Real World Financial Mismanagement in Alzheimer's Disease, Frontotemporal Dementia, and Primary Progressive Aphasia.

Background: Whereas clinical experience in dementia indicates high risk for financial mismanagement, there has been little formal study of real world financial errors in dementia. Objective: We aimed to compare caregiver-reported financial mistakes among people with Alzheimer's disease, behavioral variant frontotemporal dementia (bvFTD), and primary progressive aphasia (PPA). Methods: Caregivers reported whether participants with dementia had made financial mistakes within the last year; and if so, categorized these as resulting from: (a) being too trusting or gullible, (b) being wasteful or careless with money, or (c) trouble with memory. In a pre-registered analysis https://archive.org/details/osf-registrations-vupj7-v1), we examined the hypotheses that (1) financial mistakes due to impaired socioemotional function and diminished sensitivity to negative outcomes are more prevalent in bvFTD than in Alzheimer's disease, and (2) financial mistakes due to memory are more prevalent in Alzheimer's disease than in bvFTD. Exploratory analyses addressed vulnerability in PPA and brain-behavior relationships using voxel-based morphometry. Results: Concordant with our first hypothesis, bvFTD was more strongly associated than Alzheimer's disease with mistakes due to being too trusting/gullible or wasteful/careless; contrary to our second hypothesis, both groups were similarly likely to make mistakes due to memory. No differences were found between Alzheimer's disease and PPA. Exploratory analyses indicated associations between financial errors and atrophy in right prefrontal and insular cortex. Conclusions: Our findings cohere with documented socioemotional and valuation impairments in bvFTD, and with research indicating comparable memory impairment between bvFTD and Alzheimer's disease.

Does Consumer Credit Precede or Follow Health Among Older Adults? An Investigation in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial.

Background and Objectives: Consumer credit has shown increasing relevance to the health of older adults; however, studies have not been able to assess the extent to which creditworthiness influences future health or health influences future creditworthiness. We assessed the relationships between 4-year pre and postmorbid consumer credit history and self-rated physical and mental health outcomes among older adults. Research Design and Methods: Generalized estimating equations models assessed pre and postmorbid credit history (credit scores, derogatory accounts, and unpaid accounts in collections) and the onset of poor self-rated health (SF-36 score <50) among 1,740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly study from 2001 to 2017, linked to TransUnion consumer credit data. Results: In any given year, up to 1/4 of participants had a major derogatory, unpaid, or collections account, and up to 13% of the sample had poor health. Each 50-point increase in credit score trended toward a 5% lower odds of poor health in the next 1 year, a 6% lower odds in the next 2 years, and a statistically significant finding of 13% lower odds by 3 years. A drop in credit score was associated with a 10% greater odds of poor health in the next year, and having a major derogatory account was associated with an 86% greater odds of poor health in the next 3 years. After poor health onset, credit scores continued to see significant losses up to the 3 years, with larger decrements over time. Discussion and Implications: Having a major derogatory account or a sudden loss in credit may be a time to monitor older adults for changes in health. After a downturn in health, supporting older adults to manage their debt may help stabilize their credit.

Does Consumer Credit Precede or Follow Changes in Cognitive Impairment Among Older Adults? An Investigation in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial.

OBJECTIVES: We assessed the relationships between pre- and post-morbid consumer credit history (credit scores, debts unpaid, or in collections) and classification of mild (or greater) cognitive impairment (MCI). METHODS: Generalized Estimating Equation models assessed pre-and post-morbid credit history and MCI risk among 1740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, linked to TransUnion consumer credit data. RESULTS: Each 50-point increase in credit score was associated with up to 8% lower odds of MCI in the next 3 years. In contrast, new unpaid collections over doubled the odds of having MCI in the next 3 years. MCI was associated with subsequent credit score declines and a 47%-71% greater risk of having a new unpaid collection in the next 4 years. DISCUSSION: Credit declines may signal risk for future MCI. MCI may lead to financial challenges that warrant credit monitoring interventions for older adults.

The Proximity of Disaster Experiences and Financial Preparedness for Emergencies in the US.

OBJECTIVE: This study investigated how the proximity of disaster experience was associated with financial preparedness for emergencies. METHODS: The data used were from the 2018 National Household Survey, which was administered by the Federal Emergency Management Agency. The working sample included 4779 respondents. RESULTS: Logistic Regression showed that the likelihood of setting aside emergency funds tended to be the highest between 2-5 years after experiencing a disaster, which declined slightly but persisted even after 16 years. Recent disaster experience within 1 year did not show a significant impact, indicating a period of substantial needs. However, the proximity of disaster experience did not significantly affect the amount of money set aside. CONCLUSION: It is suspected that increased risk perception related to previous experiences of disasters is more relevant to the likelihood of preparing financially; whereas other capacity-related factors such as income and having a disability have more effect on the amount of money set aside.

The hidden impact of rapid spread of the COVID-19 pandemic in professional, financial, and psychosocial health of Latin American orthopedic trauma surgeons.

OBJECTIVE: To assess the quality of life of Latin American orthopedic trauma surgeons during the beginning of COVID-19 pandemic in Latin America. METHODS: A total of 400 orthopedic trauma surgeons from 14 Latin American countries were invited to complete an electronic survey aiming to understand the general situation of COVID-19 in each country and how COVID-19 had impacted life's participant financially and psychosocially. The relationship between the occurrence of the disease and the existence of legal regulations on the medical activity in the respondent's country, protocols for tracking the disease among patients hospitalized in an emergency basis due to skeletal trauma, and personal protective equipment to deal with patients diagnosed with COVID-19 who need orthopedic trauma surgery was investigated, as well as the financial and psychosocial impact caused by the disease. Data was statistically analyzed with significance p < 0.05. RESULTS: 220 respondents completed the survey. 21 respondents were diagnosed with COVID-19. Local regulation was decisive in terms of increasing the risk for COVID-19 disease (p = 0.001). 91.8% of the respondents reported being concerned about their financial health and 57.7% described a state of feeling emotionally overextended. 75.0% believe that pandemic can change their professional activity. CONCLUSION: The rapid spread of the COVID-19 pandemic in Latin America has negatively impacted the professional, financial, and psychosocial health of orthopedic trauma surgeons. It seems reasonable to state that the combination of psychosocial distress and deprivation together with financial uncertainty and decreased revenue can be straightly related to development of burnout symptoms among doctors.

Padrões de acumulação setorial: finanças e serviços nas transformações contemporâneas da saúde / Capital accumulation patterns: capital and services in the current transformations of the health system

O objetivo deste artigo é introduzir elementos da reprodução econômica da sociedade capitalista na avaliação da dinâmica contemporânea da acumulação da saúde. São identificadas a direção e o sentido da acumulação de capital e o ambiente onde se desenvolvem os atuais processos de competição.O trabalho considerou a hipótese da hipertrofia da órbita financeira como um modo de estruturação da economia capitalista desde o último quartel do século XX, onde ficam embaçadas e corroídas antigas delimitações entre produção de bens e prestação de serviços. Mudam os padrões de competição entre as empresas, bem como as contradições internas e externas ao setor saúde. A abordagem é teórico-histórico-conceitual, visando aportar elementos para uma abordagem contemporânea do tema "complexo médico-industrial". São identificadas transformações internacionais e nacionais referentes à dinâmica do capital no complexo, com destaque para o crescente papel dos serviços. A nova abordagem é elaborada a partir do pensamento econômico de Marx, acrescido da discussão contemporânea sobre financeirização e novas configurações produtivas da grande empresa. Ao final, o caráter das contradições existentes no interior do complexo produtivo da saúde é problematizado.

The purpose of this article is to introduce elements of the capitalist society economic reproduction to the discussion around the current dynamics of health accumulation. It identifies the direction and significance of capital accumulation in the health area as well as the characteristics of the economic environment where the competition currently takes place. The hypothetic hypertrophy of the financial sphere is seen as a means for structuring the capitalist economy since the late twentieth century. The former delimitations between industrial production and service delivery are blurred and weakened; the competition process shows new features and the contradictions - internally between the different elements of the health industry and externally with other sectors - are changing. This article aggregates elements for a contemporary analysis of the "medical-industrial complex" on the basis of a theoretical-historical-conceptual approach. We identify changes in the capital dynamics of this complex at international and national level and stress the increasing role of the health services as a forefront of capital accumulation. The new approach is based on the economic thinking of Marx in addition to the current discussions about the theory of financial capital accumulation and the new productive configurations of the large corporations.

[Spending and financing in health care: situation and trends]. / Gasto y financiamiento en salud: situación y tendencias.

Being knowledgeable about national health expenditures and sources of financing is essential for decision-making. This awareness also makes it possible to evaluate the equity of allocation and the efficiency of utilization of these resources. Changes in financing have been a substantial component of health sector reform in the Americas. The goal has shifted from merely one of financial sustainability to simultaneously seeking equitable access to quality services. In this article the Pan American Health Organization (PAHO) presents a proposal for analyzing and designing a policy on health financing. The aim of the policy is to identify the mix of financing mechanisms most likely to simultaneously produce financial sustainability, equity, access, and efficiency. The PAHO proposal combines traditional mechanisms for generating resources (public funds from taxes, as well as private health insurance, national health insurance, and user fees) with complementary subsidy mechanisms for vulnerable groups. Health financing strategies ought to explicitly consider the financing both of care for individuals and of health interventions for the general public good, for which public financing is the most equitable and efficient approach.

Financing blood transfusion services in sub-Saharan Africa: a role for user fees?

The provision of a secure and safe blood supply has taken on new importance in sub-Saharan Africa with the onset of the AIDS epidemic. Blood transfusion services capable of providing safe blood are not cheap, however, and there has been some debate on the desirability and sustainability of different financing mechanisms for blood transfusion services. This paper examines patterns of financing blood transfusion in three countries--Côte d'Ivoire, Zimbabwe and Mozambique. It goes on to consider the conceptual options for financing safe blood, and to examine in detail the possible role of user fees for blood transfusion in Africa, developing a simple model of their likely burden to patients based on data from Côte d'Ivoire. The model indicates that, at best, there can only be a limited role for user fees in the financing of safe blood transfusion services, due mainly to the relatively high cost of producing a unit of safe blood. Charging individuals for the blood they receive is likely to be administratively complex and costly, could realistically recover only a fraction of the production costs involved, and is further complicated by the fact that the main recipients of blood transfusion in sub-Saharan Africa are children and pregnant women. If cost-recovery for safe blood is to be attempted, the most viable option appears to be that of charging a collective fee, levied upon all inpatients, not just on those who receive blood. Such a mechanism is not without problems, not least in its failure to offer incentives for more appropriate blood use, and it is still likely to recover only a portion of the costs of producing safe blood. Whether or not cost-recovery is instituted, there will remain an important role for public funding of blood transfusion services, and, by implication, an important role for foreign donor support.

Financing reforms for the Thai health card scheme.

The Thai health card scheme originated from a pilot study on community financing and primary health care in maternal and child health in 1983. The scheme later changed to one of voluntary health insurance and finally received a matching subsidy from the government. The coverage of the scheme is described by a U-curve, i.e. it started with 5% of the total population in 1987, declined to 3% in 1992, with an upturn to 14% in 1997. The upturn has been the result of concerns about universal coverage policy, together with reforms of fund management. The provincial fund is responsible for basic health, basic medical, referral, and accident and emergency services. The central fund takes 2.5% of the total fund to manage cross-boundary services and high cost care (a reinsurance policy). On average, the utilization rate of the voluntary health card was higher than that of the compulsory (social security) scheme. And amongst three variants of health cards, the voluntary health card holders used health services twice to three times more than the community and health volunteer card holders. Cost recovery was low, especially in the provinces with low coverage. In the province with highest coverage, cost recovery was as high as 90% of the non-labour recurrent cost. Only 10% of the budgeted fund for reinsurance was disbursed, implying considerable management inefficiency. The management information system as well as the management capacity of the Health Insurance Office should be strengthened. After comparing the health card with other insurance schemes in terms of coverage, cost recovery, utilization and management cost, it is recommended that this voluntary health insurance should be modified to be a compulsory insurance, with some other means of premium collection and minimal co-payment at the point of delivery.

Benchmarks for health expenditures, services and outcomes in Africa during the 1990s.

There is limited information on national health expenditures, services, and outcomes in African countries during the 1990s. We intend to make statistical information available for national level comparisons. National level data were collected from numerous international databases, and supplemented by national household surveys and World Bank expenditure reviews. The results were tabulated and analysed in an exploratory fashion to provide benchmarks for groupings of African countries and individual country comparison. There is wide variation in scale and outcome of health care spending between African countries, with poorer countries tending to do worse than wealthier ones. From 1990-96, the median annual per capita government expenditure on health was nearly US$ 6, but averaged US$ 3 in the lowest-income countries, compared to US$ 72 in middle-income countries. Similar trends were found for health services and outcomes. Results from individual countries (particularly Ethiopia, Ghana, Côte d'Ivoire and Gabon) are used to indicate how the data can be used to identify areas of improvement in health system performance. Serious gaps in data, particularly concerning private sector delivery and financing, health service utilization, equity and efficiency measures, hinder more effective health management. Nonetheless, the data are useful for providing benchmarks for performance and for crudely identifying problem areas in health systems for individual countries.

Health sector reform and reproductive health in Latin America and the Caribbean: strengthening the links.

Many countries in Latin America and the Caribbean (LAC) are currently reforming their national health sectors and also implementing a comprehensive approach to reproductive health care. Three regional workshops to explore how health sector reform could improve reproductive health services have revealed the inherently complex, competing, and political nature of health sector reform and reproductive health. The objectives of reproductive health care can run parallel to those of health sector reform in that both are concerned with promoting equitable access to high quality care by means of integrated approaches to primary health care, and by the involvement of the public in setting health sector priorities. However, there is a serious risk that health reforms will be driven mainly by financial and/or political considerations and not by the need to improve the quality of health services as a basic human right. With only limited changes to the health systems in many Latin American and Caribbean countries and a handful of examples of positive progress resulting from reforms, the gap between rhetoric and practice remains wide.

African heads of state promise action against malaria.

PIP: Heads of state of Africa signed a pledge to reduce the continent's malaria mortality by 50% by 2110 at an international summit of Malaria in Abuja, Nigeria. The primary focus of the malaria control program will be insecticide-treated bednets. The WHO wants a 30-fold increase in the availability of bednets in the next 5 years, as well as immediate access to cheap and effective antimalarial combination therapy for families at risk of malaria, including pregnant women. Malaria control requires annual donations of US$1 billion from industrialized countries. However, donations alone will be insufficient unless there is immediate debt cancellation, says Jeffrey Sachs, director of the Center for International Development at Harvard. The World Bank also raised criticisms concerning the US$150 million annual donation. In response, Ok Pannenborg of the World Bank stated that there are 100 World Bank operations all over Africa and its US$150 million annual donation for African malarial control projects is money they can use, but whether they use it is another matter.^ieng

Financing of vaccines.

PIP: This article discusses the need to increase the financial assistance for vaccine development. A health situation was cited to present the intolerable impact of the shortfall in funding for vaccines. This situation, on the other hand, has awakened the world community to respond by forming organizations and projects that will help eliminate this kind of problem in the future. However, this renewed interest in vaccine development would be impossible if there is no adequate funding and political commitment. Furthermore, the research and development to conduct and achieve highly effective vaccines will require a hundred to a hundred million US dollars in annual combined public and private research expenditures. To help solve this problem, one suggested solution is the development of a global fund to support production and distribution of new vaccines. Aside from that, other alternatives being looked into are the mechanisms used in other sectors that generated successful funding. This leads to the idea of creating a new treaty, which will provide the flexibility to gain support from new constituencies, to strengthen institutions, and to create adequately strong budgetary commitments.^ieng

USA spearheads renewed efforts to combat AIDS.

PIP: This article presents the renewed efforts made by the US against AIDS. US Vice-President Al Gore claimed a US$150 million investment to help combat the international AIDS pandemic and contribute to international infectious disease control efforts. Likewise, the US will invest another US$100 million in HIV and AIDS prevention and treatment in Africa and Asia. It was also proposed that the US government would allocate US$325 million in the 2001 budget for worldwide HIV/AIDS prevention measures. Gore also promised that US$50 million would be allocated in February 2000 for funding, research, purchase and distribution of vaccines, as well as funding for militaries to prevent the spread of AIDS. Despite the increase in budget, the World Bank claims that the resources are inadequate for the fight against the epidemic. An annual allocation of US$1-2.3 billion would be necessary for AIDS prevention in Africa and currently Africa is receiving only US$160 million/year in official assistance for HIV/AIDS. The impact of AIDS has created societal instability and fertile ground for both internal and cross-border conflict. It was emphasized that without economic and social hope the nation would not have peace, and AIDS undermines both.^ieng

Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition.

This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality.

PIP: This paper summarizes results from eight country studies of inequality in the health sector. The analyses included household data to examine the distribution of service use and health expenditures. In each case, the results were presented by income quintiles, estimated using consumption expenditures. Results revealed that the rich groups have a higher probability of obtaining care when sick, to be more likely to be seen by physicians, and have a higher probability of receiving medicines, than the poor groups. The rich also spend more in absolute terms on care. There was no consistent pattern in the use of private providers. Wealthier households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicated that intuition concerning inequalities could result in misguided decisions. Thus, it would be worthwhile to measure the direction and extent of inequality in order to identify problems and to gauge the success of policy-making. Implications for further research are discussed.

Contraceptive equity bills continue to gain.

PIP: Contraceptive equity legislation could reduce the number of unintended pregnancies and the need for abortion by providing affordable and reliable contraception for women. However, businesses are not keen on the idea of covering contraception in health plans. They argue that the role of health insurance is to treat illness and provide a safety net between health disasters and destitution, thus excluding pregnancy since it is not an illness or a disaster. If this were the case, then erectile dysfunction would not qualify any more than pregnancy, yet health plans nationwide are agreeing to cover the drug Viagra. Moreover, they say that a change in policy would cause an immediate increase in reimbursement expenses, as well as stop small business from providing health coverage due to its cost. Helping women plan their pregnancies is cost-effective, and helping female employees prevent unintended pregnancies will save far more money than skimping on prescription coverage.^ieng

Nepal RH efforts to continue.

PIP: This article reports the activities undertaken by the Nepalese in order to sustain the JOICFP/Family Planning Association of Nepal (FPAN) project in the Panchkhal and Sunsari areas. With the end of UN Population Fund financial support to the project in 1999, Aiko Iijima, JOICFP Human Resource Division Director, visited Nepal to collaborate with project managers and community leaders in the project areas to help sustain the project activities. These activities covered 6 villages in Sunsari, which formed their own nongovernmental organizations and established a trust fund, while the remaining 5 villages are awaiting the approval of the Ministry of Health. Also through the JOICFP Voluntary Fund, 11 villages were provided with US$760, provided that each village raised a matching fund of at least 25%. Furthermore, FPAN proposed that 6 Japanese Overseas Cooperation Volunteers be dispatched to the project, and that a senior volunteer work with a Nepalese community health expert to support and supervise the volunteers. In addition, a Family Welfare Center was constructed in Sunsari, and the Village Health Committee of Haraicha, Morang District, organized a contest for the healthiest baby.^ieng

Volunteers who won't give up in Tanzania.

PIP: The voluntary position of community-based distribution agent (CBDA) is not one to be taken lightly. There are many responsibilities and burdens, and the community looks to CBDAs for guidance. However, when support for their activities stop and funding runs dry, many volunteers give up. Consequently, the Family Planning Association of Tanzania (UMATI) has gone to great lengths to ensure the quality and success of those chosen to be CBDAs, nurturing them into "volunteers who won't give up". In Tanzania, CBDAs are tested and selected through the joint efforts of the community and UMATI, and they therefore become respected members of the community. UMATI ensures their success by regular supervision and community participation. The active participation of the community leaders creates a sense of responsibility and ownership for a project, and this helps to support the CBDAs as well. UMATI's CBD training includes management of income generating activities (IGA), since the volunteers have to earn a living in addition to working for the community. There is also a network of support of IGAs that CBDAs can draw on. In addition to this support, there are nonmonetary incentives, such as bicycles and uniforms, which give the CBDAs a visible social presence. In some areas, village authorities have exempted CBDAs from other community services, and some villages provide space or land for IGAs for CBDAs. All of these factors, especially community support, lead to a very low dropout rate for volunteers, and the high morale and commitment of the CBDAs.^ieng

The development role of community banks in rural Nigeria.

PIP: This paper examined the development role of community banks in rural Nigeria by using the deposit mobilization capability and funding capacity in key sectors of the rural economy as yardsticks. By using a cluster sampling technique, it looks at the achievements of the community banking scheme initiative in terms of economic development. The scheme, established in 1991, has sustained itself and promoted rural development in the country. It is noted that communities have, for the first time, realized that they can advance their own economic fortunes. However, the scheme's performance as supporter of the agricultural sector has not been as well as expected, despite the fact that agriculture dominates Nigeria's rural economy. In view of this, non-banking activities are a welcome development since some of their approaches are proven to be knowledge enhancing and empowering for the rural population. Overall, community banks should attempt to strengthen non-banking approaches by collaborating more with self-help groups or nongovernmental organizations to be more empowering, results-oriented, and sustainable. Moreover, regulatory authorities should ensure that guidelines relate to credit application in terms of volume and sector allocation.^ieng

Gender impact assessment in microfinance and microenterprise: why and how.

PIP: This article discusses the reasons for conducting gender impact assessment in microfinance and microenterprise. Although women are increasingly being targeted in microfinance and microenterprise projects, this does not necessarily mean that gender relations are being taken into account. Rather, targeting women raises a host of questions about the context in which women are operating their businesses or handling finance. Assessing gender impact in microfinance and microenterprise can help answer the questions in order to understand whether women are able to use the services and make the anticipated improvements in their livelihoods. Moreover, several approaches are suggested: 1) establish a gender baseline; 2) consider the potential impacts of the project on gender relations; 3) establish the information and indicators required; and 4) collect and analyze the data using tools and techniques appropriate to the task. However, in the context of gender relations there remains much ground, which often cannot be openly discussed. The discussion of how people organize their financial and economic affairs inside the household is usually a delicate area. Hence, it is suggested that such matters should be handled very carefully and to consider the composition and dynamics of the research team itself.^ieng