Supprimer les paiements directs des soins en Afrique subsaharienne : débat international, défis de mise en oeuvre et revue réaliste du recours aux soins

Payer ses soins est une réalité coûteuse pour les usagers des services de santé en Afrique subsaharienne. Plusieurs pays suppriment donc certains types de paiements directs des soins au point de service, en instaurant des politiques d’exemption des paiements (PEP). Cette thèse explore trois enjeux majeurs soulevés par ces réformes. Le premier article analyse le positionnement des acteurs de la santé mondiale dans le débat sur les paiements directs des soins dans les pays à faible et moyen revenu. Cette étude documentaire montre que la majorité des acteurs s’exprime en défaveur des paiements directs en invoquant notamment leurs effets néfastes sur l’équité d’accès aux soins. Le second article met en lumière les effets perturbateurs des PEP sur les systèmes de santé des pays à faible et moyen revenu. Cette synthèse exploratoire indique que leur mise en œuvre perturbe les systèmes de santé de plusieurs manières : augmentation immédiate de l’utilisation des services gratuits, indisponibilité des médicaments, financement imprévisible et insuffisant, multiplicité des organes impliqués dans la mise en œuvre, et déficiences dans la planification et la communication. Le troisième article examine la manière dont les PEP influencent le recours aux soins des usagers. La revue réaliste a permis de développer une théorie qui explique ce processus, et de la mettre à l’épreuve d’études empiriques. Selon cette théorie, les PEP sont une ressource contribuant à renforcer le pouvoir d’agir des usagers. Ce pouvoir d’agir est également influencé par des facteurs structurels, locaux et individuels qui agissent sur la « capabilité » des usagers de se saisir de cette ressource, et de choisir de recourir aux services de santé gratuits. Trois mécanismes jouent un rôle essentiel dans ce choix : la confiance, l’acceptabilité, et la reconnaissance du risque. Cette thèse contribue au développement des connaissances empiriques sur une réforme majeure des systèmes de santé en Afrique subsaharienne. Elle apporte également des enseignements méthodologiques à la revue réaliste, et participe à la construction du champ de la recherche sur les politiques et systèmes de santé dans les pays à faible et moyen revenu.

Compensation to Workmen for Industrial Injuries

This thesis Entitled compensation to workmen for industrial injuries.Evaluation of the different forms of liability for compensating industrial injuries makes it evident that the liability under the social insurance scheme is the most befitting one, as it eliminates the problem of evasion of liability by the employer by providing for sharing of liability. Liability for compensation under the workmen's Compensation Act, 1923 and the Employees' State Insurance Act, 1948 arises only in the case of accidents, arising in the course of and out of employment. Majority of the workers, covered by the workmen's Compensation Act, have supported lumpsum payment of compensation under the Act. It appears that workers are ignorant of the cemerits of lumpsum payment. So, the workers should be properly educated by the Inspectorate, proposed above, about the comparative advantages of periodical payments. It is suggested that the workmens Compensation Act, 1923 may be amended, imposing fee upon the parties for each adjournment. It is also suggested that provision may be made in the workmens Compensation Act, 1923 for the expeditious despatch of amendments of the Workmen's Compensation Act, 1923, the Workmens· Compensation Rules, 1924 and the Schedules, made from time to time, to the comrnissioners for workmens Compensation, This will help them mete out justice to an injured workman, as required by the changes in the law. The Employees' State Insurance Act, 1948 and the Rules may be amended, requiring the employers to provide the employees with necessary information, in the vernacular language, about the employment injury benefits available under the Employees' State Insurance Act, 1948 and the formalities for obtaining the same. This will help the illiterate employees, especially the casual ones, avail of employment injury benefits. Changes in the law, on the lines suggested above, are imperative to make the system of compensation for industrial injuries prove effective and beneficial to injured workmen.

La administración cuantitativa del riesgo financiero en la provisión de un plan de salud

El diseño del sistema de seguridad social en salud y su efectiva implementación es uno de los más grandes retos de la sociedad, y a su vez es la principal garantía del goce efectivo del derecho a la salud. Un gran desafío de estos sistemas es la administración del riesgo financiero implícito en la provisión de los servicios de salud. Este documento ilustra en qué medida este desafío se puede enmarcar dentro de un problema de administración cuantitativa de los riesgos financieros. Si bien el uso de estas herramientas no son nuevas en el diseño del sistema de seguridad social en salud colombiano, es importante dar claridad sobre el alcance que han tenido estas herramientas, las posibles mejoras que se puedan hacer y los desafíos, en la gestión de estos riesgos, implícitos en la reforma actual de la institucionalidad del sistema.

The impact of broadband quality standards on internet services market structure in Colombia

This paper develops a structural model which allows estimating the impact of regulatory decisions looking for the setting of download-speed standards on market structure and performance. We characterize a setting under which quality standards improve both service quality and availability. As to quality, we evaluate the impact of quality standards on the performance of local demand from a detailed database of broadband internet subscribers, discriminated by the main attributes of an internet subscription contract as location, supplier, monthly-fee, download- and upload-speed features. From these results, we are able to identify the effect of quality regulation on the behavior of internet providers in a differentiated product market approach. As a consequence, we are able to assert that the response of internet service providers to quality regulation is a more intense product differentiation that contributes to demand expansion and therefore to improve broadband penetration indicators.

Doctors´ remuneration schemes and hospital competition in two-sided markets with common network externalities

This paper uses a two-sided market model of hospital competition to study the implications of di§erent remunerations schemes on the physiciansí side. The two-sided market approach is characterized by the concept of common network externality (CNE) introduced by Bardey et al. (2010). This type of externality occurs when occurs when both sides value, possibly with di§erent intensities, the same network externality. We explicitly introduce e§ort exerted by doctors. By increasing the number of medical acts (which involves a costly e§ort) the doctor can increase the quality of service o§ered to patients (over and above the level implied by the CNE). We Örst consider pure salary, capitation or fee-for-service schemes. Then, we study schemes that mix fee-for-service with either salary or capitation payments. We show that salary schemes (either pure or in combination with fee-for-service) are more patient friendly than (pure or mixed) capitations schemes. This comparison is exactly reversed on the providersíside. Quite surprisingly, patients always loose when a fee-for-service scheme is introduced (pure of mixed). This is true even though the fee-for-service is the only way to induce the providers to exert e§ort and it holds whatever the patientsívaluation of this e§ort. In other words, the increase in quality brought about by the fee-for-service is more than compensated by the increase in fees faced by patients.

CP Andr??s Segovia : somos eco-escuelas

Eco-escuelas, es una campa??a a nivel europeo cuyo objetivo es potenciar la educaci??n ambiental implicando a la comunidad educativa, organizaciones juveniles de barrio, ONGs y Ayuntamientos. Se trabaja sobre agua, energ??a y residuos s??lidos y su organizaci??n corre a cargo de la Fundaci??n Europea de Educaci??n Ambiental (FEE). El art??culo se centra en la historia, organizaci??n y caracter??sticas del centro p??blico de integraci??n Andr??s Segovia de Legan??s, centro que forma parte de la campa??a eco-escuelas.

Centros de bandera verde : Red Andaluza de Ecoescuelas.

Se trata de un programa dirigido a la gestión y certificación ambiental y a la educación para el desarrollo sostenible en los centros educativos. Ecoescuelas es un programa de ámbito internacional coordinado por la Fundación Europea de Educación Ambiental (FEE) y desarrollado en España por la Asociación de Educación Ambiental y el Consumidor (ADEAC). En Andalucía está coordinado por las consejerías de Educación y Medio Ambiente, a través del Programa Aldea y en colaboración con ADEAC. Su finalidad es impulsar la educación ambiental en la vida escolar, implicando a todo su entorno, así como crear una red de centros educativos que favorezcan los intercambios y la cooperación. El desarrollo de la Red Andaluza de Ecoescuelas se sustenta en: apoyo a los centros a través de recursos humanos, apoyo de recursos materiales y formación específica..

Dichotomous-choice contingent valuation with 'don't know' responses and misreporting

A new approach is presented that simultaneously deals with Misreporting and Don't Know (DK) responses within a dichotomous-choice contingent valuation framework. Utilising a modification of the standard Bayesian Probit framework, a Gibbs with Metropolis-Hastings algorithm is used to estimate the posterior densities for the parameters of interest. Several model specifications are applied to two contingent valuation datasets: one on wolf management plans, and one on the US Fee Demonstration Program. We find that DKs are more likely to be from people who would be predicted to have positive utility for the bid. Therefore, a DK is more likely to be a YES than a NO. We also find evidence of misreporting, primarily in favour of the NO option. The inclusion of DK responses has an unpredictable impact on willingness-to-pay estimates, since it impacts differently on the results for the two datasets we examine. Copyright (C) 2009 John Wiley & Sons, Ltd.

Carbon-decorated FePt nanoparticles

FePt magnetic nanoparticles are an important candidate material for many future magnetic applications. FePt exists as two main phases, that is, a disordered face-centered cubic (fcc) structure, which is generally prepared by chemical methods at low temperatures, and the high-temperature chemically ordered face-centered tetragonal (fct) structure. The fee FePt, with low coercivity but associated with superparamagnetic properties, may find applications as a magnetic fluid or as a nanoscale carrier for chemical or biochemical species in biomedical areas, while fct FePt is proposed for use in ultrahigh-density magnetic recording applications. However, for both of these applications an enhancement of the intrinsically weak magnetic properties, the avoidance of magnetic interferences from neighbor particles, and the improved stability of the small magnetic body remain key practical issues. We report a simple synthetic method for producing FePt nanoparticles that involves hydrothermal treatment of Fe and Pt precursors in glucose followed by calcination at 900 degrees C. This new method produces thermally stable spheroidal graphite nanoparticles (large and fullerene-like) that encapsulate or decorate FePt particles of ca. 5 nm with no severe macroscopic particle coalescence. Also, a low coercivity of the material is recorded; indicative of small magnetic interference from neighboring carbon-coated particles. Thus, this simple synthetic method involves the use of a more environmentally acceptable glucose/aqueous phase to offer a protective coating for FePt nanoparticles. It is also believed that such a synthetic protocol can be readily extended to the preparation of other graphite-coated magnetic iron alloys of controlled size, stoichiometry, and physical properties.

Engineering of a monodisperse core-shell magnetic Ti-O-Si oxidation nanocatalyst

There has been limited development in catalyst carriers for magnetic separations where superparamagnetic nanoparticles of a high saturation magnetization with no coercivity are required to isolate expensive catalyst reagent that are subjected to repeated magnetic cycles. By using simple stepwise layer-by-layer nanochemistry techniques, we show that an fee FePt nanomagnet can be created inside each silica particle with tailored dimensions to great precision. Subsequent engineering of the external surface with Ti-O-Si species in an optimum structure to create a unique interface gives high activity and excellent selectivity of the composite material for the trans-stilbene oxidation to the corresponding epoxide in the presence of tert-butyl hydroperoxide. Thus, a new magnetic separable epoxidation catalyst is described. This work clearly demonstrates the significance of nanoengineering of a single catalyst particle by a bottom-up construction approach in modern catalyst design, which could lead to new catalytic. properties.

The surface geometry of carbon monoxide and oxygen co-adsorbed on Ni{111}

Low energy electron diffraction (LEED) structure determinations have been performed for the p(2 x 2) structures of pure oxygen and oxygen co-adsorbed with CO on Ni{111}. Optimisation of the non-geometric parameters led to very good agreement between experimental and theoretical IV-curves and hence to a high accuracy in the structural parameters. In agreement with earlier work atomic oxygen is found to adsorb on fee sites in both structures. In the co-adsorbed phase CO occupies atop sites. The positions of the substrate atoms are almost identical, within 0.02 Angstrom, in both structures, implying that the interaction with oxygen dominates the arrangement of Ni atoms at the surface.

A spatial–temporal analysis of the impact of access restrictions on forest landscapes and household welfare in Tanzania

This paper explores the impact of the re-introduction of access restrictions to forests in Tanzania, through participatory forest management (PFM), that have excluded villagers from forests to which they have traditionally, albeit illegally, had access to collect non-timber forest products (NTFPs). Motivated by our fieldwork, and using a spatial–temporal model, we focus on the paths of forest degradation and regeneration and villagers' utility before and after an access restriction is introduced. Our paper illustrates a number of key points for policy makers. First, the benefits of forest conservation tend to be greatest in the first few periods after an access restriction is introduced, after which the overall forest quality often declines. Second, villagers may displace their NTFP collection into more distant forests that may have been completely protected by distance alone before access to a closer forest was restricted. Third, permitting villagers to collect limited amounts of NTFPs for a fee, or alternatively fining villagers caught collecting illegally from the protected forest, and returning the fee or fine revenue to the villagers, can improve both forest quality and villagers' livelihoods.

The future of bioscience fieldwork in UK higher education

Fieldwork is an important and often enjoyable part of learning in Bioscience degree courses, however it is unclear how the recent reforms to Higher Education (HE) may impact the future funding of outdoor learning. This paper reports on the findings from a recent survey of 30 HE Bioscience practitioners from across the UK. Their current level of fieldwork provision and factors affecting this provision in the future were explored. The data showed that the level of fieldwork had remained similar over the past five years and this was set to remain so over the next academic year and also into the next five years (when it may even increase). Funding of fieldwork was under review in most institutions due to the increase in student tuition fees and it was found that in some cases the cost of compulsory fieldwork will be subsumed within the overall course fee. Many influencing factors were discussed, but the most frequently raised topics were that of the development of employability skills during fieldwork and its importance in attracting and retaining students. Both topics are high on the agenda of HE institutions going forward into the new funding model, suggesting that fieldwork will remain a central part of the Bioscience curriculum.

Simulation of field-induced structural formation and transition in electromagnetorheological suspensions

A computer simulation method has been used to study the three-dimensional structural formation and transition of eleetromagnetorheological (EMR) suspensions under compatible electric and magnetic fields. When the fields are applied simultaneously and perpendicularly to each other, the particles rapidly arrange into single layer structures parallel to both fields. In each layer, there is a two-dimensional hexagonal lattice. The single layers then combine together to form thicker sheetlike structures. With the help of the thermal fluctuations, the thicker structures relax into three-dimensional close-packed structures, which may be face-centered cubic (fcc), hexagonal close-packed (hup) lattices, or, more probably, the mixture of them, depending on the initial configurations and the thermal fluctuations. On the other hand, if the electric field is applied first to induce the body-centered tetragonal (bct) columns in the system, and then the magnetic field is applied in the perpendicular direction, the bet to fee structure transition is observed in a very short time. Following that, the structure keeps on evolving due to the demagnetization effect and finally forms close-packed structures with fee and hcp lattice character. The simulation results are in agreement with the theoretical and experimental results.