Needs-based health care funding: implications for resource distribution in Ontario

Capitation models have been suggested as an alternative to funding methods based on historical utilization patterns. Capitation funding distributes esources to regions or programs according to their population, adjusted for the age and gender composition and relative need. The most commonly used relative needs measure is the Standardized Mortality Ratio (SMR). This paper compares the distribution of resources in Ontario implied by a variety of capitation formula. Another aspect of this research is to design a mechanism that translates the SMR into a funding allocation index. We specify a non‐linear model to capture the relationship between current expenditures and the SMR while controlling for historical utilization factors. In contrast to previous work, in which a linear relationship between expenditures and need was assumed, our estimates suggest that the relationship may actually be highly non‐linear. This non‐linearity ncreases transfers to regions of relative need relative to a linear capitation program. JEL Classification: I0, H51 On a suggéré des modèles de financement per capita des soins de santé pour remplacer les méthodes de financement fondées sur les patterns historiques d'utilisation. Cette solution de rechange distribuerait les ressources aux régions et programmes selon la population (avec des ajustements pour tenir compte de la structure 'âges, de sexes, et de besoins relatifs). La mesure la plus commune des besoins relatifs est le taux de mortalité standardisé (TMS). Ce mémoire compare la répartition des ressources en Ontario qui découlerait de l'emploi d'une variété de formules. On tente aussi de construire un mécanisme qui traduise le TMS en un indice d'allocation des fonds. Les auteurs construisent un odèle non‐linéaire qui saisit la relation entre TMS et épenses courantes tout en normalisant pour tenir compte des facteurs historiques d'utilisation. Contrairement aux résultats des travaux antérieurs qui postulaient une relation linéaire entre épenses et besoins, les résultats de cette étude uggèrent que cette relation peut être fortement non‐linéaire, et que cette non‐linéarité tend à ccroître les transferts aux régions qui ont les besoins les plus grands.     

Genomics and proteomics: the next generation of health care

Biotechnology research will dramatically impact health care, and the pharmaceutical industry in particular, in the coming decade. Health outcomes may be improved in a cost-effective manner through the ability to selectively prescribe medications; safer, more effective treatment may reduce long-term health care costs. As genetic testing becomes the standard of care, new challenges will surface around how genetic information will be used or misused, and how and where health care dollars are spent.     

Chest x-ray stages of sarcoidosis

The initial chest x-ray is used to classify the stage of sarcoidosis. This report shows x-rays with findings of Stages I to IV. Underwriting sarcoidosis requires information of the history, the stage and pulmonary function tests.     

FRACAS: A Computerized Aid for Reasoning in Tax

Problem solving in the tax domain requires two kinds of knowledge: of the law itself and of how the law has been applied in the past. The need for the second factor arises as a result of the ambiguity of natural language. The problem solver requires information on how the courts have adjudicated specific cases in the past. This information would then provide the basis for reasoning about the current case. In this paper we address the issue of developing a system which will retrieve relevant historical cases. The cases are stored using a frame representation scheme and the users can retrieve cases by specifying either attributes alone or attributes and values associated with them. Currently the system has been implemented in Pascal on a Cray. The case base contains 250 cases relating to Section 183 of the tax code.     

Cost effectiveness of a medical vigilance system to reduce patient falls

Patient falls are a serious problem in hospitals, resulting in substantial morbidity, mortality, length of stay, and costs. The results of a small trial of a patient vigilance system in a post-neurosurgery unit of a large acute care hospital are reported. The system includes two components: (a) passive sensor array placed under the patient in a hospital bed, and (b) a bedside unit that connects to the nurse call system already in place at the hospital. This trial demonstrated the overall effectiveness of the vigilance system in reducing the rate of patient falls. The cost-effectiveness analysis found that use of this system was associated with somewhat higher measured costs. It is likely that the system was cost-saving, due to unmeasured costs.     

Responses to COVID-19 in Southeast Asia: Diverse Paths and Ongoing Challenges

Due to geographical proximity and trade links with China, Southeast Asian countries were among the first to be exposed to and affected by COVID-19. However, despite shared challenges including protecting population health and economic security, policy responses by national governments have been varied and remain so a year into the pandemic. This article critically reviews Southeast Asian countries' approaches to COVID-19 with reference to individual country experiences and Association of Southeast Asian Nations. We discuss key policy responses: leadership, public risk communications, health system preparedness and resilience, economic support and social protection, aid and global health diplomacy, digital technologies, and the region's multilateral response.     

Herbal Pharma Inc.: Conducting an Effective Group Audit*

As the relative weight of global economic activity continues to shift toward non-OECD countries (OECD 2018), audit firms are more likely to encounter clients with significant business operations in foreign jurisdictions. The associated need to engage and oversee local component auditors in these jurisdictions can lead to challenges arising from different business cultures and the resulting intra-audit miscommunications. Audit deficiencies related to these challenges have been detected by regulators (PCAOB 2011, 2010; CPAB 2012, 2015). Standard setters such as the IAASB and the Auditing and Assurance Standards Board (AASB) have responded by issuing an exposure draft proposing revisions to ISA 600 (IAASB 2020) and CAS 600 (AASB 2020) to strengthen the auditor's approach and provide enhanced guidance to practitioners. In light of this evolving area of assurance, this case was developed to deepen students' understanding of both group and component audits in an international context. The case takes the perspective of the group auditor and features an audit senior in a specialized role overseeing the component audit of a client's increasingly material Chinese subsidiary. Deficiencies in the prior year component audit, along with a change in the component auditor, further underlines the importance of robust risk analysis for the upcoming engagement.