Health insurance as a strategy for access : Streamlined facts of the Colombian Health Care Reform

La reforma colombiana al sistema de salud (Ley 100 de 1993) estableció, como estrategia para facilitar el acceso, la universalidad de un seguro de salud que se adquiere mediante la cotización en el régimen contributivo o mediante la afiliación gratuita al régimen subsidiado, con la meta de cubrir a toda la población con un plan de beneficios único que comprende servicios de todos los niveles de atención. En el documento se analizan los principales hechos estilizados de la reforma en cuanto a cobertura del seguro y acceso y, mediante modelos logit, se estiman los determinantes de la afiliación y del acceso, con datos de las encuestas de calidad de vida de 1997 y 2003. Se destaca que la cobertura pasó del 20% de la población en 1993 al 60% en 2004, aunque parece imposible alcanzar la universalidad; la estructura y evolución de la cobertura muestran que los dos regímenes son complementarios, de modo que mientras el contributivo tiene mayor presencia en las ciudades y entre la población con empleo formal, el subsidiado tiene mayor peso entre la población rural y con bajos niveles de ingresos; por otra parte, el seguro tiene ventajas para la población subsidiada, con una mayor probabilidad de utilización de servicios, aunque el plan es inferior al del contributivo y existen barreras para el acceso.

Horizontal Inequity in Access to Health Care in Four South American Cities

The objective of this paper is compare socioeconomic inequalities in the use of healthcare services in four South-American cities: Buenos Aires, Santiago, Montevideo, and San Pablo. We use secondary data from SABE, a survey on Health, Well-being and Aging administered in 2000 underthe sponsorship of the Panamerican Health Organization, and representative of the elderly population in each of the analyzed cities. We construct concentration indices of access to and quality of healthcare services, and decompose them in socioeconomic, need, and non-need contributors. Weassess the weight of each contributor to the overall index and compare indices across cities. Our results show high levels of pro-rich socioeconomic inequities in the use of preventive services in all cities, inequities in medical visits in Santiago and Montevideo, and inequities in quality of access to care in all cities but Montevideo. Socioeconomic inequality within private or public health systems explains a higher portion of inequalities in access to care than the fragmented nature of health systems. Our results are informative given recent policies aimed at enforcing minimum packages of services and given policies exclusively focused on defragmenting health systems.

Barreras en el acceso a la dirección escolar : diferencias entre profesoras y directoras de centros de Educación Infantil y Primaria. 'Barriers in the access to school management : differences between teachers and head-teachers from early childhood and elementary education schools'.

Resumen tomado de la publicación. Con el apoyo económico del departamento MIDE de la UNED

Estimation of age- and stage-specific Catalan breast cancer survival functions using US and Catalan survival data

During the last part of the 1990s the chance of surviving breast cancer increased. Changes in survival functions reflect a mixture of effects. Both, the introduction of adjuvant treatments and early screening with mammography played a role in the decline in mortality. Evaluating the contribution of these interventions using mathematical models requires survival functions before and after their introduction. Furthermore, required survival functions may be different by age groups and are related to disease stage at diagnosis. Sometimes detailed information is not available, as was the case for the region of Catalonia (Spain). Then one may derive the functions using information from other geographical areas. This work presents the methodology used to estimate age- and stage-specific Catalan breast cancer survival functions from scarce Catalan survival data by adapting the age- and stage-specific US functions. Methods: Cubic splines were used to smooth data and obtain continuous hazard rate functions. After, we fitted a Poisson model to derive hazard ratios. The model included time as a covariate. Then the hazard ratios were applied to US survival functions detailed by age and stage to obtain Catalan estimations. Results: We started estimating the hazard ratios for Catalonia versus the USA before and after the introduction of screening. The hazard ratios were then multiplied by the age- and stage-specific breast cancer hazard rates from the USA to obtain the Catalan hazard rates. We also compared breast cancer survival in Catalonia and the USA in two time periods, before cancer control interventions (USA 1975–79, Catalonia 1980–89) and after (USA and Catalonia 1990–2001). Survival in Catalonia in the 1980–89 period was worse than in the USA during 1975–79, but the differences disappeared in 1990–2001. Conclusion: Our results suggest that access to better treatments and quality of care contributed to large improvements in survival in Catalonia. On the other hand, we obtained detailed breast cancer survival functions that will be used for modeling the effect of screening and adjuvant treatments in Catalonia

Integration of knowledge-based, qualitative and numeric tools for real time dynamic systems supervision

The proposal presented in this thesis is to provide designers of knowledge based supervisory systems of dynamic systems with a framework to facilitate their tasks avoiding interface problems among tools, data flow and management. The approach is thought to be useful to both control and process engineers in assisting their tasks. The use of AI technologies to diagnose and perform control loops and, of course, assist process supervisory tasks such as fault detection and diagnose, are in the scope of this work. Special effort has been put in integration of tools for assisting expert supervisory systems design. With this aim the experience of Computer Aided Control Systems Design (CACSD) frameworks have been analysed and used to design a Computer Aided Supervisory Systems (CASSD) framework. In this sense, some basic facilities are required to be available in this proposed framework: ·

Surveillance and data retention in Poland

The object of analysis in the present text is the issue of operational control and data retention in Poland. The analysis of this issue follows from a critical stance taken by NGOs and state institutions on the scope of operational control wielded by the Polish police and special services – it concerns, in particular, the employment of “itemized phone bills and the so-called phone tapping.” Besides the quantitative analysis of operational control and the scope of data retention, the text features the conclusions of the Human Rights Defender referred to the Constitutional Tribunal in 2011. It must be noted that the main problems concerned with the employment of operational control and data retention are caused by: (1) a lack of specification of technical means which can be used by individual services; (2) a lack of specification of what kind of information and evidence is in question; (3) an open catalogue of information and evidence which can be clandestinely acquired in an operational mode. Furthermore, with regard to the access granted to teleinformation data by the Telecommunications Act, attention should be drawn to a wide array of data submitted to particular services. Also, the text draws on the so-called open interviews conducted mainly with former police officers with a view to pointing to some non-formal reasons for “phone tapping” in Poland. This comes in the form of a summary.

Use of fused airborne scanning laser altimetry and digital map data for urban flood modelling

Flood modelling of urban areas is still at an early stage, partly because until recently topographic data of sufficiently high resolution and accuracy have been lacking in urban areas. However, Digital Surface Models (DSMs) generated from airborne scanning laser altimetry (LiDAR) having sub-metre spatial resolution have now become available, and these are able to represent the complexities of urban topography. The paper describes the development of a LiDAR post-processor for urban flood modelling based on the fusion of LiDAR and digital map data. The map data are used in conjunction with LiDAR data to identify different object types in urban areas, though pattern recognition techniques are also employed. Post-processing produces a Digital Terrain Model (DTM) for use as model bathymetry, and also a friction parameter map for use in estimating spatially-distributed friction coefficients. In vegetated areas, friction is estimated from LiDAR-derived vegetation height, and (unlike most vegetation removal software) the method copes with short vegetation less than ~1m high, which may occupy a substantial fraction of even an urban floodplain. The DTM and friction parameter map may also be used to help to generate an unstructured mesh of a vegetated urban floodplain for use by a 2D finite element model. The mesh is decomposed to reflect floodplain features having different frictional properties to their surroundings, including urban features such as buildings and roads as well as taller vegetation features such as trees and hedges. This allows a more accurate estimation of local friction. The method produces a substantial node density due to the small dimensions of many urban features.

Detection of flood extent in urban areas using high resolution TerraSAR-X data

Flooding is a major hazard in both rural and urban areas worldwide, but it is in urban areas that the impacts are most severe. An investigation of the ability of high resolution TerraSAR-X data to detect flooded regions in urban areas is described. An important application for this would be the calibration and validation of the flood extent predicted by an urban flood inundation model. To date, research on such models has been hampered by lack of suitable distributed validation data. The study uses a 3m resolution TerraSAR-X image of a 1-in-150 year flood near Tewkesbury, UK, in 2007, for which contemporaneous aerial photography exists for validation. The DLR SETES SAR simulator was used in conjunction with airborne LiDAR data to estimate regions of the TerraSAR-X image in which water would not be visible due to radar shadow or layover caused by buildings and taller vegetation, and these regions were masked out in the flood detection process. A semi-automatic algorithm for the detection of floodwater was developed, based on a hybrid approach. Flooding in rural areas adjacent to the urban areas was detected using an active contour model (snake) region-growing algorithm seeded using the un-flooded river channel network, which was applied to the TerraSAR-X image fused with the LiDAR DTM to ensure the smooth variation of heights along the reach. A simpler region-growing approach was used in the urban areas, which was initialized using knowledge of the flood waterline in the rural areas. Seed pixels having low backscatter were identified in the urban areas using supervised classification based on training areas for water taken from the rural flood, and non-water taken from the higher urban areas. Seed pixels were required to have heights less than a spatially-varying height threshold determined from nearby rural waterline heights. Seed pixels were clustered into urban flood regions based on their close proximity, rather than requiring that all pixels in the region should have low backscatter. This approach was taken because it appeared that urban water backscatter values were corrupted in some pixels, perhaps due to contributions from side-lobes of strong reflectors nearby. The TerraSAR-X urban flood extent was validated using the flood extent visible in the aerial photos. It turned out that 76% of the urban water pixels visible to TerraSAR-X were correctly detected, with an associated false positive rate of 25%. If all urban water pixels were considered, including those in shadow and layover regions, these figures fell to 58% and 19% respectively. These findings indicate that TerraSAR-X is capable of providing useful data for the calibration and validation of urban flood inundation models.

Determining the effect of asymmetric data on the variogram. I. Underlying asymmetry

Matheron's usual variogram estimator can result in unreliable variograms when data are strongly asymmetric or skewed. Asymmetry in a distribution can arise from a long tail of values in the underlying process or from outliers that belong to another population that contaminate the primary process. This paper examines the effects of underlying asymmetry on the variogram and on the accuracy of prediction, and the second one examines the effects arising from outliers. Standard geostatistical texts suggest ways of dealing with underlying asymmetry; however, this is based on informed intuition rather than detailed investigation. To determine whether the methods generally used to deal with underlying asymmetry are appropriate, the effects of different coefficients of skewness on the shape of the experimental variogram and on the model parameters were investigated. Simulated annealing was used to create normally distributed random fields of different size from variograms with different nugget:sill ratios. These data were then modified to give different degrees of asymmetry and the experimental variogram was computed in each case. The effects of standard data transformations on the form of the variogram were also investigated. Cross-validation was used to assess quantitatively the performance of the different variogram models for kriging. The results showed that the shape of the variogram was affected by the degree of asymmetry, and that the effect increased as the size of data set decreased. Transformations of the data were more effective in reducing the skewness coefficient in the larger sets of data. Cross-validation confirmed that variogram models from transformed data were more suitable for kriging than were those from the raw asymmetric data. The results of this study have implications for the 'standard best practice' in dealing with asymmetry in data for geostatistical analyses. (C) 2007 Elsevier Ltd. All rights reserved.

Determining the effect of asymmetric data on the variogram. II. Outliers

Asymmetry in a distribution can arise from a long tail of values in the underlying process or from outliers that belong to another population that contaminate the primary process. The first paper of this series examined the effects of the former on the variogram and this paper examines the effects of asymmetry arising from outliers. Simulated annealing was used to create normally distributed random fields of different size that are realizations of known processes described by variograms with different nugget:sill ratios. These primary data sets were then contaminated with randomly located and spatially aggregated outliers from a secondary process to produce different degrees of asymmetry. Experimental variograms were computed from these data by Matheron's estimator and by three robust estimators. The effects of standard data transformations on the coefficient of skewness and on the variogram were also investigated. Cross-validation was used to assess the performance of models fitted to experimental variograms computed from a range of data contaminated by outliers for kriging. The results showed that where skewness was caused by outliers the variograms retained their general shape, but showed an increase in the nugget and sill variances and nugget:sill ratios. This effect was only slightly more for the smallest data set than for the two larger data sets and there was little difference between the results for the latter. Overall, the effect of size of data set was small for all analyses. The nugget:sill ratio showed a consistent decrease after transformation to both square roots and logarithms; the decrease was generally larger for the latter, however. Aggregated outliers had different effects on the variogram shape from those that were randomly located, and this also depended on whether they were aggregated near to the edge or the centre of the field. The results of cross-validation showed that the robust estimators and the removal of outliers were the most effective ways of dealing with outliers for variogram estimation and kriging. (C) 2007 Elsevier Ltd. All rights reserved.