Health Equity: 08/22/12

Wednesday, August 22, 2012

[EQ] Bayesian probabilistic population projections for all countries

Bayesian probabilistic population projections for all countries

Adrian E. Rafterya,1, Nan Lib, Hana Ševčíkovác, Patrick Gerlandb, and Gerhard K. Heiligb

aDepartments of Statistics and Sociology, University of Washington, Seattle, WA bPopulation Division, Department of Economic and Social Affairs, 2, United Nations, New York,; and cCenter for Statistics and the Social Sciences, University of Washington, Seattle, WA

Proceedings of the National Academy of Sciences of the United States of America

PNAS Early Edition August 20, 2012

Available online at: http://bit.ly/MJ3faF

Supporting information data also available online .

"……Projections of countries' future populations, broken down by age and sex, are widely used for planning and research. They are mostly done deterministically, but there is a widespread need for probabilistic projections. We propose a Bayesian method for probabilistic population projections for all countries. The total fertility rate and female and male life expectancies at birth are projected probabilistically using Bayesian hierarchical models estimated via Markov chain Monte Carlo using United Nations population data for all countries.

These are then converted to age-specific rates and combined with a cohort component projection model.

This yields probabilistic projections of any population quantity of interest. The method is illustrated for five countries of different demographic stages, continents and sizes. The method is validated by an out of sample experiment in which data from 1950–1990 are used for estimation, and applied to predict 1990–2010.

The method appears reasonably accurate and well calibrated for this period. The results suggest that the current United Nations high and low variants greatly underestimate uncertainty about the number of oldest old from about 2050 and that they underestimate uncertainty for high fertility countries and overstate uncertainty for countries that have completed the demographic transition and whose fertility has started to recover towards replacement level, mostly in Europe….."

KMC/2012/HSD
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[EQ] Action Plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases

Action Plan for implementation of the European Strategy for the
Prevention and Control of Noncommunicable Diseases
2012−2016

World Health Organization WHO Regional Office for Europe

Copenhagen, Denmark – 2012

Available online PDF [33p.] at: http://bit.ly/NgJxo5

"…………..No less than 86% of deaths and 77% of the disease burden in the WHO European Region are caused by noncommunicable diseases. Investing in prevention and better control of this broad group of disorders will reduce premature death and preventable morbidity and disability, improve the quality of life and well-being of people and societies, and help reduce the growing health inequalities they cause.

With attention to noncommunicable diseases reaching unprecedented levels worldwide, this action plan was adopted in September 2011. It identifies priority action areas and interventions for countries to focus on over the next five years (2012–2016), as they implement the European Strategy for the Prevention and Control of Noncommunicable Diseases…………"

Content:

Mandate

Epidemiological context

Why an action plan, and why now?

Rationale and guiding principles

Scope

Linkages

Capitalizing on common features

Mental disorders

Violence and injury

Infectious diseases

Environment and health

Vision, goal and objectives

Organizing principles for the Action Plan

Priority action areas

Governance for NCD, including building alliances and networks, and fostering citizen

empowerment

Strengthening surveillance, monitoring and evaluation, and research

Promoting health and preventing disease

Reorienting health services further towards prevention and care of chronic diseases

Priority interventions

Promoting healthy consumption via fiscal and marketing policies

Replacement of trans fats in food with polyunsaturated fats

Salt reduction

Cardio-metabolic risk assessment and management

Early detection of cancer

Supporting interventions

Promoting active mobility

Promoting health in settings

References

Relevant WHO strategies, action plans, resolutions and ministerial conference declarations

Annex 1. Examples of existing NCD surveillance systems

Annex 2. Resolution EUR/RC61/R3 on the Action Plan for implementation of the European Strategy

for the Prevention and Control of Noncommunicable Diseases 2012−2016

KMC/2012/HSD
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[EQ] An Alternative Framework for Analyzing Financial Protection in Health

An Alternative Framework for Analyzing Financial Protection in Health

Jennifer Prah Ruger argues for a more multidemensional assessment of financial protection in health,
which can better capture health expenditures and the full burden of health cost burdens

Yale Schools of Medicine and Public Health, New Haven, Connecticut, United States of America

PLoS Med 9(8): e1001294. doi:10.1371/journal.pmed.1001294

Published: August 21, 2012 at: http://bit.ly/NkzdFC

Summary Points

Inadequate financial protection in health increases people's vulnerability and diminishes well-being, exacerbating inequities and raising moral concerns.

Conventional indicators of financial protection such as catastrophic spending and impoverishing spending are too narrowly conceived and likely to underestimate the adverse effects of insufficient financial protection.

Limitations of conventional indicators include failure to capture cost barriers to access, differences in health care utilization by ability to pay, different degrees of financial protection and coverage, “informal” treatment payments, debt financing of health spending, reduced consumption of other household necessities, as well as indirect costs of illness and coping strategies.

A multidimensional financial protection profile can capture interrelated aspects of health expenditure, such as direct and indirect costs of illness, coping strategies used to meet costs, insurance status and utilization, household consumption patterns, and how health costs affect them.

With the data the profile yields, researchers can further study health costs' effects by poverty or income level and type of health treatment for a fuller, more comprehensive view of health cost burdens and their distribution. …”

“…….Consensus had developed among academic and policy analysts on two primary metrics, catastrophic and impoverishing spending, for financial protection. Both methods use as a measure the percentage of out-of-pocket health spending in households' overall spending. They differ in the way medical spending is deemed problematic: catastrophic spending is above a threshold percentage, while impoverishing spending pushes a household below the poverty line. Both metrics are helpful indicators of the absolute and relative level of household out-of-pocket health care spending and have been employed in multiple studies worldwide.
Our research group conducted a study focusing on a modification of these metrics—the out-of-pocket spending burden ratio using household equivalent income derived from the Organisation for Economic Co-operation and Development (OECD) Equivalence Scale [11].

But the consensus has given way, and critiques of the conventional approach now run wide and deep. Critics include those who are most invested and who have employed these methodologies,and those who argue that estimates of household health expenditures themselves are subject to considerable variability depending on survey design.

This article proposes a multidimensional financial protection profile that offers a more holistic view of health spending, one that goes beyond the level of spending to cover aspects directly related to health care, such as health care access and insurance utilization, and examines broader impacts on current and longer-term household consumption. This multidimensional approach aims to help policy makers understand the larger context of household health spending and make health and social policy adjustments to mitigate damaging effects…..”

KMC/2012/HSS
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and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] DRG-based payments systems in low- and middle-income countries: Implementation experiences and challenges

DRG-based payments systems in low- and middle-income countries:
Implementation experiences and challenges

Inke Mathauer1, Friedrich Wittenbecher2

1 Department of Health Systems Financing, World Health Organization, Switzerland

2 University of Berlin, Germany

HSF Discussion Paper 01-2012, Department of Health Systems Financing, World Health Organization

Available online PDF [55p.] at: http://bit.ly/SSqM70

Objective:

This discussion paper provides an in-depth overview of DRG-based payment systems in low- and middle-income countries.
This fills a research gaps as it is the first in its kind. Evidence is presented of how DRG-based payment systems have been implemented in low- and middle-income countries, and what challenges they face to operate in their institutional environment.
Of equal interest is their institutional design, e.g. the number of groups, type of costing, purchasing arrangements and related thereto the scope of fragmentation, expenditure ceilings and monitoring/review features.

Findings and conclusions:

This overview reveals that DRG-based payment is increasingly applied across the world, with 13 low- and middle-income countries with national DRG-systems in place in Eastern Europe, across Asia and one in the Central American region. 12 other low- and middle-income countries across all regions are in the process of developing and piloting DRGs. Another 9 countries are in the explorative stage.

Patterns emerge with regards to the role of government financing and presence of a public purchaser, the number and scope of DRGs, the choice of DRG variant, the approaches to adapt a DRG variant to a country context, and DRG piloting processes. Challenges relate to the technical complexity of a DRG-based payment system, and more so to wider health financing institutional design issues that are crucial for desirable DRG incentives to become effective.

Several success factors for DRG payment system implementation are identified:
1) mandatory application to the widest range of providers;
2) purchaser capacity
3) regulation relating to balance-billing,
4) inclusion of the private sector in the DRG-based remuneration;
5) piloting and incremental introduction, particularly in larger countries;
6) definition of expenditure ceilings; an
7) instruments to promote provider cooperation and patient acceptance…..”

KMC/2012/HSS
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