Links between energy budgets, somatic condition, and life history reveal heterogeneous energy management tactics in a group-living mesocarnivore.

BACKGROUND: Optimal management of voluntary energy expenditure is crucial to the survival and reproductive success of wild animals. Nevertheless, a growing appreciation of inter-individual variation in the internal state driving movement suggests that individuals may follow different, yet equally optimal tactics under the same environmental conditions. However, few studies in wild populations have investigated the occurrence and demographic context of different contemporaneous energetic expenditure tactics. Here, we explore this neglected aspect of energy budgeting in order to determine the effect of life-history traits such as age and reproductive status on the co-occurrence of different energy-budgeting tactics in wild populations. METHODS: We investigated inter-individual heterogeneity in energy expenditure within a wild population of European badgers (Meles meles) by quantifying individual overall dynamic body acceleration (ODBA, from tri-axial accelerometry collars) and total daily energy expenditure (DEE, from doubly-labelled water) during 6-9 day deployments and dosing periods over six different seasons (spring, summer, and autumn) in 2018-2019. We obtained ODBA values for 41 deployments (24 unique badgers) and DEE measurements for 41 dosings (22 unique badgers). We then evaluated correlations between these energetic metrics and computed individual ratios of ODBA/DEE as a proxy for the proportion of total energy spent on activity. We measured the impact of alternative ODBA/DEE ratios on body condition, and use survival models constructed using 29 years of demographic data from the same population to situate body-condition changes in the context of age and reproductive status. RESULTS: Both ODBA and DEE were highly variable between individuals and exhibited season-specific relationships with individual body condition and life-history factors. DEE scaled allometrically with body weight, but only in summer and autumn; post-reproductive female badgers were lighter than other badgers during the spring but expended on average 350 kJ/day more than predicted from allometric scaling. Older badgers expended significantly less energy on movement during the summer than did younger adults. The ratio of ODBA to DEE (OD) provides a measure of proportional investment into movement. This ratio correlated more significantly with next-season body condition than either energetic metric did independently. However, the majority of individuals with high OD ratios were either younger badgers or reproductive females, for which lower body condition typically presented less of a mortality risk in previous analyses of this population. CONCLUSIONS: Within a single population under the same environmental conditions, we found wide inter-individual variation in both mechanical and total energy expenditure. The adoption of different tactics aligns with relationships between life-history parameters and mortality risk previously studied within the population. Crucially, younger badgers and reproductive females appeared able to tolerate energy expenditure tactics that depleted their body condition more than other badgers. These findings provide a mechanism by which differences in individual energetic context set by life history can maintain heterogeneity in wild populations, providing a wide range of potential energetic tactics under changing environmental conditions.

Behavioral thermoregulation in primates: A review of literature and future avenues.

Primates face severe challenges from climate change, with warming expected to increase animals' thermoregulatory demands. Primates have limited long-term options to cope with climate change, but possess a remarkable capacity for behavioral plasticity. This creates an urgency to better understand the behavioral mechanisms primates use to thermoregulate. While considerable information exists on primate behavioral thermoregulation, it is often scattered in the literature in a manner that is difficult to integrate. This review evaluates the status of the available literature on primate behavioral thermoregulation to facilitate future research. We surveyed peer-reviewed publications on primate thermoregulation for N = 17 behaviors across four thermoregulatory categories: activity budgeting, microhabitat use, body positioning, and evaporative cooling. We recorded data on the primate taxa evaluated, support for a thermoregulatory function, thermal variable assessed, and naturalistic/manipulative study conditions. Behavioral thermoregulation was pervasive across primates, with N = 721 cases of thermoregulatory behaviors identified across N = 284 published studies. Most genera were known to utilize multiple behaviors ( x ¯ = 4.5 ± 3.1 behaviors/genera). Activity budgeting behaviors were the most commonly encountered category in the literature (54.5% of cases), while evaporative cooling behaviors were the least represented (6.9% of cases). Behavioral thermoregulation studies were underrepresented for certain taxonomic groups, including lemurs, lorises, galagos, and Central/South American primates, and there were large within-taxa disparities in representation of genera. Support for a thermoregulatory function was consistently high across all behaviors, spanning both hot- and cold-avoidance strategies. This review reveals asymmetries in the current literature and avenues for future research. Increased knowledge of the impact thermoregulatory behaviors have on biologically relevant outcomes is needed to better assess primate responses to warming environments and develop early indicators of thermal stress.

Carbon trade-off and energy budgeting under conventional and conservation tillage in a rice-wheat double cropping system.

Amid rising energy crises and greenhouse gas (GHG) emissions, designing energy efficient, GHG mitigation and profitable conservation farming strategies are pertinent for global food security. Therefore, we tested a hypothesis that no-till with residue retaining could improve energy productivity (EP) and energy use efficiency (EUE) while mitigating the carbon footprint (CF), water footprint (WF) and GHG emissions in rice-wheat double cropping system. We studied two tillage viz., conventional and conservation, with/without residue retaining, resulting as CT0 (puddled-transplanted rice, conventional wheat -residue), CTR (puddled-transplanted rice, conventional wheat + residue), NT0 (direct seeded rice, zero-till wheat -residue), and NTR (direct seeded rice, zero-till wheat + residue). The overall results showed that the NTR/NT0 had 34% less energy consumption and 1.2-time higher EP as compared to CTR/CT0. In addition, NTR increased 19.8% EUE than that of CT0. The grain yield ranged from 8.7 to 9.3 and 7.8-8.5 Mg ha-1 under CT and NT system, respectively. In NTR, CF and WF were 56.6% and 17.9% lower than that of CT0, respectively. The net GHG emissions were the highest (7261.4 kg CO2 ha-1 yr-1) under CT0 and lowest (4580.9 kg CO2 ha-1 yr-1) under NTR. Notably, the carbon sequestration under NTR could mitigate half of the system's CO2-eq emissions. The study results suggest that NTR could be a viable option to offset carbon emissions and water footprint by promoting soil organic carbon sequestration, and enhancing energy productivity and energy use efficiency in the South Asian Indo-Gangetic Plains.

High-cost drugs for rare diseases: their expenditure and value based on a regional area-based study.

Background: in the field of rare diseases (RDs) most of the European studies on budget impact analysis of drugs that have been conducted often lay on theoretical assumptions and focus only on Orphan drugs (ODs). Objectives: we aimed to estimate the budget impact of specific drugs for non-oncological RDs, both ODs and non-ODs, using real-world data about patients residing in Veneto Region (Italy) and to describe its expenditure structure and dynamics. Methods: a population-based multi-source observational study was conducted using data from Regional administrative databases; an ad-hoc drugs' list specific for RDs including both ODs and non-ODs and classifying them by ATC codes has been created. Results: In 2019, the total expenditure for drugs specific for RDs was EUR 97.2 million (6.6% of the total Regional budget). The RD drug list included 58 ATC codes, of which 15 ATC had an annual budget impact over EUR 1 million ("blockbuster drugs"). The most expensive treatment was a non-OD drug (Coagulation factor VIII). The two most represented therapeutical areas were the metabolic and the hematological ones. Conclusions: Cost analyses on RD high-cost drugs expenditure should consider any specific RD drug, not only ODs. Expenditure dynamics for RD drugs are peculiar showing "blockbuster drugs". Some therapeutical areas seem to be lacking in the drug research field.

Continuing Medical Education in the Post COVID-19 Pandemic Era.

Continuing medical education (CME) is a requirement for medical professionals to stay current in their ever-changing fields. The recent significant changes that have occurred due to the COVID-19 pandemic have significantly impacted the process of providing and obtaining CME. In this paper, an updated approach to successfully creating and administering CME is offered. Recommendations regarding various aspects of CME development are covered, including competitive assessment, marketing, budgeting, property sourcing, program development, and speaker and topic selection. Strategies for traditional and hybrid CME formats are also explored. Readers and institutions interested in developing CME, especially in the setting of the ongoing pandemic, will be able to use these strategies as a solid framework for producing CME. The recommendations and strategies presented within this paper are based on the authors' opinions, expert opinions, and experiences over 13 years of creating CME events and challenges brought about due to the COVID-19 pandemic.

Devices and furniture for small and sick newborn care: systematic development of a planning and costing tool.

BACKGROUND: High-quality neonatal care requires sufficient functional medical devices, furniture, fixtures, and use by trained healthcare workers, however there is lack of publicly available tools for quantification and costing. This paper describes development and use of a planning and costing tool regarding furniture, fixtures and devices to support scale-up of WHO level-2 neonatal care, for national and global newborn survival targets. METHODS: We followed a systematic process. First, we reviewed planning and costing tools of relevance. Second, we co-designed a new tool to estimate furniture and device set-up costs for a default 40-bed level-2 neonatal unit, incorporating input from multi-disciplinary experts and newborn care guidelines. Furniture and device lists were based off WHO guidelines/norms, UNICEF and national manuals/guides. Due to lack of evidence-based quantification, ratios were based on operational manuals, multi-country facility assessment data, and expert opinion. Default unit costs were from government procurement agency costs in Kenya, Nigeria, and Tanzania. Third, we refined the tool by national use in Tanzania. RESULTS: The tool adapts activity-based costing (ABC) to estimate quantities and costs to equip a level-2 neonatal unit based on three components: (1) furniture/fixtures (18 default but editable items); (2) neonatal medical devices (16 product categories with minimum specifications for use in low-resource settings); (3) user training at device installation. The tool was used in Tanzania to generate procurement lists and cost estimates for level-2 scale-up in 171 hospitals (146 District and 25 Regional Referral). Total incremental cost of all new furniture and equipment acquisition, installation, and user training were US$93,000 per District hospital (level-2 care) and US$346,000 per Regional Referral hospital. Estimated cost per capita for whole-country district coverage was US$0.23, representing 0.57% increase in government health expenditure per capita and additional 0.35% for all Regional Referral hospitals. CONCLUSION: Given 2.3 million neonatal deaths and potential impact of level-2 newborn care, rational and efficient planning of devices linked to systems change is foundational. In future iterations, we aim to include consumables, spare parts, and maintenance cost options. More rigorous implementation research data are crucial to formulating evidence-based ratios for devices numbers per baby. Use of this tool could help overcome gaps in devices numbers, advance efficiency and quality of neonatal care.

Budgeting in Healthcare Systems and Organizations: A Systematic Review.

Background: Budgeting is the process resource allocation to produce the best output according to the revenue levels involved. Among the constraints that healthcare organizations, including hospitals, both in the public and private sectors, grapple with is budgetary constraints. Therefore, cost control and resource management should be considered in healthcare organizations under such circumstances. Methods: We aimed to identify methods of budgeting in healthcare systems and organizations as a systematic review. To extract and analyze the data, a form was designed by the researcher to define budgeting methods proposed in the literature and to identify their strengths, weaknesses, and dimensions. The search was conducted in Google Scholar, Web of science, Pub med and Scopus databases covering the period 1990-2022. Results: Overall, 33 articles were included in the study for extraction and final analysis. The study results were reported in four main themes: healthcare system budgeting, capital budgeting, global budgeting, and performance-based budgeting. Conclusion: Each budgeting approach has its own pros and cons and requires meeting certain requirements. These approaches are selected and implemented depending on each country's infrastructure and conditions as well as its organizations. These infrastructures need to be thoroughly examined before implementing any budgeting method, and then a budgeting method should be selected accordingly.

Temporal Structuring as Self-Discipline: Managing time in the budgeting process.

We examine how actors engage in temporal self-discipline so as to achieve entrainment of a practice to temporal norms. Temporal self-discipline is about imposing self-created temporal structures on one's future behaviour and goes along with the (re-)production of a time-conscious self. Based on our fieldwork, we show how such self-discipline materializes both in the form of a very detailed temporal plan and in spaces for coordination to ensure sticking to this plan. We demonstrate that practising temporal self-discipline provides accountants with a sense of control over the budgeting process - a way to achieve 'controlled' entrainment to the temporal norm. We also show how temporal disruptions may challenge controlled entrainment, forcing actors into a passive mode of reaction and potential deviation from their intended plan.

Challenges of Budgeting and Public Financial Management in Iran's Health System: A Qualitative Study.

Background: Efficient and effective management of budgets and financial resources is critical for health systems to achieve their goals; in this regard, countries may face budgetary and financial challenges owing to the weak prediction of resources and consumptions, and lack of prioritization for their budget. This study aims to identify the most critical policies and events that have affected public financial management and health budgeting and existing challenges in Iran. Methods: We conducted the present study in 2022 using a 2-stage qualitative method. First, by reviewing upstream documents and laws, we identified evidence related to health budgeting. Then, we conducted 13 semi-structured interviews with informed people in the health budgeting field that led us toward the main challenges through thematic content analysis. Results: After reviewing 48 upstream documents related to health budgeting, we identified 85 policies. After reviewing the articles, we achieved 11 themes and 71 subthemes. The most critical challenges of the budgeting cycle were as follows: (I) budget formulation, including inappropriate budget structure, conflicts of interest and infringement, lack of financial sustainability, and transparency; (II) budget execution, including a nonexecutable approved budget, complicated allocation process, and ineffective allocations; and (III) monitoring, reporting, and evaluation (MR&E), including fragmentation of MR&E processes, ineffective monitoring and evaluation, weak evaluation of platforms, and inadequate transparency. Conclusion: Most challenges in the health budgeting system are related to the budget formulation and approval stage that have their roots in implementation, monitoring, and reporting. In addition, Iran's macroeconomic and financial issues have also damaged the budgeting of the health sector. Budget problems affect the goals and outcomes of this sector, especially the health system.

Food-energy­carbon nexus of Himalayan okra-pea cropping system: Impacts of AM-fungi, precision phosphorus and irrigation regimes in an acid Alfisol.

Conventional farming practices are energy and carbon-intensive. Low-cost technologies like AM-fungi (AMF) and precision P-management vis-à-vis precision irrigation-scheduling may enhance P-bioavailability, and crop- and water-productivity with reduced energy and carbon-footprints in acid-Alfisol of north-western Himalayas. Hence, an experiment was done in okra (Abelmoschus esculentus)-pea (Pisum sativum) cropping system (OPCS) using AMF (Glomus mosseae) at three inorganic-P levels (50, 75 & 100 % of soil-test based P-dose) and two irrigation-regimes (40 & 80 % AWC). AMF-inoculation significantly enhanced the system-productivity (∼11 %), bio-energy output (∼8 %) and SOC-storage over non-AMF plots in OPCS. Carbon-input use followed the trend of water>diesel>fertilizers> FYM > herbicides> pesticides>AMF in OPCS. AMF-inoculation significantly reduced the carbon-footprints (0.466 kg CO2-e kg-1) by ∼10.2 % over non-AMF plots. Soil-test based 100 % P-dose significantly enhanced the system-productivity (6.3-15.6 %) and bio-energy output (4.7-12.6 %) with lesser carbon-footprints (5.3-15 %) over 50 and 75 % P-dose. Irrigation at 80 % AWC enhanced system-productivity (∼4.1 %), however at 40 % AWC reduced carbon-footprints by ∼11.7 % besides saving irrigation-water by ∼24 % (150 mm ha-1/year) in OPCS. Hence, farmers must necessarily use AMF-inoculation coupled with soil-test based P-fertilization (75-100 %) while preserving a balance in irrigation water-use at 40-80 % AWC depending upon water-availability for higher crop- and water-productivity besides lesser energy and carbon-footprints in OPCS in Himalayan acid Alfisol.

Disaster risk index on disaster management budgeting: Indonesia's national data set.

This study analysed Indonesian local government budgeting model based on the Disaster Risk Index (DRI). This study used a sample of local governments in Indonesia consisting of provincial, regency and municipality levels, especially for 2015-2019 data with a final sample of 2609 observations. The results of the analysis and testing showed that most of the Indonesian local governments fall into the high category in the DRI. The DRI has a positive effect on the Disaster Response Emergency Fund (DREF). The results were robust to the differences in DRI measurements, both using scores and DRI categories. This study also found that the DRI has been used as the basis for budgeting regional expenditures. The budget was allocated in disaster-related public procurements such as public service, housing, public facilities and public health. The budgeting for the implementation of economic and social functions was not influenced by the DRI. Instead, the DRI was found to have a negative effect on the implementation of environmental functions. The findings showed that in general, DRI has been used as the basis for budgeting for regional disaster management, but it is still limited to functions related to disaster emergency response. The budgeting of functions related to the prevention stage has not been optimally carried out, especially by mitigating natural hazards through strengthening the quality of the environment. Contribution: The results are expected to contribute to the local government to improve disaster resilience through strengthening regional financial funding.

Impact of a free care policy on routine health service volumes during a protracted Ebola virus disease outbreak in the Democratic Republic of Congo.

BACKGROUND: In response to the DRC's 10th Ebola Virus Disease (EVD) outbreak, the government subsidized routine health services in select health zones with the goal of maintaining routine service volumes. We assess the impact of the initial and revised Free Care Policies (FCP) on total clinic visits, uncomplicated malaria, simple pneumonia, fourth antenatal care clinic visits, and measles vaccinations, testing the hypothesis that routine services would not significantly decrease during the FCP. METHODS AND FINDINGS: We used data from the DRC's national health information system spanning January 2017 to November 2020. Intervention facilities were those that were initially and secondarily enrolled in the FCP, which occurred in August 2018 and November 2018, respectively. Comparison facilities were limited to the North Kivu Province and were from health zones that recorded at least one case of Ebola. A controlled interrupted time series analysis was conducted. The FCP appeared to have a positive effect in increasing overall clinic attendance rates, uncomplicated malaria case rates, and simple pneumonia case rates in those health zones where the policy was enacted relative to comparison sites. The longer-term effects of the FCP were mostly non-significant or, if significant, relatively modest in nature. Rates for measles vaccinations and fourth ANC clinic visits appeared to be unaffected or minimally affected, respectively, by the implementation of the FCP and relative to comparison sites. We did not observe the decrease in measles vaccinations that has been observed elsewhere. The study is limited in that we were unable to account for health facility bypassing and service volumes at private health facilities. CONCLUSIONS: Our findings provide evidence that FCPs can be used to maintain routine service provision during outbreaks. Additionally, the study design demonstrates that routinely reported health information from the DRC are sensitive enough to detect changes in health policy.

Health financing and public financial management during the Covid-19 pandemic: Evidence from Pakistan as low-income country.

PURPOSE: This article aims to explore the areas of misalignment between the public financial management (PFM) and health financing during the COVID-19 pandemic in Pakistan. ORIGINALITY/VALUE: To the best of our knowledge, it is the first study on South Asian countries to adopt a framework and bring forward the dominant themes that cause the misalignment between PFM and health financing. The timing of the research was excellent as the world was facing the biggest health challenge in the form of COVID-19 which has put pressure on the PFM and has seriously hampered health service delivery. Therefore, the findings of the study are helpful for the ministry of health to draft policies to improve health allocations and move towards Universal Health Coverage. DESIGN/METHODOLOGY/APPROACH: In-depth semi-structured interviews of 15 participants were used to explore the areas of misalignment between PFM and health financing. Based on qualitative data, thematic content analysis has been carried out. FINDINGS: The findings of the study can be divided into five clusters and their explanations. First overall budget allocation has an impact on the health sector budget. For example, the budget for priority health interventions is not reflected in the budget allocation process. Further, the budget is classified by inputs rather than disease and finally, the budget is not released by the health priorities. The second cluster was the devolution of health to provinces which is unfinished agenda. Under this cluster fiscal decentralisation has been found to cause problems for the provinces as they have not provided fiscal autonomy to spend the money and there is a lack of coordination between the federal and provincial authorities. The third cluster was donor funding, and it was observed that it is not aligned with the government policies and priorities. Forth cluster was procurement and it was discovered that it is a lengthy process and caused delays in procuring the essential health equipment. The fifth cluster was an organisational culture that is not conducive to the health sector. Under this cluster, the attitude, knowledge, and practices of departments responsible for the health sector require complete revamping.

Hail netting: an economically competitive IPM alternative to insecticides for Midwest apple production.

Apple orchards are highly managed agricultural ecosystems where growers typically rely on insecticides to minimize the risk of pest-related fruit losses. Apple growers practicing integrated pest management require cost-effective alternatives to conventional insecticides for control of major pests such as codling moth (Cydia pomonella L.) and apple maggot (Rhagoletis pomonella Walsh). Exclusion netting has been shown to effectively control multiple insect pest species, limit fruit damage and reduce the use of insecticides while also conferring consumer and environmental benefits. In this study, partial budgeting was applied to explore the financial efficacy of using a hail netting (DrapeNet®) system as a sustainable pest management strategy for Midwest U.S. apple (Malus x domestica). The cost of the hail netting was compared to a common Midwest insecticide spray regimen for apples using yield and quality data from a field study at two Minnesota apple orchards in 2021-2022. The PB analysis indicated that the netting system was an economically competitive alternative to conventional insecticide applications. The economic results were robust across a range of apple prices and yields suggesting that Minnesota apple growers can benefit economically from the application of hail netting for sustainable pest management.

Implementing Competitive Bidding in the Medicare Program: An Expressway to Solvency.

The Medicare program faces increasing budgetary pressures, with recent estimates suggesting that the Medicare Hospital Insurance Trust will be insolvent as soon as 2028. Simultaneously, the Medicare Advantage (MA) program, a managed competition model, continues to grow its market penetration as beneficiaries increasingly choose private plans over traditional fee for service (FFS) Medicare. With the relative cost of the 2 forms of Medicare a subject of debate, policy experts have proposed a variety of policy options to address the program's budgetary pressures and place it on a firmer fiscal footing. This paper explores the implementation of one of these proposals in greater detail: fully transitioning the entire Medicare program to a competitive bidding model in order to reduce overall program costs and improve price competition. Current MA plan bidding methodology is explored, followed by a description of prior proposed competitive bidding models. Implementation challenges are addressed, along with specific policy considerations to protect beneficiaries who wish to remain in FFS Medicare.

The Properties of Alpha Risk Parity Portfolios.

Risk parity is an approach to investing that aims to balance risk evenly across assets within a given universe. The aim of this study is to unify the most commonly-used approaches to risk parity within a single framework. Links between these approaches have been identified in the published literature. A key point in risk parity is being able to identify and control the contribution of each asset to the risk of the portfolio. With alpha risk parity, risk contributions are given by a closed-form formula. There is a form of antisymmetry-or self-duality-in alpha risk portfolios that lie between risk budgeting and minimum-risk portfolios. Techniques from information geometry play a key role in establishing these properties.

Feeling and Calculation: The Impact of Lay Rationalism Thinking Mode on Mental Budgeting.

Mental budgeting is a cognitive process that helps individuals control consumption expenditures. Previous literature has shown that mental budgeting is influenced by people's cognitive capabilities and emotions, which indicates a potential influence of thinking modes on mental budgeting. Under the view of lay rationalism, the present three studies investigated the relationship between thinking modes (i.e., calculation-based thinking and feeling-based thinking) and mental budgeting, as well as the moderating effect of product types that participants consume. It was found that, first, the scores of lay rationalism, which indicate calculation-based thinking, were positively correlated with the mental budgeting levels of college students (Study 1a) and newcomers in the workplace (Study 1b); second, the activation of calculation-based thinking (vs. feeling-based thinking) decreased participants' consumption willingness (Study 2); and third, the calculation-based thinking exhibited a stronger binding effect in participants who consumed only hedonic products than in participants who consumed only utilitarian products (Study 2). The results demonstrated the effects of lay rationalism thinking mode and product types on mental budgeting, which highlighted different implications for consumers and merchants. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03689-5.

Communicating amounts in terms of commonly used budgeting periods increases intentions to claim government benefits.

Millions of eligible families did not claim their 2021 expanded child tax credit (CTC), collectively forgoing billions of dollars. To address this problem, many policymakers focused on increasing awareness of the CTC by highlighting that families could receive up to $3,600 a year per child. However, people rarely budget on a yearly basis. We propose that communicating the CTC benefit amount in terms of commonly used budgeting periods (e.g., $300 a month) instead of uncommonly used budgeting periods (e.g., $3,600 a year) could increase interest in claiming the CTC. Two large-scale field experiments ([Formula: see text]) among low-income individuals support this account. Using common (vs. uncommon) budgeting periods to describe CTC benefit amounts increased CTC claiming intentions by 16 to 26%. A third large-scale field experiment ([Formula: see text]) demonstrated that encouraging people to consider different budgeting periods moderated these effects. These results suggest that communicating amounts in terms of common budgeting periods is a simple, cost-effective way to stimulate interest in claiming government benefits.

Co-production and Voice in Policymaking: Participatory Processes in the European Periphery.

Co-production is now the gold standard in policymaking, characterised by national and international actors with different types of knowledge working together to contribute to a collaborative decision-making process. The benefits of co-production in policymaking can include improved knowledge generation that merges practice-centred, political and technical knowledge and incorporates local knowledges to provide complementary information and increase ownership over policymaking processes. Nevertheless, it can also present pitfalls such as multiple and diverging interests, incomplete and asymmetric information, and resource asymmetries and elite capture as highlighted by Bender in (Eur J Dev Res, 2022). By reviewing a case in the European periphery, we document and illustrate situations of collaboration and conflict, benefits and pitfalls resulting from policymaking co-production, throughout recent Portuguese history and in present-day participatory budget initiatives. From competing national actors to influences from the Global North and Global South, the final outcome reflects a learning process in collaboration but also underlying power struggles.

La co-création est désormais la référence en matière d'élaboration des politiques. Elle est caractérisée par des acteurs nationaux et internationaux dotés de différents types de connaissances qui travaillent ensemble pour contribuer à un processus décisionnel collaboratif. Les avantages de la co-création dans l'élaboration des politiques peuvent inclure une meilleure création de connaissances qui permet de fusionner les connaissances politiques et techniques centrées sur la pratique et qui intègre les connaissances locales pour fournir des informations complémentaires et accroître l'appropriation des processus d'élaboration des politiques. Néanmoins, la co-création peut également présenter des écueils tels que des intérêts multiples et divergents, des informations incomplètes et asymétriques, des asymétries de ressources et une accaparation par les élites, comme le souligne Bender in in (Eur J Dev Res, 2022). Par le biais d'une étude de cas dans la zone européenne, nous documentons et illustrons des situations de collaboration et de conflit, ainsi que les avantages et les inconvénients résultant de la co-création de politiques, grâce à l'histoire portugaise récente et, actuellement, dans le cadre des initiatives budgétaires participatives. Qu'il soit question d'acteurs nationaux concurrents ou d'influences issues des pays du Nord et du Sud, le résultat final reflète un processus d'apprentissage collaboratif ainsi que des luttes de pouvoir sous-jacentes.

The Impact of Cost-Containment Schemes on Outpatient Services for Schoolchildren with Refractive Errors in Taiwan-A Population-Based Study.

OBJECTIVES: Extant research on cost-sharing finds no impact on health care utilization when the amount is insubstantial. This research investigates the effects on nonacute outpatient services for schoolchildren with refractive errors in Taiwan and discusses the potential harm caused by cost sharing and relevant cost containment policies. METHODS: Longitudinal claims data from the National Health Insurance database are employed. District demographic information is also used for aggregate-level analyses. Interventional modeling is conducted on pooled individual-level data with a Poisson model and negative binomial models. Generalized least square modeling is performed on aggregate district-level data to elucidate the impacts of cost sharing and the reimbursement rate with controls for patient and institutional characteristics, district socioeconomic factors, and competitiveness among institutions. RESULTS: The findings of this study show that cost sharing does not significantly affect children's utilization of outpatient services in the patient-level analyses. However, it significantly decreases the service volume based on the results of district aggregate analyses. There are potentially marginal patients in society, and they are more likely to be girls in poorer families, whose chances of seeking medical care significantly decrease when cost sharing increases. CONCLUSIONS: The gap in health inequity can be widened when stringent cost-containment policies are implemented. The offset effect caused by delayed care may also result in higher health care expenditures later. Cost sharing for children should be separately and prudently designed to better protect them from deprivations caused by changes in health policies.