Prepayment Systems Research Articles

Evaluating Performance and Satisfaction of Bus Raid Transit Using the Hybrid T2NN-APPRESAL Method

There are many factors that affect the environment in general, the most important of which is climate change as well as population growth. To preserve the environment, researchers seek to find the best ways and solutions to preserve the quality of the environment through the use of renewable energy to reduce emissions resulting from other energies as well as provide a good life for people in light of population density. The high One of these solutions is bus rapid transit (BRT). It's a public transportation system that uses dedicated lanes to provide fast, efficient bus service. BRT systems often feature stations with elevated platforms for easy boarding, prepayment systems to speed up boarding, and traffic signal priority to keep buses moving smoothly. BRT is designed to offer many of the benefits of light rail or subway systems at a lower cost and with more flexibility. It's commonly implemented in cities around the world as a way to improve public transportation and reduce congestion. The term "BRT" is mainly used in the Americas and China, while in India, it is called "BRTS," and in Europe, it is often referred to as a "busway" or "BHLS." This paper seeks to analyze the BRT system based on its features according to the user’s satisfaction using the Approach for Preference, Performance and Ranking Evaluation with SAtisfaction Level (APPRESAL) method to overcome the problems of multi-criteria decision-making (MCDM) methods that lack in dealing with user satisfaction as well as the influence of factors on the analysis under the type-2 neutrosophic numbers (T2NN) environment to overcome ambiguity and uncertainty resulting from the collected data.

Risk and determinants of catastrophic health expenditure among rural households in rivers state

Background: Concerns about how the expense of healthcare impacts rural families' ability to pay their bills are rising, especially in environments where prepayment systems are inadequate and people pay cash while using health services. This research evaluated the method of payment, frequency, and contributing factors of catastrophic health expenditure (CHE) among rural inhabitants of Rivers State. Methods: This retrospective longitudinal study was conducted among 450 inhabitants in six rural communities in Rivers State. The participants were chosen using a multistage sampling process. A validated semi-structured questionnaire which was interviewer administered was used to obtain the data. IBM statistical package for the social sciences version 25 was used to analyze the data. Data were summarized using means, frequency, and proportions while bivariate and multivariate binary logistic regression were used to explore determinants of CHE with p≤0.05 considered statistically significant. Results: The result showed that 94.9% of rural households pay for health care via out-of-pocket payment and 88.4% rural residents experience catastrophic health payment. Household income of less than N100,000 (AOR=2.8, 95% C.I.=1.4-5.4, p=0.002) and having two or more dependents (AOR=3.3, 95% C.I.=1.3-8.0 p=0.002) were determinants of CHE. Conclusions: There is need to increase public funding for healthcare as well as expand the coverage of the NHIS to mitigate the effect of health care cost on rural residents in Rivers State.

Paths towards Universal Health Coverage: beyond political commitments.

The rapid economic growth in low and middle-income countries provides the opportunity of translating political commitment into action for achieving Universal Health Coverage. However, this is not straightforward. High donor dependence in low income countries; the lack of fiscal space; the inadequacy of attention to primary health care and under-developed pre-payment systems all pose challenges. Windows of political opportunity open up and ensuring that Universal Health Coverage makes it into the agenda of parties and subsequent holding them accountable by citizens can address political inertia. Not only is more money for health needed, but governments also need to gain more health for money through effective strategic purchasing and addressing the main drivers of inefficiency. Moving Universal Health Coverage from political aspiration to reality requires approaching it as a citizen’s rights and entitlement to health, through full subsidies for the poor and vulnerable.

The catastrophic out-of-pocket health expenditure of multiple sclerosis patients in Iran

BackgroundThe present study was designed and conducted to evaluate multiple sclerosis (MS) treatment costs and the resulting economic impact imposed on MS patients in Iran.MethodsThis was a cross-sectional study, among randomly selected 300 MS patients, registered in the MS Association of East Azerbaijan Province, Iran (1 year after their treatment began). The regression analysis, ANOVA, T-test, and chi-square were used.ResultsThe average amount of out-of-pocket payments (OOPs) by MS patients during the previous year was 1669.20 USD, most of which was spent on medication, rehabilitation care, and physician visits. Their mean annual income was 5182.84 USD. Fifty four percent of families with an MS patient suffer from catastrophic health expenditure (CHE) and 44% experience poverty caused by the OOPs. Occupational status, having supplemental health insurance, and being residents of Tabriz significantly affect OOPs, CHE, and the resulting poverty (P < 0.05).ConclusionThe catastrophic financial burden of health care costs on MS patients and their families justifies health policymakers to promote pre-payment systems and provide subsidies to less well-off patients to protect them from the unfairness of OOPs and its resulting CHE and poverty.

Impact of government budget on health prepayment levels: evidence from OECD countries.

Health prepayment, a key indicator under the Sustainable Development Goals monitoring framework, is strongly associated with household financial protection; however, the impact of government health budget on the level of prepayment has rarely been discussed. To address the following research questions. (1) Does a higher government health budget translate into higher prepayment rates in the healthcare financing system? (2) What are the effects of government health budget on public prepayment and private prepaid plans? (3) What are the heterogeneities between groups of countries with different income levels and public health prepayment systems? Analysis of panel co-integration, impulse response function, and variance decomposition were conducted in 34 Organisation for Economic Co-operation and Development (OECD) members for the period 1995-2016. Government health budget has a long-running equilibrium relationship with the level of public and total prepayment. However, a stable relationship could not be confirmed with private prepaid plans. Moreover, government health budget played a significant positive role in explaining the fluctuations in the total and public prepayments over a long time, that is, 51 and 37 periods, respectively. Considering differences between groups of countries, the impacts are greater for those with higher income levels and more public-dominated health-financing systems. Government health budget has a long-time relationship with the levels of both total prepaid expenditure and public prepayment. By contrast, it does not systematically crowd out private prepaid plans.

Extending coverage to informal sector populations in Kenya: design preferences and implications for financing policy

BackgroundUniversal health coverage (UHC) is important in terms of improving access to quality health care while protecting households from the risk of catastrophic health spending and impoverishment. However, progress to UHC has been hampered by the measures to increase mandatory prepaid funds especially in low- and middle-income countries where there are large populations in the informal sector. Important considerations in expanding coverage to the informal sector should include an exploration of the type of prepayment system that is acceptable to the informal sector and the features of such a design that would encourage prepayment for health care among this population group. The objective of the study was to document the views of informal sector workers regarding different prepayment mechanisms, and critically analyze key design features of a future health system and the policy implications of financing UHC in Kenya.MethodsThis was part of larger study which involved a mixed-methods approach. The following tools were used to collect data from informal sector workers: focus group discussions [N = 16 (rural = 7; urban = 9)], individual in-depth interviews [N = 26 (rural = 14; urban = 12)] and a questionnaire survey [N = 455(rural = 129; urban = 326)]. Thematic approach was used to analyze qualitative data while Stata v.11 involving mainly descriptive analysis was used in quantitative data. The tools mentioned were used to collect data to meet various objectives of a larger study and what is presented here constitutes a small section of the data generated by these tools.ResultsThe findings show that informal sector workers in rural and urban areas prefer different prepayment systems for financing UHC. Preference for a non-contributory system of financing UHC was particularly strong in the urban study site (58%). Over 70% in the rural area preferred a contributory mechanism in financing UHC. The main concern for informal sector workers regardless of the overall design of the financing approach to UHC included a poor governance culture especially one that does not punish corruption. Other reasons especially with regard to the contributory financing approach included high premium costs and inability to enforce contributions from informal sector.ConclusionOn average 47% of all study participants, the largest single majority, are in favor of a non-contributory financing mechanism. Strong evidence from existing literature indicates difficulties in implementing social contributions as the primary financing mechanism for UHC in contexts with large informal sector populations. Non-contributory financing should be strongly recommended to policymakers to be the primary financing mechanism and supplemented by social contributions.

The Role of Community Based Health Insurance Scheme on Financial Protection and Healthcare Seeking Behavior of Households in &amp;lt;i&amp;gt;Tehuledere&amp;lt;/i&amp;gt; District, Northeast Ethiopia

Healthcare financing in many developing countries dominantly come from out-of-pocket expenditure, and it has remained problematic for its catastrophic consequences on the poor. Community based health insurance scheme become potential strategy to protect households from out- of –pocket expenditure and impoverishment, and access affordable and effective healthcare. Therefore, this study examined the role of community based health insurance on financial protection and healthcare seeking behavior of households in rural Ethiopia. Mixed research approach employed concurrently to collect data from participants, and collected data were analyzed through descriptive, inferential and thematic analysis. The study finding revealed that 71.5% of households protected from extra out of payments (other than premium payment for the scheme). Furthermore, large number of respondents (66.3%) replied that price for the scheme was easily affordable. Moreover, by avoiding out -of -pocket payment, community based health insurance improve healthcare seek behavior of households from modern healthcare providers. However, there were challenges in reimbursement, moral hazards or miss utilizations and adverse selections or the inclusion of chronically ill, poor and fee waivers during enrolment. In general, in the absence of third party and prepayment systems such as health insurance and tax-based healthcare financing, households in many low-income countries are exposed to the financial risks of paying large medical bills from out-of-pocket demands introduction of community based health insurance as alternative financial approach.

Community-Based Health Insurance and Out-of-Pocket Healthcare Spending in Africa: Evidence from Rwanda

In the absence of third party and prepayment systems such as health insurance and tax-based healthcare financing, households in many low-income countries are exposed to the financial risks of paying large medical bills from out-of-pocket. In recent years, community based health insurance schemes have become popular alternatives to fill such void in the healthcare financing systems. This paper investigates the impact of these schemes on out-of-pocket spending based on three rounds of nationally representative data from Rwanda. We estimate an Extended Two-Part Model to address endogeniety in insurance enrollment and censoring in healthcare expenditure data. We find that community based health insurance program has non-linear and mixed impacts on out-of-pocket expenditure. While the program significantly increases the probability of overall spending, it decreases the amount of per capita spending on healthcare. The program also significantly reduces spending on drug but increases outpatient spending with no detectable impact on inpatient services. Furthermore, we find notable heterogeneity in treatment effects in which households in the top income distribution realize the highest reduction in out-of-pocket spending.

Participation in the National Health Insurance Scheme Among Nurses in a Tertiary Teaching Hospital, North central Nigeria.

Background: The National Health Insurance Scheme was established under Act 35 of 1999 by the Federal Government of Nigeria and is aimed at providing easy access to health care for all Nigerians at an affordable cost through various prepayment systems. It is totally committed to achieving universal coverage and access to adequate and affordable health care aimed at improving the health status of Nigerians. Assessment of the programme after four years of operation, revealed less than three percent coverage of the Nigerian population. Therefore this study aimed at determining the level of its participation among nurses in a teaching hospital. Methodology : This was a descriptive cross sectional, facility-based study involving four hundred nurses selected using multistage sampling technique. Structured, self-administered questionnaires were used to collect data that was analysed using Epi info version 3.5.1 statistical software. Results : Majority: 268 (67%) of the respondents had good knowledge of the scheme, reflected by all of them acknowledging to having heard of the scheme with 312 (78%) actively participating in the scheme. One hundred and eighty eight (37.8%) of them had been participating for a duration of 0-2 years. A larger proportion; 216 (54%) respondents were not satisfied with the scheme with 80 (37.0%) of them noting that the process was cumbersome. There were statistically significant associations between sex (p<0.0001), cadre (p<0.0001) and participation in the scheme. Conclusion: Though all the nurses had heard about the scheme, with a greater percentage having a good knowledge of what it entails, there were negative findings regarding practice in terms of payments made and the cumbersome nature of the scheme by respondents. There is therefore a need to address these observed gaps so as to improve acceptability and accessibility of the scheme among them. Keywords: Participation, National Health Insurance Scheme, Nurses,Tertiary Teaching Hospital, North central Nigeria.

Future Trends in Dental Benefits

Dentistry and dental payment systems as we know them today will continue to evolve. Dentistry as practiced today and the prepayment systems of dentistry are substantially different than they were fifty years ago when dental insurance as we know it was first developed. Dentistry has always changed with the development of our science and the expression of dentistry's diseases in the populations we serve. The changes that are likely to occur in the future will be focused on improving health outcomes across risk-analyzed populations with the goals of providing optimal health outcomes at reasonable costs. Dentists will increasingly become engaged in the whole health of their patients. Where sufficient correlations can be leveraged between dentistry and overall health, medical plans will play an increasing role in dentistry's future for two reasons. Given favorably altered therapeutic outcomes for medical systems that preserve scarce resources, it will be an economic imperative to engage the dental system. It will also be the right thing to do from a total health perspective. In the final analysis, this elevates the role of dentistry and empowers the dentist to participate in the total health of their patients.

Solar home systems: Offering credit and ensuring recovery

Numerous studies have concluded that provision of credit would contribute to widespread deployment of SHS among populations otherwise deprived of the access to modern electricity services. Paradoxically, offering credit also represents a significant source of risk to the creditors, given the nature of the product and the specifics of the market. Pre-payment systems could offer a way out of this impasse and programme designers could do well to pay greater attention to the development, testing and deployment of such systems. Sunderasan Srinivasan, Solar Energy Society of India reports.

Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome

Study Objective: Cost concerns may inhibit emergency medical services (EMS) use. Novel tax-based and subscription prepayment programs indemnify patients against the cost of EMS treatment and transport. We determine whether the presence of (or enrollment in) prepayment plans increase EMS use among patients with acute chest discomfort, particularly those residing in low-income areas, those lacking private insurance, or both. Methods: This study uses a subset of baseline data from the REACT trial, a multicenter, randomized controlled community trial designed, in part, to increase EMS use. The sample includes 860 consecutive noninstitutionalized patients (>30 years old) presenting with nontraumatic chest discomfort to hospital emergency departments in 4 Oregon/Washington communities. The association between prepayment systems and EMS use was analyzed using multivariable logistic regression. Results: Overall EMS use was 52% (n=445). Among EMS users, 338 (75%) were subsequently admitted to the hospital and 110 (25%) were released from the ED. Prepayment was not associated with increased EMS use in the overall patient sample. However, patients residing in low-income census block groups (median annual income <$30,000) were 2.6 times (95% confidence interval [CI] 1.4 to 4.8) more likely to use EMS when a prepayment system was available than when no system was present. No association was noted among higher-income block group residents. Among low-income block group residents lacking private insurance, prepayment systems were associated with 3.8 times (95% CI 1.2 to 13.4) greater EMS usage. Conclusion: Economic considerations may affect EMS system utilization among underinsured and low-income patients experiencing a cardiac event. Prepayment systems may increase EMS utilization among these groups. [Seipmann DB, Mann NC, Hedges JR, Daya MR, for the Rapid Early Action for Coronary Treatment (REACT) Study. Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome. Ann Emerg Med. June 2000;35:573-578.]

Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome

Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome

Vehicular implementations of public key cryptographic techniques

The author discusses public key cryptography techniques offering solutions to the unique problems associated with transaction authentication procedures using the open communication channel between a vehicle and an unprotected ground terminal. Valuable secrets embedded in costly security modules are not kept at the terminals. Playback of recorded taped communications or attempts at rehashing messages would be useless, and will not assist illicit falsification or forging of subsequent transactions. To prevent the unauthorized use of the crediting facility of a vehicle, an integral part of this facility is to be carried by the driver when the vehicle is not in operation. This can be integrated into existing electronic ignition keys. A public key cryptographic module installed in a vehicle can also be used for theft prevention by enhancing both ignition security and remote controlled door locking/unlocking mechanisms. The same device can be used for authenticating smartcard-based prepayment systems for parking or toll-road usage. This methodology is described.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>

Monitoring quality-of-life needs of cancer patients

The advent of prepayment systems in hospitals has greatly shortened the length of stay of patients who are therefore increasingly treated and cared for in outpatient settings while living at home with family or other caretakers. This shift in the locus of treatment has created a critical need for the development of organized systems of follow-up that monitor a patient's needs while he or she is undergoing active treatment but living at home. Over time, failure to develop such systems of care is likely to result in major gaps in the continuity of care, a decrease in the quality of patients' lives while on treatment, tremendous stress on caretakers, and a general decrease in the quality of services provided to patients. This article reports on a study of one such system of monitoring i.e., a computer-automated telephone outreach system that would routinely assess the concrete needs of chemotherapy outpatients (e.g., transportation to the hospital and need for assistance with activities of daily living). This automated intervention was designed in response to previous findings that 62% of chemotherapy outpatients had at least one unmet need within the month before assessment and 39% had two or more; clinical knowledge that cancer patients' needs vary considerably over time as a consequence of both the disease and its treatment; and that, because of limited professional staff, patients' needs cannot be routinely assessed without the aid of automation, particularly as the proportion of cancer patients treated as outpatients continues to increase. These conditions suggested the need to develop a cost-efficient strategy for the universal assessment of patients' need on a periodic basis, so that emerging needs could be identified in a timely way. For the feasibility study, 97 chemotherapy outpatients were surveyed at least once over the telephone by a computer in a high quality digitally-stored voice asking 12 questions regarding the patients' concrete needs. The data suggested that our computer-automated telephone outreach system is reliable and valid and has the potential for relatively broad-based acceptance. In addition, the intervention frequently allows for timely social work assistance for identified needs. It further serves as a form of outreach that can compensate for patients' reluctance to identify themselves as needing help and for passivity that may be associated with depression or physical illness. This intervention appears to have the potential to be a time- and labor-efficient strategy for ongoing assessment of the changing needs of large numbers of cancer or other chronic diseased outpatients, insuring timely professional intervention as needs arise.

The Dentist and Prepaid Capitated Systems

Dentistry's involvement in HMOs and alternative delivery systems has increased dramatically in recent years. Because funding available for dental care is interdependent of general medical expenditures, ways must be found to utilize resources most appropriately. Dentists involved in the new reimbursement programs must understand the risks they are taking.

ORGANIZATION SECTION

<h3>Washington Letter</h3> (From a Special Correspondent) Sept. 12, 1949. <h3>Brookings Institution Launches Broad Health Survey</h3> The Brookings Institution of Washington has confirmed a report, first published in the Washington Report on the Medical Sciences, that it has launched a comprehensive survey of medical care in the United States. The study, which it is estimated will take about two years, will examine the facts and figures of private medical practice, voluntary prepayment systems, insurance indemnity coverage, hospital facilities, industrial health protection and all other major aspects of the problem. Observations will be published in two volumes, one on availability of services and the other on evaluation, according to present plans. <h3>Funds for Military to Employ Civilian Doctors</h3> Medical department appropriations for Army, Navy and Air Force in 1950 could be used, when necessary, for employment of civilian physicians, dentists and nurses, by provisions of the military appropriations bill in the form