RESUMO
Drug repurposing can be cheaper and faster than developing new compounds. Yet, it remains underused, partially because of regulatory and intellectual property challenges. Policy-makers in the United States and Europe have created seven drug development programs that aim to overcome these challenges using a variety of different strategies.
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Reposicionamento de Medicamentos , Humanos , Estados Unidos , Europa (Continente) , Incerteza , Propriedade Intelectual , Programas Governamentais/economiaRESUMO
This Viewpoint summarizes inefficiencies in the 340B program and provides suggestions for equitable reform that will potentially benefit patients.
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Custos de Medicamentos , Programas Governamentais , Medicamentos sob Prescrição , Custos de Medicamentos/legislação & jurisprudência , Estados Unidos , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Governo FederalAssuntos
Negro ou Afro-Americano , Atenção à Saúde , Programas Nacionais de Saúde , Fatores Socioeconômicos , Atenção à Saúde/economia , Atenção à Saúde/normas , Programas Governamentais/economia , Programas Governamentais/normas , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/normasRESUMO
Four studies demonstrate that the public's understanding of government budgetary expenditures is hampered by difficulty in representing large numerical magnitudes. Despite orders of magnitude difference between millions and billions, study participants struggle with the budgetary magnitudes of government programs. When numerical values are rescaled as smaller magnitudes (in the thousands or lower), lay understanding improves, as indicated by greater sensitivity to numerical ratios and more accurate rank ordering of expenses. A robust benefit of numerical rescaling is demonstrated across a variety of experimental designs, including policy relevant choices and incentive-compatible accuracy measures. This improved sensitivity ultimately impacts funding choices and public perception of respective budgets, indicating the importance of numerical cognition for good citizenship.
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Orçamentos , Compreensão , Programas Governamentais , Programas Governamentais/economia , HumanosRESUMO
This paper aims to explore several ways to construct a scientific and comprehensive early warning system (EWS) for local government debt risk in China. In order to achieve this goal, this paper studies the local government debt risk from multiple perspectives, i.e., individual risk, contagion risk, static risk and dynamic risk. Firstly, taking China's 30 provinces over the period of 2010~ 2018 as a sample, this paper establishes early warning indicators for individual risk of local government debt, and uses the network model to establish early warning indicators for contagion risk of local government debt. Then, this paper applies the criteria importance though intercrieria correlation (CRITIC) method and coefficient of variation method to obtain the proxy variable â , which combines the above two risks. Secondly, based on the proxy variable â , both the Markov-switching autoregressive (MS-AR) model and coefficient of variation method are used to obtain the proxy variable â ¡, which comprehensively considers the individual risk, contagion risk, static risk and dynamic risk of local government debt. Finally, machine learning algorithms are adopted to generalize the EWS designed in this paper. The results show that: (1) From different perspectives of local government debt risk, the list of provinces that require early warning is different; (2) The support vector machines can well generalize our EWS.
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Economia/tendências , Programas Governamentais/economia , Programas Governamentais/métodos , Algoritmos , China , Análise Custo-Benefício/métodos , Fatores Econômicos , Economia/estatística & dados numéricos , Programas Governamentais/tendências , Humanos , Governo Local , Aprendizado de Máquina , Fatores de Risco , Máquina de Vetores de SuporteAssuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Programas Governamentais/organização & administração , Máscaras/provisão & distribuição , Kit de Reagentes para Diagnóstico/provisão & distribuição , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Teste para COVID-19/instrumentação , Controle de Doenças Transmissíveis/economia , Programas Governamentais/economia , Humanos , Máscaras/economia , Kit de Reagentes para Diagnóstico/economia , SARS-CoV-2/patogenicidade , Estados Unidos/epidemiologiaAssuntos
Programas Governamentais , Pandemias/prevenção & controle , Administração em Saúde Pública , Desenvolvimento de Vacinas , Vacinas Virais , Animais , Surtos de Doenças , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Programas Governamentais/organização & administração , Humanos , Pandemias/economia , Saúde Pública , Estados Unidos , Zoonoses/epidemiologiaRESUMO
Economic vulnerability is an important indicator to measure regional coordination, health and stability. Despite the importance of vulnerabilities, this is the first study that presents 26 indicators selected from the dimensions of the domestic economic system, external economic system and financial system in the Belt and Road Initiative (BRI) countries. A quantitative analysis is conducted to analyze the characteristics of spatial heterogeneity of vulnerability of the economic subsystems and the comprehensive economic system of the BRI countries and the main influencing factors of the comprehensive economic system vulnerability (CESV) are identified based on obstacle degree model. The results show that the CESV of the East Asia, South Asia and ASEAN countries are lower than that of the Middle Eastern Europe, Central Asia and West Asia countries. The CESV of the BRI countries are generally in the middle level and the average vulnerability index of highly vulnerable countries is twice as much as that of lowly vulnerable countries. In addition, in terms of the vulnerability of the three subsystems, the spatial distribution of vulnerability of the domestic economic system (DESV) and financial system (FSV) is basically consistent with the spatial distribution pattern of CESV, both of which are low in East Asia and South Asia and high in West Asia and Central Asia. While, the vulnerability of external economic system (EESV) shows a different spatial pattern, with vulnerability of West Asia, Central Asia and ASEAN higher than that of East Asia and South Asia. The main obstacle factors influencing the CESV of BRI countries include GDP growth rate, saving ratio, ratio of bank capital to assets, service industry level, industrialization level and loan rate. Therefore, the key way to maintain the stability and mitigate the vulnerability of the economic system of BRI countries is to focus on the macroeconomic development and operation, stimulate the economy and market vitality, promote the development of industries, especially the service and secondary industries, and optimize the economic structure, banking system and financial system.
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Desenvolvimento Econômico/tendências , Economia/tendências , Meios de Transporte/economia , Ásia , Dióxido de Carbono/análise , China , Europa (Continente) , Programas Governamentais/economia , Produto Interno Bruto/tendênciasRESUMO
BACKGROUND: For-profit (FP) trauma centers (TCs) charge more for trauma care than not-for-profit (NFP) centers. We sought to determine charges, length of stay (LOS), and complications associations with TC ownership status (FP, NFP, and government) for three diagnoses among patients with overall low injury severity. METHODS: Adult patients treated at TCs with an International Classification of Diseases-based injury severity score (ICISS) survival probability ≥ 0.85 were identified. Only those who with a principal diagnosis of femur, tibial or rib fractures were included. RESULTS: Total charges were significantly higher at FP centers than NFP and lower at government centers (89.6% and -12.8%, respectively). FP TCs had a 12.5% longer LOS and government TCs had a 20.4% longer LOS than NFP TCs. CONCLUSION: Patients presenting to FP TCs with mild/moderate femur, tibial, or rib fractures experienced higher charges and increased LOS compared with government or NFP centers. There was no difference in overall complication rates.
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Fixação de Fratura/economia , Fraturas Ósseas/cirurgia , Propriedade/economia , Complicações Pós-Operatórias/epidemiologia , Centros de Traumatologia/estatística & dados numéricos , Adolescente , Adulto , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/estatística & dados numéricos , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/economia , Programas Governamentais/economia , Programas Governamentais/estatística & dados numéricos , Preços Hospitalares/estatística & dados numéricos , Hospitais Privados/economia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/economia , Hospitais Públicos/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Centros de Traumatologia/economia , Centros de Traumatologia/organização & administração , Adulto JovemRESUMO
OBJECTIVES: The Balancing Incentive Program (BIP) was an optional program for states within the Patient Protection and Affordable Care Act to promote Medicaid-funded home and community-based services (HCBS) for older adults and persons with disabilities. Twenty-one states opted to participate in BIP, including several states steadfastly opposed to the health insurance provisions of the Affordable Care Act. This study focused on identifying what factors were associated with states' participation in this program. METHODS: Event history analysis was used to model state adoption of BIP from 2011 to 2014. A range of potential factors was considered representing states' economic, political, and programmatic conditions. RESULTS: The results indicate that states with a higher percentage of Democrats in the state legislature, fewer state employees per capita, and more nursing facility beds were more likely to adopt BIP. In addition, states with fewer home health agencies per capita, that devoted smaller proportions of Medicaid long-term care spending to HCBS, and that had more Money Follows the Person transitions were also more likely to pursue BIP. DISCUSSION: The findings highlight the role of partisanship, administrative capacity, and program history in state BIP adoption decisions. The inclusion of BIP in the Affordable Care Act may have deterred some states from participating in the program due to partisan opposition to the legislation. To encourage the adoption of optional HCBS programs, federal policymakers should consider the role of financial incentives, especially for states with limited bureaucratic capacity and that have made less progress rebalancing Medicaid long-term services and supports.
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Serviços de Saúde Comunitária , Pessoas com Deficiência , Programas Governamentais , Serviços de Assistência Domiciliar , Medicaid , Casas de Saúde , Patient Protection and Affordable Care Act , Política , Governo Estadual , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/legislação & jurisprudência , Pessoas com Deficiência/legislação & jurisprudência , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/legislação & jurisprudência , Humanos , Assistência de Longa Duração/economia , Assistência de Longa Duração/legislação & jurisprudência , Medicaid/economia , Medicaid/legislação & jurisprudência , Casas de Saúde/economia , Casas de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Estados UnidosRESUMO
Since its early spread in early 2020, the disease caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Coronavirus Disease 2019 (COVID-19) has caused mass disruptions to health services. These have included interruptions to programs that aimed to prevent, control, and eliminate neglected tropical diseases (NTDs). In March 2020, the World Health Organization (WHO) released interim guidelines recommending the temporary cessation of mass drug administration (MDA), community-based surveys, and case detection, while encouraging continuation of morbidity management and vector control where possible. Over the course of the following months, national programs and implementing partners contributed to COVID-19 response efforts, while also beginning to plan for resumption of NTD control activities. To understand the challenges, opportunities, and recommendations for maximizing continuity of disease control during public health emergencies, we sought perspectives from Nigeria and Guinea on the process of restarting NTD control efforts during the COVID-19 pandemic. Through semistructured interviews with individuals involved with NTD control at the local and national levels, we identified key themes and common perspectives between the 2 countries, as well as observations that were specific to each. Overall, interviewees stressed the challenges posed by COVID-19 interruptions, particularly with respect to delays to activities and related knock-on impacts, such as drug expiry and prolonged elimination timelines, as well as concerns related to funding. However, respondents in both countries also highlighted the benefits of a formal risk assessment approach, particularly in terms of encouraging information sharing and increasing coordination and advocacy. Recommendations included ensuring greater availability of historical data to allow better monitoring of how future emergencies affect NTD control progress; continuing to use risk assessment approaches in the future; and identifying mechanisms for sharing lessons learned and innovations between countries as a means of advancing postpandemic health systems and disease control capacity strengthening.
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COVID-19 , Controle de Doenças Transmissíveis/organização & administração , Doenças Negligenciadas/prevenção & controle , Controle de Doenças Transmissíveis/economia , Programas Governamentais/economia , Programas Governamentais/organização & administração , Guiné , Humanos , Administração Massiva de Medicamentos , Nigéria , SARS-CoV-2 , Medicina Tropical/métodosRESUMO
The paper takes listed companies in the heavily polluting industry from 2009-2017 as a research sample to explore whether heavy pollution enterprises' environmental protection investment helps their debt financing under the institutional background of China's continuous implementation of green credit policy. It is found that, in general, the environmental protection investment of heavy pollution enterprises helps them to obtain more and relatively long-term new loans; in terms of time, this effect is more evident after the release of China's Green Credit Guidelines in 2012; in addition, the level of regional environmental pollution, the level of financial development and the green fiscal policy also have a moderating effect on this. This paper enriches the study of the economic consequences of corporate environmental protection investment from the perspective of debt financing. It examines the effects of the implementation of China's green credit policy and other institutional factors to provide a reference for the heavy pollution enterprises' environmental protection investment and the implementation of green credit policy by local governments in China.
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Conservação dos Recursos Naturais/métodos , Poluição Ambiental/economia , Poluição Ambiental/prevenção & controle , China , Política Ambiental/economia , Política Ambiental/legislação & jurisprudência , Poluentes Ambientais/efeitos adversos , Política Fiscal , Programas Governamentais/economia , Programas Governamentais/tendências , Indústrias/legislação & jurisprudência , Investimentos em Saúde , OrganizaçõesRESUMO
As digital finance is widely spread and applied in China, this new format of financial technology could become a new way to reduce poverty in rural areas. By matching digital financial indexes of the prefectural-level cities with microdata on rural households from the China Household Finance Survey (CHFS) in 2017, we find that digital finance significantly suppresses absolute poverty and relative poverty among rural households in China, which is supported by a series of robustness tests, such as the instrumental variable approach, using alternative specifications, and excluding extreme observations. Additionally, we provide evidence that the poverty reduction effect of digital finance is likely to be explained by alleviating credit constraints and information constraints, broadening social networks, and promoting entrepreneurship. Our findings further complement the research field on financial poverty reduction and offer insights for the development of public financial policies of poverty reduction in other countries, especially in some developing countries.
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Tecnologia Digital/tendências , Programas Governamentais/economia , Pobreza/prevenção & controle , China , Cidades , Empreendedorismo , Características da Família , Fazendeiros , Programas Governamentais/tendências , Humanos , Pobreza/estatística & dados numéricos , Pobreza/tendências , Política Pública , População Rural/estatística & dados numéricos , TecnologiaAssuntos
COVID-19/etnologia , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Financiamento Governamental/economia , Disparidades em Assistência à Saúde/etnologia , Programas Governamentais/economia , Programas Governamentais/normas , História do Século XX , Humanos , Pandemias/históriaRESUMO
BACKGROUND: The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. METHODS: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. FINDINGS: In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7-8·8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5-0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0-25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. INTERPRETATION: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. FUNDING: Bill & Melinda Gates Foundation.
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COVID-19/prevenção & controle , Países em Desenvolvimento/economia , Desenvolvimento Econômico , Financiamento da Assistência à Saúde , Agências Internacionais/economia , COVID-19/economia , COVID-19/epidemiologia , Financiamento Governamental/economia , Financiamento Governamental/organização & administração , Saúde Global/economia , Programas Governamentais/economia , Programas Governamentais/organização & administração , Programas Governamentais/estatística & dados numéricos , Programas Governamentais/tendências , Produto Interno Bruto , Gastos em Saúde/estatística & dados numéricos , Gastos em Saúde/tendências , Humanos , Agências Internacionais/organização & administração , Cooperação InternacionalRESUMO
BACKGROUND: Brazil has made great progress in reducing child mortality over the past decades, and a parcel of this achievement has been credited to the Bolsa Família program (BFP). We examined the association between being a BFP beneficiary and child mortality (1-4 years of age), also examining how this association differs by maternal race/skin color, gestational age at birth (term versus preterm), municipality income level, and index of quality of BFP management. METHODS AND FINDINGS: This is a cross-sectional analysis nested within the 100 Million Brazilian Cohort, a population-based cohort primarily built from Brazil's Unified Registry for Social Programs (Cadastro Único). We analyzed data from 6,309,366 children under 5 years of age whose families enrolled between 2006 and 2015. Through deterministic linkage with the BFP payroll datasets, and similarity linkage with the Brazilian Mortality Information System, 4,858,253 children were identified as beneficiaries (77%) and 1,451,113 (23%) were not. Our analysis consisted of a combination of kernel matching and weighted logistic regressions. After kernel matching, 5,308,989 (84.1%) children were included in the final weighted logistic analysis, with 4,107,920 (77.4%) of those being beneficiaries and 1,201,069 (22.6%) not, with a total of 14,897 linked deaths. Overall, BFP participation was associated with a reduction in child mortality (weighted odds ratio [OR] = 0.83; 95% CI: 0.79 to 0.88; p < 0.001). This association was stronger for preterm children (weighted OR = 0.78; 95% CI: 0.68 to 0.90; p < 0.001), children of Black mothers (weighted OR = 0.74; 95% CI: 0.57 to 0.97; p < 0.001), children living in municipalities in the lowest income quintile (first quintile of municipal income: weighted OR = 0.72; 95% CI: 0.62 to 0.82; p < 0.001), and municipalities with better index of BFP management (5th quintile of the Decentralized Management Index: weighted OR = 0.76; 95% CI: 0.66 to 0.88; p < 0.001). The main limitation of our methodology is that our propensity score approach does not account for possible unmeasured confounders. Furthermore, sensitivity analysis showed that loss of nameless death records before linkage may have resulted in overestimation of the associations between BFP participation and mortality, with loss of statistical significance in municipalities with greater losses of data and change in the direction of the association in municipalities with no losses. CONCLUSIONS: In this study, we observed a significant association between BFP participation and child mortality in children aged 1-4 years and found that this association was stronger for children living in municipalities in the lowest quintile of wealth, in municipalities with better index of program management, and also in preterm children and children of Black mothers. These findings reinforce the evidence that programs like BFP, already proven effective in poverty reduction, have a great potential to improve child health and survival. Subgroup analysis revealed heterogeneous results, useful for policy improvement and better targeting of BFP.
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Mortalidade da Criança , Programas Governamentais , Benefícios do Seguro , Avaliação de Programas e Projetos de Saúde , Brasil , Pré-Escolar , Estudos de Coortes , Análise Custo-Benefício , Estudos Transversais , Conjuntos de Dados como Assunto , Feminino , Programas Governamentais/economia , Humanos , Lactente , Benefícios do Seguro/economia , Masculino , Avaliação de Programas e Projetos de Saúde/economia , Medição de RiscoRESUMO
Due to increasing demand and scarce financial resources for healthcare, health system efficiency has become a major topic in political and scientific debates. While previous studies investigating determinants of health system efficiency focused primarily on economic and social influence factors, the role of the political regime has been neglected. In addition, there is a lack of formal theoretical work on this specific topic, which ensures transparency and logical consistency of arguments and implications. Using a public choice approach, this paper provides a rigorous theoretical and empirical investigation of the relationships between health system efficiency and political institutions. We develop a simple principal-agent model describing the behavior of a government with respect to investments in population health under different political regimes. The main implication of the theoretical model is that governments under more democratic regimes put more effort in reducing embezzlement of health expenditure than non-democratic regimes. Accordingly, democratic countries are predicted to have more efficient health systems than non-democratic countries. We test this hypothesis based on a broad dataset including 158 countries over the period 1995-2015. The empirical results clearly support the implications of the theoretical model and withstand several robustness checks, including the use of alternative indicators for population health and democracy and estimations accounting for endogeneity. The empirical results also indicate that the effect of democracy on health system efficiency is more pronounced in countries with higher income levels. From a policy perspective, we discuss the implications of our findings in the context of health development assistance.