Background The use of vaccines is among the most cost-effective tools for preventing infectious diseases and their complications. However, poor uptake and increasing exemption to routine childhood vaccination have been linked with outbreaks of infectious diseases such as measles, pertussis, and more recently poliomyelitis in the US. The objective of the study is to determine the prevalence, pattern, and predisposing factors of vaccine exemptions to childhood immunization amongst parents of children in the Northeast Region from 2017 to 2021. Methods The routine immunization data of children between 1-24 months in the Northeast region, Tennessee from 2017- 2021 was extracted. Based on the population of children within the birth cohort, a random sample of children was selected from birth certificates of children born in the first three months of 2 years prior in Tennessee’s eight counties in the Northeast region. Descriptive statistics with trends, Chi-square, and logistic regression were conducted to delineate factors associated with vaccine exemption in the region. Result The prevalence of vaccine exemption was 2% on average, but the vaccine exemption rate increased significantly from 1.5% in 2019 (pre-COVID pandemic) to 2.5% in 2020 (peri-COVID period). However, the mother’s level of education (aOR=2.37; CI=0.55-10.17), mother’s age (aOR=0.59; CI=0.14-2.51), TennCare attendance (aOR=0.57; CI=0.15-2.21) do not show statistically significant association with exemption to childhood vaccination in Northeast region in Tennessee. Conclusion There appears to be an increasing trend in the vaccine exemption to routine childhood immunizations in the Northeast region of Tennessee over the years. However, the impact of other factors associated with exemptions to childhood vaccinations needs further research.

No description available.

In 2012, 48,277 cases of pertussis were diagnosed in the United States. Pertussis, otherwise known as whooping cough, is a highly contagious, often debilitating, sometimes deadly, vaccine-preventable disease with an increasing incidence and death rate in the U.S, which may be due to vaccine exemptions. The purpose of this project was to determine if a relationship exists between immunization policies and immunization exemption rates, immunization exemption rates and pertussis rates, and immunization policies and pertussis rates in each state. Bronfenbrenner's bio-ecological framework was used to guide the project. Publically available data from the Centers for Disease Control and Prevention (CDC), schools of public health, state health departments, and public health officials were retrieved for this cross-sectional, ecological comparison study. Spearman's r product-moment correlation coefficient was used to investigate the relationship between the variables. States with lenient vaccine laws had higher exemption rates (r = .359, p < .01), and states with higher exemption rates had higher pertussis rates (r = .470, p < .01). Finally, states with lenient vaccine laws had higher pertussis rates (r = .111, p = 0.439). This project should be added to the literature used to inform and educate the public as well as influence policy makers. As a result of this study, arguments for eliminating non-medical vaccine exemptions should be strengthened. As policies are changed, social change should follow in the form of decreased immunization exemption rates and decreased pertussis rates.

L’amélioration de l’accès aux soins de santé de la population est aujourd’hui au coeur des politiques de réduction de la pauvreté. Dans ce contexte, de plus en plus de pays en Afrique subsaharienne (ASS) adoptent des politiques de suppression des paiements directs des soins au point de service. Ces politiques ont pour objectifs d’augmenter la demande de soins en levant une partie de la barrière financière à l’accès aux soins et diminuer le fardeau financier de la maladie qui contribue aux dépenses catastrophiques. Avec l’urbanisation massive constatée dans le monde et en particulier dans les pays d’ASS, la prise en charge de la santé de la population en milieu péri-urbain est devenue plus complexe. L’augmentation de la charge de morbidité lié aux maladies chroniques, plus celle des maladies transmissibles toujours importante, rend plus difficile la maîtrise de la situation sanitaire de ces pays. Les enjeux posés par ces changement sont conduit à un regain d’intérêt sur les questions d’accès aux soins et de dépenses de santé des ménages en milieu urbain.Cette thèse, à partir de données recueillies sur le terrain, s’intéresse à la demande de soins et aux dépenses de santé des individus en milieu péri-urbain. Le chapitre I est consacré à la présentation du cadre théorique de l’analyse de la demande de soins et des spécificités de ce marché et à la présentation du Sénégal. Le chapitre II présente la méthodologie de recueil de données et une analyse détaillée des types de maladie identifiés, l’itinéraire thérapeutique des malades et leurs dépenses de soins. Le chapitre III porte sur l’analyse du comportement de la demande de soins lié aux symptômes aigus déclarés par les individus. L’analyse est effectuée à partir de l’estimation d’un probit multinomial. Le chapitre IV analyse les déterminants des dépenses de santé des individus avec un modèle de Heckman. / Improving population’s access to health care services stands among the utmost priorities in the’agenda of alleviating poverty in Africa. Recently, many policymakers in sub Saharan African countries have tried to remove users fees at the point of service This policy aims at easing the financial burden of out of pocket paiements in an episode of illness,which can be catastrophic,hence boosting the demand for healthcare services. Delivering adequate healthcare services in urban suburbs has become increasingly difficult with the massive urbanization trend, particularlyin Sub Saharan Africa. In addition, difficulties in improving health conditions are intensified by the rise in the morbidity, due to chronic and communicable diseases. Combined together, these phenomenons have brought to the forefront the relevance of the issues relative to healthcare delivery, access and financing in urban areas.Building upon survey data, this thesis focuses on individual’s demand of healthcare services and their corresponding health expenditure in urban suburbs of Senegal. Chapter I lays the theoretical foundations of healthcare services demand and its specific features; and presents the Senegalese context. The methodology relative to data collection and data analysis, including the identified diseases, their course of treatment and the associated health expenditures are detailed in Chapter II. Using a multinomial probit model, Chapter III analyzes the demand of healthcare services resulting from individual’s statement of acute symptoms. Finally, Chapter IV assesses the determinants of health expenditure, using the Heckman model.

Problématique : Dans les pays africains où les soins de santé sont encore payants au point de service, la barrière financière est un des obstacles majeurs au recours aux soins. Les indigents, qui sont les plus démunis, en sont les plus affectés. Pour faire face à ce défi, certains pays ont entrepris l’élaboration de programmes de santé ciblant les indigents pour leur permettre d’avoir un meilleur recours aux soins de santé par l’intermédiaire d’une exemption du paiement. Mais il existe un réel défi à identifier les indigents. De plus, peu d’études ont évalué l’impact de programmes d’exemption du paiement sur leur recours aux soins. Les indigents sont en majorité des personnes âgées avec des besoins importants en santé. Les personnes âgées en Afrique consultent très peu les professionnels de santé et les déterminants de leur recours aux soins sont peu connus. Pourtant, leur proportion est en augmentation dans les pays à faibles et moyens revenus. Ils sont en perte d’autonomie, ont de faibles revenus et présentent une prévalence élevée de maladies chroniques et d’incapacités fonctionnelles. Ces affections surviennent de façon précoce surtout chez les femmes. Objectifs : Cette thèse a pour objectifs : i) de déterminer le caractère équitable d’un processus de sélection communautaire des indigents au Burkina Faso qui vise à les faire bénéficier d’une exemption du paiement des soins; ii) de mesurer l’impact de ce programme d’exemption sur le recours aux soins de santé des indigents ; iii) d’analyser les facteurs associés au recours aux soins de santé par les personnes âgées au Nigéria. Méthode : Le cadre conceptuel de cette étude est le modèle d’Andersen et Newman qui regroupe les déterminants de l’utilisation des soins de santé en facteurs prédisposants (âge, sexe, état matrimonial, occupation), en facteurs facilitants (revenu, existence d’un recours à une aide financière, alimentaire ou instrumentale, cohabitation) et en besoins (présence de maladies chroniques et de limites de la vision, de la force musculaire et de la mobilité). Dans un premier temps, pour déterminer le caractère équitable d’une sélection communautaire des indigents, nous avons réalisé une étude transversale en 2010 dans le district de Ouargaye au Burkina Faso. Au cours de cette enquête, 1687 indigents ont été interrogés. La variable dépendante est la possession de la carte d’exemption du paiement des soins. Des analyses bivariées et une régression logistique ont été réalisées. Dans un deuxième temps, à partir d’un devis quasi expérimental pré/post, nous avons évalué les effets de ce programme d’exemption du paiement des soins sur le recours aux soins de santé des personnes en situation d’indigence au Burkina Faso. Au cours de cette recherche, 1224 indigents ont été interrogés en 2010 sur leur recours aux soins de santé. Parmi eux, 540 ont été sélectionnés et ont reçu une carte d’exemption du paiement des soins. Un an plus tard, un suivi a été réalisé avec un taux de rétention de 55,3%. Des analyses bivariées et une régression logistique ont été réalisées. Dans un troisième temps, à partir des données d’une étude transversale nationale, le General Household Survey de 2012-2013 du Nigéria qui couvre toutes les régions du pays, nous avons étudié le recours aux soins de 3587 personnes âgées dont 850 ont déclaré avoir été malades. Nous avons tenté d’identifier les facteurs qui y sont associés. Des analyses pondérées bivariées et une regression de Poisson pondérée ont été effectuées. Résultats : Au Burkina Faso, l’exemption du paiement des soins a été accordée en majorité aux veufs (ves) (OR=1,40 IC 95% [1,10-1,78]), à ceux qui ne bénéficient pas d’aide financière de leur ménage pour recourir aux soins de santé (OR=1,58 IC 95% [1,26-1,97], qui vivent seuls (OR=1,28 IC 95% [1,01-1,63]), qui vivent avec leurs époux/se (OR=2,00 IC 95% [1,35-2,96], qui ont des troubles de la vision (OR=1,45 IC 95% [1,14-1,84]), qui ont une faible force musculaire et une bonne mobilité (OR=1,73 IC 95% [1,28-2,33]). Le processus de sélection communautaire des indigents n’est pas parfaitement équitable, car très restrictif, bien qu’il ait permis de sélectionner les plus démunis. Il existe des différences de genre concernant les déterminants du recours aux soins chez les indigents. Être veufs (OR=0,53 IC 95% [0,33-0,81]) et avoir des troubles de la vision (OR=0,42 IC 95% [0,28-0,63]) freinent le recours aux soins chez les hommes, mais pas chez les femmes. Les maladies chroniques demeurent un obstacle commun aux hommes (OR=4,05 IC 95% [2,84-5,77]) et aux femmes (OR=2,14 IC 95% [1,54 – 2,97]). Le fait d’être exempté du paiement des soins n’est pas associé à l’augmentation de l’utilisation des services de santé (OR=1,1 IC 95% [0,80-1,51]). Qu’ils aient bénéficié ou pas de l’exemption du paiement des soins, les indigents qui ont un âge supérieur à 69 ans (OR=1,66 IC 95% [1,05-2,64]), qui appartiennent au genre masculin (OR=1,44 IC 95% [0,99-2,08]), qui appartiennent à un ménage à faible revenu (OR=1,71 IC 95% [1,15-2,54]) et ceux qui ont recours à l’aide financière familiale pour accéder aux soins de santé (OR=1,59 IC 95% [1,1-2,28]), sont les plus susceptibles d’augmenter leur utilisation des soins de santé. Au Nigéria, seulement 53% des personnes âgées ont consulté un agent de santé suite à un épisode de maladie. L’absence de scolarisation (PR = 0.73, 95% CI [0.6 0–0.8]), la faiblesse du revenu de ménage (PR = 0.75, 95% CI [0.5–0.9]), et le fait de résider dans les zones du Sud-Sud (PR = 0.59 95% CI [0.4–0.7]) et du Sud-Ouest (PR = 0.60 95% CI [0.4–0.7]), constituent des freins à la consultation d’un agent de santé. Conclusion La sélection communautaire est une des méthodes qui semble avoir permis de sélectionner les indigents avec une prévalence élevée de besoins en santé et d’obstacles économiques au recours aux soins. Cependant, l’exemption du paiement des soins n’est pas suffisante pour améliorer leur recours aux soins. Les déterminants de leur recours aux soins différent selon le genre, mais les maladies chroniques constituent un motif commun. Les personnes âgées et les indigents ont des caractéristiques communes telles que l’âge avancé, mais certains facteurs qui déterminent leurs recours aux soins diffèrent. Le déterminant commun est le facteur financier, soit la capacité contributive de ces personnes dans un contexte où l’utilisateur des services de santé est le payeur. En attendant la couverture universelle de soins, il serait approprié que les interventions pour améliorer le recours aux soins ciblent en premier lieu les populations ayant des besoins importants telles que les indigents et les personnes âgées en ôtant la barrière financière. Pour les indigents par contre, il faudrait y ajouter des mesures additionnelles comme, par exemple l’accompagnement, le transport et les frais d’hébergement. Enfin, les interventions doivent aussi considérer les différences de genre qui existent dans les facteurs qui déterminent leur recours aux soins. / Problem In African countries with point-of-service healthcare user fees, financial barriers are one of the major obstacles to healthcare-seeking behaviour, and the indigent, the poorest members of society, are the most affected. To address this issue, some countries have begun developing health programs targeting indigent people to help them gain better access to healthcare by waiving healthcare fees. Unfortunately, it is a genuine challenge to identify those who are indigent. In addition, few studies have assessed the impact of user fees exemption programs on healthcare-seeking behaviour. The majority of indigent people are older with significant health needs. Older people in Africa do not often consult health professionals. The determinants regarding healthcare-seeking behaviour by older people is little-known, although proportionately, their numbers are increasing in low- and middle- income countries. They are losing their autonomy, have little income and have a high prevalence of chronic diseases and functional disabilities. These problems occur early on, especially among women. Objectives The objectives of this thesis are as follows: (i) to determine the equitable nature of a community-based selection process for indigent people in Burkina Faso that aims to exempt them from paying healthcare user fees; (ii) to measure the impact of this user fees exemption program on healthcare-seeking behaviour among indigent people; (iii) to analyze the factors associated with healthcare-seeking behaviour by older people in Nigeria. Method The conceptual framework of this study is based on the model developed by Andersen and Newman, which groups healthcare use determinants into predisposing factors (age, gender, marital status, occupation), enabling factors (income, means and know-how to access financial, food or instrumental assistance, social relationships), and needs (presence of chronic disease and vision, muscle strength and mobility limitations). To determine the equitable nature of a community-based selection of indigent people, we carried out a cross-sectional study in 2010 in the Ouargaye District of Burkina Faso, in which 1687 indigent people were interviewed. The dependent variable was possession of an exemption card. Bivariate analyses and logistic regression were performed. Next, using a quasi-experimental before/after approach, we assessed the effects of this user fees exemption program on healthcare-seeking behaviour by indigent people in Burkina Faso. To that end, 1224 indigent people were interviewed in 2010 about their healthcare-seeking behaviour. Among them, 540 were selected and received an exemption card. One year later, a follow-up was conducted, with a 55.3% retention rate. Bivariate analyses and logistic regression were performed. Finally, using data from a national cross-sectional study, the Nigerian 2012–2013 General Household Survey, which covers all the country’s regions, we studied healthcare-seeking behaviour by 3587 older people, of whom 850 stated that they were ill. We attempted to identify the associated factors. Weighted bivariate analyses and a weighted Poisson regression were performed. Results In Burkina Faso, healthcare payment waivers were mainly granted to widows or widowers (OR=1.40 IC 95% [1.10–1.78]), to those who do not receive financial support from their household for healthcare (OR=1.58 IC 95% [1.26–1.97], or those who live alone (OR=1.28 IC 95% [1.01–1.63]), or with their spouse (OR=2.00 IC 95% [1.35-2.96], who have vision impairment (OR=1.45 IC 95% [1.14–1.84]), who have limited muscle strength and good mobility (OR=1.73 IC 95% [1.28–2.33]). The community-based selection process of indigent people is not completely equitable, although it did enable the most needy to be selected. There are gender differences concerning healthcare-seeking behaviour determinants among indigent people. Being a widower (OR=0.53 IC 95% [0.33–0.81]), and having vision impairment (OR=0.42 IC 95% [0.28–0.63]) were factors limiting healthcare-seeking behaviour among men but not among women. Chronic diseases remain a common obstacle among men (OR=4.05 IC 95% [2.84–5.77]) and women (OR=2.14 IC 95% [1.54–2.97]). User fees exemption is not associated with an increased use of healthcare services (OR=1.1 IC 95% [0.80–1.51]). Whether they received or did not receive exemption cards, indigent people over the age of 69 (OR=1.66 IC 95% [1.05–2.64]), who were male (OR=1.44 IC 95% [0.99–2.08]), who belong to a low-income household (OR=1.71 IC 95% [1.15–2.54]), and those who had financial assistance from family to access healthcare (OR=1.59 IC 95% [1.1–2.28]), are more likely to increase their use of healthcare. In Nigeria, only 53% of older people consulted a health practitioner after an episode of illness. Lack of education (PR = 0.73, 95% CI [0.60–0.8]), low household income (PR = 0.75, 95% CI [0.5–0.9]), and residence in Nigeria’s South South (PR = 0.59 95% CI [0.4–0.7]) and South West zones (PR = 0.60 95% CI [0.4–0.7]) constituted limitations to consulting a health practitioner. Conclusion Community-based selection is one method that appears to have made it possible to select indigent people with a high prevalence of health needs and obstacles to seeking healthcare. Healthcare payment waivers are not sufficient to increase their healthcare-seeking behaviour. Healthcare use determinants differ according to gender, but chronic disease constitutes a common theme. Elderly and indigent people have common characteristics, such as advanced age, but some factors that determine their healthcare-seeking behaviour differ. The common determinant is the financial factor, i.e., the contributory capacity of these people in a context where the user pays. Until there is universal healthcare coverage, it would be appropriate to ensure that activities to improve healthcare-seeking behaviour primarily target populations with significant needs, such as indigent and elderly people, by removing financial barriers. For indigent people, however, additional measures must be included, such as accompaniment, transportation and accommodation expenses. And activities must also take existing gender differences into account among the factors determining their healthcare-seeking behaviour.

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The primary objective of this dissertation was to identify and estimate the relative importance of factors used by the Tax Court in deciding hobby loss cases. This was accomplished in two steps. The first step was to review the Treasury Regulations, cases and literature pertaining to hobby losses to determine the relevant factors used by the Court in deciding this issue. The second step involved using probit analysis to identify which of these factors actually influenced the Court in deciding hobby loss cases and to determine the relative importance of the factors. A secondary purpose was to to explore the probit model's ability to predict decisions likely to be appealed. The probit model was based on the analysis of 219 post-1954 Tax Court cases involving determination of whether activities were or were not engaged in for profit. By application of log-likelihood techniques, it was determined that the model developed was stable over time and across lines of "business," the implication being that cases decided both before and after the passage of Section 183 and involving all types of activity should have precedential value in conflicts between taxpayers and the Internal Revenue Service. Five factors were found to be significant predictors: manner of operation, level of expertise, time expended, history of income and loss, and presence of elements of personal pleasure. It is important to note that the two factors not susceptible to tax planning--success in other activities and financial status of the taxpayer--were insignificant discriminators between business and hobby outcomes. The implication is that with careful tax planning, one can organize and operate a given activity so that it is likely to receive favorable tax treatment. The probit model proved to be unable to predict decisions likely to be appealed. The probability that a particular case would be classified by the Court as a business did not appear to be a significant predictor of whether a taxpayer would appeal an adverse decision.

The purpose of the thesis is to analyse the relation between tax legislation and banking services. The thesis is formed of two parts. The first part (Chapter 1-3) covers aspects of the actual tax legislation in relation with banking services, the second part (Chapter 4-8) addresses trends which may be followed in the future regarding financial sector taxation. The thesis is composed of eight chapters. Chapter One deals with the position of banks as taxpayers of income tax, tax aspects of the banking business, tax provisions and the position of the banks as a payer of tax. The conclusions may be made that only limited pieces of income tax legislation are exclusive for banks. Peculiarities of banking transactions are reflected by accounting rules. Chapter Two focuses on the exemption of financial services from the system of value added tax. Some of financial services which are subject to the VAT are mentioned. Alternatives to the exemption approach are also investigated. Chapter Three is devoted to the system of deposit insurance and contributions of banks to the Deposit Insurance Fund. Future development in this field is also commented. Chapter Four deals with a general approach to the financial sector taxation, its motives, opportunities and related risks. Chapter Five examines the state of...

Broulík in his Master's Thesis sets his goal to analyse the automobile sales sector. He focuses mainly on the situation of automobile dealers. He depictures the contemporary development of automobile sales in the Czech Republic and in the world. He observes the impacts of the world economic crisis on automobile producers and dealers. He closer addresses the Škoda brand sales network which he uses to illustrate his findings. On the basis of the analysis of the automobile sales sector he establishes its particularities which he categorizes as supplier -- dealer relation particularities, sector particularities and dealer -- consumer relation particularities. Broulík assesses the current block exemption and compares it with the legal regime which will apply to the automobile sales sector in EFTA from the 1st June 2013. He concludes that the current block exemption suits the established sector particularities better. He however closes that neither the automobile producers' ascendancy over dealers nor many other sector particularities should be treated through economic competition legal regulation.

A research report submitted to the Faculty of Commerce, Law and Management in partial fulfilment of the requirements for the degree of Master of Commerce / The debt reduction provisions contained in s 19 and para 12A of the Eighth Schedule to the Income Tax Act 58 of 1962 seek to reverse the tax benefits claimed or enjoyed by debtors in relation to debt which has been forgiven, wholly or in part. In most cases, the application of these provisions should not lead to any difficulty. Nevertheless, some scenarios are not adequately provided for by the legislation, including debt reduction in favour of debtors carrying on mining operations, as well as partial debt reductions. Furthermore, the applicability of some of the exemptions to these provisions is unclear. Despite recent amendments to these provisions, which will apply to years of assessment commencing on or after 1 January 2013, the legislature has not addressed these issues. Key words: allowance assets; base cost; capital assets; capital gains tax; debt forgiveness; debt reduction; debt waiver; deemed donation; donation; donations tax; exemption; group of companies; operating expenditure; mining capital expenditure; tracing of expenditure; trading stock.