IMPLEMENTING HEALTH INSURANCE FOR THE POOR: THE ROLLOUT OF RSBY IN KARNATAKA

The National Health Insurance Scheme (Rashtriya Swasthya Bima Yojana, RSBY) aims to improve poor people's access to quality health care in India. This paper looks at the implementation of the scheme in Karnataka, drawing on a large survey of eligible households and interviews with empanelled hospitals in the state. Six months after initiation, an impressive 85% of eligible households in the sample were aware of the scheme, and 68% had been enrolled. However, the scheme was hardly operational and utilisation was virtually zero. A large proportion of beneficiaries were yet to receive their cards, and many did not know how and where to obtain treatment under the scheme. Moreover, hospitals were not ready to treat RSBY patients. Surveyed hospitals complained of a lack of training and delays in the reimbursement of their expenses. Many were refusing to treat patients under the scheme until the issues were resolved, and others were asking cardholders to pay cash. As is typical for the implementation of a government scheme, many of the problems discussed can be related to a misalignment of incentives.

Teaching physics novices at university: A case for stronger scaffolding

In 2006 a new type of tutorial, called Map Meeting, was successfully trialled with novice first year physics students at the University of Sydney, Australia. Subsequently, in first semester 2007 a large-scale experiment was carried out with 262 students who were allocated either to the strongly scaffolding Map Meetings or to the less scaffolding Workshop Tutorials, which have been run at the University of Sydney since 1995. In this paper we describe what makes Map Meetings more scaffolding than Workshop Tutorials—where the level of scaffolding represents the main difference between the two tutorial types. Using a mixed methods approach to triangulate results, we compare the success of the two with respect to both student tutorial preference and examination performance. In summary, Map Meetings had a higher retention rate and received more positive feedback from students—students liked the strongly scaffolding environment and felt that it better helped them understand physics. A comparison of final examination performances of students who had attended at least 10 out of 12 tutorials revealed that only 11% of Map Meeting students received less than 30 out of 90 marks compared to 21% of Workshop Tutorial students, whereas there were no differences amongst high-achieving students. Map Meetings was therefore particularly successful in helping low-achieving novices learn physics

Motivating knowledge agents : can incentive pay overcome social distance?

This paper studies the interaction of incentive pay and social distance in the dissemination of information. We analyse theoretically as well as empirically the e ect of incentive pay when agents have pro-social objectives, but also preferences over dealing with one social group relative to another. In a randomised eld experiment undertaken across 151 villages in South India, local agents were hired to spread information about a public health insurance programme. Relative to at pay, incentive pay improves knowledge transmission to households that are socially distant from the agent, but not to households similar to the agent

What are the main sources of smoking cessation support used by adolescent smokers in England?: a cross-sectional study

Background Adolescent smoking is a worldwide public health concern. Whilst various support measures are available to help young smokers quit, their utilization of cessation support remains unknown. Methods A cross-sectional study was conducted using data from the 2012 Smoking, Drinking and Drug Use among Young People survey to quantify the use of seven different types of cessation support by adolescents aged 11-16 in England who reported current smoking and having tried to quit, or ex-smoking. Logistic regression was used to calculate odds ratios and 95 % confidence intervals for the associations between participant characteristics and reported use of cessation support. Results Amongst 617 current and ex-smokers, 67.3 % (95 % CI 63.0-71.2) reported use of at least one cessation support measure. Not spending time with friends who smoke was the most commonly-used measure, reported by 45.4 % of participants (95 % CI 41.1-49.8), followed by seeking smoking cessation advice from family or friends (27.4 %, 95 % CI 23.7-31.5) and using nicotine products (15.4 %, 95 % CI 12.6-18.7). Support services provided by the National Health Service (NHS) were infrequently utilized. Having received lessons on smoking was significantly associated with reported use of cessation support (adjusted OR 1.55, 95 % CI 1.02-2.34) and not spending time with friends who smoked (adjusted OR 1.98, 95 % CI 1.33-2.95). Students with family members who smoked were more likely to report asking family or friends for help to quit (adjusted OR 1.74, 95 % CI 1.07-2.81). Respondents who smoked fewer cigarettes per week were generally less likely to report use of cessation support measures. Conclusion The majority of young smokers reported supported attempts to quit, though the support they used tended to be informal rather than formal. Evidence is needed to quantify the effectiveness of cessation support mechanisms which are acceptable to and used by young smokers

Evolution and current state of assays for measuring parathyroid hormone

Development of the assays for parathyroid hormone (PTH) stems from the early radioimmunoassay development. Recognition of the assay shortcomings led to the development of the newer immunometric assays (IMA) that allowed for better characterization and understanding of the PTH molecule secretion, action and metabolism. Newer assays also allowed for reliable diagnosis of primary hyperparathyroidism and hypoparathyroidism in the majority of the patients. However, despite apparent improvements in the assay\u27s characteristics, considerable difficulties remain in assessment of the bone metabolism in the patients with end stage renal disease. Combining the results of second generation PTH IMA assays with third generation PTH IMA assays or standardizing the PTH results may offer further enhancement in the ability to assess bone metabolism in these patients, but further studies are necessary to elucidate their true clinical value

Rapidly increasing trend of recorded alcohol consumption since the end of the armed conflict in Sri Lanka

Aim: To evaluate temporal changes in recorded alcohol consumption in Sri Lanka during and after the armed conflict 1998 – 2013. Methods: District level alcohol sales, and mid-year population data for the whole study period (1998-2013) were consistently available from the Department of Excise and the Department of Census and Statistics for 18 of 25 districts. These data were used to estimate the recorded per capita consumption for the areas that were not directly exposed to the armed conflict. An interrupted time series design was employed to estimate the impact of the end of the armed conflict on recorded adult per capita alcohol consumption of population lived in the 18 districts. Results: Adult per capita recorded alcohol consumption among Sri Lankans living in the 18 districts was 1.59 litres of pure alcohol in 1998. This increased up to 2.07 litres in 2009 and 2.55 litres in 2013. Prior to the end of the conflict in 2009 adult per capita recorded consumption increased by 0.051 litres of pure alcohol per year (95% CI 0.029-0.074, p<0.001); after 2009 this was 0.166 litres per year (95% CI 0.095-0.236, p<0.001). Beer consumption showed the highest per capita growth compared with other beverages. Conclusions: Adult per capita recorded alcohol consumption among Sri Lankans living in areas that were not directly exposed to the conflict increased markedly after the end of the conflict. Rapid socio-economic development, alcohol industry penetration and lack of alcohol control strategies during the post-conflict period may have driven this increase

Note On The Effectiveness OF Stochastic Optimization Algorithms For Robust Design

Robust design optimization (RDO) uses statistical decision theory and optimization techniques to optimize a design over a range of uncertainty (introduced by the manufacturing process and unintended uses). Since engineering ob jective functions tend to be costly to evaluate and prohibitively expensive to integrate (required within RDO), surrogates are introduced to allow the use of traditional optimization methods to find solutions. This paper explores the suitability of radically different (deterministic and stochastic) optimization methods to solve prototypical robust design problems. The algorithms include a genetic algorithm using a penalty function formulation, the simultaneous perturbation stochastic approximation (SPSA) method, and two gradient-based constrained nonlinear optimizers (method of feasible directions and sequential quadratic programming). The results show that the fully deterministic standard optimization algorithms are consistently more accurate, consistently more likely to terminate at feasible points, and consistently considerably less expensive than the fully nondeterministic algorithms

Measuring alcohol consumption in population surveys: a review of international guidelines and comparison with surveys in England

Aims: To review the international guidelines and recommendations on survey instruments for measurement of alcohol consumption in population surveys, and to examine how national surveys in England meet the core recommendations. Methods: A systematic search for international guidelines for measuring alcohol consumption in population surveys was undertaken. The common core recommendations for alcohol consumption measures and survey instruments were identified. Alcohol consumption questions in national surveys in England were compared with these recommendations for specific years and over time since 2000. Results: Four sets of international guidelines and three core alcohol consumption measures (alcohol consumption status, average volume of consumption, frequency and volume of binge drinking) with another optional measure (drinking context) were identified. English national surveys have been inconsistent over time in including questions that provide information on average volume of consumption but have not included questions on another essential alcohol consumption measure, frequency of heavy episodic drinking. Instead they have used questions that focus only on maximum volume of alcohol consumed on any day in the previous week. Conclusions: International guidelines provide consistent recommendations for measuring alcohol consumption in population surveys. These recommendations have not been consistently applied in English national surveys and this has contributed to the inadequacy of survey measurements for monitoring vital aspects of alcohol consumption in England over recent years

Implementing health insurance for the poor: the rollout of RSBY in Karnataka

The National Health Insurance Scheme (Rashtriya Swasthya Bima Yojana, RSBY) aims to improve poor people’s access to quality health care in India. This paper looks at the implementation of the scheme in Karnataka, drawing on a large survey of eligible households and interviews with empanelled hospitals in the state. Six months after initiation, an impressive 85% of eligible households in the sample were aware of the scheme, and 68% had been enrolled. However, the scheme was hardly operational and utilisation was virtually zero. A large proportion of beneficiaries were yet to receive their cards, and many did not know how and where to obtain treatment under the scheme. Moreover, hospitals were not ready to treat RSBY patients. Surveyed hospitals complained of a lack of training and delays in the reimbursement of their expenses. Many were refusing to treat patients under the scheme until the issues were resolved, and others were asking cardholders to pay cash. As is typical for the implementation of a government scheme, many of the problems discussed can be related to a misalignment of incentives