely on vaccination and treatment regimens are often short-lived and unrewarding. The basis of any successful ongoing health program is a working health management system. The key to the success of the system is a functioning record system that generates information meaningful to management. The basic information generated should include morbidity and mortality data categorized by cause, the number of repeat treatments, and the number of chronic animals or railers. Goals should be set for each major category so that a database can be established for a feedlot operation to assess problems and progress. The most common reason for expectations not being achieved is factors that are largely beyond the control of the feed yard. Although attempts to address these factors should be periodically reviewed, attention to the health program and potential modifications are among the factors that we can control and modify as appropriate. BRD is the most important economic disease in the feedlot. Prearrival management is extremely important in assessing the risk category of incoming calves and in applying a preventive health strategy. Good husbandry, proper nutrition, proper pen maintenance, and selective immunization help to ensure that the cattle adapt quickly to the feed yard environment. Careful observation, timely effective therapy, and excellent hospital management increase the opportunity to produce cost-competitive, safe, and wholesome beef in a humane fashion with limited effects of the environment.

Animal Husbandry↗
PubMed1995

[Realization and financing of different models of home care].

In the long term perspectives for home care are characterized by four challenges: First, home care services can be rationalized only below average. If professionals in the home care services shall take part nevertheless in the general development of wages in the economy, it is necessary that a rising part of domestic income will be spent for these services. Second, in the families tensions between the desire for self-realization of the middle generations and expectations of home care patients that the next generation shall take over caring responsibilities, will increase, which will lead to a rising demand for professional home care services. Third, the rising proportion of single households will also lead to a rising demand for professional services, because people living alone need more services than people living within families. Fourth, the future demographic development will not only lead to a rising number of people in need of home care but also to declining number of younger people. This will cause not only problems for financing of welfare state programs for people in need of home care but will also lead to a scarcity of nursing professionals. Against this background the new "Social Long Term Care Insurance," which will come into effect in Germany by 1995 has to be examined for its economic justifiability, for its distributional justice and for the effectiveness of its benefits. The new insurance program can strengthen home care; however in terms of economic justifiability and distributional justice it is not without risks.

Aged↗
PubMed1993

After-hours telephone coverage: the application of an area-wide telephone triage and advice system for pediatric practices.

BACKGROUND: After-hours telephone calls are a stressful and frustrating aspect of pediatric practice. At the request of private practice pediatricians in Denver, a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care. This system, the After-Hours Program (AHP), uses specially trained pediatric nurses with standardized protocols to provide after-hours telephone triage and advice for the patients of 92 Denver pediatricians, representing 56 practices. OBJECTIVES: This report describes the AHP, presents data from 4 years' experience with the program, and describes results of our evaluation of the following aspects of the program: subscribing physician satisfaction, parent satisfaction, the accuracy and appropriateness of telephone triage, and program costs. METHODS: After-Hours Program records (including quality assurance data) for all 4 years of operation were retrospectively reviewed, tabulated, and analyzed. The results of two subscribing physician surveys and one parent caller satisfaction survey are presented. A retrospective review of after-hours patient care encounter forms assessed the necessity for after-hours visits triaged by the AHP. An analysis of the total cost of this program to 10 randomly selected subscribing physicians was conducted using current AHP data and a survey of the 10 physicians. RESULTS: In 4 years, 107,938 calls have been successfully managed without an adverse clinical outcome. Minor errors in using protocols occurred in one call out of 1450 after-hours calls. After-hours phoen calls necessitated an after-hours patient visit 20% of the time and generated one after-hours hospital admission out of every 88 calls. Just over half of the patients were managed with home care advice only, and 28% were given home care advice after-hours and seen the next day in the primary physician's office. Of all patients directed by the telephone triage nurses to be seen after hours, 78% were determined to have a condition necessitating after-hours care. Data are presented regarding call volumes by time of day, day of week, patient age, and patient's initial complaint. The 6 most common complaints accounted for more than one half of the calls, and 38 complaints accounted for more than 95% of all after-hours calls. Utilization by subscribing physicians is described. Satisfaction among subscribing pediatricians was 100%, and among parents was 96% to 99% on a variety of issues. The total cost to participating Denver pediatricians (which includes revenues "given up" as a result of not seeing patients after hours) ranged from 1% to 12% of their annual net income, depending on a variety of factors. CONCLUSIONS: Large-scale after-hours telephone coverage systems can be effective and well-received by patients, parents, and primary physicians. Data presented in this report can assist in planning the training of personnel who provide after-hours telephone advice and triage. Controversies associated with this type of program are discussed. Suggestions are made regarding the direction of future programs and research.

Ambulatory Care↗
PubMed2001

Indirect institutional revenue generated from an academic primary care clinical network.

BACKGROUND AND OBJECTIVES: As the financial performances of US academic health centers have faltered under managed care and the Balanced Budget Act of 1997, increasing attention has been paid to the costs and benefits of operating primary care networks. This study examines the indirect revenues to a university hospital and faculty group practice that result from such a primary care network using a method of abstracting billing data. METHODS: A primary care patient cohort was identified by selecting all patients who generated at least one charge in any of the 10 primary care clinics in the network over a 15-month period. All charges from the hospital and the faculty practice group for this cohort were then examined during a 6-month period, and the total charges generated in the primary care setting were compared with charges generated elsewhere in the health system. RESULTS: The primary care patient cohort included 56,459 patients and generated a total of $7,243,312 in charges for primary care services, $43,559,741 of charges in the hospital billing system for non-primary care services, and $8,825,611 of charges for services from specialty faculty. This cohort accounted for 18.5% of the gross charges for hospital care and 17.6% of charges generated by the specialty physicians. CONCLUSIONS: Using a simple and replicable methodology, this study estimates a substantial financial benefit to the hospital and specialty practices from a primary care network.

Academic Medical Centers↗
PubMed1995

The prevalence of grandmothers as primary caregivers in a poor pediatric population.

In the wake of the HIV/AIDS and crack cocaine epidemics, poor urban communities face growing numbers of older adults, largely grandmothers, who have become surrogate parents to children orphaned by these epidemics. This study is the first in the United States to determine the prevalence of older surrogate parents among families registered at pediatric clinics. The three clinics selected were in low income neighborhoods of New York City with a high incidence of female HIV/AIDS and substance abuse. Using a 50% random sample of 1,375 records of registered families, data were obtained on the number and ages of relatives serving as surrogate parents. In 11% of these 1,375 families with children 12 years and under a parent was not the caregiver. In 8% the caregiver was a grandmother. Forty-seven percent of these women were 55 years or older, 25% were 60 years or older and 8% were 70 years or older. Most of these women were caring for more than one child. Ten percent of the total of 2,445 children, 12 years and under, lived in non-parent headed families. Eight percent lived with a grandmother, 1% with other parental generation relatives and 1% in foster care. Given the stresses associated with caregiving in late life and the greater risk of poor health among low income African-American and Hispanic elderly, older surrogate parents from these communities are a potentially high health risk population whose own needs may go unrecognized and unattended. The young ages of the children suggest that many grandparents may continue to be caregivers as they reach their sixties, seventies and even eighties. Clinical and longitudinal data are needed to determine how prolonged surrogate parenting in late life affects the health of older caregivers and the children in their care. Coordination between health and social services for the elderly and for children are needed to promote effective programs for these families.

Aged↗
PubMedDate not supplied

The physician office laboratory: profitability under managed care.

CLIA has forced many physician offices to close their labs because the costs of operating them have been out-weighed by the revenues they generated. Managed care has imposed even further restrictions because managed care organizations (MCO) limit reimbursement to a very few in-house procedures. To reverse this trend, physician offices must make their labs attractive to MCOs by emphasizing quality, promoting customer satisfaction, discussing cost effectiveness and discounting laboratory fees. Once these are set, the next step is negotiating with the MCOs.

Cost-Benefit Analysis↗