Biomedical subjects

Vivian Valdmanis

Publications and source records attributed to Vivian Valdmanis.

7 recordsLinked to original sources

PubMed2006

The relationship between prevalence of active trachoma, water availability and its use in a Tanzanian village.

This study aimed to establish the relationship between the prevalence of active trachoma in children, water availability and household water use in a village in Tanzania. Nine hundred and fourteen children aged 1-9 years were examined for signs of trachoma. Data were collected on time taken to collect water, amount of water collected and other trachoma risk factors. In a sub-study, 99 randomly selected households were visited twice daily on two consecutive days to document patterns of water use. The prevalence of active trachoma in the children examined was 18.4% (95% CI 15.9-20.9). Active trachoma prevalence increased with increasing water collection time (OR 2.25; 95% CI 1.13-4.46) but was unrelated to the amount of water collected. In the sub-study, active trachoma prevalence was substantially lower in children from households where more water was used for personal hygiene (P for trend < or =0.01), independent of the total amount of water used. The allocation of water to hygiene was predicted by lower water collection time. The key element in the relationship between water availability and trachoma is the allocation of water within households. Collection time may influence both the quantity of water collected and its allocation within the household.

Child↗

PubMed2006

A pan-Canadian perspective on institutional long-term care.

We aggregate long-term care (LTC) facility-level data collected by Statistics Canada to National and regional levels to make observations relating to environmental characteristics--including the age distribution by region, and market share by type of ownership--and organizational characteristics--including ownership, facility size, resident age distribution, and the types of care provided in facilities by ownership. We observe significant differences in ownership by region, in facility size by ownership, and in levels of resident care provided by ownership. Further, we examine some of the classic proxies for quality of care for the LTC sector in this paper, including a variety of staffing intensity levels, observing significant differences in staffing intensities by region. We hope that our observations prompt researchers and policy makers to question the desirability and implications of this variation in the Canadian LTC industry.

Aged↗

PubMed2005

A modified three-stage data envelopment analysis. The Netherlands.

In The Netherlands the care for the disabled accounts for 10% of total health care costs, or almost 1% of GNP. About half of these costs are devoted to the residential care for the mentally disabled. This study studied the amount of cost inefficiency in a sample of homes operating in 1998. We first apply a data envelopment analysis to our sample and then apply another stage-evaluating the nonradial slack of each input and the effects external factors have on them. After "correcting" for the external effects we find that technical and scale inefficiency disappears and cost efficiency increases by 6%. We attribute these findings with the strict regulation under which Dutch homes operate. Further, this approach can be applied to any service or market that faces governmental regulation.

Costs and Cost Analysis↗

PubMed2005

Observations on institutional long-term care in Ontario: 1996-2002.

We provide descriptive statistics for data collected via the Residential Care Facilities Survey (RCFS), from long-term care (LTC) facilities operating in Ontario between 1996 and 2002. The LTC sector in Ontario is dominated by large, proprietary for-profit facilities. The proportion of residents receiving extended care has increased from 53 per cent in 1996 to over 61 per cent in 2002. Government-owned facilities are significantly larger than both for-profit proprietary facilities and lay non-profit facilities. Religious and lay non-profit facilities provide care to more residents 85 years of age and older than do for-profit and government-owned facilities, while government-owned facilities provide care to a greater proportion of higher needs residents. Government-owned facilities have higher nursing intensity levels and higher direct care staffing levels than other ownership types, while for-profit facilities have significantly lower levels than other facility types. Non-profit operators have higher ratios of administrative to care staff than proprietary and government-owned facilities.

Aged↗

PubMed2004

Capacity in Thai public hospitals and the production of care for poor and nonpoor patients.

OBJECTIVE: To assess the capacity of Thai public hospitals to proportionately expand services to both the poor and the nonpoor. This is accomplished by measuring the production of services provided to poor, relative to nonpoor, patients and the plant capacity of individual public hospitals to care for the patient load. STUDY SETTING: Thai public hospitals operating in 1999, following the economic crisis when public hospitals were required to treat all patients irrespective of ability to pay. STUDY DESIGN AND DATA COLLECTION: Input and output data for 68 hospitals were collected using databases and questionnaire surveys. A distinction was made between inpatient and outpatient services to both poor and nonpoor patients and the data were assessed statistically. DATA ANALYSIS: Congestion and capacity indices to measure poor/nonpoor service trade-offs and capacity utilization were estimated. The analysis was undertaken by data envelopment analysis (DEA), a nonparametric linear programming approach used to derive efficiency and productivity estimates. Principal Findings. Increases in the amount of services provided to poor patients did not reduce the amount of services to nonpoor patients. Overall, hospitals are producing services relatively close to their capacity given fixed inputs. Possible increases in capacity utilization amounted to 5 percent of capacity. CONCLUSIONS: Results suggest that some increased public hospital care can be accomplished by reallocation of resources to less highly utilized hospitals, given the budgetary constraints. However, further expansion and increase in access to health services will require plant investments. The study illustrates how DEA methodologies can be used in planning health services in data constrained settings.

Data Collection↗

PubMed2003

Are vaccination sites in Bangladesh scale efficient?

OBJECTIVES: The overall aim of this study is to discern whether and to what degree vaccination sites exhibit constant returns to scale. METHODS: Data Envelopment Analysis is used to compare all the facilities in the sample in terms of input costs used to produce multiple outputs. The application considers the Expanded Program on Immunization (EPI), which operated in Dhaka City, Bangladesh, during 1999. RESULTS: A preponderance of EPI sites were determined to be operating at increasing returns to scale. CONCLUSIONS: Our findings question the applicability of cost-effectiveness analyses that assume constant returns to scale.

Bangladesh↗

PubMed2002

Charity care: do not-for-profits influence for-profits?

This study further examines whether not-for-profit hospitals exert pressure on for-profit hospitals to provide charity care and whether for-profit hospitals react differently than not-for-profit hospitals to managed care pressures and hospital competition in providing charity care. A two equation model is estimated using 1996 data from California hospitals. The results indicate that in mixed ownership markets, for-profit hospitals provide significantly less charity care as not-for-profit hospitals in the market provide more. Unexpectedly, study for-profit hospitals were not more influenced by price competition than other hospitals with respect to charity care. Having a unique role in providing charity care may justify continuing tax exemption for not-for-profit hospitals and enhance interest in payment and other policies with regard to conversions to ensure that not-for-profit hospitals continue to be represented in market areas.

California↗