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PubMed2006

Using focus groups to develop contingent valuation scenarios--a case study of women's groups in rural Nepal.

The construction of a contingent valuation (CV) scenario forms a critical component of willingness-to-pay (WTP) survey design, especially when working across diverse cultural and socio-economic settings. However, the methods used to develop CV scenarios have not been well reported in the health economics literature. This paper begins by describing how qualitative methods can be used to develop CV surveys. It then presents a case study illustrating how focus groups were used to develop a CV survey to value a women's group intervention in rural Nepal. A series of focus group discussions were conducted with three stakeholder groups. These were used to determine the most appropriate description of the good to be valued and the means by which payment would be elicited. These methods were very helpful in designing the survey tool and choosing the key attributes to describe the intervention. They also familiarised field workers with the concept of WTP. Further work of this kind will help to highlight additional advantages and limitations of qualitative approaches to survey design.

Data Collection↗
PubMed2002

New large solar photocatalytic plant: set-up and preliminary results.

A European industrial consortium called SOLARDETOX has been created as the result of an EC-DGXII BRITE-EURAM-III-financed project on solar photocatalytic detoxification of water. The project objective was to develop a simple, efficient and commercially competitive water-treatment technology, based on compound parabolic collectors (CPCs) solar collectors and TiO2 photocatalysis, to make possible easy design and installation. The design, set-up and preliminary results of the main project deliverable, the first European industrial solar detoxification treatment plant, is presented. This plant has been designed for the batch treatment of 2 m3 of water with a 100 m2 collector-aperture area and aqueous aerated suspensions of polycrystalline TiO2 irradiated by sunlight. Fully automatic control reduces operation and maintenance manpower. Plant behaviour has been compared (using dichloroacetic acid and cyanide at 50 mg l(-1) initial concentration as model compounds) with the small CPC pilot plants installed at the Plataforma Solar de Almería several years ago. The first results with high-content cyanide (1 g l(-1)) waste water are presented and plant treatment capacity is calculated.

Automation↗
PubMed2005

A costs analysis of dental treatment for ectodermal dysplasia.

OVERVIEW: Dental treatment modalities for ectodermal dysplasia (ED) vary markedly depending on the clinical manifestations, but to date there have been no studies exploring the potential economic impact of ED. On the basis of anecdotal and clinical reports, the authors postulate that costs of dental treatment for this condition can have a substantial financial impact on patients and their families. OBJECTIVE: The purpose of the authors' pilot study was to develop an economic model for various treatment modalities for ED with severe hypodontia. METHODS: The authors first used a comprehensive review of the literature and expert consensus to establish a treatment modalities model for ED. Next, they completed chart reviews to validate the model with sample treatment and costs information. Using these data, they then constructed a model of treatment options and associated costs. RESULTS: The sample included 24 patients with ED who had severe hypodontia. Forty-two percent were female; patients' ages ranged from 4 years, 11 months to 31 years, 1 month. Forty-two percent had dental insurance coverage, while more than one-half paid for services out of pocket. An estimated 84 percent had undergone prosthodontic treatment, 37 percent orthodontic treatment and 19 percent implant surgery. Depending on the age of the patient and types of dental treatment, there was a broad variation in costs. This ranged from $2,038 to $3,298 for those who had received prosthodontic treatment only; it ranged from $12,632 to $41,146 for those who had received a combination of prosthodontic, orthodontic and implant treatment. CONCLUSIONS: Dental treatment for ED had a marked financial impact on patients and their families and varied depending on the type and duration of treatment.

Adolescent↗
PubMed1999

Willingness to pay for periodontal therapy: development and testing of an instrument.

OBJECTIVES: The objective of this study was to develop and test the feasibility and validity of a willingness to pay (WTP) tool in a dental setting. METHODS: A questionnaire measured individuals' preferences among alternative treatments for periodontal disease and the maximum they would be willing to pay for their treatment of choice in terms of dental insurance premiums. The questionnaire provides detailed information, in probabilistic terms, of the risks and benefits of treatment choices for moderate to advanced adult periodontitis. It was pilot tested on 23 periodontal patients and 18 dental school faculty and staff. RESULTS: The majority (92.6%) felt the questionnaire was an accurate representation of treatments and outcomes, establishing face and content validity. In terms of construct validity, four hypotheses were tested: (1) manipulation of the outcomes of the preferred treatment led to a predictable shift in preferences for 38 subjects (92.7%); (2) although periodontal patients were not more likely to choose periodontal surgery than nonpatients (P = .14), those with a history of surgery were more likely to choose surgery again (P = .06); (3) WTP was positively related to income level (P = .05); and (4) subjects were willing to pay more for coverage for themselves than for others. Periodontal surgery was the preferred treatment for moderate to advanced periodontal disease, and was more strongly preferred than other choices (i.e., a higher WTP) for all income groups. The intraclass correlation coefficient for treatment preferences was 0.95 (P < .001) and the kappa for WTP was 0.78 (P < .001). CONCLUSION: This pilot study supports some of the criteria concerning validity of the WTP questionnaire to measure preferences for alternative periodontal therapies. Further testing on larger samples is required to confirm these results.

Adult↗
PubMed2004

Incomplete and biased perpetrator coding among hospitalized assaults for women in the United States.

BACKGROUND: Since 1997, hospital discharge data have included external cause of injury (E codes) for designating perpetrator relationship in assaults. For intentional injuries, guidelines require using two E codes; one for the injury mechanism and another (E967.n) identifying perpetrator relationship. Completeness and characteristics of the use of these codes have not been studied on a multistate level among states with complete E coding. METHODS: Hospital discharge data for 1997 were solicited from states with good E coding completeness. Data were received from 19 states (51.9% of women in the United States, ages 15-49). For assaulted women, a regression model was constructed to identify factors associated with perpetrator code assignment using age, payment source, pregnancy status, race, and severity as covariates. RESULTS: Among 137 887 injured hospitalized women age 15-49, there were 7402 assaults (5.4%). Among all assaults to women, perpetrator coding was poor (8.8%). Among those that were perpetrator coded, 83.7% were spouse/partner related. Age was positively associated with probability of having a perpetrator code (p<0.001). Those paid by a private source were 42.9% more likely to have a perpetrator code (p = 0.007). Pregnant women were seven times more likely to have a perpetrator code (p<0.001). Non-white women were 66.8% less likely to have a perpetrator code (p<0.001) than white women. CONCLUSIONS: The poor use of perpetrator codes in hospital discharge data minimizes their usefulness for surveillance of serious injury from intimate partner violence. An implication of this research is the need to understand the gaps and strengthen the completeness of perpetrator documentation and coding. The findings suggest caution when interpreting the results from existing hospital discharge data based intimate partner violence surveillance systems.

Adolescent↗
PubMed2004

Benefit plan design and prescription drug utilization among asthmatics: do patient copayments matter?

The ratio of controller-to-reliever medication use has been proposed as a measure of treatment quality for asthma patients. In this study we examine the effects of plan-level mean out-of-pocket asthma medication patient copayments and other features of benefit plan design on the use of controller medications alone, controller and reliever medications (combination therapy), and reliever medications alone. The 1995--2000 MarketScan claims data were used to construct plan-level out-of-pocket copayment and physician/practice prescriber preference variables for asthma medications. Separate multinomial logit models were estimated for patients in fee-for-service (FFS) and non-FFS plans relating benefit plan design features, physician/practice prescribing preferences, patient demographics, patient comorbidities, and county-level income variables to patient-level asthma treatment patterns. We find that the controller-to-reliever ratio rose steadily over 1995--2000, along with out-of-pocket payments for asthma medications, which rose more for controllers than for relievers. After controlling for other variables, however, plan-level mean out-of-pocket copayments were not found to have a statistically significant influence on patient-level asthma treatment patterns. On the other hand, physician/practice prescribing patterns strongly influenced patient-level treatment patterns. There is no strong statistical evidence that higher levels of out-of-pocket copayments for prescription drugs influence asthma treatment patterns. However, physician/practice prescribing preferences influence patient treatment.

Adult↗
PubMed1998

Gastroenterology research in the United Kingdom: funding sources and impact.

AIMS: To determine the sources of founding for UK gastroenterology research papers and the relative impact of papers funded by different groups and of unfunded ones. METHODS: UK gastroenterology papers from 1988-94 were selectively retrieved from the Science Citation Index by means of a specially constructed filter based on their title keywords and journal names. They were looked up in libraries to determine their funding sources and these, together with their numbers of authors, numbers of addresses, and research category (clinical/basic) were considered as input parameters to the research. Output parameters analysed were mean journal impact category, citation counts by papers, and the frequency of citation by a US patient. RESULTS: Gastroenterology papers comprise about 7% of all UK biomedical research and 46% of them have no acknowledged funding source. One quarter of the papers acknowledged government support, and a similar fraction a private, non-profit source; 11% were funded by the pharmaceutical industry. The papers acknowledging funding had significantly more impact than the others on all three measures. The citing patents had six times more UK inventors than the average for all US Patent and Trademark Office patents in the relevant classes and were mostly generic in application. CONCLUSION: The variation in impact of papers funded by different sources can mostly be explained by a simple model based on the input factors (numbers of funding bodies, numbers of authors, numbers of addresses, and research type). The national science base in gastroenterology is important for the underpinning of UK invented patents citing to it.

Financing, Organized↗
PubMed1983

Government revamp of the health care system: effect on patient care and research.

Since the end of World War II, the United States has been in a golden age of medicine. Unprecedented advances in biomedical research have resulted in a fundamental understanding of many disease processes; pharmaceutical research and development has produced a host of new therapeutic agents; and new technology has opened new vistas in the areas of diagnosis and therapeutics. This new knowledge has been translated into the health care delivery system. The federal government made the crucial decision that new hospital construction and increased bed capacity were needed to upgrade medical care in the modern, high-technology era. Another crucial decision made by the government was that health care was a fundamental right of all its citizens, and access to the health care system for the elderly, poor, and middle class had to be assured. This decision was culminated by the enactment of the entitlement programs of Medicare and Medicaid in 1965. These policies helped to decrease the mortality rate of our population by 1.5 percent per year. Our elderly citizens are healthier as a group and living longer. During the past decade strains on the economy secondary to the inflationary spiral produced by the Arab Oil Embargo and the huge budget deficits of the Reagan Administration have led to broad-based efforts to decrease spending on health care. A complex system of cost limits has been initiated, including a prospective reimbursement system for Medicare and Medicaid based on diagnostic-related groups. This system will force hospitals to shift from direct medical care to ambulatory, lower-cost services, making it costlier and more difficult for individuals, particularly the poor, elderly, and middle class, to have access to the health care system.

Cost Control↗
PubMed1978

The scope and limits of equality as a normative guide to federal health care policy.

In American political culture, as in much of Western political thought, the proposition that men are and ought to be treated as equal in the eyes of polity, law, and society is highly valued. Whether traditional arguments for equality can be properly extrapolated from the political and social spheres to a third sphere--the distribution of resources and services under public welfare state policies--is another question, rarely explored with care. In one of these policy areas, health care, the notion that each citizen is entitled by right to equal access to medical care has grown very popular. Federal programs that equalize access among groups by means of biomedical research, hospital construction and renovation, and financial aid for the elderly and poor have dominated federal health care policy since the end of the Second World War. Empirical consideration of the nature of medical care services, the structure of the health care system, and the consequences of programs to equalize access suggests, however, that public expectations and federal policy may have placed more weight on the principle of equality than it can properly bear. In recent years policy analysts have begun to insist that the equal access issue be viewed in the context of the national cost of medical services relative to that of other social goods, the cost effectiveness of medical services, and the degree to which health and illness result from behavior in an individual's power to pursue or avoid. Attracted by the new revisionist thinking, but unwilling to follow its arguments to their logical policy implications, federal policy makers have institutionalized their ambivalence. The mainstream equalizing programs continue to receive strong support, but they are now challenged by another set of federal programs based largely on revisionist premises. This seemingly inconsistent policy solution is probably the most rational approach to preserving the claims of equality of medical care services, while assigning the principle of equality an appropriately delimited scope.

Federal Government↗
PubMedDate not supplied

[An analysis of the pharmaceuticals market in Vietnam].

This article sheds a light on the Vietnamese pharmaceutical market. The progress that has been made in the recent years following the opening of the Vietnamese regime to the western world, although not easy, brought a certain number of opportunities for domestic firms and foreign investors. The pharmaceutical Vietnamese industry started to emerge at the beginning of the 1990s. Although, the consumption of drugs is low, it does reach the sum of $ 5.5 per capita. As the majority of these products are imported, foreign companies tend to dominate the market both in volume and in diversity. The state has always played an important role with the implementation of a strict price control strategy and most national drug companies remain state-owned. The production and consumption of drugs were also largely influenced by state policies as the latter also control hospitals. In the second half of the eighties, the progressive liberalisation of the country allowed private drug pharmacies to appear and advertisement campaigns became legal. Because the lack of specific products like antibiotics was clear, the government increased the flow of imports, including private imports by citizens. Sources of imports have become more diverse, although France remains an important source of supply. Fournier, Lipha and Pierre Fabre are among the French drug manufacturers located in Vietnam. Other foreign companies include from India, South Korea, Thailand and Germany. Joint ventures were also created with French and Japanese companies. The import of medical materials is subjected to authorisations from the Ministry of Health and the Ministry of Foreign Trade as it is necessary to obtain a licence to do so. Licences are issued on the basis of the production of drugs that do not currently exist on the local market. But Vietnam also exports pharmaceutical products to Laos, Cambodia, and Cuba. Local resources constitute an important source of new products and have stirred a strong interest among pharmaceutical researchers. A strong decentralisation process characterises the pharmaceutical sector, with pharmacies in the provinces and districts while wholesalers remain located in Hanoi and Saigon. The presence of many middlemen has contributed to an increase in prices. Today, a concentration of pharmacies is still noted in inner cities while the suburbs and the villages still have difficulties supplying drugs for inhabitants. Solutions have been implemented such as the opening of new pharmacies and additional professional training for pharmacists. Prices were lowered while the quality of the supply chain was improved. Local production is encouraged as hospitals are prompted to prescribe Vietnamese products. The modernisation of the Vietnamese pharmaceutical industry is also visible through the importation of medical materials and an increase in the number of private hospitals financed with both the help of local and foreign investors, mainly through joint-ventures, most often in Saigon and Hanoi. The renovation of local hospitals was also possible with the help of France and Japan. Columbia Gia Dinh International, located in Saigon, is one of the very few US/Vietnamese medical institutions created with a local partner, the Gia Dinh hospital. The recovery of the economy will accelerate the creation of new projects designed to improve local medical infrastructures. Other private companies, some of which are based in Singapore, have been specifically designed to deliver care to expatriates working in Vietnam. Insurance coverage has been provided in Vietnam since in 1992. Other improvements concern the implementation of "Good Manufacturing Practices" (GMP) and "Good Laboratory Practices" and "Good Storage Practices". Most norms were implemented at the end of the 90s in joint companies linking foreign investors and local partners or in independent foreign drug manufacturers based in Vietnam. Special areas were created to receive high tech investments in the medical and pharmaceutical field. Prices should diminish as competition on the market increases and new products are placed on the market to achieve economies of scale. But investment in medical research is still strongly needed.

Advertising↗
PubMed1996

Effects of the growth of managed care on academic medical centers and graduate medical education.

The author offers insights into how the proliferation of competitive health care financing and service delivery systems based on managed care affects the financial support available to academic medical centers (AMCs), especially to their programs in graduate medical education (GME). The paper is based largely on case studies of AMCs conducted by the author in the summer of 1994 in the health care markets of San Diego, California, Minneapolis-St. Paul, Minnesota, and Washington, D.C., complemented by a review of the literature. In sum, the investigator found consensus among all parties that in the current market, managed care plans neither are willing nor feel able to pay much, if any, premium for the services of AMCs, particularly when established, respected alternatives exist, as they typically do for most services in major urban markets. Relatively few short-term adverse effects on AMCs were found from the growth of competitive systems, but AMCs are nevertheless very concerned that managed care will put them at a disadvantage. They are thus seeking ways to position themselves for the future. The AMCs are concerned that at some point, the cost reductions they are making will hinder the fulfillment of their unique traditional mission, since they believe that the costs of their GME programs can be reduced only so far without harming residents' training. Many managed care plans, however, question the AMC mission, taking issue particularly with the training AMCs provide and its relevance to current needs for primary and ambulatory care. The investigators also found considerable support for pooled funding for GME among diverse parties, but no consensus on how this funding should be structured, who should receive it, or what it should support. Potential conflicts were also identified between national, state, and market objectives for provider supply and specialty distribution because these objectives can embody different criteria for assessing the handling and locations of specialists' training. In addition, the findings indicate that it could be unwise to consider AMC policy independent of workforce objectives; doing so could create conflicts about the kinds of physicians who should be trained. The author concludes with a list of approaches to future research that may be constructive.

Academic Medical Centers↗
PubMedDate not supplied

Willingness to pay: a valid and reliable measure of health state preference?

The development of methods to measure willingness to pay (WTP) has renewed interest in cost-benefit analysis (CBA) for the economic evaluation of health care programs. The authors studied the construct validity and test-retest reliability of WTP as a measure of health state preferences in a survey of 102 persons (mean age 62 years; 54% male) who had chronic lung disease (forced expiratory volume < 70%). Interview measurements included self-reported symptoms, the oxygen-cost diagram for dyspnea, Short-Form 36 for general health status, rating scale and standard gamble for value and utility of current health state relative to death and healthy lung functioning, and WTP for a hypothetical intervention offering a 99% chance of healthy lung functioning and a 1% chance of death. WTP was elicited by a simple bidding game. To test for starting-point bias, the respondents were randomly assigned to one of five starting bids. All health status and preference measurements except WTP (controlling for income) showed significant (p < 0.05) difference between disease-severity groups (mild/moderate/severe). WTP was significantly (p = 0.01) associated with household income, but other health status and preference measure were not. The measure most highly correlated with WTP was standard gamble (r = -0.46). There was no association between starting bid and mean WTP adjusted for income and health status. The test-retest reliability of WTP was acceptable (r = 0.66) but lower than that for the standard gamble (r = 0.82).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Children and the elderly: divergent paths for America's dependents.

Let me summarize briefly. My argument is that we have made a set of private and public choices that have dramatically altered the age profile of well-being. These choices are in an important sense joint ones involving the number of dependents we have as well as the conditions in which they live. This jointness derives from several sources. One is that the same institution--the conjugal family--remains the principal agent responsible for both childbearing and childrearing. Factors that influence the health of that institution invariably affect both numbers of and conditions for children. There was simply no way to protect children fully from the earthquake that shuddered through the American family in the past 20 years. The factors at work here are not only the objective conditions we face but also the set of values and mental constructs we elect to face them with. At the other end of the age scale, we can obviously affect the number of elderly persons as well as their circumstances by altering health programs, as we have so decisively chosen to do. A final source of jointness is that numbers themselves affect conditions. Some of these effects are largely inadvertent, as I've argued in regard to public schooling, and others seem to be very deliberate outcomes of the political process. It's useful to step back and ask whether the mixture of numbers and conditions that we've chosen is the one that best serves us. In regard to redistributions from the working-age population to the elderly, the answer is far from obvious. There is surely something to be said for a system in which things get better as we pass through life rather than worse. The great levelling off of age curves of psychological distress, suicide and income in the past two decades might simply reflect the fact that we have decided in some fundamental sense that we don't want to face futures that become continually bleaker. But let's be clear that the transfers from the working-age population to the elderly are also transfers away from children, since the working ages bear far more responsibility for childrearing than do the elderly. And let's also recognize that the sums involved are huge. Just the increase in federal expenditures on the elderly between 1977 and 1983, if distributed among the population under age 15, would come to well over $2,000 per child.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2002

FGF-4 gene therapy GENERX--Collateral Therapeutics.

Collateral Therapeutics and Schering AG in Germany are developing a gene therapy product, GENERX for coronary artery disease. Based on the terms of the agreement, Schering or its affliates will be responsible for conducting and financing phase II/III clinical trials which are currently underway in the US and Europe. In particular, Berlex Labs (the US subsidiary of Schering AG), is involved in developing the gene therapy in the US. GENERX is an angiogenic gene therapy which triggers the production of a protein that stimulates new blood vessel growth providing an alternative route for blood to bypass clogged and blocked arteries in the heart. GENERX involves a one-time, non-surgical delivery of an adenovirus vector containing the human fibroblast growth factor-4 (FGF-4) into coronary arteries via a standard catheter. The FGF-4 gene was licensed from New York University. Collateral Therapeutics has been granted a US patent for "gene transfer-mediated angiogenesis therapy" for the nonsurgical administration of angiogenic genes for coronary and peripheral vascular disease. The patented technology has been licensed from the University of California. Collateral and Berlex have initiated pivotal phase IIb/III trials with GENERX in the US and Europe. The US-based study will evaluate the safety and efficacy of GENERX in patients with stable exertional angina due to coronary artery disease. The European-based study will evaluate patients with advanced coronary artery disease who are not considered candidates for interventions such as angioplasty and bypass surgery and/or patients who are unlikely to have positive outcomes from such interventions. Both studies, of a multicentre, randomised, double-blind and placebo-controlled design, will evaluate 2 dose levels of GENERX which will be non-surgically administered to the heart via intracoronary infusion through a standard cardiac catheter. Collateral also plans to develop a non-surgical gene therapy product using the FGF-4 gene for the treatment of patients with heart failure. In a blinded placebo-controlled study in a pig model of pacing-induced heart failure, intracoronary delivery of human FGF-4 expressed in an adenovirus vector showed significant improvement in regional cardiac function and a reduction in the size of the heart over a 3-week study period. If these results translated favourably to humans, FGF-4 gene therapy may be a therapeutic option for patients with dilated heart failure. Collateral Therapeutics has also announced a research collaboration with Targeted Genetics on the use of viral vectors to deliver therapeutic genes in cardiovascular disease. Under the terms of the agreement, Targeted Genetics and Collateral Therapeutics each have the option to collaborate further to use Targeted Genetics' recombinant adeno-associated viral vector to treat congestive heart failure. In such an event, Targeted Genetics would be responsible for constructing and manufacturing the vector, and Collateral Therapeutics will fund the costs of future collaboration. Either party may terminate this agreement at any time upon 30 days prior written notice.

Adenoviridae↗
PubMed2004

The effect of two ammonia-emission-reducing pig housing systems on odour emission.

Odour nuisance from agricultural activities is increasing in densely populated countries like the Netherlands. To develop adequate regulations, a large-scale, government-financed monitoring programme was started in the mid-1990s to establish odour emission levels for both conventional and low ammonia emission housing systems for cattle, pigs and poultry. The results indicate that high- and low-odour emission housing are difficult to distinguish because of the large variation within housing systems. Measurements on different farm locations within the same housing system show both a large variation between locations and within one location (in time). The latter, however, is significantly smaller, which suggests that farm management is an important determinant in odour emission that interferes with the effects of housing systems. The current research was aimed at determining the effect of two common ammonia-reducing pig-housing systems on odour emissions compared to conventional housing systems under similar management conditions. The respective reduction principles of these systems are reducing the emitting surface of the manure pit and cooling of manure in the manure pit (both pits beneath slatted floor). Five farms that combined conventional housing with one low-ammonia system (three reduced emitting surface and two manure cooling) were selected for a direct, pair-wise comparison of (olfactometric) odour emission measurements. The results show a highly significant effect (p < 0.01) for two of the three reduced emitting surface systems and for one of the two manure cooling system. The average odour reduction percentages of these systems are 35% (from 24.9 to 16.0 OUE/s per animal) and 23% (from 30.1 to 24.0 OUE/s per animal) respectively. Although odour emission reduction through the type of housing system is possible, management factors interact with the system and thereby determine whether the system reduces odour emission or not.

Air Pollutants↗
PubMed2006

Oral health care in Canada--a view from the trenches.

PURPOSE: Concern is increasing over the effect of lack of access to oral health care on the oral health, and hence general health, of disadvantaged groups. In preparation for a national symposium on this issue, key informants across Canada were canvassed for their perceptions of oral health services and their recommendations for improving oral health care delivery. This paper reports the results of that survey. METHOD: A questionnaire was constructed to address problems facing agencies with responsibility for meeting the oral health care needs of people receiving government assistance, the underhoused and the working poor. The survey was sent to 200 agencies, government and professional organizations. Data from the returned questionnaires were entered into a Statistical Package for the Social Sciences database and analyzed. Responses from Ontario were compared with those from the rest of Canada, those from government organizations were compared with others and results were examined by cultural nature of clients and by type of organization. RESULTS: In assessing the positive aspects of oral health care, 84% of respondents agreed that public programs were useful and 81% felt that dentists offer good care. However, 77% disagreed that preventive care is accessible and that access to dentists and dental specialists is easy. More Ontarians than others thought that there are few alternative settings for care delivery (95% vs. 83%) and that the poor feel unwelcome in dental offices (83% vs. 70%). The issues most commonly identified were the need for alternative delivery sites, such as community health centres where service delivery could be affordable, accountable and sustainable; the need for oral health to be recognized as part of general health; regulatory issues (e.g., expanding practice opportunities for non-dentist oral health care providers and removing restrictions on other dental health professionals in providing basic care to the financially challenged); and training. DISCUSSION: The survey helped to identify access and care issues across the country. There was considerable agreement that lack of access to dental care services is an important detriment to the oral and general health of many Canadians. Respondents believe that dental health is isolated from general health.

Canada↗
PubMed1998

Algorithms for resource allocation of substance abuse prevention funds based on social indicators: a case study on state of Florida--Part 3.

The purpose of Part 3 is to develop an algorithm for an equitable distribution of state prevention funds to its substate jurisdictions based on the need for prevention services. In this series, the need for prevention services is measured in terms of the existing social indicators observed at the county level. In order to establish a conceptual link as well as the empirical relevance of the selected social indicators as proxy measurements of the estimated need for prevention at the county level, we have employed both concurrent and construct validity tests using the following three constructs as the criterion variables in a multiple regressing setting: 1) county-based composite drug use index score (COMDRUG) measured via the statewide drug survey; 2) county-based proportions of prevention target populations using the conceptual definition advanced by the Institute of Medicine (IOM); and 3) the composite risk factor score (COMRISK) assembled from a list of twenty-two risk and protective factors observed for each county. These constructs were identified previously in Parts 1 and 2. While employing eight social indicators to estimate the overall prevention needs observed at the county level, the social indicators thus selected were able to explain 69 percent of the variations in COMDRUG, 68 percent of the variation in the proportions of students in need of prevention services using IOM definition, and 60 percent of the variation in COMRISK. Following successful validations of the social indicators as viable media with which to estimate county-based prevention needs, the ensuing multiple regression equation is, then, used to build a resource allocation model by determining the proportion of each county's share of the total statewide COMDRUG-predicted from the social indicators and, then, by weighting the latter proportion by the population size of each county under age eighteen. In this way, we have devised county-based Prevention Needs Index (PNI) scores based solely on social indicators. Finally, the county's share of PNI score is computed as a proportion of to the total statewide PNI score. Following this line of algorithm for resource allocation, we were able to develop yet another resource allocation model solely based on social indicators without the benefits of survey data. Comparing the funding results originating from four resource allocation models (i.e., COMDRUG, IOM Definition, COMRISK, and Social Indicators), it has been learned that there is a remarkable similarity from one funding level to another. Since all four schedules of county-based prevention funding levels have shown very high intercorrelations with a range from .9862 to .9993, it has been determined that these schedules are measuring essentially either the same domain or latent domains that are functionally equivalent to one another. Accordingly, no preference is made among the resource allocation models suggested, although it is suggested that the final decision on the level of funding must be based on the selection of the schedule for resource allocation rather than the suggested amount or level of funding computed for each county.

Algorithms↗
PubMed1999

Government funding of the UK National Health Service: what does the historical record reveal?

OBJECTIVES: To examine the historic funding record of the UK National Health Service (NHS) by year (1948-1997), political administration and political party. METHODS: Construction of a deflated expenditure series between 1948 and 1997 from published sources of cash spending for each UK country and by four main NHS budget heads using extrapolated NHS-specific inflation measures for each budget head. Analysis of the resultant real funding record for the UK NHS by year, political administration, political party and pre-general election years. RESULTS: A historical funding record constructed from a number of official sources appears to show noticeable differences in volume levels of government spending on the NHS in the UK between political administrations and between political parties. All administrations (apart from the 1951-1955 Churchill/Eden government) have increased funds to the NHS over and above the level of NHS-specific inflation during their periods of office. Labour administrations have increased average annual real percentage funding by around 3.75% compared with an average increase of 2.33% for Conservative administrations. It does not appear that incumbent governments spend more than the long-run trend in pre-election (or, indeed, election) years. The economic difficulties of the mid 1970s (primarily the oil price shocks) appear to have realigned NHS spending at a lower level compared with spending rates in the 1950s, 1960s and early 1970s. Between 1950 and 1997, NHS cash spending as a percentage of gross domestic product increased by around 0.06% per year, with decreases in this proportion in 25 out of the 48 years examined. A comparatively crude analysis of changes in productive efficiency in the hospital and community health services sector between 1951 and 1991 suggests that there is no significant relationship between financial inputs (adjusted for NHS-specific inflation) and outputs (discharges and deaths). One explanation is that the NHS copes (at unknown cost) in times of financial stringency, but, conversely, does not systematically respond (at least, not in terms of increased output) in times of financial plenty. In policy terms, a very tentative interpretation of these findings would be that improvements in productivity can be brought about by restricting financial inputs and at the same time applying managerial pressure to the NHS to at least maintain (or improve) output levels (through, for example, improvements in medical practice). CONCLUSIONS: As a guide to voting, this analysis may confirm some prejudices. However, judging the performance of political administrations in relation to the NHS is rather more complex than a macro analysis of financial inputs alone suggests. The apparently weak relationship between inputs and outputs and the possible ability of governments to increase productivity by restricting inputs (and hence partially to deflect criticism of their funding policy) perhaps confirms other prejudices about the productive slack of large organisations. Again, however, care should be taken in the interpretation of the macro analysis, since the potential costs (e.g. reduced quality) arising from parsimonious funding are not captured by the global output measure used in this analysis.

Data Collection↗