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Global Billionaires Political Power Index

September 18, 2014 Comments off

Global Billionaires Political Power Index
Source: Brookings Institution

Darrell West’s Global Billionaires Political Power Index is a ranking of the top global billionaires in terms of overall political power. There are a number of existing rankings that rate the net worth of billionaires, but no one has assessed their overall political influence globally or in particular countries around the world. Kings, queens, dictators, or authoritarian heads of state were not considered because of the difficulty of ascertaining their wealth. Gauging wealth is impossible in some places even though it is suspected that certain leaders are billionaires. Families of government leaders who have gained extensive wealth were also left out because it is hard to gauge their specific holdings.

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The Health Risks of Bathing in Recreational Waters: A Rapid Evidence Assessment of Water Quality and Gastrointestinal Illness

September 18, 2014 Comments off

The Health Risks of Bathing in Recreational Waters: A Rapid Evidence Assessment of Water Quality and Gastrointestinal Illness
Source: RAND Corporation

The European Bathing Directive (2006/7/EC) stipulates water quality standards for recreational bathing waters based on specified limits of faecal indicator organisms (FIOs). Presence of FIOs above the limits is considered to be indicative of poor water quality and to present a risk to bathers’ health. The European Bathing Directive (2006) is to be reviewed in 2020. We conducted a rapid evidence assessment on recreational bathing waters and gastrointestinal illness (GI) to identify the extent of the literature published since the previous review period in 2003 and to determine whether there is any new evidence which may indicate that a revision to the Directive would be justified.

Overall, 21 papers (from 16 studies), including two RCTs, met the inclusion criteria; 12 were conducted in marine waters and four were conducted in freshwater. Considerable heterogeneity existed between study protocols and the majority had significant methodological limitations, including self-selection and misclassification biases. Moreover, there was limited variation in water quality among studies, providing a limited evidence base on which to assess the classification standards.

Overall, there appears to be a consistent significant relationship between faecal indicator organisms and GI in freshwater, but not marine water studies. Given the apparent lack of relationship between GI and water quality, it is unclear whether the boundaries of the Bathing Waters Directive are supported by studies published in the post-2003 period. We suggest that more epidemiological evidence is needed to disprove or confirm the original work that was used to derive these boundaries for marine waters.

Who Runs the International System? Power and the Staffing of the United Nations Secretariat

September 17, 2014 Comments off

Who Runs the International System? Power and the Staffing of the United Nations Secretariat
Source: Center for Global Development

National governments frequently pull strings to get their citizens appointed to senior positions in international institutions. We examine, over a 60 year period, the nationalities of the most senior positions in the United Nations Secretariat, ostensibly the world’s most representative international institution. The results indicate which nations are successful in this zero-sum game, and what national characteristics correlate with power in international institutions. The most overrepresented countries are small, rich democracies like the Nordic countries. Statistically, democracy, investment in diplomacy, and economic/military power are predictors of senior positions–even after controlling for the U.N. staffing mandate of competence and integrity. National control over the United Nations is remarkably sticky; however the in influence of the United States has diminished as US ideology has shifted away from its early allies. In spite of the decline in US influence, the Secretariat remains pro-American relative to the world at large.

The State of Nonprofit Governance

September 17, 2014 Comments off

The State of Nonprofit Governance
Source: Urban Institute

This report provides a snapshot of nonprofit governance policies and practices among operating public charities. Using IRS Form 990 data, we find that many public charities have good governance policies and practices in place. In 2010, more than 60 percent of organizations had a conflict of interest policy, an independent audit and a compensation review and approval process for their chief executive. We also find that organizational characteristics such as size, type of organization, government funding, age, board size and board independence all appear related to whether or not a public charity chooses to adopt these recommended practices.

Transforming Cancer Care and the Role of Payment Reform

September 17, 2014 Comments off

Transforming Cancer Care and the Role of Payment Reform
Source: Brookings Institution

According to the National Cancer Institute there are more than 13 million people living with cancer in the United States; it is the second leading cause of death in the U.S. It is expected that 41% of Americans will be diagnosed with cancer at some point during their lives. More than 1.6 million new cases of cancer will be diagnosed in 2014; a nearly 22% increase over the last decade.

Cancer care is also expensive. In 2010 it accounted for $125 billion in health care spending and is expected to cost at least $158 billion by 2020, due to population increase. In 2011 Medicare alone spent nearly $35 billion in fee-for-service (FFS) payments for cancer care, representing almost 9% of all Medicare FFS payments overall.

Broadly speaking, problems in complex clinical care fall into two categories: deficits in knowledge (for example, lack of any effective treatment for certain brain tumors) and deficits in execution (for example, failure to treat breast cancer with a standard-of-care protocol). Delivery reform seeks to find opportunity in the latter problem type. Considering cancer care through this lens, there are many opportunities to improve outcomes and potentially lower costs, including better coordination of care, eliminating duplication of services and reducing fragmentation of care. In addition, almost two-thirds of oncology revenue derives from drug sales, and pricing for drugs (calculated by the average sale price plus 6% profit for providers) may incentivize the use of the most expensive drugs rather than equally effective, lower-cost alternatives.

Promising approaches are being developed to deliver high quality care, improve the patient experience, and reduce costs for this condition and other chronic diseases. Care redesign strategies such as adopting team-based models, offering extended practice hours, providing triage to keep patients out of the emergency room, and implementing care pathways help providers address avoidable costs and maximize the value of care. Many of these strategies are not currently reimbursed in the FFS, volume-based payment system.

Consequently, much policy attention is focusing on payment reform. On the heels of the Affordable Care Act (ACA), and numerous quality and payment focused initiatives in the private sector, health care organizations need to enhance the competitiveness and efficiency of their system in the marketplace. Alternative payment models (APMs) such as Accountable Care Organizations (ACOs), bundled payments, and patient-centered oncology medical homes (PCOMH) are just a few of the initiatives supported by public and private payers to align care redesign and payment reform and encourage continuous improvement. This paper provides a comprehensive overview of the complex care associated with oncology and the alternate payment models which help support optimal care and encourage continuous improvement.

Assessing Locally Focused Stability Operations

September 17, 2014 Comments off

Assessing Locally Focused Stability Operations
Source: RAND Corporation

This report describes how the Army and other services can better measure and assess the progress and outcomes of locally focused stability operations (LFSO), which are defined as the missions, tasks, and activities that build security, governance, and development by, with, and through the directly affected community, in order to increase stability at the local level. A number of issues related to assessing LFSO are identified, along with foundational challenges that include an inherently complex operational environment, limited doctrinal guidance, competing visions of stability, untested assumptions, and redundant or excessive reporting requirements. The report offers solutions to these and other challenges, and provides concrete recommendations and implementation-related guidance for designing and conducting assessments of LFSO. The report concludes with an assessment plan for a notional African LFSO scenario that illustrates the practical application of those insights.

Taking Stock: Health Insurance Coverage for Parents under the ACA in 2014

September 16, 2014 Comments off

Taking Stock: Health Insurance Coverage for Parents under the ACA in 2014
Source: Urban Institute

Nationally, between September 2013 and June 2014, the estimated uninsured rate for parents fell 2.4 percentage points from 16.7 percent to 14.3 percent, a drop of 14.4 percent. In June 2014, the uninsured rate for nonelderly parents was estimated to be 14.3 percent (95% CI [12.5, 16.2]) for the nation (figure 1, table 1).7 The uninsured rate declined for parents by 2.4 percentage points (95% CI [0.2, 4.6]) between September 2013 and June of 2014, a drop of 14.4 percent. This compares with the decline of 22.3 percent found in the uninsured rate for all nonelderly adults over this time frame (Long, Kenney, Zuckerman, Wissoker, Shartzer, Karpman, Anderson, and Hempstead 2014).

See also: A First Look at Children’s Health Insurance Coverage under the ACA in 2014

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