Cosmopolitan morality trades off in-group for the world, separating benefits and protection.

Global cooperation rests on popular endorsement of cosmopolitan values-putting all humanity equal to or ahead of conationals. Despite being comparative judgments that may trade off, even sacrifice, the in-group's interests for the rest of the world, moral cosmopolitanism finds support in large, nationally representative surveys from Spain, the United Kingdom, Germany, China, Japan, the United States, Colombia, and Guatemala. A series of studies probe this trading off of the in-group's interests against the world's interests. Respondents everywhere distinguish preventing harm to foreign citizens, which almost all support, from redistributing resources, which only about half support. These two dimensions of moral cosmopolitanism, equitable security (preventing harm) and equitable benefits (redistributing resources), predict attitudes toward contested international policies, actual charitable donations, and preferences for mask and vaccine allocations in the COVID-19 response. The dimensions do not reflect several demographic variables and only weakly reflect political ideology. Moral cosmopolitanism also differs from related psychological constructs such as group identity. Finally, to understand the underlying thought structures, natural language processing reveals cognitive associations underlying moral cosmopolitanism (e.g., world, both) versus the alternative, parochial moral mindset (e.g., USA, first). Making these global or local terms accessible introduces an effective intervention that at least temporarily leads more people to behave like moral cosmopolitans.

Judicialization 2.0: Understanding right-to-health litigation in real time.

Over the past two decades, debate over the whys, the hows, and the effects of the ever-expanding phenomenon of right-to-health litigation ('judicialization') throughout Latin America have been marked by polarised arguments and limited information. In contrast to claims of judicialization as a positive or negative trend, less attention has been paid to ways to better understand the phenomenon in real time. In this article, we propose a new approach-Judicialization 2.0-that recognises judicialization as an integral part of democratic life. This approach seeks to expand access to information about litigation on access to medicines (and health care generally) in order to better characterise the complexity of the phenomenon and thus inform new research and more robust public discussions. Drawing from our multi-disciplinary perspectives and field experiences in highly judicialized contexts, we thus describe a new multi-source, multi-stakeholder mixed-method approach designed to capture the patterns and heterogeneity of judicialization and understand its medical and socio-political impact in real time, along with its counterfactuals. By facilitating greater data availability and open access, we can drive advancements towards transparent and participatory priority setting, as well as accountability mechanisms that promote quality universal health coverage.

Will more inputs improve the delivery of health services? Analysis of district vaccination coverage in Pakistan.

In order to determine whether physical resources or technical inputs can make a difference to the delivery of health services, we carried out a study that examined the large variation in district level vaccination coverage in Pakistan. Vaccination coverage was assessed by district-wise cluster surveys and the predictor variables were collected from census data and from a survey of 99 district health offices. Information was collected on basic supplies, physical infrastructure, management, training, socio-economic variables, and a variety of other indicators. Univariate and multivariate analyses were carried out. A model including female literacy rate, TV ownership, and provincial dummies explained 48% of the variation in DTP3 coverage. Very few of the other variables examined were significantly correlated to coverage. Possible explanatory variables like adequacy of syringe and vaccine supply, the number of vaccinators per capita, recent training of managers, frequency of supervision, availability of micro-plans, and turnover of managers were not correlated with coverage. While the Government of Pakistan has ensured that many physical resources and technical inputs have been provided to the district health offices, this does not appear able to explain the relatively low overall coverage or the variation between districts. Bolder initiatives and innovations are likely needed to improve delivery of basic health services.

Separating financing from provision: evidence from 10 years of partnership with health cooperatives in Costa Rica.

OBJECTIVE: This article examines the impact of contracting health care provision to health care cooperatives in Costa Rica. METHODOLOGY: The article uses a panel dataset on health care outputs in traditional clinics and cooperatives in Costa Rica from 1990-99. RESULTS: Controlling for community socioeconomic characteristics, annual time trends and clinic complexity, the cooperatives conducted an average of 9.7-33.8% more general visits (95% confidence interval), 27.9-56.6% more dental visits, and 28.9-100% fewer specialist visits. Numbers of non-medical, emergency and first-time visits per capita were not different from the traditional public clinics. These results suggest that the cooperatives substituted generalist for specialist services and offered additional dental services, but did not turn away new patients, refuse emergency cases, or substitute nurses for doctors as care providers. Cooperatives authorized 30.4-60.5% fewer sick days (95% confidence interval), conducted 24.7-37.2% fewer lab exams, and gave out 26.7-38.3% fewer medications per visit than the traditional public clinics. Real total expenditure per capita in cooperatives was 14.7-58.9% lower than in traditional clinics. CONCLUSIONS: The findings suggest that cooperatives might, with an appropriate regulatory framework and incentives, be able to combine advantages of public and private approaches to health care service provision. Under certain conditions, they might be able to maintain accessibility, a sense of mission and efficiency in service provision.