Who Should Pay for Global Health, and How Much?
- Publication Date
- February 19, 2013
- Journal
- PLOS Medicine
- Authors
- Luis R. Carrasco, Richard Coker & Alex R. Cook
- Volume
- 10
- Issue
- 2
- Pages
- e1001392
- DOI
- https://dx.plos.org/10.1371/journal.pmed.1001392
- Publisher URL
- http://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1001392
- PubMed
- http://www.ncbi.nlm.nih.gov/pubmed/23431273
- PubMed Central
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576343
- Europe PMC
- http://europepmc.org/abstract/MED/23431273
- Web of Science
- 000315592800009
- Scopus
- 84874483206
- Mendeley
- http://www.mendeley.com/research/pay-global-health-much
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Mendeley | Further Information
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Journal Comments | Further Information
- {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/bf84d08c-1489-41e3-801a-6890ada562ab", "title"=>"Inequitable domestic health spending increases global suffering", "body"=>"The authors offer a mechanism under the aegis of the United Nations for more efficiently, effectively, and substantially allocating global health development aid. They note analogies to global carbon permit markets. I have summarised these using the DPSIR framework:\n\nFor carbon, lifestyle is the Driver for material consumption, which puts Pressure on the State of environmental carbon dioxide, which in turn has an Impact on physical ecosystems. The Response is to cap and trade as much carbon dioxide production as possible. As a corollary, the MDGs are the Driver for health care, which puts Pressure on the State of DALYs, which in turn has the Impact that ‘donor countries can benefit substantially’. The proposed response is to cap and trade a limited portion of human suffering.\n\nThe paper’s analogy fails somewhat in its ethical conviction: Whereas carbon production is directly related to greed (the responsbility for damaging global commons is direct, and free-loading is absolutely wrong), averting DALYs is related to methodology (there is no responsibility for global health inequity, only for imbalanced and inefficient global inputs; free-loading is a relative misdirection).\n\nHowever, the mechanism which the paper suggests might link health expenditure in over-developed countries to that in developing countries is breath-takingly radical (and I endorse its principles): essentially, it taxes inequitable domestic health spending using globally relevant indicators (what the paper calls ‘compensation for inefficient domestic allocations’).\n\nBut the paper only argues for enforcement of methodological excellence in the context of marginally increased global contributions.Why stop at the MDGs? (From the paper’s figures, I calculate that if the USA paid its way to achieving the MDGs under the mechanism, it would still spend 222 times more on domestic health expenditure.) I project that over-developed countries will not take kindly to this proposal, being unwilling to accept the possibility that they are causal to global ill-health through the perpetuation of various forms of global inequity which preferentially benefit themselves. MDGs are only the thin end of a wedge for which such a ‘compensation’ scheme could operate. Furthermore, I hypothesise that doctors and others who have internalised highly inequitable global health systems, actually tend to perpetuate them. (Note for example, the successful pressure from China’s medical elite to ban the training of new ‘bare foot doctors’ despite so few being themselves willing to work in China’s many very poor and remote areas; or the self-justifying encouragement over the years of some of Britain’s health-related Royal Colleges to the development of highly specialist postgraduate training in developing countries, instead of supporting basic primary health initiatives; or globally distorted health research and drug development priorities).\n\nIn conclusion, richer country politicians and professionals will not even want to start down this road, for fear of legitimising the argument that inequitable domestic health spending worsens global DALYs. Doing it for MDGs will actually be an admission of much wider culpability: for unfairly causing many of the world’s DALYs (i.e. hurting people) in the first place. Indeed, the MDGs may be missed not simply because of a lack of US$45 billion, but because of underlying, negligently (or even deliberately) perpetuated inequities.", "isRemoved"=>false, "created"=>"2013-04-09T19:37:04Z", "lastModified"=>"2013-04-09T19:37:04Z", "creator"=>{"userId"=>"327571"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.1001392", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>1, "mostRecentActivity"=>"2013-04-11T14:45:28Z", "replies"=>[{"type"=>"REPLY", "parentID"=>64013, "annotationUri"=>"info:doi/10.1371/reply/51b5457b-6eed-4c77-b7ab-1006cd804079", "title"=>"RE: Inequitable domestic health spending increases global suffering", "body"=>"We agree with the points raised. The analogy between climate change and global health is not perfect: whereas carbon emissions generate a direct externality to other countries, domestic health investment does not. To make the analogy work, we need to invoke the perspective of a global social planner aiming at reducing global disease burden with a unique global common budget. From such perspective, low cost-effectiveness projects in high-income countries are not an efficient allocation of resources to reduce global disease burden. Of course, this does not hold if we adopt the perspective of individual countries.\nAlthough, we agree that this is a radical idea and that it might not be welcome by some countries, we believe it is an intuitive choice. At any rate, linking contributions to the DALY market to national health expenditure is only one of the possibilities to set the cap-and-trade rules. Other metrics that for instance reflect wealth can be used as well. \nOur main point is that a DALY credit market may have an enormous untapped potential in terms of scaling-up donations. The exact way in which the contributions of each country (or project) are to be determined will probably need to be the subject of political debate. If, by decoupling the cap-and-trade rule from national health expenditure, the DALY market is less controversial, then alternative metrics are also welcome.\n\nRoman Carrasco\n", "isRemoved"=>false, "created"=>"2013-04-11T14:45:28Z", "lastModified"=>"2013-04-11T14:45:28Z", "creator"=>{"userId"=>"156467"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.1001392", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2013-04-11T14:45:28Z", "replies"=>[]}]}
- {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/dde84b50-0d1e-4900-8f08-c9f277ed55d9", "title"=>"Market-Based control proposals in health are not new but are under investigated", "body"=>"There are clear theoretical benefits to creating \"price' signals in healthcare to help us move the system in directions it otherwise might not wish to go. The notion of cap and trade, or market-based control (MBC), is one such mechanism, and it is one which we have already strongly argued for, both as a mechanism for reducing iatrogenic harm, but also as for broader changes in health system behaviour.\n\nIn our first paper on the subject \"Market-based control mechanisms for patient safety\" (Qual Saf Health Care 2009;18:99-103 doi:10.1136/qshc.2007.025833 and http://qualitysafety.bmj.com/content/18/2/99.short ) we demonstrated how cap and trade might be used to create permits, and set limits for, iatrogenic harm. We finished by noting that cap and trade \"may be the key to effective healthcare reform, promoting safety and error reduction, and may become a widely used governance mechanism, directed at many aspects of healthcare service delivery\" as now demonstrated in the paper by Carrasco et al (2015).\n\nOur paper was not without criticism at the time, and BMJ Quality and Safety ran a set of four editorials to accompany our paper - each both intrigued by the idea, but in the end highly critical (http://qualitysafety.bmj.com/content/18/2.toc). We were provided a right of reply to these comments, and in our reply hopefully made clear that we were being criticised for mutually inconsistent reasons (http://qualitysafety.bmj.com/content/18/2/90.extract). \n\nOne line of argument against us was that there was no role for government intervention, as health was clearly not an economic public good (an argument from the Chicago School of Economics). We were also attacked from the opposite end of the political spectrum, where health was clearly a public good, and so there were real risks in leaving it to the 'market\".\n\nAs we pointed out in our reply, both arguments were based on an ideological reading of market-based control. If we had not used the 'market' word, but perhaps just called it feedback control, then maybe these alarms may not have sounded at all. Our perspective is simply that MBC is one in a long line of system level tools, starting with simpler less adaptive mechanisms like target setting, that can be applied at help shape system behaviours. We use MBC when simpler tools do not achieve the outcomes we hope for.\n\nWe are very glad to see Carrasco et al. breath additional life into the argument for MBC (although perhaps disappointed to not see our prior work cited). The key really is to move now from merely stating the proposition for MBC, to undertaking research that will help us understand in which settings this approach will work best, and what market designs work best.", "isRemoved"=>false, "created"=>"2015-07-12T04:50:23Z", "lastModified"=>"2015-07-12T04:50:23Z", "creator"=>{"userId"=>"514191"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.1001392", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2015-07-12T04:50:23Z", "replies"=>[]}
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- {"id"=>"304035991386210304", "text"=>"#plos Who Should Pay for Global Health, and How Much? http://t.co/tOcCy5yj http://t.co/PoiI0HQz", "created_at"=>"2013-02-20T01:13:23Z", "user"=>"bookapharmacist", "user_name"=>"Kazeem Olalekan", "user_profile_image"=>"http://a0.twimg.com/profile_images/1859820850/3a_normal.png"}
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- {"id"=>"304110575875678208", "text"=>"Who should pay for global health, and how much? Luis R. Carrasco et al. http://t.co/1Vnqznph", "created_at"=>"2013-02-20T06:09:46Z", "user"=>"mmi_updates", "user_name"=>"MMI global health", "user_profile_image"=>"http://a0.twimg.com/profile_images/2969175093/32a21dc6bc43dc9cafa1eb897188bedd_normal.png"}
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- {"id"=>"304122920739938304", "text"=>"Who Should Pay for #GlobalHealth, and How Much? http://t.co/mxhkpXzG #ethics #commons", "created_at"=>"2013-02-20T06:58:49Z", "user"=>"markomanka", "user_name"=>"Marco Manca", "user_profile_image"=>"http://a0.twimg.com/profile_images/219309250/Io_normal.jpg"}
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- {"id"=>"304130453961601024", "text"=>"A DALY tradable credit market MT @mmi_updates: Who should pay for global health, and how much? http://t.co/aN68Y3Jc”", "created_at"=>"2013-02-20T07:28:45Z", "user"=>"ftissandier", "user_name"=>"Fred Tissandier", "user_profile_image"=>"http://a0.twimg.com/profile_images/2035325604/IMG_0780_normal.JPG"}
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- {"id"=>"304179813898412032", "text"=>"Who Should Pay for #GlobalHealth, and How Much? http://t.co/BXcSOJAb #healthfinancing", "created_at"=>"2013-02-20T10:44:53Z", "user"=>"AnantBhan", "user_name"=>"Anant Bhan", "user_profile_image"=>"http://a0.twimg.com/profile_images/2427712507/k1m6zq5hshb3rxku5qmy_normal.jpeg"}
- {"id"=>"304180334784815104", "text"=>"@PLOSMedicine article http://t.co/BXcSOJAb argues that #US needs to scale up its #globalhealth spending while #UK has met commitments", "created_at"=>"2013-02-20T10:46:57Z", "user"=>"AnantBhan", "user_name"=>"Anant Bhan", "user_profile_image"=>"http://a0.twimg.com/profile_images/2427712507/k1m6zq5hshb3rxku5qmy_normal.jpeg"}
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- {"id"=>"304270919487062016", "text"=>"RT @AnantBhan: @PLOSMedicine article http://t.co/BXcSOJAb argues that #US needs to scale up its #globalhealth spending while #UK has met ...", "created_at"=>"2013-02-20T16:46:54Z", "user"=>"PLOSMedicine", "user_name"=>"PLOS Medicine", "user_profile_image"=>"http://a0.twimg.com/profile_images/2436335697/k93oob5au2gllc775hk5_normal.jpeg"}
- {"id"=>"304272346439639041", "text"=>"RT @AnantBhan: @PLOSMedicine article http://t.co/BXcSOJAb argues that #US needs to scale up its #globalhealth spending while #UK has met ...", "created_at"=>"2013-02-20T16:52:35Z", "user"=>"BattamsSamantha", "user_name"=>"Samantha Battams", "user_profile_image"=>"http://a0.twimg.com/profile_images/1656845413/April2011SBresized_normal.jpg"}
- {"id"=>"304281970240794625", "text"=>"Can't decide if this DALY trading scheme, is brilliant, crazy, or totally irrelevant http://t.co/Kle2OuY6", "created_at"=>"2013-02-20T17:30:49Z", "user"=>"alanna_shaikh", "user_name"=>"Alanna Shaikh", "user_profile_image"=>"http://a0.twimg.com/profile_images/2701574761/c48ddb04326f79af9f1a65023b6134a6_normal.jpeg"}
- {"id"=>"304283023250186241", "text"=>"RT @alanna_shaikh: Can't decide if this DALY trading scheme, is brilliant, crazy, or totally irrelevant http://t.co/Kle2OuY6", "created_at"=>"2013-02-20T17:35:00Z", "user"=>"tompaulson", "user_name"=>"Tom Paulson", "user_profile_image"=>"http://a0.twimg.com/profile_images/1718286532/mugshot_normal.jpg"}
- {"id"=>"304283091403423744", "text"=>"RT @PLOSMedicine: Who should pay for global health? Can the carbon emission trading model work for healthcare? http://t.co/X1DlXzP6", "created_at"=>"2013-02-20T17:35:16Z", "user"=>"drjnsmith", "user_name"=>"James Smith", "user_profile_image"=>"http://a0.twimg.com/profile_images/3235825167/6544bed4c660bfa9cd4cf78248ce5b03_normal.jpeg"}
- {"id"=>"304318017272160256", "text"=>"PLoS Med: Who Should Pay for Global Health, and How Much? http://t.co/pnubofaa", "created_at"=>"2013-02-20T19:54:03Z", "user"=>"greg_folkers", "user_name"=>"Greg Folkers", "user_profile_image"=>"http://a0.twimg.com/profile_images/769552769/gf_normal.jpg"}
- {"id"=>"304335640240209920", "text"=>"One World One health ! Et si nous mutualisions les dépenses de santé publique à l'échelle planétaire ? #PLOSMedicine: http://t.co/bZqVh8UE", "created_at"=>"2013-02-20T21:04:05Z", "user"=>"gdsra", "user_name"=>"GDS Rhône-Alpes", "user_profile_image"=>"http://a0.twimg.com/profile_images/2434757983/GDS_normal.JPG"}
- {"id"=>"304480378423504896", "text"=>"RT @in2mh: Who Should Pay for #GlobalHealth, and How Much? http://t.co/Kk1sjSvC #healthfinancing via @AnantBhan", "created_at"=>"2013-02-21T06:39:13Z", "user"=>"EvaAlisic", "user_name"=>"Dr Eva Alisic", "user_profile_image"=>"http://a0.twimg.com/profile_images/1885252507/Eva_Alisic_normal.jpg"}
- {"id"=>"304495541742600192", "text"=>"#PLOSMedicine: Who Should Pay for Global Health, and How Much? http://t.co/wsNNbvGOde #global_health http://t.co/DjQgQfD51p", "created_at"=>"2013-02-21T07:39:29Z", "user"=>"info_TGHN", "user_name"=>"GlobalHealthNetwork", "user_profile_image"=>"http://a0.twimg.com/profile_images/2304637134/q97ics2h80c98jqc96qn_normal.jpeg"}
- {"id"=>"304501998009593856", "text"=>"Who should pay for global health, and how much? http://t.co/rO10U1qJlY Carrasco LR, Coker R and Cook AR in @PLOSMedicine", "created_at"=>"2013-02-21T08:05:08Z", "user"=>"InisCom", "user_name"=>"Inis Communication", "user_profile_image"=>"http://a0.twimg.com/profile_images/1761844821/INIS_logo_icon-03_normal.jpg"}
- {"id"=>"304508760569810944", "text"=>"Big question @PLOSMedicine: Who Should Pay for Global Health, and How Much? http://t.co/b3mle90rWN #globalhealth", "created_at"=>"2013-02-21T08:32:00Z", "user"=>"UCGHR", "user_name"=>"Umeå Global Health", "user_profile_image"=>"http://a0.twimg.com/profile_images/2991644928/ec28d1fcc18de14b5a46e288c4fe2d55_normal.jpeg"}
- {"id"=>"304544258558414848", "text"=>"RT @UCGHR: Big question @PLOSMedicine: Who Should Pay for Global Health, and How Much? http://t.co/b3mle90rWN #globalhealth", "created_at"=>"2013-02-21T10:53:04Z", "user"=>"KatriBertram", "user_name"=>"KatriBertram", "user_profile_image"=>"http://a0.twimg.com/profile_images/2961226783/59aa8902116f14db7834a78a65d3b8bd_normal.jpeg"}
- {"id"=>"304557872551964673", "text"=>"New on @PLOSMedicine: Who Should Pay for #GlobalHealth, and How Much? http://t.co/aRE8l5nMoh", "created_at"=>"2013-02-21T11:47:09Z", "user"=>"HealthNetTPO", "user_name"=>"HealthNet TPO", "user_profile_image"=>"http://a0.twimg.com/profile_images/1810352187/healthnetlogotwitter2_normal.png"}
- {"id"=>"304564485014831104", "text"=>"RT @GorikOoms: Interesting paper in #PLOSMedicine by Carrasco et al: Who Should Pay for Global Health, and How Much? http://t.co/tzqxoxM7", "created_at"=>"2013-02-21T12:13:26Z", "user"=>"KrisTorgeson", "user_name"=>"Kris Torgeson", "user_profile_image"=>"http://a0.twimg.com/profile_images/1215687779/Small_me_photo_7_10_normal.jpg"}
- {"id"=>"304603292909047808", "text"=>"Who Should Pay for Global Health, and How Much?: http://t.co/fF69RlapSv", "created_at"=>"2013-02-21T14:47:38Z", "user"=>"mrjasonray", "user_name"=>"Jason Ray", "user_profile_image"=>"http://a0.twimg.com/profile_images/1479014981/image_normal.jpg"}
- {"id"=>"304652585208520704", "text"=>"Interesting: DALY tradable credit markets as an option for global health investments. http://t.co/HdaABsNFg0", "created_at"=>"2013-02-21T18:03:31Z", "user"=>"SaniaNishtar", "user_name"=>"Sania Nishtar", "user_profile_image"=>"http://a0.twimg.com/profile_images/3089997175/f5dd8923860de214b46d823b9dfd4830_normal.jpeg"}
- {"id"=>"304734113645080576", "text"=>"RT @PLOSMedicine: Who should pay for global health? Can the carbon emission trading model work for healthcare? http://t.co/X1DlXzP6", "created_at"=>"2013-02-21T23:27:29Z", "user"=>"ayktozkan", "user_name"=>"Aykut Özkan", "user_profile_image"=>"http://a0.twimg.com/profile_images/3250023104/c8c45e09019d58035774057d4127b0e5_normal.jpeg"}
- {"id"=>"304782925948399617", "text"=>"RT @SaniaNishtar: Interesting: DALY tradable credit markets as an option for global health investments. http://t.co/HdaABsNFg0", "created_at"=>"2013-02-22T02:41:26Z", "user"=>"HeartfileTweets", "user_name"=>"Heartfile", "user_profile_image"=>"http://a0.twimg.com/profile_images/2424513983/HF_normal.jpg"}
- {"id"=>"304929658472910848", "text"=>"#PLOSMedicine: Who Should Pay for Global Health, and How Much? http://t.co/vmmhJVnp6A", "created_at"=>"2013-02-22T12:24:30Z", "user"=>"huangwt", "user_name"=>"Wan-Ting Huang", "user_profile_image"=>"http://a0.twimg.com/profile_images/2191985843/image_normal.jpg"}
- {"id"=>"304993722104422400", "text"=>"Who should pay for #globalhealth and how much ? http://t.co/6ohoGugKaS @lagugu @mike_eliasz @faejones @GenBois", "created_at"=>"2013-02-22T16:39:04Z", "user"=>"c_pdesrosiers", "user_name"=>"Claudel P-Desrosiers", "user_profile_image"=>"http://a0.twimg.com/profile_images/3258701693/be7a7512ffc67cce3073f7ddfdc71f5e_normal.jpeg"}
- {"id"=>"304996978041958400", "text"=>"RT @alanna_shaikh: Can't decide if this DALY trading scheme, is brilliant, crazy, or totally irrelevant http://t.co/Kle2OuY6", "created_at"=>"2013-02-22T16:52:00Z", "user"=>"PLOSMedicine", "user_name"=>"PLOS Medicine", "user_profile_image"=>"http://a0.twimg.com/profile_images/2436335697/k93oob5au2gllc775hk5_normal.jpeg"}
- {"id"=>"304996997792952322", "text"=>"RT @SaniaNishtar: Interesting: DALY tradable credit markets as an option for global health investments. http://t.co/HdaABsNFg0", "created_at"=>"2013-02-22T16:52:05Z", "user"=>"PLOSMedicine", "user_name"=>"PLOS Medicine", "user_profile_image"=>"http://a0.twimg.com/profile_images/2436335697/k93oob5au2gllc775hk5_normal.jpeg"}
- {"id"=>"304997215703805952", "text"=>"RT @alanna_shaikh: Can't decide if this DALY trading scheme, is brilliant, crazy, or totally irrelevant http://t.co/Kle2OuY6", "created_at"=>"2013-02-22T16:52:57Z", "user"=>"claudiavaca5", "user_name"=>"claudia vaca", "user_profile_image"=>"http://a0.twimg.com/profile_images/2542843912/eidjxrrqdk6e3x5tq2bw_normal.jpeg"}
- {"id"=>"305006075143389185", "text"=>"RT @c_pdesrosiers: Who should pay for #globalhealth and how much ? http://t.co/6ohoGugKaS @lagugu @mike_eliasz @faejones @GenBois", "created_at"=>"2013-02-22T17:28:09Z", "user"=>"faejones", "user_name"=>"Felicity Jones", "user_profile_image"=>"http://a0.twimg.com/profile_images/2593675621/nvsw4shdrub5bfhrv7zf_normal.jpeg"}
- {"id"=>"305052599864942592", "text"=>"RT @alanna_shaikh: Can't decide if this DALY trading scheme, is brilliant, crazy, or totally irrelevant http://t.co/Kle2OuY6", "created_at"=>"2013-02-22T20:33:02Z", "user"=>"IlonaKickbusch", "user_name"=>"Ilona Kickbusch", "user_profile_image"=>"http://a0.twimg.com/profile_images/2627430313/blogger-profile-large-016_normal.jpeg"}
- {"id"=>"305095050386362370", "text"=>"#PLOSMedicine: tradeable global DALY market: headline grabbing gimmick or good idea? http://t.co/rgjnpiBULJ", "created_at"=>"2013-02-22T23:21:43Z", "user"=>"DarkKindOfLight", "user_name"=>"Louise", "user_profile_image"=>"http://a0.twimg.com/profile_images/1596636953/photome_normal.JPG"}
- {"id"=>"305178944821407744", "text"=>"Who Should Pay for Global Health, and How Much? http://t.co/2e3GebUmtH @PLoSMedicine", "created_at"=>"2013-02-23T04:55:05Z", "user"=>"GSSHealth", "user_name"=>"GSS Health", "user_profile_image"=>"http://a0.twimg.com/profile_images/1802486658/lab_tech_w_mic_in_window_normal.jpg"}
- {"id"=>"305277560231698432", "text"=>"RT @GSSHealth: Who Should Pay for Global Health, and How Much? http://t.co/2e3GebUmtH @PLoSMedicine", "created_at"=>"2013-02-23T11:26:56Z", "user"=>"CD2Transition", "user_name"=>"CD2Transition", "user_profile_image"=>"http://a0.twimg.com/profile_images/2766895969/cc587bd81a12f9ff5ecaa7f74e043669_normal.png"}
- {"id"=>"305293590584782849", "text"=>"Top story: PLOS Medicine: Who Should Pay for Global Health, and How Much? http://t.co/r4s0M5xfQo, see more http://t.co/bIL61sl2qj", "created_at"=>"2013-02-23T12:30:38Z", "user"=>"ATP_CME", "user_name"=>"ATP EGYPT", "user_profile_image"=>"http://a0.twimg.com/profile_images/1337289872/DSCF1510_normal.JPG"}
- {"id"=>"305331748710010880", "text"=>"RT @PLOSMedicine: Who should pay for global health? Can the carbon emission trading model work for healthcare? http://t.co/X1DlXzP6", "created_at"=>"2013-02-23T15:02:16Z", "user"=>"Shams_Syed", "user_name"=>"Shams Syed", "user_profile_image"=>"http://a0.twimg.com/profile_images/3013531495/0e4b3df83717bae6d99f232fbbd1da4b_normal.jpeg"}
- {"id"=>"305688280907792385", "text"=>"#PLOSMedicine: Parallels with Tradable Carbon Permits: Global Health Permits?http://t.co/4arFHEi20f #globalhealth", "created_at"=>"2013-02-24T14:39:00Z", "user"=>"Emma_Hannay", "user_name"=>"Emma Hannay", "user_profile_image"=>"http://a0.twimg.com/profile_images/2297080124/7fa75s0k27kni75bgd3a_normal.jpeg"}
- {"id"=>"305694093743357954", "text"=>"Who Should Pay for Global Health, and How Much? http://t.co/KAI20GbLbb", "created_at"=>"2013-02-24T15:02:06Z", "user"=>"dopaminergic13", "user_name"=>"dopaminergic13", "user_profile_image"=>"http://a0.twimg.com/profile_images/2351687003/k53vqv9ga23lnah9l6qw_normal.jpeg"}
- {"id"=>"305968448100499456", "text"=>"RT @InisCom: Who should pay for global health, and how much? http://t.co/rO10U1qJlY Carrasco LR, Coker R and Cook AR in @PLOSMedicine", "created_at"=>"2013-02-25T09:12:17Z", "user"=>"GAPMarilyn", "user_name"=>"Marilyn Mehlmann", "user_profile_image"=>"http://a0.twimg.com/profile_images/1373286116/Smallest_compressed_normal.jpg"}
- {"id"=>"306468314937450497", "text"=>"Who Should Pay for #GlobalHealth, and How Much?\n@PLOSMedicine\nhttp://t.co/9G4FJgNkeA", "created_at"=>"2013-02-26T18:18:34Z", "user"=>"CarinaAlm", "user_name"=>"Carina Alm", "user_profile_image"=>"http://a0.twimg.com/profile_images/3074731045/862674ceadee9fa3a10957e4c9c33837_normal.jpeg"}
- {"id"=>"306883537385177088", "text"=>"Cap and trade for global health costs? With a credit market in DALYs?? http://t.co/ucJct7thm8", "created_at"=>"2013-02-27T21:48:31Z", "user"=>"porousboundary", "user_name"=>"Josh Berson", "user_profile_image"=>"http://a0.twimg.com/profile_images/2160125678/Avatar_normal.jpg"}
- {"id"=>"307026311778557952", "text"=>"Idea to scale-up funding to meet health MDGs\nhttp://t.co/KFQBG94GWF\n#MDGs2013", "created_at"=>"2013-02-28T07:15:51Z", "user"=>"lromancarrasco", "user_name"=>"Roman Carrasco", "user_profile_image"=>"http://a0.twimg.com/sticky/default_profile_images/default_profile_3_normal.png"}
- {"id"=>"307184467922006016", "text"=>"PLOS Medicine: Who Should Pay for Global Health, and How Much? http://t.co/DVbgQBLcKE", "created_at"=>"2013-02-28T17:44:19Z", "user"=>"mdimairo", "user_name"=>"Munya Dimairo", "user_profile_image"=>"http://a0.twimg.com/profile_images/2615907682/345594326_normal.jpg"}
- {"id"=>"308364559796817920", "text"=>"#PLOSMedicine: Who Should Pay for Global Health, and How Much? http://t.co/3t6J1dwJNT", "created_at"=>"2013-03-03T23:53:34Z", "user"=>"riyadhonline", "user_name"=>"Riyadh Alshamsan", "user_profile_image"=>"http://a0.twimg.com/profile_images/1311362559/picture-304_normal.jpg"}
- {"id"=>"308653315841994752", "text"=>"MT @anantbhan: @PLOSMedicine article http://t.co/VNVgkAiy3f argues US needs to scale up #globalhealth spending while #UK has met commitments", "created_at"=>"2013-03-04T19:00:59Z", "user"=>"healthhumrights", "user_name"=>"Health&HumanRights", "user_profile_image"=>"http://a0.twimg.com/profile_images/2372961933/9p61nox6o3tpoe6ubzgn_normal.png"}
- {"id"=>"309039515803213824", "text"=>"Who Should Pay for Global Health, and How Much? #globalhealth \nhttp://t.co/fDiJv7j5eH", "created_at"=>"2013-03-05T20:35:36Z", "user"=>"eqpaho", "user_name"=>"PAHO/WHO Equity", "user_profile_image"=>"http://a0.twimg.com/profile_images/89456617/opslogo_bigger_normal.jpg"}
- {"id"=>"309059921427709952", "text"=>"RT @eqpaho: Who Should Pay for Global Health, and How Much? #globalhealth \nhttp://t.co/fDiJv7j5eH", "created_at"=>"2013-03-05T21:56:41Z", "user"=>"RuizEF", "user_name"=>"Eloy Ruiz", "user_profile_image"=>"http://a0.twimg.com/profile_images/1500864894/pic2_normal.jpg"}
- {"id"=>"309204409953431552", "text"=>"Who Should Pay for Global Health, and How Much? @PLOSMedicine article/discussion\nhttp://t.co/QIJtCwk2xy #globalhealth #development", "created_at"=>"2013-03-06T07:30:50Z", "user"=>"in2mh", "user_name"=>"in2mentalhealth", "user_profile_image"=>"http://a0.twimg.com/profile_images/867009577/AfbeeldingRh_normal.GIF"}
- {"id"=>"309755700039544832", "text"=>"A month old, but interesting to think about - DALY credits, akin to carbon? http://t.co/Qnn3yaPjb4 #GBD2010 @IHME_UW @PLOSMedicine", "created_at"=>"2013-03-07T20:01:28Z", "user"=>"nwnancy", "user_name"=>"Nancy Fullman", "user_profile_image"=>"http://a0.twimg.com/profile_images/3092379597/5da63a61d5b1398e7b52173cfb3d9ac4_normal.jpeg"}
- {"id"=>"309759680262053890", "text"=>"RT @nwnancy: A month old, but interesting to think about - DALY credits, akin to carbon? http://t.co/Qnn3yaPjb4 #GBD2010 @IHME_UW @PLOSM ...", "created_at"=>"2013-03-07T20:17:17Z", "user"=>"PLOSMedicine", "user_name"=>"PLOS Medicine", "user_profile_image"=>"http://a0.twimg.com/profile_images/2436335697/k93oob5au2gllc775hk5_normal.jpeg"}
- {"id"=>"309759751124819969", "text"=>"Who Should Pay for #GlobalHealth, and How Much? http://t.co/b4AlbW3WHc via @PLOSMedicine", "created_at"=>"2013-03-07T20:17:34Z", "user"=>"UAEMNorge", "user_name"=>"UAEM Norge", "user_profile_image"=>"http://a0.twimg.com/profile_images/2570545793/d46o5q549svgcwjreosx_normal.jpeg"}
- {"id"=>"309763256078196737", "text"=>"RT @nwnancy: A month old, but interesting to think about - DALY credits, akin to carbon? http://t.co/Qnn3yaPjb4 #GBD2010 @IHME_UW @PLOSM ...", "created_at"=>"2013-03-07T20:31:30Z", "user"=>"pannaj", "user_name"=>"panna", "user_profile_image"=>"http://a0.twimg.com/profile_images/1598344096/image_normal.jpg"}
- {"id"=>"310029199115182080", "text"=>"Top story: PLOS Medicine: Who Should Pay for Global Health, and How Much? http://t.co/A0zrk7wLo4, see more http://t.co/bIL61sl2qj", "created_at"=>"2013-03-08T14:08:15Z", "user"=>"ATP_CME", "user_name"=>"ATP EGYPT", "user_profile_image"=>"http://a0.twimg.com/profile_images/1337289872/DSCF1510_normal.JPG"}
- {"id"=>"321211059606282240", "text"=>"Available to download: Article - Who Should Pay for Global #Health, and How Much? http://t.co/6Dw4BYDjxH", "created_at"=>"2013-04-08T10:40:59Z", "user"=>"DPP_OU", "user_name"=>"DPP Open University", "user_profile_image"=>"http://a0.twimg.com/profile_images/1824983712/logo_-_plainfgp1_normal.png"}
- {"id"=>"338581678119350272", "text"=>"MT Great idea; could also be applied to #livestock health. @lromancarrasco scale-up funding health MDGs\nhttp://t.co/5y4mQmSELi\n#MDGs2013\"", "created_at"=>"2013-05-26T09:05:37Z", "user"=>"ulrich_sperling", "user_name"=>"Ulrich Sperling", "user_profile_image"=>"http://a0.twimg.com/profile_images/3503557600/05ad1c0aa650a9117f3c89013ed90239_normal.jpeg"}
- {"id"=>"367561469699059712", "text"=>"Who should pay for global health, and how much? @PloSMedicine http://t.co/5tpkHFiVGx", "created_at"=>"2013-08-14T08:20:57Z", "user"=>"GPHF", "user_name"=>"Dr Richard Jähnke", "user_profile_image"=>"http://a0.twimg.com/profile_images/543965319/GPHF_bigger_normal.gif"}
- {"id"=>"367581861553250306", "text"=>"RT @GPHF: Who should pay for global health, and how much? @PloSMedicine http://t.co/5tpkHFiVGx", "created_at"=>"2013-08-14T09:41:59Z", "user"=>"PLOSMedicine", "user_name"=>"PLOS Medicine", "user_profile_image"=>"http://a0.twimg.com/profile_images/2436335697/k93oob5au2gllc775hk5_normal.jpeg"}
- {"id"=>"367597085119746048", "text"=>"RT @GPHF: Who should pay for global health, and how much? @PloSMedicine http://t.co/5tpkHFiVGx", "created_at"=>"2013-08-14T10:42:29Z", "user"=>"ranitmd", "user_name"=>"Ranit Mishori MD MHS", "user_profile_image"=>"http://a0.twimg.com/profile_images/1625179696/parade_profile_normal.jpg"}
- {"id"=>"369388694160936960", "text"=>"#PLOSMedicine: Who Should Pay for Global #Health, and How Much? http://t.co/SeZu6cPKqD", "created_at"=>"2013-08-19T09:21:42Z", "user"=>"TiffDahmash", "user_name"=>"Tiff Dahmash", "user_profile_image"=>"http://a0.twimg.com/profile_images/378800000139259610/a9ab0b1b3a5d08ed8faaf914132271ed_normal.jpeg"}
- {"id"=>"369412326253793281", "text"=>"Who Should Pay for Global Health, and How Much? (via @PLOSMedicine) http://t.co/2wGdoNbSRm", "created_at"=>"2013-08-19T10:55:36Z", "user"=>"ISGLOBALorg", "user_name"=>"ISGlobal", "user_profile_image"=>"http://a0.twimg.com/profile_images/1564273948/logopantone_normal.jpg"}
- {"id"=>"369976394022805504", "text"=>"RT @TiffDahmash: #PLOSMedicine: Who Should Pay for Global #Health, and How Much? http://t.co/SeZu6cPKqD", "created_at"=>"2013-08-21T00:17:00Z", "user"=>"mikeharv", "user_name"=>"Michael Harvey", "user_profile_image"=>"http://a0.twimg.com/profile_images/378800000157601200/9e888e7b47d96016dbca457fcbbe3512_normal.png"}
- {"id"=>"464917337490345985", "text"=>"RT @GorikOoms: Interesting paper in #PLOSMedicine by Carrasco et al: Who Should Pay for Global Health, and How Much? http://t.co/tzqxoxM7", "created_at"=>"2014-05-09T23:58:25Z", "user"=>"salignonp", "user_name"=>"Salignon Pierre", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3067764886/a2d3f7f498b1f7dd675b79613ade9bf0_normal.jpeg"}
- {"id"=>"620084335991918593", "text"=>"Oh dear, conflicts of interest red flag http://t.co/CckDxG3C9W http://t.co/Ns0W6uG3t2 http://t.co/hezFp8Fw0k http://t.co/PW5foOoKLZ", "created_at"=>"2015-07-12T04:16:40Z", "user"=>"adamgdunn", "user_name"=>"Adam Dunn", "user_profile_image"=>"http://pbs.twimg.com/profile_images/594785201655455745/UamUKRwJ_normal.jpg"}
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PMC Usage Stats | Further Information
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Relative Metric
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