Day: July 11, 2023

Categories : Healthcare Politics and RegulationsTags :

Funding the NHI: ‘Political Suicide’ and Tax Revolts

On By ModernMedia
Photo by Jp Valery on Unsplash

According to a 27-page ‘factsheet’ purportedly produced by the Department of Health and the Presidency, the National Health Insurance (NHI) scheme would be funded through a payroll tax and additional personal income taxes. There are however better ways to go about this, according to a number of experts who weighed in on the topic.

Professor Alex van den Heever said that the payroll tax plan is misguided, according to Daily Investor. In the same vein as Unemployment Insurance Fund (UIF) payment, both employers and employees would make contributions to a payroll tax.

But Van den Heever criticised this, saying that those who suggested this do not have the qualifications to make financial comments such as NHI funding.

“They talk of introducing payroll taxes. You don’t introduce payroll taxes for a general government allocation,” he explained. “Payroll taxes are for contributory systems where you get a specific benefit or entitlement for what you contribute.”

The term “payroll taxes” in relation to funding NHI does not make sense, he said. Discussions on raising taxes and a new payroll tax shows that the government does not know how to fund the NHI.

He called them an “incredibly naïve set of fiscal proposals that you cannot even consider implementing,” and that they were “incoherent from a public finance perspective.” Introducing them as is would be politically suicidal: the tax base is already overburdened, and raising taxes beyond a certain point results in a reduction in taxes actually collected.

“It is very dangerous to overstress your tax bases. We are hitting the limit on the amount you can fund the government and the public health system from taxes.”

Huge tax increases needed to fund NHI

Van der Heever’s viewpoint is shared by Connie Mulder, Solidarity Research Institute head and Ryan Noach, Discovery Health CEO.

Mulder said trying to fund NHI through additional taxes is unfeasible because of the tremendous amount of money needed.

Mulder said that the massive additional taxation would “crush South Africa’s economic outlook.”

It is naive for the Department of Health to assume that medical aid contributions will be funnelled into a national health insurance scheme, said Noach. The NHI scheme would force South African taxpayers to pay much higher taxes but cut their healthcare entitlement by 72%, and would provoke a tax revolt.

South Africa has a unique situation where a very small tax base of 5.5 million people funds nearly all government expenditures, accounting for 80% of public healthcare funding, he said. Notably, their after-tax disposable income is used to pay medical aid and private healthcare.

The single-funder model described in the NHI Bill would not be able to achieve the government’s goal of equitable access to healthcare, Noach told Daily Investor. This is a model which Discovery Health does not endorse, calling it not only “risky and inefficient” but also not likely to be equitable because “cross-subsidies cannot be properly managed”.

He reiterated earlier comments where he said that the NHI Bill would have no immediate impact on medical schemes, but once it is fully implemented (with “implemented” remaining undefined), medical aid schemes would only be allowed to offer what is not covered under the NHI – at the discretion of the Health Minister. This would make NHI a single monopolistic funder for the NHI package of services, which he had said in an earlier interview with Newzroom Afrika was without a parallel anywhere in the world. 

Even though implementation is a decade away, this is going to drive off health sector investment, Noach said.

Noach recommended a multi-fund framework, which he described as “not only less risky and faster to implement, but also ensures that cross-subsidies are managed to ensure that social solidarity is achieved”.

Collaboration between the private and public sectors is the only way financial integrity and sustainability is achievable, something which has been built on the successful COVID-19 partnerships.

NHI ‘charade’ – but Obamacare offers an alternative

Business Leadership South Africa CEO Busi Mavuso has a similar view – and didn’t mince her words. According to Mavuso, NHI as currently envisaged, was a “charade” without any thought to funding, according to Moneyweb. One that would leave all South Africans worse off, and recommends instead a private-public partnership.

She also pointed to the public–private partnership behind South Africa’s COVID-19 response. The two entities sourced resources, rolled out vaccines and funded other interventions.

“It was a clear demonstration that national health outcomes are achieved faster and more efficiently when government and business work together, drawing on their respective strengths,” she said.

“With the right incentives, the private sector can complement government efforts, speed up the investment needed and reduce costs to the state and users.” 

One viable alternative to the NHI’s single buyer model was the US’ Affordable Care Act (aka Obamacare) in the US, wherein health insurers provide minimum cover, with the state subsidising those below a certain level. Insurers are however able to compete to offer coverage.

One other disadvantage of South Africa effectively ending the private sector was that it would discourage internationally mobile businesspeople from working in the country.

Categories : Neurology PaediatricsTags :

Children with Autism Have Memory Impairments, Study Finds

On By ModernMedia
Photo by Ben Wicks on Unsplash

Children with autism have memory challenges that hinder not only their memory for faces but also their ability to remember other kinds of information, according to new research. These impairments are reflected in distinct connection patterns children’s brains, the study found.

Published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, the study findings clarify a debate about memory function in children with autism, showing that their memory struggles surpass their ability to form social memories. The finding should prompt broader thinking about autism in children and about treatment of the developmental disorder, according to the scientists who conducted the study.

“Many high-functioning kids with autism go to mainstream schools and receive the same instruction as other kids,” said lead author Jin Liu, PhD at Stanford University. Memory is a key predictor of academic success, said Liu, adding that memory challenges may academically disadvantage children with autism.

The study’s findings also raise a philosophical debate about the neural origins of autism, the researchers said. Social challenges are recognised as a core feature of autism, but it’s possible that memory impairments might significantly contribute to the ability to engage socially.

“Social cognition can not occur without reliable memory,” said senior author Vinod Menon, PhD.

“Social behaviours are complex, and they involve multiple brain processes, including associating faces and voices to particular contexts, which require robust episodic memory,” Menon said. “Impairments in forming these associative memory traces could form one of the foundational elements in autism.”

Comprehensive memory tests

Affecting about one in every 36 children, autism is characterised by social impairments and restricted, repetitive behaviours. The condition exists on a wide spectrum, with those on one end having severe intellectual disability and about a third of people with autism have intellectual impairments. On the other end of the spectrum, many people with high-functioning autism have normal or high IQ, complete higher education and work in a variety of fields.

Children with autism are known to have difficulty remembering faces. Some small studies have also suggested that children with autism have broader memory difficulties. They included children with wide ranges of age and IQ, both of which influence memory.

To clarify the impact of autism on memory, the new study included 25 children with high-functioning autism and normal IQ who were 8 to 12 years old, and a control group of 29 typically developing children with similar ages and IQs.

All participants completed a comprehensive evaluation of their memory skills, including their ability to remember faces; written material; and non-social photographs, or photos without any people. The scientists tested participants’ ability to accurately recognise information (identifying whether they had seen an image or heard a word before) and recall it (describing or reproducing details of information they had seen or heard before). The researchers tested participants’ memory after delays of varying lengths. All participants also received fMRI scans of their brains to evaluate how memory-associated regions are connected to each other.

Distinct brain networks drive memory challenges

In line with prior research, children with autism had more difficulty remembering faces than typically developing children, the study found.

The research showed they also struggled to recall non-social information. On tests about sentences they read and non-social photos they viewed, their scores for immediate and delayed verbal recall, immediate visual recall and delayed verbal recognition were lower.

“We thought that behavioural differences might be weak because the study participants with autism had fairly high IQ, comparable to typically developing participants, but we still observed very obvious general memory impairments in this group,” Liu said.

Among typically developing children, memory skills were consistent: If a child had good memory for faces, he or she was also good at remembering non-social information.

This wasn’t the case in autism. “Among children with autism, some kids seem to have both impairments and some have more severe impairment in one area of memory or the other,” Liu said.  

“It was a surprising finding that these two dimensions of memory are both dysfunctional, in ways that seem to be unrelated – and that maps onto our analysis of the brain circuitry,” Menon said.

The brain scans showed that, among the children with autism, distinct brain networks drive different types of memory difficulty.

For children with autism, the ability to retain non-social memories was predicted by connections in a network centred on the hippocampus. But face memory was predicted by a separate set of connections centred on the posterior cingulate cortex, a key region of the brain’s default mode network, which has roles in social cognition and distinguishing oneself from other people.

“The findings suggest that general and face-memory challenges have two underlying sources in the brain which contribute to a broader profile of memory impairments in autism,” Menon said.

In both networks, the brains of children with autism showed over-connected circuits relative to typically developing children. Over-connectivity, likely from insufficient selective pruning of neural circuits, has been found in other studies of brain networks in children with autism.

New autism therapies should account for the breadth of memory difficulties the research uncovered, as well as how these challenges affect social skills, Menon said. “This is important for functioning in the real world and for academic settings.”

Source: Stanford University Medical Center

Categories : Injury & TraumaTags :

Burn Scars Worsen High School Educational Outcomes

On By ModernMedia
Photo by Andrew Neel on Unsplash

A new study published in the BMJ’s Archives of Disease in Childhood has found that young people who were hospitalised due to burns were less likely to finish high school than their peers.

Led by Associate Professor Rebecca Mitchell from the Australian Institute of Health Innovation (AIHI) at Macquarie University, the study compared the academic performance and high school completion rates of about 2000 young people to matched peers who had not been hospitalised for an injury.

The study found that the young people who had been burned were four times as likely to not finish Year 10, and more than twice as likely to not finish Year 11 or Year 12.

This research is the latest in a series of studies looking at the effects of hospitalisation for injuries and illnesses including broken bones, asthma, diabetes, epilepsy and mental health on young people’s educational outcomes.

The research team used linked birth, health and education records in New South Wales from 2005 to 2018 to analyse national literacy and numeracy test results and high school completion.

To create a peer comparison group, each hospitalised young person was age and gender matched to a random person in their postcode area who had not been hospitalised for an injury.

In the case of the burns patients, the most common cause of injury was contact with hot drinks, food, fats or cooking oils, followed by other hot fluids including hot or boiling water.

Almost all of the children in the burns cohort had more than 10% of the surface of their bodies affected, with torsos the most commonly injured area, followed by hands or wrists.

Associate Professor Mitchell says in addition to an increased risk of not finishing high school, girls who had burn injuries also had a higher risk of not achieving the national minimum standards in reading.

“Reasons why young females hospitalised with a burn have worse academic performance for reading could include reduced learning opportunities, school absenteeism, or psychosocial anxieties due to lower self-esteem and stigmatisation,” she says.

“This research shows that we need to monitor academic progression in young people after they sustain a burn to identify if they require any learning support.”

Paediatric burns specialist and co-author Professor Andrew Holland says that while most burns occur early in childhood, the effects can extend far beyond the initial period of acute care and recovery.

“In some cases, burns patients experience ongoing pain and poor sleep quality, which can disrupt a young person’s ability to engage and learn,” he says.

“In addition to this, scarring can have an influence on their motivation or ability to attend school.”

Source: Macquarie University

Categories : HospitalsTags :

Don’t Teach us Resilience – Fix the Problem, Doctors and Nurses Say

On By ModernMedia
Source: Pixabay CC0

A unique collaborative study on hospital clinician wellbeing by teams at 60 of the best US hospitals, was published in JAMA Health Forum. The study found that physicians and nurses, even at hospitals known to be good places to work, experienced adverse outcomes during the pandemic and want hospital management to make significant improvements in their work environments and in patient safety.

The solutions to high hospital clinician burnout and turnover, they say, are not resilience training for clinicians to better cope with adverse working conditions but organisational improvements that provide safe workloads and better work-life balance.

Researchers sought information in 2021 from 21 050 physicians and registered nurses practicing in 60 Magnet recognised hospitals in 22 states. Forty-seven percent of nurses and 32% of physicians experienced high burnout. Twenty-three percent of physicians and 40% of nurses said they would leave their jobs if possible. Less than 10% of physicians and nurses reported experiencing joy in their work.

Many clinicians are downright hostile to programmes – like resilience training – that are designed to adapt them to poor work conditions; clinicians want the working conditions improved.

Linda H Aiken, PhD, study lead author

Not having enough nurses to care for patients, having little control over workloads, lack of confidence in management to resolve problems in patient care, and concerns about patient safety were all associated with higher burnout, job dissatisfaction, and intent to leave among both nurses and physicians.

Lead author Linda H Aiken, PhD, at the University of Pennsylvania said, “Physicians and nurses largely agree about what hospital management could do to address their burnout, job dissatisfaction, and plans to leave their current jobs; they want improved staffing, modern working conditions in which they can spend more time in direct patient care, greater control over their workloads and work schedules, and a higher priority on patient safety.”

Eighty-seven percent of nurses and 45% of physicians said improving nurse staffing was very important to their own mental health and wellbeing. Other high priorities for clinicians were health breaks without interruption and reduced time spent on documentation. Aiken added, “Many clinicians are downright hostile to programmes – like resilience training – that are designed to adapt them to poor work conditions; clinicians want the working conditions improved.”

Clinicians are concerned about quality and safety of care. Half of physicians and nurses lack confidence that their patients can safely manage their care after discharge highlighting the need for improvement in discharge planning. Patient safety remains a concern with 26% of nurses and 12% of physicians giving their own hospitals an unfavorable patient safety grade. Thirty-nine percent of nurses and 33% of physicians feel mistakes are held against them contrary to recommendations of the National Academy of Medicine to search for and correct system deficiencies that cause most medical errors.

The study was carried out by Penn Nursing’s Center for Health Outcomes and Policy Research in collaboration with the US Clinician Wellbeing Study Consortium composed of 60 Magnet Hospitals. The study took place in 2021 during the COVID pandemic, a time when all US hospitals were severely challenged. Previous research shows that clinicians in hospitals with better work environments prior to the pandemic had better outcomes during the pandemic. The Consortium committed to this study to learn from their experiences during the pandemic how to sustain and further improve their favourable work environments to better withstand external threats and to rebound rapidly.

Source: University of Pennsylvania School of Nursing

Categories : Obstetrics & GynaecologyTags :

B Cells Are Elevated in PCOS – But Are not The Cause

On By ModernMedia
Phot by Sora Shimazaki on Pexels

While previous research have shown that while more B cells are present in women in polycystic ovary syndrome (PCOS), a new study by researchers at Karolinska Institutet has ruled out B cells as the cause of this common syndrome. The study is published in eLife.

Affecting 10–15% of women of fertile age, PCOS is linked to irregular ovulation and menstruation, pregnancy complications, and insulin resistance, all of which are worsened by being overweight. PCOS increases with rising body mass index, and in women with severe obesity, it is around 25%. While the root cause of the condition is unknown, a driver is a surplus of androgens.  

A recent study has shown that women with PCOS have a higher number of B cells in their blood and proposed that these contribute to the development of PCOS through the production of autoimmune antibodies.

“We’ve now examined how B cells affect the development of PCOS with the goal to find new ways of treating the conditions,” says the study’s last author Elisabet Stener-Victorin, research group leader for reproductive endocrinology and metabolism at the Department of Physiology and Pharmacology at Karolinska Institutet.

First, blood from women with PCOS was examined and showed abnormal variations in the frequency of different populations of B cells compared to healthy women. Among these were the so called double negative B cells, a heterogeneous cluster, where some have been described as poised to develop autoimmune functions.

To study whether B cells may cause PCOS, the researchers transferred antibodies from women with PCOS to mice to see if they developed the syndrome. While this proved not to be the case, they did put on weight.

Mice unaffected by B cells

The next step was to transfer B cells from PCOS-like mice (induced by continuous exposure to androgens) to mice lacking B cells to test the hypothesis that B cells drive the development of the disease. However, the recipient mice were unaffected by this transfer.

To see if B cells play an essential role in the development of PCOS, mice lacking B cells were exposed to androgens. These mice were not protected as expected, but developed the same characteristics as normal mice acquire when exposed to androgens.

Finally, androgen exposed PCOS-like mice displayed altered B cell frequencies, as women with PCOS, and simultaneous treatment with a drug that blocks androgen receptors, prevents these alterations of B cells in both blood and tissues, such as ovaries and endometrium.

The researchers conclude that androgens are necessary for the condition to form, but not B cells, the role of which remains unclear.

“B cells are clearly affected in the syndrome, which could contribute to a higher susceptibility to some comorbidities, but they don’t cause PCOS,” says Sara Torstensson, PhD student at Institutet and shared first author.

“We are now studying how other immune cells are affected and how this influences reproductive and metabolic function in PCOS,” says Angelo Ascani, guest PhD student at Graz University, Austria and also first author.

Source: Karolinska Institutet