System Reliance Research Articles

Overwhelming health expenditures among the poor in a transition economy: A case study from Turkey

A primary goal of modern health systems is to protect citizens from catastrophic health expenditures. Today, health care spending is a significant cause of poverty and the poor are more vulnerable to catastrophic payments. Similar to other countries, Turkey is facing problems of poverty due recent economic crises and it has developed poverty alleviation programs with the support of international organizations such as the World Bank. In the literature, no studies have identified and measured catastrophic health expenditures among poor people in Turkey. This study included 92 households in the Etimesgut region of Ankara, with these households being in the priority group for assistance identified by the Social Risk Mitigation Project of the Social Solidarity Fund (SYDTF). In the study, households' socio-demographic characteristics, living standards, health status and situations regarding catastrophic health expenditures were examined via face-to-face interviews. The results of the study indicate that poverty, households' socio-demographic characteristics and living standards are strongly related. The poverty rate of female-headed households (61.33%) was greater than that of male-headed households (32.8%). Moreover, 125 household members (34.3%) had at least one chronic illness and/or disability, and 14 households (15.2%) were facing catastrophic health expenditures that constituted an average of 62.3% of their non-food expenditures. One conclusion of the study is that particularly in poor households, people can be protected from catastrophic health expenditures by reducing the health system's reliance on out-of-pocket payments and by providing more financial risk protection. If the poor are not protected, their increased health risks will create further financial and social burdens at both the community and government levels.

Biotech in Court

This paper examines the American legal system's reliance upon the unity of science through a close study of the testimony presented in a biotech patent trial, explicated through the context of the legal practice of patent drafting and the history of the American biotechnology industry. In order to decide whether a key patent related to the polymerase chain reaction (PCR) was invalid, the court needed to decide whether the inventing scientists had made intentional misrepresentations in the process of drafting and prosecuting the patent. I analyze the various images of science presented to the court by scientists testifying about how scientists report their experimental results in scientific publications. By setting this testimony about scientific authorship in the context of the legal understanding of patent authorship, I explain why the court was prepared to accept a universal notion of science and of the scientist that rendered unimportant any distinctions between papers and patents, or between professors and biotech scientists. This image of universal science was opposed at trial by local and specific images of sciences which have been institutionalized in industrial science throughout the 20th century, and which I argue were adopted and adapted by the American biotech industry of the 1970s to the 1990s in ways that contributed both to the trial court's finding against the patent, and to the instability of that ruling.

Path perception during rotation: influence of instructions, depth range, and dot density

How do observers perceive their direction of self-motion when traveling on a straight path while their eyes are rotating? Our previous findings suggest that information from retinal flow and extra-retinal information about eye movements are each sufficient to solve this problem for both perception and active control of self-motion [Vision Res. 40 (2000) 3873; Psych. Sci. 13 (2002) 485]. In this paper, using displays depicting translation with simulated eye rotation, we investigated how task variables such as instructions, depth range, and dot density influenced the visual system's reliance on retinal vs. extra-retinal information for path perception during rotation. We found that path errors were small when observers expected to travel on a straight path or with neutral instructions, but errors increased markedly when observers expected to travel on a curved path. Increasing depth range or dot density did not improve path judgments. We conclude that the expectation of the shape of an upcoming path can influence the interpretation of the ambiguous retinal flow. A large depth range and dense motion parallax are not essential for accurate path perception during rotation, but reference objects and a large field of view appear to improve path judgments.

Household catastrophic health expenditure: a multicountry analysis

Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. Yet catastrophic expenditure is not rare. We investigated the extent of catastrophic health expenditure as a first step to developing appropriate policy responses. We used a cross-country analysis design. Data from household surveys in 59 countries were used to explore, by regression analysis, variables associated with catastrophic health expenditure. We defined expenditure as being catastrophic if a household's financial contributions to the health system exceed 40% of income remaining after subsistence needs have been met. The proportion of households facing catastrophic payments from out-of-pocket health expenses varied widely between countries. Catastrophic spending rates were highest in some countries in transition, and in certain Latin American countries. Three key preconditions for catastrophic payments were identified: the availability of health services requiring payment, low capacity to pay, and the lack of prepayment or health insurance. People, particularly in poor households, can be protected from catastrophic health expenditures by reducing a health system's reliance on out-of-pocket payments and providing more financial risk protection. Increase in the availability of health services is critical to improving health in poor countries, but this approach could raise the proportion of households facing catastrophic expenditure; risk protection policies would be especially important in this situation.

A Rhetorical Perspective on the 1997 British Party Manifestos

This article discusses the British political system's reliance on party manifestos and suggests that they deserve study as rhetorical texts. The magazine-like 1997 manifestos of the Conservative, Labour, and Liberal Democrat Parties are analyzed with respect to their iconic structure, the priority of policy domains in their social critiques, their historical narratives, and their narratives on the central issue of economics. Results suggest that all three parties focused on British history since 1979 and on economic issues. The Conservative Manifesto subordinated people to icons and graphs, concentrated on economic analyses, and portrayed the party's policies as successful. Labour and Liberal Democrats emphasized economic failures; the Liberal Democrats sought wide-ranging populist reforms, while "New" Labour ran against the Tory record and the historic radicalism of "Old" Labour.

Ideal observer perturbation analysis reveals human strategies for inferring surface orientation from texture.

Optical texture patterns contain three quasi-independent cues to planar surface orientation: perspective scaling, projective foreshortening and density. The purpose of this work was to estimate the perceptual weights assigned to these texture cues for discriminating surface orientation and to measure the visual system's reliance on an isotropy assumption in interpreting foreshortening information. A novel analytical technique is introduced which takes advantage of the natural cue perturbations inherent in stochastic texture stimuli to estimate cue weights and measure the influence of an isotropy assumption. Ideal observers were derived which compute the exact information content of the different texture cues in the stimuli used in the experiments and which either did or did not rely on an assumption of surface texture isotropy. Simulations of the ideal observers using the same stimuli shown to subjects in a slant discrimination task provided trial-by-trial estimates of the natural cue perturbations which were inherent in the stimuli. By back-correlating subjects' judgments with the different ideal observer estimates, we were able to estimate both the weights given to each cue by subjects and the strength of subjects' prior assumptions of isotropy. In all of the conditions tested, we found that subjects relied primarily on the foreshortening cue. A small, but significant weight was given to scaling information and no significant weight was given to density information. In conditions in which the surface textures deviated from isotropy by random amounts from stimulus to stimulus, subject judgements correlated well with the estimates of an ideal observer which incorrectly assumed surface texture isotropy. This correlation was not complete, however, suggesting that a soft form of the isotropy constraint was used. Moreover, the correlation was significantly lower for textures containing higher-order information about surface orientation (skew of rectangular texture elements). The results of the analysis clearly implicate texture foreshortening as a primary cue for perceiving surface slant from texture and suggest that the visual system incorporates a strong, though not complete, bias to interpret surface textures as isotropic in its inference of surface slant from texture. They further suggest that local texture skew, when available in an image, contributes significantly to perceptual estimates of surface orientation.

Spreading the news: the American postal system from Franklin to Morse

Spreading the News: The American Postal System from Franklin to Morse, by Richard R. John, (Harvard University Press, 1995, 369 pp. Works cited, index; $51.95 hardbound; $18.95 softbound.) One might gather from reading recent business news that the impact of information technology on the culture and economy of the United States is unique in the nation's history. But Richard R. John's evocative Spreading the News authoritatively suggests it has, in many ways, happened before. Spreading the News is really the story of the Post Office Act of 1792. John contends the act greatly aided the expansion of the nation, especially in the decades following the War of 1812 during the settlement and development of the Old Northwest. Congress' appropriation of the power to establish post offices and post routes, forbidding government inspection of the mails, establishing the symbiotic relationship between the post office and stagecoach companies, and mandating the inclusion of all newspapers in the official mail were major innovations of the act. Combined, they assured the astonishing success of the government's first venture into information technology - efficiently delivering the private and business communications and news the mails contained. The post office, strange as it may seem today, was once admired as the most efficient arm of the federal government. During the 1830s, it was also the largest government agency John reports the startling fact that in 1831, the postal service's 8,700 postmasters far out-numbered the 6,332 soldiers in the U.S. Army In 1831, French traveler and commentator Alexis de Tocqueville expressed surprise at how well informed even backwoodsmen in the wilds of Michigan and Illinois were about national politics. For that he credited the U.S. Post Office, which he praised as being far in advance of anything in Europe. John shows de Tocqueville's impression was correct. At the time, and with far less population, the U.S. had several times as many post offices as England and France combined. The postal system was successful, John sugBests, because of its unparalleled ability to quickly and securely transmit everything from cash to letters to newspapers. Vital to this effort was the system's reliance on private stagecoach contractors to carry the mails. John shows the relationship between the post office and these firms was so close the companies were in all but name post office subsidiaries. In fact, until 1840, stage contractors who lost their mail contracts were required to sell their rolling stock, teams and other equipment to the successful bidders. Passengers were carried by stagecoach as well, of course. The presence of the mail meant passengers were carried along with the mail on regular schedules. Because one-third or more of stagecoach company revenues were derived through mail contracts, the firms became, John contends, the first federally subsidized mass transit system in the nation's history. Since colonial times, publishers had relied on the postal service to circulate exchange papers - editions traded with other publishers in an embryonic version of what eventually became wire services. But not until the Post Office Act of 1792 was the practice codified in both law and postal regulations by requiring free carriage of exchanges. In addition, the act required all newspapers to be considered part of the official mail, something previously left up to the whims of individual postmasters. Finally, the act set low newspaper postage rates. As a result, small country weeklies were assured large metropolitan papers could not use their greater wealth to flood rural markets, something that had a profoundly beneficial impact on the independence and vigor of the American press. …

Services and Trends in Israel's Mental Health System

Despite a rapidly growing population, continuing funding shortages, and threats to its national security, Israel has developed a comprehensive mental health care system, based on the psychiatric hospital. Services are provided through several networks, including government-financed and for-profit hospitals, government-financed mental health clinics in each of 23 service areas, and four health funds. Other networks provide care for specific groups such as soldiers, kibbutz members, orthodox Jews, and Israeli Arabs. The system's reliance on the hospital creates special problems, such as dependency and fragmentation of care, and a community mental health model adopted almost 20 years ago has yet to achieve the goal of shifting treatment to the community. However, Israel's mental health system is in a transition period. By drawing on its many strengths and learning from other countries' experience, Israel has the potential for developing a unique community-focused system.

The training and visit agricultural extension in rainfed agriculture: Lessons from Ethiopia

This study provides an analytical framework for the monitoring and evaluation of extension projects through an examination of the applicability of the training and visit (T&V) extension in Ethiopia. The field evaluation reveals the T&V system's effectiveness in disseminating innovations and increasing yields among contact farmers, upgrading extension agents' skills, and imparting valuable lessons for other extension systems in Ethiopia. At same time, the system's reliance on small groups of contact farmers for rapid diffusion of innovations to the masses restrains its effectiveness, suggesting the need for a correction in its application. Efforts should be made to bring women into all levels of the T&V structure. Women are noticeably absent at present. The findings from this study support the continuation of the T&V system in the relatively fertile regions of Ethiopia. But they also highlight its limited applicability in resource-poor and drought-prone regions of the country.