Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Income Generation Programs”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources
PubMed1993

Demographic and employment shifts: implications for benefits and economic security.

This Issue Brief examines factors affecting the population's age distribution and composition, such as mortality rates, fertility rates, and immigration. In addition, it examines factors affecting labor force composition, such as immigration, increased labor force participation of women, and retirement trends, and discusses the potential impact of these changes on publicly financed programs: Medicare, Medicaid, Social Security, and federal employee retirement systems. The discussion also highlights the implications of these population and labor force changes on employers, employees, and retirees. The elderly population--now 31.8 million, representing 12.6 percent of the population--is projected to experience tremendous growth between 2010 and 2030, when the baby boom generation reaches age 65, rising from 39.7 million, or 13.3 percent of the population, to 69.8 million, or 20.2 percent of the population. Growth in the elderly population has implications for retirement and health care systems. Population projections suggest that the traditionally pyramid-shaped work force, with a proportionately greater number of younger workers than older workers, will be replaced with a more even age distribution. Consequently, significant and continued modifications to benefit packages, such as changes in compensation structures in which earnings automatically rise with age, are likely to occur. Women's labor force participation began to accelerate in the mid-1950s, rising 75 percent among women aged 25-44 in 1991, although there is some indication that this growth may be flattening. With women comprising a greater part of the labor force, employers will be encouraged to develop and implement programs to better accommodate their needs. Increased life expectancy, a decreased percentage of entry level workers, changes in Social Security's normal retirement age from 65 to 67, and employer plans to raise the normal age of retirement or provide incentives to delay retirement, could raise the average age of retirement. However, other factors, such as poor health, other sources of retirement income, and individual preferences for retirement, could still dominate the retirement decision. The combination of increased average life expectancy guaranteeing more years of retirement to finance and rising dependency ratios increases the future cost of Social Security financing. Medicare financing is also an important policy issue because the program is projected to experience financial difficulties in the short term, resulting from explosive health care costs. In addition, Medicaid expenditures are consuming increasing amount of shrinking state budget resources--a large portion of which is used to finance nursing home care for a growing elderly population.

Age Distribution↗
PubMed2000

Health system reform and the role of field sites based upon demographic and health surveillance.

Field sites for demographic and health surveillance have made well-recognized contributions to the evaluation of new or untested interventions, largely through efficacy trials involving new technologies or the delivery of selected services, e.g. vaccines, oral rehydration therapy and alternative contraceptive methods. Their role in health system reform, whether national or international, has, however, proved considerably more limited. The present article explores the characteristics and defining features of such field sites in low-income and middle-income countries and argues that many currently active sites have a largely untapped potential for contributing substantially to national and subnational health development. Since the populations covered by these sites often correspond with the boundaries of districts or subdistricts, the strategic use of information generated by demographic surveillance can inform the decentralization efforts of national and provincial health authorities. Among the areas of particular importance are the following: making population-based information available and providing an information resource; evaluating programmes and interventions; and developing applications to policy and practice. The question is posed as to whether their potential contribution to health system reform justifies arguing for adaptations to these field sites and expanded investment in them.

Developing Countries↗
PubMed1998

Smoking cessation among inner-city African Americans using the nicotine transdermal patch.

OBJECTIVE: To determine the efficacy of the transdermal nicotine patch for smoking cessation in inner-city African Americans. DESIGN: Double-blind, placebo-controlled, randomized trial. SETTING: Outpatient in an inner-city hospital. PATIENTS AND PARTICIPANTS: A computer-generated random numbers table with a block size set at 20 was used to randomize 410 patients to one of two study arms. INTERVENTIONS: The transdermal nicotine patch for 10 weeks as an adjunct to brief counseling. MEASUREMENTS AND MAIN RESULTS: Of the 410 patients randomized, mean age was 48 years, 65% were female, 41% had less than a high school education, 51% had an annual household income of less than $8,000, and the average number of cigarettes smoked per day was 20. Quit rates at 10 weeks were 21.5% (44/205) with the nicotine patch, and 13.7% (28/205) with the placebo patch (p = .03). At 6 months, quit rates were 17.1% (35/205) with the nicotine patch, and 11.7% (24/205) with the placebo patch (p = .08). After adjusting for baseline differences in age and educational attainment, differences remained significant at 10 weeks (p = .04), but were not significant at 6 months (p = .14). Compliance rates for return visits were 83%, 78%, 55%, and 52%, at 1, 2, 6, and 10 weeks, respectively. CONCLUSIONS: The nicotine patch significantly improves short-term quit rates in inner-city African Americans who are interested in trying to quit smoking. Efforts should be made to reach underserved populations through smoking cessation programs, and to assist in maintaining abstinence.

Administration, Cutaneous↗
PubMed1997

Liability issues in managed care.

The explosive growth in Managed Care Organizations as a mechanism for providing health care in the United States has generated an equal explosion in litigation and new legislation related to problems within this delivery system. Abuses have included the "gagging" of physicians from providing full disclosure of medical options for their patients, inappropriate denial of care, denial of specialty referral, false claims data, insurer insolvency, economic credentialling, deselection, financial disincentives to render care, and lack of appeal or grievance mechanisms. These issues and others have resulted in injuries to patients and damage to the patient/physician relationship. This article discusses some of the more dramatic litigated cases and endeavors to alert both physicians and patients to potential legal matters that should be considered before becoming involved within this structure.

Confidentiality↗
PubMed1995

Can a public health care system achieve equity? The Norwegian experience.

Equity in health care provision is an important policy goal in Norway. This article addresses equality in the services provided by primary care physicians. These services are the responsibility of local government financed mainly through public funding. Patient fees are low. The local government system results in geographical variation in the number of physicians relative to local health demands. The authors present the hypothesis that this generates inequalities in health care utilization. The system of government finance is based on the assumption that utilization of health services is independent of patient income. Therefore, variation in income is expected to have only a small impact on utilization. The authors estimate a demand model by combining extensive micro data with aggregate data on municipal supply. There is very little relationship between indicators of access and health care utilization. The estimated income elasticities approximate zero, supporting the argument that equality in utilization has been achieved. However, the authors results also raise the question of whether equality has been achieved at the cost of limiting supply of services for people who could afford to consume more, or to pay for services of higher quality.

Adolescent↗
PubMedDate not supplied

Cost and utilization impacts of oral antihistamines in the California Medi-Cal program.

OBJECTIVES: Newer oral allergic rhinitis (AR) medications, the second-generation antihistamines (SGAs) have gained widespread acceptance because of their efficacy and reduced side effects relative to first-generation antihistamines (FGAs). There are no empirical studies comparing the costs of treatment of SGAs relative to FGAs. METHODS: We analyzed data from a 20% beneficiary sample (approximately 120,000 continuously enrolled beneficiaries per year) for the Medi-Cal Fee-for-Service program during 1999 to 2000. AR medications available under Medi-Cal included three SGA medications (loratadine, fexofenadine, and cetirizine) and over 200 FGA products containing either diphenhydramine or chlorpheniramine or both. Because multiple medications were evaluated, a sample selection model was estimated using a two-stage multinomial logistic--variance components regression framework. RESULTS: SGA medications have significantly lower total direct health-care treatment costs per patient than FGA medications with costs ranging from US 347 dollars to US 448 dollars less (P < 0.001), despite higher AR medication costs. Total drug expenditures were also not significantly different for patients using SGA or FGA medications despite SGA prescriptions averaging US 47 dollars higher than FGAs. Emergency department visits, inpatient admissions and physician office visits were also significantly lower for patients using SGA medications. CONCLUSIONS: Significant cost and utilization reductions were associated with all of the SGA medications relative to FGA drugs, despite their higher acquisition costs. If facing higher copayments for prescription AR drugs, many patients, particularly lower income patients, may choose cheaper over-the-counter (OTC) FGAs rather than SGAs. Our analysis finds this might lead to increased overall health-care treatment costs, unless Medicaid and health insurance plans subsidize OTC AR medications.

Administration, Oral↗
PubMed1982

The problems and benefits of associating academic medical centers with health-maintenance organizations.

The growth of prepaid medical-care programs has caused the leaders of a number of academic medical centers to begin to have an increased interest in affiliating with or sponsoring centers in prepaid programs -- otherwise known as health-maintenance organizations (HMOs)--is motivated by a number of potential benefits. An HMO may provide an academic medical center with an additional source of patients for teaching and research; generate additional revenue; increase resources for education in primary care; increase the exposure of students, residents, and faculty to the characteristics of prepaid medical practice; and improve the delivery of health services locally. Issues of importance to the academic medical center include the pros and cons of sponsorship of, as opposed to affiliation with, an HMO and the additional costs attributable to medical education in the HMO setting. Problems may arise between HMOs and medical centers as a result of disparate styles of practice, the high cost of clinical services at the medical center, and the differing perspectives of HMO and medical-center policy makers.

Academic Medical Centers↗
PubMed2005

Delivery of rehabilitation services to people aging with a disability.

The disabled elderly population continues to grow. Systems of care for the disabled elderly are vast, ranging from inpatient facilities to outpatient programs and home programs. Recent advances in technology allow us to reach patients in their homes through telemedicine. Support services within the community are growing, and case managers are becoming more necessary as it becomes more difficult to navigate the health care system. As providers of rehabilitative services, we must help our patients find the most appropriate setting to receive care. As the focus continues to shift from inpatient to outpatient care and to home services, we must approach health care in a dynamic fashion and with flexibility. We must be advocates for our patients and their caretakers. Significant research questions remain, and health care policy requires development. As the population ages and the disabled elderly population become a focus of fiscal experts, we must look to provide the most cost-effective yet functionally productive health care. We may shift from focusing on functional performance in a therapy gym or inpatient rehabilitation unit to functional performance at home. We must focus on IADL and QOL indicators and must strive to find ways to provide efficient, cost-effective care. Medicaid, Medicare, and third-party insurers offer various options. The VHA offers additional benefit to those who are eligible. Advocacy groups such as the American Association of Retired Persons struggle to meet its members' needs and concerns while generating income to provide education and other resources. We must work to promote the strengths of the elderly population by addressing preventive strategies while maintaining functional independence.

Aged↗
PubMed1996

Prevalence of gallbladder disease and associated clinical variables in a low income population of Mexico City.

We present the results of a population-based survey carried out in a low income area of Mexico City. The aim of this study is to characterize the prevalence of clinically significant gallbladder disease (CSGD) using the self-reported history of cholecystectomy (CG) or cholelithiasis (CL) demonstrated by cholecystography and/or ultrasonography. The population of the studied area was 15,532 inhabitants, of whom 3505 (22.6%) were age eligible (35-64 year-old men and non-pregnant women). Home interviews were obtained in 2810 (80.2%). A physical and laboratory examination was performed in 2282 individuals (65.1%; 941 men and 1341 women). The prevalence of CSGD in men was 2.0% (95% confidence intervals 1.1-2.9%) and 9.2% in women (95% confidence intervals 7.7-10.7%). Patients with CSGD were older, men (p < 0.003) and women (p < 0.001). Women with CSGD had higher waist to hip circumference ratio (p < 0.06), higher fasting glucose (p < 0.03) as well as 2 h post challenge glycemia (p < 0.04) and insulinemia (p < 0.03). In the multiple logistic regression model only age (p < 0.001) and sex (p < 0.001) remained significantly associated. We conclude that CSGD is quite prevalent in this population. It is associated with age in both genders and in women, higher glucose and insulin levels. The prospective follow-up of this cohort is important since it could generate the information needed to implement a preventive program to diminish the impact of this condition.

Adult↗
PubMed2003

Economic merit of crossbred and purebred US dairy cattle.

Heterosis and breed differences were estimated for milk yield traits, somatic cell score (SCS), and productive life (PL), a measure of longevity. Yield trait data were from 10,442 crossbreds and 140,421 purebreds born since 1990 in 572 herds. Productive life data were from 41,131 crossbred cows and 726,344 purebreds born from 1960 through 1991. The model for test-day yields and SCS included effects of herd-year-season, age, lactation stage, regression on sire's predicted transmitting ability, additive breed effects, heterosis, and recombination. The model for PL included herd-year-season, breed effects, and general heterosis. All effects were assumed to be additive, but estimates of heterosis were converted to a percentage of the parent breed average for reporting. Estimates of general heterosis were 3.4% for milk yield, 4.4% for fat yield, and 4.1% for protein yield. A coefficient of general recombination was derived for multiple-breed crosses, but recombination effects were not well estimated and small gains, not losses, were observed for yield traits in later generations. Heterosis for SCS was not significant. Estimated heterosis for PL was 1.2% of mean productive life and remained constant across the range of birth years. Protein yield of Brown Swiss x Holstein crossbreds (0.94 kg/d) equaled protein yield of purebred Holsteins. Fat yields of Jersey x Holstein and Brown Swiss x Holstein crossbreds (1.14 and 1.13 kg/d, respectively) slightly exceeded that of Holsteins (1.12 kg/d). With cheese yield pricing and with all traits considered, profit from these crosses exceeded that of Holsteins for matings at breed bases. For elite matings, Holsteins were favored because the range of evaluations is smaller and genetic progress is slower in breeds other than Holstein, in part because fewer bulls are sampled. A combined national evaluation of data for all breeds and crossbreds may be desirable but would require an extensive programming effort. Animals should receive credit for heterosis when considered as mates for another breed.

Aging↗
PubMed2006

Promoting condoms in Brazil to men who have sex with men.

DKT International is a non-profit social marketing enterprise whose mission is to provide safe, affordable options for family planning and STI/HIV prevention. In Brazil, DKT sells male and female condoms to mostly lower-income couples nationwide. This paper is about the introduction of a ribbed, lubricated, latex condom called Affair to the Brazilian market in 2000. Sales were initially very low, but based on reports that Affair was well liked by some men who have sex with men, we took the opportunity to give Affair that positioning. We worked with our advertising agency, a local research company and Dignidade, a Brazilian NGO working for the rights of men who have sex with men. Two new products--a baggy condom called Affair Sensation and a complimentary lubricating gel called Affair Personal Lubricant--with new packaging and a promotional campaign were launched in February 2006. The billboard advertisement generated controversy in São Paulo, where the Advertising Council required it to be taken down due to complaints. However, the controversy helped promotion and at the same time generated public debate on sexuality and human rights. Our overall experience has been positive, sales are up and we have received messages of support for the products and their promotion from consumers.

Brazil↗
PubMed2002

[Are the "elderly" living at the expense of the "young"? Remarks on the burden distribution between "generations" in an aging population from the economic perspective].

Public and scientific discussion on the effects of an aging population is often biased: aging is primarily seen as an economic burden. Increasing contribution rates in pension schemes, health and long-term care insurance are highlighted. This paper tries to provide a more balanced view. The distinction between a cross-sectional and a longitudinal view already gives different information on distributional effects. Labeling older people as "economically inactive" is a much too narrow perspective focused on the activity on the labor market only. Other types of work are neglected such as caring for children or frail elderly as well as economic activities from wealth, consumption as well as paying taxes to finance public expenditure. The approach of "generational accounting" is also narrow, focusing on public expenditure, social insurance contributions and only some types of taxes, but not dealing with private, especially intrafamily transfers. In economic terms, a comprehensive approach is needed regarding the effect of institutions and measures on the economic situation of cohorts. The role of investment in human capital is mentioned as a decisive factor for productivity in a country. Further education and retraining of older workers is one important element. An integrative approach dealing with the different fields of activities is needed when analyzing the intergenerational as well as the intragenerational distribution. This requires an elaborated and differentiated reporting of distributional effects. This important precondition, however, does not exist in Germany.

Aged↗
PubMed2005

Forecasting municipal solid waste generation in a fast-growing urban region with system dynamics modeling.

Both planning and design of municipal solid waste management systems require accurate prediction of solid waste generation. Yet achieving the anticipated prediction accuracy with regard to the generation trends facing many fast-growing regions is quite challenging. The lack of complete historical records of solid waste quantity and quality due to insufficient budget and unavailable management capacity has resulted in a situation that makes the long-term system planning and/or short-term expansion programs intangible. To effectively handle these problems based on limited data samples, a new analytical approach capable of addressing socioeconomic and environmental situations must be developed and applied for fulfilling the prediction analysis of solid waste generation with reasonable accuracy. This study presents a new approach--system dynamics modeling--for the prediction of solid waste generation in a fast-growing urban area based on a set of limited samples. To address the impact on sustainable development city wide, the practical implementation was assessed by a case study in the city of San Antonio, Texas (USA). This area is becoming one of the fastest-growing regions in North America due to the economic impact of the North American Free Trade Agreement (NAFTA). The analysis presents various trends of solid waste generation associated with five different solid waste generation models using a system dynamics simulation tool--Stella. Research findings clearly indicate that such a new forecasting approach may cover a variety of possible causative models and track inevitable uncertainties down when traditional statistical least-squares regression methods are unable to handle such issues.

Cities↗
PubMed1994

Would national health insurance improve equity and efficiency of health care in South Africa? Lessons from Asia and Latin America.

Arguments for and against national health insurance (NHI) for South Africa are illuminated by the experiences of other middle-income developing countries. In many Latin American and Asian countries the majority of their populations are covered by NHI, coverage having steadily increased over the last decade. Patterns of care under NHI tend to be inefficient--hospital-oriented, highly specialised and technical, with excessive investigation, surgery and medication, neglect of primary care and severe cost escalation. In some cases, however, urban primary care has been promoted through polyclinics and health maintenance organisations. Inequalities in funding, access and utilisation exist between the insured and uninsured, between strata of the insured, and between urban and rural areas. These inequalities have at times been ameliorated by expansion of coverage, subsidisation of poorer beneficiaries and initiation of programmes that extend care to rural areas. NHI can improve or impair efficiency and equity in health care, depending on structures and processes of revenue generation, payment and organisation of care. These depend in turn on how those likely to lose or gain from each option exercise their collective power.

Asia↗
PubMed2005

Key performance indicators for the implementation of social health insurance.

Several low- and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. For those countries interested in such an extension, it is important to understand what characterises a well performing social health insurance scheme. This article provides a simple framework to analyse key performance issues related to the functions of health financing within the context of social health insurance. The framework first illustrates how performance in the health financing functions of revenue collection, pooling and purchasing affects the realisation of health financing targets of resource generation, optimal resource use and financial accessibility of health services for all. Then, within each health financing function, key performance issues and associated measurable indicators are developed. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. In doing so, policy makers can come closer to achieving universal coverage -- access to appropriate healthcare for all at an affordable cost -- the ultimate goal of social health insurance.

Developing Countries↗
PubMedDate not supplied

Indirect cost in economic evaluation: the opportunity cost of unpaid inputs.

Unpaid time represents a potentially significant input into the health production function. The paper sets out the basis for valuation of time inputs consistent with the notion of opportunity cost. Such analysis requires consideration of whether time displaced in the production of health involves lost work or lost leisure. Furthermore, because valuation of opportunity cost requires the consistent treatment of costs and benefits, the study also considers the valuation of outputs. The basis for valuing the shadow price of work time is examined by firstly assuming perfect competition. The analysis then considers the presence of monopoly and monopsony in product markets and income and sales taxes. The basis for valuing the shadow price of leisure ("leisure' being all uses of time except paid employment) is restricted to an examination of methods previously used to value unpaid housework. The two methods examined are the replacement cost and the opportunity cost method. As the methods are not equivalent, the circumstances where each is appropriate vary depending on whether the output lost in producing health is replaced. Although not set out as the primary focus of the paper, the issues surrounding the valuation of outputs generated by non-market and quasi-market activity are examined. In particular, where activities such as informal care result in indirect utility to the carers (and patients) themselves, it is likely the full market wage provides a lower bound estimate of the value of marginal benefit. Finally the paper provides a practical approach to examining opportunity cost of unpaid inputs consistent with the concepts set out in preceding sections.

Caregivers↗
PubMed2005

A profile of home care workers from the 2000 census: how it changes what we know.

PURPOSE: The goal of our study was to identify a representative sample of direct care aides to generate an accurate profile of the long-term-care workforce, with a special focus on home care workers. DESIGN AND METHODS: Data were taken from the 5% Public Use Microdata Sample (PUMS) of the 2000 Census. RESULTS: Variable coding in the 2000 Census data allowed for a more detailed identification of long-term-care workers than was available in previous studies. On the basis of this new sample, the estimated size of the home care workforce is much larger than that in previous estimates, and it is more heterogeneous. In addition, our analyses revealed more self-employed workers, higher salaries than previously reported, and greater ethnic diversity, with Hispanics or Latinos comprising a significant proportion of the home care workforce. IMPLICATIONS: Numerous state and federal programs are currently underway to increase the capacity of the long-term-care workforce. A more comprehensive understanding of the characteristics of the long-term-care workforce will facilitate more effective development of programs designed to enhance recruitment and retention of these workers to meet the increasing demands of future years.

Adult↗
PubMed1996

Learning shortcuts to success. Africa.

The exchange of experiences and lessons has been a feature of JOICFP's IP in Africa since the project's earliest days, particularly at the local level. At the end of 1995, this exchange system was expanded to the regional level with the swap of study teams between Zambia and Tanzania. Five personnel from Tanzania visited Zambia from October 14 to 28 and four IP personnel from Zambia visited Tanzania from November 4 to 18. For both teams the experience was one of learning and provided insights into different approaches to such areas as logistics, operational strategy, service delivery, organization setup, administration, income-generation and sustainability, data collection, analysis and reporting and cost-effectiveness. The Tanzanian team was impressed with the effective use of the health advisory committees at the village level in Zambia to reach local people. The steering committee structure ends at the ward level and not the village level in Tanzania. They also noted the strong involvement of men in the project and the dual existence of clubs for men and women. In one of the villages visited, the team joined an IP Open Day attended by over 5000. The study visit to Tanzania was also effective for the Zambian team, which was impressed with the IP system for the collection and analysis of CYP/CPR data. The members noted the close UMATI-government collaboration and joining of forces for FP service delivery. Tanzania's success with systematic CBD/CBS deployment was another impressive feature for the Zambians.

Africa↗