Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Financing, Construction”

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 937 records · Page 52Linked to original sources
PubMed2001

Child care in Slovenia: an example of a successful transition.

Slovenia is a country which has managed to retain most of its advantages and achievements in preschool child care attained in the socialist period, while, during the transition years, rather successfully reforming services according to principles of the market economy. The female activity rate has been high since the mid 1940s, and female employment has been the main factor influencing the demand for preschool child care services. Slovenian mothers work full-time and after 1 year of paid maternity and parental leave they mostly stay in the labour market. Child care facilities, 70% of them constructed in the period 1971-1985, are sufficient for almost 60% of the preschool population, and just a very small percentage of demand remains unmet. Child care services are traditionally highly subsidised. On average, parents finance up to a quarter of the current costs, so that the average in-kind transfer for a child in child care amounts to about 30% of the average net salary. Social assistance recipients are exempt from paying fees altogether, while the rest of the parents pay from 15% to 80% of the current costs. The highest fee is paid by families with a per capita income > 110% of the average salary in Slovenia. Research into the burden of parental fees for child care in Ljubljana in 1994 has shown that three-quarters of families spent between 5 and 15% of their total net income on child care (for one or more children). For three-quarters of families, the total of fees paid did not exceed 30% of their net income per family member. The lower middle income group was relatively most burdened by child care fees.

Child Day Care Centers↗
PubMed1997

Undercontribution bias in health care spending account decisions.

Results from this work describe 239 responses to a mailed survey regarding employee benefits decisions at a large eastern university. The primary objective of this work is to test for an undercontribution bias in health care financing decisions. The results establish the existence of an undercontribution bias in both actual employee decisions and hypothetical flexible spending account contribution decisions. We describe this bias within the context of related biases including loss aversion, mental accounting, status quo and omission biases. Surprisingly, we find a significant order effect in this study and posit that preference construction in this context is an active, reference-dependent process. In addition, results from this work demonstrate the endogenous nature of health care flexible spending account expenditures. The results have important implications both for the descriptive framework of and the normative solution to the flexible spending account contribution decision.

Community Participation↗
PubMed1995

Cost-effective facility parking strategies.

For many healthcare facilities, increasing use of outpatient services has resulted in a greater demand for parking space. Consequently, parking structure costs have become a more important capital budget item than in previous years. Financial managers need to understand the parameters of parking costs for their facilities and their capital financing options, including off-balance sheet leaseback arrangements.

Budgets↗
PubMed2000

Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa.

BACKGROUND: Despite growing international pressure to provide HIV-1 treatment to less-developed countries, potential demographic and epidemiological impacts have yet to be characterised. We modelled the future impact of antiretroviral use in South Africa from 2000 to 2005. METHODS: We produced a population projection model that assumed zero antiretroviral use to estimate the future demographic impacts of the HIV-1 epidemic. We also constructed four antiretroviral-adjusted scenarios to estimate the potential effect of antiretroviral use. We modelled total drug cost, cost per life-year gained, and the proportion of per-person health-care expenditure required to finance antiretroviral treatment in each scenario. FINDINGS: With no antiretroviral use between 2000 and 2005, there will be about 276,000 cumulative HIV-1-positive births, 2,302,000 cumulative new AIDS cases, and the life expectancy at birth will be 46.6 years by 2005. By contrast, 110,000 HIV-1-positive births could be prevented by short-course antiretroviral prophylaxis, as well as a decline of up to 1 year of life expectancy. The direct drug costs of universal coverage for this intervention would be US$54 million--less than 0.001% of the per-person health-care expenditure. In comparison, triple-combination treatment for 25% of the HIV-1-positive population could prevent a 3.1-year decline in life expectancy and more than 430,000 incident AIDS cases. The drug costs of this intervention would, however, be more than $19 billion at present prices, and would require 12.5% of the country's per-person health-care expenditure. INTERPRETATION: Although there are barriers to widespread HIV-1 treatment, limited use of antiretrovirals could have an immediate and substantial impact on South Africa's AIDS epidemic.

Africa South of the Sahara↗
PubMed2006

Natural disasters and the challenge of extreme events: risk management from an insurance perspective.

Loss statistics for natural disasters demonstrate, also after correction for inflation, a dramatic increase of the loss burden since 1950. This increase is driven by a concentration of population and values in urban areas, the development of highly exposed coastal and valley regions, the complexity of modern societies and technologies and probably, also by the beginning consequences of global warming. This process will continue unless remedial action will be taken. Managing the risk from natural disasters starts with identification of the hazards. The next step is the evaluation of the risk, where risk is a function of hazard, exposed values or human lives and the vulnerability of the exposed objects. Probabilistic computer models have been developed for the proper assessment of risks since the late 1980s. The final steps are controlling and financing future losses. Natural disaster insurance plays a key role in this context, but also private parties and governments have to share a part of the risk. A main responsibility of governments is to formulate regulations for building construction and land use. The insurance sector and the state have to act together in order to create incentives for building and business owners to take loss prevention measures. A further challenge for the insurance sector is to transfer a portion of the risk to the capital markets, and to serve better the needs of the poor. Catastrophe bonds and microinsurance are the answer to such challenges. The mechanisms described above have been developed to cope with well-known disasters like earthquakes, windstorms and floods. They can be applied, in principle, also to less well investigated and less frequent extreme disasters: submarine slides, great volcanic eruptions, meteorite impacts and tsunamis which may arise from all these hazards. But there is an urgent need to improve the state of knowledge on these more exotic hazards in order to reduce the high uncertainty in actual risk evaluation to an acceptable level. Due to the rarity of such extreme events, specific risk prevention measures are hardly justified with exception of attempts to divert earth-orbit crossing meteorites from their dangerous path. For the industry it is particularly important to achieve full transparency as regards covered and non-covered risks and to define in a systematic manner the limits of insurability for super-disasters.

Disaster Planning↗
PubMed2004

TOSCA-Imaging--developing Internet based image processing software for screening and diagnosis of diabetic retinopathy.

The primary aim of TOSCA-Imaging, which was a part of the TOSCA Project financed by EU's Fifth Framework IST Programme, was to develop Internet based software and image data bases for screening and diagnosis of diabetic retinopathy and implementing it into a real life situation. The work consisted of: 1) Construction of an Internet based communication platform for transmitting and analyzing retinal images. 2) Implementation of routines for detecting the first microaneurysm (transition from normal to pathologic), detecting patients needing referral for treatment (presence of venous beading or hard exudates near the fovea), and for serial analysis (image alignment). 3) Construction of a reference image data base. A preliminary validation showed that decisions that depended on a precise detection of individual lesions, e.g. the detection of normality, had a sensitivity and specificity of around 80%, whereas decisions that depended on the detection of lesion patterns, e.g. clinically significant macular oedema, had a sensitivity and specificity of more than 95%. Validation of the reference image data base by double grading by two expert graders suggested a sensitivity and a specificity of just below 90% for any lesion and of more than 95% for predicting the overall retinopathy grade. TOSCA-Imaging has succeeded in its primary aim of developing Internet based software and implementing it into a real life situation, integrating work within image processing done in four different European countries (England, Germany, Ireland, and Denmark) to be accessed from one Internet web site.

Algorithms↗
PubMed1997

[Equity in the Brazilian Health Care System: a contribution for debate]

In this article it is discussed some relevant issues in regard to inequalities in the consumption of health care services and the construction of more equitable health care system in Brazil. The concept of inequalities in health is distinguished from the concept of inequalities in the consumption of health care services. It is argued that the geographical dimension of health care service consumption differs from the social dimension. This implies that a better distribution of financial resources between geographical regions acts at the level of regional inequalities but might not have a positive impact on existing social inequalities. A more equitable system depends on a greater participation on the financing of the system of the richer people. It depends on the solidarity of the different social groups in society. The present situation of great scarcity of financial resources calls for a definition of priorities. Nonetheless, it is argued that the establishment of priorities in the availability of health care services is an ethical approach only if it is assumed to be a transient strategy directed to the construction of a system based in universal access for all those in need.

Journal Article↗
PubMed2004

Medical aspects of the National Centre For Oncological Hadrontherapy (CNAO-Centro Nazionale Adroterapia Oncologica) in Italy.

More than 20 hadrontherapy centres are active in the world and about 40,000 patients have been treated, almost 4000 with ions. Physical selectivity and high relative biologic efficiency (RBE) represent the rationale for using ions in the treatment of tumours. The clinical results are very promising and justify the construction of new centres. We present the main characteristics of CNAO (Centro Nazionale Adroterapia Oncologica) and its possible integration in a nationwide network. The Italian project started in 1991 thanks to the activity of the TERA Foundation and was financed by the Italian Government in 2002. The CNAO will be built in Pavia to start clinical activity in 2007. The equipment will include a synchrotron and 3 treatment rooms mainly devoted to carbon ions but able to deliver also protons. The Centre should be able to deliver up to 20,000 fractions / year. The realization of CNAO is part of a more ambitious project to set up an integrated national network. The need of hadrontherapy centres is defined by epidemiological studies based on Italian tumour registries showing that almost 900 patients can be electively treated with protontherapy and about 10,000 could be included in clinical trials. Considering that ions could be used for radioresistant tumours that affect about 25,000 new patients/year, we estimate that 10-15%, i.e. 3000-4000 patients would benefit from ion therapy. The realization of a nationwide network possibly linked to a larger European network will be very helpful in making available hadrontherapy for a large part of the population.

Carbon↗
PubMedDate not supplied

Youth performing arts entertainment-education for HIV/AIDS prevention and health promotion: practice and research.

Entertainment-education approaches to health promotion and disease prevention are a popular method for many interventions that target adolescents and young adults. This article documents how this approach is used to educate and influence young people about HIV/AIDS, other sexually transmitted diseases (STDs), and other health issues in the United States. A review of the literature is followed by a two-phase descriptive study of American youth performing arts entertainment-education programs. First, a quantitative survey was conducted among youth performing arts participants who were attending a national conference on the subject. This was followed by a qualitative survey among adult and youth conference attendees from established HIV/AIDS prevention youth performing arts programs. These two approaches provided detailed insight into the characteristics, approaches, and frameworks used to create, implement, and evaluate these entertainment-education efforts. Nine domains that define the effects and effectiveness of youth HIV prevention entertainment-education interventions are identified and described, including those related to performances, intervention management, and audiences. Given the importance of evaluation for the success and effectiveness of intervention programs, these domains are used to construct a framework for entertainment-education research and evaluation efforts.

Adolescent↗
PubMed1976

The token economy in the National Health Service: possibilities and limitations.

The effects after 1 year of the introduction of a token economy system into a long-term male psychiatric ward of 45 mainly schizophrenic patients are described. The main objectives were (1) to define the limits of such programmes in "average" National Health Service conditions, where additional resources in staff, finance, and facilities are very limited and (2) to introduce the principles and techniques of behaviour modification to nursing staff. The programme succeeded in reducing social withdrawal and apathy and in increasing self-care skills and involvement in constructive activity. There was no change in the level of socially embarrassing behaviour. The major limitation affecting the maintenance of the programme was found to be the rapid turnover and unpredictable changes in nursing staff. It was concluded that such programmes are feasible with very little in the way of increased resources, and that such efforts will continue to be necessary in view of the existing large numbers of long-tern patients and the slow but significant accumulation of new patients.

Adult↗
PubMedDate not supplied

Market reforms in health care and sustainability of the welfare state: lessons from Sweden.

Reforming health care systems which are predominantly publicly provided and financed has usually been motivated as a way of increasing efficiency even if it seldom is explicit whether it is in the official sense related to individual utility or in the unofficial sense related to health outcomes. In the case of Sweden the welfare state has been made politically sustainable through a construction where cash benefits and service provision are tailored to satisfy not only the basic needs but even the more discriminating needs of the middle classes. Their loyalty with the taxes is politically crucial and therefore their evaluation of the services in the welfarist sense equally important. That loyalty was however threatened in a situation where cost-containment policies were applied while equity principles were still a strong priority. Health care utilization was increasing among the very old and chronically ill while it was decreasing for other groups. The reforms introduced in some counties during the 1990s have been focussing on a purchaser-provider split and fee-for-service payment of providers. They have increased productivity sharply, increased utilization even among the groups that previously were 'pressed out' and reduced waiting lists. Increased efficiency however, threatens equity in some specific aspects. Fee-for-service payment means increased production and so far even increased costs. If they are to be met with increased private financing, rather than with present tax financing, it will bring the risk of inequities. Payment of hospitals through DRG systems means payment to providers for medical interventions with no incentives to deal with social consequences of illness. Inequities in health care can be related to the way health care deals with inequalities in health due to inequalities in living conditions or inequalities in living conditions due to ill health. In the short perspective the reforms may threaten equity in the second aspect, in the longer perspective the problems of cost control and the pressure it raises for alternative financial sources may be a more serious risk even for the former.

Efficiency, Organizational↗
PubMed2006

Getting on the soapbox: views of an innovator in consumer-directed care.

Consumer-directed health care (CDHC) is often thought of solely as a demand-side solution to the health care cost crisis. One could argue that CDHC is a financing and service revolution that seeks to develop more-efficient financial services products with consumer information to bring about market-based changes in the U.S. health care system. Developing a balanced review of CDHC's potential will help construct future implementations of consumer-directed products and services and advance policy recommendations that improve the cost and quality of health care services.

Consumer Behavior↗
PubMed2001

Practice autonomy among primary care physician assistants: the predictive abilities of selected practice attributes.

The practice autonomy of primary care physician assistants (PAs) is of interest to those organizing, financing, and delivering health services. This study examined the predictive abilities of practice attributes with respect to multidimensional aspects of practice autonomy (clinical decision making and prescriptive authority) in primary care PAs. A sample of 225 practicing PAs was used to construct the 16-item Physician Assistant Autonomy of Practice Instrument (PAAPI), which includes three subscales, routine prescriptive authority, advanced prescriptive authority, and clinical decision making. All were used as dependent variables in multiple regression analyses. The most significant correlates of practice autonomy included years in practice as a PA, years in practice with supervising physician, annual income from practice, recognition as the exclusive primary care provider for patients, primary practice in a rural county, and primary employment setting (single-specialty group practice). More primary care PAs continue to be used in under-served rural areas and in managed care. Organizational structure of the work setting may influence these PAs' practice autonomy.

Adult↗
PubMed1996

Beyond the orthodox: heresy in medicine and the social sciences from a cross-cultural perspective.

An analysis of the concepts of orthodoxy and heresy with due consideration to the social context (historical, religious, cross-cultural dimensions), within which the terms are discussed, leads us to look historically at its European significance embodied in the witch-craze of the 15th-17th centuries. One way to conceptualize heresy is to analyze it in the context of the relationship of the scientists and scientific theories vis-á-vis societal establishment (ie. power bases such as governments, finance bases, public consensus). Today, unorthodoxy lies in attempts to accomplish interdisciplinary work, or in proposing alternative explanatory strategies (as in alternative medicine). A shift in scientific paradigms seems to characterize the revolutionary changes of our era. The foremost challenge in the construction of new paradigms seems to be the ability to effectively integrate the components of emotion or feelings taking into account both those of the researcher as well as those who are being investigated. This will involve a new conceptualization of objectivity. In an era which is distinguished by globalization, such a task necessitates a new level of understanding that integrates gender related analysis as well as the implications of the recognition of cross-cultural interaction and cultural diversity.

Christianity↗
PubMed1981

The burden on the family of a psychiatric patient: development of an interview schedule.

This paper describes the construction of a semi-structured interview schedule to assess the burden placed on families of psychiatric patients living in the community. The Indian population studied found their sick relatives most burdensome in respect of the effect of the illness on family finances, the disruption of normal family activities and the production of stress symptoms in family members other than the patient. The inter-investigator reliability of the interview schedule proved to be high.

Activities of Daily Living↗
PubMed2005

Functional competency and cognitive ability in mild Alzheimer's disease: relationship between ADL assessed by a relative/ carer-rated scale and neuropsychological performance.

BACKGROUND: Alzheimer's disease (AD) is characterized by multiple cognitive deficits and affects functional competency to perform daily activities (ADL). As this may contribute to the patient's overall disability, it is important to identify factors that compromise competency. OBJECTIVE: The relationship between different cognitive domains and functional activities in AD was studied. METHODS: The functional competency of 73 Japanese AD patients, most with mild dementia, was assessed using a 27-item relative/carer-rating scale covering 7 ADL: managing finances, using transportation, taking precautions, self-care, housekeeping, communication and taking medicine. Cognitive assessment used 16 neuropsychological tests from the Japanese version of the WAIS-R and COGNISTAT, covering 9 cognitive domains: orientation, attention, episodic memory, semantic memory, language, visuoperceptual and construction abilities, computational ability, abstract thinking, and psychomotor speed. RESULTS: Multiple regression analysis by the stepwise method indicated that functional competency could, for the most part, be predicted from test scores for orientation, abstract thinking and psychomotor speed. DISCUSSION: The results of this study suggest that impairment of these three cognitive domains plays an important role in the functional deterioration of AD.

Activities of Daily Living↗