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Fulltext Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses

Asante A, Price J, Hayen A, Jan S, Wiseman V

PLoS One, 2016;11(4):e0152866.
PMID: 27064991 DOI: 10.1371/journal.pone.0152866

INTRODUCTION: Health financing reforms in low- and middle- income countries (LMICs) over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA.
METHODS AND FINDINGS: Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA) and/or financing incidence analysis (FIA) as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing.
CONCLUSION: Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance equity. The results overall suggest that there are impediments to making health care more accessible to the poor and this must be addressed if universal health coverage is to be a reality.
Mind the gap in clinical trials: A participatory action analysis with citizen collaborators

Price A, Liew SM, Kirkpatrick J, Price J, Lopreto T, Nelken Y

J Eval Clin Pract, 2017 Feb;23(1):178-184.
PMID: 27917564 DOI: 10.1111/jep.12678

What are the strengths, gaps, expectations, and barriers to research engagement in clinical trials as communicated through social media? Clinical trials test treatments to provide reliable information for safety and effectiveness. Trials are building blocks in which what is learned in earlier research can be used to improve treatments, compare alternatives, and improve quality of life. For 20 years, the percentages of clinical trials volunteers have decreased whereas the costs of running clinical trials have multiplied. Participants enroll in trials to access latest treatments, to help others, and to advance science, but there is growing unrest. The priorities of those running the trials differ from those of the participants, and the roles for public research involvement lack clarity. Changes to bridge these gaps in the research culture are proposed through the use of participatory action research (PAR) in which stakeholders collaborate to improve research methodology, galvanize citizen participation, multiply health knowledge, problem-solve barriers to access, and explore the value of research volunteers as collaborators. PAR enabled the inclusion of citizens as full collaborators. Social media data were gathered for 120 days until saturation was reached. De-identified data were organized into a Strengths Weaknesses, Opportunities and Threats framework and coded into themes for analysis. After the analysis, the authors prioritized potential solutions for improving research engagement. Strengths and opportunities remained constant through trial phases, disease burdens, and interventions. Threats included alienation, litigation, disparity, and shaming. Poor management and barriers to inclusion were identified as weaknesses. Opportunities included improving resource management and information quality. Barriers were minimized when relationships between staff and participants were inclusive, respectful, tolerant, and open to change. Participants' communications ranged from fulfillment through trial involvement to disparities and rights violations. PAR provides a safe space without power imbalances in which researchers and citizen worked as equals rather than as researchers and objects of research.
Fulltext What second-language speakers can tell us about pragmatic processing

Khorsheed A, Md Rashid S, Nimehchisalem V, Geok Imm L, Price J, Ronderos CR

PLoS One, 2022;17(2):e0263724.
PMID: 35180247 DOI: 10.1371/journal.pone.0263724

Upon hearing the phrase Some cats meow, a listener might pragmatically infer that 'Some but not all cats meow'. This is known as a scalar implicature and it often arises when a speaker produces a weak linguistic expression instead of a stronger one. Several L2 studies claim that pragmatic inferences are generated by default and their comprehension presents no challenges to L2 learners. However, the evidence obtained from these studies largely stems from offline-based tasks that provide limited information about how scalar implicatures are processed. This study investigated scalar implicature processing among L2 speakers of English and the degree to which differences in L2 proficiency and Theory of Mind abilities would modulate pragmatic responding. The experiment used an online sentence verification paradigm that required participants to judge, among multiple control items, the veracity of under-informative sentences, such as Some cats are mammals, and to respond as quickly as possible. A true response to this item is indicative of a logical some and perhaps all reading and a false response to a pragmatic some but not all reading. Our results showed evidence that scalar inferences are not generated by default. The answer linked to the pragmatic reading some but not all took significantly longer to make relative to the answer that relies on the logical interpretation some and perhaps all. This processing slowdown was also significantly larger among participants with lower English proficiency. Further exploratory analyses of participants' Theory of Mind, as measured by the Social Skill subscale in the Autism Spectrum Quotient, revealed that socially inclined participants are more likely than the socially disinclined to derive a scalar inference. These results together provide new empirical insights into how L2 learners process scalar implicatures and thus implications for processing theories in experimental pragmatics and second language acquisition.

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