Out-of-pocket expenditures for hospital care in Iran : who is at risk of incurring catastrophic payments?

Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian—regardless of their employment status—can better protect households from catastrophic health spending.

Hospital care in Iran : an examination of national health system performance

This study examines hospital care system performance in Iran. We first briefly review hospital care delivery system in Iran. Then, the hospital care system in Iran has been investigated from financial, utilization, and quality perspectives. In particular, we examined the extent to which health care system in Iran protects people from the financial consequence of health care expenses and whether inpatient care distributed according to need. We also empirically analyzed the quality of hospital care in Iran using patient satisfaction information collected in a national health service survey. The Iranian health care system consists of unequal access to hospital care; mismatch between the distribution of services and inpatients' need; and high probability of financial catastrophe due to out-of-pocket payments for inpatient services. Our analysis indicates that the quality of hospital care among Iranian provinces favors patients residing in provinces with high numbers of hospital beds per capita such as Esfahan and Yazd. Patients living in provinces with low levels of accessibility to hospital care (e.g. Gilan, Kermanshah, Hamadan, Chahar Mahall and Bakhtiari, Khuzestan, and Sistan and Baluchestan) receive lower-quality services. These findings suggest that policymakers in Iran should work on several fronts including utilization, financing, and service quality to improve hospital care.

Coming of Age in 9/11 Fiction: Bildungsroman and Loss of Innocence

Directly after the horrific events of September 11, 2001, many Americans were saying the same thing: the world has changed forever. They were overwhelmed with a sense that “the party was over.” It was clear that America had lost its innocence; it now had to “grow up.” Much of the fiction produced since 9/11 and with 9/11 at its core provides evidence of the larger cultural belief that September 11 was a turning point (much like adolescence) from which there is no turning back. In this chapter, I examine how three post-9/11 novels—Lorrie Moore’s A Gate at the Stairs, Joyce Maynard’s The Usual Rules, and John Updike’s Terrorist—position readers to understand September 11 as a moment that changed how young Americans come of age.

Endogenous and exogenous effects in self-exciting process models of terrorist activity

A model based on the cluster process representation of the self-exciting process model in White and Porter 2013 and Ruggeri and Soyer 2008is derived to allow for variation in the excitation effects for terrorist events in a self-exciting or cluster process model. The details of the model derivation and implementation are given and applied to data from the Global Terrorism Database from 2000–2012. Results are discussed in terms of practical interpretation along with implications for a theoretical model paralleling existing criminological theory.

Unitary Taxation of the Finance Sector

Multinational financial institutions (MNFIs) play a significant role in financing the activities of their clients in developing nations. Consistent with the ‘follow-the-customer’ phenomenon which explains financial institution expansion, these entities are increasingly profiting from activities associated with this growing market. However, not only are MNFIs persistent users of tax havens, but also, more than other industries, have the opportunity to reduce tax through transfer pricing measures. This paper establishes a case for an industry-specific adoption of unitary taxation with formulary apportionment as a viable alternative to the current regime. In doing so, it considers the practicalities of implementing this by examining both definitional issues and possible formulas for MNFIs. This paper argues that, while there would be implementation difficulties to overcome, the current domestic models of formulary apportionment provide important guidance as to how the unitary business and business activities of MNFIs should be defined, as well as the factors that should be included in an allocation formula, and the appropriate weighting. This paper concludes that unitary taxation with formulary apportionment is a viable industry-specific alternative for MNFIs.

The opportunity for implementing Islamic project financing to the Indonesian infrastructure development

Purpose: This chapter discusses the opportunity of Islamic project financing implementation for public infrastructure development in Indonesia. Design/Methodology/Approach: This chapter, firstly, reviewed existing literature on Islamic finance to explore the applicability of Islamic financing in infrastructure development. Interviews were conducted as the first stage of Delphi method approach. This was then followed by reviewing Indonesia’s government policies and regulations in infrastructure industry and Islamic financing. Findings: This chapter enlightens the implementation of Islamic financing on infrastructure project financing in Indonesia. The findings indicate that the government policies and regulations on both infrastructure investment and Islamic financing support the implementation of Islamic project financing, whereas, an improvement is still needed in order to overarch infrastructure business and Islamic financing investment. Research: Financing framework development for Indonesia infrastructure projects. Limitations/Implications: The result reported comprises the preliminary study of Islamic project paper written based on published research papers and interviews. Furthermore, the data collected for the study are limited to the case of Indonesian infrastructure projects. Practical Implication: Islamic financing in Indonesia infrastructure projects development has not been optimally implemented. Therefore, this chapter serves as a catalyst to explore alternative financial scheme such as Islamic financing for infrastructure development. Originality/Value: This chapter highlights possibilities and obstacles in applying Islamic scheme to infrastructure project financing. This provides a framework to analyse the steps to implement Islamic financing successfully in infrastructure development.

Pastoral care in times of high stakes testing and accountability

The unknown future is a challenge to educators in preparing young people for life post school. While history can be said to repeat itself, the reality is that each generation is faced with new challenges and threats. Therefore, the challenge for contemporary schooling is to prepare students to live in a fast paced, complex world where threats such as terrorism, cyberbullying and depleted resources are juggled with high stakes testing and curriculum accountability. This presentation draws on the notion of a future of supercomplexity while critically examining current pastoral care delivery in schools to develop a new model of practice in preparing students for an unknown future.