Changes In Funding Policies Research Articles

Higher Education Funding Policy and Research Productivity of Universities in Georgia

This research study explores the existing funding systems of higher education in Georgia and their influence on universities’ research productivity. The research used Harman’s (2007) typology of research funding— institutional, project, and special program—to analyze each approach’s effect on universities’ research productivity. The research revealed that these funding models did not substantially affect the development of scholarly and research capacity. Major barriers to the development of higher education and research are largely related to the amount and financing models. Analysis of the higher education financing policy showed that per capita financing does not allow sufficient research activities at HEI, and targeted financing programs oriented toward developing specific scientific directions or improving scientific infrastructure do not promote research productivity. Based on research findings, the author argues that immediate changes in funding policy are required for the institutional development of university-based research in higher education of Georgia.

Outcomes of patients with T1a,b N0 Her2-positive breast cancer treated with adjuvant trastuzumab in a prospective registry in Ontario, Canada.

533 Background: Multiple randomized trials of chemo +/- tras in early stage, Her 2 positive BrCa demonstrated improvement in survival, but patients (pts) with T1a,b N0 disease were mostly excluded. Given the uncertainty of benefit in this group and the toxicities of chemo + tras, treatment in Ontario was funded for these patients conditional upon data collection for toxicity and survival endpoints. We report the outcomes for 483 patients enrolled in this Evidence Building Program (EBP). Methods: Between 2011 and 2018, 483 eligible pts with Her 2 pos disease and adequate cardiac function were treated with chemo + tras in the EBP. Cardiac toxicity, febrile neutropenia (FN), event-free (EFS), and overall survival (OS) were determined for this cohort from administrative datasets, and compared retrospectively to controls of similar stage selected from the Ontario Cancer Registry who did not receive tras and/or chemo. For the EBP cohort, clinicians also reported changes in left ventricular ejection fraction (LVEF). Results: Pt characteristics are shown in the Table. EBP patients had improved OS when compared to controls who received no chemo or tras. The 3-year OS in the EBP pts was 99.1%, versus 96.9% in the controls [adjusted HR 0.59 (95% CI 0.29-1.20)]. Patients receiving EBP tras had a significantly longer EFS than controls with or without chemo [adjusted HR 0.54 (0.36-0.83), p=0.005]. Use of chemo + tras in EBP pts was associated with an increased risk of clinical congestive heart disease (CHD) and febrile neutropenia (FN). About 3.5% of pts experienced CHD during treatment with chemo + tras. About 6% of pts had an absolute reduction of LVEF >10% or reached LVEF <50%. In an adjusted analysis, the risk of CHD was higher in older pts [HR 1.06 (1.03-1.08) per 1-yr increase in age, p<0.0001) and for pts who received anthracyclines [HR 5.00 (1.71-14.7). In a matched analysis, the crude frequency of FN during treatment was 20% in EBP pts vs. 3% among controls who did not receive chemo or tras (p<0.001). Conclusions: Analysis of the Ontario EBP for pts with, T1a,b N0 HER2 pos BrCa revealed that the prognosis is excellent and is improved with the use of chemo + tras. The safety profile was expected and tolerable, especially when non anthracycline chemo was used. These results led to a funding policy change where prospective data collection has been discontinued and chemo + tras is now routinely funded in this population. [Table: see text]

Incentivizing Effort Allocation Through Resource Allocation: Evidence from Scientists’ Response to Changes in Funding Policy

Prior research in management and economics has predominantly focused on how managers or policymakers can shape workers’ allocation of effort using output-based or effort-based incentives. In many settings, however, managers may seek to influence workers’ effort choices through resource allocation—that is, changing the cost of securing resources for different projects or activities. In this paper, we develop a formal model to investigate how a worker changes the allocation of a fixed amount of effort across different projects in response to changes in the cost of securing resources for each project. Our model shows how cutting resources available to one project, under certain circumstances, can inadvertently reduce the share of effort allocated to other projects and vice versa. We use the insights from the model to explore the effectiveness of funding strategies designed to influence the research direction of academic scientists. We specifically examine how U.S. scientists working in stem cell research responded to a 2001 policy change that restricted access to federal funding for research in the human embryonic stem cell (hESC) area. In line with our model’s predictions, we find that cutting resources for hESC research inadvertently reduced U.S. scientists’ output in non-hESC areas of stem cell research—an effect that is strongest among the highest-ability scientists. Our findings highlight the complexities of incentivizing effort allocation using resource-based incentives. In particular, we show how altering resource-based incentives in one area can have unforeseen spillover effects on effort allocation in other areas. Funding: Financial support from the London Business School is gratefully acknowledged. Supplemental Material: The online appendix is available at https://doi.org/10.1287/orsc.2021.1565 .

The Privilege of Choice: How Prospective College Students’ Financial Concerns Influence Their Choice of Higher Education Institution and Subject of Study in England

ABSTRACT A hallmark of English higher education (HE) over the last twenty years has been policies seeking to increase provider competition and student choice. Central to this has been student funding policy changes, leading to rising college costs. This article asks if prospective HE students’ concerns about college costs and the financial strategies they anticipate using because of them, widen or limit their choice of HE institution and subject of study. It calls on the findings from a nationally representative survey of 1,374 English college applicants and uses latent class analysis to develop a typology of students’ planned financial coping mechanisms: Minimizing costs; Managing costs and maximizing returns; and No financial concerns; which prove to be socially stratified. Minimizing costs students are the most disadvantaged and adopt mechanisms which constrain their choices of where and what to study, unlike students in the other groups. Thus, government policies aimed at improving student choice potentially have the opposite effect for the most disadvantaged, perpetuating existing inequalities in access to, and the experience of, HE.

Exploring the Association of Tiered Funding for Economic Development and Enrollment

ABSTRACT In 2011, North Carolina implemented a tiered funding model for community colleges in an attempt to address program cost differentiation. In 2014, the funding model changed from a three-tiered model to a four-tiered model with additional funds for courses that address skills gaps and lead to higher-wage jobs. The purpose of this study was to examine the 2014 funding policy change and enrollment behavior between 2014 to 2018 at North Carolina community colleges, overall and by specific institutional grouping categories: geographic region, disciplinary focus, prevalent student type, undergraduate classification, size of institution, and degree of urbanization (locale). The aggregate community college enrollment and 19 out of 20 institutional grouping categories saw decreased enrollment in the lower funded course and increased enrollment in higher financed courses, supporting resource dependency theory. Further, the results showed that the tiered enrollment profile was dependent on time for the aggregate population as well as the institutional groupings.

Scandinavian Archaeology Goes Abroad

During the past two decades Scandinavian archaeologists have increasingly participated in projects abroad. Only a few ofthe projects are based on past cultural-historical links, while the majority are based on comparative and collaborative perspectives, often on other continents. The reason for this development is partly the theoretical development within the discipline, and partly also changes in funding policies. This new situation presents Scandinavian rcsearchers with many practical, ethical and political challenges, but if we take them seriously we may often be rewarded.

Proactive Recruitment of Older African-Americans for Alzheimer's Research with Brain Donation: a Cohort Case Study of Success.

Older African-American adults are under-recruited for Alzheimer's-related research that includes brain donation. This article describes the Minority Aging Research Study's brain donation challenges, processes, and successful procurement with older African-American adults (65years and older). The recruitment and retention strategy of the Minority Aging Research Study Brain Gifting Program was developed in accordance with Peplau's theory of interpersonal relationship and Swanson's middle-range theory of caring. At the time of this submission, approximately 345 of 755 older African-American adults in the Minority Aging Research Study consented to brain donation to be completed at the time of death. Furthermore, the Minority Aging Research Study has had 33 successful brain donations with family amenability. Tailored caring behaviors are effective to achieve high donation rates with older African-American adults who have consented to brain donation within an Alzheimer Research Study. Changes in funding policy are needed to meet tailored active recruitment that is required to close the gaps in older African-American adults' participation in Alzheimer's-related research studies.

The effects of funding policy change on the scientific performance of government research institutes

ABSTRACT Despite growing government financial support for scientific development, our understanding of the effect of funding practices on scientific performance is limited. This study investigates the effects of funding policy change on the scientific performance measured by research output of government research institutes (GRIs) in South Korea. This paper analyzes the balanced panel data to examine performance at Korean GRIs during 90's. Our findings indicate that the introduction of a new funding policy improved the journal impact factors of papers.

Effect of PEPFAR funding policy change on HIV service delivery in a large HIV care and treatment network in Nigeria.

The transition to PEPFAR 2.0 with its focus on country ownership was accompanied by substantial funding cuts. We describe the impact of this transition on HIV care in a large network of HIV clinics in Nigeria. We surveyed 30 comprehensive HIV treatment clinics to assess services supported before (October 2013-September 2014) and after (October 2014-September 2015) the PEPFAR funding policy change, the impact of these policy changes on service delivery areas, and response of clinics to the change. We compared differences in support for staffing, laboratory services, and clinical operations pre- and post-policy change using paired t-tests. We used framework analysis to assess answers to open ended questions describing responses to the policy change. Most sites (83%, n = 25) completed the survey. The majority were public (60%, n = 15) and secondary (68%, n = 17) facilities. Clinics had a median of 989 patients in care (IQR: 543–3326). All clinics continued to receive support for first and second line antiretrovirals and CD4 testing after the policy change, while no clinics received support for other routine drug monitoring labs. We found statistically significant reductions in support for viral load testing, staff employment, defaulter tracking, and prevention services (92% vs. 64%, p = 0.02; 80% vs. 20%, 100% vs. 44%, 84% vs. 16%, respectively, p<0.01 for all) after the policy change. Service delivery was hampered by interrupted laboratory services and reduced wages and staff positions leading to reduced provider morale, and compromised quality of care. Almost all sites (96%) introduced user fees to address funding shortages. Clinics in Nigeria are experiencing major challenges in providing routine HIV services as a result of PEPFAR’s policy changes. Funding cutbacks have been associated with compromised quality of care, staff shortages, and reliance on fee-based care for historically free services. Sustainable HIV services funding models are urgently needed.

Management Strategies and Patient Selection After a Hospital Funding Reform for Prostate Cancer Surgery in Canada

Hospital funding reforms for prostate cancer surgery may have altered management of localized prostate cancer in the province of Ontario, Canada. To determine whether changes in hospital funding policy aimed at improving health care quality and value were associated with changes in the management of localized prostate cancer or the characteristics of patients receiving radical prostatectomy (RP) for localized prostate cancer. This population-based, interrupted time series study used linked population-based administrative data regarding adults in Ontario with incidental localized prostate cancer and those who underwent RP for localized prostate cancer. Patients who underwent RP were compared with patients who underwent surgical procedures for localized renal cell carcinoma, which was not included in the policy change but was subjected to similar secular trends and potential confounders. Monthly outcomes were analyzed using interventional autoregressive integrated moving average models. Data were collected from January 2011 to November 2017 and analyzed in January 2019. Funding policy change in April 2015 from flexible block funding for all hospital-based care to prespecified payment amounts per procedure for treatment of localized prostate cancer, coupled with the dissemination of a diagnosis-specific handbook outlining best practices. Initial management (RP vs radiation therapy vs active surveillance) and tumor risk profiles per management strategy among incident cases of localized prostate cancer. Additional outcomes were case volume, mean length of stay, proportion of patients returning to hospital or emergency department within 30 days, proportion of patients older than 65 years, mean Charlson Comorbidity Index, and proportion of minimally invasive surgical procedures among patients undergoing RP for localized prostate cancer. A total of 33 128 patients with incident localized prostate cancer (median [interquartile range (IQR)] age, 67 [61-73] years; median [IQR] cases per monthly observation interval, 466 [420-516]), 17 159 patients who received radical prostatectomy (median [IQR] age, 63 [58-68] years; median [IQR] cases per monthly observation interval, 209 [183-225]), and 5762 individuals who underwent surgery for renal cell carcinoma (median [IQR] age, 62 [53-70] years; median [IQR] cases per monthly observation interval, 71 [61-77]) were identified. By the end of the observation period, radical prostatectomy and radiation therapy were used in comparable proportions (30.3% and 28.9%, respectively) and included only a small fraction of low-risk patients (6.4% and 2.9%, respectively). No statistically significant association of the funding policy change with most outcomes was found. The implementation of funding reform for hospitals offering RP was not associated with changes in the management of localized prostate cancer, although it may have encouraged more appropriate selection of patients for RP. Mostly preexisting trends toward guideline-conforming practice were observed. Co-occurring policy changes and/or guideline revisions may have weakened signals from the policy change.

The MyHealthRecord System Impacts on Patient Workflow in General Practices.

Digital health is widely believed to have vast potential in improving patient care. MyHealthRecord (MyHR) is a digital health information system which enables Australian citizens to access their health information centrally, making it available anywhere, at anytime. The aim of this study is to explore the adoption of MyHR in general practices in Victoria and understand its impacts. A qualitative case study research method was used to underpin this investigation. Ten general practices were engaged where MyHR was implemented/used. Detailed interviews with MyHR implementers were held and GPs were engaged in short interviews. Twenty observations were made during GP/patient consultations for health summary uploads. Findings indicate that the practice incentive payment (PIP) funding policy change encouraged the use of MyHR, but the adoption was limited to satisfy funding criteria. Change management was often extemporised. Health summary upload was a quick and easy process but was influenced by clinical system data quality and GP familiarity with the system. Community awareness and GP interest in MyHR was lacking. The conclusion is that MyHR was not well integrated in general practices nor the community. As a result, an improved engagement approach between healthcare organisations, the MyHR system operator and Australians is required.

UK Students’ Subjective Experiences and Responses to Higher Education Austerity : Implications and Lessons for the Future

The 2010 UK Coalition government published The Coalition: our programme for government, outlining ‘deficit reduction’ as the main priority for the Coalition’s fixed 5 years of government. The significance of this became apparent through the austerity measures in public expenditure and specifically social policy expenditure. However, it is young people for whom austerity has had the most deleterious effects, with the policy changes in higher education funding in 2011 being emblematic. These changes included a tripling of undergraduate higher education (UHE) tuition fees paid by students from £ 3,000 to £ 9,000 per year, and an increase in means tested repayable maintenance loans of up to £ 5,500 for those living outside London. The government rationalised these changes as a way to pay for the increasing student population. As a consequence of these significant changes, the estimate of debt from the Institute for Fiscal Studies for students leaving UHE following these changes is over £ 44,000, nearly € 20,000 more than before the change (Crawford and Jin 2014). This empirical qualitative study aims to explore the ways in which UHE students in the UK have been affected by these policy measures. The study analyses students’ subjective experiences and responses to the UHE funding policy changes, and highlights in particular that these austerity policy changes to UHE student financing is impacting on younger generation in a way that has the potential to destabilize their personal and professional lives now and in the future. The study also discusses how in other European countries who may be affected by similar austerity measures.

Bridging the Gap between Evidence and Practice for Adults with Medically Refractory Temporal Lobe Epilepsy: Is a Change in Funding Policy Needed to Stimulate a Shift in Practice?

Objective. Surgery for medically refractory epilepsy (MRE) in adults has been shown to be effective but underutilized. Comprehensive health economic evaluations of surgery compared with continued medical management are limited. Policy changes may be necessary to influence practice shift. Methods. A critical review of the literature on health economic analyses for adults with MRE was conducted. The MEDLINE, EMBASE, CENTRAL, CRD, and EconLit databases were searched using relevant subject headings and keywords pertaining to adults, epilepsy, and health economic evaluations. The screening was conducted independently and in duplicate. Results. Four studies were identified (1 Canadian, 2 American, and 1 French). Two were cost-utility analyses and 2 were cost-effectiveness evaluations. Only one was conducted after the effectiveness of surgery was established through a randomized trial. All suggested surgery to be favorable in the medium to long term (7-8 years and beyond). The reduction of medication use was the major cost-saving parameter in favor of surgery. Conclusions. Although updated evaluations that are more generalizable across settings are necessary, surgery appears to be a favorable option from a health economic perspective. Given the limited success of knowledge translation endeavours, funder-level policy changes such as quality-based purchasing may be necessary to induce a shift in practice.

Exploring productivity and collaboration in Australian Indigenous health research, 1995–2008

BackgroundBuilding research capacity in Indigenous health has been recognised as integral in efforts to reduce the significant health disparities between Indigenous and other Australian populations. The past few decades have seen substantial changes in funding policy for Australian Indigenous health research, including increases in overall expenditure and a greater focus on collaborative and priority-driven research. However, whether these policy shifts have resulted in any change to the structure of the research workforce in this field is unclear. We examine research publications in Australian Indigenous health from 1995–2008 to explore trends in publication output, key themes investigated, and research collaborations.MethodsA comprehensive literature search was undertaken to identify research publications about Australian Indigenous health from 1995–2008. s of all publications identified were reviewed by two investigators for relevance. Eligible publications were classified according to key themes. Social network analyses of co-authorship patterns were used to examine collaboration in the periods 1995–1999, 2000–2004 and 2005–2008.ResultsNine hundred and fifty three publications were identified. Over time, the number of publications per year increased, particularly after 2005, and there was a substantial increase in assessment of health service-related issues. Network analyses revealed a highly collaborative core group of authors responsible for the majority of outputs, in addition to a series of smaller separate groups. In the first two periods there was a small increase in the overall network size (from n = 583 to n = 642 authors) due to growth in collaborations around the core. In the last period, the network size increased considerably (n = 1,083), largely due to an increase in the number and size of separate groups. The general size of collaborations also increased in this period.ConclusionsIn the past few decades there has been substantial development of the research workforce in Indigenous health, characterised by an increase in authors and outputs, a greater focus on some identified priority areas and sustained growth in collaborations. This has occurred in conjunction with significant changes to funding policy for Indigenous health research, suggesting that both productivity and collaboration may be sensitive to reform, including the provision of dedicated funding.

Effects of Funding Policy Changes and Health Warnings on the Use of Erythropoiesis-Stimulating Agents

To characterize the effects of formulary changes and governmental safety warnings on use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. We conducted a cross-sectional time-series analysis using health administrative data from Ontario, Canada. From January 1997 to December 2009 we identified all ESA initiations among patients diagnosed with cancer. We explored the effects of two formulary changes that progressively liberalized coverage for ESAs, first by rescinding the requirement for blood transfusion in 2003 and then by removing all restrictions in 2007. We also explored the effect of US Food and Drug Administration and Health Canada warnings issued in the second quarter of 2007. To assess regional variability in ESA use, we determined prescription rates for each of Ontario's 14 regional cancer centers. After the first formulary change, the ESA initiation rate increased to 1.66 new users per 1,000 patients with cancer, 374% more than predicted (P < .001). After the second formulary change, the initiation rate increased to 3.97 new users per 1,000 patients with cancer, 73% more than predicted (P < .001). After the safety warnings, this rate declined 81% by study end (P < .001). We found significant regional variation in ESA use. Formulary access and safety warnings had significant impacts on the new use of ESA drugs in patients with cancer. This suggests that both are effective means of influencing the use of these drugs. Variable ESA prescription rates across our region may reflect a lack of consensus regarding their utility.

Understanding the episode of care for transplant patients

Funders and policy makers are looking for ways to manage increasing healthcare costs and provide funding for entire episodes of care that extend beyond a single stay or visit at a healthcare institution. In Ontario hospital funding is based on global funding, which is a lump sum distributed annually to hospitals. A small percentage of funding in Ontario is based on volume and fixed fees for selected procedures. In a departure from the current funding policies, the Ontario Ministry of Health and Long-Term Care (MoHLTC) is formulating a strategy to increase patient based funding. This initiative is known as Patient based Payment (PbP). To execute this change in funding policy, the MoHLTC is extensively using patient level cost data to develop strategy and funding models. To gather evidence based information, the MoHTLC has funded a case-costing project to assist 48 facilities produce patient level cost data. The current information systems and reporting standards in Canada are designed to record patient-care information by patient type during a single stay or visit in one institution. Although patients may receive health care from multiple healthcare providers, patient information is not linked or accessible by the multiple healthcare providers. The limitations of the current information systems have resulted in patient data that is difficult to access even within a single healthcare facility. The single episode of care (one stay or visit) is not representative of the healthcare needed, or the entire cost of care related to a condition. This is particularly true for patients living with chronic diseases, or patients who have received complex medical procedures such as transplants and, ultimately, the healthcare services received throughout a patient’s life. The transplant process is complex and can be divided into four phases: pre-transplant, assessment and waiting period; donor procurement; peri-operative; and post-discharge phase. Pre- and post-transplant healthcare services are not included in the procedure based funding and may be provided by multiple healthcare providers. Moreover, post-transplant care has increased as a result of improved survival rate resulting in continued healthcare. In response, we propose to develop a linking of patient data describing complete care for all activities related to transplant. We suggest that a new model for episodic care is needed that provides funding for an entire episode of care. This will result in the proper incentives for improved care between providers. In this paper, we identify challenges and opportunities for this type of work in the future.

Where next for veterinary education?

Neil Gorman examines the Government's proposals for reform of higher education in England and the likely consequences for students, universities and the veterinary profession FACED with an economic crisis and...

British Columbia hospitals: examination and assessment of payment reform (B-CHeaPR).

BackgroundAccounting for 36% of public spending on health care in Canada, hospitals are a major target for cost reductions through various efficiency initiatives. Some provinces are considering payment reform as a vehicle to achieve this goal. With few exceptions, Canadian provinces have generally relied on global and line-item budgets to contain hospital costs. There is growing interest amongst policy-makers for using activity based funding (ABF) as means of creating financial incentives for hospitals to increase the 'volume' of care, reduce cost, discourage unnecessary activity, and encourage competition. British Columbia (B.C.) is the first province in Canada to implement ABF for partial reimbursement of acute hospitalization. To date, there have been no formal examinations of the effects of ABF policies in Canada.This study proposal addresses two research questions designed to determine whether ABF policies affect health system costs, access and hospital quality. The first question examines the impact of the hospital funding policy change on internal hospital activity based on expenditures and quality. The second question examines the impact of the change on non-hospital care, including readmission rates, amount of home care provided, and physician expenditures.Methods/DesignA longitudinal study design will be used, incorporating comprehensive population-based datasets of all B.C. residents; hospital, continuing care and physician services datasets will also be used. Data will be linked across sources using anonymized linking variables. Analytic datasets will be created for the period between 2005/2006 and 2012/2013.DiscussionWith Canadian hospitals unaccustomed to detailed scrutiny of what services are provided, to whom, and with what results, the move toward ABF is significant. This proposed study will provide evidence on the impacts of ABF, including changes in the type, volume, cost, and quality of services provided. Policy- and decision-makers in B.C. and elsewhere in Canada will be able to use this evidence as a basis for policy adaptations and modifications. The significance of this proposed study derives from the fact that the change in hospital funding policy has the potential to affect health system costs, residents' access to care and care quality.

From Jugendbewegung to RAF: Youth, Friendship, and Protest in Post-Wall German Cinema

From Jugendbewegung to RAF: Youth, Friendship, and Protest in Post-Wall German Cinema

Ghosts in Machines and a Snapshot of Scholarly Journal Publishing in Canada

Ghosts in Machines and a Snapshot of Scholarly Journal Publishing in Canada