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42. Rural-Urban Disparities in the Utilization of Mental Health Inpatient Services in China: The Role of Health Insurance
- Author:
- Junfang Xu, Jian Wang, Madeleine King, Ruiyun Liu, Fenghua Yu, Jinshui Xing, Lei Su, and Mingshan Lu
- Publication Date:
- 01-2018
- Content Type:
- Commentary and Analysis
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China’s on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China.
- Topic:
- Health, Health Care Policy, Mental Health, Urban, and Rural
- Political Geography:
- China and Asia
43. Substance Abuse Policy in Thailand: Current Challenges and Future Strategies
- Author:
- Darika Saingam
- Publication Date:
- 01-2018
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Substance abuse has been an important social and public health problem in Thailand for decades. The National Household Survey on Substance and Alcohol Use in Thailand, which has been conducted six times, shows that substance abuse has steadily increased. Extrapolated country-wide in recent data, the estimated number of people who have used at least one addictive substance at some time in their lives was 2,964,444 or 5.8% of the total population aged 12 - 65 years. Kratom, Methamphetamine, methamphetamine hydrochloride crystal (ice), and cannabis were the most prevalent substances of abuse. Historical documentation and policy reports were used in this study. The objectives of this study were to complete a document review, determine the effectiveness of previous measures to control illegal substance abuse in Thailand, and consider options for the future. Controlling illegal substance abuse in the future and minimizing total harm requires a delicate balance of efforts to reduce the prevalence, quantity, and harmful effects of substances. Drug policy interventions should be continually evaluated for their effectiveness. The strategies relevant to drug policy, apart from primary prevention, are health services for chronic drug users, reform of criminal sanctions against drug addicts, and legalization of kratom.
- Topic:
- Health, Drugs, and Substance Abuse
- Political Geography:
- Asia and Thailand
44. Dual Practice of Public Hospital Physicians in Vietnam
- Author:
- Ngan Do and Young Kyung Do
- Publication Date:
- 04-2018
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon of so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. The analysis is based on a hospital-based survey of 483 physicians at 10 public hospitals in four provinces of Vietnam. Nearly half of the participants in the study sample reported themselves as dual practitioners. Various types of private practice were mentioned. Private practice at health facilities owned by the private sector was the most prevalent, followed by private practice delivered at health facilities owned by the dual practitioners themselves. Private practice inside public hospitals was also noted. Dual practitioners were likely to be senior and hold management positions inside their public hospitals. Substantial income differences were found between dual practitioners and those physicians practicing in only the public sector. The majority of dual practitioners, however, reported the willingness to give up private practice if certain conditions were met, such as a basic salary increase or non-pecuniary benefits. The main reasons dual practitioners gave for not leaving the public sector included a sense of public responsibility and opportunities to gain a broader professional network and more training. This study reiterates the significant challenges associated with dual practice, including its financial implications and possible effects on health care quality and access. The need for a high-quality workforce committed to the public sector is particularly critical, given the possibility of universal insurance coverage. Future research should address the need to improve data collection on physicians’ dual practice and incorporate the topic in policy debates on health reform.
- Topic:
- Health, Health Care Policy, Reform, and Hospitals
- Political Geography:
- Asia and Vietnam
45. Economic Dimensions of Personalized and Precision Medicine in Asia: Evidence from Breast Cancer Treatment in Taiwan
- Author:
- Jui-fen Rachel Lu and Karen Eggleston
- Publication Date:
- 04-2018
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- High costs of precision medicine raise concerns about exacerbating income-related disparities in healthcare utilization and health outcomes. One approach to expanding coverage in Asia has been to cover the precision therapy but require the pharmaceutical firm to cover the costs of the companion diagnostic test. Taiwan’s National Health Insurance (NHI) adopted this approach for lung cancer, colorectal cancer and leukemia, but not for the first target therapy covered by NHI, trastuzumab for the treatment of HER2-positive breast cancer. Analyzing a unique dataset linking medical claims, cancer registry data and proxies for income between 2004 and 2015, we find that lower-income patients are more likely to be diagnosed with later stages of breast cancer, and this pattern renders NHI coverage of anti-HER2 therapy pro-poor even before full coverage of the diagnostic tests. Moreover, the expansion of NHI coverage—including the FISH diagnostic test and trastuzumab for early-stage breast cancer—strengthened the pro-poor distribution of genetic testing and target treatment, albeit only marginally. The extent of pharmaceutical company coverage of testing and its impact on patient access are topics of our ongoing research, contrasting breast cancer with colorectal cancer.
- Topic:
- Health, Health Care Policy, Economic Inequality, and Medicine
- Political Geography:
- Taiwan and Asia
46. Building Regulations For Faecal Sludge Management: Review of Building Regulations From Indian States
- Author:
- Arkaja Singh
- Publication Date:
- 12-2018
- Content Type:
- Special Report
- Institution:
- Centre for Policy Research, India
- Abstract:
- Getting approvals under the various building regulations applicable to any particular jurisdiction is often the first step in construction and development. The Report ‘Building Regulations for Faecal Sludge Management: Review of Building Regulations from Indian States’ seeks to understand how these building regulations address on-site sanitation, what kind of standards do they impose on developers, and how well do they incorporate mechanisms to enforce these standards. In this report, we look at six states: Andhra Pradesh, Odisha, Rajasthan, Tamil Nadu, Maharashtra, and Uttar Pradesh. We also look at other standards that are applicable to on-site containment of Faecal sludge, and the manner in which these standards get incorporated into the building regulations. We find that context-specific attention to On-Site Containment of Faecal Sludge is only given in very few states, at least within our sample size. Usually, Building Regulations seem to rely on already existing standards such as the National Building Code, 2016. Additionally, the inconsistencies within the bye-laws exhibit a lack of understanding on the issue of FSM, amongst the policy-makers. As Faecal Sludge Management is an issue at the interface of environment, sanitation, and public health, a lack of convergence between various departments of the government is also noticed.
- Topic:
- Environment, Government, Health, Regulation, and Sanitation
- Political Geography:
- South Asia, India, and Asia
47. Unpacking the Processes of Open Defecation Free Status in Udaipur: A case study of Udaipur, Rajasthan
- Author:
- Devashish Deshpande and Avani Kapur
- Publication Date:
- 08-2018
- Content Type:
- Case Study
- Institution:
- Centre for Policy Research, India
- Abstract:
- This report is the culmination of a study conducted by the Accountability Initiative (AI) on Swachh Bharat Mission-Gramin in 2017 on the request of the Udaipur district administration. The study understands the outcomes, and the processes, which led to Open Defecation Free status in selected Gram Panchayats.
- Topic:
- Development, Health, Social Policy, Sanitation, and Services
- Political Geography:
- South Asia, India, and Asia
48. ACKNOWLEDGING THE FLEXIBILITIES OF THE TRIPS AGREEMENT: ENSURING THE RIGHT TO ACCESS TO MEDICINES OR A STRATEGY OF PASSIVE REVOLUTION?
- Author:
- Sevgi BALKAN-ŞAHİN
- Publication Date:
- 10-2018
- Content Type:
- Journal Article
- Journal:
- Alternative Politics
- Institution:
- Department of International Relations, Abant Izzet Baysal University, Turkey
- Abstract:
- The Doha Ministerial Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and Public Health adopted in November 2001 clarified the right to use the TRIPS flexibilities to promote public health. Examining the hegemonic struggle of opposing social forces from a neo-Gramscian perspective, the paper attributes this outcome to the strategy of trasformismo used by market-oriented social forces to legitimize the policies of the World Trade Organization (WTO) and prevent resistance against the market-driven TRIPS Agreement. It argues that although non-governmental organizations (NGOs) such as Medecins Sans Frontieres, Third World Network, and Oxfam worked as a counter-hegemonic force to ensure the access of least developed countries to generic versions of patented drugs, flexibilities confirmed by the Doha Declaration can be seen more as a strategy of trasformismo to absorb counter-hegemonic ideas than the counter-hegemonic groups’ successful incorporation of the right to ensure public health into the TRIPS Agreement.
- Topic:
- Health, World Trade Organization, Hegemony, Health Care Policy, NGOs, and Public Health
- Political Geography:
- United States, Europe, Asia, and North America
49. Infrastructure, Gender and Violence: Women and Slum Sanitation Inequalities in Delhi
- Author:
- Susan Esme Chaplin and Reetika Kalita
- Publication Date:
- 10-2017
- Content Type:
- Special Report
- Institution:
- Centre for Policy Research, India
- Abstract:
- In Delhi, as in many other Indian cities, millions of men, women and children who live in slums and informal settlements haveto daily confront the lack of adequate sanitation facilities. These sanitation inequalities have a greater impact on the health and socioeconomic status of women and girls because of their greater social vulnerability to sexual violence; there is also the role played by biology in their need for privacy, safety and cleanliness. Men and boys, on the other hand, tend to use public urinals and open defecation (OD) sites generally more frequently, because their need for privacy during these sanitation activities is not such a cause for concern. In addition, women and girls are forced every day to risk using precarious spaces for their sanitation activities that may expose them to gender-based violence and harassment and not satisfy their biological and socio-cultural needs. These urban sanitation inequalities also negatively impact the time women have available for paid employment as well as their daily domestic responsibilities, as they have to spend each morning queuing for toilets or getting up earlier to go with other women to OD sites. For adolescent girls this can often mean being late for school, which threatens their education and future life choices. India failed to meet Millennium Development Goal No. 7 (adopted by the United Nations in 2000) relating to halving the proportion of people without access to basic sanitation. In terms of toilet usage across India, the Census 2011 found that 81 percent of urban households had a private toilet or latrine. But when it came to slum households, only 66 percent had a toilet, meaning that 34 percent had to either use a community or public toilet or resort to OD (Ministry of Housing and Urban Poverty Alleviation & National Buildings Organisations 2013, p. 60). In reality, there are an estimated 41 million urban dwellers still practising OD because of a lack of access to improved sanitation (WaterAid 2016). OD is a compulsion, not a choice, and creates particular risks and imposes a variety of harms upon women and children that men and boys do not suffer. Who or what is responsible for such socioeconomic consequences of the lack of adequate sanitation infrastructure in Indian cities which perpetuate gender inequalities? How do harms like gender-based violence impact the everyday lives of women and girls living in slums in particular? This project report examines these issues using the notion of infrastructural violence and then examines the harms and suffering caused by a lack of sanitation infrastructure in two long-established localities in Delhi: Mangolpuri and Kusumpur Pahari. Mangolpuri is a resettlement colony in the northwest region of Delhi with an estimated population of more than 350,000. It is interspersed with eight JJCs clusters of varying sizes. Kusumpur Pahari is located in the heart of south Delhi, near Jawaharlal Nehru University, and now has five blocks of JJCs and an estimated population of nearly 50,000.
- Topic:
- Development, Gender Issues, Health, Children, Women, Income Inequality, and Sanitation
- Political Geography:
- South Asia, India, and Asia
50. Bird Flu — It’s What’s for Dinner: What Human Population Growth and Climate Change Mean for the Future of Avian Influenza Outbreaks
- Author:
- Nahid Bhadelia
- Publication Date:
- 07-2017
- Content Type:
- Journal Article
- Journal:
- Fletcher Security Review
- Institution:
- The Fletcher School, Tufts University
- Abstract:
- China is currently experiencing its fifth epidemic of “bird flu,” or avian influenza H7N9, since 2013 when it was first noted to cause human infections. The virus, which is mainly transmitted from poultry to humans, is also prone to limited human-to-human transmission. To date, there have been 1,258 human cases, with one-third of those cases (460) occurring during this year’s epidemic alone.[1] There are many “subtypes” of avian influenza circulating in birds around the world and most of these viruses cause limited or no human infections. However, two avian influenzas subtypes causing high human mortality have jumped from birds to humans in the last decade, H5N1 and then H7N9. The significant potential of this class of viruses to cause a human pandemic is a global public health concern, particularly because the conditions leading to the rise of these infections are becoming more favorable — for the viruses.
- Topic:
- Climate Change, Environment, Health, and Infectious Diseases
- Political Geography:
- China, Asia, and Global Focus