scholarly journals Cost-Sharing in Medical Care Can Increase Adult Mortality Risk in Lower-Income Countries

2021 ◽  
Author(s):  
Giancarlo Buitrago ◽  
Grant Miller ◽  
Marcos Vera-Hernández
Keyword(s):  
Medical Care ◽  
Mortality Risk ◽  
Cost Sharing ◽  
Service Use ◽  
National Health System ◽  
Adult Mortality ◽  
Absolute Difference ◽  
Lower Income ◽  
Outpatient Cost ◽  
Lower Income Countries

AbstractPatient cost-sharing in medical care constrains total health spending, presumably with little harm to underlying patient health. This paper re-evaluates the link between cost-sharing and health, studying Colombia’s entire formal sector workforce with individual-level health care utilization records linked to payroll data and vital statistics. Given discrete breaks in outpatient cost-sharing imposed at multiple income thresholds by Colombia’s national health system, we use a regression discontinuity design and find that outpatient cost-sharing reduces use of outpatient care, resulting in fewer diagnoses of common chronic diseases and increasing subsequent emergency room visits and hospitalizations. Ultimately, these effects measurably increase mortality, and disproportionately so among the poor – raising the absolute difference in 7-year mortality risk by 0.80 and 0.23 deaths per 1,000 individuals at lower- and higher-income thresholds, respectively. To the best of our knowledge, this study is the first to show a relationship between cost-sharing and adult mortality risk in lower-income countries, a relationship important to incorporate into social welfare analyses of cost-sharing policies.One Sentence SummaryOutpatient cost-sharing in medical care discourages use – but over time, also increases costly hospital service use and raises mortality risk.

Who or what is a development manager?

1998 ◽  
Vol 17 (1) ◽  
pp. 63-68
Author(s):  
Ron Clarke
Keyword(s):  
Social Development ◽  
Management Training ◽  
Macro Level ◽  
Lower Income ◽  
Development Management ◽  
Development Policies ◽  
Is Development ◽  
Lower Income Countries ◽  
Development Manager

Although ill-defined, the term “development management” is broadly understood to refer to the management of economic and social development, and the reduction of poverty, at various levels from macro to micro, in lower income countries. “Development management” pre-supposes “development managers”, but this term is even less well defined. Popular perceptions suggest that the concept is less easily applied at the macro level, but more readily at the micro, and also more to someone who is development-minded than someone whose job is to manage or implement development policies and processes, although the two can overlap. This perception – and its implications for management training – is followed through to suggest a profile of a development manager as someone who is forward-thinking, people-oriented, resourceful, flexible in his or her approach to means of achieving objectives, and morally committed.

scholarly journals Impact of Domestic and Transboundary Conflicts on Militarization

2020 ◽  
Vol 1 (1) ◽  
pp. 24-35
Author(s):  
Hafiz Syed Mohsin Abbas ◽  
Xiaodong Xu ◽  
Chunxia Sun ◽  
Saif Ullah ◽  
Muhammad Ahsan Ali Raza
Keyword(s):  
High Income ◽  
Global Perspective ◽  
Fragile States ◽  
Lower Income ◽  
Security Issues ◽  
Military Equipment ◽  
Income Groups ◽  
Global Concern ◽  
Global Peace ◽  
Lower Income Countries

AbstractSecurity issues are the global concern nowadays, which triggers government spending on military equipment and supply chain. This paper analyzes the global perspective of cohesion indicators on Militarization by using 177 countries panel data from the Years 2011-2018 based on middle/lower and high-income groups. By applied OLS and Fixed Effect modelling, we explored the idea that Group Grievance and Population Growth Rate have a significant impact on Militarization in both income groups worldwide. However, middle/lower income group’s Militarization is more fragile than high-income groups due to state cohesion. It further analyses that Security Apparatus and Fractionalization Elite are significant in Middle/ lower-income countries and have an insignificant impact on Militarization in high-income countries. In the end, the study suggested that the United Nations must keenly observe the militarization trends of the less fragile states by considering global peace concerns and should play its role to resolve the bilateral conflicts in the region to maintain world peace environment.

scholarly journals Nutrition and cancer – global and African perspectives: a focused update

2015 ◽  
Vol 74 (4) ◽  
pp. 437-440 ◽  
Author(s):  
Martin J Wiseman
Keyword(s):  
Physical Inactivity ◽  
Preventive Measures ◽  
Great Majority ◽  
Developed Countries ◽  
Excess Body Weight ◽  
Lower Income ◽  
The World ◽  
Nutritional Transition ◽  
High Level ◽  
Lower Income Countries

The burden of cancer worldwide is predicted to almost double by 2030 to nearly 23 million cases annually. The great majority of this increase is expected to occur in less economically developed countries, where access to expensive medical, surgical and radiotherapeutic interventions is likely to be limited to a small proportion of the population. This emphasises the need for preventive measures, as outlined in the declaration from the United Nations 2011 High Level Meeting on Non-communicable Diseases. The rise in incidence is proposed to follow from increasing numbers of people reaching middle and older ages, together with increasing urbanisation of the population with a nutritional transition from traditional diets to a more globalised ‘Western’ pattern, with a decrease in physical activity. This is also expected to effect a change in the pattern of cancers from a predominantly smoking and infection dominated one, to a smoking and obesity dominated one. The World Cancer Research Fund estimates that about a quarter to a third of the commonest cancers are attributable to excess body weight, physical inactivity and poor diet, making this the most common cause of cancers after smoking. These cancers are potentially preventable, but knowledge of the causes of cancer has not led to effective policies to prevent the export of a ‘Western’ pattern of cancers in lower income countries such as many in Africa.

scholarly journals Age-specific and sex-specific adult mortality risk in India in 2014: analysis of 0·27 million nationally surveyed deaths and demographic estimates from 597 districts

2015 ◽  
Vol 3 (12) ◽  
pp. e767-e775 ◽  
Author(s):  
Usha Ram ◽  
Prabhat Jha ◽  
Patrick Gerland ◽  
Ryan J Hum ◽  
Peter Rodriguez ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Adult Mortality

Associations of DNA Methylation Mortality Risk Markers with Congenital Microcephaly from Zika Virus: A Study of Brazilian Children Less than 4 Years of Age

2021 ◽  
Vol 67 (1) ◽  
Author(s):  
Jamaji C Nwanaji-Enwerem ◽  
Lars Van Der Laan ◽  
Elorm F Avakame ◽  
Kristan A Scott ◽  
Heather H Burris ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Mortality Risk ◽  
Zika Virus ◽  
Clinical Decision Making ◽  
Linear Models ◽  
Adult Mortality ◽  
Plasminogen Activator Inhibitor 1 ◽  
Congenital Microcephaly ◽  
Pai 1 ◽  
Brazilian Children

ABSTRACT Background Zika virus (ZIKV)-associated congenital microcephaly is an important contributor to pediatric death, and more robust pediatric mortality risk metrics are needed to help guide life plans and clinical decision making for these patients. Although common etiologies of pediatric and adult mortality differ, early life health can impact adult outcomes—potentially through DNA methylation. Hence, in this pilot study, we take an early step in identifying pediatric mortality risk metrics by examining associations of ZIKV infection and associated congenital microcephaly with existing adult DNA methylation-based mortality biomarkers: GrimAge and Zhang’s mortality score (ZMS). Methods Mortality measures were calculated from previously published HumanMethylationEPIC BeadChip data from 44 Brazilian children aged 5–40 months (18 with ZIKV-associated microcephaly; 7 normocephalic, exposed to ZIKV in utero; and 19 unexposed controls). We used linear models adjusted for chronological age, sex, methylation batch and white blood cell proportions to evaluate ZIKV and mortality marker relationships. Results We observed significant decreases in GrimAge-component plasminogen activator inhibitor-1 [PAI-1; β = −2453.06 pg/ml, 95% confidence interval (CI) −3652.96, −1253.16, p = 0.0002], and ZMS-site cg14975410 methylation (β = −0.06, 95% CI −0.09, −0.03, p = 0.0003) among children with microcephaly compared to controls. PAI-1 (β = −2448.70 pg/ml, 95% CI −4384.45, −512.95, p = 0.01) and cg14975410 (β = 0.01, 95% CI −0.04, 0.06, p = 0.64) results in comparisons of normocephalic, ZIKV-exposed children to controls were not statistically significant. Conclusion Our results suggest that elements of previously-identified adult epigenetic markers of mortality risk are associated with ZIKV-associated microcephaly, a known contributor to pediatric mortality risk. These findings may provide insights for efforts aimed at developing pediatric mortality markers.

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