Inequality in access to dental services in a market-based dental care system. A population study from Norway 1975-2018

Objective: To examine income-related inequalities in access to dental services from 1975 to 2018. In Norway, dental care services for adults are privately financed. This might lead to income-related inequalities in access to dental services. However, over the last decades Norwegians have experienced a rapid growth in income, including people with lower income. This may have led to improved access to dental services for these people. Therefore, inequalities in access to dental services may have become less over the last decades. Research design: This was a prospective study. Statistics Norway collected samples of cross-sectional health survey data for the following years: 1975, 1985, 1995, 2002, 2008, 2012 and 2018. For each sample, individuals 20 years and older were drawn randomly from the non-institutionalized adult population using a two-stage stratified cluster sample technique. Inequalities were measured using the concentration index. The dependent variable was use of dental services during the last year and the key independent variable was equalized household income. Results: The concentration index for inequalities in use of dental services according to income decreased from 0.10 (95% confidence interval = 0.09, 0.11) in 1975 to 0.04 (95% confidence interval = 0.03, 0.05) in 2018. The decrease was particularly large from 2002 to 2012. This was a period with a large growth in gross national income. Conclusion: People with a low income had a marked increase in their purchasing power from 1975 to 2018. This coincided with an increase in demand for dental care for this low-income group.

Shorter delay to treatment by integrated diagnostic services and NGO- provided support among breast cancer patients in two Brazilian referral centres

Background: The diagnosis of breast cancer requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies.Design and Methods: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals.Results: If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p=0.033) and 4.44-fold (95%CI: 1.58-12.46; p=0.004), respectively. If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median time between diagnostic mammography and the diagnostic result was 53 and 65 days in the integrated (HNL) and outsourced public system, compared to 29 days in the outsourced private system (p<0.050). The median time between the first medical visit and the diagnostic results of patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p<0.050).Conclusion: Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic-histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.

National Development Finance in Middle-Income Countries

This chapter focuses on the roles of National Development Banks (NDBs) in emerging and developing economies. They finance investment in sectors key for dynamic and sustainable growth, both through their own lending, and by catalyzing private finance. For NDBs to contribute significantly to avoiding a middle-income trap, there are several conditions: they must be “good,” well-run development banks, their scale must be sufficiently large to help meet investment needs on a significant scale, and there must be a clear national development strategy, for NDBs to implement. This chapter stresses NDBs contribution to financing investment in innovative sectors and infrastructure. This is complementary to supporting provision of public goods, particularly investments that help combat climate change and financial inclusion. NDBs should provide counter-cyclical financing in the busts, when privately-financed investment tends to decline and NDB lending increases to help maintain crucial investment, and in booms, when lending by NDBs should slow down.

Corruption, Democracy, and Privately Financed Infrastructure

Do political institutions moderate the influence of corruption on privately financed infrastructure projects? We argue that electoral competition incentivizes politicians to monitor bureaucratic corruption and focus on the public benefits of projects. Without such incentives, corruption is not monitored and the private benefits of bribes and favorable contract terms are responsible for increasing numbers of projects. Studying 116 countries between 1984 and 2012, we find that as public-sector corruption increases in democracies, no change in the number of projects is observed, while more projects emerge in non-democracies as corruption worsens.

ESE and EASE call for high standards of research and editing

The world has changed in the past few months in a way most of us could not imagine. The words &ldquo;novel corona virus&rsquo;&rsquo; (SARS-CoV-2), &ldquo;COVID-19&rsquo;&rsquo;, &ldquo;prevention&rdquo;, &ldquo;flattening the curve&rsquo;&rsquo; and&nbsp;&ldquo;hand washing&rsquo;&rsquo; have become constant references within the&nbsp;daily news reports of mortality rates, the lack of equipment&nbsp;and possible therapies. The novel corona virus (SARS-CoV-2),&nbsp;which was first identified in the Chinese province of Hubei,&nbsp;has led to a pandemic&nbsp;and the whole scientific community, both in the public and privately-financed sector, is searching for an effective therapy as well as for a vaccine. All scientists (clinicians, epidemiologists, virologists, and public health&nbsp;experts) are under great pressure to give advice on matters where there is still no evidence. We are used to reading fake&nbsp;news and non-filtered information in the media, but are we&nbsp;ready for similar occurrences in science journals?

Shorter delay to treatment by integrated diagnostic services and NGO- provided support among breast cancer patients in two Brazilian referral centres

Background: The diagnosis of breast cancer, from first medical visit until treatment initiation, requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies. Methods: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals among patient groups. Results: If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p= 0.033) and 4.44-fold (95%CI: 1.58-12.46; p= 0.004), respectively. The median time between the first medical visit and the diagnostic result and between the first medical visit and the initiation of treatment was, respectively, 56.0 and 116.5 days. For these time intervals, 54 (34.8%) and 114 (64.8%) patients had a delay of >90 days for diagnostic results and the initiation of treatment, respectively. For patients in the FAP and HNL who had a delay of >90 days, the median time between the first medical visit and the diagnostic results was 180 and 158 days, respectively (p= 0.032). If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median delay between diagnostic mammography and the diagnostic result was 65.0 or 29.0 days, respectively, compared to 53.0 days in the integrated (HNL) publicly financed system (p < 0.050). The median time between the first medical visit and the diagnostic results of all patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p < 0.050).Conclusions: Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic-histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.