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A model for developing optimal finance method for health care systems in which user charges add to the fixed health care budgets, is presented. Such a method ensures equity and efficiency of the health care systems.

System dynamics is a methodology useful for studying policy variables as they move towards equilibrium. A model of supply and demand using data from the British National Health Service illustrates the point.

Background A fundamental debate in the transition towards universal health coverage concerns whether to establish an explicit health benefits package to which all citizens are entitled, and the level of detail in which to specify that package. At one extreme, the treatments to be funded, and the circumstances in which patients qualify for the treatment, might be specified in great detail, and be entirely mandatory. This would make clinicians little more than automata, carrying out prescribed practice. At the other extreme, priorities may be expressed in very broad terms, with no compulsion or other incentives to encourage adherence. Objectives The paper examines the arguments for and against setting an explicit benefits package, and discusses the circumstances in which increased detail in specification are most appropriate. Methods The English National Health Service is used as a case study, based on institutional history, official documents and research literature. Results Although the English NHS does not explicitly specify a health benefits package, it is in some respects establishing an ‘intelligent’ package, based on instruments such as an essential medicines list, clinical guidelines, provider payment and performance reporting, which acknowledges gaps in evidence and variations in local resource constraints. Conclusions Further moves towards a more explicit specification are likely to yield substantial benefits in most health systems. Considerations in determining the ‘hardness’ of benefits package specification might include the quality of information about the costs and benefits of treatments, the heterogeneity of patient needs and preferences, the financing regime in place, and the nature of supply side constraints. [ABSTRACT FROM AUTHOR]

A semi-quantitative risk assessment model for dispersion of ballast water organisms in shelf seas is applied to the Scotian Shelf region of eastern Canada. The ballast water exchange process is simulated as the dispersion of tracer released into the surface layer of an ocean circulation model of the region. Circulation model variability is driven by wind stress from a cyclical year of forcing representing climatological storminess. Dispersion metrics related to invasion risk are developed and incorporated into a risk equation that computes the relative overall risk of invasion for ballast water exchange segments along vessel tracks crossing the shelf. Three hundred and sixty dispersion simulations are done for each segment of each of six tracks. Because the flow fields represent climatological variability in shelf circulation, the application of the risk assessment model captures the expected variability in invasion risk. Model results indicate that more than an order of magnitude variation in risk can exist along a given vessel track, and that tracks with offshelf segments provide a lower risk option compared to onshelf tracks. The model provides quantitative guidance to regulators regarding what is an acceptable trip diversion and can aid in numerous other management decisions. [Copyright &y& Elsevier]

Deals with a study which analyzed mean current, temperature and salinity observations from moorings in the major Gulf of Maine inflows off southwest Nova Scotia and in Northeast Channel. Water properties in the gulf; Climatic effects of warm core rings; Conclusions.

Abstract: Background: People who consume unhealthy amounts of alcohol are more likely to use illicit drugs. We tested the ability of a screening test for unhealthy alcohol use to simultaneously detect drug use. Methods: Adult English speaking patients (n =286) were enrolled from a primary care waiting room. They were asked the screening question for unhealthy alcohol use “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women, and a response of one or more is considered positive. A standard diagnostic interview was used to determine current (past year) drug use or a drug use disorder (abuse or dependence). Oral fluid testing was also used to detect recent use of common drugs of abuse. Results: The single screening question for unhealthy alcohol use was 67.6% sensitive (95% confidence interval [CI], 50.2–82.0%) and 64.7% specific (95% CI, 58.4–70.6%) for the detection of a drug use disorder. It was similarly insensitive for drug use detected by oral fluid testing and/or self-report. Conclusions: Although a patient with a drug use disorder has twice the odds of screening positive for unhealthy alcohol use compared to one without a drug use disorder, suggesting patients who screen positive for alcohol should be asked about drug use, a single screening question for unhealthy alcohol use was not sensitive or specific for the detection of other drug use or drug use disorders in a sample of primary care patients. [Copyright &y& Elsevier]

To estimate the expected socio-economic value of booster vaccination in terms of averted deaths and averted closures of businesses and schools using simulation modelling. The value of booster vaccination in Indonesia is estimated by comparing simulated societal costs under a twelve-month, 187-million–dose Moderna booster vaccination campaign to costs without boosters. The costs of an epidemic and its mitigation consist of lost lives, economic closures and lost education; cost-minimising non-pharmaceutical mitigation is chosen for each scenario. The cost-minimising non-pharmaceutical mitigation depends on the availability of vaccines: the differences between the two scenarios are 14 to 19 million years of in-person education and $153 to $204 billion in economic activity. The value of the booster campaign ranges from $2,500 ($1,400-$4,100) to $2,800 ($1,700-$4,600) per dose in the first year, depending on life-year valuations. The societal benefits of booster vaccination are substantial. Much of the value of vaccination resides in the reduced need for costly non-pharmaceutical mitigation. We propose cost minimisation as a tool for policy decision-making and valuation of vaccination, taking into account all socio-economic costs, and not averted deaths alone. [ABSTRACT FROM AUTHOR]

It is often the case that only routinely collected, highly aggregate administrative data are available for the purposes of evaluating major public policy initiatives. Such data clearly fall short of the information advocated by statisticians and economists for the purposes of policy evaluation. This paper examines the extent to which methodologies developed in the productivity literature can nevertheless extract useful evaluative information from administrative data. A non-parametric Malmquist Index approach is used that seeks to decompose changes in efficiency into technical efficiency changes, scale effects and technological change. The study applies the methods to the system of “community care” introduced in 1993 for people affected by problems associated with ageing, mental illness, learning disability or physical disability. Non-parametric methods are used to estimate productivity changes amongst 39 English county councils over a four-year period from 1992 to 1995. The results suggest a steady annual increase in productivity of about 1.4% per annum over the period under investigation, but it is not possible to determine the extent to which this progress can be attributed to the introduction of community care. The paper nevertheless concludes that the methods deployed can exploit readily available datasets at low cost, and are a valuable form of exploratory data analysis, if interpreted with discretion. [Copyright &y& Elsevier]

Abstract: Improving the health and wellbeing of citizens ranks highly on the agenda of most governments. Policy action to enhance health and wellbeing can be targeted at a range of geographical levels and in England the focus has tended to shift away from the national level to smaller areas, such as communities and neighbourhoods. Our focus is to identify the potential for targeting policy interventions at the most appropriate geographical levels in order to enhance health and wellbeing. The rationale is that where variations in health and wellbeing indicators are larger, there may be greater potential for policy intervention targeted at that geographical level to have an impact on the outcomes of interest, compared with a strategy of targeting policy at those levels where relative variations are smaller. We use a multi-level regression approach to identify the degree of variation that exists in a set of health indicators at each level, taking account of the geographical hierarchical organisation of public sector organisations. We find that for each indicator, the proportion of total residual variance is greatest at smaller geographical areas. We also explore the variations in health indicators within a hierarchical level, but across the geographical areas for which public sector organisations are responsible. We show that it is feasible to identify a sub-set of organisations for which unexplained variation in health indicators is significantly greater relative to their counterparts. We demonstrate that adopting a geographical perspective to analyse the variation in indicators of health at different levels offers a potentially powerful analytical tool to signal where public sector organisations, faced increasingly with many competing demands, should target their policy efforts. This is relevant not only to the English context but also to other countries where responsibilities for health and wellbeing are being devolved to localities and communities. [Copyright &y& Elsevier]

Abstract: The Minas Basin, the eastern end of the Bay of Fundy, is well known for its high tide ranges and strong tidal currents, which can be exploited to extract electricity power. The properties of the tidally-induced sediment transport in the Minas Basin, where significant changes in tidal processes may occur due to a recently proposed tidal power project, have been studied with a three-dimensional hydrodynamic model, an empirical bed load sediment transport model and surface sediment concentrations derived from the remotely-sensed images. The hydrodynamic model was evaluated against independent observational data, which include tidal elevation, tidal current (in the full water column and bottom layer), residual current profile and tidal asymmetry indicators. The evaluation shows that the model is in good agreement with the observations. The sediment transport includes two components, bed load and suspended particulate load. The bed load is calculated using the modelled bottom shear stress and the observed grain size data. The estimated features of bed load transport roughly agree with the observed patterns of the erosion and deposition in the Minas Basin and Cobequid Bay. The transport of the suspended load is estimated using the modelled velocity fields and the surface sediment concentration derived from remote-sensing images. The comparisons between the modelled results and the limited observations illustrate that the observed directions of suspended sediment transport are basically reproduced by the model. The modelled net suspended sediment input into the Minas Basin through Minas Passage is 2.4×106 m3 yr−1, which is comparable to the observed value of 1.6×106 m3 yr−1. The variations of the bed load and the suspended load in space and time are also presented. The total net transport, defined as the mean value of the sum of bed and suspended load transports during the tidal cycle, shows strong spatial variability. The magnitude of the transport flux ranges from 0.1 to 0.2kgm−1 s−1 in Minas Channel and Minas Passage, 0.1kgm−1 s−1 in Cobequid Bay, to 0.01kgm−1 s−1 in the central Minas Basin and Southern Bight. In Minas Channel, the sediment transport follows the structure of the tidal residual circulation, which features a large anticlockwise gyre. The sediment in Minas Passage moves eastward and deposits into the central Minas Basin. However, the sediment from the eastern part of the Basin moves westward and deposits in the central Minas Basin as well. In the Cobequid Bay, sediment moves eastward and deposits in the upper bay. [Copyright &y& Elsevier]

Abstract: We present numerical simulations of the ocean surface waves generated by hurricane Juan in 2003 as it reached its mature stage (travelling from deep waters off Bermuda to Nova Scotia and making landfall near Halifax) using SWAN (v.40.31) nested within WAVEWATCH-III (v.2.22; denoted WW3) wave models, implemented on multiple-nested domains. As for all storm-wave simulations, spectral wave development is highly dependent on accurate simulations of storm winds during its life cycle. Due to Juan’s rapid translation speed (accelerating from 2.28ms−1 on 27 September, 1200UTC to 20ms−1 on 29 September, 1200UTC), an interpolation method is developed to blend observed hurricane winds with numerical weather prediction (NWP) model winds accurately. Wave model results are compared to in situ surface buoys and ADCP wave data along Juan’s track. At landfall, Juan’s maximum waves are mainly swell-dominated and peak waves lag the occurrence of the maximum winds. We explore the influence of surface waves on the wind and show that the accuracy of the wave simulation is enhanced by introducing swell and Stokes drift feedback mechanisms to modify the winds, and by limiting the peak drag coefficient under high wind conditions, in accordance with recent theoretical and experimental results. [Copyright &y& Elsevier]