Browsing by Subject "Southeast Asia"
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Item Open Access A Southeast Asian collaborative Delphi consensus on surveying risk factors for head and neck cancer screening and prevention.(Global surgery (London), 2022-01) Pan, DR; Juhlin, E; Tran, AN; Wei, Q; Tang, S; Bui, AT; Iyer, NG; Lee, WTThe objective of this study was to determine high value questions for early detection and prevention of head and neck cancer by querying content experts on patient risk factors relevant to local communities in Southeast Asia (i.e., Vietnam, Laos, China, and Singapore). The Delphi method was employed using three rounds of asynchronous surveying which included participants among five different collaborating medical centers. 60 total survey items were assessed for consensus defined by a priori measures on the relative level of value of these questions for use in head and neck cancer screening. 77% of items reached a consensus and no items were concluded to be of low value despite differences in conclusions regarding relative importance. Survey items focused on patient demographic information and physical examination were examined across variables such as expert department affiliation, academic designation, and years of experience and found to be without statistically significant differences. However, with consensus items related to social risk factors, it was determined that participants who had 15 or more years of experience or identified as otolaryngologists rated these items at a relatively lower value than their peers with less experience (p < 0.0001, p = 0.0017) or outside the field of otolaryngology (p = 0.0101). This study explicitly identifies patient variables to consider in head and neck cancer screening that have not previously been comprehensively or methodically assessed in current literature. Increasing awareness of these risk factors may benefit the design and implementation of future head and neck cancer early detection and prevention programs in Southeast Asia and beyond as well as positively impact head and neck cancer outcomes.Item Open Access Equity in access to healthcare in Brunei Darussalam: Results from the Brunei Darussalam Health System Survey (HSS)(2014) Tant, Elizabeth MichelleBackground: Universal healthcare has been promoted by organizations including the World Health Organization and United Nations as a means of ensuring healthcare access for vulnerable populations. Despite momentum towards universal healthcare, especially among Southeast Asian nations, little research has been conducted to understand healthcare equity in nations that have already implemented universal healthcare. This paper assesses equity in healthcare access in Brunei Darussalam using results from the Brunei Darussalam Health System Survey (HSS).
Methods: Data were gathered using a nationally-representative survey of 1,197 households across four districts in Brunei Darussalam. The Health System Survey aimed to measure individual's expectations and utilization of the Brunei national healthcare system. Data were analyzed using descriptive statistics and multinomial logistic regression to identify respondent- and household-level characteristics that affect healthcare utilization and expenditures.
Results: HSS data suggest that healthcare utilization in Brunei varies by ethnicity, district of residence, health status, and income. When compared to other ethnic groups, Chinese households were significantly less likely to utilize public healthcare and significantly more likely to utilize private healthcare services. Indigenous groups also demonstrated significantly lower rates of private healthcare utilization compared to other ethnicities. Temburong district had the lowest rates of both private and public healthcare utilization and was associated with a 2.67 decreased likelihood of using public healthcare in the past six months. When stratifying for health status, data indicate that healthcare utilization in Brunei is proportional to healthcare need, with 93 percent of respondents in poor health reporting using government hospitals 12 or more times in the past six months compared to 76 percent of respondents in excellent health reporting using healthcare only once in the past six months. Income was also found to be positively associated with increased healthcare expenditures and private healthcare use.
Conclusion: This study highlights an example of a universal healthcare system in Southeast Asia and indicates that a well-funded universal healthcare system can reduce significant utilization disparities. Substantial financial resources do not, however, guarantee equity among rural and minority populations and universal healthcare efforts should incorporate measures to understand and address barriers to healthcare among these groups.
Item Open Access Traditional Institutions and the Political Economy of the Philippines(2020) Dulay, Dean Gerard CThis dissertation is comprised of three essays on the political economy of the Philippines. It combines a variety of methods---historical and qualitative analysis, interviews, and statistical analysis---to examine various aspects of the interaction of politics and economics in the country. The first chapter examines the relationship between horizontal political dynasties and economic outcomes. I argue that horizontal dynasties---more than one member of a political family holding office simultaneously---allow members of the dynasties to coordinate over policy by circumventing veto points in the policy processes. This leads to higher spending on public goods. I further show that this increase in spending is not associated with improved development, suggesting that the increased spending is used inefficiently. The second chapter examines the interaction of rank and gender norms in dynastic politics. I argue that male candidates are more likely to replace higher ranking female, candidates, but the inverse is not true. This rationalizes existing strategies by dynasties such as benchwarming. The third chapter argues for the positive long-run effect of the colonial Catholic mission. Municipalities that had a colonial mission are more developed and have higher levels of state capacity today. This is because missions functioned as de facto states and vehicles for the establishment of local government. This chapter emphasizes that missions were not merely religious or educational institutions but vehicles for governance.