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SummaryIntroductionThere has been an unprecedented increase in global demand for medical oxygen equipment to solve the acute oxygen shortages caused by SARS-CoV-2 infection. The study aims to assess the value of improved access and use of OCs and cylinders during the COVID-19 pandemic in India. This evaluation is relevant to strengthening health systems in many resource-constrained LMIC settings.MethodsUsing a Probability Proportional to Size (PPS) sampling method, primary surveys were conducted in 450 health facilities across 21 states in India. The primary outcomes measured were self-reported utility of oxygenation devices in meeting the oxygen demand in the short-run and long-run utility of devices compared to the pre-oxygen-devices-distribution-period. We perform bivariate and multivariate regression analyses.ResultsAround 53-54% of surveyed facilities reported that the distributed oxygenation devices helped meet oxygen demand in the short run and are expected to increase their long-run capacity to admit non-COVID patients with oxygen needs. Timely availability of technicians was associated with meeting oxygen demand using the additional oxygenation devices at the facilities. Facilities that increased the number of staff members who were able to administer oxygen devices were at higher odds of reducing the administrative load on their staff to organize oxygen support in the long run. Hospital infrastructure was also associated with the long-run outcomes.ConclusionWe find that oxygenation devices such as cylinders and OCs were useful in addressing the oxygen demand during the COVID-19-related oxygen emergency. Overall production of oxygen to meet the demands and investments in training personnel to administer oxygen could help save lives.FundingNoneResearch in ContextWhat is already known on this topic?Oxygen therapy is an essential medicine for the treatment of severely ill patients with COVID-19. Availability of adequate oxygen support was therefore crucial for every health facility that serves COVID-19 patients, particularly in low-resource settings. Medical equipment donation to low-resource settings is also a frequently used strategy to address existing disparities, but there is a paucity of reported experience and evaluation of the impact of these devices. Challenges such as infrastructure gaps, lack of technological and maintenance capabilities, and non-prioritization of essential supplies have previously been highlighted in other developing-country contexts.What this study adds?Timely availability of technicians, the average load of COVID-19 patients during the second wave, and timely availability of oxygenation devices such as OCs were factors associated with the additional oxygenation devices having a significant impact on meeting the oxygen demand at the facility. Further, facilities that increased the number of staff members that were able to administer oxygen devices at the beginning of the second wave were at higher odds of expecting a reduction in the administrative load on their staff to organize oxygen support in the long run.How this study might affect research, practice or policy?This is the first study to demonstrate the utility of oxygen devices such as cylinders and OCs in meeting oxygen demand during the COVID-19 oxygen emergency.Prior findings of the literature from other LMICs stress the importance of hospital infrastructure such as power outlets in the effective use of these oxygen devices. Our analysis also finds these barriers to be significant and additionally suggests that the timely availability of oxygen administrators and technicians is crucial in the utilization of these devices.

In a rapidly digitizing country, Digital Financial Services (DFS) hold the promise of bringing financial inclusion to the last mile. Through the use of DFS, vulnerable and marginalized groups can reduce the risk and cost of using cash, and increase their access to a suite of financial services that would have been otherwise unavailable, or difficult to obtain, such as credit, savings, insurance, and pension. This paper provides an overview of the policy environment regulating digital finance in India as well as presents high-level statistics on the level of digitization across population segments in the country. It then moves on to describe the digital readiness, current usage of digital financial services, and specific issues and solutions for three vulnerable and marginalized groups with high digitization potential: women, micro-entrepreneurs, and domestic migrants. This is complemented by insights drawn from LEAD at Krea University’s primary research on these topics. Finally, the paper provides recommendations to accelerate the penetration of digital financial services among vulnerable groups. These include monitoring the implementation of recently introduced policies on data privacy, grievance redressal, and KYC simplification. It is also recommended to develop customized digital financial services that address the unique needs and profiles of vulnerable groups, such as those specifically analysed in this paper.

Public entities are one of the main producers of socio-economic data around the world. The Open Government Data (OGD) movement encourages these entities to make their data publicly available in order to improve transparency and accountability, which may lead to good governance. Thus, OGD can promote evidence-based public policy by supporting empirical research through making quality data available. Hence, in this paper we discuss the current status of OGD initiative in India, how its principles are considered and applied by the public authorities, and the feedback of the research community about OGD in India. Les institutions publiques sont parmi les principaux producteurs de données socio-économiques. Le mouvement « Données Gouvernementales ouvertes » les encourage et assiste parfois dans la mise à disposition de leurs données au public, pour améliorer la transparence, ce qui peut conduire à une meilleure gouvernance. Ainsi, les données ouvertes gouvernementales peuvent conduire à de meilleures politiques publiques basées sur leurs résultats en soutenant la recherche par la publication de données de qualité. Ce document traite de la situation des données ouvertes en Inde, leur publication et usage par les institutions publiques et par la communauté de recherche. Las instituciones públicas son los principales productores de datos socio-económicos. El movimiento de " datos gubernamentales abiertos" alienta estas entidades de poner sus datos a disposición del público para mejorar la transparencia, y la gobernanza. Por lo tanto los datos gubernamentales abiertos pueden promover políticas públicas basadas en evidencia, mediante el apoyo a la investigación empírica a través de hacer datos de calidad disponibles. En este trabajo se discute lo que es la realidad de los datos gubernamentales abiertos en la India, cómo sus principios están consideradas y aplicadas por las autoridades públicas y la comunidad de investigación.

Chit Funds are indigenous financial institutions in India that combines credit and savings in a single scheme. In a chit fund scheme, a group of individuals come together for a predetermined time period and contribute to a common pool at regular intervals. In order to understand the intricacies of the chit fund model in India, we studied the size of the registered chit fund industry and how it serves the members. We find that the money circulated in the registered chit fund industry ranges from 10 per cent to 50 per cent of bank finance when compared to the total deposits and credits in the bank. The number of chit schemes registered has been reducing over the years. The average percentage change in the number of schemes registered from 2003 to 2006 is approximately a negative 10 per cent. While the number of schemes has reduced, the total value of registered chit schemes increased by approximately 13 per cent from 2003 to 2006. Our survey of the chit fund members shows that as much as 72 per cent of the members participate in chit funds for saving. Additionally, 96 per cent of the current and non-current chit fund members think that chit funds are safe. Majority of the current and non-current chit fund members belong to low-income households. Our study also suggests that the institutional arrangements which govern the functioning of the chit scheme that have emerged seem to serve the interest of all participants irrespective of their socio-economic status. Perhaps, this could explain why this industry has survived for such a long period of time. Our findings point to the fact that though chit funds are an important source of finance for small businesses and low-income households in India, there has been a general exodus of low value chit schemes from the registered chit fund market. This is mainly because registered chit funds find it less lucrative to serve the poor due to the increased cost of operating such schemes imposed by the regulators. We find that the chit fund industry addresses the savings needs of people, is considered very safe and also offers loans at lower interest rates than moneylenders.

Background There are few comprehensive estimates of the cost of psoriasis in the United States. Objective We sought to quantify the incremental direct medical and indirect work loss costs associated with psoriasis. Methods A de-identified claims database from 31 self-insured employers during the period 1998 to 2005 was used. Patients with at least two psoriasis diagnosis claims (N = 12,280) were compared with 3 control subjects (matched on year of birth and sex) without psoriasis. Multivariate two-part regression analysis was used to isolate the incremental cost of psoriasis by controlling for comorbidities and other confounding factors. Results After multivariate adjustment, the incremental direct and indirect costs of psoriasis were approximately $900 and $600 ( P Limitations The database used in this study does not contain information on patient out-of-pocket costs or loss of productivity costs at work. Conclusion The incremental cost of psoriasis is approximately $1500 per patient per year, with work loss costs accounting for 40% of the cost burden.

The objective of this study was to quantify the incremental medical costs that are associated with untreated anemia among elderly patients with predialysis chronic kidney disease (CKD). An analysis of claims and laboratory data between January 1999 and February 2005 was conducted. Inclusion criteria were age >/=65 yr, two or more hemoglobin readings, one or more claims for CKD, and two or more GFR values of

To assess the health care utilization and cost of illness for osteoarthritis (OA) patients taking pain medications. Specifically, the goals were to estimate the direct health care and indirect costs of OA.A claims database of privately insured patients was used to identify OA patients. Prescription drug pain treatments included tramadol, cyclooxygenase-II inhibitors, and nonsteroidal anti-inflammatory drugs. Mean annual per patient costs were calculated from an employer's perspective.OA patients were prescribed multiple drugs simultaneously and/or sequentially to manage pain. OA patients had a number of prevalent comorbid conditions. Average annual direct medical, drug, and indirect work loss costs were $8601, $2941, and $4603, respectively.There was a substantial payer burden associated with OA resulting from the drug, medical, and disability costs and OA-related comorbidities and high concomitant medication utilization.

The goal of this study was to quantify the incremental direct medical and indirect work-loss costs associated with patients diagnosed with atopic dermatitis (AD). A de-identified administrative claims database was used comprising 5.1 million covered beneficiaries from 31 Fortune 500 self-insured employers between 1998 and 2005. Patients with at least two AD diagnosis claims (N = 13,749) were compared with three matched controls (based on yr of birth and gender) with no AD diagnosis (N = 41,247). In addition, a multivariate two-part regression analysis was used to isolate the cost increase attributable to AD by controlling for confounding factors such as age, gender, health plan type, comorbidities, organ transplantation, industry of employer, region, and year. Direct medical and indirect work-loss costs for the AD group were higher on average by $88 and $64 per patient per month, respectively (both P.001). After multivariate adjustment, the total incremental cost per patient per month for the AD group was $83 (direct: $52, P.001; indirect: $31, P.001). Employer-payers experience a significant annual cost burden of $991 per patient attributable to AD. Employee disability and increased sick days account for 38% of the cost burden.

Background: Anemia commonly occurs in the elderly (≥65), and has been associated with a number of adverse consequences. Thirty percent of the community-dwelling elderly fall annually and this risk increases to 50% by the age of 80. Serious injuries caused by a fall, such as fractures and head injuries, are sustained by about 10% of the elderly and often lead to functional disability, increased health care costs, and increased mortality. Identification of reversible risk factors is critical for the management of falls and related injuries. The purpose of the current study is to investigate whether anemia increases the risk of injurious falls (IF) in the elderly. Methods: Health claims data from over 30 health plans from 01/1999 through 04/2004 were used. Patients ≥65 years with ≥1 hemoglobin (Hb) measurement were selected. IF were defined as a fall claim followed by an injurious event claim within 30 days after the fall. Injurious events were defined as fractures of the hip, pelvis, femur, vertebrae, ribs, humerus, and lower limbs, Colle’s fracture, head injuries, or hematomas. An open-cohort design was employed to classify patients’ observation periods by: (1) by anemia status based on WHO criteria (< 12 g/dL for women; < 13 g/dL for men), and (2) by Hb level: Results: Among the 47,530 study subjects, a statistically significant linear trend of increasing risk of falls (i.e., IF and non-IF events) with decreasing Hb was observed (p Conclusion: Anemia was significantly and independently associated with an increasing risk for IF, especially IF to the hip and head, in elderly persons. Furthermore, the risk of IF increased as the anemia worsened. The impact of anemia correction on the risk of falls and IF needs to be evaluated.

Background: Anemia is common in the elderly (≥65) and increases with age, reaching 26% in community dwelling (CD) men 85 yrs and older. Falls, especially those leading to serious injuries such as a fracture or head injury, affect about 10% of the CD elderly. The prevalence of anemia and the occurrence of falls is even higher in nursing home residents. Falls in the elderly are a significant cause of functional disability and significantly increase health care burden. This analysis was performed to determine if the presence of anemia significantly increases medical costs related to injurious falls (IF) in the CD elderly. Methods: A retrospective economic analysis of medical claims from over 30 health plans from 01/1999 through 04/2004 was conducted. Patients ≥65 years with ≥1 hemoglobin (Hb) reading were selected. An open-cohort design was employed to classify patients’ observation period into anemic and non-anemic periods. Anemia was defined as Hb