Past research has shown that transportation system improvements can affect economic growth and productivity by changing access to markets and connectivity to intermodal terminals. However, most past research has adopted singular measures of market access and business productivity. This study demonstrates how various transportation projects can have larger or smaller impacts on business concentration and productivity by affecting different aspects of market access in areas with different business mixes. The study demonstrates these relationships through a two-step process. First, it defines seven types of access and connectivity measures, including access to labor markets, truck delivery markets, and intermodal terminals. The process then develops econometric models of the relationship between access and connectivity characteristics of local areas and relative levels of business productivity, job concentration, and export base. These relationships are estimated with simultaneous, nonlinear equations that allow access threshold effects to be recognized and for different relationships to apply for 54 industry sectors. The results confirm that different types of access are relevant to different industry sectors. As a consequence, the productivity and agglomeration of a given industry in a given area can be related to more than one dimension of accessibility. These results can have important implications for estimating the wider economic benefits of transportation investment and suggest the need to consider both industry detail and forms of accessibility in order to calculate accurately the relative impact of specific project proposals.
SUMMARYBackground. Ghana has made major strides in improving access to health services. Despite these improvements, Ghana did not meet the Millennium Development Goals 4 and 5. Quality of care is a major factor that could explain this shortfall. Objective. To understand current practice and to identify needs in the area of quality of care in Ghana for improving health outcomes and to guide the National Institute for Health and Care Excellence (NICE) in supporting the care quality improvement efforts in Ghana. Methods. The directory of existing standards, guidelines and protocols of the Ghana Health Service was reviewed and sixteen in-depth interviews were conducted to identify interventions that addressed quality of care. Additional information was obtained during a NICE scoping visit to Accra followed by a study tour of Ghanaian stakeholders to NICE and to the National Health Service. Results. Since 1988, 489 policy interventions have been identified that address quality of care. Among them, the development of health protocols and guidelines were the most frequent interventions (n=150), followed by health policies and strategies (n=106); interventions related to health information (n=77); development of training manuals and staff training (n=69); development of regulations (n=38) and interventions related to organisation of services (n=15). Conclusions. Ghana has made significant efforts in developing guidelines, policies and conducting in-service training. Supervision, monitoring and evaluation have also received attention. However, less effort has been made in developing processes and systems and involving communities and service users. Some recommendations were made to guide the future work on quality of care.
This framework is a resource for public insurers that are responsible for rapidly expanding access to care, as it places the mechanisms that insurers directly control within the context of broader strategies of improving health-care quality. The framework bridges the existing gap in the literature between broad frameworks for strategy design for system improvement and narrower discussions of the technical methods by which payers directly influence the quality.
The pilot represented the start of what is intended to be a healthcare process change for the country of Jordan. Issues emerged which can inform strategies to ensure a more cohesive and comprehensive approach to the cost-effective use of appropriate drugs in managing chronic disease in Jordan and countries operating in a similarly resource-constrained environment. Furthermore, our pilot highlights how richer countries with relevant experience in evidence-informed healthcare policy making can assist others in strengthening their decision-making methods and processes.
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