Financial Interventions Research Articles

Effects of educational and financial interventions on the quality of antibiotics use in community care clinics in Bangkok: An interrupted time-series analysis

Effects of educational and financial interventions on the quality of antibiotics use in community care clinics in Bangkok: An interrupted time-series analysis

Land Transfer or Trusteeship: Can Agricultural Production Socialization Services Promote Grain Scale Management?

Grain Scale Management (GSM) is a crucial factor in ensuring national food security. However, in countries facing rigid resource constraints and complex land tenure relationships, the strategy of promoting large-scale grain management through land management rights transfer may not be sustainable. Therefore, based on the traditional agricultural division of labor theory, we analyze the mechanism and rationality of Agricultural Production Socialization Services (APSS) with scale characteristics to promote GSM and propose a new approach to GSM with empirical evidence from China. Using county-level panel data from Hubei province spanning from 2010 to 2021, we construct a multi-period double difference model based on the difference in the time of the establishment of pilot agricultural production socialization service counties in Hubei province. Our empirical results demonstrate the role of APSS in promoting GSM at the macro level. Specifically, the establishment of pilot counties for APSS significantly improves the level of local GSM. Furthermore, our study reveals that the degree of local financial intervention, regional industrial structure, and regional topography have heterogeneous effects on the implementation of the policy.

Reckoning with Digital Inequity in Place-Based Community Revitalization

Place-based community development in America has a rich history. Practices and procedures for successful redevelopment are supported by lobbying efforts, public administration, policy, federal funding, and the efforts of non-profits dedicated to neighborhood revitalization. Community revitalization work is often centered around specific geographic locations, while in recent decades modern technology has caused social networks to become increasingly geographically disparate. Social networks have been demonstrated to support the economic mobility that community development strives to create. However, the impact of modern technology on place-based community development has not been clearly understood. Increasing digitalization has impacted the effectiveness of place-based social equity efforts such as community organizing, affordable housing and economic development, and financial capability interventions. This essay explores how place-based community organizing led to the creation of current policies that govern community development, how technology has impacted urban communities and how these changes may subsequently affect social equity objectives in public administration.

Effects of Mobile-Based Financial Incentive Interventions for Adults at Risk of Developing Hypertension: Feasibility Randomized Controlled Trial.

Hypertension is the leading modifiable risk factor for cardiovascular disease and mortality. Adopting lifestyle modifications, like increasing physical activity (PA), can be an effective strategy in blood pressure (BP) control, but many adults do not meet the PA guidelines. Financial incentive interventions have the power to increase PA levels but are often limited due to cost. Further, mobile health technologies can make these programs more scalable. There is a gap in the literature about the most feasible and effective financial incentive PA framework; thus, pay-per-minute (PPM) and self-funded investment incentive (SFII) frameworks were explored. The aims were to (1) determine the feasibility (recruitment, engagement, and acceptability) of an 8-week mobile-based PPM and SFII hypertension prevention PA program and (2) explore the effects of PPM and SFII interventions relative to a control on the PA levels, BP, and PA motivation. In total, 55 adults aged 40-65 years not meeting the Canadian PA guidelines were recruited from Facebook and randomized into the following groups: financial incentive groups, PPM or SFII, receiving up to CAD $20 each (at the time of writing: CAD $1=US $0.74), or a control group without financial incentive. PPM participants received CAD $0.02 for each minute of moderate-to-vigorous PA (MVPA) per week up to the PA guidelines and the SFII received CAD $2.50 for each week they met the PA guidelines. Feasibility outcome measures (recruitment, engagement, and acceptability) were assessed. Secondary outcomes included changes in PA outcomes (MVPA and daily steps) relative to baseline were compared among PPM, SFII, and control groups at 4 and 8 weeks using linear regressions. Changes in BP and relative autonomy index relative to baseline were compared among the groups at follow-up. Participants were randomized to the PPM (n=19), SFII (n=18), or control (n=18) groups. The recruitment, retention rate, and engagement were 77%, 75%, and 65%, respectively. The intervention received overall positive feedback, with 90% of comments praising the intervention structure, financial incentive, and educational materials. Relative to the control at 4 weeks, the PPM and SFII arms increased their MVPA with medium effect (PPM vs control: η2p=0.06, mean 117.8, SD 514 minutes; SFII vs control: η2p=0.08, mean 145.3, SD 616 minutes). At 8 weeks, PPM maintained a small effect in MVPA relative to the control (η2p=0.01, mean 22.8, SD 249 minutes) and SFII displayed a medium effect size (η2p=0.07, mean 113.8, SD 256 minutes). Small effects were observed for PPM and SFII relative to the control for systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PPM: η2p=0.12, Δmean SBP 7.1, SD 23.61 mm Hg; η2p=0.04, Δmean DBP 3.5, SD 6.2 mm Hg; SFII: η2p=0.01, Δmean SBP -0.4, SD 1.4 mm Hg; η2p=0.02, Δmean DBP -2.3, SD 7.7 mm Hg) and relative autonomy index (PPM: η2p=0.01; SFII: η2p=0.03). The feasibility metrics and preliminary findings suggest that a future full-scale randomized controlled trial examining the efficacy of PPM and SFII relative to a control is feasible, and studies with longer duration are warranted.

Financial Sector Troubles and Energy Markets

Literature shows the dynamics of energy markets impacting a variety of sectors. In response to the 2007/2008 financial crisis, the U.S. Treasury provided financial assistance (bailouts) to hundreds of public and private financial institutions under the Troubled Asset Recovery Program (TARP) and the Targeted Investment Program. Several studies suggest that bailouts alter the risk profile of the receiving companies. Since risk profiles are at the core of volatility transmissions between asset groups, in this study, we evaluate the volatility impacts of energy markets on these financial institutions before and after they received financial assistance. After controlling for systematic components, our findings show no volatility transmission before the financial intervention but suggest robust volatility transmission from oil and natural gas markets to the bailout banks post bailouts.

Cardiovascular Disease and Its Implication for Higher Catastrophic Health Expenditures Among Households in Sub-Saharan Africa.

Background: Cardiovascular diseases (CVDs) impose an enormous and growing economic burden on households in sub-Saharan Africa (SSA). Like many chronic health conditions, CVD predisposes families to catastrophic health expenditure (CHE), especially in SSA due to the low health insurance coverage. This study assessed the impact of CVD on the risks of incurring higher CHE among households in Ghana and South Africa. Methods: The World Health Organization (WHO) Study on Global AGEing and Adult Health (WHO SAGE), Wave 1, implemented 2007-2010, was utilized. Following standard procedure, CHE was defined as the health expenditure above 5%, 10%, and 25% of total household expenditure. Similarly, a 40% threshold was applied to household total nonfood expenditure, also referred to as the capacity to pay. To compare the difference in mean CHE by household CVD status and the predictors of CHE, Student's t-test and logistic regression were utilized. Results: The share of medical expenditure in total household spending was higher among households with CVD in Ghana and South Africa. Households with CVD were more likely to experience greater CHE across all the thresholds in Ghana. Households who reported having CVD were twice as likely to incur CHE at 5% threshold (odds ratio [OR], 1.946; confidence interval [CI], 0.965-1.095), 3 times as likely at 10% threshold (OR, 2.710; CI, 1.401-5.239), and 4 times more likely to experience CHE at both 25% and 40% thresholds, (OR, 3.696; CI, 0.956-14.286) and (OR, 4.107; CI, 1.908-8.841), respectively. In South Africa, households with CVD experienced higher CHE across all the thresholds examined compared with households without CVDs. However, only household CVD status, household health insurance status, and the presence of other disease conditions apart from CVD were associated with incurring CHE. Households who reported having CVD were 3 times more likely to incur CHE compared with households without CVD (OR, 3.002; CI, 1.013-8.902). Conclusions: Our findings suggest that CVD predisposed households to risk of higher CHE. Equity in health financing presupposes that access to health insurance should be predicated on individual health needs. Thus, targeting and prioritizing the health needs of individuals with regard to healthcare financing interventions in SSA is needed.

Cardiovascular Disease and Its Implication for Higher Catastrophic Health Expenditures Among Households in Sub-Saharan Africa

Background: Cardiovascular diseases (CVDs) impose an enormous and growing economic burden on households in sub-Saharan Africa (SSA). Like many chronic health conditions, CVD predisposes families to catastrophic health expenditure (CHE), especially in SSA due to the low health insurance coverage. This study assessed the impact of CVD on the risks of incurring higher CHE among households in Ghana and South Africa. Methods: The World Health Organization (WHO) Study on Global AGEing and Adult Health (WHO SAGE), Wave 1, implemented 2007-2010, was utilized. Following standard procedure, CHE was defined as the health expenditure above 5%, 10%, and 25% of total household expenditure. Similarly, a 40% threshold was applied to household total nonfood expenditure, also referred to as the capacity to pay. To compare the difference in mean CHE by household CVD status and the predictors of CHE, Student’s t-test and logistic regression were utilized. Results: The share of medical expenditure in total household spending was higher among households with CVD in Ghana and South Africa. Households with CVD were more likely to experience greater CHE across all the thresholds in Ghana. Households who reported having CVD were twice as likely to incur CHE at 5% threshold (odds ratio [OR], 1.946; confidence interval [CI], 0.965-1.095), 3 times as likely at 10% threshold (OR, 2.710; CI, 1.401-5.239), and 4 times more likely to experience CHE at both 25% and 40% thresholds, (OR, 3.696; CI, 0.956-14.286) and (OR, 4.107; CI, 1.908-8.841), respectively. In South Africa, households with CVD experienced higher CHE across all the thresholds examined compared with households without CVDs. However, only household CVD status, household health insurance status, and the presence of other disease conditions apart from CVD were associated with incurring CHE. Households who reported having CVD were 3 times more likely to incur CHE compared with households without CVD (OR, 3.002; CI, 1.013-8.902). Conclusions: Our findings suggest that CVD predisposed households to risk of higher CHE. Equity in health financing presupposes that access to health insurance should be predicated on individual health needs. Thus, targeting and prioritizing the health needs of individuals with regard to healthcare financing interventions in SSA is needed.

Financial Inclusion or Encampment? Rethinking Digital Finance for Refugees

Humanitarian actors touting financial inclusion posit that access to financial services builds refugees’ resilience and self-reliance. They claim that new digital financial tools create more efficient and dignified pathways for humanitarian assistance and enable refugees to better manage their savings and invest in livelihoods, especially during protracted displacement. Our in-depth, repeat interviews with refugees in Kenya and Jordan refute this narrative. Instead, self-reliance was hindered primarily by refugees’ lack of foundational rights to move and work. Financial services had limited ability to support livelihoods in the absence of those rights. The digital financial services offered to refugees under the banner of ‘financial inclusion’ were not mainstream services designed to empower and connect. Instead, they were segregated, second-class offerings meant to further isolate and limit refugee transactions in line with broader political desires to encamp and exclude them. The article raises questions about the circumstances in which humanitarian funding ought to fund financial service interventions and what those interventions are capable of achieving.

Factors moderating the effect of financial incentives on household recycling: A motivation crowding perspective

Prior research has shown considerable variability in the impact of financial incentive interventions on household recycling behavior, but it remains unclear which factors determine the effect of incentive policies. Building on the motivation crowding framework, this study explores how intrapersonal, interpersonal, and policy framing factors moderate the incentive effect on household recycling. Theoretical propositions were evaluated using quasi-experimental data from an incentivized recycling program in Quzhou, China. Although the program increased the recycling levels of residents, it reduced individuals' intrinsic motivation to protect the environment and, through this, exerted a negative indirect effect on recycling behavior. Such motivation crowding out was more salient among people with higher levels of environmental self-identity or self-efficacy and those embedded in stronger neighbor ties or social norms. Consequently, the incentive program was less effective in promoting recycling behavior among these subpopulations. Framing the program in an environmentally beneficial way did not affect its motivational and behavioral influences. Overall, the results extend knowledge regarding the mechanisms underlying the performance of incentive policies and the conditions that affect policy effectiveness.

Cost of Cancer in Adolescents and Young Adults in the United States: Results of the 2021 Report by Deloitte Access Economics, Commissioned by Teen Cancer America.

The purpose of this report, commissioned by Teen Cancer America and performed by Deloitte Access Economics in 2021, was to estimate the total costs incurred by adolescent and young adults (AYAs) after cancer diagnosis in the United States (US) over their life course. The incidence of cancer in 2019 among AYAs age 15-39 years was estimated from the US Cancer Statistics Public Use Database, and relative survival was projected from the Surveillance, Epidemiology, and End Results Program. Cost domains included health system, productivity, and well-being costs. Components were estimated with published literature and pooled data from the Medical Expenditure Panel Survey from 2008 to 2012 and inflated to 2019 dollars. The economic and human costs of cancer in AYAs are substantial-$23.5 billion overall, corresponding to $259,324 per person over the lifetime. The majority of costs are borne by AYA cancer survivors themselves in the form of lost productivity, loss of well-being, and loss of life. These findings underscore the need to address the burden of cancer in AYAs through targeted programs for AYAs, such as financial navigation and health insurance literacy interventions, as well as local and national policy initiatives to address access to and enhanced coverage for clinical trials participation, fertility services, and survivorship care.

A typology of integrated care policies in the care home sector: A policy document analysis.

Health and social care systems in many countries have begun to trial and adopt "integrated" approaches. Yet, the significant role care homes play within the health and social care system is often understated. A key first step to identifying the care home integration interventions that are most (cost-)effective is the ability to precisely identify and record what has been implemented, where, and when-a "policy map." To address gaps relating to the identification and recording of (cost-)effective integrated care home interventions, we developed a new typology tool. We conducted a policy mapping exercise in a devolved region of England-Greater Manchester (GM). Specifically, we carried out systematic policy documentary searches and extracted a range of qualitative data relating to integrated health and social care initiatives in the GM region for care homes. The data were then classified according to existing national ambitions for England as well as a generic health systems framework to illustrate gaps in existing recording tools and to iteratively develop a novel approach. A combined total of 124 policy documents were identified and screened, in which 131 specific care home integration initiatives were identified. Current initiatives emphasized monitoring quality in care homes, workforce training, and service delivery changes (such as multi-disciplinary teams). There was comparatively little emphasis on financing or other incentive changes to stimulate provider behavior for the care home setting. We present a novel typology for capturing and comparing care home integration policy initiatives, largely conceptualizing which part of the system or specific transition point the care home integration is targeting, or whether there is a broader cross-cutting system intervention being enacted, such as digital or financial interventions. Our typology builds on the gaps in current frameworks, including previous lack of specificity to care homes and lack of adaptability to new and evolving initiatives internationally. It could provide a useful tool for policymakers to identify gaps in the implementation of initiatives within their own areas, while also allowing researchers to evaluate what works most effectively and efficiently in future research based on a comprehensive policy map.

Determinants of national health insurance enrolment among people at risk of statelessness in the Awutu Senya East Municipality and Gomoa East District of Ghana

BackgroundThis paper investigates the factors influencing the decision to enrol in Ghana’s National Health Insurance Scheme (NHIS) among people at risk of statelessness, with emphasis on the individual's demographic and socioeconomic factors. MethodsThe study used data from a cross-sectional household survey undertaken in the Awutu Senya East Municipality and Gomoa East District of Ghana's Central Region between March 9 and June 26, 2021, on healthcare utilization culture among people at risk of statelessness. Descriptive statistics and binary logistic regression were used in analysing data from a sample of 384 people at risk of statelessness. ResultsThe results reveal that about 51% of the at-risk population have ever enrolled while 48% of the respondents were enrolled on the NHIS at the time of the survey (active members). The majority of the enrolled members acquired their membership through self-payment of the enrolment fee. Additionally, respondents aged 26–35 had higher odds of enrolling, whiles those within 56–65 years had lower odds of enrolling in health insurance. Also, persons who are married and have a high school education or an equivalent qualification were more likely to enrol, while persons with no employment were less likely to enrol.ConclusionAccording to the paper, while the gap in coverage between rich and poor, married and single appears to have narrowed, these factors continue to determine NHIS coverage among people at risk of statelessness. The same is true for education. Efforts must be increased to ensure equal access to healthcare financing interventions for better access to health services.

MOTIVATION OF FIRMS TO ISSUE SUKUKS

Our paper critically reviews the different factors that motivate a corporation to issue a Sukuk versus a Conventional Bond. Currently, Sukuk papers are growing, yet the studies are limited compared to Conventional Bond research. Our paper analyzes firm performance and characteristics to demonstrate how this affects choosing between the two securities. We examine these in a time series with the 2008 financial crisis intervention to see how this may have affected the issuance choice through logistic regression. Our study examines 628 Conventional Bonds and 227 Sukuk issuers globally across 12 countries from 2005 – 2017. We find in our research that the performance of companies issuing Sukuks resembles Conventional Bond issuers in financial performance. We confirm that larger companies will enter the Sukuk market as an alternative to the Conventional Bond market when there is a higher demand for capital. We also find that firms with higher financial performance may enter the Sukuk market as a premium where it may not be accessible in the Conventional Bond Market.

The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries.

The COVID-19 pandemic disproportionately affected vulnerable populations' access to health care. By proactively reaching out to them, general practices attempted to prevent the underutilization of their services. This paper examined the association between practice and country characteristics and the organization of outreach work in general practices during COVID-19. Linear mixed model analyses with practices nested in countries were performed on the data of 4982 practices from 38 countries. A 4-item scale on outreach work was constructed as the outcome variable with a reliability of 0.77 and 0.97 at the practice and country level. The results showed that many practices set up outreach work, including extracting at least one list of patients with chronic conditions from their electronic medical record (30.1%); and performing telephone outreach to patients with chronic conditions (62.8%), a psychological vulnerability (35.6%), or possible situation of domestic violence or a child-rearing situation (17.2%). Outreach work was positively related to the availability of an administrative assistant or practice manager (p < 0.05) or paramedical support staff (p < 0.01). Other practice and country characteristics were not significantly associated with undertaking outreach work. Policy and financial interventions supporting general practices to organize outreach work should focus on the range of personnel available to support such practice activities.

Investigation of factors influencing career choice among STEM undergraduates in Nigeria universities

Shortage of expertise in science, technology, engineering and mathematics (STEM) fields have been reported over the years despite financial and social interventions by government through policies and efforts of stakeholders. Remediating the afore stated requires a retrospection into the factors responsible for learners’ choice and career orientation in STEM. As such, this study investigated undergraduates’ choice of STEM field and career orientation employing descriptive research. Undergraduates’ choice of career questionnaire with interpersonal, intrapersonal and career outcome expectancy components formed the instrument with reliability index of 0.86. Purposive sampling was employed in the selection of 200 undergraduates in STEM related disciplines from public universities in Nigeria. Three research questions were raised to evaluate the extent of agreement and variance to each of the factors while three hypotheses were formulated and tested using one-way ANOVA among undergraduates’ choices. From the findings, career outcome expectancy outclassed both interpersonal and intrapersonal factors as reason for career choice. This study recommends that factors considered in this study have the possibility of impacting how institutional policies, educational leaders, and stakeholders determine the kind of support/intervention expected to buffer career choice among STEM students.

Moderation of the association between COVID-19-related income loss and depression by receipt of financial support: Repeated cross-sectional surveys of young adults in Canada and France (2020–2021)

BackgroundTo mitigate the adverse effects of the COVID-19 pandemic on financial resources, governments and family/friends mobilized financial support interventions (e.g., emergency aid funds) and assistance. However, little is known about how financial assistance alleviated mental health problems. This study aimed to investigate the moderating effect of financial support from the government or from family/friends on the association between income loss and depression among young adults. MethodsTwo online cross-sectional surveys among young adults ages 18–29 living in Canada and France were conducted in 2020 (n = 4,511) and 2021 (n = 3,329). Moderate-to-severe depressive symptoms were measured using the Patient Health Questionnaire-9 (cut-off score: ≥10). Two logistic regression models were performed for each survey with an interaction term between income loss and financial support (government or family/friends modeled separately), controlling for demographics. ResultsOverall, half reported depressive symptoms (2020/2021: 53.5%/45.6%), and over a third lost income (2020/2021: 10.2%/11.6% all income, 37.7%/21.6% some income). In 2020, 40.6% received government financial support (17.7% in 2021) while family/friends support was received by 12% (in both surveys). In both surveys, among those who received governmental financial support, income loss was associated with depression, whether participants lost all their income (e.g., 2020: Adjusted Odds Ratios (AOR) 1.75, 95% Confidence Interval [1.29–2.44]), or some of their income (e.g., 2020: AOR 1.45 [1.17–1.81]). However, among those who received family/friends financial support, income loss was no longer significantly associated with depression in both cycles, whether participants lost all their income (e.g., 2020: AOR 1.37 [0.78–2.40]), or some of their income (e.g., 2020: AOR 1.31 [0.86–1.99]). ConclusionsAssociation between income loss and depression was moderated by receipt of family/friends financial support but not by receipt of government financial support. Financial support interventions may help to mitigate the negative effects of income loss on young adults mental health during periods of economic crisis.

Prevalence of Anxiety among Senior Citizens during the Pandemic in Partido District of Camarines Sur, Philippines

This is a descriptive and correlational study of the prevalence of anxiety among senior citizens of the mainland Partido District, Camarines Sur, Philippines. It determines the level of support, locality and other socio-economic factors affecting anxiety of the elderly during the pandemic. It likewise determines the relationship between these variables to level of anxiety of the respondents. The study utilized randomly selected municipalities of the district from which 385 respondents were selected using stratified random sampling. Further, it utilized the Depression, Anxiety and Stress Scale (DASS-21), secondary data, unstructured interview and researchers’ observation in gathering data. This study found that the majority of the respondents experienced normal level of anxiety but a significant number experienced moderate level of anxiety during the pandemic. There was neutrality and dissatisfaction in the level of social support provided by friends and relatives. Likewise, there was a significant correlation between levels of anxiety and social support and income. On the other hand, a significant negative correlation was found between levels of anxiety and socio-demographic factors such age gender, localities, home ownership and educational attainment. It was recommended that appropriate psychological and financial support and interventions accorded to the elderly so that anxiety levels may be reduced during pandemics making it more manageable to the elderly. Establishing better relationships through regular visits and monitoring of the elderly by health workers during pandemics are avenues to improve social support to senior citizens. The existing “relief system” of the government in the form of goods may be improved making it more sustainable and continuous throughout the duration of pandemics.

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

Healthy financial habits in young adults: An exploratory study of the relationship between subjective financial literacy, engagement with finances, and financial decision‐making

AbstractThis paper provides insights into young adults' financial habits and decision‐making considerations as they enter the workforce. We use 28 semi‐structured interviews with Australian university graduates to explore how their motivation to engage with personal finances and their subjective financial literacy, i.e., self‐reported, support healthy financial habits. Our findings show that a young adult's social context and exposure to financial hardship rather than their financial confidence determine the health of their financial habits. We observed research participants in a romantic partnership as more focused on their future. This future focus motivates them to engage more with their finances and manifests as explicit goal setting, formal budgeting, or adherence to strict bucket systems. These insights might be useful for policymakers and educators: social context matters when designing financial health interventions, while financial education programs predominately should aim at demystifying complex long‐term financial decision‐making such as investments and retirement.

The role of learning motivation on financial knowledge among Vietnamese college students

AbstractUsing survey data from 730 undergraduates in Vietnam, we find that learning motivation and its components, especially self‐efficacy, finance learning value, and achievement goals, significantly correlate with students' financial literacy performance. In addition, these correlations are moderated by student characteristics, among which academic seniority, university type, parents' education, and extra math study during high school matter the most. Our results raise significant implications to policymakers, researchers, and educators that include understanding the role of motivation and incorporating it in financial literacy education and intervention programs and considering the moderation roles that individuals' characteristics play in the motivation‐financial literacy link. We encourage more research in these areas.