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Electronic identification services (eIDs) have become strategic services in the global governance of online societies. In this article, we argue that eIDs are sociotechnical constructs that also have political-economic dimensions. In the European context, governmental and corporate efforts to develop eIDs are shaped by legal EU frameworks, which are almost exclusively focussed on technical and legal interoperability, such as the European Interoperability Framework (EIF) and the European Interoperability Reference Architecture (EIRA). Public concerns such as privacy, security, user empowerment and control over one's personal information prompts developers to propose a decentralized, attribute-based system governed on a nonprofit, nonstate basis (DAN-eID). To illustrate our argument, we explore a single emerging eID system (IRMA; acronym for I Reveal My Attributes) that is developing in a national context (The Netherlands). We argue that developing eIDs requires more than engineering ingenuity and legal compliance; as sociotechnical and political-economic constructs, they involve negotiation of conflicting social and political values.

The Government of Lao Peoples' Democratic Republic (Lao PDR) has embarked on a path to achieve universal health coverage (UHC) through implementation of four risk-protection schemes. One of these schemes is community-based health insurance (CBHI) – a voluntary scheme that targets roughly half the population. However, after 12 years of implementation, coverage through CBHI remains very low. Increasing coverage of the scheme would require expansion to households in both villages where CBHI is currently operating, and new geographic areas. In this study we explore the prospects of both types of expansion by examining household and district level data.

Abstract Background The Government of Lao Peoples' Democratic Republic (Lao PDR) has embarked on a path to achieve universal health coverage (UHC) through implementation of four risk-protection schemes. One of these schemes is community-based health insurance (CBHI) – a voluntary scheme that targets roughly half the population. However, after 12 years of implementation, coverage through CBHI remains very low. Increasing coverage of the scheme would require expansion to households in both villages where CBHI is currently operating, and new geographic areas. In this study we explore the prospects of both types of expansion by examining household and district level data. Methods Using a household survey based on a case-comparison design of 3000 households, we examine the determinants of enrolment at the household level in areas where the scheme is currently operating. We model the determinants of enrolment using a probit model and predicted probabilities. Findings from focus group discussions are used to explain the quantitative findings. To examine the prospects for geographic scale-up, we use secondary data to compare characteristics of districts with and without insurance, using a combination of univariate and multivariate analyses. The multivariate analysis is a probit model, which models the factors associated with roll-out of CBHI to the districts. Results The household findings show that enrolment is concentrated among the better off and that adverse selection is present in the scheme. The district level findings show that to date, the scheme has been implemented in the most affluent areas, in closest proximity to the district hospitals, and in areas where quality of care is relatively good. Conclusions The household-level findings indicate that the scheme suffers from poor risk-pooling, which threatens financial sustainability. The district-level findings call into question whether or not the Government of Laos can successfully expand to more remote, less affluent districts, with lower population density. We discuss the policy implications of the findings and specifically address whether CBHI can serve as a foundation for a national scheme, while exploring alternative approaches to reaching the informal sector in Laos and other countries attempting to achieve UHC.

Avoidance behaviors are central to the anxiety disorders and implicated in many other forms of psychopathology, but the reinforcing mechanism of avoidance remains largely elusive. It has been suggested that subjective relief during successful omission of threat may serve as a reinforcer and contribute to the development of excessive avoidance. Also, relatively little is known about how avoidance behaviors generalize and what the role is of relief in generalization. The purpose of this experiment was three-fold: (1) to investigate the influence of anxiety-traits on the dynamics of relief during avoidance learning, (2) to characterize the dynamics of relief during avoidance generalization, and (3) to investigate the generalization of avoidance behavior over a dimension of avoidability. In a large sample of 101 participants, two lamp colors (CS +) were first associated with an aversive electrical stimulation (US), while a third color was not (CS-). Next, clicking a button during one CS + could effectively avoid the US (CS + av), but not during the other (CS + unav). Finally, avoidance generalization was tested via button clicks during morphed colors between CS + av and CS + unav (avoidability dimension), and to morphed colors between CS + av and CS- (safety dimension). Throughout the experiment, a relief rating scale appeared whenever a lamp color was not followed by the US. Results revealed that anxiety traits (distress tolerance and intolerance of uncertainty) were associated with higher levels of avoidance and subjective relief. In addition, gradients of avoidance generalization and relief were observed over dimensions of avoidability (CS + av -> CS + unav) and safety (CS + av -> CS-). Together, these results suggest a role for excessive relief in the development and generalization of maladaptive avoidance. ; National PhD Scholarship (Chile) - CONICYT's Advanced Human Capital Training Program (CONICYT-PCHA/Doctorado Nacional) 2015-21150074 European Union (EU) PIOF-GA-2013-627743

The Government of Cambodia recently launched its National Social Protection Policy Framework to strengthen and expand its social protection system. To inform the future direction of social health protection policy in Cambodia we examine the 2016 Cambodia Socio-economic survey to assess the current coverage potential of existing health insurance schemes and coverage gaps; and, compare fair and equitable contribution rates. The current health coverage expansion efforts are likely to primarily benefit individuals from higher income households. In addition, recent directives to expand coverage to some informal workers leaves significant gaps, particularly among vulnerable groups, farmers, and the self-employed. The average out-of-pocket health care costs exceed capacity to pay among individuals in the lower wealth quintiles. Thus, we conclude they should be considered financially vulnerable.Finally, we illustrate that a fair and equitable approach to individual, monthly healthcare contributions will yield low premium rates and collection costs could exceed the amount collected, particularly among the informal sector. Therefore, we recommend that, in addition to other vulnerable groups and uncovered households in the first wealth quintile, people second and third quintiles who are not formally employed, should be exempted from premium payments as social health protection is expanded.

The Government of Cambodia recently launched its National Social Protection Policy Framework to strengthen and expand its social protection system. To inform the future direction of social health protection policy in Cambodia we examine the 2016 Cambodia Socio-economic survey to assess the current coverage potential of existing health insurance schemes and coverage gaps; and, compare fair and equitable contribution rates. The current health coverage expansion efforts are likely to primarily benefit individuals from higher income households. In addition, recent directives to expand coverage to some informal workers leaves significant gaps, particularly among vulnerable groups, farmers, and the self-employed. The average out-of-pocket health care costs exceed capacity to pay among individuals in the lower wealth quintiles. Thus, we conclude they should be considered financially vulnerable.Finally, we illustrate that a fair and equitable approach to individual, monthly healthcare contributions will yield low premium rates and collection costs could exceed the amount collected, particularly among the informal sector. Therefore, we recommend that, in addition to other vulnerable groups and uncovered households in the first wealth quintile, people second and third quintiles who are not formally employed, should be exempted from premium payments as social health protection is expanded.

In the early months of 2020, the deadly Covid-19 disease spread rapidly around the world. In response, national and regional governments implemented a range of emergency lockdown measures, curtailing citizens' movements and greatly limiting economic activity. More recently, as restrictions begin to be loosened or lifted entirely, the use of so-called contact tracing apps has figured prominently in many jurisdictions' plans to reopen society. Critics have questioned the utility of such technologies on a number of fronts, both practical and ethical. However, little has been said about the ways in which the normative design choices of app developers, and the products that result therefrom, might contribute to ethical reflection and wider political debate. Drawing from scholarship in critical design and human–computer interaction, this paper examines the development of a QR code-based tracking app called Zwaai ('Wave' in Dutch), where its designers explicitly positioned the app as an alternative to the predominant Bluetooth and GPS-based approaches. Through analyzing these designers' choices, this paper argues that QR code infrastructures can work to surface a set of ethical–political seams, two of which are discussed here—responsibilization and networked (im)permanence—that more 'seamless' protocols like Bluetooth actively aim to bypass, and which may go otherwise unnoticed by existing ethical frameworks.

Cambodia's healthcare system has seen significant improvements in the last two decades. Despite this, access to quality care remains problematic, particularly for poor rural Cambodians. The government has committed to universal health coverage (UHC) and is reforming the health financing system to align with this goal. The extent to which the reforms have impacted the poor is not always clear. Using a system-wide approach, this study assesses how benefits from healthcare spending are distributed across socioeconomic groups in Cambodia. Benefit incidence analysis was employed to assess the distribution of benefits from health spending. Primary data on the use of health services and the costs associated with it were collected through a nationally representative cross-sectional survey of 5000 households. Secondary data from the 2012-14 Cambodia National Health Accounts and other official documents were used to estimate the unit costs of services. The results indicate that benefits from health spending at the primary care level in the public sector are distributed in favour of the poor, with about 32% of health centre benefits going to the poorest population quintile. Public hospital outpatient benefits are quite evenly distributed across all wealth quintiles, although the concentration index of -0.058 suggests a moderately pro-poor distribution. Benefits for public hospital inpatient care are substantially pro-poor. The private sector was significantly skewed towards the richest quintile. Relative to health need, the distribution of total benefits in the public sector is pro-poor while the private sector is relatively pro-rich. Looking across the entire health system, health financing in Cambodia appears to benefit the poor more than the rich but a significant proportion of spending remains in the private sector which is largely pro-rich. There is the need for some government regulation of the private sector if Cambodia is to achieve its UHC goals.

AbstractIntroductionThe number of individuals initiating antiretroviral pre‐exposure prophylaxis (PrEP) is increasing, but we do not fully understand who is coming forward for PrEP, how they use it and how they are followed‐up. The objective of this study was to examine PrEP user profiles, dynamics in PrEP use and follow‐up over time.MethodsWe conducted a cohort analysis of longitudinally collected clinical record and questionnaire data among PrEP users at an HIV centre in Antwerp, Belgium, between June 2017 and March 2020. PrEP follow‐up and user profiles were examined using descriptive analyses and bivariate logistic regression. We compared early adopting PrEP users (started before June 2018) with late users. We also calculated the probabilities of switching between daily and on‐demand PrEP, and interruption, using a naïve estimator.Results and discussionWe included 1347 PrEP users in the analysis. After 12 months, retention in care was 72.3%. Median time between PrEP visits was 98 days (IQR 85–119 days). At screening visit, early adopting PrEP users (starting June 2017–May 2018) were significantly more likely to report one or more sexually transmitted infection in the prior 12 months, having used drugs during sex, a higher number of sexual partners and a history of paid sex and PrEP use prior to initiation, compared with PrEP users who initiated later (starting June 2018–February 2020). When taking PrEP daily, the probability of staying on daily PrEP at the next visit was 76%, while this was 73% when taking PrEP on‐demand. Those using on‐demand PrEP had a higher probability (13%) of interrupting PrEP care than daily PrEP users (7%), whereas those returning to PrEP care would mostly re‐start with on‐demand (35% vs. 13% for daily).ConclusionsThe majority of PrEP users in this sample remained in care after 12 months. The probability of remaining on the same PrEP regimen at the subsequent visit was high. Though, we observed a diversity of transitions between regimens and interruptions in between visits. Our findings reaffirm the need to provide tailored PrEP services, counselling PrEP users across their life course.