Universal health coverage is an aspirational goal "to ensure that all people obtain the health services they need without suffering financial hardship when paying for them." To move toward greater health coverage, low-income countries can foster health systems that increase utilization, improve scope of services, and reduce financial costs to care. Voucher programs operate on both the demand and supply sides to target subsidies to beneficiaries, who in the absence of the subsidy, would likely not afford the healthcare. Governments that create these programs and take them to scale can expect to see greater utilization of priority health services by disadvantaged and can protect low-income populations from catastrophic health expenditure. As national risk pools mature, these voucher programs can become the foundation for larger, more comprehensive health purchasing agencies that cover the whole population with high quality, low cost healthcare.
Sumar Program's Universal Coverage: Achievements & New Goals Towards 2020RBFHealth
A presentation by Martín Sabignoso of Argentina's Ministry of Health delivered at the RBF Health Seminar, QOn the Road to Effective Universal Health Coverage: What’s New in Argentina’s Use of Performance Incentives? on June 11, 2015.
Effect of Voucher Programs on Utilization, Out-of-Pocket Expenditure and Qual...RBFHealth
A presentation by Timothy Abuya, delivered at the RBF Health Seminar, The Role of Vouchers in Serving Disadvantaged Populations and Improving Quality of Care.
The Devil is in the Details: Designing and Implementing UHC Policies that Rea...HFG Project
This presentation was given by Suneeta Sharma at a side session at the Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand, on January 29, 2017.
WHO Implementation Research Program on Factors Explaining Success and Failure...RBFHealth
A presentation by Maryam Bigdeli, delivered during "Transforming Health Systems Through Results-Based Financing," an event held during the Third Global Symposium on Health Systems Research in Cape Town on September 30, 2014. This event was hosted by the Health Results Innovation Trust Fund at The World Bank, in partnership with the PBF Community of Practice in Africa.
As mandated in the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, CDC’s BioSense program was launched in 2003 with the aim of establishing an integrated system of nationwide public health surveillance for the early detection and prompt assessment of potential bioterrorism-related illness. Over the following several years, as awareness grew about the limits of syndromic and related automated surveillance systems, including BioSense, in providing early and accurate epidemic alerts, increased emphasis was placed on their use in providing timely situation awareness throughout the course of public health emergencies. In practice, a key application of these systems has been their use in tracking the course of seasonal influenza and, in 2009, the impact of the H1N1 influenza pandemic. While retaining the original purpose of BioSense of early event (or threat) detection and characterization, we believe the most efficient and effective approach to achieve the program’s long-term business case is to build on existing systems and programs. This will have additional public health benefits that can improve the nation’s health at all times, including: 1. Public health situation awareness, 2. Routine public health practice, 3. Improving health outcomes and public health; and 4. Monitoring healthcare quality
How can health accounts inform health sector investments? Lessons from countr...HFG Project
Countries must have a firm grasp on their health financing landscape in order to ensure sufficient and effective use of resources. Health Accounts—an internationally standardized methodology that allows a country to understand the source, magnitude, and flow of funds through its health sector—provide a wealth of information on past spending. When combined with macroeconomic, health utilization, and health indicator data, Health Accounts provide powerful insights for health financing policy.
USAID’s Health Finance and Governance (HFG) project supports countries to institutionalize their Health Accounts so that they are produced regularly and efficiently, and are a useful tool for policymakers. In this technical briefing webinar, held June 29, 2016, HFG experts used country examples to demonstrate how Health Accounts have been (and can be) used to inform national health financing decisions. The experts also provided perspectives on the future of Health Accounts.
Sumar Program's Universal Coverage: Achievements & New Goals Towards 2020RBFHealth
A presentation by Martín Sabignoso of Argentina's Ministry of Health delivered at the RBF Health Seminar, QOn the Road to Effective Universal Health Coverage: What’s New in Argentina’s Use of Performance Incentives? on June 11, 2015.
Effect of Voucher Programs on Utilization, Out-of-Pocket Expenditure and Qual...RBFHealth
A presentation by Timothy Abuya, delivered at the RBF Health Seminar, The Role of Vouchers in Serving Disadvantaged Populations and Improving Quality of Care.
The Devil is in the Details: Designing and Implementing UHC Policies that Rea...HFG Project
This presentation was given by Suneeta Sharma at a side session at the Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand, on January 29, 2017.
WHO Implementation Research Program on Factors Explaining Success and Failure...RBFHealth
A presentation by Maryam Bigdeli, delivered during "Transforming Health Systems Through Results-Based Financing," an event held during the Third Global Symposium on Health Systems Research in Cape Town on September 30, 2014. This event was hosted by the Health Results Innovation Trust Fund at The World Bank, in partnership with the PBF Community of Practice in Africa.
As mandated in the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, CDC’s BioSense program was launched in 2003 with the aim of establishing an integrated system of nationwide public health surveillance for the early detection and prompt assessment of potential bioterrorism-related illness. Over the following several years, as awareness grew about the limits of syndromic and related automated surveillance systems, including BioSense, in providing early and accurate epidemic alerts, increased emphasis was placed on their use in providing timely situation awareness throughout the course of public health emergencies. In practice, a key application of these systems has been their use in tracking the course of seasonal influenza and, in 2009, the impact of the H1N1 influenza pandemic. While retaining the original purpose of BioSense of early event (or threat) detection and characterization, we believe the most efficient and effective approach to achieve the program’s long-term business case is to build on existing systems and programs. This will have additional public health benefits that can improve the nation’s health at all times, including: 1. Public health situation awareness, 2. Routine public health practice, 3. Improving health outcomes and public health; and 4. Monitoring healthcare quality
How can health accounts inform health sector investments? Lessons from countr...HFG Project
Countries must have a firm grasp on their health financing landscape in order to ensure sufficient and effective use of resources. Health Accounts—an internationally standardized methodology that allows a country to understand the source, magnitude, and flow of funds through its health sector—provide a wealth of information on past spending. When combined with macroeconomic, health utilization, and health indicator data, Health Accounts provide powerful insights for health financing policy.
USAID’s Health Finance and Governance (HFG) project supports countries to institutionalize their Health Accounts so that they are produced regularly and efficiently, and are a useful tool for policymakers. In this technical briefing webinar, held June 29, 2016, HFG experts used country examples to demonstrate how Health Accounts have been (and can be) used to inform national health financing decisions. The experts also provided perspectives on the future of Health Accounts.
From Advocacy to Accountability: Empowering communities throughout the UHC Pr...HFG Project
This presentation was presented by Ricardo Valladares Cardona at a side session at the Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand, on January 29, 2017.
The Science of Delivery: Use of Administrative Data in The HRITF PortfolioRBFHealth
A presentation by Ha Thi Hong Nguyen, delivered during "Transforming Health Systems Through Results-Based Financing," an event held during the Third Global Symposium on Health Systems Research in Cape Town on September 30, 2014. This event was hosted by the Health Results Innovation Trust Fund at The World Bank, in partnership with the PBF Community of Practice in Africa.
Health Outcomes: What Does the Evidence Tell us about the Impact of Health Sy...HFG Project
Presented at USAID's Global Health Mini-University, March 2016.
Laurel Hatt (HFG), Ben Johns (HFG), Joe Naimoli (USAID/GH/OHS)
USAID’s Office of Health Systems and the HFG Project recently launched the Impact of Health Systems Strengthening on Health report, which for the first time presents a significant body of peer-reviewed evidence linking health systems strengthening interventions to measurable impacts on health outcomes. The report identifies 13 types of health systems strengthening interventions with quantifiable effects. It shares evidence on how to strengthen health system performance to achieve sustainable health improvements at scale, particularly toward EPCMD, an AFG, and protecting communities against infectious diseases. Interventions were found to be associated with reductions in mortality and morbidity for a range of conditions, including diarrhea, malnutrition, low birth weight, and diabetes. HSS interventions are also associated with improvements in service utilization, financial protection, and quality service provision.
Presentation given by Eric C. Schneider, MD, Senior Vice President for Policy and Research of The Commonwealth Fund at the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, MI on December 7, 2017.
The Future of Personalizing Care Management & the Patient ExperienceRaphael Louis Vitón
Actionable segmentation model findings - by Raphael Louis Vitón & Dream team of industry experts, physicians and leaders from Blue Cross, GEHealthCare, RingLeaderVentures, Maddock Douglas, Dr.Daniel Friedland, etc working on improving health outcomes by Personalizing the Care Management business model for Better Outcomes & Better Economics (through patient empowerment)
Preparing for future shocks: Building resilient health systemsHFG Project
Presentation at USAID's Global Health Mini-University on Friday, March 4, 2016.
Preparing for Future Shocks: Building Resilient Health Systems
Kate Greene (HFG), Bob Emrey (USAID/GH/OHS), Jodi Charles (USAID/GH/OHS), Temitayo Ifafore, (USAID/GH/OHS)
After the recent Ebola outbreak, global health experts have turned to resilience frameworks used by other fields such as agriculture and engineering to understand how to build health systems that can withstand shocks, including infectious disease outbreaks, natural disasters, and political conflict. Speakers will first briefly outline each of the five key elements of the Resilience Framework, adapted from the Rockefeller Foundation and presented in a Lancet article in 2015, that can be applied to health systems. Participants will then work in small groups to discuss which health systems interventions should be pursued in response to a one-page description of an unnamed country. Speakers will then reveal what real-world interventions they designed for the country example and answer questions.
From Advocacy to Accountability: Empowering communities throughout the UHC Pr...HFG Project
This presentation was presented by Ricardo Valladares Cardona at a side session at the Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand, on January 29, 2017.
The Science of Delivery: Use of Administrative Data in The HRITF PortfolioRBFHealth
A presentation by Ha Thi Hong Nguyen, delivered during "Transforming Health Systems Through Results-Based Financing," an event held during the Third Global Symposium on Health Systems Research in Cape Town on September 30, 2014. This event was hosted by the Health Results Innovation Trust Fund at The World Bank, in partnership with the PBF Community of Practice in Africa.
Health Outcomes: What Does the Evidence Tell us about the Impact of Health Sy...HFG Project
Presented at USAID's Global Health Mini-University, March 2016.
Laurel Hatt (HFG), Ben Johns (HFG), Joe Naimoli (USAID/GH/OHS)
USAID’s Office of Health Systems and the HFG Project recently launched the Impact of Health Systems Strengthening on Health report, which for the first time presents a significant body of peer-reviewed evidence linking health systems strengthening interventions to measurable impacts on health outcomes. The report identifies 13 types of health systems strengthening interventions with quantifiable effects. It shares evidence on how to strengthen health system performance to achieve sustainable health improvements at scale, particularly toward EPCMD, an AFG, and protecting communities against infectious diseases. Interventions were found to be associated with reductions in mortality and morbidity for a range of conditions, including diarrhea, malnutrition, low birth weight, and diabetes. HSS interventions are also associated with improvements in service utilization, financial protection, and quality service provision.
Presentation given by Eric C. Schneider, MD, Senior Vice President for Policy and Research of The Commonwealth Fund at the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, MI on December 7, 2017.
The Future of Personalizing Care Management & the Patient ExperienceRaphael Louis Vitón
Actionable segmentation model findings - by Raphael Louis Vitón & Dream team of industry experts, physicians and leaders from Blue Cross, GEHealthCare, RingLeaderVentures, Maddock Douglas, Dr.Daniel Friedland, etc working on improving health outcomes by Personalizing the Care Management business model for Better Outcomes & Better Economics (through patient empowerment)
Preparing for future shocks: Building resilient health systemsHFG Project
Presentation at USAID's Global Health Mini-University on Friday, March 4, 2016.
Preparing for Future Shocks: Building Resilient Health Systems
Kate Greene (HFG), Bob Emrey (USAID/GH/OHS), Jodi Charles (USAID/GH/OHS), Temitayo Ifafore, (USAID/GH/OHS)
After the recent Ebola outbreak, global health experts have turned to resilience frameworks used by other fields such as agriculture and engineering to understand how to build health systems that can withstand shocks, including infectious disease outbreaks, natural disasters, and political conflict. Speakers will first briefly outline each of the five key elements of the Resilience Framework, adapted from the Rockefeller Foundation and presented in a Lancet article in 2015, that can be applied to health systems. Participants will then work in small groups to discuss which health systems interventions should be pursued in response to a one-page description of an unnamed country. Speakers will then reveal what real-world interventions they designed for the country example and answer questions.
Measuring to Manage Progress toward Universal Health CoverageBen Bellows
In spite of greater economic convergence globally, as low-income countries grow into middle-income country economies, intra-country inequalities – economic, social, and health status – risk being exacerbated. To expand access to high quality healthcare at low cost at point of care, guidance is needed to identify effective performance measures to gauge progress. Is is increasing access to the current healthcare package to new users, is it adding more or better healthcare for current beneficiaries, or is healthcare expansion to be understood as lower prices and greater protection from out-of-pocket spending on health services? Results are presented from a 2012 pilot of two equity measures that set out to determine whether either of the measures was more practical to implement at lower cost and easily understood by social protection program managers. Recommendations are made for integrating these measures into existing programs.
The explosion in the number of applications (apps) designed for the medical and wellness sectors has been noted by many. Recently we have seen increased presence of truly medical apps, in addition to consumer health and wellbeing apps, designed for clinical professionals and patients with medical conditions.
Consumer based mHealth apps typically allow people to do old things in new ways, such as recording health measures digitally rather than on paper. We see this also with medical apps, where increases in the quality and efficiency of existing health care models provide clinical staff with digital tools that replace paper based documentation. In rare and exciting cases we are also seeing mHealth applications that are doing things in entirely new ways to drive real innovation in health care delivery through mobile devices.
The aim of the tutorial is to highlight real world, high impact mobile research that is relevant to the key discipline of Mobile HCI. Thus, the tutorial will be application rather than academically focused. The tutorial will highlight the wide range of mHealth applications available that go far beyond trackers and behavior change tools and encourage researchers to look beyond consumer applications in their research. Four key areas of mHealth applications will be covered including Apps for the HealthyWell, mHealth in Hospitals, Practice and Clinical Apps and Patient Apps and will cover applications for health assessment, treatment and triage, behavior change, chronic illness, mental health, adolescent health, rehabilitation and age care with a focus on the need for rigorous evaluation and efficacy analysis.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
A presentation by Ben Bellows, delivered at the RBF Health Seminar, The Role of Vouchers in Serving Disadvantaged Populations and Improving Quality of Care.
A preliminary proposal for an application to the Health Care Innovation Challenge sponsored by CMS. Focus of this proposal include gestational diabetes, maternal obesity, postpartum weight loss, and as well as patient engagement / health literacy
Overview of Community Based Health Insurance LessonsHFG Project
Presentation during the Institutionalizing Community Health Conference in Johannesburg, South Africa, on March 28th, 2017. This presentation gives an overview of Community-based Health Insurance (CBHI), and explores country experiences and lessons with CBHI in Rwanda, Ghana, and Senegal.
Overview of Community Based Health Insurance LessonsHFG Project
Presentation during the Institutionalizing Community Health Conference in Johannesburg, South Africa, on March 28th, 2017. This presentation gives an overview of Community-based Health Insurance (CBHI), and explores country experiences and lessons with CBHI in Rwanda, Ghana, and Senegal.
CMS Innovation Center, Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative.
More at: http://innovations.cms.gov/resources/Strong-Start-Webinar-State-Partnerships.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Services hosted a webinar on Thursday, April 14, 2016. During this webinar staff provided an overview of the model. A repeat of the webinar was held on Tuesday, April 19.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
Similar to Can vouchers help move health systems toward universal health coverage? (20)
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Can vouchers help move health systems toward universal health coverage?
1. Can vouchers help move
health systems toward
universal health
coverage?
Ben Bellows
GIC Forum on Health and Social Protection
27 August 2013
2. Problem: inequality within country
"Countries across Africa [and Asia] are
becoming richer but whole sections of society
are being left behind.... The current
pattern of trickle-down growth is
leaving too many people in poverty, too
many children hungry and too many young
people without jobs."
- Africa Progress Panel, May 2012
3. • Of 12 MNH interventions in a review of
public data across 54 countries, family
planning was the third most inequitable
*Barros, A. J. D., Ronsmans, C., et al. (2012). Equity in maternal, newborn, and child health interventions in Countdown to
2015: a retrospective review of survey data from 54 countries . Lancet, 379(9822), 1225-33.
4. constraints^3 to financing UHC
in a finite universe
• Trade-offs in three dimensions
1. Utilization: expand population covered?
2. Scope: expand health services offered?
3. Financial protection: increase size of
subsidies per service (or improve
regulation of informal charges)?
How universal can vouchers really be?
Despite growing evidence for vouchers’
mpressive impact in terms of equity,
financial protection and quality of care, they
remain for now a specific tool to enable
underserved groups to access priority
services. However the WHO’s ‘cube’ frames
progress towards UHC in terms of the share
of people, services and costs covered, with
a focus on growing these three dimensions
as far as possible
xi
. Given this
understanding of UHC, how important can
vouchers’ contribution to UHC really be?
The first point to remember is that vouchers
do not have to be targeted. For example, all
families were eligible for the wildly successful Pitfall 1: Social Health Insurance can
Figure 1: WHO's Universal Health Coverage 'Cube'
5. Financing trade-offs
• Finance movement toward UHC either
from a greater budget allocation or
greater efficiency
• Interventions that generate greatest
efficiency will likely operate on supply &
demand
6. Voucher functions (management)
• Decide to government-run, contract-out, or franchise
• Conduct provider administrative & clinical training (i.e. CMEs)
• Design & maintain claims processing & fraud control
• Monitor costs, utilization, quality
• Offer credit to facilities
Facility
• Accredited?
• Clinical quality?
• Competition?
• Reimbursement rates?
Client
• Poverty status & need?
• Voucher is free or fee?
• Which services
offered?
Program design & functions
Objective – reach beneficiaries who in the absence
of subsidy would not have sought equivalent care
7. What can vouchers do & where
are the gaps in knowledge?
• Recent review catalogued 40 programs
that used vouchers for reproductive
health services (excluded TB and
coupons for health products)
• Summarized evidence from multiple
studies of 21 voucher programs
8. Number of active reproductive health voucher
programs
0
5
10
15
20
25
30
Small (<$250k /yr)
Medium ($250k-
$1m /yr)
Large (>$1m /yr)
9. Program contracts with public & private
providers
18
6
10
1
5
0
2
4
6
8
10
12
14
16
18
20
private mostly private mixed mostly public public
10. Outcome
type
Number of
studies
Direction of effect & gaps in research
Equity or
targeting
8 studies Positive effects: inequalities were
reduced.
Missing: nationally standard measures.
Costing 4 studies Positive effects: OOP spending reduced.
Missing: cost-effectiveness,
administrative-to-service delivery ratio
Knowledge 5 studies Positive effects: increased knowledge of
important health conditions.
Missing: measures of community norms
and partner knowledge.
Evaluation outcomes (1 of 2)
11. Outcome
type
Number of
studies
Direction of effect & gaps in research
Utilization 17 studies Positive effects: increased use of ANC,
facility deliveries and contraceptives.
Missing: Postnatal care.
Quality 8 studies Positive effects: improved customer care,
infrastructure upgrades.
Missing: clinical care scores.
Health 8 studies Positive effects: decreases in STI
prevalence, fewer stillbirths, fewer
unwanted pregnancies
Missing: maternal mortality, DALYs
averted, CYPs
Evaluation outcomes (2 of 2)
12. Prospective studies 2009-2013
• Quasi-experimental design for voucher
programs about to launch or expand
• Measure change in:
• utilization (new users, aggregate use)
• equity (concentration indices, standard
quintiles)
• quality of care frameworks (Donabedian,
Respectful Care, facility investments)
• out-of-pocket spending on healthcare
13. Data sources:
• 2 rounds of household surveys
• 4 voucher & 3 non-voucher
sites
• 5 km radius from voucher &
comparison facilities
• Births within two years before
survey
• 2010-11: 962 births among
2,933 women 15-49 years
• 2012: 1,494 births among
3,094 women 15-49 years
Study #1, Demand: Study of voucher
utilization in Kenya
Data sources
14. Analysis
• Cross tabulation with Chi-square tests
• births by place of delivery over time
• Multilevel random-intercept logit analysis
𝑙𝑜𝑔𝑖𝑡 (𝜋𝑖𝑗𝑘)= 𝑋𝑖𝑗𝑘β + µ𝑗𝑘
• Three arm design
• 2006 voucher arm: respondents within 5km of
facilities in program since 2006
• 2010-11 voucher arm: respondents within 5km of
facilities added to program in 2010 & 2011
• Comparison arm: respondents within 5 km of non-
voucher facilities
14
15. 2006 voucher
arm
2011 voucher
arm
Comparison arm
Place of
delivery
First
survey
Second
survey
First
survey
Second
survey
First
survey
Second
survey
Home 32% 21% 59% 47% 45% 42%
Health
facility
66% 79% 39% 51% 54% 57%
Public
facility
45% 49% 32% 36% 41% 44%
Private
facility
21% 30% 7% 15% 13% 13%
p-value p<0.01 p<0.01 p=0.59
Change in place of delivery
16. Outcome 2006
voucher arm
2010-11
voucher arm
Comparison
arm
Facility
delivery
2.04**
(1.40-2.98)
1.72**
(1.22-2.43)
1.32
(0.96-1.81)
Home delivery 0.53**
(0.36-0.78)
0.61**
(0.43-0.85)
0.75
(0.54-1.03)
Adjusted odds ratios
• Changes consistent with increased use of
vouchers by respondents
• 2006 voucher arm: 20% -> 43%
• 2010-11 voucher arm: 11% -> 45%
• Comparison arm: 0% in both rounds
17. Limitations of analysis
• Teasing out direct and indirect effects of
the program on facility delivery
• Identification of respondents within
specified distances to facilities could affect
over or under-estimation of impact
• Most covariates for multivariate analysis
pertain to time of interview
• Changes in time dependent co-variates
could affect access to facilities
18. Study
#2,
Supply:
Facility
use
of
reimbursements
• Cross
sectional
data
from
77
accredited
facilities
• Retrospective
measurement
of
how
accredited
facilities
allocated
revenues
across
six
standard
cost
categories
for
phase
1
(2006-‐2008)
and
phase
2
(2008-‐2011)
• A
structured
questionnaire
sent
to
accredited
facilities
• 88%
response
rate
achieved
• Responses
analyzed
to
show
percentages
of
revenue
used
in
standard
accounting
categories
19. Use
of
revenue
by
category
in
Phase
2
9%
6%
33%
35%
11%
7%
0%
5%
10%
15%
20%
25%
30%
35%
40%
20. Revenue
source
before
vouchers
program
Prior
to
the
GoK
Voucher
program
81%
of
the
facili7es
reported
that
following
the
launch
of
the
voucher
program,
the
voucher
program
has
been
their
main
revenue.
Revenue
Source
Public
Facilities
Private
Facilities
FBOs
Government
50%
0
0
Self-‐generated
revenue
31%
57%
53%
Bank
Loans
0
43%
0
Donors
19%
0
37%
21. Facilities
also
reported…
Challenges
in
accessing
and
purchasing
medical
and
non-‐
medical
supplies.
Voucher
revenue
used
to:
1. Cover
the
financing
shorDall
for
purchases
2. Increase
capacity
and
provide
more
services
3. Improve
service
quality
and
increase
pa7ent
volumes/
bed
capacity
Flexibility
in
using
revenue
may
help
overcome
perennial
problems
of
centrally
managed,
public
sector
supply
and
commodity
constraints
and
private
sector
financing
gaps
to
provide
beMer
healthcare
services.
22. In a scaled vouchers strategy that
moves us toward UHC, which trade-
offs would be less painful than others?
Is this a more efficient option p than
alternatives?How universal can vouchers really be?
Despite growing evidence for vouchers’
mpressive impact in terms of equity,
financial protection and quality of care, they
remain for now a specific tool to enable
underserved groups to access priority
services. However the WHO’s ‘cube’ frames
progress towards UHC in terms of the share
of people, services and costs covered, with
a focus on growing these three dimensions
as far as possible
xi
. Given this
understanding of UHC, how important can
vouchers’ contribution to UHC really be?
The first point to remember is that vouchers
do not have to be targeted. For example, all
families were eligible for the wildly successful Pitfall 1: Social Health Insurance can
Figure 1: WHO's Universal Health Coverage 'Cube'
23. US$
millions
70%
coverage
of
2
lowest
quintiles
2013
2014
2015
Service
delivery
cost
23
29
32
Management
cost
(15-‐20%)
3
6
6
Total
cost:
Maternal
voucher
27
35
38
%
MOH
2011-‐12
budget
$813m
3.3%
4.3%
4.7%
Family
planning
service
cost
16
17
20
Management
cost
(15-‐20%)
3
3
3
Total
cost:
FP
voucher
19
20
22
%
MOH
2011-‐12
budget
$813m
2.3%
2.5%
2.7%
Think like a demographer. An incremental
allocation could take vouchers to scale
24. UHC & vouchers - Equity
• Voucher clients are often identified as poor,
with a low likelihood of using care
• Vouchers educate households to use service,
even when the service is free (“patient’s
charter”)
• Vouchers can control informal payments
• Vouchers provide managers with data on
eligible households, utilization, and feedback
on populations that need extra mobilization
• Vouchers can be targeted to the poor to pay
their insurance premiums
25. UHC & vouchers- Financial
protection
• Voucher clients receive a subsidy and
avoid paying out-of-pocket at point-of-
care
• Voucher programs often contract
private facilities, which expand access
and improve the likelihood that
households will avoid OOP
26. UHC & vouchers- Quality of care
• Accreditation standards screen out
underperforming facilities
• Reimbursements paid conditional on
meeting minimum service delivery
requirements
• Quality-adjusted reimbursements are
possible
26