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blog30407 | Very sore this morning from SensibleGym yesterday. I will try to glide early, so I can shower and go to the lecture at the art museum. I'm kind of forcing myself to do it, but I imagine I'll enjoy it once I get there. I've become a real hermit the past couple weeks. | blog |
blog30407 | But boy do those calories add up fast. 40 here, 120 there, and all of a sudden you're at 2000. | blog |
blog30407 | Also because whenever I finally see Daisy I want to wear them in victory. So we are making slow but sure progress there. | blog |
blog30407 | Which I think I will, by the end of Month Two. Which will be in two and a half weeks. Also please note that I didn't drink today. | blog |
blog30407 | 1999. Directed by Mike Leigh. A British film about Gilbert and Sullivan and the ups and downs during their creation and production of The Mikado. The sound design is awesome, and as in Victor/Victoria, all musical numbers take place as musical numbers on the stage, not the main characters suddenly bursting into synchronized song. Entertaining. | blog |
blog30407 | Maybe I'm being unrealistic about how few calories I can eat -- when I look at my charts, I'm not eating a large amount of food, they're quite reasonable meals. I can't tell if ending up with close to 2000 calories today is rationalizing and allowing myself to fall off the horse, or if it's simply a realistic give-and-take with any diet. | blog |
blog30407 | It seems to be from the snacking. Morning AND afternoon snacks. | blog |
blog30407 | I should now be approaching the Period, and if I am not mistaken, last month I was quite hungry then. So that might be a normal part of my rhythm; I might need more food the week before. | blog |
blog30407 | I truly hope to get all the priming done today. In a perfect world, we'd get to the tiling also, but I know that is unlikely... | blog |
blog30407 | I expected a whopper total because of the sandwich and pizza, but when I add it up it's actually pretty good. I estimated big on those items, too. | blog |
blog30407 | Doing a little better with water, though not where I should be. Oh wait, now I remember what I did this afternoon -- a little logo project. | blog |
blog30407 | Well, the pistachios are all gone now, so that's not an issue, and I won't buy chocolate almonds any more. Maybe when I've gotten through two months, or reached some sort of goal, then I will have a little reward that includes chocolate. | blog |
blog30407 | Back in the day, 12 was kinda medium. But there's been some size inflation since then, and a 12 now fits someone quite larger. | blog |
blog30407 | Delicious. I had to use the numbers for grouper, tilapia wasn't in the book. I had too big of a portion, 8 ounces uncooked. | blog |
blog30407 | By the end of the day, can I subtract 1001 exercise calories from, say, 1720 eaten calories, for a total of 719 calories today? Or is that cheating or delusional? | blog |
blog30407 | I think my diet can tolerate, and even benefit from, a week off plan, but more than that is iffy, and of course I need to get right back on. Exercise today will be difficult, since I'm short of sleep, but at least I'm eating right again! | blog |
blog30407 | You know, I'd like to look at this as a quest to eat the BEST food, not the LEAST food, but right now I need to go overboard. Maybe that can be the motto for my maintenance, rest-of-my-life diet. | blog |
blog30407 | I want to point out, though, that I have also significantly increased my exercise. I'm not depending solely on dieting to achieve this weight loss. | blog |
blog30407 | I guess I just have to make this my life for now. That's been pretty easy to do since I'm not working, I don't know what it will be like when (hopefully) I'm back on the job. | blog |
blog30407 | 12:08 p.m. I've decided to give myself the day off, to some extent. Not regarding food and exercise, regarding everything else. | blog |
blog30407 | On another subject, Man Bites Dog theater was disappointing. It was comedy improv night, and apparently they are known for drama improv. | blog |
blog30407 | I mean, I want to lose weight. I want to lose. | blog |
blog30407 | 8:30 a.m. I can tell this isn't going to be a wonderful day for me. | blog |
blog30407 | 8:51 a.m. Just finished 20 minutes of TotalGym and lifting small weights. Whew! | blog |
blog30407 | Now I'm ripping down the wallpaper in the guest bathroom. There's still SO much to do before the house is ready to sell. | blog |
blog30407 | Got the floor sanded and primed. So now in an hour or two, I can start laying tiles! | blog |
blog30407 | We got about half of the bad spot cut out of the floor. It's very slow going, that RotoZip tool is not beefy. | blog |
blog30407 | I can't tell how much exercise this was, because although I am sore as hell, it's not the same kind of sore as from weightlifting or gliding. It's more injury-sore than exercise-sore. | blog |
blog30407 | If I eat X amount of calories and maintain my weight, then if I reduce by Y number of calories, I should lose Z number of pounds. No matter what X equals. | blog |
blog30407 | I haven't been able to get a really definite milestone. The Measurement Pants are cursed, and my next session with the measuring tape isn't for another four days. | blog |
blog30407 | This was Daisy's idea - describe your perfect day, as is CURRENTLY POSSIBLE, in order to begin living that way. It's meant to be an exercise in deliberate living. When I wrote my perfect day, I sort of ignored that aspect of it, and wrote what my dream life would be like. It's very diet and fitness oriented, because that's where my head was (and is), but in general it's what I would consider an absolutely ideal day in a perfect universe: | blog |
blog30407 | IF her scale is accurate, I have lost 35 pounds since I started in December. But whatever, even if her scale isn't accurate, I've lost 15 pounds since the last time I've weighed myself. | blog |
blog30407 | Also I'm concerned that I'm not eating enough fiber. I want about 14 grams, and I'm doing more like 4 or 5 grams. | blog |
blog30407 | Somehow I became fascinated with this little Google game. You enter your name as the search term, along with the verb of your choice. Put it in quotes so Google doesn't ignore the verb. For example: "Marla was" or "Marla thinks". Some of the results are very amusing, especially since "Marla" is featured prominently in porn sites. | blog |
blog30407 | With exercise, once you do it, it's done. Poof. Nothing to talk about. | blog |
blog30407 | I'm buckling them in the middle row, not the loosest row. So yay for me. Or my boobs. Oh yeah, now I remember why it reminded me: Janet Jackson. | blog |
blog30407 | Not sure what else I will do. Perhaps pack more. Bleh. | blog |
h | Malaria is of particular concern. According to the WHO, malaria is endemic in over 80% of the areas currently experiencing humanitarian emergencies. Overcrowding facilitates transmission of measles, acute respiratory infections, and meningococcal diseases. Decreased nutrition makes it much more likely that displaced people will become sick after exposure. | amt |
h | Before discussing the relationship between equity and efficiency, it is important to discern between the three types of efficiency:. Technical efficiency is maximizing outputs based on a given level of resources by ensuring the proper mix of resources (vaccines, equipment, drugs, and so on). Economic efficiency consists of producing a level of effective services at the lowest cost possible. Allocative efficiency consists of "doing the right things." | amt |
h | Having looked at some of the reasons for the high failure rate of these rural insurance schemes, what can be done when developing the scheme make it more likely to succeed? | amt |
h | That being said, there are some pitfalls of the pay for performance model that should be considered in the implementation phase of an HIV/AIDS-based bonus model in Namibia in order to be successful. Firstly, it is important that the performance measures that are rewarded are 1) based on research done on current levels of treatment/access and 2) targeted at increasing quality and care. If targets are not set based on current levels of services provided, there is a chance that levels will be set too low and will not affect services provided. This was seen when the UK established a pay for performance model in the 80s. | amt |
h | Incentivizing the number of clients upon which HIV tests are performed for example, leads to increasing access for patients to HIV screening, and should result in physicians offering these services to patients they would not have offered this service to otherwise. | amt |
h | The reasons for this increased risk is mostly straight-forward. Lack of adequate drinking water and sanitation leads to an increased incidence of water-borne diseases. | amt |
h | One major drawback is that investing heavily in programming for one particular area of the health sector often means that funding for other areas suffers and human resources will flock towards working in that area that has more resources (the effect of international funding to HIV/AIDS and its effect on the family planning sector is one example). In addition, running multiple parallel programs for one area results in duplication of services that are also uncoordinated between programs. This leads to an increase in forms and paperwork for supplies and funding. | amt |
h | As a result, administrative costs and fees often further hamper the organization's viability. In addition, the premium fees are often set on the basis of how much the members can pay rather than on the costs of provision of care. This means that the administrators must develop a package of services that are covered and decide what is excluded. | amt |
h | Other frequent interventions to halt the spread of communicable diseases include vector control, sanitation and waste disposal, and the provision of safe food, in the hopes that those services will ease the spread of disease. In armed conflicts that interrupt infrastructure and displace citizens, the first goal of health systems strengthening should concern provision of health care. | amt |
h | As an example, the WHO found that after violence erupted following the 2007 elections in Kenya, "30% of the health facilities are not functioning. This disruption in the health system is affecting routine health care delivery and emergency care services. Already there are reports of patients on Anti-Retroviral Therapy for HIV and Tuberculosis treatment being unable to access their drugs." These sorts of shortages are quite common in conflict-affected zones, due to the increased logistical frustrations of avoiding fighting or insurgents who might steal supplies. | amt |
h | There are knobs by which governments can effect horizontal equity, namely through financing options, providing more money to rural providers to incentivize serving communities that traditionally have less access. Governments can also facilitate community-based health insurance schemes to help those in marginal areas increase access. CBHIs, however, may not always be vertically equitable, as the poorest are still often unable to pay premiums for service. | amt |
h | In addition, service-specific strategies mean healthcare professionals can be trained or separately for multiple different vertical programs, reducing the time available to treat patients. As can be seen vertical programs cause redundancies that often lead to a decrease in health sector efficiency. Health system responses, on the other hand, have the benefit of strengthening the framework by addressing underlying issues affecting access, quality, and efficiency across the healthcare system. | amt |
h | This practice can also be extended to other health sector performance issues. | amt |
h | There are no incentives for providing services towards the MDG goals. As a result, the recommendation for Indonesian health systems strengthening are two-fold: An increased federal investment in a social insurance scheme and the development of a pay for performance bonus system for certain services offered. | amt |
h | These sorts of issues mean that administration of these insurance schemes really need qualified, experienced administrators that are often lacking in these rural areas. A poorly-run scheme with staff that is not up to the task likely will eat up potential funds with administrative fees. A third likely reason for the failing of so many rural insurance schemes is the lack of government support that would help such a setup to thrive. Generally, donor-funded schemes will need to become independent at some point after insurance scheme has been established and the initial donor has pulled out. | amt |
h | Not only did most doctors earn nearly the limit for bonuses offered (well over $100,000), but studies showed that the services provided were comparable to US rates, which did not have a bonus model. In other words, the performance measures were set too low and were too easy to meet to have any real effect on care. In addition, setting out-come based and quality-based targets must be the focus. | amt |
h | That being said, this category still includes traditional workers, such as midwives, who cannot provide medical interventions should the pregnancy be complicated (hence the large percentage of maternal deaths caused by hemorrhage). In other words, the improvements made in this particular indicator are somewhat misleading and there is still much work to be done. In addition, there has been a decline in the percentage of diarrheal cases in children under five years treated by a health professional. While data on postnatal care is incomplete, it is clear that this area is also of concern, with low rates across the country. Cesarian-section rates are still lower than should be expected, around 4%. | amt |
h | When these sorts of root problems are addressed, improvements can be seen in all aspects of health services delivery, rather than one specific, focused area. This approach has limitations as well, primarily fact that goals are much less focused and require much more coordination among stakeholders. | amt |
h | One final recommendation for Namibia when implementing a pay for performance model, ensure that supplies are available on the anticipated level needed before introducing a bonus model. As HIV testing will likely increase, and ARVs will logically be used more as a result, stock needs to be adequate to meet increased demand. Another related recommendation is to do implement the new bonus system as fast as possible. | amt |
h | There are many ways in which a scheme can often become a financial disaster. Firstly, when rural insurance is developed, the risk pools the insurance organize from are often smaller, leading to a decreased risk pool. | amt |
h | The concern of provision poses a number of logistical issues, namely access to services and security issues for supplies. Not only are IDPs often settled in places with marginal access to begin with, but their presence causes undue pressure on services established for the communities that already existed, complicating access for everyone in the region. In addition, conflict almost always causes some disruption of healthcare services as a tactical ploy in the fighting. | amt |
h | Between 2000 and 2006 there were 30 communicable disease outbreaks in 14 different conflict-affected countries, including the Democratic Republic of the Congo (Ebola, Marburg, monkeypox, cholera, plague) and the Sudan (meningitis, relapsing fever, hepatitis E, ebola, cholera). The most common diseases in the Sudan include pneumonia, measles, and malaria. The WHO document, "Communicable Disease Risk Assessment: Protocol For Humanitarian Emergencies" explains why communicable diseases are such a huge issue for both refugee populations and IDPs . | amt |
h | It wasn't long until a child diagnosed with leukemia was denied care because the services weren't viewed as cost-effective in Medicaid's new system. The uproar over denial of care for cancer treatments eventually led to Oregon abandoning the system altogether. That being said, efficiency and equity are not in direct opposition, per se. One of the most attractive elements of efficiency is that it should in theory free up funding that can be devoted to providing services for the poor. | amt |
h | The high number of vulnerable populations (i.e. children, women and elderly) in IDP settings. | amt |
h | Ensuring that the benefits outweigh the expected cost increases is of the utmost importance. In establishing a pay for performance model, it is important that Namibia first ensure they have reliable data as to the current inefficiencies in their HIV/AIDS monitoring and treatment system, otherwise they risk setting performance targets that are too easy to meet, much like the UK did. A thorough study of how frequently HIV testing and treatment is done must be performed before targets can be realistically set. | amt |
h | As a rule, egalitarian liberalism is primarily concerned with equal access. There are a number of "control knobs" available to governments to affect equality, namely financing (how funds are collected for services, out of pocket vs. tax-collection), payment (how providers are paid for services provided), and regulation (establishing a basic package of services, for example). Equity's relationship with efficiency is an important aspect for governments to consider as well. | amt |
h | In addition, around 75% of the doctors who have left are expected not to return to Iraq after the conflict is over. In Iraq, the reasons for doctor migration vary, including about 13% who stated they left due to threats of kidnapping or murder. Complicating the "Brain Drain" problem even further is the traditional issue of physician compensation. | amt |
h | Another important aspect of health systems in conflict situations is the question of where the financial resources will originate from. Government support in extended conflicts typically wanes, increasing reliance on NGO and bilateral agency funding for health-sector funding. | amt |
h | In addition, ensuring that social insurance is available for all employed citizens (with an additional federal or federally subsidized program for the unemployed and indigent) ensures that there is accountability, rather than throwing more money at district governments than they know what to do with. In addition, the development of a "bonus" system for providing antenatal and postnatal care should provide an incentive for doctors to continue care for both mother and child. Perhaps offering bonuses for meeting certain thresholds, such as number of births attended or mean number of visits with children under five years. | amt |
h | Increasing the number of doctors trained in their medical schools is one way to counteract the problem, but in the shorter term, doctor shortage will further contribute to the access issues already facing the country. While everyone in Iraq, even IDPs, have access to healthcare, the quality is sure to suffer, particularly in Baghdad. | amt |
h | In recent years, prevention of the spread of infectious diseases has become a priority in IDP healthcare, as so many of the deaths in IDP camps are preventable. | amt |
h | In these sorts of logistically difficult situations, not only are basic services not accessible, but access to care is virtually impossible. Diseases that are easily treatable, such as malaria and tuberculosis, can run rampant due to insufficient resources to deal with outbreaks as well as having many people in a small area together.. As a case study of the issues relating to inadequate access to clinics and services one can look at 2007 Kenya. Extended violence broke out after the elections that year. | amt |
h | This puts the insurance organization at an immediate disadvantage, as the ability to pay out for all care needed is decreased when the risk pool is smaller. In addition, these sorts of systems, when not developed properly, may allow people to move in and out of the system with relative ease, meaning a person can pay for coverage when they need it (say when a woman becomes pregnant) and stop participating when they are in relatively good health. In other words, these people will only be adding stress to an already small risk pool, further hurting the financial viability of the organization. This problem can be fixed, usually through a waiting period during which the person is paying into the pool but not able to utilize services, but these sorts of decisions should be made before a rural insurance scheme is implemented. | amt |
h | In addition, the lack of clear, direct goals lead to discouragement among actors. These difficulties, though, are not surmountable, and the long-term strengthening benefits of health-systems wide approaches make this preferable to programmatic interventions. In defining next steps in improving neonatal and maternal healthcare in Indonesia, one must discuss the ability of the government to make changes that will improve services and service utilization. Of particular concern is the fact that the current system is largely decentralized and underfunded, with the vast majority of Indonesian citizens lacking insurance, almost 74%. | amt |
h | While there may not be any perfectly equitable system, it is clear that those systems that run largely on out-of-pocket payments (as in most developing countries) or private insurance-based systems like the US (where insurance providers often participate in adverse selection to decrease their risk) largely are not equitable. While health systems that provide universal coverage are generally more equitable, there are still other considerations, such as how funds are raised, the distribution of healthcare providers across the country, and so on. The reason for the mixed success of many donor-funded rural insurance schemes is complicated. | amt |
h | The need for quality data is also an ongoing concern, as services provided will need to continue to be monitored once a bonus structure is put in place. | amt |
h | However, the importance of providing basic medical services to all citizens cannot be understated. Individually displaced people (IDPs) have very specific medical needs due to their circumstances. Infectious diseases often run wild among IDP communities, and mental health is an ongoing issue that often goes overlooked. | amt |
h | A second major issue, and one that has long-term post-conflict implications, is of doctor migration out of the country, also known as the "Brain Drain". While the "Brain Drain" traditionally occurs due to a lesser-developed country not being able to offer competitive compensation to in-country doctors, conflict can have the same effect. | amt |
h | In addition, Spiegel points to the "poor access to services and the absence of mandate and funding for one agency to assume decisive responsibility for non-refugee populations" as a complicating issue . In other words, the lack of an international mandate to serve IDPs, like the one that exists for people deemed worthy of "refugee" status, complicates issues. | amt |
h | For an illness like HIV/AIDS, number cured obviously cannot be a monitored outcome. Patients in ongoing treatment, however, and cases of HIV detected certainly can. One measure that Namibia may want to consider is number of new HIV cases detected and put on ongoing therapy, in order to ensure that the adverse selection mentioned above. In many ways, incentivizing numbers of clients rather than percentages may be a good idea to ensure comprehensive care for HIV-positive citizens. | amt |
h | Another contributor to the failing of so many of these sorts of schemes is the administrative stress of developing such schemes. For smaller schemes like these sorts of rural insurance organizations, administrative costs are high, owing to the reduced funding pool, and the high administrative needs. For instance, most administrators must negotiate rates with providers, set premiums and collect premiums from members, and coordinate recruitment into the scheme. | amt |
h | Developing a social insurance mandate has occurred somewhat for federal employees, with the employees and employers paying a percentage of the premium. Continuing to develop a system with a wider reach, much like Thailand developed, should help solve a number of the access issues. In addition, expanding federal insurance coverage for the poor should help ensure a more equitable distribution of care. | amt |
h | Some of the various issues in IDP and conflict situations are issues of access, doctor migration out of country, and financing. While conflict often causes NGOs and bilateral agencies to intervene, this adds yet another level of coordination to the puzzle. In this paper, various armed conflicts around the world will be discussed, highlighting particular health system needs and basic health-systems failings. | amt |
h | During this conflict, the three biggest causes of morbidity and mortality were all easily treatable: acute respiratory disease, malaria, and diarrhea. In addition to a prevalence of preventable deaths, the decline of the healthcare infrastructure during conflict leads to long-term demographic health issues for countries like Kenya. As Dr. | amt |
h | The rate of neonatal and infant mortality in Indonesia remained rather static for the last ten years. While the country is on track to meet many of the Millennium Development Goals, such as the water and sanitation targets, the rates of improvement for child and maternal health are woefully short of the improvements needed to meet their target goals by 2015. The multiple reasons for these shortcomings will be discussed below, and point to a need to strengthen the health system rather than focus on programmatic interventions. Indonesia has made improvements in the number of births with a skilled health worker attending, with 72% of births now meeting this target. | amt |
h | This issue is not constrained to only doctors, either. In 2006 it was found that only about 30% of all healthcare staff positions were filled. In a place like Iraq, the "Brain Drain" is a very real issue that threatens long-term health systems stability. | amt |
h | With government backing, one might be able to get additional funding, or at least a "safety net" that may be willing to help the insurance organization should it experience funding problems in the future. Thirdly, it is important that the rural insurance scheme be developed to provide at the very least a basic set of services that can be paid for. In other words, the insurance scheme will need to ensure from the start that catastrophic costs are not going to cause the entire scheme to fold. As undesirable as it may be, that may mean that services will need to be excluded from coverage (for example, paying for outpatient services at clinics but not paying for hospital services). Related to this is the consideration mentioned earlier about a waiting period before services can be utilized. | amt |
h | In fact, as Rawl's notes, inequality should only be allowed in raising the status of the poor. In discussing equity, it is important to note that there are two aspects that need to be analyzed: vertical equity and horizontal equity. Vertical equity is the distribution of services across income levels . In other words, do the richest citizens have the same level of access compared to the poorest? | amt |
h | In discussing next steps towards improving neonatal and maternal care indicators, the most basic question is how to most effectively address the lack of service. Specifically, should Indonesia develop program-specific approaches or strengthen the overall health system without focusing on pre and post-pregnancy care for the mother and child. There is no question that programmatic approaches to solve the problems outlined above are attractive. | amt |
h | Even for providers who don't suffer from threats of violence against them, in a place like Iraq today they cannot afford to hold on to the existing doctors. As stated by Agron Ferati in the Brookings Institute's 2009 panel, "Monitoring Health Services among Iraqi Refugees and Internally Displaced Persons," "Why should I remain in Baghdad as a surgeon, when I can go in Dubai and earn $5,000 salary, while in Baghdad I risk my own life, my family's lives, for $600 or $700?" This problem only surface in Iraq after the war. | amt |
h | In addition, some common considerations, such as the common use of mobile health clinics and the provision of mental health care, are also discussed. Finally, the special case of Nepal deserves attention. | amt |
h | In many ways, this payment structure, when used in an intelligent manner, can increase health outcomes and increase health access. When performance incentives are set up to measure outcomes, say the percentage of HIV-positive patients put on anti-retroviral therapy, increased health status should be a clear outcome. This also adds to efficiency, as performance targets can be set to reward providers who provide low-cost, high effectiveness treatments and interventions. Preventative care and screening, say HIV testing during regular checkups, can also add to efficiency, as HIV testing and screening has been shown to be a cost-effective intervention by the CDC. In addition, for performance-based measures, physicians often have incentives to provide certain services to as much of the population as possible. | amt |
h | Another issue of access concerns vertical equity. There is a 27% gap in service utilization between the poorest and richest quintiles. Clearly the poor are finding it much more difficult to access healthcare services, likely due to out of pocket costs. | amt |
h | The international response to the genocide in Rwanda in the 1990s was, in the words of Dr. Paul Spiegel, "disastrous" . The UN had very little presence in the country for the majority of the conflict, largely due to US reticence to intervene. | amt |
h | In fact, physician migration has occurred time and time again during unrest in a country. Over half of Cuba's doctors left during the revolution. Zimbabwe lost over two thirds of their physicians in the 1990s. Even in Iraq today, it is estimated that over half of the doctors have left the country, many for Jordan. It should be noted that the doctor loss was most severe in Baghdad, likely due to the intensity of the conflict there. | amt |
h | Complicating the issue even further, IDP populations usually are not sufficiently vaccinated to prevent epidemics. Some of the threats posed by communicable diseases in IDP settings according to the WHO include:. Increased incidence of endemic disease - Increased morbidity and mortality from diseases like HIV/AIDS. | amt |
h | One concern with setting a target such as total number of HIV tests administered means that providers have incentives to test people already tested recently (within the last three months, say) or people who have no risk. There is some incentive to abuse the system for providers, in other words. Another problem with a pay for performance model is the risk that it might cause some adverse selection. If there are performance measures for the percentage of HIV-positive patients on ARVs, for instance, there would be an incentive for providers not to take on new HIV-positive clients to ensure they are still meeting these sorts of ratio benchmarks. | amt |
h | Recognizing the ongoing issue of infectious disease, the international community has stressed the importance of preventing disease transmission among IDP communities. The WHO has developed a three-step framework to identify communicable disease risk in conflict and disaster situations. Event Description - Characterizing the nature of the event and the characteristics of those displaced can help to determine the risk of communicable disease outbreak among the population. | amt |
h | What is so intriguing about is the fact that during a ten year conflict within the country from 1996-2006, there was improvement in 16 of 19 Millennium Development Goals at the same time. This goes against traditional thinking, that during conflict health indicators will regress. Are there lessons that can be taken away for future conflict interventions? | amt |
h | It is important to keep in mind these sorts of unintended consequences of pay for performance implementation. A third and final issue with the pay for performance model is the fact that it will increase administrative costs. Rather than paying providers on a salaried basis, the setting of performance targets means there will need to be follow-up to ensure services provided are not inflated and there is a new built in payment system that requires more staff. While this shouldn't discourage a country from implementing a pay for performance model, it must be considered early on, as healthcare spending will likely increase. | amt |
h | Jeff Wilkinson said at the time of the outbreak of violence, "With the unrest, the Kenyan people cannot get access to the preventive tools, such as bed nets to guard against malaria, or condoms to guard against sexually transmitted diseases. Moreover, if they get sick, they cannot make it to clinics for treatments. Since tuberculosis and HIV require long-term treatment, lack of access is a huge obstacle to controlling the diseases." | amt |
h | In theory, providing a risk-pooling scheme for areas where nothing existed before seems rather straightforward. In practice, however, these communities often have certain issues developing viable, sustainable health insurance schemes. The primary reason many of the rural insurance schemes have failed in the past is due to insufficient funding. | amt |
h | In other words, devoting resources to the most critical services and doing so in a cost-effective way. These concepts can seem at times to be in direct opposition to the idea of equity. A good example of this tension between equity and efficiency can be seen in Oregon in the 1990s when their Medicaid system decided to prioritize health interventions based on their DALYs and what services were most cost efficient. This ground-breaking system was based on the idea of allocative efficiency. | amt |