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Source: http://www.businessinsider.com/google-acquires-wireless-internet-network-2012-11
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Community awareness and participation can go a long way in help making health systems more accountable by demanding better services.?Carol Nyirenda, the TB HIV activist from Zambia, who was one of the over 30 community representatives at the conference, feels that no amount of TB control will work without the active engagement of the affected community. Members of the community will have to be empowered and take ownership of the TB programme. According to her, ?Any policy and structure cannot be complete without community inputs and voices. For this, we have to de- stigmatize TB and empower TB patients by giving them enough basic knowledge about the disease from a public health point of view. TB has remained with doctors and scientists for too long. Unless the TB patients and community are informed in simple language about TB there can be no meaningful TB activism. In HIV, even persons like me from the affected community, with no medical background, have a basic understanding about the clinical aspects of HIV as it has been explained to me in simple terms. This makes it easier for me to argue with other stakeholders across the table to demand better facilities for my community. Unfortunately, this has not happened in TB and TB patients are not empowered with enough medical information about the disease. They do not even know the names of the drugs they have to eat, they do not know why they have to take them without a break and complete the treatment even though they may start feeling better after sometime. This dis-connect has to break down. There has to be simplification of messages which convey all information about TB. The process has already begun, although slowly. If TB patients realize the gravity of the situation and know that TB can kill and devastate, they will start advocating for their right to access treatment and better drugs. Sickness should not come in the way of becoming an advocate; rather it could be a result of it. In Africa we find more concrete action on TB activism. We have very few activists from India and there should be many more. We need to build a good cadre of informed and trained community advocates.?
Dr Wilson also would like the local population and community to be empowered enough to question the public healthcare provider for laxity in services?non- functioning laboratories, non- availability/absence of staff, shortage of drugs, irresponsible behaviour of health workers. He feels that right now the system puts a barrier on the community in being able to demand what is rightfully and legally theirs? patients cannot question the doctor for not arriving at the clinic on time, although it is their right that the doctor is available during working hours and listens to them and treats them with respect. Dr Wilson avers that, ?It is the people from the community who will have to be the game changers. We have to help people to become empowered and the process has begun through projects like Axshaya. Mass media can also help in improving awareness about TB and other diseases by informing people through television ads and jingles. All this will immediately have a positive effect.?
Dr Kapur too believes in utilizing the untapped potential of community health workers by giving them good training, the right information, proper equipment and enough resources. He rues that, ?We are talking of giving the Akash computer tablets free to school children in India, but if the same resources were used for community health workers, it would be a tremendous asset in terms of the ability to provide interactive education and to record/transfer data and information. It is also about community and people mobilization to understand the role of good governance.?
Let us remember that providing basic health services to the people is not an obligation but a duty on part of the government, and it is the right of people to get it. Communities will have to demand that healthcare systems become accountable to the people for whom they have been created and governments will have to ensure that public policies are implemented honestly at the grassroots level.
?Shobha Shukla ? CNS
?
(The author is the Managing Editor of Citizen News Service (CNS). She is currently providing on-site news coverage from 43rd Union World Conference on Lung Health, with kind support from the Lilly MDR TB Partnership and Global Alliance for TB Drug Development (TB Alliance). She is a J2J Fellow of National Press Foundation (NPF) USA. She received her editing training in Singapore, has worked earlier with State Planning Institute, UP and taught physics at India?s prestigious Loreto Convent. She also authored a book on childhood TB (2012), co-authored a book (translated in three languages) ?Voices from the field on childhood pneumonia? and a report on Hepatitis C and HIV treatment access issues in 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)?
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BEIRUT (AP) ? Lebanon's Hezbollah group would fire thousands of rockets into Israel in any future war and target cities in the country's heartland, the group's leader said Sunday.
Sheik Hassan Nasrallah's warning came days after an eight-day Israeli offensive against Gaza ended with a truce. Nasrallah said Gaza militants had won "a clear victory" against Israel with their rocket bombardment.
Hezbollah, like Hamas and other Gaza militant factions, maintains a rocket arsenal and regularly threatens to use it. It fought an inconclusive 34-day war with the Jewish state in 2006 that left 1,200 Lebanese and 160 Israelis dead.
The Gaza war marked the first use by Palestinian factions of a longer ranged Iranian-made rocket, the Fajr-5. It caused no casualties but did trigger air raid warnings in the heartland cities of Tel Aviv and Jerusalem, which, unlike cities closer to the Lebanese and Gaza borders, have not experienced any sustained missile attack since Iraqi Scuds were fired in the 1991 Gulf War.
Hezbollah fired at least one long-range rocket ineffectually in the 2006 war. But Israeli intelligence now believes the militant group has the capability to strike anywhere in the country, although Israel now deploys air defense systems designed to counter the threat.
In the Gaza conflict, Israeli aircraft launched some 1,500 strikes on targets linked to the Palestinian territory's Hamas rulers and other groups, while Gaza militants fired roughly the same number of rockets into Israel.
Nasrallah said in a speech in Beirut that the Fajr-5 attacks "shook Israel." He asked: "How is it (Israel) going to stand thousands of rockets that will fall on Tel Aviv and other areas if it launches an aggression against Lebanon?"
Nasrallah spoke via a video link from a secret location to tens of thousands of supporters in Beirut who gathered to mark Ashoura, the annual Shiite commemoration of the 7th-century death of Imam Hussein, the Prophet Muhammad's grandson.
Hezbollah fired nearly 4,000 rockets at Israel during the 2006 war and is believed to have upgraded its arsenal since then. Nasrallah did not say how many missiles and rockets his group possesses, although in the past he said they have more than 20,000. Israel estimates the number at several times that.
"The battle with us is going to be all over occupied Palestine," the black-turbaned Nasrallah said. "From the border with Lebanon to the frontier with Jordan to the Red Sea."
"The Israelis should listen well to me. From Kiryat Shemona to Eilat," Nasrallah said referring to a northern Israeli town near the border with Lebanon to the southern resort town of Eilat on the Red Sea.
Since the 2006 war ended, both Israeli and Hezbollah officials have been warning each other that the next battle between the two groups will be more destructive.
Some Israeli generals had spoken of the "Dahiya doctrine," named after the Beirut suburbs considered a Hezbollah stronghold where Israel turned dozens of buildings to piles of debris in 2006.
In August, Nasrallah said Hezbollah will transform the lives of Israelis to "hell" if Israel attacks Lebanon, adding that the group would not hesitate to hit targets that would leave tens of thousands of Israelis dead.
Hezbollah was created in 1982, weeks after Israel invaded Lebanon. Israel withdrew in 2000 to a border drawn by the U.N., but Lebanon says Israel still occupies a slice of its territory.
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CAIRO (AP) ? Gaza's ruling Hamas will not stop arming itself because only a strong arsenal, not negotiations, can extract concessions from Israel, the No. 2 in the Islamic militant group told The Associated Press in an interview Saturday.
The comments by Moussa Abu Marzouk, just three days after the worst bout of Israel-Hamas fighting in four years, signaled trouble ahead for Egyptian-brokered talks between the hostile neighbors on a new border deal.
Hamas demands that Israel and Egypt lift all restrictions on the movement of goods and people in and out of the Palestinian territory, which has been buckling under a border blockade since the Islamists seized the territory in 2007. The restrictions have been eased somewhat in recent years, but not enough to allow Gaza's battered economy to develop.
Israeli officials were not immediately available for comment Saturday, the Jewish Sabbath. However, an Israeli security official said this week that Israel would likely link a significant easing of the blockade to Hamas's willingness to stop smuggling weapons into Gaza and producing them there.
Abu Marzouk said Saturday that the group would not disarm, arguing that recent Palestinian history has shown that negotiations with Israel lead nowhere unless backed by force.
"There is no way to relinquish weapons," Abu Marzouk said in his office on the outskirts of Cairo. "These weapons protected us and there is no way to stop obtaining and manufacturing them."
Hamas' founding charter calls for Israel's destruction, but leaders of the group have also said they are ready for a long-term cease-fire with the Jewish state.
The group is believed to have amassed a large arsenal of thousands of rockets since Israel's last military offensive in Gaza four years ago. Hamas has been smuggling weapons through tunnels under the border with Egypt, but also claims to have begun manufacturing longer-range rockets in Gaza.
During the latest round of fighting, Hamas fired Iranian-made Fajr-5 rockets that came close to Israel's heartland, including the cities of Tel Aviv and Jerusalem for the first time. Israel warplanes pounded the tunnel area during the offensive to disrupt smuggling, and tunnel operators reported serious damage, but in the past were able to rebuild quickly.
Hamas used to be evasive about Iranian weapons support, but in recent days senior officials in the group have openly thanked Tehran. Gaza strongman Mahmoud Zahar told reporters on Saturday that he is confident that Iran will increase military and financial support to Hamas and the smaller militant group Islamic Jihad.
Iran and its regional rivals, the Sunni Muslim-led states in the Gulf, have been competing in recent months to lure Hamas into their respective camps. The top Hamas leader in exile, Khaled Mashaal, is being hosted by the Gulf state of Qatar, which has promised hundreds of millions of dollars for Gaza reconstruction.
Zahar said Saturday that Hamas is not beholden to anyone, but defended the group's ties with Iran. "If they don't like it, let them compete with Iran in giving us weapons and money," he said in an apparent jab at the Gulf states.
Abu Marzouk, meanwhile, said Hamas would not stand in the way of a bid by its main political rival, internationally backed Palestinian President Mahmoud Abbas, to seek U.N. recognition for a state of Palestine next week.
Abbas will ask the U.N. General Assembly to approve "Palestine" ? made up of the West Bank, Gaza and east Jerusalem, areas Israel captured in 1967 ? as a non-member observer state.
Such a state is far from being established, but Palestinians hope U.N. recognition would affirm its future borders, to be used as a baseline once negotiations with Israel resume. Israel, while willing to cede some land, refuses with withdraw to the 1967 lines and opposes Abbas' U.N. move as an attempt to bypass negotiations. Israel has moved half a million Israelis into settlements on war-won land.
Abu Marzouk suggested that Abbas is wasting his time at the U.N. "Hamas believes the General Assembly is not the one to create states," he said. "Occupation needs resistance, not negotiations."
Israel and the West have shunned Hamas, which has killed hundreds of Israelis in shootings and bombings over the years, as a terror organization. However, Hamas officials believe the boycott is slowly eroding, pointing to U.S. support for the cease-fire deal brokered by Egypt and the ongoing indirect negotiations between Israel and Hamas.
Overall, Hamas leaders have claimed the group has emerged victorious from this round, noting that Israel did not make good on threats to send ground troops into Gaza. Israel says it has achieved its goal of halting rocket fire on Israel.
Abu Marzouk said the next round of indirect talks will take place in Cairo on Monday. He has not met his Israeli interlocutors, he said, but said they are security officials and experts on border arrangements.
Until late last year, most top Hamas leaders in exile were based in Syria, the Islamists' main foreign backer in addition to Iran. However, Syrian President Bashar Assad's brutal crackdown on a popular uprising there made Hamas' alliance with the Damascus regime untenable.
Abu Marzouk, who has settled in a quiet Cairo suburb, said the follow-up talks with Israel were going well so far.
In Gaza, residents said Saturday that Israel has already eased some restrictions.
Fishermen were able to sail six nautical miles out to sea, or double the previous limit, said Mahfouz Kabariti, head of the local fishermen's association. "This is an opportunity and a chance for a better catch, though it is still a limited area," said Kabariti, who represents some 3,500 fishermen.
Israeli navy boats have been enforcing a sea blockade in an attempt to prevent weapons smuggling to Gaza. The restrictions on fishermen have fluctuated over the years, linked to the ups and downs in Israeli-Palestinian relations.
Meanwhile, some Gaza residents said they were able to enter an Israeli-enforced buffer zone on the Gaza side of the border Saturday with Israel without fear of being fired on.
Israel's military had carved out a 300-meter-wide (300-yard-wide) zone several years to try to prevent militants from sneaking into Israel. The zone gobbled up scarce farmland in one of the most densely populated areas in the world.
On Saturday, 42-year-old farmer Nidal Abu Dakka said soldiers stood and watched as he and others moved close to the fence. In other border areas, residents said Hamas police kept them away from the fence.
An Israeli government spokesman said he was unaware restrictions had been eased. A defense official said the Israeli military was no longer enforcing the no-go zone, but reserved the right to act against suspicious people. Both spoke on condition of anonymity because they were not allowed to discuss the issue with reporters.
___
El Deeb reported from Gaza City. Associated Press writer Karin Laub in Gaza City contributed reporting.
Source: http://news.yahoo.com/ap-interview-hamas-no-2-rejects-gaza-arms-143906318.html
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Dana P. Goldman is the director of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California. Michael Chernew and Anupam Jena are professors of health care policy at Harvard University.
With the re-election of President Obama, the Affordable Care Act is back on track for being carried out in 2014. Central to its success will be the creation of health-insurance exchanges in each state. Beneficiaries will be able to go a Web site and shop for health insurance, with the government subsidizing the premiums of those whose qualify. By encouraging competition among insurers in an open marketplace, the health care law aims to wring some savings out of the insurance industry to keep premiums affordable.
Certainly, it is hard to be against competition. Economic theory is clear about its indispensable benefits. But not all health care markets are composed of rational, well-informed buyers and sellers engaged in commerce. Some have a limited number of service providers; in others, patients are not well informed about the services they are buying; and in still others, the quality of the service offerings vary from provider to provider. So the question is: What effect does insurer competition have in a marketplace with so many imperfections?
The evidence is mixed, but some of it points to a counterintuitive result: more competition among insurers may lead to higher reimbursements and health care spending, particularly when the provider market ? physicians, hospitals, pharmaceuticals and medical device suppliers ? is not very competitive.
In imperfect health care markets, competition can be counterproductive. The larger an insurer?s share of the market, the more aggressively it can negotiate prices with providers, hospitals and drug manufacturers. Smaller hospitals and provider groups, known as ?price takers? by economists, either accept the big insurer?s reimbursement rates or forgo the opportunity to offer competing services. The monopsony power of a single or a few large insurers can thus lead to lower prices. For example, Glenn Melnick and Vivian Wu have shown that hospital prices in markets with the most powerful insurers are 12 percent lower than in more competitive insurance markets.
So health insurance exchanges are probably welcome news for hospitals, physicians, and pharmaceutical and medical device companies throughout the United States. If health insurance exchanges divide up the market among many insurers, thereby diluting their power, reimbursement rates may actually increase, which could lead to higher premiums for consumers.
Ultimately, economic theory predicts that the effect of insurance exchanges on insurance premiums will depend on two offsetting factors. On one hand, smaller, less-consolidated insurance companies may have less bargaining power with large hospitals, physician groups and pharmaceutical companies, which traditionally command substantial market power. Reimbursements to these parties, as well as costs to insurers, may rise in a fractionated market, and if so, these costs would be passed on to consumers as higher premiums. On the other hand, exchanges may inject competition into the marketplace, reducing premiums as even the smallest insurer can market its plans, forcing larger insurers to lower their premiums to remain competitive. Which theoretical effect will dominate in reality is an open empirical question with important policy implications.
There is some evidence on how insurer market power affects premiums. Leemore Dafny, Mark Duggan, and Subramaniam Ramanarayanan have found that greater concentration resulting from an insurance merger is associated with a modest increase in premiums ? suggesting that concentration may not help consumers so much ? although they did report a reduction in physician earnings on average. Over all, however, the evidence is limited and mixed.
A simple analysis of the nationwide growth in premiums over the last decade is illustrative. Using 2001-10 data from the National Association of Insurance Commissioners, we examined the relationship between insurer market power (defined as the market share of the two largest companies) and changes in premiums. We found that concentration of insurer power ? hence less competition ? was not significantly associated with higher premiums, as can be seen in the chart below.
Hawaii is a good example. Kaiser Permanente and Blue Cross Blue Shield together controlled more than 90 percent of the insurance market in 2001. In this highly concentrated market, the average premium rose only 72 percent over the decade, compared to an overall increase of 135 percent nationwide. By contrast, Virginia had one of the most competitive markets in 2001, with its two largest insurers controlling only 25 percent of the market, yet premiums in the state increased nearly 140 percent over the period.
Greater competition in the insurance industry ? either through health insurance exchanges or other measures ? may not lower insurance premiums. Weakening insurers? bargaining power could instead translate into higher costs for all of us in the form of higher premiums.
In financial markets, we ask if banks are too big to fail. When it comes to health care, perhaps we should ask if insurers are too small to succeed.
Source: http://economix.blogs.nytimes.com/2012/11/23/health-insurance-exchanges-may-be-too-small-to-succeed/
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