The paper reviews the theoretical basis for the application of user fees in the public health sector in low-income countries with particular reference to the special characteristics of medical care as a commodity. The general equilibrium efficiency result of the market mechanism is shown to be the theoretical justification for the financing of health services via a system of user charges. If markets for all goods and services exist, and are perfect in a very strict sense, the welfare outcome of the price mechanism cannot be improved upon by any other resource allocation device. Furthermore, the decentralized and impersonal nature of this mechanism renders it more convenient to use in the allocation of commodities, health care included, than its alternatives such as a system of centrally administered prices or a system of administrative controls and directives. However, since many of the assumptions of the price system are rarely met in actual situations, especially in the health sector, it should be applied with caution. In particular, problems of information asymmetry and consumption externalities in health care markets necessitate a simultaneous use of fees with government interventions in order for fees to achieve their often intended aim of efficiency and equity improvement in health care provision. The most important intervention of the government here is the enactment and enforcement of institutions that reduce costs of transacting in health care markets and that in addition facilitate the emergence of new markets such as the markets for medical insurance. A striking finding of the paper is that health services in low-income countries are best financed primarily by revenue from general taxation, supplemented by a system of moderate user fees. Since medical insurance markets are generally non-existent in low-income areas, it is argued that financing health services primarily through user fees in such areas would be inefficient and inequitable. However, to mitigate the moral hazard problem as well as the problem of the commons, both of which characterize publicly financed health care, imposition of modest user fees is required. The importance of fees in this proposal increases with economic growth and with evolution of institutions that facilitate market transactions. Strategic interaction among economic agents is shown to affect the structure and implementation of user fees. A game-theoretic analysis of the general problem of health care financing shows that this problem is best tackled by harnessing the efforts of households, private health care providers, the government and civil society. These entities form what might be called a winning coalition in health care financing game of society. It is argued that the government is better placed to provide an institutional framework for coordinating the efforts of the various players to the desired end.
The stormy years which Salisbury underwent immediately after World War II present a singular contrast to the politically tranquil pre-1945 era. Yet, looked upon as a people's history, the postwar urban protest had long historical roots: it was very much the consummation of the urban traditions and organizations which the people had created in the prewar years.Before the early 1930s Salisbury's African community was a segmented and decentralized one. Urban institutions and associations did exist, but the town's ‘preindustrial’ topography and other circumstances hardly encouraged the interlocking of workers' institutions and the growth of a ‘self-conscious’ community. But after the Depression the community was considerably structured and centralized. Instrumental in this development was the Mashonaland Native Welfare Society, which promoted sports and recreation among urban Africans for the social control purposes. Many sport and social clubs, old and new, came under the Society's umbrella, with their daily activities coordinated by the Sports and Games Committee.After 1942 the people were outgrowing the Welfare Society's basic tenets. Location residents took a greater interest in improving living conditions, seeking a more autonomous power. Clubs and societies in the meantime distanced themselves from the Welfare Society. A few community activists even espoused political radicalism, when they joined the Labour Party's African Branch, and had C. Mzingeli, the Branch chairman and a former ICU activist, as their leader.The postwar years witnessed a groundswell of labour and community protest, and the ascendency of the re-constructed ICU to the apex of urban politics. The situation, though it might appear totally novel, was in many ways the product of prewar urban traditions: the Reformed ICU was launched by African Labourites, who were also long-established community leaders. Behind the grassroots mobilization by the Union, moreover, lay the growing structuring and centralization of the urban community.
Israel's ongoing health reform provides lessons regarding attempts to combine universal coverage under national health insurance with a version of managed competition. Based on principles of 'justice, equality and mutual aid," Israel's National Health Insurance Law, 1994 guarantees access to a broad basket of basic services to be provided by four competing sick funds, and the availability of resources adequate to finance the basket. The new rights of citizens to universal coverage and to move freely among sick funds constituted a major policy breakthrough. However, successive amendments to the Law reflect continuing controversy over the amount of resources required to finance the basic basket. Despite the intention to base the system on decentralization and competition, successive amendments have placed more control over health system finance and sick fund management in the hands of the Ministries of Finance and Health. Updating the basic basket to take account of new technologies and drugs has raised unresolved dilemmas. In the Israeli case the dialectic of management vs. competition and of government vs. market, obscures fundamental issues related to the right of citizens to health services. The process set in motion by adoption of The National Health Insurance Law, 1994 calls on public managers and politicians to design institutions which can set priorities within a limited budget and effectively regulate the health care system.
Richard Graham Halliday, A.L. Drasdo, Cynthia E. Lumley, Stuart Walker
A survey of 45 leading pharmaceutical companies has been used to investigate aspects of their Research and Development (R&D) strategies, the allocation of resources including the financing and staffing of R&D functions, and the numbers of New Chemical Entities (NCEs) in the development process. The companies included the top ten by R&D expenditure in 1992 (top 10 companies). The study identified characteristics of leading companies and provided comparative data. The principal findings are that: top ten companies had the highest R&D to sales ratios, progressed more NCEs after the drug candidate selection stage in 1992 and had achieved a greater geographical decentralization of staff than any other company. Japanese companies differed in some respects from western companies, even those of a similar size. They operated with smaller clinical and regulatory affairs functions and made detailed plans for R&D expenditure further ahead than western companies, on average, more than 5 years compared with 3 years. an increase in aggregated R&D staffing had occurred between 1990 and 1992 in 33 companies for which data for both years were available and staff numbers had decreased in only five of those companies. top ten companies differed from others in their apparent productivity measured in terms of staff or R&D expenditure per NCE after the drug candidate selection stage, utilizing more staff and having greater R&D expenditure per NCE. The results also appear to indicate early signs of a change in the structure of the industry according to R&D expenditure, which has since become more apparent. There was a distinct polarization by R&D budget size among the respondent companies: five companies were spending $900m or more on R&D in 1992 while the majority of the rest were spending less than a third of that amount.
In the course of constructing these PCP'S we abstract a tool we call locking systems. We provide the definition and also a locking system with very efficient parameters. This mechanism may be useful in other settings as well.
We present zero-knowledge proofs and arguments for arithmetic circuits over finite prime fields, namely given a circuit, show in zero-knowledge that inputs can be selected leading to a given output. For a field GF(q), where q is an n-bit prime, a<br />circuit of size O(n), and error probability 2^−n, our protocols require communication of O(n^2) bits. This is the same worst-cast complexity as the trivial (non zero-knowledge)<br />interactive proof where the prover just reveals the input values. If the circuit involves n multiplications, the best previously known methods would in general require communication<br />of Omega(n^3 log n) bits.<br />Variations of the technique behind these protocols lead to other interesting applications.<br />We first look at the Boolean Circuit Satisfiability problem and give zero-knowledge proofs and arguments for a circuit of size n and error probability 2^−n in which there is an interactive preprocessing phase requiring communication of O(n^2)<br />bits. In this phase, the statement to be proved later need not be known. Later the prover can non-interactively prove any circuit he wants, i.e. by sending only one message, of size O(n) bits.<br />As a second application, we show that Shamirs (Shens) interactive proof system for the (IP-complete) QBF problem can be transformed to a zero-knowledge proof<br />system with the same asymptotic communication complexity and number of rounds. The security of our protocols can be based on any one-way group homomorphism with a particular set of properties. We give examples of special assumptions sufficient for this, including: the RSA assumption, hardness of discrete log in a prime order group, and polynomial security of Die-Hellman encryption. We note that the constants involved in our asymptotic complexities are small enough for our protocols to be practical with realistic choices of parameters.
This paper is the fruit of an attempt to distinguish the elements, present in a fiscal decentralization process, that are likely to contribute to efficiency enhancement in the provision of social services in developing countries. From the methodological point of view, the paper makes an effort, whenever possible, to isolate the economic from the political in the arguments for and against fiscal decentralization. These two sets of arguments, economic and political, both equally important, are often intermingled in the literature. The distinction between them may improve our understanding of the advantages and limitations of the selection of a 'decentralized' provision of social services. Although nearly all the aspects of the fiscal decentralization process may be of some relevance in terms of the issue of equitable social service provision, the paper tries to stress the need to provide adequate incentives to local bureaucracies through the design of transfers and through community participation.
Via regression analysis, this study is able to establish factors that impinge on per capita social sector expenditures. In addition, 32 out of the 62 provincial governments have allocated less on social sectors than what is needed to maintain their 1991 expenditure level in real terms. Inconsistencies regarding budget allocation of provincial governments on the social sectors and the objective indicators are detected.
This paper is intended to analyze, in a comparative perspective, the financing mechanisms of urban local governments in two groups of countries. The first group refers to a sample of OECD countries. They are rather decentralized, and have institutional features which date back many years from now. The scope of responsibilities faced by these countries. The second group is constituted by a number of Latin American countries. They are, in general, less decentralized and have the characteristic of not having a well established institutional structure. This has experienced various changes over the recent years, one of them being a process of transferring responsibilities to local tiers of governments, a tendency which in general, has not been accompanied by an increasing capacity to get resources neither from the central government nor from the local financial market.
Ivan Damgård, Torben Pryds Pedersen, Birgit Pfitzmann
<p>We present and compare definitions of the notion of "statistically<br />hiding" protocols, and we propose a novel statistically hiding commitment<br />scheme. Informally, a protocol statistically hides a secret if a<br />computationally unlimited adversary who conducts the protocol with<br />the owner of the secret learns almost nothing about it. One definition<br />is based on the L1-norm distance between probability distributions,<br />the other on information theory. We prove that the two definitions are<br />essentially equivalent. For completeness, we also show that statistical<br />counterparts of definitions of computational secrecy are essentially<br />equivalent to our main definitions. Commitment schemes are an important<br /> cryptologic primitive. Their purpose is to commit one party to a certain value,<br /> while hiding this value from the other party until some later time.<br /> We present a statistically<br />hiding commitment scheme allowing commitment to many<br />bits. The commitment and reveal protocols of this scheme are constant<br />round, and the size of a commitment is independent of the number of<br />bits committed to. This also holds for the total communication complexity,<br />except of course for the bits needed to send the secret when it<br />is revealed. The proof of the hiding property exploits the equivalence<br />of the two definitions.</p><p>Index terms -- Cryptology, Shannon theory, unconditional security,<br />statistically hiding, multi-bit commitment, similarity of ensembles<br />of distributions, zero-knowledge, protocols.</p><p> </p>
The worldwide economic recession and the concomitant limited stock of finances have had an influence on the available money of every household and have also inhibited the improvement of socio-economic conditions and medicine. The Reconstruction and Development Programme (RDP) has the objective of improving the living conditions of the people with regard to housing, education, training and health care. The latter seems to be a major problem which has to be addressed with the emphasis on the preventive and promotional aspects of health care. A comprehensive health care system did not come into being property in the past because of the maldistribution of health care services, personnel and differences in culture and health care beliefs and values. The question that now arises, is how to render a quality health care service within the constraints of inadequate financing and resources. A comprehensive literature study has been done with reference to quality health care and financing followed by a survey of existing health services and finances. Recommendations are made about minimum requirements to be accepted if one were to adapt rather than die in terms of the provision of healthcare: the decentralization and rationalization of the administration of health care, the stress on and realization of effective and efficient primary health care, the acceptance of participative management in health providing organizations, the provision of financial management training for health care managers and the application of management accounting principles for the improvement of the efficiency and effectiveness of management.
OBJECTIVES: This paper reviews Russia's health crisis, financing, and organization and public health reform needs. METHODS: The structure, policy, supply of services, and health status indicators of Russia's health system are examined. RESULTS: Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. CONCLUSIONS: The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.
C.M. Rémillard, Benjamin G. Zifkin, Allan L. Sherwin, William Feindel
George A. Savoy was born in Cohoes, New York, in 1873. He left the U.S.A. in 1921 to manage the Canadian branch of a large manufacturer of ledgers and looseleaf registers. This company was asked to supply Professor Jasper's laboratory with rolls of plain unlined paper and it was George Savoy who later developed fanfolded and lined EEG paper, which was first used at the Montreal Neurological Institute. He also had personal contacts with Wilder Penfield concerning their mutual interest in the needs of patients with epilepsy. He was a successful industrialist involved with several charitable organizations funding programmes for people with epilepsy. He was opposed to the sectarianism then prevalent in Quebec, which was unfamiliar to him, and in reaction built his own institution, Dieppe House, a home for people with epilepsy, later renamed <<Foyer Savoy>>. It was to operate without regard to race, language or religion. In 1971, his son Harold and other generous donors decided to create a foundation to support research in epilepsy. The Foyer Savoy was sold in 1988 and the proceeds used to increase the endowment of the foundation. His grandson George M. Savoy is the current president. The fourth generation is also represented by Caroline Savoy, daughter of the president, who joined the board of directors in 1992. The foundation will distribute from $300,000 to $400,000 yearly to researchers from many different countries working in the field of epilepsy in universities and hospitals throughout Canada.
We present a zero-knowledge proof system [19] for any NP language L, which<br />allows showing that x in L with error probability less than 2^−k using communication<br />corresponding to O(|x|^c) + k bit commitments, where c is a constant depending only<br />on L. The proof can be based on any bit commitment scheme with a particular set<br />of properties. We suggest an efficient implementation based on factoring.<br />We also present a 4-move perfect zero-knowledge interactive argument for any NP-language<br />L. On input x in L, the communication complexity is O(|x|^c) max(k; l)<br />bits, where l is the security parameter for the prover. Again, the protocol can be<br />based on any bit commitment scheme with a particular set of properties. We suggest<br />efficient implementations based on discrete logarithms or factoring.<br />We present an application of our techniques to multiparty computations, allowing<br />for example t committed oblivious transfers with error probability 2^−k to be done<br />simultaneously using O(t+k) commitments. Results for general computations follow<br />from this.<br />As a function of the security parameters, our protocols have the smallest known<br />asymptotic communication complexity among general proofs or arguments for NP.<br />Moreover, the constants involved are small enough for the protocols to be practical in<br />a realistic situation: both protocols are based on a Boolean formula Phi containing and-<br />, or- and not-operators which verifies an NP-witness of membership in L. Let n be<br />the number of times this formula reads an input variable. Then the communication<br />complexity of the protocols when using our concrete commitment schemes can be<br />more precisely stated as at most 4n + k + 1 commitments for the interactive proof<br />and at most 5nl +5l bits for the argument (assuming k <= l). Thus, if we use k = n,<br />the number of commitments required for the proof is linear in n.<br />Both protocols are also proofs of knowledge of an NP-witness of membership in<br />the language involved.
The price increase in the cryptocurrency market over the past 1 year has resulted in a further increase in the interest of ordinary citizens and amateur investors in digital assets. At the same time, the increase in prices has motivated people to invest in cryptocurrencies. At the moment, the main questions that interest investors are: how are the commissions charged during the purchase and cashing of cryptocurrencies and in what form is tax paid on cryptocurrency income. Considering these factors, the information contained in this article about the commissions charged during cryptocurrency trading and the mechanism of taxation of cryptocurrency income is quite relevant.
Toshio Fukuda, Go Iritani, Fumihito Arai, Koji Yamada
In this research, we address the organization of group behavior on decentralized autonomous robotic systems. Collective group behavior is exhibited in the natural world, such as by ants and fish, in teamwork in sports and by the human society. Therefore, research on group behavior of decentralized autonomous robotic systems can be regarded as one the research fields of Artificial Life. Decentralized autonomous robotic systems refer to multiple robotic systems including many autonomous robots, such as the Cellular Robotic System (CEBOT). The CEBOT, which has been studied by the authors, consists of a number of robotic units called cells. In research on the CEBOT, it is necessary to evolve a cooperative group behavior effectively in the system, since a well-organized group behavior is required to carry out given tasks efficiently and influences its performance ability. In order to organize the behavior in a dynamic environment, we proposed a concept of the self-recognition for the decision making of the behavior in a robotic group. In addition to the proposed concept, this paper will show a construction mechanism of group behavior using the character of the attractor. Based on this idea, we present the behavioral evolution of a group robotic system.
There had been well known claims of unconditionally secure quantum protocols for bit commitment. However, we, and independently Mayers, showed that all proposed quantum bit commitment schemes are, in principle, insecure because the sender, Alice, can almost always cheat successfully by using an Einstein-Podolsky-Rosen (EPR) type of attack and delaying her measurements. One might wonder if secure quantum bit commitment protocols exist at all. We answer this question by showing that the same type of attack by Alice will, in principle, break any bit commitment scheme. The cheating strategy generally requires a quantum computer. We emphasize the generality of this ``no-go theorem'': Unconditionally secure bit commitment schemes based on quantum mechanics---fully quantum, classical or quantum but with measurements---are all ruled out by this result. Since bit commitment is a useful primitive for building up more sophisticated protocols such as zero-knowledge proofs, our results cast very serious doubt on the security of quantum cryptography in the so-called ``post-cold-war'' applications. We also show that ideal quantum coin tossing is impossible because of the EPR attack. This no-go theorem for ideal quantum coin tossing may help to shed some lights on the possibility of non-ideal protocols.
Robin Boadway, Isao Horiba, Raghbendra Jha, Boadway, Robin · 6 authors
It has realized since Pigou (1947) that if public goods are financed by distortionary taxation, the marginal social cost of providing the public good will exceed the actual resource cost by the marginal deadweight cost of taxation.
We present a 4-move zero-knowledge proof system [21] for any NP language L, which allows showing that x 2 L with error probability less than 2 \\Gammak using communication corresponding to O(jxj c )+O(k) bit commitments, where c is a constant depending only on L. We also present a 4-move perfect zero knowledge interactive argument for any NP-language L. On input x 2 L, the communication complexity is O(jxj c ) \\Delta max(k; l) bits, where l is the security parameter for the prover 1 . The protocols can be based on any bit commitment scheme with a particular set of properties. We suggest efficient implementations based on discrete logarithms or factoring. As a function of the security parameters, our protocols have the smallest known asymptotic communication complexity among general proofs or arguments for NP. Moreover, the constants involved are small enough for the protocols to be practical in a realistic situation: our protocols allows proving/arguing satisfiability of a Boo...