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Sample records for catastrophic health expenditure

  1. Catastrophic health expenditure and impoverishment in Mongolia

    OpenAIRE

    Dorjdagva, Javkhlanbayar; Batbaatar, Enkhjargal; Svensson, Mikael; Dorjsuren, Bayarsaikhan; Kauhanen, Jussi

    2016-01-01

    Background The social health insurance coverage is relatively high in Mongolia; however, escalation of out-of-pocket payments for health care, which reached 41 % of the total health expenditure in 2011, is a policy concern. The aim of this study is to analyse the incidence of catastrophic health expenditures and to measure the rate of impoverishment from health care payments under the social health insurance scheme in Mongolia. Methods We used the data from the Household Socio-Economic Survey...

  2. Multiple Sclerosis and Catastrophic Health Expenditure in Iran

    Science.gov (United States)

    Juyani, Yaser; Hamedi, Dorsa; Hosseini Jebeli, Seyede Sedighe; Qasham, Maryam

    2016-01-01

    Background: There are many disabling medical conditions which can result in catastrophic health expenditure. Multiple Sclerosis is one of the most costly medical conditions through the world which encounter families to the catastrophic health expenditures. This study aims to investigate on what extent Multiple sclerosis patients face catastrophic costs. Method: This study was carried out in Ahvaz, Iran (2014). The study population included households that at least one of their members suffers from MS. To analyze data, Logit regression model was employed by using the default software STATA12. Results: 3.37% of families were encountered with catastrophic costs. Important variables including brand of drug, housing, income and health insurance were significantly correlated with catastrophic expenditure. Conclusions: This study suggests that although a small proportion of MS patients met the catastrophic health expenditure, mechanisms that pool risk and cost (e.g. health insurance) are required to protect them and improve financial and access equity in health care.

  3. Catastrophic Health Expenditure and Household Impoverishment: a case of NCDs prevalence in Kenya

    Directory of Open Access Journals (Sweden)

    Daniel Mwai

    2016-03-01

    Full Text Available Introduction and problem: Non-Communicable Diseases (NCDs have become one of the leading causes of morbidity and mortality in Kenya. Their claim on financial and time resources adversely affects household welfare. Health care cost for NCDs in Kenya is predominantly paid by households as OOP. Health expenditure on NCD stands at 6.2% of Total Health Expenditure which is 0.4 % of the total gross domestic product of the country. This expenditure scenario could have implications on household welfare through catastrophic expenditure in Kenya. Most studies done on catastrophic expenditure in Kenya have not looked at the effect of NCD on poverty. Methodology: The paper has investigated the determinants of catastrophic health spending in a household with special focus on the NCDs. It has also investigated the effect of catastrophic expenditure on household welfare.A National household level survey data on expenditure and utilization is used. Controlling for endogeneity, the results revealed that NCDs and communicable diseases contribute significantly to the likelihood of a household incurring catastrophic expenditure. Results: Although all types of sicknesses have negative effects on household welfare, NCDs have more severe impacts on impoverishment. Policy wise, government and development partners should put in place a health financing plan entailing health insurance and resource pooling as a mean towards social protection. Key words:  Non-Communicable Diseases (NCD, Catastrophic Health Expenditure, endogeneity Impoverishment

  4. Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

    OpenAIRE

    Bakhtiar Piroozi; Ghobad Moradi; Bijan Nouri; Amjad Mohamadi Bolbanabad; Hossein Safari

    2016-01-01

    Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percenta...

  5. Catastrophic Health Expenditures for Households with Disabled Members: Evidence from the Korean Health Panel.

    Science.gov (United States)

    Lee, Jeong-Eun; Shin, Hyung-Ik; Do, Young Kyung; Yang, Eun Joo

    2016-03-01

    Persons with disabilities use more health care services due to ill health and face higher health care expenses and burden. This study explored the incidence of catastrophic health expenditures of households with persons with disabilities compared to that of those without such persons. We used the Korean Health Panel (KHP) dataset for the years 2010 and 2011. The final sample was 5,610 households; 800 (14.3%) of these were households with a person with a disability and 4,810 (85.7%) were households without such a person. Households with a person with a disability faced higher catastrophic health expenditures, spending about 1.2 to 1.4 times more of their annual living expenditures for out-of-pocket medical expenses, compared to households without persons with disabilities. Households having low economic status and members with chronic disease were more likely to face catastrophic health expenditures, while those receiving public assistance were less likely. Exemption or reduction of out-of-pocket payments in the National Health Insurance and additional financial support are needed so that the people with disabilities can use medical services without suffering financial crisis. PMID:26955233

  6. Catastrophic Medical Expenditure Risk

    NARCIS (Netherlands)

    G. Flores (Gabriela); O.A. O'Donnell (Owen)

    2012-01-01

    textabstractMedical expenditure risk can pose a major threat to living standards. We derive decomposable measures of catastrophic medical expenditure risk from reference-dependent utility with loss aversion. We propose a quantile regression based method of estimating risk exposure from cross-section

  7. Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India

    DEFF Research Database (Denmark)

    Brinda, Ethel Mary; Kowal, Paul; Attermann, Jørn;

    2015-01-01

    BACKGROUND: Healthcare financing through out-of-pocket payments and inequities in healthcare utilisation are common in low and middle income countries (LMICs). Given the dearth of pertinent studies on these issues among older people in LMICs, we investigated the determinants of health service use......, out-of-pocket and catastrophic health expenditures among older people in one LMIC, India. METHODS: We accessed data from a nationally representative, multistage sample of 2414 people aged 65 years and older from the WHO's Study on global Ageing and adult health in India. Sociodemographic...... the number of health visits and out-of-pocket health expenditures. The prevalence of catastrophic health expenditure among older people in India was 7% (95% CI 6% to 8%). Older men and individuals with chronic diseases were at higher risk of catastrophic health expenditure, while access to health insurance...

  8. Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries

    Science.gov (United States)

    Arsenijevic, Jelena; Pavlova, Milena; Rechel, Bernd; Groot, Wim

    2016-01-01

    Introduction It is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries. Methods The SHARE dataset for individuals aged 50+ and their households, collected in 2010–2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model. Results We found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure. Discussion Our study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio

  9. Stories from Around the Globe: Financing Catastrophic Health Expenditures in Selected Countries

    OpenAIRE

    Dela Cruz, Anna Mae D.; Nuevo, Christian Edward L.; Haw, Nel Jason L.; Tang, Vincent Anthony S.

    2014-01-01

    This study reviews literature on financing catastrophic health expenditures in selected countries to describe and synthesize the strategies of relatively successful health financing schemes. It begins with a review of basic concepts and definitions to set the stage for later discussions. This is followed by a country selection process, where countries were selected based on their income level, health outcomes, coverage outcomes, cost effectiveness, and the availability of information on their...

  10. Catastrophic medical expenditure risk.

    Science.gov (United States)

    Flores, Gabriela; O'Donnell, Owen

    2016-03-01

    We propose a measure of household exposure to particularly onerous medical expenses. The measure can be decomposed into the probability that medical expenditure exceeds a threshold, the loss due to predictably low consumption of other goods if it does and the further loss arising from the volatility of medical expenses above the threshold. Depending on the choice of threshold, the measure is consistent with a model of reference-dependent utility with loss aversion. Unlike the risk premium, the measure is only sensitive to particularly high expenses, and can identify households that expect to incur such expenses and would benefit from subsidised, but not actuarially fair, insurance. An empirical illustration using data from seven Asian countries demonstrates the importance of taking account of informal insurance and reveals clear differences in catastrophic medical expenditure risk across and within countries. In general, risk is higher among poorer, rural and chronically ill populations.

  11. 灾难性医疗支出研究%Study on Catastrophic Health Expenditure

    Institute of Scientific and Technical Information of China (English)

    褚福灵

    2016-01-01

    Catastrophic heath expenditure occurs when the total out-of-pocket health payments are ≥40%of the household’s capacity to pay(non-living expenses). Studies have showed that the highest rate of catastrophic payments was 13%% in the world, and there were about 5% of poverty caused by serious illness. We should calculate the rate of catastrophic payment and poverty due to illness by using normative methods, and adopt comprehensive measures to prevent the occurrence of catastrophic health expenditure.%家庭的医疗费用支出等于或超过家庭支付能力(非生存支出)的40%时,该家庭即发生了灾难性医疗支出。世界范围内,家庭灾难性医疗支出发生率最高为13%,因病致贫发生率最高为5%。应采用规范的方法测算灾难性医疗支出发生率与因病致贫率,并采取综合措施防范灾难性医疗风险的发生。

  12. Indian community health insurance schemes provide partial protection against catastrophic health expenditure

    Directory of Open Access Journals (Sweden)

    Ranson Kent

    2007-03-01

    Full Text Available Abstract Background More than 72% of health expenditure in India is financed by individual households at the time of illness through out-of-pocket payments. This is a highly regressive way of financing health care and sometimes leads to impoverishment. Health insurance is recommended as a measure to protect households from such catastrophic health expenditure (CHE. We studied two Indian community health insurance (CHI schemes, ACCORD and SEWA, to determine whether insured households are protected from CHE. Methods ACCORD provides health insurance cover for the indigenous population, living in Gudalur, Tamil Nadu. SEWA provides insurance cover for self employed women in the state of Gujarat. Both cover hospitalisation expenses, but only upto a maximum limit of US$23 and US$45, respectively. We reviewed the insurance claims registers in both schemes and identified patients who were hospitalised during the period 01/04/2003 to 31/03/2004. Details of their diagnoses, places and costs of treatment and self-reported annual incomes were obtained. There is no single definition of CHE and none of these have been validated. For this research, we used the following definition; "annual hospital expenditure greater than 10% of annual income," to identify those who experienced CHE. Results There were a total of 683 and 3152 hospital admissions at ACCORD and SEWA, respectively. In the absence of the CHI scheme, all of the patients at ACCORD and SEWA would have had to pay OOP for their hospitalisation. With the CHI scheme, 67% and 34% of patients did not have to make any out-of-pocket (OOP payment for their hospital expenses at ACCORD and SEWA, respectively. Both CHI schemes halved the number of households that would have experienced CHE by covering hospital costs. However, despite this, 4% and 23% of households with admissions still experienced CHE at ACCORD and SEWA, respectively. This was related to the following conditions: low annual income, benefit

  13. National Health Insurance Scheme: How Protected Are Households in Oyo State, Nigeria from Catastrophic Health Expenditure?

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    Olayinka Stephen Ilesanmi

    2014-05-01

    Full Text Available Background The major objective of the National Health Insurance Scheme (NHIS in Nigeria is to protect families from the financial hardship of large medical bills. Catastrophic Health Expenditure (CHE is rampart in Nigeria despite the take-off of the NHIS. This study aimed to determine if households enrolled in the NHIS were protected from having CHE. Methods The study took place among 714 households in urban communities of Oyo State. CHE was measured using a threshold of 40% of monthly non-food expenditure. Descriptive statistics were done, Principal Component Analysis was used to divide households into wealth quintiles. Chi-square test and binary logistic regression were done. Results The mean age of household respondent was 33.5 years. The median household income was 43,500 naira (290 US dollars and the range was 7,000–680,000 naira (46.7–4,533 US dollars in 2012. The overall median household healthcare cost was 890 naira (5.9 US dollars and the range was 10-17,700 naira (0.1–118 US dollars in 2012. In all, 67 (9.4% households were enrolled in NHIS scheme. Healthcare services was utilized by 637 (82.9% and CHE occurred in 42 (6.6% households. CHE occurred in 14 (10.9% of the households in the lowest quintile compared to 3 (2.5% in the highest wealth quintile (P= 0.004. The odds of CHE among households in lowest wealth quintile is about 5 times. They had Crude OR (CI: 4.7 (1.3–16.8, P= 0.022. Non enrolled households were two times likely to have CHE, though not significant Conclusion Households in the lowest wealth quintiles were at higher risk of CHE. Universal coverage of health insurance in Nigeria should be fast-tracked to give the expected financial risk protection and decreased incidence of CHE.

  14. Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

    Science.gov (United States)

    Piroozi, Bakhtiar; Moradi, Ghobad; Nouri, Bijan; Mohamadi Bolbanabad, Amjad; Safari, Hossein

    2016-01-01

    Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. Methods: A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. Results: The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. Conclusion: The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform

  15. Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

    Directory of Open Access Journals (Sweden)

    Bakhtiar Piroozi

    2016-07-01

    Full Text Available Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE after the implementation of HSEP and the factors that determine CHE. Methods: A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. Results: The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. Conclusion: The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of

  16. Maternity or catastrophe: a study of household expenditure on maternal health care in India

    OpenAIRE

    2013-01-01

    Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in urban and rural areas separately. Additionally, it measures the effect of maternal health care expenditure on poverty incidence and examines the factors associated with such impoverishment due to maternal health care payments. We found that maternal health care expenditure in urban ...

  17. Pathways to catastrophic health expenditure for acute coronary syndrome in Kerala: ‘Good health at low cost’?

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    Daivadanam Meena

    2012-04-01

    Full Text Available Abstract Background Universal health coverage through the removal of financial and other barriers to access, particularly for people who are poor, is a global priority. This viewpoint describes the many pathways to catastrophic health expenditure (CHE for patients with Acute Coronary Syndrome (ACS based on two case studies and the thematic analysis of field notes regarding 210 patients and their households from a study based in Kerala, India. Discussion There is evidence of the severe financial impact of non-communicable diseases (NCDs, which is in contradiction to the widely acclaimed Kerala model: Good health at low cost. However, it is important to look beyond the out-of-pocket expenditure (OOPE and CHE to the possible pathways and identify the triggers that make families vulnerable to CHE. The identified pathways include a primary and secondary loop. The primary pathway describes the direct path by which families experience CHE. These include: 1 factors related to the pre-event period that increase the likelihood of experiencing CHE, such as being from the lower socio-economic strata (SES, past financial losses or loans that leave families with no financial shock absorber at the time of illness; 2 factors related to the acute event, diagnosis, treatment and hospitalization and expenditures incurred for the same and; 3 factors related to the post-event period such as loss of gainful employment and means of financing both the acute period and the long-term management particularly through distress financing. The secondary pathway arises from the primary and includes: 1 the impact of distress financing and; 2 the long- and short- term consequences of CHE. These factors ultimately result in a vicious cycle of debt and poverty through non-compliance and repeat acute events. Summary This paper outlines the direct and indirect pathways by which patients with ACS and their families are trapped in a vicious cycle of debt and poverty. It also

  18. Household economic impact of an emerging disease in terms of catastrophic out-of-pocket health care expenditure and loss of productivity: investigation of an outbreak of chikungunya in Orissa, India catastrophic out-of-pocket health care expenditure and loss of productivity: investigation of an outbreak of chikungunya in Orissa, India

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    Saji Saraswathy Gopalan

    2009-02-01

    Full Text Available Background & objectives: To examine the household economic impact of an outbreak of chikungunya in terms of out-of-pocket health care expenditure and income foregone due to loss of productive time in Orissa, India.Methods: Structured interviews were conducted on 150 respondents, bread winners from the affected households of a village with maximum number of reported cases in the state, during August 2007. We looked at the economic profile, treatment history, and patient-side cost of care, loss of productivity and consequent income loss.Results: The median out-of-pocket health care expenditure was US$ 84, of which the proportion of cost of diagnosis was the highest (US$ 77. One hundred and forty nine respondents incurred cost of care more than 10% of their monthly household income (catastrophic health expenditure. The median catastrophic health care expenditure was 37%. The respondents depended more on private health care providers (49% and 31% of them accessed care from both public and private health care providers. The median work days lost was 35 with a consequent loss of income of US$ 75.Interpretation & conclusion: Outbreak of an emerging disease creates unforeseen catastrophic health care expenditure and reinforcing the poverty ill-health nexus. The priorities of tackling emerging diseases should include; discretionary public health spending, financial protection against the cost of illness and productivity with special emphasis on people living on daily wages with less financial reserves, and further research on therapeutic measures to reduce the duration of suffering and consequent economic loss.

  19. National Health Expenditure Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — National Health Expenditure Accounts are comprised of the following, National Health Expenditures - Historical and Projected, Age Estimates, State Health...

  20. Catastrophic health expenditure: a comparative analysis of empty-nest and non-empty-nest households with seniors in Shandong, China

    Science.gov (United States)

    Yang, Tingting; Chu, Jie; Zhou, Chengchao; Medina, Alexis; Li, Cuicui; Jiang, Shan; Zheng, Wengui; Sun, Liyuan; Liu, Jing

    2016-01-01

    Objective The aim of this study was to compare the catastrophic health expenditure (CHE) prevalence and its determinants between empty-nest and non-empty-nest elderly households. Setting Shandong province of China. Participants A total of 2761 elderly households are included in the analysis. Results CHE incidence among elderly households was 44.9%. The CHE incidence of empty-nest singles (59.3%, p=0.000, OR=3.19) and empty-nest couples (52.9%, p=0.000, OR=2.45) are both statistically higher than that of non-empty-nest elderly households (31.4%). An inverse association was observed between CHE incidence and income level in all elderly household types. Factors including 1 or more household elderly members with non-communicable chronic diseases in the past 6 months, 1 or more elderly household members being hospitalised in the past year and lower household income, are significant risk factors for CHE in all 3 household types (p<0.05). Health insurance status was found to be a significant determinant of CHE among empty-nest singles and non-empty-nest households (p<0.05). Conclusions CHE incidence among elderly households is high in China. Empty-nest households are at higher risk for CHE than non-empty-nest households. Based on these findings, we suggest that special insurance be developed to broaden the coverage of health services and heighten the reimbursement rate for empty-nest elderly in the existing health insurance schemes. Financial and social protection interventions are also essential for identified at-risk subgroups among different types of elderly households. PMID:27381206

  1. National Health Expenditures - Historical

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Health Expenditure Accounts (NHEA) are the official estimates of total health care spending in the United States. Historical spending measures annual...

  2. Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China

    Institute of Scientific and Technical Information of China (English)

    Chengchao Zhou; Qian Long; Jiaying Chen; Li Xiang; Qiang Li; Shenglan Tang; Fei Huang

    2016-01-01

    Background:Tuberculosis (TB) often causes catastrophic economic effects on both the individual suffering the disease and their households.A number of studies have analyzed patient and household expenditure on TB care,but there does not appear to be any that have assessed the incidence,intensity and determinants of catastrophic health expenditure (CHE) relating to TB care in China.That will be the objective of this paper.Methods:The data used for this study were derived from the baseline survey of the China Government-Gates Foundation TB Phase Ⅱ program.Our analysis included 747 TB cases.Catastrophic health expenditure for TB care was estimated using two approaches,with households defined as experiencing CHE if their annual expenditure on TB care:(a) exceeded 10 % of total household income;and (b) exceeded 40 % of their non-food expenditure (capacity to pay).Chi-square tests were used to identify associated factors and logistic regression analysis to identify the determinants of CHE.Results:The incidence of CHE was 66.8 % using the household income measure and 54.7 % using non-food expenditure (capacity to pay).An inverse association was observed between CHE rates and household income level.Significant determinants of CHE were:age,household size,employment status,health insurance status,patient income as a percentage of total household income,hospitalization and status as a minimum living security household.Factors including gender,marital status and type of TB case had no significant associations with CHE.Conclusions:Catastrophic health expenditure incidence from TB care is high in China.An integrated policy expanding the free treatment package and ensuring universal coverage,especially the height of UHC for TB patients,is needed.Financial and social protection interventions are essential for identified at-risk groups.

  3. Household catastrophic healthcare expenditure and impoverishment due to rotavirus gastroenteritis requiring hospitalization in Malaysia.

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    Tharani Loganathan

    Full Text Available While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking.We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia.A two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur and rural (Kuala Terengganu setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained.Of the 658 stool samples collected at both centers, 248 (38% were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; p<0.001. The mean direct and indirect costs for rotavirus gastroenteritis consisted 20% of monthly household income in Kuala Lumpur, as compared with only 5% in Kuala Terengganu. Direct medical costs paid out-of-pocket caused 141 (33% households in Kuala Lumpur to experience catastrophic expenditure and 11 (3% households to incur poverty. However in Kuala Terengganu, only one household (0.5% experienced catastrophic healthcare expenditure and none were impoverished. The lowest income quintile in Kuala Lumpur was more likely to experience catastrophic payments compared to the highest quintile (87% vs 8%. The concentration index for out-of-pocket healthcare payments was closer to zero at Kuala Lumpur (0.03 than at Kuala Terengganu (0.24.While urban households were wealthier, healthcare expenditure due to gastroenteritis had more catastrophic and poverty impact on the urban poor. Universal rotavirus vaccination would reduce both disease burden and health

  4. A study to assess catastrophic household expenditure on childhood illness in an urban slum in Bijapur

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    Patil Shailaja

    2009-01-01

    Full Text Available Objective: In this study, the various factors determining the out-of-pocket expenditure on child health care by households are discussed to answer the following questions: How much are households currently spending on child health care? Is there any role of socio-economic status of households on expenditure on child health care? What percentage of their income is spent on child health care and is it catastrophic? Materials and Methods: Four slums with a total a population of 7000 were selected for this study. Households where there is history of illness/ sickness in children under 5 years in last one month were included in the study. Results: There were a total of 218 episodes of child illness in the households. The household′s belonging to socio- economic class I and II had higher spending on child′s illness per episode as compared to households of socio- economic class III, IV, and V. Socioeconomic status was the key determinant of health care expenditure. Conclusion: In this study, it has been found that almost all the households suffered from catastrophic health expenditure.

  5. National health expenditures, 1999.

    Science.gov (United States)

    Cowan, C A; Lazenby, H C; Martin, A B; McDonnell, P A; Sensenig, A L; Smith, C E; Whittle, L S; Zezza, M A; Donham, C S; Long, A M; Stewart, M W

    2001-01-01

    The health care spending share of gross domestic product (GDP) remained steady between 1993 and 1999 as moderate-to-strong economic growth coincided with a rapid shift to managed care. This shift, along with decelerating growth in Medicare spending, appears to have generated a mostly one-time saving that lowered aggregate health expenditure growth.

  6. National Health Expenditures, 1979

    OpenAIRE

    Gibson, Robert M

    1980-01-01

    Outlays for health care in the nation reached $212.2 billion in calendar year 1979—12.5 percent higher than in 1978, according to preliminary figures compiled by the Health Care Financing Administration. This estimate represented $943 per person in the United States and was equal to 9.0 percent of the Gross National Product. This latest report in the annual series representing national health expenditures provides detailed estimates of health care spending by type of service and method of fin...

  7. Catastrophic Health Expenditure amongst People Living with HIV/AIDS Availing Antiretroviral Treatment Services at Two Tertiary Care Health Facilities in District of Northern India

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    Mukesh Shukla, Monika Agarwal, Jai Vir Singh, Anil Kumar Tripathi, Anand Kumar Srivastava, Vijay Kumar Singh

    2015-01-01

    Conclusions: Decentralisation of ART programme up to grass root level, integration of HIV/AIDS-related services into primary health care services and bridging of the loop holes like effective convening of various government benefit schemes to patients during their visit to ART centre and there by promoting utilisation could reduce their financial burden for care and treatment."

  8. National Health Expenditures - State (Residence)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Health Expenditure Accounts (NHEA) are the official estimates of total health care spending in the United States. Personal health care (PHC)...

  9. National Health Expenditures - State (Provider)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Health Expenditure Accounts (NHEA) are the official estimates of total health care spending in the United States. Personal health care (PHC)...

  10. Health-related financial catastrophe, inequality and chronic illness in Bangladesh.

    Directory of Open Access Journals (Sweden)

    Md Mizanur Rahman

    Full Text Available BACKGROUND: Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk. OBJECTIVE: This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe. METHODS: A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively. RESULTS: On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults. CONCLUSION: Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by

  11. Household catastrophic healthcare expenditure and impoverishment due to rotavirus gastroenteritis requiring hospitalization in malaysia.

    OpenAIRE

    Tharani Loganathan; Way-Seah Lee; Kok-Foo Lee; Mark Jit; Chiu-Wan Ng

    2015-01-01

    Background While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking. Objectives We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia. Methods A...

  12. Health Care Expenditure of Rural Households in Pondicherry, India

    Directory of Open Access Journals (Sweden)

    Poornima Varadarajan

    2013-11-01

    Full Text Available Background: Shortcomings in healthcare delivery has led people to spend a substantial proportion of their incomes on medical treatment. World Health Organization (2005 estimates reveal that every year 25 million households are forced into poverty by illness and the struggle to pay for healthcare. Thus we planned to calculate the health care expenditure of rural households and to assess the households incurring catastrophic health expenditure. Methods: A cross-sectional study was conducted in the service area of Sri Manakula Vinayagar Medical College and Hospital from May to August 2011. A total of 100 households from the 4 adjoining villages of our Institute were selected for operational and logistic feasibility. The household’s capacity to pay, out of pocket expenditure and catastrophic health expenditure were calculated. Data collection was done using a pretested questionnaire by the principal investigator and the analysis was done using SPSS (version 16. Results: The average income in the highest income quintile was Rs 51,885 but the quintile ratio was 14.98. The median subsistence expenditure was Rs 4,520. About 18% of households got impoverished paying for health care. About 81% of households were incurring out of pocket expenditure and 66% were facing catastrophic health expenses of 40%.Conclusion There was very high out of pocket spending and a high prevalence of catastrophic expenditure noted. Providing quality care at affordable cost and appropriate risk pooling mechanism are warranted to protect households from such economic threats.

  13. Equity in Health Care Expenditure in Nigeria

    Directory of Open Access Journals (Sweden)

    Olanrewaju Olaniyan

    2013-07-01

    Full Text Available Equity isone of the basic principles of health systems and features explicitly in theNigerian health financing policy. Despite acclaimed commitment to theimplementation of this policy through various pro-poor health programmes andinterventions, the level of inequity in health status and access to basichealth care interventions remain high. This paper examines the equity of healthcare expenditure by individuals in Nigeria. The paper evaluated equity in out-of-pocketspending( OOP for the country and separately for the six geopolitical zones ofthe country.The methodological framework rests onKakwani Progressivity Indices (KPIs, ReynoldSmolensky indices andconcentration indices (CIs using data from the 2004 Nigerian National LivingStandard Survey( NLSS collected by the National Bureau of Statistics. .The results reveal that health financing isregressive with the incidence disproportionately rest on poor households withabout 70% of the total expenditure on health is through out-of-pocket paymentsby households. Poor households are prone to bear most of the expenses in theevent of any health shock. The catastrophic consequences thus push some intopoverty, and aggravate the poverty of others.The paper therefore suggests that thecountry’s health financingsystems must be designed not only to allow people to access services when theyare needed, but must also protect household, from financial catastrophe, byreducing OOP spending through risk pooling and prepayment schemes within thehealth system.Keywords:                            Equity, Health careexpenditure, Kakwani progressivity index, Nigeria.

  14. Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean Countries Gastos catastróficos en salud de los hogares: un análisis comparativo de doce países en América Latina y el Caribe

    Directory of Open Access Journals (Sweden)

    Felicia Marie Knaul

    2011-01-01

    Full Text Available OBJECTIVE: Compare patterns of catastrophic health expenditures in 12 countries in Latin America and the Caribbean. MATERIAL AND METHODS: Prevalence of catastrophic expenses was estimated uniformly at the household level using household surveys. Two types of prevalence indicators were used based on out-of-pocket health expense: a relative to an international poverty line, and b relative to the household's ability to pay net of their food basket. Ratios of catastrophic expenditures were estimated across subgroups defined by economic and social variables. RESULTS: The percent of households with catastrophic health expenditures ranged from 1 to 25% in the twelve countries. In general, rural residence, lowest quintile of income, presence of older adults, and lack of health insurance in the household are associated with higher propensity of catastrophic health expenditures. However, there is vast heterogeneity by country. CONCLUSIONS: Cross national studies may serve to examine how health systems contribute to the social protection of Latin American households.OBJETIVO: Comparar los patrones de gastos catastróficos en salud en 12 países de América Latina y el Caribe. MATERIAL Y MÉTODOS: Se estimó la prevalencia de gastos catastróficos de manera uniforme para doce países usando encuestas de hogares. Se emplearon dos tipos de indicadores para medir la prevalencia basados en el gasto de bolsillo en salud: a en relación con una línea de pobreza internacional; y b en relación con la capacidad de pago del hogar en términos de su propia canasta alimentaria. Se estimaron razones para comparar el nivel de gastos catastróficos entre subgrupos poblacionales definidos por variables económicas y sociales. RESULTADOS: El porcentaje de hogares con gastos catastróficos variaron de 1 a 25% en los 12 países. En general, la residencia rural, el bajo nivel de ingresos, la presencia de adultos mayores, y la carencia de aseguramiento en salud de los hogares

  15. Kidney transplantation is associated with catastrophic out of pocket expenditure in India.

    Directory of Open Access Journals (Sweden)

    Raja Ramachandran

    Full Text Available Kidney transplantation (KT is only viable renal replacement option for most patients in India. Most patients do not have health insurance and meet treatment expenditure from their own resources. We prospectively evaluated the expenses associated with KT and its impact on the socioeconomic status of families in a public hospital. All direct and indirect expenses incurred by the patients from the time of diagnosis of chronic kidney disease to KT were recorded. Direct expenses included physician fees, cost of drugs and disposables, dialysis, and expenses on investigations and hospitalization. Indirect expenses included travel, food, stay, and loss of income suffered by the family. Educational dropout and financial loss were also recorded. There were 43 males and 7 females between the ages of 12 and 57 years. Direct expenses ranged from US$ 2,151-23,792 and accounted for two-thirds of the total expenses. Pre-referral hospitalization, dialysis and medication accounted for majority of direct expense. Indirect expenses ranged from US$ 226-15,283. Travel expenses and loss of income accounted for most of indirect expense. About 54%, 8%, and 10% of families suffered from severe, moderate, and some financial crisis respectively. A total of 38 families had job losses, and 1 patient and 12 caregivers dropped out of studies. To conclude, KT is associated with catastrophic out-of-pocket expenditure and pushes a majority of the patients who come for treatment to public hospitals into severe financial crisis. Educational dropout and loss of jobs are other major concerns. Systematic efforts are required to address these issues.

  16. The Effects of Intellectual Property Rights on Access to Medicines and Catastrophic Expenditure.

    Science.gov (United States)

    Jung, Youn; Kwon, Soonman

    2015-01-01

    Since the introduction of Trade-Related Aspects of Intellectual Property Rights (TRIPS) in 1995, there has been considerable concern that poor access to essential medicines in developing countries would be exacerbated because strengthening intellectual property rights (IPR) leads to monopoly of pharmaceutical markets and delayed entry of lower-cost generic drugs. However, despite extensive research and disputes regarding this issue, there are few empirical studies on the topic. In this study, we investigated the effect of IPR on access to medicines and catastrophic expenditure for medicines, using data from World Health Surveys 2002-2003. The index of patent rights developed by Ginarte and Park (1997) was used to measure the IPR protection level of each country. Estimates were adjusted for individual and country characteristics. In the results of multilevel logistic regression analyses, higher level of IPR significantly increased the likelihood of nonaccess to prescribed medicines even after controlling for individual socioeconomic status and national characteristics associated with access to medicines. This study's finding on the negative impact of IPR on access to medicines calls for the implementation of more active policy at the supra-national level to improve access in low- and middle-income countries. PMID:26077858

  17. Incentives of Health Care Expenditure

    Directory of Open Access Journals (Sweden)

    Eero Siljander

    2012-12-01

    Full Text Available The incentives of health care expenditure (HCE have been a topic of discussion in the USA (Obama reforms and in Europe (adjustment to debt crisis. There are competing views of institutional versus GDP (unit income elasticity and productivity related factors of growth of expenditure. However ageing of populations, technology change and economic incentives related to institutions are also key drivers of growth according to the OECD and EU’s AWG committee. Simulation models have been developed to forecast the growth of social expenditure (including HCEs to 2050. In this article we take a historical perspective to look at the institutional structures and their relationship to HCE growth. When controlling for age structure, price developments, doctor density and in-patient and public shares of expenditures, we find that fee-for-service in primary care, is according to the results, in at least 20 percent more costly than capitation or salary remuneration. Capitation and salary (or wage remuneration are at same cost levels in primary care. However we did not find the cost lowering effect for gatekeeping which could have been expected based on previous literature. Global budgeting 30 (partly DRG based percent less costly in specialized care than other reimbursement schemes like open contracting or volume based reimbursement. However the public integration of purchaser and provider cost seems to result to about 20 higher than public reimbursement or public contracting. Increasing the number of doctors or public financing share results in increased HCEs. Therefore expanding public reimbursement share of health services seems to lead to higher HCE. On the contrary, the in-patient share reduced expenditures. Compared to the previous literature, the finding on institutional dummies is in line with similar modeling papers. However the results for public expansion of services is a contrary one to previous works on the subject. The median lag length of

  18. Patterns of Health Expenditures and Financial Protections in Vietnam 1992-2012.

    Science.gov (United States)

    Hoang, Van Minh; Oh, Juhwan; Tran, Tuan Anh; Tran, Thi Giang Huong; Ha, Anh Duc; Luu, Ngoc Hoat; Nguyen, Thi Kim Phuong

    2015-11-01

    Health financing has been considered as an important building block of a health system and has a key role in promoting universal health coverage in the Vietnam. This paper aims to describe the pattern of health expenditure, including total health expenditure and composition of health expenditure, over the last two decades in Vietnam. The paper mainly uses the data from Vietnam National Health Account and Vietnam Living Standards Survey. We also included data from other relevant published literature, reports and statistics about health care expenditure in Vietnam. The per capita health expenditure in Vietnam increased from US$ 14 in 1995 to US$ 86 in 2012. The total health expenditure as a share of GDP also rose from 5.2% in 1995 to 6.9% in 2012. Public health expenditure as percentage of government expenditure rose from 7.4% in 1995 to nearly 10% in 2012. The coverage of health insurance went up from 10% in 1995 to 68.5% in 2012. However, health financing in Vietnam was depending on private expenditures (57.4% in 2012). As a result, the proportion of households with catastrophic expenditure in 2012 was 4.2%. The rate of impoverishment in 2012 was 2.5%. To ensure equity and efficient goal of health system, policy actions for containing the health care out-of-pocket payments and their poverty impacts are urgently needed in Vietnam.

  19. The concentration of health care expenditures, revisited.

    Science.gov (United States)

    Berk, M L; Monheit, A C

    2001-01-01

    In two previous publications, we described the distribution of health care expenditures among the civilian, noninstitutionalized U.S. population, specifically in terms of the share of aggregate expenditures accounted for by the top spenders in the distribution. Our focus revealed considerably skewed distribution, with a relatively small proportion of the population accounting for a large share of expenditures. In this paper we update our previous tabulations (last computed using data more than a decade old) with new data from the 1996 Medical Expenditure Panel Survey (MEPS). Our findings show that the skewed concentration of health care expenditures has remained very stable; 5 percent of the population accounts for the majority of health expenditures.

  20. Corruption and health expenditure in Italy

    OpenAIRE

    Lagravinese, Raffaele; Paradiso, Massimo

    2012-01-01

    The vulnerability of health sector to corruption lies in the complex interaction between the social environment and the institutional setting of health systems. We investigate this interaction in the case of Italy, speci�cally looking at the impact of corruption on health expenditure. In Italy corruption is a social phenomenon. Health sector has been often involved in corruption o¤ences and decentralized health expenditure is considerably out of control. We show that the impact of corrupti...

  1. Modeling Per Capita State Health Expenditure Variat...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Modeling Per Capita State Health Expenditure Variation State-Level Characteristics Matter, published in Volume 3, Issue 4, of the Medicare and Medicaid Research...

  2. Impacto del Seguro Popular en el gasto catastrófico y de bolsillo en el México rural y urbano, 2005-2008 Impact of “Seguro Popular” on catastrophic and out-of-pocket health expenditures in rural and urban Mexico, 2005-2008

    Directory of Open Access Journals (Sweden)

    Sandra G Sosa-Rubí

    2011-01-01

    Full Text Available OBJETIVO. Estimar el efecto del Seguro Popular (SP sobre la incidencia del gasto catastrófico en salud (GCS y sobre el gasto de bolsillo en salud (GBS en el mediano plazo. MATERIAL Y MÉTODOS. Con base en la Encuesta de Evaluación del Seguro Popular (2005-2008, se analizaron los resultados del efecto del SP en la cohorte rural para dos años de seguimiento (2006 y 2008 y en la cohorte urbana para un año (2008. RESULTADOS. A nivel conglomerado no se detectaron efectos del SP. A nivel hogar se encontró que el SP tiene un efecto protector en el GCS y en el GBS en consulta externa y hospitalización en zonas rurales; y efectos significativos en la reducción de GBS en consulta externa en zonas urbanas. CONCLUSIONES. El SP se muestra como un programa efectivo para proteger a los hogares contra gastos de bolsillo por motivos de salud en el mediano plazo.OBJECTIVE. To estimate the effect of "Seguro Popular" (SP on the incidence of catastrophic health expenditure (CHE and out-of-pocket (OOP health expenditure in the medium term. MATERIAL AND METHODS. We used the 'Encuesta de Evaluación del SP' -SP Survey Evaluation- (2005-2008. We analyzed the SP effect on the rural cohort during two years of follow-up (2006 and 2008 and in the urban cohort during one year of follow-up (2008. RESULTS. At the local level (regional clusters we did not find an effect of the SP. At the household level we found a protective effect of SP on CHE and the OOP health payments in outpatient and hospitalization in rural areas; and a significant effect on the reduction of OOP health payments in outpatient services in urban zones. CONCLUSIONS. SP seems to be an effective program to protect poor household against out-of-pocket health expenditures in the medium term.

  3. Retirement Age and Health Expenditures

    OpenAIRE

    CREMER, Helmuth; Lozachmeur, Jean-Marie; PESTIEAU, Pierre

    2004-01-01

    This Paper studies the design of pension benefits and contributions when an individual’s health status (disutility of continued activity) is endogenous and depends on consumption of health services. Health services can be subsidized (in a linear or non-linear way, depending on the information structure). Uniform public provision of health services is also considered. We show that as with exogenous health status, the second-best policy may induce early retirement for some types of individuals....

  4. Aging Risk and Health Care Expenditure in Korea

    OpenAIRE

    Sang-Ho Nam; Byongho Tchoe

    2010-01-01

    This paper analyzes the impact of population aging on health care expenditures in Korea. Examination of the age-expenditure profile reveals that health care resources are allocated more for the older cohort of population over time, suggesting significant growth of health care expenditures due to population aging. We contend, however, that population aging is considered as a parameter rather than an independent variable to explain rising health care expenditures. This paper shows that populati...

  5. Health care expenditure in Sweden--an international comparison.

    Science.gov (United States)

    Gerdtham, U G; Jönsson, B

    1991-01-01

    This paper analyses health care expenditure in Sweden and compares this with the corresponding expenditure in OECD countries. The definition and measurement problems of health care expenditure are discussed, new figures for the development of health care expenditure are presented and different measures of health care expenditure are provided. We found that health care expenditure has increased by about 20% in constant prices for Sweden between 1980 and 1988, but that health care expenditure as a share of the GDP has dropped during the same period in current prices. Health care expenditure disaggregated on different age groups show for Sweden that in the age group 15-64 years, health care expenditure has not increased in constant prices between 1976 and 1985, but in the oldest age group, health care expenditure has increased considerable during this period. Health care expenditure in Sweden is as high as would be expected, taking into account the degree of economic development and the growth of expenditure during the 80s, and has followed that in comparable OECD countries. However, the relative price is lower, which means that the input of real resources are greater than in other countries.

  6. Maternal and neonatal health expenditure in mumbai slums (India: A cross sectional study

    Directory of Open Access Journals (Sweden)

    Joshi Wasundhara

    2011-03-01

    Full Text Available Abstract Background The cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. We analyzed spending on maternity care in urban slum communities in Mumbai to better understand the equity of spending and the impact of spending on household poverty. Methods We used expenditure data for maternal and neonatal care, collected during post-partum interviews. Interviews were conducted in 2005-2006, with a sample of 1200 slum residents in Mumbai (India. We analysed expenditure by socio-economic status (SES, calculating a Kakwani Index for a range of spending categories. We also calculated catastrophic health spending both with and without adjustment for coping strategies. This identified the level of catastrophic payments incurred by a household and the prevalence of catastrophic payments in this population. The analysis also gave an understanding of the protection from medical poverty afforded by coping strategies (for example saving and borrowing. Results A high proportion of respondents spent catastrophically on care. Lower SES was associated with a higher proportion of informal payments. Indirect health expenditure was found to be (weakly regressive as the poorest were more likely to use wage income to meet health expenses, while the less poor were more likely to use savings. Overall, the incidence of catastrophic maternity expenditure was 41%, or 15% when controlling for coping strategies. We found no significant difference in the incidence of catastrophic spending across wealth quintiles, nor could we conclude that total expenditure is regressive. Conclusions High expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context. Differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance spending, all highlight the heavier burden borne by the most poor. If a policy objective

  7. Health expenditures in Latin America and the Caribbean.

    Science.gov (United States)

    Govindaraj, R; Chellaraj, G; Murray, C J

    1997-01-01

    This paper presents the results of a study commissioned by the Latin American and Caribbean Technical Department of the World Bank to document and analyze health expenditures in Latin America and the Caribbean. In 1990, the countries of this region spent US$ 69 billion on health, with an average per capita health expenditure of US$ 162. On average, the countries spent 6.2% of their GDP on health, with the expenditures divided about equally between the public and private sectors. In both the public and private sectors, per capita health expenditures were positively and significantly correlated with per capita income. However, this relationship holds only for the public sector, when health expenditures are measured as a proportion of GDP. While several poorer countries were dependent on external assistance, with increasing income, the countries relied more on public expenditures to finance health care. Based on the limited time series data, it is evident that there was a considerable variation among countries regarding the proportion spent on capital investments, primary health care, and drugs, but not on salaries. Looking ahead, with increasing economic development, the proportion of GDP spent on health, along with public health expenditure as a proportion of total health expenditure, is likely to increase rapidly, while aid dependency is likely to decline. PMID:9015869

  8. Health expenditures in Latin America and the Caribbean.

    Science.gov (United States)

    Govindaraj, R; Chellaraj, G; Murray, C J

    1997-01-01

    This paper presents the results of a study commissioned by the Latin American and Caribbean Technical Department of the World Bank to document and analyze health expenditures in Latin America and the Caribbean. In 1990, the countries of this region spent US$ 69 billion on health, with an average per capita health expenditure of US$ 162. On average, the countries spent 6.2% of their GDP on health, with the expenditures divided about equally between the public and private sectors. In both the public and private sectors, per capita health expenditures were positively and significantly correlated with per capita income. However, this relationship holds only for the public sector, when health expenditures are measured as a proportion of GDP. While several poorer countries were dependent on external assistance, with increasing income, the countries relied more on public expenditures to finance health care. Based on the limited time series data, it is evident that there was a considerable variation among countries regarding the proportion spent on capital investments, primary health care, and drugs, but not on salaries. Looking ahead, with increasing economic development, the proportion of GDP spent on health, along with public health expenditure as a proportion of total health expenditure, is likely to increase rapidly, while aid dependency is likely to decline.

  9. The Chernobyl catastrophe: Consequences on human health

    International Nuclear Information System (INIS)

    This new Greenpeace report estimates that the full consequences of the Chernobyl disaster could top a quarter of a million cancers cases and nearly 100,000 fatal cancers. It reports that the report involved 52 respected scientists and includes information never before published in English. It challenges the International Atomic Energy Agency Chernobyl Forum report, which predicted 4,000 additional deaths attributable to the accident as a gross simplification of the real breadth of human suffering. Their data, based on Belarus national cancer statistics, predicts approximately 270,000 cancers and 93,000 fatal cancer cases caused by Chernobyl. The report also concludes that on the basis of demographic data, during the last 15 years, 60,000 people have additionally died in Russia because of the Chernobyl accident, and estimates of the total death toll for the Ukraine and Belarus could reach another 140,000. The report also looks into the ongoing health impacts of Chernobyl and concludes that radiation from the disaster has had a devastating effect on survivors; damaging immune and endocrine systems, leading to accelerated ageing, cardiovascular and blood illnesses, psychological illnesses, chromosomal aberrations and an increase in foetal deformations

  10. The Chernobyl catastrophe: Consequences on human health

    Energy Technology Data Exchange (ETDEWEB)

    Yablokov, A.; Labunska, I.; Blokov, I.; Santillo, D.; Johnston, P.; Stringer, R.; Sadownichik, T. (eds.); Antipkin, Yu.G. [Institute of Paediatrics, Obstetrics and Gynaecology, Academy of Medical Sciences, Kiev (Ukraine); Arabskaya, L.P. [Institute of Paediatrics, Obstetrics and Gynaecology, Academy of Medical Sciences, Kiev (Ukraine); Bazyka, D.A. [Research Centre for Radiation Medicine, Academy of Medical Sciences, Kiev (Ukraine)] (and others)

    2006-04-15

    This new Greenpeace report estimates that the full consequences of the Chernobyl disaster could top a quarter of a million cancers cases and nearly 100,000 fatal cancers. It reports that the report involved 52 respected scientists and includes information never before published in English. It challenges the International Atomic Energy Agency Chernobyl Forum report, which predicted 4,000 additional deaths attributable to the accident as a gross simplification of the real breadth of human suffering. Their data, based on Belarus national cancer statistics, predicts approximately 270,000 cancers and 93,000 fatal cancer cases caused by Chernobyl. The report also concludes that on the basis of demographic data, during the last 15 years, 60,000 people have additionally died in Russia because of the Chernobyl accident, and estimates of the total death toll for the Ukraine and Belarus could reach another 140,000. The report also looks into the ongoing health impacts of Chernobyl and concludes that radiation from the disaster has had a devastating effect on survivors; damaging immune and endocrine systems, leading to accelerated ageing, cardiovascular and blood illnesses, psychological illnesses, chromosomal aberrations and an increase in foetal deformations.

  11. A snapshot of catastrophic post-disaster health expenses post-Haiyan

    Directory of Open Access Journals (Sweden)

    Noel Espallardo

    2015-11-01

    Full Text Available Introduction: This paper provides a snapshot of the health-care costs, out-of-pocket expenditures and available safety nets post-Typhoon Haiyan. Methods: This descriptive study used a survey and document review to report direct and indirect health-care costs and existing financial protection mechanisms used by households in two municipalities in the Philippines at one week and at seven months post-Haiyan. Results: Reported out-of-pocket health-care expenses were high immediately after the disaster and increased after seven months. The mean reported out-of-pocket expenses were higher than the reported average household income (US$ 24 to US$ 59. Discussion: The existing local and national mechanisms for health financing were promising and should be strengthened to reduce out-of-pocket expenses and protect people from catastrophic expenditures. Longer-term mechanisms are needed to ensure financial protection, especially among the poorest, beyond three months when most free services and medicines have ended. Preparedness should include prior registration of households that would ensure protection when a disaster comes.

  12. Public health expenditure in Spain: is there partisan behaviour?

    OpenAIRE

    Clemente, Jesús; Lazaro, Angelina; Montanes, Antonio

    2016-01-01

    This study examines the disparities in the evolution of Spanish regional public health expenditures from 1991 to 2010. We find that the recent development of the Spanish regional public health system have led the regions to reflect a very heterogeneous pattern of behaviour. These differences depend on economic and demographic factors, but also on the ideology of the regional governments. The longer a region is governed by a right-wing party, the lower the public health expenditure. This resul...

  13. Health Care Use and Expenditures of Medicare HMO Disenrollees

    OpenAIRE

    Stephen T Parente; Evans, William N.; Schoenman, Julie A.; Finch, Michael D.

    2005-01-01

    We examine the impact of the first wave of Medicare health maintenance organization HMO withdrawals. With data from CMS and United Health Group, we estimate use and expenditure changes between 1998 and 1999 for HMO enrollees who were involuntarily dropped from their plan and returned to fee-for-service (FFS) Medicare using a difference-in-difference model. Compared to those who voluntarily left an HMO, involuntarily disenrolled beneficiaries had higher out-of-pocket expenditures, an 80 percen...

  14. Economic impact of chikungunya epidemic: out-of-pocket health expenditures during the 2007 outbreak in Kerala, India.

    Science.gov (United States)

    Vijayakumar, K; George, B; Anish, T S; Rajasi, R S; Teena, M J; Sujina, C M

    2013-01-01

    The southern state of Kerala, India was seriously affected by a chikungunya epidemic in 2007. As this outbreak was the first of its kind, the morbidity incurred by the epidemic was a challenge to the state's public health system. A cross sectional survey was conducted in five districts of Kerala that were seriously affected by the epidemic, using a two-stage cluster sampling technique to select households, and the patients were identified using a syndromic case definition. We calculated the direct health expenditure of families and checked whether it exceed the margins of catastrophic health expenditure (CHE). The median (IQR) total out-of-pocket (OOP) health expenditure in the study population was USD7.4 (16.7). The OOP health expenditure did not show any significant association with increasing per-capita monthly income.The major share (47.4%) of the costs was utilized for buying medicines, but costs for transportation (17.2%), consultations (16.6%), and diagnoses (9.9%) also contributed significantly to the total OOP health expenditure. The OOP health expenditure was high in private sector facilities, especially in tertiary care hospitals. For more than 15% of the respondents, the OOP was more than double their average monthly family income. The chikungunya outbreak of 2007 had significantly contributed to the OOP expenditure of the affected community in Kerala.The OOP health expenditure incurred was high, irrespective of the level of income. Governments should attempt to ensure comprehensive financial protection by covering the costs of care, along with loss of productivity. PMID:23682438

  15. Health expenditures in major industrialized countries, 1960-87

    Science.gov (United States)

    Schieber, George J.

    1990-01-01

    In this article, levels and changes in health care expenditures for Canada, France, the Federal Republic of Germany, Italy, Japan, the United Kingdom, and the United States are analyzed. First, the levels and changes in the share of gross domestic product (GDP) devoted to health are reviewed in terms of the health-to-GDP ratio, nominal health expenditure and GDP growth, and changes in population and prices. Second, absolute levels of health spending denominated in U.S. dollars are compared over time. Finally, some concluding observations are made. PMID:10113400

  16. The Causal Relationship between Health and Education Expenditures in Malaysia

    Directory of Open Access Journals (Sweden)

    Chor Foon TANG

    2011-08-01

    Full Text Available A major macroeconomic policy in generating economic growth is to encourage investments on human capital such as health and education. This is because both health and education make significant contribution to increasing productivity of the labour force which ultimately exerts a positive effect on raising output levels. A question that arises is whether investments on health and education have a causal relationship and if so, what is the directional causality? The objective of this study is to examine the causal relationship between health and education expenditures in Malaysia. This study covered annual data from 1970 to 2007. Using Granger causality as well as Toda and Yamamoto MWALD causality approaches, this study suggests that education Granger-causes health expenditure in both the short run and long run. The findings of this study implied that the Malaysian society places preference on education expenditure rather than health. This preference is not unexpected as generally, an educated and knowledgeable society precedes a healthy one. Before a society has attained a relatively higher level of education, it is less aware of the importance of health. Thus, expenditure on education should lead expenditure on health.

  17. Health Sector:Public Expenditure Review 2010/11

    OpenAIRE

    Kikuli, Regina; Ally, Mariam

    2012-01-01

    The main objective of Health Sector Public Expenditure Review for fiscal year (FY) 2011 (PER FY11) was to assess the budgetary allocations and expenditures to inform stakeholders about progress made in key health financing milestones over the 2006/07–2011/12 period. Specifically, the Health Sector PER sets out to provide: A review of PER FY10 findings and actions taken by the sector in response to those findings, indicating unaccomplished/pending actions, and identifying follow-up actions fo...

  18. Energy Expenditure in Infants in Health and Disease

    Directory of Open Access Journals (Sweden)

    Ross Shepherd

    1997-01-01

    Full Text Available Measurement of energy balance represents a basic theoretical concept in the determination of nutritional and fluid requirements in humans in health and disease. Infants have special nutrient requirements, more limited reserves and relative immaturity of organ function. Energy requirements of infants have been based either retrospectively on intakes required to achieve normal growth or on equations derived from energy expenditure studies performed early this century. Recently, improved techniques for studying resting energy expenditure (REE, total energy expenditure (TEE and metabolically active body compartments in infants have facilitated more accurate estimates of energy requirements. Such studies indicated that current reference values for energy requirements are overestimates, and that compared with measured values, predicted values vary markedly between the various predictive equations with wide co-efficients of variation. In disease states with altered body composition, such as cystic fibrosis and end-stage liver disease, predictive equations markedly underestimate both energy and fluid requirements. In cystic fibrosis, both TEE and REE are 25% higher than values in healthy infants. In extrahepatic biliary atresia, energy expenditure per unit body cell mass is markedly elevated, suggesting that this is a catabolic condition in infants. Current estimates of energy and fluid requirements in both health and disease in infants need reappraisal. Bedside and free living energy expenditure methodology should be used to define accurately components of energy requirement in individual infants.

  19. Health Literacy Impact on National Healthcare Utilization and Expenditure

    Directory of Open Access Journals (Sweden)

    Rafia Rasu

    2015-11-01

    Full Text Available Background Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL on healthcare utilization and healthcare expenditure. Methods Database analysis used Medical Expenditure Panel Survey (MEPS from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL. HLS ranged from 0-500. Health literacy level (HLL and categorized in 2 groups: Below basic or basic (HLS <226 and above basic (HLS ≥226. Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI. A Pvalue of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA®11.0 statistical software. Results The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%. Caucasian were the predominant racial ethnic group (83% and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05. The extrapolated national

  20. Projections of national health expenditures through the year 2000

    OpenAIRE

    Sonnefeld, Sally T.; Waldo, Daniel R.; Lemieux, Jeffrey A.; McKusick, David R.

    1991-01-01

    In this article, the authors present a scenario for health expenditures during the 1990s. Assuming that current laws and practices remain unchanged, the Nation will spend $1.6 trillion for health care in the year 2000, an amount equal to 16.4 percent of that year's gross national product. Medicare and Medicaid will foot an increasing share of the Nation's health bill, rising to more than one-third of the total. The factors accounting for growth in national health spending are described as wel...

  1. 30 years life with Chernobyl, 5 years life with Fukushima. Health consequences of the nuclear catastrophes of Chernobyl and Fukushima

    International Nuclear Information System (INIS)

    The IPPNW report on health consequences of the nuclear catastrophes of Chernobyl and Fukushima covers the following issues: Part.: 30 years life with Chernobyl: Summarized consequences of Chernobyl, the accident progression, basic data of the catastrophe, estimation of health hazards as a consequence of the severe accident of Chernobyl, health consequences for the liquidators, health consequences for the contaminated population, mutagenic and teratogenic effects. Part B: 5 years life with Fukushima: The start of the nuclear catastrophe, emissions and contamination, consequences of the nuclear catastrophe on human health, thyroid surveys in the prefecture Fukushima, consequences of the nuclear catastrophe on the ecosystem, outlook.

  2. Forecasting drug utilization and expenditure in a metropolitan health region

    OpenAIRE

    Korkmaz Seher; Kalin Mats; Wilking Nils; Persson Marie E; Wettermark Björn; Hjemdahl Paul; Godman Brian; Petzold Max; Gustafsson Lars L

    2010-01-01

    Abstract Background New pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning), forecasting of drug utilization and expenditure, critica...

  3. Determinants of Regional Variation in Health Expenditures in Germany.

    Science.gov (United States)

    Göpffarth, Dirk; Kopetsch, Thomas; Schmitz, Hendrik

    2016-07-01

    Health care expenditure in Germany shows clear regional differences. Such geographic variations are often seen as an indicator for inefficiency. With its homogeneous health care system, low co-payments and uniform prices, Germany is a particularly suited example to analyse regional variations. We use data for the year 2011 on expenditure, utilization of health services and state of health in Germany's statutory health insurance system. This data, which originate from a variety of administrative sources and cover about 90% of the population, are enriched with a wealth of socio-economic variables, data on pollutants, prices and individual preferences. State of health and demography explains 55% of the differences as measured by the standard deviation while all control variables account for a total of 72% of the differences at county level. With other measures of variation, we can account for an even greater proportion. A higher proportion of variation than usually supposed can thus be explained. Whilst this study cannot quantify inefficiencies, our results contradict the thesis that regional variations reflect inefficiency. Copyright © 2015 John Wiley & Sons, Ltd. PMID:25962986

  4. What drives public health care expenditure growth? Evidence from Swiss cantons, 1970-2012.

    Science.gov (United States)

    Braendle, Thomas; Colombier, Carsten

    2016-09-01

    A better understanding of the determinants of public health care expenditures is key to designing effective health policies. We integrate demand and supply-side determinants and factors from political economy into an empirical analysis of the highly decentralized Swiss health care system and control for major health care finance reforms. We compile a novel data set of the cantonal health care expenditure in Switzerland, which currently amounts to about one fifth of total health care expenditure. We analyze the period 1970-2012 and use dynamic panel estimation methods. We find that per capita income, the unemployment rate and the share of foreigners are positively related to public health care expenditure growth. With regard to political economy aspects, public health care expenditures increase with the share of women elected to parliament. However, institutional restrictions for politicians, such as fiscal rules, do not appear to limit public health care expenditure growth. PMID:27496155

  5. The impact of changes in county public health expenditures on general health in the population.

    Science.gov (United States)

    Brown, Timothy T; Martinez-Gutierrez, Maria S; Navab, Bahar

    2014-07-01

    We estimate the effect of changes in the per capita expenditures of county departments of public health on county-level general health status. Using panel data on 40 counties in California (2001-2009), dynamic panel estimation techniques are combined with the Lewbel instrumental variable technique to estimate an aggregate demand for health function that measures the causal cumulative impact that per capita public health expenditures have on county-level general health status. We find that a $10 long-term increase in per capita public health expenditures would increase the percentage of the population reporting good, very good or excellent health by 0.065 percentage points. Each year expenditures were increased would result in ∼24,000 individuals moving from the 'poor or fair health' category to the 'good, very good or excellent health' category across these 40 counties. In terms of the overall impact of county public health departments on general health status, at current funding levels, each annual expenditure cycle results in over 207,000 individuals being in the 'good, very good or excellent' categories of health status rather than the 'poor or fair' categories.

  6. Forecasting drug utilization and expenditure in a metropolitan health region

    Directory of Open Access Journals (Sweden)

    Korkmaz Seher

    2010-05-01

    Full Text Available Abstract Background New pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning, forecasting of drug utilization and expenditure, critical drug evaluation as well as structured programs for the introduction and follow-up of new drugs. The aim of this paper is to present the forecasting model and the predicted growth in all therapeutic areas in 2010 and 2011. Methods Linear regression analysis was applied to aggregate sales data on hospital sales and dispensed drugs in ambulatory care, including both reimbursed expenditure and patient co-payment. The linear regression was applied on each pharmacological group based on four observations 2006-2009, and the crude predictions estimated for the coming two years 2010-2011. The crude predictions were then adjusted for factors likely to increase or decrease future utilization and expenditure, such as patent expiries, new drugs to be launched or new guidelines from national bodies or the regional Drug and Therapeutics Committee. The assessment included a close collaboration with clinical, clinical pharmacological and pharmaceutical experts from the regional Drug and Therapeutics Committee. Results The annual increase in total expenditure for prescription and hospital drugs was predicted to be 2.0% in 2010 and 4.0% in 2011. Expenditures will increase in most therapeutic areas, but most predominantly for antineoplastic and immune modulating agents as well as drugs for the nervous system, infectious diseases, and blood and blood-forming organs. Conclusions The utilisation and expenditure of drugs is difficult to forecast due to uncertainties about the rate

  7. Budgetary Expenditure on Health and Human Development in India

    Directory of Open Access Journals (Sweden)

    Brijesh C. Purohit

    2012-01-01

    Full Text Available This study aims at analyzing the differentials across rich and poor states and across rich and poorer strata and rural urban segments of 19 major Indian states. The study indicates that besides individual health financing policies of the respective state governments, there are significant disparities even between rural and urban strata and rich and poorer sections of the society. These are indicated by high inequality coefficients and an emerging pattern of life style second generation health problems as well as levels of utilization of both preventive and curative care both in public and private sectors. Our results emphasise that there is a need to increase public expenditure on health, improve efficiency in utilization of existing public facilities, and popularize government run health insurance schemes meant primarily for the poor. These steps may help to mitigate partly the inequitable outcomes.

  8. Canadian health expenditures: Where do we really stand internationally?

    Science.gov (United States)

    Deber, R; Swan, B

    1999-01-01

    There are different ways to measure how much Canada spends on health care and the quality of these measurements may vary. This paper examines Organization for Economic Cooperation and Development data for 3 common standards of measure: health expenditures as a proportion of gross domestic product (GDP), nominal spending per capita (US dollars) and spending per capita in purchasing power parities (PPP) equivalents. In 1994, the most recent year for which there were firm data. Canada spent 9.9% of its GDP on health care (rank 3 of 29), and $1999 PPPs per capita (rank 3). However, actual spending was only US$1824 per capita (rank 14). In the same year Japan spent 7% of GDP on health care (rank 22), $1478 in PPPs per capita (rank 16), but actually spent US$2614 per capita (rank 3). Although each measure is suitable for some policy purposes, Canadian spending remains modest by international standards. PMID:10410638

  9. Health-related expenditure patterns in selected migrant groups: data from the Australian Household Expenditure Survey, 1984.

    Science.gov (United States)

    Powles, J; Hage, B; Cosgrove, M

    1990-01-01

    Australians born in Italy, Greece and East and South East Asia all have substantially lower mortality levels than those born in Australia, the British Isles or Holland and Germany. Using data from the 1984 Household Expenditure Survey, the health-related consumption expenditure of these six groups was compared (excluding expenditure on medical care). The heterogeneity of household types was largely removed by confining attention to married couple households with dependent children. The two groups with mortality levels comparable to those of the Australian-born (British Isles and Holland/Germany) also shared a similar pattern of consumption expenditures. There was a tendency (not always fully consistent), for the low mortality groups to spend more on fruits, vegetables, cereal products and fish and substantially less on alcohol. Patterns that might be 'unexpected' in low mortality groups are the (presumptively) substantial expenditures on tobacco among males (especially in the Greek group) and the substantial expenditures on red meat in all three groups. Analysis of available data sets such as this can provide useful descriptions of the distribution of health-influencing behaviour in our population.

  10. The determinants of health expenditure in Malaysia: A time series analysis

    OpenAIRE

    Tang, Chor Foon

    2010-01-01

    The purpose of this study is to investigate the determinants of health expenditure in Malaysia within the time series framework from 1967 to 2007. This study employed the Johansen-Juselius cointegration test to examine the cointegration relationship. The results showed that health expenditure and its determinants are cointegrated. Consistent with economic theory, the TYDL and variance decomposition analysis reveals that the key explanatory variables in Malaysia’s health expenditure model are ...

  11. Explaining health care utilization for panic attacks using cusp catastrophe modeling.

    Science.gov (United States)

    Katerndahl, David

    2008-10-01

    Despite increased health care utilization, patients with panic disorder continue to report unmet needs. The objective was to compare the fit of linear and Cusp Catastrophe Modeling in explaining changes in utilization of emergency, general and mental health settings, and self-treatments for panic symptoms. This community-based study surveyed 97 subjects with panic attacks drawn from a sample of randomly-selected adults from randomly-selected households. The stressor (splitting) variable used was Phobic Anxiety while predisposing variables included Family Health Care Utilization, Perceived Life Threat and Need For Treatment, and Treatment Experience. Outcomes consisted of the number of sites and self-treatments used for panic symptoms when first seeking care and during the 2 months prior to survey. Use of mental health sites and self-treatments demonstrated superior modeling with cusp catastrophe approaches using treatment experience as the predisposing variable, accounting for 47% and 38% of variances respectively, improving the fit by over 20% compared to the best linear models in both cases. Cusp catastrophe modeling accounted for more variance than all linear models when describing use of mental health settings and self-treatments. Cusp catastrophe may explain bimodal distributions in behavior, delays in behavior change, and sudden shifts in behavior in stressful situations. PMID:18765074

  12. Health Care Expenditure among People with Disabilities: Potential Role of Workplace Health Promotion and Implications for Rehabilitation Counseling

    Science.gov (United States)

    Karpur, Arun; Bruyere, Susanne M.

    2012-01-01

    Workplace health-promotion programs have the potential to reduce health care expenditures, especially among people with disabilities. Utilizing nationally representative survey data, the authors provide estimates for health care expenditures related to secondary conditions, obesity, and health behaviors among working-age people with disabilities.…

  13. Diagnosed Prevalence and Health Care Expenditures of Mental Health Disorders among Dual Eligible Older People

    Science.gov (United States)

    Lum, Terry Y.; Parashuram, Shriram; Shippee, Tetyana P.; Wysocki, Andrea; Shippee, Nathan D.; Homyak, Patricia; Kane, Robert L.

    2013-01-01

    Purpose: Little is known about mental health disorders (MHDs) and their associated health care expenditures for the dual eligible elders across long-term care (LTC) settings. We estimated the 12-month diagnosed prevalence of MHDs among dual eligible older adults in LTC and non-LTC settings and calculated the average incremental effect of MHDs on…

  14. Should catastrophic risks be included in a regulated competitive health insurance market?

    NARCIS (Netherlands)

    W.P.M.M. van de Ven (Wynand); F.T. Schut (Erik)

    1994-01-01

    textabstractIn 1988 the Dutch government launched a proposal for a national health insurance based on regulated competition. The mandatory benefits package should be offered by competing insurers and should cover both non-catastrophic risks (like hospital care, physician services and drugs) and cata

  15. The effect of inflation on expenditures by mental health organization between 1969 and 1990.

    Science.gov (United States)

    Witkin, M J; Atay, J E; Manderscheid, R W

    1994-06-01

    At first glance, the rise in current dollar expenditures for all mental health organizations from $3.3 billion in 1969 to $28.4 billion in 1990 seems enormous. However, if the annual expenditures are adjusted for inflation and expressed in constant dollars, the rise in expenditures is only from $3.3 billion in 1969 to $5.6 billion in 1990. Thus, most of the increase in expenditures by mental health organizations over the past two decades is due to inflation, with less than 10 percent due to increases in real purchasing power. Since both the number of private psychiatric hospitals and the expenditures they incurred increased dramatically between 1969 and 1990, these hospitals showed gains in absolute dollar amounts and in dollar amounts per capita, even if the expenditures are expressed in constant dollars. To a lesser extent, the same was true of RTCs. Although both VA medical centers and State mental hospitals showed increases in expenditures as measured in current dollars, if expenditures are expressed in constant dollars, these organizations showed net decreases. Their inpatient populations also decreased during this period. However, if expenditures per inpatient under care are examined, the reverse is true. The per patient expenditures for State mental hospitals increased between 1969 and 1990, even if the results are stated in constant dollars.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7791607

  16. The burden of abdominal obesity with physical inactivity on health expenditure in Brazil

    Directory of Open Access Journals (Sweden)

    Jamile S. Codogno

    2015-03-01

    Full Text Available The purpose of this study was to analyze the association between the clustering of physical inactivity with abdominal obesity and public health care expenditure in Brazilian adults. The sample was composed of 963 patients of both genders, randomly selected in the Brazilian Public Health care System during 2010. Entire health care expenditures during the last year were computed and stratified into: medical consultations, medication dispensing, laboratory tests and overall expenditure. Waist circumference was used to diagnose abdominal obesity and physical activity was assessed by previously validated questionnaire. Sedentary and abdominally obese patients (OR= 3.01 [OR95%CI= 1.81-4.99] had higher likelihood be inserted in the group of higher expenditures than only abdominally obese patients (OR= 1.66 [OR95%CI= 1.07-2.59]. There is a synergic effect between abdominal obesity and physical inactivity on overall health care expenditures.

  17. Returns on investment in public health: effect of public health expenditures on infant health, 1983-1990.

    Science.gov (United States)

    Becker, E R; Principe, K; Adams, E K; Teutsch, S M

    1998-01-01

    In this study, we developed a broad conceptual framework focusing on how public health expenditures impact the nation's health. We then applied this framework to infant health outcomes and, using an eight-year state panel database, empirically analyzed how state public health expenditures, ceteris paribus, impact a state's level of teenage births and the receipt of prenatal care. Two hypotheses were tested. Hypothesis 1 states that over time, public health expenditures and public health activities, ceteris paribus, significantly decrease births to mothers less than 20 years of age. Hypothesis 2 states that over time, public health expenditures and public health activities, ceteris paribus, significantly decrease the number of infants whose mothers received late or no prenatal care. We find support for both hypotheses but observe that the way public health expenditures are measured has an impact on the findings. Other important implications of the study are noted. To our knowledge, this is the first article that has taken an aggregate state perspective over time and applied it to specific measures of infant health. PMID:9718507

  18. Methodological aspects of health evaluation of the population suffered after the Chernobyl catastrophe

    International Nuclear Information System (INIS)

    Ecological situation in Belarus and the necessity of liquidation of medical consequences of the Chernobyl NPP Catastrophe demand many years' dynamic observation after the health condition of large people's contingents. At present this problem is being solved by the clinical follow up of the population undergone irradiation due to the Chernobyl catastrophe which is the basis of medical-prevention measures, directed to low medical consequences of the Chernobyl catastrophe. All the information on population's health received during the clinical follow up is put to a special State Data Base which was started for a clinical follow op information support, carrying out scientific researches and receiving reliable data on medical- biological consequences of the Chernobyl catastrophe. At present there's a problem of correct evaluation of health changes of the population who need clinical follow up on all its levels. The problem of comparative analyses of stored data hasn't been solved yet. It's necessary to underline that illness data of the population suffered after the Chernobyl catastrophe received due to intensive clinical follow up can't be compared with illness data of the population in general received due to ordinary applies to hospitals. It would be methodologically incorrect. Besides all said above, including into the research all the classes and forms of illnesses according to IDC-9, IDC-10 (International Disease Classification 9,10) what in a great degree enlarges volume of the research and its expenses is irrational. While studying the Chernobyl catastrophe medical consequences one must include to the analysis classes and nosologic illness forms which level and dynamic changes connected in some extend to radiation irradiation. By doing this one can minimize the volume and the expenses in the research like this. In this situation it's necessary to state such population health indexes which level exposed to a distortion in the lowest degree in the result of

  19. Inadequate physical activity and health care expenditures in the United States.

    Science.gov (United States)

    Carlson, Susan A; Fulton, Janet E; Pratt, Michael; Yang, Zhou; Adams, E Kathleen

    2015-01-01

    This study estimates the percentage of health care expenditures in the non-institutionalized United States (U.S.) adult population associated with levels of physical activity inadequate to meet current guidelines. Leisure-time physical activity data from the National Health Interview Survey (2004-2010) were merged with health care expenditure data from the Medical Expenditure Panel Survey (2006-2011). Health care expenditures for inactive (i.e., no physical activity) and insufficiently active adults (i.e., some physical activity but not enough to meet guidelines) were compared with active adults (i.e., ≥150minutes/week moderate-intensity equivalent activity) using an econometric model. Overall, 11.1% (95% CI: 7.3, 14.9) of aggregate health care expenditures were associated with inadequate physical activity (i.e., inactive and insufficiently active levels). When adults with any reported difficulty walking due to a health problem were excluded, 8.7% (95% CI: 5.2, 12.3) of aggregate health care expenditures were associated with inadequate physical activity. Increasing adults' physical activity to meet guidelines may reduce U.S. health care expenditures.

  20. Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, south India

    Directory of Open Access Journals (Sweden)

    Narayana Delampady

    2011-01-01

    Full Text Available Abstract Background In the Indian context, a household's caste characteristics are most relevant for identifying its poverty and vulnerability status. Inadequate provision of public health care, the near-absence of health insurance and increasing dependence on the private health sector have impoverished the poor and the marginalised, especially the scheduled tribe population. This study examines caste-based inequalities in households' out-of-pocket health expenditure in the south Indian state of Kerala and provides evidence on the consequent financial burden inflicted upon households in different caste groups. Methods Using data from a 2003-2004 panel survey in Kottathara Panchayat that collected detailed information on health care consumption from 543 households, we analysed inequality in per capita out-of-pocket health expenditure across castes by considering households' health care needs and types of care utilised. We used multivariate regression to measure the caste-based inequality in health expenditure. To assess health expenditure burden, we analysed households incurring high health expenses and their sources of finance for meeting health expenses. Results The per capita health expenditures reported by four caste groups accord with their status in the caste hierarchy. This was confirmed by multivariate analysis after controlling for health care needs and influential confounders. Households with high health care needs are more disadvantaged in terms of spending on health care. Households with high health care needs are generally at higher risk of spending heavily on health care. Hospitalisation expenditure was found to have the most impoverishing impacts, especially on backward caste households. Conclusion Caste-based inequality in household health expenditure reflects unequal access to quality health care by different caste groups. Households with high health care needs and chronic health care needs are most affected by this inequality

  1. Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, south India

    Science.gov (United States)

    2011-01-01

    Background In the Indian context, a household's caste characteristics are most relevant for identifying its poverty and vulnerability status. Inadequate provision of public health care, the near-absence of health insurance and increasing dependence on the private health sector have impoverished the poor and the marginalised, especially the scheduled tribe population. This study examines caste-based inequalities in households' out-of-pocket health expenditure in the south Indian state of Kerala and provides evidence on the consequent financial burden inflicted upon households in different caste groups. Methods Using data from a 2003-2004 panel survey in Kottathara Panchayat that collected detailed information on health care consumption from 543 households, we analysed inequality in per capita out-of-pocket health expenditure across castes by considering households' health care needs and types of care utilised. We used multivariate regression to measure the caste-based inequality in health expenditure. To assess health expenditure burden, we analysed households incurring high health expenses and their sources of finance for meeting health expenses. Results The per capita health expenditures reported by four caste groups accord with their status in the caste hierarchy. This was confirmed by multivariate analysis after controlling for health care needs and influential confounders. Households with high health care needs are more disadvantaged in terms of spending on health care. Households with high health care needs are generally at higher risk of spending heavily on health care. Hospitalisation expenditure was found to have the most impoverishing impacts, especially on backward caste households. Conclusion Caste-based inequality in household health expenditure reflects unequal access to quality health care by different caste groups. Households with high health care needs and chronic health care needs are most affected by this inequality. Households in the most

  2. Refining estimates of public health spending as measured in national health expenditure accounts: the Canadian experience.

    Science.gov (United States)

    Ballinger, Geoff

    2007-01-01

    The recent focus on public health stemming from, among other things, severe acute respiratory syndrome and avian flu has created an imperative to refine health-spending estimates in the Canadian Health Accounts. This article presents the Canadian experience in attempting to address the challenges associated with developing the needed taxonomies for systematically capturing, measuring, and analyzing the national investment in the Canadian public health system. The first phase of this process was completed in 2005, which was a 2-year project to estimate public health spending based on a more classic definition by removing the administration component of the previously combined public health and administration category. Comparing the refined public health estimate with recent data from the Organization for Economic Cooperation and Development still positions Canada with the highest share of total health expenditure devoted to public health than any other country reporting. The article also provides an analysis of the comparability of public health estimates across jurisdictions within Canada as well as a discussion of the recommendations for ongoing improvement of public health spending estimates. The Canadian Institute for Health Information is an independent, not-for-profit organization that provides Canadians with essential statistics and analysis on the performance of the Canadian health system, the delivery of healthcare, and the health status of Canadians. The Canadian Institute for Health Information administers more than 20 databases and registries, including Canada's Health Accounts, which tracks historically 40 categories of health spending by 5 sources of finance for 13 provincial and territorial jurisdictions. Until 2005, expenditure on public health services in the Canadian Health Accounts included measures to prevent the spread of communicable disease, food and drug safety, health inspections, health promotion, community mental health programs, public

  3. Refining estimates of public health spending as measured in national health expenditure accounts: the Canadian experience.

    Science.gov (United States)

    Ballinger, Geoff

    2007-01-01

    The recent focus on public health stemming from, among other things, severe acute respiratory syndrome and avian flu has created an imperative to refine health-spending estimates in the Canadian Health Accounts. This article presents the Canadian experience in attempting to address the challenges associated with developing the needed taxonomies for systematically capturing, measuring, and analyzing the national investment in the Canadian public health system. The first phase of this process was completed in 2005, which was a 2-year project to estimate public health spending based on a more classic definition by removing the administration component of the previously combined public health and administration category. Comparing the refined public health estimate with recent data from the Organization for Economic Cooperation and Development still positions Canada with the highest share of total health expenditure devoted to public health than any other country reporting. The article also provides an analysis of the comparability of public health estimates across jurisdictions within Canada as well as a discussion of the recommendations for ongoing improvement of public health spending estimates. The Canadian Institute for Health Information is an independent, not-for-profit organization that provides Canadians with essential statistics and analysis on the performance of the Canadian health system, the delivery of healthcare, and the health status of Canadians. The Canadian Institute for Health Information administers more than 20 databases and registries, including Canada's Health Accounts, which tracks historically 40 categories of health spending by 5 sources of finance for 13 provincial and territorial jurisdictions. Until 2005, expenditure on public health services in the Canadian Health Accounts included measures to prevent the spread of communicable disease, food and drug safety, health inspections, health promotion, community mental health programs, public

  4. Determinants and Equity Evaluation for Health Expenditure Among Patients with Rare Diseases in China

    Institute of Scientific and Technical Information of China (English)

    Xiao-Xiong Xin; Liang Zhao; Xiao-Dong Guan; Lu-Wen Shi

    2016-01-01

    Background:China has not established social security system for rare diseases.Rare diseases could easily impoverish patients and their families.Little research has studied the equity and accessibility of health services for patients with rare diseases in China.This study aimed to explore the factors that influence health expenditure of rare diseases and evaluate its equity.Methods:Questionnaire survey about living conditions and cost burden of patients with rare diseases was conducted.Individual and family information,health expenditure and reimbursement in 2014 of 982 patients were collected.The impact of medical insurance,individual sociodemographic characteristics,family characteristics,and healthcare need on total and out-of-pocket (OOP) health expenditures was analyzed through the generalized linear model.Equity of health expenditure was evaluated by both concentration index and Lorenz curve.Results:Of all the surveyed patients,11.41% had no medical insurance and 92.10% spent money to seek medical treatment in 2014.It was suggested female (P =0.048),over 50 years of age (P =0.062),high-income group (P =0.021),hospitalization (P =0.000),and reimbursement ratio (RR) (P =0.000) were positively correlated with total health expenditure.Diseases not needing long-term treatment (P =0.000) was negatively correlated with total health expenditure.Over 50 years of age (P =0.065),high-income group (P =0.018),hospitalization (P =0.000) and having Urban Employee Basic Medical Insurance (UEBMI) (P =0.022) were positively correlated with OOP health expenditure.Patient or the head of the household having received higher education (P =0.044 and P =0.081) and reimbursement ratio (P =0.078) were negatively correlated with OOP health expenditure.The equity evaluation found concentration indexes of health expenditure before and after reimbursement were 0.0550 and 0.0539,respectively.Conclusions:OOP health expenditure of patients with UEBMI was significantly more than that of

  5. Iranian Households’ Payments on Food and Health Out-of-Pocket Expenditures: Evidence of Inequality

    Directory of Open Access Journals (Sweden)

    Hesam GHIASVAND

    2015-10-01

    Full Text Available Background: Inequality in households’ payments on food and health expenditures presents the accessibility and utili-zation patterns between them. This study investigated the Iranian rural and urban households’ inequality in payments on food and Out-of-Pocket health expenditures from 1998 to 2012.Methods: This descriptive study was conducted through the analysis of Iranian Statistics Centre data on Iranian households’ income and expenditures. The Gini Coefficients, Concentration and Kakwani indices have been calculat-ed for Iranian rural and urban households’ Out-of-Pocket health and food expenditures.Results: The means of Iranian rural and urban total consumption expenditures inequality were 0.48 and 0.48, respec-tively. The means of concentration index of food expenditures for rural and urban regions were 0.35 and 0.34, respec-tively. The means of Out-of-Pocket payments for health services for rural and urban regions were 0.51 and 0.5, re-spectively. Finally the means of Kakwani index of Out-of-Pocket health payments in rural and urban households were -0.005 and -0.018, respectively.Conclusion: There are relative high levels of inequality in Iranian households’ payments on food and Out-of-Pocket health expenditures.

  6. Estimating the Relationship between Economic Growth and Health Expenditures in ECO Countries Using Panel Cointegration Approach.

    Science.gov (United States)

    Hatam, Nahid; Tourani, Sogand; Homaie Rad, Enayatollah; Bastani, Peivand

    2016-02-01

    Increasing knowledge of people about health leads to raising the share of health expenditures in government budget continuously; although governors do not like this rise because of budget limitations. This study aimed to find the association between health expenditures and economic growth in ECO countries. We added health capital in Solow model and used the panel cointegration approach to show the importance of health expenditures in economic growth. For estimating the model, first we used Pesaran cross-sectional dependency test, after that we used Pesaran CADF unit root test, and then we used Westerlund panel cointegration test to show if there is a long-term association between variables or not. After that, we used chaw test, Breusch-Pagan test and Hausman test to find the form of the model. Finally, we used OLS estimator for panel data. Findings showed that there is a positive, strong association between health expenditures and economic growth in ECO countries. If governments increase investing in health, the total production of the country will be increased, so health expenditures are considered as an investing good. The effects of health expenditures in developing countries must be higher than those in developed countries. Such studies can help policy makers to make long-term decisions.

  7. The effect of telehealth systems and satisfaction with health expenditure among patients with metabolic syndrome.

    Science.gov (United States)

    Uei, Shu-Lin; Tsai, Chung-Hung; Kuo, Yu-Ming

    2016-04-29

    Telehealth cost analysis has become a crucial issue for governments in recent years. In this study, we examined cases of metabolic syndrome in Hualien County, Taiwan. This research adopted the framework proposed by Marchand to establish a study process. In addition, descriptive statistics, a t test, analysis of variance, and regression analysis were employed to analyze 100 questionnaires. The results of the t$ test revealed significant differences in medical health expenditure, number of clinical visits for medical treatment, average amount of time spent commuting to clinics, amount of time spent undergoing medical treatment, and average number of people accompanying patients to medical care facilities or assisting with other tasks in the past one month, indicating that offering telehealth care services can reduce health expenditure. The statistical analysis results revealed that customer satisfaction has a positive effect on reducing health expenditure. Therefore, this study proves that telehealth care systems can effectively reduce health expenditure and directly improve customer satisfaction with medical treatment. PMID:27163314

  8. Investigation for integration of the German Public Health Service in catastrophe and disaster prevention programs in Germany

    International Nuclear Information System (INIS)

    This research project aimed at investigating the integration of the GPHS into the plans for civil defence and protection as well as catastrophe prevention of the Federal Republic of Germany. Following a comprehensive analysis of the current situation, potential proposals for an improved integrative approach will be presented. In view of the lack of topics relevant for medical care in disaster medicine in educational curricula and training programs for medical students and postgraduate board programs for public health physicians, a working group of the Civil Protection Board of the German Federal Ministry of the Interior already complained in their 'Report on execution of legal rules for protection and rescue of human life as well as restitution of public health after disaster' in 1999, that the integration of the GPHS into catastrophe and disaster prevention programs has insufficiently been solved. On a point-by-point approach, our project analysed the following issues: - Legislative acts for integration of the German Public Health Service into medical care in catastrophes and disasters to protect the civilian population of Germany and their implementation and execution. - Administrative rules and directives on state and district levels that show relationship to integration of the German Public Health Service into preparedness programs for catastrophe prevention and management and their implementation and execution. - Education and postgraduate training options for physicians and non-physician employees of the German Public health Service to prepare for medical care in catastrophes and disasters. - State of knowledge and experience of the German Public Health Service personnel in emergency and disaster medicine. - Evaluation of the German administrative catastrophe prevention authorities with regard to their integration of the German Public Health Service into preparedness programs for catastrophe prevention and management. - Development of a concept to remedy the

  9. Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices.

    Science.gov (United States)

    Ladapo, Joseph A; Turakhia, Mintu P; Ryan, Michael P; Mollenkopf, Sarah A; Reynolds, Matthew R

    2016-05-01

    Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care.

  10. Investigating the Effect of Government Health Expenditure on HDI in Iran

    OpenAIRE

    Mohammad Javad Razmi; Ezatollah Abbasian; Sahar Mohammadi

    2012-01-01

    Human development is used as one of the most important indices to measure the level of countries development in resent decades. This study examines the effect of government health expenditure on human development index (HDI) by using the ordinary least squares method (OLS) over the period 1990-2009 in Iran. The results show a positive and significant elationship between government health expenditure and human development index. Also, Granger Causality Test indicates that there is no bilateral...

  11. 42 CFR 457.618 - Ten percent limit on certain Children's Health Insurance Program expenditures.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Ten percent limit on certain Children's Health Insurance Program expenditures. 457.618 Section 457.618 Public Health CENTERS FOR MEDICARE & MEDICAID... (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Payments to States § 457.618 Ten percent limit on...

  12. Final report:Health sector Public Expenditure Review (PER) update Financial Year (FY) 05

    OpenAIRE

    Ministry of Health,Tanzania, (MHT)

    2008-01-01

    In contrast to recent years, the health sector Public Expenditure Review update for FY05 is presented largely as an internal sectoral document for reviewing trends in budget and expenditure rather than as a detailed input to the budget process due to its delayed timing and a change in the focus of the overall government poverty reduction strategy with the development of the MKUKUTA (the Kiswahili acronym for the National Strategy for Growth and Poverty Reduction, the second Poverty Reduction ...

  13. What drives health care expenditure?--Baumol's model of 'unbalanced growth' revisited.

    Science.gov (United States)

    Hartwig, Jochen

    2008-05-01

    The share of health care expenditure in GDP rises rapidly in virtually all OECD countries, causing increasing concern among politicians and the general public. Yet, economists have to date failed to reach an agreement on what the main determinants of this development are. This paper revisits Baumol's [Baumol, W.J., 1967. Macroeconomics of unbalanced growth: the anatomy of urban crisis. American Economic Review 57 (3), 415-426] model of 'unbalanced growth', showing that the latter offers a ready explanation for the observed inexorable rise in health care expenditure. The main implication of Baumol's model in this context is that health care expenditure is driven by wage increases in excess of productivity growth. This hypothesis is tested empirically using data from a panel of 19 OECD countries. Our tests yield robust evidence in favor of Baumol's theory. PMID:18164773

  14. Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, south India

    OpenAIRE

    Narayana Delampady; Haddad Slim; Mukherjee Subrata

    2011-01-01

    Abstract Background In the Indian context, a household's caste characteristics are most relevant for identifying its poverty and vulnerability status. Inadequate provision of public health care, the near-absence of health insurance and increasing dependence on the private health sector have impoverished the poor and the marginalised, especially the scheduled tribe population. This study examines caste-based inequalities in households' out-of-pocket health expenditure in the south Indian state...

  15. Managed care, deficit financing, and aggregate health care expenditure in the United States: a cointegration analysis.

    Science.gov (United States)

    Murthy, N R; Okunade, A A

    2000-09-01

    We applied a battery of cointegration tests comprising those of Johansen and Juselius [19], Phillips and Hansen [35], and Engle and Granger [6], to model aggregate health care expenditure using 1960-96 US data. The existence of a stable long-run economic relationship or cointegration is confirmed, in the United States, between aggregate health care expenditure and real GDP, population age distribution, managed care enrollment, number of practicing physicians, and government deficits. The evidence of cointegration among these variables, chosen on the theoretical basis of prior studies, implies that while they are individually non-stationary in levels, together they are highly correlated and move, in the long run to form an economic equilibrium relationship of US aggregate health care expenditure. More specifically, and for the first time in this line of inquiry, (i) managed care enrollment is found to be negatively associated with the level of health care spending, (ii) supply disinduced demand effects of physicians tend to moderate health expenditure, and (iii) government deficit financing is positively related to health care spending. The observed sign and magnitude of the income coefficient are consistent with health care being a luxury good.

  16. Managed care, deficit financing, and aggregate health care expenditure in the United States: a cointegration analysis.

    Science.gov (United States)

    Murthy, N R; Okunade, A A

    2000-09-01

    We applied a battery of cointegration tests comprising those of Johansen and Juselius [19], Phillips and Hansen [35], and Engle and Granger [6], to model aggregate health care expenditure using 1960-96 US data. The existence of a stable long-run economic relationship or cointegration is confirmed, in the United States, between aggregate health care expenditure and real GDP, population age distribution, managed care enrollment, number of practicing physicians, and government deficits. The evidence of cointegration among these variables, chosen on the theoretical basis of prior studies, implies that while they are individually non-stationary in levels, together they are highly correlated and move, in the long run to form an economic equilibrium relationship of US aggregate health care expenditure. More specifically, and for the first time in this line of inquiry, (i) managed care enrollment is found to be negatively associated with the level of health care spending, (ii) supply disinduced demand effects of physicians tend to moderate health expenditure, and (iii) government deficit financing is positively related to health care spending. The observed sign and magnitude of the income coefficient are consistent with health care being a luxury good. PMID:11105414

  17. Comparison of the Effects of Public and Private Health Expenditures on the Health Status: a Panel Data Analysis in Eastern Mediterranean Countries

    Directory of Open Access Journals (Sweden)

    Enayatollah Homaie Rad

    2013-01-01

    Full Text Available BackgroundHealth expenditures are divided in two parts of public and private health expenditures. Public health expenditures contain social security spending, taxing to private and public sectors, and foreign resources like loans and subventions. On the other hand, private health expenditures contain out of pocket expenditures and private insurances. Each of these has different effects on the health status. The present study aims to compare the effects of these expenditures on health in Eastern Mediterranean Region (EMR. MethodsIn this study, infant mortality rate was considered as an indicator of health status. We estimated the model using the panel data of EMR countries between 1995 and 2010. First, we used Pesaran CD test followed by Pesaran’s CADF unit root test. After the confirmation of having unit root, we used Westerlund panel cointegration test and found that the model was cointegrated and then after using Hausman and Breusch-Pagan tests, we estimated the model using the random effects. ResultsThe results showed that the public health expenditures had a strong negative relationship with infant mortality rate. However, a positive relationship was found between the private health expenditures and infant mortality rate (IMR. The relationship for public health expenditures was significant, but for private health expenditures was not. ConclusionThe study findings showed that the public health expenditures in the EMR countries improved health outcome, while the private health expenditures did not have any significant relationship with health status, so often increasing the public health expenditures leads to reduce IMR. But this relationship was not significant because of contradictory effects for poor and wealthy peoples.

  18. Healthcare coalitions: the new foundation for national healthcare preparedness and response for catastrophic health emergencies.

    Science.gov (United States)

    Courtney, Brooke; Toner, Eric; Waldhorn, Richard; Franco, Crystal; Rambhia, Kunal; Norwood, Ann; Inglesby, Thomas V; O'Toole, Tara

    2009-06-01

    After 9/11 and the 2001 anthrax letters, it was evident that our nation's healthcare system was largely underprepared to handle the unique needs and large volumes of people who would seek medical care following catastrophic health events. In response, in 2002 Congress established the Hospital Preparedness Program (HPP) in the U.S. Department of Health and Human Services (HHS) to strengthen the ability of U.S. hospitals to prepare for and respond to bioterrorism and naturally occurring epidemics and disasters. Since 2002, the program has resulted in substantial improvements in individual hospitals' disaster readiness. In 2007, the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) contracted with the Center for Biosecurity of the University of Pittsburgh Medical Center to conduct an assessment of U.S. hospital preparedness and to develop tools and recommendations for evaluating and improving future hospital preparedness efforts. One of the most important findings from this work is that healthcare coalitions-collaborative groups of local healthcare institutions and response agencies that work together to prepare for and respond to emergencies-have emerged throughout the U.S. since the HPP began. This article provides an overview of the HPP and the Center's hospital preparedness research for ASPR. Based on that work, the article also defines healthcare coalitions and identifies their structure and core functions, provides examples of more developed coalitions and common challenges faced by coalitions, and proposes that healthcare coalitions should become the foundation of a national strategy for healthcare preparedness and response for catastrophic health events.

  19. Measuring the effects of reducing subsidies for private insurance on public expenditure for health care.

    Science.gov (United States)

    Cheng, Terence Chai

    2014-01-01

    This paper investigates the effects of reducing subsidies for private health insurance on public sector expenditure for hospital care. An econometric framework using simultaneous equation models is developed to analyse the interrelated decisions on the intensity and type of health care use and private insurance. The framework is applied to the context of the mixed public-private system in Australia. The simulation projections show that reducing premium subsidies is expected to generate net cost savings. This arises because the cost savings achieved from reducing subsidies are larger than the potential increase in public expenditure on hospital care.

  20. Health care expenditure decisions in the presence of devolution and equalisation grants.

    Science.gov (United States)

    Levaggi, Rosella; Menoncin, Francesco

    2014-12-01

    In a model where health care provision, its regional distribution and the equalisation grant are the result of a utilitarian bargaining between a (relatively) rich region and a poor one, a First Best solution can be reached only if the two Regions have the same bargaining power. From a policy point of view, our model may explain the observed cross-national differences in the redistributive power of health care expenditure and it suggests that to equalise resources across Regions an income based equalisation grant may be preferred because it causes less distortions than an expenditure based one.

  1. Low birth weight and health expenditures from birth to late adolescence

    OpenAIRE

    Hummer, Michael; Lehner, Thomas; Gerald J. Pruckner

    2012-01-01

    Using administrative panel data of health insurants, we estimate the effects of low birth weight on health service utilization among children and young adults between birth and 21 years old. To account for time-invariant heterogeneity of mothers, we use sibling fixed- effects estimation. We find that low birth weight strongly increases subsequent health expenditures and that the effect is particularly pronounced in the first year of life. Starting in compulsory schooling, we observe a shift i...

  2. Health care expenditure and decentralization: a national and international empirical analysis for OECD countries

    OpenAIRE

    Mosca, Ilaria; Filippini, Massimo; Meneguzzo, Marco; Crivelli, Luca

    2006-01-01

    The consistent rise in health care expenditure in these last years has attracted a lot of attention by academics, policy makers, and politicians. The quota of GDP spent on health has become considerably high in many OECD countries and pundits searched for possible solutions to increase the efficiency of the health care sector and to contain waste. Decentralization has been perceived as a solution to be pursued in order to achieve better economic performance thanks to the closeness of the gove...

  3. A sustainable training strategy for improving health care following a catastrophic radiological or nuclear incident.

    Science.gov (United States)

    Blumenthal, Daniel J; Bader, Judith L; Christensen, Doran; Koerner, John; Cuellar, John; Hinds, Sidney; Crapo, John; Glassman, Erik; Potter, A Bradley; Singletary, Lynda

    2014-02-01

    The detonation of a nuclear device in a US city would be catastrophic. Enormous loss of life and injuries would characterize an incident with profound human, political, social, and economic implications. Nevertheless, most responders have not received sufficient training about ionizing radiation, principles of radiation safety, or managing, diagnosing, and treating radiation-related injuries and illnesses. Members throughout the health care delivery system, including medical first responders, hospital first receivers, and health care institution support personnel such as janitors, hospital administrators, and security personnel, lack radiation-related training. This lack of knowledge can lead to failure of these groups to respond appropriately after a nuclear detonation or other major radiation incident and limit the effectiveness of the medical response and recovery effort. Efficacy of the response can be improved by getting each group the information it needs to do its job. This paper proposes a sustainable training strategy for spreading curricula throughout the necessary communities. It classifies the members of the health care delivery system into four tiers and identifies tasks for each tier and the radiation-relevant knowledge needed to perform these tasks. By providing education through additional modules to existing training structures, connecting radioactive contamination control to daily professional practices, and augmenting these systems with just-in-time training, the strategy creates a sustainable mechanism for giving members of the health care community improved ability to respond during a radiological or nuclear crisis, reducing fatalities, mitigating injuries, and improving the resiliency of the community.

  4. Does general practitioner gatekeeping curb health care expenditure?

    NARCIS (Netherlands)

    Delnoij, D.; Merode, G. van; Paulus, A.; Groenewegen, P.

    2000-01-01

    Objectives: It is generally assumed that health care systems in which specialist and hospital care is only accessible after referral by a general practitioner (GP) have lower total health care costs. In this study, the following questions were addressed: do health care systems with GPs acting as gat

  5. The Pattern of Govemment Health Expenditure in China

    Institute of Scientific and Technical Information of China (English)

    Yang Ling; Liu Yuanli

    2012-01-01

    For a while since the inception of economic system re- form programs in 1980s, China's government investment in health was weakened. This resulted in healthcare provider's increasing re- liance on user charges for their income, poorer access to healthcare for the vulnerable population groups, and increasing socioeconomic disparities in health and healthcare. To address these problems, China initiated a series of health sector reforms since late 1990s. Our comprehensive review study has found that indeed Chinese government spending on health has been increasing in recent years, especially since 2009, when the new Healthcare Reform Plan was announced. Still, China needs to both further strengthen government investment in health and address the structural imbal- ances in government health financing, in order to make the overall Chinese health system more equitable and more efficient.

  6. National health expenditures: the past, present, future and solutions

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2015-10-01

    Full Text Available The costs of health care in the US have been increasing for many years and the US now spends more on health care than other developed country. The cost of health care is higher in the US in nearly every category. However, the dramatic rise in health care costs over the past 35 years occurs during the time when pharmaceutical costs and administrative costs have also dramatically risen. It seems likely that these costs may account for much of the increase in health care. However, neither is dealt with by the Affordable Care Act (ACA. Until a system of oversight is enacted on medical costs, it seems likely that US health care costs will continue to rise.

  7. Health care expenditure and life expectancy in Australia: how well do we perform?

    Science.gov (United States)

    Taylor, R; Salkeld, G

    1996-06-01

    The Australian health care system consists of mixed public and private financing underpinned by Medicare, a universal government-run insurance scheme paid through taxation (and levy) on income. Australia has improved its ranking for life expectancy (at birth) since 1960, and in 1990 ranked ninth and seventh of 24 countries for females and males respectively; this is ahead of the United States and United Kingdom, and approximately equal to Canada. Australian hospital bed supply and utilisation are average, after deletion of day-only cases. The proportion of gross domestic product (GDP) spent on health, in relation to GDP per capita (adjusted for purchasing power), in Australia in 1990 was average, and the prices for health care from 1975 to 1990 did not increase when adjusted for inflation. Although 68 per cent of health expenditure emanates from public sources in Australia, this is lower than in the majority of European countries and Canada. Some countries are doing poorly (such as the United States, with lower than average life expectancy and higher than predicted health expenditure) and some countries are doing well (with higher than average life expectancy and lower than predicted health expenditure; for example, Japan). Australia has higher than average life expectancy and only slightly higher than predicted health expenditure per capita. Although the Australian system could be improved, there are no indications that radical changes are required. The relatively high life expectancy in Australia can be attributed to favourable social and economic conditions, successful public health programs, and the availability of universal quality health care. PMID:8768411

  8. A Performance Analysis of Public Expenditure on Maternal Health in Mexico

    Science.gov (United States)

    Servan-Mori, Edson; Avila-Burgos, Leticia; Nigenda, Gustavo; Lozano, Rafael

    2016-01-01

    We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio -adjusted by coverage of adequate ANC- observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003–2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship. PMID:27043819

  9. A Performance Analysis of Public Expenditure on Maternal Health in Mexico.

    Science.gov (United States)

    Servan-Mori, Edson; Avila-Burgos, Leticia; Nigenda, Gustavo; Lozano, Rafael

    2016-01-01

    We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio--adjusted by coverage of adequate ANC--observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003-2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship. PMID:27043819

  10. A Performance Analysis of Public Expenditure on Maternal Health in Mexico.

    Directory of Open Access Journals (Sweden)

    Edson Servan-Mori

    Full Text Available We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content, and the maternal mortality ratio--adjusted by coverage of adequate ANC--observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003-2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship.

  11. Health care expenditure for hospital-based delivery care in Lao PDR

    Directory of Open Access Journals (Sweden)

    Douangvichit Daovieng

    2012-01-01

    Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family

  12. Refining estimates of public health spending as measured in national health expenditures accounts: the United States experience.

    Science.gov (United States)

    Sensenig, Arthur L

    2007-01-01

    Providing for the delivery of public health services and understanding the funding mechanisms for these services are topics of great currency in the United States. In 2002, the Department of Homeland Security was created and the responsibility for providing public health services was realigned among federal agencies. State and local public health agencies are under increased financial pressures even as they shoulder more responsibilities as the vital first link in the provision of public health services. Recent events, such as hurricanes Katrina and Rita, served to highlight the need to accurately access the public health delivery system at all levels of government. The National Health Expenditure Accounts (NHEA), prepared by the National Health Statistics Group, measure expenditures on healthcare goods and services in the United States. Government public health activity constitutes an important service category in the NHEA. In the most recent set of estimates, Government Public Health Activity expenditures totaled $56.1 billion in 2004, or 3.0 percent of total US health spending. Accurately measuring expenditures for public health services in the United States presents many challenges. Among these challenges is the difficult task of defining what types of government activity constitute public health services. There is no clear-cut, universally accepted definition of government public health care services, and the definitions in the proposed International Classification for Health Accounts are difficult to apply to an individual country's unique delivery systems. Other challenges include the definitional issues associated with the boundaries of healthcare as well as the requirement that census and survey data collected from government(s) be compliant with the Classification of Functions of Government (COFOG), an internationally recognized classification system developed by the United Nations.

  13. Sex and age differences in health expenditure in Northern Italy

    OpenAIRE

    Simone Ghislandi; Pier Giorgio Crosignani; Eva Negri; Carlo La Vecchia; Carlo Zocchetti

    2014-01-01

    BACKGROUND: Little is known about the health care spending distribution across the age and sex gradient in European systems. The aim of the present study is to examine gender and age differences in health care utilization in Lombardy, Italy.METHODS: We analysed administrative data for the year 2010 in Lombardy (the largest Italian region, with about 10 million inhabitant) including spending for inpatient and outpatient services and pharmaceuticals. Data were aggregated across age and sex.RESU...

  14. Budgetary Expenditure on Health and Human Development in India

    OpenAIRE

    Brijesh C. Purohit

    2012-01-01

    This study aims at analyzing the differentials across rich and poor states and across rich and poorer strata and rural urban segments of 19 major Indian states. The study indicates that besides individual health financing policies of the respective state governments, there are significant disparities even between rural and urban strata and rich and poorer sections of the society. These are indicated by high inequality coefficients and an emerging pattern of life style second generation health...

  15. On the international stability of health care expenditure functions: are government and private functions similar?

    Science.gov (United States)

    Clemente, Jesús; Marcuello, Carmen; Montañés, Antonio; Pueyo, Fernando

    2004-05-01

    This paper studies the stability of health care expenditure functions in a sample of OECD countries. We adopt the cointegration approach and the results show that there is a long-term relationship between total health care expenditure (HCE) and gross domestic product (GDP). However, the existence of cointegration is only shown when we admit the presence of some changes in the elasticities of the model. Our results also provide evidence against the existence of a unique relationship between health and GDP for the sample. Thus, we can conclude that the differences in health systems may cause differences in the aggregate functions. Additionally, we examine aggregate health functions for government (GHCE) and private expenditures (PHCE), again finding evidence of different patterns of behaviour. Finally, we open a discussion on the character of health as a necessary or luxury good. In this context, we find differences between the government and the private function. In order to illustrate these findings, we propose a theoretical model as an example of the influence of political decisions on income elasticity.

  16. The Weight of Health Expenditures on Household Income in Cameroon

    Directory of Open Access Journals (Sweden)

    Joseph Parfait OWOUNDI

    2014-02-01

    Full Text Available  African leaders pledged at the Abuja conference in 2001, to mobilize more financial resources to allocate at least 15% of their national budgets to the health sector to achieve the Millennium Development Goals (MDGs, seem to have difficulty meeting this commitment because of weakness and fragmentation of health systems. These commitments were renewed in Gaborone, Botswana in 2005 and in Ouagadougou, Burkina Faso in 2006. Indeed, donor funding is still a large part of public health spending on the continent. In some countries, 50% or more of their budgets come from foreign or private assistance. In about half the countries, the private health financing is equal to or exceeds largely public funding, up to 70% in some states like Sudan, Côte d'Ivoire, Cameroon, Chad, Liberia and Uganda. Only five countries (Rwanda, Malawi, Zambia, Burkina Faso, and Togo have so far respected the promise made to the Abuja conference. In Cameroon, where 51% of the population lives on less than two dollars per day, the average propensity of the total medical consumption is very high. Indeed, 32% of households spend less than half of income on health, while 16% of households spend more than half of the income and 52% spend more than the total income. This corresponds to a weight of 68% in health care spending.  

  17. Nuclear catastrophe in Japan. Health consequences resulting from Fukushima; Atomkatastrophe in Japan. Gesundheitliche Folgen von Fukushima

    Energy Technology Data Exchange (ETDEWEB)

    Paulitz, Henrik; Eisenberg, Winfrid; Thiel, Reinhold

    2013-03-06

    On 11 March 2011, a nuclear catastrophe occurred at the Fukushima Dai-ichi nuclear power plant in Japan in the wake of an earthquake and due to serious safety deficiencies. This resulted in a massive and prolonged release of radioactive fission and decay products. Approximately 20% of the radioactive substances released into the atmosphere have led to the contamination of the landmass of Japan with 17,000 becquerels per square meter of cesium-137 and a comparable quantity of cesium-134. The initial health consequences of the nuclear catastrophe are already now, after only two years, scientifically verifiable. Similar to the case of Chernobyl, a decline in the birth rate was documented nine months after the nuclear catastrophe. Throughout Japan, the total drop in number of births in December 2011 was 4362, with the Fukushima Prefecture registering a decline of 209 births. Japan also experienced a rise in infant mortality, with 75 more children dying in their first year of life than expected statistically. In the Fukushima Prefecture alone, some 55,592 children were diagnosed with thyroid gland nodules or cysts. In contrast to cysts and nodules found in adults, these findings in children must be classified as precancerous. There were also the first documented cases in Fukushima of thyroid cancer in children. The present document undertakes three assessments of the expected incidence of cancer resulting from external exposure to radiation. These are based on publications in scientific journals on soil contamination in 47 prefectures in Japan, the average total soil contamination, and, in the third case, on local dose rate measurements in the fall of 2012. Taking into consideration the shielding effect of buildings, the medical organization IPPNW has calculated the collective lifetime doses for individuals at 94,749 manSv, 206,516 manSv, and 118,171 manSv, respectively. In accordance with the risk factors set by the European Committee on Radiation Risk (ECRR) for death

  18. Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: A secondary data analysis

    Directory of Open Access Journals (Sweden)

    Frank Chirowa

    2013-01-01

    Full Text Available Background: This article provided an analysis of gender inequality, health expenditure and its relationship to maternal mortality.Objective: The objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA. A unique analysis was used to correlate the Gender Inequality Index (GII, Health Expenditure and Maternal Mortality Ratio (MMR. The GII captured inequalities across three dimensions – Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadavanatges of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR.Method: An exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique,South Africa, Zambia and Zimbabwe.Results: Countries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more.Conclusion: A potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels.

  19. Health sector planning led by management of recurrent expenditure: an agenda for action-research.

    Science.gov (United States)

    Segall, M

    1991-01-01

    Health services in developing countries face a crisis of recurrent costs. Far from being able to fund primary health care (PHC) developments, governments now have difficulty in keeping existing health services in operation. This article proposes an approach to the problem based on the proactive planning and management of recurrent health expenditure. The system addresses existing services as well as future plans and allows explicit trade-offs to be made in resource allocation. This may be termed 'recurrent-expenditureled planning'. The article describes a diagnostic health sector review, which incorporates a recurrent expenditure profile in four planes: by type of provider, source of finance, level of care and recipient population group. A fifth dimension of time trends for certain expenditure categories can be added. The steps of a strategic planning cycle for health services resources are then described, which allows health service strategies to be tested for broad economic feasibility. It also results in the establishment of resource targets that can act as benchmarks against which actual levels of funding can be compared. The targets help to maintain sectoral priorities in resource allocation even in times of economic constraint and to channel funds preferentially to localities and facilities in greatest need. The system calls for innovations in the methods of health planning and financial management in the health sector. Implementation will require health systems action-research at the country level. The essential purpose is to promote PHC policy-led resource allocation and use. No amount of planning can substitute for political action to realize 'health for all', but this system provides technical support to the political forces in favour of distributive PHC policies.

  20. Can mothers rely on the Brazilian health system for their deliveries? An assessment of use of the public system and out-of-pocket expenditure in the 2004 Pelotas Birth Cohort Study, Brazil

    Directory of Open Access Journals (Sweden)

    Bertoldi Andréa D

    2008-03-01

    Full Text Available Abstract Background In a country where comprehensive free health care is provided via a public health system (SUS, an unexpected high frequency of catastrophic out-of-pocket expenditure has been described. We studied how deliveries were financed among mothers of a birth cohort and whether they were an important source of household out-of-pocket expenditure. Methods All deliveries occurring in the city of Pelotas, Brazil, during 2004, were recruited for a birth cohort study. All mothers were interviewed just after birth and three months later. Comprehensive data on the pregnancy, delivery, birth conditions and newborn health were collected, along with detailed information on expenses related to the delivery. Results The majority of the deliveries (81% were financed by the public health system, a proportion that increased to more than 95% among the 40% poorest mothers. Less than 1% of these mothers reported some out-of-pocket expenditure. Even among those mothers covered by a private health plan, nearly 50% of births were financed by the SUS. Among the 20% richest, a third of the deliveries were paid by the SUS, 50% by private health plans and 17% by direct payment. Conclusion The public health system offered services in quantity and quality enough to attract even beneficiaries of private health plans and spared mothers from the poorest strata of the population of practically any expense.

  1. Lifetime medical costs of obesity: prevention no cure for increasing health expenditure.

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    Pieter H M van Baal

    2008-02-01

    Full Text Available BACKGROUND: Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention. METHODS AND FINDINGS: With a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and "healthy-living" persons (defined as nonsmokers with a body mass index between 18.5 and 25. Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions. CONCLUSIONS: Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.

  2. Modifiable health risk factors and medical expenditures - The case of Taiwan.

    Science.gov (United States)

    Lin, Tsui-Fang

    2008-12-01

    To contain escalating healthcare spending has become a great challenge for many countries around the world. Among all factors influencing medical costs, extensive studies have shown that adoption of healthy lifestyles such as not smoking, moderate drinking, eating healthy food, and exercising regularly can contribute to good health and lower the odds of having diseases that result in higher medical spending. The goal of this paper is to explore the relationship between modifiable risk factors and healthcare costs in Taiwan. A two-part model is employed to estimate the association between modifiable risk factors and medical expenditures. A logit model is used in the first stage of estimation and a generalized linear model is used in the second stage of estimation. Linking the 2001 National Health Interview Survey (NHIS) and the claims data in the National Health Insurance Research Database (NHIRD) in Taiwan, I find some significant associations between several lifestyle variables and medical expenditures. Former smokers are found to have higher probability of using medical care and incur higher medical expenses. People with exercise habits are less likely to use inpatient care services, and they incur lower inpatient expenses. Therefore, healthcare policies promoting non-smoking and physical activities should be used in Taiwan to curb rising expenditures and to achieve better care for people with chronic diseases. PMID:18950919

  3. UK and Twenty Comparable Countries GDP-Expenditure-on-Health 1980-2013: The Historic and Continued Low Priority of UK Health-Related Expenditure

    Science.gov (United States)

    Harding, Andrew J.E.; Pritchard, Colin

    2016-01-01

    It is well-established that for a considerable period the United Kingdom has spent proportionally less of its gross domestic product (GDP) on health-related services than almost any other comparable country. Average European spending on health (as a % of GDP) in the period 1980 to 2013 has been 19% higher than the United Kingdom, indicating that comparable countries give far greater fiscal priority to its health services, irrespective of its actual fiscal value or configuration. While the UK National Health Service (NHS) is a comparatively lean healthcare system, it is often regarded to be at a ‘crisis’ point on account of low levels of funding. Indeed, many state that currently the NHS has a sizeable funding gap, in part due to its recently reduced GDP devoted to health but mainly the challenges around increases in longevity, expectation and new medical costs. The right level of health funding is a political value judgement. As the data in this paper outline, if the UK ‘afforded’ the same proportional level of funding as the mean average European country, total expenditure would currently increase by one-fifth.

  4. UK and Twenty Comparable Countries GDP-Expenditure-on-Health 1980-2013: The Historic and Continued Low Priority of UK Health-Related Expenditure

    Directory of Open Access Journals (Sweden)

    Andrew J.E. Harding

    2016-09-01

    Full Text Available It is well-established that for a considerable period the United Kingdom has spent proportionally less of its gross domestic product (GDP on health-related services than almost any other comparable country. Average European spending on health (as a % of GDP in the period 1980 to 2013 has been 19% higher than the United Kingdom, indicating that comparable countries give far greater fiscal priority to its health services, irrespective of its actual fiscal value or configuration. While the UK National Health Service (NHS is a comparatively lean healthcare system, it is often regarded to be at a ‘crisis’ point on account of low levels of funding. Indeed, many state that currently the NHS has a sizeable funding gap, in part due to its recently reduced GDP devoted to health but mainly the challenges around increases in longevity, expectation and new medical costs. The right level of health funding is a political value judgement. As the data in this paper outline, if the UK ‘afforded’ the same proportional level of funding as the mean averageEuropean country, total expenditure would currently increase by one-fifth.

  5. Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study.

    Science.gov (United States)

    Bailey, Robin; Wells, Adrian

    2016-03-01

    Psychological theories have identified a range of variables contributing to health anxiety, including, dysfunctional illness beliefs, catastrophic misinterpretation, somatosensory amplification and neuroticism. More recently, metacognitive beliefs have been proposed as important in health anxiety. This study aimed to test the potential causal role of metacognitive beliefs in health anxiety. A prospective design was employed and participants (n = 105) completed a battery of questionnaire at two time points (6 months apart). Results demonstrated that cognitive, personality and metacognitive variables were bi-variate prospective correlates of health anxiety. Hierarchical regression analysis revealed that only metacognitive beliefs emerged as independent and significant prospective predictors of health anxiety. Moderation analysis demonstrated that metacognitive beliefs prospectively moderated the relationship between catastrophic misinterpretation and health anxiety. Follow-up regression analysis incorporating the interaction term (metacognition × misinterpretation) showed that the term explained additional variance in health anxiety. The results confirm that metacognition is a predictor of health anxiety and it is more substantive than misinterpretations of symptoms, somatosensory amplification, neuroticism, and illness beliefs. These results may have major implications for current cognitive models and for the treatment of health anxiety.

  6. Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study.

    Science.gov (United States)

    Bailey, Robin; Wells, Adrian

    2016-03-01

    Psychological theories have identified a range of variables contributing to health anxiety, including, dysfunctional illness beliefs, catastrophic misinterpretation, somatosensory amplification and neuroticism. More recently, metacognitive beliefs have been proposed as important in health anxiety. This study aimed to test the potential causal role of metacognitive beliefs in health anxiety. A prospective design was employed and participants (n = 105) completed a battery of questionnaire at two time points (6 months apart). Results demonstrated that cognitive, personality and metacognitive variables were bi-variate prospective correlates of health anxiety. Hierarchical regression analysis revealed that only metacognitive beliefs emerged as independent and significant prospective predictors of health anxiety. Moderation analysis demonstrated that metacognitive beliefs prospectively moderated the relationship between catastrophic misinterpretation and health anxiety. Follow-up regression analysis incorporating the interaction term (metacognition × misinterpretation) showed that the term explained additional variance in health anxiety. The results confirm that metacognition is a predictor of health anxiety and it is more substantive than misinterpretations of symptoms, somatosensory amplification, neuroticism, and illness beliefs. These results may have major implications for current cognitive models and for the treatment of health anxiety. PMID:26851713

  7. Why do some countries spend more for health? An assessment of sociopolitical determinants and international aid for government health expenditures.

    Science.gov (United States)

    Liang, Li-Lin; Mirelman, Andrew J

    2014-08-01

    A consensus exists that rising income levels and technological development are among key drivers of total health spending. Determinants of public sector health expenditure, by contrast, are less well understood. This study examines a complex relationship across government health expenditure (GHE), sociopolitical risks, and international aid, while taking into account the impacts of national income, debt and tax financing and aging populations on health spending. We apply a fixed-effects two-stage least squares regression method to a panel dataset comprising 120 countries for the years 1995 through 2010. Our results show that democratic accountability has a diminishing positive correlation with GHE, and that levels of GHE are higher when government is more stable. Corruption is associated with less GHE in developing countries, but with higher GHE in developed countries. We also find that development assistance for health (DAH) is fungible with domestically financed government health expenditure (DGHE). For an average country, a 1% increase in DAH to government is associated with a 0.03-0.04% decrease in DGHE. Furthermore, the degree of fungibility of DAH to government is higher in countries where corruption or ethnic tensions are widespread. However, DAH to non-governmental organizations is not fungible with DGHE.

  8. Monitoring expenditure and utilisation of medicines in the European Union. A public health approach

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    Pietro Folino-Gallo

    2006-03-01

    Full Text Available

    Background Thousands of medicinal products are licensed in the European Union Member States.This large quantity of medicines has an important impact on individual and public health but the information available on the licensed medicines, their clinical properties, prices, utilisation and expenditure is difficult to retrieve. Thus there is a need for monitoring the price, expenditure and utilisation of medicines and their impact on the population’s health. For these reasons the European Commission funded a project to define a set of indicators and to build a European database of medicines.

    Methods A collaboration of academics and government agencies was formed to undertake the project which aims to fill the information gap on medicines in Europe by identifying the available data sources, defining a set of EU pharmaceutical indicators, and building a European database of medicines available on the internet.

    Results The project has formed a Library of European Union Pharmaceutical Indicators. This includes recommendations for national registers (to produce valid and comparable data, and a set of indicators (price, expenditure, utilisation for monitoring pharmaceutical policies. Moreover, the project has built a (beta version database of licensed medicines in Europe, which can be freely accessed on the internet.The database provides, in a simple manner, useful information difficult to retrieve by other sources.

    Conclusions The EURO-MED-STAT project has defined a set of indicators to monitor the utilisation and expenditure of medicines from a public health perspective. It has also proven that a European database of medicines is feasible and can provide useful information to stakeholders.

  9. Psychiatric inpatient expenditures and public health insurance programmes: analysis of a national database covering the entire South Korean population

    OpenAIRE

    Chung Woojin

    2010-01-01

    Abstract Background Medical spending on psychiatric hospitalization has been reported to impose a tremendous socio-economic burden on many developed countries with public health insurance programmes. However, there has been no in-depth study of the factors affecting psychiatric inpatient medical expenditures and differentiated these factors across different types of public health insurance programmes. In view of this, this study attempted to explore factors affecting medical expenditures for ...

  10. Nuclear catastrophe in Japan. Health consequences resulting from Fukushima; Atomkatastrophe in Japan. Gesundheitliche Folgen von Fukushima

    Energy Technology Data Exchange (ETDEWEB)

    Paulitz, Henrik; Eisenberg, Winfrid; Thiel, Reinhold

    2013-03-06

    On 11 March 2011, a nuclear catastrophe occurred at the Fukushima Dai-ichi nuclear power plant in Japan in the wake of an earthquake and due to serious safety deficiencies. This resulted in a massive and prolonged release of radioactive fission and decay products. Approximately 20% of the radioactive substances released into the atmosphere have led to the contamination of the landmass of Japan with 17,000 becquerels per square meter of cesium-137 and a comparable quantity of cesium-134. The initial health consequences of the nuclear catastrophe are already now, after only two years, scientifically verifiable. Similar to the case of Chernobyl, a decline in the birth rate was documented nine months after the nuclear catastrophe. Throughout Japan, the total drop in number of births in December 2011 was 4362, with the Fukushima Prefecture registering a decline of 209 births. Japan also experienced a rise in infant mortality, with 75 more children dying in their first year of life than expected statistically. In the Fukushima Prefecture alone, some 55,592 children were diagnosed with thyroid gland nodules or cysts. In contrast to cysts and nodules found in adults, these findings in children must be classified as precancerous. There were also the first documented cases in Fukushima of thyroid cancer in children. The present document undertakes three assessments of the expected incidence of cancer resulting from external exposure to radiation. These are based on publications in scientific journals on soil contamination in 47 prefectures in Japan, the average total soil contamination, and, in the third case, on local dose rate measurements in the fall of 2012. Taking into consideration the shielding effect of buildings, the medical organization IPPNW has calculated the collective lifetime doses for individuals at 94,749 manSv, 206,516 manSv, and 118,171 manSv, respectively. In accordance with the risk factors set by the European Committee on Radiation Risk (ECRR) for death

  11. Diabetes, minor depression and health care utilization and expenditures: a retrospective database study

    Directory of Open Access Journals (Sweden)

    McCollum Marianne

    2007-04-01

    Full Text Available Abstract Background To estimate the prevalence of minor depression among US adults with diabetes, health care resource utilization, and expenditures by people with diabetes with and without minor depression. Methods Among adult 2003 Medical Expenditure Panel Survey respondents, diabetes was identified by diagnosis code and self-report. Depression was identified by diagnosis code plus ≥ one antidepressant prescription. Odds of having depression was estimated in people with diabetes and the general population, adjusted for sociodemographic variables (e.g., age, sex, race/ethnicity. Multivariate regressions evaluated factors associated with utilization and log-transformed expenditures for ambulatory care, hospitalizations, emergency visits, and prescriptions. Results In 2003, 1932 respondents had diabetes, 435/1932 had diabetes and minor depression. Adults with diabetes were more likely than the general population to have depression (adjusted OR 1.81, 95% CI 1.56, 2.09. People with diabetes with versus without comorbid depression were more likely to be women, have lower incomes and health status, and more diabetes complications (all p Conclusion People with diabetes are twice as likely to have depression as the general population. Screening for and treatment of depression is warranted, as is additional research into a causal relationship between diabetes and depression.

  12. Spending to save? State health expenditure and infant mortality in India.

    Science.gov (United States)

    Bhalotra, Sonia

    2007-09-01

    There are severe inequalities in health in the world, poor health being concentrated amongst poor people in poor countries. Poor countries spend a much smaller share of national income on health expenditure than do richer countries. What potential lies in political or growth processes that raise this share? This depends upon how effective government health spending in developing countries is. Existing research presents little evidence of an impact on childhood mortality. Using specifications similar to those in the existing literature, this paper finds a similar result for India, which is that state health spending saves no lives. However, upon allowing lagged effects, controlling in a flexible way for trended unobservables and restricting the sample to rural households, a significant effect of health expenditure on infant mortality emerges, the long run elasticity being about -0.24. There are striking differences in the impact by social group. Slicing the data by gender, birth order, religion, maternal and paternal education and maternal age at birth, I find the weakest effects in the most vulnerable groups (with the exception of a large effect for scheduled tribes).

  13. 30 years life with Chernobyl, 5 years life with Fukushima. Health consequences of the nuclear catastrophes of Chernobyl and Fukushima; 30 Jahre Leben mit Tschernobyl, 5 Jahre Leben mit Fukushima. Gesundheitliche Folgen der Atomkatastrophen von Tschernobyl und Fukushima

    Energy Technology Data Exchange (ETDEWEB)

    Claussen, Angelika; Rosen, Alex

    2016-02-15

    The IPPNW report on health consequences of the nuclear catastrophes of Chernobyl and Fukushima covers the following issues: Part.: 30 years life with Chernobyl: Summarized consequences of Chernobyl, the accident progression, basic data of the catastrophe, estimation of health hazards as a consequence of the severe accident of Chernobyl, health consequences for the liquidators, health consequences for the contaminated population, mutagenic and teratogenic effects. Part B: 5 years life with Fukushima: The start of the nuclear catastrophe, emissions and contamination, consequences of the nuclear catastrophe on human health, thyroid surveys in the prefecture Fukushima, consequences of the nuclear catastrophe on the ecosystem, outlook.

  14. The Impact of Health Insurance Programs on Out-of-Pocket Expenditures in Indonesia: An Increase or a Decrease?

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    Aurelia Souares

    2013-07-01

    Full Text Available We used panel data from the Indonesian Family Life Survey to investigate the impact of health insurance programs on reducing out-of-pocket expenditures. We employed three linear panel data models, two of which accounted for endogeneity: pooled ordinary least squares (OLS, pooled two-stage least squares (2SLS for instrumental variable (IV, and fixed effects (FE. The study revealed that two health insurance programs had a significantly negative impact on out-of-pocket expenditures by using IV estimates. In the IV model, Askeskin decreased out-of-pocket expenditures by 34% and Askes by 55% compared with non-Askeskin and non-Askes, respectively, while Jamsostek was found to bear a nonsignificant effect on out-of-pocket expenditures. In the FE model, only Askeskin had a significant negative effect with an 11% reduction on out-of-pocket expenditures. This study showed that two large existing health insurance programs in Indonesia, Askeskin and Askes, effectively reduced household out-of-pocket expenditures. The ability of programs to offer financial protection by reducing out-of-pocket expenditures is likely to be a direct function of their benefits package and co-payment policies.

  15. Psychiatric inpatient expenditures and public health insurance programmes: analysis of a national database covering the entire South Korean population

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    Chung Woojin

    2010-09-01

    Full Text Available Abstract Background Medical spending on psychiatric hospitalization has been reported to impose a tremendous socio-economic burden on many developed countries with public health insurance programmes. However, there has been no in-depth study of the factors affecting psychiatric inpatient medical expenditures and differentiated these factors across different types of public health insurance programmes. In view of this, this study attempted to explore factors affecting medical expenditures for psychiatric inpatients between two public health insurance programmes covering the entire South Korean population: National Health Insurance (NHI and National Medical Care Aid (AID. Methods This retrospective, cross-sectional study used a nationwide, population-based reimbursement claims dataset consisting of 1,131,346 claims of all 160,465 citizens institutionalized due to psychiatric diagnosis between January 2005 and June 2006 in South Korea. To adjust for possible correlation of patients characteristics within the same medical institution and a non-linearity structure, a Box-Cox transformed, multilevel regression analysis was performed. Results Compared with inpatients 19 years old or younger, the medical expenditures of inpatients between 50 and 64 years old were 10% higher among NHI beneficiaries but 40% higher among AID beneficiaries. Males showed higher medical expenditures than did females. Expenditures on inpatients with schizophrenia as compared to expenditures on those with neurotic disorders were 120% higher among NHI beneficiaries but 83% higher among AID beneficiaries. Expenditures on inpatients of psychiatric hospitals were greater on average than expenditures on inpatients of general hospitals. Among AID beneficiaries, institutions owned by private groups treated inpatients with 32% higher costs than did government institutions. Among NHI beneficiaries, inpatients medical expenditures were positively associated with the proportion of

  16. Gender Difference in Health-Care Expenditure: Evidence from India Human Development Survey.

    Directory of Open Access Journals (Sweden)

    Nandita Saikia

    Full Text Available While the gender disparity in health and mortality in various stages of life in India is well documented, there is limited evidence on female disadvantage in health-care expenditure (HCE.Examine the gender difference in HCE in short-term and major morbidity in India, and understand the role of factors underlying the difference.Using two rounds of nationally representative panel data-the India Human Development Survey (IHDS 2004-2005 and 2011-2012 (IHDS I & II-we calculate morbidity prevalence rate and mean HCE by gender, and examine the adjusted effect of gender on major morbidity-related HCE by using a two-part regression model. Further, we performed Oaxaca-Blinder decomposition of the gender gap in HCE in major morbidity to understand the contribution of demographic and socio-economic factors.Health-care expenditure on females was systematically lower than on males across all demographic and socio-economic groups. Multivariate analysis confirms that female HCE is significantly lower than male HCE even after controlling demographic and socio-economic factors (β = -0.148, p = 0.000, CI:-0.206-0.091. For both short-term and major morbidity, a female disadvantage on HCE increased from IHDS I to IHDS II. For instance, the male-female gap in major morbidity related expenditure increased from INR 1298 to INR 4172. A decomposition analysis of gender gap in HCE demonstrates that about 48% of the gap is attributable to differences in demographic and socio-economic factors (endowment effect, whereas 50% of the gap is due to the differential effect of the determinants (coefficient effect.Indians spend less on female health care than on male health care. Most of the gender gap in HCE is not due to differential distribution of factors affecting HCE.

  17. Gender Difference in Health-Care Expenditure: Evidence from India Human Development Survey

    Science.gov (United States)

    Saikia, Nandita; Moradhvaj; Bora, Jayanta Kumar

    2016-01-01

    Background While the gender disparity in health and mortality in various stages of life in India is well documented, there is limited evidence on female disadvantage in health-care expenditure (HCE). Aims Examine the gender difference in HCE in short-term and major morbidity in India, and understand the role of factors underlying the difference. Data and Methods Using two rounds of nationally representative panel data—the India Human Development Survey (IHDS) 2004–2005 and 2011–2012 (IHDS I & II)—we calculate morbidity prevalence rate and mean HCE by gender, and examine the adjusted effect of gender on major morbidity-related HCE by using a two-part regression model. Further, we performed Oaxaca-Blinder decomposition of the gender gap in HCE in major morbidity to understand the contribution of demographic and socio-economic factors. Results Health-care expenditure on females was systematically lower than on males across all demographic and socio-economic groups. Multivariate analysis confirms that female HCE is significantly lower than male HCE even after controlling demographic and socio-economic factors (β = -0.148, p = 0.000, CI:-0.206–0.091). For both short-term and major morbidity, a female disadvantage on HCE increased from IHDS I to IHDS II. For instance, the male–female gap in major morbidity related expenditure increased from INR 1298 to INR 4172. A decomposition analysis of gender gap in HCE demonstrates that about 48% of the gap is attributable to differences in demographic and socio-economic factors (endowment effect), whereas 50% of the gap is due to the differential effect of the determinants (coefficient effect). Interpretation Indians spend less on female health care than on male health care. Most of the gender gap in HCE is not due to differential distribution of factors affecting HCE. PMID:27391322

  18. Critical Amount of Resource in Containing Catastrophic Epidemics

    CERN Document Server

    Chen, Xiaolong; Feng, Ling; Yang, Chun; Wang, Moming; Fan, Xiaoming; Hu, Yanqing

    2016-01-01

    During an epidemic control, the containment of the disease is usually achieved through increasing public health resource to quickly identify, quarantine and cure the infected population. However, the exact impact of this resource expenditure on the physical spreading dynamics remains unknown. In this work we find that the influence of resource expenditure exhibits extreme critical behaviour, which is the first order phase transition in nature. Specifically, if the amount of invested resource is below a critical value, a significant fraction of the total population will become infected; once it is more than that critical value, the disease outbreak can be effectively eradicated or contained. This finding implies that the government expenditure on infectious disease control needs to meet a certain critical threshold to be of any effectiveness. Otherwise, the outbreak could be catastrophic. We have validated our theoretical results on one real contact network and three typical social networks, with all of them e...

  19. More Health Expenditure, Better Economic Performance? Empirical Evidence From OECD Countries.

    Science.gov (United States)

    Wang, Fuhmei

    2015-01-01

    Recent economic downturns have led many countries to reduce health spending dramatically, with the World Health Organization raising concerns over the effects of this, in particular among the poor and vulnerable. With the provision of appropriate health care, the population of a country could have better health, thus strengthening the nation's human capital, which could contribute to economic growth through improved productivity. How much should countries spend on health care? This study aims to estimate the optimal health care expenditure in a growing economy. Applying the experiences of countries from the Organization for Economic Co-Operation and Development (OECD) over the period 1990 to 2009, this research introduces the method of system generalized method of moments (GMM) to derive the design of the estimators of the focal variables. Empirical evidence indicates that when the ratio of health spending to gross domestic product (GDP) is less than the optimal level of 7.55%, increases in health spending effectively lead to better economic performance. Above this, more spending does not equate to better care. The real level of health spending in OECD countries is 5.48% of GDP, with a 1.87% economic growth rate. The question which is posed by this study is a pertinent one, especially in the current context of financially constrained health systems around the world. The analytical results of this work will allow policymakers to better allocate scarce resources to achieve their macroeconomic goals. PMID:26310501

  20. Ageing and health-care expenditure: the red herring argument revisited.

    Science.gov (United States)

    Seshamani, Meena; Gray, Alastair

    2004-04-01

    Zweifel and colleagues have previously proposed that proximity to death is a more important influence on health-care costs than age, suggesting that demographic change per se will not have a large impact on future aggregate health expenditure. However, issues of econometric methodology have led to challenges of the robustness of these findings. This paper revisits the analysis. Using a longitudinal hospital data set from Oxfordshire, England, the two-step Heckman model from the Zweifel study is first replicated, to find that neither age nor proximity to death have a significant effect on hospital costs. Econometric problems with the model are demonstrated, and instead a two-part model shows both age and proximity to death to have significant effects on quarterly hospital costs. Cost predictions, calculated with bootstrapped 95% confidence intervals, further demonstrate that while age may significantly affect quarterly costs, these cost changes are small compared to the tripling of quarterly costs that occurs with approaching death in the last year of life. The analyses show the importance of model selection to properly assess the determinants of health-care expenditures.

  1. Medical technology as a key driver of rising health expenditure: disentangling the relationship

    Directory of Open Access Journals (Sweden)

    Sorenson C

    2013-05-01

    Full Text Available Corinna Sorenson,1,2 Michael Drummond,2,3 Beena Bhuiyan Khan1 1LSE Health, London School of Economics and Political Science, London, UK; 2European Health Technology Institute for Socioeconomic Research, Brussels, Belgium; 3Centre for Health Economics, University of York, York, UK Abstract: Health care spending has risen steadily in most countries, becoming a concern for decision-makers worldwide. Commentators often point to new medical technology as the key driver for burgeoning expenditures. This paper critically appraises this conjecture, based on an analysis of the existing literature, with the aim of offering a more detailed and considered analysis of this relationship. Several databases were searched to identify relevant literature. Various categories of studies (eg, multivariate and cost-effectiveness analyses were included to cover different perspectives, methodological approaches, and issues regarding the link between medical technology and costs. Selected articles were reviewed and relevant information was extracted into a standardized template and analyzed for key cross-cutting themes, ie, impact of technology on costs, factors influencing this relationship, and methodological challenges in measuring such linkages. A total of 86 studies were reviewed. The analysis suggests that the relationship between medical technology and spending is complex and often conflicting. Findings were frequently contingent on varying factors, such as the availability of other interventions, patient population, and the methodological approach employed. Moreover, the impact of technology on costs differed across technologies, in that some (eg, cancer drugs, invasive medical devices had significant financial implications, while others were cost-neutral or cost-saving. In light of these issues, we argue that decision-makers and other commentators should extend their focus beyond costs solely to include consideration of whether medical technology results in

  2. Does managed care reduce health care expenditure? Evidence from spatial panel data.

    Science.gov (United States)

    Ehlert, Andree; Oberschachtsiek, Dirk

    2014-09-01

    Similar to, for example, the US, Switzerland or Great Britain the German health care sector has recently undergone a series of reforms towards managed care. These measures are intended to yield both a higher quality of care and cost containment. In our study we ask whether managed care reduces health care expenditure at the market level. We apply a macroeconomic evaluation approach based on a regional panel data set which is as yet unique in the context of managed care. Econometrically, we account for both unobserved heterogeneity and spatial dependence, i.e. regional interrelations in health care. We discuss alternative model specifications and include a range of sensitivity analyses. Our results suggest that in contrast to public perception the share of managed care contracts has a positive impact on pharmaceutical spending, in particular through regional spillover effects. PMID:24691774

  3. Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads.

    Science.gov (United States)

    Philpot, Lindsey M; Stockbridge, Erica L; Padrón, Norma A; Pagán, José A

    2016-06-01

    Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211). PMID:26440215

  4. [Health expenditure in the context of social expenditure. A generational analysis of tendencies in Spain in the context of demographic aging. 2008 SESPAS Report].

    Science.gov (United States)

    López Casasnovas, Guillem; Mosterín Höpping, Ana

    2008-04-01

    The tendency for public welfare spending to be increasingly aimed at the elderly has been identified in several developed countries. While population aging is a common trend, it is not obvious why the shift in spending exceeds the trend in aging, or why per capita spending on the elderly is increasing. In the first part of the present article, we show that this trend is occurring in Spain, identify the losers from this development, discuss the policies that underlie it, and propose adjustments based on Musgrave's fixed proportions rule for fair intergenerational distribution. These policies aim to manage population aging, labor market participation of youth and women, as well as public policies that combine 'work-fare' strategies with the more traditional 'welfare' strategies. In the second part of this paper, we explore the contribution of public health expenditure to overall public social expenditure, and analyze the effect of increasing health on distributional fairness. This analysis is guided by our perception that social policy, including health policy, should be more horizontal, i.e. it should take into account the sum total of a mixed basket of resources aimed at any recipient group, to avoid the skewed allocation of resources that arises from compounding various independent distributions of resources. Coordination of the various channels of social expenditure should ensure precisely targeted recipients and cross-departmental sources. The normative fairness criterion to be used should be precisely specified. In Spain (1980-2000) the oldest segment of the population has gained the most, appropriating an increased share of resources. This increase goes beyond the amount that could be explained by population aging throughout the period. The 'losers' are individuals with different fragility conditions. On average the youngest working group has suffered the highest relative loss.

  5. Longitudinal Relationships between Caloric Expenditure and Gray Matter in the Cardiovascular Health Study

    Science.gov (United States)

    Raji, Cyrus A.; Merrill, David A.; Eyre, Harris; Mallam, Sravya; Torosyan, Nare; Erickson, Kirk I.; Lopez, Oscar L.; Becker, James T.; Carmichael, Owen T.; Gach, H. Michael; Thompson, Paul M.; Longstreth, W.T.; Kuller, Lewis H.

    2016-01-01

    Background: Physical activity (PA) can be neuroprotective and reduce the risk for Alzheimer’s disease (AD). In assessing physical activity, caloric expenditure is a proxy marker reflecting the sum total of multiple physical activity types conducted by an individual. Objective:To assess caloric expenditure, as a proxy marker of PA, as a predictive measure of gray matter (GM) volumes in the normal and cognitively impaired elderly persons. Methods: All subjects in this study were recruited from the Institutional Review Board approved Cardiovascular Health Study (CHS), a multisite population-based longitudinal study in persons aged 65 and older. We analyzed a sub-sample of CHS participants 876 subjects (mean age 78.3, 57.5% F, 42.5% M) who had i) energy output assessed as kilocalories (kcal) per week using the standardized Minnesota Leisure-Time Activities questionnaire, ii) cognitive assessments for clinical classification of normal cognition, mild cognitive impairment (MCI), and AD, and iii) volumetric MR imaging of the brain. Voxel-based morphometry modeled the relationship between kcal/week and GM volumes while accounting for standard covariates including head size, age, sex, white matter hyperintensity lesions, MCI or AD status, and site. Multiple comparisons were controlled using a False Discovery Rate of 5 percent. Results: Higher energy output, from a variety of physical activity types, was associated with larger GM volumes in frontal, temporal, and parietal lobes, as well as hippocampus, thalamus, and basal ganglia. High levels of caloric expenditure moderated neurodegeneration-associated volume loss in the precuneus, posterior cingulate, and cerebellar vermis. Conclusion:Increasing energy output from a variety of physical activities is related to larger gray matter volumes in the elderly, regardless of cognitive status. PMID:26967227

  6. Health Care Expenditure and GDP in African Countries: Evidence from Semiparametric Estimation with Panel Data

    Directory of Open Access Journals (Sweden)

    Zhike Lv

    2014-01-01

    Full Text Available A large body of literature studies on the relationship between health care expenditure (HCE and GDP have been analyzed using data intensively from developed countries, but little is known for other regions. This paper considers a semiparametric panel data analysis for the study of the relationship between per capita HCE and per capita GDP for 42 African countries over the period 1995–2009. We found that infant mortality rate per 1,000 live births has a negative effect on per capita HCE, while the proportion of the population aged 65 is statistically insignificant in African countries. Furthermore, we found that the income elasticity is not constant but varies with income level, and health care is a necessity rather than a luxury for African countries.

  7. Comparisons of annual health care utilization, drug consumption, and medical expenditure between the elderly and general population in Taiwan

    OpenAIRE

    Wan-Hsuan Lu, MS; Wei-Ju Lee, MD, MS; Liang-Kung Chen, MD, PhD; Fei-Yuan Hsiao, PhD

    2016-01-01

    Background/Purpose: The aim of this study was to present an overview of health care utilization (outpatient, inpatient, and emergency visits), total medical expenditure, and drug consumption between the elderly and general population under Taiwan's National Health Insurance program. Methods: We conducted a cross-sectional analysis using the 2010 Taiwan's Longitudinal Health Insurance Database. Our analysis included 999,418 beneficiaries with eligible records under the National Health Insur...

  8. Climate catastrophes

    Science.gov (United States)

    Budyko, Mikhail

    1999-05-01

    Climate catastrophes, which many times occurred in the geological past, caused the extinction of large or small populations of animals and plants. Changes in the terrestrial and marine biota caused by the catastrophic climate changes undoubtedly resulted in considerable fluctuations in global carbon cycle and atmospheric gas composition. Primarily, carbon dioxide and other greenhouse gas contents were affected. The study of these catastrophes allows a conclusion that climate system is very sensitive to relatively small changes in climate-forcing factors (transparency of the atmosphere, changes in large glaciations, etc.). It is important to take this conclusion into account while estimating the possible consequences of now occurring anthropogenic warming caused by the increase in greenhouse gas concentration in the atmosphere.

  9. A longitudinal study on health expenditure in a rural community attached to mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra

    Directory of Open Access Journals (Sweden)

    Tapas Bera

    2012-01-01

    Full Text Available Community based study on health expenditure is a rarity in India. A Rural Community based longitudinal study was undertaken in Jaulgaon village of Maharashtra, with objectives of finding out the health expenditure contributed by direct treatment, related travel and relevant loss of wages with certain pertinent associated factors. 50% of the village population was studied (N = 256 by pre-designed, pre-tested schedule following WHO guidelines. A monthly house to house interview was conducted over 12 months. During study period, 78% study subjects suffered some illness with mean illness episode 1.74/person and 6.37/family without any sex difference. The annual health expenditure of the community was Rs 1,576/family, 4,31/person and 2,42/episode, which was about 4.3% of their income. The major part of the expenditure (82% was for direct treatment cost, followed by loss of wages (12% and travel related cost (6%. Expenditure was seen to be significantly associated with family income (P = 0.000 and education (P = 0.006.

  10. A longitudinal study on health expenditure in a rural community attached to Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra.

    Science.gov (United States)

    Bera, Tapas; Sadhukhan, Sanjoy Kumar; Premendran, John S

    2012-01-01

    Community based study on health expenditure is a rarity in India. A Rural Community based longitudinal study was undertaken in Jaulgaon village of Maharashtra, with objectives of finding out the health expenditure contributed by direct treatment, related travel and relevant loss of wages with certain pertinent associated factors. 50% of the village population was studied (N = 256) by pre-designed, pre-tested schedule following WHO guidelines. A monthly house to house interview was conducted over 12 months. During study period, 78% study subjects suffered some illness with mean illness episode 1.74/person and 6.37/family without any sex difference. The annual health expenditure of the community was Rs 1,576/family, 4,31/person and 2,42/episode, which was about 4.3% of their income. The major part of the expenditure (82%) was for direct treatment cost, followed by loss of wages (12%) and travel related cost (6%). Expenditure was seen to be significantly associated with family income (P = 0.000) and education (P = 0.006).

  11. Resounding Catastrophe

    DEFF Research Database (Denmark)

    Kristensen, Thomas Bjørnsten

    2012-01-01

    The article discusses specific aesthetic strategies for articulating and describing the catastrophic event of 9/11 by focusing on its auditory aspects. This is done through a reading of the American media- and sound artist Stephen Vitiello’s work and novelist Don DeLillo’s Falling Man....

  12. The core determinants of health expenditure in the African context: some econometric evidence for policy.

    Science.gov (United States)

    Murthy, Vasudeva N R; Okunade, Albert A

    2009-06-01

    This paper, using cross-sectional data from 44 (83% of all) African countries for year 2001, presents econometric model estimates linking real per-capita health expenditure (HEXP) to a host of economic and non-economic factors. The empirical results of OLS and robust LAE estimators indicate that real per-capita GDP (PRGDP) and real per-capita foreign aid (FAID) resources are both core and statistically significant correlates of HEXP. Our empirical results suggest that health care in the African context is technically, a necessity rather than a luxury good (for the OECD countries). This suggests that the goal of health system in Africa is primarily 'physiological' or 'curative' rather than 'caring' or 'pampering'. The positive association of HEXP with FAID hints that external resource inflows targeting health could be instrumental for spurring economic progress in good policy environments. Most African countries until the late 1990s experienced economic and political instability, and faced stringent structural adjustment mandates of the major international financial institution lenders for economic development. Therefore, our finding a positive effect of FAID on HEXP could suggest that external resource inflows softened some of the macroeconomic fiscal deficit impacts on HEXP in the 2000s. Policy implications of country-specific elasticity estimates are given. PMID:19108929

  13. Explaining the increased health care expenditures associated with gastroesophageal reflux disease among elderly Medicare beneficiaries with chronic obstructive pulmonary disease: a cost-decomposition analysis

    Directory of Open Access Journals (Sweden)

    Ajmera M

    2014-04-01

    Full Text Available Mayank Ajmera,1 Amit D Raval,1 Chan Shen,2 Usha Sambamoorthi1 1Department of Pharmaceutical Systems and Policy, School of Pharmacy, School of Medicine, West Virginia University, Morgantown, WV, USA; 2Department of Biostatistics and Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA Objective: To estimate excess health care expenditures associated with gastroesophageal reflux disease (GERD among elderly individuals with chronic obstructive pulmonary disease (COPD and examine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors to the excess expenditures, using the Blinder-Oaxaca linear decomposition technique. Methods: This study utilized a cross-sectional, retrospective study design, using data from multiple years (2006-2009 of the Medicare Current Beneficiary Survey linked with fee-for-service Medicare claims. Presence of COPD and GERD was identified using diagnoses codes. Health care expenditures consisted of inpatient, outpatient, prescription drugs, dental, medical provider, and other services. For the analysis, t-tests were used to examine unadjusted subgroup differences in average health care expenditures by the presence of GERD. Ordinary least squares regressions on log-transformed health care expenditures were conducted to estimate the excess health care expenditures associated with GERD. The Blinder-Oaxaca linear decomposition technique was used to determine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors, to excess health care expenditures associated with GERD. Results: Among elderly Medicare beneficiaries with COPD, 29.3% had co-occurring GERD. Elderly Medicare beneficiaries with COPD/GERD had 1.5 times higher ($36,793 vs $24,722 [P<0.001] expenditures than did those with COPD/no GERD. Ordinary

  14. Rural mass casualty preparedness and response: the Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events.

    Science.gov (United States)

    Viswanathan, Kristin P; Bass, Robert; Wijetunge, Gamunu; Altevogt, Bruce M

    2012-10-01

    The Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a workshop at the request of the Federal Interagency Committee on Emergency Medical Services (FICEMS) that brought together a range of stakeholders to broadly identify and confront gaps in rural infrastructure that challenge mass casualty incident (MCI) response and potential mechanisms to fill them. This report summarizes the presentations and discussions around 6 major issues specific to rural MCI preparedness and response: (1) improving rural response to MCI through improving daily capacity and capability, (2) leveraging current and emerging technology to overcome infrastructure deficits, (3) sustaining and strengthening relationships, (4) developing and sharing best practices across jurisdictions and sectors, (5) establishing metrics research and development, and (6) fostering the need for federal leadership to expand and integrate EMS into a broader rural response framework. PMID:23077273

  15. Machines that Go 'Ping': Medical Technology and Health Expenditures in OECD Countries.

    Science.gov (United States)

    Willemé, Peter; Dumont, Michel

    2015-08-01

    Technology is believed to be a major determinant of increasing health spending. The main difficulty to quantify its effect is to find suitable proxies to measure medical technological innovation. This paper's main contribution is the use of data on approved medical devices and drugs to proxy for medical technology. The effects of these variables on total real per capita health spending are estimated using a panel model for 18 Organisation for Economic Co-operation and Development (OECD) countries covering the period 1981-2012. The results confirm the substantial cost-increasing effect of medical technology, which accounts for almost 50% of the explained historical growth of spending. Despite the overall net positive effect of technology, the effect of two subgroups of approvals on expenditure is significantly negative. These subgroups can be thought of as representing 'incremental medical innovation', whereas the positive effects are related to radically innovative pharmaceutical products and devices. A separate time series model was estimated for the USA because the FDA approval data in fact only apply to the USA, while they serve as proxies for the other OECD countries. Our empirical model includes an indicator of obesity, and estimations confirm the substantial contribution of this lifestyle variable to health spending growth in the countries studied. PMID:25070599

  16. Seizing Catastrophes

    DEFF Research Database (Denmark)

    Kublitz, Anja

    2013-01-01

    Based on fieldwork among Palestinians in Denmark the article investigates the Palestinian temporality of Nakba that is equivalent to a time of security in the sense that it is concerned with existential threats and emergency action. The Arabic term Nakba literally means catastrophe and is in Pale......Based on fieldwork among Palestinians in Denmark the article investigates the Palestinian temporality of Nakba that is equivalent to a time of security in the sense that it is concerned with existential threats and emergency action. The Arabic term Nakba literally means catastrophe...... and is in Palestinian national discourse used to designate the Arab-Israeli war of 1948, when more than half of the Palestinian population were expelled from their homeland – a reverse national myth about how Palestine failed to come into being. Yet, according to Palestinians in Denmark, the Nakba cannot be relegated...... of the Nakba in 2008 and clashes between the police and young Palestinians in 2006, the article demonstrates how Palestinians in Denmark seek to reverse the reverse myth of 1948 by seizing contemporary catastrophes to enact not only past and present Nakbas, but also potential futures. The article concludes...

  17. Urban-Rural Differences in the Effect of a Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expenditures

    Science.gov (United States)

    Meng, Hongdao; Wamsley, Brenda; Liebel, Diane; Dixon, Denise; Eggert, Gerald; Van Nostrand, Joan

    2009-01-01

    Purpose: To evaluate the impact of a multicomponent health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries. To determine if these outcomes vary by urban or rural residence. Design and Methods: We analyzed data from a 22-month randomized controlled trial of a health…

  18. Medicare: Comparison of Catastrophic Health Insurance Proposals--An Update. Briefing Report to the Chairman, Select Committee on Aging, House of Representatives.

    Science.gov (United States)

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This document updates a recent report by the General Accounting Office (GAO) which compared Medicare catastrophic health insurance proposals. The update includes H.R. 2470, as passed by the House of Representatives and S. 1127, as reported by the Senate Committee on Finance. An introduction explains the roles of Medicare, Medicaid, the Veterans…

  19. Catastrophe medicine; Medecine de catastrophe

    Energy Technology Data Exchange (ETDEWEB)

    Lebreton, A. [Service Technique de l`Energie Electrique et des Grands Barrages (STEEGB), (France)

    1996-12-31

    The `Catastrophe Medicine` congress which took place in Amiens (France) in December 5 to 7 1996 was devoted to the assessment and management of risks and hazards in natural and artificial systems. The methods of risk evaluation and prevision were discussed in the context of dams accidents with the analysis of experience feedbacks and lessons gained from the organisation of emergency plans. Three round table conferences were devoted to the importance of psychological aspects during such major crises. (J.S.)

  20. Health care utilization and expenditures among Medicaid beneficiaries with neuropathic pain following spinal cord injury

    Directory of Open Access Journals (Sweden)

    Margolis JM

    2014-07-01

    Full Text Available Jay M Margolis,1 Paul Juneau,1 Alesia Sadosky,2 Joseph C Cappelleri,3 Thomas N Bryce,4 Edward C Nieshoff5 1Truven Health Analytics, Bethesda, MD, USA; 2Pfizer Inc., New York, NY, USA; 3Pfizer Inc., Groton, CT, USA; 4Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA Background: The study aimed to evaluate health care resource utilization (HRU and costs for neuropathic pain (NeP secondary to spinal cord injury (SCI among Medicaid beneficiaries. Methods: The retrospective longitudinal cohort study used Medicaid beneficiary claims with SCI and evidence of NeP (SCI-NeP cohort matched with a cohort without NeP (SCI-only cohort. Patients had continuous Medicaid eligibility 6 months pre- and 12 months postindex, defined by either a diagnosis of central NeP (ICD-9-CM code 338.0x or a pharmacy claim for an NeP-related antiepileptic or antidepressant drug within 12 months following first SCI diagnosis. Demographics, clinical characteristics, HRU, and expenditures were compared between cohorts. Results: Propensity score-matched cohorts each consisted of 546 patients. Postindex percentages of patients with physician office visits, emergency department visits, SCI- and pain-related procedures, and outpatient prescription utilization were all significantly higher for SCI-NeP (P<0.001. Using regression models to account for covariates, adjusted mean expenditures were US$47,518 for SCI-NeP and US$30,150 for SCI only, yielding incremental costs of US$17,369 (95% confidence interval US$9,753 to US$26,555 for SCI-NeP. Factors significantly associated with increased cost included SCI type, trauma-related SCI, and comorbidity burden. Conclusion: Significantly higher HRU and total costs were incurred by Medicaid patients with NeP secondary to SCI compared with matched SCI-only patients. Keywords: spinal

  1. Cosmic Catastrophes

    Science.gov (United States)

    Wheeler, J. Craig

    2014-08-01

    Preface; 1. Setting the stage: star formation and hydrogen burning in single stars; 2. Stellar death: the inexorable grip of gravity; 3. Dancing with stars: binary stellar evolution; 4. Accretion disks: flat stars; 5. White Dwarfs: quantum dots; 6. Supernovae: stellar catastrophes; 7. Supernova 1987A: lessons and enigmas; 8. Neutron stars: atoms with attitude; 9. Black holes in theory: into the abyss; 10. Black holes in fact: exploring the reality; 11. Gamma-ray bursts, black holes and the universe: long, long ago and far, far away; 12. Supernovae and the universe; 13. Worm holes and time machines: tunnels in space and time; 14. Beyond: the frontiers; Index.

  2. Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition.

    Science.gov (United States)

    Makinen, M; Waters, H; Rauch, M; Almagambetova, N; Bitran, R; Gilson, L; McIntyre, D; Pannarunothai, S; Prieto, A L; Ubilla, G; Ram, S

    2000-01-01

    This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality.

  3. Spatio-temporal dependencies between hospital beds, physicians and health expenditure using visual variables and data classification in statistical table

    Science.gov (United States)

    Medyńska-Gulij, Beata; Cybulski, Paweł

    2016-06-01

    This paper analyses the use of table visual variables of statistical data of hospital beds as an important tool for revealing spatio-temporal dependencies. It is argued that some of conclusions from the data about public health and public expenditure on health have a spatio-temporal reference. Different from previous studies, this article adopts combination of cartographic pragmatics and spatial visualization with previous conclusions made in public health literature. While the significant conclusions about health care and economic factors has been highlighted in research papers, this article is the first to apply visual analysis to statistical table together with maps which is called previsualisation.

  4. Spatio-temporal dependencies between hospital beds, physicians and health expenditure using visual variables and data classification in statistical table

    Directory of Open Access Journals (Sweden)

    Medyńska-Gulij Beata

    2016-06-01

    Full Text Available This paper analyses the use of table visual variables of statistical data of hospital beds as an important tool for revealing spatio-temporal dependencies. It is argued that some of conclusions from the data about public health and public expenditure on health have a spatio-temporal reference. Different from previous studies, this article adopts combination of cartographic pragmatics and spatial visualization with previous conclusions made in public health literature. While the significant conclusions about health care and economic factors has been highlighted in research papers, this article is the first to apply visual analysis to statistical table together with maps which is called previsualisation.

  5. Private expenditure and the role of private health insurance in Greece: status quo and future trends.

    Science.gov (United States)

    Siskou, Olga; Kaitelidou, Daphne; Economou, Charalampos; Kostagiolas, Peter; Liaropoulos, Lycourgos

    2009-10-01

    The health care system in Greece is financed in almost equal proportions by public and private sources. Private expenditure, consists mostly of out-of-pocket and under-the-table payments. Such payments strongly suggest dissatisfaction with the public system, due to under financing during the last 25 years. This gap has been filled rapidly by the private sector. From this point of view, one might suggest that the flourishing development of private provision may lead in turn to a corresponding growth in private health insurance (PHI). This paper aims to examine the role of PHI in Greece, to identify the factors influencing its development, and to make some suggestions about future policies and trends. In the decade of 1985-1995 PHI show increasing activity, reflecting the intention of some citizens to seek health insurance solutions in the form of supplementary cover in order to ensure faster access, better quality of services, and increased consumer choice. The benefits include programs covering hospital expenses, cash benefits, outpatient care expenses, disability income insurance, as well as limited managed care programs. However, despite recent interest, PHI coverage remains low in Greece compared to other EU countries. Economic, social and cultural factors such as low average household income, high unemployment, obligatory and full coverage by social insurance, lead to reluctance to pay for second-tier insurance. Instead, there is a preference to pay a doctor or hospital directly even in the form of under-the-table payments (which are remarkably high in Greece), when the need arises. There are also factors endogenous to the PHI industry, related to market policies, low organisational capacity, cream skimming, and the absence of insurance products meeting consumer requirements, which explain the relatively low state of development of PHI in Greece. PMID:19593628

  6. Private expenditure and the role of private health insurance in Greece: status quo and future trends.

    Science.gov (United States)

    Siskou, Olga; Kaitelidou, Daphne; Economou, Charalampos; Kostagiolas, Peter; Liaropoulos, Lycourgos

    2009-10-01

    The health care system in Greece is financed in almost equal proportions by public and private sources. Private expenditure, consists mostly of out-of-pocket and under-the-table payments. Such payments strongly suggest dissatisfaction with the public system, due to under financing during the last 25 years. This gap has been filled rapidly by the private sector. From this point of view, one might suggest that the flourishing development of private provision may lead in turn to a corresponding growth in private health insurance (PHI). This paper aims to examine the role of PHI in Greece, to identify the factors influencing its development, and to make some suggestions about future policies and trends. In the decade of 1985-1995 PHI show increasing activity, reflecting the intention of some citizens to seek health insurance solutions in the form of supplementary cover in order to ensure faster access, better quality of services, and increased consumer choice. The benefits include programs covering hospital expenses, cash benefits, outpatient care expenses, disability income insurance, as well as limited managed care programs. However, despite recent interest, PHI coverage remains low in Greece compared to other EU countries. Economic, social and cultural factors such as low average household income, high unemployment, obligatory and full coverage by social insurance, lead to reluctance to pay for second-tier insurance. Instead, there is a preference to pay a doctor or hospital directly even in the form of under-the-table payments (which are remarkably high in Greece), when the need arises. There are also factors endogenous to the PHI industry, related to market policies, low organisational capacity, cream skimming, and the absence of insurance products meeting consumer requirements, which explain the relatively low state of development of PHI in Greece.

  7. Pre-test of questions on health-related resource use and expenditure, using behaviour coding and cognitive interviewing techniques

    Directory of Open Access Journals (Sweden)

    Chernyak Nadja

    2012-09-01

    Full Text Available Abstract Background Validated instruments collecting data on health-related resource use are lacking, but required, for example, to investigate predictors of healthcare use or for health economic evaluation. The objective of the study was to develop, test and refine a questionnaire collecting data on health-related resource use and expenditure in patients with diabetes. Methods The questionnaire was tested in 43 patients with diabetes mellitus types 1 and 2 in Germany. Response behaviour suggestive of problems with questions (item non-response, request for clarification, comments, inadequate answer, “don’t know” was systematically registered. Cognitive interviews focusing on information retrieval and comprehension problems were carried out. Results Many participants had difficulties answering questions pertaining to frequency of visits to the general practitioner (26%, time spent receiving healthcare services (39%, regular medication currently taken (35% and out of pocket expenditure on medication (42%. These difficulties seem to result mainly from poor memory. A number of comprehension problems were established and relevant questions were revised accordingly. Conclusion The questionnaire on health-related resource use and expenditure for use in diabetes research in Germany was developed and refined after careful testing. Ideally, the questionnaire should be externally validated for different modes of administration and recall periods within a variety of populations.

  8. Impacts of Cost Containment Strategies on Pharmaceutical Expenditures of the National Health Insurance in Taiwan, 1996-2003

    OpenAIRE

    Yue-Chune Lee; Ming-Chin Yang; Yu-Tung Huang; Chien-Hsiang Liu; Sun-Bing Chen

    2006-01-01

    Introduction: Pharmaceutical expenditure (PE) of the National Health Insurance (NHI) programme in Taiwan grew from 62.2 billion Taiwan new dollars ($NT) in 1996 to $NT94.5 billion in 2003.The government has been introducing many strategies to control PE since the inception of NHI including price adjustment based on the prices of international products or existing products (inter-brands comparison), or market price and volume survey; delegation of financial responsibility to regional bureaux; ...

  9. Accuracy of Medicare expenditures in the medical expenditure panel survey.

    Science.gov (United States)

    Zuvekas, Samuel H; Olin, Gary L

    2009-01-01

    This paper examines underreporting and underrepresentation of high expenditure cases in the Medical Expenditure Panel Survey (MEPS) and their implications for analyses. Our data come from a sample of Medicare beneficiaries in the MEPS who were matched to their Medicare claims and enrollment files, with supplemental data from the Medicare Current Beneficiary Survey (MCBS). Underreporting of expenditures affected all groups of Medicare beneficiaries in the matched sample, but uniformly so that behavioral analyses were largely unaffected. Straightforward adjustments to the MEPS expenditure estimates could align them with aggregate sources, such as the National Health Expenditure Accounts, while preserving underlying relationships between expenditures and key correlates.

  10. Below the Glass Floor : Analytical Review of Expenditure by Provincial Administrations on Rural Health from Health Function Grants and Provincial Internal Revenue

    OpenAIRE

    World Bank

    2013-01-01

    Below the glass floor is a report that explores the impact of recent increases in operational function grant funding to provinces to support rural health service delivery. It seeks to identify what expenditure provinces have made to support and enable key front line service delivery activities such as; facility operations, patrols, medical supply distribution, emergency patient transfer, r...

  11. Radiation situation and health statistics of the people in the Tula region of Russia after the Chernobyl catastrophe

    International Nuclear Information System (INIS)

    Long-term programs are necessary in order to minimize the medical consequences and to increase the efficiency of medical assistance to those who have undergone radiation action as a result of the Chernobyl catastrophe. It is also necessary to evaluate objectively the state of health of the sufferers, to obtain scientifically grounded conclusions on effects of 'low' radiation doses on human organism, and to estimate the genetic consequences for future generations. These programs must foresee the implementation of various activities, including: 1. Provision of further monitoring of persons attributed to the groups of risk, especially: those whose thyroid was irradiated when they were children and adolescents; children born by mothers whose thyroid was irradiated in their children-adolescent age; children whose thyroid was irradiated in pre-natal period; pregnant women; liquidators of 1986-1987 and their children born after 1986. 2. Provision of medical-prophylactic institutions on the polluted territories (of district and regional levels) and clinics of research centers with modern medico-diagnostic equipment, as well as regular supply of necessary reagents and medicines to hospitals and clinics. 3. Development of system of rehabilitation medical activities and sanatorium bases for the Chernobyl sufferers, especially for children. 4. Supply of food products with radioprotective properties; fresh vegetables, fruits etc., especially for children in the polluted territories. 5. Scientific study of radiation action combined with action of other carcinogens including chemical pollutants. (J.P.N.)

  12. Commercial porters of eastern Nepal: health status, physical work capacity, and energy expenditure.

    Science.gov (United States)

    Malville, N J; Byrnes, W C; Lim, H A; Basnyat, R

    2001-01-01

    The purpose of the study was to compare full-time hill porters in eastern Nepal with part-time casual porters engaged primarily in subsistence farming. The 50 porters selected for this study in Kenja (elevation 1,664 m) were young adult males of Tibeto-Nepali origin. Following standardized interviews, anthropometry, and routine physical examinations, the porters were tested in a field laboratory for physiological parameters associated with aerobic performance. Exercise testing, using a step test and indirect calorimetry, included a submaximal assessment of economy and a maximal-effort graded exercise test. Energy expenditure was measured in the field during actual tumpline load carriage. No statistically significant differences were found between full-time and part-time porters with respect to age, anthropometric characteristics, health, nutritional status, or aerobic power. Mean VO2 peak was 2.38 +/- 0.27 L/min (47.1 +/- 5.3 ml/kg/min). Load-carrying economy did not differ significantly between porter groups. The relationship between VO2 and load was linear over the range of 10-30 kg with a slope of 9 +/- 4 ml O2/min per kg of load. During the field test of actual work performance, porters expended, on average, 348 +/- 68 kcal/hr in carrying loads on the level and 408 +/- 60 kcal/hr in carrying loads uphill. Most porters stopped every 2 min, on average, to rest their loads briefly on T-headed resting sticks (tokmas). The technique of self-paced, intermittent exercise together with the modest increase in energy demands for carrying increasingly heavier loads allows these individuals to regulate work intensity and carry extremely heavy loads without creating persistent medical problems. PMID:11466966

  13. Coherent catastrophism

    Science.gov (United States)

    Asher, D. J.; Clube, S. V. M.; Napier, W. M.; Steel, D. I.

    We review the theoretical and observational evidence that, on timescales relevant to mankind, the prime collision hazard is posed by temporally correlated impacts (coherent catastrophism, Δt ˜ 10 2-10 4 yr) rather than random ones (stochastic catastrophism, Δt ˜ 10 5-10 8 yr). The mechanism whereby coherent incursions into and through the terrestrial atmosphere occur is described as being the result of giant cometary bodies arriving in orbits with perihelia in the inner solar system. Hierarchical fragmentation of such large (100 km-plus) bodies — due to thermal stresses near perihelion, collisions in the asteroid belt, or passages through the Jovian Roche radius — results in numerous ˜kilometre-sized objects being left in short-period orbits, and appearing in telescopic searches as Apollo-type asteroids. Many more smaller objects, in the 10-100 metre size range and only recently observed, by the Spacewatch team, are expected to be in replenished clusters in particular orbits as a result of continuing disintegrations of large, differentiated, cometary objects. Gravitational perturbations by Jupiter bring these clusters around to have a node at 1 AU in a cyclic fashion, leading to impacts at certain times of year every few years during active periods lasting a few centuries, such periods being separated by intervals of a few millennia. Furthermore, fragmentations within the hierarchy result in significant bombardment commensurabilities ( Δt ˜ 10-10 2 yr) during active periods occurring at random intervals ( Δt ˜ 10 2-10 3 yr). It appears that the Earth has been subject to such impacts since the break-up of such a comet ˜2×10 4 years ago; currently we are not passing through a high-risk epoch, although some phenomena originating in the products of this break-up have been observed in the 20th century. This most recent hierarchical disintegration, associated with four well-known meteor showers and termed the Taurid Complex, is now recognized as resulting

  14. Incremental health expenditure and lost days of normal activity for individuals with mental disorders: results from the São Paulo Megacity Study

    OpenAIRE

    Chiavegatto Filho, Alexandre Dias Porto; Wang, Yuan-Pang; Campino, Antonio Carlos Coelho; Malik, Ana Maria; Viana, Maria Carmen; Andrade, Laura Helena

    2015-01-01

    Background With the recent increase in the prevalence of mental disorders in developing countries, there is a growing interest in the study of its consequences. We examined the association of depression, anxiety and any mental disorders with incremental health expenditure, i.e. the linear increase in health expenditure associated with mental disorders, and lost days of normal activity. Methods We analyzed the results from a representative sample survey of residents of the Metropolitan Region ...

  15. Catastrophic volcanism

    Science.gov (United States)

    Lipman, Peter W.

    1988-01-01

    Since primitive times, catastrophes due to volcanic activity have been vivid in the mind of man, who knew that his activities in many parts of the world were threatened by lava flows, mudflows, and ash falls. Within the present century, increasingly complex interactions between volcanism and the environment, on scales not previously experienced historically, have been detected or suspected from geologic observations. These include enormous hot pyroclastic flows associated with collapse at source calderas and fed by eruption columns that reached the stratosphere, relations between huge flood basalt eruptions at hotspots and the rifting of continents, devastating laterally-directed volcanic blasts and pyroclastic surges, great volcanic-generated tsunamis, climate modification from volcanic release of ash and sulfur aerosols into the upper atmosphere, modification of ocean circulation by volcanic constructs and attendent climatic implications, global pulsations in intensity of volcanic activity, and perhaps triggering of some intense terrestrial volcanism by planetary impacts. Complex feedback between volcanic activity and additional seemingly unrelated terrestrial processes likely remains unrecognized. Only recently has it become possible to begin to evaluate the degree to which such large-scale volcanic processes may have been important in triggering or modulating the tempo of faunal extinctions and other evolutionary events. In this overview, such processes are examined from the viewpoint of a field volcanologist, rather than as a previous participant in controversies concerning the interrelations between extinctions, impacts, and volcanism.

  16. Reverse Catastrophe

    Directory of Open Access Journals (Sweden)

    Przemysław Czapliński

    2015-01-01

    Full Text Available The principal notion of the article–a “backward catastrophe”– stands for a catastrophe which occurs unseen until it becomes recognized and which broadens its destructive activity until it has been recognized. This concept in the article has been referred to the Shoah. The main thesis is that the recognition of the actual influence of the Holocaust began in Polish culture in the mid-1980s (largely it started with the film by Claude Lanzmann Shoah and the essay by Jan Błoński Biedni Polacy patrzą na getto [“The Poor Poles Look at the Ghetto”], that is when the question: “What happened to the Jews”, assumes the form: “Did the things that happened to the Jews, also happened to the Poles?”. Cognitive and ethical reorientation leads to the revealing of the hidden consequences of the Holocaust reaching as far as the present day and undermining the foundations of collective identity. In order to understand this situation (and adopt potentially preventive actions Polish society should be recognized as a postcatastrophic one.

  17. Efficiency of social sector expenditure in India: a case of health and education in selected Indian states

    Directory of Open Access Journals (Sweden)

    Brijesh C. Purohit

    2014-07-01

    Full Text Available Social sector expenditure in India captures a number of important aspects including health, nutrition, education, water supply, sanitation, housing and welfare, among others. Over a period of time, besides budgetary outlay on this sector, private sector has also played a considerable role. Thus, efficiency of expenditure in this sector by state government has to be reckoned both in terms of relative levels of various aspects across the states and in terms of comparable benchmarks for different aspects of the sector. This paper attempts an analysis of social sector efficiency focusing on two major aspects: health and education. Unlike other studies on the Indian context, this analysis focusing on major states in India uses both non-parametric and parametric approaches. Although both approaches provide benchmarks to judge relative efficiency across states, the former provides a yardstick more at an aggregative level without parametric restrictions, whereas the latter is used for major focus on health care aspects. Results of free disposal hull analysis are suggestive of a considerably more scope for improvement in efficiency of public expenditure in health relative to education. Our results of stochastic frontier analysis indicate considerable state level disparities which could be reduced through a mix of strategies involving reallocation of factors (namely, manpower and supply of consumables within the sector, mobilizing additional resources possibly through enhanced budgetary emphasis, or encouraging more private sector participation. Based on our results, this may enhance efficiency by nearly 20% in health care sector and increase availability and equity across low performing and poorer states like Madhya Pradesh and Uttar Pradesh.

  18. National Health Expenditure Projections, 2015-25: Economy, Prices, And Aging Expected To Shape Spending And Enrollment.

    Science.gov (United States)

    Keehan, Sean P; Poisal, John A; Cuckler, Gigi A; Sisko, Andrea M; Smith, Sheila D; Madison, Andrew J; Stone, Devin A; Wolfe, Christian J; Lizonitz, Joseph M

    2016-08-01

    Health spending growth in the United States for 2015-25 is projected to average 5.8 percent-1.3 percentage points faster than growth in the gross domestic product-and to represent 20.1 percent of the total economy by 2025. As the initial impacts associated with the Affordable Care Act's coverage expansions fade, growth in health spending is expected to be influenced by changes in economic growth, faster growth in medical prices, and population aging. Projected national health spending growth, though faster than observed in the recent history, is slower than in the two decades before the recent Great Recession, in part because of trends such as increasing cost sharing in private health insurance plans and various Medicare payment update provisions. In addition, the share of total health expenditures paid for by federal, state, and local governments is projected to increase to 47 percent by 2025.

  19. Lifetime medical costs of obesity : Prevention no cure for increasing health expenditure

    NARCIS (Netherlands)

    van Baal, Pieter H. M.; Polder, Johan J.; de Wit, G. Ardine; Hoogenveen, Rudolf T.; Feenstra, Talitha L.; Boshuizen, Hendriek C.; Engelfriet, Peter M.; Brouwer, Werner B. F.

    2008-01-01

    Background Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to c

  20. Components of growth in current public-expenditure on education and health

    OpenAIRE

    Ohagan, J; Kelly, M.

    1984-01-01

    Abstract: This paper examines the growth in the GDP share of current public expenditure on national, vocational and university education in Ireland between 1961 and 1979 in terms of four factors: transfer changes, demographic changes, enrolment changes, and movements in relative "costs". The change in the relative cost of hospital care between 1966 and 1979 is also estimated.

  1. Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994-2013.

    Directory of Open Access Journals (Sweden)

    Kayvan Bozorgmehr

    Full Text Available Access to health care for asylum-seekers and refugees (AS&R in Germany is initially restricted before regular access is granted, allegedly leading to delayed care and increasing costs of care. We analyse the effects of (a restricted access; and (b two major policy reforms (1997, 2007 on incident health expenditures for AS&R in 1994-2013.We used annual, nation-wide, aggregate data of the German Federal Statistics Office (1994-2013 to compare incident health expenditures among AS&R with restricted access (exposed to AS&R with regular access (unexposed. We calculated incidence rate differences (∆IRt and rate ratios (IRRt, as well as attributable fractions among the exposed (AFe and the total population (AFp. The effects of between-group differences in need, and of policy reforms, on differences in per capita expenditures were assessed in (segmented linear regression models. The exposed and unexposed groups comprised 4.16 and 1.53 million person-years. Per capita expenditures (1994-2013 were higher in the group with restricted access in absolute (∆IRt = 375.80 Euros [375.77; 375.89] and relative terms (IRR = 1.39. The AFe was 28.07% and the AFp 22.21%. Between-group differences in mean age and in the type of accommodation were the main independent predictors of between-group expenditure differences. Need variables explained 50-75% of the variation in between-group differences over time. The 1997 policy reform significantly increased ∆IRt adjusted for secular trends and between-group differences in age (by 600.0 Euros [212.6; 986.2] and sex (by 867.0 Euros [390.9; 1342.5]. The 2007 policy reform had no such effect.The cost of excluding AS&R from health care appears ultimately higher than granting regular access to care. Excess expenditures attributable to the restriction were substantial and could not be completely explained by differences in need. An evidence-informed discourse on access to health care for AS&R in Germany is needed; it

  2. Reference-Based Pricing Schemes: Effect on Pharmaceutical Expenditure, Resource Utilisation and Health Outcomes

    OpenAIRE

    Ioannides-Demos, Lisa L.; Ibrahim, Joseph E.; McNeil, John J.

    2002-01-01

    Pharmaceutical expenditure is rising more rapidly than the general inflation rate in most advanced countries. One strategy that has been introduced to control pharmaceutical costs is reference-based pricing (RBP). Its potential is restricted to those specific segments of the drug market where several drugs (and/or their generic forms) exist without substantial evidence that any particular agent is superior. Three broad approaches have been adopted. These involve the aggregation of drugs into ...

  3. Government Expenditures on Education, Health, and Infrastructure : A Naive Look at Levels, Outcomes, and Efficiency

    OpenAIRE

    Estache, A.; Gonzalez, M; L. Trujillo

    2007-01-01

    All interested parties seem to agree that it is important to be able to monitor public sector performance at the sectoral level, but most current work based on multi-country databases does not lend itself to country-specific conclusions. This is due to a large extent to major data limitations both on sectoral expenditures and on sectoral outcomes. This paper discusses the related issues an...

  4. Impact of Medication-Assisted Treatment for Opioid Addiction on Medicaid Expenditures and Health Services Utilization Rates in Vermont.

    Science.gov (United States)

    Mohlman, Mary Kate; Tanzman, Beth; Finison, Karl; Pinette, Melanie; Jones, Craig

    2016-08-01

    In the face of increasing rates of overdose deaths, escalating health care costs, and the tremendous social costs of opioid addiction, policy makers are asked to address the questions of whether and how to expand access to treatment services. In response to an upward trend in opioid abuse and adverse outcomes, Vermont is investing in statewide expansion of a medication-assisted therapy program delivered in a network of community practices and specialized treatment centers (Hub & Spoke Program). This study was conducted to test the rationale for these investments and to establish a pre-Hub & Spoke baseline for evaluating the additive impact of the program. Using a serial cross-sectional design from 2008 to 2013 to evaluate medical claims for Vermont Medicaid beneficiaries with opioid dependence or addiction (6158 in the intervention group, 2494 in the control group), this study assesses the treatment and medical service expenditures for those receiving medication-assisted treatment compared to those receiving substance abuse treatment without medication. Results suggest that medication-assisted therapy is associated with reduced general health care expenditures and utilization, such as inpatient hospital admissions and outpatient emergency department visits, for Medicaid beneficiaries with opioid addiction. For state Medicaid leaders facing similar decisions on approaches to opioid addiction, these results provide early support for expanding medication-assisted treatment services rather than relying only on psychosocial, abstinence, or detoxification interventions. PMID:27296656

  5. Measurement and analysis of government health expenditures and health efficiency%政府卫生支出健康效率测算及分析

    Institute of Scientific and Technical Information of China (English)

    肖海翔; 曹天舒; 唐李伟

    2014-01-01

    目的::测算和分析中国1990年、2000年和2010年政府卫生支出的健康效率及其影响因素。方法:运用DEA和Tobit测算政府卫生支出的健康效率,评估效率值的影响因素。结果:政府卫生支出的健康生产效率在波动中有所提高,不同年度处于前沿面的省份基本一致,远离前沿面的省份存在较大差别;该效率在各区域间的差异较显著,东部地区政府卫生支出的健康生产效率高于中、西部地区;财政分权与政府卫生支出健康效率存在显著负相关关系。结论:财政分权制度的改革与完善是提高政府卫生支出健康效率的重要途径。%Objective:To calculate the health efficiency of government health expenditures in 1990 , 2000 and 2010 and analyze its determinants. Methods:To calculate the health efficiency of government health expenditures and analyze its determinants by using the DEA-Tobit model. Results:Health efficiency of government health expenditures has been increasing gradually;the same provinces are found to be on the productive frontier, but the provinces off the frontier are different;eastern provinces have a higher efficiency than those in the middle and western regions. Fiscal decentralization has a significant negative impact on health efficiency. Conclusion:The current Chinese fiscal decen-tralization system reform is important to improve the health efficiency of government health expenditures.

  6. Health care use and costs for children with attention-deficit/hyperactivity disorder - National estimates front the Medical Expenditure Panel Survey

    NARCIS (Netherlands)

    Chan, E; Zhan, CL; Homer, CJ

    2002-01-01

    Context: Although attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent chronic condition of childhood, little is known about patterns of health care use and associated expenditures. Objective: To compare health care use and costs among children with ADHD, children with asthma, and t

  7. Protein kinase A induces UCP1 expression in specific adipose depots to increase energy expenditure and improve metabolic health.

    Science.gov (United States)

    Dickson, Lorna M; Gandhi, Shriya; Layden, Brian T; Cohen, Ronald N; Wicksteed, Barton

    2016-07-01

    Adipose tissue PKA has roles in adipogenesis, lipolysis, and mitochondrial function. PKA transduces the cAMP signal downstream of G protein-coupled receptors, which are being explored for therapeutic manipulation to reduce obesity and improve metabolic health. This study aimed to determine the overall physiological consequences of PKA activation in adipose tissue. Mice expressing an activated PKA catalytic subunit in adipose tissue (Adipoq-caPKA mice) showed increased PKA activity in subcutaneous, epididymal, and mesenteric white adipose tissue (WAT) depots and brown adipose tissue (BAT) compared with controls. Adipoq-caPKA mice weaned onto a high-fat diet (HFD) or switched to the HFD at 26 wk of age were protected from diet-induced weight gain. Metabolic health was improved, with enhanced insulin sensitivity, glucose tolerance, and β-cell function. Adipose tissue health was improved, with smaller adipocyte size and reduced macrophage engulfment of adipocytes. Using metabolic cages, we found that Adipoq-caPKA mice were shown to have increased energy expenditure, but no difference to littermate controls in physical activity or food consumption. Immunoblotting of adipose tissue showed increased expression of uncoupling protein-1 (UCP1) in BAT and dramatic UCP1 induction in subcutaneous WAT, but no induction in the visceral depots. Feeding a HFD increased PKA activity in epididymal WAT of wild-type mice compared with chow, but did not change PKA activity in subcutaneous WAT or BAT. This was associated with changes in PKA regulatory subunit expression. This study shows that adipose tissue PKA activity is sufficient to increase energy expenditure and indicates that PKA is a beneficial target in metabolic health. PMID:27097660

  8. Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India.

    Directory of Open Access Journals (Sweden)

    Deepak Balasubramanian

    Full Text Available Generation of resources for providing health care services is an important issue in developing countries. User charges in the form of Surgical Package Program (SPP were introduced in all district hospitals of Haryana to address this problem. We evaluate the effect of this SPP program on surgical care utilization and out-of-pocket (OOP expenditures.Data on 25437 surgeries, from July 2006 to June 2013 in 3 districts of Haryana state, was analyzed using interrupted time series analysis to assess the impact of SPP on utilization of services. Adjustment was made for presence of any autocorrelation and seasonality effects. A cross sectional survey was undertaken among 180 patients in District hospital, Panchkula during June 2013 to assess the extent of out of pocket (OOP expenditure incurred, financial risk protection and methods to cope with OOP expenditure. Catastrophic health expenditure, estimated as any expenditure in excess of 10% of the household consumption expenditure, was used to assess the extent of financial risk protection.User charges had a negative effect on the number of surgeries in public sector district hospitals in all the 3 districts. The mean out-of-pocket expenditure incurred by the patients was Rs.4564 (USD 74.6. The prevalence of catastrophic expenditure was 5.6%. A higher proportion among the poorest 20% population coped through borrowing money (47.2%, while majority (86.1% of those belonging to richest quintile paid from their monthly income or savings, or had insurance.There is a need to increase the public financing for curative services and it should be based on the needs of population. Any form of user charge in public sector hospitals should be removed.

  9. Reference-based pricing schemes: effect on pharmaceutical expenditure, resource utilisation and health outcomes.

    Science.gov (United States)

    Ioannides-Demos, Lisa L; Ibrahim, Joseph E; McNeil, John J

    2002-01-01

    Pharmaceutical expenditure is rising more rapidly than the general inflation rate in most advanced countries. One strategy that has been introduced to control pharmaceutical costs is reference-based pricing (RBP). Its potential is restricted to those specific segments of the drug market where several drugs (and/or their generic forms) exist without substantial evidence that any particular agent is superior. Three broad approaches have been adopted. These involve the aggregation of drugs into generic groups, related drug groups (e.g. ACE inhibitors) or drugs grouped by therapeutic indication (e.g. antihypertensives). For each drug group, a single reimbursement level or reference price is set. Drugs above the reference price require part or total payment by the patient. The experience with RBP ranges from over 10 years in Germany (involving all levels of RBP) to the more recent implementation of RBP for related drug groups in Australia. This review summarises the current state of knowledge on RBP from the published experiences in the countries where RBP has been adopted. The published systematic reviews of RBP from the countries that have implemented it suggest that RBP has been successful at temporarily capping drug prices for the RBP drug groups and achieving short term cost savings. However, other factors influencing total pharmaceutical expenditure have often occurred simultaneously and make it difficult to isolate specific effects of RBP. Further investigation is required before any valid conclusions can be drawn about the net effect of RBP on healthcare costs. RBP has withstood the initial legal challenges of pharmaceutical companies and the criticisms of some clinicians. Where the reference price is based on the lowest priced drug(s) in the group, RBP appears to be one of the few strategies likely to be effective at encouraging doctors to use the least expensive agents as first-line therapy and utilise more expensive agents in those who experience side effects

  10. Measuring overfitting in nonlinear models: a new method and an application to health expenditures.

    Science.gov (United States)

    Bilger, Marcel; Manning, Willard G

    2015-01-01

    When fitting an econometric model, it is well known that we pick up part of the idiosyncratic characteristics of the data along with the systematic relationship between dependent and explanatory variables. This phenomenon is known as overfitting and generally occurs when a model is excessively complex relative to the amount of data available. Overfitting is a major threat to regression analysis in terms of both inference and prediction. We start by showing that the Copas measure becomes confounded by shrinkage or expansion arising from in-sample bias when applied to the untransformed scale of nonlinear models, which is typically the scale of interest when assessing behaviors or analyzing policies. We then propose a new measure of overfitting that is both expressed on the scale of interest and immune to this problem. We also show how to measure the respective contributions of in-sample bias and overfitting to the overall predictive bias when applying an estimated model to new data. We finally illustrate the properties of our new measure through both a simulation study and a real-data illustration based on inpatient healthcare expenditure data, which shows that the distinctions can be important. PMID:24123628

  11. National health expenditure projections, 2013-23: faster growth expected with expanded coverage and improving economy.

    Science.gov (United States)

    Sisko, Andrea M; Keehan, Sean P; Cuckler, Gigi A; Madison, Andrew J; Smith, Sheila D; Wolfe, Christian J; Stone, Devin A; Lizonitz, Joseph M; Poisal, John A

    2014-10-01

    In 2013 health spending growth is expected to have remained slow, at 3.6 percent, as a result of the sluggish economic recovery, the effects of sequestration, and continued increases in private health insurance cost-sharing requirements. The combined effects of the Affordable Care Act's coverage expansions, faster economic growth, and population aging are expected to fuel health spending growth this year and thereafter (5.6 percent in 2014 and 6.0 percent per year for 2015-23). However, the average rate of increase through 2023 is projected to be slower than the 7.2 percent average growth experienced during 1990-2008. Because health spending is projected to grow 1.1 percentage points faster than the average economic growth during 2013-23, the health share of the gross domestic product is expected to rise from 17.2 percent in 2012 to 19.3 percent in 2023.

  12. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    OpenAIRE

    Phillips, Charles D

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...

  13. Expenditures in the health care system in Brazil: the participation of states and the Federal District in financing the health care system from 2002 to 2013

    Directory of Open Access Journals (Sweden)

    Renata Maria de Deus Costa

    2015-04-01

    Full Text Available OBJECTIVE: To analyze the public expenditures of states on health care and the participation of states and the Federal District in financing the Unified Health System, better known by the acronym SUS. To develop the research, two targets were used: “to rescue expenses per government source (federal, state and municipal during the period from 2002 to 2013” and “to rescue resource transfers from the federal SUS to the states and also to municipalities”. METHODS: This research is bibliographic, documentary and descriptive and used a quantitative approach. Data were extracted from the Information System Public Health Budget, and additional data were collected from the public managers of states, municipalities and the Federal District during the period from 2002 to 2013. Federal data from the Undersecretary of Planning and Budget (originally extracted from the Integrated System of Financial Administration of the Federal Government and available on the Budget Public Health System webpage were also collected. RESULTS: The data revealed that during the same researched period, the Federal District has maintained the health care system budget, whereas states and municipalities have increased their budgets for the same spending. CONCLUSIONS: By analyzing the results, there is clearly a disparity regarding the investment expended by the entities of the Federation. Although municipalities and states have gradually increased their application of resources to health care, the federal state has maintained the same budget. These results reveal a bit of concern about public health funding.

  14. Burden of out-of-pocket expenditure for road traffic injuries in urban India

    Directory of Open Access Journals (Sweden)

    Kumar G

    2012-08-01

    Full Text Available Abstract Background Road traffic injuries (RTI are an increasing public health problem in India where out-of-pocket (OOP expenditures on health are among the highest in the world. We estimated the OOP expenses for RTI in a large city in India. Methods Information on medical and non-medical expenditure was documented for RTI cases of all ages that reported alive or dead to the emergency departments of two public hospitals and a large private hospital in Hyderabad. Differential risk of catastrophic OOP total expenditure (COPE-T and medical expenditure (COPE-M, and distress financing was assessed for 723 RTI cases that arrived alive at the study hospitals with multiple logistic regression. Catastrophic expenditure was defined as expenditure > 25% of the RTI patient’s annual household income. Variation in intensity of COPE-M in RTI was assessed using multiple classification analysis (MCA. Results The median OOP medical and non-medical expenditure was USD 169 and USD 163, respectively. The prevalence of COPE-M and COPE-T was 21.9% (95% CI 18.8-24.9 and 46% (95% CI 42–49.3, respectively. Only 22% had access to medical insurance. Being admitted to a private hospital (OR 5.2, 95% CI 2.7–9.9 and not having access to insurance (OR 3.8, 95% CI 1.9–7.6 were significantly associated with risk of having COPE – M. Similar results were seen for COPE - T. MCA analysis showed that the burden of OOP medical expenditure was mainly associated with in-patient days in hospital (Eta =0.191. Prevalence of distress financing was 69% (95% CI 65.5-72.3 with it being significantly higher for those reporting to the public hospitals (OR 2.8, 95% CI 1.7-4.6, those belonging to the lowest per capita annual household income quartile (OR 7.0, 95% CI 3.7-13.3, and for those without insurance access (OR 3.4, 95% CI 2.0-5.7. Conclusions This paper has outlined the high burden of out-of-pocket medical and total expenditure associated with RTI in India. These data

  15. The Ongoing Catastrophe

    DEFF Research Database (Denmark)

    Kublitz, Anja

    2016-01-01

    as camps. Based on fieldwork among Palestinians in the Danish camps, this article explores why my interlocutors describe their current lives as a catastrophe. Al-Nakba literally means the catastrophe and, in Palestinian national discourse, it is used to designate the event of 1948, when the Palestinians...

  16. The Ongoing Catastrophe

    DEFF Research Database (Denmark)

    Kublitz, Anja

    for the girl talk is centred on catastrophes or Nakbas, as they are referred to in Arabic. Not only al-Nakba of 1948 when the Palestinians were displaced from their homeland, but also the many recurring wars and the individual catastrophes that involve dead family members, rapes, loss of children and abusive...

  17. Uzbekistan: health system review.

    Science.gov (United States)

    Ahmedov, Mohir; Azimov, Ravshan; Mutalova, Zulkhumor; Huseynov, Shahin; Tsoyi, Elena; Rechel, Bernd

    2014-01-01

    Uzbekistan is a central Asian country that became independent in 1991 with the break-up of the Soviet Union. Since then, it has embarked on several major health reforms covering health care provision, governance and financing, with the aim of improving efficiency while ensuring equitable access. Primary care in rural areas has been changed to a two-tiered system, while specialized polyclinics in urban areas are being transformed into general polyclinics covering all groups of the urban population. Secondary care is financed on the basis of past expenditure and inputs (and increasingly self-financing through user fees), while financing of primary care is increasingly based on capitation. There are also efforts to improve allocative efficiency, with a slowly increasing share of resources devoted to the reformed primary health care system. Health care provision has largely remained in public ownership but nearly half of total health care expenditure comes from private sources, mostly in the form of out-of-pocket expenditure. There is a basic benefits package, which includes primary care, emergency care and care for certain disease and population categories. Yet secondary care and outpatient pharmaceuticals are not included in the benefits package for most of the population, and the reliance on private health expenditure results in inequities and catastrophic expenditure for households. While the share of public expenditure is slowly increasing, financial protection thus remains an area of concern. Quality of care is another area that is receiving increasing attention. PMID:25689490

  18. Benefit-incidence analysis: are government health expenditures more pro-rich than we think?

    Science.gov (United States)

    Wagstaff, Adam

    2012-04-01

    Authors of benefit-incidence analyses (BIA) have to impute subsidies using assumptions about the relationship between unobserved subsidies 'captured' by the household and what can be observed at the household and aggregate levels. This paper shows that one of the two assumptions used in BIA studies to date will necessarily produce a more pro-rich (or less pro-poor) picture of government health spending than the other, depending on whether utilization is more pro-rich or pro-poor than fees paid to public providers. Both assumptions have their disadvantages, and the paper suggests a couple of alternatives that explicitly link fees paid to the costliness of care. It shows that in the most likely case where fees are distributed in a more pro-rich fashion than utilization, the two traditional assumptions will produce less pro-rich distributions of subsidies than the two new alternatives. Also considered are three complications that arise in BIA studies, including factoring in social health insurance. The paper's theoretical results are illustrated with an empirical BIA for Vietnam.

  19. Health care seeking behaviour and expenditure pattern among Scrub Typhus patients attending a tertiary care hospital in Mysore city

    Directory of Open Access Journals (Sweden)

    Rajesh Jayanandan

    2015-05-01

    areas, unskilled workers and children were affected predominantly. With timely diagnosis and appropriate treatment, significant morbidity and mortality could be prevented. Promotion of various public and private health insurance schemes among public would minimise the OOP expenditure and prevents debts. [Int J Res Med Sci 2015; 3(5.000: 1181-1188

  20. Unemployment, public–sector health care expenditure and HIV mortality: An analysis of 74 countries, 1981–2009

    Directory of Open Access Journals (Sweden)

    Mahiben Maruthappu

    2015-06-01

    Full Text Available Background: The global economic downturn has been associated with increased unemployment and reduced public–sector expenditure on health care (PSEH. We determined the association between unemployment, PSEH and HIV mortality. Methods: Data were obtained from the World Bank and the World Health Organisation (1981–2009. Multivariate regression analysis was implemented, controlling for country–specific demographics and infrastructure. Time–lag analyses and robustness–checks were performed. Findings: Data were available for 74 countries (unemployment analysis and 75 countries (PSEH analysis, equating to 2.19 billion and 2.22 billion people, respectively, as of 2009. A 1% increase in unemployment was associated with a significant increase in HIV mortality (men: 0.1861, 95% CI: 0.0977 to 0.2744, P<0.0001, women: 0.0383, 95% CI: 0.0108 to 0.0657, P=0.0064. A 1% increase in PSEH was associated with a significant decrease in HIV mortality (men: –0.5015, 95% CI: –0.7432 to –0.2598, P=0.0001; women: –0.1562, 95% CI: –0.2404 to –0.0720, P=0.0003. Time–lag analysis showed that significant changes in HIV mortality continued for up to 5 years following variations in both unemployment and PSEH. Interpretation: Unemployment increases were associated with significant HIV mortality increases. PSEH increases were associated with reduced HIV mortality. The facilitation of access–to–care for the unemployed and policy interventions which aim to protect PSEH could contribute to improved HIV outcomes.

  1. Can Health Technology Assessment (HTA provide a solution to tackle the increasing health-care expenditure in India?

    Directory of Open Access Journals (Sweden)

    Amit Dang

    2016-01-01

    Full Text Available The private health-care system in India is effective but expensive. Due to the absence of a comprehensive and well-penetrated insurance scheme that caters to the majority of the Indian population, most of the private health care consultations are out-of-pocket (OOP, and this is pushing many people to poverty. In this article, we describe the concept of health technology assessment (HTA, and review its possible role in improving the health-care system in India. We additionally comment on its present status and possible role of its implementation in the Indian context.

  2. Can Health Technology Assessment (HTA) provide a solution to tackle the increasing health-care expenditure in India?

    Science.gov (United States)

    Dang, Amit; Vallish, B N

    2016-01-01

    The private health-care system in India is effective but expensive. Due to the absence of a comprehensive and well-penetrated insurance scheme that caters to the majority of the Indian population, most of the private health care consultations are out-of-pocket (OOP), and this is pushing many people to poverty. In this article, we describe the concept of health technology assessment (HTA), and review its possible role in improving the health-care system in India. We additionally comment on its present status and possible role of its implementation in the Indian context. PMID:27350708

  3. Explaining health marginalisation of the lower educated: the role of cross-national variations in health expenditure and labour market conditions.

    Science.gov (United States)

    Gesthuizen, Maurice; Huijts, Tim; Kraaykamp, Gerbert

    2012-05-01

    Several studies have shown ample cross-national variation in the risk that lower educated people run to be in poor health. However, explanations for this cross-national variation are still scarce. In this article we aim at filling this lacuna by investigating to what extent cross-national variation in the health gap between the lower and higher educated in Europe is explained by governmental health expenditure, namely, how much governments contribute to a country's total healthcare costs, and labour market conditions, that is, unemployment rates and modernisation of the labour market. We used information from the European Social Survey (ESS) 2002-2008 on more than 90,000 individuals in 32 European nations, and estimated hierarchical models with cross-level interactions to test our expectations. Our results show that the relative risk of being in poor health of lower educated individuals is smaller in countries where the government spends much on healthcare and with a highly modernised labour market. PMID:21834939

  4. Family healthcare expenditure on children affiliated to the Medical Insurance for a New Generation Gasto en salud de los hogares con niños afiliados al Seguro Médico para una Nueva Generación

    OpenAIRE

    Evelyne Eugenia Rodríguez-Ortega; Elvira Mireya Pasillas-Torres

    2012-01-01

    OBJECTIVE: To analyze household health expenditures on children who are beneficiaries of the Medical Insurance for a New Generation (SMNG), program created in 2007 to cover healthcare costs of children without social security born after December 1st, 2006. MATERIALS AND METHODS: Using the SMNG National Survey, out-the-pocket and catastrophic spending on child health were calculated using several definitions. Results are presented by socioeconomic level, rural and urban areas and for Oportunid...

  5. Catastrophic events and older adults.

    Science.gov (United States)

    Cloyd, Elizabeth; Dyer, Carmel B

    2010-12-01

    The plight of older adults during catastrophic events is a societal concern. Older persons have an increased prevalence of cognitive disorders, chronic illnesses, and mobility problems that limit their ability to cope. These disorders may result in a lack of mental capacity and the ability to discern when they should evacuate or resolve problems encountered during a catastrophe. Some older persons may have limited transportation options, and many of the elderly survivors are at increased risk for abuse, neglect, and exploitation. Recommendations for future catastrophic events include the development of a federal tracking system for elders and other vulnerable adults, the designation of separate shelter areas for elders and other vulnerable adults, and involvement of gerontological professionals in all aspects of emergency preparedness and care delivery, including training of frontline workers. Preparation through preevent planning that includes region-specific social services, medical and public health resources, volunteers, and facilities for elders and vulnerable adults is critical. Elders need to be protected from abuse and fraud during catastrophic events. A public health triage system for elders and other vulnerable populations in pre- and postdisaster situations is useful, and disaster preparedness is paramount. Communities and members of safety and rescue teams must address ethical issues before an event. When older adults are involved, consideration needs to be given to triage decision making, transporting those who are immobile, the care of older adults who receive palliative care, and the equitable distribution of resources. Nurses are perfectly equipped with the skills, knowledge, and training needed to plan and implement disaster preparedness programs. In keeping with the tradition of Florence Nightingale, nurses can assume several crucial roles in disaster preparedness for older adults. Nurses possess the ability to participate and lead community

  6. A comparison of smoking patterns in the People's Republic of China with the United States. An impending health catastrophe in the middle kingdom.

    Science.gov (United States)

    Yu, J J; Mattson, M E; Boyd, G M; Mueller, M D; Shopland, D R; Pechacek, T F; Cullen, J W

    1990-09-26

    Half of the global increase in tobacco use from 1976 to 1986 occurred in the People's Republic of China. In 1984, the first national smoking survey was conducted in China, involving over a half-million subjects. Sixty-one percent of Chinese males over age 15 smoke, with higher rates in all occupational groups than for corresponding groups in the United States. Current smoking patterns in China are similar to those in the United States during the 1950s, and these patterns forecast a steadily increasing epidemic of smoking-related deaths. It is estimated that by 2025, two million Chinese men will die annually from smoking. Foreign tobacco companies are mounting massive production and advertising campaigns in China. Government health education programs lack funds to counter these influences with sustained and comprehensive educational and interventional campaigns. To avert an impending national health catastrophe, China must launch a comprehensive smoking-control initiative aimed at public education, cessation, and legislation and policy. PMID:2395200

  7. Habitability and cosmic catastrophes

    CERN Document Server

    Hanslmeier, Arnold; McKay, Christopher P

    2008-01-01

    Catastrophic cosmic events such as asteroid impacts appear in the range of some 100 million years and have drastically affected evolution. The author discusses whether and how such events could have occurred in recently found extrasolar planetary systems.

  8. Catastrophic Antiphospholipid Syndrome.

    Science.gov (United States)

    El-Shereef, Rawhya R; El-Abedin, Zein; Abdel Aziz, Rashad; Talat, Ibrahim; Saleh, Mohammed; Abdel-Samia, Hanna; Sameh, Amro; Sharha, Mahmoud

    2016-01-01

    This paper reports one case of successfully treated patients suffering from a rare entity, the catastrophic antiphospholipid syndrome (CAPS). Management of this patient is discussed in detail. PMID:27375916

  9. Catastrophic Antiphospholipid Syndrome

    Directory of Open Access Journals (Sweden)

    Rawhya R. El-Shereef

    2016-01-01

    Full Text Available This paper reports one case of successfully treated patients suffering from a rare entity, the catastrophic antiphospholipid syndrome (CAPS. Management of this patient is discussed in detail.

  10. Entanglement in quantum catastrophes

    CERN Document Server

    Emary, C; Brandes, T; Emary, Clive; Lambert, Neill; Brandes, Tobias

    2005-01-01

    We classify entanglement singularities for various two-mode bosonic systems in terms of catastrophe theory. Employing an abstract phase-space representation, we obtain exact results in limiting cases for the entropy in cusp, butterfly, and two-dimensional catastrophes. We furthermore use numerical results to extract the scaling of the entropy with the non-linearity parameter, and discuss the role of mixing entropies in more complex systems.

  11. Catastrophes in surface scattering

    International Nuclear Information System (INIS)

    Theoretical and experimental studies concerning atom-surface interactions in the energy range from hyperthermal to approximately 100 eV are reported. An extended study of the interaction of low energetic alkalis (sodium and potassium) with a silver crystal is presented. Finally the ultimate experimental result in this research, the first observation of catastrophes in surface scattering, is shown. The results clearly indicate the strength of the catastrophe analysis in gas-surface scattering. 218 refs.; 40 figs.; 170 schemes; 4 tabs

  12. 42 CFR 403.754 - Monitoring expenditure level.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Monitoring expenditure level. 403.754 Section 403..., Conditions of Participation, and Payment § 403.754 Monitoring expenditure level. (a) Tracking expenditures... between the trigger level and Medicare expenditures for a FFY results in a carry forward that...

  13. Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi.

    Science.gov (United States)

    Wang, Qun; Brenner, Stephan; Leppert, Gerald; Banda, Thomas Hastings; Kalmus, Olivier; De Allegri, Manuela

    2015-03-01

    Malawi is facing a rising chronic non-communicable disease (CNCD) epidemic. This study explored health seeking behaviour and related expenditure on CNCDs in rural Malawi, with specific focus on detecting potential differences across population groups. We used data from the first round of a panel household health survey conducted in rural Malawi between August and October 2012 on a sample of 1199 households. Multinomial logistic regression was used to analyse factors associated with health seeking choices for CNCDs, distinguishing between no care, informal care and formal care. Descriptive statistics (mean, standard deviation and median) were used to describe related household out-of-pocket expenditure. There were 475 individuals (equivalent to 8.4% of all respondents) reporting at least one CNCD. Among them, 37.3% did not seek any care, 42.5% sought formal care (facility-based care), and 20.2% opted for informal care (traditional or home treatment). Regression analysis showed that illness severity and duration, socio-economic status, being a household head, and the proportion of household members living with a CNCD were significantly associated with health care utilization. Among those seeking care, 65.8% incurred out-of-pocket expenditure with an average of USD 1.49 spent on medical treatment and an additional USD 0.50 spent on transport. Further qualitative inquiry is needed to understand the reasons for low service utilization and to explore the potential role of supply-side factors. To increase access to care for people suffering from CNCDs, the provision of a free Essential Health Package in Malawi ought to be strengthened through the integration of system-wide screening, risk factor modification and continuity of care options for people suffering from CNCDs. This would ensure affordable services to modulate health seeking behaviour of patients at risk of major chronic illnesses.

  14. Reconciling medical expenditure estimates from the MEPS and NHEA, 2002.

    Science.gov (United States)

    Sing, Merrile; Banthin, Jessica S; Selden, Thomas M; Cowan, Cathy A; Keehan, Sean P

    2006-01-01

    The Medical Expenditure Panel Survey (MEPS) and National Health Expenditure Accounts (NHEA) are often used for health care policy analysis and simulations because they contain comprehensive estimates of national health care expenditures. The NHEA are primarily based on aggregate provider revenue data, while MEPS is based on person-level data on health care expenditures. This article compares MEPS and NHEA expenditure estimates for 2002 and discusses the differences. When MEPS and the NHEA are adjusted to be on a consistent basis, their expenditure estimates differ by 13.8 percent.

  15. Health equity in Lebanon: a microeconomic analysis

    Directory of Open Access Journals (Sweden)

    Raad Firas

    2010-04-01

    Full Text Available Abstract Background The health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes. Methods We use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region. Results We find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender. However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62 on health a year in excess of the uninsured, they devote a smaller

  16. 我国公共卫生支出效率分析%The Efficiency Analysis of China’s Public Expenditure on Health

    Institute of Scientific and Technical Information of China (English)

    邓大松; 吴迪

    2015-01-01

    This paper use the Data Envelopment Analysis(DEA)on the data of 31 provinces and cities in our country as an independent decision-making unit, choose the government expenditure on health per person, the num⁃ber of bed in health care institutions per thousand people ,the number of medical staff member per thousand people,the number of health care institutions as the input variables. Choose the bed utilization rate, physicians daily visits and hu⁃man mortality as output variables to analyze the efficiency of public health expenditure in China. The results shows that the public health expenditure has such problems as inadequate input scale and irrational structure, etc.%文章运用数据包络分析方法(DEA)将中国31个省市作为独立决策单元,选择人均政府卫生支出、千人卫生机构床位数、千人卫生技术人数与卫生机构数为投入变量,将床位利用率、医师日均担负诊疗人次与人口死亡率为产出变量对中国公共卫生支出的效率进行分析。通过研究发现中国公共卫生支出存在投入规模不足及结构不合理等问题,并根据这些问题提出相应的政策建议。

  17. Catastrophizing and Parental Response to Child Symptom Complaints

    OpenAIRE

    Langer, Shelby L.; Romano, Joan M.; Levy, Rona L; Walker, Lynn S.; Whitehead, William E.

    2009-01-01

    This study investigated whether catastrophic thinking about pain by children with functional abdominal pain or by their parents is associated with health outcomes in the child. Subjects were 132 parent-child dyads. Child catastrophizing predicted child depression, anxiety and functional disability. Parents’ catastrophizing cognitions about their own pain predicted self-reported protective responses to their children’s abdominal pain (responding in ways that encourage illness behavior). Protec...

  18. Socio-Economic Differentials in Impoverishment Effects of Out-of-Pocket Health Expenditure in China and India: Evidence from WHO SAGE.

    Directory of Open Access Journals (Sweden)

    Kaushalendra Kumar

    Full Text Available The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE on impoverishment in China and India, two of the fastest growing economies of the world.The paper uses data from the World Health Organisation's Study on Global Ageing and Adult Health (WHO SAGE, and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE on impoverishment in China and India.Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population from poverty line due to OOPHE is 2% in China and 1.3% in India. Further, findings from the multivariate analysis indicate that lower wealth status and inpatient as well as outpatient care increase the odds of falling below poverty line significantly (with the extent much higher in the case of in-patient care due to OOPHE in both China and India. In addition, having at least an under-5 child in the household, living in rural areas and having a household head with no formal education increases the odds of falling below poverty line significantly (compared to a head with college level education due to OOPHE in China; whereas having at least an under-5 child, not having health insurance and residing in rural areas increases the odds of becoming poor significantly due to OOPHE in India.

  19. Patterns and expenditures of multi-morbidity in an insured working population in the United States: insights for a sustainable health care system and building healthier lives.

    Science.gov (United States)

    Greene, Robert; Dasso, Edwin; Ho, Sam; Frank, Jerry; Scandrett, Graeme; Genaidy, Ash

    2013-12-01

    The U.S. health care system is currently heading toward unsustainable health care expenditures and increased dissatisfaction with health outcomes. The objective of this population-based study is to uncover practical insights regarding patients with 1 or more chronic illnesses. A cross-sectional investigation was designed to gather data from health records drawn from diverse US geographic markets. A database of 9.74 million fully-insured, working individuals was used, together with members in the same households. Among nearly 3.43 million patients with claims, 2.22 million had chronic conditions. About 24.3% had 1 chronic condition and 40.4% had multi-morbidity. Health care expenditures for chronic conditions accounted for 92% of all costs (52% for chronic costs and 40% for nonchronic costs). Psychiatry, orthopedics-rheumatology, endocrinology, and cardiology areas accounted for two thirds of these chronic condition costs; nonchronic condition costs were dominated by otolaryngology, gastroenterology, dermatology, orthopedics-rheumatology conditions, and preventive services. About 50.1% of all households had 2 or more members with chronic conditions. In summary, multi-morbidity is prevalent not only among those older than age 65 years but also in younger and working individuals, and commonly occurs among several members of a household. The authors suggest that the disease-focused model of medicine should change to a more holistic illness-wellness model, emphasizing not only the physical but also the mental and social elements that can influence individual health. In that way the chronic care model could be broadened in context and content to improve the health of patients and households.

  20. Medical Expenditure Panel Survey (MEPS) Query Tool

    Data.gov (United States)

    U.S. Department of Health & Human Services — MEPSnet HC Query Tool MEPSnet/Household Component provides easy access to nationally representative statistics of health care use, expenditures, sources of payment,...

  1. The Dynamic Relationship of Total Health Expenditure and Economic Growth%我国卫生总费用与经济增长的动态关系

    Institute of Scientific and Technical Information of China (English)

    杨洋

    2014-01-01

    To study the dynamic relationship of total health expenditure and economic growth so as to provide references for designing health economic policies. Methods: Using the regression models with multiple structural changes to estimate the structural change point of model parameter. Results: Compared to the elastic coefficient of economic growth, the total health expenditure and social health expenditure remained stably, the elasticity coefficient of government spending on health increased after decreased while elastic coefficient of personal spending health costs decreased after increased. Conclusion:In the early years of 1990s, the responsibility of government in health care financing funding weakened, which led to the increasing personal expenses. The situation began to reverse since 2004.%目的:研究我国卫生总费用以及其筹资结构与经济增长的动态关系,为我国卫生经济政策的制定提供依据。方法:运用具有多个结构突变点的回归模型,估计模型参数发生结构突变的时点。结果:卫生总费用和社会支出卫生费用相对于经济增长的弹性系数保持稳定,政府支出卫生费用相对于经济增长的弹性系数先变小再变大,而个人支出卫生费用相对于经济增长的弹性系数先变大再变小。结论:在20世纪90年代初,政府支出在卫生筹资领域的责任弱化,导致个人支出负担大大加剧,自2004年以来,这种局面开始逆转。

  2. Financial access to health care for older people in Cambodia: 10-year trends (2004-14) and determinants of catastrophic health expenses

    OpenAIRE

    Jacobs, Bart; de Groot, Richard; Fernandes Antunes, Adélio

    2016-01-01

    Background Older people make up an increasing proportion of the population in low- and middle-income countries. This brings a number of challenges, as their health needs are greater than, and different from, those of younger people. In general, these health systems are not geared to address their needs, and traditional support systems tend to erode, potentially causing financial hardship when accessing health care. This paper provides an overview of older Cambodians’ financial access to healt...

  3. Evaluation and Analysis on Expenditure of China Public Health 1978-2008%中国公共卫生支出评价分析:1978—2008

    Institute of Scientific and Technical Information of China (English)

    许敏兰; 沈时伯

    2012-01-01

    For 30 years since 1978, the general trend of the public health expenditure in China is increased and then decreased after the rise again. The excessively market reform causes public health service system lose its public welfare and can not meet public need. The main problems are that the proportion of public health expenditure is declining in GDP, finance expenditure, and the total amount of health expenditure, the input in public health service insufficient, and the structure of public health expenditure improper. Hence, the government should increase finance input in public health to reach the aim that every citizen has the essential health, particularly; the central govern- ment should increase expenditure on it to improve transfer payment system.%改革开放30年来,我国公共卫生支出呈现出先增加后下降再上升的三阶段趋势。由于过度市场化改革,造成公共医疗卫生服务体系逐渐丧失其公共性与公益性,不能满足公共需要。主要体现在公共卫生支出占GDP、财政支出、卫生总费用的比例逐步下降,公共卫生服务经费投入的不足以及公共卫生支出结构不合理。为达到“人人享有最基本的健康”服务的目标,必需增加政府对公共卫生的财政投入,尤其是提高中央政府在公共卫生方面的支出责任,改善转移支付体系。

  4. Catastrophic primary antiphospholipid syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hun; Byun, Joo Nam [Chosun University Hospital, Gwangju (Korea, Republic of); Ryu, Sang Wan [Miraero21 Medical Center, Gwangju (Korea, Republic of)

    2006-09-15

    Catastrophic antiphospholipid syndrome (CAPLS) was diagnosed in a 64-year-old male who was admitted to our hospital with dyspnea. The clinical and radiological examinations showed pulmonary thromboembolism, and so thromboembolectomy was performed. Abdominal distension rapidly developed several days later, and the abdominal computed tomography (CT) abdominal scan revealed thrombus within the superior mesenteric artery with small bowel and gall bladder distension. Cholecystectomy and jejunoileostomy were performed, and gall bladder necrosis and small bowel infarction were confirmed. The anticardiolipin antibody was positive. Anticoagulant agents and steroids were administered, but the patient expired 4 weeks after surgery due to acute respiratory distress syndrome (ARDS). We report here on a case of catastrophic APLS with manifestations of pulmonary thromboembolism, rapidly progressing GB necrosis and bowel infarction.

  5. Valuing Catastrophic Citrus Losses

    OpenAIRE

    Adams, Damian C.; Kilmer, Richard L.; Moss, Charles B.; Schmitz, Andrew

    2004-01-01

    Courts are often required to estimate changes in welfare to agricultural operations from catastrophic events. For example, courts must assign damages in lawsuits, such as with pesticide drift cases, or determine "just compensation" when the government takes private land for public use, as with the removal of dairy farms from environmentally sensitive land or destruction of canker-contaminated citrus trees. In economics, the traditional method of quantifying producer losses is estimating chang...

  6. The Great Recession And Increased Cost Sharing In European Health Systems.

    Science.gov (United States)

    Palladino, Raffaele; Lee, John Tayu; Hone, Thomas; Filippidis, Filippos T; Millett, Christopher

    2016-07-01

    European health systems are increasingly adopting cost-sharing models, potentially increasing out-of-pocket expenditures for patients who use health care services or buy medications. Government policies that increase patient cost sharing are responding to incremental growth in cost pressures from aging populations and the need to invest in new health technologies, as well as to general constraints on public expenditures resulting from the Great Recession (2007-09). We used data from the Survey of Health, Ageing and Retirement in Europe to examine changes from 2006-07 to 2013 in out-of-pocket expenditures among people ages fifty and older in eleven European countries. Our results identify increases both in the proportion of older European citizens who incurred out-of-pocket expenditures and in mean out-of-pocket expenditures over this period. We also identified a significant increase over time in the percentage of people who incurred catastrophic health expenditures (greater than 30 percent of the household income) in the Czech Republic, Italy, and Spain. Poorer populations were less likely than those in the highest income quintile to incur an out-of-pocket expenditure and reported lower mean out-of-pocket expenditures, which suggests that measures are in place to provide poorer groups with some financial protection. These findings indicate the substantial weakening of financial protection for people ages fifty and older in European health systems after the Great Recession. PMID:27385235

  7. The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts

    OpenAIRE

    Wang Hong; Rajkotia Yogesh; Nguyen Ha TH

    2011-01-01

    Abstract Background One of the key functions of health insurance is to provide financial protection against high costs of health care, yet evidence of such protection from developing countries has been inconsistent. The current study uses the case of Ghana to contribute to the evidence pool about insurance's financial protection effects. It evaluates the impact of the country's National Health Insurance Scheme on households' out-of-pocket spending and catastrophic health expenditure. Methods ...

  8. 卫生总费用决策支持模块需求分析与设计研究%Research on Requirement Analysis and Design of the Decision Support System on Total Health Expenditure

    Institute of Scientific and Technical Information of China (English)

    雷行云; 高星; 胡红濮; 郑英

    2013-01-01

      卫生总费用是卫生资源最重要的组成部分,能够全面反映一个国家或地区卫生事业发展的情况。以历年报告中的卫生总费用统计数据为基础,在完成数据分析、功能分析的前提下,进行了详细的卫生总费用决策支持模块的功能设计,帮助卫生决策者了解卫生总费用概况、结构和流向及未来增长趋势,从而及时有效地进行科学决策。%The total health expenditure is the most important part of the health resources which could comprehensively reflect the health development of a country or a region. Based on each year' s statistics of the reported total health expenditure data, this paper completes the data analysis, the functional analysis and functional design of decision support system of total health expenditure, in the aim of assisting the health decision-makers to understand the overview, the structure and flow, and the growth trend in the future of total health expenditure, so that the scientific decisions can be efficiently made in time.

  9. Comparisons of annual health care utilization, drug consumption, and medical expenditure between the elderly and general population in Taiwan

    Directory of Open Access Journals (Sweden)

    Wan-Hsuan Lu, MS

    2016-06-01

    Conclusion: Elderly people had higher medical utilization than the general population, which may contribute to a fragmented health care system. Strategies to integrate health care for older people would be considered a first priority task of policymakers and health professionals.

  10. CATASTROPHIC EVENTS MODELING

    Directory of Open Access Journals (Sweden)

    Ciumas Cristina

    2013-07-01

    Full Text Available This paper presents the emergence and evolution of catastrophe models (cat models. Starting with the present context of extreme weather events and features of catastrophic risk (cat risk we’ll make a chronological illustration from a theoretical point of view of the main steps taken for building such models. In this way the importance of interdisciplinary can be observed. The first cat model considered contains three modules. For each of these indentified modules: hazard, vulnerability and financial losses a detailed overview and also an exemplification of a potential case of an earthquake that measures more than 7 on Richter scale occurring nowadays in Bucharest will be provided. The key areas exposed to earthquake in Romania will be identified. Then, based on past catastrophe data and taking into account present conditions of housing stock, insurance coverage and the population of Bucharest the impact will be quantified by determining potential losses. In order to accomplish this work we consider a scenario with data representing average values for: dwelling’s surface, location, finishing works. On each step we’ll make a reference to the earthquake on March 4 1977 to see what would happen today if a similar event occurred. The value of Bucharest housing stock will be determined taking firstly the market value, then the replacement value and ultimately the real value to quantify potential damages. Through this approach we can find the insurance coverage of potential losses and also the uncovered gap. A solution that may be taken into account by public authorities, for example by Bucharest City Hall will be offered: in case such an event occurs the impossibility of paying compensations to insured people, rebuilding infrastructure and public buildings and helping the suffering persons should be avoided. An actively public-private partnership should be created between government authorities, the Natural Disaster Insurance Pool, private

  11. Evaluation of Expenditure Alternates

    Science.gov (United States)

    Poehlein, Gary W.; And Others

    1973-01-01

    Illustrates a system of calculating dollar expenditures over periods of time in terms of present value. The system enables planners, school boards, and administrators to compare expenditure alternatives as a decisionmaking factor. (Author)

  12. 42 CFR 441.354 - Aggregate projected expenditure limit (APEL).

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Aggregate projected expenditure limit (APEL). 441... Requirements § 441.354 Aggregate projected expenditure limit (APEL). (a) Definitions. For purposes of this... September 30, 1987); or (2) In the case of a State which did not report expenditures on the basis of...

  13. 42 CFR 403.750 - Estimate of expenditures and adjustments.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Estimate of expenditures and adjustments. 403.750...-Benefits, Conditions of Participation, and Payment § 403.750 Estimate of expenditures and adjustments. (a) Estimates. CMS estimates the level of expenditures for services provided under this subpart before the...

  14. 42 CFR 457.230 - FFP for State ADP expenditures.

    Science.gov (United States)

    2010-10-01

    ... procedures regarding the availability of FFP for ADP expenditures are in 45 CFR part 74, 45 CFR part 95... 42 Public Health 4 2010-10-01 2010-10-01 false FFP for State ADP expenditures. 457.230 Section 457...; Reduction of Federal Medical Payments § 457.230 FFP for State ADP expenditures. FFP is available for...

  15. Medical Expenditure Panel Survey Household Component

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medical Expenditure Panel Survey (MEPS) Household Component (HC) collects data from a sample of families and individuals in selected communities across the...

  16. Reconciling Medical Expenditure Estimates from the MEPS...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Reconciling Medical Expenditure Estimates from the MEPS and NHEA, 2007, published in Volume 2, Issue 4 of the Medicare and Medicaid Research Review, provides a...

  17. Manipulation of pain catastrophizing: An experimental study of healthy participants

    Directory of Open Access Journals (Sweden)

    Joel E Bialosky

    2008-11-01

    Full Text Available Joel E Bialosky1*, Adam T Hirsh2,3, Michael E Robinson2,3, Steven Z George1,3*1Department of Physical Therapy; 2Department of Clinical and Health Psychology; 3Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida, USAAbstract: Pain catastrophizing is associated with the pain experience; however, causation has not been established. Studies which specifically manipulate catastrophizing are necessary to establish causation. The present study enrolled 100 healthy individuals. Participants were randomly assigned to repeat a positive, neutral, or one of three catastrophizing statements during a cold pressor task (CPT. Outcome measures of pain tolerance and pain intensity were recorded. No change was noted in catastrophizing immediately following the CPT (F(1,84 = 0.10, p = 0.75, partial η2 < 0.01 independent of group assignment (F(4,84 = 0.78, p = 0.54, partial η2 = 0.04. Pain tolerance (F(4 = 0.67, p = 0.62, partial η2 = 0.03 and pain intensity (F(4 = 0.73, p = 0.58, partial η2 = 0.03 did not differ by group. This study suggests catastrophizing may be difficult to manipulate through experimental pain procedures and repetition of specific catastrophizing statements was not sufficient to change levels of catastrophizing. Additionally, pain tolerance and pain intensity did not differ by group assignment. This study has implications for future studies attempting to experimentally manipulate pain catastrophizing.Keywords: pain, catastrophizing, experimental, cold pressor task, pain catastrophizing scale

  18. Free Medicines Thanks to Retirement: Impact of Coinsurance Exemption on Pharmaceutical Expenditures and Hospitalization Offsets in a national health service.

    Science.gov (United States)

    Puig-Junoy, Jaume; García-Gómez, Pilar; Casado-Marín, David

    2016-06-01

    This paper examines the impact of coinsurance exemption for prescription medicines applied to elderly individuals in Spain after retirement. We use a rich administrative dataset that links pharmaceutical consumption and hospital discharge records for the full population aged 58 to 65 years in January 2004 covered by the public insurer in a Spanish region, and we follow them until December 2006. We use a difference-in-differences strategy and exploit the eligibility age for Social Security to control for the endogeneity of the retirement decision. Our results show that this uniform exemption increases the consumption of prescription medicines on average by 17.5%, total pharmaceutical expenditure by 25% and the costs borne by the insurer by 60.4%, without evidence of any offset effect in the form of lower short term probability of hospitalization. The impact is concentrated among consumers of medicines for acute and other non-chronic diseases whose previous coinsurance rate was 30% to 40%. Copyright © 2015 John Wiley & Sons, Ltd. PMID:26082341

  19. Catastrophic pediatric sports injuries.

    Science.gov (United States)

    Luckstead, Eugene F; Patel, Dilip R

    2002-06-01

    The high school sports of wrestling, gymnastics, ice hockey, baseball, track, and cheerleading should receive closer attention to prevent injury. Safer equipment and sport-specific conditioning should be provided and injuries strictly monitored. Greater attention must also be paid to swimming and diving techniques, and continued observation is needed for heat stroke and heat intolerance in sports such as football, wrestling, basketball, track and field, and cross-country. An increased awareness of commotio cordis in sports other than baseball should include ice hockey, football, track field events, and lacrosse. American football because of the sheer numbers and associated catastrophic injury potential must continue to be monitored at the highest medical levels! PMID:12119866

  20. Potential for Application of a Probabilistic Catastrophe Risk Modelling Framework to Poverty Outcomes

    OpenAIRE

    Porter, Catherine; White, Emily

    2016-01-01

    This paper analyzes the potential to combine catastrophe risk modelling (CAT risk modeling) with economic analysis of vulnerability to poverty using the example of drought hazard impacts on the welfare of rural households in Ethiopia. The aim is to determine the potential for applying a derived set of damage (vulnerability) functions based on realized shocks and household expenditure/consu...

  1. Using an ounce of prevention: does it reduce health care expenditures and reap pounds of profits? A study of the financial impact of wellness and health risk screening programs.

    Science.gov (United States)

    Phillips, Janet F

    2009-01-01

    As we are all well aware, health care expenditures in the United States are out of control and growing at epic proportions. Since private industry shoulders a significant burden of paying these rising health care costs, the huge and ever increasing sum paid by these corporations continues to impact the US economy translating into higher prices of services and manufactured goods and reduced job opportunities when companies outsource jobs or locate manufacturing facilities to avoid paying health care benefits for workers. As a result, health care expenditures have become a centerpiece of an enormous public policy debate as Congress is currently working on several versions of a bill to completely revise health care from the ground up. This research project was accomplished to examine the effectiveness of one approach to control rising health care costs and contain corporate financial responsibility--the establishment of wellness and health risk screening programs to improve the health of employees. Total health care cost per insured individual was gathered through an online survey directly from health care benefit administrators. The survey also asked information about wellness and health risk screening programs and the related responses were used to determine if there were a relationship between health care costs and health prevention programs. While statistical analysis was hampered in the current study because of the small sample size, some valid conclusions were reached. The study was successful in identifying a benchmark of Average Total Health Care Cost per Individual from $5,100 to $5,800 for 2005 through 2007. This is especially interesting in light of the fact that an average of $7,026 was spent on health care per person in 2006 in the United States. The study was also able to contribute an estimate of the increase realized in these expenditures of 6 percent in 2007 over 2006, and 4 percent in 2006 over 2005, which were in fact similar to the national average

  2. Using an ounce of prevention: does it reduce health care expenditures and reap pounds of profits? A study of the financial impact of wellness and health risk screening programs.

    Science.gov (United States)

    Phillips, Janet F

    2009-01-01

    As we are all well aware, health care expenditures in the United States are out of control and growing at epic proportions. Since private industry shoulders a significant burden of paying these rising health care costs, the huge and ever increasing sum paid by these corporations continues to impact the US economy translating into higher prices of services and manufactured goods and reduced job opportunities when companies outsource jobs or locate manufacturing facilities to avoid paying health care benefits for workers. As a result, health care expenditures have become a centerpiece of an enormous public policy debate as Congress is currently working on several versions of a bill to completely revise health care from the ground up. This research project was accomplished to examine the effectiveness of one approach to control rising health care costs and contain corporate financial responsibility--the establishment of wellness and health risk screening programs to improve the health of employees. Total health care cost per insured individual was gathered through an online survey directly from health care benefit administrators. The survey also asked information about wellness and health risk screening programs and the related responses were used to determine if there were a relationship between health care costs and health prevention programs. While statistical analysis was hampered in the current study because of the small sample size, some valid conclusions were reached. The study was successful in identifying a benchmark of Average Total Health Care Cost per Individual from $5,100 to $5,800 for 2005 through 2007. This is especially interesting in light of the fact that an average of $7,026 was spent on health care per person in 2006 in the United States. The study was also able to contribute an estimate of the increase realized in these expenditures of 6 percent in 2007 over 2006, and 4 percent in 2006 over 2005, which were in fact similar to the national average

  3. Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) - Smoking Attributable Expenditures (SAE)

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2005-2009. SAMMEC - Smoking-Attributable Mortality, Morbidity, and Economic Costs. Smoking attributable expenditures (SAEs) are excess health care expenditures...

  4. Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) - Smoking-Attributable Expenditures (SAE)

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2005-2009. SAMMEC - Smoking-Attributable Mortality, Morbidity, and Economic Costs. Smoking-attributable expenditures (SAEs) are excess health care expenditures...

  5. Gasto federal en salud en población no asegurada: México 1980-1995 Federal expenditure in health for non-insured population: Mexico 1980-1995

    Directory of Open Access Journals (Sweden)

    ALEJANDRO LARA

    1997-03-01

    Full Text Available Las crisis económicas que han afectado a México desde principios de los años ochenta han influido de manera determinante en el gasto público en bienestar social y, por lo mismo, en el gasto público en salud. En este trabajo se discute la relación que ha existido entre las estrategias de ajuste y el gasto en salud en población no asegurada, así como la distribución de este gasto por regiones. En la primera parte se describe la evolución del gasto público general, el gasto en bienestar social y el gasto público en salud en México entre 1980 y 1995. En la segunda parte se describe con mayor detalle la distribución del gasto público en salud en ese mismo periodo entre la población no asegurada de las cinco regiones en las que dividió al país la Encuesta Nacional de Salud II. La principal conclusión que se desprende de este trabajo es que en el periodo 1980-1995 se mantuvieron las brechas en el gasto en salud para población no asegurada que desde tiempos remotos existen entre las cinco regiones de México. Estas brechas afectan sobre todo a los estados más marginados –que se ubican en su gran mayoría en el sur del país–, no guardan ninguna relación con las diferencias regionales en las condiciones de salud y corren el riesgo no sólo de mantenerse sino incluso de profundizarse como resultado de los nuevos recortes relativos del gasto en bienestar social que contempla la política de ajuste adoptada por la presente administración.In the last fifteen years Mexico suffered several economic crisis which have negatively affected public expenditure in social welfare and, as a consequence, public expenditure in health. This paper discusses the relationship between the adjustment policies adopted to confront these crisis and public expenditure in health care for the non-insured population, as well as the regional distribution of this expenditure. In part one, the evolution of general public expenditure, public expenditure in social

  6. Treatment Seeking Behavior and Health Care Expenditure Incurred for Hypertension among elderly in Urban Slums of Belgaum City

    Directory of Open Access Journals (Sweden)

    Sulakshana S Baliga, Praveen S Gopakumaran, Sangappa M Katti, Maheshwar D Mallapur

    2013-01-01

    Material and methods: A Cross sectional study was conducted among elderly population aged 60 years and above in three slums of urban health centre Ram Nagar, Belgaum. Results: Out of the 336 elderly population studied, 174(52% were found to be hypertensive. Of the 174 hypertensive’s, 146 were found to be known hypertensive’s. Among the known hypertensive patients only 41 (28% took regular treatment. High level of out of pocket spending by elderly is observed by way of purchase of medicines, high cost of hospitalization of varying length and charges for diagnostic services. Conclusion: With reduced ability to generate resources, the elderly lack basic needs that affect their health status. Emphasis for an effective health policy for the elderly is recommended.

  7. Geographic Distribution of VA Expenditures Report (GDX)

    Data.gov (United States)

    Department of Veterans Affairs — Geographic Distribution of VA Expenditures Report (GDX) located on the Expenditures page in the Expenditure Tables category. This report details VA expenditures at...

  8. 基于证据的重特大疾病医保政策界定分析%Analysis on Evidence-based Definition of Catastrophic Illness in Social Health Insurance System of China

    Institute of Scientific and Technical Information of China (English)

    张晓; 刘蓉; 刘孟娜

    2015-01-01

    The definition of catastrophic illness in health insurance policy should base on its goals rather than expanded social responsibility and health care functions, should seek a way to use the fund fairly, justly and effectively under the constraints of limited medical insurance fund, and should take a optimal way to achieve the policy objectives. Through analysis on the practical experience, we define the contents and goals of catastrophic illness in health insurance policy, and specify, in the construction of medical security system, how to use insurance fund more effectively and make insurance system running more efficiently to achieve the policy goal of basic medical insurance, and to reflect the rationality in our insurance system.%重特大疾病的医保政策界定,应基于医保制度目标,而非扩大化的社会责任和医疗职能,应在有限医保基金约束条件下,寻求如何体现基金使用公平、公正与高效的效果,以最优方式和路径完成其政策目标。对此,本文旨在通过政策实践分析,对重特大疾病医保的政策概念内涵与政策目标进行界定和分析,明确在医疗保障制度建设中,医保应如何更加有效地发挥基金的作用,保证医保健康高效运行,实现基本医保制度中重特大疾病保障的政策目标,体现制度的理性。

  9. Ukraine: Health system review.

    Science.gov (United States)

    Lekhan, Valery; Rudiy, Volodymyr; Richardson, Erica

    2010-01-01

    The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Ukrainian health system has preserved the fundamental features of the Soviet Semashko system against a background of other changes, which are developed on market economic principles. The transition from centralized financing to its extreme decentralization is the main difference in the health system in comparison with the classic Soviet model. Health facilities are now functionally subordinate to the Ministry of Health, but managerially and financially answerable to the regional and local self-government, which has constrained the implementation of health policy and fragmented health financing. Health care expenditure in Ukraine is low by regional standards and has not increased significantly as a proportion of gross domestic product (GDP) since the mid 1990s; expenditure cannot match the constitutional guarantees of access to unlimited care. Although prepaid schemes such as sickness funds are growing in importance, out-of-pocket payments account for 37.4% of total health expenditure. The core challenges for Ukrainian health care therefore remain the ineffective protection of the population from the risk of catastrophic health care costs and the structural inefficiency of the health system, which is caused by the inefficient system of health care financing. Health system weaknesses are highlighted by increasing rates of avoidable mortality. Recent political impasse has complicated health system reforms and policy-makers face significant challenges in overcoming popular distrust and

  10. New indoor environment chambers and field experiment offices for research on human comfort, health and productivity at moderate energy expenditure

    Energy Technology Data Exchange (ETDEWEB)

    Toftum, J.; Langkilde, G.; Fanger, P.O. [Technical Univ., Lyngby (Denmark). International Centre for Indoor Environment and Energy

    2004-09-01

    This article describes three new indoor environment chambers, a new laboratory for the study of air movement in spaces and five offices for controlled environment exposures of human subjects in field experiments at the International Centre for Indoor Environment and Energy, Technical University of Denmark. Together with three older chambers, the Centre now has at its disposal 12 spaces for studying indoor environments and their impact on human comfort, health, productivity at moderate energy demands. [Author].

  11. An evaluation of the impact of patient cost sharing for antihypertensive medications on adherence, medication and health care utilization, and expenditures

    Directory of Open Access Journals (Sweden)

    Pesa JA

    2012-01-01

    Full Text Available Jacqueline A Pesa1, Jill Van Den Bos2, Travis Gray2, Colleen Hartsig2, Robert Brett McQueen3, Joseph J Saseen3, Kavita V Nair31Janssen Scientific Affairs, LLC, Louisville, CO, USA; 2Milliman, Inc, Denver, CO, USA; 3University of Colorado Anschutz Medical Campus, Aurora, CO, USAObjective: To assess the impact of patient cost-sharing for antihypertensive medications on the proportion of days covered (PDC by antihypertensive medications, medical utilization, and health care expenditures among commercially insured individuals assigned to different risk categories.Methods: Participants were identified from the Consolidated Health Cost Guidelines (CHCG database (January 1, 2006–December 31, 2008 based on a diagnosis (index claim for hypertension, continuous enrollment ≥12 months pre- and post-index, and no prior claims for antihypertensive medications. Participants were assigned to: low-risk group (no comorbidities, high-risk group (1+ selected comorbidities, or very high-risk group (prior hospitalization for 1+ selected comorbidities. The relationship between patient cost sharing and PDC by antihypertensive medications was assessed using standard linear regression models, controlling for risk group membership, and various demographic and clinical factors. The relationship between PDC and health care service utilization was subsequently examined using negative binomial regression models.Results: Of the 28,688 study patients, 66% were low risk. The multivariate regression model supported a relationship between patient cost sharing per 30-day fill and PDC in the following year. For every US$1.00 increase in cost sharing, PDC decreased by 1.1 days (P < 0.0001. Significant predictors of PDC included high risk, older age, gender, Charlson Comorbidity Index score, geography, and total post-index insurer- and patient-paid costs. An increase in PDC was associated with a decrease in all-cause and hypertension-related inpatient, outpatient, and emergency

  12. ANALYSIS OF INCOME AND EXPENDITURE OF HOUSEHOLDS IN THE EAST COAST OF PENINSULAR MALAYSIA

    OpenAIRE

    Noorhaslinda Kulub Abd. Rashid; Aslina Nasir; Nik Hashim Nik Mustapha; Nik Fuad Kamil

    2011-01-01

    Analysis of expenditure and income patterns of households in Malaysia that focuses on income, expenditure, loan, and saving is important. This study analyzes the impact of post global economic crisis on the income and expenditure patterns of Malaysian households. The study identifies major components of household’s expenditure on food, education, and health; as well as saving and loan, in relation to household income. In Pahang, Kelantan and Terengganu, the total expenditures come from the va...

  13. Seasonal Variation in Mortality, Medical Care Expenditure and Institutionalization in Older People: Evidence from a Dutch Cohort of Older Health Insurance Clients.

    Directory of Open Access Journals (Sweden)

    Herbert Jan Albert Rolden

    Full Text Available The mortality rates of older people changes with the seasons. However, it has not been properly investigated whether the seasons affect medical care expenditure (MCE and institutionalization. Seasonal variation in MCE is plausible, as MCE rises exponentially before death. It is therefore important to investigate the impact of the seasons on MCE both mediated and unmediated by mortality.Data on mortality, MCE and institutionalization from people aged 65 and older in a region in the Netherlands from July 2007 through 2010 were retrieved from a regional health care insurer and were linked with data from the Netherlands Institute for Social Research, and Statistics Netherlands (n = 61,495. The Seasonal and Trend decomposition using Loess (STL method was used to divide mortality rates, MCE, and institutionalization rates into a long-term trend, seasonal variation, and remaining variation. For every season we calculated the 95% confidence interval compared to the long-term trend using Welch's t-test.The mortality rates of older people differ significantly between the seasons, and are 21% higher in the winter compared to the summer. MCE rises with 13% from the summer to the winter; this seasonal difference is higher for the non-deceased than for the deceased group (14% vs. 6%. Seasonal variation in mortality is more pronounced in men and people in residential care. Seasonal variation in MCE is more pronounced in women. Institutionalization rates are significantly higher in the winter, but the other seasons show no significant impact.Seasonal changes affect mortality and the level of MCE of older people; institutionalization rates peak in the winter. Seasonal variation in MCE exists independently from patterns in mortality. Seasonal variation in mortality is similar for both institutionalized and community-dwelling elderly. Policy-makers, epidemiologists and health economists are urged to acknowledge and include the impact of the seasons in future

  14. Determinants on aged population’s health expenditures in China%我国老年人医疗卫生支出影响因素研究

    Institute of Scientific and Technical Information of China (English)

    马爱霞; 许扬扬

    2015-01-01

    Objective:To provide references for policy-making on the establishment of a sound healthcare sys-tem for China’s aged population. Methods:Based on the framework of The Behavioral Model of Health Services Use and data from China Health and Retirement Longitudinal Study in 2011 , the Tobit model of aged population’s health expenditures is built. Results: Self-rated health conditions, chronic disease, medical insurance, endowment insur-ance, self-rated living standard, age, gender, marital status and urban-rural character are the significant determi-nants. Conclusions:The healthcare system for China’s aged population should be built through simultaneously apply-ing disease prevention and access facilitation policies and the characteristic differences of different groups of aged pop-ulation should be taken into consideration.%目的::为完善老年人医疗保障体系提供政策建议。方法:基于Andersen医疗服务利用行为模型框架,利用中国健康与养老追踪调查2011年数据,建立我国老年人医疗卫生支出影响因素的Tobit模型。结果:需要因素中的自评健康状况与是否患有慢性病,能力因素中的医疗保险、养老保险与自评生活水平,以及倾向因素中的年龄、性别、婚姻状况和城乡身份显著影响我国老年人的医疗卫生支出。结论:建议按照“堵疏结合,区别对待”的原则,构建我国老年人医疗保障体系。

  15. Health care seeking patterns and out of pocket payments for children under five years of age living in Katchi Abadis (slums), in Islamabad, Pakistan

    OpenAIRE

    Rehman, Aneeqa; Shaikh, Babar Tasneem; Ronis, Katrina A

    2014-01-01

    Background Since 1990, Pakistan has faced an unprecedented rate of urbanization, thereby resulting in the uncontrolled proliferation of slums (Katchi Abadis) in all large cities. These areas lack the basic municipal services such as safe water supply, sanitation and waste collection. There is limited access to quality health care services, both curative and preventive. Therefore, communities living in katchi abadis are faced with health seeking challenges and catastrophic expenditure to pay f...

  16. Radiation occupational health interventions offered to radiation workers in response to the complex catastrophic disaster at the Fukushima Daiichi Nuclear Power Plant

    International Nuclear Information System (INIS)

    The Fukushima Daiichi Nuclear Power Plant (NPP) 1 was severely damaged from the chain reaction of the Great East Japan Earthquake and Tsunami on 11 March 2011, and the consequent meltdown and hydrogen gas explosions. This resulted in the worst nuclear accident since the Chernobyl accident of 1986. Just as in the case of Chernobyl, emergency workers were recruited to conduct a wide range of tasks, including disaster response, rescuing activities, NPP containment, and radiation decontamination. This paper describes the types and efficacy of the various occupational health interventions introduced to the Fukushima NPP radiation workers. Such interventions were implemented in order to prevent unnecessary radiation overexposure and associated adverse health effects and work injuries. Less than 1% of all emergency workers were exposed to external radiation of >100 mSv, and to date no death or health adversities from radiation have been reported for those workers. Several occupational health interventions were conducted, including setting of new regulatory exposure limits, improving workers' radiation dosimetry, administration of stable iodine, running an occupational health tracking system, and improving occupational medicine and preventative care. Those interventions were not only vital for preventing unnecessary radiation, but also for managing other general health issues such as mental health, heat illness and infectious disease. Long-term administration of the aforementioned occupational health interventions is essential to ensure the ongoing support and care for these workers, who were put under one of the most severe occupational health risk conditions ever encountered. (author)

  17. Tax Expenditures in Croatia

    Directory of Open Access Journals (Sweden)

    Vjekoslav Bratić

    2006-06-01

    Full Text Available The tax system of the Republic of Croatia contains a large number of very diverse kinds of tax expenditures whose the declared aim is to achieve certain social and economic objectives. This paper considers all the items that constitute tax expenditures in Croatia, within the systems of the personal income tax, corporate income tax, and real estate transfer tax and value added tax. The objective of the article is to determine the real level of tax expenditures per form of tax in the 2001-2004 period. We hypothesised that the tax expenditures in the analysed forms of tax are both high and growing, which was ultimately borne out, for almost all the analysed items in the tax forms considered are growing.

  18. Pain catastrophizing: a critical review.

    Science.gov (United States)

    Quartana, Phillip J; Campbell, Claudia M; Edwards, Robert R

    2009-05-01

    Pain catastrophizing is conceptualized as a negative cognitive-affective response to anticipated or actual pain and has been associated with a number of important pain-related outcomes. In the present review, we first focus our efforts on the conceptualization of pain catastrophizing, highlighting its conceptual history and potential problem areas. We then focus our discussion on a number of theoretical mechanisms of action: appraisal theory, attention bias/information processing, communal coping, CNS pain processing mechanisms, psychophysiological pathways and neural pathways. We then offer evidence to suggest that pain catastrophizing represents an important process factor in pain treatment. We conclude by offering what we believe represents an integrated heuristic model for use by researchers over the next 5 years; a model we believe will advance the field most expediently. PMID:19402782

  19. 甘肃省卫生总费用筹资水平及结构分析%Analysis of Total Health Expenditure Scale and Its Composition in Gansu Province

    Institute of Scientific and Technical Information of China (English)

    聂丹; 韩雪梅; 季韶荣; 梁佩佩; 吴艳倩

    2016-01-01

    Objectives Based on the analysis of total health expenditure(THE)scale and its composition in Gansu Province from 2003 to 2012,we aim to evaluate the health funding burden of government,society and out-of-pocket in the macroscopic level,and provide the fundamental basis for the government on development and adjustment of health decision-making.Methods According to the study objective,we applied financing source to measure Gansu TEH.With the data of related Health Statistics Yearbook,we used Excel,SPSS13.0 software to make estima-tion.Results During 2003 to 2012,Gansu TEH and per capita TEH increased year by year,with their average annu-al growth rate respectively being 21.02% and 21.20%.The proportion of government expenditure on health in-creased from 22.40% to 37.97%.Social health expenditure had little changes in proportion,reached 25.62% in 2012.The proportion of the out-of-pocket expenditure on health was reduced from 53.85% to 36.41%.Conclusions The total expenditure on health in Gansu was gradually increasing,but there were still a wide gap between the per capita levels compared with the national per capita level.It is needed to strengthen the government's responsibili-ty.The government should play a leading role in the basic medical and public health services and improve the total health expenditure accounting work.%目的:运用筹资来源法对2003—2012年甘肃省卫生总费用进行测算,初步了解甘肃省卫生总费用筹资水平及结构,从宏观上分析政府、社会和个人筹资负担,为甘肃省制定和调整卫生政策提供科学的参考依据。方法根据研究目的,运用筹资来源法,查阅相关统计年鉴及统计公报,得到相关指标,建立相应的数据库,应用 Ex-cel、SPSS 19.0等软件对数据进行统计和分析。结果2003—2012年甘肃省卫生总费和人均卫生总费用呈逐年增加趋势,平均增长速度分别为21.02%和21.20%。2003—2012年政府卫生支

  20. The Climate Catastrophe as Blockbuster

    DEFF Research Database (Denmark)

    Eskjær, Mikkel Fugl

    2013-01-01

    Modern disaster films constitute a specific cultural form that speaks to the anxieties of the “risk society.” This essay looks at how risks like climate change is presented and constructed in popular culture. It regards blockbuster representations as part of a wider discourse of “catastrophism...

  1. ENERGI EXPENDITURE PADA LANSIA

    Directory of Open Access Journals (Sweden)

    Yuniar Rosmalina

    2012-11-01

    Full Text Available ENERGY EXPENDITURE OF ELDERLY PEOPLE.Background: Physical activity is a factor to estimate the energy requirement. The elderly tend to reduce their activities which influence their energy requirement. Now aday the energy need for elderly is extrapolated from the adult. Energy expenditure based on their daily activities Is a method to estimate the energy requirement.Objectives: The purpose of the study was to assess energy expenditure of elderly people based on the daily physical activities.Methods: The study was conducted in 2 sub-sub districts of Bogar Country. A total of 92 elderly (42 men and 50 women were included in this study. The inclusion criteria were BMI 18.5- 25.0, physically and hematologically healthy and agree to participate in this study. Physical activities data were collected 3 days respectively using method record and recall and energy intakes using 3 day food record by weighing.Results: The average age was 67.5 ± 5,1 years for male elderly and 65.4 ± 3.9 years of female elderly. Recreational activities (reading, watching TV, sitting were the most activities done by male elderly (34.9% of the day while female elderly 34.8% of the day were spent for sleeping activity. The highest energy expenditure of male elderly was contributed from reactional activities (570.3 ± 187.8 Kcal/day while female elderly the highest energy expenditure was contributed from household work activities. The average energy expenditure for male elderly was 1870.2 ± 261.2 Kcal/day or 34.4 Kcal/Body weight/day and female elderly was 1840.2 ± 255.7 Kcal/day or 38.2 Kcal/Body weight/day. The energy Intake of male elderly was 1858 ± 471.7 Kcal/day or 34.1 Kcal/Body weight/day and female elderly was 1472 ± 255.7 Kcal/day or 30.8 Kcal/Body weight/day.Conclusions: Conclusion of this research was the energy expenditure of male elderly balance with their energy consumption, while the energy expenditure of female elderly higher than their energy consumption

  2. Oil sands tax expenditures

    International Nuclear Information System (INIS)

    The oil sands are a strategic Canadian resource for which federal and provincial governments provide financial incentives to develop and exploit. This report describes the Oil Sands Tax Expenditure Model (OSTEM) developed to estimate the size of the federal income tax expenditure attributed to the oil sands industry. Tax expenditures are tax concessions which are used as alternatives to direct government spending for achieving government policy objectives. The OSTEM was developed within the business Income Tax Division of Canada's Department of Finance. Data inputs for the model were obtained from oil sands developers and Natural Resources Canada. OSTEM calculates annual revenues, royalties and federal taxes at project levels using project-level projections of capital investment, operating expenses and production. OSTEM calculates tax expenditures by comparing taxes paid under different tax regimes. The model also estimates the foregone revenue as a percentage of capital investment. Total tax expenditures associated with investment in the oil sands are projected to total $820 million for the period from 1986 to 2030, representing 4.6 per cent of the total investment. 10 refs., 2 tabs., 7 figs

  3. THE CATASTROPHIC RISK REINSURANCE: FOREIGN EXPERIENCE

    Directory of Open Access Journals (Sweden)

    T. Tatarina

    2014-03-01

    Full Text Available The article deals with foreign experience of catastrophic risks reinsurance. The directions to ensure savings and increase capitalization of insurance companies under reinsurance protection. The necessary of catastrophic risk reinsurance in Ukraine has brought.

  4. 42 CFR 52c.6 - Expenditure of grant funds.

    Science.gov (United States)

    2010-10-01

    ... the applicable cost principles prescribed by subpart Q of 45 CFR part 74. (b) The Secretary may permit... 42 Public Health 1 2010-10-01 2010-10-01 false Expenditure of grant funds. 52c.6 Section 52c.6... RESEARCH SUPPORT PROGRAM § 52c.6 Expenditure of grant funds. (a) Any funds granted pursuant to this...

  5. 42 CFR 52d.7 - Expenditure of grant funds.

    Science.gov (United States)

    2010-10-01

    ... of the awards, and the applicable cost principles prescribed by subpart Q of 45 CFR part 74, except... 42 Public Health 1 2010-10-01 2010-10-01 false Expenditure of grant funds. 52d.7 Section 52d.7... INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.7 Expenditure of grant funds. (a) Any funds...

  6. Pain-related catastrophizing in pain patients and people with pain in the general population.

    NARCIS (Netherlands)

    Boer, M.J. de; Struys, M.M.; Versteegen, G.J.

    2012-01-01

    BACKGROUND: Catastrophizing is a defining factor in the pain experience and strongly contributes to the prediction of various aspects of health. Catastrophizing is not just present in pain patients, but may also be present in people with non-clinical pain. The aim of the present study is to investig

  7. Pain-related catastrophizing in pain patients and people with pain in the general population

    NARCIS (Netherlands)

    de Boer, M. J.; Struys, M. M. R. F.; Versteegen, G. J.

    2012-01-01

    Background Catastrophizing is a defining factor in the pain experience and strongly contributes to the prediction of various aspects of health. Catastrophizing is not just present in pain patients, but may also be present in people with non-clinical pain. The aim of the present study is to investiga

  8. Explaining health marginalisation of the lower educated: The role of cross-national variations in health expenditure and labour market conditions

    NARCIS (Netherlands)

    Gesthuizen, M.J.W.; Huijts, T.H.M.; Kraaykamp, G.L.M.

    2012-01-01

    Several studies have shown ample cross-national variation in the risk that lower educated people run to be in poor health. However, explanations for this cross-national variation are still scarce. In this article we aim at filling this lacuna by investigating to what extent cross-national variation

  9. Out-Of-Pocket Expenditure on Institutional Delivery in Rural Lucknow

    Directory of Open Access Journals (Sweden)

    Mukesh Shukla

    2015-06-01

    Full Text Available AbstractIntroduction: Promotion of reproductive health through institutional delivery has been adopted by government as a strategy for reducing maternal mortality rate but still about half of the deliveries have been conducted at home. Cost barrier is one of the major cause for preferring home delivery instead of institutional delivery. Not only the direct costs responsible for low institutional delivery but also indirect costs too accountable for less number of institutional births in the country. Aims & Objectives: To estimate the out of pocket expenditure incurred by households during delivery and its determinants. Materials and methods: A community based cross sectional study was conducted during which a total 272 households having women who had recently delivered in government institutions were interviewed. Result: The mean out of pocket expenditure was found to be Rs. 1406.04 ± 103.27 including spending’s on drugs, travel, pathological tests and unofficial payments. Low socioeconomic class, residence outside the catchment area of delivery point, tertiary and secondary health care facilities as place of delivery and low literacy status of head of the family below high school  were found to be significantly associated with out of pocket expenditure bivariate analysis (p<0.05. On multivariate analysis low socioeconomic (OR 22.40; 95% CI 9.44-53.15; p = 0.01   and residence (OR 13.07; 95% CI (1.58-116.55; p = 0.03  outside the catchment area of delivery point were found to be independent predictors of catastrophic out of pocket expenditure during delivery. Conclusions: Although government has been running lot of schemes for availing free of cost health services but still one has to pay from their pocket as medical expenses. In order to bear these expenses, they have to borrow money, sell their assets and securities due to which households suffer a lot. In the present study, unofficial payment was found prevalent in public institutions

  10. Pressures to Increase Public Expenditure and Patterns of Procyclical Expenditure

    OpenAIRE

    Andrew Abbott; Philip Jones

    2014-01-01

    This paper draws on the literature that explains why governments spend procyclically, to predict the pattern of cyclical expenditure across government budgets. Procyclical expenditure increases at a faster rate than income in economic upturns and falls at a faster rate in recessions. The more politicians indulge pressures to increase expenditure in an economic upturn, the more they find it difficult to sustain expenditure in a recession. In this paper, differences in politicians' willingness ...

  11. Energy Expenditure During Extravehicular Activity Through Apollo

    Science.gov (United States)

    Paul, Heather L.

    2012-01-01

    Monitoring crew health during manned space missions has always been an important factor to ensure that the astronauts can complete the missions successfully and within safe physiological limits. The necessity of real-time metabolic rate monitoring during extravehicular activities (EVAs) came into question during the Gemini missions, when the energy expenditure required to complete EVA tasks exceeded the life support capabilities for cooling and humidity control and, as a result, crew members ended the EVAs fatigued and overworked. This paper discusses the importance of real-time monitoring of metabolic rate during EVAs, and provides a historical look at energy expenditure during EVAs through the Apollo Program.

  12. Coping with ecological catastrophe: crossing major thresholds

    Directory of Open Access Journals (Sweden)

    John Cairns, Jr.

    2004-08-01

    Full Text Available The combination of human population growth and resource depletion makes catastrophes highly probable. No long-term solutions to the problems of humankind will be discovered unless sustainable use of the planet is achieved. The essential first step toward this goal is avoiding or coping with global catastrophes that result from crossing major ecological thresholds. Decreasing the number of global catastrophes will reduce the risks associated with destabilizing ecological systems, which could, in turn, destabilize societal systems. Many catastrophes will be local, regional, or national, but even these upheavals will have global consequences. Catastrophes will be the result of unsustainable practices and the misuse of technology. However, avoiding ecological catastrophes will depend on the development of eco-ethics, which is subject to progressive maturation, comments, and criticism. Some illustrative catastrophes have been selected to display some preliminary issues of eco-ethics.

  13. Severe catastrophes and public reactions

    International Nuclear Information System (INIS)

    nuclear opposition. Economical basis of nuclear energy stagnation is in not very successful competition of nuclear engineering with fossil energy production technologies. Much money has been spent for improvement of safety of NPPs. Social roots of the opposition are linked with a bad experience of the public with demonstration of the nuclear energy- The explosion of atomic bombs, some contamination of the territories after nuclear arm tests, misfortunes with TMI-2 and Chernobyl have created a stable enmity and non-acceptance of the all connected with 'atom'. The mass media have strongly promoted the dissemination of the fear of radiation exposures. There is also an influence on that attitude the radiation protection regulation via the declaration of the linear no-threshold dependence of the radiation detriments and dose of exposure. Such concept ignores the adoptive features of all living. But modem studies have showed that protracted irradiation at the same dose is much less dangerous compared with sharp one. It could change public attitude to nuclear energy in the society. Role of nuclear communication for public informing: The reactions of public on various technological and man-made events differ significantly and are being determined not scales of catastrophes but the mental impression and a multiplication of psychological stresses in the society by mass -media. In present situation a nuclear community has to improve the contacts with the pubic, to launch more effective campaign for explanation of real adventures of nuclear power. It needs to compare the risks of climate warming and health detriments from different electricity production technologies and to show that nuclear power is a single alternative all fossil burning techniques of electricity production. It's the truth the nuclear power is a real method of fight for suppression of emission the greenhouse gases, isn't it? (author)

  14. Empirical Analysis on the Relationship of Total Health Expenditure, Physical Capital Investment and Economic Growth%卫生总费用、物质资本投入与经济增长关系实证分析

    Institute of Scientific and Technical Information of China (English)

    聂丽

    2013-01-01

    目的:分析我国国内生产总值、卫生总费用、物质资本投入3个变量间关系,为我国卫生经济政策制定及分配制度改革提供依据。方法:采用1978-2011年统计年鉴数据,建立VAR模型研究变量间动态关系。结果:通过单位根检验得出模型较稳定,3个变量间有Granger关系,通过脉冲响应函数得出: GDP增加会引起卫生费用和物质资本投入增加,物质资本与卫生费用变化具有反向关系等。结论:卫生总费用与物质资本相比具有更强经济增长效应,政府应合理分配卫生费用,从提高劳动者素质角度提高物质资本的社会效益从而促进经济增长。%Objective: By analyzing the three variables relationship of GDP, total health expenditure and physical capital input, to provide basis for health economic policy and distribution system reform in China. Methods: Using the data from 1978 to 2011, the VAR model of the dynamic relationship is established. Results: The establishment of VAR model is stable by unit root test, there is Granger relation between the 3 variables, the result of the impulse response function is obtained that GDP will increase the input of health costs and physical capital, and physical capital and health expenditure have a reverse relation. Conclusion: Total health expenditure has greater effect on economic growth compared with physical capital, the government should allocate health costs, improve social benefits from the prospective of improving the quality of workers to promote economic growth.

  15. The Diseconomies of Environmental Catastrophes

    OpenAIRE

    Cairns, John

    2006-01-01

    Four factors are almost certain to lead to one or more catastrophes unless major remedial measures are taken. (1) China has replaced the United States as the world s leading consumer of resources, except for oil (Brown, 2006a), but China is already a major factor in the world market in this area also. Together, China and the United States consume approximately half the world s resources and the global population is still increasing on a finite planet. (2) The over 20% global ecological oversh...

  16. Catastrophic Evaporation of Rocky Planets

    CERN Document Server

    Perez-Becker, Daniel

    2013-01-01

    Short-period exoplanets can have dayside surface temperatures surpassing 2000 K, hot enough to vaporize rock and drive a thermal wind. Small enough planets evaporate completely. We construct a radiative-hydrodynamic model of atmospheric escape from strongly irradiated, low-mass rocky planets, accounting for dust-gas energy exchange in the wind. Rocky planets with masses 2000 K are found to disintegrate entirely in 0.1 M_Earth/Gyr --- our model yields a present-day planet mass of < 0.02 M_Earth or less than about twice the mass of the Moon. Mass loss rates depend so strongly on planet mass that bodies can reside on close-in orbits for Gyrs with initial masses comparable to or less than that of Mercury, before entering a final short-lived phase of catastrophic mass loss (which KIC 12557548b has entered). Because this catastrophic stage lasts only up to a few percent of the planet's life, we estimate that for every object like KIC 12557548b, there should be 10--100 close-in quiescent progenitors with sub-da...

  17. Extensional rheometer based on viscoelastic catastrophes outline

    DEFF Research Database (Denmark)

    2014-01-01

    The present invention relates to a method and a device for determining viscoelastic properties of a fluid. The invention resides inter alia in the generation of viscoelastic catastrophes in confined systems for use in the context of extensional rheology. The viscoelastic catastrophe is according to...... the invention generated in a bistable fluid system, and the flow conditions for which the catastrophe occurs can be used as a fingerprint of the fluid's viscoelastic properties in extensional flow....

  18. Yoga attitudes in chronic low back pain: Roles of catastrophizing and fear of movement.

    Science.gov (United States)

    Combs, Martha A; Thorn, Beverly E

    2015-08-01

    Chronic low back pain is a significant public health problem and, although underused, yoga may be an effective complementary treatment. The current study examined associations of pain catastrophizing and fear of movement with attitudes toward yoga in adults with chronic low back pain. Participants completed three quantitative questionnaires assessing specific constructs: beliefs about yoga, fear of movement, and pain catastrophizing. A semi-structured in-person interview was then conducted to obtain specific pain-related information. Hierarchical regression and mediational analyses were used to test hypotheses. Consistent with the fear-avoidance model of chronic pain, catastrophizing and fear of movement were negatively associated with yoga attitudes. Specifically, fear of movement was a mediator between catastrophizing and attitudes toward yoga. Individuals with higher levels of catastrophizing and fear of movement may be less likely to consider a pain treatment involving physical movement. PMID:26256134

  19. Catastrophe mechanism & classification of discontinuity behavior in thermal science (Ⅰ) --Fold catastrophe

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The mechanism of discontinuity behavior has important significance in the study of thermal science,such as fire,combustion,explosion and heat transfer.This sort of discontinuity behavior and the catastrophe caused by system nonlinearity may be equivalently classified according to the catastrophe model promulgated by catastrophe theory.Under the conditions of uniform temperature and thermal isolation,the self-ignition behavior of a Semenov System can be viewed as a result of the fold catastrophe of the system.

  20. 42 CFR 419.30 - Base expenditure target for calendar year 1999.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Base expenditure target for calendar year 1999. 419.30 Section 419.30 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Services § 419.30 Base expenditure target for calendar year 1999. (a) CMS estimates the aggregate...

  1. Advertising Expenditure and Consumer Prices

    OpenAIRE

    Ferdinand Rauch

    2011-01-01

    This paper studies the effect of a change in the marginal costs of advertising on advertising expenditures of firms and consumer prices across industries. It makes use of a unique policy change that caused a decrease of the taxation on advertising expenditures in parts of Austria and a simultaneous increase in other parts. Advertising expenditures move immediately in the opposite direction to the marginal costs of advertising. Simultaneously the price reaction to advertising is negative in so...

  2. Academic Training: Predicting Natural Catastrophes

    CERN Multimedia

    Françoise Benz

    2005-01-01

    2005-2006 ACADEMIC TRAINING PROGRAMME LECTURE SERIES 12, 13, 14, 15, 16 December from 11:00 to 12:00 - Main Auditorium, bldg. 500 Predicting Natural Catastrophes E. OKAL / Northwestern University, Evanston, USA 1. Tsunamis -- Introduction Definition of phenomenon - basic properties of the waves Propagation and dispersion Interaction with coasts - Geological and societal effects Origin of tsunamis - natural sources Scientific activities in connection with tsunamis. Ideas about simulations 2. Tsunami generation The earthquake source - conventional theory The earthquake source - normal mode theory The landslide source Near-field observation - The Plafker index Far-field observation - Directivity 3. Tsunami warning General ideas - History of efforts Mantle magnitudes and TREMOR algorithms The challenge of 'tsunami earthquakes' Energy-moment ratios and slow earthquakes Implementation and the components of warning centers 4. Tsunami surveys Principles and methodologies Fifteen years of field surveys and re...

  3. Catastrophic disruption experiments: Recent results

    Science.gov (United States)

    Martelli, G.; Ryan, E. V.; Nakamura, A. M.; Giblin, I.

    1994-01-01

    This paper presents a review of the progress in the field of catastrophic disruption experiments over the past 4 years, since the publication of the review paper by Fujiwara et al. (1989). We describe the development of new techniques to produce shattering impacts relevant to the study of the collisional evolution of the asteroids, and summarize the results from numerous experiments which have been performed to date, using a variety of materials for both the impactor and the targets. Some of these, such as ice-on-ice, loose aggregates and pressurized targets, are quite new and have provided novel and exciting results. Some of the gaps existing previously in the data on fragment ejection-angle distributions, as well as translational and rotational velocity fields (including fine fragments) have been filled, and these new results will be surveyed.

  4. A STUDY ON IMPLEMENTATION OF COMMUNITY HEALTH INSURANCE SCHEME IN THE CARDIOLOGY DEPARTMENT OF A TERTIARY CARE GOVERNMENT HOSPITAL

    Directory of Open Access Journals (Sweden)

    Kalyani

    2015-02-01

    Full Text Available In many parts of the developing world, health care expenditure is largely met out of pocket, and illness can drive individuals and families into poverty and debt. India ranks third in the World Health Organization's 2012 list of "countries with highest out of pocket (OOP expenditure on health" in the south - east Asia region with almost 60% of total health expenditure paid by the common man in 2009 (World Health Organization 2009 . 1 The Rajiv Aarogyasri Community Health Insurance (RACHI in Andhra Pradesh (AP has been very popular social insurance scheme with a private public partnership model to deal with the problems of catastrophic medical expenditures at tertiary level care for the poor households is achieved AIM OF THE STUDY: To study implementation of Aarogyasri community health insurance scheme in the department of cardiology of a tertiary care government hospital. MATERIAL : A total number of 27 cases of cardiac patients recruited over a period of ten weeks from 5 - 9 - 14 to 15 - 11 - 14 in the department of cardiology K.G.H Visakhapatnam. DISCUSSION: Community health insurance scheme is one of the models for providing health security for the people below poverty line. The Aarogyasri scheme of Andhra Pradesh aims to ensure health care for the BPL population at the time of critical and catastrophic illness. All the cases in the study group underwent surgical treatment, PTCA with one stent and for one case an additional stent was placed. Cash less packages also covered free food and transportation charges. Medicines are given for ten days at the time of discharge. Many states, and even the central government, are believed to be looking at the scheme to see if this can be replicated across the country . 6 CONCLUSSION: The case travel time from registration to final claims disposal is less than two weeks because of the organization pattern of the Arogyasri community health insurance scheme.

  5. Climate Catastrophe - The Giant Swindle

    International Nuclear Information System (INIS)

    Energy is the life-blood of civilization. More than 80% of global energy is supplied by fossil fuels. And this will continue for the foreseeable future - if an implementation of the Kyoto Protocol does not lead to a dramatic decrease of these fuels causing worldwide turmoil of unprecedented dimensions. However, the scaremongering with a 'climate catastrophe' allegedly caused by 'greenhouse gas' emissions from the burning of fossil fuels is a huge hoax. Its only 'scientific' base is the IPCC management's enigmatic assessment: 'The balance of evidence suggests a discernable human influence on climate'. But even IPCC had to admit at the World Energy Conference in Tokyo in 1996: 'We have no evidence'. And all the scaremongering assertions of the protagonists of 'global warming' have been convincingly refuted by the world elite of scientists. This paper will: - show how the whole anti-CO2 campaign has been manipulated from the very beginning till today; - give great many scientific and logical reason why the arguments of the scaremongers are incorrect; - outline the catastrophic economic and social consequences of the proposed anti-CO2 measures - without any benefit for the environment of climate; - name the driving forces behind this campaign and their interests. The witchhunt against CO2 is an incredible scientific and political scandal, CO2 does not damage the environment at all, and labelling it a 'climate killer' is absurd. On the contrary, this gas is vital for the life on our plant, and a stronger concentration of CO2 will be beneficial by doubling plant growth and with this combatting global famine. And to pretend that we could influence - with a CO2 tax - the climate, is insane arrogance. Man is absolutely helpless when confronted with the forces of nature. The squandering of multimillions USD of taxpayer's money for the travelling circus of 'Climate summits' and the stultification of the population must stop. The 'global warming' lie is the biggest

  6. Las evidencias benefician al sistema de salud: reforma para remediar el gasto catastrófico y empobrecedor en salud en México Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico

    Directory of Open Access Journals (Sweden)

    Felicia Marie Knaul

    2007-01-01

    Full Text Available La falta de protección financiera en salud es una enfermedad recientemente diagnosticada de los sistemas de salud. El síntoma más obvio es que las familias enfrentan la ruina económica y el empobrecimiento por financiar su atención médica. México fue uno de los primeros países en diagnosticar el problema, atribuirlo a la falta de protección financiera y proponer una terapia sistémica a través de la reforma del sistema de salud. Este trabajo analiza la manera en que México convirtió las evidencias sobre los gastos catastróficos y empobrecedores en salud en un catalizador de la renovación institucional a través de la reforma que creó el Seguro Popular de Salud (SPS. Presentamos tanto las tendencias de los últimos 15 años sobre la evolución de los gastos catastróficos y emprobrecedores en salud, como las evidencias recientes sobre el mejoramiento en estos indicadores con la expansión del SP. Los resultados de la experiencia mexicana sugieren que la organización y el financiamiento del sistema de salud han jugado un papel muy importante en la reducción del empobrecimiento y en la protección de los hogares durante los periodos de crisis financiera individual y colectiva.Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular de Salud (Popular Health Insurance. We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results

  7. The financing and effectiveness of agricultural expenditure

    OpenAIRE

    Chatellier, Vincent

    2008-01-01

    This text presents a critical analysis on the financial and effectiveness of public expenditure allocated to European agriculture. It deals with the proposals made by the European Commission under the health check of the Common Agricultural Policy (CAP). To provide some answers to the questions raised by his interlocutors (European parliament), the author draws on his analysis of agricultural policy and simulations applied to the French Farm Accountancy Data Network (FADN). The first part dea...

  8. Adaptation to and Recovery from Global Catastrophe

    Directory of Open Access Journals (Sweden)

    Seth D. Baum

    2013-03-01

    Full Text Available Global catastrophes, such as nuclear war, pandemics and ecological collapse threaten the sustainability of human civilization. To date, most work on global catastrophes has focused on preventing the catastrophes, neglecting what happens to any catastrophe survivors. To address this gap in the literature, this paper discusses adaptation to and recovery from global catastrophe. The paper begins by discussing the importance of global catastrophe adaptation and recovery, noting that successful adaptation/recovery could have value on even astronomical scales. The paper then discusses how the adaptation/recovery could proceed and makes connections to several lines of research. Research on resilience theory is considered in detail and used to develop a new method for analyzing the environmental and social stressors that global catastrophe survivors would face. This method can help identify options for increasing survivor resilience and promoting successful adaptation and recovery. A key point is that survivors may exist in small isolated communities disconnected from global trade and, thus, must be able to survive and rebuild on their own. Understanding the conditions facing isolated survivors can help promote successful adaptation and recovery. That said, the processes of global catastrophe adaptation and recovery are highly complex and uncertain; further research would be of great value.

  9. Catastrophizing delays the analgesic effect of distraction.

    Science.gov (United States)

    Campbell, Claudia M; Witmer, Kenny; Simango, Mpepera; Carteret, Alene; Loggia, Marco L; Campbell, James N; Haythornthwaite, Jennifer A; Edwards, Robert R

    2010-05-01

    Behavioral analgesic techniques such as distraction reduce pain in both clinical and experimental settings. Individuals differ in the magnitude of distraction-induced analgesia, and additional study is needed to identify the factors that influence the pain relieving effects of distraction. Catastrophizing, a set of negative emotional and cognitive processes, is widely recognized to be associated with increased reports of pain. We sought to evaluate the relationship between catastrophizing and distraction analgesia. Healthy participants completed three sessions in a randomized order. In one session (Pain Alone), pain was induced by topical application of a 10% capsaicin cream and simultaneous administration of a tonic heat stimulus. In another session (Pain+Distraction), identical capsaicin+heat application procedures were followed, but subjects played video games that required a high level of attention. During both sessions, verbal ratings of pain were obtained and participants rated their degree of catastrophizing. During the other session (Distraction Alone) subjects played the video games in the absence of any pain stimulus. Pain was rated significantly lower during the distraction session compared to the "Pain Alone" session. In addition, high catastrophizers rated pain significantly higher regardless of whether the subjects were distracted. Catastrophizing did not influence the overall degree of distraction analgesia; however, early in the session high catastrophizers had little distraction analgesia, though later in the session low and high catastrophizers rated pain similarly. These results suggest that both distraction and catastrophizing have substantial effects on experimental pain in normal subjects and these variables interact as a function of time.

  10. Environmental Catastrophes Under Time-inconsistent Preferences

    NARCIS (Netherlands)

    Michielsen, T.O.

    2013-01-01

    Abstract I analyze optimal natural resource use in an intergenerational model with the risk of a catastrophe. Each generation maximizes a weighted sum of discounted utility (positive) and the probability that a catastrophe will occur at any point in the future (negative). The model generates time-in

  11. Fracto—emissions in Catastrophic Cleavage Process

    Institute of Scientific and Technical Information of China (English)

    HonglaiTAN; WeiYANG

    1996-01-01

    Fracto-emissions accompanying crack propagation are observed in the recent experiments.The energy impulses during and after fracture stimulate the fracto-emissions.Model concerning atomic scale cleavage processes is proposed to formulate a catastrophic fracure theory relevant to these phenomena.A criterion for catastrophic jump of the cleavage potential is applied to representative crystals.

  12. FLYPAPER EFFECTS ANOMALY OF WEST PAPUA CAPITAL PUBLIC EXPENDITURE

    Directory of Open Access Journals (Sweden)

    Marthen Anthon Pentury

    2013-04-01

    Full Text Available In fiscal decentralization, local governments should be able to provide public service facilities for all communities. This study aims to determine the existence of flypaper effect in the total capital public expenditure and capital expenditure on education, health and infrastructure in districts in West Papua, 2003-2006. Tools of analysis used is panel data regression. The General Allocation Fund (DAU, the Special Allocation Fund (DAK and the Special Autonomy Fund (DOK partially and simultaneously have positive impact on total capital spending and capital expenditure in education, health, and infrastructure. It is also indicated the anomaly of flypaper effect in DAU, DAK, and DOK.Keywords: Flypaper effect, anomaly, fiscal decentralization, capital expendituresJEL classification numbers: H50, H75

  13. Catastrophe mechanism and classification of discontinuity behavior in thermal science (Ⅱ) -- Cusp catastrophe

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The catastrophe mechanisms of thermal performance characteristics of the firebox gas combustion system were analyzed from the viewpoint of catastrophe theory. The mathematical models of cusp catastrophe were established. The relationship between the thermal performance characteristics and the changing of system control variables was studied. The cusp catastrophe mechanisms of typical performance characteristics, such as kicking and lagging, and those of transition from quenching to igniting were explained. It was illustrated that discontinuity behavior of thermal systems with an "S" motion feature curve and lagging feature may be equivalently classified according to the topology of cusp catastrophe, influenced by two groups of independent control variables.

  14. Measuring financial protection for health in families with chronic conditions in Rural China

    Directory of Open Access Journals (Sweden)

    Jiang Chunhong

    2012-11-01

    Full Text Available Abstract Background As the world’s largest developing country, China has entered into the epidemiological phase characterized by high life expectancy and high morbidity and mortality from chronic diseases. Cardiovascular diseases, chronic obstructive pulmonary diseases, and malignant tumors have become the leading causes of death since the 1990s. Constant payments for maintaining the health status of a family member who has chronic diseases could exhaust household resources, undermining fiscal support for other necessities and eventually resulting in poverty. The purpose of this study is to probe to what degree health expenditure for chronic diseases can impoverish rural families and whether the New Cooperative Medical Scheme can effectively protect families with chronic patients against catastrophic health expenditures. Methods We used data from the 4th National Health Services Survey conducted in July 2008 in China. The rural sample we included in the analysis comprised 39,054 households. We used both households suffering from medical impoverishment and households with catastrophic health expenditures to compare the financial protection for families having a chronic patient with different insurance coverage statuses. We used a logistic regression model to estimate the impact of different benefit packages on health financial protection for families having a chronic patient. Results An additional 10.53% of the families with a chronic patient were impoverished because of healthcare expenditure, which is more than twice the proportion in families without a chronic patient. There is a higher catastrophic health expenditure incidence in the families with a chronic patient. The results of logistic regression show that simply adding extra benefits did not reduce the financial risks. Conclusions There is a lack of effective financial protection for healthcare expenditures for families with a chronic patient in rural China, even though there is a high

  15. Estimating expenditure impacts without expenditure data using asset proxies

    OpenAIRE

    Martin Wittenberg

    2009-01-01

    When asset indices are used in regressions the coefficients obtained are typically difficult to interpret. We show how lower bounds on expenditure effects can be extracted, if the relationship between the assets and expenditure can be calibrated on an auxiliary data set.

  16. 75 FR 69082 - Federal Financial Participation in State Assistance Expenditures; Federal Matching Shares for...

    Science.gov (United States)

    2010-11-10

    ... for Medicaid, the Children's Health Insurance Program, and Aid to Needy Aged, Blind, or Disabled... (Medicaid) and Children's Health Insurance Program (CHIP) expenditures, Temporary Assistance for Needy... medical assistance and child health assistance, and assistance payments for certain social services....

  17. Constrained Total Energy Expenditure and Metabolic Adaptation to Physical Activity in Adult Humans.

    Science.gov (United States)

    Pontzer, Herman; Durazo-Arvizu, Ramon; Dugas, Lara R; Plange-Rhule, Jacob; Bovet, Pascal; Forrester, Terrence E; Lambert, Estelle V; Cooper, Richard S; Schoeller, Dale A; Luke, Amy

    2016-02-01

    Current obesity prevention strategies recommend increasing daily physical activity, assuming that increased activity will lead to corresponding increases in total energy expenditure and prevent or reverse energy imbalance and weight gain [1-3]. Such Additive total energy expenditure models are supported by exercise intervention and accelerometry studies reporting positive correlations between physical activity and total energy expenditure [4] but are challenged by ecological studies in humans and other species showing that more active populations do not have higher total energy expenditure [5-8]. Here we tested a Constrained total energy expenditure model, in which total energy expenditure increases with physical activity at low activity levels but plateaus at higher activity levels as the body adapts to maintain total energy expenditure within a narrow range. We compared total energy expenditure, measured using doubly labeled water, against physical activity, measured using accelerometry, for a large (n = 332) sample of adults living in five populations [9]. After adjusting for body size and composition, total energy expenditure was positively correlated with physical activity, but the relationship was markedly stronger over the lower range of physical activity. For subjects in the upper range of physical activity, total energy expenditure plateaued, supporting a Constrained total energy expenditure model. Body fat percentage and activity intensity appear to modulate the metabolic response to physical activity. Models of energy balance employed in public health [1-3] should be revised to better reflect the constrained nature of total energy expenditure and the complex effects of physical activity on metabolic physiology.

  18. Energy Expenditure of Sport Stacking

    Science.gov (United States)

    Murray, Steven R.; Udermann, Brian E.; Reineke, David M.; Battista, Rebecca A.

    2009-01-01

    Sport stacking is an activity taught in many physical education programs. The activity, although very popular, has been studied minimally, and the energy expenditure for sport stacking is unknown. Therefore, the purposes of this study were to determine the energy expenditure of sport stacking in elementary school children and to compare that value…

  19. Why do Education Expenditures Fail to Reduce Child Labor? Looking for an Optimal Composition of the Social Expenditures

    OpenAIRE

    Grigoriou, Christopher; Rota-Graziosi, Grégoire

    2005-01-01

    In a framework, where child labor results from a risky choice between working and schooling, we study the reason why public education expenditures may fail to reduce child labor. We determine an optimal composition of social expenditures between education and health which minimizes child labor for a given government's budget. This is tested with panel data over 81 developing countries. It is evidenced that the unbalanced structure of the social spending favourable to education to the detrimen...

  20. Effects of a popular exercise and weight loss program on weight loss, body composition, energy expenditure and health in obese women

    Directory of Open Access Journals (Sweden)

    Magrans-Courtney Teresa

    2009-05-01

    Full Text Available Abstract Objective To determine the safety and efficacy of altering the ratio of carbohydrate and protein in low-energy diets in conjunction with a popular exercise program in obese women. Design Matched, prospective clinical intervention study to assess efficacy of varying ratios of carbohydrate and protein intake in conjunction with a regular exercise program. Participants One-hundred sixty one sedentary, obese, pre-menopausal women (38.5 ± 8.5 yrs, 164.2 ± 6.7 cm, 94.2 ± 18.8 kg, 34.9 ± 6.4 kg·m-2, 43.8 ± 4.2% participated in this study. Participants were weight stable and not participating in additional weight loss programs. Methods Participants were assigned to either a no exercise + no diet control (CON, a no diet + exercise group (ND, or one of four diet + exercise groups (presented as kcals; % carbohydrate: protein: fat: 1 a high energy, high carbohydrate, low protein diet (HED [2,600; 55:15:30%], 2 a very low carbohydrate, high protein diet (VLCHP [1,200 kcals; 63:7:30%], 3 a low carbohydrate, moderate protein diet (LCMP [1,200 kcals; 50:20:30%] and 4 a high carbohydrate, low protein diet (HCLP [1,200 kcals; 55:15:30%]. Participants in exercise groups (all but CON performed a pneumatic resistance-based, circuit training program under supervision three times per week. Measurements Anthropometric, body composition, resting energy expenditure (REE, fasting blood samples and muscular fitness assessments were examined at baseline and weeks 2, 10 and 14. Results All groups except CON experienced significant reductions (P P P P P Conclusion Exercise alone (ND appears to have minimal impact on measured outcomes with positive outcomes apparent when exercise is combined with a hypoenergetic diet. Greater improvements in waist circumference and body composition occurred when carbohydrate is replaced in the diet with protein. Weight loss in all diet groups (VLCHP, LCMP and HCLP was primarily fat and stimulated improvements in markers of

  1. A smooth mixture of Tobits model for healthcare expenditure.

    Science.gov (United States)

    Keane, Michael; Stavrunova, Olena

    2011-09-01

    This paper develops a smooth mixture of Tobits (SMTobit) model for healthcare expenditure. The model is a generalization of the smoothly mixing regressions framework of Geweke and Keane (J Econometrics 2007; 138: 257-290) to the case of a Tobit-type limited dependent variable. A Markov chain Monte Carlo algorithm with data augmentation is developed to obtain the posterior distribution of model parameters. The model is applied to the US Medicare Current Beneficiary Survey data on total medical expenditure. The results suggest that the model can capture the overall shape of the expenditure distribution very well, and also provide a good fit to a number of characteristics of the conditional (on covariates) distribution of expenditure, such as the conditional mean, variance and probability of extreme outcomes, as well as the 50th, 90th, and 95th, percentiles. We find that healthier individuals face an expenditure distribution with lower mean, variance and probability of extreme outcomes, compared with their counterparts in a worse state of health. Males have an expenditure distribution with higher mean, variance and probability of an extreme outcome, compared with their female counterparts. The results also suggest that heart and cardiovascular diseases affect the expenditure of males more than that of females.

  2. Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013.

    Directory of Open Access Journals (Sweden)

    Anadi Gupt

    Full Text Available Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY, should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013.We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains.Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%. The median overall OOPE was $39 (Rs 2567 in the non-beneficiaries group as compared to $11 (Rs 713 in the beneficiaries group (p<0.01. Median expenditure on in house and out house drugs and consumables was $23 (Rs 1500 in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01. Non-beneficiary status was significantly associated [OR: 2.4 (1.3-4.3] with OOPE above median independently and also after adjusting for various covariates.RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility.

  3. Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013

    Science.gov (United States)

    Gupt, Anadi; Kaur, Prabhdeep; Kamraj, P.; Murthy, B. N.

    2016-01-01

    Introduction Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY), should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE) for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL) families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013. Methods We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains. Results Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%). The median overall OOPE was $39 (Rs 2567) in the non-beneficiaries group as compared to $ 11 (Rs 713) in the beneficiaries group (p<0.01). Median expenditure on in house and out house drugs and consumables was $ 23 (Rs 1500) in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01). Non-beneficiary status was significantly associated [OR: 2.4 (1.3–4.3)] with OOPE above median independently and also after adjusting for various covariates. Conclusion RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility. PMID:26895419

  4. How do Expenditure Rules affect Fiscal Behaviour?

    OpenAIRE

    Peter Wierts

    2008-01-01

    This paper investigates the role of self-enforced national expenditure rules in limiting the expenditure bias and procyclical expenditure increases/decreases due to revenue windfalls/shortfalls. A simple model predicts that expenditure rules can have the intended effects, but only if the political and institutional costs of non compliance are sufficiently large. Empirical estimations provide some support that expenditure rules affect expenditure outcomes in the hypothesised manner, especially...

  5. 42 CFR 436.1004 - FFP in expenditures for medical assistance for individuals who have declared United States...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false FFP in expenditures for medical assistance for... Financial Participation (FFP) Ffp for Expenditures for Determining Eligibility and Providing Services § 436.1004 FFP in expenditures for medical assistance for individuals who have declared United...

  6. 42 CFR 457.622 - Rate of FFP for State expenditures.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Rate of FFP for State expenditures. 457.622 Section... Payments to States § 457.622 Rate of FFP for State expenditures. (a) Basis. Sections 1905(b), 2105(a) and... child health assistance plan. In general, FFP for administration under title XXI is not available...

  7. Catastrophes in Scale-Free Networks

    Institute of Scientific and Technical Information of China (English)

    ZHOU Tao; WANG Bing-Hong

    2005-01-01

    @@ An alternative model about cascading occurrences caused by perturbation is established to search the mechanism because catastrophes in networks occur. We investigate the avalanche dynamics of our model on two-dimensional Euclidean lattices and scale-free networks and find that the avalanche dynamic behaviour is sensitive to the topological structure of networks. The simulation results show that the catastrophes occur much more frequently in scale-free networks than those in Euclidean lattices, and the greatest catastrophe in scale-free networks is much more serious than that in Euclidean lattices. Furthermore, we have studied how to reduce the catastrophes'degree, and have schemed out an effective strategy, called the targeted safeguard strategy for scale-free networks.

  8. Catastrophic event modeling. [lithium thionyl chloride batteries

    Science.gov (United States)

    Frank, H. A.

    1981-01-01

    A mathematical model for the catastrophic failures (venting or explosion of the cell) in lithium thionyl chloride batteries is presented. The phenomenology of the various processes leading to cell failure is reviewed.

  9. Insuring catastrophes and the role of governments

    Directory of Open Access Journals (Sweden)

    M. M. Boyer

    2013-08-01

    Full Text Available In this paper we model the cost of providing insurance coverage against natural and man-made hazards. We propose an insurance market model that explains (1 the use of reinsurance to help finance the cost of catastrophic events and (2 the implicit (or explicit presence of government entities acting as (reinsurers of last resort. Using an economic model, we show how insurance programmes should be designed to cover the losses due to a possible catastrophic natural hazard. Our results show that the optimal structure of a reinsurance programme minimizes the cost of offering insurance protection. We also show how government intervention can reduce the cost of insurance against natural catastrophes and increase policyholders' welfare. Our paper therefore offers public policy implications as to the role and presence of government as an insurer of last resort and the minimum insurance premium necessary to cover the cost of catastrophic events.

  10. Valuing Catastrophe Bonds Involving Credit Risks

    OpenAIRE

    Jian Liu; Jihong Xiao; Lizhao Yan; Fenghua Wen

    2014-01-01

    Catastrophe bonds are the most important products in catastrophe risk securitization market. For the operating mechanism, CAT bonds may have a credit risk, so in this paper we consider the influence of the credit risk on CAT bonds pricing that is different from the other literature. We employ the Jarrow and Turnbull method to model the credit risks and get access to the general pricing formula using the Extreme Value Theory. Furthermore, we present an empirical pricing study of the Property C...

  11. The Economic and Policy Consequences of Catastrophes

    OpenAIRE

    Robert S. Pindyck; Neng Wang

    2013-01-01

    How likely is a catastrophic event that would substantially reduce the capital stock, GDP, and wealth? How much should society be willing to pay to reduce the probability or impact of a catastrophe? We answer these questions and provide a framework for policy analysis using a general equilibrium model of production, capital accumulation, and household preferences. Calibrating the model to economic and financial data, we estimate the mean arrival rate of shocks and their size distribution, the...

  12. Catastrophic avalanches and methods of their control

    Directory of Open Access Journals (Sweden)

    N. A. Volodicheva

    2014-01-01

    Full Text Available Definition of such phenomenon as “catastrophic avalanche” is presented in this arti-cle. Several situations with releases of catastrophic avalanches in mountains of Caucasus, Alps, and Central Asia are investigated. Materials of snow-avalanche ob-servations performed since 1960s at the Elbrus station of the Lomonosov Moscow State University (Central Caucasus were used for this work. Complex-valued measures of engineering protection demonstrating different efficiencies are consid-ered.

  13. Mindfulness, acceptance and catastrophizing in chronic pain.

    Directory of Open Access Journals (Sweden)

    Maaike J de Boer

    Full Text Available OBJECTIVES: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain. METHODS: A cross-sectional survey was conducted, including 87 chronic pain patients from an academic outpatient pain center. RESULTS: The results show that general psychological acceptance (measured with the AAQ-II is a strong predictor of pain-related catastrophizing, independent of gender, age and pain intensity. Mindfulness (measured with the MAAS did not predict levels of pain-related catastrophizing. DISCUSSION: Acceptance of psychological experiences outside of pain itself is related to catastrophizing. Thus, acceptance seems to play a role in the pain experience and should be part of the treatment of chronic pain. The focus of the ACT treatment of chronic pain does not necessarily have to be on acceptance of pain per se, but may be aimed at acceptance of unwanted experiences in general. Mindfulness in the sense of "acting with awareness" is however not related to catastrophizing. Based on our research findings in comparisons with those of other authors, we recommend a broader conceptualization of mindfulness and the use of a multifaceted questionnaire for mindfulness instead of the unidimensional MAAS.

  14. The association between age and mortality related hospital expenditures: Evidence from a complete national registry

    Directory of Open Access Journals (Sweden)

    Fredrik Alexander Gregersen

    2014-01-01

    Full Text Available The aim of this paper is to contribute to the debate on population aging and growth in health expenditures, by providing precise estimates on how mortality related expenditures are influenced by age. Using a complete register of inpatient hospital admissions to create gender-cohort specific panels for each of the 430 Norwegian municipalities, we are able to identify mortality related hospital expenditures by separating the impact of mortality on current hospital expenditures from the impact of patients’ age and gender. We apply model estimates to quantify the mortality-related hospital expenditures for twenty age groups. The results suggest that mortality-related hospital expenditures are a decreasing function of age. Furthermore, the results clearly suggest that, both age and mortalities should be included when predicting future health care expenditures. The estimation results suggest that 9.2 % of all hospital expenditures is associated with treating individuals in their last year of life. Our results also suggest that the reduction in mortality rates in the period from 1998 to 2009 have, cet. par. contributed to an estimated reduction in total hospital expenditures of 0.6 billion NOK, a difference corresponding to 2 % of the expenditures in 2009. (The appendix can be found under "Supplementary Files" in the menu to the right

  15. Gasto de hogares durante la hospitalización de menores derechohabientes, con diagnóstico de leucemia, en dos hospitales en México Out-of-pocket expenditures during hospitalization of young leukemia patients with state medical insurance in two Mexican hospitals

    Directory of Open Access Journals (Sweden)

    Arnoldo Rocha-García

    2003-08-01

    Full Text Available OBJETIVO: Estimar el gasto de los hogares durante la primera hospitalización en 51 menores de 15 años de edad con leucemia, atendidos en dos hospitales del Instituto Mexicano del Seguro Social, en México durante 1997. MATERIAL Y MÉTODOS: Estudio transversal hecho en 1997 en el Distrito Federal y en León, Guanajuato. Se aplicó un cuestionario a los padres de 51 menores de 15 años de edad con diagnóstico de leucemia, hospitalizados por primera vez, en dos unidades del Instituto Mexicano del Seguro Social. Se capturó la información de los costos directos e indirectos enfrentados por los hogares durante esa primera hospitalización. Se aplicó el Indice de Precios al Consumidor (1997-2002 para expresar las estimaciones en precios de 2002. Se estimaron indicadores de gasto promedio y gastos catastróficos. Se establecieron los factores asociados, mediante un modelo de regresión lineal, utilizando el gasto total durante la hospitalización como variable dependiente. RESULTADOS: El costo promedio por paciente hospitalizado es de 7 318 pesos. El 86% corresponde a gastos asociados con la atención y 14% a costos indirectos. Para 14% de los hogares este gasto fue catastrófico. En 47% de los casos la erogación rebasó 100% de su ingreso disponible durante el periodo. Estos gastos se asociaron con lugar de residencia, nivel de ingreso y tipo de seguro. CONCLUSIONES: Ser derechohabiente de la seguridad social reduce los gastos de bolsillo por atención directa de los pacientes, pero no reduce los gastos complementarios, que pueden resultar onerosos para una elevada proporción de hogares. El costo de la primera hospitalización significó, en más de la mitad de los casos estudiados, el consumo de los ahorros, el endeudamiento o la venta de propiedades de los hogares, y dificultó la continuidad del tratamiento.OBJECTIVE: To estimate out-of-pocket expenditures for health care during the first hospitalization of children treated for leukemia in

  16. Coverage and Financial Risk Protection for Institutional Delivery: How Universal Is Provision of Maternal Health Care in India?

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    Full Text Available India aims to achieve universal access to institutional delivery. We undertook this study to estimate the universality of institutional delivery care for pregnant women in Haryana state in India. To assess the coverage of institutional delivery, we analyze service coverage (coverage of public sector institutional delivery, population coverage (coverage among different districts and wealth quintiles of the population and financial risk protection (catastrophic health expenditure and impoverishment as a result of out-of-pocket expenditure for delivery.We analyzed cross-sectional data collected from a randomly selected sample of 12,191 women who had delivered a child in the last one year from the date of data collection in Haryana state. Five indicators were calculated to evaluate coverage and financial risk protection for institutional delivery--proportion of public sector deliveries, out-of-pocket expenditure, percentage of women who incurred no expenses, prevalence of catastrophic expenditure for institutional delivery and incidence of impoverishment due to out-of-pocket expenditure for delivery. These indicators were calculated for the public and private sectors for 5 wealth quintiles and 21 districts of the state.The coverage of institutional delivery in Haryana state was 82%, of which 65% took place in public sector facilities. Approximately 63% of the women reported no expenditure on delivery in the public sector. The mean out-of-pocket expenditures for delivery in the public and private sectors in Haryana were INR 771 (USD 14.2 and INR 12,479 (USD 229, respectively, which were catastrophic for 1.6% and 22% of households, respectively.Our findings suggest that there is considerably high coverage of institutional delivery care in Haryana state, with significant financial risk protection in the public sector. However, coverage and financial risk protection for institutional delivery vary substantially across districts and among different socio

  17. Tax Expenditures: A Theoretical Review

    Directory of Open Access Journals (Sweden)

    Vjekoslav Bratić

    2006-06-01

    Full Text Available Tax expenditures are an instrument frequently used when a government wishes to achieve certain economic and social effects. But because of the increasing number and scope of tax expenditures, their proper use, quality of administration and record-keeping have become a major challenge for the tax authorities and the whole of the government. The article considers and explains very diverse forms of tax expenditure such as reliefs, tax deductions, tax allowances, tax exceptions and special rates of taxation and the ways in which they are defined and calculated. The key problems in the analysis are the absence of a single definition and of methodology for the calculations; these ultimately make it impossible to compare tax expenditures between or among countries.

  18. Public expenditure planning in Albania

    OpenAIRE

    Bogdani, Irena Dh.

    2002-01-01

    This paper looks at public expenditure planning in Albania, presenting and analysing the first two post-communist era Medium-Term Expenditure Plans (METPs) that have been introduced by the Albanian government for the periods 2000-2001 and 2002-2004, respectively. Albania's medium-term macroeconomic perspectives and elements of fiscal decentralisation, as incorporated by the Local Government Law of Albania, are presented, too. It is found that, taking into account the first years of post-commu...

  19. Redistributive Taxation and Public Expenditures

    OpenAIRE

    Bandyopadhyay, Sanghamitra; Esteban, Joan

    2007-01-01

    We introduce a model of redistributive income taxation and public expenditure. Besides redistributing personal income by means of taxes and transfers, the government supplies goods and services. The government chooses the tax schedule that is found acceptable by the largest share possible of the population. We show that there is a unique income tax schedule that is universally acceptable. The progressivity of the income tax is shown to depend on the composition of the public expenditure and o...

  20. Drug Expenditure Trends in the Canadian Provinces: Magnitude and Causes from 1998 to 2004

    OpenAIRE

    Morgan, Steve

    2005-01-01

    This analysis uses a consistent pan-Canadian dataset – Canadian CompuScript from IMS Health, Canada – to quantify trends in per capita drug expenditures within each Canadian province over the period of 1998 to 2004. The impacts of changes in six potential determinants of drug expenditure are calculated for every province. Each of the six detailed cost drivers falls into one of three broad categories: volume effects, price effects and therapeutic choices. Despite wide variation in expenditure ...

  1. Research on catastrophe control in 1-D system

    Institute of Scientific and Technical Information of China (English)

    SUN Yao; TANG Li-ping; LI Xue-lian

    2003-01-01

    A new method of catastrophe control is described in one dimension nonlinear system. Catastrophe control based on catastrophe theory is a brand new area for control theory. A certain catastrophe is created at a desired location by appropriate control, which has preferred properties. Washout filter is presented and applied to preserve the original equilibrium of a system. Washout filter aided dynamic feedback controller is developed for the creation of catastrophe, and an example is given to illustrate the process. Catastrophe control may provide a new way of designing warning signals of impending collapse or catastrophe for monitoring and control purposes.

  2. Pricing for Catastrophe Bonds Based on Expected-value Model

    Directory of Open Access Journals (Sweden)

    Junfei Chen

    2013-02-01

    Full Text Available As the catastrophes cannot be avoided and result in huge economic losses, therefore the compensation issue for catastrophe losses become an important research topic. Catastrophe bonds can effectively disperse the catastrophe risks which mainly undertaken by the government and the insurance companies currently and focus on capital more effectively in broad capital market, therefore to be an ideal catastrophe securities product. This study adopts Expectancy Theory to supplement and improve the pricing of catastrophe bonds based on Value Theory. A model of expected utility is established to determine the conditions of the expected revenue R of catastrophe bonds. The pricing model of the value function is used to get the psychological value of R,U (R-R‾, for catastrophe bonds. Finally, the psychological value is improved by the value according to expected utility and this can more accurately evaluate catastrophe bonds at a reasonable price. This research can provide decision-making for the pricing of catastrophe bonds.

  3. Downward Catastrophe of Solar Magnetic Flux Ropes

    Science.gov (United States)

    Zhang, Quanhao; Wang, Yuming; Hu, Youqiu; Liu, Rui

    2016-07-01

    2.5-dimensional time-dependent ideal magnetohydrodynamic (MHD) models in Cartesian coordinates were used in previous studies to seek MHD equilibria involving a magnetic flux rope embedded in a bipolar, partially open background field. As demonstrated by these studies, the equilibrium solutions of the system are separated into two branches: the flux rope sticks to the photosphere for solutions at the lower branch but is suspended in the corona for those at the upper branch. Moreover, a solution originally at the lower branch jumps to the upper, as the related control parameter increases and reaches a critical value, and the associated jump is here referred to as an upward catastrophe. The present paper advances these studies in three aspects. First, the magnetic field is changed to be force-free; the system still experiences an upward catastrophe with an increase in each control parameter. Second, under the force-free approximation, there also exists a downward catastrophe, characterized by the jump of a solution from the upper branch to the lower. Both catastrophes are irreversible processes connecting the two branches of equilibrium solutions so as to form a cycle. Finally, the magnetic energy in the numerical domain is calculated. It is found that there exists a magnetic energy release for both catastrophes. The Ampère's force, which vanishes everywhere for force-free fields, appears only during the catastrophes and does positive work, which serves as a major mechanism for the energy release. The implications of the downward catastrophe and its relevance to solar activities are briefly discussed.

  4. Equity in health care financing in Portugal: findings from the Household Budget Survey 2010/2011.

    Science.gov (United States)

    Quintal, Carlota; Lopes, José

    2016-07-01

    Equity in health care financing is recognised as a main goal in health policy. It implies that payments should be linked to capacity to pay and that households should be protected against catastrophic health expenditure (CHE). The risk of CHE is inversely related to the share of out-of-pocket payments (OOP) in total health expenditure. In Portugal, OOP represented 26% of total health expenditure in 2010 [one of the highest among Organisation for Economic Co-operation and Development (OECD) countries]. This study aims to identify the proportion of households with CHE in Portugal and the household factors associated with this outcome. Additionally, progressivity indices are calculated for OOP and private health insurance. Data were taken from the Portuguese Household Budget Survey 2010/2011. The prevalence of CHE is 2.1%, which is high for a developed country with a universal National Health Service. The main factor associated with CHE is the presence of at least one elderly person in households (when the risk quadruples). Payments are particularly regressive for medicines. Regarding the results by regions, the Kakwani index for total OOP is larger (negative) for the Centre and lower, not significant, for the Azores. Payments for voluntary health insurance are progressive.

  5. Expenditure Composition in Indian State Governments

    OpenAIRE

    M. Seenuvasan

    2005-01-01

    The study of Expenditure Composition on scientific basis helps us to understand the relative importance, quality, effects and nature of various kinds of expenditure. The study of expenditure composition at the disaggregative level would be of useful to policy makers to examine and evaluate the effects and efficiency of allocation of fiscal resources on desirable directions. Prof Shiras said that the test of public expenditure is not the aggregate expenditure, but it is the pattern of expendit...

  6. The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts

    Directory of Open Access Journals (Sweden)

    Wang Hong

    2011-01-01

    Full Text Available Abstract Background One of the key functions of health insurance is to provide financial protection against high costs of health care, yet evidence of such protection from developing countries has been inconsistent. The current study uses the case of Ghana to contribute to the evidence pool about insurance's financial protection effects. It evaluates the impact of the country's National Health Insurance Scheme on households' out-of-pocket spending and catastrophic health expenditure. Methods We use data from a household survey conducted in two rural districts, Nkoranza and Offinso, in 2007, two years after the initiation of the Ghana National Health Insurance Scheme. To address the skewness of health expenditure data, the absolute amount of out-of-pocket spending is estimated using a two-part model. We also conduct a probit estimate of the likelihood of catastrophic health expenditures, defined at different thresholds relative to household income and non-food consumption expenditure. The analysis controls for chronic and self-assessed health conditions, which typically drive adverse selection in insurance. Results At the time of the survey, insurance coverage was 35 percent. Although the benefit package of insurance is generous, insured people still incurred out-of-pocket payment for care from informal sources and for uncovered drugs and tests at health facilities. Nevertheless, they paid significantly less than the uninsured. Insurance has been shown to have a protective effect against the financial burden of health care, reducing significantly the likelihood of incurring catastrophic payment. The effect is particularly remarkable among the poorest quintile of the sample. Conclusions Findings from this study confirm the positive financial protection effect of health insurance in Ghana. The effect is stronger among the poor group than among general population. The results are encouraging for many low income countries who are considering a

  7. Evolutionary Catastrophes and the Goldilocks Problem

    CERN Document Server

    Cirkovic, Milan M

    2007-01-01

    One of the mainstays of the controversial "rare Earth" hypothesis is the "Goldilocks problem" regarding various parameters describing a habitable planet, partially involving the role of mass extinctions and other catastrophic processes in biological evolution. Usually, this is construed as support for the uniqueness of the Earth's biosphere and intelligent human life. Here I argue that this is a misconstrual and that, on the contrary, observation-selection effects, when applied to catastrophic processes, make it very difficult for us to discern whether the terrestrial biosphere and evolutionary processes which created it are exceptional in the Milky Way or not. In particular, an anthropic overconfidence bias related to the temporal asymmetry of evolutionary processes appears when we try to straightforwardly estimate catastrophic risks from the past records on Earth. This agnosticism, in turn, supports the validity and significance of practical astrobiological and SETI research.

  8. On a new global catastrophic ICT model

    DEFF Research Database (Denmark)

    Riaz, M. Tahir; Bhalerao, Dipashree M.; Madsen, Ole Brun;

    2011-01-01

    Many parts of India are prone to natural disasters, particularly caused by earthquakes and floods because of its geographical location. The Catastrophic areas can be rural, remote or urban anywhere in the world. It has been understood that earthquakes directly do not cause causalities but instead...... of the world's population suffers from affordable ICT solutions and the presence of sufficient ICT infrastructure. The main goal of this paper is to create a framework to define catastrophic areas from an ICT point of view. QOS features like packet loss rate, delay, throughput and delivery ratio for 50 nodes...... coverage before and after calamities. This definition of catastrophic area from ICT point of view has no one tried before. Network parameters behavioural graphs are also important. This paper presents only behavioural part....

  9. Valuing Catastrophe Bonds Involving Credit Risks

    Directory of Open Access Journals (Sweden)

    Jian Liu

    2014-01-01

    Full Text Available Catastrophe bonds are the most important products in catastrophe risk securitization market. For the operating mechanism, CAT bonds may have a credit risk, so in this paper we consider the influence of the credit risk on CAT bonds pricing that is different from the other literature. We employ the Jarrow and Turnbull method to model the credit risks and get access to the general pricing formula using the Extreme Value Theory. Furthermore, we present an empirical pricing study of the Property Claim Services data, where the parameters in the loss function distribution are estimated by the MLE method and the default probabilities are deduced by the US financial market data. Then we get the catastrophe bonds value by the Monte Carlo method.

  10. Mindfulness, Acceptance and Catastrophizing in Chronic Pain

    NARCIS (Netherlands)

    de Boer, Maaike J.; Steinhagen, Hannemike E.; Versteegen, Gerbrig J.; Struys, Michel M. R. F.; Sanderman, Robbert

    2014-01-01

    Objectives: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT) suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to exami

  11. Novel percolation transitions and coupled catastrophes

    Science.gov (United States)

    D'Souza, Raissa

    Collections of interdependent networks are at the core of modern society, spanning physical, biological and social systems. Simple mathematical models of the structure and function of networks can provide important insights into real-world systems, enhancing our ability to steer and control them. Here our focus is on abrupt changes in networks, due both to phase transitions and to jumping between bi-stable equilibria. We begin with an overview of novel classes of percolation phase transitions that result from repeated, small interventions intended to delay the transition. These new phenomena allow us to extend percolation approaches to modular networks, Brownian motion, and cluster growth dynamics. We then focus on abrupt transitions due to a system jumping between bi-stable equilibria, modeled as a cusp catastrophe in nonlinear dynamics. We show that when systems that each undergo a cusp catastrophe interact, we can observe a new phenomena of catastrophe-hopping leading to non-local cascading failures. Here an intermediate system facilitates the propagation of a sudden change or collapse, and we show that catastrophe hopping is consistent with the outbreak of protests observed during the Arab Spring of 2011.

  12. The Pain Catastrophizing Scale: Development and Validation.

    Science.gov (United States)

    Sullivan, Michael J. L.; And Others

    1995-01-01

    A series of 4 studies involving 547 college students and community adults report the development of the Pain Catastrophizing Scale, its validity with clinical and nonclinical samples, and its correlation with measures of related constructs. The scale provides information about heightened responses to aversive procedures or events. (SLD)

  13. 78 FR 52832 - Catastrophic Risk Protection Endorsement

    Science.gov (United States)

    2013-08-27

    .... See the Notice related to 7 CFR part 3015, subpart V, published at 48 FR 29115, June 24, 1983... the Federal Register at 76 FR 50929-50931. The public was afforded 60 days to submit written comments... Federal Crop Insurance Corporation 7 CFR Part 402 RIN 0563-AC31 Catastrophic Risk Protection...

  14. Understanding the “Cash-Less” Nature of Government-Sponsored Health Insurance Schemes

    Directory of Open Access Journals (Sweden)

    Priyanka Rent

    2015-11-01

    Full Text Available The public health spending in India has been hovering around 1% of gross domestic product (GDP, and it contributes only 28% of total health expenditure. Hence, out-of-pocket (OOP payments continue to be the dominant source of health care financing in India. However, for providing protection from the economic effects of health shocks, last few years have seen a plethora of central and state government–sponsored private health insurance schemes for the deprived groups, particularly those working in the unorganized sector. The latest is the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY, launched by the Government of Maharashtra in 2012. This study is an attempt to assess the extent to which RGJAY protects the families from making OOP expenditure while availing the tertiary care from the RGJAY accredited facilities. Both primary and secondary data were utilized for this study. Despite being enrolled in RGJAY, more than three fifths (63% of the beneficiaries still incurred OOP payments for services when admitted in the hospital, and more worryingly, it was found that a significantly higher proportion of persons from Below Poverty Line (BPL families (88.23% reported paying for diagnostics, medications, or consumables. Furthermore, our study found that about a third of the beneficiaries experienced financial catastrophe if indirect expenditure is taken into consideration. This also implies that for the poor, ill-health has further deepened the existing poverty.

  15. Greek's health, waiting for the 'deus ex machina'.

    Science.gov (United States)

    Fanourgiakis, John; Kanoupakis, Emmanuel

    2014-10-01

    Greece from May 2010 has been following Troika's (European Commission, European Central Bank and International Monetary Fund) austere policies in all over the public finance sector. Troika's instructions which are adopted by the politicians resulted to depressed and weak citizens. The consequences in health care sector are becoming visible across the society. A big part of Greek's society is uninsured without any access to public health care system. The vulnerable social groups confront catastrophic health care expenditures and impoverishment with no social net protection. Greeks are paying the price of their irrational way of living. The current paper has gathered from the literature the early effects of the implementation of these policies on public health and healthcare. PMID:24902711

  16. 45 CFR 263.2 - What kinds of State expenditures count toward meeting a State's basic MOE expenditure requirement?

    Science.gov (United States)

    2010-10-01

    ... AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES EXPENDITURES OF STATE AND FEDERAL TANF FUNDS... separate State programs may count if they are made for the following types of benefits or services: (1...) of the Act including: (i) Nonmedical treatment services for alcohol and drug abuse and some...

  17. 78 FR 54796 - Research Expenditures

    Science.gov (United States)

    2013-09-06

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BE64 Research Expenditures AGENCY: Internal Revenue Service... section 174 of the Internal Revenue Code (Code). In particular, these proposed regulations provide... property, including pilot models. The regulations will affect taxpayers engaged in research...

  18. Chernobyl catastrophe: Information for people living in the contaminated areas

    International Nuclear Information System (INIS)

    The radioactive blow-outs after the Chernobyl Nuclear Power Plant catastrophe reached many states. The largest amount of them (according to experts' estimations - 70%) fell out on the Belarus territory. The estimation of radioecological, medico-biological, economic and social consequences of the Chernobyl catastrophe has shown that unimaginable damage was incurred on Belarus and its territory became the zone of ecological calamity. More than 14 years have passed since the Chernobyl NPP accident but some of the problems caused by the catastrophe have not been solved. This is bound up, first of all, with a high collective dosage absorbed by the population, with difficulties in forecasting and prophylactics of remote radiological effects, with ecological and economic crisis. The consequences of the disaster greatly affect all the aspects of vital activities of the affected regions and the state as a whole. Destructive tendencies have been revealed in all spheres of the life activity of people who experienced radiation effects. The processes of social adaptation and socio-psychological support of the population inhabiting the contaminated territory and resettled as well, require considerable optimisation. Negative factors of the Chernobyl catastrophe, which are significant for human health can be divided into two groups as follows: radiation-based, directly related to influence of ionising radiation and non radiation based, related to changes in habitat and prolonged psychological stress. The specific peculiarities of psychogenic disorders caused by the catastrophe are determined by the following reasons: insufficient knowledge of radiation effects; constant apprehension for the health and well-being of themselves and their families, especially children; unexpected change of the life stereotype (forced resettlement, the break of the former life, changing the place and the character of work, etc.); the necessity of constant keeping precaution measures and prophylactic

  19. Pollution Abatement and Control Expenditures Survey (PACE)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Pollution Abatement Costs and Expenditures (PACE) survey is the most comprehensive national source of pollution abatement costs and expenditures related to...

  20. The impact of public expenditure on undernourishment distribution in Mexico.

    Science.gov (United States)

    Moreno-Macías, Lidia; Palma-Solís, Marco; Zapata-Vázquez, Rita E

    2013-09-01

    The status of undernourishment in children under the age of five in Mexico is open to debate. Linked to poverty, underweight and stunting, the rates of undernourishment are reported to be diminishing, although poverty remains an incessant problem. This study was done to determine whether there is an association between public expenditure and underweight and stunting distribution in Mexico based on data from the 2006 health and population census and from macroeconomic, social, and demographic variables. We used principal component analysis to reduce the number of variables and analyze their behavior. Multiple regressions showed that underweight and stunting are significantly associated with the marginalization index, support from the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) supplies and breakfast program, the gross domestic product per capita, and expenditure from the Opportunities program. Further, public expenditure aimed to combat undernourishment is inadequately oriented to address the needs of the poor.

  1. Government consumption expenditures and the current account

    OpenAIRE

    Michele Cavallo

    2005-01-01

    This paper distinguishes between two components of government consumption, expenditure on final goods and expenditure on hours, and compares the effects of changes in these two on the current account. I find that changes in government expenditure on hours do not directly affect the current account and that their impact is considerably smaller than the impact produced by changes in government expenditure on final goods. These findings indicate that considering government consumption as entirel...

  2. Determinants of military expenditure in Zimbabwe

    OpenAIRE

    Zachary Tambudzai

    2011-01-01

    While many articles have been written on the determinants of military expenditure in developing countries, few have attempted to use a qualitative approach to investigate the underlying motives for military expenditure. This article uses data drawn from interviews with key informants and documentary sources to study the determinants of military expenditure in Zimbabwe. Findings suggest that Zimbabwe’s military expenditure since 1980 has been influenced more by internal political dynamics than...

  3. 76 FR 50887 - Elections Regarding Start-Up Expenditures, Corporation Organizational Expenditures, and...

    Science.gov (United States)

    2011-08-17

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BE77 Elections Regarding Start-Up Expenditures, Corporation... final regulations relating to elections to deduct start-up expenditures, organizational expenditures of... the lesser of (1) the amount of the start-up expenditures that relate to the active trade or...

  4. CATASTROPHE FRACTURE OF THIN-WALL PRESSURE TUBES

    Institute of Scientific and Technical Information of China (English)

    魏德敏; 杨桂通

    2002-01-01

    Catastrophe theory was used to investigate the fracture behavior of thin-wall cylindrical tubes subjected to nternal explosive pressure. Based on the energy theory and catastrophe theory, a cusp catastrophe model for the fracture was established, and a critical condition associated with the model is given.

  5. Personality and temperament correlates of pain catastrophizing in young adolescents

    NARCIS (Netherlands)

    P.E.H.M. Muris (Peter); C.M.G. Meesters (Cor); M.F.C.M. Van Den Hout (Mari F. C. M.); S. Wessels (Sylvia); I.H.A. Franken (Ingmar); E.G.C. Rassin (Eric)

    2007-01-01

    textabstractPain catastrophizing is generally viewed as an important cognitive factor underlying chronic pain. The present study examined personality and temperament correlates of pain catastrophizing in a sample of young adolescents (N = 132). Participants completed the Pain Catastrophizing Scale f

  6. Industrial arsenic contamination causes catastrophic changes in freshwater ecosystems

    Science.gov (United States)

    Chen, Guangjie; Shi, Haibin; Tao, Jianshuang; Chen, Li; Liu, Yuanyuan; Lei, Guoliang; Liu, Xiaohai; Smol, John P.

    2015-11-01

    Heavy metal pollution is now widely recognized to pose severe health and environmental threats, yet much of what is known concerning its adverse impacts on ecosystem health is derived from short-term ecotoxicological studies. Due to the frequent absence of long-term monitoring data, little is known of the long-tem ecological consequences of pollutants such as arsenic. Here, our dated sediment records from two contaminated lakes in China faithfully document a 13.9 and 21.4-fold increase of total arsenic relative to pre-1950 background levels. Concurrently, coherent responses in keystone biota signal pronounced ecosystem changes, with a >10-fold loss in crustacean zooplankton (important herbivores in the food webs of these lake systems) and a >5-fold increase in a highly metal-tolerant alga. Such fundamental ecological changes will cascade through the ecosystem, causing potentially catastrophic consequences for ecosystem services in contaminated regions.

  7. On the governance of global and catastrophic risks

    DEFF Research Database (Denmark)

    Faber, Michael Havbro

    2011-01-01

    The focus of the present paper regards the identification and treatment of critical issues in the process of societal decision making concerning management of global and catastrophic risks. Taking basis in recent works by the author, the paper in particular addresses: 1) Which are the most relevant...... hazards in a holistic global perspective and how may these be categorised in view of strategies for their treatment?; 2) How might robust societal decisions on risk management subject to large uncertainties be formally supported?; 3) How may available economic resources be prioritised for the purpose...... of sustainable and global life safety and health improvements? Finally, new results and perspectives are presented on the issue of allocation of resources for the purpose of improving global public health and a discussion on global risk governance concludes the paper....

  8. Copula bivariate probit models: with an application to medical expenditures

    OpenAIRE

    Winkelmann, Rainer

    2011-01-01

    The bivariate probit model is frequently used for estimating the eff*ect of an endogenous binary regressor (the "treatment") on a binary health outcome variable. This paper discusses simple modifi*cations that maintain the probit assumption for the marginal distributions while introducing non-normal dependence using copulas. In an application of the copula bivariate probit model to the effect of insurance status on the absence of ambulatory health care expenditure, a model based on the Frank ...

  9. Expenditure policy in Angola : impact on economic development and inequality

    OpenAIRE

    Delgado, Albertina da Rosa

    2013-01-01

    Government Expenditure (GE) is an instrument by which the State distributes resources with efficiency and responsibility. Several studies have analysed the relationship between GE and economic growth, as well as the relationship between inequality and GE by region. Studies in Africa have found a positive relationship between education and health spending with respect to economic growth, which means that the greater public investment in education and health, the greater the economic growth. ...

  10. Managed Care and Medical Expenditures of Medicare Beneficiaries

    OpenAIRE

    Michael Chernew; Philip DeCicca; Robert Town

    2008-01-01

    This paper investigates the impact of Medicare HMO penetration on the medical care expenditures incurred by Medicare fee-for-service enrollees. We find that increasing penetration leads to reduced health care spending on fee-for-service beneficiaries. In particular, a one percentage point increase in Medicare HMO penetration reduces such spending by .9 percent. We estimate similar models for various measures of health care utilization and find penetration-induced reductions, consistent with o...

  11. Financial protection from health spending in the Philippines: policies and progress.

    Science.gov (United States)

    Bredenkamp, Caryn; Buisman, Leander R

    2016-09-01

    The objective of this article is to assess the progress of the Philippines health sector in providing financial protection to the population, as measured by estimates of health insurance coverage, out-of-pocket spending, catastrophic payments and impoverishing health expenditures. Data are drawn from eight household surveys between 2000 and 2013, including two Demographic and Health Surveys, one Family Health Survey and five Family Income and Expenditure Surveys. We find that out-of-pocket spending increased by 150% (real) from 2000 to 2012, with the sharpest increases occurring in recent years. The main driver of health spending is medicines, accounting for almost two-thirds of total health spending, and as much as three-quarters among the poor. The incidence of catastrophic payments has tripled since 2000, from 2.5% to 7.7%. The percentage of people impoverished by health spending has also increased and, in 2012, out-of-pocket spending on health added 1.5 percentage points to the poverty rate, pushing more than 1.5 million people into poverty. In light of these findings, recent policies to enhance financial risk protection-such as the expansion of government-subsidized health insurance from the poor to the near-poor, a policy of zero copayments for the poor, a deepening of the benefit package and provider payment reform aimed at cost-containment-are to be commended. Indeed, between 2008 and 2013, self-reported health insurance coverage increased across all quintiles and its distribution became more pro-poor. To speed progress toward financial protection goals, quick wins could include issuing health insurance cards to the poor to increase awareness of coverage and limiting out-of-pocket spending by clearly defining a clear copayment structure for non-poor members. An in-depth analysis of the pharmaceutical sector would help to shed light on why medicines impose such a large financial burden on households. PMID:27072948

  12. Financial protection from health spending in the Philippines: policies and progress.

    Science.gov (United States)

    Bredenkamp, Caryn; Buisman, Leander R

    2016-09-01

    The objective of this article is to assess the progress of the Philippines health sector in providing financial protection to the population, as measured by estimates of health insurance coverage, out-of-pocket spending, catastrophic payments and impoverishing health expenditures. Data are drawn from eight household surveys between 2000 and 2013, including two Demographic and Health Surveys, one Family Health Survey and five Family Income and Expenditure Surveys. We find that out-of-pocket spending increased by 150% (real) from 2000 to 2012, with the sharpest increases occurring in recent years. The main driver of health spending is medicines, accounting for almost two-thirds of total health spending, and as much as three-quarters among the poor. The incidence of catastrophic payments has tripled since 2000, from 2.5% to 7.7%. The percentage of people impoverished by health spending has also increased and, in 2012, out-of-pocket spending on health added 1.5 percentage points to the poverty rate, pushing more than 1.5 million people into poverty. In light of these findings, recent policies to enhance financial risk protection-such as the expansion of government-subsidized health insurance from the poor to the near-poor, a policy of zero copayments for the poor, a deepening of the benefit package and provider payment reform aimed at cost-containment-are to be commended. Indeed, between 2008 and 2013, self-reported health insurance coverage increased across all quintiles and its distribution became more pro-poor. To speed progress toward financial protection goals, quick wins could include issuing health insurance cards to the poor to increase awareness of coverage and limiting out-of-pocket spending by clearly defining a clear copayment structure for non-poor members. An in-depth analysis of the pharmaceutical sector would help to shed light on why medicines impose such a large financial burden on households.

  13. Parkinson’s Disease and Home Healthcare Use and Expenditures among Elderly Medicare Beneficiaries

    Directory of Open Access Journals (Sweden)

    Sandipan Bhattacharjee

    2015-01-01

    Full Text Available This study estimated excess home healthcare use and expenditures among elderly Medicare beneficiaries (age ≥ 65 years with Parkinson’s disease (PD compared to those without PD and analyzed the extent to which predisposing, enabling, need factors, personal health choice, and external environment contribute to the excess home healthcare use and expenditures among individuals with PD. A retrospective, observational, cohort study design using Medicare 5% sample claims for years 2006-2007 was used for this study. Logistic regressions and Ordinary Least Squares regressions were used to assess the association of PD with home health use and expenditures, respectively. Postregression nonlinear and linear decomposition techniques were used to understand the extent to which differences in home healthcare use and expenditures among elderly Medicare beneficiaries with and without PD can be explained by individual-level factors. Elderly Medicare beneficiaries with PD had higher home health use and expenditures compared to those without PD. 27.5% and 18% of the gap in home health use and expenditures, respectively, were explained by differences in characteristics between the PD and no PD groups. A large portion of the differences in home healthcare use and expenditures remained unexplained.

  14. Microtubule dynamics: Caps, catastrophes, and coupled hydrolysis

    DEFF Research Database (Denmark)

    Flyvbjerg, H.; Holy, T.E.; Leibler, S.

    1996-01-01

    An effective theory is formulated for the dynamics of the guanosine triphosphate (GTP) cap believed to stabilize growing microtubules. The theory provides a ''coarse-grained'' description of the cap's dynamics. ''Microscopic'' details, such as the microtubule lattice structure and the fate of its...... data. A constant nonzero catastrophe rare, identical for both microtubule ends, is predicted at large growth rates. The delay time for dilution-induced catastrophes is stochastic with a simple distribution that fits the experimental one and, like the experimental one, does not depend on the rate of....... A recent experimental result for the size of the minimal cap that can stabilize a microtubule is shown to agree with the result predicted by the cap model, after its parameters have been extracted from previous experimental results. Thus the effective theory and cap model presented here provide a...

  15. On Catastrophe and Cavitation for Spherical Cavity

    Institute of Scientific and Technical Information of China (English)

    MingJIN; KefuHUANG; 等

    1999-01-01

    This work deals with catastrophe of a spherical cavity and cavitation of a spherical cavity for Hooke material with 1/2 Poisson's ratio.A nonlinear problem.which is the Cauchy traction problem,is solved analytically.The governing equations are written on the deformed region or on the present configuration.And the conditions are described on moving boundary.A closed form solution is found.Furthermore,a bifurcation solution in closed form is given from the trivial homogeneous solution of a solid sphere.The results indicate that there is a tangent bifurcation on the displacement-load curve for a sphere with a cavity.On the tangent bifurcation point,the cavity grows up suddenly,which is a kind of catastrophe,And there is a pitchfork bifurcation on the displacement-load curve for a solid sphere.On the pitchfork bifurcation point.there is a cavitation in the solid sphere.

  16. 中国儿童预防费用核算与分析--基于“卫生费用核算体系2011”%The Expenditure Accounting and Analysis of Financing for Prevention of Children in China---Based on the System of Health Account 2011

    Institute of Scientific and Technical Information of China (English)

    柴培培; 万泉; 张毓辉; 郭锋; 翟铁民; 王从从; 王秀峰

    2015-01-01

    基于“卫生费用核算体系2011”,从服务功能、筹资方案和服务提供机构三个维度核算儿童预防服务费用。结果显示:2012年中国儿童预防服务费用411.61亿元,占儿童卫生费用的比重为23.49%,主要用于免疫项目、健康状况监测和疾病早期诊断。45.67%的儿童预防服务费用由政府方案筹资,但家庭卫生支出仍占26.00%;儿童预防服务主要由公共卫生机构及基层医疗卫生机构提供。为此,需要增加政府筹资和社会医疗保险筹资,优化儿童预防服务筹资结构,保障儿童健康。%Based on System of Health Account 2011, the expenditure on prevention of children was accounted from three dimensions: service function, financing programs and service institutions. The results showed that national expenditure on prevention of children was 41.161 billion yuan in 2012, accounting for 23.49% of the total expenditure on health of children; mainly covered immunization programs, health status monitoring and early diagnosis of diseases. 45.67%of the expenditure of children was financed from the government, while accounting for 26.00%of the family health cost;prevention services on children are mainly provided by public health agencies and primary health care institutions. Thus, it requires to increase the government as well as social health insurance financing, and to optimize the financing structure on children preventive services to protect children's health.

  17. Recent catastrophic landslides and mitigation in China

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Increasing population density and development of mountainous terrain have brought human settlements within reach of landslide hazards.In recent years,due to the shortening of return period for severe natural events such as heavy rainfall,snowline retreating,great earthquake together with human activities,catastrophic landslides happened more frequently than before,resulting in large-scale casualties due to the increasing occurrences of rapid long-runout rock avalanches,especially in China.This paper present...

  18. Valuing Catastrophic Losses for Perennial Agricultural Crops

    OpenAIRE

    Adams, Damian C.; Kilmer, Richard L.; Moss, Charles B.; Schmitz, Andrew

    2003-01-01

    Courts are often required to estimate changes in welfare to agricultural operations from catastrophic events. For example, courts must assign damages in lawsuits, such as with pesticide drift cases, or determine 'just compensation' when the government takes private land for public use, as with the removal of dairy farms from environmentally sensitive land or destruction of canker-contaminated citrus trees. In economics, the traditional method of estimating changes in producer welfare is the c...

  19. Catastrophic Consequences of Kicking the Chameleon

    OpenAIRE

    Erickcek, Adrienne L.; Barnaby, Neil; Burrage, Clare; Huang, Zhiqi

    2013-01-01

    The physics of the "dark energy" that drives the current cosmological acceleration remains mysterious, and the dark sector may involve new light dynamical fields. If these light scalars couple to matter, a screening mechanism must prevent them from mediating an unacceptably strong fifth force locally. Here we consider a concrete example: the chameleon mechanism. We show that the same coupling between the chameleon field and matter employed by the screening mechanism also has catastrophic cons...

  20. Catastrophic Natural Disasters and Economic Growth

    OpenAIRE

    Cavallo, Eduardo; Galiani, Sebastian; Noy, Ilan; Pantano, Juan

    2010-01-01

    We examine the short and long run average causal impact of catastrophic natural disasters on economic growth by combining information from comparative case studies. We assess the counterfactual of the cases studied by constructing synthetic control groups taking advantage of the fact that the timing of large sudden natural disasters is an exogenous event. We find that only extremely large disasters have a negative effect on output both in the short and long run. However, we also show that thi...

  1. Crisis Management Aspects of Bam Catastrophic Earthquake: Review Article

    Directory of Open Access Journals (Sweden)

    Homayoun Sadeghi-Bazargani

    2015-03-01

    Full Text Available Background: Bam earthquake was the most catastrophic natural disasters in recent years. The aim of this study was to review different aspects of crisis manage­ment during and after the catastrophic earthquake in Bam City, Iran.Methods: Data needed for this systematic review were collected through search­ing PubMed, EMBASE and SID databases, for the period from 2003 to 2011. Keywords included earthquake, Iran and Bam earthquake. The data were summarized and were analyzed using Content Analysis.Results: Out of 422 articles, 25 articles were included in the study. Crisis Manage­ment aspects and existing pitfalls were classified into seven categories including planning and organization, human resource management, management of logistics, international humanitarian aids, field performance of the military and security forces, health and medical service provision, and information manage­ment. Positive aspects and major pitfalls of crisis management have been introduced in all the mentioned categories. Conclusion: The available evidence indicated poor crisis management during Bam earthquake that resulted in aggravating the losses as well as diminishing the effect of interventions. Thus, concerning the importance of different aspects of the crisis management and the high prevalence of disasters in Iran, the observed vulnerability in disaster management process should be addressed.

  2. A critical look at catastrophe risk assessments

    CERN Document Server

    Kent, A

    2004-01-01

    Recent papers by Busza et al. (BJSW) and Dar et al. (DDH) argue that astrophysical data can be used to establish bounds on the risk of a catastrophe in forthcoming collider experiments. The safety case set out by BJSW does not rely on these bounds, but on theoretical arguments, which BJSW find sufficiently compelling. However, DDH and other commentators (initially including BJSW) have suggested that the astrophysical bounds alone do give sufficient reassurance. This seems unsupportable when the bounds are expressed in terms of expected cost. For example, DDH's main bound, $p_{\\rm catastrophe} < 2 \\times 10^{-8}$, implies only that the expectation value of the number of deaths is bounded by 120. We thus reappraise the DDH and BJSW risk bounds by comparing risk policy in other areas. We find that requiring a catastrophe risk of no higher than 10^{-15} is necessary to be consistent with established policy for risk optimisation from radiation hazards, even if highly risk tolerant assumptions are made. A respec...

  3. Prediction of Catastrophes: an experimental model

    CERN Document Server

    Peters, Randall D; Pomeau, Yves

    2012-01-01

    Catastrophes of all kinds can be roughly defined as short duration-large amplitude events following and followed by long periods of "ripening". Major earthquakes surely belong to the class of 'catastrophic' events. Because of the space-time scales involved, an experimental approach is often difficult, not to say impossible, however desirable it could be. Described in this article is a "laboratory" setup that yields data of a type that is amenable to theoretical methods of prediction. Observations are made of a critical slowing down in the noisy signal of a solder wire creeping under constant stress. This effect is shown to be a fair signal of the forthcoming catastrophe in both of two dynamical models. The first is an "abstract" model in which a time dependent quantity drifts slowly but makes quick jumps from time to time. The second is a realistic physical model for the collective motion of dislocations (the Ananthakrishna set of equations for creep). Hope thus exists that similar changes in the response to ...

  4. Downward catastrophe of solar magnetic flux ropes

    CERN Document Server

    Zhang, Quanhao; Hu, Youqiu; Liu, Rui

    2016-01-01

    2.5D time-dependent ideal magnetohydrodynamic (MHD) models in Cartesian coordinates were used in previous studies to seek MHD equilibria involving a magnetic flux rope embedded in a bipolar, partially open background field. As demonstrated by these studies, the equilibrium solutions of the system are separated into two branches: the flux rope sticks to the photosphere for solutions at the lower branch but is suspended in the corona for those at the upper branch. Moreover, a solution originally at the lower branch jumps to the upper, as the related control parameter increases and reaches a critical value, and the associated jump is here referred to as upward catastrophe. The present paper advances these studies in three aspects. First, the magnetic field is changed to be force-free. The system still experiences an upward catastrophe with an increase in each control parameter. Secondly, under the force-free approximation, there also exists a downward catastrophe, characterized by a jump of a solution from the u...

  5. Catastrophic fragmentation of asteroids: Evidence from meteorites

    Science.gov (United States)

    Keil, K.; Haack, H.; Scott, E. R. D.

    1994-01-01

    Meteorites are impact-derived fragments from approximately 85 parent bodies. For seven of these bodies, the meteorites record evidence suggesting that they may have been catastrophically fragmented. We identify three types of catastrophic events: (1) impact and reassemble events greater than 4.4 Gy ago, involving molten or very hot parent bodies (greater than 1200 C); this affected the parent bodies of the ureilites, Shallowater, and the mesosiderites. In each case, the fragments cooled rapidly (approximately 1-1000 C/day) and then reassembled. (2) Later impacts involving cold bodies which, in some cases, reassembled; this occurred on the H and L ordinary chondrite parent bodies. The L parent body probably suffered another catastrophic event about 500 My ago. (3) Recent impacts of cold, multi-kilometer-sized bodies that generated meter-sized meteoroids; this occurred on the parent bodies of the IIIAB irons (650 My ago), the IVA irons (400 My ago), and the H ordinary chondrite (7 My ago).

  6. Capitalizing R&D Expenditures

    OpenAIRE

    Diewert, Erwin; Huang, Ning

    2008-01-01

    The next international version of the System of National Accounts will recommend that R&D (Research and Development) expenditures be capitalized instead of being immediately expensed as in the present System of National Accounts 1993. An R&D project creates a new technology, which in principle does not depreciate like a reproducible asset. A new technology is however subject to obsolescence, which acts in a manner that is somewhat similar to depreciation. The paper looks at the net benefits o...

  7. Catastrophe theory and its application status in mechanical engineering

    Directory of Open Access Journals (Sweden)

    Jinge LIU

    Full Text Available Catastrophe theory is a kind of mathematical method which aims to apply and interpret the discontinuous phenomenon. Since its emergence, it has been widely used to explain a variety of emergent phenomena in the fields of natural science, social science, management science and some other science and technology fields. Firstly, this paper introduces the theory of catastrophe in several aspects, such as its generation, radical principle, basic characteristics and development. Secondly, it summarizes the main applications of catastrophe theory in the field of mechanical engineering, focusing on the research progress of catastrophe theory in revealing catastrophe of rotor vibration state, analyzing friction and wear failure, predicting metal fracture, and so on. Finally, it advises that later development of catastrophe theory should pay more attention to the combination of itself with other traditional nonlinear theories and methods. This paper provides a beneficial reference to guide the application of catastrophe theory in mechanical engineering and related fields for later research.

  8. Quantifying the contribution of changes in healthcare expenditures and smoking to the reversal of the trend in life expectancy in the Netherlands Health policies, systems and management in high-income countries

    NARCIS (Netherlands)

    F. Peters (Frederick); W.J. Nusselder (Wilma); Reibling, N. (Nadine); Wegner-Siegmundt, C. (Christian); J.P. Mackenbach (Johan)

    2015-01-01

    textabstractBackground: Since 2001 the Netherlands has shown a sharp upturn in life expectancy (LE) after a longer period of slower improvement. This study assessed whether changes in healthcare expenditure (HCE) explain this reversal in trends in LE. As an alternative explanation, the impact of cha

  9. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review

    Directory of Open Access Journals (Sweden)

    Burns LC

    2015-01-01

    Full Text Available Lindsay C Burns,1–3 Sarah E Ritvo,1 Meaghan K Ferguson,1 Hance Clarke,3–5 Ze’ev Seltzer,3,5 Joel Katz1,3–5 1Department of Psychology, York University, Toronto, ON, Canada; 2Arthritis Research Centre of Canada, Vancouver, BC, Canada; 3Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; 4Department of Anesthesia, University of Toronto, Toronto, ON, Canada; 5Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, ON, Canada Background: Total knee arthroplasty (TKA is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA. Methods: We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed. Results: We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant

  10. Effect of health expenses on household capabilities and resource allocation in a rural commune in Vietnam.

    Directory of Open Access Journals (Sweden)

    Kim Thuy Nguyen

    Full Text Available BACKGROUND: Significant health expenses can force households to reduce consumption of items required for daily living and long-term well-being, depriving them of the capability to lead economically stable and healthy lives. Previous studies of out-of-pocket (OOP and other health expenses have typically characterized them as "catastrophic" in terms of a threshold level or percentage of household income. We aim to re-conceptualize the impact of health expenses on household "flourishing" in terms of "basic capabilities." METHODS AND FINDINGS: We conducted a 2008 survey covering 697 households, on consumption patterns and health treatments for the previous 12 months. We compare consumption patterns between households with and without inpatient treatment, and between households with different levels of outpatient treatment, for the entire study sample as well as among different income quartiles. We find that compared to households without inpatient treatment and with lower levels of outpatient treatment, households with inpatient treatment and higher levels of outpatient treatment reduced investments in basic capabilities, as evidenced by decreased consumption of food, education and production means. The lowest income quartile showed the most significant decrease. No quartile with inpatient or high-level outpatient treatment was immune to reductions. CONCLUSIONS: The effects of health expenses on consumption patterns might well create or exacerbate poverty and poor health, particularly for low income households. We define health expenditures as catastrophic by their reductions of basic capabilities. Health policy should reform the OOP system that causes this economic and social burden.

  11. A unified approach of catastrophic events

    Directory of Open Access Journals (Sweden)

    S. Nikolopoulos

    2004-01-01

    Full Text Available Although there is an accumulated charge of theoretical, computational, and numerical work, like catastrophe theory, bifurcation theory, stochastic and deterministic chaos theory, there is an important feeling that these matters do not completely cover the physics of real catastrophic events. Recent studies have suggested that a large variety of complex processes, including earthquakes, heartbeats, and neuronal dynamics, exhibits statistical similarities. Here we are studying in terms of complexity and non linear techniques whether isomorphic signatures emerged indicating the transition from the normal state to the both geological and biological shocks. In the last 15 years, the study of Complex Systems has emerged as a recognized field in its own right, although a good definition of what a complex system is, actually is eluded. A basic reason for our interest in complexity is the striking similarity in behaviour close to irreversible phase transitions among systems that are otherwise quite different in nature. It is by now recognized that the pre-seismic electromagnetic time-series contain valuable information about the earthquake preparation process, which cannot be extracted without the use of important computational power, probably in connection with computer Algebra techniques. This paper presents an analysis, the aim of which is to indicate the approach of the global instability in the pre-focal area. Non-linear characteristics are studied by applying two techniques, namely the Correlation Dimension Estimation and the Approximate Entropy. These two non-linear techniques present coherent conclusions, and could cooperate with an independent fractal spectral analysis to provide a detection concerning the emergence of the nucleation phase of the impending catastrophic event. In the context of similar mathematical background, it would be interesting to augment this description of pre-seismic electromagnetic anomalies in order to cover biological

  12. Household expenditure on food at home in Malaysia

    OpenAIRE

    Tey, (John) Yeong-Sheng

    2008-01-01

    “Engel’s law” explains that the share of household expenditure on food typically falls as income and expenditure increase. The objectives of this study are to investigate the food expenditure patterns of different income groups and the relationships between household characteristics and expenditure patterns. Household Expenditure Survey 2004/2005 data from Department of Statistics was used to analyze the food expenditure pattern of households. An expenditure model was developed and the coeffi...

  13. Netherlands: Health System Review.

    Science.gov (United States)

    Kroneman, Madelon; Boerma, Wienke; van den Berg, Michael; Groenewegen, Peter; de Jong, Judith; van Ginneken, Ewout

    2016-03-01

    This analysis of the Dutch health system reviews recent developments in organization and governance, health financing, healthcare provision, health reforms and health system performance. Without doubt, two major reforms implemented since the mid-2000s are among the main issues today. The newly implemented long-term care reform will have to realize a transition from publicly provided care to more self-reliance on the part of the citizens and a larger role for municipalities in its organization. A particular point of attention is how the new governance arrangements and responsibilities in long-term care will work together. The 2006 reform replaced the division between public and private insurance by one universal social health insurance and introduced managed competition as a driving mechanism in the healthcare system. Although the reform was initiated almost a decade ago, its stepwise implementation continues to bring changes in the healthcare system in general and in the role of actors in particular. In terms of performance, essential healthcare services are within easy reach and waiting times have been decreasing. The basic health insurance package and compensations for lower incomes protect citizens against catastrophic spending. Out-of-pocket payments are low from an international perspective. Moreover, the Dutch rate the quality of the health system and their health as good. International comparisons show that the Netherlands has low antibiotic use, a low number of avoidable hospitalizations and a relatively low avoidable mortality. National studies show that healthcare has made major contributions to the health of the Dutch population as reflected in increasing life expectancy. Furthermore, some indicators such as the prescription of generics and length of stay reveal improvements in efficiency over the past years. Nevertheless, the Netherlands still has one of the highest per capita health expenditures in Europe, although growth has slowed considerably after

  14. Catastrophic volcanic collapse: relation to hydrothermal processes.

    Science.gov (United States)

    López, D L; Williams, S N

    1993-06-18

    Catastrophic volcanic collapse, without precursory magmatic activity, is characteristic of many volcanic disasters. The extent and locations of hydrothermal discharges at Nevado del Ruiz volcano, Colombia, suggest that at many volcanoes collapse may result from the interactions between hydrothermal fluids and the volcanic edifice. Rock dissolution and hydrothermal mineral alteration, combined with physical triggers such as earth-quakes, can produce volcanic collapse. Hot spring water compositions, residence times, and flow paths through faults were used to model potential collapse at Ruiz. Caldera dimensions, deposits, and alteration mineral volumes are consistent with parameters observed at other volcanoes.

  15. State energy price and expenditure report 1994

    International Nuclear Information System (INIS)

    The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the United States. The price and expenditure estimates developed in the State Energy Price and Expenditure Data System (SEPEDS) are provided by energy source and economic sector and are published for the years 1970 through 1994. Consumption estimates used to calculate expenditures and the documentation for those estimates are taken from the State Energy Data Report 1994, Consumption Estimates (SEDR), published in October 1996. Expenditures are calculated by multiplying the price estimates by the consumption estimates, which are adjusted to remove process fuel; intermediate petroleum products; and other consumption that has no direct fuel costs, i.e., hydroelectric, geothermal, wind, solar, and photovoltaic energy sources. Documentation is included describing the development of price estimates, data sources, and calculation methods. 316 tabs

  16. State energy price and expenditure report 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-06-01

    The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the United States. The price and expenditure estimates developed in the State Energy Price and Expenditure Data System (SEPEDS) are provided by energy source and economic sector and are published for the years 1970 through 1994. Consumption estimates used to calculate expenditures and the documentation for those estimates are taken from the State Energy Data Report 1994, Consumption Estimates (SEDR), published in October 1996. Expenditures are calculated by multiplying the price estimates by the consumption estimates, which are adjusted to remove process fuel; intermediate petroleum products; and other consumption that has no direct fuel costs, i.e., hydroelectric, geothermal, wind, solar, and photovoltaic energy sources. Documentation is included describing the development of price estimates, data sources, and calculation methods. 316 tabs.

  17. State energy price and expenditure report 1992

    Energy Technology Data Exchange (ETDEWEB)

    1994-12-01

    The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the United States. The price and expenditure estimates are provided by energy source and economic sector and are published for the years 1970, 1980, and 1985 through 1992. Data for all years, 1970 through 1992, are available on personal computer diskettes.

  18. Structure and determinants of consumer expenditures

    OpenAIRE

    Stejskal, Ladislav; Stávková, Jana

    2011-01-01

    The local and worldwide present economic situation is often judged and discussed on the basis of the consumer expenditures development. Consumer expenditures or a buying behaviour outcome of each individual market subject is in marketing defined as a product and service seeking, from that consumers expect satisfying of their needs. On the basis of the introduced determination authors conducted a marketing research. Results in combination with a marketing insight into consumer expenditures rea...

  19. Household energy and consumption and expenditures, 1990

    International Nuclear Information System (INIS)

    The purpose of this supplement to the Household Energy Consumption and Expenditures 1990 report is to provide information on the use of energy in residential housing units, specifically at the four Census regions and nine Census division levels. This report includes household energy consumption, expenditures, and prices for natural gas, electricity, fuel oil, liquefied petroleum gas (LPG), and kerosene as well as household wood consumption. For national-level data, see the main report, Household Energy Consumption and Expenditures 1990

  20. Bankruptcy by catastrophes for major multi-nationals: stock exchange sensitivity for three catastrophes

    NARCIS (Netherlands)

    Van Gulijk, C.; Ale, B.J.M.

    2012-01-01

    This paper investigates the effect of major catastrophes have on stock exchange values for the major multi-nationals. The paper demonstrates that the Sharpe analysis is more sensitive in identifying effects than just following the daily stock values for assessing market response. It was found that m

  1. State energy price and expenditure report 1990

    International Nuclear Information System (INIS)

    The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the United States. The estimates are provided by energy source and economic sector. This report is an update of the State Energy Price and Expenditure Report 1989 published in September 1991. Energy price and expenditure estimates are published for the years 1970, 1975, 1980, and 1985 through 1990. Documentation follows the tables and describes how the price estimates are developed, including sources of data, methods of estimation, and conversion factors applied

  2. Geographic Distribution of VA Expenditures FY2010

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  3. Geographic Distribution of VA Expenditures FY2012

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  4. Geographic Distribution of VA Expenditures FY2013

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  5. Geographic Distribution of VA Expenditures FY2001

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  6. Geographic Distribution of VA Expenditures FY1996

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  7. Geographic Distribution of VA Expenditures FY2006

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  8. Geographic Distribution of VA Expenditures FY2003

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  9. Geographic Distribution of VA Expenditures FY2007

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  10. Geographic Distribution of VA Expenditures FY2011

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  11. Geographic Distribution of VA Expenditures FY2000

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  12. Geographic Distribution of VA Expenditures FY1999

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  13. Geographic Distribution of VA Expenditures FY2005

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  14. Geographic Distribution of VA Expenditures FY2002

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  15. Geographic Distribution of VA Expenditures FY2009

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  16. Geographic Distribution of VA Expenditures FY1997

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  17. Geographic Distribution of VA Expenditures FY1998

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  18. Geographic Distribution of VA Expenditures FY2004

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  19. Geographic Distribution of VA Expenditures FY2008

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  20. Public expenditure and drug policies in Bulgaria in 2014

    OpenAIRE

    Toni Yonkov Vekov; Silviya Aleksandrova-Yankulovska

    2015-01-01

    Aim: The objective of this study was to provide an analysis of the factors which have a significant impact on the growth of public expenditure on medical products in Bulgaria. Methods: This research work consists of a critical analysis of the data reported by the National Health Insurance Fund in Bulgaria on the stability of the healthcare insurance model and the implementation of the budget for 2014. Results: The results from the current analysis indicate that the growth of public...

  1. Inside money, procyclical leverage, and banking catastrophes.

    Science.gov (United States)

    Brummitt, Charles D; Sethi, Rajiv; Watts, Duncan J

    2014-01-01

    We explore a model of the interaction between banks and outside investors in which the ability of banks to issue inside money (short-term liabilities believed to be convertible into currency at par) can generate a collapse in asset prices and widespread bank insolvency. The banks and investors share a common belief about the future value of certain long-term assets, but they have different objective functions; changes to this common belief result in portfolio adjustments and trade. Positive belief shocks induce banks to buy risky assets from investors, and the banks finance those purchases by issuing new short-term liabilities. Negative belief shocks induce banks to sell assets in order to reduce their chance of insolvency to a tolerably low level, and they supply more assets at lower prices, which can result in multiple market-clearing prices. A sufficiently severe negative shock causes the set of equilibrium prices to contract (in a manner given by a cusp catastrophe), causing prices to plummet discontinuously and banks to become insolvent. Successive positive and negative shocks of equal magnitude do not cancel; rather, a banking catastrophe can occur even if beliefs simply return to their initial state. Capital requirements can prevent crises by curtailing the expansion of balance sheets when beliefs become more optimistic, but they can also force larger price declines. Emergency asset price supports can be understood as attempts by a central bank to coordinate expectations on an equilibrium with solvency.

  2. Inside money, procyclical leverage, and banking catastrophes.

    Directory of Open Access Journals (Sweden)

    Charles D Brummitt

    Full Text Available We explore a model of the interaction between banks and outside investors in which the ability of banks to issue inside money (short-term liabilities believed to be convertible into currency at par can generate a collapse in asset prices and widespread bank insolvency. The banks and investors share a common belief about the future value of certain long-term assets, but they have different objective functions; changes to this common belief result in portfolio adjustments and trade. Positive belief shocks induce banks to buy risky assets from investors, and the banks finance those purchases by issuing new short-term liabilities. Negative belief shocks induce banks to sell assets in order to reduce their chance of insolvency to a tolerably low level, and they supply more assets at lower prices, which can result in multiple market-clearing prices. A sufficiently severe negative shock causes the set of equilibrium prices to contract (in a manner given by a cusp catastrophe, causing prices to plummet discontinuously and banks to become insolvent. Successive positive and negative shocks of equal magnitude do not cancel; rather, a banking catastrophe can occur even if beliefs simply return to their initial state. Capital requirements can prevent crises by curtailing the expansion of balance sheets when beliefs become more optimistic, but they can also force larger price declines. Emergency asset price supports can be understood as attempts by a central bank to coordinate expectations on an equilibrium with solvency.

  3. Averting Catastrophes: The Strange Economics of Scylla and Charybdis

    OpenAIRE

    Martin, Ian; Pindyck, R. S.

    2014-01-01

    How should we evaluate public policies or projects to avert, or reduce the likelihood of, a catastrophic event? Examples might include inspection and surveillance programs to avert nuclear terrorism, investments in vaccine technologies to help respond to a "mega-virus," or the construction of levees to avert major flooding. A policy to avert a particular catastrophe considered in isolation might be evaluated in a cost-benefit framework. But because society faces multiple potential catastrophe...

  4. Mutation accumulation and the catastrophic senescence of Pacific salmon

    CERN Document Server

    Penna, T J P; Stauffer, D; Stauffer, Dietrich

    1995-01-01

    The bit-string model of biological aging is used to simulate the catastrophic senescence of Pacific Salmon. We have shown that reproduction occuring only once and at a fixed age is the only ingredient needed to explain the catastrophic senescence according the mutation accumulation theory. Several results are presented, some of them with up to 10^8 fishes, showing how the survival rates in catastrophic senescence are affected by changes in the parameters of the model.

  5. Eurozone Imbalances: Measuring the Contribution of Expenditure Switching and Expenditure Volumes 1990-2013

    OpenAIRE

    Enno Schröder

    2015-01-01

    This paper introduces a decomposition of the trade ratio. The dynamics of the trade ratio are composed of contributions from expenditure switching, from the terms of trade, and from relative expenditure (i.e. the ratio of foreign to domestic expenditure). Country-specific, dynamically tradeweighted indicators of foreign expenditure are constructed for use in the application of the decomposition to 11 euro area countries in 1990-2013. Over 1999-2007, Germany and Spain shared the same pattern o...

  6. Revenue and Expenditure Separation Increases Rate of First Contact Care in Community Health Centers among Community Residents%社区卫生收支两条线改革对社区首诊的作用研究

    Institute of Scientific and Technical Information of China (English)

    郭泓; 梁小云; 金承刚

    2012-01-01

    Objective To evaluate the impact of revenue and expenditure separation (RES) on rate of first contact care in community health centers (CHCs) among community residents. Methods Baseline household survey was conducted in February 2009 , before the implementation of RES, and endline household survey was conducted between July and August 2011, after the implementation of RES. According to the baseline and endline household survey results, residents who visited CHC within two weeks before the conduction of each survey were included in this study. This study employed a pre - post quasi - experiment design and independent variables were selected based on the Andersen model. Multiple regression models were used to i-dentify the impact of RES on first contact care. Results During the two weeks before the RES implementation, 31 community residents first sought care in CHC, out of 95 who had used medical services, and the figure after the RES implementation was 89 out of 146. Multiple regression analysis showed that the rate of first contact care in CHC increased by 28. 3% (P = 0.000) . Conclusion RES has improved the rate of first contact care in CHC among the community residents. RES helped attract community residents for two main reasons. First, CHCs start to be financed by the government instead of revenue from medication and medical services, so overtreatment is controlled and spending is reduced. Second, a series of medical personnel performance appraisal methods are introduced along with RES, which promote the provision of public health services.%目的 评估收支两条线改革对居民到社区卫生服务中心进行首诊的作用效果.方法 分别于收支两条线改革前后进行居民入户调查,采取前后比较的类试验方法及安德森行为模型,利用多元Logistic回归控制其他因素的混杂,估计政策的净效应.结果 基线调查中,到社区卫生服务中心进行首诊的只有31人,社区首诊率为32.6%;终线调查中,

  7. The Impact of Out-of-Pocket Payments on Health Care Inequity: The Case of National Health Insurance in South Korea

    Directory of Open Access Journals (Sweden)

    Weon-Young Lee

    2014-07-01

    Full Text Available The global financial crisis of 2008 has led to the reinforcement of patient cost sharing in health care policy. This study aimed to explore the impact of direct out-of pocket payments (OOPs on health care utilization and the resulting financial burden across income groups under the South Korean National Health Insurance (NHI program with universal population coverage. We used the fourth Korean National Health and Nutrition Examination Survey (KNHNES-IV and the Korean Household Income and Expenditure Survey (KHIES of 2007, 2008 and 2009. The Horizontal Inequity Index (HIwv and the average unit OOPs were used to measure income-related inequity in the quantitative and qualitative aspects of health care utilization, respectively. For financial burden, the incidence rates of catastrophic health expenditure (CHE were compared across income groups. For outpatient and hospital visits, there was neither pro-poor or pro-rich inequality. The average unit OOPs of the poorest quintile was approximately 75% and 60% of each counterpart in the richest quintile in the outpatient and inpatient services. For the CHE threshold of 40%, the incidence rates were 5.7%, 1.67%, 0.72%, 0.33% and 0.27% in quintiles I (the poorest quintile, II, III, IV and V, respectively. Substantial OOPs under the NHI are disadvantageous, particularly for the lowest income group in terms of health care quality and financial burden.

  8. The Chernobyl catastrophe consequences in the Republic of Belarus. National report

    International Nuclear Information System (INIS)

    The estimation of radioecological, medico-biological, economic and social consequences of the Chernobyl catastrophe has shown that unimaginable damage was incurred on Belarus and its territory became the zone of ecological calamity. The Chernobyl NPP catastrophe has led to the contamination of almost the fourth part of the territory of Belarus where there lived 2,2 million people. The damage caused to the republic by the catastrophe makes up 32 annual budgets of the republic of the pre-accident period in account for the 30-years period for its overcoming. Radioecological situation in Belarus is characterized by complexity and heterogeneous contamination of the territory by different radionuclides and their presence on all the components of the environment. It stipulates the plurality of ways of external and internal irradiation of the population and jeopardizes its health. There is registered the worsening of the population's health, of evacuated and inhabiting the contaminated areas as well, with increase of a number of somatic diseases, including oncological diseases, there are disorders in the metabolic processes and functions of the main systems of the organism. The demographic indices are decreasing. Particular concern causes the children's morbidity growth and genetic consequences of the accident. The contamination of agricultural lands has stipulated in the neighboring the Chernobyl NPP zone the impossibility of their use for food production. On the other lands it has been required to re-profile the farms and create new technologies of the agricultural production. There have been revealed the destructive tendencies in all spheres of the life activity of people who experienced radiation effects. The processes of social adaptation and socio-psychological support of the population require considerable optimization. In spite of that for ten years passed after the catastrophe the discrepancy of its estimations has not been overcome completely. At the same time

  9. Remittances, expenditure patterns, and gender: Parametric and semiparametric evidence from Ecuador

    OpenAIRE

    Göbel, Kristin

    2013-01-01

    This study estimates the impact of migrants' remittances on households' spending decisions in Ecuador. Applying both parametric and semiparametric techniques, we find strong evidence that remittances enhance expenditures on education, health, and housing, but decrease expenditures on food. This supports the hypotheses that these inflows result in a stronger human capital accumulation and therefore improve the long-run production possibilities. We do not find strong differences in the impact o...

  10. Madame Bovary and Catastrophism: Revolving narratives

    Directory of Open Access Journals (Sweden)

    Ruth Morris

    2011-07-01

    Full Text Available Cet article relie Madame Bovary au contexte scientifique français des années 1850, en lisant le roman de Flaubert à la lumière des théories de Cuvier. Le savant français Georges Cuvier, avec nombre de ses contemporains, explique les origines du monde à l’aide de la théorie des catastrophes. D’après cette théorie, le monde est divisé en périodes très courtes ponctuées de grandes catastrophes ou, en termes cuviériens, de « révolutions » qui ont éradiqué toute vie et ont permis au monde d’être entièrement repeuplé. Une telle conception affecte l’idée même du « temps ». Cuvier pense que la formation de la Terre est relativement récente, l’époque présente n’étant vieille que de cinq mille ans. Cette compression temporelle peut être rapportée à Madame Bovary dont le « tempo » s’accroît au fur et à mesure qu’on se rapproche du dénouement. Dans la théorie des catastrophes comme dans le roman, le temps ne suit pas une ligne chronologique. Les « révolutions » viennent briser le fil continu du temps et Emma est souvent incapable de distinguer entre le passé, le présent et le futur. Les « révolutions » servent aussi à ponctuer et à perturber le cours de la vie sur Terre en produisant des événements majeurs dans l’histoire du globe. Il en est de même dans la vie d’Emma. Son existence est marquée par des événements majeurs, comme le bal, qui créent un éclatement et une fragmentation de la temporalité, comme dans la théorie de Cuvier. Je défendrai aussi l’idée d’un lien entre la soudaineté et la violence des « révolutions » et les crises nerveuses d’Emma, qui surviennent brusquement et relèvent de l’hystérie. La conception cuviérienne de la temporalité doit enfin être envisagée au regard des théories de l’évolution, ce qui implique de réévaluer les notions d’adaptation, d’hérédité et de mort dans le roman de Flaubert.This paper locates Madame

  11. State energy price and expenditure report 1989

    International Nuclear Information System (INIS)

    The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates for the 50 States, the District of Columbia, and the United States. The estimates are provided by energy source (e.g., petroleum, natural gas, coal, and electricity) and by major consuming or economic sector. This report is an update of the State Energy Price and Expenditure Report 1988 published in September 1990. Changes from the last report are summarized in a section of the documentation. Energy price and expenditure estimates are published for the years 1970, 1975, 1980, and 1985 through 1989. Documentation follows the tables and describes how the price estimates are developed, including sources of data, methods of estimation, and conversion factors applied. Consumption estimates used to calculate expenditures, and the documentation for those estimates, are from the State Energy Data Report, Consumption Estimates, 1960--1989 (SEDR), published in May 1991. Expenditures are calculated by multiplying the price estimates by the consumption estimates, adjusted to remove process fuel and intermediate product consumption. All expenditures are consumer expenditures, that is, they represent estimates of money directly spent by consumers to purchase energy, generally including taxes. 11 figs., 43 tabs

  12. State energy price and expenditure report 1989

    Energy Technology Data Exchange (ETDEWEB)

    1991-09-30

    The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates for the 50 States, the District of Columbia, and the United States. The estimates are provided by energy source (e.g., petroleum, natural gas, coal, and electricity) and by major consuming or economic sector. This report is an update of the State Energy Price and Expenditure Report 1988 published in September 1990. Changes from the last report are summarized in a section of the documentation. Energy price and expenditure estimates are published for the years 1970, 1975, 1980, and 1985 through 1989. Documentation follows the tables and describes how the price estimates are developed, including sources of data, methods of estimation, and conversion factors applied. Consumption estimates used to calculate expenditures, and the documentation for those estimates, are from the State Energy Data Report, Consumption Estimates, 1960--1989 (SEDR), published in May 1991. Expenditures are calculated by multiplying the price estimates by the consumption estimates, adjusted to remove process fuel and intermediate product consumption. All expenditures are consumer expenditures, that is, they represent estimates of money directly spent by consumers to purchase energy, generally including taxes. 11 figs., 43 tabs.

  13. Uganda Sustainable Land Management : Public Expenditure Review

    OpenAIRE

    World Bank

    2008-01-01

    This report summarizes the findings of the Uganda Sustainable Land Management Public Expenditure Review (SLM PER). The SLM PER was undertaken to achieve six main objectives: (i) establish a robust data base on SLM-related public expenditure that can support credible empirical analysis; (ii) develop a sound methodology for conducting SLM PERs, which could guide similar work in the future; (...

  14. Beyond UHC: monitoring health and social protection coverage in the context of tuberculosis care and prevention.

    Science.gov (United States)

    Lönnroth, Knut; Glaziou, Philippe; Weil, Diana; Floyd, Katherine; Uplekar, Mukund; Raviglione, Mario

    2014-09-01

    Tuberculosis (TB) remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC) and social protection. One of the proposed targets is that "No TB affected families experience catastrophic costs due to TB." High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.

  15. Beyond UHC: monitoring health and social protection coverage in the context of tuberculosis care and prevention.

    Directory of Open Access Journals (Sweden)

    Knut Lönnroth

    2014-09-01

    Full Text Available Tuberculosis (TB remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC and social protection. One of the proposed targets is that "No TB affected families experience catastrophic costs due to TB." High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.

  16. Government expenditure and energy intensity in China

    Energy Technology Data Exchange (ETDEWEB)

    Yuxiang, Karl [School of Economics and Business Administration, Room 230 of the 11th Dormitory at Campus B, Chongqing University, Chongqing 400044 (China); Chen, Zhongchang [Center for Population, Resources, and Environment Research, Chongqing University, Chongqing 400044 (China)

    2010-02-15

    The recent economic stimulus package of China has raised growing concern about its potential impact on energy demand and efficiency. To what extent does such expansion of government expenditure influence energy intensity? This question has not been well answered by the previous research. Using provincial panel data, this paper provides some evidence of a link between government expenditure and energy intensity in China. The empirical results demonstrate that the expansion of government expenditure since Asian financial crisis has exerted a significant influence on energy intensity. An increase in government expenditure in China leads to an increase in energy intensity. Further analysis compares such relationships in different economic situations. The comparison shows that such positive effect of government expenditure remains significant after the alteration in economic situation. Therefore, the results suggest introducing some measures to consolidate China's existing gains in energy efficiency. The analysis also explains why the downward trend in energy intensity is reversed in China since 2002. (author)

  17. State energy price and expenditure report, 1995

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-08-01

    The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the US. The estimates developed in the State Energy Price and Expenditure Data System (SEPEDS) are provided by energy source and economic sector and are published for the years 1970 through 1995. Data for all years are available on a CD-ROM and via Internet. Consumption estimates used to calculate expenditures and the documentation for those estimates are taken from the State Energy Data Report 1995, Consumption Estimates (SEDR), published in December 1997. Expenditures are calculated by multiplying the price estimates by the consumption estimates, which are adjusted to remove process fuel; intermediate petroleum products; and other consumption that has no direct fuel costs, i.e., hydroelectric, geothermal, wind, solar, and photovoltaic energy sources.

  18. Effect of Neuromuscular Electrical Muscle Stimulation on Energy Expenditure in Healthy Adults

    Directory of Open Access Journals (Sweden)

    Ya-Ju Chang

    2011-02-01

    Full Text Available Weight loss/weight control is a major concern in prevention of cardiovascular disease and the realm of health promotion. The primary aim of this study was to investigate the effect of neuromuscular electrical stimulation (NMES at different intensities on energy expenditure (oxygen and calories in healthy adults. The secondary aim was to develop a generalized linear regression (GEE model to predict the increase of energy expenditure facilitated by NMES and identify factors (NMES stimulation intensity level, age, body mass index, weight, body fat percentage, waist/hip ratio, and gender associated with this NMES-induced increase of energy expenditure. Forty sedentary healthy adults (18 males and 22 females participated. NMES was given at the following stimulation intensities for 10 minutes each: sensory level (E1, motor threshold (E2, and maximal intensity comfortably tolerated (E3. Cardiopulmonary gas exchange was evaluated during rest, NMES, and recovery stage. The results revealed that NMES at E2 and E3 significantly increased energy expenditure and the energy expenditure at recovery stage was still significantly higher than baseline. The GEE model demonstrated that a linear dose-response relationship existed between the stimulation intensity and the increase of energy expenditure. No subject’s demographic or anthropometric characteristics tested were significantly associated with the increase of energy expenditure. This study suggested NMES may be used to serve as an additional intervention for weight loss programs. Future studies to develop electrical stimulators or stimulation electrodes to maximize the comfort of NMES are recommended.

  19. Application of catastrophe theory to nuclear structure

    International Nuclear Information System (INIS)

    Three two-parameter models, one describing an A-body system (the atomic nucleus) and two describing many-body systems (the van der Waals gas and the ferroelectric (perovskite) system) are compared within the framework of catastrophe theory. It is shown that each has a critical point (second-order phase transition) when the two counteracting forces controlling it are in balance; further, each undergoes a first-order phase transition when one of the forces vanishes (the deforming force for the nucleus, the attractive force for the van der Waals gas, and the dielectric constant for the perovskite). Finally, when both parameters are kept constant, a kind of phase transition may occur at a critical angular momentum, critical pressure, and critical electric field. 3 figures, 1 table

  20. 76 FR 36000 - Rulemaking Petition: Independent Expenditure Reporting

    Science.gov (United States)

    2011-06-21

    ... 11 CFR Part 109 Rulemaking Petition: Independent Expenditure Reporting AGENCY: Federal Election... expenditures by persons other than political committees. The Petition is available for inspection in the... committees], including corporations and labor organizations, which make independent expenditures, in order...

  1. Grasshopper Population Ecology: Catastrophe, Criticality, and Critique

    Directory of Open Access Journals (Sweden)

    Jeffrey A. Lockwood

    2008-06-01

    Full Text Available Grasshopper population dynamics are an important part of the North American rangeland ecosystem and an important factor in the economies that derive from the rangeland. Outbreak dynamics have plagued management strategies in the rangeland, and attempts to find simple, linear and mechanistic solutions to both understanding and predicting the dynamics have proved fruitless. These efforts to ground theory in a correspondence with the “real” world, including whether the population dynamics are ultimately density dependent or density independent, have generated abundant heat but little light. We suggest that a pragmatic approach, in which theories are taken to be “tools” rather than competing claims of truth, has greater promise to move ecological research in a constructive direction. Two recent non-linear approaches exploiting the tools of complexity science provide insights relevant to explaining and forecasting population dynamics. Observation and data collection were used to structure models derived from catastrophe theory and self-organized criticality. These models indicate that nonlinear processes are important in the dynamics of the outbreaks. And the conceptual structures of these approaches provide clear, albeit constrained or contingent, implications for pest managers. We show that, although these two frameworks, catastrophe theory and self-organized criticality, are very different, the frequency distributions of time series from both systems result in power law relationships. Further, we show that a simple lattice-based model, similar to SOC but structured on the biology of the grasshoppers gives a spatial time series similar to data over a 50-year span and the frequency distribution is also a power law relationship. This demonstration exemplifies how a “both–and” rather than an “either–or” approach to ecological modeling, in which the useful elements of particular theories or conceptual structures are extracted, may

  2. Experiments on Mixotrophic Protists and Catastrophic Darkness

    Science.gov (United States)

    Jones, Harriet; Cockell, Charles S.; Goodson, Claire; Price, Nicola; Simpson, Annika; Thomas, Benjamin

    2009-08-01

    Catastrophically darkened photic zone conditions in water bodies are postulated to be induced by a diversity of mechanisms that are recorded in the geological record, including asteroid and comet impacts and large-scale volcanic eruptions. Giant wildfires, such as those that followed the great fires in Siberia in 1915, have been directly shown to cause large reductions in sunlight penetrating to the ground. Previous studies on the response of phototrophs to s udden prolonged darkness have focused on the survival of axenic strains. In this paper, we describe laboratory experiments to investigate the survival and growth of isolated and mixed cultures of freshwater and marine mixotrophs after 6 months of darkness and in the low light that would follow these events. Mixotrophs could survive 6 months of darkness. Some species used dissolved organic carbon, which can be released from dead biomass after loss of light and was shown to improve feeding rates. Mixotrophs also improved the survival and subsequent growth of obligate phototrophs at low light levels when grown in mixed cultures. The ability of mixotrophs to switch from photosynthesis to heterotrophy following sudden darkening would not only allow them to survive but to grow and contribute to active food chains. The experiments suggest that, following the return of light, resumption of photosynthesis can be rapid. These experiments improve our understanding of the collapse of photosynthesis following catastrophic darkening and emphasize the important role of mixotrophy in the resilience of the photosynthetic biosphere during such periods. We speculate on the implications for the Cretaceous-Tertiary impact event and periods of global freezing.

  3. Does the pharmacy expenditure of patients always correspond with their morbidity burden? Exploring new approaches in the interpretation of pharmacy expenditure

    Directory of Open Access Journals (Sweden)

    Abad-Díez José

    2010-05-01

    Full Text Available Abstract Background The computerisation of primary health care (PHC records offers the opportunity to focus on pharmacy expenditure from the perspective of the morbidity of individuals. The objective of the present study was to analyse the behaviour of pharmacy expenditure within different morbidity groups. We paid special attention to the identification of individuals who had higher values of pharmacy expenditure than their morbidity would otherwise suggest (i.e. outliers. Methods Observational study consisting of 75,574 patients seen at PHC centres in Zaragoza, Spain, at least once in 2005. Demographic and disease variables were analysed (ACG® 8.1, together with a response variable that we termed 'total pharmacy expenditure per patient'. Outlier patients were identified based on boxplot methods, adjusted boxplot for asymmetric distributions, and by analysing standardised residuals of tobit regression models. Results The pharmacy expenditure of up to 7% of attendees in the studied PHC centres during one year exceeded expectations given their morbidity burden. This group of patients was responsible for up to 24% of the total annual pharmacy expenditure. There was a significantly higher number of outlier patients within the low-morbidity band which matched up with the higher variation coefficient observed in this group (3.2 vs. 2.0 and 1.3 in the moderate- and high-morbidity bands, respectively. Conclusions With appropriate validation, the methodologies of the present study could be incorporated in the routine monitoring of the prescribing profile of general practitioners. This could not only enable evaluation of their performance, but also target groups of outlier patients and foster analyses of the causes of unusually high pharmacy expenditures among them. This interpretation of pharmacy expenditure gives new clues for the efficiency in utilisation of healthcare resources, and could be complementary to management interventions focused on

  4. Purchase of Catastrophe Insurance by Dutch Dairy and Arable Farmers

    NARCIS (Netherlands)

    Ogurtsov, V.; Asseldonk, van M.A.P.M.; Huirne, R.B.M.

    2009-01-01

    This article analyzed the impact of risk perception, risk attitude, and other farmer personal and farm characteristics on the actual purchase of catastrophe insurance by Dutch dairy and arable farmers. The specific catastrophe insurance types considered were hail–fire–storm insurance for buildings,

  5. Cell death by mitotic catastrophe: a molecular definition

    NARCIS (Netherlands)

    Castedo, M.; Perfettini, J.-L.; Roumier, T.; Andreau, K.; Medema, R.H.; Kroemer, G.

    2004-01-01

    The current literature is devoid of a clearcut definition of mitotic catastrophe, a type of cell death that occurs during mitosis. Here, we propose that mitotic catastrophe results from a combination of deficient cell-cycle checkpoints (in particular the DNA structure checkpoints and the spindle ass

  6. Can a stochastic cusp catastrophe model explain housing market crashes?

    NARCIS (Netherlands)

    C. Diks; J. Wang

    2016-01-01

    Like stock market prices, housing prices often exhibit temporary booms and busts. A possible explanation for the observed abrupt changes is offered by the stochastic catastrophe model. This paper addresses the question whether the catastrophe model can describe and predict the dynamics of housing ma

  7. Catastrophic Incident Recovery: Long-Term Recovery from an Anthrax Event Symposium

    Energy Technology Data Exchange (ETDEWEB)

    Lesperance, Ann M.

    2008-06-30

    On March 19, 2008, policy makers, emergency managers, and medical and Public Health officials convened in Seattle, Washington, for a workshop on Catastrophic Incident Recovery: Long-Term Recovery from an Anthrax Event. The day-long symposium was aimed at generating a dialogue about restoration and recovery through a discussion of the associated challenges that impact entire communities, including people, infrastructure, and critical systems.

  8. Using administrative data to estimate population displacement and resettlement following a catastrophic U.S. disaster

    OpenAIRE

    Plyer, Allison; Bonaguro, Joy; Hodges, Ken

    2009-01-01

    After a large scale evacuation, authorities need to know the new and frequently changing population distributions in order to meet needs for housing, schools, health care, and other services. This paper reviews literature from the fields of demography and other disciplines to identify available administrative data sets that can form the basis of sound, relevant, and timely county-level population estimates following a catastrophic U.S. event. The most appropriate data to estimate population i...

  9. ANALYSIS OF PUBLIC EXPENDITURE IN ROMANIA DURING 1995-2009

    OpenAIRE

    ANA-PETRINA STANCIU

    2011-01-01

    The objective of this paper is to analyze the evolution of Romania’s public expenditure during the period 1995-2009. Expenditure analysis involves tracking their evolution in absolute and relative size, determining the share of public expenditure within the GDP, as well as determining the level of total public expenditure and of each category of expenditure per capita. At the same time there are several econometric models used in optimizing public expenditure for the various economic sectors ...

  10. Public expenditure and drug policies in Bulgaria in 2014

    Directory of Open Access Journals (Sweden)

    Toni Yonkov Vekov

    2015-11-01

    National Health Insurance Fund in Bulgaria on the stability of the healthcare insurance model and the implementation of the budget for 2014. Results: The results from the current analysis indicate that the growth of public expenditure is directly proportional to the number of reimbursed medical products and that the pattern of prescriptions including the innovative medical products mainly for the treatment of oncological and rare diseases has a significant impact on it. Conclusion: The reasons for the increase of public expenditure in Bulgaria include the non-transparent decisions in pricing and reimbursement of the products, the lack of guidelines for presenting pharmacological evidence and the lack of legislatively-defined drug policies for the management and control of the patterns of medical prescriptions.

  11. Pharmaceutical expenditure changes in Serbia and Greece during the global economic recession

    OpenAIRE

    Mihajlo (Michael) Jakovljevic; Kyriakos Souliotis

    2016-01-01

    Aim: Clarity on health expenditures is essential for the timely identification of risks that jeopardize the democratic provision of health services and the credibility of health insurance systems. Furthermore, observing health outcomes with geographical scope is essential for making multilateral associations. This study aimed at conveying information on the variability of important economic parameters of the health sector of Serbia and Greece from 2007 to 2012, when the most serious financial...

  12. Psychological resilience predicts decreases in pain catastrophizing through positive emotions.

    Science.gov (United States)

    Ong, Anthony D; Zautra, Alex J; Reid, M Carrington

    2010-09-01

    The study used a daily process design to examine the role of psychological resilience and positive emotions in the day-to-day experience of pain catastrophizing. A sample of 95 men and women with chronic pain completed initial assessments of neuroticism, psychological resilience, and demographic data, and then completed short diaries regarding pain intensity, pain catastrophizing, and positive and negative emotions every day for 14 consecutive days. Multilevel modeling analyses indicated that independent of level of neuroticism, negative emotions, pain intensity, income, and age, high-resilient individuals reported greater positive emotions and exhibited lower day-to-day pain catastrophizing compared with low-resilient individuals. Mediation analyses revealed that psychologically resilient individuals rebound from daily pain catastrophizing through experiences of positive emotion. Implications for research on psychological resilience, pain catastrophizing, and positive emotions are discussed.

  13. Grey forewarning and prediction for mine water inflowing catastrophe periods

    Institute of Scientific and Technical Information of China (English)

    MA Qi-hua; CAO Jian-jun

    2007-01-01

    Based on the theory of grey system, established GM (1, 1) grey catastrophe predict model for the first time in order to forecast the catastrophe periods of mine water inflowing (not the volume of water inflowing). After establishing the grey predict system of the catastrophe regularity of 10 month-average volume of water inflowing, the grey forewarning for mine water inflowing catastrophe periods was established which was used to analyze water disaster in -400 meter level of Wennan Colliery. Based on residual analysis,it shows that the result of grey predict system is almost close to the actual value. And the scene actual result also shows the reliability of prediction. Both the theoretical analysis and the scene actual result indicate feasibility and reliability of the method of grey catastrophe predict system.

  14. Copula bivariate probit models: with an application to medical expenditures.

    Science.gov (United States)

    Winkelmann, Rainer

    2012-12-01

    The bivariate probit model is frequently used for estimating the effect of an endogenous binary regressor (the 'treatment') on a binary health outcome variable. This paper discusses simple modifications that maintain the probit assumption for the marginal distributions while introducing non-normal dependence using copulas. In an application of the copula bivariate probit model to the effect of insurance status on the absence of ambulatory health care expenditure, a model based on the Frank copula outperforms the standard bivariate probit model. PMID:22025413

  15. Determinants of Healthcare Expenditure in Economic Cooperation Organization (ECO Countries: Evidence from Panel Cointegration Tests

    Directory of Open Access Journals (Sweden)

    Enayatollah Homaie Rad

    2013-05-01

    Full Text Available Background Over the last decade there has been an increase in healthcare expenditures while at the same time the inequity in distribution of resources has grown. These two issues have urged the researchers to review the determinants of healthcare expenditures. In this study, we surveyed the determinants of health expenditures in Economic Cooperation Organization (ECO countries. Methods We used Panel data econometrics methods for the purpose of this research. For long term analysis, we used Pesaran cross sectional dependency test followed by panel unit root tests to show first whether the variables were stationary or not. Upon confirmation of no stationary variables, we used Westerlund panel cointegration test in order to show whether long term relationships exist between the variables. At the end, we estimated the model with Continuous-Updated Fully Modified (CUP-FM estimator. For short term analysis also, we used Fixed Effects (FE estimator to estimate the model. Results A long term relationship was found between the health expenditures per capita and GDP per capita, the proportion of population below 15 and above 65 years old, number of physicians, and urbanisation. Besides, all the variables had short term relationships with health expenditures, except for the proportion of population above 65 years old. Conclusion The coefficient of GDP was below 1 in the model. Therefore, health is counted as a necessary good in ECO countries and governments must pay due attention to the equal distribution of health services in all regions of the country.

  16. Catastrophic injury in rugby union: is the level of risk acceptable?

    Science.gov (United States)

    Fuller, Colin W

    2008-01-01

    Rugby union is a full contact sport with a relatively high overall risk of injury and a small specific risk of fatal and catastrophic spinal injury. Although catastrophic injuries in rugby union cause public concern and generate strong emotive reactions, the magnitude of society's concern about this type of injury is often dominated by people's perceptions rather than by actual levels of risk. This article assesses published values for the risk of catastrophic injuries in rugby union, evaluates these against the risk standards of the UK Health and Safety Executive (HSE) and compares the values with the risks associated with other common sport and non-sport activities. The assessment showed that the risks of sustaining a catastrophic injury in rugby union in England (0.8/100,000 per year), Ireland (0.9/100,000 per year) and Argentina (1.9/100,000 per year) were within the HSE's 'acceptable' region of risk (0.1-2/100,000 per year), whilst the risks in New Zealand (4.2/100,000 per year), Australia (4.4/100,000 per year) and Fiji (13/100,000 per year) were within the 'tolerable' region of risk (2-100/100,000 per year). The risk of sustaining a catastrophic injury in rugby union was generally lower than or comparable with the levels reported for a wide range of other collision sports, such as ice hockey (4/100,000 per year), rugby league (2/100,000 per year) and American Football (2/100,000 per year). In addition, the risk of catastrophic injury in rugby union was comparable with that experienced by most people in work-based situations and lower than that experienced by motorcyclists, pedestrians and car occupants. Whilst ranking risks provides an effective way of assessing their acceptability, it is recognized that representing risks by a single risk value can be misleading, as account must also be taken of the public's perception of the risks and the inherent differences in the types of risk being considered. However, an acceptable level of risk is often regarded as

  17. Applications of modelling historical catastrophic events with implications for catastrophe risk management

    Science.gov (United States)

    Sorby, A.; Grossi, P.; Pomonis, A.; Williams, C.; Nyst, M.; Onur, T.; Seneviratna, P.; Baca, A.

    2009-04-01

    The management of catastrophe risk is concerned with the quantification of financial losses, and their associated probabilities, for potential future catastrophes that might impact a region. Modelling of historical catastrophe events and, in particular, the potential consequences if a similar event were to occur at the present day can provide insight to help bridge the gap between what we know can happen from historical experience and what potential losses might be out there in the "universe" of potential catastrophes. The 1908 Messina Earthquake (and accompanying local tsunami) was one of the most destructive earthquakes to have occurred in Europe and by most accounts remains Europe's most fatal with over 70,000 casualties estimated. However, what would the potential consequences be, in terms of financial and human losses, if a similar earthquake were to occur at the present day? Exposures, building stock and populations can change over time and, therefore, the consequences of a similar earthquake at the present day may sensibly differ from those observed in 1908. The city of Messina has been reconstructed several times in its history, including following the 1908 earthquake and again following the Second World War. The 1908 earthquake prompted the introduction of the first seismic design regulations in Italy and since 1909 parts of the Messina and Calabria regions have been in the zones of highest seismic coefficient. Utilizing commercial catastrophe loss modelling technology - which combines the modelling of hazard, vulnerability, and financial losses on a database of property exposures - a modelled earthquake scenario of M7.2 in the Messina Straits region of Southern Italy is considered. This modelled earthquake is used to assess the potential consequences in terms of financial losses that an earthquake similar to the 1908 earthquake might have if it were to occur at the present day. Loss results are discussed in the context of applications for the financial

  18. An Analysis of Education Expenditures in the Welfare State in the Post 1980 Period in Turkey

    Directory of Open Access Journals (Sweden)

    Düriye Toprak

    2016-06-01

    Full Text Available  The welfare state that had become stronger gradually in the post-2nd World War has been in the process of restructuring after the 1980 period as a result of globalisation and neo-liberal policies. Social welfare state has had responsibilities in different fields ranging from health to education and from social security to poverty reduction. In Turkey, the education expenditures may be accepted as social expenditures contributing to general social welfare of the society. The goal of this study is to explain the social welfare state briefly, to review the methodological approaches to social expenditures in the context of the social welfare state, and to examine and compare the level of education expenditures in Turkey and some other countries. 

  19. Household energy consumption and expenditures, 1990

    International Nuclear Information System (INIS)

    This report, Household Energy Consumption and Expenditures 1990, is based upon data from the 1990 Residential Energy Consumption Survey (RECS). Focusing on energy end-use consumption and expenditures of households, the 1990 RECS is the eighth in a series conducted since 1978 by the Energy Information Administration (EIA). Over 5,000 households were surveyed, providing information on their housing units, housing characteristics, energy consumption and expenditures, stock of energy-consuming appliances, and energy-related behavior. The information provided represents the characteristics and energy consumption of 94 million households nationwide

  20. Avoiding Environmental Catastrophes: Varieties of Principled Precaution

    Directory of Open Access Journals (Sweden)

    Alan R. Johnson

    2012-09-01

    Full Text Available The precautionary principle is often proposed as a guide to action in environmental management or risk assessment, and has been incorporated in various legal and regulatory contexts. For many, it reflects the common sense notion of being safe rather than sorry, but it has attracted numerous critics. At times, proponents and critics talk at cross purposes, due to the multiplicity of ways the precautionary principle has been formulated. The approach taken here is to examine four general varieties of precaution, relating each to arguments made in various contexts by others. First, I examine the parallel between the precautionary principle and an argument referred to as Pascal's wager. Critics are right to dismiss versions of the precautionary principle that follow the logic of Pascal's wager, because that argument requires assumption of an infinite catastrophe, which is seldom the case in environmental decisions. Second, I explore precaution viewed as an instance of the phenomenon of ambiguity aversion as described by Daniel Ellsberg. Third, I evaluate precautionary perspectives on our duties to future generations, drawing inspiration from the views of Gifford Pinchot. Fourth, I consider the precautionary principle as an instance of Aldo Leopold's notion of intelligent tinkering. Although controversy persists, I find that a legitimate theoretical foundation exists to implement Ellsbergian, Pinchotian and Leopoldean varieties of precaution in environmental decision making. Additionally, I remark on the role of adaptive management and maintaining resilience in ecological and social systems as an approach to implementing the precautionary principle.

  1. Catastrophic Cracking Courtesy of Quiescent Cavitation

    CERN Document Server

    Daily, D Jesse; Thomson, Scott L; Truscott, Tadd T

    2012-01-01

    A popular party trick is to fill a glass bottle with water and hit the top of the bottle with an open hand, causing the bottom of the bottle to break open. We investigate the source of the catastrophic cracking through the use of high-speed video and an accelerometer attached to the bottom of a glass bottle. Upon closer inspection, it is obvious that the acceleration caused by hitting the top of the bottle is followed by the formation of bubbles near the bottom. The nearly instantaneous acceleration creates an area of low pressure on the bottom of the bottle where cavitation bubbles form. Moments later, the cavitation bubbles collapse at roughly 10 times the speed of formation, causing the bottle to break. The accelerometer data shows that the bottle is broken after the bubbles collapse and that the magnitude of the bubble collapse is greater than the initial impact. The fluid dynamics video highlights that this trick will not work if the bottle is empty nor if it is filled with a carbonated fluid because the...

  2. Public Expenditures, Budgetary Sustainability and the Assessment of Management of Public Expenditures in Kosovo

    OpenAIRE

    Behxhet Brajshori

    2009-01-01

    Public expenditures are public outlays which competent state organs realize for the purpose of fulfilling obligations of general public interest. They are manifested in different forms and in different social, economic and political areas. Public expenditures produce direct and indirect effects in production and influence consumption and prices. Economic structure and conjectural courses of one country have an impact on the highness of the public expenditures. Economic and social subsidies pr...

  3. Northeast Marine Recreational Fishing Expenditure Survey

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — A series of expenditure surveys have been done both regionally and nationally. This data pertains to the Northeast U.S. states that was collected in 1998....

  4. Marine angler expenditures 2006 (NCEI Accession 0145343)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Angler expenditures for their most recent trip in 2006, by fishing mode - for-hire, private boat, shore. Includes categories such as bait, ice, fuel, lodging,...

  5. Risk Measure and Premium Distribution on Catastrophe Reinsurance

    Institute of Scientific and Technical Information of China (English)

    XUN LI; WANG DE-HUI

    2012-01-01

    In this paper,we propose a new risk measure which is based on the Orlicz premium principle to characterize catastrophe risk premium.The intention is to develop a formulation strategy for Catastrophe Fund.The logarithm equivalent form of reinsurance premium is regarded as the retention of reinsurer,and the differential earnings between the reinsurance premium and the reinsurer's retention is accumulated as a part of Catastrophe Fund.We demonstrate that the aforementioned risk measure has some good properties,which are further confirmed by numerical simulations in R environment.

  6. State energy price and expenditure report 1993

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-12-01

    The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 states and the District of Columbia and in aggregate for the US. The five economic sectors used in SEPER correspond to those used in SEDR and are residential, commercial, industrial, transportation, and electric utility. Documentation in appendices describe how the price estimates are developed, provide conversion factors for measures used in the energy analysis, and include a glossary. 65 tabs.

  7. Corruption, Public Expenditure, and Human Capital Accumulation

    OpenAIRE

    Spyridon Boikos

    2013-01-01

    In this paper we investigate the effect of corruption on human capital accumulation through two channels. The first channel is through the effect of corruption on the public expenditure on education and the second channel is through the effect of corruption on the physical capital investment. Public expenditure on education affects positively human capital, while physical capital can obsolete human capital. Initially, we construct an endogenous two-sector growth model with human capital accum...

  8. Aid, public expenditure, and Dutch disease.

    OpenAIRE

    Christopher S. Adam; Bevan, David L.

    2003-01-01

    Contemporary policy debates on the macroeconomics of aid often concentrate on short-run Dutch disease effects, ignoring the possible supply side impact of aid— financed public expenditure. We develop a simple model of aid and public expenditure in which public infrastructure capital generates an inter-temporal productivity spillover for both tradable and non-tradable sectors, where these productivity effects may display sector-specific biases. The model also allows for non-homo...

  9. 11 CFR 9002.12 - Expenditure report period.

    Science.gov (United States)

    2010-01-01

    ... 11 Federal Elections 1 2010-01-01 2010-01-01 false Expenditure report period. 9002.12 Section 9002... ELECTION FINANCING DEFINITIONS § 9002.12 Expenditure report period. Expenditure report period means, with... section, as appropriate. (a) In the case of a major party, the expenditure report period begins...

  10. 26 CFR 1.528-6 - Expenditure test.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Expenditure test. 1.528-6 Section 1.528-6...) INCOME TAXES (CONTINUED) Homeowners Associations § 1.528-6 Expenditure test. (a) In general. An... or more of its expenditures for such taxable year are qualifying expenditures as defined...

  11. 10 CFR 603.560 - Estimate of project expenditures.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Estimate of project expenditures. 603.560 Section 603.560... Business Evaluation Fixed-Support Or Expenditure-Based Approach § 603.560 Estimate of project expenditures... have confidence in the estimate of the expenditures required to achieve well-defined...

  12. Universal Health Insurance in India: Ensuring equity, efficiency, and quality

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    2012-01-01

    Full Text Available Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI. Large proportion of informal sector labor in India′s workforce prevents major upscaling of social health insurance (SHI. Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS, with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete.

  13. Heterogeneity in the Effect of Common Shocks on Healthcare Expenditure Growth.

    Science.gov (United States)

    Hauck, Katharina; Zhang, Xiaohui

    2016-09-01

    Healthcare expenditure growth is affected by important unobserved common shocks such as technological innovation, changes in sociological factors, shifts in preferences, and the epidemiology of diseases. While common factors impact in principle all countries, their effect is likely to differ across countries. To allow for unobserved heterogeneity in the effects of common shocks, we estimate a panel data model of healthcare expenditure growth in 34 OECD countries over the years 1980 to 2012, where the usual fixed or random effects are replaced by a multifactor error structure. We address model uncertainty with Bayesian model averaging, to identify a small set of robust expenditure drivers from 43 potential candidates. We establish 16 significant drivers of healthcare expenditure growth, including growth in GDP per capita and in insurance premiums, changes in financing arrangements and some institutional characteristics, expenditures on pharmaceuticals, population ageing, costs of health administration, and inpatient care. Our approach allows us to provide robust evidence to policy makers on the drivers that were most strongly associated with the growth in healthcare expenditures over the past 32 years. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26940606

  14. Orphan Drug Expenditures In The United States: A Historical And Prospective Analysis, 2007-18.

    Science.gov (United States)

    Divino, Victoria; DeKoven, Mitch; Kleinrock, Michael; Wade, Rolin L; Kaura, Satyin

    2016-09-01

    The Orphan Drug Act of 1983 established incentives for the development of drugs that treat rare, or orphan, diseases. We used the IMS Health MIDAS database of audited biopharmaceutical sales to measure US annual spending on orphan drugs in the period 2007-13, and we estimated spending on the drugs for the period 2014-18. We identified 356 brand-name orphan drugs that were approved by the Food and Drug Administration in the period 1983-2013. While we included orphan drugs with both orphan and other indications, we adjusted spending to include only spending for orphan indications. In 2014 dollars, expenditures on orphan drugs totaled $15 billion in 2007 and $30 billion in 2013-representing 4.8 percent and 8.9 percent of total pharmaceutical expenditures, respectively. Our future trend analysis for the period 2014-18 suggests a slowing in the growth of orphan drug expenditures. The overall impact of orphan drugs on payers' drug budgets is relatively small, and spending on orphan drugs as a percentage of total pharmaceutical expenditures has remained fairly stable. Concerns that growth in orphan drug expenditures may lead to unsustainable drug expenditures do not appear to be justified. PMID:27605637

  15. Large-scale coastal impact induced by a catastrophic storm

    DEFF Research Database (Denmark)

    Fruergaard, Mikkel; Andersen, Thorbjørn Joest; Johannessen, Peter N;

    Catastrophic storms and storm surges induce rapid and substantial changes along sandy barrier coasts, potentially causing severe environmental and economic damage. Coastal impacts of modern storms are associated with washover deposition, dune erosion, barrier breaching, and coastline and shoreface...

  16. Pain frequency moderates the relationship between pain catastrophizing and pain

    Science.gov (United States)

    Kjøgx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene

    2014-01-01

    Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency. Results: In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed. Conclusions: This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations. PMID:25646089

  17. Pain frequency moderates the relationship between pain catastrophizing and pain

    Directory of Open Access Journals (Sweden)

    Heidi eKjøgx

    2014-12-01

    Full Text Available Background Pain frequency has been shown to influence sensitization, psychological distress and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method A non-clinical (247 students and a clinical (223 pain patients sample completed the Danish versions of the Pain Catastrophizing Scale, Beck Depression Inventory and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency Results In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed.Conclusions This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations.

  18. Catastrophic Events and Mass Extinctions: Impacts and Beyond

    Science.gov (United States)

    2000-01-01

    This volume contains extended abstracts that have been accepted for presentation at the conference on Catastrophic Events and Mass Extinctions: Impacts and Beyond, July 9-12, 2000, in Vienna, Austria.

  19. UKRAINIAN EVENTS AS HISTORICAL, INTERNATIONAL CATASTROPHE

    Directory of Open Access Journals (Sweden)

    V. V. Kasyanov

    2016-01-01

    Full Text Available In the scientific article fully examines current events in Ukraine in 2014-2015. The author believes that the causal and comparative historical analysis of the current Ukrainian crisis allows characterizing it as a major historical and ethnic catastrophe on a global scale after the collapse of the USSR in 1991. Obvious microand macroeffects inevitably impact on the history of relations between Ukrainian and Russian brotherly nations, lead (and has led to freeze their contacts, projects and links. It causes a feeling of well-founded anxiety for the fate of not only bilateral relations between Ukraine and Russia and the state of Post-Soviet space, but also for the development of all Slavic ethnic groups in the world. According to the author, it is necessary to review quickly realized Ukrainian direction of Russian state policy. It is necessary, as quickly as possible to get away from officiously promotional activities, technologies and techniques of information war and bring aid all the diversity of cultural cooperation. It is only a means of soft power, understood by us in the manner of the approach of its founder, American political scientist Joseph Nye, are able to restore the broken trust and interaction structures. Only the culture, and more specifically it such areas as language, traditions, generation feats, faith, can gradually normalize, and then to improve the bilateral relations, the each other perception, to restore a sense of respect, friendship and mutual assistance between Ukraine and Russia. It is obvious that bilateral cultural project able to change the existing negative situation.

  20. Characteristics of Fluid Milk Expenditure Patterns in the Northeast Region

    OpenAIRE

    Raunikar, Robert; Huang, Chung-Liang

    1984-01-01

    Expenditure patterns for whole milk and lowfat milk in the Northeast region were examined by applying the Tobit maximum likelihood procedure to the 1977-78 USDA NFCSdata. Results suggest that differing expenditure patterns exist between whole milk and lowfat milk. Household income estimates indicate significant positive effects on expenditure for lowfat milk but negative on expenditure for whole milk. Whole milk expenditure was estimated to be strongly related to the family life cycle stages ...

  1. Estimating PIGLOG Demands Using Representative versus Average Expenditure

    OpenAIRE

    Hahn, William F.; Taha, Fawzi A.; Davis, Christopher G.

    2013-01-01

    Economists often use aggregate time series data to estimate consumer demand functions. Some of the popular applied demand systems have a PIGLOG form. In the most general PIGLOG cases the “average” demand for a good is a function of the representative consumer expenditure not the average consumer expenditure. We would need detailed information on each period’s expenditure distribution to calculate the representative expenditure. This information is generally unavailable, so average expenditure...

  2. Time-series properties of state-level public expenditure.

    OpenAIRE

    Rajaraman, Indira; Mukhopadhyaya, Hiranya; Rao, Kavita R.

    2001-01-01

    Public expenditure reform must be underpinned by some understanding of the time-series properties of public expenditure. This paper examines the univariate properties of aggregate revenue expenditure at the level of State governments in India over the period 1974-98 for three states: Punjab, Haryana and Maharashtra. The empirical exercise is performed on the logarithmic transformation of aggregate revenue expenditure in terms of nominal (rather than ex post real) expenditure, not normalised t...

  3. WHEN IS EXPENDITURE "EXOGENOUS" IN SEPARABLE DEMAND MODELS?

    OpenAIRE

    LaFrance, Jeffrey T.

    1991-01-01

    The separability hypothesis and expenditure as an exogenous variable in a system of conditional demands are analyzed. Expenditure cannot be weakly exogenous in a system of conditional demands specified as functions of the prices of the separable goods and total expenditure on those goods. Furthermore, expenditure is uncorrelated with the residuals of the conditional demand equations only when severe restrictions are satisfied. Therefore, expenditure will seldom be strictly exogenous. Economet...

  4. Pain frequency moderates the relationship between pain catastrophizing and pain

    OpenAIRE

    Heidi eKjøgx; Robert eZachariae; Mogens ePfeiffer-Jensen; Helge eKasch; Peter eSvensson; Troels Staehelin Jensen; Lene eVase

    2014-01-01

    Background Pain frequency has been shown to influence sensitization, psychological distress and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale, Beck Depression Inventory and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency Results In...

  5. Psychological Resilience Predicts Decreases in Pain Catastrophizing Through Positive Emotions

    OpenAIRE

    Ong, Anthony D.; Zautra, Alex J.; Reid, M. Carrington

    2010-01-01

    The study used a daily process design to examine the role of psychological resilience and positive emotions in the day-to-day experience of pain catastrophizing. A sample of 95 men and women with chronic pain completed initial assessments of neuroticism, psychological resilience, and demographic data, and then completed short diaries regarding pain intensity, pain catastrophizing, and positive and negative emotions every day for 14 consecutive days. Multilevel modeling analyses indicated that...

  6. Mathematical modeling of human behaviors during catastrophic events

    OpenAIRE

    Verdière, Nathalie; Lanza, Valentina; Charrier, Rodolphe; Provitolo, Damienne; Dubos-Paillard, Edwige; Bertelle, Cyrille; Aziz-Alaoui, Moulay

    2014-01-01

    In this paper, we introduce a new approach for modeling the human collective behaviors in the speci c scenario of a sudden catastrophe, this catastrophe can be natural (i.e. earthquake, tsunami) or technological (nuclear event). The novelty of our work is to propose a mathematical model taking into account di erent concurrent behaviors in such situation and to include the processes of transition from one behavior to the other during the event. Here, we focus more on the sequence of behaviors ...

  7. Climate change policy in a growing economy under catastrophic risks

    OpenAIRE

    Tsur, Yacov; Zemel, Amos

    2007-01-01

    Under risk of catastrophic climate change, the occurrence hazard is added to the social discount rate. As a result, the social discount rate (i) increases and (ii) turns endogenous to the global warming policy. The second effect bears profound policy implications that are magnifed by economic growth. In particular, it implies that green- house gases (GHG) emission should gradually be brought to a halt. Due to the public bad nature of the catastrophic risk, the second effect is ignored in a co...

  8. Some Aspects of the Economics of Catastrophe Risk Insurance

    OpenAIRE

    Gollier, Christian

    2005-01-01

    The ability to share risk efficiently in the economy is essential to welfare and growth. However, the increased frequency of natural catastrophes over the last decade has raised once again questions associated to the limits of insurability in a free-market economy, and to the relevance of public interventions on risk-sharing markets. In this paper, we explore the potential reasons for the lack of insurance specifically associated to catastrophe environmental risks. Our final aim is to link ea...

  9. Pain Catastrophizing Correlates with Early Mild Traumatic Brain Injury Outcome.

    Science.gov (United States)

    Chaput, Geneviève; Lajoie, Susanne P; Naismith, Laura M; Lavigne, Gilles

    2016-01-01

    Background. Identifying which patients are most likely to be at risk of chronic pain and other postconcussion symptoms following mild traumatic brain injury (MTBI) is a difficult clinical challenge. Objectives. To examine the relationship between pain catastrophizing, defined as the exaggerated negative appraisal of a pain experience, and early MTBI outcome. Methods. This cross-sectional design included 58 patients diagnosed with a MTBI. In addition to medical chart review, postconcussion symptoms were assessed by self-report at 1 month (Time 1) and 8 weeks (Time 2) after MTBI. Pain severity, psychological distress, level of functionality, and pain catastrophizing were measured by self-report at Time 2. Results. The pain catastrophizing subscales of rumination, magnification, and helplessness were significantly correlated with pain severity (r = .31 to .44), number of postconcussion symptoms reported (r = .35 to .45), psychological distress (r = .57 to .67), and level of functionality (r = -.43 to -.29). Pain catastrophizing scores were significantly higher for patients deemed to be at high risk of postconcussion syndrome (6 or more symptoms reported at both Time 1 and Time 2). Conclusions. Higher levels of pain catastrophizing were related to adverse early MTBI outcomes. The early detection of pain catastrophizing may facilitate goal-oriented interventions to prevent or minimize the development of chronic pain and other postconcussion symptoms. PMID:27445604

  10. Pain Catastrophizing Correlates with Early Mild Traumatic Brain Injury Outcome

    Directory of Open Access Journals (Sweden)

    Geneviève Chaput

    2016-01-01

    Full Text Available Background. Identifying which patients are most likely to be at risk of chronic pain and other postconcussion symptoms following mild traumatic brain injury (MTBI is a difficult clinical challenge. Objectives. To examine the relationship between pain catastrophizing, defined as the exaggerated negative appraisal of a pain experience, and early MTBI outcome. Methods. This cross-sectional design included 58 patients diagnosed with a MTBI. In addition to medical chart review, postconcussion symptoms were assessed by self-report at 1 month (Time 1 and 8 weeks (Time 2 after MTBI. Pain severity, psychological distress, level of functionality, and pain catastrophizing were measured by self-report at Time 2. Results. The pain catastrophizing subscales of rumination, magnification, and helplessness were significantly correlated with pain severity (r=.31 to .44, number of postconcussion symptoms reported (r=.35 to .45, psychological distress (r=.57 to .67, and level of functionality (r=-.43 to -.29. Pain catastrophizing scores were significantly higher for patients deemed to be at high risk of postconcussion syndrome (6 or more symptoms reported at both Time 1 and Time 2. Conclusions. Higher levels of pain catastrophizing were related to adverse early MTBI outcomes. The early detection of pain catastrophizing may facilitate goal-oriented interventions to prevent or minimize the development of chronic pain and other postconcussion symptoms.

  11. Environment-related expenditures in 2013

    International Nuclear Information System (INIS)

    In 2013, households, private corporations and general government spent Euro 47.2 billion for environmental protection, an increase of 1.8% over 2012. For the 2000-2013 period on the whole, this expenditure has been rising faster than the gross domestic product (GDP): +4% on an annual average for the environmental protection expenditure compared with +2.8% for the GDP. In connection with the growing environmental concerns of society, public policy contributed to this steady increase through economic incentives ('bonus/malus' system, for instance) and regulation. In particular, the latter led to a technical improvement of processes (selective collection of waste, bringing up to standard of water treatment plants) which participated in the growth of expenditure. Wastewater and waste managements are the two main environmental protection expenditure domains. Furthermore, they are connected with topics related to resource management: drinking water supply and materials recovery. However, the expenditure for the materials recovery sector is decreasing in 2013, due to declines in raw materials prices. Expenditure for renewable energies - another topic related to environment - is considerably growing in 2013. Electricity production notably from water power is rising sharply, as a result of a particularly rainy spring. Nevertheless, the growth of environmental expenditures does not impact the corresponding employment in a systematic way. Thus, even if value added of the environmental goods and services sector (EGSS) increased by 1.8% in 2013, employment decreased by 0.3%. And the labor market in the green economy has been in decay since 2011, at a practically similar rate as for the economy as a whole

  12. 76 FR 56973 - Elections Regarding Start-Up Expenditures, Corporation Organizational Expenditures, and...

    Science.gov (United States)

    2011-09-15

    ... Wednesday, August 17, 2011 (76 FR 50887) relating to elections to deduct start-up expenditures... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 RIN 1545-BE77 Elections Regarding Start-Up Expenditures,...

  13. Demographic and Expenditure Profiles of Zambian Households: Evidence from the June 1991 Zambian Household Expenditure and Income Survey

    OpenAIRE

    Gary Stampley

    1993-01-01

    The HEIS's linkage of household-level demographic and expenditure data for Zambia provides the foundation for an analysis of household expenditure patterns. For this report, total household expenditure was composed of two broad expenditure classifications, food and nonfood. An analytical emphasis was placed on developing the food expenditure patterns of household groups identified by various socioeconomic characteristics. In general, within the various household classifications, there were th...

  14. The race between cooperation and catastrophe

    International Nuclear Information System (INIS)

    If a nuclear weapon were detonated in London, or in any of the world's major cities, it would change our world forever. Beyond the horror and the immediate death, and the lives that would be shortened by radioactive fallout, the casualties could also include civil liberties, privacy, world confidence and the global economy. With so much at stake, our citizens have every reason to ask: 'Are we doing all we can to prevent a nuclear attack?' My emphatic answer is 'No, we are not.' We have, however, taken some important steps, including: - The Nunn-Lugar Cooperative Threat Reduction programme, working since 1991 to secure and destroy weapons and material in the former Soviet Union. This programme helped Kazakhstan, Ukraine and Belarus get rid of all their nuclear weapons, a historic achievement. - The G8 commitment launched three years ago to create and fund the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction. - The recently launched US-Russian Global Threat Reduction Initiative to remove and secure high enriched uranium from research facilities around the globe. - The IAEA Nuclear Security Fund, launched to help Member States strengthen the security of nuclear material worldwide. - The commitment by Libya to give up its nuclear weapons programme following skilful diplomacy led by the United Kingdom and the United States of America, with important oversight by the IAEA. - The recent Bush-Putin summit, in which the President of the Russian Federation and the President of the USA each made a personal commitment to enhance and accelerate efforts to secure nuclear weapons and nuclear material worldwide. These are all indispensable steps for global security, but we have miles to go before we sleep. We must remove roadblocks, we must provide more resources, we must convert pledges to programmes and words to deeds. We must develop a global partnership against catastrophic terrorism that is effective, focused and truly global. This includes

  15. Angular Momentum Transfer in Catastrophic Asteroid Impacts

    Science.gov (United States)

    Love, S. G.; Ahrens, T. J.

    1996-09-01

    Incomplete knowledge of angular momentum transfer in asteroid impacts has hampered efforts to deduce asteroid collisional histories from their rotation rates. This problem traditionally has been investigated using impact experiments on cm-scale, strength-dominated targets. Recent evidence, however, indicates that impacts on asteroids of km size and larger may be controlled by gravity rather than strength, and that the analogy to laboratory impacts may not hold. Accordingly, we have modelled catastrophic impacts on gravitating asteroids to better understand angular momentum transfer in such events. We employ a 3--D, strengthless, gravitating SPH computer code. Target bodies are 10 to 1000 km in diameter and do not initially rotate. Impact speeds are 3--7 km/s; impact angles are 15--75(deg) . Each target is composed of 1791 mass elements: spatial resolution is coarse but acceptable for large scale energy transfer. We simulate the hydrodynamic phase of each impact, after which particle motions are ballistic and treated analytically. Escaping particles have kinetic energy greater than the gravitational energy binding them to the rest of the system; the others reaccrete to form a ``rubble pile'' which is assumed spherical. The rubble pile's size, mass, and angular momentum define its rotation rate. Spin rates for ejected fragments cannot be determined. The target's final spin period depends on the impact angle and the fraction of target mass ejected, but not on impact speed or target size in the ranges tested. The lack of size dependence cannot explain the observed excess of slowly rotating asteroids of ~ 100 km diameter. The fraction of projectile angular momentum retained by the target varies dramatically with impact speed and angle and with target size and fraction of mass removed, complicating its use in models where collision geometry varies. The final spin period of an asteroid losing 50% of its mass is 6--10 hours, comparable to the asteroidal mean of 8 hours

  16. From Catastrophizing to Recovery: a pilot study of a single-session treatment for pain catastrophizing

    Directory of Open Access Journals (Sweden)

    Darnall BD

    2014-04-01

    Full Text Available Beth D Darnall, John A Sturgeon, Ming-Chih Kao, Jennifer M Hah, Sean C MackeyDivision of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, CA, USABackground: Pain catastrophizing (PC – a pattern of negative cognitive-emotional responses to real or anticipated pain – maintains chronic pain and undermines medical treatments. Standard PC treatment involves multiple sessions of cognitive behavioral therapy. To provide efficient treatment, we developed a single-session, 2-hour class that solely treats PC entitled “From Catastrophizing to Recovery”[FCR].Objectives: To determine 1 feasibility of FCR; 2 participant ratings for acceptability, understandability, satisfaction, and likelihood to use the information learned; and 3 preliminary efficacy of FCR for reducing PC.Design and methods: Uncontrolled prospective pilot trial with a retrospective chart and database review component. Seventy-six patients receiving care at an outpatient pain clinic (the Stanford Pain Management Center attended the class as free treatment and 70 attendees completed and returned an anonymous survey immediately post-class. The Pain Catastrophizing Scale (PCS was administered at class check-in (baseline and at 2, and 4 weeks post-treatment. Within subjects repeated measures analysis of variance (ANOVA with Student's t-test contrasts were used to compare scores across time points.Results: All attendees who completed a baseline PCS were included as study participants (N=57; F=82%; mean age =50.2 years; PCS was completed by 46 participants at week 2 and 35 participants at week 4. Participants had significantly reduced PC at both time points (P<0001 and large effect sizes were found (Cohen's d=0.85 and d=1.15.Conclusion: Preliminary data suggest that FCR is an acceptable and effective treatment for PC. Larger, controlled studies of longer duration are needed to determine durability of response, factors

  17. The Impact of a Telephone-Based Chronic Disease Management Program on Medical Expenditures.

    Science.gov (United States)

    Avery, George; Cook, David; Talens, Sheila

    2016-06-01

    The impact of a payer-provided telephone-based chronic disease management program on medical expenditures was evaluated using claims data from 126,245 members in employer self-ensured health plans (16,224 with a chronic disease in a group enrolled in the self-management program, 13,509 with a chronic disease in a group not participating in the program). A random effects regression model controlling for retrospective risk, age, sex, and diagnosis with a chronic disease was used to determine the impact of program participation on market-adjusted health care expenditures. Further confirmation of results was obtained by an ordinary least squares model comparing market- and risk-adjusted costs to the length of participation in the program. Participation in the program is associated with an average annual savings of $1157.91 per enrolled member in health care expenditures. Savings increase with the length of participation in the program. The results support the use of telephone-based patient self-management of chronic disease as a cost-effective means to reduce health care expenditures in the working-age population. (Population Health Management 2016;19:156-162).

  18. Determining the intensity and energy expenditure during commuter cycling

    Science.gov (United States)

    de Geus, B; De Smet, S; Nijs, J; Meeusen, R

    2007-01-01

    Objectives To determine the intensity and energy expenditure during commuter cycling, and to investigate whether cycling to work at a self‐chosen intensity corresponds to recommendations of the Centers for Disease Control and Prevention (CDC) and American College of Sports Medicine (ACSM) for health improvement and ACSM recommendations for fitness improvement. Methods 18 healthy, untrained middle‐aged people, who did not cycle to work, underwent two maximal exercise tests (MT and MT2) in order to measure their maximal heart rate and oxygen consumption (VO2). MT2 was performed 24 weeks after MT. Participants were asked to cycle at least three times a week to their workplace over a one‐way minimum distance of 2 km. Data on cycling were recorded in a diary. 12 weeks after MT, a field test was conducted, where participants had to cycle to or from their workplace. The same measurements were taken as during MT as markers of exercise intensity. Metabolic equivalents (METs) and energy expenditure were calculated. Results The intensity during the field test was >75% of their maximal aerobic capacity. The mean (SD) MET value was 6.8 (1.9). The energy expenditure during the field test was 220 (115) kcal or 540 (139) kcal/h and 1539 (892) kcal/week. Men consumed significantly (p<0.01) more energy per hour than women. Conclusion Commuter cycling at a self‐selected intensity meets the CDC and ACSM recommendations for health improvement and the ACSM recommendations for improvement of cardiorespiratory fitness. However, as the participants cycled faster during the field test than during daily cycling, the results should be interpreted with caution. PMID:17021003

  19. Household energy consumption and expenditures 1993

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-10-05

    This presents information about household end-use consumption of energy and expenditures for that energy. These data were collected in the 1993 Residential Energy Consumption Survey; more than 7,000 households were surveyed for information on their housing units, energy consumption and expenditures, stock of energy-consuming appliances, and energy-related behavior. The information represents all households nationwide (97 million). Key findings: National residential energy consumption was 10.0 quadrillion Btu in 1993, a 9% increase over 1990. Weather has a significant effect on energy consumption. Consumption of electricity for appliances is increasing. Houses that use electricity for space heating have lower overall energy expenditures than households that heat with other fuels. RECS collected data for the 4 most populous states: CA, FL, NY, TX.

  20. The expenditures related to the use of antifungal drugs in patients with hematological cancers: a cost analysis

    OpenAIRE

    Gedik H

    2015-01-01

    Habip Gedik Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Okmeydani Training and Research Hospital, Istanbul, Turkey Objective: The aim of this study is to analyze the expenditures related to the use of antifungal drugs in patients with hematological malignancies. Methods: In this retrospective study, the expenditures related to use of antifungal drugs for treatment of invasive fungal infections in patients with hematological malignancies between November 20...

  1. MARKETING EXPENDITURES IN THE INDONESIAN CONSTRUCTION INDUSTRY

    OpenAIRE

    Krishna Mochtar

    2004-01-01

    In the 1960s, a ânewâ marketing concept known as "four Ps marketing mix" appeared and shifted the focus from the product to the customer. The objective of the new concept was not only profit, and the means of achieving the objective expanded to include the entire âmarketing mixâ: product, price, promotion, and place (channels and distribution). Expenditures of marketing in a company should be explored from these mixes, because each mix would have an impact on the total marketing expenditures....

  2. Adam Smith on public expenditure and taxation

    Directory of Open Access Journals (Sweden)

    Maurício C. Coutinho

    2001-01-01

    Full Text Available This paper presents Adam Smith’s view on taxation and public expenditure, by means of an almost literal reading of the Wealth of Nations famous passages on the "duties of the sovereign" and on the "maxims of taxation". Contrarily to the commonest usage of these passages, we will show that their core is the preoccupation with the public expenditure soaring and the defence of decentralisation. Furthermore and also contrarily to the existing interpretations we defend the non-existence of any contradiction between Smith’s income and price theory (and the incidence hypothesis, provided due attention is paid to the guiding role of the "maxims".

  3. Energy expenditure on recreational visits to different natural environments.

    Science.gov (United States)

    Elliott, Lewis R; White, Mathew P; Taylor, Adrian H; Herbert, Stephen

    2015-08-01

    Physical inactivity poses a significant challenge to physical and mental health. Environmental approaches to tackle physical inactivity have identified natural environments as potentially important public health resources. Despite this, little is known about characteristics of the activity involved when individuals visit different types of natural environment. Using Natural England's Monitor of Engagement with the Natural Environment Survey, we examined 71,603 English respondents' recreational visits to natural environments in the past week. Specifically, we examined the intensity of the activities they undertook on the visits (METs), the duration of their visit, and the associated total energy expenditure (MET minutes). Visits to countryside and urban greenspace environments were associated with more intense activities than visits to coastal environments. However, visits to coastal environments were associated with the most energy expenditure overall due to their relatively long duration. Results differed by the urbanity or rurality of the respondent's residence and also how far respondents travelled to their destination. Knowledge of what types of natural environment afford the highest volumes and intensities of physical activity could inform landscape architecture and exercise prescriptions. Isolating activity-supporting characteristics of natural environments that can be translated into urban design is important in providing physical activity opportunities for those less able to access expansive environments. PMID:26151390

  4. Energy expenditure on recreational visits to different natural environments.

    Science.gov (United States)

    Elliott, Lewis R; White, Mathew P; Taylor, Adrian H; Herbert, Stephen

    2015-08-01

    Physical inactivity poses a significant challenge to physical and mental health. Environmental approaches to tackle physical inactivity have identified natural environments as potentially important public health resources. Despite this, little is known about characteristics of the activity involved when individuals visit different types of natural environment. Using Natural England's Monitor of Engagement with the Natural Environment Survey, we examined 71,603 English respondents' recreational visits to natural environments in the past week. Specifically, we examined the intensity of the activities they undertook on the visits (METs), the duration of their visit, and the associated total energy expenditure (MET minutes). Visits to countryside and urban greenspace environments were associated with more intense activities than visits to coastal environments. However, visits to coastal environments were associated with the most energy expenditure overall due to their relatively long duration. Results differed by the urbanity or rurality of the respondent's residence and also how far respondents travelled to their destination. Knowledge of what types of natural environment afford the highest volumes and intensities of physical activity could inform landscape architecture and exercise prescriptions. Isolating activity-supporting characteristics of natural environments that can be translated into urban design is important in providing physical activity opportunities for those less able to access expansive environments.

  5. [Healthcare expenditures growth: the red herring of demographic ageing?].

    Science.gov (United States)

    Tenand, Marianne

    2016-02-01

    Demographic ageing is often deemed responsible for the massive increase in health expenditures experienced by developed countries. As the elderly consume more medical care than the rest of the population, how could the increase in the share of the 60 + not lead to a marked expansion of healthcare public and private budgets? Despite its apparent logics, such reasoning is fallacious: it ignores that medical care consumption depends on many factors beyond age, which have tremendously evolved in the last decades and may change again in the future. Based on French stylized facts, this article provides an overview of the international literature that aimed at disentangling the respective roles of population ageing and of the non-demographic factors in explaining the dynamics of health expenditures. Paradoxically, technical medical progress has been a major contributor to the increase of healthcare spending. Results from economics research lead to qualify the impact of demographic trends and call for more attention to the public policies decisions that shape healthcare systems. PMID:26936179

  6. Catastrophic destabilization of tunnel under rocks slipping in faultage

    Institute of Scientific and Technical Information of China (English)

    LIU Hai-qing; WANG Xue-qing; YUAN Jing

    2008-01-01

    The model of catastrophic destabilization of tunnel under rock slipping in fault zone based on catastrophic theory and the potential function of fault movement were presented. On the basis of the results above, through Taylor series expansion of the equation of equilibrium surface, its standard form was obtained. Analysis show that catastrophic destabilization of tunnel will occur only when stiffness ratio between elastic sector and strain weakening sector of soft rocks was larger than or equal to 1. On the other hand,sliding behavior and evolution path of fault were directly affected by exogenous process,and it was a major extraneous factor which leads to catastrophic destabilization of tunnel.In the condition of system catastrophe could be generated, if external forces vary from smaller to larger, firstly, fault sticks or creeps, and secondly, when external force equal to or larger than critical value, fault turns to slip suddenly. Inverse, if external forces vary from larger to smaller, fault smoothly slips firstly, when external force equal to or smaller than critical value, and fault turns to stick or creep suddenly.

  7. THE EFFECT OF GOVERNMENT EXPENDITURE ON INFRASTRUCTURE ON THE GROWTH OF THE NIGERIAN ECONOMY, 1977-2009

    Directory of Open Access Journals (Sweden)

    Mary Modupe Fasoranti

    2012-01-01

    Full Text Available The paper examined the effects of government expenditures on infrastructure on the growth of the Nigerian economy. The data sourced majorly from the various issues of Central Bank statistical bulletin was analyzed with the aid of econometric methods. Data collected included government expenditures on education, environment and housing, health services, transport and communication, agriculture, security, inflation rate and gross domestic product. Data treatment methods used was the unit root test, co-integration and vector error correction estimation. Simple multiple regression model was used to obtain the results used for the analysis. Results showed a long run relationship between the growth of the economy and government expenditures in education, environment and housing, health services, water resources, inflation rate, agriculture, security, transport and communication. The paper observed that government expenditures on health services, transport and communication imparted negatively on growth while expenditures in agriculture and security were not significant in the growth of the economy. To increase the growth rate of the economy, the government must adopt stringent controls on its expenditures on infrastructure so as to reduce fraud, fund diversion and mismanagement. Moreover, monitoring and evaluation of government spending must be given top priority. This will help to ensure that the targets of government spending are reached.

  8. Chromosome catastrophes involve replication mechanisms generating complex genomic rearrangements.

    Science.gov (United States)

    Liu, Pengfei; Erez, Ayelet; Nagamani, Sandesh C Sreenath; Dhar, Shweta U; Kołodziejska, Katarzyna E; Dharmadhikari, Avinash V; Cooper, M Lance; Wiszniewska, Joanna; Zhang, Feng; Withers, Marjorie A; Bacino, Carlos A; Campos-Acevedo, Luis Daniel; Delgado, Mauricio R; Freedenberg, Debra; Garnica, Adolfo; Grebe, Theresa A; Hernández-Almaguer, Dolores; Immken, LaDonna; Lalani, Seema R; McLean, Scott D; Northrup, Hope; Scaglia, Fernando; Strathearn, Lane; Trapane, Pamela; Kang, Sung-Hae L; Patel, Ankita; Cheung, Sau Wai; Hastings, P J; Stankiewicz, Paweł; Lupski, James R; Bi, Weimin

    2011-09-16

    Complex genomic rearrangements (CGRs) consisting of two or more breakpoint junctions have been observed in genomic disorders. Recently, a chromosome catastrophe phenomenon termed chromothripsis, in which numerous genomic rearrangements are apparently acquired in one single catastrophic event, was described in multiple cancers. Here, we show that constitutionally acquired CGRs share similarities with cancer chromothripsis. In the 17 CGR cases investigated, we observed localization and multiple copy number changes including deletions, duplications, and/or triplications, as well as extensive translocations and inversions. Genomic rearrangements involved varied in size and complexities; in one case, array comparative genomic hybridization revealed 18 copy number changes. Breakpoint sequencing identified characteristic features, including small templated insertions at breakpoints and microhomology at breakpoint junctions, which have been attributed to replicative processes. The resemblance between CGR and chromothripsis suggests similar mechanistic underpinnings. Such chromosome catastrophic events appear to reflect basic DNA metabolism operative throughout an organism's life cycle.

  9. Catastrophic ice lake collapse in Aram Chaos, Mars

    CERN Document Server

    Roda, Manuel; Zegers, Tanja E; Oosthoek, Jelmer H P

    2014-01-01

    Hesperian chaotic terrains have been recognized as the source of outflow channels formed by catastrophic outflows. Four main scenarios have been proposed for the formation of chaotic terrains that involve different amounts of water and single or multiple outflow events. Here, we test these scenarios with morphological and structural analyses of imagery and elevation data for Aram Chaos in conjunction with numerical modeling of the morphological evolution of the catastrophic carving of the outflow valley. The morphological and geological analyses of Aram Chaos suggest large-scale collapse and subsidence (1500 m) of the entire area, which is consistent with a massive expulsion of liquid water from the subsurface in one single event. The combined observations suggest a complex process starting with the outflow of water from two small channels, followed by continuous groundwater sapping and headward erosion and ending with a catastrophic lake rim collapse and carving of the Aram Valley, which is synchronous with ...

  10. Vitality of Neural Networks under Reoccurring Catastrophic Failures.

    Science.gov (United States)

    Sardi, Shira; Goldental, Amir; Amir, Hamutal; Vardi, Roni; Kanter, Ido

    2016-01-01

    Catastrophic failures are complete and sudden collapses in the activity of large networks such as economics, electrical power grids and computer networks, which typically require a manual recovery process. Here we experimentally show that excitatory neural networks are governed by a non-Poissonian reoccurrence of catastrophic failures, where their repetition time follows a multimodal distribution characterized by a few tenths of a second and tens of seconds timescales. The mechanism underlying the termination and reappearance of network activity is quantitatively shown here to be associated with nodal time-dependent features, neuronal plasticity, where hyperactive nodes damage the response capability of their neighbors. It presents a complementary mechanism for the emergence of Poissonian catastrophic failures from damage conductivity. The effect that hyperactive nodes degenerate their neighbors represents a type of local competition which is a common feature in the dynamics of real-world complex networks, whereas their spontaneous recoveries represent a vitality which enhances reliable functionality. PMID:27530974

  11. Catastrophic disasters and the design of disaster medical care systems.

    Science.gov (United States)

    Mahoney, L E; Reutershan, T P

    1987-09-01

    The National Disaster Medical System (NDMS) is aimed at medical care needs resulting from catastrophic earthquakes, which may cause thousands of deaths and injuries. Other geophysical events may cause great mortality, but leave few injured survivors. Weather incidents, technological disasters, and common mass casualty incidents cause much less mortality and morbidity. Catastrophic disasters overwhelm the local medical care system. Supplemental care is provided by disaster relief forces; this care should be adapted to prevalent types of injuries. Most care should be provided at the disaster scene through supplemental medical facilities, while some can be provided by evacuating patients to distant hospitals. Medical response teams capable of stabilizing, sorting, and holding victims should staff supplemental medical facilities. The NDMS program includes hospital facilities, evacuation assets, and medical response teams. The structure and capabilities of these elements are determined by the medical care needs of the catastrophic disaster situation. PMID:3631673

  12. Vitality of Neural Networks under Reoccurring Catastrophic Failures

    Science.gov (United States)

    Sardi, Shira; Goldental, Amir; Amir, Hamutal; Vardi, Roni; Kanter, Ido

    2016-08-01

    Catastrophic failures are complete and sudden collapses in the activity of large networks such as economics, electrical power grids and computer networks, which typically require a manual recovery process. Here we experimentally show that excitatory neural networks are governed by a non-Poissonian reoccurrence of catastrophic failures, where their repetition time follows a multimodal distribution characterized by a few tenths of a second and tens of seconds timescales. The mechanism underlying the termination and reappearance of network activity is quantitatively shown here to be associated with nodal time-dependent features, neuronal plasticity, where hyperactive nodes damage the response capability of their neighbors. It presents a complementary mechanism for the emergence of Poissonian catastrophic failures from damage conductivity. The effect that hyperactive nodes degenerate their neighbors represents a type of local competition which is a common feature in the dynamics of real-world complex networks, whereas their spontaneous recoveries represent a vitality which enhances reliable functionality.

  13. Vitality of Neural Networks under Reoccurring Catastrophic Failures.

    Science.gov (United States)

    Sardi, Shira; Goldental, Amir; Amir, Hamutal; Vardi, Roni; Kanter, Ido

    2016-08-17

    Catastrophic failures are complete and sudden collapses in the activity of large networks such as economics, electrical power grids and computer networks, which typically require a manual recovery process. Here we experimentally show that excitatory neural networks are governed by a non-Poissonian reoccurrence of catastrophic failures, where their repetition time follows a multimodal distribution characterized by a few tenths of a second and tens of seconds timescales. The mechanism underlying the termination and reappearance of network activity is quantitatively shown here to be associated with nodal time-dependent features, neuronal plasticity, where hyperactive nodes damage the response capability of their neighbors. It presents a complementary mechanism for the emergence of Poissonian catastrophic failures from damage conductivity. The effect that hyperactive nodes degenerate their neighbors represents a type of local competition which is a common feature in the dynamics of real-world complex networks, whereas their spontaneous recoveries represent a vitality which enhances reliable functionality.

  14. Gravothermal Catastrophe: the dynamical stability of a fluid model

    CERN Document Server

    Sormani, M C

    2013-01-01

    A re-investigation of the gravothermal catastrophe is presented. By means of a linear perturbation analysis, we study the dynamical stability of a spherical self-gravitating isothermal fluid of finite volume and find that the conditions for the onset of the gravothermal catastrophe, under different external conditions, coincide with those obtained from thermodynamical arguments. This suggests that the gravothermal catastrophe may reduce to Jeans instability, rediscovered in an inhomogeneous framework. We find normal modes and frequencies for the fluid system and show that instability develops on the dynamical time scale. We then discuss several related issues. In particular: (1) For perturbations at constant total energy and constant volume, we introduce a simple heuristic term in the energy budget to mimic the role of binaries. (2) We outline the analysis of the two-component case and show how linear perturbation analysis can be carried out also in this more complex context in a relatively straightforward wa...

  15. Strategic reasoning and bargaining in catastrophic climate change games

    Science.gov (United States)

    Verendel, Vilhelm; Johansson, Daniel J. A.; Lindgren, Kristian

    2016-03-01

    Two decades of international negotiations show that agreeing on emission levels for climate change mitigation is a hard challenge. However, if early warning signals were to show an upcoming tipping point with catastrophic damage, theory and experiments suggest this could simplify collective action to reduce greenhouse gas emissions. At the actual threshold, no country would have a free-ride incentive to increase emissions over the tipping point, but it remains for countries to negotiate their emission levels to reach these agreements. We model agents bargaining for emission levels using strategic reasoning to predict emission bids by others and ask how this affects the possibility of reaching agreements that avoid catastrophic damage. It is known that policy elites often use a higher degree of strategic reasoning, and in our model this increases the risk for climate catastrophe. Moreover, some forms of higher strategic reasoning make agreements to reduce greenhouse gases unstable. We use empirically informed levels of strategic reasoning when simulating the model.

  16. Dynamical systems V bifurcation theory and catastrophe theory

    CERN Document Server

    1994-01-01

    Bifurcation theory and catastrophe theory are two of the best known areas within the field of dynamical systems. Both are studies of smooth systems, focusing on properties that seem to be manifestly non-smooth. Bifurcation theory is concerned with the sudden changes that occur in a system when one or more parameters are varied. Examples of such are familiar to students of differential equations, from phase portraits. Moreover, understanding the bifurcations of the differential equations that describe real physical systems provides important information about the behavior of the systems. Catastrophe theory became quite famous during the 1970's, mostly because of the sensation caused by the usually less than rigorous applications of its principal ideas to "hot topics", such as the characterization of personalities and the difference between a "genius" and a "maniac". Catastrophe theory is accurately described as singularity theory and its (genuine) applications. The authors of this book, the first printing of w...

  17. Nigeria - Lagos Rolling First Public Expenditure Review

    OpenAIRE

    World Bank

    2010-01-01

    This review provides an analysis of the fiscal performance and sustainability of the State of Lagos, performance of the budgeting system and of the public procurement system. It is the first in a planned rolling Public Expenditure Reviews (PERs) for Lagos state. The analysis finds that the state's fiscal policy is broadly sound and that its fiscal program is sustainable in the medium term,...

  18. The Effect of Recessions on Gambling Expenditures

    NARCIS (Netherlands)

    C. Horváth (Csilla); R. Paap (Richard)

    2012-01-01

    textabstractThis article examines the influence of the business cycle on expenditures of three major types of legalized gambling activities: Casino gambling, lottery, and pari-mutuel wagering. Empirical results are obtained using monthly aggregated US per capita consumption time series for the perio

  19. Lithuania - Social sectors public expenditure review

    OpenAIRE

    World Bank, (WB)

    2009-01-01

    This report aims to provide technical assistance to the Government of Lithuania in preparation for the June 2009 budget amendment and beyond. This Public Expenditure Review (PER) includes a number of recommendations on short run fiscal consolidation (mainly through spending cuts) as well as efficiency-enhancing reforms that could eventually generate fiscal savings and reduce the fiscal def...

  20. Modeling Imports in a Keynesian Expenditure Model

    Science.gov (United States)

    Findlay, David W.

    2010-01-01

    The author discusses several issues that instructors of introductory macroeconomics courses should consider when introducing imports in the Keynesian expenditure model. The analysis suggests that the specification of the import function should partially, if not completely, be the result of a simple discussion about the spending and import…