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PubMed1987

Judgment, 2 September 1987.

The Court held that the defendant had discriminated against the plaintiff flight hostesses in violation of Article VI of the Constitution when it paid them less in unemployment benefits than it paid men. The Court rejected an argument that, since flight hostesses were paid less than male employees, their unemployment benefits should be less, ruling that there was no valid reason related to sex to justify the difference in pay.

Belgium↗
PubMed1987

M/s. MacKinnon Mackenzie and Co. v. Audrey D'Costa, 26 March 1987.

The respondent female employee charged her employer with discrimination under the Equal Remuneration Act (No. 25 of 1976). She claimed that she was paid less as a stenographer than male stenographers performing the same work or work of a similar nature. The Supreme Court upheld a lower court decision supporting the respondent's claims. It rejected arguments that a) the work of female stenographers was different because they worked in a different place and as confidential stenographers attached to senior executives; and b) the difference in pay was justified under the terms of a settlement between the employer and the respondent's union. It noted that an employer could not deliberately create conditions of work only with the object of driving away women from a particular type of work that they can otherwise perform with the object of paying them less and that union settlements must yield to the provisions of the Equal Remuneration Act.

Asia↗
PubMed1987

Pickstone v. Freemans plc, 25 March 1987.

The applicants, female warehouse operatives for the defendant, challenged the defendant's policy of paying warehouse checkers more than they were being paid. They claimed that both groups were engaged in work of equal value and should be given equal pay. The case was dismissed by a lower court because the defendant employed men in both positions at the same pay as women in those positions and the Equal Pay Act 1970 prohibited suits in such circumstances. The Court of Appeal reversed this decision, holding that Article 119 of the EEC Treaty authorized the suit and overrode conflicting national legislation. It remanded the case for determination whether the pay differential between the two jobs was due to reasons other than sex discrimination.

Developed Countries↗
PubMed2001

Is equity being sacrificed? Willingness and ability to pay for schistosomiasis control in China.

Decentralization of the health care system in China has led to an increasing need for income generation at all operational levels, both for curative services and for public health programmes. In general, people have accepted the costs of curative services, although the impact of charges on health-seeking behaviour has yet to be assessed. Public health programmes present particular problems in terms of revenue generation, however, because of the less direct impact of these activities on individual health and well-being. In this paper, we report the results of a cross-sectional study of willingness and ability to pay for schistosomiasis control. Questionnaires were administered to household heads of six representative villages in the Dongting Lake Region of Hunan Province, China. A total of 628 valid questionnaires were analyzed. The yearly mean household expenditure on schistosomiasis diagnosis and treatment was RMB 59.50 +/- 146.04 Yuan (US$1 = 8 RMB Yuan), accounting for 0.94% of the total yearly household income. Most household heads (514, 82%) thought schistosomiasis was the greatest health threat in their communities, but only 30.9% of them were willing to pay for screening, diagnosis and treatment of the infection. On the other hand, 72.3% of the respondents were willing to undertake volunteer work for control.

Adult↗
PubMed1999

Economic evaluation and mental health: sparse past. fertile future?

BACKGROUND: Demands for economic inputs to mental health policy-making, practice decisions and research evaluations have grown considerably in recent years, but the overall supply response has been modest and uneven. AIMS: This paper examines the key historical phases in the development of mental health economics research, and what they imply for the way economics is received and employed. Focusing on the quest for cost-effectiveness, the paper considers challenges for mental health economics. METHODS: An informal review of the growing demand for mental health economics (and how that demand has been expressed), and how economists have responded. RESULTS: Five historical development phases characterize this growth. Initially, the dominant feature is innocence or neglect of scarcity. Cost measures are rarely calculated, cost-effectiveness is not part of the decision-making lexicon and the potential for inefficiency is huge. In the second phase, innocence turns to criticism of attempts to introduce resource rationality, and many clinicians actively reject economics. Health is seen as priceless, and not to be compromised by the pursuit of efficiency. After a period of reluctance there follows impetuosity as the need for economic insights is recognized, but the search for data is desperate and undiscriminating. Poor quality research is conducted, with the risk that decisions are misinformed and perhaps damaging. Once again, resources are inappropriately used. Next follows the constructive development phase: previous mistakes are appreciated and the standards of evaluation improve markedly. Studies are better designed, more likely to be integrated into clinical or policy evaluations, carefully conducted and sensibly interpreted. Inefficiency should be reduced, along with inequity. Finally, there is perhaps a nirvana-like fifth phase in which sophisticated economic studies are widely undertaken, where systematic reviews and meta-analyses help to reveal the wider picture and where findings are readily available to clinicians, managers and providers. Whether such a stage is attainable is open to question. DISCUSSION: Although the number and sophistication of economic evaluations have both increased noticeably over recent years, there remain imbalances. There is little economics evidence on care arrangements or treatments for dementia, most of the neuroses and the disorders of childhood and adolescence. There are many fewer good evaluations of psychological interventions than of drug treatments. Geographically, few economic evaluations are conducted outside Western Europe, North America or Australasia. IMPLICATIONS FOR DECISION-MAKERS AND RESEARCH: Many challenges consequently face the next generation of mental health economics evaluations, both for research economists and for those health care decision-makers who find themselves increasingly having to draw on economics evidence. One challenge is to be fully aware that the information that economists can currently offer may fall short of what decision-makers need. The gap between the two must be fully appreciated. Building more comprehensive pictures of the cost and outcome consequences of different care policies and treatment interventions is one way to bridge this gap. At the same time a sense of perspective must be maintained and promoted. For example, there is growing concern across the world about the high prices of new drugs, yet drug acquisition costs usually represent only a small proportion of total costs. Decisions sometimes appear to be disproportionately focused on small parts of the overall mental health care picture. A similar tendency prompts another challenge, which is to undertake and interpret research so as to overcome, or at least not to exacerbate, the boundary problems that characterize the multi-service, multi-agency reality of many mental health care systems. The adequacy of short-term evaluations - which dominate our field - must be questioned in light of the chronicity of many mental health problems, and of their externality effects (including inter-generational transmission of problems). Although funding will always be a problem, longer-term evidence is needed. So, too, is research that looks at the reasons for inter-individual cost and outcome variations. Economic evaluations should also pay more attention to equity as well as efficiency as a criterion of improved resource allocation. Finally, more economic data should be gathered alongside and not after clinical data, particularly as economic assumptions often appear to drive key practice and policy changes.

Journal Article↗
PubMedDate not supplied

Equity shortfalls & failure of the welfare state: community willingness to pay for health care at government facilities in Jehlum (Pakistan).

BACKGROUND: The question of willingness to pay is very crucial in planning for services. In Pakistan, the long-term issues of sustainability of health systems particularly, allocation of finances have routinely been addressed by planners with insufficient data and unclear goals. This study was conducted with the objectives to determine the demand for health care services in the community; at first level care facilities and community level and determine the willingness of the community (Willingness to pay) to participate in cost sharing mechanisms for provision of primary health care in fee for service and prepayment mechanisms. METHODS: A cross sectional stratified household interview survey of 600 households was carried out in urban and rural areas of district Jehlum, to address the financial sustainability of government health care interventions at the community level and to explore the question of willingness to pay for health care and their ability to participate in the cost sharing mechanisms. RESULTS: In response to willingness to pay at a Government facility to obtain health care 437 (72.7%) of the households expressed their willingness to pay for health care. In 72% of the cases, cost was not considered as a barrier in seeking care and only 19% of the cases considered cost as a partial barrier; the rest said that cost prohibited seeking care. A majority across all strata is willing to pay for consultation and medicines at public sector facilities, although the responses from the low income groups exhibit a slight decrease in the willingness to pay. The willingness to pay is marginally affected by income, place of residence and/or cost of the treatment incurred. CONCLUSION: The findings of this study suggest that the community is willing to pay for health care at the public sector facilities if payment can ensure provision of essential curative services and medications at improved quality levels.

Adolescent↗
PubMed2005

How equitable is the scaling up of HIV service provision in South Africa?

OBJECTIVES: To assess the extent of inequalities in availability and utilisation of HIV services across South Africa. DESIGN: Cross-sectional descriptive study. SETTING: Three districts reflecting different socio-economic conditions, but with similar levels of HIV infection, were purposively sampled. OUTCOME MEASURES: Availability and utilisation of HIV services and management and support structures for programmes were assessed through the collection of secondary data supplemented by site visits. RESULTS: There were marked inequalities in service delivery between the three sites. Compared with two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing (100% v. 52% and 24% respectively), better uptake of this service (59 v. 9 and 5.5 clients per 1000 adults respectively) and greater distribution of condoms (15.6 v. 8.2 condoms per adult male per year). Extra counsellors had also been employed at the urban site in contrast to the other 2 sites. The urban site also had far more intensive management support and monitoring, with 1 manager per 12 health facilities compared with 1 manager per more than 90 health facilities at the other 2 sites. CONCLUSION: The process of scaling up of HIV services seems to be accentuating inequalities. The urban site in this study was better able to utilise the extra resources. In contrast, the poorer sites have thus far been unable to scale up the response to HIV even with the availability of extra resources. Unless policy makers pay more attention to equity, efficacious interventions may prove to be of limited effectiveness.

Adult↗
PubMed2004

Is combination therapy for malaria based on user-fees worthwhile and equitable to consumers? Assessment of costs and willingness to pay in Southeast Nigeria.

OBJECTIVES: To examine the equity implications of the costs of an episode of malaria, the benefit/cost ratios of using two artemisinin-based combination therapy (CT) from the consumers' view and inequities in willingness to pay (WTP) for CT. METHODS: A cross-sectional survey was conducted in Southeast Nigeria, where there is a moderate to high level of malaria resistance to chloroquine and sulfadoxine-pyrimethamine formulations. WTP was elicited from respondents using the bidding game (BG) and the structured haggling technique (SH). A socio-economic status (SES) index was used to examine the level of inequity in the key variables. In the benefit/cost ratios, the average cost of CT in Nigeria and price of Coartem were, respectively, used as the cost inputs while the mean WTP was the measure of benefit. Multiple regression analyses were used to determine the validity of the WTP estimates. RESULTS: More than 90% of the respondents were willing to pay for CT. The mean WTP in the BG was 301.1 Naira while it was 438.0 Naira in the SH. People in the highest SES quartile (Q4) were more willing to pay for CT than the lowest SES quartile (Q1). In the regression models, the SES quartiles were significantly related to levels of WTP. The benefit/cost ratios were higher in the SH group, and the ratio was only more than 1 using Coartem in only the SH group. The Q1 groups had the least benefit cost-ratios but the trend of SES differentials in benefit/cost ratios were not statistically significant in the BG group but was in the SH group. CONCLUSION: CT based on user-fees may not be worthwhile and equitable because there are economic and equity constraints to its wide-scale use. Benefit/cost ratios depend on the type of questions that were used to elicit WTP. Governments and donors should be willing to commit funds to make CT affordable to the poor consumers for the intervention to be used to significantly reduce the burden of malaria.

Antimalarials↗
PubMed2002

Tobacco, taxation, and fairness.

The author defends himself against an attack by Smith and Bopp on his views on smoking and taxation. The theory that, on the grounds of equity and/or fairness, smokers should pay via taxation on tobacco for the health care costs of treating smoking-related medical conditions is discussed and shown to be defective. It is argued that the fundamental mistake that Smith and Bopp make is to confuse and conflate the separate issues of whether particular taxes are fair and whether they are justifiable. The conclusion is reached that an excise duty on tobacco is a good tax. It is a non-fair or even an unfair tax but it is justified on grounds other than fairness.

Health Care Costs↗
PubMed2006

Inequalities in access to medical care by income in developed countries.

BACKGROUND: Most of the member countries of the Organization for Economic Cooperation and Development (OECD) aim to ensure equitable access to health care. This is often interpreted as requiring that care be available on the basis of need and not willingness or ability to pay. We sought to examine equity in physician utilization in 21 OECD countries for the year 2000. METHODS: Using data from national surveys or from the European Community Household Panel, we extracted the number of visits to a general practitioner or medical specialist over the previous 12 months. Visits were standardized for need differences using age, sex and reported health levels as proxies. We measured inequity in doctor utilization by income using concentration indices of the need-standardized use. RESULTS: We found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland. INTERPRETATION: Although in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered.

Adolescent↗
PubMed2004

Access to health care for all? User fees plus a Health Equity Fund in Sotnikum, Cambodia.

User fees in health services are a source of much debate because of their potential risk of negative effects on access to health care for the poor. A Health Equity Fund that identifies the poor and pays on their behalf may be an alternative to generally ineffective fee exemption policies. This paper presents the experience of such a Health Equity Fund, managed by a local non-governmental organization, in Sotnikum, Cambodia. It describes the results of the first 2 years of operations, investigates the constraints to equitable access to the district hospital and the effects of the Health Equity Fund on these constraints. The Health Equity Fund supported 16% of hospitalized patients. We found four major constraints to access: financial, geographical, informational and intra-household. The results of the study show that the Health Equity Fund effectively improves financial access for the poor, but that the poor continue to face many constraints for timely access. The study also found that the Health Equity Fund as set up in Sotnikum was very cost-effective, with minimal leakage to non-poor. Health Equity Funds managed by a local non-governmental organization seem to constitute a promising channel for donors who want to invest in poverty reduction. However, further research and experimentation are recommended in different contexts and with different set-ups.

Cambodia↗
PubMed1985

Surgonomics: the cost of gastrointestinal hemorrhage, the identifier concept.

The Tax Equity and Fiscal Responsibility Act will pay hospitals a set price for Medicare patients by one of 467 Diagnostic Related Groups (DRGs). The purpose of this study was to examine one DRG and perform indepth financial analysis in order to develop strategies for cost containment. In addition, we tested the hypothesis that an entity called an identifier (here, the presence or absence of transfusions) could be used to group patients within a specific DRG and demonstrate differences in costs. All patients (n = 46) with gastrointestinal hemorrhage under 70 years old without complications and not requiring surgery (DRG 175) treated at the Long Island Jewish-Hillside Medical Center during 1983 had their hospital charges examined. Total charges (hospital charges exclusive of physician fees) were $3891 +/- 2128 (mean +/- SEM)/patient. Patients requiring transfusion (n = 26) had total charges of $4707 +/- 2292, whereas those not requiring transfusion (n = 20) had total charges of $2765 +/- $1300. Findings in this study are: 1) within a given DRG there is a wide variance of hospital charges, 2) identifiers (in this case transfusion) may be used to clinically aggregate patients with similar resource consumption within a DRG, 3) patients receiving transfusion had 170% greater total charges, 165% greater hematology charges, and 526% greater total blood charges than those not receiving transfusion.

Adult↗