scholarly journals Municipal expenditures using own-source revenues and resilience of territorial inequalities in health

2020 ◽  
Vol 29 (4) ◽  
Author(s):  
José Angelo Machado ◽  
Guilherme Quaresma ◽  
Carmem E. Leitão Araújo
Keyword(s):  
Fiscal Federalism ◽  
Health Sector ◽  
National Health System ◽  
Tree Edge ◽  
Edge Removal ◽  
Spatially Distributed ◽  
Dispersion Measures ◽  
Redistributive Effects ◽  
Municipal Health ◽  
Municipal Expenditures

Abstract The objective of this study is to assess the importance of municipal expenses executed with own-source revenues for the maintenance of the territorial inequalities between resources allocated by Brazilian municipalities in the health sector, in spite of the redistributive effects attributed to the vertical transfers of the Brazilian National Health System. The formation of municipal own-source revenues is strongly impacted by regional economic inequalities, corresponding to almost 60% of the resources allocated by municipalities to health in recent years. Based on the Tree Edge Removal method, the total expenditures and those executed with own-source revenues by the municipalities were spatially distributed, thereby enabling identification of clusters from 2005 to 2015 in both cases. Central and dispersion measures were calculated for the two types of expenditure in this interval for the clusters. In the end, we found municipal expenditures with own-source revenues show levels of inequality which are significantly higher than those of the total municipal health expenditure, and even more significant is that these inequalities increase in time with higher intensity in the case of the former. Since municipalities are the main implementers of public health policy, results suggest higher levels of territorial equity will necessarily require adjustments in fiscal federalism in this sector.

scholarly journals Focusing neighborhood context and self-rated health in the Pró-Saúde Study

2018 ◽  
Vol 34 (5) ◽  
Author(s):  
Simone M. Santos ◽  
Guilherme Loureiro Werneck ◽  
Eduardo Faerstein ◽  
Claudia S. Lopes ◽  
Dóra Chor
Keyword(s):  
Neighborhood Context ◽  
Individual Factors ◽  
University Employees ◽  
Self Rated Health ◽  
Tree Edge ◽  
Edge Removal ◽  
Health Related ◽  
The Relationship ◽  
The City ◽  
Level 2

The influence of neighborhood characteristics on self-rated health has been little studied. A multilevel approach using hierarchical models was applied to analyze the relationship between the socioeconomic characteristics in 621 neighborhoods (level 2) in the city of Rio de Janeiro, Brazil, and the self-rated health of 3,054 university employees (level 1) from the baseline of the Pró-Saúde Study. Neighborhoods were created using the SKATER algorithm (Spatial ‘K’luster Analysis by Tree Edge Removal) to cluster census tracts according to four indicators and a minimum population of 5,000 people. After adjustment for individual factors (per capita income, schooling, age, sex, ethnicity, health-related behavior and chronic diseases), low level of neighborhood income and higher numbers of members per household were significantly associated with poor self-rated health. Participants living in medium income-level neighborhoods were 34% more likely to self-rate their health as being poor. Those living in areas with a higher density of members per household were 50% more likely to present poor self-rated health. Neighborhood context influences self-rated health, beyond the effect of individual factors. Worsening neighborhood socioeconomic conditions affect health adversely, which in turn increasing the chance of poor self-rated health.

scholarly journals Exploring the Evolution of Drought Characteristics in Balochistan, Pakistan

2020 ◽  
Vol 10 (3) ◽  
pp. 913 ◽  
Author(s):  
Shoaib Jamro ◽  
Falak Naz Channa ◽  
Ghulam Hussain Dars ◽  
Kamran Ansari ◽  
Nir Y. Krakauer
Keyword(s):  
Climate Change ◽  
Drought Index ◽  
Risk Index ◽  
Trend Test ◽  
Standardized Precipitation Evapotranspiration Index ◽  
Long Duration ◽  
Tree Edge ◽  
Edge Removal ◽  
The 1960S

In the wake of a rapidly changing climate, droughts have intensified, in both duration and severity, across the globe. The Germanwatch long-term Climate Risk Index ranks Pakistan among the top 10 countries most affected by the adverse effects of climate change. Within Pakistan, the province of Balochistan is among the most vulnerable regions due to recurring prolonged droughts, erratic precipitation patterns, and dependence on agriculture and livestock for survival. This study aims to explore how the characteristics of droughts have evolved in the region from 1902–2015 using 3-month and 12-month timescales of a popular drought index, the Standardized Precipitation Evapotranspiration Index (SPEI). The region was divided into six zones using Spatial “K”luster Analysis using Tree Edge Removal (SKATER) method, and run theory was applied to characterize droughts in terms of duration, severity, intensity, and peak. The results of the non-parametric Mann–Kendall trend test applied to SPEI indicate prevailing significant negative trends (dryer conditions) in all the zones. Balochistan experienced its most severe droughts in the 1960s and around 2000. The effects of climate change are also evident in the fact that all the long duration droughts occurred after 1960. Moreover, the number of droughts identified by 3-month SPEI showed a significant increase after 1960 for all six zones. The same trend was found in the 12-month SPEI but for only three zones.

scholarly journals Regionalization and Spatiotemporal Variation of Drought in China Based on Standardized Precipitation Evapotranspiration Index (1961–2013)

2015 ◽  
Vol 2015 ◽  
pp. 1-18 ◽  
Author(s):  
Xiongfei Liu ◽  
Shixin Wang ◽  
Yi Zhou ◽  
Futao Wang ◽  
Wenjun Li ◽  
...  
Keyword(s):  
Southern China ◽  
Central China ◽  
Tibet Plateau ◽  
Severe Drought ◽  
Standardized Precipitation Evapotranspiration Index ◽  
Spatiotemporal Variations ◽  
Drought Duration ◽  
Mk Test ◽  
Tree Edge ◽  
Edge Removal

China is considered to be one of the most drought prone countries. This study is dedicated to analyzing the regionalization and spatiotemporal variations of drought based on the Standardized Precipitation Evapotranspiration Index, which covers the period 1961–2013 across 810 stations in China. Using Spatial “K”luster Analysis by Tree Edge Removal method, China was divided into eight regions: southwest (SW), northeast (NE), north (N), southeast (SE), Yangtze River (YR), northwest (NW), central China (C), and Tibet Plateau (TP). The spatiotemporal variations of drought characteristics indicated that the drought count in NE and C was generally high. Southern China and NW had suffered long drought duration and extreme severity. The MK test results show that stations with significant drying trends mainly locate in SW, N, NW, and C. The severe drought frequency was very high in 1990s and 2000s. Furthermore, more attention should be paid to abnormal less precipitation in summer and abnormal high temperature in spring in SW, NE, N, and C. Besides, abnormal less precipitation is the main factor of drought in SE and YR in whole year. This study is anticipated to support the water resources management, and to promote the realization of environmental protection and agricultural production.

scholarly journals Reflections on Health Management from a Systems Perspective: A Reinterpretation of the Italian National Health System

2021 ◽  
Vol 16 (5) ◽  
pp. 79
Author(s):  
Armando Masucci ◽  
Antonietta Megaro
Keyword(s):  
Health System ◽  
National Health ◽  
Systems Approach ◽  
Health Management ◽  
Health Sector ◽  
National Health System ◽  
Well Being ◽  
Economic Activities ◽  
Viable Systems ◽  
Italian National Health

The provision of health services represents a set of central activities in the social context since, through the offer of prevention, diagnostic, treatment, care and rehabilitation services, they allow the pursuit of the ultimate goal of any health system, the well-being of the population and public health. The considerable relevance of the topic, supported by the ethical-social purposes that the health system ultimately assumes, make it an important field of analysis in business studies in general, and in management in particular, considering the economic activities developed by the many actors involved in the dispensing process. The importance of these activities and their strategic nature make them a highly regulated context, in which over time the reference legislative framework has developed and articulated for the determination of reciprocal relations between the actors, for the regulation of the flow of resources, for the control of medical activities to protect citizens. However, the proliferation of laws and regulations at the various levels of government (community, national and regional) has contributed to increasing the interpretative complexity of the health system. This work proposes the use of the Viable Systems Approach (VSA) for the interpretation and management of complex phenomena in the health sector, concerning the Italian National Health System (NHS). The deepening of the implications arising from the analysis enables the VSA as a useful approach to the advancement of research in health management, through the understanding of complexity, stimulating the observer with analysis methodologies capable of better understanding the health context under exam.

scholarly journals Application of modified Spatial K’luster Analysis by Tree Edge Removal Method (SKATER) on the level of Crime data in Way Kanan district, Lampung

CAUCHY ◽  
2017 ◽  
Vol 4 (4) ◽  
pp. 155
Author(s):  
Kadek Yama Rinaldi
Keyword(s):  
Spatial Autocorrelation ◽  
Spatial Patterns ◽  
Crime Rate ◽  
Minimum Spanning Tree ◽  
Spatial Clustering ◽  
Theory Approach ◽  
Tree Edge ◽  
Edge Removal ◽  
Specific Object ◽  
Relationship Of

<p>Modification of method Spatial K'luster Analysis by Tree Edge Removal (SKATER) is one of the regionalization method for clustering based on the location by spatial autocorrelation and spatial patterns. This method uses graph theory approach to identify the homogeneous location is the minimum spanning tree. In addition to clustering objects based on similarity characteristics, in everyday life, often found that there are significant spatial clustering that affect specific object. This study was conducted to determine the relationship of the crime rate between districts in Way Kanan, Lampung. Based on these results, the characteristics of the crime rate in terms of spoliation, robbery and gambling have spatial autocorrelation and spatial patterns. Further applied modifications of SKATER. Generate 4 cluster (k) graded of the 14 districts. on average k<sub>1 </sub>(17.67% )  k<sub>2</sub> (10.09%)   k<sub>3</sub> (7.80%)  k<sub>4</sub> (4.28%).</p>

scholarly journals Health, development, and institutional factors: The Mozambique case

2020 ◽  
Author(s):  
Paulo Ivo Garrido
Keyword(s):  
National Health ◽  
Health Sector ◽  
National Health System ◽  
The Elderly ◽  
Health Needs ◽  
The Social ◽  
The Disabled ◽  
Health Institutions ◽  
The Republic ◽  
The Impact

The central aim of this text is to show the impact institutions have on the performance of the health sector in Mozambique. The text shows that of the social determinants of health, institutions play a central role in the performance of the Mozambican health sector—and, through it, economic and social development—particularly for the poorer and more vulnerable, such as children, women, the disabled, and the elderly. It is also argued that the deficiencies and inefficiencies of the operation of the health sector in Mozambique are largely the result of the fact that the institutions with influence on the health sector are controlled by a minority of privileged people who do not give the appropriate priority to the basic health needs of the majority of the population. Finally, it is argued that the most important institutional measures for improving the state of health of Mozambicans are the revision of the Constitution of the Republic, the strengthening of the National Health System (particularly the National Health Service), and the reduction of poverty and economic and social inequality.

scholarly journals Positive impacts of Covid-19 pandemic to strengthen National Health Defense

2021 ◽  
Vol 24 ◽  
pp. 562-570
Author(s):  
Widyati Widyati ◽  
I Dewa Ketut Kerta Widana
Keyword(s):  
Public Health ◽  
National Health ◽  
Medical Devices ◽  
Raw Materials ◽  
Health Sector ◽  
National Health System ◽  
Healthcare Sector ◽  
National Defense ◽  
Medical And Healthcare ◽  
Positive Impacts

During the past one and a half year, we all have faced the COVID-19 pandemic. In national defense perspective, COVID-19 Pandemic could be viewed as a non-military threat to national defense. The COVID-19 pandemic is a wake-up call that improves our awareness on the necessity to be fully independent and self-sufficient in health sector. So far, we have been complacent with the ease of importing raw materials for medicines and medical devices. Thus, the advent of the COVID-19 pandemic has made us aware to reduce Indonesia’s high dependence on import of health and medicine goods. Despite of the losses and prolonged sadness brought by the COVID-19 pandemic, there are also positive impacts for this nation as the result of the COVID-19 pandemic. One of the impacts on the National Health System is the strengthening and involvement of all levels of society and the apparatus in dealing with COVID-19 pandemic, which can be seen in the prevention, detection, and orderly response to COVID-19. Adjustment of public health service capacity is also carried out very swiftly to respond the pandemic situation. Another indicator is seen in the financing of medical and healthcare sector that was able to rapidly finding sources of funding for a very sharp increase in public health needs. Meanwhile, Human Resources capacity development appears to be very prominent as seen from the rapid improvement of training and research in medical and healthcare competences. No less important is the pharmaceuticals and medical devices sectors that are more determined to improve their independence and self-sufficiency in terms of drugs and vaccines raw materials. Independent raw materials provision for drugs and vaccines has an important value in the national economy and strengthening national security in the public health sector.

scholarly journals Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

2020 ◽  
Author(s):  
Sarah C Masefield ◽  
Alan Msosa ◽  
Jean Grugel
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Health System ◽  
National Health ◽  
Low Income ◽  
Service Providers ◽  
Health Sector ◽  
National Health System ◽  
Low Income Countries ◽  
Health Coverage

Abstract BackgroundAll countries face challenging decisions about healthcare coverage. Malawi has committed to achieving Universal Health Coverage (UHC) by 2030, the timeframe set out by the Sustainable Development Goals (SDGs). As in other low income countries, scarce resources stand in the way of more equitable health access and quality in Malawi. Its health sector is highly dependent on donor contributions, and recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve more effective cooperation with stakeholders. This study explores health sector stakeholders’ perceptions of the challenges to improving governance in Malawi’s national health system within the post-2017 context of government attempts to articulate a way forward.MethodsA qualitative study design was used. Interviews were conducted with 22 representatives of major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. Content relating to healthcare governance was identified in the transcripts and field notes and analysed using inductive content analysis.ResultsStakeholders view governance challenges as a significant barrier to achieving a more effective and equitable health system. Three categories were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).ConclusionsHealth sector stakeholders see serious political, structural, and financial challenges to improving governance in the national health system in Malawi which will impact the government’s goal of achieving UHC by 2030. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the policy documents, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC. The difficulties stakeholders perceive in relation to building equitable and effective healthcare governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

scholarly journals Implementing Federalism in the Health System of Nepal: Opportunities and Challenges

2018 ◽  
Vol 8 (4) ◽  
pp. 195-198 ◽  
Author(s):  
Rajshree Thapa ◽  
Kiran Bam ◽  
Pravin Tiwari ◽  
Tirtha Kumar Sinha ◽  
Sagar Dahal
Keyword(s):  
Health System ◽  
Local Governments ◽  
Health Sector ◽  
National Health System ◽  
Health Needs ◽  
Federal System ◽  
National Healthcare ◽  
Speed Up ◽  
Local Healthcare ◽  
Improve Health

Nepal moved from unitary system with a three-level federal system of government. As federalism accelerates, the national health system can also speed up its own decentralization process, reduce disparities in access, and improve health outcomes. The turn towards federalism creates several potential opportunities for the national healthcare system. This is because decision making has been devolved to the federal, provincial and local governments, and so they can make decisions that are more representative of their localised health needs. The major challenge during the transition phase is to ensure that there are uninterrupted supplies of medical commodities and services. This requires scaling up the ability of local bodies to manage drug procurement and general logistics and adequate human resource in local healthcare centres. This article documents the efforts made so far in context of health sector federalization and synthesizes the progress and challenges to date and potential ways forward. This paper is written at a time while it is critical to review the federalism initiatives and develop way forward. As Nepal progress towards the federalized health system, we propose that the challenges inherent with the transition are critically analysed and mitigated while unfolding the potential of federal health system.

The Growth of Health Spending in the United States From 1776 to 2026

2019 ◽  
Author(s):  
Thomas E. Getzen
Keyword(s):  
United States ◽  
National Health ◽  
Health Sector ◽  
National Health System ◽  
Health Spending ◽  
Health Financing ◽  
The United States ◽  
Medical Spending ◽  
Rural And Urban ◽  
Long Run

During the 18th and 19th centuries, medical spending in the United States rose slowly, on average about .25% faster than gross domestic product (GDP), and varied widely between rural and urban regions. Accumulating scientific advances caused spending to accelerate by 1910. From 1930 to 1955, rapid per-capita income growth accommodated major medical expansion while keeping the health share of GDP almost constant. During the 1950s and 1960s, prosperity and investment in research, the workforce, and hospitals caused a rapid surge in spending and consolidated a truly national health system. Excess growth rates (above GDP growth) were above +5% per year from 1966 to 1970, which would have doubled the health-sector share in fifteen years had it not moderated, falling under +3% in the 1980s, +2% in 1990s, and +1.5% since 2005. The question of when national health expenditure growth can be brought into line with GDP and made sustainable for the long run is still open. A review of historical data over three centuries forces confrontation with issues regarding what to include and how long events continue to effect national health accounting and policy. Empirical analysis at a national scale over multiple decades fails to support a position that many of the commonly discussed variables (obesity, aging, mortality rates, coinsurance) do cause significant shifts in expenditure trends. What does become clear is that there are long and variable lags before macroeconomic and technological events affect spending: three to six years for business cycles and multiple decades for major recessions, scientific discoveries, and organizational change. Health-financing mechanisms, such as employer-based health insurance, Medicare, and the Affordable Care Act (Obamacare) are seen to be both cause and effect, taking years to develop and affecting spending for decades to come.

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